bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial translocation, intestinal ultrastructure and cell membrane permeability early after major liver resection in the rat
Authors: Wang X D , Pärsson H , Andersson R , Soltesz V , Johansson K , Bengmark S
Published: March 2007

The process and route of bacterial translocation from the gut after major liver resection remain unclear. In the present study enteric bacterial translocation, enterocyte ultra-structure in the ileum and colon, the process and route of bacterial invasion and the permeability of the cell membrane system and blood–tissue barrier were evaluated in rats receiving sham operation, and 70 or 90 per cent hepatectomy. The incidence of bacterial translocation to mesenteric lymph nodes was 80–100 per cent in rats 6 h after 70 per cent and 2–4 h after 90 per cent hepatectomy, and 80–100 per cent to the systemic circulation 2–4 h after 90 per cent hepatectomy but only 20 per cent to the portal vein. An increase in bacterial adherence to the intestinal surface, damage to the permeability of the cell membrane system and blood–tissue barrier, and pathological alterations in the ileum and colon developed, correlating with the extent of liver removed and the time that had passed after hepatectomy. Most translocating bacteria appeared in morphologically intact enterocytes with increased membrane permeability, in antigen-presenting cells and in submucosal lymphatics, but some bacteria were also seen within damaged enterocytes 4 h after 90 per cent hepatectomy. These results indicate that altered permeability of the cell membrane system may be one of the earliest characteristics of challenged enterocytes, and that enteric bacteria translocate through both morphologically normal and abnormal enterocytes. Translocation occurred mainly into the lymphatics, bacteria either being ‘carried’ by antigen-presenting cells or entering by active invasion.
Angiographic changes in the hepatic artery after skeletonization resection for biliary tract cancer
Authors: Yuasa N , Nimura Y , Hayakawa N , Kamiya J , Kondo S , Nagino M
Published: March 2007

Using preoperative and postoperative arteriography, angiographic changes in the hepatic artery were studied after skeletonization of the hepatoduodenal ligament and hepatic resection for biliary tract carcinoma. Of 52 patients evaluated (32 with carcinoma of the bile duct, 20 with gallbladder cancer), no angiographic changes were apparent after operation in 30 (58 per cent) and there were pathological findings in 22 (42 per cent; smooth stenosis in five patients, irregular stenosis in seven, a beaded appearance in four, dilatation in two, obstruction in four). Based on angiographic findings, patients were classified into three subgroups (no change, 30 patients; irregular form, 18; obstructed, four). Postoperative liver function was also evaluated. No definite correlation was evident between angiographic findings and the incidence of hepatic failure or liver dysfunction in the first month after operation. Given that connective tissue and lymph node dissection in the hepatoduodenal ligament is essential for curative resection of biliary tract carcinoma, these findings suggest that skeletonization is an acceptable operative procedure.
Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: Physiological evidence from ambulatory monitoring
Authors: Farouk R , Duthie G S , Pryde A , Bartolo D C C
Published: March 2007

Patients with idiopathic pruritus ani have an abnormal rectoanal inhibitory reflex and a lower threshold for internal sphincter relaxation during the saline continence test. This led to the hypothesis that these patients may exhibit abnormalities of the transient internal anal sphincter relaxation reflex. To study this, 23 men of median age 41 (range 27–64) years with idiopathic pruritus ani and 16 male controls of median age 39 (range 26–68) years were assessed using computerized ambulatory anorectal electromyography and manometry. Resting anal pressure, maximum anal squeeze pressure, internal sphincter electromyogram frequency, the number of internal sphincter relaxations and pudendal nerve terminal motor latency were similar for the two groups. The rise in rectal pressure during internal sphincter relaxation was higher in patients with pruritus than in controls (median (range) 29 (18–60) versus 18 (11–37) cmH2O, P < 0·01). Furthermore, the fall in anal pressure was greater in patients with pruritus than in controls (median (range) 39 (15–52) versus 29 (21–43) cmH2O, P < 0·01). The duration of internal sphincter relaxation was prolonged in patients compared with controls (median (range) 29 (18–55) versus 8 (5–12) s, P < 0·001). Fourteen patients reported staining of underclothes and 17 complained of perianal itch within 1 h of these episodes of abnormal internal sphincter relaxation. Pruritus ani may result from occult faecal leakage as a result of abnormal transient internal sphincter relaxation.
Ischaemia-reperfusion injury
Authors: Grace P A
Published: March 2007

Ischaemia-reperfusion injury is a complex phenomenon often encountered in surgical practice. The consequences of such injury are local and remote tissue destruction, and sometimes death. Several different processes have been implicated. This review discusses the pathology of such injury, the mechanisms of free radical production, and the role of neutrophils and endothelial factors in ischaemiareperfusion. Finally, several mechanisms that limit ischaemiareperfusion injury are discussed and a number of novel therapies presented.
Intravenous digital subtraction angiography versus computed tomography in the assessment of abdominal aortic aneurysm
Authors: Salaman R A , Shandall A , Morgan R H , Fligelstone L , Davies W T , Lane I F
Published: March 2007

