bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noradrenaline improves the tumour to normal blood flow ratio and drug delivery in a model of liver metastases
Authors: Shankar A , Loizidou M , Burnstock G , Taylor I 
Published: March 2003

Abstract

Background
Vasopressors administered via the hepatic artery appear to increase drug delivery to colorectal liver metastases, but are limited by a short duration of action. This study measured their effect on blood flow and drug delivery during a prolonged infusion in a model of liver metastases.

Methods
In Hooded Lister rats with liver metastases, blood flow in tumour and adjacent normal liver was measured using laser Doppler flowmetry during a 30-min hepatic arterial infusion of endothelin 1, angiotensin II, vasopressin, N-nitro-l-arginine methyl ester (l-NAME), noradrenaline or saline (n = 6 per group). The same agents were co-administered with radiolabelled 5-fluorouracil (5-FU) (n = 6 per group) and uptake in the tumour and normal liver was measured.

Results
The mean(s.d.) duration of effect and resulting percentage changes in tumour to normal blood flow ratio of the vasopressors during this period were: noradrenaline, 2·9(0·4) min and 34(5) per cent (P &lt; 0·05); angiotensin II, 4·2(0·2) min and 10(2) per cent (P &lt; 0·05); vasopressin, 11·1(0·9) min and 7(2) per cent (P &lt; 0·05); endothelin 1, 21·5(2·3) min and 14(5) per cent (P &lt; 0·05); and l-NAME, 22·6(3·3) min and 2(1) per cent (Pnot significant). The mean(s.d.) uptake of radiolabelled 5-FU by the tumour in the groups studied was: saline, 5·1(3·2) × 105 c.p.m. per g tissue; angiotensin II, 5·1(1·4) × 105 c.p.m. per g; endothelin 1, 15·8(14·2) × 105 c.p.m. per g; l-NAME, 3·5(1·3) × 105 c.p.m. per g; and vasopressin, 6·8(3·5) × 105 c.p.m. per g. Significant improvements in 5-FU uptake only resulted from noradrenaline infusion (22·0(9·8) × 105 c.p.m. per g; P &lt; 0·05).

Conclusion
These findings suggest that hepatic arterially infused noradrenaline might be used to improve drug delivery to liver metastases.
Identification of patients likely to benefit from biofeedback for outlet obstruction constipation
Authors: McKee R F , McEnroe L , Anderson J H , Finlay I G 
Published: March 2003

Abstract

Background
Biofeedback for outlet obstruction constipation has a varying success rate. The aim of this study was to identify which patients are likely to respond to biofeedback.

Methods
Thirty patients with severe outlet obstruction constipation were treated by a specialist nurse using three or four sessions of visual and auditory feedback of anal sphincter pressures. All patients were assessed by evacuating proctography, whole-gut transit studies and anorectal physiology before treatment.

Results
Two patients did not complete the course of biofeedback. Nine patients improved. Before treatment these patients had predominantly normal anorectal physiology and were all able to open the anorectal angle at evacuating proctography. Nineteen patients did not improve, of whom only three had no measured abnormality other than inability to empty the rectum. Ten of these patients had abnormal anorectal physiology which may have been due to previous vaginal delivery.

Conclusion
Biofeedback for outlet obstruction constipation is more likely to be successful in patients without evidence of severe pelvic floor damage.
Surgical implications of underestimation of adrenal tumour size by computed tomography
Authors: Lau H , Lo C Y , Lam K Y 
Published: March 2003

Abstract

Background
Size of adrenal mass is an important consideration during adrenal surgery, with regard to the choice of surgical approach and management of adrenaloma. The aim of the present study was to evaluate the precision of preoperative computed tomography (CT) on the size estimation of adrenal lesions and to review its potential implications on surgical decision making.

Methods
Records of 110 patients who underwent adrenalectomy for various adrenal pathologies from 1981 to 1997 were reviewed retrospectively. Patients (n = 92) who had documented dimensions of adrenal mass by both preoperative CT and pathological examination were selected for analysis.

