bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indications for early mandatory laparotomy in abdominal stab wounds
Authors: Leppäniemi A K , Voutilainen P E , Haapiainen R K 
Published: March 2003

Abstract

Background
Patients with an abdominal stab wound presenting with shock, peritonitis or evisceration are usually subjected to early laparotomy, although very few studies have been done to validate the criteria.

Methods
In a retrospective study of 209 consecutive patients with stab wounds of the anterior abdomen, flank or lower chest, 23 clinical and radiological criteria were evaluated for their accuracy in predicting the presence of significant abdominal organ injury.

Results
Overall, 89 patients (43 per cent) had a significant abdominal injury. The criteria with the highest positive predictive values for significant injury were: signs of continuing haemorrhage in initially normotensive patients (86 per cent), shock on admission (83 per cent) and generalized peritonitis (81 per cent). No positive direct or indirect signs of peritoneal penetration including omental evisceration, extraluminal air on plain radiography, or free peritoneal fluid on abdominal ultrasonography were independent predictors of significant injury.

Conclusion
Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ-specific evaluation, such as computed tomography or laparoscopy, to identify patients who can safely be treated without operation.
Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma
Authors: van Lanschot J J B , van Blankenstein M , Oei H Y , Tilanus H W 
Published: March 2003

Abstract

Background
After potentially curative resection of oesophageal cancer and prevertebral gastric tube reconstruction, approximately one-quarter of patients develop secondary dysphagia due to locoregional recurrence. In half of them dysphagia can be prevented by using an extra-anatomical reconstruction route. The present randomized study was conducted to compare the technical and functional results after prevertebral and retrosternal gastric tube reconstruction.

Methods
Sixty patients underwent resection of a carcinoma of the oesophagus or gastro-oesophageal junction with curative intent. Subsequently, these patients were randomly allocated to either prevertebral (n = 30) or retrosternal (n = 30) gastric tube reconstruction. Early and late complications and functional results were carefully monitored.

Results
Creation of the retrosternal tunnel was not accompanied by any perioperative complications. Postoperative recovery, anastomotic leakage and benign stricture formation were not significantly different between the two groups. Functional results, as measured by scintigraphic gastric emptying, quantitative and qualitative oral food intake, and changes in body-weight were similar in the two groups.

Conclusion
After subtotal oesophagectomy retrosternal gastric tube reconstruction can be performed easily and safely, and gives functional results similar to those obtained with prevertebral reconstruction. In patients at high risk for developing secondary malignant dysphagia the extra-anatomical route is the reconstruction of first choice.
Local and systemic effects of intraoperative whole-colon washout with 5 per cent povidone–iodine
Authors: Basha G , Penninckx F , Mebis J , Filez L , Geboes K , Yap P 
Published: March 2003

Abstract

Background
Segmental intraluminal instillation of several tumoricidal agents including povidone–iodine has been advocated to prevent anastomotic recurrence after colonic resection for colorectal cancer. The local and systemic effects of on-table whole-colon washout using 5 per cent povidone–iodine were assessed in patients undergoing elective surgery for colorectal cancer.

Methods
The local effect of 5 per cent povidone–iodine on the colonic mucosa and the effect of colonic mucosal damage by povidone–iodine on tumour take was first investigated in Fischer 344 rats. In 12 euthyroid non-allergic patients, on-table whole-colon lavage via the appendix was performed. Systemic (thyroid function) and local (mucosal damage assessed by repeat biopsies) effects were studied, as well as the in vitro tumoricidal effect of the final anal effluent on tumour cell suspensions.

Results
After 30 min of contact with povidone–iodine the rat colonic mucosa was severely injured, with detachment of the epithelial cell layer. Povidone–iodine-induced ‘colitis’ did not result in tumour development after inoculation of 106 Mtln3 carcinoma cells in ten rats. Epithelial desquamation was also observed, in all but one patient, 1 and 4 h after colonic lavage. However, epithelial restitution started within 1 day and no abnormality was revealed after 3–7 days. Urinary iodine excretion increased markedly and was not within normal values after 1 week. Levels of thyroid hormones decreased significantly but became normal within 1 week. The anal effluent containing povidone–iodine was found to be tumoricidal in vitro on a human colonic carcinoma cell line and on a tumour cell suspension produced from the patient's tumour.

