bluuebunny/crossref_metadata_2025 huggingface dataset:
Monocyte HLA-DR antigen expression characterizes clinical outcome in the trauma patient
Authors: Hershman M J , Cheadle W G , Wellhausen S R , Davidson P F , Polk H C
Published: March 2007

Immunological assessment is important to characterize the host defence response of trauma patients as infection is the most common cause of severe morbidity and late death. Sixty trauma patients were followed serially and divided into three groups: those with an uneventful recovery (n = 17), those with recovery after major sepsis (n = 27) and those who died (n = 16). The ability of peripheral blood monocytes to express the antigen HLA-DR was measured and compared to the results from 77 asymptomatic volunteers. After initial injury, there was a significant reduction from normal in the three trauma groups. It took one week for HLA-DR antigen expression to return to the normal range in the first group, three weeks in the second group, and in the third group it never returned to normal. Monocyte HLA-DR antigen expression, after incubation with lipopolysaccharide, distinguished those patients who survived from those who died. There was no difference in HLA-DR antigen expression between a high transfusion group of 31 patients who received 10 or more units of blood and a low transfusion group of 29 patients who received less than 10 units. The ability of monocytes to express HLA-DR antigen correlated directly with the clinical course in these patients and its measurement identified a group of patients at high risk of infection and death following trauma.
Self protection in surgery: The use of double gloves
Authors: Dodds R D A , Barker S G E , Morgan N H , Donaldson D R , Thomas M H
Published: March 2007

This study assesses the perforation rate of single and double gloves and thus the extent to which double gloving protects the surgeon from diseases transmissible from the patient. We have also investigated whether double gloving offers the patient extra protection by reducing wound sepsis. Two hundred adult hernia repairs were performed, the first 100 single gloved and the second 100 double gloved. Glove perforation rates were not significantly different between single gloves and the outer of the double gloves. Although 46 of 400 outer gloves were perforated there were only 15 inner glove perforations and only eight of these matched the outer perforations. The percentage of operations in which the latex protective barrier was breached was reduced from 31 per cent when the surgeon wore single gloves to 8 per cent with double gloves. Wound sepsis was not increased by glove perforation nor reduced by double gloving. While careful technique remains mandatory we conclude that double gloving offers increased protection to the surgeon operating on high risk infectious cases.
Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics
Authors: Sabanathan S , Mearns A J , Smith P J Bickford , Eng J , Berrisford R G , Bibby S R , Majid M R
Published: March 2007

To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P < 0·01) and required less papaveretum (P < 0·01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P < 0·01). Restoration of pulmonary function was superior in the bupivacaine group (P < 0·01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.
Repeat hepatic resections for colorectal metastases
Authors: Griffith Kean D , Sugarbaker Paul H , Chang Alfred E
Published: March 2007

We identified 106 patients who had undergone complete resection of isolated colorectal hepatic metastases. Nine of these patients subsequently underwent repeat liver resections for isolated hepatic recurrences. The median follow-up for these patients was 21 months. One postoperative death was related to the second hepatectomy. At the time of last follow-up, five patients were alive and free of recurrent disease at 9, 19, 31, 50, and 67 months after their second hepatic resection. The remaining three patients were alive, but disease had recurred 11 months after resection in the first patient, 12 months after resection in the second, and 18 months after resection in the third. Among these three patients, two had solitary pulmonary nodules, which were resected, and one had unresectable liver disease. Our experience and a review of the literature suggest that repeat hepatic resection for isolated colorectal metastases can result in long-term survival in selected patients.
Metabolic effects of cancer
Authors: Douglas R G , Shaw J H F
Published: March 2007

The potential causes of deranged metabolism in cancer are discussed with emphasis on changes in energy metabolism of glucose, fat and protein. The implications of these changes for the treatment of cachexia are then considered.
Xanthogranulomatous cholecystitis
Authors: Benbow E W
Published: March 2007

This short review discusses the incidence, cause and methods of diagnosis of Xanthogranulomatous cholecystitis. The association between the condition and gallbladder cancer is also considered.
Faecal occult blood screening for colorectal neoplasia: A randomized trial of three days or six days of tests
Authors: Thomas W M , Pye G , Hardcastle J D , Mangham C M
Published: March 2007

