bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved outcome for children with hepatoblastoma
Authors: Stringer M D , Hennayake S , Howard E R , Spitz L , Shafford E A , Mieli-Vergani G , Saxena R , Malone M , Dicks-Mireaux C , Karani J , Mowat A P , Pritchard J
Published: March 2007

Between 1981 and 1993, 41 children were treated for hepatoblastoma. Clinical, radiological and pathological data were reviewed retrospectively, focusing on surgical aspects of treatment and outcome. Fourteen children underwent primary resection of the hepatic tumour. One infant with severe congenital anomalies received only palliative treatment. Of 26 with irresectable disease, pulsed cytotoxic chemotherapy (cisplatin and doxorubicin) enabled subsequent surgical excision in 22 and one child with persistent extensive intrahepatic disease was successfully treated by liver transplantation. Thus, with a policy of selective preoperative chemotherapy, 90 per cent of hepatoblastomas were resectable. There were no perioperative deaths from haemorrhage but one child died from an intraoperative tumour embolus. A total of 28 survivors, 27 of whom are disease-free, were followed for a median of 5 years. The cumulative probability of survival in patients treated with intent to cure was 67 per cent. Analysis of survival data suggested a favourable outcome for those with a pure fetal histological tumour subtype. These results demonstrate significant progress in the treatment of hepatoblastoma.
Setons in the surgical management of fistula in ano
Authors: McCourtney J S , Finlay I G
Published: March 2007

Seton techniques have been used in the successful management of fistula in ano for thousands of years. In particular, the cutting seton is useful for complex high anal fistula, and drainage setons may have a significant role in the treatment of sepsis related to Crohn's disease and in immunocompromised patients.
Enhanced intra-anastomotic healing by operative lavage with nutrient solutions in experimental left-sided colonic obstruction
Authors: Aguilar-Nascimento J E , Mathie R T , Man W K , Williamson R C N
Published: March 2007

The influence of intraoperative lavage with various solutions was tested on the healing of experimental colonic anastomoses performed in the presence of obstruction. After 24 h of ligature obstruction to the pelvic colon, male Wistar rats (n = 108) underwent colonic resection and primary anastomosis, using lavage with one of four different fluids: saline, povidone-iodine, 10 per cent hypertonic glucose and short-chain fatty acids (SCFA). Controls had no lavage. The anastomotic segment was excised and studied after 3 or 6 days. At day 3, mean(s.d.) bursting pressure was significantly greater in animals receiving SCFA compared with controls (81.2(23.0)mmHg versus 34.8(34.0)mmHg). Mean(s.d.) bowel wall tension was higher in rats with SCFA (30.6(8.1) N/m × 10−4) or hypertonic glucose (29.5(10.1) N/m × 10−4) compared with controls (12.2(12.1) N/m × 10−4). By day 6, the anastomosis was more resistant to intraluminal pressure in each lavage group; mean(s.d.) hydroxyproline concentration at the anastomosis was greater in rats with SCFA (12.4(1.5) μg/mg) or hypertonic glucose (11.6(2.9) μg/mg) than in controls (8.9(1.5)μg/mg). Anastomotic healing is improved by all types of intraoperative colonic lavage, particularly with SCFA and hypertonic glucose solutions.
Abdominal aortic aneurysm in the Irish population: A familial screening study
Authors: Fitzgerald P , Ramsbottom D , Burke P , Grace P , McAnena O , Croke D T , Collins P , Johnson A , Bouchier-Hayes D
Published: March 2007

A pilot screening programme was undertaken in Ireland to determine the incidence of abdominal aortic aneurysm (AAA) (diameter 3 cm or greater) in the siblings of 120 patients known to have AAA. There were 621 siblings; 270 of them were dead, 32 were over 80 years old and 85 lived outside Ireland, leaving 234 under 80 years of age still living in Ireland who were invited to attend for ultrasonographic screening. Of the 270 siblings who had died, 102 were women and 168 men; eight men (4.8 per cent) had died from ruptured AAA. Only 125 (53.4 per cent) of the 234 siblings agreed to participate in the screening programme, 60 brothers from 31 families and 65 sisters from 35 families. Fifteen (12.0 per cent) of the 125 siblings had an AAA (median size 4.2 (range 3.1–6.8) cm), 13 (22 per cent) of the 60 male siblings and two (3 per cent) of the 65 female siblings. The prevalence of AAA among siblings was not affected by the age or sex of the patient with aneurysm. Seven of the 14 male siblings with hypertension had an AAA, compared with only six of the 46 who were normotensive (P = 0.01). The high incidence of AAA in brothers of affected patients highlights the need to counsel this group on their risk of aneurysm. The relatively low participation rate by siblings in this screening programme indicates that a hospital-based unit is unlikely to be effective in recruiting all patient siblings at risk from an AAA.
Penetrating injuries of the femoral artery
Authors: Degiannis E , Levy R D , Velmahos G C , Potokar T , Saadia R
Published: March 2007

