bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma
Authors: Hughes T M D , A'Hern R P , Thomas J M 
Published: March 2003

Abstract

Background
The appropriate management of melanoma metastatic to inguinal lymph nodes remains controversial. The aim of this study was to identify disease- and treatment-related factors that influence the outcome of patients undergoing therapeutic groin dissection for clinically detectable melanoma lymph node metastases.

Methods
A retrospective analysis was performed on data collected from the case records of patients who had a therapeutic inguinal lymph node dissection performed between 1984 and 1998.

Results
Some 132 patients were suitable for inclusion. Sixty patients had superficial inguinal lymph node dissection (SLND) and 72 had combined superficial inguinal and pelvic lymph node dissection (CLND). There was no difference in postoperative morbidity or major lymphoedema between SLND and CLND. The overall survival rate was 34 per cent at 5 years. On univariate analysis, age (P = 0·003), the number of involved superficial lymph nodes (P = 0·001) and the presence of extracapsular spread (P = 0·003) were found to have a significant impact on survival. The presence or absence of pelvic lymph node metastases in patients who had CLND was a significant prognostic factor for survival (5-year survival 19 versus 47 per cent; P = 0·015).

Conclusion
The prognosis of patients with clinically detectable melanoma metastases to the groin is variable and related to the biological characteristics of each case. CLND provided additional prognostic information and optimal regional control with no increased morbidity compared with SLND.
Analysis of risk factors for nosocomial sepsis in surgical patients
Authors: Fariñas-Álvarez C , Fariñas M C , Fernández-Mazarrasa C , Llorca J , Casanova D , Delgado-Rodríguez M 
Published: March 2003

Abstract

Background
This study aimed to identify patients at high risk for developing sepsis following surgery according to criteria determined by the American College of Chest Physicians and the Society of Critical Care Medicine Consensus Conference on sepsis.

Methods
A prospective case–control study was performed in surgical patients in a tertiary care centre over 1 year. Patients were identified by a daily prospective surveillance. Controls were selected randomly from the daily list of surgical inpatients. Data were collected prospectively. Crude and adjusted odds ratios (ORs) and their 95 per cent confidence intervals were computed using logistic regression analysis.

Results
During follow-up, 99 cases and 99 controls were identified. The main risk factors for sepsis found in the multivariate analysis were coma within 48 h before sepsis (OR 13·5, 95 per cent confidence interval 3·6–50·8), low serum albumin level at admission (OR 15·8, 5·4–46·4), two or more intrinsic co-morbidities (OR 11·8, 2·8–49·4) and parenteral nutrition (OR 5·1, 1·5–17·1). Emergency surgery (OR 3·0, 1·4–6·4), abdominal surgery (OR 2·6, 1·0–6·8) and number of surgical interventions (OR 2·5, 1·1–6·1) were the variables related to surgery that significantly increased the risk of sepsis. Both the study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance indices showed a statistically significant trend with sepsis.

Conclusion
Patient-related factors appear to represent the greatest risk for developing postoperative nosocomial sepsis, rather than factors associated with the surgery.
Use of superficial femoropopliteal vein for suprainguinal arterial reconstruction in the presence of infection
Authors: Gibbons C P , Ferguson C J , Edwards K , Roberts D E , Osman H 
Published: March 2003

Abstract

Background
Conventional treatment of mycotic aneurysms or graft infections of the aortoiliac segment by in situ or extra-anatomic prosthetic reconstruction has a high mortality and morbidity rate, with a substantial risk of persistent graft infection. The use of autologous vein may reduce this.

Methods
Eleven patients with suprainguinal arterial infections including two with mycotic aortic aneurysms, four with aortic graft infections, four infected femorofemoral grafts and an infected axillofemoral graft were treated by debridement and in situ reconstruction with autologous superficial femoropopliteal vein. All patients received appropriate antibiotic therapy and were followed by regular postoperative duplex imaging. Preoperative femoral vein duplex imaging was performed in eight of the 11 patients.

Results
Ten of the 11 patients survived with a functioning graft and without limb loss or evidence of infection at 4–33 months. One patient died from myocardial infarction after operation. Three patients had minor swelling of one leg. Four patients required subsequent angioplasty of anastomotic stenoses detected by duplex surveillance.

