bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastrointestinal Quality of Life Index: Development, validation and application of a new instrument
Authors: Eypasch E , Williams J I , Wood-Dauphinee S , Ure B M , Schmulling C , Neugebauer E , Troidl H
Published: March 2007

At present, an instrument for measuring the quality of life, specifically for patients with gastrointestinal disease, is not available. A new instrument for gastrointestinal disorders that is system-specific has been developed in three phases. In the first phase, questions were collated and then tested on 70 patients with gastrointestinal diseases and those that worked well were retained. In the second phase, the questions were modified and tested on 204 patients and the results verified by international experts. The instrument was also validated against other generic measures of quality of life. During the third phase, the instrument was validated with 168 normal individuals. Reproducibility was tested on 25 patients with stable gastrointestinal disease and responsiveness was tested on 194 patients undergoing laparoscopic cholecystectomy. The result is a bilingual (German and English) questionnaire containing 36 questions each with five response categories. The responses to questions are summed to give a numerical score. It is concluded that the Gastrointestinal Quality of Life Index (GIQLI) is ready to be used in clinical practice and research.
Effect of ibuprofen on the acute-phase response and protein metabolism in patients with cancer and weight loss
Authors: Preston T , Fearon K C H , McMillan D C , Winstanley F P , Slater C , Shenkin A , Carter D C
Published: March 2007

The aim of this study was to determine whether administration of the non-steroidal anti-inflammatory agent ibuprofen might attenuate the acute-phase response in patients with colonic cancer. Cytokines and acute-phase proteins were measured before administration of ibuprofen and again 3 days later, when protein synthesis was measured using 15N-glycine. In patients with cancer, ibuprofen caused a significant reduction in the plasma concentration of all five acute-phase proteins studied. Although interleukin 6 levels were raised, they did not change following administration of ibuprofen. Unlike the situation in patients with cancer who did not receive ibuprofen, whole-body protein kinetics were similar to those of control subjects in patients with cancer who received ibuprofen. Whether or not ibuprofen had been administered, non-export hepatic protein synthesis rates were significantly lower in patients with than in those without cancer. These results suggest that short-term administration of ibuprofen can attenuate accelerated whole-body protein kinetics and the acute-phase response in patients with advanced cancer.
Treatment of lymphocele in renal transplant recipients by laparoscopic fenestration after transcutaneous staining
Authors: Schilling M , Abendroth D , Kunz R
Published: March 2007

Lymphocele is a rare cause of impairment of graft function after renal transplantation. Treatment ranges from external drainage to laparoscopic internal marsupialization. A therapeutic approach to the treatment of symptomatic lymphocele is described, which employs external drainage, if necessary followed by methylene blue staining and laparoscopic internal drainage, should conservative treatment fail. Five patients developed post-transplant lymphocele of varying size and were treated according to this protocol. Identification of the blue lymphocele at laparoscopy was straightforward and complete marsupialization was performed. After a mean follow-up of 8·4 months all patients are free from symptoms and have well functioning grafts.
Role of intraoperative cholangiography in laparoscopic cholecystectomy
Authors: Madhavan K K , MacIntyre I M C , Wilson R G , Saunders J H , Nixon S J , Hamer-Hodges D W
Published: March 2007

The results of a policy of selective cholangiography were assessed in 400 patients undergoing laparoscopic cholecystectomy. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 81 patients (20 per cent) of whom 31 (38 per cent) showed definite or possible evidence of stones in the bile duct. Seventeen of the 400 patients underwent intraoperative cholangiography and the majority of these (12) were normal. After a minimum follow-up of 1 year, 17 patients (4 per cent) have had ERCP for suspected residual duct stones. Eight (2 per cent) of these revealed stones and all were successfully treated with sphincterotomy and duct clearance. Preoperative and postoperative ERCP was not associated with mortality or major morbidity. No major duct injury occurred and none was diagnosed within 2 years of operation. Routine intraoperative cholangiography is not a necessary part of laparoscopic cholecystectomy in the presence of an efficient and safe ERCP service.
Peroperative endoscopic sphincterotomy during laparoscopic cholecystectomy for choledocholithiasis
Authors: Cox M R , Wilson T G , Toouli J
Published: March 2007

The development of laparoscopic cholecystectomy has created a dilemma in the management of choledocholithiasis. A number of options exist, including endoscopic sphincterotomy (ES) before laparoscopic cholecystectomy in patients with suspected common bile duct (CBD) calculi, laparoscopic bile duct exploration, open CBD exploration and postoperative ES. None of these options has emerged as ideal or universally acceptable. An alternative technique, peroperative ES, has been developed. A prospective assessment of the use of peroperative ES in 13 patients in whom choledocholithiasis was demonstrated with operative cholangiography is presented. Eleven patients had successful ES and clearance of stones. The CBD could not be cannulated in one patient, and an adequate ES for stone extraction could not be performed in the remaining patient. Both procedures were converted to open CBD exploration. Complications were mild postoperative pancreatitis (two patients) and pulmonary atelectasis (one). The median total operating time was 165 min and the median postoperative hospital stay was 3 days. Peroperative ES at the time of laparoscopic cholecystectomy provides a safe technique for clearance of the CBD.
Bile duct injury and bile leakage in laparoscopic cholecystectomy
Authors: McMahon A J , Fullarton G , Baxter J N , O'Dwyer P J
Published: March 2007

The introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. This review presents the incidence of bile duct injury in reported series and examines the role of the learning curve and other contributing factors. There is good evidence to suggest that, with adequate training and experience, the incidence of biliary injury can be reduced to a level comparable to that of open cholecystectomy. Continued audit is required to ensure that the low complication rates achieved in selected centres with wide experience are reproduced by the surgical community in general.
Faecal occult blood testing and colonoscopy in the surveillance of subjects at high risk of colorectal neoplasia
Authors: Robinson M H E , Kronborg O , Williams C B , Bostock K , Rooney P S , Hunt L M , Hardcastle J D
Published: March 2007

Colonoscopy is the established method of surveillance of subjects at high risk of developing colorectal neoplasia but the procedure is expensive, time consuming and occasionally hazardous. Faecal occult blood tests can be prepared at home and are cheap, simple and safe. Hemeselect is an immunological faecal occult blood test that is more sensitive for colorectal cancer than Haemoccult. The aim of this study was to determine the sensitivity of the Hemeselect test for asymptomatic colorectal neoplasia in subjects at high risk of the disease who were undergoing colonoscopy, thus assessing its suitability as an alternative means of screening high-risk groups. A total of 919 asymptomatic subjects were asked to complete Hemeselect tests. These were completed satisfactorily by 808 individuals (compliance rate 88 per cent) and were positive in 164 patients (20 per cent). At colonoscopy 11 cancers were detected in ten patients (seven Hemeselect positive) and 36 (16 Hemeselect positive) had at least one adenoma 1 cm or more in diameter. The test sensitivities of Hemeselect for carcinoma and large (1 cm or more) adenomas were 70 and 44 per cent respectively. In a subset of 417 subjects who also completed Haemoccult tests, the sensitivities were 33 and 18 per cent. Hemeselect specificity is 88 per cent compared with 98 per cent for Haemoccult. While the sensitivity of Hemeselect is higher than that of Haemoccult, it is still insufficient to replace colonoscopy in high-risk groups.
New method to evaluate the therapeutic value of lymph node dissection for gastric cancer
Authors: Sasako M , McCulloch P , Kinoshita T , Maruyama K
Published: March 2007

The results of 1281 potentially curative resections for advanced gastric cancer performed at the National Cancer Center Hospital between 1972 and 1986 were studied using a novel approach which circumvents the stage migration phenomenon. The incidence of metastasis and the 5-year survival rate of patients with positive nodes were calculated independently for each lymph node ‘station’, without any reference to overall pathological nodal stage. The therapeutic value of extended lymph node dissection was estimated by multiplication of incidence of metastasis and percentage 5-year survival rate of patients with metastasis for each station. The incidence of metastasis ranged from 2·4 per cent to 66 per cent and the 5-year survival rate of affected patients from 0 to 58·7 per cent in perigastric stations, depending on the site of the primary tumour. The incidence of metastasis was between 3·0 per cent and 44·4 per cent in the second tier of nodes (n2), and the 5-year survival rate ranged from 0 per cent to 47·5 per cent. The majority of second-tier stations showed evidence of benefit from node dissection.
Preoperative assessment of lymph nodes in the prediction of disease spread and outcome in cancer of the thoracic oesophagus
Authors: Matsubara T , Ueda M , Nakajima T
Published: March 2007

Prospective assessment of lymph node status, based on the findings of computed tomography, external ultrasonography and palpation, was compared with clinical results in 179 patients who underwent oesophagectomy with systematic node dissection. Preoperative findings for each node group were classified into four grades: involvement not suspected (−); possible involvement (±); probable involvement (+); and definite involvement (++). When only (++) or (+) assessment was categorized as positive, the specificity was more than 94 per cent, although the sensitivity was less than 40 per cent. The preoperative assessment correlated significantly with the incidence of node involvement (P < 0·02), the degree of lymphatic invasion (P < 0·0001) and outcome after operation. For patients with all nodes assessed as (−), the 5-year survival rate was 70 per cent, compared with 26 per cent for those with nodes assessed as (+), P = 0·001. Preoperative assessment provided useful information on nodal status.
High amplification of the hst-1 gene correlates with haematogenous recurrence after curative resection of oesophageal carcinoma
Authors: Chikuba K , Saito T , Uchino S , Sato K , Miyahara M , Tsuda H , Hirohashi S , Kobayashi M
Published: March 2007

Amplification of the hst−1 gene was examined in 82 patients with oesophageal carcinoma by dot blot hybridization to assess the potential of haematogenous recurrence after curative resection. Intensity of amplification was considered negative (one- to twofold increase) in 45 patients, low (three-sixfold increase) in 19 and high (greater than sevenfold) in 18. Haematogenous recurrence after curative resection was found in seven of eight patients with high amplification and was significantly higher in such patients than in those without amplification (P<0·05). The finding that sevenfold or greater amplification of the hst-l gene seems to be associated with haematogenous recurrence of oesophageal cancer after resection may serve to assess the clinical outcome.
Effect of starch-containing glove powder on wound healing in the rat
Authors: Corless D J , Holland J , Wastell C
Published: March 2007

