bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer
Authors: Jansen L , Doting M H E , Rutgers E J Th , de Vries J , Olmos R A Valdés , Nieweg O E
Published: March 2003

Background

Lymphatic mapping in patients with breast cancer can reveal sentinel lymph nodes that are not located at level I–II of the axilla. Little is known about the clinical relevance of these nodes.

Methods

Some 113 consecutive patients with clinical stage T1–3 N0 M0 breast cancer were studied. Based on preoperative lymphoscintigraphy, sentinel node biopsy was performed guided by a γ probe and patent blue dye. All sentinel nodes that were visible on lymphoscintigraphy were sought. Pathological examination of the sentinel nodes included step-sections and staining with CAM 5·2. Axillary node dissection was performed regardless of sentinel lymph node status.

Results

Twenty-one (19 per cent) of 113 patients had sentinel lymph nodes outside level I–II of the axilla, mostly in the internal mammary chain. Twenty-two of the 30 sentinel nodes at these sites were harvested. Three patients had sentinel nodes only outside the axilla. Four other patients had metastases outside the axilla. This changed postoperative treatment in three patients. No postoperative complication occurred.

Conclusion

Sentinel lymph nodes outside level I–II of the axilla were present in 19 per cent of patients with breast cancer in this series. Biopsy of these nodes was technically demanding but was performed without additional morbidity. The clinical impact was limited; treatment changed in only 3 per cent.
Preoperative portal vein embolization improves prognosis after right hepatectomy for hepatocellular carcinoma in patients with impaired hepatic function
Authors: Tanaka H , Hirohashi K , Kubo S , Shuto T , Higaki I , Kinoshita H
Published: March 2003

Background

Percutaneous transhepatic portal vein embolization (PTPE) increases the safety of subsequent major hepatectomy. The aim of this study was to determine the effect of PTPE on long-term prognosis after hepatectomy in patients with hepatocellular carcinoma (HCC).

Methods

Seventy-one patients with HCC underwent right hepatectomy between 1984 and 1998. Preoperative PTPE was performed in 33 patients (group 1) and was not used in 38 patients (group 2). Outcome after operation was compared between the groups. The patients were further divided according to the median tumour diameter (cut-off 6 cm) and indocyanine green retention rate at 15 min (ICGR15) (cut-off 13 per cent).

Results

The cumulative survival rate was significantly higher in group 1 than in group 2 in patients with an ICGR15 of at least 13 per cent. Tumour-free survival rates were similar in both groups. Of patients with tumour recurrence after right hepatectomy, those in group 1 were more frequently subjected to further treatment.

Conclusion

Preoperative PTPE improves the prognosis after right hepatectomy for HCC in patients with impaired hepatic function, although it does not prevent tumour recurrence.
Transvenous sclerotherapy for huge oesophagogastric varices using open injection sclerotherapy
Authors: Kitano S , Baatar D , Bandoh T , Yoshida T , Tsuboi S , Matsumoto T
Published: March 2003

Background

The optimum procedure for long-term management of oesophagogastric varices when endoscopic sclerotherapy or ligation fails is yet to be established. This report describes a new procedure for treating huge oesophagogastric varices by open injection sclerotherapy.

Methods

Twenty-three patients with huge oesophagogastric varices underwent laparotomy and devascularization of the upper stomach with splenectomy. The left gastric vein was catheterized for repeated injection of 5 per cent ethanolamine oleate during the postoperative period.

Results

In all patients, the varices were eradicated after a mean of 3 sessions of sclerotherapy. There were no deaths or major complications during the mean follow-up period of 41 months. Small recurring varices in two patients were treated successfully by endoscopic sclerotherapy and interventional radiology.

Conclusion

Open injection sclerotherapy is an effective and safe procedure for the treatment of huge oesophagogastric varices.
Quality of life after total colectomy with ileorectal anastomosis or proctocolectomy and ileal pouch—anal anastomosis for familial adenomatous polyposis
Authors: van Duijvendijk P , Slors J F M , Taat C W , Oosterveld P , Sprangers M A G , Obertop H , Vasen H F A
Published: March 2003

Background

Knowledge of postoperative health status is important in decision-making about the type of operation necessary in patients with familial adenomatous polyposis (FAP). This study compared the quality of life (QoL) between patients with an ileorectal anastomosis (group 1) and those with an ileal pouch–anal anastomosis (group 2).

Methods

QoL was assessed with both a generic questionnaire (Short Form-36 Health Survey; SF-36) and a disease-specific questionnaire (European Organization for Research and Treatment of Cancer Colorectal QoL Questionnaire; EORTC QLQ-CR38). The SF-36 consists of 36 items representing eight generic health domains, and the EORTC QLQ-CR38 comprises 38 items representing disease-specific health domains. Both questionnaires were distributed among 323 patients with FAP known at the Dutch Polyposis Registry who had previously undergone either operation. The results of the SF-36 were compared with the scores of age- and sex-matched respondents from the general population.

Results

Some 279 patients (86 per cent), 161 in group 1 and 118 in group 2, completed the questionnaire. Generic and disease-specific QoL was the same for groups 1 and 2. The SF-36 scores of both groups were significantly lower than those of the general population.

