bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome
Authors: Bartels H E , Stein H J , Siewert J R 
Published: March 2003

Abstract

Background
Lesions of the trachea or main-stem bronchi with air leakage are a grave complication of oesophagectomy.

Methods
Prevalence, predisposing factors and outcome of non-malignant lesions of the trachea or main-stem bronchi were analysed retrospectively in a consecutive series of 785 patients who had oesophagectomy for oesophageal cancer.

Results
Overall 31 of 785 patients developed a tracheobronchial fistula 1–30 days after oesophagectomy. Based on the location of the lesions and clinical circumstances, the tracheobronchial fistulas were thought to be due to surgical injury (four patients), cuff pressure of the tracheostomy tube (two), local peritracheal infection resulting from a cervical anastomotic leak (seven) or ‘ischaemia’ after extensive peritracheal dissection (18). On multivariate analysis, transthoracic en bloc resection (P &lt; 0·01) and preoperative radiochemotherapy for locally advanced tumours located at or above the level of the tracheal bifurcation (P &lt; 0·01) predisposed to this complication.

Conclusion
Non-malignant tracheobronchial lesions are a serious complication of transthoracic oesophagectomy with extensive lymph node dissection, particularly in patients undergoing preoperative radiochemotherapy for locally advanced tumours.
Surgical resection of locally recurrent colorectal adenocarcinoma
Authors: Delpero J R , Pol B , Le Treut Y P , Bardou V J , Moutardier V , Hardwigsen J , Granger F , Houvenaeghel G 
Published: March 2003

Abstract

Background
Recurrence rates after curative resection of colorectal adenocarcinoma remain steady at 50 per cent. Thirty per cent of the deaths are linked to locoregional recurrence. The aim of this study was to evaluate the results of resection for locoregional recurrence.

Methods
This retrospective review analysed a series of 120 patients who underwent resection of colonic (56) or rectal (64) locoregional recurrence. Sixty-nine resections were considered as curative. Sixty-one recurrences required extended resection. There were nine synchronous hepatic resections.

Results
The hospital mortality rate was 7 per cent and the morbidity rate was 40 per cent. The overall 5-year survival rate was 27 per cent. Survival was significantly higher: (1) after curative resection (44 versus 0 per cent after palliative resection, P &lt; 0·0001); (2) in women (44 versus 11 per cent for men, P = 0·0036); and (3) after resection for intramural recurrence (45 versus19 per cent for extramural recurrence, P = 0·0024). Multifactorial analysis showed that curability of the resection was the most important prognostic parameter.

Conclusion
The results in this highly selected group seem to justify an attempt at reresection whenever possible. Long-term results may be improved by using adjuvant treatment.
Prediction of resectability of pancreatic malignancy by computed tomography
Authors: McCarthy M J , Evans J , Sagar G , Neoptolemos J P 
Published: March 2003

Abstract

Background
The accuracy of computed tomography (CT) in predicting resectability of pancreatic malignancy has been questioned recently and alternative methods have been recommended.

Methods
To determine the accuracy of CT for predicting resectability and its influence on survival, a standard protocol for performing CT and reporting the results was developed and then compared retrospectively with the ability of one surgeon to perform a resection during 1989–1994. Postoperative survival was determined.

Results
Of 88 consecutive patients 35 (40 per cent) had CT-resectable disease and 53 (60 per cent) had CT-irresectable disease. Twenty-one patients were excluded because of advanced disease or poor performance status. Of the remaining 67 patients, 47 (70 per cent) had pancreatic ductal adenocarcinoma and 20 (30 per cent) had ampullary adenocarcinoma, of whom 32 had a resection, 32 had a palliative bypass and three had only a staging laparoscopy. The sensitivity and specificity for computed tomographic prediction of resectability were 72 and 80 per cent respectively. The positive predictive value was 77 per cent and the negative predictive value 76 per cent. There were seven false-positive and nine false-negative findings. Survival was more dependent on whether or not resection was performed than on computed tomographic predictability of resection.

