bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 21-year experience of abdominal aortic aneurysm operations in Edinburgh
Authors: Bradbury A W , Adam D J , Makhdoomi K R , Stuart W P , Murie J A , Mcl. Jenkins A , Ruckley C V 
Published: March 2003

Abstract

Background
This study reviews the results of infrarenal abdominal aortic aneurysm (AAA) surgery over 21 years (1 January 1976 to 31 December 1996).

Methods
A prospectively gathered database was analysed.

Results
Infrarenal AAA repair was performed in 1515 patients: 492 (32·5 per cent) had elective repair of an asymptomatic AAA; 194 (12·8 per cent) had elective repair of a symptomatic AAA; 156 (10·3 per cent) had emergency repair of a symptomatic non-ruptured AAA; and 673 (44·4 per cent) had surgery for a ruptured AAA. The 30-day and/or same admission mortality rates were 6·1, 5·8, 14·1 and 37 per cent respectively. Operative mortality increased in all four groups over the study interval, although this only attained statistical significance in patients having elective repair of a symptomatic, non-ruptured AAA. There was a significant increase in the age of patients undergoing elective repair of an asymptomatic AAA, but not in the other three groups. There was also a significant increase in the proportion of straight ‘tube’ grafts inserted in all four groups.

Conclusions
It remains the minority of patients who have elective operation before the onset of symptoms and/or rupture. Despite anaesthetic and surgical specialization, the results of AAA repair have not improved over the past two decades. Operative mortality may be increasing, possibly because of the increasing age and associated comorbidity of the patients presenting to this unit.
Perioperative allogeneic blood transfusion does not cause adverse sequelae in patients with cancer: a meta-analysis of unconfounded studies
Authors: McAlister F A , Clark H D , Wells P S , Laupacis A 
Published: March 2003

Abstract

Background
There is controversy over whether perioperative allogeneic red blood cell transfusions are associated with an increased risk of cancer recurrence, postoperative infection or death in patients with cancer undergoing surgery.

Methods
A systematic meta-analysis was performed to answer this question. Studies were identified from electronic databases (Medline 1966–1997, Cancerlit 1983–1997, Current Contents, Cinahl 1982–1996, Healthstar 1990–1997, Bioabstracts 1990–1996 and Embase), by hand search of the bibliographies of identified studies and relevant journals, and by contact with experts in the field. All randomized controlled trials or prospective cohort studies with active comparator controls (autologous or leucocyte-depleted allogeneic blood) were eligible for inclusion if they reported on mortality, infection or recurrence rate in patients with cancer undergoing potentially curative surgical resection. The validity of the identified studies was assessed by means of a standardized scale, and data abstraction was carried out by two investigators independently. A random effects model was used for data synthesis.

Results
Of the 2172 references identified, only 17 studies fulfilled the inclusion criteria. After exclusion of duplicate publications, six randomized controlled trials and two prospective cohort studies with appropriate concurrent controls were included in the analysis. The summary risk ratios were 0·95 (95 per cent confidence interval (c.i.) 0·79–1·15) for all-cause mortality and 1·06 (95 per cent c.i. 0·88–1·28) for cancer recurrence, the two endpoints that were appropriate to combine statistically. There was significant heterogeneity (explainable by differences in study design and patient characteristics) in the postoperative infection data and the summary risk ratio was 1·00 (95 per cent c.i. 0·76–1·32) for the four studies that were appropriate to subject to meta-analysis. Given the sample sizes of these eight studies, this meta-analysis had insufficient power to detect a relative difference of less than 20 per cent in the frequency of death, cancer recurrence or infection between the allogeneic and control transfusion arms.

Conclusion
Although more studies are required before a definitive statement can be made, at this time there is no evidence that allogeneic blood transfusion increases the risk of clinically important adverse sequelae in patients with cancer undergoing surgery.
Effect of graft reperfusion on intracellular calcium levels in mononuclear leucocytes during human orthotopic liver transplantation
Authors: Enright S M , Srinivasa R , Bellamy M C 
Published: March 2003

Abstract

Background
Orthotopic liver transplantation (OLT) is accompanied by local and systemic manifestations of the ischaemia–reperfusion syndrome. Local effects are mediated in part through changes in intracellular calcium levels in Kupffer cells. Arachidonic acid metabolites mediate increases in intracellular calcium concentration and thus potentiate the effect of free radicals. This study was carried out to characterize white blood cell (WBC) calcium changes as a mediator for white cell activation in human OLT.

