bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of laparoscopic ultrasonography in the management of patients with oesophagogastric cancer
Authors: Smith A , Finch M D , John T G , Garden O J , Paterson Brown S 
Published: March 2003

Abstract

Background
Laparoscopy and laparoscopic ultrasonography (lapUS) have been shown to improve the staging of patients with oesophagogastric cancer but there remains doubt as to whether most benefit follows laparoscopy alone and how much is contributed by the addition of lapUS.

Methods
The role of lapUS in surgical decision making was evaluated prospectively in a consecutive series of patients with oesophagogastric cancer following conventional radiological assessment. The results of the lapUS findings over and above the laparoscopic findings were documented in order to identify the additional benefit of lapUS.

Results
After initial conventional assessment 41 patients were considered unsuitable for surgery and treated by palliation, with a further 25 patients proceeding to surgery without laparoscopy. Of the 93 patients who underwent laparoscopy, 18 were shown to have irresectable disease and avoided further surgery; a further seven avoided inappropriate surgery by the addition of lapUS. The open–close laparotomy rate was reduced from five of 25 in patients who did not undergo laparoscopy to nine (12 per cent) of 75 by the introduction of laparoscopy and to two (3 per cent) of 68 with the addition of lapUS.

Conclusion
Laparoscopy alone prevented unnecessary surgery in 18 (19 per cent) of 93 patients with oesophagogastric cancer and the addition of lapUS identified a further seven patients (8 per cent) in whom unnecessary surgery was avoided.
Adjuvant medical therapy in peripheral bypass surgery
Authors: Watson H R , Belcher G , Horrocks M 
Published: March 2003

Abstract

Background
A review was conducted of published clinical trials of adjuvant medical therapy in infrainguinal bypass procedures to evaluate the strength of the evidence for the use of various agents.

Methods
Trials were identified by literature search. The methods used were reviewed and the results with each agent tested were assessed taking into account the soundness of the study design.

Results
Thirty-three studies were identified; fewer than half had a randomized and double-blind design. Most were single-centre studies including a mixture of different surgical procedures and patients with varying degrees of lower limb ischaemia. Clinical outcomes were seldom reported. The median sample size was 61. The median follow-up duration was 12 months, but was often not standardized for all patients in a trial. Only aspirin in prosthetic grafts and ticlopidine in vein grafts have been shown in well designed, double-blind, randomized, controlled trials to reduce the likelihood of occlusion in infrainguinal bypass grafts.

Conclusion
The majority of the trials reviewed had significant deficiencies in their design, reducing the reliance that can be placed on their results. Further studies are required to investigate adequately the effectiveness of existing medical therapies for the maintenance of infrainguinal bypass grafts.
Intragraft expression of transforming growth factor β1 gene in isolated glomeruli from human renal transplants
Authors: Nicholson M L , Bicknell G R , Barker G , Doughman T M , Williams S T , Furness P N 
Published: March 2003

Abstract

Background
Experimental evidence suggests that transforming growth factor (TGF) β1 is a fibrogenic cytokine. The histopathological changes of chronic renal allograft nephropathy are dominated by fibrotic changes and TGF-β may have an important aetiological role. This study investigated the relationship between intragraft TGF-β gene expression and extracellular matrix protein deposition in human renal allografts.

Methods
Sixteen cadaveric renal transplant recipients immunosuppressed with cyclosporin and steroids were studied. Individual glomeruli were isolated from protocol needle-core biopsies and, following messenger RNA extraction, intragraft gene expression was studied by reverse transcriptase–polymerase chain reaction. Collagen III deposition in these renal transplant biopsies was examined by immunohistochemistry and quantified by computerized histomorphometry.

Results
There was a positive correlation between renal cortical collagen III immunostaining and the levels of glomerular complementary DNA for TGF-β1.

Conclusion
TGF-β1 is a profibrotic influence in human renal transplants. The methods described should prove of benefit in investigating the mechanisms of chronic renal allograft damage.
Results of pneumatic dilatation in patients with dysphagia after antireflux surgery
Authors: Gaudric M , Sabate J M , Artru P , Chaussade S , Couturier D 
Published: March 2003

Abstract

Background
The mechanisms and treatment of persistent dysphagia after antireflux surgery are not well established. The results of pneumatic dilatation were evaluated in a retrospective study.

