bluuebunny/crossref_metadata_2025_split huggingface dataset:
Salvage surgery for ileal pouch outlet obstruction
Authors: Herbst F , Sielezneff I , Nicholls R J 
Published: March 2007

Abstract
Sixteen patients with ileal pouch outlet mechanical obstruction had major abdominal revision of the ileoanal anastomosis. Before operation all had severe difficulty in evacuation which required catheterization in 11. Eleven patients had a long efferent limb and/or long anorectal cuff, and five had a persistent stricture at the ileoanal anastomosis. None had pouchitis. The pouch was fully mobilized abdominally and the obstructing lesion resected. A new handsewn ileoanal anastomosis was formed. In two cases pouch volume was increased by incorporating an additional loop of ileum. All anastomoses but one were covered by a loop ileostomy. There were no deaths. Major complications occurred in two patients. Function was assessed in 15 patients; in one the ileostomy had not been closed. Median (interquartile range) frequency of defaecation per 24 h fell from 15 (7·3–19·5) to 6 (4·5–6·0) (P = 0·0033). Of the 11 patients who required a catheter before operation six evacuated spontaneously, three were improved but intubated on some occasions and two were unchanged after revisional surgery. Of the ten incontinent patients, five became continent, four were improved and one remained unchanged. There was a new continence disturbance in four (minor nocturnal in three) of the remaining five patients. One patient underwent further abdominal salvage surgery and another required establishment of an ileostomy because of poor function. Combined abdominoanal salvage surgery for outlet mechanical obstruction was successful in averting an ileostomy in 13 of 16 patients, and significantly improved pouch function in 12 of 15.
Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy
Authors: Mathai V , Ong B C , Ho Y H 
Published: March 2007

Abstract
A prospective trial was conducted to compare haemorrhoidectomy alone (control, group 1) with haemorrhoidectomy plus lateral internal sphincterotomy (group 2) for prolapsed piles. Some 33 patients (18 men, 15 women) of mean(s.e.m.) age 40(2·3) years were randomized, 16 to group 1 and 17 to group 2. There were no significant differences in postoperative pain scores. Mean resting and maximum anal squeeze pressures, studied 6 weeks and 3 months after operation, were generally lower in group 2, but were not significantly different. Two patients in group 2 were distressed by incontinence to liquid faeces which persisted in one after 1 year. There were no other complications in either group after a mean(s.e.m.) follow-up of 11(0·4) months. The addition of lateral internal sphincterotomy to routine haemorrhoidectomy is unnecessary and carries the added risk of incontinence.
Adrenalectomy for metastatic disease to the adrenal glands
Authors: Lo C Y , Van Heerden J A , Soreide J A , Grant C S , Thompson G B , Lloyd R V , Harmsen W S 
Published: March 2007

Abstract
A policy of supportive treatment is frequently adopted for patients with metastatic disease to the adrenal glands. This study reports an experience with adrenalectomy for adrenal metastasis. Between 1983 and 1993, adrenalectomy was performed in 52 patients for metastasis to the adrenal glands. Survival was calculated by the Kaplan- Meier method and compared with the log rank test. Primary tumour sites included kidney (n = 15), lung (n = 11), colon (n = 7), unknown (n = 5), stomach (n = 3), melanoma (n = 3) and other (n = 8). Adenocarcinoma (69 per cent) was the most common histological cell type. Thirty-two patients were asymptomatic on initial evaluation. Symptomatic adrenal pain relief was achieved in 11 of 13 patients. Overall survival rates were 73 per cent at 1 year and 40 per cent at 2 years. Patients with potentially curative resection had better survival than those who had a palliative procedure. Patients with adrenal metastases due to adenocarcinoma had improved survival compared with that in those with other histological cell types. Although long-term survival is generally poor, highly selected patients with adrenal metastasis (symptomatic disease or adenocarcinoma) may benefit from surgical resection.
Early postoperative plasma calcium concentration as a predictor of the need for calcium supplement after parathyroidectomy
Authors: Wong W K , Wong N A C S , Farndon J R 
Published: March 2007

