bluuebunny/crossref_metadata_2025 huggingface dataset:
Early discharge from hospital after open appendicectomy
Authors: Ramesh S , Galland R B
Published: March 2007

A prospective study of 200 consecutive open emergency appendicectomies was carried out. All patients were informed before operation that they would be discharged the following day if possible. The operation was performed through a standard muscle-splitting incision. At the end of the operation the wound was infiltrated with bupivacaine and a diclofenac suppository was given. There were 29 normal, 129 acutely inflamed, six gangrenous and 36 perforated appendices. In all, 147 patients (73·5 per cent) were discharged home within 24 h and reviewed 2 weeks later. Twelve patients had seen their general practitioner, mainly for wound problems (eight) or pain (two). Two others required readmission. Thirty-four patients (23·1 per cent) required no postoperative analgesia; 104 (70·7 per cent) required paracetamol or co-proxamol for ≦ 3 days and nine (6·1 per cent)for >3 days. No patient had a problem directly related to early discharge from hospital. Fifty-three patients (26·5 per cent) were not discharged home early due to peritonitis (36), social reasons (seven), nausea (seven), associated caecal volvulus (one) and pregnancy (two). Early discharge from hospital within 24 h after emergency appendicectomy is safe and has good patient acceptability.
Effect of putative phospholipase A2 inhibitors on acetic acidi-induced acute colitis in the rat
Authors: Fabia R , Ar'Rajab A , Willén R , Andersson R , Bengmark S
Published: March 2007

Phospholipase activation may play an important role in ulcerative colitis. This hypothesis was tested by evaluating the effect of two non-selective phospholipase (PL) A2 inhibitors, quinacrine and p-bromophenacyl-bromide (pBPB), on acetic acid-induced colitis in the rat. The calcium antagonist verapamil, which may also act as a PLA2 inhibitor, was also tested. Acute colitis was induced in an isolated colonic segment by instillation of 4 per cent acetic acid for 15 s; this induces a uniform colitis after 4 days. The severity of colitis was evaluated histologically, by measuring myeloperoxidase (MPO) activity and by determining plasma exudation into the lumen of the colon (permeability) with 125I-labelled albumin given intravenously. All three putative PLA2 inhibitors tested were found to prevent the development of colitis. Intravenous administration of quinacrine 10 mg kg−1 at 30 min before instillation of acetic acid resulted in a normal mucosal appearance, normal MPO activity and a significantly reduced increase in plasma exudation into the colon. A similar effect was achieved using verapamil. Intracolonic administration of either quinacrine or pBPB also prevented acetic acid-induced colitis. However, three doses, starting immediately after acetic acid administration and repeated on the first and second days, were needed to achieve this, whereas one dose produced only a partial effect. PLA2 may play an important role in acetic acid-induced colitis and inhibition of its activity, may offer an alternative mode of treatment in ulcerative colitis.
Smoking impairs endothelium-dependent relaxation of saphenous vein
Authors: Higman D J , Greenhalgh R M , Powell J T
Published: March 2007

Samples of proximal saphenous vein were obtained from heavy smokers and non-smokers: 28 were obtained at varicose vein surgery and eight at infrainguinal bypass surgery. The veins were prepared for histological examination and for mounting in an organ bath to measure changes in isometric tension. Vein rings from both smokers and non-smokers responded equally to sodium nitroprusside, a reagent that acts directly on smooth muscle cells, undergoing 90–100 per cent relaxation. The mean(s.e.m.) maximum relaxation in response to bradykinin of rings obtained at varicose vein surgery was 50·0(5·3) per cent in non-smokers compared with only 31·6(2·2) per cent in smokers (P = 0·03). Similarly, in specimens obtained at bypass surgery the mean(s.e.m.) maximum relaxation in smokers was only 25·1(6·3) per cent compared with 48·4(4·1) per cent in smokers (P = 0·04). Relaxation in response to the bradykinin stimulus was abolished in the presence of L-nitroarginine methyl ester, a specific inhibitor of the synthesis of endothelium-derived relaxing factor (EDRF). Preincubation of the vein rings with L-arginine, the precursor of EDRF, did not increase the vasorelaxation in smokers. The mean(s.e.m.) maximum relaxation in response to the calcium ionophore A23187 was 53·5(3·8) per cent in non-smokers compared with only 27·0(4·9) per cent in smokers (P = 0·01). The results indicate that heavy smokers have impaired release of EDRF in response to both bradykinin and calcium ionophore. This impairment may increase vasomotor tone, platelet aggregation and smooth muscle proliferation, thereby resulting in an increased risk of graft occlusion.
Influence of type III collagen genotype on aortic diameter and disease
Authors: Powell J T , Adamson J , Macsweeney S T R , Greenhalgh R M , Humphries S E , Henney A M
Published: March 2007

