bluuebunny/crossref_metadata_2025_split huggingface dataset:
Venous thromboprophylaxis in oesophageal cancer surgery
Authors: Rakićc S , Peško P , Jagodić M , Dunjić M S , Maksimović Ž 
Published: March 2007

Abstract
In a retrospective study of 127 patients who underwent resection for oesophageal cancer without anticoagulant thromboprophylaxis, the incidence of clinically established postoperative deep vein thrombosis (DVT) was 1·6 per cent. In a prospective study the Sue-Ling DVT risk factor index was calculated for 53 consecutive patients with oesophageal cancer; the mean(s.d.) value was −4·4(3·5). For 29 patients who underwent resection the following policy of thromboprophylaxis was applied. Patients undergoing transthoracic oesophagectomy with risk score &gt; − 4 (four patients) and those undergoing transhiatal resection with risk score &gt; - 1 (four) received both anticoagulant and mechanical thromboprophylaxis; the remaining 21 patients received only mechanical thromboprophylaxis. No patient developed DVT after operation. There were no haemorrhagic complications in the group undergoing anticoagulant thromboprophylaxis. The selective approach, based on the Sue-Ling risk factor index and type of operation, spared 72 per cent of the patients operated on from undergoing anticoagulant thromboprophylaxis and produced favourable results in this small series.
Temporal relationship of acinar and microvascular changes in caerulein-induced pancreatitis
Authors: Kelly D M , McEntee G P , Delaney C , McGeeney K F , Fitzpatrick J M 
Published: March 2007

Abstract
A study in rats investigated the temporal relationship between acinar cell changes and alterations in the local microvasculature in oedematous pancreatitis produced by administration of caerulein, 5 μg kg−1 h−1. Samples were taken from experimental and control animals after 15 min, 30 min, 1 h and 2 h of caerulein infusion. Transmission electron microscopy showed ultrastructural acinar cell changes after 15 min whereas the earliest microvascular changes were seen after 30 min. Ultrastructural alterations in the acinar cells thus preceded local microvascular changes. Microvascular distortion appears to be a consequence and not a cause of pancreatitis in the caerulein model.
Resection for adenocarcinoma of the body and tail of the pancreas
Authors: Johnson C D , Schwall G , Flechtenmacher J , Trede M 
Published: March 2007

Abstract
Adenocarcinoma of the pancreatic body and tail often presents late and is widely regarded as incurable by surgical resection; long-term survivors are rare. Thirteen patients underwent left resection (n = 7) or total pancreatectomy (n = 6) in a consecutive series of 105 patients with carcinoma of the body or tail of the pancreas. Comparison was made with 17 patients with locally advanced or metastatic disease. Preoperative computed tomography predicted irresectable disease when a large perivascular lymph node mass was demonstrated. Preoperative angiography predicted irresectable disease when there was encasement or obliteration of the coeliac axis or its major branches, or of the superior mesenteric artery or vein. Splenic vessel involvement was sometimes compatible with resection. After resection, median survival was 13 (range 3–50) months, with a minimum follow-up of 2 years. Five patients survived more than 2 years, and three are still alive 30, 43 and 50 months after resection. Resection of carcinoma of the body or tail of the pancreas was possible in 12 per cent of patients and long-term survival was observed in some of these.
Laparoscopic cholecystectomy in the Netherlands
Authors: Go P M N Y H , Schol F , Gouma D J 
Published: March 2007

