bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of a hemoglobin index determined by electronic endoscopy in the diagnosis of helicobacter pylori gastritis
Authors: Toyota Yoshio , Honda Hirohito , Omoya Toshihiro , Inayama Kumi , Suzuki Masaharu , Kubo Kenichirou , Nakasono Masahiko , Muguruma Naoki , Okamura Seisuke , Shimizu Ichirou , Ii Kunio , Ito Susumu
Published: March 2003

Background:

In patients with Helicobacter pylori infection, gastric endoscopy usually shows diffuse mucosal redness that disappears after successful H. pylori eradication. However, some infected patients do not show such redness. Therefore, disagreement continues concerning the need for gastric endoscopy in suspected H. pylori infection.

Methods:

Usefulness of a hemoglobin index (IHb) in diagnosis and follow up of H. pylori gastritis was examined endoscopically and histopathologically.

Results:

Patients with infection showed a higher mean IHb than those without infection (70.0 ± 10.0 vs 54.3 ± 4.7, P < 0.0001). Sensitivity, specificity and accuracy of IHb for diagnosing H. pylori infection based on a cutoff value of 60 was higher than for the endoscopist's evaluation of diffuse redness (sensitivity 95.7 vs 92.6%, specificity 82.4 vs 66.6%, accuracy 93.0 vs 87.2%). Hemoglobin indices also reflected histolosically evident mucosal inflammatory changes more closely than did the endoscopist's evaluation. Hemoglobin indices significantly decreased after H. pylori eradication, as did histologic findings of mucosal congestion and numbers of erythrocytes in foveolae. Both histologic findings correlated positively with hemoglobin indices.

Conclusion:

The IHb is an objective endoscopic measure of mucosal inflammation that is useful in the diagnosis and follow up of H. pylori gastritis.
Pancreatic cancer evaluated by contrast‐enhanced color doppler endoscopic ultrasonography
Authors: Ueno Norio , Ozawa Y
Published: March 2003

We performed contrast‐enhanced color Doppler endoscopic ultrasonography in a 78‐year‐old patient with pancreatic cancer. Extracorporeal ultrasound demonstrated dilatation of both the intra‐ and extrahepatic bile ducts; however, the cause of obstructive bile‐duct change was not clarified. Endoscopic ultrasonography was performed in the routine manner and demonstrated a small tumor in the head of the pancreas. Before Levovist administration, there were no color signals detected in either the tumor or the pancreatic parenchyma. After administration of the agent, color signals began to emerge only in the pancreatic parenchyma surrounding the cancer tumor. There was still a lack of color signals inside the tumor. It is suggested that detailed hemodynamic changes that were not apparent by the conventional method could be identified by the contrast method under endoscopic ultrasonography.
EXPANDABLE METALLIC STENT‐ASSISTED BILIARY LITHOTRIPSY IN PATIENTS WITH BILLROTH II GASTRECTOMY
Authors: MINAMI ATSUSHI
Published: March 2003

The difficulty in orienting a duodenoscope or sphincterotome in Billroth II gastrectomy patients with an afferent loop is well known to experienced biliary endoscopists. Endoscopic papillary balloon dilation (EPD) can be particularly useful in this group of patients. However, while EPD is relatively simple, lithotripsy afterward is difficult. To address this point, a new technique was developed to gain and preserve access to the common bile duct (CBD). This new technique, expandable metallic stent‐assisted biliary lithotripsy (EMS‐L), utilizes a self‐expandable metallic stent to dilate the major duodenal papilla and preserve access to the CBD. In three patients who had previously undergone a Billroth II gastrectomy, EMS‐L was attempted and was successful. No previous reports of EMS‐L in Billroth II gastrectomy patients are available.
Comparison of the effects of intravenous infusion of omeprazole and H2‐receptor antagonists on intragastric pH in bleeding duodenal ulcer patients
Authors: Bihui Zhong , Yuhong Yuan , Minhu Chen , Jinkun Lin , Pinjin Hu
Published: March 2003

OBJECTIVE: To evaluate the effects of intravenous infusion of omeprazole and H2‐receptor antagonists on 24‐h intragastric pH levels in patients with bleeding duodenal ulcers.

METHODS: Fifty patients with active bleeding duodenal ulcers were randomly assigned to receive one of four treatment regimens: 40 mg omeprazole by intravenous infusion every 12 h, 40 mg famotidine intravenously every 12 h, 50 mg ranitidine intravenously every 6 h, 200 mg cimetidine intravenously every 6 h. Intragastric pH values were monitored in each subject at the baseline level and continuously for 24 h after treatment.

RESULTS: Only the omeprazole group produced mean and median intragastric pH values of above 6. The famotidine group had mean and median intragastric pH values above 4. In the other two groups, pH values were both below 4. The mean percentages of time that intragastric pH levels were < 4, < 5 and < 6 over the 24 h period in each of the treatment groups were found to increase in the following order (smallest percentage to largest percentage): omeprazole, famotidine, ranitidine and cimetidine.

