bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostaglandins and acute pancreatitis—experimental and clinical studies
Authors: Standfield N J , Kakkar V V
Published: March 2007

Acute pancreatitis has a mortality of 10–20 per cent, and in cases of acute haemorrhagic pancreatitis this rises to 80–90 per cent. At present there is no reliable treatment for this condition. Based on the hypothesis that the release locally and systemically of the intracellularly activated pancreatic digestive enzymes is due to cell membrane instability, we have studied the cytoprotective (cell membrane stabilizing) role of prostaglandins in this condition. In the first part of this study, an animal model of acute pancreatitis with a mortality of 100 per cent by 14 days has been established by feeding mice a choline-deficient ethionine supplemented diet. Using this model we have demonstrated improved survival (16 out of 50 survived 14 days or longer) by administering prostaglandin E2 subcutaneously (P < 0·02). We have demonstrated that the improved survival is dose-dependent, in the range 2·5–5·0 mg/kg body weight 8 hourly (P < 0·02) and time-dependent, still being effective if treatment is delayed for 24 h (P < 0·02). Great emphasis has been placed on not commencing treatment until after the induction of acute pancreatitis. In the second part we have used cell membrane marker enzymes to study the cell membrane stabilizing effect of prostaglandin E2 in the human. It has been demonstrated that cell membrane instability occurs. In 12 of 50 episodes treated by prostaglandin E2 infusion, the lysosomal, mitochondrial and cell membranes are stabilized, thus decreasing the release of intracellular enzymes.
Surgery for thyrotoxicosis
Authors: Simms J M , Talbot C H
Published: March 2007

Recent reports have suggested the use of radio-iodine for the treatment of all cases of thyrotoxicosis. This paper evaluates the results of 627 patients undergoing subtotal thyroidectomy with a mean follow-up of 5·8 years. The most common complications were hypothyroidism (26·6 per cent) and recurrent thyrotoxicosis (2·6 per cent). Permanent hypocalcaemia occurred in 8 cases (1·4 per cent) and one patient developed a permanent, though asymptomatic, unilateral cord palsy (0·2 per cent). Ultimately all patients receiving radio-iodine appear to become hypothyroid and there is continued worry about possible thyroid malignancy. Almost 70 per cent of our cases were free of complications and euthyroid and we therefore believe that surgery remains the treatment of choice for thyrotoxicosis. We also discuss the difference in results between Graves disease and toxic multinodular goitre.
Hepatic metastases—a physiological approach to treatment
Authors: Chamberlain M N , Gray B N , Heggie J C P , Chmiel R L , Bennett R C
Published: March 2007

Hepatic metastases derived from primary malignancy of the gastrointestinal tract have a grave prognosis, with median survival rates varying from 3 to 11 months. Surgery for isolated metastases and intrahepatic artery chemotherapy are the most effective treatment options currently available. We have explored the potential use of radioactive microspheres delivered into the liver by the hepatic artery as a form of internally irradiating metastatic liver cancer. Microspheres containing radioactive Yttrium injected into the hepatic artery concentrate in the metastases rather than normal liver parenchyma, due to the fact that the blood supply of metastases is derived preferentially from the hepatic artery. Using a rabbit tumour model, radioactive microspheres delivered into the hepatic artery have been shown to lodge preferentially in tumour tissue. The therapeutic application of this phenomenon is that metastases may receive many times the radiation dose delivered to normal liver parenchyma when radioactive microspheres are delivered into the hepatic artery. This would mean that a mean dose of 30 Gy delivered to normal liver tissue would result in greater than 150 Gy being delivered to tumour tissue. Current results in experiments suggest that this form of treatment may have considerable potential for prolonging survival of patients with hepatic metastases.
A hypothesis of the healing of deep dermal burns and the significance for treatment
Authors: Holmes J D , Muir I F K , Rayner C R W
Published: March 2007

Deep dermal burns heal by a combination of new connective tissue formation (granulation) and epithelialization. In deep dermal wounds, which are unhealed after 14 days of conservative treatment, epithelialization can be enhanced by abrasion either alone or combined with provision of a skin graft. Some 42 burn wounds in 25 patients treated by this method have healed quickly and with good results. This method represents a move away from the current trend of early tangential excision and grafting of burn wounds and raises the possibility of developing a regime with the advantages but not the disadvantages of early tangential excision and grafting.
Does 111indium-platelet deposition predict patency in prosthetic arterial grafts?
Authors: Goldman M , Hall C , Dykes J , Hawker R J , McCollum C N
Published: March 2007

The relationship between the rate of 111In-platelet deposition on vascular grafts and subsequent thrombosis has been examined in patients undergoing femoropopliteal by-pass. Sixty-seven patients undergoing femoropopliteal by-pass using vein, Dacron or PTFE were randomized to aspirin plus dipyridamole (ASA/DPM) or placebo. Autologous 111In-platelets were injected in the second postoperative week and Thrombogenicity Index (TI) calculated as the mean daily rise in the ratio of radioactivity graft/contralateral thigh. Graft patency was assessed to 1 year. Mean (+ s.e.m.) TI at 1 week in 21 grafts that occluded within 12 months was 0·19 ± 0·018 compared with 0·07 ± 0·009 in the 38 that remained patient (P < 0·001). Grafts with a TI less or greater than the median had a 90 per cent or 39 per cent cumulative 1-year patency, respectively (P < 0·001). In the prosthetic grafts ASA/DPM reduced mean TI from 0·17 ± 0·02 to 0·11 ± 0·01 (P < 0·02) and enhanced 1-year patency from 36 to 67 per cent (P < 0·05). Following femoropopliteal by-pass TI related to subsequent graft patency. Radiolabelled platelet deposition therefore provides a guide as to how new materials or antithrombotic drugs may influence clinical graft thrombosis. Platelet inhibition reduced both graft thrombogenicity and subsequent occlusion.
The role of partial denervation of the puborectalis in idiopathic faecal incontinence
Authors: Bartolo D C C , Jarratt J A , Read M G , Donnelly T C , Read N W
Published: March 2007

