bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of long-term survival after successful repair of ruptured and non-ruptured abdominal aortic aneurysm
Authors: Stonebridge P A , Callam M J , Bradbury A W , Murie A , McL. Jenkins A , Ruckley C V
Published: March 2007

Long-term survival was assessed after the repair of non-ruptured (n = 311) and ruptured (n = 227) abdominal aortic aneurysm. Follow-up was 94.2 per cent complete, and the overall survival rate at 8 years was 43.6 per cent. There was no significant difference in 8-year survival rates between patients with non-ruptured (45.2 per cent) and ruptured (40.5 per cent) aneurysms. The survival curves were also compared with that for an age- and sex-matched population derived from Scottish Home and Health Department data.
Mesothelial seeding of knitted Dacron
Authors: Bearn P E , Seddon A M , McCollum C N , Marston A
Published: March 2007

Bilateral superficial femoral artery replacement using knitted Dacron was performed in 38 dogs. One side was seeded with omental mesothelium and the other acted as an unseeded contro. 111In-labelled platelet accumulation on grafts was measured at 5 days and 2 months and the thrombogenicity index of seeded and unseeded grafts calculated. Patency was monitored for 2 months, at which time grafts were removed and luminal thrombus, ultrastructural cell cover and prostacyclin release were measured. Cell seeding did not influence the mean(s.e.m.) thrombogenicity index of 0.95 (0.25) and 0.88(0.24) at 5 days in control and seeded grafts respectively; nor was there any difference between the groups at 2 months. Occlusion occurred in six control and four seeded grafts. Seeding did not significantly improve the percentage thrombus-free area or luminal cell cover. Neither did it enhance mean(s.e.m.) luminal 6-keto-prostaglandin F1α release of 2.58(0.80) pg cm−2 in controls and 2.63(0.78) pg cm−2 in seeded grafts. Further studies demonstrated that only a mean(s.e.m.) of 4.4(1.9) per cent of the seeded inoculum was present on grafts 48 h after implantation, providing too few cells to achieve confluent cover. Mesothelial cell seeding might be useful in promoting a healed graft surface but critical levels of seeding density must be achieved before the techinque can be properly evaluated.
Rectus repair for midline ventral abdominal wall hernia
Authors: Naraynsingh V , Ariyanayagam D
Published: March 2007

Recurrence-free repair of midline ventral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial defect are directly brought together to obliterate the hernia, the intervening linea alba and intact hernia sac being “keeled” into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia.
Management of non-functioning neuroendocrine tumours of the pancreas
Authors: Cheslyn-Curtis S , Sitaram V , Williamson R C N
Published: March 2007

Between 1982 and 1991, 20 patients of median age 44 (range 22–76) years were treated for non-functioning neuroendocrine tumours of the pancreas. Presenting features were obstructive jaundice (seven patients), abdominal pain (seven), weight loss (six), abdominal mass (eight) and severe haemorrhage (four). Gut hormone profiles were normal except for one patient who had a raised pancreatic polypeptide level. Contrast-enhanced computed tomography localized the tumour in 17 patients and visceral angiography in 14 of 15; all but three tumours were highly vascular. Ten patients underwent curative resection, and the remainder were managed palliatively by resection (four). bypass procedures (three) or biopsy alone (three). There were two postoperative deaths and seven early complications. Seven of the remaining 18 patients have died from disease a median of 16 (range 4–30) months after presentation. The 11 survivors, eight of whom had curative resections, have been followed for a median of 42 (range 7–72) months. Ten patients are asymptomatic but only five are free from disease. These tumours are seldom curable by radical surgery, but patients may remain free from symptoms for many years.
Hepatitis B immunization and exposure to blood among surgical staff
Authors: Williams S , Gooch C , Cockcroft A
Published: March 2007

A questionnaire was sent to all 158 staff of the operating department of a London teaching hospital to confirm their hepatitis B immunization status and establish the number of incidents involving exposure to blood during the preceding 4 weeks. Of these personnel, 104 (66 per cent) were known to be immune to hepatitis B either through immunization (97) or previous infection (seven). A further 23 (15 per cent) had completed a course of immunization but their seroconversion had not been checked. There were 26 sharps injuries sustained by 14 (12 per cent) of 119 staff and 240 other exposures to blood. Four of the sharps injuries had been reported. Staff known to be immune were more likely than those with unknown or negative immunity to report incidents (20 versus 0 per cent (95 per cent confidence interval of difference 2-38 per cent)). Doctors sustained more non-sharps exposures to blood than others (47 versus 23 per cent (95 per cent confidence interval of difference 7-40 per cent)). An important minority of operating department staff remains unimmunized against hepatitis B, although exposure to blood is common. Incidents are rarely reported and staff with unknown or negative immunity seem less likely to report than those known to be immune.
Natural history of abdominal aortic aneurysm detected by screening
Authors: Bengtsson H , Nilsson P , Bergqvist D
Published: March 2007