This is a retrospective study of 106 patients with penetrating injuries to the femoral artery. The cause of injury was gunshot in 82 per cent, stabbing in 13 per cent and pellets in 5 per cent. We believe that angiography is unnecessary in patients with ‘hard’ signs of vascular injury: 97 patients underwent immediate exploration with positive findings. The presence of ‘soft’ signs alone mandates angiography as five of 12 patients with suspected injury were saved a negative exploration. Proximity of injury was a poor predictor of arterial injury. There were four amputations. Ligation of the femoral vein is not reliably associated with amputation but it was an aggravating factor in the setting of severe arterial disruption and delay to surgery.
Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 Xal units in 2070 patients
Authors: Bergqvist D , Burmark U S , Flordal P A , Frisell J , Hallböökr T , Hedberg M , Horn A , Kelty E , Kvitting P , Lindhagen A , Ljungström K G , Mätzsch T , Risberg B , Syk I , Törngren S , Wellander E , Örtenwall P
Published: March 2007

The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 Xal units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter. The study was designed as a prospective, randomized, double-blind, multicentre trial. Some 66.4 per cent of patients were operated on for a malignant disorder. The primary endpoint was deep vein thrombosis (DVT) detected with the fibrinogen uptake test. Bleeding complications were recorded and classified. Analysis was made both on an intention to treat basis and in patients given correct prophylaxis (86.3 per cent). A total of 2097 patients were randomized and 27 excluded after randomization. A technically correct fibrinogen uptake test was obtained in 1957 patients. The incidence of DVT was significantly lower in patients given 5000 Xal units, this being true for both correct prophylaxis (6.8 versus 13.1 per cent, P < 0.001), on an intention to treat basis (6.6 versus 12.7 per cent, P < 0.001), and in patients with malignant disease (8.5 versus 14.9 per cent, P < 0.001). Sixty-seven patients (3.2 per cent) died within 30 days with no difference between the groups. There were two cases of fatal pulmonary embolism. The frequency of bleeding complications in the whole series was higher in patients randomized to 5000 Xal units (4.7 versus 2.7 per cent, P = 0.02), although this was not the case in those operated on for malignant disease (4.6 versus 3.6 per cent, P not significant). Dalteparin in the dose of 5000 Xal units started in the evening before surgery has a good thromboprophylactic effect in high-risk general surgery at the cost of a small bleeding risk. In patients with malignant disease there was no increased risk of bleeding. The overall frequency of fatal pulmonary embolism with dalteparin is extremely low, even in this high-risk group of patients.
Endoscopically guided surface repair of inguinal hernia
Authors: Darzi A , Bouchier-Hayes D , Menzies-Gow N , Nduka C C
Published: March 2007

A novel tension-free prosthetic mesh repair for inguinal hernia is described. This is performed through 2-cm groin incision and the inguinal canal is traversed with the aid of a 5-mm videoendoscope. Spermatic mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic guidance. Between October 1993 and January1994, 22 primary unilateral hernia, and two bilateral repairs were undertaken. The mean (range) age was 47 (35–64) years in 23 men and one woman. The mean (range) operative time was 42 (35–58) min. All patients left hospital on the day after surgery. One patient developed a scrotal swelling that required a scrotal support.
Increasing incidence and changing presentation of thyroid cancer over a 30-year period
Authors: Fahey T J , Reeve T S , Delbridge L
Published: March 2007

During a 30-year period 8561 thyroidectomies were performed and 660 new patients presented with thyroid cancer. The number of thyroidectomies performed annually remained relatively constant for the past 20 years but the annual incidence of thyroid cancer increased from two patients in 1963 to 60 in 1992. Possible contributing factors include: altered referral patterns as a result of the introduction of fine-needle aspiration biopsy; an increase in the incidence of occult papillary cancer as a result of performing total thyroidectomy for multinodular goitre; and a background increase of thyroid cancer in the population. Data from the New South Wales State Cancer Registry implicate a background increase in the incidence of thyroid cancer in the population as a major contributing factor.
Paraoesophageal hiatus hernia: An important complication of laparoscopic Nissen fundoplication
Authors: Watson D I , Jamieson G G , Devitt P G , Mitchell P C , Game P A
Published: March 2007

Postoperative paraoesophageal hiatus hernia occurred in 17 of 253 patients who underwent laparoscopic fundoplication at five different hospitals. Ten patients have undergone subsequent surgical revision, eight by an open technique and two by laparoscopy. This complication may have important implications for the technique of laparoscopic fundoplication, as it is possible that routine posterior repair of the diaphragmatic hiatus may greatly reduce the risk. Early postoperative contrast radiology may also achieve earlier diagnosis, enabling correction to be undertaken by laparoscopy.
Prospective audit of perforation rates following upper gastrointestinal endoscopy in two regions of England
Authors: Quine M A , Bell G D , McCloy R F , Matthews H R
Published: March 2007

After cardiopulmonary complications, perforation is the second most important cause of complications following flexible upper gastrointestinal endoscopy. A recent audit of 14149 procedures detected a perforation rate of 0.05 per cent (overall mortality rate 0.008 per cent) during diagnostic endoscopy, and a perforation rate of 2.6 percent (overall mortality rate 1.0 per cent) following oesophageal intubation or dilatation. The incidence of perforation following both diagnostic and therapeutic upper gastrointestinal endoscopy has not changed over the past 10 years. The risk factors are numerous but this audit demonstrated that inexperience increases the likelihood of perforation.
Haemorrhoidectomy and disordered rectal and anal physiology in patients with prolapsed haemorrhoids
Authors: Ho Y H , Seow-Choen F , Goh H S
Published: March 2007

