bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bioflavonoid quercetin scavenges superoxide and increases nitric oxide concentration in ischaemia–reperfusion injury: an experimental study
Authors: Huk I , Brovkovych V , Nanobash Vili J , Weigel G , Neumayer Ch , Partyka L , Patton S , Malinski T 
Published: March 2003

Abstract

Background
l-Arginine-depleted environments accompanying ischaemia–reperfusion enhance superoxide production, leading to the formation of reactive oxygen species and a concomitant reduction in basal nitric oxide levels. The bioflavonoid quercetin may prevent these undesirable effects by scavenging superoxide.

Methods
Untreated rabbits were compared with those infused with quercetin (5 mg/kg for 2 min) during hindlimb ischaemia (2·5 h) and reperfusion (2 h). In both groups, nitric oxide concentration was measured (porphyrinic microsensor) in the femoral artery wall. Microvasculature changes (morphometry) and superoxide concentration (chemiluminescence) were measured intermittently in biopsies.

Results
Approximately 6 min into the period of ischaemia a rapid increase in nitric oxide level from a mean(s.e.m.) basal level of 50(20) to 450(30) nmol/l was observed. In untreated animals, nitric oxide concentration dropped to an undetectable level (less than 1 nmol/l) during reperfusion. In quercetin-treated animals, the decrease in nitric oxide concentration was slower, such that substantial amounts (60(20) nmol/l) accumulated during reperfusion. In biopsies after ischaemia–reperfusion maximal calcium ionophore A23187-stimulated nitric oxide concentration increased (25-30 per cent) in the presence of quercetin, while the superoxide concentration decreased.

Conclusion
Quercetin treatment mollified ischaemia–reperfusion injury to skeletal muscle by scavenging destructive superoxide and enhancing the cytoprotective nitric oxide concentration.
In vivo pressure profiles of thigh-length graduated compression stockings
Authors: Wildin C J , Hui A C W , Esler C N A , Gregg P J 
Published: March 2003

Abstract

Background
The aim of the study was to assess whether the appropriate pressure profile is generated by thigh-length graduated compression stockings in human subjects. The effect of leg posture on the pressure profile was assessed in three commonly used brands of graduated compression stockings.

Methods
The study involved 17 human volunteers from the Department of Orthopaedic Surgery. Three different brands of stockings commonly recommended for the prevention of deep vein thrombosis were applied to each individual and the interface pressure profile under the stocking was measured. The effect of posture was assessed by comparing the interface pressure profile with the subject supine and in standing and sitting positions.

Results
Appropriate median pressure profiles were achieved only with the subject standing or supine. In the sitting position with the knee flexed, a high median interface pressure in excess of 28 mmHg was generated at the popliteal fossa. Overall, inconsistent performance was found in all three brands of stockings; fewer than 30 per cent of the pressure readings fell within 20 per cent of the ‘ideal’. Reversed pressure profile was observed in over 70 per cent of subjects.

Conclusion
Thigh-length graduated compression stockings may be most effective in bedridden patients. Knee-length stockings may be more suitable for the prevention of deep vein thrombosis in ambulant patients.
Subparietal hepaticojejunal access loop for the long-term management of intrahepatic stones
Authors: Beckingham I J , Krige J E J , Beningfield S J , Bornman P C , Terblanche J 
Published: March 2003

Abstract

Background
The subparietal hepaticojejunal biliary access loop is a recognized technique for the long-term management of primary intrahepatic stone disease. This paper assesses the results of this approach in a series of South African patients.

Methods
Between 1985 and 1997, 21 patients, of mean age 34 (range 24–66) years, underwent surgical extraction of intrahepatic stones and formation of an hepaticojejunal access loop. The access loop was subsequently used for further stone removal and stricture dilatation. Patients were followed prospectively (median 47 months) and details of the number and type of procedures performed, stone clearance rates, morbidity and subsequent outcome were recorded.

Results
The distribution of intrahepatic stones was left lobe in 13 of 21 patients, right lobe in one and bilateral in seven. Six patients underwent additional left lobectomy at the initial operation because of associated atrophy of the left lobe. Following operation, stone removal and/or stricture dilatation was performed on 97 occasions (median 4 (range 0–24) procedures per patient). Complete stone clearance was achieved in 17 of 21 patients with partial clearance in the remaining four. There were no major complications and no deaths associated with the procedures.

Conclusion
The subparietal access loop permits long-term access to the intrahepatic ducts allowing removal of stones and dilatation of strictures with minimal patient discomfort and low morbidity.
Early results of a randomized trial of rifampicin-bonded Dacron grafts for extra-anatomic vascular reconstruction
Authors: Braithwaite B D , Davies B , Heather B P , Earnshaw J J 
Published: March 2003

Abstract

Background
The aim of this study was to determine whether the routine use of an antibiotic-bonded gelatin-coated Dacron graft could reduce the incidence of prosthetic graft infection. Extra-anatomic grafts were chosen for study as they have the highest risk of graft infection. This paper reports early results up to 1 month after surgery.

