bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopy, ultrasound and computed tomography in cancer of the oesophagus and gastric cardia: A prospective comparison for detecting intra-abdominal metastases
Authors: Watt I , Stewart I , Anderson D , Bell G , Anderson J R
Published: March 2007

We have evaluated the sensitivity, specificity and accuracy of laparoscopy under general anaesthesia, ultrasound and computed tomography (CT) in detecting intra-abdominal metastases in 90 consecutive patients with carcinoma of the oesophagus or cardia. Metastases were histologically confirmed as hepatic in 25 patients, nodal in 35 and peritoneal in nine. All investigations had high specificity (86–100 per cent) for each type of metastasis. Laparoscopy was found to be significantly more sensitive (P<0.01; P<0.02) and more accurate (P<0.01; P<0.01) than either ultrasound or CT, respectively, with regard to hepatic status. Although laparoscopy performed best with regard to nodal metastases, this reached statistical significance only when sensitivity of ultrasound was compared (P<0.01). Neither ultrasound nor CT detected any peritoneal metastases, although laparoscopy detected eight out of nine, giving a sensitivity of 89 per cent and an accuracy of 98 per cent. There was no morbidity or mortality associated with laparoscopy, which offers a safe, reliable method of determining intra-abdominal status and may obviate the need for surgery in some patients with malignant dysphagia.
Resectability of large focal liver lesions
Authors: Baer H U , Gertsch Ph , Matthews J B , Schweizer W , Triller J , Zimmermann A , Blumgart L H
Published: March 2007

Despite modern imaging techniques evaluation of the resectability of large focal liver lesions is often difficult or impossible until the time of operation. Based on experience with 54 primary or secondary focal liver tumours, a simple morphological classification has been found to be reasonably predictive of resectability. All tumours were classified before operation using computed tomography, ultrasound and angiography; 38 patients underwent laparotomy. Dependent, ‘hanging’ tumours (n = 7) were resected in six cases, expansively growing ‘pushing’ tumours (n = 19) were resected in 18 cases, and infiltrating, ‘invasive’ tumours (n = 17) were not resected because of involvement with major vascular structures. Eleven small tumours (<5 cm) were not classifiable by this system. This simple classification may be a useful clinical concept in preoperative assessment of resectability of focal liver lesions. Hanging tumours should always be resected, and large expansile tumours are generally resectable despite their size. Invasive tumours can only be resected in exceptional cases.
Bile leaks after simple cholecystectomy
Authors: Rayter Z , Tonge C , Bennett C E , Robinson P S , Thomas M H
Published: March 2007

Drains after cholecystectomy are used commonly to avoid biliary leaks and subsequent peritonitis. Thirty-five patients who had had cholecystectomy without drainage underwent 99mTc-labelled dimethyl-phenylcarbamoylmethyliminodiacetic acid (HIDA) and ultrasound scans the morning after surgery. Biliary leaks detected by positive HIDA scans occurred in 11 patients. Subhepatic fluid collections were seen on 20 ultrasound scans. There was no relation between biliary leaks and subhepatic collections. Many of the collections were not seen on the HIDA scan, suggesting that they contained blood and not bile. Many of the patients with bile leaks showed no fluid collection. Clinical complications were few and evenly distributed between those with positive and negative scans. We conclude that bile leaks are not an occasional event but occur after 31 per cent of undrained cholecystectomies and that these bile leaks remain clinically unimportant.
Critical assessment of the quality of continence after postanal repair for faecal incontinence
Authors: Yoshioka K , Keighley M R B
Published: March 2007

One hundred and twenty-four patients had a postanal repair for the treatment of faecal incontinence between January 1976 and July 1987. One hundred and sixteen of these patients have been followed up for more than 1 year with a median follow-up of 5 years. Incontinence was improved in 81 per cent of patients. Furthermore, bowel frequency fell: 58 per cent had more than four bowel movements before operation compared with 19 per cent after operation. However, 60 per cent of patients still claimed urgency, 76 per cent still leaked faeces and 52 per cent continued to wear pads after the operation. Maximum resting anal pressure and maximum squeeze pressure did not change significantly after operation either in patients whose bowel control was improved or in those who were not. The results indicate that the quality of continence after postanal repair is poor.
Gastrointestinal malignancy: Rationale for adjuvant therapy using early postoperative intraperitoneal chemotherapy
Authors: Cunliffe W J , Sugarbaker P H
Published: March 2007

The treatment of gastrointestinal cancer and the prognosis of patients with this disease have changed very little over the past several decades. No screening tools have been developed which allow this disease to be surgically treated for cure at an early stage. None of the forms of adjuvant chemotherapy instituted in the months and years after surgical resection of cancer have been successful. We show that resection site recurrence and spread of disease on the peritoneal surfaces are the most common sites for surgical treatment failure. By changing the route of administration and the timing of chemotherapy, the efficacy of drugs now routinely employed in gastrointestinal cancer can be markedly improved. Our early studies suggest that there is a definite change in the natural history of these malignancies when intraperitoneal chemotherapy is administered immediately after surgery. The pharmacology and physiology of drug delivery in the immediate postoperative period are explored. Toxicity studies have been performed in a series of treatment protocols already in use. These protocols need to be subjected to randomized controlled trials in the near future.
Abdominal pain: a surgical audit of 1190 emergency admissions
Authors: Irvin T T
Published: March 2007

