bluuebunny/crossref_metadata_2025_split huggingface dataset:
Marsupialization of fistulotomy wounds improves healing: a randomized controlled trial
Authors: Ho Y-H , Tan M , Leong A F P K , Seow-Choen F 
Published: March 2003

Abstract

Background
Marsupialization of anal fistulotomy wounds leaves less raw unepithelialized tissue to granulate and may improve wound healing.

Methods
Some 103 consecutive patients with uncomplicated intersphincteric or trans-sphincteric fistula in ano were recruited into a randomized controlled trial. Fistula tracts were identified and laid open under general anaesthesia. The patients were randomized to have either the wounds left open (LO group) or wound edges marsupialized to the fistula tract with interrupted absorbable sutures (MS group). Anal manometry was performed before operation, and 6 weeks and 3 months after surgery.

Results
Some 52 patients were randomized to the LO group and 51 to the MS group. There were no differences in the age, sex, fistula type and fistula length distribution between the groups. Mean follow-up times were 9 and 10·2 months respectively. Wounds in the MS group healed faster (mean(s.e.m.) 6·0 (0·4) weeks) than those in the LO group (10·0(0·5) weeks) (P&lt;0·001). Only one patient (2 per cent) in the MS group was incontinent of liquids after operation compared with six (12 per cent) in the LO group. There was less impairment in maximum anal squeeze pressure at 3 months after marsupialization compared with leaving fistulotomy wounds open (P&lt;0·05). Apart from a slightly longer operative time required for marsupialization, the hospitalization and complication rates were the same.

Conclusion
Anal fistulotomy wounds healed faster after marsupialization. Anal squeeze pressures were better preserved and this may improve anal continence.
Intra-abdominal and pelvic abscess in Crohn's disease: results of non-invasive and surgical management
Authors: Jawhari A , Kamm M A , Ong C , Forbes A , Bartram C I , Hawley P R 
Published: March 2003

Abstract

Background
Intra-abdominal and pelvic abscesses occur in 10–30 per cent of patients with Crohn's disease. The aim of this study was to establish the clinical characteristics and outcome of patients admitted over a 4-year period with an abdominal or pelvic abscess secondary to Crohn's disease.

Methods
Patients with Crohn's disease-related intra-abdominal or pelvic abscess were identified from a prospectively collected database, comprising all admissions between 1991 and 1994. Medical records were reviewed retrospectively and data gathered regarding management and outcome.

Results
Thirty-six patients were identified with Crohn's disease-related abscess, of whom 15 were considered for initial percutaneous drainage. Drainage was technically possible in eight of these patients: it failed in four, gave good long-term results in two, and was followed by recurrence after 3 years in one and by later surgery unrelated to the abscess in one. Twenty-eight patients underwent surgery, with only four requiring a stoma. Complications occurred in 12 patients. At 3 months, 22 of the 36 patients were in remission.

Conclusion
Crohn's intra-abdominal abscesses are associated with a high morbidity rate. Selected cases can be drained percutaneously, without adding to the morbidity, and sometimes resulting in abscess resolution.
Bile duct obstruction due to portal biliopathy in extrahepatic portal hypertension: surgical management
Authors: Chaudhary A , Dhar P , Sarin S K , Sachdev A , Agarwal A K , Vij J C , Broor S L 
Published: March 2003

Abstract

Background
Varices can develop in and around the bile duct in the presence of portal hypertension, especially when it is caused by extrahepatic portal vein thrombosis. The term ‘portal biliopathy’ is used to describe changes in the bile duct due to these varices, which may cause bile duct obstruction. This paper reviews experience of the surgical management of patients with symptomatic portal biliopathy.

Methods
Nine patients with extrahepatic portal vein obstruction with symptomatic portal biliopathy were reviewed retrospectively.

Results
Eight patients presented with jaundice, two had abdominal pain and one had recurrent cholangitis. Endoscopic retrograde cholangiography revealed abnormality of the bile duct wall, with stricture in eight patients and bile duct calculi in two. Portasystemic shunting relieved jaundice in five of seven patients, and in two a second-stage hepaticojejunostomy was required.