Methods
Twenty consecutive patients had OLT using standard surgery and anaesthesia techniques. Blood samples were drawn for estimation of WBC cytosolic calcium content at induction of anaesthesia, 5 min before graft reperfusion and 15 min after reperfusion. The rate of rise in intracellular calcium concentration after the addition of a calcium chloride 1 mmol l−1 solution to the extracellular milieu was used as an estimate of membrane calcium permeability.

Results
Both extracellular (P = 0·0002) and intracellular (P = 0·0008) calcium concentrations rose with time. However, at no time was there a correlation between extracellular and intracellular calcium levels or rate of calcium influx (r2 = 0·002, P = 0·78). There was a significant increase in intracellular calcium concentration (P = 0·0008) and in the rate of rise of intracellular calcium levels (P = 0·0009) after reperfusion.

Conclusion
There was a significant increase in circulating monocyte membrane permeability for calcium and cytosolic calcium concentration following reperfusion in human OLT. This was independent of extracellular calcium concentration. These results are consistent with WBC activation by reperfusion and could be implicated in the systemic reperfusion syndrome seen in OLT in humans.
Comparison of POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery
Authors: Wijesinghe L D , Mahmood T , Scott D J A , Berridge D C , Kent P J , Kester R C 
Published: March 2003

Abstract

Background
The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) scoring system has been proposed as an accurate predictor of death which takes account of case mix. It appears to overpredict death, and may have drawbacks which prevent accurate individual or subgroup analysis. An alternative system, the Portsmouth predictor equation for mortality (P-POSSUM) may have overcome these problems, but its apparent advantage could be related to inappropriate analysis of POSSUM predictions.

Methods
Some 312 patients having arterial procedures were studied. POSSUM and P-POSSUM scores were used to predict death and compared with actual outcomes. The observed:predicted (O:E) mortality ratios were calculated by two methods for each of the scoring systems. First the analysis devised by the inventors of POSSUM was used and second the method devised for P-POSSUM.

Results
The O:E ratio for POSSUM using its recommended ‘exponential’ method of analysis was 1·14, but it was 0·59 if the P-POSSUM ‘linear’ analysis was used. The O:E ratio for P-POSSUM using its correct method of analysis was 0·89, but it was 0·67 if the method of analysis devised for POSSUM was used.

Conclusion
The O:E ratios for POSSUM and P-POSSUM were close to unity when the appropriate analysis was performed. Both POSSUM and P-POSSUM overpredicted death if the incorrect analysis was used.
Different gastric emptying of solid and liquid meals after pylorus-preserving pancreatoduodenectomy
Authors: Kobayashi I , Miyachi M , Kanai M , Nagino M , Kondo S , Kamiya J , Nakao M , Hayakawa N , Nimura Y 
Published: March 2003

Abstract

Background
Transient gastric stasis immediately after pylorus-preserving pancreatoduodenectomy (PPPD) is a common complication, but the cause remains unknown. Changes in gastric emptying were investigated in patients undergoing PPPD for periampullary malignancy.

Methods
In 14 patients undergoing PPPD, liquid- and solid-phase gastric emptying were evaluated before and after operation (mean 38 (range 27–53) days after operation). Two pharmacological gastric-emptying tests were used: the acetaminophen test for liquid-phase emptying and the sulphamethizole capsule food test for solid-phase gastric emptying.

Results
All patients exhibited delayed solid emptying but fairly good liquid emptying.