Haemoccult®, a guaiac test for faecal occult blood, detects 56–78 per cent of asymptomatic carcinomas when performed over 3 days. In patients with known colorectal cancer the sensitivity of the test for neoplasia is increased by extending the test period to 6 days. We report the first randomized comparison of 3 day with 6 day testing in asymptomatic individuals. 35184 age and sex matched individuals were randomly allocated to receive Haemoccult over 3 or 6 days. The tests were completed by 10176 (57·8 per cent) of the 17616 offered 3 day Haemoccult and 9461 (53·9 per cent) of the 17568 offered 6 day Haemoccult, a significant decrease in compliance (P<0·001). Of the 3 day Haemoccult tests 131 (1·29 per cent) were positive, significantly fewer than the 160 (1·69 per cent) positive tests after 6 day Haemoccult (0·01 < P < 0·02). Investigation of subjects with a positive test revealed 20 carcinomas (1·14 per 1000 offered and 1·97 per 1000 completing the test) in the 3 day group and 24 carcinomas (1·37 per 1000 offered and 2·54 per 1000 completing the test) after 6 day Haemoccult tests (0·5<P<0·7 for those offered the test and 0·3<P<0·5 for those completing it). After 3 day Haemoccult 112 adenomas in 76 persons were detected (4·31 per 1000 offered and 7·47 per 1000 completing the test). In the 6 day group 123 adenomas in 83 persons (4·72 per 1000 offered and 8·77 per 1000 completing the test) were detected (0·5 < P < 0·7 for those offered the test and 0·3 < P < 0·5 for those completing it). Large adenomas were found in 27 individuals after 3 day testing (1·53 per 1000 offered the test and 2·65 per 1000 completing it) and in 35 individuals after 6 day testing (1·99 per 1000 offered the test and 3·70 per 1000 completing it) (0·3<P<0·5 for those offered the test and 0·l<P<0·2 for those completing it). This study has not demonstrated a significant increase in the yield of neoplasia in asymptomatic subjects offered Haemoccult over 6 days. However there was a significant decrease in compliance and a higher rate of colonoscopy in those offered 6 day testing.
Operative findings in patients with early forms of gallbladder cancer
Authors: de Aretxabala X , Roa I , Araya J C , Burgos L , Flores P , Huenchullan I , Miyazaki I
Published: March 2007

Of 52 patients diagnosed as having gallbladder cancer in a 2-year period, 15 had no evidence of serosal involvement. Four of these 15 patients had tumour confined to the mucosa and did not undergo reoperation while 11 patients underwent lymph node dissection and hepatic wedge resection at a second operation. The correct diagnosis was suspected before the first operation in only one of 11 patients undergoing reoperation; the tumour was found microscopically in seven patients. Of the 11 patients who underwent reoperation, five had lymph node involvement, and three of these patients had both liver and lymphatic involvement. Our results underline the difficulty of establishing the diagnosis of gallbladder cancer before operation and the lack of major morbidity and mortality suggests that there may be value in reoperating on patients found to have gallbladder carcinoma without serosal involvement. Further follow-up is required to assess the long-term value of this approach.
The effect of caerulein induced pancreatitis on the hepatic microvasculature
Authors: Delaney C , McEntee G , Cottell D , McGeeney K , Fitzpatrick J M
Published: March 2007

A three-dimensional morphological study of the hepatic microvasculature in caerulein induced oedematous pancreatitis was performed using scanning electron microscopy (SEM) vascular casts and transmission electron microscopy (TEM) of hepatocytes and hepatic sinusoids. TEM studies provided ultrastructural evidence of hepatocellular damage while SEM views demonstrated gross irregularity of the sinusoidal outline with abruptly terminating sinusoidal buds and extravasation of cast material, findings which were similar to those previously reported in the pancreas itself using the same model and which were supported by TEM cross-sectional views of the hepatic sinusoids. The results suggest that caerulein induced pancreatitis is associated with extrapancreatic microvascular damage which may be an important factor in the pathogenesis of extrapancreatic organ impairment associated with acute pancreatitis.
Towards decreasing the relaparotomy rate in the Peutz–Jeghers syndrome: The role of peroperative small bowel endoscopy
Authors: Spigelman A D , Thomson J P S , Phillips R K S
Published: March 2007

Relaparotomy occurs commonly in patients with the Peutz–Jeghers syndrome, and at quite short intervals. Between 1943 and 1987 laparotomies were performed on 54 occasions in 23 patients with the Peutz–Jeghers syndrome who at some time came under the care of St. Mark's Hospital. In four patients repeat laparotomy was performed within a single year. Between 1987 and 1989 a further five patients have undergone laparotomy with on-table small bowel endoscopy. External palpation and small bowel transillumination failed to demonstrate 17 out of a total of 45 hamartomas (38 per cent). Of these 17 polyps identified endoscopically, 11 (65 per cent) were sufficiently large that a snare was used to remove them. We recommend peroperative enteroscopy as an adjunct to surgery in the Peutz–Jeghers syndrome.
Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis
Authors: Stone H Harlan , Chauvin E J
Published: March 2007

To denervate the pancreas of sensory afferents, 15 patients with intractable pain of chronic alcohol induced pancreatitis underwent left transthoracic splanchnicectomy with concomitant bilateral truncal vagotomy. All were malnourished and 11 were addicted to opiates. No respite had been obtained from 33 previous operative procedures. Each patient experienced almost immediate pain relief. Five, however, later had return of pain, but only to the right epigastrium. These five then underwent right transthoracic splanchnicectomy, after which four noted complete and apparently permanent disappearance of pain. In those 14 with a successful outcome there has been a 29 per cent mean increase in body weight, break of hard drug addition in ten of the 11 so afflicted, and return to gainful work or a relatively normal lifestyle in all 14 at a mean follow-up of 16 months. Although 11 of the 14 do have delayed gastric emptying, only one has required a drainage procedure. There have been no other late complications. This approach for control of incapacitating pain in chronic pancreatitis is both safe and simple and at the same time it appears to be reasonably reliable.
Immunodeficiency following splenectomy in the early postimmunization period
Authors: Barren P T , Richter M
Published: March 2007