Conclusion
CT was reasonably accurate in predicting resectability but cannot be relied on entirely, requiring an improvement in staging methods for pancreatic malignancy.
Effect of the introduction of total mesorectal excision for the treatment of rectal cancer
Authors: Carlsen E , Schlichting E , Guldvog I , Johnson E , Heald R J 
Published: March 2003

Abstract

Background
Total mesorectal excision (TME) has been reported to reduce local recurrence and improve survival rates in patients with rectal carcinoma. This paper reports the problems that have arisen with the introduction of this new surgical technique.

Methods
This was a prospective study of two consecutive groups of patients: one who underwent TME (n = 76) and one who did not (non-TME, n = 76).

Results
Postoperative mortality rate in the non-TME and TME group was 5 and 7 per cent respectively, and the rate of anastomotic failure was 8 and 16 per cent respectively. Anastomotic leaks in TME patients were located in the mid and lower rectum. TME patients with anastomotic failure had lower anastomoses and a longer duration of operation than non-TME patients. Intraoperative problems were encountered in 71 per cent of the failures. All TME patients who had a leak required reoperation compared with 25 per cent of non-TME patients. TME patients without postoperative complications stayed significantly longer in hospital than non-TME patients.

Conclusion
Anastomotic dehiscence increased after introduction of the TME technique but this improved with experience.
Structured data collection improves the diagnosis of acute appendicitis
Authors: Körner H , Söndenaa K , Söreide J A , Andersen E , Nysted A , Lende T H 
Published: March 2003

Abstract

Background
Structured preoperative data collection and computer-assisted methods are claimed to improve diagnostic accuracy in patients with acute abdominal pain. The aim of this study was to evaluate a possible age- and sex-related effect of using structured data collection in the preoperative diagnosis of patients with suspected acute appendicitis.

Methods
Between 1989 and 1994, clinical and demographic data from 1764 consecutive patients were recorded. In 1990 and 1992, various detailed symptom, clinical and laboratory data were collected prospectively on a structured registration form. Age- and sex-specific diagnostic accuracy as well as perforation rate were calculated for each year.

Results
Diagnostic accuracy increased significantly by 5 (95 per cent confidence interval (c.i.) 1–9) per cent when structured data registration was applied. In female patients aged between 13 and 40 years, diagnostic accuracy increased by 16 (95 per cent c.i. 8–24) per cent. Significant changes in diagnostic accuracy were not seen in other subgroups. Perforation rates remained unchanged during the entire study period.

Conclusion
In this population-based study, diagnostic accuracy in patients operated on for suspected acute appendicitis increased for all patients when structured preoperative data collection was used. However, the only subgroup with a significant increase in diagnostic accuracy was female patients aged between 13 and 40 years. Perforation rate was unaffected by structured data collection.
Genetic alterations in chronic pancreatitis: evidence for early occurrence of p53 but not K-ras mutations
Authors: Gansauge S , Schmid R M , Muller J , Adler G , Mattfeldt T , Beger H G 
Published: March 2003

Abstract

Background
In patients suffering from chronic pancreatitis the risk for the development of pancreatic cancer ranges from 4 to 6 per cent. Various mutations are associated with pancreatic cancer, especially of p53 and K-ras. The incidence of these mutations in resected chronic pancreatitic tissue was investigated.

Methods
In the present study DNA from 80 samples of tissue from patients with chronic pancreatitis was isolated and subjected to single-strand conformation polymorphism (SSCP) analysis of p53 exons 5–9 and restriction fragment length polymorphism analysis of K-ras (codon 12).

Results
No mutations in the K-ras gene were detected. On SSCP analysis, eight of 80 cases of chronic pancreatitis showed alterations (two in exon 5, four in exon 6, two in exon 7). DNA sequence analysis revealed one deletion of 21 amino acids (exon 5), four polymorphisms in exon 6 with no change in the amino acid sequence, one point mutation in exon 5, and two point mutations located in the intron between exons 6 and 7.

Conclusion
These data show that in some cases of chronic pancreatitis mutations in the p53 gene occur without morphological evidence of pancreatic cancer.
Prospective randomized controlled trial to compare skin staples and polypropylene for securing the mesh in inguinal hernia repair
Authors: Mills I W , Mcdermott I M , Ratliff D A 
Published: March 2003

Abstract

Background
The Lichtenstein tension-free repair has become the standard method for repairing inguinal hernia in many surgical units. This study compared two methods of mesh fixation.