Conclusion
Symptomatic biliary obstruction in patients with extrahepatic portal hypertension may be relieved by a portasystemic shunt. Rarely biliary bypass may be required and is rendered safer by previous portasystemic shunting to decompress the pericholedochal varices. A direct approach to the biliary tract without a preliminary shunt may be hazardous and is frequently unnecessary.
Significance of local recurrence of rectal cancer as a local or disseminated disease
Authors: Maetani S , Onodera H , Nishikawa T , Morimoto H , Ida K , Kitamura O , Imamura M 
Published: March 2003

Abstract

Background
The nature of ‘local recurrence’ of rectal cancer remains unclear.

Methods
Fifty-nine patients with locally recurrent rectal cancer who underwent extended repeat resections including total pelvic exenteration (39) and sacrectomy (43) were reviewed. Twelve patients had distant metastases before or at the time of repeat resection.

Results
The 5-year survival rate was 25 per cent. A second recurrence occurred in 45 patients including five of the eight 5-year survivors. Thirty-six of these recurrences had locoregional manifestations and 29 had distant metastases. Of 18 prognostic factors examined, the most significant determinant was the postoperative carcinoembryonic antigen doubling time (CEADT), followed by the preoperative CEADT, carcinoembryonic antigen (CEA) level and occurrence of distant metastases, in decreasing order. Late onset of first recurrence was also a favourable indicator. Thus, the growth rate of the tumour had a more profound impact on survival than the current extent of tumour progression. After operation the CEADT was reduced in patients with second recurrence (P = 0·05).

Conclusion
Locally recurrent rectal cancer is a manifestation of disseminated disease spreading locoregionally and often to distant organs with a low probability of long-term cure. However, survival varies widely depending on the tumour growth rate, which is biologically predetermined and is also influenced by surgery.
Encouraging results of split-liver transplantation
Authors: Mirza D F , Achilleos O , Pirenne J , Buckels J A C , Mcmaster P , Mayer A D 
Published: March 2003

Abstract

Background
Liver donor shortage presently accounts for a 10 per cent waiting list mortality rate. Split-liver transplantation (SLT) can improve utilization of this scarce resource.

Methods
Twenty-four SLTs (11 left, 13 right grafts) from 13 livers were performed in 23 patients (nine adults, 14 children), comprising 4·5 per cent of all orthotopic liver transplants (14 urgent or emergency, ten elective). The left graft comprised segments II and III, whereas the right graft comprised segments V–VIII in eight cases, IV–VIII in three, and segments I, IV–VIII, and I, V–VIII in one case each. Additional arterial extension grafts were required in six of 24 cases, and portal venous interposition graft in one.

Results
Twenty-one grafts showed good initial function, with one primary non-function and two initial poor function. The median peak aspartate aminotransferase level was 782 (range 94–2301) and 982 (range 382–2520) units/l for left and right grafts respectively. Five patients died (all urgent recipients), all within the first 30 days after surgery. Two SLT recipients underwent subsequent retransplantation. All ten elective recipients are alive. The 1-year actuarial patient and graft survival rates at a median follow-up of 20 months were 78 and 68 per cent respectively.

Conclusion
These encouraging results compare favourably with those of reduced-size and whole-liver transplantation and justify wider application of this technique, thereby optimizing donor resource use.
TRISS methodology in trauma: the need for alternatives
Authors: Demetriades D , Chan L S , Velmahos G , Berne T V , Cornwell E E , Belzberg H , Asensio J A , Murray J , Berne J , Shoemaker W 
Published: March 2003

Abstract

Background
Trauma and Injury Severity Score (TRISS) methodology has become a standard tool for evaluating the performance of trauma centres and identifying cases for critical review. Recent work has identified several limitations and questioned the validity of the methodology in certain types of trauma.

Methods
The usefulness and limitations of the TRISS methodology were evaluated in an urban trauma centre. Trauma registry data of 5445 patients with major trauma were analysed with respect to 30 demographic, prehospital, injury severity and hospitalization attributes. The performance of TRISS was measured primarily by the percentage of misclassifications, including false positives and false negatives, comparing the survival status predicted by TRISS with the true status. Sensitivity, specificity, and positive and negative predictive values were also measured for subgroups defined by the 30 attributes. Logistic regression analysis was used to identify significant independent factors related to the performance of TRISS.

