bluuebunny/crossref_metadata_2025 huggingface dataset:
True anti‐anionic phospholipid immunoglobulin M antibodies can exert lupus anticoagulant activity
Authors: Gallart Teresa , Benito Carmen , Reverter Joan‐Carles , Bosch Francesc , Blay Maite , Tàssies Dolors , Vigorito Elena , Cervera Ricard , Font Josep , Gomis Ramon , Campo Elias , Vives Jordi
Published: March 2003

Summary.  True (cofactor‐independent) anticardiolipin antibodies (aCL) are thought to lack lupus anticoagulant (LA) activity and pathogenic potential. A serum monoclonal immunoglobulin Mλ (mIgMλ) with aCL and LA activities found in a man with a splenicIgMλ+ B‐cell lymphoplasmacytic lymphoma (LPL) without thrombotic events has been characterized. LPL‐derived hybridoma clones (designated HY‐FRO) producing the serum mIgMλ were obtained. mIgMλ secreted by HY‐FRO grown in protein‐free culture medium, like that purified from serum, (i) showed binding, in a cofactor‐free system, to solid‐phase CL and phosphatidylserine (PS) and to the membrane of PS‐expressing cells (apoptotic cells and activated platelets); (ii) failed to bind neutral phospholipids (PL), β2Glycoprotein, histone, ssDNA, dsDNA, human IgG and umbilical vein endothelial cells. Absorption with apoptotic cells abolished its binding to anionic plate‐bound CL and PS. IgMλ‐FRO used poorly mutated VH and Vλ region genes, with a pattern that was inconsistent with an antigen‐driven selection. Basic amino acids were present in the IgH complementarity determining region 3 (CDR3), which can be important for binding to anionic PL. These findings demonstrate unequivocally that true anti‐anionic PL IgM antibodies can exert LA and indicate this anti‐PL type does not involve thrombophilia.
Hormonal replacement therapy, prothrombotic mutations and the risk of venous thrombosis
Authors: Rosendaal F. R. , Vessey M. , Rumley A. , Daly E. , Woodward M. , Helmerhorst F. M. , Lowe G. D. O.
Published: March 2003

Summary. Hormone replacement therapy (HRT) increases the risk of venous thrombosis. We investigated whether this risk is affected by carriership of hereditary prothrombotic abnormalities. Therefore, we determined the two most common prothrombotic mutations, factor V Leiden and prothrombin 20210A in women who participated in a case–control study on venous thrombosis. Relative risks were expressed as odds ratios (OR) with 95% confidence intervals (CI95). Among 77 women aged 45–64 years with a first venous thrombosis, 51% were receiving HRT at the time of thrombosis, compared with 24% of control women (OR = 3·3, CI95 1·8–5·8). Among the patients, 23% had a prothrombotic defect, versus 7% among the control women (OR = 3·8, CI95 1·7–8·5). Women who had factor V Leiden and used HRT had a 15‐fold increased risk (OR = 15·5, CI95 3·1–77), which exceeded the expected joint odds ratio of 6·1 (under an additive model). We conclude that the thrombotic risk of HRT may particularly affect women with prothrombotic mutations. Efforts to avoid HRT in women with increased risk of thrombosis are advisable.
The new ID‐heparin/PF4 antibody test for rapid detection of heparin‐induced antibodies in comparison with functional and antigenic assays
Authors: Eichler Petra , Raschke Ricarda , Lubenow Norbert , Meyer Oliver , Schwind Peter , Greinacher Andreas
Published: March 2003

Summary. Heparin‐induced thrombocytopenia (HIT) is an immune‐mediated complication of heparin treatment. Several in vitro assays are available to detect the causative HIT antibodies: functional assays, usually requiring freshly prepared platelets and immunological tests based on the enzyme‐linked immunosorbent assay (ELISA) principle. We compared a new, simple and rapid test based on the ID‐microtyping particle agglutination system with 14C‐serotonin release assay, heparin‐induced platelet activation (HIPA) test and two ELISAs. Sera from 100 confirmed HIT patients, 20 serologically negative suspected HIT patients and 20 healthy blood donors were used. The specificity and sensitivity of the new test was similar to the functional assays. Compared with the ELISAs, specificity was better at the cost of reduced sensitivity. As in all other immunological tests, HIT antibodies against less typical antigens, such as interleukin (IL)‐8 or neutrophil‐activating peptide (NAP) 2 could not be detected. Thus, although the ID‐Heparin/PF4 antibody test seems to be a quick, reliable and robust test to determine the presence of HIT antibodies, it should still be combined with a functional assay if possible. Evaluation of the test in a prospective setting as well as interlaboratory variation should be assessed as a next step.
Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy
Authors: Ganio E , Altomare D F , Gabrielli F , Milito G , Canuti S
Published: March 2003

Background

The aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular stapling device (group 2).

Methods

One hundred patients with symptomatic third- and fourth-degree haemorrhoids were enrolled by five hospitals. Patients were allocated to the two groups according to a centralized randomization scheme featuring five permutated blocks of 20. Preoperative clinical examination and anorectal manometry demonstrated no features of anal incontinence. Patients had a clinical and manometric re-evaluation after operation and were asked to complete a clinical diary. After a median of 16 (range 8–19) months patients were administered a standardized questionnaire by telephone.

