bluuebunny/crossref_metadata_2025 huggingface dataset:
The p53 tumour suppressor gene
Authors: Steele R J C , Thompson A M , Hall P A , Lane D P
Published: March 2003

Background

Abnormalities of the p53 tumour suppressor gene are thought to be central to the development of a high proportion of human tumours. This article reviews current understanding of its function and potential clinical significance.

Methods

Material was identified from previous review articles, references cited in original papers, a Medline search of the literature over the 12 months to January 1998, and by scanning the latest issues of relevant journals.

Results and conclusion

p53 is considered to be a stress response gene, its product (the p53 protein) acting to induce cell cycle arrest or apoptosis in response to DNA damage, thereby maintaining genetic stability in the organism. These functions are executed by a complex and incompletely understood series of steps known as the ‘p53 pathway’, part of which involves induction of the expression of a number of other genes. As p53 is the most commonly mutated gene in human cancer, it has attracted a great deal of interest as a prognostic factor, diagnostic tool and therapeutic target. However, despite many promising studies, its potential in practical cancer management has still to be realized.
Pathophysiology and treatment of anterior rectal mucosal prolapse syndrome
Authors: Tsiaoussis J , Chrysos E , Glynos M , Vassilakis J S , Xynos E
Published: March 2003

Background

The study was designed to investigate the clinical presentation and laboratory findings of anterior rectal mucosal prolapse (ARMP) and to assess the results of two therapeutic modalities.

Methods

Some 162 women with ARMP were assessed clinically and by defaecography and rectoanal manometry before and 1 year after one or two sessions of submucosal sclerotherapy or, in the case of recurrence, after transanal excision of the prolapsing mucosa.

Results

Almost all patients reported a combination of symptoms suggesting obstructive defaecation. At defaecography anterior rectocele and excessive perineal descent at straining were present in 78 and 72 per cent respectively. The size of coexisting anterior rectocele and the extent of perineal descent were significantly related to the duration of the disease (P < 0·001). One or, in the event of recurrence, two sessions of sclerotherapy led to an overall success rate of 51 per cent. Improvement after sclerotherapy was associated with partial recovery of anal tone and improvement of anal sampling and rectal sensation. Failure of sclerotherapy was related to rectocele of larger size (P < 0·001) and a longer perineal descent at straining (P < 0·001) than in patients with a successful outcome. Excision of the prolapsing mucosa resulted in symptomatic improvement in 42 of 47 patients and was associated with significant improvement of the defaecographic and manometric findings.

Conclusion

ARMP is usually associated with anterior rectocele and excessive perineal descent. Submucosal sclerotherapy is successful in half of the cases, but only in the presence of a rather small anterior rectocele and short perineal descent. Failures after sclerotherapy can be treated by transanal excision of the prolapsing mucosa.
Survival following pancreatic carcinoma: a follow-up study of all cases recorded in Malmö, Sweden, 1977–1991
Authors: Hedberg M , Borgström A , Genell S , Janzon L
Published: March 2003

Background

The aim of this follow-up study was to assess whether there has been any increase in the percentage of patients offered attempted curative surgery for pancreatic carcinoma and whether the overall survival rate has improved, during the time period 1977–1991.

Methods

Details of new cases of pancreatic carcinoma arising in the population of Malmö during the study period were retrieved from the Local Tumour Register in Lund, Sweden. In all, 740 patients were found; 575 of these were diagnosed before death. Kaplan–Meier analysis was used to calculate overall survival rates, and Cox regression analysis was used to assess survival in relation to year of diagnosis after adjustment for sex, age at diagnosis and stage of disease.

Results

Cytological or histopathological evidence of the disease was given in 95 per cent of cases. The overall 5-year survival rate was 0·5 per cent (three of 575). Curative surgery was attempted in 24 patients (4·2 per cent); the proportion undergoing curative surgery increased in the last part of the study. Two of the 24 patients in this group survived for 5 years.

Conclusion

The prognosis in pancreatic carcinoma remains dismal. Attempted curative surgery still is the only hope for cure, but the group of patients that can be offered this possibility is very limited. In this study, an increase was found in the proportion of patients who were offered attempted curative surgery, but there was no statistically significant increase in the 5-year survival rate following surgery.
Radionuclide scanning in parathyroid diseases
Authors: Pattou F , Huglo D , Proye C
Published: March 2003

Background

New radionuclide agents and scanning procedures have markedly improved preoperative parathyroid gland localization. The aim of this review was to evaluate the results of parathyroid scanning and to clarify its current place in the clinical management of parathyroid diseases.

Methods

The literature describing the different radioisotopes and available scanning techniques was analysed and their clinical outcome in various parathyroid diseases was evaluated.

Results

Using 99mTc-radiolabelled sestamibi or other 99mTc-labelled cationic complexes, parathyroid scintigraphy detects 87 per cent of solitary adenomas (n = 894), 55 per cent of abnormal glands in patients with multiglandular disease (n = 303) and 75 per cent of persistent or recurrent lesions in patients with previous neck surgery (n = 240). If necessary, three-dimensional imaging techniques can clarify the spatial localization of an ectopic uptake focus. The positive predictive value of the available scanning procedures is over 95 per cent, but false-positive uptake may be encountered.

