bluuebunny/crossref_metadata_2025_split huggingface dataset:
CURATIVE EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE CARCINOMA: RESULTS IN 231 PATIENTS TREATED IN LYON
Authors: Gerard Jean‐Pierre , Xie Conghua , Carrie Christian , Romestaing Pascale , Pommier Pascal , Mornex Françoise , Clippe Sébastien , Sentenac Irénée , Ginestet Chantal 
Published: March 2003

Background: Radical prostatectomy and external beam radiation therapy (EBRT) are the mainstays of treatment of prostate cancer with curative intent. The possible development of radiation proctitis and rectal bleeding are major concerns when using EBRT. Recently, conformal radiotherapy has been introduced in an attempt to improve the results of EBRT. This paper presents an overview of the Lyon experience using standard EBRT with doses of 68 Gy, and reports the preliminary results of a study of conformal radiotherapy with dose escalation. Methods: From 1981 to 1995, EBRT was used to treat 231 patients with localized adenocarcinomas of the prostate. The dose of EBRT was 68 Gy/34 fractions/7 weeks using a four‐field box technique with 18‐MeV photons. A feasibility study of conformal radiotherapy was commenced in 1996. To date, 145 patients have been treated with doses escalating from 68 to 80 Gy. Results: In the EBRT group of 231 patients, the 5‐year overall survival was 80.3%. Anorectal function was scored as excellent in 90% of patients. Rectal bleeding was seen in 14.3% of patients and required local treatment in only seven. In the group treated with conformal radiotherapy, the preliminary results indicate good early tolerance. Conclusion: The curative treatment of patients with prostate cancer using EBRT gives good long‐term survival with low rectal toxicity. Conformal radiotherapy appears to be an interesting approach to improve local control and perhaps survival.
ADULT HEAD AND NECK LYMPHOMAS IN PAPUA NEW GUINEA: A RETROSPECTIVE STUDY OF 70 CASES
Authors: Dubey S. P. , Sengupta S. K. , Kaleh L. K. , Morewaya J. T. 
Published: March 2003

Background: During a 10‐year period (1986–95), 70 adult Papua New Guineans with head and neck lymphomas were seen in the 18 years‐and‐above age group. Methods: The clinical information was obtained from the medical records section of the Port Moresby General Hospital. Relevant treatment modalities and the follow‐up data were acquired from the National Cancer Centre, Angau Memorial Hospital, Lae. Results: Of a total of 227 adult lymphomas recorded in a 10‐year period, 70 cases were seen in the head and neck region. Non‐Hodgkin’s lymphoma constituted 56 cases, which included seven cases of adult Burkitt’s‐like lymphoma. Fourteen cases of Hodgkin’s lymphoma were recorded. Conclusions: In Papua New Guinea, malignant lymphomas primarily affecting the head and neck region were seen in 30.8% of all lymphomas. This constitues 2.8% of all malignancies in this region. These lymphomas appear to be more aggressive at this site. Proper tissue diagnosis and combination chemoradiotherapy are the key factors in its management.
A BIODIALYSIS SYSTEM FOR LIVER SUPPORT TESTED IN A PORCINE HEPATIC FAILURE MODEL
Authors: Sheil A. G. Ross , Sun Junhong , Wang Lisheng , Rao Nitin , Mears Douglas C. , Wang Chuanmin , Woodman Kevin , Johnston Brendan , Watson Jennifer 
Published: March 2003

Background: A practical liver support system for patients in fulminant hepatic failure (FHF) remains a needed therapeutic modality. A new method of bioartificial liver support, the liver biodialysis system (LBDS), is described. Methods: Porcine hepatocytes, removed from direct contact with the treated subject’s circulation, are in culture in a bioreactor which is combined in a dialysis circuit for patient treatment. The LBDS was tested in a porcine ischaemic hepatic failure model. Results: The viable hepatocyte content of the bioreactor was 2.49 ± 0.72 × 10
10. Cells remained viable in culture throughout the experiments (30 ± 3 h) without evidence of immunological damage. A decrease in the degree of accumulation in the blood of ammonia (P < 0.02) and of 14 amino acids (P < 0.001) was achieved by the LBDS. Cerebral perfusion pressure was maintained at significantly higher levels in LBDS‐treated animals (P < 0.05). Conclusions: In the LBDS, hepatocytes in large numbers and satisfactory culture conditions in a bioreactor have sustained viability and function. When combined in a dialysis circuit for the treatment of FHF pigs, immune reactions between the blood and hepatocytes were prevented and beneficial metabolic effects were observed.
Gastric resection in the aged (≥ 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors
Authors: Kubota Hirofumi , Kotoh Tsukasa , Dhar Dipok Kumar , Masunaga Reiko , Tachibana Mitsuo , Tabara Hideki , Kohno Hitoshi , Nagasue Naofumi 
Published: March 2003

