bluuebunny/crossref_metadata_2025_split huggingface dataset:
Faecal occult blood screening for colorectal neoplasia: A randomized trial of three days or six days of tests
Authors: Thomas W M , Pye G , Hardcastle J D , Mangham C M 
Published: March 2007

Abstract
Haemoccult®, a guaiac test for faecal occult blood, detects 56–78 per cent of asymptomatic carcinomas when performed over 3 days. In patients with known colorectal cancer the sensitivity of the test for neoplasia is increased by extending the test period to 6 days. We report the first randomized comparison of 3 day with 6 day testing in asymptomatic individuals. 35184 age and sex matched individuals were randomly allocated to receive Haemoccult over 3 or 6 days. The tests were completed by 10176 (57·8 per cent) of the 17616 offered 3 day Haemoccult and 9461 (53·9 per cent) of the 17568 offered 6 day Haemoccult, a significant decrease in compliance (P&lt;0·001). Of the 3 day Haemoccult tests 131 (1·29 per cent) were positive, significantly fewer than the 160 (1·69 per cent) positive tests after 6 day Haemoccult (0·01 &lt; P &lt; 0·02). Investigation of subjects with a positive test revealed 20 carcinomas (1·14 per 1000 offered and 1·97 per 1000 completing the test) in the 3 day group and 24 carcinomas (1·37 per 1000 offered and 2·54 per 1000 completing the test) after 6 day Haemoccult tests (0·5&lt;P&lt;0·7 for those offered the test and 0·3&lt;P&lt;0·5 for those completing it). After 3 day Haemoccult 112 adenomas in 76 persons were detected (4·31 per 1000 offered and 7·47 per 1000 completing the test). In the 6 day group 123 adenomas in 83 persons (4·72 per 1000 offered and 8·77 per 1000 completing the test) were detected (0·5 &lt; P &lt; 0·7 for those offered the test and 0·3 &lt; P &lt; 0·5 for those completing it). Large adenomas were found in 27 individuals after 3 day testing (1·53 per 1000 offered the test and 2·65 per 1000 completing it) and in 35 individuals after 6 day testing (1·99 per 1000 offered the test and 3·70 per 1000 completing it) (0·3&lt;P&lt;0·5 for those offered the test and 0·l&lt;P&lt;0·2 for those completing it). This study has not demonstrated a significant increase in the yield of neoplasia in asymptomatic subjects offered Haemoccult over 6 days. However there was a significant decrease in compliance and a higher rate of colonoscopy in those offered 6 day testing.
Operative findings in patients with early forms of gallbladder cancer
Authors: de Aretxabala X , Roa I , Araya J C , Burgos L , Flores P , Huenchullan I , Miyazaki I 
Published: March 2007

Abstract
Of 52 patients diagnosed as having gallbladder cancer in a 2-year period, 15 had no evidence of serosal involvement. Four of these 15 patients had tumour confined to the mucosa and did not undergo reoperation while 11 patients underwent lymph node dissection and hepatic wedge resection at a second operation. The correct diagnosis was suspected before the first operation in only one of 11 patients undergoing reoperation; the tumour was found microscopically in seven patients. Of the 11 patients who underwent reoperation, five had lymph node involvement, and three of these patients had both liver and lymphatic involvement. Our results underline the difficulty of establishing the diagnosis of gallbladder cancer before operation and the lack of major morbidity and mortality suggests that there may be value in reoperating on patients found to have gallbladder carcinoma without serosal involvement. Further follow-up is required to assess the long-term value of this approach.
The effect of caerulein induced pancreatitis on the hepatic microvasculature
Authors: Delaney C , McEntee G , Cottell D , McGeeney K , Fitzpatrick J M 
Published: March 2007

Abstract
A three-dimensional morphological study of the hepatic microvasculature in caerulein induced oedematous pancreatitis was performed using scanning electron microscopy (SEM) vascular casts and transmission electron microscopy (TEM) of hepatocytes and hepatic sinusoids. TEM studies provided ultrastructural evidence of hepatocellular damage while SEM views demonstrated gross irregularity of the sinusoidal outline with abruptly terminating sinusoidal buds and extravasation of cast material, findings which were similar to those previously reported in the pancreas itself using the same model and which were supported by TEM cross-sectional views of the hepatic sinusoids. The results suggest that caerulein induced pancreatitis is associated with extrapancreatic microvascular damage which may be an important factor in the pathogenesis of extrapancreatic organ impairment associated with acute pancreatitis.
Towards decreasing the relaparotomy rate in the Peutz–Jeghers syndrome: The role of peroperative small bowel endoscopy
Authors: Spigelman A D , Thomson J P S , Phillips R K S 
Published: March 2007

