bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emerging trends in the management of the impalpable testis
Authors: Flett M E , Jones P F , Youngson G G 
Published: March 2003

Abstract

Background
The management of the impalpable undescended testis is controversial. The study examines emerging trends in the management of this problem.

Methods
Two groups of boys were treated consecutively and recorded prospectively from 1974 to 1984 and from 1990 to 1998 inclusive. A consistent policy of using the preperitoneal approach for impalpable testis was adopted during both time intervals but during the second study period examination under anaesthesia and diagnostic laparoscopy were introduced to ascertain testicular presence and location.

Results
Some 919 boys were treated for cryptorchidism during the study period. Ninety boys in the first group (23 per cent) underwent preperitoneal explorations for impalpable testes. Anorchia was present in 18 and orchidectomy was performed in two boys. Thirty boys in the later group (5 per cent) were diagnosed as having impalpable testes. Fifteen boys underwent successful preperitoneal orchidopexy, anorchia was present in 11 and four underwent orchidectomy, carried out for high intra-abdominal testes.

Conclusion
Examination under anaesthesia and subsequent laparoscopic assessment for all impalpable testes has reduced the need for preperitoneal exploration for the impalpable undescended testis. In this large series, division of the testicular vessels in order to secure scrotal placement of the testis was required in one instance only.
Endoscopically assisted, minimally invasive parathyroidectomy
Authors: Gauger P G , Reeve T S , Delbridge L W 
Published: March 2003

Abstract

Background
Despite the success of open parathyroid exploration, minimally invasive alternatives have been emerging. This study reports an experience with endoscopically assisted, minimally invasive parathyroidectomy and evaluates its current role in patients undergoing surgery for hyperparathyroidism.

Methods
One hundred consecutive patients requiring surgery for hyperparathyroidism were evaluated. Endoscopic parathyroidectomy was offered based on the absence of coexisting nodular thyroid disease, previous neck surgery or irradiation, suspicion of parathyroid hyperplasia, or other anatomical or medical contraindications. Some 24 of 100 patients fulfilled the criteria and underwent endoscopic parathyroidectomy. Unequivocal localization to a single site by a technetium-99m-radiolabelled sestamibi scan allowed removal of the adenoma through a 25-mm suprasternal incision while being guided by a surgical telescope.

Results
There were no statistically significant differences in operating time or the mean size of resected adenomas between patients undergoing endoscopic and open parathyroidectomy. Four patients required conversion to an open procedure. Two patients developed temporary recurrent laryngeal nerve paresis and one had persistent hyperparathyroidism.

Conclusion
Although endoscopic parathyroidectomy is technically feasible, its applicability is limited to a minority of patients undergoing operation for hyperparathyroidism. The potential for higher complication and failure rates makes optimism for the procedure appropriately guarded.
Long-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair
Authors: Leibl B J , Däubler P , Schmedt C-G , Kraft K , Bittner R 
Published: March 2003

Abstract

Background
At present only short-term follow-up data are available to compare endoscopic and conventional hernia surgery. This paper presents data from a randomized study 6 years after initial recruitment.

Methods
In 1993 a randomized comparative study of transabdominal preperitoneal (TAPP) and Shouldice repair was commenced. Endpoints were rate of recurrence, late complications, complaints and patient satisfaction.

Results
The rate of recurrence in the TAPP group was one (2 per cent) of 48 patients and in the Shouldice group two (5 per cent) of 43. Only five patients in the Shouldice and three in the TAPP group reported slight discomfort in the inguinal region at 6-year follow-up. In neither group was chronic pain syndrome observed. Altogether, 46 (96 per cent) of 48 patients in the TAPP group and 35 (81 per cent) of 43 of those having the Shouldice procedure stated complete satisfaction with the hernia repair.

