bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized study of the value of laparoscopy before appendicectomy
Authors: Olsen J B , Myrén C J , Haahr P E 
Published: March 2007

Abstract
Two groups of 30 women with clinical signs of appendicitis were randomized to immediate appendicectomy or diagnostic laparoscopy. In the latter group, appendicectomy was performed if a diagnosis of acute appendicitis was established or if the appendix could not be visualized. Eleven patients undergoing immediate operation had unnecessary appendicectomy, compared with two having laparoscopy. This difference of 30 per cent (95 per cent confidence interval 11–49 per cent) was significant (P = 0.01). There was no significant difference in postoperative morbidity rate in the two groups. Diagnostic laparoscopy is a useful preliminary investigation in women with clinical signs of acute appendicitis.
Management of superficial femoral artery occlusive disease
Authors: van der Heijden F H W M , Eikelboom B C , Banga J D , Mali W P Th M 
Published: March 2007

Abstract
The prevalence of intermittent claudication in men aged 55–74 years is 4·5 per cent and a common cause of such claudication is superficial femoral artery (SFA) occlusive disease. The preferred management of patients with this condition remains a subject of discussion. Therapeutic options range from conservative treatment to endovascular intervention and surgical bypass or endarterectomy. Conservative therapy is the primary treatment of choice. However, if this fails and an endovascular technique is chosen, percutaneous transluminal angioplasty (PTA) is the best option; other endovascular methods have failed to achieve higher rates of technical success or patency. PTA should be considered only for short lesions (⩽10 cm). The usual surgical option for SFA occlusive disease is femoropopliteal bypass using autogenous vein, which has an expected 5-year patency rate of 56–76 per cent. Patency rates decrease if other types of graft are used. An alternative to vein bypass is endarterectomy, with an expected 5-year patency rate of 35–71 per cent. A multicentre randomized trial should be conducted to determine the optimal management of claudication caused by SFA occlusive disease.
Scar formation after breast-conserving surgery for cancer
Authors:   Sir Charles Gairdner Hospital Breast Cancer Group, Orford J E , Ingram D M , Kaard A O , Sheiner H J 
Published: March 2007

Abstract
A study of surgery for breast cancer was performed to examine the influence of haematoma formation and radiotherapy on the development of mammographically detected scars. Fifty-nine women undergoing lumpectomy and radiotherapy were studied. Sixteen had mammographic scars 12 months after surgery. There was a correlation between postoperative haematoma formation and scarring (P = 0·03) but not between tumour size and scarring. The type of radiation therapy did not influence scar formation.
Surgical reintervention for differentiated thyroid cancer
Authors: Goretzki P E , Simon D , Frilling A , Witte J , Reiners C , Grussendorf M , Horster F A , Röher H-D 
Published: March 2007

Abstract
Reoperation was performed in 110 of 185 patients with a differentiated thyroid carcinoma. In 25 patients (23 per cent) the indication for reintervention was a large thyroid remnant and in the other 85 (77 per cent) persistent or recurrent cancer was suspected. In 32 (29 per cent) of the 110 patients undergoing reoperation no evidence of cancer tissue was found. Tumour tissue in 33 patients (30 per cent) was resectable. Of 45 patients (41 per cent) with residual tumour after operation 24 showed only occult thyroid carcinoma with a raised serum thyroglobulin level. Eight of 21 patients with macroscopically persistent tumour died from the disease during a mean follow-up of 2·3 years. In 13 of 38 patients the investigated recurrent tumours were histologically less differentiated than the primary lesions, stressing the importance of total tumour clearance. The treatment of choice for persistent and recurrent differentiated thyroid carcinoma is surgical reintervention, if feasible, before radioiodine and radiation therapy are considered.
Elective hepatic resection for benign and malignant liver disease: Early results
Authors: Habib N A , Koh M K , Zografos G , Awad R W , Bottino G 
Published: March 2007

