bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total pancreatectomy for chronic pancreatitis
Authors: Cooper M J , Williamson R C N , Benjamin I S , Carter D C , Cuschieri A , Linehan I P , Russell R C G , Torrance H B 
Published: March 2007

Abstract
A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19–61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2–18 h) and median blood loss was 3 units (1–21 units). Intra-operative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1·5 years (range 0·25–10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.
Urological complications in 600 consecutive renal transplants
Authors: Jaskowski A , Jones R M , Murie J A , Morris P J 
Published: March 2007

Abstract
The results of 600 consecutive renal transplant operations (540 cadaver and 60 living related donor) in 491 patients were assessed with respect to urological complications. In nearly all cases the ureter was inserted into the bladder using a Leadbetter-Politano ureteroneocystostomy technique. The bladder was drained by Foley catheter for 5 days and the operation site by vacuum drain for a variable period. After 26 operations in 26 patients, 27 episodes of ureteric obstruction were identified (one re-obstruction). These occurred between 1 day and 45 months after transplantation and involved the lowest third of the ureter 19 times, the middle third 3 times and the proximal third 4 times. They were due to stricture (11), pelvic collection (7), redundant or twisted ureter (3) or other cause (5). An anatomical predisposing factor in either patient or graft was identified in 31 per cent of these caes. After 18 operations in 18 patients, 21 episodes of urine leakage were identified (three re-leakages). These occurred between 1 day and 6 months after transplantation and an anatomical predisposing factor in either patient or graft was present in 59 per cent. Thus, overall, 7 per cent of patients developed a urological complication in this series. This rate has declined in recent years in parallel with a general reduction in steroid dose for immunosuppression. This last feature, combined with the surgical technique described, has resulted in a low incidence of urological complication after transplantation, being now between 1 and 2 per cent.
Treatment and outcome in 52 consecutive cases of ampullary carcinoma
Authors: Neoptolemos J P , Talbot I C , Carr-Locke D L , Shaw D E , Cockleburgh R , Hall A W , Fossard D P 
Published: March 2007

Abstract
The results of treatment and outcome in 52 consecutive patients presenting to Leicester from 1972 to 1984 are presented. The number of patients diagnosed increased from two per year before the introduction of duodenoscopy to nearly five per year afterwards. Endoscopic drainage (ED) was attempted in 21 patients with a success rate of 81 per cent. In eight cases ED was used pre-operatively and in the remainder as definitive treatment. Twenty-four patients had a Whipple's resection (12·5 per cent mortality), four patients had a local resection (no deaths), ten patients had surgical bypass (60 per cent mortality) and thirteen patients had ED alone (23 per cent mortality). The major risk factor score was significantly greater in patients undergoing surgical bypass compared with Whipple's resection. Age and risk factor scores were significantly greater in patients who had ED drainage alone than in surgical patients. The 5 year survival rate for resection was 56 per cent versus 13 per cent for drainage procedures (P &lt; 0·001). Survival in resection cases was directly related to the degree of tumour differentiation and a new staging system. It is proposed that all patients with ampullary tumours should have endoscopic biopsy followed by ED; Whipple's resection remains the surgical treatment of choice.
Postoperative intra-abdominal sepsis
Authors: Rogers P N , Wright I H 
Published: March 2007

Abstract
Postoperative intra-abdominal sepsis carries a high mortality. Diagnosis by clinical examination is often difficult, and imaging techniques may be helpful. Diagnostic laparotomy should be considered early, even in the absence of localizing signs. The use of aggressive surgical techniques may improve prognosis. The timing of surgical intervention is as important as the technique. Early diagnosis and treatment is particularly crucial in critically ill patients.
Current spectrum of intestinal obstruction
Authors: McEntee G , Pender D , Mulvin D , McCullough Majella , Naeeder S , Farah S , Badurdeen M S , Ferraro V , Cham C , Gillham N , Matthews P 
Published: March 2007

