bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of need for multiple dilatations after cervical oesophagogastrostomy
Authors: Hollowood A D , Kavadas V , Vickery C W , Hardwick R H , Barham C P , Alderson D 
Published: March 2003

Abstract

Background
The aim of this study was to investigate the frequency of anastomotic stricture formation after subtotal oesophagectomy with cervical oesophagogastrostomy.

Methods
Patients undergoing surgery over a 3-year period using an identical handsewn single-layer anastomotic technique were studied. Details of the operations, complications and need for anastomotic dilatation were recorded.

Results
Sixty-two patients (41 men) with a mean age of 64 (range 36–90) years were included. Fifty-eight underwent surgery for carcinoma, two for stromal tumours, one for achalasia and one for Crohn's disease. Thirty-two (2 per cent) developed a benign anastomotic stricture requiring a median of 4 (range 1–22) dilatations. The median time from operation to first dilatation was 50 days. There was a significant correlation between the time to first dilatation and the total number of dilatations (P = 0·006). Patients who developed symptomatic strictures within 30 days of operation required a median of 9·5 dilatations compared with 3·5 in those who presented beyond this time (P = 0·01). The development of a clinical leak significantly increased the number of dilatations required, from a mean of 5·2 to 10·4 (P = 0·04).

Conclusion
The incidence of benign anastomotic stricture formation requiring dilatation after cervical oesophagogastrostomy is about 50 per cent. Patients who require dilatation within 30 days of surgery to restore swallowing to normal are likely to require the procedure on multiple occasions and should be counselled accordingly.
Oesophagectomy and total gastrectomy in a specialized district general hospital unit
Authors: Wayman J , Linsley A , Raimes S A 
Published: March 2003

Abstract

Background
The aim was to demonstrate that a low operative mortality rate (less than 5 per cent) is achievable for both oesophagectomy and total gastrectomy (TG) in a medium-sized district general hospital (DGH).

Methods
This was a prospective audit of all oesophagectomies and TGs performed in the first 5 years after establishment of a specialized upper gastrointestinal surgical–anaesthetic team.

Results
Some 82 procedures were undertaken, all by the same surgical team. Forty patients (median age 66 (range 41–76) years) underwent subtotal oesophagectomy (STO) using the two-stage approach. Forty-two patients (median age 68 (range 35–80) years) underwent TG using a left thoracoabdominal approach in four and an abdominal approach in 38. There were no deaths in hospital or within 30 days for either procedure. Two patients in each group died within 90 days: one from myocardial infarction and one from paraneoplastic syndrome after STO; one from pulmonary embolism and one from malignant adhesive obstruction after TG. There was one anastomotic leak in each group. Four patients required a second procedure: for a postoperative bleed, a thoracic duct leak and a feeding jejunostomy (one patient each) after STO; and for drainage of a left subphrenic abscess after TG.

Conclusion
It is reasonable to aim for an operative mortality rate of under 5 per cent for both STO and TG even in a DGH treating relatively small numbers of patients. Preoperative assessment and peroperative management by a single surgical–anaesthetic team, use of epidural analgesia and treatment in dedicated ward areas are all contributory factors. Clinical, audit and research links to the Northern Oesophago-Gastric Cancer Unit in Newcastle have ensured a uniformity of care across the region.
Pattern of lymph node dissemination from adenocarcinoma of the oesophagogastric junction
Authors: Dresner S M , Wayman J , Bennett M K , Hayes N , Griffin S M 
Published: March 2003

Abstract

Background
Adenocarcinoma of the oesophagogastric junction (OGJ) is rapidly increasing in incidence and the role of radical lymphadenectomy for such tumours remains controversial. The aim of this study was to identify the pattern of metastatic nodal spread by histopathological assessment of all lymph node groups retrieved from resected specimens.

Methods
Data were collected prospectively from patients undergoing potentially curative (R0) resection with lymphadenectomy for adenocarcinoma of the OGJ between January 1996 and May 1998. Patients with type 1 tumours (lower third of the oesophagus) underwent two-stage subtotal oesophagogastrectomy with two-tier lymphadenectomy. Patients with type 2 (gastric cardia) tumours underwent D2 total gastrectomy. At the time of surgery all lymph node groups were dissected out from the specimens, labelled and assessed by a single consultant histopathologist.