Results of preoperative investigation of 127 patients who underwent elective aortic aneurysm repair during a 3-year period were examined and compared with findings at operation. The accuracy of preoperative computed tomography (CT) and intravenous digital subtraction angiography (DSA) in assessing proximal and distal aneurysm extent was compared. From a total of 118 CT scans, ten of 12 suprarenal aneurysms were correctly predicted, with 11 false positives (positive predictive value 48 per cent, sensitivity 83 per cent, specificity 90 per cent). After 103 DSA investigations, six of ten suprarenal aneurysms were correctly predicted with one false positive (positive predictive value 86 per cent, sensitivity 60 per cent, specificity 99 per cent). Using CT, 30 of 54 aneurysmal iliac arteries were correctly diagnosed with 20 false positives (positive predictive value 60 per cent, sensitivity 56 per cent, specificity 88 per cent). Thirty-six of 48 aneurysmal iliac arteries were diagnosed correctly using DSA, with 32 false positives (positive predictive value 53 per cent, sensitivity 75 per cent, specificity 79 per cent). Intravenous DSA also provided useful information about renal and peripheral occlusive disease. Both investigations have their own specific limitations; clinicians should be aware of these when ordering and interpreting them.
Surgical treatment of insulinoma
Authors: Pedrazzoli S , Pasquali C , D'Andrea A Alfano
Published: March 2007

The role of preoperative and intraoperative procedures for the localization of insulinoma has been extensively debated. Transhepatic portal vein sampling before surgery has been recommended when other tests fail to localize the tumour. To determine the role of different investigations, 53 patients with insulinoma, four with hyperplasia or nesidioblastosis and one with insulin autoimmune syndrome were studied. Patients were operated on in three consecutive periods during each of which a different localization procedure was considered to represent the ‘gold standard’. During the first period, of 16 patients (including one with hyperplasia) investigated by arteriography, 13 underwent successful resection. Tumours in the other three patients with insulinoma were resected at a second operation, one during the first period and one each during the second and third periods. During the second period, 28 patients underwent exploration after transhepatic portal sampling: the tumour was found in all 26 patients with insulinoma operated on in this hospital, one patient with hyperplasia is receiving medical treatment and one patient had unsuccessful surgical exploration elsewhere despite positive findings on arteriography and transhepatic portal sampling performed in this department. During the third period 13 procedures were performed. All were successful using intraoperative ultrasonography without transhepatic portal sampling. In three further patients intraoperative localization failed because of non-adenomatous β cell disease. Left-sided resection successfully cured symptoms in two patients with hyperplasia and prompted the diagnosis of insulin autoimmune syndrome. High success rates for surgical treatment of insulinoma can be achieved with transhepatic portal vein sampling or intraoperative ultrasonography. Transhepatic portal sampling is therefore unnecessary before a first operation on the pancreas for insulinoma. In the rare failures of intraoperative localization of an insulinoma, a small left pancreatic resection can help to distinguish insulinoma from hyperplasia without precluding further segmental resection.
Long-term human vein graft contractility and morphology: A functional and histopathological study of retrieved coronary vein grafts
Authors: Cross K S , Davies M G , El-Sanadiki M N , Murray J J , Mikat E M , Hagen P-O
Published: March 2007

Vasoreactivity of 11 coronary artery vein bypass grafts and 13 human saphenous veins was examined. Isometric tension studies were performed in response to potassium chloride (110 mmol/l), noradrenaline (10−9–10−4 mol/l), serotonin (10−9–10−4 mol/l) and histamine (10−8–10−2 mol/l). After precontraction with noradrenaline (10−5 mol/l), the response to acetylcholine (10−8–10−4 mol/l) and the calcium ionophore A23187 (10−8–10−4 mol/l) was also assessed. Results are given as mean(s.e.m.). Compared with saphenous veins, vein grafts showed decreased sensitivity to noradrenaline (1·7(0·5) versus 04(0·1) μmol/l, P = 0·01), no change in sensitivity to serotonin (55(18) versus 37(15) μmol/l, P>0·05) and supersensitivity to histamine (3·2(0·9) versus 30·1(13·2) μmol/l, P=0·01). Vein grafts had a decreased maximal contraction to potassium chloride (1·1(0·3) versus 5·5(0·8)g, P = 0·0001), noradrenaline (1·2(0·3) versus 4·1(0·8)g, P = 0·005), histamine (1·2(0·3) versus 4·5(0·8)g, P = 0·003) and serotonin (0·7(0·2) versus 5·7(0·6)g, P = 0·0002) compared with saphenous vein. Precontracted vein grafts did not relax in response to acetylcholine; in contrast, saphenous vein relaxed in a done-dependent manner to a maximal relaxation of 22(3) per cent. Both saphenous vein and vein graft relaxed in response to A23187. Vein graft intimal thickness was approximately fourfold greater than that of saphenous vein (540(110) versus 136(30)μm). Scanning electron microscopy of vein and vein graft revealed an intact endothelium. Coronary artery vein grafts are capable of responding to various contractile agonists; these responses are notably different from those of saphenous vein and there is a loss of endothelium-dependent relaxation. Even at a late stage vein grafts are not inert but are functional conduits with an abnormally responsive endothelium and a less potent, but significantly altered, smooth muscle contractile profile.
Screening for abdominal aortic aneurysm in Northumberland
Authors: Holdsworth J D
Published: March 2007

