bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct retroperitoneal approach to necrosis in severe acute pancreatitis
Authors: Fagniez P-L , Rotman N , Kracht M 
Published: March 2007

Abstract
From 1981 to 1987, 40 patients with severe acute pancreatitis were operated on using a direct retroperitoneal approach, 22 primarily and 18 after a first operation performed through another incision. The severity of the disease was assessed by Ranson's bioclinical and computed tomography scan scoring systems. The retroperitoneal approach consisted of a left lateral incision, just anterior to the 12th rib, allowing direct access to the pancreas and a complete manual exploration of the gland and peripancreatic spaces. All patients but one were operated on for infected necrosis. The overall mortality rate was 33 per cent but was lower in the patients operated on primarily through a direct retroperitoneal approach (18·2 per cent). Twenty patients (50 per cent) developed a local complication (haemorrhage, colon fistula and/or necrosis). The direct retroperitoneal approach permits the removal of necrosis and several reoperations without the risk of large wound dehiscence and does not preclude the extension of the incision to a subcostal incision when necessary.
Proctocolectomy and ileoanal pouch anastomosis without conservation of a rectal muscular cuff
Authors: Chaussade S , Verduron A , Hautefeuille M , Risleight G , Guerre J , Couturier D , Valleur P , Hautefeuille P 
Published: March 2007

AbstractThe technique of proctocolectomy and formation of an ileal reservoir with ileoanal anastomosis is well described. It is believed that the conservation of a rectal muscular cuff is necessary for continence but no data are available to support this contention. The aims of this study were to describe the clinical and physiological aspects of continence after proctocolectomy and ileal J pouch anastomosis without conservation of a rectal muscular cuff. Eighteen consecutive patients (mean age 37·3 years, 16 ulcerative colitis, two familial polyposis) who underwent proctocolectomy and ileoanal anastomosis on the dentate line were studied 6 months after closure of the loop ileostomy. The 18 patients and eight controls underwent: (a) anal manometry; (b) determination of maximum tolerable volume (MTV); (c) liquid continence test (infusion of NaCl at 60 ml/min for 25 min) with simultaneous measurement of ileal reservoir pressure. The volume evacuated during 5 min after the continence test was also measured. The frequency of bowel actions was (mean ± s.e.m.) 5·3 ± 0·4 per 24 h (nocturnal 1·14 ± 0·26). Seventeen of 18 patients (94 per cent) had normal continence and defaecation; one patient was incontinent. A decrease in resting anal canal pressure (102·5 ± 4 versus 47·5 ± 6 cmH2O) was observed after ileoanal anastomosis. A rectoanal inhibitory reflex was elicited in one of the 18 patients (6 per cent). Patients were able to retain 1023 ± 68 ml saline during the liquid continence test. The percentage evacuation of the ileal reservoir was 61 ± 4·5 per cent. Correlations were found (P = 0·05) between daily stool frequency and the volume of saline retained during the liquid continence test. It is concluded that conservation of a rectal muscular cuff is not necessary for the achievement of good clinical results.
A common pathophysiology for full thickness rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer
Authors: Sun Wei Ming , Read N W , Donnelly T Carmel , Bannister J J , Shorthouse A J 
Published: March 2007

Abstract
Anorectal pressures at rest, during conscious contraction of the external sphincter, during serial distension of the rectum and during straining to inflate a balloon were measured in 56 patients (21 patients with full thickness rectal prolapse, 24 patients with anterior mucosal prolapse, 11 patients with solitary rectal ulcer) and in 30 normal subjects. Both basal and squeeze pressures were significantly lower in the three groups of patients compared with matched normal controls (P &lt; 0·05). During increases in intra-abdominal pressure, anal pressure remained above maximum rectal pressure (P &lt; 0·05) in normal controls, with the highest anal pressures being recorded in the most caudal anal channels. In contrast, anal pressures tended to be lower than rectal pressures during this manoeuvre in patients with rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer, and the highest pressures were recorded in the channels nearest the rectum. During serial distension of the rectum, 64 per cent of patients with solitary rectal ulcer, 75 per cent with anterior mucosal prolapse and 76 per cent with rectal prolapse, but only 10 per cent of controls, showed repetitive rectal contractions. The highest anal pressure always remained higher than rectal pressure during rectal distension in normal subjects (P &lt; 0·05) but not in patients. The threshold rectal volume required to cause a desire to defaecate and the maximum tolerable volume were significantly lower (P &lt; 0·05) in each of the patient groups, compared with normal subjects. The similarity in the results from patients with rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer support the hypothesis that they share a common pathophysiology. In each of the groups, the rectum is hypersensitive and hyper-reactive, and weakness of the anal sphincter creates the conditions for prolapse of the rectum to occur into or through the anal canal.
Thigh length versus knee length stockings in the prevention of deep vein thrombosis
Authors: Porteous M J Lef , Nicholson E A , Morris L T , James R , Negus D 
Published: March 2007

