bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving operative safety for cirrhotic liver resection
Authors: Wu C-C , Yeh D-C , Lin M-C , Liu T-J , P'Eng F-K 
Published: March 2003

Abstract

Background
Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose safe strategies for cirrhotic liver resection.

Methods
Based on the date of operation, 359 cirrhotic liver resections in 329 patients were divided into two intervals: period 1, from September 1989 to December 1994, and period 2, from January 1995 to December 1999. The patient backgrounds, operative procedures and early postoperative results were compared between the two periods. The factors that influenced surgical morbidity were analysed.

Results
In period 2, patient age was higher and the amounts of blood loss and blood transfused were lower. Although postoperative morbidity rates were similar, blood transfusion requirement, postoperative hospital stay and mortality rate were significantly reduced in period 2. No death occurred in 154 consecutive cirrhotic liver resections in the last 38 months of the study. Prothrombin activity and operative time were independent factors that influenced postoperative morbidity.

Conclusion
With improving perioperative assessment and operative techniques, most complications after cirrhotic liver resection can be treated with a low mortality rate. However, more care should be taken if prothrombin activity is low or there is a long operating time.
One-year survey of carcinoma of the oesophagus and stomach in Wales
Authors: Pye J K , Crumplin M K H , Charles J , Kerwat R , Foster M E , Biffin A 
Published: March 2003

Abstract

Background
The aim of the study was to identify all patients who presented with oesophagogastric malignancy within a single National Health Service region (Wales) over 1 year, and to follow the cohort for 5 years. Management and outcome were analysed to identify current practice and draft guidelines for Wales.

Methods
Patients were identified from hospital records. Details were recorded in structured format for analysis.

Results
Analysable data were obtained for 910 of 916 patients. The overall incidence was 31·4 per 100 000 population. Treatment was by resection 298 (33 per cent), palliation 397 (44 per cent) or no treatment 215 (24 per cent). The 30-day mortality rate was 12 per cent and the in-hospital mortality rate was 13 per cent. Some 226 patients (25 per cent) were alive at 2 years. Resection conferred a significant survival advantage over palliation (P &lt; 0·001) and no treatment. Anastomotic leakage occurred in 16 patients (5 per cent), of whom eight died in hospital. ‘Open and close’ operations were common (23 per cent), laparoscopy was infrequent (16 per cent), and many surgeons undertook small caseloads. Operating on fewer than six patients per year increased the mortality rate after partial gastrectomy (P &lt; 0·05) and was associated with a trend to a higher mortality rate after mediastinal and cardia surgery. Operating on more than 70 per cent of patients seen resulted in a significantly higher mortality rate (P &lt; 0·01) irrespective of case volume.

Conclusion
Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate.
Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas: a systematic review of randomized controlled trials
Authors: Li-Ling J , Irving M 
Published: March 2003

Abstract

Background
The aim of this study was to evaluate, through systematic review, the effectiveness of somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of established enterocutaneous pancreatic fistulas.

Methods
Electronic databases, including Medline and EMBASE, were searched systematically by using keywords including ‘somatostatin’, ‘octreotide’, ‘fistula’ and ‘randomiz(s)ed controlled trial’. In addition, citations of relevant primary and review articles were examined. Particular authors were contacted when necessary. Data on patient recruitment, intervention and outcome were extracted from the included trials and analysed.

Results
Use of somatostatin or octreotide for the prevention of postpancreatectomy complications, including pancreatic fistulas, was identified in 14 randomized controlled trials, including one abstract and one conference proceeding, involving a total of 1686 patients. Use of somatostatin or octreotide for the treatment of established enterocutaneous pancreatic fistulas was identified in ten trials involving a total of 301 patients. Significant heterogeneity was found among the identified trials with regard to the definition of fistula, dosage of octreotide, starting time and duration of the treatment, among other factors.