CONCLUSIONS: The effect of intravenous use of omeprazole in active duodenal ulcer bleeding is superior to that of H2‐receptor antagonists and the increase in intragastric pH is maintained for a longer period.
Clinical implications and prevalence of cagA, cagE and cagT genes in the pathogenicity island of Helicobacter pylori strains isolated from Shanghai patients
Authors: Li Xiaobo , Liu Wenzhong , Xu Weiwen , Shi Yao , Xiao Shudong
Published: March 2003

OBJECTIVE: The cag pathogenicity island (cag PAI) has been reported to be the major factor controlling the virulence of Helicobacter pylori and has been associated with clinical outcome after H. pylori infection. The role of cag PAI genes in the pathogenicity of H. pylori infection remains to be established. The aim of the present study was to investigate: (i) the prevalence of cagA, cagE and cagT, the representative genes of cag PAI status, in H. pylori strains isolated from patients with various gastroduodenal diseases in the Shanghai region; and (ii) the relationship between the presence of these genes and different gastroduodenal diseases.

METHODS: Ninety‐nine H. pylori strains were isolated from patients with chronic superficial gastritis (17), chronic atrophic gastritis (21), gastric ulcers (19), duodenal ulcers (23) and gastric cancer (19). The prevalence of the cagA, cagE, and cagT genes was studied in these strains by using the polymerase chain reaction (PCR) method.

RESULTS: The total prevalences of cagA, cagE and cagT genes were 84.8, 99 and 84.8%, respectively, in the 99 strains of H. pylori tested. There was no significant difference in the prevalence of cagA, cagE or cagT in H. pylori isolated from different gastroduodenal diseases (all P > 0.05). Of the 98 cagE‐positive isolates, 14 (14.3%) were cagA negative. Only one of 99 isolates was negative for both cagE and cagA. Of the 84 cagT‐positive strains, two were cagA negative.

CONCLUSIONS: Most of the H. pylori isolates in the Shanghai region may have intact cag PAI. It was found that cagE, but not cagA, could be used as a marker for the presence of cag PAI. There is no correlation between the integrity of cag PAI and the clinical outcome after infection with H. pylori.
Effects of γ‐interferon gene‐modified hepatocytes on murine implanted liver carcinoma
Authors: Leng Jianhang , Zhang Lihuang , Yao Hangping , Cao Xuetao
Published: March 2003

OBJECTIVE: Cancer immunotherapy and gene therapy are attractive approaches that have been widely investigated in different types of cancer. The present study examined the therapeutic effects of intrasplenically transplanted γ‐interferon (IFN‐γ) gene‐modified hepatocytes on murine implanted liver carcinoma.

METHODS: Embryonic murine hepatocytes (BNL.CL2) were transfected with a recombinant adenovirus encoding IFN‐γ; two cell lines, BNL.LacZ and BNL.CL2, were used as controls. One week after intrasplenic C26 (colon carcinoma) cells were injected, 60 tumor‐bearing syngeneic mice underwent the intrasplenic transplantation of IFN‐γ gene‐modified hepatocytes and were divided into treatment (BNL.IFN‐γ) and control groups (BNL.LacZ and BNL.CL2). Two weeks later, the serum levels of IFN‐γ, tumor necrosis factor‐α (TNF‐α) and nitric oxide (NO) in the implanted liver carcinoma‐bearing mice were assayed, the cytotoxicity of splenic cytotoxic T lymphocytes (CTL) were measured, and the mor‐phology of the hepatic tumors was studied to evaluate the therapeutic effects of the treatment.

RESULTS: In the treatment group, the serum levels of IFN‐γ, TNF‐α and NO increased significantly (P < 0.01), and the splenic CTL activity also increased markedly (P < 0.01), accompanied by a substantial decrease in tumor volume and an increase in survival.

CONCLUSIONS: These data indicate that the IFN‐γ recombinant adenovirus was able to exert potent therapeutic effects and that the intrasplenic transplantation of adenovirus‐mediated IFN‐γ gene‐ modified hepatocytes could be used as a treatment for implanted liver carcinoma.
Influence of NG‐nitro‐L‐arginine methyl ester and L‐arginine on gastric mucosal tolerant cytoprotection under stress
Authors: CUI Zhong Min , LI Zhao Shen , XU Guo Ming , ZHAN Xian Bao
Published: March 2003

OBJECTIVE: To determine the role of endogenous nitric oxide (NO) in gastric mucosal tolerant cytoprotection under stress and its possible mechanism.

METHODS: Sprague–Dawley rats were exposed to repeated water immersion
and restraint stress (WRS), during which NG‐nitro‐L‐arginine
methyl ester (L‐NAME), a non‐selective NO synthase inhibitor, and
L‐arginine (L‐Arg), a substrate for NO synthesis, were administered to inhibit or promote the synthesis of endogenous NO, respectively. Gastric mucosal blood flow (GMBF) was measured with an LDF‐3 Flowmeter (Electronic Instrument Factory of Nankai University, Tianjin, China), the NO level in the gastric mucosa was monitored by the Griess reaction and gastric mucosal lesions were evaluated using the ulcer index (UI). The relationships between changes in GMBF, UI and NO content in the gastric mucosa were analyzed by linear correlation analysis.

