bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival in hepatocellular carcinoma: Impact of screening and etiology of liver disease
Authors: KEMP WILLIAM , PIANKO STEPHEN , NGUYEN SHARA , BAILEY MICHAEL J , ROBERTS STUART K 
Published: August 2010

AbstractBackground and Aims:  As the merits of screening at‐risk populations for hepatocellular carcinoma (HCC) remain unclear, we compared the clinico‐pathologic features and survival of patients with cirrhosis and HCC detected by screening (Group A) to that in non‐screened cases (Group B).Methods:  We studied cirrhotics who developed HCC between 1994 and 2002. During this period, cirrhotics managed by the Gastroenterology Unit were regularly screened at 6–12 monthly intervals while those managed by other hospital units were not. Demographic data, tumor details, treatment received and survival were recorded and compared according to screening status.Results:  There were 96 cases identified; 41 by screening (group A) and 55 by non‐screening methods (Group B). HCC in Group A were smaller (P < 0.01), more likely unilobar (P < 0.01), at an early stage (P < 0.0005) and before vascular invasion (P < 0.005) than Group B cases. The frequency of hepatic surgery and/or local ablation was higher in Group A than Group B (P = 0.001). Overall median survival of Group A was 882 days versus 99 days in Group B (P < 0.0001). One‐ and 3‐year probabilities of survival in Group A were 89% and 38%, versus 33% and 19% in Group B (P < 0.001). Independent predictors of survival included screening, Child‐Pugh score, creatinine, tumor stage and absence of alcohol as the etiology.Conclusions:  Screening for HCC in cirrhosis identifies tumors at an earlier stage, results in a higher chance of receiving curative treatment and possibly improves patient survival. The absence of alcoholic liver disease impacts favorably on survival.
Age‐related analysis of functional outcome and quality of life after restorative proctocolectomy and ileal pouch‐anal anastomosis for familial adenomatous polyposis1
Authors: Erkek Ayhan B , Church James M , Remzi Feza H 
Published: August 2010

AbstractBackground:  The aim of the present study was to evaluate the influence of a younger age at the time of ileal pouch‐anal anastomosis (IPAA) on functional outcome and quality of life in patients with familial adenomatous polyposis (FAP).Method:  A total of 105 patients with FAP who had undergone IPAA were retrieved from a dedicated Institutional Review Board (IRB)‐approved IPAA database. Fifty‐three patients who had complete follow‐up data at 1, 3 and 5 years were included in the study. Patients were categorized into three groups according to their ages at the time of surgery. Group 1, patients ≤20 years of age (n = 9); group 2, patients >20 and ≤40 years of age (n = 23); and group 3, patients >40 years of age (n = 21). Perioperative characteristics, postoperative complications, quality of life scores and functional outcome at 1, 3 and 5 years of postoperative follow‐up were assessed.Results:  At any time point, there were no significant differences among the groups in terms of perioperative characteristics, quality of life scores or level of satisfaction with the procedure. However, younger patients had significantly lower nocturnal bowel movements at the first and third years of follow‐up and tended to have less bowel movements per day at all stages of follow‐up.Conclusion:  These findings indicate that younger patients with FAP are inclined to have better functional outcome after IPAA in the early postoperative period. This finding may be encouraging for colorectal surgeons who will operate on young patients with FAP.
Long‐term gastroesophageal reflux disease therapy improves reflux symptoms in elderly patients: Five‐year prospective study in community medicine
Authors: Miyamoto Masaki , Haruma Ken , Kuwabara Masao , Nagano Makoto , Okamoto Takeshi , Tanaka Mio 
Published: August 2010

