bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective analysis of the diagnostic yield of extended en bloc resection for adenocarcinoma of the oesophagus or gastric cardia
Authors: Hulscher J B F , Van Sandick J W , Offerhaus G J A , Tilanus H W , Obertop H , Van Lanschot J J B 
Published: March 2003

Abstract

Background
The extent of lymph node dissection can affect tumour node metastasis staging. The resulting ‘stage migration’ might hamper stage-by-stage comparison between different forms of oesophageal resection. The aim of this study was to assess the diagnostic impact of extended en bloc lymphadenectomy in staging (adeno)carcinoma of the mid/distal oesophagus or gastric cardia.

Methods
This was a prospective study of 74 patients (67 men and seven women; median age 63 (range 40–78) years) who underwent extended oesophagectomy between 1994 and 2000.

Results
A median of 31 (range 15–78) lymph nodes was resected (and identified), with a median of 5 (range 0–31) positive nodes. Twenty-seven patients (36 per cent) had tumour-positive nodes in extended fields: 15 patients (20 per cent) in the abdomen and 15 patients (20 per cent) in the mediastinum. Subcarinal nodes were most affected (19 per cent). Extended resection led to tumour upstaging in 17 patients (23 per cent); two patients had isolated positive subcarinal nodes and 15 other tumours became M1a owing to positive nodes near the coeliac axis, hepatic artery or splenic artery. Tumour positivity in paratracheal or aortopulmonary nodes occurred in 8 per cent of patients, without influencing staging.

Conclusion
Extended en bloc lymphadenectomy altered staging in 17 of 74 patients (23 per cent) with adenocarcinoma of the oesophagus or cardia, mainly into M1a owing to positive coeliac nodes (20 per cent).
Endovascular intervention compared with carotid endarterectomy
Authors: Beard J D , Cleveland T , Gaines P A , Lonsdale R 
Published: March 2003

Abstract

Background
Endovascular intervention has only recently been used for the treatment of carotid disease. The 30-day outcome of 226 endovascular carotid interventions for atherosclerosis performed since August 1993 is presented.

Methods
All patients were symptomatic apart from four (2 per cent) who underwent intervention before coronary artery bypass. The last presenting symptom was transient ischaemic attack (TIA) (40 per cent), amaurosis fugax (31 per cent), retinal artery occlusion (3 per cent) and stroke (24 per cent). A moderate stenosis (50–69 per cent; North American Symptomatic Carotid Endarterectomy Trial technique) was present in 24 patients (11 per cent), a severe stenosis (70–95 per cent) in 144 (64 per cent), and a preocclusive stenosis (more than 95 per cent) in 58 (26 per cent). The contralateral internal carotid artery was significantly diseased (greater than 70 per cent) or occluded in 65 patients (29 per cent). All patients were pretreated with aspirin; 5000 units heparin and 1·2 mg atropine were given during the procedure. Initially, stents were reserved for treating residual stenosis after angioplasty (16 of 108 procedures). Later, a change was made to primary stenting (116 procedures). A femoral approach was used for all patients.

Results
At 30 days there were four deaths (2 per cent) and eight disabling strokes (4 per cent) (death and disabling stroke rate 5 per cent; death and all-strokes rate 8 per cent). For angioplasty and selective stenting the death and disabling stroke rate and the death and all-strokes rate were 6 and 9 per cent respectively, compared with 5 and 8 per cent for primary stenting (P not significant). However, there was a significant difference between the incidence of all adverse events (31 versus 11 per cent) as a result of fewer TIAs associated with primary stenting. During the same interval, 300 carotid endarterectomies (similar indications and severity of disease) were performed. There were six deaths (2 per cent) and eight disabling strokes (3 per cent) (death and disabling stroke rate 5 per cent; death and all-strokes rate 6 per cent). The complications of both endovascular intervention and conventional endarterectomy seem to be improving with time.

