bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis
Authors: Yin X -Y , Lai P B S , Lee J F Y , Lau J W Y
Published: March 2003

Background

Hepatic blood inflow occlusion during hepatectomy may influence postoperative liver regeneration. The aim of this study was to investigate the influence of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in thioacetamide-induced cirrhotic rats.

Methods

Forty-three cirrhotic Wistar–Furth rats were randomly assigned to three groups. Rats in group 1 underwent 64 per cent hepatectomy alone, those in group 2 were subjected to 15 min hepatic blood inflow occlusion followed by 64 per cent hepatectomy, and animals in group 3 were subjected to 30 min inflow occlusion followed by 64 per cent hepatectomy. Liver function, 5-bromo-2′-deoxyuridine (BrdU) labelling index and percentage of initial liver weight on days 1, 2 and 7 posthepatectomy were assessed.

Results

Rats in groups 1 and 2 had a significantly higher serum albumin level and a markedly lower alanine aminotransferase level than animals in group 3 on day 1 posthepatectomy (P < 0·05). There was no significant difference in the serum level of total bilirubin of the three groups on days 1, 2 and 7. The BrdU labelling index was significantly higher in groups 1 and 2 than in group 3 animals on day 1 posthepatectomy (P < 0·01 and P < 0·05 respectively). Percentages of initial liver weight were similar in groups 1, 2 and 3 on days 1, 2 and 7 after hepatectomy.

Conclusion

Hepatic blood inflow occlusion for up to 30 min suppressed DNA synthesis and hepatocyte proliferation at an early posthepatectomy stage and consequently delayed recovery of liver function in cirrhotic rats. However, it did not affect restoration of liver mass or survival after 64 per cent hepatectomy.
Vasoactive and proliferative effects of parathyroid hormone and parathyroid hormone-related peptide on human vascular smooth muscle
Authors: Chadwick D R , Harrison B J , Chan P , Chong L , Peachell P
Published: March 2003

Background

Hyperparathyroidism is associated with an increased incidence of hypertension and cardiovascular disease. Experiments in rats suggest that this results from desensitization of the normally inhibitory effects of parathyroid hormone-related peptide (PTHrP) on vascular smooth muscle cells (VSMCs) by previous exposure to parathyroid hormone (PTH).

Methods

Isometric tension in vitro was measured in segments of vessels obtained at neck surgery from six normotensive patients with hyperparathyroidism and 12 eucalcaemic controls undergoing thyroid surgery. Vessels were precontracted with noradrenaline to allow the vasodilatory effects of PTH and PTHrP to be observed. Human VSMCs were cultured in 0·5, 5 and 15 per cent serum with or without PTH (10−11 to 10−7 nmol l−1) and proliferation was assessed by cell counts after 14 days.

Results

Vasodilatation of arterial segments produced by both PTH 20 nmol l−1 and PTHrP 100 nmol l−1 did not differ significantly between control and hyperparathyroidism groups (P > 0·08, Mann–Whitney U test). Vasodilatation by PTHrP was not reduced by preincubation of vessels in vitro with PTH 50 nmol l−1 for 1 h (P > 0·36, Wilcoxon test). No effects of PTH on serum-induced proliferation of human VSMCs were observed.

Conclusion

These data imply that homologous desensitization to PTHrP is not implicated in the pathogenesis of vascular disease in patients with hyperparathyroidism.
Differential effects of cyclosporin and tacrolimus on the expression of fibrosis-associated genes in isolated glomeruli from renal transplants
Authors: Bicknell G R , Williams S T , Shaw J A , Pringle J H , Furness P N , Nicholson M L
Published: March 2003

Background

Chronic allograft nephropathy is characterized by an excessive accumulation of extracellular matrix proteins leading to glomerular and interstitial fibrosis. The aim of this study was to determine the effects of two different immunosuppressive agents (cyclosporin and tacrolimus) on the expression of the genes controlling extracellular matrix deposition in renal transplant glomeruli.

Methods

Fifty-one renal transplant recipients were randomized to receive immunosuppression with either microemulsion cyclosporin or tacrolimus. Isolated glomeruli were plucked from protocol transplant biopsies performed 1 week, 3 months and 6 months after transplantation. Expression of the genes for collagen IVα2, collagen III, matrix metalloproteinase 2, tissue inhibitor of metalloproteinases (TIMP) 1 and TIMP-2, tenascin and transforming growth factor (TGF) β1 was studied by quantitative reverse transcriptase–polymerase chain reaction.

Results

The expression of messenger RNA (mRNA) for collagen III and TIMP-1 was significantly higher in patients receiving cyclosporin therapy than in those having tacrolimus (P < 0·01); this finding was accounted for by differences in the biopsy material at 1 week. A significant difference in collagen III, TIMP-1 and TIMP-2 mRNA expression was also detected between patients depending on the source of renal donor (cadaveric or living). There were no significant differences in the level of glomerular TGF-β1.

