bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving cytological diagnosis and surgical management of parotid adenolymphoma
Authors: Lewis D R , Webb A J , Lott M F , Brookes S T , Farndon J R 
Published: March 2003

Abstract

Background
The role of fine-needle aspiration cytology (FNAC) in the diagnosis and management of discrete parotid swellings remains controversial. Controlled enucleation can be appropriate with accurate preoperative diagnosis. This study (1985–1995) reviewed the role of FNAC in the diagnosis and surgical management of adenolymphoma.

Methods
Review of cytological smears by two observers concentrated on the features of infarction and squamoid metaplasia. Sensitivity, interobserver and intraobserver variation were evaluated statistically in a two-run ‘blinded’ analysis of 80 cytological slides from a variety of lesions.

Results
Of 222 epithelial neoplasms of the parotid, 33 were adenolymphomas. FNAC was performed before operation in 32, producing 34 slides, and a correct cytological diagnosis was made in 21 patients. Retrospective review of the 34 slides, to examine specific features of squamoid metaplasia and infarction, improved diagnostic accuracy. The reliability and reproducibility of cytodiagnosis was confirmed by analysis of interobserver and intraobserver agreement. The sensitivity was high (0·76–0·88). Controlled enucleation was performed in 12 patients and superficial parotidectomy in 11. There were no tumour recurrences.

Conclusion
Attention to the features of squamoid metaplasia and infarction improves cytological diagnosis and directs appropriate surgical management.
Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly
Authors: Borzellino G , de Manzoni G , Ricci F , Castaldini G , Guglielmi A , Cordiano C 
Published: March 2003

Abstract

Background
The morbidity and mortality rates associated with acute cholecystitis are higher in the elderly. This study reports the results of treatment of acute cholecystitis in the elderly with emergency ultrasonographically guided percutaneous cholecystostomy followed by elective cholecystectomy after endoscopic treatment of any common bile duct stones diagnosed by percutaneous cholangiography.

Methods
From January 1989 to December 1998, 92 patients aged over 70 years were treated for acute gallstone cholecystitis. A group of 84 patients with ultrasonographic signs of severe cholecystitis or an American Society of Anesthesiologists score of II to IV were submitted to ultrasonographically guided percutaneous cholecystostomy. Transcatheter cholangiography was performed in all patients and endoscopic sphincterotomy was performed before operation in patients with common bile duct stones. After resolution of the acute phase and treatment of any associated diseases, patients were submitted to cholecystectomy.

Results
Cholecystostomy was performed successfully in 83 patients and permitted resolution of the acute attack in all after a mean period of 1·8 days. Cholangiography yielded a diagnosis of non-gallstone obstruction in one patient and common bile duct stones in 19 patients; preoperative endoscopic sphincterotomy and stone extraction was performed in 18 patients. Elective cholecystectomy was then performed in 70 patients with no deaths and a morbidity rate of 24 per cent.

Conclusion
Combining emergency ultrasonographically guided percutaneous cholecystostomy, preoperative endoscopic treatment of common bile duct stones and subsequent elective chole-cystectomy constitutes an optimal treatment regimen for acute gallstone cholecystitis in selected elderly patients with a mortality rate of zero in the authors' experience.
Prospective study of chronic pain after groin hernia repair
Authors: Callesen T , Bech K , Kehlet H 
Published: March 2003

Abstract

Background
The aim was to provide a detailed description of any residual pain 1 year after elective day-case open groin hernia repair under local anaesthesia.

Methods
This was a prospective consecutive case series study by questionnaire of 500 consecutive operations in 466 unselected adult patients 1 year after surgery. Pain was scored (none, mild, moderate or severe) at rest, while coughing and during mobilization, and compared with similar data collected 1 and 4 weeks after operation.

Results
Some 419 questionnaires were returned (response rate 93 per cent); 20 patients had died within the year and 30 data sets from patients who had a subsequent operation during the study were excluded. Eighty patients (19 per cent) reported some degree of pain, and 25 (6 per cent) had moderate or severe pain. Pain restricted daily function in 24 patients (6 per cent). The incidence of moderate or severe pain was higher after repair of recurrent than primary hernias (14 versus 3 per cent; P &lt; 0·001). The risk of developing moderate or severe pain was increased in patients who had a high pain score 1 week after operation (9 versus 3 per cent; P &lt; 0·05) and also in patients who had moderate or severe pain 4 weeks after operation (24 versus 3 per cent; P &lt; 0·001).

