bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged molecular remission in advanced acute promyelocytic leukaemia after treatment with gemtuzumab ozogamicin (MylotargTM CMA‐676)
Authors: Petti Maria C. , Pinazzi Maria B. , Diverio Daniela , Romano Atelda , Petrucci Maria T. , De Santis Silvia , Meloni Giovanna , Tafuri Agostino , Mandelli Franco , Lo Coco Francesco 
Published: March 2003

We report a patient with acute promyelocytic leukaemia (APL) who received two doses of gemtuzumab ozogamicin for advanced disease. Previous treatments included front‐line all‐trans retinoic acid and anthracyclines, polychemotherapy consolidation, salvage chemotherapy for the first relapse followed by autologous stem cell transplantation (ASCT), arsenic trioxide for the second relapse followed by a second ASCT and then high‐dose methotrexate for more advanced systemic disease with central nervous system involvement. The patient achieved prolonged haematological and molecular remission after monotherapy with gemtuzumab ozogamicin given at the time of the third relapse.
Assessment of combined bile acid and pH profiles using an automated sampling device in gastro-oesophageal reflux disease
Authors: Nehra D , Howell P , Pye J K , Beynon J 
Published: March 2003

Abstract

Background
Bile acid reflux is an important component of duodenogastro-oesophageal reflux but there is no effective method of quantifying it. The contribution of bile acids to oesophageal pH is unknown.

Methods
Oesophageal aspirates were collected over 15 h using a new automated suction device and pH was monitored in ten asymptomatic volunteers (group 1) and 30 patients with reflux oesophagitis (group 2, minimal mucosal injury; group 3, erosive oesophagitis; group 4, stricture or Barrett's oesophagus). Bile acid assay was performed by high-performance liquid chromatography.

Results
The concentration of bile acids was significantly higher in group 3 (median (interquartile range) 124 (50–301) µmol/l) and group 4 (181 (85–591) µmol/l) compared with group 1 (0 µmol/l) and group 2 (14 (0–100) µmol/l). Patients in groups 3 and 4 also had significantly greater DeMeester acid scores. Combined bile acid and oesophageal acid reflux was observed in eight of ten patients with stricture or Barrett's oesophagus. There was no correlation between total bile acid concentration and oesophageal acid or alkaline exposure.

Conclusion
This study supports the theory of toxic synergism between acid and bile acids in reflux oesophagitis. Bile acids may contribute to the pathogenesis of Barrett's metaplasia.
Correlation of the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in primary varicose veins
Authors: Sakurai T , Gupta P C , Matsushita M , Nishikimi N , Nimura Y 
Published: March 2003

Abstract

Aim
The aim of this study was to correlate the anatomical distribution of venous reflux with clinical symptoms and venous haemodynamics in patients with primary varicose veins.

Methods
Venous reflux was examined using duplex colour Doppler ultrasonography in 266 legs in 191 patients. The venous refilling and reflux times were also measured.

Results
Of the 266 legs, 82 per cent had reflux in the long saphenous vein (LSV), 26 per cent in the short saphenous vein (SSV), 62 per cent had incompetent perforators (IPs) in the calf and 48 per cent had reflux in the deep veins. LSV reflux combined with SSV reflux and/or IPs was associated significantly with severe venous disease and abnormal venous haemodynamics. Femoropopliteal reflux played a role in the development of venous eczema and ulcers when combined with superficial venous reflux.

Conclusion
Patients at high risk of developing complications of venous disease may be identified by an accurate non-invasive evaluation of reflux patterns.
Effect of colonic obstruction on the distribution of matrix metalloproteinases during anastomotic healing
Authors: Savage F J , Lacombe D L P , Hembry R M , Boulos P B 
Published: March 2003

Abstract

Background
Anastomotic dehiscence is common after surgery for colonic obstruction. The strength of an anastomosis is dependent on collagen, which is degraded by matrix metalloproteinases (MMPs). The aim of this study was to determine the distribution of the MMPs and their inhibitor, tissue inhibitor of metalloproteinases (TIMP) 1 in an experimental model of colonic obstruction, with and without resection and anastomosis.

