bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antihepatitis C virus status in hepatocellular carcinoma and the influence on clinicopathological findings and operative results
Authors: Takeda S , Nagafuchi Y , Tashiro H , Abe Y , Fukushige H , Komori H , Okamoto K , Ohsato K , Haratake J 
Published: March 2007

Abstract
Antihepatitis C virus (HCV) status was investigated in 100 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) between 1980 and 1989. The clinicopathological findings and operative results, inpatients with or without HCV marker, were compared retrospectively. The positivity rate of anti-HCV was 51 per cent. In this group there was a higher mean age, fewer symptoms, raised alanine aminotransferase level, higher 15-min indocyanine green clearance rate and earlier tumour stage compared with the anti-HCV negative group. Positive tumour margins and vascular invasion were seen less frequently in the anti-HCV positive group. HCC with HCV marker showed characteristic features of chronic non-A non-B hepatitis and of HCC originating from liver cirrhosis. There was a better cumulative 1-year survival rate for anti-HCV positive patients, but 3- and 5-year survival rates after hepatectomy were similar in both groups. Although HCV-related HCC had typical features of chronic non-A non-B hepatitis and a relatively early stage of tumour, biological features and operative results were similar with or without the HCV marker.
Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern
Authors: Nugent K P , Phillips R K S 
Published: March 2007

Abstract
The risk of rectal cancer in 224 patients with familial adenomatous polyposis with an ileorectal anastomosis has been estimated by life-table analysis. Until the age of 50 years the cumulative risk is reasonably low at 10 per cent (95 per cent confidence interval 4.5–16 per cent), increasing sharply to 29 per cent (95 per cent confidence interval 18–40 per cent) by the age of 60 years. This means that surveillance of the retained rectum in older patients must either be improved or they should undergo restorative proctocolectomy in earlier middle age.
Mucin changes in ileoanal pouches monitored by metabolic labelling and histochemistry
Authors: Corfield A P , Warren B F , Bartolo D C C , Wagner S A , Clamp J R 
Published: March 2007

Abstract
The pattern of mucin synthesis and secretion in mucosal biopsies from the proximal ileum, distal ileum, rectum and pouch before and after ileostomy closure was monitored in patients undergoing restorative proctocolectomy by metabolic labelling with [3H]glucosamine and [35S]sulphate and compared with the mucin histochemistry in each patient. Metabolic labelling clearly demonstrated a reduction in sulphation associated with the rectal mucosa in colitis. Significant diferences in the turnover of isolated secreted mucin between proximal and distal ileum and rectum were also found, as was a metaplastic change towards a colonic-type mucosa in the pouch before and after ileostomy closure relative to the proximal and distal ileum, and rectum. This technique can be used to monitor colonic metaplasia in the pouch mucosa and is suitable for comparative studies where mucin changes are implicated.
General surgery in patients aged 80 years and older
Authors: Rørbæk-Madsen M , Dupont G , Kristensen K , Holm T , Sørensen J , Dahger H 
Published: March 2007

Abstract
This study reviews 594 surgical admissions, of patients aged 80 years and older, to departments of general surgery during 1 year. Half of the patients were admitted as emergencies and 60 per cent underwent surgery. The operative mortality rate was 8 per cent and the overall mortality rate for all admissions 9 per cent. The number of complications and the mortality rate after surgery increased in emergency cases and in patients with coexisting disease. Of all admissions, 72 per cent were uncomplicated and in 70 per cent patients could be discharged directly home; such patients do not generally take up beds and are discharged as soon as medical care is no longer indicated. The number of admissions of patients over 80 years of age will increase by about 30 per cent during this decade and, unless additional resources are provided to meet this challenge, new standards must be considered for the distribution of resources and of indications for surgery in both young and old.
Prosthetic vascular graft infection
Authors: O'Brien T , Collin J 
Published: March 2007

Abstract
The aetiology, diagnosis and management of prosthetic vascular graft infection are reviewed. The importance of contamination at the time of surgery as the crucial aetiological factor is highlighted. Staphylococcus epidermidis is the causative organism in over 50 per cent of cases and the reasons for this are explored. Sound surgical technique, use of prophylactic antibiotics and the avoidance of a groin incision are emphasized as the most important factors in prevention of graft infection. Difficulties of diagnosis are highlighted and the diagnostic role of various imaging methods is assessed. Graft excision with extra-anatomic revascularization is presented as the conventional surgical solution, while the roles of less radical surgical solutions and non-operative management are discussed.
Mechanical properties of the aneurysmal aorta
Authors: Macsweeney S T R , Young G , Greenhalgh R M , Powell J T 
Published: March 2007

