bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loss of substance in bile ducts treated by a new surgical endoprosthesis
Authors: Sezeur A , Kracht M , Rey P , Leandri J , Malafosse M 
Published: March 2007

Abstract
Three cases of loss of substance of the common bile duct in patients with neoplastic disease treated by a new surgical endoprosthesis are reported. In all patients a good biliary drainage was obtained without a biliary fistula. There were no complications related to this method. Long-term follow-up showed persistence of the good immediate results. Surgical endoprostheses might be an alternative in cases with peroperative loss of substance of the common bile duct in patients with neoplastic disease to hepato-enteric anastomoses.
Fascia closure after midline laparotomy: Results of a randomized trial
Authors: Wissing Joke , van Vroonhoven Th J M V , Schattenkerk M Eeftinck , Veen H F , Ponsen R J G , Jeekel J 
Published: March 2007

Abstract
Four techniques to close the fascia after midline laparotomy were compared in a prospective randomized multicentre trial. The four techniques were: interrupted closure with polyglactin; continuous closure with polyglactin; continuous closure with polydioxanone-s, and continuous closure with nylon. The early postoperative results in 1491 patients revealed an incidence of wound infection of 8·6 per cent and of wound dehiscence of 2·3 per cent with no statistically significant differences between the four techniques. We reviewed 1156 patients after 1 year. Wound pain was present in 9·7 per cent of the patients, statistically significantly more in the group closed with nylon (16·7 per cent). Suture sinuses developed in 3·5 per cent of the patients, statistically significantly more frequently in the nylon group (7·7 per cent). The total number of incisional hernias detected 1 year postoperatively was high (15·2 per cent) (interrupted polyglactin 16·9 per cent, continuous polyglactin 20·6 per cent, continuous polydioxanone 13·2 per cent and continuous nylon 10·3 per cent). The difference between nylon and continuous polyglactin is statistically significant. The results of this trial indicate that although nylon has the lowest incidence of incisional hernia it also is associated with more wound pain and suture sinuses.
Salvage autotransfusion in aortic surgery: Initial studies using a disposable reservoir
Authors: Clifford P C , Kruger A R , Smith A , Chant A D B , Webster J H H 
Published: March 2007

Abstract
Transmission of disease by allogeneic transfusion can be avoided using several techniques by which a patient receives his own blood. Sixty patients undergoing aortic surgery consented to salvage interoperative autotransfusion. A mean of 895 ml shed blood was reinfused under full heparinization, representing 12-74 per cent of total blood loss. Bank blood requirements fell from 4·9 units to 3·4. No important haematological or clinical complications were noted (including coagulation studies) but haemolysis was detected 4 h postoperatively by plasma haemoglobin levels of 0·05 ± 0·03 g/dl. This preliminary study confirms the applicability of salvage autotransfusion during elective vascular surgery by demonstrating an appreciable saving in bank blood transfusion (70 per cent).
Node dissection in gastric cancer
Authors: De Aretxabala X , Konishi K , Yonemura Y , Ueno K , Yagi M , Noguchi M , Miwa K , Miyazaki I 
Published: March 2007

Abstract
Three hundred patients who underwent absolute and relative curative gastrectomy and lymph node dissection for gastric cancer were reviewed with respect to postoperative mortality; proportion of patients with node involvement according to the extent of dissection; number of metastatic nodes dissected according to the extent of dissection; accuracy of macroscopic evaluation of node involvement and microscopic node involvement according to tumour location. If more nodes were dissected the proportion of patients with node involvement and the total number of metastatic nodes increased; conversely within R0 and R3 the extent of dissection did not affect postoperative survival. Finally when the presence and extent of node involvement was only macroscopically evaluated, the patients were classified incorrectly in 9·5 per cent of the N0 group and 20·2 per cent of the N1 group. The data suggest that lymph node dissection may be useful in the treatment of gastric cancer, and within the extent studied the employment of this procedure does not affect the postoperative mortality.
Barrett's oesophagus: pH profile
Authors: Gillen P , Keeling P , Byrne P J , Hennessy T P J 
Published: March 2007

