bluuebunny/crossref_metadata_2025 huggingface dataset:
Duplex ultrasonography for assessment of venous valvular function of the lower limb
Authors: Sarin S , Sommerville K , Farrah J , Scurr J H , Smith P D Coleridge
Published: March 2007

Both legs of 29 patients with venous disease and those of 15 controls without venous disease were assessed by duplex ultrasonography. The duration of reverse flow after release of manual calf compression was measured in the common femoral, long saphenous, popliteal and short saphenous veins. Before undertaking the study, the reproducibility of the technique was evaluated in six subjects by repeating the examination over 3 consecutive days; the coefficient of variation of the test was 7·3 per cent. The 95 per cent confidence interval (c.i.) of the median (0·16 s) of all measurements in the normal limbs was 0·12-0·18 s. The 95 per cent c.i. for the 95th percentile of all measurements in normal limbs was 0·32-0·52 s. In limbs with clinical evidence of venous disease at least one of the sites examined was found to have reverse flow lasting longer than 0·5 s. These data suggest that the measurement of reverse flow after release of manual calf compression is a reproducible technique. While the method records some reverse flow in normal veins, its duration is unlikely to exceed 0·5 s; significant reflux is therefore defined as reverse flow exceeding 0·5 s.
Rehabilitation outcome 5 years after 100 lower-limb amputations
Authors: McWhinnie D L , Gordon A C , Collin J , Gray D W R , Morrison J D
Published: March 2007

Received wisdom commends a policy of maximizing the ratio of below-knee to above-knee amputations in patients with end-stage arterial disease. After adoption of this policy, the long-term outcome of 100 consecutive lowerlimb amputations in 96 patients was monitored by annual review for 5 years. The ratio of primary below-knee to above-knee amputations was 2:1, with 9 per cent of belowknee amputations undergoing revision to a higher level. At 2 years after amputation only 26 per cent of patients were successfully walking out of doors, while 40 per cent had died. By 5 years 67 per cent were dead and only 9 per cent continued to walk out of doors with an artificial limb, although a further 8 per cent continued to use the limb within the confines of their own homes. In a previous audit of 193 amputations performed during the 3·5 years to December 1984, stump healing was a problem in 45 per cent of primary below-knee amputations, compared with 25 per cent in the present study. Although the below- to above-knee ratio in 1984 was only 1:2, the overall rehabilitation rate, as determined by the proportion of patients able to walk at 2 years, was 34 per cent. It is concluded that increasing the proportion of below-knee amputations from one-third to two-thirds of lower-limb amputations for occlusive arterial disease does not improve effective rehabilitation rates. Received wisdom on the desirability of a high below- to above-knee ratio may be wrong.
Multifocal nature of adenolymphoma of the parotid
Authors: Lam K H , Ho H C , Ho C M , Wei W I
Published: March 2007

The multifocal nature of adenolymphoma of the parotid salivary gland was studied in 24 patients who underwent parotidectomy. Twenty-six resected specimens were examined by a step-serial whole-organ sectioning technique; multiple adenolymphoma was found in 13. The maximum number of synchronous tumours in any gland was four. Salivary epithelial elements were found embedded within lymph nodes in nine resected specimens. Synchronous or metachronous bilateral tumours were found in eight patients. The multifocal nature of adenolymphoma of the parotid gland is demonstrated.
Interstitial laser photocoagulation as a treatment for breast cancer
Authors: Harries S A , Amin Z , Smith M E F , Lees W R , Cooke J , Cook M G , Scurr J H , Kissin M W , Bown S G
Published: March 2007

This preliminary report describes the use of interstitial laser photocoagulation to manage small breast cancers. Forty-four patients were treated with a diode laser of 805 nm under local anaesthesia in the interval between diagnosis and surgery. Ultrasonography was used in 42 patients and computed tomography (CT) in two to place the fibre in the tumour and monitor laser effects. Laser-induced necrosis within the resected tumour varied from 0 to 25 mm in diameter. The presence of charring in the tumour around the fibre tip after treatment was associated with significantly larger diameters of necrosis than when charring did not occur (median 13 versus 6 mm, P = 0·002). Precharring the fibre resulted in a more predictable diameter of necrosis (median 14 mm). Ultrasonography was inaccurate in assessing laser damage; dynamic CT and magnetic resonance imaging, may be of more use. Interstitial laser photocoagulation is simple and safe, and can produce necrosis of a reasonably predictable extent.
Two-team synchronous oesophagectomy
Authors: Gurtner G C , Robertson C S , Chung S C S , Li A K C
Published: March 2007

Between 1984 and 1992, 131 patients underwent two-team synchronous oesophagectomy for carcinoma. Some 95 per cent of tumours were successfully resected by this technique. In 5 per cent of patients the tumour was found to be irresectable at operation and gastric bypass was performed. The overall operative mortality rate was 8 per cent and the pulmonary complication rate 10 per cent. The actuarial survival rate was 55 per cent at 1 year, 22 per cent at 3 years and 16 per cent at 5 years. When compared with the traditional two-stage Lewis approach, two-team synchronous oesophagectomy was significantly faster (mean 222 versus 282 min), but was not significantly different with respect to blood loss, transfusion requirement, pulmonary complications or operative mortality rate. Patients undergoing two-team oesophagectomy had a significantly shorter hospital stay than those receiving the two-stage procedure (mean 16 versus 24 days).
Patient satisfaction and postoperative demands on hospital and community services after day surgery
Authors: Ghosh S , Sallam S
Published: March 2007

