bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of superficial vein surgery in treatment of venous ulceration
Authors: Bello A M , Scriven M , Naylor A R , Bell P R F , London N J M 
Published: March 2003

Abstract

Background
Recent colour duplex studies of patients presenting with venous ulceration in the community have shown that between 55 and 60 per cent have isolated superficial venous insufficiency. Previous studies of the role of superficial surgery in the treatment of venous ulceration have applied postoperative compression bandaging and therefore it has not been possible to determine the role of superficial surgery in promoting ulcer healing. The purpose of this prospective study was, therefore, to examine the healing rate after superficial surgery in patients with isolated superficial venous incompetence and venous ulceration who did not undergo postoperative compression bandaging.

Methods
Patients with isolated superficial venous incompetence, as demonstrated by colour duplex scanning and an ankle: brachial pressure index greater than 0·8, underwent saphenofemoral or saphenopopliteal disconnection under local anaesthesia, or a high tie and strip under general anaesthesia. Compression bandaging was not applied after operation. Patients were followed regularly after surgery and the endpoint was ulcer healing.

Results
Between May 1994 and July 1997, 122 legs with venous ulceration and isolated superficial venous incompetence underwent superficial surgery. Ninety-three (76 per cent) had long saphenous incompetence alone, 13 (11 per cent) had short saphenous incompetence alone and 16 (13 per cent) had combined long and short saphenous incompetence. The median (range) patient age was 72 (28–94) years and the median duration of ulceration was 32 weeks (range 2 weeks to 32 years). The median (range) ulcer area was 9 (1–500) cm2. Ninety patients (74 per cent) had a local anaesthetic procedure while 32 (26 per cent) had general anaesthesia. Of patients who had long saphenous surgery, 69 had high ligation only and 24 had high ligation and strip. The healing rate by life-table analysis was 58 per cent at 6 months, 73 per cent at 1 year and 82 per cent at 18 months. Clinical review and colour duplex examination of patients with ulcers that had failed to heal (n = 18) showed that two had recurrent superficial to deep connections; the remainder had fixed ankle joints or severe osteoarthritis of the hip and knee.

Conclusion
Superficial venous surgery in patients with isolated superficial venous incompetence and venous ulceration can achieve a very high healing rate in the absence of postoperative compression.
Prevalence and significance of thrombophilia in patients with intermittent claudication
Authors: Evans S M , Brittenden J , Adam D J , Ludlam C , Bradbury A W 
Published: March 2003

Abstract

Background
Thrombophilia may be associated with premature atherosclerosis, an increased susceptibility to primary arterial thrombosis and an increased failure rate for peripheral vascular or endovascular interventions. The aim of this study was to determine the prevalence of thrombophilia in patients with intermittent claudication (IC).

Methods
This was a prospective study of 116 consecutive new patients (70 men; median age 65 (range 43–84) years) referred to this regional vascular surgery unit with IC. Patients on warfarin, or who had previously undergone lower limb reconstruction and/or angioplasty, were excluded.

Results
Thrombophilia was demonstrated in 24 patients (21 per cent). The commonest abnormality (15 patients, 13 per cent) was a raised level of anticardiolipin antibody (ACLA) (11 immunoglobulin (Ig) M, four IgG). Other abnormalities comprised: lupus anticoagulant (one), protein C deficiency (two), protein S deficiency (two), activated protein C resistance (one) and factor V Leiden heterozygosity (three). All abnormalities were confirmed on repeat testing. No patient had a history of venous thrombosis. There was no statistically significant relationship between ACLA status and age, sex, ankle: brachial pressure index, previous myocardial infarction or stroke, previous carotid endarterectomy or coronary artery surgery, serum cholesterol, current use of antiplatelet agents or current smoking status.

Conclusion
Almost one-quarter of new patients referred to this regional vascular unit with IC have thrombophilia; over half of those affected have a raised ACLA level compatible with the antiphospholipid syndrome. At present, the clinical significance and management implications of these abnormalities remain unknown.
Review of out-of-hours vascular procedures in a tertiary vascular unit
Authors: Kelly M , Potter K , Nassef A , Jacob S , Loosemore T , Dormandy J , Taylor R 
Published: March 2003

Abstract

Background
The aim of this study was to review out-of-hours vascular procedures in a tertiary vascular unit.

