bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical significance of the bile duct of Luschka
Authors: McQuillan T , Manolas S G , Hayman J A , Kune G A 
Published: March 2007

Abstract
In 20 post-mortem dissections, the subvesical bile duct of Luschka was noted in six specimens. Microscopic examination of ten other post-mortem gallbladders revealed small bile ducts on the gallbladder surface in five. Four cases of injury to the duct of Luschka during cholecystectomy are described and illustrated with cholangiographic and histological evidence. Post-cholecystectomy bile leaks from the drain tube, which closed spontaneously without sequelae, were noted in 9 per cent of 204 randomly selected cases and were regarded, at least in some, as being caused by a divided duct of Luschka. The practical significance of this duct during cholecystectomy is to keep close to the gallbladder wall during removal of the gallbladder, and to ligate a divided bile duct of Luschka if recognized at surgery.
Serum phospholipase A2 activity in acute pancreatitis: An early guide to severity
Authors: Bird N C , Goodman A J , Johnson A G 
Published: March 2007

Abstract
Daily measurements of serum phospholipase A2 activity were carried out on 73 consecutive patients admitted to hospital with acute pancreatitis. During the first 6 days there were significant differences in activity in those patients predicted as severe by multiple prognostic criteria when compared with those with mild disease. Follow-up studies at 6 weeks showed no difference between those graded as mild and those graded as severe at the time of attack. In the patients with elevated activity, nine had this at the time of admission and all were raised within 24 h. Elevated activity correlated well with the clinical outcome and showed good agreement with the multiple prognostic criteria in the prediction of severe disease. It is suggested that measurement of serum phospholipase A2 activity may provide a simple test for the early identification of most patients with severe acute pancreatitis.
Operative mortality following surgery for colorectal cancer
Authors: Canivet J-L , Damas P , Desaive C , Lamy M 
Published: March 2007

Abstract
From 1973 to 1986 at the Baviere Hospital, University of Liège. 476 patients underwent surgery for colorectal cancers. The overall operative mortality rate was 13·4 per cent. The following postoperative life-threatening complications occurred: myocardial infarction (14 per cent of the postoperative deaths) during the first three postoperative days; bronchopneumonia (27 per cent of the postoperative deaths) mainly during the first postoperative week; pulmonary embolism (17 per cent of the postoperative deaths) mainly during the second postoperative week; anastomotic leakage and cerebrovascular accident (14 and 8 per cent of the postoperative deaths respectively) mainly during the third and fourth postoperative weeks. Specific risk factors were chronic obstructive airways disease associated with a higher incidence of postoperative bronchopneumonia, and previous myocardial infarction associated with postoperative myocardial infarction and pulmonary embolism. General risk factors were old age and emergency procedure, both of which were associated with a higher incidence of infectious complications. The operative mortality rate fell from 20·1 per cent in the 1973–79 period to 7·8 per cent in the 1980–86 period.
Idiopathic constipation associated with impaired urethrovesical and sacral reflex function
Authors: Kerrigan D D , Lucas M G , Sun W M , Donnelly T C , Read N W 
Published: March 2007

Abstract
Sixteen chronically constipated women (age range 20–66 years) and 29 healthy control subjects (age range 22–53 years) underwent neurophysiological assessment of the integrity of pelvic spinal reflexes. The results were compared with videourodynamic studies and multiport anorectal manometry combined with external anal sphincter electromyography. The neurophysiological assessment consisted of electrical stimulation of the dorsogenital nerve, while recording any evoked reflex activity in the external anal and urethral sphincters with concentric needle and surface electrodes. Of these constipated women, 75 per cent had absence of one or more evoked sacral reflexes (compared with 20 per cent of healthy controls, P &lt; 0·05). Sensory thresholds and motor unit potentials in the external anal sphincter were similar in healthy and constipated women. Nine (56 per cent) constipated women displayed urodynamic abnormalities (increased bladder capacity, acontractile bladder and genuine stress incontinence). Only 38 per cent of constipated women perceived a desire to defaecate during rectal distension with up to 100 ml, compared with 95 per cent of normal subjects (P &lt; 0·0005). Moreover, 73 per cent of constipated women did not relax the external anal sphincter during defaecation, compared with 12 per cent of controls (P = 0·001). Taking into account the possible significance of our data in relation to previous findings it is suggested that the integration of sensory information within the sacral cord may be impaired in chronic idiopathic constipation.
Effect of anterior resection on anal sphincter function
Authors: Horgan P G , O'Connell P R , Shinkwin C A , Kirwan W O 
Published: March 2007