Methods
Sixteen patients were reviewed. All had severe and persistent postoperative dysphagia evaluated by oesophageal manometry before pneumatic dilatation.

Results
Seven patients had one dilatation and nine had two dilatations. There was no complication and no relapse of reflux symptoms. Results were satisfactory in nine patients (mean(s.e.m.) follow-up 19·2(6·9) months) and poor in seven, who required revisional surgery. Age, time since operation and weight loss were not related to the outcome. Thirteen patients had abnormal manometry with an ‘achalasia-like’ motor pattern in four. Lower oesophageal sphincter (LOS) pressure, LOS relaxation and oesophageal contraction amplitude were similar in the two groups. The only difference was in the percentage of normal peristaltic contractions (mean(s.e.m.) 82·2(11) versus 39·1(13·8) per cent for satisfactory and poor results respectively; P &lt; 0·05).

Conclusion
In this retrospective study pneumatic dilatation was effective and safe in nine of 16 patients with dysphagia following antireflux surgery. Peristalsis was normal in eight patients, in seven of whom it was associated with satisfactory results.
Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test
Authors: Lam C M , Fan S T , Lo C M , Wong J 
Published: March 2003

Abstract

Background
Liver failure is the commonest cause of postoperative death in patients with hepatocellular carcinoma (HCC). With the improvement in operative technique and perioperative care, the limit of hepatic functional reserve may be lowered. The aim of this study was to evaluate the postoperative morbidity, mortality and survival rates in patients with an indocyanine green (ICG) retention value higher than 14 per cent, after major hepatectomy for HCC.

Methods
From January 1994 to December 1997, 117 patients underwent major hepatectomy for HCC; 92 patients had preoperative ICG retention at 15 min lower than 14 per cent (median 8·3 (range 1·6–13·8) per cent), while 25 patients had ICG retention greater than 14 per cent (17·4 (range 14·3–35·3) per cent). Data were collected prospectively and analysed retrospectively.

Results
The two groups of patients were similar in terms of age, sex ratio, preoperative platelet count, liver biochemistry, Child–Pugh status and operative procedures performed, but the prothrombin time was significantly longer in the high ICG group. The operative blood loss (1·5 litres), the amount of blood transfused and the number of patients requiring blood transfusion were similar. The postoperative complication rate (41 versus 40 per cent), duration of hospital stay (12 versus 13 days), hospital mortality rate (1 versus 4 per cent) and median survival time (47 versus 45 months) were not significantly different.

Conclusion
With meticulous surgical technique to decrease intraoperative blood loss and good perioperative care, selected patients with limited hepatic functional reserve can achieve a good immediate postoperative result and a survival rate similar to that of patients with good hepatic functional reserve.
Management of liver trauma
Authors: Parks R W , Chrysos E , Diamond T 
Published: March 2003

Abstract

Background and methods
Management of blunt or penetrating injuries to the liver remains a significant challenge. This review discusses the mechanisms of liver injury, grading system for severity, available diagnostic modalities and current management options. It is based on a Medline literature search and the authors' clinical experience.

Results
Unstable patients require immediate laparotomy, but selected patients who are haemo- dynamically stable may be managed without operation. The preferred operative techniques include resectional debridement, hepatotomy with direct suture ligation and perihepatic packing; anatomical resection, hepatic artery ligation and various bypass techniques have a limited, more defined role for selected injuries. Major complications include haemorrhage, sepsis and bile leak.

Conclusion
Enhanced resuscitation, anaesthesia and intensive care have contributed to a significant reduction in mortality rates from liver trauma. Optimum results are obtained with a specialist team that includes an experienced liver surgeon, anaesthetist, endoscopist and interventional hepatobiliary radiologist with expertise in managing postoperative complications.
Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias
Authors: Toms A P , Dixon A K , Murphy J M P , Jamieson N V 
Published: March 2003

Abstract

Background
The assessment of abdominal wall hernias has long been a clinical skill that only occasionally required the supplementary radiological assistance of herniography. However, with the advent of cross-sectional imaging, a new range of diagnostic tools is now available to help the clinician in difficult cases.

