bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smoking is a major risk factor for wound dehiscence after midline abdominal incision; case–control study
Authors: Abbas Saleh M. , Hill Andrew G. 
Published: April 2009

AbstractBackground:  The incidence of acute fascial wound dehiscence (AFWD) after major abdominal operations is as high as 3%. AFWD is associated with mortality rates of 15–20%. Male gender, advanced age and numerous systemic factors including malignancy hypoproteinemia and steroid use have been associated with increased risk. The aim of the present study was to investigate the association between smoking prevalence and AFWD.Methods:  Middlemore Hospital records were retrieved from the 1997–2006 period for patients who had undergone midline abdominal surgery and developed AFWD. A return to the operating theatre for closure of the fascial dehiscence was required for study group inclusion. Each patient in the study group was matched to two control patients who had been admitted in the same year for surgery and who had a similar initial surgical intervention. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals, representing the risk of developing fascial wound dehiscence in smokers compared with the non‐smoking group.Results:  There were 52 patients (32 male, 20 female) and 104 controls (64 male, 40 female). Median age for both groups was 63 years. A history of heavy tobacco use (≥20 pack‐years) was more prevalent in those who had AFWD (46%) compared with the control group (16%; P = 0.0002; odds ratio 3.7).Conclusions:  Smoking is associated with an increased incidence of acute fascial wound dehiscence following laparotomy. It is not known whether smoking is a causal or a surrogate factor.
Oesophagectomy for tumours and dysplasia of the oesophagus and gastro‐oesophageal junction
Authors: Epari Krishna , Cade Richard 
Published: April 2009

AbstractBackground:  Neoadjuvant therapy, radical lymphadenectomy and treatment in high‐volume centres have been proposed to improve outcomes for resectable oesophageal tumours. The aim of the present study was to review the oesophagectomy experience of a single surgeon with a moderate caseload who uses neoadjuvant therapy selectively and performs a conservative lymphadenectomy.Methods:  A retrospective review of prospectively collected data was performed. The study included 125 consecutive attempted oesophageal resections performed by a single surgeon (RC) from 1993 to 2006.Results:  All patients were staged with computed tomography and also laparoscopy for lower third and junctional tumours. Endoscopic ultrasound was used in 69%. Seventy‐seven per cent were adenocarcinomas. Neoadjuvant therapy was used selectively in 23%. One hundred and twenty‐one resections were carried out, giving an overall resection rate of 97% with an R0 resection in 82%. In‐hospital mortality was 0.8%, clinical anastomotic leak 1.7% and median length of stay 14 days. Overall median and 5‐year survival were 46 months and 47%. Stage‐specific 5‐year survival was 100%, 71%, 41% and 21% for stages 0, I, II and III, respectively. Isolated local recurrence occurred in 8%.Conclusions:  A moderate volume surgeon with specialist training in oesophageal resectional surgery can achieve a low mortality and anastomotic leak rate with good survival outcomes. The role for neoadjuvant therapy and radical lymphadenectomy is controversial and remains to be clearly defined. Accurate preoperative staging is essential for selection of patients for curative surgery with or without neoadjuvant therapy and for comparison of results.
Treatment of internal iliac artery aneurysms: single‐centre experience
Authors: Tsilimparis Nikolaos , Alevizakos Pavlos , Yousefi Sharham , Laipple Andreas , Hagemann Jürgen , Rogalla Patrik , Hanack Ulrich , Rückert Ralph I. 
Published: April 2009

AbstractBackground:  The aim of the present study was to analyse the short‐term results of treatment of internal iliac artery aneurysms (IIAA).Methods:  In a prospective single‐centre cohort study all patients with IIAA (symptomatic or maximal diameter ≥30 mm) were evaluated for endovascular repair, which included coil embolization of the run‐off vessels and coverage of the orifice of the IIAA with a stent graft. Open repair was performed with aneurysm excision or aneurysmorrhaphy. Outcome criteria were technical and clinical success and complications of treatment.Results:  In a period of 40 months 11 patients underwent operation for 12 IIAA. Nine aneurysms were repaired endovascularly and three with open repair. Coil embolization was routinely performed in all cases. At a median follow up of 18 months, technical and clinical success was 100%. Major complications included two early limb thromboses, a contrast‐agent‐induced nephropathy, and an intraoperative ureteric injury.Conclusion:  Despite the limited number of patients, the present series, with good short‐term results, further supports the trend towards endovascular repair of suitable IIAA.
Is laparoscopic colectomy as cost beneficial as open colectomy?
Authors: Shabbir Asim , Roslani April C. , Wong Kutt‐Sing , Tsang Charles B. S. , Wong Hwee‐Bee , Cheong Wai‐Kit 
Published: April 2009

