bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unique clinical characteristics of primary hyperparathyroidism in India
Authors: Mishra S K , Agarwal G , Kar D K , Gupta S K , Mithal A , Rastad J 
Published: March 2003

Abstract

Background
The features of primary hyperparathyroidism (PHPT) in developing countries have rarely been examined. This study explored the clinical characteristics of PHPT in India with the hypothesis that this may improve understanding of the pathogenesis of the disease worldwide.

Methods
Consecutive patients with PHPT (24 women, five men) were examined prospectively before and after parathyroidectomy.

Results
All patients had osteitis fibrosa cystica with a median symptom duration of 2·5 (range 1–26) years. Single or multiple fragility fractures were present in 14 patients (eight were bedridden); 20 had brown tumours. Mean preoperative serum calcium was 3·1 mmol/l, while mean serum intact parathyroid hormone (iPTH) and total alkaline phosphatase (ALP) levels were 17-fold and 12-fold higher than normal respectively. Nine patients had overt renal damage, mainly nephrocalcinosis. Parathyroidectomy invariably resulted in severe hypocalcaemia, necessitating long-term vitamin D treatment. The mean parathyroid gland weight was 8·6 (range 2·0–36·6) g and features of carcinoma were found in four patients. Serum calcidiol level correlated inversely (P &lt; 0·05) with serum iPTH and ALP, and parathyroid gland weight.

Conclusion
PHPT in Indians is a severe, symptomatic disorder with skeletal, muscular and renal manifestations at a young age. The presence of this severe variant of PHPT in vitamin D-sufficient Indians, and the lack of skeletal disease in other vitamin D-deficient populations, raises the possibility of additional pathogenetic factors.
Probability of axillary node involvement in patients with tubular carcinoma of the breast
Authors: Papadatos G , Rangan A M , Psarianos T , Ung O , Taylor R , Boyages J 
Published: March 2003

Abstract

Background
The aim of this study was to investigate the frequency of axillary metastasis in women with tubular carcinoma (TC) of the breast.

Methods
Women who underwent axillary dissection for TC in the Western Sydney area (1984–1995) were identified retrospectively through a search of computerized records. A centralized pathology review was performed and tumours were classified as pure tubular (22) or mixed tubular (nine), on the basis of the invasive component containing 90 per cent or more, or 75–90 per cent tubule formation respectively. A Medline search of the literature was undertaken to compile a collective series (20 studies with a total of 680 patients) to address the frequency of nodal involvement in TC. A quantitative meta-analysis was used to combine the results of these studies.

Results
The overall frequency of nodal metastasis was five of 31 (16 per cent); one of 22 pure tubular and four of nine mixed tumours (P = 0·019). None of the tumours with a diameter of 10 mm or less (n = 16) had nodal metastasis compared with five of 15 larger tumours (P = 0·018). The meta-analysis of 680 women showed an overall frequency of nodal metastasis in TC of 13·8 (95 per cent confidence interval 9·3–18·3) per cent. The frequency of nodal involvement was 6·6 (1·7–11·4) per cent in pure TC (n = 244) and 25·0 (12·5–37·6) per cent in mixed TC (n = 149).

Conclusion
A case may be made for observing the clinically negative axilla in women with a small TC (10 mm or less in diameter).
Risk factors for complications following resection of large gastric cancer
Authors: Yasuda K , Shiraishi N , Adachi Y , Inomata M , Sato K , Kitano S 
Published: March 2003

Abstract

Background
Although there is a low mortality rate after gastrectomy in Japan, most studies include many early gastric cancers. There have been few studies on the morbidity after gastrectomy for advanced gastric cancer. The aim of this study was to clarify the characteristics and risk factors for postoperative complications after resection of large gastric cancers based on three clinical factors: patient, operation and tumour.

Methods
A retrospective study was carried out on 97 patients with a gastric tumour measuring 10 cm or more in diameter. Postoperative complications were recorded and the patients were divided into two groups: 38 with complications and 59 without. Patient, operative and tumour findings were compared between the two groups.

