bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood leukaemia and surgery
Authors: MacKinnon A E , Hann I M , Morris-Jones P 
Published: March 2007

Abstract
In a 9-year period 285 children were treated for leukaemia at the Royal Manchester Children's Hospital. The experience of operating on 72 patients is described and the favourable outcome of elective surgery emphasized. The importance of leukaemic involvement of abdominal organs and the difficulty of diagnosis of abdominal crises is discussed.
Antrectomy for recurrent ulcer after parietal cell vagotomy
Authors: Hoffmann J , Meisner S , Jensen H-E 
Published: March 2007

Abstract
The results of antrectomy for recurrent ulcer after parietal cell vagotomy are reviewed. Eighteen patients underwent precise antrectomy between 6 months and 7 years after their primary operation. Fourteen patients were reconstructed with a gastroduodenostomy and 4 with a gastrojejunostomy. Eighteen patients were available for follow-up of between 18 months and 10 years. One patient (6·25 per cent) developed a recurrent ulcer 1 year after antrectomy. There was no operative mortality. Six patients (33 per cent) had minor complications in the immediate postoperative period, and one (5·5 per cent) had a major complication. According to Visick grading, 75 per cent had good or excellent results and 25 per cent poor results. Antrectomy following parietal cell vagotomy can be achieved with a low operative mortality, a low ulcer recurrence rate and a satisfactorily low incidence of post-gastrectomy problems.
Early return to work after repair of a unilateral inguinal hernia
Authors: Taylor E W , Dewar E P 
Published: March 2007

Abstract
Ninety-seven Royal Naval and Royal Marine officers and ratings undergoing repair of a unilateral inguinal hernia were randomized postoperatively into two groups: A, those who returned to full working duties 21 days after operation; B, those who returned to light duties 21 days after operation and to full duties at 3 months. Patients were reviewed at 3 and 12 months. One patient was withdrawn because of the development of late sepsis. Two patients in group B developed a recurrence of hernia within 1 year. No patient who returned to full duties at 21 days was unable to do any duty assigned to him. In a concurrent trial 119 male civilian patients were treated in the same hospital under identical conditions. All patients were reviewed 21 days after operation and were randomized into two groups: C, those advised to return to work immediately; D, those given no advice. Patients in group C returned to work in a mean of 38 days (range 14–96 days), whereas those in group D returned in a mean of 71 days (range 14–280 days). There was no recurrence of hernia in either group within the review period. It is concluded that there is no contraindication to resuming physical work 3 weeks after the uncomplicated repair of a unilateral inguinal hernia, and that active encouragement shortens the interval before return to work.
Prophylaxis of postappendicectomy sepsis by metronidazole and cefotaxime; a randomized, prospective and double blind trial
Authors: Lau W Y , Fan S T , Yiu T F , Poon G P , Wong S H 
Published: March 2007

Abstract
A randomized, prospective and double blind trial was conducted on 308 patients. Thirty-one out of 102 patients receiving metronidazole developed wound infection compared with 13 out of 103 patients receiving cefotaxime and 14 out of 103 patients receiving metronidazole and cefotaxime. The reduction in the wound sepsis by the use of cefotaxime or a combination of metronidazole and cefotaxime was statistically significant when compared with patients who received metronidazole only. For early cases including normal, acutely inflamed and gangrenous appendices, we gave a single dose of antibiotics just before operation. For late cases with perforation and abscess formation, the antibiotics were continued for 5 days. There was no statistical difference in wound infection between patients who received cefotaxime alone and these who received a combination of metronidazole and cefotaxime.
Growth enhancement of implanted human colorectal cancer cells by the addition of fibroblasts in vivo
Authors: Loizidou M C , Carpenter R , Laurie H , Cooper A J , Alexander P , Taylor I 
Published: March 2007

