bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased plasma levels of atrial natriuretic peptide and endocrine markers of volume depletion in patients with obstructive jaundice
Authors: Gallardo J M , Padillo J , Martín-Malo A , Miño G , Pera C , Sitges-Serra A
Published: March 2003

Background

Hypovolaemia may cause renal dysfunction in obstructive jaundice. This study investigated whether, in patients with obstructive jaundice: (1) atrial natriuretic peptide (ANP) is increased; (2) fluid-regulating hormones are altered; and (3) biliary drainage improves fluid homoeostasis.

Methods

Forty-three patients with obstructive jaundice were investigated. A renal profile was obtained and levels of ANP, renin, aldosterone and vasopressin were determined. In a subset of 18 patients, studies were repeated 3 days after endoscopic biliary drainage and changes in extracellular volume were measured.

Results

Creatinine clearance was impaired in ten of 30 patients. Patients with obstructive jaundice had higher mean levels of ANP (118 versus 40 pg/ml, P = 0·0001) and aldosterone (156 versus 43 pg/ml, P = 0·0001) than matched controls. Increased renin levels were observed in ten of the 43 patients and were associated with impaired creatinine clearance. After biliary drainage ANP concentration decreased (110 versus 67 pg/ml, P = 0·004) as well as aldosterone level (182 versus 85 pg/ml, P = 0·0002) and the mean extracellular volume increased (20·5 versus23·1 per cent of body-weight, P = 0·001).

Conclusion

Plasma ANP concentration is increased in obstructive jaundice. Endocrine markers of hypovolaemia are activated in obstructive jaundice. After biliary drainage there is an improvement of endocrine and fluid derangements.
Comparison of endoanal magnetic resonance imaging with surgical findings in perirectal sepsis
Authors: Zbar A P , de Souza N M , Puni R , Kmiot W A
Published: March 2003

Background

A small percentage of patients presenting with perirectal sepsis will have complicated or recurrent disease. In these cases, clinical examination may be difficult or unreliable and accurate preoperative imaging may be of value

Methods

A prospective study using a specially designed internal coil for magnetic resonance imaging (MRI) was carried out in ten patients with simple cryptogenic perirectal sepsis and in 11 patients with complex recurrent disease. Fistulas and abscesses were classified independently by a colorectal surgeon unaware of the results of MRI and a radiologist unaware of the operative findings.

Results

In patients with simple perirectal infection, endoanal MRI accurately detected all abscesses and four of five fistulas. In complicated cases (multiple recurrences, sepsis secondary to inflammatory bowel disease or where the fistula track(s) traversed the main sphincter complex), endoanal MRI identified six of seven abscesses with confirmation of abscess site and horseshoe configuration when present in all cases. Surgical and radiological concordance was present in 12 of 14 fistulas with identification by MRI of the internal opening in nine of 12 cases.

Conclusion

Endoanal MRI provides high-resolution images of the relationship of collections and tracks to the levator plate and is recommended in the evaluation of complex or recurrent perirectal sepsis.
Restenting malignant oesophageal strictures
Authors: Lagattolla N R F , Rowe P H , Anderson H , Dunk A A
Published: March 2003

Background

Self-expanding metal stents are used to palliate malignant strictures of the oesophagus. This study was designed to identify the characteristics of patients requiring restenting of malignant oesophageal strictures.

Methods

Fifty-three stents were inserted in 42 patients. Thirty-two patients did not require further stenting (once-stented group). Ten patients received second stents for recurrent oesophageal obstruction (restented group), with one patient requiring restenting a second time. Comparisons were drawn between the once-stented and restented groups with regard to survival, patient, tumour and procedural characteristics.

Results

There were no significant differences with regard to tumour grade, tumour type, involvement of the cardia, procedural difficulties or the need for postprocedural oesophageal dilatation between the two groups. Survival from initial stenting was significantly greater in the restented group (median 24 (range 4–43) weeks) than in the once-stented group (median 9·5 (range 1–84) weeks) (P < 0·05). The mean length of stents used in the once-stented group was significantly greater than that of the initial stents used in the restented group (12 versus 10 cm, P = 0·032).

Conclusion

Inserting a covered stent through a previously inserted uncovered stent is an uncomplicated and well tolerated technique which maintains palliation from obstructing oesophageal carcinoma. The need for restenting cannot be predicted on the basis of tumour characteristics alone.
Management of acute leg ischaemia in the elderly
Authors: Braithwaite B D , Davies B , Birch P A , Heather B P , Earnshaw J J
Published: March 2003

Background

Peripheral thrombolysis is advocated by some as the best initial treatment for acute leg ischaemia, but this may not be true for elderly patients. This study reviewed the management of acute leg ischaemia in patients aged over 75 years.

Methods

Over a 5-year interval, 91 events of acute leg ischaemia in 84 patients were managed in a single district general hospital according to a local protocol. There were 60 women and 24 men of median age 81 (range 75–100) years. Fifteen patients were too elderly and infirm for active treatment and received anticoagulation alone. Some 76 events (84 per cent) occurred in patients suitable for active therapy: 33 were managed by initial surgery and 43 by peripheral thrombolysis with tissue plasminogen activator.

