bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective randomized trial of laparoscopic Nissen fundoplication versus maintenance proton pump inhibition in the treatment of gastro-oesophageal reflux disease in patients aged under 65 years: preliminary results
Authors: Decadt B , Lowndes R , Rhodes M 
Published: March 2003

Abstract

Background
Laparoscopic Nissen fundoplication (LNF) was compared with maintenance proton pump inhibition (PPI) in patients with gastro-oesophageal reflux disease (GORD).

Methods
Some 113 patients (60 men; median age 45 (range 25–64) years) presented between June 1997 and June 1998 with a history of GORD of at least 2 years' duration. After giving informed consent they were investigated by endoscopy, 24-h pH and oesophageal manometry. Of 66 patients who completed the investigations, 57 had significant GORD; these were randomized, 29 to PPI and 28 to LNF.

Results
Endoscopic findings were equivalent in the two groups: 75 per cent of the PPI group had a hiatus hernia compared with 78 per cent of the LNF group; 54 per cent of the PPI group had oesophagitis compared with 71 per cent in the LNF group. Twenty-four-hour pH monitoring revealed De Meester scores of 21 (range 7–92) in the PPI group compared with 20 (range 10–99) in the LNF group. Manometry revealed a median␣lower oesophageal sphincter pressure (LOSP) of 10 (range 0–30) mmHg in the PPI group compared with 7 (range 1–30) mmHg in the LNF group. At 3 months after start of therapy, 24-h pH monitoring revealed a median De Meester score of 11 for both groups (PPI range 7–24, LNF range 9–39). Median LOSP was 15 mmHg in the PPI group compared with 17 mmHg in the LNF group.

Conclusion
Preliminary results suggest that LNF provides the same reduction in acid reflux as maintenance PPI in the short term. Further study of this group of patients will assess not only the physiological benefits of surgery versus maintenance PPI but also its impact on well being and relative costs of the two treatments.
Reliable screening for acute pancreatitis with rapid urine trypsinogen-2 test strip
Authors: Kylänpää-Bäck M-L , Kemppainen E , Puolakkainen P , Hedström J , Haapiainen R , Perhoniemi V , Kivilaakso E , Korvuo A , Stenman U-H 
Published: March 2003

Abstract

Background
This study was designed to evaluate the validity of a new rapid urinary trypsinogen-2 test strip (Actim Pancreatitis) for detection of acute pancreatitis in patients with acute abdominal pain.

Methods
A total of 525 consecutive patients presenting with abdominal pain at two emergency units was included prospectively and tested with the Actim Pancreatitis test strip. Urine trypsinogen-2 concentrations were also determined by a quantitative method. The diagnosis and assessment of severity of acute pancreatitis was based on raised serum and urinary amylase levels, clinical features and findings on dynamic contrast-enhanced computed tomography.

Results
In 45 patients the diagnosis of acute pancreatitis could be established. The Actim Pancreatitis test strip result was positive in 43 of them resulting in a sensitivity of 96 per cent. Thirty-seven false-positive Actim Pancreatitis test strips were obtained in patients with non-pancreatic abdominal pain resulting in a specificity of 92 per cent. Nine patients with severe acute pancreatitis were all detected by the dipstick.

Conclusion
A negative Actim Pancreatitis strip result excludes acute pancreatitis with high probability. Positive results indicate the need for further evaluation, i.e. other enzyme measurements and/or radiological examinations. The test is easy and rapid to perform, unequivocal in its interpretation and can be used in healthcare units lacking laboratory facilities.
Surgical treatment for recurrent gastro-oesophageal reflux disease after failed antireflux surgery
Authors: Bais J E , Horbach J M L M , Masclee A A M , Smout A J P M , Terpstra J L , Gooszen H G 
Published: March 2003

Abstract

Background
Recurrent or persistent symptoms occur in 10–15 per cent of patients after antireflux surgery. Failure of surgery is not uniform in its presentation. The cause of failure is not easily detected and even harder to treat. Different approaches have been proposed and few reports are available on the objective and subjective outcome of reoperation.

Methods
This study focuses on 30 patients (16 men and 14 women; age range 20–69 years) with recurrent symptomatic gastro-oesophageal reflux disease (GORD) resistant to medical treatment. In all patients reoperation was by the Belsey Mark IV antireflux operation. A clinical history, endoscopy and oesophageal manometry were obtained in all patients, and 24-h pH monitoring was performed in 27 of 30 before and in most patients after the Belsey procedure.

