bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer
Authors:   Danish Ranx05 Colorectal Cancer Study Group, Mynster T , Christensen I J , Moesgaard F , Nielsen H J 
Published: March 2003

Abstract

Background
The frequency of postoperative infectious complications is significantly increased in patients with colorectal cancer receiving perioperative blood transfusion. It is still debated, however, whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise affects the prognosis.

Methods
Patient risk variables, variables related to operation technique, blood transfusion and the development of infectious complications were recorded prospectively in 740 patients undergoing elective resection for primary colorectal cancer. Endpoints were overall survival (n = 740) and time to diagnosis of recurrent disease in the subgroup of patients operated on with curative intention (n = 532). The patients were analysed in four groups divided with respect to administration or not of perioperative blood transfusion and development or non-development of postoperative infectious complications.

Results
Overall, 19 per cent of 288 non-transfused and 31 per cent of 452 transfused patients developed postoperative infectious complications (P &lt; 0·001). The median observation period was 6·8 (range 5·4–7·9) years. In a multivariate analysis, risk of death was significantly increased among patients developing infection after transfusion (n = 142) compared with patients receiving neither blood transfusion nor developing infection (n = 234): hazard ratio 1·38 (95 per cent confidence interval (c.i.) 1·05–1·81). Overall survival of patients receiving blood transfusion without subsequent infection (n = 310) and patients developing infection without preceding transfusion (n = 54) was not significantly decreased. In an analysis of disease recurrence the combination of blood transfusion and subsequent development of infection (hazard ratio 1·79 (95 per cent c.i. 1·13–2·82)), localization of cancer in the rectum and Dukes classification were independent risk factors.

Conclusion
Blood transfusion per se may not be a risk factor for poor prognosis after colorectal cancer surgery. However, the combination of perioperative blood transfusion and subsequent development of postoperative infectious complications may be associated with a poor prognosis.
Results of treatment of 33 patients with peritoneal mesothelioma
Authors: Sebbag G , Yan H , Shmookler B M , Chang D , Sugarbaker P H 
Published: March 2003

Abstract

Background
Peritoneal mesothelioma is a rare peritoneal malignancy, representing approximately one-third of all mesotheliomas. It is regarded as a universally fatal cancer with few treatment options.

Methods
Records of 33 patients with peritoneal mesothelioma were reviewed retrospectively. Demographic, clinical and quantitative prognostic indicators were evaluated and analysed statistically using survival as endpoint. Patients were treated by a uniform strategy involving cytoreductive surgery with peritonectomy procedures and perioperative intraperitoneal chemotherapy (cisplatin, doxorubicin).

Results
There were ten women and 23 men; mean age was 53·0 years. Asbestos exposure was recorded in five patients and a family history of cancer in 13. Presentation was mainly abdominal distension and pain. Median survival was 31·0 months; overall projected survival at 3 years was 56 per cent. The most significant positive predictive factors of survival were: female sex (P = 0·003), low prior surgical score (P = 0·002), completeness of cytoreduction (P = 0·0002) and second-look surgery (P = 0·019). The morbidity rate for this combined treatment was 33 per cent and the perioperative mortality rate was 3 per cent.

Conclusion
Although peritoneal mesothelioma is rare, progress in its management has occurred. Survival has been extended and selection factors by which patients may be allocated to aggressive management strategies have been defined.
Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas
Authors: Ortíz H , Marzo J 
Published: March 2003

Abstract

Background
Low-lying trans-sphincteric anal fistulas respond well to simple fistulectomy or fistulotomy. However, management of high fistulas has long been a serious problem because of the necessity of preserving at least some of the sphincter mechanism. The clinical results of endorectal flap advancement and fistulectomy for complex anal fistulas were assessed.

Methods
A total of 103 consecutive patients with high trans-sphincteric (n = 91) and suprasphincteric (n = 12) fistulas undergoing endorectal advancement flap repair together with core fistulectomy were included in a prospective study. Clinical outcome was assessed in terms of continence and recurrence by an independent observer for a period of 1 year after operation.

Results
Successful healing was achieved in 96 patients (93 per cent). Recurrent fistula occurred in six (7 per cent) of the 91 patients in the trans-sphincteric group and in one of the 12 patients in the suprasphincteric group. Continence disturbance was noted in eight patients (8 per cent). Previous repair and the level of the fistula did not adversely affect the results obtained.