The effect of the starch-containing powder Bio Sorb on wound healing was examined in an immunocompetent and a T cell-deficient animal model. Wounds were tested by tensionometry to give values of resilience, ultimate strength, toughness and extension. Starch significantly decreased the resilience (P < 0·03), ultimate strength (P < 0·004), and toughness (P < 0·006) of wounds in the immunocompetent model but was not shown to affect the healing of wounds in T cell-depleted animals. When the uncontaminated wounds of the two groups were compared, those from T cell-depleted animals were tougher (P < 0·04) and less extensile (P < 0·0002). These results suggest that starch impairs wound healing by its effect on the T cell-mediated immune system, and that this system may also be involved in regulation of the reparative process because its absence leads to tougher wounds.
Morbidity and mortality after hepatic resection of metastases from colorectal cancer
Authors: Doci R , Gennari L , Bignami P , Montalto F , Morabito A , Bozzetti F , Bonalumi M G
Published: March 2007

A review was carried out of morbidity and mortality after hepatic resection for metastatic colorectal cancer in 208 consecutive patients who underwent this procedure between 1980 and 1992. Overall postoperative morbidity and mortality rates were 35 and 2·4 per cent respectively. The major morbidity rate was 18 per cent, the main complications being intra-abdominal sepsis, biliary fistula and haemorrhage. Of the different factors examined, morbidity was significantly related to the extent of liver resection (53 versus 21 per cent after major and minor resections respectively), amount of blood transfused (18 versus 52 per cent for no transfusion and more than 300 ml transfused respectively) and the date of the operation (53 versus 24 per cent before and after 1986 respectively). Multivariate analysis showed that only the extent of hepatic resection and the period at which surgery was performed retained their statistical significance. These data support the opinion that surgical treatment of hepatic metastases from colorectal cancer is an effective procedure with acceptable mortality and morbidity rates. An extensive experience of hepatic surgery is, however, necessary to optimize results.
Lymph node metastases in carcinoma of the head of the pancreas region
Authors: Nakao A , Harada A , Nonami T , Kaneko T , Murakami H , Inoue S , Takeuchi Y , Takagi H
Published: March 2007

Histopathological examination of lymph node metastatic involvement in 139 specimens obtained from patients who underwent pancreatoduodenectomy or total pancreatectomy combined with wide resection of lymph nodes was performed, to clarify the critical areas of lymph node dissection in patients with carcinoma of the head of the pancreas region. Perigastric lymph node involvement in patients with carcinoma of the head of the pancreas was 14 per cent, in those with carcinoma of the distal bile duct 0 per cent and in those with carcinoma of the papilla of Vater 4 per cent. Para-aortic lymph node involvement in patients with carcinoma of the head of the pancreas, the distal bile duct and the papilla of Vater was 26, 9 and 0 per cent, respectively. On the basis of these results, pylorus-preserving pancreatoduodenectomy is indicated in almost all patients with carcinoma of the distal bile duct and the papilla of Vater. In patients with carcinoma of the head of the pancreas, however, wide dissection of lymph nodes, including para-aortic lymph nodes, should be carried out because of the relatively high incidence of para-aortic lymph node involvement.
Risk-adjusted analysis of surgeon performance: A 1-year study
Authors: Copeland G P , Sagar P , Brennan J , Roberts G , Ward J , Cornford P , Millar A , Harris C
Published: March 2007

A 1-year prospective analysis was undertaken of all non-day-case general surgery in a district general hospital. Using the Physiological and Operative Severity Score for the en Umeration of Mortality and Morbidity (POSSUM) scoring system 3004 patients were assessed. From the predictions of mortality and morbidity so obtained, a quality measure, the ratio of observed to expected numbers of deaths and complications (O:E ratio) was determined for each surgeon, both overall and within specialty zones. The present study demonstrates the serious hazard in using ‘raw’ uncorrected mortality and morbidity statistics to compare surgeon performance. Mortality rates varied from 1·0 to 4·9 per cent whereas O:E ratios ranged from 0·83 to 1·06; morbidity rates varied from 5·3 to 12·6 per cent with O:E ratios 0·86-1·02. Great misunderstanding may result from the publication of surgeon or hospital ‘league tables’. The present study demonstrates a technique that might allow surgeon performance to be monitored adequately and accurately.
Human intraperitoneal fibrinolytic response to elective surgery
Authors: Scott-Coombes D , Whawell S , Vipond M N , Thompson J
Published: March 2007

Intra-abdominal adhesions develop in over 90 per cent of patients undergoing laparotomy. Peritoneal fibrinolysis is believed to be important in the pathophysiology of adhesion formation. This study investigated the fibrinolytic response of postoperative peritoneal fluid in 12 patients undergoing elective laparotomy. There was a significant reduction in the plasminogen activating activity to undetectable levels at 24 h, which was sustained at 48 h (P <0·05). While there was an early reduction in the concentration of tissue plasminogen activator (median 40·0, 28·2, 16·3 and 31·9 ng/ml at 2, 6, 24 and 48 h respectively, P < 0·05), the abolition of functional fibrinolytic activity appeared to be secondary to a marked increase in the concentration of plasminogen activator inhibitor (PAI) 1 (median 86, 196, 800 and 730 ng/ml at 2, 6, 24 and 48 h respectively; P < 0·05) and PAI-2 (median less than 6, 12, 155 and 245 ng/ml at 2, 6, 24 and 48 h respectively; P < 0·05). This reduction in the plasminogen activating activity of peritoneal fluid may favour the formation of permanent fibrous adhesions following surgery.
Lactulose as an antiendotoxin in experimental colitis
Authors: Gardiner K R , Erwin P J , Anderson N H , McCaigue M D , Halliday M I , Rowlands B J
Published: March 2007