Recent studies have suggested that patients with idiopathic faecal incontinence have neuropathic damage to the external anal sphincter and pelvic floor musculature, though no direct assessment of puborectalis function has been made in intact man. Obstetric trauma and chronic straining at stool are thought to be possible causes for damage to the puborectalis nerve supply. In this study the motor unit potential duration in the external sphincter and puborectalis was measured by conventional electromyography in incontinent patients and two groups of continent patients who strained at stool. Our results confirm that incontinent patients had significant neuropathic damage to the puborectalis and the external sphincter compared with controls. Patients with the descending perineum syndrome, who were continent, showed partial denervation of the external sphincter and puborectalis, though the degree of abnormality in puborectalis was less than that in incontinent patients. Finally, patients with constipation showed neurogenic abnormalities in the external anal sphincter but not in the puborectalis. The findings suggest that partial denervation of the external sphincter can occur independently of partial denervation of the puborectalis in patients who strain at stool but if severe changes are present in both muscles, the patient is likely to be incontinent.
The assessment of calf pump function by isotope plethysmography
Authors: Whitehead S , Lemenson G , Browse N L
Published: March 2007

A method of measuring the function of the calf muscle pump using in vivo 99Tcm-labelled red cells is described. This new, non-invasive method can provide detailed information about the emptying and refilling of the deep and superficial veins of the calf which may prove to be superior to those methods of assessment currently used in the selection and follow-up of patients for venous surgery.
Surgical management of locally recurrent rectal cancer
Authors: Sagar P M , Pemberton J H
Published: March 2007

The surgical management of locally recurrent rectal cancer may involve major procedures and is not for the faint-hearted. Nevertheless, such treatment is preferable to chemotherapy and radiotherapy; the latter will fail over a period of months during which the patient is likely to experience intractable pain. Radical surgery offers good palliation and a better quality of life. Survival is prolonged by such operations which may be curative in up to one-third of patients. Nevertheless, surgeons must be realistic in their assessment of and discussions with patients.
Molecular genetic basis of colorectal cancer susceptibility
Authors: Cunningham C , Dunlop M G
Published: March 2007

The past decade has seen considerable advances in understanding of the molecular processes involved in the development of colorectal cancer. With an increased awareness of genetic aspects of the disease there have already been significant changes in clinical management. This is exemplified by familial adenomatous polyposis, where identification of mutations in the adenomatous polyposis coli (APC) gene in affected individuals can be used directly to reduce the requirement for clinical screening in at-risk relatives. In other more common but less well defined heritable forms of colorectal cancer, testing to identify individuals for early diagnosis and treatment will soon become routine practice. This review does not set out to discuss all aspects of the molecular genetics of colorectal cancer but concentrates on the roles of the APC gene and the recently discovered DNA mismatch repair genes in colorectal cancer. The identification of these genes and their functional significance in the neoplastic process is discussed, and the relevance of such discoveries to future research and clinical management explored.
Reconstruction of a new inferior vena cava after right atrial disruption during recipient hepatectomy
Authors: Oldhafer K J , Ziemer G , Raygrotzki S , Pichlmayr R
Published: March 2007

Polycystic liver disease is a rare indication for liver transplantation1,2. Recipient hepatectomy appears to be the most challenging part of the surgical procedure3. This is especially true in patients suffering from polycystic liver disease, who may have extremely large livers (up to 15 kg). In these patients hepatectomy and, particularly, dissection of the suprahepatic inferior vena cava (IVC) may be difficult. Management of a disrupted suprahepatic IVC, including a tear of the: right atrium, during hepatectomy for polycystic liver disease is described.
Local recurrence following total mesorectal excision for rectal cancer
Authors: Arbman G , Nilsson E , Hallböök O , Sjödahl R
Published: March 2007

Early results after rectal cancer surgery in a defined population were compared before and after the introduction of total mesorectal excision. In the first period (1984–1986) 211 cases of rectal cancer were diagnosed and in the second (1990–1992) 230. Of these, 134 patients in the first period (group 1) had anterior resection or abdominoperineal excision which was considered curative. In the second period 128 curative anterior resections and abdominoperineal excisions were performed by a limited number of surgeons familiar with total mesorectal excision (group 2). No differences between the groups were found in stage distribution, rate of curative operations, postoperative complications or postoperative mortality. Local recurrence had developed in 19 patients in group 1 and in eight in group 2, 1 year after the end of the study periods (P = 0·03). Local radicality was in doubt in 13 patients in group 1 and in eight in group 2. In the remaining 121 and 120 patients, 13 and four local recurrences respectively were present (P = 0·03). Actuarial analysis showed a significant reduction in local recurrence rate (P = 0·03) and an increase in crude survival (P = 0·03) at 4 years in group 2 compared with group 1. Total mesorectal excision reduces the local recurrence rate after excision of rectal cancer.
Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer
Authors: Havenga K , De Ruiter M C , Enker W E , Welvaart K
Published: March 2007

