bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-loop biliary and gastric bypass for irresectable pancreatic carcinoma
Authors: Watanapa P , Williamson R C N
Published: March 2007

Twenty-five patients with irresectable carcinoma of the pancreatic head received a modified type of palliative bypass in which the transected bile duct and the gastric antrum were anastomosed to the same Roux loop of jejunum. There were 13 women and 12 men with a median age of 54 (range 35–74) years. All but three patients were jaundiced and 11 underwent preoperative biliary decompression. In 18 patients jaundiced at the time of operation, the median preoperative serum bilirubin level was 287 (range 57–804) μmol/l. The median operative time was 4·0 (range 2·5–6·0) h. There were no hospital deaths. Minor postoperative complications occurred in nine patients and the median hospital stay after operation was 13 (range 7–49) days. The median postoperative survival was 4·8 (range 1·5–11·5) months. This operation provides good palliation safely in selected patients with irresectable pancreatic carcinoma.
Individuals with a strong family history of colorectal cancer demonstrate abnormal rectal mucosal proliferation
Authors: Rooney P S , Robinson M H E , Clarke P A , Hardcastle J D , Armitage N C
Published: March 2007

Thirty-seven individuals with an increased lifetime risk of colorectal cancer because of family history and a control group (n = 21) with no such family history underwent colonoscopy. No neoplastic lesion was found in any individual. Rectal biopsies of macroscopically normal mucosa were taken 8 cm from the anal margin and mucosal proliferation assessed by the crypt cell production rate (CCPR). There was no difference in CCPR between the control group (median 10 (95 per cent confidence interval 7–11) cells per crypt per h) and those at intermediate risk (lifetime risk between 1:17 and 1:10, n = 14). However, there was a significant difference in CCPR between the control group and those at higher risk (lifetime risk > 1:10, n = 23) (median CCPR 13 (95 per cent confidence interval 10–17) cells per crypt per h, P = 0·004). A high risk of colorectal cancer derived from family history correlates with an increased colorectal mucosal proliferation rate.
Internal anal sphincter dysfunction in neurogenic faecal incontinence
Authors: Farouk R , Duthie G S , Pryde A , McGregor A B , Bartolo D C C
Published: March 2007

Forty-eight patients of median age 57 years with neurogenic faecal incontinence and 44 normal subjects of median age 51 years underwent fine-wire anal sphincter electromyography and anal manometry. The median (interquartile range (i.q.r.)) internal anal sphincter (IAS) electromyogram frequency was 0·26 (0·21–0·32) Hz for patients with faecal incontinence and 0·44 (0·31–0·55) Hz for controls (P < 0·01). The median (i.q.r.) ambulatory resting pressure was 48 (34–68) cmH2O for patients and 86 (72–102) cmH2O for controls (P < 0·01) and median (i.q.r.) frequency of transient IAS relaxations 9 (7–12) and 4 (3–7) per h respectively (P < 0·05). Mid-anal pressure fell to a greater extent in patients with incontinence during these episodes of transient IAS relaxation. Rectal pressure during such relaxation did not exceed mid-anal canal pressure in controls; for the patient group. rectal pressure increased during relaxation and exceeded mid-anal canal pressure in 36 cases. Frequent abnormal episodes of IAS relaxation may cause occult faecal leakage in patients with neurogenic faecal incontinence.
Intra-abdominal photodynamic therapy: From theory to feasibility
Authors: Evrard S , Aprahamian M , Marescaux J
Published: March 2007

Photodynamic therapy is a new anticancer technique, directed at the selective destruction of neoplastic tissue, which has been used in the treatment of superficial or intraluminal lesions. The technique has now reached the stage where it can be considered in the peroperative management of gastrointestinal tumours, for example in an attempt to eradicate micrometastases in the tissue around the primary tumour or in residual lymph nodes after curative resection. Many practical problems remain to be solved, such as the pharmacokinetics of photosensitizers, the dosimetry of illumination and the sensitivity of intra-abdominal organs. An experimental and clinical evaluation is in progress to assess the feasibility of photodynamic therapy in surgical practice.
High incidence of arteriovenous fistula after biopsy of kidney allografts
Authors: Merkus J W S , Zeebregts C J A M , Hoitsma A J , van Asten W N J C , Koene R A P , Skotnicki S H
Published: March 2007

Arteriovenous fistula (AVF) is a well known but rarely diagnosed complication of percutaneous biopsy of kidney allografts. In the past diagnosis was usually made when clinical signs of an AVF occurred but Doppler ultrasonography has now enabled non-invasive diagnosis. Doppler examination of kidney allografts was performed after 100 biopsies. A total of ten AVFs were diagnosed within 2 weeks of biopsy. On repeated examination 2 months later, no additional fistula was detected. All fistulas were detected by abnormal colour shading of the artery and vein of the fistula caused by high blood velocity. Quantification in the artery supplying the fistula showed a higher systolic velocity compared with that in a normal artery of comparable size and location in the graft (mean (range) 64 (25–150) versus 36 (20–65) cm/s, P <0.05). Diastolic velocity was also higher in the artery supplying the fistula than in a normal artery (mean (range) 34 (9–72) versus 7 (0–13) cm/s, P <0.05). In the group with an AVF the proportion with a prolonged bleeding time (>3 min) was higher (80 versus 47 per cent, P < 0.05), as was the prevalence of a platelet count < 200 × 109/l (60 versus 22 per cent, P < 0.05). After detection of the fistula, four of the grafts were lost because of rejection and two patients died from sepsis during antirejection treatment. During follow-up of the remaining four AVFs three disappeared spontaneously and one persisted. None of the fistulas has had an impact on renal function requiring intervention. In conclusion, AVF is a complication observed frequently after kidney allograft biopsy that can be detected and monitored by Doppler ultrasonography.
Autologous predonation, haemodilution and intraoperative blood salvage in elective abdominal aortic aneurysm repair
Authors: Tulloh B R , Brakespear C P , Bates S C , Adams D C R , Dalton R G , Richards M J , Durkin M A , Bristol J B , Poskitt K R
Published: March 2007