Methods
This multicentre study involved 14 vascular units in the UK. A total of 257 patients underwent extra-anatomic bypass. Patients were randomized to rifampicin bonding (1 mg/ml rifampicin soak for 15 min before graft insertion) or a control group. Routine three-dose antibiotic prophylaxis was administered to patients in both groups.

Results
There were 178 men and 79 women of median age 69 (range 43–92) years. Rifampicin-bonded (n=123) and control (n=134) groups were well matched for clinical details, risk factors and operative techniques. No side-effects were noted from rifampicin bonding. Only one patient (in the control group) developed a graft infection and this proved fatal. There were no significant differences between bonded and unbonded grafts in terms of perioperative mortality rate (9 and 5 per cent respectively), median hospital stay (10 days for both groups), total infective complications (15 and 21 per cent respectively) or need for postoperative antibiotics (13 and 18 per cent respectively).

Conclusion
Early results from this study have not identified any significant advantage in the routine use of rifampicin bonding, but the rate of graft infection was very low (0·4 per cent). Gelatin coating alone may provide protection against infection. Definitive recommendations about the role of antibiotic bonding cannot be made until longer follow-up becomes available.
Traumatic and septic shock alias post-trauma critical illness
Authors: Hardaway R M 
Published: March 2003

Abstract

Background
The mortality associated with septic shock, both in percentage of septic shock cases and total number of septic shock cases, has been increasing over the past several decades. This is despite major advances in diagnosis and treatment. The basic cause of traumatic and septic shock has been only partially elucidated.

Methods
Data sources include research papers on the subject of traumatic and septic shock from 1875 to the present. These papers numbered over 10 000, few of which are included in the reference list because many are duplicative or negative. Over 1000 articles were reviewed which documented the unsuccessful search for a treatment for septic shock based on the theory that septic shock is due to endotoxin and its secondarily induced host mediators. These references are available from the author.

Results and conclusion
The concept of a shock toxin in trauma and sepsis as promulgated during World War I is correct. This toxin is a thrombogenic aminophospholipid which occurs only on the inner layer of all cell membranes and is liberated by cell destruction. It causes disseminated intravascular coagulation which may obstruct the microcirculation of any or all organs, producing multiple organ failure by microclots. These microclots may be lysed by plasminogen activator and circulation to the organs restored.
Tube caecostomy to protect rectal anastomoses
Authors: Thomson W H F , White S , O'Leary D P 
Published: March 2003

Abstract

Background
Low rectal anastomoses are associated with a substantial risk of anastomotic leakage. Tube caecostomy offers a potentially simple method of anastomotic protection.

Methods
Some 226 patients undergoing restorative rectal resection with on-table colonic lavage and tube caecostomy over an 11-year period were reviewed. Endpoints selected included clinical anastomotic leakage, requirement for a subsequent formal stoma and complications of tube caecostomy.

Results
Overall, clinical anastomotic leakage occurred in 25 patients with a caecostomy (11·1 per cent). All leaks were noted among patients in whom caecostomy protection had been used after low anterior resection, giving a leak rate of 14·9 per cent (25 of 168) for this group of whom 17 (10·1 per cent) required reoperation and a formal stoma, and five (3·0 per cent) died. Complications of caecostomy or prolonged drainage after tube removal occurred in ten (4·4 per cent) and 15 (6·6 per cent) patients respectively. There were two cases of life-threatening invasive infection.

Conclusion
Tube caecostomy provides inadequate protection of rectal anastomoses; complications are common and may be life threatening.
Growth rates and risk of rupture of abdominal aortic aneurysms
Authors: Vardulaki K A , Prevost T C , Walker N M , Day N E , Wilmink A B M , Quick C R G , Ashton H A , Scott R A P 
Published: March 2003

Abstract

Background
Early identification of abdominal aortic aneurysms (AAAs) may reduce the risk of death from rupture by providing the opportunity for elective repair. Before a screening policy for AAA is implemented, the growth rates of AAAs and the accompanying risk of rupture without intervention should be established.

Methods
The growth rates of AAAs were calculated using longitudinal aneurysmal growth data from screening studies in Chichester and Huntingdon. Estimates of the growth rates of AAAs and the risks of rupture over time were made taking measurement error and individual variability into account.

Results
Growth rate estimates were found to vary by initial aortic diameter, with a more rapid growth seen in large aneurysms (50 mm or more). The rate of aneurysm growth did not differ with age or sex. The estimated risk of rupture of an AAA with an initial diameter of 45 mm did not exceed 20·5 per cent over 5 years. An AAA with an initial diameter of 30 mm has a 4·0 per cent or less chance of rupture over 5 years.