In an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non-specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17-per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10–29 years (31 per cent) and 60–79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20–29 years). Fifty-one deaths resulted in a 30-day hospital mortality rate of 4·4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged ≥60 years, and patients aged 80–89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), perforated peptic ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and perforated ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and perforated peptic ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients suffering from NSAP.
Surgical treatment of chronic pancreatic cholangiopathy
Authors: Pereira-Lima L , Kalil A N , Wilson T J
Published: March 2007

In a consecutive surgical series of 70 patients with chronic calcifying pancreatitis, 18 presented with fixed stenosis of the terminal common bile duct. Nine patients presented with jaundice and two had a palpable gallbladder. The most relevant laboratory datum in the series was a persistently high serum alkaline phosphatase level. Long tapering of the terminal common bile duct was the characteristic radiological sign in 45 of our patients. In five of the 18 cases compression of the terminal bile duct was due to cephalic pseudocysts. Hepaticojejunostomy-en-Y was the type of drainage chosen in 16 cases, and an end-to-side technique was used in 15 patients. Side-to-side choledochoduodenostomy was performed in two cases. In 14 patients, biliary drainage was associated with other surgical procedures on the pancreatic parenchyma. No postoperative complications due to the biliary drainage occurred in this series.
Acute pancreatitis after renal transplantation
Authors: Fernández-Cruz L , Targarona E M , Cugat E , Alcaraz A , Oppenheimer F
Published: March 2007

Post-transplantation pancreatitis is an infrequent complication with a high risk of mortality. In a 7-year period, there were five patients who had documented pancreatitis out of a total of 488 renal homograft recipients, an incidence of 1 per cent. Two cases occurred in patients with an orthotopic transplant, one of them as a result of surgical injury of the pancreas and the other as a consequence of cytomegalovirus infection. The third case was an acute pancreatitis of hypercalcaemic origin, the fourth patient developed postoperative pancreatitis and acute acalculous cholecystitis, and the fifth had acute pancreatitis and sepsis associated with cytomegalovirus infection. Three patients died as a direct result of the complication. The mean incidence and mean mortality rate of post-transplantation pancreatitis, as determined from our review of the literature of the last 15 years, are 2·3 and 61·3 per cent, respectively; these are similar to the figures found up to 1970 of 1·7 and 52·2 per cent. A multiplicity of factors present in the uraemic patient may be responsible for the continued frequency of post-transplant pancreatitis despite advances in surgical technique and immunosuppressive therapy.
Mirizzi syndrome and cholecystobiliary fistula: A unifying classification
Authors: Csendes A , Diaz J Carlos , Burdiles P , Maluenda F , Nava O
Published: March 2007

A new classification of patients with Mirizzi syndrome and cholecystobiliary fistula is presented. Type I lesions are those with external compression of the common bile duct. In type II lesions a cholecystobiliary fistula is present with erosion of less than one-third of the circumference of the bile duct. In type III lesions the fistula involves up to two-thirds of the duct circumference and in type IV lesions there is complete destruction of the bile duct. A total of 219 patients were identified with these lesions from 17 395 patients with benign biliary tract diseases undergoing surgery. The incidence of type I lesions was 11 per cent, type II 41 per cent, type III 44 per cent and type IV 4 per cent. The majority had obstructive jaundice. In type I lesions. cholecystectomy plus choledochostomy is effective. In type II lesions, suture of the fistula with absorbable material or choledochoplasty with the remnant of gallbladder can be performed. In type III lesions suture is not indicated and choledochoplasty is recommended. In type IV lesions, bilioenteric anastomosis is preferred. Operative mortality rate increases according to the severity of the lesion, as does postoperative morbidity. During cholecystectomy, partial resection is recommended in order to extract the stones, visualize the common bile duct and define the type and location of the fistula. T tubes should be placed distal to the fistula.
Wound sepsis following Ramstedt pyloromyotomy
Authors: Rao N , Youngson G G
Published: March 2007

Wound sepsis is common following pyloromyotomy in children and in a retrospective study of 178 cases the incidence of wound infection was 21 (11·8 per cent). On preliminary analysis, three variables were associated with wound sepsis: age, duration of projectile vomiting and surgical technique. Only surgical technique was found to be statistically significant on sequential multivariate analysis. Mass closure with polydioxanone was associated with a 1 per cent (one of 70) wound sepsis rate. Wound sepsis after pyloromyotomy is dependent on technique, and mass closure with polydioxanone is recommended. The routine use of tension sutures should be abandoned.
Peptic pyloric stenosis treated by endoscopic balloon dilatation
Authors: Griffin S M , Chung S C S , Leung J W C , Li A K C
Published: March 2007