Conclusion

The data provide new in vivo evidence that tacrolimus may exert a less fibrogenic influence on transplant glomeruli than cyclosporin.
Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease
Authors: Trondsen E , Mjåland O , Raeder J , Buanes T
Published: March 2003

Background

Based on a series of successful outpatient laparoscopic cholecystectomies, day-case laparoscopic fundoplication for gastro-oesophageal reflux disease was introduced in January 1997. The initial results are reported.

Methods

Inclusion criteria were American Society of Anesthesiologists grade I–II, living within 30 min travel from the hospital, and adult company at home. Initially only selected patients were offered day-case treatment, but later it was adopted as routine. The patients underwent general intravenous anaesthesia with propofol and remifentanil, and were given ketorolac, propacetamol, droperidol and ondansetron as prophylaxis against postoperative pain and nausea. The surgical procedure was Nissen–Rosetti fundoplication or semifundoplication depending on oesophageal manometric results.

Results

Forty-five patients were included. Four patients were admitted; 41 were discharged as planned 3–8 h after operation, and five of these patients were readmitted. One underwent reoperation for necrosis of the gastric fundus. A further five patients visited the outpatient department without need for admission. At follow-up 31 patients were satisfied with the day-case treatment, five were indifferent, and five were dissatisfied because of pain. If offered a similar operation in the future, 26 patients would have preferred and seven would have accepted day-case treatment, and eight would not.

Conclusion

Outpatient laparoscopic fundoplication is safe and well tolerated by the majority of patients.
Gender differences in the longitudinal pressure profile of the anal canal related to anatomical structure as demonstrated on three-dimensional anal endosonography
Authors: Williams A B , Cheetham M J , Bartram C I , Halligan S , Kamm M A , Nicholls R J , Kmiot W A
Published: March 2003

Background

Anal canal squeeze pressure is assumed to be due to external sphincter contraction, but the contribution of other muscles has not been explored.

Methods

Ten male and ten nulliparous female asymptomatic subjects had three-dimensional anal endosonography and manometry. Incremental squeeze pressures at 0·5-cm intervals, expressed as a percentage of the maximum pressure recorded anywhere in the canal, were related to the following anatomical levels: puborectalis, overlap between external anal sphincter (EAS) and puborectalis, external and internal anal sphincters, and external anal sphincter only. Levels were determined by coronal and sagittal endosonographic reconstructions.

Results

Puborectalis was the same length in men and women (median 23·9 versus 27·1 mm) but represented a greater proportion of the anal canal in women (45 versus 61 per cent; P = 0·02). At the level of puborectalis alone, the pressure generated as a proportion of maximum anal canal pressure was 71 (range 32–100) per cent in men and 62 (range 32–100) per cent in women. At the level of the EAS alone, the pressure was 60 (4–98) per cent in men and 82 (41–100) per cent in women; where the external sphincter was overlapped by puborectalis, the pressure was 98 (60–100) per cent in men and 75 (47–100) per cent in women.

Conclusion

Maximal anal canal squeeze pressure is found where the puborectalis overlaps the EAS. This segment represents a significant proportion of anal canal length in women.
Immediate breast reconstruction after mastectomy for cancer
Authors: Malata C M , McIntosh S A , Purushotham A D
Published: March 2003

Background

Immediate breast reconstruction after mastectomy has increased over the past decade following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. Broadly, it is undertaken in the treatment of breast cancer, after prophylactic mastectomy in high-risk patients, and in the management of treatment failure after breast-conserving surgery and radiotherapy. Immediate breast reconstruction can be achieved reliably with a variety of autogenous tissue techniques or prosthetic devices. Careful discussion and evaluation remain vital in choosing the correct technique for the individual patient.

Methods

This review is based primarily on an English language Medline search with secondary references obtained from key articles.

Results and Conclusion

Immediate breast reconstruction is a safe and acceptable procedure after mastectomy for cancer; there is no evidence that it has untoward oncological consequences. In the appropriate patient it can be achieved effectively with either prosthetic or autogenous tissue reconstruction. Patient selection is important in order to optimize results, minimize complications and improve quality of life, while simultaneously treating the malignancy. Close cooperation and collaboration between the oncological breast and reconstructive surgeons is desirable in order to achieve these objectives.
Duodenal injuries
Authors: Degiannis E , Boffard K
Published: March 2003

Background

The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma.

Methods

The English language literature on duodenal trauma over the period 1970–1999 was reviewed.

Results and Conclusion

Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains the ultimate diagnostic test if a high suspicion of duodenal injury continues in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair. More complicated injuries require more sophisticated techniques. High-risk duodenal injuries are followed by a high incidence of suture line dehiscence and they should be treated by duodenal diversion. Pancreaticoduodenectomy should be considered only if no alternative is available. ‘Damage control’ should precede definitive reconstruction.
Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population
Authors: Kennedy T M , Jones R H
Published: March 2003

Background

Some patients with irritable bowel syndrome (IBS) may undergo unnecessary cholecystectomy. This paper describes the prevalence of cholecystectomy and IBS in a sample of British adults in Teesside. Associations between the two conditions and their relationship to consultation behaviour and socioeconomic status are described. The results are compared with those from Bristol in an attempt to determine the influence of service-related factors on the prevalence of cholecystectomy.

