bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anorectal function after restorative proctocolectomy and low anterior resection with coloanal anastomosis
Authors: Sun W M , Read N W , Katsinelos P , Donnelly T C , Shorthouse A J 
Published: March 2007

Abstract
Anorectal manometry and electromyography were studied in 17 patients before and after restorative proctocolectomy with stapled pouch-anal anastomosis, in ten patients before and after low anterior resection with stapled coloanal anastomosis, and in 35 normal controls. More than 80 per cent of patients in both groups developed abnormal oscillation of anal pressure after operation (amplitude 15–60 (median 25) cmH2O, frequency 4–10 (median 8) per min) and showed no anal relaxation in response to intermittent neorectal distension. All patients lost discriminative rectal sensation and none could perceive a normal desire to defaecate. Patients with postoperative soiling had a greater amplitude of anal pressure oscillation and lower minimum basal pressure, although those who underwent coloanal anastomosis had a greater risk of incontinence because of large asynchronous oscillations in neorectal pressure. The common pathophysiological features after restorative proctocolectomy and coloanal anastomosis probably relate to damage to the autonomic and enteric nerve supplies. The presence of an unstable internal anal sphincter may be an important cause of postoperative nocturnal incontinence.
Postanal repair for faecal incontinence persisting after rectopexy
Authors: Carraro P Setti , Nicholls R J 
Published: March 2007

Abstract
Eleven patients (nine women) with persistent faecal incontinence after rectopexy for rectal prolapse were treated by postanal repair. Follow-up data, including clinical and anorectal physiology, at 5–8 years (median 76 (range 64–95) months) were available for nine patients. At long-term follow-up, seven of the nine patients had improved continence (two were continent to solid and liquid stools, and five to solid stool). One patient required a colostomy. Median (range) physiological findings before and after postanal repair in the nine patients were: anal canal length 2·3 (1·5–3·0) versus 3·5 (2·0–5·5) cm (P&lt;0·05); resting anal pressure 20 (0–49) versus 35 (10–55) cmH2O (P&lt;0·05); perineal descent 2 (1–3) versus 0 (3 to –0·2) cm; and mean pudendal nerve terminal motor latency 2·35 (2·0–3·1) versus 2·85 (2·3–3·4) ms.
Pelvic ileal reservoirs: The options
Authors: Sagar P M , Taylor B A 
Published: March 2007

Abstract
Restorative proctocolectomy has become an established surgical option for patients with chronic ulcerative colitis and familial adenomatous polyposis. However, despite a large number of different reservoir designs there is so far no acknowledged ideal configuration. This paper reviews the advantages and disadvantages of the different types of pelvic ileal reservoir so far studied.
Coronary artery disease in patients with peripheral vascular disease
Authors: Gajraj H , Jamieson C W 
Published: March 2007

Abstract
For patients requiring peripheral vascular surgery, coronary artery disease is the major determinant of perioperative mortality and long-term survival. The management of coronary artery disease in these patients is controversial as no randomized blinded prospective studies have been conducted. Data on the prevalence, diagnosis and management are reviewed.
Management of advanced rectal cancer
Authors: Baigrie R J , Berry A R 
Published: March 2007

Abstract
If possible, palliative resection should be undertaken for advanced rectal cancer as it provides good relief of local symptoms; there is, however, little evidence that it prolongs survival. If palliative excision is not possible, endoscopic transanal resection may be used for obstructing lesions at or below the peritoneal reflection. Laser therapy is an alternative in the frail. Both procedures allow quick and effective relief of symptoms. These methods and other options for treating advanced rectal cancer are described in this review.
Prevalence of anal human papillomavirus infection and intraepithelial neoplasia in renal allograft recipients
Authors: Ogunbiyi O A , Scholefield J H , Raftery A T , Smith J H F , Duffy S , Sharp F , Rogers K 
Published: March 2007

