bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early postoperative compensatory anti-inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer
Authors: Mokart D , Capo C , Blache J L , Delpero J R , Houvenaeghel G , Martin C , Mege J L 
Published: October 2002

AbstractBackgroundPatients who undergo major surgery for cancer are at high risk of postoperative infection. Postoperative immunosuppression may be due to dysregulation of cytokine production. The aim of this study was to investigate the association between changes in serum proinflammatory and anti-inflammatory cytokine concentrations and postoperative septic complications after major surgery.MethodsSerial blood samples were collected from 30 consecutive patients for determination of serum cytokine levels. Healthy volunteers were used as the control group.ResultsEleven patients developed no complications (group 1), 14 developed sepsis or severe sepsis (group 2), and five developed septic shock (group 3). On day 1 the patients in groups 2 and 3 had significantly higher levels of interleukin (IL) 6 than those in group 1. IL-6 levels remained high until day 5. Tumour necrosis factor (TNF), IL-1, interferon (IFN) γ and IL-12 levels were not affected by surgical trauma or by the occurrence of septic complications. After operation the circulating IL-1 receptor antagonist (IL-1ra) concentration was increased in all groups, but patients in group 3 had significantly higher levels of IL-1ra than those in group 1. IL-1ra levels correlated with IL-6 levels. The pattern of IL-10 levels was similar to that of IL-1ra levels.ConclusionSerum concentrations of proinflammatory cytokines (TNF, IL-1, IFN-γ and IL-12) were not affected by operation or the occurrence of septic complications. The postoperative increase in IL-6 concentration was associated with septic morbidity, while raised IL-1ra concentration was associated with postoperative septic shock.
Value of palliative resection in gastric cancer
Authors: Hartgrink H H , Putter H , Klein Kranenbarg E , Bonenkamp J J , van de Velde C J H 
Published: October 2002

Abstract

Background
Western patients with gastric cancer often present with incurable disease. The role of palliative surgical resection is still debatable. Non-curatively treated patients from the Dutch Gastric Cancer Trial were studied to define more accurately which patients might benefit from palliative resection.

Methods
In the Dutch Gastric Cancer Trial 285 (26 per cent) of the randomized patients were found to have incurable tumours at laparotomy. Four signs of incurability were noted: irresectable tumour (T+), hepatic metastasis (H+), peritoneal metastasis (P+) and distant lymph node metastasis (N4+). Patients had either an explorative laparotomy, a gastroenterostomy, or a resection (partial or total). In the analysis, particular attention was paid to the prognostic factors of age, number of metastatic features, and a combination of these.

Results
Overall survival time was greater if a resection was performed (8·1 versus 5·4 months; P &lt; 0·001). For patients aged over 70 years there was still a survival advantage of about 3 months if resection was carried out. Morbidity and perioperative mortality rates in this older age group were, however, high (50 and 20 per cent respectively). For patients with one metastatic site a resection was of significant benefit (survival 10·5 versus 6·7 months; P = 0·034). For patients with two or more metastatic sites resection had no significant survival advantage (5·7 versus 4·6 months; P = 0·084). Combination of these factors indicates that patients aged less than 70 years with one metastatic site will benefit significantly from a palliative resection, in contrast to other combinations of factors.

Conclusion
Age as well as the number of metastatic sites should be taken into account when a palliative resection is considered. Palliative resection may be beneficial for patients under 70 years of age if the tumour load is restricted to one metastatic site.
Management of popliteal aneurysm
Authors: Galland R B , Magee T R 
Published: October 2002

Abstract

Background
The best management of patients with a popliteal aneurysm has yet to be established. This paper describes an experience of managing both patent and acutely thrombosed popliteal aneurysms.

Methods
A prospective study was carried out of all patients who presented with a popliteal aneurysm from January 1988 to December 2001. Since 1993 asymptomatic popliteal aneurysms less than 3 cm in diameter without distortion have been managed conservatively. Ultrasonography was repeated at 6-month intervals. These results were compared with conservative management of popliteal aneurysms greater than 3 cm in diameter in patients who declined or were unfit for operation, and with the outcome of patients who underwent elective bypass of a popliteal aneurysm.

