bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic management of acute small bowel obstruction
Authors: Bailey I S , Rhodes M , O'Rourke N , Nathanson L , Fielding G 
Published: March 2003

Abstract

Background
Laparoscopic management of acute small bowel obstruction is hypothetically attractive but little is known of its clinical potential.

Methods
A retrospective study was undertaken of patients with acute small bowel obstruction requiring surgery, managed by a laparoscopic unit (LU; n = 69) and a general unit (GU; n = 70).

Results
Laparoscopy was performed in 55 patients (80 per cent) in the LU compared with ten (14 per cent) in the GU. Laparoscopic surgery completed treatment in 31 patients (45 per cent) in the LU and assisted in a further 15 (22 per cent). Patients treated laparoscopically were discharged earlier than those treated by laparotomy (median 3 (range 1–15) versus median 8 (range 1–46) days). Patients treated laparoscopically had a higher chance of early unplanned reoperation than those treated by laparotomy (five of 35 versusfour of 88) (P &lt; 0·05).

Conclusion
Laparoscopy can be performed in a high percentage of patients requiring surgery for acute small bowel obstruction. Hospital stay was reduced but the risk of early unplanned reoperation was increased in patients managed laparoscopically.
Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis
Authors: Galindo Gallego M , Fadrique B , Nieto M A , Calleja S , Fernández-Aceñero M J , Ais G , González J , Manzanares J J 
Published: March 2003

Abstract

Background
Several diagnostic aids have been developed to improve diagnosis in suspected appendicitis including ultrasonography and clinical diagnostic scoring. The aim of this study was to elaborate a new scoring system and to measure its accuracy in the preoperative diagnosis of appendicitis, comparing it with the available scoring systems.

Methods
The clinical, radiological and ultrasonographic data of 192 patients with suspected appendicitis were collected prospectively.

Results
Only six of the 12 variables analysed were shown to have prognostic significance. Using Bayesian methodology, a weight was given to each criterion and two overall scores were calculated (ultrasonographic and classical scores). A cut-off point was identified to separate patients who needed surgery and those for observation. The ultrasonographic score showed an 81 per cent sensitivity and a 96 per cent specificity, compared with 60 and 73 per cent respectively for the classical score.

Conclusion
Ultrasonography increases the diagnostic accuracy in patients with suspected acute appendicitis.
Non-invasive measurement of colonic blood flow distribution using laser Doppler imaging
Authors: Hajivassiliou C A , Greer K , Fisher A , Finlay I G 
Published: March 2003

Abstract

Background
This study tested a prototype laser Doppler scanner for the measurement of human colonic blood flow.

Methods
Blood flow distribution was assessed in human colon during operation in six controls and in six patients with inflammatory bowel disease undergoing colectomy. Image processing software analysed several hundred reading points, expressing average flow in perfusion units.

Results
Blood flow in the colon was not significantly lower in the control group than in patients with inflammatory bowel disease (mean(s.e.m.) 297·8(24·5) versus347.2(59·0) perfusion units, P=0·12). Intestinal colonic mural blood supply was demonstrated up to a distance of 6 cm and ischaemia demarcation lines were identified before the onset of visible changes.

Conclusion
This prototype laser Doppler flowscanner overcomes the previous limitations of laser Doppler flowmeters and may have many clinical and research applications.
Functional results after transanal rectal advancement flap repair of trans-sphincteric fistula
Authors: Kreis M E , Jehle E C , Ohlemann M , Becker H D , Starlinger M J 
Published: March 2003

Abstract

Background
Transanal rectal advancement flap repair is an operation to treat trans-sphincteric fistula which leaves the external sphincter muscle essentially untouched. Anal sphincter function was evaluated prospectively before and after this procedure.

Methods
Anorectal manometry was performed in 24 patients before operation and 3 months after surgery. A detailed standardized questionnaire on faecal continence was answered before surgery, then at 3 and 48 months after surgery.

