bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of weight on claudication distance
Authors: Wyatt M G , Scott P M J , Scott D J A , Poskitt K , Baird R N , Horrocks M
Published: March 2007

Conservative measures to improve claudication distance include advice on smoking, exercise, diet and weight reduction. Although the effects of smoking, exercise and diet are established, the effect of weight is less clear. The aim of this study was to investigate the effect of carrying extra weight on the maximum walking distance in stable claudicants. Twenty stable claudicants were exercised on a treadmill (3.5 km/h, 0º slope) carrying 0, 2.5, 5, 7.5 and 10 kg weights in randomized sequence. Maximum claudication distance and ankle: brachial pressure indices were recorded. Patients were categorized into mild or severe claudicants depending on their ability to walk 200 m. A response index (RI) was calculated as the reduction in claudication distance per kilogram load; RI = [CD0 − CD10]/10 m/kg, where CD0 and CD10 represent claudication distance with 0 and 10 kg weights, respectively. Claudication distance was significantly reduced in subjects carrying 5 kg or more (P < 0.01). A linear relationship was demonstrated between the mean claudication distance and the load carried (r = 0.98, P < 0.01) with a mean response index of 10.2 m/kg. The mean(s.e.m.) RI in mild claudicants (25.9(9.5) m/kg) was greater than the value observed in the severe claudicants (3.3(0.8) m/kg; P < 0.01, Mann-Whitney U test). This study demonstrates that weight adversely affects claudication distance and suggests that weight reduction may deserve greater emphasis in the management of some patients with intermittent claudication.
Role of splenectomy as a salvage procedure in thrombotic thrombocytopenic purpura
Authors: Wells A D , Young A E , Majumdar G , Slater N G P
Published: March 2007

Thrombotic thrombocytopenic purpura is a rare but serious haematological disease for which first-line therapy is medical, but not always successful. The role of splenectomy in the management of such patients is unclear. This paper reports three patients with the condition who went into remission following splenectomy after other forms of therapy had failed. Because thrombotic thrombocytopenic purpura is nearly always fatal if a remission is not obtained, splenectomy should be considered in patients who prove to be resistant to medical therapy.
Effects of different lipid emulsions on lymphocyte function during total parenteral nutrition
Authors: Sedman P C , Ramsden C W , Brennan T G , Somers S S , Guillou P J
Published: March 2007

A prospective randomized study of the immunological effects of three total parenteral nutrition (TPN) regimens in patients undergoing preoperative parenteral nutrition was conducted. In one regimen the calories were derived solely from glucose. The others were identical except that 50 per cent of the calories were provided as lipid emulsion, in one as long-chain triglycerides (LCT) only while the other contained half the fat as medium-chain triglycerides (MCT) and half as LCT (MCT/LCT). Natural killer (NK) activity and lymphokine-activated killer (LAK) activity were significantly higher after TPN with the MCT/LCT solution. A significant fall in LAK activity occurred after TPN with the LCT solution. The interleukin 2 content in supernatants from activated T lymphocytes was significantly higher after TPN with the LCT-containing solution. Solutions containing LCT and those containing MCT perturb cytokine interactions, but this is less with MCT-containing solutions, which may augment certain responses. These observations may have implications for the design of TPN regimens.
Relationship between blood transfusion and tumour behaviour
Authors: Francis D M A
Published: March 2007

Blood transfusion results in significant alterations in some parameters of immune function. Because some human cancers appear to stimulate immune responses and may be influenced by host immunity, the possibility arises that transfusion could alter the behaviour of tumours. Experimental studies indicate that allogeneic transfusion can directly alter tumour growth in some circumstances, but at present studies of human cancers do not provide evidence of a causal association between transfusion and tumour growth.
Sphincter injury after anal dilatation demonstrated by anal endosonography
Authors: Speakman C T M , Burnett S J D , Kamm M A , Bartram C I
Published: March 2007

Anal dilatation is still used in the treatment of anal fissure and haemorrhoids. Using anorectal physiology and anal endosonography we have studied 12 men presenting with faecal incontinence following anal dilatation. Resting anal pressures were low, pudendal nerve latencies were normal; 11 men had a disrupted internal anal sphincter and in ten this was extensively fragmented. Three also had defects of the external anal sphincter. These findings demonstrate for the first time the nature of the structural injury which may be caused by anal dilatation.
Lateral ligament division during rectopexy causes constipation but prevents recurrence: Results of a prospective randomized study
Authors: Speakman C T M , Madden M V , Nicholls R J , Kamm M A
Published: March 2007

Denervation of the rectum during rectopexy has been suggested as a reason for postoperative constipation. Bowel symptoms and anorectal function have been examined in a prospective randomized study of rectopexy with (n = 14) or without (n = 12) division of the lateral ligaments. Incontinence improved in both groups of patients. Division of the lateral ligaments increased the number of patients with constipation (three before operation, ten after operation, P<0.01). Mean anal canal pressures were higher after operation in all patients. Rectal electrical sensory threshold increased significantly in those in whom the ligaments had been divided (preoperative 27.6 mA versus postoperative 56.7mA; P<0.01) but not in those in whom they were preserved (39.0 versus 34.9 mA; P>0.05). Prolapse recurred in six patients who did not undergo division of the lateral ligaments, but in none of the group in whom the ligaments were divided.
Prospective audit of an extramucosal technique for intestinal anastomosis
Authors: Carty N J , Keating J , Campbell J , Karanjia N , Heald R J
Published: March 2007

