bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anal fistula
Authors: Seow-Choen F , Nicholls R J 
Published: March 2007

AbstractAnal, fistula is a common cause of chronic irritation to both patients and surgeons. Treatment failure rates may be decreased by a good appreciation of normal anorectal anatomy and fistula pathoanatomy, as wlell as a wide and practical knowledge of the possible treatment regimens. The various treatment options available for acute abscesses as well as simple and complex anal fistulae are presented and discussed. Identification of the patient at risk of postoperative anal incontinence or of the dificult or high fistula may allow treatment in a specialized proctology unit.
Management variability in surgery for colorectal emergencies
Authors: Darby C R , Berry A R , Mortensen N 
Published: March 2007

Abstract
A prospective study was made of 92 patients who underwent emergency colorectal surgery during a 1-year period. A dedicated emergency theatre allowed half of the patients to be operated on between 09.00 and 17.00 hours with greater seniority of operating surgeons. The overall mortality rate was 14 per cent and the primary resection rate was 79 per cent. The mortality rate was 12 per cent for right-sided resection with anastomosis and 24 per cent for left-sided resection without anastomosis, including those undergoing Hartmann's procedure which had a 35 per cent mortality rate. Immediate left-sided anastomosis was performed safely in all 14 patients in whom it was attempted. Firms headed by consultants with and without a special interest in colorectal disease made differing use of primary resection and immediate anastomosis (67 versus 41 per cent, P &lt; 0·05) and Hartmann's (7 versus 25 per cent, P &lt; 0·05) and non-resectional (15 versus 29 per cent, P not significant) procedures. Retrospective surveys of perioperative deaths examine inadequate management and subsequent mortality rates, but do not reveal the significant morbidity rate that occurs in survivors. This audit revealed significant diferences in the management of patients with colorectal emergencies between, firms headed by specialist and non-specialist consultants. In order to minimize these diflerences we believe that recent advances in colorectal practice should be included in the training of all surgeons.
Extracorporeal shockwave lithotripsy and litholytic therapy in cholelithiasis
Authors: Erdamar I , Avci G , Füzün M , Harmancioğlu Ö 
Published: March 2007

Abstract
Extracorporeal shockwave lithotripsy (ESWL) and litholytic therapy were used in 100 patients over a period of 16 months. ESWL was carried out with a Lithostar Plus and chenodeoxycholic acid was used as the lytic agent, given until 3 months after complete disappearance of stones. Within a period of 8–12 months, stones disappeared completely in 82 per cent of the patients who had a single stone ≤ 20 mm in diameter and in 50 per cent of those with a single stone &gt; 20 mm in size or with multiple stones. Complications requiring surgery developed in five patients: three had acute cholecystitis and two developed acute pancreatitis. Of the patients in whom complete stone clearance was achieved, two of 11 followed up developed recurrence of stones 4 months after cessation of lytic therapy.
Serum electrolytes and capillary blood gases in the management of hypertrophic pyloric stenosis
Authors: Shanbhogue L K R , Sikdar T , Jackson M , Lloyd D A 
Published: March 2007

Abstract
The purpose of this study was to assess whether the concentration of serum chloride and other variables, namely serum sodium, potassium and bicarbonate, can be used to predict metabolic acid–base status in infants with hypertrophic pyloric stenosis (HPS) and to assess whether such a prediction is influenced by the state of hydration. One hundred and sixty-three infants with HPS who had at least one set of serum electrolyte and capillary blood gas estimations performed after admission were studied retrospectively. A further 25 infants who had their electrolyte and blood gases measured after at least 12 h of rehydration and correction of the serum sodium and chloride abnormalities were studied prospectively. Stepwise multiple regression analysis, using standard bicarbonate as the dependent variable, revealed serum chloride concentration to be the most powerful independent predictor of standard bicarbonate level (r = −0·69, P &lt; 0·0001). Other variables did not improve the correlation significantly. In the retrospective study of untreated patients, the calculation of a 90 per cent prediction interval for the model indicated that if the serum chloride level is less than 96 mmol/l, one could be 95 per cent confident (one tail) that the patient was alkalaemic. To be 95 per cent confident that the patient was not alkalaemic, the serum chloride level would have to be greater than 121 mmol/l. The prospective study found that following rehydration a serum chloride level greater than or equal to 106 mmol/l more accurately predicted absence of alkalaemia. We conclude that predictability of acid–base status from measurement of serum chloride depends on the state of hydration of the patient.
Carcinoma in multinodular goitre
Authors: Koh K B H , Chang K W 
Published: March 2007