This study presents the outcome of a survey of patient satisfaction following day surgery and an assessment of the level of contact between patients and community services within the first 48 h after discharge from a day-surgery unit. A total of 953 patients were provided with a self-completion questionnaire after day surgery; replies were received from 557 (58·4 per cent). Areas investigated regarding overall satisfaction were outpatient services, admission procedure, day-surgery services, preoperative and postoperative information, and postoperative pain relief. The incidence of contact with the hospital or community services in the 48 h after operation was also recorded. Overall satisfaction following day surgery was very high. Only 2·5 per cent of respondents reported that they had needed to contact the hospital within 24 h of discharge. Contact with community services in the 48 h after operation was minimal. Only 4·3 per cent consulted their general practitioner and 1·4 per cent a district nurse. For the small number of patients who did contact the hospital or their general practitioner, the most frequent reason was a problem with pain management.
Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head
Authors: Allema J H , Reinders M E , Van Gulik T M , Van Leeuwen D J , De Wit L Th , Verbeek P C M , Gouma D J
Published: March 2007

Of 176 patients with carcinoma of the pancreatic head region 156 underwent standard pancreatoduodenectomy (group 2) and 20 with macroscopic suspicion of invasion of the portal vein or superior mesenteric vein (SMV) underwent pancreatoduodenectomy with partial resection of the portal vein or SMV (group 1). In 16 patients in group 1 end-to-end anastomosis was used for reconstruction of the vein. The morbidity rate in groups 1 and 2 was similar (55 versus 63 per cent). The hospital mortality rate was 15 per cent in group 1 and 7 per cent in group 2 (P=0·22). Histological examination confirmed tumour invasion of the portal vein or SMV in ten patients in group 1. Invasion of the portal vein or SMV was significantly more frequent in patients with pancreatic cancer than in those with distal bile duct or ampullary carcinoma. Of the 20 patients in group 1 only three underwent curative resection with tumour-free margins. The median survival time after resection of the portal vein or SMV was 8 months; the 2-year survival rate was 19 per cent. Comparison of survival in group 1 with survival in subgroups of patients undergoing standard pancreatoduodenectomy, matched for all histological parameters, showed no significant difference. It is concluded that partial resection of the portal vein or SMV in patients undergoing pancreatoduodenectomy who are suspected of having tumour invasion of the portal vein or SMV does not improve either the rate of curative resection or survival.
Laparoscopic cholecystectomy for acute cholecystitis
Authors: Kum C K , Goh P M Y , Isaac J R , Tekant Y , Ngoi S S
Published: March 2007

The safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis were evaluated in a 2-year retrospective review. Results of laparoscopic cholecystectomy in 66 patients with acute inflammation of the gallbladder were compared with those of the standard open procedure for this condition (43 patients) and routine laparoscopic cholecystectomy (227 patients). The laparoscopic procedure for acute cholecystitis was successful in 46 of 66 patients. There was no difference in mean operating time when the inflamed gallbladder was removed laparoscopically or at open surgery (82 versus 84 min); however, each procedure took longer than did routine laparoscopic cholecystectomy (mean 69 min; P <0·01). There was no difference in analgesic requirement between patients who underwent laparoscopic removal of an acutely inflamed gallbladder and those in the other two groups. Postoperative recovery was significantly faster than that after open surgery (P<0·01), but took longer than that following routine laparoscopic cholecystectomy (P<0·01). Inability to identify the cystic duct was the most common reason for conversion to open operation, which occurred in 20 cases of acute cholecystitis. Bile duct injury occurred in one of 66 patients with acute cholecystitis treated laparoscopically, two of 227 cases of routine laparoscopic cholecystectomy but in no patient who underwent open cholecystectomy. In conclusion, laparoscopic cholecystectomy is technically achievable in the majority of patients with acute cholecystitis. The conversion rate is high but, if the procedure is completed successfully, postoperative recovery is more rapid than that after open surgery. However, the method carries a higher incidence of complications and should be attempted only by experienced surgeons.
Impact of intraoperative ultrasonography on treatment strategy for colorectal cancer
Authors: Paul M A , Mulder L Sibinga , Cuesta M A , Sikkenk A C , Lyesen G K S , Meijer S
Published: March 2007