Conclusion
Long-term evaluation demonstrated greater satisfaction with the result of the repair in the endoscopic group. The difference between the groups in the recurrence rate was not significant, because of the small numbers. The TAPP method appears to be an effective surgical alternative in patients with inguinal hernia.
Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids
Authors: Misra M C , Parshad R 
Published: March 2003

Abstract

Background
Patients with acute bleeding from internal haemorrhoids often have to be referred by the general practitioner to the surgeon for definitive treatment with invasive outpatient procedures. At the initial consultation, patients frequently seek postponement of immediate surgery to a more convenient time. Effective and rapid non-invasive control of acute bleeding could be of practical use in scheduling surgery to a time convenient to both patient and surgeon.

Methods
In a 90-day randomized, double-blind study treatment with a micronized purified flavonoid fraction (MPFF) was compared with placebo, in 100 outpatients who presented for treatment of acute internal haemorrhoids of less than 3 days' duration. The primary endpoint was cessation of bleeding on the third day of treatment.

Results
Of 50 patients randomized to each group, acute bleeding ceased by the third day in 40 (80 per cent) who received MPFF compared with 19 (38 per cent) who had placebo (P &lt; 0·01). Mean(s.d.) duration of acute bleeding from onset to cessation of 4·9(1·6) days was 2·1 (95 per cent confidence interval 1·2–2·9) days less than that in patients receiving placebo (P &lt; 0·01). Continued treatment in patients with no bleeding prevented a relapse in 30 of 47 patients, compared with 12 of 30 receiving placebo (P &lt; 0·05).

Conclusion
Patients with acute internal haemorrhoids treated with MPFF had rapid cessation of bleeding and a reduced risk of relapse. This could be of value in the more convenient timing of treatment with invasive outpatient procedures.
Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence
Authors: van de Watering L M G , Brand A , Houbiers J G A , Klein Kranenbarg W M , Hermans J , van de Velde C J H 
Published: March 2003

Abstract

Background
Perioperative blood transfusions are reported to be related to cancer recurrence and reduced survival. Different underlying mechanisms have been proposed, and allogeneic leucocytes in transfused blood have been suggested to contribute to this phenomenon.

Methods
Packed red cells without buffy coat (PC group) were compared with filtered, leucoreduced, red cells (LD group) in a randomized trial of 697 patients with colorectal carcinoma. Five-year survival and cancer recurrence rates were determined, with special emphasis on the location of recurrence.

Results
The intention-to-treat analysis showed a survival rate of 63·6 per cent in the PC group and 65·3 per cent in the LD group (P = 0·69), with recurrence rates of 27·8 and 27·9 per cent respectively. The observational analysis showed a significant difference in survival between transfused and non-transfused patients (59·6 versus 72·9 per cent; P &lt; 0·001). The difference in cancer recurrence rate between transfused and non-transfused patients was not statistically significant (29·8 versus 24·3 per cent; P = 0·13). Local recurrences were more frequent in transfused than non-transfused patients (11·9 versus 7·6 per cent; P = 0·09).

Conclusion
Leucocyte depletion of perioperative transfused blood has no effect on long-term survival and/or cancer recurrence. Perioperative blood transfusions are associated with impaired survival, but not with cancer recurrence. The slight increase in local recurrence rate in transfused patients appears to be related to complicated, in particular rectal, surgery.
Electrolytic ablation as an adjunct to liver resection: experimental studies of predictability and safety
Authors: Wemyss-Holden S A , Dennison A R , Finch G J , de la M Hall P , Maddern G J 
Published: March 2003

Abstract

Background
Combined liver resection and local ablation may offer the only chance of cure to patients with liver metastases who are presently deemed unresectable because of a single awkwardly placed metastasis. By definition, such a metastasis is often close to a major vein. An ablative technique is needed that is both predictable and safe in such a circumstance.

Methods
Electrolytic liver lesions were created in 21 pigs using platinum electrodes, connected to a direct current generator. Both electrolytic ‘dose’ and electrode separation were varied to produce different sized lesions. The ‘dose’ was correlated with the volume of necrosis and any vascular damage was determined histologically.

Results
There was a significant (P &lt; 0·001) correlation between the electrolytic ‘dose’ and the volume of liver necrosis. For a given ‘dose’ the volume of necrosis was less when the electrodes were together, rather than separated. Liver enzymes were only transiently deranged. There were no significant vascular injuries.

