bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis
Authors: Madden M V , Neale K F , Nicholls R J , Landgrebe J C , Chapman P D , Bussey H J R , Thomson J P S
Published: March 2007

Restorative proctocolectomy with an ileal reservoir (RPC) should prevent colorectal cancer in patients with familial adenomatous polyposis. Until this is confirmed its role compared with total colectomy and ileorectal anastomosis (IRA) will depend on the relative morbidity and postoperative bowel function after the two procedures. This was analysed in 99 patients (37 RPC, 62 IRA) operated on between 1977 and 1989. Morbidity was greater after RPC with subsequent ileostomy closure (median hospital stay, 24 versus 11 days; complications, 60 versus 21 per cent; reoperation, 29 versus 3 per cent; return to normal activity, 31 versus 14 weeks). There was little difference in bowel function; after IRA median frequency was 3/24 h and urgency (unable to wait 15 min) occurred in 50 per cent, compared with 4·5/24 h and 17 per cent after RPC. Night evacuation occurred in 10 and 43 per cent respectively. IRA was performed in younger patients (median 19 versus 31 years) who had fewer bowel motions before operation (2 versus 5/24 h). The greater morbidity of RPC suggests that it should be restricted to patients at higher risk of developing later rectal cancer, including those unavailable for follow-up and those with large or confluent rectal polyps or with curable colon cancer at the initial colectomy.
Node negative breast cancer: The prognostic value of DNA ploidy for long-term survival
Authors: Yuan J , Hennessy C , Corbett I P , Dykin R , Givan A L , Shenton B K , Henry J A , Wright C , Lennard T W J
Published: March 2007

The DNA content of breast tumours from 170 patients who presented between 1978 and 1980 was measured by flow cytometry. The relationship between tumour ploidy and disease outcome was assessed and its association with other prognostic factors evaluated. Compared with those with diploid tumours, patients with aneuploid tumours had significantly earlier relapse and shorter survival (P<0·0001). Tumour ploidy was strongly related to grade (P<0·001), but there was no significant association between DNA ploidy and c-erb-B-2 expression, lymph node status or tumour size. In lymph node negative and c-erb-B-2 negative patients, aneuploid tumours were associated with a poorer prognosis (P<0·001) than diploid tumours. Multivariate analysis showed that tumour ploidy gave independent information on disease free and overall survival. Tumour ploidy may be used as an independent prognostic variable in patients with breast cancer and it may be helpful in defining patients within the node negative or c-erb-B-2 negative groups likely to have a poor outcome who might benefit from adjuvant treatment.
Influence of phlebographic abnormalities on the natural history of venous ulceration
Authors: Stacey M C , Burnand K G , Thomas M Lea , Pattison M
Published: March 2007

Eighty-five limbs in 73 patients with a healed venous ulcer were assessed by ascending and descending phlebography, foot volume plethysmography and transcutaneous oxygen measurements. Forty-four limbs had post-thrombotic changes on ascending phlebography. In 24 (28 per cent) these extended into the femoral vein, while in 20 (24 per cent) only the calf veins were involved. In the 41 limbs (48 per cent) with normal deep veins on ascending phlebography, 11 had evidence of localized incompetence of the calf communicating veins, 14 had either long saphenous incompetence, deep vein reflux to the level of the knee or below, or both of these abnormalities, and 16 limbs had no phlebographic abnormalities. However all limbs had a decreased half volume refilling time on foot volume plethysmography. Limbs with post-thrombotic changes extending into the femoral vein were associated with a significantly longer history of ulceration and more ulcer recurrences than limbs with calf vein damage (P < 0·05 for each) and limbs with normal deep veins (P < 0·01 for each). However, these limbs did not have lower transcutaneous oxygen ratios or longer times to achieve ulcer healing. Ascending phlebography identified a group of limbs with extensive post-thrombotic changes in which there was a higher incidence of ulcer breakdown, but this was not associated with a delay in ulcer healing.
Recurrent peptic ulceration after highly selective vagotomy: Long-term outcome
Authors: Maddern G J , Vauthey J-N , Devitt P , Britten-Jones R , Hetzel D J , Jamieson G G
Published: March 2007

A prospective assessment was made of the outcome 4 years after diagnosis of recurrence in a group of 27 patients with documented ulceration after highly selective vagotomy (16 symptomatic recurrence and 11 asymptomatic). In the 16 patients with a previous symptomatic recurrence, eight of the 11 patients with duodenal ulcer underwent a further endoscopy at 4 years and one active ulcer was found. Five patients with previous symptomatic gastric ulcer recurrence have all undergone further surgery. In the 11 patients who originally had an asymptomatic ulcer recurrence (five gastric, six duodenal) no patient has undergone further surgery, although two patients with a recurrent gastric ulcer and two with a recurrent duodenal ulcer subsequently developed symptoms from their ulcer and required H2 receptor blocker therapy. Eight of the 11 originally asymptomatic patients underwent further endoscopy at 4 years and two further duodenal ulcers were found. After highly selective vagotomy, asymptomatic ulcer recurrence occurs frequently and 40 per cent of these patients may develop symptoms.
A more physiological alternative to total fundoplication for the surgical correction of resistant gastro-oesophageal reflux
Authors: Watson A , Jenkinson L R , Ball C S , Barlow A P , Norris T L
Published: March 2007

