bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic antireflux surgery in the treatment of the acid-sensitive oesophagus
Authors: Booth M I , Stratford J , Thompson E , Dehn T C B 
Published: March 2003

Abstract

Background
Approximately 10 per cent of patients referred for 24-h oesophageal pH tests with symptoms suggestive of gastro-oesophageal reflux disease will have a normal endoscopic examination and normal distal oesophageal acid exposure times, but a clear temporal correlation between their symptoms and episodes of acid reflux. These patients have an ‘acid-sensitive oesophagus’, which forms part of the spectrum of reflux-related conditions. Their response to antireflux surgery has not been reported previously. This study represents a prospective cohort analysis of a clearly defined group of patients with acid-sensitive oesophagus who have undergone laparoscopic antireflux surgery.

Methods
Nineteen patients (nine male and ten female; median age 32 years) underwent laparoscopic antireflux surgery for acid-sensitive oesophagus. All had had an incomplete response to medical therapy.

Results
Eighteen of 19 patients were graded Visick I or II at 6 months after operation; all 16 patients followed for 1 year were graded Visick I or II. There were significant falls in DeMeester symptom score (4·0 versus 0·5; P &lt; 0·001), symptom events (20 versus none; P &lt; 0·001), number of reflux episodes (17 versus two; P &lt; 0·001) and overall acid exposure times (1·2 versus 0·3 per cent; P &lt; 0·001) after operation.

Conclusion
Laparoscopic antireflux surgery is a valid and effective treatment for patients with an acid-sensitive oesophagus.
Fate of hypertension after repair of coarctation of the aorta in adults
Authors: Bhat M A , Neelakandhan K S , Unnikrishnan M , Rathore R S , Mohan Singh M P , Lone G N 
Published: March 2003

Abstract

Background
Unrepaired aortic coarctation is known to have a detrimental effect on survival. The benefit of coarctation repair on systolic hypertension in adults has been questioned. This retrospective study was conducted to evaluate the impact of repair of aortic coarctation on systolic hypertension in adults.

Methods
Repair of aortic coarctation was performed in 84 patients aged 16–54 (mean 29) years. All patients were hypertensive before surgical intervention (mean systolic blood pressure 162 mmHg; mean diastolic blood pressure 93 mmHg). All patients underwent echocardiography and/or cardiac catheterization. The peak mean systolic gradient across the coarctation was 60 mmHg. The patients were followed after coarctation repair for between 1 and 12 (mean 5·2) years.

Results
There was significant regression of hypertension (P &lt; 0·001) in all patients. Thirty-five patients (42 per cent) did not need any antihypertensive medication 3 months after surgery. The prevalence of hypertension at the last follow-up (after mean 5·2 years) was 31 per cent.

Conclusion
Surgical repair of coarctation of the aorta in adults leads to regression of systolic hypertension and a decreased requirement for antihypertensive medication.
Interleukin 6 and the prognosis of abdominal aortic aneurysms
Authors: Jones K G , Brown L C , Brull D J , Humphries S E , Greenhalgh R M , Powell J T 
Published: March 2003

Abstract

Background
Abdominal aortic aneurysm (AAA) is a familial disorder, inflammation being an important pathophysiological feature. Increased plasma concentrations of the inflammatory cytokine interleukin (IL) 6 have been associated with AAA and early aortic dilatation. This study was designed to test the hypothesis that high concentrations of plasma IL-6 and/or IL-6 genotype predict rapid AAA growth.

Methods
Genomic DNA from 466 patients, kept under ultrasonographic surveillance for small AAAs, was analysed for a G to C polymorphism at position −174 of the IL-6 promoter. Baseline plasma IL-6 concentration was measured by enzyme-linked immunosorbent assay and AAA growth rates were calculated by linear regression.

Results
The median concentration of plasma IL-6 was 4·9 (range 0–604) pg ml−1. IL-6 concentration was not associated with aneurysm growth rate. The frequency of the C allele was 0·40, similar to that in the healthy population. Patients of GG genotype had a lower plasma concentration of IL-6 than patients of either GC or CC genotype (median 1·9, 4·8 and 15·6 pg ml−1 respectively; P = 0·047, Kruskal–Wallis test). The AAA growth rate for patients of GG, GC and CC genotypes was 0·38, 0·36 and 0·36 cm per year respectively (P = 0·37). Mortality was lower for patients of GG genotype than for those with GC or CC genotype: hazard ratio 0·51 (95 per cent confidence interval (c.i.) 0·25–1·00), P = 0·05; and 0·32 (95 per cent c.i. 0·12–0·93), P = 0·036, for all-cause and cardiovascular mortality respectively.

