bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trefoil peptides and surgical disease
Authors: Longman R J , Thomas M G , Poulsom R 
Published: March 2003

Abstract

Background
Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides appear to be important in mucosal healing processes and in neoplastic disease.

Methods
This manuscript reviews the relevant literature obtained by an extensive text word search of the Medline database and a manual search of references from the articles identified.

Results and Conclusion
Trefoil peptides are aberrantly expressed by a wide range of human carcinomas and gastrointestinal inflammatory conditions. They impart protection from injury to the gastrointestinal mucosa by possible interaction with mucin glycoproteins. Trefoil peptides influence epithelial cell migration and mucosal restitution following injury. In the future, serum levels of trefoil peptides might be used as markers for both neoplastic and inflammatory diseases. In addition, novel therapies based on such peptides might be used for gastrointestinal inflammatory conditions and to accelerate repair of the gastrointestinal mucosa after surgery.
Spiral computed tomography for preoperative staging of potentially resectable carcinoma of the pancreatic head
Authors: Phoa S S K S , Reeders J W A J , Rauws E A J , de Wit L , Gouma D J , Laméris J S 
Published: March 2003

Abstract

Background
Pancreatic cancer is often locally invasive. Preoperative staging attempts to identify patients suitable for resection, in order to minimize unnecessary operations. The aim of this study was to assess the improved imaging provided by spiral computed tomography (CT) in the preoperative staging of potentially resectable pancreatic head carcinoma.

Methods
In 56 consecutive patients with pancreatic head carcinoma spiral CT findings were correlated prospectively with operative and histopathological findings. Criteria for irresectability at CT were infiltration of the peripancreatic fat and vascular ingrowth grade D, on a scale from A to F.

Results
At operation 27 (48 per cent) of 56 tumours were irresectable. Small metastases were found in seven patients (12 per cent). Ingrowth (adherence) to the portal or mesenteric vein was present in 19 patients (34 per cent). The sensitivity and specificity of CT for irresectability were 78 and 76 per cent respectively. Resection rates with a vascular margin free of tumour were 100 per cent for grade A, 63 per cent for grade B, 44 per cent for grade C, 15 per cent for grade D and 0 per cent for grade E, with a predictive value for ingrowth of 88 per cent for grades D or higher. The resectability rate was 11 per cent (one of nine) when infiltration of the anterior peripancreatic fat was present and 67 per cent when infiltration was absent (P &lt; 0·01).

Conclusion
Spiral CT with thin slices seems to improve detection of distant metastases and vascular ingrowth in patients with pancreatic head carcinoma.
Biphasic role for nitric oxide in experimental renal warm ischaemia–reperfusion injury
Authors: Weight S C , Furness P N , Nicholson M L 
Published: March 2003

Abstract

Background
Whilst nitric oxide has a clearly defined role in renal haemostasis, debate continues over its pathophysiology. This study investigated the function of nitric oxide in a model of renal warm ischaemia–reperfusion injury.

Methods
Rats underwent bilateral renal warm ischaemia (45 min) after pretreatment with nitric oxide donors, nitric oxide synthase (NOS) inhibitors or saline (control). Following reperfusion (20 min) a unilateral nephrectomy was performed to measure renal nitric oxide (as nitroxides) and oxidative DNA and protein damage. Renal function was measured on days 2 and 7 before terminal nephrectomy for analysis and morphology.

Results
The increase in renal nitric oxide level seen early in reperfusion (20 min) (P &lt; 0·01) was prevented by inhibition of constitutive (cNOS) but not inducible (iNOS) NOS. The increase in oxidative damage (P &lt; 0·01) was exacerbated by nitric oxide donors (P &lt; 0·01) but ameliorated by NOS inhibition (P &lt; 0·01). Control nitric oxide remained increased through to day 7 (P &lt; 0·01) but was reduced by nitric oxide donors and cNOS inhibitors (P &lt; 0·05). Oxidative damage returned towards normal in the control group, whereas both DNA and protein damage persisted following NOS inhibition (P &lt; 0·01).