Conclusion
There was major disagreement between the studies on whether use of the drugs in question is of value in preventing postoperative complications. This analysis suggests that, in units where the postoperative fistula rate following pancreaticoduodenectomy for neoplasia and other pancreatic conditions exceeds 10 per cent, somatostatin or octreotide administered before operation may significantly reduce the rate of major postoperative complications, particularly pancreatic fistulas. The identified evidence also suggests that there may be a limited role for such drugs in the treatment of established postoperative enterocutaneous pancreatic fistulas. A major conclusion is that further clarification of the roles of these drugs is still required through large, high-quality, randomized trials.
Standards of documentation of the surgeon—patient consultation in current surgical practice
Authors: Fernando K J , Siriwardena A K 
Published: March 2003

Abstract

Background
This study was designed to assess the reliability of the system whereby junior doctors document the surgeon–patient consultation in general surgical practice in the UK.

Methods
A prospective observational study was carried out, with an independent observer recording details of the surgeon–patient consultation and assessing the reliability of documentation. An exact record of the information given by consultants was transcribed in shorthand at the time of consultation. Data were recorded in the categories recommended for notation by the General Medical Council: clinical findings, decisions made, information given to patient and treatment prescribed. Case notes were examined within 24 h of the ward round to ascertain reliability of the documentation.

Results
The study population comprised 432 surgeon–patient consultations. There were important deficiencies in the documentation of consultants' clinical findings and management decisions. In addition, information given by consultants to the patients regarding clinical findings and treatment planned (including the need for operation) was recorded in a median of 6 per cent of consultations.

Conclusion
This study provides objective evidence of shortfalls in the documentation of the surgeon–patient consultation process. These deficiencies are such that, under present circumstances, the requirements of the General Medical Council with respect to case note documentation are not fulfilled in this setting.
Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer
Authors: Wigmore S J , MacMahon A J , Sturgeon C M , Fearon K C H 
Published: March 2003

Abstract

Introduction
An acute-phase protein response (APPR) has been associated with reduced crude survival rates and increased recurrence following apparently curative resection in patients with colorectal cancer. This study investigated the prognostic significance of a preoperative and postoperative APPR in relation to disease-specific mortality rate.

Methods
Some 202 patients with colorectal cancer were followed for at least 5 years. C-reactive protein concentration, measured before and at 3 months after operation, was used as an index of the APPR. Univariate and multivariate analyses were performed on a number of potential prognostic factors.

Results
Thirty-six per cent of patients had an APPR and this was associated with a higher rate of local tumour invasion, fewer curative resections and a higher carcinoembryonic antigen (CEA) concentration. There was no difference in Dukes' stage between patients with or without an APPR. The most important prognostic factor related to both disease-specific and crude survival was Duke's stage (P &lt; 0·0001). Subgroup analysis demonstrated that APPR had prognostic significance only in patients with advanced disease (P = 0·013). An APPR was present in a minority of patients (11 per cent) after operation and was not associated with increased likelihood of tumour recurrence.

Conclusion
The APPR is increased in more than a third of patients presenting with colorectal cancer and is associated with more frequent local tumour invasion, fewer curative resections and a higher CEA level. An APPR at 3 months after operation does not have the prognostic significance reported by earlier studies.
Epidemiology of abdominal aortic aneurysms in the Asian community
Authors: Spark J I , Baker J L , Vowden P , Wilkinson D 
Published: March 2003

Abstract

Background
Studies relating to the ethnic origin of patients with an abdominal aortic aneurysm (AAA) are few and are mainly concerned with the differences between black and white Americans. The purpose of this study was to determine whether the incidence of AAA among the Asian population of Bradford is different from that in the Caucasian population.

Methods
A retrospective study of patients with an AAA was carried out between 1990 and 1997 using data collected by the Patient Administrative Service, personal databases of the vascular consultants and theatre records. Information about the ethnic composition of the population of Bradford was obtained from the 1991 national census. Demographic data, including ethnic origin and clinical details, were obtained from patient notes.

Results
Two hundred and thirty-three patients with an AAA were identified during the study interval. The Asian population comprised 14·0 per cent of the total population of Bradford. Twenty-eight AAAs would be expected per year. All of the aneurysms identified occurred in the Caucasian population and none in the Asian community.