Splenectomy is associated with an increased risk of serious infection with encapsulated micro-organisms in a small number of individuals. The immunological defects in this state are unclear. We have investigated in rabbits the effect of splenectomy, before and after primary immunization with a specific antigen (sheep erythrocytes) similar in structure to the pneumococcal capsular antigen, on the organ localization of antibody forming cells and the long-lived memory cells. Antibody forming cell and memory cell assays were performed at intervals up to day 270 after primary immunization. Antibody titres following secondary immunization were also measured. The results show that the major site of antibody forming cells is in the spleen following primary immunization of the untreated rabbit and that antibody forming cells subsequently migrate to the lymph nodes and thymus. On the other hand, in rabbits splenectomized before primary immunization the major site of the antibody forming cells is the peripheral lymph nodes. These rabbits also gave good secondary immune responses. However, splenectomy 40 days after primary immunization results in a poor secondary immune response, indicating that essentially all the antibody forming cells following primary immunization were localized in the spleen at the time of splenectomy.
Thallium isotope scintigraphy and ultrasonography: Comparative studies of localization techniques in primary hyperparathyroidism
Authors: Carlson G L , Farndon J R , Clayton B , Rose P G
Published: March 2007

Controversy exists about whether preoperative localization procedures are indicated in patients with primary hyperparathyroidism before first neck exploration. Currently, thallium subtraction scintigraphy and ultrasonography are the techniques used most frequently. This paper examines prospectively the accuracy and value of these techniques in a group of 71 patients with primary hyperparathyroidism. When considering all glands, thallium scanning produced a sensitivity of 46·6 per cent with a specificity of 91·5 per cent, compared with a sensitivity of only 21·4 per cent and specificity of 94·5 per cent for ultrasonography. Accuracy rates, for all glands, were 80 per cent and 75·7 per cent respectively. Both localization procedures were consistently ineffective in localizing adenomas weighing less than 500 mg, over 80 per cent of which went undetected by both scanning modalities. While both scans produced satisfactory results in localizing adenomas weighing more than 1 g, these adenomas should not represent a challenge to an experienced endocrine surgeon and, therefore, neither localization is recommended before first neck exploration.
Statistical comparison of two methods of clinical measurement
Authors: Murray G D , Miller R
Published: March 2007

The comparison of two measurement techniques, neither of which can be regarded as being a ‘gold standard’, is fundamental to much basic research. This apparently simple problem raises many statistical difficulties, which are reviewed in this paper in the context of anorectal manometry. It is concluded that a recently developed approach focusing on the agreement between the two techniques is far superior to the more conventional approach based on correlation. However, until the benefits of the new analysis are more widely recognized (and it is hoped that this paper is a step towards that goal), it is argued that it is useful to present both analyses in such comparisons of measurement techniques.
Role of duplex scanning in the selection of patients for carotid endarterectomy
Authors: Farmilo R W , Scott D J A , Cole S E A , Jeans W D , Horrocks M
Published: March 2007

A retrospective review of 63 patients undergoing duplex scanning and angiography for suspected carotid artery disease was performed to evaluate the need for routine angiography before carotid endarterectomy. A consultant surgeon (M.H.) made a simulated management decision on the basis of a clinical summary and a duplex scan report. Twenty-four patients were selected for surgery without angiography; duplex scanning had a sensitivity of 100 per cent and a specificity of 90 per cent in the detection of internal carotid artery stenosis. In two cases duplex scanning misdiagnosed a total occlusion as a critical stenosis. Eighteen patients failed to meet the criteria for surgery and were referred for angiography. Twenty-one patients were selected for conservative treatment on the basis of the duplex scan report. Combining the surgical and conservative groups (45 patients), duplex scanning had a sensitivity of 96 per cent and specificity of 95 per cent for the detection of stenosis greater than 50 per cent. In the identification of a total occlusion, duplex scanning had a poor sensitivity of 50 per cent. These results suggest that routine angiography before carotid endarterectomy is unnecessary in selected patients but that a suspected occlusion should be confirmed by angiography.
Epidermal growth factor increases tensile strength in intestinal wounds in pigs
Authors: Kingsnorth A N , Vowles R , Nash J R G
Published: March 2007

Growth factors enhance tensile strength, angiogenesis and collagen synthesis in skin wounds. The effects were studied of a continuous intraperitoneal infusion of epidermal growth factor (EGF) on the mechanical properties of healing in linear full-thickness wounds of the stomach, ileum and colon of young pigs (n = 16, mean(s.d.) body-weight 20·1(1·9) kg). In half the animals an osmotic minipump was implanted into the peritoneal cavity to deliver recombinant human EGF at a rate of 0·5 µg kg−1 24 h−1. Animals were killed at 5 days and the integrity of a 20-mm ring of intestine was tested for tensile strength. Breaking strength (gmm−2) of the intestinal wounds in untreated pigs (n = 8) was: stomach 28·0(2·0), ileum 46·8(4·8), colon 85·6(4·2). Intestinal wounds in pigs (n = 8) receiving supplemental EGF had significantly increased breaking strength: stomach 32·4(2·2) (P < 0·05), ileum 56·8(5·4) (P < 0·05), colon 96·0(3·8) (P < 0·01) compared with untreated animals. At 5 days after the initial injury intraperitoneal EGF increases the tensile strength of intestinal wounds in pigs.
Jejunal pouch reconstruction after total gastrectomy for cancer: Experience in 29 patients
Authors: Cuschieri A
Published: March 2007

