bluuebunny/crossref_metadata_2025 huggingface dataset:
Classification of the sequelae of bowel resection for Crohn's disease
Authors: Cosnes J , De Parades V , Carbonnel F , Beaugerie L , Ngo Y , Gendre J P , Sezeur A , Gallot D , Malafosse M , Le Quintrec Y
Published: March 2007

A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0·64 and 0·90, and 0·60 and 0·99 respectively in the retrospective series; values were 0·80 and 0·71, and 0·25 and 1·00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.
Laparoscopic surgery in patients with human immunodeficiency virus
Authors: Tanner A G , Hartley J E , Darzi A , Rosin R D , Monson J R T
Published: March 2007

Fifteen patients with acquired immune deficiency syndrome (AIDS), and one who tested positive for human immunodeficiency virus but had no AIDS-defining diagnosis, underwent a range of laparoscopic procedures between March 1991 and March 1993. Seven cholecystectomies and one cholecystojejunostomy were performed. Three patients underwent diagnostic laparoscopy after presenting with abdominal emergencies. Two further patients had laparoscopic adhesiolysis and one appendicectomy. A further patient underwent laparoscopically assisted end colostomy and another an inguinal hernia repair, both performed electively. Two patients died in the postoperative period. There was little postoperative morbidity. Six patients died 3–18 months after surgery from progressive AIDS. This early experience suggests that laparoscopic surgery is well tolerated in these patients.
Survival after surgery for cancer of the gallbladder
Authors: Ouchi K , Suzuki M , Tominaga T , Saijo S , Matsuno S
Published: March 2007

The records of 45 patients with carcinoma of the gallbladder who had undergone surgical resection at least 5 years previously were reviewed retrospectively to determine which factors influence long-term survival. Seventeen patients survived at least 5 years and 23 died from recurrence (five patients were excluded from analysis). Of the 17 long-term survivors 15 had tumours superficial to the subserosa that showed a non-infiltrative growth pattern. Those alive at 5 years were more likely than short-term survivors to have tumours that were papillary (P<0·05) or well differentiated (P<0·01) adenocarcinoma. Venous, lymphatic and perineural invasion was more common in short- than in long-term survivors (87 versus 29 per cent, P<0·001). Patients with tumours limited to the muscularis and those with non-infiltrative subserosal involvement are likely to have better survival and may have a chance of cure after extended cholecystectomy.
Virtual reality and laparoscopic surgery
Authors: Coleman J , Nduka C C , Darzi A
Published: March 2007

The nature of laparoscopic surgery makes it likely to benefit from current and future developments in virtual reality and telepresence technology. High-definition screens, three-dimensional sensory feedback and remote dextrous manipulation will be the next major developments in laparoscopic surgery. Simulators may be used in surgical training and in the evaluation of surgical capability.
Familial adenomatous polyposis
Authors: Campbell W J , Spence R A J , Parks T G
Published: March 2007

Familial adenomatous polyposis (FAP) is an autosomal dominant condition resulting in the development of more than 100 adenomatous polyps in the large bowel. In addition, a number of extracolonic manifestations of the condition may occur. Recently, increasing knowledge relating to the extracolonic abnormalities, and localization and sequencing of the gene for FAP, have had important implications for screening and long-term follow-up of those affected. In this review the natural history of the disease and the extracolonic manifestations associated with it are considered. Surgical management and advances in understanding at a molecular level are discussed, as well as the problems relating to screening for FAP and the implications of the new knowledge.
Proliferating cell nuclear antigen in the assessment of Barrett's mucosa
Authors: Gillen P , McDermott M , Grehan D , Hourihane D O'B , Hennessy T P J
Published: March 2007

Proliferating cell nuclear antigen (PCNA) expression was assessed in oesophageal epithelium from 70 patients with Barrett's oesophagus. PCNA counts were expressed in the form of a PCNA index. There were 24 patients with dysplastic epithelium, nine with regenerative atypia, 18 with benign histology and 19 with adenocarcinoma arising in Barrett's epithelium. The PCNA index of malignant tissue was significantly different from that of benign (P < 0.001) and dysplastic (P < 0.05) specimens. PCNA indices in histologically normal Barrett's epithelium adjacent to a tumour were significantly different (P < 0.001) from those in normal Barrett's epithelium with no adjacent tumour. These findings support the use of PCNA measurement in the assessment of Barrett's epithelium.
Groin dissection in malignant melanoma
Authors: Karakousis C P , Driscoll D L
Published: March 2007

A total of 205 patients who underwent groin dissection for malignant melanoma were reviewed to document complications and survival rates. Wound complications included skin-edge necrosis in 8 per cent, wound infection in 16 per cent, lymphocele in 5 per cent and lymphorrhoea in 11 per cent. Lymphoedema of the operated leg below the knee was noted in 40 per cent, but all patients had localized oedema of the anteromedial thigh. The 5-year overall and disease-free survival rates were 43 and 35 per cent respectively when only the inguinal nodes were involved; they were 34 and 21 per cent with involvement of both the inguinal and deep nodes. The 10-year survival rate for these two groups was 39 and 25 per cent respectively, which suggests that a thorough, complete dissection of the deep nodes is worth-while when the inguinal nodes are palpably positive.
Wheat fibre, lactulose and rectal mucosal proliferation in individuals with a family history of colorectal cancer
Authors: Rooney P S , Hunt L M , Clarke P A , Gifford K -A , Hardcastle J D , Armitage N C
Published: March 2007