Results
Symptomatic improvement was reported in 24 of 30 patients. Oesophagitis (present before operation in 19 patients) was cured or remained absent in 24 of 30 patients, stabilized in one, improved in four and deteriorated in one. Relief of symptoms combined with absence of oesophagitis was obtained in 21 of 30 patients, with concomitant normalization of the 24-h pH profile in 11 of 22 patients. The median basal lower oesophageal sphincter (LOS) pressure increased significantly from 6·9 to 9·0 mmHg (P &lt; 0·01). Redo surgery had no effect on oesophageal body motility.

Conclusion
Reoperation performed for documented recurrent GORD had a good and lasting effect on symptoms, on oesophagitis (both in 24 of 30 patients) and on the combination of both (21 of 30). In these patients reoperation increased basal LOS pressure and decreased reflux time. Overall, the results approximate to those of primary operation.
Characteristics of patients with pancreatic cancer expressing a novel cancer cachectic factor
Authors: Wigmore S J , Todorov P T , Barber M D , Ross J A , Tisdale M J , Fearon K C H 
Published: March 2003

Abstract

Background
Recently a novel tumour-derived cachectic factor was identified in the murine MAC16 colonic adenocarcinoma model of cachexia. This factor, provisionally named proteolysis-inducing factor (PIF), was subsequently identified in the urine of weight-losing patients with cancer but not in the urine of weight-stable patients with cancer or weight-losing controls with benign disease. This study determined the nutritional characteristics of patients with pancreatic cancer who excrete PIF in the urine and investigated the relationship between PIF and the acute-phase protein response.

Methods
PIF was isolated from urine by precipitation and ultrafiltration and was then identified by Western blotting of nitrocellulose membranes using a previously developed monoclonal antibody. Full nutritional assessment of patients was undertaken at the same time as urine collection.

Results
PIF was detected in the urine of 80 per cent of patients (n = 55). These patients had a significantly greater total weight loss and rate of weight loss than patients whose urine did not contain PIF (median 12·5 (range 4–43) kg versus 4·5 (0–14) kg; P &lt; 0·0002). No association was evident between the presence of PIF in patients' urine and serum C-reactive protein (CRP) concentration. Furthermore, the accelerated weight loss associated with PIF expression also appeared to be independent of the acute-phase response. Overall the presence of PIF was not associated with reduced survival, although the previously reported association between raised CRP concentration and poor prognosis was confirmed.

Conclusion
PIF is associated with an accelerated rate of weight loss in patients with a tumour of the pancreatic head. This observation appears to be independent of the effect of an increased hepatic acute-phase protein response.
Autonomic nerve plexus involvement and prognosis in patients with rectal cancer
Authors: Ueno H , Mochizuki H , Fujimoto H , Hase K , Ichikura T 
Published: March 2003

Abstract

Background
A detailed knowledge of the fundamental basis for cancer involvement of the autonomic nerve plexus and the outcome of patients with such cancer foci is important when considering nerve-preserving surgery for rectal cancer.

Methods
Extrarectal autonomic nerve plexuses were obtained from 61 patients with advanced rectal cancer who were undergoing extended resection of the rectum with the associated nervous system. The specimens were sectioned totally so that any indirect cancer involvement of the extrarectal autonomic nerves and/or the surrounding tissue could be detected.

Results
Autonomic nerve plexus involvement was observed in nine patients: none of 25 with Dukes A/B, six of 28 with Dukes C and three of eight with Dukes ‘D’ lesions. Five of 26 patients with nodal involvement in the pararectal area had such foci, and four of eight patients with nodal involvement further from the primary tumour. Furthermore, of the nine patients with nerve plexus involvement, seven had extranodal cancer deposits in the mesorectum. The 3-year survival rate of patients with nerve plexus involvement was 33 per cent, while it was 83 per cent in those without such disease.

