bluuebunny/crossref_metadata_2025_split huggingface dataset:
CT31 HYPERBARIC OXYGEN IN POST‐CARDIAC SURGERY STROKE PATIENTS – THE CHRISTCHURCH EXPERIENCE
Authors: Gibson A. J. 
Published: April 2007

Introduction  Post‐operative strokes occur in a small percentage of adult cardiac surgical patients and have devastating consequences for these patients. There is evidence to suggest that Cerebral Arterial Gas Embolism (CAGE) is an important aetiological factor in most of these cases.Hyperbaric Oxygen therapy (HBOT) is the administration of 100% oxygen at greater than atmospheric pressure. It is accepted as the definitive treatment for CAGE related to SCUBA diving accidents. The similarities between this and the pathophysiology of post cardiac‐surgical strokes due to iatrogenic CAGE suggest that beneficial effects from HBOT may accrue to these patients.Purpose  The purpose of this study is to review the experience of treating post cardiac‐surgical stroke patients in our local hyperbaric oxygen facility, including their presentation, delay before treatment and outcomes. The current evidence base is reviewed.Method  A retrospective case series analysis was conducted.Results  Over a 10 year period, patients with post cardiac‐surgical strokes and who presented within the first 48 hours were referred for HBOT, of whom 12 were treated. The neurological outcomes were excellent in all but one case who died.A review of the literature provides a rational basis for the potential benefits of HBOT in this scenario, but at present there is only limited clinical data to support its use.Conclusion  The postulated mechanisms for the development of post cardiac‐surgical strokes provide a sound theoretical basis for the suggestion that the use of HBOT is associated with improved outcomes. However there is no prospective data to support such a claim. Such a trial would be problematic and until more evidence is available, HBOT should be considered on a case by case basis.
CT07 THE UNIVERSAL ANASTOMOTIC STENT – A NOVEL PROXIMAL CORONARY ARTERY BYPASS ANASTOMOTIC DEVICE
Authors: Harden M. P. , Sims A. 
Published: April 2007

Purpose  Proximal anastomotic devices have been developed to produce predictable results that eliminate surgical technique as a variable with respect to the anastomosis, improve graft patency and lower the incidence of stroke. One criticism of current devices is foreign material contact at the anastomosis which is thought to stimulate intimal hyperplasia and thrombosis. In co‐operation with AllVascular Restorative Vascular Solutions, an anastomotic device for use in vein graft‐aortic anastomosis, the Universal Anastomotic Stent (UAS), was developed to eliminate foreign body contact with blood.Methodology  The design concept for the UAS was based on the Venous Valve Transfer stent developed by AllVascular. This stent is designed to transfer a functional venous valve to a vein with valve incompetence as a treatment of venous valve insufficiency. The UAS prototype developed from this stent underwent pre‐clinical testing in sheep for design review.Results  Animal trials established that an external nitinol expanding stent can be used to create an arterial anastomosis. Loading a vein graft onto the UAS proved difficult in the absence of a crimping tool. A design concept for a dedicated loading tool has been developed and an animal model for future testing was finalised.Conclusions  The UAS, compared to existing anastomotic devices, has the advantage of maintaining intima‐intima contact at the anastomosis, which may reduce the inflammatory response. External stenting may limit compliance mismatch at the anastomosis and reduce intimal hyperplasia. Further animal testing is required to establish if this novel anastomotic device will be suitable for human use.
CT08 SURGICAL MANAGEMENT OF INFECTIVE ENDOCARDITIS: OUR EXPERIENCE
Authors: Das D. , Mohanraj A. , Hayward P. , Kuba P. K. , Seevanayagam S. , Buxton B. 
Published: April 2007