The feasibility of predonated autologous blood transfusion and intraoperative blood salvage in elective abdominal aortic aneurysm repair was studied. Twenty consecutive patients were evaluated, of whom five were excluded according to protocol criteria. Patients each donated 1 unit blood 14 and 7 days before operation. A third unit was withdrawn in the anaesthetic room and replaced with Hartmann's solution, producing a haemodiluted state. Intraoperative losses were minimized using the Haemonetics Cell Saver III Plus autotransfusion system. Predonated blood from two patients passed its expiry date owing to repeated operation postponements, leaving 13 patients for study. The mean(s.d.) intraoperative blood loss was 700(300) ml with a mean(s.d.) intraoperative salvage of 420 (300) ml. Two patients were transfused with bank blood in breach of the protocol and two others were transfused according to clinical need. Thus nine patients safely avoided homologous transfusion. With autologous predonation, haemodilution and intraoperative blood salvage, elective aortic aneurysm repair can be performed safely with minimal need for homologous blood.
Surgical treatment of reflux stricture of the oesophagus
Authors: Bonavina L , Fontebasso V , Bardini R , Baessato M , Peracchia A
Published: March 2007

The choice of surgery in patients with reflux-induced oesophageal stricture remains controversial. From 1976 to 1990, a total of 65 patients underwent fundoplication (36 patients), Collis gastroplasty plus fundoplication (ten), total duodenal diversion (four) and oesophageal resection (15). The postoperative mortality rate was 5 per cent (three patients): necrosis of the colon transplant in two patients and acute pancreatitis in one. The median follow-up was 25 (range 6–120) months. After conservative surgery, the median number of dilatations per patient per year significantly decreased (P <0.001). Nine patients (25 per cent) complained of persistent or recurrent symptoms after standard fundoplication and six required reoperation. Clinical results were satisfactory in patients who underwent Collis fundoplication, total duodenal diversion and oesophageal resection. It is concluded that the causes of failed fundoplication are irreversible stricture or persistent gastro-oesophageal reflux; the latter may be caused by inefficacy or deterioration of the partial fundoplication wrap. A subtle degree of oesophageal shortening is probably underestimated in such patients and this may explain the better results obtained with the Collis fundoplication. Total duodenal diversion is a good therapeutic option in patients who have undergone previous oesophagogastric surgery. Oesophageal resection should be reserved for patients with tight strictures unresponsive to dilatation or those with scleroderma, multiple previous operations or severe dysplasia in Barrett's oesophagus.
Monofilament versus multifilament absorbable sutures for abdominal closure
Authors: Sahlin S , Ahlberg J , Granström L , Ljungström K-G
Published: March 2007

This study compares monofilament continuous absorbable sutures with multifilament interrupted absorbable sutures for abdominal closure. Before closure of an abdominal ineision, 988 patients were randomized to receive either a monofilament polyglyconate (Maxon) or a multifilament polyglactin 910 (Vicryl) suture. At 1 year after operation, 684 patients (69 per cent) were examined for the presence of incisional hernia, sinus and other wound-healing problems; 179 (18 per cent) had died and 125 (13 per cent) did not attend for follow-up. Incisional hernia occurred in 8 per cent of patients receiving monofilament continuous sutures compared with 6 per cent of those having multifilament interrupted closure (P not significant). Wound dehiscence occurred in 1 per cent of both groups. The mean time for suturing was 7.1 min for monofilament continuous and 8.7 min for multifilament interrupted sutures (P <0.001). It is concluded that closure of an abdominal incision can be effected by a monofilament continuous absorbable suture more quickly than by multifilament interrupted absorbable sutures without an increased risk of wound dehiscence or incisional hernia.
Early gastric cancer: Follow-up after gastrectomy in 159 patients
Authors: Guadagni S , Reed P I , Johnston B J , De Bernardinis G , Catarci M , Valenti M , Di Orio2 F , Carboni M
Published: March 2007

The postoperative course of 159 patients with early gastric cancer operated on between 1974 and 1987 was followed for a median of 7.3 years. The cumulative 10-year survival rate(s.e.) calculated using follow-up data to the end of 1989 was 90.6(2.7) per cent excluding operative death and that from causes other than gastric cancer, or 86.3(3.0) per cent when operative mortality was included. The overall 10-year survival rate(s.e.) was 77.3(3.7) per cent. Univariate analysis showed a significant difference in survival rates between cancers confined to the mucosa and those with submucosal invasion (P = 0.02), between patients with and without lymph node metastases (P = 0.05) and between those >50 and >50 years of age (P = 0.02). Using Cox multivariate analysis and a stepwise procedure for eight variables (sex, age, depth of invasion, lymph node metastases, presence of ulceration, location, histological type, type of surgery), age and histological type had the most significant effect on survival. Seven operative deaths were recorded. Eleven patients died from recurrent cancer and one is still alive with a gastric remnant recurrence. Other causes of death were metachronous primary cancer (six patients), cardiovascular disease (two), pneumonia (three), sepsis (one) and car accident (one). Although the prognosis of early gastric cancer is relatively good in western countries, patients should be carefully followed over a long period for late recurrence and for metachronous cancer, which has a high incidence.
Photoplethysmography in the diagnosis of superficial venous valvular incompetence
Authors: Rutgers P H , Kitslaar P J E H M , Ermers E J M
Published: March 2007