Abstract
Between August 1989 and April 1992, 60 consecutive elective hepatic resections were performed by one surgeon at two hospitals. This personal series was reviewed to determine the early results of elective hepatic resection. There were 17 patients with liver metastases from colorectal cancer, 14 with hepatocellular carcinoma (three with cirrhosis), seven with cholangiocarcinoma, six with carcinoma of the gallbladder plus liver involvement, ten with liver metastases from other sites and six with benign conditions of the liver. Thirty-eight patients underwent major liver resection, seven unisegmentectomy, six bisegmentectomy, four trisegmentectomy an five non-anatomical resection. Total vascular exclusion was used in 50 cases and the Pringle manoeuvre in ten. The mean(s.d.) operative blood transfusion was 990(1260) ml packed red blood cells (range 0–13 units); 17 patients did not receive blood transfusion. There were two operative deaths; non-fatal complications developed in 16 patients. The two deaths were from postoperative liver failure and there was no other hospital death.
Profiles of workload in general surgery from linked hospital statistics
Authors: Goldacre M J , Ferguson J A , Welch A , Kettlewell M G W 
Published: March 2007

Abstract
Data from the Oxford Record Linkage Study between 1976 and 1986 were used to analyse statistical profiles of hospital care, taking account of multiple admissions per patient. Admission rates were higher in the elderly than the young, they were higher for men than women, and they increased over time. Episode-based admission rates increased by 15·5 per cent and person-based rates by 11·6 per cent. Most of the increase therefore represented a real rise in the number of people treated rather than an increase in multiple admissions per person. In the latest year of the study there was a mean of 125 admissions per annum per 100 male patients admitted and of 118 admissions per annum per 100 female patients admitted. The mean length of stay per admission and the total time spent in hospital per person per annum declined substantially from 1976 to 1986. Admission rates for prostatectomy, colectomy and varicose vein surgery increased signficantly and those for appendicectomy, cholecystectomy and peptic ulcer decreased significantly.
Acute limb deterioration during intra-arterial thrombolysis
Authors: Galland R B , Earnshaw J J , Baird R N , Lonsdale R J , Hopkinson B R , Giddings A E B , Dawson K J , Hamilton G 
Published: March 2007

AbstractApproximately 12 per cent of limbs undergoing intra-arterial thrombolysis (IAT) develop distal embolism or extension of thrombus during the procedure. These are usually of little clinical consequence and can be treated by increasing the rate of administration of the lytic agent. However, in some patients the clinical condition of the limb deteriorates rapidly. In an attempt to define the incidence of acute limb deterioration during IAT, information was collected from five centres in the UK with experience of the technique. A total of 866 treatments were recorded, with 20 limbs (2·3 per cent) undergoing acute deterioration. This complication was more common during the treatment of thrombosed popliteal aneurysm than during that of emboli or thrombosed atheromatous arteries or grafts (P &lt;0·001). The amputation rate associated with the complication was high, and operative intervention provided better results than continuation of lysis.
Anterior versus posterior reconstruction after transhiatal oesophagectomy: A randomized controlled trial
Authors: Bartels H , Thorban S , Siewert J R 
Published: March 2007

Abstract
In a prospective randomized trial the clinical results after transhiatal oesophagectomy with reconstruction in the anterior mediastinum (51 patients) or posterior mediastinum (45 patients) were compared. There were no differences in age, preoperative risk factors, tumour stage and local (surgical) complications between the two groups. However, reconstruction in the posterior mediastinum was associated with significantly fewer days spent in the intensive therapy unit (9 versus 14), fewer cardiopulmonary complications (13 versus 25 per cent) and lower mortality (30-day mortality rate 2 versus 6 per cent; hospital mortality rate 4 versus 10 per cent). These data show superiority of reconstruction in the posterior mediastinum after transhiatal oesophagectomy. This route is strongly recommended, particularly for patients with cardiopulmonary risk factors.
Extensive versus limited lymph node dissection for gastric cancer: A comparative study of 320 patients
Authors: Pacelli F , Doglietto G B , Bellantone R , Alfieri S , Sgadari A , Crucitti F 
Published: March 2007