Conclusion
Genetic polymorphism is associated with clinical events in patients with an AAA. The G to C IL-6 polymorphism at position −174 predicts future cardiovascular mortality. Neither plasma IL-6 concentration nor IL-6 genotype predicts AAA growth.
Evaluation of duplex ultrasonography versus other investigations in the diagnosis of ‘venous aetiology’ in patients with leg ulcers
Authors: Drinkwater S , McGuinness C , Lockhart S , Burnand K 
Published: March 2003

Abstract

Background
The aim was to compare duplex imaging, venography, foot volumetry and air plethysmography in patients with healed leg ulcers considered to be caused by venous disease to discover whether duplex scanning alone could confirm a venous aetiology. The importance of isolated reflux in a segment of the deep system below a competent valve was assessed.

Methods
A total of 125 patients with 153 healed leg ulcers was examined. An Acuson (Mountain View, California, USA) scanner was used to detect reflux lasting for more than 0·5 s in the deep, superficial and calf perforating veins; the findings were compared with those obtained with ascending venography, foot volumetry and air plethysmography.

Results
Thirteen legs showed no reflux on duplex imaging, but ten of these had abnormal foot volumetry and 12 had abnormal plethysmography. Venography showed post-thrombotic change in 26 legs, but there was evidence of deep venous scarring in only six on duplex ultrasonography. Eight of 75 legs with a normal venogram had ‘complete’ (thigh-to-calf) deep reflux on duplex imaging. Forty-five legs showed segmental deep reflux on duplex imaging, of which 29 had associated perforating vein incompetence. Mean half-refilling times on foot volumetry were 8·46 s for femoral and 5·84 s for popliteal reflux, compared with 3·84 s in the 33 patients who had thigh-to-calf reflux (P &lt; 0·05).

Conclusion
Absence of reflux in all venous segments on duplex imaging does not exclude a venous aetiology for ulceration. Segmental femoral and popliteal incompetence on duplex imaging is usually associated with other sites of valvular incompetence, but depresses calf function less than thigh-to-calf reflux.
Mortality rates from ruptured abdominal aortic aneurysms in England
Authors: Hafez H , Clayton G , Greenhalgh R M , Davies A H 
Published: March 2003

Abstract

Background
Over the past 10 years significant advances have been made in understanding the natural history and pathophysiology of aortic aneurysm disease. Despite a rapid improvement in alternative repair techniques, surgery for abdominal aortic aneurysm (AAA) remains the standard method of treatment. The aim of this study was to evaluate the efficacy of this treatment at a national level.

Methods
Data for elective and emergency AAA procedures performed in England between 1989 and 1998 were obtained from the Department of Health Hospital Episode Statistics. Data for deaths secondary to ruptured and non-ruptured AAA in England for the same period were obtained from the Office of National Statistics. All figures represent age-adjusted incidence per 100 000 population.

Results
The rise in elective and emergency AAA repair rates affected mainly men rather than women. The rise in death rates from ruptured AAA was 30·3 per cent in women and 2·0 per cent in men.

Conclusion
Despite a considerable increase in elective AAA repair procedures in England, deaths from ruptured AAA continue to rise. These findings highlight the need for an efficient national strategy for improving the outcome of patients with AAA.
Systemic levels of plasmin–antiplasmin complexes are correlated with the expansion rate of small abdominal aortic aneurysms
Authors: Lindholt J S , Jorgensen B , Vammen S , Fastin H , Henneberg E W 
Published: March 2003

Abstract

Background
The cystatine proteolytic system, the serine proteolytic system and the metallodependent proteolytic system have all been reported to be involved in the matrix degradation of the aortic wall, causing abdominal aortic aneurysm (AAA). Plasmin is a common activator of all three systems and could theoretically be involved in the pathogenesis of AAA by activating all three systems. However, plasmin is immediately inactivated by antiplasmin, forming plasmin–antiplasmin (PAP) complexes when it reaches the circulation. This study was designed to assess whether the systemic levels of PAP complex in conservatively treated patients with AAA could be related to the natural history of AAA.