Abstract
Laparoscopic cholecystectomy was introduced into the Netherlands in the Spring of 1990. The aim of this study was to evaluate the results of the procedure in Dutch hospitals over the first 2 years to obtain some insight into its safety and efficacy in general surgical practice. A written questionnaire was sent to all 138 Dutch surgical institutions enquiring about conversion rate, complications (with emphasis on mortality rate and common bile duct injuries), operating time and hospital stay. The surgeons' opinions were also sought on possible contraindications such as previous operation, bile duct stones and cholecystitis, as were their estimations of the percentage of patients in their practice eligible for laparoscopic cholecystectomy. Data were obtained for 6076 laparoscopic cholecystectomies; the response rate was 100 per cent. Conversion to open cholecystectomy was necessary in 413 patients (6·8 per cent), mostly because of adhesions, cholecystitis, haemorrhage and unclear anatomy. Postoperative complications were reported in 260 patients (4·3 per cent). There were seven deaths (0·12 per cent) and 52 (0·86 per cent) bile duct injuries, of which 20 were recognized during laparoscopy. The mean operating time for the ten most recent patients in each institute was 70 (range 30–180) min and the mean hospital stay 4·5 (range 2–8) days. Previous lower abdominal operations were not considered to be a contraindication by 96 per cent of surgeons, whereas, previous upper abdominal procedures were regarded as a contraindication by 66 per cent. After successful clearance of the bile duct at endoscopic retrograde cholangiopancreatography, only 12 per cent would perform an open procedure. Moderate cholecystitis was not considered a contraindication to laparoscopic cholecystectomy by 71 per cent of surgeons, but severe cholecystitis was a reason for open cholecystectomy for 83 per cent. In most surgical practices 70–80 per cent of patients were considered to be eligible for the laparoscopic procedure. In conclusion, laparoscopic cholecystectomy has gained rapid acceptance in the Netherlands. Although the number of bile duct injuries is high, the findings of this general survey are similar to those from highly specialized centres and match the overall results of conventional cholecystectomy.
Palliation of biliary obstruction in patients with advanced breast cancer using endoscopic stents
Authors: Mitchell P L R , Harvey V J , Lane M R , Evans B D , Thompson P I , Hamilton I 
Published: March 2007

Abstract
Endoscopic insertion of a biliary endoprosthesis was successful in eight patients with extrahepatic biliary obstruction caused by breast cancer metastases. The serum bilirubin level was significanty reduced in seven patients and in four this was accompanied by marked symptomatic improvement. Endoprostheses required replacement after a median of 8 (range 3–127) weeks. Two patients responding to systemic anticancer therapy survived 27 and 43 months. Endoscopically placed stents offer effective palliation of extrahepatic biliary obstruction caused by metastatic breast cancer and long-term survival may be possible.
Early discharge from hospital after open appendicectomy
Authors: Ramesh S , Galland R B 
Published: March 2007

Abstract
A prospective study of 200 consecutive open emergency appendicectomies was carried out. All patients were informed before operation that they would be discharged the following day if possible. The operation was performed through a standard muscle-splitting incision. At the end of the operation the wound was infiltrated with bupivacaine and a diclofenac suppository was given. There were 29 normal, 129 acutely inflamed, six gangrenous and 36 perforated appendices. In all, 147 patients (73·5 per cent) were discharged home within 24 h and reviewed 2 weeks later. Twelve patients had seen their general practitioner, mainly for wound problems (eight) or pain (two). Two others required readmission. Thirty-four patients (23·1 per cent) required no postoperative analgesia; 104 (70·7 per cent) required paracetamol or co-proxamol for ≦ 3 days and nine (6·1 per cent)for &gt;3 days. No patient had a problem directly related to early discharge from hospital. Fifty-three patients (26·5 per cent) were not discharged home early due to peritonitis (36), social reasons (seven), nausea (seven), associated caecal volvulus (one) and pregnancy (two). Early discharge from hospital within 24 h after emergency appendicectomy is safe and has good patient acceptability.
Effect of putative phospholipase A2 inhibitors on acetic acidi-induced acute colitis in the rat
Authors: Fabia R , Ar'Rajab A , Willén R , Andersson R , Bengmark S 
Published: March 2007

Abstract
Phospholipase activation may play an important role in ulcerative colitis. This hypothesis was tested by evaluating the effect of two non-selective phospholipase (PL) A2 inhibitors, quinacrine and p-bromophenacyl-bromide (pBPB), on acetic acid-induced colitis in the rat. The calcium antagonist verapamil, which may also act as a PLA2 inhibitor, was also tested. Acute colitis was induced in an isolated colonic segment by instillation of 4 per cent acetic acid for 15 s; this induces a uniform colitis after 4 days. The severity of colitis was evaluated histologically, by measuring myeloperoxidase (MPO) activity and by determining plasma exudation into the lumen of the colon (permeability) with 125I-labelled albumin given intravenously. All three putative PLA2 inhibitors tested were found to prevent the development of colitis. Intravenous administration of quinacrine 10 mg kg−1 at 30 min before instillation of acetic acid resulted in a normal mucosal appearance, normal MPO activity and a significantly reduced increase in plasma exudation into the colon. A similar effect was achieved using verapamil. Intracolonic administration of either quinacrine or pBPB also prevented acetic acid-induced colitis. However, three doses, starting immediately after acetic acid administration and repeated on the first and second days, were needed to achieve this, whereas one dose produced only a partial effect. PLA2 may play an important role in acetic acid-induced colitis and inhibition of its activity, may offer an alternative mode of treatment in ulcerative colitis.
Smoking impairs endothelium-dependent relaxation of saphenous vein
Authors: Higman D J , Greenhalgh R M , Powell J T 
Published: March 2007

