bluuebunny/crossref_metadata_2025_split huggingface dataset:
Out-patient operation of inguinal hernia in children
Authors: Mejdahl S , Gyrtrup H J , Kvist E 
Published: March 2007

Abstract
A retrospective review is presented of 496 children with a median age of 4 years (range 0–13 years) on whom a total of 527 hernia repairs were performed as out-patients. No wound infections were observed, and the rate of early surgical complications was 1·5 per cent. There were 15 (3·7 per cent) known recurrences. No complications from the anaesthetic were recorded. Owing to the negligible infection rate and the low surgical complication and recurrence rates it is concluded that children with inguinal hernia would benefit from operation as out-patients, and that they should be operated on immediately after diagnosis, irrespective of age. Besides probably minimizing the children's psychological trauma, out-patient surgery provided considerable savings to the health service in the present study.
Ischaemic strictures in patients treated with a low anterior resection and perioperative radiotherapy for rectal carcinoma
Authors: Påhlman L , Glimelius B , Frykholm G 
Published: March 2007

Abstract
In five (6 per cent) of 78 consecutive patients treated with an anterior resection for rectal carcinoma, a stenosis of the sigmoid colon just above the anastomosis was observed. Four patients had received preoperative radiotherapy over a period of 1 week to a total dose of 25·5 Gy and one patient had received postoperative radiotherapy (60 Gy) over a total of 8 weeks. The length of the stenosis varied from 4 to 120 cm. Two patients subsequently underwent reoperation with an abdominoperineal resection and three patients with a Hartmann procedure. In all patients the inferior mesenteric artery had been ligated close to the aorta. It is proposed that the stenosis may have been due to insufficient circulation in the marginal artery. This insufficiency may have been aggravated by the irradiation, as the retained part of the sigmoid colon was partly included in the irradiation target.
Anorectal physiology validated: A repeatability study of the motor and sensory tests of anorectal function
Authors: Rogers J , Laurberg S , Misiewicz J J , Henry M M , Swash M 
Published: March 2007

Abstract
Sixteen subjects (mean (s.d.) age 50·7 (12·8) years, three men) were studied on two separatè occasions by two experienced investigators in random order. A standard protocol of anatomical, manometric and electrophysiological assessments of anorectal motor and sensory function was followed. No significant differences were found between the results obtained by the two investigators in the measurements of perineal descent, anal canal length, anal canal resting pressure and squeeze pressure, pudendal nerve terminal motor latency, single-fibre electromyography fibre density of the external anal sphincter, and thresholds of mucosal electrosensitivity. This study shows that the standard tests of anorectal sensorimotor function are repeatable by different investigators. In addition, it suggests that comparison of data obtained in different centres using these techniques is valid.
Intraoperative immunostaining for detection of invasive cells at the resection margin of Borrmann type 4 gastric carcinoma using monoclonal antibody S202
Authors: Yokota T , Yamaguchi T , Sawai K , Takahashi T 
Published: March 2007

Abstract
Borrmann type 4 gastric cancer is clinically characterized by diffuse infiltration with carcinoma cells. An antiscirrhous carcinoma monoclonal antibody (MAb) S202 was used in a rapid immunostaining procedure to identify the limit of tumour invasion during surgery in samples obtained from the resection margins in 37 cases of Borrmann type 4 gastric cancer. In two instances, conventional cytological diagnosis using haematoxylin and eosin staining was negative, and in another it was inconclusive; whereas by the rapid immunostaining method single cells stained darkly, indicating malignancy. In two specimens, a positive diagnosis could be made by both methods, but immunostaining of these sections served to highlight the adenocarcinoma cells against the inflammatory background: further resection was performed. This technique enables clear recognition of the infiltrating tumour cells in the frozen sections of resected specimens. The rapid immunostaining method using MAb S202 allowed accurate and rapid determination of the limit of tumour extension at the surgical margin during surgery.
Changes in vascularity of liver tumours after hepatic arterial embolization with degradable starch microspheres
Authors: Civalleri D , Scopinaro G , Balletto N , Claudiani F , Decian F , Camerini G , Depaoli M , Bonalumi U 
Published: March 2007

