bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of life after gastrectomy in patients with carcinoma of the stomach
Authors: Korenaga D , Orita H , Okuyama T , Moriguchi S , Maehara Y , Sugimachi K
Published: March 2007

One hundred and fifty patients without recurrence of disease after R2 gastrectomy for carcinoma of the stomach were interviewed to determine their quality of life after surgery. Patients ate less and weighed less but most appeared to be well adjusted and had an optimistic attitude regarding their physical state. There was no evidence of a diminished quality of life in those who had undergone distal partial gastrectomy. These patients had a higher overall food tolerance, body-weight and performance status compared with those treated by total gastrectomy. Considering the satisfactory outcome and the sustained quality of life, radical R2 gastrectomy may be the treatment of choice for carcinoma of the stomach.
Colour Doppler ultrasonography studies of benign and malignant breast lesions
Authors: Dixon J M , Walsh J , Paterson D , Chetty U
Published: March 2007

Colour Doppler scanning was carried out on 53 patients with solid, discrete breast masses. Twenty-five of 32 breast cancers and none of 21 benign lesions gave a positive scan, giving a sensitivity of 78 per cent for association with malignancy, a specificity of 100 per cent and a positive predictive value of 100 per cent. Tumours less than 1 cm in diameter and invasive lobular cancers were least likely to give a positive scan. Axillary node scans were performed in 31 of 32 patients with breast cancer with 29 undergoing an axillary staging procedure. Nine patients had a positive axillary scan and all nine had involved axillry nodes. Three patients had involved axillary nodes, but a negative axillary scan. The sensitivity of colour Doppler scanning for axillary node involvement was 75 per cent, with a specificity of 100 per cent and a positive predictive value of 100 per cent.
Incidence of arm swelling following axillary clearance for breast cancer
Authors: Hoe A L , Iven D , Royle G T , Taylor I
Published: March 2007

Arm swelling was measured using volume determination in 118 patients following mastectomy (n = 60) or wide excision (n = 58), both with axillary clearance. The mean age was 60·5 years and the median follow-up was 22·5 months. Axillary clearance removed level III nodes. Axillary irradiation was given to only three patients with extensive (more than 75 per cent) nodal involvement. The incidence of early postoperative complications was 18·6 per cent. The incidence of lymphoedema was 7·6 per cent (nine patients). Three of these patients had early lymphoedema within 6 months of treatment. Arm circumference differences correlated poorly with volume diferences. The incidence of lymphoedema following axillary clearance is low and comparable to that for sampling or no axillary surgery.
Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up
Authors: Hashmonai M , Kopelman D , Kein O , Schein M
Published: March 2007

Primary palmar hyperhidrosis is a functionally and socially disabling condition. Upper thoracic sympathectomy is the best curative treatment. Several surgical approaches have been suggested and, recently, less invasive techniques have been communicated. To evaluate which method is the best, the short- and particularly the long-term results must be compared. A series is presented of 170 upper thoracic sympathectomies by the supraclavicular approach performed on 85 patients with palmar hyperhidrosis. Follow-up for a mean of 8·3 years was obtained on 124 operated limbs. The immediate failure rate for relief from hyperhidrosis was 2·4 per cent and hyperhidrosis recurred in another 4·1 per cent of limbs after a period of between 2 and 18 months. Thirteen per cent of patients were dissatisfied with the results of operation, one because of persisting vasomotor rhinitis, two because of Horner's syndrome and five because of persisting or recurrent hyperhidrosis. Satisfactory results in approximately 87 per cent of cases make the operation rewarding. This outcome should be compared with the long-term results of other methods, such as percutaneous phenol injection and the transthoracoscopic approach, when such data are compiled and published.
Influence of prazosin on experimental vein graft intimal thickening
Authors: Norman P E , House A K
Published: March 2007

The influence of prazosin on experimental vein graft intimal thickening was studied in a rat model. The iliolumbar vein was grafted into the common iliac artery in a prazosin-treated group (n = 17) and a control group (n = 23). Three weeks after grafting the animals were killed and the grafts harvested. Longitudinal sections were prepared and the intimal thickness measured in the proximal, mid and distal graft. Intimal thickness varied considerably in both groups. Median (range) intimal thicknesses for the control group were: proximal 50 (10–120) μm; mid 30 (10–70) μm; and distal graft 30 (10–100) μm. Results for the prazosin-treated group were: proximal 70 (10–160) μm; mid 25 (5–60) μm; and distal graft 25 (5–135) μm. There was no statistically significant difference in median intimal thicknesses between the control und treated groups.
Role of selective decontamination in surgery
Authors: Tetteroo G W M , Wagenvoort J H T , Bruining H A
Published: March 2007

Aspects of selective decontamination as an antibiotic prophylaxis in general surgery are discussed with respect to the respiratory tract and wound infection. The high rate of nosocomial infection encountered in surgical patients, who experience up to 71 per cent of all such infection, is considered. The infection rate increases to 70–80 per cent after 1 week in the surgical intensive care unit, while the infection-related mortality rate rises to up to 60 per cent. The endogenous origin of nosocomial infection suggests the importance of maintaining colonization resistance to prevent colonization with Gram-negative micro-organisms, especially using selective decontamination which eliminates potentially pathogenic micro-organisms while leaving colonization resistance intact. Selective decontamination has proved eflective in decreasing infection rates by 50–80 per cent, and is especially successful in respiratory tract infection. Possible adverse effects and future indications for selective decontamination are discussed.
Anterior resection without a defunctioning colostomy: questions of safety
Authors: Mealy K , Burke P , Hyland J
Published: March 2007