Conclusion

Radionuclide parathyroid gland scanning with 99mTc-labelled cationic complexes is the initial non-invasive method of choice for preoperative parathyroid gland localization in patients at special risk and/or with previous neck exploration. While scanning has also been proposed to facilitate parathyroidectomy, there is no objective evidence to support its routine use before a first-time surgical procedure.
Popliteal artery entrapment syndrome: collaborative experience of the Joint Vascular Research Group
Authors: Lambert A W , Wilkins D C
Published: March 2003

Background

Popliteal artery entrapment syndrome (PAES) is rare and probably underdiagnosed. This study reviewed a collected experience.

Methods

Patients were identified by the Joint Vascular Research Group (vascular surgeons from ten hospitals serving a population of approximately four million) during 1984–1995. Case notes were reviewed.

Results

Twenty-one legs in 17 patients were identified with PAES. There were 15 men and two women. The median age at presentation was 29 (range 14–45) years. One patient was excluded because no further information was available. PAES was bilateral in four patients in whom three legs were asymptomatic. At presentation, the duration of symptoms ranged from a few hours (acute leg ischaemia) to intermittent claudication of 6 years' duration. Primary investigation included angiography (20 patients), duplex imaging (four), plain radiography (one) and magnetic resonance imaging (one). In two cases, attempted thrombolysis failed. Surgery was carried out on 17 legs but failed in two. No amputations were required. Following surgery, 12 legs were asymptomatic and five had residual symptoms.

Conclusion

PAES should be excluded in young patients with intermittent claudication or acute ischaemia.
Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery
Authors: Jones A , Cahill D , Gardham R
Published: March 2003

Background

The risk of rupture of large abdominal aortic aneurysms (AAAs) remains uncertain. This study aimed to provide data to help decide whether or not to operate on high-risk patients.

Methods

Clinicians were asked to refer all patients with an AAA, even if unfit or elderly. One hundred and ninety-two patients with an intact AAA of 5 cm or greater in diameter were seen in 9 years; 59 had no elective operation and follow-up data were available for 57 at a minimum of 2 years. Initial AAA diameters were 5·0–5·9 cm (n = 25) and 6·0 cm or more (n = 32). Survival curves were constructed for both groups.

Results

At the end of the study 50 of 57 patients had died. Median survival was 18 (range 1–90) months. Twenty (35 per cent) suffered rupture at a median interval of 18 (range 1–38) months. The risk of rupture within 3 years was 28 (95 per cent confidence interval 12–49) per cent for 5·0–5·9-cm AAAs and 41 (24–59) per cent for AAAs of 6 cm or greater. In 133 elective AAA operations in fit patients the 30-day mortality rate was 3 per cent.

Conclusion

The risk of rupture within 3 years of diagnosis of an AAA of 5 cm or greater exceeds the expected operative mortality rate for fit patients. However, the majority of patients unfit for surgery died from other causes, and only a few would have benefited from aneurysm repair.
Plasma concentration of cytokine antagonists in patients with infection following liver resection
Authors: Kimura F , Miyazaki M , Suwa T , Sugiura T , Shinoda T , Itoh H , Ambiru S , Shimizu H , Nakagawa K
Published: March 2003

Background

The interactions between endogenous cytokine antagonists, surgical injury and perioperative infection are poorly understood.

Methods

Perioperative plasma concentrations of soluble tumour necrosis factor receptor p55 (STNFR p55), interleukin (IL) 1 receptor antagonist (IL-1ra) and IL-6 were measured by immunoassay in 29 consecutive patients undergoing liver resection.

Results

Plasma concentrations of STNFR p55, IL-1ra and IL-6 showed a striking increase immediately after operation (day 0) and on postoperative day 1. STNFR p55 concentrations correlated significantly with operating time (P < 0·05); IL-1ra levels with operating time, blood loss and weight of resected liver (P < 0·05); and IL-6 concentrations with operating time and blood loss (P < 0·05). Eight of the 29 subjects developed postoperative infections, of whom four had positive cultures of enteric organisms. Plasma STNFR p55 and IL-6 concentrations were significantly higher in the infected group than in the uninfected group (P < 0·05). STNFR p55 and IL-6 concentrations on day 0 differentiated between the two groups with a diagnostic accuracy of 79 and 83 per cent respectively.

Conclusion

These results suggest that STNFR p55, IL-1ra and IL-6 are produced during operation in response to surgical stress. This production of STNFR p55 and IL-6 may be enhanced further by intraoperative bacterial translocation. Measurement of plasma STNFR and IL-6 concentrations may predict the development of postoperative infectious complications.
Long-term outcome of necrotizing pancreatitis treated by necrosectomy
Authors: Tsiotos G G , Luque-De León E , Sarr M G
Published: March 2003

Background

Long-term functional outcome after operative treatment of necrotizing pancreatitis (NP) has not been studied extensively.

Methods

Pancreatic function, performance status, recurrence of symptoms and other related problems were analysed in 44 consecutive patients successfully discharged from hospital after operative necrosectomy (1983–1995) and followed up completely for a mean of 5 years.

