bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasonographic screening for abdominal aortic aneurysm in an urban community
Authors: Smith F C T , Grimshaw G M , Paterson I S , Shearman C P , Hamer J D 
Published: March 2007

Abstract
As part of the Birmingham Community Aneurysm Screening Project, 3500 men aged 65–75 years from 20 urban general practices were invited for aortic ultrasonographic screening at their own general practitioner's surgery; 2669 (76.3 per cent) attended. Compliance rates varied between catchment areas, from 52.1 per cent for inner-city areas to 89.6 per cent for suburbs. Successful aortic imaging was achieved in 97.3 per cent of scans. Aortic diameter &gt; 29 mm occurred in 219 patients (8.4 per cent) and 79(3.0 per cent) with a diameter &gt; 40 mm were referred for vascular surgical assessment; 140 patients with an aortic diameter of 29–40 mm are currently undergoing follow-up by serial ultrasonographic examinations at intervals of 3 months at their doctor's surgery. Risk factor analysis revealed ischaemic heart disease in 21.9 per cent of men with aneurysm, compared with 11.6 per cent in those without (P &lt; 0.001); 18.3 per cent of men with aneurysm had had a previous myocardial infarction and 13.2 per cent had peripheral vascular disease, compared with 7.4 per cent (P &lt; 0.001) and 8.0 per cent (P &lt; 0.01) respectively of those without. No association was found between aneurysm and hypertension or diabetes. Community-based aortic screening is an inexpensive, effective method of diagnosis of aneurysm, with high compliance from the at-risk cohort of an urban population. Such screening programmes may help to reduce the mortality rate from aortic aneurysm rupture.
Resting energy expenditure in patients undergoing transhiatal or transthoracic oesophagectomy for carcinoma of the thoracic oesophagus
Authors: Sato N , Kusama A , Ohkawa A , Koyama Y , Oyamatsu M , Kayama S , Yoshikawa K , Tanaka O , Muto T 
Published: March 2007

Abstract
Resting energy expenditure (REE) was studied in five patients undergoing transhiatal and in 14 undergoing transthoracic oesophagectomy for carcinoma. All resections were performed with an intention to cure. REE was measured by indirect calorimetry before operation and on days 1, 3, 5 and 7 after surgery. Following transthoracic oesophagectomy, REE increased significantly on days 1, 3, 5 and 7 after operation, and on day 7 the value was significantly higher (P &lt;0·05) than that obtained after transhiatal surgery. Energy expenditure following transhiatal oesophagectomy is lower than that after transthoracic oesophagectomy; this may be a result of reduced surgical stress.
Lymph node metastases in early rectal cancer
Authors: Huddy S P J , Husband E M , Cook M G , Gibbs N M , Marks C G , Heald R J 
Published: March 2007

Abstract
Local excision of early rectal tumours is an attractive proposition, avoiding the morbidity and mortality of major resection and possible permanent stoma. This study was designed to investigate the incidence of lymph node metastases associated with tumours that are locally confined to the bowel wall. A total of 454 rectal excision specimens were reviewed. Twenty-two (20 per cent) of 109 patients with tumours locally confined to the bowel wall had metastases in local lymph nodes, although 14 of these had only one or two involved nodes. Three of 27 patients with tumours that did not penetrate through the submucosa had lymph node metastases. Less well differentiated tumours were more likely to have metastasized but there was no significant difference in the height or size of tumours or in the depth of invasion between patients with or without lymph node metastases.
Role of the leucocyte in the pathogenesis of vascular disease
Authors: Bradbury A W , Murie J A , Ruckley C V 
Published: March 2007

Abstract
The leucocyte plays a key role in the local and systemic tissue injury that results from peripheral arterial disease and chronic venous insufficiency. Despite the apparent dissimilarities between limb ischaemia and chronic venous ulceration, in both diseases macrovascular abnormalities lead to microvascular leucocyte trapping and activation. Activated leucocytes adhere to and damage adjacent endothelium by expressing adhesion molecules and releasing harmful moieties such as proteases and free radicals. Subsequent loss of endothelial integrity and the migration of activated leocytes outwith the circulation leads to destruction of surrounding tissue. Leucocytes and their products are also involved in the systemic manifestations of ischaemia such as multiple organ failure and coagulopathy. An overview of leucocyte biology as it pertains to peripheral arterial and venous disease is presented. The opportunities for novel therapeutic interventions based on a better understanding of this biology are also discussed.
Role of surgery and chemotherapy for peripheral lymph node tuberculosis
Authors: Subrahmanyam M 
Published: March 2007