The need to defunction the anastomosis at anterior resection remains controversial. As the policy in this unit has been not to perform a defunctioning colostomy during anterior resection, the outcome of a consecutive series of 114 anterior resections, all carried out without a covering colostomy, was studied. During the period February 1985 to September 1991, 21 abdominoperineal resections, six Hartmann's procedures and two resections with coloanal anastomosis were also performed. Within the anterior resection group six clinical leaks (5.3 per cent) occurred, all in the low anastomosis group (8 per cent leak rate) and all of which required an end colostomy. The perioperative mortality rate within the anterior resection group was 3.5 per cent; of the four deaths one was attributable to anastomotic dehiscence and sepsis and the others were due to unassociated medical conditions. The results demonstrate similar leakage and mortality rates to published studies where anterior resection is frequently performed with a defunctioning colostomy. These results indicate that the routine use of a defunctioning colostomy at anterior resection should now be questioned.
Poor palliation of colorectal malignancy with the neodymium yttrium–aluminium–garnet laser
Authors: Bright N , Hale P , Mason R
Published: March 2007

The neodymium yttrium-aluminium-garnet (NdYAG) laser was used to palliate the symptoms of 38 patients with rectal carcinoma unsuitable for radical surgery. All patients with small tumours (n = 6) reported resolution of their symptoms. In contrast, those with large tumours frequently showed little improvement (n = 18) and alternative surgical management was necessary in 12 patients. The overall early mortality rate (< 1 month after first treatment) was 21 per cent. The NdYAG laser offers good palliation and may even cure small colorectal tumours in patients who are unsuitable for surgery. For large circumferential tumours, those associated with obstruction and those close to or involving the anal sphincters, however, the results are poor and better symptom control may be achieved by other means.
Gastric involvement of oesophageal squamous cell carcinoma
Authors: Kuwano H , Baba K , Ikebe M , Kitamura K , Adachi Y , Mori M , Sugimachi K
Published: March 2007

Among 402 patients with squamous cell carcinoma of the oesophagus, gastric wall involvement was evident in 32 (8.0 per cent). These could be grouped into four types according to the pattern of involvement: group 1 included six patients with gastric involvement via metastases in perigastric lymph nodes: group 2 consisted of 11 patients with gastric intramural metastasis; group 3 contained 12 with direct invasion of the gastric wall by the oesophageal squamous cell carcinoma; and group 4 three patients with intraepithelial spread of oesophageal cancer to the gastric epithelium. Prognosis was poor, all patients dying except for one in each of groups 3 and 4. The mean survival time was 5.6, 8.6, 14.8 and 18.7 months in groups 1, 2, 3 and 4, respectively. Gastric involvement via metastases to lymph nodes and by intramural metastasis therefore indicates an extremely poor prognosis, while the prognosis in groups 3 and 4 was influenced by the depth of invasion and lymph node metastasis of the oesophageal cancer. Histological examination of tissues from group 4 patients demonstrated that malignant squamous cells proliferated and invaded the gastric epithelial layer, that is, there was intraepithelial spread of the oesophageal cancer.
Attitudes and experiences of human immunodeficiency Virus-positive patients to surgery and surgeons
Authors: Gill S K , Emberton M , Scott H J
Published: March 2007

The issues regarding screening and identification of patients at risk for human immunodeficiency virus (HIV) infection before surgery continue to be discussed, and there is a need for information regarding attitudes of both surgeons and patients to this issue. A population of HIV-positive patients attending a genitourinary medicine clinic were given an anonymous questionnaire to review their experiences of attending for operation. Of 174 patients who replied, 52 had undergone a total of 65 procedures. In all but three of the operations, the HIV status was made known to the surgeon.
Glomus tumour: An analysis of 43 patients and review of the literature
Authors: Heys S D , Brittenden J , Atkinson P , Eremin O
Published: March 2007

Glomus tumours are hamartomas derived from the normal glomus body. A total of 43 glomus tumours have been seen over the past 18 years, and are reviewed. Their clinical presentations and pathology are analysed and the continuing difficulty in diagnosis is examined.
Assessment of quality of life in surgery
Authors: O'Boyle C A
Published: March 2007

The concept patient's quality of life is assuming increasing importance in modern medicine and surgery. Interventions are increasingly being assessed in terms of their impact on such areas of functioning as mobility, mood, cognitive function, ability to fulfil occupational and social roles, and general life satisfaction. This paper discusses the theoretical underpinnings of the quality-of-life paradigm and its practical relevance for modern surgery.
Knotting technique and suture materials
Authors: Brown R P
Published: March 2007