RESULTS: Repeated WRS induced gastric mucosal tolerant cytoprotection and
this was accompanied by increased GMBF and NO levels in the gastric mucosa. Inhibition
of endogenous NO synthesis by L‐NAME worsened mucosal lesions induced
by single WRS and, after repeated WRS, the adaptive incremence in GMBF was abolished
and the NO content in the gastric mucosa was significantly reduced. In contrast,
enhancement of endogenous NO synthesis by L‐Arg attenuated mucosal erosions caused by single WRS. After repeated WRS, GMBF and the NO content in the mucosa increased gradually. Mucosal lesions were negligible after rats were exposed to the fourth WRS.

CONCLUSIONS: During the tolerant cytoprotection, GMBF, UI and the NO content
showed regular changes and there were good relationships between them. L‐NAME
and L‐Arg changed the levels of endogenous NO, which, accordingly, affected GMBF and the gastric tolerance. By regulating GMBF, endogenous NO may play an important role in the gastric mucosal tolerant cytoprotection under stress. Inhibition of the synthesis of NO delayed the induction of tolerant cytoprotection, whereas increased NO synthesis promoted cytoprotection.
Value of the p53 protein for diagnosing cancer in pancreatic cells obtained by endoscopic pancreatic duct brushing
Authors: LI Zhao Shen , LIU Feng , XU Guo Ming , SUN Zhen Xing , ZHOU Guo Xiong , MAN Xiao Hua
Published: March 2003

OBJECTIVE: To investigate the value of the p53 protein for diagnosing cancer in pancreatic cells obtained by using endoscopic pancreatic duct brushing.

METHODS: Immunohistochemical methods were used to assay the amount of p53 protein in cytological specimens. The results were compared with those obtained by hematoxylin and eosin (H&E) staining.

RESULTS: Detection of the p53 protein by staining cytological specimens with H&E diagnosed pancreatic cancer with 53% sensitivity, 100% specificity and 70% accuracy. Using immunohistochemical methods, pancreatic cancer was diagnosed with 59% sensitivity, 100% specificity and 74% accuracy. The methods in combination produced a test with 71% sensitivity, 100% specificity and 81% accuracy.

CONCLUSIONS: Hematoxylin and eosin staining combined with p53 protein detection in cells obtained by using endoscopic pancreatic duct brushing is a useful tool in the diagnosis of pancreatic cancer, and in the differentiation of benign and malignant pan­creatic disease.
FHIT alterations in human esophageal, gastric and colorectal carcinomas
Authors: YU Hong Gang , SUN Lai Bao , YU Bao Ping , LUO He Sheng , YU Jie Ping
Published: March 2003

OBJECTIVE:  To assay alterations in the fragile histidine triad (FHIT) gene in human esophageal, gastric and colorectal carcinomas.

METHODS:  Carcinomatous tissues from 93 patients with digestive tract carcinoma (including 21 esophageal, 43 gastric and 32 colorectal carcinomas) and neighboring non‐carcinomatous tissues were examined in addition to 18 normal tissue samples. From the above tissue samples, RNA was extracted using guanidinium thiocyanate−phenol−chloroform. FHIT gene transcripts were amplified by using nested reverse transcription−polymerase chain reaction (RT‐PCR).

RESULTS:  Only wild‐type transcripts of the FHIT gene were found in the 18 normal tissue samples. Wild‐type FHIT gene transcripts were found in most carcinoma tissues, with the exception of seven cases (including two esophageal cancers, three gastric carcinomas and two colorectal carcinomas). In addition, abnormal FHIT transcripts were obtained from 33.3% of esophageal carcinomas, 51.7% of gastric carcinomas and 31.3% of colorectal carcinomas. Abnormal FHIT transcripts were obtained from neighboring tissue from 4.8, 20.9 and 9.4% of esophageal, gastric and colorectal carcinomas, respectively. The proportion of abnormal FHIT transcripts in carcinomatous tissues was significantly higher (P < 0.05) than that in neighboring non‐carcinomatous tissues and normal tissues.

CONCLUSION:  The proportion of abnormal FHIT cDNA in carcinomatous tissue is greater than that in non‐carcinomatous tissues, which suggests that transcripts of abnormal FHIT genes are related to the occurrence and development of carcinomas in the digestive tract.
Inhibitory efficacy of local angiostatin expression in treatment of human hepatic carcinoma cells
Authors: WU Jing , ZHANG De Xin , YANG Jing Hua , FAN Dai Ming
Published: March 2003

OBJECTIVE: To study the efficacy of local therapy using overexpression of the mouse angiostatin gene to treat human hepatic carcinoma. To investigate the mechanism of any therapeutic effect.

METHODS: Full‐length mouse angiostatin cDNA was directly cloned into the eukaryotic expression plasmid pcDNA3.1(+). The recombinant plasmid was used to transfect HCC7721 human hepatic carcinoma cells (experimental group). The vector control group cells were transfected with pcDNA3.1(+), and the mock control group was not exposed to the plasmid. Angiostatin expression at the mRNA and protein levels was detected by using RNA dot blots and fluorescence‐activated cell sorter (FACS), respectively. Cell growth in vitro was assayed with thiazoyl blue tetrazolium bromide and cell cycle distributions were analyzed with FACS. Angiostatin‐expressing cells and the vector control cells were transplanted subcutaneously into nude BALB/c mice and tumor volumes were measured after 30 days. Microvessel densities (MVD) and angiostatin expression in the tumor tissues were detected by using immunohistochemical staining with the primary anti‐vWF and anti‐HA antibodies, respectively.

