bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparotomy and laparoscopy differentially accelerate experimental flank tumour growth
Authors: Da Costa M L , Redmond H P , Finnegan N , Flynn M , Bouchier-Hayes D 
Published: March 2003

Abstract

Background
Surgery depresses host tumoricidal activity and may increase tumour growth. This study compared the effects of laparoscopy with laparotomy on extraperitoneal tumour growth and immune function in a murine model.

Methods
C57BL/6 female mice aged 8–10 weeks had tumours induced in the right flank (n = 45) and were randomized to undergo halothane anaesthesia only, laparoscopy or laparotomy. Flank tumour volume was assessed over 10 days. A second group of animals (n = 540) were randomized to undergo the same procedures and killed at 24, 48 and 96 h. Splenocytes were harvested for natural killer (NK) cell and lymphokine activated killer (LAK) cell cytotoxicity studies.

Results
There was a significant increase in flank tumour growth in the first 48 h after laparotomy and laparoscopy compared with controls (P&lt;0·01). By 96 h the difference was only significant in the laparotomy group (P&lt;0·01). Both NK and LAK cell cytotoxicities were suppressed significantly (P≤0·03) from 24 h up to 96 h following laparotomy compared with control and laparoscopy groups. There was also a significant suppression in the laparoscopy group compared with controls in the first 48 h after operation (P≤0·02).

Conclusion
Extraperitoneal tumour growth was significantly accelerated after laparotomy and correlated with significantly suppressed NK and LAK cytotoxicity for at least 4 days after operation. Laparoscopy had a shorter, less profound effect on tumour growth and immune function.
Cystic tumours of the pancreas
Authors: Martin I , Hammond P , Scott J , Redhead D , Carter D C , Garden O J 
Published: March 2003

Abstract

Background
Cystic pancreatic tumours may be misdiagnosed as pseudocysts.

Methods
From August 1990 to January 1998, 21 patients (16 women) with a median age of 60 years underwent operation for a cystic mass in the pancreas with histological confirmation of neoplasia (six serous cystadenoma (SCA), three mucinous cystic adenoma (MCA), ten mucinous cystadenocarcinoma (MCAC), one ductal adenocarcinoma with cystic degeneration, one cystic islet cell tumour).

Results
While the lesion had been labelled as a pseudocyst in eight patients, only one patient (MCA in the pancreatic head) had had acute pancreatitis previously. In seven patients the computed tomogram (CT) lacked suspicious neoplastic features, while endoscopic retrograde cholangiopancreatography, angiography and percutaneous cyst fluid analysis were unhelpful or misleading in 16 of 18 investigations with respect to differentiating tumour from pseudocyst. Attempted operation for cure was performed in 18 patients despite diagnostic delays of up to 6 years and initial treatment with cystenterostomy in two cases.

Conclusion
Retrospective review revealed that all 21 cystic neoplasms could be diagnosed before operation by a history excluding previous pancreatitis (20 of 21 patients) or a CT suspicious for neoplasia (14 of 21). The diagnosis relies more on absence of previous pancreatitis and a suspicious clinician who errs on the side of resecting a pseudocyst rather than watching or draining a cystic neoplasm.
Pseudomyxoma peritonei
Authors: Hinson F L , Ambrose N S 
Published: March 2003

Abstract

Background
Pseudomyxoma peritonei is an unusual condition in which gelatinous fluid collections are associated with mucinous implants on the peritoneal surfaces and omentum. The pathological origin and ideal treatment of the condition are subjects of debate.

Methods
An unrestricted Medline search over 1986–1997 was performed for pseudomyxoma peritonei.

