bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice of agent for peripheral thrombolysis
Authors: Earnshaw J J , Scott D J A , Horrocks M , Baird R N 
Published: March 2007

Abstract
Evidence has been accumulating that tissue plasminogen activator (tPA) is a more rapid and effective agent than streptokinase for peripheral thrombolysis. Twenty-three patients with acute limb-threatening ischaemia treated with tPA (0.5 mg h−1) over 15 months were compared with 20 consecutive patients previously receiving streptokinase (5000–10000 units h−1). There were no major differences between the rates of complete and partial lysis (61 per cent for tPA versus 65 per cent for streptokinase) or limb salvage (65 versus 55 per cent respectively). Complication rates were also similar. It was not possible to show that tPA, an agent ten times more expensive than streptokinase, was superior for peripheral thrombolysis.
Myocardial infarction after reconstruction of the abdominal aorta
Authors: Kalra M , Charlesworth D , Morris J A , Al-Khaffaf H 
Published: March 2007

Abstract
The records of 555 patients who underwent elective abdominal aortic reconstruction were analysed to identify risk factors predisposing to cardiac complications. Perioperative myocardial infarction occurred in 35 patients (6·3 per cent), of whom 12 (2·2 per cent) died. Using multiple logistic regression, four preoperative factors that were independently predictive for postoperative myocardial infarction were identified with the following relative risk ratios: history of transient ischaemic attacks, 5·08; raised serum creatinine level, 3·66; age &gt;60 years, 3·00; and angina requiring regular treatment, 2·74. A scoring system using these four factors was devised that identified 150 of the 555 patients as at high risk, and included 69 per cent of those with myocardial infarction after operation and 83 per cent of those who died. A clinical risk score is a practical first step in identifying patients at risk of myocardial infarction; it would also reduce the number of patients for whom sophisticated tests of cardiac function were necessary.
Ankle fracture is associated with prolonged venous dysfunction
Authors: Tierney S , Burke P , Fitzgerald P , O'sullivan T , Grace P , Bouchier-Hayes D 
Published: March 2007

Abstract
Leg swelling is a significant problem following ankle fracture. Venous pump function and femoral and popliteal venous patency were assessed prospectively in 26 patients with ankle fractures requiring open reduction, internal fixation and immobilization in plaster. Functional venous volume, venous filling index (VFI), ejection volume fraction (EVF) and residual volume fraction (RVF) were measured using air plethysmography at 5 days and at 6, 12 and 18 weeks after fracture. The uninjured leg was used as a control. Popliteal and femoral venous patency was determined using duplex ultrasonography. No patient developed deep vein thrombosis during the study. At 5 days after fracture there was a significant reduction in mean(s.d) EVF, 18·2(12·1) versus 55·9(19·5) percent, and increase in RVF, 87·0(14·3) versus 42·5(22·2) per cent (both P &lt; 0·001). Analogous values were similar at 6 weeks, EVF 28·5(21·2) versus 55·6(21·9) per cent, RVF 82·2(16·8) versus 48·5(23·8) per cent (both P &lt; 0·001), and at 12 weeks, EVF 39·1(16·0) versus 60·3(14·9) per cent, RVF 64·7(18·8) versus 38·8(13·2), per cent (both P &lt; 0·001). However, by 18 weeks there was no significant difference in venous function between fractured and control limbs. It is concluded that there is a significant and prolonged impairment in venous pump function following ankle fracture.
Parathyroidectomy in the treatment of patients with chronic renal failure: A 10-year review
Authors: Bessell J R , Proudman W D , Parkyn R F , Disney A P S 
Published: March 2007

Abstract
The technique and outcome of surgery for the manifestations of secondary hyperparathyroidism are described. Forty-seven patients were analysed retrospectively over a 10-year period. Total parathyroidectomy and autotransplantation to the forearm was performed in all but five patients. Improvement occurred in 87 per cent of patients and there were no graft failures. Of six deaths, none was related to surgery. Four patients had recurrent hyperparathyroidism, three being graft dependent and one requiring re-exploration of the neck. Total parathyroidectomy and autotransplantation is a safe and effective approach. The major management problem was graft hyperplasia, seen in three of the 47 patients and managed by simple excision.
Cholecystectomy and oesophageal reflux: A prospective evaluation
Authors: Jazrawi S , Walsh T N , Byrne P J , Hill A D , Li H , Lawlor P , Hennessy T P J 
Published: March 2007