Abstract
Twenty-four patients with a columnar-lined (Barrett's) oesophagus underwent oesophageal manometry and 24 h ambulatory oesophageal pH monitoring. The results were compared with 25 patients with oesophagitis studied in the same fashion. No significant difference in lower oesophageal sphincter pressure was demonstrated between the two groups. The Barrett's patients demonstrated significantly greater acid exposure in the distal oesophagus than oesophagitis patients. Clearance of refluxed acid was poorer in Barrett's patients than oesophagitis patients. Twelve of the Barrett's patients presented with complications of the condition, i.e. ulceration or stricture. No significant difference in acid exposure was demonstrated between Barrett's patients with or without complications. These results suggest that patients with columnar-lined (Barrett's) oesophagus have greater acid exposure than patients with oesophagitis. The development of complications of a Barrett's oesophagus may not be dependent on acid reflux alone.
Late results of mesocaval interposition shunting for bleeding oesophageal varices
Authors: Terpstra O T , Ausema B , Bruining H A , Laméris J S , Reuvers C B , Schalm S W , van Urk H , Wilson J H P 
Published: March 2007

Abstract
Survival, encephalopathy and shunt patency were studied in 64 consecutive patients who underwent mesocaval shunting with a wide-calibre Dacron® prosthesis. Half of the patients were operated as emergency cases. Operative blood loss in patients who had emergency procedures was significantly higher than during elective operations. Overall, 30-day mortality was 27 per cent. Survival was 61 per cent after 1 year and 39 per cent after 5 years. Serious encephalopathy requiring hospital admission occurred in 5 patients (11 per cent of patients surviving more than 1 month). Shunt patency was assessed by scintisplenoportography and ultrasonography. Cumulative shunt occlusion rate was 16 per cent after 1 year, 33 per cent after 5 years and 52 per cent after 8 years of follow-up. Out of 17 patients with an occluded shunt, 9 had persistent or recurrent bleeding, while 3 patients had recurrent bleeding despite a patent shunt. We conclude that the mesocaval Dacron interposition shunt should not be recommended as the procedure of first choice for portosystemic shunting.
Bilateral ankle skin temperature as a predictor of early vascular graft patency
Authors: Jansson I G , Thomsen M B , Elfström J L 
Published: March 2007

Abstract
The efficacy of postoperative bilateral ankle skin temperature as a predictor of early graft patency was prospectively evaluated in 138 consecutive cases of femoropopliteal bypass surgery. The difference between ipsilateral and contralateral ankle temperature (hourly registrations) was significantly greater in the patients with patent graft on postoperative day 1 than in those with an occluded graft. In measurements 8 h postoperatively, highest sensitivity (84 per cent) and specificity (93 per cent) of the test were obtained when the difference was + 0·4°C. The overall accuracy of prediction with this simple method was 89 per cent.
Selective conservative and routine early operative treatment in acute limb ischaemia
Authors: Jivegård L E , Arfvidsson B , Holm J , Scherstén T 
Published: March 2007

Abstract
Arterial thrombo-embolectomy is often unsuccessful in those patients with acute limb ischaemia that have peripheral arteriosclerosis. During this study, conservative heparin treatment and, when needed, delayed surgery was employed in acute limb ischaemia when the ischaemia was less severe as judged by assessment of distal motor and sensory functions, regardless of the presumed aetiology of the acute ischaemia. The results are compared with those during a preceding period, when the routine treatment was emergency thrombo-embolectomy. The emergency operation rate was reduced to 49 per cent. There were overall fewer deaths with gangrene (8 per cent versus 18 per cent). In acute arterial thrombosis, more good results were obtained (76 per cent versus 47 per cent), whereas results were unchanged in embolic cases despite the reduced emergency operation rate. This study suggests that the choice of initial treatment of patients with acute limb ischaemia may be based on the severity of the ischaemia, and that patients with less severe acute ischaemia benefit from initial conservative heparin treatment.
Pre-operative albendazole therapy for hydatid cyst
Authors: Morris D L 
Published: March 2007

