bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insonation and impedance analysis in graft surveillance
Authors: Woodburn K R , Murtagh A , Breslin P , Reid A W , Leiberman D P , Gilmour D G , Pollock J G 
Published: March 2007

Abstract
Seventy consecutive patients with infrainguinal bypass grafts entered a 1-year graft surveillance programme involving colour duplex scanning, direct graft insonation and computer-assisted impedance analysis. Graft patients with a positive duplex scan, high frequencies on graft insonation or an impedance value above 0.50 subsequently underwent arteriography. Sixteen patients were excluded before the initial surveillance visit. The 54 remaining patients with grafts (30 vein, 24 synthetic) underwent a total of 137 surveillance visits, with 21 grafts confirmed to be ‘at risk’. The sensitivity of an impedance value above 0.55 in identifying these grafts was 86 per cent, rising to 95 per cent when combined with graft insonation. Duplex scanning did not identify any abnormalities in 11 grafts that were either shown by arteriography to be ‘at risk’ or occluded before arteriography. Impedance measurement and graft insonation are simple screening techniques with a high sensitivity (when combined), which identify ‘at risk’ infrainguinal grafts. Positive graft insonation or an impedance value over 0.55 will identify all ‘at risk’ vein grafts while minimizing the number of unnecessary arteriograms.
Pain relief after inguinal hernia repair: A randomized double-blind study
Authors: Nehra D , Gemmell L , Pye J K 
Published: March 2007

Abstract
A randomized double-blind study was undertaken using 0.5 per cent bupivacaine ilioinguinal field block and oral papaveretum-aspirin tablets to assess pain relief after hernia surgery. A consecutive series of 200 men undergoing repair of a unilateral inguinal hernia underwent random allocation into one of the four groups to receive: bupivacaine and papaveretum-aspirin (group 1), bupivacaine and oral placebo (group 2), saline and papaveretum-aspirin (group 3), or saline and oral placebo (group 4). Patients were prescribed postoperative oplates to be given on demand. Pain levels and mobility were assessed at 6 and 24 h after operation. Patients in group 1 reported significantly less pain, required less additional opiates and had better mobility than those in group 4 (pain score P &lt; 0.001 at 6 h and P = 0.002 at 24 h) and group 3 (P = 0.002 for pain and mobility scores at 6 h). Bupivacaine alone provided good immediate postoperative pain relief (P = 0.002 group 2 versus group 4 at 6 h). The combination of bupivacaine and papaveretum-aspirin provided the best results and is suitable for day-case postoperative analgesia.
Electrically stimulated colonic reservoir for total anorectal reconstruction
Authors: Hughes S F , Scott S M , Pilot M A , Williams N S 
Published: March 2007

Abstract
Total anorectal reconstruction after abdominoperineal excision of the rectum has failed to achieve perfect continence. Electrically stimulated reservoir evacuation in combination with an electrically stimulated gracilis neoanal sphincter might improve results. A J pouch was constructed in an isolated colonic loop of seven dogs. Bipolar square wave pulses were delivered via two intramural stainless steel electrode pairs at 10 Hz. Stimulation parameters were varied to achieve adequate contraction. Serosal strain gauges recorded spontaneous and stimulated pouch motility. Evacuation was quantified by a volume displacement technique and observed fluoroscopically. Recordings were performed for a median of 3 (range 1–11) months. At 10 Hz and 0·5 ms pulse width, stimulation was required for 2 min and at voltages of 15 V (n = 4), 18 V (n = 1) and 20 V (n = 2) to obtain a contraction of amplitude comparable to that of a spontaneous contraction. Suprathreshold stimulation invariably resulted in colonic pouch contraction. The mean(95 per cent confidence interval (c.i.)) stimulus-response latency was 25·5(1-9) s. The mean(95 per cent c.i.) intraluminal pressure generated during stimulation was 114±1(17±0) cmH2O and 64±6(12±0) cmH2O during spontaneous activity (P&lt;0±001). In conclusion, electrical stimulation via intramural electrodes produced contraction generating sufficient intraluminal pressure to effect evacuation of a canine colonic pouch. This has potential for incorporation with an electrically stimulated neoanal sphincter in total anorectal reconstruction to improve evacuation and continence.
Factors that influence functional outcome after coloanal anastomosis for carcinoma of the rectum
Authors: Miller A S , Lewis W G , Williamson M E R , Holdsworth P J , Johnston D , Finan P J 
Published: March 2007

