bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity and functional outcome after double dynamic graciloplasty for anorectal reconstruction
Authors: Rullier E , Zerbib F , Laurent C , Caudry M , Saric J 
Published: March 2003

Abstract

Background
After abdominoperineal resection (APR), anorectal reconstruction with dynamic graciloplasty has been proposed to avoid abdominal colostomy and improve quality of life. Graciloplasties involving one or two gracilis muscles with various configurations have been described. The aim of this study was to evaluate morbidity and functional results in a homogeneous series of patients undergoing double dynamic graciloplasty following APR for rectal cancer.

Patients and methods
From May 1995 to May 1998, 15 patients (ten men and five women; mean age 54 (range 39–77) years) underwent anorectal reconstruction with double dynamic graciloplasty after APR for low rectal carcinoma. All patients had preoperative radiotherapy (45 Gy), 11 with concomitant chemotherapy, eight had intraoperative radiotherapy (15 Gy) and ten received adjuvant chemotherapy for 6 months. The surgical procedure was performed in three stages: APR with coloperineal anastomosis and double graciloplasty (double muscle wrap); implantation of the stimulator 2 months later; and ileostomy closure after a training period.

Results
There was no operative death. At a mean of 28 (range 3–48) months of follow-up, there was no local recurrence; two patients had lung metastases. Early and late morbidity occurred in 11 patients, mainly related to the neosphincter (12 of 16 complications). The main complication was stenosis of the neosphincter (n = 6), which developed with electrical stimulation. Of 12 patients available for functional outcome, seven were continent, two were incontinent and three had an abdominal colostomy (two for incontinence, one for sepsis). Compared with patients without stenosis, patients with neosphincter stenosis required major reoperations (four versus zero) and had a poor outcome (two of six versus five of six with a good result).

Conclusion
The double dynamic graciloplasty is associated with a high risk of neosphincter stenosis, which may entail morbidity, reintervention and poor functional results. The stenosis is a heterogeneous feature of the neosphincter induced by asymmetrical traction of both gracilis muscles. It is suggested that single dynamic graciloplasty should be used for anorectal reconstruction after APR.
In-hospital delay in the diagnosis of breast cancer
Authors: Jenner D C , Middleton A , Webb W M , Oommen R , Bates T 
Published: March 2003

Abstract

Background
There is evidence that delay in the diagnosis of breast cancer may prejudice survival. The aim of this study was to determine the incidence, time trends and causes of delay in a dedicated breast clinic.

Methods
The interval between first breast clinic visit and a definitive diagnosis was recorded in all patients with invasive breast cancer between 1988 and 1997. In all patients with a delay of 3 months or more, the case notes were reviewed for evidence of a triple assessment (clinical examination, imaging and needle biopsy). The principal cause of delay was identified.

Results
Of 1004 patients with invasive breast cancer, there was a delay in diagnosis of 3 months or more in 42 patients between 1988 and 1997, an incidence of 4·2 per cent. The median delay was 6 months and the median age at diagnosis was 53 (range 27–89) years. Triple assessment was undertaken in 30 patients; ten did not have a needle biopsy performed and three patients had no mammography. The principal cause of delay was: false-negative or inadequate fine-needle aspiration cytology (FNAC) in 19 patients, failure of follow-up in eight, clinical signs did not impress in five, FNAC not carried out in four, false-negative mammogram in three, failure of needle localization in two and one patient did not accept clinical advice. The annual incidence of delay in diagnosis did not change significantly over the 10-year interval.

Conclusion
Triple assessment is not sufficiently sensitive to detect every breast cancer and a small incidence of diagnostic delay is therefore inevitable with current techniques.
Evolution of nutritional support in acute pancreatitis
Authors: Lobo D N , Memon M A , Allison S P , Rowlands B J 
Published: March 2003

Abstract

Background
Acute pancreatitis is a catabolic illness and patients with the severe form have high metabolic and nutrient demands. Artificial nutritional support should therefore be a logical component of treatment. This review examines the evidence in favour of initiating nutritional support in these patients and the effects of such support on the course of the disease.