Abstract
Above-knee graduated compression stockings are effective in preventing postoperative deep vein thrombosis, but are more expensive and less acceptable than below-knee stockings. One hundred and fourteen patients undergoing major abdominal surgery were randomly allocated to wear above-knee or below-knee graduated compression stockings. Deep vein thromboses were diagnosed by isotope uptake in three of 56 patients (5·4 per cent) in the above-knee group and one of 58 patients (1·7 per cent) in the below-knee group. These differences are not statistically significant. Results suggest that below-knee stockings are as effective as above-knee in the prevention of postoperative deep vein thrombosis.
Ten-year experience of strictureplasty for obstructive Crohn's disease
Authors: Dehn T C B , Kettlewell M G W , Mortensen N J Mcc , Lee E C G , Jewell D P 
Published: March 2007

Abstract
Strictureplasty is controversial in the management of obstructive Crohn's disease. Only a small proportion of patients undergoing surgery for obstructive Crohn's disease are suitable for strictureplasty. Lesions which are most amenable for this procedure are short, fibrous strictures. Over a 10-year period 24 patients have undergone 30 operations at which 86 strictureplasties were performed. The median follow-up has been 40 (range 4–112) months. No leaks or fistulae arose from the stricture-plasties. The median weight gain 3 months postoperatively was + 4·0 kg. Four patients subsequently required a further 13 strictureplasty procedures, between 12 and 36 (median 18) months after the initial operation; all but one of the previous strictureplasties were patent. Thirteen patients have been symptom free following surgery, four have required further medical therapy for recurrent Crohn's disease and three have sustained episodes of self-limiting intestinal colic. Strictureplasty is a safe and effective procedure in selected patients undergoing surgery for obstructive Crohn's disease.
Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment
Authors: Fisher S E , Breckon K , Andrews H A , Keighley M R B 
Published: March 2007

Abstract
Fifty patients attending for surgical treatment of chronic constipation (n = 21) or faecal incontinence (n = 29) were studied using two psychiatric screening tests: the Hospital Anxiety and Depression (HAD) scale and the General Health Questionnaire (GHQ). Each patient was assessed preoperatively and 6–12 months postoperatively. Results were compared with age and sex-matched controls (n = 50). Constipated patients had significantly higher HAD depression scores compared with controls (median and range): 6 (2–12) versus 4 (0–8), P &lt; 0·05. Constipated patients who were improved by operation (n = 13) had significantly lower preoperative HAD anxiety scores compared with those who were not improved (n = 8): 8 (3–14) versus 15 (10–19), P &lt; 0·01; they also had significantly lower HAD depression scores: 4 (2–12) versus 7 (5–11), P &lt; 0·05. Using these parameters incontinent patients did not differ from controls, but patients who had a bad result after operation (n = 15) had significantly higher HAD anxiety scores than those who obtained clinical benefit (n = 14): 10 (2–15) versus 6 (2–12), P &lt; 0·05; HAD depression scores were also greater: 5 (2–15) versus 3 (0–9), P &lt; 0·05; and GHQ scores were greater: 12 (0–47) versus 4 (0–41), P &lt; 0·05.
Splenectomy for massive splenomegaly
Authors: Shaw J H F , Clark M 
Published: March 2007