A group of 88 patients with abdominal aortic dilatation found in four ulrasonographic screening studies was followed prospectively by repeated ultrasonography. The initial aortic diameter ranged between 18 and 70 mm. In 19 patients (22 per cent) the aortic diameter exceeded 39 mm. The mean(s.e.m.) annual expansion rate of dilatations < 40 mm in diameter was 0.8(1.2) mm; among those ⩽ 40 mm it was 3.3(1.2) mm. The expansion rate increased with increasing initial diameter. Thirty-eight patients died; the overall mortality rate in the group was high in comparison with an age- and sex-matched population. One patient died after elective aneurysm surgery but none died from a ruptured aneurysm. In conclusion, in about 80 per cent of dilatations found in screening studies the aortic diameter was < 40 mm, with a low risk of rupture. One annual rescanning of an aneurysm < 35 mm in diameter is sufficient; a high overall mortality rate must be expected.
Use of desmopressin to prevent bleeding complications in patients treated with aspirin
Authors: Flordal P A , Sahlin S
Published: March 2007

Aspirin induces a haemorrhagic diathesis that persists for at least I week after discontinuation of the drug. The effect of the vasopressin analogue desmopressin was studied in 12 patitents treated with aspirin who were undergoing cholecystectomy. Desmorpressin was given to six of these patients. There were five postoperative bleeding complications; all occurred in patients who had not received desmopressin (P < 0·05). The bleeding time was prolonged in aspirin-treated patients and normalized by desmopressin (P < 0·05). Desmopressin can be used safely to prevent bleeding induced by aspirin.
Patterns of venous reflux in limbs with skin changes associated with chronic venous insufficiency
Authors: Lees T A , Lambert D
Published: March 2007

The distribution of venous reflux in patients with skin changes associated with chronic venous insufficiency presenting to a specialist clinic was assessed. A total of 300 limbs in 153 patients were examined by Doppler ultrasonography with colour-flow imaging for the presence of venous reflux in superficial veins, deep veins and medial perforating veins, both above and below the knee. Ninety-eight limbs had skin changes, which included hyperpigmentation, lipodermatosclerosis, atrophie blanche and ulceration. Of this group, 2 per cent had no evidence of venous reflux on duplex scanning, 39 per cent had deep vein incompetence, 57 per cent had superficial vein incompetence and 2 per cent had isolated medial perforating vein reflux. Of 25 limbs with ulceration, 13 had superficial and 12 deep vein reflux. A total of 202 legs, which included 20 normal control limbs, had no skin changes; 22·3 per cent of these had no venous reflux, 8·4 per cent had deep vein incompetence, 65·3 per cent had superficial incompetence and 4.0 per cent had isolated medial calf perforating vein incompetence.
Growth hormone therapy initiated before starvation ameliorates the catabolic state and enhances the protein-sparing effect of total parenteral nutrition
Authors: Koea J B , Douglas R G , Shaw J H F , Gluckman P D
Published: March 2007

The effect of 7 days of subcutaneously administered bovine growth hormone (bGH) (0.2 mg kg−1 day−1; n = 4) or an equivalent volume of 0.15 mol l−1 saline (n = 3) on protein metabolism was assessed in lambs. The catabolic response to 48 h of starvation and subsequent hypocaloric total parenteral nutrition (TPN) was measured using primed constant intravenous infusions of [15N]urea and[14C]leucine. Following 48h, of starvation and 7 h of TPN, bGH-treated animals had a significantly decreased rate of net protein catabolism compared with controls (mean(s.e.m.) 2·4(0·2) versus 3·2(0·3)g kg−1 day−1, P < 0·01). The means(s.e.m.) rate of whole-body protein catabolism was also significantly decreased in bGH-treated animals at 10·9(0.3) g kg−1 day−1 compared with 12·9(0·7) g kg−1 day−1 in saline-treated controls (P < 0·05). In addition, the rates of net and whole-body protein catabolism decreased significantly (P < 0·05) during the period of hypocaloric parenteral feeding to mean(s.e.m.) values of 2·3(0·2) and 8·6(0·6) g kg−1 day−1 respectively in bGH-treated animals. By contrast, in saline-treated controls net and whole-body protein catabolism continued to increase during hypocaloric parenteral feeding. There was a significant decrease (P < 0·05) in the rate of[14C]leucine uptake in tissues of the gastrointestinal tract, heart and diaphragm in bGH-treated animals compared with controls. These results demonstrate that daily administration of growth hormone decreases the catabolic response to a metabolic stress, resulting in the conservation of protein in the heart, diaphragm, gastrointestinal tract and musculoskeletal system by a primary anticatabolic action. In addition, growth hormone therapy initiated before induction of the catabolic state enhances the protein-sparing effects of TPN. Further study is justified to determine whether growth hormone therapy initiated before elective or urgent surgery in the nutritionally depleted patient may have a role in reducing the severity of the postoperative catabolic state, particularly in the patient in whom a complicated course is anticipated.
Prospective comparison of C-reactive protein level, Ranson score and contrast-enhanced computed tomography in the prediction of septic complications of acute pancreatitis
Authors: Vesentini S , Bassi C , Talamini G , Cavallini G , Campedelli A , Pederzoli P
Published: March 2007