In a single-blind study 38 individuals at increased risk of developing colorectal cancer because of a family history of the disease were randomized to take 10.5 g wheat fibre (Trifyba) or 60 ml lactulose daily for 12 weeks. Rectal biopsies were taken before and after treatment and rectal mucosal proliferation was measured by the crypt cell production rate (CCPR). The mean(s.d.) CCPR was significantly lower in those taking wheat fibre after 12 weeks (7.2(3.4) crypt cells per crypt per h) compared both with values obtained before treatment with wheat fibre (10.2(5.1) crypt cells per crypt per h; P=0.02) and after treatment with lactulose (9.4(3.8) crypt cells per crypt per h; P=0.05). Proliferation in the lactulose group was not significantly different at 12 weeks compared with the value obtained before treatment. This study confirms an anti-proliferative effect of wheat fibre in a group of high-risk individuals.
Inflammatory mediators in acute pancreatitis
Authors: Formela L J , Galloway S W , Kingsnorth A N
Published: March 2007

The cellular events leading to acute pancreatitis are not well defined and the mechanism by which known aetiological factors initiate the disease process remains to be established. Inflammatory mediators have recently been implicated as potential early markers of disease severity and may help elucidate the pathophysiology of the disease. Oxidative stress is emerging as a common effector of the acinar cell injury in experimental acute pancreatitis and clinical findings indicate that neutrophil activation is a significant early event. In common with neutrophil-mediated tissue damage in states of tissue hypoperfusion, acute pancreatitis shows many features of an ischaemia-reperfusion injury. Increased levels of phospholipase A2 have been demonstrated; this enzyme induces synthesis of prostaglandins and platelet-activating factor, a potent inflammatory mediator. New therapeutic approaches to the complications of acute pancreatitis may be through manipulation of such mediators of inflammation.
Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: Indications and results
Authors: Mouroux J , Riquet M , Padovani B , Debesse B , Richelme H
Published: March 2007

The records of 97 patients with thoracic complications of human immunodeficiency virus (HIV) were analysed to determine the reasons for surgery and the results of these procedures. Of the patients, 79 underwent surgery; the remaining 18 were managed non-surgically. A total of 36 procedures were performed for diagnostic purposes: mediastinoscopy (21 patients), lung biopsy (15 patients). Therapeutic procedures were performed in 61 patients to treat pneumothorax (23 cases) or empyema thoracis (18 cases), for resection of pulmonary lesions (13 cases), and to treat various other pathologies (seven cases). Ten patients died in hospital: seven after surgery and three after a non-surgical procedure. Eleven patients developed a postoperative complication. Hospital mortality varied from 0 per cent to 20 per cent, depending on the procedure. The mortality rate appears to be linked to the stage of HIV infection at the time of therapy rather than to the type of procedure performed. Surgical decisions must take into account the patient's Centers for Disease Control stage and physiological status, therapeutic possibilities, and the prognosis of the pathology requiring treatment.
Predictive value of colour Doppler ultrasonography in detecting failure of vascular access grafts
Authors: Köksoy C , Kuzu A , Erden Ǐ , Türkçapar A G , Düzgün Ǐ , Anadol E
Published: March 2007

The predictive role of colour Doppler ultrasonography in determining the initial success and long-term patency of polytetrafluoroethylene (PTFE) vascular access grafts for haemodialysis was investigated. Two groups of patients were studied. The upper extremities of 21 patients in the control group were assessed by clinical examination only; those of 17 in a second group (Doppler group) were also assessed by ultrasonography before and after operation. Straight PTFE vascular access grafts were used between the brachial artery and axillary vein in all patients. The median preoperative brachial artery flow rate was significantly lower in patients who later developed graft thrombosis (66 versus 87 ml/min, P <0·01), as was the median postoperative graft flow rate (480 versus 800 ml/min, P <0·001). Routine preoperative and postoperative colour Doppler ultrasonography is recommended for every patient in whom a vascular access graft is planned.
Diagnostic difficulties in patients with a ruptured bladder
Authors: Mokoena T , Naidu A G
Published: March 2007

Isolated bladder rupture has an insidious presentation which results in delayed diagnosis and management. Forty-four patients, of mean age 33·3 years, were seen over a period of 7 years. There was a history of trauma in 33 patients, although this was minor in 20. Alcohol intoxication, head injury or paraplegia could have led to lack of sensation of the distending and subsequently injured bladder in 18 patients. The mean delay between an identifiable incident or presentation and diagnosis was 5·4 days. The mean admission or preoperative levels of blood urea and creatinine were raised to 19·6 mmol/1 and 362 μmol/1 respectively in those with a delayed diagnosis. The diagnosis was made by voiding cystourethrography in 36 patients and by laparotomy in eight. When blood urea and creatinine concentrations are increased in a patient with an ill-defined abdominal ailment and a history of trauma or drunkenness, ruptured bladder should be considered.
Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer
Authors: Forouhi P , Dixon J M , Leonard R C F , Chetty U
Published: March 2007