Results
Overall morbidity and mortality rates were 39 and 7 per cent respectively. The most frequent complication was pleural effusion (17 per cent), followed by anastomotic leakage (14 per cent), abdominal abscess (12 per cent), wound infection (12 per cent), pancreatic leakage (8 per cent) and peritonitis (6 per cent). Risk factors associated with postoperative complications were operating time (400 versus 337 min, P &lt; 0·01), blood loss (1338 versus 782 ml, P &lt; 0·01), pancreatic invasion (26 versus 8 per cent, P &lt; 0·05) and raised serum carcinoembryonic antigen (CEA) level (5 ng/ml or greater) (36 versus 17 per cent, P &lt; 0·05), independent of patient age, nutritional status, type of gastrectomy, splenectomy or pancreatectomy, extent of lymph node dissection, tumour location, size and stage of disease.

Conclusion
Even in Japan, the morbidity of gastrectomy for large gastric cancer is high and associated with operating time, blood loss, pancreatic invasion and serum CEA level.
Clinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma
Authors: Uenishi T , Hirohashi K , Kubo S , Yamamoto T , Yamazaki O , Kinoshita H 
Published: March 2003

Abstract

Background
The prognosis for patients with intrahepatic cholangiocarcinoma differs according to macroscopic type. The identification of clinical and pathological features that predict outcome in patients with mass-forming intrahepatic cholangiocarcinoma is required in order to determine optimal surgical strategies for patients with this type of tumour.

Methods
The details of 35 patients with resected mass-forming intrahepatic cholangiocarcinomas were analysed retrospectively. Univariate analysis of potential prognostic factors was performed.

Results
The cumulative survival rate at 1, 3 and 5 years after operation was 58, 33 and 33 per cent respectively. Patients with stage II tumours had a better outcome than those with advanced stage tumours. By univariate analysis, lymphatic invasion, lymph node metastasis, intrahepatic satellite lesions and microscopic resection margin involvement were found to be highly significant variables and were identified as possible risk factors for a poor outcome after operation.

Conclusion
When frozen-section examination of lymph nodes reveals negative nodal metastasis, extensive anatomical hepatic resection is indicated for mass-forming intrahepatic cholangiocarcinomas. Intraoperative frozen-section examination of the resection margin to confirm the absence of cancer cells is recommended.
Tumour location and the effects of preoperative radiotherapy in the treatment of rectal cancer
Authors: Holm T , Johansson H , Rutqvist L E , Cedermark B 
Published: March 2003

Abstract

Background
Preoperative radiotherapy improves local control and survival in rectal cancer, but may also increase postoperative morbidity and mortality rates. Establishing selection criteria for preoperative radiotherapy is crucial. The tumour level above the anus may be one such criterion. The effect of preoperative radiotherapy in relation to the distance between the tumour and the anus was therefore assessed.

Methods
In 457 patients operated for cure included in the Stockholm II Trial the local recurrence rate in irradiated and non-irradiated patients was analysed in relation to the tumour location (low, mid or upper rectum).

Results
Radiotherapy reduced the local recurrence rate from 30 to 20 per cent in low rectal cancer, from 25 to 11 per cent in mid rectal cancer and from 21 to 5 per cent for tumours in the upper rectum.

Conclusion
With conventional surgical techniques preoperative radiotherapy plays an important role in rectal cancer irrespective of the location of the tumour. To irradiate only patients with tumours in the lower rectum and to omit this treatment for patients with tumours in the mid and upper rectum cannot be recommended. Whether this statement is valid with standardized total mesorectal excision (TME) surgery is not known. Until this knowledge is available the current indications for preoperative radiotherapy should probably also be used with TME surgery.
Totally extraperitoneal endoscopic repair of recurrent inguinal hernia
Authors: van der Hem J A , Hamming J F , Meeuwis J D , Oostvogel H J M 
Published: March 2003

Abstract

Background
Conventional repair of recurrent inguinal hernia is associated with a re-recurrence rate as high as 35 per cent. Endoscopic mesh repair has promising results regarding both recurrence and complication rates.

Methods
In a retrospective review, the results of endoscopic totally extraperitoneal repair were evaluated in 104 patients with 108 recurrent hernias. Follow-up was at least 1 year. Type of recurrence, time of occurrence after previous repair, duration of surgery, complications, duration of hospital stay and number of re-recurrences were evaluated.

