bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital caseload and the results achieved in patients with rectal cancer
Authors: Marusch F , Koch A , Schmidt U , Pross M , Gastinger I , Lippert H 
Published: March 2003

Abstract

Background
The aim of the study was to investigate the impact of hospital caseload on the short-term postoperative outcome of patients with rectal carcinoma.

Methods
A multicentre study involving 75 German hospitals was carried out between January and December 1999. Some 1463 patients with rectal carcinoma were studied.

Results
The hospitals were divided into three groups by annual caseload as follows: less than 20 (group 1), 20–40 (group 2) and more than 40 (group 3). The groups were identical in terms of age, gender, height, weight, tumour stage, risk factors and American Society of Anesthesiologists classification. Postoperative morbidity was less in hospitals with a case volume of more than 20 patients per year (41·7 per cent in group 2 versus 49·9 per cent in group 1). The proportion of patients undergoing abdominoperineal resection with a permanent stoma was less in hospitals with a case volume of more than 40 patients per year (26·4 per cent in group 3 versus 34·0 per cent in group 2).

Conclusion
A large caseload in rectal surgery results in a significant reduction in permanent stoma formation and postoperative morbidity.
Prospective controlled trial of a standardized meal stimulation test in the detection of pancreaticoduodenal endocrine tumours in patients with multiple endocrine neoplasia type 1
Authors: Langer P , Wild A , Celik I , Kopp I , Bergenfelz A , Bartsch D K 
Published: March 2003

Abstract

Background
Use of a standardized meal stimulation test has been recommended for the early diagnosis of pancreaticoduodenal endocrine tumours (PETs) in patients with multiple endocrine neoplasia type 1 (MEN 1). The diagnostic value of this test was re-evaluated.

Methods
In a prospective, controlled trial 58 standardized meal stimulation tests (563 kcal) were performed in 12 patients with MEN 1 and histologically, biochemically and/or radiologically confirmed PETs (group 1), 11 carriers of an MEN 1 mutation with no evidence of PETs (group 2) and in 27 healthy controls (group 3). Serum pancreatic polypeptide (PP) and gastrin concentrations were measured before and during the test meal.

Results
Patients in group 1 had significantly higher mean basal serum PP and gastrin concentrations than patients in group 2 and controls (P &lt; 0·05). In all three groups an increase in serum PP was observed after meal stimulation, but there was no significant difference between the groups. No increase in gastrin level was found in any of the groups after meal stimulation.

Conclusion
The standardized meal stimulation test does not reliably indicate the presence of PETs in patients with MEN 1, whereas raised basal serum PP and gastrin levels do. The expensive and time-consuming meal test can be excluded from MEN 1 screening programmes.
Reintervention as a clinical trial endpoint after peripheral arterial bypass surgery
Authors: Watson H R , Belcher G , Horrocks M 
Published: March 2003

Abstract

Background
Graft patency is usually the primary endpoint in studies of peripheral arterial bypass surgery, but gives only a limited indication of clinical outcome. The aim of this study was to evaluate reintervention as a study endpoint after femorodistal bypass surgery.

Methods
The database from a multicentre, prospectively planned study of 517 patients undergoing femorodistal bypass for severe ischaemia was used to investigate the predictive value of technical endpoints. Clinical symptoms, graft patency, vascular interventions and clinical outcomes were recorded for 12 months after operation.

Results
Complete follow-up data were obtained on 498 patients (96 per cent). Success in terms of patients' need for reintervention agreed with clinical outcome in 90 (95 per cent confidence interval (c.i.) 87–93) per cent of cases. Primary and secondary patency agreed with the clinical outcome in 80 (95 per cent c.i. 77–84) and 81 (95 per cent c.i. 78–85) per cent of patients respectively. However, the best agreement with clinical outcome was obtained from the composite endpoint of ‘patient alive without reintervention’: 92 (95 per cent c.i. 90–94) per cent.

