bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma gastrin and cholecystokinin responses after pylorus-preserving pancreatoduodenectomy and defunctioned Roux loop pancreaticojejunostomy
Authors: Kingsnorth A N , Formela L J , Chen D , Rehfeld J F 
Published: March 2007

Abstract
Several methods can be used to re-establish gastrointestinal continuity after the standard Whipple's Billroth II procedure or Longmire pylorus-preserving pancreatoduodenectomy (PPPD). Standard pancreatoduodenectomy abolishes the postprandial gastrin response whereas the response after Longmire PPPD is similar to that in controls. A novel reconstruction after PPPD has been designed to separate the biliary and pancreatic secretions by restoring continuity in the Billroth I manner, retaining the gastric antrum and with the pancreatic remnant anastomosed to a separate defunctioned Roux loop. Gastrin and cholecystokinin (CCK) responses were measured in the fasting state and after a standard liquid meal of 250 ml containing 15 per cent protein, 30 per cent fat and 55 per cent carbohydrate with an energy value of 525 kJ. Basal gastrin and CCK concentrations were similar in five healthy unoperated controls, and after standard pancreatoduodenectomy (five patients) and isolated Roux loop PPPD (six patients). In controls and after the new PPPD operation, but not after standard pancreatoduodenectomy, mean(s.e.m.) postprandial plasma gastrin values rose from 8·66(0·33) to 13·00(0·33) pmol 1−1 at 10 min (controls) and from 7·66(1·56) to 15·00(1·36) pmol 1−1 at 10 min (defunctioned Roux loop PPPD); the concentration remained raised for 20 min then fell transiently; a second peak was maintained for 40 min (controls) to 60 min (modified PPPD). In controls, mean(s.e.m.) postprandial plasma CCK concentrations rose from 0·43(0·12) basal to 10·50(1·03) pmol 1−1 and returned to basal after 60 min. After standard pancreatoduodenectomy postprandial CCK concentrations rose at a similar rate and remained raised for 80 min. After isolated Roux loop PPPD plasma CCK concentrations remained low (mean(s.e.m.) 0·38(0·29) pmol 1−1)after the test meal.
Significance of aneuploidy
Authors: Rew D A 
Published: March 2007

Abstract
Aneuploidy is a state of abnormal and highly variable DNA and chromosome content found in both hereditary disorders and human malignancy. For two decades flow cytometry has allowed a wide-ranging survey of aneuploidy in clinicopathological series. Although up to 75 per cent of all tumours analysed display aneuploidy, its value as a clinical marker of biological aggressiveness is still uncertain. New technologies promise to reveal more precisely the genetic and subchromosomal changes that constitute aneuploidy and contribute to the malignant phenotype in human tumours.
Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: A prospective study of 100 patients
Authors: Gaunt M E , Martin P J , Smith J L , Rimmer T , Cherryman G , Ratliff D A , Bell P R F , Naylor A R 
Published: March 2007

Abstract
A study was performed to investigate the clinical significance of microembolization detected by transcranial Doppler ultrasonography (TCD) by determining the quantity and character of emboli and correlating these with neurological and psychometric outcome, fundoscopy, automated visual field testing and computed tomographic brain scans in 100 consecutive patients undergoing carotid endarterectomy. Embolization was detected in 92 per cent of successfully monitored operations. Most emboli were characteristic of air and not associated with adverse clinical outcome. However, more than ten particulate emboli during initial carotid dissection correlated with a significant deterioration in postoperative cognitive function. A relationship between persistent particulate embolization in the immediate postoperative period, and both incipient carotid artery thrombosis and the development of major neurological deficits was observed. Immediate intervention, based on TCD evidence of embolization, has the potential to avert neurological deficits resulting from particulate embolization.
Long-term results of highly selective vagotomy: A prospective study with implications for future laparoscopic surgery
Authors: Wilkinson J M , Hosie K B , Johnson A G 
Published: March 2007

