bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower limb surveillance following autologous vein bypass should be life long
Authors: McCarthy M J , Olojugba D , Loftus I M , Naylor A R , Bell P R F , London N J M 
Published: March 2003

Abstract

Background
The aim of the study was to investigate whether infrainguinal vein graft surveillance can be stopped at 1 year without prejudicing graft or leg survival.

Methods
Data were collected prospectively on 351 infrainguinal vein bypass grafts (326 patients) that had been entered into a vein graft surveillance programme between 1988 and 1997.

Results
Some 104 grafts (30 per cent) developed significant new vein graft stenoses, 95 (91 per cent) of which occurred within 12 months. After 1 year, the risk of developing a significant graft stenosis was 3 per cent per year. Sixty-nine grafted limbs (20 per cent) developed new arterial inflow or run-off stenoses that required intervention, but only 37 (54 per cent) occurred within the first year, after which the risk was 9 per cent per year. The overall risk of developing a new vein graft or arterial stenosis after 1 year was 10 per cent per year.

Conclusion
The incidence of vein graft stenosis decreases significantly 1 year after operation but there is still at risk of developing potentially graft-threatening arterial stenoses. Legs that have undergone infrainguinal vein bypass grafting should continue to be monitored in a surveillance programme for life.
Effect of a novel prosthetic anal neosphincter on human colonic blood flow
Authors: Hajivassiliou C A , Finlay I G 
Published: March 2003

Abstract

Background
An artificial anal sphincter has been developed which aimed to simulate the normal physiology of the anorectum. As a prelude to human implantation the present study reports the effect of inflation of this device on colonic perfusion in patients undergoing colectomy, which was assessed by using a laser Doppler scanner.

Methods
Eleven patients (median age 49·8 (range 24·3–78·7) years) were studied. Five patients had inflammatory bowel disease (IBD). The neosphincter was placed around the bowel and progressively inflated. The model was designed so that blood flow changes to the colon under the neosphincter would be reflected in the distal segment of the bowel, which could be scanned by the laser Doppler scanner.

Results
The blood flow in the colon distal to the device was significantly higher in patients with IBD (mean(s.e.m.) 288·6(71·9) versus 211·1(57·6) perfusion units; P &lt; 0·001). The mean(s.e.m.) ‘biological zero’ value was 46(14) perfusion units. Blood flow distal to the neosphincter decreased progressively with increased sphincteric compression by 0·66 per cent per mmHg applied pressure in controls and 0·35 per cent per mmHg in patients with IBD (P &lt; 0·05).

Conclusion
These results suggest that at the planned operating occlusion pressure (less than 45 mmHg) this neosphincter should not put the vascularity of the human colon at risk.
Detection of response to chemotherapy using positron emission tomography in patients with oesophageal and gastric cancer
Authors: Couper G W , McAteer D , Wallis F , Norton M , Welch A , Nicolson M , Park K G M 
Published: March 2003

Abstract

Background
The aim of the study was to determine whether 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET) could detect response to chemotherapy in patients with oesophageal and gastric cancer.

Methods
Fourteen patients underwent imaging before and after chemotherapy using FDG-PET. Computed tomography (CT), dysphagia scores and weight changes were used for comparison of evidence of response. Tumour to liver ratios (TLRs) and influx constants for FDG (K) were used for quantification purposes.

Results
Thirteen of 14 lesions were successfully imaged before therapy. Changes were seen in all follow-up scans, ranging from a complete response to a 15 per cent increase in tumour FDG uptake. Response was demonstrated by CT in four patients; all four had large reductions in FDG uptake after chemotherapy. Two patients with an increase in FDG uptake reported no improvement in dysphagia and continued to lose weight during therapy.

Conclusion
Changes in tumour FDG uptake were seen in all tumours after chemotherapy. FDG-PET may have a role to play in the assessment of patients with upper gastrointestinal malignancy receiving chemotherapy.
Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula
Authors: García-Aguilar J , Belmonte C , Wong W , Goldberg D W , Madoff R D 
Published: March 2003

Abstract

Background
The aim of this study was to compare the clinical results obtained with the cutting seton and the two-stage seton fistulotomy (TSSF) in the surgical management of high anal fistula.