The effect of haemorrhoidectomy on rectal and anal physiological abnormalities was studied in 24 consecutive patients (12 men and 12 women of mean(s.e.m.) age 39.1(2.4) years) and compared with results in 13 sex- and age-matched controls. Before operation those with haemorrhoids had significantly higher resting anal pressures (P < 0.005), lower rectal compliance (P < 0.05) and more perineal descent (P < 0.05). Following haemorrhoidectomy there were significant decreases in the maximum resting (P < 0.05) and maximum squeeze anal (P < 0.001) pressures to within normal values 3 months after operation. Rectal compliance also increased significantly (P < 0.05), to that of normal controls. The abnormalities found in patients with prolapsed piles reverted to the normal range within 3 months of haemorrhoidectomy. These physiological changes are therefore more likely to be an effect, rather than the cause, of enlarged anal cushions.
Ileostomy output in the early postoperative period
Authors: Tang C L , Yunos A , Leong A P K , Seow-Choen F , Goh H S
Published: March 2007

The high volume output of a defunctioning loop ileostomy after rectal excision and anastomosis may lead to severe dehydration and electrolyte imbalance if not properly managed. Although chronic losses may be seen, the early postoperative period remains the most hazardous with regard to acute fluid and electrolyte losses for the patient with a defunctioning ileostomy1–3. A prospective study was therefore conducted to determine the period and severity of excessive ileostomy loss.
Impact of ultrasonographic duplex scanning on therapeutic decision making in lower-limb arterial disease
Authors: Elsman B H P , Legemate D A , van der Heijden F H W M , de Vos H J , Mali W P Th M , Eikelboom B C
Published: March 2007

Ultrasonographic duplex scanning has become a valuable diagnostic technique in detecting and grading stenoses and occlusions of the aortoiliac and femoropopliteal arteries. However, the question remains as to whether a treatment strategy can be designed without diagnostic angiography. This prospective study evaluated the impact of duplex scanning on therapeutic decision making. Patients with intermittent claudication, rest pain or ischaemic ulceration of the lower limb who were eligible for invasive treatment were studied. If treatment was considered necessary, a duplex scan was performed instead of diagnostic angiography. The surgeon made a therapeutic decision based on clinical assessment and information obtained from the duplex scan. If it was felt that duplex scanning gave insufficient information, diagnostic angiography was then performed. A group of 112 consecutive patients were studied prospectively; 12 were excluded for logistical reasons. The 100 remaining patients (intermittent claudication in 69, rest pain in 16, ischaemic ulceration in 15) were evaluated. Based on non-invasive tests 22 patients were treated conservatively, 36 were scheduled for percutaneous transluminal angioplasty (PTA) and 32 were scheduled for surgery. Angiography was requested to determine the definitive treatment policy in 28 patients: four of the 22 were scheduled for conservative treatment and 24 of the 32 were scheduled for surgery. All PTAs were performed without prior diagnostic angiography. Angiography was considered necessary in a further ten patients to formulate a therapeutic strategy. In 62 patients the treatment strategy could be determined without diagnostic angiography. Twenty-three of the 39 angiograms performed did not give additional information on treatment strategy. Integrated use of duplex scanning for the investigation of patients with arterial occlusive disease of the lower limb can reduce the need for diagnostic angiography.
Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula
Authors: Sancho J J , di Costanzo J , Nubiola P , Larrad A , Beguiristain A , Roqueta F , Franch G , Oliva A , Gubern J M , Sitges-Serra A
Published: March 2007

Somatostatin and octreotide both enhance closure of gastrointestinal fistulas. The present trial was undertaken to test whether early combined treatment with parenteral nutrition and octreotide 100 μg every 8 h by subcutaneous injection had a beneficial effect compared with parenteral nutrition plus placebo. Thirty-one patients with postoperative gastrointestinal or pancreatic fistula were randomly assigned to receive parenteral nutrition plus octreotide (14 patients) or placebo (17) within 8 days of fistula onset. The percentage reduction in output and rate of spontaneous closure within 20 days were analysed. Mean(s.d.) reduction in output was similar after octreotide and placebo at 24 h (66(43) versus 68(47) per cent, P = 0.9), 48 h (60(46) versus 57(43) per cent, P = 0.8) and 72 h (62(50) versus 66(49) per cent, P = 0.9) after starting the combined treatment. Closure within 20 days was observed in eight of 14 fistulas in patients given octreotide and in six of 17 in those receiving placebo (P = 0.4). Administration of octreotide, within 8 days of fistula onset, associated with parenteral nutrition does not significantly increase the spontaneous fistula closure rate compared with parenteral nutrition plus placebo.
Activated carbon-oriented gastrectomy for early gastric cancer
Authors: Kitamura K , Hagiwara A , Otsuji E , Shimotsuma M , Taniguchi H , Yamaguchi T , Sawai K , Takahashi T
Published: March 2007

Twenty-two patients with early gastric cancer received injections of activated carbon particles (CH-40) to identify during surgery the location of non-palpable tumours present in the upper portion of the stomach. A few days before surgery, 0.2 ml of CH-40 was injected endoscopically into the gastric muscle adjacent to the cancer. In 20 of the 22 patients, the CH-40-stained area was recognized as a blackened patch on the serosal surface of the stomach which indicated the location of the non-palpable cancer tissue. The surgical margin for gastrectomy was defined as the proximal margin of the carbon-stained area and gastrectomies were performed on the 22 patients. CH-40 injection made it possible to choose the extent of lymph node dissection.
Laparoscopic ‘physiological’ antireflux procedure: Preliminary results of a prospective symptomatic and objective study
Authors: Watson A , Spychal R T , Brown M G , Peck N , Callander N
Published: March 2007