The incidence of mechanical complications associated with the Nissen fundoplication has prompted evaluation of an anti-reflux procedure designed to be simpler and more physiological, and encompassing a broader view of the many factors involved in the anti-reflux mechanism. Preliminary assessment of the first 100 patients with a mean follow-up of 3–5 years showed symptomatic improvement in 96 per cent and complete relief in 85 per cent. A further 100 patients were studied using formal symptom scoring, endoscopy, manometry and pH monitoring performed before operation and 3 months after operation. Similar clinical results were accompanied by improvement in endoscopic oesophagitis in 95 per cent, complete healing in 74 per cent and restoration of the pH profile to physiological levels in 84 per cent. Troublesome mechanical complications comprised a 2 per cent incidence of dysphagia, but there was no gas bloat or inability to belch or vomit, which may relate to the restoration of lower oesophageal sphincter characteristics close to those of 30 asymptomatic controls. The procedure is simpler to perform than total fundoplication, is well tolerated and is applicable to patients with reflux stricture and impaired oesophageal body motility. The results of this study support the hypotheses that effective reflux control can be achieved without total fundoplication by attention to several factors of known relevance to the anti-reflux mechanism, and that restoration of characteristics of the lower oesophageal sphincter close to physiological levels results in a lower incidence of mechanical complications.
Technique and results of localization biopsy in a breast screening programme
Authors: Campbell I D , Coddington R , Theaker J , Royle G T , Rubin C M , Guyer P B , Taylor I
Published: March 2007

The techniques of ultrasonographic and hookwire localization biopsy of impalpable breast lesions detected by a large breast screening unit during its first year of operation are described. Hookwire localization (HL) was performed using mammography. Ultrasonographic localization (UL) was used for lesions readily detectable by ultrasonography by marking the skin directly over the lesion and calculating its depth below the surface. UL is not appropriate when microcalcification is the sole mammographic abnormality. Localization was required for 150 of the 191 (78.5 per cent) screen-detected lesions. HL was used for 94 (62.7 per cent) and UL for 56 (37.3 per cent). Four lesions were missed by HL, none by UL; 35 per cent of lesions removed by HL and 39 per cent by UL were malignant, giving benign:malignant biopsy ratios of 1.8:1 and 1.5:1 respectively. Only 22 per cent of the patients required overnight hospital stay. Localization biopsy plays a major role in the surgery for screen-detected lesions and, where applicable, UL is the technique of choice.
Microcirculatory and trophic effects of short chain fatty acids in the human rectum after Hartmann's procedure
Authors: Mortensen F V , Hessov I , Birke H , Korsgaard N , Nielsen H
Published: March 2007

Short chain fatty acids (acetic, propionic and butyric) were instilled into the rectum of patients who had undergone Hartmann's procedure. The following parameters were examined before and after a 2-week treatment period with short chain fatty acids (100 ml twice daily at a total concentration of 150 mM): (1) microcirculatory effects in vivo using a laser Doppler flow technique, and (2) morphometrical changes in mucosal biopsies. The following parameters were significantly increased in all patients after treatment: (1) mucosal blood flow, (2) the fractional crypt cell epithelium plus surface epithelium volume in relation to total tissue volume down to the muscularis mucosa, (3) nuclear volume in the crypt and the surface epithelium, and (4) the fractional nuclear volume to total cell volume in the crypt and the surface epithelium. These data suggest that short chain fatty acids in the human colon have trophic and vasodilatory effects.
Oesophageal varices in a region of the Sudan endemic for Schistosoma mansoni
Authors: Saad A M A , Hassan M A , Homeida M , Eltom I , Nash T , Bennett J L
Published: March 2007

In a field study of two villages in the Gezira, an area of the Sudan endemic for Schistosoma mansoni, liver ultrasonography was used to detect subjects with Symmers' hepatic periportal fibrosis, some of whom underwent oesophagoscopy to detect oesophageal varices. The prevalence of oesophageal varices in subjects undergoing oesophagoscopy was 54 per cent and 67 per cent respectively, occurring mainly in males aged about 30 years. The varices were usually asymptomatic. Symptomatic varices (with a positive history of haematemesis) occurred in 4 per cent and 3 per cent respectively of subjects with sonographic evidence of liver periportal fibrosis. By detecting oesophageal varices in an asymptomatic phase, hepatic ultrasonography and fibreoptic oesophagoscopy may elucidate the natural history of the varices and their response to periodic anti-schistosomal chemotherapy.
Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis
Authors: Kusunoki M , Shoji Y , Yanagi H , Hatada T , Fujita S , Sakanoue Y , Yamamura T , Utsunomiya J
Published: March 2007

Twenty-eight patients undergoing anoabdominal resection of the rectum with construction of a colonic J reservoir and eight patients without a reservoir were studied 2 years after surgery. Frequency of defaecation and daytime soiling were inversely correlated with the maximum tolerable volume of the colonic J pouch. The distensibility and threshold volume of those with a pouch were significantly greater than in those without a pouch 6 months or more after stoma closure. Anal resting pressure, squeeze pressure, anal canal length and a positive inhibitory reflex were similar in both groups. Anal resting pressure, squeeze pressure and pouch distensibility correlated with frequency of defaecation in the stable phase. Pouch construction may improve the patient's quality of life in the adaptation phase.
Results of extensive surgery for liver metastases in colorectal carcinoma
Authors: Nakamura S , Yokoi Y , Suzuki S , Baba S , Muro H
Published: March 2007

