bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer
Authors: Rullier E , Sa Cunha A , Couderc P , Rullier A , Gontier R , Saric J 
Published: April 2003

AbstractBackgroundThe feasibility of laparoscopic rectal resection in patients with mid or low rectal cancer was studied prospectively with regard to quality of mesorectal excision, autonomic pelvic nerve preservation and anal sphincter preservation.MethodsLaparoscopic rectal excision was performed in 32 patients (21 men) with rectal carcinoma located 5 cm from the anal verge. Most patients had T3 disease and received preoperative radiotherapy. The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, intersphincteric resection, transanal coloanal anastomosis with coloplasty and loop ileostomy.ResultsThree patients needed conversion to a laparotomy. Postoperative morbidity occurred in ten patients, related mainly to coloplasty. Macroscopic evaluation showed an intact mesorectal excision in 29 of 32 excised specimens; microscopically, 30 of the 32 resections were R0. Sphincter preservation was achieved in 31 patients. The hypogastric nerves and pelvic plexuses were identified and preserved in 24 of the 32 patients. Sexual function was preserved in ten of 18 evaluable men.ConclusionA laparoscopic approach can be considered in most patients with mid or low rectal cancer.
Segmental nature of the porcine liver and its potential as a model for experimental partial hepatectomy
Authors: Court F G , Wemyss-Holden S A , Morrison C P , Teague B D , Laws P E , Kew J , Dennison A R , Maddern G J 
Published: April 2003

Abstract

Background
In-depth knowledge of pig liver anatomy allows potential research into segmental liver resections and hepatic regeneration, as well as liver transplantation techniques. The segmental anatomy, however, remains largely unknown. This study aimed to delineate the segmental anatomy of the porcine liver in comparison with that of the human.

Methods
The segmental anatomy of the porcine liver was determined using acrylic injection casting of ex vivo pig livers, allowing the arterial, venous and biliary supply to be visualized directly. This was correlated using multi-slice computed tomography (CT) and three-dimensional reconstructions.

Results
Although the external morphology of the porcine liver differs from that of the human, the segmental anatomy is remarkably similar in term of its vascularity and biliary tree.

Conclusion
Acrylic casting of the porcine liver accurately delineates the vascular and biliary anatomy, and is a useful tool for performing experimental liver surgery. The similarities between porcine and human segmental anatomy allow domestic swine to be used as a comparable model. Three-dimensional CT reconstructions can also accurately visualize the anatomy and may be used to perform virtual surgery, or to assess segmental volumes.
Registration and validity of surgical complications in colorectal cancer surgery
Authors: Gunnarsson U , Seligsohn E , Jestin P , Påhlman L 
Published: April 2003

AbstractBackgroundPopulation-based quality registers have become an important tool in quality assessment during the past decade. For registers to be reliable, however, data must be checked carefully for validity.MethodsThe present study describes the validity of surgical complications registered in a national register run by the National Board of Health and Welfare (NBH), a register run by Regional Oncological Centres (ROC) and, for comparison, a local quality assurance system at Uppsala University Hospital (UUH). A specialized, independent surgeon checked 10 per cent of patient records against datasheets from the registers.ResultsThe local quality assurance system at UUH showed the best validity for surgical complications. Data for complications of colonic cancer surgery were more valid than those for rectal cancer surgery. Registration of serious complications was more valid than that of wound infections. The calculated proportion of missed surgical complications was 0·69, 0·64, 0·40, 0·22 and 0·07 for rectal and colonic cancer in the NBH register, rectal and colonic cancer in the ROC register, and the UUH register respectively. Corresponding figures for reoperation were 0·45, 0·48, 0·04, 0·09 and 0·21.ConclusionLocal interest and routine use of data for quality assurance are crucial factors for valid registers. Careful monitoring of validity is necessary for use of registry data in structured systems for improvement of surgical results.
Experimental model to estimate intestinal viability using charge-coupled device microscopy
Authors: Yasumura M , Mori Y , Takagi H , Yamada T , Sakamoto K , Iwata H , Hirose H 
Published: April 2003

Abstract

Background
Intraoperative assessment of intestinal viability following release of strangulation remains difficult. The aim of this study was to establish clinical standards for the evaluation of intestinal viability by charge-coupled device (CCD) microscopy.