Conclusion
Core fistulectomy associated with endorectal advancement flap repair is a safe and effective technique for any high trans-sphincteric and suprasphincteric fistula, with good results in terms of recurrence and anal continence.
Hyaluronic acid as prognostic marker in resectable colorectal cancer
Authors: Llaneza A , Vizoso F , Rodríguez J C , Raigoso P , García-Muñiz J L , Allende M T , García-Morán M 
Published: March 2003

Abstract

Background
Hyaluronic acid (HA), an extracellular high molecular mass polysaccharide, is thought to be involved in the growth and progression of malignant tumours. The objective of this work was to evaluate the cytosolic HA content in resectable colorectal cancer, its possible relationship with clinicopathological parameters of tumours and its prognostic significance.

Methods
Cytosolic HA levels were examined by radiometric assay in 120 patients with resectable colorectal cancer. The mean follow-up period was 33·4 months.

Results
Cytosolic HA levels of tumours ranged widely, from 30 to 29 412 ng per mg protein. Intratumour HA levels were significantly correlated with Dukes stage (P &lt; 0·005), and were higher in patients with advanced tumours (mean(s.e.m.) 2695(446), 2858(293) and 5274(967) ng per mg protein for stages A, B and C respectively). In addition, Cox multivariate analysis demonstrated that tumour HA levels higher than 2000 ng per mg protein predicted shorter relapse-free survival and overall survival periods (both P &lt; 0·05).

Conclusion
There is a wide variability in cytosolic HA levels in colorectal carcinomas, which seems to be related to the biological heterogeneity of these tumours. In addition, high tumour cytosolic HA levels were associated with an unfavourable outcome in patients with resectable colorectal cancer. HA may provide additional information to that given by other biochemical markers currently used in colorectal cancer.
Clinicopathological study of multiple superficial oesophageal carcinoma
Authors: Kanamoto A , Yamaguchi H , Nakanishi Y , Tachimori Y , Kato H , Watanabe H 
Published: March 2003

Abstract

Background
Recently, the diagnosis of superficial oesophageal carcinoma has increased markedly in Japan as a result of advances in endoscopy. A number of these carcinomas have proved to be multiple.

Methods
Some 359 patients with superficial squamous cell carcinoma of the oesophagus who underwent oesophagectomy (n = 276) or endoscopic mucosal resection (EMR) (n = 83) were reviewed retrospectively. The clinicopathological features of patients with multiple superficial oesophageal carcinoma were compared with those of patients with a single superficial oesophageal carcinoma.

Results
Of the 359 patients, 99 (28 per cent) had multiple superficial oesophageal carcinoma. The male: female ratio in patients with multiple carcinoma was 98: 1, compared with 5·3: 1 for those with a single carcinoma (n = 260) (P = 0·0001). The incidence of tobacco and alcohol use was significantly higher in the patients with multiple carcinoma than in those with a single carcinoma (P = 0·04 and P = 0·03 respectively). The incidence of pharyngeal malignancy was also significantly higher in patients with multiple carcinoma (P = 0·02).

Conclusion
The high incidence of multiple superficial oesophageal carcinoma indicates a need for careful evaluation of the oesophagus at the time of initial diagnosis, treatment and follow-up for superficial oesophageal carcinoma. Male sex, smoking, alcohol use and the presence of pharnygeal malignancy are high-risk factors for multiple superficial oesophageal carcinoma.
Postoperative ileus: a preventable event
Authors: Holte K , Kehlet H 
Published: March 2003

Abstract

Background
Postoperative ileus has traditionally been accepted as a normal response to tissue injury. No data support any beneficial effect of ileus and indeed it may contribute to delayed recovery and prolonged hospital stay. Efforts should, therefore, be made to reduce such ileus.

Methods
Material was identified from a Medline search of the literature, previous review articles and references cited in original papers. This paper updates knowledge on the pathophysiology and treatment of postoperative ileus.