Methods

A postal questionnaire was sent to 4432 adults aged 20–69 years registered with six general practices. The Standard Occupational Classification was used as a proxy for socioeconomic status.

Results

In Teesside cholecystectomy was reported by 4·1 per cent of women and 1·3 per cent of men. Some 22·9 per cent of the women had IBS, and 10·5 per cent of men. Cholecystectomy was more common in patients with IBS (odds ratio 1·9 (95 per cent confidence interval 1·2–3·2); P < 0·01). The prevalence of cholecystectomy, of IBS and of consultation for symptoms of IBS was not influenced by socioeconomic status.

Conclusion

Symptoms of IBS may cause diagnostic confusion and unproductive surgery. Cholecystectomy may cause IBS-like symptoms, a single underlying disorder may produce symptoms in both gastrointestinal and biliary tracts, or the associations might be due to a combination of these factors.
Thyroid cancer management in North Trent. Case record review confirms the need for specialist care
Authors: Millar B A , Moore S , Harrison B J
Published: March 2003

Background

The Calman–Hine Report mandates the need for specialist care of patients with cancer within the UK. The next round of accreditation will include an assessment of care available to patients with thyroid cancer. The Joint Thyroid Cancer Clinic in Sheffield allows secondary and tertiary referral to a multidisciplinary specialist team for the two million people of North Trent.

Methods

A retrospective case record review of the last 159 patients referred to the clinic by specialist and non-specialist surgeons was performed to assess surgical and pathological aspects of care, including preoperative, peroperative and postoperative management, as well as operative morbidity.

Results

A total of 37 surgeons at ten hospitals were involved in the initial management of 128 women and 31 men (mean age 53 (range 10–99) years) with thyroid cancer (111 differentiated, nine medullary, 16 anaplastic, 15 lymphoma, eight others), including 23 general surgeons (69 patients), ten ear, nose and throat surgeons (ten patients) and three specialist endocrine surgeons (66 patients). Non-specialist surgeons carried out 78 reoperative procedures. Histopathological review after referral by a specialist pathologist resulted in a change in diagnosis in 10 per cent of 125 patients (13 cases). Operation-specific surgical morbidity was recorded as follows:

Cancer Registry data indicated that a further 101 patients with thyroid cancer were never referred to the Joint Thyroid Cancer Clinic during the same period.

Conclusion

In North Trent, despite the presence of a longstanding and well established clinic, many patients with thyroid cancer do not receive specialist/multidisciplinary care. Patients are often treated by surgeons with little experience of thyroid cancer, and the rates of inaccurate pathological diagnosis and operative morbidity are unacceptably high in patients treated by non-specialist teams.
Role of frozen section, sex, age and tumour size in differentiating follicular adenoma from carcinoma: a meta-analysis
Authors: Miltenburg D M , Prost H M , Graviss E A , Arem R
Published: March 2003

Background

Frozen section (FS) has been the mainstay of intraoperative decision-making in thyroid neoplasms for many years. However, since the widespread use of preoperative fine-needle aspiration, the need for FS in patients with follicular neoplasms (FNs) has been debated. Preoperative features may be better at distinguishing follicular carcinoma (FC) from adenoma (FA). One reason why these issues are unresolved is because clinical studies are often too small to reach statistical significance. The purpose of this study was to combine modern trials and use the technique of meta-analysis to determine the efficacy of FS and the role of sex, age and tumour size in patients with FNs.

Methods

Inclusion criteria were published and unpublished studies between 1990 and 1999 inclusive, in which patients had a permanent pathology (PP) diagnosis of FA or FC (including Hurthle cell tumours) and underwent FS or had clinical features recorded. A pooled sample of the combined data was analysed for the prognostic variables and outcomes. P < 0·05 was considered significant.

Results

Nineteen studies were included. FS was evaluated in 11 studies (n = 2204). FS matched PP in 82 per cent of patients and was considered helpful. FS was indeterminate in 13 per cent of cases and was considered unhelpful. FS was detrimental in 4 per cent of patients. In 27 per cent of FCs, FS reported FA (false negative) and in 1 per cent of FAs, FS reported FC (false positive). Overall, FS had an 87 per cent sensitivity, 48 per cent specificity, 92 per cent positive predictive value, 35 per cent negative predictive value and 82 per cent accuracy. Clinical features were examined in ten studies (n = 1980). Nine studies (n = 1780) reported sex; 20 per cent of patients were male. A disproportionately high percentage of patients with FC were male (28 per cent) compared with female (P < 0·001). Two studies (n = 548) reported age; 36 per cent of patients were over 50 years old. A disproportionately high percentage of patients with FC were aged over 50 years (52 per cent) compared with those younger than 50 years (P < 0·001). Six studies (n = 1620) reported tumour size; 19 per cent of FNs were larger than 3–5 cm. A disproportionately high percentage of FCs were larger than 3–5 cm (33 per cent) compared with smaller lesions (P < 0·001).