Results
Fifty-eight patients (two women) presented with 92 popliteal aneurysms. Some 39 had a thrombosed aneurysm and these patients were significantly more likely to have bilateral aneurysms (P &lt; 0·001). Of patent popliteal aneurysms managed conservatively, none below 3 cm in diameter thrombosed. The risk of postoperative complications was greater after repair of a thrombosed than a patent aneurysm (P &lt; 0·005). Preoperative lysis for a thrombosed popliteal aneurysm was associated with more complications than operation and on-table lysis (P &lt; 0·05).

Conclusion
Careful monitoring of asymptomatic popliteal aneurysms less than 3 cm in diameter is safe. Preoperative lysis is associated with increased risks compared with operation alone in patients with a thrombosed popliteal aneurysm.
p53, DCC and thymidylate synthase as predictors of survival after resection of hepatic metastases from colorectal cancer
Authors: Saw R P M , Koorey D , Painter D , Gallagher P J , Solomon M J 
Published: October 2002

Abstract

Background
Hepatic metastasis from colorectal cancer is a common problem. Hepatic resection offers the only chance of cure. Prognosis of patients following hepatic resection is currently based on clinicopathological factors (of both the primary cancer and the hepatic metastasis), which do not accurately predict the subsequent behaviour of the tumour. The aim of this study was to evaluate three molecular genetic markers – p53, DCC (deleted in colonic cancer) and thymidylate synthase – in both the primary colorectal tumour and the resected hepatic metastases, and to determine their correlation, if any, with survival in patients with resected hepatic metastases from colorectal cancer.

Methods
Sixty-three patients with hepatic metastases and 40 corresponding colorectal primary tumours were studied using immunohistochemical staining for p53, DCC and thymidylate synthase, as well as p53 gene mutations using polymerase chain reaction–single-stranded conformational polymorphism (PCR-SSCP) analysis. The results were correlated with survival.

Results
There was no correlation between p53, DCC or thymidylate synthase immunohistochemical staining, or between p53 PCR-SSCP analysis, and survival for either hepatic metastases or the colorectal primary tumour.

Conclusion
Prediction of prognosis in patients having resection of hepatic metastases from colorectal cancer continues to be problematic. Other genetic markers or combination of markers need to be evaluated.
Ranitidine as adjuvant treatment in colorectal cancer
Authors: Nielsen H J , Christensen I J , Moesgaard F , Kehlet H 
Published: October 2002

AbstractBackgroundResults from short-term studies of histamine type 2 (H2) receptor antagonists on survival of patients with solid tumours are debatable. In this study the efficacy of the H2–receptor antagonist ranitidine on long-term survival of patients with colorectal cancer was evaluated.MethodsPatients scheduled for elective resection of primary tumours were consecutively included in a randomized double-blind placebo-controlled clinical study designed to evaluate the effect of ranitidine on survival. Before skin incision ranitidine 100 mg or placebo was given intravenously twice daily followed by oral ranitidine 150 mg or placebo twice daily for 5 years. Adjuvant cytotoxic or radiation therapy was not given. An observer-blinded interim analysis performed after 40 months showed that there was no effect of ranitidine on overall survival, and the study was discontinued in accordance with the protocol. The patient cohort has been followed continuously without loss of any patient, and a final statistical analysis was performed on an intention-to-treat basis after more than 5 years; this included a subgroup analysis of perioperative blood transfusion and postoperative infectious complications.ResultsThe median observation period of the 740 patients included was 6·8 (range 5·4–7·9) years. A univariate analysis of all 740 patients and of the subgroup of 560 who underwent curative resection showed no significant effect of ranitidine on survival. Furthermore, ranitidine had no survival benefit in curatively resected patients who received a perioperative blood transfusion (n = 358), but it improved the survival of non-transfused patients (n = 202; hazard ratio (HR) 0·6 (95 per cent confidence interval (c.i.) 0·4 to 0·9), P = 0·02) and of non-transfused patients who did not develop postoperative infectious complications (n = 170; HR 0·6 (95 per cent c.i. 0·4 to 0·9), P = 0·01). In multivariate analysis of patients who had a curative resection, including Dukes' stage, age, gender, tumour location, blood transfusion, postoperative infectious complications and treatment, ranitidine still had an independent, beneficial effect on survival (HR 0·6 (95 per cent c.i. 0·4 to 1·0), P = 0·04) within the subgroup of patients who did not receive perioperative blood transfusion and did not develop postoperative infectious complications.ConclusionRanitidine may prolong the survival of patients who undergo curative resection of colorectal cancer and who do not receive perioperative blood transfusion and do not develop postoperative infectious complications.
Granulocyte colony-stimulating factor but not peritoneal lavage increases survival rate after experimental abdominal contamination and infection
Authors: Bauhofer A , Stinner B , Kohlert F , Reckzeh B , Lorenz W , Celik I 
Published: October 2002

