bluuebunny/crossref_metadata_2025_split huggingface dataset:
External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty
Authors: Briel J W , Stoker J , Rociu E , Laméris J S , Hop W C J , Schouten W R 
Published: March 2003

Abstract

Background
There is still considerable debate about the value of preoperative anorectal physiological parameters in predicting the clinical outcome after sphincteroplasty. Recently it has been reported that atrophy of the external anal sphincter can be clearly shown with endoanal magnetic resonance imaging (MRI). The aims of this study were to investigate the prevalence of external anal sphincter atrophy in women with anterior sphincter defects due to obstetric injury and to determine the impact of external anal sphincter atrophy on the outcome of sphincteroplasty.

Methods
In this prospective study, 20 consecutive women (median age 50 (range 28–75) years) with faecal incontinence due to obstetric trauma were assessed before operation with endoanal ultrasonography and endoanal MRI. The external anal sphincter was examined and evaluated for the presence of atrophy. The clinical outcome of sphincteroplasty was interpreted without knowledge of the magnetic resonance and ultrasonographic images.

Results
In all patients anterior sphincter defects could be demonstrated with ultrasonography and MRI. External anal sphincter atrophy could only be demonstrated on MRI. Eight of 20 patients had external anal sphincter atrophy. Continence was restored in 13 patients. Outcome was significantly better in those without external anal sphincter atrophy (11 of 12 patients versus two of eight; P = 0·004).

Conclusion
External anal sphincter atrophy can only be visualized on endoanal MRI and affects continence after sphincteroplasty. Endoanal MRI is valuable in the preoperative assessment of patients with faecal incontinence.
High early mortality rate from acute pancreatitis in Scotland, 1984–1995
Authors: McKay C J , Evans S , Sinclair M , Carter C R , Imrie C W 
Published: March 2003

Abstract

Background
Death from acute pancreatitis within the first week after admission is usually a consequence of multiple organ dysfunction. Reports from specialist centres suggest that, with improvements in resuscitation and supportive care, such deaths are becoming uncommon but it is unclear if this is reflected in a decrease in early mortality rate from acute pancreatitis in the general population.

Methods
Data concerning patients discharged with a diagnosis of acute pancreatitis (International Classification of Disease-9 code 577·0) between 1984 and 1995 were obtained from the Information and Statistics Division, National Health Service in Scotland, and analysed on a computer database.

Results
The incidence of acute pancreatitis in Scotland continues to increase in both sexes. The in-hospital mortality rate (death from all causes) was 7·5 per cent and showed a slight but significant downward trend over the period of study. Death within 7 days of hospital admission accounted for 53·7 per cent of all deaths and the proportion of early deaths did not decline over the study interval.

Conclusion
These results suggest that scope remains for considerable improvement in the early management of acute pancreatitis. There is an urgent need to improve the early recognition of severe pancreatitis coupled to a willingness on behalf of clinicians to transfer these patients at an early stage to a centre with high-dependency and intensive care facilities supervised by a multidisciplinary team with expertise in the endoscopic, radiological and surgical management of these patients.
Nitric oxide synthetase and Helicobacter pylori in patients undergoing appendicectomy
Authors: Kell M R , Winter D C , Ryan D , Lynch M , Brew B , Rajpal P , Kirwan W O , Redmond H P 
Published: March 2003

Abstract

Background
This study was designed to determine whether Helicobacter pylori forms part of the normal microenvironment of the appendix, whether it plays a role in the pathogenesis of acute appendicitis, and whether it is associated with increased expression of inducible nitric oxide synthetase (iNOS) in appendicular macrophages.

Methods
Serology for H. pylori was performed on 51 consecutive patients undergoing emergency appendicectomy. Appendix samples were tested for urease activity, cultured and stained for H. pylori, graded according to the degree of inflammatory infiltrate, and probed immunohistochemically for iNOS expression.

