bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perigastric lymph node status as a prognostic indicator in patients with gastric cancer
Authors: Adachi Y , Suematsu T , Shiraishi N , Tanimura H , Morimoto A , Kitano S 
Published: March 2003

Abstract

Background
The extent of lymph node dissection and histological examination of dissected lymph nodes varies among countries, which leads to the erroneous nodal stage and different surgical results in gastric cancer (stage migration, ‘Will Rogers effect’). The aim of this study was to clarify the prognostic significance of the number of positive perigastric lymph nodes, which could be evaluated simply after D1 gastrectomy.

Methods
A consecutive series of 106 patients with histologically node-positive gastric cancer treated by radical gastrectomy and lymph node dissection (D2 or D3) was studied. The number of metastatic perigastric nodes (level I, nos 1–6) was examined, and its influence on the survival of patients was analysed.

Results
The overall 5-year survival rate was 50·9 per cent; the 5-year survival rate was significantly decreased when positive perigastric nodes exceeded six (62 per cent for one to six nodes versus 23 per cent for seven or more nodes, P &lt; 0·001). Tumours having one to six positive perigastric nodes compared with those having seven or more positive perigastric nodes were more likely to have a size less than 4 cm (29 per cent versus one of 30, P &lt; 0·001), grossly localized type (45 per cent versus seven of 30, P = 0·042), absence of serosal invasion (32 per cent versus none of 30, P = 0·002) and metastasis limited to the perigastric lymph nodes (70 per cent versus seven of 30, P &lt; 0·001).

Conclusion
The results indicate that the number of positive perigastric nodes correlates with tumour progression and patient survival. This parameter is a simple and useful prognostic indicator for node-positive gastric cancer, and is available not only for D2 and D3 gastrectomy but also for D1 gastrectomy.
Predischarge duplex imaging of infrainguinal vein grafts does not predict the development of stenoses
Authors: Olojugba D H , Varty K , Hartsthorne T , Naylor A R , Bell P R F , London N J M 
Published: March 2003

Abstract

Background
The aim of this study was to determine whether predischarge duplex imaging of an infrainguinal vein graft could predict the subsequent development of graft stenosis.

Methods
Patients with infrainguinal vein grafts underwent a duplex scan of the entire graft before discharge from hospital. Grafts were classified as abnormal or normal based on the presence or absence of flow abnormalities (peak velocity ratio 1·5 or greater). All grafts were re-examined 1 month after surgery, at 3-monthly intervals for the first year and then every 6 months thereafter. A significant stenosis requiring correction was defined by a duplex-derived peak systolic velocity ratio of 3·0 or more. The relationship between the predischarge scan and subsequent development of stenosis was examined.

Results
Forty-four grafts were recruited. Two occluded soon after a normal predischarge scan and were excluded from subsequent analysis. Predischarge abnormalities were found in 16 grafts. The abnormality in one graft required immediate correction. A further four grafts subsequently developed significant stenoses and required angioplasty. Of the 26 grafts with no predischarge abnormalities, 11 developed significant stenoses and underwent angioplasty. Abnormal predischarge duplex scans had a sensitivity and specificity of 31 and 58 per cent respectively for the development of stenoses. The positive and negative predictive values were 31 and 58 per cent respectively.

Conclusion
Predischarge duplex imaging cannot be used to predict the development of stenoses in infrainguinal vein grafts.
Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma
Authors: Lam C-M , Lo C-M , Yuen W-K , Liu C-L , Fan S-T 
Published: March 2003

Abstract

Background
Pulmonary metastasis is the commonest site of extrahepatic spread from hepatocellular carcinoma (HCC). The aim of the present study was to evaluate the efficacy of surgical management in patients with solitary pulmonary metastases from HCC.

Methods
This was a retrospective study of patients with HCC admitted for hepatectomy from July 1972 to June 1995. The records of patients who had a pulmonary resection for histologically proven pulmonary recurrence after curative hepatectomy were selected for analysis.