Twenty-five patients with proven gastric outlet obstruction secondary to peptic ulcer disease were treated by endoscopic balloon dilatation using ‘through the scope’ balloons. The stricture could not be negotiated in one patient. Two patients continued to have gastric outlet obstruction despite the dilatation and required surgery. Two patients have returned up to 11 weeks after treatment with signs of recurrent gastric outlet obstruction. Twenty patients (80 percent) remained asymptomatic (follow-up: median 9 months, range 2–24 months).
Detection of lymph node metastases in colorectal carcinoma before and after fat clearance
Authors: Scott K W M , Grace R H
Published: March 2007

One hundred and three colorectal carcinoma specimens were examined to determine the value of the xylene and alcohol fat clearance technique in detecting lymph node metastases. The mesocolon or mesorectum was dissected initially by the traditional method and all the lymph nodes identified were examined histologically. After fat clearance the specimen was dissected again and further lymph nodes were examined. Forty-one specimens were obtained from the rectum and 62 from the colon. Traditional dissection produced a mean of 6·2 lymph nodes per specimen, but following fat clearance a further mean of 12·4 nodes per specimen were found. The total number of lymph nodes recovered varied from two to 69 with a mean of 18·5 per specimen. Traditional dissection showed 45 specimens (43·7 per cent) to have lymph node metastases but after fat clearance a further five specimens (4·8 per cent) were found to be lymph node positive. Therefore, of the 58 specimens graded initially as Dukes' B, five (8·6 per cent) were shown after fat clearance to be Dukes' C tumours. In the Dukes' C cases the mean (s.d.) number of involved lymph nodes per specimen was 2·7 (2·1) by traditional dissection and 4·2 (3·9) after fat clearance. Forty-seven (94·0 per cent) of the Dukes' C tumours were correctly identified after examination of specimens containing up to 13 lymph nodes. Fat clearance of the mesocolon or mesorectum should be used when traditional dissection has failed to identify at least 13 nodes and the tumour has been classified as Dukes' B.
Function after ileal pouch and stapled pouch-anal anastomosis for ulcerative colitis
Authors: Williams N S , Marzouk D E M M , Hallan R I , Waldron D J
Published: March 2007

Fourteen patients with ulcerative colitis underwent formation of an S ileal pouch and construction of a stapled pouch-anal anastomosis by a modified technique, which eliminated the use of purse-string sutures. Eleven have had their covering ileostomies closed. Anal manometry performed before and a median of 9 months after ileostomy closure showed significant impairment of internal anal sphincter function. Night evacuation was significantly reduced in the stapled group compared with a similar group of patients who had undergone S ileal pouch formation, mucosal proctectomy and manual transanal anastomosis, but this was the only parameter of function to show a difference. A stapled pouch-anal anastomosis may be superior to the conventional procedure but it still may lead to internal anal sphincter damage which cannot be due to mucosectomy or prolonged anal retraction.
Predicting local recurrence of carcinoma of the rectum after preoperative radiotherapy and surgery
Authors: Jones D J , Zaloudik J , James R D , Haboubi N , Moore M , Schofield P F
Published: March 2007

A prospective study of prognostic factors has been carried out in a group of 186 patients with tethered rectal carcinomas. Of these, 97 were randomized to surgery alone and 89 to receive preoperative radiotherapy (20 Gy in four fractions). DNA ploidy was determined by flow cytometry. DNA aneuploidy was detected in 60 patients (62 per cent) in the surgery only group, but in only 33 patients (37 per cent) after radiotherapy (P0·01). There was a significant reduction in local recurrence in irradiated patients (P<0·0001). DNA diploid tumours were less likely to recur locally: This was more marked in the radiotherapy group (P = 0·01) than in the surgery only group (P = 0·06). After radiotherapy, only the surgeons' assessments of a ‘curative’ resection and DNA ploidy were independent predictors of local recurrence in multivariate regression analysis, whilst Dukes' classification was not. In conclusion, DNA ploidy may indicate response to radiotherapy and is an important predictor of subsequent local tumour progression.
Endoluminal ultrasound for early detection of local recurrence of rectal cancer
Authors: Mascagni D , Corbellini L , Urciuoli P , Di Matteo G
Published: March 2007

The diagnostic potential of endoluminal (endorectal and endovaginal) ultrasound to detect asymptomatic resectable local recurrence after rectal cancer surgery has been assessed in 120 patients: 17 recurrences (14 per cent) were detected. The method showed 97 per cent accuracy, 94 per cent sensitivity and 98 per cent specificity; the positive predictive value was 85 per cent and the negative predictive value was 99 per cent. A longer follow-up is, however, necessary to confirm these results. Of the 17 patients with local recurrence, six were asymptomatic and underwent reoperative surgery. Of the other 11 patients with symptomatic recurrence, only two underwent reoperative surgery.
Medullary carcinoma of the thyroid: management of persistent hypercalcitonaemia utilizing [99mTc] (v) dimercaptosuccinic acid scintigraphy
Authors: Udelsman R , Mojiminiyi O A , Soper N D W , Shepstone B J , Dudley N E
Published: March 2007

