bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of chronic pancreatic cholangiopathy
Authors: Pereira-Lima L , Kalil A N , Wilson T J 
Published: March 2007

Abstract
In a consecutive surgical series of 70 patients with chronic calcifying pancreatitis, 18 presented with fixed stenosis of the terminal common bile duct. Nine patients presented with jaundice and two had a palpable gallbladder. The most relevant laboratory datum in the series was a persistently high serum alkaline phosphatase level. Long tapering of the terminal common bile duct was the characteristic radiological sign in 45 of our patients. In five of the 18 cases compression of the terminal bile duct was due to cephalic pseudocysts. Hepaticojejunostomy-en-Y was the type of drainage chosen in 16 cases, and an end-to-side technique was used in 15 patients. Side-to-side choledochoduodenostomy was performed in two cases. In 14 patients, biliary drainage was associated with other surgical procedures on the pancreatic parenchyma. No postoperative complications due to the biliary drainage occurred in this series.
Acute pancreatitis after renal transplantation
Authors: Fernández-Cruz L , Targarona E M , Cugat E , Alcaraz A , Oppenheimer F 
Published: March 2007

Abstract
Post-transplantation pancreatitis is an infrequent complication with a high risk of mortality. In a 7-year period, there were five patients who had documented pancreatitis out of a total of 488 renal homograft recipients, an incidence of 1 per cent. Two cases occurred in patients with an orthotopic transplant, one of them as a result of surgical injury of the pancreas and the other as a consequence of cytomegalovirus infection. The third case was an acute pancreatitis of hypercalcaemic origin, the fourth patient developed postoperative pancreatitis and acute acalculous cholecystitis, and the fifth had acute pancreatitis and sepsis associated with cytomegalovirus infection. Three patients died as a direct result of the complication. The mean incidence and mean mortality rate of post-transplantation pancreatitis, as determined from our review of the literature of the last 15 years, are 2·3 and 61·3 per cent, respectively; these are similar to the figures found up to 1970 of 1·7 and 52·2 per cent. A multiplicity of factors present in the uraemic patient may be responsible for the continued frequency of post-transplant pancreatitis despite advances in surgical technique and immunosuppressive therapy.
Mirizzi syndrome and cholecystobiliary fistula: A unifying classification
Authors: Csendes A , Diaz J Carlos , Burdiles P , Maluenda F , Nava O 
Published: March 2007

Abstract
A new classification of patients with Mirizzi syndrome and cholecystobiliary fistula is presented. Type I lesions are those with external compression of the common bile duct. In type II lesions a cholecystobiliary fistula is present with erosion of less than one-third of the circumference of the bile duct. In type III lesions the fistula involves up to two-thirds of the duct circumference and in type IV lesions there is complete destruction of the bile duct. A total of 219 patients were identified with these lesions from 17 395 patients with benign biliary tract diseases undergoing surgery. The incidence of type I lesions was 11 per cent, type II 41 per cent, type III 44 per cent and type IV 4 per cent. The majority had obstructive jaundice. In type I lesions. cholecystectomy plus choledochostomy is effective. In type II lesions, suture of the fistula with absorbable material or choledochoplasty with the remnant of gallbladder can be performed. In type III lesions suture is not indicated and choledochoplasty is recommended. In type IV lesions, bilioenteric anastomosis is preferred. Operative mortality rate increases according to the severity of the lesion, as does postoperative morbidity. During cholecystectomy, partial resection is recommended in order to extract the stones, visualize the common bile duct and define the type and location of the fistula. T tubes should be placed distal to the fistula.
Wound sepsis following Ramstedt pyloromyotomy
Authors: Rao N , Youngson G G 
Published: March 2007

Abstract
Wound sepsis is common following pyloromyotomy in children and in a retrospective study of 178 cases the incidence of wound infection was 21 (11·8 per cent). On preliminary analysis, three variables were associated with wound sepsis: age, duration of projectile vomiting and surgical technique. Only surgical technique was found to be statistically significant on sequential multivariate analysis. Mass closure with polydioxanone was associated with a 1 per cent (one of 70) wound sepsis rate. Wound sepsis after pyloromyotomy is dependent on technique, and mass closure with polydioxanone is recommended. The routine use of tension sutures should be abandoned.
Peptic pyloric stenosis treated by endoscopic balloon dilatation
Authors: Griffin S M , Chung S C S , Leung J W C , Li A K C 
Published: March 2007

