bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local heat-shock priming-induced improvement in microvascular perfusion in osteomyocutaneous flaps is mediated by heat-shock protein 32
Authors: Rücker M , Schäfer T , Roesken F , Spitzer W J , Bauer M , Menger M D 
Published: March 2003

Abstract

Background
Stress conditioning is thought to improve microvascular free flap survival but the mechanisms of protection are not clear. The aim of this study was to determine whether local induction of heat-shock protein (HSP) 32 improves microvascular perfusion in transferred osteomyocutaneous flaps.

Methods
The hindlimb harvest region of osteomyocutaneous flaps in Wistar rats was subjected to stress conditioning by local heating (30 min, 42·5°C) 24 h before microvascular flap transfer. In a second group of animals, after heat-shock priming, the action of HSP-32 was inhibited by tin protoporphyrin IX. Animals with unconditioned flaps served as controls. After transfer, the microcirculation of the muscle, cutaneous, subcutaneous and periosteal tissue of the flap was analysed quantitatively for 6 h using intravital fluorescence microscopy.

Results
Immunohistochemistry revealed that HSP-32 was detectable only after priming and not in unconditioned flaps. Priming did not alter functional capillary density or capillary red blood cell velocity compared with that in unconditioned flaps. However, heat-shock priming induced significant capillary dilatation (P &lt; 0·05) and thus a substantial increase in capillary blood flow volume (P &lt; 0·05) in all tissues of the transferred flaps. Inhibition of HSP-32 by tin protoporphyrin IX completely abolished the priming-induced improvement in capillary perfusion, as indicated by the lack of increased capillary diameters and volumetric blood flow.

Conclusion
The present study demonstrated that stress conditioning by local heat-shock priming improves nutritive perfusion in osteomyocutaneous flaps by capillary dilatation, probably mediated through the vasoactive action of HSP-32.
Laparoscopy in the staging of pancreatic cancer
Authors: Pisters P W T , Lee J E , Vauthey J N , Charnsangavej C , Evans D B 
Published: March 2003

Abstract

Background
Over the past decade, laparoscopy has emerged as a popular method of detecting extrapancreatic metastatic disease in patients presumed to have localized pancreatic cancer.

Methods and results
The English language literature on laparoscopic staging of pancreatic cancer was reviewed. Interpretation of this literature on staging laparoscopy is difficult because (1) there has been inconsistent use of high-quality computed tomography (CT) in prospective studies, (2) many studies have included patients with locally advanced disease, and (3) the R0/R1/R2 resection rates among patients staged by laparoscopy have not been reported, making it impossible to correlate laparoscopic findings with the R0 resection rate. Laparoscopy may prevent unnecessary laparotomy in a proportion of CT-staged patients presumed to have resectable pancreatic cancer. However, routine laparoscopy is performed on patients judged to have resectable disease by high-quality CT, this fraction of patients is between 4 and 13 per cent.

Conclusion
When state-of-the-art CT is available, the routine use of staging laparoscopy may not be easily justified from the data in the recent literature. Selective use of laparoscopy may be more appropriate and will probably be a more cost-effective staging approach. Criteria are presented for the selective use of laparoscopy in the staging of patients with localized pancreatic cancer.
Impact of laparoscopic surgery on experimental hepatic metastases
Authors: Gutt C N , Riemer V , Kim Z G , Erceg J , Lorenz M 
Published: March 2003

Abstract

Background
Metastatic disease to the liver is one of the major factors determining outcome after colonic resection with curative intention. The influence of laparoscopic surgery on metastatic disease in the liver is still largely unknown.

Methods
An intrasplenic tumour cell inoculation was performed in 30 WAG-Rij rats. After 7 days the rats were randomized into three operative groups: laparotomy (n = 10), laparoscopy with 7 mmHg carbon dioxide pneumoperitoneum (n = 10) and gasless laparoscopy (n = 10). A small bowel segmental resection was carried out in all rats. Some 21 days later the rats were evaluated for number and diameter of tumour nodules and cancer index score at eight different abdominal sites.