The ‘physiological’ antireflux procedure has been shown to be as effective as Nissen fundoplication in reflux control, but with a significant reduction in the incidence of mechanical complications. This technique was attempted laparoscopically in 26 patients in a prospective study involving independent symptomatic, manometric and pH assessment performed before operation and at a mean of 5.5 months after operation. The procedure was successfully completed laparoscopically in 23 (88 per cent) patients. Mean hospital stay was 3.8 days and mean time to return to work 1.8 weeks. There was neither mortality nor reoperation; 91 per cent of patients obtained symptomatic relief (82 per cent Visick grade 1). There was no gas-bloat or inability to belch or vomit. All 14 patients who underwent objective testing had a normal oesophageal pH profile, the mean percentage total time that pH < 4 falling from 11.0 to 1.1 (P < 0.001). Lower oesophageal sphincter characteristics, including relaxation, were similar to control values. These preliminary results suggest symptomatic and objective results comparable to those following open surgery, but with the benefits of a shorter hospital stay and time off work. In addition to a lower incidence of mechanical complications, the relative ease of performance of this procedure confers an additional advantage over Nissen fundoplication when performed laparoscopically.
Laparoscopic exploration of the common bile duct: Lessons learned from 129 consecutive cases
Authors: Rhodes M , Nathanson L , O'Rourke N , Fielding G
Published: March 2007

Since the introduction of laparoscopic cholecystectomy there has been widespread debate about the best way to manage common bile duct (CBD) calculi. Between August 1991 and July 1994, 129 patients underwent laparoscopic exploration of the CBD. Fifteen patients of median age 52 years were managed by glucagon-induced relaxation of the sphincter of Oddi and saline flushing of the bile duct through a cholangiogram catheter. This had a success rate of 73 per cent and took a median of 90min including cholecystectomy. The technique has now been replaced by Dormia basket exploration of the CBD. Transcystic common duct exploration using a Dormia basket was used in 79 patients of median age 47 years. Duct clearance was achieved in 96 per cent of cases with a median operating time of 55 min. Thirty-five patients of median age 52 years were managed by choledochotomy and T tube placement, with a 91 per cent duct clearance rate and a median operating time of 120 min. Overall duct clearance was achieved in 92 per cent of patients with an operative morbidity rate of 5.4 per cent. Duct clearance using either a Dormia basket or choledochotomy and T tube placement was obtained in 95 per cent of patients. Laparoscopic exploration of the CBD is an important alternative in the management of common duct calculi.
Homocysteine and vascular disease
Authors: Berwanger C S , Jeremy J Y , Stansby G
Published: March 2007

There is increasing evidence that a raised blood level of homocysteine (HC) is a risk factor for premature atherosclerosis. With a gene frequency between one in 70 and one in 200 this condition may be more common than previously thought. It should be suspected especially in young patients in whom other risk factors are absent. The diagnosis may be made by demonstrating raised plasma HC levels, either basally or after methionine loading. Studies have shown significantly increased levels of HC in patients with premature coronary artery, peripheral vascular and cerebrovascular disease. The mechanisms by which HC produces vascular damage are, as yet, not completely understood but endothelial injury is probably a central factor. The principle of treatment is to lower HC levels in the blood by administration of vitamin B6, vitamin B12, folate or betaine. How effective this strategy will be in preventing complications is not yet known.
Efficacy of glutamine-enriched enteral nutrition in an experimental model of mucosal ulcerative colitis
Authors: Fujita T , Sakurai K
Published: March 2007

Intact intestinal epithelium and associated lymphatic tissue act as body defences against luminal toxins. This barrier may become threatened or compromised in inflammatory bowel disease, leading to an increase in mucosal permeability and subsequent translocation of endotoxins. The effect of oral glutamine on gut mucosal ornithine decarboxylase activity and on endotoxin levels in portal vein blood was studied in a guinea-pig model of carrageenan-induced colitis. Despite failure to show induction of ornithine decarboxylase activity by glutamine administration, the mean endotoxin level of portal vein blood in guinea-pigs fed a glutamine-enriched elemental diet was 25.3 pg/ml compared with 71.2 pg/ml in animals given a standard elemental diet (P < 0.01). A glutamine-enriched elemental diet may be therapeutically beneficial in patients with inflammatory bowel disease.
Synchronous proctocolectomy and ileoanal pouch formation and the risk of Crohn's disease
Authors: Lucarotti M E , Freeman B J C , Warren B F , Durdey P
Published: March 2007