Results
No significant differences were seen between mean(s.e.m.) preoperative and postoperative values for maximum squeeze pressure (100·0(9·7) versus118·0(12·7) mmHg), maximum resting pressure (56·6(4·3) versus 52·8(4·1) mmHg), rectal compliance (4·4(0·6) versus 3·5(0·5) ml/mmHg) or any other parameter of anorectal manometry. The questionnaire revealed the occurrence of minor incontinence in two patients following surgery, which remained unchanged for 4 years. Three other patients had continence disturbances 4 years after surgery which were probably unrelated to the procedure.

Conclusion
In addition to high success rates, transanal rectal advancement flap repair also yields excellent functional results. This procedure should be performed for trans-sphincteric fistula in place of alternative treatments whenever feasible.
Management of malignant oesophageal obstruction with self-expanding metallic stents
Authors: Cowling M G , Hale H , Grundy A 
Published: March 2003

Abstract

Background
The use of self-expanding metal stents for palliation of malignant dysphagia is increasing. Experience in 70 patients was reviewed with respect to the value of stenting and management of the complications encountered.

Methods
Oesophageal stents were inserted in 70 patients (42 men) of mean age 73 years with malignant oesophageal obstruction. Data regarding stent insertion and degree of dysphagia were gathered prospectively.

Results
Seventy-six stents were placed in 70 patients. By the end of the study 57 patients had died and 13 were still alive. Three patients died within 3 days of stent insertion and dysphagia was relieved in 64 of the 67 patients remaining. Stent migration, tumour ingrowth and overgrowth, and food impaction were encountered during follow-up in eight patients.

Conclusion
Insertion of self-expanding metal stents for the palliation of malignant oesophageal obstruction is a successful therapy which can be carried out with relative ease. Palliation of dysphagia with an appropriate stent can be expected in up to 95 per cent of patients.
Randomized multicentre trial of the influence of recombinant human erythropoietin on intraoperative and postoperative transfusion need in anaemic patients undergoing right hemicolectomy for carcinoma
Authors: Kettelhack C , Hönes C , Messinger D , Schlag P M 
Published: March 2003

Abstract

Background
The possible immunosuppressive effect of blood transfusion and its influence on survival after surgery for cancer makes it worthwhile to seek methods to avoid transfusion wherever possible. Patients with right-sided colonic cancer are frequently anaemic. Such patients were entered into a study that employed erythropoietin to avoid homologous transfusion.

Methods
In a prospectively randomized double-blind placebo-controlled multicentre trial, patients with moderate anaemia (haemoglobin concentration greater than 8·5 g/dl and less than or equal to 13·5 g/dl) presenting with right-sided colonic cancer and scheduled for hemicolectomy were treated with recombinant human erythropoietin (epoetin β) 20000 units/day subcutaneously or placebo for at least 10 days over the operative period.

Results
Perioperative treatment with epoetin β was well tolerated and there were no significant differences in morbidity and mortality. Following hemicolectomy, median cumulative blood loss in the two groups was similar (epoetin β 440 ml versus placebo 345 ml). Sixteen (33 per cent) of 48 patients treated with epoetin β and 15 (28 per cent) of 54 in the placebo group received perioperative blood transfusions (P not significant). The increase in reticulocyte count between baseline and the last preoperative value was more pronounced in the epoetin β group than in those receiving placebo (P = 0·036).

Conclusion
Despite the perioperative administration of 20000 units erythropoietin per day for at least 10 days, it was not possible to reduce the intraoperative and postoperative transfusion need. None the less, a positive change in the haematological variables of treated patients was clearly discernible. The negative result may be due to the short treatment interval and to iron deficiency, which was present in the majority of patients. The general change of attitude towards allogeneic blood transfusion is demonstrated by the overall low frequency of blood transfusion in this study.
Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon
Authors: Turégano-Fuentes F , Echenagusia-Belda A , Simó-Muerza G , Camuñez F , Muñoz-Jimenez F , Del Valle Hernandez E , Quintans-Rodriguez A 
Published: March 2003

Abstract

Background
Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes.