Abstract
The effect of cholecystectomy on oesophageal function was examined prospectively. Of 37 patients studied, 17 (46 per cent) were still symptomatic 3–4 months after surgery. Thirteen patients (35 per cent) had abnormal oesophageal pH profiles before cholecystectomy, increasing to 27(73 per cent) afterwards(P &lt; 0·002). The mean(s.e.m.) DeMeester acid reflux score increased from 15·2(2·1) to 34·2(5·2) (P &lt; 0·001) after operation. Lower oesophageal sphincter function, as measured by the sphincter function index, was significantly reduced in the patients with abnormal pH profiles after operation (P &lt; 0·01). Mean(s.e.m.) supine gastric alkaline shift (proportion of time at pH &gt; 4) increased from 9·2(2·0) to 17·7(3·7) per cent (P &lt; 0·02) and the incidence of gastritis from eight patients (22 per cent) to 23 (62 per cent) (P &lt; 0·001). These data suggest that cholecystectomy results in gastro-oesophageal reflux that appears to be related to compromised sphincter competence.
Gastric remnant cancer as a metachronous multiple lesion
Authors: Furukawa H , Iwanaga T , Hiratsuka M , Imaoka S , Ishikawa Kabuto O T , Sasaki V , Kameyama M 
Published: March 2007

Abstract
The pathological characteristics and natural history of 35 gastric remnant cancers after partial gastrectomy for a malignant condition and 16 gastric cancers after gastrectomy for benign conditions were compared. Gastric remnant cancer following malignant disease was characterized by a well defined rather than diffuse appearance (in 43 versus 12 per cent of gastric remnant cancers after benign conditions, P &lt; 0·05), location away from the anastomosis (83 versus 25 per cent, P &lt; 0·05) and a shorter interval after the first operation (5–14 versus ≧ 20 years, P &lt; 0·01). The 15- and 16-year survival rates appeared to be worse for gastric remnant cancer after malignant than after benign disease, but there was no statistically significant difference between the two groups in a generalized Wilcoxon test. In the former, direct invasion to adjacent organs was frequently observed. These findings suggest that gastric remnant cancer after gastrectomy for malignancy may be a metachronous multiple lesion, while that following benign disease may occur as a new cancer caused by the partial gastrectomy. To improve the survival of patients with cancer after gastrectomy for malignancy, a rational extended operation may be useful.
Nucleolar organizing regions in the opeerated rat stomach: Relationship to metaplasia, dysplasia and carcinoma
Authors: Seven R , Mercan S , Özarmaǧan S , Titlz I , Savci N , Doǧan Ö 
Published: March 2007

Abstract
This study investigated the role of duodenogastric reflux in rats after antecolic gastrojejunostomy. At the end of the study, adenocarcinoma was present in 43 per cent, dysplasia in 14 per cent and intestinal metaplasia in 43 per cent of animals. No such changes were found in control rats. A technique for silver staining nucleolar organizing regions (AgNORs) was applied to these lesions and to the control group. The AgNOR count gradually increased from normal gastric mucosa to carcinoma. This technique demonstrated differences in AgNOR count between normal mucosa and other lesions (adenocarcinoma, dysplasia, intestinal metaplasia) (P &lt; 0·001). There was, however, considerable overlap among adenocarcinoma, dysplasia and metaplasia (P &lt; 0·1).
Bacterial translocation in acute liver failure induced by 90 per cent hepatectomy in the rat
Authors: Wang X D , Soltesz V , Andersson R , Bengmark S 
Published: March 2007

Abstract
Bacterial infection and bacteraemia have been observed in patients with acute liver failure. The exact source of bacteria and nature of pathophysiological mechanisms explaining the development of infection remain unclear. In the present study, acute liver failure was induced by 90 per cent hepatectomy in the rat. The mesenteric lymph nodes and organs were harvested aseptically for bacteriological culture after sham operation or 90 per cent hepatectomy. Function of the liver and reticuloendothelial system (RES) was assayed; gut oxygen extraction was also measured. Translocation of enteric bacteria occurred 2 h after operation and increased with time following hepatectomy. Overgrowth of Escherichia coli in the distal small intestine started 2 h after operation. RES function decreased immediately after 90 per cent hepatectomy; uptake rates per gram tissue in other organs increased signicantly. These results indicate that bacterial translocation occurred early after 90 per cent hepatectomy, associated with a decrease in RES function and gut oxygen extraction, and overgrowth of intestinal bacteria.
Controlled liver splitting for transplantation in two recipients: Technique, results and perspectives
Authors: Houssin D , Boillot O , Soubrane O , Couinaud C , Pitre J , Ozier Y , Devictor D , Bernard O , Chapuis Y 
Published: March 2007