Abstract
A retrospective review of 107 patients operated on for multinodular goitre was carried out to determine the incidence of carcinoma. Of the group 7.5 per cent harboured incidental carcinomas with papillary carcinoma being the most common variety. The indications for removal of multinodular goitre should be compressive symptoms, suspicion of malignancy and cosmesis.
Improving survival in gastric cancer: Review of 5-year survival rates in English language publications from 1970
Authors: Akoh J A , Macintyre I M C 
Published: March 2007

Abstract
In this review of English language publications from 1970, 5-year survival rates after surgery for gastric cancer have been analysed. While the proportion of patients coming to operation has fallen from 92 per cent before 1970 to 71 per cent by 1990, the proportion of operated patients undergoing resection has increased from 37 per cent before 1970 to 48 per cent before 1990. This change suggests improved preoperative staging leading to better patient selection for operation. The 5-year survival rate following all resections has increased significantly from 20.7 per cent before 1970 to 28.4 per cent before 1990, an increase of 7.7 per cent (95 per cent confidence interval 7.1–8.3 per cent). The 5-year survival rate following curative or radical resection has risen from 37.6 to 55.4 per cent over the same period, an increase of 17.8 per cent (95 per cent confidence interval 17.1–18.5 per cent). It is likely that this improvement has contributed to the decrease in the mortality rate from gastric cancer. Comparison of Japanese series with others suggests that diagnosis and treatment of the disease at an earlier stage will result in an even greater increase in 5-year survival rates outside Japan. Of the papers studied, 56 per cent were excluded from analysis, the majority because the data provided about 5-year survival rates were insufficient or the survival calculations inappropriate. Results of survival after operations for gastric cancer should be calculated and presented in a standardized manner.
Audit of open cholecystectomy in a district general hospital
Authors: Davies M G , O'Broin E , Mannion C , McGinley J , Gupta S , Shine M F , Lennon F 
Published: March 2007

Abstract
This retrospective study audited all non-malignant biliary surgery carried out in a district general hospital between January 1985 and December 1990. Surgery was performed on 722 patients: 555 (77 per cent) were women and 167 (23 per cent) were men. The mean(s.d.) age of the patients was 49(16) years. Elective admissions accounted for 70 per cent of cases and 30 per cent were emergency admissions. Ultrasonography confirmed the diagnosis in 93 per cent of cases. An elective operation was performed in 542 patients and 180 patients underwent an urgent or emergency operation. Simple cholecystectomy was performed on 616 patients (8.5 per cent); 92 (13 per cent) also underwent common bile duct exploration and 14 (2 per cent) had an additional unrelated procedure. The mean(s.d.) hospital stay was 12.3(6.3) (range 4–34) days. There was one perioperative death. The general overall morbidity rate was 2.5 per cent and the procedure-related morbidity rate was 7 per cent. For simple cholecystectomy (n = 630) there were no deaths; the general morbidity rate was 15 per cent and the procedure-related rate was 3 per cent.
Laparoscopy in the management of pancreatic cancer: Endoscopic cholecystojejunostomy for advanced disease
Authors: Shimi S , Banting S , Cuschieri A 
Published: March 2007

