bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of a specialized leg ulcer service on management and outcome
Authors: Ghauri A S K , Taylor M C , Deacon J E , Whyman M R , Earnshaw J J , Heather B P , Poskitt K R 
Published: March 2003

Abstract

Background
The organization of leg ulcer care is poorly defined in the community. This study assessed the overall influence of a specialized community service on management and outcome of chronic leg ulcers, irrespective of aetiology.

Methods
Assessment and outcome of ulcers were compared in patient samples (n = 200) from East and West Gloucestershire, before and after the introduction of specialized clinics into East Gloucestershire. In clinics, vascular disease was routinely assessed by duplex scanning and determination of the ankle: brachial pressure index.

Results
There was no coordinated community structure for the care of patients with leg ulcers before the service was introduced, and 74 and 67 per cent of limbs in East and West Gloucestershire respectively had aetiology undiagnosed. After introduction of the clinics, the 12-week healing rate increased from 12 to 22 per cent in East Gloucestershire (P = 0·05) and to 47 per cent in the specialized East Gloucestershire clinics (P &lt; 0·001). The 12-month recurrence rate decreased from 50 to 41 per cent in East Gloucestershire and to 17 per cent in the East clinics (P &lt; 0·001). The West Gloucestershire control showed no significant changes.

Conclusion
A specialized leg ulcer service with defined protocols provides an improved management structure for treating patients with leg ulcers in the community. Accurate diagnosis of chronic leg ulcers and improved outcome may be achieved within this specialized service.
Prospective analysis of a scoring system to predict choledocholithiasis
Authors: Menezes N , Marson L P , deBeaux A C , Muir I M , Auld C D 
Published: March 2003

Abstract

Background
The management of choledocholithiasis in the laparoscopic era remains debatable. A common policy is to perform preoperative endoscopic retrograde cholangiopancreatography (ERCP) on patients suspected of having common bile duct (CBD) stones, using standard risk criteria. The aim of this study was to evaluate prospectively a scoring system designed to improve the accuracy of CBD stone prediction before laparoscopic cholecystectomy.

Methods
Known clinical, biochemical and radiological risk factors for CBD stones were analysed retrospectively in 233 patients. The presence (n = 77) or absence (n = 156) of CBD stones was determined by preoperative ERCP and/or laparoscopic cholangiography. Using multivariate analysis, the significant risk factors for CBD stones were identified and a new preoperative scoring system was developed. A score of 3 or more was taken as the cut-off point to suggest CBD stones and the need for preoperative ERCP. This scoring system was then tested prospectively in 211 consecutive patients with symptomatic gallstones requiring surgery. Patients whose bile ducts could not be demonstrated by ERCP or operative cholangiography were excluded.

Results
Fifty-five patients scored 3 or more (predicted ERCP rate of 29 per cent), of whom 23 (42 per cent) had proven CBD stones. Intraoperative cholangiography was successful in 87 per cent. Five patients (4 per cent) who scored less than 3 had small stones (less than 5 mm) demonstrated at operative cholangiography. The overall sensitivity and specificity of this scoring were 82 and 80 per cent respectively.

Conclusion
Formal risk assessment of the presence of CBD stones using this scoring system is simple and may be used for preoperative selection of patients for biliary tract imaging by magnetic resonance cholangiography or ERCP.
Diagnosis and treatment of portal vein thrombosis following splenectomy
Authors: van 't Riet M , Burger J W A , van Muiswinkel J M , Kazemier G , Schipperus M R , Bonjer H J 
Published: March 2003

Abstract

Background
Portal vein thrombosis is a rare but potentially fatal complication of splenectomy. The aim of this study was to assess the incidence, risk factors, treatment and outcome of portal vein thrombosis after splenectomy in a large series of patients.

Methods
All patients who had undergone a splenectomy in the University Hospital, Rotterdam, between 1984 and 1997 were reviewed retrospectively. Splenectomy that was followed by symptomatic portal vein thrombosis was selected for analysis. Risk factors for portal vein thrombosis were sought.