A study was carried out to examine the feasibility of setting up a community-based screening programme for abdominal aortic aneurysm (AAA) in men aged 65–79 years served by a district general hospital. A pilot project was run in two general practices from which 800 men were invited to undergo ultrasonography of the abdominal aorta. Of these, 628 (78·5 per cent) attended; 42 (6·7 per cent) were found to have an aneurysm (aortic diameter greater than 29 mm), ten (1·6 per cent) had a large aneurysm (diameter above 49 mm) and seven (1·1 per cent) received aortic grafts. On the basis of these findings it was felt that to screen all men aged 65–79 years (n = 12800) or aged 65–74 years (n = 10300) would lead to more operations than local facilities could handle. A more practical option would be to target annually men aged 65 years, with rescreening at intervals of 5 years until age 75 years, but even this would eventually lead to an unmanageable number of operations.
Life-table analysis of stomal complications following ileostomy
Authors: Leong A P K , Londono-Schimmer E E , Phillips R K S
Published: March 2007

Stomal complications of ileostomy may occur many years after construction. An actuarial analysis of complications of 150 permanent end ileostomies constructed over a 10-year period is reported. By 20 years the incidence of stomal complications approached 76 per cent in patients operated on for ulcerative colitis and 59 per cent in those with Crohn's disease (P < 0·05). Revisional surgery rates were higher in patients with ulcerative colitis than in those with Crohn's disease (28 versus 16 per cent), albeit not significantly. The four commonest complications were skin problems (cumulative probability 34 per cent), intestinal obstruction (23 per cent), retraction (17 per cent) and parastomal herniation (16 per cent). Closure of the lateral space did not reduce the probability of developing intestinal obstruction (18 per cent at 20 years in those with closure versus 3 per cent in those without, P gt; 0·1). Fixation of the mesentery did not reduce the probability of developing prolapse of the ileostomy (11 per cent in those with fixation versus none in those without, P < 0·1). The incidence of parastomal herniation was not reduced by siting through the rectus abdominis (21 per cent in those sited through the body of the rectus abdominis versus 7 per cent in those sited through the oblique muscles, P < 0·1). Some of the surgical dogmas relating to ileostomy construction are not supported by the results of this study.
Rectoanal inhibition and incontinence in patients with rectal prolapse
Authors: Farouk R , Duthie G S , Macgregor A B , Bartolo D C C
Published: March 2007

Thirty-five patients with complete rectal prolapse, 32 with neurogenic faecal incontinence and 33 controls underwent ambulatory recording using a computerized anal electromyographic and anorectal manometry system. Median resting anal pressures were 34 cmH2O in patients with prolapse, 51 cmH2O in those with neurogenic faecal incontinence and 94 cmH2O in controls. Median basal rectal pressures were 18, 21 and 21 cmH2O respectively. High-pressure rectal waves of median amplitude 71 cmH2O lasting 30–150 s and associated with inhibition of the electromyographic activity of the internal anal sphincter and a fall in anal pressures were seen in all patients with prolapse but not in controls or those with neurogenic incontinence. These waves were abolished following successful resection rectopexy. Recovery of continence occurs by abolition of high-pressure rectal waves, which produce maximal inhibition of sphincter activity before operation.
Neutrophils may contribute to the morbidity and mortality of claudicants
Authors: Hickman P , McCollum P T , Belch J J F
Published: March 2007

Peripheral arterial occlusive disease is a common cause of morbidity in middle-aged men; 5 per cent of those aged over 50 years suffer from intermittent claudication. While claudication itself is not fatal, claudicants have a mortality rate approximately three times that of non-claudicating men of the same age, mainly from cardiovascular disease. This review examines the evidence for involvement of the neutrophil in this increased mortality and describes the possible pathogenesis. It also discusses how treatment of claudication may modify neutrophil behaviour, reducing subsequent mortality and morbidity rates.
Management of bile duct stones in the era of laparoscopic cholecystectomy
Authors: Perissat J , Huibregtse K , Keane F B V , Russell R C G , Neoptolemos J P
Published: March 2007

The introduction of laparoscopic cholecystectomy has resulted in increased options for the management of bile duct stones and has stimulated a fundamental reappraisal of the situation before the laparoscopic era. This article reviews the natural history of bile duct stones and details the different ways in which they may now be treated. New areas of controversy are highlighted and the need for further studies is emphasized.
Influence of Losartan, an angiotensin receptor antagonist, on neointimal proliferation in cultured human saphenous vein
Authors: Varty K , Allen K E , Jones L , Sayers R D , Bell P R F , London N J M
Published: March 2007

An organ culture of human saphenous vein was used as a model of vein graft intimal hyperplasia and the potential of Losartan, an angiotensin II receptor antagonist, to inhibit neointimal proliferation was investigated. Median (range) neointimal thickness was reduced from 17 (16–19) to 11 (8–18) μm in veins cultured with Losartan (median difference 5 (95 per cent confidence interval 2–8) μm). A similar decrease in the median neointimal proliferation index was seen from 21 (range 14–47) to 15 (range 5–31) per cent (median difference 8 per cent (95 per cent confidence interval 5–11 per cent)). These results demonstrate that angiotensin II receptor antagonists may be of therapeutic value for the modulation of vein graft intimal hyperplasia.
Diagnosis of intracranial occlusive disease before carotid endarterectomy: Preliminary experience with transcranial colour-flow Doppler ultrasonography
Authors: Martin P J , Gaunt M E , Naylor A R , Bell P R F
Published: March 2007

