bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of conventional Lewis-Tanner two-stage oesophagectomy with the synchronous two-team approach
Authors: Hayes N , Shaw I H , Raimes S A , Griffin S M 
Published: March 2007

Abstract
Twenty-seven patients with oesophageal carcinoma had subtotal oesophagectomy by the Lewis-Tanner operation (group 1, n = 14) or a synchronous modification (group 2, n = 13). Synchronous operations were completed more quickly (230 versus 305 min, P &lt;0·01), but with more time spent under single-lung anaesthesia (160 versus 120 min, P &lt;0·01) and a greater fall in systolic blood pressure during hiatal manipulation (60 versus 30mmHg, P &lt;0·01). Operative blood loss was not significantly greater in group 2, but the total volume of blood transfused in the perioperative period was greater in this group (5 versus 3 units, P &lt;0·01). Four patients in group 1 suffered significant postoperative complications, compared with seven in group 2; three postoperative deaths occurred in group 2. This study suggests that the synchronous two-team oesophagectomy produces a higher incidence of complications than the conventional operation. Continued use of the Lewis-Tanner two-stage oesophagectomy is recommended for patients with carcinoma of the oesophagus.
Early oesophageal cancer: Results of a European multicentre survey
Authors: Bonavina L 
Published: March 2007

Abstract
Early oesophageal cancer has been extensively studied in Far-Eastern countries, where its prevalence is high. A multicentre survey was conducted within the Groupe Européen pour l'Etude des Maladies de l'Oesophage to analyse results of surgical treatment in patients with disease staged as pTis-T1 N0 M0 according to the tumour node metastasis classification. Of 9743 patients with squamous cell oesophageal carcinoma observed since 1980, 4663 underwent resection; 253 (5·4 per cent) of these fulfilled the criteria for inclusion in the study. The overall mortality rate was 9·1 percent (23 patients), and was higher after transthoracic than transhiatal oesophagectomy (10·7 versus 6 per cent, P not significant). Pathological examination showed an intraepithelial tumour in 46 patients (18·2 percent), intramucosal carcinoma in 64 (25·3 percent) and a submucosal lesion in 143 (56·5 percent). The overall 5-year survival rate for patients with intraepithelial, intramucosal and submucosal tumours was 92·8, 72·8 and 44·3 percent respectively. The 5-year survival rate was higher after transthoracic than transhiatal oesophagectomy (66 versus 52 percent). No survival advantage was observed after either operation in patients with mucosal tumours. Of 21 patients with recurrent disease, 20 had a submucosal lesion. The 5-year survival rate in patients with submucosal tumour was higher after transthoracic than transhiatal oesophagectomy (54·2 versus 25·5 per cent).
Gastric carcinoma in patients over 70 years of age
Authors: Maehara Y , Oshiro T , Oiwa H , Oda S , Baba H , Akazawa K , Sugimachi K 
Published: March 2007

Abstract
The clinicopathological features and prognosis of gastric cancer in 344 patients aged 70 years or older who underwent gastrectomy between 1965 and 1990 were determined. Over the years the mean size of the tumour decreased, differentiated tumour tissue was more common, depth of penetration was less prominent, lymphatic and vascular involvement was less frequent, and the rate of lymph node metastasis and peritoneal dissemination decreased. Extensive lymph node dissection was more frequently carried out and the rate of curative resection rose. Survival rates improved with early detection of gastric cancer and there was no increase in operative morbidity and mortality rates. As age alone is not a contraindication to surgery for patients with gastric carcinoma, early detection of the lesion and surgical treatment are expected to increase the survival of elderly patients with this malignancy.
Intraoperative laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia
Authors: Liu C , Chin T , Jan S-E , Wei C 
Published: March 2007