Abstract
Relaparotomy occurs commonly in patients with the Peutz–Jeghers syndrome, and at quite short intervals. Between 1943 and 1987 laparotomies were performed on 54 occasions in 23 patients with the Peutz–Jeghers syndrome who at some time came under the care of St. Mark's Hospital. In four patients repeat laparotomy was performed within a single year. Between 1987 and 1989 a further five patients have undergone laparotomy with on-table small bowel endoscopy. External palpation and small bowel transillumination failed to demonstrate 17 out of a total of 45 hamartomas (38 per cent). Of these 17 polyps identified endoscopically, 11 (65 per cent) were sufficiently large that a snare was used to remove them. We recommend peroperative enteroscopy as an adjunct to surgery in the Peutz–Jeghers syndrome.
Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis
Authors: Stone H Harlan , Chauvin E J 
Published: March 2007

Abstract
To denervate the pancreas of sensory afferents, 15 patients with intractable pain of chronic alcohol induced pancreatitis underwent left transthoracic splanchnicectomy with concomitant bilateral truncal vagotomy. All were malnourished and 11 were addicted to opiates. No respite had been obtained from 33 previous operative procedures. Each patient experienced almost immediate pain relief. Five, however, later had return of pain, but only to the right epigastrium. These five then underwent right transthoracic splanchnicectomy, after which four noted complete and apparently permanent disappearance of pain. In those 14 with a successful outcome there has been a 29 per cent mean increase in body weight, break of hard drug addition in ten of the 11 so afflicted, and return to gainful work or a relatively normal lifestyle in all 14 at a mean follow-up of 16 months. Although 11 of the 14 do have delayed gastric emptying, only one has required a drainage procedure. There have been no other late complications. This approach for control of incapacitating pain in chronic pancreatitis is both safe and simple and at the same time it appears to be reasonably reliable.
Immunodeficiency following splenectomy in the early postimmunization period
Authors: Barren P T , Richter M 
Published: March 2007

Abstract
Splenectomy is associated with an increased risk of serious infection with encapsulated micro-organisms in a small number of individuals. The immunological defects in this state are unclear. We have investigated in rabbits the effect of splenectomy, before and after primary immunization with a specific antigen (sheep erythrocytes) similar in structure to the pneumococcal capsular antigen, on the organ localization of antibody forming cells and the long-lived memory cells. Antibody forming cell and memory cell assays were performed at intervals up to day 270 after primary immunization. Antibody titres following secondary immunization were also measured. The results show that the major site of antibody forming cells is in the spleen following primary immunization of the untreated rabbit and that antibody forming cells subsequently migrate to the lymph nodes and thymus. On the other hand, in rabbits splenectomized before primary immunization the major site of the antibody forming cells is the peripheral lymph nodes. These rabbits also gave good secondary immune responses. However, splenectomy 40 days after primary immunization results in a poor secondary immune response, indicating that essentially all the antibody forming cells following primary immunization were localized in the spleen at the time of splenectomy.
Thallium isotope scintigraphy and ultrasonography: Comparative studies of localization techniques in primary hyperparathyroidism
Authors: Carlson G L , Farndon J R , Clayton B , Rose P G 
Published: March 2007

Abstract
Controversy exists about whether preoperative localization procedures are indicated in patients with primary hyperparathyroidism before first neck exploration. Currently, thallium subtraction scintigraphy and ultrasonography are the techniques used most frequently. This paper examines prospectively the accuracy and value of these techniques in a group of 71 patients with primary hyperparathyroidism. When considering all glands, thallium scanning produced a sensitivity of 46·6 per cent with a specificity of 91·5 per cent, compared with a sensitivity of only 21·4 per cent and specificity of 94·5 per cent for ultrasonography. Accuracy rates, for all glands, were 80 per cent and 75·7 per cent respectively. Both localization procedures were consistently ineffective in localizing adenomas weighing less than 500 mg, over 80 per cent of which went undetected by both scanning modalities. While both scans produced satisfactory results in localizing adenomas weighing more than 1 g, these adenomas should not represent a challenge to an experienced endocrine surgeon and, therefore, neither localization is recommended before first neck exploration.
Statistical comparison of two methods of clinical measurement
Authors: Murray G D , Miller R 
Published: March 2007