Photoplethysmography was compared with clinical investigation combined with Doppler ultrasonography in the diagnosis of superficial venous valvular incompetence of the lower limb. In 268 consecutive patients, 536 limbs were investigated. A total of 22.I per cent of the photoplethysmographic investigations were uninterpretable because they did not allow reliable determination of the refilling time. Agreement between clinical investigation combined with Doppler ultrasonography and photoplethysmography was found to be poor (K = 0.30). These results suggest that photoplethysmography is not the non-invasive method of choice for routine evaluation of superficial venous valvuular incompetence of the leg.
Cardiac risk and peripheral vascular surgery: New approach based on a multifactorial risk index
Authors: Jivegård L , Frid I , Haljamäe H , Hallenberg B , Holm J , Johansson S R
Published: March 2007

An inexpensive approach to stratification of patients admitted for arterial surgery into groups of high and low cardiac risk has been prospectively evaluated in 235 consecutive patients. The Goldman and Detsky indices, assessed by a nurse the day before surgery, both identified patient groups with increased risk of lethal or potentially lethal (myocardial infarction, pulmonary oedema) cardiac events within 30 days after peripheral vascular surgery. The Goldman index was the more sensitive predictor of cardiac death (overall frequency 3.1 per cent) while the Detsky index was superior for prediction of non-lethal cardiac events (overall frequency 5.9 per cent). The simplest and yet most effective stratification into high and low cardiac risk was achieved using a Detsky score of 10 as the cut-off. It is concluded that multifactorial risk index-based preoperative screening can identify low-risk patients (Detsky score ⩽ 10), who may be accepted for vascular surgery (aortic aneurysm surgery excluded) without additional cardiac testing.
Effect of seeding time and density on endothelial cell attachment to damaged vascular surfaces
Authors: Thompson M M , Budd J S , Eady S L , Allen K E , James M , James R F L , Bell P R F
Published: March 2007

An in vitro model to facilitate the study of endothelial cell seeding of damaged vascular surfaces has been developed. This may have applications in the study of endothelial seeding of angioplasty and endarterectomy sites. Using this model, the optimum endothelial seeding time for attachment to damaged vascular surfaces should not exceed 30 min and, to achieve confluent cell attachment, a seeding density >5 × 105 cells/cm2 should be used.
Long-term results of treatment of peptic stricture of the oesophagus with the Angelchik prosthesis
Authors: Wyllie J H , Baker S R , Hakhamaneshi D , Soo K S , Edwards D A W
Published: March 2007

An Angelchik prosthesis was inserted in 43 patients with a peptic stricture above a hiatus hernia; 16 showed columnar lining of the oesophagus below the stricture. The mean preoperative bore of strictures was 8.7 mm. Within months, and without dilatation, 33 strictures shortened, 35 widened and of these 13 disappeared with a mean bore of 11.7 mm. In the long term, three more strictures resolved but three recurred. Final measurements gave a mean bore of 12.2 mm. The mean follow-up was 3.5 years. Symptomatic and radiological assessments suggested that the prosthesis was less effective when sited in the chest.
Sphincter rupture in childbirth
Authors: Sørensen M , Tetzschner T , Rasmussen O Ø , Bjarnesen J , Christiansen J
Published: March 2007

Thirty-eight women with rupture of the anal sphincter occurring during childbirth were followed for 3–12 months. Nineteen had complete rupture of the external and sphincter, 14 had a lesion involving more than half of the sphincter muscle and five had a superficial rupture. Fourteen patients presented with continence disturbances: nine to solid or liquid faeces and five to flatus. Incontinence was present in nine women 3 months after childbirth. Anal manometry and electromyography were performed in patients 3–5 days after delivery and repeated at 3,6 and 12 months. Manometry and electromyography were also performed in 16 control subjects who were nulliparous or had given birth more than 2 years previously and 24 primiparous controls, who were investigated at 3–5 days and at 3 months. There were significant differences between both incontinent and continent patients compared with nulliparous and primiparous controls. Primiparous control subjects had decreased anal squeeze pressure as well as decreased electromyographic activity on the first days after delivery compared with nulliparous controls. After 3 months no differences were found. Continence disturbances are frequent after sphincter rupture; these patients should be monitored after delivery and those with persisting incontinence offered sphincter repair.
Expression of p53 in colorectal cancer and dysplasia complicating ulcerative colitis
Authors: Taylor H W , Boyle M , Smith S C , Bustin S , Williams N S
Published: March 2007

An immunohistochemical method using Pab 1801, a monoclonal antibody specific to the human p53 protein, was applied to detect p53 expression in colorectal cancer and dysplasia complicating ulcerative colitis. Of 20 tissue samples with dysplasia, six showed positive immunoreactivity. Archival paraffin-embedded tissue blocks from 21 colitic cancers were analysed; 11 showed positive immunoreactivity, compared with ten of 21 samples from matched sporadic colorectal cancers (P not significant). Previous data suggesting that colorectal carcinoma complicating ulcerative colitis has a reduced frequency of c-Ki-ras mutation compared with sporadic cancer have led to the hypothesis that different genetic lesions underlie colitic and sporadic colorectal carcinoma. The present results suggest that this is not the case with regard to p53 gene alterations.
New technique to measure mucosal metabolism and its use to map substrate utilization in the healthy human large bowel
Authors: Chapman M A S , Grahn M F , Giamundo P , O'Connell P R , Onwu D , Hutton M , Maudsley J , Norton B , Rogers J , Williams N S
Published: March 2007