Abstract
A technique of controlled liver splitting for transplantation in two recipients is proposed, based on a full anatomical assessment of the graft including arteriography and cholangiography on the back-table. Using eight livers, 16 patients received a graft: right liver (eight patients), left lobe (four) or left liver (four). Twelve patients required urgent or very urgent transplantation. Anatomical assessment of the graft demonstrated a portal bifurcation in all cases, a common trunk of the left and middle hepatic veins in five, a right biliary duplication in three and duplication of the left branch of the middle hepatic artery in one. After revascularization of the graft, bleeding was greater in patients with a right graft, particularly if the middle hepatic vein had been ligated. The main postoperative complications were hepatic artery thrombosis (four cases), biliary complications (four), portal vein thrombosis (two), haematoma (two) and abscess (two). No primary non-function of the graft was observed. The postoperative survival rate was 75 per cent. The four patients in whom transplantation was not considered urgent are still alive. The immediate survival rate of the grafts was 69 per cent. These results compare favourably with those in the literature. In spite of the technical, logistical and ethical problems raised by this technique, the results suggest that controlled liver splitting for transplantation in two recipients may in the future significantly improve the feasibility of liver transplantation.
Management of traumatic liver injuries
Authors: Schweizer W , Tanner S , Baer H U , Lerut J , Huber A , Gertsch Ph , Blumgart L H 
Published: March 2007

Abstract
Liver injuries in Europe are usually caused by blunt trauma and a high mortality rate is generally reported. The severity of liver injury in 175 patients was graded from I to V and the Injury Severity Score assessed. Seventy-five patients in a prospective study (1987–1990) were treated according to a defined protocol. Non-operative management was used for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, liberal use of packing was made and a low threshold for relaparotomy employed. Increasing experience resulted in fewer indications for resection and a 40 per cent rate of non-operative treatment in the prospectively managed group. The overall mortality rate was 12 per cent (15 per cent in the retrospective and 8 per cent in the prospective group). Death in patients with multiple injuries should only rarely result from liver trauma.
Traumatic pancreatic pseudocysts
Authors: Lewis G , Krige J E J , Bornman P C , Terblanche J 
Published: March 2007

Abstract
Fifteen patients who developed pseudocysts following pancreatic trauma were evaluated to determine outcome in relation to the nature and site of pancreatic duct injury. Pseudocysts developed in eight patients operated on within 48 h of abdominal trauma and in seven who were initially treated conservatively. In none was duct injury diagnosed during initial management. Presentation was a median of 20 (range 8–360) days after injury. In 14 patients, pseudocysts (mean diameter 9 (range 3–16) cm) were confirmed by computed tomography or ultrasonography. Endoscopic retrograde pancreatography (ERP) demonstrated the site and severity of the duct injury in eight of 11 patients. Two patients with side duct injury on ERP were treated successfully without intervention. Pseudocysts arising from distal duct injuries (four patients) were treated by percutaneous aspiration or catheter drainage, although one patient required subsequent distal resection for recurrent pancreatitis caused by a pancreatic duct stricture. Three patients with duct injuries in the neck or body with pancreatic disruption underwent distal pancreatectomy. Proximal duct injuries with mature pseudocysts (three patients) were drained internally. Three patients had complicated pseudocysts (haemorrhage in one, sepsis in two) that necessitated emergency laparotomy and external drainage; one of these patients died from sepsis. These findings suggest that traumatic pancreatic pseudocysts that follow peripheral duct injury may resolve spontaneously, whereas those associated with distal duct injuries can be treated by percutaneous aspiration or catheter drainage. Proximal duct injuries, however, require surgical intervention using either resection or internal drainage, depending on the maturity of the cyst wall.
Effect of anorectal eversion during restorative proctocolectomy on anal sphincter function
Authors: Lewis W G , Holdsworth P J , Sagar P M , Blandy J P , Holmfield J H M , Johnston D 
Published: March 2007

