bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac ischaemia induces vagally mediated lower oesophageal sphincter relaxation
Authors: Caldwell M T P , Byrne P J , Marks P , Walsh T N , Hennessy T P J 
Published: March 2007

Abstract
Gastro-oesophageal reflux and coronary artery disease frequently coexist. Direct stimulation of myocardial vagal receptors impairs lower oesophageal sphincter (LOS) function but the effect of cardiac ischaemia has not been examined. Eight adult mongrel dogs were studied under general anaesthesia. Each underwent occlusion of the left circumflex coronary artery before and after bilateral cervical vagotomy. Blood pressure, heart rate and LOS responses were measured. Median (range) LOS tone was significantly reduced by coronary artery occlusion, from 9 (6–14) to 6 (3–8) sphinctometer units (P &lt; 0.01). This was accompanied by a reduction in heart rate (P &lt; 0.05) and blood pressure (P &lt; 0.01). After bilateral cervical vagotomy the same ischaemic insult produced no significant alteration in LOS tone or heart rate. These data suggest a direct vagal reflex to explain the high incidence of gastro-oesophageal reflux in patients with coronary artery disease.
Observer variation in assessment of quality of life in patients with oesophageal cancer
Authors: Blazeby J M , Williams M H , Alderson D , Farndon J R 
Published: March 2007

Abstract
Quality of life (QOL) assessment may improve the evaluation of treatment for oesophageal cancer but patient compliance using self completion questionnaires is often poor. The use of a proxy to estimate QOL might improve data collection from patients who are either unable or unwilling to complete the questionnaire. This study examined whether a doctor or patients' carers could accurately assess QOL using the QLQ-C30 questionnaire developed by the European Organisation for Research and Treatment of Cancer Study Group on Quality of Life. One doctor, 52 patients and 39 carers completed the instrument independently. Proxy and patient ratings were analysed for agreement using weighted k scores. Agreement was poor or moderate in most QOL scales and items (κ ≤60). This study demonstrates that a carer or doctor is not sufficiently accurate to postulate the patient's responses to the questionnaire. Quality of life data, therefore, should come from the patients themselves.
Abdominoperineal resection and anterior resection in the treatment of rectal cancer: Results in relation to adjuvant preoperative radiotherapy
Authors: Holm T , Rutqvist L-E , Johansson H , Cedermark B 
Published: March 2007

Abstract
The outcome of patients with rectal cancer treated by abdominoperineal or anterior resection, with or without preoperative radiotherapy, was assessed to detect any differences attributable to the operative method and interactions between radiotherapy and type of surgery. The study was based on 1292 patients included in two consecutive controlled randomized trials of preoperative radiotherapy in operable rectal carcinoma. The outcome was not related to surgical method. Radiotherapy increased postoperative mortality and complications and reduced local and distant recurrence, but had no effect on overall survival. Effects of radiotherapy were similar irrespective of the type of surgery, except that the increase in postoperative mortality in irradiated patients was greater in those treated with abdominoperineal resection. Sphincter-saving procedures appear to have no adverse effects on outcome of rectal cancer, but the optimum use of radiotherapy is still to be defined.
Postocclusive hyperaemic duplex scan: A new method of aortoiliac assessment
Authors: Currie I C , Wilson Y G , Baird R N , Lamont P M 
Published: March 2007

Abstract
Aortoiliac duplex scanning, while accurate, is time-consuming and technically demanding. This study aimed to develop a fast, non-invasive screening test for aortoiliac disease. Colour duplex scanning was used to record common femoral Doppler ultrasonographic waveforms following 3 min of arterial occlusion using a thigh cuff in 25 patients with normal aortoiliac segments and 25 patients with significant aortoiliac disease. The latter patients had a prolonged period of postocclusive hyperaemic flow compared with the former. End diastolic velocity, 70 s after cuff release, was a significant discriminant between the two groups (sensitivity of 88 per cent, accuracy of 92 per cent). The postocclusive hyperaemic duplex (PHD) test performed well when used prospectively in a further 50 limbs (sensitivity of 86 per cent, accuracy of 84 per cent). The test was more sensitive than femoral pulse palpation and compared favourably with arteriography. The PHD test provides a simple, non-invasive assessment for aortoiliac disease that can be performed on the initial outpatient clinic visit.
Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas
Authors: Madiba T E , Mokoena T R 
Published: March 2007