Conclusion
These data confirm the feasibility of endovascular carotid intervention and highlight the need for a large randomized trial comparing it with conventional surgery. The benefit of stents and cerebral protection systems also requires further investigation.
Ischaemic preconditioning before lower limb ischaemia–reperfusion protects against acute lung injury
Authors: Harkin D W , Barros D'Sa A A B , McCallion K , Baker R , Hoper M , Campbell F C 
Published: March 2003

Abstract

Background
Ischaemic preconditioning (IPC) of skeletal muscle, by exposing it to repeated brief periods of ischaemia and reperfusion (I-R) before a subsequent longer ischaemic period, protects against local damage on reperfusion. In a large animal model of hindlimb I-R it was hypothesized that hindlimb IPC would attenuate the systemic inflammatory response syndrome and prevent acute lung injury associated with limb reperfusion injury.

Methods
Anaesthetized ventilated swine (six per group) were used throughout. After midline laparotomy, animals were randomized to the following three groups: bilateral external iliac artery occlusion for 120 min, followed by reperfusion for 180 min (I-R group); IPC (three cycles of 5 min ischaemia, then 5 min reperfusion of both external iliac arteries) followed by bilateral external iliac artery occlusion for 120 min and reperfusion for 180 min (I-R + IPC group); or laparotomy alone (control group). Acute lung injury was assessed by invasive pulmonary artery pressure (PAP) measurement, arterial to alveolar (A-a) oxygen gradient, lung tissue wet: dry weight ratio, and lung myeloperoxidase (MPO) concentration.

Results

Conclusion
Lower limb I-R induces systemic inflammation and acutely impairs oxygen transport associated with lung neutrophil sequestration. IPC attenuates acute pulmonary hypertension, impairment of oxygen transport, oedema and leucosequestration in planned lower limb I-R.
Scottish leg ulcer project: a randomized trial evaluating the implementation of national guidelines
Authors: Ruckley C V 
Published: March 2003

Abstract

Background
Innumerable consensus documents and guidelines have been published, but little is known about their implementation or impact. Community nurses provide more than 80 per cent of the care of patients with chronic leg ulcers. Healing rates of 50–74 per cent at 3 months have been reported in published trials. Outcomes in the community are largely unknown. National guidelines on leg ulcer care were published in 1998 by the Scottish Intercollegiate Guideline Network (SIGN), which produces evidence-based guidelines using strict criteria and methodology. The aim was to evaluate the impact of national guidelines, with or without a structured nurse training programme, on leg ulcer healing rates in the community nationwide.

Methods
Community healthcare trusts covering a population of 2·65 million were divided into 50 geographically and administratively distinct localities averaging 53 000 population, which were randomized to either SIGN guidelines (control) or guidelines plus a guideline-based nurse training programme (intervention). Data were collected from 649 caseload managers by 3-monthly censuses throughout the 2·5 years of the project. After a 6-month baseline period, guidelines were distributed and an intensive programme of training was provided throughout Scotland by a multidisciplinary team in the intervention localities for 51 link nurses, who were trained and resourced to cascade their training to approximately 1700 community nurses.

Results
Some 4413 patients with 4984 ulcerated legs were registered. The mean age of 77 years was more than a decade older than that in published trials. Multiple co-morbidities were reported. The response rate from caseload managers was 99·4 per cent, rising to 100 per cent for the rest of the study. Intercensal follow-up was complete for 98·9 per cent of patients. The baseline 3-month ulcer healing rate was 30 per cent; it remained the same throughout the subsequent 2 years, with no difference between intervention and control groups.

Conclusion
Neither national guidelines nor an intensive training programme made any impact on leg ulcer healing rates. The outcomes of leg ulcer care are poor. The delivery of care requires reorganization. The impact and implementation of consensus statements and guidelines should be evaluated.
Reduction of vascular smooth muscle cell proliferation by immunomodulation
Authors: Chan Y C , Shukla N , Okonko D O , Singh M , Stanford J L , Mansfield A O , Stansby G 
Published: March 2003

Abstract

Background
Immunological factors may play an important role in mediating the progression of atherosclerosis and myointimal hyperplasia, with heat shock proteins being implicated as possible autoantigens. The authors have shown previously that immunomodulation can reduce vascular smooth muscle cell (vSMC) proliferation following balloon injury to rat carotid arteries. The aim of the present study was to examine the effects of immunomodulatory agents on the proliferation of rat aortic vSMCs remote from the area of balloon injury. The agents used were SRL172 (heat-killed Mycobacterium vaccae) and heat shock protein 65 kDa (HSP65) in Freund's incomplete adjuvant. Both these agents are known to influence T-cell responses.