Three groups of knots were examined using six no. 1 (metric 4) suture materials to identify the most effective and efficient knotting techniques. The three groups were the square or reef knot, the surgeon's knot and a double throw knot. Sequential single additional throws were added to these in order to determine when the strength of the knot reached the breaking force of the material, thus nullifying the need for additional throws. This strength was reached in all cases by a maximum of two additional throws. Suture materials examined were the non-absorbable monofilaments nylon and polypropylene, the absorbable monofilaments polyglyconate and polydioxanone and the braided materials polyglactin and polyglycolic acid, both coated. These were examined for their knot-holding capacity and breaking force to determine the best materials, which were polypropylene, polyglyconate and polyglycolic acid.
Prediction of wound tensile strength: An experimental study
Authors: Savunen T J A , Viljanto J A
Published: March 2007

Wound cell specimens were obtained using a Cellstic device after 24, 48 and 72 h healing time in guinea-pig skin wounds. Cell counts from these were compared with the tensile strength values of the same wounds 7, 14 or 21 days after operation. No single cell type was predictive of wound tensile strength, although absolute numbers of diferent cells and selected ratios of cell types on the second or third day after operation were more predictive. Absolute and proportional changes from day 1 to day 2 had the greatest predictive power with a mean error of 9.46 per cent (F = 13.6, P < 0.0001). The same regression model was predictive in animals with lower wound tensile strengths given perioperative hydrocortisone (3 mg/100 g).
Adenomatous goitre: Therapeutic strategy, postoperative outcome, and study of epidermal growth factor receptor
Authors: Sugenoya A , Masuda H , Komatsu M , Yokoyama S , Shimizu T , Fujimori M , Kobayashi S , Iida F
Published: March 2007

A total of 377 patients with histologically proven adenomatous goitre was operated on, 34 as a second operation, and assessed for postoperative outcome (including the incidence of unsuspected malignancy) and immunohistochemical localization of epidermal growth factor receptor. In primary surgery, enucleation of all the nodules was carried out. Patients requiring reoperation showed multicystic degenerate nodules involving one or both lobes. A coexistent cancer was observed in 18 patients (4.8 per cent). The immunohistochemically detected expression of epidermal growth factor receptor in adenomatous goitre was more evident in patients with multinodular lesions. Near-total lobectomy of the involved side(s) is desirable for the prevention of recurrence and complications after operation.
Plasma fatty acid profiles in benign breast disorders
Authors: Gateley C A , Maddox P R , Pritchard G A , Sheridan W , Harrison B J , Pye J K , Webster D J T , Hughes L E , Mansel R E
Published: March 2007

Breast pain (mastalgia) and macroscopic breast cysts present commonly. Mastalgia may be improved by dietary manipulation to reduce saturated fat or supplement essential fatty acid intake. Fatty acid profiles were measured in women with mastalgia and breast cysts, before and during treatment with evening primrose oil, a rich source of essential fatty acids. The fatty acid profiles of both groups of patients were abnormal, with increased proportions of saturated fatty acids and reduced proportions of essential fatty acids. Treatment with evening primrose oil improved the fatty acid profiles towards normal, but this was not necessarily associated with a clinical response.
Effect of phosphatidylcholine on postoperative adhesions after small bowel anastomosis in the rat
Authors: Snoj M , Ar'Rajab A , Ahrén B , Bengmark S
Published: March 2007

The possibility of preventing postoperative adhesions using phosphatidylcholine (PC) was studied in rats. A small bowel anastomosis was created using continuous or interrupted 5/0 silk sutures. Adhesions were measured by recording the maximal length of adhesions around the anastomosis and the number of organs involved in the adhesions. PC was administered intraperitoneally either as a single dose or as three separate doses. Postoperative adhesions developed in all animals; the degree of adhesion was independent of the suture technique used. PC given once at a dose of 20 mg significantly decreased adhesion formation (P < 0.01). The mechanism underlying this effect may be that the exogenous PC provides a lubricant layer replacing endogenous hydrolysed phospholipid. The result with repeated PC administration was not different from that after a single dose. Increasing the single dose of PC to 40 or 60mg resulted in anastomotic dehiscence and subsequent peritonitis. It is concluded that PC in a single dose of 20 mg reduces adhesion formation after small bowel anastomosis in the rat.
Audit of general practitioner referrals to an acute surgical unit
Authors: Dookeran K A , Thompson M M , Lloyd D M , Everson N W
Published: March 2007

One hundred and ninety referrals from general practitioners (GPs) to an acute surgical unit were audited prospectively over a 6-month period. A total of 78 admissions were considered inappropriate of whom 23 patients were thought to have needed neither surgical admission nor opinion. The estimated expenditure resulting from admissions deemed inappropriate was £25000. The daytime commitments of more senior staff on routine emergency duty days meant they were not easily available to deal with calls concerning acute GP referrals. These admissions reduce the efficiency of the service; this may be improved by a senior member of the team accepting and screening GP calls.
Management of colovesical fistulae associated with pelvic malignancy
Authors: Holmes S A V , Christmas T J , Kirby R S , Hendry W F
Published: March 2007

