bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications of radiofrequency coagulation of liver tumours
Authors: Mulier S , Mulier P , Ni Y , Miao Y , Dupas B , Marchal G , De Wever I , Michel L 
Published: March 2003

AbstractBackgroundRadiofrequency coagulation (RFC) is being promoted as a novel technique with a low morbidity rate in the treatment of liver tumours. The purpose of this study was to assess critically the complication rates of RFC in centres with both large and limited initial experience, and to establish causes and possible means of prevention and treatment.MethodsThis is an exhaustive review of the world literature (articles and abstracts) up to 31 December 2001; 82 independent reports of RFC of liver tumours were analysed.ResultsIn total, 3670 patients were treated with percutaneous, laparoscopic or open RFC. The mortality rate was 0·5 per cent. Complications occurred in 8·9 per cent: abdominal bleeding in 1·6 per cent, abdominal infection in 1·1 per cent, biliary tract damage in 1·0 per cent, liver failure in 0·8 per cent, pulmonary complications in 0·8 per cent, dispersive pad skin burn in 0·6 per cent, hepatic vascular damage in 0·6 per cent, visceral damage in 0·5 per cent, cardiac complications in 0·4 per cent, myoglobinaemia or myoglobinuria in 0·2 per cent, renal failure in 0·1 per cent, tumour seeding in 0·2 per cent, coagulopathy in 0·2 per cent, and hormonal complications in 0·1 per cent. The complication rate was 7·2, 9·5, 9·9 and 31·8 per cent after a percutaneous, laparoscopic, simple open and combined open approach respectively. The mortality rate was 0·5, 0, 0 and 4·5 per cent respectively.ConclusionThe morbidity and mortality of RFC, while low, is higher than previously assumed. With adequate knowledge, many complications are preventable.
Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction
Authors: Sailer M , Fuchs K-H , Fein M , Thiede A 
Published: March 2003

Abstract

Background
Functional results after rectal resection with straight coloanal anastomosis are poor. While most functional aspects are improved with coloanal J pouch anastomosis, it is still unclear whether this translates into better quality of life. The aim of this trial was to investigate health-related quality of life as a primary endpoint in patients undergoing sphincter-saving rectal resection.

Methods
Sixty-four patients were randomized to either straight (n = 32) or coloanal J pouch (n = 32) anastomosis. Patients were studied before operation, at the time of stoma reversal and at 3-month intervals for 1 year thereafter. Quality of life was measured using two generic (Gastrointestinal Quality of Life Index and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) and one disease-specific (EORTC QLQ-CR38) instruments. Functional results using a standardized score as well as manometric variables were recorded.

Results
Thirty-nine patients (19 with a pouch and 20 with a straight anastomosis) completed the trial. There was a marked difference between the two groups with regard to quality of life profile. Patients with a pouch reconstruction had a significantly better quality of life, particularly in the early postoperative period.

Conclusion
Patients undergoing low anterior rectal resection and coloanal J pouch reconstruction may expect not only better functional results but also an improved quality of life in the early months after surgery compared with patients who receive a straight coloanal anastomosis.
Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy
Authors: Catheline J M , Turner R , Paries J 
Published: March 2003

Abstract

Background
Intraoperative cholangiography and laparoscopic ultrasonography are both used in the detection of common bile duct stones at laparoscopic cholecystectomy. The aim of this prospective study was to determine whether laparoscopic ultrasonography has an alternative or a complementary role with respect to cholangiography in achieving this end.

Methods
The biliary trees of 900 patients undergoing laparoscopic cholecystectomy were examined routinely by the two methods. The diagnostic power of each investigation and of the two techniques in combination was evaluated. The statistical non-random concordance between the two methods was also determined.