Results
The overall misclassification rate was 4·3 per cent. However, in many subgroups of patients with severe trauma the misclassification rate was very high: 34 per cent in patients older than 54 years with Injury Severity Score (ISS) greater than 20; 29 per cent in those with fall injuries and ISS above 20; 29 per cent in patients with injuries involving four or more body areas and ISS greater than 20; 28·6 per cent in patients with injuries needing admission to the intensive care unit (ICU) and ISS greater than 20; 26·4 per cent in patients in severe distress before reaching hospital with ISS greater than 20; and 26·1 per cent in patients whose ISS score was above 20 and who had complications in hospital.

Conclusion
The TRISS methodology has major limitations in many subgroups of patients, especially in severe trauma. In its present form TRISS has no useful role in major urban trauma centres. Its use should be seriously reconsidered, if not abandoned.
Influence of graft material on blood rheology and plasma biochemistry following insertion of an infrainguinal bypass graft
Authors: Woodburn K R , Rumley A , Love J G , Murray G D , Lowe G D O 
Published: March 2003

Abstract

Background
Occlusive arterial disease causes alterations in blood rheology and levels of potential thrombotic and fibrinolytic mediators. The aim of this study was to investigate the effect of graft materials on these parameters in patients undergoing successful infrainguinal revascularization.

Methods
Some 186 consecutive infrainguinal grafts were observed for 12 months. Venous blood was sampled before operation and at 3, 6, and 12 months after surgery. Samples were assayed for thrombotic and rheological parameters. An area under the curve analysis was used to compare the effects of vein and synthetic grafting on these parameters in 99 patients whose grafts remained patent and free from stenosis.

Results
Plasma levels of fibrin degradation products were significantly higher in patients with synthetic grafts (n = 46) than in those with autogenous vein grafts (n = 53) (median 274 versus150 ng/ml; P &lt; 0·001). There were no significant differences in plasma fibrinogen or any other parameters between the two groups.

Conclusion
Patients with a synthetic infrainguinal graft have a higher fibrin turnover than those with a vein graft. Further studies are required to determine whether this increase in fibrin turnover is an essential requirement to maintain patency of a synthetic infrainguinal graft.
Risk factors for anastomotic leakage after resection of rectal cancer
Authors: Rullier E , Laurent C , Garrelon J L , Michel P , Saric J , Parneix M 
Published: March 2003

Abstract

Background
The most important surgical complication following rectal resection with anastomosis is symptomatic anastomotic leakage, which is associated with a 6–22 per cent mortality rate. The aim of this retrospective study was to evaluate the risk factors for clinical anastomotic leakage after anterior resection for cancer of the rectum.

Methods
From 1980 to 1995, 272 consecutive anterior resections for rectal cancer were performed by the same surgical team; 131 anastomoses were situated 5 cm or less from the anal verge. The associations between clinical anastomotic leakage and 19 patient-, tumour-, surgical- and treatment-related variables were studied by univariate and multivariate analysis.

Results
The rate of clinical anastomotic leakage was 12 per cent (32 of 272). Multivariate analysis of the overall population showed that only male sex and level of anastomosis were independent factors for development of anastomotic leakage. The risk of leakage was 6·5 times higher for anastomoses situated less than 5 cm from the anal verge than for those situated above 5 cm; it was 2·7 times higher for men than for women. In a second analysis of low anastomoses (5 cm or less from the anal verge; n = 131), obesity was statistically associated with leakage.

Conclusion
A protective stoma is suitable after sphincter-saving resection for rectal cancer for anastomoses situated at or less than 5 cm from the anal verge, particularly for men and obese patients.
Histamine in human breast cancer
Authors: Reynolds J L , Akhter J A , Magarey C J , Schwartz P , Adams W J , Morris D L 
Published: March 2003

Abstract

Background
Histamine inhibits lymphocyte function in vitro at concentrations of greater than 10−6 mol/l. The aim of this study was to determine whether histamine concentrations in breast cancers were sufficient to produce an immunological effect.