Abstract
The role of vascularity as a prognostic factor was investigated in 35 patients undergoing arterial chemotherapy for liver tumours. Compared with parenchyma, tumour vascularity was classified as hot (18 cases), cold (12 cases), and mixed (12 cases) using 99mTc-macroaggregated albumin (MAA) hepatic arterial scans. The proportion of patients showing complete and partial responses to treatment was higher in the hot group (56 per cent) than in the combined cold and mixed group (12 per cent). In 15 cases (six hot, six cold and three mixed lesions), additional MAA scans were performed immediately after arterial embolization with degradable starch microspheres (DSMs). Either complete or partial reversal of tumour vascularity was observed after DSM-embolization in five and seven cases respectively, two and two of them respectively showing native cold lesions. As tumour vascularity appears to be a prominent prognostic factor, DSM-embolization should improve the efficacy of treatment by improving liver extraction of drugs and causing flow redistribution towards hypovascular areas.
Human fasting and postprandial sphincter of Oddi motility
Authors: Worthley C S , Baker R A , Lannos J , Saccone G T P , Toouli J 
Published: March 2007

Abstract
Sphincter of Oddi motility was evaluated in post-cholecystectomy patients with indwelling T tubes during fasting and after feeding. A triplelumen catheter was positioned to record from the sphincter of Oddi and duodenum. The sphincter of Oddi was characterized by phasic contractions independent of duodenal contractions. During fasting duodenal wave frequency exhibited four phases, whereas only two phases could be identified from the sphincter of Oddi. A prolonged phase A in the sphincter of Oddi corresponded to duodenal phases I, II and IV. A short phase B in the sphincter of Oddi just preceded the onset of duodenal phase III and was temporally related to it. Sphincter of Oddi basal pressure increased during duodenal phases III and IV. After ingestion of food, sphincter of Oddi basal pressure, wave amplitude and duration decreased, but the frequency remained unchanged. Conversely, duodenal frequency increased but there was no change in amplitude. Thus, the human sphincter of Oddi and duodenum exhibited independent motility demonstrating distinct phases during the interdigestive period. After food, sphincter of Oddi motility altered in a manner which would facilitate the passive flow of fluid into the duodenum.
Effect of mechanical bowel preparation on anastomotic integrity following low anterior resection in dogs
Authors: O'Dwyer P J , Conway W , McDermott E W M , O'Higgins N J 
Published: March 2007

Abstract
To assess the effect of mechanical bowel preparation on anastomotic integrity after low anterior resection, 36 mongrel dogs were randomized to have low anterior resection with or without mechanical bowel preparation. All dogs received prophylactic antibiotics and anastomotic integrity was assessed on the ninth postoperative day by barium enema, inspection of anastomoses for defects after careful excision at laparotomy, and anastomotic bursting pressures. Bursting pressures were significantly higher (P &lt;0·005) in the group with bowel preparation. Anastomotic defects were present in 13 per cent of animals with bowel preparation and 47 per cent without bowel preparation (P = 0·057). Pelvic abscess and death from peritonitis occurred in 6 per cent of the group with bowel preparation and 29 per cent of the unprepared group. Mechanical bowel preparation significantly enhanced anastomotic integrity and reduced complications in this model.
Three-dimensional morphological study of the pancreatic microvasculature in caerulein-induced experimental pancreatitis
Authors: McEntee G , Leahy A , Cottell D , Dervan P , McGeeney K , Fitzpatrick J M 
Published: March 2007

Abstract
A morphological study of the pancreatic microvasculature in experimental pancreatitis was performed in dogs, using three-dimensional scanning electron microscopy vascular casting and transmission electron microscopy. Animals with pancreatitis were characterized by a marked reduction in the number of capillaries outlined by the cast and by distortion of those that were outlined, with irregularity of the capillary lumen, abruptly terminating capillary buds and leakage of the cast material through the capillary membrane. The study provides convincing morphological evidence that one of the earliest changes in acute pancreatitis is distortion of the capillary circulation.
Endoscopic management of inoperable cholangiocarcinoma using iridium-192
Authors: Ede R J , Williams S J , Hatfield A R W , McIntyre S , Mair G 
Published: March 2007