Abstract
Following a period of animal experimentation in pigs, a laparoscopic technique for sutured gastrointestinal and bilioenteric anastomoses was developed and its safety and efficacy tested in chronic experiments. The method involves the construction of a preformed external jamming loop knot and continuous suturing using a specially developed Endoski needle. The technique was used to construct a cholecystojejunostomy in five patients with advanced cancer of the pancreas (four hand-sutured and one stapled/sutured). Four of the patients recovered from the procedure with no complications, minimal postoperative discomfort and complete relief of their jaundice. In one patient relief of jaundice was slow due to blockage of the anastomosis by debris and blood clot; this resolved following removal of the inspissated material. This minimally invasive procedure has the potential for complete palliation with short hospital stay and avoids the hazards of endoscopic stenting such as encrustation and cholangitis.
Metabolic bone disease following gastrectomy: Assessment by dual energy X-ray absorptiometry
Authors: Inoue K , Shiomi K , Higashide S , Kan N , Nio Y , Tobe T , Shigeno C , Konishi J , Okumurat H , Yamamuro T , Fukunaga M 
Published: March 2007

Abstract
Although disorders in bone metabolism have long been recognized as typical sequelae of gastrectomy, there has until now been no reliable method of providing precise assessment of bone mass, resulting in a variation of reported incidence. In this study, metabolic bone disease was evaluated in a well characterized population: 34 men 2–5 years after gastrectomy; 11 men 6–10 years after gastrectomy; eight men 2–5 years after colonic resection; and 115 healthy men. The age range was 50–69 years. An innovative reliable method of dual energy X-ray absorptiometry was used which allows quantitative assessment of bone mineral content. Measurement of lumbar spine bone mineral density revealed that the mean(s.e.m.) bone mineral density in patients who had had a gastrectomy (2–5 years 0.84(0.03) g/cm2, 6–10 years 0.85(0.05) g/cm2) was significantly lower than that of patients who had undergone colonic resection (0.96(0.04) g/cm2) or healthy men (0.96(0.03) g/cm2). This study demonstrates that a high incidence of bone atrophy is induced at the relatively early period of 2–5 years after gastrectomy.
Proliferation indices of invasive breast carcinomas after in vivo 5-bromo-2′-deoxyuridine labelling: A flow cytometric study of 75 tumours
Authors: Rew D A , Campbell I D , Taylor I , Wilson G D 
Published: March 2007

Abstract
In vivo labelling of human breast tumours with 5-bromo-2′-deoxyuridine and analysis of proliferation by multiparameter flow cytometry is a new tool by which the labelling index, S phase duration (Ts) and potential doubling time (Tpot) of the tumour can be estimated. Tumour specimens from 75 patients with invasive breast carcinoma were studied. Six tumours could not be analysed, and the Ts and Tpot values could not be calculated for a further 18. The median labelling index (n = 69) was 4.2 per cent. The median Ts (n = 51) was 8.7 h and the median Tpot (n = 51) was 8.2 days. The median intra-assay coefficient of variation for determination of the labelling index was 0.29 in five tumours. There were no significant differences in the total labelling index, Ts or Tpot when patients were stratified according to lymph node status, tumour size, tumour grade or menopausal status.
Shrinkage of the below-knee stump in leprosy
Authors: Mahaisavariya B , Jeeravipoolvarn P , Vipulakorn K , Sirichativapee V 
Published: March 2007

Abstract
The long-term progress of below-knee stumps was studied in 65 leprotic amputees. Thirty-seven patients underwent amputation with a long posterior flap (LP) and 28 patients with an equal anterior and posterior flap (EF) technique. Mean follow-up was for 6 and 7 years respectively. Shrinkage of the soft tissue and retraction of the posterior calf muscles caused the posterior skin flap of the stump to rotate posteriorly in all cases, with a mean 26° of rotation in LP stumps and 42° of rotation in EF stumps. The LP stumps remained thicker, with soft tissue padding at the bony ends, and had fewer stump complications than the EF stumps.
Predeposit autologous blood transfusion in patients with colorectal cancer: A feasibility study
Authors: Harrison S , Steele R J C , Johnston A K , Jones J A , Morris D L , Hardcastle J D 
Published: March 2007

