bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etiological analysis of chronic pancreatitis in 215 cases
Authors: QIAN Jia Ming , LI Jing Nan , TIAN Zi Li , LU Hong , TAO Li Ping 
Published: March 2003

OBJECTIVE:  To investigate the etiology of chronic pancreatitis in China.METHODS:  The causes of 215 cases of chronic pancreatitis treated at Peking Union Medical College Hospital between 1990 and 2000 were analyzed retrospectively.RESULTS:  The causes of chronic pancreatitis were biliary diseases (36.7%), alcoholic (26.5%), idiopathic (30.2%), and other uncommon causes such as auto­immune disease, recurrent acute pancreatitis, trauma and heredity. Among biliary diseases, the most common cause was cholecystolithiasis, followed by bile duct stone and cholecystitis.CONCLUSIONS:  The main cause of chronic pancreatitis in China is biliary disease. That caused by ethanol is increasing, and autoimmune disease is also receiving increasing attention.
Gene transfer of human vascular endothelial growth factor 165 for prevention of stent restenosis after transjugular intrahepatic portosystemic shunt
Authors: LI Zi Jun , CHENG Xiao Ming , HU Ping Jin , LUO Peng Fei , QIAO Hui , LIN Qiu Xiong , WANG Qi Yi 
Published: March 2003

OBJECTIVE:  To test the hypothesis that locally directed gene transfer of human vascular endothelial growth factor 165 (hVEGF165) is able to passivate hepatic venous metallic stents by accelerating endo­thelialization and augmenting the biocompatibility of endovascular stents.METHODS:  Complexes of pAdtrackCMV‐hVEGF165 and lipofectamine were smeared homogeneously on the surface of the stents coated with poly‐L‐lysine. Bare stents were used as controls. All stents were implanted into the right hepatic vein by transjugular intrahepatic venous stent deployment.RESULTS:  At the end of the first week after implantation, green fluorescence and the expression of the hVEGF165 gene were detected in the transferred stent vessels of the treated group, but were not detected in the control group. Scanning electron microscopy revealed that the endothelialization of stents was more pronounced in the treated group than that in the control group. At the end of the eighth week after implantation, quantitative angiography analysis showed the internal diameter of the stent was significantly greater in the treated group than in the control group. The de novo intima, their mean areas and percentage cross‐sectional area narrowing in the treated group were significantly less than those in the control group. Immunohistochemical analysis indicated that the proliferation of vascular smooth muscle cells was more active in the control group than that in the treated group.CONCLUSION:  Local gene transfer of hVEGF165 can passivate endovascular stents by accelerating stent endothelialization and enhancing their biocompatibility in the hepatic vein, resulting in a reduction of thrombus formation and attenuation of intimal hyperplasia.
Retrospective study on the need of intensive care unit admission after major head and neck surgery
Authors: To Edward W. H. , Tsang Wai M. , Lai Eric C. H. , Chu Ming C. 
Published: March 2003

Background: The present article aims to study the pattern and need of Intensive Care Unit admission after major head and neck operations. Methods: A retrospective study was undertaken of the hospital records of patients who underwent major head and neck operations during the period from February 1997 to February 2000 at the Division of Head and Neck Surgery, Department of Surgery, the Chinese University of Hong Kong. Results: A total of 268 consecutive elective major operations were carried out over the 3 year period. The patients’ age ranged from 14 to 82 years with a mean of 55 years. The male to female ratio was 4:1.Forty‐seven patients underwent an operation with a combination of major resection, neck dissection, flap reconstruction and tracheostomy (‘flaps group’). Two hundred and twenty‐one patients had major head and neck operations without the need of flap reconstruction (‘non‐flaps group’). Three (6.3%) out of 47 patients (flaps group) were admitted to intensive care unit (ICU) immediately after the operation. Only one patient (2.2%) out of the remaining 44 patients was admitted for emergency treatment 3 weeks post operation. All four patients recovered uneventfully.In the non‐flaps group of 221 patients, there were 12 (5.4%) planned admissions and 2 (0.96%) unplanned admissions to ICU. In the group of planned admissions, one out of the 12 patients died. The other two patients who were not planned for ICU admission died of basal meningitis that was disease‐related rather than related to the intensity of postoperative care. The overall admission rate to ICU was 18 (6.7%) out of 268 patients. The overall mortality was 1.1% (one planned, two unplanned). Conclusion: The present study showed that it is safe and cost‐effective to discharge the majority of patients after major head and neck operations back to a specialist ward for nursing care.
Proximal femoral osteotomy for the treatment of hip arthritis in young adults
Authors: Devane Peter A. , Coup Robert , Horne J. Geoffrey 
Published: March 2003