Total mesorectal excision with autonomic nerve preservation for rectal cancer is based on the anatomy of the mesorectum and of the pelvic autonomic nerves. Cadaver dissections were performed to describe the relationship between these structures. Between the rectum and the sacrum a retrorectal space can be developed, lined anteriorly by the visceral leaf and posteriorly by the parietal leaf of the pelvic fascia. The hypogastric nerve runs anterior to the visceral fascia, from the sacral promontory in a laterocaudad direction. The splanchnic sacral nerves originate from the sacral foramina, posterior to the parietal fascia, and run caudad, laterally and anteriorly. After piercing the parietal layer of the pelvic fascia, approximately 4 cm from the midline, the sacral nerves run between a double layer of the visceral part of the pelvic fascia. The relationship between the hypogastric nerves, the splanchnic nerves and the pelvic fascia was comparable in all six specimens examined.
Diagnosis of arterial disease of the lower extremities with duplex ultrasonography
Authors: Koelemay M J W , den Hartog D , Prins M H , Kromhout J G , Legemate D A , Jacobs M J H M
Published: March 2007

The development of duplex scanning carries the prospect of an entire non-invasive work-up of patients with peripheral arterial occlusive disease. To obtain the best available estimates of its diagnostic accuracy, a meta-analysis of 71 studies evaluating duplex scanning was performed. Independent methodological judgement left 16 studies for data extraction. Pooled estimates 95 per cent confidence interval of sensitivity and specificity for detection of a stenosis greater than or equal to 50 per cent or occlusion in the aortoiliac tract were 86 (80–91) per cent and 97 (95–99) per cent respectively. The results for the femoropopliteal tract compared well with this, with a sensitivity of 80 (74–85) per cent and a specificity of 96 (94–98) per cent. The accuracy of detection of a stenosis greater than or equal to 50 per cent or an occlusion in the infragenicular arteries was lower with a sensitivity and specificity of 83 (59–96) per cent and 84 (69–93) per cent respectively. Duplex scanning is an accurate tool for assessment of atherosclerotic lesions in the aortoiliac and femoropopliteal tract and can replace routine pre-interventional angiography in a substantial number of patients.
Simple and reliable technique for local resection of early gastric cancer
Authors: Nihei Z , Ichikawa W , Osanai T , Togo S , Miyanaga T , Hayashi T , Hirayama R , Mishima Y
Published: March 2007

There has been an increase in the number of recognized early gastric cancers with the recent advance in diagnostic modalities1. In some cases, less aggressive procedures are indicated and local resection, with or without limited lymph node dissection, is one of the treatments of choice. It is, however, sometimes difficult to ensure adequate excision with tumour-free margins because such lesions are movable and may not be firmly fixed to the muscle layer. A simple technique to determine the sites to be incised to allow adequate resection of the tumorous lesion with ease and safety is reported here.
Postoperative thromboembolism after day-case herniorrhaphy
Authors: Riber C , Alstrup N , Nymann T , Bogstad J W , Wille-Jørgensen P , Tønnesen H
Published: March 2007

Thromboembolism is a serious complication oi surgery and prophylaxis is therefore recommended. This study examines a new aspect of the problem, the incidence of thromboembolism after day-case surgery. From 1982 to 1992, 2281 patients underwent day-case repair for inguinal hernia management. Hospital admission for thromboembolism within the first 30 days after surgery was identified by computer linkage to the National In-Patient Register, which contains details of all hospital admissions in Denmark. One patient developed non-fatal pulmonary embolism. No other patients were admitted to hospital with venous thromboembolism within 30 days of herniorrhaphy. It is concluded that there is no need for routine prophylaxis for thromboembolism in day-case hernia surgery.
Arterial therapy of hepatic colorectal metastases
Authors: Vauthey J-N , Marsh R De W , Cendan J C , Chu N-M , Copeland E M
Published: March 2007

Considerable experience of the treatment of irresectable hepatic colorectal metastases has accumulated over the past three decades. In this review, the rationale for hepatic artery treatment of colorectal metastases to the liver is presented and various access techniques and chemotherapeutic agents for infusion are discussed. Randomized trials of hepatic artery chemotherapy (HAC) are analysed, and the promising results of recent studies combining less toxic and more effective agents are summarized. Continuous infusion pumps provide the most reliable and long-lasting access for HAC. Appropriate surgical techniques and medical management can minimize complications. Although tumour progression is best controlled by HAC, a clear-cut survival advantage has yet to be demonstrated. While hepatic artery infusion chemotherapy cannot yet be recommended outside investigational protocols, the experience gained so far should stimulate further studies.
Liver metastases from colorectal cancer: Lessons from past and present clinical studies
Authors: Taylor I
Published: March 2007

In patients with primary colorectal cancer the development of liver metastases has traditionally been equated with imminent demise. This metastatic event is remarkably common; indeed, liver metastases are present in some 25 per cent of patients at the time of initial colorectal resection and over 50 per cent of patients will eventually develop them. Some 90 per cent of patients who die from colorectal cancer have liver metastases. There are few cancers in which the metastatic pattern has such a high degree of predictability. Information from past and present clinical studies should, therefore, provide a basis for logical approaches to prevention and treatment.
Annales de Chirurgie
Authors: Frileux P , Castaing D
Published: March 2007