Abstract
Minor difficulties with continence may occur after low anterior resection. Intraoperative injury to the internal anal sphincter or its nerve supply may contribute to this. To study the effect of low anterior resection on the anal sphincter mechanism, anal manometry was performed on 20 patients before and 10 days after resection. Fifteen patients were studied again 6 months after operation. Resting, maximum squeeze and squeeze increment pressures were recorded. Intraoperative manometry (n = 11) and presacral nerve stimulation (n = 6) were performed to determine whether peroperative injury to the internal anal sphincter had occurred. Resting and maximum squeeze anal canal pressures were reduced by low anterior resection, and did not recover. The squeeze pressure increment did not change. Division of the inferior mesenteric artery, full mobilization of the rectum and mesorectum, and rectal transection did not affect resting anal pressure, which was reduced after EEA® anastomosis (mean (s.e.m.) before, 40(5) mmHg; after, 27(4) mmHg; P &lt; 0.05, n = 5). Presacral nerve stimulation produced relaxation of the internal sphincter. Anal sphincter pressures are reduced after low anterior resection. The external anal sphincter and the nerve supply to the internal anal sphincter appear intact. A direct injury to the internal sphincter is postulated.
Fatty tumours of the large intestine: A clinicopathological review of 13 cases
Authors: Ryan J , Martin J E , Pollock D J 
Published: March 2007

Abstract
Thirteen cases of benign fatty tumours of the colon have been reviewed. There were ten instances of submucosal lipoma, two of which were multiple, and three of lipohyperplasia of the ileocaecal valve. Abdominal pain and gastrointestinal bleeding were the commonest symptoms. Barium enema and angiography were misleading, the former in confusing polypoid lipomas and protruberant ileocaecal valves with carcinoma, the latter in misinterpreting fatty tissue vasculature as angiodysplasia in three patients. Most lesions were in the right side of the colon, and many were treated by limited colectomy as if for carcinoma or angiodysplasia. No patient has died as a result of their disease. Awareness of the possibility of colonic lipomas and knowledge of the normal ileocaecal valve anatomy are of importance to radiologists and endoscopists, particularly now that angiography is localizing the smaller fatty lesions.
Expanded polytetrafluoroethylene patch for the repair of large abdominal wall defects
Authors: van der Lei B , Bleichrodt R P , Simmermacher R K J , van Schilfgaarde R 
Published: March 2007

Abstract
Expanded polytetrafluoroethylene (ePTFE) was used to repair 11 large abdominal wall defects in ten patients. Three patches were fixed to the adjacent abdominal aponeurosis with a single row of sutures; seven patches were implanted with a 1–2 cm overlap of patch and aponeurosis and a double row of sutures. Recurrent buttonhole hernias were found in two patients, in both of whom a single row of sutures had been used. This reherniation was due to insufficient anchorage of the patch to the fascia. It is concluded that ePTFE is a useful material to repair large abdominal wall defects provided the patch is fixed to the aponeurosis with an overlap and a double row of sutures to prevent buttonhole hernias.
Squamous cell carcinoma of the anus at one hospital from 1948 to 1984
Authors: Pintor M Pinna , Northover J M A , Nicholls R J 
Published: March 2007