Results
Laparoscopic ultrasonography was performed in all 900 patients. Cholangiography was performed in 762 (85 per cent). The mean (range) duration was 9·8 (4–21) min for laparoscopic ultrasonography and 17·6 (7–42) min for cholangiography. For the detection of common bile duct stones, with a kappa coefficient of 0·57 (95 per cent confidence interval (c.i.) 0·43 to 0·71), the non-random concordance between the two methods was considered to be fair to good. The sensitivity of laparoscopic ultrasonography was 0·80 (95 per cent c.i. 0·65 to 0·91) and its specificity was 0·99 (95 per cent c.i. 0·98 to 1·00). The respective values for cholangiography were 0·75 (95 per cent c.i. 0·59 to 0·87) and 0·99 (95 per cent c.i. 0·98 to 1·00). The examinations combined had a sensitivity of 0·95 (95 per cent c.i. 0·86 to 0·99) and a specificity of 0·98 (95 per cent c.i. 0·96 to 1·00).

Conclusion
Laparoscopic ultrasonography and intraoperative cholangiography are complementary, as the combination of both methods maximizes the intraoperative detection of choledocholithiasis.
In situ ablation of experimental liver metastases delays and reduces residual intrahepatic tumour growth and peritoneal tumour spread compared with hepatic resection
Authors: Isbert C , Boerner A , Ritz J-P , Schuppan D , Buhr H J , Germer C-T 
Published: March 2003

Abstract

Background
The aim of this study was to evaluate the influence of in situ ablation and hepatic resection of experimental liver metastases on residual intrahepatic tumour growth and macroscopic peritoneal tumour spread.

Methods
Two colonic carcinomas (CC 531) were implanted into 90 WAG rat livers, one in the right liver lobe (untreated tumour) and one in the left liver lobe (treated tumour) of each rat. The animals were randomized into two test groups and a sham-operated control group. Animals in group 1 received in situ ablation (laser-induced thermotherapy) of the treated tumour. Rats in group 2 were submitted to partial hepatectomy. Untreated tumour volumes were calculated and the incidence of macroscopic peritoneal spread was determined at different times.

Results
After 21 days median (95 per cent confidence interval) volumes of untreated tumours were 507 (282) mm3 in group 1, 2096 (994) mm3 in group 2 and 1896 (755) mm3 in group 3. Compared with values obtained before treatment, growth of the untreated tumours had increased significantly after 4 days in group 2, after 7 days in group 3 and after 10 days in group 1. Macroscopic peritoneal tumour spread was detected in six of 30 animals in group 1 (laser), in 20 of 30 in group 2, and in 24 of 30 in group 3.

Conclusion
Compared with hepatic resection, in situ ablation of experimental liver metastases delays and reduces residual intrahepatic tumour growth and macroscopic peritoneal tumour spread.
Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques
Authors: Fagevik Olsén M , Wennberg E , Johnsson E , Josefson K , Lönroth H , Lundell L 
Published: March 2003

Abstract

Background
Pulmonary complications are frequently seen after thoracoabdominal resection of the oesophagus. The aim of this study was to compare the effects of two different breathing exercise regimens applied in the immediate postoperative period on the risk of pulmonary insufficiency after thoracoabdominal resection.

Methods
Seventy patients undergoing thoracoabdominal resection for cancer of the oesophagus and cardia were randomized after operation to breathing exercises by inspiratory resistance–positive expiratory pressure (IR-PEP) (n = 36) or continuous positive airway pressure (CPAP) (n = 34). The study groups were well matched for all relevant clinical and demographic data.

Results
Respiratory function deteriorated significantly immediately after operation; the lowest values of forced vital capacity and peak expiratory flow were measured during the first postoperative day and oxygen saturation was lowest on days 4–6. Significantly fewer patients in the CPAP group required reintubation and prolonged artificial ventilation (P &lt; 0·05). There were minor non-significant differences between the study groups with respect to respiratory and other postoperative variables, usually in favour of CPAP.