Abstract
The mechanical properties of the abdominal aorta were investigated non-invasively in 30 patients with aortic anaeurysm and II with peripheral arterial disease. The distensibility of the aorta was measured using M-mode ultrasonography, permitting non-invasive assessment of the pressure-strain elastic modulus or aortic stiffness, Ep. The median Ep value increased, from 4.0 N/cm2 in control subjects in their third decade of life (n = 10) to 10.4 N/cm2 in middle age (n = 11) to 14.0 N/cm2 in the elderly (n = 13). In the presence of a normal diameter.peripheral arterial disease with aortic atherosclerosis had little effect on aortic stiffness, median Ep being 16.0 N/cm2. Aneurysmal dilatation was associated with a significant increase in aortic stiffness, median Ep being 31.3 N/cm2 (P &lt; 0.001). For aortas of normal diameter, Ep was at all ages dependent on mean arterial pressure. In patients with aortic aneurysms there was no clear relationship between Ep and mean arterial pressure or aortic diameter. Of the patients studied, 15 underwent aortic rcconstruction; increasing aortic stiffness (log Ep) was associated with a decreased medial elastin content of the aortic biopsy (r = −0.63, P &lt; 0.02). This study demonstrates the marked stiffness or inelasticity of dilated or aneurysmal vessels, part of which is attributable to the loss of elastin.
Effect of free radical scavenging on skeletal muscle blood flow during postischaemic reperfusion
Authors: Hardy S C , Homer-Vanniasinkam S , Gough M J 
Published: March 2007

Abstract
After 6-h tourniquet ischaemia of one hindlimb in male Sprague-Dawley rats, gastrocnemius muscle blood flow was measured following 10, 120 and 240 min of reperfusion using radiolabelled microspheres. A perfusion index was calculated (experimental limb: contralateral limb) for each of these times. Comparison of perfusion indices in ten control animals (6 h ischaemia, 4 h reperfusion) with similar measurements in ten normal rats with no ischaemia and in ten ischaemic animals with the tourniquet in situ demonstrated low median (interquartile range (i.q.r.)) reflow after 10 min (control 0.12 (0.02–0.43), ischaemia 0.04 (0.00–0.07), normal 1.05 (0.68–1.18); control versus ischaemia, P not signficant; control versus normal, P &lt; 0.01). Relative reperfusion occurred at 120 min (control 0.48 (0.11–0.70), ischaemia 0.02 (001–0.07), normal 0.97 (0.79−1.13); control versus ischaemia, P &lt; 0.05; control versus normal, P &lt; 0.05) and reperfusion injury after 240 min of revascularization, with muscle blood flow being little diflerent from that in the ischaemic group (control 0.05 (0.01−0.38), ischaemia 0.03 (0.00–0.07), normal 1.01 (0.73–1.16); control versus ischaemia, P not significant; control versus normal, P &lt; 0.01). Two groups of 12 rats were given either intravenous superoxide dismutase and catalase or dimethylthiourea 30 min before tourniquet release, continuing throughout the period of reperfusion. Superoxide dismutase and catalase reversed low reflow, producing a median (i.q.r.) perfusion index of 0.94 (0.54−1.12) (P &lt; 0.01 versus control, P not significant versus normal), but had no effect on relative reperfusion (0.66 (0.42–1.01), P not significant versus control) or on reperfusion injury (0.27 (0.01–0.35), P not significant versus control). In contrast, dimethylthiourea had no effect on perfusion at either 10 min (0.10 (0.03–0.15), P not significant versus control) or 240 min (0.04 (0.00–0.11), P not significant versus control), but abolished the phase of relative reperfusion at 120 min (0.04 (0.02–0.21), P &lt; 0.01 versus control). These results indicate that, although superoxide radicals are harmful during postischaemic reperfusion, hydroxyl radicals may be beneficial.
Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit
Authors: Jones D R , Copeland G P , De Cossart L 
Published: March 2007

