bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carcinoma of the head of the pancreas arising from the uncinate process
Authors: Birk D , Schoenberg M H , Gansauge F , Formentini A , Fortnagel G , Beger H G 
Published: March 2003

Abstract

Background
Carcinoma located in the uncinate process (CUP) of the pancreatic head is considered to be rare. Exact epidemiological data, however, are not available because the series published so far consist of fewer than ten patients. The purpose of this prospective study was to evaluate the clinical appearance of CUP and to compare findings with those of patients with carcinoma in the ventral aspect of the pancreatic head (VPC), which represents the most frequent localization.

Results
Some 39 (8 per cent) of 506 evaluated patients suffered from CUP. Mean age was 63·3 years. The most frequent complaints were upper abdominal pain (n = 32) and weight loss (n = 35). Jaundice was seen in only five patients and was never an early symptom. The level of CA19-9 was raised in 33 patients. The best diagnostic procedure to detect CUP was computed tomography (CT) (sensitivity 93 per cent), whereas endoscopic retrograde cholangiopancreatography was not useful (sensitivity 21 per cent). Vascular involvement was significantly (P &lt; 0·01) more common in CUP (n = 19) than in VPC (48 versus 19 per cent). This finding and the fact that most patients with CUP were diagnosed at a late stage with distant metastasis or severe vascular involvement present (n = 21) are responsible for the significantly lower rate of operation (n = 25) (64 versus 92 per cent, P &lt; 0·05) and the significantly shorter median survival time (5 versus 11 months, P &lt; 0·05).

Conclusion
Patients with CUP have a poor prognosis as a result of the lack of early symptoms (jaundice) and early vascular involvement due to the proximity of the uncinate process to the mesenteric root. A raised level of CA19-9, together with weight loss and/or upper abdominal pain, should prompt CT.
Simple laparoscopic gastropexy as the initial treatment of paraoesophageal hiatal hernia
Authors: Agwunobi A O , Bancewicz J , Attwood S E A 
Published: March 2003

Abstract

Background
Paraoesophageal hiatal hernia is relatively rare compared with sliding hernia but it is associated with serious complications. Its clinical management presents a major challenge since many patients are elderly and unfit for a formal repair. This paper describes a laparoscopic method aimed at reducing the complications of open repair.

Methods
Thirteen patients treated for symptomatic paraoesophageal hernia were included in the study. Eleven patients successfully underwent a simple laparoscopic modification of the Boerema anterior gastropexy. Two patients required an open anterior gastropexy through a minilaparotomy because of incomplete reduction of the hernia. A five-puncture technique was used. The stomach and any other contents of the sac were reduced into the abdomen and the stomach was firmly fixed to the fascia of the anterior abdominal wall with Gore-Tex sutures tied extracorporeally.

Results
There was one postoperative death due to spontaneous intrathoracic perforation of the posterior aspect of the stomach in an elderly woman with severe cardiac disease. There was no postoperative morbidity. Eight of the ten patients who went home following laparoscopic gastropexy have remained asymptomatic on follow-up. In three patients, two in the laparoscopic group and one in the open group, symptoms recurred.

Conclusion
While anterior gastropexy has a significant incidence of recurrent herniation, the clinical results of this simple procedure in a high-risk population support its use as the initial surgical option.
Randomized placebo-controlled trial of local anaesthetic infusion in day-case inguinal hernia repair
Authors: Oakley M J , Smith J S , Anderson J R , Fenton-Lee D 
Published: March 2003

Abstract

Background
This study investigated the efficacy of local anaesthetic wound perfusion following day-case inguinal hernia repair.

Methods
Seventy-two patients entered a randomized controlled trial with three patient groups: group 1, pump containing bupivacaine; group 2, pump containing normal saline; and group 3, control group without a pump. All patients had a Lichtenstein hernia repair together with ilioinguinal and iliohypogastric nerve blocks and were prescribed oral analgesia. Postoperative pain was assessed over 5 days using a visual analogue scale.

