bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between Flutter Valve Drainage Bag and Underwater Seal Device for Pleural Drainage after Lung Surgery
Authors: Vuorisalo S. , Aarnio P. , Hannukainen J. 
Published: January 2017

Aim of the study: The purpose of the present study was to compare the use of a conventional underwater seal device with suction and a flutter valve drainage bag for pleural drainage after lung surgery. Patients and Methods: Altogether 59 patients undergoing elective lung surgery except pneumonectomy between February 2001 and April 2002 were prospectively randomized to receive postoperative pleural drainage by 28F chest tube(s) attached to underwater seal device placed on negative pressure of 15 cm of water or flutter valve drainage bag. Following withdrawal of four patients from the study, 55 patients were evaluated (31 patients in the underwater seal device group and 24 patients in the flutter valve drainage bag group). Results: In the conventional underwater seal device group the mean drainage time was 2.6 (SD ± 2.0) days and in the flutter valve drainage bag group the mean drainage time was 3.3 days (SD ± 4.0); difference −0.8, 95% confidence interval (CI) −2.4 to 0.9. The mean length of hospitalization in the surgical ward was 3.6 (SD ± 2.7) and 4.1 (SD ± 4.4) days respectively (difference −0.5, 95% CI −2.5 to 1.4). Conclusions: The results of this study suggest that flutter valve drainage system is a safe and feasible alternative in managing postoperative air leaks and haemorrhage after lung surgery other than pneumonectomy if air leaks are not extremely massive.
Four or Twelve Months' Follow-Up in the Evaluation of Functional Outcome after Hip Fracture Surgery?
Authors: Heikkinen T. , Jalovaara P. 
Published: January 2017

Background and Aims: As a rule, follow-up for at least one year is recommended for fracture studies. This is considered the shortest reliable interval. Still, in the case of hip fractures of the elderly, shorter follow-up might be more practical, since the life expectancy of these patients is often short. The aim of this study was to see if a short four months follow-up period would be acceptable in hip fracture surveys. Material and Methods: Information on 196 consecutive non-pathological hip fracture patients aged 50 years or over (mean 79 years) was collected using a standardised hip fracture audit concentrating on functional measurements at admission and at four and twelve months' follow-ups. Results: 167 patients were alive at four months and 152 and at one year. The patients who died between four and twelve months had poorer functional capacity in the four-month evaluation than those who survived one year. The analysis of repeated measures, including only the patients alive at the last follow-up, showed that residential status, use of walking aids and 6 out of 10 and ADL variables (bathing, toileting, shopping, household activities, doing laundry, banking) did not change significantly. Walking ability and the rest 4 ADL variables (dressing, eating, food preparation, use of transportation) improved and pain decreased. Conclusions: Due to high mortality and age-related deterioration of functioning, no steady state i.e. “final result” is ever reached after hip fracture in the elderly. Four-month follow-up is justified as the shortest possible period, because the socioeconomically most important variable, i.e. place of living, and most of the ADL functions do not change significantly after that.
Gamma Irradiation and Ethylene Oxide in the Sterilization of Native Reindeer Bone Morphogenetic Protein Extract
Authors: Pekkarinen T. , Hietala O. , Jämsä T. , Jalovaara P. 
Published: January 2017

Background and Aims: For human use, it is necessary to sterilize bone morphogenetic proteins (BMPs), in order to reduce the risk of infections and associated complications. We compared the effects of ethylene oxide and gamma irradiation in the sterilization of native reindeer BMP extract with regard to bone induction in the Balb/C mouse thigh muscle pouch model. Materials and Methods: BMP extract, sterilized with ethylene oxide gas (Steri-Vac 4XL' temperature 29°C, exposure time 4 h, ethylene oxide concentration 860 mg/l), or gamma irradiation at doses of 3.15 MRad was administered in implants containing 5 or 10 mg of BMP extract with collagen carrier. Non-sterilized collagen implants served as controls. New bone formation was evaluated based on the incorporation of Ca45 and radiographically three weeks after implantation. Results: The collagen was not able to induce new bone visible in radiographs. The mean Ca45 incorporation in the gamma sterilized group containing 5 mg of BMP extract was 30 % (p = 0.04) and that containing 10 mg of BMP extract was 60 % (p = 0.02) higher than seen in the corresponding ethylene oxide sterilized groups. The mean new bone areas were 45 % higher in the gamma sterilized groups than in the corresponding ethylene oxide sterilized groups, but the differences were not significant. The mean optical density of new bone in the gamma sterilized group containing 5 mg of BMP extract was 75 % (p = 0.00) and in that containing 10 mg of BMP extract was 70 % (p = 0.00) higher than seen in the corresponding ethylene oxide sterilized groups. Conclusion: Native reindeer BMP extract is more sensitive to the effects of ethylene oxide gas sterilization than gamma irradiation. These results suggest that gamma irradiation is recommendable for the sterilization of BMP extracts.
Carcinoid Tumours in the Gastrointestinal Tract — A Population-Based Study from Western Norway
Authors: Helland S. K. , Prøsch A. M. , Viste A. 
Published: January 2017