Methods
Tumour and adjacent normal breast content of histamine was measured using a radioenzymatic assay in 29 patients having surgery for breast cancer.

Results
The median content of histamine in breast cancer tissue was 5·4 (range 0·9–27·3) µg/g (median concentration 4·5 × 10−5 mol/l), and was significantly greater than that in adjacent breast tissue (P = 0·007).

Conclusion
The concentration of histamine in breast cancer was sufficient to inhibit lymphocyte function and could be locally immunosuppressive.
Survival following pancreaticoduodenectomy with resection of the superior mesenteric–portal vein confluence for adenocarcinoma of the pancreatic head
Authors: Leach S D , Lee J E , Charnsangavej C , Cleary K R , Lowy A M , Fenoglio C J , Pisters P W T , Evans D B 
Published: March 2003

Abstract

Background
The survival of patients who underwent pancreaticoduodenectomy with or without en bloc resection of the superior mesenteric–portal vein (SMPV) confluence for adenocarcinoma of the pancreatic head was compared.

Methods
To be considered for surgery, patients were required to fulfil the following computed tomography criteria for resectability: (1) absence of extrapancreatic disease, (2) no evidence of tumour extension to the superior mesenteric artery (SMA) or coeliac axis, and (3) a patent SMPV confluence. Tumour adherence to the superior mesenteric vein (SMV) or SMPV confluence was assessed at operation and en bloc venous resection was performed when necessary to achieve complete tumour extirpation.

Results
Seventy-five consecutive patients underwent pancreaticoduodenectomy, 44 without venous resection and 31 with en bloc resection of the SMPV confluence. There were no perioperative deaths in either group; late (more than 6 months) occlusion of the reconstructed SMPV confluence contributed to the death of two patients. Median survival in the 31 patients who required venous resection at the time of pancreaticoduodenectomy was 22 months, and that for the 44 control patients was 20 months (P = 0·25).

Conclusion
Patients with adenocarcinoma of the pancreatic head who require venous resection during pancreaticoduodenectomy for isolated tumour extension to the SMV or SMPV confluence (in the absence of tumour extension to the SMA or coeliac axis) have a duration of survival no different from that of patients who undergo standard pancreaticoduodenectomy. These data suggest that venous involvement is a function of tumour location rather than an indicator of aggressive tumour biology.
Arteriovenous fistula using transposed basilic vein
Authors: Butterworth P C , Doughman T M , Wheatley T J , Nicholson M L 
Published: March 2003

Abstract

Background
Patients who need long-term haemodialysis often require multiple operations to maintain their vascular access. The options for secondary or tertiary access procedures may become increasingly limited. Prosthetic conduits are commonly used in difficult cases but are associated with a high incidence of complications.

Methods
The brachial artery–transposed basilic vein arteriovenous fistula has been used in preference to a prosthetic graft on 31 occasions.

Results
There were no technical failures and 28 of these fistulas matured. No major infective complications occurred.

Conclusion
This procedure should be considered before resorting to a prosthetic graft for vascular access.
Trials and tribulations of vascular surgical benchmarking
Authors: Berridge D C , Scott D J A , Beard J D , Hands L 
Published: March 2003

Abstract

Background
Benchmarking is a new tool to assess the efficiency of different hospitals. Classification of operations using healthcare resource groups (HRGs) is related to parameters including number of cases, length of stay (LOS) and age profile.

Methods
A National Comparative Database was used to compare three hospitals. Analysis was confined to the major HRGs involved with vascular/venous surgery.

Results
For high-volume low-complexity varicose vein surgery, all three hospitals had similar numbers of patients and LOS. In contrast, the LOS for routine vascular operations in hospital A was double that in hospital B (16·3 versus 7·4 days). Hospital A had three times as many patients classified as ‘other – peripheral vascular disease’ as hospital C and six times as many as hospital B (329, 49 and 111 for hospitals A, B and C respectively). LOS following major amputation in hospitals A and C was nearly double that in hospital B (32·4, 18·3 and 33·6 days for hospitals A, B and C respectively).