Background: The outcome of proximal femoral osteotomy for hip arthritis in young adults performed at the Wellington Hospital (Wellington, New Zealand) was reviewed. Methods: Seventeen patients underwent 21 proximal femoral osteotomies for the treatment of hip arthritis at Wellington Hospital between 1992 and 1999. Thirteen patients (17 hips) were contacted and were able to complete a questionnaire form specific for hip pain and function. Results: There was a response rate of 76.5% (13 out of a possible 17 patients undergoing proximal femoral osteotomy) at a mean 3 years 4 months postoperatively. Of these, one patient has had a total hip joint replacement and one patient is currently on the waiting list for a total hip joint replacement. Three other patients (three hips) report moderate or severe hip pain. The remaining eight patients (12 hips) report having mild or no hip pain. Questionnaire results show a postoperative decrease in hip pain in most patients. Hip function as assessed by the questionnaire was essentially unchanged. Conclusions: Proximal femoral osteotomy is a satisfactory option for young patients with degenerative hip arthritis. The operation is only likely to be useful in the treatment of pain.
Pattern of management of common bile duct stones in the laparoscopic era: A NSW survey
Authors: Dias Maxwell M. , Martin Christopher J. , Cox Michael R. 
Published: March 2003

Background: The management of common bile duct (CBD) stones in the laparoscopic era remains controversial with various management strategies employed by surgeons. The aim of this study was to ascertain the common practice across a single Australian state, and to see if a ‘best practice’ for CBD stone management could be established. Methods: A questionnaire was sent to 390 general surgeons in New South Wales in April 1999. Data collected included the type of practice, number of cholecystectomies performed, preoperative markers of CBD stones, indications for preoperative endoscopic retrograde cholangiopancreatography (ERCP), use of operative cholangiography (OC) and the management of CBD stones found on OC. Results: The questionnaire was returned by 223 (57%) surgeons. Fifty‐four (14%) of these respondents were excluded as they did not perform laparoscopic cholecystectomy, leaving 169 (43%) respondents for analysis. The preoperative indicators for CBD stones were ranked as: jaundice > dilated CBD on ultrasound > serum bilirubin > serum alkaline phosphatase/alanine aminotransferase > previous biliary pancreatitis. Preoperative ERCP would be performed by 88% for persistent jaundice or cholangitis, 33% for elevated liver function test, 25% for dilated CBD and 24% for biliary pancreatitis. Operative cholangiography is routinely performed by 67%, selectively by 29% and never by 4%. If CBD stones are encountered 47% would attempt laparoscopic clearance via the cystic duct or choledochotomy; however, 72% replied that they would use postoperative ERCP as part of their usual strategy for the management of CBD stones. Conclusions: There was no clear common pattern for the management of suspected or proven CBD stones. There were three management issues in which there was a ‘common practice’. These were: (i) the use of preoperative ERCP for patients with persistent jaundice or cholangitis; and the routine use of (ii) OC and (iii) postoperative ERCP to clear the CBD, assuming other methods had failed.
Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin
Authors: Sangthawan Pornpen , Fox Jane , Atkins Robert C. , Kerr Peter G. 
Published: March 2003

Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. Methods: The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. Results: In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25–70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25–18.5 years). Eighty‐seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had ‘dense mammograms’, all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. Conclusion: The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.
Laparoscopic transcystic bile duct stenting in the management of common bile duct stones
Authors: Martin Christopher J. , Cox Michael R. , Vaccaro Lisa 
Published: March 2003

