bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of laparoscopic hysterectomy on bladder neck and urinary symptoms
Authors: Long Cheng‐Yu , Hsu Shih‐Cheng , Wu Tung‐Pi , Fu Jung‐Chung , Hsu Yu‐Sin , Su Jiun‐Huang 
Published: March 2003

AbstractObjective: To assess the effect of laparoscopic hysterectomy (LH) on the mobility and position of bladder neck (BN) and urinary symptoms.Design: We assessed the BN and urinary symptoms of 151 patients by introital ultrasonography and questionnaires before and after LH.Sample: One hundred and fifty‐one women who underwent LH from June 1999 to June 2001.Results: A significant decrease was noted in the number of women exhibiting one or more urinary symptoms from 81 (53.6%) preoperatively to 58 (38.4%) postoperatively (P < 0.01). The incidence of urinary frequency, mild stress incontinence and nocturia decreased significantly after laparoscopic hysterectomy (P < 0.01). Changes in other urinary symptoms following hysterectomy showed no statistical significance (P > 0.05). During straining, the postoperative position of the BN localised more dorsally (P < 0.01) and the ventral mobility of the BN decreased significantly following surgery (P < 0.05). There was no significant difference in the location of the BN with respect to the pubis at rest and during straining, in the cephalocaudal direction, before and after hysterectomy (P > 0.05).Conclusion: Some patients experienced a substantial improvement of preoperative urinary symptoms following LH, partly as a result of a decrease in the hypermobility of BN.
Systematic review of antiplatelet therapy for the prevention of myocardial infarction, stroke or vascular death in patients with peripheral vascular disease
Authors: Robless P , Mikhailidis D P , Stansby G 
Published: March 2003

Abstract

Background
Antiplatelet agents may prevent vascular events and death in patients with peripheral vascular disease (PVD).

Methods
A systematic review of 39 randomized controlled trials of antiplatelet therapy in patients with PVD was performed.

Results
For patients with PVD the number suffering a non-fatal myocardial infarction, non-fatal stroke or vascular death in the antiplatelet group was 6·5 per cent compared with 8·1 per cent in the placebo group (odds ratio 0·78 (95 per cent confidence interval (c.i.) 0·63–0·96); P = 0·02), favouring antiplatelet treatment. For infrainguinal bypass surgery (ten trials) and balloon angioplasty (two) the differences were still in favour of antiplatelet therapy, but they did not reach statistical significance. In five trials of aspirin against another antiplatelet agent, 8·4 per cent in the aspirin group suffered a vascular event compared with 6·6 per cent in the second antiplatelet group (odds ratio 0·76 (95 per cent c.i. 0·64–0·91); P &lt; 0·01), favouring ticlopidine/clopidogrel/aspirin + dipyridamole against aspirin alone.

Conclusion
Antiplatelet therapy reduces serious vascular events and vascular death in patients with PVD. For infrainguinal arterial surgery or balloon angioplasty the benefit remains unproven, but the number of trials to date is small. There is also evidence to support the use of antiplatelet drugs other than aspirin for the prevention of vascular events in those with PVD.
Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma
Authors: Stengel D , Bauwens K , Sehouli J , Porzsolt F , Rademacher G , Mutze S , Ekkernkamp A 
Published: March 2003

Abstract

Background
How precise and reliable is ultrasonography as a primary tool for injury assessment in blunt abdominal trauma?

Methods
A systematic review and meta-analysis were conducted of prospective clinical trials of ultrasonography for blunt abdominal trauma. Publications were retrieved by structured searching among databases, review articles and major text books. Authors and experts in the field were contacted for original and unpublished data. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using weighted and robust regression models, with Q* denoting the shoulder of the curve. Post-test probabilities were calculated as a function of pooled likelihood ratios (LRs).

Results
Thirty of 123 trials enrolling 9047 patients were eligible for final analysis. With respect to targeting organ lesions, ultrasonography showed a summary Q* value of 0·91 (inverse variance weights, 95 per cent confidence interval (c.i.) 0·76–1·07); negative predictive values ranged from 0·72 to 0·99. A similar SROC slope was calculated for screening for free fluid (Q* = 0·89 (95 per cent c.i. 0·73–1·05)). Ultrasonography detects the presence of organ lesions, but fails to exclude abdominal injuries (random effects negative LR 0·23 (95 per cent c.i. 0·18–0·28)). Given a pretest probability of 50 per cent for blunt abdominal injury, a post-test probability of nearly 25 per cent remains in the case of a negative sonogram.