Abstract
Twenty-five patients with proven gastric outlet obstruction secondary to peptic ulcer disease were treated by endoscopic balloon dilatation using ‘through the scope’ balloons. The stricture could not be negotiated in one patient. Two patients continued to have gastric outlet obstruction despite the dilatation and required surgery. Two patients have returned up to 11 weeks after treatment with signs of recurrent gastric outlet obstruction. Twenty patients (80 percent) remained asymptomatic (follow-up: median 9 months, range 2–24 months).
Detection of lymph node metastases in colorectal carcinoma before and after fat clearance
Authors: Scott K W M , Grace R H 
Published: March 2007

Abstract
One hundred and three colorectal carcinoma specimens were examined to determine the value of the xylene and alcohol fat clearance technique in detecting lymph node metastases. The mesocolon or mesorectum was dissected initially by the traditional method and all the lymph nodes identified were examined histologically. After fat clearance the specimen was dissected again and further lymph nodes were examined. Forty-one specimens were obtained from the rectum and 62 from the colon. Traditional dissection produced a mean of 6·2 lymph nodes per specimen, but following fat clearance a further mean of 12·4 nodes per specimen were found. The total number of lymph nodes recovered varied from two to 69 with a mean of 18·5 per specimen. Traditional dissection showed 45 specimens (43·7 per cent) to have lymph node metastases but after fat clearance a further five specimens (4·8 per cent) were found to be lymph node positive. Therefore, of the 58 specimens graded initially as Dukes' B, five (8·6 per cent) were shown after fat clearance to be Dukes' C tumours. In the Dukes' C cases the mean (s.d.) number of involved lymph nodes per specimen was 2·7 (2·1) by traditional dissection and 4·2 (3·9) after fat clearance. Forty-seven (94·0 per cent) of the Dukes' C tumours were correctly identified after examination of specimens containing up to 13 lymph nodes. Fat clearance of the mesocolon or mesorectum should be used when traditional dissection has failed to identify at least 13 nodes and the tumour has been classified as Dukes' B.
Function after ileal pouch and stapled pouch-anal anastomosis for ulcerative colitis
Authors: Williams N S , Marzouk D E M M , Hallan R I , Waldron D J 
Published: March 2007

Abstract
Fourteen patients with ulcerative colitis underwent formation of an S ileal pouch and construction of a stapled pouch-anal anastomosis by a modified technique, which eliminated the use of purse-string sutures. Eleven have had their covering ileostomies closed. Anal manometry performed before and a median of 9 months after ileostomy closure showed significant impairment of internal anal sphincter function. Night evacuation was significantly reduced in the stapled group compared with a similar group of patients who had undergone S ileal pouch formation, mucosal proctectomy and manual transanal anastomosis, but this was the only parameter of function to show a difference. A stapled pouch-anal anastomosis may be superior to the conventional procedure but it still may lead to internal anal sphincter damage which cannot be due to mucosectomy or prolonged anal retraction.
Predicting local recurrence of carcinoma of the rectum after preoperative radiotherapy and surgery
Authors: Jones D J , Zaloudik J , James R D , Haboubi N , Moore M , Schofield P F 
Published: March 2007

AbstractA prospective study of prognostic factors has been carried out in a group of 186 patients with tethered rectal carcinomas. Of these, 97 were randomized to surgery alone and 89 to receive preoperative radiotherapy (20 Gy in four fractions). DNA ploidy was determined by flow cytometry. DNA aneuploidy was detected in 60 patients (62 per cent) in the surgery only group, but in only 33 patients (37 per cent) after radiotherapy (P0·01). There was a significant reduction in local recurrence in irradiated patients (P&lt;0·0001). DNA diploid tumours were less likely to recur locally: This was more marked in the radiotherapy group (P = 0·01) than in the surgery only group (P = 0·06). After radiotherapy, only the surgeons' assessments of a ‘curative’ resection and DNA ploidy were independent predictors of local recurrence in multivariate regression analysis, whilst Dukes' classification was not. In conclusion, DNA ploidy may indicate response to radiotherapy and is an important predictor of subsequent local tumour progression.
Endoluminal ultrasound for early detection of local recurrence of rectal cancer
Authors: Mascagni D , Corbellini L , Urciuoli P , Di Matteo G 
Published: March 2007