Methods
Male Sprague–Dawley rats were used. All immunizations were given subcutaneously. Four groups were studied (ten animals in each group): group 1 animals were immunized with normal saline, group 2 received SRL172, group 3 SRL172 and HSP65–Freund's, and group 4 HSP65–Freund's. Three immunizations were performed as well as carotid balloon injury. Three animals died, leaving 37 for analysis. Some 5 weeks later the animals were killed and the aorta was harvested. Standard explant techniques were applied to grow aortic vSMCs until confluency, passaged three times, quiesced, and fetal calf serum (FCS) of varying concentrations (0·4–10 per cent) was then added, incubated for another 48 h and cell counts carried out.

Results
The proliferation rate of aortic vSMCs in the control group was significantly greater than that in the other study groups (Fig.). While all the treatment groups had significantly less proliferation compared with the control group (*P &lt; 0·05, †P &lt; 0·01, Mann–Whitney U test), no statistically significant differences existed between any of the study groups.

Conclusion
Immunomodulation may result in a reduction of vSMC proliferation. Although the precise mechanisms involved are unclear, these results are in concordance with previous findings that T-cell immunomodulation decreases the development of myointimal hyperplasia after injury, and suggest that a fundamental phenotypic shift has been produced by these immunizations.
Prospective audit of major amputations for peripheral vascular disease
Authors: Vallabhaneni S R , Hughes D M , Reilly D T , Blair S D , Greaney M G 
Published: March 2003

Abstract

Background
Primary amputation followed by prosthetic fitting has been proposed as an alternative worth considering if lower limb bypass has poor prospects of patency. This is an outcome audit of major amputations at a single centre where amputations were performed only if limb salvage was not possible.

Methods
Consecutive major amputations (n = 162) for peripheral vascular disease from January 1996 to December 1998 were studied prospectively. Duration of hospital stay, causes of morbidity and mortality, and reasons for being unsuitable for prosthesis were recorded. Mobility at admission and after rehabilitation was documented using a standard grading system (grades 1–6).

Results
There were 114 above-knee, 45 below-knee and three through-knee amputations. The 30-day mortality rate was 14 per cent (22 patients), increasing to 29 per cent (47) at 9 months. Some 57 patients (35 per cent) were rehabilitated with a prosthetic limb (30 above knee, 27 below knee). Mobility with prosthesis was better or maintained in 24 patients, worse by one grade in 17, and by two or more grades in the remaining 16. Fifty-eight patients (36 per cent) were unsuitable for an artificial limb; in four this was because of stump-related problems, and the rest because of co-morbidity. Cardiorespiratory events were the most frequent cause of morbidity and mortality. The mean hospital stay after amputation was 37 days in survivors.

Conclusion
Perioperative and late mortality rates following amputation are high. A large proportion of amputees were not suitable for prosthesis, mainly because of co-morbidity. Of the patients receiving a prosthesis, only 42 per cent (15 per cent of the total) maintained or improved their mobility. The results are unlikely to be different if a policy of selective primary amputation were to be adopted. The outcome of amputation is worse than widely perceived despite the improvements in prostheses and a well executed rehabilitation process.
Use of minilaparotomy in the treatment of colonic cancer
Authors: Nakagoe T , Sawai T , Tsuji T , Ayabe H 
Published: March 2003

Abstract

Background
The feasibility and safety of a minilaparotomy approach for curative resection of colonic cancer have not been fully elucidated. The purpose of this study was to compare outcomes utilizing this alternative technique with those of conventional laparotomy.

Methods
Eighty-four patients scheduled to undergo resection for colonic cancer via minilaparotomy between 1997 and 1999 were studied prospectively. The minilaparotomy involved complete resection performed through a skin incision less than 7 cm in length. Sixty-nine patients who underwent a similar resection via a conventional laparotomy between 1994 and 1996 served as the control group.

Results
The minilaparotomy approach was successful in 72 of 84 patients. Colectomy type, operating time and histopathological features of tumours were similar between cases and controls, whereas operative blood loss in the control group was significantly greater (P = 0·002). Postoperative times to standing, walking, passage of flatus and urinary catheter removal were significantly shorter in the minilaparotomy group (P = 0·007, P = 0·003, P = 0·03 and P = 0·006 respectively), and analgesic requirements were significantly lower (P = 0·001). At a median follow-up of 24·8 months there have been no tumour recurrences at the minilaparotomy incision sites.

