bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coloanal sleeve anastomosis in the treatment of diffuse cavernous haemangioma of the rectum: Long-term results
Authors: Londono-Schimmer E E , Ritchie J K , Hawley P R 
Published: March 2007

Abstract
Diffuse cavernous haemangioma of the rectum is an unusual lesion. In 1971 Parks and co-workers described resection and coloanal sleeve anastomosis as an alternative operation in the treatment of this rare malformation. The clinical presentation, diagnosis and long-term results of patients with this condition managed by such a surgical technique are described. Resection and coloanal sleeve anastomosis offers major advantages such as a lower risk of intraoperative bleeding, no risk of damaging the pelvic nerves, sparing of continence and avoidance of a permanent colostomy. It should therefore be considered the treatment of choice for this uncommon condition.
Treatment of anal intraepithelial neoplasia
Authors: Scholefield J H , Ogunbiyi O A , Smith J H F , Rogers K , Sharp F 
Published: March 2007

Abstract
The natural history and malignant potential of anal intraepithelial neoplasia (AIN) remain uncertain, making management decisions about such lesions difficult. The management of 70 patients with AIN is described. The majority of lesions encountered were low grade (AIN I and II; 43 of 70) and required no treatment, but eight invasive anal cancers associated with high-grade AIN occurred over the 4-year study period. Three were a result of apparent progression of high-grade lesions; three more invasive lesions were found in areas of AIN III on histological examination. Surgical excision was used to treat 27 patients with AIN III. Treatment of extensive lesions involving the perianal and anal canal epithelium circumferentially in six patients involved excision of the whole of this epithelium and application of split skin grafts.
Endothelial seeding of compliant polyurethane vascular graft material
Authors: Stansby G , Berwanger C , Shukla N , Schmitz-Rixen T , Hamilton G 
Published: March 2007

Abstract
Compliance was measured in a new compliant polyurethane vascular graft material and in polytetrafluoroethylene (PTFE) graft material using an ultrasonic device; attachment of indium-111 oxine-labelled human endothelial cells to both surfaces with a range of surface coatings was assessed. Compliant polyurethane was six to eight times more compliant than PTFE (P&lt;0·01) at all pressures in the range 50-120 mmHg, and endothelial cell attachment to uncoated polyurethane was three times better than to uncoated PTFE at times up to 90 min (P&lt;0·01). Attachment to polyurethane was also better after blood clot, collagen and fibronectin treatment at times up to 30 min (P&lt;0·05). Endothelial seeding of compliant graft material may provide a prosthetic vascular substitute with characteristics similar to those of autologous vein.
Traumatic arteriovenous fistula: Experience with 202 patients
Authors: Robbs J V , Carrim A A , Kadwa A M , Mars M 
Published: March 2007

Abstract
Experience with the management of 202 patients with 210 traumatic arteriovenous fistulas is reported. Penetrating trauma accounted for 98 per cent of injuries caused mainly by stabs (63 per cent) and missile wounds (26 per cent). Seven of 15 patients with shotgun wounds had multiple lesions. Over half of all fistulas occurred in the cervicomediastinal vessels; abdominal and thoracic vessels were infrequently involved. The upper limbs were involved in 22 per cent and the lower limbs in 20 per cent. Some 133 patients were diagnosed and treated within 1 week of injury; 69 presented 1 week to 12 years later. Machinery murmur was noted in 61 per cent of the early presenters, but was an almost universal finding in those presenting late. Only three patients had cardiac failure and all had underlying cardiomyopathy. Active overt haemorrhage was not common. Arterial continuity was restored in 80 per cent of cases, usually by autogenous reconstruction. Venous injury was usually treated by ligation or lateral suture. Patients treated within 1 week of injury had a lower rate of perioperative mortality and morbidity than those treated late, due mainly to technical difficulties in controlling the vessels caused by fibrosis and massive venous dilatation. If a policy of selective exploration of penetrating trauma is to be followed, careful assessment for arteriovenous fistula must be made and the patient evaluated at regular intervals for several months. Shotgun injuries require routine angiography at the time of presentation. The earlier treatment is instituted, the better the results.
Improved survival in simulated surgical infection with combined cytokine, antibiotic and immunostimulant therapy
Authors: Gaar E , Naziri W , Cheadle W G , Pietsch J D , Johnson M , Polk H C 
Published: March 2007