AbstractBackground:  Laparoscopic colectomy has yet to gain widespread acceptance in cost‐conscious health‐care institutions. The aim of the present study was to define the cost–benefit relationship of laparoscopic versus open colectomy.Methods:  Thirty‐two consecutive patients undergoing elective laparoscopic colectomy (LC) by a single colorectal surgeon between August 2004 and September 2005 were reviewed. Cases were matched with a historical cohort undergoing elective open colectomy (OC) between June 2003 and July 2004. Demography, perioperative data, histopathology and cost were compared.Results:  Both groups had similar demographics. Most resections (90.6%) were for cancer. Operative time was significantly longer for LC compared to OC (180 min vs 110 min, P < 0.001). Four patients (12.5%) in the LC group required conversion. LC patients, however, had lower median pain scores (3, 2 and 1 vs 6, 4 and 2 at 24, 48 and 72 h postoperatively, P < 0.001), faster resolution of ileus (3 vs 4 days, P < 0.001) and earlier discharge (6 vs 9 days, P < 0.001) compared to the OC group. As a result, overall hospital cost for both procedures was not significantly different (US$7943 vs US$7253, P = 0.41).Conclusion:  Laparoscopic colectomy is as cost‐beneficial in the short term as open colectomy.
Cricotracheal reconstruction following external beam radiotherapy for recurrent thyroid cancer
Authors: Ashford Bruce G. , Clark Jonathan R. 
Published: April 2009

AbstractTracheal resection for invasive thyroid cancer is well described. Segmental tracheal or cricotracheal resection and reconstruction is an uncommon but established method in the treatment of invasive thyroid cancer. This has seldom been reported in a recurrence following external beam radiotherapy. Radiotherapy compromises healing and predisposes tracheal reconstruction to dehiscence. A fascia‐only radial forearm free‐flap reconstruction of a segmental cricotracheal resection is described.
Transanal endoscopic microsurgery
Authors: Platell Cameron 
Published: April 2009

AbstractTransanal endoscopic microsurgery (TEM) is a minimally invasive surgical technique that was developed more than two decades ago to manage distal colorectal neoplasias. The aim of the current study was to present a prospective review of 7 years of experience in using this equipment. All patients undergoing TEM between 1999 and 2007 were prospectively evaluated. Patients underwent regular endoscopic follow up. Cumulative incidence probability analysis was used to calculate rates of recurrence. The study involved 232 patients, median age 68 years (interquartile range (IQR), 37–90). The median neoplasia area was 12 cm2 (IQR, 6–25 cm2) and the median height above the anal verge was 9 cm (IQR, 3–17 cm). Histology indicated 128 adenomas, 52 carcinomas in situ, and 52 adenocarcinomas. The median postoperative stay was 1 day (IQR, 1–3 days). There was one (0.5%) unplanned return to theatre and no postoperative deaths. Sixteen patients (6.9%) underwent more radical surgical procedures following the identification of carcinoma in the resected specimen. During a median follow up of 4.2 years (IQR, 2.6–6.2 years), the 5‐year cumulative incidence for local recurrence for benign pathology was 3.1% (95% confidence interval (CI): 1.2–6.7%, n = 180) and for cancers managed primarily by TEM excision it was 8.5% (95%CI: 1.4–23.9%, n = 36). TEM is an excellent treatment modality for benign rectal neoplasias of any size, and in any location. TEM is an oncologically inferior treatment for rectal cancer, however, when compared to more radical treatments. Its principal advantage in this setting is that it is associated with relatively minimal morbidity and mortality.
Surgical management of extracranial carotid artery aneurysms
Authors: Choudhary Anwar S. , Evans Richard J. , Naik Dilip K. , Tripathi Ramesh K. , Wickremesekera Janaka K. 
Published: April 2009

AbstractExtracranial carotid artery aneurysms are uncommon and not much is known about them. The purpose of this study is to report the authors’ surgical experience and present a review of this entity. This single institution experience shows that resection of these aneurysms and restoration of flow can be accomplished using a number of surgical techniques with relatively low morbidity and mortality. Endovascular techniques are also increasingly being considered in the repair of these aneurysms, although long‐term data from such techniques are not currently available.
Reporting of minimum clinically important differences in surgical trials
Authors: Kashani Irwin , Hall Jane L. , Hall John C. 
Published: April 2009