Abstract
Surgical management of hydatid cyst is associated with recurrence in 10 per cent of patients. The role of perioperative chemotherapy in prevention of recurrence has not been extensively explored. Sixteen patients with Echinoccus granulosus were treated with albendazole 10 mg kg−1 before operation; of fourteen patients who received albendazole for 1 month or more before operation only one (with doubtful therapeutic compliance) had viable protoscoleces, in contrast both of the two remaining patients who received only 1 and 3 weeks therapy had live disease at the time of operation. A 1 month pre-operative course of albendazole kills most if not all protoscoleces within hydatid cysts in man. This may allow pre-operative ‘sterilization’ of cysts and a reduction in the risk of recurrence.
Management of periampullary carcinoma
Authors: Robertson J F R , Imrie C W , Hole D J , Carter D C , Blumgart L H 
Published: March 2007

Abstract
Forty-one patients presented to our hospital between 1959 and 1983 with periampullary carcinoma. Twenty-six (63 per cent) underwent radical surgery, eight (20 per cent) local excision of the tumour, six (15 per cent) had bypass procedures and one was treated by endoscopic sphincterotomy (2 per cent). Potentially curative resection was performed in 83 per cent of the 41 patients. The operative mortalities for radical, local and bypass surgery were 7·7 per cent, 25 per cent and 16·6 per cent respectively. The degree of tumour differentiation significantly affected survival while local spread did not significantly affect survival in patients treated radically. The 5 year survival rates (calculated actuarially) for radical, local and bypass surgery were 34,44 and 0 per cent respectively.
Circumumbilical versus transumbilical abdominal incision
Authors: Paes T R F , Stoker D L , Ng T , Morecroft J 
Published: March 2007

Abstract
One hundred and fifteen patients were entered into a prospective randomized trial to establish whether midline abdominal incisions through the umbilicus produced any differences in the incidence of wound infection or failure when compared with the more conventional midline incision skirting around the umbilicus. No significant difference was shown between wound infection rates in 58 transumbilical and 51 circumumbilical incisions. Follow-up of surviving patients for at least one year showed no difference in incisional hernia rate between the two groups of patients. No problems were encountered in making the incisions through the umbilicus, but skirting the umbilicus was felt to cause problems with slewing of the scalpel blade, and asymmetry of the scar in 13 circumumbilical incisions. This study has shown that the practice of avoiding the umbilicus in midline abdominal surgery serves no useful purpose.
Appraisal of hepatic resection in the treatment of minute hepatocellular carcinoma associated with liver cirrhosis
Authors: Nagasue N , Yukaya H , Chang Y C , Ogawa Y , Ota N , Kimura N , Nakamura T 
Published: March 2007

Abstract
During the last 6 years, 205 patients with primary hepatocellular carcinoma (HCC) were admitted to our surgical departments. Thirty-eight had HCC smaller than 3 cm in diameter. There were 34 men and 4 women with an average age of 56·5 years. All patients had underlying hepatic disease: liver cirrhosis in 35 patients and chronic active hepatitis with fibrosis in the remaining 3. Pre-operative complications included: oesophageal varices in ten, cholelithiasis in five, peptic ulcer in two, gastric cancer in one, and severe hypersplenism in one instance. A radical resection was performed in 32 cases and palliative resection in 6. Simultaneous operations were carried out for the above mentioned associated conditions: distal splenorenal shunt in six, Hassab's devascularization procedure in one, splenectomy in one, cholecystectomy in four, cholecystolithotomy in one, and partial gastrectomy in one. Four patients had postoperative complications: liver failure, rebleeding, right haemothorax, and upper gastrointestinal bleeding from acute mucosal lesion of the stomach. One patient with liver failure died in coma within 1 month. The operative and in-hospital mortality rates were 2·6 and 7·9 per cent, respectively. Survival rates during the first 4 years in 32 patients with radical hepatic resection were 89·9, 67·2, 58·8, and 58·8 per cent, respectively. We suggest that hepatic resection should be the first choice of treatment for minute HCC even in the presence of liver cirrhosis.
Role of surgery in the treatment of primary carcinoma of the liver: A 31-year experience
Authors: Lin T-Y , Lee C-S , Chen K-M , Chen C-C 
Published: March 2007