Conclusion

There were no differences with respect to health status between patients in groups 1 and 2, and preference for either procedure cannot be based on QoL.
Experimental study of faecal continence and colostomy irrigation
Authors: O'Bichere A , Sibbons P , Doré C , Green C , Phillips R K S
Published: March 2003

Background

Colostomy irrigation is a useful method of achieving faecal continence in selected conditions, but remains largely underutilized because it is time consuming. This study investigated the effect of modifying irrigation technique (route, infusion regimen and pharmacological manipulation) on colonic emptying time in a porcine model.

Methods

An end-colostomy and caecostomy were fashioned in six pigs. Twenty markers were introduced into the caecum immediately before colonic irrigation. Irrigation route (antegrade or retrograde), infusion regimen (tap water, polyethylene glycol (PEG), 1·5 per cent glycine) and pharmacological agent (glyceryl trinitrate (GTN) 0·25 mg/kg, diltiazem 3·9 mg/kg, bisacodyl 0·25 mg/kg) were assigned to each animal at random. Colonic transit was assessed by quantifying cumulative expelled markers (CEM) and stool every hour for 12 h.

Results

Mean CEM at 6 h for bisacodyl, GTN and diltiazem were 18·17, 12·17 and zero respectively; all pairwise differences in means were significant (P < 0·001). The difference at 12 h between the two routes (P = 0·001) and three fluids (tap water 6·75, glycine 14·83, PEG 16·33; P < 0·001) was significant, but not for PEG versus glycine and bisacodyl versus GTN. Cumulative output was significantly more with the antegrade than retrograde route using PEG, but the difference in mean cumulative output for bisacodyl and GTN at 12 h was not significant.

Conclusion

Colonic emptying is more efficient with antegrade than retrograde irrigation. PEG and glycine enhance emptying similar to bisacodyl and GTN solution. These findings show promise for improved faecal continence by colostomy irrigation and may justify construction of a Malone conduit at the time of colostomy in selected patients who wish to irrigate.
Cholecystectomy, peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and gastric cardia
Authors: Freedman J , Lagergren J , Bergström R , Näslund E , Nyrén O
Published: March 2003

Background

Gastro-oesophageal reflux is a strong risk factor for oesophageal adenocarcinoma. Bile and pancreatic enzymes may be particularly carcinogenic. Cholecystectomy causes an increased gastric level of these constituents. A decreased risk of oesophageal adenocarcinoma has been observed in persons infected with cagA-positive Helicobacter pylori. There is a strong correlation between ulcer disease and Helicobacter pylori infection. The aim of this study was to determine whether previous cholecystectomy or peptic ulcer disease affects the risk of oesophageal carcinoma.

Methods

Data were collected as a nationwide population-based case–control study in Sweden between 1995 and 1997. Multivariate adjusted odds ratios (ORs) were calculated with logistic regression.

Results

There was no statistically significant association between cholecystectomy and the risk of oesophageal carcinoma. Among persons with previous peptic ulcer, the adjusted OR for oesophageal adenocarcinoma was below unity (OR = 0·6, 95 per cent confidence interval 0·3–1·1). The relative risk estimates for cardia adenocarcinoma and oesophageal squamous cell carcinoma were close to unity.

Conclusion

Cholecystectomy, despite its effect on the composition of gastric juice, does not appear to increase the risk of adenocarcinoma of the oesophagus or gastric cardia. While the data do not contradict a protective effect of H. pylori, the results are also consistent with absence of such an effect.
Severity of acute pancreatitis: a multivariate analysis of oxidative stress markers and modified Glasgow criteria
Authors: Abu-Zidan F M , Bonham M J D , Windsor J A
Published: March 2003

Background

It is unknown whether measurement of markers of oxidative stress can improve the prediction of severity of acute pancreatitis.

Methods

Consecutive patients admitted with a diagnosis of acute pancreatitis were divided into mild (n = 62) and severe (n = 23) groups based on the Atlanta classification. Plasma oxidative stress markers were measured within 24 h of admission and included ascorbic acid (endogenous antioxidant), protein carbonyl (a marker of protein oxidation), thiobarbituric acid reactive substances (a marker of lipid peroxidation) and myeloperoxidase (a neutrophil enzyme that produces oxidants). Canonical correlation analysis was used to describe the relationship between these markers and the modified Glasgow criteria. Canonical variate analysis was used to define the best variables that could discriminate mild and severe pancreatitis.

Results

There was a significant correlation between markers of oxidative stress and the modified Glasgow criteria (first canonical correlation 0·69, P < 0·0001, Wilk's lambda test). Blood urea, serum albumin and white cell count were the best variables that discriminated mild and severe acute pancreatitis, and all were better than the oxidative stress markers.

Conclusion

The markers of oxidative stress were highly correlated with the severity of pancreatitis. They are unlikely to be better than the modified Glasgow criteria in predicting it.
Pancreatic fistula after pancreatic head resection
Authors: Büchler M W , Friess H , Wagner M , Kulli C , Wagener V , Z'graggen K
Published: March 2003

Background

Pancreatic resections can be performed with great safety. However, the morbidity rate is reported to be 40–60 per cent with a high prevalence of pancreatic complications. The aim of this study was to analyse complications after pancreatic head resection, with particular attention to morbidity and pancreatic fistula.

Methods

From November 1993 to May 1999, perioperative and postoperative data from 331 consecutive patients undergoing pancreatic head resection were recorded prospectively. Data were analysed and grouped according to the procedure performed: classic Whipple resection, pylorus-preserving pancreatoduodenectomy (PPPD) or duodenum-preserving pancreatic head resection (DPPHR).