Methods
In 1994, 112 of 141 men with AAA (greater than 3 cm) diagnosed by population screening were interviewed, examined, and had blood samples taken and prepared for serum and ethylenediamine tetra-acetic acid plasma by a standard method. The serum and plasma were frozen at − 21°C until analysis. Of the 112 patients, 99 were followed with annual control scans and blood pressure measurements for 1–5 (mean 2·5) years, and were referred for operation if the AAA exceeded 5 cm in diameter. Of the 99 patients, a random sample of 70 had their level of PAP complexes determined (Dade Behring, Rødovre, Denmark). Furthermore, the level of serum elastin peptides (SEPs) was determined by enzyme-linked immunosorbent assay. Spearman's rank sum correlation test, multivariate linear regression analysis and receiver–operator characteristic (ROC) curve analysis were used for statistical analysis (SPSS 10.0; SPSS, Chicago, Illinois, USA).

Results
The level of PAP complex was positively correlated with annual expansion rate (r = 0·29, P = 0·01), but not with the initial AAA size (r = 0·17, P = 0·16) or SEP (r = 0·04, P = 0·77). The significant association to expansion persisted after adjustment for initial AAA size, SEP and smoking. Furthermore, the level of PAP complex was significantly predictive for AAAs expanding to operation recommendable size (area under ROC curve 65 per cent), with an optimal sensitivity and specificity of 65 and 67 per cent respectively. SEP level was also significantly predictive for AAAs expanding to operation recommendable size (area under ROC curve 56 per cent), with an optimal sensitivity and specificity of 56 and 57 per cent.

Conclusion
The progression of AAA seems to be caused by a general activation of the proteolytic systems involving plasmin and not by genetic or environmental factors causing increased activation of specific proteases or decreased activity of their specific inhibitors. Furthermore, the level of PAP complex in patients with an aneurysm seems to have a better and independently predictive value of the natural history of AAA, compared with the best serological predictor known to date, the serum level of elastin peptides.
Enhanced critical care improves the mortality rate following elective aneurysm repair
Authors: Anderton M , Treharne G , London N , Naylor R , Bell P R , Thompson M M 
Published: March 2003

Abstract

Background
In a previous study performed at this centre (1994–1997) to document the impact of instituting an endovascular programme, the mortality rate for elective infrarenal aneurysm repair was unacceptable (16 per cent). In an attempt to reduce this complication rate, two fundamental changes in practice were instituted. First, patients were selected and counselled for operation on the basis of a physiological scoring system, POSSUM (Physiological and Operative Surgical Score for the enUmeration of Mortality and morbidity). Second, patients were admitted to the critical care unit for at least 3 days after operation, before discharge to the ward. The aim of the study was to audit the result of these changes.

Methods
Data were collected prospectively for all patients admitted for elective aneurysm repair between November 1998 and January 2000. POSSUM score, postoperative mortality and morbidity, and intensive care unit (ITU) or high dependency unit stay were compared between historical controls (1994–1997) and operations performed after the change in practice.

Results
The results are tabulated below as median values.
Comparison between the two groups demonstrated that after changes in referral practice, the perioperative mortality rate improved significantly from 16 to 4 per cent. Comparison of the patient cohorts demonstrated no significant differences in preoperative physiological status.

Conclusion
These data demonstrate that defined changes in the perioperative management of patients undergoing elective aneurysm surgery may favourably affect mortality. As there was no difference in POSSUM scores between the two groups, it is likely that the improved outcome reflects more intensive postoperative care.
Impact of subintimal angioplasty on treatment of critical leg ischaemia
Authors: Tisi P V , Mirnezami A , Baker S , Tawn J , Parvin S D , Darke S G 
Published: March 2003

Abstract

Background
Distal bypass for critical leg ischaemia (CLI) is technically demanding and a physiological challenge to the patient. Angioplasty offers an attractive alternative, the application of which may be extended by subintimal techniques. This study reports on the immediate success of subintimal angioplasty and its impact on workload in this unit since the introduction of the technique in 1997.

Methods
This was a retrospective review of a consecutive series of 166 legs (156 patients) with CLI treated by subintimal angioplasty from 1997 to 1999. Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria were used to determine clinical status and patency.

Results
From 1997 to 1998 the rate of subintimal angioplasty increased, with a corresponding reduction in major amputation and surgery rates (P &lt; 0·001, χ2 test). The increase in surgical reconstruction in 1999 could reflect delayed treatment of patients with late occlusion of a previously dilated segment.
The technical success rate of subintimal angioplasty was 84·9 per cent (25 primary failures). Twelve proceeded to bypass surgery, with one occluded graft subsequently requiring amputation. Amputation was needed in three other patients with technical failure, while a further patient had a successful repeat subintimal angioplasty.