AbstractBackgroundThe value of peritoneal lavage for intra-abdominal contamination and infection has never been proven scientifically. In contrast, the stimulation of host defence mechanisms with cytokines such as granulocyte colony-stimulating factor (G-CSF) has appeared promising in recent clinical trials.MethodsClinic modelling randomized trials (CMRTs), which model the complexity of the clinical reality, were used in rats in which peritoneal contamination and infection (PCI) was produced with human stool bacteria. The following groups were compared: trial 1, intraoperative peritoneal lavage with saline versus taurolin (18 rats per group); trial 2, no lavage versus saline lavage versus saline lavage plus subcutaneous administration of G-CSF (18 rats per group); trial 3, lavage with saline versus no lavage (30 rats per group). The primary endpoint was mortality at 120 h. Secondary endpoints were the phagocytic activity of granulocytes, and systemic and peritoneal cytokine levels.ResultsIn trial 1 lavage with taurolin was not superior to that with saline (five of 18 versus eight of 18 animals survived; P = 0·32). In trial 2, six of 18 animals having no lavage and three of 18 receiving saline lavage survived. The combination of lavage and G-CSF increased the number of animals surviving to 11 of 18 (P &lt; 0·05). Lavage combined with G-CSF stimulated granulocyte phagocytic activity (P &lt; 0·01) and reduced the levels of interleukin (IL) 6 (P &lt; 0·01) and tumour necrosis factor α (P &lt; 0·05) in peritoneal fluid, as well as plasma levels of IL-6 (P &lt; 0·05) and IL-10 (P &lt; 0·01). In trial 3, survival was not significantly different in animals having lavage (14 of 30) and no lavage (19 of 30) (P = 0·14).ConclusionIn these CMRTs of intra-abdominal contamination and infection, peritoneal lavage was not beneficial, but when lavage was combined with subcutaneous administration of G-CSF mortality was reduced and the local and systemic cytokine response was downgraded. Results from these CMRTs were used directly to define the trial conditions of a randomized clinical trial with G-CSF. Peritoneal lavage is not recommended.
Peritoneal response to pneumoperitoneum and laparoscopic surgery
Authors: Bergström M , Ivarsson M-L , Holmdahl L 
Published: October 2002

Abstract

Background
It is generally believed that laparoscopic surgery inflicts less trauma to the peritoneum than open surgery. Local peritoneal fibrinolysis is a critical factor in adhesion development. The objective was to investigate fibrinolytic changes in the peritoneum during laparoscopic and open surgery.

Methods
At laparotomy (n = 10) peritoneal biopsies were taken at opening of the abdomen and just before closure. At laparoscopy (n = 12) opening peritoneal biopsies were taken after carbon dioxide insufflation, and closure biopsies just before exsufflation. Tissue concentrations of tissue-type plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1) and the resulting tPA activity were assayed.

Results
Concentrations of tPA in peritoneal tissue declined during operation in both groups, but significantly so only in the laparotomy group (−53 per cent; P = 0·01). PAI-1 levels were higher in opening biopsies from the laparoscopy group (P = 0·004). There was an increase in PAI-1 concentration during laparotomy, but not during laparoscopy. At the end of the operation, there was no difference between the groups. The resulting tPA activity did not differ between groups at opening or closure. In both groups there was a significant decline during operation (laparotomy: −59 per cent, P = 0·02; laparoscopy: −63 per cent, P = 0·01).

