bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer
Authors: Asao T , Hosouchi Y , Nakabayashi T , Haga N , Mochiki E , Kuwano H 
Published: March 2003

Abstract

Background
A secure lymphadenectomy in a laparoscopically assisted gastrectomy performed for gastric cancer is required because of the high prevalence of lymph node metastasis. A surgical technique for laparoscopic gastrectomy with lymph node dissection and reconstruction using a conventional circular stapler is reported.

Methods
Forty-nine laparoscopically assisted gastrectomies with lymphadenectomy (47 distal and two total gastrectomies) were performed using devices for retraction of the stomach and laparoscopic ligation of arteries, which were developed to ensure secure dissection of lymph nodes. Reconstruction by Billroth I or intestinal interposition using a conventional circular stapler was performed through a small incision through which the specimen was removed. When submucosal invasion was suspected (n = 16), the lymph nodes along with the common hepatic artery were also dissected through the same incision.

Results
The operations were performed without serious complication. None was converted to laparotomy, and there were no deaths. Metastatic lymph nodes were seen in perigastric nodes and nodes along the left gastric artery in five cases. In five of the 49 patients the macroscopic diagnosis of depth of invasion was underestimated.

Conclusion
A technique of laparoscopic gastrectomy with lymph node dissection for early invasive gastric cancer is described. A definitive answer concerning the appropriate level of lymph node dissection and the role of laparoscopic gastrectomy in the treatment of more advanced gastric cancer remains to be defined.
Prospective evaluation of the morbidity of axillary clearance for breast cancer
Authors: Duff M , Hill A D K , McGreal G , Walsh S , McDermott E W , O'Higgins N J 
Published: March 2003

Abstract

Background
Axillary clearance, despite its morbidity, retains an essential role in the management of patients with breast cancer. The aim of this prospective study was to document the development of arm swelling and limitation of shoulder movement following complete axillary clearance.

Methods
One hundred patients who had axillary clearance to level III, for treatment of breast cancer, were followed prospectively for over 1 year. Arm volumes were measured using an optoelectronic volometer and shoulder movements with a goniometer.

Results
Ten patients had significant arm swelling at 1 year. The swelling was mild in eight and moderate in two. No patient developed severe swelling. Reduced arm movements were noted in the first week after operation but had returned to normal at 6 months.

Conclusion
This study provided accurate documentation of the morbidity associated with axillary clearance, together with a reproducible method of arm volume measurement.
Postoperative liver function after elective right hepatectomy in elderly patients
Authors: Ettorre G M , Sommacale D , Farges O , Sauvanet A , Guevara O , Belghiti J 
Published: March 2003

Abstract

Background
Because the influence of age on the risk of liver resection is controversial, the outcome of major liver resection in patients older than 65 years was evaluated.

Methods
Between 1990 and 1997, 24 patients aged 65 years or more underwent elective right hepatectomy (segments V–VIII) for a malignant liver tumour arising in a normal liver. They were evaluated retrospectively in terms of operative deaths, morbidity and postoperative liver function, and compared with 22 patients aged 40 years or less who had undergone a similar resection during the same interval.

Results
Elective right hepatectomy in patients aged 65 years or more resulted in a similar number of deaths (one versus none) and a similar severe complication rate (12 versus 5 per cent) to that observed in patients aged 40 years or less. Evaluation of liver function on days 2, 5 and 8 after operation, in patients aged 65 years or more and 40 years or less, showed that mean prothrombin time was 52 versus 56 per cent, 58 versus 62 per cent and 76 versus 72 per cent respectively (P not significant) and that the mean total serum bilirubin level was 35 versus 38 µmol/l, 32 versus 36 µmol/l and 25 versus 28 µmol/l (P not significant). Postoperative levels of aminotransferases, γ-glutamyl transpeptidase and alkaline phosphatase were similar in the two groups. Mean(s.d.) duration of hospital stay was 15(7) days in patients aged 65 years or more and 13(4) days in the younger patients.

Conclusion
Postoperative liver function after elective right hepatectomy in selected patients older than 65 years was similar to that in younger patients.
Response of visceral peritoneum to abdominal surgery
Authors: Ivarsson M-L , Falk P , Holmdahl L 
Published: March 2003

Abstract

Background
Postoperative adhesion formation has been associated with a reduced capacity to degrade fibrin within the peritoneal cavity. Peritoneal fibrinolytic capacity has been shown to decrease during the course of a surgical operation. The aim of this study was to investigate whether tissue-type plasminogen activator (tPA), a key fibrinolytic enzyme, is released into the peritoneal cavity during operation.