Conclusion

FS is able to differentiate FC from FA in over 80 per cent of patients. It has a false-positive rate of less than 1 per cent and therefore may be trusted most when it reports a FC. In cases in which FS reports FA, male sex, age greater than 50 years and tumour size larger than 3–5 cm can be used as indicators that a FN will be a FC.
Discovery of germline and somatic mutations in apparently sporadic parathyroid tumours
Authors: Uchino S , Noguchi S , Sato M , Yamashita H , Yamashita H , Watanabe S , Ohshima A , Nagatomo M , Adachi M
Published: March 2003

Background

To discriminate between sporadic and hereditary parathyroid tumours and characterize multiple endocrine neoplasia type 1 (MEN1) somatic mutations, MEN1 gene mutations were examined in patients with apparently sporadic parathyroid tumours.

Methods

DNA was extracted from fresh frozen parathyroid tumour specimens from 112 patients, as well as from peripheral blood leucocytes (PBL) from 60 of the 112 patients. Sequencing was performed to examine exons 2–10 of the MEN1 gene for mutations. In addition, exons 10 and 11 of the RET gene were sequenced.

Results

MEN1 mutations were found in 25 (22 per cent) of the 112 patients. Two patients had two simultaneous point-mutations. A total of 27 mutations were characterized, 24 of which have not been reported previously. There were seven nonsense mutations, ten frameshift mutations, two splice-site deletions, five missense mutations and three in-frame mutations. Nineteen mutations resulted in truncation of menin protein. Germline MEN1 mutations were found in three of 60 patients who had no family history of endocrine tumours associated with MEN1, and these patients were identified as MEN1 gene family probands. No somatic or germline RET exon 10 and 11 mutations were found in this series.

Conclusion

These findings suggest that MEN1 gene mutation may be associated not only with endocrine tumours of affected patients with MEN1 but also with sporadic parathyroid tumours. MEN1 gene analysis can distinguish inheritable from non-inheritable parathyroid tumours and MEN1 gene evaluation of patients with apparently sporadic parathyroid tumours is necessary before parathyroid surgery.
Non-invasive imaging of freshly excised parathyroid glands using confocal reflectance microscopy
Authors: White W M , Tearney G J , Fabian R L , Gaz R D
Published: March 2003

Background

Successful surgical management of primary hyperparathyroidism requires an understanding of the underlying pathological diagnosis. Various methods have been employed to distinguish normal from hyperfunctional diseased glands. Confocal reflectance microscopy (CRM) is a novel optical method of imaging tissue non-invasively without the need for fixation, sectioning and staining as in standard histopathology. Gray-scale images are displayed in real time on a monitor, and represent horizontal (en face) optical sections through the tissue. Using CRM, the goal of this study was to delineate histological features characteristic of the parathyroid gland, and to determine if confocal imaging could distinguish normal from adenomatous parathyroid tissue.

Methods

In this pilot observational cohort study, a total of 18 parathyroid glands was imaged using CRM immediately after excision in eight patients undergoing surgery for primary hyperparathyroidism. Confocal images were compared with corresponding permanent, haematoxylin and eosin-stained sections obtained from the same gland. For each patient, the percentage area occupied by fat cells was calculated in ten independent images (593 μm × 509 μm) of both normal and diseased glands.

Results

Characteristic histological features of the parathyroid gland were readily discernible by CRM and correlated well with permanent, haematoxylin and eosin-stained sections. The fat content of both normal and diseased glands could be determined easily. The percentage area occupied by fat cells was distinctly different in normal (mean(s.d.) 21·8(5·3) per cent) and diseased (0·9(2·4) per cent) parathyroid glands.

Conclusion

CRM rapidly revealed histological features of the parathyroid gland without histological processing. This new, simple, rapid and non-invasive technique has the potential for use as an adjunct to frozen-section analysis in intraoperative consultation during parathyroidectomy. This may provide a technique for in situ histological diagnosis of endocrine or other tissues without an excisional biopsy. Work is currently under way to develop an intraoperative probe for in vivo use.
Murine model of allogeneic adrenocortical cell transplantation: perspectives for the treatment of Addison's disease in man
Authors: Ellerkamp V , Musholt T J , Klebs S H G , Musholt P B , Scheumann G F W , Klempnauer J , Hoffman M W
Published: March 2003

Background

Hormone substitution for the treatment of adrenocortical insufficiency (Addison's disease) does not adequately substitute the physiological circadian secretion of corticosteroids leading to long-term sequelae and reduced quality of life. Moreover, oral administration of corticosteroids cannot mimic the hormone peaks required in stress situations. This lack of adaptation to physical and psychological stress may lead to life-threatening Addisonian crises. Allogeneic transplantation of adrenal cortex may offer an alternative.