AbstractTwo hundred and twenty-eight patients with anal carcinoma treated between 1948 and 1984 were reviewed. Of 145 with anal canal carcinoma, 118 were treated by total anorectal excision, nine by local excision and 13 by radiotherapy. Fifteen patients were inoperable. There were five postoperative deaths. Crude and cancer-specific survival rates of 123 patients treated 5 or more years previously were 58 and 64 per cent. These rates for patients undergoing total anorectal excision were 62 and 65 per cent, and local excision 87 and 100 per cent. Eighty-three patients had carcinoma of the anal margin. Of these, 55 were treated by local excision, 18 by total anorectal excision and 20 by radiotherapy. Eight patients were inoperable. Crude and cancer-specific survival rates for 72 patients followed for 5 years were 55 and 57 per cent with respective rates of 65 and 69 per cent after local excision and 36 and 40 per cent after total anorectal excision. The 5-year survival rate of 27 patients with TNM N1 stage was 48 per cent. Histological confirmation was obtained in only nine of these patients, however, but five (55 per cent) survived 5 years after block dissection or radiotherapy. Metachronous lymphadenopathy occurred in 25 patients. The 5-year survival rate in the 23 cases that were histologically confirmed was 35 per cent after block dissection (17 cases) and radiotherapy (four cases). Using a modification of Papillon's T classification for anal canal carcinoma, stage correlated with survival after combining T1 with T2 tumours and T2 with T3 tumours. Five-year survival rates in these groups were 60 and 54 per cent respectively. The TN M-UICC classification for anal margin carcinoma correlated with survival in a similar manner. The 5-year survival rate was 65 per cent for patients with T1 and T2 tumours and 33 per cent for those with T3 and T4 tumours.
Chronic intussusception in children
Authors: Reijnen J A M , Festen C , Joosten H J M 
Published: March 2007

Abstract
Nine children presented with intussusception lasting for 14 days or more. Their mean age was 8·5 years. Diagnosis of intussusception was delayed considerably, probably due to an unusual presentation. Compared with acute intussusception, symptoms consist of infrequent attacks of abdominal pain, sporadic vomiting and no, or small, changes in defecation. Marked weight loss and an abdominal mass assume diagnostic significance, in contradiction to bloody stools. Ultra-sonography can be of diagnostic value. An attempt at hydrostatic reduction is often unsuccessful. A high frequency of organic lesions precipitating intussusception warrants early surgical intervention.
Relationship between DNA ploidy and survival in patients with primary breast cancer
Authors: Eskelinen M J , Pajarinen P , Collan Y , Pesonen E , Alhava E , Kettunen K , Nordling S 
Published: March 2007

Abstract
The DNA ploidy of breast cancer tissue from paraffin blocks was measured by flow cytometry in 117 patients whose disease had been detected and treated with surgery between 1974 and 1976. Patients with aneuploid tumours had positive axillary nodes and distant metastases more often than those with diploid tumours. Aneuploid tumours were more common in postmenopausal than premenopausal women. The S-phase fraction (SPF) was significantly higher in aneuploid than in diploid tumours and positive axillary lymph nodes were found in 26 per cent of the patients who had a tumour with a SPF below the median (4·8 per cent) and in 48 per cent of those with tumours with SPF values above the median. At the primary clinical investigation 2 per cent of the patients with diploid tumours and 6 per cent of those with aneuploid tumours had distant metastases. During the follow-up, the proportion of patients with distant metastases increased to 42 and 72 per cent, respectively. With a follow-up of 11·5 years, the DNA aneuploidy of the tumour showed a significant association with decreased survival. Thirty-three per cent of patients with diploid and 65 per cent of patients with aneuploid tumours had died from breast cancer during the follow-up (P &lt; 0·001). All patients with hypertetraploid or multiploid tumours died from breast cancer. High SPF values were associated more closely with distant metastases or death during the follow-up than low SPF values. Our results suggest that DNA ploidy measured by flow cytometry from paraffin embedded tissue blocks of human breast cancer can be used to predict the aggressiveness of the tumour and the survival of the patients.
CA15-3: Its relationship to clinical stage and progression to metastatic disease in breast cancer
Authors: Kerin M J , McAnena O J , O'Malley V P , Grimes H , Given H F 
Published: March 2007