Thirteen patients with malignant colovesical fistulae are presented. The underlying pathology was cancer of the colon (seven cases), bladder (four cases) and cervix (two cases). The series demonstrates that wide surgical excision may be needed to achieve tumour clearance and that this may necessitate pelvic exenteration. Three patients who underwent inadequate tumour excision developed recurrence in the bladder, two with a fatal outcome. Wide excision of the bladder may be performed without urinary diversion by subtotal cystectomy and a reconstructive procedure. Substitution cystoplasty was performed on two patients at the time of tumour excision. Urinary tract involvement by such tumours is often extensive and optimal results may be achieved with a multidisciplinary approach.
Laparoscopic fixation of sigmoid volvulus
Authors: Miller R , Roe A M , Eltringham W K , Espiner H J
Published: March 2007

Colonic volvulus accounts for 1–2 per cent of cases of intestinal obstruction in western populations1. If conservative measures fail, colectomy is usually the treatment of choice. A case of laparoscopic fixation for a recurrent sigmoid volvulus is reported.
Outcome in patients with early colorectal carcinoma
Authors: Moreira L F , Iwagaki H , Hizuta A , Sakagami K , Orita K
Published: March 2007

Twenty-four patients seen between 1978 and 1990 with early colorectal carcinoma were reviewed to determine the outcome of surgical treatment. The mean age was 62 (range 35–79) years; there were 16 men and eight women. The site of the tumour was the ascending colon in two patients, sigmoid colon in ten and rectum in 12. The polypoid and flat-elevated ulcerated (IIa + IIc) subtypes were detected in 14 and nine lesions respectively. Restorative colectomy was carried out in 19 patients, andjive required Miles' operation. There were no postoperative complications or deaths at a mean follow-up of 71 (range 12–151) months. Neither recurrence nor distant metastasis was found during follow-up. There was a close relationship between the depth of submucosal invasion and presence of flat-elevated ulcerated subtype lesions with lymphatic infiltration. This association may play an important role in the mechanism of metastasis. Major surgical resection is probably required if longer disease-free intervals and better cure rates are desired.
Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram
Authors: Farouk R , Duthie G S , Bartolo D C C , Macgregor A B
Published: March 2007

Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal anal sphincter (IAS), external anal sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05–0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15–64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19–0.38) Hz (P < 0.03), and resting anal pressure, median (i.q.r.) 41 (20–72) cmH2O (P < 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36–0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition.
The Editors of The British Journal of Surgery
Authors: Williamson Robin
Published: March 2007

Continuing our series, which started last month with the Chairman and Vice-Chairmen of The British Journal of Surgery Society, we now present the Editorial Team of the Journal.
Screening for large bowel neoplasms in individuals with a family history of colorectal cancer
Authors: Dunlop M G
Published: March 2007

Logistical problems associated with population screening for colorectal cancer are identified and the possibility of targeting screening to those with a familial predisposition to the disease is discussed. Evidence for a substantial genetic eflect on the overall incidence of colorectal cancer is reviewed. The screening detection rate of colorectal neoplasms in relatives of patients with colorectal cancer has been shown to be higher than that expected in a non-selected population; the evidence that polypectomy will reduce future colorectal cancer risk in such individuals is explored. Recent advances in the molecular genetics of colorectal cancer susceptibility are reviewed; it is possible that a genetic test might be developed in the future which could identify at least a proportion of those at risk. Excluding financial considerations, the risk-benefit ratio of colonoscopy in a screened population is intimately related to the remaining risk of colorectal cancer in those who undergo the examination. At present, patients undergoing colonoscopy to investigate a positive faecal occult blood (FOB) test as part of a population-based screening programme include individuals with a familial predisposition as well as those without. About 20 per cent of all cases of colorectal cancer are associated with an obvious genetic predisposition, and the risk of cancer in their relatives is high. Because false positives occur with Haemoccult, the residual risk to the population who are FOB positive but do not have a familial trait may be suflciently low that the dangers of colonoscopy could outweigh the potential benefits. Scotland has a high incidence of colorectal cancer, and analysis of recent Scottish incidence data shows an actuarial lifetime risk of developing this disease of one in 23 for men and one in 33 for women. As a family history of the disease increases that risk by two to four times and the neoplasms arise throughout the colon in such a group, there may be a case for oflering colonoscopy to all first-degree relatives of those under 50 years of age at diagnosis, if not of all index cases of colorectal cancer.
Prevention of venous thromboembolism after surgery: A review of enoxaparin
Authors: Bergqvist D , Lowe G D O , Berstad A , Haas S , Hirsh J , Rud Lassen M , Samama M , Verhaeghe R
Published: March 2007

This review discusses the problem of deep vein thrombosis (DVT) after operation and identifies three levels of risk of DVT: low (< 10 per cent), moderate (10–40 per cent) and high (40–80 per cent). Special emphasis is placed on the most recent prophylactic treatment, low molecular weight heparins (LMWHs), particularly enoxaparin. Several LMWHs are now available, but they difer slightly and each must be evaluated on its own merits. In general, however, LMWHs are both efective and safe in those patients at moderate or high risk of DVT. Thromboprophylaxis is cost effective when analysed using healtheconomic methodology.
Mechanism of action of external compression on venous function
Authors: Sarin S , Scurr J H , Smith P D Coleridge
Published: March 2007