Purpose  In the light of improvement in results of surgery for acute infective endocarditis(IE),we analysed our surgical outcomes and risk factors associated with mortality in patients operated for acute IE in the past decade.Methodology  A retrospective study of 85 consecutive patients (54 males, 31 females, Mean age 50.4 ± 18.9 years) who underwent surgery for IE between January 1997 to December 2006 was performed. The preoperative profiles,intraoperative findings and the postoperative outcomes were analysed.Results  Native valve endocarditis (NVE) was present in 78/85 patients and prosthetic valve endocarditis(PVE) in 7/85 patients. The aortic, mitral, tricuspid and multiple valves were involved in 30, 28, 15 and 9 pateints respectively. Seven out of 12 intravenous drug abusers had tricuspid valve involvement.The commonest organism was Staphylococcus aureus. The indications for surgery were heart failure (75.2%), failure of medical management (15.2%), abcess (9.4%) and embolism (8.2%). 65 patients underwent valve replacements (55 prosthetic valves, 6 homografts and 2 Ross procedures). 20 patients underwent valve repairs/vegetectomies, of which 5 were mitral repairs. There were 16 in‐hospital deaths (18.8% overall). The mortality was 16.6% in NVE compared to 42.8% in PVE (p < 0.05). PVE, ventilation greater than 24 hours, acute renal failure and severe left ventricular dysfunction were associated with increased mortality (p < 0.05). 4 patients required reoperation for recurrent endocarditis during 1 year follow‐up.Conclusion  Operation for active IE carries acceptable mortality rate for this aggressive disease. Prolonged ventilation, renal failure and severe LV dysfunction are associated with increased risk of mortality.
CT09 ACUTE ISCHAEMIC VENTRICULAR SEPTAL RUPTURE – A FORMIDABLE SURGICAL CHALLENGE
Authors: Sibal A. K. , Prasad S. , Milsom P. F. , Raudkivi P. J. , Alison P. M. , Haydock D. A. 
Published: April 2007

Purpose  To evaluate our surgical results for ischaemic Ventricular Septal Rupture and suggest practice guidelines.Methodology  A retrospective review of data from patient records from 1992 to 2006 for presentation, surgical approaches, recurrence and mortality and analyzed for future management guidelines.Results  We had 36 patients with a mean age of 70.44(+/− 6.34). 14 patients (38.9%) had an inferior/ posterior defect, 28 were in shock (22 on IABP). Severe LV and RV dysfunction were present in 18 and 20 patients respectively. Repair involved patches after infarctectomy (17) or infarct exclusion (18), using either continuous or interrupted suture. Concomitant CABG was performed in 15. 11 patients had residual shunts, 2 requiring device closure and one surgery. Prolonged ICU and hospital stay was the norm. Early mortality was 52.78% (inferior defects – 85.71%, anterior defects – 31.82%). On Univariate analysis Inferior VSD (OR 7.7; 95% CI 1.7, 33.3), Moderate to severe RV impairment (OR 5.0; 95% CI 0.92, 33.3), Pre op shock (OR 6.7; 95% CI 1.6, 33.3), Early presentation post MI and infarctectomy during repair (3.8; 95% CI 0.9, 15.4), predicted mortality. For subgroup of anterior VSD, only pre‐op shock (OR11.1; 95% CI 1.0, 100) predicted a poor outcome. On multivariate analysis, Inferior defects and shock at presentation were the dominant predictors for early death. Repair without cardioplegia (OR5.2; 95% CI 0.48, 56.09) was the only risk factor for recurrence.Conclusions  Acute ischaemic VSD is a grim surgical disease with high mortality. Inferior defects should be offered surgery only in exceptional circumstances due to uniformly poor outcome.
CR10 LAPAROSCOPIC RIGHT HEMICOLECTOMY PERFORMED DURING THE ‘LEARNING CURVE PHASE’ DOES NOT IMPACT ON ONCOLOGICAL RESECTION
Authors: Mignanelli E. , Torey E. , Skinner S. 
Published: April 2007

Purpose  Laparoscopic colectomy for the management of colonic neoplasia is technically feasible and increasingly popular. It is expected that the laparoscopic operation deliver similar oncological clearance to open operation. The ‘learning curve’ for laparoscopic right hemicolectomy has been estimated to be 20 cases and is now set as a guideline by ASCRS. This study was performed to compare histopathology specimens following laparoscopic right hemicolectomy (LRH) performed during the ‘learning curve’ phase with those following open right hemicolectomy (ORH) to evaluate oncological clearance of colonic neoplasms.Methods  125 patients were identified as having undergone right hemicolectomy by two surgeons for colonic neoplasia from January 2001. Data regarding patient details and tumour pathology were obtained by retrospective case note review. Thirty‐five patients underwent LRH compared to 90 who had ORH during the same period. Histopathology from the two groups were compared for length of specimen resected, proximal and distal resection margins, size of tumour resected or number of lymph nodes harvested. Analysis was performed using Student’s T‐test.Results  The two groups were matched with respect to age, sex and tumour characteristics. There was no significant difference between the groups in terms of length of specimen resected (p = 0.37), proximal (p = 0.29) and distal (p = 0.40) resection margins, size of tumour resected (p = 0.37) or number of lymph nodes harvested (p = 0.58).Conclusions  ‘Learning curve’ laparoscopic right hemicolectomy allows similar lymphovascular clearance to traditional open surgery.
CR12 ENTEROCUTANEOUS FISTULAE – ARE WE GETTING IT RIGHT?
Authors: Gyorki D. E. , Brooks C. , Gett R. , Heriot A. G. 
Published: April 2007

