bluuebunny/crossref_metadata_2025 huggingface dataset:
Simple method of orientating breast biopsies following hook-wire or ultrasonographic localization of impalpable mammographic abnormalities
Authors: D'Costa H , Barham C P , Jones P A , Teasdale C , Watkins R M
Published: March 2007

Localization of impalpable breast lesions with fine wires is standard practice and several variations of the hook-wire device have been described1. More recently ultra-sonography2 has been used as an accurate and rapid method of preoperative localization of mass lesions. Accurate biopsy of all clinically impalpable suspicious mammographic abnormalities is essential and complete excision is important in those patients with malignant disease3. Having performed a localization biopsy, precise specimen orientation allows further excision if original margins are involved. A simple and inexpensive method of orientating tissue specimens following excision biopsy is described.
Analysis of 8651 appendicectomies in England and Wales during 1992
Authors: Baigrie R J , Dehn T C B , Fowler S M , Dunn D C
Published: March 2007

In 1990 the Royal College of Surgeons of England established the Comparative Audit Service to enable surgeons to compare their results with those of other colleagues. In addition, the large volume of collected data provides insight into national patterns of surgical practice. In 1992 data were collected for a range of operations including appendicectomy, resulting in by far the largest single analysis in the international literature of this common surgical problem.
Expression of tenascin in gastric carcinoma
Authors: Ilunga K , Iriyama K
Published: March 2007

Tenascin expression was determined by an immuno-histochemical technique in 120 surgical specimens of gastric carcinoma to investigate its relationship with clinicopathological factors. Tenascin expression was more prominent in the neoplastic area than in the adjacent non-neoplastic mucosa. Tenascin was frequently observed in gastric mucosa with diffuse chronic gastritis, glandular atrophy and intestinal metaplasia. In the neoplastic area, tenascin expression was positive in 72 cases (60 per cent). Tumours with a high frequency of tenascin expression included: Borrmann type II (19 of 20), well or moderately differentiated tumours (52 of 63), tumours with expansive growth and with an intermediate growth pattern (40 of 42), and those with a medullary or intermediate-type stroma (55 of 73). There was no significant relationship between tenascin expression and age, sex, depth of tumour invasion, lymph node metastasis, invasion to lymphatic vessel, venous invasion and the 4-year survival rate.
Management of bile leaks after laparoscopic cholecystectomy
Authors: Barton J R , Russell R C G , Hatfield A R W
Published: March 2007

The success of laparoscopic cholecystectomy has been tarnished by the increased risk of bile duct damage associated with the operation. Many of these injuries can be managed by endoscopic techniques. Experience of such injuries between 1991 and 1994 was reviewed. Twenty-four patients were referred: 11 with injuries to the cystic duct alone, five with complete hepatic duct obstruction and eight with high bile duct leaks. All patients with leaks from the cystic duct were managed successfully endoscopically (sphincterotomy, four; stent, seven) without recourse to further surgery. Patients with complete obstruction were aided in their recovery by endoscopic and percutaneous techniques, either for postoperative problems (two patients) or in preparation for surgery (three). The eight patients with high bile duct leaks were managed endoscopically by stenting (seven patients) or sphincterotomy (one). Stenting appeared to encourage leaks to heal better than sphincterotomy alone; stents should probably be left in situ for 2 months before removal. There were no deaths and all but one patient had normal biliary function at follow-up. It is suggested that all suspected injuries after biliary surgery require management by a combination of interventional radiology and endoscopic interventional techniques. Surgery may be required only if there is complete obstruction of the biliary tree.
Transplantation for fulminant and subfulminant hepatic failure with preservation of portal and caval flow
Authors: Belghiti J , Noun R , Sauvanet A , Durand F , Aschehoug J , Erlinger S , Benhamou J P , Bernuau J
Published: March 2007

This article describes experience with preservation of portal and caval flow during orthotopic liver transplantation (OLT) for fulminant or subfulminant hepatic failure (FSHF) as an alternative to venous bypass. As a modification of the standard procedure, hepatectomy and graft implantation were performed with preservation or caval patency in combination with a temporary portocaval shunt. From July 1991 to March 1994, 25 consecutive patients with FSHF underwent OLT with preservation of portal and caval flow. All patients had severe confusion (n = 9) or coma (n = 16) with a mean(s.d.) clotting factor V of 13(5) per cent and a mean(s.d.) serum bilirubin level of 408(151) μmol/l. During the anhepatic phase, haemodynamic data showed a preservation of cardiac filling pressure, mean arterial pressure, and renal perfusion pressure, while the mean(s.d.) urine flow was maintained at 182(120) ml/h. Venous bypass was not required. There were three (12 per cent) deaths after the operation, and all survivors made a full neurological recovery. Normal postoperative creatinine values allowed the early use of baseline immunosuppression. The authors conclude that, in patients with FSHF, successful liver transplantation can be achieved with this technical procedure.
Laparoscopic adrenalectomy
Authors: Deans G T , Kappadia R , Wedgewood K , Royston C M S , Brough W A
Published: March 2007

This report describes the initial collective experience of a group of British surgeons in performing laparoscopic adrenalectomy.
Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy
Authors: Ho Y-H , Foo C L , Seow-Choen F , Goh H S
Published: March 2007