AbstractBackground:  Gastroesophageal reflux disease (GERD) impairs the patient's quality of life (QOL), but the effect of long‐term maintenance therapy in elderly patients is unknown.Methods:  We conducted a long‐term prospective study. Forty‐four GERD patients (11 males; mean age 74 years; QUEST score of at least 6 points) were enrolled in this study. Step‐down therapy was selected (proton‐pump inhibitor [PPI], histamine‐2 receptor antagonist and prokinetic agents for 1 month, respectively). Optimal medication for each patient was continued for 5 years. The efficacy, safety of treatment and reflux symptoms were analyzed. The profiles of the patients who had to continue PPI maintenance therapy were also analyzed.Results:  Reflux symptoms were reduced by the PPI based step‐down therapy (baseline 13.8 times/month, after 3.2 times/month, P < 0.001). Reflux symptoms improved in 34 patients (77%). None of the 44 patients had to cease treatment because of side‐effects and none experienced any complications during the 5‐year period. The prevalence of Helicobacter pylori (Hp) infection in the PPI group (29%, 4/14) was significantly lower (P < 0.01) than in the other treatment group (72%, 21/29). The serum pepsinogen I/II ratio in the PPI treatment group (5.7 ± 0.5) was significantly higher (P < 0.01) than in the others (4.0 ± 0.3). The predictive factors for PPI maintenance therapy were Hp‐negative status and serum pepsinogen I/II ratio >6.0 (odds ratio 12.0, 95% confidence interval 2.7–54.2).Conclusions:  Long‐term medication for GERD selected on the basis of the patient's profile (i.e. Hp status and gastric atrophy) improved reflux symptoms.
Clinical analysis of primary duodenal adenocarcinoma: An 11‐year experience
Authors: Hung Fu‐Chih , Kuo Chung‐Mou , Chuah Seng‐Kee , Kuo Chung‐Huang , Chen Yaw‐Sen , Lu Sheng‐Nan , Chang Chien Chi‐Sin 
Published: August 2010

AbstractBackground and Aim:  The impact of obstructive jaundice (OJ) complicated by primary duodenal adenocarcinoma (PDA) on survival, and its treatment options, has rarely been mentioned in literature. The aim of the present study was to review the clinical features of PDA patients in an attempt to determine the prognostic factors and the influence of OJ on survival.Methods:  From May 1994 to February 2005, all duodenal malignancies treated at Kaohsiung Chang Gung Memorial Hospital were reviewed. Preliminary findings were made on a total of 116 duodenal adenocarcinoma (DA) cases. After excluding metastatic DA and the papilla of Vater cancer, 23 patients (19.8%), confirmed as having PDA, were enrolled.Results:  Among the 23 predominantly male patients with a mean age of 68 years, abdominal pain was the most common symptom. Major tumor origin was the second portion, and the predominantly cytological feature was moderate differentiation. Tumor‐node‐metastasis (TNM) cancer stage IV accounted for 47.8% of the patients, and cancer‐directed surgeries (CDS) were performed on 11 patients. Seven patients experienced complications due to OJ, which could be a sign of grave prognosis predicting survival of less than 1 year. Four of the patients received internal or external biliary drainage before CDS or palliative surgeries. Cigarette smoking, cytology, TNM stage, aspartate aminotransferase (AST), OJ, and CDS were significant factors of overall survival in a univariate analysis. The independent predictors of long‐term survival were CDS, TNM stage, cytology, cigarette smoking, and AST using the Cox proportional hazard model.Conclusion:  PDA patients who did not smoke and who were eligible for and received CDS had better prognostic outcomes.
Chronic obstructive pulmonary disease in the absence of chronic bronchitis in China
Authors: LU Ming , YAO Wanzhen , ZHONG Nanshan , ZHOU Yumin , WANG Chen , CHEN Ping , KANG Jian , HUANG Shaoguang , CHEN Baoyuan , WANG Changzheng , NI Diantao , WANG Xiaoping , WANG Dali , LIU Shengming , LU Jiachun , SHEN Ning , RAN Pixin 
Published: August 2010

ABSTRACTBackground and objective:  COPD has a variable natural history and not all individuals follow the same course. The aim of this study was to assess the prevalence of COPD in the absence of chronic bronchitis (CB) based on a population survey in China, and to identify the determinants of CB in patients with COPD.Methods:  A multi‐stage cluster sampling strategy was used to survey a population from seven different provinces/cities of China. All residents over 40 years of age were interviewed using a standardized questionnaire and spirometry was measured. A post‐bronchodilator FEV1/FVC < 70% was defined as the diagnostic criterion for COPD. All COPD patients who were screened were divided into two groups according to the presence or absence of CB.Results:  Of the population of 20 245 that was surveyed, 70% of the 1668 patients who were diagnosed with COPD reported no history of CB. The ages, BMI and comorbidities of COPD patients with or without CB were similar. Male gender, residence in a rural area, having a lower level of education, exposure to tobacco smoke or biomass fuels, poor ventilation in the kitchen and a family history of respiratory disease were all associated with a higher risk of COPD with CB. Patients without CB had less difficulty in walking and higher FEV1/FVC values than patients with CB, but were more likely to be underdiagnosed. The strongest predictors of CB were male gender, current smoking and severity of dyspnoea.Conclusions:  This survey confirmed that there is a high prevalence of COPD in the absence of CB in China. It appears that CB is not essential to the diagnosis of COPD.
Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome
Authors: AKAHOSHI Toshiki , UEMATSU Akihito , AKASHIBA Tsuneto , NAGAOKA Kenichi , KIYOFUJI Kouji , KAWAHARA Seiji , HATTORI Tomohiro , KANEITA Yoshitaka , YOSHIZAWA Takayuki , TAKAHASHI Noriaki , UCHIYAMA Makoto , HASHIMOTO Shu 
Published: August 2010