The influence of primary systemic therapy in treating operable breast cancer on postmastectomy morbidity rates was investigated. The contribution of other risk factors was assessed by multiple logistic regression. Seventy-nine eligible patients were randomly allocated, 39 to undergo immediate modified radical mastectomy, and 40 to receive initial cytotoxic or endocrine treatment followed by mastectomy. Postoperative wound seroma, infection and necrosis were recorded prospectively. Fourteen minor and six major complications occurred in 17 patients treated conventionally, while 14 patients developed 11 minor and six major complications after systemic therapy (P >0·4). Median hospital stay was 8 days for both groups. Age, smoking, immediate breast reconstruction and the type of primary systemic treatment given were not independent predictors of complication risk. Obesity emerged as a significant risk factor for postmastectomy complications (P = 0·015). Primary systemic therapy does not increase the rate of morbidity after mastectomy.
Modulation of the cytokine and acute-phase response to major surgery by recombinant interleukin-2
Authors: Deehan D J , Heys S D , Simpson W , Broom J , McMillan D N , Eremin O
Published: March 2007

Major surgery suppresses host immune reactivity through alterations in monocyte and T cell-derived cytokine, eicosanoid and acute-phase protein release. Recombinant interleukin (IL) 2 augments T lymphocyte and monocyte activity in vitro. Eighteen patients, with localized colorectal cancer, were randomized to receive either recombinant IL-2 or placebo for 3 days by subcutaneous injection before surgery. Serum levels of IL-1β, IL-6, tumour necrosis factor α, soluble IL-2 receptor, C-reactive protein (CRP) and albumin were measured, and T lymphocyte surface expression of HLA-DR and CD25 and neutrophil phagocytosis were determined, before and for 21 days after surgery. Significant augmentation of IL-6, CRP and soluble IL-2 receptor production, enhanced expression of activation markers and increased neutrophil activity were found. Recombinant IL-2 may have a role in ameliorating immunosuppression found after major surgery.
Gastric motility following oesophagectomy
Authors: Walsh T N , Caldwell M T P , Fallon C , McGeown G , Kidney D , Freyne P , Byrne P J , Hennessy T P J
Published: March 2007

The motility of the vagally denervated transposed stomach after oesophagectomy was examined by ambulatory gastric manometry and videofluoroscopy. Two groups of subjects were studied. Group 1 comprised ten patients who had undergone oesophagectomy 6–12 months previously and group 2 consisted of six normal control subjects. Studies were performed on fasting and fed subjects, and following injection of erythromycin 8 mg/kg. No distinguishable manometric wave activity was seen in either group while fasting. Feeding generated a measurable wave pattern in the patient group only. A significant increase in the mean(s.e.m.) distal wave amplitude was identified after infusion of erythromycin in both patients (34·0(15·1) versus 12·2(3·1) mmHg, P < 0·05) and controls (15·1(3·4) versus 5·0(0·0) mmHg, P = 0·05). The response to erythromycin was more rapid in patients than in controls (mean(s.e.m.) 113(16) versus 377(133) s, P <0·05) and the effect persisted for longer (more than 1 h) in those who had undergone oesophagectomy. Videofluoroscopy confirmed purposeful motility in both the normal and vagally denervated stomach. It is concluded that the transposed stomach is a dynamic conduit. Enhancement of motility was greatest in the denervated stomach, indicative of denervation supersensitivity.
Comparison of conventional Lewis-Tanner two-stage oesophagectomy with the synchronous two-team approach
Authors: Hayes N , Shaw I H , Raimes S A , Griffin S M
Published: March 2007

Twenty-seven patients with oesophageal carcinoma had subtotal oesophagectomy by the Lewis-Tanner operation (group 1, n = 14) or a synchronous modification (group 2, n = 13). Synchronous operations were completed more quickly (230 versus 305 min, P <0·01), but with more time spent under single-lung anaesthesia (160 versus 120 min, P <0·01) and a greater fall in systolic blood pressure during hiatal manipulation (60 versus 30mmHg, P <0·01). Operative blood loss was not significantly greater in group 2, but the total volume of blood transfused in the perioperative period was greater in this group (5 versus 3 units, P <0·01). Four patients in group 1 suffered significant postoperative complications, compared with seven in group 2; three postoperative deaths occurred in group 2. This study suggests that the synchronous two-team oesophagectomy produces a higher incidence of complications than the conventional operation. Continued use of the Lewis-Tanner two-stage oesophagectomy is recommended for patients with carcinoma of the oesophagus.
Early oesophageal cancer: Results of a European multicentre survey
Authors: Bonavina L
Published: March 2007