For this quarter's digest, Drs Pascal Frileux and Denis Castaing, from Annales de Chirurgie, choose the best from issues eight, nine and ten of 1995. A reciprocal digest written by our European Editor, Colin Johnson, appears in the French journal.
Effect of terminal ileal transposition on intestinal absorption following proctocolectomy
Authors: Hotokezaka M , Nakahara S , Iwamoto T , Chijiiwa K , Mibu R
Published: March 2007

A terminal ileal transposition procedure, in which a distal jejunal segment is interposed between the terminal ileum and the anus following proctocolectomy, is described. Adult mongrel dogs had either terminal ileal transposition (n = 5) or ileoanal anastomosis (n = 6) following two-stage proctocolectomy. Untreated dogs were used as controls (n = 7). Twelve weeks after the second-stage operation, a perfusion study was performed. After terminal ileal transposition the transposed terminal ileum showed a high absorptive capability for sodium, chloride and bile acids (P < 0·05, P < 0·05 and P < 0·001 respectively). After ileoanal anastomosis the absorptive capability of the terminal ileum was not enhanced significantly. In the mid-jejunum, the absorption of bile acids, chloride and glucose was enhanced (all P < 0·05) only after terminal ileal transposition. Terminal ileal transposition improves the absorptive capability of the terminal ileum and the mid-jejunum compared with conventional ileoanal anastomosis in this model.
Screening for colorectal cancer with an immunological faecal occult blood test: 2-Year follow-up
Authors: Robinson M H E , Marks C G , Farrands P A , Bostock K , Hardcastle J D
Published: March 2007

This study is a 2-year follow-up of an average-risk population Offered screening with both Haemoccult and Hemeselect tests to determine the interval cancer rate, and thus sensitivity. The effect on compliance with Hemeselect of testing over 1 day rather than 3 days was investigated in a separate cohort. In the first study, 3948 subjects received tests; 1489 (37·7 per cent) completed both tests and 148 had a positive result, 17 (1·1 per cent) were Haemoccult positive and 145 (9·7 per cent) were Hemeselect positive. Investigation of 142 patients revealed ten with cancer (Dukes stage A, seven; B, one; C, two). All were detected by Hemeselect but only one was Haemoccult positive. After a median follow-up of 35 (range 26–43) months, seven further patients developed colorectal cancer (stage A, one; B, three; C, three) but none followed a negative Hemeselect test (100 per cent sensitivity). In the second study 2703 subjects were offered Hemeselect tests. Compliance for testing over 1 day (48·6 per cent) was significantly better than that over 3 days (43·1 per cent) (χ2 = 8·1, 1 d.f., P < ·01). Hemeselect is a promising screening test for the early detection of colorectal cancer.
Comparison of venous reflux in the affected and non-affected leg in patients with unilateral venous ulceration
Authors: Bradbury A W , Brittenden J , Allan P L , Ruckley C V
Published: March 2007

In 54 patients with unilateral leg ulceration of purely venous aetiology the only difference in venous reflux between affected and non-affected legs was with respect to the popliteal and crural veins. Deep and superficial venous reflux is common in legs without the skin changes typical of chronic venous insufficiency. The significance of venous reflux in an ulcerated leg cannot therefore be determined without reference to the contralateral, clinically normal, limb. Surgery should be directed at correcting reflux present in the ulcerated limb but not in the unaffected limb. In a minority of patients this entails superficial venous surgery alone, but in the majority such an approach would, ideally, entail correction of deep venous incompetence.
Surveillance imaging of the operated artery does not alter clinical outcome following carotid endarterectomy
Authors: Naylor A R , John T , Howlett J , Gillespie I , Allan P , Ruckley C V
Published: March 2007

Clinical outcome was studied in 243 patients undergoing 260 carotid endarterectomies; 166 of these patients underwent serial postoperative surveillance imaging. Including perioperative events, cumulative freedom from ipsilateral stroke was 86 and 82 per cent at 5 and 10 years respectively; the mean incidence of ipsilateral stroke was 1·8 per cent per annum. Twenty patients (8 per cent) suffered cerebral ischaemic events in the hemisphere of the operated side during follow-up: eight transient ischaemic attacks (TIA) and 12 strokes (only two preceded by TIA). Two symptomatic patients were found to have occluded the operated artery but the remainder had no evidence of significant recurrent disease. Cumulative freedom from occlusion or severe (greater than 70 per cent) recurrent stenosis was 87 and 78 per cent at 5 and 10 years respectively; the mean incidence of recurrence of significant disease was 2·2 per cent per annum. No revisional surgery was performed on the operated arteries. In its current format, neither clinical nor surveillance imaging could have prevented any of the strokes observed during follow-up.
Laparotomy for abdominal sepsis in the critically ill
Authors: Anderson I D , Fearon K C H , Grant I S
Published: March 2007