Objective: To analyze population-based incidence, anatomic distribution and patient characteristics of gastrointestinal carcinoid tumours. Background: Neuroendocrine carcinomas (NE, carcinoid tumours) arise from neuroendocrine cells and are most commonly found in gastrointestinal tract and lungs. Previous studies on carcinoids report varying incidence rates, location of tumours and patient survival rates. Methods: Retrospective study.88 patients were diagnosed with carcinoids located in the gastrointestinal tract in the period 1983–2003 in the Norwegian counties Hordaland and Sogn og Fjordane. Patient and tumour characteristics, treatment and survival were analyzed in a sub-group of 51 patients treated at Haukeland University Hospital. Results: Incidence of carcinoids was 0.8 when analyzed from the counties Hordaland and Sogn og Fjordane as well as when analyzed from Haukeland University Hospital. There were 26 men and 25 women. Median age at surgery was 61 years (range 17–87 years). The tumours were located in the small bowel in 53%, appendix 18%, colon 4%, rectum 4%, stomach 8% and duodenum 10%. Five-year survival rate was 50% in stomach, 80% in duodenum, 43% in the small bowel, 100% for tumours in appendix, 40% in colon and 100% in rectum. Conclusion: Carcinoid tumours are relatively uncommon neoplasms and most of them are found in the small bowel. Carcinoids in the ileum tend to be more aggressive and carry a poorer prognosis than carcinoids at other locations. Tumours in the appendix are found at lower age and in an early stage. They rarely metastasize and have an excellent prognosis.
Diagnostic Laparoscopy and Ultrasonography for Colorectal Liver Metastases
Authors: Mortensen F. V. , Zogovic S. , Nabipour M. , Nielsen D. Tønner , Pahle E. , Rokkjaer M. , Jensen L. 
Published: January 2017

Background and Aims: To evaluate diagnostic laparoscopy (DL) and laparoscopic ultrasonography (LuS) in the diagnostic workout of patients with colorectal liver metastases, who were considered to have resectable disease after multi detector computed tomography (MDCT). Material and Methods: The medical records of 45 patients, 22M/23F, mean age 62.0 (± 10.6), who were considered to have resectable liver metastases after CT-scan, were analysed. Results: DL and LuS could not be performed in 7 patients (16%) because of adhesions. unresectable disease was detected by DL in 3 patients (7%), in all cases due to carcinosis. Additional lesions in the liver were detected by DL in 2 cases (4%), none of these making the patient unresectable. LuS showed additional lesions in 3 patients (7%), which in one case (2%) made the patient unresectable. None of the patients in the present study experienced adverse effects to DL or LUS. Conclusion: DL and LUS, due to the low efficacy with regard to avoid unnecessary laparotomies and the relative high failure rate because of adhesions, should not be a routine part of the diagnostic work out in patients with colo-rectal liver metastases.
Pulmonary Sequestration — A Review of 8 Cases Treated with Lobectomy
Authors: Pikwer A. , Gyllstedt E. , Lillo-Gil R. , Jönsson P. , Gudbjartsson T. 
Published: January 2017