Conclusion
Recording the number of patients who did not need reintervention for 12 months after femorodistal bypass gave a more accurate assessment of the number with clinical improvement than was obtained by recording bypass graft patency. Inclusion of patient survival in a composite endpoint increased the clinical relevance of this endpoint in patients with severe ischaemia who had femorodistal bypass surgery.
Community mortality after ruptured abdominal aortic aneurysm is unrelated to the distance from the surgical centre
Authors: Cassar K , Godden D J , Duncan J L 
Published: March 2003

Abstract

Background
Ruptured abdominal aortic aneurysm (RAAA) carries a high community mortality. Raigmore Hospital, Inverness serves Highland Region, an area the size of Wales with a population of 204 000. The aim of this retrospective review was to determine the community mortality and hospital mortality rates from RAAA in Highland Region and to assess whether distance travelled had any significant impact on survival.

Methods
Data were retrieved from hospital records, the Registrar General for Scotland and the Information and Statistics Division of the National Health Service in Scotland about patients diagnosed with RAAA between 1992 and 1999.

Results
Of 198 patients with RAAA, 131 (66 per cent) were transferred to Raigmore Hospital while the other 67 (34 per cent) died in a community hospital or at home. Of those reaching Raigmore 109 (83 per cent) had surgery, of whom 65 (60 per cent) survived. The overall community mortality rate was 67 per cent while the hospital mortality rate was 50 per cent. The hospital and community mortality rates for patients living within 50 miles of Raigmore Hospital were 60 and 67 per cent respectively, compared with 26 and 68 per cent for those living more than 50 miles away.

Conclusion
Distance from Raigmore Hospital had no significant impact on community mortality from RAAA.
Management of thoracic duct injuries after oesophagectomy
Authors: Wemyss-Holden S A , Launois B , Maddern G J 
Published: March 2003

Abstract

Background
Thoracic duct laceration is a rare but potentially life-threatening complication of oesophagectomy. The management of such an injury is uncertain in respect of the relative merits of conservative and surgical treatment.

Methods
The literature was reviewed by searching Medline databases from 1966 to the present time. The majority of the evidence presented is level 3, as no randomized or controlled data are available.

Results
Prolonged conservative treatment of thoracic duct injury is associated with a mortality rate of 50–82 per cent. The results of early surgical ligation of the duct are more encouraging, with a mortality rate of 10–16 per cent. Elective ligation of the duct reduces the incidence of postoperative chylothorax.

Conclusion
The thoracic duct should be ligated during oesophagectomy. A high index of suspicion for duct injury must be maintained in all patients after operation. A policy of very early thoracic duct ligation at 48 h from diagnosis is proposed for duct injury if aggressive conservative management fails.
Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery
Authors: Maurer C A , Z'graggen K , Renzulli P , Schilling M K , Netzer P , Büchler M W 
Published: March 2003

Abstract

Background
The introduction of total mesorectal excision (TME) has been shown to improve local recurrence rates in rectal cancer. The present study investigated the impact of this more extensive and radical procedure with regard to autonomic pelvic nerve function.

Methods
Patients with resected primary rectal cancer were interviewed by means of a questionnaire asking about preoperative and postoperative urinary bladder and genital function. The results in patients after rectal cancer surgery without TME (group 1; n = 29) were compared with those obtained after introduction of the TME technique (group 2; n = 31). Patients in group 2 were older and had a lower level of anastomosis than patients in group 1. Other patient, treatment and tumour characteristics were comparable between the groups.

Results
Newly acquired and permanent symptoms of bladder dysfunction after rectal excision were present as follows (group 1 versus group 2): difficulty in bladder emptying 7 versus 19 per cent; sensation of incomplete bladder voiding 17 versus 17 per cent; urgency 17 versus 14 per cent; incontinence 10 versus 3 per cent; dysuria 7 versus 7 per cent; and dribbling 14 versus 8 per cent. Male patients stated the following sexual functions before operation/after operation in group 1 versus group 2: interest in sex 80 per cent/40 per cent versus 63 per cent/37 per cent; sexually active 67 per cent/7 per cent versus 53 per cent/22 per cent; impotence 75 per cent/6 per cent versus 58 per cent/26 per cent; ability to have intercourse 75 per cent/13 per cent versus 67 per cent/29 per cent; ability to achieve orgasm 88 per cent/13 per cent versus 76 per cent/47 per cent; and orgasm with ejaculation 88 per cent/9 per cent versus 76 per cent/53 per cent.

