bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery
Authors: Huddy S P J , Joyce W P , Pepper J R 
Published: March 2007

Abstract
Thirty-nine gastrointestinal complications occurred in 35 of 4473 patients (0·78 per cent) who underwent surgery involving cardiopulmonary bypass during an 8-year period. The mortality rate when one of these complications occurred was 22 (63 per cent) representing 11·5 per cent of the 191 deaths from all causes in the series. The relative risk of developing a gastrointestinal complication was 1:249 when the heart was not opened, 1:66 when it was and 1:5 after cardiac transplantation. Gastrointestinal bleeding (n = 20) was the most common complication of whom nine (45 per cent) died, followed by intestinal infarction (n = 12) with eight (67 per cent) deaths and acute pancreatitis (n = 6) all of whom died. There was one death after surgery for gastrointestinal bleeding (n = 7). No patient survived bowel infarction without operation but resection was possible in five of the eight who underwent surgery, four of whom survived. The results demonstrate that surgical intervention is not associated with undue mortality but inappropriate conservative therapy is poorly tolerated in this high-risk group.
Isotopic study of the effects of platelets on development of intimal thickening in autologous vein grafts in dogs
Authors: Yukizane T , Okadome K , Eguchi H , Muto Y , Sugimachi K 
Published: March 2007

Abstract
The effects of platelets on the development of intimal thickening of arterially transplanted autologous vein grafts was investigated using canine poor run-off models. A new apparatus consisting of a shielding lead block to measure in vivo platelet adherence only on the intima of the vein graft was developed. In 23 dogs, 51Cr-labelled platelets (20 μCi/kg) were injected and isotope emission over the grafts was counted. Platelet adherence was expressed as the thrombocyte accumulation index (TAI), i.e. the ratio of counts over the graft under an abnormal flow condition in the poor run-off model to those over the graft under normal flow conditions of the contralateral leg. The TAI of the total graft (TTAI) was significantly high immediately and on the first and third days after implantation. The TAIs of the proximal (PTAI) and distal (DTAI) portions of the vein graft were also high at these same times. At 7, 10, 14 and 21 days, the TAI was almost equal to 1·0, a time at which endothelial regeneration was complete as confirmed by scanning electron microscopy. Thus, the prominent intimal thickening of arterially transplanted autologous vein grafts in dogs, induced under an abnormal flow condition, correlates well with the enhanced platelet adherence on the intima of the vein grafts in an early period after implantation.
POSSUM: A scoring system for surgical audit
Authors: Copeland G P , Jones D , Walters M 
Published: March 2007

Abstract
POSSUM, a Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity, is described. This system has been devised from both a retrospective and prospective analysis and the present paper attempts to validate it prospectively. Logistic regression analysis yielded statistically significant equations for both mortality and morbidity (P &lt; 0·001). When displayed graphically zones of increasing morbidity and mortality rates could be defined which could be of value in surgical audit. The scoring system produced assessments for morbidity and mortality rates which did not significantly differ from observed rates.
Repair and replacement of deep vein valves in the treatment of venous insufficiency
Authors: Wilson N M , Rutt D L , Browse N L 
Published: March 2007

Abstract
Venous insufficiency is a widespread condition, the prevalence of venous ulceration being 0·5–1·0 per cent in Western populations. A principal abnormality causing venous insufficiency is deep venous reflux, usually resulting from post-thrombotic valve destruction. Patients undergoing treatment for venous insufficiency should have all venous abnormalities investigated, defined and corrected where possible. Although treatment for superficial and communicating vein incompetence is available, correction of deep vein reflux has been neglected until recently. Deep vein valve physiology, the selection of patients for deep vein valve surgery and methods of valve repair and replacement are reviewed.
Carotid endarterectomy in Great Britain and Ireland: Trends and current practice
Authors: Murie J A , Morris P J 
Published: March 2007

