bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oesophageal dysmotility is not associated with poor outcome after laparoscopic Nissen fundoplication
Authors: Beckingham I J , Cariem A K , Bornman P C , Callanan M D , Louw J A 
Published: March 2003

Abstract

Background
Nissen fundoplication has become the standard operation in the surgical management of gastro-oesophageal reflux disease. Postoperative dysphagia is thought to occur more commonly in patients with oesophageal dysmotility and it has been recommended that fundoplication be modified or avoided in these patients. The aim of this study was to determine the outcome of patients with normal motility and dysmotility undergoing laparoscopic Nissen fundoplication.

Methods
This was a single-centre prospective cohort study with 1-year follow-up, using dysphagia as the main outcome variable. Of 81 patients who underwent laparoscopic surgery, 48 had normal motility and 33 had oesophageal dysmotility (defined as percentage peristalsis, using ten wet swallows, of 50 per cent or less and/or a mean distal pressure of less than 40 mmHg).

Results
Dysphagia was present before operation in 14 of 48 patients with normal motility and 15 of 33 in the dysmotility group (P = 0·2). At 3-month follow-up, new or worse dysphagia was present in 13 of 48 patients in the normal group and four of 33 in the dysmotility group (P = 0·17). At 1 year the incidence of dysphagia was six of 48 in the normal group and five of 33 in the dysmotility group (P = 0·9).

Conclusion
Preoperative manometric assessment of oesophageal motility does not correlate with postoperative outcome, and oesophageal dysmotility should not be regarded as a contraindication to laparoscopic Nissen fundoplication.
Gastric carcinoid expresses the gastrin autocrine pathway
Authors: Smith A M , Watson S A , Caplin M , Clarke P , Griffin N , Varro A , Hardcastle J D 
Published: March 2003

Abstract

Background
In gastric adenocarcinoma the gastrin autocrine–paracrine pathway is activated. As enterochromaffin-like (ECL) cells originate from the same stem as epithelial cells, the aim of this study was to determine if the gastrin autocrine pathway is present in gastric carcinoid.

Methods
Samples from ten patients with gastric carcinoid were assessed by immunocytochemistry using primary antibodies directed against gastrin precursors and the gastrin/cholecystokinin B receptor and detected using the avidin–biotin immunoperoxidase system.

Results
A high level of expression of precursor and mature gastrin peptides, together with the gastrin receptor, was seen in all carcinoids screened.

Conclusion
In common with the glandular epithelium of the stomach the gastrin gene is activated during the neoplastic process in ECL cells. This finding may explain why some carcinoids do not regress after surgical procedures that lower serum gastrin. Antigastrin agents may be a useful treatment for carcinoid either in their own right or as an adjunct to surgery.
Long-term clinical outcome of surgery for solitary rectal ulcer syndrome
Authors: Sitzler P J , Kamm M A , Nicholls R J , Mckee R F 
Published: March 2003

Abstract

Background
When severe symptoms of solitary rectal ulcer syndrome persist despite medical management, surgery may be necessary.

Methods
A retrospective review was carried out of 81 patients undergoing surgery for solitary rectal ulcer syndrome in the 10-year period from 1984 to 1993 to determine the long-term outcome at a minimum follow-up of 12 months. Of the 81 patients, 15 were excluded from further analysis (11 were followed up for less than 12 months, two died and two were lost to follow-up). Sixty-six patients were studied (median age 38 (range 15–77) years; 53 female). Of these, 49 underwent rectopexy, nine Delorme's operation, two anterior resection and four creation of a stoma as the initial operation.

Results
At a median follow-up of 90 (range 12–177) months, the rectopexy had failed in 22 of 49 patients; 19 of these patients underwent further surgery, including rectal resection with coloanal anastomosis (four with three failures), colostomy (11) and other procedures (four). Ultimately, 14 required a stoma. Constipation was the indication for a stoma in nine of the 11 patients who had colostomy as the first procedure after failure of rectopexy. Nine patients had Delorme's operation as the first procedure. At median follow-up of 38 (range 19–107) months, there were four failures. Two of these ultimately required a stoma. Of the seven patients who underwent anterior resection as the initial or subsequent procedure, a stoma was finally necessary in four. Anterior resection used as a salvage procedure was not successful. The overall stoma rate was 30 per cent (20 patients). Of 11 symptoms assessed before operation only incontinence and incomplete evacuation were related to a poor outcome following surgery.