Abstract
The contralateral internal ring of 96 children was examined laparoscopically during unilateral hernia repair to minimize the chance of development of contralateral hernia. Laparoscopy was performed through the hernia sac before ligation. Of 29 patients with positive laparoscopic findings, 28 had a patent processus vaginalis as confirmed by simultaneous contralateral exploration and there was one false positive. Patency of the contralateral processus vaginalis was found in 28 (29 per cent) of the 96 patients. Children under 2 years of age had a significantly higher incidence of patent contralateral processus vaginalis than older patients. The only complication of the procedure was wound infection in two patients. This is a simple, safe and accurate procedure to select children for contralateral surgical exploration.
Restoration of continuity following pancreaticoduodenectomy
Authors: Madiba T E , Thomson S R 
Published: March 2007

Abstract
Current controversies surrounding restoration of gastrointestinal continuity after pancreaticoduodenectomy are reviewed. The optimum method of reconstruction following this procedure remains debatable, particularly with regard to the pancreatic anastomosis. Pylorus-preserving pancreaticoduodenectomy is increasing in popularity. Pancreaticogastrostomy is associated with at least as low a morbidity rate as pancreaticojejunostomy and is a safe alternative.
Pelvic floor physiology in women with faecal incontinence and urinary symptoms
Authors: Thorpe A C , Roberts J P , Williams N S , Blandy J P , Badenoch D F 
Published: March 2007

Abstract
Anorectal manometry, balloon proctometrography, measurement of anorectal angles and videourodynamics were used to investigate 45 asymptomatic women and 13 with faecal incontinence and urinary symptoms, nine of whom also had stress urinary incontinence. The anorectal angle was measured and videourodynamics performed on 17 constipated women with urinary symptoms. Mean (s.e.m.) values obtained with anorectal manometry were lower in women with faecal incontinence and urinary symptoms than in controls (maximum resting pressure 42·5(8·1) versus 82·5(9·3) cmH2O, P = 0·001; maximum attained pressure 80·5(13·7) versus 216·2(11·2) cmH2O, P = 0·001; maximum squeeze increment 35·3(7·5) versus 141·6(100) cmH2O, P = 0·001), indicating a weakened puborectalis and external anal sphincter. Mean(s.e.m.) anorectal angles at rest, squeeze and strain were all significantly greater in the doubly incontinent women than in those with constipation (114(3·8) versus 93(5·9)°, P = 0·01; 103(2·5) versus 78(3·5)°, P &lt; 0·001; 120(2·9) versus 104(4·2)°, P = 0·01). Urinary incontinence was worse in the doubly incontinent than in the constipated women (eight of nine versus one of eight with grade 2a or higher, P = 0·002). These results suggest that doubly incontinent women have a significantly weakened pelvic floor and that this should be taken into account before any planned surgery for urinary incontinence.
Adjuvant intraoperative photodynamic therapy in experimental colorectal cancer
Authors: Abulafi A M , Dejode M , Allardice J T , Ansell J , Rogers J , Williams N S 
Published: March 2007

Abstract
A reliable animal model for quantitative assessment of local recurrence of colorectal cancer was developed using colo26 tumour in BALB/c mice. The effect of adjuvant intraoperative photodynamic therapy to potentially curative surgery on local recurrence was examined in four study and four control groups. Study groups received 15 mg kg Photofrin (a photosensitizing drug) 24 h before surgery. After ‘curative’ tumour excision, the tumour beds were illuminated with either 630 nm or 510 nm laser light each at 40 and 70 J/cm −2. Controls received surgery only, surgery and Photofrin only or surgery and either 630 nm or 510 nm light. The local recurrence rates at 70 days were 17–33 percent in the study groups compared with 83–100 per cent in the control groups (P &lt; 0·001; log rank test). Photodynamic therapy is capable of reducing local recurrence following potentially curative excision of tumour in this model.
Endoscopic and external bowel changes and histopathology in patients with Crohn's disease
Authors: Smedh K , Olaison G , Franzén L , Sjodahl R 
Published: March 2007