Background: The management of patients with common bile duct stones associated with stones in the gall bladder remains controversial. Methods: Over the three‐year period from 1996 to 1999, patients with cholelithiasis and known choledocholithiasis, or choledocholithiasis found at laparoscopic cholecystectomy, were initially treated by placing a stent across the sphincter of Oddi. The stent was pushed along a guide wire through the cystic duct and then down the common bile duct, before the cystic duct was closed. Subsequently, the stent was used to facilitate performance of a needle knife endoscopic sphincterotomy. The stent was then removed, a cholangiography was performed and the common bile duct was cleared. Patients with persistent jaundice usually had a preoperative endoscopic retrograde cholangio‐pancreatography. Results: Transcystic stenting was the ‘intention‐to‐treat’
basis of therapy for 56 of the patients. The placement of the stent only failed once
when the stent became trapped in the cystic duct. Complications of the operation
included: pain and jaundice (n = 2), cholangitis (n = 1), and pulmonary
embolus (n = 1). The median postoperative hospitalization was 2 days (range: 1–15). Five further patients had common bile duct stones removed via a choledochotomy; a stent was placed through the choledochotomy before its closure. The selective common bile duct cannulation rate at the first endoscopic retrograde cholangio‐pancreatography, was 98%. A second endoscopic retrograde cholangio‐pancreatography was required in 15% of patients. The only complication of all the endoscopic procedures was a single case of mild cholangitis; there were no cases of pancreatitis. Conclusion: A treatment option open to all surgeons for non‐jaundiced patients with known choledocholithiasis or choledocholithiasis found at operative cholangiogram, is the transcystic stenting of the sphincter of Oddi at the time of laparoscopic cholecystectomy. At a subsequent sitting, the common bile duct can be safely cleared endoscopically using a sphincterotomy facilitated by the stent.
Primary melioidotic prostatic abscess: Presentation, diagnosis and management
Authors: Tan James K. , Yip Sidney K. H. , Png Damian J. C. , Moorthy P. 
Published: March 2003

Introduction:  In South‐East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community‐acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare.Methods:  The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study.Results:  The mean age at presentation was 53 years (range: 29−69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re‐resection while another patient developed severe septic shock requiring intensive care and ­inotropic support. There was no mortality in our series.Conclusions:  Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome.
Inguinal hernia repair: Where to next?
Authors: Zib Martina , Gani Jon 
Published: March 2003

Background:  Hernia repair is one of the most frequently performed operations in general surgery − a total of 39 000 elective inguinal hernia repairs were performed in public and private hospitals in Australia between July 1998 and June 1999 − and, as such, even minor alterations in outcome and resource use have appreciable impact. However, decisions regarding choice of operation for hernia repair remain controversial. The purpose of the present paper is to critically evaluate the evidence available regarding recently introduced open mesh repair techniques and to try to identify meaningful directions for future hernia research.Methods:  A thorough search of all published surgical literature was undertaken. Medline, EMBASE and the Cochrane databases were searched by title, by key words and by author. References in review articles and in textbooks were pursued. The manufacturing companies were contacted for trials evaluating their product.Results:  Eight original articles evaluating either the Kugel Patch, the PerFix Plug or the Prolene Hernia System were located. None of these trials directly compared two or more of these repair systems. To date, there has been no published review of the evidence regarding the newer mesh repair techniques. With one exception, all of these articles qualify as Level IV evidence. Highlighted is the lack of evidence regarding chronic significant posthernioplasty pain − this has an incidence of 6−12%. This complication is 3−5 times more common than recurrence after open repair, is clinically relevant, is poorly understood and has been poorly studied. Arguably it is a more important end point than recurrence.Conclusion:  Only one study comparing the newer techniques of open hernia repair (PerFix Plug) constitutes Level II evidence. The PerFix Plug appears to be quicker to insert and uses a smaller incision. Chronic significant posthernioplasty pain is a more important endpoint in hernia research than is recurrence, and this review concludes with a proposal for a multicentre, randomized, controlled trial evaluating the incidence of chronic significant posthernioplasty pain following elective mesh repair of primary, unilateral ­hernias.
Same‐day lymphoscintigraphy and sentinel node biopsy for early breast cancer
Authors: Sutton Richard , Kollias James , Prasad Varni , Chatterton Barry , Grantley Gill P. 
Published: March 2003