A prospective randomized controlled trial was carried out on the effects of Daflon 500 mg (a micronized flavonidic fraction containing diosmin 450 mg and hesperidin 50 mg) on bleeding after haemorrhoidectomy. In all, 228 consecutive patients with prolapsed irreducible piles were recruited. Elective haemorrhoidectomy was performed with a standardized diathermy excision method. Some 114 patients were randomized to receive Daflon 500 mg for 1 week after operation (group 1), and there were 114 controls (group 2). Postoperative analgesia and laxative prescription as well as hospital stay were otherwise the same. One patient (0·9 per cent) from group 1 and seven (6·1 per cent) from group 2 had postoperative bleeding (P=0·03). All bleeding occurred from 6 to 15 days after haemorrhoidectomy. There were no side-effects from the use of Daflon 500 mg. The risk of secondary bleeding from haemorrhoidectomy is reduced with postoperative Daflon.
Experimental study to show that growth hormone treatment before trauma increases glutamine uptake in the intestinal tract
Authors: Mjaaland M , Unneberg K , Jenssen T G , Revhaug A
Published: March 2007

This study examined whether growth hormone treatment deprived the intestinal tract of glutamine after trauma. Piglets were treated with growth hormone 24 units daily 3 days before and at the start of the trauma (GH-3, n = 8) or at the start of the trauma only (GH-i, n = 8). Eight piglets acted as non-treated controls. The trauma consisted of a standardized abdominal surgical procedure. Primed constant infusions of U-14C-glutamine were given. Intestinal, hepatic, renal and hindleg—glutamine fluxes were measured. Growth hormone treatment increased mean(s.e.m.) net intestinal glutamine uptake: GH-3, 39·7(9·4) and 48·7(12·7) μmol/min; GH-1, 33·2(5·5) and 25·7(12·3) μmol/min; controls, 19·5(10·3) and 2·0(15·3) μmol/min at 1 h and 5 h after trauma, respectively, (P = 0·02). The treatment increased glutamine oxidation (P = 0·025), and decreased hindleg glutamine net (P = 0·0052) and absolute release (P = 0·0063), glutamine rate of appearance (P = 0·01), and percentage of glucose coming from glutamine (P = 0·05). Growth hormone treatment before trauma increased mtestinal glutamine uptake.
Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing
Authors: Osther P J , Gjøde P , Mortensen B B , Mortensen P B , Bartholin J , Gottrup F
Published: March 2007

A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P 0·04). Monofilament polyglyconate suture does not reduce the incidence of fascial disruption and incisional hernia after laparotomy in patients with suspected impaired wound healing but the incidence of wound infection may be reduced compared with that of multifilament polyglycolic acid suture.
Upper-limb arterial disease in women treated for breast cancer
Authors: Taylor P J , Cooper G G , Sarkar T K
Published: March 2007

A 5-year cohort of patients treated 15–19 years previously for breast cancer was studied to establish the prevalence of symptoms and objective evidence of circulatory insufficiency in the upper limbs. There were 187 survivors of the original cohort of 665. In all, 102 patients were evaluated; 50 had received radiotherapy in addition to surgery. Irradiated and non-irradiated groups were comparable for age, extent of axillary dissection and vascular risk factors. Both arms were assessed for symptoms and examined by Doppler ultrasonographically derived segmental pressures and hyperaemia testing, Doppler ultrasonographic waveform analysis, pulse volume recording and venous outflow air plethysmography. Seven ipsilateral arms (14 per cent) in patients given radiotherapy were symptomatic, compared with four (8 per cent) in those receiving surgery alone, and two contralateral control arms (2 per cent). Evidence of arterial disease was found in 11 ipsilateral arms of patients given radiotherapy (22 per cent) and two ipsilateral arms of those receiving surgery alone (4 per cent) (P < 0·03). There was no association between symptoms and evidence of arterial disease, and no evidence of abnormal venous function.
Effect of aberrant hepatic arterial anatomy on tumour response to hepatic artery infusion of floxuridine for colorectal liver metastases
Authors: Burke D , Earlam S , Fordy C , Allen-Mersh T G
Published: March 2007

Regional hepatic artery infusion of colorectal liver metastases produces the highest reported treatment response. The effect of variation in hepatic artery anatomy on tumour response to regional floxuridine (FUdR) was studied. Aberrant hepatic arterial anatomy occurred in 13 of 74 patients (18 per cent) who underwent cannulation of the hepatic artery and infusion of FUdR for colorectal liver metastases. The non-dominant hepatic artery was ligated and the dominant artery cannulated in those with aberrant anatomy. Despite evidence of a collateral circulation to the non-dominant area of the liver in these patients, there was no significant reduction in median tumour volume with treatment (before treatment 214 ml, after treatment 339 ml). By contrast, there was a significant (P < 0·001) decrease in median tumour volume (before treatment 329 ml, after treatment 148 ml) in those with normal anatomy. Delivery of FUdR to metastases via an intrahepatic collateral circulation was not as effective as through a main hepatic artery.
Tissue factor expression correlates with histological grade in human pancreatic cancer
Authors: Kakkar A K , Lemoine N R , Scully M F , Tebbutt S , Williamson R C N
Published: March 2007