Results
In the study interval, 380 patients with HCC underwent hepatectomy. Some 48 patients (12·6 per cent) developed pulmonary metastases documented pathologically or radiologically. Nine (seven men and two women) were suitable for curative pulmonary resection. The median disease-free survival between hepatectomy and appearance of the lung metastasis was 21 months. The median survival after pulmonary resection was 42 months, and the 1-, 2- and 5-year survival rates were 100, 78 and 67 per cent respectively.

Conclusion
Pulmonary resection for metastases from HCC resulted in long-term survival in these highly selected patients.
Preservation of pectoralis minor in axillary clearance for breast cancer
Authors: Markandoo P , Smith P , Chaudary M A , Fentiman I S 
Published: March 2003

Abstract

Background
There has been a gradual shift away from radical surgery towards conservation treatment for breast cancer. The pectoralis minor muscle is increasingly preserved in women undergoing axillary clearance as part of either breast conservation or mastectomy.

Methods
A retrospective study was conducted to determine the axillary node count in 578 patients who underwent axillary clearance, 276 with removal of pectoralis minor and 302 who had the muscle preserved.

Results
The mean number of nodes excised in the group who had pectoralis minor excised was 25·5 (range 8–50) compared with 24·5 (range 9–68) in the preservation group.

Conclusion
For the majority of patients with operable breast cancer, retention of the pectoralis minor muscle is not associated with understaging or undertreatment of the axilla.
New model of renal warm ischaemia–reperfusion injury for comparative functional, morphological and pathophysiological studies
Authors: Weight S C , Furness P N , Nicholson M L 
Published: March 2003

Abstract

Background
Renal warm ischaemia–reperfusion injury is pertinent to vascular and transplant surgery. While established models provide functional and morphological data the authors wanted to be able to correlate this with the underlying pathophysiology at any chosen time point, thus allowing future interventional effects on reperfusion injury to be evaluated.

Methods
In a rodent model bilateral renal warm ischaemia (15–60 min) and then reperfusion (20 or 80 min) before nephrectomy allowed for analysis of early reperfusion pathophysiology. The remaining kidney provided functional data (glomerular filtration rate (GFR)) at days 2 and 7 before nephrectomy for late analysis and morphology using a new grading system.

Results
Acceptable survival rate (ten of 12 animals) was seen with up to 45 min of warm ischaemia. Renal function was impaired at day 2 following 30–60 min of warm ischaemia (P &lt; 0·01) and day 7 in the 45- and 60-min groups (P &lt; 0·05 and P &lt; 0·01 respectively). Strong correlation existed between duration of ischaemia and GFR at day 2 (r2 = 0·88) and day 7 (r2 = 0·95). Histological damage in the cortical tubules was evident in the 45- and 60-min groups (P &lt; 0·01).

Conclusion
This new model allowed comparative functional, morphological and pathophysiological studies while minimizing the number of animals required. Overall 45 min of warm ischaemia gave significant, recoverable injury and is recommended for investigating renal reperfusion injury.
Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair
Authors: Poen A C , Felt-Bersma R J F , Strijers R L M , Dekker G A , Cuesta M A , Meuwissen S G M 
Published: March 2003

Abstract

Background
This study was designed to investigate the long-term clinical and anorectal functional results after primary repair of a third-degree obstetrical perineal rupture.

Methods
One hundred and fifty-six consecutive women who had a primary repair of a third-degree perineal rupture were sent a questionnaire and asked to undergo anorectal function testing (anal manometry, anorectal sensitivity, anal endosonography and pudendal nerve terminal motor latency (PNTML))

Results
Some 117 women (75 per cent) responded. Anal incontinence was present in 47 women (40 per cent); however, in most cases only mild symptoms were present. In 40 women additional anorectal function tests were performed and compared with findings in normal controls. Mean(s.d.) maximum squeeze pressure (31(15) versus 63(17) mmHg, P&lt;0·001) was decreased and first sensation to filling of the rectum (88(47) versus 66(33) ml, P = 0·03) and anal mucosal electrosensitivity (4·7(1·7) versus 2·5(0·8) mA, P = 0·003) were increased compared with values in normal controls. In 35 women (88 per cent) a sphincter defect was found with anal endosonography. Factors related to anal incontinence were the presence of a combined anal sphincter defect (relative risk (RR) 1·7 (95 per cent confidence interval (c.i.) 1·1–2·8)) or subsequent vaginal delivery (RR 1·6 (95 per cent c.i. 1·1–2·5)).

