bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local recurrence of rectal adenocarcinoma after ‘curative’ surgery with and without preoperative radiotherapy
Authors: Holm T , Cedermark B , Rutqvist L-E 
Published: March 2007

Abstract
The natural history of locally recurrent rectal cancer was analysed to assess whether preoperative irradiation altered the clinical course of the disease. In a randomized controlled trial of 849 patients, the value of preoperative radiotherapy in those with operable rectal adenocarcinoma was examined. After a minimum follow-up of 4 years, 156 patients who developed local recurrence were studied retrospectively. There were no differences concerning symptoms and the site of local recurrence between irradiated and non-irradiated patients. Curative treatment was rarely possible and median survival was only about 1 year, irrespective of adjuvant treatment. Local recurrence was the only manifestation of disease in 30–50 per cent of patients. An earlier and more aggressive surgical approach might improve survival.
Canine model for treatment of faecal incontinence using transposed and electrically stimulated sartorius muscle
Authors: Konsten J , Baeten C G M I , Havenith M G , Soeters P B 
Published: March 2007

Abstract
A neosphincter was successfully created around each end of a Thiry-Vella loop in five dogs using transposed sartorius muscle to study new treatments for faecal incontinence. One of these dynamic neosphincters in each dog was electrically trained for 8 weeks while the other served as a control. Muscle biopsies demonstrated an increase in type 1 fatigue-resistant fibres from a median of 49 (range 37–54) per cent before electrical stimulation to 78 (range 53–99) per cent 8 weeks later in the stimulated sartorius neosphincters (P&lt;0.05), whereas the percentage of type 1 fibres in control neosphincters increased only slightly.
Retention times of saline increased from a median of 10 (range 5–50) s before to 340 (range 100–470) s after electrical stimulation (P&lt; 0.05) but also increased in control neosphincters (to 370 (range 330–1200) s); this may indicate that electrical stimulation immediately increases acute retention times. It is concluded that construction of a neosphincter is technically feasible with preservation of muscle morphology and that stimulation induces morphological and functional changes towards the characteristics of the external anal sphincter.
Short bowel syndrome: Metabolic and surgical management
Authors: Shanbhogue L K R , Molenaar J C 
Published: March 2007

Abstract
The management of short bowel syndrome requires long-term nutritional support and monitoring, medication, and occasionally additional surgical procedures. Constant attention is required to ensure adequate adaptation of the gut. This article reviews the normal function of the small bowel, adaptation following resection, total parenteral and enteral nutrition, and the role of adjunctive surgical procedures in the management of short bowel syndrome.
Malignant anal tumours
Authors: Deans G T , McAleer J J A , Spence R A J 
Published: March 2007

Abstract
Anal tumours represent 5 per cent of anorectal cancers and exist as two clinical entities: tumours of the anal canal and those of the anal margin. Smoking and sexual behaviour, particularly homosexual anal intercourse, are important aetiological factors. This association is related to anal warts and human papillomavirus infection, notably type 16, which is found in around 70 per cent of warts. Symptoms are non-specific and are frequently attributed to benign conditions. Rectal examination reveals a characteristically infiltrating lesion and any suspicious anal area should be biopsied. There are two histological types. Squamous carcinoma comprises approximately 95 per cent of anal tumours and includes the 35 per cent of tumours derived from the anal transition zone (cloacogenic tumours), containing a mixture of squamous and mucinous elements. The remaining 5 per cent of anal tumours are adenocarcinoma. Squamous cell tumours of the anal canal are probably best treated using radiotherapy (with chemotherapy) as complete response rates, 5-year survival rates, and incidences of normal sphincter function and significant toxicity are around 80, 70, 75 and 20 per cent respectively. Treatment failures may be salvaged by surgery. The 5-year survival and local recurrence rates for radical surgery are around 60 and 25 per cent respectively; there are few indications for local excision. In contrast, 60 per cent of anal margin tumours are suitable for local excision, the 5-year survival rate being in excess of 80 per cent. Combining radiotherapy with surgery may give additional benefit. Current randomized controlled trials should further clarify the relative merits and demerits of the treatment options.
Treatment and outcome of severe lower-limb ischaemia
Authors: Sayers R D , Thompson M M , Hartshorne T , Budd J S , Bell P R F 
Published: March 2007

