bluuebunny/crossref_metadata_2025_split huggingface dataset:
Road traffic fatalities in Victoria, Australia and changes to the trauma care system
Authors: McDermott F T , Cordner S M , Tremayne A B 
Published: March 2003

Abstract

Background
The aim was to identify organizational and clinical errors in the management of road traffic fatalities and to use this information to improve Victoria's trauma care system.

Methods
A multidisciplinary committee evaluated the complete ambulance, hospital and autopsy records of 559 consecutive road traffic fatalities, who were alive on arrival of ambulance services, in five substantial time periods between 1992 and 1998. Patients who survived more than 30 days were excluded. Errors or inadequacies in each phase of management, including those contributing to death, were identified and an assessment was made of the potential preventability of death.

Results
Findings between 1992 and 1998 were similar. In 1998, 1672 problems were identified in 110 deaths with 1024 (61 per cent) contributing to death. Eight hundred and forty-two (50 per cent) of the total problems occurred in the emergency department. There were frequent problems in initial patient reception and medical consultation, resuscitation, investigation and assessment (especially of the abdomen and head), and in transfer to the operating theatre or to a higher-level hospital. Victoria's combined preventable and potentially preventable death rate has been unchanged between 1992 and 1998 (34–38 per cent).

Conclusion
The problems identified led to a Ministerial Taskforce on Trauma and Emergency Services in Victoria as a consequence of which a new trauma system is now being implemented.
Effect of multimodality therapy on circulating vascular endothelial growth factor levels in patients with oesophageal cancer
Authors: McDonnell C O , Harmey J H , Bouchier-Hayes D J , Walsh T N 
Published: March 2003

Abstract

Background
Angiogenesis is critical for tumour growth and metastasis. The switch to the angiogenic phenotype depends on the net balance between positive and negative angiogenic factors released by the tumour. It was hypothesized that patients with oesophageal cancer would express raised serum levels of vascular endothelial growth factor (VEGF) which would return to normal values with neoadjuvant chemoradiotherapy.

Methods
Forty-four patients with oesophageal cancer who were selected for treatment with neoadjuvant chemoradiotherapy had blood samples taken before treatment, during chemoradiotherapy, before operation, on days 1, 3 and 5 after surgery, and 3 months after resection. Serum levels of VEGF were measured. Values were correlated with response to treatment. Controls were patients who were undergoing surgery for non-malignant conditions.

Results
Serum VEGF levels were raised in patients with oesophageal cancer compared with age-matched controls (mean 247 versus 1157 pg/ml; P &lt; 0·01). VEGF levels were unaffected by neoadjuvant treatment but fell significantly on the first day after operation (652 versus 1057 pg/ml before operation; P &lt; 0·05). No decrease occurred in control patients. VEGF levels had returned to preoperative levels by day 5. A similar postoperative rise in VEGF levels was seen in the control subjects (1194 pg/ml on day 5 versus 71 pg/ml before operation; P = 0·001). There was no correlation between VEGF level and response to treatment or tumour stage. VEGF levels had decreased significantly at 3 months following tumour resection (594 versus 1558 pg/ml on day 5; P = 0·03).

Conclusion
VEGF levels are raised in patients with oesophageal cancer and are unaltered by neoadjuvant treatment, suggesting an additional source other than tumour cells for this proangiogenic agent.
Intragastric balloon in the treatment of patients with morbid obesity
Authors: Evans J D , Scott M H 
Published: March 2003

Abstract

Background
Morbid obesity is a major health problem. This study evaluated the effectiveness and safety of an intragastric balloon (IGB) for the treatment of morbid obesity.

Methods
Sixty-nine IGBs were inserted endoscopically over a 3-year period in 63 consecutive patients (59 women; median age 41 (range 24–67) years). Median weight and body mass index were 124·5 (range 89·0–177·8) kg and 46·3 (range 36·2–72·4) kg/m2 respectively. Significant coexistent disease was present in 34 patients. Median American Society of Anesthesiologists score was 3 (range 1–4). Data were recorded following retrospective review of patient case notes.