Results and conclusions
There is increasing evidence that pseudomyxoma peritonei is a neoplastic condition which usually arises from a primary adenoma or adenocarcinoma of the appendix. Reported series include a spectrum of pathological lesions, from entirely benign ruptured mucocele to advanced carcinoma. This, and the rarity of the condition, limit the conclusions that can be drawn regarding its treatment and prognosis. Most authorities agree that a thorough surgical debulking should be made. In most cases this will be a difficult and time-consuming undertaking, possibly requiring cooperation between two or more specialists and consideration of delivering intraperitoneal adjuvant therapy during or immediately after surgery. Treatment therefore requires a planned approach with accurate preoperative assessment of the diagnosis and the extent of the condition. There is some largely anecdotal evidence in favour of intraperitoneal chemotherapy and radioisotope treatment. Ultraradical surgery, with heated intraoperative and further postoperative chemotherapy, is strongly advocated by one group but remains contentious. The majority of patients will eventually suffer recurrence. The 5-year survival rate ranges from 53 to 75 per cent, but outcomes vary widely between relatively benign and malignant subgroups.
Marimastat inhibits neointimal thickening in a model of human vein graft stenosis
Authors: Porter K E , Loftus I M , Peterson M , Bell P R F , London N J M , Thompson M M 
Published: March 2003

Abstract

Background
There is now accumulating evidence that matrix metalloproteinases (MMPs), the physiological mediators of matrix deposition and degradation, play an important role in the development of intimal hyperplasia following arterial bypass. This study investigated the effect of marimastat, an orally active specific MMP inhibitor, on neointima formation in cultured human saphenous vein.

Methods
Segments of human saphenous vein obtained from ten patients undergoing arterial bypass surgery were cultured for 14 days in serum-supplemented RPMI medium (controls) or in control medium supplemented with marimastat at three different concentrations (treatment groups). Following culture, half of each segment was prepared for histological examination and MMPs were extracted from the other half for gelatin zymography.

Results
Marimastat inhibited neointimal thickening in a concentration-dependent manner; inhibition was significant at 10−5 and 10−6 mol/l (P = 0·006). This observation was paralleled by a significant reduction in the levels of MMP-2 and MMP-9 in the tissues.

Conclusion
Marimastat significantly reduced neointimal thickening in this laboratory model. MMP inhibitors may offer a potential therapeutic strategy in the prevention of intimal hyperplasia.
Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly
Authors: Poon R T-P , Law W-L , Chu K-W , Wong J 
Published: March 2003

Abstract

Background
Emergency colorectal surgery in the elderly has been associated with a high mortality rate. Although the current trend for the management of obstructing left-sided colorectal carcinoma favours primary resection and anastomosis, the safety and benefits of this approach in the elderly have not been studied.

Methods
Some 57 elderly (aged more than 70 years) and 59 younger patients underwent emergency resection of an acutely obstructing left-sided colorectal carcinoma. Postoperative results in the two groups were compared.

Results
The primary resection rate was 95 per cent in the elderly and 89 per cent in younger patients (P = 0·70), with a primary anastomosis rate of 84 per cent and 78 per cent respectively (P = 0·64). Elderly patients had a significantly higher incidence of premorbid risk factors and postoperative cardiorespiratory complications but no increase in surgical complications. Anastomotic leaks occurred in 6 per cent of the elderly and 4 per cent of younger patients (P = 0·65), and the hospital mortality rate was 9 and 5 per cent respectively (P = 0·48).

Conclusion
Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma can be performed with favourable outcome in the elderly and should be the treatment of choice in most elderly patients.
The p53 tumour suppressor gene
Authors: Steele R J C , Thompson A M , Hall P A , Lane D P 
Published: March 2003

Abstract

Background
Abnormalities of the p53 tumour suppressor gene are thought to be central to the development of a high proportion of human tumours. This article reviews current understanding of its function and potential clinical significance.

Methods
Material was identified from previous review articles, references cited in original papers, a Medline search of the literature over the 12 months to January 1998, and by scanning the latest issues of relevant journals.

Results and conclusion
p53 is considered to be a stress response gene, its product (the p53 protein) acting to induce cell cycle arrest or apoptosis in response to DNA damage, thereby maintaining genetic stability in the organism. These functions are executed by a complex and incompletely understood series of steps known as the ‘p53 pathway’, part of which involves induction of the expression of a number of other genes. As p53 is the most commonly mutated gene in human cancer, it has attracted a great deal of interest as a prognostic factor, diagnostic tool and therapeutic target. However, despite many promising studies, its potential in practical cancer management has still to be realized.
Pathophysiology and treatment of anterior rectal mucosal prolapse syndrome
Authors: Tsiaoussis J , Chrysos E , Glynos M , Vassilakis J S , Xynos E 
Published: March 2003

Abstract

Background
The study was designed to investigate the clinical presentation and laboratory findings of anterior rectal mucosal prolapse (ARMP) and to assess the results of two therapeutic modalities.