Whole body scintigraphy with [99mTc](v)dimercaptosuccinic acid (pentavalent DMSA) was performed in seven patients with histologically confirmed medullary carcinoma of the thyroid (MCT). Six of these patients had undergone previous thyroid resections for MCT and, although asymptomatic at the time of pentavalent DMSA scintigraphy, had persistent and serial elevations in their plasma calcitonin levels. One additional patient was scanned before and after total thyroidectomy for MCT. The pentavalent DMSA scintigram demonstrated either local neck recurrence (three patients) or distant metastases (two patients) in five of the six asymptomatic patients. In one asymptomatic patient only equivocal neck uptake was demonstrated. Since he had only minimal calcitonin elevations, repeat neck exploration was not performed. The one patient studied before thyroid resection for MCT demonstrated neck uptake before, but not after, total thyroidectomy. The results of the scintigrams had significant impact on patient care and resulted in neck re-exploration (three patients), neck biopsy (one patient), and lumbar spine biopsy and subsequent radiotherapy (one patient). These data demonstrate pentavalent DMSA to be a sensitive localizing agent in the evaluation of asymptomatic MCT patients with hypercalcitonaemia. Accurate targeting of treatment may be shown in due course to have a beneficial impact on survival.
Surgical management of acute pancreatitis
Authors: Poston G J , Williamson R C N
Published: March 2007

This review examines the lack of improvement in terms of mortality and outcome in patients with acute pancreatitis. Energetic fluid replacement is the only treatment of proven value. There is a strong case for identification of patients with severe disease who may benefit from early operative intervention. Eradication of gallstones may prevent further attacks in patients with gallstone pancreatitis. The benefits of pancreatic resection and necrosectomy still require full evaluation.
Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver
Authors: Pichlmayr R , Grosse H , Hauss J , Gubernatis G , Lamesch P , Bretschneider H J
Published: March 2007

The clinical experience with 11 patients undergoing ex situ operation of the liver (nine operations) or surgery on an in situ hypothermic perfused liver after vascular isolation (three operations) is described. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection would not have been sufficiently radical. In one patient the ex situ approach avoided the need to undertake liver grafting for a benign tumour. To date, hepatocellular tumours and metastases not compromising global hepatic function or causing cholestasis are considered to be suitable conditions; cholestasis appears to be highly detrimental for the postoperative course after an ex situ procedure. Elaboration of methods for better grading of pre-existing liver damage and of its prognostic significance is essential. The assessment of the final therapeutic value of the described procedure requires further experience.
Endoscopic sphincterotomy in hepatic hydatid disease open to the biliary tree
Authors: Vignote M L , Miño G , de la Mata M , de Diosand J F , Gomez F
Published: March 2007

Communication with the biliary tree is the most common complication of hydatid disease of the liver and up to a few years ago surgery was the only way to treat it successfully. The introduction of endoscopic sphincterotomy represented a great advance in the management of this disease. We report the results obtained with this technique in ten patients after surgical treatment of hepatic hydatid disease open to the biliary tree. The results were satisfactory in all cases, with no morbidity or mortality. Endoscopic sphincterotomy is now the first choice treatment for surgical complications of hepatic hydatid disease open to the biliary tree, as well as the drainage procedure of choice in patients with cholangitis due to hydatid disease.
Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication
Authors: Mughal M M , Bancewicz J , Marples M
Published: March 2007

A prospective study of the value of preoperative oesophageal manometry in selecting patients for gastro-oesophageal reflux surgery has been performed. One hundred and twenty-six consecutive patients had a floppy Nissen fundoplication with a median follow-up period of 48 months (range 21–96 months). Reflux was controlled in 116 patients (92·1 per cent). One hundred and jive patients (83·3per cent) had a clinically satisfactory result (Visick grades 1 and 2). Poor results were largely due to recurrent reflux, technical failure or the irritable bowel syndrome. An unsatisfactory result was not more likely in those with upright reflux, an oesophageal motility disorder or a competent cardia as defined by manometry. Preoperative oesophageal studies, other than those required to make an accurate diagnosis, were found to have no value in deciding the suitability of patients for surgical correction of gastro-oesophageal reflux.
Total gastrectomy and oesophagojejunostomy – a prospective randomized trial of hand-sutured versus mechanically stapled anastomoses
Authors: Seufert R M , Schmidt-Matthiesen A , Beyer A
Published: March 2007

Eighty patients undergoing total gastrectomy for malignant disease were entered into a prospective randomized study, comparing anastomoses constructed mechanically (staples) with hand-sewn (single layer Maxon®) anastomoses. The groups were matched with respect to clinical features, medical risk factors and were staged for tumour. Only one anastomotic leak was observed after operation and this was in the group of stapled anastomoses. One patient died in each group (owing to cardiac infarction and multiorgan failure). Operating time, morbidity and hospital stay showed no significant differences between groups. These results indicate that hand-sewn and mechanically stapled oesophagojejunostomy anastomoses allow the same high standard of performance.
Early and late results of extended surgery for cancer of the stomach
Authors: Bozzetti F , Regalia E , Bonfanti G , Doci R , Ballarini D , Gennari L
Published: March 2007