Methods
Fluid released from the serosal surface of the small bowel was collected in a plastic bag from 16 patients undergoing surgery. Intraoperative blood samples were also taken from seven patients. Concentrations of the fibrinolytic components tPA and urokinase plasminogen activator (uPA), tPA activity and plasminogen activator inhibitor type 1 (PAI-1) concentration were measured by enzyme-linked immunoabsorbent assay.

Results
Intraoperative tPA concentrations were significantly raised in the peritoneal fluid collected compared with peripheral blood levels (P = 0·008). This resulted in a significantly higher tPA activity in the fluid compared with blood (P = 0·001). However, neither uPA (P = 0·29) nor PAI-1 (P = 0·84) concentrations differed significantly in fluid compared with blood.

Conclusion
These data suggest that tPA is rapidly released by the visceral peritoneum during abdominal surgery. The different concentrations in peripheral blood and peritoneum suggest that tPA is released from the peritoneum by an active process, and does not solely derive from leakage of plasma.
Presented in part to the International Congress on Peritoneal Repair and Adhesions (PAX, 5th meeting), Grantham, UK, October 1999, and to the XXXVth European Society for Surgical Research in Malmö, Sweden, June 2000
Value and cost of follow-up after adjuvant treatment of patients with Dukes' C colonic cancer
Authors: Bleeker W A , Mulder N H , Hermans J , Otter R , Plukker J T M 
Published: March 2003

Abstract

Background
The clinical value and costs of different diagnostic tools used to identify potentially curable recurrent disease in patients treated adjuvantly for curatively resected Dukes' C colonic cancer were examined.

Methods
The study group comprised 496 patients treated with chemotherapy over a 1-year interval. Follow-up consisted of interim history, physical examination, liver ultrasonography or computed tomography (CT), measurement of carcinoembryonic antigen (CEA) levels, chest radiography and colonoscopy.

Results
Two hundred and thirteen patients had recurrent disease (median follow-up 43 months). Forty-two patients with recurrence (20 per cent) were treated with curative intent (median survival 38 months; 5-year survival rate 40 per cent). Recurrence was identified by liver ultrasonography or CT (n = 14), evaluation of symptoms (n = 12), colonoscopy (n = 8), CEA measurement (n = 3), chest radiography (n = 2), physical examination (n = 1) and other modalities in two patients. The mean cost of diagnostic procedures per curative resected recurrence for patients amenable to salvage surgery was US$9011. Of all treatable recurrences, 12 of 42 were identified by evaluation of symptoms only. Ultrasonography and colonoscopy identified 22 recurrences at a cost of US$11 790 per patient, while routine follow-up by CEA measurement, chest radiography and physical examination identified a further six at a cost of US$19 850 per patient.

Conclusion
Potentially curable recurrences were detected primarily by liver imaging and colonoscopy. The yield of CEA measurement, chest radiography and physical examination was relatively low; such methods were expensive and should not be recommended in the routine follow-up of these patients.
Selection of patients for laparoscopic repair of perforated peptic ulcer
Authors: Lee F Y J , Leung K L , Lai P B S , Lau J W Y 
Published: March 2003

Abstract

Background
Although randomized and non-randomized studies have evaluated the safety of laparoscopic repair for perforated peptic ulcer, no definite guidelines have been published on selection of patients for laparoscopic repair. This cohort study aimed to define patients who may not benefit from laparoscopic techniques.

Methods
The data from 374 consecutive patients with perforated peptic ulcer treated by simple repair were collected prospectively and analysed.

Results
From January 1992 to December 1998, 219 patients were treated by open suture repair, 109 by laparoscopic sutureless (fibrin glue) repair and 46 by laparoscopic suture repair. The overall leak rate after laparoscopic suture and sutureless repair was 6 and 16 per cent respectively. Leakage was noted to be associated with a significantly higher rate of wound infection, intra-abdominal abscess formation, prolonged ileus (P &lt; 0·001) and longer hospital stay (11 versus 5 days; P &lt; 0·001). Multivariate analysis demonstrated that Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission predicted the likelihood of a leak after laparoscopic fibrin glue repair (P = 0·006).