Methods
The distal colon of rabbits was obstructed with a Silastic ring for 24 h and then either the ring was removed or the obstructed segment was resected and an anastomosis formed. Rabbits were killed immediately or at intervals for up to 7 days after operation. The distribution of the MMPs and TIMP-1 was examined by indirect immunofluorescence.

Results
MMPs and TIMP-1 were present throughout the descending colon for 24 h in both groups. They persisted to the third day in rabbits with an anastomosis but by day 7 were restricted to the suture line. Their presence correlated with microscopic damage.

Conclusion
The extensive distribution of the MMPs suggests that these enzymes contribute to anastomotic dehiscence, but only in the immediate postoperative period.
Avoidable deaths still occur after large bowel surgery
Authors: Macarthur D C , Nixon S J , Aitken R J 
Published: March 2003

Abstract

Background
Postoperative death following large bowel surgery is relatively infrequent and no large study has analysed the cause of all deaths comprehensively and critically.

Methods
In-hospital deaths following large bowel surgery in South-East Scotland were reviewed by independent assessors. The audit was confidential but not anonymous. Independent assessors' reports were returned to consultants.

Results
The audit documented 187 deaths. The independent assessors noted an adverse event in 78 patients (42 per cent). Twenty-six deaths (14 per cent) occurred following an anastomotic leak. A further 43 deaths (23 per cent) occurred because surgery was delayed (17) or there was undue delay in making the initial diagnosis (12) or recognizing a developing complication (14). Consultants operated on only half the patients classed as American Society of Anesthesiologists grade IV or V, or undergoing a second or subsequent operation.

Conclusion
Half the patients dying in this study had identifiable deficiencies in their management. There is a clear need for greater consultant input with critically ill patients.
Bile duct injury during laparoscopic cholecystectomy without operative cholangiography
Authors: Wright K D , Wellwood J M 
Published: March 2003

Abstract

Background
The role of operative cholangiography in the prevention of bile duct injuries is controversial. A prospective audit of biliary injury is presented.

Methods
Laparoscopic cholecystectomy without operative cholangiography was undertaken in a consecutive series of 1200 patients. All biliary injuries were recorded.

Results
Meticulous dissection proved to be a reliable safeguard against injury to the right hepatic, common hepatic and common bile ducts. However, four accessory ducts were sacrificed and localized injury to the common hepatic or common bile duct occurred in three patients. These injuries would not have been prevented by operative cholangiography.

Conclusion
Operative cholangiography is not a prerequisite for the safe performance of laparoscopic cholecystectomy and cannot be relied upon to prevent all biliary injuries.
Hepatic resection with cryotherapy to involved or inadequate resection margin (edge freeze) for metastases from colorectal cancer
Authors: Dwerryhouse S J , Seifert J K , Mccall J L , Iqbal J , Ross W B , Morris D L 
Published: March 2003

Abstract

Background
In patients undergoing liver resection for colorectal liver metastases, a resection edge either involved by tumour or with the tumour extending to within 1 cm is associated with a high risk of liver recurrence and survival is reduced markedly.

Methods
Twenty-six patients underwent cryotherapy of the resection edge following liver resection for metastases from colorectal carcinoma with an involved or inadequate (less than 1 cm) resection margin.

Results
At a median follow-up of 23 (range 1–47) months four patients were alive and disease free, and 21 had developed recurrence, of whom 13 had died. One patient died following surgery. Sixteen patients developed recurrences involving the liver, only five of which were at the resection margin.

Conclusion
Cryotherapy to involved or inadequate resection margins improves local disease control considerably. The use of resection edge cryotherapy might allow a greater proportion of patients with liver metastases to be usefully treated and help to avoid high-risk resections.
Improved survival in patients with rectal cancer: a population-based register study
Authors: Dahlberg M , Påhlman L , Bergström R , Glimelius B 
Published: March 2003

Abstract

Background
Between 1985 and 1989, only one centre in Sweden combined preoperative radiotherapy with total mesorectal excision (TME) in the primary treatment of rectal cancer. The aim of this study was to investigate whether this change in primary treatment had an impact on the outcome.