Randomized clinical trials of antibiotic prophylaxis in acute pancreatitis are now warranted in the light of recent evidence of pancreatic penetration of certain antibiotics at therapeutic minimal inhibitory concentrations. The aim of the present prospective clinical study was to investigate whether there are detectable risk factors for pancreatic sepsis in acute pancreatitis that would allow better selection of patients for inclusion in clinical trials. Fifty-nine consecutive patients with acute pancreatitis were recruited and submitted to admission baseline and 48-h determinations of Ranson score, and assay of C-reactive protein at admission and weekly intervals thereafter. Contrast-enhanced computed tomography (CT) was also performed within 24 h of admission. Pancreatic sepsis, defined as infection of pancreatic and/or peripancreatic collections, was demonstrated in all cases by culture of samples obtained by needle aspiration and at laparotomy. Although all prognostic indices correlated significantly with sepsis, multivariate logistic regression analysis showed that the only variables predictive of the risk of subsequent sepsis were the presence and extent of necrosis. Early detection of pancreatic necrosis by CT should be the primary inclusion criterion in future clinical trials of antibiotic prophylaxis in acute pancreatitis.
Gunshot wounds of the colon: Role of retained bullets in sepsis
Authors: Demetriades D , Charalambides D
Published: March 2007

The role in the development of local sepsis of retained bullets that have passed through the colon was investigated. Of 84 patients with gunshot wounds of the colon, the bullet was retained in the body in 40 and had left or was removed from the body in 44. The groups were similar with regard to Revised Trauma Score, Injury Severity Score, Penetrating Abdominal Trauma Index and type of colonic trauma. The incidence of major local complications was 5 per cent in patients with a retained bullet and 7 per cent in those without. These results suggest that retained bullets that have penetrated the colon do not contribute to local septic complications.
Detection and enumeration of circulating tumour cells in colorectal cancer
Authors: Leather A J M , Gallegos N C , Kocjan G , Savage F , Smales C S , Hu W , Boulos P B , Northover J M A , Phillips R K S
Published: March 2007

Immunocytochemistry was used in parallel with conventional cytology to detect circulating malignant epithelial cells in 42 patients undergoing resection for colorectal cancer. Preoperative peripheral and peroperative mesenteric venous blood samples were taken. Tumour cells were isolated on a density gradient and cytospins prepared. Slides were stained by conventional cytology (May-Grünwald-Giemsa) and by an indirect immunoperoxidase technique with the anticytokeratin antibody KG 8.13. Using conventional cytology, definite morphological evidence of malignancy was observed in three patients and suspicious features in a further seven. Immunocytochemistry confirmed these findings in all three of the malignant but in only one of the suspicious cases. Counts of immunostained cytospins showed the concentration of tumour cells in blood samples from these four patients to be in the range 0-954 cells/ml. This study supports the use of immunological markers to detect and enumerate malignant cells. This method provides a powerful tool to investigate one aspect of the metastatic process.
Endoscopic transanal resection in the management of patients with sessile rectal adenomas, anastomotic stricture and rectal cancer
Authors: Wetherall A P , Williams N M A , Kelly M J
Published: March 2007

Forty patients underwent 61 endoscopic transanal resections using a urological resectoscope. Preoperative diagnoses were adenoma in 28 patients, carcinoma in seven and benign anastomotic stricture in five. Four patients with adenomas were found to have frank carcinoma. Ablation of 22 of 23 adenomas was achieved, 11 with a single transanal resection. Open operation was required for one patient. Locally advanced rectal malignancy was palliated in five of seven patients. All those with benign anastomotic stricture were cured by a single resection. The median operating time was 25 min, with 11 procedures exceeding 30 min. There were complications in seven cases (six bleeding, one septicaemia). The median hospital stay for the procedure alone was 3·5 days. There were no deaths within 30 days of operation. Endoscopic transanal resection is minimally invasive, quick, safe and effective. Histological surveillance is a major advantage and appears reliable. Low complication rates can be achieved by opting for several “easy” resections and by restricting use of the procedure to lesions within 15 cm of the anal verge.
Screening for breast cancer detects tumours at an earlier biological stage
Authors: Crisp W J , Higgs M J , Cowan W K , Cunliffe W J , Liston J , Lunt L G , Peakman D J , Young J R
Published: March 2007

Between August 1988 and July 1990, 17678 women in the Gateshead, Sunderland, South Tyneside and Durham districts attended the national breast screening programme. A total of 131 cancers were detected. The morphology of cancers detected by screening was compared with that of tumours in 71 patients presenting clinically in the same period. Screen-detected cancers included a higher proportion of tumours of more favourable histological grade and type, were smaller in size and had less axillary lymph node involvement than those detected clinically. Survival was predicted from the Nottingham Prognostic Index. Patients with screen-detected cancer had an expected survival advantage (95 per cent confidence interval) of 26.5 (12.3–40.6) per cent at 5 years, 26.5 (11.8–41.2) per cent at 10 years and 29.1 (14.5–43.7) per cent at 15 years. This survival advantage in screened patients expected at 5, 10 and 15 years is consistent with the 30 per cent reduction in mortality rate demonstrated in the Health Insurance Plan study and the Swedish two counties trial.
Oesophagomyotomy for achalasia: A 22-year experience
Authors: Ellis F H
Published: March 2007

