bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of strictureplasty for duodenal Crohn's disease
Authors: Yamamoto T , Bain I M , Connolly A B , Allan R N , Keighley M R B 
Published: March 2003

Abstract

Background
The outcome of strictureplasty for duodenal Crohn's disease has not been critically documented. The aim of this study was to assess the outcome of strictureplasty for duodenal Crohn's disease.

Methods
A retrospective review was undertaken of 13 patients who underwent strictureplasty (including four pyloroplasties) for obstructive duodenal Crohn's disease between 1974 and 1997.

Results
Ten patients underwent strictureplasty as the primary procedure, and in three strictureplasty was used as a revision procedure after previous bypass surgery. Two patients developed anastomotic breakdown and were treated either by Roux-en-Y duodenojejunostomy or partial gastrectomy. Symptoms of obstruction persisted in four patients after strictureplasty; three eventually resolved after prolonged nasogastric aspiration, but the other required gastrojejunostomy. In the long term, six patients developed restricture at the previous strictureplasty site. Five required repeat strictureplasty and the other patient underwent duodenojejunostomy. One patient who had repeat strictureplasty required a further strictureplasty because of restricture at the previous strictureplasty site. Overall nine of 13 patients required further surgery because of early postoperative complications or restricture at the strictureplasty site.

Conclusion
Strictureplasty for duodenal Crohn's disease is associated with a high incidence of postoperative complications and restricture.
Experimental study of the effect of intraperitoneal heparin on tumour implantation following laparoscopy
Authors: Neuhaus S J , Ellis T , Jamieson G G , Watson D I 
Published: March 2003

Abstract

Background
Conclusions drawn from clinical reports of port site metastases following laparoscopic resection of intra-abdominal malignancy are now supported by a burgeoning experimental literature which suggests that laparoscopy promotes tumour metastasis to wounds. This study investigated the effect of intraperitoneal blood and heparin on the incidence of tumour cell implantation and port site metastasis.

Methods
Twenty-four Dark Agouti rats underwent laparoscopy with carbon dioxide insufflation and the instillation of a tumour cell suspension and/or blood into the peritoneal cavity. Rats were allocated randomly to one of the following study groups (six rats per group): (1) controls; (2) intraperitoneal blood (2 ml blood introduced from a syngeneic donor rat); (3) intraperitoneal heparin; (4) intraperitoneal blood and heparin. Rats were killed 7 days after the procedure, and the peritoneal cavity and port sites were examined for the presence of tumour.

Results
Tumour implantation and port site metastases were reduced by the intraperitoneal administration of heparin, but increased by the presence of intraperitoneal blood.

Conclusion
The results of this study suggest that tumour implantation following laparoscopy is promoted by the presence of intraperitoneal blood and that this effect may be reduced by the use of intraperitoneal heparin.
Minimizing recurrence after sigmoid volvulus
Authors: Chung Y F A , Eu K-W , Nyam D C N K , Leong A F P K , Ho Y H , Seow-Choen F 
Published: March 2003

Abstract

Background
This study was a retrospective review of a series of patients with sigmoid volvulus to identify risk factors for recurrence and recommend appropriate treatment.

Methods
Thirty-five patients with sigmoid volvulus were treated over 8 years.

Results
Six patients had emergency surgery for peritonitis. Twenty-eight of the other 29 patients had successful endoscopic decompression; 15 of these patients had elective surgery during the same admission. Twelve of the 14 patients who refused operation after endoscopic decompression developed recurrent volvulus, a median of 2·8 months later. Eight subsequently agreed to surgery and underwent elective operation following repeat decompression. Of 29 patients who had surgery, 27 had sigmoid colectomy (two were initial Hartmann procedures) and two had subtotal colectomy. Six patients who had sigmoid colectomy developed recurrent volvulus. Concomitant megacolon and megarectum at the time of initial surgery were significant predictors of recurrence.

Conclusion
Subtotal colectomy, carried out as the primary procedure if there is concomitant megacolon or megarectum, might reduce the risk of recurrent sigmoid volvulus.
Transhiatal approach to total gastrectomy for adenocarcinoma of the gastric cardia
Authors: Wayman J , Dresner S M , Raimes S A , Griffin S M 
Published: March 2003

Abstract

Background
A thoracoabdominal approach has traditionally been described for the resection of tumours of the gastric cardia. The aim of this study was to evaluate a transhiatal approach for resection of cancers of the gastric cardia.