Abstract
The comparison of two measurement techniques, neither of which can be regarded as being a ‘gold standard’, is fundamental to much basic research. This apparently simple problem raises many statistical difficulties, which are reviewed in this paper in the context of anorectal manometry. It is concluded that a recently developed approach focusing on the agreement between the two techniques is far superior to the more conventional approach based on correlation. However, until the benefits of the new analysis are more widely recognized (and it is hoped that this paper is a step towards that goal), it is argued that it is useful to present both analyses in such comparisons of measurement techniques.
Role of duplex scanning in the selection of patients for carotid endarterectomy
Authors: Farmilo R W , Scott D J A , Cole S E A , Jeans W D , Horrocks M 
Published: March 2007

Abstract
A retrospective review of 63 patients undergoing duplex scanning and angiography for suspected carotid artery disease was performed to evaluate the need for routine angiography before carotid endarterectomy. A consultant surgeon (M.H.) made a simulated management decision on the basis of a clinical summary and a duplex scan report. Twenty-four patients were selected for surgery without angiography; duplex scanning had a sensitivity of 100 per cent and a specificity of 90 per cent in the detection of internal carotid artery stenosis. In two cases duplex scanning misdiagnosed a total occlusion as a critical stenosis. Eighteen patients failed to meet the criteria for surgery and were referred for angiography. Twenty-one patients were selected for conservative treatment on the basis of the duplex scan report. Combining the surgical and conservative groups (45 patients), duplex scanning had a sensitivity of 96 per cent and specificity of 95 per cent for the detection of stenosis greater than 50 per cent. In the identification of a total occlusion, duplex scanning had a poor sensitivity of 50 per cent. These results suggest that routine angiography before carotid endarterectomy is unnecessary in selected patients but that a suspected occlusion should be confirmed by angiography.
Epidermal growth factor increases tensile strength in intestinal wounds in pigs
Authors: Kingsnorth A N , Vowles R , Nash J R G 
Published: March 2007

Abstract
Growth factors enhance tensile strength, angiogenesis and collagen synthesis in skin wounds. The effects were studied of a continuous intraperitoneal infusion of epidermal growth factor (EGF) on the mechanical properties of healing in linear full-thickness wounds of the stomach, ileum and colon of young pigs (n = 16, mean(s.d.) body-weight 20·1(1·9) kg). In half the animals an osmotic minipump was implanted into the peritoneal cavity to deliver recombinant human EGF at a rate of 0·5 µg kg−1 24 h−1. Animals were killed at 5 days and the integrity of a 20-mm ring of intestine was tested for tensile strength. Breaking strength (gmm−2) of the intestinal wounds in untreated pigs (n = 8) was: stomach 28·0(2·0), ileum 46·8(4·8), colon 85·6(4·2). Intestinal wounds in pigs (n = 8) receiving supplemental EGF had significantly increased breaking strength: stomach 32·4(2·2) (P &lt; 0·05), ileum 56·8(5·4) (P &lt; 0·05), colon 96·0(3·8) (P &lt; 0·01) compared with untreated animals. At 5 days after the initial injury intraperitoneal EGF increases the tensile strength of intestinal wounds in pigs.
Jejunal pouch reconstruction after total gastrectomy for cancer: Experience in 29 patients
Authors: Cuschieri A 
Published: March 2007

Abstract
The experience with interposed jejunal pouch after total gastrectomy for cancer in 29 patients is reviewed. There were two postoperative deaths (7 per cent) due, respectively, to myocardial infarction on day 5 and massive haemorrhage from the splenic vein on day 14. Anastomotic leaks, all from the proximal anastomosis, were encountered in three patients (11 per cent). These consisted of one minor clinical leak in a stapled anastomosis and two radiological leaks from hand-sutured anastomoses. Obstruction of the pouch or its conduit by recurrent tumour was not observed in any patient, including those who died from metastatic disease. There was one instance of benign stenosis of the distal anastomosis to the duodenum which required revisional surgery. The symptomatic assessment in the long-term surviving patients was good except for mild oesophagitis due to bile reflux in five patients. Body-weight was maintained and adverse nutritional consequences were not observed.
Endoscopic and radiological appraisal of gastric varices
Authors: Mathur S K , Dalvi A N , Someshwar V , Supe A N , Ramakantan R 
Published: March 2007