Abstract
A study was performed to test the hypothesis that renal allograft recipients are at high risk of developing anal human papillomavirus (HPV) infection and anal intraepithelial neoplasia (AIN). A total of 133 renal allograft recipients and 145 control patients underwent anoscopy and biopsy. A polymerase chain reaction was used to detect HPV16 DNA in biopsy samples. A histological diagnosis of anal HPV infection or AIN was made in 32 allograft recipients (HPV infection, five; AIN I, 20; AIN II, three; AIN III, three; AIN III and anal cancer, one). One subject with AIN was detected in the control group. HPV16 DNA was detected in 47 and 12.4 per cent of anal biopsies in the allograft and control groups respectively. Renal allograft recipients are at high risk of developing anal HPV infection and neoplasia (P&lt;0.05). Further studies are required to determine whether screening anal examination is required in organ allograft recipients.
Low-dose intra-arterial thrombolysis in the treatment of phlegmasia caerulea dolens
Authors: Wlodarczyk Z K , Gibson M , Dick R , Hamilton G 
Published: March 2007

Abstract
Three patients with phlegmasia caerulea dolens treated successfully by low-dose intra-arterial thrombolysis are presented. In all patients a rapid improvement was observed and amputation avoided. The risk of pulmonary embolus was reduced by the use of a retrievable vena cava filter in one patient and thrombolytic therapy in the presence of a previously inserted cava filter in the other two.
Psychomotor skills of surgical trainees compared with those of different medical specialists
Authors: Harris C J , Herbert M , Steele R J C 
Published: March 2007

Abstract
Forty-eight trainees in surgery, psychiatry, anaesthetics and medicine underwent objective testing of manual dexterity (Mandex test), hand-eye coordination (Gibson spiral maze test) and visuospatial ability (embedded figures task). Surgical trainees performed significantly more quickly on the spiral maze test than psychiatrists (P = 0.03) but made more errors (P = 0.02). Combining male and female subjects across all groups, women were significantly more accurate than men. When men only were compared no psychomotor differences between specialty groups could be demonstrated. There were no differences in visuospatial ability by either sex or specialty. Self-selection on the basis of such skill is therefore unlikely.
Triage by laparoscopy in patients with penetrating abdominal trauma
Authors: Fernando H C , Alle K M , Chen J , Davis I , Klein S R 
Published: March 2007

Abstract
Laparoscopy was performed on 33 patients with penetrating abdominal injuries to identify those with peritoneal penetration. Diagnostic or therapeutic manoeuvres were not attempted; evidence of peritoneal penetration mandated exploratory laparotomy. Twenty-two patients had gunshot wounds and 11 stab wounds. Ten patients had multiple penetrating injuries. Intraperitoneal injury was not evident by clinical assessment in any patient and all were haemodynamically stable. Twenty-three patients underwent negative laparoscopy and no intraperitoneal injury was subsequently detected. Laparoscopy demonstrated peritoneal penetration in ten patients and subsequent laparotomy detected intraperitoneal injuries in nine. No complications of laparoscopy occurred. In stable patients with penetrating trauma and no clinical evidence of intraperitoneal injury, laparoscopy effectively and safely detects those with peritoneal penetration.
Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus
Authors: Roder J D , Busch R , Stein H J , Fink U , Siewert J R 
Published: March 2007

Abstract
Prognostic factors that may alter the indications for primary surgical resection or that can be influenced by the extent of the procedure were analysed in a homogeneous group of 186 patients with squamous cell carcinoma of the oesophagus. All patients underwent standardized en bloc oesophagectomy and lymph node dissection with prospective documentation of the histopathological findings; follow-up was complete. Multivariate analysis identified the Union Internacional Contra la Cancrum R category (i.e. the presence of residual tumour after resection) as the most important independent prognostic factor (P&lt; 0.001) followed by the ratio of invaded to removed lymph nodes (P&lt; 0.001). These data suggest that only patients in whom R0 resection can be anticipated based on preoperative assessment should undergo primary resection for oesophageal cancer. Extended lymphadenectomy may improve survival in patients with a limited number of invaded mediastinal nodes.
Local anaesthetic agents in surgery for ingrown toenail
Authors: Connolly A A P , Meyer L C , Tate J J T 
Published: March 2007