Conclusion
Anal incontinence prevails in 40 per cent of women 5 years after primary repair of a third-degree perineal rupture. The presence of a combined sphincter defect or subsequent vaginal delivery increase the risk of anal incontinence.
Tissue markers as predictors of postoperative adhesions
Authors: Ivarsson M I , Bergström M , Eriksson E , Risberg B , Holmdahl I 
Published: March 2003

Abstract

Background
Postoperative adhesion formation has been associated with a decreased capacity to degrade intra-abdominally deposited fibrin. Adhesions, once lysed, have a high propensity for reformation. This study tested the hypothesis that patients with a high propensity for adhesion formation as well as adhesion tissue had a reduced fibrinolytic capacity.

Methods
Peritoneal biopsies were taken during abdominal surgery from 21 patients who had previously undergone operation; previously formed adhesion tissue was sampled from ten of these patients. Adhesion formation was scored. The fibrinolytic capacity of peritoneum was determined in tissue extracts.

Results
At the time of opening of the abdominal cavity, levels of plasminogen activator inhibitor (PAI) type 1 (P = 0·009) and tissue-type plasminogen activator (tPA)/PAI complex (P = 0·008) were increased in peritoneal samples from patients with severe adhesions compared with those in samples from patients with less severe adhesions. Adhesion tissue similarly had reduced fibrinolytic capacity as judged by a decrease in tPA activity (P = 0·005) and an increase in PAI-1 level (P = 0·01), reflected in an increased level of tPA/PAI complex (P = 0·008) compared with unaffected peritoneum.

Conclusion
These observations demonstrate reduced fibrinolytic capacity in peritoneal tissue in patients with a greater propensity for development of adhesions and likewise in adhesion tissue. This suggests that components of the fibrinolytic system may be used as markers of an increased risk of adhesion development.
Preoperative duplex imaging is required before all operations for primary varicose veins
Authors: Mercer K G , Scott D J A , Berridge D C 
Published: March 2003

Abstract

Background
Physical examination is unreliable in the detection of sources of reflux in varicose veins. Hand-held Doppler (HHD) ultrasonography has been recommended as an accurate adjunct to physical examination. The aim of this study was to evaluate the accuracy of HHD imaging in comparison with duplex ultrasonography.

Methods
Eighty-nine legs in 61 patients with primary varicose veins were examined with an HHD probe to detect reflux at the saphenofemoral junction (SFJ), the saphenopopliteal junction (SPJ) and in thigh perforators (TPs). Patients then underwent duplex imaging and the results of the tests were compared.

Results
The sensitivity of the HHD technique was 73 per cent at the SFJ, 77 per cent at the SPJ and 51 per cent for TPs. In primary varicose veins the surgery planned using HHD imaging alone would have left residual sites of reflux in 24 per cent.

Conclusion
Examination with HHD ultrasonography is not sufficiently accurate to plan varicose vein surgery. Duplex imaging is recommended before all operations for primary varicose veins.
Anal endosonography in patients with anorectal symptoms after haemorrhoidectomy
Authors: Abbasakoor F , Nelson M , Beynon J , Patel B , Carr N D 
Published: March 2003

Abstract

Background
Anorectal symptoms after haemorrhoidectomy are common and treatment is often empirical. Because of this, an audit was carried out of the value of anal endosonography in patients with anorectal symptoms after haemorrhoidectomy.

Methods
Between May 1993 and February 1997, 16 patients (ten men and six women of median age 56 (range 35–77) years) were investigated by anal endosonography for anorectal symptoms after haemorrhoidectomy which involved anorectal incontinence (n = 10), anal pain (n = 4) and obstructive defaecation (n = 2). The findings were compared with those in a matched group of asymptomatic patients after haemorroidectomy.