Abstract
Thirty consecutive patients had laboratory assessment of anorectal function after rectal excision and stapled coloanal anastomosis for rectal carcinoma. Eleven patients experienced perfect continence but 19 had faecal leakage with or without urgency of defaecation. Median (interquartile range) function was related to the pressures generated in the anal sphincter at rest (good versus poor function: 80 (63–91) versus 51 (23–60) cmH2O, P&lt;0±01), during maximum squeeze (160 (126-203) versus 102 (58-112) cmH2O, P&lt;0±01) and during reflex inhibition (58 (23-63) versus 36 (18-54) cmH2O, P&lt;0±05). Poor function was significantly commoner in women than in men (P&lt;0±01). These findings suggest that occult damage may have occurred to the anal sphincter before low anterior resection. Careful preoperative evaluation with manometry and endoanal ultrasonography may detect such damage and allow selection of patients for colopouch reconstruction.
Clinical impact of colonoscopic screening in first-degree relatives of patients with hereditary non-polyposis colorectal cancer
Authors: Green S E , Chapman P D , Burn J , Bishop D T , Varma J S 
Published: March 2007

Abstract
Sixty-one asymptomatic individuals with an affected first-degree relative from five large hereditary non-polyposis colorectal cancer (HNPCC) kindreds were screened by colonoscopy. Neoplasms were found in nine (15 per cent) of 61 individuals on the first screen. Five subjects had a single adenoma while two had two adenomas each. There were two patients (3 per cent) with malignant neoplasms: one with a Dukes B adenocarcinoma and one with synchronous Dukes C adenocarcinomas in the caecum and ascending colon. These findings support the hypothesis that adenomas do not occur in large numbers in HNPCC families but, because of the high malignant conversion rate, biennial colonoscopy with removal of polyps seen is recommended.
Carbon dioxide laser ablation as an alternative treatment for cutaneous metastases from malignant melanoma
Authors: Lingam M K , McKay A J 
Published: March 2007

Abstract
Surgical excision of cutaneous malignant melanoma metastases is practical only when the number of lesions is small. In some patients isolated limb perfusion is not possible or fails to achieve control, and carbon dioxide laser ablation is then an alternative treatment. Between September 1992 and September 1994, 19 patients aged 45–94 years were treated with carbon dioxide laser. Two patients had received no previous limb perfusion, while the remaining 17 had up to three previous perfusions. The number of lesions per patient ranged from three to 40 nodules. A Sharplan 1030 portable carbon dioxide laser was used, which generates a beam wavelength of 10-6 μm and has a maximum power output of 80W. All procedures were carried out under general anaesthesia. Each lesion was destroyed with a focused laser beam of 10–20 W with a spot size of 0±5–1±0 mm. At a mean follow-up of 15 months, five patients have died from the disease. Among the 14 survivors, eight have had no limb recurrence of the disease, three have had one further treatment and three a further two treatments to control cutaneous metastases at new sites. Early experience suggests that carbon dioxide laser ablation of cutaneous metastases is an effective palliative treatment after failed isolated limb perfusion, and there may be a group of patients in whom laser ablation should be the initial treatment of choice.
Use of a semipermeable polyamide dressing over skin grafts to venous leg ulcers
Authors: Mahajan R , Mosley J G 
Published: March 2007

Abstract
A polyamide semipermeable mesh interface placed over a skin graft allows absorption of exudate and soaking of the graft with an antiseptic solution. Forty-five patients with large venous leg ulcers (more than 100 cm2) were treated by a split skin graft covered by a polyamide mesh. The mean time to healing and graft take was compared with those of a similar group of 30 patients whose graft was not protected by an interface. The mesh significantly shortened the mean time for complete healing from 41 to 32 days.
Optimum method for urinary drainage in major abdominal surgery: A prospective randomized trial of suprapubic versus urethral catheterization
Authors: O'Kelly T J , Mathew A , Ross S , Munro A 
Published: March 2007