Conclusion
These early results suggest that AAA is rare among the Asian population.
Determinants of death following burn injury
Authors: Muller M J , Pegg S P , Rule M R 
Published: March 2003

Abstract

Background
Burn care has changed considerably. Early surgery, nutritional support, improved resuscitation and novel skin replacement techniques are now well established. The aim of the study was to establish whether changes in management have improved survival following burn injury and to determine the contributory factors leading to non-survival.

Methods
This was a retrospective outcome analysis of data collected from a consecutive series of 4094 patients with burns admitted to a tertiary referral, metropolitan teaching hospital between 1972 and 1996.

Results
The overall mortality rate was 3·6 per cent. This decreased from 5·3 per cent (1972–1980) to 3·4 per cent (1993–1996) (P = 0·076). The risk of death was increased with increasing burn size (relative risk (RR) 95·90 (95 per cent confidence interval 12·60–729·47) if more than 35 per cent of the total body surface area was burned; P &lt; 0·001) increasing age (RR 7·32 (3·08–17·42) if aged more than 48 years; P &lt; 0·001), inhalation injury (RR 3·61 (2·39–5·47); P &lt; 0·001) and female sex (RR 1·82 (1·23–2·69); P = 0·003). Operative intervention (RR 0·11 (0·06–0·21); P &lt; 0·001) and the presence of an upper limb burn (RR 0·53 (0·35–0·79); P = 0·002) decreased the risk.

Conclusion
Modern burn care has decreased the mortality rate. Increasing burn size, increasing age, inhalation injury and female sex increased, while operative intervention and an upper limb burn decreased, the risk of death.
Role of tumour necrosis factor in lung injury caused by intestinal ischaemia–reperfusion
Authors: Köksoy C , Kuzu M A , Kuzu I , Ergün H , Gürhan I 
Published: March 2003

Abstract

Background
Despite the well known inflammatory effects of tumour necrosis factor α (TNF), the mechanism of TNF-mediated lung injury following ischaemia–reperfusion (I/R) is still unclear. In this study, the role of TNF in the development of acute lung injury following intestinal I/R was investigated.

Methods
Male Wistar rats underwent either sham operation (n = 10), 1 h of superior mesenteric artery occlusion and 2 h of reperfusion (I/R, n = 10), or pretreatment with anti-TNF polyclonal antibody 2 mg/kg and I/R (n = 6). Lung injury was evaluated by Evans blue dye concentration, immunohistochemical staining and morphometric analysis. Intestinal injury was assessed by Evans blue dye concentration and histological examination.

Results
Intestinal I/R resulted in lung injury characterized by an increase in Evans blue dye concentration, neutrophil sequestration, and obvious staining for expression of pulmonary CD11b and CD18. Pretreatment of animals with anti-TNF antibody led to a reduction in the sequestration of neutrophils, and a decrease in expression of pulmonary intracellular adhesion molecule 1 and CD18. Anti-TNF antibody pretreatment also reduced the intestinal microvascular injury but not histological grade after intestinal I/R.

Conclusion
Treatment with an anti-TNF antibody resulted in a significant attenuation of lung injury following intestinal I/R. The data indicate that TNF is an important trigger for upregulation of pulmonary endothelial and neutrophil adhesion molecules after intestinal I/R.
Leptin and its relation to weight loss, ob gene expression and the acute-phase response in surgical patients
Authors: Moses A G W , Dowidar N , Holloway B , Waddell I , Fearon K C H , Ross J A 
Published: March 2003

Abstract

Background
Patients with cachexia suffer from anorexia, weight loss and hypermetabolism. This study examined the relationship between plasma leptin concentration, leptin gene expression, weight loss and the acute-phase response in a group of surgical patients.

Methods
Body composition, plasma leptin, interleukin (IL) 6, soluble tumour necrosis factor receptor (sTNF-R) 55, sTNF-R75 and C-reactive protein were analysed in a cohort of 28 patients undergoing elective surgery. Subcutaneous and omental leptin messenger RNA (mRNA) was analysed in a subgroup of 14 patients.