Conclusion
Predictable and reproducible necrosis is produced by electrolysis in the pig liver. The treatment appears to cause little or no damage to immediately adjacent liver or major vascular structures and, when combined with resection, may offer the chance of a cure to many patients who are currently unresectable.
Effect of venous ulcer exudates on angiogenesis in vitro
Authors: Drinkwater S L , Smith A , Sawyer B M , Burnand K G 
Published: March 2003

Abstract

Background
Angiogenesis, the formation of new from existing capillaries, is an important mechanism in venous ulcer healing. The aim of this study was to determine whether venous leg ulcer wound exudates stimulate or inhibit angiogenesis.

Methods
Fluid exudate was obtained from 16 venous ulcers over a 4-h interval. Five of the ulcers had not healed after more than 1 year of compression bandaging, and five were rapidly healing ulcers. As a control, acute wound fluids were collected from subcutaneous drains in seven patients. Vascular endothelial growth factor (VEGF) at 2 ng/ml acted as a positive control. Tubules stained with an antiendothelial antibody were quantified using an image analysis system. The extent of angiogenesis was expressed as the ratio of the mean tubule length in the test wells over that in blank control wells.

Results
Venous ulcer exudates significantly inhibited angiogenesis (mean (95 per cent confidence interval) 0·72 (0·48 to 0·96)) compared with acute wound fluids (2·48 (0·86 to 4·10)) (P &lt; 0·002) and VEGF (1·47 (1·32 to 1·61)) (P = 0·01). Exudates from the five non-healing venous ulcers inhibited angiogenesis (0·31 (0·15 to 0·46)) significantly more than exudates from the five rapidly healing venous ulcers (0·93 (0·21 to 1·65)) (P = 0·03).

Conclusion
Fluid exudate from venous ulcers, in particular those that healed slowly, inhibited experimental angiogenesis in this study.
The colorectal adenoma–carcinoma sequence
Authors: Leslie A , Carey F A , Pratt N R , Steele R J C 
Published: March 2003

Abstract

Background
It is widely accepted that the adenoma–carcinoma sequence represents the process by which most, if not all, colorectal cancers arise. The evidence supporting this hypothesis has increased rapidly in recent years and the purpose of this article is to review this evidence critically and highlight its clinical significance.

Methods
Medline searches were used to identify recent key articles relating to the adenoma–carcinoma sequence. Further pertinent articles were obtained by manual scanning of the reference lists of identified papers.

Results
The evidence supporting the adenoma–carcinoma sequence can be classified as epidemiological, clinicopathological and genetic. The most recent and largest body of data relates to molecular genetic events and their cellular effects; however, many other approaches, such as cytogenetics, molecular cytogenetics and cytometry, have also yielded valuable information.

Conclusion
Recent work continues to support the adenoma–carcinoma sequence, but there is a paucity of data on the interrelationship between different genetic mutations and on the relationship between molecular and other types of genetic abnormalities. The clinical utility of the observations described has yet to be fully realized and global genetic analysis of colorectal tumours may prove to be central in rational adenoma management.
Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers
Authors: Bachmann M O , Alderson D , Edwards D , Wotton S , Bedford C , Peters T J , Harvey I M 
Published: March 2003

Abstract

Background
To evaluate specialization in National Health Service (NHS) cancer care, volume–outcome relationships were examined.

Methods
This was a cohort study of 1512 patients with oesophageal or gastric cancer in 23 acute NHS hospitals. Outcomes were survival time and operative (30 day) mortality. Multiple regression analysis was performed, adjusted for diagnoses, prognoses and treatments.

Results
For oesophageal cancer, the operative mortality rate decreased by 40 per cent (odds ratio 0·60 (95 per cent confidence interval (c.i.) 0·36 to 0·99 per cent); P = 0·047) for each increase of ten patients in doctors' annual surgical caseloads, and the risk of death decreased by 8 per cent (hazard ratio 0·92 (95 per cent c.i. 0·85 to 0·99); P = 0·021) for each increase of ten patients in doctors' annual caseloads. For gastric cancer, the operative mortality rate decreased by 41 per cent (odds ratio 0·59 (95 per cent c.i. 0·32 to 1·07)) for each increase of ten patients in doctors' annual surgical caseloads, and the risk of death decreased by 7 per cent (hazard ratio 0·93 (95 per cent c.i. 0·89 to 0·98); P = 0·009) for each increase of ten patients in hospitals' annual caseloads. Patients of higher-volume doctors were more likely to receive most investigations and treatments, independently of presenting features.