Conclusion
While both conventional rectal cancer surgery and TME result in similarly favourable postoperative bladder function, both techniques decrease sexual function. However, TME offers a significant advantage with regard to preservation of postoperative sexual function in men and constitutes a true advance in rectal cancer surgery compared with conventional techniques.
Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy
Authors: Gouillat C , Chipponi J , Baulieux J , Partensky C , Saric J , Gayet B 
Published: March 2003

Abstract

Background
It remains debatable whether somatostatin can prevent pancreatic fistula and other pancreatic stump-related complications following pancreaticoduodenectomy. This study assessed the effects of somatostatin-14 (S-14) on pancreatic remnant exocrine secretion.

Methods
This was a double-blind, randomized, placebo-controlled trial in patients undergoing pancreaticoduodenectomy for malignancy. Patients received a continuous infusion of S-14 (n = 38) or placebo (n = 37) for 7 days. Pancreatic juice and peripancreatic drainage fluid was collected and measured, and pancreatic enzymes were monitored daily. Postoperative complications were recorded.

Results
S-14 infusion was associated with a decrease in median daily pancreatic juice and pancreatic amylase output. Amylase concentration and output in the peripancreatic drain fluid were significantly lower after S-14 infusion than in the control group (both P &lt; 0·05). The incidence of clinical pancreatic fistula (two of 38 versus eight of 37; P &lt; 0·05) and total pancreatic stump-related complications (five of 38 versus 12 of 37; P &lt; 0·05) was lower in patients treated with S-14. Duration of hospital stay was shorter after S-14 (18 versus 26 days; P = 0·01).

Conclusion
Although the effect of S-14 on exocrine secretion remains difficult to demonstrate, it did reduce pancreatic juice leakage from the pancreatic remnant.
Suspected acute appendicitis: trends in management over 30 years
Authors: Jones P F 
Published: March 2003

Abstract

Background
Tradition taught that patients with signs suspicious of acute appendicitis should be explored surgically, but studies in the 1960s found that if this group was closely observed about one-third recovered without treatment. To differentiate these patients a strict regimen of active observation was introduced and this has now been studied over 30 years. Ultrasonography, laparoscopy and computed tomography (CT) have also been used to clarify the diagnosis in these patients.

Methods
Papers on the management of patients with suspected appendicitis published since 1970 were traced through Index Medicus, English-language journals and Medline. All those that mention the use of observation are reviewed, with selective reports on the other methods used. The advantages and disadvantages of various methods of management are compared.

Results and conclusion
Active observation has yielded a consistently low negative appendicectomy rate without a rise in the perforation rate; there was one death in over 1600 patients. It has proved to be a practical method of discriminating between patients who do and do not need an operation. In this situation, both ultrasonography and CT yield some false-negative reports, so results must be checked at the bedside. Furthermore, CT involves exposure to significant doses of radiation.
Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative
Authors: Basse L , Madsen J L , Kehlet H 
Published: March 2003

Abstract

Background
Postoperative ileus usually lasts for 2–5 days after colonic surgery and may contribute to discomfort and pulmonary complications. With multimodal rehabilitation (epidural analgesia, early oral nutrition and mobilization, and laxative) defaecation occurs 1–2 days after colonic surgery. The aim of this study was to assess the transit rate of the entire gastrointestinal tract after colonic resection with multimodal rehabilitation.

Methods
Gastrointestinal motility was assessed by means of a scintigraphic method in 12 patients undergoing open colonic resection with multimodal rehabilitation and in 12 matched healthy volunteers. After intragastric or oral administration of 4 MBq 111In-labelled diethylenetriamine penta-acetic acid, images of the abdomen were taken at 24 and 48 h with a double-headed γ camera.

Results
Patient and volunteer demographics were similar. The first defaecation occurred a median of 1 day after operation in the patients. Some 57 per cent of the tracer was excreted in faeces of patients and 53 per cent in faeces of volunteers (P &gt; 0·05) within 48 h, indicating rapid recovery of the entire gastrointestinal motility after colonic resection with multimodal rehabilitation.