Among 125 patients admitted to an intensive care unit (ICU) with severe abdominal sepsis over a 3-year period, further laparotomy was required in 60 (48 per cent). The median age of these 60 patients was 67 (range 22–88) years and their admission APACHE (Acute Physiology and Chronic Health Evaluation) I1 score was 24 (range 7–40); 25 patients (42 per cent) survived to leave the ICU but only 19 (32 per cent) survived to leave hospital. These patients underwent 95 (median 1; range 1–6) operations after admission to the ICU and survival fell with increasing number of operations in the ICU (P = 0·01). A total of 81 operations (85 per cent) were therapeutic in that pus was drained or dead tissue removed, and 41 operations (43 per cent) resulted in improvement in the patient's condition within 48 h of surgery. Only nine per cent of patients not improved by their first operation in the ICU survived (P < 0·0001). The source of sepsis was eradicated from the abdomen in 37 patients (62 per cent); this was a prerequisite for survival but was achieved less frequently with increasing number of operations (P < 0·002). When operations were delayed until the diagnosis was clear, the need for subsequent procedures was significantly increased (P < 0·05). Multiple operations for patients with abdominal sepsis in the ICU were associated with diminishing returns and alternative surgical strategies merit active consideration.
Laparoscopic mobilization of the stomach for oesophageal replacement
Authors: Jagot P , Sauvanet A , Berthoux L , Belghiti J
Published: March 2007

Nine patients of mean(s.d.) age 61(8) years underwent oesophagogastrectomy with laparoscopic gastric mobilization and abdominal lymphadenectomy for oesophageal cancer. Moderate to severe airway obstruction was present in all patients, in whom the mean(s.d.) value of forced expiratory flow rate at 1 s was 65(17) (range 35–85) per cent of the predicted value. Six patients had an abdominal laparoscopic approach combined with a right open thoracotomy; the other three had a laparoscopic abdominal and transhiatal approach combined with a left cervicotomy. No patient required conversion to open laparotomy. All had an uneventful postoperative course with extubation occurring at the end of the surgical procedure (n = 2) or on day 1 after operation (n = 7). Mean(s.d.) duration of hospitalization was 10·3(3·1) (range 8–18) days. The laparoscopic approach for gastric mobilization and abdominal lymphadenectomy is safe and can be used in patients with impaired pulmonary function.
Fc-receptor function after human splenic autotransplantation
Authors: Leemans R , Beekhuisi H , Timenss W , The T Hauw , Klasen H J
Published: March 2007

Mononuclear phagocytic function was studied using the Fc-receptor test in 24 patients who underwent splenectomy, ten of whom underwent splenic autotransplantation. All patients undergoing autotransplantation had mononuclear phagocyte system (MPS) activity at the transplantation sites. In eight of the 14 patients who did not undergo autotransplantation there was also scintigraphic MPS activity indicative of ectopic splenic tissue. Although the Fc-receptor test showed delayed and monoexponential blood clearance in all patients after splenectomy, there were no significant differences between the patient groups. Autotransplantation of small amounts of splenic tissue after splenectomy provides some MPS activity but is inadequate for blood clearance.
Laparoscopic surgery for duodenal ulcer: First results of a multicentre study applying a personal procedure
Authors: Gomez-Ferrer F , Balique J G , Azagra S , Bicha-Castelo H , Castro-Sousa F , Espalieuh P , Rodero D , Estour E
Published: March 2007

Between January 1991 and February 1995 data were gathered on 136 patients operated on in 14 surgical centres. All patients underwent posterior truncal vagotomy (PTV) and anterior linear gastrectomy (ALG) for chronic duodenal ulcer. Recurrence and repeated bleeding were the main indications for surgery. An antireflux technique was simultaneously carried out in 17 patients, while 13 underwent cholecystectomy. There were no peroperative complications or deaths, and the mean duration of operation was 65 (range 25–180) min. Immediate postoperative morbidity rate was 2·9 per cent, with a mean hospital stay of 3·1 (range 2–13) days. A total of 131 patients were evaluated between 6 and 33 (mean 25) months after operation. Of these, 126 (96·2 per cent) were graded as Visick I or II. Four (3·0 per cent) were Visick III, and one patient (0·8 per cent) was considered Visick IV. Gastric function studies were performed in 45 patients before and after operation, with a maximum acid output reduction of 83 per cent 3 months after the operation. Laparoscopic PTV with ALG constitutes a simple, efficient, rapid and safe method in the treatment of patients with chronic duodenal ulcer.
Synergistic antitumour effect of recombinant human tumour necrosis factor a with melphalan in isolated limb perfusion in the rat
Authors: Manusama E R , Nooijen P T G A , Stavast J , Durante N M C , Marquet R L , Eggermont A M M
Published: March 2007

The efficacy of isolated limb perfusion (ILP) for ‘intransit’ metastases from malignant melanoma and irresectable soft tissue sarcoma has been improved considerably by the addition of tumour necrosis factor (TNF) α. A rat sarcoma tumour model was, therefore, developed to evaluate the effects of TNF-α, melphalan and the combination of these drugs in the treatment of sarcoma. In BN rats bearing the non-immunogenic BN 175 sarcoma ILPs were performed with perfusate only, TNF-α, melphalan alone, or in combination when tumours had grown to approximately 1·5 cm in diameter. All rats treated with sham perfusion or perfusion with 50 μg TNF-α showed progressive disease. After perfusion with 40 μg melphalan no change in tumour diameter was observed in any rats at 4 days. After a combined perfusion with 40 μg melphalan and 50 μg TNF-α complete remission was noted in 12 of 16 rats. This synergistic effect in vivo between relatively ineffective doses of TNF-α and melphalan was not observed in vitro.
Nutritional pharmacology and malignant disease: A therapeutic modality in patients with cancer
Authors: Heys S D , Gough D B , Khan L , Ermin O
Published: March 2007