Type III collagen contributes to the tensile strength of the aortic wall, and mutations in the type III collagen gene have been suggested as the basis for the familial tendency to abdominal aortic aneurysm (AAA). Variation in this gene was investigated in 153 patients with AAA, 87 with aortoiliac stenosis and 98 age-matched controls. The rare mutation at amino acid 619 of Gly → Arg, previously associated with AAA in a single family, was not found in any of the patients with aneurysm. For the Ala → Thr variation at amino acid 531, the frequency of the threonine allele was 0·25 in patients with AAA and stenosis, compared with 0·35 in controls. The frequency of the rare allele in the region 3' to the gene demonstrated by Ava II digestion (0·27 in the general population) was found to be 0·29 in the AAA group and 0·19 in the stenosis group (P = 0·023). In the AAA group the presence of the Ava II rare allele was associated with a significant increase in aneurysm diameter (P = 0·044). Non-invasive assessment of aortic distensibility was available in 25 patients: those carrying the Ava II rare allele had less distensible aortas than those not carrying this allele (median pressure-strain elastic modulus 42·0 and 23·9 N/cm2 respectively, P = 0·008). Variation in the type III collagen gene may influence the mechanical properties of the ageing aorta and hence its susceptibility to disease and dilatation. In contrast, there is no evidence for a single common founder mutation in type III collagen predisposing to AAA.
Early detection of occult colorectal hepatic metastases using duplex colour Doppler sonography
Authors: Leen E , Goldberg J A , Robertson J , Angerson W J , Sutherland G R , Cooke T G , McArdle C S
Published: March 2007

Previous studies have shown that overt intrahepatic tumours are associated with subtle changes in liver perfusion that can be measured directly using duplex colour Doppler sonography (DCDS). This study assessed the predictive value of DCDS in the early detection of occult colorectal hepatic metastases. Hepatic arterial and portal venous blood flow was measured in 50 control subjects and 135 patients with colorectal cancer, 67 with overt liver metastases and 68 with an apparently disease-free liver on the basis of computed tomography and laparotomys findings. The Doppler perfusion index (DPI), defined as the ratio of hepatic arterial to total liver blood flow, was calculated. Clear separation of the DPI values of controls and those of patients with overt metastases was observed (P < 0·0001). Thirty-eight of the 68 patients with a disease-free liver also had an abnormally high DPI value. After 1 year of follow-up, 21 patients with an abnormally high DPI at the time of apparently curative primary resection had developed liver metastases and a further four had died without post-mortem examination. The 30 patients with normal DPI remain disease-free. The data suggest that DPI is of value in the early detection of occult liver metastases.
Ventilatory and blood gas changes during laparoscopic and open cholecystectomy
Authors: McMahon A J , Baxter J N , Kenny G , O'Dwyer P J
Published: March 2007

As part of a randomized trial, ventilatory and arterial blood gas changes were assessed during open (n = 30) and laparoscopic (n = 30) cholecystectomy. Measurements were made during anaesthesia before the start of surgery and at the time of removal of the gallbladder. Despite an increase in minute ventilation from a mean(s.d.) of 5·7(1·4) to 6·1(1·2) litres, mean(s.d.) arterial carbon dioxide tension (PaCO2) rose from 5·3(0·9) to 6·0(0·9) kPa during laparoscopic cholecystectomy. End-tidal carbon dioxide tension (PE'CO2) had poor precision in predicting PaCO2 (95 per cent interval of agreement −0·61 to 1·93 kPa). Mean(s.d.) peak airway pressure increased from 17(4) to 23(4) cmH2O. The mean PaCO2–PE'CO2 value did not change significantly, although there was significant within-patient variation. Arterial oxygen levels did not change significantly. By comparison, no clinically significant changes in ventilation or blood gas values occurred during open cholecystectomy. In conclusion, laparoscopic cholecystectomy requires a substantial but variable increase in minute ventilation to compensate for carbon dioxide absorption from the peritoneum.
Comparison of metabolic responses to laparoscopic and minilaparotomy cholecystectomy
Authors: McMahon A J , O'Dwyer P J , Cruikshank A M , McMillan D C , O'Reilly D St J , Lowe G D O , Rumley A , Logan R W , Baxter J N
Published: March 2007

This randomized study compared the metabolic responses to laparoscopic cholecystectomy (n = 10) and minilaparotomy cholecystectomy with a 5–7-cm incision (n = 10). Venous blood samples were taken before operation and at 3, 6, 9, 12, 18, 24, 48, 72 and 168 h after incision and analysed for levels of C-reactive protein, interleukin 6, cortisol, albumin, transferrin, iron, fibrinogen, fibrin degradation products and polymorphonuclear elastase, and for neutrophil and lymphocyte counts. Urine samples (24 h) were analysed for urea, creatinine, 3-methylhistidine and catecholamines. The magnitude of the metabolic changes from baseline levels was quantified by calculating areas under each individual curve. A significant metabolic response with a similar time course and magnitude of changes occurred after laparoscopic and minilaparotomy cholecystectomy but with wide variation in magnitude between individuals.
Long-term results of a single protocol for thrombolysis in acute lower-limb ischaemia
Authors: Giddings A E B , Quraishy M S , Walker W J
Published: March 2007

In a prospective study, 78 of 157 patients with acute lower-limb ischaemia were considered suitable for thrombolysis. The immediate and 4-year results of 52 patients managed by a single protocol are reported. Of 34 patients alive at 4 years, 23 had limb salvage. Initial treatment produced effective lysis in 38 patients (73 per cent) with significant benefit in 35 (67 per cent); that benefit was sustained for a minimum of 4 years in 30 patients (58 per cent). Seven of the 18 deaths by 4 years occurred within 30 days. Amputation was carried out in six patients within 30 days and in five during the next 4 years. Delayed amputation followed persistent distal occlusion or progression of distal disease. No death or amputation was caused by complication of treatment. In selected patients the risks of thrombolysis can be reduced to an acceptable level by personal supervision and a strict protocol. In survivors, limb salvage is generally sustained for at least 4 years.
Low-dose aspirin fails to inhibit increased platelet reactivity in patients with peripheral vascular disease
Authors: Walters T K , Mitchell D C , Wood R F M
Published: March 2007