Abstract
The overall outcome of severe lower limb ischaemia in terms of limb salvage and mortality is poorly documented. A consecutive series of 232 severely ischaemic legs in 209 patients was therefore studied. An aggressive policy of revascularizaon has been pursued; this was attempted in 89 per cent of legs, with a primary amputation rate of 8 per cent. The perioperative 30-day limb salvage rate was 79 per cent with a patient mortality rate of 20 per cent. At 12 and 24 months the limb salvage rates were 74 and 71 per cent and patient survival rates 75 and 73 per cent respectively. To identify high-risk groups the effects on limb salvage and mortality of age, sex, presentation, diabetes and ankle systolic pressure of 50 mmHg or less were studied. Using life-table analysis, none of the preoperative risk factors had an effect on limb salvage and mortality. An aggressive policy of revascularization provides excellent results in the treatment of patients with severe leg ischaemia.
Penetrating injuries of the subclavian vessels
Authors: Degiannis E , Velmahos G , Krawczykowski D , Levy R D , Souter I , Saadia R 
Published: March 2007

Abstract
A study was made of 76 patients with subclavian vessel injury. The mechanism of trauma was stabbing in 40 patients (53 per cent) and gunshot in 36 (47 per cent). There were marked differences between the two groups in clinical presentation, operative management and outcome. The group with gunshot injury was characterized by a more immediate threat to life, and a greater need for a median sternotomy and use of interposition grafts. The mortality rate in patients with gunshot wounds was more than twice that in the group with stab injury.
Extracranial carotid artery flow measurement during carotid endarterectomy using a Doppler ultrasonographic flowmeter
Authors: Whyman M R , Naylor A R , Ruckley C V , Wildsmith J A W 
Published: March 2007

Abstract
A study was performed to evaluate immediate changes in carotid artery blood flow after carotid endarterectomy using a Doppler ultrasonographic flowmeter. Forty-seven consecutive patients aged 49–78 (median 64) years with symptomatic internal carotid artery (ICA) stenosis underwent carotid endarterectomy. Volume flow, resistance and pulsatility index were measured in the common carotid artery (CCA) and ICA both before and after operation. ICA flow increased by 54 per cent (P&lt;0.01) and resistance decreased by 58 per cent (P = 0.01). CCA flow rose by 17 per cent (P = 0.1) and resistance fell by 21 per cent (P = 0.02). The pulsatility index did not change significantly. The Doppler ultrasonographic flowmeter offers a simple, non-invasive and convenient means of improving understanding of the immediate haemodynamic effects of carotid endarterectomy. It is useful in everyday practice to confirm the adequacy of endarterectomy, particularly in the absence of other methods of quality control. Duplex ultrasonography might still be necessary after surgery if the flowmeter does not demonstrate an increase in flow compared with the preoperative value.
Postoperative changes in resting energy expenditure and interleukin 6 level in infants
Authors: Jones M O , Pierro A , Hashim I A , Shenkin A , Lloyd D A 
Published: March 2007

Abstract
The relationship was determined between resting energy expenditure (REE) and interleukin (IL) 6 level following surgery in infants. Sixteen infants of mean(s.e.m.) weight 3.2(0.2) kg undergoing uncomplicated surgery were studied. The operative stress score was recorded and plasma IL-6 levels were measured before and 4, 8, 12 and 24 h after surgery. Respiratory gas exchange was measured by indirect calorimetry before and at 2, 4, 6, 8, 10, 12, 24 and 48 h. Urinary nitrogen excretion was measured and calculated. IL-6 levels increased significantly after surgery (P = 0.006) and were maximal at 12 h. There was a linear correlation between the increase in IL-6 level and operative severity score (r = 0.61, P = 0.012). REE increased significantly after operation (P0.001), peaking at 2–4 h, and returned to baseline levels by 12 h. The changes in REE preceded those in IL-6. IL-6 is a marker of the stress response in infants and may play a role in the subsequent modulation of this response.
Effect of surgical trauma on muscle protein synthesis in the rat
Authors: Emery P W , Ghusain-Choueiri A 
Published: March 2007