The transmembrane cellular receptor tissue factor (TF) is the primary initiator of the coagulation cascade in man. Expression of TF was determined in 55 specimens of ductal adenocarcinoma of the pancreas and was found to correlate strongly with the degree of histological differentiation. A significant linear trend was observed with stronger immunoreactivity observed in poorly differentiated tumours (X2 = 6·69, P = 0·0098). No TF staining was seen in pancreatic samples from normal controls (n = 18). As expression of TF may be associated with tumour progression, its analysis could provide useful prognostic information in patients with pancreatic malignancy.
Inflammatory bowel disease in primary sclerosing cholangitis: An analysis of patients undergoing liver transplantation
Authors: Miki C , Harrison J D , Gunson B K , Buckels J A C , McMaster P , Mayer A D
Published: March 2007

Fifty-five patients undergoing orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) were reviewed retrospectively. After OLT there were significantly more episodes of acute rejection in 31 patients with a previous history of inflammatory bowel disease (IBD) than in 24 without such a history. Patients who had severe acute rejection were significantly younger at diagnosis of IBD. Five patients with histological features suggestive of recurrent PSC after OLT were significantly younger at the time of transplantation than those who did not develop recurrence. Patients with poor control of IBD after OLT had a significantly lower age at diagnosis of bowel inflammation. The presence of IBD did not affect the outcome after OLT, but was associated with a higher rate of acute rejection. Younger patients had a greater risk of developing severe rejection, recurrent PSC and poor control of IBD after liver transplantation.
Effective administration of heparin and antibiotic prophylaxis
Authors: Avery C M E , Jamieson N , Calne R Y
Published: March 2007

A prospective audit was performed to determine whether new departmental procedures had improved the administration of heparin and antibiotic prophylaxis in patients undergoing major surgery who were at risk of deep vein thrombosis, pulmonary embolism and postoperative wound infection. The results are compared with a previous retrospective audit of the same ‘at-risk’ groups. A significant improvement in prophylaxis administration is demonstrated.
Local excision of rectal tumours
Authors: Banerjee A K , Jehle E C , Shorthouse A J , Buess G
Published: March 2007

Local excision of colorectal tumour may be palliative or curative. Recent advances in minimal access techniques have allowed curative excision to be offered to a wider range of patients. Absolute indications for potentially curative local excision include mobile tumours, T1 tumours (assessed by ultrasonography), well or moderately differentiated histology (determined by biopsy) and tumour size less than 3 cm. Relative indications include T2 and T3 tumours (by ultrasonography), poorly differentiated histology (by biopsy) and tumour size greater than 3 cm depending on patient fitness. The rationale for these recommendations is described in detail.
Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction
Authors: Gee A S , Durdey P
Published: March 2007

A proportion of patients with faecal incontinence experience debilitating urgency of defaecation and urge incontinence. This study prospectively assessed 56 faecally incontinent patients by means of standard interview, physical examination and anorectal physiology. Patients with urge incontinence, when compared with those without urge incontinence, were symptomatically worse, had had more vaginal deliveries and had more bowel actions each day. Physiological tests included anal manometry, anal electrosensitivity, pudendal nerve terminal motor latency and a standard proctometrogram. The only physiological differences between the groups were a reduction in voluntary squeeze pressure (median (interquartile range (i.q.r.)) 43 (26–67) versus 67 (45–122) mmHg, P = 0.01) and a smaller percentage change in pressure-volume, an integral of sphincter length and squeeze (median (i.q.r.) 43.5 (0–289) versus 247 (71–455), P = 0.02), in those with urgency. The authors conclude that urge incontinence is associated with impairment of the striated musculature of the anal sphincter complex.
Nitrergic inhibitory innervation of porcine rectal circular smooth muscle
Authors: Stebbing J F , Brading A F , Mortensen N J McC
Published: March 2007

This study was performed to determine whether nitric oxide contributes to inhibitory non-adrenergic non-cholinergic (NANC) neurotransmission in the circular smooth muscle layer of pig rectum. Smooth muscle strips were mounted for isometric tension recording in superfusion organ baths. In the presence of atropine sulphate and guanethidine, transmural electrical field stimulation (EFS) produced frequency-dependent relaxation of precontracted muscle strips. Nω-nitro-l-arginine (l-NOArg), a powerful competitive antagonist of nitric oxide synthase, reduced the relaxant response in dose-dependent fashion; this response was maximally reduced by mean(s.e.m.) 86.5(2.6) per cent (P = 0.0003) at a concentration of 3 × 10−5 mol/l l-NOArg. The response was restored by the addition of l-arginine. Sodium nitroprusside, an exogenous donor of nitric oxide, mimicked the relaxant response. Responses to EFS were abolished by tetrodotoxin. These results suggest that inhibitory NANC neurotransmission in this tissue is mediated, at least in part, by nitric oxide. The failure of l-NOArg to completely abolish the relaxant response suggests that additional neurotransmitters may be involved.
Primary soft tissue sarcoma of the extremities in adults
Authors: Karakousis C P , Proimakis C , Walsh D L
Published: March 2007