Abstract
This study evaluated early postoperative serum calcium concentration as a predictor of hypocalcaemic symptoms and the need for calcium supplements. A total of 64 consecutive patients undergoing curative para- thyroidectomy for primary hyperparathyroidism were studied. Twenty patients (31 per cent) developed hypocalcaemic symptoms requiring calcium supplements. Plasma calcium levels in the preoperative and early postoperative periods were similar in patients who required calcium supplements and those in whom they were not necessary. There was no significant difference in the percentage decrease in early calcium levels after operation between the two groups. In those undergoing reoperative surgery and subtotal parathyroidectomy the percentage decline was significantly higher in patients who required calcium supplements (12.8 versus 5.6 percent, P &lt;0.005). A fall of 10 per cent or more was consistently followed by hypocalcaemic symptoms. Calcium determination in the early postoperative period is of little value in predicting the onset of hypocalcaemic symptoms.
Ultrasonographic carotid plaque morphology in predicting stroke risk
Authors: Geroulakos G , Hobson R W , Nicolaides A 
Published: March 2007

Abstract
A number of new studies have provided evidence which suggests that carotid plaque surface characteristics and internal structure, as seen on ultrasonography, contribute to the development of cerebrovascular endpoints. This review is a critical presentation of the evidence that has emerged so far supporting the hypothesis that the ultra-sonographic morphology of the carotid plaque may be an independent variable in predicting the risk of stroke. It is concluded that Ultrasonographic plaque morphology should be used together with other local risk factors in prospective natural history studies which aim to identify a subgroup of patients at high risk of stroke.
Adhesion molecules as determinants of disease: From molecular biology to surgical research
Authors: Menger M D , Vollmar B 
Published: March 2007

Abstract
Cellular adhesion is mediated by distinct cell surface receptors (adhesion molecules) and plays a pivotal role in the biological processes of morphogenesis, cell migration and cell-cell communication. During the past decade many adhesion molecules have been identified and structurally analysed. This has allowed an understanding of their role in the pathophysiology of disease, including inflammation and sepsis, ischaemia and reperfusion, transplant rejection, atherosclerosis and thrombosis, angiogenesis and wound healing, as well as carcinogenesis and tumour metastasis. Understanding of the molecular mechanisms of cellular communication is not only vital for advances in surgical pathophysiology, it also has the potential to widen the spectrum of diagnosis and therapy of disease. Analysis of expression of individual surface molecules may help in the diagnosis of transplant rejection and allow a prognostic determination of tumour progression and metastasis formation. Moreover, manipulation of adhesion molecule function by monoclonal antibodies, antisense oligonucleotides or single gene products may open the door for novel therapeutic regimens to prevent transplant rejection and ischaemia-, sepsis- and shock-induced tissue injury.
Spontaneous rupture of hepatocellular carcinoma
Authors: Zhu L X , Wang G S , Fan S T 
Published: March 2007

Abstract
Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening condition; the mechanism is not clear but it is suggested that rupture is usually preceded by rapid expansion of the tumour secondary to bleeding from within its substance. Diagnosis may be made by abdominal paracentesis, ultrasonography, computed tomography or angiography; the positive rates of diagnosis are 86, 66, 100 and 20 per cent respectively. Prognosis is poor. Based on treatment results reported in the literature, the mean survival time for patients who underwent hepatectomy, transcatheter arterial embolization (TAE) and conservative therapy were 247, 98 and 13 days respectively. Judging from the reported results the first choice for emergency treatment of haemostasis is TAE. If laparotomy is undertaken, hepatic artery ligation, preferably of the branch supplying the liver lobe bearing the tumour, should be considered, together with haemostasis of the rupture site by various means (suture plication, packing, argon beam coagulation, use of microwave or absolute ethanol). Emergency hepatectomy should be reserved for patients with an easily resectable lesion who are in a stable cardiovascular condition. Conservative therapy may be used for selected patients in extremely poor condition. The rational treatment for the majority of patients with ruptured HCC is TAE, followed by hepatectomy if the lesion is resectable.
Immune function early in acute pancreatitis
Authors: Widdison A L , Cunningham S 
Published: March 2007

