bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective conservative management of abdominal gunshot wounds: A prospective study
Authors: Muckart D J J , Abdool-Carrim A T O , King B 
Published: March 2007

Abstract
A prospective study of 111 patients with low velocity gunshot wounds of the abdomen was conducted to determine whether a policy of selective conservative management based on repeated physical examination is a safe form of treatment. Laparotomy was undertaken in 89 patients (80 per cent), seven of which were negative. Of the patients 22 (20 per cent), eight of whom were considered to have peritoneal penetration, underwent conservative management. None required delayed laparotomy. Eight patients (7 per cent) died, all deaths occurring in the positive laparotomy group. The incidence of significant intra-abdominal injury if the peritoneal cavity had been penetrated was 89 per cent. Selective conservative management may be applied safely to a limited group of patients with gunshot wounds of the abdomen.
Prospective study of the value of ultrasound measurements in the diagnosis of acute rejection following renal transplantation
Authors: Nicholson M L , Williams P M , Bell A , Donnelly P K , Veitch P S , Bell P R F 
Published: March 2007

Abstract
In this prospective study we have used ultrasonographic measurements of the cross-sectional area of transplanted kidneys, as an objective assessment of graft size, for diagnosis of acute rejection episodes. Sixty episodes of acute graft dysfunction (serum creatinine rise of ≥ 30 μmol/l) were studied in 40 patients. Tru-Cut® biopsy under ultrasound control was performed in all cases and 36 episodes of acute cellular rejection were identified. An increase in graft cross-sectional area of ≥ 10 per cent was defined as a positive scan, indicative of an acute rejection episode. Using these criteria, ultrasound correctly diagnosed rejection in 29 out of 36 cases (sensitivity 81 per cent) and there were four false positive results (specificity 83 per cent). The investigation had a predictive value of 88 per cent when positive and 74 per cent when negative.
Axillofemoral bypass as a limb salvage procedure in high risk patients with aortoiliac disease
Authors: Naylor A R , Ah-See A K , Engeset J 
Published: March 2007

Abstract
Thirty-eight patients presenting with severe limb ischaemia and considered unfit for major aortic reconstruction underwent axillofemoral bypass as a limb salvage procedure. Four patients (11 per cent) died, including two who had presented with bilateral ischaemia secondary to acute aortic occlusion. The operative mortality rate for patients presenting with rest pain or ulceration/gangrene was 6 per cent. Cumulative 5-year survival and limb salvage were 44 per cent and 86 per cent respectively. Graft occlusion was the principal cause of worsening symptoms during follow-up (5-year primary patency of 68 per cent) and accounted for all major amputations of the operated limb. Axillounifemoral grafts had a significantly worse 5-year patency (50 per cent) than axillobifemoral grafts (80 per cent, P &lt; 0·05) and three of five patients who developed worsening symptoms in the non-operated limb died or required a major limb amputation as a consequence. Axillofemoral bypass is a valuable alternative to major aortic reconstruction in elderly patients and allows a greater proportion to be offered reconstruction than would otherwise be possible.
Anatomical aspects of the blood supply to the skin of the posterior calf: Technique of below-knee amputation
Authors: Gray D W R , Ng R L H 
Published: March 2007

Abstract
Whether or not the soleus muscle should be excised during below-knee amputation is a point of contention. The anatomical basis for the blood supply to the skin of the posterior calf has been examined by dissection and selective arterial injection of cadavers. The results showed that the skin used to construct the posterior flap for below-knee amputation derives its blood supply from both axial vessels, running with the peripheral nerves, and perforating vessels arising through the gastrocnemius muscle. There is no contribution by blood vessels that pass through the soleus muscle. When a posterior flap for below-knee amputation is constructed the soleus muscle should be completely excised.
Lymph node metastasis from melanoma with an unknown primary site
Authors: Jonk A , Kroon B B R , Rümke Ph , Mooi W J , Hart A A M , Van Dongen J A 
Published: March 2007

