bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis
Authors: Hammarström L E , Stridbeck H , Ihse I 
Published: March 2003

Abstract

Background
Endoscopic sphincterotomy alone, or followed by cholecystectomy, are options in patients with gallstone pancreatitis.

Methods
Ninety-six patients of median age 74 (range 30–93) years with gallstone pancreatitis had endoscopic retrograde cholangiography and were followed for a median of 84 (range 33–168) months. Forty-eight of 49 patients with, and nine of 47 without, common bile duct (CBD) stones had urgent endoscopic sphincterotomy. One patient with, and six without, CBD stones had delayed endoscopic sphincterotomy a median of 35 (range 12–111) days after acute pancreatitis. Thus, 64 patients had endoscopic sphincterotomy (group 1) and 32 did not (group 2). Fifteen and 16 patients in each group respectively had interval cholecystectomy after a median of 3 months and 1 month.

Results
Patients in groups 1 and 2 had similar rates of interval cholecystectomy (15 of 64 versus 16 of 32 patients respectively) or required cholecystectomy (15 of 49 versus five of 16 patients), recurrent CBD calculi (three of 64 versus three of 32 patients) or total length of hospitalization after interval cholecystectomy (median 15·5 and 15 days) or required (median 22 and 24 days) cholecystectomy. The overall incidence of recurrent pancreatitis was one of 64 patients in group 1 and five of 32 in group 2 (P = 0·02), but after interval cholecystectomy the recurrence rate of biliopancreatic symptoms was similar (one of 15 patients versus three of 16 patients respectively).

Conclusion
Endoscopic sphincterotomy, but not interval cholecystectomy, reduced the overall incidence of recurrent pancreatitis, but not of late biliary complications. Some 31 per cent of the patients required cholecystectomy, suggesting that routine cholecystectomy should be considered in fit patients following acute pancreatitis.
Association between restriction fragment length polymorphism of the L-myc gene and susceptibility to gastric cancer
Authors: Shibuta K , Mori M , Haraguchi M , Yoshikawa K , Ueo H , Akiyoshi T 
Published: March 2003

Abstract

Background
L-myc polymorphism has been documented to be a representative genetic trait which is related an individual's susceptibility to several cancers. However, there have been no reports concerning any significant association between susceptibility to gastric cancer and L-myc polymorphism.

Methods
The distribution of L-myc polymorphism in 61 patients with gastric cancer was determined by polymerase chain reaction-based restriction fragment length polymorphism and compared with that of 107 healthy control subjects.

Results
There was a significant difference in the distribution of both genotypes (P = 0·024) and allele frequencies (P = 0·026) between the two groups. The relative risk of gastric cancer for genotypes with the shorter (S) allele was 3·09 compared with the longer (L) allele homozygote. No significant correlation with clinicopathological features of the cancers except for prognosis was found. The patients with SS genotypes had a worse prognosis than those with LL or LS genotypes (P = 0·029).

Conclusion
L-myc polymorphism may be significant in an individual's susceptibility to gastric cancer in Japan, and may be a useful marker for identifying patients at high risk of developing gastric cancer.
Results of aortic screening in the brothers of patients who had elective aortic aneurysm repair
Authors: van der Graaf Y , Akkersdijk G J M , Hak E , Godaert G L R , Eikelboom B C 
Published: March 2003

Abstract

Background
Brothers of patients with an abdominal aortic aneurysm (AAA) are at high risk. In the present study brothers of patients who underwent elective AAA surgery were invited for aneurysm screening and the psychological consequences studied.

Methods
All brothers over the age of 50 years were invited for abdominal ultrasonography. They were asked to complete a standard psychological well-being questionnaire both before, and 3 months after screening.

Results
Some 571 brothers were identified: 251 were dead, 35 lived abroad, 16 could not be contacted for other reasons, 46 refused to participate and 13 were already known to have an AAA. Some 210 subjects (37·8 per cent) accepted the offer of screening. A new AAA was detected in 26 (12·3 per cent, 95 per cent confidence interval 8–18 per cent) of the men screened resulting in an overall prevalence of 18 per cent (95 per cent confidence interval 13–26 per cent). Eight (3·8 per cent) aneurysms were 5 cm or more in diameter and elective surgery was performed in five patients (2·4 per cent). The psychological dimensions of well-being (depression, anxiety, energy, and positive well-being) had not changed significantly 3 months after screening.