Abstract
Over a 2-year period, a predeposit autologous blood transfusion service was provided for all patients undergoing elective surgery for left-sided colonic or rectal cancer in one hospital. Of 129 such patients, 28 were suitable for autologous donation. Eight of these received autologous blood only, 13 required no transfusion, and seven needed additional homologous blood. Thus, although predeposit autologous transfusion for patients with colorectal cancer is possible, only a very small proportion are likely to derive any benefit which it might confer.
Attitudes of cardiothoracic surgeons in the UK to human immunodeficiency virus
Authors: Roxburgh J C , Shah S S , Loveday C , Goldstraw P , Yacoub M 
Published: March 2007

Abstract
A survey was carried out into attitudes of cardiothoracic surgeons in the UK to human immunodeficiency virus type 1 (HIV-1) infection associated with clinical situations that would normally have been managed surgically with low operative mortality rates and long median survival times. The survey response rate was 72.4 per cent. In patients with acute valvular insuficiency or with continuing angina despite maximal medical therapy (unstable angina) who were HIV-1 antibody positive, 75.8 and 80.8 per cent, respectively, of surgeons would operate. If the patient had end-stage infection, acquired immune deficiency syndrome (AIDS), 29.7 per cent and 34.7 per cent, respectively, would consider surgical intervention. When asked to perform simple procedures such as open lung biopsy or pleurectomy on a patient with AIDS, more than half of surgeons would operate (52.2 and 65.6 per cent respectively). In patients with operable carcinoma of the lung and asymptomatic HIV-1 infection 52.3 per cent would operate. This fell to 15.0 per cent if the patient had a diagnosis of AIDS. The majority of surgeons (77.2 per cent) felt patients should have an HIV-1 antibody test before operation and this rose to 95.6 per cent if patients were in a high-risk group; 60.2 per cent of surgeons had changed their surgical practice to reduce the risks of blood-borne infection.
Persistence of allogeneic cells in graft and host tissues after small bowel transplantation
Authors: Clark C L Ingham , Price B A , Crane P W , Lear P A , Wood R F M 
Published: March 2007

Abstract
Small bowel transplantation is associated with a significant risk of graft versus host disease owing to the large amount of organized lymphoid tissue within the graft. This study assessed whether graft lymphoid cells could persist in the long term following fully allogeneic small bowel transplantation when graft rejection was prevented by cyclosporin immunosuppression. Transplantation was carried out between PVG and DA strains of rat. Cyclosporin (15 mg/kg) was given daily from transplantation, and groups of animals were studied at 28 and 56 days after grafting. The proportions of donor- and recipient-derived cells in the graft and in the host gut and lymphoid tissues were assessed using immunohistochemical tissue staining and monoclonal antibodies specific for cells expressing class I antigens from the two strains of rat. Results demonstrated a persisting population of graft-derived T cells which were capable of migration to the host. Therefore, there may be a long-term risk of graft versus host disease after small bowel transplantation under cyclosporin immunosuppression.
Dermatan sulphate: A safe approach to prevention of postoperative deep vein thrombosis
Authors: Prandoni P , Meduri F , Cuppini S , Toniato A , Zangrandi F , Polistena P , Gianese F , Faccioli A Maffei 
Published: March 2007

Abstract
To assess the eficacy and safety of dermatan sulphate (MF 701) in preventing postoperative deep vein thrombosis (DVT), 324 patients aged 40 years or over undergoing elective major general surgical operations were included in a randomized trial comparing MF 701 (100 my intramuscularly once a day) with unfractionated calcium heparin (UFH, 5000 units subcutaneously three times daily). Both treatments were initiated before operation and continued until discharge. In all, 316 patients were included in the analysis (MF 701, 157; UFH, 159). Serial impedance plethysmography was performed in all patients; a 125I-radiolabelled fibrinogen uptake test was added to impedance plethysmography in a randomized subsample of 62 patients (MF 701, 28; UFH, 34). Positivity in either test was confirmed where possible by venography. DVT was diagnosed by venography or, when this could not be performed, by positivity of either impedance plethysmography or fibrinogen uptake test. The incidence of DVT was 3.1 per cent (patients receiving MF 701) and 1.6 per cent (those receiving UFH) in patients undergoing impedance plethysmography alone, and 7.1 and 11.8 per cent, respectively, in those undergoing both impedance plethysmography and fibrinogen uptake test; in neither case was the difference between treatments statistically significant. There were five in-hospital deaths, two in patients receiving MF 701 and three in patients on UFH. The incidence of clinically overt haemorrhage was 5.7 per cent in patienis on MF 701 and 17.6 per cent in those on UFH (P &lt; 0.01). Postoperative transfusions and reoperations due to bleeding were significantly less frequent in patients receiving MF 701. Mortality rates at 3 months were similar for the two treatment groups. Compared with standard prophylaxis using UFH, MF701 showed a similar eficacy with a significantly greater safety.
Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery
Authors: Jensen L S , Andersen A J , Christiansen P M , Hokland P , Juhl C O , Madsen G , Mortensen J , Meller-Nielsen C , Hanberg-Sørensen F , Hokland M 
Published: March 2007