Abstract
Twenty-six patients, treated surgically between 1961 and 1986 because of lymph node metastasis from melanoma with an unknown primary, were analysed. Six patients had a history of spontaneous regression of a skin lesion. Following node dissection, the overall actuarial disease-free survival rate was 49 per cent, after both 5 and 10 years. When considered as single factors, female (versus male), one lymph node involved (versus more than one node involved) and site of metastasis in the groin or axilla (versus the neck) were found to have significantly favourable effects on prognosis with 5-year survival rates of 82 per cent (25 per cent), 82 per cent (27 per cent) and 80 per cent (11 per cent) respectively. However, at multifactorial analysis only the site of cervical metastases maintained a significant influence on survival (P = 0·005). As survival in this series is comparable with, or even better than, that of adequately treated patients with lymph node metastasis from a known primary melanoma, a radical node dissection is essential also in these patients.
Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma
Authors: Matsumata T , Kanematsu T , Shirabe K , Sonoda T , Furuta T , Sugimachi K 
Published: March 2007

Abstract
From September 1981 to December 1988, 163 patients underwent hepatic resection for hepatocellular carcinoma. The patients were divided into two groups: those operated on from September 1981 to March 1985 (n = 55) and those operated on from April 1985 to December 1988 (n = 705). There was an increase in the number of relatively small hepatocellular carcinomas in 1987–88. Differences in the incidence of accompanying liver cirrhosis (72 versus 62 per cent) were not statistically significant; however, values of the indocyanine green test (21·5 versus 77·0 per cent, P &lt; 0·01) aided in strict patient selection. In more recent years, initial hepatic hilar dissection for control of vascular structures was undertaken and an ultrasonic dissector was used in about three-quarters of these patients. Consequently, the mean estimated blood loss (2500 versus 1300ml, P&lt;0·001) and mean intraoperative blood replacement (2200 versus 560 ml, P &lt; 0·001) were significantly less than in the earlier period. Among the 58 patients treated in the early period, hospital morbidity and mortality rates were 52 and 29 per cent respectively. In contrast, the rates were 23·8 and 1·9 per cent respectively among the 105 patients operated on during the recent period (P&lt;0·01). The decline in hospital mortality is attributed to the careful selection of patients, use of modern tools, and a diminished blood loss.
Gallbladder cholesterolosis: An aetiological factor in acute pancreatitis of uncertain origin
Authors: Paricio P Parrilla , Olmo D Garcia , Franco E Pellicer , González A Prieto , González L Carrasco , López J Bermejo 
Published: March 2007

Abstract
To investigate the possible relationship between gallbladder cholesterolosis and acute pancreatitis, we studied 3797 cholecystectomy specimens and found 55 cases of gallbladder cholesterolosis unassociated with biliary lithiasis. From the reviewed case notes, 27 of these patients presented with recurrent attacks of acute pancreatitis which disappeared after cholecystectomy (follow-up 65·1 months). A microscopic study revealed frank cholesterolosis in all cases with a pseudopolyp transformation of the mucosa, some polyps reaching a diameter of 2 mm. We postulate that the mechanism could be temporary impaction of cholesterolosis polyps at the sphincter of Oddi and suggest that patients with recurrent attacks of acute pancreatitis and negative aetiological investigation must be considered as at high risk of having gallbladder cholesterolosis and that they could benefit from cholecystectomy.
Gallstone ileus
Authors: Clavien P-A , Richon J , Burgan S , Rohner A 
Published: March 2007

Abstract
Thirty-seven patients (33 women and four men, median age 78 years) were operated on for gallstone ileus over a 12-year period with a median follow-up of 6·2 years. Twenty-three patients (62 per cent) had serious concomitant diseases. Plain abdominal radiographs performed at admission were diagnostic in only 17 patients (46 per cent) and other procedures such as ultrasonography, gastrointestinal contrast studies and computed tomographic scan were required in ten patients (27 per cent). The diagnosis was made before operation in 27 patients (73 per cent) but in only 17 (46 per cent) at admission. Obstructing stones were located in the terminal ileum in 27 patients (73 per cent), in the proximal ileum or jejunum in five (14 per cent), in the duodenum in two (5 per cent), and in the colon in three (8 per cent). In six instances (16 per cent), more than one stone was involved. Cholecystduodenal fistula was the most frequent fistula type (n = 25, 68 per cent), followed by cholecystcolonic (n = 2, 5 per cent) and cholecystduodenocolonic (n = 2, 5 per cent) types. The site of the fistula was not established in the other eight instances. A one-stage procedure consisting of the removal of the impacted stone, fistula repair and cholecystectomy was performed in eight patients, two of whom died. A second group of six patients underwent a two-stage procedure consisting of enterolithotomy followed by elective biliary surgery, with no mortality. Removal of impacted stones was the only surgical treatment in the remaining 23 patients, with five deaths. Operative mortality and morbidity rates associated with the initial procedure did not differ significantly among the three therapeutic groups, which were comparable in terms of patient age, associated concomitant diseases and APACHE II score. However, later biliary complications were prominent in patients treated only by enterolithotomy. These results support the view that a one-stage procedure is, when feasible, a valid option and may be the procedure of choice. When local or surgical conditions argue against a one-stage procedure, biliary surgery at a second stage should be considered, if residual stones are present. In poor risk patients, non-operative methods should be considered.
Diagnosis of soft tissue tumours by Tru-Cut® biopsy
Authors: Ball A B S , Fisher C , Pittam M , Watkins R M , Westbury G 
Published: March 2007