ABSTRACTBackground and objective:  Several features of OSA syndrome suggest that it is a manifestation of the metabolic syndrome (MS). In this study, we investigated the prevalence of the MS among male Japanese patients with OSA, as well as the relationship between OSA in non‐obese patients and components of the MS other than obesity (hypertension, dyslipidaemia and glucose intolerance).Methods:  The study included 416 Japanese men who were diagnosed as having OSA by polysomnography. Among these, 101 non‐obese patients were selected and the severity of OSA, as well as the prevalence of hypertension, dyslipidaemia and glucose intolerance, was assessed.Results:  The MS was associated with OSA in 218/416 patients (52.4%). A significant increase in the prevalence of the MS was associated with increased severity of OSA, as categorized according to AHI. In the non‐obese patients with OSA (mean age 57.6 years, BMI 22.7 kg/m2, AHI 34.3 events/h), hypertension, dyslipidaemia and glucose intolerance were identified in 70 (69.3%), 43 (42.6%) and 20 patients (19.8%), respectively. At least two of these factors were identified in 40 patients (39.6%). Non‐obese patients with severe OSA had a significantly higher prevalence of two or more of these factors (33/59 patients, 55.9%).Conclusions:  Although Asians are generally less obese than Caucasians, the prevalence of the MS was high among Japanese patients with OSA, and even among non‐obese patients, OSA was associated with risk factors for the MS.
IMPLEMENTATION OF A TRAUMA TEAM
Authors: Deane S. A. , Gaudry P. L. , Pearson I. , Ledwidge D. G. , Read C. 
Published: August 2010

A team approach to the initial assessment, investigation and management of potentially seriously injured patients has been instituted. Team members are alerted through an emergency paging system which is activated when a patient fulfils one of a predetermined list of criteria relating to the injury incident, physiological status of the patients and anatomic injuries. Medical members of the team include surgical, intensive care, anaesthetic, and accident and emergency staff. The surgical representative acts as team coordinator.Aspects of the function of the trauma team system were assessed over 4 months during which time 721 injured patients were admitted, 240 patients satisfied the trauma team criteria, and the team was called 152 times. The observed ‘false alarm’ rate was 38% but the true false alarm rate would have been 46%. Injuries sustained by some patients, who satisfied the criteria but who were not evaluated by the team, were of sufficient severity to justify a greater compliance with the system than was observed at this early stage after its implementation. Although a false alarm rate of 46% is higher than desirable, the number of calls per day would still only average 2 in a hospital with a high trauma patient load. The checklist criteria were highly sensitive (97%) in identifying those patients who should have been evaluated by the trauma team.Although hospitals differ in workload and staffing, this trauma team model is recommended for more widespread use and for further evaluation and modification.
PERFORATED PEPTIC ULCER: A DELIBERATIVE APPROACH
Authors: Cocks J. R. , Kernutt R. H. , Sinclair G. W. G. , Dawson J. H. McL. , Hong B. H. 
Published: August 2010