Abstract
A total of 105 patients with peripheral lymph node tuberculosis were treated by either surgical excision and chemotherapy or chemotherapy alone. The cervical nodes were affected in 98 patients, axillary nodes in four and inguinal nodes in three. Biopsy of the lymph nodes confirmed the diagnosis in all cases. Thirty-five patients who had sinus, ulcer or abscess underwent excision of the lymph nodes with drainage of the abscess, or resection of the sinus or ulcer. The remaining 70 patients received only chemotherapy. Chemotherapy in all patients consisted of isoniazid and ethambutol for 18 months. Of the 35 patients treated with surgery and chemotherapy, two had gaping wounds, one infection and one cellulitis of the face and neck. After 3 months, one patient had recurrence of the lymph node mass and one recurrence of a sinus; these were excised. Of the 70 patients treated only with chemotherapy, 13 were lost to follow-up. Four had non-healing wounds at the biopsy site, six wound infection and two sinus formation. Five of these patients had persistent lymph node masses, which were excised after 3 months. The remaining 52 patients had no recurrence.
Reliability of clinical judgement in evaluation of the nutritional status of surgical patients
Authors: Lupo L , Pannarale O , Altomare D , Memeo V , Rubino M 
Published: March 2007

Abstract
The ability of surgeons to make a reproducible and reliable evaluation of the nutritional status of patients was assessed. Three independent observers assigned 64 patients to one of four nutritional states — normal nourishment, and mild, moderate and severe malnutrition — using a questionnaire and clinical examination. Interobserver variability was analysed using the K statistic and reliability by assessing the correlation between the assigned class and total serum protein, haemoglobin, albumin, transferrin and cholesterol levels, weight loss and the results of immunological skin tests. Concordance was observed in 49 of the 64 judgements (77 per cent) and partial agreement in the remainder (K = 0·74, P &lt; 0·001). Clinical judgement correlated significantly with albumin, transferrin and cholesterol levels and weight loss (R2 = 0·73, P &lt; 0·001). Surgeons are able to assess nutritional status using clinical judgement.
Prolonged normothermic ischaemia of human cirrhotic liver during hepatectomy: A preliminary report
Authors: Kim Y I , Nakashima K , Tada I , Kawano K , Kobayashi M 
Published: March 2007

Abstract
To evaluate the tolerance of the cirrhotic liver to extended warm ischaemia, 47 patients with cirrhosis who underwent liver resection over a 4-year period were studied retrospectively. Three groups of patients were identified. In group 1 (14 patients) liver resection was performed under conditions of portal triad occlusion ranging from 50 to 75 (mean 57·1) min. Group 2 (12 patients) was treated with portal occlusion for a period ranging from 30 to 42 (mean 33·1) min. Group 3 comprised 21 patients who underwent hepatectomy using conventional techniques. Mean blood loss was significantly reduced by portal triad occlusion (819 ml in group 1, 523 ml in group 2) compared with the conventional technique (1652 ml in group 3) (P &lt; 0·05, group 1 versus group 3; P &lt; 0·01, group 2 versus group 3). Hospital death occurred in three of the 21 patients in group 3 but in no patient who underwent portal triad occlusion. The morbidity rate was lower in the two occlusion groups (four of 26 patients) than in group 3 (six of 21). Bilirubin metabolism was substantially better after surgery in the occlusion groups (P &lt; 0·05, groups 1 and 2 versus group 3 at day 14). Although the serum levels of transaminases were significantly raised until day 3 in patients undergoing long-term occlusion, the cirrhotic liver withstood the ischaemia—reperfusion insult, as assessed by changes in hepatic microcirculation, lipid peroxidation and the morphology of hepatic sinusoids. It is concluded that prolonged ischaemia during liver resection can be sustained in patients with cirrhosis and without high-risk factors.
Total pelvic exenteration: A justified procedure
Authors: Plukker J Th , Aalders J G , Mensink H J A , Oldhoff J 
Published: March 2007