Results
The mean age of the patients was 21 (range 7–51) years. Seventeen patients (33 per cent) were seropositive for H. pylori but no evidence of H. pylori was found in any appendix specimen. However, an enhanced inflammatory cell infiltration was observed in seropositive patients (P &lt; 0·04) and the expression of macrophage iNOS in the mucosa of normal and inflamed appendix specimens was increased (P &lt; 0·01).

Conclusion
H. pylori does not colonize the appendix and is unlikely to be a pathogenic stimulus for appendicitis. Priming effects on mucosal immunology downstream from the foregut may occur after infection with H. pylori.
Xenotransplantation
Authors: White S A , Nicholson M L 
Published: March 2003

Abstract

Background
Over the past 10 years xenotransplantation has generated much interest in the hope that it will enable us to overcome the current lack of human organ donors. This review examines the evolution and current therapeutic strategies that have been developed to overcome the predominant problem of graft rejection.

Methods
A literature review was undertaken using a Medline search from January 1966 to August 1999.

Results and conclusion
Despite the considerable advances that have been made in molecular biological techniques, xenograft rejection cannot be prevented without significant immunosuppression and toxic side-effects. The problem of delayed rejection, in particular, will probably be very difficult to overcome, although some of the difficulties associated with hyperacute rejection have been resolved. The potential risk of porcine endogenous retrovirus transmission has generated much debate recently, but it is likely that some of the important issues relating to xenotransplantation will never be resolved until carefully regulated clinical trials are allowed to begin.
Transcranial Doppler-directed dextran therapy in the prevention of postoperative carotid thrombosis
Authors: Hayes P , Lennard N , Smith J , Abbott R , Evans D , London N , Bell P , Naylor A R 
Published: March 2003

Abstract

Background
Evidence suggests that embolization precedes carotid thrombosis, a previously unpredictable event complicating 2–3 per cent of all carotid endarterectomies. It was hypothesized that dextran 40 therapy might prevent progression to complete thrombosis in high-risk patients.

Methods
Between October 1995 and July 1998, 400 consecutive patients were monitored following carotid endarterectomy using transcranial Doppler ultrasonography. Those with sustained embolization (more than 25 in 10 min) or those with emboli that distorted the middle cerebral artery waveform were commenced on an incremental dextran 40 infusion.

Results
Two hundred and sixteen patients (54 per cent) had one or more emboli detected (96 per cent within 2 h of flow restoration) but only 15 (4 per cent) required dextran therapy. Embolization ceased in each case although the dextran dose had to be adjusted in four. In one of the latter patients, embolization recurred on day 5 but was again controlled with high-dose dextran. Overall, the death and any stroke rate was 2 per cent and no patient suffered a stroke due to carotid thrombosis.

Conclusion
A few patients develop sustained embolization following carotid endarterectomy which, in previous studies, has been shown to be highly predictive of carotid thrombosis. The authors' experience to date suggests that dextran can stop this phase of embolization and prevent progression to complete carotid thrombosis. However, the dose of dextran has to be adjusted in 25 per cent of patients (i.e. blind administration of dextran may not be effective) and, very rarely, embolization may recur later.
Near-infrared spectroscopic monitoring of patients undergoing carotid endarterectomy under locoregional anaesthesia
Authors: Williams D J , Laws P , Imray C , Lambert A W , Horrocks M 
Published: March 2003

Abstract

Background
The level of cerebral desaturation, which is associated with a change in level of consciousness during carotid endarterectomy, was measured by near-infrared spectroscopy.

Methods
Patients were recruited in two centres over 24 months. Surgery was performed under deep and superficial cervical block using 0·5 per cent bupivacaine, with temazepam as a premedication. Cerebral oxygenation was measured by Critikon 2020 near-infrared spectrophotometers (Johnson and Johnson Medical, Newport, UK).

Results
Forty-nine procedures were performed on 45 patients (39 men; age range 52–84 (mean 68) years). Recordings were made from the ipsilateral frontal site in 38 patients, from the ipsilateral temporal site in 23 and bifrontally in eight patients. Monitoring failed in three subjects. Percentage changes in regional cerebral oxygen saturation are detailed below.

