bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anocutaneous advancement flap closure of high anal fistulas
Authors: Jun S H , Choi G S 
Published: March 2003

Abstract

Background
Fistula-in-ano may be treated by closing the internal fistulous opening. An anocutaneous flap was developed to facilitate this closure.

Methods
From October 1995 to April 1997, 40 patients with high trans-sphincteric or suprasphincteric anal fistulas were treated. The important components of the procedure are excision of the internal opening, excision or curettage of the tract, closure of the internal opening by an anocutaneous flap, and external drainage.

Results
In two patients (5 per cent) the flap separated and the sutured internal opening was exposed. One of the two was healed 4 weeks later. In the remaining 38 patients, complete healing occurred 2–3 weeks after operation. No patient was incontinent of gas or stool.

Conclusion
This procedure is technically simple, heals rapidly with minimal scarring, and cures anal fistulas while preserving the anal sphincter.
Follow-up of patients with a thin melanoma
Authors: Johnson R C , Fenn N J , Horgan K , Mansel R E 
Published: March 2003

Abstract

Background
The aim of this study was to determine the value of follow-up in two subgroups of patients with a thin melanoma less than 0·76 mm and 0·76–1·5 mm thick.

Methods
The study group comprised all patients presenting to the Cardiff Melanoma Clinic from its introduction in 1976 to the end of 1994. All patients attend follow-up according to a strict protocol, determined by the thickness of the original melanoma (less than 0·76 mm, annually; more than 0·76 mm, every 2 months for 2 years, 3 monthly for 2 years, 4 monthly for 1 year and then annually).

Results
In total there were 306 patients with a thin melanoma: 178 with a melanoma thinner than 0·76 mm (group 1) and 128 with a melanoma of 0·76–1·5 mm (group 2). The groups were well matched for age (mean 50·6 (range 8–87) versus 50·6 (range 19–89) years respectively) and length of follow-up (mean 88·6 (range 4–296) versus 80·4 (range 2–296) months). Four patients (2·2 per cent) developed recurrence in group 1 and 16 (12·5 per cent) in group 2. The mean time to recurrence was 84·5 (range 49–143) months in group 1 and 45·3 (range 2–74) months in group 2. All patients in group 1 and 14 of 16 in group 2 died from recurrent disease.

Conclusion
Follow-up of patients with a melanoma less than 0·76 mm thick is not worthwhile. All recurrences would have been detected by annual review for 7 years in patients with melanomas between 0·76 and 1·5 mm thick.
External oblique aponeurosis nerve entrapment as a cause of groin pain in the athlete
Authors: Ziprin P , Williams P , Foster M E 
Published: March 2003

Abstract

Background
Groin pain in sportsmen is a common management problem. The results of surgical exploration in 25 male athletes presenting with groin pain are described.

Methods
All patients had had failed non-operative management. All groins were explored via an inguinal incision and the patients were reviewed for the presence of pain, function and their own subjective opinion.

Results
Nineteen injuries were unilateral and six bilateral. One patient had an occult inguinal hernia and another had a patent processus vaginalis. In the others, defects were found in the external oblique aponeurosis through which neurovascular bundles containing terminal branches of the iliohypogastric nerve passed. These tears were repaired after division of the bundles. The mean time to referral was 29·3 weeks (range 4–79 weeks). After operation no pain or only mild pain was experienced in 28 groins. All had improved function. Twenty of 23 patients described the operation as good or excellent. The mean time to resumption of sporting activities after operation was 11·6 (range 4–20) weeks.

Conclusion
Athletes' groin pain may be due to nerve entrapment in the external oblique aponeurosis. An awareness of this injury may reduce delays in operating leading to an earlier return to sport.
Indication for and outcome of laparoscopy-assisted Billroth I gastrectomy
Authors: Shiraishi N , Adachi Y , Kitano S , Bandoh T , Katsuta T , Morimoto A 
Published: March 2003

Abstract

Background
Since 1991, laparoscopy-assisted Billroth I gastrectomy has been used for patients with early gastric cancer. The aim of this study was to clarify the outcome of 40 patients who underwent this operation and to examine the indications based on a retrospective histological study of 248 resected cases of early gastric cancer.

