bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical presentation of Kawasaki disease (mucocutaneous lymph node syndrome)
Authors: Wheeler R A , Najmaldin A S , Soubra M , Griffiths D M , Burge D M , Atwell J D 
Published: March 2007

Abstract
Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction. As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy.
Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis
Authors: Waterhouse N , Healy C 
Published: March 2007

Abstract
We present our experience using the vastus lateralis myocutaneous flap for the repair of defects around the groin and pelvis. It is a relatively new technique, with many advantages over other flaps used in this area, though it has limitations. The history, anatomy and surgical technique of raising the flap are described and clinical cases are discussed. The importance of patient selection is highlighted.
Intraluminal pressure adjacent to left colonic anastomoses
Authors: Burkitt D S , Donovan I A 
Published: March 2007

Abstract
A cumulative total of 89 h of pressure data was acquired from both sides of a left colonic anastomosis in 15 patients over a median period of 7 postoperative study days. Patients had a colonic ileus lasting 3–10 days and during this proximal and distal inactivity the intraluminal pressure remained within 6 mmHg of atmospheric pressure. After recovery of activity, pressures proximal to the anastomosis in excess of 10 mmHg occurred during less than 1 per cent of the recording time. Distal peak pressures were significantly elevated with respect to the proximal site (P &lt; 0.001). Two-thirds of the distal pressures recorded were between 10 and 20 mmHg and 98per cent were less than 50 mmHg; the peak distal pressure was 90 mmHg. Four patients had distal repetitive tonic contractions creating a pressure difference across the anastomosis with a mean of 20 mmHg and a peak of 45 mmHg. Each contraction persisted for 15–20 min. Intraluminal pressures are unlikely to play a role in anastomotic dehiscence.
Irreducible inguinal hernia in children below two years of age
Authors: Davies N , Najmaldin A , Burge D M 
Published: March 2007

Abstract
Eighty-five cases of irreducible inguinal hernia in children below 2 years of age were reviewed. Non-operative treatment was successful in 71 (84 per cent); 14 children required emergency surgery. The younger the child and the longer the duration of symptoms at presentation, the worse was the outcome of non-operative treatment. In 35 (41 per cent) children the diagnosis of inguinal hernia had been made before irreducibility. There is an increased incidence of postoperative complication associated with irreducibility, especially inpreterm infants. Early diagnosis of inguinal hernia in young children and prompt referral for surgery is recommended.
New isotopic technique for detecting prosthetic arterial graft infection: 99mTc-hexametazime-labelled leucocyte imaging
Authors: Insall R L , Jones N A G , Chamberlain J , Lambert D , Keavey P M 
Published: March 2007

Abstract
Early and accurate detection of prosthetic arterial graft infection is important because this serious complication of vascular surgery carries high morbidity and mortality rates. This report describes the use of a new method of isotopic imaging to detect graft infection using 99mTc-hexametazime-labelled leucocytes. Seventeen patients with potentially infected arterial grafts were imaged in addition to routine investigations but were managed according to our normal surgical practice. 99mTc-imaging was positive in eight patients with proven graft infection and falsely positive in one patient with a groin haematoma (89 per cent specificity). There were no false negatives (100 per cent sensitivity) after an average follow-up of 6 months (range 3–9 months). This technique has proved a reliable and rapid method of confirming graft infection.
Buerger's colour
Authors: Kimura T , Yoshizaki S , Tsushima N , Sano M , Hanai G 
Published: March 2007

Abstract
Cyanosis of the hands and feet in Buerger's disease is known as ‘Buerger's colour’. This characteristic skin colour is produced by the subpapillary venous plexus. The reactions of the subpapillary venous plexus in patients with Buerger's disease were observed by analysing the fractional blood volume of tissue using a visible light reflective spectrophotometer. Capillary morphology was investigated using an intravital video-microscopic system. Twenty-seven subjects, comprising 13 normals and 14 patients with Buerger's disease, were studied. In the nailbeds of patients with Buerger's disease, an increase in the number of loops, cyanotic colour change and dilatation were observed. In this condition there was incompetence of venular tonus and regurgitation at venular valves. Buerger's colour is probably due to excessive congestion of venous blood in the subpapillary venous plexus which is produced by these mechanisms.
Changes in cardiovascular homeostasis after injury are mediated by tissue damage and not haemorrhage
Authors: Anderson I D , Little R A , Pyman J A , Irving M H 
Published: March 2007