Abstract
Between 1979 and 1984, 141 patients (110 men, 31 women) underwent highly selective vagotomy (HSV) by a standard open technique for duodenal ulcer. All patients had received preoperative treatment with full-dose H2-receptor antagonists. Some 107 of these patients underwent HSV for persistent relapse on withdrawal of H2-receptor antagonists (relapsing responders) and 30 because of non-response to such drugs. After 4 years of follow-up, non-responders were found to be more likely to have symptoms after operation (P &lt;0·001), but did not have a higher rate of recurrent ulceration. At a median of 11 (range 8–14) years after operation 126 patients were still alive; 115 (91 per cent) of these were followed up. Ten patients (9 per cent) were found to have had endoscopically proven recurrence and eight (7 per cent) still had symptoms without evidence of recurrence. The endoscopic recurrence rate and symptom rate at 11 years were no longer significantly different between relapsing responders and non-responders. The preoperative response to H2-receptor antagonist therapy does not help in predicting the likelihood of ulcer recurrence or long-term symptoms after HSV. Postoperative symptoms do not necessarily predict long-term ulcer recurrence. The long-term endoscopic recurrence rate after HSV is low and, if equally good results can be obtained laparoscopically, this will be an important and cost-effective option in the management of duodenal ulcer.
Genetic susceptibility to colorectal cancer in patients under 45 years of age
Authors: Hall N R , Finan P J , Ward B , Turner G , Bishop D T 
Published: March 2007

Abstract
A study was conducted to assess the genetic contribution to the development of colorectal cancer in young probands. Of 83 patients aged 45 years or under diagnosed with colorectal cancer in one health region over a 2-year period, 65 or their surviving next of kin were available for interview, from whom were obtained 60 detailed and five limited family histories. Five families fulfilled the Amsterdam criteria and a further eight satisfied less strict criteria for hereditary non-polyposis colorectal cancer, a total of 20 per cent of the cohort. Eleven of these families came from the subgroup of 13 probands who had one or more first-degree relatives with colorectal cancer. Overall the relative risk of colorectal cancer in close relatives was 5·2 (P&lt;0·0001). This risk was highest for female relatives at 9·7 (P&lt;0·0001) and relatives of female probands at 6·7 (P&lt;0·0001). This study highlights the importance of taking a family history in this group of patients. Screening by colonoscopy for all close relatives of young patients with colorectal cancer is recommended.
Plasma elastase in venous disease
Authors: Shields D A , Andaz S K , Sarin S , Scurr J H , Smith P D Coleridge 
Published: March 2007

Abstract
The plasma elastase level was measured as a marker of neutrophil degranulation in three groups, each of 15 patients, with uncomplicated varicose veins, lipodermatosclerosis (LDS) and venous ulceration. The values obtained were compared with those in age- and sex-matched control subjects. Significantly higher levels of elastase were found in all patient groups compared with controls: median 25·6 ng/ml for patients with uncomplicated varicose veins, 22·1 ng/ml for those with LDS, 26·0 ng/ml for those with venous ulceration. There was no difference in neutrophil count between the patient and control groups. These results provide evidence of increased neutrophil degranulation in patients with venous disease. The finding of raised elastase levels in all three patient groups shows that this was not due solely to the inflammatory process characterizing LDS and venous ulceration.
Asymptomatic popliteal aneurysm: Elective operation versus conservative follow-up
Authors: Dawson I , Sie R , van Baalen J M , Van Bockel J H 
Published: March 2007

Abstract
In a retrospective study 42 patients with asymptomatic popliteal artery aneurysm were followed without surgery to identify variables predicting the risk of complications. The mean aneurysm size was 3·1 cm. Abnormal ankle pulses were found in 18 of the 42 limbs in which an asymptomatic popliteal aneurysm was present. Follow-up was complete (mean 6·2 years). Twenty-five patients developed complications at a mean observation time of 18 months. As a result three lost the limb, eight had claudication, two needed a fasciotomy and one had a peroneal nerve palsy. The cumulative risk of developing complications during follow-up was 24 per cent at 1 year, rising to 68 per cent at 5 years. Patients with absent ankle pulses and those already operated on for abdominal aortic aneurysm proved to be especially at risk. Patient survival appeared to be normal for the period of observation. It is concluded that asymptomatic aneurysm of the popliteal artery is a potentially dangerous lesion that may justify elective surgery; it is possible to select those at highest risk.
Breast cancer incidence, penetrance and survival in probable carriers of BRCA1 gene mutation in families linked to BRCA1 on chromosome 17q12–21
Authors: Porter D E , Cohen B B , Wallace M R , Smyth E , Chetty U , Dixon J M , Steel C M , Carter D C 
Published: March 2007