Abstract
Tru-Cut® biopsies were obtained from 52 consecutive patients referred with soft tissue tumours. Forty-five patients had soft tissue sarcomas; seven had benign soft tissue tumours. Of the biopsies 96 per cent provided adequate material for diagnosis. The histological diagnosis made from the Tru-Cut biopsy was compared with that made from the resected specimen. There were no false positive diagnoses of malignancy. The accuracy of Tru-Cut biopsy was 98 per cent for the diagnosis of malignancy and 94 per cent for the diagnosis of sarcoma. Tumour subtype was correctly specified in 85 per cent of sarcomas and tumour grade in 88 per cent. Tru-Cut biopsy should replace open biopsy as the primary means of diagnosis of soft tissue tumours unless a satisfactory tissue sample cannot be obtained.
Complications and local recurrence following lymphadenectomy
Authors: Shaw J H F , Rumball E M 
Published: March 2007

Abstract
We have retrospectively reviewed the case notes of 208 patients undergoing either cervical, axillary, or inguinal lymphadenectomy with a view to determining the factors that predispose to complications and local recurrence. The most frequent complications were wound infection, seroma formation, paraesthesiae and lymphoedema. The main predisposing factor for complications was anatomical site; wound complications occur with twice the frequency in the inguinal lymphadenectomy group than in the two other sites. Preresection biopsy was also associated with an almost twofold increase in complications, while fine needle aspiration cytology was not. The two major factors influencing the incidence of local recurrence were the stage of the disease process and the use of preresection biopsy. There was a steady increase in the incidence of local recurrence with increasing stage of regional disease. In addition, local recurrence was almost twice as common in patients who had undergone biopsy before resection when compared with patients who either did not have tissue sampling before resection or had fine needle aspiration cytology alone. We conclude that fine needle aspiration cytology is safe and the investigation of choice in patients undergoing lymphadenectomy. In contrast, preresection biopsy should be avoided as it promotes both complications and local recurrence. In addition, wound complications and lymphoedema are frequent following lymphadenectomy, especially following inguinal dissection.
Hyperthermic isolated perfusion with melphalan in the treatment of advanced malignant melanoma of the lower limb
Authors: Skene A I , Bulman A S , Williams T R , Thomas J Meirion , Westbury G 
Published: March 2007

Abstract
A retrospective study of 91 patients with malignant melanoma treated by lower limb isolated hyperthermic regional perfusion was performed. Objective response in patients with evaluable disease was 78 per cent. The role of perfusion as primary treatment of large melanomas of the foot is confirmed and recommended. Control of locoregional disease and limb salvage remains a valuable and attainable therapeutic goal using this technique.
Experimental colonic carcinogenesis after gastric surgery
Authors: Houghton P W J , Owen R J , Henly P J , McC. Mortensen N J , Hill M J , Williamson R C N 
Published: March 2007