Purpose  Enterocutaneous fistulae (ECF) present a difficult management problem and can cause significant morbidity. The aim of the study was to assess the outcome of these patients.Methodology  A retrospective chart review of all patients with ECF managed at a tertiary centre between 1996 and 2006. Demographic, management and outcome data was recorded. Factors influencing ECF closure and outcome were assessed with Cox regression analysis.Results  Thirty‐three patients (17 male) were identified with ECF (median age 63, range 27–84). The primary aetiology was Crohn’s (30%), anastomotic leak (24%), iatrogenic (18%), mesh (6%), neoplasia (6%) and other (16%). Definitive surgery was undertaken in 21 (64%) at a median of 6.4 months (0.4–72 range) following presentation. Twenty percent of patients required emergency surgical intervention and 5 patients required preoperative total parenteral nutrition (TPN). Surgical management was formal resection and reanastomosis in all patients, with a mean operative time of 4.75 hours (SD = 1.8). The median hospital stay for the operative group was 19 days (7–85). Four patients required post‐operative TPN. Fistula closure rate was 97% (operative group 21/21, non‐operative group 11/12). Mean follow up was 37.3 months (0.5–217). Six operative patients (19%) developed fistula recurrence. There were 2 deaths at 2 and 5 months (fistula aetiology malignant colonic fistula and radiation enteritis respectively). No factor was predictive of fistula recurrence.Conclusion  Patients with enterocutaneous fistula can be treated with low morbidity and low recurrence rate in a multidisciplinary setting. Patients with ECF should be referred to specialist units for management.
CR13 UTILITY OF 18‐FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY (FDG‐PET) IN THE STAGING AND MANAGEMENT OF ANAL CANCER
Authors: Tasevski R. , De Winton E. , Ngan S. , Mackay J. , Hicks R. , Heriot A. G. 
Published: April 2007

Purpose  Accurate nodal staging in anal cancer is important for prognosis and planning of chemo‐radiation fields. Mounting evidence exists for FDG‐PET in the staging and management of cancer, with superior sensitivity and specificity compared to conventional imaging (CI) shown for several tumour sites, although little published data for anal cancer. The aim of the study was to determine the impact of FDG‐PET on the nodal staging and management of patients with primary anal cancer.Methods  Sixty‐two consecutive patients with anal cancer referred to a tertiary centre between August 1997 and November 2005 were staged with CI and FDG‐PET. The stage determined by CI and the proposed management plan was prospectively recorded prior to FDG‐PET. The impact of FDG‐PET on stage and management was assessed and the accuracy of changes confirmed by subsequent clinical follow‐up.Results  The stage was changed in 23% (14/62) as a result of FDG‐PET (15% up‐staged, 8% down‐staged). The staging FDG‐PET scan had high impact (altering management intent) in 3% (2/62), and medium impact (altering radiotherapy fields) in 13% (8/62). Fourteen percent of T1 patients (3/22), 42% of T2 patients (10/24) and 38% of T3‐4 patients (6/16), assessed using CI, had a change in their N or M stage following FDG‐PET. Sensitivity for nodal disease for CI and FDG‐PET was 72% and 92% and specificity was 99.5% and 100% respectively.Conclusion  FDG‐PET shows increased sensitivity over CI for staging nodal disease in anal cancer and changes management in a significant proportion of patients.
CR15 LOCAL RECURRENCE AFTER CURATIVE RESECTION FOR RECTAL CANCER IS ASSOCIATED WITH ANTERIOR POSITION OF THE TUMOUR
Authors: Rickard M. J. F. X. , Chan C. L , Bokey E. L. , Chapuis P. H. , Renwick A. A. , Dent O. F. 
Published: April 2007