Conclusion
The study supports concentration of services for oesophageal and gastric cancers. Specialization of doctors and their teams is at least as important as specialization of hospitals.
Identifying patients for blood conservation strategies
Authors: van Klei W A , Rheineck Leyssius A T , Grobbee D E , Moons K G M 
Published: March 2003

Abstract

Background
Generally, only the type of operation is used to estimate the need for perioperative homologous blood transfusion. This study quantified the extent to which the estimation could be improved if, in addition, simple patient characteristics were taken into account.

Methods
Retrospective data on 24 509 consecutive adult surgical patients were used to derive and validate three models to predict perioperative homologous transfusion. The first model was a univariable model with type of operation as the only predictor. The second and third models were a full and a simplified multivariable logistic regression model. The performance of the multivariable models was tested in two validation sets: in similar patients who had operations in the same general hospital (internal validation) and in patients who had operations in a university hospital (external validation). The areas under the receiver–operator characteristic (ROC) curve were compared with that found in the derivation set.

Results
There were no important differences in characteristics between the derivation and validation sets. The ROC area of the model including surgery only was 0·92 (99 per cent confidence interval (c.i.) 0·91 to 0·94) and that of the full and simplified multivariable models 0·95 (99 per cent c.i. 0·94 to 0·96) and 0·94 (99 per cent c.i. 0·93 to 0·95) respectively. The latter two were significantly different from the first one. In the external validation set the ROC area of the simplified model was 0·84 (95 per cent c.i. 0·83 to 0·86). Patients who had a preoperative haemoglobin level lower than 13 g/dl and underwent major invasive surgery had the highest risk (43 per cent) of transfusion.

Conclusion
A simple algorithm using type of operation and haemoglobin concentration was effective in identifying patients likely to need perioperative homologous blood transfusion.
Nitric oxide enhances experimental wound healing in diabetes
Authors: Witte M B , Kiyama T , Barbul A 
Published: March 2003

Abstract

Background
Diabetes is characterized by a nitric oxide deficiency at the wound site. This study investigated whether exogenous nitric oxide supplementation with the nitric oxide donor molsidomine (N-ethoxycarbomyl-3-morpholinyl-sidnonimine) could reverse the impaired healing in diabetes.

Methods
Wound healing was studied by creating a dorsal skin incision with subcutaneous polyvinyl alcohol sponge implantation in diabetic and non-diabetic rats. Half of each group was treated with molsidomine. Collagen metabolism was assessed by wound breaking strength, hydroxyproline (OHP) content, RNA expression for collagen type I and III, and matrix metalloproteinase (MMP) 2 activity in wound sponges. Wound fluid, plasma and urinary nitric oxide metabolite levels, and the number of inflammatory cells were assessed.

Results
OHP content and wound breaking strength were significantly increased by molsidomine. MMP-2 activity in wound fluid was decreased in diabetes and upregulated by nitric oxide donors. The impaired inflammatory reaction in diabetes was unaffected by nitric oxide donor treatment and ex vivo nitric oxide synthesis was no different between wound macrophages from control and diabetic animals, suggesting that the nitric oxide deficiency in the wound is due to a smaller inflammatory reaction in diabetes.

Conclusion
The nitric oxide donor molsidomine can at least partially reverse impaired healing associated with diabetes.
All-comers policy for laparoscopic exploration of the common bile duct
Authors: Thompson M H , Tranter S E 
Published: March 2003

Abstract

Background
Laparoscopic exploration of the common bile duct is associated with substantial variation in results suggesting that different patient populations are being reported. This report observes the results in a defined population and on an intention-to-treat basis.