Conclusion
APACHE II score may be a useful index for selecting patients for laparoscopic fibrin glue repair.
Reduction of experimental adhesion formation by inhibition of plasminogen activator inhibitor type 1
Authors: Falk K , Björquist P , Strömqvist M , Holmdahl L 
Published: March 2003

Abstract

Background
Adhesion formation is a common cause of complications following surgery. A reduction in peritoneal fibrinolytic capacity during operation is a key mechanism in the early formation of adhesions. An increase in the main inhibitor of fibrinolysis, plasminogen activator inhibitor type 1 (PAI-1), is a major factor in the loss of fibrinolytic activity. The aim of this study was to investigate if inhibition of PAI-1 could reduce the formation of adhesions after surgery.

Methods
Mice (n = 53) were subjected to a standard surgical procedure in order to induce adhesion formation to the abdominal side wall. At the conclusion of the operation, fragments for antigen binding of polyclonal rabbit antibody against PAI-1 (PRAP-1) were injected intraperitoneally, at two different concentrations. Control animals received an equal volume of the vehicle (saline). One week after operation adhesion formation was quantified.

Results
Both doses of PRAP-1 significantly reduced adhesion formation compared with the saline control (P = 0·003 and P = 0·002). There were no signs of bleeding in the postoperative period or at reoperation.

Conclusion
The present observations lend further support to the hypothesis of a pivotal role of fibrinolysis in the early formation of adhesions, and open up new possibilities for adhesion reduction by inhibiting PAI-1.
Randomized clinical trial of laparoscopic versus open appendicectomy
Authors: Pedersen A G , Petersen O B , Wara P , Rønning H , Qvist N , Laurberg S 
Published: March 2003

Abstract

Background
Laparoscopy in patients with a clinical suspicion of acute appendicitis has not gained wide acceptance, and its use remains controversial.

Methods
In a randomized controlled trial of laparoscopic versus open appendicectomy, 583 of 828 consecutive patients consented to participate. Three hundred and one patients were allocated to open appendicectomy and 282 patients to laparoscopy, 65 of whom required conversion to open appendicectomy. Length of stay in hospital was the primary endpoint, while operating time, postoperative morbidity, duration of convalescence and cosmesis were secondary endpoints.

Results
Intention-to-treat analysis revealed an equally short hospital stay in the two groups (median 2 days). The median time to return to normal activity (7 versus 10 days) and work (10 versus 16 days) was significantly shorter following laparoscopy. Laparoscopy was associated with fewer wound infections (P &lt; 0·03) and improved cosmesis (P &lt; 0·001), but the operating time was longer (60 versus 40 min). Laparoscopy was associated with more intraperitoneal abscesses (5 versus 1 per cent) but, adjusted for a greater number of gangrenous or perforated appendices in this group, the difference failed to reach statistical significance.

Conclusion
Hospital stay was equally short, whereas laparoscopic appendicectomy was associated with fewer wound infections, faster recovery, earlier return to work and improved cosmesis.
Dysphagia after antireflux surgery
Authors: Wills V L , Hunt D R 
Published: March 2003

Abstract

Background
Dysphagia is experienced by many patients after antireflux surgery. This literature review examines factors associated with the development, prediction and management of postoperative dysphagia.

Methods
Published studies examining issues related to dysphagia, gastro-oesophageal reflux and fundoplication were reviewed.

Results
Postoperative dysphagia is usually temporary but proves troublesome for 5–10 per cent of patients. Technical modifications, such as a partial wrap, division of short gastric vessels and method of hiatal closure, have not conclusively reduced its incidence. There is no reliable preoperative test to predict dysphagia.

Conclusion
It is uncertain whether postoperative dysphagia arises from patient predilection or is largely a consequence of mechanical changes created by fundoplication. Anatomical errors account for a significant proportion of patients referred for correction of dysphagia but these are uncommon in large single-institution studies. Abnormal manometry cannot predict dysphagia and, on current evidence, ‘tailoring’ the operation does not prevent its occurrence.
Sodium hyaluronate enhances colorectal tumour cell metastatic potential in vitro and in vivo
Authors: Tan B , Wang J H , Wu Q D , Kirwan W O , Redmond H P 
Published: March 2003

Abstract

Background
Sodium hyaluronate has been used intraperitoneally to prevent postoperative adhesions. However, the effect of sodium hyaluronate on tumour growth and metastasis in vitro and in vivo is still unknown.