Results

Clinical pancreatic insufficiency developed in half the patients. Diabetes mellitus (11 patients), steatorrhoea (six) or both (five) were associated with a mean estimate of 52, 66 and 67 per cent parenchymal necrosis respectively. Normal pancreatic function was associated with 27 per cent parenchymal necrosis (P < 0·05). Diabetes worsened while steatorrhoea tended to improve over time. Abdominal pain and pancreatitis recurred in six and two patients respectively. Performance status worsened in four patients because of recurrent pancreatitis and severe steatorrhoea. Poor long-term performance was associated with a higher Acute Physiology And Chronic Health Evaluation II score on admission (mean 14 versus 9).

Conclusion

NP has prominent effects on long-term pancreatic exocrine and endocrine function in half the patients, but most preserve a good overall functional status. The development of pancreatic insufficiency varies with the extent of pancreatic parenchymal necrosis.
Glutaraldehyde as a possible cause of diarrhoea after sigmoidoscopy
Authors: Hanson J M , Plusa S M , Bennett M K , Browell D A , Cunliffe W J
Published: March 2003

Background

An outbreak of proctitis at the start of a colorectal cancer screening programme utilizing flexible sigmoidoscopy prompted scrutiny of the incidence of this complication and the role of glutaraldehyde in its aetiology.

Methods

Questionnaires completed 1 day and 3 months after sigmoidoscopy were reviewed for 388 patients, and glutaraldehyde levels in the recycled rinse water of the endoscope washing machine were measured. The incidence of symptoms in the subsequent 612 patients after installation of a washer that does not recycle rinse water was examined.

Results

Five patients (1·3 per cent) presented to hospital with bloody diarrhoea occurring immediately after a normal flexible sigmoidoscopy. Repeat examination confirmed the presence of proctitis. Symptoms subsided rapidly with either no treatment or steroid enemas. Eight additional patients (2·1 per cent) recorded similar problems but received no treatment and the symptoms settled spontaneously. Glutaraldehyde levels rose progressively in the rinse water after each wash cycle with 2 per cent glutaraldehyde solution. Only one possible case of proctitis (0·2 per cent) was identified from the questionnaires completed by 612 patients after changing to a washer that did not recycle the rinse water.

Conclusion

These observations should prompt the careful assessment of cleaning techniques. The use of washing machines that do not recycle rinse water may avoid this complication.
Laparoscopic treatment of symptomatic cysts of the liver
Authors: Diez J , Decoud J , Gutierrez L , Suhl A , Merello J
Published: March 2003

Background

Reports of successful treatment of liver cysts by the laparoscopic approach prompted the use of this technique in a series of patients.

Methods

Ten patients with symptomatic liver cysts were treated by the laparoscopic deroofing technique. Eight patients had one solitary cyst, one had two cysts and the remaining patient had polycystic disease with a giant cyst. Hydatid disease was excluded serologically and radiologically but albendazole was used before operation in six cases because hydatid disease is endemic in Argentina.

Results

There was no surgical morbidity or death. For between 6 months and 3 years all patients were asymptomatic. Computed tomography showed recurrence of a cyst in one patient, who was successfully reoperated on laparoscopically.

Conclusion

Laparoscopic fenestration of either solitary or multiple liver cysts is the treatment of choice. It produces minimal surgical trauma, shorter hospital stay and avoids the morbidity of laparotomy. Reduced postoperative adhesions allows repeated procedures if the condition recurs.
Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication
Authors: Watson D I , Jamieson G G , Pike G K , Davies N , Richardson M , Devitt P G
Published: March 2003

Background

In the operative management of gastro-oesophageal reflux, a balance must be achieved between adequate control of reflux and excessive dysphagia. The ideal technique is not known. A randomized study was performed to determine whether laparoscopic anterior fundoplication is associated with a lower incidence of postoperative dysphagia than laparoscopic Nissen fundoplication, while achieving equivalent control of reflux.

Methods

Patients presenting for laparoscopic antireflux surgery were randomized to undergo either a Nissen fundoplication (n = 53) or an anterior 180° hemifundoplication (n = 54). Patients were blinded to which procedure had been performed, and follow-up was obtained by a blinded independent investigator. Standardized clinical grading systems were used to assess dysphagia, heartburn and patient satisfaction 1, 3 and 6 months after operation. Objective measurement of lower oesophageal sphincter pressure, oesophageal emptying time, distal oesophageal acid exposure and endoscopic healing of oesophagitis was also performed.

Results

Operating time was similar for the two procedures (58 min for the Nissen procedure versus 60 min for anterior fundoplication). Resting and residual lower oesophageal sphincter pressures were lower following anterior fundoplication (29 versus 18 mmHg, and 13 versus 6 mmHg), and oesophageal emptying times were faster (92 versus 116 s). Acid exposure times and ability to heal oesophagitis were similar. At 3 months' follow-up clinical outcomes were similar for the two procedures. At 6 months, however, patients who had undergone anterior fundoplication experienced significantly less dysphagia for solid food and were more likely to be satisfied with the clinical outcome.