Results and conclusion
Pathogenesis mainly involves inhibitory neural reflexes and inflammatory mediators released from the site of injury. The most effective method of reducing ileus is thoracic epidural blockade with local anaesthetic. Opioid-sparing analgesic techniques and non-steroidal anti-inflammatory agents also reduce ileus, as does laparoscopic surgery. Of the prokinetic agents only cisapride is proven beneficial; the effect of early enteral feeding remains unclear. However, postoperative ileus may be greatly reduced when all of the above are combined in a multimodal rehabilitation strategy.
Groin hernia repair in Scotland
Authors: Hair A , Duffy K , McLean J , Taylor S , Smith H , Walker A , Macintyre I M C , O'Dwyer P J 
Published: March 2003

Abstract

Background
The use of mesh for groin hernia repair has dramatically changed the way this common operation is performed. The aim of this study was to survey the methods of groin hernia repair in Scotland and to assess patient satisfaction with the operation.

Methods
Between 1 April 1998 and 31 March 1999 all patients who underwent groin hernia repair in the National Health Service in Scotland were identified. As well as looking at the type of hernia repair performed and postoperative morbidity, patients were sent a Short Form-36 about 3 months after the operation to assess satisfaction and return to normal activity.

Results
Information was obtained on 5506 (97 per cent) of patients who underwent groin hernia repair during the study period. Eighty-five per cent of patients had an open mesh repair and 4 per cent had a laparoscopic repair. Most operations (85 per cent) were performed using general anaesthesia on an inpatient basis (78 per cent), and 8 per cent were for repair of a recurrent hernia. Potentially serious intraoperative complications were rare (seven patients), although they were significantly (P &lt; 0·001) more likely to be associated with a laparoscopic approach or repair of a femoral hernia: relative risk compared with open inguinal hernia repair 33 (95 per cent confidence interval (c.i.) 6–197) and 22 (95 per cent c.i. 3–152) respectively. Wound complications were common and 10 per cent of patients required a district nurse to attend the wound. Patients expressed a high degree of satisfaction; 94 per cent would recommend the same operation to someone else if required.

Conclusion
An open mesh repair using general anaesthesia has become the repair of choice for a groin hernia in Scotland. Despite a high incidence of wound complications, patients are satisfied with this operation.
Randomized controlled trial of standardized meal stimulation for the detection of enteropancreatic endocrine tumours in patients with multiple endocrine neoplasia type 1
Authors: Langer P , Bartsch D K , Schilling T , Kopp I , Celik I , Wild A , Rothmund M 
Published: March 2003

Abstract

Background
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterized by the occurrence of hyperparathyroidism (approximately 100 per cent), and pituitary (approximately 40 per cent) and enteropancreatic endocrine (approximately 70 per cent) tumours. It has been suggested previously that serum pancreatic polypeptide and serum gastrin after standardized meal test stimulation are useful indicators for early identification of enteropancreatic tumours in MEN1. Therefore the usefulness of the meal test was evaluated in a screening programme of MEN1 mutation carriers.

Methods
In a prospective, controlled trial between September 1997 and December 1995, 55 standardized meal stimulation tests (563 kcal) were performed in 13 MEN1 mutation carriers with no evidence of enteropancreatic tumours (group 1); ten patients with MEN1 with histologically, biochemically and radiologically evident enteropancreatic tumours (group 2); and in 28 healthy adults for control (group 3). Genetic analysis was done by single-strand conformation analysis and direct sequencing. Serum pancreatic polypeptide and serum gastrin levels were measured by radioimmunoassay (Ideon, Sweden). Data were analysed using analysis of variance (Kruskal–Wallis test, 2 d.f.) and Mann–Whitney test.

Results
Median (range) basal serum pancreatic polypeptide levels were 214 (38–897) pg ml−1 in group 1, 126 (13–263) pg ml−1 in group 2 and 73 (13–357) pg ml−1 in group 3. Median (range) serum gastrin levels were 103 (37–391), 551 (25–4080) and 65 (17–198) pg ml−1 respectively, but gastrin levels in group 2 were strongly influenced by patients with known gastrinoma. Levels of both variables increased after meal stimulation in all groups. However, there was no significant difference between the groups after stimulation (P &gt; 0·05).