Results
CT overall underestimated the actual size of adrenal lesions by 16 per cent compared with measurement of resected specimens (mean 3·1 versus 3·6 cm; P&lt; 0·001). There was a significant underestimation of the actual size of adrenal lesions measuring less than 6 cm by CT but not for lesions larger than 6·0 cm. Phaeochromocytoma (n = 17) was the only pathological condition consistently underestimated by CT.

Conclusion
Conventional CT overall underestimates the real size of adrenal lesions, in particular phaeochromocytoma and adrenal tumours of less than 6·0 cm in size. Surgical decision making based on size should take this limitation into account.
Red blood cells inhibit tumour cell adhesion to the peritoneum
Authors: van Rossen M E E , Stoop M P O , Hofland L J , van Koetsveld P M , Bonthuis F , Jeekel J , Marquet R L , van Eijck C H J 
Published: March 2003

Abstract

Background
Perioperative blood transfusion has been associated with increased tumour recurrence and poor prognosis in colorectal cancer. Blood loss in the peritoneal cavity might be a tumour-promoting factor for local recurrence. The aim of this study was to investigate whether blood in the peritoneal cavity affects local tumour recurrence.

Methods
In an established in vivo rat model the effect of 1·5 ml syngeneic whole blood on tumour cell adhesion and tumour growth was investigated. In the same model the effect of 1·5 ml pure red blood cell (RBC) concentrate and 1·5 ml RBC-derived substances on tumour cell adhesion was studied. In an established in vitro model the effect of increasing numbers of RBCs (0–250 × 106) on tumour cell adhesion and tumour growth was assessed.

Results
Both the presence of blood and RBC concentrate in the peritoneal cavity prevented tumour cell adhesion in vivo (overall P ≤ 0·001 and P ≤ 0·05 respectively), rather than promoting adherence. RBC concentrate and RBC-derived substances had a comparable inhibitory effect on tumour cell adhesion. In in vitro studies RBCs inhibited tumour cell adhesion but not tumour growth.

Conclusion
RBC-derived factors prevent tumour cell adhesion to the peritoneum, and consequently tumour recurrence.
Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma
Authors: Joosten J J A , Strobbe L J A , Wauters C A P , Pruszczynski M , Wobbes Th , Ruers T J M 
Published: March 2003

Abstract

Background
Orderly progression of nodal metastases has been described for melanoma and breast cancer. The first draining lymph node, the sentinel node, is also the first to contain metastases and accurately predicts nodal status. The aim of this study was to assess the feasibility of lymphatic mapping and sentinel node biopsy in colorectal cancer.

Methods
In 50 patients with colorectal cancer patent blue dye was injected around the tumour. After resection of the tumour the specimen was examined to identify blue-stained lymph nodes. Routine histopathological examination was performed on all nodes and the blue, haematoxylin and eosin-stained tumour-negative nodes were tested immunohistochemically.

Results
Lymphatic mapping was possible in 35 of 50 patients (70 per cent). Pathological examination with haematoxylin and eosin staining showed lymph node metastases in 20 of 35 patients. In eight of these 20 patients the blue nodes showed tumour, while in 12 the blue nodes were not involved. This represents a false-negative rate of 60 per cent.

Conclusion
Lymphatic mapping using patent blue dye is feasible in colorectal cancer. The blue-stained nodes do not predict nodal status of the remaining lymph nodes in the resected specimen. The concept of lymphatic mapping and sentinel node identification is not valid for colorectal cancer.
Interstitial laser coagulation for hepatic tumours
Authors: Heisterkamp J , van Hillegersberg R , IJzermans J N M 
Published: March 2003

Abstract

Background
The potential role of interstitial laser coagulation (ILC) for patients with irresectable hepatic tumours is currently being investigated. Since its introduction in 1983 it has evolved into an innovative minimally invasive technique.

Methods
On the basis of a Medline literature search and the authors' experience, the principles, current state and prospects of ILC for hepatic tumours are reviewed.