Conclusion
Despite its high specificity, ultrasonography has an unexpectedly low sensitivity for the detection of both free fluid and organ lesions. In clinically suspected abdominal trauma, another assessment (e.g. helical computed tomography) must be performed regardless of the initial ultrasonographic findings.
Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy
Authors: Larsen J F , Ejstrud P , Svendsen F , Redke F , Pedersen V , Rahr H B 
Published: March 2003

Abstract

Background
Carbon dioxide pneumoperitoneum may be an important pathophysiological factor stimulating the coagulation system during conventional laparoscopic cholecystectomy. The aim of this study was to test the hypothesis that gasless laparoscopy produces smaller changes in the coagulation and fibrinolytic system than carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

Methods
Fifty patients were allocated randomly to conventional (n = 26) or gasless (n = 24) laparoscopic cholecystectomy. Blood samples were obtained on admission, after induction of anaesthesia, after insufflation or traction, 30 min after introduction of the laparoscope, 10 min after exsufflation of carbon dioxide or traction, 4 h after extubation and 24 h after operation.

Results
The two groups were comparable with respect to age, sex, body mass index and duration of operation. Plasma levels of prothrombin fragment 1 and 2 (F1 + 2), soluble fibrin and d-dimer did not differ between the two groups. F1 + 2 levels varied significantly in both groups during and after operation (P &lt; 0·001). Soluble fibrin and d-dimer levels did not change during operation in either group, but after operation the levels increased significantly in both groups (P &lt; 0·001).

Conclusion
Carbon dioxide pneumoperitoneum does not enhance the activation of coagulation and fibrinolysis associated with laparoscopic cholecystectomy. The coagulation and fibrinolytic systems are activated during and after gasless as well as conventional laparoscopic cholecystectomy.
Microcirculatory effects of experimental acute limb ischaemia—reperfusion
Authors: Dammers R , Wehrens X H T , oude Egbrink M G A , Slaaf D W , Kurvers H A J M , Ramsay G 
Published: March 2003

Abstract

Background
The object of this study was to develop an animal model in which changes in microvascular haemodynamics and leucocyte–vessel wall interactions due to acute limb ischaemia–reperfusion (I/R) can be measured in the skin. Furthermore, it was investigated whether these changes are related to local muscle injury.

Methods
Male Lewis rats were subjected to unilateral limb ischaemia for 1 h (n = 8) or 2 h (n = 8) by cuff inflation, or to a sham protocol (n = 6). Intravital video microscopic measurements of leucocyte–vessel wall interactions, venular diameter, red blood cell velocity and reduced velocity (which is proportional to wall shear rate) were performed in skin venules before ischaemia and at 0·5, 1, 2, 3 and 4 h after the start of reperfusion. Oedema and leucocyte infiltration of ischaemic/reperfused skeletal muscle were quantified histologically.

Results
In skin venules, both 1 and 2 h of ischaemia induced a significant increase in leucocyte rolling (six and five times baseline, respectively; P &lt; 0·05) and adherence during reperfusion (eight and four times baseline; P &lt; 0·05). No significant increase in muscular leucocyte infiltration was detected. After an initial hyperaemic response of 180 per cent of baseline values (P &lt; 0·05), blood flow decreased to about 60 per cent after 4 h of reperfusion in skin venules of both experimental groups. I/R induced tibial muscle oedema, the severity of which depended on the ischaemic interval (wet to dry ratio: control, 4·0; 1 h, 4·5 (P not significant); 2 h, 5·8 (P &lt; 0·05)).

Conclusion
A non-invasive animal model was developed that enables investigation of the consequences of acute limb I/R.
Anorectal injury following pelvic radiotherapy
Authors: Hayne D , Vaizey C J , Boulos P B 
Published: March 2003

Abstract

Background
Current knowledge of the effects of radiation on the anorectum is based on a limited number of studies. Variability in delivery techniques, both currently and historically, combined with a paucity of prospective and randomized studies makes interpretation of the literature difficult. This review presents the existing evidence and identifies areas that require further work.

Methods
This review is based on a literature search (Medline and PubMed) and manual cross-referencing.

Results and conclusion
More than three-quarters of patients receiving pelvic radiotherapy experience acute anorectal symptoms and up to one-fifth suffer from late-phase radiation proctitis. About 5 per cent develop other chronic complications, such as fistula, stricture and disabling faecal incontinence. The risk of rectal cancer may be increased. Conservative treatment options are of limited value. Surgery may be considered if symptoms are severe, provided sphincter function is adequate and recurrent disease is excluded. Large prospective studies with accurate dosimetric data and long-term follow-up are needed to provide meaningful information on which to base new strategies to minimize the side-effects from radiotherapy.
Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer
Authors: Yamada K , Ishizawa T , Niwa K , Chuman Y , Akiba S , Aikou T 
Published: March 2003

Abstract

Background
Local recurrence of rectal cancer after curative resection remains a difficult clinical problem. The aim of this study was to elucidate prognostic risk factors after resection of recurrent cancer.