The experience with interposed jejunal pouch after total gastrectomy for cancer in 29 patients is reviewed. There were two postoperative deaths (7 per cent) due, respectively, to myocardial infarction on day 5 and massive haemorrhage from the splenic vein on day 14. Anastomotic leaks, all from the proximal anastomosis, were encountered in three patients (11 per cent). These consisted of one minor clinical leak in a stapled anastomosis and two radiological leaks from hand-sutured anastomoses. Obstruction of the pouch or its conduit by recurrent tumour was not observed in any patient, including those who died from metastatic disease. There was one instance of benign stenosis of the distal anastomosis to the duodenum which required revisional surgery. The symptomatic assessment in the long-term surviving patients was good except for mild oesophagitis due to bile reflux in five patients. Body-weight was maintained and adverse nutritional consequences were not observed.
Endoscopic and radiological appraisal of gastric varices
Authors: Mathur S K , Dalvi A N , Someshwar V , Supe A N , Ramakantan R
Published: March 2007

Of 104 patients with portal hypertension who were subjected to oesophageal variceal sclerotherapy, gastric varices were seen in 81 (78 per cent) at endoscopy and 69 (74 per cent) at splenoportography. In 50 (48 per cent) patients gastric varices were seen at the initial endoscopic examination and in 31 they developed during follow-up at intervals varying from 1 to 56 weeks. Gastric varices were seen significantly more often along the lesser curvature than in the gastric fundus and the left gastric vein was the main feeding vessel in 75 per cent of cases. Varices bled in nine of 81 patients and bleeding was seen significantly more often from fundal varices (30 per cent) than from lesser curve varices (5 per cent) (P < 0·02). The incidence of gastric varices is high, and contrary to popular belief they are more often located along the lesser curvature of the stomach than in the gastric fundus.
Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer
Authors: Boku T , Nakane Y , Minoura T , Takada H , Yamamura M , Hioki K , Yamamoto M
Published: March 2007

Survival rates after curative gastrectomy for advanced gastric cancer among 238 patients in whom the cancer was invading the serosa were compared with 283 patients without serosal invasion. Generalized Wilcoxon estimates for 5-year survival rate were 47·1 per cent for patients exhibiting serosal invasion and 75·9 per cent for patients without serosal invasion. The frequency of lymph node metastasis increased proportionately with the extent of serosal invasion: 18·4 per cent in cases of S0; 53·8 per cent in cases of S1; 80·0 per cent in cases of S2; and 91·4 per cent in cases of S3. The higher the aggregate total of S (serosal invasion) and n (lymph node metastasis) factors, the lower the 5-year survival rate. In addition, patients with serosal invasion had a propensity for peritoneal dissemination of cancer cells; the percentage of cases with intraperitoneal free cancer cells increased with the extent of serosal invasion. It is worth noting that when cancer infiltration proceeded to the deeper layers and was accompanied by nodal metastasis, cancerous invasion of the perinodal fatty tissue was frequently evident. Therefore, unfavourable prognosis after curative resection in gastric cancer patients with serosal invasion may be largely dependent on whether or not the cancer has invaded the peritoneal cavity and the perinodal fatty tissue.
Obstructive jaundice and wound healing
Authors: Grande L , Garcia-Valdecasas J C , Fuster J , Visa J , Pera C
Published: March 2007

Wound healing was studied in 95 jaundiced patients and 123 anicteric patients using skin prolylhydroxylase activity as an index of collagen synthesis. The mean(s.d.) value of skin prolylhydroxylase activity in jaundiced patients was significantly lower than that of controls in the preoperative period (40·1(19·2) versus 369·2(32·2) c.p.m./mg protein, respectively, P < 0·001). Before operation there was a significant difference between patients with benign or malignant obstruction of the biliary tree (55·0(12·3) versus 25·2(10·4) c.p.m./mg protein, respectively, P < 0·05). In patients with benign obstruction skin prolylhydroxylase activity returned to normal values (326·3(53·1) c.p.m./mg protein, P < 0·001 versus preoperative values), while in patients with malignant lesions skin prolylhydroxylase activity increased significantly with respect to the preoperative period (25·2(10·4) versus 82·9(14·3) c.p.m./mg protein, P < 0·01) but was still below normal values. Abdominal wound dehiscence was more common in jaundiced patients (six of 95) than in the anicteric group (two of 123). This complication appeared to be associated with a low skin prolylhydroxylase activity.
Prediction of mortality by logistic regression analysis in patients with postoperative enterocutaneous fistulae
Authors: Altomare D F , Serio G , Pannarale O C , Lupo L , Palasciano N , Memeo V , Rubino M
Published: March 2007