Hepatic resections were performed during the past 13 years on 31 patients with hepatic metastases from colorectal carcinoma. Of the 31 patients, 22 underwent lymph node dissection of the hepatic hilus. Ten patients underwent removal of recurrent lesions in the liver, lung, adrenal gland and brain after initial hepatic resection. The overall 5-year survival rate was 45 per cent. The outcome for six patients who underwent repeat hepatectomy after an initial hepatectomy was significantly better than for nine patients with unresectable recurrence (P < 0·01). Six of the 22 patients who underwent lymph node dissection had nodes positive for tumour. Two of the six patients underwent repeat hepatectomy and are alive after 49 and 66 months. Three- and 4-year survival rates of patients with positive lymph nodes were both 40 per cent. Repeat hepatectomy and dissection of hilar lymph nodes improves prognosis in selected patients with hepatic metastases of colorectal cancer.
Randomized, controlled study evaluating effects of branched chain amino acids and alpha-ketoisocaproate on protein metabolism after surgery
Authors: Sandstedt S , Jorfeldt L , Larsson J
Published: March 2007

The effect of nutritional supplementation with branched chain amino acids or the ketoacid α-ketoisocaproate on protein metabolism after surgery was studied in 24 patients with gastrointestinal cancer. They were randomized to receive one of three nutritional regimens. All patients received a balanced amino acid solution and group 1 (n = 8) received no further supplements, group 2 (n = 8) received supplementation with α-ketoisocaproate (17 g day−1) and group 3 (n = 8) received a branched chain solution including leucine, isoleucine and valine, corresponding to 3·3 g nitrogen day−1. Plasma albumin, prealbumin, fibronectin and serum urea concentrations, nitrogen balance and 3-methylhistidine release from the leg and its excretion in the urine were measured. Albumin and prealbumin concentrations fell after surgery in all groups, and fibronectin levels fell in group 2 (P < 0·001). In group 2 there was also a significant increase in serum urea concentration after operation (P < 0·05). Cumulative nitrogen balance after 3 days was −5·6 g (group 1), −3·8 g.(group 2) and −1·7 g (group 3). The release of 3-methylhistidine (nmol 100 g−1 min−1) from the leg after operation, following an overnight fast, was −0·42 (group 1), −0·51 (group 2) and -0·66 (group 3). During infusion the release was −0·56, −0·99 and −0·81, respectively. A balanced amino acid solution with an adequate energy supply has an optimal nitrogen-sparing effect. Branched chain amino acids or α-ketoisocaproate did not improve nitrogen balance or reduce protein degradation.
Renal tubular cell injury and serum phospholipase A2 activity in acute pancreatitis
Authors: Grönroos J M , Hietaranta A J , Nevalainen T J
Published: March 2007

Early diagnosis of threatening renal complication is essential for the adequate treatment of acute pancreatitis. Deposition of phospholipase A2 (PLA2) in rat renal proximal tubular cells has been observed in experimentally induced acute pancreatitis. The value of measuring the catalytic activity of PLA2 in serum as an early warning of developing renal tubular cell injury was therefore investigated in a prospective study of 31 consecutive patients suffering from acute pancreatitis. A positive correlation was found (r = 0.66, P < 0.001) between the highest serum PLA2 activity, as measured early in the course of acute pancreatitis, and the highest N-acetyl-β-glucosaminidase (NAG): creatinine ratio in the urine. The correlation between the highest serum concentration of immunoreactive pancreatic PLA2 and the highest urinary NAG: creatinine ratio was weaker (r = 0.36, P < 0.05). These results indicate that the measurement of the catalytic activity of PLA2 in serum early in acute pancreatitis may provide a simple test for the detection of threatening renal complication.
Influence of 5-fluorouracil and folinic acid on colonic healing: An experimental study in the rat
Authors: Graf W , Weiber S , Glimelius B , Jiborn H , Påhlman L , Zederfeldt B
Published: March 2007

Male Wistar rats were subjected to colonic resection and randomized to one of four groups: control group (intraperitoneal NaCl, intravenous NaCl); 5-fluorouracil(5-FU) group (intraperitoneal 5-FU, intravenous NaCl); folinic acid group (intraperitoneal NaCl, intravenous, folinic acid); and 5-FU-folinic acid group (intraperitoneal 5-FU, intravenous folinic acid). Treatment was started immediately after surgery and continued until the animals were killed at 3 or 7 days. Anastomotic complications (abscesses or dehiscence) occurred in four of 33 animals in the control group, 12 of 36 in the 5-FU group, one of 32 in the, folinic acid group and nine of 36 in the 5-FU—folinic acid group. Anastomotic and skin breaking strength did not differ between groups on day 3 but by day 7 were significantly reduced in the 5-FU group. In rats given 5-FU—folinic acid, breaking strength was also reduced, but less so than in the 5-FU group. Breaking strength in animals receiving, folinic acid was similar to that in the control group. In this model colonic healing was impaired after intraperitoneal 5-FU administration, but when folinic acid was added no further deterioration occurred.
Iliofemoral versus femorofemoral bypass: A 6-year audit
Authors: Ng R L H , Gillies T E , Davies A H , Baird R N , Horrocks M
Published: March 2007

