bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lymphocyte function in wound healing and following injury
Authors: Schäffer M , Barbul A 
Published: March 2003

Abstract

Background
Injury activates a cascade of local and systemic immune responses.

Methods
A literature review was undertaken of lymphocyte function in wound healing and following injury.

Results
Lymphocytes are not required for the initiation of wound healing, but an intact cellular immune response is essential for a normal outcome of tissue repair. Injury affects lymphocyte immune mechanisms leading to generalized immunosuppression which, in turn, increases host susceptibility to infection and sepsis. Although the exact origin of post-traumatic immunosuppression remains unknown, stress hormones and immunosuppressive factors, such as inflammatory cytokines, prostaglandin E2 and nitric oxide, affect lymphocyte function adversely. Post-traumatic impairment of T lymphocyte immune function is reflected in decreased lymphocyte numbers, as well as altered T cell phenotype and activity. Antibody-producing B lymphocytes are variably affected by injury, probably secondary to alterations of T lymphocyte function, as a result of their close interaction with helper T cells. Therapeutic modulation of the host immune response may include non-specific and specific interventions to improve overall defence mechanisms.

Conclusion
Early resuscitation to restore lymphocyte function after injury is important for tissue repair and the prevention of immunosuppression.
Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis
Authors: Michalowski K , Bornman P C , Krige J E J , Gallagher P J , Terblanche J 
Published: March 2003

Abstract

Background
The open subtotal cholecystectomy technique has simplified removal of the difficult gallbladder. Increasing laparoscopic experience has made laparoscopic subtotal cholecystectomy (LSC) a feasible option in patients with complicated acute or chronic cholecystitis.

Methods
LSC was performed in 29 patients with severe inflammation or fibrosis of the gallbladder associated with gallstone disease over a 23-month period. These 29 patients (mean age 53 years; 22 women) constituted 8·5 per cent of the total number of laparoscopic cholecystectomies performed (n = 340) and 15·6 per cent of 186 patients with acute cholecystitis. Eighteen patients in the latter group underwent conversion to open cholecystectomy. The indications for LSC were acute cholecystitis/empyema (n = 23) and severe fibrosis (n = 6).

Results
The cystic duct was either clipped before division (n = 15), sutured (n = 2) or ligated using an Endoloop (n = 10). In two patients the gallbladder bed was drained without isolating the cystic duct. The posterior wall of the gallbladder was left intact to avoid excessive bleeding or damage to bile ducts in the gallbladder bed. A suction drain was inserted in 14 cases. Median operating time was 73 (range 45–130) min. One patient died after operation from a myocardial infarction. Six patients had local complications (two haematomas, three bile leaks, one minor wound sepsis) and nine developed respiratory infections. Median hospital stay was 5 (range 2–28) days.

Conclusion
LSC is a safe, relatively simple and definitive procedure allowing removal of a difficult gallbladder and reducing the need for open conversion or cholecystostomy in the majority of patients.
Glutaraldehyde cross-linked collagen in the treatment of faecal incontinence
Authors: Kumar D , Benson M J , Bland J E 
Published: March 2003

Abstract

Background
The treatment of faecal incontinence secondary to internal anal sphincter dysfunction is unsatisfactory. The aim of the study was to evaluate the efficacy of anal glutaraldehyde cross-linked (GAX) collagen injections in patients with a surgically incorrectable disorder.

Methods
Seventeen patients were studied: nine had idiopathic faecal incontinence, three had incontinence following haemorrhoidectomy, two following internal sphincterotomy, two following an internal sphincter defect from obstetric injury and one following treatment for fistula in ano. All patients were refractory to conservative treatment and were unsuitable for surgical repair. All had anorectal physiology and endoanal ultrasonography before and after GAX collagen injections.

Results
All patients tolerated the injection without side-effects. All patients had an intact external anal sphincter. Following injection, 11 patients showed marked symptomatic improvement. One patient reported symptomatic improvement but remained in clinical grade 3, and two reported minimal improvement. There was no improvement in three patients, but one of these had a repeat injection and showed significant improvement subsequently.