Results
Of 563 splenectomies, nine (2 per cent) were complicated by symptomatic portal vein thrombosis. All these patients had either fever or abdominal pain. Two of 16 patients with a myeloproliferative disorder developed portal vein thrombosis after splenectomy (P = 0·03), and four of 49 patients with haemolytic anaemia (P = 0·005). Treatment within 10 days after splenectomy was successful in all patients, while delayed treatment was ineffective.

Conclusion
Portal vein thrombosis should be suspected in a patient with fever or abdominal pain after splenectomy. Patients with a myeloproliferative disorder or haemolytic anaemia are at higher risk; they might benefit from early detection and could have routine Doppler ultrasonography after splenectomy.
Estimation of lymph node metastasis by size in patients with intrathoracic oesophageal cancer
Authors: Funai T , Osugi H , Higashino M , Kinoshita H 
Published: March 2003

Abstract

Background
The preoperative evaluation of lymphatic metastasis in patients with oesophageal cancer is of vital importance in determining a therapeutic strategy. The aim of this study was to establish criteria for the preoperative diagnosis of lymph node metastases based on the size and shape of nodes.

Methods
Some 123 patients with intrathoracic oesophageal cancer were studied and 6822 nodes were obtained by extended lymphadenectomy. The nodes were classified anatomically and their size was measured by the operating surgeon during or immediately after operation. All were examined histologically and criteria for the diagnosis of metastasis were evaluated.

Results
The size of the lymph nodes varied by anatomical site. Nodes were smallest in the neck and largest at the tracheal bifurcation. The cut-off value for the diagnosis of metastasis was 5 mm in the neck, 6 mm in the abdomen and 8 mm in the mediastinum, except for tracheal nodes. Lymph nodes 10 mm or larger tended to become spherical when involved by metastasis.

Conclusion
The incidence of metastasis in each lymph node can be estimated by its size. Discounting nodes less than 10 mm can lead to an underestimation of the stage of oesophageal cancer during preoperative evaluation.
Vertical reduction rectoplasty: a new treatment for idiopathic megarectum
Authors: Williams N S , Fajobi O A , Lunniss P J , Scott S M , Eccersley A J P , Ogunbiyi O A 
Published: March 2003

Abstract

Background
The aetiology of idiopathic megarectum is unknown and the results of surgery are often unsatisfactory. Rectal hyposensation is common and poor perception of rectal filling may contribute to the poor evacuatory function. By reducing the capacity of the rectum, it was hypothesized that sensory thresholds to rectal distension and perception of urge to defaecate would be improved.

Methods
Vertical reduction rectoplasty (VRR) and concomitant sigmoid colectomy was performed on six patients with idiopathic megarectum. Patients were evaluated before and after operation by detailed questionnaire and anorectal physiology. Postoperative rectal compliance was also studied by means of a programmable electronic barostat. Where appropriate, physiological data were compared with those obtained in eight healthy volunteers.

Results
Bowel frequency increased from a preoperative median of 2·5 to 16 per month after operation. Four patients reported improved rectal perception of the urge to defaecate. Thresholds for defaecatory urge and maximum tolerated volume were significantly reduced following VRR (P &lt; 0·05). Post-VRR rectal compliance was no different from that in healthy volunteers. Colonic transit time decreased significantly after VRR (P &lt; 0·05) and evacuation on proctography increased from a median of 30 per cent to 50 per cent. At a median of 57 weeks' follow-up five of the six patients expressed continued satisfaction with the results.

Conclusion
VRR is a new approach to the treatment of idiopathic megarectum. Clinical and physiological studies confirm that it can improve sensory feedback and defaecation. The procedure needs further evaluation as the number of patients undergoing the procedure increases.
Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia
Authors: Ravichandran D , Kalambe B G , Pain J A 
Published: March 2003

Abstract

Background
There is uncertainty as to whether preservation or elective division of the ilioinguinal nerve influences pain and sensory loss following inguinal hernia repair.

Methods
In 20 men with primary bilateral inguinal hernias undergoing open tension-free mesh repair, the sides (right or left) were randomized for preservation or division of the ilioinguinal nerve. Patients were reviewed on day 1, 4 weeks and 6 months after operation. Any pain or numbness, as well as any loss of sensation in the area supplied by the nerve, was recorded.