Methods
All patients with suspected bile duct stones who were fit for surgery from April 1994 were offered laparoscopic bile duct exploration. There were 224 patients of mean age 56 years, of whom 174 were women. Endoscopic sphincterotomy was used in 149 patients deemed unfit for surgery. All data were recorded prospectively and checked at the time of discharge. Patients were followed up after 6 months and beyond after the operation.

Results
Stones were removed transcystically in 56 patients, transductally in 158 and by flushing in nine. The duct clearance rate was 96 per cent overall, 98 per cent for transcystic and 94 per cent for transductal exploration. Intracorporeal lithotripsy safely reduced the failure rate of exploration from seven of the first 28 to four of the subsequent 196 procedures. Biliary complications occurred in 16 per cent of procedures in which a T tube was used but only 4 per cent if the duct was closed by suturing. Conversion to open operation for severe gallbladder inflammation was necessary in 6 per cent of patients. There were no deaths, bile duct injuries or pancreatitis but complications occurred in 19 per cent, associated with use of T tubes and advancing age. Laparoscopic duct exploration succeeded in seven patients after previous cholecystectomy.

Conclusion
Laparoscopic bile duct exploration is effective and safe when used for all patients. For young and fit patients it should replace endoscopic sphincterotomy.
Gadd45 mutations are uncommon in human tumour cell lines
Authors: Campomenosi P. , Hall P. A. 
Published: March 2003

GADD45 is an evolutionarily conserved gene that encodes a small acidic, nuclear protein and is an example of a p53 responsive gene. Gadd45 protein has been shown to interact with PCNA and also p21waf1. It has been implicated in growth arrest, DNA repair, chromatin structure and signal transduction. The confusing biochemical data has been clarified by the demonstration that Gadd45 null mice have a phenotype strikingly similar to that of p53 null mice, being tumour prone and showing marked genomic instability. We have tested the hypothesis that mutations in the GADD45 coding region might substitute for p53 abnormalities in tumour cell lines where p53 is wild type. After generating cDNA from mRNA in a panel of 24 cell lines we sequenced the GADD45 cDNA and have demonstrated that no mutations can be observed, even in the p53 wild type cell lines. Such data suggest that Gadd45 mutations are uncommon in human cancer. From this we postulate that, despite the phenotype of the GADD45 null mouse, GADD45 is unlikely to be the key mechanistic determinant of the tumour suppressor activity of the p53 pathway.Note on nomenclature: We have employed GADD45 to designate the gene and Gadd45 to designate the encoded protein. This gene has also be denoted GADD45α elsewhere in the literature.
The implications of adoption for donor offspring following donor‐assisted conception
Authors: Blyth Eric , Crawshaw Marilyn , Haase Jean , Speirs Jennifer 
Published: March 2003

ABSTRACTIn this paper the authors, all experienced social workers with research and practice interests in assisted conception, review practices concerning access to genetic origins information in adoption, and consider to what extent these may be relevant for practice in donor‐assisted conception. The paper concludes with policy and practice recommendations that take account of the views of donor offspring and their desire for increased information about their genetic heritage.
Social workers’ attitudes towards family group conferences in Sweden and the UK
Authors: Sundell Knut , Vinnerljung Bo , Ryburn Murray 
Published: March 2003

ABSTRACTThe New Zealand family group conference (FGC) approach to decision making in child welfare and protection has attracted strong interest among policy makers and professionals all over the world. While New Zealand’s legislation makes use of FGCs more or less mandatory in child protection, other countries permit social workers to refer families to an FGC at their own discretion. Knowledge about social workers’ attitudes towards the model is thus paramount if we want to understand implementation and evaluations of FGCs outside New Zealand. This study looks at attitudes towards and actual referrals to FGCs amongst 219 social workers from 18 local authorities in Sweden and the UK. Results reveal an overwhelmingly positive attitude towards FGCs in both countries. Given these attitudes it was striking that only 42% of the social workers had initiated at least one FGC over an 18‐month period. The number of implemented FGCs was almost exactly the same in Sweden and the UK, after adjusting for time and number of social workers. Possible explanations for this paradox are discussed, using data from the survey and child welfare literature.