Results
A total of 103 patients were studied. Eleven patients were understaged before operation and were inoperable or had palliative resections. Of the remaining 92 patients, 68 had type 1 tumours and 24 had type 2 tumours. Some 2301 nodes were analysed representing a median of 27 nodes per patient (26 from the oesophagectomy group and 30 from the gastrectomy group). Over 70 per cent of all patients had lymph node metastases at the time of surgery. Some 6 per cent of type 1 tumours with lymph node metastases had dissemination in both the abdominal and mediastinal nodal tiers. The common abdominal sites were the paracardial (right, 23 of 41; left, 23 of 41) and left gastric nodes (29 of 41) whereas within the mediastinum paraoesophageal (25 of 41) and bronchial (right, seven of 41; left, six of 41) metastases were more often encountered. Type 2 tumours had positive lymph nodes most frequently in the left paracardial (nine of 16), lesser curve (11 of 16) (N1 group) and left gastric (eight of 16) (N2 group) territories. The extent of lymph node positivity correlated with the T stage and differentiation of the primary tumour, as well as the presence of perineural, lymphatic and vascular invasion (P &lt; 0·05).

Conclusion
The high incidence and widespread dissemination of nodal metastases at the time of surgery seen with these tumours may justify the approach of systematic lymphadenectomy in the hope of performing a curative resection. The current definition of the lymph node sites in the abdominal and mediastinal tiers for type 1 tumours is based on experience with lower-third squamous carcinomas. These results demonstrate a different pattern of dissemination for junctional␣oesophageal adenocarcinomas requiring redefinition of the nodal stations to be resected in radical lymphadenectomies for such tumours.
Validation of the gastrointestinal quality of life index for patients with potentially operable periampullary carcinoma
Authors: Nieveen van Dijkum E J M , Terwee C B , Oosterveld P , van der Meulen J H P , Gouma D J , de Haes J C J M 
Published: March 2003

Abstract

Background
A disease-specific quality of life questionnaire is not available for patients with periampullary carcinoma, although cancer-specific questionnaires and the Gastrointestinal Quality of Life Index (GIQLI) have been used. The aim of this study was to validate the GIQLI for patients with periampullary tumours and to evaluate if subscales of the GIQLI could be identified to allow a more detailed assessment of the patients' quality of life.

Methods
Patients with periampullary carcinoma, included in a study concerning diagnostic laparoscopy, were asked about symptoms and completed a questionnaire comprising the Medical Outcomes Study (MOS) 24 questionnaire, the GIQLI and one question of the Rotterdam Symptom Check List (RSCL). Clinical interpretation and statistical factor analysis were used to identify subscales of the GIQLI.

Results
The GIQLI could be divided into four subscales, measuring physical well-being, mental well-being, digestion and defaecation. All four subscales had a good internal reliability and the construct validity was supported by the pattern of correlations with the MOS and RSCL as well as differences in subscale scores for patients with or without certain symptoms.

Conclusion
In patients with periampullary tumours the GIQLI can be divided into four subscales, measuring different aspects of quality of life. These subscales provide insight into the different problems affecting the patient.
Specialized intestinal metaplasia in patients with gastro-oesophageal reflux disease
Authors: Carton E , Caldwell M T P , McDonald G , Rama D , Tanner W A , Reynolds J V 
Published: March 2003

Abstract

Background
There is an increasing awareness that short (less than 3 cm) segments of Barrett's epithelium and macroscopically normal cardia epithelium may harbour specialized intestinal metaplasia (SIM), a premalignant phenotype. The prevalence of SIM was studied prospectively in an unselected population of patients attending for endoscopy, and the association of SIM with symptoms, lifestyle, medication, endoscopic oesophagitis and carditis was investigated.

Methods
Two hundred consecutive patients underwent endoscopy. Biopsies taken from just below the squamocolumnar junction were stained for SIM, and were analysed for carditis and Helicobacter pylori infection. A detailed questionnaire of symptoms, tobacco consumption and the use of proton pump inhibitors was completed.