Results

Postoperative bleeding requiring haemostatic procedures occurred in three patients in each group. Patients in group 1 complained of moderate pain for a median of 5·3 (range 0–19) days compared with 3·1 (range 0–10) days in group 2 (P = 0·01), while severe pain was present for 2·3 (range 0–24) days in group 1 but only for 1 (range 0–14) day in group 2 (P = 0·03). The median hospital stay was 2 days in group 1 compared with 1 day in group 2 (P = 0·01). In the early days after operation, patients in group 2 had greater difficulty in maintaining normal continence to liquid stools (P = 0·01), but after 30 days the continence score was better in group 2 (P = 0·04).

Conclusion

Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy. Reduced postoperative pain, shorter hospital stay and a trend toward earlier return to work suggest short-term advantages for the stapled technique.
Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery
Authors: Mismetti P , Laporte S , Darmon J-Y , Buchmüller A , Decousus H
Published: March 2003

Background

Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated.

Methods

A meta-analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH.

Results

Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0·28 (95 per cent confidence interval 0·14–0·54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0·25 (0·08–0·79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0·29 (0·11–0·73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0·049), a trend also found for cancer surgery. LMWH at doses below 3400 anti-Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage.

Conclusion

Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation.
Late mortality in patients with severe acute pancreatitis
Authors: Gloor B , Müller C A , Worni M , Martignoni M E , Uhl W , Büchler M W
Published: March 2003

Background

Mortality due to severe or necrotizing acute pancreatitis most often results from multiorgan dysfunction syndrome (MODS) occurring either early (within the first 14 days) or 2 weeks or more after the onset of symptoms due to septic complications. The aim of this study was to analyse the course of the disease in patients who died from severe acute pancreatitis.

Methods

Between January 1994 and August 2000 details of 263 consecutive patients with acute pancreatitis were entered prospectively into a database. All patients were treated in an intermediate or intensive care unit.

Results

The overall mortality rate was 4 per cent (ten of 263 patients). The mortality rate was 9 per cent (ten of 106) in patients with necrotizing disease. No patient died within the first 2 weeks of disease onset. The median day of death was 91 (range 15–209). Six patients died from septic MODS. Ranson score, Acute Physiology and Chronic Health Evaluation (APACHE) II score during the first week of disease, pre-existing co-morbidity, body mass index, infection and extent of necrosis were significantly associated with death (P < 0·01 for all parameters). However, only infection of the necrotic pancreas was an independent risk factor in the multivariate analysis.

Conclusion

Early deaths in patients with severe acute pancreatitis are rare, mainly as a result of modern intensive care treatment. Nine of the ten deaths occurred more than 3 weeks after disease onset. Infection of pancreatic necrosis was the main risk factor for death.
Differences in the detection of cyclo-oxygenase 1 and 2 proteins in symptomatic and asymptomatic carotid plaques
Authors: Wijeyaratne S M , Abbott C R , Homer-Vanniasinkam S , Mavor A I D , Gough M J
Published: March 2003

Background

The expression of cyclo-oxygenase (COX) 1 and 2 has been demonstrated in atherosclerotic arteries. In the present study this was correlated with symptoms arising from a carotid plaque.

Methods

Carotid plaques from 12 asymptomatic patients were compared with 11 plaques from patients who had had neurological symptoms within the preceding 30 days. Sections were stained with haematoxylin and eosin, elastin van Gieson and goat antihuman antibodies to COX-1 and COX-2. Plaque morphology was correlated with neurological symptoms. The area with positive COX-1 and COX-2 staining was measured by computerized planimetry in entire cross-sections and in specific areas of the plaque.

Results

There was a significant association between cap thinning and plaque rupture with symptoms (P = 0·003). The percentage area of positive staining in entire cross-sections for both COX-1 and COX-2 was significantly greater in symptomatic plaques (P = 0·001 and 0·0004 respectively). Staining in symptomatic plaques was significantly greater in the cap (COX-1: P = 0·001; COX-2: P = 0·0001) and shoulder (COX-1: P = 0·008; COX-2: P = 0·007) regions of the plaque. COX-1 expression in the sclerotic area was not increased (P = 0·15) although COX-2 staining was significantly greater (P = 0·04).

Conclusion

Both COX-1 and COX-2 detection was increased in symptomatic plaques. COX may contribute to plaque rupture and the onset of symptoms.
Penetrating atherosclerotic ulcers of the aorta
Authors: Troxler M , Mavor A I D , Homer-Vanniasinkam S
Published: March 2003

Background

Penetrating aortic ulcers burrow into the aortic wall and can have fatal consequences. Although they were first described as long ago as 1934 they have only recently been recognized as a distinct pathological entity.

Method

A review of the current literature was undertaken, based primarily on an English language Medline search with secondary references obtained from key articles.