A new method of assessing substrate utilization in gastrointestinal mucosal specimens is described. Small human endoscopic biopsy specimens with wet weights ranging between 1.4 and 12.2 mg were used to quantify the oxidation of three metabolic substrates, glucose, glutamine and butyrate, through to carbon dioxide over a 2-h period. The technique proved to be reproducible and capable of distinguishing variations in mucosal metabolism between individuals (P < 0.0001 for each substrate). Results were similar to those obtained previously using human and rat colonocytes. To characterize the metabolism of the healthy large bowel, specimens were obtained from five regions in 15 patients who had a normal colonoscopic examination. The results show that butyrate is the preferred fuel source of large bowel mucosa, followed by glutamine, then glucose (P < 0.01). There was no significant regional variation in utilization of the three substrates between the five regions; with respect to glutamine, this is contrary to previous findings.
Abdominal aortic aneurysm: Still missing the message
Authors: Craig S R , Wilson R G , Walker A J , Murie J A
Published: March 2007

Over a 7-month period 50 patients presented to the vascular unit with a ruptured or acute symptomatic abdominal aortic aneurysm (AAA). Information regarding the 24 months before acute presentation was obtained from the patient, family doctor and relevant case records to determine whether an asymptomatic aneurysm had previously been diagnosed but the patient not referred to the vascular service, or whether the patient had undergone an examination at which an aneurysm might reasonably have been expected to be diagnosed. Thirteen patients (26 per cent) had previously had an AAA diagnosed but only five had been referred. Thirteen patients (26 per cent) had had a total of 16 inpatient hospital admissions without an asymptomatic aneurysm being diagnosed. Six patients (12 per cent) underwent abdominal examination for an unrelated complaint by the family doctor without an asymptomatic aneurysm being diagnosed. A significant impact on overall mortality from aortic aneurysm may be made by increasing the number of patients undergoing elective aneurysm repair. All doctors should assess aortic diameter in all patients over 50 years of age who undergo abdominal examination for whatever reason. All patients diagnosed as having an asymptomatic AAA should be referred to a vascular surgeon for assessment.
Role of reflux oesophagitis and acid in the development of columnar epithelium in the rat oesophagus
Authors: Seto Y , Kobori O
Published: March 2007

The role of reflux oesophagitis and acid in the development of oesophageal columnar epithelium was investigated in the rat. Twenty-four animals underwent total gastrectomy and oesophagojejunostomy, inducing reflux of duodenal contents into the oesophagus, and were divided into two groups: an ‘acid’ group, which drank syrup water with hydrochloric acid (pH 1.8), and a ‘non-acid’ group, which drank only syrup water (pH 6.5). Four rats were killed at 4, 8 and 12 weeks after surgery. Reflux oesophagitis was found in the lower portion of the oesophagus in all cases. Columnar epithelium was observed in the oesophagus of one rat in the non-acid group at week 8 and of three in the acid group at week 12. These results indicate that the development of columnar epithelium of the oesophagus is preceded by reflux oesophagitis and that acidic conditions may promote this change. Columnar epithelialization may result from metaplasia of squamous epithelium as well as from upward extension of columnar epithelium.
Norwegian multicentre study of survival and prognostic factors in patients undergoing curative resection for gastric carcinoma
Authors:   Members of The Norwegian Stomach Cancer Trial, Haugstvedt T K , Viste A , Eide G E , Söreide O
Published: March 2007

The influence of clinical and tumour-related variables on long-term survival in patients with gastric carcinoma was studied in a national prospective multicentre study. A total of 532 patients underwent curative surgery with a 5-year survival rate of 40 per cent. In a Cox multivariate analysis, age, stage of disease and macroscopic appearance of tumour were the only factors that independently affected survival. The estimated probability of survival to 5 years for a 50-year-old patient with a flattened tumour type and stage I disease was 71 per cent, but 50 per cent for an 80-year-old with the same tumour type and stage. For stage II disease the rates were 56 and 32 per cent, for stage III 39 and 13 per cent and for stage IV 19 and 3 per cent, respectively. A 70-year-old patient with stage II linitis plastica tumour type had an estimated probability of 5-year survival of 20 per cent. Stage of disease was the single most important factor in determining survival. Laurén histopathological type and location of tumour, Karnofsky performance index, weight loss and type of resection had no significant effect on long-term survival.
Obesity: An important prognostic factor in acute pancreatitis
Authors: Funnell I C , Bornman P C , Weakley S P , Terblanche J , Marks I N
Published: March 2007