The efficacy of lactulose as an antiendotoxin was studied and the effect of lactulose or colistin on faecal flora was investigated in a hapten-induced rat model of colitis. Enteral administration of lactulose to rats with colitis was associated with a significant reduction in the systemic concentration of endotoxin (median (range) 5.4 (0–19.9) versus 23.7 (0–145.0) pg/ml in colitic rats treated with water; 4.6 (0–10.8) pg/ml in healthy animals). Enteral administration of colistin significantly reduced the faecal count of aerobic Gram-negative bacilli (median (range) 2.84 (1.40–8.43) versus 8.26 (4.50–10.40) log10 colony-forming units per g faeces after treatment with water) but not the faecal load of endotoxin. Patients with inflammatory bowel disease may benefit from enteral treatment with lactulose to prevent systemic endotoxaemia and/or with colistin to modify enteric bacteria.
Human immunodeficiency virus infection and genital warts as risk factors for anal intraepithelial neoplasia in homosexual men
Authors: Carter P S , de Ruiter A , Whatrup C , Katz D R , Ewings P , Mindel A , Northover J M A
Published: March 2007

The incidence of anal intraepithelial neoplasia (AIN) was studied in a group of 210 homosexual and bisexual men. The presence of genital warts and human immunodeficiency virus (HIV) infection was assessed as risk factors for the development of AIN. In all, 74 (35 per cent) of the group had histological evidence of AIN. The relative risk of being positive for HIV on AIN (relative to being negative for HIV) was 1.58 (95 per cent confidence interval (c.i.) 1.01–2.48). The relative risk of anal warts on AIN (relative to absence of anal warts) was 4.70 (95 per cent c.i. 1.81–12.20). Logistic regression analysis showed no significant interactive effect between HIV and anal warts on the risk of AIN. It is concluded from the results of a Mantel-Haenzel analysis that the presence of anal warts and HIV infection are independent risk factors for the development of AIN in homosexual and bisexual men.
Activities of phospholipase A2 and diacylglycerol lipase are increased in human colorectal cancer
Authors: Hendrickse C W , Radley S , Donovan I A , Keighley M R B , Neoptolemos J P
Published: March 2007

Experimental, clinical and epidemiological studies have implicated arachidonic acid and its metabolites as important mediators in colorectal carcinogenesis. Although arachidonic acid levels are increased in tumour membrane lipids, its availability for metabolic processes is not known. The activities of phospholipase A2 (PLA2) and diacylglycerol lipase therefore were assessed in tumour and normal mucosal specimens from 20 patients with colorectal cancer using 14C-radiolabelled substrates. The median (interquartile range) PLA2 activity was increased in tumour tissue (10.5 (6.0, 18.5) pmol arachidonic acid mg−1 h−1) compared with that in normal mucosa (5.6 (2.5, 8.5) pmol arachidonic acid mg−1 h−1) (P < 0.001, Wilcoxon signed rank test). Activity of diacylglycerol lipase was also greater in tumoral tissue (47.4 (21.6, 82.1) pmol arachidonic acid mg−1 h−1) than in mucosa (19.1 (9.4, 42.9) pmol arachidonic acid mg−1 h−1) (P < 0.005). There was no correlation between either PLA2 or diacylglycerol lipase activity and myeloperoxidase activity, suggesting that these increases were not directly attributable to tumour inflammatory cell infiltrate. Augmentation of arachidonic acid release in colorectal tumours may have implications for therapy.
Inadequate levels of metronidazole in subcutaneous fat after standard prophylaxis
Authors: Badia J M , de la Torre R , Farré M , Gaya R , Martínez-Ródenas F , Sancho J J , Sitges-Serra A
Published: March 2007

The efficacy of antibiotic prophylaxis depends on appropriate tissue levels of the drug being present at the time of potential wound contamination. Metronidazole concentrations in serum, muscle and subcutaneous fat were measured after a single intravenous dose given at two different intervals before operation. Twenty-six patients undergoing abdominal wall procedures were divided into two groups. Patients in group 1 received metronidazole 500 mg intravenously 2 h before surgery, and those in group 2 were given the drug during induction of anaesthesia. Mean plasma levels of metronidazole at the beginning of the procedure were significantly lower (P = 0.01) in group 1 (7.3 (95 per cent confidence interval 5.7–8.9)) μg/ml than in group 2 (12.3(8.9–15.7)) μg/ml although in both cases were above the minimum inhibitory concentration for 90 per cent of Bacteroides fragilis. Similar therapeutic concentrations of metronidazole were achieved in plasma and muscle in both groups at the end of the operation. However, patients in both groups had non-therapeutic concentrations of metronidazole in subcutaneous fat: group 1 0.9 (0.6–1.2)μg/mg, group 2 1.2 (0.7–1.7)μg/mg at the beginning of operation, and 1.2 (0.8–1.6) and 1.5 (0.9–2.1)μg/mg respectively at the end of the procedure. It is concluded that infusion of metronidazole 2 h before surgery or during induction of anaesthesia achieved adequate plasma and muscle levels but failed to achieve therapeutic levels in subcutaneous fat.
Acute thrombotic occlusion of the suprarenal aorta: Importance of early diagnosis and treatment
Authors: Mestres C A , Castella M , Barriuso C , Mulet J
Published: March 2007