Abstract
A study was performed to find an ideal combination and sequence of cytokines, antibiotics and immunorestorative agents to enhance survival from serious infection. The effects of combinations of granulocyte-macrophage colony-stimulating factor (GM-CSF), tumour necrosis factor (TNF) a, the immune adjuvant muramyl dipeptide (MDP) and two systemic antibiotics were studied in a validated murine model of surgical infection. A single cotton suture containing absorbed Klebsiella pneumoniae was placed into the thighs of mice to produce local and systemic infection. Control mice received a volume of subcutaneous saline equal to that of the therapeutic agent; only 18 per cent survived 9 days after infection. The survival time of mice treated with any single agent was similar to that of controls. The group given maximal combined therapy (65 mice) received GM-CSF, TNF-a, MDP, and ampicillinsulbactam or cefoxitin for 6 days. The survival rate in this group 9 days after the introduction of infection was 84–90 per cent (P&lt; 0·0001), suggesting that specific combinations of cytokines, immunostimulants and antibiotics may be useful in combating lethal infection.
Randomized comparison of fine-needle aspiration cytology and Biopty-Cut needle biopsy after unsatisfactory initial cytology of discrete breast lesions
Authors: Carty N J , Ravichandran D , Carter C , Mudan S , Royle G T , Taylor I 
Published: March 2007

Abstract
In a minority of patients with a discrete breast lump the initial cytological assessment is either unsatisfactory or at variance with the results of other methods of diagnosis. A randomized comparison of repeat cytology and needle-core biopsy provided clinically useful information in 14 of 31 patients receiving repeat cytology and in 26 of 29 randomized to core biopsy. Nineteen patients had carcinoma: ten who received repeat cytology, which indicated malignancy in only three (diagnostic of malignancy in one, suspicious in two), while all nine patients who underwent core biopsy had a correct diagnosis (only suspicious of malignancy in one). The sensitivity for the definitive diagnosis of carcinoma on repeat cytology and core biopsy was 10 and 89 per cent respectively. Patients with a discrete breast lump and unclear cytology results require needle-core biopsy. This has more diagnostic value than repeat cytology.
Detection of hepatitis C virus RNA in the ultrasonic dissector irrigating solution used in liver surgery
Authors: Higashi H , Matsumata T , Hayashi J , Yanaga K , Shimada M , Shirabe K , Taketomi A , Kashiwagi S , Sugimachi K 
Published: March 2007

Abstract
Hepatitis C virus (HCV) RNA was detected in the irrigating solution aspirated by the ultrasonic dissector system used in liver surgery with a reverse transcription polymerase chain reaction technique and was then compared with HCV RNA in the serum to clarify the risk of viral transmission to hospital personnel. The positivity of HCV RNA in the aspirated irrigating solution was approximately equal in all patients whose serum was positive for HCV RNA. However, viral RNA was not detected in the aspirated irrigating solution of any patient who was seronegative for HCV RNA. These results indicate that it is necessary to be cautious regarding the transmission of HCV during liver surgery when using the ultrasonic dissector in HCV RNA seropositive patients, because the irrigating solution aspirated by this device appears to be highly infectious.
Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas
Authors: Izbick J R , Bloechle C , Knoefel W T , Wilker D K , Dornschneider G , Seifert H , Passlick B , Rogiers X , Busch C , Broelsch C E 
Published: March 2007