Abstract
The rate of protein synthesis in skeletal muscle was measured in vivo in rats at various times during the first 2 days after abdominal surgery. Protein synthesis in abdominal muscle at the site of the wound was slightly reduced 2 h after operation, had returned to normal by 24 h and was massively increased by 48 h after surgery. In contrast, there was no change at any time in the rate of protein synthesis in either the gastrocnemius muscle or abdominal muscle distant from the wound site. Surgery had no effect on the weight or protein content of the gastrocnemius muscle, although urinary nitrogen excretion was increased relative to food intake, indicating the presence of a net catabolic response. Changes in whole-body protein turnover in response to uncomplicated abdominal surgery are thus likely to reflect the anabolic processes of wound healing and repair as well as any catabolic response in uninjured tissues.
Non-radical therapy for early gastric cancer
Authors: Heesakkers J P F A , Gouma D J , Thunnissen F B J M , Bemelmans M H A , Von Meyenfeldt M F 
Published: March 2007

Abstract
To assess the potential benefit of R2 gastrectomy for patients with early gastric cancer, complications and long-term survival of patients who underwent conventional resection with limited lymphadenectomy (R1 gastrectomy) were analysed retrospectively. Resection margins of all 46 consecutive patients were free from tumour. Tumours were limited to the mucosa in 35 patients and infiltrated the submucosa in 11. Positive lymph nodes were found in two patients. The 30-day mortality was two patients, and cardiac and pulmonary complications occurred in five and six respectively. Anastomotic leakage developed in two patients. During 5 years of follow-up two patients died from tumour recurrence; one of these had lymph node metastases at the initial resection. Resection with limited lymphadenectomy for early gastric cancer results in a 91 per cent 5-year survival rate without the need for R2 gastrectomy with its probably higher morbidity and mortality.
Laparoscopic highly selective vagotomy
Authors: Dallemagne B , Weerts J M , Jehaes C , Markiewicz S , Lombard R 
Published: March 2007

Abstract
Between February 1991 and August 1992, 35 patients underwent laparoscopic highly selective vagotomy (HSV) for recurrent duodenal ulcer disease. An antireflux procedure was also performed in 25 of these patients. There was no 30-day mortality and morbidity. The mean operating time was 110 (range 85-205) min for HSV and 155 (range 100–300) min for vagotomy and antireflux repair. Follow-up is short but initial postoperative gastric acid secretion studies have demonstrated results similar to those obtained after conventional open HSV. The main advantage of laparoscopic HSV is the reduction of 70 per cent in hospital stay and 50 per cent in the overall recovery period compared with open surgery.
Effect of human leucocyte antigen matching on the incidence of acute rejection in renal transplantation
Authors: Beckingham I J , Dennis M J S , Bishop M C , Blamey R W , Smith S J , Nicholson M L 
Published: March 2007

Abstract
The influence of human leucocyte antigen (HLA) matching on the incidence of acute rejection and graft survival was examined in 181 consecutive patients receiving cadaveric renal transplants. Allografts with better HLA-DR and HLA-B matching showed significantly lower rejection rates than less well matched grafts on both univariate (rejection rates 25, 62 and 82 per cent for zero, one and two DR mismatches; P&lt;0·001) and multivariate analysis. Rejection episodes occurred earlier in mismatched grafts (P&lt;0·001). Superior matching was associated with improved graft function at 1 year after transplantation (mean serum creatinine level 137, 180 and 225 μmol l−1 for zero, one and two DR mismatches; P&lt;0·05). No association was, however, demonstrated between the degree of matching and overall graft survival. Good HLA matching reduces the number of acute rejections episodes, producing significant savings in drug costs and hospital stay. Long-term graft function is improved and minimizing early graft damage helps to avoid later development of chronic rejection.
Radical pancreatoduodenectomy for misdiagnosed pancreatic mass
Authors: Smith C D , Behrns K E , Van Heerden J A , Sarr M G 
Published: March 2007