Abstract
Samples of proximal saphenous vein were obtained from heavy smokers and non-smokers: 28 were obtained at varicose vein surgery and eight at infrainguinal bypass surgery. The veins were prepared for histological examination and for mounting in an organ bath to measure changes in isometric tension. Vein rings from both smokers and non-smokers responded equally to sodium nitroprusside, a reagent that acts directly on smooth muscle cells, undergoing 90–100 per cent relaxation. The mean(s.e.m.) maximum relaxation in response to bradykinin of rings obtained at varicose vein surgery was 50·0(5·3) per cent in non-smokers compared with only 31·6(2·2) per cent in smokers (P = 0·03). Similarly, in specimens obtained at bypass surgery the mean(s.e.m.) maximum relaxation in smokers was only 25·1(6·3) per cent compared with 48·4(4·1) per cent in smokers (P = 0·04). Relaxation in response to the bradykinin stimulus was abolished in the presence of L-nitroarginine methyl ester, a specific inhibitor of the synthesis of endothelium-derived relaxing factor (EDRF). Preincubation of the vein rings with L-arginine, the precursor of EDRF, did not increase the vasorelaxation in smokers. The mean(s.e.m.) maximum relaxation in response to the calcium ionophore A23187 was 53·5(3·8) per cent in non-smokers compared with only 27·0(4·9) per cent in smokers (P = 0·01). The results indicate that heavy smokers have impaired release of EDRF in response to both bradykinin and calcium ionophore. This impairment may increase vasomotor tone, platelet aggregation and smooth muscle proliferation, thereby resulting in an increased risk of graft occlusion.
Influence of type III collagen genotype on aortic diameter and disease
Authors: Powell J T , Adamson J , Macsweeney S T R , Greenhalgh R M , Humphries S E , Henney A M 
Published: March 2007

Abstract
Type III collagen contributes to the tensile strength of the aortic wall, and mutations in the type III collagen gene have been suggested as the basis for the familial tendency to abdominal aortic aneurysm (AAA). Variation in this gene was investigated in 153 patients with AAA, 87 with aortoiliac stenosis and 98 age-matched controls. The rare mutation at amino acid 619 of Gly → Arg, previously associated with AAA in a single family, was not found in any of the patients with aneurysm. For the Ala → Thr variation at amino acid 531, the frequency of the threonine allele was 0·25 in patients with AAA and stenosis, compared with 0·35 in controls. The frequency of the rare allele in the region 3' to the gene demonstrated by Ava II digestion (0·27 in the general population) was found to be 0·29 in the AAA group and 0·19 in the stenosis group (P = 0·023). In the AAA group the presence of the Ava II rare allele was associated with a significant increase in aneurysm diameter (P = 0·044). Non-invasive assessment of aortic distensibility was available in 25 patients: those carrying the Ava II rare allele had less distensible aortas than those not carrying this allele (median pressure-strain elastic modulus 42·0 and 23·9 N/cm2 respectively, P = 0·008). Variation in the type III collagen gene may influence the mechanical properties of the ageing aorta and hence its susceptibility to disease and dilatation. In contrast, there is no evidence for a single common founder mutation in type III collagen predisposing to AAA.
Early detection of occult colorectal hepatic metastases using duplex colour Doppler sonography
Authors: Leen E , Goldberg J A , Robertson J , Angerson W J , Sutherland G R , Cooke T G , McArdle C S 
Published: March 2007