Results
Hepatic tumour growth scored with the cancer index was significantly reduced in the gasless laparoscopy group compared with that in the carbon dioxide laparoscopy group (P = 0·04) and the laparotomy group (P = 0·02). Tumour growth at the port site and total tumour load were significantly reduced in the gasless group compared with the laparotomy group (P ≤ 0·04).

Conclusion
Laparoscopy with carbon dioxide insufflation seems to stimulate the growth of dormant tumour cells into overt liver metastases. Gasless laparoscopy on the other hand may have a protective effect against metastatic disease in the liver. The promoting and inhibiting effects of laparoscopic procedures on growth of liver metastases need further evaluation.
Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei
Authors: Witkamp A J , de Bree E , Kaag M M , van Slooten G W , van Coevorden F , Zoetmulder F A N 
Published: March 2003

Abstract

Background
Pseudomyxoma peritonei remains a fatal disease. However, extensive surgical cytoreduction combined with intraoperative heated intraperitoneal chemotherapy (HIPEC) has recently emerged as a new treatment modality, which might improve survival.

Methods
Patients underwent treatment if the tumour appeared to be technically resectable on preoperative abdominal computed tomography and there were no distant metastases. After aggressive surgical cytoreduction, HIPEC with the administration of mitomycin C was performed for 90 min. Depending on histological grading, patients received adjuvant 5-fluorouracil and leucovorin therapy.

Results
Forty-six patients were treated. Optimal surgical cytoreduction was obtained in 40 patients. Postoperative surgical complications occurred in 18 patients. Four patients died as a direct result of the treatment. Bone marrow suppression due to mitomycin C toxicity occurred in 22 patients. There was no other major toxicity related to the HIPEC procedure. After a median follow-up of 12 months, 40 patients are alive, eight of whom have proven recurrence. The actuarial survival rate (Kaplan–Meier) at 3 years was 81 per cent.

Conclusion
These results confirm that extensive surgery combined with HIPEC is feasible in patients with pseudomyxoma peritonei and that improved long-term survival might be achieved.
Expression of gastrin in developing gastric adenocarcinoma
Authors: Henwood M , Clarke P A , Smith A M , Watson S A 
Published: March 2003

Abstract

Background
A stepwise progression through premalignant stages has been identified for the intestinal type of gastric carcinoma. As gastrin has been identified as a growth factor for the intestinal type of gastric adenocarcinoma, the aim of this study was to investigate whether gastrin is expressed in premalignant gastric conditions.

Methods
Ninety archival samples of atrophic gastritis, intestinal metaplasia, mild gastric epithelial dysplasia, moderate gastric epithelial dysplasia, severe gastric epithelial dysplasia and intestinal-type gastric adenocarcinoma were obtained. Immunocytochemistry was performed using antibodies directed against gastrin and its post-translational precursors, and the gastrin/cholecystokinin B receptor. Positive staining was identified using the avidin–biotin immunoperoxidase method and quantified using an image analysis system.

Results
Gastrin and its receptor were shown to be expressed in specimens of atrophic gastritis, intestinal metaplasia, epithelial dysplasia and the intestinal type of gastric carcinoma.

Conclusion
Gastrin seems to be an important growth factor in gastric carcinogenesis.
Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children
Authors: Lintula H , Kokki H , Vanamo K 
Published: March 2003

Abstract

Background
Appendicectomy is the most common emergency surgical operation in children. The aim of this study was to compare recovery after appendicectomy using either a laparoscopic or an open technique in children.

Methods
Sixty-one children aged 4–15 years undergoing appendicectomy for suspected uncomplicated appendicitis were studied. The study was prospective, randomized and single-blinded, with parallel groups. Standardized anaesthetic technique and pain management were used. The study endpoints were postoperative pain, need for rescue analgesia, and length of hospital stay.

Results
Children had significantly less pain after laparoscopic compared with open appendicectomy 8 h after operation and on the first and second postoperative mornings (P &lt; 0·05). Laparoscopic appendicectomy resulted in a reduced requirement for rescue analgesia with oxycodone in hospital: mean(s.d.) 3·6(2·5) versus 5·8(3·3) doses (mean difference 2·2 doses, 95 per cent confidence interval (c.i.) 0·6–3·8 doses); P = 0·01. The mean(s.d.) length of hospital stay was significantly shorter in the laparoscopic group: 1·9(0·7) versus 2·6(0·9) days (mean difference 0·7 days, 95 per cent c.i. 0·3–1·1 days); P = 0·001. Three children who had open appendicectomy developed a wound infection.