Abstract
To determine the most effective local anaesthetic for ingrown toenail surgery, 100 procedures were performed after patients had been randomized to receive lignocaine, bupivacaine or hyaluronidase and bupivacaine. The effect of each anaesthetic was monitored and 80 patients returned a follow-up questionnaire. There was no significant difference in the time for the local anaesthetic to take effect, or in the pain caused by its injection or the procedure. Significant differences were found between treatments with respect to pain at discharge from hospital and significantly fewer patients who received bupivacaine experienced pain 24 h after surgery (P = 0.002). Bupivacaine provides quickacting and long-lasting anaesthesia and should be used in preference to lignocaine.
Prospective study of postoperative renal function in obstructive jaundice and the effect of perioperative dopamine
Authors: Parks R W , Diamond T , McCrory D C , Johnston G W , Rowlands B J 
Published: March 2007

Abstract
A prospective study was undertaken to assess postoperative renal dysfunction in patients with obstructive jaundice and to determine the effectiveness of dopamine in reducing its incidence. A total of 23 patients undergoing surgical relief of obstructive jaundice (serum bilirubin level above 100 μmol l−1) were randomized into two groups. Those in the control group (n = 10) received 3 litres 5 per cent dextrose intravenously during the 24 h before surgery plus a bolus of intravenous frusemide 1 mg kg−1 at induction of anaesthesia. The second group (n = 13) received a similar fluid and frusemide regimen plus an infusion of dopamine 3 μg kg−1 min−1 starting at induction of anaesthesia and continuing for 48 h after surgery. Postoperative oliguria occurred in two of the ten patients in the control group and in three of the 13 given dopamine (P = 0.74). No patient developed acute renal failure. There was no significant difference in mean levels of serum bilirubin, urea and creatinine, creatinine clearance and 24-h urinary output, on the day before and on days 1–5 after operation, between the two groups. It is concluded that, with careful preoperative resuscitation and control of fluid and electrolyte balance, the incidence of postoperative renal dysfunction in patients with obstructive jaundice is not as high as in some previous studies and is unaltered by administration of perioperative low-dose dopamine.
Biliary bile acid profiles in patients with familial adenomatous polyposis before and after colectomy
Authors: Barker G M , Radley S , Bain I , Davis A , Lawson A M , Keighley M R B , Neoptolemos J P 
Published: March 2007

Abstract
The development of colorectal polyps and cancer in patients with familial adenomatous polyposis (FAP) is directly linked to inactivation of the APC gene. Other, epigenetic, mechanisms may be involved in tumorigenesis and a previous study suggested that an intrinsic difference in the biliary bile acid profile of untreated patients with FAP persisted after colectomy. Gas chromatography and gas chromatography-mass spectrometry were used to examine the biliary bile acid profiles of four groups of patients with normal gallbladders: 20 patients with an intact colon comprising 12 with FAP and eight controls; and 26 patients after colectomy comprising 12 with FAP and 14 controls. Comparison of ten different bile acids from both amidate fractions (glycine and taurine) revealed a small increase in the molar percentage of a minor bile acid (12-oxolithocholic acid) in patients with FAP and an intact colon compared with the matching control group. Colectomy was associated with a dramatic reduction in levels of secondary bile acids but with little difference between patients with FAP and controls.
Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation
Authors: Brewster N T , Grieve D C , Saunders J H 
Published: March 2007

Abstract
Over a 3-year period, all patients referred for barium enema examination had a double-contrast barium enema and flexible sigmoidoscopy performed on the same day. A total of 462 joint examinations were performed. Abnormalities were found in 193 patients by the use of barium enema, 164 patients by using sigmoidoscopy and 294 by the use of both methods of investigation. Sigmoidoscopy was superior to barium enema in the detection of polyps and inflammatory bowel disease but barium enema was more sensitive for diverticular disease. The presenting symptoms had no predictive value in distinguishing carcinoma, polyps and diverticular disease. Diverticular disease did not reduce the sensitivity of barium enema examination to polyps in the sigmoid colon. Fibreoptic sigmoidoscopy immediately before barium enema was well tolerated by patients. The investigations were complementary in the diagnosis of colonic polyps, inflammatory bowel disease and diverticular disease.
Population screening for colorectal cancer: Comparison between guaiac and immunological faecal occult blood tests
Authors: Robinson M H E , Marks C G , Farrands P A , Thomas W M , Hardcastle J D 
Published: March 2007