Methods
Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists.

Results
The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patients, three of whom underwent emergency colostomy.

Conclusion
Transanal SEMS placement is an appealing method for the relief of obstruction in selected patients, obviating the need for palliative colostomy.
Iron metabolism and erythropoiesis after surgery
Authors: van Iperen C E , Kraaijenhagen R J , Biesma D H , Beguin Y , Marx J J M , van de Wiel A 
Published: March 2003

Abstract

Background
This was a prospective study comparing the effect of major and minor surgery on haematological variables concerning erythropoiesis, iron metabolism and acute-phase response proteins.

Methods
Thirty-one otherwise healthy patients, 15 having major orthopaedic surgery and 16 undergoing minor surgery, were studied. Blood samples were taken before surgery and 1, 4, 10 and 28 days after operation.

Results
Haemoglobin concentration was decreased for up to 4 weeks after surgery. Serum erythropoietin concentration and reticulocyte count were raised after major surgery only. Serum iron concentration dropped the day after major (to 23 per cent of its preoperative level) and minor (to 46 per cent of its preoperative level) surgery and remained lower for up to 28 days after major surgery. Serum transferrin concentration and transferrin saturation decreased after both types of surgery while ferritin concentration increased. Serum transferrin receptor concentration increased only 4 weeks after major surgery (P &lt; 0·01). The interleukin 6 peak (day 1) was greater after major than minor surgery, as was the C-reactive protein peak (day 4).

Conclusion
Both major and minor surgery induce a state of hypoferraemia in the presence of adequate iron stores. The degree of this transient form of ‘anaemia of chronic disease’ is related to the extent of surgery. Iron supplementation in the first weeks after surgery (if iron stores were normal before operation) is ineffective.
An 8-year experience of hepatic resection: indications and outcome
Authors: Finch M D , Crosbie J L , Currie E , Garden O J 
Published: March 2003

Abstract

Background
Most reports highlighting decreasing operative morbidity and mortality rates following hepatic resection have focused on the management of metastatic disease. Information on the full range of hepatic disease is lacking.

Methods
The indications for hepatic resection in a specialist hepatobiliary unit have been reviewed and the operative morbidity and mortality rates assessed.

Results
Among 129 patients undergoing 133 hepatic resections between October 1988 and September 1996, the principal indication for resection was hepatic malignancy (102 resections), metastatic in 66 cases. Other indications included contiguous tumour (n = 20), primary tumour (n = 16) and benign disease (n = 31). Some 116 procedures were classical anatomical resections. Blood transfusion was required in 40 per cent of cases but major morbidity occurred in 20 per cent. There were six deaths following surgery, five of which were due to hepatic failure and followed resection for malignancy or trauma. The 3-year survival rate in patients resected for colorectal metastases was 65 per cent.

Conclusion
This experience has demonstrated an increasing role for hepatic resection in a wide variety of hepatobiliary pathologies. Despite the low postoperative mortality rate, the significant risk of complications in the postoperative period serves to emphasize the need for careful selection of patients for such surgery, which should be undertaken in specialist centres.
Prospective randomized trial of systemic antibiotics in patients undergoing liver resection
Authors: Wu C-C , Yeh D-C , Lin M-C , Liu T-J , P'Eng F-K 
Published: March 2003

Abstract

Background
Systemic antibiotics are administered frequently after hepatectomy to prevent infective complications, but their effectiveness is uncertain.

Methods
A total of 127 patients with liver tumours were prospectively randomized into two groups after hepatectomy: in group 1 (62 patients) no antibiotics were given until the appearance of infective complications; in group 2 (65 patients) intravenous cephazolin 1 g every 6 h and gentamicin 80 mg every 8 h were given for 7 days. On the day before surgery all patients received bowel preparation by clear liquid diet and oral antibiotics (neomycin 1 g and erythromycin 1 g, given together in three doses).