The impact of intraoperative ultrasonography (IOUS) on treatment strategy was studied in 122 patients with primary colorectal cancer. All patients underwent preoperative liver imaging by ultrasonography and computed tomography (CT). After curative resection of the primary tumour patients were eligible for adjuvant chemotherapy. The findings on IOUS were assessed by ultrasonography 6 months after laparotomy. Of 34 patients with suspected liver metastases on ultrasonography or CT, the diagnosis was confirmed by IOUS in 21. In the remaining 13 patients the suspect lesions were shown to be benign. Of the 88 patients with normal preoperative imaging results, suspect lesions were detected in five; in four the lesion was found by IOUS only. One of these four also had an extrahepatic metastasis. At follow-up the diagnosis of metastasis proved to be wrong in two of the remaining three patients, so IOUS was helpful in only one patient. Surgical management was not markedly influenced by findings on IOUS in any patient. However, IOUS correctly changed the stage of the disease, and consequently postoperative treatment, in 14 patients (11 per cent). Two patients were erroneously excluded from the adjuvant protocol following an incorrect diagnosis based on IOUS.
Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer
Authors: Beets G , Penninckx F , Schiepers C , Filez L , Mortelmans L , Kerremans R , Aerts R , De Rao M
Published: March 2007

To assess the clinical value of whole-body positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) in recurrent colorectal cancer, 35 patients were studied: 15 had resectable liver metastases, one a resectable lung metastasis, eight resectable pelvic recurrence, eight a presacral mass with equivocal findings on imaging, and three increasing serum levels of carcinoembryonic antigen (CEA) without clinical or radiological signs of recurrent disease. PET affected management decisions in seven of 16 patients with metastatic disease. In one of eight patients with pelvic recurrence demonstrated by computed tomography (CT), PET detected unknown pulmonary metastases. In five of eight presacral masses with equivocal CT findings, PET was correct and unexpected distant metastases were detected in one of these patients. In two of three patients with increasing CEA levels and normal pelvic CT findings, pelvic recurrence was identified. Overall, whole-body PET affected management in 14 patients. PET is a valuable tool for staging local recurrence and metastatic disease.
Motor abnormalities in the terminal ileum of patients with chronic idiopathic constipation
Authors: Panagamuwa B , Kumar D , Ortiz J , Keighley M R B
Published: March 2007

Abnormalities in oesophageal, gastric and jejunal motility have been described in patients with chronic idiopathic constipation, suggesting that this may be a panenteric disorder. To test the hypothesis that ileal motility is also abnormal in constipation, terminal ileal motility was studied in ten patients and six healthy controls by prolonged and ambulant manometry. Mean(s.e.m.) phase II activity was significantly prolonged in patients compared with controls, during wakefulness (61·6(7·3) versus 19·3(3·5) per cent, P<0·001) and sleep (44·4(9·0) versus 1·1(0·8) per cent, P<0·001). The mean(s.e.m.) duration of phase III fronts was shorter in patients (7·9(1·8) min) than in controls (13·2(1·3) min; P<0·001). Retrograde propagation was seen in approximately 15 per cent of all phase IIIs in patients but not in control subjects. The mean(s.e.m.) duration of postprandial activity was significantly shorter in patients than in controls (30·1(6·2) versus 130·0(68·0) min, P<0·001). Ileal motility is abnormal in patients with chronic idiopathic constipation. This may result from an abnormality of the enteric nervous system or abnormal modulation of this system by the central nervous system.
Effect of age, sex and parity on anorectal function
Authors: Jameson J S , Chia Y W , Kamm M A , Speakman C T M , Chye Y H , Henry M M
Published: March 2007

Ninety-one healthy subjects (51 women; age range 16–85 years) were studied prospectively to determine the effect of age, sex and parity on anorectal function. Maximum resting pressure, voluntary contraction pressure, rectal sensation to distension, rectal and mid-anal electrosensitivity, perineal descent, pudendal nerve terminal motor latency and fibre density of the external anal sphincter were measured. Sex influenced mean(s.d.) voluntary contraction pressure (148(56) versus 95(43) cmH2O for men versus women, P<0·0001), perineal descent on straining (1·0(0·5) versus 1·3(0·4) cm, P=0·02) and fibre density (1·43(0·14) versus 1·52(0·15), P=0·02). Age influenced resting pressure (r= −0·43, P= 0·0001), perineal position at rest (r= −0·55, P<0·0001), mid-anal electrosensitivity (r=0·42, P=0·0001) and rectal electrosensitivity (r=0·54, P<0·0001). Parity affected mean(s.d.) voluntary contraction pressure (105(53) versus 75(20) cmH2O for nulliparous versus parous women, P=0·04) and mid-anal electrosensitivity (5·3(2·3) versus 4·5(2·3) mA, P=0·02). Increasing age leads to perineal descent at rest, slowed pudendal nerve conduction, a fall in resting anal pressure and decreased anorectal sensory function. Women have a lower anal squeeze pressure, greater perineal descent, longer pudendal nerve terminal motor latency and a greater muscle fibre density than men. Parity leads only to lower squeeze pressure.
Systemic responses in patients with intermittent claudication after treadmill exercise
Authors: Edwards A T , Blann A D , Suarez -Mendez V J , Lardi A M , McCollum C N
Published: March 2007