Abstract
Occasionally pancreatoduodenectomy is performed for clinically suspected pancreatic malignancy only for the surgeon to find that a benign aetiology accounts for the pancreatic mass. The aim of this study was twofold: to determine the incidence of pancreatoduodenectomy performed for a misdiagnosis of pancreatoduodenal malignancy and to identify potentially avoidable errors in preoperative and intraoperative judgement. Between 1956 and 1990, radical pancreatoduodenectomy was performed in 603 patients at the Mayo Clinic; 29 (5 per cent) underwent pancreatoduodenectomy for a diagnosis made before and during surgery of primary pancreatic or periampullary malignancy that was later proven histopathologically to be either unsuspected subacute or chronic pancreatitis (22 patients), benign fibrous common bile duct stricture (two), and penetrating duodenal ulcer, metastatic melanoma, ampullary adenoma, intrahepatic drug-induced cholestasis and pseudocyst (one each). No patient had a preoperative diagnosis of chronic pancreatitis. Weight loss, pain and/or jaundice were present in 27 of the 29 patients. Objective imaging tests, such as computed tomography, ultrasonography and/or endoscopic retrograde cholangio-pancreatography, were performed in 25 patients. Potential errors in judgement may be avoided by a more aggressive attempt at biopsy in selected patients; in others, resection for presumed malignancy may be unavoidable.
Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones: A prospective study
Authors: Widdison A L , Longstaff A J , Armstrong C P 
Published: March 2007

Abstract
In patients with symptomatic gallstones the management of choledocholithiasis has been controversial since the introduction of laparoscopic cholecystectomy. A prospective study was made of 300 consecutive patients with symptomatic gallstones managed by laparoscopic cholecystectomy and preoperative endoscopic retrograde cholangiography (ERC) over 2 years. Fourteen patients were excluded either because urgent surgery was required or because they were unfit for laparoscopic cholecystectomy. ERC was performed on 96 patients (34 per cent) who were at risk of choledocholithiasis. The presence of bile duct calculi was confirmed in 59 patients (21 per cent of the total, 61 per cent of those undergoing ERC); stones were removed endoscopically in 53 cases (90 per cent of attempts). The remaining six patients underwent open cholecystectomy and bile duct exploration. Laparoscopic cholecystectomy was attempted in 280 patients (98 per cent); it was necessary to convert to open operation in only three (1 per cent). There were no deaths, no retained stones and no bile duct injuries, and only three patients (1 per cent) developed a significant postoperative complication. Symptomatic gallstones can be managed by preoperative ERC and laparoscopic cholecystectomy with minimal morbidity and mortality.
Abdominal wall metastases following laparoscopy
Authors: Nduka C C , Monson J R T , Menzies-Gow N , Darzi A 
Published: March 2007

Abstract
Only 18 cases of recurrence at the sites of cannula insertion after laparoscopy have been reported in the literature, ten of them in the past year. The period between laparoscopic surgery and presentation of wound metastasis varies widely, from 7 days to 10 months; the lesions are typically hard, craggy and painful. The most likely mechanism is direct implantation of viable exfoliated tumour cells but three aspects specific to laparoscopy may also be important. First, there may be increased exfoliation of tumour cells following manipulation by laparoscopic instruments of an unsuspected malignancy. Second, there may be repeated close contact between tumour-laden instruments and the port. Third, the passage of resected tissue through a small incision may coat the wound with potentially malignant cells.
Variation in outcome of surgical procedures
Authors: Houghton A 
Published: March 2007

Abstract
Evidence regarding the relationship between outcome and the number (volume) of patients treated at individual hospitals or by individual surgeons is reviewed and the interplay of other factors such as hospital characteristics, population profiles and referral preferences examined. An inverse relationship between mortality rate and hospital volume has repeatedly been found and, while there have been similar findings for surgeon volume, these results have been less consistent. What is certain is that wide variation in outcome does occur. What is less clear is whether the relationship to volume is a causal one or whether it is due to other factors such as those mentioned above. Despite there being a great deal that we do not understand about these relationships, considerable action has been taken as a result of the studies reported here, in the USA in particular. This has taken the form of rationalization of services, publication of hospital mortality rates and the setting of minimum numbers of specific procedures that should be performed each year by individual surgeons. Understanding of this area should be much greater before rationalization is considered in the name of higher quality and before mortality rates according to hospital or surgeon are published.
Intestinal anastomosis with a skin stapler: A safe and efficient method in humans
Authors: Fraser I 
Published: March 2007