Abstract
Circulating lymphocyte numbers and activation together with granulocyte function were measured in 20 patients in the early stages of an attack of acute pancreatitis and in 20 healthy controls. Circulating lymphocytes, T lymphocytes, and CD4 and CD8 T lymphocyte subsets were decreased in both mild pancreatitis (67–80 per cent of controls) and severe pancreatitis (22–40 per cent of controls). CD4: CD8 ratios were unchanged and median (interquartile range) interleukin 2 receptor expression was increased from less than 1 per cent in controls to 14(6) per cent in severe pancreatitis, suggesting lymphocyte activation. Median granulocyte chemiluminescence was increased to 293 per cent of controls in severe pancreatitis and random motility was reduced to 77 per cent of controls, indicating increased metabolic activity. Complement-mediated antibody-independent opsonization and chemotaxis toward endotoxin were normal. Immune function is not reduced early in acute pancreatitis. Granulocyte hyperactivity may be important in the development of multiple organ failure.
Role of segmental colonic transit time studies to select patients with slow transit constipation for partial left-sided or subtotal colectomy
Authors: de Graaf E J R , Gilberts E C A M , Schouten W R 
Published: March 2007

Abstract
This prospective study investigated the value of segmental colonic transit time studies in the surgical treatment of slow transit constipation. Overall, 346 patients with chronic constipation were analysed; slow transit constipation was diagnosed in 86 (25 per cent). Based on the results of segmental colonic transit time studies, 18 patients underwent partial left-sided colectomy and 24 subtotal colectomy. Recurrent constipation was seen in three of 18 patients and seven of 24 respectively. Severe abdominal discomfort was noted in six of 18 and 15 of 24 respectively. Disabling diarrhoea and faecal incontinence developed in two of 14 and five of 20 patients with an anastomosis respectively. Although these results indicate that segmental colonic transit time studies are useful in selecting patients with slow transit constipation for partial left-sided or subtotal colectomy, both procedures should be performed with prudence.
No obvious advantages for thoracoscopic two-stage oesophagectomy
Authors: Robertson G S M , Lloyd D M , Wicks A C B , Veitch P S 
Published: March 2007

Abstract
Thoracoscopically assisted Ivor-Lewis oesophagectomy potentially combines the pulmonary advantages of transhiatal oesophageal dissection, with the visibility and control permitted by thoracotomy. This study reviewed 17 patients who underwent this procedure with an intrathoracic anastomosis. Five patients required conversion to thoracotomy, four because of technical difficulties with the anastomosis. After operation 13 patients had radiological evidence of atelectasis, six developed a left pleural effusion and five had clinically significant pneumonia. Three patients developed an anastomotic leak, two of whom died giving an in-hospital mortality rate of 12 per cent. Median postoperative hospital stay was 12 days. Four patients developed benign anastomotic strictures requiring dilatation. The 1- and 2-year survival rates were 73 per cent (11 of 15 patients) and 63 per cent (five of eight) respectively. The use of minimal access techniques in this context does not appear to reduce the postoperative incidence of either pulmonary or anastomotic complications.
Strategies to decrease the incidence of intra-abdominal recurrence in resectable gastric cancer
Authors: Averbach A M , Jacquet P 
Published: March 2007

Abstract
Two main approaches are suggested to improve treatment results in resectable gastric cancer: extended lymph-adenectomy and adjuvant antitumour therapy. Progress is to some extent stalled by the perception of gastric cancer as a pathophysiologically uniform disease; it has been demonstrated, however, that there are variants of gastric cancer associated with predominantly intra-abdominal spread or with haematogenous metastases. Recent clinicopathological studies have provided information about the mechanisms of this metastatic diversity. A review of clinical trials suggests that no single method of treatment can efficiently address all variants of gastric cancer spread, but new treatment strategies may be based on defining the pathophysiological variant of gastric cancer and selecting adjuvant therapy according to the most probable mode of tumour spread. Treatment should start with surgery which includes a ‘reasonably’ extended lymphadenectomy aimed at achieving an increased rate of curative resection and more accurate staging. Risk factors for peritoneal spread of tumour require the perioperative use of intraperitoneal chemotherapy. Subsequent adjuvant therapy may be indicated in patients at high risk of further cancer spread or occult metastases, as determined by pathological examination of the resected specimen.
Resection of hepatocellular carcinoma in patients with cirrhosis
Authors: Balsells J , Charco R , Lazaro J L , Murio E , Vargas V , Allende E , Margarit C 
Published: March 2007