Methods
The case records of 59 patients with high anal fistula of cryptoglandular origin treated with cutting seton (n = 12) or TSSF (n = 47) over a 5-year period were retrospectively reviewed. There was no difference between the groups in age, sex distribution, or estimated percentage of anal sphincter involved by the fistula. Follow-up was by a mailed questionnaire inquiring about fistula recurrence, incontinence, and degree of satisfaction. Mean follow-up was similar in both groups (27 months for cutting seton versus 33 months for TSSF). Comparisons were made by Student t and χ2 tests, as required.

Results
There were no differences in the rate of fistula recurrence between the groups treated with cutting seton or TSSF (one of 12 versus four of 47), difficulty holding gas (six of 12 versus 25 of 47), underwear staining (six of 12 versus 18 of 47), stool incontinence (three of 12 versus 12 of 27), overall incontinence (eight of 12 versus 31 of 47) and mean incontinence score (4·9 versus 4·2). The fistula healing time and degree of satisfaction with the operation were not significantly different between the groups. One-half of the patients treated by TSSF had the seton removed under general or epidural anaesthesia.

Conclusion
Both techniques are equally effective in eradicating the fistula, and both are associated with a similar rate of incontinence.
Reintervention and mortality after infrainguinal reconstructive surgery for leg ischaemia
Authors: Dawson I , van Bockel J H 
Published: March 2003

Abstract

Background
Progression of atherosclerosis and graft-related complications are common indications for late vascular intervention. The aim of this study was to determine the cumulative risk of late reintervention or death after infrainguinal bypass grafting.

Methods
Some 205 consecutive patients with limb-threatening ischaemia were included. All data were recorded prospectively. The principal endpoint was reintervention for a graft-related complication or recurrent leg ischaemia. Mean follow-up was 3·3 years. Life-table and multivariate analyses were employed to estimate the cumulative risk of reintervention or death during follow-up and to assess factors influencing this risk.

Results
Beyond 30 days after insertion of the infrainguinal bypass, 67 patients (33 per cent) had 112 subsequent vascular interventions in the ipsilateral extremity. The cumulative reintervention rate was 25 per cent at 1 year and 40 per cent at 5 years. Poor run-off (P &lt; 0·005) and prosthetic grafts (P &lt; 0·001) were significant and independent risk factors. Long-term survival was poor and affected by the presence of diabetes (P &lt; 0·01) and renal insufficiency (P &lt; 0·01).

Conclusion
Late reinterventions are common after infrainguinal bypass for limb-threatening ischaemia, and contribute to morbidity and discomfort. Such information is of particular relevance to patients in high-risk groups and should be explained as an integral part of informed consent.
Prospective randomized multicentre study of laparoscopic versus open appendicectomy
Authors: Hellberg A , Rudberg C , Kullman E , Enochsson L , Fenyö G , Graffner H , Hallerbäck B , Johansson B , Anderberg B , Wenner J , Ringqvist I , Sörensen S 
Published: March 2003

Abstract

Background
A prospective randomized multicentre study was performed to compare the outcome of laparoscopic and open appendicectomy in patients with suspected acute appendicitis.

Methods
A total of 523 patients was randomized, but because of 23 withdrawals the outcome in 500 patients is reported, 244 in the laparoscopic group and 256 in the open group.

Results
Patients having laparoscopic appendicectomy recovered more quickly than those having open surgery (13 versus 21 days, P &lt; 0·001). There was no significant difference in duration of sick leave after operation (laparoscopic group 11 days versus open group 14 days). Postoperative pain (at 24 h, 7 days and 14 days) was less after laparoscopic operations and a functional index 1 week after operation was more favourable in these patients (P&lt; 0·001). Operating time was significantly longer in the laparoscopic group (60 versus 35 min, P&lt; 0·01). Hospital stay and complications did not differ between the groups. Thirty laparoscopic procedures (12 per cent) were converted to open appendicectomy.