Results
Patients who had a local anaesthetic infusion had significantly less pain than either the placebo or control groups. This was greatest during the first 48 h (day 1, P = 0·028 and 0·011 respectively; day 2, P = 0·012 and 0·037 respectively).

Conclusion
A portable infusion pump for the delivery of local anaesthetic reduced pain after day-case inguinal hernia repair.
Total vascular exclusion of the liver for the resection of lesions in contact with the vena cava or the hepatic veins
Authors: Berney T , Mentha G , Morel Ph 
Published: March 2003

Abstract

Background
This study reviews experience with total vascular exclusion of the liver (TVE), for the resection of tumours in contact with the hepatic veins or the vena cava.

Methods
A retrospective study was carried out of 366 hepatic resections performed over 13 years. Forty-one patients (11 per cent) were operated under TVE.

Results
Twenty-four patients were operated for malignancy and 17 for benign disease. Major hepatectomy was performed in 26 patients and minor hepatectomy in 15. The technique allowed vascular repair in eight patients. Median intraoperative blood transfusion was 2 (range 0–26) units; 14 patients required none. Median duration of TVE was 29 (range 5–58) min. No deaths occurred. Significant complications occurred in ten patients. Morbidity was related to the malignant nature of the lesion, duration of surgery and volume of blood transfusion, but not to duration of TVE.

Conclusion
TVE facilitates resection of critically located hepatic lesions with safety and minimal blood loss. Within the limits of 1 h, prolonged TVE does not increase morbidity.
Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer
Authors: Bartels H , Stein H J , Siewert J R 
Published: March 2003

Abstract

Background
Postoperative mortality after oesophagectomy for oesophageal cancer depends largely on the preoperative physiological status of the patient.

Methods
A composite scoring system to predict the risk of oesophagectomy based on objective preoperative parameters was developed based on a retrospective review of patients operated on and evaluated prospectively in two subsequent patient groups.

Results
An initial retrospective multivariate analysis of 432 patients who had oesophagectomy identified a compromised general status (P&lt;0·001) and poor cardiac (P&lt;0·001), hepatic (P&lt;0·05) and respiratory (P&lt;0·05) function as independent predictors of a fatal postoperative course. Based on the relative risk associated with the individual impaired organ functions, a composite risk score was established. A prospective study in 121 patients confirmed that this composite scoring system provides a better identification of high-risk patients than any of the individual parameters. Inclusion of the composite score into the process of patient selection and choice of the procedure resulted in a decrease of postoperative mortality rate from 9·4 per cent (52 of 553) to 1·6 per cent (four of 252) (P&lt;0·001).

Conclusion
The risk of death after oesophagectomy for oesophageal cancer can be assessed objectively before surgery and quantified by a composite risk score. This score provides a useful tool for refining the criteria of patient selection for resection or the choice of procedure.
Early colorectal cancer: recognition, classification and treatment
Authors: Mainprize K S , Mortensen N J McC , Warren B F 
Published: March 2003

Abstract

Background
With the introduction of colorectal cancer screening and improvements in endoscopic technology, the recognition and management of early colorectal cancer assumes increasing importance.

Methods
A literature review was undertaken using Medline (National Library of Medicine, Washington DC, USA) searches of the headings early colonic, colorectal and rectal cancer, carcinoma and adenocarcinoma up to and including 1997. All relevant references were examined.

Results and conclusion
The diagnosis, classification and treatment options are described. Accurate diagnosis, preoperative and histopathological staging is crucial in the management of early colorectal cancer.
Adjuvant therapy for resectable rectal and colonic cancer
Authors: Heriot A G , Kumar D 
Published: March 2003

Abstract

Background
Recurrence of rectal and colonic carcinoma remains substantial despite apparently curative surgery. Adjuvant therapy has been applied to improve prognosis.

Methods
This review evaluates the use of adjuvant therapy in the management of resectable rectal and colonic carcinoma. It assesses critically the evidence supporting the addition of radiotherapy, chemotherapy, chemoradiotherapy and other treatment modalities to optimal surgery.