Abstract
Eight breast cancer pedigrees with a high probability of containing individuals with the BRCA1 gene mutation (odds 79·2–99·9 per cent) were identified through genetic linkage analysis using probes located within q12–22 on the long arm of chromosome 17. Some 102 female relatives were successfully typed with one or both of adjacent markers D17S588 and D17S579, and 41 were probable non-BRCA1 mutation carriers. Of the remaining 61 women classified as probable BRCA1 carriers, breast cancer was diagnosed in 35. As expected from epidemiological segregation analysis studies, 13 of these had bilateral disease. Approximately two-thirds of women unaffected by malignancy and alive at the time of observation were non-BRCA1 carriers. Lifetime disease penetrance of the BRCA1 gene was 88 per cent and this plateau was reached earlier (by age 65 years) than that estimated in segregation analysis. The survival curve of patients with breast cancer was less steep in BRCA1 gene carriers than that in the general population; 5-, 10- and 20-year survival rates unadjusted for non-cancer deaths were 83, 63 and 41 per cent respectively. The 5-year survival rate was significantly higher in BRCA1 carriers than that in an age-matched Scottish population (P&lt;0·05).
Herniography for occult hernia and groin pain
Authors: Eames N W A , Deans G T , Lawson J T , Irwin S T 
Published: March 2007

Abstract
In a prospective 3-year study herniography was used to assess patients with unexplained groin pain in whom clinical signs were inconclusive. Fifty-two patients were studied. No serious complications were observed. Twenty-two hernias were identified in 18 patients. The positive herniographic findings were confirmed at operation in 12 patients. Of 34 patients with a negative herniogram, none has developed a hernia. Pain settled spontaneously in 29 patients and five were referred to a pain clinic for further management.
Penetrating cardiac injuries: Clinical classification and management strategy
Authors: Saadia R , Levy R D , Degiannis E , Velmahos G C 
Published: March 2007

Abstract
The management of penetrating cardiac injury is controversial. To facilitate decision making, a simple clinical classification of patients with such an injury is proposed. Five categories are considered: (1) lifeless, (2) critically unstable, (3) cardiac tamponade, (4) thoracoabdominal injury and (5) benign presentation. Investigation, if indicated, and the timing and setting of surgical intervention are discussed for each category.
Molecular and cellular basis of cancer invasion and metastasis: Implications for treatment
Authors: Jiang W G , Puntis M C A , Hallett M B 
Published: March 2007

Abstract
In the past decade significant advances in establishing the underlying biological mechanisms of tumour invasion and metastasis have been made. Some of the triggering factors and genes relevant to metastatic spread have been identified. Advances have also been made in understanding the signal transduction pathways involved in invasion and metastasis. This increased comprehension of the malignant metastatic process has enabled new antimetastatic strategies to be devised. This review summarizes progress in these areas and discusses the implications for the treatment of metastasis.
Duplex ultrasonography for assessment of venous valvular function of the lower limb
Authors: Sarin S , Sommerville K , Farrah J , Scurr J H , Smith P D Coleridge 
Published: March 2007

Abstract
Both legs of 29 patients with venous disease and those of 15 controls without venous disease were assessed by duplex ultrasonography. The duration of reverse flow after release of manual calf compression was measured in the common femoral, long saphenous, popliteal and short saphenous veins. Before undertaking the study, the reproducibility of the technique was evaluated in six subjects by repeating the examination over 3 consecutive days; the coefficient of variation of the test was 7·3 per cent. The 95 per cent confidence interval (c.i.) of the median (0·16 s) of all measurements in the normal limbs was 0·12-0·18 s. The 95 per cent c.i. for the 95th percentile of all measurements in normal limbs was 0·32-0·52 s. In limbs with clinical evidence of venous disease at least one of the sites examined was found to have reverse flow lasting longer than 0·5 s. These data suggest that the measurement of reverse flow after release of manual calf compression is a reproducible technique. While the method records some reverse flow in normal veins, its duration is unlikely to exceed 0·5 s; significant reflux is therefore defined as reverse flow exceeding 0·5 s.
Rehabilitation outcome 5 years after 100 lower-limb amputations
Authors: McWhinnie D L , Gordon A C , Collin J , Gray D W R , Morrison J D 
Published: March 2007