Abstract
The outcome of suprapubic and urethral catheterization in abdominal surgery was compared in a prospective randomized trial. Twenty-eight patients received a suprapubic and 29 a urethral catheter. The groups were similar in terms of age, sex, operation performed and postoperative analgesia. There was no difference in the duration of catheterization (suprapubic: median 5 (range 4-10) days; urethral: median 4 (range 2–11) days). Urinary sepsis occurred in three patients in each group. Urethral catheters caused pain in significantly more patients (urethral 13; suprapubic two; χ2 = 8±6, 1 d.f. P&lt;0±01), on more days (suprapubic: 6 of 142 catheter days; urethral: 37 of 126 catheter days; χ2 = 29±5, 1 d.f. P&lt;0±001). Two men with urethral catheters and one with a suprapubic catheter failed to void urethrally when required to do so. Suprapubic catheterization is the method of choice for urinary drainage when this is required in abdominal surgery.
Randomized trial of laparoscopic cholecystectomy and mini-cholecystectomy
Authors: McGinn F P , Miles A J G , Uglow M , Ozmen M , Terzi C , Humby M 
Published: March 2007

Abstract
Three hundred and ten patients having elective cholecystectomy were randomized to either laparoscopic cholecystectomy or mini-cholecystectomy. There were 155 patients in each group. Conversion to open cholecystectomy was significantly more common with laparoscopic cholecystectomy (13 versus 4 per cent) and complications were significantly more frequent with laparoscopic cholecystectomy (9 versus 3 per cent). If laparoscopic cholecystectomy was successful, hospital stay was significantly shorter than for mini-cholecystectomy (2 versus 3 days respectively), but overall the hospital stay was not significantly different. Postoperative analgesia requirements were reduced and return to normal activities and to work were faster after laparoscopic cholecystectomy. There was no significant cost difference between the two procedures.
Radical resection of locally advanced colorectal cancer
Authors: Poeze M , Houbiers J G A , van de Velde C J H , Wobbes Th , von Meyenfeldt M F 
Published: March 2007

Abstract
Multivisceral resection has been accepted as treatment for patients with locally advanced colorectal cancer. Nodal status has recently been claimed to be the most important predictor of survival in patients with such disease, with no survival after 2 years for patients with lymph node metastasis. A retrospective analysis was carried out of the prognostic significance of different tumour characteristics, and whether a more limited palliative resection is warranted in patients with positive lymph nodes. Of 1346 patients with colorectal adenocarcinoma operated on between 1987 and 1991, all those with a tumour staged as T4N0M0 or T4N1M0 (94 patients) were selected. From the remainder, 195 patients with stage T3N0M0 and T3N1M0 lesions were randomly selected as a control group. Overall survival was assessed at the beginning of 1993. The most important predictors of survival were lymph node status and involvement of the resection margins of the tumour. Overall survival in patients with T4 tumours who underwent radical resection was not significantly different from that in those with T3 tumours, even in N1 stages. Extended resection did not induce unacceptable morbidity or mortality. Surgery for locally advanced colorectal adenocarcinoma should result in tumour-free margins, and should therefore include multivisceral resection, even in patients with lymph node metastasis.
Prognostic factors in surgery for local recurrence of rectal cancer
Authors: Gagliardi G , Hawley P R , Hershman M J , Arnott S J 
Published: March 2007

Abstract
Fifty-five patients had resection of locally recurrent rectal cancer. Fourteen patients (25 per cent) had distant metastases, which were resected concurrently in six (11 per cent). Thirty-three patients (60 per cent) had preoperative (one patient) or postoperative (32) external beam radiotherapy (45–60 Gy). The 5-year survival rate was 18 per cent with a median survival of 24 months. The median symptom-free interval was 24 months. At a median follow-up of 28 months 53 per cent of patients had a second local recurrence and 24 per cent metastases only. Treatment complications occurred in 12 patients (22 per cent), three (5 per cent) of whom died 3–10 months after operation. Variables that were significantly related with longer survival and palliation were the radical nature of the operation, the absence of severe symptoms (such as pain, obstruction or sepsis), a recurrent tumour diameter of less than 5 cm measured on the resected specimen and a normal carcinoembryonic antigen level after reoperation. A Cox regression model showed that recurrent tumour diameter was the only independent prognostic variable. Surgery for local recurrence achieved local control in 47 per cent of patients with a low morbidity and mortality rate.
High morbidity rate after converted laparoscopic colorectal surgery
Authors: Slim K , Pezet D , Riff Y , Clark E , Chipponi J 
Published: March 2007