Early oesophageal cancer has been extensively studied in Far-Eastern countries, where its prevalence is high. A multicentre survey was conducted within the Groupe Européen pour l'Etude des Maladies de l'Oesophage to analyse results of surgical treatment in patients with disease staged as pTis-T1 N0 M0 according to the tumour node metastasis classification. Of 9743 patients with squamous cell oesophageal carcinoma observed since 1980, 4663 underwent resection; 253 (5·4 per cent) of these fulfilled the criteria for inclusion in the study. The overall mortality rate was 9·1 percent (23 patients), and was higher after transthoracic than transhiatal oesophagectomy (10·7 versus 6 per cent, P not significant). Pathological examination showed an intraepithelial tumour in 46 patients (18·2 percent), intramucosal carcinoma in 64 (25·3 percent) and a submucosal lesion in 143 (56·5 percent). The overall 5-year survival rate for patients with intraepithelial, intramucosal and submucosal tumours was 92·8, 72·8 and 44·3 percent respectively. The 5-year survival rate was higher after transthoracic than transhiatal oesophagectomy (66 versus 52 percent). No survival advantage was observed after either operation in patients with mucosal tumours. Of 21 patients with recurrent disease, 20 had a submucosal lesion. The 5-year survival rate in patients with submucosal tumour was higher after transthoracic than transhiatal oesophagectomy (54·2 versus 25·5 per cent).
Gastric carcinoma in patients over 70 years of age
Authors: Maehara Y , Oshiro T , Oiwa H , Oda S , Baba H , Akazawa K , Sugimachi K
Published: March 2007

The clinicopathological features and prognosis of gastric cancer in 344 patients aged 70 years or older who underwent gastrectomy between 1965 and 1990 were determined. Over the years the mean size of the tumour decreased, differentiated tumour tissue was more common, depth of penetration was less prominent, lymphatic and vascular involvement was less frequent, and the rate of lymph node metastasis and peritoneal dissemination decreased. Extensive lymph node dissection was more frequently carried out and the rate of curative resection rose. Survival rates improved with early detection of gastric cancer and there was no increase in operative morbidity and mortality rates. As age alone is not a contraindication to surgery for patients with gastric carcinoma, early detection of the lesion and surgical treatment are expected to increase the survival of elderly patients with this malignancy.
Intraoperative laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia
Authors: Liu C , Chin T , Jan S-E , Wei C
Published: March 2007

The contralateral internal ring of 96 children was examined laparoscopically during unilateral hernia repair to minimize the chance of development of contralateral hernia. Laparoscopy was performed through the hernia sac before ligation. Of 29 patients with positive laparoscopic findings, 28 had a patent processus vaginalis as confirmed by simultaneous contralateral exploration and there was one false positive. Patency of the contralateral processus vaginalis was found in 28 (29 per cent) of the 96 patients. Children under 2 years of age had a significantly higher incidence of patent contralateral processus vaginalis than older patients. The only complication of the procedure was wound infection in two patients. This is a simple, safe and accurate procedure to select children for contralateral surgical exploration.
Restoration of continuity following pancreaticoduodenectomy
Authors: Madiba T E , Thomson S R
Published: March 2007

Current controversies surrounding restoration of gastrointestinal continuity after pancreaticoduodenectomy are reviewed. The optimum method of reconstruction following this procedure remains debatable, particularly with regard to the pancreatic anastomosis. Pylorus-preserving pancreaticoduodenectomy is increasing in popularity. Pancreaticogastrostomy is associated with at least as low a morbidity rate as pancreaticojejunostomy and is a safe alternative.
Pelvic floor physiology in women with faecal incontinence and urinary symptoms
Authors: Thorpe A C , Roberts J P , Williams N S , Blandy J P , Badenoch D F
Published: March 2007

Anorectal manometry, balloon proctometrography, measurement of anorectal angles and videourodynamics were used to investigate 45 asymptomatic women and 13 with faecal incontinence and urinary symptoms, nine of whom also had stress urinary incontinence. The anorectal angle was measured and videourodynamics performed on 17 constipated women with urinary symptoms. Mean (s.e.m.) values obtained with anorectal manometry were lower in women with faecal incontinence and urinary symptoms than in controls (maximum resting pressure 42·5(8·1) versus 82·5(9·3) cmH2O, P = 0·001; maximum attained pressure 80·5(13·7) versus 216·2(11·2) cmH2O, P = 0·001; maximum squeeze increment 35·3(7·5) versus 141·6(100) cmH2O, P = 0·001), indicating a weakened puborectalis and external anal sphincter. Mean(s.e.m.) anorectal angles at rest, squeeze and strain were all significantly greater in the doubly incontinent women than in those with constipation (114(3·8) versus 93(5·9)°, P = 0·01; 103(2·5) versus 78(3·5)°, P < 0·001; 120(2·9) versus 104(4·2)°, P = 0·01). Urinary incontinence was worse in the doubly incontinent than in the constipated women (eight of nine versus one of eight with grade 2a or higher, P = 0·002). These results suggest that doubly incontinent women have a significantly weakened pelvic floor and that this should be taken into account before any planned surgery for urinary incontinence.
Adjuvant intraoperative photodynamic therapy in experimental colorectal cancer
Authors: Abulafi A M , Dejode M , Allardice J T , Ansell J , Rogers J , Williams N S
Published: March 2007