RESULTS: The pcDNA3.1(+)‐angio recombinant eukaryotic expression plasmid was successfully constructed. No significant differences existed in cell morphology, cell growth curve and cell cycle distributions among the three study groups in vitro. However, markedly smaller tumor volumes, lower microvessel densities in tumor tissues, and stronger angiostatin‐positive staining were observed in the experimental group relative to the control group, indicating reduced tumorigenesis associated with angiostatin overexpression in vivo.

CONCLUSIONS: Mouse angiostatin did not directly inhibit human hepatic carcinoma cell growth and proliferation in vitro. However, local production of angio­statin effectively inhibited tumorigenesis of HCC7721 in vivo, probably because of inhibition of tumor angio­genesis via a paracrine pathway. Transfer of the angiostatin gene may be an effective new approach to the treatment of hepatic carcinoma.
Etiological analysis of chronic pancreatitis in 215 cases
Authors: QIAN Jia Ming , LI Jing Nan , TIAN Zi Li , LU Hong , TAO Li Ping
Published: March 2003

OBJECTIVE:  To investigate the etiology of chronic pancreatitis in China.

METHODS:  The causes of 215 cases of chronic pancreatitis treated at Peking Union Medical College Hospital between 1990 and 2000 were analyzed retrospectively.

RESULTS:  The causes of chronic pancreatitis were biliary diseases (36.7%), alcoholic (26.5%), idiopathic (30.2%), and other uncommon causes such as auto­immune disease, recurrent acute pancreatitis, trauma and heredity. Among biliary diseases, the most common cause was cholecystolithiasis, followed by bile duct stone and cholecystitis.

CONCLUSIONS:  The main cause of chronic pancreatitis in China is biliary disease. That caused by ethanol is increasing, and autoimmune disease is also receiving increasing attention.
Gene transfer of human vascular endothelial growth factor 165 for prevention of stent restenosis after transjugular intrahepatic portosystemic shunt
Authors: LI Zi Jun , CHENG Xiao Ming , HU Ping Jin , LUO Peng Fei , QIAO Hui , LIN Qiu Xiong , WANG Qi Yi
Published: March 2003

OBJECTIVE:  To test the hypothesis that locally directed gene transfer of human vascular endothelial growth factor 165 (hVEGF165) is able to passivate hepatic venous metallic stents by accelerating endo­thelialization and augmenting the biocompatibility of endovascular stents.

METHODS:  Complexes of pAdtrackCMV‐hVEGF165 and lipofectamine were smeared homogeneously on the surface of the stents coated with poly‐L‐lysine. Bare stents were used as controls. All stents were implanted into the right hepatic vein by transjugular intrahepatic venous stent deployment.

RESULTS:  At the end of the first week after implantation, green fluorescence and the expression of the hVEGF165 gene were detected in the transferred stent vessels of the treated group, but were not detected in the control group. Scanning electron microscopy revealed that the endothelialization of stents was more pronounced in the treated group than that in the control group. At the end of the eighth week after implantation, quantitative angiography analysis showed the internal diameter of the stent was significantly greater in the treated group than in the control group. The de novo intima, their mean areas and percentage cross‐sectional area narrowing in the treated group were significantly less than those in the control group. Immunohistochemical analysis indicated that the proliferation of vascular smooth muscle cells was more active in the control group than that in the treated group.

CONCLUSION:  Local gene transfer of hVEGF165 can passivate endovascular stents by accelerating stent endothelialization and enhancing their biocompatibility in the hepatic vein, resulting in a reduction of thrombus formation and attenuation of intimal hyperplasia.
Retrospective study on the need of intensive care unit admission after major head and neck surgery
Authors: To Edward W. H. , Tsang Wai M. , Lai Eric C. H. , Chu Ming C.
Published: March 2003

Background: The present article aims to study the pattern and need of Intensive Care Unit admission after major head and neck operations.

Methods: A retrospective study was undertaken of the hospital records of patients who underwent major head and neck operations during the period from February 1997 to February 2000 at the Division of Head and Neck Surgery, Department of Surgery, the Chinese University of Hong Kong.

Results: A total of 268 consecutive elective major operations were carried out over the 3 year period. The patients’ age ranged from 14 to 82 years with a mean of 55 years. The male to female ratio was 4:1.

Forty‐seven patients underwent an operation with a combination of major resection, neck dissection, flap reconstruction and tracheostomy (‘flaps group’). Two hundred and twenty‐one patients had major head and neck operations without the need of flap reconstruction (‘non‐flaps group’). Three (6.3%) out of 47 patients (flaps group) were admitted to intensive care unit (ICU) immediately after the operation. Only one patient (2.2%) out of the remaining 44 patients was admitted for emergency treatment 3 weeks post operation. All four patients recovered uneventfully.