Iliofemoral and femorofemoral crossover bypass operations performed over a 6-year period were reviewed. A total of 226 patients underwent 231 operations from 1984 to 1990. Seventy-two patients had 75 iliofemoral grafts and 154 patients had 156 femorofemoral grafts. The early mortality rate was 6 per cent for the iliofemoral group and 1.3 per cent for femorofemoral reconstruction. There was a higher reoperation rate in the iliofemoral group (31 versus 16.0 per cent). The cumulative patency rate at 6 years was 75 per cent for iliofemoral bypass and 92 per cent for the femorofemoral procedure (P < 0.01), while the survival rates for the same period were 55 and 74 per cent respectively (P < 0.01). Hospital stay was significantly shorter for patients undergoing femorofemoral bypass (P < 0.05).
Effects of tumour necrosis factor on protein metabolism
Authors: Evans D A , Jacobs D O , Wilmore D W
Published: March 2007

Increased skeletal muscle breakdown and negative nitrogen balance are features of sepsis that may be mediated by cytokines. The effects of tumour necrosis factor (TNF) on protein metabolism were studied. When administered to anaesthetized dogs (0·57 × 105 units per kg body-weight over 6h), TNF caused urinary nitrogen excretion to increase (mean(s.e.m.) 165(15) mg kg−1 for dogs that received TNF versus 113(8) mg kg−1 for control animals, P <0·01). Amino acid nitrogen release from the hindlimbs showed no change over the study period, indicating that the additional urinary nitrogen was not derived from peripheral protein stores. In a second study the same dose of TNF or saline was infused after the intestine had been removed. The mean(s.e.m.) urinary nitrogen excrtion in control dogs that had undergone enterectomy (101(7) mg kg1) was similar to that of intact animals, and addition of TNF did not significantly increase nitrogen excretion (86(18) mg kg−1). The results suggest that nitrogen excreted in the urine during administration of TNF is derived, at least initially, from the intestinal tract.
Change towards earlier stage at presentation of colorectal cancer
Authors: Robinson M H E , Thomas W M , Hardcastle J D , Chamberlain J , Mangham C M
Published: March 2007

A study was carried out to investigate the change in stage at presentation of patients with colorectal cancer over 10 years. Cases were identified from the control group of subjects enrolled into a randomized controlled study based on Haemoccult screening for colorectal neoplasia. Of 405 subjects in the control group presenting with symptomatic colorectal cancer, 206 presented before 1989 and 199 since then. The number of patients with Dukes' stage A carcinoma diagnosed since 1989 rose from 21 (10·4 per cent) to 35 (18·1 per cent); this change occurred for rectosigmoid tumours (9·9 per cent before 1989, 28 per cent after 1989) but not for colonic cancer (10·9 per cent before 1989, 11·5 percent thereafter). An increase in the proportion of patients with symptomatic early-stage rectosigmoid cancer has been observed in the past 10 years. No such change occurred in those with colonic cancer. This may reflect a change in awareness of the disease and its symptoms by patients and general practitioners.
Epidemiology of varicose veins
Authors: Callam M J
Published: March 2007

Assessment and treatment of varicose veins comprises a significant part of the surgical workload. In the UK, National Health Service waiting lists suggest that there is still considerable unmet need. This review analyses all published data on the epidemiology of varicose veins, paying particular regard to the differing epidemiological terminology, populations sampled, assessment methods and varicose vein definitions, which account for much of the variation in literature reports. Half of the adult population have minor stigmata of venous disease (women 50–55 per cent; men 40–50 per cent) but fewer than half of these will have visible varicose veins (women 20–25 per cent; men 10–15 per cent). The data suggest that female sex, increased age, pregnancy, geographical site and race are risk factors for varicose veins: there is no hard evidence that family history or occupation are factors. Obesity does not appear to carry any excess risk. Accurate prevalence data allow provision of appropriate resources or at least aid rational debate if demand is greater than the resources available.
Conservative initial treatment for liver abscesses in children
Authors: Moore S W , Millar A J W , Cywes S
Published: March 2007

A total of 124 children aged less than 14 years with a liver abscess were seen in a 16-year period (1974–1990) and treated by non-operative initial management. Of the abscesses 98 occurred in the right liver and 26 in the left. The abscesses were solitary in 93 patients. Overall, 77 of the solitary and 21 of the multiple abscesses were confined to the right liver. In 78 of the right-sided and 20 of the left-sided abscesses the infection was primarily pyogenic in nature with Staphylococcus aureus being the usual organism cultured. The remainder were of amoebic origin. Clinical features were similar in patients with amoebic and pyogenic abscesses. Clinical and ultrasonographic follow-up demonstrated successful non-operative management and healing in 37 per cent of all patients submitted to an initial protocol of medical supportive care and antibiotic therapy. Of the multiple abscesses 60 per cent responded to non-operative management. Fourteen of the 16 solitary left-sided liver abscesses required drainage and three left-sided abscesses ruptured before drainage. Patients with a solitary left-sided abscess warrant early operative intervention.
‘Reversible chemical sphincterotomy’ by local application of glyceryl trinitrate
Authors: Loder P B , Kamm M A , Nicholls R J , Phillips R K S
Published: March 2007