Methods
Twenty consecutive patients undergoing transhiatal gastro-oesophagectomy for cancer of the gastric cardia were studied. Data were collected prospectively with regard to operating time, operative blood loss, intensive care unit (ICU) stay, analgesia use, duration of hospital stay, and pathological details of resection margin clearance and lymph node yield. Results were compared with those of the 20 preceding patients for whom the same prospective information had been recorded following resection via the standard thoracoabdominal approach.

Results
The transhiatal approach required a shorter operating time (median 190 (range 105–255) versus 280 (225–330) min; P = 0·004). It resulted in less blood loss (median 405 (180–2000) versus 1000 (420–3200) ml; P = 0·03) and fewer days in the ICU (median 0 (0–31) versus 2 (1–8) days; P = 0·005) despite being performed in an older patient population (median 71 (43–78) versus 63 (59–70) years; P = 0·016). There was no difference in either the lymph node harvest or length or involvement of upper resection margins.

Conclusion
The transhiatal approach to the resection of tumours at the gastric cardia is a valid and safe alternative to the standard thoracoabdominal technique. This technique avoids thoracotomy and its associated morbidity and is accompanied by reduced blood loss, decreased operating time and a shorter ICU stay.
Randomized clinical trial of laparoscopic versus open inguinal hernia repair
Authors: Juul P , Christensen K 
Published: March 2003

Abstract

Background
Several studies have suggested that better results are obtained after laparoscopic repair of inguinal hernia than after conventional operation. This is most obvious for bilateral and recurrent hernias but less accepted for primary unilateral hernias.

Methods
This was a randomized clinical trial comparing transabdominal preperitoneal laparoscopic repair with the Shouldice technique in patients with primary unilateral hernia. Some 138 patients were randomized to laparoscopic hernia repair and 130 to open surgical repair.

Results
The complication rates in the two groups were similar. In the laparoscopic group the patients returned to work more rapidly with a median time of 13 versus 18 days (P &lt; 0·005) and had a shorter period of analgesia intake with a median time of 2·1 versus2·7 days (P&lt; 0·02). The follow-up was 97·8 per cent complete. At a median of 12 months, four recurrences (2·9 per cent) were detected in the laparoscopic group and three (2·3 per cent) in the open group.

Conclusion
This study shows that in patients with a primary unilateral hernia laparoscopic repair results in less postoperative pain and a quicker recovery than open repair.
Accuracy of intraoperative frozen-section analysis of axillary nodes
Authors: Dixon J M , Mamman U , Thomas J 
Published: March 2003

Abstract

Background
Intraoperative assessment of axillary lymph node involvement would allow selection of patients who would benefit from axillary lymph node dissection.

Methods
Eighty-eight patients undergoing mastectomy or wide excision had four nodes sampled and sent for frozen-section examination.

Results
Frozen-section analysis of the nodes was correct in 81 of the 88 patients but missed seven of the 26 patients who had involved nodes on paraffin section (sensitivity 73 per cent).

Conclusion
Frozen-section analysis of axillary lymph nodes as currently practised cannot be recommended for routine use although it may have a role in specific groups of patients.
Influence of volume of work on the outcome of treatment for patients with colorectal cancer
Authors: Parry J M , Collins S , Mathers J , Scott N A , Woodman C B J 
Published: March 2003

Abstract

Background
Recent recommendations for the reorganization of cancer services emphasize the importance of a ‘minimal acceptable volume of work’. The influence of both hospital and surgical workload has been examined using a population-based series of patients with colorectal cancer.

Methods
Nine hundred and twenty-seven patients with primary colorectal cancer diagnosed during the period 1 January to 30 June 1993 were identified from the North Western Regional Cancer Registry. Case notes were reviewed for information on patient age and sex, histological diagnosis, disease stage, degree of tumour differentiation, mode of admission, identity of operating surgeon, timing of operative procedure, and use of radiotherapy and/or chemotherapy. A multivariate Cox proportional hazards model was then constructed to examine, simultaneously, the effects of patient-, disease- and health service-related variables on survival.