In the non‐flaps group of 221 patients, there were 12 (5.4%) planned admissions and 2 (0.96%) unplanned admissions to ICU. In the group of planned admissions, one out of the 12 patients died. The other two patients who were not planned for ICU admission died of basal meningitis that was disease‐related rather than related to the intensity of postoperative care. The overall admission rate to ICU was 18 (6.7%) out of 268 patients. The overall mortality was 1.1% (one planned, two unplanned).

Conclusion: The present study showed that it is safe and cost‐effective to discharge the majority of patients after major head and neck operations back to a specialist ward for nursing care.
The internet: From basics to telesurgery
Authors: Hall John C.
Published: March 2003

The exponential growth in information technology is resulting in a rapid increase in the ability to develop useful applications on the Internet. The purpose of the present article is to provide a brief review of the Internet with a consideration of its relevance to surgeons. This review is intended to indicate a range of relevant issues, rather than to discuss any specific topic in depth. It is becoming difficult for surgeons to reach their full potential unless they exploit Internet‐based activities. This is because the ability to rapidly capture information of quality is an essential ingredient in a reflective approach to surgical problems. More futuristic is the prospect of using computer‐based technology to operate upon patients from a distance (telesurgery).
Proximal femoral osteotomy for the treatment of hip arthritis in young adults
Authors: Devane Peter A. , Coup Robert , Horne J. Geoffrey
Published: March 2003

Background: The outcome of proximal femoral osteotomy for hip arthritis in young adults performed at the Wellington Hospital (Wellington, New Zealand) was reviewed.

Methods: Seventeen patients underwent 21 proximal femoral osteotomies for the treatment of hip arthritis at Wellington Hospital between 1992 and 1999. Thirteen patients (17 hips) were contacted and were able to complete a questionnaire form specific for hip pain and function.

Results: There was a response rate of 76.5% (13 out of a possible 17 patients undergoing proximal femoral osteotomy) at a mean 3 years 4 months postoperatively. Of these, one patient has had a total hip joint replacement and one patient is currently on the waiting list for a total hip joint replacement. Three other patients (three hips) report moderate or severe hip pain. The remaining eight patients (12 hips) report having mild or no hip pain. Questionnaire results show a postoperative decrease in hip pain in most patients. Hip function as assessed by the questionnaire was essentially unchanged.

Conclusions: Proximal femoral osteotomy is a satisfactory option for young patients with degenerative hip arthritis. The operation is only likely to be useful in the treatment of pain.
Pattern of management of common bile duct stones in the laparoscopic era: A NSW survey
Authors: Dias Maxwell M. , Martin Christopher J. , Cox Michael R.
Published: March 2003

Background: The management of common bile duct (CBD) stones in the laparoscopic era remains controversial with various management strategies employed by surgeons. The aim of this study was to ascertain the common practice across a single Australian state, and to see if a ‘best practice’ for CBD stone management could be established.

Methods: A questionnaire was sent to 390 general surgeons in New South Wales in April 1999. Data collected included the type of practice, number of cholecystectomies performed, preoperative markers of CBD stones, indications for preoperative endoscopic retrograde cholangiopancreatography (ERCP), use of operative cholangiography (OC) and the management of CBD stones found on OC.

Results: The questionnaire was returned by 223 (57%) surgeons. Fifty‐four (14%) of these respondents were excluded as they did not perform laparoscopic cholecystectomy, leaving 169 (43%) respondents for analysis. The preoperative indicators for CBD stones were ranked as: jaundice > dilated CBD on ultrasound > serum bilirubin > serum alkaline phosphatase/alanine aminotransferase > previous biliary pancreatitis. Preoperative ERCP would be performed by 88% for persistent jaundice or cholangitis, 33% for elevated liver function test, 25% for dilated CBD and 24% for biliary pancreatitis. Operative cholangiography is routinely performed by 67%, selectively by 29% and never by 4%. If CBD stones are encountered 47% would attempt laparoscopic clearance via the cystic duct or choledochotomy; however, 72% replied that they would use postoperative ERCP as part of their usual strategy for the management of CBD stones.

Conclusions: There was no clear common pattern for the management of suspected or proven CBD stones. There were three management issues in which there was a ‘common practice’. These were: (i) the use of preoperative ERCP for patients with persistent jaundice or cholangitis; and the routine use of (ii) OC and (iii) postoperative ERCP to clear the CBD, assuming other methods had failed.
Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin
Authors: Sangthawan Pornpen , Fox Jane , Atkins Robert C. , Kerr Peter G.
Published: March 2003

Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied.

Methods: The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year.

Results: In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25–70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25–18.5 years). Eighty‐seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had ‘dense mammograms’, all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study.

Conclusion: The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.
Laparoscopic transcystic bile duct stenting in the management of common bile duct stones
Authors: Martin Christopher J. , Cox Michael R. , Vaccaro Lisa
Published: March 2003

Background: The management of patients with common bile duct stones associated with stones in the gall bladder remains controversial.