AbstractThe diagnostic potential of endoluminal (endorectal and endovaginal) ultrasound to detect asymptomatic resectable local recurrence after rectal cancer surgery has been assessed in 120 patients: 17 recurrences (14 per cent) were detected. The method showed 97 per cent accuracy, 94 per cent sensitivity and 98 per cent specificity; the positive predictive value was 85 per cent and the negative predictive value was 99 per cent. A longer follow-up is, however, necessary to confirm these results. Of the 17 patients with local recurrence, six were asymptomatic and underwent reoperative surgery. Of the other 11 patients with symptomatic recurrence, only two underwent reoperative surgery.
Medullary carcinoma of the thyroid: management of persistent hypercalcitonaemia utilizing [99mTc] (v) dimercaptosuccinic acid scintigraphy
Authors: Udelsman R , Mojiminiyi O A , Soper N D W , Shepstone B J , Dudley N E 
Published: March 2007

Abstract
Whole body scintigraphy with [99mTc](v)dimercaptosuccinic acid (pentavalent DMSA) was performed in seven patients with histologically confirmed medullary carcinoma of the thyroid (MCT). Six of these patients had undergone previous thyroid resections for MCT and, although asymptomatic at the time of pentavalent DMSA scintigraphy, had persistent and serial elevations in their plasma calcitonin levels. One additional patient was scanned before and after total thyroidectomy for MCT. The pentavalent DMSA scintigram demonstrated either local neck recurrence (three patients) or distant metastases (two patients) in five of the six asymptomatic patients. In one asymptomatic patient only equivocal neck uptake was demonstrated. Since he had only minimal calcitonin elevations, repeat neck exploration was not performed. The one patient studied before thyroid resection for MCT demonstrated neck uptake before, but not after, total thyroidectomy. The results of the scintigrams had significant impact on patient care and resulted in neck re-exploration (three patients), neck biopsy (one patient), and lumbar spine biopsy and subsequent radiotherapy (one patient). These data demonstrate pentavalent DMSA to be a sensitive localizing agent in the evaluation of asymptomatic MCT patients with hypercalcitonaemia. Accurate targeting of treatment may be shown in due course to have a beneficial impact on survival.
Surgical management of acute pancreatitis
Authors: Poston G J , Williamson R C N 
Published: March 2007

Abstract
This review examines the lack of improvement in terms of mortality and outcome in patients with acute pancreatitis. Energetic fluid replacement is the only treatment of proven value. There is a strong case for identification of patients with severe disease who may benefit from early operative intervention. Eradication of gallstones may prevent further attacks in patients with gallstone pancreatitis. The benefits of pancreatic resection and necrosectomy still require full evaluation.
Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver
Authors: Pichlmayr R , Grosse H , Hauss J , Gubernatis G , Lamesch P , Bretschneider H J 
Published: March 2007

Abstract
The clinical experience with 11 patients undergoing ex situ operation of the liver (nine operations) or surgery on an in situ hypothermic perfused liver after vascular isolation (three operations) is described. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection would not have been sufficiently radical. In one patient the ex situ approach avoided the need to undertake liver grafting for a benign tumour. To date, hepatocellular tumours and metastases not compromising global hepatic function or causing cholestasis are considered to be suitable conditions; cholestasis appears to be highly detrimental for the postoperative course after an ex situ procedure. Elaboration of methods for better grading of pre-existing liver damage and of its prognostic significance is essential. The assessment of the final therapeutic value of the described procedure requires further experience.
Endoscopic sphincterotomy in hepatic hydatid disease open to the biliary tree
Authors: Vignote M L , Miño G , de la Mata M , de Diosand J F , Gomez F 
Published: March 2007