Results

Pancreatic head resection had a mortality rate of 2·1 per cent; the difference in mortality rate between the three groups (0·9–3·0 per cent) was not significant. Total and local morbidity rates were 38·4 and 28 per cent respectively. DPPHR had a lower morbidity, both local and systemic, than pancreatoduodenectomy. The prevalence of pancreatic fistula was 2·1 per cent in 331 patients, and was not dependent on the procedure or the aetiology of the disease. Reoperations were performed in 3·9 per cent of patients, predominantly for bleeding and non-pancreatic fistula. None of the patients with pancreatic fistula required reoperation or died in the postoperative course.

Conclusion

A standardized technique and a continuing effort to improve perioperative management may be responsible for low mortality and surgical morbidity rates after pancreatic head resection. Pancreatic complications occur with Whipple, PPPD and DPPHR procedures with a similar prevalence. Pancreatic fistula no longer seems to be a major problem after pancreatic head resection and rarely necessitates surgical treatment.
Role of a defunctioning stoma in the management of large bowel Crohn's disease
Authors: Edwards C M , George B D , Jewell D P , Warren B F , Mortensen N J McC , Kettlewell M G W
Published: March 2003

Background

The faecal stream plays a significant role in the pathogenesis of Crohn's disease. This retrospective study aimed to assess the effect of faecal diversion on the natural history of refractory Crohn's colitis (RCC) and severe perianal disease (PAD).

Methods

All patients undergoing a defunctioning stoma without resection for RCC or PAD between 1970 and 1997 were studied. Indications for surgery, acute clinical response, subsequent outcome and stoma rates were recorded.

Results

Some 73 patients underwent a defunctioning stoma (55 RCC and 18 PAD). Acute remission was achieved in 63 patients (48 RCC, 15 PAD). Twenty-nine patients had subsequent closure of the defunctioning stoma (25 of 48 acute responders with RCC and four of 15 acute responders with PAD). Eleven patients with RCC and two with PAD achieved good long-term function without disease relapse (median follow-up 36 months). Overall 52 patients have undergone proctocolectomy or remain with a defunctioning stoma (37 with RCC and 15 with PAD).

Conclusion

Faecal diversion is associated with acute clinical remission in the majority of patients with RCC and PAD, but sustained benefit occurs less often. For selected patients, diversionary surgery alone offers a realistic alternative to major bowel resection.
Role of xanthine oxidase in small bowel mucosal dysfunction after surgical stress
Authors: Anup R , Susama P , Balasubramanian K A
Published: March 2003

Background

The small intestine is highly susceptible to surgical stress even at remote locations. An earlier study using a rat model indicated that oxidative stress plays an important role in this process. The enzyme xanthine oxidase is an important source of free radicals in the small intestine. The role of this enzyme in intestinal damage after surgical stress was examined.

Methods

Rats pretreated with xanthine oxidase inhibitors were subjected to surgical stress by opening the abdomen and handling the intestine, as done during laparotomy. Enterocytes at various stages of differentiation were isolated and the protection offered by xanthine oxidase inhibitors against damage due to surgical stress was determined and compared with normal controls. Protection against ultrastructural changes to the mucosa, as well as mitochondrial function was examined.

Results

Surgical stress affected both the villus as well as crypt cells, causing increased superoxide generation, accompanied by increased activity of xanthine oxidase. Xanthine oxidase inhibitors ameliorated the increased superoxide generation, and protected against mitochondrial damage and ultrastructural changes in the intestine.

Conclusion

Surgical stress affects both the villus and crypt cell populations in the small intestine. The enzyme xanthine oxidase maybe an important mediator of surgical stress in the intestine.
Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus
Authors: Bollschweiler E , Schröder W , Hölscher A H , Siewert J R
Published: March 2003

Background

The outcome after oesophagectomy depends not only on the surgical procedure itself but can be improved by the selection of patients based on a preoperative risk score.

Methods

In order to compare the preoperative risk for different histological subtypes of oesophageal carcinoma, 221 patients with a squamous cell carcinoma (SCC) and 104 patients with an adenocarcinoma (AC) were enrolled in a prospective study. The preoperative assessment included socioeconomic status, alcohol and tobacco consumption, general and nutritional status, and pulmonary, cardiovascular, hepatic and renal function.

Results

More patients with an SCC were ‘blue collar’ and with an AC were ‘white collar’ workers (P < 0·001). Alcohol and tobacco consumption was higher in patients with an SCC (P < 0·01 and P < 0·05 respectively). The preoperative forced expiratory volume, arterial partial pressure of oxygen and the aminopyrine breath test showed more severely compromised pulmonary and hepatic function in patients with an SCC (P < 0·05 for all variables). Some 50 per cent of patients with an AC were overweight with a higher body mass index (P < 0·001). More patients with an AC had severely impaired cardiac function (P < 0·01).

Conclusion

Patients with SCC and AC of the oesophagus differed regarding their socioeconomic and preoperative risk factors for surgery.
Population screening reduces mortality rate from aortic aneurysm in men
Authors: Heather B P , Poskitt K R , Earnshaw J J , Whyman M , Shaw E
Published: March 2003

Background

Rupture of an unsuspected abdominal aortic aneurysm is a major cause of death in men over the age of 65 years. A significant reduction in deaths is likely to result only from higher rates of detection and increased numbers of elective aneurysm repairs. Screening of men reaching the age of 65 years has been taking place in the county of Gloucestershire, UK since 1990 and the aim of this study was to investigate any change in the mortality rate from aortic aneurysm in the screened portion of the population.