Abstract
Peptic ulcer surgery may predispose to the subsequent development of colorectal cancer. This experimental study has investigated the effects of gastric operations on colonic cell proliferation, bile acid excretion and carcinogenesis. Male Sprague-Dawley rats (n = 705) underwent sham operation, Polya partial gastrectomy or vagotomy and pyloroplasty. The carcinogen azoxymethane was administered weekly for 6 weeks thereafter (total dose 60 mg kg−1). When the animals were killed 24 weeks after operation, colons were examined for mucosal mass, crypt cell production rate (CCPR) and tumour yield; faeces were assayed for contents of neutral steroids and bile acids (both total and individual). Morphometric indices and mucosal DNA content were similar in all three groups. Polya gastrectomy reduced: (1) CCPR throughout the colon (by 42–65 per cent, P&lt; 0·002); (2) the number of rats with colorectal tumours (26 per cent versus 63 per cent, P&lt;0·05); (3) faecal levels of neutral steroids and bile acids, notably hyodeoxycholic acid (P&lt;0·01). Although vagotomy and pyloroplasty increased caecal CCPR, there were no consistent differences in faecal steroids and no alteration in tumour yield after the operation. These results fail to support clinical studies suggesting that gastric surgery predisposes to colonic carcinogenesis. Indeed, Polya partial gastrectomy exerts a protective effect, probably by inhibiting colonic cell proliferation.
Prospective randomized controlled trial of hepatic arterial embolization or infusion chemotherapy with 5-fluorouracil and degradable starch microspheres for colorectal liver metastases
Authors: Flowerdew A D S , Birch S J , Williams J D , Mullee M A , Taylor I 
Published: March 2007

Abstract
Survival benefit from hepatic artery embolization (HAE) or hepatic arterial infusion chemotherapy (HAI) in patients with unresectable colorectal liver metastases has not previously been assessed in a randomized controlled trial. Sixty-one patients were randomized, 20 to receive no treatment, 22 to receive HAE, and 19 to receive HAI with 5-fluorouracil and degradable starch microspheres. Both treatments were acceptable to the patients in terms of low treatment morbidity rate. Median survival from diagnosis of metastases was 9·6 months for controls, 8·7 months for the HAE group and 13·0 months in the HAI group. There was no apparent survival benefit for the HAE group. The increased survival in the HAI group was observed in all the subgroups analysed but failed to reach statistical significance. The greatest observed benefit was achieved in the subgroup with &lt; 50 per cent hepatic replacement with tumour at presentation (median survival from diagnosis 10·0 months for controls, 10·2 months for HAE and 23·6 months for HAI); 36 per cent of patients developed extrahepatic disease recurrence. No significant benefit has been shown from either HAE or HAI, but a more carefully selected group of patients with only low volume hepatic disease may benefit from HAI therapy.
Use of thermography in the differential diagnosis of phylloides tumour
Authors: Pierart J , Burmeister R , Steinberg J , Schalper J , Cid L 
Published: March 2007

Abstract
Thermography can be used as a method of diagnosing breast masses. We report our results of its use in the differential diagnosis of fibroadenoma from phylloides tumours (n = 47 and 20 respectively). Thermographic resolution (Th) and the difference in temperature between the tumour and a similar zone in the contralateral breast (δ2) were compared. Thermograms were class Thl (with a similar thermal pattern in both breasts without hypervascularization or hot points) and TH2 (with hypervascularization or a hot area with a thermal difference with the same area in the opposite breast (δ2) of less than 2°C) in most (95·7 per cent) of the patients with fibroadenoma and were class Th5 (having one or more pathological sign) in 85 per cent of the patients with phylloides tumours. Patients with phylloides tumours had a mean δ2 of 2·99°C whereas most of the patients with a fibroadenoma showed no difference in temperature. Their mean δ2 was 0·2°C (P&lt;0·0005). We conclude that thermography helps in differential diagnosis between a fibroadenoma and a phylloides tumour.
Metabolic effects of recombinant human growth hormone: Isotopic studies in the postabsorptive state and during total parenteral nutrition
Authors: Douglas R G , Humberstone D A , Haystead A , Shaw J H F 
Published: March 2007

