bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kupffer cell blockade, tumour necrosis factor secretion and survival following endotoxin challenge in experimental biliary obstruction
Authors: Kennedy J A , Lewis H , Clements W D B , Kirk S J , Campbell G , Halliday M I , Rowlands B J 
Published: March 2003

Abstract

Background
Gram-negative sepsis and its sequelae frequently complicate invasive procedures in patients with obstructive jaundice. In response to endotoxin, Kupffer cells secrete tumour necrosis factor (TNF), a pivotal early mediator of sepsis. An investigation was carried out into the specific role of Kupffer cell TNF secretion following endotoxin challenge in obstructive jaundice.

Methods
Survival following intraperitoneal administration of endotoxin (2·0, 0·02 and 0·0002 mg per 100 g) was determined in rats following bile duct ligation (BDL) or sham operation. Plasma TNF concentration was quantified following endotoxin administration (0·0002 mg per 100 g) at 1, 2 and 6 h. Subsequently, the effect of Kupffer cell blockade by gadolinium chloride on survival and plasma TNF concentration was assessed.

Results
Jaundiced animals showed a significantly increased mortality rate following intraperitoneal injection of endotoxin 2·0 mg per 100 g (BDL 100 per cent versus sham 0 per cent) and 0·02 mg per 100 g (BDL 70 per cent versus sham 0 per cent; P = 0·002, Fisher's exact test). Median plasma TNF concentration was significantly greater in jaundiced animals 1 h after endotoxin administration (BDL 943 (interquartile range (i.q.r.) 211–3900) pg/ml versus sham 64 (i.q.r. 47–127) pg/ml; P = 0·002, Mann–Whitney U test). Kupffer cell blockade with gadolinium chloride increased the survival rate following endotoxin administration in BDL animals (BDL-GdCl3 100 per cent versus BDL-saline 40 per cent; P = 0·0003, Fisher's exact test) and decreased median plasma levels of TNF (BDL-GdCl3 88 (i.q.r. 0–1065) pg/ml versus BDL-saline 16 550 (1255–29 360) pg/ml; P = 0·002, Mann–Whitney U test).

Conclusion
Kupffer cell blockade improved survival and suppressed systemic TNF activity after endotoxin challenge. In obstructive jaundice, hypersecretion of TNF by Kupffer cells may supplement systemic cytokine production and be responsible for significant complications.
Patients' perception of surgical services in a district general hospital
Authors: Johnson R C , Pye J K , Scriven M W , Billings P J , Wood C , Crumplin M K H 
Published: March 2003

Abstract

Background
In addition to studying the outcomes of surgery in terms of mortality and morbidity rates and performance, it is also important to consider how patients perceive the delivery of the service given to them.

Methods
A patient satisfaction survey was carried out by the Surgical Epidemiology and Audit Unit of the Royal College of Surgeons of England, on patients undergoing surgical procedures by the Department of Surgery at Wrexham Maelor Hospital. No day cases were included in the study. Two hospitals in southern England (undergoing the same survey) designated X and Y were used for comparison.

Results
Some 2000 questionnaires were sent out twice; 1666 subjects (83 per cent) responded to the first questionnaire and 1445 (87 per cent) of these responded to a second questionnaire 6 weeks later (overall response 72 per cent). A total of 35 per cent of patients were older than 65 years of age. Some 76 per cent of patients with a malignant condition were seen within 4 weeks of referral compared with 38 per cent of those with a benign condition (P &lt; 0·0001). A total of 78 per cent of patients with cancer were admitted within 4 weeks compared with 84 and 88 per cent in hospitals X and Y. Some 23 per cent of patients were admitted as an emergency. Eighteen per cent of patients did not know who presented a consent form to them before surgery compared with 13 and 17 per cent in hospitals X and Y (P &lt; 0·0001). Some 26 per cent of patients perceived that they had complications after surgery compared with 27 and 25 per cent for hospitals X and Y. A total of 35 per cent of patients did not receive a follow-up appointment and 20 per cent of these patients were unhappy about this. Two areas of major concern revealed by the responses were the lack of written information and the overall poor scores generally attained by the emergency admission ward. However, 94 per cent of patients said that they would return to the same consultant.