Abstract
The effect of fibroblasts on the growth of HT29 human colorectal cancer cells was used to study stromal modulation of tumour growth dynamics. Fibroblasts were isolated from rat livers 1, 2.5 and 4 days after two-thirds partial hepatectomy and from normal livers. Cells harvested 2.5 and 4 days after hepatectomy (‘fast’ fibroblasts) had a significantly faster growth rate in vitro than those harvested on day 1 or those from normal livers (P&lt;0.02). The fibroblasts were inoculated with HT29 colorectal cancer cells into nude mice: Controls received cancer cells with or without a fibroblast cell line (C3H10T 1/2). At 3 weeks both tumour take and growth (size) were significantly greater in the group inoculated with cancer cells and ‘fast’ fibroblasts than in the other groups (tumour take 100 versus 42–75 per cent, P&lt;0.03; median tumour size 3.5 versus 0.3–0.4 g, P&lt;0.02). In conclusion, tumour growth is enhanced by fibroblasts, especially by those derived from actively regenerating liver. It is suggested that the stimulation is not only mechanical but may also involve a humoral mechanism.
Prospective study of hand-sutured anastomosis after colorectal resection
Authors: Mann B , Kleinschmidt S , Stremmel W 
Published: March 2007

Abstract
A total of 370 patients underwent colorectal resection: 320 had a primary single-layer seromucosal anastomosis without a protective colostomy, 22 had Hartmann's procedure and 28 abdominoperineal resection. There were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical anastomotic leak rate 3.4 per cent. After elective operation, the leak rate for intraperitoneal anastomosis was 0.6 per cent and for low extraperitoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a significant increase in morbidity rate (46 per cent) in comparison with those having elective surgery (χ2= 31.5, 1 d.f., P&lt;0.0001). Patients who had bowel obstruction and no bowel preparation had a significantly higher morbidity rate of 26 per cent and mortality rate of 7 per cent, compared with those having an elective procedure (χ2 = 11.2, 1 d.f., P&lt;0.001; χ2 = 8.7, 1 d.f., P&lt;0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent), compared with those operated on with curative intent (1.5 per cent) (χ2 = 28.7, 1 d.f., P&lt; 0.0001). Cost-saving hand-sutured anastomosis is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in colorectal surgery.
Failure of the unopened colostomy to protect high-risk rectal anastomoses
Authors: Dixon A R , Thomson W H F 
Published: March 2007

Abstract
Anastomotic breakdown, the most serious complication of restorative rectal resection, is responsible for half the postoperative morbidity rate and one-third of deaths1. While many surgeons defunction low anastomoses2, others consider this unnecessary3. A tube caecostomy can be used after on-table orthograde bowel lavage to avoid a stoma4. An obstructing unopened loop ‘colostomy’ offers potential advantages5. It can be returned to the abdomen if the anastomosis heals soundly or opened into a colostomy if it leaks. This method was evaluated in seven patients.
Anorectal angle enhances faecal continence
Authors: Hajivassiliou C A , Carter K B , Finlay I G 
Published: March 2007

Abstract
This study was performed with an In vitro model to assess the relative importance of sphincter pressure and anorectal angulation in maintaining faecal continence. Water and semisolid material were infused separately into porcine intestine compressed by an inflatable cuff until leakage was observed. Angulation of the bowel with respect to the cuff was 180° and then 90° With water, holdback pressure was independent of angulation. In contrast, when semisolid material was used, angling the bowel to 90° increased holdback pressure by at least 100 per cent. Measurements taken in solid tubes demonstrated that both a restriction in the tube and an unconstricted 90° bend produced a resistance to flow of the semisolid material which was dependent on flow rate. These data suggest that liquid is retained in the rectum by occlusion pressure alone, whereas the retention of semisolid material is enhanced by angulation.
Anastomotic leakage and functional outcome after anterior resection of the rectum
Authors: Hallböök O , Sjödahl R 
Published: March 2007

Abstract
Nineteen patients with symptomatic anastomotic leakage after anterior resection were compared with 19 without leakage. The two groups were closely matched according to age, sex, height of anastomosis and follow-up. No patient had any sign of anastomotic stricture or neoplastic recurrence at the time of the study. After a median of 30 (range 12–87) months there was no difference in sphincter function as measured by manometry. Neorectaf volume at distension pressures of 40 and 50 cmH2O and compliance at sensation of filling, urge to defaecate and maximum tolerated volume were significantly reduced in patients with leakage. This reduction in neorectal reservoir function was reflected in impaired anorectal function, measured by a combination of: (1) frequency of bowel movements; (2) degree of urgency; (3) incontinence score; and (4) degree of impaired evacuation. Long-term functional outcome may be impaired by anastomotic leakage.
New technique for subcuticular suture in lengthy wounds
Authors: Tantawy H S 
Published: March 2007