Abstract
Chronic pancreatitis frequently generates complications through involvement of adjacent organs. Distal common bile duct stenosis and segmental duodenal stenosis, the most frequent complications, are usually treated by resection or bypass procedures. This study presents experience with duodenum-preserving resection of the head of the pancreas in the treatment of patients with chronic pancreatitis with predominant involvement of the pancreatic head and coexisting complications involving adjacent organs. This procedure preserves the structure and function of the bile duct and duodenum. Sixty-six patients with severe chronic pancreatitis underwent duodenum-preserving resection of the head of the pancreas. Thirty-eight had associated complications of neighbouring organs: 37 had distal common bile duct stenosis, seven had duodenal stenosis, ten had evidence of segmental portal hypertension and one suffered from a pancreatopleural fistula. Details of all patients were documented prospectively; mean follow-up was 4·2 years. The complications of adjacent organs were permanently eradicated in 36 of 38 patients. Two patients required endoscopic stenting for persisting bile duct obstruction. There was substantial or complete relief of all symptoms in 35 patients. Duodenum-preserving resection of the head of the pancreas is effective in the treatment of severe chronic pancreatitis with predominant involvement of the pancreatic head and provides definitive management of associated complications of adjacent organs.
Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses
Authors: Berggren U , Gordh T , Grama D , Haglund U , Rastad J , Arvidsson D 
Published: March 2007

Abstract
Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholecystolithiasis. There is very little evidence, however, to support the claimed benefit to patients. In the present study 30 consecutive patients below the age of 65 years without acute cholecystitis and with no signs of common bile duct stones were randomized to laparoscopic or conventional open eholecystectomy. Median (interquartile range) intravenous consumption of pethidine with a patientcontrolled injection device between 13 and 24 h after surgery was 125 (62–175) mg in patients who underwent the laparoscopic procedure and 200 (150–250) mg in those who had open operation. Urinary adrenaline and cortisol levels as well as those of plasma glucose, C-reactive protein and interleukin 6 were increased after surgery in both groups of patients, but without any significant difference between them. The mean(s.d.) duration of postoperative hospital stay (2·8(0·8) versus 1·8(0·6) days) and sick leave (24·0(4·4) versus 11·7(4·1) days) was significantly longer with open than laparoscopic cholecystectomy. The findings demonstrate obvious advantages of laparoscopic surgery as regards postoperative pain and convalescence, although factors reflecting the magnitude of trauma did not differ.
Colectomy and ileorectal anastomosis in patients with Crohn's disease
Authors: Chevalier J M , Jones D J , Ratelle R , Frileux P , Tiret E , Parc R 
Published: March 2007

Abstract
Eighty-three patients underwent colectomy and ileorectal anastomosis for Crohn's disease of the large bowel. There were two postoperative deaths and seven anastomotic leaks. Fifty-two patients retained a functioning anastomosis with a mean follow-up of 8 years. Forty had an excellent or good functional result. The cumulative proportion of patients with a functioning ileorectal anastomosis was 77 and 63 per cent at 5 and 10 years respectively. Patients presenting with perforating Crohn's disease had a significantly increased risk of failure of the anastomosis. Perianal Crohn's disease following ileorectal anastomosis was significantly related to the need to defunction or excise the rectum.
Trauma in pregnancy
Authors: Vaizey C J , Jacobson M J , Cross F W 
Published: March 2007

Abstract
Trauma is a major cause of maternal death in pregnancy. The pregnant woman who has been involved in an episode leading to her arrival in an accident and emergency department presents with specific problems that often require specialist attention. The correct initial management of such patients should not be beyond the capabilities of an average trauma team and such management is clearly taught as part of the Advanced Trauma Life Support course now available in the UK. This review outlines the physiological changes associated with pregnancy that become important during resuscitation and definitive care. It discusses the presentation and management of specific problems, and the safety - or otherwise - of commonly administered drugs. Only the initial resuscitation of the patient is considered; specialist obsteric care is beyond the scope of the article.
Macrolides in roles beyond antibiotic therapy
Authors: Pilot M-A 
Published: March 2007