Abstract
To compare extensive with limited lymph node dissection in the surgical treatment of gastric cancer, 320 patients undergoing gastric resection during 1981–1990 were divided into two groups. Although patients undergoing extended lymphadenectomy (n = 157) had a longer operating time (P = 0·0001) and a greater intraoperative blood transfusion requirement (P = 0·009) than those receiving limited dissection (n = 163), the incidence of postoperative complications (22·3 versus 28·2 per cent, P = 0·13) and the hospital mortality rate (3·8 versus 7·4 per cent, P = 0·12) were similar in the two groups. The 5-year survival rate after curative resection (117 and 121 patients after extensive and limited lymph node dissection respectively) was 65·4 versus 50·1 per cent (P = 0·01): 85·9 versus 82·2 per cent for stage I disease (P = 0·60), 66·1 versus 57·8 per cent for stage II (P = 0·82) and 48·7 versus 29·8 per cent for stage III (P = 0·02). Multivariate analysis using the Cox model showed that the extent of lymphadenectomy was an independent prognostic factor for survival (P = 0·01). The results support the value of extensive lymph node dissection in the surgical treatment of gastric carcinoma.
Computed tomography and fine-needle aspiration cytology for preoperative evaluation of cystic tumours of the pancreas
Authors: Iselin C E , Meyer P , Hauser H , Kurt A-M , Vermeulen B J M , Rohner A 
Published: March 2007

Abstract
Cystic neoplasms of the pancreas are rare. They may present as a mucinous (malignant or potentially malignant) tumour or as benign serous cystadenoma. Accurate preoperative diagnosis is therefore essential, as an asymptomatic serous tumour may safely be followed clinically for years, whereas mucinous tumours require aggressive surgery. Thirteen patients with cystadenoma and cystadenocarcinoma of the pancreas were reviewed and how best to improve the rate of preoperative diagnosis was considered. Fine-needle aspiration cytology and computed tomography enable accurate preoperative distinction between mucinous and serous cystic tumours of the pancreas.
Complications of circumcision
Authors: Williams N , Kapila L 
Published: March 2007

Abstract
Circumcision remains a common operation, with over 30000 procedures performed annually in the UK, mostly on children. The British Medical Association has recommended that circumcision should be performed only for medical reasons. Despite this, controversy exists over whether too many circumcisions are being performed. Are patients being exposed to an unnecessary operation? It may be argued that in doubtful cases it is easier to proceed to circumcision on the assumption that the attendant risks are low, but the operation is associated with a definite morbidity and rare deaths have been reported. This review considers the spectrum of complications that may result from circumcision and discusses the possible aetiological mechanisms.
Multidrug-resistant colonic cancer cell line LoVoDx is efficiently killed by lymphokine-activated killer cells from patients with carcinoma of the colon
Authors: Mooney E F , Dye J F , Guillou P J , Monson J R T 
Published: March 2007

Abstract
Multidrug-resistant (MDR+) cancer cells have the ability to grow in the presence of cytotoxic concentrations of antineoplastic drugs as a result of possessing the transmembrane drug efflux pump p-glycoprotein. The MDR+ colonic cancer cell line LoVoDx (derived from the drug-sensitive line LoVo) was tested for sensitivity to lymphokine-activated killer (LAK) cell-mediated toxicity. LAK cells were cultured from patients with colonic cancer and from matched controls with benig disorders. LAK cells from patients with cancer were as effective as those from controls in mediating cytotoxicity. The MDR+ cell line was significantly more sensitive to LAK cell-mediated cell killing than its parental drug-sensitive line LoVo (P &lt; 0.05). These results indicate a possible role for adoptive immunotherapy in MDR+ tumours expressing p-glycoprotein.
Changing trends in the management of lower-limb ischaemia: A 17-year review
Authors: Sayers R D , Thompson M M , Varty K , Jagger C , Bell P R F 
Published: March 2007

Abstract
Over a 17-year period, 2930 vascular procedures were performed for chronic lower-limb occlusive disease. During this time, the total vascular surgical workload rose significantly as a result of an increase in the rates of arterial reconstruction and percutaneous transluminal angioplasty. Although the major lower-limb amputation rate did not change significantly, there was a decrease in the above- to below-knee ratio. In addition, there were significant increases in the percentage of patients treated over the age of 75 years and the proportion of attempted revascularizations before amputation. The mortality rates for arterial reconstruction, percutaneous transluminal angioplasty and amputation did not change significantly during the study period. The duration of hospital stay increased significantly for patients undergoing amputation and decreased significantly for those receiving arterial reconstruction.
Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography
Authors: Geroulakos G , Ramaswami G , Nicolaides A , James K , Labropoulos N , Belcaro G , Holloway M 
Published: March 2007