The experience of the Istituto Nazionale Tumori of Milan of 143 patients who underwent extended surgery for cancer of the stomach from 1965 to 1980 is reviewed. They represent 16·3 per cent of the patients who underwent curative surgery. The operative mortality rate was 15·4 per cent but this significantly decreased in recent years to 8per cent and the morbidity rate to 17·5 percent. The overall 5-year survival rate was 19 per cent. Survival was analysed according to tumour penetration (pT) and nodal status (N). It was found that patients without tumour penetration of adjacent structures and nodal involvement (pT3N−) had a better 5-year survival rate (21 per cent) than patients with nodal involvement (pT3N+) (2 per cent). Patients with tumour penetration of adjacent structures and without nodal involvement (pT4N−) had a better 5-year survival rate (29 per cent) than patients with nodal involvement (pT4N+) (5 per cent). These differences were significant on log rank test (P < 0·000001 and P < 0·001 respectively) and suggest that nodal status is a stronger prognostic variable than pT level. The role of extended surgery is discussed from the viewpoint of the oncological surgeon who has to weigh up the difficulty of a preoperative diagnosis of tumour infiltration of adjacent structures (predictive positive value 0·39), with the operative mortality rate of at least 8per cent and long-term results which are strongly affected by the nodal status.
Comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty: Results at 8–15 years
Authors: Koruth N M , Dua K S , Brunt P W , Matheson N A
Published: March 2007

In 1983 we reported the early results (mean 5 years) of a prospective randomized comparison of highly selective vagotomy (HSV) with truncal vagotomy and pyloroplasty (TVP) where all 137 operations were performed by the same surgeon. HSV was significantly better than TVP in terms of Visick grading and side-effects. The same patients were assessed at a mean of 12 years (range 8–15 years) after operation. There was no difference on assessment using Visick grading between TVP (59 patients) and HSV (57 patients) (grades I and II, 75per cent in each case). However, 20per cent of TVP patients (but none of the HSV patients) had undergone reoperation in the intervening period. The endoscopically proven recurrence rate was 7per cent after TVP and 5per cent after HSV. This long-term follow-up supports the optimism that HSV is a better operation than TVP in the elective treatment of duodenal ulcer.
Simple closure of perforated duodenal ulcer: A prospective evaluation of a conservative management policy
Authors: Bornman P C , Theodorou N A , Jeffery P C , Marks I N , Essel H P , Wright J P , Terblanche J
Published: March 2007

One hundred and thirteen consecutive patients admitted with a perforated duodenal ulcer over a 5-year period (1978–82) and treated by simple closure have been followed prospectively over a median period of 43 months. Patients were divided into two categories according to their previous history of dyspepsia; group 1 (66 patients) with a chronic history of more than 3 months and group 2 (47 patients) where there was no history of dyspepsia or a history of less than 3 months duration. The follow-up periods were similar (group 1, 44 months; group 2, 43 months). The overall recurrence rate was 42per cent and to date only 14per cent of the total group of 113 patients have required a definitive operation. The incidence of ulcer recurrence was higher in group 1 than in group 2 in terms of total recurrence (group 1, 50per cent; group 2, 32per cent) and patients requiring further surgery (group 1, n = 14, 21 per cent; group 2, n = 7, 75per cent). Five of these 21 patients required an emergency procedure for haemorrhage or reperforation (group 1, n = 2; group 2, n = 3). There were no significant differences between the 5-year predictive recurrence rate or the requirement for definitive surgery between the groups. Five of the 27 patients currently on medical treatment have required maintenance treatment while the remaining patients receive active treatment for a mean of 20 per cent of the time since they developed recurrent ulceration. These results support continuation of our ‘wait and see’ policy following simple closure of perforated duodenal ulcer, even in patients with a history of chronic dyspepsia.
Vertical Silastic ring gastroplasty: A 6-year experience
Authors: Ismail T , Kirby R M , Crowson M C , Baddeley R M
Published: March 2007

Vertical Silastic® ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48per cent and 65per cent respectively. Subsequently the weight stabilized around this level with 58per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7per cent) failed to lose weight. Sixteen patients (23per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.
Pancreatic exocrine function after a sutureless pancreaticojejunostomy following pancreaticoduodenectomy
Authors: Hall R I , Rhodes M , Isabel-Martinez L , Kelleher J , Venables C W
Published: March 2007