Background:  The minimum clinically important difference (MCID) is the smallest difference in outcome between the groups that would be of clinical interest. It influences the estimates that are made to determine the required sample side. The aim of this study was to explore the reporting of the MCID in surgical trials.Method:  Surgical trials that were published between January 1981 and December 2006 in five prestigious surgical journals were evaluated. Selected for study were trials that studied two groups and reported the main outcome event as a proportion.Results:  Only 21% (100/486) of the admissible surgical trials mentioned a value for the MCID when estimating the sample size. There was a trend, however, for compliance with these factors to increase during the study period. The present post‐hoc calculations of the required sample size, which were based on the observed differences between the groups at the end of the study, suggested that one‐third of the trials should have accrued at least fivefold the number of patients. Although reporting an estimate of the sample size was associated with the study of more patients (median sample size 145 vs 100), it was not associated with the reporting of more positive results, that is, 61% (95/155) versus 65% (214/331).Conclusion:  There has been an improvement in the proportion of surgical trials reporting formal estimates of sample size during the last three decades. But the construct of these estimates is often suspect because of a failure to provide realistic values for the MCID.
Novel approach to laparoscopic resection of tumours of the distal pancreas
Authors: Das De Soumen , Wei Cheah Kow Alfred , Hin Liau Kui , Hee Lim Khong , Kiat Ho Choon 
Published: April 2009

AbstractBackground:  Laparoscopic resection for small lesions of the pancreas has recently gained popularity. We report our initial experience with a new approach to laparoscopic spleen‐preserving distal pancreatectomy so that the maximum amount of normal pancreas can be preserved while ensuring adequate resection margins and preservation of the spleen and splenic vessels.Methods:  Three patients underwent laparoscopic distal pancreatectomy with spleen and splenic vessel preservation over a 2‐month period. Surgical techniques and patient outcomes were examined.Results:  All three patients were females, with ages ranging from 31 to 47 years. Two patients underwent resection using the conventional medial‐to‐lateral dissection as the lesion was close to the body or proximal tail of the pancreas. The third patient had a lesion in the distal tail of the pancreas and surgery was carried out in a lateral‐to‐medial manner. This new approach minimized excessive sacrifice of normal pancreatic tissue for such distally located lesions. The splenic artery and vein were preserved in all cases and there was no significant difference in clinical outcome, operative time or intraoperative blood loss.Conclusion:  Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels is a feasible surgical technique with acceptable outcome. We have shown that a tailored approach to dissection and pancreatic transection based on the location of the lesion allows the maximum amount of normal pancreatic tissue to be preserved without additional morbidity. Although the conventional ‘medial‐to‐lateral’ approach is recommended for more proximal tumours of the pancreas, distal lesions can be safely addressed using the ‘lateral‐to‐medial’ approach.
Alternating vigilance states: new insights regarding neuronal networks and mechanisms
Authors: Fort P. , Bassetti C. L. , Luppi P‐H. 
Published: April 2009

AbstractSince the discovery of rapid eye movement (REM) sleep (also known as paradoxical sleep; PS), it is accepted that sleep is an active process. PS is characterized by EEG rhythmic activity resembling that of waking with a disappearance of muscle tone and the occurrence of REMs, in contrast to slow‐wave sleep (SWS, also known as non‐REM sleep) identified by the presence of delta waves. Here, we review the most recent data on the mechanisms responsible for the genesis of SWS and PS. Based on these data, we propose an updated integrated model of the mechanisms responsible for the sleep–wake cycle. This model introduces for the first time the notion that the entrance and exit of PS are induced by different mechanisms. We hypothesize that the entrance from SWS to PS is due to the intrinsic activation of PS‐active GABAergic neurons localized in the posterior hypothalamus (co‐containing melanin‐concentrating hormone), ventrolateral periaqueductal gray and the dorsal paragigantocellular reticular nucleus. In contrast, the exit from PS is induced by the inhibition of these neurons by a PS‐gating system composed of GABAergic neurons localized in the ventrolateral periaqueductal gray and just ventral to it, and waking systems such as the pontine and medullary noradrenergic neurons and the hypothalamic hypocretin neurons. Finally, we review human neurological disorders of the network responsible for sleep and propose hypotheses on the mechanisms responsible for REM behavior disorder and narcolepsy.
Identifying the lethal fish egg parasite Ichthyodinium chabelardi as a member of Marine Alveolate Group I
Authors: Skovgaard Alf , Meneses Isabel , Angélico Maria Manuel 
Published: April 2009