Conclusion
On-table whole-colon washout using 5 per cent povidone–iodine seems clinically feasible. This technique deserves further study as a substitute for preoperative bowel preparation and may help to prevent recurrent cancer due to implantation of viable exfoliated tumour cells.
Preoperative magnetic resonance staging of rectal cancer with an endorectal coil and dynamic gadolinium enhancement
Authors: Drew P J , Farouk R , Turnbull L W , Ward S C , Hartley J E , Monson J R T 
Published: March 2003

Abstract

Background
The aim of the study was to assess the value of endorectal coil magnetic resonance imaging (MRI) with gadolinium enhancement in the preoperative staging of rectal cancer.

Methods
In addition to standard evaluation, patients with rectal lesions were assessed by MRI obtained with a pelvic phased-array coil in combination with an endorectal coil.

Results
The study group comprised 29 patients with rectal cancer staged with an endorectal coil who had surgery without preoperative adjuvant therapy. In addition to standard T1- and T2-weighted images, dynamic contrast-enhanced images were acquired in all patients. Considerable interobserver variation was noted, particularly for pathological tumour stage pT1 or pT2 (κ = 0·36). Compared with pathological findings, endorectal MRI correctly staged nine patients, overstaged 16 and understaged four. Whilst lymph node metastases were accurately detected in 70 per cent of patients, the positive predictive value was only 58 per cent.

Conclusion
MR staging of rectal cancer with an endorectal coil and gadolinium enhancement is inaccurate for early tumours (stage T1 or T2) and is associated with a considerable degree of interobserver variation for individual scan sequences.
Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme
Authors: Kehlet H , Mogensen T 
Published: March 2003

Abstract

Background
Hospital stay after colonic surgery is usually between 5 and 10 days, limiting factors being pain, ileus, organ dysfunction and fatigue. Single-modality intervention to reduce these factors with laparoscopic surgery usually requires a hospital stay of 5 days. This paper reports the results of a multimodal rehabilitation regimen after open sigmoidectomy.

Methods
Sixteen unselected patients scheduled for elective sigmoid resection (median age 71 years) underwent operation under combined spinal–epidural anaesthesia. After operation, epidural analgesia was continued for 48 h, with immediate oral nutrition and mobilization, and with planned discharge 2 days after surgery.

Results
The median postoperative hospital stay was 2 (range 2–6) days (48 h), patients being mobilized for a median of 5 h on the second postoperative day (24–48 h) and for 10 h on the third day (48–72 h). Within 48 h of operation 14 patients had an oral intake of 2000 ml or more and 15 had resumed defaecation. Fatigue and pain scores were low during the first 8–9 days after operation, with a median of 13 h of mobilization per day after discharge. There were no medical or surgical complications during 30 days of follow-up, except for two patients who suffered postspinal headache.

Conclusion
Postoperative recovery after open colonic surgery may be accelerated by effective pain relief integrated into an accelerated rehabilitation programme.
Carotid endarterectomy before and after publication of randomized controlled trials
Authors: Brittenden J , Murie J A , Jenkins A McL , Ruckley C V , Bradbury A W 
Published: March 2003

Abstract

Background
In 1991, the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) demonstrated that carotid endarterectomy (CEA), in addition to best medical therapy, significantly reduces ipsilateral stroke in patients with high-grade (70 per cent or more) carotid artery stenosis compared with best medical therapy alone. In 1995, the Asymptomatic Carotid Atherosclerosis Study demonstrated that CEA was of benefit in asymptomatic patients with stenosis greater than 60 per cent. The aim of this paper was to examine how the practice and outcome of CEA have changed since publication of these data.