Conclusion
The study provides a more accurate assessment of the risk of aneurysm rupture without surgery and helps to define rescreening intervals for those with an enlarged aortic diameter.
Learning curve for oesophageal cancer surgery
Authors: Sutton D N , Wayman J , Griffin S M 
Published: March 2003

Abstract

Background
Surgical training and experience are frequently claimed to influence early and late outcome measures. The aim of this study was to examine any improvement in an individual surgeon's performance in one operation over a period of 7 years from initial appointment to date.

Methods
Patients undergoing Ivor Lewis subtotal oesophagectomy performed by a single surgeon between April 1990 and December 1996 were identified from a prospectively compiled oesophageal cancer database. Operating time (abdominal, thoracic and ‘one-lung time’), blood loss, transfusion requirements (intraoperative and total), extent of lymphadenectomy (number of lymph nodes sampled), intensive treatment unit (ITU) stay, hospital stay, postoperative morbidity and mortality, pathological stage, grade and survival were recorded.

Results
The records of 150 patients were identified for analysis. The cohort was split into five groups, each of 30 patients operated on consecutively. Each of the groups was comparable for age, sex, smoking history, preoperative haemoglobin and creatinine levels, weight loss, American Society of Anesthesiologists' grade, and histological stage and grade of disease. Analysis of the variables pertaining to operation revealed a significant improvement with time including reduced single-lung operating time (P = 0·01), reduced blood loss (P = 0·03), reduced transfusion requirement (P &lt; 0·0001), reduced ITU stay (P &lt; 0·0001), reduced inpatient stay (P &lt; 0·0001) and an increased yield of lymph nodes (P &lt; 0·0001).

Conclusion
This study showed a continuing improvement in a surgeon's performance over a 7-year period. With the current trend to shorter training periods there is a case for continuing supervision of the ‘fully trained’ surgeon within highly specialist units.
Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery
Authors: Salvadori B , Marubini E , Miceli R , Conti A R , Cusumano F , Andreola S , Zucali R , Veronesi U 
Published: March 2003

Abstract

Background
This study aimed to analyse the possibility of surgical rescue of intrabreast tumour recurrence (IBTR) following conservative operation for breast cancer, i.e. quadrantectomy, axillary dissection and radiotherapy.

Methods
Of 2544 patients treated with this approach, 209 presented with an IBTR as the first and only sign of relapse. Some 197 patients were considered suitable for further surgery; 12 were inoperable. Six patients declined operation.

Results
Reoperative surgery was total mastectomy in 134 patients (70 per cent) and further local resection in 57 (30 per cent). Median follow-up after second surgery was 73 (range 1–192) months. The overall survival probability at 60 months was 70 per cent after mastectomy and 85 per cent following further local excision. There was no difference in disease-free survival between the two operative groups. Second IBTR was more common at 5 years in the re-excision group (19 versus 4 per cent).

Conclusion
Since the type of surgery did not seem to affect survival, breast conservation can be considered in selected patients with IBTR.
No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer
Authors: Kitamura K , Nishida S , Ichikawa D , Taniguchi H , Hagiwara A , Yamaguchi T , Sawai K 
Published: March 2003

Abstract

Background
It remains unknown whether extended surgery improves the survival rate of patients with gastric cancer. This study was a review of combined pancreaticosplenectomy with total gastrectomy for gastric cancer.

Methods
The clinicopathological details of 190 patients who underwent combined pancreaticosplenectomy with total gastrectomy between 1969 and 1996 were compared retrospectively with those of 206 patients who underwent total gastrectomy with splenectomy alone.

Results
There was no statistical difference in the survival rate when pancreaticosplenectomy was added to total gastrectomy. The mortality rate was similar, but the morbidity rate was higher in patients who had pancreaticosplenectomy. Six patients who had direct pancreatic invasion and two thought to have involved lymph nodes along the splenic artery survived for more than 5 years after operation. In the latter group, the metastatic lymph nodes along the splenic artery could have been resected without pancreatectomy.

Conclusion
Since a combined pancreaticosplenectomy adds no survival advantage to total gastrectomy for gastric cancer, this procedure should no longer be regarded as routine.
Evaluation of a protocol for the non-operative management of perforated peptic ulcer
Authors: Marshall C , Ramaswamy P , Bergin F G , Rosenberg I L , Leaper D J 
Published: March 2003

Abstract

Background
The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome.

Methods
The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol.

Results
Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy.

Conclusion
This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.
Intraoperative abdominal ultrasonography
Authors: Luck A J , Maddern G J 
Published: March 2003

Abstract

Background
Ultrasonography during abdominal surgery has been reported since the 1960s, but its use did not become widespread until the recent availability of high-frequency, high-resolution transducers. This review discusses the application of intraoperative ultrasonography to open and laparoscopic abdominal surgery.