Conclusion
Injection of GAX collagen in the anal canal is a simple and well tolerated method of treating faecal incontinence due to internal sphincter dysfunction. Early results suggest it provides an easy and reliable alternative to the currently available methods that are often unsuccessful and at best unpredictable.
Diagnosis and treatment of sphincter of Oddi dysfunction
Authors: Tzovaras G , Rowlands B J 
Published: March 2003

Abstract

Background
Sphincter of Oddi dysfunction is a challenge from both the diagnostic and therapeutic point of view. There is much ongoing debate about the accuracy and usefulness of various diagnostic tests, as there is about the effectiveness of proposed therapeutic alternatives.

Methods
A comprehensive review of the past 15 years' literature was undertaken, using the Medline database and cross-referencing of major articles on the subject.

Results and conclusion
Endoscopic and surgical treatments result in similar outcomes, with considerable failure rates. The latter reflect the difficulties in accurate diagnosis and a lack of sound objective criteria for selecting patients for intervention. In addition, in some patients sphincter of Oddi dysfunction may be only part of a generalized motility disorder of the gastrointestinal tract.
Stimulation of inflammatory markers after blunt trauma
Authors: Giannoudis P V , Smith R M , Banks R E , Windsor A C J , Dickson R A , Guillou P J 
Published: March 2003

Abstract

Background
Inflammatory mediators are released after trauma and may be related to the pathogenesis of sepsis. A prospective combined study of the pattern of release of an inflammatory mediator, interleukin (IL) 6, leucocyte activation (polymorphonuclear leucocyte (PMN) CD11b receptor expression and plasma elastase-α1 proteinase inhibitor complex (E–α1PI)) and soluble endothelial adhesion molecule expression (soluble E-selectin (sE-selectin) and soluble intracellular adhesion molecule 1 (sICAM-1)) was performed in patients suffering blunt trauma without adult respiratory distress syndrome (ARDS) or multiple organ failure syndrome (MOFS).

Methods
Thirty-one patients with a mean Injury Severity Score (ISS) of 14 (range 9–57) were studied. Venous blood samples were collected within 6 h of injury and then at 1, 3, 5 and 7 days. Leucocyte CD11b expression was quantified by flow cytometry. Serum IL-6, plasma E–α1PI, sE-selectin and sICAM-1 were measured by enzyme-linked immunosorbent assay.

Results
Serum IL-6, CD11b expression and E–α1PI levels were significantly raised above control values (P &lt; 0·0001) on admission, slowly returning towards control values over the study period (median IL-6, 140 pg/ml versus undetectable; CD11b, 14·8 versus 6·4 mean channel fluorescence units; E–α1 PI, 208 versus 52 µg/l). The sICAM-1 level rose to a median of 539 ng/ml at 5 days (control 243 ng/ml). The median sE-selectin level also progressively increased to a maximum level of 80 ng/ml at 5 days (control 49 ng/ml). Eleven patients developed postoperative sepsis. Significant differences in CD11b expression were seen at days 3, 5 and 7 and in E–α1 PI at 6 h, 24 h and 3 days in patients who subsequently developed sepsis (P &lt; 0·05). Severe injury (ISS 16 or greater) was associated with significantly greater responses in these measurements.

Conclusion
These data show that markers of inflammation are specifically stimulated by trauma even when ARDS and MOFS do not occur. The CD11b receptor on PMNs may be useful in screening patients destined to develop post-traumatic sepsis.
Clinical significance of clonality in thyroid nodules
Authors: Kim H , Piao Z , Park C , Chung W Y , Park C S 
Published: March 2003

Abstract

Background
Many different neoplastic and hyperplastic thyroid diseases present with clinically apparent thyroid nodules. Clonality analysis indicates whether a nodule arises from the polyclonal proliferation of a group of cells or forms a clone from a genetically altered cell and thus provides objective information on the origin of the thyroid nodules. Clonality was studied in thyroid nodules using the polymerase chain reaction (PCR) assay in the X-linked human androgen receptor (HUMARA) gene by random X chromosome inactivation in women.

Methods
DNA samples were obtained from 28 nodules in 21 women. All nodules and non-tumour thyroid tissues were fractioned selectively under a cryostat. Genomic DNA was isolated and digested with HhaI. PCR amplification of the HUMARA locus was performed using PCR mixtures containing [α-32P]2′-deoxycytidine 5′-triphosphate. The PCR products were analysed by denaturing gel electrophoresis.