Abstract
The relationships between intraoperative endoscopic findings, exterior bowel wall changes and transmural histopathology were investigated in 23 patients with Crohn's disease (24 resections). Villous atrophy and leucocyte infiltration of the epithelium, lamina propria and submucosa were common in intestine without endoscopic lesions. Minor endoscopic ulcers were associated with leucocyte infiltration, ulcers and pyloric metaplasia, and large endoscopic ulcers and stricture with severe transmural inflammation, fibrosis and fissures. In ileal Crohn's disease (19 resections), correlation was close between endoscopic stage and histopathology (rs = 0·77, P &lt;0·0001), but an exterior lesion index showed worse correlations with endoscopy and histology (rs = 0·57 and rs = 0·59 respectively). The difference was attributable to patients with previous resection and/or fistula showing exterior lesions without concomitant histological or endoscopic abnormalities. Intraoperative surgical decisions should be guided by endoscopic observations rather than by assessment of exterior bowel wall changes.
Mesocaval interposition shunt with small-diameter polytetrafluoroethylene grafts in sclerotherapy failure
Authors: Paquet K-J , Lazar A , Koussouris P , Hotzel B , Gad H A , Kuhn R , Kalk J-F 
Published: March 2007

Abstract
Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh grade A disease and 26 grade B; all had a liver volume of 1000–2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.
Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: Long—term outcome
Authors: Dunlop P , Varty K , Hartshorne T , Bell P R F , Bolia A , London N J M 
Published: March 2007

Abstract
The aim of this prospective study was to examine the long-term outcome of infrainguinal vein graft stenosis managed by percutaneous transluminal angioplasty (PTA) as first-line treatment. Thirty-three infrainguinal vein graft stenoses detected by graft surveillance during a 44-month period were treated initially by PTA. The median (range) follow-up after angioplasty was 39 (18–56) months. Although 19 stenoses were successfully treated by a single PTA, 14 stenoses recurred at a median (range) interval of 8·5 (1–39) months. Restenosis occurred more frequently in the distal third of a graft (P = 0·002) compared with that in the proximal or mid-grafts, and restenosis was more common in in situ than reversed vein grafts (P = 0·03). It is concluded that infrainguinal vein graft stenoses were successfully treated by single PTA. There was, however, a high restenosis rate after angioplasty of stenosis in the distal third of a vein graft and, while approximately one third of such stenoses can be treated by a single PTA, the optimal management of recurrent stenosis requires further investigation.
Prospective study of intra-abdominal hypertension and renal function after laparotomy
Authors: Sugrue M , Buist M D , Hourihan F , Deane S , Bauman A , Hillman K 
Published: March 2007

Abstract
The value of postoperative monitoring of intra-abdominal pressure (IAP) in surgical patients has not been established. This study prospectively evaluated the occurrence of increased IAP and its association with renal impairment and outcome in surgical patients admitted to an intensive care unit. One hundred consecutive patients after laparotomy were studied, 88 of whom had complete IAP measurements. IAP was measured using an intravesical catheter and was considered increased when equal to 20 mmHg or above. Renal impairment was defined as a postoperative serum creatinine concentration of greater than 130 (μmol/1), or an increase in serum creatinine of greater than 100 μmol/1 within 72 h of surgery. The median (range) APACHE (Acute Physiology And Chronic Health Evaluation) II score of the patients was 13° (4–43). The incidence of raised IAP was 29 of 88 (33 per cent). Renal impairment was present in 29 of 88 (33 per cent), of whom 20 of 29 (69 per cent) had raised IAP (P &lt;0·01). The odds ratios (95 per cent confidence interval) for the development of renal impairment and death in patients with increased IAP were 12·4 (3·8–41·7) and 11·2 (2·8–47·9) respectively. There is a clinically significant association between increased IAP and renal impairment in patients admitted to an intensive care unit after laparotomy.
Three-dimensional reconstruction of the biliary tract using spiral computed tomography
Authors: Kwon A-H , Uetsuji S , Yamada O , Inoue T , Kamiyama Y , Boku T 
Published: March 2007