The effect of 5 min treadmill exercise was investigated in claudicant patients and healthy controls; systemic neutrophil count, plasma thromboxane and von Willebrand's factor (a marker for endothelial injury) were measured. Median (interquartile range (i.q.r.)) resting neutrophil count was 5.6 (5.2–6.0) × 106 cells 1−1 in claudicants and 2.8 (2.6–3.2) × 106 1−1 in controls (P < 0.05); this increased in those with claudication to 7.1 (6.2–7.7) × 106 1−1 immediately after exercise (P < 0.05). The resting plasma thromboxane level was 32.1 (25.0–60.0) pg m1 −1 in claudicants and rose to 135.0 (104.0–141.3) pg ml−1 15 min after exercise, compared with a rise from 25.0 (22.0–33.5) to 55.5 (33.0–67.0) pg ml−1 in controls (P < 0.05). The resting serum von Willebrand's factor level was 127 (110–135) units dl−1 in claudicants compared with 60 (48–71) units dl−1 in controls; this difference persisted after exercise (P < 0.01). In patients with claudication, the level of von Willebrand's factor increased to 150 (140–156) units dl−1 60 min after exercise (P < 0.05). Free radical scavenging capacity was also investigated by measuring the plasma antioxidant activity of glutathione peroxidase and its essential non-metal co-factor selenium. Scavenging capacity was lower in claudicant patients whose median (i.q.r.) glutathione peroxidase activity (change in absorbance per min per ml plasma) was 2.84 (2.39–3.61) versus 3.24 (3.06–3.79) in controls (P < 0.05). Similarly, plasma concentrations of selenium were lower in claudicants at a median (i.q.r.) of 75.0 (58.0–81.0) μg 1−1 compared with 88.0 (75.0–92.5) μg 1−1 in controls (P < .05). Exercise in claudicant patients leads to neutrophilia and thromboxane production with subsequent endothelial injury. The antioxidant activity of glutathione peroxidase is reduced in patients with claudication and may allow the unopposed action of free radicals to damage endothelium.
Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery
Authors: Drummond M , Aristides M , Davies L , Forbes C
Published: March 2007

Deep vein thrombosis (DVT) is a common complication in patients undergoing elective hip surgery. Because of the associated risk of pulmonary embolism, prophylaxis with standard (unfractionated) heparin is becoming increasingly important. Recent clinical trials have shown a low molecular weight form of heparin, enoxaparin, to be more effective than standard heparin in preventing DVT, but the new drug is also more expensive. Data on clinical effectiveness and cost were combined in an economic evaluation of the two regimens. It was found that prophylaxis with enoxaparin would be expected to lead to a net saving of £20 per patient. The economic results are sensitive to the costs of enoxaparin, the costs of drug administration and the probability of false clinical diagnosis of DVT or pulmonary embolism.
Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy
Authors: Nies C , Sitter H , Zielke A , Bandorski T , Menze J , Ehlenz K , Rothmund M
Published: March 2007

A randomized controlled trial was performed to compare two techniques of bilateral subtotal thyroidectomy for non-toxic nodular goitre with regard to postoperative parathyroid function. The 50 patients in group 1 underwent ligation of the trunks of the inferior thyroid arteries. In group 2 (50 patients) the branches of these arteries were suture-ligated at the thyroid capsule. Total calcium, ionized calcium and parathyroid hormone levels were determined before operation, and 6, 24 and 72 h after surgery. Ninety-one patients were seen at follow-up 5–10 months after operation. Ten patients in group 1 and 12 in group 2 required calcium and/or vitamin D supplementation for symptomatic hypocalcaemia in the immediate postoperative period. At follow-up only one patient in each group had mild hypoparathyroidism. No statistically significant differences were found between groups regarding total calcium, ionized calcium and parathyroid hormone levels. Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy does not cause hypoparathyroidism or hypocalcaemia.
Early results of laparoscopic intraperitoneal onlay mesh repair for inguinal hernia
Authors: Chan A C W , Lee T W , Ng K W , Chung S C S , Li A K C
Published: March 2007

Over a 15-month period, 39 patients (37 men) of mean age 52 yean underwent laparoscopic inguinal hernia repair. Seven patients had bilateral hernia. Forty-six hernias (33 indirect, five direct, eight both direct and indirect) were repaired. A piece of polypropylene mesh measuring 8 × 10 cm was used to cover the direct and indirect spaces with an endoscopic multifeed hernia stapler. The mean operating time for unilateral and bilateral repair was 49 and 63 min respectively (range 25–90 min). One-third of patients required no postoperative analgesia and only seven had more than one injection of pethidine. The median postoperative stay was 7 (range 4–3) days. The mean period to resumption of daily activities was 7 (range 4–21) days. Three patients complained of paraesthesia of the lateral aspect of the thigh and one developed a hydrocele. Two recurrences were noted on follow-up at 3 months.
Combination chemotherapy with epirubicin, cisplatin and 5-fluorouracil for the palliation of advanced gastric and oesophageal adenocarcinoma
Authors: Highley M S , Parnis F X , Trotter G A , Houston S J , Penson R T , Harper P G , Mason R C
Published: March 2007

The palliative efficacy of laser therapy with combination chemotherapy (cisplatin, epirubicin and continuous infusion of 5-fluorouracil) was assessed in 34 patients with inoperable gastro-oesophageal cancer. Comparison was made with a group of 30 patients treated previously by laser alone. Twenty patients responded to chemotherapy. There was a significant improvement in dysphagia, as measured by a decreased laser requirement to maintain satisfactory swallowing. In this non-randomized prospective phase II trial, palliation was attained and some responses were long-lasting (median duration of response 8.7 (range 2.3 to more than 29.2) months).
Gamma probe-guided sentinel node biopsy to select patients with melanoma for lymphadenectomy
Authors: Van Der Veen H , Hoekstra O S , Paul M A , Cuesta M A , Meijer S
Published: March 2007