Results

Overall outcome after 30 days was limb salvage in 48 (53 per cent), amputation in five (5 per cent) and death in 38 (42 per cent). In actively treated patients the corresponding values were 43 (57 per cent), four (5 per cent) and 29 (38 per cent). Initial successful revascularization was more likely following surgery (29 of 33 versus 25 of 43 events with thrombolysis, P < 0·01), but the 30-day outcome was similar in the actively treated groups owing to subsequent morbidity and mortality.

Conclusion

A group of patients (mostly women) with emboli could be identified, using clinical criteria, who had a high chance of successful revascularization following embolectomy. Late outcome remained poor due to associated co-morbid conditions. Thrombolysis is associated with substantial risk in the elderly, and with high complication rates.
Screening for gastric cancer by Helicobacter pylori serology: a retrospective study
Authors: Whiting J L , Hallissey M T , Fielding J W L , Dunn J
Published: March 2003

Background

Screening by serology for Helicobacter pylori in young dyspeptic patients has been shown to be effective in reducing demand for endoscopy. H. pylori has been implicated in the causation of gastric cancer and the reported seropositivity rate in patients with gastric cancer ranges from 69 to 94 per cent. The aim of this study was to assess the potential value of Helicobacter antibodies as a method of selecting dyspeptic patients over the age of 45 years for endoscopy.

Methods

A retrospective comparison of the antibody status to H. pylori was made between 154 patients with gastric cancer and a sex- and date of birth-matched dyspeptic control group. Results from the former group were correlated with demographic data and tumour characteristics.

Results

Significantly more patients with gastric cancer were seropositive than controls (77 versus 66 per cent). H. pylori was not related to the Laurén classification of the tumour. Tumour site was significant: body and antrum tumours were associated with Helicobacter whereas cardial tumours appeared to be unrelated.

Conclusion

Screening by antibody assays to H. pylori would miss more than 30 per cent of current gastric cancers. The increasing incidence of cardial cancer would cause this percentage to rise in the future.
Quality of life after pouch excision
Authors: Tan H T , Morton D , Connolly A B , Pringle W , White M , Keighley M R B
Published: March 2003

Background

Pouch excision is a devastating experience for patients having restorative proctocolectomy for ulcerative colitis.

Methods

The quality of life among patients having pouch excision for ulcerative colitis was compared with that in those having proctocolectomy and ileostomy for ulcerative colitis using a validated standardized self-administered questionnaire.

Results

After pouch excision patients (n = 9) had more troublesome bowel symptoms (mainly from liquid stoma output) than those in the proctocolectomy group (n = 14) (mean(s.d.) score 5·64(0·92) versus 6·13(0·37), P = 0·03). However, the mean scores for the other parameters (systemic symptoms, functional, social and emotional impairment) did not differ significantly.

Conclusion

Patients having pouch excision for ulcerative colitis have more liquid ileostomy loss but a comparable quality of life to those treated by standard proctocolectomy and ileostomy.
Management of symptomatic locoregional recurrence during regional chemotherapy for colorectal liver metastases
Authors: Davies M M , Fordy C , Burke D , Allen-Mersh T G
Published: March 2003

Background

The incidence of symptomatic locoregional recurrence is doubled in patients receiving regional chemotherapy with hepatic arterial floxuridine infusion (HAI) compared with that in those with colorectal liver metastases treated by symptom control. This study assessed the management of symptomatic locoregional recurrence in HAI-treated patients with colorectal liver metastases.

Methods

A retrospective review of all patients with colorectal liver metastases treated by HAI in one hospital over a 10-year period was carried out and the management of those who developed symptomatic locoregional recurrence was studied.

Results

Twenty-three (14 per cent) of 166 HAI-treated patients with colorectal liver metastases developed symptoms of locoregional recurrence. Liver metastases were responding to HAI at the onset of symptoms in 19 (ten abdominal, nine pelvic recurrence) of the 23 patients. Resection of abdominal recurrence was possible in seven of the ten patients, with a median hospital stay of 14 days; there was one perioperative death. Resected patients survived a median of 15 months after resection of the recurrence, with five of seven remaining free of symptoms of locoregional recurrence. In contrast, six of nine HAI-responding patients with pelvic recurrence treated by external beam radiotherapy died from uncontrolled symptomatic pelvic disease.

Conclusion

Resection of abdominal recurrence achieved worthwhile palliation in patients with HAI-controlled liver metastases, but palliation of pelvic recurrence by irradiation was unsatisfactory.
Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis
Authors: Hammarström L E , Stridbeck H , Ihse I
Published: March 2003

Background

Endoscopic sphincterotomy alone, or followed by cholecystectomy, are options in patients with gallstone pancreatitis.

Methods

Ninety-six patients of median age 74 (range 30–93) years with gallstone pancreatitis had endoscopic retrograde cholangiography and were followed for a median of 84 (range 33–168) months. Forty-eight of 49 patients with, and nine of 47 without, common bile duct (CBD) stones had urgent endoscopic sphincterotomy. One patient with, and six without, CBD stones had delayed endoscopic sphincterotomy a median of 35 (range 12–111) days after acute pancreatitis. Thus, 64 patients had endoscopic sphincterotomy (group 1) and 32 did not (group 2). Fifteen and 16 patients in each group respectively had interval cholecystectomy after a median of 3 months and 1 month.