Exocrine pancreatic function was measured in 14 patients after pancreaticoduodenectomy for periampullary neoplasms in order to assess the patency of a sutureless pancreatico-enteric anastomosis. Pancreatic function was examined by the p-aminobenzoic acid/p-aminosalicylic acid (PABA/PAS) test 3–160 months after operation and compared with age- and sex-matched controls. There were no significant differences between mean (s.e.m.) serum PABA concentrations 3 h after ingestion of N-benzoyl-l-tyrosyl-PABA (25·5 (3·6)) μmol/l for patients, 26·1 (2·0 (μmol/l for controls)). However, the mean (s.e.m.) PABA excretion index was significantly lower in the patients (0·58 (0·08)) than in the controls (0·76 (0·04)). Four patients required pancreatic enzyme supplements for control of diarrhoea. Self-limiting pancreatic leaks occurred in two patients. The results suggest that the sutureless pancreatico-enteric anastomosis has an acceptably low leakage rate but that pancreatic exocrine function is diminished following pancreaticoduodenectomy with this technique. However, the majority of patients require no enzyme supplements and no significant tendency to late stenosis of the anastomosis was demonstrated.
Evaluation of fine catheter aspiration cytology of the peritoneum as an adjunct to decision making in the acute abdomen
Authors: Vipond M N , Paterson-Brown S , Tyrrell M R , Coleman D , Thompson J N , Dudley H A F
Published: March 2007

Fine catheter aspiration cytology of the peritoneal cavity was performed successfully in 61 patients admitted with acute abdominal pain. Aspirates were examined microscopically and the percentage of neutrophils in the specimen counted. In patients in whom the clinical need for operation was certain (n = 25) all patients required surgery and the peritoneal neutrophil count was >50per cent. In patients in whom the clinical need for operation was uncertain (n = 36) 19 patients required operation: the peritoneal neutrophil count was > 50per cent in 18 and in one patient with ectopic pregnancy fresh blood was aspirated. Of the 17 patients not requiring operation the peritoneal neutrophil count was < 10per cent in 15 and > 50per cent in two patients (both had acute pelvic inflammatory disease). This study confirms peritoneal cytology as a useful adjunct to decision making in those patients with acute abdominal pain in whom the decision to operate is in doubt.
Role of compartmental resection for soft tissue sarcoma of the limb and limb girdle
Authors: Stotter A , Fallowfield M , Mott A , Fisher C , Westbury G
Published: March 2007

A total of 143 consecutive operations for soft tissue sarcoma of the extremity, performed by one surgeon over a 5-year period, was studied to determine the place of compartmental excision. The surgical aim was to achieve the nearest to radical surgery compatible with preservation of a functional limb. Of the operations, 73 were for previously untreated primary tumour and 70 for local recurrence. Two tumours arose in areas previously irradiated for other malignancies and 35 recurrences had occurred despite prior radiotherapy; of the 106 remaining cases, adjuvant radiotherapy was used for 79. Adjuvant chemotherapy was used only occasionally and was more often regional than systemic. For the majority of tumours, compartmentectomy was inappropriate or inadequate: 49 were extracompartmental in origin and 48 extended beyond their compartment of origin at the time of surgery. The remaining 46 were confined to one compartment; in only 21 of these 46 operations was a radical compartmental excision performed. Compartmental excision was more likely to be performed when the tumour was centrally located within a compartment, was so large that it replaced most of the muscle group, or was high grade or recurrent (particularly when adjuvant radiotherapy had already been used). The general preference was to combine less-than-radical surgery with adjuvant radiotherapy rather than sacrifice entire muscle groups or adjacent, functionally important, structures such as artery or nerve. This reflects the proven efficacy of radiotherapy in controlling microscopic disease. Overall, compartmental excision was considered appropriate in only 15per cent of operations.
Photodynamic therapy for colorectal cancer: A quantitative pilot study
Authors: Barr H , Krasner N , Boulos P B , Chatlani P , Bown S G
Published: March 2007

Ten patients with colorectal cancers unsuitable for operation were treated with endoscopic photodynamic therapy (PDT). The patients were assessed before treatment, and at 1 week and 1 month after treatment by colonoscopy with biopsy and endoluminal ultrasound examination. The depth of tumour was measured and the effect of PDT was quantified by measuring the reduction in tumour depth. All patients were sensitized with 2·5mg kg−1 of haematoporphyrin derivative, 48h before phototherapy. A standard treatment protocol of light exposure was used. Up to four parts of the tumour were treated with 50 J of red light (630 nm) from a tuneable dye laser, through a flexible optical fibre passed through the colonoscope and inserted into the tumour. Two patients with small lesions are tumour-free 20 and 28 months after PDT. One treatment of an advanced tumour was complicated by a haemodynamically significant secondary haemorrhage. PDT may be most suitable for the treatment of small tumours or for small areas of persistent tumour where the bulk has been removed by alternative techniques.
Blood transfusion and survival following surgery for prostatic carcinoma
Authors: McClinton S , Moffat L E F , Scott S , Urbaniak S J , Kerridge D F
Published: March 2007

Blood transfusion in the perioperative period has been reported to have a detrimental effect on survival in many types of cancer. Other studies have failed to confirm this. We have examined retrospectively the records of 246 patients with prostatic carcinoma who underwent transurethral resection of the prostate (TURP) in Aberdeen Royal Infirmary between 1977 and 1982. Bilateral orchiectomy (BLO) was performed in 193 patients. Of these patients, 71 of 246 (29 per cent) received perioperative blood transfusion. After controlling for differences due to a number of variables, transfusion of non-autologous blood was shown to be associated with a significant negative effect on survival. Perioperative transfusion of non-autologous blood should be avoided in patients with malignancy, unless there are clear overriding clinical indications. Prospective trials are needed urgently.
Results of surgical treatment of neonatal necrotizing enterocolitis
Authors: Jackman S , Brereton R J , Wright V M
Published: March 2007