It is now established that certain nutrients have a significant effect on cellular metabolism and growth, tissue repair and regeneration, and modulation of host defences. So far, however, potential clinical benefits have been difficult to demonstrate. Nevertheless, the use of nutrients in combinations seems to have promise and may be associated with a reduction in infectious complications and length of hospital stay. Nutritional pharmacology in the future may be able to improve tumour response to chemotherapy and may minimize the metabolic effect of cachexia.
Assessment of splanchnic tissue oxygenation by gastric tonometry in patients undergoing laparoscopic and open cholecystectomy
Authors: Thaler W , Frey L , Marzoli G P , Messmer K
Published: March 2007

This experimental study compared the effects of laparoscopic (n = 31) and open (n = 32) cholecystectomy on gastric intramucosal pH (pHj). For this purpose, pHj was measured tonometrically before induction of anaesthesia, at 30-min intervals during surgery, and 1, 2 and 4 h after operation in otherwise healthy patients undergoing elective cholecystectomy. Additionally, perioperative arterial pH (pHa), arterial carbon dioxide tension (PaCO2), intramucosal carbon dioxide tension, arterial bicarbonate concentration, end-tidal carbon dioxide pressure (PECO2), levels of serum lactate, lactate dehydrogenase (LDH) and γ-glutamyl transferase (GGT), haematocrit and arterial blood pressure were recorded. In the two groups no significantly different changes occurred in pHi, pHa, serum lactate concentration or haematocrit at any of the observation times. PECO2 and PaCO2 were significantly raised during the laparoscopic procedure, whereas levels of LDH and GGT and arterial blood pressure rose during and after open cholecystectomy. In spite of the increased intra-abdominal pressure and the peritoneal carbon dioxide absorption related to the creation of a pneumoperitoneum, no decrease in pHi was detectable during laparoscopic cholecystectomy.
Survival after resection for ductal adenocarcinoma of the pancreas
Authors: Sperti C , Pasquali C , Piccoli A , Pedrazzoli S
Published: March 2007

A retrospective study was performed of 113 patients who underwent surgical resection of carcinoma of the pancreas from 1970 to 1992. The postoperative mortality rate was 15 per cent (5 per cent in the last 11 years). The actuarial 5-year survival rate was 12 per cent. Survival was significantly influenced by age (P = 0·03), vascular resection (P = 0·02), radicality of operation (P = 0·01), number of transfused blood units (P = 0·01), tumour differentiation (P = 0·002), lymph node status (P = 0·001), perineural invasion (P = 0·01), tumour size (P = 0·008), preoperative diabetes (P = 0·001) and stage (P = 0·0001). Multivariate analysis showed that stage, diabetes, age and grade were independent predictors of long-term survival. The type of pancreatic resection (Whipple, subtotal, total or distal pancreatectomy) did not influence prognosis. The 5-year survival rate was 14 per cent in the period 1970–1981 and 11 per cent in the period 1982–1992, with no statistical difference. These results suggest that patient characteristics and tumour findings rather than operative procedures affect long-term survival after resection for pancreatic carcinoma.
Donor arterial variations in liver transplantation: Management and outcome of 527 consecutive grafts
Authors: Soin A S , Friend P J , Rasmussen A , Saxena R , Tokat Y , Alexander G J M , Jamieson N V , Calne R Y
Published: March 2007

The impact of donor arterial variations and their management was investigated retrospectively in 527 consecutive allografts. Anomalous arteries were found in 161 grafts (30·6 per cent). There was no significant difference in the overall incidence of arterial complications between grafts with normal (3·6 per cent) and abnormal (5·6 per cent) anatomy. However, there was a higher incidence of arterial complications in transplants requiring multiple arterial anastomoses (P = 0·02), or anastomosis of donor vessels to recipient aorta with (P = 0·0003) or without (P = 0·04) an interposition graft for arterial reconstruction. The incidence of biliary complications was similar in grafts with a normal (18·8 per cent) or anomalous (18·0 per cent) arterial supply. Anomalies of hepatic arterial anatomy occur in one-third of all livers and do not compromise graft outcome unless multiple anastomoses or direct anastomosis to the recipient aorta are required for arterial reconstruction.
Antegrade colonic enemas
Authors: Dick A C , McCallion W A , Brown S , Boston V E
Published: March 2007

Thirteen children aged 6–14 (mean 8) years in whom an antegrade colonic enema procedure was performed were reviewed retrospectively. All presented with refractory constipation or faecal soiling over a 3-year period. Nine of the children had previously undergone pull-through procedures for Hirschsprung's disease or high anorectal malformations. Two were suffering from spina bifida and two from idiopathic functional constipation. The operation was performed through a right iliac fossa incision. A catheterizable conduit was created. The appendix was brought out to the wound edge and made continent by intussuscepting the appendix base into the caecum. When the appendix was absent or unusable, a caecal tube was formed. Five patients suffered minor morbidity, six required a further operative procedure and two eventually required a sigmoid colostomy. However, the eventual outcome of a continent stoma was attained in 11 of the 13 children, all of whom would have been considered for sigmoid colostomy before introduction of the antegrade colonic enema procedure.
Acute right iliac fossa pain in acquired immunodeficiency: A comparison between patients with and without acquired immune deficiency syndrome
Authors: Savioz D , Lironi A , Zurbuchen P , Leissing C , Kaiser L , Morel P
Published: March 2007