Results
Anal endosonography demonstrated an abnormality in 12 symptomatic patients. Of the ten patients with anorectal incontinence, endosonography showed an internal anal sphincter defect (n = 5), a combined sphincter defect (n = 2) and an isolated external anal sphincter defect (n = 1). Normal appearances were seen in all asymptomatic patients. The endosonographic abnormalities of the four patients with anal pain included internal anal sphincter defect (n = 1), extrinsic mass (n = 1), and intersphincteric abscess (n = 1). One of the two patients with obstructive defaecation had an isolated external anal sphincter defect on endosonography.

Conclusion
These results show a high yield of endosonographic abnormalities in patients who experience symptoms after haemorrhoidectomy. In particular, occult sphincter injury as a cause of incontinence in these patients can frequently be demonstrated.
Rectal adaptation to distension in patients with overt rectal prolapse
Authors: Siproudhis L , Bellissant E , Juguet F , Mendler M-H , Allain H , Bretagne J-F , Gosselin M 
Published: March 2003

Abstract

Background
High recovery rates of continence are observed after surgical procedures for rectal prolapse. Increases in rectal compliance but no obvious rise in anal pressures have been reported. The authors' hypothesis was that decreased rectal adaptation to distension may contribute to incontinence in patients suffering from overt rectal prolapse.

Methods
This was a prospective study conducted in 20 consecutive incontinent patients suffering from overt rectal prolapse with no mucosal change (two men and 18 women; mean(s.e.m.) age 50(3) years). They were compared with 20 age- and sex-matched patients with incontinence without rectal prolapse and ten age- and sex-matched healthy volunteers observed during the same period. The subjects were submitted to phasic isobaric distension of the rectum with an electronic barostat. Anal pressures, perception scores and rectal volumes were recorded at six different preselected pressures.

Results
Compared with healthy subjects, maximum rectal volumes (mean(s.e.m) 98(6) versus 167(11) ml; P = 0·005), volumes related to compliance (56(5) versus 100(9) ml; P = 0·004) and tone (41(3) versus 67(4) ml; P = 0·003) were decreased significantly in the rectal prolapse group. Prolapse and incontinence groups did not differ significantly with respect to rectal adaptation for all three parameters and steps of distension considered.

Conclusion
Patients suffering from overt rectal prolapse had markedly impaired rectal adaptation to distension which may contribute to incontinence.
Controlled prospective study of positron emission tomography using the glucose analogue [18F]fluorodeoxyglucose in the evaluation of pulmonary nodules
Authors: Präuer H W , Weber W A , Römer W , Treumann T , Ziegler S I , Schwaiger M 
Published: March 2003

Abstract

Background
Positron emission tomography (PET) is a new imaging technique which, by measuring focal metabolic activities, can make a qualitative statement (benign or malignant) about a tumour. PET has been described in many studies to provide a high diagnostic accuracy for the evaluation of pulmonary coin lesions. However, these studies were not always supported by histological confirmation of the results. In a controlled prospective study, it was investigated whether the diagnostic accuracy of PET is sufficiently high to allow omission of diagnostic thoracotomy or thoracoscopy in the case of a negative finding.

Methods
A PET scan was carried out before operation using [18F]fluorodeoxyglucose (FDG) in 50 patients with pulmonary coin lesions (diameter 30 mm or less). All of these lesions were completely removed thoracoscopically or by a formal thoracotomy and were examined histologically. Using the histology results, the diagnostic accuracy of the PET procedure with regard to a benign or malignant diagnosis was evaluated and compared with that of computed tomography (CT).

Results
From a total of 54 coin lesions (four of the 50 patients had two lesions) there were 31 malignant (19 primary bronchial carcinomas, 12 metastases) and 23 benign diagnoses. With the PET procedure 28 of 31 malignant and 19 of 23 benign lesions were classified correctly (sensitivity 90 per cent, specificity 83 per cent). False negatives included two bronchial carcinomas and one metastasis. CT had a sensitivity of 100 per cent and specificity of 52 per cent.

Conclusion
FDG PET cannot generally be considered as a replacement for diagnostic thoracoscopy or thoracotomy at the present time. However, by combining FDG PET with radiological follow-up, clinical applications may evolve in patients at low risk for a malignant tumour or at high risk for surgical complications.
Surgical treatment and outcome in patients with a hepatocellular carcinoma greater than 10 cm in diameter
Authors: Lee N H , Chau G Y , Lui W Y , King K Ls , Tsay S H , Wu C W 
Published: March 2003

Abstract

Background
Hepatocellular carcinoma (HCC) over 10 cm in diameter at the time of diagnosis continues to account for a number of patients undergoing hepatic resection. This study evaluated the clinicopathological features and outcome following surgery for large HCC.