Methods
Human colorectal tumour cell lines SW480, SW620 and SW707 were treated with sodium hyaluronate (10–500 μg/ml) and carboxymethylcellulose (0·125–1 per cent), and tumour cell proliferation and motility were determined in vitro. For the in vivo experiments male BD IX rats were randomized to a sodium hyaluronate group (n = 11; intraperitoneal administration of 0·5 × 106 DHD/K12 tumour cells and 5 ml 0·4 per cent sodium hyaluronate) or a phosphate-buffered saline group (n = 11; 0·5 × 106 DHD/K12 tumour cells and 5 ml phosphate-buffered saline intraperitoneally). Four weeks later the intraperitoneal tumour load was visualized directly.

Results
In vitro sodium hyaluronate increased tumour cell proliferation and motility significantly. Sodium hyaluronate-induced tumour cell motility appeared to be CD44 receptor dependent, whereas sodium hyaluronate-induced tumour cell proliferation was CD44 receptor independent. In vivo there was a significantly higher total tumour nodule count in the peritoneal cavity of the sodium hyaluronate-treated group compared with the control (P = 0·016).

Conclusion
Sodium hyaluronate enhances tumour metastatic potential in vitro and in vivo, which suggests that use of sodium hyaluronate to prevent adhesions in colorectal cancer surgery may also potentiate intraperitoneal tumour growth.
Presented to the Patey Prize Session of the Surgical Research Society and the annual scientific meeting of the Association of Surgeons of Great Britain and Ireland, Brighton, UK, 4–7 May 1999
Effect of CD4+ and CD8+ cell depletion on wound healing
Authors: Davis P A , Corless D J , Aspinall R , Wastell C 
Published: March 2003

Abstract

Background
Depression of the immune system can result in poor or delayed wound healing.

Methods
Thymectomized rats were depleted of CD4+ and CD8+ lymphocytes by intraperitoneal injection of Medical Research Council Oxford (MRC OX)38 antibodies and MRC OX8. Significant depletion was demonstrated throughout the wound healing process by immunofluorescence studies of peripheral blood. Following depletion the rats underwent laparotomy incisions which were allowed to heal for 10 weeks. Differences in healing were demonstrated by analysing the wounds biomechanically by tensiometry to obtain values of ultimate strength, resilience, toughness, maximum extension and elastic constant.

Results
Wounds of animals depleted of CD4+ lymphocytes showed a significant decrease in ultimate strength, resilience and toughness. Wounds of animals depleted of CD8+ lymphocytes showed a significant increase in ultimate strength, resilience and toughness.

Conclusion
Wounds healed in the absence of T lymphocytes. However, the subsets have an opposing regulatory role, with CD4+ lymphocytes upregulating and CD8+ lymphocytes downregulating wound healing.
Influence of aspirin on early allograft thrombosis and chronic allograft nephropathy following renal transplantation
Authors: Murphy G J , Taha R , Windmill D C , Metcalfe M , Nicholson M L 
Published: March 2003

Abstract

Background
Primary thrombosis and chronic allograft nephropathy are important causes of early and late graft loss, respectively, following renal transplantation. This study examined the potential for aspirin therapy to reduce these complications.

Methods
A consecutive series of 105 cadaveric renal transplants treated with aspirin 150 mg daily for the first 3 months after transplantation was compared with an untreated historical control group (n = 121). Protocol needle-core biopsies were performed on all transplants in both groups at 1 week and 12 months after transplantation. Needle-core allograft biopsies were performed at 3, 6 and 12 months after transplantation, and serum creatinine was measured at each outpatient attendance for the duration of follow-up.

Results
There was a significantly lower rate of primary allograft thrombosis in patients treated with aspirin (none of 105) compared with that in the control group (six (5 per cent) of 121; P = 0·03). There were no differences in renal function or 2-year allograft survival between the two groups. Aspirin-treated patients had a lower incidence of chronic allograft nephropathy at 1 year than controls although this did not reach statistical significance (16 versus 26 per cent; P = 0·075). There were no major bleeding complications in either group in association with peptic ulcer disease or following renal transplant biopsy.