Abstract
Spiral computed tomography (SCT) is a recently introduced technique which enables scanning of one large volume with no interscan intervals. Three-dimensional reconstruction using this technique is emerging as an effective means of identifying complex anatomical relationships. Ninety-two patients with cholecystolithiasis including ten with choledocholithiasis were investigated. All underwent SCT after oral and intravenous infusion cholangiography (IVC-SCT) and 22 were also examined by endoscopic retrograde cholangiography (ERC). IVC-SCT showed significantly more anatomical detail than conventional intravenous infusion cholangiography (IVC). The junction between the cystic duct and the common bile duct could be identified before surgery in 19 of 22 patients undergoing ERC, in 18 of 22 receiving IVC-SCT and in five of 22 undergoing IVC. Significant differences were noted between IVC-SCT, ERC and conventional IVC. Three-dimensional surface reconstruction of the biliary tract is useful in the evaluation of anatomical relationships between the cystic duct and the common bile duct (clearly seen in 86 per cent of cases). Three-dimensional reconstruction using SCT scanning is useful for anatomical assessment before laparoscopic cholecystectomy.
Resection of hepatocellular carcinoma with diaphragmatic invasion
Authors: Lau W Y , Leung K L , Leung T W T , Liew C T , Chan M , Li A K C 
Published: March 2007

Abstract
Fourteen consecutive patients with hepatocellular carcinoma (HCC) and diaphragmatic invasion found during operation and confirmed histopathologically were studied. They were treated by resection of the liver tumour en bloc with part of the diaphragm. Eight of the 14 patients had a diaphragmatic hump on chest radiography. Pre-operative ultrasonography, computed tomography and hepatic angiography were unable to diagnose diaphragmatic invasion in these patients. A control group of 14 closely matched patients were selected from 98 undergoing curative resection for HCC during the period of the study. No evidence of a diaphragmatic hump was found in the control patients (P &lt; 0·001). There was no significant difference in survival, operative morbidity or mortality rates between the two groups. In patients with HCC situated in the dome of the liver, the presence of a diaphragmatic hump on chest radiography strongly suggests invasion of the diaphragm. There was no difference in outcome in patients with or without diaphragmatic invasion; the tumour should be resected if the patient is fit for operation.
Prospective trial comparing Lichtenstein with laparoscopic tension-free mesh repair of inguinal hernia
Authors: Wilson M S , Deans G T , Brough W A 
Published: March 2007

Abstract
A prospective study of 242 patients with inguinal hernia who underwent tension-free mesh repair by the laparoscopic transperitoneal (n = 121) or the open Lichtenstein (n = 121) technique was performed. There was no significant difference in operation time between the laparoscopic (median (range) 35 (20–90) min) and Lichtenstein (40 (20–90) min) procedures. Discharge within 24 h of operation was more common after laparoscopic surgery (89·3 per cent versus 48·7 per cent). Consequently, hospital stay was reduced with this approach (median (range) 1 (1–7) days versus 2 (1–10) days for patients who had a Lichtenstein repair). There was no significant difference in parenteral analgesia requirements or visual analogue pain scores between the two groups. Although use of oral analgesia in hospital was greater in patients who underwent Lichtenstein hernioplasty, this may reflect their longer stay. Rehabilitation to normal activity and return to work was shorter in patients receiving laparoscopic repair (median 7 and 10 days, respectively) than Lichtenstein repair (14 and 21 days) (P &lt; 0·001). Initial results suggest that laparoscopic procedures may be associated with more rapid rehabilitation compared with that of open tension-free mesh surgery. Most patients with inguinal hernia undergoing tension-free mesh repair by either technique would be suitable for day-case surgery.
Port site metastases after laparoscopic colorectal surgery for cure of malignancy
Authors: Wexner S D , Cohen S M 
Published: March 2007

Abstract
Laparoscopic surgery is excellent for treating benign disease of the colon and rectum, and for palliative operations for malignancy. Its application for cure of colorectal malignancy, however, must be approached with caution. Port site recurrence of tumour is a particular, and increasingly recognized, drawback. This review discusses the evidence to date to support prospective randomized trials of laparoscopic colectomy for cure of carcinoma.
Neoplastic lesions of the appendix
Authors: Deans G T , Spence R A J 
Published: March 2007