Abstract
Twenty-six patients underwent restorative proctocolectomy with end-to-end ileal pouch—anal anastomosis, without resection of the anal mucosa, by the eversion technique. Before surgery patients underwent tests of anorectal function. These were repeated a median of 8 (range 3–21) months after operation. The median (range) maximum resting anal pressure was 93 (36–149) cmH2O before and 71 (40—131) cmH2O after operation (P = 0·002). The median (range) maximum squeeze pressure before operation was 136 (73—280) cmH2O; it was 149 (69—290) cmH2O afterwards (P not significant). The median (range) length of the anal sphincter was 3·5 (2·5—4·5) cm before and 3·5 (2·0—4·5) cm after operation (P not significant). Thresholds for sensation in the upper, middle and lower thirds of the anal canal before and after operation were, respectively, 8·7 versus 8·7, 6·8 versus 7·4 and 4·2 versus 6·2 mA (P not significant). All 26 patients were continent, although one experienced minor leakage. Function of the anal sphincter is not significantly impaired by eversion of the rectum and anus during restorative proctocolectomy.
Pancreatic infection complicating acute pancreatitis
Authors: Widdison A L , Karanjia N D 
Published: March 2007

Abstract
Pancreatic infection is the leading cause of death from acute pancreatitis. Patients with severe necrotizing pancreatitis are most at risk. Early computed tomography and percutaneous fine-needle aspiration microbiology of areas of pancreatic necrosis enable early diagnosis. Pancreatic infection should be treated surgically, although sterile necrosis may be managed conservatively. The role of antimicrobial drugs is uncertain.
Intermittent claudication incites systemic neutrophil activation and increased vascular permeability
Authors: Hickey N C , Hudlicka O , Gosling P , Shearman C P , Simms M H 
Published: March 2007

Abstract
Reperfusion following severe ischaemia incites a systemic response involving neutrophil activation and vascular injury. Recent work suggests that intermittent claudication may also be capable of inducing similar changes, reversible by revascularization. This observation may have implications for the treatment of claudication and explain the high associated cardiovascular mortality. This hypothesis was investigated using an in vivomodel. Rats underwent repeated hindlimb stimulation after common iliac artery ligation. Intravital fluorescence microscopy was used to observe postcapillary venules of the tibialis anterior muscle in the hindlimb. This revealed a bilateral increase in leucocyte–endothelial adhesion and vascular permeability to albumin after unilateral subtotal ischaemia and muscle stimulation, associated with increased urinary albumin excretion. These results provide further evidence supporting the association of intermittent claudication with potentially deleterious systemic manifestations.
Interventional radiology in the maintenance of infrainguinal vein graft patency
Authors: London N J M , Sayers R D , Thompson M M , Naylor A R , Hartshorne T , Ratliff D A , Bell P R F , Bolia A 
Published: March 2007

Abstract
The impact of interventional radiology on the cumulative patency rate of 112 consecutive infrainguinal vein grafts was reviewed. The primary. primary assisted and secondary cumulative patency rates at 42 months were 40, 65 and 69 per cent respectively. The difference between primary and primary assisted patency rates (40 versus 65 per cent, P = 0·001) resulted from the early detection and treatment of stenoses in 30 grafts by percutaneous transluminal angioplasty (PTA). Interventional radiology also improved the cumulative graft patency rate through PTA of one inflow and five outflow arteries, thrombolysis of two graft occlusions, embolization of two persistent arteriovenous fistulas and salvage of one graft on the first day after operation by percutaneous aspiration of distal graft thrombus. Interventional radiology has a crucial role to play in the maintenance of infrainguinal vein graft patency; provided that graft stenoses are detected early in their development by aggressive graft surveillance, PTA is a highly effective treatment.
Survey of minor surgery in general practice in the West of Scotland
Authors: Morrison J M , Murray T S 
Published: March 2007