Methods
This review explores the ability of computed tomography and magnetic resonance imaging to demonstrate many of the hernias encountered in the anterior abdominal wall. Also discussed is the role of imaging techniques in the management of a variety of hernias.

Results and conclusion
Cross-sectional imaging techniques are being employed with increasing frequency for the assessment of hernias. Although the anatomical detail can usually be delineated clearly, the accuracy of the various methods and their place in the clinical management of hernias has yet to be fully determined.
Touch imprint cytological analysis of sentinel lymph nodes for detecting axillary metastases in patients with breast cancer
Authors: Ratanawichitrasin A , Biscotti C V , Levy L , Crowe J P 
Published: March 2003

Abstract

Background
Sentinel lymph node biopsy is a procedure that examines the first tumour-draining lymph node. Touch imprint cytology may provide a quick method for intraoperative screening of sentinel lymph nodes for the presence of metastases.

Methods
Touch imprint cytological analysis of sentinel lymph nodes was compared prospectively with the findings obtained on routine paraffin sections. Touch imprint slides from 55 patients with breast cancer were prepared during operation from multiple sections of sentinel lymph nodes, stained with haematoxylin and eosin. A cytopathologist blinded to the histological results interpreted the smears.

Results
The concordance between touch imprint and paraffin sections of sentinel lymph nodes was 98 per cent (54 of 55). When touch imprint analysis of sentinel lymph nodes was compared with paraffin sectioning of all lymph nodes from the axillary node dissection, the concordance was 95 per cent (52 of 55). The sensitivity and specificity of sentinel lymph node touch imprints in detecting metastases were 82 and 100 per cent respectively. The positive and negative predictive values were 100 and 93 per cent respectively.

Conclusion
Touch imprint cytology is potentially useful for the intraoperative evaluation of sentinel lymph nodes in patients with breast cancer.
Outcome of biofeedback for faecal incontinence
Authors: Norton C , Kamm M A 
Published: March 2003

Abstract

Background
Biofeedback has been reported to improve or eliminate symptoms in approximately 70 per cent of patients with faecal incontinence. However, it is unknown which patients respond in relation to the different symptomatic types of faecal incontinence and the different structural sphincter aetiologies.

Methods
One hundred consecutive patients (84 women; median age 49 years) who completed biofeedback treatment were prospectively characterized by symptoms and by structural integrity of the internal and external anal sphincters as assessed endosonographically (87 patients). Patients underwent a median of 4 biofeedback sessions.

Results
Overall, 43 of the 100 patients regarded themselves as symptomatically cured and 24 improved after treatment. Cure or improvement was experienced by 24 of 30 patients with a structurally normal anal sphincter, by 27 of 46 patients with an external anal sphincter structural defect, and by seven of 11 with an isolated internal anal sphincter defect or atrophy. Thirty-three of 60 patients with urge incontinence alone were symptomatically cured, compared with five of 22 of those with only passive incontinence.

Conclusion
Biofeedback retraining is effective in the short term in treating a majority of patients with faecal incontinence. It is most successful in treating urge incontinence, but also helps some patients with passive leakage. Even in patients with structural anal sphincter damage, some symptom improvement or cure is achieved.
Desmoid tumours complicating familial adenomatous polyposis
Authors: Clark S K , Neale K F , Landgrebe J C , Phillips R K S 
Published: March 2003

Abstract

Background
Desmoid tumours are one of the most important and intriguing extracolonic manifestations of familial adenomatous polyposis (FAP). They have been studied only in small numbers of patients.

Methods
Patients with FAP who also had desmoid tumour were identified from a polyposis registry database and their hospital notes were reviewed.

Results
There were 166 desmoids in 88 patients (median age 32 (interquartile range 22–38) years; 51 (58 per cent) female); 83 tumours (50 per cent) were within the abdomen and 80 (48 per cent) were in the abdominal wall. All but 16 individuals (18 per cent) had already undergone abdominal surgery, which was significantly more recent in women (P = 0·01, Mann–Whitney U test). Intra-abdominal desmoids caused small bowel and ureteric obstruction and resulted in ten deaths; survival was significantly poorer than in patients with abdominal wall desmoid alone (χ2 = 3·93, 1 d.f., P = 0·047, log rank test), and eight of 22 patients who underwent resection of intra-abdominal desmoid died in the perioperative period.