A computerized prospective audit was conducted of 500 intestinal anastomoses constructed in 470 operations on 461 consecutive patients between 1 January 1986 and 16 November 1990. All anastomoses were constructed by an open extramucosal method, emphasizing the avoidance of sutures through mucosa and avoiding the use of intestinal clamps. There were 214 men and 247 women, with a median age of 66 years. Clinical anastomotic leakage was detected from 11 (2.2 per cent) of 500 anastomoses. There were 18 (3.8 per cent) deaths resulting from the 470 operations, but only two (0.4 per cent) were associated with anastomotic leakage, which was not the direct cause of death in either. Peritonitis occurred as a consequence of leakage in two (8 per cent) of 26 resections for Crohn's disease, but the patients survived after reoperation. The single-layer extramucosal technique is probably the safest method available for intestinal suture.
Combined inguinal herniorrhaphy and transurethral prostatectomy
Authors: González-Ojeda A , de La Garza L , Marquina M , Calva J , Mendoza A
Published: March 2007

Between January 1979 and June 1988, 41 men underwent combined inguinal herniorrhaphy and transurethral prostatectomy at the Instituto Nacional de la Nutrición in México. These cases (group 1) were compared retrospectively with 100 consecutive cases of inguinal herniorrhaphy alone (group 2) and 100 consecutive cases of transurethral prostatectomy alone (group 3) during the same period. Group 1 had the highest incidence of preoperative risk factors because of age and associated medical problems. However, there were no significant differences in the rate of operative or postoperative complications between groups. No recurrences of inguinal hernia were recorded in group 1 after a follow-up period of 47.1 months. The length of hospitalization was similar between groups, and no patient died. Our observations suggest that when an inguinal hernia and symptomatic prostatism occur together, combined inguinal herniorrhaphy and transurethral prostatectomy is a practical, safe and effective operative procedure. The advantages of this combined procedure include one anaesthetic period, one operative procedure, one hospital stay and one convalescence with morbidity and mortality rates that are comparable to those of inguinal herniorrhaphy or transurethral prostatectomy alone.
Mechanical lithotripsy of large common bile duct stones using a basket
Authors: Chung S C S , Leong H T , Li A K C , Leung J W C
Published: March 2007

Experience with the Olympus basket mechanical lithotriptor (BML-1Q) in crushing large common bile duct stones before their endoscopic removal is reported. From January 1988 to January 1990, 68 patients with common duct stones too large to be extracted by Dormia baskets or balloon catheters after sphincterotomy were treated with the BML system. The largest stones in each patient ranged from 1.0 to 4.9 cm in diameter. Fifty-seven patients required one session of lithotripsy, ten patients two sessions and one patient three sessions; 26 patients required further endoscopic extraction of stone fragments after successful lithotripsy. The stones were successfully crushed by the BML system and the ducts cleared in 55 patients (81 per cent). In 13 patients mechanical lithotripsy failed because the stones could not be engaged in the lithotriptor basket. In one patient the stone was crushed with the Soehendra lithotriptor, six patients were successfully managed by electrohydraulic lithotripsy through a ‘mother and baby’ endoscope, indwelling stents were inserted in four patients and two patients underwent surgery.
Influence of epidural analgesia upon postoperative fatigue
Authors: Zeiderman M R , Clark R G , Welchew E A
Published: March 2007

This study examined the effect of epidural analgesia on the development of postoperative fatigue and the ability to ambulate after surgery. Seventeen patients admitted for elective abdominal surgery were randomized to receive postoperative analgesia with a continuous infusion of epidural fentanyl (epidural group) or intermittent intramuscular morphine (non-epidural group). Fatigue was assessed on an analogue scale of 1 (fit) to 10 (fatigued). Steady state measurements of respiratory gas exchange, respiratory rate, tidal volume and heart rate were made before operation and repeated on the third postoperative day. Energy expenditure was calculated from Weir's formula. Ambulatory measurements were made during treadmill walking at a work rate of 20 kpm min−1 (3.3 W). At rest, patients in both groups had a similar cardiorespiratory response to surgery irrespective of the method of analgesia. Subjective feelings of fatigue were significantly greater in those patients who had received epidural analgesia (P<0.01) and patients in this group expended significantly more energy in performing the postoperative exercise test than did those in the non-epidural group (P<0.05). The use of epidural opiate analgesia does not limit postoperative fatigue in patients undergoing upper abdominal surgery.
Role of salivary epidermal growth factor in the pathogenesis of Barrett's columnar lined oesophagus
Authors: Gray M R , Donnelly R J , Kingsnorth A N
Published: March 2007