Conclusion

Laparoscopic anterior fundoplication achieved equivalent control of reflux, more physiological postoperative manometry parameters, and an improved clinical outcome at 6 months. Continued follow-up remains necessary to confirm the long-term efficacy of the partial fundoplication procedure.
Diaphragmatic herniation following oesophagectomy
Authors: van Sandick J W , Knegjens J L , van Lanschot J J B , Obertop H
Published: March 2003

Background

Intrathoracic herniation of abdominal viscera is a potentially life-threatening condition, especially when diagnosis is delayed. The aim of this study was to estimate its incidence following oesophageal resection and to define contributing factors that might influence its occurrence.

Methods

All radiographic studies of the chest that were made during follow-up in a series of 218 patients who underwent oesophagectomy between 1993 and 1997 were reviewed.

Results

Herniation of bowel alongside the oesophageal substitute was detected in nine patients (4 per cent). Four hernias occurred within the first week after operation and five were detected at late follow-up. Surgical treatment was indicated in six patients. Analysis of predisposing factors revealed that extended incision and partial resection of the diaphragm were associated with an increased risk of postoperative hernia formation (four of 29 following extended enlargement versus five of 189 after routine opening of the oesophageal hiatus; P = 0·02).

Conclusion

Diaphragmatic herniation was found in 4 per cent of patients after oesophagectomy. After extended iatrogenic disruption of the normal hiatal anatomy, narrowing of the diaphragmatic opening may be indicated to avoid postoperative herniation of bowel into the chest. Awareness of its possible occurrence may help prevent the development of intestinal obstruction and strangulation.
Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn's disease
Authors: Orsoni P , Barthet M , Portier F , Panuel M , Desjeux A , Grimaud J C
Published: March 2003

Background

Endosonography and magnetic resonance imaging (MRI) are promising methods for evaluating perineal and anorectal fistulas or abscesses. The aim of this study was to compare the results of anal endosonography (AES), MRI and surgical exploration in the assessment of anorectal fistula or abscess complicating Crohn's disease.

Methods

Twenty-two patients with Crohn's disease, seven men and 15 women of mean age 38 (range 17–67) years, were included in this prospective study. All patients underwent AES (linear probe 7 MHz), MRI and operative assessment.

Results

AES and MRI demonstrated 14 and nine abscesses respectively, whereas 11 abscesses were confirmed by surgical exploration in ten patients. The sensitivity of AES and MRI as means of evaluating anorectal abscesses was 100 and 55 per cent respectively. The agreement per patient was 86 per cent (19 of 22) for AES and 59 per cent (14 of 22) for MRI. AES and MRI demonstrated 26 and 14 fistulas respectively, whereas 27 fistulas were confirmed during surgical exploration in 16 patients. The sensitivity of AES and MRI was 89 and 48 per cent respectively. The level of agreement per patient was 82 per cent (18 of 22) for AES and 50 per cent (11 of 22) for MRI.

Conclusion

AES with a linear probe is more accurate than MRI in detecting anorectal abscesses complicating Crohn's disease, and much more accurate in the evaluation of complex fistulas.
Topical phenylephrine increases anal sphincter resting pressure
Authors: Carapeti E A , Kamm M A , Evans B K , Phillips R K S
Published: March 2003

Background

Phenylephrine is an α1-adrenergic agonist which causes contraction of human internal anal sphincter muscle in vitro. Its intra-arterial administration in animals has been shown to increase resting sphincter pressure in vivo. In this study the effect of topical application of phenylephrine on resting anal pressure in healthy human volunteers was investigated.

Methods

Twelve healthy volunteers had measurements of maximum resting sphincter pressure (MRP) and anodermal blood flow taken before and after topical application of increasing concentrations of phenylephrine gel to the anus. To determine the duration of effect of the agent, readings were taken throughout the day after a single application.

Results

There was a dose-dependent rise in the resting anal sphincter pressure, with a small 8 per cent rise after 5 per cent phenylephrine (P = 0·012) and a larger 33 per cent rise with 10 per cent phenylephrine (mean(s.d.) MRP 85(12) cmH2O before versus 127(12) cmH2O after treatment, P < 0·0001). Thereafter no additional response was noted with higher concentrations of phenylephrine. The median duration of action of a single application of 10 per cent phenylephrine was 7 (range from 6 to more than 8) h.

Conclusion

Topical application of 10 per cent phenylephrine gel to the anus produces a significant rise in the resting anal sphincter pressure in healthy human volunteers. This represents a potential novel therapeutic approach to the treatment of passive faecal incontinence associated with a low resting anal sphincter pressure.
Intraobserver and interobserver agreement in anal endosonography
Authors: Gold D M , Halligan S , Kmiot W A , Bartram C I
Published: March 2003

Background

The aim of this study was to determine intraobserver and interobserver agreement for sonographic measurements of anal canal structures using anal endosonography (AES), and to determine interobserver agreement for the diagnosis of anal sphincter disruption.

Methods

Fifty-one consecutive patients referred for AES for the investigation of possible sphincter abnormality were examined. Studies were reviewed by two observers who measured anal canal structures at defined levels and locations, and recorded an opinion on sphincter integrity. Repeated measurements made by each observer were compared to determine intraobserver agreement, and measurements and diagnoses were compared between observers to determine interobserver agreement.

Results

Intraobserver agreement was better than interobserver agreement for measurements of anal canal structures. Interobserver limits of agreement for external sphincter measurements spanned 5 mm, whereas those for the internal sphincter spanned 1·5 mm. Interobserver agreement for diagnosis of sphincter disruption and internal sphincter echogenicity was very good (κ = 0·80 and 0·74 respectively).