Methods

Total number of deaths from all aortic aneurysm-related causes in the county's population was calculated from hospital and post-mortem records, together with computerized death certificate records, for the years 1994–1998. The overall number of aneurysm-related deaths in men aged 65–73 years, who have been progressively influenced by the screening programme, was compared with that for men of all other ages.

Results

The total number of aneurysm-related deaths in men aged 65–73 years decreased progressively year by year between 1994 and 1998; this reduction is highly statistically significant (P < 0·001). No such change was observed in the unscreened part of the population.

Conclusion

Screening for asymptomatic abdominal aortic aneurysm results in a significant reduction in numbers of deaths from all aneurysm-related causes in the screened portion of the male population.
Expression and processing of gastrin in pancreatic adenocarcinoma
Authors: Caplin M , Savage K , Khan K , Brett B , Rode J , Varro A , Dhillon A
Published: March 2003

Background

Gastrin is a trophic hormone and promotes growth of gastrointestinal and non-gastrointestinal cancers. Studies both in vitro and in vivo have suggested that pancreatic cancer cells not only have the ability to respond to circulating forms of gastrin but also to respond to the autocrine production of gastrin and its precursors. The aim of this study was to identify the expression of CCK-B/gastrin receptor, progastrin, glycine-extended gastrin and amidated gastrin in both normal pancreas and pancreatic adenocarcinoma.

Methods

Tissue sections from patients with normal pancreas (n = 10) and pancreatic cancer (n = 22) were assessed using immunohistochemical methods for CCK-B/gastrin receptor, progastrin, glycine-extended gastrin and amidated gastrin expression.

Results

Normal pancreas showed no expression of receptor or gastrin isoforms except for occasional cells in the islets. Definite expression of CCK-B/gastrin receptor, progastrin, glycine-extended gastrin and amidated gastrin was observed in 95, 91, 55 and 23 per cent of sections from patients with pancreatic cancer respectively.

Conclusion

Pancreatic cancer cells express CCK-B/gastrin receptor and gastrin precursor forms in most patients. Expression of the gastrin precursor forms is probably related to autocrine production. New therapeutic strategies need to be developed for the management of pancreatic cancer. Targeting gastrin and its receptor may provide a novel treatment option.
Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients
Authors: Wullstein C , Gross E
Published: March 2003

Background

The morbidity and mortality associated with colorectal surgery results partly from anastomotic leakage. Animal experiments have shown some advantages of sutureless anastomosis over conventional colorectal anastomosis. Compression anastomosis follows the same biological principles as sutureless anastomosis.

Methods

The compression anastomosis AKA-2 was evaluated in a prospective consecutive audit of 442 patients between September 1989 and August 1998.

Results

Anastomoses were performed in 372 elective and 70 emergency situations. The indication for operation was colorectal cancer (56·3 per cent) and diverticulitis (23·5 per cent). A defunctioning colostomy was performed in 110 patients (24·9 per cent). Fourteen patients died (3·2 per cent). Death was related to anastomotic complications in three patients (0·7 per cent). Twenty-four patients (5·4 per cent) developed intra-abdominal complications. There were 11 symptomatic (2·5 per cent) and six asymptomatic (1·4 per cent) leakages. Anastomoses that were more than 10 cm from the anal verge leaked in seven (2·4 per cent) of 291 cases, while anastomoses between 5 and 10 cm leaked in three (2·6 per cent) of 116 cases and those less than 5 cm from the anal verge leaked in one (3 per cent) of 35 cases.

Conclusion

The low incidence of anastomotic complications demonstrates good biological healing of compression anastomoses. The compression anastomosis AKA-2 is safe in both high and low anterior resection and can therefore be recommended for use in colorectal surgery.
Effect of contralateral disease on duplex measurements of internal carotid artery stenosis
Authors: Ray S A , Lockhart S J M , Dourado R , Irvine A T , Burnand K G
Published: March 2003

Background

Duplex ultrasonography is increasingly used as the sole method of imaging before carotid endarterectomy. This study investigated the measured degree of stenosis in the contralateral carotid artery before and after operation.

Methods

Duplex-derived peak systolic velocity (PSV), end-diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) velocity ratios were measured in the contralateral unoperated ICA before 131 consecutive unilateral endarterectomies and compared with preoperative angiographic findings. Three months later duplex scans were repeated to assess whether there had been any alteration in the severity of the stenosis in the contralateral unoperated artery.

Results

Bilateral ICA disease (greater than 50 per cent stenosis) was present in 50 patients (38 per cent). Three months after operation, ultrasonography of the 105 unoperated, patent, contralateral arteries showed a decrease in mean(s.d.) PSV (1·21(0·83) versus 1·07(0·69) m/s; P < 0·01) and EDV (0·41(0·29) versus 0·35(0·24) m/s; P < 0·01). This resulted in 14 (42 per cent) of 33 patients with contralateral disease being downgraded to a less severe category of stenosis. Use of the ICA/CCA velocity ratio prevented overestimation in eight of the 14 patients, while preoperative angiography correctly classified 13 of the 14 patients.