Abstract
Received wisdom commends a policy of maximizing the ratio of below-knee to above-knee amputations in patients with end-stage arterial disease. After adoption of this policy, the long-term outcome of 100 consecutive lowerlimb amputations in 96 patients was monitored by annual review for 5 years. The ratio of primary below-knee to above-knee amputations was 2:1, with 9 per cent of belowknee amputations undergoing revision to a higher level. At 2 years after amputation only 26 per cent of patients were successfully walking out of doors, while 40 per cent had died. By 5 years 67 per cent were dead and only 9 per cent continued to walk out of doors with an artificial limb, although a further 8 per cent continued to use the limb within the confines of their own homes. In a previous audit of 193 amputations performed during the 3·5 years to December 1984, stump healing was a problem in 45 per cent of primary below-knee amputations, compared with 25 per cent in the present study. Although the below- to above-knee ratio in 1984 was only 1:2, the overall rehabilitation rate, as determined by the proportion of patients able to walk at 2 years, was 34 per cent. It is concluded that increasing the proportion of below-knee amputations from one-third to two-thirds of lower-limb amputations for occlusive arterial disease does not improve effective rehabilitation rates. Received wisdom on the desirability of a high below- to above-knee ratio may be wrong.
Multifocal nature of adenolymphoma of the parotid
Authors: Lam K H , Ho H C , Ho C M , Wei W I 
Published: March 2007

Abstract
The multifocal nature of adenolymphoma of the parotid salivary gland was studied in 24 patients who underwent parotidectomy. Twenty-six resected specimens were examined by a step-serial whole-organ sectioning technique; multiple adenolymphoma was found in 13. The maximum number of synchronous tumours in any gland was four. Salivary epithelial elements were found embedded within lymph nodes in nine resected specimens. Synchronous or metachronous bilateral tumours were found in eight patients. The multifocal nature of adenolymphoma of the parotid gland is demonstrated.
Interstitial laser photocoagulation as a treatment for breast cancer
Authors: Harries S A , Amin Z , Smith M E F , Lees W R , Cooke J , Cook M G , Scurr J H , Kissin M W , Bown S G 
Published: March 2007

Abstract
This preliminary report describes the use of interstitial laser photocoagulation to manage small breast cancers. Forty-four patients were treated with a diode laser of 805 nm under local anaesthesia in the interval between diagnosis and surgery. Ultrasonography was used in 42 patients and computed tomography (CT) in two to place the fibre in the tumour and monitor laser effects. Laser-induced necrosis within the resected tumour varied from 0 to 25 mm in diameter. The presence of charring in the tumour around the fibre tip after treatment was associated with significantly larger diameters of necrosis than when charring did not occur (median 13 versus 6 mm, P = 0·002). Precharring the fibre resulted in a more predictable diameter of necrosis (median 14 mm). Ultrasonography was inaccurate in assessing laser damage; dynamic CT and magnetic resonance imaging, may be of more use. Interstitial laser photocoagulation is simple and safe, and can produce necrosis of a reasonably predictable extent.
Two-team synchronous oesophagectomy
Authors: Gurtner G C , Robertson C S , Chung S C S , Li A K C 
Published: March 2007

Abstract
Between 1984 and 1992, 131 patients underwent two-team synchronous oesophagectomy for carcinoma. Some 95 per cent of tumours were successfully resected by this technique. In 5 per cent of patients the tumour was found to be irresectable at operation and gastric bypass was performed. The overall operative mortality rate was 8 per cent and the pulmonary complication rate 10 per cent. The actuarial survival rate was 55 per cent at 1 year, 22 per cent at 3 years and 16 per cent at 5 years. When compared with the traditional two-stage Lewis approach, two-team synchronous oesophagectomy was significantly faster (mean 222 versus 282 min), but was not significantly different with respect to blood loss, transfusion requirement, pulmonary complications or operative mortality rate. Patients undergoing two-team oesophagectomy had a significantly shorter hospital stay than those receiving the two-stage procedure (mean 16 versus 24 days).
Patient satisfaction and postoperative demands on hospital and community services after day surgery
Authors: Ghosh S , Sallam S 
Published: March 2007