Conclusion

The limits of agreement for intraobserver and interobserver measurements of anal canal structures on AES have been defined. Interobserver assessment of sphincter disruption is very good.
Intraoperative lymphatic mapping and sentinel lymph node biopsy for Merkel cell carcinoma
Authors: Hill A D K , Brady M S , Coit D G
Published: March 2003

Background

Merkel cell carcinoma is a rare cutaneous neoplasm which commonly spreads to the regional lymph nodes. The feasibility of identifying the sentinel node in patients with clinically node-negative Merkel cell carcinoma was evaluated.

Methods

Sentinel lymphatic mapping was performed in 18 patients with stage 1 Merkel cell carcinoma using the combination of isosulphan blue dye and 99mTc-radiolabelled sulphur colloid. Patients with tumour metastasis in the sentinel node underwent complete dissection of the remainder of the lymph node basin.

Results

Eighteen patients underwent removal of 35 sentinel nodes. Two patients demonstrated metastatic disease in the sentinel lymph nodes; complete dissection of the involved nodal basin revealed no additional positive nodes suggesting that the sentinel lymph node had been identified. The node-negative patients received no further surgical therapy, with no evidence of recurrent disease in the sentinel nodal basin at a median of 7 months' follow-up.

Conclusion

Sentinel node biopsy is feasible in patients with Merkel cell carcinoma. It can be used to stage patients and provides important prognostic information. In those with subclinical nodal disease, it may direct early regional lymphadenectomy but the effect of such surgery on survival remains unclear.
Survey of antibiotic prophylaxis in acute pancreatitis in the UK and Ireland
Authors: Powell J J , Campbell E , Johnson C D , Siriwardena A K
Published: March 2003

Background

Current surgical practice with regards to antibiotic prophylaxis in acute pancreatitis in the UK and Ireland was overviewed.

Methods

The 1103 members of the Association of Surgeons of Great Britain and Ireland were surveyed by postal questionnaire. A total of 528 replies were received (48 per cent). Following exclusion of surgeons not treating patients with acute pancreatitis, analysis was carried out on 429 replies.

Results

Respondents treated a median of 12 (interquartile range (i.q.r.) 10–20) patients per year with acute pancreatitis. Prophylactic antibiotic therapy was used by 88 per cent of responding surgeons, of whom 24 per cent used it in all cases. For surgeons professing selective use of antibiotics, the most common indication for use was in patients with prognostically severe disease. A cephalosporin was prescribed in 72 per cent of patients; cefuroxime was the single most common antibiotic. Combination therapy with metronidazole was used in 48 per cent of attacks. The median duration of antibiotic therapy was 5 (i.q.r. 5–7) days. An adverse drug reaction attributable to the use of prophylactic antibiotics was reported by 11 per cent of respondents.

Conclusion

This study has established that a significant body of clinicians charged with the responsibility of treating acute pancreatitis use antibiotic prophylaxis in the initial treatment of patients with predicted severe disease.
Preliminary report on local resection with lymphadenectomy for early gastric cancer
Authors: Seto Y , Nagawa H , Muto Y , Kaizaki S , Kitayama J , Muto T
Published: March 2003

Background

The frequency of lymph node metastasis in mucosal gastric cancers 2–4 cm in diameter was low (three (1·3 per cent) of 234) in patients treated in this unit between 1966 and 1995. This study was a prospective report on local resection with lymphadenectomy for early gastric cancer.

Methods

Eight patients with a single early gastric cancer underwent local resection with lymphadenectomy. The tumour was excised with a non-cancerous rim of approximately 2 cm. The extent of lymphadenectomy depended on tumour location. Intraoperative endoscopic examination and frozen-section analysis of the dissected nodes were used to determine the resection line and evaluate nodal status.

Results

Mean operating time, blood loss and number of dissected nodes were 171 min, 87 ml and 8 respectively. There were no operative complications. Cancer invasion was confined to the mucosa in six tumours but two patients had minute submucosal invasion. The maximum diameter of the resected specimens was 10 cm and no nodal involvement was detected. No patient developed postgastrectomy syndrome.

Conclusion

For selected patients with early gastric cancer, local resection with lymphadenectomy can provide a good quality of life without compromising cure rate.
Comparison of two closure techniques for the repair of experimental colonic perforations
Authors: Edwards D P , Warren B F , Galbraith K A , Watkins P E
Published: March 2003

Background

Primary repair of penetrating wounds of the colon is gaining increasing acceptance in surgical practice. This study compared two techniques for the repair of experimental colonic perforations in the presence of peritonitis.

Methods

Multiple colonic perforations were created in the colon of 24 pigs. Following a 6-h delay the perforations were closed either by local excision and suture or by skin staples applied to the seromuscular layers of the colon. The repairs were assessed biomechanically and histologically for up to 14 days after surgery.

Results

All animals had diffuse peritonitis at the time of colonic repair. Stapled repairs were completed significantly faster than sutured repairs (mean(s.d.) 4·8(1·6) versus 30·7(4·0) min, P < 0·001). Bio-mechanical evaluation of repairs revealed no significant differences between the two techniques. Histological examination of repairs closed by staples demonstrated more advanced healing compared with suture closure, on the basis of tissue apposition and inflammatory changes.