Abstract
In a 12-month prospective study incorporating four neighbouring district general hospitals, 228 patients required a total of 236 admissions with intestinal obstruction. The aetiological factors included adhesions 75 (32 per cent), malignant disease 61 (26 per cent), strangulated hernias 59 (25 per cent), volvulus 10 (4 per cent), acquired megacolon 6 (3 per cent), pseudo-obstruction 4 (2 per cent), faecal impaction 6 (3 per cent) and miscellaneous 15 (6 per cent). The peak incidence for obstruction due to adhesions, malignant disease and strangulated hernias each occurred in the eighth decade. Surgery was performed within 48 h of admission in 29 per cent adhesive obstructions (22), 30 per cent obstructions due to malignant disease (18) and 68 per cent strangulated hernias (40) - bowel resection rates in these three groups were 13·5, 50 and 29 per cent, respectively. The overall mortality was 11·4 per cent (26 deaths) and postoperative mortality was 12·3 per cent (19 deaths). During the 12-month study period, 228 patients required a total of 2993 impatient hospital days as a result of intestinal obstruction. Postoperative adhesions have become the commonest cause of intestinal obstruction but strangulated hernias and intra-abdominal malignant disease still account for 50 per cent of all cases and mortalities. Obstruction due to strangulated hernias and intra-abdominal malignant disease typically occurs in the elderly age group where a more aggressive policy of elective surgical intervention is likely to be associated with increased postoperative morbidity and mortality.
Subclavian vascular injuries
Authors: Demetriades D , Rabinowitz B , Pezikis A , Franklin J , Palexas G 
Published: March 2007

Abstract
This study comprises 228 patients with penetrating injuries of the subclavian vessels. The vein alone was involved in 44 per cent, the artery alone in 39 per cent, and both vessels in 17 per cent. The majority of the victims (61 percent) did not reach the hospital alive, and in those who were operated on the mortality was 15·5 per cent (overall mortality 66 percent). The overall mortality of venous injuries was significantly higher than the arterial ones (P&lt;0·01), probably because of the dangerous complication of air embolism. Physical examination is reliable in the diagnosis of these injuries and there is no need for an emergency angiogram. The clavicular incision was the preferred approach. Repair was performed in 94 per cent of those with arterial injury. Vein injuries were treated by suture in 60 per cent and ligation in 40 per cent. A selective conservative approach is advised.
Transluminal angioplasty versus conventional operation in the treatment of haemodialysis fistula stenosis: Results from a 5-year study
Authors: Dapunt O , Feurstein M , Rendl K H , Prenner K 
Published: March 2007

Abstract
In this retrospective study we have used life table analysis to compare the results of 37 transluminal angioplasties with those of 37 conventional operations (thrombectomy, thrombendarterectomy with/without grafting, bypass) in the treatment of stenoses and occlusions of haemodialysis fistulae. There was no difference between the groups in terms of lesion morphology or the patients' age and sex. Cumulative patency rates for angioplasty and surgery, respectively, were 94·5 and 78·1 per cent after 1 week, 72·3 and 64·1 per cent after 1 month, 41·2 and 28·9 per cent after 5 months and 31·3 and 19·3 per cent after 1 year (χ2 test, P&lt;0·001). The difference is due mainly to a high percentage of early occlusions in the first week after surgery. When transluminal angioplasty of haemodialysis fistula stenoses is possible it achieves results which are at least as good as those of operation.
Pathophysiology of acute obstructive cholecystitis: Implications for non-operative management
Authors: Jivegård L , Thornell E , Svanvik J 
Published: March 2007

Abstract
Recent research suggests that disturbances in gallbladder mucosal functions are important in the initiation of acute cholecystitis and its progression. Prostaglandins have pathophysiological significance and prostaglandin synthesis inhibitors such as indomethacin inhibit fluid secretion by gallbladder mucosa, reduce distension and relieve pain. Nerves in the gallbladder wall are involved in disturbed mucosal function, and the benefits of opiates may derive from reduction of active fluid secretion in the inflamed and obstructed gallbladder as well as from central analgesic effects.
Surgical management of strictures of the major bile ducts in recurrent pyogenic cholangitis
Authors: Lau W Y , Fan S T , Yip W C , Wong K K 
Published: March 2007