Methods
Fifty men undergoing unilateral primary Lichtenstein inguinal hernia repair under general anaesthesia were randomized into two groups. In the control group polypropylene mesh was secured with 2/0 polypropylene sutures and the skin closed with subcuticular 3/0 polydioxanone. In the study group polypropylene mesh was secured with skin staples and the skin was closed with staples from the same staple gun. Duration of the operation was recorded. Early follow-up was achieved by patient review at 6 weeks and postal questionnaire at 12 weeks.

Results
The operation was significantly shorter when staples were used (median 20 min 0 s versus 29 min 30 s, P &lt; 0·001). There was no significant difference in the incidence of postoperative complications or pain score. The study group reported earlier return to normal activity (4 weeks 0 days versus 6 weeks 2 days, P &lt; 0·01) although there was no difference in the time taken to return to work or driving.

Conclusion
The use of skin staples to secure mesh in the Lichtenstein inguinal hernia repair significantly reduced the duration of the operation and was as effective as conventional mesh fixation with polypropylene in the short term.
Magnetic resonance imaging in evaluation of the common bile duct
Authors: Musella M , Barbalace G , Capparelli G , Carrano A , Castaldo P , Tamburrini O , Musella S 
Published: March 2003

Abstract

Background
The ideal method for evaluation of the common bile duct (CBD) before or during cholecystectomy remains controversial. Magnetic resonance cholangiography (MRC) is a new, promising technique. A prospective evaluation is reported.

Method
Sixty-one patients (45 women) were studied by MRC. There were 29 patients with symptomatic gallstone disease and without clinical, biochemical or ultrasonographic evidence of CBD stones (group 1); 28 of them also underwent intraoperative cholangiography (IOC). In addition, there were 21 patients with symptomatic gallstone disease, with mild biochemical and ultrasonographic signs of CBD involvement (group 2), of whom 19 underwent IOC, and 11 patients with symptomatic CBD stones (group 3), nine of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP) following MRC.

Results
MRC showed that no patient in group 1 and three patients in group 2 had CBD stones. Three patients (one in group 1, two in group 2) did not undergo IOC because of technical or clinical problems. In group 3, ERCP confirmed the results of MRC in nine patients. Two patients underwent open surgery because of ultrasonographic, MRC and radiographic signs of pancreatic malignancy.

Conclusion
MRC could replace IOC and ERCP for identification of asymptomatic CBD stones. In symptomatic patients MRC combined with other non-invasive imaging techniques can direct the surgeon to appropriate management.
Ignoring small lymph nodes can be a major cause of staging error in gastric cancer
Authors: Noda N , Sasako M , Yamaguchi N , Nakanishi Y 
Published: March 2003

Abstract

Background
Stage migration in gastric cancer confounds establishment of standard treatment according to stage.

Methods
To determine how closely lymph nodes should be examined to report correct staging, 402 node-positive patients were evaluated retrospectively. A total of 23 233 lymph nodes were reviewed histologically and their maximum dimension was measured. Another 254 nodes from 12 patients were used to evaluate shrinkage after fixation and preparation of the histological slide.

Results
Metastasis was detected in 3142 nodes, 1163 with well differentiated tumours (WDTs) and 1979 with poorly differentiated tumours (PDTs). Mean(s.d.) size of metastatic nodes was 7·80(5·08) mm in all, 8·44(5·74) mm in WDTs and 7·42(4·62) mm in PDTs. Both positive and negative nodes shrank between 10 and 20 per cent during histological processing. If all nodes 5 mm or less in size when fixed are ignored 37·8 per cent of all metastatic nodes will be missed. Downstaging will occur in 14·9 per cent and 4·2 per cent of the cases if all nodes less than 6 and 4 mm respectively are ignored.

Conclusion
To keep the rate of stage migration caused by this factor below 5 per cent, all lymph nodes 4 mm or more in size (5 mm when fresh) should be retrieved and examined.
Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis
Authors: Rau B , Pralle U , Mayer J M , Beger H G 
Published: March 2003

Abstract

Background
Early detection of infected pancreatic necrosis has a major impact on further management and outcome in acute pancreatitis. The aim of this study was to evaluate the clinical value of ultrasonographically guided fine-needle aspiration cytology (FNAC) in patients with necrotizing pancreatitis over an 8-year period.