Methods
Medline and Science Citation Index searches were performed to locate English language publications on nutritional support in acute pancreatitis in the 25 years preceding December 1999. Manual cross-referencing was also carried out. Letters, editorials, older review articles and most case reports were excluded.

Results and conclusion
There is no evidence that nutritional support in acute pancreatitis affects the underlying disease process, but it may prevent the associated undernutrition and starvation, supporting the patient while the disease continues and until normal and sufficient eating can be resumed. The safety and feasibility of enteral nutrition in acute pancreatitis have been established; enteral nutrition may even be superior to parenteral nutrition. Some patients, however, cannot tolerate enteral feeding and this route may not be practical in others. Parenteral nutrition still has a role, either on its own or in combination with the oral and enteral routes, depending on the stage of the illness and the clinical situation.
Bascom's operation in the day-surgical management of symptomatic pilonidal sinus
Authors: Senapati A , Cripps N P J , Thompson M R 
Published: March 2003

Abstract

Background
Many treatments for symptomatic pilonidal sinus disease have been described. Ambulatory treatment with minimal morbidity and a rapid return to normal activity is desirable. Bascom's operation fulfils these requirements. This paper describes the operative technique and results of treatment.

Methods
Some 218 patients of mean age 27 years were treated as day cases. The mean duration of symptoms was 2·4 years. Sixty-eight per cent of patients had complex disease with more than two midline pits and/or a lateral discharging sinus. One hundred and eighty-three patients (84 per cent) were operated on under local anaesthesia.

Results
Ninety-five per cent of patients have been followed up for a mean of 12·1 (range 1–60) months. All except one midline wound healed. Lateral wounds healed after a mean of 4·0 (range 1–15) weeks. Postoperative complications were few, including bleeding in 4 per cent and abscess formation treated by reopening the lateral incision in 6 per cent. Twenty-one patients (10 per cent) have had recurrence and have needed reoperation.

Conclusion
Bascom's operation is simple and results in considerable financial savings with minimal social disruption and an early return to work. Recurrent disease is no more frequent than after other treatments.
Clinical governance and the vascular surgeon
Authors: Irvine C D , Grayson D , Lusby R J 
Published: March 2003

Abstract

Background
Audit of adverse outcome might allow identification of substandard surgical results. To test this hypothesis statistical modelling was applied to two indicator vascular procedures (elective abdominal aortic aneurysm repair and carotid endarterectomy) with accepted adverse event rates.

Methods
Binomial statistical models for varying adverse event rates were constructed. A power calculation was used in an attempt to predict the case numbers required to determine substandard results for individual surgeons and vascular units. Two scenarios were considered: first a base adverse event rate of 6 per cent and surgical practice with 9, 12 and 24 per cent morbidity rates, and second a base adverse event rate of 3 per cent and surgical practice with 6, 9 and 12 per cent morbidity rates.

Results
A mean of 57 elective abdominal aortic aneurysm repairs and 70 carotid endarterectomies were performed per annum. The adverse event rate for both operations was 4 per cent. Power calculations revealed that 130 patients would need to be studied to detect a surgeon with an adverse event rate twice 6 per cent and over 280 patients would be required with an adverse event rate twice 3 per cent. To gather this number of patients 2 years of unit data and between 3 and 22 years of individual data would need to be studied for a base adverse event rate of 6 per cent. A base rate of 3 per cent requires 7–47 years for an individual and 4–65 years for the unit. With a base adverse event rate of 6 per cent, detection of widely variant surgical practice (four times the morbidity rate as base) requires only 21 procedures.

Conclusion
Statistical modelling demands assumptions about accepted adverse event rates, confidence criteria and what constitutes substandard results. Data from large numbers of patients are required even for common operations with accepted adverse event rates. These data raise serious questions as to the feasibility of performing clinical governance on the basis of morbidity and mortality event rates alone.
Reperfusion injury is greater with delayed restoration of venous outflow in concurrent arterial and venous limb injury
Authors: Harkin D W , Barros D'Sa A A B , Yassin M M I , Young I S , McEneny J , McMaster D , McCaigue M D , Halliday M I , Parks T G 
Published: March 2003

Abstract

Background
Complex limb trauma often involves combined arterial and venous injury, and the resultant ischaemia–reperfusion injury (IRI) causes both local and remote organ injury. This study assessed the influence of the timing of restoration of venous drainage on IRI.