Epidermal growth factor (EGF) is implicated in the regeneration of epithelial cells at the site of inflammation or ulceration in the gastrointestinal tract. Single parotid EGF concentration and production was studied in 64 patients with Barrett's columnar lined oesophagus (CLO), in 22 patients with severe reflux oesophagitis without columnar metaplasia and in 51 normal controls. In control patients, mean salivary EGF concentration was 2790 pg/ml (median 1450 pg/ml; range 450–16 500 pg/ml) and mean single parotid EGF production was 2550 pg/min (median 1750 pg/min; range 790–18000 pg/min). Patients with severe reflux oesophagitis had a similar EGF concentration (mean 3112 pg/ml; median 1500 pg/ml; range 300–16 000 pg/ml) and production (mean 3100 pg/min; median 2200 pg/min; range 790–17950 pg/min) to controls. Patients with CLO had a 62 per cent lower mean EGF concentration (mean 1197 pg/ml; median 640 pg/ml; range 233–4500 pg/ml) (P < 0.001, Mann-Whitney U test) and a 60 per cent lower EGF production (mean 1254 pg/min; median 800 pg/min; range 170–3125 pg/min) (P < 0.001, Mann-Whitney U test) than patients with severe reflux oesophagitis. A subpopulation with malignant change in CLO (n = 16) had a similar EGF concentration and production to the CLO group as a whole (mean 1240 and 1300 pg/min, respectively). Low salivary EGF levels are associated with Barrett's CLO but not with severe oesophagitis without columnar metaplasia. EGF levels do not identify those patients who will subsequently develop malignant change.
24-Hour survival of autotransfused red cells in elective aortic surgery: A comparison of two intra-operative autotransfusion systems
Authors: Kent P , Ashley S , Thorley P J , Shaw A , Parkin A , Kester R C
Published: March 2007

Twelve patients undergoing elective aortic surgery had intraoperative autotransfusion using either the Haemonetics Cell Saver or the Solcotrans device. The 24-h post-transfusion survival of the patients' preoperative red cells, labelled with indium-111, was compared with the survival of salvaged red cells labelled with chromium-51. A correction coefficient for the instability of the indium-111 label was calculated from the study of red cell survival in six healthy volunteers. There was no significant difference in the volume of circulating red cells measured using each isotope, indicating that extensive early destruction of the autotransfused red cells does not occur. The percentage survival of autotransfused red cells at 24 h was similar to that of the red cells that had not undergone salvage. Both devices were comparable with respect to the effects of cell salvage on the 24-h survival rate of autotransfused red cells.
Aggressive arterial reconstruction for critical lower limb ischaemia
Authors: Hickey N C , Thomson I A , Shearman C P , Simms M H
Published: March 2007

A consecutive series of 315 patients underwent arterial reconstruction for 329 critically ischaemic lower limbs over a 5-year period. Patients were not excluded from limb salvage surgery on the basis of poor run-off on preoperative angiography. Femorocrural bypass to a single calf vessel was required in 239 limbs (73 per cent); the 30-day cumulative mortality rate was 7 per cent, rising to 41 per cent at 5 years. Cumulative graft patency at 30 days, 1 year, 2 years and 5 years was 96, 85, 84 and 82 per cent respectively and was independent of the level of reconstruction. In situ long saphenous vein was the conduit of choice for distal bypass but, when this was absent, satisfactory results were obtained with arm vein or composite vein grafts. Acceptable results can be obtained for reconstructive surgery without preoperative angiographic selection of patients. An aggressive approach to limb salvage is therefore justified.
Risk factors for early lower limb loss after embolectomy for acute arterial occlusion: A population-based case-control study
Authors: Ljungman C , Adami H-O , Bergqvist D , Sparen P , Bergström R
Published: March 2007

To identify risk factors for lower limb loss after arterial embolectomy a cohort of 1189 patients was studied. Detailed data were obtained for 165 patients who underwent a major amputation within 30 days of embolectomy and for 165 matched controls. The amputation risk was increased in patients with two or more myocardial infarctions (odds ratio (OR) 3.1, 95 per cent confidence interval (CI) 0.8–11.2), chronic ischaemia (OR 2.1, CI 0.9–4.9), long duration of symptoms (OR 4.3, CI 1.9–9.6, for ⩾25 h versus ⩽6 h) or postoperative heart failure (OR 3.4, CI 1.8–6.5). Reduced risks were found in association with acute myocardial infarction (OR 0.3, CI 0.1–0.9) and postoperative anticoagulation treatment with warfarin (OR 0.3, CI 0.1–0.9). The independent prognostic value of chronic ischaemia and symptom duration, and the beneficial effect of postoperative anticoagulation gained additional support in multivariate analysis. We conclude that the risk of early amputation after arterial embolectomy or thrombectomy can be predicted by several clinical characteristics.
Surgical palliation for pancreatic cancer: developments during the past two decades
Authors: Watanapa P , Williamson R C N
Published: March 2007

Improvements in pancreatic imaging over the past 20 years have revolutionized the preoperative diagnosis and assessment of resectability in patients with suspected pancreatic cancer. This review highlights the resultant trends in the surgical treatment of ductal carcinoma of the pancreas, comparing series reported between 1981 and 1990 with those from the previous decade. Small but worthwhile gains have been achieved both in overall resection rate and in the survival rate from such resections. Nevertheless, 80 per cent or more of afected patients are still unsuitable for resection because of the extent of their disease. Laparotomy retains a crucial role in the management of carcinoma of the pancreatic head, although percutaneous and endoscopic stents provide a useful alternative for palliation of malignant obstructive jaundice in elderly patients or those with carcinomatosis. Operation provides the chance to confirm the nature and full extent of the tumour, to circumvent duodenal obstruction and to abolish pain, besides relieving jaundice without the need for tubes (with their potential to block). By contrast, operative treatment generally has much less to offer in patients with carcinoma of the pancreatic body, unless diagnosis and irresectability remain in doubt. In combination, radiotherapy and 5-fluorouracil may achieve more as adjuncts to palliative surgery than either agent alone. The increasing safety of pancreaticoduodenectomy raises the possibility of palliative resection in younger patients with limited but incurable disease.
Therapeutic perihepatic packing in complex liver trauma
Authors: Krige J E J , Bornman P C , Terblanche J
Published: March 2007