Conclusion
Nerve plexus involvement was observed in direct proportion to the extent of cancer spread to the mesorectum, and the prognosis of patients with such disease was unfavourable. Further investigation is needed to better identify those patients who would clearly benefit from an en bloc resection of the autonomic nerves.
Bladder and sexual dysfunction after mesorectal excision for rectal cancer
Authors: Nesbakken A , Nygaard K , Bull-Njaa T , Carlsen E , Eri L M 
Published: March 2003

Abstract

Background
Urinary and sexual dysfunction are recognized complications of rectal excision for cancer. The aim of this study was to examine the frequency of such complications after mesorectal excision, shortly after this method was introduced.

Methods
Spontaneous flowmetry, residual volume of urine measurement and urodynamic examination, including cystometry and simultaneous detrusor pressure and urinary flow recording, was carried out before and 3 months after curative rectal excision. Urinary symptoms and sexual function were evaluated by means of questionnaires before and after operation. Each patient served as his or her own control.

Results
Forty-nine consecutive patients, 39 of whom had a total mesorectal excision (TME) and ten a partial mesorectal excision, were examined before surgery and 35 again after operation. In two patients, a weak detrusor was detected before operation. Two patients developed signs of bladder denervation after operation. Transitory moderate urinary incontinence appeared in four other women. Six of 24 men reported some reduction in erectile function and one became impotent. Two men reported retrograde ejaculation. All the complications were seen in the TME group.

Conclusion
Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.
Recurrence following curative resection for gastric carcinoma
Authors: Yoo C H , Noh S H , Shin D W , Choi S H , Min J S 
Published: March 2003

Abstract

Background
The diagnosis and treatment of recurrent gastric cancer remains difficult. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the prognosis for these patients.

Methods
Of 2328 patients who underwent curative resection for gastric cancer from 1987 to 1995, 508 whose recurrence was confirmed by clinical examination or reoperation were studied retrospectively. The risk factors that determined the recurrence patterns and timing were investigated by univariate and multivariate analysis.

Results
The mean time to recurrence was 21·8 months and peritoneal recurrence was the most frequent (45·9 per cent). Logistic regression analysis showed that serosal invasion and lymph node metastasis were risk factors for all recurrence patterns and early recurrence (at 24 months or less). In addition, independent risk factors involved in each recurrence pattern included younger age, infiltrative or diffuse type, undifferentiated tumour and total gastrectomy for peritoneal recurrence; older age and larger tumour size for disseminated, haematogenous recurrence; and older age, larger tumour size, infiltrative or diffuse type, proximally located tumour and subtotal gastrectomy for locoregional recurrence. Other risk factors for early recurrence were infiltrative or diffuse type and total gastrec-tomy. Reoperation for cure was possible in only 19 patients and the mean survival time after conservative treatment or palliative operation was less than 12 months.

Conclusion
The risk factors for each recurrence pattern and timing of gastric cancer can be predicted by the clinicopathological features of the primary tumour. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.
Effect of liver blood flow and function on hepatic indocyanine green clearance measured directly in a cirrhotic animal model
Authors: Jiao L R , El-Desoky A A , Seifalian A M , Habib N , Davidson B R 
Published: March 2003

Abstract

Background
Peripheral blood clearance of indocyanine green (ICG) has been used as a test of liver function but gives little information on biliary excretion. Hepatic ICG uptake and clearance can be measured directly by near-infrared spectroscopy (NIRS). Direct ICG measurement has not previously been correlated with liver blood flow and function in cirrhosis.

Methods
Two groups of New Zealand white rabbits (n = 12) underwent laparotomy for liver exposure. Cirrhosis was induced by feeding animals (n = 6) with a high-cholesterol (2 per cent) diet for 16 weeks. Hepatic blood flow and microcirculation were measured. Hepatic ICG concentration was measured directly using NIRS probes on the liver surface. From the ICG concentration–time curve, hepatic ICG uptake and excretion rates were calculated by a non-linear least square curve fitting method.

Results
There was a significant reduction in ICG uptake rate (mean(s.d.) 0·300(0·130) versus 2·040(0·420) min−1; P = 0·0001) and ICG excretion rate (0·007(0·009) versus 0·227(0·096) min−1; P = 0·002) in cirrhotic animals. The hepatic ICG uptake rate correlated with hepatic blood flow and flow in the microcirculation (r = 0·81, P = 0·002; r = 0·92, P &lt; 0·001, respectively). The hepatic ICG excretion rate was significantly associated with indicators of impaired liver function including bilirubin (r = −0·86, P = 0·0004), aspartate aminotransferase (r = −0·81, P = 0·001) and lactate dehydrogenase (r = −0·83, P = 0·0008).