Abstract
Of 309 questionnaires on carotid endarterectomy sent to all surgeons in Great Britain and Ireland who might use this technique, 298 (96 per cent) were returned. In all, 110 (37 per cent) of 298 surgeons performed at least one carotid endarterectomy in 1989; 67 performed &lt; 10 and 43 &gt;10. In total, these 110 surgeons performed 1417 operations in 1989, a situation that has changed little over 5 years since the previous survey. Transient ischaemic attack and minor stroke remain the main indications for carotid endarterectomy; the operation was hardly ever performed for asymptomatic stenosis. By 1989 almost all surgeons initially assessed prospective patients using a technique less invasive than conventional angiography; duplex scanning was used ‘always’ or ‘sometimes’ by 70 per cent of surgeons. While 72 per cent of surgeons in 1984 ‘always’ required conventional angiograms before operation, by 1989 only 21 per cent did so, most now relying on less invasive techniques. During operation there was an increasing use of shunts, carotid sinus nerve blockade and patch closure of the arteriotomy. The overall number of carotid endarterectomies performed annually in Great Britain and Ireland has remained steady over the past 5 years and is relatively low for a population of 60 millions. An increase in the number of surgeons performing the operation is almost entirely accounted for by an increase in those performing &lt; 10 carotid endarterectomies per year.
Prevention of perioperative deep vein thrombosis in general surgery: A multicentre double blind study comparing two doses of Logiparin and standard heparin
Authors: Liezorovicz A , Picolet H , Peyrieux J C , Boissel J P 
Published: March 2007

Abstract
A total of 1290 patients were enrolled in a randomized multicentre double blind study in order to investigate the use of two doses of a new low molecular weight heparin, Logiparin®, in the prevention of deep vein thrombosis (DVT) in general surgery. Patients who were included had no contraindication to heparin therapy and had at least one of the recognized risk factors for DVT. Patients were randomized to receive unfractionated heparin (UH) 5000 units b.d., Logiparin 2500 units daily or Logiparin 3500 units daily. Each treatment was given subcutaneously 2h before surgery and continued for 7–10 days. Daily 125I-labelled fibrinogen uptake tests (FUTs) were performed from day 2 to day 7 to detect DVT, and phleboangiography was used to confirm the diagnosis. The wound was examined on a daily basis to check for haematoma formation, and all patients were followed up for 1 month after operation. All three treatment arms were well matched for age, sex, weight, diagnosis and type of operation performed. The three major inclusion criteria in the trial were malignancy, age over 60 years and a history of varicose veins. Positive FUTs (UH=4·2 per cent, Logiparin 2500 units daily = 7·9 per cent, Logiparin 3500 units daily = 3·7 per cent) and positive angiograms (UH=3·0 per cent, Logiparin 2500 units daily = 5·6 per cent, Logiparin 3500 units daily = 2·3 per cent) were significantly more common in the Logiparin 2500 units daily group than in the UH and Logiparin 3500 units daily groups. The rates of major complications (severe haemorrhage, death, pulmonary embolism, reintervention) were similar in the three groups.
Peritoneal adhesion formation after lysis: Inhibition by polyethylene glycol 4000
Authors: O'Sullivan D , O'Riordain M , O'Connell R P , Dineen M , Brady M P 
Published: March 2007

Abstract
Peritoneal adhesions cause much long-term postoperative morbidity. This study evaluates the efficacy of polyethylene glycol (PEG) 4000 in reducing adhesion reformation after lysis. Adhesions were induced, by abrasion, in 111 Sprague-Dawley rats at a first laparotomy. At a second operation, 10 days later, these adhesions were graded and lysed, after which the animals received one of the following solutions intra-peritoneally: 5 per cent PEG 4000 (n = 21), 25 per cent PEG 4000 (n = 23), 32 per cent dextran 70 (n = 22) or isotonic saline (n = 25), or were left as an untreated control group (n = 20). When the reformed adhesions were graded after a further 10 days 5 per cent PEG 4000 was found to be the only solution that inhibited adhesion reformation. The adhesions that reformed in the other four test groups were significantly worse than when they were first graded (P ≦0·033 for all groups). Therefore 5 per cent PEG 4000 may be useful in clinical practice for the reduction of adhesion formation after lysis.
Comparison between anal endosonography and digital examination in the evaluation of anal fistulae
Authors: Choen S , Burnett S , Bartram C I , Nicholls R J 
Published: March 2007