Methods: Over the three‐year period from 1996 to 1999, patients with cholelithiasis and known choledocholithiasis, or choledocholithiasis found at laparoscopic cholecystectomy, were initially treated by placing a stent across the sphincter of Oddi. The stent was pushed along a guide wire through the cystic duct and then down the common bile duct, before the cystic duct was closed. Subsequently, the stent was used to facilitate performance of a needle knife endoscopic sphincterotomy. The stent was then removed, a cholangiography was performed and the common bile duct was cleared. Patients with persistent jaundice usually had a preoperative endoscopic retrograde cholangio‐pancreatography.

Results: Transcystic stenting was the ‘intention‐to‐treat’
basis of therapy for 56 of the patients. The placement of the stent only failed once
when the stent became trapped in the cystic duct. Complications of the operation
included: pain and jaundice (n = 2), cholangitis (n = 1), and pulmonary
embolus (n = 1). The median postoperative hospitalization was 2 days (range: 1–15). Five further patients had common bile duct stones removed via a choledochotomy; a stent was placed through the choledochotomy before its closure. The selective common bile duct cannulation rate at the first endoscopic retrograde cholangio‐pancreatography, was 98%. A second endoscopic retrograde cholangio‐pancreatography was required in 15% of patients. The only complication of all the endoscopic procedures was a single case of mild cholangitis; there were no cases of pancreatitis.

Conclusion: A treatment option open to all surgeons for non‐jaundiced patients with known choledocholithiasis or choledocholithiasis found at operative cholangiogram, is the transcystic stenting of the sphincter of Oddi at the time of laparoscopic cholecystectomy. At a subsequent sitting, the common bile duct can be safely cleared endoscopically using a sphincterotomy facilitated by the stent.
Bone spurs: Mechanism of production of different shapes based on observations in Dupuytren’s diathesis
Authors: Thurston Alan J.
Published: March 2003

Bone spur formation on the shaft of the middle phalanx of the little finger was an incidental finding during surgical treatment of five cases of Dupuytren’s contracture. The presence of such spurs in Dupuytren's contracture is not adequately explained in the literature. In areas of high tensile stress, such as the attachments of fascia and fibrous cords, bone remodels to reduce stress concentration and to make the stress transfer from one tissue to the other as smooth as possible. It cannot be regarded as the same process that is seen in heterotopic calcification in other sites in the body, and should be regarded instead as a physiological bone response to tensile stresses rather than a change intimately coupled with Dupuytren’s disease.
Primary melioidotic prostatic abscess: Presentation, diagnosis and management
Authors: Tan James K. , Yip Sidney K. H. , Png Damian J. C. , Moorthy P.
Published: March 2003

Introduction:  In South‐East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community‐acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare.

Methods:  The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study.

Results:  The mean age at presentation was 53 years (range: 29−69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re‐resection while another patient developed severe septic shock requiring intensive care and ­inotropic support. There was no mortality in our series.

Conclusions:  Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome.
Inguinal hernia repair: Where to next?
Authors: Zib Martina , Gani Jon
Published: March 2003

Background:  Hernia repair is one of the most frequently performed operations in general surgery − a total of 39 000 elective inguinal hernia repairs were performed in public and private hospitals in Australia between July 1998 and June 1999 − and, as such, even minor alterations in outcome and resource use have appreciable impact. However, decisions regarding choice of operation for hernia repair remain controversial. The purpose of the present paper is to critically evaluate the evidence available regarding recently introduced open mesh repair techniques and to try to identify meaningful directions for future hernia research.

Methods:  A thorough search of all published surgical literature was undertaken. Medline, EMBASE and the Cochrane databases were searched by title, by key words and by author. References in review articles and in textbooks were pursued. The manufacturing companies were contacted for trials evaluating their product.

Results:  Eight original articles evaluating either the Kugel Patch, the PerFix Plug or the Prolene Hernia System were located. None of these trials directly compared two or more of these repair systems. To date, there has been no published review of the evidence regarding the newer mesh repair techniques. With one exception, all of these articles qualify as Level IV evidence. Highlighted is the lack of evidence regarding chronic significant posthernioplasty pain − this has an incidence of 6−12%. This complication is 3−5 times more common than recurrence after open repair, is clinically relevant, is poorly understood and has been poorly studied. Arguably it is a more important end point than recurrence.

Conclusion:  Only one study comparing the newer techniques of open hernia repair (PerFix Plug) constitutes Level II evidence. The PerFix Plug appears to be quicker to insert and uses a smaller incision. Chronic significant posthernioplasty pain is a more important endpoint in hernia research than is recurrence, and this review concludes with a proposal for a multicentre, randomized, controlled trial evaluating the incidence of chronic significant posthernioplasty pain following elective mesh repair of primary, unilateral ­hernias.
Same‐day lymphoscintigraphy and sentinel node biopsy for early breast cancer
Authors: Sutton Richard , Kollias James , Prasad Varni , Chatterton Barry , Grantley Gill P.
Published: March 2003

Background:  Lymphoscintigraphy and sentinel node biopsy are currently being assessed as an alternative to axillary dissection for staging in early breast cancer. However, little is known about the optimum timing of surgery following injection of the radio­isotope into the breast. The aim of the present study was to establish whether lymphoscintigraphy on the morning of surgery allowed efficacious and accurate sentinel node identification and biopsy.