Abstract
A method of intestinal anastomosis with a skin stapler has been used successfully in 39 patients to form 40 anastomoses. The method has been employed in elective and emergency surgery, in small and large intestine, for a variety of pathological conditions and in the presence of obstruction, sepsis and soiling. Bowel anastomosis with a skin stapler is safe, simple and efficient in time and materials.
Repeated reconstruction for recurrent benign bile duct stricture
Authors: Kozicki I , Bielecki K , Kawalski A , Krolicki L 
Published: March 2007

Abstract
Since 1965, 101 operations for benign bile duct stricture have been performed, including 51 Roux-en-Y end-to-side hepaticojejunostomies. Complete follow-up to a mean of 12·5 years has been achieved. Nine patients required reoperation for stricture; the total cumulative late patency rate was 90 per cent, including successful repair. Seven of the nine patients who underwent a second operation had a favourable outcome. Early hepaticojejunostomy is a satisfactory treatment for recurrent biliary stricture.
Endoluminal ultrasonography in the follow-up of patients with rectal cancer
Authors: Ramirez J M , McC Mortensen N J , Takeuchi N , Humphreys M M Smilgin 
Published: March 2007

Abstract
One principal aim in follow-up after curative surgery for colorectal cancer is to identify recurrent disease at an early and possibly treatable stage. The major problem for patients with rectal carcinoma is local recurrence, which occurs in 3–30 per cent of cases and carries a 5-year survival rate of less than 5 per cent. Since 1989, in addition to digital and sigmoidoscopic examination, endorectal ultrasonography has routinely been used in the follow-up of patients with rectal cancer. Sixty-six patients (40 men) who had undergone attempted radical surgery for mid- and lower-third rectal cancer were included in the study. The mean age was 68 (range 43–87) years. A total of 190 scans were performed, with a mean of 3 (range 1–9) for each patient. Thirteen (20 per cent) of the 66 patients developed local recurrence; in all cases this was suggested by rectal ultrasonography. Digital examination and rigid sigmoidoscopy failed to detect recurrence in three patients. Four detected recurrences were treated radically; the remaining patients received radiotherapy, palliative transanal resection or laser management because of advanced age or refusal to undergo surgery. Six patients were alive a mean of 21 (range 4–50) months after recurrence. Of these six patients, four were free from disease (three had undergone salvage surgery and one radiotherapy). Postoperative rectal ultrasonography can detect some local recurrences at an early treatable stage. The method is more accurate than digital examination and sigmoidoscopy, and should be used as part of a regular follow-up programme.
Inappropriate neutrophil activation in venous disease
Authors: Whiston R J , Hallett M B , Davies E V , Harding K G , Lane I F 
Published: March 2007

Abstract
Neutrophil oxygen radical production was studied in 18 limbs with class 2 or 3 venous disease and compared with that of nine normal limbs. Neutrophils were isolated from arm and leg venous samples. Free radical production was determined using chemiluminescence after stimulation with the chemotactic peptide formyl-methionyl–leucyl–phenyl-alanine (FMLP) or the ester phorbol myristate acetate (PMA). The ratio of leg to arm luminescence was greater after FMLP stimulation in patients with venous disease median 1·52 (95 per cent confidence interval (c.i.) 1·27–2·60)) than in controls (median 0·97 (95 per cent c.i. 0·70–1·12); P &lt; 0·01). These changes were not observed with PMA (venous disease 1·16 (95 per cent c.i. 1·05–1·40); controls 0·95 (95 per cent c.i. 0·78–1·24)). There were fewer FMLP receptors on activated leg neutrophils (median 20·19 (95 per cent c.i. 3·58–51·42) fluorescence units) than arm neutrophils (median 36·03 (95 per cent c.i. 13·00–65·28) fluorescence units; P &lt; 0·05), indicating an amplification of signal transduction. Intracellular calcium imaging demonstrated a larger release of calcium after stimulation of leg neutrophils (median 25·0 per cent (95 per cent c.i. 15·7–43·9 per cent)) compared with neutrophils from the arm (median 8·0 per cent (95 per cent c.i. 5·6–16·1 per cent); P = 0·04), demonstrating calcium-dependent activation. Neutrophils in patients with chronic venous disease inappropriately produce more oxygen free radicals as a result of amplification of a calcium-dependent signal pathway.