Results
Mean operating time was 22 (range 15–30) min and median inpatient stay was 1 (range 1–6) day. Vomiting was the commonest early complication following 31 procedures and necessitated early removal of four IGBs. Of 58 patients with long-term follow-up, 18 suffered displacement of the IGB after at least 6 months in situ and three required a laparotomy for intestinal obstruction. Fifty patients (86 per cent) lost weight; median weight loss was 15·0 kg (P &lt; 0·001). Median excess weight loss was 16·4 (range − 49·0 to +4·8) and 18·7 (range −51·5 to 12·6) per cent by 4 and 7 months after IGB insertion respectively.

Conclusion
The IGB represents a useful device for the treatment of morbid obesity, particularly in preparation for definitive antiobesity procedures. Early IGB replacement is essential to minimize complications.
Expression of inducible nitric oxide synthase contributes to the development of pancreatitis following pancreatic ischaemia and reperfusion
Authors: Ayub K , Serracino-Inglott F , Williamson R C N , Mathie R T 
Published: March 2003

Abstract

Background
Inducible nitric oxide synthase (iNOS) activity is increased in experimentally induced acute pancreatitis. Increased expression of this isoform of nitric oxide synthase has been demonstrated in several organs subjected to ischaemia–reperfusion injury. The present experiment investigated the expression of iNOS and the effect of selective iNOS inhibition in pancreatic ischaemia–reperfusion.

Methods
Wistar rats (n = 40) were randomly and equally assigned to four groups. Groups 2 and 4 underwent 60 min of total pancreatic ischaemia followed by 6 h of reperfusion (I–R). Groups 1 and 3 underwent sham operation. The selective iNOS inhibitor l-N6-(1-iminoethyl)-lysine (l-NIL) was administered to groups 3 and 4. Expression of iNOS was examined by immunohistochemistry. Other investigations included measurement of serum amylase activity and pancreatic wet: dry weight ratio, and histopathological examination.

Results
Eight of ten rats in group 2 (I–R only) expressed iNOS but none of the ten animals in group 1 (sham laparotomy) did so. Group 4 (I-R + l-NIL) animals had significantly lower serum amylase levels and wet: dry weight ratios than those in group 2 (I–R only). Microscopic evidence of pancreatic injury was present only in rats in group 2 (I–R only).

Conclusion
Expression of iNOS during reperfusion following pancreatic ischaemia contributes significantly to the development of acute pancreatitis.
Comparison of cardiac troponin I and creatine kinase ratios in the detection of myocardial injury after aortic surgery
Authors: Haggart P C , Adam D J , Ludman P F , Bradbury A W 
Published: March 2003

Abstract

Background
Perioperative myocardial infarction may not be diagnosed correctly because World Health Organization criteria are often not met and creatinine kinase myocardial fraction (creatinine kinase/creatinine kinase MB isoenzyme; CK/CK-MB) ratios can be difficult to interpret. Cardiac troponin (cTn) I and cTnT are the most sensitive and specific markers of myocardial cell necrosis currently available but are not widely used in surgical practice. The aim was to compare cTnI and CK/CK-MB ratios in the detection of myocardial injury following aortic surgery.

Methods
This was a prospective study of 59 patients undergoing elective (n = 28) or ruptured (n = 24) abdominal aortic aneurysm repair or elective aortofemoral bypass (n = 7). cTnI level was measured before operation and at 6, 24 and 48 h after surgery. The CK/CK-MB ratio was measured where cTnI was detectable.

Results
Some 14 of 24 emergency and ten of 35 elective patients had detectable cTnI (greater than 0·5 ng/ml) at one or more time-points. The CK/CK-MB ratio was greater than 5 per cent in only four of 24 patients having an emergency operation and in none of the elective patients with detectable cTnI.

Conclusion
Over half of patients undergoing emergency operation and more than a quarter of those having elective aortic surgery suffered myocardial necrosis as determined by detectable cTnI levels. This was accompanied by a raised CK/CK-MB ratio in less than one-fifth of patients.
Population-based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancer
Authors: Manfredi S , Benhamiche A M , Meny B , Cheynel N , Rat P , Faivre J 
Published: March 2003

Abstract

Background
Few data are available from population-based statistics on the risk of local recurrence after surgery for rectal cancer. The aims of this study were to determine factors influencing local control and to analyse treatment and prognosis of recurrences in a well defined population.