Background and Aims: Pulmonary sequestration (PS) is a rare congenital malformation where non-functioning lung tissue is separated from the bronchial tree and vascularised with an aberrant artery from the systemic circulation. The aim of this report was to study all patients who were treated for PS at Lund University Hospital between 1994 and 2004, with emphasis on clinical presentation of the disease and evaluate the results of surgical treatment. Material and Methods: 8 cases were identified, 7 females and one male, with a mean age of 7.3 years (range 25 days — 17 years) at the time of diagnosis. Results: Out of 8 patients, seven presented with respiratory symptoms and two with congestive heart failure. Five patients had other congenitial malformations; including scimitar syndrome and congenital heart disease. All the patients underwent a successful lobectomy. There were no major postoperative complications. At a medium follow-up of 77 months all of the fully treated children were doing well. Conclusion: Respiratory and cardiovascular symptoms are the most common symptoms related to PS. The wide range of clinical symptoms may cause diagnostic problems, especially in children and young adults with concomitant congenital heart disease. Therefore PS should be considered as a differential diagnosis in children with unexplained respiratory symptoms or with signs of congestive heart failure. In patients with PS, lobectomy seems to be a good therapeutic option.
Predictive Value of Parathyroid Scintigraphy in the Preoperative Evaluation of Patients with Primary Hyperparathyroidism
Authors: Rasmussen K. , Larsen L. P. , Arveschoug A. , Nielsen J. Theil , Vestergaard P. , Rønning H. , Mosekilde L. , Christiansen P. 
Published: January 2017

Background and Aims: The surgical gold standard in primary hyperparathyroidism was until recently exploration of all four parathyroid glands. Today more patients undergo minimal invasive procedures demanding more accurate preoperative localization studies. The aim of the study was to determine the positive predictive value (PPV) of parathyroid scintigraphy (PS) and to some extent ultrasonography (US), defined as the probability of finding one single adenoma on the affected side at surgery when the scans had shown one single focus. Material and Methods: Eighty-eight surgically treated patients (76 women and 12 men, 8 with multiglandular disease) were included. The PS consisted of 99mTc-sestamibi scan with dual-phase technique, both planar and SPECT imaging, followed by 99mTc-pertechnetate scan. A positive scan was defined as a single focus accumulating sestamibi. Focal lesions on US were defined as hypoechoic nodules. Results: PS was positive in 80 patients. Seventy-nine had only one focus, of which 64 were correctly localized adenomas (PPV 81%). Forty-seven of 77 US examinations were positive. In 44 there was only one focus of which 38 were correctly localized (PPV 86%). PPV was 97% when both examinations were positive. Conclusions: Both PS and US have acceptably high PPVs defined as the ability to predict whether or not one single focus represents a parathyroid adenoma. Concordant positive results were accompanied by a PPV close to 100%.
The Essentials of Locoregional Control in the Treatment of Gastric Cancer
Authors: den Dulk M. , Verheij M. , Cats A. , Jansen E. P. M. , Hartgrink H. H. , van de Velde C. J. H. 
Published: January 2017

Gastric cancer is the fourth most frequent cancer in the world. For curative treatment and local control of gastric cancer, surgery is essential. The extent of the lymph node dissection is still under debate. Only one available trial showed significantly increased overall survival, whereas in all other randomised trials no significant difference could be found. As surgery alone often is not sufficient in the curative treatment in gastric cancer, different (neo)adjuvant treatment strategies have extensively been studied. The recently published MAGIC trial showed downstaging, downsizing and an improved overall survival for patients treated with perioperative chemotherapy, compared to surgery alone (difference 13%, p = 0.009). The INT 0116 trial on the other hand, demonstrated the benefit of postoperative chemoradiotherapy compared to surgery alone for patients with a curative resection of gastric cancer. However, the quality of resections in this trial was poor, illustrating the importance of standardisation by quality control. This could be done by the Maruyama index, which quantifies the likelihood of unresected disease. In the Netherlands, the CRITICS trial has recently been launched, which will be a quality controlled trial comparing postoperative chemoradiotherapy and chemotherapy on survival and/or locoregional control in patients who receive neoadjuvant chemotherapy followed by a D1+ gastric resection.
Adenocarcinoma of the Esophago-Gastric Junction
Authors: Siewert J. R. , Stein H. J. , Feith M. 
Published: January 2017