Abstract
Neoplasms occur in 0–5 percent of appendices. Ultrasonography or computed tomography is beneficial, but preoperative detection is rare. At operation, the diagnosis is considered in under half of cases. Mucocele, localized pseudomyxoma peritonei, benign tumours and most appendiceal carcinoids are cured by appendicectomy alone. Right hemicolectomy is indicated for: (1) invasive adenocarcinoma; (2) tumours close to the caecum; (3) lesions larger than 2 cm; (4) mucin production; (5) invasion of the lymphatics, serosa or mesoappendix; and (6) cellular pleomorphism with a high mitotic rate. Tumours of 1–2 cm, small mucinous carcinoids, adenocarcinoma confined to the mucosa, and tumours in children may be treated by appendicectomy alone at the surgeon's discretion. The 5-year survival rate associated with classical carcinoid is more than 90 percent. The prognosis of mucinous carcinoid is intermediate between that of classical carcinoid and well differentiated adenocarcinoma. The prognosis of adenocarcinoma is determined by Dukes' stage and is similar, stage for stage, to that of colorectal carcinoma.
Island advancement flaps in the management of anal fissures
Authors: Nyam D C N K , Wilson R G , Stewart K J , Farouk R , Bartolo D C C 
Published: March 2007

Abstract
The classic high-pressure fissure responds well to lateral internal sphincterotomy. The management of recurrent fissures and those that occur in patients with weak sphincters is open to debate. An island advancement flap technique used in 21 patients is described with the above criteria. Preoperative median resting anal pressure was 66 (range 43–90) cmH2O and median maximal squeeze pressure was 132 (range 76–193) cmH2O, values that were significantly lower than in controls and those with classic fissure. Endoanal ultrasonography in 15 of these patients showed defects in the anal sphincters. All flaps healed primarily with preservation of sensation. Perfect continence was maintained in all patients. Follow-up was for a median of 18 (range 2–28) months. There were no serious complications. All fissures healed with minimal postoperative discomfort. This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure might jeopardize continence.
Presentation of comparative audit data
Authors: Murray G D , Hayes C , Fowler S , Dunn D C 
Published: March 2007

Abstract
The Royal College of Surgeons of England organizes a voluntary comparative audit service for its general surgical fellows. To date, the information from the audit has been presented purely descriptively, which does not take account of statistical variability and the effects of differences in case mix between the participants. A new approach to the presentation of these data, based on statistical modelling of the effects of case mix, is presented. The approach is illustrated in an application based on data relating to 136203 admissions reported by 110 surgeons. The result of adjusting for case mix is a substantial change in the relative performance of the participating surgeons, which demonstrates the folly of attempting to compare surgical performance on the basis of a measure as crude as the unadjusted mortality rate. Further development of the statistical modelling is required, but this new statistical approach appears to enhance greatly the credibility of the audit data, by quantifying its strengths and limitations.
Oesophageal acid clearance in patients with severe reflux oesophagitis
Authors: Barham C P , Gotley D C , Mills A , Alderson D 
Published: March 2007

Abstract
Previous studies examining oesophageal acid clearance have employed a variety of techniques to induce or simulate acid reflux. Clearance abnormalities have been deduced from abnormal standard motility studies, barium radiology or from 24-h pH recordings. In this study a 24-h pH and oesophageal motility recording system was used to study naturally occurring acid reflux episodes in control subjects and in two groups of patients with severe acid reflux disease (erosive oesophagitis and oesophageal stricture). Acid clearance was compared between the subject groups. Patients with oesophageal stricture were found to have poor oesophageal peristaltic ability and particularly poor oesophageal acid clearance. Those with erosive oesophagitis had normal peristaltic swallowing but abnormal acid clearance. This study has characterized, for the first tune, the abnormalities in acid clearance during naturally occurring acid reflux episodes in patients with severe reflux disease. A more complete understanding of these clearance abnormalities could influence future medical and surgical strategies in the management of severe gastro-oesophageal reflux disease.