Conclusion

Experimental colonic injuries may be treated successfully by primary repair in the presence of peritonitis. The use of skin staples for repair does not appear to prejudice colonic wound healing.
Comparative study of two sites of colonic conduit placement in the treatment of constipation due to rectal evacuatory disorders
Authors: Eccersley A J P , Maw A , Williams N S
Published: March 2003

Background

Chronic constipation may be treated by antegrade colonic irrigation via a colonic conduit.

Methods

Two alternative sites of colonic conduit construction were evaluated for their effect on the symptoms of 21 consecutive women with intractable constipation primarily due to rectal evacuatory disorders. The conduit was constructed in the sigmoid colon in the first 11 patients and in the transverse colon in the subsequent ten. Symptomatic outcome was evaluated clinically and by questionnaires, with a prospective quality of life assessment in the transverse group.

Results

During a median follow-up of 12 (range 6–60) months, reflux or stenosis necessitated revision or dilatation in six patients. Irrigation with a median of 1·3 (0·8–2·0) litres of water achieved evacuation in all patients. Improvements in abdominal pain and bloating were reported by seven of the ten patients in the transverse conduit group, but benefit was found in only three of 11 in the sigmoid group. There was no significant improvement in quality of life scores. In the medium term, seven patients retained a transverse conduit compared with three with a sigmoid conduit.

Conclusion

The transverse colonic conduit offers better relief from the symptoms of constipation due to rectal evacuatory dysfunction than the sigmoid conduit.
Appropriate use, complications and advantages demonstrated in 500 consecutive needle catheter jejunostomies
Authors: Sarr M G
Published: March 2003

Background

The ability to deliver nutrition enterally after operation has been a significant advance in managing patients after major intra-abdominal operations.

Methods

The experience of a single surgeon at a tertiary referral hospital over a 10-year period with insertion and use of 500 consecutive needle catheter jejunostomies (NCJs) was reviewed critically from prospectively collected data.

Results

The NCJ was used to deliver nutrition in 93 per cent, fluid and electrolytes in 95 per cent, and various medications in the postoperative period in the majority of patients. There were three major complications: small bowel obstruction and pneumatosis intestinalis in one and two patients respectively. Minor complications included diarrhoea (15 per cent), abdominal distension (15 per cent), abdominal cramps (3 per cent), subcutaneous infection at the insertion site (1 per cent) and catheter occlusion precluding use (1 per cent). In 16 patients, the NCJ was replaced percutaneously with a larger-bore catheter for more prolonged enteral feeding at home after discharge.

Conclusion

Through the experience gained, indications are offered for the placement of NCJs and cautions are provided concerning appropriate use of an NCJ to provide nutritional support, fluid and electrolyte replacement or maintenance, and safe enteral administration of medication. Overall, an NCJ appears to allow safer, cheaper and equally effective delivery of nutrition compared with total parenteral nutrition after major intra-abdominal operations.
Clinical significance of telomerase activity in the non-cancerous epithelial region of oesophageal squamous cell carcinoma
Authors: Koyanagi K , Ozawa S , Ando N , Takeuchi H , Ueda M , Kitajima M
Published: March 2003

Background

The aim of this study was to examine telomerase activity in affected and adjacent tissue in patients with oesophageal squamous cell carcinoma (SCC).

Methods

Telomerase activity was measured in oesophageal SCC cells, normal oesophageal culture cells, primary cancer tissues and adjacent normal tissues from patients with oesophageal SCC using a polymerase chain reaction-based assay.

Results

All oesophageal SCC cells had telomerase activity, whereas normal cultured cells showed no activity. All 57 cancer tissues showed telomerase activity compared with only five (10 per cent) of 50 normal tissues. Cancer cells infiltrating the vessels of mucosal or submucosal tissues in non-cancerous regions were detected in four of five telomerase-positive normal tissues, whereas such infiltration was detected in only three of 45 telomerase-negative normal tissues.

Conclusion

In patients with oesophageal SCC, measurement of telomerase activity in normal epithelium is a highly sensitive method of detecting the microinvasion of cancer cells.
Laparoscopic surgery for colonic polyps
Authors: Eijsbouts Q A J , Heuff G , Sietses C , Meijer S , Cuesta M A
Published: March 2003

Background

Benign colonic polyps that are impossible to remove with the aid of the flexible colonoscope because of their size or location must be removed surgically.

Methods

Twenty patients with colonic adenomatous polyps that could not be resected by colonoscopy because of size or difficult location (n = 18) or polyps in combination with diverticulitis (n = 2) underwent polyp removal through a small ‘assisted’ incision in the abdominal wall using a standard ‘dissection-facilitated’ laparoscopic approach to the affected colonic segment.

Results

In six patients the polyp was removed through a colotomy, in three through a limited resection (two ileocaecal and one limited sigmoid resection) and in 11 through a standard colectomy (four right hemicolectomy, one left hemicolectomy, four sigmoid and two anterior resections) because of suspicion of cancer. In only one patient could the polyp not be found during laparoscopy, resulting in a second conventional surgical intervention. In four patients carcinoma was diagnosed in the specimen.