Results
Follow-up ranged from 12 to 29 (mean 16) months. Forty-three recurrences were direct, 41 indirect and 15 combined; one was a femoral hernia. Median time to previous operation was 36 months (range 8 days to 42 years). Median duration of surgery was 63 (range 25–160) min. While there were no complications during operation, 12 patients (12 per cent) had a postoperative complication. Two direct re-recurrences (2 per cent) occurred as a result of inadequate positioning of the prosthetic mesh.

Conclusion
The endoscopic totally extraperitoneal technique is safe and effective for the repair of recurrent inguinal hernia.
Recombinant soluble P-selectin glycoprotein ligand 1 moderates local and remote injuries following experimental lower-torso ischaemia
Authors: Kyriakides C , Favuzza J , Wang Y , Austen W G , Moore F D , Hechtman H B 
Published: March 2003

Abstract

Background
A central role for the polymorphonuclear leucocyte (PMN) in skeletal muscle ischaemia–reperfusion has been demonstrated by the observation that PMN depletion reduced local and remote pulmonary vascular permeability. This study investigated the role of recombinant soluble P-selectin glycoprotein ligand–immunoglobulin fusion protein (rPSGL-Ig), a P- and E-selectin antagonist, in moderating injury.

Methods
Mice underwent 2 h of hindlimb ischaemia and 3 h of reperfusion. Muscle and lung vascular permeability index (PI) was assessed by extravasation of 125I-radiolabelled albumin. Lung myelo peroxidase (MPO) activity was also measured.

Results
In mice treated with rPSGL-Ig 1 mg/kg before reperfusion (n = 12) muscle PI was reduced by 40 per cent, whereas it was moderated by 20 per cent in animals treated 30 min after reperfusion (n = 15). Lung PI in mice treated with rPSGL-Ig before (n = 12) and 30 min after (n = 15) reperfusion was reduced by over 99 and 98 per cent respectively. Lung MPO activity in mice treated with rPSGL-Ig before (n = 10) and 30 min after (n = 12) reperfusion was reduced by 68 and 58 per cent respectively. Treatment with rPSGL-Ig 1 h after reperfusion, or with m20ek.Fc 1 mg/kg (n = 9; negative control for rPSGL-Ig which is inactive for selectin binding) before reperfusion failed significantly to moderate local or remote organ injury.

Conclusion
Selectin blockade moderated local skeletal muscle and remote lung injury following hindlimb ischaemia–reperfusion. Significantly, delayed antiselectin therapy also decreased injury.
Endotoxin, cytokines and lipid peroxides in children with intussusception
Authors: Willetts I E , Kite P , Barclay G R , Banks R E , Rumley A , Allgar V , Stringer M D 
Published: March 2003

Abstract

Background
Intussusception is a relatively common paediatric surgical emergency. The aim of this study was to investigate selected inflammatory mediators in children with acute intussusception and to identify potentially useful plasma markers of clinical outcome.

Methods
Clinical, radiographic, operative and pathological details were recorded prospectively of all children presenting to a single institution with a confirmed diagnosis of acute intussusception during 1 year. Paired acute and convalescent venous blood samples were collected in a standard manner for blinded analysis of the following: malondialdehyde, C-reactive protein (CRP), interleukin (IL) 6, neopterin, tumour necrosis factor α, endotoxin, and immunoglobulin (Ig) G and IgM antiendotoxin core antibody (EndoCAb).

Results
Thirty-two consecutive children (23 boys, nine girls) with a median age of 4 months were studied. Acute ileocolic intussusception was managed by air enema reduction (n = 19), operative reduction (n = 8) or surgical resection (n = 5). Peripheral blood cultures were sterile. Acute levels of plasma IL-6, neopterin and CRP were significantly raised in comparison to both normal laboratory ranges and convalescent samples (P &lt; 0·001). Using stepwise discriminant analysis, CRP was identified as the best variable at distinguishing between the three treatment groups (P &lt; 0·001). IgM EndoCAb concentrations were significantly greater in the convalescent sera of all the patients (P &lt; 0·001).