Ninety-nine patients with acute pancreatitis in whom body mass index (BMI = weight (kg)/height2 (m2)) was measured were studied prospectively to determine the importance of obesity as a prognostic factor in this disease. Of 19 obese patients (BMI ⩾ 30 kg/m2), 12 developed severe pancreatitis; seven had abscesses, of whom five died, and two further patients died. In 80 non-obese patients, the incidence of severe pancreatitis (n = 5), abscess formation (n = 4) and death (n = 4) was significantly less (P = 0.0007). The mean(s.d.) BMI of 17 patients with severe acute pancreatitis was significantly higher than that in 82 patients with mild acute disease (31.2(5.6) versus 23.3(5.6) kg/m2, P < 0.001). As a single prognostic factor, obesity had a sensitivity of 63 per cent and a specificity of 95 per cent for predicting disease severity. When five obese women with gallstone pancreatitis were excluded, the sensitivity of obesity increased to 86 per cent. Severe pancreatitis occurred in all eight obese patients with disease of an alcoholic aetiology. These data suggest that increased fat deposits in the peripancreatic and retroperitoneal spaces in obese patients may increase the risk of peripancreatic fat necrosis, abscess and death. Consideration should be given to including obesity as a prognostic factor in acute pancreatitis.
Changes in liver blood flow associated with the growth of hepatic LV10 and MC28 sarcomas in rats
Authors: Hemingway D M , Cooke T G , Grime S J , Jenkins S A
Published: March 2007

Abnormalities in liver blood flow are known to occur in patients and animals with overt hepatic tumour. This study investigated the changes in liver blood flow associated with the development of overt hepatic tumour in two different models. Hepatic tumour was induced by intraportal inoculation of either 300 LV10 sarcoma cells or 105 MC28 sarcoma cells in rats. Liver blood flow and hepatic haemodynamics were measured 3 weeks later when overt liver tumour was present. The hepatic perfusion index (HPI), the ratio of hepatic arterial to total liver blood flow, was raised and portal venous inflow reduced in rats with LV10 tumours, but not in those with MC28 lesions. Hepatic arterial flow was unchanged in LV10 tumours when the HPI was raised and neither model demonstrated arteriosystemic or portosystemic shunting. The changes in portal venous inflow were associated with a significant increase in portal and splanchnic vascular resistance. These studies suggest that liver blood flow changes in the presence of overt hepatic tumour are not related to portal venous obstruction but may be caused by a circulating splanchnic vasoconstrictor.
Oral calcium inhibits rectal epithelial proliferation in familial adenomatous polyposis
Authors: Thomas M G , Thomson J P S , Williamson R C N
Published: March 2007

Calcium reduces colorectal cell turnover and might therefore protect against neoplasia. The inhibitory effects of dietary calcium were tested in a double-blind controlled trial in patients with familial adenomatous polyposis who had undergone previous abdominal colectomy and ileorectal anastomosis. Patients received supplemental calcium carbonate (1500 mg/day) or placebo tablets for 6 months; sigmoidoscopy was performed before and after treatment. Rectal biopsies were maintained in short-term organ culture, and crypt cell production rate (CCPR) was measured stathmokinetically. A total of 25 patients completed the trial; polyp counts were obtained before and after treatment in all and CCPR values in 16. Calcium treatment reduced the mean(s.e.m.) CCPR from 4.72(0.48) to 2.42(0.48) cells per crypt per h (P < 0.05), while values for placebo were unchanged (5.46(1.21) versus 5.08(1.17) cells per crypt per h). Calcium had no demonstrable effect on the number, size or distribution of rectal polyps. The ability of oral calcium supplementation to suppress rectal epithelial proliferation supports its potential to prevent development of colorectal carcinoma in high-risk individuals.
Carcinoid tumours of the appendix in children 1957–1986: Incidence, treatment and outcome
Authors: Parkes S E , Muir K R , Al Sheyyab M , Cameron A H , Pincott J R , Raafat F , Mann J R
Published: March 2007

Forty carcinoid tumours of the appendix were identified in children under 15 years of age between 1957 and 1986 from the records of the West Midlands Regional Children's Tumour Research Group. A significant excess of girls was observed (P = 0.02). All tumours were discovered incidentally and two patients underwent further surgery. Twenty-two of the 29 confirmed locations (76 per cent) were at the tip of the appendix and 34 of the 40 tumours (85 per cent) had invaded beyond the appendiceal submucosa. The reported incidence rate of 1.14 per million children per year remained constant throughout the study period. No recurrences, metastases or deaths from tumour were detected. Appendicectomy alone is confirmed as usually curative, although right hemicolectomy is occasionally necessary. Caution during routine appendicectomy is recommended to avoid possible tumour damage, as is consistent histological examination of all appendices in the paediatric age group. The importance of long-term follow-up is emphasized.
Anal endosonography and correlation with in vitro and in vivo anatomy
Authors: Sultan A H , Nicholls R J , Kammt M A , Hudson C N , Beynon J , Bartram C I
Published: March 2007

The endosonographic anatomy of the anal sphincters was studied by in vivo and in vitro correlation with anatomical dissection. Fourteen fresh anorectal specimens (eight abdominoperineal resection, six post mortem) were scanned in a water-bath with sequential dissection and correlation with the ultrasonographic images. Accurate anatomical identification of the layers during dissection was confirmed histologically. Anal endosonography was performed during operation in 12 patients to validate the in vitro findings. The in vivo study confirmed the in vitro results. Basic endosonographic anatomy has been clarified and inaccuracies in the previous description of the longitudinal muscle and external anal sphincter corrected.
Laparoscopic cholecystectomy
Authors: Macintyre I M C , Wilson R G
Published: March 2007

After laparoscopic cholecystectomy, the patient can expect a hospital stay of < 2 days and a return to work within 2 weeks. The associated operative mortality rate is low at < 0.2 per cent. The increased incidence of bile duct injury with the laparoscopic technique compared with open cholecystectomy is a cause for concern but such injuries should decrease with proper training in laparoscopic surgery. The use of operative cholangiography (whether routine, selective or never) is controversial but there is no evidence that routine cholangiography will prevent major bile duct injury.
Modern management of pancreatic pseudocysts
Authors: Grace P A , Williamson R C N
Published: March 2007