Method
The survival rate of 94 262 patients with colorectal cancer from the total Swedish population between 1960 and 1989 was analysed.

Results
A continuous improvement in relative survival rate occurred during the first year of follow-up for both colonic and rectal cancer. Some improvement was also seen during follow-up years 2–5, but this was much more pronounced during the last period (1985–1989) for rectal cancer in the county of Uppsala. The improvement was particularly marked during follow-up years 3–5.

Conclusion
There are strong indications from this study that altered primary treatment for rectal cancer results in improved long-term survival.
Anovestibular fistula to Bartholin's gland
Authors: Cripps N P J , Northover J M A 
Published: March 2003

Abstract

Background
Acquired fistulation from the anal canal to Bartholin's gland has not been reported before. This fistula has been identified in 11 women treated between 1991 and 1995.

Methods
All discharge diagnoses during this period were searched. The clinical records of patients managed for this diagnosis were reviewed.

Results
Eleven women aged 24–49 years were identified. Seven of 11 fistulas arose in association with inflammatory bowel disease (five Crohn's disease, two ulcerative colitis). Patients typically presented with the vulval passage of flatus and faeces or acute sepsis of Bartholin's gland. Time to diagnosis of the fistula ranged from 1 to 15 (median 8) months after the onset of symptoms. Anatomically, all fistulas were high trans-sphincteric or suprasphincteric. All eight fistulas for which repair was attempted (five in the presence of inflammatory bowel disease) remain healed at short-term follow-up. Proctocolectomy was undertaken in two patients with severe Crohn's colitis.

Conclusion
Ano–Bartholin's fistulas, although rare in general surgical practice, present with troublesome symptoms and may be repaired successfully. Gynaecologists and surgeons should be aware of this clinical entity to avoid unnecessary delays in treatment.
Multimodality treatment in the control of deep musculoaponeurotic fibromatosis
Authors: Skene A I , Barr L , A'Hern R P , Fisher C , Meirion Thomas J 
Published: March 2003

Abstract

Background
Deep musculoaponeurotic fibromatoses are rare soft tissue neoplasms with a propensity for local recurrence.

Methods
A retrospective analysis was carried out of the factors contributing to local disease control in 75 patients treated between 1963 and 1993.

Results
Multivariate analysis identified the type of surgical excision (P&lt;0·001) and involvement of pathological resection margins (P&lt;0·02) as significant factors contributing to local recurrence. After a median follow up of 47 months (range 24 months to 29 years) 31 (49 per cent) of the 63 patients who had an ‘adequate’ surgical resection developed local recurrence. The median time before development of local recurrence was 83·4 (range 8–129) months in patients with clear pathological resection margins. This was significantly shortened to 13·1 (range 2–35) months in those with positive margins (P&lt;0·001).

Conclusion
Adequate surgical extirpation is the most important determinant in local disease control. Treatment of local recurrence ranged from observation during periods of disease stabilization to multimodality treatment for aggressive disease.
Prospective randomized trial of woven versus collagen-impregnated knitted prosthetic Dacron grafts in aortoiliac surgery
Authors: Quarmby J W , Burnand K G , Lockhart S J M , Donald A E , Sommerville K M , Jamieson C W , Browse N L 
Published: March 2003

Abstract

Background
Despite the theoretical advantages of coating knitted grafts with a material designed to reduce blood loss, their performance has not been directly compared with woven grafts in a prospective randomized trial. The aim of this study was to compare the graft handling qualities and operative blood loss of the two types of arterial prosthesis, as well as complication rate and patient survival at 1 year.

Methods
A total of 267 consecutive patients having surgery for occlusive or aneurysmal disease of the aortoiliac arteries were randomized to receive woven (141 patients) or knitted collagen-impregnated Dacron (126 patients) grafts. Graft patency was assessed on discharge and at 1 year by duplex imaging.

Results
Mean(s.d.) intraoperative blood loss was statistically greater with woven grafts (1690(1424) ml) compared with knitted (1363(1172) ml) (P = 0·049). An insignificant 1-year increase in mean(s.d.) graft diameter of 1·2(0·2) mm was found at the distal anastomosis in the knitted group. There was no difference in graft patency between the groups and only one graft became infected.