Abstract
During treatment of the injured patient it is assumed that the cardiovascular responses follow recognized physiological principles. Studies in humans have shown that injury causes a profound suppression of arterial baroreflex function which alters the normal relationship between heart rate and blood pressure and casts doubt on this assumption. To investigate the mechanism of baroreflex suppression, we have studied the effects of the two major components of injury, blood loss and tissue damage, on baroreflex function in healthy volunteers. Baroreflex function was assessed using suction stimulation of the carotid sinus. The loss of 500 ml blood had no effect on baroreflex sensitivity. A human laboratory model of tissue injury reduced the ability of the baroreflex to compensate for a rise in blood pressure (P &lt; 0·05, Wilcoxon signed rank test). We conclude that tissue damage, rather than hypovolaemia, appears to mediate the effect of injury on baroreflex function in the injured. Blockade of neural signals from damaged tissue may have a role in the treatment of injury.
Adrenergic control of the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence
Authors: Speakman C T M , Hoyle C H V , Kamm M A , Henry M M , Nicholls R J , Burnstock G 
Published: March 2007

Abstract
There is histological and functional evidence that the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence. The in vitro responsiveness of the internal anal sphincter to nor adrenaline (an important sympathetic neurotransmitter) and electrical field stimulation (known to stimulate the intrinsic innervation) has been studied. Muscle strips from eight patients with incontinence undergoing postanal repair and five controls undergoing' resection for low rectal carcinoma were studied. The contraction-response curves for nor-adrenaline were significantly different, and the EC50, the concentration required to produce 50 per cent of maximum contraction, was higher in incontinent patients (P &lt; 0.001). Electrical field stimulation produced initial contractions in four of the control group which were blocked by phentolamine. This contraction was not present in the incontinent patients (P &lt; 0.01). These results indicate an abnormality in the adrenergic innervation of the internal anal sphincter in patients with idiopathic faecal incontinence.
Adjuvant chemotherapy with 5-fluorouracil, vincristine and CCNU for patients with Dukes' C colorectal cancer
Authors:   Swedish Gastrointestinal Tumour Adjuvant Therapy Group, Hafström L , Domellöf L , Rudenstam C-M , Norryd C , Bergman L , Nilsson T , Hansson K , Wählby L , Asklöf G , Kugelberg C 
Published: March 2007

Abstract
A prospective controlled randomized trial testing adjuvant postoperative combination chemotherapy (5-fluorouracil, lomustine (CNU) and vincristine) versus no adjuvant therapy in patients operated on for Dukes' C colorectal cancer is reported. In total 334 patients aged less than 70 years were recruited: 205 patients with colonic and 99 with rectal cancer, but there were three protocol violations and these cases are excluded from further consideration. Twenty-seven patients had a limited resection of their cancer. After 5 years follow-up there was no significant difference in the tumour-free survival rate or in the survival rate between the treated and control groups. Twenty-nine of the 147 patients who started chemotherapy discontinued this treatment because of side-effects, mainly from the gastrointestinal tract. In 30 patients treatment was discontinued because of recurrent disease. The conclusion is that systemic administration of combination chemotherapy for colorectal cancer after operation is not worthwhile in routine clinical practice.
Risk of cancer death in first-degree relatives of patients with hereditary non-polyposis cancer syndrome (Lynch type II): A study of 130 kindreds in the United Kingdom
Authors: Itoh H , Houlston R S , Harocopos C , Slack J 
Published: March 2007

Abstract
To estimate the relative risks of cancer in first-degree relatives of index patients, 130 pedigrees of dominantly inherited Lynch type II cancer family syndrome have been analysed. The risk of death from all causes was significantly increased in women over 45 years of age and the overall liability to cancer in women was greater than for men. A sevenfold increase in risk of colon cancer was found in both sexes. In female relatives the risk of breast cancer was increased fivefold and lifetime risk of breast cancer was 1 in 3·7. A screening programme based on estimated risks could be offered to first-degree relatives of index patients with Lynch type II cancer family syndrome.
Achalasia of the cardia: Long-term results of oesophagomyotomy and posterior partial fundoplication
Authors: Paricio P Parrilla , de Haro L Martínez , Ortiz A , Aguayo J L 
Published: March 2007

Abstract
Forty-eight patients with achalasia of the cardia were treated by Heller's myotomy with a posterior fundoplication of approximately 270°, suturing the gastric fundus to the edges of the myotomy. The mean(s.d.) postoperative follow-up period was 5·4(2·8) years. The clinical results were good to excellent in 44 cases (92 per cent) and fair in four cases (8 per cent) (two with residual dysphagia and two with gastro-oesophageal reflux). Barium studies showed a decrease in oesophageal diameter and disappearance of distal narrowing but normal oesophageal emptying did not occur. Postoperative manometric studies (29 patients) revealed a significant decrease in lower oesophageal sphincter pressure and a significant increase in the length of the infradiaphragmatic segment. In the oesophageal body a recovery of peristaltic waves in the proximal third was seen in ten of the patients (34 per cent). Twenty-four-hour pH monitoring showed pathological reflux in only three of 25 patients studied, and one of these was asymptomatic. This technique is effective, improving oesophageal symptoms and controlling long-term reflux.
Infrainguinal bypass surgery: Factors determining late graft patency
Authors: Budd J S , Brennan J , Beard J D , Warren H , Burton P R , Bell P R F 
Published: March 2007