Abstract
Erythromycin and other macrolides with a closely related structure are widely used antibiotics. Side-effects related to administration of such drugs are mostly gastrointestinal. The direct effect of erythromycin on gastrointestinal motility was studied; it was found to have a stimulatory effect proximally, on stomach and duodenal motility, with an apparent distal inhibition. Gastric emptying was accelerated by erythromycin via an antroduodenal coordination mechanism, an effect that has proved to be beneficial in surgical and medical conditions in which gastroparesis is a problem. Erythromycin is now used experimentally and clinically; it has been found to accelerate gastric as well as gallbladder emptying and to have an effect on the oesophagus. Analogues of erythromycin have been developed that have potent gastrointestinal activity but little or no antibacterial potential. Macrolides modulate the antibacterial action of neutrophils, with some action on the oxidative burst. Finally, two new macrolide immunosuppressants have been developed that compare favourably with traditional drugs.
Surgical workload as a consequence of screening for abdominal aortic aneurysm
Authors: Scott R A P , Gudgeon A M , Ashton H A , Allen D R , Wilson N M 
Published: March 2007

Abstract
A study was performed to evaluate the surgical workload that has resulted from screening an at-risk population for abdominal aortic aneurysm (AAA) and to forecast the likely workload from an established screening programme. Over an 8-year period 8944 people aged 65–80 years were screened; 356 were found to have an AAA of 3 cm or greater in diameter. There were 288 outpatient consultations involving 171 patients, and 43 patients (4·8 per 1000 screened) had surgery during the study period. A fully operational screening programme for a population of 250000, screening men and women at a rate of 2000 per year, would be expected to produce a surgical workload of nine or ten operations for AAA per year. Screening men only would increase this to 34 annually.
Pulse-generated run-off versus dependent Doppler ultrasonography for assessment of calf vessel patency
Authors: Currie I C , Wilson Y G , Davies A H , Micciche M , Wakeley C J , Baird R N , Lamont P M 
Published: March 2007

Abstract
Pulse-generated run-off (PGR) is an established technique in the assessment of calf vessel patency. Dependent Doppler ultrasonography is proposed as a fast and simple alternative. Twenty-six limbs with severe ischaemia were evaluated by PGR, dependent Doppler examination and intra-arterial digital subtraction angiography (DSA). PGR was performed and scored as previously described. Dependent Doppler ultrasonography was performed after 5 min of foot dependency and scored as for PGR. Angiograms were scored by an independent radiologist, who awarded 2 for a vessel widely patent to the ankle, 1 for a diseased vessel crossing the ankle and 0 if no vessel was visualized. Of 78 calf vessels evaluated, 59 (76 per cent) appeared patent on PGR and dependent Doppler examination but only 33 (42 per cent) appeared patent to the ankle with ïntra-arterial DSA. There was very good agreement between PGR and dependent Doppler for detection of patent calf vessels (κ = 0·93). Doppler signals were biphasic in six calf vessels on dependency and in 22 vessels with PGR. PGR and dependent Doppler ultrasonography detected 26 vessels communicating with the pedal arch compared with seven detected angiographically. There was good agreement between PGR and dependent Doppler examination for diagnosis of the most suitable vessel for distal anastomosis (κ = 0·80). The wide availability and simplicity of dependent Doppler ultrasonography mean that no patient with a critically ischaemic limb should be denied reconstructive surgery on the basis of angiographic findings alone.
Saphenous vein reflux without incompetence at the saphenofemoral junction
Authors: Abu-Own A , Scurr J H , Smith P D Coleridge 
Published: March 2007