Conclusion

Bilateral carotid artery disease can cause overestimation of the severity of stenosis by duplex ultrasonography if absolute velocity is used as the main criterion.
Hereditary pancreatitis and mutations of the cationic trypsinogen gene
Authors: O'Reilly D A , Kingsnorth A N
Published: March 2003

Background

Mutations of the cationic trypsinogen gene have been detected in hereditary pancreatitis. This article reviews current understanding of their function and clinical significance.

Methods

An unrestricted Medline search was conducted using the key words ‘hereditary pancreatitis’ and ‘cationic trypsinogen’. Additional material was obtained from references cited in original papers and recently published abstracts of meetings.

Results and conclusion

Cationic trypsinogen mutations have been identified in most, but not all, families with hereditary pancreatitis. This confirms existing evidence that premature trypsinogen activation plays a central role in the pathogenesis of human pancreatitis. Patients currently clinically defined as having hereditary pancreatitis should be screened for the presence of cationic trypsinogen mutations. A subgroup of patients with non-hereditary pancreatitis may also benefit from being screened for these mutations. Patients with hereditary pancreatitis should be entered into prospective, multicentre trials investigating secondary screening for pancreatic cancer. Gene therapy for hereditary pancreatitis is beyond current technological capability but remains a future therapeutic prospect for this often debilitating condition.
Diagnosis and management of cystic pancreatic tumours with mucin production
Authors: Shima Y , Mori M , Takakura N , Kimura T , Yagi T , Tanaka N
Published: March 2003

Background

To aid selection of the most appropriate treatment for intraductal tumours (IDTs) and mucinous cystic tumours (MCTs) of the pancreas, this study describes the clinical and diagnostic features of these tumours and compares the clinicodiagnostic features of malignant and benign tumours and hyperplasia.

Methods

The clinical features of 28 IDTs (four cases of hyperplasia, six adenomas and 18 adenocarcinomas) and six MCTs (four adenomas and two adenocarcinomas) were studied.

Results

An IDT was found in 24 men and four women with a mean age of 64·5 years, whereas all patients with an MCT were women, with a mean age of 50·8 years. Twenty IDTs were located in the pancreatic head, whereas all MCTs were in the pancreatic body–tail. The mean size of IDTs was smaller than that of MCTs (4·4 versus 7·7 cm). The mean size of hyperplastic lesions, adenomas and adenocarcinomas in IDTs were 1·7, 2·9 and 5·4 cm respectively. Hyperplastic IDT lesions were smaller than 2 cm without either mural nodules or dilatation of the main pancreatic duct. IDTs larger than 3 cm with mural nodules and mucin secretion from an enlarged papilla orifice and dilatation of the main pancreatic duct were often adenocarcinomas.

Conclusion

Although follow-up of intraductal hyperplasia is a reasonable approach, other types of IDT and MCT require surgical treatment.
Molecular changes in extracellular matrix turnover after renal ischaemia–reperfusion injury
Authors: Jain S , Bicknell G R , Nicholson M L
Published: March 2003

Background

Renal ischaemia–reperfusion (IR) injury is an inevitable consequence of transplantation and contributes to later graft fibrosis. This study aimed to elucidate the possible mechanisms by studying the expression of genes associated with extracellular matrix (ECM) turnover.

Methods

Male Wistar rats underwent laparotomy, clamping of the right renal pedicle for 45 min, and left nephrectomy. Control animals underwent left nephrectomy only, or had no operation. Animals were killed at 8, 16 and 24 weeks and messenger RNA was extracted from renal tissue. Genes of interest were amplified and then quantified in an enzyme-linked immunosorbent assay system with levels expressed as a ratio to a known housekeeping gene (GAPDH).

Results

Experimental animals developed progressive proteinuria from 16 weeks onwards. At 8 weeks after IR injury, gene levels of matrix metalloproteinase (MMP) 2, an ECM-degrading enzyme, were significantly increased. Levels then fell progressively. This was associated with increasing expression of tissue inhibitor of metalloproteinases (TIMP) 1, an inhibitor of MMP-2, and of transforming growth factor (TGF) β, a profibrotic cytokine, by 24 weeks following injury.

Conclusion

These results suggest that, after an initial phase of increased ECM turnover following IR injury, the balance turns towards one of reduced degradation. This is likely to be an important mechanism in the subsequent development of fibrosis.
Hyaluronic acid-based agents do not affect anastomotic strength in the rat colon, in either the presence or absence of bacterial peritonitis
Authors: Reijnen M M P J , de Man B M , Hendriks Th , Postma V A , Meis J F G M , van Goor H
Published: March 2003

Background

Hyaluronic acid (HA) agents reduce postsurgical adhesion formation. The effect of their perioperative administration on early anastomotic healing is unknown. This study investigated the influence of two HA-containing agents on the development of strength in colonic anastomosis during the first postoperative week, both in normal rats and in rats with bacterial peritonitis.

Methods

In 90 male Wistar rats a 1-cm segment was resected from the descending colon and an end-to-end anastomosis was constructed. In 108 rats a bacterial peritonitis was induced using caecal ligation and puncture (CLP). Some 24 h after CLP the abdomen was reopened, the caecum was taken out and, after resection of a 1-cm segment, an anastomosis was made. Animals in both groups were randomized to receive either an HA–carboxymethylcellulose (CMC) bioresorbable membrane, 0·4 per cent HA solution or no treatment. One-third of each group was killed at day 1, 3 and 7 after operation. Cultures were taken from the abdominal cavity for microbiological analysis in half of the animals. Subsequently, both bursting pressure and breaking strength were determined as parameters for anastomotic strength.