Abstract
Definitive surgical procedures were performed on 46 patients with strictures of the major bile ducts: dilatation of strictures was undertaken in 6 patients, hepatotomy and plastic repair in 2, biliary-enteric anastomosis in 18, and liver resection with or without drainage for the rest of the biliary tree in 20 patients. The overall operative morbidity was 21·7 percent. Two patients died within 30 days of operation. One patient died of septicaemia after emergency dilatation of stricture while another died of sepsis from a leakage after hepatotomy and plastic repair. The median follow-up for the 44 patients who survived the operation was 43 months. All strictures reformed after dilatation within 2 months. Acute cholangitis occurred in six patients, two after dilatation of strictures (with documented recurrent stone formation in one), two after biliary-enteric anastomosis and two after liver resection. Thus, good clinical results were obtained in 38 out of 44 patients (86·4 percent).
Left-sided subtotal oesophagectomy for carcinoma
Authors: Matthews H R , Steel A 
Published: March 2007

Abstract
Oesophageal resection for carcinoma has been performed using a two-part left-sided approach with cervical anastomosis in 75 patients, all of whom have been followed up to death or for a minimum of 5 years. Operative mortality was 12 per cent, but long-term survival was 28 per cent for all squamous tumours and 12 per cent for all adenocarcinomas, irrespective of node status. It is suggested that this approach offers significant advantages.
Splenectomy and renal allograft survival in the rat
Authors: Cranston D , Wood Kathryn J , Morris P J 
Published: March 2007

Abstract
The effect of splenectomy on renal allograft survival is not clear. In the rat, spleens isolated from recipients with functioning grafts have been shown to be a major source of cells that are capable of suppressing the rejection response (suppressor T lymphocytes). Thus the removal of the spleen in these allograft recipients could be detrimental to renal allograft survival. This study investigates this hypothesis, and looks for the presence of suppressor cells in other lymphoid organs apart from the spleen. In the rat renal allograft model, donor Lewis spleen cells given to DA recipients intravenously 1 week before transplantation of a Lewis kidney leads to indefinite allograft survival (median survival time (MST) &gt; 100 days). Splenectomy before or after pretreatment with donor spleen cells failed to abrogate this effect (MST &gt; 100 days). Experiments were performed in which cells or serum were prepared from long-term surviving splenectomized animals which had already been pretreated and transplanted, and then were injected into untreated recipients (adoptive transfer experiments). This was done to determine if cells capable of suppressing graft rejection were present in lymphoid organs outside the spleen in these splenectomized recipients. Thus the IV transfer of 108 lymph node cells harvested from splenectomized DA recipients with a long-term surviving LEW graft (LTS), into untreated but lightly irradiated (200 rad) DA recipients resulted in indefinite survival of a fresh Lewis kidney (MST &gt; 100 days). In contrast, adoptive transfer of normal DA lymph node cells was ineffective (MST 13 days). Thus splenectomy is not necessarily detrimental to graft survival, as cells capable of preventing graft rejection are found in other lymphoid organs, such as lymph nodes, in splenectomized recipients.
Anorectal sampling: A comparison of normal and incontinent patients
Authors: Miller R , Bartolo D C C , Cervero F , McC Mortensen N J 
Published: March 2007

Abstract
It has been suggested that sampling of rectal contents by the anal canal may play a role in the continence mechanism. To investigate this concept we studied 18 patients with faecal incontinence and 18 age and sex matched controls. A microtransducer catheter was positioned so that pressures were recorded from the rectum, the junction of the upper and middle thirds of the anal canal and the lower anal canal. Recordings were taken at rest and while distending the rectum with air in a balloon, and then with air injected freely into the rectum. Sampling (equalization of the rectal and upper anal canal pressures) was seen to occur spontaneously in 16 of the controls and only 6 of the incontinent group (P&lt;0·02) and induced sampling occurred at a higher rectal volume in the incontinent group than in controls for freely injected air (P&lt;0·002). Defective anorectal sampling may be an important contributory factor in the pathogenesis of anorectal incontinence.
Investigation of anorectal function
Authors: Felt-Bersma Richelle J F , Klinkenberg-Knol Elly C , Meuwissen S G M 
Published: March 2007