Abstract
The records of 152 patients with pancreatic injury treated over a 5-year period were reviewed. The diagnosis was made at laparotomy in all patients. Gunshot wounds, stab wounds and blunt trauma occurred in 63, 66 and 23 patients respectively with mean ages of 28, 28 and 30 years. Multiple organ injury was most common after gunshot wounds. Intraoperative management was by drainage of the pancreatic injury site alone in the majority of patients in all aetiological groups. The rate of fistula formation was 14 per cent after gunshot wounds, 9 per cent after stab injury and 13 per cent after blunt trauma. Death occurred after 24 h in 8, 2 and 10 per cent of patients following gunshot wounds, stab wounds and blunt trauma respectively, and was attributable to other organ damage. It is concluded that gunshot injury to the pancreas may be more extensive than other injuries, but conservative management with surgical drainage of pancreatic injury is justified irrespective of the mechanism of injury.
Distal pancreatectomy for gunshot injuries of the distal pancreas
Authors: Degiannis E , Levy R D , Potokar T , Lennox H , Rowse A , Saadia R 
Published: March 2007

Abstract
This study comprised 57 patients with gunshot injury of the distal pancreas. There were 16 grade II, 29 grade III and 12 grade IV pancreatic injuries. The intraoperative mortality rate was 12 per cent. Patients with the most severe grade II injuries and all those with grade III and IV injuries had distal pancreatectomy and splenectomy, with a 14 per cent fistula formation rate and 2.3 per cent postoperative mortality rate directly related to the pancreatic injury. The remaining patients with grade II injuries were managed by debridement and drainage; there were no fistulas or deaths. The method of closure of the pancreatic resection margin is unrelated to fistula formation, and identification of the duct for ligation is unnecessary. Liberal use of distal pancreatectomy with splenectomy for gunshot injuries of the distal pancreas is suggested.
Incidence and management of laser-associated oesophageal perforation
Authors: Tyrrell M R , Trotter G A , Adam A , Mason R C 
Published: March 2007

Abstract
The incidence of oesophageal perforation in 350 patients referred for laser treatment to palliate malignant dysphagia is reported. Perforation occurred in 6 per cent of patients or 2 per cent of treatment episodes. Perforation was usually due to oesophageal dilatation undertaken before laser treatment (23 of 25 perforations). Immediate recognition and the institution of an aggressive non-operative management protocol resulted in survival in 20 of 23 patients.
Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis
Authors: Friess H , Beger H G , Sulkowski U , Becker H , Hofbauer B , Dennler H-J , Büchler M W 
Published: March 2007

Abstract
A randomized double-blind placebo-controlled multicentre trial was carried out in 247 patients undergoing major elective surgery for chronic pancreatitis to clarify whether the perioperative application of octreotide prevents postoperative complications. Eleven complications were defined, including death, anastomotic leakage, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency and postoperative pancreatitis. A total of 124 patients underwent pancreatic head resection, 55 left resection, 61 pancreaticojejunostomy and seven had other procedures. The overall mortality rate was 1.2 per cent (octreotide group 0.8 per cent, placebo group 0.4 per cent (P not significant)). The postoperative complication rate in the octreotide group was 16.4 per cent (20 of 122 patients) and in the placebo group 29.6 per cent (37 of 125) (P &lt; 0.007). The perioperative application of octreotide substantially reduces the risk of postoperative complications in patients undergoing major pancreatic surgery for chronic pancreatitis.
Polyposis: The Peutz-Jeghers syndrome
Authors: Spigelman A D , Arese P , Phillips R K S 
Published: March 2007

Abstract
The classical pigmentation of Peutz-Jeghers syndrome distinguishes it immediately from the other polyposis syndromes. Less widely appreciated than this most obvious manifestation are the pitfalls in management presented by the risk of cancer and by the performance of multiple laparotomies that also characterize this condition. An outline of these risks and an approach that minimizes them is presented.
Continent colonic conduit for the treatment of faecal incontinence associated with disordered evacuation
Authors: Hughes S F , Williams N S 
Published: March 2007