A reliable animal model for quantitative assessment of local recurrence of colorectal cancer was developed using colo26 tumour in BALB/c mice. The effect of adjuvant intraoperative photodynamic therapy to potentially curative surgery on local recurrence was examined in four study and four control groups. Study groups received 15 mg kg Photofrin (a photosensitizing drug) 24 h before surgery. After ‘curative’ tumour excision, the tumour beds were illuminated with either 630 nm or 510 nm laser light each at 40 and 70 J/cm −2. Controls received surgery only, surgery and Photofrin only or surgery and either 630 nm or 510 nm light. The local recurrence rates at 70 days were 17–33 percent in the study groups compared with 83–100 per cent in the control groups (P < 0·001; log rank test). Photodynamic therapy is capable of reducing local recurrence following potentially curative excision of tumour in this model.
Endoscopic and external bowel changes and histopathology in patients with Crohn's disease
Authors: Smedh K , Olaison G , Franzén L , Sjodahl R
Published: March 2007

The relationships between intraoperative endoscopic findings, exterior bowel wall changes and transmural histopathology were investigated in 23 patients with Crohn's disease (24 resections). Villous atrophy and leucocyte infiltration of the epithelium, lamina propria and submucosa were common in intestine without endoscopic lesions. Minor endoscopic ulcers were associated with leucocyte infiltration, ulcers and pyloric metaplasia, and large endoscopic ulcers and stricture with severe transmural inflammation, fibrosis and fissures. In ileal Crohn's disease (19 resections), correlation was close between endoscopic stage and histopathology (rs = 0·77, P <0·0001), but an exterior lesion index showed worse correlations with endoscopy and histology (rs = 0·57 and rs = 0·59 respectively). The difference was attributable to patients with previous resection and/or fistula showing exterior lesions without concomitant histological or endoscopic abnormalities. Intraoperative surgical decisions should be guided by endoscopic observations rather than by assessment of exterior bowel wall changes.
Mesocaval interposition shunt with small-diameter polytetrafluoroethylene grafts in sclerotherapy failure
Authors: Paquet K-J , Lazar A , Koussouris P , Hotzel B , Gad H A , Kuhn R , Kalk J-F
Published: March 2007

Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh grade A disease and 26 grade B; all had a liver volume of 1000–2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.
Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: Long—term outcome
Authors: Dunlop P , Varty K , Hartshorne T , Bell P R F , Bolia A , London N J M
Published: March 2007

The aim of this prospective study was to examine the long-term outcome of infrainguinal vein graft stenosis managed by percutaneous transluminal angioplasty (PTA) as first-line treatment. Thirty-three infrainguinal vein graft stenoses detected by graft surveillance during a 44-month period were treated initially by PTA. The median (range) follow-up after angioplasty was 39 (18–56) months. Although 19 stenoses were successfully treated by a single PTA, 14 stenoses recurred at a median (range) interval of 8·5 (1–39) months. Restenosis occurred more frequently in the distal third of a graft (P = 0·002) compared with that in the proximal or mid-grafts, and restenosis was more common in in situ than reversed vein grafts (P = 0·03). It is concluded that infrainguinal vein graft stenoses were successfully treated by single PTA. There was, however, a high restenosis rate after angioplasty of stenosis in the distal third of a vein graft and, while approximately one third of such stenoses can be treated by a single PTA, the optimal management of recurrent stenosis requires further investigation.
Prospective study of intra-abdominal hypertension and renal function after laparotomy
Authors: Sugrue M , Buist M D , Hourihan F , Deane S , Bauman A , Hillman K
Published: March 2007

The value of postoperative monitoring of intra-abdominal pressure (IAP) in surgical patients has not been established. This study prospectively evaluated the occurrence of increased IAP and its association with renal impairment and outcome in surgical patients admitted to an intensive care unit. One hundred consecutive patients after laparotomy were studied, 88 of whom had complete IAP measurements. IAP was measured using an intravesical catheter and was considered increased when equal to 20 mmHg or above. Renal impairment was defined as a postoperative serum creatinine concentration of greater than 130 (μmol/1), or an increase in serum creatinine of greater than 100 μmol/1 within 72 h of surgery. The median (range) APACHE (Acute Physiology And Chronic Health Evaluation) II score of the patients was 13° (4–43). The incidence of raised IAP was 29 of 88 (33 per cent). Renal impairment was present in 29 of 88 (33 per cent), of whom 20 of 29 (69 per cent) had raised IAP (P <0·01). The odds ratios (95 per cent confidence interval) for the development of renal impairment and death in patients with increased IAP were 12·4 (3·8–41·7) and 11·2 (2·8–47·9) respectively. There is a clinically significant association between increased IAP and renal impairment in patients admitted to an intensive care unit after laparotomy.
Three-dimensional reconstruction of the biliary tract using spiral computed tomography
Authors: Kwon A-H , Uetsuji S , Yamada O , Inoue T , Kamiyama Y , Boku T
Published: March 2007