Results
No significant difference was seen in pain or numbness between the divided and preserved sides. Sensory loss detected by clinical examination was more common following the division of the nerve compared with preservation.

Conclusion
Within the limitations of a small sample size, elective division of the ilioinguinal nerve during inguinal hernia repair does not appear to be associated with a significant increase in postoperative symptoms.
Matrix metalloproteinases, their tissue inhibitors and colorectal cancer staging
Authors: Baker E A , Bergin F G , Leaper D J 
Published: March 2003

Abstract

Background
Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are important in tumour invasion and metastasis. The levels of MMPs, TIMPs and total MMP activity were compared in paired colorectal tumour (n = 50) and normal tissue (n = 49) samples and correlated with clinical and pathological staging.

Methods
Gelatin zymography (MMP-2 and MMP-9), enzyme-linked immunosorbent assays (MMP-1, MMP-3, TIMP-1 and TIMP-2) and quenched fluorescent substrate hydrolysis (total MMP activity) were employed in resection specimens from 50 patients, four with adenomas and 46 with colorectal cancer.

Results
The levels of active MMP-2 and MMP-9 and total MMP-1, MMP-3 and TIMP-1 were significantly greater in tumour tissue than in normal colon (e.g. TIMP-1 tumour median 72 (range 25–351) versus normal 26 (4–107) ng per mg total protein content; P &lt; 0·05); however, TIMP-2 levels were significantly greater in normal tissue (P &lt; 0·05). Total MMP activity was significantly greater in tumour than in normal tissue (15 025 (1750–174 400) versus 7250 (750–354 650) pmol l−1 min−1 mg protein−1; P &lt; 0·05). Correlations were found between both MMP and TIMP levels and pathological tumour staging. MMP-1 appeared to be most important as its concentration correlated positively with Dukes staging, tumour differentiation and lymphatic invasion.

Conclusion
The levels of the studied MMPs and total MMP activity were upregulated in colorectal tumours. MMP-1 is important in colorectal cancer progression.
Timing of endothelin and nitric oxide inhibition is crucial for survival in septic shock
Authors: Iskit A B , Guc M O 
Published: March 2003

Abstract

Background
The effect of endothelin and nitric oxide inhibition on survival from septic shock was investigated in mice, with particular emphasis on the timing of the administration of their blockers after an endotoxin (lipopolysaccharide; LPS) challenge.

Methods
Male Swiss albino mice (20–40 g) received LPS (Escherichia coli 055: B5; 60 mg kg−1 intraperitoneally) followed by intraperitoneal injection of the endothelin receptor antagonist bosentan 30 mg kg−1, either 2 or 12 h after LPS, alone or in addition to intraperitoneal nitric oxide synthase blockers l-canavanine 20 or 100 mg kg−1, L-NAME 3 mg kg−1 or aminoguanidine 15 mg kg−1, which were given twice, at 2 and 6 h after LPS. Control animals received saline and survival rates in each group (n = 10) were recorded over 24 h at 6-h intervals.

Results
At 24 h, the survival rate was 10 per cent in controls, but 30 per cent (P not significant) and 70 per cent (P &lt; 0·05) in animals that received bosentan only at 2 and 12 h respectively, indicating a relatively ‘late’ involvement of endothelin. In contrast, these values were 70 per cent (P &lt; 0·05) and 80 per cent (P &lt; 0·05) at 12 h for L-NAME and l-canavanine, which both decreased to 10 per cent (P not significant) at 24 h implying a relatively ‘early’ involvement of nitric oxide. A higher value (60 per cent; P &lt; 0·05) was obtained when bosentan given at 2 h was combined with L-NAME. The best outcome (90 per cent survival rate; P &lt; 0·05) was observed when bosentan was given at 12 h in combination with L-NAME at 2 and 6 h. Interestingly, the survival rate was 70 per cent (P &lt; 0·05) in the aminoguanidine group, which can be explained by other pharmacological effects of this drug in addition to nitric oxide blockade.