The contrasting results of treatment of patients with postoperative enterocutaneous fistulae reflect the heterogeneity of the disease and depend on the patient's condition and the characteristics of the fistulae. For this reason, the use of a prognostic index, which enables such patients to be classified according to their risk of death, could be useful. In this study we propose a prognostic index based on a logistic regression analysis, obtained by using two (APACHE II score and serum albumin concentration) of the eight risk factors that have been retrospectively analysed in a series of 70 patients with postoperative enterocutaneous fistulae treated in our surgical department since 1981. The logistic regression equation indicates that patients with a probability of dying of less than 0·35 have a good prognosis, with a sensitivity of 90 per cent, a specificity of 90 per cent, a negative predictive value of 79 per cent, a positive predictive value of 96 per cent and an accuracy of 90 per cent. The predictive performance of the index has also been evaluated in a group of 17 patients studied prospectively, and this confirms the sensitivity and specificity of the model. This postoperative enterocutaneous fistulae index could be a helpful tool in clinical trials and surgical audit.
Demonstration of blood flow patterns in human soft tissue sarcomas using 99mTo-labelled hexamethyl propyleneamineoxime
Authors: Sinnett H D , Rowell N P , McCready V R , Lawrence R
Published: March 2007

Blood flow patterns have been studied in 28 patients with soft tissue sarcoma (29 tumours) using 99mTc-labelled hexamethyl propyleneamineoxime with planar views of the tumour-bearing region. Tumour:back-ground ratios ranged from 1·13 to 6·60 (mean 2·74) and maximum:minimum tumour ratios (between peripheries and centres of tumours) ranged from 1·34 to 32·0 (mean 4·70). In eight of 29 tumours (seven of which were involving the trunk) the tumour could not be identified. This study demonstrates that the blood supply to soft tissue sarcomas is generally greater than that to adjacent normal tissues and that tumour centres are relatively underperfused compared with the tumour periphery. In this heterogeneous series there was no clear-cut relationship between blood flow and histological grade or type.
Gut barrier function and the surgeon
Authors: Saadia R , Schein M , MacFarlane C , Boffard K D
Published: March 2007

There is accumulating evidence that multiple organ failure is not always the result of an established septic focus. Increasing attention has centred on the gut as a reservoir of bacteria (and bacterial endotoxins) that can traverse the intestinal mucosal barrier (a process called ‘bacterial translocation’) and initiate the septic state. Although the link between haemorrhagic shock and sepsis was recognized decades ago, the full experimental demonstration of this phenomenon is more recent. It was shown to occur in three main settings: physical disruption of the gut mucosa, impaired defence mechanisms and altered gut microbial ecology. Conditions such as haemorrhagic shock, burns, protein malnutrition and sepsis are seen in the severely ill surgical patient or the multiply injured, and are known to cause various combinations of circumstances favourable to bacterial translocation and endotoxin absorption. These may play an important role in the mortality of the critically ill.
Patient throughput and mortality rate in a trauma service
Authors: Schiowitz M F
Published: March 2007

Trauma centre standards of the American College of Surgeons set a minimum annual volume of cases for trauma surgeons. The volume requirement, however, lacks an objective basis. The author reviews a personal series of cases revealing considerably lower volume than recommended, while injury severity and mortality were comparable to published data. No death was considered preventable on review. Possibly, lower individual caseloads are acceptable for trauma surgeons.
Prognostic index for the development of liver metastases in patients with colorectal cancer
Authors: Taylor I , Mullee M A , Campbell M J
Published: March 2007

The incidence of synchronous and metachronous liver metastases in patients with colorectal cancer is extremely high. Approximately 25 per cent of patients will have overt liver metastases at the time of presentation, and in the remainder up to 40 per cent will eventually develop liver metastases. In an attempt to obtain a prognostic index for the prediction of those patients most likely to develop liver metastases, 134 patients with primary colorectal cancer but without overt liver metastases at initial presentation were followed up for between 5–10 years. Regular liver scans were performed and the presence of liver metastases observed. A total of 47 patients developed liver metastases. Those preoperative variables related to the subsequent development of liver metastases were sex, log10 serum alkaline phosphatase level and Dukes' classification. A prognostic index using these parameters has been calculated.
Metachronous colorectal carcinoma
Authors: Bülow S , Svendsen L B , Mellemgaard A
Published: March 2007

During the period 1943–67, 903 Danish patients aged <40 years had colorectal carcinoma. The patients were followed up for up to 41 years and during this period 44 of 501 (9 per cent) operated on for cure developed a metachronous colorectal carcinoma. The cumulative risk of a metachronous colorectal carcinoma was 30 per cent after up to 41 years of observation. The occurrence of a metachronous colorectal carcinoma was evenly distributed in the observation period. The cumulative survival rate after operation for a metachronous colorectal carcinoma was 41 per cent after 20 years of observation. We propose a lifelong follow-up programme after resection of colorectal carcinoma for cure in this age group, including annual Hemoccult® test and colonoscopy at 3-year intervals.
Incidence of dysplasia in the anorectal mucosa in patients having restorative proctocolectomy
Authors: Tsunoda A , Talbot I C , Nicholls R J
Published: March 2007