Packing for control of haemorrhage was used in 22 of 294 patients undergoing surgery for liver trauma over a 6-year period. The major indication for packing was transfusion-induced coagulopathy. Sixteen patients had blunt trauma and six penetrating trauma including five gunshot wounds; 19 patients had major right lobe injuries, three left lobe and five also had hepatic vein injuries. Packing provided definitive control of bleeding in 18 patients but four patients had recurrent bleeding due to hepatic artery injury (three) and hepatic vein injury (one); three required further surgery and bleeding was controlled in the fourth by selective hepatic artery embolization. Six patients died and in two of these recurrent bleeding, despite packs, was a contributing factor. Mean blood loss in the six patients who died was 18 (range 10–30) units, compared with 13.1 (range 8–30) units in survivors. Packs were removed from the 16 survivors at laparotomy at a mean of 3.1 days after insertion; six patients rebled during pack extraction and were successfully repacked. Major morbidity occurred in 12 of the 16 survivors. Seven patients developed intra-abdominal sepsis following packing, one of whom died. Therapeutic liver packing provides life-saving control of hepatic bleeding which is frequently aggravated by coagulopathy. This approach permits resuscitation in an intensive care unit and subsequent planned relaparotomy for retrieval of packs and further intervention as necessary.
Effects of fine needle aspiration on subsequent mammograms
Authors: Horobin J M , Matthew B M , Preece P E , Thompson A J
Published: March 2007

The efects of fine needle aspiration on subsequent mammography were studied in a group of women who were referred with palpable breast lumps. Fifty-two women aged between 36 and 73 (median 53) years underwent mammography before and within 5 days of needle aspiration. Preaspiration and postaspiration mammograms were examined ‘blind’ by one radiologist. In ten cases, a diference was seen between the preaspiration and postaspiration films. In seven (aged 36–50 years) this was due to aspirated cysts. In three the diferences were unexpected and were more significant, although the radiological diagnosis was not altered. If this proportion is extrapolated for a large number of patients then significant numbers of artifacts from fine needle aspiration might be seen on mammograms. It is posssible that some might be interpreted falsely as malignant and some small cancers might be obscured. Women accepted mammography more readily before aspiration than after.
Progress in the management of head injury
Authors: Miller J D , Jones P A , Dearden N M , Tocher J L
Published: March 2007

Three 1-year surveys of head injury management spanning a 9-year period in a single regional centre are presented, There was a reduction in total numbers of head injury admissions after guidelines for admission and referral were implemented. More liberal use of computed tomography resulted in detection of a greater number of intracranial haematomas with the majority detected in non-comatose patients. The early mortality rate in severe head injury fell from 45 per cent to 34 per cent despite referral of large numbers of patients with multiple injuries and a substantial proportion (12per cent) of patients aged more than 70 years in whom outcome did not improve. Total occupied bednights and bednights occupied per surviving patient with severe head injury fell over the period of study. Care for patients with significant head injury should be based on regional neurosurgical units associated with trauma services.
Early cardiorespiratory findings after severe blunt thoracic trauma and their relation to outcome
Authors: Rady M Y , Edwards J D , Nightingale P
Published: March 2007

This study examined the initial haemodynamic and oxygen transport patterns in 24 patients with severe blunt thoracic trauma in whom immediate monitoring with femoral and pulmonary artery catheters was required after admission to the intensive care unit. All patients required mechanical ventilation and were studied before receiving inhalational anaesthesia and within 12 h of injury. Two groups of patients were identified; nine patients (group 1) had an impaired left ventricular stroke work index (LVSWI) and 15 patients had a normal LVSWI (group 2). There were no significant diferences in the abbreviated injury scale score for the chest, the total injury severity score, or the mean ages of the two groups. There were significant diferences in stroke volume index, 32 versus 56 ml m −2 (P < 0.001), and cardiac index, 3.2 versus 5.3 l min−1 min−2 (P < 0.001), and therefore in oxygen delivery, 469 versus 852 ml min−1 m−2 (P < 0.001), despite apparently adequate volume expansion using the same protocol and clinical criteria in both groups. Oxygen consumption was not significantly diferent in the two groups, 135 versus 157ml min−1 m−2, because of a higher oxygen extraction ratio in group 1, 29 versus 19 per cent (P < 0.001), and hence lower mixed venous oxygen saturation, 73 versus 82 per cent (P < 0.02). Seven patients in group 1 died (78 per cent) compared with two in group 2 (13 per cent). Early depression of cardiac, function is associated with poor outcome in patients with thoracic trauma, and measurements of oxygen transport variables may influence resuscitation and the timing of surgical procedures.
Effect of transforming growth factor beta and basic fibroblast growth factor on steroid-impaired healing intestinal wounds
Authors: Slavin J , Nash J R , Kingsnorth A N
Published: March 2007