Abstract
The results of 373 infrainguinal bypass grafts, in a single centre, between 1980 and 1988 are reviewed. One hundred and thirty in situ vein (ISV), 47 reversed saphenous vein (RSV), 118 polytetrafluoroethylene (PTFE) and 78 human umbilical vein (HUV) grafts were used. The indications for surgery were disabling claudication in 25 per cent of patients and limb salvage in 75 per cent. In 36 per cent of operations the distal anastomosis was above the knee and in 64 per cent it was below the knee. Overall 5-year patency rates and limb salvage rates respectively were, for ISV (41 and 69 per cent), RSV (62 and 90 per cent), PTFE (31 and 67 per cent) and HUV (29 and 59 per cent). There was no significant difference in patency among these grafts at the above-knee level, but significant differences between vein and prosthetic grafts were evident below the knee (P &lt; 0.001). Using a proportional hazards model the three factors that consistently correlated with late graft patency were graft type (P &lt; 0.001), site of distal anastomosis (P &lt; 0.001) and distal run-off (P &lt; 0.001). Overall, the results suggest that prosthetic grafts are a suitable alternative to autogenous vein when the distal anastomosis is above the knee, but vein should always be used, if available, below the knee joint.
Popliteal aneurysms identified by intra-arterial streptokinase: A changing pattern of presentation
Authors: Lancashire M J R , Torrie E P H , Galland R B 
Published: March 2007

Abstract
Five patients presenting with chronic or subacute leg ischaemia due to thrombosed popliteal artery aneurysm are described. Only one of these aneurysms was diagnosed before intra-arterial streptokinase infusion, which successfully lysed the thrombus in all cases. One aneurysm had been symptomatic for 5 years and another for 2 years. Popliteal aneurysm may well be underdiagnosed as a cause of chronic leg ischaemia.
Extradural haematoma in the Irish Republic: An analysis of 82 cases with emphasis on ‘delay’
Authors: O'Sullivan M G J , Gray W P , Buckley T F 
Published: March 2007

Abstract
Eighty-two cases of extradural haematoma were analysed to elucidate the factors contributing to delay in treatment and poor outcome. The majority of cases occurred in the first three decades of life with falls being the commonest aetiological factor. Five distinct modes of presentation are described. Excessive delay occurred in recognizing the condition and in subsequent transfer of patients. This resulted in many patients being operated on while in coma. Associated intracranial and extracranial injury occurred in a significant number of cases. Recommendations for the management of these patients are outlined.
Extracorporeal gas exchange in adult respiratory distress syndrome: Associated morbidity and its surgical treatment
Authors: Wagner P K , Knoch M , Sangmeister C , Müller E , Lennartz H , Rothmund M 
Published: March 2007

Abstract
Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. Most pneumothoraces were bilateral. Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.
Outcome measurement using hospital activity data: Deaths after surgical procedures
Authors: Kind P 
Published: March 2007

Abstract
There is a pressing need to develop measures of health outcome for use in medical audit and in shaping decisions on the allocation of resources. Such measurement is not normally performed except in specific research settings. Routine information collected on hospital inpatients contains very crude data on two health outcomes, namely whether such patients were alive or dead at the end of their hospital stay. This paper analyses hospital activity data with particular reference to those patients who had undergone a surgical procedure. The results are broadly consistent with the earlier findings of the Confidential Enquiry into Perioperative Deaths and reveal a crude mortality rate of under 15 deaths per WOO surgical admissions. Rates as high as 280 per 1000 admissions were found for certain procedures. Since death is a relatively rare health outcome it is argued that the development of a more acceptable measure must be a priority to provide information on the vast majority of surgical patients with non-fatal outcomes.
Infrarenal abdominal aortic disease: A review of the retroperitoneal approach
Authors: Grace P A , Bouchier-Hayes D 
Published: March 2007

Abstract
Transabdominal exposure is the most widely used surgical approach to the infrarenal aorta. Over the last 30 years a number of surgeons have championed the retroperitoneal approach for repair of abdominal aortic aneurysms and aortoiliac occlusive disease using a variety of incisions. Several studies attest to the clinical superiority of this approach over the transabdominal route and recent evidence demonstrates reduced physiological disturbance with this technique. The retroperitoneal approach is suitable for all elective operations on the abdominal aorta, particularly in patients with high-risk aneurysms and in selected patients with symptomatic and ruptured aneurysms.
Recurrence of Crohn's disease after resection
Authors: Williams J G , Wong W D , Rothenberger D A , Goldberg S M 
Published: March 2007

