bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of the RET proto-oncogene in papillary thyroid carcinoma and its correlation with clinical outcome
Authors: Kjellman P , Learoyd D L , Messina M , Weber G , Höög A , Wallin G , Larsson C , Robinson B G , Zedenius J 
Published: March 2003

Abstract

Background
In papillary thyroid carcinoma (PTC), presence of the oncogenes RET/PTC has been described, but their correlation with prognosis is debated. The aim of this study was to investigate the expression of the RET proto-oncogene (RET) and correlate it with clinical outcome.

Methods
Sixty-one PTCs were analysed for expression of RET and the oncogenes RET/PTC1–4 by polymerase chain reaction of complementary DNA.

Results
Twenty-nine PTCs (48 per cent) expressed the RET tyrosine kinase domain (RET-TK). Twelve expressed wild-type RET (WT-RET). One tumour expressed RET/PTC3, one a variant of RET/PTC3, and one RET/PTC1 and WT-RET simultaneously. The remaining 14 expressed RET-TK only. WT-RET expression was detected more frequently in poorly differentiated PTCs (P &lt; 0·05) and in PTCs from patients with aggressive disease (P &lt; 0·01). WT-RET expression remained an independently significant risk factor for aggressive disease when analysed together with other recognized risk factors using a stepwise multiple logistic regression model.

Conclusion
Almost half of the PTCs showed RET-TK expression; in only three was this explained by expression of a RET/PTC rearrangement. Instead, expression of WT-RET was detected in 45 per cent of the RET-TK-positive tumours and this expression was an independently significant risk factor for aggressive PTC.
Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease
Authors: Gooszen A W , Tollenaar R A E M , Geelkerken R H , Smeets H J , Bemelman W A , Van Schaardenburgh P , Gooszen H G 
Published: March 2003

Abstract

Background
A primary anastomosis after resection of the sigmoid colon for suspected acute complicated diverticular disease has the advantage of saving the patient a secondary operation for restoring bowel continuity. Fear of anastomotic leakage often deters surgeons from making a primary anastomosis.

Methods
A series of 45 patients who underwent primary anastomosis was studied prospectively to evaluate the feasibility of a primary anastomosis following acute sigmoid resection. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mannheim Peritonitis Index (MPI) and Hughes' peritonitis classification were used to classify patients and to detect factors predictive of postoperative outcome. Death, anastomotic leakage and septic complications were main outcome measures.

Results
Neither anastomotic leakage (four of 45 patients) nor death (three of 45) was related to a higher MPI, APACHE II or Hughes' score. More postoperative septic complications were seen in patients with a MPI over 16. Death, anastomotic leakage, reintervention and wound infection were observed more frequently in patients who presented with colonic obstruction than in those with abscess or perforation.

Conclusion
Primary anastomosis is safe and effective in non-obstructed cases of complicated diverticular disease. Colonic obstruction seems to be a risk factor for the development of postoperative complications.
Endoscopic axillary surgery in breast cancer
Authors: Kuehn T , Santjohanser C , Grab D , Klauss W , Koretz K , Kreienberg R 
Published: March 2003

Abstract

Background
The aim was to provide an assessment of the current status of endoscopic axillary surgery in patients with breast cancer.

Methods
Fifty-three patients underwent endoscopic lymphadenectomy. The surgical efficiency (operating time, number of resected nodes, intraoperative and postoperative complications), short-term morbidity (duration of drainage, total lymph flow, seroma rate) and long-term outcome (pain, numbness, mobility, strength, oedema) were assessed. The incidence and severity of different arm symptoms were compared with the results of 396 patients treated with a conventional axillary procedure. Finally, all available data relating to endoscopic axillary surgery were reviewed.

Results
The operating time ranged from 60 to 150 min. A mean 17 (range 10–28) lymph nodes was resected. The extent of postoperative lymphorrhoea (mean 372 ml) and the seroma rate (eight of 34 patients) were not significantly reduced in comparison with conventional surgery. The assessment of long-term morbidity revealed fewer disturbances of sensitivity and a decreased rate of severe symptom intensity for pain, oedema and complaints related to mobility.