There is controversy on the advisability of one-stage proctocolectomy and the formation of an ileoanal pouch. Accurate preoperative diagnosis is essential to avoid the error of constructing a pouch in a patient with Crohn's disease. Twenty-four consecutive patients undergoing subtotal colectomy for inflammatory bowel disease were reviewed. All patients had been treated with systemic steroids, 23 were on 5-aminosalicylates and 11 on azathioprine. The preoperative diagnoses, based on a combination of clinical features, colonoscopy, barium enema and biopsy histology, were ulcerative colitis (19), Crohn's disease (four) and inflammatory bowel disease (unclassified) (one). The final diagnosis was made on histological examination of the resected specimen. A discrepancy between initial and final diagnosis occurred in eight patients. In three, the diagnosis was changed from ulcerative colitis to Crohn's disease. Three preoperative diagnoses of Crohn's disease were changed to ulcerative colitis (one), Behcet's disease (one) and diverticulitis (one) on final histology. These data suggest that caution should be exercised in performing synchronous proctocolectomy with the formation of an ileoanal pouch.
Lysis-assisted angioplasty in the treatment of lower-limb arterial thrombosis
Authors: Golledge J , Torrie E P H , Galland R B
Published: March 2007

This study examined the results in 30 patients treated with lysis-assisted angioplasty and compared them with the results of 30 patients with simple stenotic disease treated by angioplasty alone. One patient died on the day of treatment with lysis-assisted angioplasty from arterial perforation and haemorrhage. Of the remaining 29 patients 16 (55 per cent) were symptomatically improved and 13 had early reocclusion. Six patients developed major complications (two deaths, two major haemorrhage, two cerebrovascular accident). The late results were comparable to those for patients undergoing angioplasty alone. The best outcome was obtained in patients with proximal disease (P < 0.01); poor run-off or critical ischaemia did not preclude a good outcome.
Differences in body temperature changes during dressing change in surviving and non-surviving burned patients
Authors: Shiozaki T , Hiraide A , Shimazu T , Ohnishi M , Tasaki O , Yoshioka T , Sugimoto T
Published: March 2007

Change in body temperature (Δ BT) while dressings were being changed was measured in 52 extensively burned adults. The patients were divided into four groups based on outcome and the prognostic burn index (PBI; age + burn index): group I (15 survivors, PBI less than or equal to 80), group II (15 survivors, PBI between 80 and 120), group III (14 non-survivors, PBI between 80 and 120), and group IV (eight non-survivors, PBI greater than 120). The body temperature before the change of dressings was the same in the four groups. The mean(s.d.) Δ BT in all patients was −0.5(0.8)°C. The magnitude of Δ BT was not related to the time required for changing dressings (r = 0.04) or to the non-epithelialized area present at each change of dressings (r = −0.05). All groups showed a similar increase in Δ BT during the early period after the burn, but in group I it began to decrease progressively after the 16th day after the burn (P < 0.05). A reduction in Δ BT was noted in group II from day 25, whereas it was unchanged in groups III and IV (P < 0.05). It also significantly increased 2 days before the diagnosis of sepsis (P < 0.05). These results emphasize that Δ BT may provide useful information about prognosis and the development of sepsis.
Exfoliative cytology in the diagnosis of breast disease
Authors: Dunn J M , Lucarotti M E , Wood S J , Mumford A , Webb A J
Published: March 2007

A total of 393 nipple discharge or scrape smears from 360 women were examined cytologically over a 12-year period. Twenty-nine breast cancers (8 per cent) have been histologically confirmed in this group, of which 16 had malignant smear cytology (sensitivity 55 per cent). Nine patients with breast cancer and positive cytology had impalpable tumours. Two of these cancers were not detected by any other investigation. Thirteen patients with nipple discharge had false-negative cytology, but there were no false-positive results (specificity 100 per cent). All patients with expressible or spontaneous nipple discharges and those with skin changes at the nipple should undergo examination of cytological smears.
Physiological and symptomatic outcome after laparoscopic gastric fundoplication
Authors: McAnena O J , Willson P D , Evans D F , Kadirkamanathan S S , Mannur K R , Wingate D L
Published: March 2007

The complications of open antireflux operations may be reduced by laparoscopic techniques. Fifteen patients of median age 42 (range 16–79) years with gastro-oesophageal reflux underwent laparoscopic fundoplication. Preoperative and postoperative assessment was by clinical scoring, oesophageal pH measurement and manometry. Median (range) operating time was 115 (60–210) min and hospital stay 3 (1–6) days, with no conversions to open operation and only one minor wound infection. Four patients had occasional reflux symptoms on postoperative assessment at a median of 7 weeks and nine had occasional dysphagia. Median DeMeester symptom scores improved from 4 to 1.5 (P = 0.001). There were significant increases in both lower oesophageal sphincter pressure and length. The nocturnal proportion of time at pH < 4 decreased from 9.6 to 0.05 per cent (P = 0.02), although the drop in total proportion of time at pH < 4 (10.4 to 2.2 per cent) was not statistically significant (P = 0.08). Early objective results of laparoscopic fundoplication show improved symptoms, decreased acid reflux and altered lower sphincter function. The procedure combines the benefits of early mobilization and reduced morbidity with the efficacy of the traditional open operation.
Manometric assessment of the effect of the diaphragmatic crural sling in gastro-oesophageal reflux: Implications for surgical management
Authors: Peck N , Callander N , Watson A
Published: March 2007