Abstract
Twenty-four patients who underwent resection of giant spleen (spleen weight &gt; 1·5 kg) have been reviewed to determine the difficulties and benefits of the procedure and, in particular, whether the use of adrenaline injection into the splenic artery could safely reduce technical difficulty. Although morbidity was higher in patients with giant spleens compared with those undergoing resection of smaller spleens the incidence of serious complications was small, and there were no operative or in-hospital deaths. In addition, virtually all patients benefited either on the basis of minimized haematological defect, or palliation of symtoms. Further, the injection of 1 ml of 1:10000 adrenaline into the splenic artery before splenic mobilization reduced the splenic volume by approximately 40 per cent on average, and resulted in improved exposure, thereby facilitating the procedure.
Surgery in patients with von Willebrand's disease
Authors: Blombäck M , Johansson G , Johnsson H , Swedenborg J , Wabö E 
Published: March 2007

Abstract
The risk of bleeding complications in the surgical treatment of patients with von Willebrand's disease has been evaluated. Sixty-four major surgical procedures were performed in 51 patients with various forms of von Willebrand's disease. In 18 cases, the bleeding disorder was unknown at the time of surgery, resulting in bleeding complications in 12 cases (67 per cent). Forty-five operations were carried out in patients in whom the diagnosis of von Willebrand's disease was known at the time of surgery. In these patients, the following haemostatic preparations were given: factor concentrate, fresh plasma, tranexamic acid and desmopressin. Haemostatic complications occurred in three of these operations (6·7 per cent); all were managed easily. No mortality was observed. It is concluded that patients with von Willebrand's disease do not carry an increased operative risk if appropriate precautions are taken.
Plasma eicosanoids, platelet function and cold sensitivity
Authors: Wilkinson D , Vowden P , Gilks L , Latif A B , Rajah S M , Kester R C 
Published: March 2007

Abstract
As abnormal eicosanoid (prostaglandin) metabolism has been suggested as a factor in the aetiology of vasospastic diseases we have measured levels of stable eicosanoid metabolites using a radioimmunoassay in 30 normal subjects and 31 patients with Raynaud's phenomenon. There were 13 patients with primary Raynaud's, ten with Raynaud's secondary to scleroderma and eight men with vibration white finger (VWF) disease. We have also measured platelet aggregation to adenosine diphosphate (ADP), collagen and adrenaline in 19 normal subjects, 22 patients with primary Raynaud's, 12 with Raynaud's secondary to scleroderma and 14 men with VWF. When compared with our normal subjects, patients with VWF have an elevated thromboxane B2 level, with a normal 6-keto-prostaglandin F1α (6-keto-PGF1α) level. Their platelets are less sensitive to ADP and collagen. Patients with primary and secondary Raynaud's have elevated thromboxane B2 levels but this is much more marked in the secondary group. Patients with primary Raynaud's have a normal 6-keto-PGF1α level but in patients with secondary Raynaud's the 6-keto-PGF1α level is markedly raised. The platelets from both groups are more sensitive to ADP and collagen and this is more marked in the secondary group. Whether these phenomena are a cause or an effect of vasospasm remains unknown.
Obstacles to organ donation
Authors: Wakeford R E , Stepney R 
Published: March 2007

Abstract
Attitudes towards transplantation were investigated in national surveys of the general public (n = 1471), the medical profession (n = 590) and key clinical staff in units referring potential organ donors (n = 380). A clear majority of doctors would like to see more transplants. Only 16 per cent of doctors opposed them on cost grounds, and a 50 per cent 5-year survival rate is seen as more than adequate clinical justification. However, doctors are less supportive of liver and heart grafts than of kidney and cornea grafts. Few lay people would refuse donation of specific organs, but 30 per cent worry that doctors might be pressured into removal of organs when they are not sure the patient is dead. Religious or moral objection is rare. Intensive care unit staff felt the most important factor restricting organ harvest in their own units was dislike of adding to relatives' distress, followed by lack of training in approaching relatives and adverse media publicity. Only 11 per cent thought reservations on brain stem death a likely or possible influence. Enhanced public awareness of the need for transplants was seen as the most important means of increasing organ harvest. Required request would be controversial and perhaps impossible to implement. We conclude that the time, effort and expense involved in potential organ donation do not play a substantial part in limiting referral. Neither do reservations about brain stem death. Increased training of staff (both in communication skills and in the professional responsibility to encourage donation) and greater public awareness are seen as the twin foundations of a realistic approach to enhancing referral.
Long-term follow-up after choledochojejunostomy for bile duct stones with complex clearance of the bile duct
Authors: Gouma D J , Konsten J , Soeters P B , von Meyenfeldt M , Obertop H 
Published: March 2007