Abstract
The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 9.5 per cent confidence interval 13–32 per cent), in one patient transfused with blood free from leucocytes and platelets (2 per cent, 9.5 per cent confidence interval 0.05–11 per cent) and in two non-transfusedpatients (2 per cent, 95 per cent conjidence interval 0.3-8per cent) (P &lt; 0.01). Natural killer cell function was significantly (P &lt; 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.
Elective hepatic resection in the elderly
Authors: Mentha G , Huber O , Robert J , Klopfenstein C , Egeli R , Rohner A 
Published: March 2007

Abstract
This retrospective review assessed the safety and validity of elective liver resection in patients older than 64 years of age. In all, 293 patients underwent elective liver resection over a 23-year period (1967–1990). Fifty-two patients (18 per cent) were older than 64 (maximum 84, mean 70.4) years and all but four of these did not have cirrhosis. In this older subgroup, indications for resection were liver metastases in 30 patients, primary malignancy in 16, benign tumours in five and multiple abscesses in one. There were 21 major resections, with two deaths from hepatic failure, and 31 minor resections, with one death from cardiac failure (total mortality rate 6 per cent). During the same period, there were seven deaths after elective resections performed in 222 patients without cirrhosis who were younger than 64 years (P = 0.39). Mortality rate and duration of postoperative hospital stay were not related to the extent of liver resection nor to patients' grading according to the American Society of Anesthesiologists' criteria. Intraoperative blood loss was the only parameter found to influence mortality rate (P = 0.008) and duration of hospital stay (P = 0.04). Elective liver resection can be safely undertaken in elderly patients without cirrhosis, provided that intraoperative blood loss is minimized.
Clinical experience with adult polycystic liver disease
Authors: Vauthey J-N , Maddern G J , Kolbinger P , Baer H U , Blumgart L H 
Published: March 2007

Abstract
Adult polycystic liver disease is characterized by multiple difluse cystic lesions of the liver, usually in association with polycystic kidney disease. Rarely, significant liver disease will produce enough symptoms to call for surgical attention. Symptoms range from simple compression to fatal liver failure. Treatment of seven patients (six women) with symptomatic polycystic liver disease over 18 months is reported. Rapidly progressing liver failure and sepsis from infected ascites following puncture developed in one patient and precluded surgery. Another presented with an acute abdomen and anaemia from liver cyst bleeding and was treated conservatively. Five patients with massive hepatomegaly and compression symptoms underwent fenestration and resection to debulk the cystic liver mass. No intra-abdominal drains were used after operation and there were no hospital deaths. One patient developed a bile leak which was managed by percutaneous drainage. Clinical approach, complications and treatment options in adult polycystic liver disease are reviewed.
Siting a transverse colostomy
Authors: Majno P E , Lees V C , Goodwin K , Everett W G 
Published: March 2007

Abstract
Traditional teaching suggests that a transverse colostomy should be sited in the right upper quadrant. This study of 67 colostomies (26 right upper quadrant and 41 right iliac fossa) indicates that they should be placed in the optimum position for each patient, which is usually the right iliac fossa.