Abstract
Subcuticular sutures used for cosmetic skin approximation usually produce a satisfactory scar. Non-absorbable monofilament sutures further increase the advantages of subcuticular closure1,2, but in lengthy wounds it is difficult to use fine material such as 3/0 or 4/0, as it may break on withdrawal.
Several methods have been employed to secure the loose ends of running subcuticular stitches. Beads and bulky knots may produce an unsightly scar at the ends of the suture line. For several years the author has used a technique for non-absorbable subcuticular sutures that allows sound wound approximation, minimal scarring and can be applied to lengthy wounds.
Thoracic and thoracoabdominal aortic aneurysm and dissection: An investigation based on autopsy
Authors: Svensjö S , Bengtsson H , Bergqvist D 
Published: March 2007

Abstract
The city of Malmö (population approximately 230 000) has a fairly stable urban population and a high autopsy rate (83 per cent of all deaths). Autopsy records for the period from 1958 to 1985 were scrutinized and three groups of patients were defined: those with asymptomatic thoracic aortic aneurysm (TAA), those with rupture of the thoracic aorta, and those with dissection. The findings were used to calculate prevalence and incidence according to age and sex. Asymptomatic TAA was found in 205 patients (109 men). There was a predominance of men in higher age groups and about 5 per cent of the lesions were thoracoabdominal. Rupture of the thoracic aorta was the cause of death in 63 patients; no age difference between the sexes was observed. Death as a result of dissection occurred in 216 patients, women dying on average 7 years later than men. The incidence of rupture was 0.9 per 100 000 for men and 1.0 per 100 000 for women; the incidence of dissection was 3.2 per 100 000 for both sexes. Prevalence and incidence of fatal complications of TAA are low; this may influence decisions about where these patients should be treated.
Role of cimetidine in the prevention of intimal hyperplasia in rat carotid artery
Authors: Low J D , House A K , Norman P E 
Published: March 2007

Abstract
In vitro studies have revealed that histamine increases smooth muscle cell proliferation and migration, an effect abolished by the H2 antagonist cimetidine. This study examined the effect of cimetidine on intimal hyperplasia in vivo. Thirty male Wistar rats underwent endothelial denudation of the left carotid artery; 15 received cimetidine 350 mg per kg per day for four weeks and 15 received vehicle only. Four weeks after injury the left carotid arteries were perfusion fixed and harvested. Morphometric analysis revealed that there was no significant difference between the intima: media ratio of rats treated with cimetidine (median (interquartile range (i.q.r.)) 1.69 (0.59)) and those treated with vehicle (median (i.q.r.) 1.59 (0.59), P = 0.28). Similarly, the percentage luminal reduction was not significantly different between the groups (median (i.q.r.) 54.7 (19.9) per cent and 45.8 (13.4) per cent respectively, P = 0.30). It is concluded that treatment with cimetidine does not reduce the formation of intimal hyperplasia in rat carotid arteries de-endothelialized with a balloon catheter.
Real and apparent mortality from congenital diaphragmatic hernia
Authors: Jaffray B , Mackinlay G A 
Published: March 2007

Abstract
Some 50 cases of congenital diaphragmatic hernia (CDH) born in the authors' regional referral area over the 14 years from 1980 to 1993 were reviewed, contrasting 7 years when management included preoperative ventilatory stabilization with the preceding 7 when urgent surgery was performed. Six children experienced no respiratory distress and suffered no mortality. For infants with respiratory distress in the first 6 h of life, ventilatory stabilization improved survival rates of those who reached the surgical centre from 45 per cent between 1980 and 1986 to 59 per cent between 1987 and 1993. A larger proportion of the total number of patients, however, continued to die without reaching the surgical centre. The improvement in survival rate based on the true incidence of CDH was from 28 per cent in the first period to 38 per cent in the second. The apparent poor survival rate of patients born in central obstetric units compared with those born in peripheral units (37 versus 75 per cent) can be attributed to patient selection; a larger number of children born in central units were transferred for surgery (70 versus 57 per cent). There is no evidence that paediatricians have altered their referral practice to include prolonged ventilation outside the surgical unit since delayed surgery was advocated. Assessment of the impact of altering the management of CDH cannot be made without knowing the number of patients who die before transfer to a neonatal surgical unit. Any serious attempt to reduce the mortality rate of CDH must be directed to neonates who are not presently referred to the surgical service.
Ultrasonographically guided excisional biopsy of non-palpable breast lesions
Authors: Di Giorgio A , Alessi G , Arnone P , Canavese A 
Published: March 2007