Conclusion
Provision of CPAP in the immediate postoperative period decreased the risk of respiratory distress requiring reintubation and the need for artificial ventilation compared with breathing exercises by IR-PEP.
Rectal washout with cytotoxic solution can be extended to the whole colon
Authors: Mariani P P , van Pelt J F , Ectors N , Topal B , D'Hoore A , Penninckx F 
Published: March 2003

Abstract

Background
Rectal irrigation with a cytotoxic agent does not kill viable intraluminal cancer cells proximal to the primary tumour. To prevent implantation of these cells at the time of restorative proctectomy, the feasibility of retrograde whole-colon irrigation just before surgery was explored.

Methods
The cytotoxic efficacy of different combinations of povidone–iodine (PVPI) and Gastrografin was tested with the trypan blue exclusion test on a human colon carcinoma cell line (SW620) in vitro. Subsequently, a retrograde whole-colon lavage with PVPI 5 per cent and Gastrografin 12 per cent was performed in 14 euthyroid, non-allergic patients with colorectal cancer using a colostomy irrigation set. Thyroid function and mucosal damage were assessed.

Results
It took 2 min and approximately 1 litre of infused solution to reach the caecum in all patients. The solution was 100 per cent tumoricidal in vitro and remained so after colonic irrigation. Total serum tri-iodothyronine (T3) levels decreased and those of reverse T3 increased, but normalized after 1 week. Superficial epithelial desquamation was observed shortly after irrigation; however, complete restoration occurred within 7 days.

Conclusion
A rectal washout can easily be extended to a retrograde irrigation of the whole colon in elective colorectal cancer surgery. This may help to prevent anastomotic and local recurrence due to implantation of viable exfoliated tumour cells.
Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct
Authors: Tranter S E , Thompson M H 
Published: March 2003

AbstractBackgroundLaparoscopic exploration of the common bile duct is becoming more popular, although endoscopic sphincterotomy remains the usual treatment for bile duct stones. However, loss of the biliary sphincter causes permanent duodenobiliary reflux, and recurrent stone disease and biliary neoplasia may be a consequence.MethodsA systematic literature review was conducted to compare laparoscopic exploration with endoscopic sphincterotomy. A text word search of the Medline, Pubmed and Cochrane databases, and a manual search of the citations from these references, was used.ResultsEndoscopic sphincterotomy is associated with a median (range) mortality rate of 1 (0–6) per cent, compared with 1 (0–5) per cent for laparoscopic bile duct exploration. The median (range) rate of pancreatitis following endoscopic sphincterotomy is 3 (1–19) per cent; this is a rare complication after laparoscopic duct exploration. The combined morbidity rate for laparoscopic cholecystectomy and endoscopic sphincterotomy is 13 (3–16) per cent, which is greater than 8 (2–17) per cent for laparoscopic bile duct exploration. Randomized trials are few and contain relatively small numbers of patients. They show little overall difference in rates of duct clearance, but a higher mortality rate and number of hospital admissions are noted for endoscopic sphincterotomy compared with laparoscopic bile duct exploration. Endoscopic sphincterotomy is associated with recurrent stone formation (up to 16 per cent) with associated cholangitis. It is also associated with bacterobilia and chronic mucosal inflammation. The late development of bile duct cancer has been reported in up to 2 per cent of patients.ConclusionLaparoscopic exploration of the common bile duct may be a better way of removing stones than endoscopic sphincterotomy plus laparoscopic cholecystectomy.
Proliferation in murine epidermis after minor mechanical stimulation Part 1. Sustained increase in keratinocyte production and migration
Authors: Potten C.S. , Barthel D. , Li Y.Q. , Ohlrich R. , Matthé B. , Loeffler M. 
Published: March 2003