Conclusion
A minilaparotomy approach to the curative resection of colonic cancer is an attractive alternative to conventional laparotomy in selected patients.
Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer
Authors: Tang C-L , Eu K-W , Tai B-C , Soh J G S , Machin D , Seow-Choen F 
Published: March 2003

Abstract

Background
Laparoscopic surgery is believed to produce an attenuated metabolic stress response and to have a less dampening effect on the immune response than open surgery. To date, the effect has not been studied in a randomized clinical trial of colorectal cancer.

Methods
The study was a two-armed randomized prospective trial conducted in parallel with the UK Medical Research Council's Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial comparing laparoscopically assisted colorectal surgery for left-sided tumours with conventional open surgery. Systemic immunity was assessed by determining the T- and B-cell counts, the CD4: CD8 ratio, the natural killer cell counts, the immunoglobulin (Ig) G, IgM and IgA levels, and C3 and C4 levels. The white cell phagocytic activity (nitroblue tetrazolium test) was studied before operation and on the third postoperative day.

Results
A total of 236 patients were randomized in the immune study between 11 March 1997 and 14 August 1999; 161 had complete preoperative and postoperative assays for the analysis of results. There was no difference in mean response between the two surgical groups for each of the immune parameters studied. The unadjusted difference for the primary endpoint, T-cell count, 3 days after operation was −1·6 per cent (95 per cent confidence interval −5·0 to 1·8 per cent).

Conclusion
There is no difference in the systemic immune response in patients having laparoscopically assisted colectomy compared with those undergoing conventional open surgery for colorectal cancer.
Book reviews
Authors: Bcrgqvist D , Cheslyn-Curtis S 
Published: March 2003

Abstract

Vascular Reconstructions: Anatomy, Exposures, and Techniques
J. J. Hoballah 285 × 219 mm. Pp. 393. Illustrated. 2000. New York: Springer. £65⋅00.

Schein's Common Sense Emergency Abdominal Surgery
M. Schein 235 × 156 mm. Pp. 382. Illustrated. 2000. Berlin: Springer. £30⋅50.
Radio-guided sentinel node detection for gastric cancer
Authors: Kitagawa Y , Fujii H , Mukai M , Kubota T , Otani Y , Kitajima M 
Published: March 2003

Abstract

Background
Radio-guided detection of sentinel nodes (SNs) has been used to predict regional metastases in patients with malignant melanoma and breast cancer. However, the validity of the SN hypothesis is still controversial for gastrointestinal cancers including gastric cancer. The aim of this study was to test the feasibility and accuracy of radio-guided mapping of SNs for gastric cancer.

Methods
Some 145 consecutive patients with gastric cancer diagnosed as T1 or T2 and evaluated clinically as N0 were enrolled. Endoscopic injection of technetium-99m-radiolabelled tin colloid was performed before operation and radioactive SNs were identified with a γ probe. Standard radical gastrectomy with lymphadenectomy was performed in all patients and all resected nodes were evaluated by routine histopathological examination.

Results
Using radio-guided methods, SNs were detected in 138 (95·2 per cent) of 145 patients. The SN was positive in 22 of 24 patients with lymph node metastasis. The incidence of metastasis in the SNs (7·8 per cent) was significantly higher than that in the non-SNs (0·3 per cent) (P &lt; 0·01). The diagnostic accuracy according to SN status was 98·6 per cent (136 of 138).

Conclusion
Radio-guided SN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with early-stage gastric cancer.
Percutaneous radiofrequency thermoablation as an alternative to surgery for treatment of liver tumour recurrence after hepatectomy
Authors: Elias D , De Baere T , Smayra T , Ouellet J F , Roche A , Lasser P 
Published: March 2003

Abstract

Background
Radiofrequency (RF) current, converted into heat through ion agitation and friction, can destroy liver tumours by means of coagulation necrosis. This study assessed whether percutaneous RF ablation is a useful and safe technique for the treatment of liver tumour recurrence after hepatectomy.

Methods
Forty-seven patients presenting with local recurrence after hepatectomy for malignant tumours (29 with colorectal secondaries) were treated with percutaneous RF ablation instead of repeat hepatectomy. RF thermal ablation was performed under image guidance for 12–15 min. This group represented 63 per cent of 75 patients treated with curative intent for liver recurrence in the same time interval. The other 28 patients underwent repeat hepatectomy.