To determine the clinical results in achalasia, particularly as regards postoperative gastro-oesophageal reflux, a 22-year personal experience with transthoracic short oesophagomyotomy without an antireflux procedure was analysed. A total of 185 such procedures were performed, of which 179 (97 per cent) were available for analysis. There was an overall improvement rate of 89 per cent over a mean postoperative interval of 9 years. Primary procedures were followed by a 93 per cent rate of improvement. Twenty patients, nine of whom had previously undergone one or more oesophageal operations, were considered as having a poor result. Marked gastro-oesophageal reflux accounted for a poor outcome in nine patients. Although the overall rate of postoperative improvement did not deteriorate significantly with time, the level of improvement did, the proportion of excellent results declining from 54 to 32 per cent (P = 0.02) at 10–20 years after operation. These findings substantiate the view that a short transthoracic oesophagomyotomy without an antireflux procedure provides excellent long-term relief of dysphagia for the patient with oesophageal achalasia and is accompanied by an extremely low risk of serious postoperative gastro-oesophageal reflux.
Kinetic changes and experimental carcinogenesis after Billroth I and II gastrectomy
Authors: Miwa K , Kamata T , Miyazaki I , Hattori T
Published: March 2007

To determine the risk of gastric remnant cancer according to the type of surgical reconstruction, the distal two-thirds of the glandular stomach was resected in male Wistar rats, followed by gastroduodenostomy (Billroth I anastomosis) or gastrojeunostomy (Billroth II anastomosis). No carcinogens were given and the animals were killed 50 weeks after operation. No cancers developed in 22 rats undergoing Billroth I gastrectomy, but five of 24 with Billroth II anastomosis had adenocarcinoma (P < 0.05). All carcinomas were confined to the stoma. Animals with Billroth II anastomosis had a more advanced grade of mucosal atrophy at the stoma, with a higher incidence of cystic dilatation, submucosal adenocystic proliferation and pseudopyloric metaplasia (P < 0.05). Cell kinetics in the stomal mucosa after Billroth II gastrectomy showed an increased cell count in the proliferative zone, longer duration of S phase and increased cell cycle time (P < 0.05). These results suggest that Billroth II gastrectomy carries a greater risk of cancer than the Billfroth I procedure.
Superselective intra-arterial chemotherapy with mitomycin for gallbladder cancer
Authors: Mäkelä J T , Kairaluoma M I
Published: March 2007

A group of 27 patients with carcinoma of the gallbladder was treated by superselective intra-arterial chemotherapy with mitomycin between 1981 and 1990. Results were compared with those in 22 historical controls. The overall response rate to intra-arterial chemotherapy was 48 per cent. The median survival time for responders was 34 months and for non-responders 8 months. Survival was significantly related to tumour stage in patients treated by chemotherapy (P < 0.001) and controls (P < 0.01); all patients with tumour extending beyond the serosa died within 4 years. The median survival period after intra-arterial chemotherapy was 14 months, compared with 4 months in controls. The cumulative 5-year survival rates for patients treated by chemotherapy and controls were not significantly different. Cessation of chemotherapy was required in 16 of the 27 patients: in eight because of tumour progression, in seven after toxicity to chemotherapy and in one because of patient refusal. Superselective intra-arterial chemotherapy can be useful for patients with cancer restricted to the gallbladder wall but cannot prevent tumour growth once this has extended beyond the gallbladder serosa.
Randomized study of the value of laparoscopy before appendicectomy
Authors: Olsen J B , Myrén C J , Haahr P E
Published: March 2007

Two groups of 30 women with clinical signs of appendicitis were randomized to immediate appendicectomy or diagnostic laparoscopy. In the latter group, appendicectomy was performed if a diagnosis of acute appendicitis was established or if the appendix could not be visualized. Eleven patients undergoing immediate operation had unnecessary appendicectomy, compared with two having laparoscopy. This difference of 30 per cent (95 per cent confidence interval 11–49 per cent) was significant (P = 0.01). There was no significant difference in postoperative morbidity rate in the two groups. Diagnostic laparoscopy is a useful preliminary investigation in women with clinical signs of acute appendicitis.
Management of superficial femoral artery occlusive disease
Authors: van der Heijden F H W M , Eikelboom B C , Banga J D , Mali W P Th M
Published: March 2007

The prevalence of intermittent claudication in men aged 55–74 years is 4·5 per cent and a common cause of such claudication is superficial femoral artery (SFA) occlusive disease. The preferred management of patients with this condition remains a subject of discussion. Therapeutic options range from conservative treatment to endovascular intervention and surgical bypass or endarterectomy. Conservative therapy is the primary treatment of choice. However, if this fails and an endovascular technique is chosen, percutaneous transluminal angioplasty (PTA) is the best option; other endovascular methods have failed to achieve higher rates of technical success or patency. PTA should be considered only for short lesions (⩽10 cm). The usual surgical option for SFA occlusive disease is femoropopliteal bypass using autogenous vein, which has an expected 5-year patency rate of 56–76 per cent. Patency rates decrease if other types of graft are used. An alternative to vein bypass is endarterectomy, with an expected 5-year patency rate of 35–71 per cent. A multicentre randomized trial should be conducted to determine the optimal management of claudication caused by SFA occlusive disease.
Scar formation after breast-conserving surgery for cancer
Authors:   Sir Charles Gairdner Hospital Breast Cancer Group, Orford J E , Ingram D M , Kaard A O , Sheiner H J
Published: March 2007

A study of surgery for breast cancer was performed to examine the influence of haematoma formation and radiotherapy on the development of mammographically detected scars. Fifty-nine women undergoing lumpectomy and radiotherapy were studied. Sixteen had mammographic scars 12 months after surgery. There was a correlation between postoperative haematoma formation and scarring (P = 0·03) but not between tumour size and scarring. The type of radiation therapy did not influence scar formation.
Surgical reintervention for differentiated thyroid cancer
Authors: Goretzki P E , Simon D , Frilling A , Witte J , Reiners C , Grussendorf M , Horster F A , Röher H-D
Published: March 2007