Five patients with suprarenal aortic thrombosis were diagnosed and treated over the past 6 years. Attempts were made to establish aggressive medical and surgical treatment promptly. Three patients died in spite of immediate therapeutic measures. Two patients survived operation but one died 9 months later from myocardial infarction. The syndrome of high acute aortic occlusion is considered; attention is focused towards immediate diagnosis and treatment.
Wound management in burn centres in the United Kingdom
Authors: Papini R P G , Wilson A P R , Steer J A , McGrouther D A , Parkhouse N
Published: March 2007

Despite advances in the use of topical and parenteral antimicrobial therapy, and the practice of early tangential excision, infection of the burn wound remains a leading cause of morbidity and mortality. The aim of this study was to survey and compare wound management and antibiotic usage in burn surgery in all UK burn centres. A postal questionnaire was used, followed up by telephone. Answers were obtained from all 39 units treating burns in the UK. A written policy on antibiotic usage was used by 13 centres. Excisions were covered routinely by prophylactic antibiotic therapy in 18 units, and three of these used antibiotic cover during all procedures in which the wound was manipulated. No routine antibiotic cover was given in 21 units. All units obtained surface swab cultures, but only two performed punch biopsy of the wounds. Quantitative bacteriology (counting colony forming units) was employed by three centres. Most units cleaned the burn with saline (17 of 39) or chlorhexidine (eight of 39) but combinations of these and other agents were also used. Nearly half (17 of 37) of those who replied had not seen any cases of proven or suspected toxic shock syndrome in the past 2 years. Four units gave prophylaxis against Staphylococcus aureus, and four gave antibiotics against Streptococcus pyogenes, despite recommendations in the literature. Twenty-nine units gave no prophylaxis. This study has revealed that there is no consensus on antibiotic usage amongst centres treating burns in the UK and that most units rely on surface swab cultures to monitor infection.
Aggressive fibromatosis (non-familial desmoid tumour): Therapeutic problems and the role of adjuvant radiotherapy
Authors: Plukker J Th , van Oort I , Vermey A , Molenaar I , Hoekstra H J , Panders A K , Dolsma W V , Koops H Schraffordt
Published: March 2007

Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, even after apparently adequate resection. Wide local excision with a margin of at least 3 cm, depending on the anatomical location, should be performed to improve rates of recurrent disease. There is no consensus concerning the role of radiotherapy in the treatment of these lesions. The clinical findings of 39 cases diagnosed between 1972 and 1991 were reviewed retrospectively. Local control was effected in 19 of 32 patients treated with surgery alone after a median (range) follow-up of 72 (18–236) months. There were 40 cases of recurrent fibromatosis in 15 patients. Local control was obtained in 13 of 14 patients who received radiotherapy using a wide-field technique and doses of more than 50 Gy over a period of 5 weeks after marginal or incomplete resection of primary or recurrent lesions (P < 0.001). The results suggest that in a selected group of patients with aggressive fibromatosis radiotherapy may effectively achieve control of residual disease after surgery without marked disfigurement and loss of function.
Failure of macrophage activation in experimental obstructive jaundice: Association with bacterial translocation
Authors: Reynolds J V , Murchan P , Redmond H P , Watson R W G , Leonard N , Hill A , Clarke P , Marks P , Keane F B V , Tanner W A
Published: March 2007

Bacterial translocation from the gastrointestinal tract and macrophage activation are central to current theories of sepsis. The relevance of both in obstructive jaundice is unclear. The effect of bile duct ligation for 7 days on bacterial translocation to mesenteric lymph nodes and on macrophage activation in a rat model was examined. Compared with an incidence of zero in sham-ligated controls, bile-duct ligated rats had a 67 per cent incidence of Gram-negative colonization of mesenteric lymph nodes. This was associated with a significant (P < 0.001) decrease in macrophage tumour necrosis factor, superoxide anion and nitric oxide production compared with that in sham controls. Spontaneous bacterial translocation occurs in experimental obstructive jaundice and is associated with marked suppression of macrophage activation. This suggests a mechanism whereby jaundiced patients may be more susceptible to persistent infection but relatively protected against uncontrolled sepsis.
Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease
Authors: Makowiec F , Jehle E C , Becker H D , Starlinger M
Published: March 2007

A total of 36 rectal advancement flap repairs were performed in 32 patients with perianal Crohn's disease. There were 12 anovaginal and 20 trans-sphincteric fistulas. Patients were followed prospectively for a mean of 19.5 months to evaluate postoperative recurrence rate. The prognostic influence of fistula type, rectal disease, intestinal disease and faecal diversion on recurrence was assessed. Four of 36 repairs showed primary failure, the operated fistula recurred in 11 patients after a median of 7 months, and a new fistula developed in six patients. The fistula recurrence rate was higher in patients with anovaginal fistula or Crohn's colitis but did not correlate with disease activity. Transitory mild incontinence of stool was observed in one patient only. Although rectal advancement flap repair does not cure perianal fistulas in most patients with Crohn's disease, those without Crohn's colitis may have long-term benefit. Short-term improvement of symptoms justifies this simple procedure even in patients with anovaginal fistula.
Surgical repair of thoracoabdominal aortic aneurysm: 10 years' experience
Authors: Gilling-Smith G L , Worswick L , Knight P F , Wolfe J H N , Mansfield A O
Published: March 2007