Conclusion
The prevalence of AAA in brothers of patients with AAA is far higher than in the overall male population of the same age. Screening does not seem to have a negative influence on psychological well-being.
Relation between tumour necrosis factor α and interleukin 1β producing capacity of peripheral monocytes and pulmonary complications following oesophagectomy
Authors: Katsuta T , Saito T , Shigemitsu Y , Kinoshita T , Shiraishi N , Kitano S 
Published: March 2003

Abstract

Background
Adult respiratory distress syndrome and pneumonia remain a significant cause of morbidity and death following oesophagectomy. The aim of this study was to clarify the association between tumour necrosis factor (TNF) α and interleukin (IL) 1β with these pulmonary complications.

Methods
The in vitro TNF-α and IL-1β producing capacity of peripheral monocytes with or without lipopolysaccaride (LPS) and serum level of IL-6 was measured in 19 patients with oesophageal cancer before and after surgery and in ten age-matched controls.

Results
Six patients had raised TNF-α and IL-1β producing capacity of monocytes without LPS both before operation and on the day after surgery. In these patients plasma elastase and serum IL-6 levels subsequently increased while the ratio of arterial partial pressure of oxygen to fraction inspired oxygen decreased, and they developed bilateral lung infiltration on chest radiography on days 3–7. Five of the six developed pneumonia compared with none of the remaining 13 patients (P &lt; 0·05).

Conclusion
Pulmonary impairment and pneumonia following oesophageal surgery was associated with raised monocyte producing capacity of TNF-α and IL-1β. These markers may be valuable in the preoperative assessment of patients awaiting oesophagectomy.
Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy
Authors: Silvis R , Gooszen H G , Kahraman T , Groenendijk A G , Lock M T W T , Italiaander M V , Janssen L W M 
Published: March 2003

Abstract

Background
This study was conducted to investigate the results of rectovaginovesicopexy (RVVP) in patients with combined defaecation and micturition disorders. RVVP was developed from a standard procedure for different forms of defaecation disorders (the rectovaginopexy (RVP)). It is only a limited extension to the RVP and results in elevation of all three pelvic compartments.

Methods
In a consecutive series of 25 patients the effects or RVVP were evaluated prospectively. Information about the clinical history and results was obtained by a standard questionnaire filled out before and 3 and 12 months after operation. Dynamic defaecography was performed before and 3 months after RVVP. Before operation urodynamic studies were conducted.

Results
RVVP improved constipation (14 of 18 patients improved, P=0·001), faecal incontinence (11 of 16 patients improved, P=0·005) and dysfunctional voiding (ten of 16 patients improved, P=0·07) without induction of these disorders. Overall urinary incontinence improved in 11 of 22 patients (P=0·18), with deterioration of urinary incontinence in three and induction of urinary incontinence in two of the patients. Patients with isolated urinary stress incontinence fared better (eight of 13 patients improved) than those with mixed urinary incontinence.

Conclusion
RVVP provides satisfactory improvement of combined defaecation and micturition disorders. The benefits of a limited extension of the RVP seem to outweigh potential side-effects such as deterioration or de novo defaecation or micturition disorders.
Experimental study of acid burden and acute oesophagitis
Authors: Pursnani K G , Mohiuddin M A , Geisinger K R , Weinbaum G , Katzka D A , Castell D O 
Published: March 2003

Abstract

Background
The relationship of the pH of oesophageal refluxate and its pepsin content to injury of oesophageal mucosa remains unclear. A study was made of the earliest morphological alterations in the oesophageal mucosa secondary to varying concentrations of hydrochloric acid with or without pepsin.

Methods
Adult cats had varying concentrations of acid with and without 1 per cent porcine pepsin infused into the oesophagus through a paediatric feeding tube placed 5 cm above the oesophagogastric junction at a rate of 1 ml/min for 30 min. At autopsy 24 h later, the oesophagus was removed intact and scored by an expanded modification of a previously published histopathological scoring system. This included estimates of the intensity and distribution of four morphological features: basal cell hyperplasia (BCH), intraepithelial leucocytes (IELs), subepithelial leucocytes and ulcers. Each of these four categories was scored from 0 to 4, with a maximum injury score of 16.