Pseudocysts may develop as a complication of acute pancreatitis, chronic pancreatitis or pancreatic trauma. As new methods of imaging provide fuller information on their incidence and natural history, important differences are emerging between the pseudocysts of acute and chronic pancreatitis. Traditional surgical approaches to the management of pseudocyst are now being challenged by endoscopic techniques and interventional radiology. In the light of these developments the options available are reviewed and strategies for the modern management of pancreatic pseudocysts are suggested.
Peripheral arterial thrombolysis: Intermediate-term results
Authors: Lonsdale R J , Whitaker S C , Berridge D C , Earnshaw J J , Gregson R H S , Wenham P W , Hopkinson B R , Makin G S
Published: March 2007

To determine the intermediate-term results of intra-arterial thrombolysis, 127 consecutive patients receiving 129 courses of treatment were reviewed at a median follow-up of 3 years. At initial review, 30 days after treatment, thrombolysis was successful in 63 cases (49 per cent). Of these patients, 16 were lost to follow-up: 15 died without further vascular symptoms and one moved from the area. Some 35 patients were alive and asymptomatic, of whom 33 had either angiographic or clinical evidence of continued arterial patency. Symptomatic reocclusion occurred in 12 cases; a further two patients remained asymptomatic and reocclusion was detected at follow-up. Two of the 12 symptomatic patients required amputation. Estimated patency rates were 80 per cent at 1 year, 72 per cent at 2 years and 70 per cent at 3 years. The intermediate-term results in the 66 cases in which lysis was unsuccessful were worse, only 16 patients (24 per cent) surviving to follow-up with the treated limb intact. It is concluded that, if thrombolysis is successful at 30 days, the intermediate-term results are good.
Long-term circulatory access via a peripheral implantable port
Authors: Carey P C , Mann D V , Pearce S Z , Windsor A C J , Pullyblank A M , Guillou P J , Monson J R T
Published: March 2007

The use of a novel indwelling central venous catheter system is described which combines the safety of peripheral venous catheter placement with a novel electromagnetic locator device for guidance of the catheter tip into the correct position. This locator system obviates the need for radiological screening or chest radiography for checking catheter placement. Fifty-one patients were studied prospectively and all were successfully cannulated. An infection rate of 0.29 per 1000 catheter-days was seen with a mean system life of 220 (range 15–510) days. The new port has a lower infection rate than other commonly used systems and eliminates complications such as pneumothorax and puncture of major arteries.
Results of a prospective randomized trial of the Angelchik prosthesis and of a consecutive series of 119 patients
Authors: Eyre-Brook I A , Codling B W , Gear M W L
Published: March 2007

The results of a randomized multicentre trial comparing the Angelchik prosthesis with floppy Nissen fundoplication for gastro-oesophageal reflux were assessed 4–6 years after surgery. Of the original 52 patients 48 were traced. A good or excellent result (Visick grade 1 or 2) was obtained in 21 of 25 after insertion of the Angelchik prosthesis compared with 18 of 23 after fundoplication. Poor results were due to recurrent heartburn after fundoplication and to dysphagia after prosthesis insertion. In a separate consecutive series of 119 patients receiving Angelchik prostheses, results were good or excellent in 101 (85 per cent) and poor in 18 (15 per cent). Control of reflux with a correctly positioned prosthesis was good. Troublesome dysphagia (Visick grade 3 or 4) was experienced in eight of the 119 patients. There was no mortality and no incidence of splenectomy or gas-bloat syndrome.
Perineural invasion of carcinoma of the pancreas and biliary tract
Authors: Nagakawa T , Mori K , Nakano T , Kadoya M , Kobayashi H , Akiyama T , Kayahara M , Ohta T , Ueno K , Higashino Y , Konishi I , Miyazaki I
Published: March 2007

Carcinoma of the pancreatobiliary system often produces perineural invasion extending to extrabiliary and extrapancreatic sites. A surgical technique has been developed to manage this invasion and has been used since 1974. Serial sections were prepared from 90 resected specimens and examined for perineural involvement of intramural and extramural biliary plexuses as well as the pancreatic nerve plexus. Perineural invasion was seen in 34 of 40 patients with carcinoma of the common bile duct, in ten of 14 with cancer of the gallbladder and in four of 15 with carcinoma of the papilla of Vater. Invasion extended to the extramural biliary or pancreatic nerve plexuses in 24 of 40 patients with carcinoma of the bile duct. Involvement of the intrapancreatic nerves was seen in all 21 patients with carcinoma of the pancreatic head and that of the pancreatic nerve plexus in 17 of 21. Perineural invasion was often found at the most progressive margin of the tumour. The survival rate of patients with perineural invasion was low compared with that of those without such invasion, although survival of patients with perineural invasion tended to be longer after extensive resection. The perineural space should be regarded as an important route for the spread of pancreatic and biliary carcinoma.
Temporary loop ileostomy for restorative proctocolectomy
Authors: Senapati A , Nicholls R J , Ritchie J K , Tibbs C J , Hawley P R
Published: March 2007