Results
After adjustment for fat mass (FM), a significant partial correlation coefficient was found between plasma leptin and serum IL-6 concentration (P = 0·037). A positive correlation was found only between plasma leptin and omental leptin mRNA (P = 0·009). Patients with an acute-phase response had a significantly higher level of plasma leptin per unit FM (P = 0·049). Stepwise multiple regression showed that FM (P &lt; 0·0005) and serum IL-6 (P = 0·018) were independent predictors of plasma leptin level.

Conclusion
Plasma leptin levels appear to be influenced by proinflammatory cytokines. Omental fat may have more influence on plasma leptin than subcutaneous fat. Accelerated weight loss in patients with cancer with an ongoing inflammatory response could be mediated in part by inappropriately high plasma levels of leptin.
Early gallbladder carcinoma does not warrant radical resection
Authors: Wakai T , Shirai Y , Yokoyama N , Nagakura S , Watanabe H , Hatakeyama K 
Published: March 2003

Abstract

Background
This study was designed to address whether gallbladder cancer invading the muscle layer (stage pT1b) is a local disease and whether radical resection is necessary.

Methods
A retrospective analysis of 25 patients with pT1b gallbladder tumours, 13 of whom underwent simple cholecystectomy and 12 radical resection with regional lymph node dissection, was performed. A total of 147 regional lymph nodes was examined for metastasis. The median follow-up time was 95 months.

Results
No patient had blood vessel or perineural invasion on histology. Lymphatic vessel invasion was seen in one patient. Both overt metastasis and micrometastases were absent in all lymph nodes examined. Overall 10-year survival was 87 per cent. The outcome after simple cholecystectomy was comparable to that after radical resection (P = 0.16). Two patients who underwent radical resection died from tumour relapse in distant sites.

Conclusion
Most pT1b gallbladder carcinomas spread only locally. Additional radical resection is not necessary when the depth of invasion of gallbladder carcinoma is limited to the muscle layer after simple cholecystectomy.
Myocardial infarction following aortic surgery: a comparison of cardiac troponin I and creatine kinase ratio
Authors: Haggart P C , Adam D J , Ludman P F , Bradbury A W 
Published: March 2003

Abstract

Background
Perioperative myocardial infarction may be underdiagnosed and/or misdiagnosed because World Health Organization criteria are often not met and creatinine kinase/creatinine kinase-muscle band (CK/CK-MB) ratios can be difficult to interpret. Cardiac troponin (cTn) I is the most sensitive and specific marker of myocardial cell necrosis but is not yet widely available. The aim was to compare cTnI and CK/CK-MB ratios in the diagnosis of myocardial infarction following aortic surgery.

Methods
This prospective study included 58 patients undergoing elective (27 aneurysm, seven occlusive) or emergency (24 ruptured aneurysms) aortic surgery. cTnI concentration was measured before operation and 6, 24, 48, 72 and 96 h after surgery. CK and CK-MB levels were measured where cTnI was detectable. Clinical and electrocardiographically detected cardiac events were documented prospectively.

Results

Conclusion
More than half of patients undergoing emergency, and more than a quarter of those undergoing elective, aortic surgery suffer myocardial necrosis as determined by cTnI concentration. This is accompanied by an increased CK/CK-MB ratio in less than one-fifth of cases.
Mortality following aortic surgery as a possible indicator of clinical performance
Authors: Rigby K , Palfreyman S , Michaels J 
Published: March 2003

Abstract

Background
The mortality rate following aortic surgery has been suggested as a possible indicator of clinical performance.

Methods
Routine hospital data on mortality following aortic surgery were collected for a 2-year interval in the Trent region. Procedural and diagnostic codes, mode of admission, district of residence, treatment and specialty data were analysed and compared with audit data and the Operating Theatre Information System.

Results
Inaccuracies in coding using the HRG (Health Resource Group) codes meant that 21·4 per cent of elective aortic cases (HRG Q01) were probably emergencies and 26 per cent of probable emergency ruptures were not coded as vascular emergencies. The HRG system does not identify complex procedures carried out in specialist centres, thereby distorting the overall mortality figures. Case mix and patient selection introduced a bias, apparent between tertiary and district general hospitals, with higher-risk elective and lower-risk emergency cases at tertiary referral centres. For patients aged over 80 years, two districts undertook no elective aortic surgery, and the rates for emergency surgery varied between 16 and 25 per cent in the districts and 77 per cent in the tertiary centre. After correction for these factors, there remains significant variation in mortality rates between tertiary referral centres and the district hospitals (Table).