Methods
A literature search (Medline) was undertaken. All papers pertaining to the subject matter that were located were included in the review.

Results
Intraoperative ultrasonography influences surgical strategy in up to 50 per cent of liver resections for malignancy. It is the single most sensitive technique for the detection of occult hepatic metastases at the time of primary colorectal resection. In pancreatic surgery, intraoperative ultrasonography is of value in the localization of islet cell tumours and in the assessment of resectability of adenocarcinoma. The technique may also have a role in staging laparoscopy, and in the operative management of kidney and gastrointestinal diseases.

Conclusion
Ultrasonography is an ideal operative tool as it is safe, reproducible and requires no special patient preparation or positioning. It should be regarded as an essential component of major hepatobiliary and pancreatic procedures. The recent availability of flexible laparoscopic probes is likely to lead to a similar impact on minimal access surgery.
Risk scoring in surgical patients
Authors: Jones H J S , de Cossart L 
Published: March 2003

Abstract

Background
A large number of scoring systems for assessing a patient's risk of complications or death has been developed over recent years. This is a review of those that are of relevance to general surgeons.

Methods
A Medline literature search was performed to identify all articles concerning ‘severity of illness’, ‘morbidity’, ‘mortality’ and ‘postoperative complications’ in the field of surgery from 1966 to 1997. Further searches were performed to find papers about specific identified scoring systems, and relevant articles from the reference lists of these were also sought.

Results and conclusion
The advantages of an accurate assessment of a patient's risk include, on an individual level, the opportunity to give a more accurate prognosis and choose the most appropriate treatment. If the risk of an adverse outcome is known for a group of patients, the actual outcome can be compared with the predicted outcome, and comparison can be made between groups in different surgical units for the purposes of audit or research. The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) is the most appropriate of the currently available scores for general surgical practice.
Effect of radioimmunoscintigraphy in management of recurrent colorectal cancer
Authors: Lunniss P J , Skinner S , Britton K E , Granowska M , Morris G , Northover J M A 
Published: March 2003

Abstract

Background
Radioimmunoscintigraphy (RIS) is being used increasingly as a new investigation in the diagnosis of recurrent colorectal cancer. This study assessed the efficacy of 99mTc-radiolabelled PR1A3 scanning in a cohort of patients with possible recurrent colorectal cancer and the effects of scan interpretation on subsequent clinical management.

Methods
The scans and case notes of patients scanned over a 3-year period were reviewed.

Results
Forty-seven scans in 40 patients were available for analysis. In 39 instances in which scan interpretation could be verified accurately, sensitivity for recurrent colorectal cancer was 22 of 23 (96 per cent), specificity for recurrent colorectal cancer was eight of 16 (50 per cent), positive predictive value for recurrence was 22 of 30 (73 per cent) and negative predictive value for recurrence was eight of nine (89 per cent). In 16 of the 40 patients, scan interpretation strengthened a management decision or altered management. This was beneficial to ten patients and possibly detrimental to six.

Conclusion
This study demonstrated that RIS is sensitive in the detection of recurrent colorectal cancer and benefited the patient in one-quarter of cases. For the majority of patients, accurate detection of recurrent disease cannot be followed by curative therapy, but there is an important subgroup of patients in whom RIS alters management beneficially. However, a randomized prospective study is needed to confirm this.
Effect of training on the incidence of nerve damage in thyroid surgery
Authors: Lamadé W , Renz K , Willeke F , Klar E , Herfarth Ch 
Published: March 2003

Abstract

Background
In thyroid surgery early postoperative recurrent laryngeal nerve (RLN) dysfunction offers a sensitive measure of the quality of the operation. The aim of this study was to analyse the effect of training in thyroid surgery on the rate of early functional disturbances of the RLN after thyroid resection.

Methods
In 617 patients (median age 48 years, female to male ratio 2·8: 1) who underwent unilateral or bilateral thyroid resection, 1059 RLNs were subjected to operative risk. Laryngoscopy was performed before and after operation. The 45 surgeons were divided into three groups: group 1, specialist thyroid surgeons; group 2, experienced surgeons; and group 3, residents. Personal gain of experience was defined by the preceding number of thyroid operations. Within each group the complication profile was determined by adding the personal complication profiles of each surgeon.

Results
The complication rates were low during surgical residency (group 3). In group 2 complication rates increased up to the 50th operation. Group 1 showed the expected exponential decrease to under 1 per cent after another 130 operations.

Conclusion
Complication rates are affected considerably by the extent of surgical experience in a non-linear and complex logarithmic manner, starting with low rates in the beginner group, peaking after further experience and then decreasing exponentially.