Results
Forty-two patients (21 per cent) had SIM: 19 (15 per cent) of 126 in an endoscopically normal oesophagus, 15 (24 per cent) of 63 in a short segment of Barrett's epithelium and eight of 11 in classical Barrett's oesophagus. There was a significant association between SIM and carditis (P &lt; 0·0001) and endoscopic oesophagitis (P = 0·03).

Conclusion
SIM is prevalent in patients undergoing endoscopy, does not correlate with symptoms or H. pylori infection, but is significantly associated with endoscopic and pathological markers of gastro-oesophageal reflux.
Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm
Authors: Vardulaki K A , Walker N M , Day N E , Duffy S W , Ashton H A , Scott R A P 
Published: March 2003

Abstract

Background
The prevalence of abdominal aortic aneurysm (AAA) in a community-based sample of men and women aged 65–79 years was correlated with known risk factors. In addition, the effect of high blood pressure and the use of antihypertensive medication on growth of AAAs were studied.

Methods
Aortic diameter was assessed by ultrasonography and data on risk factors were collected by self-administered questionnaire for 5356 men and women as part of a randomized controlled trial.

Results
Current hypertension increased the risk of having an aortic aneurysm by 30–40 per cent while use of antihypertensive medication increased the risk by 70–80 per cent, adjusting for current blood pressure. There was no clear relationship between hypertension and growth rates of existing aneurysms in this study, although these results were largely from data on small aneurysms. Men were nearly six times more likely to develop an AAA than women; the risk increased by 40 per cent every 5 years after the age of 65 years. Smoking was an independent risk factor for AAA, with level of exposure being more significant than duration.

Conclusion
Male sex, smoking and hypertension are strong risk factors for the development of AAA. In this study hypertension did not significantly increase the growth rate of existing aneurysms. Smoking remains the most important avoidable risk factor for AAA. The analyses presented here suggest that selection for screening, other than by age and sex, is not worthwhile.
Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage
Authors: Chung Y F A , Wong W K , Soo K C 
Published: March 2003

Abstract

Background
Oesophagogastroduodenoscopy (OGD) is the diagnostic tool of choice in acute upper gastrointestinal haemorrhage. However, the factors causing diagnostic failure are not well documented or discussed.

Methods
OGDs performed by a single surgeon for acute upper gastrointestinal haemorrhage were reviewed retrospectively for ‘missed’ diagnosis.

Results
There were nine cases (1·4 per cent) of ‘missed’ diagnosis in 638 OGDs performed over a 3-year period. Incomplete examination caused by a fundal pool precluded three examinations in which two Dieulafoy's lesions and one chronic gastric ulcer were later found. Other difficult examination sites were the cardia/high lesser curve (three cases), the stomal line of a gastrojejunostomy anastomosis (two) and at the junction of the first and second part of the duodenum (one). Four of the overlooked diagnoses were Dieulafoy's lesions.

Conclusion
OGD was able to diagnose the cause of bleeding in 98·6 per cent of patients with acute upper gastrointestinal haemorrhage. The factors that caused diagnostic failure were a difficult examination site and failure to recognize lesions (Dieulafoy's).
Manometric assessment of an artificial bowel sphincter
Authors: Savoye G , Leroi A M , Denis P , Michot F 
Published: March 2003

Abstract

Background
This study investigated the relationship between functional clinical results after artificial bowel sphincter implantation and manometric assessment in 12 consecutive patients.

Methods
A postoperative manometric study was performed in 12 patients, including measurement of resting and squeeze pressures, opening characteristics and pressure during straining. The relationship between postoperative findings, clinical outcome and preoperative manometric data was investigated. Anal pressure after rectal distension with a closed cuff was studied in seven patients. Results were expressed as mean(s.d.).