Conclusion

Precise preoperative localization of the polyp and the use of dissection-facilitated laparoscopic colonic surgery make laparoscopic removal of benign colonic polyps an alternative to an open procedure.
Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy
Authors: Dudley N E , Harrison B J
Published: March 2003

Background

This study reviewed the results of initial experiences of open posterior adrenalectomy and transperitoneal laparoscopic adrenalectomy in 46 patients.

Methods

Twenty-three adrenalectomies were performed using the open posterior approach. Detailed records of the patients' operative and postoperative progress were compared with those of the first 36 laparoscopic adrenalectomies undertaken for a similar range of conditions.

Results

Conversion to laparotomy was necessary in one of 23 open posterior adrenalectomies and five of 36 laparoscopic adrenalectomies. The mean operating time for laparoscopic unilateral adrenalectomy was nearly double that for open surgery (158 versus 85 min). Postoperative complications occurred more frequently in the open adrenalectomy series (12 of 23 versus two of 36) but one late unexplained death followed bilateral laparoscopic adrenalectomy. A mean reduction in hospital stay of 5 days was recorded after laparoscopic adrenalectomy (range 2–5 days for laparoscopic versus 6–11 days for open operation).

Conclusion

Transperitoneal laparoscopic adrenalectomy was attended by a lower morbidity rate than open adrenalectomy and patients were discharged from hospital more quickly.
Deep venous thrombosis in peripheral vascular disease
Authors: Libertiny G , Hands L
Published: March 2003

Background

This prospective study aimed to determine the prevalence of lower limb deep venous thrombosis in patients with peripheral vascular disease (PVD).

Methods

Some 136 patients admitted for arteriography, angioplasty or arterial reconstruction with limiting claudication (n = 72), ischaemic rest pain (n = 26) or gangrene (n = 38) and 40 control subjects admitted for general surgical procedures but without evidence of PVD were screened with colour duplex ultrasonography for the presence of venous thrombosis in the lower limb deep veins before any surgical or radiological procedures were undertaken. Patient age, the ankle: brachial pressure index (ABPI) and the presence of other risk factors for venous thromboembolism were also recorded.

Results

Venous thrombosis was found in 27 of 136 patients with PVD and two of 40 control patients (P = 0·03). Logistic regression analysis demonstrated that decreasing ABPI independently contributed to an increased risk of deep venous thrombosis.

Conclusion

There was a high prevalence of venous thrombosis among patients with PVD which was related to the severity of the ischaemia.
Trefoil peptides and surgical disease
Authors: Longman R J , Thomas M G , Poulsom R
Published: March 2003

Background

Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides appear to be important in mucosal healing processes and in neoplastic disease.

Methods

This manuscript reviews the relevant literature obtained by an extensive text word search of the Medline database and a manual search of references from the articles identified.

Results and Conclusion

Trefoil peptides are aberrantly expressed by a wide range of human carcinomas and gastrointestinal inflammatory conditions. They impart protection from injury to the gastrointestinal mucosa by possible interaction with mucin glycoproteins. Trefoil peptides influence epithelial cell migration and mucosal restitution following injury. In the future, serum levels of trefoil peptides might be used as markers for both neoplastic and inflammatory diseases. In addition, novel therapies based on such peptides might be used for gastrointestinal inflammatory conditions and to accelerate repair of the gastrointestinal mucosa after surgery.
Spiral computed tomography for preoperative staging of potentially resectable carcinoma of the pancreatic head
Authors: Phoa S S K S , Reeders J W A J , Rauws E A J , de Wit L , Gouma D J , Laméris J S
Published: March 2003

Background

Pancreatic cancer is often locally invasive. Preoperative staging attempts to identify patients suitable for resection, in order to minimize unnecessary operations. The aim of this study was to assess the improved imaging provided by spiral computed tomography (CT) in the preoperative staging of potentially resectable pancreatic head carcinoma.

Methods

In 56 consecutive patients with pancreatic head carcinoma spiral CT findings were correlated prospectively with operative and histopathological findings. Criteria for irresectability at CT were infiltration of the peripancreatic fat and vascular ingrowth grade D, on a scale from A to F.

Results

At operation 27 (48 per cent) of 56 tumours were irresectable. Small metastases were found in seven patients (12 per cent). Ingrowth (adherence) to the portal or mesenteric vein was present in 19 patients (34 per cent). The sensitivity and specificity of CT for irresectability were 78 and 76 per cent respectively. Resection rates with a vascular margin free of tumour were 100 per cent for grade A, 63 per cent for grade B, 44 per cent for grade C, 15 per cent for grade D and 0 per cent for grade E, with a predictive value for ingrowth of 88 per cent for grades D or higher. The resectability rate was 11 per cent (one of nine) when infiltration of the anterior peripancreatic fat was present and 67 per cent when infiltration was absent (P < 0·01).

Conclusion

Spiral CT with thin slices seems to improve detection of distant metastases and vascular ingrowth in patients with pancreatic head carcinoma.
Biphasic role for nitric oxide in experimental renal warm ischaemia–reperfusion injury
Authors: Weight S C , Furness P N , Nicholson M L
Published: March 2003

Background

Whilst nitric oxide has a clearly defined role in renal haemostasis, debate continues over its pathophysiology. This study investigated the function of nitric oxide in a model of renal warm ischaemia–reperfusion injury.