Reoperation was performed in 110 of 185 patients with a differentiated thyroid carcinoma. In 25 patients (23 per cent) the indication for reintervention was a large thyroid remnant and in the other 85 (77 per cent) persistent or recurrent cancer was suspected. In 32 (29 per cent) of the 110 patients undergoing reoperation no evidence of cancer tissue was found. Tumour tissue in 33 patients (30 per cent) was resectable. Of 45 patients (41 per cent) with residual tumour after operation 24 showed only occult thyroid carcinoma with a raised serum thyroglobulin level. Eight of 21 patients with macroscopically persistent tumour died from the disease during a mean follow-up of 2·3 years. In 13 of 38 patients the investigated recurrent tumours were histologically less differentiated than the primary lesions, stressing the importance of total tumour clearance. The treatment of choice for persistent and recurrent differentiated thyroid carcinoma is surgical reintervention, if feasible, before radioiodine and radiation therapy are considered.
Elective hepatic resection for benign and malignant liver disease: Early results
Authors: Habib N A , Koh M K , Zografos G , Awad R W , Bottino G
Published: March 2007

Between August 1989 and April 1992, 60 consecutive elective hepatic resections were performed by one surgeon at two hospitals. This personal series was reviewed to determine the early results of elective hepatic resection. There were 17 patients with liver metastases from colorectal cancer, 14 with hepatocellular carcinoma (three with cirrhosis), seven with cholangiocarcinoma, six with carcinoma of the gallbladder plus liver involvement, ten with liver metastases from other sites and six with benign conditions of the liver. Thirty-eight patients underwent major liver resection, seven unisegmentectomy, six bisegmentectomy, four trisegmentectomy an five non-anatomical resection. Total vascular exclusion was used in 50 cases and the Pringle manoeuvre in ten. The mean(s.d.) operative blood transfusion was 990(1260) ml packed red blood cells (range 0–13 units); 17 patients did not receive blood transfusion. There were two operative deaths; non-fatal complications developed in 16 patients. The two deaths were from postoperative liver failure and there was no other hospital death.
Profiles of workload in general surgery from linked hospital statistics
Authors: Goldacre M J , Ferguson J A , Welch A , Kettlewell M G W
Published: March 2007

Data from the Oxford Record Linkage Study between 1976 and 1986 were used to analyse statistical profiles of hospital care, taking account of multiple admissions per patient. Admission rates were higher in the elderly than the young, they were higher for men than women, and they increased over time. Episode-based admission rates increased by 15·5 per cent and person-based rates by 11·6 per cent. Most of the increase therefore represented a real rise in the number of people treated rather than an increase in multiple admissions per person. In the latest year of the study there was a mean of 125 admissions per annum per 100 male patients admitted and of 118 admissions per annum per 100 female patients admitted. The mean length of stay per admission and the total time spent in hospital per person per annum declined substantially from 1976 to 1986. Admission rates for prostatectomy, colectomy and varicose vein surgery increased signficantly and those for appendicectomy, cholecystectomy and peptic ulcer decreased significantly.
Acute limb deterioration during intra-arterial thrombolysis
Authors: Galland R B , Earnshaw J J , Baird R N , Lonsdale R J , Hopkinson B R , Giddings A E B , Dawson K J , Hamilton G
Published: March 2007

Approximately 12 per cent of limbs undergoing intra-arterial thrombolysis (IAT) develop distal embolism or extension of thrombus during the procedure. These are usually of little clinical consequence and can be treated by increasing the rate of administration of the lytic agent. However, in some patients the clinical condition of the limb deteriorates rapidly. In an attempt to define the incidence of acute limb deterioration during IAT, information was collected from five centres in the UK with experience of the technique. A total of 866 treatments were recorded, with 20 limbs (2·3 per cent) undergoing acute deterioration. This complication was more common during the treatment of thrombosed popliteal aneurysm than during that of emboli or thrombosed atheromatous arteries or grafts (P <0·001). The amputation rate associated with the complication was high, and operative intervention provided better results than continuation of lysis.
Anterior versus posterior reconstruction after transhiatal oesophagectomy: A randomized controlled trial
Authors: Bartels H , Thorban S , Siewert J R
Published: March 2007

In a prospective randomized trial the clinical results after transhiatal oesophagectomy with reconstruction in the anterior mediastinum (51 patients) or posterior mediastinum (45 patients) were compared. There were no differences in age, preoperative risk factors, tumour stage and local (surgical) complications between the two groups. However, reconstruction in the posterior mediastinum was associated with significantly fewer days spent in the intensive therapy unit (9 versus 14), fewer cardiopulmonary complications (13 versus 25 per cent) and lower mortality (30-day mortality rate 2 versus 6 per cent; hospital mortality rate 4 versus 10 per cent). These data show superiority of reconstruction in the posterior mediastinum after transhiatal oesophagectomy. This route is strongly recommended, particularly for patients with cardiopulmonary risk factors.
Extensive versus limited lymph node dissection for gastric cancer: A comparative study of 320 patients
Authors: Pacelli F , Doglietto G B , Bellantone R , Alfieri S , Sgadari A , Crucitti F
Published: March 2007