Results
Age, tumour stage and differentiation, and mode of admission were revealed as significant independent prognostic variables. After adjusting for these variables, neither operator grade (consultant versus junior), consultant workload nor hospital throughput were identified as independently influencing patient survival.

Conclusion
The results of this study do not support an association between volume of work and patient outcome.
Chronic groin sepsis following tension-free inguinal hernioplasty
Authors: Taylor S G , O'Dwyer P J 
Published: March 2003

Abstract

Background
Chronic groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. The aim of this study was to determine the number of surgeons performing tension-free inguinal hernioplasty in the West of Scotland and assess the frequency with which chronic groin sepsis was encountered.

Methods
A questionnaire was sent to all consultant surgeons performing inguinal hernia repair in the region and follow-up of patients with chronic groin sepsis following tension-free inguinal hernioplasty was undertaken.

Results
Of 80 consultants who replied to the questionnaire, 79 were performing tension-free hernioplasty. Of these, 76 were performing only open repairs while three were also undertaking laparoscopic repairs. Sixteen consultants reported 20 patients with groin sepsis after mesh repair. Twelve patients were traced; eight had chronic sinuses and four had groin abscesses. The median interval between repair and presentation was 4 months (range from 2 weeks to 39 months). All have required complete (11 patients) or partial (one) removal of mesh to resolve the symptoms.

Conclusion
Tension-free inguinal hernioplasty has become the operation of choice for surgeons in the region. Chronic groin sepsis may be more frequent than reported previously. Complete removal of mesh is required to treat this condition.
Comparison of radioguided excision with wire localization of occult breast lesions
Authors: Luini A , Zurrida S , Paganelli G , Galimberti V , Sacchini V , Monti S , Veronesi P , Viale G , Veronesi U 
Published: March 2003

Abstract

Background
Clinically occult breast lesions are found with increasing frequency as a result of the widespread use of mammographic screening.

Methods
This study reports a new localization technique in which a small quantity of 99mTc-labelled colloidal albumin is inoculated directly into the lesion under stereotactic–radiographic or ultrasonographic guidance. Correct positioning of the inoculum is checked by scintigraphy. A γ ray detection probe is then used to locate the lesion and guide its surgical removal. The results of this method in 30 patients were compared with those obtained using the established hook wire method in another 30 patients.

Results
In the wire localization group, the mean(s.d.) distance from the lesion centre to the specimen margin was 24·5(0·4) (range 15–45) mm. For the radioguided group the figures were 13·8(0·3) (range 5–25) mm. The mean(s.d.) lesion concentricity (difference between the maximum and minimum distance from the lesion border to specimen margin) was 6·2(0·4) (range 2–15) mm in the wire localization group and 3·8(0·2) (range 1–10) mm in the radioguided group.

Conclusion
Use of a γ probe allowed rapid, easy and accurate removal of occult breast lesions. In comparison to the hook wire method, radioguided removal allows reduced excision volume and better lesion centring within the specimen.
Treatment of gallbladder cancer by radical resection
Authors: Todoroki T , Kawamoto T , Takahashi H , Takada Y , Koike N , Otsuka M , Fukao K 
Published: March 2003

Abstract

Background
The use of radical resection for gallbladder cancer is controversial. This study evaluated results of resection for gallbladder cancer and analysed prognostic factors.

Methods
A retrospective review of 135 patients who underwent surgical resection for gallbladder cancer between 1976 and 1998 was performed. Of these, 123 patients underwent radical resection and the remaining 12 had palliative resection. The resections included 32 hepatopancreatoduodenectomies and 57 with adjuvant radiotherapy. Twelve prognostic factors were analysed. A subset of 96 patients with stage IV disease was analysed separately with respect to residual tumour level and adjuvant radiotherapy.

Results
Surgical resection was associated with a 5-year survival rate of 36 per cent, with a mean follow-up time of 870 days. Twenty-two patients have survived more than 5 years including three with stage IV disease. Overall operative morbidity and mortality rates were 13 and 4 per cent respectively. The 5-year survival rate decreased with disease stage: 100, 78, 69 and 11 per cent for stages I (n = 13), II (n = 19), III (n = 7) and IV (n = 96) respectively. Performance status, jaundice, histopathological type and grade, primary tumour, lymph node, distant metastasis, stage grouping, residual tumour level and adjuvant radiotherapy were significant prognostic factors.