A longitudinal intestinal wound model in the pig was used to assess the effect of parenteral steroids (betamethasone 12 mg 50 kg−1 intramuscularly twice daily) on breaking load. Steroid treatment significantly decreased the breaking load of wounds in the ileum and colon in comparison with wounds from saline-treated animals. In a further group of animals receiving steroids, paired longitudinal wounds were constructed. One wound of a pair was treated with a local application of transforming growth factor beta (TGF-β) (5 μg per wound) or basic fibroblast growth factor (5 μg per wound) in a collagen suspension. The other wound was treated with a collagen suspension alone. Ileal wounds treated with TGF-β were significantly stronger than collagen-treated controls at 7 days. The steroid-induced impairment of breaking load in intestinal wounds is partially reversed by a local application of TGF-β in a collagen suspension at the time of surgery.
Early reoperation after major vascular surgery: a four-year prospective analysis
Authors: Davies A H , Pope I , Collin J , Morris P J
Published: March 2007

Between I January 1985 and 31 December 1988, 1176 major vascular operations were performed on 1040 patients by the Oxford Regional Vascular Service, of which 136 (12 per cent) were reoperations within 30 days of the initial procedure (110 patients). Sixty-seven (49 per cent) of the reoperations were attempted revascularizations, 43 (32 per cent) were amputations, and surgery for bleeding accounted for 18 (13 per cent). Of the first reoperations 71 (65 per cent) were successful, but among the remaining 39 patients, 17 underwent 26 further reoperations, 15 of which were reoperations for revascularization. The 30-day mortality rate for patients undergoing one reoperation was 13 per cent; this rose to 35 per cent if more than one reoperation was performed. Early reoperation after major vascular surgery is common and carries a high operative mortality. This should be borne in mind when obtaining the informed consent of the patient.
Laser-assisted angioplasty for arterial occlusion of the lower limb: initial results and follow-up
Authors: Mitchell D C , Murray A , Wood R F M , Grasty M , Smith R E , Dacie J E , Walters T K , Cotton G
Published: March 2007

A flashlamp-pumped pulsed dye laser operating at either 480 or 504 nm, coupled to an integral ball-tipped optical fibre, was used to recanalize occluded lower limb arteries. All channels created by the laser were augmented with balloon dilafarion. We have treated 78 limbs in 71 patients; 46 limbs (59 per cent) had rest pain and 22 (48 per cent) of these had tissue loss. The median occlusion length was 18 (range 0.5–58) cm. Technical success was achieved in 58 limbs (74 per cent) with clinicalsuccess in 46 (59 per cent). Success rates fell with increasing length of occlusion. Two patients died in the perioperative period. A subgroup of 22 patients with marked discrete arterial calcificarion had a lower technical success rate than the subgroup without calcification (50 per cent versus 84 per cent, P < 0·01). Both subgroups displayed a similar pattern of reclosure during follow-up. The cumulative patency rate after technical success was 67 per cent at 6 months and 45 per cent at 12 months. Forty-six (59 per cent) limbs avoided bypass surgery or amputation. Laser-assisted angioplasty may offer an alternative to femoropapliteal bypass, although the former procedure is not as durable.
Acute colonic pseudo-obstruction
Authors: Dorudi S , Berry A R , Kettlewell M G W
Published: March 2007

The syndrome of acute colonic pseudo-obstruction is well delineated but its aetiology remains poorly understood and patients are still treated inappropriately. This article reviews the pathogenesis and surgical management of this condition. Early diagnosis is stressed as a pivotal factor in reducing morbidity and mortality.
Abdominal rectopexy for rectal prolapse: a comparison of techniques
Authors: Duthie G S , Bartolo D C C
Published: March 2007

To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence inpatients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18–83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex® rectopexy (n = 20), posterior Ivalon® rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper anal sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.
Prognostic factors from computed tomography in acute left colonic diverticulitis
Authors: Ambrosetti P , Robert J , Witzig J A , Mirescu D , de Gautard R , Borst F , Meyer P , Rohner A
Published: March 2007

This prospective study examined factors which may predict a poor outcome (complications and recurrence) after a first attack of diverticulitis which has been successfully managed conservatively. Twenty-four of 107 patients who entered the study had a poor outcome: persistent diverticulitis (nine cases), recurrence (seven cases), colonic stenosis (six cases), residual parasigmoid abscess (one case) and colovesical fistula (one case). Eight of the 18 men aged 50 years or less had a poor outcome compared with 16 of the remaining 89 patients (P = 0.032). Twelve of 76 patients (16 per cent) with mild findings on computed tomography (CT) (localized thickening of colonic wall and inflammation of pericolic fat) had a poor outcome compared with 11 of 23 patients (48 per cent) whose CT was estimated as severe (abscess and/or extraluminal air and/or extraluminal Gastrografin®) (P = 0.004). These results suggest that elective colectomy can be proposed after afirst attack of acute left diverticulitis in men up to 50 years of age and/or in patients whose initial CT reveals findings of severe diverticulitis.
In vitro modulation of haematoporphyrin derivative photodynamic therapy on colorectal carcinoma multicellular spheroids by verapamil
Authors: Purkiss S F , Grahn M F , Turkish M , Macey M G , Williams N S
Published: March 2007

