bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas
Authors: Suzuki Y , Fujino Y , Tanioka Y , Hori Y , Ueda T , Takeyama Y , Tominaga M , Ku Y , Yamamoto Y M , Kuroda Y 
Published: March 2003

Abstract

Background
Resection of the non-fibrotic pancreas is prone to postoperative pancreatic fistula because of well preserved exocrine secretions and easily crushed soft parenchyma. The purpose of this study was to evaluate ultrasonic dissection for division of the non-fibrotic pancreas in distal pancreatectomy.

Methods
All pancreata included in this study were soft on direct palpation and their main ducts had no dilatation, at least proximally from the transection line. Fifty-eight patients with gastric cancer or pancreatic disease were randomly assigned to the two groups. In the ultrasonic dissection (UD) group (n = 27), all pancreatic ducts were identified and ligated securely. The stump was left open without parenchymal suturing. In the conventional (CV) group (n = 31), the pancreas was cut with a knife and the stump was oversewn in mattress fashion. The main pancreatic duct was ligated in all patients in both groups. Pancreatic fistula was defined as a pancreatic fluid discharge for more than 7 days after operation diagnosed according to amylase concentration in the drainage fluid.

Results
In the UD group, approximately 20–30 tubes including a mean(s.d.) 5·2(0·8) (range 4–6) pancreatic ducts were skeletonized and ligated per patient. There were nine pancreatic fistulas (16 per cent); one in the UD group and eight in the CV group (P= 0·020).

Conclusion
In distal pancreatectomy for the non-fibrotic pancreas, ultrasonic dissection without suture closure of the stump reduced the incidence of pancreatic fistula compared with conventional division and suture, in this randomized trial.
Controlled digital anal dilatation under total neuromuscular blockade for chronic anal fissure: a justifiable procedure
Authors: Strugnell N A , Cooke S G , Lucarotti M E , Thomson W H 
Published: March 2003

Abstract

Background
There is widespread antipathy to digital dilatation of the anus (DDA) for medically resistant anal fissure. A retrospective study was therefore undertaken to test the validity of the criticism of this technique.

Methods
Some 273 patients who underwent DDA for fissure between November 1982 and July 1997 were sent a questionnaire and/or telephoned. Those with impaired control were offered investigation. In addition, routine clinic follow-up data were scrutinized in the 302 available notes of the 307 patients who had undergone DDA for fissure to determine its efficacy.

Results
Some 241 patients (88·3 per cent) were contacted successfully a median of 7·8 years after operation. Follow-up records showed the fissure to have healed in 89·1 per cent of 302 patients. No patient was rendered incontinent. Fifteen patients indicated persistently impaired control in the questionnaire, nine (3·8 per cent) as a result of the DDA and six preceding it. All 23 patients who had experienced either temporary or permanent impairment, whether or not pre-existing, were invited to attend for ultrasonography and manometric measurements, of whom 18 accepted. No sphincteric fragmentation was seen, and resting and squeeze pressures did not differ from normal.

Conclusion
A single DDA appears to heal 89 per cent of chronic anal fissures. Consequent impairment of control is infrequent and minor if the procedure is performed carefully and with the patient paralysed.
Peroperative time–motion analysis of diagnostic laparoscopy with laparoscopic ultrasonography
Authors: den Boer K T , de Wit L T , Dankelman J , Gouma D J 
Published: March 2003

Abstract

Background
Advanced technology is being introduced rapidly into laparoscopic procedures, frequently without an accurate evaluation of its functioning. In this study, standardized time–motion analysis was applied to evaluate the peroperative surgical process and the technical equipment used in 18 cases of diagnostic laparoscopy with laparoscopic ultrasonography (DLLU).

Methods
The image through the laparoscope, the ultrasonograph and an overview of the operating theatre were recorded simultaneously. The time for each phase, efficient actions (e.g. identifying lesions by inspection, making an ultrasonogram or taking a biopsy) and limiting factors (e.g. technical problems, time spent waiting) were determined, and a current standard was defined.

Results
Of the actions performed, 52 per cent were qualified as efficient, 17 per cent were classified as time spent waiting for personnel, instruments were positioned in 13 per cent, and unnecessary instrument exchanges were involved in 10 per cent. The evaluation led to a significant reduction in delay times and resulted in design criteria for improved biopsy instruments. The current standard was calculated from the mean time and number of actions determined for each phase.