Conclusion
Laparoscopic appendicectomy is as safe as open appendicectomy and has the advantage of allowing a quicker recovery.
Colour–coded duplex imaging and dependent Doppler ultrasonography in the assessment of cruropedal vessels
Authors: McCarthy M J , Nydahl S , Hartshorne T , Naylor A R , Bell P R F , London N J M 
Published: March 2003

Abstract

Background
It has been suggested that ultrasonography could replace diagnostic arteriography in the assessment of patients who present with leg ischaemia. This study investigated a group of consecutive patients who had femorodistal bypass and who were assessed before operation with colour-coded duplex and dependent Doppler insonation alone.

Methods
Thirty-seven consecutive patients with critical lower limb ischaemia underwent surgical exploration with a view to femorodistal bypass. Results of preoperative colour-coded duplex and dependent Doppler insonation were compared with intraoperative arteriograms and surgical findings.

Results
There was very good agreement between colour-coded duplex imaging and dependent Doppler insonation with intraoperative angiography and surgical findings in the prediction of the optimal run-off vessel (κ = 1·0) and the site of the distal anastomosis (κ = 0·85; 95 per cent confidence interval 0·71–1·0). There was also very good agreement between dependent Doppler insonation and intraoperative arteriography (κ = 1·0) in predicting pedal arch patency and the predominant feeding vessel.

Conclusion
Assessment of leg arteries before femorodistal bypass can be performed accurately with non-invasive colour-coded duplex imaging and dependent Doppler insonation alone, thus obviating the need for preoperative arteriography.
Laparoscopic reoperation following failed antireflux surgery
Authors: Watson D I , Jamieson G G , Game P A , Williams R S , Devitt P G 
Published: March 2003

Abstract

Background
The aim was to determine the feasibility of laparoscopic revision surgery following previous open and laparoscopic antireflux operations.

Methods
The outcome was determined for 27 patients (14 men, 13 women) who had undergone attempted laparoscopic revision between 3 months and 25 years after a previous antireflux operation. Median follow-up was 12 (range 3–48) months.

Results
Thirteen patients had previously had an open antireflux procedure (Nissen fundoplication, seven; transthoracic anatomical repair, five; Belsey procedure, one) and 14 a laparoscopic procedure (Nissen, 12; anterior partial fundoplication, two). The indications for revision were: recurrent reflux, 15; paraoesophageal hiatus hernia, six; troublesome dysphagia, six. Fifteen procedures comprised construction of a new Nissen fundoplication, six conversion from a Nissen to a partial wrap, three repair of a paraoesophageal hernia and three widening of the oesophageal hiatus. Revision was successfully completed laparoscopically in 12 patients following a previous laparoscopic procedure and in nine following a previous open operation. Median operating time was 105 min after previous open surgery and 80 min after laparoscopic surgery. No perioperative complications occurred in either group and a good outcome was achieved in 25 of the 27 patients.

Conclusion
Laparoscopic reoperative antireflux surgery is feasible. Reoperation is likely to be more difficult following failure of an open procedure than a laparoscopic one.
Pathology and outcome of surgical treatment for lithium-associated hyperparathyroidism
Authors: Abdullah H , Bliss R , Guinea A I , Delbridge L 
Published: March 2003

Abstract

Background
Hyperparathyroidism associated with long-term lithium therapy is well described. However, few studies have clearly defined the pathological findings or looked at the outcome of surgical treatment.

Methods
The study was a retrospective review of 11 patients with bipolar affective disorder who had surgery for lithium-associated hyperparathyroidism.

Results
Twelve patients were identified who had received lithium therapy, of whom 11 (nine women and two men, aged 46–84 (mean 65) years) had prolonged treatment from 2 to 30 (mean 15·3) years. At operation a single adenoma was identified in six patients, whereas multigland disease was seen in five patients. All patients resumed lithium treatment after operation. One patient had recurrent hyperparathyroidism at 3 years, while another had an increased serum level of parathyroid hormone in the presence of a normal serum calcium level after 1 year.

