bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carcinoma of the pancreas and periampullary region: Palliation versus cure
Authors: Klinkenbijl J H G , Jeekel J , Schmitz P I M , Rombout P A R , Nix G A J J , Bruining H A , van Blankenstein M 
Published: March 2007

Abstract
A retrospective study of 310 patients with carcinoma of the head of the pancreas or periampullary region was performed. Preoperative bile drainage by placement of a stent reduced the number of postoperative complications, especially bleeding (P = 0·03). The operative mortality rate was nil in patients with periampullary cancer aged under 70 years and 23 per cent in those over 70 years of age (P &lt; 0·001). In the last 2 years of the study, the mortality rate following resection decreased to 2 per cent. Tumour-containing resection margins did not influence survival after resection (P = 0·48). Tumour dimension of pancreatic and periampullary cancer and the presence of tumour in locoregional lymph nodes (N1a) resected with the primary tumour in cancer of the head of the pancreas were of no prognostic value. Following palliative resection of carcinoma of the pancreatic head, median survival was significantly better than when no resection was performed (10·1 versus 3·9 months, P &lt; 0·001). In conclusion, even palliative resection may benefit some patients. Preoperative bile drainage is indicated in those with jaundice. Resection should be performed, irrespective of tumour size, provided that the unit's operative mortality rate is sufficiently low.
Randomized controlled trial comparing laparoscopic and open appendicectomy
Authors: Kum C K , Ngoi S S , Goh P M Y , Tekant Y , Isaac J R 
Published: March 2007

Abstract
A study was carried out of 137 patients with a diagnosis of acute appendicitis who were randomized to either laparoscopic or open appendicectomy. Patients found to have perforated or normal appendices at histological examination were excluded. Fifty-two patients undergoing laparoscopic appendicectomy and those receiving 57 open procedures were analysed. Laparoscopic appendicectomy took no longer than the open procedure (mean 43 versus 40 min). The number of doses of pethidine (1 mg per kg body-weight) required in the immediate postoperative period did not differ between the two groups but the mean number of doses of oral analgesic (naproxen sodium 550 mg twice daily) required was less in patients undergoing laparoscopic appendicectomy (2·8 versus 5·0, P &lt; 0·05). There was no significant difference between time to resumption of fluid and diet intake and length of hospital stay. There were five (9 per cent) wound infections after open appendicectomy compared with none after the laparoscopic operation (P &lt;0·01). Patients who underwent laparoscopy returned to full home (17 versus 30 days, P &lt; 0·01) and social (19 versus 32 days, P &lt; 0·05) activities earlier than those who underwent open operation. Laparoscopic appendicectomy may allow reduction in the number of wound infections and earlier return to normal activities.
Follow-up after inguinal herniotomy or surgery for hydrocele in boys
Authors: Morecroft J A , Stringer M D , Higgins M , Holmes S J K , Capps S N J 
Published: March 2007

Abstract
A retrospective review of 556 boys who had undergone inguinal herniotomy or surgery for hydrocele was carried out to assess the value of early routine postoperative follow-up. Of 386 children given an appointment, 319 (82·6 per cent) attended. The testis was no longer palpable in the normal scrotal position in 12 boys; eight were normal on further review and four required orchidopexy. Six hydroceles, all of which resolved, and four contralateral hernias were detected. Nineteen boys (4·9 per cent) were referred later with recurrent hernia (two patients), ipsilateral high testis (two), or contralateral hernia or hydrocele (15). Of 170 children not given a routine appointment, ten (5·9 per cent) were subsequently referred back with a transient hydrocele (two) or a contralateral hernia (eight). After a total of 440 appointments, eight boys (1·8 per cent) were found to have a significant abnormality. The rate of referral back to hospital was similar in both groups. Early discharge would make more efficient use of outpatient resources without significantly affecting overall outcome.
Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis
Authors: Nugent K P , Farmer K C R , Spigelman A D , Williams C B , Phillips R K S 
Published: March 2007