Conclusion
Gastric function in the early postoperative period after PPPD is characterized by delayed solid-phase but good liquid-phase emptying.
Provision of training in carotid surgery does not compromise patient safety
Authors: Naylor A R , Thompson M M , Varty K , Sayers R D , London N J M , Bell P R F 
Published: March 2003

Abstract

Background
Vascular surgeons perceive that carotid endarterectomy carries a higher risk of stroke if performed by a surgical trainee. Accordingly, some trainees consider that they receive a less than adequate training in carotid surgery before taking up a consultant position. The aim of this study was to establish whether the stroke rate was adversely affected if carotid endarterectomy was performed by a surgical trainee under consultant supervision.

Methods
This was a prospective study of 151 consecutive patients undergoing carotid endarterectomy between 1 January and 31 December 1996 using a standardized technique including intraoperative and postoperative transcranial Doppler monitoring and completion angioscopy.

Results
The overall mortality and/or disabling stroke rate was 0·7 per cent (one of 151 patients), whereas the mortality and/or any stroke rate was 1·3 per cent (two of 151). Surgical trainees performed 82 of 151 carotid endarterectomies, with a mortality rate of 1 per cent and a mortality and/or any stroke rate of 2 per cent. There was no significant difference in the incidence of retained thrombus or intimal flaps between trainees and consultants as detected by angioscopy.

Conclusion
Vascular surgical trainees can receive a comprehensive training in carotid artery surgery without incurring an unacceptable increase in operative risk.
Lymph node metastasis of early gastric cancer with submucosal invasion
Authors: Kurihara N , Kubota T , Otani Y , Ohgami M , Kumai K , Sugiura H , Kitajima M 
Published: March 2003

Abstract

Background
A clinicopathological study of early gastric cancer with submucosal invasion was carried out in relation to lymph node metastasis.

Methods
A retrospective study was conducted of 245 patients with submucosal gastric cancer treated by gastrectomy combined with D2 lymph node resection between 1985 and 1994 in a university hospital.

Results
Lymph node metastasis was observed in 34 patients (14 per cent). The mortality rate due to recurrence in patients with lymph node metastasis (three of 34) was significantly higher than in those without lymph node metastasis (five (2 per cent) of 211) (χ2 = 3·95, 1 d.f., P &lt; 0·05). Tumour size, depth of invasion, lymphatic involvement of cancer cells and preoperative diagnosis of advanced cancer correlated significantly with the presence of lymph node metastasis. When the submucosal carcinomas were classified into three categories according to depth of invasion by dividing the submucosal (sm) layer into three equal parts, sm1, sm2 and sm3, the incidence of lymph node metastasis increased from 2 per cent to 12 and 20 per cent respectively.

Conclusion
When the pathological report reveals sm1 invasion after laparoscopic or endoscopic surgery, reoperation should not be necessary because sm1-carcinomas with diameters of less than 2 cm do not usually metastasize to the lymph nodes.
Follow-up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients
Authors: Sugiyama M , Atomi Y 
Published: March 2003

Abstract

Background
With the advent of laparoscopic cholecystectomy, the indications for endoscopic sphincterotomy (ES) have been extended to young patients with choledocholithiasis. However, the long-term results of ES are largely unknown.

Methods
Between 1977 and 1986, 115 patients aged 60 years or less underwent ES for choledocholithiasis. Stone classification, and early and long-term outcomes of ES were analysed retrospectively.

Results
Early complications occurred in nine patients (7·8 per cent), but there were no deaths. ES and stone clearance were successful in 110 patients. Long-term information was available in 103 of the 110 patients, with a mean overall follow-up duration of 14·2 (range 10·4–19·3) years. Ten patients (9·7 per cent) developed late complications, including stone recurrence and/or cholangitis (nine patients) and acute cholecystitis (one of 23 patients with the gallbladder in situ). The choledochal complication rate was somewhat higher in patients with calcium bilirubinate stones at ES (seven of 65 patients) than in those with cholesterol stones (two of 38 patients). Choledochal complications were manageable endoscopically.

Conclusion
Approximately 10 per cent of patients develop late complications. However, endoscopic retreatment is safe and effective. ES is a reasonable method for treating choledocholithiasis, even in young patients.
Long-term results of femorotibial bypass with vein or polytetrafluoroethylene
Authors: Sayers R D , Raptis S , Berce M , Miller J H 
Published: March 2003

Abstract

Background
This was a retrospective review of the long-term results of femorotibial bypass using autologous vein and polytetrafluoroethylene (PTFE) over 24 years.