Methods
Between January 1983 and December 1999, 83 patients with locally recurrent rectal cancer were studied retrospectively for survival benefit by re-resection. Sixty patients underwent resection for recurrent cancer, including total pelvic exenteration in 30 patients and sacrectomy in 23 patients. The extent of locally recurrent tumour was classified by the pattern of pelvic invasion as follows: localized, sacral invasion and lateral invasion.

Results
Multivariate analysis showed that the pattern of pelvic invasion was a significant prognostic factor which independently influenced survival after resection of recurrent cancer (P &lt; 0·001). The 5-year survival rates were 38 per cent in the localized type (n = 27), 10 per cent in the sacral invasive type (n = 16) and zero in the lateral invasive type (n = 17).

Conclusion
Resection for locally recurrent rectal cancer is potentially curative in patients with localized or sacral invasive patterns of recurrence. Alternatives should be explored in patients with recurrence involving the lateral pelvic wall.
Outcome and resource utilization in gastroenterological surgery
Authors: Lång M , Niskanen M , Miettinen P , Alhava E , Takala J 
Published: March 2003

Abstract

Background
A small minority of patients undergoing gastroenterological surgery are at high risk for postoperative complications, which may lead to prolonged hospital stay, disproportionate use of resources and increased mortality. The nature and frequency of, and predictive factors for, postoperative complications were studied and the impact of complications on resource utilization was assessed.

Methods
A prospective observational study was undertaken of 503 patients undergoing gastroenterological surgery in a tertiary care centre. The incidence of cardiorespiratory, infective and surgical complications was assessed. The need for reoperation, intensive care and length of hospital stay, readmission, death at 6 months and costs were evaluated.

Results
Some 235 patients (47 per cent) had at least one complication, most commonly delayed oral intake (n = 70). Complications were associated with cardiovascular disease, prolonged operation, high Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity, and increased number of Shoemaker's criteria. The length of hospital stay of patients with complications was longer than that of those without complications (11 versus 6 days). Morbidity resulted in a twofold increase in median costs.

Conclusion
High-risk patients could be identified by simple clinical criteria, although the commonly used risk criteria were not very sensitive. A reduction in postoperative complication rates would result in marked cost savings.
Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery
Authors: Bruce J , Krukowski Z H , Al-Khairy G , Russell E M , Park K G M 
Published: March 2003

Abstract

Background
Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently used as an indicator of the quality of surgical care provided. Comparison of rates between and within institutions depends on the use of standard definitions and methods of measurement of anastomotic leak. The aim of this study was to review the definition and measurement of anastomotic leak after oesophagogastric, hepatopancreaticobiliary and lower gastrointestinal surgery.

Methods
A systematic review was undertaken of the published literature. Searches were carried out on five bibliographical databases (Medline, Embase, The Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and HealthSTAR) for English language articles published between 1993 and 1999. Articles were critically appraised by two independent reviewers and data on definition and measurement of anastomotic leak were extracted.

Results
Ninety-seven studies were reviewed and a total of 56 separate definitions of anastomotic leak were identified at three sites: upper gastrointestinal (13 definitions), hepatopancreaticobiliary (14) and lower gastrointestinal (29). The majority of studies used a combination of clinical features and radiological investigations to define and detect anastomotic leak.

Conclusion
There is no universally accepted definition of anastomotic leak at any site. The definitions and values used to measure anastomotic failure vary extensively and preclude accurate comparison of rates between studies and institutions.
Effect of oesophagectomy on monocyte-induced apoptosis of peripheral blood T lymphocytes
Authors: Kono K , Takahashi A , Iizuka H , Fujii H , Sekikawa T , Matsumoto Y 
Published: March 2003

Abstract

Background
Surgical stress has been reported to induce immunosuppression. The mechanisms giving rise to T-cell dysfunction following surgery are still unclear. The cellular mechanisms behind T-cell dysfunction following surgery were investigated, based on the induction of T-cell apoptosis and downregulation of T-cell signalling molecules.

Methods
Peripheral blood T cells were collected and separated before and after surgery in patients who had oesophagectomy, gastrectomy or cholecystectomy, and studied for their ability to produce cytokines, the induction of T-cell apoptosis with terminal deoxynucleotidyl transferase-mediated dUPT-biotin nick end labelling methods, and the expression of T-cell signalling zeta (TCR ζ) molecules with intracellular staining.

Results
The increased degree of T-cell apoptosis, downregulation of TCR ζ molecules and impaired cytokine production of T cells were significant on days 1 and 3 after operation in patients who had oesophagectomy, but not after gastrectomy or cholecystectomy. A higher level of T-cell apoptosis was observed in the co-culture with postoperative monocytes than with preoperative monocytes.