Conclusion
Despite excellent visualization of anatomical landmarks and improved long-term morbidity, endoscopic lymph node dissection cannot be regarded as a suitable technique for routine axillary management in breast cancer because of long operating times.
Quality of life as an outcome measure in surgical oncology
Authors: Langenhoff B S , Krabbe P F M , Wobbes T , Ruers T J M 
Published: March 2003

Abstract

Background
There is a growing interest in assessing the impact of a disease and the effect of a treatment on a patient's life, expressed as health-related quality of life (HRQoL). HRQoL assessment can provide essential outcome information for cancer surgery.

Methods
The core of this review is derived from a literature search of the Medline database.

Results
Three types of HRQoL instrument can be distinguished: generic, disease specific and symptom specific. There are criteria against which HRQoL instruments may be evaluated. The instrument chosen must be reliable, valid and sensitive to change.

Conclusion
HRQoL measurement may be useful in identifying the optimal surgical procedure. It may also be of help in deciding whether surgery in patients with limited life expectancy should still be considered. No HRQoL instrument fits all the recommended conditions or is suitable in all clinical situations. Using the appropriate instrument is essential to arrive at valid and clinically meaningful outcome measures.
An endothelin type A receptor antagonist inhibits neointimal hyperplasia and increases luminal area in porcine vein grafts
Authors: Bulbulia R A , Smith F C T , Lamont P M , Baird R N , Angelini G D , Jeremy J Y , Yim A , Wan S 
Published: March 2003

Abstract

Background
Neointimal hyperplasia is responsible for the majority of cases of vein graft failure. To date, no pharmacological intervention has proved successful in preventing this process in humans. Endothelin (ET) 1 is a potent vasoconstrictor and promotes the proliferation of vascular smooth muscle cells in vitro. The authors have shown previously that porcine vein grafts contain high levels of ET-1 and ET type A (ETA) receptor subtypes. The aim was to investigate the effect of an ETA receptor antagonist, BSF 302146, on luminal area and graft wall dimensions in a porcine model of arteriovenous bypass grafting.

Methods
Bilateral saphenous vein–carotid artery interposition grafting was performed in two groups of Large White pigs (26–32 kg; n = 5 per group). BSF 302146 (10 mg kg−1 day−1) was administered orally to animals in group 1; group 2 animals acted as controls. After 4 weeks the grafts were explanted and pressure-fixed ex vivo. Histological sections were obtained and graft dimensions assessed by means of computer-aided planimetry.

Results
BSF 302146 significantly reduced both neointimal hyperplasia and medial thickening, and increased luminal area by 77 per cent.

Conclusion
The ETA receptor antagonist BSF 302146 inhibits neointimal hyperplasia and increases luminal area in a porcine model of saphenous vein bypass grafting.
Angiogenesis in carotid atherosclerosis: the association with morphological features of plaque instability
Authors: Mofidi R , McCarthy P , Sheehan S J , Mehigan D , Crotty T , Keaveny T V 
Published: March 2003

Abstract

Background
Intimal angiogenesis is a recognized feature of the atherosclerotic process. It has been described in the context of unstable coronary atherosclerotic lesions. The aims of this study were to assess the association between angiogenesis in atherosclerotic plaques and microscopic features of plaque instability, in particular intraplaque haemorrhage.

Methods
Consecutive patients undergoing carotid endarterectomy for carotid stenosis were included in the study. Endarterectomy specimens were examined and divided into their constituent atherosclerotic lesions. Histological sections were prepared and stained with haematoxylin and eosin, and immunohistochemically with an endothelial cell marker (CD34). Each lesion was classified according to the American Heart Association classification of atherosclerotic lesions. The size of plaque haemorrhage was measured in transverse histological sections using computerized image analysis. Haemorrhagic lesions were classified according to the size of haemorrhagic area (under 50 per cent of section area; over 50 per cent of section area). Microvessel counts were performed in CD34-stained sections at × 400 magnification and were verified with computerized image analysis. The Kruskal–Wallis test was used to study the differences in microvessel count in different atherosclerotic plaque types.