Results
Continence for solid stool was achieved in all 12 patients. Five patients remained incontinent for gas. Anal resting pressure was 108(22) cmH2O; there was no difference between continent and incontinent patients. Rectal distension induced anal relaxation in six of seven patients. Total duration of cuff opening was 113(8) s with an amplitude of 60(22) per cent; residual pressure was correlated with the preoperative resting pressure. The total duration of the opening phase in patients with defaecation difficulties (47(24) (range 0–65) s) was shorter than that in patients without defaecation difficulties (178(78) (range 100–320) s) (P = 0·0022).

Conclusion
Postoperative defaecation difficulties after implantation of an artificial bowel sphincter are related to a short duration of opening of the cuff. The anal sphincter played a role in postoperative resting anal pressures and allowed relaxation even if the cuff was closed.
Exercise training and peripheral vascular disease
Authors: Tan K H , de Cossart L , Edwards P R 
Published: March 2003

Abstract

Background
Conservative management is advocated as a treatment of choice for patients with intermittent claudication. This is a review of the mechanisms behind the improvement following an exercise rehabilitation programme.

Methods
All Medline articles from the National Library of Medicine, USA containing the text words ‘claudication’ or ‘peripheral vascular disease’ and ‘exercise’ were reviewed. Cross-referencing from relevant articles was carried out.

Results and conclusion
The poor physical status of a patient with intermittent claudication is not solely due to a reduction in blood flow to the lower limbs; associated factors, such as metabolic inefficiency, poor cardiorespiratory reserve and exercise-induced inflammation contribute. An exercise programme frequently improves both the physical aspect and quality of life, and the success of such exercise is multifactorial. An increase in the blood flow to the lower extremity is uncommon. Other factors, such as a redistribution of blood flow, changes in oxidative capacity of the skeletal muscles and greater utilization of oxygen, occur and the associated metabolic dysfunction of the skeletal muscles is rectified. Following exercise training, blood rheology improves and exercise-induced inflammation is ameliorated; cardiorespiratory status also benefits and the oxygen cost of exercise decreases.
In vivo evaluation of an implantable portal pump system for augmenting liver perfusion
Authors: Jiao L R , Seifalian A M , Davidson B R , Habib N 
Published: March 2003

Abstract

Background
Increasing portal inflow in cirrhosis using a mechanical pump reduces portal venous pressure and improves liver function. A pump has been developed for portal vein implantation in human cirrhosis. This study describes the initial in vivo evaluation in a porcine model.

Methods
Five Large White pigs underwent laparotomy and exposure of the liver. Flow in the hepatic artery, portal vein and hepatic microcirculation was monitored continuously. Hepatic tissue oxygenation was measured by near-infrared spectroscopy. After baseline measurements the pump was inserted into the portal vein. Pump flow rate was then increased stepwise to 50 per cent over the baseline value for a period of 2 h. The pump was then stopped for 20 min and left in situ while continuing to collect systemic and hepatic haemodynamic data. The animal was killed and biopsies for histological examination were taken from the liver, small intestine and spleen.

Results
The baseline total hepatic blood flow was 626(39) ml/min; the hepatic artery supplied 18·4(2·1) per cent and the portal vein 81·6(2·1) per cent. The pump was inserted successfully in all animals without surgical complications. During surgical insertion of the pump, the temporary portal vein occlusion resulted in a significant rise in hepatic artery blood flow (22(3) per cent; P &lt; 0·01 versus baseline). Portal vein flow was augmented by pumping; there was a significant correlation between the pump motor speed and portal vein flow (P &lt; 0·0001). This inflow correlated directly with flow in the hepatic microcirculation and hepatic tissue oxygenation (P &lt; 0·001). The pump ran satisfactorily throughout the study. Histological examination revealed no evidence of structural damage to the liver or ischaemic changes in the small intestine or spleen.

Conclusion
It is technically possible and safe to insert an implantable pump in the portal vein. Portal venous blood flow can be increased up to 50 per cent with a resultant increase in flow in the hepatic microcirculation and hepatic oxygenation and without adverse effects on either hepatic or systemic haemodynamics.
Sportsman's hernia
Authors: Fon L J , Spence R A J 
Published: March 2003

Abstract

Background
Sportsman's hernia is a debilitating condition which presents as chronic groin pain. A tear occurs at the external oblique which may result in an occult hernia. The definition, investigation and treatment of this condition remain unclear.