Conclusion
Superficial femoropopliteal vein is an excellent conduit for suprainguinal reconstruction in the presence of infection. Duplex imaging is useful for confirming the suitability of deep veins for use as a graft and for postoperative surveillance.
Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period
Authors: Nilsson G , Larsson S , Johnsson F 
Published: March 2003

Abstract

Background
There is a widespread belief that introduction of the laparoscopic technique in antireflux surgery has led to easier postoperative recovery. To test this hypothesis a prospective randomized clinical trial with blind evaluation was conducted between laparoscopic and open fundoplication.

Methods
Sixty patients with gastro-oesophageal reflux disease were randomized to open or laparoscopic 360° fundoplication. The type of operation was unknown to the patient and the evaluating nurses after operation.

Results
The operating time was longer in the laparoscopy group, median 148 versus 109 min (P &lt; 0·0001). The need for analgesics was less in the laparoscopically operated patients, 33·9 versus 67·5 mg morphine per total hospital stay (P &lt; 0·001). There was no significant difference in postoperative nausea and vomiting. On the first day after operation patients in the laparoscopy group had better respiratory function: forced vital capacity 3·2 versus 2·2 litres (P = 0·004) and forced expiratory volume 2·6 versus 2·0 litres (P = 0·008). Postoperative hospital stay was shorter in the laparoscopic group, median (range) 3 (2–6) versus 3 (2–10) days (P = 0·021). No difference was found in the duration of sick leave.

Conclusion
Laparoscopic fundoplication was associated with a longer operating time, better respiratory function, less need for analgesics and a shorter hospital stay, while no reduction in the duration of postoperative sick leave was found compared with open surgery.
Randomized, multicentre, double-blind, placebo-controlled trial of the use of aprotinin in the repair of ruptured abdominal aortic aneurysm
Authors: Robinson J , Nawaz S , Beard J D 
Published: March 2003

Abstract

Background
The use of aprotinin in cardiac surgery reduces blood transfusion requirements. The aim of this trial was to see whether the same benefit applies in the repair of ruptured abdominal aortic aneurysm (AAA).

Methods
In this prospective, randomized trial, nine centres with local ethics committee approval recruited 77 patients with a ruptured AAA. A bolus of aprotinin 2 × 106 units, followed by an infusion of 0·5 × 106 units every 30 min, was administered to 38 patients, and 39 received a placebo infusion. The quantity of blood products transfused during surgery and in the first 12 h after operation was noted, along with the incidence of complications, mortality rates and length of hospital stay.

Results
Seventeen of the 38 patients who received aprotinin and 17 of the 39 given placebo died within 30 days (overall mortality rate 44 per cent). The median amount of blood given to the aprotinin group after operation was 1 (range 0–14) unit, while for the placebo group it was 3 (range 0–13) units (P = 0·02). However, the difference in the total number of units of blood transfused did not reach significance (10 (range 2–29) versus 14 (range 4–38) units respectively).

Conclusion
The use of high-dose aprotinin during the repair of a ruptured AAA reduced blood transfusion requirements in the first 12 h after operation, but had no significant effect on the overall blood transfusion requirement.
Fournier's gangrene: a review of 1726 cases
Authors: Eke N 
Published: March 2003

Abstract

Background
Although there is much consensus, certain controversies exist regarding the management of Fournier's gangrene.

Method
Publications in English on Fournier's gangrene from January 1950 to September 1999 were obtained through the Medline database and relevant reference lists in publications. It was possible to identify 1726 cases for study. Data extracted for review included country of reported cases, number of patients in each report and relevant clinical features.

Results
Fournier's gangrene occurs worldwide. However, its definition has generated considerable controversy as efforts are made to refine the original description in the light of increasingly understood aetiological factors. Attempts to classify the disease into primary and secondary forms have not been successful. The basic pathological process, necrotizing fasciitis, has been identified in the perineum of women and children, although the disease afflicts the male more often than the female. Most reported cases have occurred in the USA and Canada. The major sources of sepsis are the local skin, colon, anus and rectum, and the lower urinary tract. Colonic, anal and rectal sources carry the worst prognosis. Diabetes mellitus is important in aetiological terms. Rare causes include vasectomy and circumcision. Investigations are essential to define the cause of an episode but not for the diagnosis of the disease. Early aggressive treatment of Fournier's gangrene and underlying conditions is essential. Hyperbaric oxygen and honey are treatment modalities yet to be universally adopted. Risk of death, 16 per cent overall in this series, is related to the patient's condition at presentation.