Nitric oxide has emerged as one of the most important neurotransmitters mediating internal anal sphincter relaxation. The effect of glyceryl trinitrate, a nitric oxide donor, on anal tone was examined. Maximum resting pressure, predominantly a function of the smooth muscle internal anal sphincter, was measured before and 20 min after application of 0·2 per cent glyceryl trinitrate ointment in ten patients. Pressure decreased by a mean of 27 per cent (95 per cent confidence interval 18–36 per cent) (P = 0·0004) after administration of the drug. A further 20 patients were then randomized to either active or placebo ointment. Anal pressure was significantly decreased (P = 0·002) in those who received 0·2 per cent glyceryl trinitrate, but there was no significant reduction in the control patients. Mild headache occurred in two patients who were given the active preparation and in one who received placebo. Manometry was repeated 9 h after application of glyceryl trinitrate and showed a sustained decrease in pressure in two patients. Topical glyceryl trinitrate may have a role in the treatment of anal fissure, haemorrhoids, certain types of constipation and anal pain. It may also reduce injury to the internal sphincter during peranal operations.
Epidemiology of leg amputation: The influence of vascular surgery
Authors: Ebskov L B , Schroeder T V , Holstein P E
Published: March 2007

The number of amputations performed for vascular disease in Denmark has decreased from 1777 (34·5 per 100 000 population) in 1983 to 1288 (25·0 per 100 000) in 1990, a reduction of 28 per cent. This decline coincided with an increase in vascular surgical activity of up to 100 per cent, including a marked rise in the rate of femorodistal reconstruction. Moreover, regional variation in vascular surgical activity correlated with percentage reduction in amputation rate (rs = 0·65, P < 0·01). The relative number of above-knee amputations also decreased in favour of more distal levels during the period studied. These findings suggest that vascular surgery may be responsible for the lower amputation rate.
Expression of p53 protein in oesophageal carcinoma: Clinicopathological correlation and prognostic significance
Authors: Vijeyasingam R , Darnton S J , Jenner K , Allen C A , Billingham C , Matthews H R
Published: March 2007

Correlation of p53 expression with 5-year survival and histopathological parameters was examined immunohisto-chemically in two groups of 30 patients with oesophageal carcinoma (5-year survivors versus non-survivors). Tumour type, sex, operative procedure and age were matched. Some 64 per cent of squamous carcinomas and 79 per cent of adenocarcinomas were p53 positive. Normal squamous, normal glandular and metaplastic glandular epithelia were negative. Dysplastic squamous and glandular epithelium adjacent to tumours was positive when the tumour was positive and negative when it was not. Univariate analysis showed that nodal status (P = 0·001), and grade and depth of invasion (both P = 0·01) correlated with outcome. Correlation of tumour grade with outcome, when the most poorly differentiated area is used, is a novel finding for oesophageal carcinoma. The p53 status was not significantly associated with survival or any of these parameters.
Effect of ranitidine on soluble interleukin 2 receptors and CD8 molecules in surgical patients
Authors: Nielsen H J , Mynster T , Jensen S , Hammer J , Nielsen H
Published: March 2007

The effect of perioperative immunomodulation with the H2-receptor antagonist ranitidine on postoperative changes in soluble interleukin (IL) 2 receptor and soluble CD8 levels was assessed in 24 patients undergoing major elective abdominal surgery. Eleven patients were randomized to receive intravenous ranitidine 100 mg twice daily for 4 days from skin incision, followed by oral ranitidine 150 mg twice daily for a further 5 days; 13 control patients received no ranitidine. Routine blood analysis, clinical data, duration of surgery, anaesthesia, antibiotic prophylaxis and perioperative blood transfusion were similar in the two groups. Serum concentrations of soluble IL-2 receptor and CD8 were measured before operation (day 0) and in the morning of postoperative days 1, 3 and 9 using commercial enzyme-linked immunosorbent assay kits. In patients treated with ranitidine, the serum level of soluble IL-2 receptor increased from day 0 to day 9 (P < 0.01); in control patients it decreased from day 0 to day 1, did not change significantly by day 3 and increased by day 9. The change from day 0 to day 1 was significantly different between the two groups (P < 0.01). Five of the 13 control patients developed postoperative infectious complications. No significant differences were shown in soluble CD8 concentration during the postoperative period. The postoperative change in soluble IL-2 receptor level may reflect lymphocyte activation status; ranitidine appears to promote activation of mainly CD4-positive lymphocytes since serum levels of CD8 were unchanged. Ranitidine may, therefore, improve immune function during major surgery.
Butyrate metabolism in the terminal ileal mucosa of patients with ulcerative colitis
Authors: Chapman M A S , Grahn M F , Hutton M , Williams N S
Published: March 2007

The rate of oxidation of butyrate, glutamine and glucose was investigated in terminal ileal mucosal biopsy samples from nine patients with ulcerative colitis undergoing restorative proctocolectomy and from 12 patients undergoing laparotomy for reasons other than ulcerative colitis. Substrate oxidation was assayed using a radiolabelled isotope technique. Butyrate was the preferred fuel substrate, followed by glutamine and then glucose (median (95 per cent confidence interval) 567 (262–894), 63 (35–123) and 81 (5·1–18) pmol μg−1 h−1 respectively; P <0·01, Mann-Whitney U test) in normal terminal ileal mucosa. The patients with ulcerative colitis had a significantly reduced rate of butyrate oxidation compared with the control group (194 (81–321) versus 567 (262–894) pmol μg−1 h−1, P < 0·05). Normal terminal ileal mucosa oxidized butyrate in greater quantities than glucose and glutamine. Ulcerative colitic terminal ileal mucosa exhibited an impaired rate of butyrate oxidation.
An experimental study of altered nitric oxide metabolism as a mechanism of cyclosporin-induced renal vasoconstriction
Authors: Bloom I T M , Bentley F R , Spain D A , Garrison R N
Published: March 2007