In 6 years, 74 neonates were treated for necrotizing enterocolitis, 40 (54 per cent) of whom underwent operation. The early postoperative mortality rate was 23 per cent and there was one late death. Of the 30 postoperative survivors, two have short bowel syndrome, two have chronic respiratory disease, two are partially sighted, and five (17 per cent) have severe developmental delay. Only 15 (50 per cent) survivors enjoy good health.
Surgical correction of the efferent ileal limb for disordered defaecation following restorative proctocolectomy with the S ileal reservoir
Authors: Nicholls R J , Gilbert J M
Published: March 2007

The S ileal reservoir has been superseded in this unit but 76 patients had this operation between 1976 and 1983. Forty-one (54 per cent) patients had to catheterize the reservoir to evacuate faeces and this was primarily due to the long efferent ileal limb. In six patients, the need to catheterize and other problems with defaecation were such that surgical correction of the efferent ileal limb was undertaken. These six patients are reported. Presenting features were the need to catheterize the reservoir, difficulty in catheterizing, faecal incontinence, stenosis of the efferent ileal limb and transanal prolapse of the efferent ileal limb. All patients had an excessively long efferent ileal limb of 8cm or more which was resected and reanastomosed to the anal canal. The resection was performed endoanally in three patients but was successful in only one. In the two patients in whom endoanal excision was unsuccessful and in the remaining three resection of at least 5 cm was performed transabdominally with endoanal reanastomosis. Three of these five patients were converted from catheterizing the reservoir to spontaneous evacuation, but two patients still needed to catheterize. All six patients benefited in terms of the need for, or frequency of, catheterization, or by improvement in continence. Excessive length of the efferent limb of an S ileal reservoir may cause unsatisfactory defaecation, which may be improved by partial resection. The transabdominal route is recommended for the resection, with endoanal reanastomosis. This surgery is potentially problematic and, although no anastomotic leakage was encountered, a covering loop ileostomy is recommended.
Role of intraoperative prograde colonic lavage and a decompressive loop ileostomy in the management of transmural amoebic colitis
Authors: Luvuno F M
Published: March 2007

A prospective analysis is presented of a selected group of 45 consecutive patients with transmural amoebic colitis treated by laparotomy, colonic lavage and ileostomy (phase 1 surgery) over 3 years. The diagnosis of amoebic colitis and amoebic perforation of the bowel were difficult and therefore all patients with ‘acute abdomen’ had proctosigmoidoscopy and a trial of metronidazole for 24–48 h before laparotomy. At laparotomy, adhesive wraps were present in all patients; 13 perforations were exposed by inadvertent disturbance of adhesive wraps but were successfully closed by suture to any available organ in close proximity, such as the amentum or small bowel. Four patients (9 per cent) died after phase 1 surgery. After 6 weeks when the acute disease had healed, 33 of the remaining 41 patients (80 per cent) required closure of ileostomy only, five had resection of stricture and three (7 per cent) needed stricturoplasty (phase 2 surgery). Two patients (5 per cent) died after phase 2 surgery. Thus, in surgery for transmural amoebic colitis adhesive wraps should not be disturbed as they mechanically protect the peritoneal cavity from faecal soiling when perforation occurs. The colon should be emptied by lavage and the faecal stream diverted to avoid secondary bacterial effects.
Endoscopic sphincterotomy for the palliation of ampullary carcinoma
Authors: Bickerstaff K I , Berry A R , Chapman R W , Britton B J
Published: March 2007

Palliative endoscopic sphincterotomy was performed on 17 patients with adenocarcinoma of the ampulla of Vater. An endoprosthesis was inserted immediately after the sphincterotomy in four of the patients. Fourteen patients made uncomplicated recoveries from the procedure and their jaundice resolved completely. Early complications developed in three patients. One patient died from haemorrhage. Two patients, both of whom had an endoprosthesis, developed cholangitis. The endoprosthesis was removed and another inserted in one patient and the other underwent surgery. Both thereafter made uncomplicated recoveries. Jaundice subsequently recurred in eight patients and further endoscopic treatment was successful in five of these patients. Eleven patients died between 4 days and 23 months after the sphincterotomy with a median survival of 12 months. Four patients remain alive between 3 and 17 months after treatment. The results indicate that reasonable palliation can be achieved safely by endoscopic sphincterotomy.
Intact parathyroid hormone in primary hyperparathyroidism
Authors: Flentje D , Schmidt-Gayk H , Fischer S , Stern J , Blind E , Buhr H , Herfarth Ch
Published: March 2007