Abstract
This study presents the outcome of a survey of patient satisfaction following day surgery and an assessment of the level of contact between patients and community services within the first 48 h after discharge from a day-surgery unit. A total of 953 patients were provided with a self-completion questionnaire after day surgery; replies were received from 557 (58·4 per cent). Areas investigated regarding overall satisfaction were outpatient services, admission procedure, day-surgery services, preoperative and postoperative information, and postoperative pain relief. The incidence of contact with the hospital or community services in the 48 h after operation was also recorded. Overall satisfaction following day surgery was very high. Only 2·5 per cent of respondents reported that they had needed to contact the hospital within 24 h of discharge. Contact with community services in the 48 h after operation was minimal. Only 4·3 per cent consulted their general practitioner and 1·4 per cent a district nurse. For the small number of patients who did contact the hospital or their general practitioner, the most frequent reason was a problem with pain management.
Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head
Authors: Allema J H , Reinders M E , Van Gulik T M , Van Leeuwen D J , De Wit L Th , Verbeek P C M , Gouma D J 
Published: March 2007

Abstract
Of 176 patients with carcinoma of the pancreatic head region 156 underwent standard pancreatoduodenectomy (group 2) and 20 with macroscopic suspicion of invasion of the portal vein or superior mesenteric vein (SMV) underwent pancreatoduodenectomy with partial resection of the portal vein or SMV (group 1). In 16 patients in group 1 end-to-end anastomosis was used for reconstruction of the vein. The morbidity rate in groups 1 and 2 was similar (55 versus 63 per cent). The hospital mortality rate was 15 per cent in group 1 and 7 per cent in group 2 (P=0·22). Histological examination confirmed tumour invasion of the portal vein or SMV in ten patients in group 1. Invasion of the portal vein or SMV was significantly more frequent in patients with pancreatic cancer than in those with distal bile duct or ampullary carcinoma. Of the 20 patients in group 1 only three underwent curative resection with tumour-free margins. The median survival time after resection of the portal vein or SMV was 8 months; the 2-year survival rate was 19 per cent. Comparison of survival in group 1 with survival in subgroups of patients undergoing standard pancreatoduodenectomy, matched for all histological parameters, showed no significant difference. It is concluded that partial resection of the portal vein or SMV in patients undergoing pancreatoduodenectomy who are suspected of having tumour invasion of the portal vein or SMV does not improve either the rate of curative resection or survival.
Laparoscopic cholecystectomy for acute cholecystitis
Authors: Kum C K , Goh P M Y , Isaac J R , Tekant Y , Ngoi S S 
Published: March 2007

Abstract
The safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis were evaluated in a 2-year retrospective review. Results of laparoscopic cholecystectomy in 66 patients with acute inflammation of the gallbladder were compared with those of the standard open procedure for this condition (43 patients) and routine laparoscopic cholecystectomy (227 patients). The laparoscopic procedure for acute cholecystitis was successful in 46 of 66 patients. There was no difference in mean operating time when the inflamed gallbladder was removed laparoscopically or at open surgery (82 versus 84 min); however, each procedure took longer than did routine laparoscopic cholecystectomy (mean 69 min; P &lt;0·01). There was no difference in analgesic requirement between patients who underwent laparoscopic removal of an acutely inflamed gallbladder and those in the other two groups. Postoperative recovery was significantly faster than that after open surgery (P&lt;0·01), but took longer than that following routine laparoscopic cholecystectomy (P&lt;0·01). Inability to identify the cystic duct was the most common reason for conversion to open operation, which occurred in 20 cases of acute cholecystitis. Bile duct injury occurred in one of 66 patients with acute cholecystitis treated laparoscopically, two of 227 cases of routine laparoscopic cholecystectomy but in no patient who underwent open cholecystectomy. In conclusion, laparoscopic cholecystectomy is technically achievable in the majority of patients with acute cholecystitis. The conversion rate is high but, if the procedure is completed successfully, postoperative recovery is more rapid than that after open surgery. However, the method carries a higher incidence of complications and should be attempted only by experienced surgeons.