Conclusion
Inhibition of the postischaemic increase in the level of nitric oxide was associated with an early decrease in, but eventual exacerbation of, oxidative damage. This suggests the prolonged increase in renal nitric oxide concentration was cytoprotective overall.
Consultant surgeons' opinion of the skills required of basic surgical trainees
Authors: Baldwin P J , Paisley A M , Brown S Paterson 
Published: March 2003

Abstract

Background
Accurate and appropriate assessment of surgical trainees requires clear determination of the skills needed for surgical competence. This study was designed to identify those skills, rank them in order of importance and translate them into behavioural terms.

Methods
A Delphi technique, using anonymous postal questionnaires, was used. All consultant surgeons in South-East Scotland were asked to identify the skills they expected of surgical trainees. Skills identified were then returned to all consultants for weighting. Differences among specialties in the importance of each item were identified using analysis of variance.

Results
The qualities identified fell into five domains: technical skills, clinical skills, interaction with patients and relatives, teamwork, and application of knowledge. Consultants from all specialties gave high weightings to the generic domains of clinical skills, teamwork, and interaction with patients and relatives.

Conclusion
This study has identified the skills considered necessary by consultant surgeons in Scotland for a successful surgical career. Contrary to expectation, consultant surgeons value many generic skills more highly than technical skills, indicating that they value well rounded doctors, not just those with technical ability. The characteristics identified are being used to develop an assessment tool for use on basic surgical trainees.
Impact of laparoscopic colonic resection on tumour growth and spread in an experimental model
Authors: Gutt C N , Riemer V , Kim Z G , Jacobi C A , Paolucci V , Lorenz M 
Published: March 2003

Abstract

Background
The influence of surgical manipulation and carbon dioxide pneumoperitoneum on intraperitoneal tumour growth and port-site metastasis during laparoscopic colon resection is still unknown.

Methods
Some 33 male WAG/Rij rats were randomized into three experimental groups: a laparoscopy group with carbon dioxide pneumoperitoneum (n = 11), a gasless laparoscopy group (n = 11) and a laparotomy group (n = 11). After transanal injection of a tumour cell suspension (1 × 106 CC 531 cells) into the distal colon, a colon segment resection and an end-to-end anastomosis (laparoscopy; intra-abdominal technique) were performed. Tumour growth was scored semiquantitatively 24 days after the operation. Data were analysed by the Kruskal–Wallis test.

Results
The tumour indices from the four locations with the greatest tumour growth were significantly decreased in the laparoscopy group with carbon dioxide pneumoperitoneum compared with the gasless laparoscopy and laparotomy groups (P &lt; 0·01). Port-site metastases were significantly decreased in the carbon dioxide pneumoperitoneum group compared with the gasless laparoscopy group (P = 0·05).

Conclusion
A full laparotomy incision promotes greater tumour growth than does carbon dioxide pneumoperitoneum. Surgical manipulation stimulates local tumour spread more than the establishment of a carbon dioxide pneumoperitoneum.
Postoperative peritonitis originating from the duodenum: operative management by intubation and continuous intraluminal irrigation
Authors: Parc Y , Frileux P , Vaillant J C , Ollivier J M , Parc R 
Published: March 2003

Abstract

Background
The mortality rate associated with postoperative peritonitis remains high, especially when the source of infection cannot be eradicated. Such is the case with peritonitis arising from the duodenum, as primary closure is futile and intubation alone may be followed by local complications.

Methods
Forty-nine consecutive patients with postoperative peritonitis originating from a duodenal leak and a mean Acute Physiology And Chronic Health Evaluation II score of 17·7 were treated according to the following procedure: a three-channelled spiral drain was inserted through the leak and extraluminal drains were placed near the duodenal defect. Intraluminal irrigation was undertaken immediately through the infusion channel of the spiral drain.

Results
Eleven patients died and 26 suffered complications. The mean duration of intubation was 21 days.

Conclusion
Intubation with intraluminal irrigation has proved effective in a homogeneous group of patients with peritonitis due to duodenal leakage.
Frequency of early colorectal cancer in patients undergoing colonoscopy
Authors: Smith G A , Oien K A , O'Dwyer P J 
Published: March 2003

Abstract

Background
Early colorectal cancer is defined as carcinoma limited to the mucosa or submucosa. Up to 20 per cent of all colorectal cancers treated in some Japanese institutions are early cancers. These cancers are sometimes flat or depressed, and may be less than 1 cm in diameter. The aim of this study was to identify the frequency and morphology of early colonic cancers detected at colonoscopy by a surgeon aware of and looking for such lesions.