Background  Mobilization of rectal cancer can be difficult if the tumour is located anteriorly and may result in a higher incidence of local recurrence. The aim of this study was to determine whether local recurrence and survival following curative resection of rectal cancer were associated with the position of the tumour.Methods  Data were drawn from a comprehensive, prospective hospital registry of all resections for rectal cancer from January 1990 to December 1998, with follow‐up to December 2003.Results  The 5‐year local recurrence rate was 15.9 (95 per cent confidence interval (c.i.) 11.0 to 22.8) per cent in 176 patients with tumours that had an anterior component compared with 5.8 (95 per cent c.i. 2.8 to 11.9) per cent in 132 patients with tumours without an anterior component (P = 0.009). This association persisted after adjustment for other factors linked to local recurrence (hazard ratio (HR) 2.4 (95 per cent c.i. 1.1 to 5.4)). Similarly, anterior position had a significant negative independent association with survival (HR 1.4 (95 per cent c.i. 1.0 to 2.00)).Conclusion  Anterior position is an independent negative prognostic factor for both local recurrence and survival after curative resection of rectal cancer.
CR18P LAPAROSCOPIC VS OPEN TOTAL MESORECTAL EXCISION FOR RECTAL CANCER: AN EVALUATION OF THE MESORECTUM’S MACROSCOPIC QUALITY
Authors: Breukink S. O. , Grond A. J. , Pierie J. P. E. N. , Hoff C. , Wiggers T. , Meijerink W. J. H. J. 
Published: April 2007

Purpose  Next to surgical margins, yield of lymph nodes, and length of bowel resected, macroscopic completeness of mesorectal excision may serve as another quality control of total mesorectal excision (TME). In this study, the macroscopic completeness of laparoscopic TME was evaluated.Methodology  A series of 25 patients with rectal cancer were managed laparoscopically (LTME) and included in this study. The pathologic specimens of the LTME group were prospectively examined and matched with a historical group of resection specimens from patients who had undergone open TME (OTME). The two groups were matched for gender and type of resection (low anterior or abdominoperineal resection). Special care was given to the macroscopic judgment concerning the completeness of the mesorectum.Results  A three‐grade scoring system showed no differences between the LTME and OTME groups.Conclusion  The current study supports the hypothesis that oncologic resection using laparoscopic TME is feasible and adequate.
CR19P THE VALUE OF BEDSIDE COLONOSCOPY FOR THE CRITICALLY ILL PATIENT IN INTENSIVE CARE UNIT
Authors: Kao K. T. , Church J. , Moreira A. 
Published: April 2007

Purpose  Bedside colonoscopy for the critically ill patient in Intensive Care Units (ICU) confronts the endoscopist with a new set of challenges and aims. This study examines the value and benefits that colonoscopy offers to critically ill patients with acute lower gastrointestinal disease.Methodology  ICU patients who received bedside colonoscopy were identified from the colonoscopy database and the indications, co morbidities, depth of intubation, progression to surgery and death were recorded.Results  39 patients underwent one or more bedside ICU colonoscopies to investigate ischemic colitis (11, confirmed in 8, 3 operated), colonic distension (10, all decompressed, 2 operated), lower gastrointestinal hemorrhage (13, cause found in 3, 2 operated), and diarrhea (4 patients). 14 patients died. Overall, 18 patients were diagnosed with ischemic colitis; 7 were operated and 6 died.Colonoscopy reached the cecum in 16 patients, the hepatic flexure in 25 and the splenic flexure in 36. Prep was poor in 15 patients and stool prevented completion in 13. In 30% of patients colonoscopy was not pursued to the cecum because decompression was achieved without it, or because ischemic colitis was already diagnosed Colonoscopic techniques specific to ICU included prevention of a loop outside the patient and “slide‐through” with copious irrigation.Conclusion  Bedside ICU colonoscopies are able to make an accurate diagnosis. Reaching the cecum is often not the aim of the study, nor is the diagnosis of small adenomas. In many cases a serious colorectal disease can be diagnosed or excluded, helping in the management of these severely ill patients.
CR02 RECTAL ENDOMETRIOSIS: THE RESULTS OF RADICAL EXCISION
Authors: Brouwer R. , Woods R. 
Published: April 2007