Abstract
Twenty patients with advanced primary or locally recurrent pelvic tumours treated by total pelvic exenteration are described. There were no operative or postoperative deaths. The most frequent postoperative complications appeared to be related to previous irradiation. Four patients developed non-fatal intestinal complications within 30 days of operation that required further surgery. After a mean follow-up of 19 months the crude 2-year survival rate was 40 per cent. This procedure is judged to be useful in a selected group of patients.
Secondary proctectomy and ileal pouch—anal anastomosis after ileorectal anastomosis for familial adenomatous polyposis
Authors: Penna C , Kartheuser A , Parc R , Tiret E , Frileux P , Hannoun L , Nordlinger B 
Published: March 2007

Abstract
Conversion of ileorectal anastomosis to ileal pouch—anal anastomosis (IPAA) was indicated in 29 patients with familial adenomatous polyposis but technically impossible in three because of unsuspected pelvic desmoid tumours. There was no operative mortality and overall postoperative morbidity and late complication rates were no different from those in a group of 120 patients who underwent IPAA as a first operative procedure. Unsuspected adenocarcinoma (one invasive, three in situ) was found in four patients. The functional results in patients with IPAA did not differ from those of ileorectal anastomosis before conversion or from those obtained after IPAA as a first-choice procedure. Secondary proctectomy and IPAA can be safely offered to patients with ileorectal anastomosis and a high risk of rectal cancer.
Local recurrence of colorectal cancer: The problem, mechanisms, management and adjuvant therapy
Authors: Abulafi A M , Williams N S 
Published: March 2007

Abstract
Local recurrence of colorectal cancer after ‘curative’ surgery is a major clinical problem. Typically, 50–70 per cent of patients presenting to a surgical clinic will undergo apparently curative surgery for disease and of these about 10–25 per cent will develop local recurrence, in either the tumour bed or bowel wall. The wide differences in local recurrence rate both between and within institutions is probably caused by variation in surgical technique. The main causes of local recurrence are inadequate excision of the primary tumour or the draining lymph nodes, and intraoperative tumour cell implantation. The most significant single factor prognostic of local recurrence is Dukes' tumour stage. Other important factors include tumour grade and fixity, level of the tumour in the rectum, blood and lymphatic vessel invasion inadvertent perforation of the tumour during resection, and the surgeon's experience. The prognosis of patients with local recurrence is poor. Prevention of recurrence by adequate surgery and adjuvant therapy as well as its early detection offer the best prospect of improving results.
Early detection of major complications after abdominal aortic surgery: Predictive value of sigmoid colon and gastric intramucosal ph monitoring
Authors: Björck M , Hedberg B 
Published: March 2007

Abstract
The early detection and reversal of gastrointestinal ischaemia is thought to play a key role in minimizing the incidence of complications after abdominal aortic surgery. In an open prospective non-selective study intramucosal pH (pHi) was monitored in 27 patients undergoing elective aortic surgery and in seven submitted to emergency procedures. The pHi was monitored in the sigmoid colon in all 34 patients and in the stomach in 26. Eight patients developed major complications, four of whom had ischaemic colitis, and five died. Sigmoid acidosis (pHi below 7·10) served as an early warning; if acidosis was reversed within 2 h no major complication developed, if prolonged it was predictive of major morbidity (sensitivity 100 percent, specificity 92 per cent). A colonic pHi below 6·86 predicted endoscopically detectable ischaemic colitis. A gastric pHi below 7·20 predicted major complications with a sensitivity of 100 per cent and specificity of 81 per cent. Both monitoring procedures were considered feasible, although monitoring in the sigmoid colon was found to be superior for the patients studied.
Prospective study of 713 below–knee amputations for ischaemia and the effect of a prostacyclin analogue on healing
Authors: Dormandy J , Belcher G , Broos P , Eikelboom B , Laszlo G , Konrad P , Moggi L , Mueller U 
Published: March 2007