A novel approach is described by which to identify the sentinel lymph node in patients with stage I melanoma. The technique involves a combination of intradermal patent blue V injection and γ probe-assisted surgery. Eleven patients with previously resected cutaneous melanoma, clinical stage I (Breslow thickness 1.35–3.20 mm), underwent sentinel node biopsy. Before surgery lymphoscintigraphy was performed to evaluate the pathways of lymphatic drainage from the site of the previously resected melanoma. A handheld γ probe was used to localize the sentinel node and to define the exact site of incision. At the same time, patent blue V (0.1–0.2 ml) was injected intracutaneously on either side of the scar to visualize the afferent lymphatic ducts and lymph nodes. By combining the use of the γ probe and vital dye staining, the sentinel node could easily be localized and identified in all 11 patients. After removal of the sentinel node(s) no residual radioactivity could be traced. In four patients with micrometastases in the sentinel node standard lymph node dissection was performed, including excision of the biopsy site; in only one lymphadenectomy specimen were micrometastases found in two other lymph nodes.
Enhanced Kupffer cell activity after repeated hepatic arterial ischaemia in an experimental model
Authors: Wang L -Q , Ding J -W , Persson B G , Bengmark S
Published: March 2007

Kupffer cells are important for host defence against both foreign invaders and neoplasia. Several studies have demonstrated that ischaemia and reperfusion activates Kupffer cells. The effect of hepatic arterial ischaemia on Kupffer cell function was assessed using blood clearance and organ uptake of radiolabelled Escherichia coli. Transient ischaemia for 1 h did not alter Kupffer cell function in comparison with sham operation. However, prolonging arterial ischaemia for 2 h stimulated Kupffer cell function; both the phagocytic index and liver uptake of radiolabelled E. coli increased significantly (P < 0.01). Furthermore, this enhanced Kupffer cell activity was achieved each time the ischaemia was induced over a period of 5 days compared with repeated sham procedures (P < 0.05). Serum tumour necrosis factor (TNF) was significantly released after both single and repeated arterial occlusion for 2 h (P < 0.01). These observations show that transient arterial ischaemia enhances Kupffer cell function and induces TNF production.
Effect of platelet-activating factor on cold-preserved liver grafts
Authors: Hashikura Y , Kawasaki S , Matsunami H , Ikegami T , Nakazawa Y , Makuuchi M
Published: March 2007

Platelet-activating factor (PAF) may play an important role in graft injury in liver transplantation. Livers excised from male Wistar rats were preserved in University of Wisconsin solution for 6 h and then perfused with Krebs-Henseleit solution containing vehicle (bovine serum albumin) or PAF. Impairment of parenchymal cells was assessed by reference to tissue adenosine triphosphate levels, oxygen consumption and alanine aminotransferase activity in the effluent. The effect on non-parenchymal cells was evaluated by measurement of purine nucleoside phosphorylase and alanine aminotransferase levels in the effluent. Administration of as little as 1.0 ng kg−1 PAF caused a significant decrease in adenosine 5′-triphosphate concentration and oxygen consumption (P < 0.5), although non-parenchymal cell injury was not affected. PAF can therefore cause liver graft dysfunction with hepatocytes as the main target, even in the absence of microcirculatory disturbance secondary to interaction between blood cells and endothelial cells.
Amelioration of experimental acute pancreatitis with a potent platelet-activating factor antagonist
Authors: Formela L J , Wood L M , Whittaker M , Kingsnorth A N
Published: March 2007

The effect of a potent platelet-activating factor (PAF) antagonist, BB-882, on an experimental model of acute pancreatitis induced in male Wistar rats by a technique of microvascular ischaemia was studied. A single intraperitoneal injection of BB-882 (5 mg/kg) 30 min after induction of the disease in 12 animals significantly reduced (P < 0.001) the rise in the level of serum amylase (mean 2477 (range 2100–3280) units/1) compared with that in 12 control animals (mean 3928 (range 2800–5900) units/1) and significantly improved (P < 0.001) the mean pancreatic histology score (5.0. (range 3–10) versus 12.3 (range 8–18) in controls). PAF is a biologically active ether phosphorylcholine synthesized in cell membranes and a potent inflammatory mediator. Pancreatic tissue levels of this compound are increased in experimental acute pancreatitis and pretreatment with PAF receptor antagonists can ameliorate the progression of this disease. BB–882 alters the early course of experimental pancreatitis and may have a clinical therapeutic role.
Risk factors for bile duct injury in laparoscopic cholecystectomy: Analysis of 49 cases
Authors: Schol F P G , Go P M N Y H , Gouma D J
Published: March 2007