Abstract
Communication with the biliary tree is the most common complication of hydatid disease of the liver and up to a few years ago surgery was the only way to treat it successfully. The introduction of endoscopic sphincterotomy represented a great advance in the management of this disease. We report the results obtained with this technique in ten patients after surgical treatment of hepatic hydatid disease open to the biliary tree. The results were satisfactory in all cases, with no morbidity or mortality. Endoscopic sphincterotomy is now the first choice treatment for surgical complications of hepatic hydatid disease open to the biliary tree, as well as the drainage procedure of choice in patients with cholangitis due to hydatid disease.
Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication
Authors: Mughal M M , Bancewicz J , Marples M 
Published: March 2007

Abstract
A prospective study of the value of preoperative oesophageal manometry in selecting patients for gastro-oesophageal reflux surgery has been performed. One hundred and twenty-six consecutive patients had a floppy Nissen fundoplication with a median follow-up period of 48 months (range 21–96 months). Reflux was controlled in 116 patients (92·1 per cent). One hundred and jive patients (83·3per cent) had a clinically satisfactory result (Visick grades 1 and 2). Poor results were largely due to recurrent reflux, technical failure or the irritable bowel syndrome. An unsatisfactory result was not more likely in those with upright reflux, an oesophageal motility disorder or a competent cardia as defined by manometry. Preoperative oesophageal studies, other than those required to make an accurate diagnosis, were found to have no value in deciding the suitability of patients for surgical correction of gastro-oesophageal reflux.
Total gastrectomy and oesophagojejunostomy – a prospective randomized trial of hand-sutured versus mechanically stapled anastomoses
Authors: Seufert R M , Schmidt-Matthiesen A , Beyer A 
Published: March 2007

Abstract
Eighty patients undergoing total gastrectomy for malignant disease were entered into a prospective randomized study, comparing anastomoses constructed mechanically (staples) with hand-sewn (single layer Maxon®) anastomoses. The groups were matched with respect to clinical features, medical risk factors and were staged for tumour. Only one anastomotic leak was observed after operation and this was in the group of stapled anastomoses. One patient died in each group (owing to cardiac infarction and multiorgan failure). Operating time, morbidity and hospital stay showed no significant differences between groups. These results indicate that hand-sewn and mechanically stapled oesophagojejunostomy anastomoses allow the same high standard of performance.
Early and late results of extended surgery for cancer of the stomach
Authors: Bozzetti F , Regalia E , Bonfanti G , Doci R , Ballarini D , Gennari L 
Published: March 2007

Abstract
The experience of the Istituto Nazionale Tumori of Milan of 143 patients who underwent extended surgery for cancer of the stomach from 1965 to 1980 is reviewed. They represent 16·3 per cent of the patients who underwent curative surgery. The operative mortality rate was 15·4 per cent but this significantly decreased in recent years to 8per cent and the morbidity rate to 17·5 percent. The overall 5-year survival rate was 19 per cent. Survival was analysed according to tumour penetration (pT) and nodal status (N). It was found that patients without tumour penetration of adjacent structures and nodal involvement (pT3N−) had a better 5-year survival rate (21 per cent) than patients with nodal involvement (pT3N+) (2 per cent). Patients with tumour penetration of adjacent structures and without nodal involvement (pT4N−) had a better 5-year survival rate (29 per cent) than patients with nodal involvement (pT4N+) (5 per cent). These differences were significant on log rank test (P &lt; 0·000001 and P &lt; 0·001 respectively) and suggest that nodal status is a stronger prognostic variable than pT level. The role of extended surgery is discussed from the viewpoint of the oncological surgeon who has to weigh up the difficulty of a preoperative diagnosis of tumour infiltration of adjacent structures (predictive positive value 0·39), with the operative mortality rate of at least 8per cent and long-term results which are strongly affected by the nodal status.
Comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty: Results at 8–15 years
Authors: Koruth N M , Dua K S , Brunt P W , Matheson N A 
Published: March 2007