Methods
Operating time, blood loss, length of skin incision, and postoperative hospital stay and complications were examined using the operation records and medical charts. The presence or absence of lymph node metastasis, tumour size, site, gross type, histological type, depth of invasion, presence or absence of ulceration, and status of lymph node metastasis were investigated in 248 early gastric cancers.

Results
The mean operating time was 3 h and 48 min and the mean length of skin incision was 5·8 cm. Although one patient who had suffered from chronic bronchitis developed pneumonia and wound dehiscence, no other patients had a postoperative complication. The mean hospital stay after operation was 16 days and all patients were alive without recurrence at a median follow-up of 21 months. The incidence of lymph node metastasis in early gastric cancer was 2 per cent (three of 130) in mucosal cancers and 14 per cent (17 of 118) in submucosal cancers. These lesions could have been completely resected by laparoscopy-assisted gastrectomy.

Conclusion
All 40 patients were treated successfully by laparoscopy-assisted Billroth I gastrectomy without significant complications and with no recurrences to date. Pathological study of conventionally resected stomach and lymph nodes confirmed that laparoscopy-assisted Billroth I gastrectomy would be a safe and useful operation for most early gastric cancers.
Prospective evaluation of soft tissue masses and sarcomas using fluorodeoxyglucose positron emission tomography
Authors: Lucas J D , O'Doherty M J , Cronin B F , Marsden P K , Lodge M A , McKee P H , Smith M A 
Published: March 2003

Abstract

Background
The differentiation of soft tissue sarcoma (STS) from benign masses is difficult owing to their clinical and radiological similarities. Accurate staging is hindered by the large number of sites at which metastases may be found. This study examined the value of whole-body [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) in patients presenting with soft tissue masses.

Methods
Thirty patients with a soft tissue mass suspected to be malignant were evaluated with FDG PET. The images were evaluated qualitatively and quantitatively for uptake of FDG to determine whether benign lesions could be differentiated from malignant tumours, and for the presence of metastases.

Results
Thirty-one masses were removed from 30 patients; 12 were benign and 19 were malignant STSs. Using qualitative assessment of the FDG PET images, all the high-grade STSs (n = 12) were correctly identified, but low-grade STS (n = 7) could not be differentiated from a benign lesion. Using a quantification assessment, there was a 95 per cent sensitivity and a 75 per cent specificity in diagnosing STS. Three patients had metastases at presentation; two were correctly identified by FDG PET.

Conclusion
FDG PET has a role in distinguishing high-grade STS from low-grade or benign STS and may have a role in staging malignant tumours.
Clinical evaluation of lymph node metastasis in gastric cancer defined by the fifth edition of the TNM classification in comparison with the Japanese system
Authors: Fujii K , Isozaki H , Okajima K , Nomura E , Niki M , Sako S , Izumi N , Mabuchi H , Nishiguchi K , Tanigawa N 
Published: March 2003

Abstract

Background
This study compared the classification of lymph node metastasis according to the number of involved nodes based on the new tumour node metastasis (TNM) system (fifth edition) with the classification by the Japanese Research Society for Gastric Cancer from an anatomical perspective.

Methods
The two classifications were related to long-term results in 1489 patients with gastric cancer who underwent gastrectomy with systematic extended lymphadenectomy.

Results
Both classifications performed well as prognostic indicators (5-year survival rates: pathological (p) N0, 89 per cent; pN1, 66 per cent; pN2, 34 per cent; pN3, nil; and M1, 10 per cent by the TNM classification; n0, 89 per cent; n1, 63 per cent; n2, 46 per cent; n3, 20 per cent; and n4, 8 per cent by the Japanese classification). For regional lymph nodes, the TNM classification was a better index of the prognosis. Significant survival differences were observed among patients with M1disease according to the number of involved lymph nodes (between one and six nodes, 48 per cent; seven to 15 nodes, 12 per cent; more than 15 nodes, 2 per cent), indicating that patients with distant metastatic lymph nodes (M1) should also be classified by the number of involved nodes. On the other hand, the Japanese classification has the added benefit of being a good indicator of the anatomical extent of lymphadenectomy.