Conclusion
Abdominal wall desmoids caused no deaths or significant morbidity; although recurrence was common after excision, the treatment was safe. Intra-abdominal desmoids can cause serious complications and treatment is often unsuccessful; in particular, surgery for desmoids at this site is hazardous.
Long-term functional results of colonic J pouch versus straight coloanal anastomosis
Authors: Barrier A , Martel P , Gallot D , Dugue L , Sezeur A , Malafosse M 
Published: March 2003

Abstract

Background
There are very few studies evaluating the long-term functional outcome of coloanal anastomoses. This retrospective study aimed to compare long-term functional results of straight and colonic J pouch anastomoses.

Methods
Thirty-seven patients, 25 with a straight anastomosis and 12 with a J pouch anastomosis, responded to a standardized telephone questionnaire. The mean time since surgery was 10 (range 4–18) years.

Results
The mean daily stool frequency was similar in both groups of patients (1·1 in patients with a reservoir, 1·5 in patients with a straight anastomosis). In both groups, two-thirds of patients had perfect continence or limited gas incontinence. Faecal incontinence was reported by two patients with a straight anastomosis and one patient with a pouch. Nocturnal stools and fragmentation were slightly more frequent in patients with a straight anastomosis. Half of the patients regularly used medication. Thirty-five of the 37 patients reported satisfaction with functional results.

Conclusion
Long-term functional results of coloanal anastomoses are satisfactory and, unlike early results, similar for both types of anastomosis. The functional benefit of a reservoir, seen in the first year after operation, is less evident with increasing time.
Endoscopic totally extraperitoneal repair of bilateral inguinal hernias
Authors: Knook M T T , Weidema W F , Stassen L P S , Boelhouwer R U , van Steensel C J 
Published: March 2003

Abstract

Background
Recurrence rates associated with bilateral inguinal hernia repair with a giant prosthesis (Stoppa procedure) are low. Endoscopic totally extraperitoneal bilateral inguinal hernia repair with a giant prosthesis combines the low recurrence rate of the Stoppa repair and the advantages of minimally invasive surgery. The aim of this retrospective study was to investigate whether extraperitoneal bilateral inguinal hernia repair could be performed by the minimally invasive, totally extraperitoneal approach.

Methods
From February 1993 to January 1998, 98 patients with bilateral inguinal hernias underwent surgery. A polypropylene 30 × 10 cm rectangular mesh or a 30 × 10/15 cm ‘slipmesh’ was used. Follow-up, including a physical examination, of 96 per cent of patients was performed.

Results
Median operative time was 60 min. Mostly minor intraoperative complications occurred. Conversion was required for two patients. Apart from one patient with a necrotic fasciitis who died from respiratory failure, only minor postoperative complications (10 per cent) occurred. Median hospital stay was 1 (range 1–21) days. Median recuperation time was 5 (range 1–22) days. Median follow-up (96 per cent) was 32 (range 7–57) months; there were six recurrences among 34 hernias in the group of 17 patients treated with 10 × 30 cm mesh and two (1 per cent) in the group that received 30 × 10/15 cm mesh (162 hernias in 81 patients).

Conclusion
The endoscopic approach for the Stoppa procedure for bilateral inguinal hernia repair is a reliable method with minor complications. It ensures a short recuperation time and the recurrence rate is low owing to adequate overlap of the hernial defect when a ‘slipmesh’ is used.
Role of nitric oxide in intestinal ischaemia-reperfusion injury studied using electron paramagnetic resonance
Authors: Chan K L , Zhang X H , Fung P C W , Guo W H , Tam P K H 
Published: March 2003

Abstract

Background
The role of nitric oxide in intestinal ischaemia–reperfusion (I/R) remains poorly defined, partly because of difficulty in detecting the nitric oxide free radical. In this study nitric oxide production was assessed during intestinal I/R by direct measurement using electron paramagnetic resonance (EPR), and the production of nitric oxide in jejunum and ileum was correlated with their different abilities to resist I/R injury.