Conclusion
With careful patient selection, radical resection for gallbladder cancer improves the prognosis with acceptable operative mortality and morbidity rates, even for stage IV disease, provided that complete gross tumour resection is combined with radiotherapy.
Contribution of diet, tumour volume and patient-related factors to weight loss in patients with colorectal liver metastases
Authors: Fordy C , Glover C , Henderson D C , Summerbell C , Wharton R , Allen-Mersh T G 
Published: March 2003

Abstract

Background
One of the difficulties in assessing the contribution of tumour-related factors to cancer cachexia is measurement of the extent of disease where dissemination to multiple organ sites has occurred.

Methods
In this study the extent of tumour (both tumour volume and increase in marker levels), diet and patient-related factors (appetite, metabolic hormones, immune activation, liver function and quality of life) were compared in patients with colorectal liver metastases who had lost at least 1 kg in body-weight (weight loss) and patients who had not lost 1 kg in body weight (stable weight) during the preceding month.

Results
Forty patients (22 men; 14 with weight loss) were studied. Liver metastasis volume was significantly greater in patients who lost weight than in those whose weight was stable (median (interquartile range) 1179 (245–1517) versus 119 (23–523) ml; P = 0·003). The prevalence of patients with raised levels of serum immune products was significantly greater in the weight loss group for soluble interleukin (IL) 2 receptor α (sIL2rα) (P = 0·03) and IL-6 (P = 0·05), but not for soluble tumour necrosis factor receptor 1 (sTNFr1) or neopterin. There were significant correlations between serum C-reactive protein and sIL2rα (rs = 0·68, P &lt; 0·0001) and IL-6 (rs = 0·46, P = 0·008) but not sTNFr1 or neopterin levels. Significant differences in appetite, nausea, diet, energy intake, liver function tests and serum levels of metabolic hormones were not detected.

Conclusion
Weight loss in patients with colorectal liver metastases was not explained by changes in diet, quality of life, or hormones, but activation of the innate and incomplete activation of the acquired immune systems may be involved. Agents that attenuate either the acute-phase inflammatory response or T lymphocyte IL-2 receptor upregulation might reduce weight loss in patients with metastatic disease.
Experimental study of the effect of intraportal prostaglandin E1 on hepatic blood flow during reperfusion after ischaemia and hepatectomy
Authors: Hossain M A , Hamamoto I , Wakabayashi H , Goda F , Kobayashi S , Maeba T , Maeta H 
Published: March 2003

Abstract

Background
Prostaglandin E1 (PGE1) has protective effects experimentally and clinically in individual models of hepatic ischaemia–reperfusion injury and of partial hepatectomy. The present study investigated the effects of intraportal administration of PGE1 on hepatic blood flow, systemic arterial pressure and long-term animal survival after 60 min of total liver ischaemia followed by 70 per cent partial hepatectomy in rats.

Methods
Total liver ischaemia was induced by occluding the hepatoduodenal ligament for 60 min. PGE1 0·5 µg per kg per min was infused intraportally for 15 min before inducing ischaemia and for 120 min after ischaemia in the treatment group. Normal saline was infused in the control group. During ischaemia 70 per cent partial hepatectomy was performed. Portal venous flow (PVF), peripheral tissue blood flow (PTBF) and hepatic artery flow were measured before and after ischaemia. Serum biochemical analysis was carried out at 1, 3 and 24 h, and 7 and 14 days; and liver histology at 1 and 24 h, and 7 days after reperfusion. Survival was followed for 1 year.

Results
Intraportal infusion of PGE1 significantly improved PVF and PTBF without affecting the systemic arterial pressure. Long-term survival was significantly higher in the PGE1 group. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase levels decreased significantly, and 2-h bile flow was significantly improved, in the PGE1 group. Histological examination revealed significant portal venous congestion, sinusoidal congestion, fatty degeneration and tissue necrosis 24 h and 7 days after reperfusion in the control group.

Conclusion
PGE1 has a protective effect against liver damage when the liver is injured by warm ischaemia and reperfusion followed by partial resection.
Endoleak after stent-graft treatment of abdominal aortic aneurysm: a meta-analysis of clinical studies
Authors: Schurink G W H , Aarts N J M , van Bockel J H 
Published: March 2003

Abstract

Background
Endoleak is the major complication after endovascular treatment of abdominal aortic aneurysm (AAA) and its incidence seems to remain significant. Little is known about the association of device type and configuration with respect to the incidence, location, time of onset and fate of endoleakage.