Nephrotoxicity caused by cyclosporin A (CSA) is the result of vasoconstriction of the renal microcirculation. The endothelium-derived relaxing factor nitric oxide (NO) regulates microvascular blood flow in various tissues, and mediates the microcirculatory response during hypertension and sepsis. This study investigated the role of NO in CSA-induced renal vasoconstriction. Hydronephrotic kidneys in rats were suspended in an environmentally controlled tissue bath, and interlobular, afferent and efferent arteriolar diameters and blood flow were measured by in vivo videomicroscopy. CSA was administered alone, with the nitric oxide synthase (NOS) inhibitor Nw-nitro-l-arginine methyl ester (l-NAME) or with exogenous NOS substrate l-arginine. CSA significantly constricted the whole of the renal microvasculature whereas l-NAME alone preferentially constricted the preglomerular vessels. l-Arginine reversed the vasoconstriction induced by CSA whereas l-NAME had no further effect. Preglomerular basal vascular tone is dependent on continuous production of NO and alterations in the l-arginine-NO pathway contribute to CSA-induced renal vasoconstriction.
Proctographic changes after rectopexy for solitary rectal ulcer syndrome and preoperative predictive factors for a successful outcome
Authors: Halligan S , Nicholls R J , Bartram C I
Published: March 2007

Rectopexy is advocated as treatment for solitary rectal ulcer syndrome despite variable outcome. Sixteen patients with this condition, who remained symptomatic after surgery, were examined before and after operation by evacuation proctography and compared with a matched group of seven patients whose symptoms had been relieved, to investigate the effect of rectopexy on rectal configuration or emptying, or both, and to identify any preoperative factor associated with a good outcome. Rectal prolapse, demonstrated in 19 of 23 patients before operation (internal in 12, external in seven), was seen in only one patient after surgery. The rectal axis became more vertical at rest (median 44° before operation versus 35° after surgery, P = 0.006) and on evacuation (median 38° versus 31°, P = 0.023). Preoperative evacuation time was increased in patients with poor outcome (median (range) 22 (8–60) s versus 10 (5–15) s, P = 0.008). Rectopexy successfully treats rectal prolapse in patients with solitary rectal ulcer syndrome and alters rectal configuration. These features, however, are unrelated to outcome. Prolonged preoperative evacuation time, suggesting a defaecatory disorder, may predict poor symptomatic outcome.
Granulocyte–macrophage colony-stimulating factor modulates immune function and improves survival after experimental thermal injury
Authors: Molloy R G , Holzheimer R , Nestor M , Collins K , Mannick J A , Rodrick M L
Published: March 2007

Thermal injury is associated with reduced colony-stimulating activity, which correlates with increased susceptibility to infection. To assess the effect of therapeutic administration of granulocyte-macrophage colony-stimulating factor (GM-CSF), 8-week old anaesthetized mice were subjected to either a 20 per cent body surface burn or a sham burn. Animals were subsequently treated with either vehicle or a range of doses of GM-CSF (10–1000 ng) with or without indomethacin (5 μg). Sepsis was induced by caecal ligation and puncture on day 10 after injury. Survival was significantly better in animals treated with 200 ng GM- CSF on days 5–9 after the burn. Concanavalin A-stimulated T cell proliferation and interleukin (IL) 2 production were significantly depressed after burn injury. In vivo therapy with 200 ng GM-CSF, however, led to a significant improvement in both of these parameters of T cell function. These data suggest that GM-CSF has a potential therapeutic role in the prevention of death from burn sepsis and appears to act, at least in part, by restoring defective T cell proliferation and IL-2 production.
Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer
Authors: Rougier Ph , Milan C , Lazorthes F , Fourtanier G , Partensky C , Baumel H , Faivre J
Published: March 2007

Prognostic factors of unresected liver metastases in patients with colorectal cancer are not well established. A total of 544 patients with unresected liver metastases from colorectal cancer were registered in a national survey over a 1-year period and followed until death. Twenty factors were studied in a univariate analysis (log rank test) and 16 influenced survival (P<0±01). These 16 factors were entered in a multivariate analysis (Cox model) and eight, ranging from the most significant (relative risk of death 1±9) to the less significant (relative risk of death 1±2), independently influenced survival: performance status, alkaline phosphatase level, number of involved liver segments, administration of chemotherapy, presence of extrahepatic metastases, site of the primary tumour, prothrombin time and resection of the primary lesion. Two simple classifications are proposed, taking into account the performance status and the alkaline phosphatase level, or the performance status and the number of involved liver segments.
Trusses in the management of hernia today
Authors: Cheek C M , Williams M H , Farndon J R
Published: March 2007

In the UK an estimated 40 000 trusses are issued annually. The rate of 700 per million is higher than that presently found in other countries and may be because of reduced access to surgery. Despite the high use of trusses little has been published on their effectiveness, complication rates and value. This review summarizes current knowledge, and concludes that further studies on the benefits and effectiveness of trusses need to be performed to enable patients to receive appropriate advice and guidance.
Choice of prophylactic surgery for the large bowel component of familial adenomatous polyposis
Authors: Setti-Carraro P , Nicholls R J
Published: March 2007