Abstract
POSSUM and APACHE II scores from 117 consecutive admissions to a high-dependency unit after major surgery were correlated with 30-day morbidity and mortality rates. Thirteen patients (II per cent) died and 59 (50 per cent) developed a postoperative complication. Receiveroperating characteristic curve analysis showed POSSUM to have good predictive value for mortality (area under curve 0.75) and morbidity (area under curve 0.82). APACHE II scores had a significantly inferior predictive value for mortality (area under curve 0.54) (P &lt; 0.002). POSSUM was superior to APACHE II in prediction of mortality in patients admitted to a high-dependency unit after general surgery. Prediction of postoperative complications by POSSUM is accurate and may be useful for audit.
Autopsy analysis in surgical patients: A basis for clinical audit
Authors: Barendregt W B , De Boer H H M , Kubat K 
Published: March 2007

Abstract
An autopsy study was performed to quantify diagnostic fallibility in clinical surgery. Autopsy results in 312 surgical patients were compared with clinical findings. The primary clinical diagnosis was correct in 93 per cent of patients: complications had been correctly diagnosed in 60 per cent and error in treatment was found in 16 per cent. Error in treatment had an adverse impact on the course of disease in 11 per cent of patients. Infective complications such as abdominal sepsis and bronchopneumonia were encountered most often. Sensitivity was low for the clinical diagnosis of pulmonary embolism, bronchopneumonia, myocardial infarction and terminal haemorrhage. Statistical analysis showed that sudden unexpected death is the most obvious condition in which a high yield is expected from a post-mortem examination. Autopsy remains a valuable means of quality control in clinical surgery and could be a basis for surgical audit.
Subcutaneous mastectomy with immediate reconstruction as treatment for early breast cancer
Authors: Palmer B V , Mannur K R , Ross W B 
Published: March 2007

Abstract
Subcutaneous mastectomy and axillary dissection combined with immediate reconstruction was used to treat primary breast cancer in a consecutive series of 111 patients. Local recurrence occurred in 19 patients (17 per cent) during a mean, follow-up of 30 (range 6–60) months. Complete control of local disease was achieved in all patients except one, who had terminal disease. Prophylactic radiotherapy was avoided for 83 per cent of patients, and good cosmetic results were obtained in 89 per cent. These results support the use of this technique in the treatment of early breast cancer.
Regional variation in the surgical treatment of early breast cancer
Authors: Morris J 
Published: March 2007

Abstract
A questionnaire survey of consultant surgeons in England was undertaken to establish the preferred surgical management of early breast cancer. The Regional Health Authority in which each surgeon worked was recorded to document regional variation. The 14 Regional Health Authorities were divided into three geographical areas: north, central and south. The main finding was that proportionately more surgeons in the north would recommend mastectomy (P &lt; 0.0001) rather than conservative surgery compared with those in the central and southern areas. The nature of the study does not allow explanations for such variation.
Tumour oestrogen receptor content allows selection of elderly patients with breast cancer for conservative tamoxifen treatment
Authors: Low S C , Dixon A R , Bell J , Ellis I O , Elston C W , Robertson J F R , Blarney R W 
Published: March 2007

Abstract
Immunocytochemical analysis was used to determine tumour oestrogen receptor (ER) content in elderly patients with primary operable breast cancer. Only those ER positive were selected for conservative treatment with tamoxifen alone. Initial response was compared with that of historical controls not selected according to ER status. Early progressive disease was markedly reduced at 6 months, from 30 per cent in the unselected control group to 2 per cent in the study group (P &lt; 0.001). Immunocytochemical analysis is useful for the initial selection of elderly patients with breast cancer who may be treated with tamoxifen alone.
Liver trauma: A 10-year experience
Authors: John T G , Greig J D , Johnstone A J , Garden O J 
Published: March 2007