Between 1983 and 1993, a total of 110 patients underwent elective repair of thoracoabdominal aortic aneurysm. Mortality rate varied with the extent of repair: 26 per cent (five of 19) after type I repair, 42 per cent (eight of 19) after type II repair, 24 per cent (four of 17) after type III repair and 15 per cent (eight of 55) after type IV repair. A further 20 patients underwent urgent operation for suspected rupture in nine and true rupture in 11. The mortality rate was 73 per cent for those with true rupture and 33 per cent for those with threatened or contained rupture. Death was most commonly due to coagulopathy and bleeding (39 per cent) or myocardial ischaemia (19 per cent). Preoperative risk factors for death included type II repair, urgent or emergency operation, aortic dissection, impaired renal function and abnormal spirometry (P < 0.05). Postoperative risk factors included reoperation, dialysis or prolonged ventilation (P < 0.05). Twenty patients required dialysis; ten died, five recovered normal renal function and five were discharged on dialysis. Eight patients developed paraplegia and four of them died. Thoracoabdominal aneurysm remains a formidable surgical challenge, but 90 per cent of survivors are free of major morbidity.
Endothelial cell ultrastructure after aortic aneurysm rupture: An electron microscopy study
Authors: Milne A A , Bevan B H , Murphy W G , McDougall R D , Bradbury A W , Ruckley C V
Published: March 2007

Endothelial cell activation as an early response to hypovolaemic shock may be important in the pathogenesis of coagulopathy and multiple organ failure after aortic aneurysm rupture. The aim of this study was to determine whether any evidence could be found of changes in endothelial cell ultrastructure in patients undergoing operation for ruptured aneurysm and to establish a model for future studies of endothelial cells in these patients. At the start of operation, fat samples from the anterior abdominal wall were taken from five patients with ruptured abdominal aortic aneurysms and in an identical fashion from five control patients undergoing elective surgery. Endothelial cells lining capillaries were examined by transmission electron microscopy. Photomicrographs were taken of all capillaries present and these were assessed blindly by three independent observers. When compared with controls it was found that the luminal surface of the endothelial cells in patients with aneurysm rupture was more convoluted, with more frequent processes projecting into the lumen of the capillary. Budding of the luminal surface of the endothelial cell was seen in 11 of 45 capillaries in the rupture group and in none of 44 capillaries in the control group (P < 0.005). Budding was seen in at least one capillary of all five patients presenting with rupture but in none of the control group (P < 0.05). In conclusion, at the ultrastructural level there are changes within endothelial cells in capillaries at an early stage after ruptured abdominal aortic aneurysm.
Oesophagoplasty in the treatment of caustic oesophageal strictures in children
Authors: Mutaf O , Özok G , Avanoğlu A
Published: March 2007

A total of 111 children with caustic oesophageal strictures who have subsequently undergone oesophagoplasty were reviewed. Overall 80 patients had a retrosternal colon transplant; a two-stage operation with delayed cervical oesophagocolostomy was the preferred method in 68 of them. Of those having retrosternal surgery two had total necrosis and three had necrosis at the distal end of the transplant. The incidence of cervical anastomotic stenosis was six of 12 in the group undergoing single-stage surgery, compared with seven of 68 in those having the two-stage operation. Ten patients underwent a right thoracic retrohilar colon transplant, seven of whom developed redundancy of the graft. Redundancy was a lesser problem in the retrosternal placement of the transplant. Three patients underwent jejuno-oesophagoplasty which resulted in terminal necrosis in one patient and total necrosis in two. The remaining 18 patients had segmental resection of the intrathoracic oesophageal stenosis followed by end-to-end anastomosis. The overall mortality rate in the series was 3.6 per cent (four of 111).
Ambulatory oesophageal bile reflux monitoring in Barrett's oesophagus
Authors: Caldwell M T P , Lawlor P , Byrne P J , Walsh T N , Hennessy T P J
Published: March 2007

Bile reflux has been implicated in the pathogenesis of Barrett's oesophagus but evaluation remains difficult. Bilitec 2000 is an ambulatory system that detects bilirubin based on its spectrophotometric properties. Oesophageal bile exposure was evaluated in three groups of patients. Group 1 (n = 11) were normal controls, group 2 (n = 13) were patients with uncomplicated gastro-oesophageal reflux and group 3 (n = 12) were patients with Barrett's oesophagus. Bile reflux was greater in patients with Barrett's mucosa than in controls or those with uncomplicated reflux. This difference was seen in the supine and interdigestive periods. The percentage of time at which gastric pH was greater than 4 and oesophageal pH was above 7 did not differ between the groups. Bilitec 2000 detects greater bile reflux in patients with Barrett's oesophagus. No corresponding gastric or oesophageal alkaline shift is found. This ambulatory bile reflux monitoring system may be a useful tool in clinical practice.
Surgical treatment of morbid obesity
Authors: Sagar P M
Published: March 2007

Morbid obesity significantly reduces life span and is associated with much co-morbid pathology. Diet, behavioural therapy and drug therapy are largely unsuccessful. Surgical treatment offers the best hope. This review summarizes the rationale for treatment and the available surgical options.
Clinical and experimental studies of intraoperative autotransfusion using a new filtration device
Authors: Varga Z A , Thompson J F , Locke-Edmunds J C , Baird R N , Farndon J R
Published: March 2007