The modern literature on adult extremity sarcoma implies that adjuvant therapy (usually irradiation) is mandatory for adequate local control, at least in patients with high-grade tumours undergoing limb-sparing procedures. In 152 primary extremity soft tissue sarcomas, wide or radical resection was employed (116 patients) including amputation in nine patients (6 per cent), or local excision followed by adjuvant postoperative radiation therapy (36). Local recurrence alone occurred in 5 per cent of patients, and in combination with distant metastases in 9 per cent. The total rate of local recurrence was 10 per cent after wide resection (with or without chemotherapy) and 25 per cent after conservative resection and radiotherapy (with or without chemotherapy). Limb sparing was possible in 94 per cent of patients. The majority (76 per cent) had surgical resection alone as local treatment with satisfactory results. Wide resection, when feasible, provides acceptable local control and may be preferable to local excision plus radiation therapy.
Clinical outcome and restenosis following percutaneous transluminal angioplasty for ischaemic rest pain or ulceration
Authors: Ray S A , Minty I , Buckenham T M , Belli A-M , Taylor R S , Dormandy J A
Published: March 2007

The role of percutaneous transluminal angioplasty in the management of severe leg ischaemia is controversial. To investigate further the efficacy of angioplasty and the clinical consequences of restenosis, a randomly selected cohort of 29 patients with ischaemic rest pain or ulceration was studied for 6 months after a technically successful balloon angioplasty. All patients had digital subtraction arteriography at the end of follow-up. Seven of 15 patients undergoing the procedure for rest pain had sustained relief from the initial dilatation. Partial or complete healing was noted in all 14 patients with ulceration and was maintained at 6 months in 11 despite significant (greater than 30 per cent) restenosis at the angioplasty site in eight. There were no complications or clinical deterioration associated with the procedure. Angioplasty is an effective method for treating the severely ischaemic leg, especially when used to achieve ulcer healing; restenosis is often clinically unimportant.
Insonation and impedance analysis in graft surveillance
Authors: Woodburn K R , Murtagh A , Breslin P , Reid A W , Leiberman D P , Gilmour D G , Pollock J G
Published: March 2007

Seventy consecutive patients with infrainguinal bypass grafts entered a 1-year graft surveillance programme involving colour duplex scanning, direct graft insonation and computer-assisted impedance analysis. Graft patients with a positive duplex scan, high frequencies on graft insonation or an impedance value above 0.50 subsequently underwent arteriography. Sixteen patients were excluded before the initial surveillance visit. The 54 remaining patients with grafts (30 vein, 24 synthetic) underwent a total of 137 surveillance visits, with 21 grafts confirmed to be ‘at risk’. The sensitivity of an impedance value above 0.55 in identifying these grafts was 86 per cent, rising to 95 per cent when combined with graft insonation. Duplex scanning did not identify any abnormalities in 11 grafts that were either shown by arteriography to be ‘at risk’ or occluded before arteriography. Impedance measurement and graft insonation are simple screening techniques with a high sensitivity (when combined), which identify ‘at risk’ infrainguinal grafts. Positive graft insonation or an impedance value over 0.55 will identify all ‘at risk’ vein grafts while minimizing the number of unnecessary arteriograms.
Pain relief after inguinal hernia repair: A randomized double-blind study
Authors: Nehra D , Gemmell L , Pye J K
Published: March 2007

A randomized double-blind study was undertaken using 0.5 per cent bupivacaine ilioinguinal field block and oral papaveretum-aspirin tablets to assess pain relief after hernia surgery. A consecutive series of 200 men undergoing repair of a unilateral inguinal hernia underwent random allocation into one of the four groups to receive: bupivacaine and papaveretum-aspirin (group 1), bupivacaine and oral placebo (group 2), saline and papaveretum-aspirin (group 3), or saline and oral placebo (group 4). Patients were prescribed postoperative oplates to be given on demand. Pain levels and mobility were assessed at 6 and 24 h after operation. Patients in group 1 reported significantly less pain, required less additional opiates and had better mobility than those in group 4 (pain score P < 0.001 at 6 h and P = 0.002 at 24 h) and group 3 (P = 0.002 for pain and mobility scores at 6 h). Bupivacaine alone provided good immediate postoperative pain relief (P = 0.002 group 2 versus group 4 at 6 h). The combination of bupivacaine and papaveretum-aspirin provided the best results and is suitable for day-case postoperative analgesia.
Electrically stimulated colonic reservoir for total anorectal reconstruction
Authors: Hughes S F , Scott S M , Pilot M A , Williams N S
Published: March 2007

Total anorectal reconstruction after abdominoperineal excision of the rectum has failed to achieve perfect continence. Electrically stimulated reservoir evacuation in combination with an electrically stimulated gracilis neoanal sphincter might improve results. A J pouch was constructed in an isolated colonic loop of seven dogs. Bipolar square wave pulses were delivered via two intramural stainless steel electrode pairs at 10 Hz. Stimulation parameters were varied to achieve adequate contraction. Serosal strain gauges recorded spontaneous and stimulated pouch motility. Evacuation was quantified by a volume displacement technique and observed fluoroscopically. Recordings were performed for a median of 3 (range 1–11) months. At 10 Hz and 0·5 ms pulse width, stimulation was required for 2 min and at voltages of 15 V (n = 4), 18 V (n = 1) and 20 V (n = 2) to obtain a contraction of amplitude comparable to that of a spontaneous contraction. Suprathreshold stimulation invariably resulted in colonic pouch contraction. The mean(95 per cent confidence interval (c.i.)) stimulus-response latency was 25·5(1-9) s. The mean(95 per cent c.i.) intraluminal pressure generated during stimulation was 114±1(17±0) cmH2O and 64±6(12±0) cmH2O during spontaneous activity (P<0±001). In conclusion, electrical stimulation via intramural electrodes produced contraction generating sufficient intraluminal pressure to effect evacuation of a canine colonic pouch. This has potential for incorporation with an electrically stimulated neoanal sphincter in total anorectal reconstruction to improve evacuation and continence.
Factors that influence functional outcome after coloanal anastomosis for carcinoma of the rectum
Authors: Miller A S , Lewis W G , Williamson M E R , Holdsworth P J , Johnston D , Finan P J
Published: March 2007