Methods
The vascular emergencies that presented outside normal working hours (17.00 to 08.00 hours) in a vascular unit between January and June 1998 were reviewed. Only cases considered to be life or limb threatening and requiring urgent surgical or radiological intervention were assessed.

Results
The Table shows that a significant number of vascular emergencies was performed out of hours in one unit. This was, in part, due to an increase in the number of tertiary referrals, which represented 57 per cent of all emergency procedures. Reasons for the tertiary referrals were: no consultant vascular surgeon on call (33 per cent), no consultant interventional radiologist on call (26 per cent), lack of intensive care beds (30 per cent) and complex procedure (11 per cent). The overall mortality rate of patients referred in this period was 15 per cent. The unit has three consultant vascular surgeons, two consultant interventional radio- logists and one vascular specialist registrar.

Conclusion
The significant increase in out-of-hours vascular emergencies, both surgical and radiological, has placed an enormous demand on senior members of the team. In addition, it has had a significant impact on the unit's elective admissions and waiting lists, in particular those for routine general surgery. To support the growth in complex emergency referrals, senior vascular fellows in both vascular surgery and radiology have been appointed and proposals are underway to restructure local vascular services.
VSS abstracts
Authors: Woodcock S A , Hulton N 
Published: March 2003

Abstract

Background
A new emergency vascular cover service came into effect on 1 May 1997 involving three district general hospitals, eight surgeons and covering a patient population of 600 000. Each week one of the three hospitals is on call, accepting the transfer of patients requiring urgent surgical or radiological vascular intervention between 17.00 and 09.00 hours each weekday and throughout the weekend from the other two hospitals. The aim of this project was to evaluate the pattern, appropriateness of referral and increased workload in the first year following the implementation of this model of emergency vascular cover.

Methods
A retrospective study of case notes was conducted identifying all acute vascular emergency admissions from each hospital.

Results
The total number of emergency admissions when on call was 140; 71 per cent were admitted via bed bureau/accident and emergency, 26 per cent were transfers from the other two hospitals and 3 per cent were transfers from elsewhere. Some 66 per cent of admissions occurred between 17.00 and 09.00 hours or at weekends; 36 per cent required emergency operation. Of these patients, 42 per cent required abdominal aortic aneurysm repair, 42 per cent an embolectomy, 11 per cent an amputation and 5 per cent another procedure. Consultants performed 58 per cent of the emergency operations, specialist registrars 37 per cent and senior house officers 5 per cent. Of the total number of emergencies admitted, 12 per cent required intensive care unit facilities. Some 63 per cent of the patients were finally discharged, 11 per cent were transferred and 25 per cent died.

Conclusion
These data demonstrate that one consultant-led vascular team can provide an out-of-hours emergency vascular service for a population served by three hospitals. The workload is manageable without the predicted drain on resources and is preferred by the participating consultants.
Avoiding the complications of thrombolysis
Authors: Thomas S M , Gaines P A 
Published: March 2003

Abstract

Background
NATALI is a voluntary database of patients undergoing peripheral vascular thrombolysis run on behalf of the Thrombolysis Study Group. The size of the data set allows analysis to identify predictors of outcome and complications. These may be patient factors or variables related to the technique used.

Methods
Since its inception on 1 January 1990, 798 thrombolytic events have been recorded. Details are collected on a wide range of factors: perceived risk factors; details of thrombolysis technique; complications; outcome; and adjunctive procedures. Using univariate and multivariate analysis, factors associated with an increased risk of complications were investigated.

Results
Death and complications (perilysis) occurred in 25·9 per cent of episodes (n = 207). Patient factors were the main influence on the risk of complications. Increasing age, use of aspirin and thrombolysis of grafts were significantly associated with an increased risk of complications after adjustment for confounders (P &lt; 0·05). Female sex, the presence of peripheral vascular disease and Fontaine class were of borderline significance. Other patient factors were not associated with an increased risk of complication. Aspects of radiological technique, such as agent used, sheath size, length of lysis, dose of lysis, use of heparin or adjunctive procedures, had no relationship to the rate of complications.