Conclusion
Some of the difficulties in using crude mortality rates as an indicator of performance have been highlighted. They are subject to bias and distortions owing to the collection of incorrect information, patient selection differences between hospitals, case-mix differences and tertiary transfer of complicated cases. Other case-mix factors can be accounted for only with more detailed collection of clinical data such as POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scores. However, there remains considerable and worrying variation in selection and outcomes of patients undergoing aortic surgery.
Randomized trial of vein versus dacron patching during carotid endarterectomy
Authors: Hayes P D , Alroggen H , Steel S , London N J M , Thompson M M , Bell P R F , Naylor A R 
Published: March 2003

Abstract

Background
A recent overview has indicated that, while routine patching is safer than primary closure following carotid endarterectomy (CEA), there is no systematic evidence that patch type influences outcome. Most surgeons perceive that prosthetic patches are more thrombogenic than vein patches. This study tested the hypothesis that it is the patient who is prothrombotic rather than the nature of the patch.

Methods
Some 274 patients undergoing 276 CEAs were randomized to either dacron (Du Pont, Stevenage, UK) patch closure (n = 137) or vein patch closure (n = 139). All patients with an accessible cranial window were monitored for 3 h after operation using transcranial Doppler (TCD) ultrasonography. The number and rate of embolizations were quantified, together with the requirement for selective dextran therapy to control high rates of postoperative embolization. All patients were assessed after operation and again at 30 days by a neurologist, and all underwent duplex imaging at 30 days.

Results
The 30-day death or any stroke rate was 2·2 per cent for dacron-patched patients and 3·6 per cent for vein-patched patients (P = 0·72). Dacron-patched patients had a higher incidence of postoperative emboli (median 5 (interquartile range 0–10·5)), compared with a median of 3 (interquartile range 1–17) for vein (P = 0·028). However, the incidence of detecting more than 50 emboli was virtually identical and patch type had no effect on the incidence of sustained high-rate embolization requiring dextran therapy (5·3 per cent for dacron versus 3·7 per cent for vein). No patient had a carotid thrombosis at 30 days.

Conclusion
Sustained high-rate embolization, previously shown to be highly predictive of progression to carotid thrombosis, appears to be patient dependent rather than related to patch type.
Role of Chlamydia pneumoniae in an experimental animal model of aneurysm formation
Authors: Tambiah J R S , Franklin I J , Powell J T 
Published: March 2003

Abstract

Background
Chlamydia pneumoniae has been implicated in the pathogenesis of vascular disease. C. pneumoniae DNA is present in 40–50 per cent of abdominal aortic aneurysm biopsies. This study investigated whether C. pneumoniae has a causal role in experimental aortic dilatation.

Methods
Experimental aneurysms were established in cholesterol-fed rabbits by periaortic application of calcium chloride solution and a combination of thioglycollate (a non-specific macrophage activator) or C. pneumoniae (live, formalin fixed or heat inactivated at 108 organisms per ml). After 3 weeks, aortic diameter was measured and aortas were harvested for analysis of macrophage counts. C. pneumoniae DNA was measured by polymerase chain reaction and C. pneumoniae antigens (both membrane and heat shock protein 60) were determined by immunostaining.

Results
Live or formalin-fixed C. pneumoniae at concentrations of 108 organisms per ml mimicked the effects of thioglycollate to produce aortic dilatation associated with macrophage influx. Lower concentrations of C. pneumoniae had a minimal effect.

Conclusion
In this experimental study, high doses of C. pneumoniae membrane antigens stimulated macrophage influx and aortic dilatation. Lipopolysaccharide had a lesser effect. C. pneumoniae antigens could contribute to an in vivo aggregate pathogen burden by provoking an inflammatory response.