Methods
Male New Zealand white rabbits (n = 36) were randomized into six groups: sham operation (group 1) and unilateral hind limb arterial and venous occlusion for 1 h followed by no reflow for 2 h (group 2), arterial and venous reflow for 2 h (group 3), arterial reflow alone for 2 h (group 4), arterial reflow alone for 1 h followed by arterial and venous (delayed) reflow for a further 1 h (group 5), and pretreatment with an enteral combination antioxidant before occlusion of both artery and vein and delayed venous reflow (group 6). Plasma hydroperoxide (HPO) and glutathione peroxidase concentration, hind limb skeletal muscle and lung tissue wet: dry weight ratios and myeloperoxidase (MPO) concentration were measured.

Results
The plasma HPO level in the femoral vein effluent was significantly greater after delayed venous reflow (mean(s.e.m.) 2·02(0·54) μmol/l) than in control animals (0·98(0·10) μmol/l) (P &lt; 0·05). There was also a significantly greater tissue wet: dry weight ratio after delayed venous reflow than in controls, in skeletal muscle (mean(s.e.m.) 6·89(0·14) versus 5·34(0·54); P &lt; 0·05) and lung (9·20(1·14) versus 7·23(0·38); P &lt; 0·05) tissue. Lung tissue MPO activity was significantly greater after delayed venous reflow compared with controls (3·20(0·28) versus 1·86(0·14) units/g; P &lt; 0·005), and also in comparison to simultaneous arterial and venous reflow (2·40(0·24) units/g; P &lt; 0·05). In the antioxidant pretreatment group there was no significant increase in plasma HPO concentration, tissue MPO level or tissue wet: dry weight ratio compared with the control group.

Conclusion
In combined major arterial and venous injury of the limb, delayed restoration of venous drainage leads to significantly greater local skeletal muscle injury and remote neutrophil-mediated lung injury. These results support the clinical rationale for early restoration not only of arterial inflow but also venous drainage by means of intraluminal shunts.
Molecular technology and pancreatic cancer
Authors: Manu M , Buckels J , Bramhall S 
Published: March 2003

Abstract

Background
Pancreatic cancer is the fifth leading cause of cancer death in the Western world. Despite improvement in operative mortality rates, little impact has been made on overall 5-year survival. This review discusses the molecular changes peculiar to pancreatic cancer and how the use of molecular technology might affect detection, screening, diagnosis and treatment of the disease.

Methods
A literature review was performed using the National Library of Medicine's Pubmed database; this was combined with ongoing work within the Queen Elizabeth Hospital, Birmingham.

Results
Over the past 20 years great strides have been made in our understanding of the molecular basis of disease. Advances in molecular biology are now reshaping how diseases are screened for, diagnosed, investigated and treated. In recent years collaboration between clinicians and basic scientists has revealed a unique pattern of genetic and molecular events in pancreatic cancer. This review discusses how these advances may impact on patients with this disease.

Conclusion
The past decade has seen some improvement in outlook for patients with pancreatic cancer, but the ‘molecular age’ promises to deliver even better results.
Anal vector volume analysis complements endoanal ultrasonographic assessment of postpartum anal sphincter injury
Authors: Fynes M M , Behan M , O'Herlihy C , O'Connell P R 
Published: March 2003

Abstract

Background
The aim of this study was to determine the role of anal vector manometry in the assessment of postpartum anal sphincter injury and to establish the most suitable method of anal vector volume analysis for identifying significant external anal sphincter (EAS) injury in an at-risk parous population.

Methods
A total of 101 consecutive women with a history of instrumental or traumatic vaginal delivery was recruited. Anal ultrasonography and anal vector manometry were performed. Receiver–operator characteristic curves were used to determine the usefulness of anal manometry and anal vector volume analysis in the identification of significant EAS disruption (full thickness, more than one quadrant involved) detected by ultrasonography.

Results
Seventeen women had significant EAS disruption identified by anal ultrasonography. Anal vector manometry provided complementary functional information. Anal vector symmetry index (VSI), determined by analysis of mean maximum squeeze pressure, yielded 100 per cent sensitivity for significant EAS disruption, with a positive predictive value of 61 per cent.