Methods
From January 1988 to September 1996 193 (mean 2·0 (range 1–9) aspirations per patient) prospectively assessed FNACs guided ultrasonographically were performed in 98 patients with necrotizing pancreatitis proven by contrast-enhanced computed tomography. Aspirates were considered infected if either Gram stain and/or culture revealed micro-organisms.

Results
Ultrasonographically guided FNAC correctly diagnosed infection in 29 of 33 patients with infected necrosis a median of 13 days after onset of symptoms. Of 61 patients with sterile necrosis 55 were identified correctly as sterile by FNAC. There were six false-positive and four false-negative aspirates of which nine occurred during the first week of the disease. In four patients who did not undergo operation FNAC revealed Gram-negative organisms; however, in the absence of repeated aspirations, the positive results remained unconfirmed. An overall sensitivity of 88 per cent and a specificity of 90 per cent was obtained. No difference was found in biochemical and clinical parameters indicating systemic inflammatory response syndrome before each FNAC between patients with proven sterile or infected necrosis. All patients tolerated the procedure well and no major complications were observed.

Conclusion
Ultrasonographically guided FNAC is a fast and reliable technique for the diagnosis of infected necrosis. As complication rates are very low, the procedure can be repeated at short intervals to improve the diagnostic accuracy. Ultrasonographically guided FNAC is recommended for all patients with necrotizing pancreatitis in whom systemic inflammatory response syndrome persists beyond the first week after onset of symptoms.
Epidemiology and potential for prevention of abdominal aortic aneurysm
Authors: Wilmink A B M , Quick C R G 
Published: March 2003

Abstract

Background
Ruptured abdominal aortic aneurysm (AAA) is a common cause of death which is preventable by elective repair of an asymptomatic AAA.

Methods
The literature was reviewed with emphasis on epidemiological studies and population-based screening surveys.

Results and Conclusion
The prevalence of small AAA ranges between 3 and 8 per cent. The incidence of asymptomatic AAA seems to be increasing, although exact incidence estimates vary. The most important risk factors for AAA are male sex, age, family history and smoking. Hypertension is associated with a mildly increased risk, but diabetes is not associated with any increase. Primary prevention of AAA is not a realistic option. There is no evidence of an effective medical treatment to prevent growth of small AAAs, although trials with propranolol are under way. The only intervention to prevent death from aneurysm is elective repair of the asymptomatic lesion. Screening for asymptomatic AAA can reduce the incidence of rupture. However, further studies are needed to determine the cost effectiveness of screening compared with that of other health programmes.
Anomalous pancreaticobiliary junction without congenital choledochal cyst
Authors: Sugiyama M , Atomi Y 
Published: March 2003

Abstract

Background
Anomalous pancreaticobiliary junction (APBJ) without congenital choledochal cyst (CCC) carries a high risk of gallbladder carcinoma development. The aim of this study was to obtain information allowing early diagnosis and appropriate management.

Methods
The clinical features, imaging findings and surgical outcome of 18 patients with APBJ without CCC were analysed retrospectively.

Results
Fourteen patients had symptoms, including those of acute pancreatitis (five patients). In 16 patients the gallbladder showed abnormalities, including carcinoma (eight) and mucosal hyperplasia (11). Ultrasonography detected gallbladder carcinoma with 100 per cent sensitivity and mucosal hyperplasia with 91 per cent sensitivity. A long common channel was demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) in all patients, endoscopic ultrasonography in nine of ten, and magnetic resonance cholangiopancreatography (MRCP) in five of five. Five of eight patients with gallbladder carcinoma underwent extended cholecystectomy with bile duct excision. Three patients with cancer and eight with no cancer had cholecystectomy alone. None developed bile duct carcinoma or acute pancreatitis after operation. All patients without malignancy remained asymptomatic for a mean follow-up period of 4·7 years.

Conclusion
Prophylactic cholecystectomy is recommended for patients with APBJ without CCC. For early diagnosis of APBJ, gallbladder abnormalities on ultrasonography or acute pancreatitis of unknown aetiology should prompt further investigation with ERCP or less invasive imaging modalities such as endoscopic ultrasonography and MRCP.
Controlled trial of preperitoneal local anaesthetic for reducing pain following laparoscopic hernia repair
Authors: Deans G T , Wilson M S , Brough W A 
Published: March 2003

Abstract

Background
A prospective randomized trial was performed to determine whether local anaesthetic solutions injected into the preperitoneal space may provide additional pain relief following transabdominal preperitoneal laparoscopic hernia repair.