Abstract
In 1983 we reported the early results (mean 5 years) of a prospective randomized comparison of highly selective vagotomy (HSV) with truncal vagotomy and pyloroplasty (TVP) where all 137 operations were performed by the same surgeon. HSV was significantly better than TVP in terms of Visick grading and side-effects. The same patients were assessed at a mean of 12 years (range 8–15 years) after operation. There was no difference on assessment using Visick grading between TVP (59 patients) and HSV (57 patients) (grades I and II, 75per cent in each case). However, 20per cent of TVP patients (but none of the HSV patients) had undergone reoperation in the intervening period. The endoscopically proven recurrence rate was 7per cent after TVP and 5per cent after HSV. This long-term follow-up supports the optimism that HSV is a better operation than TVP in the elective treatment of duodenal ulcer.
Simple closure of perforated duodenal ulcer: A prospective evaluation of a conservative management policy
Authors: Bornman P C , Theodorou N A , Jeffery P C , Marks I N , Essel H P , Wright J P , Terblanche J 
Published: March 2007

Abstract
One hundred and thirteen consecutive patients admitted with a perforated duodenal ulcer over a 5-year period (1978–82) and treated by simple closure have been followed prospectively over a median period of 43 months. Patients were divided into two categories according to their previous history of dyspepsia; group 1 (66 patients) with a chronic history of more than 3 months and group 2 (47 patients) where there was no history of dyspepsia or a history of less than 3 months duration. The follow-up periods were similar (group 1, 44 months; group 2, 43 months). The overall recurrence rate was 42per cent and to date only 14per cent of the total group of 113 patients have required a definitive operation. The incidence of ulcer recurrence was higher in group 1 than in group 2 in terms of total recurrence (group 1, 50per cent; group 2, 32per cent) and patients requiring further surgery (group 1, n = 14, 21 per cent; group 2, n = 7, 75per cent). Five of these 21 patients required an emergency procedure for haemorrhage or reperforation (group 1, n = 2; group 2, n = 3). There were no significant differences between the 5-year predictive recurrence rate or the requirement for definitive surgery between the groups. Five of the 27 patients currently on medical treatment have required maintenance treatment while the remaining patients receive active treatment for a mean of 20 per cent of the time since they developed recurrent ulceration. These results support continuation of our ‘wait and see’ policy following simple closure of perforated duodenal ulcer, even in patients with a history of chronic dyspepsia.
Vertical Silastic ring gastroplasty: A 6-year experience
Authors: Ismail T , Kirby R M , Crowson M C , Baddeley R M 
Published: March 2007

Abstract
Vertical Silastic® ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48per cent and 65per cent respectively. Subsequently the weight stabilized around this level with 58per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7per cent) failed to lose weight. Sixteen patients (23per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.
Pancreatic exocrine function after a sutureless pancreaticojejunostomy following pancreaticoduodenectomy
Authors: Hall R I , Rhodes M , Isabel-Martinez L , Kelleher J , Venables C W 
Published: March 2007

Abstract
Exocrine pancreatic function was measured in 14 patients after pancreaticoduodenectomy for periampullary neoplasms in order to assess the patency of a sutureless pancreatico-enteric anastomosis. Pancreatic function was examined by the p-aminobenzoic acid/p-aminosalicylic acid (PABA/PAS) test 3–160 months after operation and compared with age- and sex-matched controls. There were no significant differences between mean (s.e.m.) serum PABA concentrations 3 h after ingestion of N-benzoyl-l-tyrosyl-PABA (25·5 (3·6)) μmol/l for patients, 26·1 (2·0 (μmol/l for controls)). However, the mean (s.e.m.) PABA excretion index was significantly lower in the patients (0·58 (0·08)) than in the controls (0·76 (0·04)). Four patients required pancreatic enzyme supplements for control of diarrhoea. Self-limiting pancreatic leaks occurred in two patients. The results suggest that the sutureless pancreatico-enteric anastomosis has an acceptably low leakage rate but that pancreatic exocrine function is diminished following pancreaticoduodenectomy with this technique. However, the majority of patients require no enzyme supplements and no significant tendency to late stenosis of the anastomosis was demonstrated.