Compression stockings and bandages have been shown to improve venous haemodynamics and may act by reducing venous reflux. The aim of this study was to assess the mechanism of action of compression therapy on venous function and to determine whether such treatment may correct valvular incompetence. Both lower limbs of 36 patients (median age 59 (interquartile range 45–65) years) were assessed by duplex ultrasonographic scanning. There were 17 limbs with popliteal vein reflux, 19 with long saphenous vein (LSV) reflux and 21 with short saphenous vein (SSV) reflux. A water-filled adjustable pressure cufl was applied around the knee and inflated gradually, while continuously assessing the veins for reflux using ultrasonographic imaging. The external pressure applied by the cuff was noted when reflux was abolished or when the vein was completely occluded. In four (24 per cent) of 17 popliteal veins, eight (42 per cent) of 19 LSVs and three (14 per cent) of 21 SSVs reflux was abolished before occlusion of the vein. The cufl pressures required to achieve restoration of valvular function were significantly lower than those required to occlude the veins. It is possible, in some refluxing veins, to correct valvular dysfunction by external compression therapy. Coaptation of valvular cuffs to restore valvular competence may be the mechanism of action of compression therapy in venous disease.
Angioscope-guided neodymium yttrium–aluminium–garnet laser valvulotomy for in situ vein bypass
Authors: Pflugbeil G , Wahba A , von Sommoggy St , Dörrler J , Maurer P C
Published: March 2007

Valvulotomy for in situ vein bypass is commonly performed with a valvulotome. Although the procedure can be controlled through an angioscope, the dangers of intimal damage and valve remnants remain. An experimental study was designed to evaluate angioscopic laser valvulotomy compared with standard mechanical valvulotomy (n = 16). Two different laser probes, a bare 400-µm fibre (n = 20) and a 2-mm hot-tip (n = 26) were tested. Results were investigated by histology and scanning electron microscopy. Hot-tip laser valvulotomy achieved significantly better results than the 400-µm fibre. The Insitucat valvulotome yielded the worst results, with valve remnants in all cases and an 88 per cent rate of intimal damage. It is concluded that laser valvulotomy can be performed simply and safely with a very low incidence of valve remnants and intimal damage.
Infected femoral pseudoaneurysm in intravenous drug abusers
Authors: Cheng S W K , Fok M , Wong J
Published: March 2007

The result of surgical treatment of 21 infected femoral pseudoaneurysms in 19 intravenous drug addicts was evaluated. Eight pseudoaneurysms involved only the common or superficial femoral artery and 13 involved the femoral bifurcation. Excision and ligation was performed as the sole procedure in 19 instances, and revascularization by bypass through the obturator route was carried out in two. The mean follow-up was 12.3 months. One patient required an above-knee amputation. The resultant ischaemia was greater after triple vessel ligation (mean ankle: brachial pressure index (ABPI) 0.41) than single vessel ligation (mean ABPI 0.58). Postoperative bleeding occurred in one patient. Intermittent claudication was present in 14 patients after excision and ligation. Claudication was universal and more severe after triple than after single vessel ligation. There was no subsequent limb loss. Excision and ligation is safe and is the treatment of choice for infected femoral pseudoaneurysm in drug addicts.
Effect of aprotinin on neutrophil function after major vascular surgery
Authors: Lord R A , Roath O S , Thompson J F , Chant A D B , Francis J L
Published: March 2007

High-dose aprotinin reduces blood loss and blood transfusion requirements during liver transplantation and cardiac and vascular surgery. The mechanism of the haemostatic efect of aprotinin is unclear. A general effect on the anti-inflammatory response may be involved. Because leucocyte activation is part of this process, white cell function was measured in patients undergoing aortic surgery who received high-dose aprotinin therapy (n = 10) and was compared with the results from controls who did not (n = 10). The test group received an intravenous bolus (2 × 106 kallikrein inhibitor units) of aprotinin after induction of anaesthesia followed by continuous infusion (0.5 × 106 kallikrein inhibitor units/h) until the end of the operation. Blood samples were obtained before operation, immediately after surgery, and 1 and 7 days after operation. Aprotinin maintained significantly better postoperative white cell function as measured by bipolar shape formation (P < 0.001), unstimulated nitroblue tetrazolium (NBT) reduction (P < 0.001) and chemotaxis (P < 0.001). Endotoxin-stimulated NBT reduction was similar in both groups, indicating that neutrophils from treated individuals retained the capacity to respond to oxidative stimuli. Aortic surgery activates neutrophils in vivo, as reflected by impaired chemotaxis and increased superoxide production. Aprotinin protects the cells against this potentially deleterious efect without afecting their ability to respond when provoked. Whether this afects leucocyte interaction with coagulation pathways and contributes to the reduction in blood loss remains to be determined.
Gastrointestinal tract perforation in children due to blunt abdominal trauma
Authors: Brown R A , Bass D H , Rode H , Millar A J W , Cywes S
Published: March 2007