Results

Penetrating aortic ulcer is principally a disease of elderly hypertensive men. It may run a benign course or may produce complications such as aortic rupture, embolization and aneurysm formation. Presentation may be identical to that of classical aortic dissection, but the distinction is important because an ulcer may be more likely to cause rupture.

Conclusion

Open surgical repair has been the ‘gold standard’ of treatment but endovascular stenting is an attractive option in this group of frail patients.
Role of fundoplication in patient symptomatology after laparoscopic antireflux surgery
Authors: de Beaux A C , Watson D I , O'Boyle C , Jamieson G G
Published: March 2003

Background

Symptoms following antireflux surgery are often seen as unavoidable sequelae of the operation. The aims were to determine the frequency of new adverse sequelae following antireflux surgery and the preoperative incidence of similar symptoms.

Methods

Patients undergoing fundoplication underwent prospective assessment of symptoms using a structured interview before and 6 months after surgery. In addition to the presence or absence of symptoms, Visick scores, visual analogue scales and a composite dysphagia score were used.

Results

Some 312 patients were evaluated. Antireflux surgery significantly diminished the symptoms of heartburn, epigastric pain, regurgitation, bloating, odynophagia, nausea, vomiting, diet restriction, nocturnal coughing and wheezing. In contrast, there was a significant increase in inability to belch, diarrhoea and increased passage of flatus. The symptoms of dysphagia, postprandial fullness or early satiety and anorexia were not significantly altered by antireflux surgery. There was, however, a group of patients who experienced new or worsened dysphagia after surgery and were more likely to do so if they had no dysphagia before surgery (31 per cent) than if dysphagia was present before surgery (19 per cent). Some 93 per cent of patients were satisfied with the overall outcome of the operation.

Conclusion

The majority of patients undergoing laparoscopic fundoplication for gastro-oesophageal reflux derive symptomatic benefit and are satisfied with the outcome. Many of the so-called postfundoplication sequelae are present before surgery in many patients. Overall, antireflux surgery does not lead to increased dysphagia or bloating.
Survey of the use of thromboprophylaxis in laparoscopic surgery in Denmark
Authors: Filtenborg Tvedskov T , Rasmussen M S , Wille-Jørgensen P
Published: March 2003

Background

The aim of this study was to determine the current use of thromboprophylaxis for laparoscopic surgery in Denmark.

Methods

Postal questionnaires were sent to all Danish surgical departments that performed laparoscopic surgery according to the National Laparoscopic Cholecystectomy Database.

Results

There was a written protocol for thromboprophylaxis in 93 per cent of the responding departments. In 37 per cent thromboprophylaxis was used for all patients undergoing laparoscopic surgery; only 7 per cent used thromboprophylaxis sporadically. All departments used low molecular weight heparin, 74 per cent in combination with graduated compression stockings. The criteria for using thromboprophylaxis varied greatly; in many departments conversion of the procedure to an open operation was not considered a criterion. Some 20 per cent of the departments reported previous thromboembolic complications following laparoscopic surgery.

Conclusion

Despite the widespread use of thromboprophylaxis, symptomatic thromboembolic complications were reported from several departments. Further studies are needed to determine whether laparoscopic surgery should be considered a high-risk procedure.
Hospital caseload and the results achieved in patients with rectal cancer
Authors: Marusch F , Koch A , Schmidt U , Pross M , Gastinger I , Lippert H
Published: March 2003

Background

The aim of the study was to investigate the impact of hospital caseload on the short-term postoperative outcome of patients with rectal carcinoma.

Methods

A multicentre study involving 75 German hospitals was carried out between January and December 1999. Some 1463 patients with rectal carcinoma were studied.

Results

The hospitals were divided into three groups by annual caseload as follows: less than 20 (group 1), 20–40 (group 2) and more than 40 (group 3). The groups were identical in terms of age, gender, height, weight, tumour stage, risk factors and American Society of Anesthesiologists classification. Postoperative morbidity was less in hospitals with a case volume of more than 20 patients per year (41·7 per cent in group 2 versus 49·9 per cent in group 1). The proportion of patients undergoing abdominoperineal resection with a permanent stoma was less in hospitals with a case volume of more than 40 patients per year (26·4 per cent in group 3 versus 34·0 per cent in group 2).

Conclusion

A large caseload in rectal surgery results in a significant reduction in permanent stoma formation and postoperative morbidity.
Prospective controlled trial of a standardized meal stimulation test in the detection of pancreaticoduodenal endocrine tumours in patients with multiple endocrine neoplasia type 1
Authors: Langer P , Wild A , Celik I , Kopp I , Bergenfelz A , Bartsch D K
Published: March 2003

Background

Use of a standardized meal stimulation test has been recommended for the early diagnosis of pancreaticoduodenal endocrine tumours (PETs) in patients with multiple endocrine neoplasia type 1 (MEN 1). The diagnostic value of this test was re-evaluated.

Methods

In a prospective, controlled trial 58 standardized meal stimulation tests (563 kcal) were performed in 12 patients with MEN 1 and histologically, biochemically and/or radiologically confirmed PETs (group 1), 11 carriers of an MEN 1 mutation with no evidence of PETs (group 2) and in 27 healthy controls (group 3). Serum pancreatic polypeptide (PP) and gastrin concentrations were measured before and during the test meal.