Conclusion
The new TNM classification provided a better index of the prognosis of patients who underwent systematic lymph node dissection. However, both classifications have specific benefits in the surgical treatment of gastric cancer.
Case-controlled study of the epidemiological risk factors for breast cancer in Nigeria
Authors: Adebamowo C A , Adekunle O O 
Published: March 2003

Abstract

Background
The incidence of breast cancer is increasing worldwide, more rapidly in societies that hitherto enjoyed a low incidence of the disease, such as most African countries. Most of the epidemiological data on breast cancer from Africa have been retrospective studies with propensity for bias.

Methods
This was a case-controlled study of 250 consecutive patients with breast cancer diagnosed between April 1992 and December 1995. An age- and sex-matched control group of patients with non-oncological and non-endocrine diseases was compared.

Results
The peak age incidence of breast cancer in the sample studied was 43 years. There was a statistically significant difference in the height and weight of the patients compared with the controls. Patients also tended to be older at first pregnancy and at first lactation, and had a higher mean number of pregnancies. The patients also tended to be of an early birth order, to have lactated less often, to have used contraceptives and to have abused alcohol compared with the controls.

Conclusion
The incidence of breast cancer in this environment is increasing. This is partly a result of the changing demographic profile, acquisition of ‘western’ lifestyle, and the changing socioeconomic profile of the country.
DNA aneuploidy as a marker of premalignancy in surveillance of patients with ulcerative colitis
Authors: Lindberg J Ö , Stenling R B , Rutegård J N 
Published: March 2003

Abstract

Background
Patients with ulcerative colitis have an increased risk of developing colorectal cancer. Specific and sensitive markers for premalignancy are needed. The present study evaluates the status of DNA aneuploidy (abnormal stemlines) as such a marker.

Methods
A prospective surveillance programme was conducted for all patients with ulcerative colitis from a defined area. Regular colonoscopy with mucosal sampling for histological evaluation and flow cytometric DNA analysis was performed. Some 147 patients were studied from 1984 to 1997.

Results
DNA aneuploidy was found in 20 patients. All but one had total colitis. The time from onset of disease to aneuploidy ranged from 5 to 31 years. Fourteen of the patients developed morphological alterations. In the same interval 127 patients, of whom 75 had total colitis, did not develop aneuploidy. Among patients with morphological alterations and aneuploidy, aneuploidy preceded these alterations in four patients and was present at the same examination in three; in seven patients the morphological alterations preceded the aneuploidy. Aneuploidy was diagnosed before the appearance of a dysplasia- associated lesion or mass in four of five cases.

Conclusion
Flow cytometric DNA analysis has definite value as a complement to histological examinations in cancer surveillance of patients with ulcerative colitis. Aneuploidy indicates a high risk for developing severe premalignant changes. However, there is no evidence to support the use of DNA aneuploidy as a sole indication for prophylactic surgery against cancer.
Peripheral thrombolysis for acute-onset claudication
Authors: Braithwaite B D , Tomlinson M A , Walker S R , Davies B , Buckenham T M , Earnshaw J J 
Published: March 2003

Abstract

Background
The aim of this study was to determine the outcome of patients who presented with sudden onset of incapacitating claudication of less than 2 weeks' duration and who were treated with peripheral arterial thrombolysis.

Methods
The database of the Thrombolysis Study Group was searched retrospectively for patients who received thrombolysis for acute-onset claudication. Some 108 patients (65 men, median age 69 (range 29–94) years) were treated with intra-arterial tissue plasminogen activator at 14 hospitals. The median duration of symptoms was 72 h (range from 2 h to 2 weeks). There were 52 graft and 56 native vessel arterial occlusions.