Conclusion
This time–motion study provided detailed insight into the peroperative process of DLLU, leading to improvements in the surgical process and instruments used. The defined current standard will enable evaluation of the learning curve and new technologies.
Phase II trial of radical surgery for locally advanced pelvic neoplasia
Authors: Bramhall S R , Harrison J D , Burton A , Wallace D M A , Chan K K , Harrison G , White A , Fielding J W L 
Published: March 2003

Abstract

Background
Reported operative mortality and survival rates following total pelvic exenteration (TPE) for recurrent pelvic neoplasia are now as good as those for many primary treatments. The currently accepted primary treatments for these tumours are, however, still either radiotherapy alone or radiotherapy and chemotherapy. The primary aim of this study was to evaluate the safety and tolerability of TPE and secondarily to ascertain survival after TPE.

Methods
This was a phase II study of 50 patients with locally advanced pelvic tumours who underwent TPE.

Results
Thirty-two patients (64 per cent) underwent TPE for recurrent carcinoma of the cervix, seven (14 per cent) for rectal cancer, three (6 per cent) for vulval carcinoma, three (6 per cent) for vaginal carcinoma, two (4 per cent) for prostate cancer and three (6 per cent) for other tumours. The 30-day mortality rate was 8 per cent with an in-hospital mortality rate of 16 per cent. The crude morbidity rate was 62 per cent, with 23 patients (46 per cent) having grade III or IV toxicity. A complete response was achieved in 63 per cent and a partial response in 37 per cent of patients. The overall median survival time was 86 weeks; it was 111 weeks in patients in whom a complete response was achieved.

Conclusion
The survival and operative mortality rates that are now attainable with TPE are comparable to those achieved with chemoradiotherapy in advanced pelvic neoplasia. TPE should no longer be reserved for salvage therapy and should perhaps be compared with chemoradiotherapy as first-line treatment in a phase III randomized trial in patients with these tumours.
Selective impairment of glucose storage in human sepsis
Authors: Saeed M , Carlson G L , Little R A , Irving M H 
Published: March 2003

Abstract

Background
Glucose utilization in sepsis is impaired but the mechanisms are unclear. This study examined the effect of sepsis on total glucose utilization, oxidation and storage, and the energetic costs of these metabolic processes.

Methods
Glucose infusion rate (GIR), glucose oxidation rate (GOR), non-oxidative disposal rate and the energetic cost of glucose storage were studied in 24 patients with abdominal sepsis and in 26 healthy controls, using indirect calorimetry and the euglycaemic hyperinsulinaemic clamp with insulin infusion rates of 40 and 240 mU m−2 min−1.

Results
Basal GOR was significantly lower in septic patients than in controls (1·5 versus 2·3 mg per kg fat-free mass (FFM) per min, P &lt; 0·001). Septic patients had a significantly lower GIR at 40 mU m−2 min−1 (4·2 versus 9·1 mg per kg FFM per min) and at 240 mU m−2 min−1 (7·5 versus 11·8 mg per kg FFM per min), relative to controls (P &lt; 0·001). GOR was similar in septic and control subjects at both rates of insulin infusion whereas non-oxidative disposal was significantly lower in septic patients (P &lt; 0·001) and accounted entirely for the reduction in GIR. The energetic cost of glucose disposal was unaffected by sepsis.

Conclusion
Sepsis is associated with selective impairment of glucose storage but the energetic cost of non-oxidative disposal is unaffected.
Multimodal therapy for squamous carcinoma of the oesophagus
Authors: Lehnert T 
Published: March 2003

Abstract

Background
The results of surgical treatment for oesophageal squamous cell cancer have improved over recent decades, but the long-term prognosis for patients with tumours of stage II or higher is still unsatisfactory. While uncontrolled series of adjuvant or neoadjuvant treatment have reported favourable survival rates, the true benefit of multimodal treatment can be determined only by randomized controlled trials.

Methods
The literature was searched for prospective randomized controlled trials (PRCTs) examining the effect of neoadjuvant or adjuvant treatment on the long-term survival of patients with squamous cell cancer of the oesophagus.