Methods
A review was made of all colonoscopies performed by or under the supervision of a single endoscopist between 1990 and 1998. Follow-up and outcome of all patients with early colorectal cancer was undertaken.

Results
Ninety-five invasive colorectal cancers were identified from 2198 colonoscopies. Eighteen were early colorectal cancers (T1). Macroscopically these were flat (nine tumours), villous (four) and pedunculated (five). Two patients had lymph node metastasis. The median size of flat cancers was 20 (range 9–30) mm. Median follow-up was 3 years. One patient had local recurrence, and another, whose early cancer was metachronous, died from metastatic cancer.

Conclusion
This study identified early colonic cancer with similar frequency and morphology to that reported by the Japanese. Colonoscopy should be considered as the investigation of choice for patients with large bowel symptoms.
Evidence that metastasis is less common in cirrhotic than normal liver: a systematic review of post-mortem case–control studies
Authors: Seymour K , Charnley R M 
Published: March 2003

Abstract

Background
It has been hypothesized that the cirrhotic liver is afforded protection against metastasis. The evidence has been examined and the plausibility of such a phenomenon is reviewed.

Methods
A systematic literature review was conducted with analysis of combined data from post-mortem case–control studies.

Results
Overall, the crude rate of metastasis to normal liver was 37·3 per cent, while the rate to cirrhotic liver was 23·7 per cent. The Mantel–Haenszel (MH) fixed-effects estimate of the odds ratio was 0·47 (95 per cent confidence interval (c.i.) 0·41–0·53; χ2 = 136, 11 d.f., P &lt; 0·001). The DerSimonian–Laird (DL) random-effects estimation of the odds ratio was 0·42 (95 per cent c.i. 0·31–0·58; χ2 = 28, 1 d.f., P &lt; 0·001). For tumours arising within the distribution of the portal vein, the crude rate of metastasis to normal liver was 47·6 per cent, whereas the rate to cirrhotic liver was 29·8 per cent. The MH estimate of the odds ratio was 0·45 (95 per cent c.i. 0·37–0·54; χ2 = 68·2, 5 d.f., P &lt; 0·001). The DL pooled odds ratio was 0·44 (95 per cent c.i. 0·28–0·70; χ2 = 12·3, 1 d.f., P &lt; 0·001). The MH and DL pooled estimates of the odds ratio were similar for groups of patients from the East (Japan) and the West (Europe and the USA).

Conclusion
The post-mortem evidence reviewed suggests that the likelihood of metastasis to the cirrhotic liver is lower than that to normal liver. The degree of protection for tumours arising from within the distribution of the portal vein is neither greater nor less than it is overall. Eastern and Western populations appear to have a similar degree of risk reduction. The differences noted were significant on testing in the meta-analysis, but confounding bias accounting for these differences has not been excluded.
Survival of patients with colorectal cancer diagnosed in a randomized controlled trial of faecal occult blood screening
Authors: Mapp T J , Hardcastle J D , Moss S M , Robinson M H E 
Published: March 2003

Abstract

Background
Analysis of survival of subjects with colorectal cancer diagnosed by different modalities can provide insight into the mechanism by which screening has an effect. It can also give an indication of the feasibility of using prognostic indicators as surrogate outcome measures to predict mortality in future studies.

Methods
This paper examines the survival of individuals with colorectal cancer diagnosed in the Nottingham trial and explores the role of selected prognostic factors as possible surrogate outcome measures.

Results
Survival was significantly better in subjects with screen-detected cancers than in controls, even after adjusting for tumour stage and accounting for lead-time bias. Survival was inversely related to stage of tumour, with patients with stage A tumours having the best survival. Subjects with well or moderately differentiated tumours had a significantly better survival than those with poorly differentiated tumours.