Results
In the case of rectal tumours, preoperative is more effective than postoperative radiotherapy; it can significantly reduce the incidence of local tumour recurrence. A number of trials have tended towards showing a survival advantage and a recent large randomized trial has shown a significant improvement in survival in patients with Dukes C tumours. Postoperative chemoradiotherapy is associated with a survival benefit and is standard therapy in the USA, although it is associated with increased toxicity. The effectiveness of preoperative chemoradiotherapy is currently being investigated. Postoperative fluorouracil-containing chemotherapy has resulted in a survival advantage in patients with Dukes C colonic tumours; such therapy may be administered either systemically or intraportally. The evidence of benefit with rectal tumours is more limited. Immunotherapy has been studied to a limited extent and the use of a tumour-directed monoclonal antibody has produced a survival advantage in a single trial.

Conclusion
Preoperative radiotherapy and postoperative chemoradiotherapy can produce a survival advantage in patients with Dukes C rectal carcinoma and reduce local recurrence. Postoperative fluorouracil-containing chemotherapy can produce a survival advantage in those with Dukes C colonic cancer. The optimal use and combination of adjuvant therapy remains uncertain.
Abdominal and dyspeptic symptoms in patients with peptic ulcer treated medically or surgically
Authors: Lindsetmo R-O , Johnsen R , Revhaug A 
Published: March 2003

Abstract

Background
Abdominal and dyspeptic complaints, which are prominent symptoms in patients with peptic ulceration, are commonly reported in the general population. There are few reports of follow-up study of peptic ulcer therapies in which clinical outcome has been compared with symptom reporting in community controls.

Methods
Three populations of patients with peptic ulcer disease (patients who had elective proximal gastric vagotomy (PGV), those having PGV for emergency indications and those receiving medical treatment with H2-receptor antagonists) were included in a questionnaire survey and compared with a group of randomly selected community controls.

Results
The vagotomized patients reported fewer abdominal complaints (P = 0·0003) and fewer dyspeptic complaints lasting for more than 1 week (P = 0·05) than those treated medically. There was no significant difference between vagotomized patients and community controls in the reporting of abdominal (P = 0·2) or dyspeptic (P = 0·9) complaints.

Conclusion
Taking abdominal complaints as the endpoint for former peptic ulcer treatment, surgical treatment with PGV seemed to be superior to therapy with H2-receptor antagonists and produced an almost identical level of complaints to that seen in the community population.
Efficacy of anterior, posterior and total fundoplication in an experimental model
Authors: Watson D I , Mathew G , Pike G K , Baigrie R J , Jamieson G G 
Published: March 2003

Abstract

Background
This study examined the effect of different types of laparoscopic fundoplication on an incompetent lower oesophageal sphincter to test their effectiveness at preventing gastro-oesophageal reflux in the early postoperative period.

Methods
An experimental porcine model was used. Initial oesophageal myotomy ensured an incompetent lower oesophageal sphincter with free reflux of ‘intragastric fluid’. Anterior, posterior or total fundoplication was then performed laparoscopically in 15 laboratory pigs (five in each group). Fundoplication competence and efficacy were determined 2 weeks after laparoscopic antireflux surgery by inflating the stomach with liquid through a gastrostomy cannula. Some animals were also studied at 4 and 6 weeks. Lower oesophageal sphincter pressure was determined using a water-perfused oesophageal manometry catheter incorporating a Dent sleeve.

Results
All three types of fundoplication produced similar increases in postoperative resting lower oesophageal sphincter pressure and restored adequate competence to the gastro-oesophageal junction.