Results

Patients in group 1 had significantly higher mean basal serum PP and gastrin concentrations than patients in group 2 and controls (P < 0·05). In all three groups an increase in serum PP was observed after meal stimulation, but there was no significant difference between the groups. No increase in gastrin level was found in any of the groups after meal stimulation.

Conclusion

The standardized meal stimulation test does not reliably indicate the presence of PETs in patients with MEN 1, whereas raised basal serum PP and gastrin levels do. The expensive and time-consuming meal test can be excluded from MEN 1 screening programmes.
Reintervention as a clinical trial endpoint after peripheral arterial bypass surgery
Authors: Watson H R , Belcher G , Horrocks M
Published: March 2003

Background

Graft patency is usually the primary endpoint in studies of peripheral arterial bypass surgery, but gives only a limited indication of clinical outcome. The aim of this study was to evaluate reintervention as a study endpoint after femorodistal bypass surgery.

Methods

The database from a multicentre, prospectively planned study of 517 patients undergoing femorodistal bypass for severe ischaemia was used to investigate the predictive value of technical endpoints. Clinical symptoms, graft patency, vascular interventions and clinical outcomes were recorded for 12 months after operation.

Results

Complete follow-up data were obtained on 498 patients (96 per cent). Success in terms of patients' need for reintervention agreed with clinical outcome in 90 (95 per cent confidence interval (c.i.) 87–93) per cent of cases. Primary and secondary patency agreed with the clinical outcome in 80 (95 per cent c.i. 77–84) and 81 (95 per cent c.i. 78–85) per cent of patients respectively. However, the best agreement with clinical outcome was obtained from the composite endpoint of ‘patient alive without reintervention’: 92 (95 per cent c.i. 90–94) per cent.

Conclusion

Recording the number of patients who did not need reintervention for 12 months after femorodistal bypass gave a more accurate assessment of the number with clinical improvement than was obtained by recording bypass graft patency. Inclusion of patient survival in a composite endpoint increased the clinical relevance of this endpoint in patients with severe ischaemia who had femorodistal bypass surgery.
Community mortality after ruptured abdominal aortic aneurysm is unrelated to the distance from the surgical centre
Authors: Cassar K , Godden D J , Duncan J L
Published: March 2003

Background

Ruptured abdominal aortic aneurysm (RAAA) carries a high community mortality. Raigmore Hospital, Inverness serves Highland Region, an area the size of Wales with a population of 204 000. The aim of this retrospective review was to determine the community mortality and hospital mortality rates from RAAA in Highland Region and to assess whether distance travelled had any significant impact on survival.

Methods

Data were retrieved from hospital records, the Registrar General for Scotland and the Information and Statistics Division of the National Health Service in Scotland about patients diagnosed with RAAA between 1992 and 1999.

Results

Of 198 patients with RAAA, 131 (66 per cent) were transferred to Raigmore Hospital while the other 67 (34 per cent) died in a community hospital or at home. Of those reaching Raigmore 109 (83 per cent) had surgery, of whom 65 (60 per cent) survived. The overall community mortality rate was 67 per cent while the hospital mortality rate was 50 per cent. The hospital and community mortality rates for patients living within 50 miles of Raigmore Hospital were 60 and 67 per cent respectively, compared with 26 and 68 per cent for those living more than 50 miles away.

Conclusion

Distance from Raigmore Hospital had no significant impact on community mortality from RAAA.
Management of thoracic duct injuries after oesophagectomy
Authors: Wemyss-Holden S A , Launois B , Maddern G J
Published: March 2003

Background

Thoracic duct laceration is a rare but potentially life-threatening complication of oesophagectomy. The management of such an injury is uncertain in respect of the relative merits of conservative and surgical treatment.

Methods

The literature was reviewed by searching Medline databases from 1966 to the present time. The majority of the evidence presented is level 3, as no randomized or controlled data are available.

Results

Prolonged conservative treatment of thoracic duct injury is associated with a mortality rate of 50–82 per cent. The results of early surgical ligation of the duct are more encouraging, with a mortality rate of 10–16 per cent. Elective ligation of the duct reduces the incidence of postoperative chylothorax.

Conclusion

The thoracic duct should be ligated during oesophagectomy. A high index of suspicion for duct injury must be maintained in all patients after operation. A policy of very early thoracic duct ligation at 48 h from diagnosis is proposed for duct injury if aggressive conservative management fails.
Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery
Authors: Maurer C A , Z'graggen K , Renzulli P , Schilling M K , Netzer P , Büchler M W
Published: March 2003

Background

The introduction of total mesorectal excision (TME) has been shown to improve local recurrence rates in rectal cancer. The present study investigated the impact of this more extensive and radical procedure with regard to autonomic pelvic nerve function.

Methods

Patients with resected primary rectal cancer were interviewed by means of a questionnaire asking about preoperative and postoperative urinary bladder and genital function. The results in patients after rectal cancer surgery without TME (group 1; n = 29) were compared with those obtained after introduction of the TME technique (group 2; n = 31). Patients in group 2 were older and had a lower level of anastomosis than patients in group 1. Other patient, treatment and tumour characteristics were comparable between the groups.