A retrospective review was performed of the clinical features present in 17 patients who were human immunodeficiency virus (HIV) positive requiring a diagnostic or therapeutic procedure for suspected appendicitis. Patients who were acquired immune deficiency syndrome (AIDS) free (n = 11) and those with AIDS (n = 6) were compared. Ten of the 11 patients who were AIDS-free had appendicitis. The morbidity rate was 9 per cent, similar to that expected in seronegative patients, but the appendix perforation rate was 50 per cent. Only two of the six patients with AIDS had appendicitis. Three suffered from an HIV-related disease process. Computed tomography (CT) was performed in four of the six patients with AIDS, and was considered of diagnostic help in three. In patients with AIDS, the morbidity rate rose to 50 per cent. Surgical decision-making with regard to HIV-positive patients who were AIDS-free with suspected appendicitis should be similar to that for seronegative patients. For patients with AIDS, alternative diagnostic strategies, including pre- operative CT, or possibly laparoscopy, should be considered.
Response to regional chemotherapy in patients with variant hepatic arterial anatomy
Authors: Doughty J C , Warren H , Anderson J H , Stewart I S , Reid A W , Cooke T G , McArdle C S
Published: March 2007

Regional chemotherapy for colorectal liver metastases is conventionally delivered by a catheter inserted into the gastroduodenal artery. However, up to 40 per cent of patients have ‘unconventional’ hepatic arterial anatomy. The response rate to regional chemotherapy was examined in 28 patients with normal and in 17 with variant hepatic arterial anatomy. There was no significant difference in response rates between the two groups.
Aortic prosthetic infection: 50 Patients treated by radical or local surgery
Authors: Hannon R J , Wolfe J H N , Mansfield A O
Published: March 2007

Fifty patients with aortic prosthetic infection were managed in a period of 10 years from 1983 to 1993. Twenty-five patients had recurrent sepsis after local surgery (group 1) and 22 of these eventually required radical surgery. Twenty-five patients had radical graft excision as the first procedure (group 2). Group 1 contained an excess of patients with local groin symptoms (11 in group 1 versus five in group 2, P = 0·03) and in this group fewer radiological techniques were used to document the extent of graft infection. The perioperative mortality rate was similar in both groups (seven in group 1 versus five in group 2). The number of amputations was also similar (five in group 1 versus four in group 2). The triad of occlusive disease, aortobifemoral bypass and groin symptoms was associated with eight of nine amputations. While the authors would consider using local techniques if the anastomosis was intact, the graft remained patent and infection appeared to be confined to the groin, this combination is uncommon and radical graft excision remains the preferred treatment.
Inhibition of neutrophil respiratory burst and cytokine priming by γ-linolenic acid
Authors: Jiang W G , Puntis M C A , Horrobin D F , Scott C , Hallett M B
Published: March 2007

The effect of n-6 fatty acids, particularly y-linolenic acid (GLA), on the oxidase response and neutrophil priming by tumour necrosis factor a and interleukin 8 was studied in both normal volunteers and patients with obstructive jaundice. GLA inhibited the neutrophil respiratory burst at concentrations higher than 50 μmol/l, but abolished cytokine priming at concentrations as low as 1 μmmol/1. Inhibition was not the result of either cytotoxicity to the neutrophils or alteration in cytosolic free calcium homoeostasis. It is concluded that GLA is a potential inhibitor of neutrophil priming by cytokines and of the oxidative response.
Use of a laparoscopic trocar for percutaneous introduction of drains into intra-abdominal abscesses
Authors: Singh K , Lamparelli M , Foley R J E
Published: March 2007

Drainage of an intra-abdominal abscess is a difficult problem. Laparotomy with open drainage, although effective, carries a certain morbidity and mortality rate. Percutaneous drainage using one of the various pigtail catheters is often ineffective, especially when there is debris within the abscess. These catheters tend to become blocked unless they are flushed regularly owing to a smaller lumen1. A method is described for introducing a wide-bore Robinson drain under ultrasonographic guidance using local anaesthesia.
Routine preoperative infusion cholangiography at elective cholecystectomy: A prospective study in 694 patients
Authors: Hammarström L-E , Holmin T , Stridbeck H , Ihse I
Published: March 2007

The role of preoperative infusion cholangiography (PIC) before elective cholecystectomy has yet to be defined. Between 1985 and 1991 PIC was performed routinely in 694 patients with median (range) age of 52 (17–85) years with biliary calculus disease 1 or 4 days before elective cholecystectomy. Satisfactory opacification of the biliary system was achieved in 90·1 per cent and mild to moderate adverse reactions to the infusion of contrast medium occurred in 0·9 per cent of patients. Peroperative cholangiography (POC) in 43 of 499 patients with a normal PIC was normal. The presence of common bile duct stones was confirmed in 34 of 36 patients with prominent stones at bile duct exploration and in 8 of 26 with suspected stones at PIC. Bile duct dilatation (median diameter 10 mm) without concomitant stones was seen at PIC and confirmed at POC in 20 patients. Bile duct anomalies were found or suspected in 35 patients at PIC and were confirmed in six by POC (n = 5), or during the cholecystectomy making the anomaly incidence 0·9 per cent. Information provided by the PIC was not of crucial importance for safe execution of cholecystectomy in any patient, while a single (minor) bile duct lesion (1 of 694; 0·1 per cent) could be ascribed to severe pericholecystitis. The results of this study suggest that routine PIC is not warranted. However, PIC is an alternative to selective preoperative endoscopic retrograde cholangiography or selective POC. PIC needs to be supported by POC in approximately 20 per cent of patients (in case of absent or poor opacification of the bile ducts or suspicion of stones or anomalies at PIC).
Intravenous infusion cholangiography for investigation of the bile duct: A direct comparison with endoscopic retrograde cholangiopancreatography
Authors: Bloom I T M , Gibbs S L , Keeling-Roberts C S , Brough W A
Published: March 2007