Conclusion
Controversies over the definition of Fournier's gangrene persist but these do not affect the treatment options. The diagnosis is made on clinical grounds. The occurrence of the disease in women is under-reported and may go unrecognized by some clinicians. Some treatment options, such as hyperbaric oxygenation and radical excision, remain controversial.
Multicentre study of thyroid nodules in patients with Graves' disease
Authors: Kraimps J L , Bouin-Pineau M H , Mathonnet M , De Calan L , Ronceray J , Visset J , Marechaud R , Barbier J 
Published: March 2003

Abstract

Background
The association of Graves' disease with thyroid nodules and thyroid carcinoma is rarely reported. The incidence seems to be increasing according to recent literature. The aim of this multicentre study was to review patients who had surgery for Graves' disease associated with thyroid nodules, and to evaluate the risk of thyroid carcinoma.

Methods
A retrospective study was made of 557 consecutive patients who underwent operation for Graves' disease between 1991 and 1997 in five endocrine surgery departments. Each patient underwent clinical, biochemical, ultrasonographic and scintigraphic evaluation. None of the patients had had previous radioactive iodine therapy or external irradiation. Surgery consisted of either a subtotal or total thyroidectomy.

Results
Nodules were observed before operation in 140 patients (25·1 per cent). Thyroid carcinoma was diagnosed in 21 patients (15·0 per cent), always inside a nodule. The incidence of thyroid carcinoma associated with Graves' disease was 3·8 per cent (21 of 557 patients): 20 papillary and one follicular carcinoma. The carcinoma was multifocal in two patients. Tumour diameter ranged from 2 to 25 mm. A nodule was palpable in four patients.

Conclusion
This multicentre study of patients having thyroidectomy for Graves' disease showed that 3·8 per cent had a carcinoma; the rate of carcinoma in cold nodules was 15·0 per cent. Surgery should be advised in any patient with Graves' disease and a thyroid nodule; the operation should be total thyroidectomy.
Effect of colectomy on gastric emptying in idiopathic slow-transit constipation
Authors: Hemingway D M , Finlay I G 
Published: March 2003

Abstract

Introduction
Gastric emptying is delayed in patients with idiopathic slow-transit constipation (ISTC). Gastric emptying was measured before and after colectomy and ileorectal anastomosis in patients with ISTC to determine whether the abnormality persists after operation.

Methods
Twelve patients undergoing colectomy for severe ISTC had solid-phase gastric emptying measured after an overnight fast. All 12 had an uncomplicated subtotal colectomy and ileorectal anastomosis; 11 had an excellent functional outcome. In ten of these patients gastric emptying was repeated within 3 months of operation. Seven patients (including the remaining two) had the study performed at 1 year.

Results
All 12 patients had severely delayed gastric emptying before operation. Gastric emptying remained delayed in the ten patients who underwent an early postoperative gastric emptying study. Six of seven patients assessed at 1 year had improved gastric emptying, of whom four had returned to normal. Functional outcome did not relate to gastric emptying.

Conclusion
Patients with ISTC have delayed gastric emptying. In some patients this returns to normal after colectomy, but is persistent in others. This may have implications for our understanding of ISTC.
Portal flow augmentation for liver cirrhosis
Authors: Jiao L R , Seifalian A M , Mathie R T , Habib N , Davidson B R 
Published: March 2003

Abstract

Background
Portal hypertension due to chronic liver disease is a major cause of death worldwide. Orthotopic liver transplantation offers the best therapeutic option but is available to only a minority of patients. In the past few years mechanically pumping portal venous inflow has been reported to reduce portal hypertension and improve liver function.

Methods
A review of the published data on augmented portal perfusion for the treatment of portal hypertension in cirrhosis was carried out by searching Medline and other online databases. From each published study portal pressure and blood flow data before and after augmented portal perfusion were used to calculate the change in mean intrahepatic portal vascular resistance (IHPR). The standardized data were then combined to allow meta-analysis.

Results
Seven papers were identified on normal and cirrhotic animal and human livers with augmented flow (50% to fourfold over baseline) for 30–180 min. Meta-analysis revealed that the increased portal venous inflow was associated with a significant rise in portal venous pressure on the hepatic side (P &lt; 0·001), a significant reduction on the mesenteric side (P &lt; 0·001) and a significant reduction in IHPR (P = 0·013). Limited data were available to support improved liver function.

Conclusion
Detailed in vivo cirrhotic liver studies on augmented portal flow in experimental models assessing haemodynamic and functional changes are required before clinical evaluation.
Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials
Authors:   EU Hernia Trialists Collaboration, Grant A 
Published: March 2003

Abstract

Background
The place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain.

Methods
A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed.