Abstract
Previous studies have shown that overt intrahepatic tumours are associated with subtle changes in liver perfusion that can be measured directly using duplex colour Doppler sonography (DCDS). This study assessed the predictive value of DCDS in the early detection of occult colorectal hepatic metastases. Hepatic arterial and portal venous blood flow was measured in 50 control subjects and 135 patients with colorectal cancer, 67 with overt liver metastases and 68 with an apparently disease-free liver on the basis of computed tomography and laparotomys findings. The Doppler perfusion index (DPI), defined as the ratio of hepatic arterial to total liver blood flow, was calculated. Clear separation of the DPI values of controls and those of patients with overt metastases was observed (P &lt; 0·0001). Thirty-eight of the 68 patients with a disease-free liver also had an abnormally high DPI value. After 1 year of follow-up, 21 patients with an abnormally high DPI at the time of apparently curative primary resection had developed liver metastases and a further four had died without post-mortem examination. The 30 patients with normal DPI remain disease-free. The data suggest that DPI is of value in the early detection of occult liver metastases.
Ventilatory and blood gas changes during laparoscopic and open cholecystectomy
Authors: McMahon A J , Baxter J N , Kenny G , O'Dwyer P J 
Published: March 2007

Abstract
As part of a randomized trial, ventilatory and arterial blood gas changes were assessed during open (n = 30) and laparoscopic (n = 30) cholecystectomy. Measurements were made during anaesthesia before the start of surgery and at the time of removal of the gallbladder. Despite an increase in minute ventilation from a mean(s.d.) of 5·7(1·4) to 6·1(1·2) litres, mean(s.d.) arterial carbon dioxide tension (PaCO2) rose from 5·3(0·9) to 6·0(0·9) kPa during laparoscopic cholecystectomy. End-tidal carbon dioxide tension (PE'CO2) had poor precision in predicting PaCO2 (95 per cent interval of agreement −0·61 to 1·93 kPa). Mean(s.d.) peak airway pressure increased from 17(4) to 23(4) cmH2O. The mean PaCO2–PE'CO2 value did not change significantly, although there was significant within-patient variation. Arterial oxygen levels did not change significantly. By comparison, no clinically significant changes in ventilation or blood gas values occurred during open cholecystectomy. In conclusion, laparoscopic cholecystectomy requires a substantial but variable increase in minute ventilation to compensate for carbon dioxide absorption from the peritoneum.
Comparison of metabolic responses to laparoscopic and minilaparotomy cholecystectomy
Authors: McMahon A J , O'Dwyer P J , Cruikshank A M , McMillan D C , O'Reilly D St J , Lowe G D O , Rumley A , Logan R W , Baxter J N 
Published: March 2007

Abstract
This randomized study compared the metabolic responses to laparoscopic cholecystectomy (n = 10) and minilaparotomy cholecystectomy with a 5–7-cm incision (n = 10). Venous blood samples were taken before operation and at 3, 6, 9, 12, 18, 24, 48, 72 and 168 h after incision and analysed for levels of C-reactive protein, interleukin 6, cortisol, albumin, transferrin, iron, fibrinogen, fibrin degradation products and polymorphonuclear elastase, and for neutrophil and lymphocyte counts. Urine samples (24 h) were analysed for urea, creatinine, 3-methylhistidine and catecholamines. The magnitude of the metabolic changes from baseline levels was quantified by calculating areas under each individual curve. A significant metabolic response with a similar time course and magnitude of changes occurred after laparoscopic and minilaparotomy cholecystectomy but with wide variation in magnitude between individuals.
Long-term results of a single protocol for thrombolysis in acute lower-limb ischaemia
Authors: Giddings A E B , Quraishy M S , Walker W J 
Published: March 2007

Abstract
In a prospective study, 78 of 157 patients with acute lower-limb ischaemia were considered suitable for thrombolysis. The immediate and 4-year results of 52 patients managed by a single protocol are reported. Of 34 patients alive at 4 years, 23 had limb salvage. Initial treatment produced effective lysis in 38 patients (73 per cent) with significant benefit in 35 (67 per cent); that benefit was sustained for a minimum of 4 years in 30 patients (58 per cent). Seven of the 18 deaths by 4 years occurred within 30 days. Amputation was carried out in six patients within 30 days and in five during the next 4 years. Delayed amputation followed persistent distal occlusion or progression of distal disease. No death or amputation was caused by complication of treatment. In selected patients the risks of thrombolysis can be reduced to an acceptable level by personal supervision and a strict protocol. In survivors, limb salvage is generally sustained for at least 4 years.
Low-dose aspirin fails to inhibit increased platelet reactivity in patients with peripheral vascular disease
Authors: Walters T K , Mitchell D C , Wood R F M 
Published: March 2007