Methods

Major histocompatibility complex (MHC) class I transgenic mice (H-2Kb) were used for the implementation of an animal model of adrenocortical transplantation. Tissue fragments or selectively isolated cell suspensions of the adrenal cortex were transplanted underneath the kidney capsule of adrenalectomized mice. Kb-transgenic murine cells as well as allogeneic adrenal cortex cells were cocultured in mixed lymphocyte cultures (MLC) in order to examine the alloimmune response. Lymphocytes from T-cell receptor transgenic mice and normal allogeneic mice respectively served as responder cells. The immune response, i.e. lymphocyte proliferation, was quantified by measuring the [3H]thymidine uptake of responder cells. The effect of corticosteroids secreted by adrenocortical cells was antagonized by the steroid receptor antagonist Mifepristone (RU 486).

Results

Without need for immunosuppressive drugs, adrenocortical grafts were demonstrated to proliferate and produce corticosteroids at physiological concentrations 20 days after transplantation. Coculture of adrenal cortical cells in MLC markedly suppressed lymphocyte proliferation. This inhibited immune response was not completely antagonized by RU 486.

Conclusion

In vitro, the presence of adrenocortical cells potently suppressed allogeneic immune responses. This effect was not only due to the secretion of corticosteroids, pointing to a additional immunomodulatory property of adrenocortical cells. Successful allogeneic transplantation of MHC-II-matched adrenal cortex grafts in a murine model raises the possibility of applying these methods in humans.
Cardiac disease and midgut carcinoid syndrome
Authors: Westberg G , Caidahl K , Bergh C-H , Ahlman H , Wangberg B
Published: March 2003

Background

Valvular heart disease is a well known complication of the midgut carcinoid syndrome but its impact on survival and effects of modern tumour treatment remain to be analysed.

Methods

In a prospective study cardiac abnormalities and clinical outcome were analysed in 64 consecutive patients with high urinary excretion of the serotonin metabolite 5-HIAA and carcinoid tumours with liver metastases (mean(s.d.) follow-up 119(7) months). A tumour reduction programme by radical surgery alone (including hemihepatectomy) or with hepatic artery embolization following primary surgery (in bilobar liver disease) was offered to all patients. At entry into the study, patients underwent Doppler echocardiography, exercise electrocardiography, Holter monitoring and urinary 5-HIAA determination.

Results

At follow-up, patients were grouped according to clinical outcome. Twenty-four patients were alive, 11 after radical surgery alone (group 1) and 13 after embolization plus octreotide (group 2). Forty patients had died during follow-up (group 3), three with radical surgery (unrelated disease) and 27 patients with embolization plus octreotide. Ten deceased patients had medical therapy alone after primary surgery owing to complicating diseases. The mean 5-HIAA levels before treatment were lower in group 1 (185 mol per 24 h) than in group 2 (956 (mol per 24 h) or group 3 (566 (mol per 24 h). Tricuspid valve structural abnormalities (TSA) were found in 13, 38 and 33 per cent, and holosystolic tricuspid regurgitation (TR) in 36, 54 and 60 per cent of patients in groups 1, 2 and 3 respectively. No patient had pulmonary stenosis, but 9 per cent (group 1), 15 per cent (group 2) and 13 per cent (group 3) had holodiastolic pulmonary regurgitation. A novel index (TSA–TR) of TSA (0–4) and TR (0–4) was formed. Patients with TSA–TR (3 had significantly (P = 0·025) higher 5-HIAA levels than patients with an index (1. Patients with 5-HIAA levels above 500 (mol per 24 h demonstrated a significantly (P = 0·04) higher late-to-early peak ratio (A/E) of diastolic tricuspid Doppler flow than patients with 5-HIAA levels less than 500 (mol per 24 h. Of the six patients who suffered cardiac death, five died from ischaemic heart disease or sudden death and one from advanced right heart failure.

Conclusion

Tricuspid abnormalities were common findings in patients with the midgut carcinoid syndrome and severe findings were related to high urinary excretion of 5-HIAA. The highest initial hormone levels were seen in one of the surviving groups. Sudden or ischaemic heart death was more common than death from right-sided heart failure.
Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma
Authors: Frilling A , Tecklenberg K , Goerges R , Clausen M , Broelsch C E
Published: March 2003

Background

The prognosis of differentiated thyroid carcinoma is usually excellent, but the majority of patients who develop a recurrence have a higher risk of death from the disease. Beside clinical examination, several diagnostic tools, such as ultrasonography, 131I scanning, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and thyroglobulin (TG) measurement under raised thyroid-stimulating hormone in serum can detect tumour recurrences. This prospective study compared the value of different diagnostic modalities in the detection of recurrent differentiated thyroid cancer.