Conclusion
All three variants of laparoscopic fundoplication restore gastro-oesophageal competence in the early postoperative period.
Metabolic substrate utilization differs in ileal faecal and urinary reservoirs
Authors: Duffy M M , Regan M C , Harrington M G , Fitzpatrick J M , O'Connell P R 
Published: March 2003

Abstract

Background
Construction of an ileal faecal or urinary reservoir profoundly alters ileal luminal ecology and availability of mucosal metabolic substrates. The aims of this study were to measure mucosal metabolic flux of butyrate and glutamine in histologically normal (control) ileum and to determine the effect of reservoir construction on metabolic fluxes in patients with ileal pouch–anal anastomosis and ileocystoplasty.

Methods
Endoscopic biopsy samples were obtained from normal ileum (n = 10), ileum of patients with ulcerative colitis (n = 10), ileal pouch–anal anastomosis (n = 7), ileocystoplasty (n = 7) and ileal conduit (n = 7). Using a closed microculture technique, biopsy utilization of 14C-labelled butyrate and glutamine was measured as [14C]carbon dioxide production. Biopsy DNA content was measured and [14C]carbon dioxide evolution expressed as picomoles [14C]carbon dioxide per microgram DNA per hour.

Results
The metabolic flux of both butyrate and glutamine was reduced in ileal pouch mucosa compared with that of ileal mucosa in patients with ulcerative colitis. In contrast, the metabolic flux of buyrate alone was reduced in ileal mucosa from ileocystoplasty and ileal conduit compared with that in normal ileal mucosa, while the metabolic flux of glutamine remained unchanged.

Conclusion
Ileal mucosal metabolic fluxes measured in vitro are altered by changing luminal ecology in vivo. These changes may affect the health and mucosal integrity of ileum used to construct these reservoirs.
Ward versus intensive care management of high-risk surgical patients
Authors: Curran J E , Grounds R M 
Published: March 2003

Abstract

Background
Selection of high-risk surgical patients for preoperative and perioperative admission to an intensive therapy unit (ITU) for enhancement of oxygen delivery may reduce postoperative morbidity and mortality rates. Limited resources may prevent admission of all suitable patients. This audit study examined whether it is possible to select patients most at risk and thus reduce surgical morbidity and mortality rates when ITU services are limited.

Methods
This was a retrospective audit comparing the actual outcomes of complications and death with predicted outcomes using the POSSUM socre (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) for 101 general surgical and vascular patients who would have fulfilled previously suggested criteria for preoperative admission to the ITU. Main outcome measures were the number of preoperative ITU admission criteria, American Society of Anesthesiologists (ASA) and POSSUM scores, preoperative oxygen delivery values, intravenous fluid therapy, length of ITU stay, length of hospital stay, postoperative complications and 28-day mortality.

Results
Medical staff allocated patients appropriately. There was a lower mortality rate than predicted from individual POSSUM scores. Patients who were admitted to the ITU before operation had the highest ASA scores, admission criteria and POSSUM scores; they also had significantly lower mortality and morbidity rates than predicted by the POSSUM scoring system.

Conclusion
Patients with the greatest reduction in mortality and morbidity rates were admitted to the ITU before operation and had cardiovascular physiology ‘optimized’ before surgery.
Recent advances in the surgical treatment of faecal incontinence
Authors: Vaizey C J , Kamm M A , Nicholls R J 
Published: March 2003

Abstract

Background
Improved imaging and refined technology have led to a number of recent advances in the surgical treatment of faecal incontinence.

Methods
Original articles, identified using a computer database (Medline), and recently published abstracts of meetings were selected on the basis of greatest clinical relevance; these were reviewed.

Results
Ultrasonographic characterization has led to improved therapeutic strategies. Simple structural damage is readily identified and external sphincter repair results in a good outcome for a majority of patients. For more complex structural damage, or for the newly recognized primary internal sphincter degeneration, alternative treatment strategies are emerging. The electrically stimulated gracilis neosphincter and the artificial bowel sphincter offer good results. The latter may be a more simple operation. For structurally intact but weak sphincters, sacral nerve stimulation is a promising therapy. Other therapies, such as antegrade irrigation, may be helpful for patients with neurological disorders.