Conclusion
ICG uptake measured directly by NIRS reflects the reduced liver blood flow and perfusion in cirrhosis and its excretion correlates with the degree of liver parenchymal dysfunction. This technique may allow a more accurate method of liver function assessment than peripheral blood ICG clearance.
Functional outcome after restorative panproctocolectomy for ulcerative colitis decreases an otherwise enhanced quality of life
Authors: O'Bichere A , Wilkinson K , Rumbles S , Norton C , Green C , Phillips R K S 
Published: March 2003

Abstract

Background
Restorative panproctocolectomy is a favoured operation for ulcerative colitis, but altered bowel habit may adversely affect overall quality of life.

Methods
Specific and generic quality of life questionnaires and an instrument to award money for continuing disability based on government guidelines were sent to 103 patients who had curative surgery for ulcerative colitis between 1995 and 1997. Seventy-one patients returned completed questionnaires: 30 with an ileostomy (representing incontinence and abnormal body image), 11 with a Koch pouch (representing continence and abnormal body image) and 30 with a pelvic pouch (representing continence and normal body image).

Results
Patients valued the disability of having an ileostomy similar to that for a Koch pouch or a pelvic pouch: £40 000, £30 000 and £40 000 respectively (P = 0·97). There was no sex difference. Body image measured with a visual analogue scale (least = 1, worst = 10) was worst with the ileostomy and Koch pouch (8 each) and best with a pelvic pouch (5) (P = 0·06). However, pelvic pouches scored significantly worse than an ileostomy with regard to altered bowel emptying (pelvic pouch, 8; Koch pouch, 7; ileostomy, 5) (P = 0·01).

Conclusion
Poor function after pelvic pouch surgery offsets any advantage in body image over an ileostomy. Thus, overall quality of life and perceived monetary damage were the same for the two operations. Improved pelvic pouch function is likely to be reflected in better quality of life after restorative panproctocolectomy.
Immunoglobulin G and albumin levels in whole gut lavage fluid provide an objective measure of pouch ileitis
Authors: Evgenikos N , Bartolo D C C , Hamer-Hodges D W , Ghosh S 
Published: March 2003

Abstract

Background
Gut protein loss is a characteristic of inflammatory bowel disease (IBD), and immunoglobulin (Ig) G, albumin and α1-antitrypsin concentrations in whole gut lavage fluid (WGLF) correlate with clinical disease activity. If inflammation in ileoanal pouches is similar to IBD, then measurement of protein-losing enteropathy by analysis of WGLF may provide an objective assessment of disease activity in pouches.

Methods
Forty-two patients who had restorative proctocolectomy for ulcerative colitis underwent whole gut lavage with a polyethylene glycol–electrolyte solution. The first clear effluent was filtered, processed by the addition of protease inhibitors and stored at −70°C. IgG, albumin and α1-antitrypsin were assayed in WGLF. The Pouchitis Disease Activity Index (PDAI) was calculated after pouchoscopy and biopsy; the Moskowitz criteria for pouchitis were also applied.

Results
There was a significant correlation of the pouchoscopy score and the PDAI with the concentration of WGLF IgG. All patients with ‘pouchitis’ according to the Moskowitz criteria had a WGLF IgG concentration greater than 10 μg/ml. The WGLF albumin level also showed a significant correlation with the PDAI, but α1-antitrypsin concentration did not.

Conclusion
Analysis of WGLF for IgG and albumin may be useful in the assessment of disease activity in pouch inflammation.
Laparoscopic surgery and surgical infection
Authors: Targarona E M , Balagué C , Knook M M , Trías M 
Published: March 2003

Abstract

Introduction
It has been observed that the metabolic response to surgical injury is less after laparoscopic surgery than after open surgery. However, the effect of laparoscopic surgery on surgical infection has not been given much attention in the surgical literature, even though it may decrease the incidence of infectious complications. The objective of this study was to assess the influence that laparoscopic surgery has on surgical infection and to highlight certain controversial aspects.

Methods
A review of the literature was undertaken to examine the relationship between laparoscopic surgery and surgical infection. This was achieved primarily by using PubMed Medline as a source of material.