Methods
One hundred patients undergoing transabdominal preperitoneal laparoscopic hernia repair were allocated randomly to receive (1) bupivacaine 1·5 mg/kg, (2) bupivacaine 1·5 mg/kg with 1 in 200 000 adrenaline, (3) bupivacaine 3 mg/kg or (4) saline instilled into the preperitoneal space at the end of the operation. An independent clinical assessor determined the level of pain using a visual analogue pain score and noted the parenteral and oral analgesia requirements at 4, 8, 12 and 24 h after operation.

Results
At each of the time intervals, there was no significant difference between the groups for pain scores (at 24 h, P = 0·71) or the number of doses of either morphine (at 24 h, P = 0·73) or oral analgesia (at 24 h, P = 0·89). There was also no significant difference in the time to return to normal activity or work between the groups.

Conclusion
This study suggests that instilling local anaesthetic into the preperitoneal space has no significant effect on postoperative pain relief requirement following laparoscopic hernia repair. Other methods of reducing postoperative pain should be sought that may facilitate day-case laparoscopic hernia surgery.
Surgical endoscopic techniques in the diagnosis and follow-up of patients with lymphoma
Authors: Gossot D , de Kerviler E , Brice P , Mariette X , Meignin V , Cazals-Hatem D , Frija J , Célérier M 
Published: March 2003

Abstract

Background
In patients with lymphoma, tissue for histology can be obtained through image-guided techniques or by surgery. The aim of this study was to assess the efficacy of surgical endoscopic techniques in obtaining adequate tissue specimens.

Methods
Ninety-two patients with suspected or confirmed lymphoma were referred for a surgical biopsy of a deeply located intrathoracic or intra-abdominal mass or lymph node. The 86 patients who had surgery using a surgical endoscopic technique were included in this study. There were 54 men and 32 women, of mean age 34 (range 15–78) years. Most were selected directly for surgery while five previously had a failed computed tomography-guided biopsy. A total of 89 procedures were performed in 86 patients: laparoscopy (15 patients), thoracoscopy (61) and mediastinoscopy (13).

Results
No patient died. One intraoperative complication occurred during thoracoscopy (1 per cent). Two postoperative complications were noted (2 per cent). Three patients required conversion to open surgery (3 per cent). Adequate tissue for histology was obtained by surgical endoscopic procedures in 87 per cent. Twelve of 13 mediastinoscopies were successful. After thoracoscopy, the success rate was 92 per cent but only nine of 15 laparoscopies were considered successful.

Conclusion
In patients with lymphoma, surgical endoscopic techniques have a high diagnostic yield and a low morbidity rate. Barring exceptional circumstances these should be favoured rather than conventional open surgery.
Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction
Authors: Donckier V , Closset J , Van Gansbeke D , Zalcman M , Sy M , Houben J J , Lambilliotte J P 
Published: March 2003

Abstract

Background
In adhesive small bowel obstruction, the early recognition of complications such as strangulation or volvulus is essential to choose between surgical or conservative initial treatment. The objective of this study was to determine prospectively the contribution of computed tomography (CT) to decision making in the management of these patients.

Methods
Patients with suspected adhesive small bowel obstruction had CT at admission. Patients with CT signs of volvulus or strangulation and/or clinical signs of peritoneal irritation underwent urgent surgery; other patients had conservative initial treatment.

Results
Fifty-four patients were evaluated. CT demonstrated signs of strangulation or volvulus in 19 patients, including three with signs of peritoneal irritation. Within this group, urgent laparotomy was performed in 17 patients and confirmed the CT diagnosis in 16. Thirty-seven patients without clinical or CT signs of complications had initial conservative treatment; among them, seven of 12 with a distal obstruction determined by CT required a delayed operation for persisting obstruction, compared with two of 25 patients with a proximal obstruction (P&lt;0·01).

Conclusion
CT is useful for the evaluation of adhesive small bowel obstruction, to detect accurately patients with complications who require urgent operation and to determine the location of the adhesion, which represents a significant prognostic factor for success of conservative treatment.