Results
The HUMARA alleles were heterogenous in 18 of 21 patients. Among the 23 nodules from 18 patients, all of the eight papillary thyroid carcinomas were monoclonal. Two solitary nodules from follicular adenomas were monoclonal. Of the 13 follicular nodules from nodular goitres, ten were polyclonal and three were monoclonal. The monoclonal follicular nodules were larger in size (3·5 versus 2·0 cm, P &lt; 0·05) and had a tendency towards more cystic changes than polyclonal nodules.

Conclusion
PCR-based clonality study of thyroid nodules may help to distinguish hyperplastic from neoplastic nodules.
Comparison of duplex imaging and arteriography in the evaluation of lower limb arteries
Authors: Aly S , Sommerville K , Adiseshiah M , Raphael M , Coleridge Smith P D , Bishop C C R 
Published: March 2003

Abstract

Background
The aim of this study was to assess the accuracy of duplex imaging, compared with arteriography, in detecting arterial disease distal to the renal arteries.

Methods
Some 177 legs were studied in 90 patients (59 men, 31 women; median age 68 years) with peripheral arterial disease. Each patient had conventional intra-arterial angiography and duplex ultrasonography. Each leg was divided into 17 arterial segments, and the disease in each segment was quantified by measuring the peak systolic velocity ratio across any arterial lesion that was identified.

Results
Compared with angiography, duplex imaging was able to detect arterial disease with an overall sensitivity of 92 per cent, specificity of 99 per cent, positive predictive value 91 per cent and negative predictive value 100 per cent, and with a κ value of 0·87 (95 per cent confidence interval (c.i.) 0·81–0·93). Duplex was able to determine the length of the arterial lesion with a sensitivity of 89 per cent and a specificity of 98 per cent with a κ value of 0·88 (95 per cent c.i. 0·86–0·90). When the surgeon's final management decision concerning each vascular lesion was used as the reference, duplex and arteriography were equivalent, with an accuracy of 84 per cent and 85 per cent respectively in identifying the management used.

Conclusion
Duplex ultrasonography is reliable in detecting arterial lesions in peripheral arteries and could be used routinely in the initial evaluation of patients with lower limb arterial disease.
Histological study of colonic ischaemia after aortic surgery
Authors: Welch M , Baguneid M S , Mcmahon R F , Dodd P D F , Fulford P E , Griffiths G D , Walker M G 
Published: March 2003

Abstract

Background
Colonic ischaemia is a well documented complication of abdominal aortic reconstruction. In this prospective study patients had routine preoperative and postoperative colonoscopy and biopsy, in order to determine the true incidence and implications.

Methods
Fifty-six patients undergoing elective infrarenal aortic surgery, 28 for aneurysm and 28 for occlusive disease, had colonoscopy and biopsy before and 1 week after operation.

Results
Colonic ischaemia was identified histologically in biopsies from 16 (30 per cent) of 53 patients. Almost half the patients had normal macroscopic appearances. Two factors exhibited a statistically significant association with the development of ischaemia: prolonged cross-clamp time (P &lt; 0·05) and postoperative diarrhoea (P &lt; 0·001). Co-morbidity was much higher in patients with colonic ischaemia (P &lt; 0·005). Overall morbidity was significantly greater in the aneurysm group (P &lt; 0·05).

Conclusion
Colonic ischaemia is common after aortic reconstruction. When suspected, colonoscopy with biopsy is diagnostic.
Central venous pressure and its effect on blood loss during liver resection
Authors: Jones R McL , Moulton C E , Hardy K J 
Published: March 2003

Abstract

Background
Any strategy to reduce blood loss in liver resection and decrease blood transfusion would be of benefit to the patient and surgeon. This study evaluates the association of central venous pressure (CVP) with blood loss and blood transfusion during liver resection.

Methods
One hundred consecutive hepatic resections in the period 1986–1996 were studied prospectively concerning CVP, volume of blood lost, and volume of blood transfused. Blood loss volume and blood transfusion were analysed for those with a CVP less than or equal to 5 cmH2O, and greater than 5 cmH2O. A multivariate analysis assessed potential confounding factors in the comparison.