Over a 14-year period 587 children under 13 years of age were admitted with blunt injury to the abdomen. Twenty-nine (4.9 per cent) of these were found to have bowel rupture. Evidence of peritonitis was present at initial evaluation in 11 children (38 per cent). Radiological evidence of perforation (pneumoperitoneum) was present in only five of 27 (19 per cent) with a further six of 27 (22 per cent) showing dilated loops of bowel or fluid levels. Thus 59 per cent of radiographs were not diagnostic. The mean time from admission to laparotomy was 17 h. Proximal bowel perforation was common and perforation at multiple sites occurred in five patients; 59 per cent had a concomitant injury which resulted in two deaths (from head injury). Initial clinical and radiological evidence of bowel perforation can be misleading and reliance on such indicators may result in significant diagnostic delay. Frequently repeated clinical examination is advocated; progression of abdominal signs should alert the clinician to proceed to laparotomy.
Functional evaluation of the intrathoracic stomach as an oesophageal substitute
Authors: Bonavina L , Anselmino M , Ruol A , Bardini R , Borsato N , Peracchia A
Published: March 2007

A study of duodenogastric reflux and gastric function was undertaken in 16 patients 1–7 years after oesophagectomy and high intrathoracic oesophagogastrostomy for oesophageal carcinoma. All were able to eat satisfactorily; ten complained of mild foregut symptoms and ten had endoscopic mucosal lesions. Biliary excretion scintigraphy demonstrated pathological duodenogastric reflux in 11 patients. The emptying of a semisolid radiolabelled meal from the intrathoracic stomach in the upright position was significantly quicker than in control subjects (P < 0.01). No gastric motor activity was recorded on manometry, suggesting that the transposed stomach acts like an inert tube. Results of 24-h pH monitoring showed that the area under the curve at pH < 4 in the stomach was significantly less than in control subjects (P < 0.0001). In addition, patients had a significantly greater oesophageal alkaline, exposure (P < 0.001). The vagotomized intrathoracic stomach therefore empties well in the upright position, but is subjected to reflux of alkaline duodenal contents and can retain the ability to produce acid. The interaction between alkaline and acid contents in the pathogenesis of symptoms and mucosal lesions needs further investigation.
Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: Initial experience of a new surgical approach
Authors: Shimi S M , Nathanson L K , Cuschieri A
Published: March 2007

A thoracoscopic technique is described for the execution of long oesophageal myotomy for nutcracker oesophagus causing odynophagia and non-cardiac chest pain. The technique is based on a multipuncture method and a left thoracoscopic approach. It has been performed on three patients with complete symptomatic relief in the short term, although the follow-up period is short (maximum 12 months). No complications were encountered and discharge from hospital occurred by the fifth day after operation.
Early gastric cancer
Authors: Farley D R , Donohue J H , Nagorney D M , Carpenter H A , Katzmann J A , Ilstrup D M
Published: March 2007

Early gastric cancer comprises more than 30 per cent of gastric carcinomas treated in Japan but remains an uncommon entity in the western hemisphere. A retrospective review of 48 patients with early gastric cancer undergoing operative treatment between 1965 and 1984 was carried out. The mean patient age was 70 years, in 31 men and 17 women. Preoperative diagnosis was made in 88 per cent of patients undergoing oesophagogastroduodenoscopy with biopsy but upper gastrointestinal radiography was diagnostic in only 20 per cent. Surgical management consisted of subtotal gastrectomy (86 per cent), total gastrectomy (10 per cent) and wide local excision (4 per cent). The operative mortality and morbidity rates were 0 and 38 per cent, respectively. Mean follow-up was 7.7 years, with 44 per cent of patients still alive. Multivariate analysis disclosed only a healthy. Eastern Cooperative Oncology Group score (P = 0.002) and a diploid DNA tumour pattern (P = 0.05) as significant prognostic variables of survival. The overall survival rate of patients with early gastric cancer (70 per cent at 5 years) was equivalent to that of an age- and sex-matched control population.
Surgery in tropical pancreatitis: Analysis of risk factors
Authors: Ramesh H , Augustine P
Published: March 2007

Over a 7-year period, 91 patients with tropical pancreatitis underwent operation for intractable pain. Univariate and multivariate analyses were performed to identify factors correlating with mortality, major complications, poor pain relief and associated malignancy. Patients with benign disease (group 1, n = 72) had longer survival than those with superimposed malignancy (group 2, n = 19). Pain relief was better in group 1 (59 patients compared with none, P < 0.01). Age above 40 years, short duration of symptoms, mass lesions on ultrasonography and main pancreatic duct obstruction on endoscopic retrograde pancreatography were associated with a high risk of cancer. After reoperation major complications (four of ten) or death (three of ten) occurred more commonly than after primary procedures (seven of 81, P = 0.019 and five of 81, P < 0.05, respectively). Poor pain relief in group I patients was more common after incomplete clearance of main duct stones (four of 13 versus three of 53, P < 0.01) and after short length ductotomy (three of eight versus four of 58, P < 0.01). Tropical pancreatitis has a high association with pancreatic adenocarcinoma. Wide ductotomy, stone clearance and drainage gave good symptomatic results in patients with benign disease. Overall results were poor in patients with cancer.
Endoscopic sphincterotomy in young patients with choledochal dilatation and a long common channel: A preliminary report
Authors: Ng W D , Liu K , Wong M K , Kong C K , Lee K , Chan Y T , Leung J W C
Published: March 2007