Abstract
Sixteen of 65 laparoscopically assisted colorectal operations were converted to an open procedure, usually because of dissection difficulties. Conversion was decided early in the procedure in four cases without perioperative morbidity and later in 12 cases, after a mean of 56 min. The results in patients undergoing converted operation were compared with those in 252 having a planned open colorectal procedure during the same period. The groups were comparable with regard to age, health status, factors influencing intestinal healing and grade of surgeon. A higher postoperative morbidity rate (50 versus 21 per cent) and more anastomotic leakages (25 versus 8 per cent) were apparent in the converted group. Operating time, postoperative ileus and hospital stay were longer in those requiring a converted operation. These poor results suggest that careful preoperative patient selection for laparoscopic procedures and a rapid decision to convert in case of difficulty are important.
Difference in expression of CD44 splice variants between proximal and distal adenocarcinoma of the large bowel
Authors: Mulder J W R , Kruyt P M , Sewnath M , Seldenrijk C A , Weidema W F , Pals S T , Offerhaus G J A 
Published: March 2007

Abstract
To help determine whether adenocarcinomas of the proximal and distal large bowei reflect distinct entities, the expression of two splice variants of the metastasis-associated cell adhesion molecule CD44, carrying exons v5 and v6 respectively, was investigated retrospectively in fresh frozen samples of 23 proximal and 41 distal carcinomas by immunohistochemical staining with specific anti-CD44v5 monoclonal antibody VFF8 and anti-CD44v6 monoclonal antibodies VFF4 and VFF7. Tumours were staged as: Dukes A, 0; Dukes B, 27; Dukes C, 31; and Dukes ‘D’, six. Compared with distal tumours, proximal lesions expressed significantly more CD44v5 (96 versus 87 per cent, P = 0·02) and CD44v6 (83 versus 61 per cent, P = 0·01). CD44v5 and CD44v6 are considered markers for tumour progression and aggressive behaviour. Their high expression in proximal carcinomas seems to contrast with the general belief that these tumours show less aggressive behaviour than left-sided lesions. Further study of the biological significance of the expression of CD44 splice variants is therefore needed.
Long-term results of recurrence and reoperation after strictureplasty for obstructive Crohn's disease
Authors: Stebbing J F , Jewell D P , Kettlewell M G W , McC. Mortensen N J 
Published: March 2007

Abstract
Strictureplasty extends the surgical options for the treatment of obstructive Crohn's disease. Over 15 years, 52 patients had 241 strictureplasties at 76 operations with no operative mortality and with septic complications in only two patients (4 per cent). Median (range) follow-up was 49.5 (1–182) months. Nineteen patients (36 per cent) required a second operation for Crohn's disease between 1 and 57 months after first strictureplasty. Most symptomatic recurrence was caused by new segments of stricturing or perforating disease, and recurrence of Crohn's disease was noted at only nine strictureplasty sites (3·7 per cent) in four patients. Seven patients (13 per cent) required a third operation for Crohn's disease. Patients undergoing strictureplasty alone were no more likely to require reoperation than those who had a concomitant resection at the first procedure (X2 = 0·619, P &gt; 0·2). The reoperation rates after first and second operations were similar (X2 = 0·021, P &gt; 0·2). Minimal surgery does not appear to lead to an accelerated or additional need for subsequent operation. Strictureplasty provides a safe, effective and rapid procedure to restore patients to good health while preserving the intestine and may be recommended for carefully selected strictures as an adjunct to conventional excisional surgical treatment.
Microvascular disease and anastomotic dehiscence in the colon
Authors: Fawcett A , Vashisht R , Shankar A , Dawson P M , O'Malley M K , Nott D M , Springall R G 
Published: March 2007