Conclusion
Case selection is the most important factor influencing the occurrence of complications. Radiological technique does not seem to influence the occurrence of complications.
Results of the carotid and vertebral artery transluminal angioplasty study
Authors: Brown M M 
Published: March 2003

Abstract

Background
Trials have demonstrated the benefit of surgery for severe carotid stenosis, but there is still significant morbidity from the operation. Percutaneous transluminal angioplasty (PTA) avoids general anaesthesia and trauma from a neck incision, but has not yet gained acceptance for carotid stenosis because of concern about the risks. The Carotid And Vertebral Artery Transluminal Angioplasty Study was established to investigate the risks and benefits of cerebrovascular PTA.

Methods
Twenty-four centres in Europe, Australia, Canada and the USA collaborated to randomize 504 patients (mean age 67 years; 69 per cent men) with carotid stenosis to surgery (n = 253) or angioplasty (n = 251) between 1992 and 1997.

Results
Some 90 per cent of the patients were recently symptomatic. PTA was carried out using balloon catheters with the adjunctive use of stents in 26 per cent. Mean carotid stenosis by the common carotid method was 87 per cent. Safety analysis by intention to treat showed no difference in the primary outcome measure of disabling stroke or death within 30 days of treatment (surgery, 6 per cent; PTA, 6 per cent). Cranial nerve injury and myocardial ischaemia were only reported at the time of treatment in the surgical group. Long-term survival curves showed no difference in ipsilateral stroke during follow-up.

Conclusion
Carotid surgery and angioplasty are equivalent in safety and efficacy, but angioplasty has advantages with respect to nerve injury and cardiac complications.
Laparoscopic surgery for large hiatus hernia
Authors: Davies N , Toh S , Waston D I , Devitt P G , Jamieson G G 
Published: March 2003

Abstract

Background
The results of laparoscopic surgery for large symptomatic hiatus hernia were revieved prospectively.

Methods
This was a prospective review of large (greater than 10 cm) hiatus hernias treated by laparoscopic surgery at the Royal Adelaide Hospital from January 1994 to July 1997. Demographic data, preoperative investigations, operative findings, operating times, conversion rate, complications and follow-up were recorded prospectively.

Results
Some 48 patients with a large hiatus hernia were treated laparoscopically. All had repair of the hiatal pillars and 47 had a fundoplication. The median age was 58 (range 30–87) years and there were 25 women. There were 11 sliding, eight paraoesophageal and 29 mixed hiatus hernias, and 20 completely intrathoracic stomachs. Median operating time was 75 (range 48–195) min and there were 12 conversions to an open operation; four because of difficulty reducing the hernia, three for obesity, two for bleeding, two because it was not possible to define the anatomy and one for gastric perforation. The majority of conversions occurred earlier in this experience and a change in technique to dissecting the sac out of the thoracic cavity reduced the conversion rate (38 to 15 per cent; P = 0·03, Fisher's exact test). Complications occurred in eight patients and resulted in early reoperation in two (one open and one laparoscopic). There was no death. The median stay was 3 (range 2–10) days. At a median follow-up of 19 (range 3–46) months, eight patients had minor dysphagia and two patients had an incisional hernia (both converted to open operation). One patient had a recurrent paraoesphageal hernia at 6 months and required further surgery. Median satisfaction scores were 10 (range 7–10) of 10 and all patients said they would have the operation again.

Conclusion
Large hiatus hernias can be effectively treated laparoscopically. The initial high rate of conversion to open operation was reduced by a change in operative technique.
Carcinoma of the oesophagus and stomach in Wales: a 1-year survey
Authors: Pye J K , Crumplin M K H , Foster M E , Biffin A , Charles J 
Published: March 2003

Abstract

Background
The management and outcome of patients presenting with oesophagogastric carcinoma over a 12-month period in Wales were reviewed.

Methods
Data were collected from September 1995 to September 1996 on 916 consecutive patients and submitted to confidential data analysis. The data originated from 20 hospitals and 70 surgeons treating these patients.