The aim of a defunctioning ileotomy after restorative proctocolectomy is to mitigate the consequences of pelvic sepsis, should it occur. However, there are complications related to the ileostomy itself. Of 310 patients (174 male and 136 female; mean age 33.2 years) who underwent restorative proctocolectomy between 1976 and 1990, 296 had a covering ileostomy and 14 did not. The stoma has been closed in 263 (88.9 per cent) at a median interval from formation of 12.0 weeks. Ileostomy-related complications before closure occurred in 17 patients (5.7 per cent). Laparotomy for obstruction due to the ileostomy was required in seven patients (2.4 per cent). Retraction requiring revision occurred in three patients (1.0 per cent), an abscess behind the stoma in one (0.3 per cent) and miscellaneous appliance problems in seven (2.4 per cent). Following closure, 59 patients overall (22.4 per cent) developed an ileostomy-related complication. There were 30 cases of small bowel obstruction, treated conservatively in 19 (7.2 per cent) and by laparotomy in 11 (4.2 per cent). Peritonitis requiring laparotomy occurred in three patients (1.1 per cent) and two (0.8 per cent) developed an enterocutaneous fistula. There were 14 (5.3 per cent) wound infections and 16 (6.1 per cent) other miscellaneous problems. Significant complications associated with a temporary ileostomy were less frequent in this series than in some other reports. Obstruction was the most common complication and fistula was rare.
Possible role of the autonomic nervous system in sphincter impairment after restorative proctocolectomy
Authors: Hallgren T , Fasth S , Delbro D , Nordgren S , Öresland T , Hultén L
Published: March 2007

Peroperative manometry was performed in 12 patients operated on with endoanal proctectomy and a hand-sewn pouch-anal anastomosis and in 12 in whom proctectomy was performed entirely from above, with the ileal pouch stapled to the top of the anal canal. Results from both groups showed that division of the superior rectal artery reduced the median (95 per cent confidence interval (c.i.)) resting anal pressure from 77.5 (69.9–83.3) mmHg to 64.5 (55.2–70.0) mmHg (P < 0.01). Complete rectal mobilization to the pelvic floor decreased resting pressure by an additional 22 per cent, to a median of 50.0 (95 per cent c.i. 40.1–53.5) mmHg (P < 0.01). After completion of anastomosis, irrespective of the operative technique used, a further decline in median pressure to 35.0 (95 per cent c.i. 26.0–47.7) mmHg could be demonstrated (P < 0.05). This study indicates that anal sphincter pressure is reduced to a similar extent after hand-sewn and stapled anastomoses. Injury to the autonomic nervous supply to the anal sphincter mechanism might be the major cause for this reduction.
Oestrogen and progesterone receptors in colorectal cancer and human colonic cancer cell lines
Authors: Hendrickse C W , Jones C E , Donovan I A , Neoptolemos J P , Baker P R
Published: March 2007

Receptors for oestrogen (ER) and progesterone (PR) were assayed in tissue from 17 patients with colorectal cancer and five colonic cancer cell lines using enzyme immunoassays. ERs and PRs were detected in 15 and 17 cancers respectively, although the levels detected were low: median (range) ER 1.3 (0–11.3) and PR 3.9 (0.3–10.2) fmol per mg protein. These values were not significantly different from median (range) levels of ER (1.1 (0.6–3.0) fmol/mg) and PR (1.9 (0.5–3.2) fmol/mg) detected in normal mucosa. There were significant positive correlations between the levels of ER and PR for cancer tissue (τ = 0.56, P < 0.005; r(log transform) = 0.68, P < 0.003; n = 17) but not for mucosa, and between levels of ER in cancer tissue and mucosa (τ = 0.55, P < 0.05; r(log transform) = 0.70, P < 0.025; n = 10) but not between the corresponding PR values. In maintenance media, which contained phenol red and unstripped fetal calf serum, the median (range) concentration of ER was 1.9 (1.2–10.4) fmol/mg and that for PR 24.3 (9.1–63.2) fmol/mg in the five cell lines studied (HT-29, LS174T, SW620, Lo Vo, COLO 320DM). The addition of oestradiol (10 nmol/l) to phenol red-free medium containing 5 per cent dextran-coated charcoal-treated fetal calf serum had little effect on the concentration of ERs or PRs in SW620, LoVo and COLO 320DM cells after 7 days' culture. It is concluded that ERs and PRs are expressed in malignant and normal colonic mucosa. ERs appear to be a feature of the colonic mucosa rather than the malignant process, but in carcinoma may regulate synthesis of PRs, suggesting a degree of oestrogen responsiveness.
Prophylaxis of postoperative thromboembolism with low molecular weight heparins
Authors: Jørgensen L N , Wille-Jørgensen P , Hauch O
Published: March 2007

To evaluate the thromboprophylactic use of low molecular weight heparins (LMWHs), publications from 27 orthopaedic trials and 35 studies of patients undergoing general or gynaecological surgery were scrutinized and subjected to a partial meta-analysis. In orthopaedic surgery, LMWHs were superior to placebo or dextran and at least as efficient as unfractionated heparin in the prevention of deep vein thrombosis (DVT). Compared with unfractionated heparin, one of the LMWH preparations signficantly reduced the total incidence of DVT. The rate of non-fatal pulmonary embolism was 0.49 per cent in patients receiving LMWH and 1.22 per cent in controls. Seven orthopaedic patients (0.15 per cent) died from pulmonary embolism, none of whom received LMWH. In general surgery, the LMWHs were at least as efficient as unfractionated heparin, with a trend towards a lower risk of pulmonary embolism with the former. Compared with unfractionated heparin, LMWHs did not reduce the postoperative mortality rate, nor did they cause haemorrhage. LMWHs provide safe and efficient prophylaxis by administration once daily.
Proximal gastric vagotomy and anterior seromyotomy with posterior truncal vagotomy assessed by the endoscopic congo red test
Authors: Chisholm E M , Raimes S A , Leong H T , Chung S C S , Li A K C
Published: March 2007