Results

No differences in anastomotic bursting pressure or breaking strength were found between the experimental groups and their controls. In addition, there was no significant difference in the number of bacteria cultured from the abdominal cavity between rats treated with HA and controls.

Conclusion

Neither HA-CMC bioresorbable membrane nor 0·4 per cent HA solution interferes with the development of early anastomotic strength in the colon, and can therefore be safely used to prevent intra-abdominal adhesion formation after performing bowel anastomosis.
Prognostic significance of extensive microsatellite instability in sporadic clinicopathological stage C colorectal cancer
Authors: Wright C M , Dent O F , Barker M , Newland R C , Chapuis P H , Bokey E L , Young J P , Leggett B A , Jass J R , Macdonald G A
Published: March 2003

Background

Colorectal cancers exhibiting microsatellite instability (MSI) appear to have unique biological behaviour. This study analyses the association between extensive MSI (MSI-H), clinicopathological features and survival in an unselected group of patients with sporadic Australian Clinico-Pathological Stage (ACPS) C (tumour node metastasis stage III) colorectal cancer.

Methods

Some 255 patients who underwent resection for sporadic ACPS C colorectal cancer between 1986 and 1992 were studied. No patient had received chemotherapy. Minimum follow-up for all patients was 5 years. Archival normal and tumour DNA was extracted and amplified by polymerase chain reaction using a radioactive labelling technique. MSI-H was defined as instability in 40 per cent or more of seven markers.

Results

Twenty-one patients showed MSI-H. No association was found between MSI and age or sex. Tumours exhibiting MSI-H were more commonly right sided (P < 0·00001), larger (P = 0·002) and more likely to be high grade (P = 0·049). After adjustment for age, sex and other pathological variables, patients whose cancers exhibited MSI-H had improved survival (P = 0·015).

Conclusion

Recognition of MSI-H in sporadic ACPS C tumours identifies a subset of cancers with improved prognosis. Such stratification should be considered in trials of adjuvant therapy and may be relevant to therapeutic decision making.
Pharmacological hepatic preconditioning: involvement of 70-kDa heat shock proteins (HSP72 and HSP73) in ischaemic tolerance after intravenous administration of doxorubicin
Authors: Kume M , Yamamoto Y , Yamagami K , Ishikawa Y , Uchinami H , Yamaoka Y
Published: March 2003

Background

Pharmacological preconditioning may induce a stress response which protects liver against ischaemia–reperfusion injury (IRI). The aim of this study was to determine, in an animal model, whether intravenous administration of doxorubicin induces heat shock proteins (HSPs) in liver tissue and facilitates liver tolerance to subsequent warm IRI.

Methods

Male Wistar rats were used. Production of HSPs was determined in liver tissue sequentially after the injection of doxorubicin 1 mg/kg body-weight. Acquisition of tolerance for 30 min warm ischaemia and reperfusion of the liver was determined in animals pretreated (48 h beforehand) with doxorubicin, and in controls. Biochemical liver function and liver adenine nucleotide concentration 40 min after reperfusion and survival rate at 7 days after the ischaemic insult were recorded.

Results

Expression of HSP72 and HSP73 in the liver was confirmed 48 h after doxorubicin administration. Biochemical parameters and survival rates were significantly better in pretreated animals than in controls.

Conclusion

These results indicate that doxorubicin has the potential to provide the liver with tolerance against IRI. A simultaneous increase of both HSP72 and HSP73 in liver tissue may explain the acquisition of tolerance following the administration of doxorubicin.
Natural history of patients with adhesive small bowel obstruction
Authors: Miller G , Boman J , Shrier I , Gordon P H
Published: March 2003

Background

Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure. The goals of this study were to determine factors predisposing to adhesive SBO, to note the long-term prognosis and recurrence rates for operative and non-operative treatment, to elicit the complication rate of operations and to highlight factors predictive of recurrence.

Methods

The medical records of all patients admitted to one hospital between 1986 and 1996 with the diagnosis of SBO were reviewed retrospectively. This included 410 patients accounting for 675 admissions.

Results

The frequency of previous operation by procedure type was colorectal surgery (24 per cent), followed by gynaecological surgery (22 per cent), herniorrhaphy (15 per cent) and appendicectomy (14 per cent). A history of colorectal surgery (odds 2·7) and vertical incisions (odds 2·5) tended to predispose to multiple matted adhesions rather than an obstructive band. At initial admission 36 per cent of patients were treated by means of operation. As the number of admissions increased, the recurrence rate increased while the time interval between admissions decreased. Patients with an adhesive band had a 25 per cent readmission rate, compared with a 49 per cent rate for patients with matted adhesions (P < 0·004). At the initial admission 36 per cent of patients were treated surgically. Patients treated without operation had a 34 per cent readmission rate, compared with 32 per cent for those treated surgically (P not significant), a shorter time to readmission (median 0·7 versus 2·0 years; P < 0·05), no difference in reoperation rate (14 versus 11 per cent; P not significant) and fewer inpatient days over all admissions (4 versus 12 days; P < 0·0001).