Results

Patients in groups 1 and 2 had similar rates of interval cholecystectomy (15 of 64 versus 16 of 32 patients respectively) or required cholecystectomy (15 of 49 versus five of 16 patients), recurrent CBD calculi (three of 64 versus three of 32 patients) or total length of hospitalization after interval cholecystectomy (median 15·5 and 15 days) or required (median 22 and 24 days) cholecystectomy. The overall incidence of recurrent pancreatitis was one of 64 patients in group 1 and five of 32 in group 2 (P = 0·02), but after interval cholecystectomy the recurrence rate of biliopancreatic symptoms was similar (one of 15 patients versus three of 16 patients respectively).

Conclusion

Endoscopic sphincterotomy, but not interval cholecystectomy, reduced the overall incidence of recurrent pancreatitis, but not of late biliary complications. Some 31 per cent of the patients required cholecystectomy, suggesting that routine cholecystectomy should be considered in fit patients following acute pancreatitis.
Association between restriction fragment length polymorphism of the L-myc gene and susceptibility to gastric cancer
Authors: Shibuta K , Mori M , Haraguchi M , Yoshikawa K , Ueo H , Akiyoshi T
Published: March 2003

Background

L-myc polymorphism has been documented to be a representative genetic trait which is related an individual's susceptibility to several cancers. However, there have been no reports concerning any significant association between susceptibility to gastric cancer and L-myc polymorphism.

Methods

The distribution of L-myc polymorphism in 61 patients with gastric cancer was determined by polymerase chain reaction-based restriction fragment length polymorphism and compared with that of 107 healthy control subjects.

Results

There was a significant difference in the distribution of both genotypes (P = 0·024) and allele frequencies (P = 0·026) between the two groups. The relative risk of gastric cancer for genotypes with the shorter (S) allele was 3·09 compared with the longer (L) allele homozygote. No significant correlation with clinicopathological features of the cancers except for prognosis was found. The patients with SS genotypes had a worse prognosis than those with LL or LS genotypes (P = 0·029).

Conclusion

L-myc polymorphism may be significant in an individual's susceptibility to gastric cancer in Japan, and may be a useful marker for identifying patients at high risk of developing gastric cancer.
Results of aortic screening in the brothers of patients who had elective aortic aneurysm repair
Authors: van der Graaf Y , Akkersdijk G J M , Hak E , Godaert G L R , Eikelboom B C
Published: March 2003

Background

Brothers of patients with an abdominal aortic aneurysm (AAA) are at high risk. In the present study brothers of patients who underwent elective AAA surgery were invited for aneurysm screening and the psychological consequences studied.

Methods

All brothers over the age of 50 years were invited for abdominal ultrasonography. They were asked to complete a standard psychological well-being questionnaire both before, and 3 months after screening.

Results

Some 571 brothers were identified: 251 were dead, 35 lived abroad, 16 could not be contacted for other reasons, 46 refused to participate and 13 were already known to have an AAA. Some 210 subjects (37·8 per cent) accepted the offer of screening. A new AAA was detected in 26 (12·3 per cent, 95 per cent confidence interval 8–18 per cent) of the men screened resulting in an overall prevalence of 18 per cent (95 per cent confidence interval 13–26 per cent). Eight (3·8 per cent) aneurysms were 5 cm or more in diameter and elective surgery was performed in five patients (2·4 per cent). The psychological dimensions of well-being (depression, anxiety, energy, and positive well-being) had not changed significantly 3 months after screening.

Conclusion

The prevalence of AAA in brothers of patients with AAA is far higher than in the overall male population of the same age. Screening does not seem to have a negative influence on psychological well-being.
Relation between tumour necrosis factor α and interleukin 1β producing capacity of peripheral monocytes and pulmonary complications following oesophagectomy
Authors: Katsuta T , Saito T , Shigemitsu Y , Kinoshita T , Shiraishi N , Kitano S
Published: March 2003

Background

Adult respiratory distress syndrome and pneumonia remain a significant cause of morbidity and death following oesophagectomy. The aim of this study was to clarify the association between tumour necrosis factor (TNF) α and interleukin (IL) 1β with these pulmonary complications.

Methods

The in vitro TNF-α and IL-1β producing capacity of peripheral monocytes with or without lipopolysaccaride (LPS) and serum level of IL-6 was measured in 19 patients with oesophageal cancer before and after surgery and in ten age-matched controls.

Results

Six patients had raised TNF-α and IL-1β producing capacity of monocytes without LPS both before operation and on the day after surgery. In these patients plasma elastase and serum IL-6 levels subsequently increased while the ratio of arterial partial pressure of oxygen to fraction inspired oxygen decreased, and they developed bilateral lung infiltration on chest radiography on days 3–7. Five of the six developed pneumonia compared with none of the remaining 13 patients (P < 0·05).

Conclusion

Pulmonary impairment and pneumonia following oesophageal surgery was associated with raised monocyte producing capacity of TNF-α and IL-1β. These markers may be valuable in the preoperative assessment of patients awaiting oesophagectomy.
Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy
Authors: Silvis R , Gooszen H G , Kahraman T , Groenendijk A G , Lock M T W T , Italiaander M V , Janssen L W M
Published: March 2003

Background

This study was conducted to investigate the results of rectovaginovesicopexy (RVVP) in patients with combined defaecation and micturition disorders. RVVP was developed from a standard procedure for different forms of defaecation disorders (the rectovaginopexy (RVP)). It is only a limited extension to the RVP and results in elevation of all three pelvic compartments.