Methods
Some 518 patients who underwent 635 femorotibial bypass grafts were studied. Outcome measures analysed included primary and secondary graft patency, limb salvage rates and death.

Results
Overall primary and secondary graft patencies were 62 and 67 per cent respectively at 12 months, and 44 and 48 per cent at 24 months. For vein grafts, the primary and secondary patencies were 63 and 66 per cent at 12 months, and 54 and 56 per cent at 24 months. For PTFE grafts, the primary and secondary patencies were 48 and 54 per cent at 12 months, and 31 and 37 per cent at 24 months. Limb salvage and patient survival rates were 81 and 84 per cent at 12 months, and 73 and 74 per cent at 24 months. Primary and secondary graft patencies for vein were significantly better than for PTFE (P = 0·0001). There was no difference in patency between reversed and in situ grafts.

Conclusion
Femorotibial bypass can produce excellent long-term results. Vein remains the conduit of choice but in the absence of vein acceptable results can be achieved with PTFE.
Malone antegrade continence enema for faecal incontinence and constipation in adults
Authors: Krogh K , Laurberg S 
Published: March 2003

Abstract

Background
In the Malone antegrade continence enema (ACE) technique the appendix or a ‘neoappendix’ created from the caecum is brought to the abdominal wall creating a small stoma. Thereby, antegrade enemas can be administered to empty the colorectum and prevent faecal incontinence or constipation in children with congenital malformations. The aim of this study was to describe the results of the ACE in adults suffering from faecal incontinence or constipation.

Methods
In 16 adult patients (ten women and six men) suffering from severe faecal incontinence (ten patients) or constipation (six patients) the ACE procedure was performed; the appendix was used in 12 and a ‘neoappendix’ was created in four. Patient records were used for the description of surgical procedures and complications. Results were evaluated by a structured telephone interview.

Results
After a follow-up of 1–39 (mean 17) months, four patients had stopped using the stoma because of abdominal pain or lack of effect. Among the other 12 patients overall satisfaction with the stoma was high or very high. In constipated patients mean time for defaecation was reduced from 170 to 45 min. Faecal incontinence was much reduced in eight patients; the impact on social activities and quality of life caused by bowel dysfunction was reduced in all 12 patients.

Conclusion
The ACE technique can be used to treat selected adult patients suffering from faecal incontinence or constipation.
Identification and progression of a desmoid precursor lesion in patients with familial adenomatous polyposis
Authors: Clark S K , Johnson Smith T G P , Katz D E , Reznek R H , Phillips R K S 
Published: March 2003

Abstract

Background
Desmoid tumours occur in about 10 per cent of patients with familial adenomatous polyposis (FAP), and are an important cause of morbidity and death. The natural history of desmoids was investigated by documenting prospectively the prevalence and progression of possible precursor lesions.

Methods
A group of patients with FAP and controls were examined at laparotomy. Another group, with FAP and no clinical evidence of desmoid, and a group of controls, underwent abdominopelvic computed tomography.

Results
At laparotomy 13 of 42 patients with FAP had fibromatous mesenteric plaques; seven of these had not had surgery. Seven had more extensive mesenteric fibromatosis and had undergone significantly more laparotomies than the rest. Of 103 patients scanned, two had desmoid tumours and 22 (21 per cent) had mesenteric fibromatosis. On follow-up both desmoid tumours grew rapidly; mesenteric fibromatosis was unchanged in eight and resolved in four of the 12 patients rescanned.