Conclusion

The likelihood of reobstruction increases and the time to reobstruction decreases with increasing number of previous episodes of obstruction. Patients with matted adhesions have a greater recurrence rate than those with band adhesions. Non-operative treatment for adhesions in stable patients results in a shorter hospital stay and similar recurrence and reoperation rates, but a reduced interval to reobstruction when compared with operative treatment.
Retrospective analysis of prognostic factors after liver resection and transplantation for cholangiocellular carcinoma
Authors: Weimann A , Varnholt H , Schlitt H J , Lang H , Flemming P , Hustedt C , Tusch G , Raab R
Published: March 2003

Background

Cholangiocellular carcinoma is an uncommon primary liver cancer, which may be mixed with hepatocellular carcinoma. A retrospective analysis was undertaken to evaluate the results of surgical treatment and to identify prognostic factors.

Methods

Between 1978 and 1996, 162 patients underwent surgery for cholangiocellular carcinoma: liver resection (n = 95), liver transplantation (n = 24) and exploratory laparotomy with and without drainage (n = 43). Univariate and multivariate analyses of prognostic factors were performed.

Results

Overall survival was 47 per cent at 1 year, 28 per cent at 2 years and 13 per cent at 5 years. Survival rates for patients with resectable tumours were 64, 43 and 21 per cent respectively, and for those who underwent liver transplantation 21, 8 per cent and zero respectively. Univariate analysis showed that the following variables had an effect on survival: age, jaundice, liver resection, T, N and M stage in the tumour node metastasis classification, Union Internacional Contra la Cancrum (UICC) tumour stage, tumour-free margins, vascular infiltration, tumour number, tumour size and serum level of carcinoembryonic antigen. Multivariate analysis identified jaundice, N and M category, and UICC tumour stage as independent prognostic factors.

Conclusion

The data underscore the importance and prognostic value of the UICC tumour classification for cholangiocellular carcinoma. The prognosis of mixed tumours is no different. Liver resection remains the treatment of choice; transplantation offers no solution for otherwise unresectable tumours.
Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials
Authors:   EU Hernia Trialists Collaboration, Grant A
Published: March 2003

Background

Open tension-free methods of groin hernia repair have been widely adopted despite little rigorous evaluation.

Methods

Information was assimilated from all randomized or quasi-randomized trials comparing open mesh with open non-mesh methods to assess benefits and safety. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports, and quantitative or, if not possible, qualitative meta-analysis was performed.

Results

Fifteen eligible trials, which included 4005 participants, were identified. There were similar numbers of complications in each group, with few data to address short-term pain and length of stay in hospital. Return to usual activities was quicker in the mesh group for seven of ten trials (P not significant). There were fewer reported recurrences in the mesh groups: overall 21 (1·4 per cent) of 1513 versus 72 (4·4 per cent) of 1634 (odds ratio 0·39 (95 per cent confidence interval 0·25–0·59); P < 0·001).

Conclusion

Although the rigorous search maximized trial identification, formal meta-analysis was limited by the variation in trial reporting. Within the data available, mesh repair was associated with fewer recurrences.
Influence of antiseptic agents on interleukin 8 release and transmigration of polymorphonuclear granulocytes in an in vitro model of peritonitis
Authors: Sendt W , Mansouri E , Schmitt-Graeff A , Wollenberg K , Schöffel U
Published: March 2003

Background

The effect of antiseptic agents on peritoneal cells is ill defined. The influence of taurolidine (TAU) and polyhexamide (HEX) was investigated in an in vitro model.

Methods

Human umbilical vein endothelial cells (HUVECs) and human peritoneal mesothelial cells (HPMCs) were laid on collagen-coated filter inserts (HUVECs on the bottom, HPMCs on the top), thus representing a two-chamber peritoneal model. When confluence was reached, HPMCs were stimulated with 0·5 ml tumour necrosis factor (TNF) α 10 μg ml−1 for 4 h. Afterwards 0·5 ml TAU (1 and 2 per cent) or 0·5 ml HEX (0·1 and 0·2 per cent) solutions were added to the upper compartment. After 1 h polymorphonuclear granulocytes (PMNs) (105 ml−1) were added to the lower compartment. After 2 and 6 h aliquots were taken from both compartments, transmigrated PMNs were counted and interleukin (IL) 8 concentrations were measured. Controls were either TNF-α-stimulated HPMCs or stimulated HPMCs where culture medium had been substituted for TNF-α. Significance of differences was assessed by analysis of variance with Bonferroni corrections. Correlations were calculated by linear regression analysis.

Results

Stimulation with TNF-α led to a time-dependent increase in PMN transmigration. IL-8 secretion into the apical compartment increased time dependently, resulting in a gradient between the two chambers. After substitution of the stimulus by culture medium, significantly less IL-8 was measured in both compartments. PMN transmigration was almost absent. Addition of HEX resulted in an initial increase in IL-8 levels comparable to TNF controls without further changes. A concentration-dependent decrease in IL-8 gradient was associated with reduced transmigration. The IL-8 gradient between the upper and lower chambers correlated significantly with PMN transmigration (r = 0·8205, P < 0·0001).

Conclusion

The decrease in IL-8 gradients by HEX and the diminished IL-8 response after addition of TAU may reflect either anti-inflammatory effects or cellular damage. Both antiseptic solutions reduced PMN migration, irrespective of continuous stimulation in this model.
Rebound phenomenon in tissue plasminogen activator activity of parietal peritoneum after anastomosing colon in rats with bacterial peritonitis
Authors: Reijnen M M P J , Holmdahl L , Falk P , van Goor H
Published: March 2003

Background

This study aimed to measure the fibrinolytic response, which plays a role in adhesion and abscess formation, of the parietal peritoneum to surgery in the presence and absence of bacterial peritonitis.