Methods
A rat ileus model with strangulation for between 15 and 120 min was used. The images obtained by CCD microscopy were used to calculate maximum velocity (Vmax) ratio (ratio of Vmax of blood cell transition in the experimental segment to that in the reference segment) and S ratio (the ratio of S—the effective area of the vascular bed against the total area of the vascular bed—in the experimental segment to that in the reference segment). Rats were divided into group 1, comprising animals that survived for 7 days or more, and group 2, which consisted of animals that died within 4 days.

Results
V max ratio and S ratio in group 1 were both significantly higher than those in group 2 (P &lt; 0·01). No death occurred at a Vmax ratio of 0·76 or higher and an S ratio of 0·61 or more, while there were no survivors with a Vmax ratio of 0·54 or less and an S ratio of 0·51 or less.

Conclusion
V max ratio and S ratio could be used as indices for evaluation of intestinal viability.
Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery
Authors: Gendy R K , Able J A , Rainsbury R M 
Published: April 2003

Abstract

Background
The aim of this study was to compare the outcomes of skin-sparing mastectomy (SSM) with immediate myocutaneous flap reconstruction and partial mastectomy with latissimus dorsi miniflap reconstruction (LDMF) for breast cancer.

Methods
Some 106 disease-free patients (57 SSM, 49 LDMF) who had breast reconstruction between 1991 and 1999 participated in this retrospective review. The mean duration of follow-up was 42 (range 6–102) months. Measured outcomes included surgical complications, functional disability, cosmetic result and psychological morbidity.

Results
SSM outcomes were less favourable than LDMF outcomes with regard to postoperative complications (14 versus 8 per cent), further surgical interventions (79 versus 12 per cent), nipple sensory loss (98 versus 2 per cent), restricted activities (73 versus 54 per cent) and cosmetic outcome by panel assessment. Anxiety about residual cancer and ease of breast self-examination were similar in both groups.

Conclusion
LDMF was associated with fewer adverse surgical and physical sequelae than SSM, without compromising local control or cosmetic outcome. Both operations were associated with low psychological morbidity.
Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm
Authors: Neary W D , Crow P , Foy C , Prytherch D , Heather B P , Earnshaw J J 
Published: April 2003

AbstractBackgroundThe aim was to assess to what extent the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and Hardman scoring systems were predictive of outcome after surgery for ruptured abdominal aortic aneurysm (RAAA).MethodsFrom January 1990 to December 2001, 232 patients presented with RAAA. Forty-one were treated conservatively and all died; the remainder had emergency surgery. The case notes of all but three of these patients were reviewed retrospectively. POSSUM and Hardman scores were calculated and related to mortality.ResultsThe mortality rate after emergency repair was 54 per cent (104 of 191). The physiology-only POSSUM score specific for RAAA and the Hardman Index score were both significantly associated with increased mortality after operation (P &lt; 0·001). Most non-operated patients were in the highest risk bands.ConclusionBoth POSSUM and Hardman scoring systems predicted outcome after emergency surgery for RAAA. The Hardman Index was simpler to calculate, but POSSUM identified a higher number of patients at risk. Risk scoring may help identify patients with RAAA for whom surgery is futile.
Heat preconditioning prevents oxidative stress-induced damage in the intestine and lung following surgical manipulation
Authors: Thomas S , Pulimood A , Balasubramanian K A 
Published: April 2003