Abstract
A transverse colonic conduit incorporating an intussusception valve and skin-flapped cutaneous aperture was constructed in nine patients with combined faecal incontinence and disordered evacuation. Intestinal continuity was restored with a colocolonic anastomosis. Median follow-up was 4 (range 2–15) months and daily irrigation with a median of 1·2 (range 0·3-2·0) litres of water resulted in evacuation in less than 1 h. At 1 month after operation there was no leakage of solid or liquid faeces from the anus between irrigations. The valve was continent to faeces and irrigation fluid, and no stoma appliances were required.
Defunctioning colostomy for low anterior resection: A selective approach
Authors: Grabham J A , Moran B J , Lane R H S 
Published: March 2007

Abstract
Seventy-seven consecutive low anterior resections of the rectum were performed with a selective approach to the use of a defunctioning colostomy. A defunctioning colostomy was performed in seven patients (9 per cent) where there was concern about the anastomosis due to difficult dissection (three), incomplete doughnuts (three) and tension on the anastomosis (one). The mean level of the tumour in the defunctioned group was 7±6 cm. Clinical anastomotic leakage occurred in two patients (3 per cent) in the non-defunctioned group, both of which were controlled with subsequent transverse colostomies. There were no perioperative deaths. Selective defunctioning of low colorectal anastomoses can produce low rates of anastomotic dehiscence while reducing the morbidity associated with a temporary stoma.
Detection of circulating tumour cells with the magnetic activated cell sorter
Authors: Wong L S , Bateman W J , Morris A G , Fraser I A 
Published: March 2007

Abstract
A technique has been developed for the detection of tumour cells in blood with the magnetic activated cell sorter (MACS). Colonic carcinoma cell lines and disaggregated primary tumours were used to establish optimal conditions of separation. A murine monoclonal antibody specific for epithelial cells was added to the suspension of leucocytes and tumour cells, followed by magnetic labelled goat antimouse antibody. The labelled tumour cells were retrieved by passing this suspension through a MACS separation column in a strong magnetic field. Tumour cells were detected at a dilution of 10 cells per ml blood. Tumour cells were identified in mesenteric blood in three of 24 patients undergoing surgery for colorectal cancer. This study supports the use of the MACS to detect circulating tumour cells.
Lateral subcutaneous sphincterotomy for treatment of anal fissure in children
Authors: Cohen A , Dehn T C B 
Published: March 2007

Abstract
Twenty-three children, aged between 8 and 168 months, underwent lateral subcutaneous sphincterotomy. All fissures healed by 8 weeks after operation. Two children had recurrent proctalgia and defaecating difficulties after surgery despite a healed fissure. Requirement for stool softener was reduced or abolished in 17 children. The parent-child satisfaction score after operation was more than 70 per cent in 19 of 23 cases. Lateral subcutaneous sphincterotomy is an effective procedure in children.
Single-centre prospective study of isolated limb perfusion with melphalan in the treatment of subungual malignant melanoma
Authors: Lingam M K , McKay A J , Mackie R M , Aitchison T 
Published: March 2007

Abstract
Subungual melanoma is rare and experience in treating this condition with isolated limb perfusion is limited. Between 1985 and 1990, 24 patients were treated by digital amputation and isolated limb perfusion with melphalan and mild hyperthermia. The disease was staged according to the M.D. Anderson classification: stage I (17 patients), stage IIIA (one), stage IIIB (two) and stage IIIAB (four). Thirteen lesions were on the foot and 11 on the hand. Seven patients have developed locoregional recurrence. The estimated overall 2- and 5-year probabilities of survival were 77 and 46 per cent respectively, while for disease-free survival the rates were 58 and 51 per cent. When these results were compared retrospectively with those in 111 patients treated by amputation alone, no significant difference in survival was demonstrated. This experience suggests that isolated limb perfusion with melphalan and mild hyperthermia confers no additional survival benefit over appropriate surgery.
Presentation of endometriosis to general surgeons: A 10-year experience
Authors: Singh K K , Lessells A M , Adam D J , Jordan C , Miles W F A , MacIntyre I M C , Greig J D 
Published: March 2007