Conclusion
Subintimal angioplasty has an increasing role in limb salvage, particularly in patients unfit for operation.
Outcome of subintimal angioplasty in a district general hospital
Authors: Shaw M B K , Braithwaite B D , DeNunzio M , Hinwood D , Nash R , Callum K G 
Published: March 2003

Abstract

Background
The results from major institutions of subintimal angioplasty are good. The aim was to determine the early and intermediate outcome of the technique of subintimal angioplasty in a district general hospital.

Methods
After formal training, two consultant radiologists performed subintimal angioplasty on 50 consecutive patients for the treatment of intermittent claudication (23 patients) and ulceration or gangrene (27). Patients were classified as Rutherford grade III–VI. The patient group contained 35 men and 15 women with a median age of 72 (range 45–93) years. The median treated length was 17·5 cm in the superficial femoral artery, 12·5 cm in the popliteal artery and 7·5 cm in the peroneal artery. Those with a technically successful procedure were followed with clinical assessment at 6 weeks and colour duplex ultrasonography at 6 months.

Results
Thirty-nine (78 per cent) of the 50 procedures were technically successful. Sixty per cent of these were patent at 6 months on colour duplex ultrasonography. The primary technical success rate in the first 25 consecutive patients to undergo angioplasty was 64 per cent (16 patients), compared with 92 per cent (23 patients) in the second group of 25; this difference was significant (P = 0·004, χ2 test). The overall patency rate at 6 months in the first 25 consecutive patients was 43 per cent, compared with 69 per cent in the second 25; this difference was statistically significant (P = 0·02, χ2 test).

Conclusion
After a short learning interval, subintimal angioplasty can be used effectively in a district general hospital, with good medium-term patency rates.
Pharmacotherapy and outcome in intermittent claudication
Authors: Chong P F S , Seaman H , Golledge J , Gibbs R , Lawrenson R , Greenhalgh R M , Davies A H 
Published: March 2003

Abstract

Background
Intermittent claudication (IC) carries an increased risk of vascular death compared with that in age-matched controls. The role of antiplatelets and statins in the reduction of this risk in new claudicants was evaluated in an observational study of a prospectively gathered database, the General Practice Research Database (GPRD), with 430 practices contributing 8 million patients in the UK.

Methods
All patients aged 40–79 years with newly diagnosed IC and no history of previous peripheral vascular disease were identified using recognized GPRD OXMIS codes. Prescription of antiplatelet therapy (APT) up to 12 months before or after diagnosis, and the use of statin therapy (ST) at the time of diagnosis, of IC was noted. Odds ratios (ORs) adjusted for APT, ST, sex, age, smoking, diabetes, and coexisting cardiac and cerebrovascular disease were calculated. Patients with critical limb ischaemia were excluded. Outcome measures were all-cause death, fatal stroke and fatal myocardial infarction (MI) up to 5 years after diagnosis of IC.

Results
Between 1988 and 1993, 20 474 patients with newly diagnosed IC were identified. The Table summarizes the results.

Conclusion
Prescription rates of statins and antiplatelets in new claudicants in the UK are low and could be improved. These results suggest that ST is associated with a significant reduction in all-cause mortality rate in new claudicants. Patients receiving APT demonstrated a significant reduction in death from MI.
Interhospital provision of emergency vascular services for a large population: early outcomes and clinical results
Authors: Baird R N , Baker A R , Hine C , Lamont P M , Lear P A , Loveday E , Mitchell D M , Morse M , Munro E N , Murphy K P , Rees M R , Smith F C T , Thornton M J 
Published: March 2003

Abstract

Background
In 1999 an emergency vascular service for Bristol and Avon (including Weston-Super-Mare) (population approximately 1 million) was initiated.

Methods
Collaboration between Bristol Royal Infirmary, Frenchay and Southmead Hospitals provides week-on–week-off vascular cover for patients requiring urgent and emergency interventions within 24 h. The rota accommodates National Confidential Enquiry into Perioperative Deaths and Vascular Surgical Society of Great Britain and Ireland recommendations, governance issues, and enhances emergency vascular care for Avon residents. Prospectively collected data for the first year (May 1999 to April 2000) are reviewed.