Abstract
Anorectal function tests were performed in 280 consecutive patients, who were referred for evaluation of different anorectal disorders. The relationship between the estimated anal sphincter pressure on digital palpation and the measured pressure on anal manometry was investigated and the interrelationship between anal manometry, rectal capacity and the saline infusion test was defined. A significant correlation (P&lt;0·001) was found between digitally and manometrically measured anal sphincter pressure. Considering the relationship between the three specific anorectal function tests, only manometry and the saline infusion test correlated to some extent (P&lt;0·01). This study shows that digital palpation is helpful in anorectal function investigation, but to establish the exact anal pressures, anal manometry is mandatory. Furthermore, the poor correlation observed indicates that single tests represent different aspects of anorectal function and therefore they need to be performed together.
Treatment of ‘inoperable’ neck nodes using surgical clearance and postoperative interstitial irradiation
Authors: Stafford N , Dearnaley D 
Published: March 2007

Abstract
The inability to remove all disease at the time of a radical neck dissection, or inoperable recurrent disease after a neck dissection, are both familiar problems for the head and neck surgeon. All too frequently the conventional treatment options have already been used, the patient having received external beam radiotherapy and possibly cytotoxic chemotherapy. In such circumstances, and provided that the primary tumour remains under control, a positive approach to the further management of the neck metastases should be adopted, given that the patient is in otherwise reasonable health and does not have gross distant metastatic disease. We describe our experience with postoperative interstitial irradiation (brachytherapy) using after-loaded iridium-192 (192Ir) wires positioned at the site of the tumour after its surgical exposure and debulking or clearance. All the treated patients had previously received external beam irradiation to the neck and in the first three cases local skin necrosis occurred as a sequel to interstitial implantation. Therefore, in the other five patients, cutaneous or myocutaneous flaps were used to resurface the area at the time of implant placement. This combination of technqiues, which has not been described previously, provided local tumour control in four out of the five cases without irradiation necrosis occurring in any of them.
Effect of epidural anaesthesia on intestinal blood flow
Authors: Johansson K , Ahn H , Lindhagen J , Tryselius U 
Published: March 2007

Abstract
The effect of epidural bupivacaine (5 mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in 15 patients during operations including various types of large bowel resection. In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41 per cent. In the ileum an increase was found in eight out of eleven patients who could be studied, which was significant at the 5 per cent level. Bowel function was restored satisfactorily in all patients. It is concluded that epidural bupivacaine has a favourable effect on intestinal blood flow during colorectal surgery.
Prospective study of conservative and operative treatment for faecal incontinence
Authors: Miller R , Bartolo D C C , Locke-Edmunds J C , Mortensen N J McC 
Published: March 2007

Abstract
To assess the functional results of treatment of faecal incontinence we carried out physiological and radiological measurements in 46 patients and 20 controls. Twenty patients were selected for conservative treatment and 26 for surgery (including 17 postanal repairs and 6 anterior sphincter repairs). The degree of incontinence was scored before and after treatment and postoperative investigations carried out on 17 patients (11 postanal repairs). Forty per cent of the conservative treatment group had a successful result compared with sixty-five per cent of the operative group as a whole and fifty-nine per cent of the postanal repair patients. Resting and ‘squeeze’ anal canal pressures were improved following postanal repair as was upper anal canal sensation but there was no change in the anorectal angle. We conclude that the anorectal angle is not crucial in maintaining continence.
Gastric cancer: An audit of 122 consecutive cases and the results of R1 gastrectomy
Authors: Irvin T T , Bridger J E 
Published: March 2007