Forty-nine bile duct injuries, representing 0.8 per cent of 6076 laparoscopic cholecystectomies performed in the Netherlands in 1990–1992, were reviewed. The aim of the study was to classify the injuries according to severity, to identify possible risk factors contributing to the aetiology of such injuries and to correlate these with the severity of the injury. On the basis of operative findings, bile duct injuries were classified from minor (classes I-IIIa) to extensive with loss of bile duct tissue (IIIb) or localization in the liver hilum (IV). Of 49 injuries, there were 11 in class I, six in class II, ten in class IIIa, 18 in class IIIb and four in class IV. In 16 patients the injury was detected during laparoscopic cholecystectomy and the procedure converted to laparotomy. The duct injury was minor (class I-IIIa) in 14 of these 16 patients. In 20 of the 33 patients in whom identification of the injury was delayed to a second or third operation, more severe types of injury (classes IIIb and IV) were observed. Delayed detection was associated with greater severity (P=0.002). Of eight patients with histologically proven acute cholecystitis at cholecystectomy, seven suffered severe injury (class IIIb or IV). Surgical experience with laparoscopic cholecystectomy was an important factor in the incidence of bile duct injury.
Persistence of idiopathic anal fistula may be related to epithelialization
Authors: Lunniss P J , Sheffield J P , Talbot I C , Thomson J P S , Phillips R K S
Published: March 2007

Anal fistulas may fail to heal because of continuing disease within the intersphincteric anal glands. Histological studies of the intersphincteric component of 18 consecutive idiopathic anal fistulas show that fistula persistence may be caused by epithelialization of the fistula track from internal or external openings. Some fistulas are lined by epithelium similar to that of anal gland ducts, but this may also represent epithelium derived from the transitional zone of the anal canal. Persistence may be related more to nonspecific epithelialization of the track than to a chronically infected anal gland.
Recurrent varicose veins: A varicographic analysis leading to a new practical classification
Authors: Stonebridge P A , Chalmers N , Beggs I , Bradbury W , Ruckley C V
Published: March 2007

The varicograms of 128 legs were reviewed by a panel of two vascular surgeons and a radiologist with a specialist vascular interest. Varicography effectively elucidates the anatomical basis of recurrence. Recurrent varicose veins were associated with (i) technically unsatisfactory surgery at the saphenofemoral junction (66 per cent) and (ii) failure to remove the long saphenous vein in the thigh (60 per cent). A new classification is offered as a basis for comparison of series, audit and surgical training.
Management of alimentary tract duplication in children
Authors: Stringer M D , Spitz L , Abel R , Kiely E , Drake D P , Agrawal M , Stark Y , Brereton R J
Published: March 2007

Duplication of the alimentary tract is rare but potentially dangerous. Five of 72 children with alimentary tract duplication treated between 1973 and 1992 died from postoperative complications; a further ten required more than one operation. Heal duplications were the commonest, occurring in 16 patients (22 per cent). Thoracoabdominal duplications were the most complicated and responsible for much of the overall morbidity and mortality. Surgical complications were related to the size and location of the duplication, communication with the gastrointestinal tract or vertebral canal, presence of heterotopic gastric mucosa and involvement of mesenteric vessels. Complete excision of the duplication should be possible in most cases.
Tumour growth stimulation after partial hepatectomy can be reduced by treatment with tumour necrosis factor α
Authors: Slooter G D , Marquet R L , Jeekel J , Ijzermans J N M
Published: March 2007

This study investigated whether partial hepatectomy enhances the growth of experimental liver metastases of colonic carcinoma in rats and whether treatment with recombinant human tumour necrosis factor (TNF) α can reduce this increased growth. Resection of 35 or 70 per cent of the liver was performed in inbred WAG rats, with sham-operated controls (five to eight animals per group). Immediately after surgery 5·105 CC531 colonic tumour cells were injected into the portal vein. After 28 days the animals were killed and the number of liver metastases counted. A 35 per cent hepatectomy induced a significant increase in the median number of liver metastases (28 versus 3 in controls), whereas a 70 per cent resection provoked excessive growth, consistently leading to more than 100 liver metastases and a significantly increased wet liver weight in all animals. TNF-α was given intravenously to rats following 70 per cent hepatectomy or sham operation in a dose of 160 μg/kg three times per week. This had only a marginal effect on tumour development in sham-operated rats but was very effective following partial hepatectomy (median 45 liver metastases). These observations confirm previous findings that surgical metastasectomy may act as a ‘double-edged sword’ by provoking outgrowth of dormant tumour cells and suggest that adjuvant treatment with TNF-α may be of benefit in patients undergoing resection of metastases.
Laparoscopic colonic surgery
Authors: Monson J R T , Hill A D K , Darzi A
Published: March 2007

Laparoscopic surgical techniques have recently entered the field of colorectal surgery. Because the laparoscopic approach has revolutionized biliary surgery, it is hoped that similar advances will be possible in the more elderly population with colorectal disease. Early experience suggests that such advances have not been achieved and there is concern about developing minimal access surgical techniques in the face of potentially curable cancer. This article reviews the current state of knowledge based on published series; however, the current lack of controlled data in patients with extended follow-up makes this area highly controversial. Suggestions regarding the future of laparoscopic surgery are made and include the establishment of a national register and the development of controlled randomized trials.
Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis
Authors: Eriksson S , Granström L
Published: March 2007