Conclusion
This study suggests that knitted and woven grafts have similar clinical performance and therefore the less expensive material (woven) should usually be selected unless haemorrhagic complications are anticipated.
Mortality following elective infrarenal aortic reconstruction: a Joint Vascular Research Group study
Authors: Galland R B 
Published: March 2003

Abstract

Background
This study aimed to define the cause of death in patients undergoing elective infrarenal aortic reconstruction.

Methods
Members of the Joint Vascular Research Group who had collected details prospectively of patients undergoing elective aortic reconstruction provided information on those who died.

Results
Details of 3786 patients were obtained. Some 171 patients died (133 following abdominal aortic aneurysm (AAA) and 38 after aortofemoral bifurcation graft (AFBG) for occlusive disease). The mortality rate following AAA repair was 4·8 per cent, rising to 16 per cent if repair was combined with either renal or distal reconstruction (P &lt; 0·001). Similar results were obtained with AFBG (3·4 and 11 per cent respectively, P &lt; 0·001). The first major complication encountered was cardiac (39·8 per cent), followed by bleeding (20·5 per cent), respiratory (13·5), and gut (5·3 per cent), or limb ischaemia (6·4 per cent). Bleeding was commoner following reconstruction for aneurysm compared with that for occlusive disease (P &lt; 0·05). Eighty-six patients (50·3 per cent) died from the first major complication. Of the remainder, 45 (53 per cent) developed multisystem organ failure (MSOF). The most commonly involved systems were cardiac, respiratory and renal.

Conclusion
Cardiac problems were the major cause of death following infrarenal aortic reconstruction. MSOF is the ‘final common pathway’ in about half of the patients who survive the initial complication.
Surgical treatment of severe duodenal polyposis in familial adenomatous polyposis
Authors: Penna C , Bataille N , Balladur P , Tiret E , Parc R 
Published: March 2003

Abstract

Background
Patients with familial adenomatous polyposis (FAP) are at risk for adenomas and cancers in the duodenum but the ideal management of duodenal polyposis remains uncertain.

Methods
The outcome of surgical resection was analysed in 18 patients with FAP who had severe duodenal polyposis.

Results
Duodenotomy and clearance of duodenal adenomas was performed seven times in six patients. There were two duodenal leaks and, after a mean follow-up of 53 (range 36–72) months, duodenal adenomas recurred in all patients and five had severe polyposis. Pancreatoduodenectomy was performed in seven patients with severe duodenal polyposis. Histology of the specimens revealed two unsuspected duodenal carcinomas at an early stage. After a mean follow-up of 42 months all patients were alive and well, and there was no case of jejunal polyposis. Pancreatoduodenectomy was attempted in five patients with duodenal cancer and only one survived more than 4 years.

Conclusion
Surgical excision of duodenal adenomas should be discussed before carcinoma occurs. Surgical polypectomy fails to guarantee a polyp-free duodenum and carries a risk of postoperative complications whereas pancreatoduodenectomy eliminates the risk of duodenal cancer with an acceptable morbidity rate. Pancreatoduodenectomy could be offered to some patients with large or multiple villous duodenal adenomas repeatedly showing severe dysplasia.
Percutaneous aspiration for bacteriological studies in patients with necrotizing pancreatitis
Authors: Paye F , Rotman N , Radier C , Nouira R , Fagniez P-L 
Published: March 2003

Abstract

Background
Percutaneous computed tomography (CT)-guided aspiration of abdominal collections is performed in necrotizing pancreatitis to detect infection of necrosis, which is an adverse prognostic factor and requires surgical drainage. However, in the case of sterile aspirates, the outcome and the optimum management are subject to debate. This study examined the clinical and bacteriological outcome of patients with severe acute pancreatitis with initially sterile necrosis and assessed the efficiency of percutaneous drainage in this setting.

Methods
Seventeen patients hospitalized for necrotizing pancreatitis with a septic course underwent a preliminary sterile CT-guided aspiration. Eight patients underwent simultaneous percutaneous drainage of the punctured collection. Supportive therapy was continued unless severe clinical deterioration or proven secondary infection of necrosis indicated the need for necrosectomy and drainage.