A study was performed to evaluate the effect of low-dose aspirin (75 mg/day) on platelet reactivity in patients with peripheral vascular disease. Platelet function was measured in 31 patients with advanced peripheral vascular disease requiring surgery. Shear-induced haemostasis and collagen-induced thrombus formation were used as indicators of platelet reactivity. They were measured in non-anticoagulated fresh whole blood samples ex vivo using a haemostatometer. Results were compared with those from 30 age- and sex-matched controls. Shear-induced haemostasis and collagen-induced thrombus formation were also measured in 18 of the 31 patients before the start of aspirin administration (before operation) and I week after surgery. Patients with advanced peripheral vascular disease were found to have increased platelet reactivity with a mean(s.e.m.) shear-induced haemostasis index of 1977(180) mmHgs compared with a control value of 3161(234) mmHg s (P < 0.001) and a mean(s.e.m.) collagen-induced thrombus formation index of 3980(460) mmHg s compared with a control value of 5350(420) mmHg s (P = 0.02). Perioperative low-dose aspirin failed to inhibit platelet function in patients with peripheral vascular disease.
On-scene medical decision making and overtriage
Authors: Coats T J , Wilson A W , Cross F W
Published: March 2007

This study examined whether a hospital-based helicopter trauma service led to ‘overtriage’ of patients back to the multispecialty base hospital. All accident-site triage decisions made during 1991 were studied. Seven of the 574 decisions (1·2 per cent) led to inappropriate movement of the patient to a specialist centre. Twenty-six decisions (4·5 per cent) were based on mechanism of injury alone and the possibility of overtriage by this method is discussed. A trained doctor can select the correct destination for a patient with trauma without inappropriately using the base hospital in preference to local centres.
Acute haemodilution in surgery for burns: A preliminary report
Authors: Henley M , Tomlinson P , Bailie F B , Obeid E M H
Published: March 2007

Blood loss is a major problem in the management of patients with burns treated by early excision and grafting. Acute normovolaemic haemodilution has been successfully used in cardiac surgery for many years but has not been reported previously in surgery for burns. The technique has been used in six patients with burns undergoing early excision and grafting, with no obvious morbidity and an apparent reduction in homologous blood requirements.
Axillary nodal metastases from an occult primary consistent with breast carcinoma
Authors: van Ooijen B , Bontenbal M , Henzen-Logmans S C , Koper P C M
Published: March 2007

The records of 15 women presenting with axillary nodal metastases from an occult primary consistent with breast carcinoma were reviewed. Nine patients underwent complete axillary clearance and in six the clinical mass only was excised. Radiotherapy to the axilla was given to eight patients. One woman underwent mastectomy at the time of axillary surgery but no tumour was found in the excised breast; in the remaining 14 patients the breast was left untreated. One premenopausal woman received adjuvant systemic chemotherapy and one postmenopausal patient was given tamoxifen. Three patients died from recurrent disease at 16, 50 and 56 months after treatment of the axillary mass; one is alive at 42 months with systemic recurrence. In two of these patients the tumour in the breast became apparent before other metastases. Eleven patients survived for a median of 92 (range 18–144) months without evidence of disease. The prognosis of this patient group is better than that generally reported for stage II breast carcinoma.
Non-operative treatment of small bowel obstruction following appendicectomy or operation on the ovary or tube
Authors: Meagher A P , Moller C , Hoffmann D C
Published: March 2007

This study examined the hypothesis that small bowel obstruction in patients whose only previous laparotomy was for appendicectomy or operation on the ovary or tube is unlikely to resolve with non-operative management. Results of 330 admissions for small bowel obstruction were examined. In 40 cases the only previous laparotomy was at appendicectomy or tubo-ovarian operation; in 38 (95 per cent) of these division of adhesions was undertaken compared with 154 (53 per cent) of the remaining 290 (P < 0·00001). In the former group band adhesions were commoner (86 versus 45 per cent, P < 0·00001), bowel resection was required more frequently (22 versus 10 per cent, P = 0.02) and it was considered safe to give a trial of non–operative management less often (60 versus 85 per cent, P = 0·0004). A trial of conservative management may be unsafe or not worth while in patients with obstruction following earlier appendicectomy or operation on the ovary or tube.
Colonoscopic surveillance after curative resection for colorectal cancer
Authors: Patchett S E , Mulcahy H E , O'Donoghue D P
Published: March 2007

Colonoscopic surveillance after resection for colorectal cancer has been advocated to improve detection of anastomotic recurrence, and of synchronous and metachronous tumours. The benefit provided by colonoscopy remains unproven, and the best timing of examination is unclear. To determine the value of colonoscopy after curative resection for large bowel cancer, the efficacy of an endoscopic surveillance programme in the early detection of intraluminal bowel recurrence in a series of patients admitted with colorectal cancer was examined. Between April 1983 and December 1988, 132 patients underwent colonoscopy. Eight (6·1 per cent) were found to have intraluminal recurrence without evidence of extraluminal spread. Six of these recurrences were at the site of anastomosis and two represented metachronous tumour development. All of these patients were symptomatic at the time of diagnosis. In 15 patients (11·4 per cent), adenomatous polyps were discovered during the initial endoscopic examination. These results indicate that colonoscopic surveillance will rarely allow early detection of asymptomatic intraluminal bowel recurrence, but is valuable in the detection of synchronous lesions. Frequent surveillance is not justified in the early postoperative years and colonoscopy should probably be confined to a single procedure to exclude synchronous lesions.
Hepatocyte growth factor/scatter factor, liver regeneration and cancer metastasis
Authors: Jiang W G , Hallett M B , Puntis M C A
Published: March 2007