Abstract
High-resolution ultrasonography was used to classify carotid plaques into five different types in 72 patients with symptoms and in 49 without, and with stenosis of the origin of the internal carotid artery &lt; 70 per cent. There were 72 plaques in the symptomatic group and 75 in the asymptomatic group. Type 1 plaques were uniformly echolucent, type 2 predominantly echolucent, type 3 predominantly echogenic, type 4 uniformly echogenic and type 5 consisted of plaques that could not be classified owing to heavy calcification and acoustic shadows. Type 1 Plaque was found in 90 per cent of patients with symptoms and in 10 per cent of those without, type 2 plaque was found in 53 and 47 per cent, type 3 in 34 and 66 per cent, and type 4 in 5 and 95 per cent respectively. The preponderance of echolucent plaques in symptomatic patients with stenosis &lt; 70 per cent supports the hypothesis that this type of plaque is unstable and tends to embolize. In contrast, in patients without symptoms there is preponderance of echogenic plaques.
Serial imaging of the carotid bifurcation and cerebrovascular reserve after carotid endarterectomy
Authors: Naylor A R , Merrick M V , Sandercock P A G , Gillespie I , Allen P , Griffin T M G , Ruckley C V 
Published: March 2007

Abstract
A radioisotopic method of quantifying mean cerebral transit time was used to assess the immediate effects of carotid endarterectomy on cerebrovascular reserve (CVR) in 69 patients. In addition, serial postoperative data were acquired on CVR, clinical status and non-invasive imaging of the internal carotid arteries in 56 patients over a period of 6–48 (median 24) months. Twenty-one patients (30 per cent) had preoperative evidence of impaired CVR in the symptomatic hemisphere. Within 4 days of surgery, however, reserve had returned to normal in 17 of the 21 patients. During follow-up, four of the 56 patients developed recurrent stenosis (&lt; 50 per cent) or occlusion of the artery operated on but only two of these had impairment of CVR and none was symptomatic. Three patients suffered recurrent transient ischaemic attacks (TIAs) but none had recurrent internal carotid artery disease or impaired CVR. One patient suffered a TIA in the territory of the non-operated artery during follow-up in association with disease progression and CVR impairment. However, the TIA preceded recognition of either of these changes. Twelve other patients had (or developed) stenosis (&gt; 50 per cent) in the non-operated artery during follow-up but none was symptomatic or developed impairment of CVR. Although assessment of CVR provided useful information on the frequency of haemodynamic compromise before carotid endarterectomy and on the natural history of disease progression, neither serial assessment of reserve nor non-invasive imaging of the carotid bifurcation influenced clinical practice during follow-up.
Suture length to wound length ratio and healing of midline laparotomy incisions
Authors: Israelsson L A , Jonsson T 
Published: March 2007

Abstract
The effect of suture length to wound length ratio on the healing of midline laparotomy wounds closed with a continuous suture was evaluated in a prospective clinical trial. All patients undergoing abdominal procedures through a midline incision were included except those with an incisional hernia after previous midline operation. The total incidence of wound infection was 36 of 454 patients (7·9 per cent) and wound dehiscence requiring reoperation occurred in three patients (0·7 per cent). Incisional hernia was found in 18.7 per cent of 363 patients alive 12 months after surgery. Multivariate analysis identified the suture length to wound length ratio, age and major wound infection as independent risk factors for the development of hernia, which occurred in 9.0 per cent of patients when the suture length to wound length ratio was ≧ 4 and in 23·7 per cent (P = 0·001) when it was &lt;4. The suture length to wound length ratio is an important parameter for healing of midline incisions closed with a continuous suture technique. The incidence of incisional hernia is lower when such wounds are sutured with a ratio ≧ 4.
Complications and survival of multilumen central venous catheters used for total parenteral nutrition
Authors: Savage A P , Picard M , Hopkins C C , Malt R A 
Published: March 2007