Conclusion
Peripheral blood T cells obtained after oesophagectomy underwent apoptosis that correlated with the downregulation of TCR ζ molecules. Postoperative monocytes induced by surgical stress were able to mediate the T-cell apoptosis.
Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid
Authors: Sivanandan R , Soo K C 
Published: March 2003

Abstract

Introduction
The management of cervical metastases from papillary thyroid carcinoma ranges from selective removal (berry picking) to a formal comprehensive neck dissection. Without a clear understanding of the distribution of nodes at risk, the formulation of strategies on how best to manage the clinically positive neck is difficult. This study reports on observations made in patients who underwent a therapeutic comprehensive neck dissection for metastatic papillary thyroid carcinoma by defining lymph node involvement with respect to neck level.

Methods
The clinical records and pathological reports of 75 consecutive patients who underwent a neck dissection for cervical metastases from papillary thyroid carcinoma over a 10-year period were reviewed. All dissections were therapeutic in nature, being performed in patients with clinically positive neck nodes. Eighty neck dissection specimens were obtained and analyses were divided into three groups by virtue of the type of dissection performed: a bilateral comprehensive neck dissection, unilateral radical neck dissection and unilateral comprehensive neck dissection. The relative involvement of cervical nodes was analysed with reference to node levels I–V.

Results
Patients in the anterolateral group (levels II, III and IV) were at greatest risk of metastatic disease, with level III nodes consistently the most frequently involved, across all treatment groups. Only three patients exhibited level I involvement, all of whom had extensive neck disease involving all or almost all neck levels.

Conclusion
The majority of patients present with multiple level node disease, with the anterolateral group at greatest risk. A comprehensive neck dissection is recommended for all patients with palpable cervical lymphadenopathy.
Epidemiological study of oesophageal and gastric cancer in south-east England
Authors: Kocher H M , Linklater K , Patel S , Ellul J P M 
Published: March 2003

Abstract

Background
This epidemiological study was carried out to establish the magnitude of the changing incidence of gastric and oesophageal cancer.

Methods
Time-trend analyses of subsite-specific cancers of the oesophagus and stomach were performed using data from the Thames Cancer Registry database (1960–1996) for the South Thames Region. The changes in sex ratio and peak age of incidence are reported.

Results
In the upper two-thirds of the oesophagus there was no significant change in the incidence rate, but the lower third of the oesophagus showed a marked rise for both sexes (average annual change +0·05 for men, +0·009 for women). For the gastric cardia, the incidence in males increased (average annual change +0·025), while in females it remained unchanged. Cancers of the oesophagogastric junction showed a clear increase for both sexes (average annual change +0·07 for men, +0·009 for women). There were changes in the sex ratio and peak age of incidence for all subsite cancers for both sexes.

Conclusion
Over a 37-year period the incidence of cancer of the oesophagogastric junction increased threefold, while the incidence of cancers of the other subsites of the stomach decreased. Further studies are needed to investigate the aetiology of these changes.
Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome
Authors: Gerritsen A A M , Uitdehaag B M J , van Geldere D , Scholten R J P M , de Vet H C W , Bouter L M 
Published: March 2003

Abstract

Background
Carpal tunnel syndrome (CTS) is a common disorder for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment. The object of this systematic review is to compare the efficacy of the various surgical techniques in relieving the symptoms of CTS and promoting return to work and/or activities of daily living.

Methods
Computer-aided searches of Medline, EMBASE and the Cochrane Controlled Trials Register were conducted, together with reference checking. A rating system, based on the number of studies and their methodological quality and findings, was used to determine the strength of the available evidence for the efficacy of the treatment.

Results
Fourteen studies were included in the review. None of the alternatives to standard open carpal tunnel release (OCTR) seems to offer better relief of symptoms. There is conflicting evidence about whether endoscopic carpal tunnel release results in earlier return to work and/or activities of daily living.

Conclusion
Standard OCTR is still the preferred method of treatment for CTS. It is just as effective as the alternatives, but is technically less demanding, so incurs a lower risk of complications and of added costs.
Methodology and reporting in studies of local recurrence after curative excision of the rectum for cancer
Authors: Dent O F , Chapuis P H , Bokey E L , Newland R C 
Published: March 2003

Abstract

Background
Widely varying rates have been reported in the extensive literature published in the English language on local recurrence after curative excision of rectal carcinoma. These variations may be attributable to differences in the case mix of pathological factors influencing recurrence, differences in surgical technique or expertise, differences in the administration of adjuvant therapy and various combinations of these. They may also arise from methodological differences among studies.

Methods
This paper reviews the adequacy of methodology and reporting in 21 recent studies of local recurrence after curative resection of rectal cancer.

Results
Many flaws in reporting and apparent inadequacies in methodology were identified. On an index of 26 criteria examined, eight studies scored no more than 8 and only three studies scored more than 11.

Conclusion
To date, the value of reports of local recurrence rates following curative excision of rectal cancer has been limited by inadequacies in documentation and methodology. Suggestions are made for preferred procedures to be followed in the reporting of future studies.