Results
Mean(s.e.m.) scores were as follows: pH 1, 15·0(1·0); pH 1 with pepsin, 13·3(1·4); pH 2, 15·3(0·7); pH 2 with pepsin, 11·7(1·1); pH 3, 1·8(1·6); pH 3 with pepsin, 3·7(1·9); pH 4 with or without pepsin, 0·6(0·2). Differences between pH 3 and 4 versus pH 1 and 2 were significant (P&lt;0·05).

Conclusion
Injury to the oesophagus is more dependent on the pH of refluxate than on the presence of pepsin. Peptic injury appears to occur at a critical threshold of acid burden (pH&lt;3) as opposed to a graded level of injury based on a pH scale.
Effect of growth hormone treatment on the healing of left colonic anastomoses in protein-malnourished rats
Authors: Karahasanoǧlu T , Altinli E , Hamzaoǧlu İ , Paksoy M , Yeşildere T , Alemdaroǧlu K 
Published: March 2003

Abstract

Background
Malnutrition is known to affect wound healing but it is not known with certainty whether or not postoperative hyperalimentation can reverse this defect. The present study was designed to examine the effects of recombinant human growth hormone (hGH) on left colonic anastomoses in malnourished rats.

Methods
Experimental animals were allocated randomly into four groups. In groups 1 and 2 animals were fed with normal diet for 10 days before surgery. In groups 3 and 4 animals were fed with a low-protein diet. Left colonic anastomoses were performed in all animals. Following surgery, rats in groups 1 and 3 received hGH whereas rats in groups 2 and 4 were injected with saline as control. Bursting pressure and hydroxyproline levels on day 4 after operation were used to determine anastomotic healing.

Results
Bursting pressure was lower in the malnourished rats than those fed with normal diet (P&lt;0·05). Bursting pressure was higher in normally fed rats which were given hGH. No significant differences could be noted between malnourished control rats and those receiving hGH.

Conclusion
These results suggest that hGH strengthened the left colonic anastomoses in rats fed a normal diet, but could not reverse the negative effects of malnutrition on colonic anastomoses.
Co-existing biliary anomalies and anatomical variants in choledochal cyst
Authors: Todani T , Watanabe Y , Toki A , Ogura K , Wang Z-Q 
Published: March 2003

Abstract

Background
Excision is the treatment of choice for choledochal cyst, and free bile drainage is essential to avoid ascending cholangitis. However, anastomosis between the relatively narrow common hepatic duct and bowel (conventional anastomosis) in case of type IV-A cyst, co-existing biliary anomalies and anatomical variations may cause ascending cholangitis resulting from insufficient biliary decompression.

Methods
One hundred and four patients with choledochal cyst were treated by cyst excision. Conventional anastomosis was performed in 22 patients and hilar anastomosis in 82.

Results
An anastomotic stricture developed in nine of the 22 conventional anastomosis cases and all required reoperation. Of the 82 hilar anastomosis cases, only one required reoperation for a primary stricture. Co-existing biliary anomalies and anatomical variants were seen in 26 patients: (1) primary stricture in 18; (2) aberrant posterior duct in two; (3) low confluence of the hepatic ducts in two; (4) aberrant hepatic artery in two; and (5) very small bile duct in two. All 26 patients underwent widening of the ductal lumen (ductoplasty) or additional procedures.

Conclusion
Complete removal of the extrahepatic bile duct and a wide hilar anastomosis is essential to prevent ascending cholangitis. Ductoplasty or additional procedure can be performed only at the hilum.
Colorectal cancer vaccines
Authors: Maxwell-Armstrong C A , Durrant L G , Scholefield J H 
Published: March 2003

Abstract

Background
Advances in molecular pathology have enabled a number of colorectal cancer antigens to be identified and characterized. The commonest investigated include 17-1A, 791Tgp72 and carcinoembryonic antigen. Vaccines have been developed that stimulate the immune system to target these antigens. This paper reviews current areas of research in this field.

Methods and Results
Relevant articles were obtained on vaccines for colorectal cancer from Medline and the Bath Information Data System. A number of approaches are currently being evaluated in Phase I, II and III trials. These include anti-idiotypic antibody immunization, DNA vaccines, mucin and heat shock protein-based vaccines, oncogenes and viral vectors.