To compare extensive with limited lymph node dissection in the surgical treatment of gastric cancer, 320 patients undergoing gastric resection during 1981–1990 were divided into two groups. Although patients undergoing extended lymphadenectomy (n = 157) had a longer operating time (P = 0·0001) and a greater intraoperative blood transfusion requirement (P = 0·009) than those receiving limited dissection (n = 163), the incidence of postoperative complications (22·3 versus 28·2 per cent, P = 0·13) and the hospital mortality rate (3·8 versus 7·4 per cent, P = 0·12) were similar in the two groups. The 5-year survival rate after curative resection (117 and 121 patients after extensive and limited lymph node dissection respectively) was 65·4 versus 50·1 per cent (P = 0·01): 85·9 versus 82·2 per cent for stage I disease (P = 0·60), 66·1 versus 57·8 per cent for stage II (P = 0·82) and 48·7 versus 29·8 per cent for stage III (P = 0·02). Multivariate analysis using the Cox model showed that the extent of lymphadenectomy was an independent prognostic factor for survival (P = 0·01). The results support the value of extensive lymph node dissection in the surgical treatment of gastric carcinoma.
Computed tomography and fine-needle aspiration cytology for preoperative evaluation of cystic tumours of the pancreas
Authors: Iselin C E , Meyer P , Hauser H , Kurt A-M , Vermeulen B J M , Rohner A
Published: March 2007

Cystic neoplasms of the pancreas are rare. They may present as a mucinous (malignant or potentially malignant) tumour or as benign serous cystadenoma. Accurate preoperative diagnosis is therefore essential, as an asymptomatic serous tumour may safely be followed clinically for years, whereas mucinous tumours require aggressive surgery. Thirteen patients with cystadenoma and cystadenocarcinoma of the pancreas were reviewed and how best to improve the rate of preoperative diagnosis was considered. Fine-needle aspiration cytology and computed tomography enable accurate preoperative distinction between mucinous and serous cystic tumours of the pancreas.
Complications of circumcision
Authors: Williams N , Kapila L
Published: March 2007

Circumcision remains a common operation, with over 30000 procedures performed annually in the UK, mostly on children. The British Medical Association has recommended that circumcision should be performed only for medical reasons. Despite this, controversy exists over whether too many circumcisions are being performed. Are patients being exposed to an unnecessary operation? It may be argued that in doubtful cases it is easier to proceed to circumcision on the assumption that the attendant risks are low, but the operation is associated with a definite morbidity and rare deaths have been reported. This review considers the spectrum of complications that may result from circumcision and discusses the possible aetiological mechanisms.
Multidrug-resistant colonic cancer cell line LoVoDx is efficiently killed by lymphokine-activated killer cells from patients with carcinoma of the colon
Authors: Mooney E F , Dye J F , Guillou P J , Monson J R T
Published: March 2007

Multidrug-resistant (MDR+) cancer cells have the ability to grow in the presence of cytotoxic concentrations of antineoplastic drugs as a result of possessing the transmembrane drug efflux pump p-glycoprotein. The MDR+ colonic cancer cell line LoVoDx (derived from the drug-sensitive line LoVo) was tested for sensitivity to lymphokine-activated killer (LAK) cell-mediated toxicity. LAK cells were cultured from patients with colonic cancer and from matched controls with benig disorders. LAK cells from patients with cancer were as effective as those from controls in mediating cytotoxicity. The MDR+ cell line was significantly more sensitive to LAK cell-mediated cell killing than its parental drug-sensitive line LoVo (P < 0.05). These results indicate a possible role for adoptive immunotherapy in MDR+ tumours expressing p-glycoprotein.
Changing trends in the management of lower-limb ischaemia: A 17-year review
Authors: Sayers R D , Thompson M M , Varty K , Jagger C , Bell P R F
Published: March 2007

Over a 17-year period, 2930 vascular procedures were performed for chronic lower-limb occlusive disease. During this time, the total vascular surgical workload rose significantly as a result of an increase in the rates of arterial reconstruction and percutaneous transluminal angioplasty. Although the major lower-limb amputation rate did not change significantly, there was a decrease in the above- to below-knee ratio. In addition, there were significant increases in the percentage of patients treated over the age of 75 years and the proportion of attempted revascularizations before amputation. The mortality rates for arterial reconstruction, percutaneous transluminal angioplasty and amputation did not change significantly during the study period. The duration of hospital stay increased significantly for patients undergoing amputation and decreased significantly for those receiving arterial reconstruction.
Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography
Authors: Geroulakos G , Ramaswami G , Nicolaides A , James K , Labropoulos N , Belcaro G , Holloway M
Published: March 2007

High-resolution ultrasonography was used to classify carotid plaques into five different types in 72 patients with symptoms and in 49 without, and with stenosis of the origin of the internal carotid artery < 70 per cent. There were 72 plaques in the symptomatic group and 75 in the asymptomatic group. Type 1 plaques were uniformly echolucent, type 2 predominantly echolucent, type 3 predominantly echogenic, type 4 uniformly echogenic and type 5 consisted of plaques that could not be classified owing to heavy calcification and acoustic shadows. Type 1 Plaque was found in 90 per cent of patients with symptoms and in 10 per cent of those without, type 2 plaque was found in 53 and 47 per cent, type 3 in 34 and 66 per cent, and type 4 in 5 and 95 per cent respectively. The preponderance of echolucent plaques in symptomatic patients with stenosis < 70 per cent supports the hypothesis that this type of plaque is unstable and tends to embolize. In contrast, in patients without symptoms there is preponderance of echogenic plaques.
Serial imaging of the carotid bifurcation and cerebrovascular reserve after carotid endarterectomy
Authors: Naylor A R , Merrick M V , Sandercock P A G , Gillespie I , Allen P , Griffin T M G , Ruckley C V
Published: March 2007