Methods
Forty patients with a large HCC (greater than 10 cm) (group 1) resected between 1991 and 1996 were studied retrospectively. They were compared with 245 patients who had smaller HCCs (10 cm or less) (group 2).

Results
No patient in group 1 had hepatitis C infection compared with 22·9 per cent in group 2 (P =0·001). Patients in group 1 were significantly younger, had higher α-fetoprotein levels (16 750 versus 1864 ng/ml; P &lt; 0·001), better liver function, a higher incidence of multiple tumours (27 of 40 versus 42·0 per cent; P =0·003) and venous invasion (35 of 40 versus 52·2 per cent; P &lt; 0·001), and underwent more major resections (37 of 40 versus 26·5 per cent; P &lt; 0·001) than those in group 2. Morbidity and mortality rates and hospital stay were comparable in the two groups. For group 1, the 1-, 3- and 5-year disease-free survival rates were 42, 30 and 28 per cent respectively. Multiple tumours, venous invasion and impaired liver function were factors associated with recurrence.

Conclusion
Large HCC had specific clinicopathological features. In selected patients, resection is safe and offers the chance of long-term disease-free survival.
Association between breast and colorectal cancers
Authors: Stoll B A 
Published: March 2003

Abstract

Background
The risk of breast and colorectal cancers in immigrants from non-industrialised countries is sharply increased when they adopt a Western lifestyle. In addition, epidemiological studies on Western populations show an association between the two tumours, both in the same individual and also in close relatives. Most studies agree that high energy intake, obesity and inadequate physical exercise are associated with an increased risk of both tumours.

Methods
Risk markers for each cancer are examined in order to identify causative nutritional factors or metabolic–endocrine dysfunction. The role of steroid hormones and other possible carcinogenic mechanisms is discussed, concentrating on evidence of a role for insulin and insulin-like growth factors (IGFs) in the promotion of carcinogenesis in both organs.

Results
Individuals with a genetic susceptibility to insulin resistance show triggering of hyperinsulinaemia following excessive weight gain or long-term diet high in saturated fat. Case–control studies show an association between hyperinsulinaemia and evidence of breast or colorectal carcinoma. Multiple laboratory studies show that increased activity of IGFs can stimulate the growth of human breast and colorectal cancer cells.

Conclusion
It is postulated that either insulin resistance and its concomitants promote the development of breast and colorectal cancers, or that they share common risk factors. Sex steroid metabolism and organ specificity may explain age and sex differences between the tumours in relation to the role of obesity. Recent research suggests that a diet high in n-3 polyunsaturated fatty acids may reduce the risk of developing insulin resistance. This observation may be applied to test the hypothesis that an effect on hyperinsulinaemia may modify the risk of developing breast or colorectal cancer.
Solitary rectal ulcer syndrome
Authors: Vaizey C J , van den Bogaerde J B , Emmanuel A V , Talbot I C , Nicholls R J , Kamm M A 
Published: March 2003

Abstract

Background
Solitary rectal ulcer syndrome is a rare disorder characterized by erythema or ulceration of the rectal wall, associated with typical histological features, and disturbed defaecatory behaviour with the passage of blood and mucus.

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

Results
The pathogenesis is likely to vary in different patients; it includes trauma from straining, direct digital trauma and possibly primary neuromuscular pathology. The histological findings of extension of the muscularis mucosa between crypts and muscularis propria disorganization on full-thickness specimens are characteristic. Biofeedback defaecation retraining, including habit training, can lead to symptom improvement and return to work in a majority of patients. Abdominal rectopexy offers long-term symptom improvement in approximately 50 per cent of patients. Rectal ulceration may persist after any treatment, even if symptoms improve.

Conclusion
Behavioural therapy and carefully considered operations offer the best treatment results. Further work on psychological factors and neuromuscular and vascular pathology is required.