Conclusion
Better imaging, refined classification and new operations are leading to improved surgical techniques for faecal incontinence.
Heat shock protein 72 production in liver tissue after experimental total hepatic inflow occlusion
Authors: Dai C-L , Kume M , Yamamoto Y , Yamagami K , Yamamoto H , Nakayama H , Ozaki N , Shapiro A M J , Yamamoto M , Yamaoka Y 
Published: March 2003

Abstract

Background
The pathogenesis of hepatic ischaemia–reperfusion injury is incompletely understood. This study examined the effects of reperfusion with congested portal blood on ischaemia–reperfusion injury of the liver following Pringle's manoeuvre, as monitored by heat shock protein (HSP) 72 production in rat liver tissue.

Methods
Rats were randomized to three groups. In group 1 hepatic ischaemia with portal congestion was induced by Pringle's manoeuvre for 15 min; in group 2 Pringle's manoeuvre was applied for 15 min with an extracorporeal portasystemic shunt; and in group 3 the superior mesenteric vein was occluded for 15 min. The production of HSP72 in liver tissue was measured by Western blotting at 48 h after each intervention. Conventional parameters for hepatic function were examined at 1, 3 and 48 h after reperfusion.

Results
There was marked HSP72 expression in group 1, but not in group 2 or 3, showing that a combination of liver ischaemia and reperfusion of congested portal blood is required to induce strong expression of HSP72 in the tissue. On the other hand, biochemical parameters were raised equally in both groups 1 and 2, reflecting a similar degree of ischaemic hepatocyte injury.

Conclusion
The additional stress impact of temporary portal occlusion upon ischaemia–reperfusion injury of the liver was clearly detected by in situ hepatic HSP72 production in this study.
Outcome after ‘curative’ surgery for carcinoma of the lower third of the rectum
Authors: Topal B , Penninckx F , Kaufman L , Filez L , Aerts R , Ectors N , Kerremans R 
Published: March 2003

Abstract

Background
Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone.

Methods
Eighty-two consecutive patients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma at 3·5–7·5 cm from the anal margin. Cox proportional hazards technique with univariate and corrected (multivariate) analyses and the Kaplan–Meier life-table method were used to evaluate the data.

Results
Tumour wall penetration and lymph node involvement, but not the tumour level or the type of surgery, were found to be significant predictors of outcome. The local recurrence rate at 1, 2 and 5 years was 10, 22 and 26 per cent respectively after APRE, and 5, 13 and 21 per cent after SSO. The disease-free survival rate at 1, 2 and 5 years was 85, 67 and 58 per cent respectively after APRE, and 88, 78 and 62 per cent after SSO.

Conclusion
Tumour-related factors are significant predictors of outcome. The type of surgery (APRE or SSO) did not seem to be a significant variable in this non-randomized study.
Polymers that reduce intraperitoneal adhesion formation
Authors: Falk K , Holmdahl L , Halvarsson M , Larsson K , Lindman B , Bengmark S 
Published: March 2003

Abstract

Background
Viscous macromolecules and phospholipids have been shown to reduce postoperative adhesion formation. The ideal agent, or combination of agents, still remains to be identified.

Methods
The effect of hydrophobically modified ethyl (hydroxyethyl) cellulose (HM-EHEC) and polyquarternium-24 (LM-200), two cellulose-derived polymers, and of sphingomyelin, was examined in an animal model. Adhesions were induced in the parietal peritoneum in a standardized manner and quantity, and the morphology of adhesion formation was evaluated after 7 days.

Results
A significant reduction in adhesion formation was seen in animals receiving LM-200 (P = 0·013) and HM-EHEC (P = 0·012) as a short-term treatment compared with controls given saline, but not in animals receiving sphingomyelin (P = 0·733). Additional effects were seen in the animals receiving LM-200 as a prolonged treatment (P &lt; 0·001) compared with controls. There was no difference in the magnitude of the inflammatory response between the groups.

Conclusion
These results suggest that hydrophobically modified polymers are efficient in reducing adhesions, without affecting the inflammatory response.