Conclusion
A model of desmoid tumour development is suggested, analogous to the adenoma–carcinoma sequence, in which a less benign phenotype emerges as molecular genetic abnormalities accumulate: mesenteric plaque-like desmoid precursor lesions arise in many patients with FAP before surgery as a result of abnormal fibroblast function; some, perhaps stimulated by surgery, progress to mesenteric fibromatosis; these in turn can give rise to desmoid tumours.
Malignant epithelial parotid gland tumours: analysis and results in 65 previously untreated patients
Authors: Leverstein H , van der Wal J E , Tiwari R M , Tobi H , van der Waal I , Mehta D M , Snow G B 
Published: March 2003

Abstract

Background
Optimal management of malignant epithelial parotid tumours requires knowledge of the available therapeutic modalities and the different biological characteristics. The aim of the study was to review the characteristics of patients at presentation, histological classification, disease-free and overall survival rates, and the results of the applied treatment policy regarding the facial nerve and neck.

Methods
Between 1974 and 1995 a total of 65 patients was treated with curative intent for a previously untreated malignant epithelial parotid gland tumour. All patients underwent some type of parotidectomy, 20 of whom had an en bloc radical neck dissection. In selected cases the facial nerve or its branches were peeled off the tumour thus violating the objective of tumour-free margins and relying heavily on the efficacy of postoperative radiotherapy. In total 51 patients received postoperative radiotherapy. None of the patients was lost to follow-up.

Results
There were 12 locoregional failures (18 per cent). In only one of these 12 patients was salvage therapy successful; the remaining 11 patients died from the tumour. All but one of the eight patients with distant metastasis only died from the tumour. The estimated 5- and 10-year disease-free rates were 68 and 59 per cent respectively. The corresponding survival rates were 75 per cent and 67 per cent. A significant relationship could be observed between tumour stage and survival. The presence of lymph node metastases proved to be the strongest single prognostic factor.

Conclusion
In selected cases a conservative approach towards the facial nerve is justified.
Quality of life in patients undergoing treatment for chronic radiation-induced rectal bleeding
Authors: Dent O F , Galt E , Chapuis P H , Yuile P , Sinclair G , Bokey E L 
Published: March 2003

Abstract

Background
Laser and formalin therapy have recently been shown to be safe methods of haemostasis in patients with chronic radiation-induced rectal bleeding (CRRB). The effectiveness of this treatment in terms of improved quality of life remains to be determined. The aim of this study was to develop a questionnaire measure of self-perceived quality of life in patients with CRRB.

Methods
A self-completed Rectal Bleeding Quality of Life Scale (RBQOLS) based on the social and emotional problems experienced by patients with CRRB was developed using standard psychometric methods. Before laser and formalin therapy, 34 consecutive patients completed the questionnaire which was repeated 1 month after treatment and again 5 months later. The validity of the scale was assessed in relation to patient response to treatment.

Results
The RBQOLS had high reliability (alpha = 0·89) and its concurrent validity was confirmed by a significant association with the pretreatment severity of CRRB assessed endoscopically. The mean RBQOLS score increased from 102 (95 per cent confidence interval 90–114) before treatment to 126 (111–141) after treatment (t = 3·1, 33 d.f., P = 0·004) and 136 (122–151) at follow-up attesting to its predictive validity.

Conclusion
The RBQOLS is a reliable and valid device for assessing quality of life of patients with this uncommon, previously intractable and potentially life threatening complication of radiotherapy.
Informed consent in patients with acute abdominal pain
Authors: Vessey W , Siriwardena A 
Published: March 2003

Abstract

Background
This study aimed to establish perceptions of informed consent in patients undergoing surgery for acute abdominal conditions.

Methods
A prospective observational study was carried out using a structured questionnaire-based interview technique in patients undergoing surgery for acute abdominal conditions. Main outcome measures were to establish the effects of pain and preoperative analgesia on informed consent, patient comprehension of planned surgery and the degree of discussion of potential side-effects and complications.

Results
Thirty-one of 49 patients perceived that pain did not interfere with their ability to give informed consent. Forty of 48 stated that preoperative analgesia did not impair their ability to give informed consent. Forty-two understood why an operation was being planned but 28 patients stated that there had been no preoperative discussion of any potential side-effects or complications of surgery.

Conclusion
In this study the majority of patients perceived that they retained the ability to give informed consent despite the effects of pain and analgesia. Although the majority of patients understood why an operation was being planned there is a clear need for improved discussion of potential side-effects and complications.