Conclusion
These findings indicate that the peritoneal response to open and laparoscopic surgery is similar. The initial rise in peritoneal PAI-1 concentration during laparoscopy suggests an adverse effect of carbon dioxide insufflation, which might affect peritoneal repair.
Apoptosis in Barrett's oesophagus following antireflux surgery
Authors: Chen L Q , Hu C Y , Der Sarkissian S , Ferraro P , Pera M , deBlois D , Gaboury L , Duranceau A C 
Published: October 2002

Abstract

Background
Intestinal metaplasia persists in Barrett's mucosa despite control of reflux. Tissue homeostasis is maintained by the balance between apoptosis and proliferation. There is an unexplained temporary increase in proliferation in patients with Barrett's mucosa after antireflux surgery, and the long-term effect of any therapy in altering this balance remains unclear. The aim of this study was to assess apoptosis in Barrett's oesophagus following antireflux surgery.

Methods
Apoptosis was evaluated in endoscopic biopsy specimens from 19 patients with Barrett's oesophagus 4 years after Collis–Nissen gastroplasty using an in situ terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate–biotin nick end labelling (TUNEL) method.

Results
Intestinal metaplasia had a lower apoptosis index than gastric metaplasia (0·27 versus 2·14 per cent; P &lt; 0·001). After operation there was a steady increase of apoptosis in intestinal metaplasia over time (from 0·23 per cent before operation to 0·42 per cent within 2 years and to 0·59 per cent 4 years after operation; P = 0·015). Patients with persistent acid exposure did not show any increase in apoptosis in comparison with patients without acid exposure (0·41 versus 0·59 per cent; P = 0·91).

Conclusion
Apoptosis is less in intestinal metaplasia than in gastric metaplasia, although there is an increase after antireflux surgery. Persistent acid reflux may predispose to malignancy.
Salvage abdominoperineal resection in anal epidermoid cancer
Authors: Nilsson P J , Svensson C , Goldman S , Glimelius B 
Published: October 2002

Abstract

Background
In the management of isolated locoregional failure after (chemo)radiation therapy for anal epidermoid cancer, salvage abdominoperineal resection (APR) is the treatment of choice. The results of a 15-year consecutive population-based series are reviewed.

Methods
Details of all patients with anal epidermoid cancer treated from 1985 to 2000 in the Stockholm Health Care Region were recorded prospectively. Among 308 patients with biopsy-proven anal epidermoid cancer, there have been 39 isolated locoregional failures after sphincter-preserving therapy. Thirty-five patients have undergone salvage APR. The medical records of these 35 patients were reviewed retrospectively with regard to surgical and oncological results.

Results
There were no postoperative deaths. There was considerable morbidity related to the perineal wound, with postoperative perineal infections in 13 patients and delayed healing beyond 3 months in 23 patients. Complications unrelated to the perineal wound were found in 13 patients. The crude 5-year survival rate for the 35 patients was 52 per cent (median follow-up 33 months). Patients with persistent disease fared significantly worse than those with locoregional recurrence (crude 5-year survival rate 33 versus 82 per cent; P &lt; 0·05, log rank test).

Conclusion
Salvage APR in anal epidermoid cancer is associated with a high complication rate but may result in long-term survival.
Evaluation of axillary lymph nodes using touch imprint cytology and immunohistochemistry
Authors: Salem A A , Douglas-Jones A G , Sweetland H M , Newcombe R G , Mansel R E 
Published: October 2002

Abstract

Background
The success of sentinel node biopsy in determining axillary lymph node status necessitates an accurate and rapid method for intraoperative examination of the nodes. The aim was to determine the feasibility and accuracy of immunohistochemistry (IHC) of touch imprints in detecting axillary nodal metastases intraoperatively.

Methods
Some 344 axillary nodes from 30 patients with early breast cancer were bisected, imprinted and subjected to IHC. Results were compared with those of routine haematoxylin and eosin examination of the same nodes.

Results
Using IHC, 29 nodes from nine patients were positive for metastases. Using haematoxylin and eosin, 28 nodes from eight patients were positive. On a patient basis, the sensitivities of IHC and haematoxylin and eosin were 100 and 88·9 per cent, and negative predictive values (NPVs) were 100 and 95·5 per cent, respectively. On a node basis, the sensitivities were 96·7 and 93·3 per cent, and NPVs were 99·7 and 99·3 per cent, respectively. There were no false positives. The results were obtained within 30–45 min, depending on the number of nodes examined.