Hepazocyte growth factor (HGF) is the most potent stimulator of hepatocyte growth and DNA synthesis identified; it is now known to be the same molecule as scatter factor, which increases the motility of a variety of cell types. HGF is becoming recognized as one of the most important factors in the regulation of liver regeneration after surgical resection or chemical damage. HGF is produced by several tissues, including neoplasms; it can therefore provide a stimulus for increased motility of malignant cells by both a paracrine and autocrine mechanism. The receptor for HGF has been identified as the product of the oncogene c-met, raising the possibility that this gene plays a key role in facilitating cellular invasion. HGF may therefore be important not only for liver cell growth but also in metastasis. This article summarizes the current position of research on HGF, and presents both clinical and scientific evidence that strongly implicates this factor in liver regeneration and cancer invasion and metastasis.
Significance of circumferential resection margin involvement after oesophagectomy for cancer
Authors: Sagar P M , Johnston D , McMahon M J , Dixon M F , Quirke P
Published: March 2007

This study examined the influence of tumour involvement of the circumferential resection margin on subsequent local recurrence after oesophagectomy. Fifty patients were studied: 36 men and 14 women of median age 62 (range 44–83) years. Each patient had undergone oesophagectomy at which all macroscopic disease had been removed. Pathological specimens were sectioned tangentially at 0·5–1·0-cm intervals to permit microscopic examination of the circumferential resection margin. Patients were followed and investigated by endoscopy with biopsy and imaging techniques only if symptomatic. Twenty of the 50 specimens demonstrated involvement of the circumferential resection margin. At median follow-up of 36 (range 24–52) months, eleven of these 20 patients had developed histologically proven local recurrence compared with only four of the remaining 30 in whom the resection margin was clear of tumour (P < 0·01). Circumferential spread of oesophageal cancer appears to be a significant cause of local tumour recurrence.
CD4 and CD8 monoclonal antibody therapy: Strategies to prolong renal allograft survival in the dog
Authors: Watson C J E , Cobbold S P , Davies H F S , Rebello P R U B , Waldmann H , Calne R Y , Metcalfe S M
Published: March 2007

The value of CD4 and CD8 monoclonal antibody therapy in tolerance induction has been demonstrated in rodent transplant models. In this paper the immunosuppressive potential of CD4 and CD8 monoclonal antibodies for dog renal allografts was evaluated as a preliminary to tolerogenic studies in this large animal model. Monoclonal antibodies were given for a maximum of 10 days after transplantation. Therapy was stopped prematurely following adverse reactions associated with the recipient developing an antibody response against the foreign (rat) therapeutic monoclonal antibody. Blood trough levels of CD4 and CD8 antibodies indicated that saturating doses were achieved. Although neither CD4 nor CD8 alone prolonged allograft survival (rejection by day 7), combination of CD4 and CD8 antibodies resulted in good graft function for a median of 14 days. The effect of removing circulating T lymphocytes was also assessed using a lytic Thy-1 monoclonal antibody. Alone Thy-1 had little effect but, when combined with CD4, the median allograft survival time was increased to 15.5 days. Reduction of the number of circulating T lymphocytes appears complementary to blockade of CD4 for immunosuppression, while blockade of CD4 combined with removal of CD8 also favours allograft survival.
Patient selection and timing of dynamic computed tomography in acute pancreatitis
Authors: Lucarotti M E , Virjee J , Alderson D
Published: March 2007

Dynamic computed tomography (CT) is the most accurate method for determining the extent of necrosis in acute pancreatitis. Debate exists, however, regarding patient selection and the optimal timing of CT. This study examined selection based on biochemical and/or clinical criteria and the influence of delayed dynamic CT performed 5–10 days after the onset of an attack. A total of 120 patients with acute pancreatitis were studied. Dynamic CT was performed if any of the following criteria were identified: a biochemically severe attack (according to Glasgow criteria) in the first 24 h, C-reactive protein (CRP) level above 120 mg/l in the first 3 days or failure of clinical resolution within 7 days. Of 42 patients selected for CT, five died from multisystem organ failure before day 5. There were no deaths or delayed complications in the 78 patients. not selected for scanning. Positive Glasgow criteria alone in the scanned group had a sensitivity for predicting necrosis (as recognized by CT) of 22 per cent and a specificity of 20 per cent. Measurement of CRP level alone had a sensitivity of 26 per cent and specificity of 80 per cent. Failure of clinical resolution had a sensitivity of only 7 per cent but a specificity of 100 per cent. The combination of Glasgow criteria and CRP level had a sensitivity of 44 per cent and specificity of 100 per cent. Delayed complications (pseudocyst, five; infection, six) occurred only in patients with necrosis, and there were two deaths. An ‘at-risk’ group can be identified for CT on the basis of biochemical and clinical observations. Neither routine nor emergency dynamic CT in acute pancreatitis seems justified.
Correlation between p53 mutations and antibody staining in breast carcinoma
Authors: Dunn J M , Hastrich D J , Newcomb P , Webb J C J , Maitland N J , Farndon J R
Published: March 2007