AbstractBackgroundThe intestine is increasingly recognized as a primary effector of distant organ damage, such as lung, following abdominal surgery. Surgical manipulation of the intestine generates oxygen free radicals resulting in mucosal damage. Heat preconditioning has been proposed to prevent various stress-induced alterations in cells and tissues, including oxidative stress. This study examined the effect of heat preconditioning on oxidative stress-induced damage to the intestine and lung, following surgical manipulation.MethodsControl rats and rats pretreated with heat were subjected to surgical manipulation by opening the abdominal wall and handling the intestine as done during laparotomy. Intestine and lung were assessed for damage by histology and markers of oxidative stress.ResultsSurgical manipulation resulted in ultrastructural changes in the intestine. Biochemical alterations in the enterocytes were evident, with increased xanthine oxidase activity resulting in production of superoxide anion and with a decrease in antioxidant status. Gut manipulation also resulted in neutrophil infiltration and oxidative stress in the lung as assessed by histology, myeloperoxidase activity, lipid peroxidation and antioxidant status. Heat conditioning before surgical manipulation had a protective effect against this intestinal and lung damage.ConclusionThis study suggests that mild whole-body hyperthermia before surgery might offer protection from postoperative complications.
Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse
Authors: Reay Jones N H J , Healy J C , King L J , Saini S , Shousha S , Allen-Mersh T G 
Published: April 2003

AbstractBackgroundThe late onset of pelvic visceral prolapse and incontinence after childbirth injury could be explained by menopause-associated connective tissue weakening. Uterosacral ligament resilience (UsR) was assessed to determine whether it influenced uterine or pelvic floor mobility, or varied with age, vaginal delivery, menopause or histological variations in the ligament.MethodsUsR was measured by tensiometry in ligaments from 85 hysterectomy specimens, and was correlated with the presence of symptomatic uterocervical prolapse, prehysterectomy uterine and anorectal mobility, patient age, history of vaginal delivery and menopause. Forty-five of these ligaments were examined for ligament thickness, muscle to collagen ratio, and oestrogen and progesterone receptor density. The results were correlated with UsR.ResultsUsR was significantly reduced (P = 0·02) in symptomatic uterovaginal prolapse, but there was no correlation with either uterocervical or anorectal descent in women without symptomatic prolapse. There was a significant decrease in UsR with vaginal delivery (P = 0·003), menopause (P = 0·009) and older age (P = 0·005). The uterosacral ligament was significantly thinner and contained fewer oestrogen and progesterone receptors after menopause, but this did not affect UsR.ConclusionWhere pelvic floor muscles are weakened, decreases in pelvic connective tissue resilience related to the menopause may facilitate progression to symptomatic pelvic visceral prolapse.
Preoperative fasting
Authors: Ljungqvist O , Søreide E 
Published: April 2003

Abstract

Background and methods
To avoid pulmonary aspiration, fasting after midnight has become standard in elective surgery, but recent studies have found no scientific support for this practice. Several anaesthesia societies now recommend a 2-h preoperative fast for clear fluids and a 6-h fast for solids in most elective patients. The literature supporting such fasting recommendations was reviewed.

Results
The recommendations are safe and improve well-being before operation, mainly by reducing thirst. A carbohydrate-rich beverage given before anaesthesia and surgery alters metabolism from the overnight fasted to the fed state. This reduces the catabolic response (insulin resistance) after operation, which may have implications for postoperative recovery.

Conclusion
Most patients having elective operations can be allowed a free intake of clear fluids up to 2 h before anaesthesia. Preoperative carbohydrates reduce postoperative insulin resistance.
Extracorporeal shockwave lithotripsy in the management of salivary calculi
Authors: Escudier M P , Brown J E , Drage N A , McGurk M 
Published: April 2003

Abstract

Background
The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor.

Methods
Some 122 salivary calculi (84 submandibular and 38 parotid) were treated in an experimental study using a sialolithotriptor.

Results
Complete success was achieved in 40 procedures (33 per cent), 27 of 84 submandibular and 13 of 38 parotid calculi. A further 43 patients (35 per cent) were rendered asymptomatic although some stone debris remained in the duct (26 submandibular and 17 parotid). Failure (retention of stone debris and continued symptoms) occurred in 39 patients (32 per cent), 30 submandibular and eight parotid glands. The chance of failure increased with the size of the calculus and increasing duration of symptoms.