Spiral computed tomography (SCT) is a recently introduced technique which enables scanning of one large volume with no interscan intervals. Three-dimensional reconstruction using this technique is emerging as an effective means of identifying complex anatomical relationships. Ninety-two patients with cholecystolithiasis including ten with choledocholithiasis were investigated. All underwent SCT after oral and intravenous infusion cholangiography (IVC-SCT) and 22 were also examined by endoscopic retrograde cholangiography (ERC). IVC-SCT showed significantly more anatomical detail than conventional intravenous infusion cholangiography (IVC). The junction between the cystic duct and the common bile duct could be identified before surgery in 19 of 22 patients undergoing ERC, in 18 of 22 receiving IVC-SCT and in five of 22 undergoing IVC. Significant differences were noted between IVC-SCT, ERC and conventional IVC. Three-dimensional surface reconstruction of the biliary tract is useful in the evaluation of anatomical relationships between the cystic duct and the common bile duct (clearly seen in 86 per cent of cases). Three-dimensional reconstruction using SCT scanning is useful for anatomical assessment before laparoscopic cholecystectomy.
Resection of hepatocellular carcinoma with diaphragmatic invasion
Authors: Lau W Y , Leung K L , Leung T W T , Liew C T , Chan M , Li A K C
Published: March 2007

Fourteen consecutive patients with hepatocellular carcinoma (HCC) and diaphragmatic invasion found during operation and confirmed histopathologically were studied. They were treated by resection of the liver tumour en bloc with part of the diaphragm. Eight of the 14 patients had a diaphragmatic hump on chest radiography. Pre-operative ultrasonography, computed tomography and hepatic angiography were unable to diagnose diaphragmatic invasion in these patients. A control group of 14 closely matched patients were selected from 98 undergoing curative resection for HCC during the period of the study. No evidence of a diaphragmatic hump was found in the control patients (P < 0·001). There was no significant difference in survival, operative morbidity or mortality rates between the two groups. In patients with HCC situated in the dome of the liver, the presence of a diaphragmatic hump on chest radiography strongly suggests invasion of the diaphragm. There was no difference in outcome in patients with or without diaphragmatic invasion; the tumour should be resected if the patient is fit for operation.
Prospective trial comparing Lichtenstein with laparoscopic tension-free mesh repair of inguinal hernia
Authors: Wilson M S , Deans G T , Brough W A
Published: March 2007

A prospective study of 242 patients with inguinal hernia who underwent tension-free mesh repair by the laparoscopic transperitoneal (n = 121) or the open Lichtenstein (n = 121) technique was performed. There was no significant difference in operation time between the laparoscopic (median (range) 35 (20–90) min) and Lichtenstein (40 (20–90) min) procedures. Discharge within 24 h of operation was more common after laparoscopic surgery (89·3 per cent versus 48·7 per cent). Consequently, hospital stay was reduced with this approach (median (range) 1 (1–7) days versus 2 (1–10) days for patients who had a Lichtenstein repair). There was no significant difference in parenteral analgesia requirements or visual analogue pain scores between the two groups. Although use of oral analgesia in hospital was greater in patients who underwent Lichtenstein hernioplasty, this may reflect their longer stay. Rehabilitation to normal activity and return to work was shorter in patients receiving laparoscopic repair (median 7 and 10 days, respectively) than Lichtenstein repair (14 and 21 days) (P < 0·001). Initial results suggest that laparoscopic procedures may be associated with more rapid rehabilitation compared with that of open tension-free mesh surgery. Most patients with inguinal hernia undergoing tension-free mesh repair by either technique would be suitable for day-case surgery.
Port site metastases after laparoscopic colorectal surgery for cure of malignancy
Authors: Wexner S D , Cohen S M
Published: March 2007

Laparoscopic surgery is excellent for treating benign disease of the colon and rectum, and for palliative operations for malignancy. Its application for cure of colorectal malignancy, however, must be approached with caution. Port site recurrence of tumour is a particular, and increasingly recognized, drawback. This review discusses the evidence to date to support prospective randomized trials of laparoscopic colectomy for cure of carcinoma.
Neoplastic lesions of the appendix
Authors: Deans G T , Spence R A J
Published: March 2007

Neoplasms occur in 0–5 percent of appendices. Ultrasonography or computed tomography is beneficial, but preoperative detection is rare. At operation, the diagnosis is considered in under half of cases. Mucocele, localized pseudomyxoma peritonei, benign tumours and most appendiceal carcinoids are cured by appendicectomy alone. Right hemicolectomy is indicated for: (1) invasive adenocarcinoma; (2) tumours close to the caecum; (3) lesions larger than 2 cm; (4) mucin production; (5) invasion of the lymphatics, serosa or mesoappendix; and (6) cellular pleomorphism with a high mitotic rate. Tumours of 1–2 cm, small mucinous carcinoids, adenocarcinoma confined to the mucosa, and tumours in children may be treated by appendicectomy alone at the surgeon's discretion. The 5-year survival rate associated with classical carcinoid is more than 90 percent. The prognosis of mucinous carcinoid is intermediate between that of classical carcinoid and well differentiated adenocarcinoma. The prognosis of adenocarcinoma is determined by Dukes' stage and is similar, stage for stage, to that of colorectal carcinoma.
Island advancement flaps in the management of anal fissures
Authors: Nyam D C N K , Wilson R G , Stewart K J , Farouk R , Bartolo D C C
Published: March 2007