Results
The number of cases managed by each hospital varied between two and 124, and by each surgeon from one to 44. Three tumour sites were identified: carcinoma of the oesophagus (n = 339), carcinoma of the cardia (gastro-oesophageal junction; n = 193) and gastric carcinoma (n = 384). The 30-day mortality rate was 13 per cent for oesophageal carcinoma, 12 per cent for cardia carcinoma and 11 per cent for gastric carcinoma. Resection rates for the three tumour sites were 28, 44 and 56 per cent. There were 16 anastomotic leaks overall. For patients undergoing surgery, there was an inverse relationship between case load and mortality rate. This difference narrowed when ten or more patients were operated on per annum. For surgeons consulting with more than ten patients per annum and who operated on more than 70 per cent of these, the mortality rate was 18 per cent, compared with 5 per cent for those who operated on less than 70 per cent.

Conclusion
Numerically there is a broad range of experience amongst the surgeons who treat carcinoma of the oesophagus and stomach in Wales. There may be an optimum minimal case load and, with careful selection of␣patients for surgery, morbidity and mortality rates should be minimized.
Prospective audit following the introduction of short-course preoperative radiotherapy for rectal cancer
Authors: Lele S , Radstone D , Eremin J , Kendal R , Hosie K B 
Published: March 2003

Abstract

Background
The value of introducing a short course of preoperative radiotherapy before operation for rectal cancer is still subject to debate.

Methods
One hundred consecutive patients, of mean age 68 (range 29–87) years undergoing preoperative radiotherapy for rectal cancer between January 1997 and December 1998 at two radiotherapy centres were audited prospectively.

Results
The time from referral to radiotherapy was 33 (11–74) days and from radiotherapy to operation 5 (1–42) days. There was a higher than expected anastomotic leak rate (15 per cent) and perineal wound infection rate (18 per cent). Patients waiting more than 7 days were more likely to suffer perineal wound breakdown: 15 per cent (n = 39) versus 30 per cent (n = 10).

Conclusion
The high anastomotic leak and perineal wound infection rates suggest that the introduction of preoperative radiotherapy combined with total mesorectal excision should be audited carefully or performed as part of the CRO7 trial.
Prospective study of safety, patient satisfaction and leg ulcer healing following saphenous and subfascial endoscopic perforator surgery
Authors: Nelzén O 
Published: March 2003

Abstract

Background
Subfascial endoscopic perforator surgery (SEPS) is a minimally invasive alternative to conventional techniques for incompetent calf perforators. Although SEPS has been performed for more than a decade, limited and insufficient data have been published regarding its safety, patient satisfaction and results.

Methods
A prospective follow-up was undertaken of consecutive SEPS operations on 149 legs, performed in 138 patients: 67 legs with ulceration, 34 with skin changes and 48 with varicose veins. Conventional saphenous vein surgery was performed, when indicated, together with the SEPS procedure. Follow-up was performed after 1 week and later by postal questionnaire to assess long-term morbidity, late complications and patient satisfaction. Patients with ulcers were followed continuously.

Results
Most operations (n = 107) were performed as day-case surgery. Combined saphenous vein surgery was performed in 89 per cent. No serious complications occurred: wound infection in 7 per cent; severe postoperative pain in 9 per cent; delayed wound healing in 15 per cent. After a median follow-up of 7 (1–31) months, 91 per cent of patients were satisfied. After a median of 32 (14–57) months, ulcer healing had occurred in 30 of 36 patients with open ulceration at the time of operation.

Conclusions
SEPS is a safe procedure, suitable for day-case surgery. Patients are generally satisfied with the outcome and the results of leg ulcer healing are promising.
Retrospective analysis of type of hepatic resection for hepatocellular carcinoma
Authors: Takano S , Oishi H , Kono S , Kawakami S , Nakamura M , Kubota N , Iwai S 
Published: March 2003

Abstract

Background
Hepatic resection for hepatocellular carcinoma is now considered a relatively safe procedure, owing to refined surgical techniques and management.

Methods
Three hundred different types of hepatic resection performed in one hospital were reviewed retrospectively. The operative morbidity and mortality rates and long-term survival were assessed.

Results
Tumours were extirpated by lobectomy or extended lobectomy in 48 patients, by segmentectomy in 53, by subsegmentectomy in 94 and by partial resection in 105. The overall hospital mortality rate was 4 per cent (13 of 300). No operative death occurred after lobectomy or extended lobectomy. Segmentectomy and subsegmentectomy were associated with high postoperative complication and hospital mortality rates. There was a significant difference in survival rate between patients with and without a cancer-free surgical margin of more than 1·0 cm. The overall 5- and 9-year survival rates were 51 and 9 per cent respectively. Rates were 56 and 24 per cent for lobectomy or extended lobectomy.