Conclusion
Extracorporeal shockwave lithotripsy provides a useful option for the management of salivary calculi, particularly for stones less than 7 mm in diameter.
The need for targeted research into breast cancer in the elderly
Authors: Wyld L , Reed M W R 
Published: April 2003

Abstract

Background
Breast cancer is a major source of morbidity and mortality in elderly women. Despite this, many trials on which clinical practice is based have under-represented the elderly. Consequently there is little evidence to guide best practice in this age group.

Methods
A search of the major literature databases was performed using the search terms ‘breast cancer’ and ‘elderly’. Articles relevant to the treatment of breast cancer in the elderly were selected.

Results
The elderly receive less aggressive treatment for breast cancer compared with younger patients. Primary endocrine therapy is sometimes substituted for operation, and axillary surgery, adjuvant chemotherapy and adjuvant radiotherapy are commonly omitted. Evidence for and against such treatment strategies is inadequate, making it difficult to determine what constitutes best practice.

Conclusion
There is a need for research to be targeted at the older age group of patients with breast cancer to enable the development of specific treatment guidelines.
Management of severe acute pancreatitis
Authors: Yousaf M , McCallion K , Diamond T 
Published: April 2003

AbstractBackgroundAcute pancreatitis is still associated with significant morbidity and mortality. Current management guidelines are sometimes equivocal, particularly in relation to the surgical treatment of severe disease. This review assesses available investigative and treatment strategies to allow the development of a formalized management approach.MethodsA literature review of diagnosis, staging and management of acute pancreatitis was performed.Results and conclusionRecent evidence has helped to clarify the roles of computed tomography, endoscopic retrograde cholangiopancreatography, prophylactic antibiotics, enteral feeding and fine-needle aspiration for bacteriology in the management of acute pancreatitis. Despite a relative shortage of prospective randomized trials there has been a significant change in the surgical management of acute pancreatitis over the past 20 years. This change has been away from early aggressive surgical intervention towards more conservative management, except when infected necrosis is confirmed. A formalized approach, with appropriate use of the various non-surgical and surgical options, is feasible in the management of severe acute pancreatitis.
Bilateral tentorial sinus drainage of the basal vein (of Rosenthal)
Authors: San Millán Ruíz Diego , Fasel Jean H.D. , Reverdin Alain , Gailloud Philippe 
Published: March 2003

AbstractWe report a case of bilateral collateral tentorial venous sinus drainage of the basal vein (of Rosenthal) (BV). The observation was made on a corrosion cast of the cerebral venous system obtained from a fresh cadaver. Radiographic correlation was obtained by performing standard X‐ray imaging of the corrosion cast. Embryologic and clinical considerations are discussed. Clin. Anat. 16:264–268, 2003. © 2003 Wiley‐Liss, Inc.
Isomerism of the right atrial appendages: Clinical, anatomical, and microscopic study of a long‐surviving case with asplenia and ciliary abnormalities
Authors: Raman R. , Al‐Ali S.Y. , Poole C.A. , Dawson B.V. , Carman J.B. , Calder L. 
Published: March 2003

AbstractThis study describes a case of isomerism of the right atrial appendages (bilateral morphologically right atrial appendages associated with complex congenital cardiac lesions) with ciliary abnormalities. Detailed investigation included gross anatomic dissection, review of the clinical history, and light, confocal, and electron microscopy. Clinically, this 40‐year‐old, long‐surviving male patient had relatively good health until 4 years before death, which was due to cardiac failure. Surgical intervention consisted only of a Blalock‐Taussig shunt (anastomosis of the right subclavian artery to the right pulmonary artery) at 6 years of age. Despite the presence of complex cardiac malformations and asplenia, his longevity may be attributed to the connection of the pulmonary veins to the atrium without pulmonary venous obstruction, pulmonary valvar stenosis rather than atresia, no significant atrioventricular valve regurgitation, and no serious infections during his life. Microscopic examination of bronchial epithelium revealed a narrow, disorganized epithelium with abundant goblet cells and short, angulated cilia with a random orientation and possibly an abnormal central microtubule doublet. These abnormalities were not present in controls, and have been noted in primary ciliary dyskinesia (PCD) or Kartagener's syndrome. Because this syndrome has classically been thought to cause random lateralization resulting in a mirror‐imaged arrangement of the organs, the occurrence of truly isomeric patterns is not widely recognized. Whereas polysplenia and left bronchial isomerism have been reported to occur in immotile cilia syndrome, this is the first report to present detailed postmortem anatomic evidence of isomerism of the right atrial appendages, right bronchial isomerism, and asplenia in association with microscopy suggesting ciliary abnormalities. Clin. Anat. 16:269–276, 2003. © 2003 Wiley‐Liss, Inc.
Lateral arm flap: Analysis of its anatomy and modification using a vascularized fragment of the distal humerus
Authors: Hennerbichler A. , Etzer C. , Gruber S. , Brenner E. , Papp C. , Gaber O. 
Published: March 2003