Conclusion
Aspirin reduced the rate of early graft thrombosis of renal transplants in this series but did not improve renal function or graft survival. A trend towards a lower rate of chronic allograft nephropathy was noted with aspirin treatment. These findings require confirmation in a prospective randomized trial.
Activation peptide of carboxypeptidase B and anionic trypsinogen as early predictors of the severity of acute pancreatitis
Authors: Appelros S , Petersson U , Toh S , Johnson C , Borgström A 
Published: March 2003

Abstract

Background
Early prediction of severity is important in the management of patients with acute pancreatitis. The presence of activation peptides and certain pancreatic proenzymes in plasma and urine has been shown to correlate with severity. This study was designed to assess the value of measuring levels of the activation peptide of carboxypeptidase B (CAPAP) and of anionic trypsinogen.

Methods
Concentrations of CAPAP and anionic trypsinogen were measured in the urine and serum in 60 patients with acute pancreatitis. Preset cut-off levels were used to analyse the accuracy of the tests. Severity was classified retrospectively according to the Atlanta classification.

Results
Concentrations of CAPAP in urine and serum and of anionic trypsinogen in urine correlated with the severity of the pancreatitis. CAPAP in urine showed the highest accuracy. The overall accuracy was 90 per cent, with a positive predictive value of 69 per cent and a negative predictive value of 98 per cent.

Conclusion
In this study, measurement of CAPAP in urine was an accurate way to predict the severity of acute pancreatitis, and was superior to assay of anionic trypsinogen in urine and serum. Measurement of CAPAP in urine may be of value in the management of individual patients with pancreatitis and in the selection of patients for therapeutic trials.
Procalcitonin strip test in the early detection of severe acute pancreatitis
Authors: Kylänpää-Bäck M-L , Takala A , Kemppainen E , Puolakkainen P , Haapiainen R , Repo H 
Published: March 2003

Abstract

Background
Early identification of patients who subsequently develop severe acute pancreatitis would enable the selection of patients who may benefit from early intensive management. Because severe acute pancreatitis is characterized by the development of systemic inflammation the authors studied whether procalcitonin, a marker of systemic inflammation, differentiated between patients with mild and severe acute pancreatitis.

Methods
On admission and 24 h thereafter, serum procalcitonin level was measured by a rapid, semiquantitative PCT®-Q test and serum C-reactive protein (CRP) by an immunoturbidimetric method in a consecutive series of 162 patients with acute pancreatitis. There were 38 severe and 124 mild cases. The accuracy of procalcitonin and CRP in predicting severe acute pancreatitis was compared with that of Ranson and Acute Physiology and Chronic Health Evaluation (APACHE) II scores.

Results
The PCT®-Q test was more accurate in predicting severe acute pancreatitis (sensitivity 92 per cent and specificity 84 per cent at 24 h) than CRP, APACHE II score and Ranson score. Its negative predictive value was high (97 per cent at 24 h), and it detected each patient who developed subsequent organ failure (n = 22).

Conclusion
The PCT®-Q test was a useful screening method for detecting severe acute pancreatitis. It is simple and quick to perform and, unlike currently available multiple factor scoring systems, can easily be adopted into routine clinical practice.
Sentinel nodes outside lymph node basins in patients with melanoma
Authors: Roozendaal G K , de Vries J D H , van Poll D , Jansen L , Schraffordt Koops H , Nieweg O E , Kroon B B R 
Published: March 2003

Abstract

Background
Lymphoscintigraphy occasionally reveals hot spots outside lymph node basins in patients with melanoma. The aim of this study was to evaluate such abnormally located hot spots.

Methods
Sentinel node biopsy was studied prospectively in 379 patients with clinically localized cutaneous melanoma. One day after lymphoscintigraphy, sentinel node biopsy was performed guided by vital blue dye and a γ ray detection probe.

Results
Persisting hot spots outside the regional node basins were seen in 25 patients (6·6 per cent). Several specific drainage patterns were discerned. In five patients, aberrant sentinel nodes were not explored. The hot spot represented a lymphangioma in two patients. Radioactive lymph nodes were identified in the remaining 18 patients (4·7 per cent). Four patients had metastasis in one of these aberrant lymph nodes.

Conclusion
Sentinel nodes were found outside a lymph node basin in 5 per cent of patients. Particular drainage patterns exist. It is recommended to incorporate such sites in the late scintigraphy images and to pursue aberrant sentinel nodes, as they may be the only sites of metastasis.