Abstract
Between 1987 and 1993, 53 hepatic resections for hepatocellular carcinoma (HCC) were performed in 51 patients with cirrhosis. Limited hepatic resection was performed in 66 per cent of patients. The postoperative mortality rate was 13 per cent. The tumours recurred in 27 patients (53 per cent), and the cumulative recurrence rate at 1 and 4 years was 41 and 89 per cent, respectively. Mean time to recurrence was 11·7 months and the most frequent site was the liver (21 patients). The only significant risk factor for recurrence was symptomatic tumours. The recurrence rate of HCC in patients with cirrhosis with surgical resection alone is high and actuarial survival at 4 years is very low. Other approaches to the treatment of HCC in patients with cirrhosis require consideration.
Use of glyceryl trinitrate ointment in the treatment of anal fissure
Authors: Lund J N , Armitage N C , Scholefield J H 
Published: March 2007

Abstract
Anal fissure is often treated surgically by sphincterotomy. There is growing concern over the effects of this procedure on continence. Nitric oxide donors such as glyceryl trinitrate are thought to cause a reversible ‘chemical sphincterotomy’, capable of healing the fissure. Twenty-one consecutive patients with chronic anal fissure (13 women, mean age 36 years) were treated for 4–6 weeks with 0·2 per cent glyceryl trinitrate ointment applied to the fissure twice daily. Maximum anal resting pressure (MARP) was measured before and after application of the ointment at the first visit. There were 16 posterior and five anterior fissures. Mean(s.d.) MARP fell from 118·7(45·0) to 70·3(34·1) cmH2O over 20 min after application of the ointment (P&lt;0·001). Healing was complete in 11 patients at 4 weeks and in 18 at 6 weeks. The fissure recurred in four patients after cessation of treatment; three were successfully treated by further glyceryl trinitrate. Mild headache occurred in four patients. Anal fissure can be successfully treated with 0·2 per cent glyceryl trinitrate ointment applied topically.
Prospective audit of discharge summary errors
Authors: Macaulay E M , Cooper G G , Engeset J , Naylor A R 
Published: March 2007

Abstract
During an 8-month interval of prospective audit, 63 of 637 (10 per cent) vascular discharge summaries were found to contain 94 errors. These comprised 11 (12 per cent) general errors, 21 (22 per cent) diagnostic errors, 19 (20 per cent) operative data errors, 19 (20 per cent) cases of incorrect clinical text information, 14 (15 per cent) missed complications and 10 (11 per cent) concerning follow-up arrangements. Overall, 2 per cent of consultant discharge summaries contained errors compared with 7 per cent for the senior registrar, 10 per cent for registrars and 17 per cent for senior house officers. Given that the majority of discharge summaries are currently prepared by junior staff, this study suggests that verification of the accuracy of clinical and management data should be an essential component of departmental audit meetings.
Experimental application of controlled limb reperfusion after incomplete ischaemia
Authors: Ihnken K , Beyersdorf F , Winkelmann B R , Mitrev Z , Unkelbach U 
Published: March 2007

Abstract
Severe local and systemic complications may occur after revascularization of extremities exposed to prolonged complete or incomplete ischaemia. These complications may be reduced by controlling the reperfusate and the circumstances of the reperfusion period. Ten adult German domestic pigs were exposed to 6 h of incomplete limb ischaemia by occlusion of the left iliac artery. To simulate the clinical situation of embolectomy, the occlusive snares were released after the ischaemic period in five pigs and normal blood flow developed with systemic pressure (uncontrolled reperfusion). In the other five pigs, a controlled reperfusate was delivered at controlled pressure before establishing normal blood reperfusion (controlled reperfusion). At the end of the observation period (90 min after start of reperfusion), the group with controlled reperfusion had a lower mean(s.e.m.) tissue water content (81·8(0·7) versus 84·3(0·7) per cent, P&lt;0·05, a greater increase in tissue adenosine 5′-triphosphate compared with values at the end of ischaemia (6·2(1·5) versus - 2·5(1·8) μmol per g protein, P&lt;0·03), a higher tissue pH (7·2(0·1) versus 6·8(0·1), P&lt;0·03), a smaller temperature decrease (0·3(0·2) versus 1·2(0·3)°C, P&lt;0·05), lower concentrations of creatine kinase (355·0(87·5) versus 624·4(73·4) units/1, P&lt;0·05) and lactate dehydrogenase (LDH) (369·5(42·5) versus 538·4(39·2 units/1, P&lt;0·03) in the femoral vein blood and lower LDH concentrations (356·5(48·9) versus 546·0(37·8 units/1, P&lt;0·03) in central venous blood. These data indicate that severe local and systemic damage occurs with uncontrolled (normal blood) reperfusion even after incomplete limb ischaemia, and that these changes can be reduced by delivering a controlled reperfusate under controlled conditions.
Limited operation for gastric cancer in the elderly
Authors: Tsujitani S , Katano K , Oka A , Ikeguchi M , Maeta M , Kaibara N 
Published: March 2007