Abstract
A prospective trial was performed comparing the accuracy of digital examination and anal endosonography in defining the anatomy of anal fistulae. Before operation 38 consecutive patients were assessed by the consultant in charge of the case, by a research fellow and by anal endosonography involving two radiologists. These findings were compared with the operative findings. Consultants correctly identified 26 of 33 internal openings, 29 of 34 primary tracks and 15 of 21 secondary tracks. The research fellow correctly identified 26 internal openings, 24 primary tracks and 10 secondary tracks. There was no significant difference between the accuracy of consultants and the research fellow. Anal endosonography identified 10 internal openings based on initial criteria. This rose to 24 when revised ultrasonographic criteria were applied. There was no statistical difference between consultant assessment and anal ultrasonography in correctly identifying intersphincteric and transphincteric tracks. Ultrasonography is unable to assess primary superficial, suprasphincteric and extrasphincteric tracks or secondary supralevator and infralevator tracks. Consultant assessment of secondary supralevator and infralevator tracks was correct in 78 per cent of cases.
Management of bleeding liver tumours in Hong Kong
Authors: Dewar G A , Griffin S M , Ku K W , Lau W Y , Li A K C 
Published: March 2007

Abstract
A retrospective study was undertaken of 41 patients diagnosed as having suffered spontaneous liver rupture over a 4-year period to identify the clinical features, treatment and outcome of this complication in an area in which hepatocellular carcinoma is endemic. Two patients were excluded with a revised diagnosis of haemorrhagic malignant ascites. Of the remaining 39 patients, 37 bled from ruptured hepatocellular carcinoma, one from peliosis hepatis and multiple liver cell adenomas, and one from a malignant hepatic epithelioid haemangioendothelioma. Analysis showed that 59 per cent of patients were in shock on admission and that all but two of the 37 patients with ruptured hepatocellular carcinoma were men with cirrhosis. The association with cirrhosis was significantly higher than in a series of 45 patients with hepatocellular carcinoma undergoing elective resection during the same period (P&lt;0·05). Treatment consisted of supportive care only in two patients, angiographic embolization in four, emergency liver resection in 11 of whom six died, hepatic artery ligation in 12 of whom eight died, and suture and/or packing in eight of whom six died. One patient died at laparotomy and in another patient bleeding was successfully arrested by intratumoural injection of absolute alcohol. Because of the high operative mortality of emergency surgery in these poor risk patients, prospective evaluation of emergency angiographic embolization is required.
Prevention of postoperative renal dysfunction in patients with obstructive jaundice: A multicentre study of bile salts and lactulose
Authors: Pain J A , Cahill C J , Gilbert J M , Johnson C D , Trapnell J E , Bailey M E 
Published: March 2007

Abstract
The role of preoperative lactulose and bile salts in the prevention of postoperative renal failure in patients with obstructive jaundice has been evaluated in a prospective randomized trial. One hundred and two patients undergoing surgery for obstructive jaundice (bilirubin &gt; 100 μmol/l) were randomized into three groups: those receiving preoperative oral lactulose (n = 35), those receiving oral sodium deoxycholate (n = 32) and a control group of patients receiving no specific treatment (n = 35). All patients received intravenous fluids commencing the night before surgery. One patient in the control group and none in the treatment groups developed postoperative renal failure. Postoperative deterioration of renal function in patients with normal preoperative function was significantly more common in the control group than in the treatment groups (χ2 = 8·1, d.f. = 2, P&lt;0·02). The incidence of renal failure and impairment was lower in this control group than that reported in previous studies. This may be due to the introduction of adequate preoperative hydration. Additional protection occurs by the preoperative administration of either lactulose or sodium deoxycholate.
Adrenaline injection for endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage
Authors: Steele R J C , Park K G M , Crofts T J 
Published: March 2007

Abstract
Over a 30-month period, 53 patients with actively bleeding non-variceal lesions of the oesophagus, stomach or duodenum were treated by endoscopic injection of 1/10000 adrenaline. Initial haemostasis was obtained in 50 cases, and permanent haemostasis in 44. Emergency surgery for bleeding was required in nine patients overall, and there were four deaths. All lesions requiring surgery were located on the posterior wall of the duodenum or the lesser curve of the stomach, and all but one had evidence of an exposed arterial vessel. Adrenaline injection is an effective, safe and simple method of endoscopic haemostasis.
Surgical implications of drug-induced rhabdomyolysis
Authors: Rutgers P H , Van Der Harst E , Koumans R K J 
Published: March 2007