Abnormalities of the p53 gene and protein were examined in 81 primary breast carcinoma samples. Using a polymerase chain reaction–single-strand conformational polymorphism (PCR—SSCP) analysis, mutations in p53 exons 5–8 were identified in 13 of 81 tumours (16 per cent) and confirmed by DNA sequencing. Positive staining for p53 protein was detected in ten of 77 (13 per cent) of these tumours using polyclonal CM1 antibody on formalin-fixed tissue. Mutations detected by PCR—SSCP analysis were more common in grade III tumours (P = 0·015), but no correlation was found with tumour size, node status or level of epidermal growth factor receptor expression. A p53 mutation was associated with positive antibody staining in only two patients. Positive immunohistochemical staining using a p53 antibody may detect p53 protein expression, but this may not correlate directly with an underlying mutation in the hot spot region examined.
Continuous single-layer serosubmucosal anastomosis in the upper gastrointestinal tract
Authors: Steele R J C
Published: March 2007

In a 4-year period, 100 anastomoses in the upper gastrointestinal tract were fashioned using a single serosubmucosal layer of continuous polydioxanone. One patient required revisional surgery because of anastomotic stricture after partial gastrectomy, but there was no other complication related to the anastomosis. This technique is simple, safe and quick to perform.
Native and graft pancreatitis following combined pancreas—renal transplantation
Authors: Fernández-Cruz L , Sabater L , Gilabert R , Ricart M J , Saenz A , Astudillo E
Published: March 2007

Ten patients who had undergone whole-organ pancreas transplantation and pancreatoduodenocystostomy from a total of 60 simultaneous cadaveric kidney—pancreas transplants met the criteria for graft pancreatitis. This condition is clearly different from acute rejection on the basis of marked hyperamylasaemia and significant local findings over the allograft. Graft rejection was the cause of graft loss in one of the patients; eight are alive, seven with a functioning graft 61, 30, 27, 25, 21, 18 and 14 months after transplantation. Two patients died: one from severe graft pancreatitis and the other from cytomegalovirus infection. Bladder drainage with or without antibiotics has been the most common therapy, based on the theory that damage is caused by duodenal content and infected urine reflux. To prevent graft loss, antiviral treatment should be given when pancreatitis due to cytomegalovirus is suspected or diagnosed. Two patients with native pancreatitis are also described; the disease was severe and surgery was required in both cases. The pancreas grafts have now been functioning for 2 years 7 months and 2 years 10 months respectively.
Changing trends in the management of extrahepatic cholangiocarcinoma
Authors: Guthrie C M , Haddock G , De Beaux A C , Garden O J , Carter D C
Published: March 2007

A series of 107 patients with cholangiocarcinoma diagnosed between January 1980 and December 1991 is reported. Changing patterns of investigation and treatment in the periods 1980–1985 and 1986–1991 are analysed. There was a decrease in the use of percutaneous transhepatic cholangiography in the second period (86 versus 51 per cent of patients) but increased use of endoscopic retrograde cholangiography (19 versus 71 per cent) and computed tomography (8 versus 59 per cent). The overall resectability rate (17 per cent) was similar to those of other reported series but greater in the second period (8 versus 21 per cent). Palliation by endoscopic and percutaneous stenting was associated with a high incidence of recurrent cholangitis (55 per cent) and jaundice (35 per cent). During the second 6-year period, more effective palliation was achieved by segment III cholangiojejunostomy with a lower incidence of recurrent cholangitis (19 per cent) and jaundice (19 per cent). Overall prognosis for patients with this condition is grim and efforts must usually be aimed at providing the most appropriate palliation.
Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis
Authors: Shirai Y , Tsukada K , Kawaguchi H , Ohtani T , Muto T , Hatakeyama K
Published: March 2007

The effectiveness and long-term results of percutaneous cholecystostomy for acute acalculous cholecystitis are evaluated. Fifteen patients with acute acalculous cholecystitis were treated prospectively by this procedure, using a pigtail catheter successfully placed under ultrasonographic and fluoroscopic guidance. Prompt relief of the signs and symptoms of cholecystitis was achieved in 14 patients. One required emergency cholecystectomy for uncontrolled bleeding after drainage. Another patient underwent prophylactic cholecystectomy before further chemotherapy for leukaemia. The remaining 13 patients required no further surgery. Morbidity and mortality rates were 13 per cent and nil respectively. Long-term follow-up showed no recurrence of cholecystitis after removal of the catheter. Percutaneous cholecystostomy is a safe, effective and usually definitive procedure for the treatment of acute acalculous cholecystitis.
Factors influencing the hyperaemic response after carotid endarterectomy
Authors: Naylor A R , Whyman M R , Wildsmith J A W , McClure J H , McL. Jenkins A , Merrick M V , Ruckley C V
Published: March 2007