In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment hi patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.
Primary anastomosis with transverse colostomy as an alternative to Hartmann's procedure
Authors: Maddern G J , Nejjari Y , Dennison A , Siriser F , Bardoxaglou E , Launois B
Published: March 2007

Hartmann's procedure remains the favoured option in patients with acute left colonic and sigmoid disease, despite the well documented morbidity and mortality associated with reversal. In 40 patients with left colonic pathology, primary anastomosis was performed; 32 had a covering transverse colostomy. There were six hospital deaths, five in the transverse colostomy group. Closure was not attempted in seven of the 27 patients surviving with a colostomy (three refused, four had disseminated malignancy). In the 20 undergoing closure, there was no morbidity or mortality. With advances in intensive care, antibiotic therapy and anaesthesia, it is reasonable to consider alternatives to Hartmann's procedure, particularly when subsequent reconstruction is envisaged.
Prospective randomized study of radical versus four piles haemorrhoidectomy for symptomatic large circumferential prolapsed piles
Authors: Seow-Choen F , Low H C
Published: March 2007

Twenty-eight patients (14 men, 14 women) with circumferential prolapsed piles were prospectively randomized to undergo either modified radical haemorrhoidectomy (group 1; 14 patients) or four piles haemorrhoidectomy (group 2; 14). The median duration of surgery was 30 and 10min respectively in groups 1 and 2. After operation all patients in group 1 were continent compared with 12 of 14 in group 2. Two patients in group 2 developed an anal stricture requiring manual dilatation. Five patients in group 1 had wound dehiscence requiring secondary suture; three of these developed an anal stricture: two needed anal dilatation and one required anoplasty. Two patients in group 1 had residual anal skin tags, compared with nine in group 2. Two patients in group 2 had symptomatic residual piles, whereas none in group 1 had this problem. At 6 months, six patients in group 2 considered the results to be excellent, seven acceptable and one was disappointed. In group 1 two considered the operation to be excellent, ten acceptable and two were disappointed.
Survival of patients with surgical wound infection: A case-control study of common surgical interventions
Authors: Poulsen K B , Wachmann C H , Bremmelgaard A , Sørensen A I , Raahave D , Petersen J V
Published: March 2007

A cohort of 4515 surgical patients was selected from ten different surgical intervention groups, and 291 of 317 with a postoperative wound infection were matched 1:1 with controls with regard to intervention, sex and age. The mortality rate was investigated from the time of operation, with a follow-up period from 4 years 4 months to 8 years 4 months. Eighty-seven patients with a deep infection had a significantly increased mortality rate, with a risk ratio of 1·7. Without a distinction between superficial and deep infection the former might mask the higher mortality rate associated with the latter.
Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: A prospective randomized trial
Authors: Tekant Y , Goh P , Alexander D J , Isaac J R , Kum C K , Ngoi S S
Published: March 2007

A prospective randomized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage. Some 153 consecutive patients were randomized to receive either local injection of adrenaline (1:10000) followed by heater probe thermocoagulation (74 patients) or no endoscopic treatment (79 patients). The two groups were well matched with regard to age, haemoglobin concentration on admission, non-steroidal anti-inflammatory drug usage and endoscopic findings. More patients in the treatment group were in shock on admission (21 versus 13). Initial haemostasis was achieved in all patients randomized to endoscopic therapy. Rebleeding occurred in fewer treated than control patients (five versus 16, P = 0·01). The treated group also had fewer deaths (zero versus two) and requirement for operation (two versus six). The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage.
Return to work after laparoscopic cholecystectomy
Authors: McLauchlan G J , MacIntyre I M C
Published: March 2007

To assess whether the introduction of laparoscopic cholecystectomy has led to a change in attitude regarding the resumption of normal activities after operation, the views of 407 general practitioners (GPs) and 532 patients were analysed. Although 99 per cent of GPs thought that laparoscopic cholecystectomy represented an improvement on the open operation, 55 per cent advised significant restrictions in the postoperative period. For the 231 patients in employment who had an uncomplicated laparascopic procedure the mean time of return to work was 3·3 weeks. Although 47 per cent of patients returned to work within 2 weeks, 19 per cent took more than 4 weeks. The self-employed returned significantly earlier than employees. Education through better communication among hospital, general practitioners and patients is required if prevailing attitudes towards the length of convalescence after laparoscopic cholecystectomy are to change.
Liver transplantation in patients with situs inversus
Authors: Watson C J E , Rasmussen A , Jamieson N V , Friend P J , Johnston P S , Barnes N D , Calne R Y
Published: March 2007

Seven patients with situs inversus abdominis and one with situs inversus totalis underwent liver transplantation; all are alive at follow-up of between 7 months and 5 years. Two patients required retransplantation within the first 3 weeks (for primary non-function and thrombotic infarction). Seven had additional abnormalities associated with the polysplenia-biliary atresia syndrome. Liver transplantation in these patients involved selection of relatively small donor organs or use of reduced-size grafts. Delayed abdominal wall closure was necessary in two patients and all required a modification of the ‘piggy-back’ technique of suprahepatic vena caval anastomosis to overcome recipient venous anomalies. Biliary drainage by Roux-en-Y choledochojejunostomy was the preferred technique. Although technically challenging, situs inversus is not a contraindication to liver transplantation and patients should expect full recovery.
Experience of orthotopic liver transplantation and hepatic resection for hepatocellular carcinoma of less than 8 cm in patients with cirrhosis
Authors: Tan K C , Rela M , Ryder S D , Rizzi P M , Karani J , Portmann B , Heaton N D , Howard E R , Williams R
Published: March 2007