A radioisotopic method of quantifying mean cerebral transit time was used to assess the immediate effects of carotid endarterectomy on cerebrovascular reserve (CVR) in 69 patients. In addition, serial postoperative data were acquired on CVR, clinical status and non-invasive imaging of the internal carotid arteries in 56 patients over a period of 6–48 (median 24) months. Twenty-one patients (30 per cent) had preoperative evidence of impaired CVR in the symptomatic hemisphere. Within 4 days of surgery, however, reserve had returned to normal in 17 of the 21 patients. During follow-up, four of the 56 patients developed recurrent stenosis (< 50 per cent) or occlusion of the artery operated on but only two of these had impairment of CVR and none was symptomatic. Three patients suffered recurrent transient ischaemic attacks (TIAs) but none had recurrent internal carotid artery disease or impaired CVR. One patient suffered a TIA in the territory of the non-operated artery during follow-up in association with disease progression and CVR impairment. However, the TIA preceded recognition of either of these changes. Twelve other patients had (or developed) stenosis (> 50 per cent) in the non-operated artery during follow-up but none was symptomatic or developed impairment of CVR. Although assessment of CVR provided useful information on the frequency of haemodynamic compromise before carotid endarterectomy and on the natural history of disease progression, neither serial assessment of reserve nor non-invasive imaging of the carotid bifurcation influenced clinical practice during follow-up.
Suture length to wound length ratio and healing of midline laparotomy incisions
Authors: Israelsson L A , Jonsson T
Published: March 2007

The effect of suture length to wound length ratio on the healing of midline laparotomy wounds closed with a continuous suture was evaluated in a prospective clinical trial. All patients undergoing abdominal procedures through a midline incision were included except those with an incisional hernia after previous midline operation. The total incidence of wound infection was 36 of 454 patients (7·9 per cent) and wound dehiscence requiring reoperation occurred in three patients (0·7 per cent). Incisional hernia was found in 18.7 per cent of 363 patients alive 12 months after surgery. Multivariate analysis identified the suture length to wound length ratio, age and major wound infection as independent risk factors for the development of hernia, which occurred in 9.0 per cent of patients when the suture length to wound length ratio was ≧ 4 and in 23·7 per cent (P = 0·001) when it was <4. The suture length to wound length ratio is an important parameter for healing of midline incisions closed with a continuous suture technique. The incidence of incisional hernia is lower when such wounds are sutured with a ratio ≧ 4.
Complications and survival of multilumen central venous catheters used for total parenteral nutrition
Authors: Savage A P , Picard M , Hopkins C C , Malt R A
Published: March 2007

In a prospective study of 879 triple-lumen catheters, 219 pulmonary artery catheters, 31 double-lumen and six single-lumen catheters used for the administration of total parenteral nutrition over a 1-year period, the overall complication rate was 12-5 per cent (14-7 complications per 1000 catheter-days) and the catheter-related sepsis rate 4·4 per cent (5·2 per 1000 catheter-days). The probability of development of catheter-related sepsis did not increase with the duration of catheterization. There were no differences in the rate of complications associated with 427 catheters changed by replacement at a new site compared with 159 lines changed over a guidewire. These data support the use of multilumen central venous catheters for the administration of total parenteral nutrition. They suggest that a routine weekly change of line is unnecessary; catheters should be changed only on the development of a complication. When it is required, a catheter should be changed by replacement over a guidewire.
Early wound excision and skin grafting restores cellular immunity after severe burn trauma
Authors: Cetinkale O , Ulualp K M , Ayan F , Düren M , Cizmeci O , Pusane A
Published: March 2007

Suppression of cellular immunity following thermal injury may contribute to the high incidence of postburn sepsis. Early excision and skin grafting may remove deleterious local wound factors and prevent immunosuppression. The effect on cellular immunity of early burn wound excision and skin grafting was investigated in an animal model using female Wistar rats. The development of immunosuppression shortly after burn injury was shown by popliteal lymph node assay and a 2,4-dinitrofluorobenzene skin reaction test. Excision and skin grafting 2 days after burn trauma restored parameters to normal. Burned tissue suppresses cellular immunity; this effect is preventable by early excision and skin grafting.
Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma
Authors:   Swedish Rectal Cancer Trial, Påhlman L
Published: March 2007