Results
More than 30 PRCTs studying multimodal treatment concepts aimed at improving the prognosis of squamous cell carcinoma of the oesophagus were identified. These trials have not documented improved survival by adjuvant radiotherapy or chemotherapy. Following neoadjuvant radiotherapy or chemotherapy (or a combination of both), resectability of squamous cell carcinoma is not increased, the postoperative mortality rate appears to be higher and survival is not prolonged.

Conclusion
Past multimodality protocols have not improved the prognosis of squamous carcinoma of the oesophagus. Careful design and reporting, together with strict control of surgical procedures, should allow more meaningful analysis of future multimodal treatment studies. At present, neoadjuvant or adjuvant treatment cannot be recommended outside such clinical protocols.
Saphenoperitoneal shunts for patients with intractable ascites associated with chronic liver disease
Authors: Vadeyar H J , Doran J D , Charnley R , Ryder S D 
Published: March 2003

Abstract

Background
Ascites is a common complication in patients with chronic liver disease. Some patients are resistant to diuretics and need therapeutic paracentesis on a regular basis. This is inconvenient in the long term and also has resource implications. Alternatively, these patients may be treated by peritoneovenous shunts, which require insertion of a foreign body into a central vein and are prone to occlusion. A new technique for peritoneovenous shunting without the use of foreign material is described.

Methods
Eight patients with chronic liver disease and diuretic-resistant ascites underwent this procedure. During operation, the long saphenous vein was divided at the mid-thigh level and inverted towards the inguinal canal, where it was anastomosed directly to the peritoneum at the internal inguinal ring using non-absorbable suture material.

Results
Seven patients had successful shunt formation; the remaining patient had to have the shunt removed because of ascitic leakage. In those who underwent successful shunt formation, the need for paracentesis and the dose of diuretic was significantly reduced over a median follow-up of 8 months. Hospital stay in the month after discharge was significantly less than that in the month before operation. Three patients died during follow-up from causes unrelated to the operation. One patient underwent successful liver transplantation.

Conclusion
This study suggests that saphenoperitoneal shunting is potentially a safe and effective therapy for patients with diuretic-resistant ascites. It retains the benefits of peritoneovenous shunting without the adverse effects of insertion of foreign material.
Experimental study of the influence of intestinal flora on the healing of intestinal anastomoses
Authors: Okada M , Bothin C , Kanazawa K , Midtvedt T 
Published: March 2003

Abstract

Background
The beneficial effects of the normal intestinal flora on wound healing in the skin have already been confirmed, and this study attempted to elucidate the influence of the intestinal flora on the healing process in intestinal anastomoses.

Methods
Five groups of rats were studied: germ-free, conventional, monocontaminated with Lactobacillus acidophilus La5 or Escherichia coli X7 and ex-germ-free (conventionalized). All animals underwent ileal and colonic resections followed by anastomoses. Seven days later they were killed and the bursting pressure and hydroxyproline concentration of the anastomoses were measured. The microbiological status of the animals was confirmed weekly.

Results
No bacteria were detected in the germ-free rats and no other bacteria were found in the monocontaminated animals. Conventional rats had a significantly higher anastomotic bursting pressure both in the ileum compared with rats monocontaminated with L. acidophilus, and in the colon compared with germ-free rats. The ex-germ-free rats also showed a significantly higher bursting pressure than germ-free animals and rats monocontaminated with either L. acidophilus or E. coli in the ileum and colon.

Conclusion
The presence of the intestinal flora enhanced the healing of intestinal anastomoses. The data suggest that this effect depends on differences in the types of bacteria in the intestine.
Contrast-enhanced colour Doppler ultrasonography in suspected breast cancer recurrence
Authors: Winehouse J , Douek M , Holz K , Madjar H , Gillams A , Lees W , Baum M 
Published: March 2003

Abstract

Background
Postoperative scarring and radiotherapy changes in the conservatively treated breast often mimic breast cancer recurrence, resulting in many unnecessary biopsies. Local breast cancer recurrence may be detected more accurately with contrast-enhanced colour Doppler imaging.

Methods
Fifty-eight women with suspected local breast cancer recurrence were evaluated prospectively by means of conventional and contrast-enhanced colour Doppler imaging before surgical biopsy.

Results
Sensitivity for the detection of breast cancer recurrence using contrast enhancement was 94 per cent (specificity 67 per cent). Contrast enhancement significantly increased overall diagnostic accuracy, from 80 to 90 per cent (P &lt; 0·04).