Conclusion
Chronic pain is a significant problem after open groin hernia repair. It may be worse after surgery for a recurrent hernia and may be predicted by the intensity of early postoperative pain.
Carotid angiography is used more selectively in the Asymptomatic Carotid Surgery Trial
Authors: Robless P , Halliday A 
Published: March 2003

Abstract

Background
The ongoing Asymptomatic Carotid Surgery Trial (ACST) has randomized more than 1900 patients to determine whether carotid endarterectomy prolongs stroke-free survival compared with best medical treatment alone. Previously the Asymptomatic Carotid Atherosclerosis Study demonstrated that preoperative angiography caused stroke or death in 1 per cent of patients, and many centres have now reduced or abandoned this practice. This study determined the changing practice of carotid angiography in the ACST.

Methods
Collaborating surgeons completed questionnaires annually on their use and method of angiography. Information on patients in the ACST who had angiography at randomization was also obtained.

Results
In 1993, 77 per cent of responding collaborators always performed preoperative angiography and 23 per cent used angiography selectively. This trend has reversed: by 1997, 26 per cent always used preoperative angiography, 70 per cent of respondents used preoperative angiography selectively and 4 per cent had abandoned angiography (P &lt; 0·001, χ2 for trend). Information on carotid angiography at randomization has to date been obtained on 1141 patients in the ACST. Some 44 per cent (497 of 1141) had carotid angiography at randomization. Surgical patients had angiography more commonly than those in the medical group (49 versus 42 per cent; P &lt; 0·03, χ2 test). Changes in carotid angiography were analysed by year of randomization. In 1993, 61 per cent of patients randomized had carotid angiography compared with 42 per cent in 1996 and 1997 (P &lt; 0·001, χ2 for trend). The use of carotid angiography was not related to degree of stenosis estimated by Doppler ultrasonography.

Conclusion
In the ongoing ACST, there is increasingly selective use of carotid angiography. Less than half the patients in this study had carotid angiography and the use of angiography is now decreasing. This has important implications for validation of carotid duplex in this trial and in future studies.
Analysis of cold provocation thermography in the objective diagnosis of the hand–arm vibration syndrome
Authors: Coughlin P , Chetter I C , Kent P J , Kester R C 
Published: March 2003

Abstract

Background
The hand–arm vibration syndrome (HAVS) is the commonest prescribed disease in the UK. Presently the diagnosis is subjective and the need for an objective investigation to support the diagnosis has been highlighted. This study analyses the potential of cold provocation thermography (CPT) to fulfil this role.

Methods
CPT was performed in ten controls (five men, five women; median age 35 (range 24–78) years) and 21 patients with HAVS (20 men, one woman; median age 45 (range 29–81) years). With an infrared camera, a precooling (PC) image was taken and then, following hand cooling in water at a temperature of 5°C for 1 min, further rewarming images were taken every minute for 10 min.

Results
Patient finger tip temperatures were significantly cooler than control temperatures at all time points (P &lt; 0·01, Student's t test). The following Table shows the sensitivity, specificity and PPV of CPT.

Conclusion
CPT provides strong objective evidence to support the clinical diagnosis of HAVS.
Total abdominal approach for repair of type IV thoracoabdominal aortic aneurysm
Authors: Dunning P G , Dudgill S , Brown A S , Wyatt M G 
Published: March 2003

Abstract

Background
The total transabdominal approach for thoracoabdominal aneurysm (TAA) was described in 1995 and it was suggested that outcome might be improved if the chest was not opened. This study reports early results of the technique with respect to operative morbidity and mortality rates for patients with abdominal aortic aneurysm extending to the diaphragm.

Methods
Between 1995 and 1998, 26 patients (median age 71 (range 52–84) years) underwent repair of a type IV TAA using a total abdominal approach and medial visceral rotation.