Methods

From April 1992 to October 1999, 181 patients with thyroid carcinoma, of whom 150 had a well differentiated tumour, subjected to surgical treatment were identified prospectively. Some 107 patients (71 per cent) presented with primary tumour and 43 patients (29 per cent) with recurrent disease. The patients with tumour recurrence were evaluated regarding the mode of detection of recurrent disease, including clinical examination, ultrasonography, fine-needle biopsy (FNB), TG measurement and FDG-PET, the surgical treatment and outcome.

Results

Some 63 per cent of patients presented with regional lymph node metastases and 37 per cent with local recurrence. None of the patients with local recurrence was operated on for primary tumour in this department. In 87 per cent the recurrence was detected by clinical examination. Ultrasonography and 131I scan revealed suspicious findings in 97 and 69 per cent respectively. FNB disclosed abnormal cytological findings in 95 per cent. There were pathological TG levels in 86 per cent of patients. Among patients with a raised level of TG and negative scan results, 13 underwent FDG-PET, with pathological findings in 82 per cent.

Conclusion

In patients with well differentiated thyroid carcinoma, ultrasonography and FNB are the most sensitive methods for the detection of local recurrence or regional lymph node metastases. FDG-PET is a useful diagnostic tool in patients with a negative 131I scan and a raised level of TG.
Prognostic significance of RET and NTRK1 rearrangements in sporadic papillary thyroid carcinoma
Authors: Musholt T J , Musholt P B , Khaladj N , Schulz D , Scheumann G F W , Klempnauer J
Published: March 2003

Background

The genetic background of papillary thyroid carcinoma (PTC) has been elucidated by the identification of somatic translocations of the tyrosine kinases RET and NTRK1. Expression of RET/PTC chimeras has been demonstrated in 10–25 per cent of sporadic PTCs while rearrangements of NTRK1 were detected less frequently. Based upon the limited data available, some investigators have hypothesized that RET/PTC activation is preferentially associated with slow growing tumours of low malignancy in elderly patients, while other studies support the contrary.

Methods

Tumour tissues from 115 patients with sporadic PTC were harvested at operation and snap frozen. Following RNA extraction, expression analysis of the RET proto-oncogene as well as the NTRK1 gene was performed by multiplex reverse transcriptase–polymerase chain reaction. Samples with suspected rearrangements of the genes were further analysed for expression of the hybrid messenger RNAs RET/PTC1 to RET/PTC4, and for known NTRK1 chimeras. Clinical data of all patients were documented in an extensive database of thyroid carcinomas maintained by this research group.

Results

Twenty-one (18 per cent) of 115 tumour samples revealed somatic rearrangements of RET while translocations of the NTRK1 gene were demonstrated in 2 per cent of all samples analysed to date. The mean age of all patients was 52 (range 14–86, median 54) years and that of patients positive for RET rearrangements was 49 (range 14–82, median 49) years. Nine of 21 RET-rearranged tumours showed aggressive behaviour with locally invasive tumour growth and infiltration of adjacent structures such as muscles, vessels and trachea. Tumour samples without detectable RET translocations were associated with organ-exceeding tumour growth in only 20 per cent of cases.

Conclusion

These data represent one of the most comprehensive studies on gene translocations and their clinical significance in PTC. In accordance with international publications, an incidence of 2 per cent of NTRK1 rearrangements and 18 per cent of RET translocations is reported, which is in contrast to other national reports of low rearrangement rates. Somatic translocations were associated with tumours demonstrating aggressive behaviour in almost half of patients with PTC in all age groups, indicating a prognostic role of oncogenic RET/PTC activation.
Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement
Authors:   QUOROM Group, Moher David , Cook Deborah J , Eastwood Susan , Olkin Ingram , Rennie Drummond , Stroup Donna F
Published: March 2003

Background

The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs).

Methods

The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items.

Findings

The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with ‘trial flow’, study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials.

Interpretation

We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Incidence of benign lesions in patients resected for suspicious hilar obstruction
Authors: Gerhards M F , Vos P , van Gulik T M , Rauws E A J , Bosma A , Gouma D J
Published: March 2003

Background

The differentiation between benign and malignant strictures at the hepatic hilum is difficult. The aim of this study was to assess the clinical and radiographical features of hilar lesions in a series of patients resected for a presumed cholangiocarcinoma.

Methods

Of 132 consecutive patients undergoing resection for a suspicious lesion at the hepatic hilum, 20 (15 per cent) had a histopathologically proven benign tumour, diagnosed as chronic fibrosing or erosive inflammation, sclerosing cholangitis, or a granular cell tumour. All medical files and radiological examinations of the patients were reassessed.

Results

Clinical symptoms were considered suspicious in 16 of 19 patients. At ultrasonography only one of 16 patients had an unsuspicious examination. In 14 of 18 patients cholangiographic images were considered suspicious. Overall reassessment confirmed a suspicious lesion in all 20 patients.