Conclusion
Antiprolapse operations result in a satisfactory long-term outcome in about 55–60 per cent of patients having surgery for solitary rectal ulcer syndrome. Results of anterior resection are disappointing.
Improved outcome after emergency surgery for cancer of the large intestine
Authors: Runkel N S , Hinz U , Lehnert T , Buhr H J , Herfarth Ch 
Published: March 2003

Abstract

Background
Emergency surgery for colorectal cancer has become more aggressive and radical over the past decade. This retrospective review analyses the impact on outcome.

Methods
The results of emergency surgery within 24 h of admission were compared between 1982 and 1987 (77 patients) and 1988 and 1993 (75 patients). Patient and tumour characteristics were similar in both groups.

Results
Right colonic obstruction or perforation was treated by primary resection and anastomosis in 11 of 12 patients before 1988 and in all 19 patients thereafter. Primary resection was also the treatment of choice for perforated cancer of the left colon and rectum before 18 of 20) and after (20 of 21) 1988. The rate of primary resection for obstructing cancer of the left colon and rectum increased from 17 of 45 to 30 of 35. One-stage resections for obstructing cancer were performed in ten of 45 and 22 of 35 patients before and after 1988 respectively. The overall mortality rate declined from 14 of 77 to three of 75 after 1988 (P &lt; 0·01). The rate of radical lymphadenectomy rose from six of 46 patients to 42 of 69 after 1988. The 3-year survival rate increased from 50 to 74 per cent (P &lt; 0·05).

Conclusion
The data support further efforts towards improving the immediate and late outcome of emergency surgery in complicated colorectal cancer.
Pain after groin hernia repair
Authors: Callesen T , Bech K , Nielsen R , Andersen J , Hesselfeldt P , Roikjær O , Kehlet H 
Published: March 2003

Abstract

Background
The purpose of the study was to provide a detailed description of postoperative pain after elective day-case open inguinal hernia repair under local anaesthesia.

Methods
This was a prospective consecutive case series study. After 500 hernia operations in 466 unselected patients aged 18–90 years, pain was scored (none, light, moderate or severe) at rest, while coughing and during mobilization, daily for the first postoperative week and after 4 weeks. Pain scores were added together over the first postoperative week.

Results
On days 1, 6 and 28, 66, 33 and 11 per cent respectively had moderate or severe pain while coughing or mobilizing. Total pain scores were higher while coughing or mobilizing than at rest (P&lt;0·001). Younger patients had higher total pain scores than older patients while coughing or mobilizing (P&lt;0·01), but not at rest. No significant differences were found between types of surgery or hernia.

Conclusion
Pain remained a problem despite the pre-emptive use of opioids, non-steroidal anti-inflammatory drugs and local anaesthesia, irrespective of surgical technique.
Resympathectomy for palmar and axillary hyperhidrosis
Authors: Hsu C-P , Chen C-Y , Hsia J-Y , Shai S-E 
Published: March 2003

Abstract

Background
The aim was to analyse patterns of failure or symptom recurrence after primary sympathectomy for palmar or axillary hyperhidrosis, and to carry out tactical problem-solving for resympathectomy and review the operative findings.

Methods
Over a 2-year period, 20 patients (six men and 14 women) underwent resympathectomy for palmar hyperhidrosis (13 patients, 20 sides) or axillary hyperhidrosis (seven patients, ten sides). T2–3 sympathectomy for palmar hyperhidrosis or T4–5 sympathectomy for axillary hyperhidrosis was performed during the repeat procedure. Criteria for evaluation by means of patient questionnaire included good (more than 80 per cent), fair (50–80 per cent) and poor (less than 50 per cent) improvement.

Results
Operative findings included inadequate sympathectomy on 19 sides, nerve regeneration on eight sides and no evidence of previous sympathectomy on three sides. One patient had Kuntz fibre in addition to inadequate sympathectomy. In the palmar hyperhidrosis group, good results were obtained in all 13 patients on all 20 sides after resympathectomy. In the axillary hyperhidrosis group, six of seven patients, or eight of ten sides, showed good results after resympathectomy.