Conclusion
Anal vector manometry complements endoanal ultrasonography. VSI, determined by means of the squeeze pressure profile, correlates best with significant EAS disruption identified at anal ultrasonography.
Hyperthermic intraperitoneal chemoperfusion in the treatment of locally advanced intra-abdominal cancer
Authors: Ceelen W P , Hesse U , de Hemptinne B , Pattyn P 
Published: March 2003

Abstract

Background
Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sole site of disease, reflecting biologically low-grade malignancy. These patients might, therefore, benefit from local treatment. Recently, debulking surgery followed by hyperthermic chemoperfusion has been proposed in the treatment of locally advanced or recurrent intra-abdominal cancer. This paper reviews the rationale and assesses the currently accepted indications for and results of this novel treatment.

Methods
A systematic web-based literature review was performed. Information was also retrieved from handbooks, congress abstracts and ongoing clinical trials.

Results
A growing body of experimental evidence supports the use of hyperthermia combined with chemotherapy as an adjunct to cytoreductive surgery. Randomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of pathological tumour stage pT3 or pT4 gastric cancer; several other phase III trials are ongoing. Numerous phase I and II trials have reported good results for various other indications, with acceptable morbidity and mortality rates. Case mix, limited patient numbers and absence of a standardized technique are, however, a drawback in many of these series.

Conclusion
For a subgroup of patients with peritoneal cancer without distant disease, debulking surgery followed by hyperthermic chemoperfusion may offer a chance of cure or palliation in this otherwise untreatable condition. This novel therapy should, however, be considered experimental until further results from ongoing phase III trials become available.
Administration of nitric oxide restores the abolished hepatic artery buffer responses in early porcine endotoxaemia
Authors: Götzinger P , Jørgensen P F , Scholz T , Gundersen Y , Függer R , Sautner T , Aasen A O 
Published: March 2003

Abstract

Background
Among other organs, the liver may be severely compromised by the altered haemodynamic conditions of septic shock. The hepatic artery buffer response (HABR), which is mediated mainly by adenosine 5′-triphosphate and nitric oxide as the second messenger, and is ablated during endotoxaemia, plays a central role in the autoregulation of liver perfusion. It was hypothesized that a temporarily decreased synthesis of nitric oxide during early endotoxaemia might be responsible for the dysfunction of the HABR and that administration of nitric oxide could re-establish the autoregulation of hepatic blood flow.

Methods
The experiment was performed in 15 juvenile Landrace pigs, which were randomly assigned to receive endotoxin (ET) 1·7 μg kg−1 min−1 (Escherichia coli) and the non-enzymatic nitric oxide donor sodium nitroprusside (SNP) 3 μg kg−1 min−1 (ET-SNP group; n = 7) or ET 1·7 μg kg−1 min−1 (E. coli) and vehicle (ET group; n = 8). ET and nitric oxide were administered into the portal vein. Study measurements (haemodynamic measurements, liver perfusion) were performed for 5 h.

Results
ET caused a significant decrease in liver perfusion after 5 h. Hepatic arterial flow (Qha) was reduced by 50 per cent and portal vein flow (Qpv) by 38 per cent. The additional administration of nitric oxide ameliorated liver perfusion; Qha and Qpv were not altered significantly in the ET-SNP group. The mechanical reduction of Qpv to approximately 50 per cent of baseline increased Qha in all animals before administration of ET. Flow increase in the hepatic artery due to partial Qpv occlusion (HABR) was lost in the ET group, while nitric oxide preserved a mean increase of 28 per cent in Qha (P &lt; 0·01). At time zero the Qpv reduction decreased mean hepatic artery resistance (HAR) in both groups. Thereafter ET infusion led to a continuous loss of the response of HAR to reduction of Qpv, while nitric oxide administration kept the response of HAR at pre-ET levels throughout the experiment. At 4 and 5 h the reactivity of HAR to manipulations of Qpv had returned to baseline levels in the ET group.