Abstract
In 51 hospitals in six European countries 713 patients requiring below–knee amputation for ischaemic disease were studied prospectively. The patients were allocated randomly to receive standard postoperative treatment or standard treatment plus intravenous infusion of the prostacyclin analogue iloprost for 6 h per day over 14–21 days. Healing of the amputation stump and the need for reamputation at a higher level were similar in the two groups. Overall at 3 months 59 per cent of stumps had healed, 19 per cent of patients had required reamputation at a higher level, 11 per cent had died and the remaining 11 per cent remained with unhealed stumps. Preoperative characteristics were analysed as possible risk factors or markers for primary healing, reamputation and death. Previous arterial reopening procedures (surgical or radiological) almost doubled the chances of primary stump healing (P&lt;0–05). The surgeon's assessment of the likelihood of healing was wrong in 21 per cent of cases in which the operating surgeon thought that healing would probably occur and in 52 per cent of those in which it was thought healing was improbable.
Prevalence of impaired cerebrovascular reserve in patients with symptomatic carotid artery disease
Authors: Naylor A R , Merrick M V , Gillespie I , Sandercock P A G , Warlow C P , Cull R E , Griffin T M G , Ruckley C V 
Published: March 2007

Abstract
Cerebrovascular reserve (CVR) was studied in 104 consecutive patients with symptomatic carotid territory disease and ipsilateral internal carotid artery stenosis. Overall, 30 of 104 patients (29 per cent) had impaired CVR. The frequency of CVR impairment increased with the severity of internal carotid artery stenosis: impairment was present in none of 11 patients with stenosis of less than 50 per cent, four of 24 with stenosis of 50–69 per cent, 14 of 41 with stenosis of 70–89 per cent and 12 of 28 with stenosis of 90–99 per cent. Patients presenting with a stroke were significantly more likely to have impaired CVR than those with transient ischaemic attacks and/or amaurosis fugax (odds ratio 3·7 (95 per cent confidence interval (c.i.) 1·5–9·0)), as were those with a residual neurological deficit (odds ratio 4·3 (95 per cent c.i. 1·6–11·5)) and evidence of infarction from computed tomography (odds ratio 3·8 (95 per cent c.i. 1·6–9·4)).
Insulin resistance after abdominal surgery
Authors: Thorell A , Efendic S , Gutniak M , Häggmark T , Ljungqvist O 
Published: March 2007

Abstract
A study was carried out to determine the time course and degree of postoperative insulin resistance in patients undergoing elective abdominal surgery. Mean(s.e.m.) insulin sensitivity was determined before and on the first (n = 10), fifth, ninth and 20th (n = 5) days after elective open cholecystectomy using the normoglycaemic (4·7(0·1) mmol/1), hyperinsulinaemic (402(12) pmol/1) glucose clamp technique. Preoperative insulin sensitivity expressed as the M value varied from 2·3 to 8·2 mg per kg per min. The relative reduction in insulin sensitivity was most pronounced on the first day after surgery, at a mean(s.e.m.) of 54(2) per cent. Thereafter, a large variation between individuals was found during the course of recovery, and insulin sensitivity returned to normal 20 days after operation. On the first day after surgery, plasma concentrations of glucose, C peptide, noradrenaline and glucagon were slightly but significantly higher than before operation (P &lt; 0·05), whereas insulin, growth hormone, cortisol and adrenaline levels were unaltered. Marked insulin resistance thus develops after elective upper abdominal surgery and persists for at least 5 days after operation. Factors other than simultaneous changes in levels of the hormones studied seem to regulate the maintenance of postoperative insulin resistance.
Superficial parotidectomy in the treatment of cutaneous melanoma of the head and neck
Authors: Barr L C , Skene A I , Fish S , Thomas J M 
Published: March 2007

Abstract
The preauricular lymph nodes are frequently the first site of metastatic disease from primary malignant melanoma of the upper two-thirds of the face or the anterior scalp. For these patients, or those with adjacent metastatic nodal disease, the prognosis is poor. The median survival of 13 such patients presented was 2 years, with two long-term survivors at 4 and 6 years. Palliative surgery can, however, prevent uncontrolled locoregional disease. Patients with palpable preauricular and cervical node disease should be treated by facial nerve-preserving parotidectomy and radical neck dissection. When no cervical nodes are palpable in patients with preauricular node metastasis, peroperative jugulodigastric node biopsy and frozensection histopathological examination are useful to select patients for radical neck dissection.
Peripheral versus central intravenous nutrition: Comparison of two delivery systems
Authors: Kohlhardt S R , Smith R C , Wright C R 
Published: March 2007