Conclusion
Laparoscopic appendicectomy is associated with less postoperative pain and a shorter hospital stay than open appendicectomy in children undergoing surgery for uncomplicated appendicitis.
Analysis and surgical treatment of persistent dysphagia after Nissen fundoplication
Authors: Bais J E , Wijnhoven B P L , Masclee A A M , Smout A J P M , Gooszen H G 
Published: March 2003

Abstract

Background
After Nissen fundoplication, troublesome dysphagia develops in 5–10 per cent of patients. The mechanism of dysphagia has not been fully resolved, in spite of a number of studies focusing on oesophageal motility and lower oesophageal sphincter (LOS) dynamics. Tightness and length of the wrap have had considerable attention, without giving a fully satisfactory explanation of the pathophysiological mechanism.

Methods
Eighteen patients with persistent dysphagia after Nissen fundoplication needing reoperation were studied. Eighteen patients, matched for age and sex, without dysphagia after Nissen fundoplication were used as controls. Reoperation consisted of conversion of a 360° into a 270° wrap. Barium swallow, endoscopy, oesophageal manometry and 24-h pH monitoring were performed before and after (re)operation.

Results
Peristaltic amplitude, velocity and duration of contraction were not significantly influenced by operation. In 16 of 18 patients with dysphagia, LOS relaxation was incomplete and the residual relaxation pressure was significantly higher than that in the group without dysphagia (P &lt; 0·01). No correlation was found between LOS pressure and peristaltic amplitude, nor between LOS pressure and ramp pressure in the distal oesophagus. After reoperation, basal LOS pressure decreased significantly (P &lt; 0·01) and LOS relaxation was complete in all but three patients; residual relaxation pressure decreased (P &lt; 0·01) and was significantly lower than that after uncomplicated Nissen fundoplication. In the latter group, LOS pressure, residual relaxation pressure and ramp pressure increased significantly after operation (P &lt; 0·01).

Conclusion
A return to complete LOS relaxation and a decrease in residual relaxation pressure play an important role in resolving dysphagia.
Laparoscopic Nissen versus anterior fundoplication in patients with oesophageal dysmotility: a randomized controlled trial
Authors: Ackroyd R , Watson D I , Devitt P G , Game P A , Jamieson G G 
Published: March 2003

Abstract

Background
It has been postulated that in patients with oesophageal dysmotility a partial fundoplication may be associated with a better outcome than a Nissen fundoplication. This study aimed to compare laparoscopic anterior fundoplication with laparoscopic Nissen fundoplication in patients with disordered peristalsis.

Methods
One hundred and seven patients with documented gastro-oesophageal reflux disease were randomized to undergo either a Nissen fundoplication (n = 53) or an anterior 180° hemifundoplication (n = 54), and were seen at follow-up at least once a year by a blinded investigator who used standardized clinical grading systems to assess postoperative dysphagia, heartburn and patient satisfaction. Patients were divided into two groups depending on preoperative oesophageal manometric findings: normal peristalsis (81 patients) or disordered peristalsis (26 patients – propagated less than 50 per cent of swallows and/or distal peristaltic amplitude less than 40 mmHg).

Results
At all follow-up intervals beyond 6 months, patients who underwent an anterior fundoplication experienced less dysphagia and were more likely to be satisfied with the clinical outcome. The magnitude of outcome differences was independent of peristaltic status, and there was no trend towards a poorer outcome in patients with poor peristalsis who underwent Nissen fundoplication.

Conclusion
The concept of tailoring the specific antireflux procedure according to preoperative peristaltic status was not supported by this trial. However, laparoscopic anterior fundoplication was associated with less dysphagia overall and an improved clinical outcome at 3 years.
Photodynamic therapy for dysplastic Barrett's oesophagus: long-term follow-up
Authors: Kelty C J , Ackroyd R , Brown N J , Stephenson T J , Stoddard C J , Reed M W R 
Published: March 2003

Abstract

Background
Photodynamic therapy (PDT) is a novel treatment in which tissue damage is caused by the action of light on a previously administered photosensitizing agent. The results of long-term follow-up of the use of PDT in patients with dysplastic Barrett's oesophagus are presented.