Conclusion

Because of the limitations of current diagnostic tools, a false-positive preoperative diagnosis of malignancy resulted in a 15 per cent resection rate of benign lesions in this series of suspicious hilar strictures.
Training in infrainguinal bypass surgery for severe leg ischaemia
Authors: Papp L , Evans S M , Kelman J , Chalmers R T A , Murie J A , Bradbury A W
Published: March 2003

Background

Recent changes in surgical training in the UK mean that operative experience must be gained more efficiently. However, it is important to demonstrate that improved training opportunities are not associated with inferior patient outcomes. The aim was to examine changes in training in infrainguinal bypass surgery and to compare the outcomes of operations performed by consultants and trainees.

Methods

A prospectively gathered, computerized database of 1077 consecutive infrainguinal bypasses performed on 1003 patients for chronic severe leg ischaemia between 1 January 1983 and 31 December 1998 was analysed.

Results

Consultants performed 733 (68 per cent) infrainguinal bypasses to the following distal sites: 347 (47 per cent) above-knee popliteal artery, 257 (35 per cent) below-knee popliteal artery, 121 (17 per cent) to a crural artery and eight (1 per cent) other. Trainees performed 344 operations: 170 (49 per cent) were to the above-knee popliteal artery, 122 (35 per cent) to the below-knee popliteal artery, 48 (14 per cent) crural and four (1 per cent) other. The operative mortality rate was 27 (4 per cent) of 733 for consultants and 11 (3 per cent) of 344 for trainees (P > 0·05, χ2 test). There were no significant differences in patency or limb salvage at 36 months after operation between consultants and trainees, regardless of the site of distal anastomosis and the type of conduit used.

Conclusion

With appropriate case selection and supervision, training in infrainguinal bypass grafting does not compromise early or long-term patient outcomes.

Presented to the Vascular Surgical Society, Leicester, 24 November 1999, and published in abstract form as Br J Surg 2000; 87: 490
Potential of laparoscopic ultrasonography as an alternative to operative cholangiography in the detection of bile duct stones
Authors: Tranter S E , Thompson M H
Published: March 2003

Background

Intraoperative cholangiography (IOC) is time consuming, requires radiation and sometimes fails. In contrast, laparoscopic ultrasonography (LUS) is a comparatively quick, safe and non-invasive technique. The aim of this study was to assess the potential of LUS as an alternative to IOC.

Methods

LUS was performed on 367 patients undergoing laparoscopic cholecystectomy. Laparoscopic duct exploration was performed in the presence of duct stones. Data were collected prospectively. The presence or absence and number of duct stones detected by LUS were recorded. The maximum bile duct diameter determined by LUS was compared with a preoperative ultrasonographic measurement according to age and the presence of duct stones. The final arbiter was the demonstration of stones removed at laparoscopic duct exploration (59 patients) or subsequently by endoscopic retrograde cholangiopancreatography (two patients).

Results

LUS visualized the CBD in 99 per cent of patients and the common hepatic duct in 92 per cent. It identified stones in 56 of the 61 patients with duct stones. No stones were demonstrated in the remaining 306 patients (sensitivity 92 per cent, specificity 100 per cent, positive predictive value 100 per cent, negative predictive value 98 per cent). LUS underestimated the total number of stones in 18 per cent of patients with common duct stones. The mean common bile duct diameter was 5·0 mm before operation and 5·9 mm during the procedure in patients without duct stones, rising significantly to a mean of 9·2 mm before operation and 11·2 mm at LUS in those with duct stones (P < 0·0001).

Conclusion

The combination of the demonstration of duct stones and bile duct diameter measurement makes LUS a potential replacement for IOC. Improved demonstration of the common hepatic duct would be advantageous.
Use of cadaveric superior mesenteric artery as interpositional vascular graft in orthotopic liver transplantation
Authors: Muiesan P , Rela M , Heaton N D
Published: March 2003

Background

Hepatic artery thrombosis remains the most common technical complication that causes graft failure following orthotopic liver transplantation. The development of split liver and living related liver transplantation has led to the use of shorter and smaller arteries for arterial reconstruction to the graft. The present aim was to assess the effectiveness of the superior mesenteric artery as an interpositional graft in arterial reconstruction during liver transplantation.

Methods

Cadaveric superior mesenteric artery was used to reconstruct small and short or multiple hepatic arteries in 35 liver transplants including 29 split, three living related, two whole liver transplants and one emergency revascularization post-transplantation.

Results and conclusion

A low incidence of hepatic artery thrombosis (one of 35 patients) was achieved utilizing cadaveric superior mesenteric artery as an interpositional vascular graft in liver transplantation.
Treatment of ruptured hepatocellular adenoma
Authors: Terkivatan T , de Wilt J H W , de Man R A , van Rijn R R , Tilanus H W , IJzermans J N M
Published: March 2003

Background

As the morbidity and mortality rates associated with emergency resection in patients with a ruptured hepatocellular adenoma are high, the authors have favoured initial non-operative management in haemodynamically stable patients.

Methods

A retrospective study was performed to evaluate the treatment of ruptured hepatocellular adenoma.