Background: The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient’s age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Methods: Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out. Results: The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominancy in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10‐year disease‐free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of ≥ 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion. Conclusions: Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.
EXPERIENCE WITH THE HOLMIUM LASER AS AN ENDOSCOPIC LITHOTRITE
Authors: Costello A. J. , Westcott M. J. , Peters J. S. 
Published: March 2003

Introduction: Holmium laser lithotripsy represents an additional option in the management of urinary tract calculi. We report the results of a cohort of patients with ureteric and bladder calculi treated with this modality. Methods: Twenty‐three patients underwent holmium laser lithotripsy to treat ureteric or bladder calculi. Power settings of 0.5 J to deliver 2.5–4.0 watts were used for the ureteric calculi, and up to 30 watts for the bladder calculi. Results: The mean ureteric stone size was 7.3 mm (range 4–10 mm). One stone was upper ureteric, seven were mid‐ureter and nine were lower‐ureter. Eighteen of the 19 patients with ureteric calculi were free of stones 28 days postoperatively. The remaining patient was clear by 12 weeks. All patients with bladder calculi were completely cleared of stones. There were no intraoperative complications. Discussion: Ureteric stone position can limit the use of extracorporeal shock wave lithotripsy due to imaging difficulties. Ureteric lithotripsy overcomes this problem. The holmium laser has proven to be safe and effective in clearing urinary stone burdens of a variety of sizes, sites and compositions in this cohort of patients.
HEPATIC ARTERY ACCESS PORTS: RECOGNIZING AND AVOIDING THE PROBLEMS
Authors: Wickremesekera Janaka K. , Cannan Rebecca J. , Stubbs Richard S. 
Published: March 2003

Background: Regional approaches to the management of hepatic tumours are appropriate in some clinical situations and include hepatic arterial chemotherapy (HAC) and selective internal radiation therapy (SIRT). Both require access to the hepatic artery, which is conveniently achieved with a subcutaneously placed port. Placement and use of these ports may be associated with a variety of technical problems which can impact adversely on the outcome of the treatment. The present paper outlines the problems related to port usage for regional hepatic therapies, with emphasis on the technical aspects of insertion and interpretation and management of subsequent problems. Methods: Hepatic artery port placement was attempted in 129 patients for use with either SIRT and/or HAC. Ports were used or flushed at monthly intervals. Results: Successful port insertion was achieved in 127 patients, of whom 87 received HAC alone, seven received SIRT alone, 28 patients received both and in five patients the port was never used. Methylene blue injection was used to identify anomalous arterial anatomy, which was found in 26 of 95 patients (27%), and significant extrahepatic ‘access’, which was seen in 25 patients (26%) after initial placement. Forty‐six instances of technical problems preventing continued use of the port occurred in 43 patients after a median of 4 (0–36) cycles of chemotherapy, including hepatic artery thrombosis (n = 26), catheter blockage (n = 4), duodenal fistula (n = 3), gastrointestinal (GI) bleeding (n = 3), side‐effects (n = 3), access problems (n = 3), extravasation (n = 3) and infection (n = 1). Conclusion: Methods used to identify, manage and in some instances prevent the occurrence of these problems are discussed.
SELECTIVE VASCULAR OCCLUSION WITH STAGED HEMIHEPATECTOMY FOR BLUNT LIVER TRAUMA
Authors: Martin Christopher J. , Cox Michael R. 
Published: March 2003

Background: A 23‐year‐old man with extensive blunt trauma to the right lobe of the liver in whom adequate haemostasis could not be achieved by selective suturing and packing was encountered. Contributing factors to poor haemostasis included massive transfusion, hypothermia and acidosis. Methods: Hepatic haemostasis was achieved by selective intrahepatic ligation of the right hepatic pedicle and packing. Results: After resuscitation and stabilization in the intensive care unit, a right hemihepatectomy was performed 14 h later. Conclusions: The present case describes a modification of the Pringle manoeuvre, termed ‘selective Pringle manoeuvre’. This technique is a useful additional strategy for the management of uncontrollable bleeding in massive hepatic trauma.
Effects of CO2 Insufflation and Laparotomy on Wound Healing in Mice
Authors: Agalar Faith , Hamaloglu Erhran , Daphan Cagatay , Tarim Akin , Onur Rustu , Renda Nurten , Sayek ˙iskender 
Published: March 2003