Transcranial colour-coded Doppler ultrasonography allows both imaging and simultaneous haemodynamic investigation of the basal cerebral arteries. Four of 16 patients undergoing carotid endarterectomy were found to have intracerebral artery stenotic disease by use of this technique. Discrete stenotic segments were recognized by their markedly raised blood flow velocities with damping of the spectral Doppler waveform distally. Colour-coded transcranial Doppler ultrasonography used in conjunction with extracranial duplex imaging might provide an effective and safe alternative to angiography.
Influence of compression stockings on lower-limb venous haemodynamics during laparoscopic cholecystectomy
Authors: Wilson Y G , Allen P E , Skidmore R , Baker A R
Published: March 2007

Lower-limb venous haemodynamics were studied prospectively in 40 patients (24 women, 16 men of median age 52 years) undergoing laparoscopic cholecystectomy. Patients were randomized to wear compression stockings during surgery or no stockings. All received subcutaneous heparin prophylaxis. Venous capacitance and outflow were measured non-invasively before, during and after pneumo-peritoneum. In the group without compression stockings (20 patients) venous capacitance and outflow decreased during pneumoperitoneum in most patients. In the group wearing stockings (20 patients) the changes were less pronounced or abolished. There was a significant difference between the groups in venous capacitance and outflow ratios at mid-operation: median (interquartile range) 0·89 (0·56–1·16) and 0·89 (0·56–1·15) respectively in the group without stockings versus 1·48 (1·09–2·19) and 1·71 (1·20–2·19) respectively in that with stockings (P < 0·001). Pneumoperitoneum creates a significant resistance to venous return. Compression stockings counteract the changes observed.
Multicentre audit of death from acute pancreatitis
Authors: Mann D V , Hershman M J , Hittinger R , Glazer G
Published: March 2007

A prospective audit of acute pancreatitis involving nine hospitals in the North-West Thames Region recruited 631 patients over 54 months. There were 57 deaths (9 per cent); a diagnosis had been reached in 50 patients (88 per cent) before death and in seven (12 per cent) at autopsy. Eighteen patients (32 per cent) died within the first week, usually as a result of multisystem organ failure (15 patients). Thirty-nine patients (68 per cent) died after the first week from complications related to infection (26 patients), co-morbid conditions (nine) or non-infective complications (four). Twenty-one patients (42 per cent) had been inadequately evaluated by Ranson's criteria, and only 22 (44 per cent) of 50 with a premortem diagnosis of pancreatitis had undergone computed tomography (CT). Fifteen of 26 patients who died from infection-related complications had CT and only nine underwent necrosectomy or surgical drainage. These data suggest that improved diagnosis, investigation and management of patients with acute pancreatitis is possible, and may result in improved clinical outcome.
Comparison of three methods to obtain percutaneous needle core biopsies of a renal allograft
Authors: Beckingham I J , Nicholson M L , Kirk G , Veitch P S , Bell P R F
Published: March 2007

During 280 renal transplant biopsy procedures, 440 biopsy cores were obtained using three techniques: blind vertical pass, ultrasonographic guidance and ultrasonographic guidance with immediate specimen examination by stereoscopic microscopy. The success rates per procedure in obtaining renal cortex by blind vertical pass, ultrasonographic guidance and ultrasonographic guidance with microscopy were 75, 91 and 100 per cent respectively. Ultrasonographic guidance improves the success rate of percutaneous renal allograft biopsy. The additional use of immediate examination by stereoscopic microscopy yields a 100 per cent success rate for individual biopsy procedures.
Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse
Authors: Novell J R , Osborne M J , Winslet M C , Lewis A A M
Published: March 2007

Ivalon sponge rectopexy is a safe reliable procedure in the management of rectal prolapse. Sutured rectopexy is simpler and avoids the use of foreign material. Sutured rectopexy is mandatory if synchronous resection is to be considered. Sixty-three patients (62 women) with fullthickness rectal prolapse were entered into a prospective randomized trial of Ivalon sponge rectopexy (31 patients) versus sutured rectopexy (32). Twenty patients (32 per cent) had coexistent incontinence (ten in each group). The operation was performed in the standard manner with a sutured rectangle of sponge or sutures alone placed along the length of the sacrum. Postoperative morbidity occurred in nine patients (14 per cent) of whom three underwent a sutured procedure and six Ivalon rectopexy: wound infection in three, chest infection in two, urinary tract infection in two and thromboembolism in two. There were no deaths within 30 days. At a median follow-up of 47 months prolapse had recurred in two patients (3 per cent), one in each group, 14 (22 per cent) suffered from incontinence (of whom five had undergone a sutured procedure), while 25 (40 per cent) had developed constipation (of whom 15 had received Ivalon rectopexy). The medium-term results of rectopexy by suture alone are equivalent to those obtained following the conventional Ivalon procedure. These data suggest that Ivalon rectopexy could now be abandoned.
Haemorrhoids: Pathology, pathophysiology and aetiology
Authors: Loder P B , Kamm M A , Nicholls R J , Phillips R K S
Published: March 2007