Methods
Rats were given an electron spin trapper (diethyldithiocarbamate/ferrous citrate) by intraperitoneal injection. Thirty-six segments each of jejunum and ileum were subjected to 15–90 min of ischaemia and 25 min of reperfusion. Tissue samples were analysed for EPR signals using a spectrometer.

Results
Mean(s.d.) basal nitric oxide level was significantly higher in ileum (3·39(1·42) units) than jejunum (0·65(0·05) units) (P = 0·0005). Increasing ischaemic times in the ileum resulted in decreasing nitric oxide levels (85, 32 and 13 per cent of basal level at 30, 60 and 90 min respectively); reperfusion resulted in further nitric oxide reduction (mean decrease 26 per cent). Severe (grade 3) histological damage was observed in low nitric oxide states (after 15 min of I/R in jejunum, 60 min of I/R in ileum).

Conclusion
Nitric oxide can be measured in intestinal tissues directly by EPR. The findings support a protective role for nitric oxide in I/R, and offer an explanation for the greater resistance to I/R of ileum.
Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer
Authors: de Kanter A Y , van Eijck C H J , van Geel A N , Kruijt R H , Henzen S C , Paul M A , Eggermont A M M , Wiggers T 
Published: March 2003

Abstract

Background
Axillary lymph node dissection is still performed as a staging procedure since lymph node status is the most important prognostic factor in patients with breast cancer. Sentinel node biopsy may replace routine axillary lymphadenectomy, especially in patients with small breast cancers. This study investigated whether ultrasonographically guided fine-needle aspiration cytology (FNAC) of the axillary lymph nodes in clinically node-negative patients was an accurate staging procedure to select patients for sentinel node biopsy.

Methods
One hundred and eighty-five consecutive patients were included. All had axillary ultrasonography and detected nodes were categorized according to their dimensions and echo patterns. Ultrasonographically guided FNAC was carried out if technically possible. These results were compared with the results of the sentinel node biopsy and subsequent axillary dissection.

Results
In 116 patients no lymph nodes were detected by ultrasonographic imaging. Of 69 patients with visible nodes, 31 had malignant cells on FNAC. There were no false-positive results. Some 87 of 185 patients had axillary metastases on definitive histological examination. Ultrasonography was sensitive in patients with extensive nodal involvement. Failure of the examination was caused by problems learning the method, difficulty in puncturing small lymph nodes and sampling error.

Conclusion
In patients without palpable axillary nodes, a sentinel node biopsy could be avoided in 17 per cent since ultrasonography combined with FNAC had already diagnosed axillary metastases. The method is particularly valuable in larger breast cancers.
Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer
Authors: Francis M , Cakir B , Ung O , Gebski V , Boyages J 
Published: March 2003

Abstract

Background
Breast conservation surgery with radiotherapy is a safe and effective alternative to mastectomy for early-stage breast cancer. This retrospective study examined the outcome of patients with isolated local recurrence following conservative surgery and radiotherapy in node-negative breast cancer.

Methods
Between November 1979 and December 1994, 503 women with node-negative breast cancer were treated by conservation surgery and radiotherapy without adjuvant systemic therapy.

Results
After a median follow-up of 73 months the 5-year rate of freedom from local recurrence was 94 per cent. Thirty-five patients developed an isolated local recurrence within the breast as a first event. Thirty-three patients were treated with salvage mastectomy and two patients were treated with systemic therapy alone. The 5-year rate of freedom from second relapse was 46 per cent and the overall 5-year survival rate was 59 per cent for patients who had salvage mastectomy. Patients who developed breast recurrence as a first event had a 3·25 greater risk of developing distant metastasis (P &lt; 0·001) than those who did not have breast recurrence as a first event.

Conclusion
Salvage mastectomy after local recurrence was an appropriate treatment if there was no evidence of distant metastasis. Breast recurrence after conservative surgery and radiotherapy in node-negative breast cancer predicted an increased risk of distant relapse.