Methods

In 48 male Wistar rats bacterial peritonitis was induced using caecal ligation and puncture (CLP). Some 24 h after CLP (day 0), 12 rats were killed and biopsies were taken from the parietal peritoneum. The remaining 36 rats were reoperated whereby the ligated caecum was resected followed by resection of a 1-cm segment of the descending colon and end-to-end anastomosis. Thirty additional rats underwent resection of a 1-cm segment and anastomosis of the descending colon without any previous procedure. One-third of the rats were killed on days 1, 3 and 7 after anastomosing the colon, and biopsies were taken from the parietal peritoneum. From ten untreated rats, biopsies were taken for measurement of baseline levels. All biopsies were homogenized and tissue plasminogen activator (tPA) activity was measured using an enzyme-linked immunosorbent assay.

Results

Some 24 h after inducing peritonitis (day 0), tPA activity was significantly (P < 0·0001) decreased compared with baseline levels. One day after anastomosis in rats with peritonitis, tPA activity was in the same range as baseline values, while tPA activity was significantly increased on days 3 and 7 after anastomosis, in comparison to baseline levels (P = 0·0002). There was no significant difference in tPA activity compared with baseline levels 1, 3 and 7 days after anastomosing colon in normal rats.

Conclusion

In rats with bacterial peritonitis, tPA activity in the parietal peritoneum was depressed after 24 h; 24–48 h after inducing peritonitis, tPA activity increased, reaching supranormal levels at days 3–7. Surgery alone does not influence tPA activity of the parietal peritoneum.
Investigation of a potential effect of exogenous interleukin 10 on lipopolysaccharide mediated tolerance to lipopolysaccharide in rabbits
Authors: Riese J , Cavaillon J M , Hohenberger W , Haupt W
Published: March 2003

Background

Postoperative immunosuppression is a risk factor for postoperative infection and sepsis. The lipopolysaccharide (LPS) sensitivity of circulating leucocytes is diminished in the postoperative course. A similar state of LPS tolerance can be induced in the experimental setting by injection of low doses of LPS. This tolerance may be mediated by cytokines which are released following LPS injection. In the presence of interleukin (IL) 10 the LPS-induced production of numerous cytokines is diminished in leucocytes. The aim of the study was to investigate the effect of exogenous IL-10 on LPS-induced tolerance to LPS in rabbits.

Methods

Rabbits were injected intravenously with LPS 5 μg kg−1 or human recombinant IL-10 (hrIL-10) 5 μg kg−1 or with sodium chloride or hrIL-10 1 h before LPS. Blood was drawn thereafter repeatedly up to the fifth day and incubated without or with LPS (10 ng ml−1, 1000 ng ml−1) for 20 h. Tumour necrosis factor (TNF) α was assayed in plasma supernatants using the L929 bioassay and hrIL-10 was detected in serum samples by enzyme-linked immunosorbent assay. Rectal temperature was measured at the indicated time points.

Results

Injection of LPS transiently (3 days) caused a biphasic fever and a LPS-tolerant state. IL-10, like LPS, transiently diminished the capacity for TNF-α production. The administration of IL-10 1 h before the injection of LPS neither affected the LPS-induced suppression of TNF-α production, nor modified the duration of tolerance. Likewise, fever curves were no different.

Conclusion

This pilot study shows that, despite IL-10-induced reduction of the capacity for (proinflammatory) cytokine production, LPS tolerance following LPS injection was not altered. Thus systemic cytokine production seems not to be responsible for the induction of fever and LPS tolerance.
Kinetics of tumour necrosis factor α and interleukin 10 in rats with endotoxaemia and obstructive jaundice-induced anergy
Authors: Yorganci K , Baykal A , Kologlu M , Saribas Z , Hascelik G , Sayek I
Published: March 2003

Background

Obstructive jaundice leads to a significant increase in septic complications. In addition, endotoxaemia may cause a secondary insult. The effects of endotoxaemia and obstructive jaundice-induced anergy on the kinetics of two early mediators of the response to sepsis, tumour necrosis factor (TNF) α and interleukin (IL) 10, were investigated.

Methods

Wistar rats had either bile duct ligation (BDL) or sham operation. After 2 weeks, anergy was confirmed by a delayed-type hypersensitivity response in rats that had undergone BDL. All rats were challenged with Escherichia coli lipopolysaccharide (LPS) 20 mg kg−1 or saline. After 90 and 180 min, rats were killed and blood samples were obtained for TNF-α and IL-10 measurement.

Results

There was no intragroup difference after saline challenge. LPS injection significantly increased both TNF-α and IL-10 levels in all groups compared with all saline injection groups. LPS injection following BDL led to significantly higher TNF-α levels and lower IL-10 levels at 90 min compared with those after sham operation (P < 0·05). There were no differences between TNF-α and IL-10 levels at 180 min following LPS challenge in rats that had undergone BDL.

Conclusion

BDL primes for an increase in TNF-α levels to a subsequent LPS challenge. However, the IL-10 increase following an LPS challenge is suppressed by BDL. These results suggest that BDL primes for a more vigorous inflammatory response to LPS challenge.