Haemorrhoidal disease is the consequence of distal displacement of the anal cushions, which are normal structures with an important role in continence. The causes of haemorrhoidal disease are unknown; constipation and abnormal bowel habit are commonly blamed despite largely contrary evidence. The most consistently demonstrated physiological abnormality is an increased maximum resting anal pressure. Most evidence points to this being a secondary phenomenon rather than the cause of haemorrhoidal disease. Among the many unexplored areas are the function of the longitudinal muscle in relation to haemorrhoidal disease, the description and pharmacological responsiveness of the anal subepithelial muscle, and the clinical role of specific pharmacological agents that might reverse some of the observed physiological changes.
Cerebral oxygen saturation, transcranial Doppler ultrasonography and stump pressure in carotid surgery
Authors: Williams I M , Vohra R , Farrell A , Picton A J , Mortimer A J , McCollum C N
Published: March 2007

Transcranial Doppler ultrasonography (TCD) of the middle cerebral artery (MCA), light-reflective cerebral oximetry and measurement of internal carotid artery stump pressure were compared as methods of monitoring cerebral perfusion during carotid surgery in 33 patients. Median cerebral oxygen saturation was 70 (range 62–85) per cent and TCD-measured mean blood velocity 42 (range 19–91) cm/s before carotid cross-clamping, falling to 68 (53–83) per cent and 16 (0–50) cm/s respectively on application of the clamps (P < 0·001). Stump pressure correlated closely with MCA blood velocity 30 s after the start of cross-clamping (rs = 0·58, P < 0·001), but not with cerebral oxygen saturation. A fall of 5 per cent or more in cerebral oxygen saturation following cross-clamp application was predicted by a decrease in mean MCA blood velocity of at least 60 per cent. Changes in cerebral oxygen saturation correlated significantly with systolic blood pressure throughout the perioperative period (rs = 0·41, P < 0·001). Significant falls in cerebral oxygenation were not predicted by low stump pressure but were associated with large reductions in the mean MCA blood velocity measured by TCD.
Minimal antibiotic therapy after emergency abdominal surgery: A prospective study
Authors: Schein M , Assalia A , Bachus H
Published: March 2007

The optimal duration for courses of antibiotic therapy following emergency abdominal surgery was examined. The length of postoperative administration was based on the operative findings of contamination versus infection and the degree of the latter. A total of 163 patients (mean APACHE II score 7) were stratified into four groups: group 1 (60 patients), no postoperative antibiotics; group 2 (32), antibiotic therapy for 24 h; group 3 (48), administration for 48 h; and group 4 (23), antibiotic therapy for 72 h to 5 days. Three patients (2 per cent) died. Wound infection developed in 12 patients (7 per cent) and postoperative intra-abdominal infection in two (1 per cent). Antibiotics were stopped according to the protocol in 28 patients in spite of continued fever; one developed a subhepatic abscess and three had wound infections. Distinguishing contamination from infection and operative stratification of the latter allowed a successful ‘minimal’ postoperative antibiotic policy to be employed.
Role of acid secretory response to sham feeding in predicting recurrent ulceration after proximal gastric vagotomy
Authors: Stenquist B , Forssell H , Olbe L , Lundell L
Published: March 2007

The completeness of vagal denervation in determining the long–term outcome of patients with duodenal ulcer disease after proximal gastric vagotomy (PGV) was studied by examining the relationship between the postoperative acid secretory response to sham feeding (‘chew and spit’ technique) and the subsequent ulcer recurrence rate during a mean follow-up of 7·5 (range 5–15) years. The cumulative recurrence rate of 98 patients analysed prospectively was 11 per cent Of 22 patients who had incomplete vagotomy as suggested by the sham feeding response, five had a later relapse. This compares with only an 8 per cent relapse rate among those with a secretory response suggesting complete vagotomy. Four patients suffered from a relapse more than 5 years after operation but none had undergone incomplete vagotomy. However, in seven patients with an early postoperative relapse (within 5 years) five had had incomplete vagal denervation (P < 0·05). In this latter group the median time elapsed from surgery until the first recurrence was only 1 year. It is concluded that the early postoperative acid secretory response to a sham feeding stimulus is clinically useful as it allows prediction of the risk of early relapse after PGV. This test may be helpful for the validation of new techniques of vagotomy.
Relationship between weight loss, reduction of body cell mass and inflammatory response in patients with cancer
Authors: McMillan D C , Preston T , Watson W S , Simpson J M , Fearon K C H , Shenkin A , Burns H J G , McArdle C S
Published: March 2007

Reduced food intake is a major cause of continuing weight loss in patients with cancer. Previous work has suggested that an ongoing inflammatory response may also contribute to weight loss and alter the nature of body tissue loss. To examine this, body cell mass was estimated using measurements of total body potassium (TBK) in 31 patients with gastrointestinal cancer and weight loss with or without an inflammatory response (C-reactive protein level above 5 mg/1). Albumin levels, total body water and 24-h urinary creatinine clearance were also measured. When measured TBK was expressed as a percentage of predicted normal values there was a significant reduction in TBK for patients with an inflammatory response compared with that of those without (P = 0·04). However, when a different prediction equation for TBK was used this difference was not significant (P = 0·29). Therefore, it remains uncertain whether an ongoing inflammatory response in patients with cancer and weight loss contributes to loss of body cell mass.
Localization and surgical management of insulinoma
Authors: Geoghegan J G , Jackson J E , Lewis M P N , Owen E R T C , Bloom S R , Lynn J A , Williamson R C N
Published: March 2007