Methods
Data were obtained from the cancer registry of the Côte d'Or (France). From 1976 to 1995, 682 patients resected for cure for a rectal carcinoma were included. Recurrence rates and survival rates were calculated using actuarial methods. A relative survival analysis and Cox multivariate analysis were performed.

Results
During the study 135 local recurrences were registered. The 5-year cumulative local recurrence rate was 22·7 per cent. In multivariate analysis the two variables significantly associated with local recurrence risk were stage at diagnosis and the macroscopic type of growth. There was a non-significant decrease in local recurrence rate in patients treated by preoperative radiotherapy compared with that in patients treated by surgery alone. The proportion of patients re-resected for cure was 25·2 per cent, and increased from 13·0 per cent in 1976–1985 to 37·9 per cent in 1986–1995 (P = 0·001). The 5-year relative survival rate was 13·6 per cent overall and 40·6 per cent after resection for cure (P &lt; 0·001).

Conclusion
Local recurrence of rectal cancer following resection remains a substantial problem. Improvement can be expected from better care and earlier diagnosis.
Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice technique
Authors: Fleming W R , Elliott T B , Jones R McL , Hardy K J 
Published: March 2003

Abstract

Background
The optimal technique for inguinal hernia repair remains contentious. This study compared the Shouldice repair with the totally extraperitoneal endoscopic (TEP) method in a randomized clinical trial, with quality of life (QoL) and cost analysis.

Methods
Two hundred patients were randomized to Shouldice or TEP repair. Patients were assessed after operation by questionnaire to determine operative outcomes, complications, QoL, and return to work and normal lifestyle.

Results
There were 117 TEP and 115 Shouldice repairs. Median operating time was longer for TEP repair (70 versus 56 min; P = 0·0001), but patients were discharged earlier (68 versus 48 per cent within 1 day; P = 0·0065), and had a quicker return to work (14 versus 30 days; P = 0·0001) and normal lifestyle (21 versus 35 days; P = 0·0001). Open repair was nearly 40 per cent cheaper. Late follow-up in 171 patients (86 per cent) at a median of 1·3 years found that TEP repair led to fewer complications at 1 year (9 versus 21 per cent; P = 0·05) and was associated with significant improvement for the QoL components of work performance and satisfaction, physical symptoms and sense of well-being.

Conclusion
TEP repair results in fewer complications and an earlier return to work and normal lifestyle, but is more expensive and takes longer to perform.
Small bowel obstruction after appendicectomy
Authors: Andersson R E B 
Published: March 2003

Abstract

Background
This study analysed the risk of surgically treated small bowel obstruction after open appendicectomy.

Methods
This was a historical cohort study of 245 400 patients who underwent open appendicectomy and population-based matched controls, identified by linkage of computer registries. Analyses were made with the life-table technique, Kaplan–Meier plots and Cox proportional hazards regression analysis.

Results
The cumulated risk of surgically treated small bowel obstruction after appendicectomy was 0·41 per cent after 4 weeks, 0·63 per cent after 1 year and 1·30 per cent after 30 years of follow-up, compared with 0·003 per cent at 1 year and 0·21 per cent after 30 years of follow-up among the non-operated controls. The highest risk was found after operation for other diagnoses (adjusted hazard ratio 5·2 (95 per cent confidence interval 4·6–5·8)), followed by operation for perforated appendicitis (adjusted hazard ratio 3·5 (3·1–3·8)), non-specific abdominal pain (adjusted hazard ratio 2·6 (2·3–3·0)) and mesenteric lymphadenitis (adjusted hazard ratio 2·4 (2·0–2·8)) compared with operation for non-perforated appendicitis. The relation with age was J shaped, with the lowest risk at 20–39 years. Women had a slightly lower risk than men.