Results
Thirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P &lt; 0·001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4·7 per 1000 versus 1·1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0·08). Length of hospital stay did not differ significantly between groups (P = 0·50), but return to usual activity was earlier for laparoscopic groups (P &lt; 0·001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0·56 (95 per cent confidence interval 0·33–0·93); P = 0·026).

Conclusion
Although the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.
Dietary glycine decreases liver injury after haemorrhagic shock in rats
Authors: Mauriz J L , Matilla B , Culebras J M , González P , González-Gallego J 
Published: March 2003

Abstract

Background
Resuscitation from haemorrhagic shock induces profound changes in the physiological processes of the liver and activates inflammatory cascades that include activation of stress transcriptional factors and upregulation of tumour necrosis factor (TNF) synthesis. This process is accompanied by increased levels of free radicals that may contribute to acute organ damage. Intravenous administration of glycine, a simple amino acid, has been reported to decrease release of TNF and to improve the survival rate of rats after haemorrhagic shock or endotoxin administration. The effects of feeding a glycine-containing diet (5 per cent) on liver injury and on the oxidant–antioxidant balance in resuscitated haemorrhagic rats has been investigated.

Methods
Rats were bled to maintain mean arterial pressure at 30–35 mmHg for 1 h and subsequently resuscitated with 60 per cent shed blood and lactate Ringer's solution. Thiobarbituric acid reactive substances (TBARS) and the oxidized: reduced glutathione (GSSG: GSH) ratio were measured as markers of oxidative stresss. The activities of the antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (Cat) were determined in liver cytosol.

Results
Levels of aspartate aminotransferase (ASAT) were increased 22-fold and levels of alanine aminotransferase (ALAT) eightfold 20 h after resuscitation. Leucocyte infiltration and pericentral necrosis were also observed. Serum nitrite concentration increased by 69 per cent. Liver TBARS increased by 32 per cent and the GSSG: GSH ratio by 106 per cent. There was a significant reduction in total liver glutathione concentration (−42 per cent) and in the activities of SOD (−23 per cent), GPx (−26 per cent) and Cat (−46 per cent). Serum nitrite, liver TBARS concentration and the antioxidant enzyme activities remained unchanged in animals receiving dietary glycine. The GSSG: GSH ratio and total glutathione concentration did not significantly differ from control values. The increase in serum ASAT and ALAT levels and in hepatic necrosis were markedly reduced.

Conclusion
Dietary glycine prevents liver injury caused by haemorrhagic shock in the rat. Diminished availability of nitric oxide and maintenance of the oxidant–antioxidant balance may reduce the pathophysiological sequelae of severe haemorrhage.
Procalcitonin plasma level as a marker of systemic infection in surgical patients in the intensive care unit
Authors: Giannopoulou P , Greka P , Voros D , Giamarellou H 
Published: March 2003

Abstract

Background
Increased (more than 0·5 ng ml−1) extrathyroidal production of procalcitonin (PCT; the prodromal molecule of calcitonin) has been proven to characterize cases of systemic bacterial infection. The aim of the present study was to investigate the possible role of PCT as an infection marker in 59 febrile surgical patients in the intensive care unit who were under several antimicrobial regimens.

Methods
PCT values were calculated every other day during the whole duration of the febrile period using the immunochemiluminescence method (Brahms Diagnostica, Berlin, Germany). A subgroup of ten patients (three with multiple trauma, seven with an intra-abdominal site of infection) were considered to have sepsis (SS) because of their positive blood cultures (two Gram positive, eight Gram negative). A total of 30 patients presented with the systemic inflammatory response syndrome (SIRS), which was considered to have a septic aetiology in nine (four with peritonitis, one with pancreatitis and four with multiple trauma) (white blood cell count greater than 25 000 μl−1, temperature above 39·5°C). Of the remaining patients, seven had an intra-abdominal abscess (IA) with various causes, six had acute non-complicated pancreatitis (AP) and six had localized burns (LB) (13·5–25 per cent of the total body surface).

Results
PCT values on the first day of fever (asymmetrical underlying distribution) are shown in the Table.

Conclusion
(1) Increased PCT levels are the hallmark of sepsis even from the first day of its appearance as opposed to cases of localized infection. (2) PCT levels are increased in cases of SIRS of infectious origin. (3) Low PCT levels (less than 1 ng ml−1) in patients with pancreatitis are indicative of an uncomplicated evolution. (4) Unexpectedly high PCT levels should be taken into consideration for the choice of optimal antimicrobial regimen.