Transcranial Doppler ultrasonography was used to evaluate serially the changes in middle cerebral artery blood flow velocity (MCAV) in 37 consecutive patients during the first 72h after carotid endarterectomy to identify factors that may predispose towards postoperative hyperaemia. Within 6 h of endarterectomy, median MCAV in the operated hemisphere was 48 per cent (95 per cent confidence interval 37–60 per cent) above that on admission and remained 27 per cent (95 per cent confidence interval 19–37 per cent) higher at 72h. There was a similar, but less marked, increase in MCAV in the contralateral middle cerebral artery during the same time period. There was no association between the postoperative increase in MCAV and clinical presentation, admission MCAV, the presence or absence of a residual neurological deficit or infarction on computed tomography before operation, carotid clamp time, shunt usage, internal carotid artery stump pressure or MCAV during clamping. The greatest increase in MCAV was observed in patients with internal carotid artery stenosis ⩾ 50 per cent and, more particularly, in those with preoperative evidence of impaired cerebrovascular reserve. In the latter patients, MCAV was 100 per cent above the admission level within 12 h of operation and was still 50 per cent raised at 72 h.
Randomized controlled trial of patch angioplasty for carotid endarterectomy
Authors: Ranaboldo C J , D'sa A A B Barros , Bell P R F , Chant A D B , Perry P M
Published: March 2007

A randomized controlled trial was performed to evaluate patch angioplasty for patients undergoing carotid endarterectomy. There were 213 patient episodes affecting 148 men and 65 women, with 109 allocated to patch angioplasty. Following surgery six patients suffered transient ischaemic attacks but these did not delay discharge from hospital. Six individuals (four patched operations, two not patched) required re-exploration for postoperative haemorrhage and eight (two patched procedures, six not) had potentially serious neurological problems after operation. Of these eight patients, four (none receiving patch angioplasty) underwent re-exploration and in each case a clot was removed and a patch inserted; three of the four made a good long-term recovery. The other four patients suffered completed strokes from which one died. Two further patients (one patched procedure, one not) died after operation from myocardial events, giving an overall 30-day stroke or mortality rate of 2·8 per cent. Objective follow-up assessment with duplex scanning at 1 year was completed by 94·8 per cent of patients; significantly more vessel restenoses and occlusions were observed in those not receiving patches (P < 0·01). Patch angioplasty reduces the number of immediate postoperative complications, and significantly lowers vessel restenosis and occlusion rates at 1 year after operation.
Short myotomy for vigorous achalasia
Authors: Paricio P Parrilla , Martinez de Haro L F , Escandell A Ortiz , Cuenca G Morales , Martinez J Molina
Published: March 2007

Vigorous achalasia has been considered an indication for surgery, in which a thoracic approach is recommended for extending the myotomy along the whole of the oesophageal body to the point where manometry shows high-amplitude waves. Clinical results and postoperative manometric findings in 16 patients with vigorous achalasia undergoing abdominal surgery with myotomy limited to the lower oesophageal sphincter (LOS) were analysed to assess whether extended myotomy is necessary in surgery for this form of achalasia. The clinical results were excellent or good in all cases. Surgery induced a significant decrease (P < 0·01) in the diameter of the oesophagus as determined radiologically. The most significant postoperative manometric changes were a decrease in the resting pressure of the LOS and oesophageal body, a lowering of wave amplitude at all levels of the oesophagus, and a reduction in the proportion of repetitive waves. The results suggest that vigorous achalasia can be treated surgically in the same way as classical achalasia and question, at least from a therapeutic viewpoint, the use of the term vigorous achalasia.
Prognostic value of DNA ploidy in primary gastric leiomyosarcoma
Authors: Suzuki H , Sugihira N
Published: March 2007

The prognostic value of DNA ploidy was evaluated in 25 patients with primary gastric leiomyosarcoma, using paraffin-embedded archival specimens analysed by DNA flow cytometry. Ploidy patterns were diploid in ten tumours and non-diploid in 15. They did not correlate with clinicopathological features of the lesions such as tumour size and grade or mitotic index. A non-diploid pattern was associated with a significantly reduced patient survival rate (P < 0·05), as was higher tumour grade (P < 0·01). Neither tumour size nor mitotic index correlated with patient survival.
Repeat hepatectomy for cancer
Authors: Elias D , Lasser Ph , Hoang J M , Leclere J , Debaenet B , Bognel C , Spencer A , Rougier Ph
Published: March 2007

In a series of 279 hepatectomies performed for cancer between June 1984 and March 1992, 46 were repeat operations, for metastases in 41 patients. The primary tumour was in the colon and rectum (28 patients), APU Doma (five) and miscellaneous (eight). Repeat hepatectomies were performed in 26 per cent of patients who had recurrence after the first liver resection and in 40 per cent of those who had liver recurrence. An unsuspected extrahepatic recurrence was discovered and resected in eight instances and in two other cases a known extrahepatic recurrence was resected during the second hepatectomy. The hospital mortality rate was 2 per cent (one patient); the death was from nosocomial pneumonia. The total morbidity rate including minor complications was 32 per cent, with a higher frequency of haemorrhagic problems after secondary liver resection (12 per cent) than after primary hepatectomy (5 per cent). The rate of postoperative complications after repeat hepatectomy was related significantly to operative blood loss greater than 1500 ml(P = 0·04). The technical problems of repeat hepatectomy were: (1) re-exposure of the liver, considered to be difficult in 67 per cent of second liver resections and 80 per cent of third procedures; (2) the liver parenchyma, which often had histological modifications between first and second resections and was more difficult to ‘work’ as shown by the mean duration of clamping of the hepatic pedicle (54 min for secondary versus 36 min for primary liver resection); and (3) modification of the intraparenchymal vasculobiliary anatomy following liver regeneration after major hepatectomy. Intraoperative ultrasonography was of great benefit. Rates of crude and recurrence-free survival were relatively encouraging at 47 and 33 per cent 3 years after the second liver resection for the whole group. These values were lower for colorectal cancer (37 and 21 per cent 3 years after the second hepatectomy). These figures do not, however, convey the complete picture of the outcome for these patients. During the same follow-up period, 143 recurrences were detected and a mean of 2·9 resections per patient were performed. The indications for repeat hepatectomy are still to be clarified, although the surgical technique is safe.
Haemostasis after partial hepatectomy using argon beam coagulation
Authors: Postema R R , Plaisiert P W , Ten Kate F J W , Terpstra O T
Published: March 2007