Results and conclusion
Laparoscopic surgery is associated with better preservation of the immune system than open surgery. This results in a decreased incidence of infectious complications. Although carbon dioxide pneumoperitoneum affects the peritoneal response to injury, it seems to have no harmful effect in terms of intra-abdominal infection. Nevertheless, at laparoscopic operation the virulence of intestinal micro-organisms should be recognized and, while knowing the advantages of minimally invasive surgery, the surgeon should consider the complexity of this technique. Furthermore, maintenance of laparoscopic instruments should be governed by the same norms as those used in open surgery; recommendations offered by the manufacturers should be respected.
Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer
Authors: Jansen L , Doting M H E , Rutgers E J Th , de Vries J , Olmos R A Valdés , Nieweg O E 
Published: March 2003

Abstract

Background
Lymphatic mapping in patients with breast cancer can reveal sentinel lymph nodes that are not located at level I–II of the axilla. Little is known about the clinical relevance of these nodes.

Methods
Some 113 consecutive patients with clinical stage T1–3 N0 M0 breast cancer were studied. Based on preoperative lymphoscintigraphy, sentinel node biopsy was performed guided by a γ probe and patent blue dye. All sentinel nodes that were visible on lymphoscintigraphy were sought. Pathological examination of the sentinel nodes included step-sections and staining with CAM 5·2. Axillary node dissection was performed regardless of sentinel lymph node status.

Results
Twenty-one (19 per cent) of 113 patients had sentinel lymph nodes outside level I–II of the axilla, mostly in the internal mammary chain. Twenty-two of the 30 sentinel nodes at these sites were harvested. Three patients had sentinel nodes only outside the axilla. Four other patients had metastases outside the axilla. This changed postoperative treatment in three patients. No postoperative complication occurred.

Conclusion
Sentinel lymph nodes outside level I–II of the axilla were present in 19 per cent of patients with breast cancer in this series. Biopsy of these nodes was technically demanding but was performed without additional morbidity. The clinical impact was limited; treatment changed in only 3 per cent.
Preoperative portal vein embolization improves prognosis after right hepatectomy for hepatocellular carcinoma in patients with impaired hepatic function
Authors: Tanaka H , Hirohashi K , Kubo S , Shuto T , Higaki I , Kinoshita H 
Published: March 2003

Abstract

Background
Percutaneous transhepatic portal vein embolization (PTPE) increases the safety of subsequent major hepatectomy. The aim of this study was to determine the effect of PTPE on long-term prognosis after hepatectomy in patients with hepatocellular carcinoma (HCC).

Methods
Seventy-one patients with HCC underwent right hepatectomy between 1984 and 1998. Preoperative PTPE was performed in 33 patients (group 1) and was not used in 38 patients (group 2). Outcome after operation was compared between the groups. The patients were further divided according to the median tumour diameter (cut-off 6 cm) and indocyanine green retention rate at 15 min (ICGR15) (cut-off 13 per cent).

Results
The cumulative survival rate was significantly higher in group 1 than in group 2 in patients with an ICGR15 of at least 13 per cent. Tumour-free survival rates were similar in both groups. Of patients with tumour recurrence after right hepatectomy, those in group 1 were more frequently subjected to further treatment.

Conclusion
Preoperative PTPE improves the prognosis after right hepatectomy for HCC in patients with impaired hepatic function, although it does not prevent tumour recurrence.
Transvenous sclerotherapy for huge oesophagogastric varices using open injection sclerotherapy
Authors: Kitano S , Baatar D , Bandoh T , Yoshida T , Tsuboi S , Matsumoto T 
Published: March 2003

Abstract

Background
The optimum procedure for long-term management of oesophagogastric varices when endoscopic sclerotherapy or ligation fails is yet to be established. This report describes a new procedure for treating huge oesophagogastric varices by open injection sclerotherapy.

Methods
Twenty-three patients with huge oesophagogastric varices underwent laparotomy and devascularization of the upper stomach with splenectomy. The left gastric vein was catheterized for repeated injection of 5 per cent ethanolamine oleate during the postoperative period.

Results
In all patients, the varices were eradicated after a mean of 3 sessions of sclerotherapy. There were no deaths or major complications during the mean follow-up period of 41 months. Small recurring varices in two patients were treated successfully by endoscopic sclerotherapy and interventional radiology.

Conclusion
Open injection sclerotherapy is an effective and safe procedure for the treatment of huge oesophagogastric varices.