A manometric method to measure the effect of contraction of the crural sling of the diaphragm on intraoesophageal pressure is described. The manometric crural pressure was measured in 57 patients with gastrooesophageal reflux disease, documented by 24-h ambulatory pH monitoring, and compared between patients with and without hiatal hernia. Repeat measurements were made in 33 patients who underwent antireflux surgery that incorporated a crural repair. Mean crural pressure in 41 patients with hiatal hernia was 5.0 mmHg, compared with 15.0 mmHg in 16 without hiatal hernia (P < 0.01). In the 33 patients undergoing antireflux surgery, mean crural pressure rose from 7.1 mmHg before operation to 11.6 mmHg afterwards (P < 0.02) overall, and from 4.7 to 10.1 mmHg (P < 0.01) in the 26 patients with hiatal hernia. These results confirm a measurable contribution of the diaphragmatic crural sling to resting pressure at the high-pressure zone. The crural pressure is deficient in patients with hiatal hernia compared with that in those with reflux but no hernia. The mean crural pressure is increased in patients by antireflux surgery, particularly in those with hiatal hernia. The results provide objective support for the role of the crural diaphragm in the antireflux mechanism and the rationale of performing crural repair during antireflux surgery, particularly in the presence of hiatal hernia.
Diagnostic laparoscopy combined with laparoscopic ultrasonography in staging of cancer of the pancreatic head region
Authors: Bemelman W A , de Wit L Th , van Delden O M , Smits N J , Obertop H , Rauws E J A , Gouma D J
Published: March 2007

The aim of this study was to assess the additional role of diagnostic laparoscopy combined with laparoscopic ultrasonography in the staging of patients with pancreatic head malignancy. Between January 1993 and June 1994, 73 patients with stage I cancer of the pancreatic head determined by preoperative investigation (endoscopic retrograde cholangiopancreatography and Doppler ultrasonography) were eligible for laparoscopic ultrasonography. The peritoneal cavity was investigated for peritoneal deposits, intrahepatic metastases, malignant infiltration of the portal and superior mesenteric vessels, and N3 lymph node metastases. All patients without histologically proven metastases proceeded to laparotomy. Seventy patients were eligible for evaluation. Sixteen of the 21 patients with distant metastases were diagnosed by laparoscopy with ultrasonography. Forty-nine patients had surgical exploration and trial dissection to assess local resectability. Twenty-nine patients (41 per cent) had resectable pancreatic head tumours. The positive predictive value of local ingrowth as determined by laparoscopic sonography was 93 per cent. Laparotomy was avoided in 19 per cent of patients and the preoperative stage was changed in 41 per cent. Laparoscopy including ultrasonography was effective in staging pancreatic head malignancy.
Clinical improvement after liver transplantation for type I familial amyloid polyneuropathy
Authors: Parrilla P , Ramirez P , Bueno F S , Robles R , Acosta F , Miras M , Pons J A , Andreu F L , Munar-Ques M
Published: March 2007

Long-term results of 13 liver transplantations in patients with a previous diagnosis of type I familial amyloid polyneuropathy (FAP) are presented. The diagnosis of type I FAP was based on the presence of a biochemical marker in the plasma (TTR-Met-30 in 11 patients, TTR-Ala-71 in two). Maximum follow-up is 28 months and the survival rate stands at 11 of 13 patients. Two patients died from sepsis at 2 and 6 months. TTR disappeared from plasma in all cases. Neurological status improved in all eight patients undergoing transplantation more than 6 months previously, although electromyographic studies showed a slight improvement only in the six with follow-up of more than 1 year. All 13 patients showed a hyperdynamic haemodynamic pattern with a high incidence (four patients) of the use of venovenous bypass due to haemodynamic intolerance. Two patients also received transplants by the ‘piggy-back’ technique. In conclusion, liver transplantation may be useful in the treatment of certain patients with FAP to halt and improve the neurological consequences of the disease.
Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model
Authors: Hardy K J , Tancheroen S , Shulkes A
Published: March 2007

It has been proposed that regular restoration of blood flow is beneficial during liver surgery with vascular isolation. The aim of this study was to compare intermittent versus continuous occlusion of blood flow to the resected liver, as measured by survival, liver function tests and histological examination. Male Wistar rats were allocated to have either sham operation, 80 per cent liver resection with 30 min continuous occlusion, or resection with intermittent occlusion (two 15-min periods of ischaemia separated by 5 min reperfusion). There was no significant difference in the survival rate, with 17 of 20 animals surviving in both ischaemia groups. There was a significantly higher serum alanine aminotransferase concentration on day 1 in animals receiving continuous occlusion, and significantly higher concentrations of bilirubin on days 8 and 23 and of serum alkaline phosphatase on day 23 in those having intermittent ischaemia (P < 0.001). There was a significantly greater loss and slower regaining of weight when occlusion was intermittent. Histological changes were significantly more pronounced at day 23 in animals undergoing intermittent ischaemia (P < 0.05), although these were in only one grading. Continuous and intermittent occlusion affected the components of liver function tests differently, with no advantage for one technique. These findings suggest that periodic release of inflow occlusion during liver surgery is not necessary.
Total hepatectomy and liver transplantation: A life-saving procedure in patients with severe hepatic trauma
Authors: Ringe B , Pichlmayr R
Published: March 2007