Conclusion
Acute ileocolic intussusception in childhood is associated with endotoxinaemia and significantly raised levels of circulating inflammatory cytokines. Plasma CRP at diagnosis showed a statistically significant positive correlation with disease severity.
Clinical and economic evaluation of surgical treatments for faecal incontinence
Authors: Malouf A J , Chambers M G , Kamm M A 
Published: March 2003

Abstract

Background
Faecal incontinence affects 1–2 per cent of the adult population. While many patients can be managed successfully with conservative therapy, a small proportion require surgery. Improved imaging techniques and technological advances have led to the availability of a wide range of surgical treatments. Decision-makers increasingly require clinical and cost-effectiveness studies of surgical treatments for faecal incontinence. This review examines the practical aspects of undertaking such studies.

Methods
The practical issues related to different aetiologies, different types of treatment, defining outcomes, the hidden costs of the condition and its treatment, the rapid changes in technology and issues of patient choice were all considered. A Medline search was undertaken to identify relevant publications, and the reference lists of identified papers were scanned manually.

Results
There are few randomized controlled studies and those that have been performed have been limited in their scope. There has also been very limited health economic analysis undertaken. Strategies for conducting such studies, and the criteria they use, have been outlined.

Conclusion
Randomized trials have a limited role in this setting because of variations in aetiology, difficulty in standardizing procedures, continuing evolution of devices, small patient numbers, concerns for patient choice and the need for long-term follow-up. Issues to be addressed when evaluating interventions for faecal incontinence include choosing appropriate measures of surgical outcome, using new continence scoring systems and tools for quality-of-life assessment, and choosing appropriate cost perspectives and time horizons for economic evaluation.
Performance indicators from routine hospital data: death following aortic surgery as a potential measure of quality of care
Authors: Rigby K A , Palfreyman S , Michaels J A 
Published: March 2003

Abstract

Background
There is increasing pressure to monitor surgical performance. In the UK, the Department of Health has produced clinical indicators based on routine data to monitor performance. This study analysed whether such data could measure performance in aortic surgery.

Methods
Routine hospital data on postoperative mortality were collected for 1995–1997 in the Trent region. Procedural and diagnostic codes, modes of admission, districts of residence, treatment and specialty data were compared with audit data and the Operating Theatre Information System.

Results:
Inaccuracies in the Health Resource Group (HRG) codes meant that 21·4 per cent of elective aortic cases (HRG Q02) were probably emergencies and 26 per cent of probable ruptured aneurysms were not coded as a vascular emergency. Case mix and patient selection introduced a bias, apparent between tertiary and district general hospitals. For patients aged over 80 years, two district hospitals undertook no elective aortic surgery; the rate for emergency aortic surgery varied between 16 and 25 per cent in the district hospitals, and was 77 per cent in the tertiary centre.

Conclusion
Crude mortality rates used as an indicator of performance are subject to bias and distortion owing to the collection of incorrect information, variation in patient selection between hospitals and case-mix differences. There was a considerable variation in selection and outcomes of patients undergoing aortic surgery in this study.
Prospective randomized trial of polypropylene mesh compared with nylon darn in inguinal hernia repair
Authors: Koukourou A , Lyon W , Rice J , Wattchow D A 
Published: March 2003

Abstract

Background
The main aim of this study was to evaluate outcome in patients undergoing open inguinal hernia repair with either polypropylene mesh or nylon darn.

Methods
This was a randomized prospective trial of patients who underwent the procedure with follow-up at 1 week, 6 weeks and 1 year.

Results
One hundred men underwent 105 repairs by consultant surgeons and registrars; there were 54 mesh and 51 nylon repairs. Demographics in both groups were similar at the start of the trial, as were the types of hernia. The pain scores at 24, 48 and 72 h were similar, as was the duration of analgesia requirement. There were no differences in early or late complications. Return to normal activity in each group was also similar, with a mean time of 5 weeks. The recurrence rate in both groups was comparable: 4 per cent after mesh repair and 4 per cent after darn repair at 1-year review.

Conclusion
Open inguinal hernia repair with a nylon darn was equivalent to polypropylene mesh with respect to early measures of postoperative outcome and recurrence at 1 year.
Gender differences in long-term survival of patients with colorectal cancer
Authors: Wichmann M W , Müller C , Hornung H M , Lau-Werner U , Schildberg F W 
Published: March 2003

Abstract

Background
Significant differences exist in the immunological response to surgery. This raises the possibility that gender differences exist concerning the outcome after curative colorectal cancer resection.

Methods
To study this hypothesis, a database of patients with colorectal cancer was analysed prospectively.