Abstract
In this retrospective study, the long-term follow-up of patients undergoing choledochojejunostomy (Roux-en-Y) for bile duct stones with complex clearance of the bile duct is evaluated. Bile duct exploration and subsequent choledochojejunostomy (Roux-en-Y) was performed in 43 patients (median age 67 years) in the period 1976–82. There was no mortality and only one patient had a major complication. Twenty patients died during follow-up (median follow-up period 5 years); the median follow-up period for the remaining 23 patients was 8 years. Good long-term results were found in 98 per cent of cases. No signs or symptoms could be related to bile duct obstruction or to cholangitis. Nearly all liver function tests and serum bilirubin levels were normal in the 21 patients who were tested. We conclude that patients with bile duct stones with complex clearance of the bile duct can be safely treated by means of a choledochoenterostomy (in this study a choledochojejunostomy Roux-en-Y).
Endoscopic endoprosthesis insertion following failure of cholecystojejunostomy in pancreatic carcinoma
Authors: Dowsett J F , Cairns S R , Vaira D , Polydorou A A , Hatfield A R W , Russell R C G 
Published: March 2007

Abstract
Sixteen patients in whom malignant biliary obstruction recurred after failure of cholecystojejunostomy had attempted relief of obstruction by endoscopic insertion of an endoprosthesis. This treatment was successful in 13 patients, although one required percutaneous insertion because of duodenal distortion and one required a combined percutaneous-endoscopic approach. Median survival after stenting was 3.5 months (range from 2 weeks to 16 months). Of the three treatment failures, two patients had external drainage only and one succumbed before further treatment could be attempted. There were two complications associated with the procedure (one small bile leak and one episode of cholangitis) but the 30-day mortality rate of 12.5 per cent was related to disease progression rather than the procedure. Endoscopic stent insertion may achieve further worthwhile palliation of jaundice after the failure of surgery to relieve malignant biliary obstruction.
Gallstone lithotripsy with the pulsed dye laser: In vitro studies
Authors: Murray A , Basu R , Fairclough P D , Wood R F M 
Published: March 2007

Abstract
The use of a pulsed dye laser to fragment human gallstones is reported. Laser energy was delivered by a 320 μm quartz fibre at wavelengths of 440,480,504,560,590, and 635 nm, in 1 μs pulses at energies of 5–60 mJ per pulse, producing peak powers of the order of 105 W. Cholesterol, pigment and mixed stones were fragmented. The shorter wavelengths were most efficient, using significantly less energy at 440 and 480 nm than at the longer wavelengths. Pigment stones were fragmented with significantly less energy than those in which cholesterol predominated. Thermal imaging during laser treatment showed no significant rise in temperature in the bulk of the stone. Absorption spectroscopy of bile revealed a peak at 450 nm, coinciding with the known absorption characteristic of bilirubin. Bile strongly attenuated light at shorter wavelengths, even at dilutions as great as 1:20 and protected samples of biliary epithelium from laser damage except when the optical fibre was in direct contact. The pulsed dye laser may offer significant advantages over current methods of biliary stone fragmentation.
Measurement of body water compartments after ligation of the common bile duct in the rabbit
Authors: Martinez-Ródenas F , Oms L M , Carculla X , Segura M , Sancho J J , Piera C , Fernández-Espina M R , Sitges-Serra A 
Published: March 2007

Abstract
To elucidate the pathogenesis of renal insufficiency associated with obstructive jaundice we have studied spontaneous water intake and body water compartments in rabbits undergoing common bile duct ligation. Total body water, extracellular water and plasma volume were measured by multi-isotope dilution technique. During the initial 6 postoperative days spontaneous water intake was 898 ml in sham operated animals (SO) but only 280 ml in jaundiced rabbits (OJ6) (P&lt;0.01). Creatinine clearance was almost unchanged in SO but fell to 60 per cent of the preoperative values both in OJ6 and in paired-drink sham operated animals (SO2). There was a 15 per cent decrease in total body water (P&lt;0.01) and a 24 per cent decrease in extracellular water (P&lt;0.01) 6 days after bile duct ligation. There was a further reduction of the extracellular water to 35 per cent and a 15 per cent reduction of plasma volume 12 days after ligation. Water restriction mimicked the alterations in body composition produced by bile duct ligation. We conclude that bile duct ligation is associated with hypodypsia and a depletion of extracellular water and plasma volume. These alterations could explain the tendency to develop hypotension and renal failure which are associated with obstructive jaundice.
Debridement and closed cavity irrigation for the treatment of pancreatic necrosis
Authors: Larvin M , Chalmers A G , Robinson P J , McMahon M J 
Published: March 2007