Methods
Some 162 women with ARMP were assessed clinically and by defaecography and rectoanal manometry before and 1 year after one or two sessions of submucosal sclerotherapy or, in the case of recurrence, after transanal excision of the prolapsing mucosa.

Results
Almost all patients reported a combination of symptoms suggesting obstructive defaecation. At defaecography anterior rectocele and excessive perineal descent at straining were present in 78 and 72 per cent respectively. The size of coexisting anterior rectocele and the extent of perineal descent were significantly related to the duration of the disease (P &lt; 0·001). One or, in the event of recurrence, two sessions of sclerotherapy led to an overall success rate of 51 per cent. Improvement after sclerotherapy was associated with partial recovery of anal tone and improvement of anal sampling and rectal sensation. Failure of sclerotherapy was related to rectocele of larger size (P &lt; 0·001) and a longer perineal descent at straining (P &lt; 0·001) than in patients with a successful outcome. Excision of the prolapsing mucosa resulted in symptomatic improvement in 42 of 47 patients and was associated with significant improvement of the defaecographic and manometric findings.

Conclusion
ARMP is usually associated with anterior rectocele and excessive perineal descent. Submucosal sclerotherapy is successful in half of the cases, but only in the presence of a rather small anterior rectocele and short perineal descent. Failures after sclerotherapy can be treated by transanal excision of the prolapsing mucosa.
Survival following pancreatic carcinoma: a follow-up study of all cases recorded in Malmö, Sweden, 1977–1991
Authors: Hedberg M , Borgström A , Genell S , Janzon L 
Published: March 2003

Abstract

Background
The aim of this follow-up study was to assess whether there has been any increase in the percentage of patients offered attempted curative surgery for pancreatic carcinoma and whether the overall survival rate has improved, during the time period 1977–1991.

Methods
Details of new cases of pancreatic carcinoma arising in the population of Malmö during the study period were retrieved from the Local Tumour Register in Lund, Sweden. In all, 740 patients were found; 575 of these were diagnosed before death. Kaplan–Meier analysis was used to calculate overall survival rates, and Cox regression analysis was used to assess survival in relation to year of diagnosis after adjustment for sex, age at diagnosis and stage of disease.

Results
Cytological or histopathological evidence of the disease was given in 95 per cent of cases. The overall 5-year survival rate was 0·5 per cent (three of 575). Curative surgery was attempted in 24 patients (4·2 per cent); the proportion undergoing curative surgery increased in the last part of the study. Two of the 24 patients in this group survived for 5 years.

Conclusion
The prognosis in pancreatic carcinoma remains dismal. Attempted curative surgery still is the only hope for cure, but the group of patients that can be offered this possibility is very limited. In this study, an increase was found in the proportion of patients who were offered attempted curative surgery, but there was no statistically significant increase in the 5-year survival rate following surgery.
Radionuclide scanning in parathyroid diseases
Authors: Pattou F , Huglo D , Proye C 
Published: March 2003

Abstract

Background
New radionuclide agents and scanning procedures have markedly improved preoperative parathyroid gland localization. The aim of this review was to evaluate the results of parathyroid scanning and to clarify its current place in the clinical management of parathyroid diseases.

Methods
The literature describing the different radioisotopes and available scanning techniques was analysed and their clinical outcome in various parathyroid diseases was evaluated.

Results
Using 99mTc-radiolabelled sestamibi or other 99mTc-labelled cationic complexes, parathyroid scintigraphy detects 87 per cent of solitary adenomas (n = 894), 55 per cent of abnormal glands in patients with multiglandular disease (n = 303) and 75 per cent of persistent or recurrent lesions in patients with previous neck surgery (n = 240). If necessary, three-dimensional imaging techniques can clarify the spatial localization of an ectopic uptake focus. The positive predictive value of the available scanning procedures is over 95 per cent, but false-positive uptake may be encountered.