Conclusion
Screening for colorectal cancer by means of faecal occult blood testing improved survival among subjects with screen-detected cancers. Differences in prognostic factors largely explain the differences in survival between both non-responders and subjects with interval cancers and those in the control group, but not the improved prognosis for patients with screen-detected cancers. The use of such factors as surrogate outcome measures may therefore be inappropriate.
Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon
Authors: Naraynsingh V , Rampaul R , Maharaj D , Kuruvilla T , Ramcharan K , Pouchet B 
Published: March 2003

Abstract

Background
Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage.

Methods
Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique.

Results
Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12 h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9·8 days.

Conclusion
Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage.
Early evaluation of renal reperfusion injury after prolonged cold storage using proton nuclear magnetic resonance spectroscopy
Authors: Hauet T , Goujon J M , Tallineau C , Carretier M , Eugene M 
Published: March 2003

Abstract

Background
Proton nuclear magnetic resonance (NMR) spectroscopy can be used as a non-invasive tool to measure renal damage. In the present investigation, proton NMR spectroscopy of urine was assessed in order to detect cellular damage after different periods of cold ischaemia in two standard preservation solutions.

Methods
The isolated perfused pig kidney was used to assess initial renal function after in situ cold flush and cold storage (CS) for 24 or 48 h in two standard preservation solutions: EuroCollins (EC) and University of Wisconsin (UW) solutions. Kidneys flushed with cold heparinized saline and immediately perfused were used as a control group. Kidneys were perfused for 2 h at 37·5°C for functional evaluation. During reperfusion, renal perfusion flow rate was measured. Glomerular filtration rate (GFR), tubular reabsorption of sodium ions, and lactate dehydrogenase (LDH) and N-acetyl-β-d-glucosaminidase (NAG) excretion were determined. Impairment caused by ischaemia and reperfusion was also determined by histological techniques and proton NMR spectroscopy.

Results
The perfusion flow rate, GFR and tubular reabsorption of sodium were significantly decreased in experimental groups compared with the control group. There was no significant difference between experimental groups after 24 h of CS. The perfusion flow rate was significantly decreased in the EC group after 48 h of cold ischaemia compared with that in the UW group. After 48 h of CS, GFR and tubular reabsorption of sodium were significantly reduced in the EC group compared with those in the UW group. The release of LDH into the effluent and the urinary excretion of NAG were not significantly different after 24 h of CS. After more than 45 and 60 min of reperfusion respectively, LDH and NAG excretion was no different in the 48-h CS groups. The most relevant resonances determined by proton NMR spectroscopy were of citrate, trimethylamine-N-oxide, lactate, acetate and amino acids. Excretion of these markers was significantly more accurate and efficient to assess renal ischaemia–reperfusion injury than that of biochemical markers. A resonance (P) detected particularly in the EC group after 48 h of CS was identified and correlated well with renal dysfunction. After CS for 48 h and 2 h of reperfusion, renal injury was histologically more pronounced in EC groups than in UW groups. However, the difference was not significant after CS for 24 h.

Conclusion
NMR spectroscopy, which is a non-invasive and non-destructive technique, is more accurate and efficient when assessing kidney damage after cold ischaemia and reperfusion when compared to conventional histological and biochemical analysis.
Outcome in patients with colorectal cancer managed by surgical trainees
Authors: Singh K K , Aitken R J 
Published: March 2003

Abstract

Background
The surgeon is an important variable that influences outcome following colorectal cancer surgery. Operative training of suitable quality and quantity is essential if intersurgeon variation is to be reduced. The aim of this study was to examine the outcome of colorectal cancer surgery when a high proportion of the operations were performed by trainee surgeons.

Methods
A prospective 7-year (1989–1996) audit of 306 consecutive colorectal cancers referred to a single general surgeon with a colorectal interest was carried out. The outcome (anastomotic leakage, 30-day mortality rate, local recurrence and cancer-related survival) of operations performed by the consultant was compared with that of his trainees.

Results
Some 245 (92·5 per cent) of 265 patients undergoing laparotomy had a resection. Seventy (28·6 per cent) and 67 (27·3 per cent) of operations were performed by supervised and independent trainees respectively. There was no difference between the consultant, supervised and independent trainees for 30-day mortality rate (6·5, 6 and 4 per cent respectively), clinical anastomotic leakage rate (9, 2 and 5 per cent) and local recurrence rate (2, 3 and 7 per cent). There was no difference between the three groups for adjusted 5-year disease-related survival rates.