Abstract
The management of 73 patients with liver trauma (58 male, 15 female; mean age 30 (range 6–68) years) presenting from January 1980 to August 1990 is reviewed. There were 29 cases of penetrating injury and 44 of blunt trauma. Seven patients were successfully managed without operation (five with blunt injury) and were discharged after a mean hospital stay of 8 days, Fifty-one cases were classified as simple injuries (grade I or II) and were managed by suture (with or without drainage) or required no intervention, with three deaths. Fifteen cases were classified as complex injuries (grade III or IV) and underwent one or more of the following: perihepatic packing, resectional debridement, hemihepatectomy and hepatotomy with direct suture ligation. Six of these patients died from uncontrolled haemorrhage. The continued use of suture for simple injuries and of resectional debridement and/or packing for complex injuries is supported. Judicious clinical assessment and radiological monitoring may reduce the number of unnecessary laparotomies.
Abdominal inflammatory myofibroblastic tumours in children
Authors: Stringer M D , Ramani P , Yeung C K , Capps S N J , Kiely E M , Spitz L 
Published: March 2007

Abstract
Inflammatory myofibroblastic tumours (inflammatory pseudotumours) occurring at intra-abdominal sites in children have rarely been described. This paper reports three patients with this tumour, two of whom presented with fever, anaemia and an abdominal mass, the third with chronic duodenal obstruction. All had experienced significant weight loss. At operation, each had a large fibrous tumour (7–18 cm in diameter) originating from the transverse mesocolon, small bowel mesentery and duodenum respectively. Intraoperative frozen section histological examination in one patient was misinterpreted as a sarcoma. All the lesions were judged to have been completely excised, but one was ruptured during operation and the patient subsequently developed recurrent tumour nodules. Abdominal inflammatory myofibroblastic tumours are rare. They may be suspected before operation but their clinical, radiological and pathological features may be confused with those of malignancy. Complete excision is necessary to avoid local recurrence.
Incidence and prognosis of Krukenberg tumour in Northern Ireland
Authors: Gilliland R , Gill P J 
Published: March 2007

Abstract
The case notes of 15 patients with Krukenberg tumours were studied to determine the incidence, presentation, clinical findings and prognosis of the disease in Northern Ireland. Patients tended to be young and premenopausal. A short history of abdominal pain was the most frequent presenting complaint, abdominal swelling being second. Menstrual irregularities occurred infrequently and no patient was virilized. Tumours tended to be large, bilateral and associated with ascites. The stomach was the commonest primary site. The overall prognosis was poor, especially if the primary tumour remained covert at the time of diagnosis. The prognosis was unaflected by subsequent discovery of the primary source; extensive investigation is inconvenient for the patient and wasteful of resources. The incidence of the tumour in Northern Ireland was 0.16 per 100 000 per annum: it will be rarely encountered by general surgeons.
Rectal cancer risk in patients treated for familial adenomatous polyposis
Authors: De Cosse J J , Bülow S , Neale K , Järvinen H , Alm T , Hultcrantz R , Moesgaard F , Costello C 
Published: March 2007

Abstract
Total colectomy with ileorectal anastomosis (IRA) in familial adenomatous polyposis (FAP) leaves patients at risk for rectal cancer. To assess this risk, the rectal cancer incidence in 297 patients with FAP undergoing IRA since 1951 was determined in the population-based registers of Denmark, Finland and Sweden. At the same time, detailed data on 50 patients with FAP and invasive rectal cancer were obtained from 11 international polyposis registries. The cumulative incidence of rectal cancer was 13.1 per cent at 25 years. The 5-year survival rate of patients with FAP developing rectal cancer was 71 per cent. Combining both studies, the risk of dying from rectal cancer after IRA was 2.0 per cent at 15 years of follow-up. These results justify IRA as primary treatment for most patients; restorative proctocolectomy is preferred for some subgroups. The high all-cause mortality rate observed in this relatively young population necessitates lifelong surveillance of patients with FAP.
Role of the neutrophil in adult respiratory distress syndrome
Authors: Windsor A C J , Mullen P G , Fowler A A , Sugerman H J 
Published: March 2007

Abstract
Adult respiratory distress syndrome (ARDS) remains a significant cause of morbidity and mortality in surgical practice. Despite the continued advance of surgical technique and therapy, the mainstay of treatment of ARDS remains supportive. In the past decade cytokines have been found to be primary chemical mediators of the host response to inflammatory disease. The polymorphonuclear leucocyte has also emerged as a possible cellular mediator of the end-organ damage that characterizes these inflammatory processes. The role of the neutrophil as the primary cellular mediator of alveolar capillary membrane injury in ARDS remains controversial. This article reviews the relevant current literature and considers the implications of the prevailing evidence on future management of this syndrome.
Outcome 5 years after 3600° fundoplication for gastro-oesophageal reflux disease
Authors: Johansson J , Johnsson F , Joelsson B , Florén C-H , Walther B 
Published: March 2007