Results
The median blood loss in patients with a CVP of 5 cmH2O or less was 200 ml (n = 40) and that in those with a CVP above 5 cmH2O was 1000 ml (n = 52) (P = 0·0001). Only two of 40 patients with a CVP of 5 cmH2O or less had a blood transfusion whereas 25 of 52 patients with a CVP greater than 5 cmH2O required a transfusion (P = 0·0008). A multivariate analysis did not show confounding factors.

Conclusion
The volume of blood lost during liver resection correlates with the CVP. Lowering the CVP to less than 5 cmH2O is a simple and effective way to reduce blood loss during liver surgery.
Influence of luminal obstruction on oesophageal cancer staging using endoscopic ultrasonography
Authors: Vickers J , Alderson D 
Published: March 2003

Abstract

Background
Endoscopic ultrasonography is technically limited in patients with obstructing oesophageal cancers if the endoscope cannot pass beyond the lesion. This problem may be overcome by preliminary endoscopic tumour dilatation, or by the use of narrower calibre ‘blind’ endoscopic ultrasonographic telescopes or fine-bore endoscopic ultrasonographic miniprobes. These alternatives are either potentially hazardous or time consuming and expensive. The aim of this prospective study was to determine the effect of oesophageal obstruction on the locoregional staging accuracy of endoscopic ultrasonography for oesophageal cancer.

Methods
Some 50 patients with oesophageal cancer underwent staging with endoscopic ultrasonography before oesophagectomy and the T and N stage determined by endoscopic ultrasonography was compared with final histology. In 11 cases of luminal obstruction no attempt was made to overcome the blockage and a limited mediastinal scan alone was performed.

Results
Malignant obstruction of the oesophagus did not greatly reduce the staging accuracy of endoscopic ultrasonography. It correctly assessed local infiltration in all patients with obstruction, and correctly predicted nodal stage in nine of 11 patients.

Conclusion
Tumours large enough to cause luminal obstruction are nearly all full thickness (T3), and frequently have mediastinal lymph node metastases (N1) at the time of examination. This can usually be detected from limited endoscopic ultrasonography within the mediastinum.
Selective management of renal gunshot wounds
Authors: Velmahos G C , Demetriades D , Cornwell E E , Belzberg H , Murray J , Asensio J , Berne T V 
Published: March 2003

Abstract

Background
Gunshot wounds to the kidney have been managed traditionally by surgical exploration. Concerns over increased nephrectomy rates and unnecessary explorations have placed this method under scrutiny. Selective renal exploration based on solid clinical and radiographic criteria may be a safer alternative and deserves evaluation.

Methods
The medical records of 52 consecutive patients with renal gunshot wounds, who were managed between September 1994 and August 1995 by a protocol of selective exploration, were reviewed. Renal injuries were explored only if they involved the hilum or were accompanied by signs of continued bleeding. Main outcome measures were the numbers of kidneys lost, as well as the morbidity and mortality related to the management of the renal injury.

Results
Three patients died from associated injuries shortly after admission. Fifteen patients suffered complications but only two had complications directly associated with the renal injury. Thirty-two patients underwent renal exploration and 17 of them required nephrectomy for major renovascular or parenchymal trauma (grade IV and V). Renal exploration was successfully avoided in the remaining 20 patients. No kidneys were lost unnecessarily as a result of this policy.

Conclusion
Mandatory exploration of all gunshot wounds to the kidney is not necessary. Injuries that produce stable peripheral haematomas do not require exploration.
Physiological and functional outcome following ultra-low anterior resection with colon pouch–anal anastomosis
Authors: Williams N , Seow-Choen F 
Published: March 2003

Abstract

Background
Low rectal cancer is usually managed by ultra-low anterior resection (ULAR) with total mesorectal excision and straight coloanal anastomosis. However, following this procedure patients often suffer from frequency, urgency of bowel action and, occasionally, faecal incontinence. To overcome such problems, a colon pouch may be fashioned and a subsequent colon pouch–anal anastomosis performed. The physiological and functional outcome following the use of a colon pouch are appraised.

Methods
All relevant papers identified from a Medline search and papers from cross-referencing were reviewed.