Between 1966 and 1987, 116 patients with 119 episodes of perforation were admitted to box hill hospital into one surgical unit, and 91 patients with 92 episodes were admitted into the other, with patients being admitted in alternate weeks.In the former unit, in order to avoid surgery in those patients whose ulcers had sealed spontaneously, a deliberative approach was followed according to a strict protocol—involving a deliberate time delay in surgical decision‐making. In the latter unit, a more conventional approach was adopted, and patients in that unit are used as a retrospective comparison.In the first unit, of 115 episodes which followed the protocol, six were unresuscitable, 15 needed immediate surgery and 94 followed a delayed approach. Of that 94, 12 needed surgery at 4–6h, and a further eight needed later surgery. Seventy‐four (68% of ‘operable’ patients) did not require corrective surgery at all, for their episode of perforation.The operable mortality rate was lower (6% compared with 13%), the bedstay was shorter, the prolonged bedstay rate was lower, and the morbidity was no worse, than those patients treated more conventionally in the second unit.
CAPSULE ENDOSCOPY: A SURGICAL PERSPECTIVE
Authors: Ward Salena M. , Mobsby Caroline J. , Wilkinson Stephen 
Published: August 2010

Background:  Capsule endoscopy (CE) is gaining acceptance as an accurate method of imaging the small bowel. However, it is still being assessed for its use in successfully changing management and improving outcomes. We report the initial experience of CE in Tasmania.Methods:  Findings were collected retrospectively for the first 55 consecutive CE carried out in Tasmania from May 2003 to June 2005. One surgeon had carried out and reported on these tests. Findings included indication, previous tests, abnormalities detected, subsequent change in management and outcomes.Results:  The median age was 68 years (range 33–87). Fifty‐two CE were carried out for obscure gastrointestinal bleeding (23 for overt and 29 for occult bleeding) and 3 for abdominal pain without bleeding. Fifty‐six per cent of tests had an abnormal result. Seven laparotomies were carried out to treat the abnormal findings of three suspected small bowel angiodysplasias, two suspected small bowel tumours, one patient with slow small bowel transit and abdominal pain and one patient with suspected Crohn’s disease. Two patients died of cardiac arrest within 1 week of surgery, three patients showed improvement of their symptoms of gastrointestinal bleeding, one patient had resection and definitive diagnosis of Crohn’s disease and another had excision of a bleeding Meckel’s diverticulum.Conclusion:  CE is an effective investigation for diagnosis of small bowel diseases amenable to medical or surgical management. However, the most appropriate use of this test to achieve an improvement in outcome is yet to be determined.
TREATMENT FOR DUCTAL CARCINOMAIN SITUIN AN ASIAN POPULATION: OUTCOME AND PROGNOSTIC FACTORS
Authors: Chuwa Esther W. L. , Tan Vincent H. S. , Tan Puay‐Hoon , Yong Wei‐Sean , Ho Guy‐Hui , Wong Chow‐Yin 
Published: August 2010

Background: Breast cancer is the most common cancer among Singapore women and ductal carcinomain situ(DCIS) is believed to be the precursor of most invasive breast cancers. The incidence of DCIS has increased dramatically with mammographic screening, but its treatment remains controversial. Further, results of treatment for DCIS in Asians, and in particular Singapore women, are lacking. We review our institution’s results treating a predominantly Chinese population with DCIS of the breast before the introduction of mammographic screening and aim to determine treatment outcomes and identify prognostic factors for disease recurrence.Methods: Between January 1994 and December 2000, 170 consecutive patients with DCIS were treated at our institution. One hundred and three (60.5%) were managed with breast conservation (17 with local wide excision alone and 86 with adjuvant irradiation following wide excision) whereas 67 (39.4%) underwent mastectomy. Of those who underwent wide local excision, 56 (54.3%) underwent re‐excision for margin clearance. Overall, the axilla was surgically staged in 47 (27.6%) and no nodal involvement was found in all cases. Pathological specimens were reviewed by one of the authors. Median follow up was 86 months (range 4–151 months).Results: Sixty‐two patients (36%) were asymptomatic at presentation whereas most (64%) presented with clinical symptoms; out of these more than half (54%) presented with a palpable lump. The median size of tumours was 13 mm (range 1.5–90 mm). Patients who underwent breast conservation surgery had oncologically more favourable lesions – with a significantly higher incidence of smaller and non‐palpable lesions and lesions of lower nuclear grade. However, there was also a significantly higher incidence of local recurrence in this group. At the end of follow up, there were 12 patients (7.1%) who developed local recurrence and 8 patients (4.7%) developed contralateral disease. The crude incidence of all breast events (including both local failure and contralateral events) at 5 years was 5.6%. Median time to the development of any breast event (local recurrence or contralateral disease) was 60 months (range 12–120 months). The cumulative 5‐year recurrence‐free survival for patients who underwent breast conservation surgery was 94%. Factors influencing local recurrence rate were close or involved margins (≤1 mm) and lack of adjuvant radiotherapy. There were no cancer‐specific deaths during the period of follow up.Conclusion: Our results indicate that rates of cancer‐specific survival were similar after mastectomy and breast conserving surgery. However, a close or involved margin (≤1mm) and lack of adjuvant radiotherapy were associated with local recurrence, with margin status being the independent predictor for local recurrence. Our results reinforce that optimizing local therapy is crucial to improve local control rates in women treated with DCIS in our population.
MANAGEMENT OF ACUTE GALLSTONE PANCREATITIS: SO THE STORY CONTINUES
Authors: Chiang David T. , Thompson Graeme 
Published: August 2010