Abstract
There is concern about the low sensitivity of the guaiac-based Haemoccult test in mass population faecal occult blood (FOB) screening for the early detection of colorectal carcinoma. Hemeselect, an immunological FOB test, has been shown to be more sensitive for symptomatic colorectal cancer and may prove to be a more reliable screening method. In Brighton and Guildford, 4018 asymptomatic subjects aged 50–75 years were offered screening with Haemoccult and Hemeselect. A total of 1489 (37.7 per cent) completed both tests, of which 17 (1.1 per cent) were positive for Haemoccult and 145 (9.7 per cent) positive for Hemeselect (a total of 148 subjects had positive tests). Seven subjects (4.7 per cent) refused to be investigated. Colonic investigation in the remainder revealed nine cancers and 49 patients with 67 adenomas (32 tumours 1 cm or more in size). All cancers (Dukes A, six; B, one; C, two) were detected by Hemeselect (positive predictive value 6.2 per cent) but only one patient was Haemoccult positive (positive predictive value 5.9 per cent). Hemeselect detected 65 adenomas (31 of 1 cm or more) in 48 patients (positive predictive value 33.1 per cent) compared with 11 adenomas (seven of 1 cm or more) in eight patients who were positive for Haemoccult (positive predictive value 47.1 per cent). The test specificity for neoplasia was respectively 94.9 and 99.6 per cent. The Hemeselect positive rate is high but its substantial positive predictive value for cancer warrants continuing evaluation.
Cancer of the colon and rectum in Ghana: A 5-year prospective study
Authors: Naaeder S B , Archampong E Q 
Published: March 2007

Abstract
A prospective study of 134 patients who presented to a teaching hospital in Ghana for the first time with colorectal cancer between January 1987 and December 1991 is reported. The mean number of new patients per year was nearly three times that of a decade ago. The disease afflicts both sexes equally and the age of highest incidence is in the seventh and eighth decades. Some 65 patients had colonic cancer and 69 rectal lesions. Most patients presented with advanced disease and only four of 109 in whom disease was staged (3.7 per cent) had Dukes A tumours. Right-sided cancer of the colon was more common than that of the left. The importance of rectal examination is emphasized by the finding that 78 per cent of rectal tumours were within reach of the examining finger. ‘Curative’ resection was possible in 60 per cent of patients with colonic cancer but in only 36 per cent of those with rectal tumours. The postoperative mortality rate of patients who underwent laparotomy was 13.6 per cent and in those who had resection 5.5 per cent. Long-term follow-up was poor. These results emphasize the need for accurate data collection on colorectal carcinoma, public education on the importance of early diagnosis and follow-up after treatment. These findings also call for a study of the epidemiology and aetiology of colorectal cancer in Ghana.
Ruptured aortic aneurysm: Early postoperative prediction of mortality using an organ system failure score
Authors: Meesters R C Tromp , Van Der Graaf Y , Vos A , Eikelboom B C 
Published: March 2007

Abstract
Ruptured abdominal aortic aneurysm (AAA) is a personal and public health catastrophe because of the high and unimproving mortality rate, increasingly long intensive care unit (ICU) stay and rising hospital costs. Criteria are needed to identify patients with a poor prognosis so that treatment and resources may be directed to those with a better outlook. This retrospective study reviews perioperative variables, outcome and length of ICU stay for 99 consecutive patients with operated ruptured infrarenal AAA between 1985 and 1992 who reached the ICU alive. Early death (within 48 h) occurred in 20 per cent using 24 ICU days and late death (after 48 h) occurred in 29 per cent using 420 ICU days; neither type of death could be predicted before operation. Multiple organ failure, the cause of 93 per cent of late deaths, was assessed for each patient 48 h after operation using an organ system failure score. There was a strong positive correlation between organ system failure score and mortality rate (P&lt;0.00001); all 20 patients with more than two failing organ systems died. If used in decision making the score would have saved 43 per cent of the ICU days associated with late mortality. Withdrawing postoperative treatment at an early stage in accordance with an organ system failure score may be a defensible and cost-effective option.
Vein bypass surgery to the foot in patients with diabetes and critical ischaemia
Authors: Isaksson L , Lundgren F 
Published: March 2007