Conclusion
Standardized meal stimulation test does not reliably indicate the presence of enteropancreatic endocrine tumours in patients with MEN1. It is not therefore used in the authors' routine screening programme for patients with MEN1.
Phaeochromocytoma: inherited associations, bilaterality and cortex preservation
Authors: Inabnet W B , Caragliano P , Pertsemlidis D 
Published: March 2003

Abstract

Background
Hereditary phaeochromocytoma (HP) is characterized by early onset, bilateral adrenal involvement, low malignancy rate and genetic linkage with certain familial syndromes. This retrospective review was intended to show the high yield of surveillance, predictable bilaterality and the challenge of cortex-sparing adrenalectomy.

Methods
From 1964 to 1999, 32 patients with HP (mean age 29 years) were treated at a single institution and followed for a mean of 7 (range 0·5–24) years. There were 15 patients with multiple endocrine neoplasia type 2A (MEN2A), 12 with von Hippel–Lindau disease (VHLD), three with von Recklinghausen's disease (VRD) and two patients with familial phaeochromocytoma (FP). Twenty-six of 32 patients underwent bilateral adrenalectomy (12 metachronous). Subtotal resection with orthotopic cortex preservation was performed in four patients and heterotopic autografting in 14 patients. Subcapsular segments were harvested and implanted into the rectus muscle after histological confirmation of the absence of medullary tissue. The following variables were assessed: presenting signs, interval of metachronous disease, recurrence, outcome of cortex preservation and survival.

Results
Phaeochromocytoma was the first manifestation in six of 12 patients with VHLD and four of 15 with MEN2A. Surveillance uncovered medullary thyroid cancer in five of 15 patients with MEN2A, and haemangioblastomas, renal cell carcinoma and islet cell tumours in seven of 15 patients with VHLD and VRD. HP was bilateral in 26 of 32 cases (14 of 15 MEN2A, eight of 12 VHLD, two of three VRD and both FP). In 12 cases of metachronous HP, the mean interval between adrenalectomy was 67 (range 9–156) months. Three of four patients who underwent orthotopic preservation of the adrenal cortex developed recurrence compared with none of 14 patients with heterotopic autotransplantation of cortical tissue. Four patients in this latter group had normal serum cortisol levels and required no exogenous replacement therapy. There was one case of malignant HP and there was no surgical death.

Conclusion
Inherited bilateral phaeochromocytoma is derived from medullary hyperplasia. The long interval of metachronous phaeochromocytoma argues against prophylactic removal of the contralateral ‘normal’ adrenal gland. Phaeochromocytoma frequently heralds coexisting silent VHLD or MEN-2, mandating surveillance for inherited associations. Total adrenalectomy and heterotopic autotransplantation of medulla-free cortex may diminish the need for lifelong steroid substitution and eliminates recurrence.
Cardiac dysfunction during exercise in patients with primary hyperparathyroidism
Authors: Nilsson I-L , Aberg J , Rastad J , Lind L 
Published: March 2003

Abstract

Background
‘Non-traditional’ manifestations of primary hyperparathyroidism (HPT) are controversial, and include morbidity, mortality and risk factors for cardiovascular diseases with some prospects of normalization by parathyroidectomy (PTX). This study evaluated previously unexplored data on cardiac function during exercise in HPT.

Methods
Thirty patients with HPT (mean(s.d.) serum calcium 2·96(0·24) mmol l−1) and 30 normocalcaemic controls (selected randomly from the background population, and matched for age and sex) underwent exercise testing, echocardiography and 24-h ambulatory blood pressure recordings before and a mean of 13 months after PTX.

Results
HPT was associated with higher systolic blood pressure during exercise (mean(s.d.) 223(28) versus 203(33) mmHg; P = 0·02), which correlated to the left ventricular (LV) mass and serum PTH (P = 0·014, P = 0·004); higher LV mass in men (mean(s.d.) 142(20) versus 113(28) g m−2), which might relate to the hypertrophic effect of PTH; and increased LV isovolumic relaxation times (mean(s.d.) 102(19) versus 91(15) ms; P = 0·018), indicating LV diastolic dysfunction. ST depression during exercise decreased significantly (mean(s.d.) − 1·0(0·9) versus 0·7(0·5) mm; P = 0·028) and LV mass declined in proportion with the time after PTX (P = 0·04 in men). PTX also affected systolic functions, as fractional shortening, atrioventricular plane displacement and systolic index decreased in men (P = 0·05, P = 0·04, P = 0·04). Twenty-four-hour blood pressures were higher in HPT (P = 0·008), when subjects on β-blockers (seven patients, five controls) were excluded, and were unaltered by PTX.