Thirty consecutive patients had laboratory assessment of anorectal function after rectal excision and stapled coloanal anastomosis for rectal carcinoma. Eleven patients experienced perfect continence but 19 had faecal leakage with or without urgency of defaecation. Median (interquartile range) function was related to the pressures generated in the anal sphincter at rest (good versus poor function: 80 (63–91) versus 51 (23–60) cmH2O, P<0±01), during maximum squeeze (160 (126-203) versus 102 (58-112) cmH2O, P<0±01) and during reflex inhibition (58 (23-63) versus 36 (18-54) cmH2O, P<0±05). Poor function was significantly commoner in women than in men (P<0±01). These findings suggest that occult damage may have occurred to the anal sphincter before low anterior resection. Careful preoperative evaluation with manometry and endoanal ultrasonography may detect such damage and allow selection of patients for colopouch reconstruction.
Clinical impact of colonoscopic screening in first-degree relatives of patients with hereditary non-polyposis colorectal cancer
Authors: Green S E , Chapman P D , Burn J , Bishop D T , Varma J S
Published: March 2007

Sixty-one asymptomatic individuals with an affected first-degree relative from five large hereditary non-polyposis colorectal cancer (HNPCC) kindreds were screened by colonoscopy. Neoplasms were found in nine (15 per cent) of 61 individuals on the first screen. Five subjects had a single adenoma while two had two adenomas each. There were two patients (3 per cent) with malignant neoplasms: one with a Dukes B adenocarcinoma and one with synchronous Dukes C adenocarcinomas in the caecum and ascending colon. These findings support the hypothesis that adenomas do not occur in large numbers in HNPCC families but, because of the high malignant conversion rate, biennial colonoscopy with removal of polyps seen is recommended.
Carbon dioxide laser ablation as an alternative treatment for cutaneous metastases from malignant melanoma
Authors: Lingam M K , McKay A J
Published: March 2007

Surgical excision of cutaneous malignant melanoma metastases is practical only when the number of lesions is small. In some patients isolated limb perfusion is not possible or fails to achieve control, and carbon dioxide laser ablation is then an alternative treatment. Between September 1992 and September 1994, 19 patients aged 45–94 years were treated with carbon dioxide laser. Two patients had received no previous limb perfusion, while the remaining 17 had up to three previous perfusions. The number of lesions per patient ranged from three to 40 nodules. A Sharplan 1030 portable carbon dioxide laser was used, which generates a beam wavelength of 10-6 μm and has a maximum power output of 80W. All procedures were carried out under general anaesthesia. Each lesion was destroyed with a focused laser beam of 10–20 W with a spot size of 0±5–1±0 mm. At a mean follow-up of 15 months, five patients have died from the disease. Among the 14 survivors, eight have had no limb recurrence of the disease, three have had one further treatment and three a further two treatments to control cutaneous metastases at new sites. Early experience suggests that carbon dioxide laser ablation of cutaneous metastases is an effective palliative treatment after failed isolated limb perfusion, and there may be a group of patients in whom laser ablation should be the initial treatment of choice.
Use of a semipermeable polyamide dressing over skin grafts to venous leg ulcers
Authors: Mahajan R , Mosley J G
Published: March 2007

A polyamide semipermeable mesh interface placed over a skin graft allows absorption of exudate and soaking of the graft with an antiseptic solution. Forty-five patients with large venous leg ulcers (more than 100 cm2) were treated by a split skin graft covered by a polyamide mesh. The mean time to healing and graft take was compared with those of a similar group of 30 patients whose graft was not protected by an interface. The mesh significantly shortened the mean time for complete healing from 41 to 32 days.
Optimum method for urinary drainage in major abdominal surgery: A prospective randomized trial of suprapubic versus urethral catheterization
Authors: O'Kelly T J , Mathew A , Ross S , Munro A
Published: March 2007

The outcome of suprapubic and urethral catheterization in abdominal surgery was compared in a prospective randomized trial. Twenty-eight patients received a suprapubic and 29 a urethral catheter. The groups were similar in terms of age, sex, operation performed and postoperative analgesia. There was no difference in the duration of catheterization (suprapubic: median 5 (range 4-10) days; urethral: median 4 (range 2–11) days). Urinary sepsis occurred in three patients in each group. Urethral catheters caused pain in significantly more patients (urethral 13; suprapubic two; χ2 = 8±6, 1 d.f. P<0±01), on more days (suprapubic: 6 of 142 catheter days; urethral: 37 of 126 catheter days; χ2 = 29±5, 1 d.f. P<0±001). Two men with urethral catheters and one with a suprapubic catheter failed to void urethrally when required to do so. Suprapubic catheterization is the method of choice for urinary drainage when this is required in abdominal surgery.
Randomized trial of laparoscopic cholecystectomy and mini-cholecystectomy
Authors: McGinn F P , Miles A J G , Uglow M , Ozmen M , Terzi C , Humby M
Published: March 2007