Abstract
Excision of small non-palpable breast lesions can be difficult and may result in the unnecessary removal of excessive surrounding breast tissue1. With this in mind a simple excisional biopsy technique for such lesions has been developed which employs intraoperative ultra-sonography to guide the extent of excision.
Effect of a low-fat, low-protein, high- carbohydrate diet on gallstone formation in the hamster
Authors: Pausawasdi A , Siwawetkul W , Watanapa P 
Published: March 2007

Abstract
Many epidemiological studies support the assumption that diet is of great importance in the pathogenesis of cholesterol gallstones1, but its role in the origin and development of non-cholesterol gallstones is less clear. In humans, a low-fat, low-protein, high-carbohydrate diet seems to increase the development of pigment gallstones2. The purpose of this study was to explore therefore the effect of a low-fat, low-protein, high-carbohydrate diet on the formation of gallstones and their composition. Hamsters were used because gallstones induced in these animals can be either cholesterol or pigment, depending on dietary constituents3.
Intra-arterial lignocaine in embolectomy
Authors: Campbell W B , Ballard P K 
Published: March 2007

Abstract
Acute limb ischaemia is now commonly treated by thrombolysis, but embolectomy remains a good and appropriate operation in certain cases of embolism. The patient with an acutely bloodless limb, sensory loss and an obvious source for embolus (such as atrial fibrillation) may be best treated by this means. Embolectomy is usually done under local anaesthesia, infiltrating the groin or antecubital fossa to expose the femoral or brachial artery. The one part of the operation that often causes pain is withdrawal of the inflated embolectomy balloon along the arteries to remove thrombus and clot. Although it is common practice to warn patients that they may feel discomfort during this manoeuvre, it can still prove quite distressing to some patients.
Guided by the work of van Niekerk and Coetzee1 on regional analgesia, the authors have used 0·5 per cent lignocaine during arterial embolectomy to relieve the pain of balloon withdrawal.
Aetiology and treatment of anal fissure
Authors: Lund J N , Scholefield J H 
Published: March 2007

Abstract
Anal fissure is a common problem that causes significant morbidity in a young and otherwise healthy population. Treatment has remained largely unchanged for over 150 years and the pathogenesis of this condition is not yet fully explained. Acute fissures should be treated conservatively with dietary modification. Chronic fissures do not respond to conservative treatment. The current recommended surgical treatment for chronic fissure is lateral internal sphincterotomy. However, there is a disturbance of continence in a sizeable proportion of those undergoing this procedure. As yet there is no proven non-surgical treatment for chronic fissure. Although local injection of botulinum toxin and the topical application of nitrates show early promise, further controlled trials are needed.
Influence of different collagenase solvents and timing of their delivery on porcine islet isolation
Authors: White S A , Contractor H H , Hughes D P , Johnson P R V , Clayton H A , Bell P R F , London N J M 
Published: March 2007

Abstract
Methods to minimize the effect of cold ischaemia on porcine islet isolation were investigated. Forty pancreata were randomized to intraductal collagenase delivery in University of Wisconsin solution (UW) or Hanks balanced salt solution (HBSS) (control) both before and after 65 min of cold pancreas storage. Collagenase was also administered in a specially designed cold storage solution (University of Leicester solution, ULEIC), before cold storage. Median islet yield was significantly greater if the pancreas was distended with collagenase in either UW (21 524 islet equivalents (IEQ) per g) or ULEIC (19 814 IEQ/g) before cold storage, compared with that after distension with HBSS (6924 IEQ/g) following cold storage (P&lt;0·05). Islet fragmentation, islet purification and glucose-stimulated insulin release were not significantly different after collagenase delivery in either UW or ULEIC compared with those after administration in HBSS. It is concluded that porcine islet yields can be improved significantly by intraductal collagenase administration in either UW or ULEIC immediately after excision of the pancreas.
Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: An audit of 5913 cases
Authors: Richardson M C , Bell G , Fullarton G M 
Published: March 2007