Abstract
Twenty-four patients with familial adenomatous polyposis who had previously undergone prophylactic colectomy and had advanced duodenal polyposis were entered into a randomized trial to assess the effect of the non-steroidal anti-inflammatory drug sulindac on duodenal and rectal polyps. Polyp size and number were assessed by videotaped duodenoscopy (and rectoscopy in 14 patients) at entry and after 6 months of treatment; the tapes were compared by two assessors who were unaware of the randomization and the shuffled chronological order of the recordings. Mucosal cell proliferation was measured by in vitro incorporation of 5-bromo-2′-deoxyuridine. Sulindac therapy was associated with a reduction in epithelial cell proliferation in the duodenum (median labelling index (LI) 15·8 versus 14·4 per cent, P = 0·003) and a trend towards duodenal polyp regression (P = 0·12). In the rectum, cell proliferation showed a marked reduction (median LI8·5 versus 7·4 per cent, P = 0·018), and significant (P = 0·01) polyp regression was seen. Rectal polyposis was less severe than that in the duodenum and responded more dramatically. Sulindac is a possible treatment for patients in whom rectal polyps have failed to show significant regression after ileorectal anastomosis and who are unsuitable for pouch surgery; it may be useful in early duodenal polyposis or as an adjunct after duodenal clearance.
Immunoproliferative small intestinal disease: Mediterranean lymphoma and α heavy chain disease
Authors: Martin I G , Aldoori M I 
Published: March 2007

Abstract
Gastrointestinal lymphoma, uncommon in the West, is far more prevalent in developing countries where it falls into two groups: ‘Western’-type lymphomas, similar to those seen in developed countries, and the so-called Mediterranean-type lymphoma. It is now accepted that Mediterranean lymphoma represents, in the majority if not in all cases, the late stage of α heavy chain disease (α-HCD). This disease is characterized by abnormal secretion of an immunoglobulin fragment; α-HCD and Mediterranean lymphoma constitute two ends of a spectrum of pathology now classified as immunoproliferative small intestinal disease (IPSID). IPSID is associated predominantly with poor socioeconomic conditions; patients present with progressive malabsorption in the second and third decades of life. Diagnosis is established by small bowel biopsy, with or without high serum levels of the α heavy chain protein. Treatment consists of an initial staging laparotomy, with debulking of lymphomatous deposits if appropriate, followed by chemotherapy or radiotherapy. Overall prognosis is poor but the recent use of doxorubicinbased chemotherapy offers some hope for the future.
Clinical significance of venous reflux detected by duplex scanning
Authors: Payne S P K , London N J M , Jagger C , Newland C J , Barrie W W , Bell P R F 
Published: March 2007

Abstract
Duplex scanning was used to determine the presence of valvular incompetence in the major veins of 274 legs with venous disease. Using multivariate logistic regression analysis the significance of valvular function in each vein in relation to the clinical condition of the limb was calculated. Superficial femoral, profunda femoris and short saphenous vein function did not correlate with the clinical state of the limb; common femoral, popliteal and long saphenous vein function did. A table was constructed from the statistical model such that the relative contribution made by each vein could be estimated for limbs with different patterns of venous insufficiency. This model should now be tested in a prospective study and, if validated, could be used to improve decision making in venous surgery.
Role of completion angioscopy in detecting technical error after carotid endarterectomy
Authors: Gaunt M E , Naylor A R , Ratliff D A , Bell P R F 
Published: March 2007

Abstract
Completion fibreoptic angioscopy was performed in 30 consecutive patients after carotid endarterectomy. The aim was to evaluate the potential role of angioscopy as a quality-control technique. Major abnormalities (two intimal flaps, two large thrombi) were identified in four patients and minor adherent thrombus was encountered in five. All abnormalities were corrected before restoration of flow. This preliminary experience suggests that completion angioscopy merits further study as a method for the intraoperative detection of potentially harmful lesions after carotid endarterectomy.
Regional review of blunt trauma in children
Authors: Teanby D N , Lloyd D A , Gorman D F , Boot D A 
Published: March 2007