Results

Newly acquired and permanent symptoms of bladder dysfunction after rectal excision were present as follows (group 1 versus group 2): difficulty in bladder emptying 7 versus 19 per cent; sensation of incomplete bladder voiding 17 versus 17 per cent; urgency 17 versus 14 per cent; incontinence 10 versus 3 per cent; dysuria 7 versus 7 per cent; and dribbling 14 versus 8 per cent. Male patients stated the following sexual functions before operation/after operation in group 1 versus group 2: interest in sex 80 per cent/40 per cent versus 63 per cent/37 per cent; sexually active 67 per cent/7 per cent versus 53 per cent/22 per cent; impotence 75 per cent/6 per cent versus 58 per cent/26 per cent; ability to have intercourse 75 per cent/13 per cent versus 67 per cent/29 per cent; ability to achieve orgasm 88 per cent/13 per cent versus 76 per cent/47 per cent; and orgasm with ejaculation 88 per cent/9 per cent versus 76 per cent/53 per cent.

Conclusion

While both conventional rectal cancer surgery and TME result in similarly favourable postoperative bladder function, both techniques decrease sexual function. However, TME offers a significant advantage with regard to preservation of postoperative sexual function in men and constitutes a true advance in rectal cancer surgery compared with conventional techniques.
Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy
Authors: Gouillat C , Chipponi J , Baulieux J , Partensky C , Saric J , Gayet B
Published: March 2003

Background

It remains debatable whether somatostatin can prevent pancreatic fistula and other pancreatic stump-related complications following pancreaticoduodenectomy. This study assessed the effects of somatostatin-14 (S-14) on pancreatic remnant exocrine secretion.

Methods

This was a double-blind, randomized, placebo-controlled trial in patients undergoing pancreaticoduodenectomy for malignancy. Patients received a continuous infusion of S-14 (n = 38) or placebo (n = 37) for 7 days. Pancreatic juice and peripancreatic drainage fluid was collected and measured, and pancreatic enzymes were monitored daily. Postoperative complications were recorded.

Results

S-14 infusion was associated with a decrease in median daily pancreatic juice and pancreatic amylase output. Amylase concentration and output in the peripancreatic drain fluid were significantly lower after S-14 infusion than in the control group (both P < 0·05). The incidence of clinical pancreatic fistula (two of 38 versus eight of 37; P < 0·05) and total pancreatic stump-related complications (five of 38 versus 12 of 37; P < 0·05) was lower in patients treated with S-14. Duration of hospital stay was shorter after S-14 (18 versus 26 days; P = 0·01).

Conclusion

Although the effect of S-14 on exocrine secretion remains difficult to demonstrate, it did reduce pancreatic juice leakage from the pancreatic remnant.
Suspected acute appendicitis: trends in management over 30 years
Authors: Jones P F
Published: March 2003

Background

Tradition taught that patients with signs suspicious of acute appendicitis should be explored surgically, but studies in the 1960s found that if this group was closely observed about one-third recovered without treatment. To differentiate these patients a strict regimen of active observation was introduced and this has now been studied over 30 years. Ultrasonography, laparoscopy and computed tomography (CT) have also been used to clarify the diagnosis in these patients.

Methods

Papers on the management of patients with suspected appendicitis published since 1970 were traced through Index Medicus, English-language journals and Medline. All those that mention the use of observation are reviewed, with selective reports on the other methods used. The advantages and disadvantages of various methods of management are compared.

Results and conclusion

Active observation has yielded a consistently low negative appendicectomy rate without a rise in the perforation rate; there was one death in over 1600 patients. It has proved to be a practical method of discriminating between patients who do and do not need an operation. In this situation, both ultrasonography and CT yield some false-negative reports, so results must be checked at the bedside. Furthermore, CT involves exposure to significant doses of radiation.
Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative
Authors: Basse L , Madsen J L , Kehlet H
Published: March 2003

Background

Postoperative ileus usually lasts for 2–5 days after colonic surgery and may contribute to discomfort and pulmonary complications. With multimodal rehabilitation (epidural analgesia, early oral nutrition and mobilization, and laxative) defaecation occurs 1–2 days after colonic surgery. The aim of this study was to assess the transit rate of the entire gastrointestinal tract after colonic resection with multimodal rehabilitation.

Methods

Gastrointestinal motility was assessed by means of a scintigraphic method in 12 patients undergoing open colonic resection with multimodal rehabilitation and in 12 matched healthy volunteers. After intragastric or oral administration of 4 MBq 111In-labelled diethylenetriamine penta-acetic acid, images of the abdomen were taken at 24 and 48 h with a double-headed γ camera.

Results

Patient and volunteer demographics were similar. The first defaecation occurred a median of 1 day after operation in the patients. Some 57 per cent of the tracer was excreted in faeces of patients and 53 per cent in faeces of volunteers (P > 0·05) within 48 h, indicating rapid recovery of the entire gastrointestinal motility after colonic resection with multimodal rehabilitation.