Conclusion
IHC of touch imprints can provide a fast and sensitive method for detecting metastases in axillary nodes during breast cancer surgery.
Clinical impact of false-negative sentinel node biopsy in primary breast cancer
Authors: Nano M T , Kollias J , Farshid G , Gill P G , Bochner M 
Published: October 2002

Abstract

Background
The aim was to assess the false-negative sentinel node biopsy rate in women with early breast cancer and its implications in patient treatment.

Methods
Between January 1995 and March 2001, 328 consecutive patients with clinically lymph node-negative primary operable breast cancer underwent lymphatic mapping and sentinel node biopsy using a combination of preoperative lymphoscintigraphy and/or blue dye. All underwent immediate axillary dissection. The intraoperative success rate in sentinel node identification, false-negative rate, predictive value of negative sentinel node status and overall accuracy were assessed. The clinical features and primary tumour characteristics for each false-negative case were reviewed.

Results
The sentinel node was identified in 285 (86·9 per cent) of 328 women. The false-negative rate was 7·9 per cent (eight of 101). Most members of the breast multidisciplinary team would have instituted adjuvant systemic therapy for six false-negative cases based on clinical features and primary tumour histology. In all, only two (0·7 per cent) of 285 women who had sentinel node biopsy may have had their management and survival prospects potentially jeopardized owing to a false-negative sentinel node.

Conclusion
The results of this study suggest that the clinical impact of a false-negative sentinel node is low.
Model for experimental revascularized laryngeal allotransplantation
Authors: Birchall M A , Bailey M , Barker E V , Rothkötter H-J , Otto K , Macchiarini P 
Published: October 2002

Abstract

Background
Although a human laryngeal transplant has been undertaken successfully, important questions remain that require a suitable animal model.

Methods
A pig model for allotransplantation has been developed. Organ perfusion was studied in nine animals before four transplants were performed in congenic (unrecovered) animals and eight in unmatched (recovered) animals. Larynges were regularly examined endoscopically until death at 14 days. Immunosuppression included the use of tacrolimus. Revascularization was achieved by anastomosing the donor right cervical vascular tree to the recipient common carotid. In recovered animals, four allografts were placed orthotopically and four heterotopically.

Results
The pig larynx was perfused adequately via the right cervical vascular tree and congenic grafts were well tolerated. Of eight allografts, seven were well tolerated and remained healthy for the duration of the study (14 days). One allograft became infected between days 4 and 7 after operation. Median operating time was 6 h, with a median cold ischaemia time of 3 h.

Conclusion
Revascularized allotransplants of the larynx can be undertaken reliably in pigs and this provides a preclinical model for studies of laryngeal transplantation.
Randomized study of the effectiveness of closing laparoscopic trocar wounds with octylcyanoacrylate, adhesive papertape or poliglecaprone
Authors: Maartense S , Bemelman W A , Dunker M S , de Lint C , Pierik E G J M , Busch O R C , Gouma D J 
Published: October 2002

Abstract

Background
Several methods for skin closure are used, i.e. sutures, adhesive papertape and tissue adhesives. Little is known about the efficacy of these techniques in laparoscopic surgery. This study was performed to analyse the efficacy of octylcyanoacrylate, a new tissue adhesive, adhesive papertape and poliglecaprone for wound closure in laparoscopy.

Methods
From May 2000 to September 2001, 140 patients were included in a prospective randomized trial. Wounds were closed with octylcyanoacrylate (n = 48), adhesive papertape (n = 42) or poliglecaprone (n = 50). Closing time, wound infection, cosmetic results and costs were evaluated. A time–motion analysis was also performed.

Results
The patients in the three groups were well matched for age, gender and body mass index. Closing times per wound were 26, 33 and 65 s respectively for adhesive papertape, octylcyanoacrylate and poliglecaprone (P &lt; 0·001). Cosmetic results, as scored by the patients, were no different. The number of actions required to close each wound was 5·7, 8·3 and 21·0 for octylcyanoacrylate, adhesive papertape (P = 0·05 versus octylcyanoacrylate) and poliglecaprone (P &lt; 0·01 versus octylcyanoacrylate and adhesive papertape) respectively. Octylcyanoacrylate was significantly more expensive than poliglecaprone and adhesive papertape.

Conclusion
Closure with adhesive papertape was the fastest method. The smallest number of actions required to close a wound was with octylcyanoacrylate. Adhesive papertape was the most cost-effective.