Abstract
Seventy–five severely injured children (Injury Severity Score greater than 15 or death) were identified during a 1-year prospective audit of all severe trauma in a single region. Fourteen children were admitted primarily to the regional children's hospital, comprising 0–2 per cent of that accident and emergency department workload. Paediatric trauma admissions to the 15 district general hospitals averaged 3–1 children per hospital per year or 0–007 per cent of the accident and emergency department attendances. There were 38 deaths (51 per cent), of which 15 occurred before admission to hospital. Significant deficiencies in acute management were identified at both types of hospital. There is a need to improve trauma management of children at tertiary care level and district general hospitals by developing trauma management protocols. The low number of severely injured children presenting to the district general hospitals suggests the need for a regional trauma system.
Breast-conserving surgery and tumour bed positivity in patients with breast cancer
Authors: Macmillan R D , Purushotham A D , Mallon E , Ramsay G , George W D 
Published: March 2007

Abstract
Between March 1988 and April 1992, in 264 patients undergoing breast-conserving surgery for stage I and II cancer, the tumour bed was analysed for residual disease. After a conventional breast-conserving operation the entire wall of the cavity from which the lumpectomy specimen had been taken was excised. This was involved with disease in 38 per cent of patients. Additional random biopsies of the secondary cavity were performed in 130 patients and were involved with disease in 13 per cent. Residual disease was detected in the tumour bed of 37 per cent of patients with screen-detected tumours.
Adenocarcinoma of the duodenum: Factors influencing survival
Authors: Rotman N , Pezet D , Fagniez P-L , Cherqui D , Celicout B , Lointier P 
Published: March 2007

Abstract
The records of 66 patients with histologically proven adenocarcinoma of the duodenum were reviewed retrospectively to determine factors influencing survival. The parameters studied were age, sex, weight loss, jaundice, anaemia, duodenal stenosis, type of surgical procedure, tumour size and location, depth of parietal invasion, presence and location of lymph node metastases, and pancreatic invasion. These factors were assessed in a group of 46 patients who underwent curative resection of the tumour; 20 patients who received palliative procedures were excluded from statistical analysis. Survival curves were established by the Kaplan-Meier method and compared by the Mantel-Haentszel test. The actuarial 3- and 5-year survival rates of patients undergoing curative resection were 59 and 45 per cent respectively. None of the prognostic factors studied influenced survival. These results indicate that resection of adenocarcinoma of the duodenum should be performed whenever possible, even in the presence of lymph node metastasis and pancreatic spread.
Changing pattern of admission and operation for duodenal ulcer in Scotland
Authors: Jibril J A , Redpath A , Macintyre I M C 
Published: March 2007

Abstract
To assess changes in the pattern of admission and operation for duodenal ulcer in Scotland, data recorded on Scottish Medical Records forms for the years 1975–1990 were analysed. The overall admission rate fell by 38 per cent from 157 to 98 per 100000 population while the number of operations per year dropped by 80 per cent from 2955 to 582. There was a decline in perforation rate between 1975 and 1990 from 27 to 15 per 100000 population. This general trend conceals a significant 93 per cent increase in the incidence of duodenal ulcer perforation among women aged 65 years and above, from 21 per 100000 in 1975 to 41 per 100000 in 1990 (r=0·76, P&lt;0·001). There was a general trend towards a decline in haemorrhage rates, although this was significant only for men aged 15–44 years (r= −0·73, P&lt;0·01) and 45–64 years (r= −0·63, P&lt;0·04).
Resection of hepatic and pulmonary metastases in patients with colorectal cancer
Authors: Gough D B , Donohue J H , Trastek V A , Nagorney D M 
Published: March 2007

Abstract
Nine consecutive patients underwent surgery for liver and lung metastases from colorectal cancer (Dukes' stage B in five, C in one and ‘D’ in three) between 1980 and 1991. A total of 21 procedures were performed: 16 thoracotomies with six lung lobectomies and 17 lung wedge resections, ten laparotomies with nine hepatectomies and six liver wedge resections. No operative or hospital deaths occurred and the mean(s.d.) postoperative hospital stay was 10(7) days per procedure. Perioperative blood transfusions for all nine patients amounted to a total of 7 units. The median survival after completion of liver and lung surgery was 27 (range 10–62) months. Median survival from resection of the first liver or lung metastasis was 30 (range 12–62) months and from excision of the primary colorectal tumour 46 (range 30–78) months. Two patients were alive and well 11 and 62 months after liver and lung resections; seven have died with metastases. This controversial aggressive treatment resulted in longer survival times than most alternative therapies in these highly selected and well motivated young patients, with no hospital mortality and only moderate morbidity.
Pancreatic transplantation as a small programme
Authors: Griffin P J A , Owens D , Krishnan H , Salaman J R 
Published: March 2007