Conclusion
The main cause of primary sympathectomy failure was inadequate surgery, and recurrence of palmar or axillary hyperhidrosis was seldom caused by nerve regeneration. The key factor for preventing failed sympathectomy or recurrent palmar or axillary hyperhidrosis is a first-time sympathectomy that is both accurate and adequate. Most patients with recurrent symptoms can be cured by resympathectomy.
Lymphatic mapping and sentinel node biopsy in breast cancer
Authors: Mcintosh S A , Purushotham A D 
Published: March 2003

Abstract

Background
Sentinel lymph node biopsy is a recently developed, minimally invasive technique for staging the axilla in patients with breast cancer. It has been suggested that this technique will avoid the morbidity associated with more extensive axillary dissection. A wide range of different methods and materials has been employed for lymphatic mapping, but there has been little consensus on the most reliable and reproducible technique.

Methods
This is a comprehensive review of all published literature on sentinel node biopsy in breast cancer, using the Medline and Embase databases and cross-referencing of major articles on the subject.

Results and conclusion
Sentinel node biopsy is a valid technique in breast cancer management, providing valuable axillary staging information. The optimal technique of lymphatic mapping utilizes a combination of vital blue dye and radiolabelled colloid. However, there remain controversial issues which require to be resolved before sentinel node biopsy becomes a widely accepted part of breast cancer care.
Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical–surgical series of 500 patients
Authors: Malka D , Hammel P , Lévy P , Sauvanet A , Ruszniewski P , Belghiti J , Bernades P 
Published: March 2003

Abstract

Background
The prevalence, course, treatment, outcome and risk factors of splenic complications in chronic pancreatitis are poorly documented.

Methods
Patients with splenic complications in a medical–surgical series of 500 consecutive patients with proven chronic pancreatitis prospectively followed up for a mean of 7·0 years were compared with patients without splenic complications.

Results
Eleven men (2·2 per cent) with alcoholic chronic pancreatitis (median duration 2 (range 0–5) years) had a splenic complication: intrasplenic pseudocyst (n = 5), subcapsular haematoma (n = 2) or splenic rupture (n = 4). All patients except one underwent splenectomy, five of whom also underwent distal pancreatectomy. There were no deaths. Patients with splenic complications had pancreatic tail necrosis (six of 11 versus 17·4 per cent; P = 0·007), distal pseudocyst (six of 11 versus 11·7 per cent; P = 0·0009) or splenic vein occlusion (seven of 11 versus 10·8 per cent; P &lt; 0·0001) more frequently than those without. In the 22 patients with distal pseudocyst and splenic vein occlusion, the prevalence of splenic complications was 18 per cent (odds ratio 15·0 (95 per cent confidence interval 4·0–55·7).

Conclusion
Splenic complications occur early in the course of chronic pancreatitis, are rare and are favoured by splenic vein occlusion and pseudocyst or necrosis of the pancreatic tail. Surgical treatment is usually required.
Prospective evaluation of magnetic resonance cholangiography to detect common bile duct stones before laparoscopic cholecystectomy
Authors: Dwerryhouse S J , Brown E , Vipond M N 
Published: March 2003

Abstract

Background
With the advent of laparoscopic cholecystectomy, endoscopic retrograde cholangiography (ERC) is frequently employed before operation to detect common bile duct stones. However, this is an invasive technique with recognized complications. This study evaluated the accuracy of magnetic resonance cholangiography (MRC) to detect choledocholithiasis in selected patients before laparoscopic cholecystectomy.

Methods
Patients scheduled for elective laparoscopic cholecystectomy, with risk factors for common bile duct stones, underwent MRC followed by ERC or peroperative cholangiography.

Results
Over a 2-year period 40 patients were studied. MRC had a sensitivity of 88 per cent, specificity of 93 per cent, positive predictive value of 78 per cent and negative predictive value of 97 per cent for the detection of common bile duct stones.

Conclusion
MRC is a simple non-invasive method for preoperative screening for common bile duct stones in at-risk patients. In this study it would have reduced the need for ERC by three-quarters.
Nitric oxide generation is increased in experimental renal warm ischaemia–reperfusion injury
Authors: Weight S C , Furness P N , Nicholson M L 
Published: March 2003

Abstract

Background
Nitric oxide has a clearly defined place in normal renal homoeostasis while there is a continuing debate as to its role under pathophysiological conditions. This study investigated the role of nitric oxide in a model of renal warm ischaemia–reperfusion injury.