Abstract
The relationship between operative procedures for treatment of patients with gastric carcinoma and complications was studied with special reference to the age of patients, who were divided into four groups: 50–59 years; 60–69 years; 70–79 years; and over 80 years. Preoperative risk factors that were common in patients over 70 years of age were hypertension and cardiac disease. The selected operative procedures were similar for each age group. However, neither proximal gastrectomy nor reconstruction by jejunal interposition was selected for patients of 80 years and over. In these patients, resection of the neighbouring organs was seldom performed and lymph node dissection was usually limited to the primary and secondary nodes. There was no significant difference in the rate of postoperative complications between groups. Although only limited surgery was performed for patients of 80 years and over, there was no significant difference in age-corrected cumulative survival rate between groups. Therefore, limited resection and/or lymph node dissection may allow safe surgical treatment for patients of 80 years and over with gastric carcinoma, without any negative effect on prognosis.
Incidence of clinical pulmonary embolism after laparoscopic surgery
Authors: Inderbitzin D T , Opitz I , Giger U , Kocher T , Krähenbühl L 
Published: March 2007

Abstract

Background
This study aimed to determine the incidence of pulmonary embolism (PE) following laparoscopic surgery and its potential risk factors.

Methods
Data concerning 44 453 patients from 114 surgical institutions were collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery. The incidence of postoperative PE despite thromboprophylaxis was evaluated and potential risk factors were assessed singly, and then in a consecutive stepwise logistic multiple regression analysis.

Results
Among 44 453 patients assessed, 55·8 per cent were female and 44·2 per cent were male. Interventions included cholecystectomy (52·8 per cent), hernia repair (17·7 per cent), appendicectomy (12·4 per cent), colonic surgery (4·6 per cent) and oesophageal surgery (5·5 per cent). Postoperative PE occurred in 86 patients (0·2 per cent), and the incidence tended to decrease during this study (P = 0·016). A total of 149 patients died (0·3 per cent) of which nine (6·0 per cent) were due to PE. Significant predictive risk factors were female sex (P &lt; 0·001), age (P &lt; 0·001), weight above 90 kg (P &lt; 0·001), emergency procedure (P &lt; 0·001) and operating time exceeding 150 min (P &lt; 0·001).

Conclusion
The low incidence of PE after laparoscopy, with a further decrease over the past decade, suggests a tendency towards improved perioperative thromboembolic risk management.
Closure of a coronary fistula with a transcatheter implantable coil
Authors: Van Den Brand M. , Pieterman H. , Suryapranata H. , Bogers A. J. J. C. 
Published: March 2007

AbstractLarge sized coronary artery fistulas are rare and diagnosed in only 0.05% of adult catheterized patients. Only a minority of these fistulas are operated upon. We describe a percutaneous technique to close a left coronary artery fistula draining into the right atrium in a 30‐yr‐old male patient. The fistula was closed by implantation of a trefoil coil, inserted through a catheter selectively advanced into the fistula.
Effect of exercise on indices of valvular aortic stenosis
Authors: Martin Timothy W. , Moody Joe M. , Bird Julio J. , Slife David , Murgo Joseph P. 
Published: March 2007

AbstractChanges in the physiologic state of the patient may affect indices of valvular aortic stenosis. We determined the effects of supine exercise on the Gorlin valve area, Cannon valve area, aortic valve resistance, and a modified stroke work loss index in 80 patients with aortic stenosis. Exercise caused a significant increase in the Gorlin and Cannon valve area, while work loss and valve resistance decreased significantly. The average percent change in work loss, 12.2%, was lower than the other indices (P < 0.02), i.e., 15.3% for valve resistance, 18.6% for the Gorlin area, and 19.3% for the Cannon area. The correlation between the rest and exercise measurements was highest for work loss (r = 0.94), compared to 0.93, 0.88, and 0.89 for the other 3 indices, respectively. In patients with a Gorlin area below 1 cm2, exercise caused a significant decrease in work loss, but not Cannon area or valve resistance. However, the percent change was significantly lower and the correlation was better with the work loss index. We conclude that the work loss index is less affected by supine exercise than other indices of aortic stenosis.