Abstract
Of 104 patients with portal hypertension who were subjected to oesophageal variceal sclerotherapy, gastric varices were seen in 81 (78 per cent) at endoscopy and 69 (74 per cent) at splenoportography. In 50 (48 per cent) patients gastric varices were seen at the initial endoscopic examination and in 31 they developed during follow-up at intervals varying from 1 to 56 weeks. Gastric varices were seen significantly more often along the lesser curvature than in the gastric fundus and the left gastric vein was the main feeding vessel in 75 per cent of cases. Varices bled in nine of 81 patients and bleeding was seen significantly more often from fundal varices (30 per cent) than from lesser curve varices (5 per cent) (P &lt; 0·02). The incidence of gastric varices is high, and contrary to popular belief they are more often located along the lesser curvature of the stomach than in the gastric fundus.
Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer
Authors: Boku T , Nakane Y , Minoura T , Takada H , Yamamura M , Hioki K , Yamamoto M 
Published: March 2007

Abstract
Survival rates after curative gastrectomy for advanced gastric cancer among 238 patients in whom the cancer was invading the serosa were compared with 283 patients without serosal invasion. Generalized Wilcoxon estimates for 5-year survival rate were 47·1 per cent for patients exhibiting serosal invasion and 75·9 per cent for patients without serosal invasion. The frequency of lymph node metastasis increased proportionately with the extent of serosal invasion: 18·4 per cent in cases of S0; 53·8 per cent in cases of S1; 80·0 per cent in cases of S2; and 91·4 per cent in cases of S3. The higher the aggregate total of S (serosal invasion) and n (lymph node metastasis) factors, the lower the 5-year survival rate. In addition, patients with serosal invasion had a propensity for peritoneal dissemination of cancer cells; the percentage of cases with intraperitoneal free cancer cells increased with the extent of serosal invasion. It is worth noting that when cancer infiltration proceeded to the deeper layers and was accompanied by nodal metastasis, cancerous invasion of the perinodal fatty tissue was frequently evident. Therefore, unfavourable prognosis after curative resection in gastric cancer patients with serosal invasion may be largely dependent on whether or not the cancer has invaded the peritoneal cavity and the perinodal fatty tissue.
Obstructive jaundice and wound healing
Authors: Grande L , Garcia-Valdecasas J C , Fuster J , Visa J , Pera C 
Published: March 2007

Abstract
Wound healing was studied in 95 jaundiced patients and 123 anicteric patients using skin prolylhydroxylase activity as an index of collagen synthesis. The mean(s.d.) value of skin prolylhydroxylase activity in jaundiced patients was significantly lower than that of controls in the preoperative period (40·1(19·2) versus 369·2(32·2) c.p.m./mg protein, respectively, P &lt; 0·001). Before operation there was a significant difference between patients with benign or malignant obstruction of the biliary tree (55·0(12·3) versus 25·2(10·4) c.p.m./mg protein, respectively, P &lt; 0·05). In patients with benign obstruction skin prolylhydroxylase activity returned to normal values (326·3(53·1) c.p.m./mg protein, P &lt; 0·001 versus preoperative values), while in patients with malignant lesions skin prolylhydroxylase activity increased significantly with respect to the preoperative period (25·2(10·4) versus 82·9(14·3) c.p.m./mg protein, P &lt; 0·01) but was still below normal values. Abdominal wound dehiscence was more common in jaundiced patients (six of 95) than in the anicteric group (two of 123). This complication appeared to be associated with a low skin prolylhydroxylase activity.
Prediction of mortality by logistic regression analysis in patients with postoperative enterocutaneous fistulae
Authors: Altomare D F , Serio G , Pannarale O C , Lupo L , Palasciano N , Memeo V , Rubino M 
Published: March 2007