Between March 1987 and February 1990, 1168 patients with resectable rectal cancer were recruited into a nationwide Swedish trial. Patients were randomly allocated to receive either preoperative irradiation (25 Gy infive fractions over 1 week) followed by surgery within 1 week, or surgery alone. In each group 454 patients underwent curative surgery. The groups were well matched for age, sex and surgical procedure. The postoperative mortality rates did not differ: 4 per cent after irradiation versus 3 per cent after surgery alone, but the postoperative mortality rate was significantly higher in patients treated with a two- rather than three- or four-portal technique (15 versus 3 per cent, P < 0·001). More perineal wound infections were found in patients receiving irradiation (20 versus 10 per cent, P < 0·001). No difference in the incidence of anastomotic dehiscence or other postoperative complication was found between the groups. Preoperative radiotherapy with a short-term high-dose technique can be delivered without major acute adverse effects, provided the irradiation technique is optimized.
In vitro response of the human and canal longitudinal muscle layer to cholinergic and adrenergic stimulation: Evidence of sphincter specialization
Authors: O'Kelly T J , Brading A , Mortensen N J McC
Published: March 2007

A study was performed to determine the in vitro response of the longitudinal smooth muscle layer (conjoined longitudinal coat) of the human anal canal to cholinergic and adrenergic stimulation, and to compare this with similar features of the internal anal sphincter (IAS) and rectal smooth muscle. Tissue was obtained from abdominoperineal and anterior resection specimens, and strips of muscle mounted for isometric tension recording in superfusion organ baths. Both conjoined longitudinal coat and IAS strips generated and maintained spontaneous myogenic tension (mean(s.e.m.) 0·10(0·01) and 0·48(0·04) g per mg tissue respectively), whereas equivalent rectal smooth muscle did not. Stimulation of muscarinic (cholinergic) receptors caused contraction of strips from the conjoined longitudinal coat and rectal smooth muscle layers in a dose-dependent manner (10−7-10−4 mol/l); however, IAS strips relaxed (10−6-10−4 mol/l). Activation of α-adrenergic receptors in conjoined longitudinal coat and IAS strips produced concentration-dependent contraction (10−7 -10−4 mol/l). In comparison, rectal smooth muscle relaxed. All muscle layers relaxed in response to β-adrenoceptor stimulation. These data indicate that in the anal canal both the conjoined longitudinal coat and IAS are specialized sphincteric smooth muscles.
Physiological and histochemical adaptation of the electrically stimulated gracilis muscle to neoanal sphincter function
Authors: George B D , Williams N S , Patel J , Swash M , Watkins E S
Published: March 2007

The physiological and histochemical characteristics of the gracilis muscle were studied in 19 patients undergoing electrically stimulated gracilis neosphincter construction. Indications for surgery were faecal incontinence (n = 11) and reconstruction following sphincter excision or congenital absence (n = 8). Transposition of the gracilis muscle around the anal canal followed by chronic low-frequency electrical stimulation was associated with a shift in the frequency-response curve and a prolongation of the time-course of individual muscle twitches suggestive of transformation to a slow-twitch fatigue-resistant type. Temporary cessation of electrical stimulation resulted in a reversal of the frequency-response changes. Muscle biopsies taken before and a median of 80 (range 49–137) days after transposition and low-frequency electrical stimulation indicated a significant increase in the proportion of type 1 fibres and a significant decrease in their diameter. These results show that the human gracilis muscle is capable of physiological and histochemical adaptation to long-term neosphincter function.
Eye protection for the vascular surgeon
Authors: Berridge D C , Lees T A , Chamberlain J , Jones N A G
Published: March 2007

Contamination occurring during vascular surgery was studied prospectively using a surgical mask incorporating a Splashguard visor. Over a 16-week period 78 vascular procedures were included; 44 were of < 2 h duration and 34 were of ⩾ 2 h. Contamination on both mask and visor from blood spots was recorded at the end of each procedure. Overall, 51 per cent of principal surgeons' visors were contaminated, with contamination of the mask itself in 32 per cent. When two surgeons were operating the contamination rate for the second was also high: 36 per cent for the visor and 42 per cent for the mask. Assistants had a contamination rate of 36 per cent for the visor and 13 per cent for the mask. The lowest rate of contamination occurred for the visor and mask of the scrub nurse, 10 and 4 per cent respectively. For emergency procedures the duration of operation had no influence on the frequency of contamination. However, for the principal surgeon elective operations of < 2 h duration were less likely to involve contamination than those of ⩾ 2 h (P <0·035). Blood contamination of visors and masks is common in vascular surgery but rarely appreciated by the surgeon. Routine eye protection should be considered in vascular surgery, in particular for emergency and prolonged elective procedures.
Genetic linkage analysis applied to unaffected women from families with breast cancer can discriminate high- from low-risk individuals
Authors: Porter D E , Steel C M , Cohen B B , Wallace M R , Carothers A , Chetty U , Carter D C
Published: March 2007

Up to 20 per cent of cases of breast cancer diagnosed in women under the age of 45 years may be caused by an autosomal dominant gene. A present difficulty is differentiation of mutation carriers from nonmutation carriers in high-risk families. Genetic linkage analysis has been used to localize a susceptibility gene (BRCA1) on chromosome 17q12-21 between markers 42D6 and MFD 188, a region 5–10 million base pairs in length. Odds in favour of linkage to this region were greater than 100 000: 1 in 15 families with breast cancer. In eight families in which the probability of linkage was above 75 (range 79·2–99·9) per cent, 19 women were identified who were at high lifetime risk of breast cancer (range 80·6–87·2 per cent) and 37 whose risk was similar to that for the general population (range 9·8–16·4 per cent). Genetic risk prediction of this kind may enable high-risk screening clinic resources to be concentrated on those most likely to benefit.