Photodynamic therapy has possible applications in the treatment of colorectal carcinoma. The photosensitizer haematoporphyrin derivative (HpD) is selectively retained by tumours. Agents which block p-glycoprotein, an export protein expressed to increased levels in a high proportion of colorectal carcinomas, may modulate photodynamic therapy by reducing HpD efflux from cells. Multicellular spheroids derived from the colorectal cell lines HRT18 and HT29 were incubated for 24 h with 1 μg ml−1 HpD and 0, 1, 2 and 4 μM verapamil. Bioactivity demonstrated a dose-dependent potentiation of HpD-photodynamic therapy growth retardation. Clonogenic survival of cells disaggregated from spheroids treated with HpD-photodynamic therapy was reduced when spheroids were coincubated with verapamil. The mean(s.e.m.) efflux of HpD from spheroids into fresh medium assessed by fluorimetry was greater in spheroids treated with HpD alone (93.2(18.8) arbitrary units ml−1) than in those treated with verapamil (18.1(2.8) arbitrary units ml−1), P = 0.003. Flow cytometry demonstrated increased HpD fluorescence in cells derived from spheroids coincubated with verapamil over a range of HpD incubation concentrations. Verapamil can potentiate the bioactivity of HpD-photodynamic therapy and HpD may be a substrate for p-glycoprotein.
Ileoanal pouch compliance and motor function
Authors: Levitt M D , Kamm M A , Groom J , Hawley P R , Nicholls R J
Published: March 2007

Measurement of intrapouch pressure during continuous distension with water (pouchmetrography) was performed in ten patients with good pouch function after restorative proctocolectomy and a ‘normal’ baseline pressure curve was constructed from the mean pressures at 50-ml intervals. Eight other patients with poor pouch function were studied and the two groups were compared. Patients with poor function had significantly lower maximum tolerated volumes (297.5 versus 565 ml, P < 0.02) and volumes which caused urgency (135 versus 265 ml, P < 0.02). Baseline pressure curves were above the upper limit of the normal range (mean plus two standard deviations) for a substantial proportion of the recording in six of the patients with poor function. Large, isolated contraction waves were recorded in six of ten patients with good function and in three of those with poor function. Rhythmic waves were frequently seen in both groups but were more prominent in patients with poor function. Pouchmetrography is a provocative test of pouch motor function which may unmask abnormal muscle activity resulting from reduced compliance or a primary motility disorder.
Influence of dietary calcium supplements on ileoanal pouch function and cytokinetics
Authors: Barsoum G H , Winslet M , Youngs D , Neoptolemos J P , Keighley M R B
Published: March 2007

A double-blind cross-over study was undertaken in 16 patients after panproctocolectomy and ileoanal pouch reconstruction to compare supplementary calcium (1.5 g/day) with placebo over 2 months with a 2-week washout period. Stool frequency was recorded and the eflects on pouch mucosal crypt cellular proliferation were determined using an in vitro stathmokinetic technique which measures the crypt cell production rate (CCPR) and an immunohistochemical method using the Ki67 monoclonal antibody for proliferating nuclei. The median (interquartile range) diurnal stool frequency was reduced by calcium (4 (3–5) per day) compared with values obtained before treatment (7 (5–10) per day, P < 0.002) and with placebo (7 (6–9) per day, P = 0.002). Similarly, calcium reduced nocturnal stool frequency (1 (0–1)per night) compared with pretreatment and placebo (both 2 (1–3) per night, P < 0.05) values. Calcium reduced the mean(s.e.m.) CCPR to 1.88(0.41) cells per crypt per hour compared with pretreatment (3.63(0.53), P = 0.01) and placebo (3.24(0.43), P = 0.002) values. Median (interquartile range) Ki67 activity was also reduced by calcium (13.2 (9.7–16.7) per cent), compared with values obtained before treatment (27.3 (14.3–30.2) per cent, P = 0.001) and with placebo (26.0 (17.2–32.0) per cent, P = 0.001). Stool frequency was significantly correlated with the CCPR (diurnal: r = 0.37; nocturnal: r = 0.31, both P < 0.05). Nine patients used antidiarrhoeal medication while receiving placebo compared with four patients receiving calcium (P = 0.032). This study has shown that supplementary oral calcium significantly reduced stool frequency in patients with pouches, a reduction that was associated with reduced cell proliferation. The mechanisms for this eflect are not known.
Congenital duodenal obstruction
Authors: Akhtar J , Guiney E J
Published: March 2007

Over the period 1980–1989, 49 patients with congenital duodenal obstruction due to duodenal atresia, duodenal stenosis or annular pancreas were treated. There were three deaths, all related to associated severe congenital anomalies and none related to surgery for duodenal obstruction; 78 per cent of the patients had associated congenital anomalies which, in some instances, complicated their management. Prenatal diagnosis by ultrasonography was made in 18 per cent of the patients and these patients had operations relatively earlier.
Accurate method to measure the percentage hepatic replacement by tumour and its use in prognosis of patients with advanced colorectal cancer
Authors: Purkiss S F , Williams N S
Published: March 2007