The Haemocell S-350 device has recently been introduced for intraoperative autotransfusion. The system uses a novel membrane filter to process shed blood. In the first part of this study a 0.2-μm pore size filter was used in a randomized trial comparing the use of autotransfusion (n = 8) with bank blood controls (n = 9) during aortic reconstruction. This part of the trial was abandoned because of unexpected non-surgical bleeding. Bank blood requirements fell from a median of 3.0 (range 0.0-9.0) units to 1.5 (range 0.0–7.0) units when autotransfusion was used, but these patients had a greater perioperative blood loss (1791 (range 932–3104) versus 1140 (range 440–3840) ml). There was evidence of postoperative heparin excess with an activated partial thromboplastin time ratio of 1.3 (range 0.9–3.0) versus 1.0 (range 1.0–1.2) in controls and an activated clotting time of 206 (range 143–280) versus 137 (range 107–142) s. This was confirmed by raised plasma heparin levels and a prolonged thrombin time normalized by protamine. To improve performance a 0.6-μm pore size filter was studied in ten patients. Filtration efficiency doubled from 19 to 38 per cent. Electron micrographs demonstrated better filter clearance, but 44 per cent of the original concentration of heparin remained in the reinfusate. The S-350 device may be an attractive alternative to centrifugation for intraoperative autotransfusion but, until efficiency is improved, it should only be used for cardiovascular surgery when excess heparin can be reversed with protamine.
War injuries of the crural arteries
Authors: Radonic V , Baric D , Petricevic A , Kovacevic H , Sapunar D , Glavina-Durdov M
Published: March 2007

Twenty-eight patients with military crural vascular injuries are presented. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 min). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3–47 (mean 14) days. Hyperbaric oxygenation therapy was used in conjunction with surgery and antibiotic therapy in 13 of the 28 patients. Explosive injuries were found in 14 patients and high-velocity missile injuries in nine; associated fractures were present in 20. Twenty of the 28 patients with crural vascular injuries had combined arterial and venous injuries, while eight had isolated arterial injuries. Twenty-five patients with distal ischaemia required arterial repair; five late amputations resulted. Military crural vascular injuries should be treated with soft tissue debridement, removal of foreign material, and microvascular arterial and concomitant vein reconstruction. This should be followed by external skeletal stabilization for bony and/or soft tissue instability, with fasciotomy for any associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric oxygen therapy reduced the amputation rate following combat-related crural vessel injuries.
Comparison between resectable gastric adenocarcinomas seropositive and seronegative for Helicobacter pylori
Authors: Lee W-J , Lin J-T , Shun C-T , Lee W-C , Yu S-C , Lee P-H , Chang K-J , Wei T-C , Chen K-M
Published: March 2007

The preoperative seropositivity of Helicobacter pylori was determined in 128 patients who had undergone gastrectomy for primary gastric adenocarcinoma during the past 5 years. The overall seroprevalence of H. pylori was 64 per cent. Gastric cancers positive for H. pylori were associated with tumours located in the lower third of the stomach which were of localized type (Borrmann I and II) (P < 0.05), but not with age, sex, blood type, tumour size, invasion depth, lymph node metastases, histological type, DNA ploidy or type of surgery. The cumulative 5-year survival curves after surgical resection were significantly better in patients who were positive for H. pylori. Multivariate analysis revealed that seropositivity for H. pylori was not an independent prognostic factor. Pathological tumour node metastasis staging was the only prognostic indicator. Better prognosis for those with H. pylori-seropositive gastric cancer may be attributed to the more advanced stage of H. pylori-seronegative gastric cancers. The potential role of H. pylori in gastric cancer carcinogenesis and its biological significance warrant further investigation.
Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of peritonitis
Authors: Gurtner G C , Robertson C S , Chung S C S , Ling T K W , Ip S M , Li A K C
Published: March 2007

Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteraemia. This study examines the effect of carbon dioxide pneumoperitoneum on bacteraemia, endotoxaemia and physiological correlates of sepsis in an animal model of peritonitis. New Zealand white rabbits were assigned to three groups of six animals. Group 1 received an intraperitoneal inoculation of 109 colony-forming units of Escherichia coli followed by a 10-cm midline laparotomy. Group 2 received an identical bacterial inoculum followed by a 12-mmHg carbon dioxide pneumoperitoneum for 1 h. Group 3 received no bacteria but had a 12-mmHg carbon dioxide pneumoperitoneum for 1 h. Groups 1 and 2 had significantly higher levels of bacteraemia (P < 0.01) and endotoxaemia (P < 0.01) accompanied by significantly lower mean arterial pressures (P < 0.05) and higher heart rates (P < 0.05) compared with group 3. After 6 h groups 1 and 2 were significantly hypocarbic (P < 0.01), leucopenic (P < 0.01) and thrombocytopenic (P < 0.01). There was no difference between group 1 and group 2. A carbon dioxide pneumoperitoneum of 12 mmHg does not increase bacteraemia or endotoxaemia, nor does it adversely affect physiological or laboratory correlates of sepsis compared with laparotomy in this animal model of peritonitis.
Seton treatment of perianal fistula with high anal or rectal opening
Authors: Van Tets W F , Kuijpers J H C
Published: March 2007