Conclusion
Nitric oxide plays a significantly deleterious role during the early phases of septic shock, in contrast to a relatively late involvement of endothelin peptides. This should be taken into consideration when devising treatment strategies.
Gram-positive bacterial cell wall products upregulate surface expression of intercellular adhesion molecule 1, human leucocyte antigen DR and CD14 on monocytes in human whole blood
Authors: Jørgensen P F , Wang J E , Almløf M , Thiemermann C , Aasen A O 
Published: March 2003

Abstract

Background
The aim was to investigate the influence of Gram-positive cell wall components on monocyte surface inflammatory receptors compared with lipopolysaccharide (LPS) in human whole blood.

Methods
Human whole blood from six healthy donors was incubated with peptidoglycan (PepG) 10 μg ml−1 from Staphylococcus aureus and Bacillus subtilis, lipoteichoic acid (LTA) 100 μg ml−1 from S. aureus and LPS 10 ng ml−1 from Escherichia coli in microcentrifuge tubes at 37°C with slow rotation for 4 h. Subsequent to incubation with fluorescein isothiocyanate (FITC)- and phycoerythrine (PE)-labelled monoclonal antibodies, surface molecule (CD14, CD54, CD58, CD64, CD80 and human leucocyte antigen (HLA) DR) expression was analysed by flow cytometry performed on the FACScan using the CellQuest software.

Results
All surface molecules except CD80 were expressed constitutively on monocytes in whole blood. Stimulation with either type of PepG, LTA and LPS did not induce any changes in expression of CD58 or CD64, nor did they induce expression of CD80. However, significant upregulation of CD54 and HLA-DR was observed in all donors. Contrary to LPS, PepG and LTA also upregulated the expression of monocyte surface CD14.

Conclusion
The Gram-positive cell wall products PepG and LTA strongly upregulated the expression of intercellular adhesion molecule 1 (CD54) and HLA-DR on monocytes in human whole blood, as was seen in LPS-stimulated whole blood. In contrast to Gram-negative endotoxin, the Gram-positive cell wall products also upregulated the expression of the LPS receptor CD14. This suggests possible differences in intracellular signalling between Gram-positive cell wall products and Gram-negative LPS in monocytes.
Dopamine attenuates neutrophil–endothelial interaction and is a putative anti-inflammatory cytokine
Authors: Sookhai S , Wang J H , McCourt M , Winter D C , Kirwan W O , Redmond H P 
Published: March 2003

Abstract

Background
Activated neutrophil (PMN) adherence to vascular endothelium comprises a key step for both transendothelial migration and initiation of potentially deleterious release of PMN products. Previous work has shown that the biogenic amine dopamine (DA) functions as an anti-inflammatory cytokine by inducing PMN apoptosis. The effect of DA on PMN transendothelial migration and adhesion receptor expression as well as on the endothelial molecules, E-selectin and intercellular adhesion molecule (ICAM) 1, was evaluated.

Methods
PMNs were isolated from healthy controls, stimulated with lipopolysaccharide (LPS) and tumour necrosis factor (TNF) α and treated with DA. CD11b and CD18 PMN adhesion receptor expression was assessed flow cytometrically. In a separate transwell experiment, the effect of the chemo-attractant peptide interleukin (IL) 8 on PMN migration was assessed. Human umbilical vein endothelial cells were stimulated with LPS/TNF-α, incubated with DA, and ICAM-1 and E-selectin endothelial molecule expression was assessed.

Results
There was a significant increase in transendothelial migration in stimulated PMNs as well as in CD11b/CD18, endothelial E-selectin and ICAM-1 expression compared with normal PMNs. DA attenuated these changes. The chemoattractant effect of IL-8 was also abolished.

Conclusion
These results show that DA attenuates the initial interaction between PMNs and endothelium, providing further evidence that it also functions as an anti-inflammatory cytokine.
Impact of relaparotomy in patients with abdominal sepsis
Authors: Verwaal V J 
Published: March 2003

Abstract

Background
This study determined whether relaparotomy has a positive or negative effect on prognostic scoring systems.