The classic high-pressure fissure responds well to lateral internal sphincterotomy. The management of recurrent fissures and those that occur in patients with weak sphincters is open to debate. An island advancement flap technique used in 21 patients is described with the above criteria. Preoperative median resting anal pressure was 66 (range 43–90) cmH2O and median maximal squeeze pressure was 132 (range 76–193) cmH2O, values that were significantly lower than in controls and those with classic fissure. Endoanal ultrasonography in 15 of these patients showed defects in the anal sphincters. All flaps healed primarily with preservation of sensation. Perfect continence was maintained in all patients. Follow-up was for a median of 18 (range 2–28) months. There were no serious complications. All fissures healed with minimal postoperative discomfort. This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure might jeopardize continence.
Presentation of comparative audit data
Authors: Murray G D , Hayes C , Fowler S , Dunn D C
Published: March 2007

The Royal College of Surgeons of England organizes a voluntary comparative audit service for its general surgical fellows. To date, the information from the audit has been presented purely descriptively, which does not take account of statistical variability and the effects of differences in case mix between the participants. A new approach to the presentation of these data, based on statistical modelling of the effects of case mix, is presented. The approach is illustrated in an application based on data relating to 136203 admissions reported by 110 surgeons. The result of adjusting for case mix is a substantial change in the relative performance of the participating surgeons, which demonstrates the folly of attempting to compare surgical performance on the basis of a measure as crude as the unadjusted mortality rate. Further development of the statistical modelling is required, but this new statistical approach appears to enhance greatly the credibility of the audit data, by quantifying its strengths and limitations.
Oesophageal acid clearance in patients with severe reflux oesophagitis
Authors: Barham C P , Gotley D C , Mills A , Alderson D
Published: March 2007

Previous studies examining oesophageal acid clearance have employed a variety of techniques to induce or simulate acid reflux. Clearance abnormalities have been deduced from abnormal standard motility studies, barium radiology or from 24-h pH recordings. In this study a 24-h pH and oesophageal motility recording system was used to study naturally occurring acid reflux episodes in control subjects and in two groups of patients with severe acid reflux disease (erosive oesophagitis and oesophageal stricture). Acid clearance was compared between the subject groups. Patients with oesophageal stricture were found to have poor oesophageal peristaltic ability and particularly poor oesophageal acid clearance. Those with erosive oesophagitis had normal peristaltic swallowing but abnormal acid clearance. This study has characterized, for the first tune, the abnormalities in acid clearance during naturally occurring acid reflux episodes in patients with severe reflux disease. A more complete understanding of these clearance abnormalities could influence future medical and surgical strategies in the management of severe gastro-oesophageal reflux disease.
Immediate and early follow-up results of pulse spray thrombolysis in patients with peripheral ischaemia
Authors: Yusuf S W , Whitaker S C , Gregson R H S , Wenham P W , Hopkinson B R , Makin G S
Published: March 2007

Pulse spray thrombolysis is a technique of accelerated peripheral thrombolysis which has been evaluated in 38 patients, 29 with threatened limb viability and nine with a viable but critically ischaemic limb. The median length of occlusion was 26·5 (range 3–65) cm. The lytic agent used was recombinant tissue plasminogen activator (rtPA), injected manually via a pulse spray catheter at a concentration of 0·33 mg/ml and a bolus size of 0·2ml. The median total dose of rtPA was 18 (range 5–35) mg. Patency and flow were completely restored in 34 of 38 patients and clinical success at 30 days was maintained in 27 of 38. The median lysis time was 120 (range 35–1125) min, compared with a median duration of 1545 (range 42–5760) min in 120 consecutive patients previously treated with conventional low-dose infusion thrombolysis using rtPA. This represents a 12-fold reduction in lysis time (P < 0·001). The overall estimated cumulative limb salvage rate for the 38 patients who entered the study was 84 per cent and the cumulative patency rate for the 34 patients in whom patency was restored was 74 per cent at 18 months follow-up. Pulse spray thrombolysis rapidly restores patency with good limb salvage at 30 days; the benefit is sustained even in patients with limbs at immediate risk of irreversible ischaemic injury who are not considered suitable for conventional thrombolysis.
Radical orchidectomy and benign testicular conditions
Authors: Robertson G S M
Published: March 2007

The records of 149 patients who underwent testicular exploration for suspected malignancy were reviewed retrospectively. Malignancy was confirmed in 102 patients but benign pathology was noted in 47. Patients with benign disease were older, more likely to be Asian, gave a longer history and on examination were less likely to have a testicular mass. Increased levels of tumour markers, and ultrasonographic and operative appearance of the testis were highly predictive; with ultrasonography having a sensitivity of 100 per cent but a specificity of only 36 per cent for malignancy. Preoperative ultrasonography and an awareness of the potentially benign nature of many lesions with the use of frozen-section biopsy, where appropriate, may allow a decrease in the currently high rate of unnecessary orchidectomy without missing testicular malignancy.
Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus
Authors: Molloy R G , McCourtney J S , Anderson J R
Published: March 2007