Background:  Surgical audit on management of mild acute gallstone pancreatitis at Western Health showed that non‐compliance of carrying out laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy within 4 weeks had resulted in a high readmission rate. Modification of management was then instituted and audit cycle repeated to assess the outcome.Methods:  Medical records of patients with mild acute gallstone pancreatitis between January 2000 and February 2002 were audited. The pathology results and medical imaging suggestive of acute gallstone pancreatitis were analysed. Patients with less than three positive Ranson’s criteria were included in the surgical audit. Information on the course of treatment, including method (laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy), timing, reason of non‐operation and outcome were recorded. Reasons for failing to remove stones in a timely fashion were identified and strategies to improve compliance with the guidelines were implemented. An audit was repeated 10 months later to assess changes in practice.Results:  The rate of carrying out timely stone removal has improved from 57 to 82% at the follow‐up audit. The readmission rate has also significantly decreased. Nevertheless, the rate of carrying out laparoscopic cholecystectomy during the original admission for suitable candidates was still at 39%.Conclusion:  Surgical audit has identified a need to improve in the management of mild acute gallstone pancreatitis in the Western Health system. By complying with guidelines, outcomes of patient care have improved.
EFFECT OF N‐ACETYL‐l‐CYSTEINE ON LUNG ISCHAEMIA REPERFUSION INJURY IN A PORCINE EXPERIMENTAL MODEL
Authors: Chamogeorgakis Themistocles P. , Kostopanagiotou Georgia G. , Kalimeris Constantine A. , Kabouroglou George I. , Kourtesis Antonios N. , Routsi Christine I. , Dima Cleanthi C. , Toumpoulis Ioannis K. 
Published: August 2010

Background:  The purpose of the present study was to investigate the effect of N‐acetyl‐l‐cysteine on lung ischaemia reperfusion injury.Methods:  Nineteen pigs were used. Group I (n = 5) underwent sham operation, group II (n = 7) 90‐min left‐lung ischaemia followed by 180‐min reperfusion. In group III (n = 7) N‐acetyl‐l‐cysteine was given (160 mg/kg) during ischaemia into the pulmonary artery. Lung‐functional and haemodynamic parameters were measured; serum and lung tissue samples were obtained and analysed for interleukin‐10 and tumour necrosis factor‐α. At the end of the reperfusion bronchoalveolar lavage was carried out from the ipsilateral lung and analysis for total protein, phospholipase‐A2 and platelet‐activating factor acetylhydrolase was carried out. Histological specimens were graded (0–3) for alveolar oedema, interstitial thickening and leucocyte infiltration. Statistical analysis was by means of one‐way analysis of variance and Kruskal–Wallis test.Results:  There were no differences in haemodynamic parameters, serum and tissue interleukin‐10 and tumour necrosis factor‐α. Pulmonary compliance was decreased in groups II and III (P = 0.002 and P = 0.001, respectively) during ischaemia and reperfusion. Pulmonary vascular resistance was increased in group II (P = 0.051) during reperfusion. In group III total protein and platelet‐activating factor acetylhydrolase were increased (P = 0.004 and P = 0.006, respectively) and phospholipase‐A2 was reduced (P = 0.002), indicating an indirect surfactant‐protective effect. Interstitial thickening was excessive in group II (P = 0.001); however, alveolar oedema was reduced (P = 0.002) when compared with group III.Conclusion:  N‐acetyl‐l‐cysteine when administered directly in the pulmonary artery showed no significant change in haemodynamic and functional lung parameters during ischaemia reperfusion; it does, however, have an indirect surfactant‐protective effect.