Abstract
We report a well tolerated endoscopic technique of administering intraluminal radiotherapy to 14 patients with inoperable cholangiocarcinoma, in which the iridium-192 wire source was inserted down a nasobiliary catheter placed within a previously inserted endoscopic biliary prosthesis, thus allowing bile flow to continue during treatment. Radiotherapy was commenced 2 weeks after biliary decompression, when the median serum bilirubin level had fallen from 213 to 34 μmol/l. A total radiation dose of 6000 cGy at 0·5 cm from the source was administered over a median of 85 h (range 77·116 h). In four patients there was a transient increase in serum bilirubin during iridium treatment and, in two cases (14 per cent), this was associated with mild cholangitis. Both cases resolved rapidly once the iridium wire and nasobiliary catheter were removed. The median hospital stay after treatment was 2·5 days (range 0·28 days). The late complications associated with stent blockage were minimized by routinely changing stents at 4–6-monthly intervals; ten of the patients have so far undergone from one to five (median three) stent changes. Five patients have died at 3·6–8·2 months (median 4·8 months) following iridium treatment; four had extensive type III hilar lesions at diagnosis. Nine patients are still alive at 5·4–31·0 months (median 16·4 months). The overall median survival after iridium therapy is 10·5 months. This technique of endoscopic biliary decompression before internal iridium administration minimizes complications by allowing biliary drainage during treatment. The role of this treatment in patients with inoperable cholangiocarcinoma awaits the results of randomized, controlled trials.
Thyroid lymphoma
Authors: Shaw J H F , Holden A , Sage M 
Published: March 2007

Abstract
We have reviewed the local experience of 15 cases of thyroid lymphoma with a view to documenting the epidemiology, presentation, management and prognostic factors governing outcome for this rare condition. All the patients were European despite the fact that 15 per cent of the local population is either Maori or Polynesian. The average age at presentation was 62 years and 13 of the 15 patients were women. The duration of symptoms was short: on average 9 months. Where feasible a definitive resection of the lesion was performed but this could only be performed in six of the 15 cases. The commonest histological type was non-Hodgkin's lymphoma which accounted for 14 of the 15 cases with the large cell variant being the most common (five cases). The mean period of follow-up was 3·3 years: only eight patients were alive and well at that time. The prognostic factors that influenced outcome were: (1) the histology of the lesion — large cell lymphoma carried a bad outlook; (2) whether the lesion could be totally resected or not — five out of six patients undergoing total resection remain alive and well; (3) the presence of pre-existing Hashimoto's thyroiditis was a favourable prognostic factor as only one patient without underlying Hashimoto's disease or positive antithyroid antibodies was alive at the end of the study; (4) male sex may also be an unfavourable prognostic factor as both men in the study died of disease 0·3 and 5 years after diagnosis.
Randomized study of adjusted versus fixed low dose heparin prophylaxis of deep vein thrombosis in hip surgery
Authors: Taberner D A , Poller L , Thomson J M , Lemon G , Weighill F J 
Published: March 2007

Abstract
A randomized study of adjusted versus fixed low dose heparin prophylaxis has been conducted in 100 patients undergoing surgery for hip replacement or fractured neck of femur. The two types of patients were randomized independently into the adjusted and fixed dose regimens. Patients in the adjusted group were controlled by an activated partial thromboplastin time method particularly responsive to the anticoagulant effect of heparin. The aim was to maintain the peak value just above the upper limit of the normal range. Adjustment of dosage began 24 h after surgery in the replacement group and 24 h after admission in the fracture group. Significant improvement in protection against postoperative deep vein thrombosis, assessed by venography, was observed in the adjusted group undergoing hip replacement (P = 0·013) and overall in both groups (P = 0·017) compared with a conventional fixed dose subcutaneous regimen (calcium heparin 5000 units, 8-hourly). In most instances, adjustment resulted in increased heparin dosage but this was not associated with any evidence of excessive bleeding.
Conservative treatment of ingrowing toenails
Authors: Reijnen J A M , Goris R J A 
Published: March 2007