Abstract
The presentation and management of 24 patients with endometriosis (median age 34 (range 21–68) years) presenting to general surgeons over a period of 10 years (1985–1994) was reviewed. Patients presented with an abdominal wall swelling related to a previous Pfannenstiel incision (seven patients), umbilical swelling (four), inguinal canal swelling (two), incidentally following appendicectomy (five), terminal ileal obstruction (two), rectal bleeding (two) and urinary symptoms (two). Endometriosis was not suspected in most patients but was confirmed by surgical excision or resection with minimal morbidity. No recurrence occurred during a median follow-up of 53 (range 9–113) months. Endometriosis is a disease rarely seen by general surgeons and is often diagnosed incidentally or on histological examination. Cyclical symptoms associated with menstruation are present in 50 per cent of patients and should suggest the diagnosis in those presenting with scar-related and/or subcutaneous swellings. Simple excision or resection of the presenting lesion provides adequate treatment but, since pelvic endometriosis may be present, referral to a gynaecologist is recommended in every case.
Lobular carcinoma of the breast can be managed by breast-conserving therapy
Authors: Holland P A , Shah A , Howell A , Baildam A D , Bundred N J 
Published: March 2007

Abstract
There has been a reluctance to treat patients with invasive lobular carcinoma by breast-conserving therapy because of the possibility of increased rates of local recurrence. This study is a retrospective review of 226 patients with pure invasive lobular carcinoma 4 cm or less treated by breast conservation therapy or mastectomy. Local relapse occurred in four of 52 patients (8 per cent) after breast conservation compared with 21 of 174 (12 per cent) after mastectomy. Breast conservation for invasive lobular carcinoma did not result in a higher incidence of local relapse and patients with invasive lobular and ducta carcinomas may be managed in a similar fashion.
Prospective evaluation of ultrasonography and liver function tests for preoperative assessment of the bile duct
Authors: Welbourn C R B , Haworth J M , Leaper D J , Thompson M H 
Published: March 2007

Abstract
Current means of predicting the presence of bile duct stones are sensitive but produce a large number of false-positive results, potentially leading to added morbidity from unnecessary invasive investigation. This study prospectively assessed 545 patients with gallbladder stones, including 55 patients with bile duct stones, to refine criteria for further investigation of the bile duct. The sensitivity, specificity, and positive and negative predictive values were calculated for bile duct dilatation (diameter abnormal if larger than 5 mm below age 50 years, normal value increasing by 1 mm per decade) and elevation of three liver function tests, singly or in combination. Depending on the number of abnormalities used the sensitivity ranged from 46 to 96 per cent and the positive predictive value from 35 to 77 per cent. All groupings gave at least 96 per cent negative predictive value for the absence of stones but none combined both high sensitivity and positive predictive value. The specificity was improved if the tests were done on the working day before operation. Refining criteria for predicting bile duct stones allows the selective use of cholangiography and may reduce the number of negative cholangiograms.
Laparoscopic ‘bikini mesh’ repair of bilateral inguinal hernia
Authors: Deans G T , Wilson M S , Royston C M S , Brough W A 
Published: March 2007

Abstract
Laparoscopic hernia repair using a single piece of mesh was performed in 150 patients with bilateral inguinal hernia. The median operating time was 43 (range 30–90) min with a median hospital stay of 1 (range 1–10) days. In all, 138 patients were discharged within 24 h of operation. The median time for return to normal activity was 7 (range 2–60) days and that for return to work 14 (range 2–60) days. One patient required surgery for a port-site hernia and another for a Veress needle injury to the small bowel. Additional complications included bruising in nine patients, cord seromas in seven and urinary retention in two. There have been no recurrences after a median follow-up of 18 (range 1–38) months. The cost benefits of a short hospital stay and rapid return to work afforded by laparoscopic bilateral hernia repair warrant further evaluation.
Mortality, endotoxaemia and cytokine expression after intermittent and continuous hepatic ischaemia
Authors: Hewitt G , Halliday I , McCaigue M , Campbell G , Rowlands B , Diamond T 
Published: March 2007