Methods
A prospectively gathered computerized database comprising 634 consecutive CEAs was studied. Two time intervals were analysed: 1975–1991 inclusive (17 years) and 1 January 1992 to 1 May 1998 (6 years 4 months).

Results
Since 1991, there has been a fourfold increase in the number of CEAs performed annually for symptomatic disease. CEA is now performed almost exclusively for high-grade (more than 70 per cent) stenosis. There has been a significant reduction in the total peri-operative neurological event rate (12·5 versus 5·9 per cent, P &lt; 0·05), and the 30-day combined major stroke (Rankin grade 3–5) and mortality rate has fallen to 2·0 per cent. The number of patients who have CEA for asymptomatic disease remains small with 16 of 30 being randomized within the Asymptomatic Carotid Surgery Trial.

Conclusion
Publication of ECST and NASCET data has been associated with a major increase in the number of CEAs performed for symptomatic disease in this unit. Despite a greater proportion of high-risk patients, the results have improved progressively.
Quantitative study of capillary density in the skin of the foot in peripheral vascular disease
Authors: Lamah M , Mortimer P S , Dormandy J A 
Published: March 2003

Abstract

Background
The aim of this study was to investigate possible differences in capillary density of the skin of the foot between normal subjects and patients with peripheral vascular disease.

Methods
Using in vivo video microscopy, a method was developed to measure the average capillary density (ACD) of the skin of the foot and toes. In a cross-sectional observational study, 21 patients with intermittent claudication and 23 patients with rest pain or ischaemic ulceration were compared with 19 age- and sex-matched controls.

Results
Mean(s.e.m). values of ACD of the foot were 33·7(1·9) and 34·4(1·7) per mm2 in the right and left sides respectively for controls, 31·2(1·8) per mm2 (P not significant) and 31·9(2·6) per mm2 (P not significant) in the symptomatic and contralateral sides respectively for patients with claudication, and 22·0(1·8) per mm2 (P &lt; 0·001) and 24·3(1·7) per mm2 (P &lt; 0·001) in the symptomatic and contralateral sides respectively for patients with rest pain or ulceration.

Conclusion
Capillary density of the skin of the foot is significantly reduced in patients with arterial ulceration compared with that in patients with claudication and healthy subjects.
Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden
Authors: Appelros S , Borgström A 
Published: March 2003

Abstract

Background
There is a wide range (5–50 per 100 000) in the reported annual incidence of acute pancreatitis. Furthermore, the predominant aetiology varies in different reports. This study was undertaken to establish the current incidence, aetiology and associated mortality rate in a defined population.

Methods
A retrospective study of all cases of acute pancreatitis admitted over a 10-year period to a single institution was performed. In addition the autopsy and forensic materials were reviewed.

Results
Altogether 883 attacks of acute pancreatitis were recorded, of which 547 were first attacks. The annual incidence of first attacks was 23·4 per 100 000. Including relapses, the incidence was 38·2 per 100 000. Biliary disease was the main aetiological factor in first attacks whereas alcohol was the predominant factor when relapses were included. The mean annual mortality rate for acute pancreatitis in the population was 1·3 per 100 000. Of 31 patients who died from acute pancreatitis only 15 were diagnosed before death. For recurrent disease the mortality rate was 0·3 per cent. In 12 patients the pancreatitis was associated with pancreatic carcinoma.

Conclusion
It is important to differentiate between first attacks and relapses, since both incidence and aetiology figures are influenced by this, and it is important to include autopsy and forensic material in population-based mortality studies.
Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis
Authors: Grönroos J M , Grönroos P 
Published: March 2003

Abstract

Background
The aim of the present work was to study the preoperative leucocyte counts and C-reactive protein (CRP) values in three groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendicectomy: an uninflamed appendix, uncomplicated acute appendicitis or complicated acute appendicitis. In particular, patients with acute appendicitis but a normal leucocyte count and CRP level were sought.