Abstract
Pancreatic and peripancreatic debridement combined with a closed cavity system of drainage was used to manage necrotic sequelae of severe acute pancreatitis in 14 patients. Intravenous contrast-enhanced computed tomography, or latterly incremental dynamic computed tomographic angiography, accurately detected and localized necrotic tissue. Operation was delayed where possible to permit demarcation of the necrotic area and the development of a ‘capsule’ of inflammatory tissue. A retrocolic route of access to the necrotic area was used in nine cases, and purpose-made silicone elastomer tubes with an outside diameter of 20 mm were positioned so that drainage was assisted by gravity when the patient was supine. The cavity was irrigated with saline (initially 2 litres daily), and in the last seven patients Trasylol® was included in the irrigation fluid (5 × 106 kallidinogenase inactivator (KI) units/litre) for the first postoperative week. Three elderly patients died (mean age 72 years) but all patients aged less than 68 years survived. Planned reoperation was carried out in two patients, but further reoperations were not required in the remaining 11. Drainage tubes were removed when contrast studies showed the cavity to be small and superficial; the median duration of drainage was 28 days. Although sinograms demonstrated fistulae between cavity and small bowel (n = 4) or small bowel and colon (n = 2), no clinical problems resulted and all closed spontaneously. Closed drainage may be as effective as techniques of marsupialization, but avoids the need for frequent relaparotomy.
Continuous single-layer gastrointestinal anastomosis: A prospective audit
Authors: Sarin S , Lightwood R G 
Published: March 2007

Abstract
Single-layer bowel anastomoses have conventionally been constructed using an interrupted suture technique. A single-layer continuous technique has been avoided on the grounds that it may predispose to ischaemia of the bowel ends. We have routinely used a single-layer continuous suture technique with an absorbable suture material (polyglycolic acid) to construct all recent intraperitoneal bowel anastomoses, and we present a 3-year audit of this technique. A total of 131 patients were studied of whom 66 had undergone upper gastrointestinal resections and 65 had had colonic resections. Twenty-two patients had emergency operations. Anastomotic failure was noted in 4.5 and 6.2 percent of patients in each group respectively. The incidence of minor wound infection was 1.5 and 7.7 per cent respectively. The overall mortality rate was 8.4 per cent. This study suggests that a single-layer continuous suture technique gives acceptably reliable results when used in gastrointestinal anastomosis.
Use of a bioprosthesis to relieve tension in oesophageal anastomosis: An experimental study
Authors: Carachi R , Azmy A , Gorham S , Reid J , French D A 
Published: March 2007

Abstract
Collagen-coated Vicryl® mesh was assessed as a prosthetic repair material in the oesophagus of growing piglets. In a group of six piglets (group A), a full thickness defect was created in the oesophagus without fully transecting the organ. The removed tissue was subsequently replaced with a patch of collagen-coated Vicryl mesh. Animals were killed at 4 weeks and in the five surviving piglets the prosthesis had been replaced by host scar tissue with a normal epithelial lining. Two further groups of six piglets (groups B and C) were used as controls. In group B the oesophagus was either partly transected (four animals) or completely transected (two animals) and an anastomosis was performed, whereas in group C a 2.5-cm length of oesophagus was removed so that the anastomosis was performed under tension. In group B, all six piglets survived, whereas in group C, where the anastomosis was performed under tension, only two piglets survived. Microscopic and macroscopic examination of all groups showed that the collagen-coated Vicryl prosthesis was replaced by scar tissue; moderate stenosis was observed in only one animal in group A. Collagen-coated Vicryl mesh may be used either to reinforce an anastomosis performed under tension or may find use in tubular form to bridge the gap between the two ends of the oesophagus to be joined. It is envisaged that such a material may find applications in the treatment of oesophageal atresia.