Results
There were 289 emergency admissions. (In-hospital referrals were not transferred but contributed up to 40 per cent of the extra emergency workload per unit.) Referrals were also accepted from seven Trusts outside the designated catchment area. Caseload included 86 patients with a ruptured or acutely symptomatic aortic aneurysm, of whom 69 underwent operation (30 per cent mortality rate); 17 patients were not operated on. Some 136 patients had critical leg ischaemia (43 acute, 93 chronic); angiography or duplex ultrasonography was performed in 105 cases (77 per cent); 39 patients (29 per cent) had undergone previous intervention for peripheral vascular disease; the mortality rate was 18 (13 per cent) of 136; 18 (13 per cent) of 136 patients required an amputation. Other cases included: upper limb ischaemia, 20 (7 per cent); paediatric emergency, seven (2 per cent); symptomatic carotid disease, five (2 per cent; four endarterectomies with no death or stroke). Some 5 per cent of referrals were inappropriate (venous ulcer, spinal stenosis, etc.). No outcomes were compromised by interhospital transfers. Vascular surgeons operated on nine high-risk patients away from their ‘base’ hospital. A consultant was the principal or assistant operator in more than 95 per cent of operations but, despite trainee rota adjustments, a designated vascular trainee was present in only about 40 per cent of cases.

Conclusion
Interhospital provision of emergency vascular services for a large population is feasible, does not compromise quality of care, and regulates emergency workload. Further attention to training issues is indicated.
Sentinel node biopsy with technetium-99m colloidal rhenium sulphide in patients with breast cancer
Authors: Watanabe T , Kimijima I , Ohtake T , Tsuchiya A , Shishido F , Takenoshita S 
Published: March 2003

Abstract

Background
Sentinel node biopsy is emerging as a technique to replace routine axillary lymph node dissection. The lymphatic mapping technique is still at a developmental stage and no standard technique exists. This study used technetium-99m colloidal rhenium sulphide with a mean particle size of 100 (range 50–200) nm for sentinel node mapping.

Methods
Eighty-seven patients with breast cancer, but no clinical evidence of axillary metastasis, were studied. One day before operation technetium-99m colloidal rhenium sulphide was injected at four points into breast tissue surrounding the tumour. Lymphoscintigraphy was performed 2 h after injection, and surgery was usually performed after 20 h. A hand-held γ probe guided sentinel node biopsy.

Results
Lymphoscintigraphy revealed axillary hot spots in all patients. During operation, the sentinel node was identified in all 87 patients (100 per cent). The number of sentinel nodes per patient ranged from 1 to 5 (mean 2). Metastatic sentinel nodes were identified in 37 of 87 patients. There were no false negatives.

Conclusion
This study suggests that technetium-99m rhenium sulphide is a suitable agent for sentinel node mapping in patients with breast cancer.
Extended preservation of non-heart-beating donor livers with normothermic machine perfusion
Authors: St Peter S D , Imber C J , Lopez I , Hughes D , Friend P J 
Published: March 2003

Abstract

Background
Non-heart-beating donor (NHBD) livers represent an important organ pool, but are seldom utilized clinically and require rapid retrieval and implantation. Experimental work with oxygenated perfusion during preservation has shown promising results by recovering function in these livers. This study compared sanguinous perfusion with cold storage for extended preservation of the NHBD liver in a porcine model.

Methods
Porcine livers were subjected to 60 min of in vivo total warm ischaemia before flushing, after which they were preserved by one of two methods: group 1 (n = 4), University of Wisconsin (UW) solution by standard cold storage for 24 h; group 2 (n = 4), oxygenated autologous blood perfusion on an extracorporeal circuit for 24 h. All livers were subsequently tested on the circuit during a 24-h reperfusion phase.

Results
Livers in group 1 showed no evidence of viability during the reperfusion phase with no bile production or glucose utilization; they also displayed massive necrosis. Livers in group 2 demonstrated recovery of function by synthetic function, substrate utilization and perfusion haemodynamics; these livers displayed less cellular injury by hepatocellular enzymes. All differences in parameters between the two groups were statistically significant (P &lt; 0·05). These findings were supported by histological examination.

Conclusion
Warm ischaemia for 1 h and simple cold storage (UW solution) for 24 h renders the liver non-viable. Oxygenated, sanguinous perfusion as a method of preservation recovers liver function to a viable level after 24 h of preservation.