Conclusion

This study documents early normalization of the entire gastrointestinal motility assessed by an 111In scintigraphic method in patients undergoing open colonic resection with a multimodal rehabilitation programme.
Prevention of the neoplastic progression of Barrett's oesophagus by endoscopic argon beam plasma ablation
Authors: Morris C D , Byrne J P , Armstrong G R A , Attwood S E A
Published: March 2003

Background

Patients with Barrett's oesophagus have a risk of approximately 1 per 100 patient-years for the development of oesophageal adenocarcinoma. Endoscopic ablation of Barrett's oesophagus has been shown to lead to the regrowth of a ‘neo’ squamous epithelium if gastro-oesophageal reflux is controlled, but the incidence of subsequent tumour formation is unknown.

Methods

The follow-up of 55 patients who underwent endoscopic ablation of Barrett's oesophagus by argon beam plasma coagulation (ABPC) is reported. Of the 55 patients, nine had low-grade dysplasia, nine had high-grade dysplasia and the remainder had non-dysplastic Barrett's metaplasia. Twelve patients had reflux control by antireflux surgery and the remainder received proton pump inhibitor therapy. Barrett's metaplasia was ablated by ABPC to within 2 cm of the gastro-oesophageal junction.

Results

To date, one patient has died and one patient was unable to complete treatment. The remaining patients were followed by regular endoscopic surveillance for a mean of 38·5 months to give a total follow-up of 173·5 patient-years. No malignancy has developed in any patient during follow-up.

Conclusion

The absence of malignant complications in this study of prophylactic ablation of long-segment Barrett's oesophagus strengthens the argument for endoscopic ablation in the prevention of oesophageal adenocarcinoma.
Extent of ductal carcinoma in situ within and surrounding invasive primary breast carcinoma
Authors: Crombie N , Rampaul R S , Pinder S E , Elston C W , Robertson J F R , Ellis I O
Published: March 2003

Background

The aim of this study was to evaluate the pathological and morphological features of ductal carcinoma in situ (DCIS) within and surrounding invasive ductal carcinoma, and to investigate its relationship with clinical outcome and established prognostic variables.

Methods

One hundred and seven patients with primary operable invasive breast carcinoma and associated DCIS treated by simple or subcutaneous mastectomy or wide local excision with radiotherapy were assessed. Those with pure DCIS and insufficient tumour available for examination were excluded. The most representative haematoxylin and eosin-stained sections from the remaining 91 samples were selected and examined at × 100 magnification using a 45-point, 2-mm grid graticule. The entire section was assessed and the cell under each point of the graticule was classed as either normal (a), DCIS surrounded by normal tissue (b), invasive tumour (c) or DCIS surrounded by invasive malignancy (d). The volume ratio of DCIS in the normal (b/(a + b)) and invasive (d/(c + d)) tissue was then calculated.

Results

The DCIS volume within invasive tumour was not associated with outcome. The DCIS volume within adjacent normal tissue, however, was associated with local recurrence (P = 0·025), disease-free interval (P = 0·048), the occurrence of distant metastases (P = 0·019), death (P = 0·049) and disease-free survival (P = 0·048). Volume ratios of DCIS in normal and invasive tissue were not related to known prognostic factors including lymph node stage, grade, tumour size, vascular invasion or patient age.

Conclusion

There is a significant prognostic effect relating to the extent of DCIS associated with an invasive cancer, particularly with respect to local recurrence of tumour. This effect is restricted to the volume of DCIS in the tissue surrounding the invasive lesion rather than the intratumoral component.
Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection
Authors: Roumen R M H , Kuijt G P , Liem I H , van Beek M W P M
Published: March 2003

Background

The sentinel node biopsy technique for breast cancer has been validated extensively in phase I and II studies. However, no data from phase III randomized clinical studies are available. It remains controversial whether a histologically negative sentinel node biopsy without further axillary dissection can be considered to be good clinical practice.

Methods

One hundred consecutive patients with breast cancer who had a negative sentinel node biopsy without additional axillary dissection were studied prospectively between 1997 and 2000 in order to identify tumour recurrence and to assess the morbidity of the sentinel node procedure. Special attention was paid to axillary or locoregional recurrence, distant metastases and overall survival. One year after the procedure patients were sent a questionnaire to assess any functional impairment of the arm or shoulder.

Results

Median follow-up was 24 (range 16–40) months. One patient had an axillary relapse 14 months after the initial diagnosis of breast cancer. She died after 2 years from metastatic disease. There were no other local axillary recurrences. There was a 94 per cent response rate to the questionnaire. Twelve patients developed mild disabilities, of whom two said that they had to change their hobbies, sports or daily activities owing to the sentinel node procedure. No patient developed lymphoedema or needed physiotherapy after the operation.