Background  The aim of this paper is to review the results of radical surgical excision of rectal endometriosis.Methods  All cases of endometriosis involving the rectum treated by a single colorectal surgeon were identified from a prospective database and the results reviewed.Results  Between 1995 and 2005, 213 rectal procedures were performed on 203 patients together with an endo‐gynaecologist. 18 cases involved dissection of endometriosis off the rectal wall, 58 involved full‐thickness excision of the anterior rectal wall and 137 segmental excisions of the rectum were performed. The mean follow‐up was 68 months (range 7–158 months). A loop ileostomy was required in 7 (5 percent) of the segmental resections. 75 percent of cases were laparoscopic. Infertility was significantly more common in the group requiring a segmental resection (P = .026) and a history of rectal pain during defecation more common in patients having dissection of endometriosis off the rectal wall (P = .031). There were no other significant differences in symptoms between the different types of rectal surgery. The morbidity for all rectal procedures was 7 percent and there was no significant difference in complication rate between the different groups. The overall rectal recurrence rate was 5 percent and was significantly more common in the group who had dissection of the endometriosis off the rectal wall (P = .004).Conclusions  Endometriosis of the rectum can be successfully treated with low morbidity and low recurrence rates by excising the disease as completely as possible using full‐thickness excision of the anterior rectal wall or segmental resection of the rectum.
CR20P NEED FOR STOMA DETERMINES LENGTH OF STAY AFTER LAPAROSCOPIC RECTAL SURGERY AND NOT CONVERSION TO OPEN SURGERY
Authors: Jones O. M. , Moran B. J. , Cecil T. D. 
Published: April 2007

Purpose  Published evidence suggests a shorter length of stay (LOS) following laparoscopic colorectal resection. Increased LOS may result from conversion to open surgery and post‐operative complications but these factors are generally unpredictable. By contrast, the need for a permanent or temporary stoma is often predictable and may alter the LOS.Methodology  This was a retrospective analysis of a prospectively collected database of all laparoscopic rectal procedures performed under the care of one surgeon since June 2003. Conversion was defined as an incision made in order to progress the intra‐abdominal dissection, either by a midline, Pfannenstiel or targeted incision.Results  105 patients were included in the study (90 anterior resections, 10 abdomino‐perineal resections (APER), 3 Hartmann’s resections and 2 completion proctectomies). Conversion was performed in 27 patients (26%). Median LOS was 6 (range 3–83) days for the laparoscopic group and 7 (range 4–24) days for the converted group (p = ns). A stoma was performed in 27 patients (26%). Following anterior resection without stoma, median LOS was 6 (3–83) days. By contrast, after anterior resection with covering stoma, median LOS was 9 (3–30) days, whilst in those patients undergoing APER, Hartmann’s or completion proctectomy, the corresponding figure was 13 (5–35) days (p < 0.0001).Conclusions  Conversion to open operation during laparoscopic rectal surgery did not increase mean LOS in this study. However, patients receiving a stoma have significantly longer hospital stays. Intensive pre‐ and post‐operative stoma education should be considered in these patients if overall in‐patient stay after laparoscopic surgery is to be reduced further.
CR21P MALE SEXUAL DYSFUNCTION AFTER LAPAROSCOPIC PELVIC SURGERY IS UNCOMMON WHEN PERFORMED BY SURGEONS BEYOND THEIR “LEARNING CURVE”
Authors: Jones O. M. , Stevenson A. , Stitz R. W. , Lumley J. W. 
Published: April 2007

Purpose  The CLASICC trial reported higher levels of sexual dysfunction in men after laparoscopic pelvic surgery as compared to patients undergoing open surgery. This finding has since been replicated in a smaller study from Singapore. This has led some surgeons to question the role of the laparoscopic approach to pelvic surgery. This issue has been addressed further in this study.Methodology  This study represents a retrospective analysis of a prospectively collected database for a single unit, comprising 2,000 patients undergoing laparoscopic colorectal surgery. Data collected prospectively at post‐operative clinic visit on impotence and retrograde ejaculation were evaluated.Results  150 males undergoing pelvic surgery were identified. The incidence of impotence and retrograde ejaculation were less than 5% for men undergoing laparoscopic pelvic surgery. This does not differ significantly from rates seen in patients undergoing open pelvic surgery in this unit.Conclusions  In this unit, laparoscopic pelvic surgery has been performed only since 2001, by which time there had been experience of over 1,000 laparoscopic abdominal procedures. Previous studies reporting poorer functional outcomes have probably included a significant number of patients on the surgeons’“learning curve”. By contrast, the low rates of sexual dysfunction in this unit may be attributable to pelvic dissection only being undertaken by experienced laparoscopic surgeons.