The incidence of dysplasia in the mucosal strippings from the anorectal stump was studied in 132 patients treated by restorative proctocolectomy with Heal reservoir for ulcer at ive colitis and familial adenomatosis. The anorectal mucosa was stripped from the level of division of the gut tube to the dentate line. Of 118 patients with ulcerative colitis, 12 (10–2 per cent) had dysplasia in some part of the large bowel. Mucosal strippings were examined histologically in 118 cases, of which only three (2–5 per cent) showed dysplasia. There was a correlation between dysplasia and the presence of carcinoma and the duration of the disease in the operative specimen of colon and rectum and also in the anorectal mucosal specimen although the number of patients with carcinoma (eight cases) in this analysis was small. All 14 patients with familial adenomatous polyposis showed large bowel mucosal dysplasia in the operative specimen which was severe in six cases. Anorectal mucosal strippings were examined in these patients and 12 showed dysplasia which was severe in three.
‘Close shave’ in anterior resection
Authors: Karanjia N D , Schache D J , North W R S , Heald R J
Published: March 2007

Of 192 anterior resections for rectal cancer performed over 10 years by one author (R.J.H.), 169 (88 per cent) included total mesorectal excision and all included lavage of the clamped distal rectum. Of this series, 152 (79 per cent) were classed as curative, 110 with a resection margin > 1 cm and 42 with a resection margin ≤ 1 cm. The group with a > 1 cm margin had a significantly lower Dukes' A to B ratio than the group with a margin ≤1 cm, although the proportion with Dukes' C lesions was similar in both groups (X2 = 6·712; P = 0·035). There were no local recurrences in the latter group (95 per cent confidence interval (CI) is 0–5·9 per cent) while there were four (3·6 per cent) in the former group (95 per cent CI is 0·8–7·4 per cent). There were no significant differences in recurrence rates, local and distant, between the two groups (Fisher's exact test, P = 0·2). Reduction of resection margin, provided total mesorectal excision and washout is properly performed, does not increase local recurrence or compromise survival.
Comparison of one dose versus three doses of prophylactic antibiotics, and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery
Authors: Jensen L S , Andersen A , Fristrup S C , Holme J B , Hvid H M , Kraglund K , Rasmussen P C , Toftgaard C
Published: March 2007

In a randomized prospective controlled trial involving 311 patients undergoing acute or elective colorectal surgery, the efficacy and safety of two different single dose and one triple dose regimen of antibiotic prophylaxis, as well as the influence of blood transfusion on postoperative infectious complications, were studied. Postoperative infectious complications occurred in a total of 59 patients (19-0 per cent). There were no major differences between the three treatment groups. Thirty-four patients (10·9 per cent) developed abdominal wound infection, 17 patients (5·5 per cent) intra-abdominal abscess and 16 patients (5·1 per cent) anastomotic leakage. Of 202 patients (65·0 per cent) requiring blood transfusion during hospitalization 57 (28·2 per cent; 95 per cent confidence limits of 23·36 per cent) developed infectious complications, whereas two non-transfused patients (1·8per cent; 95per cent confidence limits of 0·2 to 6per cent; P<0·001) developed infectious complications. It is concluded that one single dose of antibiotic prophylaxis in acute and elective colorectal surgery is as protective as a triple dose regimen. The development of infectious complications despite antibiotic prophylaxis is strongly related to blood transfusion.
Faecal occult blood testing in symptomatic patients: Comparison of three tests
Authors: Tate J J T , Northway J , Royle G T , Taylor I
Published: March 2007

This study examines three faecal occult blood tests, Haemoccult®, Fecatwin® and E-Z Detect®, each with different sensitivities, to determine which is best suited for use in symptomatic patients - both for the detection of cancer and of non-malignant mucosal disease of the large bowel. A test was completed by 1025 patients before double-contrast barium enema and the performance of each test was determined from the result of this investigation. The study was completed by 969 patients. There were 49 patients with colorectal cancer, 92 patients with a cancer or a polyp >5 mm, and 130 with some mucosal abnormality. The test most sensitive for blood, Fecatwin, detected 14 of 15 (93 per cent) cancers and 29 (69 per cent) of 42 patients with mucosal disease (including inflammatory bowel disease) but gave three times as many false positive results as the Haemoccult test, which is less sensitive for blood. The chance of a patient with a positive Haemoccult result having mucosal disease on barium enema was 24 of 47 patients (51 per cent) (two-thirds of these having colorectal cancer). A negative Haemoccult result, however, was unreliable and should not influence patient management. A test less sensitive for blood than Haemoccult was found to be of little value in symptomatic patients.
Whole gut irrigation and Prepacol® laxative preparation for colonoscopy: A comparison
Authors: Köhler L , Vestweber K H , Mennigen R , Sommer H , Troidl H
Published: March 2007

Two techniques for preparation of the colon for colonoscopy were compared in a controlled trial. Fifty patients given a low residue diet and the laxative Prepacol® were compared with 50 patients given whole gut irrigation. Significantly more patients suffered from vomiting (P = 0·0005), shivering (P = 0·0062) and nausea (P = 0·031) following irrigation; in two cases the procedure had to be abandoned because of profuse vomiting. Irrigation was less well tolerated by the patients (P = 0·00002) than preparation with Prepacol®. On the other hand, the quality of bowel preparation was found to be better (P = 0·0005) after irrigation. On two occasions colonoscopy was not possible following Prepacol® preparation because of faecal residue. Patients with a previous colorectal resection showed a similar quality of cleansing to those patients prepared with irrigation. We conclude that Prepacol® is as efficient as irrigation for patients who have had a previous colorectal resection because the quality of bowel preparation is as good and the associated patient discomfort is small.
Percutaneous transhepatic cholangioscopic lithotripsy
Authors: Chen M F , Jan Y Y
Published: March 2007