Conclusion
LV systolic and diastolic dysfunction occurs in HPT. The diastolic dysfunction seems to diminish with time after PTX, while the positive inotropic effect of calcium in itself may alleviate the systolic dysfunction.
Limitations of size as a criterion in evaluating adrenal tumours
Authors: Barnett C C , Dackiw A P B , Pearson A S , Varma D G , El-Naggar A K , Gagel R F , Evans D B , Lee J E 
Published: March 2003

Abstract

Background
Size is considered the single best predictor of malignancy in evaluating adrenal neoplasms identified incidentally during abdominal imaging, yet small adrenal cortical cancers have been reported previously from several centres.

Methods
This was a retrospective evaluation of the value of tumour size and other preoperative clinical parameters in predicting the presence or absence of malignancy in adult patients who underwent adrenalectomy for an adrenal tumour at this institution.

Results
One hundred and sixteen patients underwent adrenalectomy. Diagnoses were adrenal cortical carcinoma (n = 38), phaeochromocytoma (n = 27), metastasis to the adrenal gland (n = 11) and benign tumours (n = 40) (cortical adenoma, 23; cyst, two; cortical hyperplasia, five; ganglioneuroma, four; myelolipoma, six). The median size of the adrenal cortical carcinomas was 9·2 (range 1·7–30) cm; five tumours were smaller than 5·0 cm. The median overall size of the benign tumours (excluding phaeochromocytomas) was 4·0 cm; the median size of the adrenal cortical adenomas was 3·0 cm. Eleven benign tumours were larger than 5·0 cm, including two cortical adenomas. The radiographic features of three of five small adrenal cancers correctly predicted malignancy; the remaining two patients with small cancers had symptoms related to functioning tumours. Conversely, the radiographic features of seven of 11 large benign adrenal tumours correctly predicted benign histology, including five of five myelolipomas.

Conclusion
While size remains a good predictor of histology and clinical behaviour of functioning and non-functioning adrenal neoplasms, both small adrenal cortical cancers and large benign tumours occur with measurable frequency. High-quality imaging studies (computed tomography and magnetic resonance imaging) may be helpful in identifying relatively small yet radiographically atypical adrenal tumours more likely to be cancers, as well as radiographically characteristic benign myelolipomas which may be followed selectively.
Total parathyroidectomy in patients with chronic renal failure
Authors: Saunders R N , Karoo R , Tiong H Y , Murphy G J , Metcalfe M , Nicholson M L 
Published: March 2003

Abstract

Background
Total parathyroidectomy without reimplantation has been advocated as a treatment for hyperparathyroidism in patients with end-stage chronic renal failure. However, there are concerns that a lack of endogenous parathyroid hormone (PTH) can result in hypocalcaemia and adynamic bone disease. The aim of this study was to identify whether this is a significant clinical problem.

Methods
A review of 56 (51 four-gland and five three-gland) histologically confirmed parathyroidectomies performed by the same surgeon between 1994 and 1999 was performed. Mean(s.d.) follow-up was 30(22) months.

Results
Patients could be divided into three groups on the basis of a postoperative serum PTH concentration that was either undetectable (less than 0·1 pmol l−1), less than the upper limit of normal (7·6 pmol l−1 or less) or raised (more than 7·6 pmol l−1). Demographics, mean number of glands excised and histology were similar in each group. Patients with a raised serum level of PTH had a mean(s.d.) value of 54·1(73·3) pmol l−1. Three-gland parathyroidectomy occurred in three patients, raising the possibility of ectopic glands. Two patients had neck re-exploration after four-gland parathyroidectomy; an adenoma and an ectopic gland were identified. One patient had a parathyroid adenocarcinoma.

Conclusion
Total parathyroidectomy may leave residual functional parathyroid tissue that is not visualized at surgery. However, in patients who had no functional parathyroid tissue after operation there was little clinical or biochemical evidence of an increased incidence of hypocalcaemia or bone disease.