Methods
A systematic Medline search was performed and all literature pertaining to chronic groin pain, groin injury, sportsman's hernia and sportsman's groin from 1962 to 1999 was retrieved for analysis.

Results
The costs of computed tomography and magnetic resonance imaging are such that their routine use for assessment of patients with groin pain cannot be justified. They may, however, be employed in difficult cases to help define the anatomical extent of a groin injury. Plain radiography, ultrasonography and scintigraphy should be the usual first-line investigations to supplement clinical assessment. Herniography may help in situations of obscure chronic groin and pelvic pain. There is no consensus view supporting any particular surgical procedure for sportsman's hernia. A number of reports have been published describing different repairs of the posterior inguinal wall deficiency. Appropriate repair of the posterior wall results in therapeutic benefit in selected cases.

Conclusion
The diagnosis of sportsman's hernia is difficult. The condition must be distinguished from the more common osteitis pubis and musculotendinous injuries. Early surgical intervention is usually, although not always, successful when conservative management has failed.
Oesophageal resection for high-grade dysplasia in Barrett's oesophagus
Authors: Zaninotto G , Parenti A R , Ruol A , Costantini M , Merigliano S , Ancona E 
Published: March 2003

Abstract

Background
The aims of this study were to evaluate the prevalence of invasive cancer in patients with high-grade dysplasia in Barrett's oesophagus and to verify whether a second endoscopy with multiple biopsies could improve the accuracy of preoperative diagnosis. In addition, the mortality, morbidity and survival rates in patients with high-grade dysplasia having oesophageal resection were recorded.

Methods
Fifteen patients were observed from 1982 to 1998; the first seven patients were offered primary oesophageal resection after diagnosis. The other eight patients underwent a second endoscopy with a median of 12 biopsies examined. All later underwent oesophageal resection.

Results
Invasive adenocarcinoma was found in five patients, with a minimal difference between the first and second periods (two of seven versus three of eight). There were no perioperative deaths. Early morbidity was observed in eight patients and late morbidity in four. The actuarial survival rate was 79 per cent at 5 years. The Karnofsky status was unchanged from preoperative values in 13 of 15 patients after a median follow-up of 46 months.

Conclusion
These patients with high-grade dysplasia had a 33 per cent probability of harbouring invasive oesophageal carcinoma but even a second endoscopy failed to identify patients with invasive tumour. Oesophagectomy was performed with no deaths and remains a rational treatment in patients fit for surgery.
Analysis of 153 gunshot wounds of the liver
Authors: Marr J D F , Krige J E J , Terblanche J 
Published: March 2003

Abstract

Background
Gunshot wounds of the liver may result in substantial morbidity and death, and optimal management of complex injuries is controversial.

Methods
One hundred and fifty-three patients with civilian gunshot liver injuries were treated during the 10-year period 1986–1995. Demographic, clinical and operative data were recorded. Factors influencing postoperative complications and death were analysed.

Results
One hundred and forty-two patients (93 per cent) had single missile injuries and 11 (7 per cent) had shotgun injuries. Three patients were treated non-operatively and 150 patients underwent operation. In 105 patients (70 per cent) the injuries to the liver were minor and required either no treatment (93) or simple suture of bleeding vessels (12). Forty-five patients (30 per cent) had major injuries which were either packed only (26) or required more complex surgical intervention (19). This included resectional debridement (ten), major venous repair (eight) and hepatotomy (one); eight of these patients required packing combined with the procedure. Associated intra-abdominal injuries occurred in 115 patients (77 per cent). The overall mortality rate was 17 per cent (26 patients). Death was directly attributable to the liver injury in 13 patients (8 per cent), 12 of whom died from uncontrolled bleeding. Complications occurred in 63 (51 per cent) of 124 survivors, and correlated with the type and severity of the liver injury and the number of associated injuries.

Conclusion
Most gunshot liver injuries can be managed by simple surgical techniques. In complex injuries control of major haemorrhage is vital and perihepatic packing may be life saving before undertaking definitive repair of the injury under controlled conditions.