Abstract
Since April 1990 certain minor surgical procedures have attracted an item-of-service payment for general practitioners (GPs). A postal survey was undertaken to obtain information about minor surgery in general practice in the West of Scotland and to find out whether further postgraduate education is required in this field. From a random stratified sample of 356 GPs, 311 (87·4 per cent) responded. Practitioners on health board minor surgery lists have increased minor surgery activity since April 1990; they prefer to perform the less technically demanding and time-consuming procedures on the eligible list. It is concluded that there is scope for increasing postgraduate education in minor surgery for GPs.
Changes in major histocompatibility complex class II expression in monocytes and T cells of patients developing infection after surgery
Authors: Wakefield C H , Carey P D , Foulds S , Monson J R T , Guillou P J 
Published: March 2007

Abstract
Expression of class II major histocompatibility complex (MHC) on monocytes is a prerequisite for effective antigen presentation and processing, an important component of the immune response to infection. It has been reported that the level of monocyte class II expression may identify patients who go on to develop infective complications following trauma. In the present study, flow cytometry was used to measure MHC class II (human leucocyte antigen (HLA)-DR) expression on circulating monocytes and T cells in 36 patients undergoing elective major resectional surgery, of whom 12 developed septic complications. The percentage of HLA-DR positive monocytes fell significantly on the first day after operation in both groups (P &lt;0·0001) but was significantly higher in those without than in those with sepsis on days 1, 3 and 5 (P &lt;0·05). In contrast, the level of T cell HLA-DR expression rose significantly on the first day after operation (P &lt;0·05) in patients without sepsis to a level higher than in those who developed infection (P &lt;0·05). These findings have important implications, as predictive biological elements and for biological response modification, in patients at risk of developing sepsis after surgery.
Use of an accident and emergency department observation ward in the management of head injury
Authors: MacLaren R E , Ghoorahoo H I , Kirby N G 
Published: March 2007

Abstract
The management of 405 patients presenting with head injury to an accident and emergency department was assessed. Sixty-nine patients were admitted, although this number should have been 127 according to current guidelines on the management of head injury. Only three attenders were admitted inappropriately according to these guidelines. An accident and emergency observation ward was open on weekdays only; at weekends, patients with head injury were admitted to a general surgical ward. When the observation ward was open, 51 of the 76 patients (67 per cent) presenting with admission criteria were admitted. When closed, only 15 of the 51 patients (29 per cent) with these criteria were admitted. Guidelines were applied effectively to reduce the number of unnecessary admissions, but there was a significant number of patients with minor head injury who were discharged inappropriately. This number was much reduced when an observation ward was available.
Single-loop biliary and gastric bypass for irresectable pancreatic carcinoma
Authors: Watanapa P , Williamson R C N 
Published: March 2007

Abstract
Twenty-five patients with irresectable carcinoma of the pancreatic head received a modified type of palliative bypass in which the transected bile duct and the gastric antrum were anastomosed to the same Roux loop of jejunum. There were 13 women and 12 men with a median age of 54 (range 35–74) years. All but three patients were jaundiced and 11 underwent preoperative biliary decompression. In 18 patients jaundiced at the time of operation, the median preoperative serum bilirubin level was 287 (range 57–804) μmol/l. The median operative time was 4·0 (range 2·5–6·0) h. There were no hospital deaths. Minor postoperative complications occurred in nine patients and the median hospital stay after operation was 13 (range 7–49) days. The median postoperative survival was 4·8 (range 1·5–11·5) months. This operation provides good palliation safely in selected patients with irresectable pancreatic carcinoma.
Individuals with a strong family history of colorectal cancer demonstrate abnormal rectal mucosal proliferation
Authors: Rooney P S , Robinson M H E , Clarke P A , Hardcastle J D , Armitage N C 
Published: March 2007

Abstract
Thirty-seven individuals with an increased lifetime risk of colorectal cancer because of family history and a control group (n = 21) with no such family history underwent colonoscopy. No neoplastic lesion was found in any individual. Rectal biopsies of macroscopically normal mucosa were taken 8 cm from the anal margin and mucosal proliferation assessed by the crypt cell production rate (CCPR). There was no difference in CCPR between the control group (median 10 (95 per cent confidence interval 7–11) cells per crypt per h) and those at intermediate risk (lifetime risk between 1:17 and 1:10, n = 14). However, there was a significant difference in CCPR between the control group and those at higher risk (lifetime risk &gt; 1:10, n = 23) (median CCPR 13 (95 per cent confidence interval 10–17) cells per crypt per h, P = 0·004). A high risk of colorectal cancer derived from family history correlates with an increased colorectal mucosal proliferation rate.