In 49 patients with primary hyperparathyroidism, intact parathyroid hormone (PTH) was measured with a recently developed immuno-radiometric assay, and midregional PTH fragments (sequence 44–68) were measured with an established radioimmunoassay technique. In 47 normal subjects, the concentration of intact PTH ranged from 2·0 to 6·8pmol/l, and in 49 patients with primary hyperparathyroidism it ranged from 6·4 to 80·0 pmol/l. In contrast, midregional PTH fragments were normal in seven of 49 patients with primary hyperparathyroidism. In five healthy controls and in 12 patients with surgically confirmed primary hyperparathyroidism and serum calcium levels below 3·0 mmol/l, a rapid calcium loading test was performed. In healthy controls, intact PTH was in the low normal to subnormal range within 2·5–5·0 min, and had recovered within 15 min of calcium infusion. In patients with primary hyperparathyroidism, the calcium infusion also led to a 30–50 per cent decrease in intact PTH levels within 5·0–7·5 min after injection, with a slow recovery after 10–15 min. In six of the patients with only slightly elevated basal intact PTH, a suppression to the normal range was observed. In 24 patients (16 patients with a solitary adenoma and eight patients with four-gland hyperplasia) the intact PTH levels were followed intraoperatively during para-thyroidectomy, revealing a significantly different rate of decline for single adenomas compared with hyperplasia during the first 15 min after removal of the primary enlarged gland. Intact PTH values remained constantly elevated in one patient with primary hyperparathyroidism and an unsuccessful neck exploration. These results confirm that (a) the measurement of intact PTH in patients with primary hyperparathyroidism is superior to the measurement of midregional fragments; (b) PTH secretion in primary hyperparathyroidism is not totally autonomous; and (c) intraoperative monitoring of intact PTH values could be used to monitor the success of surgery.
Tissue plasminogen activator in peripheral arterial thrombolysis
Authors: Berridge D C , Gregson R H S , Makin G S , Hopkinson B R
Published: March 2007

Thirty acute peripheral arterial thromboses in 28 patients were treated with local low-dose intra-arterial recombinant tissue plasminogen activator (t-PA). All patients received 0·5 mg h−1 t-PAand 15 also received 250 units h−1 of intra-arterial heparin. Overall limb salvage at 30 days was 83 per cent (25 out of 30 limbs). Mean(s.d.) ankle/brachial index was increased by 0·53(0·26) and there was no significant difference between the group receiving t-PA alone and that receiving t-PA and heparin. No strokes or major haemorrhages occurred but there were four (13 per cent) minor haematomas associated with the catheter entry site. There were four (13 per cent) deaths from myocardial infarction occurring between 5 and 21 days after treatment. Rethrombosis occurred in four cases (13 per cent). In two patients following t-PA alone, rethrombosis occurred after 2 and 11 days. Limb salvage was achieved with a successful repeat thrombolysis and a femoropopliteal graft respectively. Rethrombosis after t-PA and heparin occurred after 30 days in two patients due to poor run-off and extensive proximal atheromatous disease respectively. t-FA is a safe, effective thrombolytic agent when given as a low-dose intra-arterial infusion. The addition of low-dose heparin does not produce any significant benefit.
Aortoiliac endarterectomy: An 11-year review
Authors: Naylor A R , Ah-See A K , Engeset J
Published: March 2007

Fifty-seven patients underwent aortoiliac endarterectomy over an 11-year period, the majority (86 per cent) for disabling daudication. No patient died within 30 days of surgery, but nine patients suffered significant complications. The cumulative survival rate was 98 per cent at 1 year, and was 94 and 78 per cent at 5 and 10 years respectively. Cumulative operated segment patency rates were 92 per cent at 5 years and 68 per cent at 10 years. There was no significant difference in survival rates between patients who smoked after surgery and those who did not, but smokers had significantly worse rates for cumulative patency, limb failure and symptom status than non-smokers. Twenty-seven patients developed worsening symptoms during follow-up and 24 patients required secondary vascular intervention. Fourteen patients subsequently required aortofemoral bypass and the largest single cause of operated segment failure was recurrent disease in the external iliac artery. Our evidence suggests that, while aortoiliac endarterectomy should be considered in young patients with localized disease not involving the external iliac artery, those who do not fit these criteria should be considered for primary aortofemoral bypass. Regardless of the choice of operation, the chance of success is jeopardized if the patient continues to smoke.
Simultaneous aortic and renal artery reconstruction
Authors: Cooper G G , Atkinson A B , D'Sa A A B Barros
Published: March 2007

Nine patients presenting with combined aortic and renal artery disease underwent simultaneous infrarenal aortic reconstruction and renal revascularization. Seven patients had aneurysmal and two had occlusive aortic disease in association with unilateral (four cases) or bilateral (five cases) atheromatous renal artery stenosis. The indications for renal revascularization were hypertension (n = 8) refractory to medical treatment or associated with renal functional impairment and chronic renal failure alone (n = 1). Five patients developed postoperative complications with one fatality. Eight patients were followed up for between 7 months and 4 years. Control of blood pressure had improved in six of seven hypertensive patients. Serum creatinine levels were stabilized or had fallen in five patients. Simultaneous aortic and renal artery reconstruction is widely recognized as having a high postoperative morbidity rate but can improve control of hypertension and stabilize renal function in carefully selected patients.