Management of blunt hepatic trauma has been refined recently and now ranges from non-operative measures to the use of extensive surgical techniques. A consecutive series of eight patients was treated by total hepatectomy, either with a temporary portacaval shunt as a bridging procedure (since no donor liver was available immediately; six patients) or followed by standard liver transplantation (two). Previous operations included perihepatic packing, deep suturing, partial liver resection and hepatic artery ligation, and were attended by severe complications, namely uncontrollable bleeding (four patients) and massive liver necrosis (four). Six of the eight patients died from multiorgan failure or sepsis, and two recipients are alive 49 and 67 months after two-stage hepatectomy and transplantation. This experience demonstrates that total hepatectomy can be a life-saving procedure in exceptional emergencies in patients with potentially lethal hepatic trauma. The prognosis is dependent not only on the severity of liver injury but also on the complications of primary treatment.
Octreotide inhibits the growth and development of three types of experimental liver metastases
Authors: Davies N , Kynaston H , Yates J , Nott D M , Nash J , Taylor B A , Jenkins S A
Published: March 2007

A study was performed to assess the effects of octreotide on the growth and development of liver metastases in rats. Tumour was induced by intraportal injection of three tumorigenic cell lines (the fibrosarcoma HSN and colonic adenocarcinomas K12/Tr and WB2054M) in syngeneic rats. Octreotide treatment (2 μg subcutaneously for 3 or 4 weeks) was started 18 h and 1 week after tumour induction; a delay in treatment of 1 week allowed micrometastases to develop. Treatment with octreotide significantly (P < 0.001) reduced the median hepatic replacement of liver by tumour compared with that of control rats given saline (controls: HSN 76.4 per cent, K12/Tr 17.5 per cent, WB2054M 43.9 per cent; octreotide treatment delayed 18 h: HSN 2.7 per cent, K12/Tr 0.6 per cent, WB2054M 1.3 per cent; octreotide treatment delayed 1 week: HSN 9.3 per cent, K12/Tr 2.5 per cent, WB2054M 2.3 per cent). These results clearly indicate that octreotide significantly inhibits the growth and development of experimental liver metastases. Further studies are required both to delineate the mechanism of action and to investigate these effects in a clinical setting.
Comparison of direct vision and electronic two- and three-dimensional display systems on surgical task efficiency in endoscopic surgery
Authors: Crosthwaite G , Chung T , Dunkley P , Shimi S , Cuschieri A
Published: March 2007

Task efficiency and knot strength was evaluated under standardized conditions using direct vision and electronic imaging with two-dimensional (2-D) and three-dimensional (3-D) systems. Three operators with different endoscopic surgical experience tied a surgeon's knot with standard endoscopic instruments using the three different visual systems in random order. Each operator tied 20 knots with each visual system. Median task efficiency (defined as the time to complete the knot) was 35.0 (interquartile range (i.q.r.) 30.3–43.8) s for direct vision and 53.0 (i.q.r. 45.3–62.8) s and 53.5 (i.q.r. 45.0–64.8) s for 2-D and 3-D imaging respectively (P < 0.05). With respect to direct vision, this represented an overall degradation of task efficiency with the use of electronic imaging of 52 per cent, with no detectable difference between 2-D and 3-D imaging. The knot strength, representing the degree of tightening, was weaker with electronic imaging but the difference was not significant due largely to variation between the three operators.
Renal dysfunction in obstructive jaundice
Authors: Fogarty B J , Parks R W , Rowlands B J , Diamond T
Published: March 2007

The association between renal dysfunction and obstructive jaundice is well established. Despite a substantial number of clinical reviews and prospective studies, the exact incidence and extent of the problem has not been determined accurately. Various pathogenic mechanisms and therapeutic strategies have been proposed but renal dysfunction remains a persistent problem in hepatobiliary practice. The intention of this review is to determine the current extent of the problem, outline the proposed pathophysiological mechanisms and assess the current therapeutic options.
Local excision and mucosal advancement for anorectal ulceration in patients infected with human immunodeficiency virus
Authors: Consten E C J , Slors J F M , Danner S A , Offerhaus G J A , Bartelsman J F W M , Van Lanschot J J B
Published: March 2007

In patients infected with human immunodeficiency virus (HIV) no effective surgical procedure has been described for anorectal ulceration that is resistant to medical thearpy. This study was designed to determine the effectiveness of surgical excision of anorectal ulcers, with or without mucosal advancement. The medical records of patients with HIV and anorectal pathology diagnosed between 1984 and 1994 were reviewed. Patients with anorectal ulcers were divided into group A which was treated only with excision and group B in which excision was combined with mucosal advancement. Surgical treatment was considered successful if relief of symptoms was achieved within 4 weeks of the operation. Excision of anorectal ulcers was successful in seven of 16 patients (44 per cent) in group A. Relief of symptoms was achieved in 12 of 13 patients (92 per cent) in group B when surgical excision was combined with mucosal advancement, which is significantly better than the results in group A (P = 0.02). This non-randomized study indicates that after unsuccessful medical treatment persistent symptomatic ulcers should be treated operatively by excision with mucosal advancement.
Bilateral gluteus maximus transposition for anal incontinence
Authors: Christiansen J , Hansen C Rønholt , Rasmussen O
Published: March 2007

Seven patients (five women and two men) with anal incontinence in whom previous surgery had failed, were treated by bilateral gluteus maximus transposition. All patients were incontinent to solid stool. Previous surgery was postanal repair in four women and secondary overlapping suture for obstetric tear in one. The two men were treated in childhood for anal atresia. No covering stoma was used. Wound infection occurred in three patients, requiring surgical drainage in two. After follow-up of more than 1 year three patients experienced improved continence but in four continence was unchanged. Anorectal physiology studies showed moderately increased resting and squeeze pressures in patients who were improved by the operation, but none could retain more than 200 ml of viscous fluid instilled into the rectum. No change in rectal sensitivity or volume tolerance was found. This preliminary series does not indicate that better results are obtained by gluteus maximus transposition than by unstimulated graciloplasty.
Prospective audit of abdominal aortic aneurysm surgery in the northern region from 1988 to 1992
Authors: Berridge D C , Chamberlain J , Guy A J , Lambert D
Published: March 2007