Methods:  We reviewed our experience of 216 consecutive cases of lymphoscintigraphy in early breast cancer using peritumoural injections of technetium99m antimony sulphide colloid and subsequent sentinel node biopsy using a hand‐held gamma probe and blue dye. The time interval between radioisotope injection and successful intraoperative identification of the sentinel node was assessed and whether this was associated with certain clinical and histological variables.

Results:  The sentinel node was identified by lymphoscintigraphy in 160 cases (74%) at a median time duration of 40 min post injection. The median time duration between isotope injection and surgery was 5 h. Of the 160 cases where the sentinel node was visualized at lymphoscintigraphy, sentinel node biopsy was successfully performed in 155 cases (97%). This compares with 25/56 (45%) cases where lymphoscintigraphy failed to localize the sentinel node (P < 0.0001). There was no association found between the injection of the radioisotope greater or less than 5 h before surgery and the successful intraoperative identification of the sentinel node. Failure to identify the sentinel node at lymphoscintigraphy beyond 3 h was associated with a low intraoperative identification rate. There was no correlation found between intraoperative identification of the sentinel node according to the duration of isotope injection in relation to surgery and the various clinical and histological factors assessed.

Conclusions:  In our experience, the chance of identifying the sentinel node at the time of surgery does not increase with longer isotope injection duration using technetium99m antimony sulphide colloid. As soon as a sentinel node is identified at lymphoscintig­raphy, one can proceed to surgery. Scanning beyond 3 h does not appear to be effective in sentinel node localization. Given that the median time for successful lymphoscintigraphic mapping was only 40 min, lymphoscintigraphy can easily be completed during the morning to allow surgery to take place the same day.
Small bowel obstruction: Is routine colonoscopy necessary after resolution?
Authors: Chew Simon Sun Beng , Ngo Tru , Crowe Philip John
Published: March 2003

Background:  Small bowel obstruction is common in clinical practice and is most often due to adhesions. The aim of this study was to determine the significance of colon cancer presenting as a small bowel obstruction at a single institution and to find out whether routine colonoscopy was necessary in patients who had spontaneous resolution of their small bowel obstruction.

Methods:  A retrospective review of the medical records of patients presenting with small bowel obstruction from 1995 to 2000 at the Prince of Wales Hospital was performed. The clinical outcomes were obtained from the medical records and the clinical notes of each surgical consultant.

Results:  Over the study period, 251 patients presented with small bowel obstruction. The mean age at presentation was 63.8 years (range 21−95 years). A total of 149 patients (59.4%) were treated conservatively with an average hospital stay of 4.6 days (range 1−20 days). Another 100 patients (39.8%) were treated operatively with a mean time from presentation to operation of 2.2 days (range <24 h−14 days). The remaining two patients (0.8%) were managed palliatively because of known metastatic disease. At laparotomy, 13 patients (13%) had a colon cancer identified. A further three patients were identified to have a colon cancer on follow up colonoscopy. However, only one of the three patients had had a previous laparotomy, that is, only 0.7% (1/149) of patients with a spontaneously resolved small bowel obstruction (presumably secondary to adhesions) had actually had colon cancer.

Conclusions:  The overall incidence of small bowel obstruction secondary to colon cancer is significant at 6.4%. However, as the incidence of colon cancer in patients who had had a previous laparotomy and spontaneous resolution of their obstruction was very low at 0.7%, routine colonoscopy does not seem warranted.
Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma
Authors: Mooney William W. W. , Cole Ian , Albsoul Nader , Pearson Sallie‐Ann
Published: March 2003

Background:  Partial laryngectomy after failure of radiotherapy for early glottic cancer is an accepted surgical salvage procedure. However,there have been only a few studies on recurrent disease or long‐term survival.

Methods:  Twenty‐one patients who were treated with salvage partial vertical laryngectomy (PVL) following failure of primary radiotherapy were prospectively studied. Median follow up was 69 months(range 24−204 months). Patients were seen at two‐ monthly intervals for the first 24 months and then 3−4 monthly for 5  years after their partial surgery or until death.

Results:  Local control was 71.4% (15/21).Among the six patients who recurred within the larynx, two patients developed a second primary; one on the ipsilateral false cord at 24  months and the other on the contra‐lateral vocal cordat 10 years. The no evidence of disease rate following salvage PVL was 95%, 85% and 73% at 12,24 and 36  months, respectively, with a mean disease free interval of 34.9 months (range 7−120). Survival was 90%, 85% and 80% at 12, 24 and 36  months, respectively, with a median survival of 152  months forthe group. Three patients died of their disease and four from other causes. Four local recurrences occurred within 32  months.Two developed neck metastases and died of their disease. Four patients were treated successfully with completion laryngectomy. Only one of these died, but this was due to a second primary squamous cell carcinoma in the lung. Three of the four patients with local recurrences had an extended procedure.

Conclusion:  Partial vertical laryngectomy is an excellent alternative to total laryngectomy for salvage following failure of ­radiation.Although local recurrence occurred more frequently in those patient shaving an extended partial procedure, this was not statistically different.
The Surgical Research Society of Australasia
Authors: Hall John C. , Ludbrook John
Published: March 2003

Background:  The Surgical Research Society of Australasia (SRS) was established in 1961. The main intent was to promote surgical research, especially by young surgeons. The 50th Scientific Meetingof the SRS is due to be held in 2002.