Results
The infective complication rate was 23 per cent in both groups (P = 0·95). The hospital costs were higher in group 2 (P &lt; 0·001). Of the group 1 patients, 51 (82 per cent) did not require antibiotic treatment. No patient in either group died after hepatectomy.

Conclusion
Postoperative systemic antibiotics cannot prevent infective complications, and their routine use after hepatectomy is unnecessary and costly. The use of antibiotics should be delayed until infective complications and persistent septic symptoms occur.
Reconstruction after total gastrectomy by the interposition of a double jejunal pouch using a double stapling technique
Authors: Ikeda M , Ueda T , Shiba T 
Published: March 2003

Abstract

Background
After total gastrectomy, sustaining good nutrition is extremely important for maintaining quality of life. A technique of neogastric pouch formation based on current physiological reconstructive principles is presented.

Methods
The use of a modified interpositioned double jejunal pouch following total gastrectomy in 18 patients with cancer was reviewed. This technique results in a complete pouch and uses a double stapling technique with site-specific anastomosis between the oesophagus and pouch, in which a Hisoid angle is created.

Results
There were no anastomotic leaks and pouch blood flow was within normal expected limits. Mean oesophageal pH above 7·0 for one 24-h period was 7·7 per cent. Emptying half-time was 67·8 min. After 2 years mean body-weight was 98·3 per cent of expected, mean food volume was 94·0 per cent of expected and mean meal frequency was 3·0 per day.

Conclusion
This form of gastric reconstruction is an acceptable procedure which improves the quality of life in patients undergoing total gastrectomy.
Assessment of a scoring system for breast imaging
Authors: Roche N A , Given-Wilson R M , Thomas V A , Sacks N P M 
Published: March 2003

Abstract

Background
Triple assessment is the standard method of assessing symptomatic breast lumps. There is an accepted format for reporting cytology but not for the reporting of mammograms or breast ultrasonographic images. This study describes a scoring system for reporting breast imaging methods.

Methods
Patients with symptomatic breast lumps seen during 1 year were included. All patients underwent triple assessment. Imaging studies were reported using a grading system from 1 to 5. The results of triple assessment were compared with the final histology.

Results
Some 127 women had both mammography and ultrasonographic imaging; the final grade was identical in 60 per cent. The positive predictive value of imaging reported as grade 5 or 4 combined with cytology of C5 or C4 was 100 per cent. All lesions with C3 cytology and benign imaging were benign on histological examination whereas if a C3 grade was combined with imaging grade 5 or 4, all the lesions were malignant.

Conclusion
Combining the imaging grade with the results of aspiration cytology and clinical examination often predicts the final histology in patients with breast disease.
Outcome following laparoscopic resection for colorectal cancer
Authors: Psaila J , Bulley S H , Ewings P , Sheffield J P , Kennedy R H 
Published: March 2003

Abstract

Background
A prospective comparison of laparoscopic or laparoscopically assisted colorectal resection versus open resection has been undertaken to evaluate early benefits and cost implications.

Methods
Consecutive patients with colorectal cancer underwent either elective laparoscopic (n = 25) or open (n = 29) resection.

Results
Mean hospital stay was significantly shorter in the laparoscopic group: 10·7 versus 17·8 days. Mean morphine requirements were less in patients who had laparoscopic resection and their recovery, as measured by the dynamometer hand grip and the SF-36 symptom score, was more rapid. Adequate tumour clearance was achieved in the laparoscopic group. In both groups, the number of lymph nodes harvested was similar. Port-site or wound recurrence has not been observed at a median follow-up of 28 months.

Conclusion
When laparoscopic colorectal resection is possible, there are significant early benefits for patients.
Abdominal ultrasonography in the diagnosis of colonic cancer
Authors: Richardson N G B , Heriot A G , Kumar D , Joseph A E A 
Published: March 2003

Abstract

Background
Colonic cancer is normally diagnosed by barium enema or colonoscopy. Neither investigation is ideal, especially in the elderly patient. This study investigates the potential role of abdominal ultrasonography in the diagnosis of colorectal carcinoma.