Background: The border between the esophagus and stomach gives rise to many discrepancies in the current literature regarding the etiology, classification and surgical treatment of adenocarcinoma arising at the esophago-gastric junction. We have consequently used the AEG-criteria (adenocarcinoma of the esophago-gastric junction) for classification and have based the selection of the surgical approach on the anatomic topographic subclassification. Methods: In the following we report an analysis of a large and homogeneously classified population of 1602 consecutive patients with adenocarcinoma of the esophago-gastric junction, with an emphasis on the surgical approach, the pattern of lymphatic spread, the outcome after surgical treatment and the prognostic factors. Demographic data, morphologic and histopathologic tumor characteristics, and long-term survival rates were compared among the three tumor subclassifiations. Results: The study confirms the marked differences in sex distribution, associated specialized intestinal metaplasia in the esophagus, tumor grading, tumor growth pattern, lymphatic spread, and stage between the three tumor entities. The degree of resection and lymph node status were the dominating independent prognostic factors by multivariate analysis. The data show no significant differences of long-term survival after abdomino-thoracic esophagectomy and extended total gastrectomy in these patients. Conclusion: The classification of adenocarcinomas of the esophago-gastric junction in three types, AEG type I, type II and type III shows marked differences between the tumor entities and is recommended for selection of a proper surgical approach. Complete tumor resection and adequate lymphadenectomy are associated with good long-term prognosis. Better surgical management and standardized procedures will improve the outcome also of patients who need to undergo more radical surgery, i.e. abdomino-thoracic esophagectomy.
Role of Infrainguinal Angioplasty in the Treatment of Critical Limb Ischaemia
Authors: Eskelinen E. , Lepäntalo M. 
Published: January 2017

Objective: To review the published papers reporting on the use of infrainguinal angioplasty in the treatment of critical limb ischaemia (CLI). Methods: A MEDLINE (1966–2005) and Cochrane library search for articles relating to the use of infrainguinal angioplasty in the treatment of CLI. Results: Recent papers reporting on the results of infrainguinal angioplasty as treatment for CLI patients show excellent limb salvage rates regardless of the patency rates. The Cochrane Database of systematic reviews has accepted two prospective randomised trials comparing bypass operations and angioplasty among CLI patients. Pooling both trials showed no overall significant difference in amputation rates between the surgery and PTA groups. A multicentre, randomised controlled trial, the BASIL (bypass versus Angioplasty in Severe Ischaemia of the Leg) trial showed that in the medium term (after six months), the outcomes after angioplasty or surgery among CLI patients did not differ significantly with respect to amputation-free survival, all-cause mortality and quality of life. Conclusions: Infrainguinal PTA is feasible in CLI patients. Data from the BASIL trial show the similar ability of bypass surgery and balloon angioplasty in preserving both life and limb in short term. These results are, however, not applicable for the majority of CLI patients as only 15% (70/456) of the patients with severe limb ischaemia were considered candidates for the trial.
Ligasure Vessel Sealing System versus Conventional Vessel Ligation in Thyroidectomy
Authors: Lepner U. , Vaasna T. 
Published: January 2017

The Ligasure Vessel Sealing System (LVSS) is a new surgical technology which has been used to secure haemostasis in various fields of surgery. There is little information in the literature about the use of the LVSS in thyroid surgery and the results of these studies are controversial. The aim of this study was to report our experience with the LVSS in thyroid surgery and to compare it with our experience with conventional vessel ligation. The non-randomized retrospective review included 403 consecutive patients who underwent primary thyroid surgery. A conventional suture-ligation technique was used in 199 patients (conventional group) and the LVSS was used in 204 patients (ligasure group). The following data were collected: patients' demographics, thyroid pathology, type of thyroidectomy, operating time and complications. The mean operating time for lobectomy, subtotal thyroidectomy and total thyroidectomy was significantly shorter in the Ligasure group compared with the conventional group. Average saving in operating time in the Ligasure group was 25.8 minutes (95% CI 19.5—32.2; p<0.0001) with relative reduction being 26.6%. Among all types of complications only postoperative transient hypoparathyroidism demonstrated a significantly lower incidence in the Ligasure group (2.5% vs 7.0%; p=0.022). We found that the LVSS is a safe method with minimal complications in thyroid surgery. Use of the LVSS for all types of thyroidectomy ensures a significantly shorter operating time.
Clinical Outcome after D1 vs D2–3 Gastrectomy for Treatment of Gastric Cancer
Authors: Danielson H. , Kokkola A. , Kiviluoto T. , Sirén J. , Louhimo J. , Kivilaakso E. , Puolakkainen P. 
Published: January 2017