Conclusion
There were a number of significant variations between the three hospitals during the 9-month interval. Explanations included the methods of coding, local facilities including availability of rehabilitation beds and difference in the patients' age profiles. Benchmarking in its present format reveals a number of variations which may not necessarily reflect real differences in clinical performance.
Spinal cord complications of thoracoabdominal aneurysm surgery
Authors: Lintott P , Hafez H M , Stansby G 
Published: March 2003

Abstract

Background
Although rare, paralysis secondary to spinal cord ischaemia after aortic aneurysm surgery is a devastating complication. Many papers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Recent articles have included advanced pharmacological approaches and the literature has been reviewed in light of these.

Methods
Relevant papers were identified by an extensive text word search of the Medline database and a review of quoted articles.

Results
Spinal cord complications are commoner after the repair of Crawford type II aneurysms than less extensive aneurysms. The presence of dissection, rupture and prolonged clamp times are associated with an increased incidence. About a quarter of all cord problems develop over 24 h after surgery and this may be due to a reperfusion type injury, although the exact mechanisms are by no means clear.

Conclusion
A combination of rapid surgery, left heart bypass for the repair of more extensive aneurysms, free spinal drainage and the avoidance of postoperative hypoxia and hypotension help to minimize spinal cord ischaemia. No pharmacological agent has yet been shown conclusively to improve outcome in the clinical setting.
Multidisciplinary approach to biliary complications of laparoscopic cholecystectomy
Authors: Doctor N , Dooley J S , Dick R , Watkinson A , Rolles K , Davidson B R 
Published: March 2003

Abstract

Background
Bile leaks and bile duct strictures are major complications of cholecystectomy which increased in incidence after the introduction of laparoscopic surgery. The management and outcome of these complications following the introduction of laparoscopic cholecystectomy was reviewed.

Methods
Eighteen patients of median age 45 (range 22–70) years were treated between January 1992 and December 1995. Six patients had a common hepatic duct (CHD) stricture, four following a failed previous repair. Nine patients had bile leaks from bile duct transection (four), cystic stump (four) or segment V duct (one). Two patients had partial bile duct damage with primary sutured repair at time of cholecystectomy. One patient had recurrent haemobilia from a hepatic artery pseudoaneurysm.

Results
Cystic stump or segment V leaks were treated successfully by endoscopic stenting (median follow-up 42 months). Roux loop biliary reconstruction was carried out in nine patients: two CHD strictures, three of the four failed primary CHD repairs and four bile duct transections. All had normal liver function test results at median follow-up of 30 months. The two patients with partial duct injuries repaired at initial surgery required no further intervention. The right hepatic artery aneurysm was successfully embolized. There have been no deaths or major complications of endoscopic, radiological or surgical intervention.

Conclusion
Endoscopic stenting successfully treats cystic stump and segment V duct leaks. Duct strictures, including failed initial repairs and transections, have a good outcome with Roux-en-Y loop reconstruction.
Oesophageal cancer staging using endoscopic ultrasonography
Authors: Vickers J , Alderson D 
Published: March 2003

Abstract

Background
Despite encouraging results from Europe and the USA, endoscopic ultrasonography has yet to become established in the UK for imaging gastrointestinal lesions. The aim of this prospective study was to investigate the accuracy of endoscopic ultrasonography for local tumour (T) and lymph node (N) staging of oesophageal cancer.

Methods
Endoscopic ultrasonography was performed in 50 consecutive patients with operable oesophageal cancer. Its accuracy for locoregional tumour staging was assessed and a detailed analysis of the distribution of ultrasonographically detected lymph nodes performed.

Results
Endoscopic ultrasonography was highly accurate for both local tumour (92 per cent correct T stage prediction) and lymph node (86 per cent correct N stage prediction) staging compared with final histology. The procedure was also superior to open surgical staging performed by the surgeon; it had a tendency to overestimate malignant involvement of individual lymph nodes and had only limited ability to identify small benign lymph nodes, particularly in the abdomen.

Conclusion
Endoscopic ultrasonography was reliable for both local tumour and lymph node staging of oesophageal cancer.