Results
Three patients presented with a contained leak. All survived but one developed paraplegia. Other complications included chest infection (five patients), myocardial infarction (three), reoperation for bleeding (three) and temporary dialysis in one patient. There were three perioperative deaths, two from myocardial infarction and one from multisystem organ failure.

Conclusion
The total abdominal approach for the repair of type IV TAA is a reasonable alternative to a full thoracoabdominal incision. Thoracic complications are minimized, renal and visceral ischaemia times are low, and the perioperative mortality rate is acceptable.
Changes in proximal aortic neck dimensions following endovascular repair of abdominal aortic aneurysm
Authors: Walker S R , Macierewicz J , Whitaker S C , Gregson R H S , Hopkinson B R 
Published: March 2003

Abstract

Background
Dilatation of the proximal neck following conventional open repair of abdominal aortic aneurysm (AAA) has been reported. Such continued dilatation following endovascular repair (EVR) could potentially be a disaster resulting in graft slippage, endoleak and aneurysm rupture. The aim of this study was to detect any change in proximal neck diameter following EVR of AAAs.

Methods
One hundred patients had undergone EVR of an AAA over a 4-year period in whom contrast-enhanced spiral computed tomography was performed both before and after EVR (1 week, 3, 6 and 12 months and annually thereafter). Change in aortic proximal neck diameter, change in maximum aortic diameter, presence of endoleaks, and change in length from the lowest renal artery to the aortic bifurcation was sought.

Results
The median anteroposterior and transverse diameter decreased from 64 mm before operation to 56 and 54 mm respectively after operation. This trend in reduction in maximum diameter was not seen in patients with endoleaks. There was no significant change in proximal neck diameter when measured at 5-mm intervals following EVR. There was also no significant change in the aortic length following EVR.

Conclusion
There was no evidence of proximal neck dilatation or aneurysm length reduction following EVR of AAAs.
Autologous transfusion reduces blood transfusion requirements in aortic surgery
Authors: Wong J , Haynes S , Dalrymple K , McCollum C N 
Published: March 2003

Abstract

Background
Elective aortic surgery is associated with a blood loss that warrants a routine blood crossmatch of 4–6 units. Autologous transfusion strategies to reduce blood requirements were evaluated in a pilot study involving six hospitals in the North West.

Methods
Eighty patients undergoing elective aortic surgery were randomized to either autologous (a combination of acute normovolaemic haemodilution and intraoperative cell salvage) or homologous transfusion. The transfusion trigger, in the absence of pressing clinical need, was 8 g dl–1 haemoglobin for both groups.

Results
Randomization achieved two groups well matched for age, aneurysm or occlusive surgery, aspirin intake, estimated blood volume, preoperative haemoglobin and aneurysm size. In the ‘best’ hospitals (n = 49) mean(s.d.) blood loss (630(49) ml) was significantly lower (P &lt; 0·01) than that in the ‘worst’ hospitals (1077(110) ml, n = 31) and fewer patients required transfusion (nine of 42 versus 15 of 30; P &lt; 0·05). No significant differences were found between homologous and autologous groups for all variables measured in the ‘best’ hospitals. In the ‘worst’ hospitals blood requirements were significantly higher (P &lt; 0·05) for the homologous group (800(112) ml) compared with the autologous group (489(65) ml), although blood loss was similar (1239(195) versus 915(92) ml respectively).

Conclusion
Autologous transfusion techniques significantly reduced homologous blood requirements in aortic surgery where blood loss exceeded 800 ml.
Mid-term results of arterial allograft below-knee bypasses for limb salvage
Authors: Albertini J N , Barral X , Branchereau A , Favre J P , Magnan P E , Magne J L , Sessa C 
Published: March 2003

Abstract

Background
Arterial allografts (AAs) have been recently reconsidered in the treatment of critical limb ischaemia when vein material is absent, because of the disappointing results with artificial grafts. The aim of this study was to report the results observed in three centres where AAs were used for infrainguinal reconstruction in critical limb ischaemia.

Methods
Between 1991 and 1997, 165 AA bypasses were performed in 148 patients (90 men) with a mean age of 70 (range 20–93) years. Indications for operation were rest pain in 54 patients and tissue loss in 111. Mean resting ankle pressure was 53 mmHg in 96 non-diabetic patients and mean transcutaneous partial pressure of oxygen was 10 mmHg in 52 diabetic patients. AAs were obtained from cadaveric donors. The distal anastomosis was to the below-knee popliteal artery in 34 cases, to a tibial artery in 114 and to a pedal artery in 17.