Over a 5-year period a prospective audit was carried out on 1131 patients undergoing surgery for abdominal aortic aneurysm (AAA) in the northern region. A total of 470 operations was performed in teaching hospitals and 661 in district hospitals; emergency operations accounted for 41-5 per cent. The overall mortality rate was 25.8 per cent; for emergency cases this value was 50.0 per cent. Mortality rates for elective surgery were 3.9 per cent in teaching and 12.0 per cent in district hospitals. Patients with ruptured AAA admitted via the accident and emergency department had a higher mortality rate (64.3 per cent) than those admitted by their general practitioner (49.5 per cent) or those referred from the urology department (18.8 per cent). In all, 73 (6.5 per cent) patients were admitted with an alternative diagnosis, ranging from collapse of unknown cause (25) to torsion of the testes (one) and colonic obstruction (one). Age had a profound effect on mortality rates. For emergency cases the mortality rate varied from 47.0 per cent (in teaching plus district hospitals) in those aged less than 80 years to 70.1 per cent in those 80 years or over (χ2 = 7.22; P = 0.007). For elective surgery the mortality rate varied from 7.6 per cent (in teaching plus district hospitals) in those under 80 years to 23.8 per cent in those 80 years or over (P = 0.0006). The overall mortality rate of 25.8 per cent is significantly less than that quoted in the Confidential Enquiry into Perioperative Deaths report of 1987. Furthermore, elective patients over 80 years of age may expect a survival rate of 76 per cent and, in the absence of major medical contraindications, should not automatically be denied surgery. Importantly, it is of note that this prospective audit identified 31 per cent more cases than recognized by regional audit data.
Anterior gastric wall stapling combined with posterior truncal vagotomy in the treatment of duodenal ulcer
Authors: Van Hee R , Mistiaen W , Hendrickx L , Blockx P
Published: March 2007

Anterior gastric stapling with posterior truncal vagotomy was examined as an alternative to highly selective vagotomy in the treatment of peptic ulcer disease. A clinical series of 32 patients who underwent the combined procedure is presented; gastric acid output was adequately reduced (basal output by 82 per cent, peak by 64 per cent). Motility changes were temporary and mild. Clinical follow-up, using a modified Visick grading, showed good to excellent results in 21 of 25 patients who could be classified. This procedure is suggested as an appropriate alternative to highly selective vagotomy.
Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy
Authors: Anvari M , Allen C , Borm A
Published: March 2007

A total of 168 patients with proven gastro-oesophageal reflux disease (GORD) receiving long-term medical therapy underwent laparoscopic Nissen fundoplication. The operation was converted to open fundoplication in four patients. All patients reported complete (92.3 per cent) or partial (7.7 per cent) relief of reflux symptoms 1 month after surgery. There were no associated deaths and the perioperative complication rate was 8.9 per cent. The mean(s.e.m.) length of operating time was 69.9(2.4) min and mean(s.e.m.) hospital stay 2.7(0.1) days. Symptom score assessment, 24-h oesophageal pH recording and lower oesophageal sphincter pressure showed significant (P < 0.0001) improvement 6 months after surgery in 85 evaluable patients. Before operation 37.5 per cent of the patients were considered symptomatically controlled on omeprazole and had excellent symptom control after surgery. This initial experience suggests that laparoscopic Nissen fundoplication is a safe and effective treatment for patients with GORD requiring long-term medication.
Small bowel obstruction caused by a retained percutaneous endoscopic gastrostomy gastric flange
Authors: Lambertz M M , Earnshaw P M , Short J , Cumming J G R
Published: March 2007

In 1980 Gauderer et al.1 described a pull-through technique to position a percutaneous endoscopic gastrostomy (PEG) tube. Recognized complications are pulmonary aspiration, peritonitis and haemorrhage. Longer term problems include peristomal wound infection, gastrocolic fistula and frequent tube blockage. The reported overall mortality rate is less than 1 per cent2,3.
Correlation between expression of sialosyl-T antigen and survival in patients with gastric cancer
Authors: Tsuchiya A , Kikuchi Y , Ando Y , Abe R
Published: March 2007

Intestinal metaplasia of the gastric mucosa is an important lesion in the pathogenesis of gastric cancer. The expression of a mucin-associated antigen, sialosyl-T antigen, in the tissue of gastric cancer was investigated immunohistochemically to assess its biological role. Sialosyl-T antigen, detected by the monoclonal antibody TKH2, was present in 30 (23.6 per cent) of 127 lesions, and expressed sporadically in intestinal metaplasia. Patients negative for sialosyl-T had a significantly better 5-year survival than those who were positive (70.4 per cent versus 47.2 per cent). Grading by sialosyl-T antigen expression and the DNA ploidy pattern had a predictive value for prognosis in patients with gastric cancer. The biological role of sialosyl-T antigen is not clear but the mucin alteration reflects upon the biological behaviour of gastric cancer.