Abstract
Seventeen pancreatic transplantations were performed in 17 patients with diabetic renal failure over a 6-year period. Ten patients received a simultaneous kidney transplant, the other seven having undergone previous successful renal transplantation. The actuarial pancreatic survival rate at 12 months was 63 per cent and the patient survival rate 92 per cent. The kidney transplant 12-month survival rate (86 per cent) did not differ significantly from that in a group of 22 diabetic patients receiving kidney transplants alone during the same period. Patients with a successful pancreatic transplantation had an increase in quality of life but most developed one or more complications; sometimes these required prolonged hospitalization. Pancreatic transplantation should be restricted to patients with diabetic renal failure who are particularly unstable or exhibit progressive diabetic complications. A small programme can be successful in directing what is an expensive procedure towards patients who are most likely to benefit.
Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract
Authors: Tsukada K , Yoshida K , Aono T , Koyama S , Shirai Y , Uchida K , Muto T 
Published: March 2007

Abstract
Seven patients with advanced carcinoma of the extrahepatic biliary tract, including two with cancer of the gallbladder, underwent major hepatectomy with concomitant pancreatoduodenectomy. The mean hepatic volume resected was 64 (range 35–81) per cent. Postoperative complications occurred in all patients and accounted for two hospital deaths. Two patients with gallbladder carcinoma survived without recurrence for 22 and 58 months. Three of five patients with bile duct cancer survived operation, although all three subsequently died from recurrent disease at 8, 10 and 27 months. Combined major hepatectomy and pancreatoduodenectomy may be appropriate in selected patients with advanced cancer of the gallbladder. Further evaluation is necessary before this approach can be recommended for those with advanced bile duct carcinoma.
Cholesterolosis in patients with chronic acalculous biliary pain
Authors: Kmiot W A , Perry E P , Donovan I A , Lee M J R , Wolverson R F , Harding L K , Neoptolemos J P 
Published: March 2007

Abstract
The outcome of patients with cholesterolosis was compared with that of those with chronic cholecystitis operated on for chronic acalculous biliary pain. A total of 55 patients with acalculous biliary pain with a median symptom duration of 24 (range 6–120) months were investigated by dynamic cholescintigraphy and followed for a median of 24 (range 12–60) months. Thirty-five patients underwent cholecystectomy, of whom 22 had a low gallbladder ejection fraction (under 35 per cent), with symptomatic improvement in 21 of these (P&lt;0·01). All four patients with a normal ejection fraction (35–50 per cent) improved after cholecystectomy but only four of nine with a high ejection fraction (over 50 per cent) did so. Results of histological examination were available in 32 patients and revealed cholesterolosis in 20. A low ejection fraction was found in 16 patients with cholesterolosis, of whom 15 showed symptomatic improvement after cholecystectomy; the other four patients had a high fraction and all improved after cholecystectomy. Overall, symptoms in 19 of 20 patients with cholesterolosis improved after cholecystectomy compared with only seven of 12 with chronic cholecystitis (P=0·03).
Choledochoduodenostomy and sphincterotomy in the treatment of choledocholithiasis
Authors: Ramirez P , Parrilla P , Bueno F S , Abad J M P , Muelas M S , Candel M F , Robles R , Aguilar J , Lujan J , Sanchez J 
Published: March 2007