Abstract
During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8·0 per cent. In the 107 patients undergoing partial hepatic resection, the operative mortality was 5·6 per cent. Of the total of 314 hepatic resections for primary carcinoma of the liver, 309 were undertaken for hepatocellular carcinoma and the remaining 5 were carried out for cholangiocarcinoma. All hepatic resections in this series were performed with the finger fracture technique without controlling the hepatic hilar vessels, hepatic ducts or hepatic veins outside the liver, although hepatic clamping and the Pringle manoeuvre were also used in selective cases. Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18·0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.
Biliary lithiasis in the over seventyfive group: A new therapeutic strategy
Authors: Duron J J , Roux J M , Imbaud P , Dumont J L , Dutet D , Validire J 
Published: March 2007

Abstract
Sixty-four gallstone patients aged 75 or more (mean age 83 ± 5.1 years) were divided prospectively into two groups. They were mostly high-risk patients (average number of major risk factors, 2.2±0.9). Thirty-three showed one or several signs of lithiasis of the common bile duct and were treated with endoscopic sphincterotomy (ES) (31 successful cases, two technical problems) followed by early cholecystectomy (33 cases). Choledocholithiasis was present in 26 cases and stones were extracted in 25 cases. Two patients (6 per cent) died. ES caused no complications. Thirty-one other patients showed no sign of choledocholithiasis and were treated by cholecystectomy with operative cholangiography. Choledocholithiasis was found in two of these patients and treated by extraction and external drainage. Five of these patients (16 per cent) died. I n 30 cases acute cholecystitis was found at operation, 15 in each group. E S is therefore an eficient procedure in highksk patients, which facilitates operation, especially in cases of acute cholecystitis, and it is recommended in all cases of complicated biliary lithiasis. Early cholecystectomy is justified for these patients by the high frequency of associated acute cholecystitis.
Effect of vagal denervation on canine gallbladder motility
Authors: Traynor O J , Byrne P J , Keegan B , Hennessy T P J 
Published: March 2007

Abstract
There is an increased incidence of gallstones after truncal vagotomy but the mechanism is unknown. Our aim was to study the early effects of vagotomy on fasting and postprandial gallbladder motility. A chronic model was constructed in 10 dogs to correlate gallbladder motility and emptying with interdigestive and postprandial duodenal motility both before and after selective hepatobiliary vagotomy (five dogs) and truncal vagotomy (5 dogs). During each study recordings were made for one complete interdigestive motor complex (IDMC) and for 90 min after a standard meal of (a) gallbladder and duodenal motility, (b) gallbladder emptying (by a dual radioisotope marker technique) and (c) duodenal output of bilirubin. In control studies the gallbladder contracted at the start of phase II of the interdigestive motor complex and ejected 20–25 per cent of its contents into the duodenum; after meals the gallbladder contracted within 5 min and emptied almost 80 per cent of its contents within 90 min. After both selective hepatobiliary vagotomy and also truncal vagotomy there was no significant difference in the pattern of contraction or emptying of the gallbladder either during fasting or postprandially. We conclude that gallbladder motility and emptying are entirely normal in the early period after vagal denervation.
Length of stay for common surgical procedures: Variation among districts
Authors: Morgan Myfanwy , Paul Elizabeth , Devlin H B 
Published: March 2007

Abstract
Lengths of stay for appendicectomy, inguinal hernia repair and cholecystectomy for the 16 districts in the Northern Regional Health Authority (NRHA) and 15 districts in the South East Thames Regional Health Authority (SETRHA) are examined using data recorded in the Hospital Activity Analysis. Considerable variations exist among districts, with the three longest stay districts for each procedure in NRHA having an age-adjusted length of stay of 113 per cent of the regional average for appendicectomy, 125 per cent for hernia and 115 per cent for cholecystectomy. This resulted in &gt; 2000 additional bed days per year being occupied in the three longest stay districts in the NRHA compared with the regional average. The age adjusted length of stay for the three shortest stay districts for each procedure is 83 per cent of the regional average for appendicectomy, 75 per cent for hernia and 85 per cent for cholecystectomy. Similar differences are seen in the SETRHA, and derive from differences in the length of both pre-operative and postoperative stay. Explanations for the observed variations are considered in terms of population, organizational and clinical variables.
Pre-operative assessment of fitness score
Authors: Playforth M J , Smith G M R , Evans Mary , Pollock A V 
Published: March 2007