Staged fistulotomy with a seton is considered to decrease the high incidence of continence disorders after surgical incision of a fistula. This retrospective study reports the results of the two-stage procedure with special emphasis on faecal continence. Thirty-four patients (aged between 20 and 57 years) were treated between 1981 and 1990 with a two-stage seton procedure for anal fistula (16 extrasphincteric and 18 trans-sphincteric) with a high anal or rectal internal opening. Thirty-one patients had normal preoperative continence. There were two recurrences. All trans-sphincteric fistulas healed. Twenty-nine patients with preoperative normal faecal control were available for follow-up. Postoperative continence was normal in 12 patients (category A according to Browning and Parks classification2): five patients had no control over flatus (B), 11 were incontinent for liquid stool or flatus (C) and one had continued faecal leakage (D). The two-stage seton technique is not recommended for fistulas with high anal or rectal openings.
Effect of low-dose dopamine on sigmoid colonic intramucosal pH in patients undergoing elective abdominal aortic aneurysm repair
Authors: Soong C V , Halliday M I , Hood J M , Rowlands B J , Barros D'Sa A A B
Published: March 2007

The effect of low-dose dopamine administration on intramucosal pH (pHi) of the sigmoid colon and on postoperative function of various organs in patients undergoing elective abdominal aortic aneurysm repair was examined. Nineteen patients were randomized to two groups; nine received dopamine at a rate of 3 μg per kg per min for 24 h from induction of anaesthesia and ten control patients received fluids without dopamine. pHi was measured with a silicone tonometer and daily samples of blood were taken for measurement of liver transaminase activity, arterial oxygen saturation and creatinine concentration. Mean(s.e.m.) pHi fell to a significantly lower minimum value in those receiving dopamine compared with control patients (6.86(0.10) versus 7.11(0.08), P<0.05). Five of the nine patients given dopamine developed intramucosal acidosis compared with only one of the ten control patients (P = 0.06). After operation the mean(s.e.m.) aspartate transminase concentration in patients given dopamine rose from 33(2) to 80(17) units/1 (P<0.01); in control patients it rose from 32(3) to 59(16) units/1 (P = 0.054). No difference between the groups was observed in the postoperative ratio of arterial oxygen saturation to inspired oxygen fraction or creatinine conceritrations. These results indicate that dopamine has no beneficial effect on bowel mucosal oxygenation and function of the various organs in patients undergoing aortic aneurysm repair.
Endoluminal transfemoral abdominal aortic aneurysm repair with aorto-uni-iliac graft and femorofemoral bypass
Authors: Yusuf S W , Baker D M , Hind R E , Chuter T A M , Whitaker S C , Wenham P W , Gregson R H S , Hopkinson B R
Published: March 2007

Endoluminal transfemoral repair of abdominal aortic aneurysm (AAA) is an important development but large aneurysms seldom have a distal neck suitable for the currently available devices for a straight aortoaortic graft1–3. A bifurcated graft system overcomes the limitation of lack of distal neck but it is unsuitable for a significant proportion of aneurysms because of a wide or aneurysmal iliac vessel1. An alternative technique of aorto-uni-iliac graft with occlusion of the contralateral common iliac with embolization and a femorofemoral crossover graft is described.
Effect of postoperative insulin-like growth factor I supplementation on protein metabolism in humans
Authors: Leinsköld T , Permert J , Olaison G , Larsson J
Published: March 2007

Insulin-like growth factor I (IGF-I) has been shown experimentally to exert a nitrogen-sparing effect in both animals and humans. Its effects on protein metabolism during the first 5 days after radical large bowel resection were investigated. Nineteen patients were randomly allocated to receive either human recombinant IGF-I (2 × 80 μ/kg body weight subcutaneously, n = 10) or placebo (n = 9) starting on the morning of the first day after operation. All patients received parenteral nutrition (glucose 3 g and nitrogen 0.1 g/kg/day). The mean(s.e.m.) urinary nitrogen: creatinine ratio was significantly reduced in patients who received IGF-I compared with those given placebo (275.0(17.1) compared with 386.3(23.6), P<0.01). The mean urinary 3-methylhistidine: creatinine ratio and nitrogen balance were lower in the IGF-I group, but not significantly so. Plasma IGF-I concentrations were four times higher in the treated group compared with those in the placebo group. Insulin-like growth factor binding protein 3 (IGFBP-3) increased significantly after the start of IGF-I treatment, compared with mean postoperative levels. The mean blood glucose concentration was significantly lower in the IGF-I group than the placebo group (P < 0.05) but no patient had a hypoglycaemic attack. The authors conclude that IGF-I does not significantly influence the nitrogen balance, but that results indicate a possible nitrogen-sparing effect in patients after major abdominal operations. IGF-I therapy is safe, and may be of value in catabolic patients after serious injury and major operations.
Clinical and surgical aspects of double adenoma in patients with primary hyperparathyroidism
Authors: Bartsch D , Nies C , Hasse C , Willuhn J , Rothmund M
Published: March 2007

The incidence of double parathyroid adenoma in 277 prospectively documented patients suffering from primary hyperparathyroidism was 5.4 per cent (15 patients). Patients with double adenoma were all symptomatic and had a significantly higher parathyroid hormone (PTH) level and tumour weight than those with a solitary adenoma or four-gland hyperplasia. In 11 patients the adenomas were located bilaterally. Bilateral neck exploration must be performed routinely to deal successfully with this condition at initial operation. In six patients one enlarged gland was found in the thymus or posterior mediastinum. These locations should be explored, especially in patients with high PTH levels, in those in whom all four parathyroid glands cannot be detected or if only one small adenoma is found. In all such patients, selective resection of the enlarged parathyroid glands resulted in normocalcaemia (median follow-up 3.5 years). Selective resection of the pathological glands is the treatment of choice.