Abstract
The contrasting results of treatment of patients with postoperative enterocutaneous fistulae reflect the heterogeneity of the disease and depend on the patient's condition and the characteristics of the fistulae. For this reason, the use of a prognostic index, which enables such patients to be classified according to their risk of death, could be useful. In this study we propose a prognostic index based on a logistic regression analysis, obtained by using two (APACHE II score and serum albumin concentration) of the eight risk factors that have been retrospectively analysed in a series of 70 patients with postoperative enterocutaneous fistulae treated in our surgical department since 1981. The logistic regression equation indicates that patients with a probability of dying of less than 0·35 have a good prognosis, with a sensitivity of 90 per cent, a specificity of 90 per cent, a negative predictive value of 79 per cent, a positive predictive value of 96 per cent and an accuracy of 90 per cent. The predictive performance of the index has also been evaluated in a group of 17 patients studied prospectively, and this confirms the sensitivity and specificity of the model. This postoperative enterocutaneous fistulae index could be a helpful tool in clinical trials and surgical audit.
Demonstration of blood flow patterns in human soft tissue sarcomas using 99mTo-labelled hexamethyl propyleneamineoxime
Authors: Sinnett H D , Rowell N P , McCready V R , Lawrence R 
Published: March 2007

Abstract
Blood flow patterns have been studied in 28 patients with soft tissue sarcoma (29 tumours) using 99mTc-labelled hexamethyl propyleneamineoxime with planar views of the tumour-bearing region. Tumour:back-ground ratios ranged from 1·13 to 6·60 (mean 2·74) and maximum:minimum tumour ratios (between peripheries and centres of tumours) ranged from 1·34 to 32·0 (mean 4·70). In eight of 29 tumours (seven of which were involving the trunk) the tumour could not be identified. This study demonstrates that the blood supply to soft tissue sarcomas is generally greater than that to adjacent normal tissues and that tumour centres are relatively underperfused compared with the tumour periphery. In this heterogeneous series there was no clear-cut relationship between blood flow and histological grade or type.
Gut barrier function and the surgeon
Authors: Saadia R , Schein M , MacFarlane C , Boffard K D 
Published: March 2007

Abstract
There is accumulating evidence that multiple organ failure is not always the result of an established septic focus. Increasing attention has centred on the gut as a reservoir of bacteria (and bacterial endotoxins) that can traverse the intestinal mucosal barrier (a process called ‘bacterial translocation’) and initiate the septic state. Although the link between haemorrhagic shock and sepsis was recognized decades ago, the full experimental demonstration of this phenomenon is more recent. It was shown to occur in three main settings: physical disruption of the gut mucosa, impaired defence mechanisms and altered gut microbial ecology. Conditions such as haemorrhagic shock, burns, protein malnutrition and sepsis are seen in the severely ill surgical patient or the multiply injured, and are known to cause various combinations of circumstances favourable to bacterial translocation and endotoxin absorption. These may play an important role in the mortality of the critically ill.
Patient throughput and mortality rate in a trauma service
Authors: Schiowitz M F 
Published: March 2007

Abstract
Trauma centre standards of the American College of Surgeons set a minimum annual volume of cases for trauma surgeons. The volume requirement, however, lacks an objective basis. The author reviews a personal series of cases revealing considerably lower volume than recommended, while injury severity and mortality were comparable to published data. No death was considered preventable on review. Possibly, lower individual caseloads are acceptable for trauma surgeons.
Prognostic index for the development of liver metastases in patients with colorectal cancer
Authors: Taylor I , Mullee M A , Campbell M J 
Published: March 2007

Abstract
The incidence of synchronous and metachronous liver metastases in patients with colorectal cancer is extremely high. Approximately 25 per cent of patients will have overt liver metastases at the time of presentation, and in the remainder up to 40 per cent will eventually develop liver metastases. In an attempt to obtain a prognostic index for the prediction of those patients most likely to develop liver metastases, 134 patients with primary colorectal cancer but without overt liver metastases at initial presentation were followed up for between 5–10 years. Regular liver scans were performed and the presence of liver metastases observed. A total of 47 patients developed liver metastases. Those preoperative variables related to the subsequent development of liver metastases were sex, log10 serum alkaline phosphatase level and Dukes' classification. A prognostic index using these parameters has been calculated.