Abstract
Death within 30 days or survival after a major operation depends on three things: the severity of the disease and the operation, the technical proficiency of the surgeon and the ability of the patient to withstand both disease and operation. The first of these can be estimated by reference to published figures, the second can only be guessed at and the third has in the past been a matter of subjective judgement. With the aim of producing an objective assessment of the likelihood of survival, we have constructed a score system comprising 26 items including age, chronic disease and acute presenting disease. These items are each given a weight of 1 to 4 and the total fitness score for any patient ranges from 0 (fit) to 10 (unlikely to survive). We have validated this score prospectively in 1517 consecutive patients undergoing emergency or elective major abdominal operations (excluding appendicectomies and hernia repairs). In 492 operations in which the patient scored 0 or 1, one patient died (0·2 per cent); in 290 with scores of 2 or 3, one died (0·3 per cent); in 313 with scores of 4 or 5, five died (1·6 per cent). It was when the score rose to 6 or over that the chances of survival progressively declined: 16 died of the 105 patients who scored 6 (15·2 per cent) as did 74 of the 191 who scored 7 or 8 (38·7 per cent) and 70 of the 126 who scored 9 or 10 (55·6 per cent). We now use the score as part of our audit and enquire particularly closely into the death of any patient with a pre-operative score of less than 6.
Effect of the pre-operative response to H2 receptor antagonists on the outcome of highly selective vagotomy for duodenal ulcer
Authors: Goodman A J , Kerrigan D D , Johnson A G 
Published: March 2007

Abstract
From 1979 to 1984, 141 consecutive patients (110 men, 31 women) underwent highly selective vagotomy (HSV) for duodenal ulcer (DU). All patients had received pre-operative treatment with full dose H2 receptor antagonists (H2RA). Indications for surgery were: persistent relapse on withdrawal of H2RA, 107 (75·9 per cent); no response to H2RA, 30 (21·3 per cent); intolerance of H2RA, 1 (0·7 per cent); acute DU bleed, 2 (1·4 per cent); duodenal stenosis, 1 (0·7 per cent). Follow-up with a median of 47 months (24–85 months) revealed six patients (4·4 per cent) with endoscopically proven recurrence, three of whom were on non-steroidal anti-inflammatory drugs (NSAIDs). Only one patient with recurrent DU was a non-responder to H2RA pre-operatively. Twenty-five patients remained symptomatic after HSV without ulcer recurrence, of which a highly significant proportion (41 per cent) were non-responders (P &lt; 0·001). The pre-operative response to H2RA does not indicate the likelihood of ulcer recurrence after HSV. However, non-responders are more likely to continue with dyspeptic symptoms despite the successful healing of their ulcers. The DU recurrence rate in patients taking long-term NSAIDs is disappointingly high (33 per cent), putting the use of HSV in these patients into question.
Experience with the ‘skew flap’ below-knee amputation
Authors: Harrison J D , Southworth S , Callum K G 
Published: March 2007

Abstract
A review of 353 lower limb amputations over the last 7 years has been performed to assess the results of the skew flap myoplastic below-knee amputation which was introduced in April 1983 because of reported advantages in terms of wound healing and earlier ambulation. Comparing the first 3½ year period with the second, the total number of amputations decreased by 31 per cent. The number of above-knee amputations remained similar in the two periods (82, 62), whilst the number of Gritti-Stokes amputations fell from 79 to 21 (0·001 &gt; P &gt; 0·01). The proportion of below-knee (BK) amputations increased from 50 (23·7 per cent) to 59 (41·5 per cent) (0·01 &gt; P &gt; 0·025). The groups were comparable in terms of previous vascular surgery and co-existing medical conditions. The time to full stump healing was significantly shorter in the skew flap group compared with the earlier Burgess type BK amputation (P = 0·001), and there was a trend to fewer stump failures in the skew flap group. We therefore feel that the skew flap amputation gives superior results to the Burgess BK amputation in terms of healing and a lower complication rate, allowing a higher proportion of BK amputations to be performed. A prospective randomized trial of the two techniques is in hand to determine the accuracy of this hypothesis.