Results
At 30 days, the mortality rate was 3 per cent, primary patency 83 per cent, secondary patency 90 per cent and limb salvage rate 98 per cent. During follow-up (mean 31 months) 65 grafts failed primarily. Causes of primary failure were thought to be progression of the distal disease in 15 cases, myointimal hyperplasia in 16, graft degradation in ten (four dilatations, three stenoses, two ruptures and one dissection), other causes in eight and not known in 16. Primary and secondary patency rates at 3 years were 35(s.e. 9) per cent and 42(s.e. 10) per cent. The limb salvage rate at 3 years was 76(s.e. 8) per cent.

Conclusion
AAs lead to a good foot salvage rate but poor patency rates. The results are similar to those obtained with polytetrafluoroethylene grafts.
New technique of in situ autogenous venous valve construction using varicose vein and bench hydrostatic testing of its properties in vitro
Authors: Amaragiri S , Lees T 
Published: March 2003

Abstract

Background
Long-term results of valve transposition and autogenous valve grafts (from axillary and brachial vein) for chronic venous insufficiency due to post-thrombotic valve destruction are poor. Attempts at constructing in situ autogenous venous valves using varicose veins have been ongoing since 1953 but have been unsuccessful. A technique has been developed to create new autogenous in situ valve.

Methods
Varicose long saphenous veins were obtained following stripping during routine varicose vein surgery. A longitudinal elliptical segment of vein wall was excised from opposite sides; this effectively reduces the diameter of the vein. Polypropylene sutures were applied on each side, starting at the centre of the elliptical defect, and brought out proximally. After closing the elliptical defects, gentle traction was applied to the initial sutures and they were tied causing invagination of the vein wall. Both ends of the vein were connected to pressure transducers and a standard pressure monitoring device. Normal saline was pumped at various pressures through the valve-bearing segment while pressures were recorded simultaneously.

Results
Fourteen constructed valves were tested for their bench hydrostatic properties. Mean(s.d.) minimum opening pressure of the valves was 5·3(2·4) mmHg. The valves were competent at a minimum pressure of 2·7(0·6) mmHg. They sustained sudden pressures of up to 139·0(13·8) mmHg and remained competent at a maximum pressure of 260 mmHg.

Conclusion
This technique produces a competent one-way valve capable of sustaining high back pressures, while allowing forward flow with minimal resistance.
Duplex ultrasonography overestimates internal carotid artery stenosis in the presence of contralateral disease
Authors: Ray S A , Lockhart S J , Burnand K G 
Published: March 2003

Abstract

Background
Duplex ultrasonography is increasingly used as the only investigation before endarterectomy for internal carotid artery stenosis. Contralateral disease is present in approximately 20 per cent of these patients and may lead to overestimation of the carotid stenosis by duplex imaging before surgery. This problem was investigated in the present study.

Methods
Peak systolic and diastolic duplex velocities were compared with angiographic data before 126 consecutive carotid endarterectomies (106 symptomatic, eight asymptomatic, 12 precoronary revascularization). Some 3 months later velocities were repeated to assess whether endarterectomy of a diseased carotid artery affected contralateral velocity measurements.

Results
Significant contralateral carotid disease was present in 36 (29 per cent) of the 126 preoperative angiograms (14 occlusions, 22 stenoses greater than 60 per cent). Three months after operation 119 of the endarterectomy sites were widely patent. Duplex ultrasonography of the 105 non-operated patent contralateral arteries showed a decrease in mean(s.d.) peak systolic and diastolic velocities from 1·21(0·83) and 0·41(0·29) m s–1 before operation to 1·08(0·69) and 0·35(0·24) m s–1 respectively (P&lt; 0·01, paired t test). Preoperative duplex velocities had indicated contralateral disease of greater than 50 per cent stenosis in 34 cases, but 14 of these were reclassified to less severe disease following surgery. Thirteen of these had been correctly classified by preoperative angiography while use of systolic and diastolic internal/common carotid artery velocity ratios reduced the overestimation of stenosis in eight of the 14 cases.