The argon beam coagulator is a new device for haemostasis during and after surgery on parenchymatous organs. No data are available on its efficacy and tissue effect following hepatic resection. Blood loss, the time needed to achieve adequate haemostasis and histological findings after liver resection were assessed in 12 pigs using argon beam coagulation or suture ligation only, the mattress suture technique and tissue glue application. The treatment was randomly assigned to each of the four liver lobes in each pig. Median blood loss following argon beam coagulation was 13 (range 2–47) ml and after simple suture ligation 55 (range 2–260) ml (P < 0·02). The median time needed for adequate haemostasis following argon beam coagulation was 3 (range 2–7) min versus 14 (range 2–48) min in the control group (P < 0·005). There was no difference between argon beam coagulation and tissue glue, which were both superior to the use of mattress sutures. Argon beam coagulation resulted in less tissue damage than tissue glue or mattress suturing. The argon beam coagulator is an efficient device for achieving haemostasis following partial hepatectomy in the pig. It causes only a moderate tissue reaction.
Laparoscopic ultrasonography for hepatobiliary and pancreatic malignancy
Authors: Cuesta M A , Meijer S , Borgstein P J , Mulder L Sibinga , Sikkenk A C
Published: March 2007

Despite the advances made since the introduction of ultrasonography, computed tomography and magnetic resonance imaging, a wide discrepancy may occur between preoperative and peroperative staging of gastrointestinal malignancy with liver and peritoneal metastases. Diagnostic laparoscopy performed immediately before a planned laparotomy can provide valuable information for the accurate assessment and appropriate management of some forms of gastrointestinal malignancy, especially that of the liver and pancreas. For evaluation of small liver and retroperitoneal malignancies, intraoperative ultrasonography performed by laparotomy is of proven value. It is now technically possible to perform ultrasonography through a laparoscopic cannula using high-resolution ultrasonographic transducers. This combination of laparoscopy and ultrasonography was studied in 25 patients with established liver lesions, carcinoma of the gallbladder or pancreatic cancer. Additional information leading to a change in surgical approach was obtained in 20 patients. Laparoscopic ultrasonography, although still in a preliminary phase of development, is a simple and reliable technique that will contribute to more accurate staging of intra-abdominal malignancy.
Carcinoma of the pancreas and periampullary region: Palliation versus cure
Authors: Klinkenbijl J H G , Jeekel J , Schmitz P I M , Rombout P A R , Nix G A J J , Bruining H A , van Blankenstein M
Published: March 2007

A retrospective study of 310 patients with carcinoma of the head of the pancreas or periampullary region was performed. Preoperative bile drainage by placement of a stent reduced the number of postoperative complications, especially bleeding (P = 0·03). The operative mortality rate was nil in patients with periampullary cancer aged under 70 years and 23 per cent in those over 70 years of age (P < 0·001). In the last 2 years of the study, the mortality rate following resection decreased to 2 per cent. Tumour-containing resection margins did not influence survival after resection (P = 0·48). Tumour dimension of pancreatic and periampullary cancer and the presence of tumour in locoregional lymph nodes (N1a) resected with the primary tumour in cancer of the head of the pancreas were of no prognostic value. Following palliative resection of carcinoma of the pancreatic head, median survival was significantly better than when no resection was performed (10·1 versus 3·9 months, P < 0·001). In conclusion, even palliative resection may benefit some patients. Preoperative bile drainage is indicated in those with jaundice. Resection should be performed, irrespective of tumour size, provided that the unit's operative mortality rate is sufficiently low.
Randomized controlled trial comparing laparoscopic and open appendicectomy
Authors: Kum C K , Ngoi S S , Goh P M Y , Tekant Y , Isaac J R
Published: March 2007

A study was carried out of 137 patients with a diagnosis of acute appendicitis who were randomized to either laparoscopic or open appendicectomy. Patients found to have perforated or normal appendices at histological examination were excluded. Fifty-two patients undergoing laparoscopic appendicectomy and those receiving 57 open procedures were analysed. Laparoscopic appendicectomy took no longer than the open procedure (mean 43 versus 40 min). The number of doses of pethidine (1 mg per kg body-weight) required in the immediate postoperative period did not differ between the two groups but the mean number of doses of oral analgesic (naproxen sodium 550 mg twice daily) required was less in patients undergoing laparoscopic appendicectomy (2·8 versus 5·0, P < 0·05). There was no significant difference between time to resumption of fluid and diet intake and length of hospital stay. There were five (9 per cent) wound infections after open appendicectomy compared with none after the laparoscopic operation (P <0·01). Patients who underwent laparoscopy returned to full home (17 versus 30 days, P < 0·01) and social (19 versus 32 days, P < 0·05) activities earlier than those who underwent open operation. Laparoscopic appendicectomy may allow reduction in the number of wound infections and earlier return to normal activities.
Follow-up after inguinal herniotomy or surgery for hydrocele in boys
Authors: Morecroft J A , Stringer M D , Higgins M , Holmes S J K , Capps S N J
Published: March 2007