Abstract
Platelet-derived serotonin released in response to tissue manipulation during surgery may contribute to mesenteric arterial vasospasm leading to postoperative anastomotic leakage after colorectal resection. Organ bath experiments were used to demonstrate the efficacy of naftidrofuryl fumarate (NFT) to oppose serotonin-induced vaso-constriction of human mesenteric arteries. Cumulative dose-response curves were derived with and without NFT at 10−9 and 10−6 mol/l concentrations. The difference in maximal contractility between the three sets of curves (n = 8 for each) was significant (P&lt;0.0001). Sensitivity to serotonin in each of the three curves was measured by calculating the concentration for half-maximal response; differences were again significant (P&lt;0.0001). NFT reduced serotonin-induced contractility in a dose-dependent fashion in rings of human mesenteric arteries in vitro. This suggests a possible role for NFT in reducing mesenteric vasospasm in colorectal surgery.
A 10-year prospective audit of outcome of surgical treatment for colorectal carcinoma
Authors: Singh S , Morgan M B F , Broughton M , Caffarey S , Topham C , Marks C G 
Published: March 2007

Abstract
The outcome of 555 patients who underwent surgery under the care of a surgeon with an interest in colorectal disease was examined prospectively over a 10-year period with no exclusions. There was a 4.7 per cent incidence of clinical leaks (10 per cent for anterior resection) and an overall corrected 10-year survival rate after curative surgery of 58, 59 and 48 per cent for right colonic, left colonic and rectal tumours respectively. The incidence of isolated local recurrence was 8 per cent after curative surgery for carcinoma of the rectum. Twenty-five per cent of patients with rectal tumours required abdominoperineal excision. Patients who underwent curative abdominoperineal excision of the rectum had corrected 5-and 10-year survival rates of 48 and 36 per cent, compared with 60 and 58 per cent respectively for curative anterior resection. The perioperative mortality rate of those undergoing palliative surgery was 8 per cent, and 75 per cent died within 2 years from distant and not local disease. A policy of always attempting resection was validated by the fact that 99 per cent of primary tumours were removed with a low perioperative mortality rate (4 per cent overall), a high curative resection rate and a low morbidity rate.
Varicose vein surgery and deep vein thrombosis
Authors: Campbell W B , Ridler B M F 
Published: March 2007

Abstract
A questionnaire was sent to 363 members of the Vascular Surgical Society of Great Britain and Ireland about their use of deep vein thrombosis (DVT) prophylaxis at the time of varicose vein surgery. Replies were received from 289 surgeons (80 per cent), of whom only 29 per cent regarded varicose veins as an important risk factor for DVT. Only 12 per cent used subcutaneous heparin prophylaxis routinely, while 71 per cent did so selectively, being influenced by a history of thromboembolism (95 per cent), obesity (47 per cent), age (35 per cent), recurrent varicose veins (22 per cent) and inpatient status (16 per cent). At the end of the operation 52 per cent applied crepe bandages, 25 per cent other bandages, 13 per cent stockings and 10 per cent Tubigrip. Subsequently, antiembolism stockings were prescribed by 55 per cent. There is a wide variation in opinion regarding DVT prophylaxis for patients having varicose vein surgery, which has both clinical and medicolegal implications.
Typhoid enteric perforation
Authors: Akgun Y , Bac B , Boylu S , Aban N , Tacyildiz I 
Published: March 2007

Abstract
Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome. The morbidity and mortality rates were 55.4 and 28.5 per cent respectively, and the median duration of hospitalization was 18 days. On the basis of these findings, a prospective series of 39 patients was studied. In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered. All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period. The morbidity and mortality rates decreased to 25 and 10 per cent respectively, and the median hospitalization time was 12 days. The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.
Onset of oesophageal peristalsis after surgery for idiopathic achalasia
Authors: Zaninotto G , Costantini M , Anselmino M , Boccu C , Ancona E 
Published: March 2007

Abstract
Twenty-seven patients were treated with a Heller myotomy and Dor fundoplication; some peristaltic contractions occurred in seven after operation. When clinical, radiological and manometric data in the seven patients developing peristalsis were compared with findings in the other 20, there were no differences in symptoms, lower oesophageal sphincter pressures and lengths, relief of dysphagia or oesophageal calibre reduction. Oesophageal resting pressure was lower and oesophageal contraction amplitudes were statistically higher in patients with restored peristalsis, which correlated only with the amplitude of contractions 5 cm above the lower oesophageal sphincter (P&lt;0.05, 95 per cent confidence interval). Peristaltic contractions probably exist before treatment, but are concealed by the dilated oesophagus and the common cavity phenomenon. Achalasia is not necessarily associated with complete aperistalsis. No difference was found in the outcome of surgical treatment, and the return to peristalsis appears to be clinically relevant.