Conclusion
Significantly different levels of cerebral desaturation occur in patients with neurological compromise during carotid endarterectomy compared with those who are unaffected.
Distal venous arterialization for non-reconstructable arterial disease
Authors: Jacob S , Nassef A , Belli A M , Dormandy J A , Taylor R S 
Published: March 2003

Abstract

Background
Despite advances in vascular surgical and interventional radiological techniques, 14–20 per cent of patients with critical lower limb ischaemia will not be suitable for distal arterial reconstruction owing to occlusion of crural and pedal vessels. Following investigation into the venous anatomy of the foot, the disease-free venous bed was used as an alternative conduit for perfusion of peripheral tissues.

Methods
For 22 months, venous arterialization was performed for all patients with non-reconstructable disease but potentially salvageable feet. There were 15 patients; 14 had surgery for chronic ischaemia and one for acute embolization from a popliteal aneurysm after unsuccessful thrombolysis. The inflow vessel was the common femoral artery in 12 and the popliteal artery in three patients. Reversed contralateral long saphenous vein was used in five, a composite graft in three and a polytetrafluoroethylene graft with vein patch in the remaining seven. The distal anastomosis was to the dorsal venous arch (13 cases) and in two to vena comitantes of the posterior tibial vein owing to extensive tissue loss. Various techniques were employed to destroy the valve.

Results
Three procedures failed immediately after operation and major amputation was required. The remaining 12 patent grafts were monitored by duplex scan; two required intervention to correct distal anastomotic stenosis by angioplasty and atherectomy (one patient each). The limb salvage rate at 2–22 months of follow-up was 80 per cent.

Conclusion
Distal venous arterialization is a unique and promising operation which merits further evaluation.
Prospective randomized double-blind placebo-controlled crossover study to assess the effect of sublingual glyceryl trinitrate in patients with intermittent claudication
Authors: Walker S R , Heer R , MacSweeney S T 
Published: March 2003

Abstract

Background
The effect of sublingual glyceryl trinitrate (GTN) on the claudication distance (CD) and maximum walking distance (MWD) of patients with intermittent claudication was assessed.

Methods
Inclusion criteria were: history of intermittent claudication; resting ankle: brachial pressure index (ABPI) of 1·00 or less; fall in ABPI of more than 0·1 following exercise; and patient not taking nitrates. In the first study 22 patients (median age 69 (range 60–73) years, 16 men, five diabetic, median resting ABPI 0·57 (range 0·1–0·64)) had their CD and MWD measured on a treadmill set at 3·2 km h–1 and 10 per cent gradient. They were then randomized to either GTN or placebo spray, and the distances were remeasured. The crossover portion of the study was then completed. In the second study 28 patients (median age 68 (range 45–84) years, 20 men, six diabetic, median resting ABPI 0·57 (range 0·13–0·98)) were randomized to either GTN or placebo and walked at their own pace along a flat corridor for 15 min. Following a rest of 15 min, the crossover portion of the study was completed. Statistical analysis was by the Wilcoxon matched pairs signed rank test.

Conclusion
GTN can increase the MWD by 19 per cent when patients with intermittent claudication are walked on a treadmill and by 9 per cent when walking at their own pace on a flat gradient.
In situ replacement of infected aortic grafts with rifampicin-bonded prostheses
Authors: Nasim A , Hayes P , London N , Barrie W W , Bell P R F , Naylor A R 
Published: March 2003

Abstract

Background
Prosthetic graft infection following abdominal aortic aneurysm (AAA) surgery is life threatening. Treatment options include total graft excision and extra-anatomic bypass or in situ replacement of the graft. The latter option is gaining popularity but the long-term outcome remains uncertain, particularly in light of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection. A retrospective study was undertaken to assess the outcome after graft excision and in situ replacement with a rifampicin-bonded prosthesis for the treatment of major aortic graft infection. The prevalence of MRSA and its influence on outcome was also assessed.

Methods
Over 6 years between January 1992 and December 1997, 11 patients (eight men) with major aortic graft infection underwent total graft excision and in situ replacement with a rifampicin-bonded prosthesis.