Laparoscopic cholecystectomy has led to an increase in preoperative endoscopic retrograde cholangiopancreatography (ERCP) for the investigation of bile duct stones. ERCP and intravenous infusion cholangiography (IIC) were compared in 111 consecutive patients without jaundice considered to be at high risk for bile duct stones. Both investigations were successfully completed in 100 patients. IIC and ERCP demonstrated a normal bile duct in 81 patients and bile duct stones in 16 patients. IIC failed to identify bile duct stones in two patients (1·8 per cent). IIC was 89 per cent sensitive and 99 per cent specific for detecting bile duct stones in patients without jaundice. It is suggested that IIC is a cost-effective preoperative investigation for bile duct calculi.
Long-term results of endoscopic stenting and surgical drainage for biliary stricture due to chronic pancreatitis
Authors: Smits M E , Rauws E A J , van Gulik T M , Gouma D J , Tytgat G N J , Huibregtse K
Published: March 2007

A retrospective evaluation was made of the long-term results of endoscopic stenting in 58 patients with benign biliary stricture due to chronic pancreatitis. Immediate relief of jaundice and cholestasis was achieved in all patients after endoscopic stent insertion. Median follow-up was 49 months. Five (9 per cent) of the 58 patients had complications following therapeutic endoscopic retrograde cholangiopancreatography. Late stent-related complications occurred in 37 (64 per cent) of 58 patients. There were no deaths. Sixteen (28 per cent) of the 58 patients had regression of the biliary stricture and permanent removal of the stent. Forty-two patients had persistent biliary stricture: 26 had continued stenting and 16 underwent surgical procedures. Early morbidity after surgery was found in six of 16 patients, with no deaths. Postoperative relief of jaundice was achieved in 15 of the 16 patients. In conclusion, endoscopic stenting and surgery are both effective treatments for biliary stricture in patients with chronic pancreatitis. Endoscopic stenting is associated with fewer early complications. However, late stent-related complications remain a major limitation. Endoscopic stenting offers definitive treatment in more than one-quarter of patients (28 per cent).
Topical glyceryl trinitrate in the treatment of chronic anal fissure
Authors: Watson S J , Kamm M A , Nicholls R J , Phillips R K S
Published: March 2007

The aetiology of anal fissure is unclear, but there is an association with high maximum resting pressure (MRP). Internal sphincterotomy reduces MRP and heals fissure through an increase in local blood supply. Glyceryl trinitrate (GTN) is a nitric oxide donor which contributes to internal anal sphincter relaxation via a non-adrenergic non-cholinergic pathway. GTN ointment was applied topically in different concentrations to the anal margin in patients with chronic anal fissure to monitor its effect primarily on MRP and secondarily on fissure healing. Nineteen patients with chronic anal fissure were treated with ointment containing increasing concentrations of GTN (0·2–0·8 per cent) to produce a reduction in MRP of greater than 25 per cent. The actual dose of GTN varied as no standard delivery system has been developed, but a ‘typical amount’ of GTN ointment weighed about 200 mg. In 15 of 19 patients, a concentration greater than 0·2 per cent was required to lower the MRP by at least 25 per cent. The minimum concentration of GTN that reduced the resting pressure by at least 25 per cent was prescribed and local application was carried out by the patient twice daily for 6 weeks. At 6 weeks, nine patients had healed, six required sphincterotomy and four were lost to follow-up. Eight of the nine patients with healed fistula required a GTN concentration of 0·3 per cent or more. Sixteen patients were resistant to the usually effective dose of 0·2 per cent GTN. In three there was tachyphylaxis and the duration of action of GTN was less than the 12 h described previously in control patients. Two patients did not fulfil the study because of headache.
Prognostic significance of radial margins of clearance in rectal cancer
Authors: de Haas-Kock D F M , Baeten C G M I , Jager J J , Langendijk J A , Schouten L J , Volovics A , Arends J W
Published: March 2007

A retrospective review of 325 patients was undertaken to analyse whether involvement of the radial resection margin (RRM) could predict locally recurrent disease or distant metastases in patients who had curative surgery for rectal or rectosigmoid cancer. Information on the RRM was available in 253 patients. The RRM was involved in 31 (12 per cent). Nine of these 31 patients developed local recurrence (29 per cent), while only 17 local recurrences were diagnosed in 217 patients (8 per cent) without involvement of the RRM (P<0·01). At 2 years the overall local recurrence rate was 10 per cent. Distant metastases were diagnosed in 46 patients (18 per cent) and RRM involvement was identified as a prognostic factor depending on lymph node involvement (N stage) (P = 0·02). Local recurrence and some distant metastases result from microscopically incomplete resection. Assessment of the radial depth of tumour invasion by careful histological examination of the specimen may be used for selection of patients for adjuvant radiotherapy and/or chemotherapy.