Conclusion
Hyperparathyroidism associated with lithium may be due to either parathyroid hyperplasia or adenoma. Observations in the present study supported a true cause and effect relationship. Routine bilateral neck exploration should be performed because of a relatively high frequency of multigland involvement. However, parathyroid resection should be limited to evident disease.
Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre
Authors: Rahim A A Abdel , Ahmed M E , Hassan M A 
Published: March 2003

Abstract

Background
Thyroidectomy for a large goitre carries a relatively high risk of postoperative respiratory obstruction which may necessitate tracheostomy.

Methods
One hundred and three patients with a large goitre who underwent thyroidectomy were studied prospectively. The presence or absence of six preoperative predictive factors for the development of serious postoperative respiratory obstruction was recorded. These factors were: goitre for more than 5 years, preoperative recurrent laryngeal nerve palsy, significant tracheal narrowing and/or deviation, retrosternal extension, difficult endotracheal intubation and thyroid cancer. Tracheostomy was performed on the basis of clinical judgement.

Results
Postoperative respiratory complications occurred in 32 patients (31 per cent), and were obstructive in 24 patients and not obstructive in eight. Tracheostomy was necessary in 13 patients (13 per cent). Tracheomalacia was the most common indication (n = 5). There were no deaths. At least four of the six risk factors were present in nine of the 13 patients who underwent tracheostomy compared with two of the 90 patients who did not.

Conclusion
Multiple preoperative risk factors in a patient with a large goitre may be useful in predicting the need for planned tracheostomy following thyroidectomy.
Management of bleeding pseudoaneurysms in patients with pancreatitis
Authors: de Perrot M , Berney T , Bühler L , Delgadillo X , Mentha G , Morel P 
Published: March 2003

Abstract

Background
Bleeding pseudoaneurysm is a rare but frequently fatal complication in patients with pancreatitis.

Method
The medical records of ten patients who presented to this institution with a bleeding pseudoaneurysm between 1978 and 1997 were reviewed retrospectively. Six patients had chronic pancreatitis and four had acute pancreatitis. The splenic artery was involved in six cases, a pancreaticoduodenal artery in two, the gastroduodenal artery in one and the cystic artery in one.

Results
Computed tomography (CT) revealed the bleeding pseudoaneurysm in all patients (n = 6) with chronic pancreatitis but in only one of three with acute pancreatitis. Arteriography always gave the correct diagnosis. Seven patients underwent pancreatic resection as an emergency (n = 3) or within 48 h (n = 4), and survived. Three patients presenting with acute pancreatitis and massive bleeding underwent transcatheter arterial embolization. Two of them had a favourable outcome and one died from a recurrent haemorrhage 7 days later. Overall, two patients suffered significant perioperative complications and one died.

Conclusion
CT is accurate in the diagnosis of pseudoaneurysms complicating pseudocysts. Primary resection of the pseudoaneurysm, which frequently requires pancreatic resection, is the treatment of choice. Angiography followed by transcatheter embolization is effective, but should be rapidly followed by operation.
Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis
Authors: Chiou T S-M , Chen S-C 
Published: March 2003

Abstract

Background
This report examines the intermediate-term results of endoscopic transaxillary T2 sympathectomy for palmar hyperhidrosis.

Methods
A retrospective review was carried out of 91 consecutive patients, 38 men and 53 women, with a mean age of 23 years. Attention was focused on patient satisfaction, late complications and morbidity.

Results
After operation, no patient died or developed Horner's syndrome. Nine of 21 patients with craniofacial, five of 16 with axillary and 17 of 73 with plantar hyperhidrosis showed simultaneous improvement. Fifteen patients (16 per cent) developed recurrent sweating, but none required reoperation. The overall mean satisfaction rate was 78 per cent with a median 80 per cent improvement using a visual linear analogue scale from 0 (poor) to 100 per cent (excellent). Twelve patients (13 per cent) were dissatisfied with the operative results, mainly owing to compensatory hyperhidrosis, which occurred in 88 patients (97 per cent) within the first year.