Results and Conclusion
Creation of a colon pouch following ULAR results in reduced bowel frequency, and a lower incidence of urgency and faecal incontinence. Although there is a slightly increased incidence of evacuatory disorder and need for enemas or suppositories, this appears to be a minor problem which may possibly be overcome by using a smaller colon pouch. Compared with straight coloanal anastomosis following ULAR, the creation of a colon pouch produced a superior functional outcome.
Quality of life after treatment for rectal cancer
Authors: Camilleri-Brennan J , Steele R J C 
Published: March 2003

Abstract

Background
The studies on patient-reported symptoms and quality of life following the treatment of rectal cancer were evaluated; guidelines for future quality of life studies in this field are proposed.

Methods
Relevant papers in the English language were identified via Medline from January 1970 to November 1997, supplemented by a manual search for similar articles.

Results
Patients suffer various short- and long-term complications after treatment of rectal cancer, although the reported prevalence of such problems varies from study to study. Recent prospective studies have shown that, despite these problems, global quality of life scores as measured by generic questionnaires improve after surgery.

Conclusion
The methodological shortcomings of previous work must be rectified if quality of life studies are to have relevance in patient management.
Results of surgical resection of liver metastases from non-colorectal primaries
Authors: Berney T , Mentha G , Roth A D , Morel P 
Published: March 2003

Abstract

Background
Advances in the field of liver surgery have lowered its associated mortality and morbidity rates, and hepatic resection for metastatic disease is increasingly performed. There are few well defined guidelines for the heterogeneous group of non-colorectal metastases. This study analysed the risks and benefits of surgical resection for liver metastases from non-colorectal primaries.

Methods
A retrospective study was performed of 34 patients who underwent 37 operations over a 10-year period. Compilation of data from 141 patients from eight additional recent series was performed in order to analyse the effect of histological type on survival.

Results
There were no perioperative deaths. Complications occurred after seven of 37 procedures. Actuarial survival rates were 61, 43 and 27 per cent at 1, 2 and 5 years. Survival was significantly improved for curative versuspalliative resection (P &lt; 0·05), and for single versus multiple metastases (P &lt; 0·05). A strong correlation was observed between time to presentation with metastasis and length of survival (P &lt; 0·0001). Survival was significantly better for patients with secondaries from neuroendocrine tumours (P &lt; 0·0001), worse for those with intestinal adenocarcinomas (P &lt; 0·0001) and similar for patients with breast carcinoma (P &gt; 0·5) when compared with the whole group.

Conclusion
The low mortality and morbidity rates and the satisfactory survival figures reported justify this type of surgery for selected patients, in the absence of therapeutic alternatives.
Effects of loperamide on ileoanal pouch function
Authors: Herbst F , Kamm M A , Nicholls R J 
Published: March 2003

Abstract

Background
Opioid analogues are used to manage increased bowel frequency in patients with an ileoanal reservoir. The aim of the study was to determine the clinical efficacy of loperamide in patients with an ileoanal reservoir and to assess its effect on pouch motility.

Methods
Fourteen patients with a pouch who had normal pouch emptying and anal function were studied. Ambulatory pouch and anal motility, and stool weights, were recorded for 24 h while taking no medication and for 24 h while receiving 8 mg loperamide. In a second analysis, patients were divided on the basis of bowel frequency into those with 4 or fewer motions (good function; n = 6) and those with more than 6 per day (poor function; n = 8), to determine any differential effects of loperamide.

Results
Loperamide decreased median bowel frequency (no loperamide 5·5 versus loperamide 4·0, P = 0·03) and 24-h stool weight (610 g versus 413 g, P = 0·03) but not individual stool weights. Patients with poor function had both higher bowel frequency (8·0 versus 3·5 per 24 h, P = 0·004) and higher stool weight (728 g versus 430 g, P = 0·05) with no treatment than those with good function. High-amplitude pouch pressure waves were greater in number before defaecation in patients with poor function and did not decrease with loperamide, in contrast to patients with good function. Pouch baseline pressure decreased after defaecation to a similar extent in both groups and was not affected by loperamide.

Conclusion
Loperamide 8 mg per day reduces bowel frequency by reducing total stool weight, not individual stool weights. In patients with good function it also affects pouch motility. High bowel frequency is associated with increased pouch high-pressure waves.