Conclusion
Evidence is accumulating to suggest that immune responses may be generated against colorectal cancer using these approaches. While the concept of vaccination against this malignancy is essentially experimental, surgeons should be aware of current advances.
Experimental study of adhesion formation in open and laparoscopic fundoplication
Authors: Krähenbühl L , Schäfer M , Kuzinkovas V , Renzulli P , Baer H U , Büchler M W 
Published: March 2003

Abstract

Background
The extent of adhesion formation following both open and laparoscopic surgery remains unclear. This study aimed to evaluate the extent of postoperative adhesion formation after laparoscopic and open fundoplication in a rat model.

Methods
Fifty-two male Sprague–Dawley rats were randomized into four groups: laparoscopic fundoplication (n = 20), open fundoplication (n = 20), laparoscopy (n = 6) and laparotomy (n = 6). Blood as well as intraperitoneal fluid was sampled for tumour necrosis factor (TNF)α measurement by enzyme-linked immunosorbent assay. All the rats were killed 3 weeks after operation, and adhesion formation was evaluated using a standardized scoring system.

Results
There were no intergroup differences in body-weight gain after surgery. The overall mortality rate was 19 per cent and death was observed only in the fundoplication groups. Animals that had open fundoplication developed significantly more adhesions than those that underwent laparoscopic fundoplication (34 versus 21). Laparoscopic surgery induced predominantly parietal adhesions, whereas open surgery was more associated with visceral adhesions. The adhesions observed in the laparoscopic groups were significant thinner than those after open surgery and the tenacity of adhesions was decreased in laparoscopic compared with open surgery. The peak plasma level of TNF-α was reached during laparoscopic fundoplication, whereas the peak level was observed 3 h after open fundoplication. Intraperitoneal TNF-α levels showed no significant differences at 3 h.

Conclusion
These findings indicate that laparoscopic fundoplication in rats leads to less severe adhesions of a different type (parietal) compared with those seen in the open controls.
Soave's procedure: the final sphincter-saving solution for iatrogenic rectal lesions
Authors: Faucheron J L , Rosso R , Tiret E , Keli E , Nugent K P , Frileux P , Parc R 
Published: March 2003

Abstract

Background
Restoring intestinal continuity in the presence of radiation-induced rectal lesions and following low colorectal anastomotic complications or low Hartmann's procedure may be fraught with difficulties. Soave's procedure avoids potentially hazardous perirectal dissection. This study examined the morbidity and mortality as well as functional results.

Methods
Between January 1978 and July 1994 30 consecutive patients underwent Soave's operation as a final attempt to restore coloanal continuity. The pathology was radiation-induced lesions in 15 patients, low colorectal anastomotic complications in nine and low Hartmann's reconstruction in six.

Results
Mean length of follow-up was 4·2 (range 1–16) years. There was no operative mortality. Early complications included one patient with postoperative haemorrhage, one with small bowel obstruction and four with pelvic or perineal sepsis. Late complications included four incisional hernias, three anastomotic strictures which were treated by dilatation, and one recurrent ischaemic colitis. Continence was normal in 19 of 23 evaluable patients.

Conclusion
Soave's procedure obviates the need for extensive pelvic dissection, providing good technical and functional results in both the long and short term.
Prospective analysis of quality of life in patients following infrainguinal reconstruction for chronic critical ischaemia
Authors: Chetter I C , Spark J I , Scott D J A , Kent P J , Berridge D C , Kester R C 
Published: March 2003

Abstract

Background
The aims of this prospective study were to analyse the health-related quality of life (QOL) changes associated with infrainguinal arterial reconstruction for chronic critical limb ischaemia (CLI) and to assess the impact of graft patency and limb salvage.

Methods
Fifty-five consecutive patients, 28 women and 27 men of median age 71 (range 41–86) years, undergoing infrainguinal arterial reconstruction for CLI, consented to participate in the study. QOL was assessed using the Short Form 36 (SF36) health survey questionnaire, which was completed before and at 1, 3, 6 and 12 months following surgery. Graft patency was assessed by duplex imaging at the same postoperative intervals.

Results
CLI severely impaired QOL. Cumulative graft patency at 1, 3, 6 and 12 months after surgery was 82, 78, 76 and 64 per cent respectively. Reconstruction resulted in significant improvements in the SF36 domains Physical Functioning, Pain, Vitality and Social Functioning (P &lt; 0·01). With a patent graft these improvements began soon after surgery and were maintained for the 12 months studied. Following irredeemable graft occlusion, patients who had secondary amputation also described some QOL improvements.