Conclusion
Contrast-enhanced colour Doppler imaging is a highly accurate method for detecting local breast cancer recurrence. Its adoption may substantially reduce biopsy rates.
Protective effect of preconditioning and adenosine pretreatment in experimental skeletal muscle reperfusion injury
Authors: Papanastasiou S , Estdale S E , Homer-Vanniasinkam S , Mathie R T 
Published: March 2003

Abstract

Background
Prolonged ischaemia followed by reperfusion (I/R) of skeletal muscle results in significant tissue injury. Ischaemic preconditioning (IPC), achieved by repeated brief periods of I/R before prolonged ischaemia or adenosine pretreatment, can prevent I/R injury in cardiac muscle. The aim of this study was to ascertain in a rodent model if damage to skeletal muscle due to global hindlimb tourniquet-induced I/R could be similarly attenuated.

Methods
Anaesthetized rats were randomized (n = 6–10 per group) to five groups: sham-operated controls; I/R (4 h of ischaemia, 2 h of reperfusion); IPC (three cycles of 10 min of ischaemia/10 min of reperfusion) alone; IPC immediately preceding I/R; or adenosine 1000 µg/kg immediately before I/R. At the end of reperfusion, biopsies were taken from the left gastrocnemius muscle for measurement of myeloperoxidase (MPO) and reduced glutathione (GSH). Before ischaemia and at the end of reperfusion, blood samples were taken for measurement of nitric oxide metabolites, tumour necrosis factor (TNF) α and macrophage inflammatory protein (MIP) 2.

Results
IPC before I/R resulted in lower levels of MPO (P &lt; 0·001) and TNF-α (P = 0·004), and higher levels of GSH (P &lt; 0·001) and nitric oxide metabolites (P = 0·002) than I/R alone. Adenosine had effects comparable to IPC pretreatment (P &lt; 0·001 for MPO, P = 0·002 for GSH, P = 0·02 for nitric oxide metabolites and P = 0·001 for TNF-α). There was no difference in the blood pressure or the MIP-2 concentration among the groups.

Conclusion
IPC or pretreatment with adenosine ameliorates the I/R injury of skeletal muscle.
Rescue of liver grafts from hepatic artery occlusion in living-related liver transplantation
Authors: Sakamoto Y , Harihara Y , Nakatsuka T , Kawarasaki H , Takayama T , Kubota K , Kimura W , Kita Y , Tanaka H , Ito M , Hashizume K , Makuuchi M 
Published: March 2003

Abstract

Background
Hepatic artery thrombosis after liver transplantation remains a significant cause of graft loss and death. Retransplantation is a difficult option after living-related liver transplantation in Japan.

Methods
Twenty-seven patients underwent living-related liver transplantation with left-sided liver grafts donated from their relatives. The hepatic artery was anastomosed end to end under a surgical microscope. Anticoagulant therapy was maintained for 2 weeks after operation. Routine post-transplant Doppler ultrasonography together with serum blood tests were performed twice a day during the first 2 weeks.

Results
Three patients developed hepatic artery occlusion, which was identified by routine Doppler ultrasonography before the serum transaminase values increased on days 7, 7 and 3 after surgery respectively. In two of the three patients, no apparent arterial thrombosis was recognized and vasospasm was therefore considered to be the cause of the occlusion. Arterial patency was restored by urgent revascularization with reanastomosis in all patients, but one patient with a functional graft died from a cerebral haemorrhage on day 47.

Conclusion
Early diagnosis of hepatic artery occlusion by routine Doppler ultrasonography and revascularization of the graft is an indispensable strategy for preventing graft loss after living-related liver transplantation.
Live kidney donor assessment in the UK and Ireland
Authors: Lumsdaine J A , Wigmore S J , Forsythe J L R 
Published: March 2003

Abstract

Background
The criteria and methods for assessing live kidney donors are not clear. This study was undertaken to establish whether there is a consensus regarding the organization and methods of assessment of living kidney donors by renal transplant centres in the UK and the Republic of Ireland.

Methods
All transplant centres in the UK and Ireland involved in living donor kidney transplantation were contacted by telephone survey followed by postal questionnaire.