Conclusion
Early administration of the non-enzymatic nitric oxide donor SNP during endotoxaemia is able to re-establish an autoregulatory response of the hepatic artery following reduction of hepatic blood flow.
Immune dysfunction following haemorrhage can be restored by interleukin 10 in males but not in females
Authors: Kahlke V , Dohm C , Brötzmann K , Schreiber S , Schröder J 
Published: March 2003

Abstract

Background
Recent studies have shown depressed immune responses following haemorrhagic shock in males, whereas they are enhanced in females. Furthermore, this results in a lower mortality rate in females following subsequent sepsis. Interleukin (IL) 10 has been shown to play a potential role in treatment of the early proinflammatory state following haemorrhagic shock. Although beneficial effects of treatment with IL-10 have been shown, it remains unclear whether the effects are sex related.

Methods
Male and female CBA/J mice were subjected to haemorrhage (35 ± 5 mmHg for 90 min and fluid resuscitation) or sham operation. At resuscitation each received either intraperitoneal recombinant murine IL-10 or placebo. In vitro splenic T cell responses were determined 48 h after resuscitation.

Results
IL-10 release of splenocytes was not enhanced after IL-10 treatment. Proinflammatory immune function was depressed (i.e. proliferation, IL-2, IFN-γ) in males receiving placebo compared with no change in females. IL-10 treatment restored the depressed proinflammatory immune response in males following haemorrhagic shock (Fig. 1). In contrast, the immune response in females receiving IL-10 was not significantly changed. However, IL-10 treatment of sham-operated male mice led to immune depression compared with placebo-treated animals.

Conclusion
Early IL-10 anti-inflammatory treatment following haemorrhage has potential beneficial effects in males only.
Effect of bacteria and antibiotic treatment on whole blood-mediated endothelial permeability in vitro
Authors: Nooteboom A , Hendriks T , van der Linden C J 
Published: March 2003

Abstract

Background
During Gram-negative sepsis bacterial endotoxin or lipopolysaccharide (LPS) may activate and damage endothelial cells resulting in systemic vascular leakage. Antibiotic treatment of Gram-negative bacteria results in significant release of LPS, inducing production of cytokines by leucocytes in vitro. The biological relevance of this finding is not well understood. A whole blood assay and cultured endothelial monolayers have been used to evaluate the effect of antibiotic treatment of bacteria on endothelial permeability.

Methods
Heat-inactivated (HI) Escherichia coli (ATCC 25922) was treated with either cefuroxime (CXM), imipenem–cilastin (IPM) or polymyxin B (poly B). The cultures were incubated with heparinized whole blood from healthy donors in a final concentration of 105 colony-forming units ml−1 and incubated at 37°C for 24 h. Plasma was then collected and added to human umbilical vein endothelial cell monolayers cultured on semipermeable Transwell COL membranes. The permeability of the monolayers was determined using fluorescein isothiocyanate-labelled (FITC) albumin and rhodamine-β-isothiocyanate-labelled (RITC) dextran. The production of interleukin (IL) 1β, IL-6, IL-1ra and tumour necrosis factor (TNF) α in whole blood was measured using radioimmunoassay.

Results
In whole blood, HI bacteria alone induced the production of IL-1β, IL-6, IL-1ra and TNF-α. CXM treatment of HI E. coli before incubation in blood induced significantly more IL-1β, TNF-α and IL-6 than the HI control, while poly B treatment induced less cytokine production. IPM did not significantly alter the production of cytokines. In the permeability assay, whole blood treated with HI bacteria alone induced a permeability increase of 2·3 times control monolayer permeability (P &lt; 0·05). While CXM or IPM treatment resulted in a significant further enhancement of the permeability, there was no significant difference between these antibiotic treatments (permeability increase 2·9 and 2·8 times the control respectively). In contrast, treatment with poly B almost completely abrogated the permeability effect of HI bacteria (1·1 times control; P &gt; 0·05).

Conclusion
Since neutralization of LPS by poly B reduces the E. coli-induced production of cytokines in whole blood and prevents increased permeability, free LPS may be the driving force of cytokine-mediated endothelial permeability. Treatment of bacteria with CXM or IPM induces a significantly different cytokine production in whole blood. However, in both cases the resulting plasma leads to a similar increase in permeability. Thus, the fact that individual antibiotics can release different amounts of LPS may be irrelevant to endothelial permeability.