Three hundred and ten patients having elective cholecystectomy were randomized to either laparoscopic cholecystectomy or mini-cholecystectomy. There were 155 patients in each group. Conversion to open cholecystectomy was significantly more common with laparoscopic cholecystectomy (13 versus 4 per cent) and complications were significantly more frequent with laparoscopic cholecystectomy (9 versus 3 per cent). If laparoscopic cholecystectomy was successful, hospital stay was significantly shorter than for mini-cholecystectomy (2 versus 3 days respectively), but overall the hospital stay was not significantly different. Postoperative analgesia requirements were reduced and return to normal activities and to work were faster after laparoscopic cholecystectomy. There was no significant cost difference between the two procedures.
Radical resection of locally advanced colorectal cancer
Authors: Poeze M , Houbiers J G A , van de Velde C J H , Wobbes Th , von Meyenfeldt M F
Published: March 2007

Multivisceral resection has been accepted as treatment for patients with locally advanced colorectal cancer. Nodal status has recently been claimed to be the most important predictor of survival in patients with such disease, with no survival after 2 years for patients with lymph node metastasis. A retrospective analysis was carried out of the prognostic significance of different tumour characteristics, and whether a more limited palliative resection is warranted in patients with positive lymph nodes. Of 1346 patients with colorectal adenocarcinoma operated on between 1987 and 1991, all those with a tumour staged as T4N0M0 or T4N1M0 (94 patients) were selected. From the remainder, 195 patients with stage T3N0M0 and T3N1M0 lesions were randomly selected as a control group. Overall survival was assessed at the beginning of 1993. The most important predictors of survival were lymph node status and involvement of the resection margins of the tumour. Overall survival in patients with T4 tumours who underwent radical resection was not significantly different from that in those with T3 tumours, even in N1 stages. Extended resection did not induce unacceptable morbidity or mortality. Surgery for locally advanced colorectal adenocarcinoma should result in tumour-free margins, and should therefore include multivisceral resection, even in patients with lymph node metastasis.
Prognostic factors in surgery for local recurrence of rectal cancer
Authors: Gagliardi G , Hawley P R , Hershman M J , Arnott S J
Published: March 2007

Fifty-five patients had resection of locally recurrent rectal cancer. Fourteen patients (25 per cent) had distant metastases, which were resected concurrently in six (11 per cent). Thirty-three patients (60 per cent) had preoperative (one patient) or postoperative (32) external beam radiotherapy (45–60 Gy). The 5-year survival rate was 18 per cent with a median survival of 24 months. The median symptom-free interval was 24 months. At a median follow-up of 28 months 53 per cent of patients had a second local recurrence and 24 per cent metastases only. Treatment complications occurred in 12 patients (22 per cent), three (5 per cent) of whom died 3–10 months after operation. Variables that were significantly related with longer survival and palliation were the radical nature of the operation, the absence of severe symptoms (such as pain, obstruction or sepsis), a recurrent tumour diameter of less than 5 cm measured on the resected specimen and a normal carcinoembryonic antigen level after reoperation. A Cox regression model showed that recurrent tumour diameter was the only independent prognostic variable. Surgery for local recurrence achieved local control in 47 per cent of patients with a low morbidity and mortality rate.
High morbidity rate after converted laparoscopic colorectal surgery
Authors: Slim K , Pezet D , Riff Y , Clark E , Chipponi J
Published: March 2007

Sixteen of 65 laparoscopically assisted colorectal operations were converted to an open procedure, usually because of dissection difficulties. Conversion was decided early in the procedure in four cases without perioperative morbidity and later in 12 cases, after a mean of 56 min. The results in patients undergoing converted operation were compared with those in 252 having a planned open colorectal procedure during the same period. The groups were comparable with regard to age, health status, factors influencing intestinal healing and grade of surgeon. A higher postoperative morbidity rate (50 versus 21 per cent) and more anastomotic leakages (25 versus 8 per cent) were apparent in the converted group. Operating time, postoperative ileus and hospital stay were longer in those requiring a converted operation. These poor results suggest that careful preoperative patient selection for laparoscopic procedures and a rapid decision to convert in case of difficulty are important.
Difference in expression of CD44 splice variants between proximal and distal adenocarcinoma of the large bowel
Authors: Mulder J W R , Kruyt P M , Sewnath M , Seldenrijk C A , Weidema W F , Pals S T , Offerhaus G J A
Published: March 2007