Background: Clinical benefit from extended lymphadenectomy for gastric cancer remains controversial as a considerable variation exists between results of different studies. Methods: 562 patients were treated at HUCH between 1987–2003, whereof 223 underwent gastrectomy with curative intent. Of these, 114 patients underwent subtotal/total gastrectomy with D1 (standard) lymphadenectomy and 109 patients had D2–3 (extended) lymph node dissection. The clinical outcome of these patients was analysed retrospectively. Results: The incidence of surgical complications was 33.0% in D2–3 and 16.8% in D1 lymphadenectomy groups (p = 0.008). Abscess was the most common complication (11.0%) among D2–3 operated patients and haemorrhage (4.4%) in D1 group. Hospital mortality was 3.7% in D2–3 and 1.8% in D1 group (p = 0.438). The only statistically significant factor influencing the rate of complications was D2–3 lymphadenectomy (OR 2.620, 95% C.I. 1.375 to 4.991). D2–3 was associated with a longer postoperative hospital stay and operation time, greater blood loss and increased need for blood transfusions compared to D1. The 5-year survival was not statistically different between lymphadenectomy groups. Conclusion: It is justified to perform a D2–3 gastrectomy in Europe with a acceptable postoperative mortality but with a significant morbidity. Further studies are needed to assess the value of extended lymphadenectomy in gastric cancer
Intraoperative Ultrasonography in Detecting and Assessment of Colorectal Liver Metastases
Authors: Kulig J. , Popiela T. , Kłęk S. , Milanowski W. , Kołodziejczyk P. , Szybiński P. , Richter P. 
Published: January 2017

Objective: to assess the clinical value of intraoperative ultrasonography (IOUS) in detecting and assessment of liver metastatic tumours in colorectal cancer patients. Methods: a study is a retrospective analysis of 388 patients operated on for colorectal carcinoma between 1997 and 2004. In all the patients intraoperative ultrasound was performed. The authors analyzed of sensitivity, specificity, PPV, NPV and accuracy of pre-and intraoperative ultrasonography in detecting and staging of colorectal metastatic lesions. Results: Intraoperative ultrasonography showed the highest sensitivity, specificity and accuracy in both, tumor detection (99.1, 98.5 and 98.9%, respectively) and assessment (95.4, 99.5 and 99.1%, respectively). Overall sensitivity of IOUS was significantly better in detection and staging compared with preoperative ultrasonography 91.1 and 72.2%, respectively). Conclusions: IOUS should be used as routine diagnostic modality in colorectal cancer patients with hepatic metastases or suspected metastases. Transabdominal ultrasonography cannot be used as the only diagnostic tool in the evaluation of liver lesions, but may be helpful in preoperative screening.
Resection Rectopexy for External Rectal Prolapse Reduces Constipation and Anal Incontinence
Authors: Johnson E. , Stangeland A. , Johannessen H.-O. , Carlsen E. 
Published: January 2017

Background and Aims: The main aim was to examine constipation and anal incontinence in patients before and after resection for external rectal prolapse. Material and Methods: Twenty patients had ligament preserving suture rectopexy and sigmoid resection (resection rectopexy) for external rectal prolapse by laparoscopic (n = 15) or open (n = 5) technique during 2001–2005. They were prospectively evaluated for constipation and anal incontinence using validated incontinence and KESS-constipation scores. Results and Conclusions: Constipation score was significantly reduced from mean 7.7 (5.4–9.9) to 4.5 (2.5–6.4) after median 4 months (1–19) and to 4.3 (2.2–6.3) after median 17 months (4–51). Six and four patients were constipated preoperatively and 17 months postoperatively, respectively. The four symptoms feeling incomplete evacuation of stool, minutes in lavatory per attempt, use of enemas/digitation and painful evacuation effort were significantly reduced, whilst stool consistency increased. Fourteen patiens (70%) had anal incontinence. Corresponding and significant reduction in their scores were from mean 12.5 (9.4–15.5) to 5.1 (2.1–8.1) and to 3.6 (1.3–5.9). Incontinence was improved in 13 and unaltered in one patient(s). Two patients with worse outcome had increased stool consistency and constipation scores. Resection rectopexy for rectal prolapse reduced anal incontinence and constipation.