Methods
Thirty-seven patients with low-grade dysplastic Barrett's oesophagus were treated with oral 5-aminolaevulinic acid (ALA) 30 mg kg1, followed by laser endoscopy 4 h later. Patients were treated between December 1995 and December 1998, and all were followed regularly with endoscopy and biopsies in the authors' surveillance programme.

Results
All patients initially showed eradication of dysplasia, and 32 of 37 had a macroscopic reduction in the length of columnar epithelium. The effect was maintained for a median of 43 (range 18–54) months, although one patient developed a late carcinoma.

Conclusion
ALA-induced PDT can provide safe and effective ablation of low-grade dysplastic Barrett's oesophagus, and the effects appear to be maintained for a protracted period of time.
High risk of surgical intervention in hereditary pancreatitis
Authors:   UK and Ireland consortium of the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer, Howes N , Lerch M M , Mössner J , Endres S , Deviere J , Verreman G , Lucidi V , Charnley R , Imrie C , Hall R , Olah A , Ihse I , Steenbergan W , O'Donnell M , Greenhalf W , Ellis I , Rutherford S , Mountford R , Whitcombe D C , Neoptolemos J P 
Published: March 2003

Abstract

Background
The aim of the study was to quantify the risk of surgical intervention in families with hereditary pancreatitis referred to the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC).

Methods
Recruitment to EUROPAC started in 1997; families were considered if two or more members had chronic pancreatitis of unknown aetiology. Families were tested for protease serine 1 (PRSS1) mutations using polymerase chain reaction restriction digestion, sequencing the PRSS1 gene-screened negative families. Clinical information about surgical intervention was obtained from family members and referring clinicians, and the cumulative incidence of surgical intervention in the N291 and R122H mutation groups was determined with the Kaplan–Meier method.

Results
Forty-four families had the R122H mutation, 21 the N291 mutation, and 31 were negative for both. Some 14 (35 per cent) of 40 patients (median age 26·5 (95 per cent confidence interval (c.i.) 21·5–36·3) years) with the N291 mutation had an operative procedure for complications of pancreatitis, compared with 21 (25 per cent) of 83 patients (median age 24 (95 per cent c.i. 13·8–35·8) years) with the R122H variant. This resulted in a cumulative lifetime risk for surgical intervention of 0·6 (95 per cent c.i. 0·5–0·8) for the R122H mutation and 0·6 (0·5–0·8) for the N291 mutation (P = 0·11, log rank test).

Conclusion
Hereditary pancreatitis carries a significantly increased risk of surgical intervention in this cohort of patients, which equates to an estimated lifetime risk of around 60 per cent. The risk of surgery appears to be independent of PRSS1 mutation type.
New classification of oesophageal and gastric carcinomas
Authors: Dolan K , Walker S J , Sutton R , Williams E M I 
Published: March 2003

Abstract

Background
The current International Classification of Diseases (ICD)-O classification of carcinomas of the oesophagus and stomach causes epidemiological and clinical confusion, particularly the use of the term cardia and the overlapping subsites described in the stomach. This study compared the epidemiological and clinical features of each subtype and subsite of carcinoma of the oesophagus and stomach to assess requirements for a new classification of these carcinomas.

Methods
Data were extracted with appropriate validity checks on all cases of oesophageal and gastric carcinoma identified throughout the period 1974–1993 by the Merseyside and Cheshire Cancer Registry, which covers a population of 2·5 million. Comparison of all identifiable epidemiological and clinical features of adenocarcinomas at four different subsites, namely the upper two-thirds of the oesophagus, the lower third of the oesophagus, cardia and subcardia of the stomach, was performed.