Conclusion
The risk of postoperative small bowel obstruction needing surgical treatment after open appendicectomy is lower than previously thought. Perforated appendicitis, negative appendicectomy and high age are the risk factors.
Randomized clinical trial of intravenous fluid replacement during bowel preparation for surgery
Authors: Sanders G , Mercer S J , Saeb-Parsey K , Akhavani M A , Hosie K B , Lambert A W 
Published: March 2003

Abstract

Background
Bowel preparation using purgatives has previously been shown significantly to increase haemoglobin concentration and decrease weight. This prospective randomized study assessed the effects of administering intravenous fluid during bowel preparation.

Methods
Patients having bowel preparation with Picolax® for colonic procedures were randomized prospectively to receive no intravenous fluid (group 1) or calculated intravenous crystalloid based on body-weight (group 2) during preparation. Physiological, haematological and biochemical variables were measured before and after bowel preparation.

Results
Forty-one patients were recruited with a median age of 69 (range 29–86) years, 22 in group 1 and 19 in group 2. There was no difference between groups in any of the variables measured before bowel preparation. On completion, there was a significant difference between groups in mean weight loss (P = 0·01), postural change in systolic pressure (P = 0·015) and serum creatinine concentration (P = 0·008). In addition there was a significant fall in erect blood pressure after bowel preparation in group 1 (P = 0·02). The mean urine output in group 1 was 982 ml and in group 2 was 1808 ml (P = 0·004). The faeces weight between groups was not significantly different.

Conclusion
Picolax® bowel preparation has a significant dehydrating effect, which can be minimized by administering a simultaneous volume of intravenous fluid (mean 2 litres in this study).
Outcome of surgical treatment for carotid body paraganglioma
Authors: Plukker J T M , Brongers E P , Vermey A , Krikke A , van den Dungen J J A M 
Published: March 2003

Abstract

Background
The present study reviewed a 30-year experience of managing carotid body paraganglioma (CBP) and analysed clinical findings associated with perioperative morbidity.

Methods
Clinical records, radiological findings and pathological reports of all patients who presented with CBP between 1966 and 1997 were reviewed. There were 39 consecutive patients with 45 tumours and median follow-up was 10 years. The Shamblin classification was used to define complication rates and long-term surgical results.

Results
Preoperative information derived from magnetic resonance angiography (MRA) and colour Doppler imaging (CDI) was comparable to that from standard four-vessel arteriography. Forty-one CBPs were resected in 35 patients. Six patients had bilateral tumours and seven had multicentric tumours. The median duration of operation and blood loss were substantially higher for Shamblin type III tumours. All major vascular complications (four of 39 patients) and permanent neurological complications (three of 39) were observed in type III tumours.

Conclusion
Surgical planning and prediction of perioperative complications can be obtained by staging derived from MRA and CDI. Severe complications occur predominantly in type III CBPs.
Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma
Authors: Shimada M , Yamashita Y , Aishima S , Shirabe K , Takenaka K , Sugimachi K 
Published: March 2003

Abstract

Background
Hepatectomy with extensive lymph node dissection is the standard operation for intrahepatic cholangiocarcinoma (IHCC). However, lymph node dissection may not always be effective at reducing tumour recurrence.

Methods
Forty-nine patients with IHCC who underwent hepatectomy were investigated to determine patterns of tumour recurrence and to estimate the value of lymph node dissection during resection.

Results
At hepatectomy most metastatic lymph nodes were identified at least to the level of group 2 lymph nodes. Among 23 patients who developed recurrence, 17 had liver metastases and the other six had recurrence at other sites, mainly in the peritoneum. Poorly differentiated histology was related to the development of liver metastases. No patient with the intraductal growth type of IHCC had tumour recurrence. Lymph node dissection did not appear to improve patient survival. Histological findings of lymph node metastases and intrahepatic metastases were independent indicators of poor prognosis.

Conclusion
Lymph node metastases were seldom limited to the regional lymph nodes; most tumour recurrence occurred in the liver. Lymph node dissection did not appear to improve patient survival. Lymph node dissection alone is not likely to improve the prognosis without further control of liver metastases.
Validity of surgical simulation for the assessment of operative skill
Authors: Paisley A M , Baldwin P J , Paterson-Brown S 
Published: March 2003

Abstract

Background
Surgical simulators are being promoted as a means of assessing a surgeon's technical skills. Little evidence exists that simulator performance correlates with actual technical ability. This study was undertaken to determine the criterion and construct validity of currently available surgical simulations in the evaluation of technical skill.