Abstract
There is increasing interest in the potential role of monoclonal antibodies as tumour markers in the early detection of metastatic disease. CA15-3 is a circulating antigen which is relatively specific for breast tissue and defined by two monoclonal antibodies. It is elevated in the serum of patients with breast cancer but its relationship to clinical stage and tumour progression has not been well defined. CA15-3 levels have been measured in a consecutive series of 97 patients with breast cancer at the time of diagnosis and at 3-monthly intervals thereafter. All patients have been evaluated and followed by using routine biochemical and radiological parameters to detect occult metastatic disease. There was no difference between a control group of patients who presented with benign disease (n = 18: mean(s.d.) 18·0(5·1) units/ml): and those who presented with stage I disease (n = 37: 18·4(5·3) units/ml) or stage II disease (n = 21: 18·0(4·0) units/ml). Patients with stage III disease (n = 23: 32·0(10·4) units/ml) had significantly elevated levels of CA15-3 compared with those in stage I (P &lt;0·001). All patients with documented metastatic disease at presentation or at follow-up had markedly elevated CA15-3 levels (n = 10: 155·8(50·2) units/ml). CA15-3 is a reliable tumour marker in patients with advanced disease.
Benign non-traumatic inflammatory strictures of the extrahepatic biliary system
Authors: Standfield N J , Salisbury J R , Howard E R 
Published: March 2007

Abstract
Obstructive jaundice was the presenting feature in 12 patients with benign, non-traumatic strictures of the extrahepatic bile ducts. Ages at presentation ranged from 1·5 to 60 years and 11 were initially referred with diagnoses of malignant strictures. Histological examination, however, showed benign changes of chronic inflammation, with ulceration in seven, which were distinct from those of primary sclerosing cholangitis. All of the patients remain well from 3 to 14 years after surgery. The aetiology of the strictures is not known.
Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders
Authors: Hansell D T , Millar M A , Murray W R , Gray G R , Gillespie G 
Published: March 2007

Abstract
Endoscopic sphincterotomy was performed in 121 patients (age range 34–92 years; median 80 years) with intact gallbladders and bile duct stones. Clearance of the duct by basket or balloon extraction was attempted in 97 patients (80 per cent) and achieved in 93 of these patients (96 per cent). In 24 patients the duct was left to empty spontaneously and this occurred in 22 patients. Immediate complications due to endoscopic sphincterotomy occurred in five patients (two haemorrhage, two perforation, one haemorrhage and perforation). Of the 101 patients reviewed 12–72 months (median 24 months) after endoscopic sphincterotomy, 76 (75 per cent) have remained asymptomatic throughout the follow-up period. Eighteen patients (18 per cent) required cholecystectomy for recurrent gallbladder symptoms 1–24 months after endoscopic sphincterotomy. One of the asymptomatic patients underwent cholecystectomy on the advice of his consultant. A further seven had recurrent biliary colic or cholangitis necessitating enlargement of the sphincterotomy and further stone retrieval in three of these patients. Endoscopic sphincterotomy is an effective treatment for bile duct stones in high risk patients, but subsequent cholecystectomy is required in a significant number of patients owing to continuing gallbladder symptoms.
Pancreatic duct pressure, duct permeability and acute pancreatitis
Authors: Harvey M H , Wedgwood K R , Austin J A , Reber H A 
Published: March 2007

Abstract
The relationship between pancreatic duct pressure, duct permeability to macromolecules and the development of acute pancreatitis was studied in a cat model. Perfusion of the pancreatic duct with 15 mM glycodeoxycholic acid, ethanol administration, or secretagogue-stimulated pancreatic secretion against &gt; 50 per cent duct obstruction resulted in an increase in peak pancreatic duct pressure in all animals. Duct permeability to 20 000 molecular weight dextran molecules was increased in 22 of 29 experimental animals compared with two of 22 control animals (P &lt;0·01). Perfusion of the pancreatic duct with activated pancreatic enzymes resulted in acute pancreatitis in 24 of 29 experimental animals compared with three of 22 control animals (P &lt;0·01). These results suggest that pancreatic ductal hypertension, resulting in increased ductal permeability to large molecules, may be a common early event in gallstone and alcoholic pancreatitis.
Haemorrhage in pancreatic disease
Authors: Shankar S , Russell R C G 
Published: March 2007