Methods

In a consecutive series of 25 patients the effects or RVVP were evaluated prospectively. Information about the clinical history and results was obtained by a standard questionnaire filled out before and 3 and 12 months after operation. Dynamic defaecography was performed before and 3 months after RVVP. Before operation urodynamic studies were conducted.

Results

RVVP improved constipation (14 of 18 patients improved, P=0·001), faecal incontinence (11 of 16 patients improved, P=0·005) and dysfunctional voiding (ten of 16 patients improved, P=0·07) without induction of these disorders. Overall urinary incontinence improved in 11 of 22 patients (P=0·18), with deterioration of urinary incontinence in three and induction of urinary incontinence in two of the patients. Patients with isolated urinary stress incontinence fared better (eight of 13 patients improved) than those with mixed urinary incontinence.

Conclusion

RVVP provides satisfactory improvement of combined defaecation and micturition disorders. The benefits of a limited extension of the RVP seem to outweigh potential side-effects such as deterioration or de novo defaecation or micturition disorders.
Experimental study of acid burden and acute oesophagitis
Authors: Pursnani K G , Mohiuddin M A , Geisinger K R , Weinbaum G , Katzka D A , Castell D O
Published: March 2003

Background

The relationship of the pH of oesophageal refluxate and its pepsin content to injury of oesophageal mucosa remains unclear. A study was made of the earliest morphological alterations in the oesophageal mucosa secondary to varying concentrations of hydrochloric acid with or without pepsin.

Methods

Adult cats had varying concentrations of acid with and without 1 per cent porcine pepsin infused into the oesophagus through a paediatric feeding tube placed 5 cm above the oesophagogastric junction at a rate of 1 ml/min for 30 min. At autopsy 24 h later, the oesophagus was removed intact and scored by an expanded modification of a previously published histopathological scoring system. This included estimates of the intensity and distribution of four morphological features: basal cell hyperplasia (BCH), intraepithelial leucocytes (IELs), subepithelial leucocytes and ulcers. Each of these four categories was scored from 0 to 4, with a maximum injury score of 16.

Results

Mean(s.e.m.) scores were as follows: pH 1, 15·0(1·0); pH 1 with pepsin, 13·3(1·4); pH 2, 15·3(0·7); pH 2 with pepsin, 11·7(1·1); pH 3, 1·8(1·6); pH 3 with pepsin, 3·7(1·9); pH 4 with or without pepsin, 0·6(0·2). Differences between pH 3 and 4 versus pH 1 and 2 were significant (P<0·05).

Conclusion

Injury to the oesophagus is more dependent on the pH of refluxate than on the presence of pepsin. Peptic injury appears to occur at a critical threshold of acid burden (pH<3) as opposed to a graded level of injury based on a pH scale.
Effect of growth hormone treatment on the healing of left colonic anastomoses in protein-malnourished rats
Authors: Karahasanoǧlu T , Altinli E , Hamzaoǧlu İ , Paksoy M , Yeşildere T , Alemdaroǧlu K
Published: March 2003

Background

Malnutrition is known to affect wound healing but it is not known with certainty whether or not postoperative hyperalimentation can reverse this defect. The present study was designed to examine the effects of recombinant human growth hormone (hGH) on left colonic anastomoses in malnourished rats.

Methods

Experimental animals were allocated randomly into four groups. In groups 1 and 2 animals were fed with normal diet for 10 days before surgery. In groups 3 and 4 animals were fed with a low-protein diet. Left colonic anastomoses were performed in all animals. Following surgery, rats in groups 1 and 3 received hGH whereas rats in groups 2 and 4 were injected with saline as control. Bursting pressure and hydroxyproline levels on day 4 after operation were used to determine anastomotic healing.

Results

Bursting pressure was lower in the malnourished rats than those fed with normal diet (P<0·05). Bursting pressure was higher in normally fed rats which were given hGH. No significant differences could be noted between malnourished control rats and those receiving hGH.

Conclusion

These results suggest that hGH strengthened the left colonic anastomoses in rats fed a normal diet, but could not reverse the negative effects of malnutrition on colonic anastomoses.
Co-existing biliary anomalies and anatomical variants in choledochal cyst
Authors: Todani T , Watanabe Y , Toki A , Ogura K , Wang Z-Q
Published: March 2003

Background

Excision is the treatment of choice for choledochal cyst, and free bile drainage is essential to avoid ascending cholangitis. However, anastomosis between the relatively narrow common hepatic duct and bowel (conventional anastomosis) in case of type IV-A cyst, co-existing biliary anomalies and anatomical variations may cause ascending cholangitis resulting from insufficient biliary decompression.

Methods

One hundred and four patients with choledochal cyst were treated by cyst excision. Conventional anastomosis was performed in 22 patients and hilar anastomosis in 82.