A retrospective review of 556 boys who had undergone inguinal herniotomy or surgery for hydrocele was carried out to assess the value of early routine postoperative follow-up. Of 386 children given an appointment, 319 (82·6 per cent) attended. The testis was no longer palpable in the normal scrotal position in 12 boys; eight were normal on further review and four required orchidopexy. Six hydroceles, all of which resolved, and four contralateral hernias were detected. Nineteen boys (4·9 per cent) were referred later with recurrent hernia (two patients), ipsilateral high testis (two), or contralateral hernia or hydrocele (15). Of 170 children not given a routine appointment, ten (5·9 per cent) were subsequently referred back with a transient hydrocele (two) or a contralateral hernia (eight). After a total of 440 appointments, eight boys (1·8 per cent) were found to have a significant abnormality. The rate of referral back to hospital was similar in both groups. Early discharge would make more efficient use of outpatient resources without significantly affecting overall outcome.
Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis
Authors: Nugent K P , Farmer K C R , Spigelman A D , Williams C B , Phillips R K S
Published: March 2007

Twenty-four patients with familial adenomatous polyposis who had previously undergone prophylactic colectomy and had advanced duodenal polyposis were entered into a randomized trial to assess the effect of the non-steroidal anti-inflammatory drug sulindac on duodenal and rectal polyps. Polyp size and number were assessed by videotaped duodenoscopy (and rectoscopy in 14 patients) at entry and after 6 months of treatment; the tapes were compared by two assessors who were unaware of the randomization and the shuffled chronological order of the recordings. Mucosal cell proliferation was measured by in vitro incorporation of 5-bromo-2′-deoxyuridine. Sulindac therapy was associated with a reduction in epithelial cell proliferation in the duodenum (median labelling index (LI) 15·8 versus 14·4 per cent, P = 0·003) and a trend towards duodenal polyp regression (P = 0·12). In the rectum, cell proliferation showed a marked reduction (median LI8·5 versus 7·4 per cent, P = 0·018), and significant (P = 0·01) polyp regression was seen. Rectal polyposis was less severe than that in the duodenum and responded more dramatically. Sulindac is a possible treatment for patients in whom rectal polyps have failed to show significant regression after ileorectal anastomosis and who are unsuitable for pouch surgery; it may be useful in early duodenal polyposis or as an adjunct after duodenal clearance.
Immunoproliferative small intestinal disease: Mediterranean lymphoma and α heavy chain disease
Authors: Martin I G , Aldoori M I
Published: March 2007

Gastrointestinal lymphoma, uncommon in the West, is far more prevalent in developing countries where it falls into two groups: ‘Western’-type lymphomas, similar to those seen in developed countries, and the so-called Mediterranean-type lymphoma. It is now accepted that Mediterranean lymphoma represents, in the majority if not in all cases, the late stage of α heavy chain disease (α-HCD). This disease is characterized by abnormal secretion of an immunoglobulin fragment; α-HCD and Mediterranean lymphoma constitute two ends of a spectrum of pathology now classified as immunoproliferative small intestinal disease (IPSID). IPSID is associated predominantly with poor socioeconomic conditions; patients present with progressive malabsorption in the second and third decades of life. Diagnosis is established by small bowel biopsy, with or without high serum levels of the α heavy chain protein. Treatment consists of an initial staging laparotomy, with debulking of lymphomatous deposits if appropriate, followed by chemotherapy or radiotherapy. Overall prognosis is poor but the recent use of doxorubicinbased chemotherapy offers some hope for the future.
Clinical significance of venous reflux detected by duplex scanning
Authors: Payne S P K , London N J M , Jagger C , Newland C J , Barrie W W , Bell P R F
Published: March 2007

Duplex scanning was used to determine the presence of valvular incompetence in the major veins of 274 legs with venous disease. Using multivariate logistic regression analysis the significance of valvular function in each vein in relation to the clinical condition of the limb was calculated. Superficial femoral, profunda femoris and short saphenous vein function did not correlate with the clinical state of the limb; common femoral, popliteal and long saphenous vein function did. A table was constructed from the statistical model such that the relative contribution made by each vein could be estimated for limbs with different patterns of venous insufficiency. This model should now be tested in a prospective study and, if validated, could be used to improve decision making in venous surgery.
Role of completion angioscopy in detecting technical error after carotid endarterectomy
Authors: Gaunt M E , Naylor A R , Ratliff D A , Bell P R F
Published: March 2007

Completion fibreoptic angioscopy was performed in 30 consecutive patients after carotid endarterectomy. The aim was to evaluate the potential role of angioscopy as a quality-control technique. Major abnormalities (two intimal flaps, two large thrombi) were identified in four patients and minor adherent thrombus was encountered in five. All abnormalities were corrected before restoration of flow. This preliminary experience suggests that completion angioscopy merits further study as a method for the intraoperative detection of potentially harmful lesions after carotid endarterectomy.