Conclusion
This study documents early normalization of the entire gastrointestinal motility assessed by an 111In scintigraphic method in patients undergoing open colonic resection with a multimodal rehabilitation programme.
Prevention of the neoplastic progression of Barrett's oesophagus by endoscopic argon beam plasma ablation
Authors: Morris C D , Byrne J P , Armstrong G R A , Attwood S E A 
Published: March 2003

Abstract

Background
Patients with Barrett's oesophagus have a risk of approximately 1 per 100 patient-years for the development of oesophageal adenocarcinoma. Endoscopic ablation of Barrett's oesophagus has been shown to lead to the regrowth of a ‘neo’ squamous epithelium if gastro-oesophageal reflux is controlled, but the incidence of subsequent tumour formation is unknown.

Methods
The follow-up of 55 patients who underwent endoscopic ablation of Barrett's oesophagus by argon beam plasma coagulation (ABPC) is reported. Of the 55 patients, nine had low-grade dysplasia, nine had high-grade dysplasia and the remainder had non-dysplastic Barrett's metaplasia. Twelve patients had reflux control by antireflux surgery and the remainder received proton pump inhibitor therapy. Barrett's metaplasia was ablated by ABPC to within 2 cm of the gastro-oesophageal junction.

Results
To date, one patient has died and one patient was unable to complete treatment. The remaining patients were followed by regular endoscopic surveillance for a mean of 38·5 months to give a total follow-up of 173·5 patient-years. No malignancy has developed in any patient during follow-up.

Conclusion
The absence of malignant complications in this study of prophylactic ablation of long-segment Barrett's oesophagus strengthens the argument for endoscopic ablation in the prevention of oesophageal adenocarcinoma.
Extent of ductal carcinoma in situ within and surrounding invasive primary breast carcinoma
Authors: Crombie N , Rampaul R S , Pinder S E , Elston C W , Robertson J F R , Ellis I O 
Published: March 2003

Abstract

Background
The aim of this study was to evaluate the pathological and morphological features of ductal carcinoma in situ (DCIS) within and surrounding invasive ductal carcinoma, and to investigate its relationship with clinical outcome and established prognostic variables.

Methods
One hundred and seven patients with primary operable invasive breast carcinoma and associated DCIS treated by simple or subcutaneous mastectomy or wide local excision with radiotherapy were assessed. Those with pure DCIS and insufficient tumour available for examination were excluded. The most representative haematoxylin and eosin-stained sections from the remaining 91 samples were selected and examined at × 100 magnification using a 45-point, 2-mm grid graticule. The entire section was assessed and the cell under each point of the graticule was classed as either normal (a), DCIS surrounded by normal tissue (b), invasive tumour (c) or DCIS surrounded by invasive malignancy (d). The volume ratio of DCIS in the normal (b/(a + b)) and invasive (d/(c + d)) tissue was then calculated.

Results
The DCIS volume within invasive tumour was not associated with outcome. The DCIS volume within adjacent normal tissue, however, was associated with local recurrence (P = 0·025), disease-free interval (P = 0·048), the occurrence of distant metastases (P = 0·019), death (P = 0·049) and disease-free survival (P = 0·048). Volume ratios of DCIS in normal and invasive tissue were not related to known prognostic factors including lymph node stage, grade, tumour size, vascular invasion or patient age.

Conclusion
There is a significant prognostic effect relating to the extent of DCIS associated with an invasive cancer, particularly with respect to local recurrence of tumour. This effect is restricted to the volume of DCIS in the tissue surrounding the invasive lesion rather than the intratumoral component.
Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection
Authors: Roumen R M H , Kuijt G P , Liem I H , van Beek M W P M 
Published: March 2003

Abstract

Background
The sentinel node biopsy technique for breast cancer has been validated extensively in phase I and II studies. However, no data from phase III randomized clinical studies are available. It remains controversial whether a histologically negative sentinel node biopsy without further axillary dissection can be considered to be good clinical practice.