The surgical options for treating the large bowel component of familial adenomatous polyposis are total proctocolectomy, colectomy with ileorectal anastomosis, and restorative proctocolectomy, with or without mucosectomy. Although the first of these eradicates all mucosa at risk, it carries several disadvantages, not least of which is a permanent ileostomy. There is little to choose functionally between the other two operations. The choice should be based on the perceived risk of cancer developing in any residual rectum; the factors influencing this risk are discussed.
Repeated liver resection for recurrent liver cancer
Authors: Neeleman N , Andersson R
Published: March 2007

Patients with cancer recurrence limited to the liver alone after a first liver resection may be candidates for a repeat resection. Some 191 second and ten third liver resections for recurrent colorectal metastases, and 128 second and ten third liver resections for recurrent hepatocellular carcinoma (HCC), were evaluated after reviewing the literature. The 5-year survival rate after second liver resection for colorectal metastases was 26 per cent with a median survival time of 30 months. Mortality and morbidity rates were 1·2 and 27·4 per cent respectively. The 5-year survival rate after second resection for HCC was 40 per cent with a median survival time of 40 months. The operative mortality rate was 2·3 per cent; morbidity occurred in 13 per cent of patients with HCC. Survival after primary colorectal resection was significantly better for patients with metachronous metastases than for those with synchronous disease; survival correlated with a long interval between the first and second liver resection (in both colorectal liver cancer and HCC). Repeated liver resection may be performed in selected patients and yield a similar survival to that obtained after first liver resection.
Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases
Authors: Elias D , Saric J , Jaeck D , Arnaud J P , Gayet B , Rivoireh M , Lorimier G , Carles J , Lasser P
Published: March 2007

Extensive lymph node dissection of the hepatic pedicle was undertaken in 100 consecutive patients undergoing curative hepatectomy for colorectal liver metastases in whom lymph node involvement of the hepatic pedicle was not macroscopically detectable. Microscopic lymph node involvement was found in 14 patients, in very different lymph node sites, and was related only to the number of metastases, extent of liver involvement and carcinoembryonic antigen level (all P< 0·05).
Postoperative mortality in rectal cancer treated with or without preoperative radiotherapy: Causes and risk factors
Authors: Holm T , Rutqvist L-E , Johansson H , Cedermark B
Published: March 2007

Adjuvant preoperative radiotherapy in patients with rectal cancer improves local control and possibly overall survival. However, an increased postoperative mortality rate after radiotherapy has been observed in some trials. This study was based on 1399 patients in two randomized trials of radiotherapy. It reviewed the causes of death after operation and attempted to identify risk factors for postoperative mortality in patients with rectal cancer treated with or without high-dose (5 × 5 Gy) preoperative radiotherapy. The majority of deaths were from cardio vascular disease or infection. The risk of postoperative mortality was significantly increased in patients irradiated with a two-portal technique to a relatively large volume compared with those not given radiotherapy, but not in those irradiated with a four-portal technique to a limited volume. Age, sex, tumour stage and coexistent cardiovascular disease were independent risk factors for postoperative mortality. The risk of postoperative death in patients with rectal cancer is related to the preoperative radiotherapy technique.
A randomized controlled study of the effect of bedside leucocyte depletion on the immunosuppressive effect of whole blood transfusion in patients undergoing elective colorectal surgery
Authors: Jensen L S , Hokland M , Nielsen H J
Published: March 2007

In a randomized study the effect of whole blood transfusion versus bedside leucocyte-depleted blood transfusion on lymphocyte proliferation, CD4+: CD8+ratio, and levels of soluble interleukin 2 receptor (sIL-2R) and interleukin (IL) 6, as well as on the development of postoperative wound infection and intra-abdominal abscess, was assessed in 60 patients undergoing elective colorectal surgery. Transfusion with whole blood induced a significant decrease in lymphocyte proliferation and CD4+:CD8+ ratio (P< 0·01) as well as a significant increase in sIL-2R and IL-6 levels (P< 0·01). Furthermore, transfusion with whole blood was accompanied by a significant increase in postoperative infectious complications (P< 0·01). In patients transfused with leucocytedepleted blood only slight and transient changes were observed, which were not significantly different from those observed in non-transfused patients.
Factors affecting outcome of patients with impalpable breast cancer detected by breast screening
Authors: Dixon J M , Ravisekar O , Cunningham M , Anderson E D C , Anderson T J , Brown H K
Published: March 2007

Factors affecting completeness of excision and outcome, whether conservation or mastectomy, in 152 patients with localized impalpable breast cancer undergoing therapeutic needle-guided wide local excision were assessed by univariate and multivariate analyses using multiple logistic regression. Independent factors related to completeness of excision at the first operation were operator experience (P=0·0001), and size of the lesion (P=0·005). Factors related to outcome were operator experience (P=0·0003), more experienced operators having a higher rate of breast conservation, and tumour size (P=0·0001), larger lesions being more likely to be treated by mastectomy. Patients initially operated on by the two most experienced surgeons were more than four times less likely to undergo mastectomy than those whose initial wide local excision was performed by a less experienced surgeon.
Cholangiocarcinoma in patients with opisthorchiasis
Authors: Watanapa P
Published: March 2007