Over a 14-year period 34 patients were referred for surgical treatment of insulinoma. The diagnosis was confirmed by demonstrating hypoglycaemia with inappropriate hyperinsulinaemia during prolonged fasting. Selective visceral angiography localized 30 solitary benign insulinomas and two carcinomas. In two patients with islet cell hyperplasia, angiography demonstrated a single lesion only. Ultrasonography had a sensitivity of 15 per cent and computed tomography a sensitivity of 24 per cent in the localization of tumours. All patients but one were treated by operation. Eighteen tumours were enucleated and 13 (including both patients with islet cell hyperplasia) were treated by distal pancreatectomy. Two patients underwent negative primary exploration; both had single adenomas removed at reexploration. There were no operative deaths but nine patients (predominantly those undergoing pancreatic resection) had complications. Thirty-one patients were symptom-free following operation at a mean follow-up of 16 months.
Diabetes impairs the development of early strength, but not the accumulation of collagen, during intestinal anastomotic healing in the rat
Authors: Verhofstad M H J , Hendriks Th
Published: March 2007

The evidence that diabetes mellitus adversely affects healing is derived from data on skin, where diminished wound strength is accompanied by a reduced collagen content. As no such data are available on intestinal anastomotic repair, and it has been reported that collagen metabolism in skin and intestine is affected differently by the diabetic state, anastomotic healing in the rat intestine during uncontrolled diabetes was examined. Wistar rats underwent resection and anastomosis of both ileum and colon 1 week after a single injection of streptozotocin (diabetic group) or citrate (control group). After 3 days the mean bursting pressure of ileal anastomoses was 4·1 kPa in controls and 1·0 kPa in diabetic animals (P < 0·05). For colon, these values were 12·0 and 4·9 kPa respectively (P < 0·05). This negative effect of diabetes persisted after 7 days in ileum but not in colon. Diabetic animals had more anastomotic abscesses, especially in the ileum: nine of 16 animals at 3 days after operation versus one of 15 in the control group (P < 0·01). Anastomotic hydroxyproline concentration and content in diabetic animals were not reduced. The postoperative collagen synthetic capacity, as measured in tissue explants, was strongly stimulated in the wound area and appeared essentially unchanged in the diabetic animals. Uncontrolled streptozotocin-induced diabetes severely impairs the development of anastomotic strength in the rat intestine but, unlike impaired wound healing in skin, this phenomenon is not caused by deficient accumulation of collagen.
Fibrinolytic activity in the abdominal cavity of rats with faecal peritonitis
Authors: van Goor H , de Graaf J S , Grond J , Sluiter W J , van der Meer J , Bom V J J , Bleichrodt R P
Published: March 2007

Generalized peritonitis causes a reduction in abdominal fibrinolytic activity, resulting in persistence of intraabdominal fibrin with subsequent adhesion and abscess formation. The activities of tissue plasminogen activator (tPA) and plasminogen activator inhibitor (PAI) were measured in the peritoneal fluid of rats with faecal peritonitis and correlated with the extent of peritoneal damage to determine the cause of decreased fibrinolysis. Activity of tPA was low during the study period of 8 days, but higher in rats with peritonitis than in controls. The activity of PAI in rats with peritonitis was significantly increased compared with that of controls during the whole study period (P < 0·001). Histological signs of damage to the peritoneum were similar in rats with peritonitis and controls. There was no correlation between the extent of peritoneal damage and tPA or PAI activity. The increased activity of PAI in the peritoneal fluid of rats with faecal peritonitis may be the main cause of reduced fibrinolysis in the abdominal cavity. Activities of tPA and PAI may originate not only from the mesothelium but from other sources.
Results of anal or low rectal anastomosis and pouch construction for megarectum and megacolon
Authors: Stewart J , Kumar D , Keighley M R B
Published: March 2007

Over a 16-year period 34 patients underwent surgery for idiopathic megarectum or megacolon; 18 had megarectum with or without megasigmoid, one megacolon only and 15 megarectum and total megacolon (nine with a previous colectomy). Ten patients underwent low rectal or anal anastomosis without pouch formation (colodistal proctostomy, eight; coloanal anastomosis, two), eight had colonic pouch-anal anastomosis (J pouch) and 14 had an ileal J pouch after restorative proctocolectomy; one underwent subtotal colectomy with ileorectal anastomosis and one loop ileostomy alone. There was one death, from intestinal obstruction 24 months after operation. Twenty-seven of 32 evaluable patients without a stoma became fully continent following resection and sphincter-saving procedures. Three of 18 had a poor result after resection for megarectum because of recurrent constipation. One of 14 patients became incontinent after restorative proctocolectomy for megacolon and megarectum and in a further four persistent abdominal distension and pain was treated by pouch excision.
Oxygen free radical activity in experimental colonic carcinoma
Authors: Qureshi A , Gorey T F , Byrne P , Kay E , McKeever J , Hennessy T P J
Published: March 2007