Since 1983, 14 patients with intrahepatic and common bile duct stones have undergone percutaneous transhepatic cholangioscopic lithotripsy because the stones were too large to be removed using ordinary percutaneous transhepatic cholangioscopy. Stones were completely fragmented in seven cases (six with intrahepatic stones and one with common bile duct stone) and partially disrupted in five cases with intrahepatic stones. Intrahepatic duct angulation and stricture was the factor most often responsible for failure. All the disintegrated stones were removed by subsequent transhepatic cholangioscopy. Amongst the seven patients with complete stone fragmentation, six stones were found with electrohydraulic shock-wave lithotripsy and one with NdYAG laser lithotripsy. Complications of percutaneous transhepatic cholangioscopic lithotripsy using electrohydraulic shock waves were found in three cases, two had transient haemobilia and one had fever and chills after the procedures. They all recovered by conservative treatment. NdYAG laser treatment was expensive, time consuming and inconvenient to use. Percutaneous transhepatic cholangioscopic lithotripsy by using electrohydraulic shock wave is an effective and safe method to fragment biliary stones and to facilitate their removal.
Management of the stump of the pancreas after distal pancreatic resection
Authors: Shankar S , Theis B , Russell R C G
Published: March 2007

The optimal management of the stump of the pancreas following distal resection remains controversial. To determine whether there was an advantage in draining the stump of the pancreas into a Roux-en-Y loop of jejunum, a retrospective survey of 113 patients who had a distal pancreatectomy for chronic pancreatitis or complications of acute pancreatitis in the non-acute phase was undertaken. The decision to perform a drainage procedure was determined on the basis of the pancreatogram, the size of the pancreatic duct and technical factors at the time of the operation. Sixty-seven patients had no drainage procedure and 46 patients had a drainage procedure. The two groups were comparable in all respects before surgery. The postoperative outcome in the short- and long-term was similar in both groups. It is concluded that caudal pancreatic drainage confers no benefit following distal pancreatic resection.
Outcome of revisional gastric surgery using a Roux-en-Y biliary diversion
Authors: Ferguson G H , Maclennan I , Taylor T V , Torrance H B
Published: March 2007

One hundred and seven patients with postoperative reflux gastritis treated by Roux-en- Y biliary diversion were reviewed. Three patients died in the postoperative period, and 16 others have since died; cardiorespiratory disease was the most frequent cause of death. Seventy-nine patients were interviewed at a median of 5·5 years (range 0·5–26 years) following Roux-en-Y diversion. At review, a satisfactory result by modified Visick grading was present in 47 per cent of patients. Bilious vomiting (P<0·001), food vomiting (P<0·01), the severity of upper abdominal pain (P<0·001) and heartburn (P<0·025) were significantly improved by Roux-en- Y diversion. Weight, haemoglobin levels and employment status were not significantly altered by the procedure. Outcome was related to the surgery preceding Roux-en- Y diversion with significantly better results after partial gastrectomy compared with truncal vagotomy and drainage (P<0·01), cholecys-tectomy (P<0·05), or combinations of these procedures (P<0·01). Outcome was not predicted by sex, preoperative symptoms, smoking status, consultant surgeon, length of Roux-en-Y or 99Tc-Sn-2,6-di-ethylacetanilidoiminodiacetate (HIDA) scanning results.
First rib resection for vascular complications of thoracic outlet syndrome
Authors: Thompson J F , Webster J H H
Published: March 2007

The surgical approach to vascular complications of the thoracic outlet syndrome remains controversial. When present, removal of a cervical rib alone has produced disappointing results. Our experience of 29 consecutive first rib excisions over a 5-year period is presented. Of 20 cases with uncomplicated subclavian artery compression 19 were cured, and of six cases with aneurysm or thrombosis five were improved. Of 12 cases with neurological symptoms nine were cured and two were improved. It is suggested that first rib excision is the essential primary treatment for patients with arterial symptoms due to thoracic outlet syndrome.
Vacuum drainage of groin wounds after vascular surgery: A controlled trial
Authors: Dunlop M G , Fox J N , Stonebridge P A , Clason A E , Ruckley C V
Published: March 2007

A pilot study of 100 consecutive groin wounds after vascular surgery demonstrated lymph leaks in 12 per cent. Lymph leak was significantly associated with wound infection and with prolongation of in-patient stay. A controlled trial was therefore instituted to assess the influence of vacuum drainage in groin wound healing. One hundred and twenty-seven wounds were randomized to drainage (n = 65) or no drainage (n = 62) and the wounds were examined ‘blind’ by independent observers. No difference in the incidence of lymph leakage or wound infection was noted between the two groups. The routine use of suction drainage for groin wounds in vascular surgery is unnecessary.
Flow cytometric and histological analysis of ductal carcinoma in situ of the breast
Authors: Locker A P , Horrocks C , Gilmour A S , Ellis I O , Dowle C S , Elston C W , Blarney R W
Published: March 2007