Results
Animal studies and early clinical studies have shown the safety and feasibility of ILC. The site of interest can be approached at laparoscopy or percutaneously and treatment is easily repeatable. Recent advances include the use of fibres with a cylindrical diffusing light-emitting tip, the length of which is adaptable to tumour diameter, water-cooled fibre systems, simultaneous multiple fibre application, and hepatic inflow occlusion during laser treatment. ILC allows complete destruction of tumours up to 5 cm in diameter. Currently a limitation is the lack of reliable real-time monitoring of laser-induced effects but progress in magnetic resonance imaging techniques should allow accurate temperature measurements to be obtained rapidly during treatment. However, the actual benefit of ILC in terms of patient survival remains to be investigated.

Conclusion
In terms of tools and experience, ILC has now been developed sufficiently to study its effect on survival of patients with irresectable hepatic tumours.
Interleukin 6 in bile as an indicator of liver function after hepatectomy in patients with biliary tract carcinoma
Authors: Maeda A , Nagino M , Takeuchi E , Sano T , Kurumiya Y , Nimura Y 
Published: March 2003

Abstract

Background
Interleukin (IL) 6 is one of the important components of the early signalling pathways leading to liver regeneration, and has been detected in the bile after liver transplantation. IL-6 concentrations in the bile were studied in an attempt to predict liver function after major hepatectomy for biliary tract carcinoma.

Methods
This study involved 24 patients without cirrhosis who underwent major hepatectomy for biliary tract carcinoma. The bile was sampled regularly through external biliary drainage tubes. IL-6 concentrations in bile and serum were measured using an enzyme-linked immunosorbent assay.

Results
Bile IL-6 concentrations increased 37-fold (from mean(s.e.) 56(13) pg/ml before hepatectomy to 2071(398) pg/ml on day 1 after operation) in patients without liver failure after hepatectomy (n = 18) and increased sevenfold (from 71(24) to 530(76) pg/ml) in patients with liver failure after hepatectomy (n = 6). The values were significantly lower in patients with liver failure than in those without liver failure (P &lt; 0·05). The bile IL-6 concentration on day 1 after operation exhibited a significant negative correlation with the maximum serum total bilirubin concentration after hepatectomy. Although serum IL-6 concentrations were also increased in both groups after hepatectomy, there was no significant correlation with postoperative liver function.

Conclusion
Increased bile IL-6 concentrations after hepatectomy may reflect liver regenerative capacity. Measurement of bile IL-6 concentrations may be clinically useful for the early identification of liver failure after hepatectomy.
Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus
Authors: Matsubara T , Ueda M , Abe T , Akimori T , Kokudo N , Takahashi T 
Published: March 2003

Abstract

Background
Lymph node metastasis is commonly found in carcinoma of the thoracic oesophagus, even when the tumour invades only the submucosa. Although lymph node status greatly influences the outcome, the pattern of early lymphatic spread has not been investigated, and the role of lymph node dissection is still a matter of controversy.

Methods
A series of 110 patients with superficial carcinoma who underwent systematic extended lymph node dissection was investigated retrospectively.

Results
Lymph node involvement was found in 0 per cent (none of nine), 23 per cent (five of 22) and 49 per cent (38 of 78) of tumours that invaded the lamina propria, muscularis mucosa and submucosa respectively. Anatomically distant lymph nodes (recurrent nerve nodes and perigastric nodes) were involved more frequently than other intrathoracic nodes adjacent to the main tumour. Only three patients had involvement limited to the intrathoracic group, and in carcinoma that invaded only the muscularis mucosae, all metastatic nodes were located at the thoracocervical junction or in the abdomen. The 5-year survival rate was 89 per cent in the node-negative group and 54 per cent in the node-positive group (P &lt; 0·0003).

Conclusion
The recurrent nerve nodes and perigastric nodes are the principal proximal regional lymph nodes involved in superficial carcinoma of the thoracic oesophagus. Systematic lymph node dissection, which included these nodes, yielded an acceptable and favourable outcome in patients with node-positive superficial carcinoma.
Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy
Authors: Lin P-W , Lin Y-J 
Published: March 2003

Abstract

Background
Pancreaticoduodenectomy, with either gastrectomy (Whipple procedure) or pylorus-preserving pancreaticoduodenectomy (PPPD), is a complex procedure. Technical diversity, variation and sampling bias exist among surgeons. Previous reports comparing these two procedures are retrospective and not randomized. These factors should be considered seriously and eliminated in comparisons between the two procedures.