Abstract
The rapid introduction of laparoscopic cholecystectomy has been associated with an apparently increased incidence of bile duct injury which has provoked worldwide concern. The true incidence and mechanism of iatrogenic ductal injury during the development of this procedure remain unclear. To assess this, the introduction of laparoscopic cholecystectomy in the West of Scotland has been audited prospectively over a 5-year period. All cases of biliary ductal injury have been independently reviewed. Some 48 surgeons undertaking laparoscopic cholecystectomy in 19 hospitals submitted prospective data between September 1990 and September 1995. A total of 5913 laparoscopic cholecystectomies were attempted with 98·3 per cent completion of data collection. During this period 37 laparoscopic bile duct injuries occurred. The annual incidence peaked at 0·8 per cent and has fallen to 0·4 per cent in the final year of audit. Injuries occurred after a median personal experience of 51 (range 3–247) laparoscopic chole cystectomies in 22 surgeons. Major bile duct injuries occurred in 20 of 37 patients, giving an incidence of 0·3 per cent. Five mechanisms for laparoscopic ductal injury were identified, including tenting, confluence and diathermy injuries as well as the classical and variant classical types. Ductal injuries were discovered at operation in 18 patients with consequent repair giving a good clinical outcome in 17. Contributory factors (severe inflammation, aberrant anatomy and poor visualization) were present in only 13 of 37 cases. This audit suggests that, at least in the introductory period, laparoscopic cholecystectomy is associated with an overall bile duct injury rate higher than that reported previously after open cholecystectomy, although the incidence of major ductal injury is similar. The late downward trend in bile duct injury, however, suggests there may be a prolonged learning curve for this procedure. Improved understanding of the mechanism of injury may lead to yet further reductions in this complication.
Colour duplex ultrasonography in the rational management of chronic venous leg ulcers
Authors: Grabs A J , Wakely M C , Nyamekye I , Ghauri A S K , Poskitt K R 
Published: March 2007

Abstract
Colour duplex ultrasonographic imaging has largely replaced venography in the assessment of lower-limb venous disorders. This is a study of the use of duplex in the management of patients with chronic venous ulceration in community ulcer clinics. Patients with chronic leg ulceration and an ankle: brachial pressure index of 0·85 or greater were studied. Assessment of venous competence in both the deep and superficial systems of the affected and unaffected legs was performed using colour venous duplex imaging. Reflux was defined as reverse flow for greater than 1 s after manual calf compression. One hundred consecutive patients were assessed over 15 months. Of 111 ulcerated legs, 96 had active ulceration, while 15 had been ulcerated within the previous 6 months. Fifty-seven (51 per cent) of the 111 ulcerated legs had superficial incompetence alone (88 per cent long saphenous system or its perforators, 12 per cent short saphenous system). Six legs (5 per cent) had isolated deep venous incompetence. Forty-two legs had mixed superficial and deep venous reflux; 22 of these had undergone previous venous surgery. Colour venous duplex assessment demonstrated superficial venous disease in approximately half of limbs with chronic leg ulceration. Venous dysfunction in these patients is potentially curable by surgery.
Still missing the boat with fatal pulmonary embolism
Authors: Gillies T E , Ruckley C V , Nixon S J 
Published: March 2007

Abstract
Deaths from pulmonary embolism during 1994 among surgical inpatients in three Scottish regions were identified through the Scottish Audit of Surgical Mortality and reviewed to identify the risk factors for thrombo-embolic disease and the thromboprophylaxis received. Fifty-seven deaths were studied (3 per cent of total deaths); 25 (44 per cent) of the patients had received prophylaxis. Thirty-six patients were in a high-risk group, 19 were at moderate risk and two at low risk. Patients admitted as an emergency, those managed conservatively and those judged to be at moderate risk of thrombo-embolic disease were most likely not to have received thromboprophylaxis.