Conclusion
Patients were generally happy with their surgical care and there was little difference between the three hospitals studied. Lower scores were given when patients were admitted to emergency admission wards. Higher scores were given when patients received printed information.
Fatal and life-threatening complications in antireflux surgery: analysis of 5502 operations
Authors: Rantanen T K , Salo J A , Sipponen J T 
Published: March 2003

Abstract

Background
There have been few comprehensive studies relating to the life-threatening or fatal complications of antireflux surgery.

Methods
Some 5502 antireflux operations were performed in Finland between January 1987 and January 1996 (population approximately 5 million); 3993 procedures (72·6 per cent) were open fundo-plications, 1162 (21·1 per cent) laparoscopic fundoplications and 347 (6·3 per cent) other antireflux procedures.

Results
There were 43 fatal or life-threatening complications (prevalence 0·8 per cent). Twenty-two followed primary open fundoplication (prevalence 0·6 per cent), 15 laparoscopic fundoplication (prevalence 1·3 per cent) (P &lt; 0·05), one refundoplication and five other antireflux procedures. The overall mortality rate was 0·3 per cent. Nine patients (0·2 per cent) died after open fundoplication, one (0·1 per cent) following laparoscopic fundoplication (P = 0·43), one following refundoplication and four after other antireflux procedures. Laparoscopic fundoplication was followed by 14 non-fatal life-threatening complications (prevalence 1·2 per cent), open fundoplication by 13 (prevalence 0·3 per cent) (P &lt; 0·01) and other antireflux procedures by one life-threatening complication (0·3 per cent).

Conclusion
Laparoscopic fundoplication was associated with more life-threatening complications than open fundoplication. This may compromise the advantages of the laparoscopic technique.
Combined inguinal and pelvic lymph node dissection for stage III melanoma
Authors: Hughes T M D , Thomas J M 
Published: March 2003

Abstract

Background
The incidence of melanoma is increasing in the UK and a significant number of patients are still presenting with primary lesions of poor prognosis. As a consequence there is likely to be an increasing number of patients with lymph node metastases for whom the appropriate extent of groin dissection remains controversial. This review summarizes the evidence to enable surgeons to make an informed decision about the management of patients with melanoma metastases to the groin lymph nodes.

Methods
A Medline search was performed to identify all English language articles about melanoma containing the words lymphadenectomy, lymph nodes, inguinal or lymphoedema. Eighty-seven relevant articles were selected from 3904 abstracts retrieved; 34 were related directly to the aim of this review.

Results
There are no randomized controlled trials comparing the outcome of combined inguinal and pelvic lymph node dissection (CLND) and superficial inguinal lymph node dissection (SLND). Excision of pelvic lymph node metastases is reported to yield a 5-year survival rate of 0–35 per cent. Recurrence within the pelvis occurs in 9–18 per cent of patients after SLND and in less than 5 per cent after CLND. Morbidity following either CLND or SLND is poorly reported. Major long-term lymphoedema limiting patient activity affects 6–20 per cent of patients after groin dissection. Cloquet's node was demonstrated in one study to be a useful predictor of pelvic lymph node involvement. Patients may be selected for pelvic node dissection on the basis of clinical findings, the results of pelvic computed tomography and the status of Cloquet's node.

Conclusion
The controversy surrounding the appropriate management of cytologically positive inguinal nodes in melanoma can be resolved only by a prospective randomized trial comparing CLND with SLND. Morbidity and local disease control must be measured as outcomes in addition to disease-free and overall survival.
Value of a surgical high-dependency unit
Authors: Jones H J S , Coggins R , Lafuente J , de Cossart L 
Published: March 2003

Abstract

Background
A minority of hospitals in the UK have a high-dependency unit (HDU). One reason for this is a lack of evidence supporting its benefit. This study sought to compare the outcomes of patients undergoing major abdominal surgery with regard to HDU utilization.

Methods
Data were collected prospectively from two groups of patients over 10 months. Patients in the no-HDU group underwent major abdominal surgery in a hospital without an HDU and returned to a general surgical ward. The other group was managed initially in an HDU. Data collected included Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) scores, complications, deaths and length of stay.