Results

Over a 21-year interval, 12 patients presented with a ruptured hepatocellular adenoma. Haemodynamic observation and support was the initial management in all 12 patients. Three underwent urgent laparotomy and gauze packing because of haemodynamic instability; no emergency liver resection was necessary. Eight patients had definitive surgery; three developed postoperative complications but none died. Regression of the tumour was observed in three of four patients treated conservatively.

Conclusion

The initial management of a ruptured hepatocellular adenoma should be haemodynamic stabilization. Definitive resection is required for rebleeding or for tumours exceeding 5 cm in diameter. A conservative approach may well be justified in case of regression of an asymptomatic adenoma.
Incidence of acquired immune deficiency syndrome (AIDS)-related disorders at laparotomy in patients with AIDS
Authors: Chambers A J , Lord R S A
Published: March 2003

Background

Patients with acquired immune deficiency syndrome (AIDS) present for surgical management of abdominal conditions that are complications of advanced human immunodeficiency virus (HIV) infection or that are caused by other disease not related to AIDS. This study compared the clinical details and postoperative outcomes of patients with AIDS-related diseases found at laparotomy with those of patients with non-AIDS-related disorders.

Methods

The medical records of 30 consecutive patients with AIDS who underwent laparotomy were examined retrospectively.

Results

Fourteen patients had AIDS-related pathologies found at laparotomy, 13 had disease processes that were not AIDS related and three had no abnormal findings at laparotomy. Patients with AIDS-related conditions at laparotomy had lower mean body-weight, serum albumin concentration and CD4 lymphocyte count, and required a longer hospital admission than those who had non-AIDS-related disease. The duration of HIV infection and the number of complications and deaths were similar in the two groups. Complications occurred in 21 patients and there were five deaths (30-day mortality rate 17 per cent).

Conclusion

AIDS-related pathologies are commonly found at laparotomy in patients with HIV/AIDS. An AIDS-related diagnosis does not confer a greater risk of complication or postoperative death than other conditions.
Portal vein embolization: rationale, technique and future prospects
Authors: Abdalla E K , Hicks M E , Vauthey J N
Published: March 2003

Background

Advances in surgery have reduced the mortality rate after major liver resection, but complications resulting from inadequate postresection hepatic size and function remain. Portal vein embolization (PVE) was proposed to induce hypertrophy of the anticipated liver remnant in order to reduce such complications. The techniques, measurement methods and indications for this treatment remain controversial.

Methods

A Medline search was performed to identify papers reporting the use of PVE before hepatic resection. Techniques, complications and results are reviewed.

Results

Complications of PVE typically occur in less than 5 per cent of patients. No specific substance (cyanoacrylate, thrombin, coils or absolute alcohol) emerged as superior. The increase in remnant liver volume averages 12 per cent of the total liver. The morbidity rate of resection after treatment is less than 15 per cent and the mortality rate is 6–7 per cent with cirrhosis and 0–6·5 per cent without cirrhosis. Embolization is currently used for patients with a normal liver when the anticipated liver remnant volume is 25 per cent or less of the total liver volume, and for patients with compromised liver function when the liver remnant volume is 40 per cent or less.

Conclusion

This treatment does not increase the risks associated with major liver resection. It may be indicated in selected patients before major resection. Future prospective studies are needed to define more clearly the indications for this evolving technique.
Transvaginal repair of pouch–vaginal fistula
Authors: Burke D , van Laarhoven C J H M , Herbst F , Nicholls R J
Published: March 2003

Background

The results of surgery for ileoanal pouch–vaginal fistula have been disappointing. Intra-anal procedures result in fistula healing in, at best, approximately 50 per cent of patients. A transvaginal approach was developed to achieve direct access to the internal opening, enabling closure without damage to the anal sphincter.

Methods

Fourteen patients were treated between January 1992 and December 1998. All had had restorative proctocolectomy for ulcerative colitis and all were defunctioned. Histological review confirmed the diagnosis in all patients.

Results

Median age was 40 (range 25–52) years. Median follow-up was 18 (range 6–60) months. The operation was successful in 11 of the 14 patients, after one attempt in six patients, after two attempts in four, and after three attempts in one patient. The operation failed in three patients, who had a permanent ileostomy. The number of bowel actions in the patients who had successful closure ranged from 2 to 10 (median 6) in 24 h, with no faecal incontinence reported.

Conclusion

This simple technique achieved healing in 11 of 14 patients. This compares favourably with the poor results in 28 patients treated by other procedures in the same hospital, with certain healing in five and definite failure in 20.
Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit
Authors: Smedh K , Olsson L , Johansson H , Åberg C , Andersson M
Published: March 2003

Background

Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques.

Methods

All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993–1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144).

Results

The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0·001). Surgical complications dropped from 37 to 11 per cent (P < 0·001). The relaparotomy rate fell from 11 to 4 per cent (P < 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0·001).

Conclusion

The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.