Abstract
This study compared mortality rates, endotoxaemia, systemic tumour necrosis factor (TNF) and interleukin (IL)-6 concentrations after continuous and intermittent hepatic ischaemia. Two groups of rats were subjected to continuous or intermittent left hepatic inflow occlusion for a total period of 120 min in each group. Intermittent ischaemia was associated with significantly lower mortality rates than continuous ischaemia (four of 20 versus 15 of 20; P = 0±0015). In a separate study, again following 120 min continuous or intermittent ischaemia, systemic blood was sampled at 0 min, 1 h, 3 h and 5 h after final clamp release for measurement of endotoxin, TNF and IL-6 concentrations. Endotoxin concentrations were significantly lower at 1 h, as were TNF and IL-6 concentrations at 3 and 5 h, after final clamp release in the group having intermittent ischaemia (P&lt;0±05). Intermittent ischaemia is associated therefore with significantly reduced mortality rates and lower systemic endotoxin, TNF and IL-6 concentrations when compared with continuous ischaemia.
Mesenteric ischaemia: A multidisciplinary approach
Authors: Bradbury A W , Brittenden J , McBride K , Ruckley C V 
Published: March 2007

Abstract
Mesenteric ischaemia may result from a wide range of pathological processes, each possessing unique clinical features, diagnostic difficulties, management strategies and outcome. Regardless of aetiology, prognosis depends crucially on rapid diagnosis and institution of treatment to prevent, or at least to minimize, bowel infarction. Progress in understanding the pathophysiology of mesenteric ischaemia has led to novel methods of treatment, so that in some circumstances therapy may be purely medical. More often surgery is required and is frequently life saving. Percutaneous transcatheter techniques are increasingly employed in both diagnosis and treatment. Close cooperation between radiologists, physicians and surgeons is therefore necessary if clinical outcome is to be optimized. This paper reviews the modern interdisciplinary management of mesenteric ischaemia in the light recent advances.
Manipulation of local and systemic host defence in the prevention of perioperative sepsis
Authors: Windsor A C J , Klava A , Somers S S , Guillou P J , Reynolds J V 
Published: March 2007

Abstract
This review addresses some of the immunological issues surrounding the complex problem of perioperative sepsis. It identifies an immunological paradox between the relative immunosuppression of the immediate postoperative period and the relative immune activation of established sepsis, in addition to discussing current knowledge of the mechanisms surrounding these phenomena. Much remains unknown about perioperative immunoregulation; there are a number of potential mechanisms, however, whereby local and systemic immune defences can be modified or enhanced. Provided patients at risk can be identified, such manipulations may find application in preventing infection and sepsis after surgery.
Endotoxaemia and cytokine production in experimental colitis
Authors: Neilly P J D , Gardiner K R , Kirk S J , Jennings G , Anderson N H , Elia M , Rowlands B J 
Published: March 2007

Abstract
Systemic endotoxaemia is a well recognized feature of inflammatory bowel disease but its pathogenic role remains uncertain. This study examined plasma endotoxin and cytokine concentrations and the acute-phase protein response in a hapten-induced model of experimental colitis. On days 2, 8 and 14 after induction of colitis with trinitrobenzenesulphonic acid in ethanol (TNBS-E), plasma endotoxin, immunoglobulin (Ig) G and IgM endotoxin-core antibody (EndoCAb), tumour necrosis factor (TNF), interleukin (IL) 6 and α2-macroglobulin (α2M) concentrations and colon macroscopic inflammation score were determined. At all time points there was significant colonic inflammation when compared with control values (P&lt;0·0001). Animals treated with TNBS-E had raised concentrations of endotoxin at all time points (P&lt;0·04). In TNBS-E-treated animals EndoCAb concentrations were reduced on day 2 (P&lt;0·0001) and later increased. There were increases in IL-6 and α2M concentrations in TNBS-E-treated animals but no significant change in TNF concentrations. Endotoxin concentrations correlated with macroscopic inflammation score, IL-6 and α2M concentrations. There was a less consistent correlation between EndoCAb concentrations and these parameters. These results suggest that endotoxin is a mediator of the systemic response in this model of experimental colitis.