Conclusion
Radionuclide parathyroid gland scanning with 99mTc-labelled cationic complexes is the initial non-invasive method of choice for preoperative parathyroid gland localization in patients at special risk and/or with previous neck exploration. While scanning has also been proposed to facilitate parathyroidectomy, there is no objective evidence to support its routine use before a first-time surgical procedure.
Popliteal artery entrapment syndrome: collaborative experience of the Joint Vascular Research Group
Authors: Lambert A W , Wilkins D C 
Published: March 2003

Abstract

Background
Popliteal artery entrapment syndrome (PAES) is rare and probably underdiagnosed. This study reviewed a collected experience.

Methods
Patients were identified by the Joint Vascular Research Group (vascular surgeons from ten hospitals serving a population of approximately four million) during 1984–1995. Case notes were reviewed.

Results
Twenty-one legs in 17 patients were identified with PAES. There were 15 men and two women. The median age at presentation was 29 (range 14–45) years. One patient was excluded because no further information was available. PAES was bilateral in four patients in whom three legs were asymptomatic. At presentation, the duration of symptoms ranged from a few hours (acute leg ischaemia) to intermittent claudication of 6 years' duration. Primary investigation included angiography (20 patients), duplex imaging (four), plain radiography (one) and magnetic resonance imaging (one). In two cases, attempted thrombolysis failed. Surgery was carried out on 17 legs but failed in two. No amputations were required. Following surgery, 12 legs were asymptomatic and five had residual symptoms.

Conclusion
PAES should be excluded in young patients with intermittent claudication or acute ischaemia.
Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery
Authors: Jones A , Cahill D , Gardham R 
Published: March 2003

Abstract

Background
The risk of rupture of large abdominal aortic aneurysms (AAAs) remains uncertain. This study aimed to provide data to help decide whether or not to operate on high-risk patients.

Methods
Clinicians were asked to refer all patients with an AAA, even if unfit or elderly. One hundred and ninety-two patients with an intact AAA of 5 cm or greater in diameter were seen in 9 years; 59 had no elective operation and follow-up data were available for 57 at a minimum of 2 years. Initial AAA diameters were 5·0–5·9 cm (n = 25) and 6·0 cm or more (n = 32). Survival curves were constructed for both groups.

Results
At the end of the study 50 of 57 patients had died. Median survival was 18 (range 1–90) months. Twenty (35 per cent) suffered rupture at a median interval of 18 (range 1–38) months. The risk of rupture within 3 years was 28 (95 per cent confidence interval 12–49) per cent for 5·0–5·9-cm AAAs and 41 (24–59) per cent for AAAs of 6 cm or greater. In 133 elective AAA operations in fit patients the 30-day mortality rate was 3 per cent.

Conclusion
The risk of rupture within 3 years of diagnosis of an AAA of 5 cm or greater exceeds the expected operative mortality rate for fit patients. However, the majority of patients unfit for surgery died from other causes, and only a few would have benefited from aneurysm repair.
Plasma concentration of cytokine antagonists in patients with infection following liver resection
Authors: Kimura F , Miyazaki M , Suwa T , Sugiura T , Shinoda T , Itoh H , Ambiru S , Shimizu H , Nakagawa K 
Published: March 2003

Abstract

Background
The interactions between endogenous cytokine antagonists, surgical injury and perioperative infection are poorly understood.

Methods
Perioperative plasma concentrations of soluble tumour necrosis factor receptor p55 (STNFR p55), interleukin (IL) 1 receptor antagonist (IL-1ra) and IL-6 were measured by immunoassay in 29 consecutive patients undergoing liver resection.

Results
Plasma concentrations of STNFR p55, IL-1ra and IL-6 showed a striking increase immediately after operation (day 0) and on postoperative day 1. STNFR p55 concentrations correlated significantly with operating time (P &lt; 0·05); IL-1ra levels with operating time, blood loss and weight of resected liver (P &lt; 0·05); and IL-6 concentrations with operating time and blood loss (P &lt; 0·05). Eight of the 29 subjects developed postoperative infections, of whom four had positive cultures of enteric organisms. Plasma STNFR p55 and IL-6 concentrations were significantly higher in the infected group than in the uninfected group (P &lt; 0·05). STNFR p55 and IL-6 concentrations on day 0 differentiated between the two groups with a diagnostic accuracy of 79 and 83 per cent respectively.