Results
Physiological and operative scores as calculated on the RAJIS POSSUM software were similar in both groups. The HDU group comprised 121 patients. Sixty-four developed a complication whereas 58·81 were expected to, giving an observed: expected (O: E) ratio of 1·09. Sixteen deaths occurred and 14·54 were expected (O: E ratio 1·10). Some 50 per cent stayed in hospital longer than was predicted. The no-HDU group comprised 71 patients. Fifty-nine developed a complication compared with 33·82 expected (O: E ratio 1·74). Ten deaths occurred, whereas 8·88 were expected, giving an O: E ratio of 1·13. Some 63 per cent stayed longer than predicted. The O: E ratios for morbidity were significantly different (P &lt; 0·0005). The complications that occurred more frequently in the absence of an HDU were chest infection, arrhythmias and hypotension.

Conclusion
Postoperative management on an HDU was associated with fewer cardiorespiratory complications. There was no difference in mortality rate but there was a trend towards shorter hospital stay.
Vocal cord paralysis after subtotal oesophagectomy
Authors: Hulscher J B F , van Sandick J W , Devriese P P , van Lanschot J J B , Obertop H 
Published: March 2003

Abstract

Background
Although vocal cord paralysis is a well known complication of subtotal oesophagectomy, precise data concerning origin, incidence and associated morbidity are lacking.

Methods
A retrospective study was performed of 241 patients who underwent transhiatal oesophagectomy for carcinoma of the mid/distal oesophagus between 1994 and 1998. Preoperative and postoperative laryngoscopy results were available for 140 patients.

Results
There were 109 men and 31 women, of mean age 63 years. Thirty-one patients (22 per cent) with recurrent laryngeal nerve paralysis were identified, three with bilateral and 28 with unilateral dysfunction. Paralysis occurred ipsilateral to the side of the cervical incision in 22 of 28 patients. It was permanent in six patients. The associated morbidity was substantial: pulmonary complications were more common in patients with vocal cord paralysis (12 of 31 versus 26 (24 per cent) of 109), leading to significantly more reintubations, and a significantly prolonged ventilation time and stay in the intensive care unit.

Conclusion
Although mostly transient, vocal cord paralysis is a frequent complication with significant associated morbidity. In an extended transthoracic resection (including a lymphadenectomy in the aortopulmonary window where the left recurrent laryngeal nerve is at risk) the cervical anastomosis should be made on the left side, to minimize the risk of bilateral vocal cord paralysis.
Twenty-three years of experience of carotid endarterectomy
Authors: Hussain T , Senaratine J W B , Green F R , Collin J , Hands L , Morris P J 
Published: March 2003

Abstract

Background
Carotid endarterectomy (CEA) has been an evidence-based treatment for symptomatic severe carotid stenosis since 1991. Surgical techniques and patient selection have changed over the years. The results of CEA in a single centre over a 23-year period were reviewed.

Methods
Prospectively gathered preoperative, operative, postoperative and long-term follow-up data were analysed. Routine intraoperative shunting and patch closure has been used since 1988. Data were analysed using the χ2 test or by logistic regression, adjusting for age at operation and date of operation.

Results
Five hundred and seventy-three CEAs (37 bilateral and three repeat procedures) were carried out on 533 patients. Trainees performed an increasing proportion of CEAs from 1996 to 1998 (15, 50 and 56 per cent respectively). The perioperative death rate was 0·8 per cent and the rate of any perioperative neurological deficit was 6·9 per cent. Other causes of morbidity included nerve injury (5·1 per cent) of which the commonest was to the hypoglossal nerve (2·7 per cent). During follow-up (median 4 (range 0–22) years) there were 81 neurological events (15·9 per cent) which included 35 ipsilateral (6·6 per cent) and 18 contralateral (3·4 per cent) strokes. There was no significant difference in outcome for grade of surgeon, intraoperative shunting or patch closure. Major causes of death were cardiac death (74; 14·6 per cent) followed by stroke (23; 4·5 per cent) and cancer (20; 3·9 per cent).