It was our objective to obtain an insight into the details and dynamics of the cell proliferative changes following minor barrier disruption, the mechanisms of recovery, and their regulation.Hair of the dorsal area of DBA2‐mice was removed and the epidermis was tape stripped. Tritiated thymidine was injected into groups of mice at daily intervals thereafter. Labelling and nuclear densities were measured at several time intervals later in the various epidermal strata to characterize cell production and cell fluxes through the tissue.A dramatic proliferative response was observed at 24 h when the labelling density increased more than sixfold in the basal layer. Labelled cells rapidly appeared in suprabasal layers within a few hours in large quantities while this process took over 2 days in normal skin. Some cycling cells were also found in the suprabasal layer (pulse labelling at 24 h) in contrast with the controls. The cellular flux through the suprabasal layers was drastically (20‐fold) increased and the transit time was shortened. Although the nuclear density in the basal layer showed only moderate changes it increased four‐fold in the suprabasal layer within 5 days. A kinetic model analysis suggested that the cell cycle time of proliferative cells dropped from a normal value of about 200 h to less than 12 h post tape strip. After 7 days, the proliferative activation still persisted, even though at 3 days post tape strip the stratum corneum had been re‐established.Hence, a mild mechanical alteration with removal of some parts of the cornified layer in mouse backskin epidermis triggers a huge proliferative response with massive overproduction of cells that lasts at least 7 days. Our findings suggest that the re‐establishment of the cornified layer does not immediately shut down cell proliferation and that more complex, slower (long‐term) regulatory processes are involved.
A model for the assessment and management of children with multiple disabilities
Authors: Cass H. , Price K. , Reilly S. , Wisbeach A. , McConachie H. 
Published: March 2003

SummaryChildren with multiple disabilities present complex management problems, both for their families and for the professionals involved in their care. For any one child, the list of functional and medical problems that need to be addressed is frequently reflected in an even longer list of involved professionals, leading to conflicting advice and problems in co‐ordination of care. A hierarchical model for assessment and management is proposed, which highlights the interdependency of apparently different areas of functioning. The model aims to assist both parents and professionals in determining priorities, to improve interdisciplinary working, and to underpin staff training. Illustrative case studies indicate the importance of resolving issues in areas such as visual functioning, positioning and nutrition before integrated functions such as communication skills can be addressed successfully.
The Perceived Illness Experience Scale (PIE): reliability and validity revisited
Authors: Eiser C. , Kopel S. , Cool P. , Grimer R. 
Published: March 2003

SummaryThis paper reports psychometric evaluation of the Perceived Illness Experience Scale (PIE). This includes eight sub‐scales developed to determine the impact of a chronic illness from the patient’s perspective. The sample included 34 patients (mean age = 17 years) successfully treated by limb salvage procedures for a primary bone tumour. Patients also completed measures of well‐being (the SF‐36) and function. To determine the relationship between patient and proxy ratings, mothers also completed the PIE. Evidence of construct validity of the PIE was obtained from significant correlations between PIE and SF‐36 scale scores. There were also significant correlations between function and three of the eight sub‐scales of PIE. Good correlations between patients’ and mothers’ ratings suggests that mothers can be useful proxy raters where patients are unable to provide data themselves. These data suggest that evaluations of patients following limb salvage surgery should not be limited to function measures alone, but need to include assessment of the perceived impact of treatment.
Parental non‐compliance — a paediatric dilemma. A medical and psychodynamic perspective
Authors: Menahem S , Halasz G 
Published: March 2003