Results
A total of 239 atherosclerotic lesions from 73 patients was available for analysis, of which 73 were early lesions, 74 were raised fibroatheromas and 92 were unstable atherosclerotic plaques. One hundred and fifty lesions were not haemorrhagic; 89 exhibited intraplaque haemorrhage, of which 28 involved less than 50 per cent of the plaque section area. In 61 lesions the haemorrhage area was over 50 per cent of the section area. There were higher microvessel counts in plaques containing more than 50 per cent haemorrhage (median 277 (range 43–467)) compared with those containing less than 50 per cent (172 (57–372)) and non-haemorrhagic plaques (81 (7–389)) (P &lt; 0·0001). Higher microvessel counts were observed in unstable atherosclerotic lesions (median 252 (range 43–467)), compared with stable fibroatheromas (106 (14–302)) and early atherosclerotic lesions (55 (7–237)) (P &lt; 0·0001).

Conclusion
There are strong associations between plaque vascularity and presence and size of haemorrhage within atherosclerotic lesions, as well as features of plaque instability. This finding highlights the likely significance of these new blood vessels in the development of plaque instability and subsequent risk of stroke.
Randomized controlled trial of acute normovolaemic haemodilution in aortic aneurysm repair
Authors: Wolowczyk L , Bulbulia R A , Stewart A , Nevin M , Day A , Smith F C T , Baird R N , Lamont P M 
Published: March 2003

Abstract

Background
Previous studies have suggested that acute normovolaemic haemodilution (ANH) reduces the need for heterologous blood transfusion in abdominal aortic aneurysm (AAA) surgery and may thus improve postoperative outcome by reducing the systemic inflammatory response. Controlled studies are lacking. The aim of this randomized controlled trial was to evaluate the effects of ANH on the systemic inflammatory response, clinical outcome and use of bank blood after AAA repair.

Methods
Patients undergoing elective AAA repair were randomized to ANH (n = 16) or control (n = 18) groups. Intraoperative cell salvage and heterologous blood were used in both groups according to predetermined transfusion triggers. Inflammatory markers in serum and urine were measured to assess the acute-phase response. Clinical outcome was determined using mortality, morbidity and the incidence of the systemic inflammatory response syndrome (SIRS).

Results
There was no difference between the ANH and control group in serial measurements of median (range) white cell count (maximum at 2 days after operation: 11·9 (7·7–21·4) versus 10·3 (7·8–20·6) × 109 l−1; P = 0·25), serum C-reactive protein level (maximum at 3 days: 150 (1–274) versus 169 (7–238) mg ml−1; P = 0·76), interleukin 6 level (maximum at 6 h: 142 (32–793) versus 105 (29–509) pg ml−1; P = 0·89), total antioxidant capacity (lowest at 1 h: 0·83 (0·67–1·22) versus 0·83 (0·68–1·23) mmol l−1; P = 0·45) or urinary albumin/creatinine ratio (maximum at 30 min after clamp release: 41 (2–923) versus 124 (4–376) mg ml−1; P = 0·10). SIRS was observed in ten of 16 patients having ANH and in 11 of 18 control patients (P = 0·99). There was no significant difference in mortality and morbidity between the groups. Similarly, there was no difference in median (range) blood loss (ANH 1800 (400–12 000) ml versus control 1600 (500–7500) ml; P = 0·55), use of cell salvage (600 (0–4740) versus 520 (0–2420) ml; P = 0·60) or heterologous blood transfusion (2 (0–32) versus 2 (0–9) units; P = 0·68).

Conclusion
In the setting of a randomized controlled trial ANH added no additional benefit, when used in combination with cell salvage, in reducing the requirements for heterologous blood transfusion, and made no impact on systemic inflammatory response and clinical outcome after AAA repair.
Randomized controlled trial of four-layer bandaging and simple venous surgery for venous ulceration
Authors: Guest M G , Smith J J , Greenhalgh R M , Davies A H 
Published: March 2003

Abstract

Background
No randomized controlled trials exist to show whether simple venous surgery benefits healing or maintenance of healing of venous ulcers.

Methods
Some 121 consecutive patients with new episodes of venous ulceration were identified; 45 patients were unfit or unwilling for randomization. The remaining 76 (39 women) were assigned randomly to received a four-layer bandage (n = 39) or simple venous surgery (n = 37). All patients were followed for a minimum of 6 months. Outcome was assessed at a minimum of 6 months as healing and health-related quality of life (HRQL).