Methods
Groups of rats underwent bilateral renal warm ischaemia (for 15–60 min) followed by reperfusion (20 or 80 min) before unilateral nephrectomy for measurement of renal nitric oxide (as nitroxides) and oxidative damage. Renal function was measured on days 2 and 7 before killing and nephrectomy. A further group received the nitric oxide synthase inhibitor NG-nitro l-arginine methyl ester (l-NAME; 50 mg per kg body-weight) before induction of warm ischaemia.

Results
In early reperfusion there was a correlation between the duration of warm ischaemia (15–45 min) and renal nitrate (r2 = 0·97) which increased from a mean(s.e.m.) baseline value of 95(5·9) to 208(17·3) nmol per mg protein following 45 min of warm ischaemia. Levels were further raised at 80 min and maintained through to day 7 (241(12·5) nmol per mg protein in 45-min group). This rise was attenuated by l-NAME (P &lt; 0·01) as was the early rise in oxidative damage seen otherwise. By day 7, however, oxidative damage was increased (all P≤0·01).

Conclusion
Renal nitric oxide increased early in recoverable warm ischaemia–reperfusion injury and remained raised to day 7. Nitric oxide synthase inhibition ameliorated early but exacerbated late damage suggesting that the early burst of nitric oxide is cytotoxic but that overall nitric oxide may exert a cytoprotective effect.
No correlation between phaeochromocytoma catecholamine secretion and granule ultrastructure
Authors: Mihai R , Wong N A C S , Luckett M , Sheffield E , Farndon J R 
Published: March 2003

Abstract

Background
It is uncertain whether biochemical markers of catecholamine secretion in patients with phaeochromocytoma correlate with tumour ultrastructure granule morphology.

Methods
Fifteen patients with an adrenal phaeochromocytoma (n=13) or paraganglioma (n = 2) (three men, 12 women; age 17–79 years) were studied. Catecholamine secretion was estimated by measuring urinary levels of free noradrenaline, adrenaline and dopamine. The number and type of secretory granules were evaluated by two independent observers on electron micrographs (area analysed approximately 70 µm2). Large round or elongated medium-density granules were adrenaline-type granules, whereas electron-dense granules lying in a vacuole were of noradrenaline type.

Results
No correlation was found between noradrenaline output and the number or percentage of noradrenaline-type granules, although tumours with normal noradrenaline output had only a minority of this type of granule (less than 25 per cent). Adrenaline-type granules were predominant (77 per cent of 163 granules) in a tumour secreting only adrenaline, but the proportion of adrenaline-type granules in six tumours with normal adrenaline output varied significantly (range 7–89 per cent). It was not possible to evaluate the granule type associated with dopamine secretion because one tumour secreting 14900 nmol dopamine and 1570 nmol adrenaline daily had a predominance of noradrenaline-type granules (63 per cent of 132 granules) and two dopamine-secreting tumours (5500 and 4250 nmol per day respectively) had 93 and 13 per cent noradrenaline-type granules.

Conclusion
The lack of correlation between hormone output and granularity suggests that other factors determine secretory patterns in these tumours.
Prospective assessment of the hepatic perfusion index in patients with colorectal cancer
Authors: Warren H W , Gallagher H , Hemingway D M , Angerson W J , Bessent R G , Wotherspoon H , Mcardle C S , Cooke T G 
Published: March 2003

Abstract

Background
This prospective study was designed to test the hypothesis that abnormal liver blood flow is related to poor prognosis in patients with colorectal cancer.

Methods
The hepatic perfusion index (HPI), measured by dynamic hepatic scintigraphy, was assessed in 202 patients with colorectal cancer. Assessment for overt hepatic metastasis included liver palpation at laparotomy and perioperative computed tomography (CT). Follow-up at a dedicated clinic included regular abdominal ultrasonography and CT.