SummaryCells of the parasitic, unicellular eukaryote Ichthyodinium chabelardi were isolated from eggs of sardine (Sardina pilchardus) and from a previously unrecognized host, bogue (Boops boops), off the Atlantic coast of Portugal. Immediately after release from the infected fish egg or newly hatched larva, I. chabelardi cells were spherical and non‐motile. After few minutes, spherical cells became flagellated and motile. Following 2–3 days of incubation and several divisions, spherical flagellated cells developed a twisted elongate shape and moved vigorously. Sequences of the small‐subunit ribosomal RNA gene (SSU rDNA) were identical for I. chabelardi of both hosts and so were sequences of ITS1, ITS2 and the 5.8S rRNA gene. This genetic similarity suggests that eggs of sardine and bogue were infected by one single population of I. chabelardi. The SSU rRNA gene sequence of I. chabelardi was, in turn, 97% similar to those of two identical Asian isolates of Ichthyodinium sp. Phylogenetic analyses showed high support for the inclusion of Ichthyodinium in the so‐called Marine Alveolate Group I (MAGI). Two morphologically well‐described genera, namely Ichthyodinium and Dubosquella, have now been shown to belong to this group of seemingly exclusively parasitic alveolates.
Viability and potential for immigration of airborne bacteria from Africa that reach high mountain lakes in Europe
Authors: Hervàs Anna , Camarero Lluís , Reche Isabel , Casamayor Emilio O. 
Published: April 2009

SummaryWe have analysed the diversity of the bacteria, which grow after addition of concentrated airborne particles and desert dust in different microcosms combinations with water samples from oligotrophic alpine lakes. We used, on the one hand, airborne bacteria transported by an African dust plume and collected in a high mountain area in the central Pyrenees (Spain). On the other hand, we collected desert dust in Mauritania (c. 3000 km distance, and a few days estimated airborne journey), a known source region for dust storms in West Africa, which originates many of the dust plumes landing on Europe. In all the dust‐amended treatments we consistently observed bacterial growth of common phyla usually found in freshwater ecosystems, i.e. Alpha‐, Beta‐ and Gammaproteobacteria, Actinobacteria, and a few Bacteroidetes, but with different composition based on lake water pretreatment and dust type. Overall, we tentatively split the bacterial community in (i) typical freshwater non‐airborne bacteria, (ii) cosmopolitan long‐distance airborne bacteria, (iii) non‐freshwater low‐distance airborne bacteria, (iv) non‐freshwater long‐distance airborne soil bacteria and (v) freshwater non‐soil airborne bacteria. We identified viable long‐distance airborne bacteria as immigrants in alpine lakes (e.g. Sphingomonas‐like) but also viable putative airborne pathogens with the potential to grow in remote alpine areas (Acinetobacter‐like and Arthrobacter‐like). Generation of atmospheric aerosols and remote dust deposition is a global process, largely enhanced by perturbations linked to the global change, and high mountain lakes are very convenient worldwide model systems for monitoring global‐scale bacterial dispersion and pathogens entries in remote pristine environments.
Hereditary mixed polyposis syndrome due to a BMPR1A mutation
Authors: O’Riordan J. M. , O’Donoghue D. , Green A. , Keegan D. , Hawkes L. A. , Payne S. J. , Sheahan K. , Winter D. C. 
Published: April 2009

AbstractThe conditions Juvenile Polyposis Syndrome (JPS) and Hereditary Mixed Polyposis Syndrome (HMPS) are associated with an increased risk of colorectal carcinoma. The genetic mechanisms which explain these conditions have until recently been poorly understood. Recent interest has focused on the transforming growth factor (TGF)‐β signalling pathway and, in particular, on mutations in the SMAD4 gene. However, not all cases of JPS and HMPS have mutations in SMAD4 and focus has now shifted to other components of the TGF‐β pathway to clarify the genetic mechanisms involved in these conditions. In this report, we describe the significance of a bone morphogenetic protein receptor type 1A gene mutation in an Irish family.
Comparative study of contour transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS) – feasibility, morbidity and early functional results
Authors: Isbert C. , Reibetanz J. , Jayne D. G. , Kim M. , Germer C.‐T. , Boenicke L. 
Published: April 2009