The natural history of patients with colorectal hepatic metastases was studied following resection of the primary tumour. Patients were stratified according to the presence of extrahepatic disease and the percentage hepatic replacement (PHR) measured by planimetry of computed tomographic images. The median(semi-interquartile range (s.i.r.)) PHR of patients without extrahepatic disease was 15.0(10.5) and for those with extrahepatic disease 5.4(2.2) (P < 0.02). The median(s.i.r) PHR of all patients was 8.7(8.5). The median(s.i.r.) survival of all patients was 125(85.5) days, 92(114) days for patients with extrahepatic disease and 175(133.5) days for patients with disease confined to the liver (P < 0.02). A linear correlation between the natural logarithm of PHR and survival was demonstrated (ρ = −0.76, P < 0.001) for patients without extrahepatic disease. Extrahepatic disease in patients with colorectal hepatic metastases is a major determinant of survival; PHR has a direct association when extrahepatic disease is absent.
Repeated hepatic resection for recurrent metastases from colorectal cancer
Authors: Bozzetti F , Bignami P , Montalto F , Doci R , Gennari L
Published: March 2007

Since 1980 120 patients with hepatic metastases from colorectal cancer underwent surgery at the Istituto Nazionale Tumori of Milan. Of these, 34 developed recurrence in the liver only and 11 underwent repeat surgery. The median interval between the two resections was 10 months and operative morbidity and mortality rates were 40 per cent and 9 per cent respectively. Nine patients with adequate follow-up were evaluated and after a median follow-up of 17 months four were alive and disease-free, two were alive with lung metastases and hepatic relapse and three had died. The overall median survival of these patients was 23 months.
Flushing technique in the management of retained common bile duct stones with a T tube in situ
Authors: Soravia C , Meyer P , Mentha G , Ambrosetti P , Rohner A
Published: March 2007

Over a 12-year-period, 6046 cholecystectomies and 918 common bile duct explorations were undertaken with 697 stone-positive choledochotomies (76 per cent). Forty patients (5.7 per cent) had retained common bile duct stones with a T tube in situ. Twenty-eight patients underwent flushing of the common bile duct with a continuous infusion of heparinized saline solution with parenteral aminophylline to induce relaxation of the sphincter of Oddi. Complete duct clearance was achieved in 17 patients; infusion was stopped in four patients and no deaths occurred. The use of percutaneous stone extraction (Burhenne's technique), gave an overall successful common bile duct clearance rate of 86 per cent. The flushing technique represents the first step in the non-operative management of retained common bile duct stones in patients with a T tube in place. It is a safe and efective method for use in the early postoperative period with a prolongation of hospital stay of not more than 1 week.
Pylorus-preserving versus standard pancreaticoduodenectomy: an analysis of 110 pancreatic and periampullary carcinomas
Authors: Roder J D , Stein H J , Hüttl W , Siewert J R
Published: March 2007

Pylorus-preserving pancreaticoduodenectomy (PPPD) has received increasing attention as a physiological alternative to the standurd pancreaticoduodenectomy (PD) in patients with adenocarcinoma of the pancreatic head or the periampullary region. We evaluated mortality, morbidity and survival in 110 patients with pancreatic carcinoma (n = 53) or periampullary carcinoma (n = 57). In each group 31 patients underwent PD, the remainder PPPD. There were no differences in age, sex and tumour stage (UICC 1987) between patients undergoing PPPD or PD. Median follow-up was 24 months. There were no significant differences in mortality and morbidity rates between procedures. The mode of resection had no influence on survival in patients with periampullary carcinoma. Patients with pancreatic carcinoma who underwent PD had a significantly better survival rate compared with those who underwent PPPD (P ≤ 0.05). This was particularly so in patients with stage III tumours (P = 0.007). These data suggest that in patients with ductal carcinoma of the head of the pancreas, PD provides better survival than PPPD. However, PPPD appears to achieve equivalent results to PD in patients with periampullary carcinoma.
Oesophagitis and pH of refluxate: an experimental and clinical study
Authors: Zaninotto G , di Mario F , Costantini M , Baffa R , Germanà B , Dal Santo P L , Rugge M , Bolzan M , Naccarato R , Ancona E
Published: March 2007

This experimental and clinical study examined the relationship between oesophageal damage and optimal pH of refuxate, and whether 24-h pH monitoring at optimal pH could discriminate the severity of oesophagitis. The rabbit oesophagus was perfused in vivo with pepsin and hydrochloric acid solutions of difering pH for 60 min. Maximal oesophageal damage coincided with peptic solutions at pH 1.5–2.5. Fifty-nine patients with proven gastro-oesophageal reflux disorders were tested for manometric features of the lower oesophageal sphincter (Pressure, overall length and abdominal length) and oesophageal exposure to different pH levels. They were classified into four groups according to the endoscopically demonstrated severity of oesophagitis. Supine exposure at the optimal pH level for pepsin activity (pH 1.5–2.5) and overall sphincter length were found to discriminate the severity of oesophagitis reliably in 75 per cent of cases.
Delays in care of the critically injured
Authors: McNicholl B P , Dearden C H
Published: March 2007

Prehospital and resuscitation periods and times to emergency surgery were studied in major trauma victims over two 12-month periods to identify factors causing delay in emergency care. Eighteen patients required emergency surgery in the first group and 13 in the second. The mean presurgery time (i.e. time from arrival in the accident and emergency department to surgery) was 117 min in the first group and 111 min in the second. Causes of delay included a sequential approach to resuscitation and investigation, limited staff and theatre availability, and failure to call the trauma team. Times for resuscitation and times to surgery could be reduced by earlier decision-making, alerting key personnel promptly and performing tasks in parallel.
Long-term changes in muscle free amino acid levels after elective abdominal surgery
Authors: Peterson B , Vinnars E , Waller S-O , Wernerman J
Published: March 2007