Background: The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wound healing in a murine incisional wound healing model. Methods: Seventy‐two male Swiss Albino mice were randomly allocated into three groups of control, laparotomy and CO2 insufflation. A transverse skin incision of 15 mm was made in the dorsum of each mouse, and four interrupted mattress sutures with 4.0 polypropylene thread were laid for wound closure. A median laparotomy was performed in the laparotomy group. CO2 insufflation was performed with an intra‐abdominal pressure of 9 mmHg. The retained gas was evacuated from the abdominal cavity at the end of a 60‐min period. Mice were killed on the 3rd, 7th and 15th postoperative days. The wound tensile strength and 5‐hydroxyproline concentration in the wound tissue were measured. Results: Tensile strength of the incised skin increased as the post‐incision period progressed. There was no significant difference between the tensile strengths of the incised skin of control, laparotomy and CO2 insufflation groups throughout the observation period. The skin 5‐hydroxyproline concentrations of all groups were not significantly different at the 3rd postoperative day. But laparotomy and CO2 insufflation groups had lower 5‐hydroxyproline concentrations at the 7th and 15th postoperative days, when compared to controls (P < 0.02 for 7th and 15th days). Conclusion: CO2 insufflation and laparotomy reduce the 5‐hydroxyproline concentration of the wound, suggesting a diminished wound healing capacity.
Colonic J Pouch Reconstruction Of The Radiation‐Damaged Neorectum
Authors: Thompson Andrew N. , Levitt Michael 
Published: March 2003

Background: Postoperative radiotherapy after restorative resection for rectal carcinoma can cause fibrosis, stricture and proctitis. There are few accounts in the literature of the surgical approach to the radiation‐damaged neorectum.Methods: Reported are four patients who underwent resection of the radiation‐damaged neorectum with colonic J pouch reconstruction between September 1996 and July 1997. The operative and postoperative course is described. Parameters of bowel function were assessed by standardized interview 6 months after ileostomy reversal. Ongoing follow up has occurred to the present time.Results: There was no mortality. Complications were splenic injury requiring splenectomy and a pelvic collection requiring percutaneous drainage. At 6 months after ileostomy reversal all patients had ongoing disturbance of bowel function, and two patients described some degree of incontinence. The mean frequency of bowel actions was four per day. Two patients have subsequently undergone further resection and formation of an end stoma.Conclusions: Resection of the radiation‐damaged neorectum with colonic J pouch reconstruction is technically feasible. Functional results in the present series were disappointing and half the patients went on to formation of a permanent stoma.
Results of Extrafascial Excision and Conventional Surgery for Rectal Cancer at Auckland Hospital
Authors: Bissett I. P. , McKay G. S. , Parry B. R. , Hill G. L. 
Published: March 2003

Background: Recent studies have suggested that local recurrence rates following rectal cancer surgery are reduced if the mesorectum is removed intact within its fascia propria. The present study aims to compare the outcomes of conventional surgery for rectal cancer and surgery in which the rectum and mesorectum are removed by the technique of extrafascial excision (EFE). Methods: All patients undergoing surgery for rectal cancer at Auckland Hospital from 1980 to 1996 were identified. Demographic, tumour, operation, outcome, survival and follow‐up data were obtained from patient charts, New Zealand (NZ) Death Registry, death certificates and the NZ Electoral Roll. Complication rates, recurrence rates, overall and cancer‐free survival and treatment costs were calculated for each group. Results: A total of 262 patients had curative surgery (138 had conventional surgery, 124 had EFE). The groups were similar with respect to age, sex, operation performed and Dukes’ stage. There was no difference in complication rates between the groups. Mean follow‐up was 7 years in survivors. Twenty‐nine conventional‐surgery (21%) and eight EFE (6%) patients developed local pelvic recurrence. The 5‐year actuarial local recurrence rates were 30% and 10%, respectively (P = 0.0006). The 5‐year overall survival was 54% for conventional surgery and 60% for EFE (P = 0.23). The 5‐year cancer‐free survival was 63% for conventional surgery and 74% for EFE (P = 0.02). Average initial costs were NZ$15 717 and NZ$15 158 for conventional surgery and EFE, respectively. The average cost of local recurrence was an additional NZ$10 471. Conclusions: The present study adds further support to the growing evidence that excision of the mesorectum within an intact fascial envelope reduces local recurrence rates after surgery for rectal cancer. There appears to be an associated improvement in cancer‐free survival. Complication rates and cost were not increased in the patients having EFE.
Successful ex vivo renal artery reconstruction and renal autotransplantation
Authors: Cho Carolyn S. L. , Robinson Philip W. , Grant Alexander B. F. , Hibberd Adrian D. 
Published: March 2003

Background: The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery. Methods: A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital. Results: Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years. Conclusion: The present review confirms the long‐term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.
Choledochal cyst: A changing pattern of presentation
Authors: Kabra Vedant , Agarwal Mudit , Adukia Tarun K. , Dixit V. K. , Agrawal A. K. 
Published: March 2003