Methods:  Selected information was extracted from the programme books for the scientific meetings of the SRS, while historical material was retrieved from the Records and Archives Unit of the Royal Australasian College of Surgeons.

Results:  There have been 48 scientific meetings of the SRS between1962 and 2000 inclusive, which have included the presentation of 1627 free papers. Forty‐one percent of the presenters (325/784)have done so on more than one occasion. The content of the presentations reflects the changing nature of surgical research during the last several decades.

Conclusions:  The SRS has achieved its original intent of promoting surgical research.
Utility of white cell count and ultrasound in the diagnosis of acute appendicitis
Authors: Fergusson James A. E. , Hitos Kerry , Simpson Erroll
Published: March 2003

Background:  Despite considerable advances in imaging, the diagnosis of acute appendicitis remains a clinical one. Nonetheless, knowledge of the characteristics of commonly used investigations for appendicitis may aid surgical decision‐making.

Methods:  The pathology, full blood counts and ultrasounds of 1013 patients who underwent appendicectomy were reviewed and subjected to statistical analysis in order to determine diagnostic characteristics of various white cell count and ultrasound results.

Results:  Total white cell count was found to be higher among patients with complicated appendicitis than those with simple appendicitis or normal appendices. Ultrasound was found to be less accurate than white cell count and neutrophil count in the diag­nosis of acute appendicitis by estimation of area under the receiver operator characteristic curve.

Conclusion:  Knowledge of the meaning of various white cell count values may be invaluable in clinical decision‐making with regard to the diagnosis of acute appendicitis. Ultrasound is of limited utility in the diagnosis of appendicitis and should only be used in selected clinical situations.
Ductal carcinoma in situ of the breast in Singapore: Recent trends and clinical implications
Authors: Tan Kong‐Bing , Lee Hui‐Yin , Putti Thomas Choudary
Published: March 2003

Background:  Breast ductal carcinoma in‐situ (DCIS) is increasingly being diagnosed as a result of screening mammography and better pathological recognition. With this and the rising breast cancer incidence in Singapore, DCIS is poised to become a bigger part of surgical practice. Principles of screening, diagnosis and management of DCIS have also been rapidly evolving. Against this background, a clinicopathological audit of recent cases of DCIS in our centre was performed.

Methods:  Thirty‐eight cases of DCIS diagnosed in the period 1997−2000 were retrospectively analysed. Histological examination and immunohistochemical studies for oestrogen and progesterone receptor expression were performed.

Results:  In the present study, DCIS was most common in the group of patients who were <50 years (58%) as compared to an American series’ where the corresponding group were ≥60 years (36%). Compared to a previous local study a decade ago, the present series showed that: (i) DCIS constituted a higher proportion of all breast cancers (6.4% vs 3.7%); (ii) a larger proportion of patients had disease detected by mammography (47% vs 10%); (iii) conservative breast excision was the only definitive surgery in 39% of cases (vs approximately 30%); and (iv) the mean size of lesions is smaller (13.5 mm vs 24.4 mm). Histologically, 26% of tumours were high grade, 71% had necrosis while 32% were oestrogen receptor (ER) and progesterone receptor (PR) negative. High grade tumours were associated with the presence of necrosis (P = 0.018), ER negativity (P = 0.015) and PR negativity (P = 0.001).

Conclusions:  This study reveals interesting trends of DCIS in Singapore. The sizeable proportion of hormone receptor‐negative tumours may have implications for the hormonal adjuvant therapy of DCIS.
An easy method of deflating a blocked Foley balloon
Authors: Bui Hai T. , Agarwal Dinesh , Clarke Anita
Published: March 2003

Blocked Foley balloons are occasionally encountered by many urological surgeons. A number of methods of removing a blocked balloon catheter have been advocated. They are usually invasive, time and resource consuming and often ineffective. A non‐invasive, reliable and safe technique of deflating a blocked catheter balloon by inserting a Glidewire through the balloon channel is reported in the present paper.
Optional sump: Novel use of triple lumen closed drainage system
Authors: Flanagan Sean , Logan David , Joseph Mark G.
Published: March 2003

Background:  The debate over the use of drains in abdominal surgery is controversial. Selective drainage using a closed system is the method employed by most surgeons. There are, however, specific circumstances where different forms of drainage are required.

Methods:  One hundred and sixty‐seven patients undergoing a mix of complex upper gastrointestinal surgery and colorectal surgery received an Axiom sump drain at the time of surgery. All side air vents were spigoted and the main lumina connected to a urine bag, with the option to convert to irrigation/suction as required.

Results:  Two patients required conversion to irrigation/suction, because of ongoing egress of fluid. In both cases drainage ceased without surgical intervention. The remaining cases resolved with no complications related to the drain.

Conclusion:  The technique described allows the use of a large bore, soft, gravity‐driven drain in cases where wound drainage is necessary. The closure of the ventilation ports maintains the advantage of a closed drainage system, yet allows for the conversion to a true sump system as required. This obviates the need for further drainage procedures.