To help determine whether adenocarcinomas of the proximal and distal large bowei reflect distinct entities, the expression of two splice variants of the metastasis-associated cell adhesion molecule CD44, carrying exons v5 and v6 respectively, was investigated retrospectively in fresh frozen samples of 23 proximal and 41 distal carcinomas by immunohistochemical staining with specific anti-CD44v5 monoclonal antibody VFF8 and anti-CD44v6 monoclonal antibodies VFF4 and VFF7. Tumours were staged as: Dukes A, 0; Dukes B, 27; Dukes C, 31; and Dukes ‘D’, six. Compared with distal tumours, proximal lesions expressed significantly more CD44v5 (96 versus 87 per cent, P = 0·02) and CD44v6 (83 versus 61 per cent, P = 0·01). CD44v5 and CD44v6 are considered markers for tumour progression and aggressive behaviour. Their high expression in proximal carcinomas seems to contrast with the general belief that these tumours show less aggressive behaviour than left-sided lesions. Further study of the biological significance of the expression of CD44 splice variants is therefore needed.
Long-term results of recurrence and reoperation after strictureplasty for obstructive Crohn's disease
Authors: Stebbing J F , Jewell D P , Kettlewell M G W , McC. Mortensen N J
Published: March 2007

Strictureplasty extends the surgical options for the treatment of obstructive Crohn's disease. Over 15 years, 52 patients had 241 strictureplasties at 76 operations with no operative mortality and with septic complications in only two patients (4 per cent). Median (range) follow-up was 49.5 (1–182) months. Nineteen patients (36 per cent) required a second operation for Crohn's disease between 1 and 57 months after first strictureplasty. Most symptomatic recurrence was caused by new segments of stricturing or perforating disease, and recurrence of Crohn's disease was noted at only nine strictureplasty sites (3·7 per cent) in four patients. Seven patients (13 per cent) required a third operation for Crohn's disease. Patients undergoing strictureplasty alone were no more likely to require reoperation than those who had a concomitant resection at the first procedure (X2 = 0·619, P > 0·2). The reoperation rates after first and second operations were similar (X2 = 0·021, P > 0·2). Minimal surgery does not appear to lead to an accelerated or additional need for subsequent operation. Strictureplasty provides a safe, effective and rapid procedure to restore patients to good health while preserving the intestine and may be recommended for carefully selected strictures as an adjunct to conventional excisional surgical treatment.
Microvascular disease and anastomotic dehiscence in the colon
Authors: Fawcett A , Vashisht R , Shankar A , Dawson P M , O'Malley M K , Nott D M , Springall R G
Published: March 2007

Platelet-derived serotonin released in response to tissue manipulation during surgery may contribute to mesenteric arterial vasospasm leading to postoperative anastomotic leakage after colorectal resection. Organ bath experiments were used to demonstrate the efficacy of naftidrofuryl fumarate (NFT) to oppose serotonin-induced vaso-constriction of human mesenteric arteries. Cumulative dose-response curves were derived with and without NFT at 10−9 and 10−6 mol/l concentrations. The difference in maximal contractility between the three sets of curves (n = 8 for each) was significant (P<0.0001). Sensitivity to serotonin in each of the three curves was measured by calculating the concentration for half-maximal response; differences were again significant (P<0.0001). NFT reduced serotonin-induced contractility in a dose-dependent fashion in rings of human mesenteric arteries in vitro. This suggests a possible role for NFT in reducing mesenteric vasospasm in colorectal surgery.
A 10-year prospective audit of outcome of surgical treatment for colorectal carcinoma
Authors: Singh S , Morgan M B F , Broughton M , Caffarey S , Topham C , Marks C G
Published: March 2007

The outcome of 555 patients who underwent surgery under the care of a surgeon with an interest in colorectal disease was examined prospectively over a 10-year period with no exclusions. There was a 4.7 per cent incidence of clinical leaks (10 per cent for anterior resection) and an overall corrected 10-year survival rate after curative surgery of 58, 59 and 48 per cent for right colonic, left colonic and rectal tumours respectively. The incidence of isolated local recurrence was 8 per cent after curative surgery for carcinoma of the rectum. Twenty-five per cent of patients with rectal tumours required abdominoperineal excision. Patients who underwent curative abdominoperineal excision of the rectum had corrected 5-and 10-year survival rates of 48 and 36 per cent, compared with 60 and 58 per cent respectively for curative anterior resection. The perioperative mortality rate of those undergoing palliative surgery was 8 per cent, and 75 per cent died within 2 years from distant and not local disease. A policy of always attempting resection was validated by the fact that 99 per cent of primary tumours were removed with a low perioperative mortality rate (4 per cent overall), a high curative resection rate and a low morbidity rate.
Varicose vein surgery and deep vein thrombosis
Authors: Campbell W B , Ridler B M F
Published: March 2007

A questionnaire was sent to 363 members of the Vascular Surgical Society of Great Britain and Ireland about their use of deep vein thrombosis (DVT) prophylaxis at the time of varicose vein surgery. Replies were received from 289 surgeons (80 per cent), of whom only 29 per cent regarded varicose veins as an important risk factor for DVT. Only 12 per cent used subcutaneous heparin prophylaxis routinely, while 71 per cent did so selectively, being influenced by a history of thromboembolism (95 per cent), obesity (47 per cent), age (35 per cent), recurrent varicose veins (22 per cent) and inpatient status (16 per cent). At the end of the operation 52 per cent applied crepe bandages, 25 per cent other bandages, 13 per cent stockings and 10 per cent Tubigrip. Subsequently, antiembolism stockings were prescribed by 55 per cent. There is a wide variation in opinion regarding DVT prophylaxis for patients having varicose vein surgery, which has both clinical and medicolegal implications.
Typhoid enteric perforation
Authors: Akgun Y , Bac B , Boylu S , Aban N , Tacyildiz I
Published: March 2007

Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome. The morbidity and mortality rates were 55.4 and 28.5 per cent respectively, and the median duration of hospitalization was 18 days. On the basis of these findings, a prospective series of 39 patients was studied. In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered. All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period. The morbidity and mortality rates decreased to 25 and 10 per cent respectively, and the median hospitalization time was 12 days. The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.
Onset of oesophageal peristalsis after surgery for idiopathic achalasia
Authors: Zaninotto G , Costantini M , Anselmino M , Boccu C , Ancona E
Published: March 2007

Twenty-seven patients were treated with a Heller myotomy and Dor fundoplication; some peristaltic contractions occurred in seven after operation. When clinical, radiological and manometric data in the seven patients developing peristalsis were compared with findings in the other 20, there were no differences in symptoms, lower oesophageal sphincter pressures and lengths, relief of dysphagia or oesophageal calibre reduction. Oesophageal resting pressure was lower and oesophageal contraction amplitudes were statistically higher in patients with restored peristalsis, which correlated only with the amplitude of contractions 5 cm above the lower oesophageal sphincter (P<0.05, 95 per cent confidence interval). Peristaltic contractions probably exist before treatment, but are concealed by the dilated oesophagus and the common cavity phenomenon. Achalasia is not necessarily associated with complete aperistalsis. No difference was found in the outcome of surgical treatment, and the return to peristalsis appears to be clinically relevant.
Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy
Authors: Elias D , Lasser P , Debaene B , Doidy L , Billard V , Spencer A , Leclercq B
Published: March 2007

Intermittent vascular exclusion of the liver (IVEL) combines clamping of the hepatic pedicle with clamping of the main hepatic veins without interruption of caval flow. In this retrospective study, eight cases of total IVEL and eight of partial IVEL were analysed (involving only the middle and left hepatic veins) during major hepatectomy for malignant tumours. Liver parenchyma was pathological in nine cases. IVEL was feasible in 16 of the 18 attempts and was efficient in reducing bleeding during hepatectomy in 15 cases. Mean duration of IVEL was 60.2 (range 37–140) min, mean blood loss was 1230 (range 300–2800) ml and there were no postoperative complications related to the procedure. The major advantages of this technique of liver vascular exclusion (good tolerance and possibility of long duration) merit its inclusion in the list of different clamping techniques available for use during hepatectomy.
Evaluation of recombinant human erythropoietin to facilitate autologous blood donation before surgery in anaemic patients with cancer of the gastrointestinal tract
Authors: Braga M , Gianotti L , Vignali A , Gentilini O , Servida P , Bordignon C , Di Carlo V
Published: March 2007

The aim of this study was to determine whether the preoperative administration of recombinant human erythropoietin (rHuEPO) could increase the rate of autologous blood donation and reduce the perioperative need for homologous blood in anaemic patients with cancer. Twenty-two anaemic (haematocrit less than 34 per cent), iron-deficient (iron less than 700 µg/I) patients, with gastric or colorectal cancer scheduled for elective surgery, were allocated randomly to two groups. The first (n = 11) received iron saccharate 200 mg/day intravenously for 12 consecutive days. The second (n = 11) received rHuEPO subcutaneously (300 units/kg as first administration, and 100 units/kg 4, 8 and 12 days later) with supplemental iron. On days 4, 8 and 12, if the haematocrit was greater than 34 per cent, patients donated one unit (350 ml) of autologous blood. In the iron group the mean haematocrit did not change from admission (31 per cent) to day 12 of treatment (31 per cent), and no patient could donate autologous blood. In the rHuEPO group, eight patients donated two units of autologous blood and three donated one unit. Four patients in the iron group received perioperative transfusion of homologous blood compared with none in the rHuEPO group. Administration of rHuEPO facilitated the donation of autologous blood and reduced perioperative homologous blood transfusion in anaemic patients with cancer.
‘Squeeze delivery’ excision of subcutaneous lipoma related to anatomic site
Authors: Kenawi M M
Published: March 2007

A small cosmetic incision followed by ‘squeeze delivery’ was attempted for 190 lipomas in 116 patients. This technique was successful without resort to widening of the incision or using scissor dissection in 87 lipomas (46 per cent). Success was not related to size but to the site of the lipoma. The success rate was 100 per cent for excision of lipomas in the forearm and leg.
Role of transoesophageal echocardiography in determining the source of peripheral arterial embolism
Authors: Lagattolla N R F , Burnand K G , Stewart A
Published: March 2007

Thirty patients with peripheral arterial embolism underwent conventional transthoracic echocardiography. Transoesophageal echocardiography was also performed in ten of the same patients. The detection rate of cardiac abnormalities considered responsible for embolism was five of 20 in patients who received only transthoracic echocardiography and eight of ten in those who underwent transoesophageal echocardiography. One abnormality was detected by transthoracic echocardiography in the ten patients who received both tests, while eight cardiac or aortic abnormalities were discovered by transoesophageal echocardiography (P < 0.05). Transoesophageal echocardiography is significantly better than conventional transthoracic echocardiography at detecting cardiac sources of peripheral arterial embolism.