Conclusion
Bilateral carotid artery disease is common and may lead to overestimation of stenosis by duplex ultrasonography, which should therefore be supplemented with other modes of imaging.
Review of 94 tibial bypasses for intermittent claudication
Authors: Byrne J , Darling R C , Chang B B , Paty P S K , Kreienberg P B , Lloyd W E 
Published: March 2003

Abstract

Background
The management of intermittent claudication is usually non-operative. Most surgeons accept, however, that intervention may be warranted for those with debilitating symptoms. Such interventions are limited to above-knee bypass or balloon angioplasty. However, the authors have performed almost 4500 bypasses for limb salvage, with careful audit of results, and suggest that, in very carefully selected cases, tibial bypass can also be performed for intermittent claudication. The present study aimed to review the results of infrainguinal bypass in this unit; to compare the results for above-knee, below-knee popliteal and tibial bypass in claudicants using either in situ or excised vein as the conduit; and to examine the indications and long-term follow-up for those undergoing tibial bypass for claudication.

Methods
A database has been maintained prospectively in this unit since 1986. Details of all patients undergoing infrainguinal bypass for claudication were retrieved. In-hospital charts were also reviewed and cross-referenced with the computer database. In addition to demographic details, data were extracted on operative indication and procedure, postoperative complications, return to desired level of activity and long-term graft patency.

Results
From 1987 to 1997, 409 infrainguinal reconstructions were performed for intermittent claudication (9 per cent of all infrainguinal reconstructions). Of these 73 per cent were in men and 27 per cent in women with a mean age of 64 (range 24–91) years. The operative procedures comprised 165 above-knee popliteal grafts, 150 bypasses to the below-knee popliteal artery and 94 to tibial arteries. There were no operative deaths. However, one of 165 patients who had an above-knee popliteal graft underwent an amputation. Primary and secondary patency rates at 4 years were 62 and 64 per cent for above-knee popliteal bypass, 77 and 81 per cent for below-knee popliteal bypass, and 86 and 90 per cent for tibial bypass. Cumulative survival was 93 per cent at 4 years.

Conclusion
Tibial bypass for severely disabling claudication can be performed with minimal morbidity and mortality rates, and is at least as durable as more commonly performed bypasses. These data indicate that concern over limb loss, death and limited life span may be exaggerated.
Non-steroidal anti-inflammatory drugs to treat abdominal aortic aneurysm
Authors: Franklin I J , Walton L J , Brown L , Greenhalgh R N , Powell J T 
Published: March 2003

Abstract

Background
Prostaglandin E2 (PGE2) and inflammatory cytokine levels are raised in the wall of abdominal aortic aneurysms (AAAs) and inflammatory processes appear to contribute to aneurysm expansion. The effect of PGE2 on aortic smooth muscle cells (SMCs) and the influence of indomethacin on AAA growth and production of inflammatory mediators were investigated.

Methods
Proliferation and apoptosis of aortic SMCs cultured with PGE2 were assessed by 5-bromo-2′-deoxyuridine uptake and oligonucleosome enzyme-linked immunosorbent assay. Full-thickness AAA explant cultures were used to measure the secretion of PGE2, interleukin (IL) 1β and IL-6 in the presence and absence of indomethacin. In a case–control study, the effect of non-steroidal anti-inflammatory drugs (NSAIDs), including indomethacin, on AAA growth was examined.

Results
PGE2 suppressed proliferation (IC50 6 ng ml–1) and increased apoptosis of aneurysm SMCs. Indomethacin diminished secretion of PGE2, IL-1β and IL-6 by AAA explants (see Table below). The median AAA growth rate of 19 patients taking NSAIDs was 1·8 (range 0–11·2) mm per year compared with 3·2 (0·4–10·9) mm per year in 59 patients (matched for age, sex, smoking and initial AAA diameter) not taking these drugs (P= 0·004).

Conclusion
PGE2 is produced in the AAA wall in concentrations that are detrimental to SMCs. Indomethacin reduces PGE2, IL-1β and IL-6 synthesis in aneurysm tissue and NSAIDs appear to reduce AAA growth. These drugs warrant further consideration for the treatment of AAA.