Conclusion
Properly supervised trainees can resect a high proportion of colorectal cancers without compromising immediate outcome or long-term survival.
Presented in part to the annual meeting of the Association of Surgeons of Great Britain and Ireland, Bournemouth, UK, April 1997, and published in abstract form as Br J Surg 1997; 84(Suppl): 56
Partial ileal resection for hypercholesterolaemia in patients undergoing surgery for obesity
Authors: Dachtler J , Johnston D , Halstead J C , King R F G J 
Published: March 2003

Abstract
The Annual Scientific Meeting of the Association of Surgeons of Great Britain and Ireland was held in Brighton on 5–7 May 1999 under the Presidency of Professor R. C. N. Williamson. The abstracts of the oral and poster presentations of the original work presented at the meeting have been published in a BJS Supplement that accompanied the June 1999 issue of the Journal. The articles that follow in the present issue describe work presented at the Brighton meeting that have been accepted for publication after peer review by the Journal's referees. Other papers from this meeting will appear in subsequent issues.
Clinicopathological study of intrapelvic cancer spread to the iliac area in lower rectal adenocarcinoma by serial sectioning
Authors: Ueno H , Yamauchi C , Hase K , Ichikura T , Mochizuki H 
Published: March 2003

Abstract

Background
The role of iliac lymphadenectomy in surgery for rectal cancer remains unknown. Detailed clinicopathological data on lateral cancer extension may be needed to determine the true role of this procedure.

Methods
Seventy consecutive patients with low rectal cancer who underwent systematic iliac lymphadenectomy between 1991 and 1995 were reviewed. The iliac area was divided into five regions: (1) middle rectal root, (2) internal iliac, (3) obturator, (4) common iliac and (5) external iliac. Iliac lymph nodes that were cancer-free based on conventional pathological examination were serially sectioned at 100-µm intervals and re-examined for occult microscopic involvement.

Results
Occult microscopic foci were detected in five (7 per cent) of the 70 patients, and the overall incidence of lateral cancer spread was 24 per cent (17 of 70). Among patients without other sites of distant metastasis or circumferential involvement of the margin, the 5-year survival rate of those with lateral spread was 35 per cent. Although the prognosis of patients with cancer involving multiple iliac regions was poor, three of six patients with metastasis to only a single region were alive without disease at 3 years.

Conclusion
Surgeons should be aware of the possibility of localized lateral spread, including microscopic metastasis, when determining the optimum procedure for iliac lymphadenectomy in patients with rectal cancer.
24-h pH monitoring is necessary to assess acid reflux suppression in patients with Barrett's oesophagus undergoing treatment with proton pump inhibitors
Authors: Ortiz A , Martínez de Haro L F , Parrilla P , Molina J , Bermejo J , Munitiz V 
Published: March 2003

Abstract

Background
Control of acid reflux is the main objective of treatment for Barrett's oesophagus. However, as these patients have a reduced sensitivity to acid reflux, disappearance of symptoms may not correlate with efficient control of acid reflux. The aim of this study was to determine in a group of patients with Barrett's oesophagus whether treatment with proton pump inhibitors suppressed patho- logical acid reflux once the symptoms of reflux had been controlled and the associated inflammatory lesions cured.

Methods
Eighteen consecutive patients with Barrett's oesophagus were studied, all of whom presented with heartburn. Twenty-four-hour oesophageal pH monitoring before treatment showed pathological acid reflux in all cases: median percentage of total time with pH less than 4, 22 (range 8–52) per cent. All patients received proton pump inhibitors (dose 20–60 mg/day) until symptoms were controlled.

Results
While on therapy, pH was reduced (median percentage of total time with pH less than 4, 3 versus 22 per cent; P &lt; 0·001). However, three patients had persistent pathological rates of acid reflux.

Conclusion
Disappearance of symptoms is not a good indicator of control of pathological acid reflux in patients with Barrett's oesophagus. Twenty-four-hour pH monitoring should be performed for proper adjustment of the dose of medication.