Results
Considerable variation was observed in the organization of living kidney donor evaluation and the methods of assessment used. The upper and lower age limits considered acceptable for kidney donation were variable, with six of 29 centres setting no lower age limit and 11 setting no upper age limit. Four centres do not currently offer living donor kidney transplantation. Of the 29 centres involved with living donor transplantation ten had no protocol for donor assessment. A dedicated transplant coordinator/nurse practitioner was employed by 20 centres and ten routinely used an independent medical assessor to evaluate living related donors. The frequency and duration of donor follow-up after kidney donation also varied widely, with 18 centres providing life-time, seven limited and three no follow-up after initial postoperative assessment.

Conclusion
The wide variation in organizational structure and method of assessment of living kidney donors in the UK and Ireland supports the need for establishment of guidelines for this practice.
Value of splenic preservation during distal pancreatectomy for chronic pancreatitis
Authors: Govil S , Imrie C W 
Published: March 2003

Abstract

Background
Pain relief after distal pancreatectomy for chronic pancreatitis is reportedly satisfactory in 50–80 per cent of patients. This study attempted to determine clinical and radiological features that might select patients likely to benefit from distal pancreatectomy, and whether splenic preservation influenced the outcome.

Methods
Thirty-eight patients with chronic pancreatitis, who underwent distal pancreatectomy between 1982 and 1998, were reviewed retrospectively. The outcome of surgery was correlated with the aetiology of pancreatitis and radiological appearance on endoscopic retrograde cholangiopancreatography and computed tomography.

Results
Good results were achieved in 23 of 36 patients for whom follow-up (median 48 months) was available, including all 11 with obstructive pancreatitis. The spleen was preserved in 22 patients. Twelve patients became diabetic after surgery: three of 20 in whom the spleen was preserved and nine of 16 who underwent splenectomy.

Conclusion
Non-alcoholic patients with a normal pancreas proximal to a dominant ductal stricture had a consistently good outcome from surgery. Spleen-preserving distal pancreatectomy, although technically demanding, can be performed safely with results equivalent to those of distal pancreatectomy with splenectomy or autotransplantation. Splenic preservation, apart from preventing postsplenectomy sepsis, might also delay the onset of diabetes.
Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication
Authors: Franzén T , Boström J , Tibbling Grahn L , Johansson K-E 
Published: March 2003

Abstract

Background
This was a prospective study of symptoms, and short-term and long-term reflux competence after partial fundoplication.

Methods
Some 101 patients were operated consecutively with posterior partial (270°) fundoplication. Indications for surgery were reflux disease without erosive oesophagitis in 25 patients, moderate oesophagitis in 43, severe oesophagitis in 25 and paraoesophageal hernia in eight. Symptom score, manometry and pH tests were performed before operation, 6 months after operation and after 6–14 years.

Results
All patients (n = 101) were free from heartburn and regurgitation at early follow-up. There was evidence of clinical recurrence at late follow-up (n = 87) in two of 22 patients without oesophagitis before operation, two of 39 with moderate oesophagitis before operation and three of 19 patients with severe oesophagitis before operation; 92 per cent had good reflux control at late follow-up.

Conclusion
Posterior partial fundoplication shows excellent reflux control at early follow-up. Ten years later fewer than 10 per cent of patients have recurrence, which is more common in patients who had severe oesophagitis before operation.
Staging of rectosigmoid neoplasia with colonoscopic endoluminal ultrasonography
Authors: Norton S A , Thomas M G 
Published: March 2003

Abstract

Background
The accurate staging of colorectal neoplasia may aid the stratification of patients for adjuvant treatment. At present the mural extent of neoplasia proximal to the mid rectum is difficult to determine. Prediction of mural invasion could help identify patients suitable for radical resection, minimal access surgery or endoscopic treatment. Colonoscopic endoluminal ultrasonography (EUS) was used in a prospective study to determine the stage of rectosigmoid neoplasia in 121 patients.

Methods
Mural tumour (T) stage was designated by EUS as uT0/1–uT4 in 121 patients. Nodal (N) staging was performed in 39 cases. EUS staging was compared with histological stage (pT and pN) in 93 patients who underwent resection.

Results
Mural staging of disease using colonoscopic EUS showed good correlation with histo-pathological stage (κ = 0·85 (95 per cent confidence interval 0·76–0·95)). Overall pT and pN stage accuracy of EUS was 92 and 65 per cent respectively.

Conclusion
EUS accurately assessed tumour stage although node staging remained suboptimal. Colonoscopic EUS may aid the selection of treatment in patients with rectosigmoid neoplasia.