Methods
Simulator assessment was carried out on 36 basic surgical trainees, 37 surgically naïve first-year medical students and 16 experienced general surgical consultants. Some 26 trainees and 36 students underwent repeat assessment after 6 months. A previously validated, 19-point technical skill assessment form, based on direct observation of trainee performance in the operating theatre, was also completed by each trainee's supervising consultant.

Results
An insignificant or weak correlation was found between simulator performance and both duration of basic surgical experience and consultant assessment of technical skill. Six months of basic surgical training led to an improvement in performance, not seen in an untrained control group, in only one of the six simulations tested. Discrimination between surgically naïve and experienced subjects was only demonstrated, in part, for four of the six tasks.

Conclusion
The assessment of technical skill needs to be improved. Work is needed to establish the reliability and validity of currently available simulation models before they are formally introduced for high-stakes assessment.
Multicentre retrospective analysis of the outcome of artificial anal sphincter implantation for severe faecal incontinence
Authors: Altomare D F , Dodi G , La Torre F , Romano G , Melega E , Rinaldi M 
Published: March 2003

Abstract

Background
A new prosthetic device, the ActiconTM artificial anal sphincter, has recently been introduced for treating severe faecal incontinence. The results of this procedure in 28 patients are presented.

Methods
The patients underwent operation for severe faecal incontinence in four Italian university hospitals and patients were reviewed after a median follow-up of 19 (range 7–41) months.

Results
Early infections occurred in four patients, requiring removal of the device in three. Dehiscence of the perineal wound occurred in nine patients. After activation of the device, the cuff had to be removed in a further four patients (for rectal erosion in two, anal pain in one and late infection in one). The cuff was accidentally broken in one patient. A new anal cuff was repositioned successfully in two patients. Overall, five patients had complete removal of the device and two removal of the cuff only. Twenty-one patients available for long-term evaluation had a major improvement in faecal continence. Median resting anal pressure increased from 27 mmHg before surgery to 32 mmHg after operation. Preoperative squeeze pressure was 42 mmHg while maximum postoperative anal pressure with the activated device was 67 mmHg. The median American Medical System incontinence score decreased significantly from 98·5 to 5·5 (P &lt; 0·001). Similar figures were observed using the Continence Grading Scale (from 14·9 to 2·6; P &lt; 0·001). Twelve patients developed symptoms of obstructed defaecation while two patients complained of anal pain.

Conclusion
Improved continence was achieved after neosphincter implantation in three-quarters of the patients. Early infection and rectal erosion, together with difficulty in evacuating, are still major concerns with this technique.
Long-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity
Authors: Altomare D F , Rinaldi M , Sallustio P L , Martino P , De Fazio M , Memeo V 
Published: March 2003

Abstract

Background
Stapled haemorrhoidectomy is gaining wide acceptance but there is still some concern about the risk of injury to the internal anal sphincter (IAS). IAS function and morphology, and anal canal sensitivity were studied prospectively in patients undergoing this operation.

Methods
Twenty patients (11 women; mean age 43 years) with stage III haemorrhoids entered the study. All underwent preoperative anorectal manometry, rectoanal inhibitory reflex (RAIR) testing and three-dimensional transanal ultrasonography. A test of anal sensation was administered to evaluate ability to discriminate between air and warm water. All the investigations were repeated 6 months after the operation.

Results
The mean(s.d.) maximal resting pressure was 87(30) mmHg before surgery and 81(20) mmHg afterwards (P not significant). The maximal squeeze pressure did not change after operation (178(43) versus 174(60) mmHg). The RAIR showed the same features in 19 of 20 patients before and 18 of 20 after operation. Three-dimensional ultrasonography demonstrated no changes in the width of the IAS (mean(s.d.) 2·1(4) mm before and 2·1(3) mm after surgery). The ability of the anal mucosa to discriminate air from warm water improved in five patients. Continence scores did not differ significantly after 6 months.

Conclusion
Stapled haemorrhoidectomy does not affect the function and morphology of the IAS in the long term. The sensitivity of the anal canal can improve in patients with preoperative sensory impairment.