Results
The immediate outcome of thrombolysis for native vessel arterial occlusion was thrombus clearance in 50 patients (89 per cent) and failed lysis in six (11 per cent). Thirty-six patients (64 per cent) had a secondary radiological or surgical procedure carried out after lysis. After 30 days four patients (7 per cent) had a major amputation, eight (14 per cent) had died, 38 (68 per cent) were symptom free and seven (12 per cent) continued to have claudication. Three patients (5 per cent) suffered a major haemorrhage. The immediate outcome of thrombolysis for graft occlusion was thrombus clearance in 48 patients (92 per cent) and failed lysis in four (8 per cent); 27 patients (52 per cent) had a secondary procedure. After 30 days four patients (8 per cent) had a major amputation, seven (13 per cent) had died, 32 (62 per cent) were symptom free and nine (17 per cent) had persistent claudication. Three patients (6 per cent) suffered a major haemorrhage.

Conclusion
Patients who presented with acute onset of incapacitating claudication had an outcome similar to that after thrombolysis for critical ischaemia. It is recommended that patients who present in this way should be observed and treated with thrombolysis only if they progress to critical ischaemia.
Uptake of tetracycline by aortic aneurysm wall and its effect on inflammation and proteolysis
Authors: Franklin I J , Harley S L , Greenhalgh R M , Powell J T 
Published: March 2003

Abstract

Background
Proteolytic degradation of the aortic wall by matrix metalloproteinases (MMPs) is considered important in the pathogenesis of abdominal aortic aneurysms (AAAs). Many of these MMPs are inhibited by tetracycline derivatives, which may have the potential to retard aneurysm growth.

Methods
Patients undergoing elective repair of an AAA (n = 5) received an intravenous bolus of tetracycline (500 mg) on induction of anaesthesia and levels of tetracycline in serum, aneurysm wall and mural thrombus were assessed by microbiological assay. In a separate series of patients (n = 7) aneurysm biopsies were placed into explant culture (with and without tetracyline) and the accumulation of protein, hydroxyproline, MMP-9, interleukin (IL) 6 and monocyte chemoattractant protein (MCP) 1 in the medium was assessed by colorimetric assay or immunoassay.

Results
At aortic cross-clamping the median concentration of tetracycline was 8·3 µg/ml in serum, 2·9 µg per g tissue in aortic wall and zero in mural thrombus. Tetracycline inhibited, in a concentration-dependent manner, both MMP-9 and MCP-1 secretion (P = 0·022 and P = 0·018 respectively), but did not alter hydroxyproline or IL-6 secretion. At the highest concentration of tetracycline (100 µg/ml) median MMP-9 secretion was reduced from 27 to 5 ng/ml (P = 0·007) and median MCP-1 secretion was reduced from 50 to 10 ng/ml (P = 0·008).

Conclusion
Tetracycline rapidly penetrates the aortic wall, but the concentration achieved may be insufficient to alter collagen turnover through limitation of MMP production or activity.
Expression and clinical significance of apolipoprotein D in male breast cancer and gynaecomastia
Authors: Serra Díaz C , Vizoso F , Lamelas M L , Rodríguez J C , González L O , Baltasar A , Medrano J 
Published: March 2003

Abstract

Background
Apolipoprotein D (Apo D) is a protein component of the human plasma lipid transport system which is present in benign and malignant human breast tissues. This study analysed the expression of Apo D in men with gynaecomastia or breast cancer, and evaluated its use as a prognostic marker in breast cancer.

Methods
Immunohistochemical expression of Apo D was examined in specimens from 15 men with gynaecomastia, two with in situ breast carcinoma and 68 with invasive male breast cancer. Median follow-up in patients with breast cancer was 44 months.

Results
All gynaecomastia specimens, both in situ carcinomas and 57 invasive carcinomas (84 per cent) stained positively for Apo D. Apo D values were significantly correlated with axillary node involvement and histological grade of the tumours. In men with breast cancer univariate analysis showed a statistical association between node status and Apo D content with relapse-free survival (P &lt; 0·001) and overall survival (P &lt; 0·05). Cox multivariate analysis showed that Apo D was a significant indicator of relapse-free survival (P = 0·0089), but node status was the strongest factor able to predict both relapse-free (P = 0·0336) and overall (P = 0·0346) survival.