Conclusion
A patent graft following infrainguinal arterial reconstruction for critical ischaemia results in an immediate and lasting improvement in health-related QOL.
Cytogenetics and the surgeon: an invaluable tool in diagnosis, prognosis and counselling of patients with solid tumours
Authors: Humphrey G M E , Squire R , Lansdown M , Markham A , Maclennan K 
Published: March 2003

Abstract

Background
Cytogenetic studies have become an important part of tumour characterization. In a minority of tumours cytogenetic and/or molecular studies may be of help for diagnosis, selection of treatment protocols and predicting outcome.

Methods
This article reviews the literature on solid tumour translocations and established family cancer syndromes. In addition, the potential importance of genetics in management of patients with breast, ovarian and pancreatic carcinoma is reviewed.

Results and conclusion
Cytogenetic analysis of tumours may help confirm the diagnosis when conventional histology demonstrates no evidence of differentiation along a particular tissue pathway. For patients with well defined cancer syndromes, cytogenetic and molecular analysis offers the prospect of screening to reduce the risk of malignant disease. For many malignancies the underlying genetic anomalies are gradually being elucidated. Further studies designed to demonstrate the significance of these findings can only be undertaken if tumour material is collected and stored in optimal conditions for cytogenetic and/or molecular biological studies.
Abscess after appendicectomy in children: the role of conservative management
Authors: Okoye B O , Rampersad B , Marantos A , Abernethy L J , Losty P D , Lloyd D A 
Published: March 2003

Abstract

Background
Intra-abdominal abscess remains a significant cause of morbidity following appendicectomy. In children, little emphasis has been placed on the non-invasive management of this complication using antibiotic therapy alone. This study reviews the experience of a paediatric surgical department in managing abscess arising after appendicectomy.

Methods
Hospital records of all children undergoing appendicectomy between January 1992 and January 1997 were reviewed retrospectively.

Results
Some 1024 children underwent appendicectomy over a 5-year period. Twenty three patients (2·2 per cent) developed abscesses after appendicectomy. Non-operative management with intravenous or oral antibiotics alone was successful in 21 patients, with complete clinical and radiological resolution of the abscess. Drainage of the septic collection was performed in only two patients: by laparotomy (n = 1) and by the transrectal route (n = 1).

Conclusion
Antibiotic therapy alone is an efficacious and safe first-line treatment modality in children who develop this complication. Drainage of an abscess developing after appendicectomy is rarely necessary in children.
Surgical treatment of 32 patients with peripheral intrahepatic cholangiocarcinoma
Authors: Harrison L E , Fong Y , Klimstra D S , Zee S Y , Blumgart L H 
Published: March 2003

Abstract

Background
Peripheral intrahepatic cholangiocarcinoma (PIC) is an intrahepatic primary liver neoplasm which is clinicopathologically distinct from hepatocellular carcinoma and major duct cholangiocarcinoma. The clinical outcome after resection of these rare tumours is not well documented.

Methods
Review of the hepatic database and tumour registry at Memorial Sloan-Kettering Cancer Center identified 32 cases of PIC resected for cure over a 23-year period. Intrahepatic cholangiocarcinomas with major bile duct involvement were excluded from this analysis. Demographics, pathological features, biochemical markers, operative results and survival were analysed.

Results
The majority of patients presented with abdominal pain (n = 19). Only two patients had pathological evidence of hepatic cirrhosis. Serum marker levels included α-fetoprotein (AFP; median 3·7 (range 0–225) ng/ml) and carcinoembryonic antigen (CEA; median 1·6 (range 0–30) ng/ml). Type of hepatic resection included: wedge (n = 2), lobectomy (n = 14) and extended lobectomy (n = 16). There was one postoperative death. Median follow-up time was 27 months. Median survival was 59 months with an actuarial 5-year survival of 42 per cent. Vascular invasion and intrahepatic satellite lesions were predictors of worse survival (P &lt; 0·05).

Conclusion
PIC is a rare hepatic primary tumour, which usually presents in non-cirrhotic livers with a normal serum AFP and CEA level. In selected patients, complete surgical resection can be performed safely and is associated with long-term survival.