Abstract
A combination of conservative measures was used to treat 105 patients with 119 ingrowing toenails. The method proved to be simple and cheap, but time consuming. Post-treatment discomfort and the time taken to return to normal activities were acceptable; the cosmetic result was good. Two-year follow-up revealed that the success rate of the method in less advanced cases (stages I and II) was high (96 per cent), although in the long term there was a tendency to recurrence in stage II cases. The failure rate in advanced cases (stage III) was high (up to 62 per cent). Conservative treatment can be used successfully in mild cases of ingrowing toenails.
The development and evaluation of a clinical test of surgical resident proficiency
Authors: Anderson Benjamin O , Sun John H , Moore Ernest E , Thompson Laetitia L , Harkin Alden H , Bartle Edward J 
Published: March 2007

Abstract
The two purposes of this study were to develop a clinical test of surgical resident proficiency and to compare this clinical test with currently applied methods of resident evaluation. Appendicitis is a common surgical disease, and its accurate diagnosis depends largely on clinical acumen. Ten third-year surgical residents prospectively evaluated 107 patients admitted because of suspected appendicitis. After taking a history, performing a physical examination, and reviewing laboratory data, these residents were asked to state, as a percentage, the likelihood that each patient had appendicitis. Sixty-three patients had appendicitis documented by pathologic inspection after appendectomy. Forty-four patients did not have appendicitis, as was determined by operation (17) or by in-house observation and resolution of abdominal pain (27). These outcomes were used to calculate a diagnostic ability score (DAS) for each resident. Residents were evaluated by standard methods including in-service examinations and monthly evaluations by the attending staff. Residents were also evaluated by nonstandard, but potentially useful, neuropsychologic and psychologic tests, including the trail making test, the Ravens progressive matrices test, the paced auditory serial addition test (PASAT), the grooved pegboard test of manual dexterity, and the profile of mood states (POMS) psychologic questionnaire. Cumulative scores were calculated and compared by multiple regression with coefficient variance analysis. The correlation (R2) of DAS with standard evaluation techniques was as follows: In-service (0.055), faculty (0.508), trails (-0.293), Ravens (0.028), PASAT (0.251), dexterity (0.432), POMS (0.381). We found that (1) the DAS is a discriminating clinical test; (2) the DAS correlates with subjective faculty evaluation; and (3) the DAS does not correlate with in-service examination scores. We conclude that faculty evaluation remains the best currently applied test of surgical resident clinical proficiency as measured by the DAS. (SURGERY 1989;106:347–53.)
Primary disorders of oesophageal motility
Authors: Stuart R C , Hennessy T P J 
Published: March 2007

Abstract
Primary motor disorders of the oesophagus have distinct manometric patterns but require full oesophageal investigation to exclude a secondary cause. Myotomy and forceful dilatation give good results in achalasia, though myotomy is superior in the long term. Indications for surgery are rare in diffuse spasm and nutcracker oesophagus. Non-cardiac chest pain may be related to reflux, diffuse spasm or nutcracker oesophagus, but correlation between motor abnormalities and symptoms is poor and psychological disturbances are frequent.
Contralateral inguinal lymph node metastasis in patients with melanoma of the lower extremities
Authors: Jonk A , Kroon B B R , Mooi W J , Hoefnagel C A 
Published: March 2007

Abstract
A retrospective study was carried out on six patients with contralateral inguinallymph node metastasis from a melanoma of the lower extremity. All six patients were found to have had a previous homolateral groin dissection and in five patients there was intercurrent disease relapse in the leg before or at the same time as the appearance of contralateral node metastasis. Although the prognosis in these patients is unfavourable, two had a survival period of 24 and 32 months and two were still alive 27 months after contralateral groin dissection. In order to determine possible pathways of dissemination, lymphoscintigraphic studies of the leg were performed in another 16 melanoma patients who in the past had undergone a groin dissection. In 13 of them uptake in the contralateral inguinal lymph nodes was detected, indicating that groin dissection can lead to a different lymphatic flow pattern, which is often directed to the contralateral groin. Contralateral lymph node involvement may be an expression of regional disease. In such patients a contralateral groin dissection is advocated.
Lateral internal sphincterotomy in the treatment of fourth degree haemorrhoids
Authors: De Roover D M L R , Hoofwijk A G M , van Vroonhoven Th J M V 
Published: March 2007