Abstract
The feasibility of vein bypass surgery to the arteries of the foot was studied in a diabetic population with critical ischaemia; whether or not such reconstruction leads to an independent lifestyle was assessed 1 year later. Thirty-three reconstructions were performed on 32 limbs in 31 patients. The mortality and reoperation rates within 1 month were both 6 per cent. Primary and secondary patency, limb salvage and survival rates at 1 year were 76, 89, 89 and 82 per cent respectively. Good results in the form of combined survival, patency, limb salvage, walking ability, relief of pain and residence at home were achieved in 64 per cent of patients after 1 year. Reconstructive vascular surgery to the foot in diabetics is feasible and affords two-thirds of patients an independent lifestyle 1 year after surgery.
Effect of mode of application of papaverine on the contractile response of the internal mammary artery
Authors: Chester A H , Panda R , Borland J A A , Tadjkarimi S , Schyns C J , O'Neil G S , Yacoub M H 
Published: March 2007

Abstract
A study was performed to investigate the duration of action of papaverine applied either intraluminally or in a combined intraluminal and extraluminal fashion in vitro, and how the reactivity of the internal mammary artery (IMA) to a range of vasoconstrictors is affected. Segments of IMA exposed to only intraluminal papaverine (10−4 mol/1) for 15 min recovered their contractile response to 90 mmol/1 potassium chloride to pretreatment levels within 2h. In contrast, combined intraluminal and extraluminal administration of papaverine resulted in a significant depression of the contractile response to 90 mmol/1 potassium chloride (P&lt;0–001), which persisted for at least 5 h. Responses to 5-hydroxytryptamine, noradrenaline, the thromboxane mimetic U46619, histamine and dopamine were not significantly different between control tissues and those that had received intraluminal papaverine. The duration of action of papaverine is affected by its route of delivery and there are no significant short-term effects on the contractile mechanisms in the arterial wall after intraluminal administration.
Value of Nissen fundoplication in patients with gastro-oesophageal reflux judged by long-term symptom control
Authors: Grande L , Toledo-Pimentel V , Manterola C , Lacima G , Ros E , García-Valdecasas J C , Fuster J , Visa J , Pera C 
Published: March 2007

Abstract
A total of 160 patients treated by Nissen fundoplication for uncomplicated gastro-oesophageal reflux disease were studied over a 20-year period. Recurrent reflux and side-effects were assessed yearly after surgery. No objective tests for reflux were performed during follow-up if patients were asymptomatic. Perioperative mortality and techniquerelated morbidity rates were both 2 per cent. At the latest evaluation, 79 per cent of patients were completely relieved of reflux symptoms, 85 per cent had symptoms of Visick grade 1 or 2 and 89 per cent would be willing to undergo surgery again under the same conditions. Actuarial analysis showed that the success rate of fundoplication was 92 per cent at 20 years. Fourteen patients (9 per cent) developed side-effects after fundoplication and had continuing disability. Nissen fundoplication achieves permanent control of reflux symptoms in most patients with few complications and has a high degree of patient satisfaction.
Atrial natriuretic peptide and glucagon release in experimental intestinal ischaemia and reperfusion
Authors: Meleagros L , Ghatei M A , Bloom S R 
Published: March 2007

Abstract
Intestinal ischaemia and reperfusion cause changes in cardiovascular and pulmonary function. In a rat model, the plasma concentrations of atrial natriuretic peptide (ANP) and pancreatic glucagon rose on reperfusion after 20 min of intestinal ischaemia, coinciding with significant arterial hypotension: mean(s.e.m.) ANP 79(13) versus control 36(4) fmol ml−1 (P&lt;0·01); and mean(s.e.m.) glucagon 22(2) versus control 10(1) fmol ml−1 (P&lt;0·001). Glucagon was also released on reperfusion after 5 min of ischaemia: mean(s.e.m.) 18(2) fmol ml−1 (P&lt;0·001 versus control). In a second experiment, pretreatment of rats with allopurinol did not prevent arterial hypotension but abolished ANP release (mean(s.e.m.) 36(2) fmol ml−1versus no pretreatment 70(7) fmol ml−1, P&lt;0·05), while glucagon release was unaffected. The release of ANP, but not that of glucagon, is therefore mediated by oxygen free radicals and may signify cardiac and/or pulmonary injury or dysfunction. The actions of these peptides may be relevant in the pathophysiological perturbation of intestinal ischaemia–reperfusion.