Oxygen free radical activity has been implicated in carcinogenesis through DNA lysis. This study measured chemiluminescence and superoxide dismutase (SOD) inhibition as an index of oxygen free radical activity in azoxymethane-induced colonic carcinoma. After 3 weeks of acclimatization, ten Fisher 344 rats were injected with azoxymethane (7 mg kg−1 week−1) over 10 weeks. All animals were killed at 37 weeks and colonic mucosa (5–25 mg wet weight) was sampled from sites of histologically confirmed gross tumour and sites 3–5 cm distant from tumour as well as from ten paired normal controls. The samples were processed in buffered luminol and chemiluminescence was measured in a luminometer. Each sample was then placed in a solution of SOD for 3 min before a second chemiluminescence estimation. Mean(s.e.m.) chemiluminescence from control mucosal samples decreased from 8·1(1·0) to 3·9(1·1) mV per 100 mg tissue (P < 0·05) after incubation in SOD, suggesting that oxygen free radical activity was being measured. There was an increase to 20·2(0·9) mV per 100 mg in azoxymethane-treated colon remote from tumour and to 53·9(2·1) mV per 100 mg at tumour sites; both were reduced significantly after incubation with SOD to 6·7(0·7) and 11·0(0·8) mV per 100 mg respectively (P < 0·001). Chemiluminescence was significantly increased in azoxymethane-induced colonic carcinoma, both remote from and maximally at the tumour site, suggesting a field change in carcinogenesis associated with oxygen free radical activity.
Reducing the risk of viral transmission at operation by electronic monitoring of the surgeon—patient barrier
Authors: MacIntyre I M C , Currie J S , Smith D N , Anderson I D , Cadossi R
Published: March 2007

A new electronic device designed to detect glove holes, wet gowns and glove permeability was assessed during 50 general surgical operations. The cause of each alarm was recorded and the surgeon's awareness of any breach noted. Some 266 alarms were recorded of which 45 were ascribed to glove holes, 86 to wet gowns, 115 to glove porosity and 20 to other causes. Glove holes occurred in 29 of the 50 procedures; the surgeon was unaware of the hole in almost 70 per cent of cases. Holes were more common in laparotomy than in laparoscopic procedures (P = 0·006). In 20 per cent of instances surgeons did not respond immediately to the alarm (median delay 16 min). Six of eight surgeons who used the device indicated that they would do so regularly for major abdominal surgery. The electronic system accurately detects breaches in the surgeon–patient barrier. Its use should improve surgical discipline in acting to restore the barrier, protecting patient and surgeon alike.
Dental infection in vascular surgical patients
Authors: Stansby G , Byrne M T L , Hamilton G
Published: March 2007

Seventy patients, 18 women and 52 men of mean age 68 (range 52–81) years, with vascular disease were studied using the Community Periodontal Index of Treatment Needs (CPITN). Twenty-six were edentulous and 44 dentate; 32 dentate patients were wearing partial dentures. All had occlusive peripheral arterial disease (ankle:brachial pressure index less than 0.9) or aortic aneurysm. No significant periodontal pathology was found in edentulous patients. Of the dentate patients, 28 were in the significant pathology range (CPITN 4) and 12 were in the moderate pathology group (CPITN 3); only four had no significant pathology (CPITN 0–2). As a proportion of prosthetic vascular graft infections may be due to dental sepsis, surgeons should consider referral for dental assessment before elective bypass grafting and patients should be warned about the importance of dental care after operation.
Comparison between preoperative cytology and intraoperative frozensection biopsy in the diagnosis of thyroid nodules
Authors: Rodríguez J M , Parrilla P , Sola J , Bas A , Aguilar J , Moreno A , Soria T
Published: March 2007

The value of intraoperative frozen-section biopsy of thyroid nodules (solitary or dominant in a multinodular goitre) was examined in patients who underwent fine-needle aspiration cytology (FNAC) for diagnosis before operation. A total of 170 consecutive patients were evaluated and classified according to whether the cytological diagnosis was benign, suspicious or malignant. In the benign group, diagnostic accuracy was 98 per cent for FNAC and 97 per cent for intraoperative biopsy. In those with suspicious cytology, diagnostic accuracy was 12 per cent for FNAC and 96 per cent for intraoperative biopsy. In those with malignant cytology there was 100 per cent accuracy for FNAC and 76 per cent for biopsy. Intraoperative biopsy by frozen section is useful in patients undergoing surgery for a thyroid nodule with a ‘suspicious’ cytology. It adds no information in patients with a diagnosis of malignancy following cytological assessment and is of limited use in those in whom a benign lesion is diagnosed.
Immunocytochemical staining of pS2 protein in fine-needle aspirate from breast cancer is an accurate guide to response to tamoxifen in patients aged over 70 years
Authors: Wilson Y G , Rhodes M , Ibrahim N B N , Padfield C J H , Cawthorn S J
Published: March 2007

Fine-needle aspirates from 52 breast cancers in 50 patients over 70 years of age were immunocytochemically stained for pS2 protein. All patients were treated with tamoxifen 40 mg/day and followed up at intervals of 2 months. The size of the tumour was serially assessed with calipers and portable ultrasonography. Change in tumour size was confirmed mammographically. Clinical monitoring was performed blind of the pS2 status. Twenty-five tumours were pS2 positive, of which 23 showed a significant response; ten went into complete remission (mean time to complete remission 6·8 (range 2–14) months) and 13 demonstrated partial remission (mean follow-up 8·9 (range 6–19) months). Two tumours remained static. Twenty-seven tumours were pS2 negative and none of these responded to tamoxifen; six remained static (mean follow-up 11·5 (range 6–14) months) and 21 progressed (mean time to progression 7·0 (range 3·14) months) (P < 0·001). Immunocytochemical assessment of fine-needle aspirates from elderly women with breast cancer accurately predicts a worthwhile response to tamoxifen.
Liver regeneration is enhanced by omeprazole in rats following partial hepatectomy
Authors: Ohtake M , Aono T , Sakaguchi T , Tsukada K , Hatakeyama K
Published: March 2007