Abstract
Forty patients with a mean age of 45 (range 22–65) years were operated on between 1982 and 1985 for gastro-oesophageal reflux disease with a short floppy 360° fundoplication. The results of the operation were determined by endoscopy, oesophageal manometry, ambulatory 24-h pH recording and symptom evaluation 6 months and 5 years after operation. These results were compared with findings in healthy controls. The median pressure in the lower oesophageal high-pressure zone was 13·3 (interquartile range (i.q.r.) 11·3–21·3) mmHg after 5 years, which did not differ significantly from the value at 6 months' follow-up or from that in controls. It was, however, significantly higher than the preoperative pressure. The median intra-abdominal length of the high-pressure zone was 1·7(i.q.r. 1·3–2·3) cm after 5 years, significantly less than at 6 months but equal to control length. Measurement of the proportion of total time at pH &lt; 4 at 5 years (median 0·2 (i.q.r. 0·0–0·6) per cent) and 6 months after operation revealed a significant reduction in acid reflux compared with preoperative values and normal controls. There was no significant difference in acid exposure between the two postoperative investigations. Endoscopy showed that 27 patients had no oesophagitis, three had erythema and three persistent Barrett's oesophagus 5 years after operation. Normal belching was possible in 22 patients and 18 experienced increased flatulence 5 years after fundoplication. An independent gastroenterologist found that the result was excellent in 16 patients, good in 16 and fair in four; two patients had a poor overall outcome of the operation. It is concluded that a 360° fundoplication provides good long-term control of reflux and that slight symptoms of overcompetence are common among patients operated on without affecting the overall result.
Liver transplantation in patients with thrombosis of the portal, splenic or superior mesenteric vein
Authors: Moreno González E , Garc García I Ía , Sanz R G ÖMez , González-Pinto I , Segurola C Loinaz , Jim Romero C Énez 
Published: March 2007

Abstract
Fourteen cases are presented of preoperative portal vein thrombosis complicating orthotopic liver transplantation from an experience of 195 transplants carried out between April 1986 and April 1991. In four patients who suffered rethrombosis of the portal vein, the mortality rate was 100 per cent from various causes. Overall there were six deaths; two of those who died had a patent portal vein at death. Three patients underwent retransplantation: one for primary non-function, two for rejection. It is concluded that: (1) portal vein thrombosis should not represent an absolute contraindication to liver transplantation; (2) preoperative screening of prospective transplant recipients for portal thrombosis should be routine; (3) postoperative anticoagulation therapy and periodic Doppler ultrasonographic assessment of portal vein flow are important elements of post-transplant management; and (4) with thrombectomy and portal vein resection an end-to-end portal anastomosis may be performed with good results.
Minimally invasive treatment for common bile duct stones
Authors: Martin I G , Curley P , McMahon M J 
Published: March 2007

Abstract
The impact of endoscopic surgery on the management of stones in the common bile duct (CBD) was studied. All patients with proven common duct stones managed by a single consultant during a 21-month period were included. Of a total of 60 patients, 48 were referred because of symptoms or signs of calculi in the CBD and 12 were found to have common duct stones although symptoms were related primarily to the gallbladder. Of the 48 patients referred with common duct stones, 41 (85 per cent) were successfully treated by endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) (complications were cholangitis (one patient), mild acute pancreatitis (one), impacted retrieval basket (one)). Of the remaining seven patients, two underwent open exploration (one after failed laparoscopic exploration) and five had successful laparoscopic duct exploration. One patient underwent laparoscopic exploration of the CBD but subsequently died. Of the patients with primary gallbladder symptoms, eight underwent preoperative ES, one was treated by laparoscopic duct exploration, one by conversion to open operation and in two patients duct stones were removed at postoperative ERC. The overall mortality rate was 2 per cent and the incidence of complications 12 per cent. Open exploration of the CBD was performed in three patients (5 per cent). This experience suggests that open duct exploration will become increasingly infrequent and may be replaced by endoscopic surgery in the majority of patients.