An anomalous elongated pancreaticobiliary common channel encourages reflux up both the biliary tree and the pancreatic ductal system, resulting in progressive choledochal dilatation, cholangitis with ductal calculi, relapsing pancreatitis and malignant change. Transduodenal sphincteroplasty has been used to improve drainage from the abnormal channel. The use of endoscopic sphincterotomy (ES) to establish drainage and minimize the surgical risks is reported in six symptomatic patients with mild choledochal dilatation (common bile duct diameter <15 mm), a common channel <15mm in length and a distal stenosis. This was successful in five patients, who have no further symptoms. ES failed in the only patient with an undilated common channel and this patient went on to have open surgery. We believe ES to be safe and effective in the treatment of selected cases of long common channel.
Reduction of mucosal crypt cell proliferation in patients with colorectal adenomatous polyps by dietary calcium supplementation
Authors: Barsoum G H , Hendrickse C , Winslet M C , Youngs D , Donovan I A , Neoptolemos J P , Keighley M R B
Published: March 2007

The crypt cell production rate was measured in 14 patients with adenomatous colorectal polyps, 17 patients with colorectal cancer and 12 control subjects. The median (interquartile range) rate (cells per crypt per hour) was found to be significantly higher (P < 0.001) in the polyp (2.45 (1.94–3.20)) and cancer (3.01 (2.35–3.68)) groups compared with controls (1.25 (0.70–1.85)). A double-blind cross-over study was performed in patients with adenomatous polyps consisting of 2 months' treatment, 2 weeks' washout, followed by 2 months' treatment with dietary calcium supplementation (1.25 g day−1) versus placebo. A significant reduction in the crypt cell production rate occurred with calcium treatment compared with the placebo (1.25 (06–2.25) versus 2.15 (1.58–3.08) cells per crypt per hour, P = 0.035). This study demonstrates a significant reduction in mucosal cell proliferation by dietary calcium supplementation in patients with adenomatous polyps. Such treatment may be worthy of further investigation in patients at high risk of developing colorectal polyps.
Improving survival rates for patients with colorectal cancer
Authors: Jatzko G , Lisborg P , Wette V
Published: March 2007

Between 1 January 1984 and 31 December 1990, 575 patients were operated on for colorectal cancer. The surgical procedure was performed consistently and no patients were lost to follow-up. Almost half of the patients (284 of 575) had tumours of stage I or II, with 5-year survival rates over 90 per cent. After extending the resection margins in 28 cases of colonic carcinoma there has been no case of tumour recurrence. The overall 5-year survival rate for patients with colonic carcinoma was 81 per cent. Complete resection of the mesorectum was mandatory for rectal resection. One-third of the carcinomas in the lower third of the rectum could be resected with maintenance of bowel continuity and an abdominoperineal resection avoided. Not only was the tumour recurrence rate in the former patients lower (10.5 per cent) compared with that in those undergoing abdominoperineal resection (14.3 per cent) but the 5-year survival rate at 90 versus 52 per cent was significantly higher. The overall 5-year survival rate for patients with rectal carcinoma was 71 per cent.
Haemorrhoids are associated not with hypertrophy of the internal anal sphincter, but with hypertension of the anal cushions
Authors: Sun W M , Peck R J , Shorthouse A J , Read N W
Published: March 2007

A combined manometric and ultrasonographic study of the internal anal sphincter was carried out in 20 patients with haemorrhoids and 20 age-matched normal controls. Mean(s.e.m.) basal anal pressure was significantly higher in patients than in controls, 62(4) versus 45(6) cmH2O (P < 0.05), although there were no significant diferences in mean maximum basal and squeeze pressures. During rectal distension 90 per cent of patients showed no reduction in anal pressure in the outermost anal channel, although the internal sphincter electromyogram was suppressed and the external sphincter electromyogram did not necessarily increase above baseline. The mean(s.e.m.) maximum residual pressure was significantly higher in patients, 70(6) versus 45(6) cmH2O (P < 0.05). Direct pressure measurement in anal cushions exhibited abnormally high median pressure in patients compared with controls, 35 versus 10 cmH2O (P < 0.001). Pressures recorded during coughing and straining were also significantly higher in patients than in controls (P < 0.001). Ultrasonographic study of the anal canal revealed a clear image of the internal sphincter, the thickness of which could easily be measured. The mean(s.e.m.) thickness of the sphincter was not significantly different, 2.3(0.2) versus 2.1(0.1) mm, between patients with haemorrhoids and controls (P = 0.18). The absence of any significant differences in the internal sphincter thickness between normal subjects and patients with haemorrhoids suggests that the high anal pressure in patients with haemorrhoids is of vascular origin.
Nutrition and malignant disease: Implications for surgical practice
Authors: Heys S D , Park K G M , Garlick P J , Eremin O
Published: March 2007