Using archival paraffin wax embedded tumour we have investigated histological grade, DNA ploidy, S phase fraction and prolifera live index in 74 patients with symptomatic ductal carcinoma in situ (DCIS) of the breast. Nine patients developed local recurrence, six invasive in character. No patients with the cribriform subtype of DCIS developed local recurrence. The cribriform subtype showed a significantly lower rate of DNA aneuploidy and a lower proliferative index than the other subtypes. Cribriform tumours were almost exclusively well differentiated in contrast with the comedo and solid variants. Our results suggest the cribriform variant is less aggressive than other subtypes of DCIS. This has possible implications for management of these lesions.
Intestinal permeability is increased in burn patients shortly after injury
Authors: Deitch Edwin A
Published: March 2007

There is increasing direct experimental and indirect clinical evidence to indicate that under certain conditions intestinal barrier function may be lost in trauma victims. No direct measurements, however, have been performed in patients to determine whether intestinal permeability is increased shortly after a major thermal injury in the absence of infection. Fifteen hemodynamically stable burn patients with burns on more than 20% of their body surface (39% ± 12%) had their intestinal permeability measured within 24 hours of injury with use of the two nonmetabolizable sugars lactulose and manmtol as permeability markers. Lactulose absorption was fourfold higher in the patients (223 ± 54 μmol) than in the controls (58 ± 77 μmole;p < 0.02), whereas the lactulose/manmtol ratio was threefold higher (5.2 vs 1.7; p < 0.05). Thus intestinal permeability was increased in patients with moderate to major burn injuries shortly after injury. (Surgery 1990;107:411-6).
Relationship between age and survival in cancer of the colon and rectum with special reference to patients less than 40 years of age
Authors: Enblad G , Enblad P , Adami H-O , Glimelius B , Krusemo U , Påhlman L
Published: March 2007

The relative survival of all patients (n = 61 769) in the entire Swedish population reported to have a malignant tumour of the colon and rectum between 1960 and 1981 was analysed with special reference to patients under 40 years of age. The 5-year relative survival rate of patients with a tumour of the colon, irrespective of histopathological diagnosis, was 62·0 per cent below the age of 40 years and 44·4 per cent in those 40 years of age or older (P < 0·05). The corresponding figures for patients with a tumour of the rectum were 46·6 per cent and 39·1 per cent, respectively. When the relative survival was analysed separately for patients with a histopathologically demonstrated adenocarcinoma, the 5-year survival rate among patients with a cancer of the colon was 50·9 per cent in patients below 40 years of age and 48-6 per cent in those 40 years of age or older. In patients with adenocarcinoma of the rectum, the 5-year relative survival rate was 41·1 per cent in patients younger than 40 years of age and 40·7 per cent in patients 40 years of age or older. Thus, patients below the age of 40 years with an adenocarcinoma of the colon and rectum as a group appear to have the same or even a better prognosis than older patients if all tumours are considered, irrespective of histopathological diagnosis.
High versus low ligation of the inferior mesenteric artery in rectal cancer
Authors: Surtees P , Ritchie J K , Phillips R K S
Published: March 2007

The argument for and against high ligation of the inferior mesenteric artery in rectal cancer has yet to be resolved. Between 1948 and 1983, 4250 patients underwent surgery for rectal carcinoma at St. Mark's Hospital, London. From these, 250 patients were selected who had undergone curative anterior resection of a Dukes' C adenocarcinoma and their records were examined. In 150 (60 per cent) the inferior mesenteric artery was ligated above the origin of the left colic artery. The outcome was analysed using the Dukes', Gastrointestinal Tumour Study Group and Astler-Coller classifications, either alone or in combination. Tumour differentiation and extent of local invasion were also considered. Despite this detailed analysis, no improved survival was seen in patients when the inferior mesenteric artery was ligated above the origin of the left colic artery.
Comparison of coloscreen self-test® and Haemoccult® faecal occult blood tests in the detection of colorectal cancer in symptomatic patients
Authors: Pye G , Jackson J , Thomas W M , Hardcastle J D
Published: March 2007

The usefulness of faecal occcult blood tests is limited by their acceptability to patients. Standard tests require the collection of a stool sample which may inhibit compliance. Self-read tests which avoid this step have therefore been devised. Coloscreen Self-Test® (CST) and Haemoccult®, which may be regarded as the standard slide test, were offered to 450 consecutive patients attending surgical outpatient clinics with symptoms suggestive of lower gastrointestinal disease. Both tests were successfully completed by 383 patients. Although 262 (68 per cent) patients indicated that they preferred CST this was not reflected in the overall compliance to the two tests (CST 86 per cent, Haemoccult 90 per cent). CST gave a positive result in only eight out of 24 patients with a colorectal cancer (sensitivity = 33 per cent) compared with 13 out of 24 for Haemoccult (sensitivity = 54 per cent). CST had no advantage from increased compliance to outweigh its lower sensitivity.