Results
The mean(s.d.) number of liver metastases destroyed was 1·4(0·7) (range 1–3) and their diameter was 21(8) (range 9–35) mm. Twenty-six patients presented with liver recurrence at least once but up to three times after the initial RF application. Incomplete local RF treatment was observed in six of 47 patients. Fifteen patients developed extrahepatic recurrence. The mean(s.d.) interval between RF ablation and the last follow-up visit was 14·4(10·1) (range 5·5–40) months. One death and three major complications occurred. Survival rates at 1 and 2 years were 88 and 55 per cent respectively. A retrospective study of the authors' database over two similar consecutive periods showed that RF ablation increased the percentage of curative local treatments for liver recurrence after hepatectomy from 17 to 26 per cent and decreased the proportion of repeat hepatectomies from 100 to to 39 per cent.

Conclusion
Percutaneous RF treatment increases the number of patients eligible for curative treatment. It should be preferred to repeat hepatectomy when feasible and safe because it is less invasive. Repeat hepatectomy is indicated only when percutaneous RF ablation is contraindicated or fails.
Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum
Authors: Schmandra T C , Mierdl S , Bauer H , Gutt C , Hanisch E 
Published: March 2003

Abstract

Background
The ultrasonically activated scalpel (UAS) enables safe and effective laparoscopic tissue dissection, making hepatic resection feasible. This study compared blood loss and risk of gas embolism using the UAS during open hepatic resection and laparoscopic hepatic resection.

Methods
Female pigs were divided into two groups for laparoscopic (n = 7) and open (n = 5) left hepatic lobectomy. The UAS was used for both tissue cutting and coagulation. Laparoscopic liver resection was performed under carbon dioxide pneumoperitoneum (intraperitoneal pressure 12 mmHg). During surgery animals were monitored haemodynamically by an arterial line and Swan-Ganz catheter. Two-dimensional transoesophageal echocardiography (2D-TEE) was used to detect gas emboli with special attention to the right atrium and ventricle. Gas emboli were graded according to size, and correlated with haemodynamic and blood gas data.

Results
During open and laparoscopic hepatic resection the UAS resulted in minimal blood loss and effective tissue dissection. No air embolism was seen during open surgery. With laparoscopic hepatic resection 2D-TEE revealed gas embolism in all animals. Gas embolism was accompanied by cardiac arrhythmia in four of seven animals. No direct correlation was observed between embolism episodes and blood gas variables. There were no deaths after episodes of embolization. A significant decrease in arterial partial pressure of oxygen was seen at the end of the laparoscopic procedure in all animals.

Conclusion
The UAS causes minimal blood loss during both open and laparoscopic hepatic resection. Laparoscopic liver dissection under carbon dioxide pneumoperitoneum carries a high risk of gas embolism.
Systematic review and meta-analysis of interventions for postoperative fatigue
Authors: Rubin G J , Hotopf M 
Published: March 2003

AbstractBackgroundPostoperative fatigue is common, even after uncomplicated operations. Various theories have been presented regarding its aetiology, each suggesting different possible interventions. The purpose of this review was to identify all studies that have assessed interventions for postoperative fatigue and to evaluate these interventions using meta-analytical techniques.MethodsRandomized controlled trials of interventions, identified from a systematic search of relevant databases, were evaluated according to standardized criteria and categorized according to intervention modality. Data relating to the efficacy of each intervention at four different postoperative time-points were collated and data synthesis by meta-analysis was performed.ResultsAnalgesia is effective in reducing fatigue immediately after operation. Perioperative administration of human growth hormone reduces fatigue between 8 and 30 days after abdominal surgery. Weaker evidence was found to suggest an influence of glucocorticoid administration and of surgical technique on fatigue in the first week after operation. No evidence was found to support the theory that psychosocial or nutritional interventions affect the symptom.ConclusionWhile the results demonstrate that improved analgesia can attenuate immediate postoperative fatigue in most patient groups, further research is needed to determine whether the efficacy of human growth hormone and glucocorticoids extends beyond abdominal surgery. The paucity of research into cognitive–behavioural, sleep and activity-based interventions also needs to be addressed.