Methods
In this retrospective study, the mean preoperative leucocyte count and CRP value in 100 consecutive patients with an uninflamed appendix (group A), in 100 consecutive patients with uncomplicated acute appendicitis (group B) and in 100 consecutive patients with complicated acute appendicitis (group C) were calculated. The numbers of patients with (1) both values normal, (2) only leucocyte count raised, (3) only CRP level raised and (4) both values raised were calculated in each of the three groups.

Results
The increase in leucocyte count was an early marker of appendiceal inflammation, whereas the CRP value increased markedly only after appendiceal perforation or abscess formation. Group A (uninflamed appendix) contained 24 patients in whom both values were normal. Neither group B (uncomplicated acute appendicitis) nor group C (complicated acute appendicitis) contained any patient with both values in the normal range.

Conclusion
Acute appendicitis is very unlikely when both the leucocyte count and CRP value are normal.
Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation
Authors: Davidson B R , Rai R , Kurzawinski T R , Selves L , Farouk M , Dooley J S , Burroughs A K , Rolles K 
Published: March 2003

Abstract

Background
Biliary reconstruction is the Achilles heel of liver transplantation. Side-to-side anastomosis of donor and recipient bile duct has been claimed to be superior to end-to-end anastomosis in uncontrolled studies.

Methods
A total of 100 consecutive patients undergoing orthotopic liver transplantation were randomized after commencement of the transplant procedure to end-to-end or side-to-side anastomosis. No T tube drainage was employed. Endoscopic retrograde cholangiography was performed 2 weeks after transplantation and findings were reported by an experienced endoscopist as normal, leak or stricture. Median follow-up was 53 (range 35–63) months.

Results
Patient age, sex, the graft preservation time and indication for transplantation were similar in both groups. Sixty patients received end-to-end and 40 side-to-side anastomosis. Ten patients randomized to side-to-side anastomosis had an end-to-end procedure. The total number of biliary complications was similar in both groups (end-to-end 32 per cent versus side-to-side 30 per cent) as were the number of leaks (17 versus 18 per cent) and biliary strictures (15 versus 12 per cent). There was no difference in the number of biliary complications that required interventional treatment (22 per cent in both groups).

Conclusion
Side-to-side and end-to-end biliary anastomosis at liver transplantation are equally effective.
Experimental techniques and models in the study of the development and treatment of abdominal aortic aneurysm
Authors: Carrell T W G , Smith A , Burnand K G 
Published: March 2003

Abstract

Background
It is still unclear what initiates aneurysmal dilatation and what determines whether or not an aneurysm will continue to expand and rupture. Early detection and operative repair of an abdominal aortic aneurysm (AAA) still remains the only effective means of reducing the high mortality rate associated with the condition. Endovascular techniques are being developed in an attempt to reduce the mortality rate associated with elective repair. A variety of animal models and experimental techniques have been described in the investigation of the pathophysiology of AAA and in the development of improved endovascular surgical and pharmacological therapies. This article discusses these models and techniques, their advantages and some of the problems encountered in extrapolating experimental findings to the human condition.

Methods
This review is based on a search of the Medline database from 1966 to March 1998 using recognized key words and text words. A further search was then conducted on references quoted within selected relevant publications.

Results and conclusion
Treatment of rodent aortas with intraluminal elastase or periaortic calcium chloride creates reproducible aneurysms that have certain similarities to the human pathology; such aneurysms have been favoured in the investigation of the pathophysiology of aneurysm expansion. However, these models lack several of the prominent features of the human lesion, such as atherosclerosis and intraluminal thrombosis. The development of gene knockout mice may lead to a more analogous aneurysm formation, with associated atherosclerosis. Many large animal models have been used in the development of endovascular techniques but, in general, these do not mimic the human pathophysiology and fail to predict medium- and long-term complications.
Randomized trial to study the effect of fundic mobilization on long-term results of Nissen fundoplication
Authors: Luostarinen M E S , Isolauri J O 
Published: March 2003

Abstract

Background
It has been suggested that fundic mobilization in Nissen fundoplication decreases adverse postoperative symptoms and increases the durability of the fundic wrap. There are no previous randomized, prospection long-term studies assessing this. This study addresses the question.