AbstractSoft tissue injuries with associated bone defects are difficult to manage and often require prolonged treatment with repeated interventions. Frequently, a free flap is applied as a first step and bone grafting is carried out in a second procedure. Ideally, these two procedures are combined in one operation, utilizing a soft tissue flap with an attached vascularized bone fragment. The lateral arm flap can provide such an osteoseptocutaneous flap and has been utilized clinically with success; however, the vascular anatomy of the flap, especially the humeral fragment, has not been described in detail previously, and there is broad disagreement concerning its innervation. In this study, the arteries and nerves of 24 fresh cadaver arms were dissected after injection of colored latex. The levels of origin of the periosteal arteries of the humerus were also documented. The lateral arm flap has a consistent arterial supply from three septocutaneous perforating branches that are arranged in a predictable pattern. The lateral supracondylar ridge of the humerus is vascularized by direct branches of the posterior branch of the radial collateral artery and by arteries that arise from muscular branches supplying adjacent muscles. The innervation of the lateral arm flap is by the inferior lateral cutaneous nerve of the arm. Knowledge of the consistent vascular anatomy of the lateral humerus and soft tissue of the donor site allows an osteoseptocutaneous flap to be raised safely with an appropriate technique. We recommend use of the lateral arm flap with a humeral fragment for the treatment of combined soft tissue and bone defects when a single step surgical solution is indicated. Clin. Anat. 16:204–214, 2003. © 2003 Wiley‐Liss, Inc.
Comparison of human and porcine aortic valves
Authors: Sim Eugene K.W. , Muskawad Sanjeev , Lim Chu‐Sing , Yeo Joon Hock , Hiang Lim Khee , Grignani Robert T. , Durrani A. , Lau Gilbert , Duran Carlos 
Published: March 2003

AbstractWe compared the anatomy of human and porcine aortic valves. Porcine hearts were collected from the abattoir. Human hearts from patients who had died of non‐cardiac causes were examined in the mortuary; only undamaged and anatomically normal hearts were used. Silicon casts were prepared by injecting engineering silicon at 80 mm Hg into the aortic arch. Various features of the aortic valve were measured: circumference, length between the commissural end point and central point of coaptation, surface diameter, and surface area. In total, 12 porcine and 12 human aortic valves were studied. The average circumferences of the human and porcine aortic valves were 8.00 ± 0.2 (SD) cm and 7.90 ± 1.0 cm, respectively. The central point of coaptation in human valves was skewed toward the left coronary cusp, whereas in porcine valves it was skewed toward the non‐coronary cusp. In human aortic valves, the non‐coronary cusp had the largest surface diameter and surface area with mean measurements of 3.6 ± 0.2 cm and 1.230 ± 0.228 cm2, respectively; the left coronary cusp was smallest for the same variables with measurements of 3.1 ± 0.3 cm and 0.898 ± 0.357 cm2. In porcine valves, the right coronary cusp had the largest surface diameter and surface area with mean measurements of 3.9 ± 0.7 cm and 1.716 ± 0.81 cm2, respectively; the non‐coronary cusp was the smallest for the same variables with measurements of 2.9 ± 0.5 cm and 1.023 ± 0.659 cm2. These differences suggest that when using porcine valves as transplant material (e.g., stentless valves), geometric considerations, such as commissural length, may be important. Clin. Anat. 16:193–196, 2003. © 2003 Wiley‐Liss, Inc.