Methods

Rats underwent bilateral renal warm ischaemia (45 min) after pretreatment with nitric oxide donors, nitric oxide synthase (NOS) inhibitors or saline (control). Following reperfusion (20 min) a unilateral nephrectomy was performed to measure renal nitric oxide (as nitroxides) and oxidative DNA and protein damage. Renal function was measured on days 2 and 7 before terminal nephrectomy for analysis and morphology.

Results

The increase in renal nitric oxide level seen early in reperfusion (20 min) (P < 0·01) was prevented by inhibition of constitutive (cNOS) but not inducible (iNOS) NOS. The increase in oxidative damage (P < 0·01) was exacerbated by nitric oxide donors (P < 0·01) but ameliorated by NOS inhibition (P < 0·01). Control nitric oxide remained increased through to day 7 (P < 0·01) but was reduced by nitric oxide donors and cNOS inhibitors (P < 0·05). Oxidative damage returned towards normal in the control group, whereas both DNA and protein damage persisted following NOS inhibition (P < 0·01).

Conclusion

Inhibition of the postischaemic increase in the level of nitric oxide was associated with an early decrease in, but eventual exacerbation of, oxidative damage. This suggests the prolonged increase in renal nitric oxide concentration was cytoprotective overall.
Consultant surgeons' opinion of the skills required of basic surgical trainees
Authors: Baldwin P J , Paisley A M , Brown S Paterson
Published: March 2003

Background

Accurate and appropriate assessment of surgical trainees requires clear determination of the skills needed for surgical competence. This study was designed to identify those skills, rank them in order of importance and translate them into behavioural terms.

Methods

A Delphi technique, using anonymous postal questionnaires, was used. All consultant surgeons in South-East Scotland were asked to identify the skills they expected of surgical trainees. Skills identified were then returned to all consultants for weighting. Differences among specialties in the importance of each item were identified using analysis of variance.

Results

The qualities identified fell into five domains: technical skills, clinical skills, interaction with patients and relatives, teamwork, and application of knowledge. Consultants from all specialties gave high weightings to the generic domains of clinical skills, teamwork, and interaction with patients and relatives.

Conclusion

This study has identified the skills considered necessary by consultant surgeons in Scotland for a successful surgical career. Contrary to expectation, consultant surgeons value many generic skills more highly than technical skills, indicating that they value well rounded doctors, not just those with technical ability. The characteristics identified are being used to develop an assessment tool for use on basic surgical trainees.
Impact of laparoscopic colonic resection on tumour growth and spread in an experimental model
Authors: Gutt C N , Riemer V , Kim Z G , Jacobi C A , Paolucci V , Lorenz M
Published: March 2003

Background

The influence of surgical manipulation and carbon dioxide pneumoperitoneum on intraperitoneal tumour growth and port-site metastasis during laparoscopic colon resection is still unknown.

Methods

Some 33 male WAG/Rij rats were randomized into three experimental groups: a laparoscopy group with carbon dioxide pneumoperitoneum (n = 11), a gasless laparoscopy group (n = 11) and a laparotomy group (n = 11). After transanal injection of a tumour cell suspension (1 × 106 CC 531 cells) into the distal colon, a colon segment resection and an end-to-end anastomosis (laparoscopy; intra-abdominal technique) were performed. Tumour growth was scored semiquantitatively 24 days after the operation. Data were analysed by the Kruskal–Wallis test.

Results

The tumour indices from the four locations with the greatest tumour growth were significantly decreased in the laparoscopy group with carbon dioxide pneumoperitoneum compared with the gasless laparoscopy and laparotomy groups (P < 0·01). Port-site metastases were significantly decreased in the carbon dioxide pneumoperitoneum group compared with the gasless laparoscopy group (P = 0·05).

Conclusion

A full laparotomy incision promotes greater tumour growth than does carbon dioxide pneumoperitoneum. Surgical manipulation stimulates local tumour spread more than the establishment of a carbon dioxide pneumoperitoneum.
Postoperative peritonitis originating from the duodenum: operative management by intubation and continuous intraluminal irrigation
Authors: Parc Y , Frileux P , Vaillant J C , Ollivier J M , Parc R
Published: March 2003

Background

The mortality rate associated with postoperative peritonitis remains high, especially when the source of infection cannot be eradicated. Such is the case with peritonitis arising from the duodenum, as primary closure is futile and intubation alone may be followed by local complications.

Methods

Forty-nine consecutive patients with postoperative peritonitis originating from a duodenal leak and a mean Acute Physiology And Chronic Health Evaluation II score of 17·7 were treated according to the following procedure: a three-channelled spiral drain was inserted through the leak and extraluminal drains were placed near the duodenal defect. Intraluminal irrigation was undertaken immediately through the infusion channel of the spiral drain.

Results

Eleven patients died and 26 suffered complications. The mean duration of intubation was 21 days.

Conclusion

Intubation with intraluminal irrigation has proved effective in a homogeneous group of patients with peritonitis due to duodenal leakage.