Abstract
We have performed a series of isotopic studies in 25 adult patients with sepsis and/or trauma in order to determine the metabolic effects of recombinant human growth hormone (rHGH) administration. Twelve of the patients were receiving total parenteral nutrition, and 13 were eating a normal ward diet and were studied postabsorption. Energy and protein kinetics were quantified isotopically before rHGH administration and following a 3-day course of rHGH (20 units subcutaneously daily). In the total parenteral nutrition group the rate of net loss of protein decreased from 0·82(0·17) gkg−1 day−1 to 0·43(0·20) g kg−1 day−1 (P &lt; 0·02) following the administration of rHGH. The rate of appearance of leucine was not altered, suggesting that the improvement in nitrogen balance following rHGH was because of an increased rate of protein synthesis rather than reduced catabolism. In the postabsorptive group, rHGH treatment significantly increased the rate of appearance of free fatty acids (from 7·4(2·2) μmolkg−1 min−1 to 11·1(2·6) μmolkg−1 min−1, P&lt;0·03) and free fatty oxidation (from 1·3(0·4) μmol kg−1 min−1 to 1·7(0·4) umol kg−1 min−1, P&lt;0·06), while the rate of leucine oxidation was reduced (from 0·44(0·05) umol kg−1 min−1 to 0·26(0·03) umol kg−1 min−1, P&lt; 0·005). Glucose appearance and oxidation remained unchanged. These results suggest that fat was being oxidized in preference to protein, which resulted in a reduction in the net rate of loss of protein of 0·3 g kg−1 day−1 (P&lt;0·05). We conclude that rHGH administration is capable of significantly reducing net protein loss in septic or injured surgical patients. Recombinant HGH may be clinically useful in supporting critically ill surgical patients who require intensive nutritional support.
Influence of glucagon on protein and leucine metabolism: A study in fasting man with induced insuiin resistance
Authors: Pacy P J , Cheng K N , Ford G C , Halliday D 
Published: March 2007

Abstract
The counter-regulatory hormones, including glucagon, may be involved in the generation of postoperative negative nitrogen balance. We examined the influence of glucagon on whole body and forearm muscle protein kinetics, determined by L-[1–13C,15N] leucine, in two matched groups of healthy fasting subjects. In one study somatostatin alone was infused continuously (0·12mgh−1) and in another with glucagon (0·04mgh−1) to generate insulin resistance. Somatostatin infusion increased leucine oxidation (P &lt; 0·05) and reduced the negative protein balance (P &lt; 0·07) across the forearm; the 15 per cent decrease in protein breakdown was not significant. Whole body leucine kinetics showed increased flux (P&lt;0·05) and synthesis (P&lt;0·01) but reduced oxidation (P&lt;0·05). Hyperglucagonaemia caused a threefold enhancement of leucine oxidation (P&lt;0·02), while the negative protein balance further increased (P&lt;0·05) across the forearm. Whole body leucine flux was unchanged; oxidation increased (P&lt;0·01) and synthesis decreased (P&lt;0·01). These studies confirm that physiological hyperglucaganaemia during insulin resistance is catabolic in the short-term and indicates, for the first time, that glucagon may influence muscle protein metabolism acutely in man. We suggest that therapeutic manoeuvres designed to reduce glucagon levels after surgery may ameliorate protein kinetic abnormalities.
Elective abdominal surgery depresses muscle protein synthesis and increases subjective fatigue: Effects lasting more than 30 days
Authors: Petersson B , Wernerman J , Waller S-O , von der Decken A , Vinnars E 
Published: March 2007

Abstract
Ten patients without metabolic disease undergoing elective cholecystectomy were studied before surgery and on days 3, 10, 20 and 30 after operation. Percutaneous muscle biopsies were taken and protein synthesis was determined from the total concentration and size distribution of ribosomes. The subjective feeling of fatigue was estimated using a visual analogue scale. The nitrogen balance was calculated at 20 days following surgery. The mean(s.e.m.) total concentration of ribosomes per milligram of DNA decreased by 27·5(6·6) per cent (P &lt; 0·07), 44·5(6·5) per cent (P &lt; 0·007), 48·3(8·9) per cent (P &lt; 0·007) and 45·0(8·2) per cent (P&lt;0·07) on days 3, 10, 20 and 30, respectively. By 30 days after surgery no sign of restoration of normality was seen. The relative proportion of polyribosomes had decreased by 20·4(6·4) per cent (P&lt;0·05) on the third postoperative day and by 20·4(3·9) per cent (P &lt; 0·07) on the tenth postoperative day and was restored to the preoperative level by day 20. The subjective fatigue score increased after operation and five of nine patients had not regained their preoperative scores 30 days after surgery. The daily nitrogen balance was negative for 5 days. The cumulated nitrogen losses were not restored until after 18 days following surgery. Elective abdominal surgery caused a sustained depression of protein synthesis for over 30 days, a longer period than previously presumed. These results show that long-term follow-up is required when the effect of different postoperative nutritional regimens are to be evaluated.