AbstractAim  Stapled transanal rectal resection (STARR) is a promising new treatment for obstructed defecation syndrome (ODS). It may be performed using either a double‐stapling technique (PPH‐STARR) or with the new Contour Transtar (CT) device. The aim of this study was to evaluate the two techniques with respect to morbidity and functional outcomes.Method  Patients presenting with ODS were evaluated using standardized clinical and radiological investigations and prospectively entered into a database. A total of 150 Patients were treated with either PPH‐STARR (n = 68) or CT (n = 82) and further evaluated at 12 month postoperatively.Results  The mean size of the resected specimen was 27 cm2 (SD ±4.86 cm2) in the PPH‐STARR group and 46 cm2 (SD ±10.6 cm2) in the CT group [P < 0.001]. Morbidity was 7.3% (n = 5) in the PPH‐STARR group and 7.5% (n = 6) in the CT group. The most common complication was minor postoperative bleeding in both groups (PPH‐STARR: n = 2, 2.9%; CT: n = 2, 2.4%) Overall there were no septic complications and no surgical re‐interventions. There was a tendency for more postoperative pain following CT (n = 3, 3.6%) as compared with PPH‐STARR (n = 1, 1.4%). Constipation Scores (CCS) were 15.50 ± 5.71 in the PPH‐STARR group and 15.70 ± 5.84 in the CT group preoperatively and decreased significantly to 8.25 (SD ±1.45) and 8.01 (SD ±2.31) 12‐months after surgery. Values did not differ significantly between the two groups.Conclusions  Contour Transtar is as safe and effective as PPH‐STARR and provides a true circumferential resection of rectal intussusception. This may benefit selected patients and result in improved long‐term durability of the technique.
Systematic review on ventral rectopexy for rectal prolapse and intussusception
Authors: Samaranayake C. B. , Luo C. , Plank A. W. , Merrie A. E. H. , Plank L. D. , Bissett I. P. 
Published: April 2009

AbstractObjective  This systematic review assesses the effectiveness of ventral rectopexy (VR) surgery for treatment of rectal prolapse (RP) and rectal intussusception (RI) in adults.Method  MEDLINE, EMBASE, Scopus and other relevant databases were searched to identify studies. Randomized controlled trials or nonrandomized studies with more than 10 patients receiving ventral mesh rectopexy surgery were considered for the review.Results  Twelve nonrandomized case series studies with 728 patients in total are included in the review. Seven studies used the Orr‐Loygue procedure (VR with posterior rectal mobilization to the pelvic floor) and five studies used VR without posterior rectal mobilization. Overall weighted mean percentage decrease in faecal incontinence (FI) rate was 45%. The weighted mean percentage decrease in constipation rate was 24%. Weighted mean recurrence rate was 3.4%.Conclusions  There are limitations in published literature on VR. The available data indicate that VR has low recurrence and improves FI in patients suffering from these conditions. There is a greater reduction in postoperative constipation if VR is used without posterior rectal mobilization.
Anastomotic leakage after curative anterior resection for rectal cancer: short and long‐term outcome
Authors: Bertelsen C. A. , Andreasen A. H. , Jørgensen T. , Harling H. ,   on behalf of the Danish Colorectal Cancer Group
Published: April 2009

AbstractObjective  The influence of symptomatic anastomotic leakage (AL) after anterior resection (AR) for rectal cancer on short and long‐term mortality and local and distant recurrence was analysed.Method  All patients with a first diagnosis of rectal carcinoma were prospectively registered in a national database. This comprised 1494 Danish citizens who had had a curative AR between May 2001 and December 2004. Data on survival and recurrence were obtained from the National Patient Register. Multivariate analyses were performed.Results  Anastomotic leakage increased the 30‐day mortality [odds ratio (OR) 4.01 (95% CI 2.24–7.17)]. Of other possible risk factors, only age had a significant interaction with leakage, as the risk of death within 30 days of AR decreased with increasing age. Long‐term survival decreased significantly after AL [hazard ratio (HR) of 1.63, CI 1.21–2.19]. A total of 97 (6.7%) and 258 (18.0%) patients had local and distant recurrence respectively in the follow‐up period. The risk of local and distant recurrence after AL was not different with HR of 1.50 (CI 0.84–2.69) and 1.13 (CI 0.76–1.69) respectively. No other factors influenced the risk of recurrence due to AL.Conclusion  Anastomotic leakage after AR for rectal cancer increases the 30‐day and long‐term mortality, but AL did not increase the risk of local and distant recurrence.