Conclusion

When strict criteria for the sentinel node biopsy procedure are used, the sentinel node biopsy without further axillary dissection after a negative histological investigation is a safe procedure. It may therefore be considered to be the standard of care for the treatment of patients with breast cancer.
Non-invasive methods of assessing angiogenesis and their value in predicting response to treatment in colorectal cancer
Authors: George M L , Dzik-Jurasz A S K , Padhani A R , Brown G , Tait D M , Eccles S A , Swift R I
Published: March 2003

Background

Tumour neoangiogenesis can be assessed non-invasively by measuring angiogenic cytokine concentrations in peripheral circulation and by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The aim of this study was to assess whether these methods can predict and monitor response to treatment in patients with rectal cancer treated with preoperative chemoradiotherapy.

Methods

Serum and plasma vascular endothelial growth factor levels were measured in 31 patients with T3/T4 rectal cancers before quantitating tumour permeability (ln Ktrans) by DCE-MRI. Sixteen patients receiving preoperative chemoradiotherapy had serial vascular endothelial growth factor (VEGF) and DCE-MRI measurements. Response to treatment was assessed using World Health Organization criteria.

Results

Serum VEGF and ln Ktrans correlated before treatment (r = 0·48, P = 0·01). Responsive tumours (n = 8) had higher pretreatment permeability values than non-responsive tumours (n = 8) (mean ln Ktrans −0·46 and −0·72 respectively; P = 0·03). Compared with pretreatment values, responsive tumours showed a marked reduction in permeability at the end of treatment (mean ln Ktrans −0·46 and −0·86 respectively; P = 0·04). Pretreatment serum VEGF levels were not statistically different between the two groups.

Conclusion

Rectal tumours with higher permeability at presentation appear to respond better to chemoradiotherapy than those of lower permeability. This may allow preselection of appropriate tumours for these regimens, with patients with low-permeability tumours being considered for alternative therapies.
Value of isotope lymphography in the diagnosis of lymphoedema of the leg
Authors: Burnand K G , McGuinness C L , Lagattolla N R F , Browse N L , El-Aradi A , Nunan T
Published: March 2003

Background

Isotope lymphography has largely replaced contrast lymphography in the diagnosis of lymphoedema. Its accuracy has only been assessed in small studies and it is not known if it can identify patients with a proximal lymphatic obstruction who may be suitable for lymphatic bypass surgery.

Methods

Three hundred and ninety-five patients suspected to have lymphoedema were investigated by isotope lymphography between 1985 and 1995. Contrast lymphography was also carried out in 29 of these patients because the isotope results were thought to be misleading, or because lymphatic bypass surgery was being considered.

Results

In the 29 patients who had both investigations isotope lymphography detected 20 of 24 abnormal lymphatic systems. Four legs with obstructed groin lymphatics were reported as normal. Two legs with normal contrast lymphograms were erroneously diagnosed as having lymphoedema in the isotope study. Detectable groin nodes on the scintigrams were indicative of either normal lymphatics or proximal lymphatic obstruction. An increase in isotope uptake over 30–60 min of less than 50 per cent, or a total absence of isotope within groin nodes, was a sensitive indicator that patients were unsuitable for lymphatic bypass surgery.

Conclusion

Isotope lymphography is a moderately sensitive test for lymphoedema, which will mistakenly classify some normal legs as lymphoedematous. It will usually correctly identify patients who are suitable for lymphatic bypass surgery.
Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer
Authors: Wibe A , Rendedal P R , Svensson E , Norstein J , Eide T J , Myrvold H E , Søreide O
Published: March 2003

Background

Knowledge of prognostic factors following resection of rectal cancer may be used in the selection of patients for adjuvant therapy. This study examined the prognostic impact of the circumferential resection margin on local recurrence, distant metastasis and survival rates.

Methods

A national population-based rectal cancer registry included all 3319 new patients from November 1993 to August 1997. Some 686 patients underwent total mesorectal excision with a known circumferential margin. This shortest radial resection margin was measured in fixed specimens. None of the patients had adjuvant radiotherapy.

Results

Following potentially curative resection and after a median follow-up of 29 (range 14–60) months, the overall local recurrence rate was 7 per cent (46 of 686 patients): 22 per cent among patients with a positive resection margin and 5 per cent in those with a negative margin (margin greater than 1 mm). Forty per cent of patients with a positive margin developed distant metastasis, compared with 12 per cent of those with a negative margin. With decreasing circumferential margin there was an exponential increase in the rates of local recurrence, metastasis and death.

Conclusion

The circumferential margin has a significant and major prognostic impact on the rates of local recurrence, distant metastasis and survival. Information on circumferential margin is important in the selection of patients for postoperative adjuvant therapy.
Right-lobe live donor liver transplantation improves survival of patients with acute liver failure
Authors: Liu C L , Fan S T , Lo C M , Yong B H , Fung A S M , Wong J
Published: March 2003

Background

Right-lobe live donor liver transplantation (LDLT) is used by many liver transplant centres for treating adult patients with terminal liver disease, but its incremental benefit for the intended recipient over cadaveric liver graft transplantation has not been determined. The impact of LDLT as a proactive approach on the outcome of patients with acute liver failure was analysed.

Methods

From January 1999 to March 2001, right-lobe LDLT was offered proactively to 50 consecutive patients with acute liver failure and their families. The outcome of those who opted for right-lobe LDLT (n = 34) was compared with that of those who did not opt for LDLT (n = 16).