Methods
One hundred consecutive patients with breast cancer who had a negative sentinel node biopsy without additional axillary dissection were studied prospectively between 1997 and 2000 in order to identify tumour recurrence and to assess the morbidity of the sentinel node procedure. Special attention was paid to axillary or locoregional recurrence, distant metastases and overall survival. One year after the procedure patients were sent a questionnaire to assess any functional impairment of the arm or shoulder.

Results
Median follow-up was 24 (range 16–40) months. One patient had an axillary relapse 14 months after the initial diagnosis of breast cancer. She died after 2 years from metastatic disease. There were no other local axillary recurrences. There was a 94 per cent response rate to the questionnaire. Twelve patients developed mild disabilities, of whom two said that they had to change their hobbies, sports or daily activities owing to the sentinel node procedure. No patient developed lymphoedema or needed physiotherapy after the operation.

Conclusion
When strict criteria for the sentinel node biopsy procedure are used, the sentinel node biopsy without further axillary dissection after a negative histological investigation is a safe procedure. It may therefore be considered to be the standard of care for the treatment of patients with breast cancer.
Non-invasive methods of assessing angiogenesis and their value in predicting response to treatment in colorectal cancer
Authors: George M L , Dzik-Jurasz A S K , Padhani A R , Brown G , Tait D M , Eccles S A , Swift R I 
Published: March 2003

Abstract

Background
Tumour neoangiogenesis can be assessed non-invasively by measuring angiogenic cytokine concentrations in peripheral circulation and by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The aim of this study was to assess whether these methods can predict and monitor response to treatment in patients with rectal cancer treated with preoperative chemoradiotherapy.

Methods
Serum and plasma vascular endothelial growth factor levels were measured in 31 patients with T3/T4 rectal cancers before quantitating tumour permeability (ln Ktrans) by DCE-MRI. Sixteen patients receiving preoperative chemoradiotherapy had serial vascular endothelial growth factor (VEGF) and DCE-MRI measurements. Response to treatment was assessed using World Health Organization criteria.

Results
Serum VEGF and ln Ktrans correlated before treatment (r = 0·48, P = 0·01). Responsive tumours (n = 8) had higher pretreatment permeability values than non-responsive tumours (n = 8) (mean ln Ktrans −0·46 and −0·72 respectively; P = 0·03). Compared with pretreatment values, responsive tumours showed a marked reduction in permeability at the end of treatment (mean ln Ktrans −0·46 and −0·86 respectively; P = 0·04). Pretreatment serum VEGF levels were not statistically different between the two groups.

Conclusion
Rectal tumours with higher permeability at presentation appear to respond better to chemoradiotherapy than those of lower permeability. This may allow preselection of appropriate tumours for these regimens, with patients with low-permeability tumours being considered for alternative therapies.
Value of isotope lymphography in the diagnosis of lymphoedema of the leg
Authors: Burnand K G , McGuinness C L , Lagattolla N R F , Browse N L , El-Aradi A , Nunan T 
Published: March 2003

Abstract

Background
Isotope lymphography has largely replaced contrast lymphography in the diagnosis of lymphoedema. Its accuracy has only been assessed in small studies and it is not known if it can identify patients with a proximal lymphatic obstruction who may be suitable for lymphatic bypass surgery.

Methods
Three hundred and ninety-five patients suspected to have lymphoedema were investigated by isotope lymphography between 1985 and 1995. Contrast lymphography was also carried out in 29 of these patients because the isotope results were thought to be misleading, or because lymphatic bypass surgery was being considered.

Results
In the 29 patients who had both investigations isotope lymphography detected 20 of 24 abnormal lymphatic systems. Four legs with obstructed groin lymphatics were reported as normal. Two legs with normal contrast lymphograms were erroneously diagnosed as having lymphoedema in the isotope study. Detectable groin nodes on the scintigrams were indicative of either normal lymphatics or proximal lymphatic obstruction. An increase in isotope uptake over 30–60 min of less than 50 per cent, or a total absence of isotope within groin nodes, was a sensitive indicator that patients were unsuitable for lymphatic bypass surgery.

Conclusion
Isotope lymphography is a moderately sensitive test for lymphoedema, which will mistakenly classify some normal legs as lymphoedematous. It will usually correctly identify patients who are suitable for lymphatic bypass surgery.