Characteristic changes in the pattern of muscle free amino acids are seen on the third day after elective surgery. The time course of the restoration to normal levels in uncomplicated cases has not been established before. Seven metabolically healthy patients undergoing cholecystectomy were studied. Muscle biopsy specimens and plasma samples were taken before operation and on days 3,10,20 and 30 after surgery. The level of total free amino acids in skeletal muscle decreased and the concentrations of branched chain and aromatic amino acids increased on day 3. The original levels were found to be restored on day 10 after surgery. A decrease in glutamine of 38per cent (P < 0·001) was seen on day 3, of 20 per cent (P < 0·05) on day 10 and of 22 per cent (P < 0·05) on day 30, compared with preoperative values. These results constitute a baseline for future studies in which the impact of nutritional and pharmacological therapies is to be evaluated beyond the immediate postoperative period.
Dormant liver metastases: an experimental study
Authors: Panis Y , Ribeiro J , Chrétien Y , Nordlinger B
Published: March 2007

Experimental work was undertaken to evaluate whether intrahepatic recurrences, observed after resection of colorectal liver metastases in humans, could be due to the activation of dormant cancer cells already present within the liver at liver resection. About 250 cell aggregates (DHDK12 colon carcinoma cell line) were injected into the portal vein of 70 BD IX rats. Eight weeks later, 43 rats with no apparent liver metastases were divided randomly into three groups: group 1(n = 15) served as control; group 2(n = 15) were given cyclosporin A(10 mg kg body-weight−1 day−1) for 28 days; and group 3 (n = 13) underwent a 70 per cent hepatectomy. Twelve weeks after the injection of cells, when the animals were killed, 20 per cent of rats in group 1 had liver metastases, 80 per cent in group 2 (P < 0·01) and 62 per cent in group 3(P < 0·05). Undetectable liver micrometastases may have been present at 8 weeks and had not developed until stimulation by cyclosporin A-induced immunosuppression or by liver regeneration after hepatectomy. A similar mechanism may occur clinically and explain some of the recurrences observed after resection of liver metastases.
Partial hepatic resection under intermittent hepatic inflow occlusion in patients with chronic liver disease
Authors: Ezaki T , Seo Y , Tomoda H , Furusawa M , Kanematsu T , Sugimachi K
Published: March 2007

A partial hepatic resection was performed in 13 patients with chronic liver disease using intermittent hepatic inflow occlusion. Eleven patients had liver cirrhosis and two had chronic hepatitis. Seven patients were classified as Child's grade A and six as Child's grade B before operation. Dissection of the hepatic parenchyma was performed during intermittent inflow occlusion. The time of clamping and declamping was 10–20 min and 5–8 min, respectively. Postoperative data on liver function showed recovery to preoperative levels by about 10 days after operation. There were no life-threatening complications. These results indicate that intermittent hepatic inflow occlusion can be achieved easily and safely to allow non-anatomical resection in patients with chronic liver disease.
Polypoid lesions of the gallbladder: diagnosis and indications for surgery
Authors: Yang H L , Sun Y G , Wang Z
Published: March 2007

One hundred and eighty-two patients with an ultrasonographic and/or pathological diagnosis of polypoid lesions of the gallbladder(PLG) were reviewed to determine the reliability of ultrasonography in the diaynosis of PLG and the indications for operation in this disease. Of the 182 patients operated on, PLG were demonstrated by the gross appearance of the resected gallbladder in 172. Histologically benign lesions were present in 159 gallbladders and malignant lesions in 13. Cholesterol polyps accounted for most benign PLG. The sensitivity of ultrasonography in detecting PLG was 90·1 per cent, signijicantly higher than that of oral cholecystography, computed tomography or endoscopic retrograde cholangiopancreatography (P < 0·01). The specificity of ultrasonography in the diagnosis of PLG was 93·9 per cent. Therefore, ultrasonography is a highly sensitive method for investigating PLG, and the preoperative diagnosis of PLG in this unit has now become entirely dependent on this technique. The size and number of PLG, the presence of gallstones and the patient's age all correlate with the nature of PLG, and these features are helpful in differentiating malignant from benign lesions before operation. Surgical treatment is indicated when PLG exceed 1.0 cm in diameter, when PLG are single in number, when PLG are associated with gallstones, when patients with PLG are over the age of 50 years, or when clinical symptoms of PLG are apparent.
Lymph node metastasis from early gastric cancer: endoscopic resection of tumour
Authors: Sano T , Kobori O , Muto T
Published: March 2007

The clinicopathological features of 748 solitary early gastric cancers were examined with regard to lymph node metastasis. Among several factors, only depth of invasion and tumour size correlated significantly with node involvement. Tumours which satisfy the following criteria may not metastasize to lymph nodes: (1) confined to the mucosa; (2) less than 1.5 cm in diameter; (3) macroscopically elevated; (4) macroscopically depressed, without intramural ulcers or ulcer scars (endoscopically, no fold convergence); and (5) histologically differentiated. With a recently developed endoscopic technique small gastric tumours can safely be resected. The cut margin and depth of tumour invasion can be verified histologically in the specimen. If an endoscopically removed tumour satisfies the above criteria, further surgical intervention may be optional as the outcome of endoscopic resection is comparable to that of radical surgery in the absence of node involvement.