Abstract
Four cases are described of acute non-traumatic rhabdomyolysis with subsequent development of a compartmental syndrome, requiring extensive fasciotomies. All the patients were young male alcoholics who were taking benzodiazepines as part of an addiction treatment programme. In this risk group clinicians should be aware of two serious complications of non-traumatic rhabdomyolysis: acute renal failure and compartmental syndrome.
Povidone-iodine in experimental peritoneal hydatidosis
Authors: Gökçe Ö , Gökçe Ç , Yilmaz M , Hüseyinog̈lu K , Günel S 
Published: March 2007

Abstract
The effect of polyvinylpyrrolidone-iodine (PVP-I) on experimental peritoneal hydatidosis was evaluated in this randomized blind controlled study. Seventy-five white, 3-month-old rats were subjected to laparotomy. After the intraperitoneal inoculation of viable scolices, the rats were randomly divided into three groups. Their peritoneal cavities were irrigated with either 1 per cent PVP-I solution (the PVP-I group), hypertonic saline (the HS group) or Ringer's lactate (the control group). Each group was assigned a separate code number; observers blind to the meaning of the code numbers noted all findings during a period of 4 months, after which the rats were killed to allow assessment of the abdominal cavity. The results were decoded after the statistical analyses were completed. The incidence of peritoneal cysts was found to be lower (8·7 per cent) in the PVP-I group compared with the HS (50 per cent) and control (90·9 per cent) groups; the mean number of hydatid cysts per animal was also lower in the PVP-I group compared with the other two groups. We conclude that the scolicidal activity of PVP-I is significantly higher than that of hypertonic saline and that it can be employed as a prophylactic agent against peritoneal hydatidosis.
Steroid receptors in breast cancer
Authors: Rayter Z 
Published: March 2007

Abstract
Recent advances in steroid receptor structure and function now indicate that oestrogen binds to the oestrogen receptor (ER) molecule at a specific site, denoted region E. This allows binding of the oestrogen-ER complex to DNA via cysteine residues in region C of the ER molecule, which tetrahedrally co-ordinate zinc. This modulates transcription and stimulates cell growth. A number of newly discovered growth factors are also regulated by ER, as is the progesterone receptor. Steroid receptor concentrations in tissues can now be measured on smaller tissue samples using enzyme immunoassay or on cells obtained by fine needle aspiration using monoclonal antibody technology. The prognostic value of steroid receptor is limited, but still constitutes the best marker for predicting response to endocrine therapy. The role of steroid receptors in selecting patients for adjuvant therapy is discussed.
Insights gained from the management of problematical anal fistulae at St. Mark's Hospital, 1984–88
Authors: Choen Seow , Phillips R K S 
Published: March 2007

AbstractTwenty-four (3·6 per cent) patients with problematical anal fistulae out of 671 with anal fistulae were analysed to assess the reasons for their recurrences and ultimate outcome. Thirteen patients (group A) had recurrent fistulae despite two definitive attempts at surgery at this hospital (median number of previous procedures before referral to this hospital was two, range 0–7; median number of definitive procedures at this hospital was three, range 3–4). In five of these patients, the reason for recurrence was missed primary (four cases) or secondary tracks (one case) at earlier operations. Five patients required multiple operations related to the use of setons. Eleven other patients (group B) required colostomy construction, eight because of severe perianal sepsis, two because of complex fistulae, and one for postrectal dermoid. Fistula healing occurred ultimately in all patients in group A afer a median of 14 months (range 4–38 months). In group B, fistula healing occurred in eight patients after a median of 7.5 months (range 2–55 months) after colostomy construction. Only one patient has had a proctectomy, and five still have their colostomy. Of the other 18 patients, continence is normal in 14, there is mucus leakage in two, flatus incontinence in one and faecal incontinence in one. In conclusion, persistent attempts to resolve anal fistulae in difficult cases are frequently successful in the long term and result in good continence.
Primary sclerosing cholangitis: Surgical options, prognostic variables and outcome
Authors: Ismail T , Angrisani L , Powell J E , Hübscher S , Buckels J , Neuberger J , Elias E , McMaster P 
Published: March 2007