Abstract
Duplex ultrasonography was used to assess patients with primary varicose veins to determine whether varicosities of the long saphenous vein (LSV) occurred without saphenofemoral junction (SFJ) incompetence. Some 167 consecutive patients with the clinical diagnosis of primary varicose veins were investigated. Of 190 limbs with LSV reflux 63 had no SFJ incompetence, of which only five had incompetent perforators; these were midthigh perforators in two limbs and medial calf perforators in three. LSV reflux, often occurs in the presence of a competent SFJ. This indicates that, in such circumstances, saphenofemoral ligation alone is unlikely to control varices associated with LSV reflux. It also suggests that the development of primary varicose veins may be an ascending rather than a descending phenomenon.
Stripping of the long saphenous vein in the treatment of primary varicose veins
Authors: Sarin S , Scurr J H , Smith P D Coleridge 
Published: March 2007

Abstract
Eighty-nine legs with long saphenous vein (LSV) reflux and saphenofemoral junction incompetence were treated by saphenofemoral ligation and multiple avulsions; patients were randomized to undergo additional stripping of the LSV from groin to upper calf (n = 43) or no additional treatment (n = 46). At a median of 21 months after surgery recurrence was evaluated by duplex ultrasonography, photoplethysmography, clinical examination and patient assessment. Fewer persisting incompetent LSVs in the calf were found (21 versus 38) and median (interquartile range) photoplethysmographic refilling times were longer (20 (13–27) versus 14 (11–21) s) when the LSV was stripped than after saphenofemoral ligation alone (both P&lt;0·01). More patients were completely satisfied (65 versus 37 per cent) and were recurrence-free (65 versus 17 per cent) when the LSV had been stripped compared with saphenofemoral ligation alone (P&lt;0·05 and P&lt;0·001 respectively). The addition of LSV stripping to saphenofemoral ligation and multiple avulsions results in a better overall outcome.
Prediction of recurrent bleeding after endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage
Authors: Park K G M , Steele R J C , Mollison J , Crofts T J 
Published: March 2007

Abstract
Endoscopic haemostasis by injection of adrenaline was attempted in 135 consecutive patients with active upper gastrointestinal bleeding. Initial haemostasis was obtained in 127 patients following injection of 5–15 ml 1 : 10000 adrenaline; eight patients in whom haemostasis was not achieved underwent immediate laparotomy. There was further haemorrhage in 25 patients, which was successfully treated by further injection of adrenaline in ten. Fifteen patients had major rebleeding requiring emergency surgery. Stepwise logistic regression analysis identified three factors that, taken together, were highly predictive of the need for surgery: pulse rate on admission, the position of the ulcer and whether the patient was obese. A scoring system was derived from the logistic analysis equation that was found to predict correctly the need for emergency surgery in 84 per cent of patients. In patients with a high probability of rebleeding surgery should be considered after initial endoscopic haemostasis and stabilization. In the majority of patients endoscopic treatment alone is sufficient for permanent haemostasis.
Surgical treatment of primary duodenal carcinoma: A personal series
Authors: Scott-Coombes D M , Williamson R C N 
Published: March 2007

Abstract
In a personal series, 22 patients (11 men, 11 women) of median age 60 (range 25–81) years with primary duodenal adenocarcinoma underwent operation between 1979 and 1993. Tumours arising from bile duct, ampullary or pancreatic tissue were excluded. Principal presenting symptoms were jaundice (12 patients), pain (seven), anaemia (six) and vomiting (six). A pre-existing villous adenoma was seen in 11 patients and adjacent duodenal dysplasia in 13. Sites of origin were mostly the second part of the duodenum (18 patients) but also the third and fourth parts (two each). Seventeen patients underwent ‘curative’ resection with one hospital death at 25 days; the 5-year survival rate thereafter was 40 per cent. Five patients who received palliative surgery survived for a median of 7 months. Primary duodenal carcinoma is a distinct entity with a better prognosis than pancreatic cancer after radical resection. It favours the descending duodenum and is closely linked with villous adenoma and epithelial dysplasia.
Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection
Authors: Scripcariu V , Carlson G , Bancewicz J , Irving M H , Scott N A 
Published: March 2007

Abstract
Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22–67) years. Intra-abdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1–18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short boweksyndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.