Results

In the group that opted for right-lobe LDLT, 16 patients eventually received a live donor right-lobe graft (14 patients survived) and three patients received a cadaveric liver graft that became available while the potential live donor was undergoing evaluation (all three patients survived). Among the group who did not opt for LDLT, only one patient received a cadaveric liver graft and survived. The former group had a higher overall survival rate (17 of 34 versus one of 16). With a proactive approach, the overall transplant rate was increased from four of 50 to 20 of 50. The morbidity rate among donors was low and none died.

Conclusion

Right-lobe LDLT improves the overall survival rate of patients with acute liver failure and should be considered as one of the treatment options for adult patients with acute liver failure.
Diethylmaleate, a pro-oxidant, attenuates experimental ischaemia–reperfusion-induced lung injury
Authors: Kiely P D , Wang J C , Kelly C J , Condron C , Watson R G K , Bouchier-Hayes D J
Published: March 2003

Background

Systemic ischaemia–reperfusion (IR) injury is in part an oxidant injury mediated by neutrophils. Diethylmaleate (DEM), an intracellular pro-oxidant agent, has been shown to alleviate neutrophil-mediated tissue injury. The aim of this study was to evaluate whether DEM could have a protective effect on neutrophil-mediated lung injury in an animal model of lower-torso IR.

Methods

Sprague–Dawley rats (seven per group) were randomized into three groups. The control group underwent midline laparotomy only; the IR group underwent laparotomy and clamping of the infrarenal abdominal aorta for 30 min followed by 2 h of reperfusion; and the third group was pretreated with DEM 6 mmol/kg intraperitoneally 1 h before the IR insult.

Results

IR resulted in a significant increase in both microvascular leakage and pulmonary neutrophil infiltration as measured by bronchoalveolar lavage protein concentration and pulmonary myeloperoxidase activity respectively. Pretreatment with DEM significantly attenuated both microvascular leakage and neutrophil infiltration.

Conclusion

Preconditioning with DEM protected against IR-induced lung injury. This protective effect raises the possibility of using pro-oxidants to prevent inflammatory injury.
Comparison of magnetic resonance cholangiography and percutaneous transhepatic cholangiography in the evaluation of bile duct strictures after cholecystectomy
Authors: Chaudhary A , Negi S S , Puri S K , Narang P
Published: March 2003

Background

Percutaneous transhepatic cholangiography (PTC) has been the preferred investigation to delineate the anatomy of the biliary tract in a patient with a bile duct stricture after cholecystectomy. Recently magnetic resonance cholangiography (MRC) has been described to evaluate the obstructed biliary tract. This paper reports a comparison of MRC with PTC in evaluating patients with an iatrogenic bile duct stricture.

Methods

This was a prospective study of 26 patients who had surgery for a bile duct stricture after cholecystectomy. Before operation all patients underwent both MRC and PTC, the results of which were compared with the intraoperative findings.

Results

Both PTC and MRC were comparable with regard to image quality, detection of intrahepatic bile duct dilatation, assessment of the level of injury and detection of abnormalities such as intraduct calculi, cholangitic liver abscesses and atrophy of liver lobes. MRC provided additional information in four patients, including detection of associated fluid collections (n = 3) and portal hypertension (n = 1). In eight patients more than one puncture had to be performed during PTC to delineate the complete anatomy.

Conclusion

MRC is an accurate and non-invasive imaging procedure for preoperative evaluation of patients with a bile duct injury after cholecystectomy, and is capable of providing additional information which may not be available with PTC.
Redox properties of the couple compound I/native enzyme of myeloperoxidase and eosinophil peroxidase
Authors: Arnhold Jürgen , Furtmüller Paul G. , Regelsberger Günther , Obinger Christian
Published: March 2003

The standard reduction potential of the redox couple compound I/native enzyme has been determined for human myeloperoxidase (MPO) and eosinophil peroxidase (EPO) at pH 7.0 and 25 °C. This was achieved by rapid mixing of peroxidases with either hydrogen peroxide or hypochlorous acid and measuring spectrophotometrically concentrations of the reacting species and products at equilibrium. By using hydrogen peroxide, the standard reduction potential at pH 7.0 and 25 °C was 1.16 ± 0.01 V for MPO and 1.10 ± 0.01 V for EPO, independently of the concentration of hydrogen peroxide and peroxidases. In the case of hypochlorous acid, standard reduction potentials were dependent on the hypochlorous acid concentration used. They ranged from 1.16 V at low hypochlorous acid to 1.09 V at higher hypochlorous acid for MPO and from 1.10 V to 1.03 V for EPO. Thus, consistent results for the standard reduction potentials of redox couple compound I/native enzyme of both peroxidases were obtained with all hydrogen peroxide and at low hypochlorous acid concentrations: possible reasons for the deviation at higher concentrations of hypochlorous acid are discussed. They include instability of hypochlorous acid, reactions of hypochlorous acid with different amino‐acid side chains in peroxidases as well as the appearance of a compound I–chloride complex.