Conclusion
The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.
Effect of exercise on calf muscle pump function in patients with chronic venous disease
Authors: Yang D , Vandongen Y K , Stacey M C 
Published: March 2003

Abstract

Background
Musculoskeletal dysfunction may be associated with poor calf muscle pump function in patients with chronic venous ulceration. The aim of this study was to evaluate the effects of physical exercise on calf muscle pump function.

Methods
Twenty patients were recruited into a 6-week intensive exercise programme. Calf muscle function and calf muscle pump function were assessed using an isokinetic device and air plethysmography respectively, before and after the exercise programme.

Results
There was significant improvement in calf muscle pump function, measured as increased ejection fraction and decreased residual fraction (P &lt; 0·05); however, venous reflux was not altered (P &gt; 0·05). Calf muscle strength and endurance parameters all increased, but not significantly (P&gt; 0·05).

Conclusion
Poor calf muscle pump function in patients with chronic venous ulceration can be improved by physical exercise.
Sensory and autonomic neuropathy in patients with idiopathic slow-transit constipation
Authors: Knowles C H , Scott S M , Wellmer A , Misra V P , Pilot M-A , Williams N S , Anand P 
Published: March 2003

Abstract

Background
Slow-transit constipation (STC) is a severe disorder of unknown aetiology, which may result from an autonomic or sensory neuropathy. This study aimed to investigate patients with STC for the presence of neural dysfunction, and relate the findings to other factors, including any familial associations.

Methods
Thirty-three patients with STC were studied using standard neurophysiological tests and a range of quantitative sensory and autonomic tests. The findings were compared with those of 20 matched control subjects and nine diabetic patients with gastrointestinal symptoms.

Results
Twenty of the 33 patients with STC gave a family history of constipation, including an affected identical twin and Hirschsprung's disease (n = 3). None had abnormalities on neurological examination or nerve conduction studies. Fifteen of the 33 patients had abnormalities on quantitative tests, including all six who required a colectomy. Eleven patients with STC had reduced axon-reflex sweating in the presence of normal sweat gland responses (P&lt; 0·001, all patients with STC versus controls). Twelve patients with STC had small sensory fibre dysfunction, with significantly increased thermal thresholds (cool, P&lt; 0·05; warm, P&lt; 0·01); these included six of nine patients with STC and rectal hyposensation. There were similar findings on quantitative testing in diabetic patients.

Conclusion
Quantitative tests in patients with STC provide evidence of a small fibre neuropathy. The high incidence of a positive family history, particularly a possible association with Hirschsprung's disease, suggests a genetic basis, which deserves further investigation.
Preoperative staging of rectal carcinoma
Authors: Heriot A G , Grundy A , Kumar D 
Published: March 2003

Abstract

Background
The development of treatment modalities for rectal cancer, including local excision, total mesorectal excision and preoperative radiotherapy, has increased the importance of accurate preoperative staging to allow the optimum treatment to be selected.

Methods
A literature review was undertaken of methods of preoperative staging of rectal carcinoma and the evidence for each was evaluated critically.

Results
Clinical assessment of rectal carcinoma may give an indication of fixity but is not accurate for staging. Endoanal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), radioimmunoscintigraphy and positron emission tomography have all been used for staging. The extent of tumour spread through the bowel wall (T stage) is most accurately assessed by endoanal ultrasonography, although this technique is poor at assessing tumour extension into adjacent organs for which both CT and MRI are more accurate. No method accurately determines lymph node involvement, but endoanal ultrasonography is the best available. Liver metastases may be assessed by abdominal ultrasonography, CT, MRI and CT portography (with increasing sensitivity and cost in that order).

Conclusion
Endoanal ultrasonography is the most effective method of local tumour staging, with the addition of either CT or MRI if adjacent organ involvement is suspected. Abdominal ultrasonography or CT is recommended for routine preoperative assessment of the liver.