Methods
From August 1994 to August 1997, a prospective randomized comparison was conducted between the Whipple procedure and PPPD performed by the same surgeon with the same approach and same anastomotic fashion for periampullary cancer. After exclusion of seven patients, 31 patients were eligible for the study, 16 receiving PPPD and 15 a Whipple procedure. No significant difference in the age, sex distribution, tumour localization or staging was noted between the two groups.

Results
One operative death after PPPD and no operative death after the Whipple procedure resulted in a 3 per cent mortality rate in the 31 patients. Median duration of the Whipple operation was 235 (range 195–305) min, with a median blood loss of 500 (range 230–3100) ml and a median blood transfusion of 0 (range 0–10) units. In the patients who had PPPD, median operating time was 230 (range 170–275) min, median blood loss was 350 (range 100–1200) ml and median blood transfusion was 0 (range 0–4) units. There were two minor leaks from the pancreaticojejunostomy after the Whipple procedure and no leakage after PPPD, resulting in 6 per cent minor leakage in 31 patients. These outcomes were not significantly different. Delayed gastric emptying was observed more frequently after PPPD (six of 16 patients) than after the Whipple procedure (one of 15 patients), with marginal significance (P = 0·08, two-sided Fisher's exact test).

Conclusion
In this prospective randomized study, both PPPD and the Whipple procedure were associated with low mortality and operative morbidity rates. There was no significant difference between PPPD and Whipple resection in terms of operative mortality and morbidity, operating time, blood loss and blood transfusion. PPPD was associated with more frequent delayed gastric emptying, although study of more patients is needed to confirm this.
Fertility after ileal pouch–anal anastomosis in women with ulcerative colitis
Authors: Olsen K Ø , Joelsson M , Laurberg S , Öresland T 
Published: March 2003

Abstract

Background
Women with ulcerative colitis are believed to have normal fertility but colectomy and ileal pouch–anal anastomosis (IPAA) may impair fertility. The aim was to compare fertility in patients with ulcerative colitis before and after IPAA with that in the national population.

Methods
Some 258 consecutive women who had undergone IPAA for ulcerative colitis were identified. Data were collected by questionnaire and from medical records. The observed number of births was compared with the number expected by indirect standardization by age and calendar year. Fertility from the age of 15 years to colectomy, from the onset of ulcerative colitis to colectomy, and from the 12 months after stoma closure to the time of data collection was investigated.

Results
A total of 237 women (92 per cent) responded. From the age of 15 years to colectomy there were 251 deliveries compared with an expected number of 286 (P &lt; 0·05). The number of births from the onset of ulcerative colitis to colectomy was 120, compared with an expected 131 (P &gt; 0·3). From the 12 months after ileostomy closure until data collection there were 34 deliveries, compared with an expected 69 (P &lt; 0·001).

Conclusion
There is a considerable reduction in postoperative fertility after restorative surgery for ulcerative colitis.
Lateral ligaments of the rectum: an anatomical study
Authors: Jones O M , Smeulders N , Wiseman O , Miller R 
Published: March 2003

Abstract

Background
The lateral ligaments of the rectum are surrounded by confusion and misconception. Their identification before ‘hooking them on the finger’, clamping and ligating is considered in many surgical texts to be an essential step in mobilization of the rectum. By contrast, it is the experience of many colorectal surgeons that the mesorectum can be dissected out either by diathermy or sharp dissection alone.

Methods
Dissection in the mesorectal plane was performed on 28 cadaveric pelves.

Results
In ten of the pelves, no connective tissue structure crossed from the pelvic side wall to the rectum. The remaining 18 had only very insubstantial connective tissue strands crossing this space. A total of 17 middle rectal arteries were found, all of them unilateral. Fourteen of these vessels crossed the mesorectum independent of any structure, while the remainder were part of a neurovascular bundle with a connective tissue element.