Methods
Fifty-four patients with known or suspected colonic carcinoma were referred for abdominal ultrasonography. A single radiologist performed scans on these patients and the site of any colonic mass or wall thickening considered to be consistent with a colonic carcinoma was reported. All carcinomas were confirmed by histology on tissue obtained at colonoscopy or surgery against which the ultrasonographic diagnosis was compared. Colonic masses detected in patients undergoing routine abdominal ultrasonography for abdominal symptoms were also reported.

Results
Forty-five of the 54 patients referred had colonic carcinoma and abdominal ultrasonography detected 43 of the tumours and correctly identified the site of 41. The sensitivity, specificity and accuracy of abdominal ultrasonography in the detection of colonic tumours considered to be consistent with a colonic carcinoma was 96, 67 and 91 per cent respectively. Seven tumours were identified in patients referred before any other investigation had been carried out.

Conclusion
Abdominal ultrasonography may detect a colonic mass or wall thickening consistent with a colonic carcinoma with a high degree of accuracy and may be useful when barium enema or colonoscopy is not possible.
Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization
Authors: Liu C-L , Ngan H , Lo C M , Fan S T 
Published: March 2003

Abstract

Background
Transarterial oily chemoembolization (TOCE) is frequently employed as a non-operative treatment for hepatocellular carcinoma (HCC). Serious complications of TOCE are well known but ruptured HCC as a fatal complication of TOCE has not been reported previously.

Methods
A retrospective study was performed on all patients who received TOCE for treatment of HCC from January 1989 to October 1996; the complication of ruptured HCC within 2 weeks from the procedure was recorded.

Results
During the study period, 391 patients received a total of 1443 sessions of TOCE (mean 3·7 sessions per patient) for the treatment of HCC, with an overall median survival of 10·4 months. Six patients developed ruptured tumour within 2 weeks after TOCE, resulting in an overall incidence of 1·5 per cent per patient or 0·4 per cent per procedure. All except one patient died 1–25 days after tumour rupture. Factors common to these six patients included: (1) male sex; (2) large tumour size (range 8–17 cm in diameter); (3) tumour located in the right lobe of the liver; (4) tumour ruptured after the first session of TOCE; and (5) TOCE performed as primary treatment without previous hepatic resection.

Conclusion
Ruptured HCC is a serious complication of TOCE although the incidence is low. It occurred predominantly in men after the first session of TOCE for a large irresectable tumour of the right lobe.
Experimental study of a novel phospholipase A2 inhibitor in acute pancreatitis
Authors: Uhl W , Schrag H-J , Schmitter N , Aufenanger J , Nevalainen T J , Büchler M W 
Published: March 2003

Abstract

Background
In acute pancreatitis, two different types of secretory phospholipase A2 (PLA2) have been found: pancreatic type I PLA2 and non-pancreatic type II PLA2. In this study a potent new PLA2 inhibitor effective against type II PLA2 was used in an experimental model of acute pancreatitis.

Methods
In 70 rats the efficacy of the compound was analysed in two experimental models of acute pancreatitis: cerulein- and taurocholate-induced acute pancreatitis, imitating mild and severe disease respectively. Serum rat type I PLA2 protein concentration and type I and type II PLA2 catalytic activities were measured while giving the inhibitor therapeutically. In a prophylactic protocol the effect on histology was analysed.

Results
In the taurocholate model, type II PLA2 activity was found to be nine-fold higher than in the cerulein model (P &lt; 0·002), whereas the activity of type I PLA2 was not increased. The inhibitor significantly decreased serum type II PLA2 activity in the taurocholate model of acute pancreatitis (P &lt; 0·05) but type I PLA2 protein concentration and type I PLA2 activity were not affected. The inhibitor also reduced histological tissue damage, with significant differences at 3 and 12 h (P &lt; 0·01).

Conclusion
The PLA2 inhibitor significantly reduced type II PLA2 activity and was able to protect the pancreas against tissue damage. PLA2 inhibition offers the possibility of a treatment for acute pancreatitis.