Cholangiocarcinoma is very common in areas endemic for the liver fluke Opisthorchis viverrini. Survival after surgical treatment of cholangiocarcinoma associated with opisthorchiasis was studied prospectively in 30 patients, all of whom resided in an endemic area. The median age was 52 (range 32–69) years and twenty-five patients were men. Seven patients had their tumours removed, four with concomitant liver resection. Twenty-two patients underwent palliative biliary bypass procedures to a segmental duct. Laparotomy with biopsy of metastatic lesions was undertaken in one patient with multiple lymph node metastases and peritoneal seedlings. No patient received postoperative chemotherapy or radiation treatment. Patients were followed for 2 years or until death. The 1-year survival rate after tumour resection was 86 per cent and the 2-year survival rate 43 per cent. After palliative procedures the 1-year survival rate was 26 per cent; no patient reached 2 years and the median survival time was 8 months. Survival after surgical treatment of cholangiocarcinoma in patients with opisthorchiasis is broadly similar to that reported for cholangiocarcinoma without liver fluke infestation.
Early measurement of interstitial fibrosis predicts long-term renal function and graft survival in renal transplantation
Authors: Nicholson M L , McCulloch T A , Harper S J , Wheatley T J , Edwards C M , Feehally J , Furness P N
Published: March 2007

This study investigated the relationships between renal allograft interstitial fibrosis, renal function and graft survival. A total of 107 consecutive renal transplant recipients immunosuppressed with cyclosporin were studied. Needle core transplant biopsies were performed before operation and at 1, 6 and 12 months after transplantation. Allograft fibrosis was assessed by histomorphometric analysis of graft interstitial volume fraction. Renal function was measured by isotopic glomerular filtration rate (GFR) measurement at the same time points. Interstitial volume fraction was already high in preperfusion biopsies, significantly increased with time but stabilized at 6 months after transplantation. GFR correlated negatively with interstitial volume fraction at 6 months (P = 0·05). Interstitial volume fraction at 1 month was not a useful predictor of subsequent graft survival but for allografts surviving to 6 months an interstitial volume fraction above 25 per cent predicted significantly poorer survival (P = 0·04). It provides an objective measure of chronic allograft damage and may prove to be a useful surrogate endpoint in the study of therapeutic intervention.
Prospective study of the aetiology of infusion phlebitis and line failure during peripheral parenteral nutrition
Authors: May J , Murchan P , MacFie J , Sedman P , Donat R , Palmer D , Mitchell C J
Published: March 2007

Four techniques of administering peripheral parenteral nutrition (PPN) were examined prospectively to investigate the role of mechanical trauma in the development of infusion phlebitis. Patients in group 1 (n = 15) were fed via a standard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm every day. Group 2 patients (n = 15) had a similar catheter sited in each forearm simultaneously, with rotation of the side of infusion each day. Patients in group 3 (n = 17) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a standard cannula sited in the contralateral forearm, with alternation of infusion each day. Those in group 4 (n = 13) had a fine-bore 23-G silicone catheter sited in one arm only. Patients in groups 1, 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle. A total of 408 patient-days of PPN were given. Mean duration of PPN in groups 1–4 was 7·5, 9, 5·5 and 5 days respectively. Infusion phlebitis was not recorded in patients who had a daily change of cannula (group 1), but occurred in four patients in group 2, eight in group 3 and eight in group 4. Phlebitis scores were 0, 9, 15 and 12 for groups 1–4 respectively. Severe phlebitis and line occlusion occurred more frequently in patients with a 15-cm catheter (group 3) and in those fed continuously over 24 h (group 4). These results suggest that mechanical trauma is an important factor in the aetiology of infusion phlebitis. This can be minimized by reducing the time for which the vein wall is exposed to nutrient infusion and by reducing the amount of prosthetic material within the vein.
Connections of diffuse bipolar cells in primate retina are biased against S‐cones
Authors: Lee Sammy C.S. , Grünert Ulrike
Published: March 2007

In mammalian retina, each diffuse bipolar type stratifies in a distinct layer of the inner plexiform layer. Thus, different types of bipolar cells provide output to distinct visual pathways. Here, the question of whether diffuse bipolar cell types differ with respect to their contacts with short wavelength‐sensitive (S‐) cones was investigated in the retinas of a New World monkey, Callithrix jacchus, and an Old World monkey, Macaca fascicularis. Subpopulations of OFF bipolar cells were labeled with antibodies to the glutamate transporter Glt‐1 and ON bipolar cells were labeled with antibodies to the alpha subunit of the Go protein (Goα). Two types of diffuse ON bipolar cells, DB4 and DB6, were identified with antibodies to protein kinase Cα and CD15, respectively. Cone pedicles were labeled either with peanut agglutinin coupled to fluorescein or with antibodies to the ribbon protein, C‐terminus binding protein 2. We found that immunoreactivity for Glt‐1 (OFF bipolar cells) is reduced at S‐cones in comparison to medium/long wavelength‐sensitive (M/L‐) cones. Immunoreactivity for Goα (ON bipolar cells) is comparable at all cone types. Nearly all M/L‐cone pedicles contact the diffuse ON bipolar types DB4 and DB6, but only between 60% and 75% of the S‐cone pedicles make contact. Furthermore, the number of dendritic tips of DB4 and DB6 cells at S‐cone pedicles is lower than that at M/L‐cone pedicles. These results suggest that there is a bias in the S‐cone connectivity of diffuse bipolar cells. J. Comp. Neurol. 502:126–140, 2007. © 2007 Wiley‐Liss, Inc.