Results
The median age was 66 (range 49–78) years. Four patients presented with haemorrhage from an aortoenteric fistula, three had retroperitoneal abscess, two had graft occlusion, one had a perigraft collection on computed tomography and one presented with a ruptured suprarenal false aneurysm. Organisms were cultured from ten patients. Staphylococcus epidermidis and Streptococcus faecalis were predominant. MRSA was isolated from two patients, both of whom had originally undergone ruptured AAA repair. Two patients died and three suffered non-fatal complications. Two patients died during follow-up, one from suspected ongoing MRSA infection and the other from recurrent graft infection. Seven patients remain alive and clinically free from infection, although two were lost to follow-up at 12 and 15 months.

Conclusion
The long-term results following total graft excision and in situ replacement with a rifampicin-bonded prosthesis appear to be favourable. MRSA infection seems to be associated with a poor prognosis.
Inhibition of systemic fibrinolysis is associated with myocardial injury in patients operated on for ruptured abdominal aortic aneurysm
Authors: Adam D J , Evans S M , Ludlam C A , Bradbury A W 
Published: March 2003

Abstract

Background
Previous work has demonstrated that ruptured abdominal aortic aneurysm (AAA) is associated with systemic thrombin generation and inhibition of systemic fibrinolysis. The procoagulant and hypofibrinolytic state associated with ruptured AAA predisposes to microvascular and macrovascular thrombosis and subsequent myocardial injury. The aim of this study was to determine the relationship between haemostatic derangement and biochemical evidence of myocardial injury in patients operated on for ruptured AAA.

Methods
Ten patients undergoing repair of ruptured AAA were studied. Tissue plasminogen activator (tPA) activity, plasminogen activator inhibitor (PAI) activity, prothrombin fragment (PF) 1 + 2, D-dimer and fibrinogen levels were measured before operation, and immediately before and 5 min after aortic clamp release. Plasma levels of cardiac troponin (cTn) I were measured before operation, and 6 and 24 h after aortic clamp release.

Results
There was no relationship between tPA activity, PF 1 + 2, D-dimer or fibrinogen and cTn-I levels at any sampling point. There was, however, a significant positive correlation (Spearman rank test) between PAI activity immediately before (median 38·6 (range 13·0–39·4) units ml–1) and 5 min after (37·2 (10·6–39·4) units ml–1) aortic clamp release, and cTn-I at 6 h (median 3·17 (range less than 0·5 to 71·1) ng ml–1) and 24 h (5·55 (range less than 0·5 to 110) ng ml–1) after aortic clamp release.

Conclusion
These data strongly support the hypothesis that the inhibition of systemic fibrinolysis which occurs in response to ischaemia and reperfusion during ruptured AAA repair contributes to the development of subsequent myocardial injury.
Endovascular aortic aneurysm repair reduces mortality: a physiological analysis
Authors: Treharne G D , Thompson M M , Whiteley M W , Bell P R F 
Published: March 2003

Abstract

Background
Endovascular techniques are gaining acceptance as minimally invasive methods for abdominal aortic aneurysm repair, although there have been few studies that provide direct comparison with conventional techniques. A prospective study that compares morbidity and mortality rates following abdominal aortic aneurysm repair, using a physiological scoring system, is presented.

Methods
Between December 1994 and November 1997, 104 elective open aneurysm repairs and 49 endovascular aneurysm repairs were performed at this institution. These patient cohorts were compared using the Portsmouth predictor equation scoring system, which has been shown to predict outcome in vascular surgery. Prospective data from patient notes were used to obtain physiological and operative severity scores that were analysed to predict expected (E) to observed (O) mortality and morbidity rates.

Results
Although physiological variables were equivalent in both groups, conventional surgery had a higher mortality (P &lt; 0·05) and morbidity (P &lt; 0·001) rate than endovascular surgery, which was related to the operative severity scores.