Results
There were 5322 primary carcinomas of the oesophagus and 10 535 carcinomas of the stomach registered between 1974 and 1993. The incidence of adenocarcinoma of the lower oesophagus and cardia trebled in males and doubled in females, whereas adenocarcinoma of the subcardia region of the stomach declined in both sexes. The incidence of adenocarcinoma of the lower oesophagus and of the cardia was similar for median age at diagnosis, male: female ratio, percentage of patients who smoked, and survival; both were significantly different from values for carcinoma of the subcardia in these respects.

Conclusion
These data suggest that there is considerable overlap between adenocarcinomas of the lower oesophagus and adenocarcinomas currently classified as of the cardia. The authors believe this is due to the group of carcinomas classified as cardia consisting mainly of carcinomas that traverse the gastro-oesophageal junction. These carcinomas were different in all studied parameters from carcinomas of the stomach and should be classified separately from gastric carcinomas. A new subsite classification of oesophageal and gastric carcinomas is proposed that includes the gastro-oesophageal junction as a subsite of the oesophagus and that simplifies the subsite classification of the stomach into proximal, distal and overlapping.
Magenstrasse and Mill vertical gastric stapling for morbid obesity
Authors: Featherstone N , Dachtler J , Johnston D , Sue-Ling H M 
Published: March 2003

Abstract

Background
The aim of the study was to determine the effects of a new vertical gastric stapling procedure used alone or in combination with a Roux-en-Y gastric bypass for patients with morbid obesity.

Methods
A consecutive series of 100 patients with morbid obesity underwent either vertical gastric stapling alone (Magenstrasse and Mill procedure; MM) (n = 80) or combined with a limited Roux-en-Y gastric bypass (MM-GB) (n = 20). Median age (39 versus 40 years), body mass index (45·9 versus 45·8) and M: F ratio (1: 4 versus 1: 3) were similar between the two groups of patients. The median follow-up of patients who underwent the MM procedure was 36 (range 0–72) months, and 15 (0–36) months for patients who had the combined MM-GB procedure.

Results
The operative mortality rate was 0 per cent and there were no major postoperataive complications. Median length of stay was 7 days for patients who had the MM procedure and 10 days for those who underwent combined MM-GB. One year after operation median(s.d.) weight loss was 38·6(15·1) kg in the MM group, compared with 50·4(8·4) kg in the MM-GB group (P = 0·02). Patients who had the MM procedure had lost 30(8·3) per cent of their original weight, compared with 36(3·2) per cent for those who had a combined MM-GB procedure (P = 0·03).

Conclusion
Gastric stapling for morbid obesity is safe in specialized surgical units. Weight loss after the combined MM-GB procedure was greater than that following the MM procedure alone, although this has to be set against the potential long-term complications of a gastric bypass procedure.
Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis
Authors: Nagasue N , Ono T , Yamanoi A , Kohno H , El-Assal O N , Taniura H , Uchida M 
Published: March 2003

Abstract

Background
Detailed follow-up of patients with chronic hepatitis has resulted in increased diagnosis of hepatocellular carcinoma (HCC) in patients without cirrhosis. Despite numerous studies on hepatic resection, the prognostic factors for intrahepatic recurrence and survival are not well known for patients with HCC without cirrhosis.

Methods
Among 349 patients with HCC treated in the past 13 years, cirrhosis was absent in 126 patients (36 per cent). Curative hepatic resection was carried out in 100 (79 per cent) of these patients. Risk factors for intrahepatic recurrence and prognostic factors for survival were evaluated by univariate and multivariate analyses.

Results
Postoperative morbidity and mortality rates were 22 and 3 per cent respectively. The 5- and 10-year disease-free and overall survival rates were 31 and 50 per cent, and 22 and 47 per cent respectively. Blood loss, surgical resection margin, intrahepatic metastasis, portal vein invasion and extent of hepatic resection were independently associated with overall survival. However, the only risk factors for intrahepatic recurrence were portal vein invasion and hepatitis C virus (HCV) infection. The former was related to early recurrence while the latter was related to later recurrence. The 5-year disease-free survival rate was 58 per cent in patients with hepatitis B virus infection while it was 6 per cent in patients with HCV infection (P &lt; 0·001).

Conclusion
In the treatment of HCC without cirrhosis, major hepatectomy is advocated to prevent early recurrence. Liver transplantation may be required for patients with HCV infection.