Methods
Between April 1995 and January 1997, 46 patients with abdominal sepsis were treated. The diagnosis of abdominal sepsis was defined as meeting the Bone criteria for sepsis before operation, in combination with infection of the abdomen proven by laparotomy. After the first laparotomy there were 41 relaparotomies in these 46 patients. From 2 days before to 3 days after the relaparotomy, data were collected to compile the Acute Physiology and Chronic Health Evaluation (APACHE) III and Multiple Organ Failure (MOF) scores. The scores were compared before and after relaparotomy, and were also compared between patients who had a recurrent infection in the abdomen and those who did not.

Results
During 41 relaparotomies, 16 patients were found to have a pus collection. Of these clinical infections only 11 had a positive culture. Overall the APACHE III and MOF scores were not significantly different before and after operation. In patients with clinical infection there was also no difference pre and post operative. The same applied for patients with and without positive intraabdominal cultures.

Conclusion
Relaparotomy in patients with abdominal sepsis did not have a negative effect on prognosis within a few days after reoperation. The authors did not find any reason to use APACHE III or MOF scoring as an indication for relaparotomy.
Risk factors for nosocomial infection after elective pulmonary thoracic surgery
Authors: Scriba D , Förster E , Gandawidjaja L , Hau T 
Published: March 2003

Abstract

Background
The aim was to identify risk factors for the development of infection after pulmonary surgery.

Methods
A retrospective analysis of 440 consecutive patients operated on between August 1987 and July 1997 was conducted.

Results
Nosocomial infections (NIs) were observed in 122 patients (27·7 per cent): pneumonia in 75 (17·0 per cent), urinary tract infection (UTI) in 40 (9·1 per cent), surgical site infection (SSI) in 37 (8·4 per cent), nine of which were pleural empyemas (2·0 per cent), and other infections in six (1·4 per cent). The infection-related mortality rate was 3·2 per cent (14 patients). Multivariate analysis of 21 variables revealed that the following were independent predictors for the development of NI:
No operation-related factor, such as infection, indication for surgery, extension of pulmonary resection, duration of operation or transfusion requirements, had a significant influence on the development of NI.

Conclusion
The results indicate that impairment of the patient's ability to respond to surgical trauma is more important for the development of postoperative infection than factors related to the operation.
Surgical treatment of infected pancreatic necrosis
Authors: Gruca Z , Dobosz M , Makarewicz W 
Published: March 2003

Abstract

Background
Twenty-six cases of infected pancreatic necrosis (IPN) treated by means of operation in the years 1997–1999 are presented.

Methods
The diagnosis of IPN was established before surgery by means of contrast-enhanced computed tomography and fine-needle aspiration of the infected pancreatic and peripancreatic tissue. Microbiological findings of infected tissue most commonly showed Escherichia coli (12) and Klebsiella pneumoniae (eight). Candidiasis was observed in three cases. All patients were stratified according to Acute Physiology and Chronic Health Evaluation (APACHE) II score within 24 h of admission to the ward and before planned surgery. Wide surgical exploration of the omental sac and retroperitoneal space, gentle necrosectomy of necrotic tissue, and continuous omental sac lavage in connection with an ‘open abdomen’ technique was carried out within 4–22 (mean 10) days from the onset of the disease. Planned relaparotomies were performed every 4–5 days until all the necrotic tissue was removed and granulation of the operating area was observed. Closure of the abdomen was performed within 14–34 (mean 23) days after primary laparotomy.

Results
Six patients died (mortality rate 23 per cent) during the postoperative period from multisystem organ failure accompanying septic shock. The poor outcome was related to a high APACHE II score (11–15). During the postoperative period the following complications were observed: respiratory insufficiency requiring mechanical ventilation (24 cases), colonic fistula (five), pancreatic fistula (three), renal insufficiency requiring haemofiltration (three), upper gastrointestinal bleeding (two) and gastric fistula (one). Incisional hernia developed in five patients who left hospital. The hospital stay for survivors ranged between 26 and 52 (mean 36) days.

Conclusion
Diagnosis of IPN based on dynamic computed tomography and bacteriological examination of necrotic aspirate and the consecutive surgical treatment, including wide repeated necrosectomy and continuous lavage combined with an ‘open abdomen’ technique, is the management of choice, and may improve the results of treatment.