Abstract
Haemorrhage is a life-threatening complication in pancreatic disease. Twenty-five patients with this complication are described; 15 had major bleeding, nine had minor bleeding and one patient had a pseudoaneurysm identified at operation. Of the 15 patients with major bleeding, six presented with this complication and in nine cases it followed pancreatic resection. Of the six patients who presented with major bleeding, five underwent resection with one death while the patient managed conservatively died. The nine patients who had major bleeding after pancreatic resection were managed by ligation of the bleeding artery in six cases with one death, and one patient who rebled after ligation of the bleeding artery was successfully managed by further resection. Three patients with postresection major bleeding were managed conservatively with one death. All minor haemorrhages were managed conservatively without mortality. Deaths after major bleeding were a result of sepsis in three cases and respiratory failure in one. The severity of the underlying pancreatitis was an important factor in two patients. Pseudocysts and pancreatic fistulae were important underlying factors leading to the complication. It is recommended that patients with sepsis, a pancreatic fistula or severe underlying pancreatitis should have their haemorrhage treated by pancreatic resection, while those patients with bleeding following pancreatic resection without such complications can be managed by ligation.
Factors influencing local recurrence after excision and radiotherapy for primary breast cancer
Authors: Locker A P , Ellis I O , Morgan D A L , Elston C W , Mitchell A , Blamey R W 
Published: March 2007

Abstract
Between November 1979 and December 1986, 263 patients were treated for primary breast cancer by local excision and radiotherapy at the City Hospital, Nottingham. Local recurrence within the treated breast occurred in 56 patients (21 per cent), in 18 (6·8 per cent) of whom it was gross and uncontrollable. An analysis of clinicopathological features shows patient age, nodal status, tumour size, presence of definitive vascular invasion, adjacent ductal carcinoma in situ and grade to be predictive of local recurrence. A Cox's multivariate analysis of these factors shows the first four to be independently significant. The factors can be combined as a prognostic index which allows identification of patients at high risk of local recurrence. On the basis of these findings we have altered our selection policy for patients suitable for breast conservation.
Non-cyclical mastalgia: An improved classification and treatment
Authors: Maddox P R , Harrison B J , Mansel R E , Hughes L E 
Published: March 2007

Abstract
A prospective study of 72 patients with non-cyclical breast pain was carried out. Non-cyclical breast pain was subdivided into true non-cyclical mastalgia (35 patients) and musculoskeletal pain (37 patients), the latter including Tietze's syndrome and other causes of chest wall pain. Mean age at presentation was significantly greater in the musculoskeletal group (39·3 versus 33·9 years) with a shorter mean duration of pain (14·7 versus 35·4 months) compared with the non-cyclical mastalgia group. True non-cyclical mastalgia was commonly bilateral and located within the upper outer quadrant of the breast, whereas musculoskeletal pain was almost always along the lateral chest wall or costochondral junctions and unilateral in 92 per cent of cases. Breast nodularity was present in 54 per cent of patients with non-cyclical mastalgia, but in only four cases (11 per cent) in the musculoskeletal group. Nine of 14 patients (64 per cent) with non-cyclical mastalgia obtained a good clinical response to drug therapy (over half responding to danazol alone); 19 underwent spontaneous remission, but there was a prolonged mean time to pain resolution of 27 months. In the musculoskeletal group 33 of 34 patients (97 per cent) had a good response to steroid and local anaesthetic injection; three resolved spontaneously without treatment, with a mean time to pain resolution of 17 months. This study indicates that differentiation of musculoskeletal pain from non-cyclical mastalgia may lead to more effective treatment with some prediction of the overall prognosis.
Computer analysis in making preoperative decisions: A rational approach to lymph node dissection in gastric cancer patients
Authors: Kampschöer G H M , Maruyama K , van de Velde C J H , Sasako M , Kinoshita T , Okabayashi K 
Published: March 2007

Abstract
In Japan, R2 lymph node dissection is standard practice for all curatively resected gastric cancer patients. From 1969 to 1984, data were collected prospectively to evaluate this procedure and to provide information for a more rational approach to node dissection for each individual case. A total of 3843 cases was included in this study and an evaluation was made of the prognostic variables and lymph node involvement at various locations. Using a computer program, it is possible to compile a group of treated patients, with prognostic variables exactly matching those of an individual patient. Analysis of this group can then give an indication of the extent of lymph node dissection required for an individual patient. This paper gives a demonstration of the structure of such a system by means of an example.