Results

An anastomotic stricture developed in nine of the 22 conventional anastomosis cases and all required reoperation. Of the 82 hilar anastomosis cases, only one required reoperation for a primary stricture. Co-existing biliary anomalies and anatomical variants were seen in 26 patients: (1) primary stricture in 18; (2) aberrant posterior duct in two; (3) low confluence of the hepatic ducts in two; (4) aberrant hepatic artery in two; and (5) very small bile duct in two. All 26 patients underwent widening of the ductal lumen (ductoplasty) or additional procedures.

Conclusion

Complete removal of the extrahepatic bile duct and a wide hilar anastomosis is essential to prevent ascending cholangitis. Ductoplasty or additional procedure can be performed only at the hilum.
Colorectal cancer vaccines
Authors: Maxwell-Armstrong C A , Durrant L G , Scholefield J H
Published: March 2003

Background

Advances in molecular pathology have enabled a number of colorectal cancer antigens to be identified and characterized. The commonest investigated include 17-1A, 791Tgp72 and carcinoembryonic antigen. Vaccines have been developed that stimulate the immune system to target these antigens. This paper reviews current areas of research in this field.

Methods and Results

Relevant articles were obtained on vaccines for colorectal cancer from Medline and the Bath Information Data System. A number of approaches are currently being evaluated in Phase I, II and III trials. These include anti-idiotypic antibody immunization, DNA vaccines, mucin and heat shock protein-based vaccines, oncogenes and viral vectors.

Conclusion

Evidence is accumulating to suggest that immune responses may be generated against colorectal cancer using these approaches. While the concept of vaccination against this malignancy is essentially experimental, surgeons should be aware of current advances.
Experimental study of adhesion formation in open and laparoscopic fundoplication
Authors: Krähenbühl L , Schäfer M , Kuzinkovas V , Renzulli P , Baer H U , Büchler M W
Published: March 2003

Background

The extent of adhesion formation following both open and laparoscopic surgery remains unclear. This study aimed to evaluate the extent of postoperative adhesion formation after laparoscopic and open fundoplication in a rat model.

Methods

Fifty-two male Sprague–Dawley rats were randomized into four groups: laparoscopic fundoplication (n = 20), open fundoplication (n = 20), laparoscopy (n = 6) and laparotomy (n = 6). Blood as well as intraperitoneal fluid was sampled for tumour necrosis factor (TNF)α measurement by enzyme-linked immunosorbent assay. All the rats were killed 3 weeks after operation, and adhesion formation was evaluated using a standardized scoring system.

Results

There were no intergroup differences in body-weight gain after surgery. The overall mortality rate was 19 per cent and death was observed only in the fundoplication groups. Animals that had open fundoplication developed significantly more adhesions than those that underwent laparoscopic fundoplication (34 versus 21). Laparoscopic surgery induced predominantly parietal adhesions, whereas open surgery was more associated with visceral adhesions. The adhesions observed in the laparoscopic groups were significant thinner than those after open surgery and the tenacity of adhesions was decreased in laparoscopic compared with open surgery. The peak plasma level of TNF-α was reached during laparoscopic fundoplication, whereas the peak level was observed 3 h after open fundoplication. Intraperitoneal TNF-α levels showed no significant differences at 3 h.

Conclusion

These findings indicate that laparoscopic fundoplication in rats leads to less severe adhesions of a different type (parietal) compared with those seen in the open controls.
Soave's procedure: the final sphincter-saving solution for iatrogenic rectal lesions
Authors: Faucheron J L , Rosso R , Tiret E , Keli E , Nugent K P , Frileux P , Parc R
Published: March 2003

Background

Restoring intestinal continuity in the presence of radiation-induced rectal lesions and following low colorectal anastomotic complications or low Hartmann's procedure may be fraught with difficulties. Soave's procedure avoids potentially hazardous perirectal dissection. This study examined the morbidity and mortality as well as functional results.

Methods

Between January 1978 and July 1994 30 consecutive patients underwent Soave's operation as a final attempt to restore coloanal continuity. The pathology was radiation-induced lesions in 15 patients, low colorectal anastomotic complications in nine and low Hartmann's reconstruction in six.

Results

Mean length of follow-up was 4·2 (range 1–16) years. There was no operative mortality. Early complications included one patient with postoperative haemorrhage, one with small bowel obstruction and four with pelvic or perineal sepsis. Late complications included four incisional hernias, three anastomotic strictures which were treated by dilatation, and one recurrent ischaemic colitis. Continence was normal in 19 of 23 evaluable patients.

Conclusion

Soave's procedure obviates the need for extensive pelvic dissection, providing good technical and functional results in both the long and short term.
Prospective analysis of quality of life in patients following infrainguinal reconstruction for chronic critical ischaemia
Authors: Chetter I C , Spark J I , Scott D J A , Kent P J , Berridge D C , Kester R C
Published: March 2003

Background

The aims of this prospective study were to analyse the health-related quality of life (QOL) changes associated with infrainguinal arterial reconstruction for chronic critical limb ischaemia (CLI) and to assess the impact of graft patency and limb salvage.

Methods

Fifty-five consecutive patients, 28 women and 27 men of median age 71 (range 41–86) years, undergoing infrainguinal arterial reconstruction for CLI, consented to participate in the study. QOL was assessed using the Short Form 36 (SF36) health survey questionnaire, which was completed before and at 1, 3, 6 and 12 months following surgery. Graft patency was assessed by duplex imaging at the same postoperative intervals.