Results
The two groups had similar co-morbidity and pattern of venous incompetence. There were no major complications in either group. The healing rate was 64 per cent (25 of 39) in the conservatively treated group and 68 per cent (25 of 37) in the operated group (P = 0·75, Pearson χ2 test). There was no significant difference between time to ulcer healing in the two treatment groups (log rank statistic = 0·69, P = 0·41). Patterns of venous incompetence did not affect the healing rate. There were no major differences in HRQL between the two groups.

Conclusion
This pilot study suggests that simple venous surgery gives no adjuvant benefit to four-layer bandaging in venous ulceration from the point of view of healing rate and quality of life.
Medicolegal claims for vascular problems
Authors: Campbell W B 
Published: March 2003

Abstract

Background
The continuing increase in medicolegal activity demands good risk management, and this requires knowledge of the most likely causes of litigation. This study examined ‘vascular’ cases notified to the Medical Defence Union (MDU) during 1990–1999, and claims initiated against the National Health Service Litigation Authority (NHSLA) since its inception in 1995.

Methods
The MDU was notified of 254 claims by 74 vascular (29 per cent) and 180 general (71 per cent) surgeons; only 35 have so far been settled. Varicose vein operations were the reason for 70 per cent of cases notified. A further 299 vascular cases were notified from primary care, of which 197 (66 per cent) involved critical limb ischaemia (80 per cent of patients had amputations and 16 per cent died), and 102 (34 per cent) involved diagnosis and treatment of aneurysms.

Results
Of 102 ‘vascular’ claims notified to the NHSLA, 70 (69 per cent) related to arterial disease and 32 (31 per cent) to venous problems (26 varicose veins and six thromboembolism). In addition there were ten arterial and 58 varicose vein claims involving ‘general’ surgeons. Varicose vein claims (n = 244) were most often for damage to nerves (n = 76), incorrect or ‘unsatisfactory’ surgery (n = 36) or damage to the femoral vessels (n = 29). The commonest arterial claims concerned aortic surgery (n = 45), failure to diagnose or treat ischaemia (n = 36) and complications of bypass grafts (n = 28).

Conclusion
Varicose vein surgery is a major cause of litigation: very explicit counselling (particularly about the risk of nerve damage) and good record-keeping are required to defend these claims.
Distal anastomotic environment: the influence of intrinsic and extrinsic factors on flow structure
Authors: Fisher R K , How T V , Brennan J A , Gilling-Smith G L , Bakran A , Harris P L 
Published: March 2003

Abstract

Background
Improved patency of the Miller cuff may be attributable to the modification of haemodynamics at the anastomosis inhibiting the accretion of myointimal hyperplasia. The influence of the distal anastomotic environment on flow patterns may therefore have important clinical significance.

Methods
Anastomotic models of Miller cuff, end-to-side (ETS) and precuffed grafts (Distaflo™, Impra, Tempe, AZ, USA) were perfused under physiological conditions. Visualization studies and Doppler colour flow mapping (P700, Philips Medical Systems, Reigate, UK) enabled qualitative flow analysis of the influence of anastomotic geometry, configuration and outflow distribution. Intraoperative flow distribution was measured with a Doppler transit time probe. Flow within in vivo precuffed grafts was analysed by means of colour flow mapping and velocity profiles.

Results
ETS anastomosis demonstrated a large area of flow separation at the graft toe, except when distal outflow approached 100 per cent, when laminar flow prevailed. The Miller cuff created a cohesive vortex within the proximal anastomosis, with reduced areas of flow separation. Outflow distribution had little effect upon the integrity of this vortex, although helical flow occurred in the distal vessel when proximal run-off was occluded. Cuff geometry, expressed as aspect ratio (cuff length: height) was important, with long and low cuffs demonstrating detrimental flow structures, including complex short-lived vortices and large areas of separation. The precuffed model produced a robust vortex, resistant to flow distribution. In vitro Doppler images of the vortex were reproduced accurately in 77 per cent of patients with precuffed grafts in situ (n = 32). Mean intraoperative flow distributions of 76 per cent distal: 24 per cent proximal in infragenicular grafts were significantly different from anticipated ratios of 50: 50 and 100: 0 (P &lt; 0·001, single-sample t test). In above-knee grafts, however, distribution approached purely distal flow (mean 85: 15 versus 100: 0; P = 0·046).