Conclusion
These data suggest that open aortic aneurysm repair has a higher operative severity than endovascular repair which may be reflected in increased mortality rates.
Influence of contralateral stenosis on long-term mortality rate following carotid surgery
Authors: Black D , Renwick P , Naidu S , McCollum P 
Published: March 2003

Abstract

Background
Recent evidence suggests that high-grade contralateral stenosis has an adverse effect on perioperative morbidity in carotid endarterectomy (CEA). The relationship between contralateral high-grade stenosis and long-term survival after CEA was examined.

Methods
Three hundred and twenty-seven patients undergoing 333 CEA operations were entered prospectively into a database and long-term follow-up was instituted. Cardiac and stroke risk factors were identified before operation and correlated with long-term survival and cause of death.

Results
Mean age at operation was 68 (range 42–86) years. Median follow-up was 2 (range 1–8) years. There were 45 deaths (seven perioperative), 17 myocardial, 16 from stroke (four perioperative), five from neoplasia, three respiratory and four others. The cumulative 5-year survival rate was 75 per cent. Patients with high-grade contralateral stenosis (greater than 80 per cent) had a significantly reduced life expectancy after CEA (P&lt; 0·05).

Conclusion
Severe contralateral carotid disease is not only an adverse perioperative risk factor but also has negative implications for survival of the patient in the longer term. Following CEA, patients in general have a lower life expectancy than a normal age-matched population.
Randomized controlled trial of heparin plus graduated compression stocking for the prophylaxis of deep venous thrombosis in general surgical patients
Authors: Perkins J , Beech A , Hands L 
Published: March 2003

Abstract

Background
A randomized controlled study was undertaken to compare heparin with heparin plus graduated compression stockings (Brevet Tx, Seton Healthcare) in the prophylaxis of deep vein thrombosis (DVT) following abdominal surgery.

Methods
Sixty high-risk patients were recruited if they met at least two of the following criteria identified as predisposing to DVT: age greater than 39 years, malignancy, varicose veins, cardiac disease or hypertension, diabetes mellitus, obesity or previous thromboembolic episode. All patients received subcutaneous heparin and were randomized to receive Brevet Tx to either the right or left leg before surgery. The stocking was worn for 2 weeks after surgery. The patients underwent duplex imaging before surgery, and at 3, 6 and 14 days after operation. All scans were performed by one sonographer. The policy was to perform a venogram where a positive result was indicated by duplex scanning.

Results
Fifty-six patients completed the study. Six patients (11 per cent) suffered a DVT in the non-stockinged leg, but none in the stockinged leg (P = 0·016, McNemar's test). The DVTs occurred on days 3, 6, 7, 8, 9 and 12 following surgery.

Conclusion
Brevet Tx in addition to low-dose subcutaneous heparin significantly reduced the incidence of DVT in high-risk patients undergoing abdominal surgery.
Caval filters are an underexploited therapy for acute pulmonary embolism
Authors: Tai N R M , Atwal A , Handa A , Platts A , Hamilton G 
Published: March 2003

Abstract

Background
Inferior vena caval filters are a recognized intervention for recurrent pulmonary embolism (PE). Filter utilization in the UK is considerably less than in Europe; this may partly be due to omission of referral of appropriate patients.

Methods
A cohort with the prospect of benefit from caval filter insertion was identified by retrospective study of inpatients who died within 30 days of a positive ventilation-perfusion (V/Q) scan over 2 years. The number of actively managed patients in this group who fulfilled the recognized criteria for caval filter insertion was determined.

Results
Fifty-two of 606 patients died within 30 days of scanning. Information was available on 38 (73 per cent) of 52 who had 39 scans (14 positive, 22 negative, three indeterminate). Six of 14 patients (two men and four women, aged 46–84 years) with a positive scan had strong indications for caval filter deployment including contraindication to anticoagulation (three), recurrent PE despite adequate anticoagulation (two) and complications arising from anticoagulation (one). All six died following continuing embolism or complications from anticoagulation.

Conclusion
Six of 14 patients who died following acute PE required caval filtration but were not offered this intervention. Failure to refer patients who would benefit from filtration may partially account for the disparity in utilization of caval filters between the UK and Europe. Furthermore, because of the choice of death as outcome marker, this study underestimated the value of caval filter utilization.