Abstract
Forty-six surgical patients who required intravenous nutrition (IVN) were randomly allocated to receive complete IVN by a peripheral (n = 23) or central (n = 23) venous delivery system. The peripheral IVN system combined a fine-bore silicone catheter with lipid-based nutrient solutions whereas the central system used a conventional glucose-based nutrient regimen and a single-lumen central venous catheter. The incidence of catheter complications and the complication·free system function over time were compared. Problems of venous access were not observed with peripheral IVN but occurred with one central catheterization. Three patients with central venous catheters developed bacteraemia but only one incident was thought to be catheter related (bacterial translocation). There were no such episodes with peripheral IVN. Peripheral catheterization was not associated with infective phlebitis, although late-onset chemical phlebitis occurred on four occasions after a mean(s.e.m.) time of 22·8(6·1) days, representing a daily risk of phlebitis of 0·009. There was no significant difference in the probability of complication-free system function with time between peripheral and central IVN (P = 0·14). The fine-bore silicone catheter peripheral IVN delivery system resulted in long-term phlebitis-free infusion for periods that were similar to those of single-lumen central catheterization by life-table analysis.
Effect of gastric resection, Roux-en-Y diversion and vagotomy on gastric emptying in the rat
Authors: Houghton A D , Liepins P , Clarke S M , Mason R C 
Published: March 2007

Abstract
Solid and liquid gastric emptying studies were conducted in 61 male Wistar rats. In 20 animals a two-thirds Póya-type gastric resection was performed and 21 had a similar resection with a 10-cm Roux-en-Y diversion. In nine of the Roux diversions truncal vagotomy was also carried out. Twenty animals acted as controls: ten unoperated and ten that received laparotomy only. Body-weight and gastric emptying were measured weekly for 4 weeks and monthly for 4 months after surgery. Animals subjected to gastrectomy revealed a weight loss of approximately 16 per cent after operation. Weight gain was slower after Roux reconstruction than after Pölya-type anastomosis and slowest in animals with vagotomy and Roux drainage (P &lt; 0·05). Gastric emptying was unchanged in unoperated controls. Animals in which a laparotomy was performed had delayed solid and liquid emptying for the first 4 weeks after operation (P &lt; 0 · 05). Following Pölya-type gastrectomy, liquid emptying was delayed for 4 months. Solid emptying was unchanged, with no evidence of the delay present in animals with a laparotomy. Animals subjected to Roux-en-Y diversion showed a greater delay in liquid emptying than those with a Póya resection; solid emptying was also delayed (P &lt; 0 · 05). Severe gastric retention of liquids and solids occurred in the early postoperative phase when vagotomy was added to the Roux diversion (P &lt; 0 · 01). Emptying of solids adopted a relatively normal linear pattern after this initial retention. Emptying of liquids, however, remained abnormal, appearing to adopt a biphasic pattern.
Testicular atrophy as a consequence of inguinal hernia repair
Authors: Reid I , Devlin H B 
Published: March 2007

Abstract
Testicular atrophy is an uncommon but well recognized complication of inguinal hernia repair and one that frequently results in litigation. A series of ten cases of testicular atrophy occurring after hernia repair in nine patients is presented. Identifiable risk factors were present in eight instances. Surgeons should make careful enquiries as to previous groin or scrotal surgery and, when indicated, warn the patient before surgery of the increased risk of testicular atrophy. Overzealous dissection of a distal hernia sac, dislocation of the testis from the scrotum into the wound and concomitant scrotal surgery should all be avoided.
Prospective study of open cholecystectomy for calculous biliary disease
Authors: Moreaux J 
Published: March 2007

Abstract
Data of 5000 consecutive patients with biliary lithiasis operated on between 1970 and 1990 were recorded prospectively. There were 476 emergency procedures and 125 reoperations. Concomitant abdominal operations were performed in 504 patients. The mean(s.d.) age was 54·7(14·2) years. Cholecystectomy was performed in 4872 patients (97·4 per cent) and intraoperative cholangiography in 4400 (88·0 per cent). There were 612 operations for acute cholecystitis, 579 for common bile duct stones, 50 for acute pancreatitis and 29 reoperations following injury to the bile duct. Complications occurred in 527 patients (10·5 per cent). There was one injury (0·02 per cent) to the hepatic duct. The complication rate was 7·0 per cent following elective cholecystectomy and 17·4 per cent after emergency surgery. The mortality rate was zero after elective procedures and 0·8 per cent after emergency surgery; the mortality rate after concomitant abdominal operations (1·0 per cent) was unrelated to the biliary procedure. The mean(s.d.) hospital stay was 12·8(5·2) days.