Conclusion
Anastomotic flow structures are determined by the geometry of the anastomosis and the relative flow distribution proximally and distally in the recipient artery. A cuffed configuration of anastomosis is likely to be of most benefit when there is substantial flow proximally as well as distally in the run-off vessel, a situation that applies most often in infragenicular reconstruction. In addition, variable cuff geometry may detract from the full potential of the Miller cuff. A precuffed graft of optimum geometry may negate this concern, with the majority of patients demonstrating accurate replication of potentially beneficial flow patterns.
A single ultrasonographic scan at age 65 years excludes 95 per cent of men from future aneurysm risk
Authors: Crow P , Shaw E , Earnshaw J , Poskitt K , Whyman M , Heather B 
Published: March 2003

Abstract

Background
In 1988, 236 men, then aged 65 or 66 years, underwent an abdominal ultrasonographic scan as part of a pilot study for an aneurysm screening programme; 223 (95 per cent) had an aortic diameter of 25 mm or less, and form the main study group.

Methods
This group was followed with repeat ultrasonography in 1993 and 2000. Eight men (4 per cent) were lost to follow-up or refused further scanning, but all are known to be still alive. Eighty-six men (39 per cent) died during the 12-year follow-up. Causes of death were investigated. None was related to abdominal aortic aneurysm (AAA). Some 129 men (58 per cent) had all three ultrasonographic scans, including some arranged in other hospitals or performed with a portable scanner at a home visit. Mean(s.e.m.) aortic diameter for this group was 18·9(2·3) mm in 1988, 19·0(2·6) mm in 1993 and 20·2(3·8) mm in 2000.

Results
At the scan in 2000, four men had an aortic diameter greater than 30 mm (32, 34, 34 and 36 mm respectively). In contrast, of the 13 men with an aortic diameter greater than 25 mm in 1988, three have undergone elective aneurysm repair, eight have died from causes unrelated to AAA and two remain under ultrasonographic surveillance.

Conclusion
Using an aortic diameter threshold of 25 mm, a single ultrasonographic scan at the age of 65 years is able to exclude 95 per cent of men who appear extremely unlikely ever to develop a clinically significant aortic aneurysm and to identify the 5 per cent who require further follow-up.
Registry of endovascular treatment of abdominal aortic aneurysms (RETA): the fate of patients with primary endoleaks
Authors: Thomas S M , Gaines P A , Beard J D 
Published: March 2003

Abstract

Background
The aim was to present the follow-up data of patients with a primary endoleak identified in the periprocedural period to establish the consequences of these endoleaks.

Methods
There were 123 primary endoleaks in the 1000 operations logged in the Registry of Endovascular Treatment of Abdominal Aortic Aneurysms (RETA) database, visualized either immediately after the procedure or at 30-day computed tomography. The sites of these were: collateral, 42 (34 per cent); proximal anastomotic (PA), 41 (33 per cent); distal anastomotic (DA), 19 (15 per cent); midgraft, 12 (10 per cent); occluder, three (2 per cent); and site not stated in six (5 per cent). The fate of these endoleaks was examined from available follow-up data.

Results
Nine patients (22 per cent) with PA endoleaks died from rupture (n = 3) or following surgery for the endoleak (n = 6). Eleven patients had persistent primary PA endoleak with or without treatment; three of these patients had rupture. Others were treated successfully with surgery, proximal cuffs or angioplasty of the proximal anastomosis. Twenty-two collateral endoleaks (52 per cent) resolved spontaneously at 30 days. There were no ruptures at follow-up. Seven of the 19 DA endoleaks resolved spontaneously by 30 days and four had further endovascular treatment before discharge. Of the eight persistent endoleaks, three resolved spontaneously and three had endovascular treatment. There were no ruptures at follow-up. Two of the three occluder endoleaks resolved spontaneously; the other patient died suddenly from an unknown cause. Nine of the 12 midgraft endoleaks resolved by 30 days, and one had resolved spontaneously at 1 year; again there were no ruptures in this group.

Conclusion
The presence of a PA endoleak justifies an aggressive approach to treatment because of their association with aneurysm rupture. However, open surgical treatments carry a significant mortality rate. Other endoleaks follow a more benign course, and many will resolve spontaneously.