Abstract
In a prospective study of 879 triple-lumen catheters, 219 pulmonary artery catheters, 31 double-lumen and six single-lumen catheters used for the administration of total parenteral nutrition over a 1-year period, the overall complication rate was 12-5 per cent (14-7 complications per 1000 catheter-days) and the catheter-related sepsis rate 4·4 per cent (5·2 per 1000 catheter-days). The probability of development of catheter-related sepsis did not increase with the duration of catheterization. There were no differences in the rate of complications associated with 427 catheters changed by replacement at a new site compared with 159 lines changed over a guidewire. These data support the use of multilumen central venous catheters for the administration of total parenteral nutrition. They suggest that a routine weekly change of line is unnecessary; catheters should be changed only on the development of a complication. When it is required, a catheter should be changed by replacement over a guidewire.
Early wound excision and skin grafting restores cellular immunity after severe burn trauma
Authors: Cetinkale O , Ulualp K M , Ayan F , Düren M , Cizmeci O , Pusane A 
Published: March 2007

Abstract
Suppression of cellular immunity following thermal injury may contribute to the high incidence of postburn sepsis. Early excision and skin grafting may remove deleterious local wound factors and prevent immunosuppression. The effect on cellular immunity of early burn wound excision and skin grafting was investigated in an animal model using female Wistar rats. The development of immunosuppression shortly after burn injury was shown by popliteal lymph node assay and a 2,4-dinitrofluorobenzene skin reaction test. Excision and skin grafting 2 days after burn trauma restored parameters to normal. Burned tissue suppresses cellular immunity; this effect is preventable by early excision and skin grafting.
Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma
Authors:   Swedish Rectal Cancer Trial, Påhlman L 
Published: March 2007

Abstract
Between March 1987 and February 1990, 1168 patients with resectable rectal cancer were recruited into a nationwide Swedish trial. Patients were randomly allocated to receive either preoperative irradiation (25 Gy infive fractions over 1 week) followed by surgery within 1 week, or surgery alone. In each group 454 patients underwent curative surgery. The groups were well matched for age, sex and surgical procedure. The postoperative mortality rates did not differ: 4 per cent after irradiation versus 3 per cent after surgery alone, but the postoperative mortality rate was significantly higher in patients treated with a two- rather than three- or four-portal technique (15 versus 3 per cent, P &lt; 0·001). More perineal wound infections were found in patients receiving irradiation (20 versus 10 per cent, P &lt; 0·001). No difference in the incidence of anastomotic dehiscence or other postoperative complication was found between the groups. Preoperative radiotherapy with a short-term high-dose technique can be delivered without major acute adverse effects, provided the irradiation technique is optimized.
In vitro response of the human and canal longitudinal muscle layer to cholinergic and adrenergic stimulation: Evidence of sphincter specialization
Authors: O'Kelly T J , Brading A , Mortensen N J McC 
Published: March 2007

Abstract
A study was performed to determine the in vitro response of the longitudinal smooth muscle layer (conjoined longitudinal coat) of the human anal canal to cholinergic and adrenergic stimulation, and to compare this with similar features of the internal anal sphincter (IAS) and rectal smooth muscle. Tissue was obtained from abdominoperineal and anterior resection specimens, and strips of muscle mounted for isometric tension recording in superfusion organ baths. Both conjoined longitudinal coat and IAS strips generated and maintained spontaneous myogenic tension (mean(s.e.m.) 0·10(0·01) and 0·48(0·04) g per mg tissue respectively), whereas equivalent rectal smooth muscle did not. Stimulation of muscarinic (cholinergic) receptors caused contraction of strips from the conjoined longitudinal coat and rectal smooth muscle layers in a dose-dependent manner (10−7-10−4 mol/l); however, IAS strips relaxed (10−6-10−4 mol/l). Activation of α-adrenergic receptors in conjoined longitudinal coat and IAS strips produced concentration-dependent contraction (10−7 -10−4 mol/l). In comparison, rectal smooth muscle relaxed. All muscle layers relaxed in response to β-adrenoceptor stimulation. These data indicate that in the anal canal both the conjoined longitudinal coat and IAS are specialized sphincteric smooth muscles.