Abstract
In a consecutive series of 122 patients with gastric carcinoma, 9 per cent had no operation, 27 per cent had incurable disease at laparotomy, and 64 per cent underwent gastric resection. R1 gastrectomy was performed in 73 of the 78 resections. The operative mortality after gastric resection was 4 per cent, but there were no deaths after potentially curative resections. The actuarial 5-year survival was 20 per cent overall, 60 per cent in patients undergoing a ‘curative’ resection with N0 disease, and 18 per cent in patients with N1 disease. Local or regional recurrence without evidence of distant metastases was identified in 11 per cent of cases after ‘curative’ resections. The probability of survival was adversely affected by N1 nodal involvement (P&lt;0.005) and by the presence of poorly differentiated or anaplastic tumours (P&lt;0.001). Only 6 per cent of patients had early gastric cancer, and absolute curative resections by Japanese criteria were possible in only 5 per cent of cases. The results suggest that the unfavourable presenting pathology is the principal determinant of the poor prognosis of gastric cancer. A more radical or extended lymphadenectomy (R2/3 gastrectomy) might have cured more patients with N1 metastases, but only 12 per cent of potentially curable patients had N1 disease in this study, and it appears that more radical surgery may have little effect on the overall survival rates for gastric cancer.
Experimental columnar metaplasia in the canine oesophagus
Authors: Gillen P , Keeling P , Byrne P J , West A B , Hennessy T P J 
Published: March 2007

Abstract
Regeneration of canine oesophageal mucosa was studied under basal conditions and in the presence of gastro-oesophageal reflux. In normal circumstances mucosal defects in the oesophagus regenerate by squamous epithelium. In the presence of gastro-oesophageal reflux of either acid or a combination of acid and bile, regeneration was frequently by columnar epithelium (Barrett's oesophagus). This columnar regeneration was not seen with bile reflux alone. By the use of squamous barriers to proximal migration of columnar epithelium in the stomach, it was demonstrated that columnar re-epithelialization may occur from cells intrinsic to the oesophagus and is not dependent on proximal migration of cardiac columnar epithelium. The cell of origin of this epithelium may be located in oesophageal gland ducts and is likely to be a multipotential stem cell since the regenerated columnar epithelium may contain goblet and parietal cells not normally found in the oesophagus. This epithelium is morphologically distinct on mucin histochemistry from cardiac columnar epithelium. These findings support the concept that Barrett's epithelium is metaplastic.
Operative management of tubulovillous neoplasms of the duodenum and ampulla
Authors: Krukowski Z H , Ewen S W B , Davidson A I , Matheson N A 
Published: March 2007

Abstract
Six patients are described to illustrate the operative management of tubulovillous neoplasms of the duodenum. Pancreaticoduodenectomy is appropriate for associated invasive carcinoma. Transduodenal submucosal excision of tubulovillous neoplasms with resection and reconstruction of the distal bile and pancreatic ducts if necessary is a satisfactory alternative when the neoplasm has not penetrated the muscularis mucosae.
Clinical management of recurrent hepatocellular carcinoma after primary resection
Authors: Kanematsu T , Matsumata T , Takenaka K , Yoshida Y , Higashi H , Sugimachi K 
Published: March 2007

Abstract
Curative resections were performed on 121 patients with primary hepatocellular carcinoma from 1975 to 1986 at Kyushu University Hospital, Japan. Up to August 1987 there was a recurrence in 41, detected between 4 and 86 (mean 20) months after surgery. Intrahepatic recurrences were the most common (82 per cent). There was no statistically significant correlation between size of the primary tumour and interval from surgery to detection of recurrence (r = −0·09). Serial measurement of serum α-fetoprotein (AFP) was useful for the detection of recurrences. However, the levels of AFP seem to be a non-specific, unreliable test for such patients since this tumour marker showed different ranges before the primary surgery and at the time of recurrence in 5 of the 41 patients (12 per cent). Postoperative chemotherapy with oral 5-fluorouracil had no apparent preventative effect on the recurrence. A second curative resection was effective in four patients, and three survived for over 2 years; the longest survival time is 9 years after the second procedure.