Abstract
The natural history of primary sclerosing cholangitis (PSC) is poorly defined and its management remains controversial. Forty-eight symptomatic patients (median age 39 years, range 8–67 years; 30 male) with PSC were reviewed retrospectively. Thirty patients had inflammatory bowel disease. Four patients (8 per cent) developed or had an associated malignancy. Twenty-one (44 per cent) died; overall 5 year actuarial survival was 30 per cent. Twenty-three patients had 27 non-transplant related biliary operations (16 patients specifically for PSC) of whom 12 died. Serum bilirubin was the only parameter to improve after biliary surgery. Seventeen patients (35 per cent) underwent orthotopic liver transplanation (OLT) of whom nine are currently alive (1 year projected survival of 55 per cent). Previous biliary surgery correlated with a poor outcome (P &lt; 0.0001) after OLT. Being male, presence of cirrhosis, duration of symptomatic disease (&gt; 3 years) and a serum bilirubin level &gt; 100 μmol/l at presentation, were independently associated with a poor outcome (P &lt; 0.05). These data provide evidence that PSC is a progressive disease and conventional surgical options have little influence on the outcome. Previous biliary surgery adversely affects outcome following OLT. For progressive liver disease, liver transplantation should be considered the treatment of choice.
Effect of percutaneous interstitial thermal laser on normal liver of pigs: Sonographic and histopathological correlations
Authors: Bosman S Saskia , Phoa S S K , Bosma A , van Gemert M J C 
Published: March 2007

Abstract
Tumour necrosis can be induced by interstitial application of low power laser light, which causes thermal damage to the tissue. In normal pig liver the effects were studied of low power Nd: YAG laser light (continuous wave; 1·5 W, 10 min, wavelength 1064 nm), administered percutaneously via a 600 um fibre. Ultrasound images were compared with histopathological findings. Histopathology showed induction of sharply demarcated lesions with a mean diameter of 10–15 mm (days 0 and 7), consisting of coagulative necrosis. Healing of the lesion occurred by granulation, fibrosis and removal of cell debris. Lesions could not be seen by week 4, which suggests complete regeneration. Ultrasonography showed a good correlation with histopathology, especially at 1 week when different histopathological tissue layers could be discriminated by ultrasonography. It is concluded that thermal lesions in liver can be induced via a percutaneous route and that ultrasound imaging is useful in monitoring the lesions during and after the procedure.
Breast cancer in elderly women: A Cancer Research Campaign trial comparing treatment with tamoxifen and optimal surgery with tamoxifen alone
Authors: Bates T , Riley D L , Houghton J , Fallowfield L , Baum M 
Published: March 2007

Abstract
Three hundred and eighty-one women with operable breast cancer aged over 70 years were randomly allocated to 40 mg tamoxifen daily and optimal surgery or to tamoxifen alone. At a median follow-up of 34 months there was no demonstrable difference in survival rate or in quality of life between the two treatment groups. More patients treated with tamoxifen alone had a subsequent change of management and this was usually an operation for local treatment failure. This progression to surgery has not been shown to be disadvantageous and the study will continue. Informed consent for randomization was difficult to obtain, leading to the exclusion of eligible patients, and it is therefore proposed to include non-randomized patients in a total cohort study.
Five-year vascular audit from a district hospital
Authors: Holdsworth J D 
Published: March 2007

Abstract
Vascular patients under the care of one surgeon over a 5-year period have been reviewed, from computer-based discharge records, with regard to in-hospital measures of outcome to determine whether or not surgery was being performed to an acceptable standard. Out of 466 procedures, 30 per cent of patients had at least one complication, 14 per cent had further surgery and 9 per cent died. Outcome was examined within the following treatment groups: aorto/iliac aneurysm, aortofemoral bypass, femoroproximal popliteal bypass, femorodistal popliteal bypass, femorocrural bypass, embolectomy and percutaneous transluminal angioplasty. Patients having below-knee bypass surgery were found to have an unacceptably high rate of complications, reoperations and amputations. An overall rate of reoperation for postoperative bleeding of 5 per cent was also considered to be high. With these exceptions, it was concluded that the surgery was being performed to an acceptable standard, but that comparative audit of this type remained difficult while there was a deficiency of national statistics against which the work of individual surgeons could be judged.