Results

CLI severely impaired QOL. Cumulative graft patency at 1, 3, 6 and 12 months after surgery was 82, 78, 76 and 64 per cent respectively. Reconstruction resulted in significant improvements in the SF36 domains Physical Functioning, Pain, Vitality and Social Functioning (P < 0·01). With a patent graft these improvements began soon after surgery and were maintained for the 12 months studied. Following irredeemable graft occlusion, patients who had secondary amputation also described some QOL improvements.

Conclusion

A patent graft following infrainguinal arterial reconstruction for critical ischaemia results in an immediate and lasting improvement in health-related QOL.
Cytogenetics and the surgeon: an invaluable tool in diagnosis, prognosis and counselling of patients with solid tumours
Authors: Humphrey G M E , Squire R , Lansdown M , Markham A , Maclennan K
Published: March 2003

Background

Cytogenetic studies have become an important part of tumour characterization. In a minority of tumours cytogenetic and/or molecular studies may be of help for diagnosis, selection of treatment protocols and predicting outcome.

Methods

This article reviews the literature on solid tumour translocations and established family cancer syndromes. In addition, the potential importance of genetics in management of patients with breast, ovarian and pancreatic carcinoma is reviewed.

Results and conclusion

Cytogenetic analysis of tumours may help confirm the diagnosis when conventional histology demonstrates no evidence of differentiation along a particular tissue pathway. For patients with well defined cancer syndromes, cytogenetic and molecular analysis offers the prospect of screening to reduce the risk of malignant disease. For many malignancies the underlying genetic anomalies are gradually being elucidated. Further studies designed to demonstrate the significance of these findings can only be undertaken if tumour material is collected and stored in optimal conditions for cytogenetic and/or molecular biological studies.
Abscess after appendicectomy in children: the role of conservative management
Authors: Okoye B O , Rampersad B , Marantos A , Abernethy L J , Losty P D , Lloyd D A
Published: March 2003

Background

Intra-abdominal abscess remains a significant cause of morbidity following appendicectomy. In children, little emphasis has been placed on the non-invasive management of this complication using antibiotic therapy alone. This study reviews the experience of a paediatric surgical department in managing abscess arising after appendicectomy.

Methods

Hospital records of all children undergoing appendicectomy between January 1992 and January 1997 were reviewed retrospectively.

Results

Some 1024 children underwent appendicectomy over a 5-year period. Twenty three patients (2·2 per cent) developed abscesses after appendicectomy. Non-operative management with intravenous or oral antibiotics alone was successful in 21 patients, with complete clinical and radiological resolution of the abscess. Drainage of the septic collection was performed in only two patients: by laparotomy (n = 1) and by the transrectal route (n = 1).

Conclusion

Antibiotic therapy alone is an efficacious and safe first-line treatment modality in children who develop this complication. Drainage of an abscess developing after appendicectomy is rarely necessary in children.
Surgical treatment of 32 patients with peripheral intrahepatic cholangiocarcinoma
Authors: Harrison L E , Fong Y , Klimstra D S , Zee S Y , Blumgart L H
Published: March 2003

Background

Peripheral intrahepatic cholangiocarcinoma (PIC) is an intrahepatic primary liver neoplasm which is clinicopathologically distinct from hepatocellular carcinoma and major duct cholangiocarcinoma. The clinical outcome after resection of these rare tumours is not well documented.

Methods

Review of the hepatic database and tumour registry at Memorial Sloan-Kettering Cancer Center identified 32 cases of PIC resected for cure over a 23-year period. Intrahepatic cholangiocarcinomas with major bile duct involvement were excluded from this analysis. Demographics, pathological features, biochemical markers, operative results and survival were analysed.

Results

The majority of patients presented with abdominal pain (n = 19). Only two patients had pathological evidence of hepatic cirrhosis. Serum marker levels included α-fetoprotein (AFP; median 3·7 (range 0–225) ng/ml) and carcinoembryonic antigen (CEA; median 1·6 (range 0–30) ng/ml). Type of hepatic resection included: wedge (n = 2), lobectomy (n = 14) and extended lobectomy (n = 16). There was one postoperative death. Median follow-up time was 27 months. Median survival was 59 months with an actuarial 5-year survival of 42 per cent. Vascular invasion and intrahepatic satellite lesions were predictors of worse survival (P < 0·05).

Conclusion

PIC is a rare hepatic primary tumour, which usually presents in non-cirrhotic livers with a normal serum AFP and CEA level. In selected patients, complete surgical resection can be performed safely and is associated with long-term survival.
Perigastric lymph node status as a prognostic indicator in patients with gastric cancer
Authors: Adachi Y , Suematsu T , Shiraishi N , Tanimura H , Morimoto A , Kitano S
Published: March 2003

Background

The extent of lymph node dissection and histological examination of dissected lymph nodes varies among countries, which leads to the erroneous nodal stage and different surgical results in gastric cancer (stage migration, ‘Will Rogers effect’). The aim of this study was to clarify the prognostic significance of the number of positive perigastric lymph nodes, which could be evaluated simply after D1 gastrectomy.