The completeness of vagotomy following proximal gastric vagotomy or anterior seromyotomy with posterior truncal vagotomy was assessed prospectively in 48 patients using the intraoperative congo red test. Pentagastrin (6 μg/kg) was given subcutaneously before the assessment. An endoscope was passed into the stomach and 180 ml congo red solution washed over the gastric mucosa. Continuing acid production was indicated by the appearance of a black colour (pH < 3) 2 min after introduction of the dye. A grading system was adopted where grades I and II showed little black discoloration and grades III and IV showed increasing areas of discoloration indicating that further denervation was required. All 20 patients undergoing anterior seromyotomy with posterior vagotomy were classified as grade I. Fifteen of an initial 23 patients receiving proximal gastric vagotomy were grade III or IV. Following division of either the right gastroepiploic nerve or the posterior vagal trunk, 22 patients improved to grade I (16) or II (six). In the subsequent five proximal vagotomies, modification of the dissection produced grade I results. Anterior seromyotomy with posterior truncal vagotomy gave consistenly complete vagotomy. The congo red test highlighted major differences in the adequacy of vagotomy achieved using various dissection techniques during proximal gastric vagotomy. The test is a useful, reproducible and simple intraoperative method for assessing the completeness of denervation.
Vitamin C status in patients with acute pancreatitis
Authors: Scott P , Bruce C , Schofield D , Shiel N , Braganza J M , McCloy R F
Published: March 2007

Vitamin C is a key antioxidant in human blood plasma and hence could influence the outcome of conditions such as acute pancreatitis in which oxidative stress apparently plays a pivotal role. The concentrations of vitamin C and its immediately bioavailable form, ascorbic acid, in fasting plasma samples from 30 healthy volunteers were compared with those in admission samples from 29 consecutive patients with acute pancreatitis and 27 patients with other acute abdominal crises. Median (range) levels of vitamin C and ascorbic acid, respectively, were 15 (6·3-19) and 12 (4·5-18) μg/ml in the control group, 2·8 (0·3-10) and < 0·5 (< 0·5-6·0) μg/ml in patients with acute pancreatitis, and 3·7 (0·6-15) and 2·3 (< 0·5-15) μg/ml in those with other acute abdominal problems. Admission plasma samples showed equally low vitamin C levels in both groups of patients (P < 0·001 versus controls), but those from patients with acute pancreatitis were further characterized by a disproportionate reduction in ascorbic acid, such that the concentration of ascorbic acid and its ratio to vitamin C were both significantly lower than in samples from patients with an acute abdomen (P < 0·005 and P < 0·001 respectively). It is concluded that the stress of an acute intra-abdominal crisis is accompanied by a non-specific decrease in the plasma level of vitamin C. In acute pancreatitis early and profound oxidative stress compounds this problem by denaturing the available vitamin. There may be a case for the judicious parenteral administration of ascorbic acid to patients with acute pancreatitis to boost plasma antioxidant defence.
Effect of suture material on tumour cell adherence at sites of colonic injury
Authors: Reinbach D , McGregor J R , O'Dwyer P J
Published: March 2007

In an experimental animal model, radiolabelled viable intraperitoneal adenocarcinoma cells adhered in similar numbers to normal rat colon and that injured by a 1-cm colotomy, with median cell counts of 7002 and 8602 respectively (P not significant). Repair of the colotomy with interrupted silk resulted in a significant increase in the median number of cells adhering to the injury site (21888; P = 0.0001 versus normal colon). Repair with Prolene had no effect on tumour cell adherence (a median of 7449 cells adhered; P not significant versus normal colon). Tumour cell adherence at sites of colonic injury is dependent on the suture material used and not on the injury itself in this model. This may be important when choosing suture type for anastomosis in patients undergoing surgery for colorectal cancer.
Increased risk of colorectal cancer associated with congenital anomalies of the urinary tract
Authors: Atwell J D , Taylor I , Cruddas M
Published: March 2007

Two young mothers of children presenting with congenital anomalies of the urinary tract underwent colectomy for carcinoma or adenomatosis of the colon. In another family with urinary anomalies, the maternal grandmother had died from carcinoma of the colon at 36 years of age. This previously unreported association led to two reviews. In the first, of 14 patients with colorectal cancer presenting under 45 years of age, three had known congenital urinary tract anomalies. In the second, which included the first three families, a detailed family history was obtained from children receiving treatment for congenital anomalies of the urinary tract. Seven of 116 grandparents and two mothers among 58 parents had colorectal carcinoma or adenomatosis of the colon; this was significantly greater than the expected incidence. A family history of congenital anomalies of the urinary tract may be a useful marker in screening for colorectal cancer.
Randomized trial comparing three forms of pelvic floor repair for neuropathic faecal incontinence
Authors: Deen K I , Oya M , Ortiz J , Keighley M R B
Published: March 2007

A randomized controlled trial in women with neuropathic faecal incontinence compared total pelvic floor repair (n = 12) with anterior levatorplasty and sphincter plication alone (n = 12) and postanal repair alone (n = 12). Review at 6 and 24 months indicated that results were significantly better for total pelvic floor repair than either of the other procedures. Comlete continence was achieved in eight of the 12 patients 2 years after total pelvic floor repair. Only total repair significantly elongated the anal canal. Both total pelvic floor repair and anterior levatorplasty improved sensation in the upper anal canal.