Conclusion
The introduction of routine intraoperative shunting and patch closure, as well as allowing surgical trainees to perform supervised CEAs, has not affected perioperative morbidity and mortality rates or long-term outcome.
Deaths from ruptured abdominal aortic aneurysm in Wales
Authors: Basnyat P S , Biffin A , Moseley L , Hedges R , Lewis M H 
Published: March 2003

Abstract

Background
The aim was to determine the true incidence and operative mortality rate of patients with ruptured abdominal aortic aneurysm (AAA) who reach hospital alive in Wales.

Methods
Patients presenting with a ruptured AAA between September 1996 and August 1997 were analysed. The data were collected prospectively by an independent body, observing strict confidentiality.

Results
Two hundred and thirty-three patients with confirmed ruptured AAA were identified. One hundred and thirty-three patients (57 per cent) underwent attempted operative repair. Eighty-five (64 per cent) died within 30 days. All 100 patients who received no operation died. Of the 233 patients, 92 were admitted under vascular surgeons (VSs) and 141 under non-vascular surgeons (NVSs). VSs operated on 82 patients (89 per cent) of whom 50 (61 per cent) died; NVSs operated on 51 (36 per cent) of whom 35 (69 per cent) died.

Conclusion
This study is the only independent prospective study of death among patients with ruptured AAA who reached hospital alive. Some 57 per cent of the patients with a ruptured AAA were operated on. The operative mortality rate was 64 per cent and the overall mortality rate was 79 per cent. VSs were significantly more aggressive (89 per cent) in the management of ruptured AAA (i.e. more likely to operate) than NVSs (36 per cent) (P &lt; 0·0001). Despite this, the operative mortality rate for VSs was 61 per cent, whereas for NVSs it was 69 per cent (P = 0·372). The overall mortality rate (including operated and non-operated patients) for NVSs (89 per cent) was significantly higher than that for VSs (65 per cent) (P &lt; 0·0001). In Conclusion, ruptured AAA is common in Wales and associated with a high mortality rate even when managed by VSs.
Superficial femoral angioplasty
Authors: Seedawy E El , Black D , Shaw J , Belch J , McCollum P 
Published: March 2003

Abstract

Background
Superficial femoral angioplasty (percutaneous transluminal angioplasty, PTA) is a widely performed therapeutic modality used throughout the UK in the treatment of intermittent claudication. However, there is still concern over its efficacy in the management of atherosclerotic occlusive disease. Long-term outcome was examined in patients undergoing PTA for short (less than 10 cm) occlusions or stenoses.

Methods
Data were collected prospectively for 413 patients undergoing femoral angioplasty and entered into a database for long-term outcome analysis. Patients were seen at 3, 6 and 12 months and at yearly intervals. Doppler ultrasonography and clinical assessment were performed in all patients and duplex imaging was carried out in those in whom there was doubt about patency. Finally, surviving patients were simply questioned as to whether they felt the original PTA to have been worthwhile.

Results
Mean follow-up time was 7 (range 2–11) years. Excluding an initial technical failure rate of 8 per cent, cumulative primary patency at 1, 2, 3, 4 and 5 years was 64, 55, 36, 21 and 14 per cent respectively. Moreover, clinical assessment revealed improvement of the presenting complaint in only 40, 29, 17, 9 and 7 per cent respectively.

Conclusion
Superficial femoral PTA does not appear to be effective in the management of intermittent claudication in most patients.
Long-term survival following repair of ruptured abdominal aortic aneurysm in patients over 75 years of age
Authors: Evans S M , Adam D J , Brittenden J , Bain M , Bradbury A W 
Published: March 2003

Abstract

Background
Previous studies have indicated that patients over the age of 75 years have an increased in-hospital mortality rate following repair of ruptured abdominal aortic aneurysm (AAA). The long-term survival of this patient group has not been reported previously, even though this information may have a strong influence on the decision to operate.

Methods
Interrogation of a prospective database identified 272 patients aged 75 years or over (median age 78 (range 75–93) years) admitted between 1983 and 1995. Long-term patient survival data and survival curves for an age- and sex-matched population were obtained from the General Register Office through the Information and Statistics Division.