Results
Some 894 patients were included, 500 (55·9 per cent) were men and 394 (44·1 per cent) were women. Median follow-up was 54·5 months for the entire group and 63·3 months for survivors. The mean(s.e.m.) patient age was 65·3(0·4) years (women 66·1(0·6), men 64·7(0·5) years; P &lt; 0·05). Women lived significantly longer after cancer resection than men (57·8(1·5) versus 52·0(1·3) months; P &lt; 0·05, log rank 0·009). Disease-free survival was significantly longer in women than in men (51·6(1·7) versus 46·0(1·4) months; P &lt; 0·05). Subgroup analysis revealed significant gender differences in Union Internacional Contra la Cancrum (UICC) stages I (n = 195, log rank 0·01) and UICC IV (n = 38, log rank 0·021). Survival analysis after rectal cancer resection revealed significant advantages for women (log rank 0·02), while no gender differences were detected when comparing patients after resection for colonic cancer. Moreover, patients older than 50 years (n = 635) showed significant gender-related survival differences (log rank 0·015).

Conclusion
Significant gender differences following curative rectal cancer resection were observed. In women disease-free and overall survival were significantly longer. Whether or not these gender differences are related to gender-specific immune functions or to other gender-related local or systemic factors remains to be determined.
Portsmouth POSSUM models for abdominal aortic aneurysm surgery
Authors: Prytherch D R , Sutton G L , Boyle J R 
Published: March 2003

Abstract

Background
The Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM) equation permits comparative audit that allows for differences in case mix. The methodology has previously been shown accurately to model general surgical and vascular surgical patients. Patients with a ruptured abdominal aortic aneurysm (AAA) are, however, very different from elective patients and it may be hypothesized that they require their own specific risk model.

Methods
POSSUM data on 444 (213 emergency, 231 elective) admissions for AAA surgery between August 1993 and July 2000 were analysed using the P-POSSUM equation for general surgery and the P-POSSUM equations developed for vascular surgery.

Results
All equations successfully modelled the elective aneurysms but failed to fit the emergency aneurysms, and the elective and emergency aneurysms combined. This suggested that admission method (not a POSSUM data item) is an important factor for patients with AAA. However, with these data it was not possible to generate a model, including admission method, that successfully modelled the combined elective and emergency data. The 213 emergency aneurysm repairs were divided into two groups by operation date. The first 106 (training set) were used to form logistic regression models following the P-POSSUM methodology. These models were found successfully to fit the remaining 107 records (test set) on prospective application (χ2 = 4·50, 4 d.f., P = 0·345).

Conclusion
Ruptured AAAs appear to be different from elective AAAs and other vascular cases and require their own risk model.
Resection rate and effect of postoperative chemotherapy on survival after surgery for colorectal liver metastases
Authors: Figueras J , Valls C , Rafecas A , Fabregat J , Ramos E , Jaurrieta E 
Published: March 2003

Abstract

Background
The purpose of this study was to investigate whether adjuvant therapy can improve survival after curative resection of colorectal liver metastases.

Methods
Some 235 patients had 256 liver resections for metastatic colorectal cancer. There were no predefined criteria for resectability with regard either to the number or size of the tumours or to locoregional invasion, except that resection had potentially to be complete and macroscopically curative. All patients who had curative hepatic resection were advised to start postoperative adjuvant chemotherapy.

Results
The resectability rate in screened patients was 91 per cent (235 of 259 patients); the postoperative mortality rate was 4 per cent. In 35 patients resection of the primary tumour was performed simultaneously with partial liver resection. Forty-four patients (19 per cent) developed intra-abdominal recurrence; 14 (6 per cent) underwent reoperation and the recurrent tumour was resected. Adjuvant chemotherapy was given to 99 patients (55 per cent), most treatments being based on 5-fluorouracil with folinic acid. The overall actuarial survival rates at 1, 3 and 5 years were 87, 60 and 36 per cent respectively. In a multivariate analysis, four or more metastases, preoperative carcinoembryonic antigen level higher than 5 ng/ml and a positive resection margin were independent predictors of poor outcome. Adjuvant chemotherapy improved the 5-year survival rate to 53 per cent.

Conclusion
This study provides some evidence that postoperative chemotherapy is beneficial; however, prospective randomized studies are necessary to define its exact role.