The effect of omeprazole on liver regeneration was studied in rats following partial (65 per cent) hepatectomy. Omeprazole 0.2 mg/kg increased the relative liver weight (weight of liver as a proportion of body-weight) and mitotic index (P < 0.05). There was no difference in food and water intake. The serum gastrin concentration was significantly higher in animals receiving omeprazole 0.2 mg/kg than in controls (P < 0.05). Omeprazole administration induced an increase in the level of serum alkaline phosphatase (P < 0.05) but had no effect on serum albumin, glutamic-pyruvic transaminase and total bilirubin levels. Omeprazole stimulates liver regeneration after partial hepatectomy and this regeneration may be mediated by gastrin.
Liver resection with total vascular exclusion for malignant tumours
Authors: Habib N , Zografos G , Dalla Serra G , Greco L , Bean A
Published: March 2007

The records of 47 patients with no cirrhosis who underwent 56 liver resections under total vascular exclusion (TVE) for malignant tumours, both primary and secondary, were reviewed to study the effects of TVE. The mean(s.e.m.) blood loss was 1651(233) (median 1200 (range 200–8500)) ml and the mean(s.e.m.) intraoperative blood transfusion 930(100) (median 700 (range 0–2800)) ml. In 18 liver resections (32 per cent) no blood transfusion was administered. The mean(s.e.m.) postoperative hospital stay was 19·7(14·2) days. The 30-day operative mortality rate was nil but the hospital mortality rate was 4 per cent. Postoperative prothrombin time was influenced by the amount of liver resected and the duration of TVE but not by the amount of blood transfused. Postoperative serum levels of aspartate aminotransferase and bilirubin were not influenced by either the amount of liver resected or the duration of TVE.
Effect of extent of anterior resection and sex on disease-free survival and local recurrence in patients with rectal cancer
Authors: Buhre L M D , Mulder N H , de Ruiter A J , van Loon A J , Verschueren R C J
Published: March 2007

Results are presented following 119 curative resections for rectal cancer performed on 47 women and 72 men. Throughout the study it was policy to remove part of the female genital tract when the rectal tumour impinged on the uterus and/or the posterior vaginal wall. After a median follow-up of 7·5 years, local recurrence occurred in three of 46 women and 15 of 71 men (P = 0·03). The survival rates at 5 years were 71 per cent for women (95 per cent confidence interval 56–83 per cent) and 60 per cent for men (95 per cent confidence interval 50–71 per cent) (P < 0·05). The risk for distant metastasis was comparable, suggesting an influence of local recurrence on survival. Reduction of the local recurrence rate coincides with the higher proportion of anterior extensions of surgery in women (19 of 47) than in men (two of 72).
Coloanal sleeve anastomosis in the treatment of diffuse cavernous haemangioma of the rectum: Long-term results
Authors: Londono-Schimmer E E , Ritchie J K , Hawley P R
Published: March 2007

Diffuse cavernous haemangioma of the rectum is an unusual lesion. In 1971 Parks and co-workers described resection and coloanal sleeve anastomosis as an alternative operation in the treatment of this rare malformation. The clinical presentation, diagnosis and long-term results of patients with this condition managed by such a surgical technique are described. Resection and coloanal sleeve anastomosis offers major advantages such as a lower risk of intraoperative bleeding, no risk of damaging the pelvic nerves, sparing of continence and avoidance of a permanent colostomy. It should therefore be considered the treatment of choice for this uncommon condition.
Treatment of anal intraepithelial neoplasia
Authors: Scholefield J H , Ogunbiyi O A , Smith J H F , Rogers K , Sharp F
Published: March 2007

The natural history and malignant potential of anal intraepithelial neoplasia (AIN) remain uncertain, making management decisions about such lesions difficult. The management of 70 patients with AIN is described. The majority of lesions encountered were low grade (AIN I and II; 43 of 70) and required no treatment, but eight invasive anal cancers associated with high-grade AIN occurred over the 4-year study period. Three were a result of apparent progression of high-grade lesions; three more invasive lesions were found in areas of AIN III on histological examination. Surgical excision was used to treat 27 patients with AIN III. Treatment of extensive lesions involving the perianal and anal canal epithelium circumferentially in six patients involved excision of the whole of this epithelium and application of split skin grafts.
Endothelial seeding of compliant polyurethane vascular graft material
Authors: Stansby G , Berwanger C , Shukla N , Schmitz-Rixen T , Hamilton G
Published: March 2007

Compliance was measured in a new compliant polyurethane vascular graft material and in polytetrafluoroethylene (PTFE) graft material using an ultrasonic device; attachment of indium-111 oxine-labelled human endothelial cells to both surfaces with a range of surface coatings was assessed. Compliant polyurethane was six to eight times more compliant than PTFE (P<0·01) at all pressures in the range 50-120 mmHg, and endothelial cell attachment to uncoated polyurethane was three times better than to uncoated PTFE at times up to 90 min (P<0·01). Attachment to polyurethane was also better after blood clot, collagen and fibronectin treatment at times up to 30 min (P<0·05). Endothelial seeding of compliant graft material may provide a prosthetic vascular substitute with characteristics similar to those of autologous vein.