Results
Sixty-nine (25 per cent) of the 272 patients did not undergo operation. Eighty-eight (43 per cent) of the 203 patients who had surgery died within the same hospital admission. The 1-, 5- and 10-year survival rates for the remaining 115 patients (median age 77 (range 75–85) years) were 88, 59 and 26 per cent respectively, at a median follow-up of 54 (range 1–157) months. The median life expectancy for this patient group was 69 months. These data are comparable to those of an age- and sex-matched population.

Conclusion
Many patients over the age of 75 years who present with ruptured AAA are considered unfit for surgery. These data demonstrate that, even in this elderly population, survivors of ruptured AAA repair enjoy a near-normal life expectancy.
Perioperative renal function following endovascular repair of abdominal aortic aneurysm with suprarenal and infrarenal stents
Authors: Macierewicz J , Walker S R , Vincent R , Wastie M , Elmarasy N , Hopkinson B R 
Published: March 2003

Abstract

Background
Endovascular repair (EVR) of abdominal aortic aneurysm (AAA) is feasible for selected patients. Placing an uncovered stent across the origins of the renal arteries may improve fixation and seal of the proximal end of the stent-graft. However, this has potential for problems (e.g. renal artery stenosis or microembolization). This study aimed to evaluate the short-term effect of a suprarenal stent on the function of the individual kidney.

Methods
In 30 patients undergoing EVR for AAA, renal function was assessed before and after operation by 99mTc-radiolabelled diethylenetriamine penta-acetate radionuclide renography and daily measurement of serum creatinine levels. Eleven patients had infrarenal stent-grafts using an aorta uni-iliac system (group 1); 19 patients had the device with an uncovered suprarenal stent (modified Gianturco Z stent), ten of which were aorta uni-iliac and nine bifurcated systems (group 2). Individual kidney function was expressed as the whole kidney transit time (WKTT). In addition, glomerular filtration rate (GFR) was measured from serial blood samples following renography.

Conclusion
No result reached statistical significance. Placing an uncovered stent over the origins of the renal arteries does not appear to impair kidney function in the short term.
Immunoglobulin A antibodies against Chlamydia pneumoniae are associated with expansion of small abdominal aortic aneurysms and declining ankle blood pressure
Authors: Lindholt J S , Vammen S , Henneberg E W , Fasting H 
Published: March 2003

Abstract

Background
The potential correlation between chronic infection with Chlamydia pneumoniae and the progression of small abdominal aortic aneurysms (AAAs) and lower limb atherosclerosis was studied.

Methods
Mass screening for AAA was carried out in outdoor clinics at all hospitals in the county. Some 139 men (aged 65–73 years) with a 3·0–4·9-cm AAA were followed prospectively for 1–3 (mean 2·7) years. Initially, an interview and examination was performed, and blood samples were taken.

Results
Some 62 per cent (53–71 per cent) had an immunoglobulin (Ig) A level of 40 or more, or an IgG level of 64 or above. Some 83 per cent (74–93 per cent) had an IgA level of 20 or more, or an IgG level of 32 or more. Men with an IgA level of 20 or more had 51 per cent greater AAA expansion and men with an IgA level of 40 or above had 24 per cent more expansion. An IgA level of 20 or more, or IgA of 40 or greater, were significant independent predictors of AAA expansion adjusted for age, smoking, initial AAA size, steroid treatment, diastolic blood pressure, pulmonary function and other plasma factors. The ankle blood pressure index (ABI) of the IgA-seropositive men decreased 11 per cent, while the ABI decreased by 5 per cent among IgA-seronegative men (P &lt; 0·05). The significant difference persisted after adjusting for age, smoking, initial systolic ankle blood pressure, initial brachial systolic or diastolic blood pressure, but disappeared after adjusting for low-density lipoprotein (LDL) levels.

Conclusion
A high proportion of men with a small AAA have signs of chronic C. pneumoniae infection. The progression of AAAs and lower limb atherosclerosis seems to be correlated to chronic infection with C. pneumoniae.