Background: The aim of the present paper was to study the spectrum of choledochal cysts and analyse the results of various surgical procedures. Methods: A prospective study was undertaken, at University Hospital, Varanasi, India, of 10 patients with choledochal cyst who presented between January 1996 and June 2000. The patients had a median age at presentation of 16.0 years (interquartile range (IQR): 13.75 years). All patients underwent ultrasonography and endoscopic retrograde cholangiopancreaticography for confirmation of diagnosis. Cyst excision was performed in eight patients followed by reconstruction by hepaticoduodenostomy and Roux‐en‐Y hepaticojejunostomy in four patients each. Two patients underwent cystoduodenostomy. Results: One patient who underwent hepaticoduodenostomy had a minor leak that responded to conservative management. All patients were asymptomatic at a median follow up of 36.5 months (IQR: 31 months). Conclusions: There is a changing trend in the commonest mode and age of presentation; fewer patients are presenting with the classical triad and the mean age of presentation is higher. Reconstruction by hepaticoduodenostomy is equally effective, more physiological and less time consuming as compared to hepaticojejunostomy, if the anastomosis can be achieved without tension.
The impact of mastectomy, breast‐conserving treatment and immediate breast reconstructions on the quality of life of Chinese women
Authors: Fung Kin Wah , Lau Yvonne , Fielding Richard , Or Amy , Yip Andrew Wai Chun 
Published: March 2003

Background: The psychosocial impact of breast surgery has been extensively studied in the Western population. There is a relative paucity of comparable data in Oriental women who are increasingly affected by cancer of the breast. The present study investigates the effects that different types of breast surgery have on the quality of life of Chinese women. Methods: Forty‐nine Chinese women with early breast cancer were interviewed at 6 months–2 years following their primary surgery (breast‐conserving treatment (BCT; 17 patients), mastectomy (15 patients) and mastectomy with immediate breast reconstruction (17 patients)). Aspects of quality of life measured included general psychological well‐being, body image, sexual functioning and social functioning. Results: Patients who received BCT had significantly better body image scores compared to mastectomy patients. They were less worried about their appearance, had more freedom in the choice of clothing, felt less upset by the change in their body and felt more accepted by their partners. The three groups did not differ significantly in the other aspects of quality of life measured. Conclusions: Compared to mastectomy or mastectomy and immediate breast reconstruction, the most significant benefit of BCT is the preservation of a better body image.
Surgical capability and surgical pathology in Papua New Guinea in the year 2000
Authors: Watters D. A. K. , Kapitgau W. M. , Kaminiel P. , Liko O. , Kevau I. , Ollapallil J. , Ponifasio P. 
Published: March 2003

Background: Papua New Guinea (PNG) is a country of 4.5 million people with an annual health budget of only 96 million Kina (1K = US$0.35). There are 19 hospitals in the country and national surgeons are now staffing most of these hospitals. This review aims to describe the surgical pathology in the year 2000 and the capability of PNG surgeons to manage it. Methods: A review of publications, reports and surgical audit data on surgery in PNG was conducted. Surgical audit has been computerized for over 5 years. The review also draws on personal experience and data from MMed theses submitted to the University of Papua New Guinea. Results: Surgical pathology Surgical practice in PNG remains very general. Late presentation and advanced disease are common. Trauma, infection, malignancy and congenital anomalies dominate the surgical scene. The pattern of disease is different from what is found in the West. Western diseases are emerging with the incidence of appendicectomy rising from 5/100 000 to 75/100 000 in the past 30 years. The incidence of diabetes and gallstones has also risen. Osteoporosis, Colles’ and neck of femur fractures are rare. Surgical capability The standard of surgical care is acceptable with a low wound infection rate for clean and clean‐contaminated abdominal surgery of 0.9% and an anastomotic leak rate of 1.6%. Transurethral prostatectomy is also being performed to a satisfactory standard for head injuries admitted with a Glasgow Coma Score of 6–8 and a good outcome is achieved in over 70% of cases. Hospital mortality for surgical admissions is 3.7%. Subspecialties in orthopaedics, urology and head and neck surgery have been established. Neurosurgery, paediatric and cardiac surgery are being developed. Priorities for the next decade Papua New Guinea needs to continue to develop surgical subspecialties, particularly paediatric and neurosurgery, while maintaining a broad competence in general surgery. Services for burns, spinal injuries, rehabilitation and oncology need to be improved. Surgeons need to be more involved in rural health and teaching basic skills to primary health‐care workers. Acquisition, maintenance and repair of surgical equipment needs to be improved so that PNG’s well‐trained surgeons can have the right tools for their trade. Conclusions: Papua New Guinea offers a wide range of surgical pathology. The standard of surgery in PNG is reasonable but there are many areas that need development during the period of the next national health plan, 2001–2010. Australasian surgery has many opportunities to assist surgeons in PNG to achieve their objectives.