Conclusion
It is proposed that the ‘lateral ligaments’ of the rectum do not exist and that the term should be dropped from surgical texts. When present, the middle rectal artery is a small vessel, close to the pelvic floor. The entire rectum may be mobilized by sharp dissection without the need for clamping or ligation of any significant structure.
Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity
Authors: Wijnhoven B P L , Siersema P D , Hop W C J , van Dekken H , Tilanus H W 
Published: March 2003

Abstract

Background
Adenocarcinomas of the distal third of the oesophagus and the gastric cardia have similar characteristics but different staging criteria are being used. In the present study the question is addressed whether these tumours should be regarded and staged as one clinical entity.

Methods
From January 1987 to January 1997, 252 patients with an adenocarcinoma of the oesophagus (n = 111) or gastric cardia (n = 141) underwent transhiatal resection. Pathology, pathological tumour node metastasis (pTNM) stage and survival were analysed retrospectively, and a comparison was made between tumours of the oesophagus and gastric cardia.

Results
Barrett's epithelium was diagnosed in 54 per cent of oesophageal adenocarcinomas compared with 13 per cent of adenocarcinomas of the gastric cardia (P &lt; 0·001). Oesophageal carcinomas had a more favourable pT stage, fewer positive locoregional lymph nodes (pN1–2 56 versus 62 per cent; P = 0·3), but more distant metastases accounted for by positive lymph nodes around the coeliac axis (pM1 19 versus 4 per cent; P &lt; 0·001). Five-year overall survival (26 versus 27 per cent; P = 0·9) and survival according to tumour stage were no different between the groups. Multivariate analysis showed that the location of the primary tumour was not an independent prognostic factor.

Conclusion
Adenocarcinomas of the distal oesophagus and gastric cardia should be regarded as one clinical entity. Uniform staging criteria for both malignancies are recommended.
Physiological comparison of open and endovascular aneurysm repair
Authors: Treharne G D , Thompson M M , Whiteley M S , Bell P R F 
Published: March 2003

Abstract

Background
This prospective study compared morbidity and mortality rates following conventional and endovascular abdominal aortic aneurysm (AAA) repair using a physiological scoring system.

Methods
Between December 1994 and November 1997, 104 elective open aneurysm repairs and 49 endovascular aneurysm repairs were performed. These patient cohorts were compared using the Portsmouth predictor equation (P-POSSUM) scoring system. Data collected prospectively from patient notes were used to obtain physiological and operative severity scores which were analysed to compare expected and observed mortality and morbidity rates.

Results
There were three deaths (6 per cent) in the endovascular AAA repair group and 17 (16 per cent) in the conventional aneurysm repair group, whereas the P-POSSUM formulae predicted mortality rates of 8 and 19 per cent respectively. Although the mean physiological scores were similar for both groups (endovascular 20·8 versus conventional 20·1), the operative severity score was significantly greater in the conventional group (26·3 versus 19·7; P &lt; 0·001).

Conclusion
In this study open aortic aneurysm repair had a higher operative severity than endovascular repair, which was reflected in the increased mortality rate.
Endoscopic band ligation of oesophageal varices
Authors: Tait I S , Krige J E J , Terblanche J 
Published: March 2003

Abstract

Background
For 25 years the optimal management of bleeding oesophageal varices has included endoscopic injection sclerotherapy (EIS) both to arrest bleeding and to prevent rebleeding. However, the recent innovation of endoscopic variceal ligation (EVL) may be a more effective treatment; this paper reviews its efficacy.

Methods
All Medline (National Library of Medicine, Washington DC, USA) articles containing the text words ‘oesophageal varices’, ‘sclerotherapy’ or ‘band ligation’ were reviewed. Prospective randomized studies comparing sclerotherapy with band ligation, or combinations thereof, were included.

Results
After an acute variceal bleed EVL is as effective as EIS for control and eradication of oesophageal varices. Initial control of bleeding is similar, but eradication is achieved in fewer sessions with EVL. EVL is associated with lower rebleeding rates and fewer procedure-related complications; it is also more effective for control of active bleeding at initial endoscopy. Combination therapy (EIS plus EVL) confers no advantage over EVL alone.

Conclusion
EVL is similar to EIS for control of bleeding varices, but the former has less associated morbidity, lower rebleeding rates and achieves more rapid variceal eradication. EVL should be considered the endoscopic treatment of choice in the management of variceal haemorrhage.