Conclusion
Apo D was expressed in gynaecomastia and a high percentage of male breast carcinomas. There was a positive association of Apo D content in male breast tumours with favourable outcome. Apo D expression was a significant independent indicator of relapse-free survival in male breast cancer.
Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis
Authors: Isenmann R , Rau B , Beger H G 
Published: March 2003

Abstract

Background
The risk factors predisposing to organ failure in patients with necrotizing pancreatitis remain unclear. The relationship between the extent of pancreatic necrosis, the presence of infection and the incidence of organ failure was analysed.

Methods
In a retrospective review, the occurrence of pulmonary insufficiency, renal insufficiency, shock, sepsis/sepsis-like syndrome (SLS) and coagulopathy was evaluated in 273 patients with necrotizing pancreatitis, and a comparison was made between patients with sterile or infected necrosis. Additionally, the relation between the incidence of organ failure and extent of pancreatic parenchymal necrosis was investigated by classifying the patients into three groups according to the amount of necrotic tissue found by contrast-enhanced computed tomography (group 1, extent less than 30 per cent; group 2, 30–50 per cent; group 3, more than 50 per cent).

Results
Organ failure was more frequent in patients with infected necrosis than in those with sterile necrosis. Differences were found in the incidence of pulmonary insufficiency, sepsis/SLS and coagulopathy. Organ failure occurred more frequently in group 3 than in group 2 or 1 (95 versus 79 and 66 per cent; P = 0·0004). The extent of infected necrosis was not related to the incidence of organ failure (group 1, 88 per cent; group 2, 86 per cent; group 3, 96 per cent). However, there was a relation between the incidence of organ failure and the extent of sterile necrosis (group 1, 59 per cent; group 2, 74 per cent; group 3, 94 per cent; P = 0·0001). Multivariate analysis confirmed the presence of infection and the extent of necrosis as independent determinants of organ failure.

Conclusion
The incidence of organ failure is determined by both bacterial infection and extent of necrosis. The incidence of organ failure is determined by the extent of necrotic parenchyma in patients with sterile necrosis. Infected necrosis is associated with a high incidence of organ failure irrespective of the extent of necrosis.
Preoperative alcoholism and postoperative morbidity
Authors: Tønnesen H , Kehlet H 
Published: March 2003

Abstract

Background
Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention.

Methods
A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity in alcohol abusers were used to evaluate the evidence.

Results
Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications account for about half of the morbidity. The pathogenic mechanisms include preoperative immune incompetence, subclinical cardiac insufficiency and haemostatic imbalance. In addition, surgical trauma and/or postoperative abstinence result in an exaggerated stress response, which may further contribute to postoperative morbidity.

Conclusion
Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration to avoid the abstinence response.
Intrapulmonary shunting in biliary atresia before and after living-related liver transplantation
Authors: Yonemura T , Yoshibayashi M , Uemoto S , Inomata Y , Tanaka K , Furusho K 
Published: March 2003

Abstract

Background
Intrapulmonary shunting (IPS) is frequently observed and causes hypoxaemia in liver cirrhosis. This study investigated the prevalence, predictors of reversibility and the effect of living-related liver transplantation (LRLT) on IPS using contrast echocardiography in patients with end-stage biliary atresia.

Methods
Fifty consecutive patients with biliary atresia were examined for IPS using contrast echocardiography before and after LRLT until IPS disappeared. The severity of IPS was classified into five grades according to the extent of contrast in the left ventricle (0, none; 1, trivial; 2, apparent; 3, complete but less than in right ventricle; 4, as dense as in right ventricle).

Results
Thirty-two patients (grade 1, n = 15; grade 2, n = 7; grade 3, n = 4; grade 4, n = 6) had IPS before LRLT. Forty-four patients have survived for 9–26 months after LRLT. Among patients with grade 3 or 4 IPS (n = 8), there was a significant correlation between age at LRLT and the duration of IPS persistence after LRLT (P = 0·044).

Conclusion
IPS takes longer to disappear in older children than in younger ones, but always disappears eventually. LRLT is an effective treatment for biliary atresia with IPS.
Presented to the 31st annual meeting of the Pacific Association of Pediatric Surgeons, Maui, Hawaii, June 1998