Conclusion
For tumours of 2·1 cm or more in size lobectomy appears to carry the least risk of postoperative complications and death in hospital and best achieves a cancer-free surgical margin.
Experimental study of the influence of endoleak size on pressure in the aneurysm sac and the consequences of thrombosis
Authors: Schurink G W H , Aarts N J M , van Baalen J M , Kool L J Schultze , van Bockel J H 
Published: March 2003

Abstract

Background
This was an experimental study of endovascular aortic surgery, looking at the relationship between the size of an endoleak, pressure in the aneurysm sac and the effect of thrombosis produced by coagulation.

Methods
In three pigs, 16 saccular aneurysms were connected to the aorta by various side branches with different diameters and lengths (‘endoleaks’). Mean and pulse pressures were measured in the systemic circulation as well as in the aneurysm sac during the experiment. Duplex ultrasonography was used to determine whether the endoleak and the aneurysm were patent or thrombosed. Thrombosis was influenced by systemic tranexamic acid, fibrinogen in the aneurysm sac, Gelfoam in both endoleak and aneurysm sac, and by Histoacryl glue in the endoleak.

Results
With an open endoleak, the mean pressure in the aneurysm and the aorta was identical. Mean aneurysm pressure was lower with a thrombosed endoleak and was related to the diameter of the endoleak. Pulse pressure was recorded in the aneurysm sac when there was an open endoleak and a non-thrombosed aneurysm, and was related to the diameter of the open endoleak. Thrombosed endoleaks never produced pulse pressure in the aneurysm. If Histoacryl and Gelfoam induced thrombosis of the endoleak, the decrease in mean aneurysm pressure was identical to that resulting from the spontaneous thrombosis of endoleaks.

Conclusion
An open endoleak results in systemic arterial pressure in the aneurysm sac. Pulse pressure is detected if the aneurysm is patent, but absent if there is complete or partial thrombosis of the aneurysm. Endoleak thrombosis, either spontaneous or by embolization, is accompanied by a decrease in mean pressure and the absence of pulse pressure in the aneurysm sac. The extent to which these experimental findings are comparable to the clinical situation represents a field of further research.
Acquiring surgical skills
Authors: Hamdorf J M , Hall J C 
Published: March 2003

Abstract

Background
Technical competence is the bedrock of surgery, yet it has only recently been viewed as a valid area for either critical evaluation or formal teaching.

Methods
This review examines the teaching of surgical skills. The core is derived from a literature search of the Medline computer database.

Results and conclusion
The impetus for surgical change has generally related to the introduction of new technology. Advances initially allowed for open operation within the main body cavities; more recently minimal access surgery has appeared. The latter was introduced in an inappropriate manner, which has led to the evolution of teaching of technical skills away from an apprenticeship-based activity towards more formal skill-based training programmes. There is now a need for a solid theoretical base for the teaching of manual skills that accommodates concepts of surgical competence.
Imaging of anorectal disease
Authors: Stoker J , Rociu E , Wiersma T G , Laméris J S 
Published: March 2003

Abstract

Background
Over the past two decades developments in imaging have changed the assessment of patients with anorectal disease.

Methods
The literature on imaging techniques for anorectal diseases was reviewed over the period 1980–1999.

Results
For the staging of primary rectal tumours, phased array magnetic resonance imaging (MRI) may be regarded as the most appropriate single technique. The combination of endosonography or endoluminal MRI with ultrasonography or spiral computed tomography yields similar results. All techniques have limitations both for local staging and in the assessment of distant metastases. MRI or positron emission tomography is preferable for tumour recurrence. For perianal fistula, high-resolution MRI (phased array or endoluminal) is the technique of choice. For constipation, defaecography is the preferred technique, nowadays with emphasis on functional information. The role of magnetic resonance defaecography is currently being evaluated. For faecal incontinence, endosonography and endoluminal MRI give similar results in detecting sphincter defects; endoluminal MRI has the advantage of detecting external sphincter atrophy.

Conclusion
High-resolution MRI, endosonography and defaecography are currently the optimal imaging techniques for anorectal disease.