Fifteen patients with cirrhosis underwent orthotopic liver transplantation for small hepatocellular carcinoma (HCC) and 12 patients with cirrhosis underwent hepatic resection for similar HCC. All tumours were of the non-fibrolamellar variant. The majority of the patients in the transplant group had Child's grade B or C cirrhosis. Median follow-up was 37 months with a minimum of 18 months. Eleven of 12 patients in the resection group had Child's grade A cirrhosis. Median follow-up was 29 months with a minimum of 16 months. Actuarial survival rates at 1 and 3 years for the transplanted patients were 80 and 63 per cent and all were tumour free. Tumour recurrence rate was 15 per cent. The overall 1- and 3-year tumour-free survival rates for patients in the resection group were 61 and 33 percent. Tumour recurrence rate was 45 percent. The results show orthotopic liver transplantation to be an important surgical option in cirrhotic patients with small HCC, particularly in those with moderate to severe hepatic decompensation.
Long-term results after laparoscopic cholecystectomy
Authors: Ure B M , Troidl H , Spangenberger W , Lefering R , Dietrich A , Eypasch E P , Neugebauer E
Published: March 2007

As part of a continuing audit of patients undergoing laparoscopic cholecystectomy (which now numbers over 1500) 468 of the 508 patients (92·1 per cent) operated on between October 1989 and March 1991 were studied between 350 and 988 days after the operation (mean 19 months). A questionnaire was filled in by each patient before operation and at the late follow-up visit. Eight specific symptoms were sought - non-colicky pain, colic, abdominal distension, nausea, vomiting, loss of appetite, flatulence, and dietary restriction. The result of each operation was assessed by two surgeons and by the patient. In 453 patients (96·8 per cent) the symptoms had improved as a result of the operation, but 260 patients (55·6 per cent) had some abdominal symptoms. The result was assessed as excellent in 310 patients (66·2 per cent); 143 (30·5 per cent) still had abdominal complaints but they were willing to cope with those symptoms. In 15 patients (3·2 per cent) the result was unsatisfactory. Statistical analysis of 26 preoperative variables showed few significant differences between patients with excellent results and patients with persisting or new symptoms. The percentage of patients with biliary colic was reduced from 82·9 per cent before to 6·4 per cent after laparoscopic cholecystectomy (P <0·05), and of those with flatulence from 62·6 per cent to 45·3 per cent (P <0·05). Flatulence persisted in 147 (50·2 per cent) of the 293 patients who had complained of flatulence before the operation, and of the 175 patients who had not complained of flatulence before surgery, 65 (37·1 per cent) reported the symptom for the first time after the operation. It appears that ‘flatulent dyspepsia’ after cholecystectomy has many causes, one of which may be removal of the gallbladder. It is concluded that the long-term results of laparoscopic cholecystectomy in patients with symptomatic gallstone disease were excellent but the prognosis in individual patients was unpredictable.
Serum tumour necrosis factor compared with C-reactive protein in the early assessment of severity of acute pancreatitis
Authors: Paajanens H , Laato M , Jaakkola M , Pulkki K , Niinikoski J , Nordback I
Published: March 2007

Tumour necrosis factor (TNF) is an early mediator of sepsis and multiple organ failure; increased concentrations in serum are also observed in acute pancreatitis. In the present study the predictive value of TNF and C-reactive protein (CRP) concentrations on admission were compared in order to differentiate complicated cases of acute pancreatitis from the mild course in 77 patients. Serum TNF concentration exceeded the detectable level only in seven of 77 patients (9 per cent), although complicated pancreatitis developed in 18 (23 per cent). The sensitivity and overall accuracy of TNF concentration in predicting severe disease were only 16 and 74 per cent respectively. The corresponding values for CRP (concentrations greater than 100 mg/1) were 84 and 74 per cent respectively. These data suggest that, in contrast with CRP, the early determination of peripheral blood TNF concentration is of no clinical value in assessing the severity of acute pancreatitis.
Re-excision of soft tissue sarcoma after inadequate initial operation
Authors: Zornig C , Peiper M , Schroder S
Published: March 2007

Between January 1988 and October 1993, 189 patients with soft tissue sarcoma of the extremities and trunk underwent surgery and since 1988, patients in whom the initial operation did not achieve safe margins underwent reoperation (67 of the 189). At re-excision an en bloc resection of the area with wide margins was achieved in 59 patients. Residual tumour was found in 30 specimens (45 per cent). Thirty-six patients received postoperative radiotherapy and/or chemotherapy. After a mean follow-up of 32 (range 1–69) months five patients (7 per cent) had local recurrence. In view of the high rate of local recurrence after local excision of soft tissue sarcoma (70–90 per cent), primary re-excision is indicated after an inadequate initial operation.