Methods

A consecutive series of 106 patients with histologically node-positive gastric cancer treated by radical gastrectomy and lymph node dissection (D2 or D3) was studied. The number of metastatic perigastric nodes (level I, nos 1–6) was examined, and its influence on the survival of patients was analysed.

Results

The overall 5-year survival rate was 50·9 per cent; the 5-year survival rate was significantly decreased when positive perigastric nodes exceeded six (62 per cent for one to six nodes versus 23 per cent for seven or more nodes, P < 0·001). Tumours having one to six positive perigastric nodes compared with those having seven or more positive perigastric nodes were more likely to have a size less than 4 cm (29 per cent versus one of 30, P < 0·001), grossly localized type (45 per cent versus seven of 30, P = 0·042), absence of serosal invasion (32 per cent versus none of 30, P = 0·002) and metastasis limited to the perigastric lymph nodes (70 per cent versus seven of 30, P < 0·001).

Conclusion

The results indicate that the number of positive perigastric nodes correlates with tumour progression and patient survival. This parameter is a simple and useful prognostic indicator for node-positive gastric cancer, and is available not only for D2 and D3 gastrectomy but also for D1 gastrectomy.
Predischarge duplex imaging of infrainguinal vein grafts does not predict the development of stenoses
Authors: Olojugba D H , Varty K , Hartsthorne T , Naylor A R , Bell P R F , London N J M
Published: March 2003

Background

The aim of this study was to determine whether predischarge duplex imaging of an infrainguinal vein graft could predict the subsequent development of graft stenosis.

Methods

Patients with infrainguinal vein grafts underwent a duplex scan of the entire graft before discharge from hospital. Grafts were classified as abnormal or normal based on the presence or absence of flow abnormalities (peak velocity ratio 1·5 or greater). All grafts were re-examined 1 month after surgery, at 3-monthly intervals for the first year and then every 6 months thereafter. A significant stenosis requiring correction was defined by a duplex-derived peak systolic velocity ratio of 3·0 or more. The relationship between the predischarge scan and subsequent development of stenosis was examined.

Results

Forty-four grafts were recruited. Two occluded soon after a normal predischarge scan and were excluded from subsequent analysis. Predischarge abnormalities were found in 16 grafts. The abnormality in one graft required immediate correction. A further four grafts subsequently developed significant stenoses and required angioplasty. Of the 26 grafts with no predischarge abnormalities, 11 developed significant stenoses and underwent angioplasty. Abnormal predischarge duplex scans had a sensitivity and specificity of 31 and 58 per cent respectively for the development of stenoses. The positive and negative predictive values were 31 and 58 per cent respectively.

Conclusion

Predischarge duplex imaging cannot be used to predict the development of stenoses in infrainguinal vein grafts.
Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma
Authors: Lam C-M , Lo C-M , Yuen W-K , Liu C-L , Fan S-T
Published: March 2003

Background

Pulmonary metastasis is the commonest site of extrahepatic spread from hepatocellular carcinoma (HCC). The aim of the present study was to evaluate the efficacy of surgical management in patients with solitary pulmonary metastases from HCC.

Methods

This was a retrospective study of patients with HCC admitted for hepatectomy from July 1972 to June 1995. The records of patients who had a pulmonary resection for histologically proven pulmonary recurrence after curative hepatectomy were selected for analysis.

Results

In the study interval, 380 patients with HCC underwent hepatectomy. Some 48 patients (12·6 per cent) developed pulmonary metastases documented pathologically or radiologically. Nine (seven men and two women) were suitable for curative pulmonary resection. The median disease-free survival between hepatectomy and appearance of the lung metastasis was 21 months. The median survival after pulmonary resection was 42 months, and the 1-, 2- and 5-year survival rates were 100, 78 and 67 per cent respectively.

Conclusion

Pulmonary resection for metastases from HCC resulted in long-term survival in these highly selected patients.
Preservation of pectoralis minor in axillary clearance for breast cancer
Authors: Markandoo P , Smith P , Chaudary M A , Fentiman I S
Published: March 2003

Background

There has been a gradual shift away from radical surgery towards conservation treatment for breast cancer. The pectoralis minor muscle is increasingly preserved in women undergoing axillary clearance as part of either breast conservation or mastectomy.

Methods

A retrospective study was conducted to determine the axillary node count in 578 patients who underwent axillary clearance, 276 with removal of pectoralis minor and 302 who had the muscle preserved.

Results

The mean number of nodes excised in the group who had pectoralis minor excised was 25·5 (range 8–50) compared with 24·5 (range 9–68) in the preservation group.

Conclusion

For the majority of patients with operable breast cancer, retention of the pectoralis minor muscle is not associated with understaging or undertreatment of the axilla.
New model of renal warm ischaemia–reperfusion injury for comparative functional, morphological and pathophysiological studies
Authors: Weight S C , Furness P N , Nicholson M L
Published: March 2003

Background

Renal warm ischaemia–reperfusion injury is pertinent to vascular and transplant surgery. While established models provide functional and morphological data the authors wanted to be able to correlate this with the underlying pathophysiology at any chosen time point, thus allowing future interventional effects on reperfusion injury to be evaluated.

Methods

In a rodent model bilateral renal warm ischaemia (15–60 min) and then reperfusion (20 or 80 min) before nephrectomy allowed for analysis of early reperfusion pathophysiology. The remaining kidney provided functional data (glomerular filtration rate (GFR)) at days 2 and 7 before nephrectomy for late analysis and morphology using a new grading system.