Abstract
Recurrent Crohn's disease develops in most patients after surgical resection if the patient is followed for sufficient time. This review examines various aspects of recurrent Crohn's disease. It is concluded that Crohn's disease is a diffuse condition of the gastrointestinal tract and that radical resection of Crohn's disease does not prevent recurrence. Assorted factors thought to be associated with recurrence are examined and the relevance of these factors to the surgeon treating Crohn's disease is discussed.
Study of belching ability in antireflux surgery patients and normal volunteers
Authors: Smith D , King N A , Waldron B , Cullen P T , Millar B , Fenwick M , Campbell F C 
Published: March 2007

Abstract
The ability to belch was evaluated by a novel test, after gaseous stomach distension to standard volume, in 16 patients after antireflux surgery and nine healthy volunteers. A structured assessment of dyspeptic symptoms was also carried out in both groups. Repeat studies in volunteers showed acceptable reproducibility for the new test of belching capacity (within-subject coefficient of variance 4·5 per cent). After antireflux surgery, patients had lower volume individual belches (median(range) 27·5(0–104) ml in patients versus 76(15–165) ml in volunteers; P &lt; 0·02) and belched less gas within 1 h of the stimulus than volunteers (median(range) 205(0–1363) ml in patients versus 456(45–818) ml in volunteers; P &lt; 0·05). Belching frequency was similar in both groups. The incidence and severity of symptoms were unrelated to belched gas volumes.
Detection of colorectal liver metastases using intraoperative ultrasonography
Authors: Charnley R M , Morris D L , Dennison A R , Amar S S , Hardcastle J D 
Published: March 2007

Abstract
Intraoperative ultrasonography of the liver has been carried out in 99 patients undergoing surgery for colorectal cancer. Palpation of the liver, preoperative abdominal ultrasonography and computed tomography scanning were also performed in all patients. Metastases were identified in 26 of the 99 patients (26 per cent). Intraoperative ultrasonography diagnosed more metastases than palpation, abdominal ultrasonography or CT scanning, identifying metastases in 24 of the 26 patients, including six patients in whom the metastases were not detected by any other technique. Identification and localization of impalpable liver metastases is therefore possible using intraoperative ultrasonography.
Proliferation characteristics of human colorectal carcinomas measured in vivo
Authors: Rew D A , Wilson G D , Taylor I , Weaver P C 
Published: March 2007

Abstract
The cell proliferation kinetics of 100 human colonic and rectal adenocarcinomas have been studied in vivo by bromodeoxyuridine infusion and multiparameter flow cytometry. A total of 97 patients, three with synchronous tumours, consented to receive a single bolus dose of 250 mg between 2·4 and 16 h before curative or palliative surgery. By this method, the ploidy pattern, the total and aneuploid labelling indices (LI), the S phase duration (Ts) and the potential doubling time (Tpot) can be estimated. Of the tumours 48 were diploid and 52 were aneuploid. The mean and median total LI of 100 tumours were 9·0 per cent (range 0·7–-22·2 per cent). The mean aneuploid LI was 12·1 per cent (median 12·0 per cent, range 2·0–25·5 per cent), and was significantly higher than the total LI (P = 0·01). The labelling index alone is not a sufficient indicator of proliferation, because the Ts also varies within and between tumours. The intertumour range of the Ts varied from 4·0 to 28·6 h. The mean was 14·1 h and the median was 13·1 h. The mean Tpot was 5·9 days (median 3·9 days) with a range of 1·7–21·4 days. No correlation was found between any kinetic parameters and the Dukes' classification or histological classification. The correlation between proliferation and prognosis will be established in due course.
Stools containing altered blood - plasma urea: Creatinine ratio as a simple test for the source of bleeding
Authors: Olsen L H , Andreassen K H 
Published: March 2007

Abstract
The plasma urea:creatinine ratio (U:C ratio) is known to be elevated in cases of upper gastrointestinal bleeding. Almost all patients with haematemesis have upper gastrointestinal (or generalized) bleeding so that in this study we characterized the diagnostic power of the U:C ratio in patients with stools containing altered blood without haematemesis in the hope that this simple laboratory test (used in conjunction, perhaps, with clinical data) might reduce the number of patients subjected to an unrewarding gastroscopy or colonoscopy. Of 76 cases seen in a provincial and a metropolitan hospital, 42 and 34 patients had upper and lower gastrointestinal bleeding, respectively. Fifty-four per cent of those with upper gastrointestinal bleeding and none of those with lower gastrointestinal bleeding had U:C ratios above 110 on admission. However, a discriminating level of 90 is considered to be more suitable, judged by the quadratic uncertainty score. At this level the odds for upper gastrointestinal bleeding were 15:1.