Methods
Fifty consecutive patients were randomized to undergo open Nissen–Rossetti fundoplication with total fundic mobilization (n = 26) or an identical procedure without mobilization (n = 24). After a median of 36 (range 6–53) months 49 had endoscopy and a personal interview.

Results
Oesophagitis was cured in 20 of 21 patients who had fundic mobilization and 18 of 19 who did not. a defective fundic wrap was observed in five and recurrent reflux symptoms in six of those who had fundic mobilization compared with two and one respectively of those who did not (P not significant). Recurrent sliding hiatal hernia was observed in nine of those with a mobilized fundus and one of those without (P = 0·02). There was no significant difference in incidence of new-onset long-term dysphagia, subjective belching ability, amount of flatus or bloating between the study groups.

Conclusion
Fundic mobilization did not give any apparent advantage regarding postoperative adverse effects. Instead, it was associated with a higher rate of recurrent hiatal hernia.
Estimation of mortality and morbidity risk in vascular surgery using POSSUM and the Portsmouth predictor equation
Authors: Midwinter M J , Tytherleigh M , Ashley S 
Published: March 2003

Abstract

Background
The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is a simple scoring system previously validated in general surgical patients which enables estimation of the risk of complications and death after operation. The Portsmouth predictor equation (P-POSSUM) is a modification that may result in more accurate prediction of death than POSSUM. The aim of this study was to test the validity of POSSUM and P-POSSUM in patients undergoing major arterial surgery in a specialist unit.

Methods
Physiological and operative severity scores in 221 patients undergoing elective and emergency arterial surgery in a pure vascular practice under a single consultant were recorded prospectively. Observed morbidity and mortality rates were compared with the rates predicted by POSSUM and P-POSSUM using a linear method of analysis.

Results
The POSSUM equation overestimated deaths with this analysis but the mortality rate estimated by P-POSSUM was not significantly different from the observed death rate. The risk of morbidity predicted by POSSUM was not significantly different from the observed complication rate.

Conclusion
The POSSUM methodology combined with the P-POSSUM adjustment for death allows satisfactory prediction of mortality and morbidity rates in patients undergoing vascular surgery.
Epidemiology of Warthin's tumour of the parotid gland in an Asian population
Authors: Chung Y F A , Khoo M L C , Heng M K D , Hong G S , Soo K C 
Published: March 2003

Abstract

Background
Recent studies have documented a number of changing demographic features in the occurrence of Warthin's tumour (adenolymphoma) of the parotid gland. In order to analyse its epidemiology in an Asian population, a retrospective study was performed on all parotid neoplasms (n = 289) operated on between 1988 and 1998.

Patients and methods
A total of 209 consecutive patients were selected for study, 136 with pleomorphic adenomas (one bilateral) and 73 with Warthin's tumours (seven bilateral). Patients were analysed with regard to tumour incidence, age, sex and race. Smoking as an aetiological factor in the development of Warthin's tumour was also studied.

Results
Warthin's tumour formed 25 per cent of parotid tumours and its ratio to pleomorphic adenomas was 1 : 1·9. Multicentricity was found in 14 patients (19 per cent). The male : female ratio for Warthin's tumours was 4·6 : 1. The proportion of Warthin's tumours did not show any increasing trend relative to pleomorphic adenomas. The racial distribution of Warthin's tumours showed an increased incidence among Chinese and a reduced incidence among Malays and Indians. The adjusted odds ratio for sex and age favouring an association between smoking and Warthin's tumour was 39·5 (95 per cent confidence interval 10·5–149·0; P &lt; 0·0001).

Conclusion
The incidence of Warthin's tumour is considerable among Asians although there is still male predominance. There is no rising incidence of Warthin's tumour; the trend parallels the declining smoking rate in the population. The lower incidence among ethnic groups with dark skin seems to suggest concomitant genetic factors other than environmental factors alone in histogenesis. Smokers have a 40-fold greater risk than non-smokers of developing a Warthin's tumour.