Results
Secondary infection of necrosis was observed in two patients of nine who had only fine-needle aspiration cytology of the collection, and in seven of eight it was drained percutaneously (P=0·01). Only one patient drained percutaneously recovered without surgery. Surgical drainage was required in 12 patients. The hospital mortality rate was 29 per cent and was not significantly affected by the bacteriological status of necrosis.

Conclusion
Percutaneous drainage of sterile collections predisposed to secondary infection of the necrosis and did not cure the patients. A first sterile percutaneous aspiration did not predict a favourable course and surgery frequently remains necessary.
Management of faecal incontinence following obstetric injury
Authors: Cook T A , Mortensen N J McC 
Published: March 2003

Abstract

Background
Faecal incontinence is common in women and the major aetiological factor is childbirth. Increasing numbers of women with faecal incontinence are presenting to surgical clinics.

Methods
A literature review was performed on Medline database for English language publications on obstetric injury. The incidence, presentation, assessment and treatment of faecal incontinence following obstetric injury were evaluated.

Results and conclusions
Third-degree tear occurs in association with less than 1 per cent of vaginal deliveries, but occult sphincter injury occurs at one-third of deliveries and may be significant in later life. Incontinence may result from sphincter damage or nerve injury, or both. Risk factors for these injuries can be identified. Clinical evaluation, anorectal physiology and endoanal ultrasonography allow accurate planning of subsequent surgery. Overlapping anterior anal sphincter repair provides symptomatic control of continence in 80 per cent of patients. Repair of an acute anal sphincter injury after a third-degree tear is controversial and a defined policy should be agreed between obstetric and colorectal teams.
Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients
Authors: Mccleary A J , Nelson M , Dearden N M , Calvey T A J , Gough M J 
Published: March 2003

Abstract

Background
Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting.

Methods
Nine patients who underwent carotid angioplasty and stenting were monitored using near-infrared spectroscopy, continuous jugular venous oximetry and transcranial Doppler ultrasonography to detect both haemodynamic ischaemia and embolic events.

Results
Significant ischaemia occurred in four of the nine patients once the stenosis had been crossed by the guidewire (spectroscopy and oximetry). Inflation of the angioplasty balloon resulted in a brief period of ischaemia and showers of emboli in all patients (ultrasonography) and this persisted for more than 3 min after balloon deflation in three patients. One patient had a major disabling stroke due to ICA thrombosis.

Conclusion
Angioplasty and stenting in these high-risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization.
Functional results following the antegrade continence enema procedure
Authors: Shankar K R , Losty P D , Kenny S E , Booth J M , Turnock R R , Lamont G L , Rintala R J , Lloyd D A 
Published: March 2003

Abstract

Background
Forty children who underwent the antegrade continence enema (ACE) procedure for faecal soiling were studied to determine factors predictive of outcome.

Methods
There were four patient groups: (1) ambulant with spinal dysraphism (n = 13), (2) wheelchair bound with spinal dysraphism (n = 14), (3) ambulant with miscellaneous disorders (n = 11) and (4) wheelchair bound with miscellaneous disorders (n = 2). Effectiveness of the procedure was assessed using technical evaluation and quality-of-life improvement (QOLI) scores (0–5). Objective assessment included colonic transit time (CTT) and anorectal manometry. Median follow-up was 21 (range 5–37) months.

Results
Some 28 of 40 children achieved continence. The procedure was reversed in four of 40 children. Of the other 36 children with a functioning ACE stoma, all reported improvement in quality of life (mean QOLI score 3·5). There were no significant differences in technical evaluation score, QOLI score, CTT, manometry findings or continence between ambulant groups and the wheelchair-bound group with miscellaneous disorders. QOLI score, anorectal squeeze pressure and continence were significantly poorer in those who were wheelchair bound with spinal dysraphism. Absent squeeze pressure was associated with poor outcome.

Conclusion
Wheelchair-bound children with spinal neuropathy have a poorer outcome following the ACE procedure. Although ACE is an effective method of promoting faecal continence, it is essential to determine the aetiology of incontinence and sphincter function before operation.