Results

Acceptable survival rate (ten of 12 animals) was seen with up to 45 min of warm ischaemia. Renal function was impaired at day 2 following 30–60 min of warm ischaemia (P < 0·01) and day 7 in the 45- and 60-min groups (P < 0·05 and P < 0·01 respectively). Strong correlation existed between duration of ischaemia and GFR at day 2 (r2 = 0·88) and day 7 (r2 = 0·95). Histological damage in the cortical tubules was evident in the 45- and 60-min groups (P < 0·01).

Conclusion

This new model allowed comparative functional, morphological and pathophysiological studies while minimizing the number of animals required. Overall 45 min of warm ischaemia gave significant, recoverable injury and is recommended for investigating renal reperfusion injury.
Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair
Authors: Poen A C , Felt-Bersma R J F , Strijers R L M , Dekker G A , Cuesta M A , Meuwissen S G M
Published: March 2003

Background

This study was designed to investigate the long-term clinical and anorectal functional results after primary repair of a third-degree obstetrical perineal rupture.

Methods

One hundred and fifty-six consecutive women who had a primary repair of a third-degree perineal rupture were sent a questionnaire and asked to undergo anorectal function testing (anal manometry, anorectal sensitivity, anal endosonography and pudendal nerve terminal motor latency (PNTML))

Results

Some 117 women (75 per cent) responded. Anal incontinence was present in 47 women (40 per cent); however, in most cases only mild symptoms were present. In 40 women additional anorectal function tests were performed and compared with findings in normal controls. Mean(s.d.) maximum squeeze pressure (31(15) versus 63(17) mmHg, P<0·001) was decreased and first sensation to filling of the rectum (88(47) versus 66(33) ml, P = 0·03) and anal mucosal electrosensitivity (4·7(1·7) versus 2·5(0·8) mA, P = 0·003) were increased compared with values in normal controls. In 35 women (88 per cent) a sphincter defect was found with anal endosonography. Factors related to anal incontinence were the presence of a combined anal sphincter defect (relative risk (RR) 1·7 (95 per cent confidence interval (c.i.) 1·1–2·8)) or subsequent vaginal delivery (RR 1·6 (95 per cent c.i. 1·1–2·5)).

Conclusion

Anal incontinence prevails in 40 per cent of women 5 years after primary repair of a third-degree perineal rupture. The presence of a combined sphincter defect or subsequent vaginal delivery increase the risk of anal incontinence.
Tissue markers as predictors of postoperative adhesions
Authors: Ivarsson M I , Bergström M , Eriksson E , Risberg B , Holmdahl I
Published: March 2003

Background

Postoperative adhesion formation has been associated with a decreased capacity to degrade intra-abdominally deposited fibrin. Adhesions, once lysed, have a high propensity for reformation. This study tested the hypothesis that patients with a high propensity for adhesion formation as well as adhesion tissue had a reduced fibrinolytic capacity.

Methods

Peritoneal biopsies were taken during abdominal surgery from 21 patients who had previously undergone operation; previously formed adhesion tissue was sampled from ten of these patients. Adhesion formation was scored. The fibrinolytic capacity of peritoneum was determined in tissue extracts.

Results

At the time of opening of the abdominal cavity, levels of plasminogen activator inhibitor (PAI) type 1 (P = 0·009) and tissue-type plasminogen activator (tPA)/PAI complex (P = 0·008) were increased in peritoneal samples from patients with severe adhesions compared with those in samples from patients with less severe adhesions. Adhesion tissue similarly had reduced fibrinolytic capacity as judged by a decrease in tPA activity (P = 0·005) and an increase in PAI-1 level (P = 0·01), reflected in an increased level of tPA/PAI complex (P = 0·008) compared with unaffected peritoneum.

Conclusion

These observations demonstrate reduced fibrinolytic capacity in peritoneal tissue in patients with a greater propensity for development of adhesions and likewise in adhesion tissue. This suggests that components of the fibrinolytic system may be used as markers of an increased risk of adhesion development.
Preoperative duplex imaging is required before all operations for primary varicose veins
Authors: Mercer K G , Scott D J A , Berridge D C
Published: March 2003

Background

Physical examination is unreliable in the detection of sources of reflux in varicose veins. Hand-held Doppler (HHD) ultrasonography has been recommended as an accurate adjunct to physical examination. The aim of this study was to evaluate the accuracy of HHD imaging in comparison with duplex ultrasonography.

Methods

Eighty-nine legs in 61 patients with primary varicose veins were examined with an HHD probe to detect reflux at the saphenofemoral junction (SFJ), the saphenopopliteal junction (SPJ) and in thigh perforators (TPs). Patients then underwent duplex imaging and the results of the tests were compared.

Results

The sensitivity of the HHD technique was 73 per cent at the SFJ, 77 per cent at the SPJ and 51 per cent for TPs. In primary varicose veins the surgery planned using HHD imaging alone would have left residual sites of reflux in 24 per cent.

Conclusion

Examination with HHD ultrasonography is not sufficiently accurate to plan varicose vein surgery. Duplex imaging is recommended before all operations for primary varicose veins.