The role of laparoscopy in determining suitability for resection was prospectively evaluated in 244 patients with cancer of the gastric cardia and oesophagus. Laparoscopy enabled detection of inoperable disease in 92 patients (38 per cent), several of whom had more than one contraindication to surgery. Hepatic metastases (n = 75, 31 per cent), extensive peritoneal (n = 25, 10 per cent) or lymph node involvement (n =5, 2 per cent) and direct invasion of the liver or colon (n = 5, 2 per cent) were considered contraindications to surgery. Laparoscopy was poorly tolerated in a further 11 (5 per cent) patients, who were not considered suitable for resection. Extra- abdominal metastatic disease was detected in 17 patients who appeared normal at laparoscopy, and a further six patients refused surgery. The remaining 118 patients underwent laparotomy with a view to resection which was successful in 85 (72 per cent). Laparoscopy thus prevented ill-advised laparotomy in 103 patients (42 per cent), either because of extensive intra-abdominal disease or poor tolerance to anaesthesia. Laparoscopy may be a valuable investigation when used to assess the feasibility of resection.
Helicobacter pylori infection in perforated peptic ulcer disease
Authors: Sebastian M , Chandran V P Prem , Elashaal Y I M , Sim A J W
Published: March 2007

This study examined a possible aetiological agent, namely, Helicobacter pylori, in perforated peptic ulcer disease and its relationship to persisting ulcer. Twenty-nine patients with perforated peptic ulcer underwent simple closure of the perforation at laparotomy. A 13C urea breath test carried out on the eighth day after operation was positive in 24 patients. Fourteen of 17 patients who underwent upper gastrointestinal endoscopy 6 weeks after discharge from hospital had a positive 13C urea breath test. The biopsy urease test performed on mucosal samples taken at endoscopy was positive in 12 of these 14 patients, indicating continuing active infection with H. pylori. Seven patients with positive 13C urea breath and biopsy urease tests had persisting duodenal ulceration. None of the three patients with a negative 13C urea breath test had evidence of duodenal ulceration at endoscopy. The association between a high rate of duodenal ulcer persistence and a high incidence of H. pylori infection suggests that antibiotic therapy to eradicate this microorganism should be given to all patients with perforated peptic ulcer disease.
Long-term survival in children with renal carcinoma: Report of two surgically treated cases
Authors: Marcus R , Watt J
Published: March 2007

Renal carcinoma in childhood is rare. Approximately 177 cases have been reported in the English literature and 71 in the Japanese literature1, 2. The Mersey Regional Cancer Registry has recorded only one case of renal carcinoma in a patient below the age of 20 years in the 19-year period since 1975. The annual incidence of this disease in children in the USA is four per 1 million3. Onus rests on authors to report the long-term follow-up of such cases, otherwise it is difficult to assess the results of treatment1.
Laparoscopic cholecystectomy minimally impairs postoperative cardiorespiratory and muscle performance
Authors: Delaunay L , Bonnet F , Cherqui D , Rimaniol J M , Dahan E , Atlan G
Published: March 2007

Surgery elicits a subjective feeling of postoperative fatigue, at least partly related to an impairment in cardiorespiratory function and muscle performance. Laparoscopic surgery is reported to impair the patient's condition minimally. The aim of this study was to assess exercise performance in patients scheduled for elective laparoscopic cholecystectomy. Nine patients assessed as having American Society of Anesthesiologists (ASA) grade I were enrolled in the study. Subjective feelings of fatigue (measured on a visual analogue scale), and heart rate, systemic arterial pressure oxygen consumption and carbon dioxide production responses to graded exercise testing, were assessed before operation and on days 3 and 10 after operation. There were no significant differences in any of these measurements, at rest or during exercise, between the preoperative and postoperative values. Uncomplicated laparoscopic cholecystectomy does not impair postoperative cardiorespiratory and muscle performance or induce significant postoperative fatigue in patients with ASA I, allowing rapid recovery.
Choledochal cysts in adults
Authors: Hewitt P M , Krige J E J , Bornman P C , Terblanche J
Published: March 2007

Fourteen adults who presented with choledochal cysts were studied. Symptoms in most cases were non-specific, which resulted in delayed diagnosis. Associated extracystic hepatobiliary disease occurred in 11 patients, including two with cholangiocarcinoma. Nine patients underwent total cyst excision (eight Todani classification type I and one type II), while four with type IVa cysts had excision of the extrahepatic cyst component. There were no surgical deaths. One patient with metastases was treated conservatively. Median follow-up was 6·5 years. Two of three patients who developed anastomotic strictures underwent successful revision surgery, while one with secondary sclerosing cholangitis developed biliary cirrhosis and died from hepatic failure after 8 years. Both patients with cholangiocarcinoma have died. Ten survivors are well and one patient was lost to follow-up. This study highlights the complexity of choledochal cysts in adults and emphasizes the need for earlier diagnosis and treatment. Cyst excision should be performed where possible, with reconstruction modified to deal with the cyst type as well as associated hepatobiliary pathology.