Results
The HPI was abnormal (greater than 0·37) in 92 (88 per cent) of 105 patients with overt liver metastases. Of 89 patients with no evidence of overt metastases or residual tumour after primary resection, 52 had an abnormal and 37 a normal HPI. At a median follow-up of 39 (range 13–76) months, 25 of 38 patients with recurrnce had an abnormal HPI. Some 31 of 45 patients who died had an abnormal HPI. The HPI predicted overall recurrence (P = 0·04, log rank test). Multivariate analysis showed the HPI was independent of Dukes stage for predicting disease-free survival (P = 0·04, relative risk 1·94 (95 per cent confidence interval (c.i.) 1·03–3·67)) but this just failed to attain significance for overall survival (P = 0·055, relative hazard 1·88 (95 per cent c.i. 1·00–3·58)).

Conclusion
The HPI predicts a poor outcome in patients with colorectal cancer and may be useful in patient selection for adjuvant chemotherapy.
Dynamic graciloplasty in the treatment of patients with faecal incontinence
Authors: Sielezneff I , Malouf A J , Bartolo D C C , Pryde A , Douglas S 
Published: March 2003

Abstract

Background
Dynamic graciloplasty is a recent innovation in the surgical management of faecal incontinence. This study reports further experience with this procedure in a series of consecutive patients.

Methods
Between July 1994 and February 1998, 21 dynamic graciloplasties were performed in 18 patients with total faecal incontinence. The two most recent patients were excluded because of follow-up less than 6 months. Continence scores and manometric data were collected before operation and 6 months afterwards. Subsequent clinical data were obtained at regular outpatient review. Seven patients had a three-stage procedure (vascular delay and stoma creation; gracilis transposition and implantation of stimulator and leads; stoma closure), four patients had a two-stage procedure (stoma, with transposition and implantation; stoma closure) and five underwent a one-stage procedure without defunctioning stoma.

Results
Mean(s.d.) follow-up was 20(10·2) months, and was complete in all patients. Eight of the 16 patients had postoperative morbidity. Thirty-three subsequent admissions and 23 reoperations were required to treat complications, to correct technical problems or to manage outcome failures. A defunctioning stoma did not protect wounds from infection (P= 0·6) or reduce the postoperative morbidity rate (P= 0·14). Continence scores were improved by the procedure (P&lt; 0·001) and anal canal pressure increased with stimulation (mean increase 35·9 cmH2O, P&lt; 0·001). Two patients required revisional surgery for perielectrode fibrosis. Five patients had revisional surgery for electrical device failure. Thirteen of the 16 patients were either improved or fully continent after operation, and satisfied with the result of the procedure. Ultimate failure (n = 3) occurred in patients with chronic preoperative constipation or diarrhoea, or abnormal rectal sensitivity.

Conclusion
Dynamic graciloplasty is an effective procedure in selected cases of end-stage faecal incontinence. Patient motivation is essential given the necessity for close follow-up.
Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity
Authors: O'Brien P E , Brown W A , Smith A , McMurrick P J , Stephens M 
Published: March 2003

Abstract

Background
Surgical control of morbid obesity should benefit from a minimally invasive approach and the ability to adjust the degree of gastric restriction.

Methods
The Lap-Band adjustable gastric banding system was evaluated prospectively in a consecutive series of 302 patients, and data on perioperative outcome and weight loss pattern at up to 4 years of follow-up are presented. Some 302 patients (89 per cent women; mean age 39 years, mean weight 124 kg) were entered into the study. Laparoscopic placement was used in 277 patients. Previous gastric stapling surgery was the principal reason for an elective open approach.

Results
The incidence of significant early complications was 4 per cent and included two perforations of the stomach after open placement. The mean length of stay after laparoscopic placement was 3·9 days and only one complication (infected reservoir site) occurred in these patients. The principal late complication of prolapse of the stomach through the band occurred in 27 patients (9 per cent). Significant modification of technique and patient care has enabled reduction of this complication in the latter part of the series. Mean(s.d.) excess weight loss was 51·0(17) per cent at 12 months (n = 120), 58·3 (20) per cent at 24 months (n = 43), 61·6(2) per cent at 36 months (n = 25) and 68·2(21) per cent at 48 months (n = 12).

Conclusion
The Lap-Band is an effective method for achieving good weight loss in the morbidly obese at up to 4 years of follow-up. Laparoscopic placement has been associated with a short length of stay and a low frequency of complications. The ability to adjust the setting of the device to achieve different degrees of gastric restriction has enabled progressive weight loss throughout the period of study.