Abstract
Between January 1984 and May 1988, 25 patients with fourth degree haemorrhoids were treated in the acute phase by lateral internal sphincterotomy under narcosis. Pain relief was immediate. The median hospital stay was 3 days. The median follow-up period was 26 months. For 20 patients a single lateral internal sphincterotomy alone was adequate treatment. If further therapy was required, simple band ligation was enough. There was one recurrence, which was treated with a further lateral internal sphincterotomy. In the long term, 18 patients had no complaints and seven had only minor complaints. Twenty-three patients were very satisfied and two were moderately satisfied. Nobody was dissatisfied. Lateral internal sphincterotomy is an attractive alternative in the treatment of fourth degree haemorrhoids, its major benefits being simplicity, efficiency and low morbidity.
Construction of a neorectum and neoanal sphincter following previous proctocolectomy
Authors: Williams N S , Hallan R I , Koeze T H , Watkins E S 
Published: March 2007

Abstract
A new operation is described in which a neorectum and neoanal sphincter mechanism have been constructed to restore gastrointestinal continuity and continence in a patient who had previously undergone proctocolectomy and a permanent ileostomy. The neorectum was constructed by forming a triplicated pouch from the distal ileum. The neoanal sphincter was fashioned from a transposed gracilis muscle and was activated electrically by an implanted stimulator. A period of chronic low frequency stimulation altered the muscle characteristics and enabled the neosphincter to contract continually without fatigue. Complete continence was achieved by the neosphincter gripping a Silastic® plug inserted within the efferent spout of the pouch. The patient was able to void completely when the stimulator was switched off and the plug removed.
Limb conservation for soft tissue sarcomas of the shoulder and pelvic girdles
Authors: Barr L C , Robinson M H , Fisher C , Fallowfield M E , Westbury G 
Published: March 2007

Abstract
Fifty-five patients with soft tissue sarcomas of the shoulder and pelvic girdles were treated between 1982 and 1987 with a consistent policy of limb conservation, using a wide variety of excisional and reconstructive surgical techniques and radical radiotherapy. Actuarial 5-year overall survival was 75 per cent for patients with low or intermediate grade tumours, and 38 per cent for those with high grade tumours (log rank test, P &lt;0·05). Five-year local recurrence rates were 32 per cent for low or intermediate grade tumours, and 48per cent for high grade tumours (log rank test, not significant). Multivariate analysis of the following risk factors for overall survival was performed: age, sex, tumour site, diameter, grade, inadequate surgical margins and local recurrence. Age over 55 years and high tumour grade emerged as independent prognostic variables for survival. Forequarter or hindquarter amputations were undertaken in seven of the 55 patients for local recurrence following previous limb-conserving surgery and radiotherapy. Local failure was not always salvaged by major amputation; satisfactory proximal tumour clearance was achieved in only two of seven patients undergoing major amputation; four of the seven patients developed stump recurrence, three of whom died with uncontrolled local disease. Meticulous attention to surgical and radiotherapeutic technique is required to minimize the incidence of local recurrence while maintaining satisfactory limb function.
Combined endocrine effects of LHRH agonist (Zoladex®) and tamoxifen (Nolvadex®) therapy in premenopausal women with breast cancer
Authors: Robertson J F R , Walker K J , Nicholson R I , Blamey R W 
Published: March 2007

Abstract
In premenopausal women with breast cancer, the use of the luteinizing hormone releasing hormone agonist, goserelin, results in the production of serum levels of oestradiol equivalent to those after surgical oöphorectomy or in postmenopausal women. The standard first line hormonal treatment for systemic breast cancer in postmenopausal women is tamoxifen. The combination of goserelin and tamoxifen in premenopausal women has been proposed. We have treated 34 premenopausal breast cancer patients with goserelin (3·6 mg) monthly and tamoxifen (20 mg) twice daily: endocrine data are available on all 34 patients. As with goserelin alone, patients on goserelin and tamoxifen showed transient stimulation of serum follicle stimulating hormone over the first 7–10 days with subsequent low gonadotrophin levels. Serum oestradiol and progesterone levels were reduced to castrate levels in all patients studied; no peaks of serum oestradiol were detected. There is no endocrinological contraindication to the use of goserelin and tamoxifen together in premenopausal women with breast cancer either as adjuvant therapy or in treating advanced disease.