Background:  Lymphoscintigraphy and sentinel node biopsy are currently being assessed as an alternative to axillary dissection for staging in early breast cancer. However, little is known about the optimum timing of surgery following injection of the radio­isotope into the breast. The aim of the present study was to establish whether lymphoscintigraphy on the morning of surgery allowed efficacious and accurate sentinel node identification and biopsy.Methods:  We reviewed our experience of 216 consecutive cases of lymphoscintigraphy in early breast cancer using peritumoural injections of technetium99m antimony sulphide colloid and subsequent sentinel node biopsy using a hand‐held gamma probe and blue dye. The time interval between radioisotope injection and successful intraoperative identification of the sentinel node was assessed and whether this was associated with certain clinical and histological variables.Results:  The sentinel node was identified by lymphoscintigraphy in 160 cases (74%) at a median time duration of 40 min post injection. The median time duration between isotope injection and surgery was 5 h. Of the 160 cases where the sentinel node was visualized at lymphoscintigraphy, sentinel node biopsy was successfully performed in 155 cases (97%). This compares with 25/56 (45%) cases where lymphoscintigraphy failed to localize the sentinel node (P < 0.0001). There was no association found between the injection of the radioisotope greater or less than 5 h before surgery and the successful intraoperative identification of the sentinel node. Failure to identify the sentinel node at lymphoscintigraphy beyond 3 h was associated with a low intraoperative identification rate. There was no correlation found between intraoperative identification of the sentinel node according to the duration of isotope injection in relation to surgery and the various clinical and histological factors assessed.Conclusions:  In our experience, the chance of identifying the sentinel node at the time of surgery does not increase with longer isotope injection duration using technetium99m antimony sulphide colloid. As soon as a sentinel node is identified at lymphoscintig­raphy, one can proceed to surgery. Scanning beyond 3 h does not appear to be effective in sentinel node localization. Given that the median time for successful lymphoscintigraphic mapping was only 40 min, lymphoscintigraphy can easily be completed during the morning to allow surgery to take place the same day.
Small bowel obstruction: Is routine colonoscopy necessary after resolution?
Authors: Chew Simon Sun Beng , Ngo Tru , Crowe Philip John 
Published: March 2003

Background:  Small bowel obstruction is common in clinical practice and is most often due to adhesions. The aim of this study was to determine the significance of colon cancer presenting as a small bowel obstruction at a single institution and to find out whether routine colonoscopy was necessary in patients who had spontaneous resolution of their small bowel obstruction.
Methods:  A retrospective review of the medical records of patients presenting with small bowel obstruction from 1995 to 2000 at the Prince of Wales Hospital was performed. The clinical outcomes were obtained from the medical records and the clinical notes of each surgical consultant.
Results:  Over the study period, 251 patients presented with small bowel obstruction. The mean age at presentation was 63.8 years (range 21−95 years). A total of 149 patients (59.4%) were treated conservatively with an average hospital stay of 4.6 days (range 1−20 days). Another 100 patients (39.8%) were treated operatively with a mean time from presentation to operation of 2.2 days (range <24 h−14 days). The remaining two patients (0.8%) were managed palliatively because of known metastatic disease. At laparotomy, 13 patients (13%) had a colon cancer identified. A further three patients were identified to have a colon cancer on follow up colonoscopy. However, only one of the three patients had had a previous laparotomy, that is, only 0.7% (1/149) of patients with a spontaneously resolved small bowel obstruction (presumably secondary to adhesions) had actually had colon cancer.
Conclusions:  The overall incidence of small bowel obstruction secondary to colon cancer is significant at 6.4%. However, as the incidence of colon cancer in patients who had had a previous laparotomy and spontaneous resolution of their obstruction was very low at 0.7%, routine colonoscopy does not seem warranted.
Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma
Authors: Mooney William W. W. , Cole Ian , Albsoul Nader , Pearson Sallie‐Ann 
Published: March 2003

Background:  Partial laryngectomy after failure of radiotherapy for early glottic cancer is an accepted surgical salvage procedure. However,there have been only a few studies on recurrent disease or long‐term survival.Methods:  Twenty‐one patients who were treated with salvage partial vertical laryngectomy (PVL) following failure of primary radiotherapy were prospectively studied. Median follow up was 69 months(range 24−204 months). Patients were seen at two‐ monthly intervals for the first 24 months and then 3−4 monthly for 5  years after their partial surgery or until death.Results:  Local control was 71.4% (15/21).Among the six patients who recurred within the larynx, two patients developed a second primary; one on the ipsilateral false cord at 24  months and the other on the contra‐lateral vocal cordat 10 years. The no evidence of disease rate following salvage PVL was 95%, 85% and 73% at 12,24 and 36  months, respectively, with a mean disease free interval of 34.9 months (range 7−120). Survival was 90%, 85% and 80% at 12, 24 and 36  months, respectively, with a median survival of 152  months forthe group. Three patients died of their disease and four from other causes. Four local recurrences occurred within 32  months.Two developed neck metastases and died of their disease. Four patients were treated successfully with completion laryngectomy. Only one of these died, but this was due to a second primary squamous cell carcinoma in the lung. Three of the four patients with local recurrences had an extended procedure.Conclusion:  Partial vertical laryngectomy is an excellent alternative to total laryngectomy for salvage following failure of ­radiation.Although local recurrence occurred more frequently in those patient shaving an extended partial procedure, this was not statistically different.