Abstract
A study was performed to evaluate the effect of low-dose aspirin (75 mg/day) on platelet reactivity in patients with peripheral vascular disease. Platelet function was measured in 31 patients with advanced peripheral vascular disease requiring surgery. Shear-induced haemostasis and collagen-induced thrombus formation were used as indicators of platelet reactivity. They were measured in non-anticoagulated fresh whole blood samples ex vivo using a haemostatometer. Results were compared with those from 30 age- and sex-matched controls. Shear-induced haemostasis and collagen-induced thrombus formation were also measured in 18 of the 31 patients before the start of aspirin administration (before operation) and I week after surgery. Patients with advanced peripheral vascular disease were found to have increased platelet reactivity with a mean(s.e.m.) shear-induced haemostasis index of 1977(180) mmHgs compared with a control value of 3161(234) mmHg s (P &lt; 0.001) and a mean(s.e.m.) collagen-induced thrombus formation index of 3980(460) mmHg s compared with a control value of 5350(420) mmHg s (P = 0.02). Perioperative low-dose aspirin failed to inhibit platelet function in patients with peripheral vascular disease.
On-scene medical decision making and overtriage
Authors: Coats T J , Wilson A W , Cross F W 
Published: March 2007

Abstract
This study examined whether a hospital-based helicopter trauma service led to ‘overtriage’ of patients back to the multispecialty base hospital. All accident-site triage decisions made during 1991 were studied. Seven of the 574 decisions (1·2 per cent) led to inappropriate movement of the patient to a specialist centre. Twenty-six decisions (4·5 per cent) were based on mechanism of injury alone and the possibility of overtriage by this method is discussed. A trained doctor can select the correct destination for a patient with trauma without inappropriately using the base hospital in preference to local centres.
Acute haemodilution in surgery for burns: A preliminary report
Authors: Henley M , Tomlinson P , Bailie F B , Obeid E M H 
Published: March 2007

Abstract
Blood loss is a major problem in the management of patients with burns treated by early excision and grafting. Acute normovolaemic haemodilution has been successfully used in cardiac surgery for many years but has not been reported previously in surgery for burns. The technique has been used in six patients with burns undergoing early excision and grafting, with no obvious morbidity and an apparent reduction in homologous blood requirements.
Axillary nodal metastases from an occult primary consistent with breast carcinoma
Authors: van Ooijen B , Bontenbal M , Henzen-Logmans S C , Koper P C M 
Published: March 2007

Abstract
The records of 15 women presenting with axillary nodal metastases from an occult primary consistent with breast carcinoma were reviewed. Nine patients underwent complete axillary clearance and in six the clinical mass only was excised. Radiotherapy to the axilla was given to eight patients. One woman underwent mastectomy at the time of axillary surgery but no tumour was found in the excised breast; in the remaining 14 patients the breast was left untreated. One premenopausal woman received adjuvant systemic chemotherapy and one postmenopausal patient was given tamoxifen. Three patients died from recurrent disease at 16, 50 and 56 months after treatment of the axillary mass; one is alive at 42 months with systemic recurrence. In two of these patients the tumour in the breast became apparent before other metastases. Eleven patients survived for a median of 92 (range 18–144) months without evidence of disease. The prognosis of this patient group is better than that generally reported for stage II breast carcinoma.
Non-operative treatment of small bowel obstruction following appendicectomy or operation on the ovary or tube
Authors: Meagher A P , Moller C , Hoffmann D C 
Published: March 2007

Abstract
This study examined the hypothesis that small bowel obstruction in patients whose only previous laparotomy was for appendicectomy or operation on the ovary or tube is unlikely to resolve with non-operative management. Results of 330 admissions for small bowel obstruction were examined. In 40 cases the only previous laparotomy was at appendicectomy or tubo-ovarian operation; in 38 (95 per cent) of these division of adhesions was undertaken compared with 154 (53 per cent) of the remaining 290 (P &lt; 0·00001). In the former group band adhesions were commoner (86 versus 45 per cent, P &lt; 0·00001), bowel resection was required more frequently (22 versus 10 per cent, P = 0.02) and it was considered safe to give a trial of non–operative management less often (60 versus 85 per cent, P = 0·0004). A trial of conservative management may be unsafe or not worth while in patients with obstruction following earlier appendicectomy or operation on the ovary or tube.