Abstract
Over a 10-year period, 2610 patients underwent operation for biliary lithiasis. Exploratory choledochotomy was indicated in 591 patients (22·6 per cent). This was followed by simple choledochorrhaphy over a T tube in 240 patients (40·6 per cent), transduodenal sphincterotomy and choledochorrhaphy over a T tube in 126 (21·3 per cent), supraduodenal choledochoduodenostomy in 216 (36·5 per cent), and choledochoduodenostomy and transduodenal sphincterotomy in nine (1·5 per cent). Choledochoduodenostomy was performed if the bile duct was more than 12 mm in diameter. The indication for transduodenal sphincterotomy was the presence of a stone impacted in the papilla and/or papillary stenosis. Six patients developed abdominal abscess and three an external biliary fistula following choledochoduodenostomy. There were four abscesses and two episodes of acute pancreatitis in patients undergoing sphincterotomy. There was no difference in mortality rate between the two groups. After a mean follow-up of 5·6 years, 71·5 per cent of patients who underwent choledochoduodenostomy and 75·2 per cent of those who received transduodenal sphincterotomy were asymptomatic. The remainder suffered from dyspepsia, colicky pain or episodes of cholangitis. Nine patients underwent reoperation for residual calculi (six choledochoduodenostomies, three sphincterotomies).
Venous and non-venous leg ulcers: Clinical history and appearance in a population study
Authors: Nelzén O , Bergqvist D , Lindhagen A 
Published: March 2007

Abstract
In a defined Swedish population of 270 800, all patients with current chronic leg ulcers (827) were identified and a random sample of 382 studied in detail. Ulcers of primarily venous cause comprised 54 per cent of the total, giving a point prevalence of 0–16 per cent (95 per cent confidence interval 0–15-0-18 per cent). Half of all patients experienced their first ulcer episode before the age of 65 years, a greater proportion (61 per cent, P&lt;0·0001) in the subgroup with venous ulcers. The median duration of ulcer diathesis was significantly longer in patients with venous than in those with non-venous lesions (13·4 versus 2·5 years, P &lt; 0·001). About half the patients with venous and non-venous ulcers had had their current lesion for longer than 1 year. Venous ulcers were more often recurrent than those of non-venous type (72 versus 45 per cent of patients, P&lt;0·0001). Patients with venous ulcers had a significantly higher body mass index (P&lt;0·001). The number of dressing changes performed per week was 1100 per 100000 population. The predictive value of ‘classical’ clinical indicators of venous ulcer did not exceed 0·76. To increase the accuracy of diagnosis of venous ulcer, clinical examination should be combined with non-invasive ‘objective’ haemodynamic assessment of the venous circulation.
Experimental experience with a temporary intraluminal heparin-bonded polyurethane arterial shunt
Authors: Walker A J , Mellor S G , Cooper G J 
Published: March 2007

Abstract
After vascular injury, intraluminal arterial shunting may be employed if definitive surgery must be delayed. This paper describes use of a heparin-bonded polyurethane shunt to restore distal circulation after ligation of the femoral artery in sheep. In studies to determine tissue viability for 12 h after insertion into the femoral artery, five of seven shunts remained patent. In another series of experiments to study tissue viability after limb ischaemia, the femoral artery was ligated and a tight Esmarch bandage applied to the limb for 6 h before shunt insertion. The shunt remained patent for 12 h in five of six cases. Nearly all shunt failures occurred shortly after placement and were attributable to intimal damage arising from difficulties during insertion.
Audit of emergency preoperative resuscitation
Authors: McIlroy B , Miller A , Copeland G P , Kiff R 
Published: March 2007

Abstract
A total of 148 patients of mean age 61 years with acute gastrointestinal disease who were assessed as requiring preoperative resuscitation were studied. Overall, the mortality rate was 14·2 per cent and the morbidity rate 50·7 per cent. Resuscitation was associated with a mean(s.e.m.) improvement in predicted mortality rate of 4·2(0·8) per cent and in morbidity rate of 4·3(0·7) per cent. However, there was a group of patients in whom resuscitation was unsuccessful, despite there being no apparent difference in duration or methods of resuscitation from those of the rest of the population studied. A poor response to resuscitation was found in 28 patients; this was commoner in the elderly (P&lt; 0·001) and in women (P&lt; 0·05). Complications were more frequent in patients failing to improve with resuscitation (P&lt; 0·001). In the group deteriorating despite resuscitative efforts, there was a greater proportion of patients with a perforated viscus (P&lt; 0·001), whereas intestinal obstruction was less common (P&lt; 0·05). This study demonstrates that resuscitation can be audited and quantified. Preoperative resuscitation appears to be beneficial, but there is a group that may benefit from synchronous surgery and resuscitation.