Methods
A meta-analysis was performed via a Medline search of clinical studies after 1995 dealing with the endovascular treatment of AAA. Details of number of patients treated, configuration and type of endovascular device were collected. Data concerning site of origin, time of occurrence and fate of the endoleak were retrieved, along with information on change in diameter of the aneurysm with time.

Results
The 23 publications included reported on 1189 patients. The 1118 patients with successfully inserted transfemoral endovascular grafts experienced 270 endoleaks (24 per cent). The majority arose from the distal stent attachment site (36 per cent), were present immediately after stent-graft placement (66 per cent) and were persistent in time (37 per cent). Tube grafts were more frequently affected by endoleakage (35 per cent; P &lt; 0·0001), especially at the distal stent attachment site (51 per cent), than bifurcated grafts (18 per cent; P = 0·004) and aortounilateral devices (20 per cent; P = 0·70). Self- expandable stent-grafts were more frequently associated with endoleaks (25 per cent) than balloon-expandable stent-grafts (17 per cent) (P = 0·037).

Conclusion
Endovascular treatment of AAA is an evolving field. Even after the initial learning curve and attention to device-related problems, it is still accompanied by a significant number of endoleaks. Uniform presentation of results of treatment is necessary for analysing the effect of differences between patients, aneurysm morphology and device type.
Periampullary diverticula and pancreaticobiliary disease
Authors: Lobo D N , Balfour T W , Iftikhar S Y , Rowlands B J 
Published: March 2003

Abstract

Background
Periampullary diverticula (PAD) are extraluminal outpouchings of the duodenum arising within a radius of 2–3 cm from the ampulla of Vater. They are frequently encountered in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and contribute to failure of ERCP. This review details the relationship of PAD to pancreaticobiliary disease and the influence of PAD on the management of patients.

Methods
The United States National Library of Medicine Medline database was searched for articles on and related to PAD published in English within the past 15 years. Major earlier works were also reviewed.

Results
The prevalence of PAD increases with age and could be as high as 27 per cent. PAD are associated with an incompetent sphincter of Oddi and colonization of bile duct with β-glucuronidase-producing organisms. PAD are implicated in the pathogenesis of pigment common bile duct stones, but there is no conclusive evidence to associate them with cholecystolithiasis or pancreatitis. PAD are a major cause of failure of ERCP, but success rates of more than 90 per cent have been achieved in specialist centres.

Conclusion
With an ageing population, there will be an increase in elderly patients with PAD and symptomatic pancreaticobiliary disease. Continuing improvements in radiological and endoscopic techniques should enable this vulnerable group to be treated effectively and safely.
Endogenous renal nitric oxide metabolism following experimental infrarenal aortic cross-clamp-induced ischaemia–reperfusion injury
Authors: Pararajasingam R , Weight S C , Bell P R F , Nicholson M L , Sayers R D 
Published: March 2003

Abstract

Background
Abdominal aortic surgery is associated with marked changes in renal haemodynamics. The aim of this study was to investigate the influence of infrarenal cross-clamping on glomerular filtration rate and endogenous renal nitric oxide metabolism.

Methods
Groups of male Wistar rats were subjected to infrarenal aortic cross-clamping followed by reperfusion. Animals were allowed to recover after a left nephrectomy. The glomerular filtration rate of the remaining kidney was measured on the second and seventh day after the procedure before the animal was killed and the remaining kidney harvested. Total nitric oxide synthase (NOS) activity and expression of inducible NOS (iNOS) was determined in renal tissue following 1 h and 7 days of reperfusion.

Results
Glomerular filtration rate was impaired on the second and seventh day after operation in all animals subjected to lower torso ischaemia compared with controls (P &lt; 0·05). Renal NOS activity was increased at 1 h and 7 days in animals subjected to infrarenal cross-clamping compared to controls (P &lt; 0·01). iNOS was detected in renal tissue of animals subjected to infrarenal aortic cross-clamping on the seventh day after operation.

Conclusion
Infrarenal aortic cross-clamping is associated with impairment of renal function in the early postoperative period. There is an increase in endogenous renal nitric oxide metabolism with iNOS expression.