Malignant disease is often associated with weight loss and malnutrition. Nutritional support is frequently provided to patients with cancer in an attempt to improve nutritional status and reverse weight loss, with the aim of reducing morbidity and mortality rates. This review evaluates the effect of supplemental nutrition on morbidity and mortality in patients with malignancy undergoing treatment with surgery, chemotherapy or radiotherapy. It also assesses the effect nutritional supplementation has on host defence mechanisms and how nutrients affect tumour cell growth. The evidence suggests that perioperative nutritional support, if given for at least 10 days, reduces morbidity and mortality in patients with biochemical evidence of severe malnutrition, manifest as a low serum albumin concentration and excessive weight loss. In contrast, there is no evidence that parenteral nutritional support benefits patients undergoing chemotherapy or radiotherapy, in terms of either an increased tumour response rate or prolongation of survival. Current research on malignant disease is highlighting the role of specific nutrients (amino acids, essential fatty acids and polyribonucleotides) as key regulators of both anticancer host defence mechanisms and the control of nitrogen metabolism and tumour growth. Arginine, essential fatty acids and ribonucleotides have all been demonstrated to stimulate antitumour host defence mechanisms and some also modulate tumour cell metabolism. Dietary manipulation offers exciting possibilities for the innovative management of malignant disease.
Delayed surgery for congenital diaphragmatic hernia
Authors: Goh D W , Drake D P , Brereton R J , Kiely E M , Spitz L
Published: March 2007

Between January 1987 and December 1990, 67 neonates were treated for congenital diaphragmatic hernia, symptomatic within 6 h of birth. The mortality rate was 33 per cent. Preoperative stabilization was achieved in 47 patients, all of whom survived initial treatment, although two died later. Stabilization could not be achieved in 20 neonates, all of whom died within 3 days of birth, 18 without undergoing operation and two after early repair. Intensive resuscitation with controlled, delayed operation for congenital diaphragmatic hernia gives long-term results similar to those of urgent operative repair. This approach avoids operation in the majority of those who subsequently die.
Effect of biliary decompression on reticuloendothelial function in jaundiced rats
Authors: Ding J W , Andersson R , Stenram U , Lunderquist A , Bengmark S
Published: March 2007

The recovery of reticuloendothelial system (RES) function following decompression of obstructive jaundice was studied using a rat model with bile duct ligation and side-to-side choledochoduodenostomy. Histopathological changes in the liver were still present 5 weeks after relief of jaundice, while results of liver function tests had returned to normal. RES function evaluated by the blood clearance and organ uptake of radiolabelled Escherichia coli using a corrected phagocytic index gradually returned to normal following biliary decompression. The severely impaired RES activity noted 1 week after operation may explain the increased incidence of sepsis and renal insufficiency in the early period after biliary surgery in jaundiced patients.
Treatment of common bile duct stones using mono-octanoin
Authors: Stock S E , Carlson G L , Lavelle M I , Lendrum R , Venables C W
Published: March 2007

A retrospective analysis of 48 patients undergoing mono-octanoin infusion via nasobiliary catheter following failure of endoscopic extraction of common bile duct stones is reported. Among 35 patients who received a complete course of treatment, nine (26 per cent) had duct clearance by the completion of the infusion and a further eight on subsequent endoscopic retrograde cholangiopancreatography (ERCP) (total 49 per cent). Two patients had a successful stone extraction after enlargement of the sphincterotomy (total non-surgical clearance rate 54 per cent). None of the patients with stones > 2 cm in diameter had stone clearance at the completion of the infusion and only one at subsequent ERCP. Among 13 patients receiving an incomplete course of treatment seven had clear ducts on repeat ERCP (54 per cent). Mono-octanoin infusion via a nasobiliary catheter is of limited value in the management of this difficult group of patients, although it may be successful in some.
Risk factors and classification of acute suppurative cholangitis
Authors: Csendes A , Diaz J C , Burdiles P , Maluenda F , Morales E
Published: March 2007

A prospective study was performed in 1282 patients with common bile duct stones to determine the clinical and laboratory parameters that could predict cholangitis, and the factors associated with greater severity of cholangitis. Patients were divided into two groups, with or without acute cholangitis, depending on the macroscopic appearance of bile aspirated from the common bile duct during surgery. Acute cholangitis was diagnosed when the aspirated fluid was turbid or clearly pus; the typical Charcot's triad was present in only 22 per cent of patients with acute cholangitis. Several clinical and laboratory parameters were significantly more common in these patients and, depending on their number, the probability of acute cholangitis increased significantly. The operative mortality rate was 1.2 per cent for patients without cholangitis and 11.9 per cent for patients with cholangitis. Depending on the number of factors present, patients with cholangitis were divided into three groups: mild acute cholangitis without mortality; moderate acute cholangitis with a mortality rate of 5.6 per cent; and severe acute cholangitis with a mortality rate of 27.5 per cent. The present classification allows the group of patients needing prompt endoscopic or surgical drainage to be identified.
Identification of the regional lymphatic system of the gallbladder by vital staining
Authors: Shirai Y , Yoshida K , Tsukada K , Ohtani T , Muto T
Published: March 2007

In 21 patients with biliary tract cancer dye was injected into the lymphatic system of the gallbladder to determine the extent of its regional lymph nodes. A volume of 0.1–0.3 ml 1 per cent indigo carmine solution was injected directly into lymphatic vessels of the gallbladder in eight patients and into lymph nodes (cystic node or pericholedochal nodes) in 13 patients during radical surgery for biliary tract cancer. The lymphatic system was visualized in a total of 14 patients. The dye descended around the bile duct, flowed into the cystic node, the pericholedochal nodes and the lymph nodes posterior to the head and neck of the pancreas, and finally reached the interaortocaval nodes adjacent to the left renal vein. The stained lymphatic tissue was regarded as the regional lymphatic system of the gallbladder. These nodes should be completely resected during radical surgery for gallbladder cancer.