Conclusion
These results suggest that STNFR p55, IL-1ra and IL-6 are produced during operation in response to surgical stress. This production of STNFR p55 and IL-6 may be enhanced further by intraoperative bacterial translocation. Measurement of plasma STNFR and IL-6 concentrations may predict the development of postoperative infectious complications.
Long-term outcome of necrotizing pancreatitis treated by necrosectomy
Authors: Tsiotos G G , Luque-De León E , Sarr M G 
Published: March 2003

Abstract

Background
Long-term functional outcome after operative treatment of necrotizing pancreatitis (NP) has not been studied extensively.

Methods
Pancreatic function, performance status, recurrence of symptoms and other related problems were analysed in 44 consecutive patients successfully discharged from hospital after operative necrosectomy (1983–1995) and followed up completely for a mean of 5 years.

Results
Clinical pancreatic insufficiency developed in half the patients. Diabetes mellitus (11 patients), steatorrhoea (six) or both (five) were associated with a mean estimate of 52, 66 and 67 per cent parenchymal necrosis respectively. Normal pancreatic function was associated with 27 per cent parenchymal necrosis (P &lt; 0·05). Diabetes worsened while steatorrhoea tended to improve over time. Abdominal pain and pancreatitis recurred in six and two patients respectively. Performance status worsened in four patients because of recurrent pancreatitis and severe steatorrhoea. Poor long-term performance was associated with a higher Acute Physiology And Chronic Health Evaluation II score on admission (mean 14 versus 9).

Conclusion
NP has prominent effects on long-term pancreatic exocrine and endocrine function in half the patients, but most preserve a good overall functional status. The development of pancreatic insufficiency varies with the extent of pancreatic parenchymal necrosis.
Glutaraldehyde as a possible cause of diarrhoea after sigmoidoscopy
Authors: Hanson J M , Plusa S M , Bennett M K , Browell D A , Cunliffe W J 
Published: March 2003

Abstract

Background
An outbreak of proctitis at the start of a colorectal cancer screening programme utilizing flexible sigmoidoscopy prompted scrutiny of the incidence of this complication and the role of glutaraldehyde in its aetiology.

Methods
Questionnaires completed 1 day and 3 months after sigmoidoscopy were reviewed for 388 patients, and glutaraldehyde levels in the recycled rinse water of the endoscope washing machine were measured. The incidence of symptoms in the subsequent 612 patients after installation of a washer that does not recycle rinse water was examined.

Results
Five patients (1·3 per cent) presented to hospital with bloody diarrhoea occurring immediately after a normal flexible sigmoidoscopy. Repeat examination confirmed the presence of proctitis. Symptoms subsided rapidly with either no treatment or steroid enemas. Eight additional patients (2·1 per cent) recorded similar problems but received no treatment and the symptoms settled spontaneously. Glutaraldehyde levels rose progressively in the rinse water after each wash cycle with 2 per cent glutaraldehyde solution. Only one possible case of proctitis (0·2 per cent) was identified from the questionnaires completed by 612 patients after changing to a washer that did not recycle the rinse water.

Conclusion
These observations should prompt the careful assessment of cleaning techniques. The use of washing machines that do not recycle rinse water may avoid this complication.
Laparoscopic treatment of symptomatic cysts of the liver
Authors: Diez J , Decoud J , Gutierrez L , Suhl A , Merello J 
Published: March 2003

Abstract

Background
Reports of successful treatment of liver cysts by the laparoscopic approach prompted the use of this technique in a series of patients.

Methods
Ten patients with symptomatic liver cysts were treated by the laparoscopic deroofing technique. Eight patients had one solitary cyst, one had two cysts and the remaining patient had polycystic disease with a giant cyst. Hydatid disease was excluded serologically and radiologically but albendazole was used before operation in six cases because hydatid disease is endemic in Argentina.

Results
There was no surgical morbidity or death. For between 6 months and 3 years all patients were asymptomatic. Computed tomography showed recurrence of a cyst in one patient, who was successfully reoperated on laparoscopically.

Conclusion
Laparoscopic fenestration of either solitary or multiple liver cysts is the treatment of choice. It produces minimal surgical trauma, shorter hospital stay and avoids the morbidity of laparotomy. Reduced postoperative adhesions allows repeated procedures if the condition recurs.