SummaryConsiderable resources have been directed towards the recognition and management of child physical and sexual abuse and/or neglect. However, the issue of parental non‐compliance is less well defined and under recognized. While outwardly seeking advice, non‐compliant parents, especially if anxious, are unable or unwilling to comply with the recommendations made. Conflicts of interest between the parent(s)’ and the health professionals’ perceptions regarding the best interest of the child may arise.Parental non‐compliance is centred around the parents’ perception of the child’s current problems and its relationship to past problems. Such non‐compliance may reflect ignorance or misunderstanding of the clinical situation. Ignorance may be readily addressed if the parents are receptive and trusting. However, non‐compliance more commonly arises from the parents’ inability to cope emotionally with the stresses surrounding the recommended treatment. Parents may be vulnerable to psychological reactions which inhibit rational thinking. Parental anxieties are best understood in terms of psychological constructs, including ‘defences’ such as ‘denial’ and ‘splitting’, ‘repetition compulsion’ and the need to ‘work through’ psychological barriers so that the child’s best interest is served. Parental non‐compliance can serve to protect the parents from overwhelming fears and anxieties, which if addressed may transform parental defensiveness to co‐operation. Extreme parental non‐compliance may represent a special form of child abuse where, due to parental psychopathology, parents are unable to consider the child’s best interest.Clinical vignettes arising from a consultant private and hospital ambulatory setting will focus on management strategies for successful outcomes. Recommendations offered on ways to reduce the risk of parental non‐compliance include building trust, eliciting the aid of a parental partner, and organizing a second opinion, thereby improving the chances of a successful outcome.
Preparing children for venepuncture. The effect of an integrated intervention on distress before and during venepuncture
Authors: Kolk A M , Hoof R van , Dop M J C Fiedeldij 
Published: March 2003

SummaryVenepuncture for routine blood sampling is a very distressing experience for a considerable number of children. Not only do they express high levels of distress during venepuncture but also in anticipation of the procedure. Therefore, prevention or reduction of distress should focus on both phases of the procedure. To this end, three preparation elements were combined: local anaesthesia of the skin, provision of sensory and procedural information, and involvement of the parent. In order to test the effect of this integrated procedure on the distress reactions of young children before as well as during venepuncture, 31 children were randomly assigned to one of two conditions: preparation or no preparation. Independent raters, who were blind to group assignments, scored segments of the videotaped behaviour of the children, according to the Groninger Distress Scale. Prepared children displayed significantly less distress before and during venepuncture than not‐prepared children, regardless of their gender, ethnical origin, age, injection history, and the tension of their parent.
Are infant behavioural feeding difficulties associated with congenital heart disease?
Authors: Clemente C , Barnes J , Shinebourne E , Stein A 
Published: March 2003

SummaryAimTo compare the feeding patterns and difficulties of infants with congenital heart disease (CHD) and healthy controls. Information was gathered via parental questionnaires.MethodsA matched case controlled study of 64 infants with CHD compared with 64 healthy controls.ResultsThe main findings were: (1) Feeding patterns: mothers with infants with CHD used bottle‐feeding as a first method of feeding their babies more often (CHD, 20%, controls, 2%); (2) Specific feeding difficulties: (a) infants with CHD were significantly more breathless when feeding (CHD = 16%, controls, 0%), (b) had more vomiting at mealtimes (CHD = 23%, controls = 11%), but (c) had significantly less spitting (CHD = 19%, controls, 41%); and (3) infants with CHD showed significantly reduced growth.ConclusionsThe feeding difficulties are related to the organic condition and not specific difficulties in mother–infant interaction. Professional support may be required for mothers of infants with CHD to maintain feeding routines and to deal with the difficulties that arise.
Integration of children with visual impairment in regular preschools
Authors: Brambring M 
Published: March 2003

SummaryThe current practice in Germany is to integrate children who are blind or partially sighted into regular preschools providing they exhibit no further severe impairments. The present study asked 72 regular preschool teachers about their experiences in integrating 24 children who were blind and 16 who were partially sighted. Results showed that integration seemed to be unproblematic except for greater emotional difficulties in children who are partially sighted. According to preschool teachers, integrating children who are blind is far more complex and difficult than integrating the partially sighted. One fifth of the blind exhibited marked to serious problems in 10 out of 28 preschool activities surveyed. Most of these difficulties involved manual, cognitive, interactive and daily living skills. When asked about difficulties that had not been anticipated before integration commenced, preschool teachers emphasized four domains: the increase in their own workload; the children's problems with concentration and motivation; fixation on one preschool teacher; and difficulties in the fine‐ and gross‐motor domain as well as in daily living skills. Findings indicate the need for improved preparations and support when integrating the blind into regular preschool.