bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pancreatic cancer resection in elderly patients
Authors: Di Carlo V , Balzano G , Zerbi A , Villa E 
Published: March 2003

Abstract

Background
Pancreatic cancer resection is considered a high-risk procedure in patients aged 70 years or older.

Methods
Some 398 patients with pancreatic adenocarcinoma, observed between 1990 and 1995, were reviewed. Operative outcome and survival of 33 patients aged 70 years or more were compared with findings in 85 younger patients who underwent resection.

Results
Resectability was not significantly different between the elderly and younger patients; neither were mortality or overall morbidity. However, patients aged 70 years or more had more relaparotomies (P &lt; 0·01) and more haemorrhagic complications (P &lt; 0·001). Nutritional recovery after resection was satisfying even for elderly patients (body-weight gain and increase in serum albumin concentrations, P &lt; 0·05). Univariate analysis showed a moderately poorer survival in the elderly (P = 0·09). Multivariate analysis demonstrated that tumour diameter, grading and Union Internacional Contra la Cancrum stage were independent prognostic factors, whereas age was not.

Conclusion
Patients aged 70 years or more can benefit from pancreatic cancer resection similarly to younger patients.
Survey of changes in the provision of vascular surgical services in the Oxford Region over 5 years
Authors: Galland R B , Magee T R 
Published: March 2003

Abstract

Aim
This study aimed to examine changes in the provision of vascular services in the Oxford region over 5 years.

Methods
A questionnaire was sent to all general surgeons in the region asking of their involvement in vascular surgery. Data were obtained from the Department of Health concerning vascular procedures and inpatient codes for each district in the Oxford Region from 1990–1991 to 1994–1995. Office of Population Censuses and Surveys (OPCS) data for abdominal aortic aneurysm repair and femoral artery reconstruction were validated against data collected prospectively for West Berkshire.

Results
Eighteen of 45 surgeons who replied to the questionnaire carried out elective and emergency arterial work. All were members of the Vascular Surgical Society of Great Britain and Ireland (VSS). All but one took part in the general surgical rota. Eight surgeons carried out emergency arterial surgery only; only two of these were members of the VSS. Of 19 surgeons undertaking no arterial surgery, 15 operated on primary and 11 on recurrent varicose veins. The number of arterial reconstructions rose from 20·8 per 100000 population to 28 per 100000 throughout the study. The greatest increase occurred in districts where a new vascular consultant had been appointed. Similar results were obtained with endovascular procedures. The number of major amputations remained fairly constant at approximately 11 per 100000 population. The number of inpatient episodes for arterial disease also rose, from 35·7 to 47·6 per 100000. In validating OPCS codes against prospectively collected data, discrepancies for individual years were noted but the annual trend was reflected fairly accurately by the codes.

Conclusion
There has been an increase in vascular activity in the region, but variations still exist between different districts.
Endoprostheses for colonic strictures
Authors: Akle C A 
Published: March 2003

Abstract

Background
Patients who present with large bowel obstruction often undergo emergency surgical intervention with its attendant risk of morbidity and death. A colostomy may be inevitable and this detracts from the patient's quality of life, especially when palliation is the only option.

Methods
This review examines the possibility of a more conservative approach using metallic stents to relieve colonic obstruction, either as the first stage of a curative surgical procedure or for palliation without surgery. The various stents available are examined.

Results
Case reports show that relief of obstruction can be achieved in over 80 per cent of patients, allowing subsequent elective surgery or achieving palliation for several months. Complications are rare but include colonic perforation, particularly when predilatation of the stricture has to be performed. Such complications are generally recognized early and patients can proceed to surgery and colostomy, as would previously have been conventional treatment; on occasion a small leak may be treated conservatively with success. The advent of newer endoprostheses which do not require active dilatation may improve the rate of successful deployment and lessen the risk of perforation.

Conclusion
The development of new endoprostheses has allowed their adaptation for use in the colon and, perhaps, the distal small bowel. The technology is evolving rapidly and warrants serious consideration in selected patients with large bowel obstruction before embarking on surgery. There is an urgent need for a controlled trial to establish whether such intervention for malignant strictures, potentially curable by surgery, leads to an increased risk of metastatic disease.
Non-operative management of blunt hepatic trauma
Authors: Carrillo E H , Platz A , Miller F B , Richardson J D , Polk H C 
Published: March 2003

Abstract

Background
Non-operative management is currently considered the treatment of choice in over 50 per cent of adult patients with blunt liver injury. This report reviews the criteria for non-operative management and its potential downside.

Methods
English language publications were reviewed.

Results
Most reports from major trauma centres in the USA support the non-operative treatment of patients with blunt liver injury if well established criteria are met. Using such criteria, non-operative treatment is successful in 50–80 per cent of cases. Adjunctive radiological techniques may be helpful in managing some complications of non-operative treatment.

Conclusion
Non-operative management is safe in haemodynamically stable patients with blunt liver injury. Computed tomography (CT) of the abdomen is extremely useful to document the extent of the damage and the presence of associated injuries, but it is not possible, based on CT alone, to predict failure; careful physiological monitoring in selected patients is indicated to avoid catastrophic complications.
Extrafascial excision of the rectum for rectal cancer
Authors: Hill G L , Rafique M 
Published: March 2003

Abstract

Background
The fascia propria of the rectum is an upward capsular projection from the superior fascia of the pelvic floor which surrounds the rectum and its mesorectum posteriorly and the fat, blood vessels, nerves and lymphatics in front and laterally. It is postulated that if rectal cancer is contained within the fascia propria and extrafascial excision of the rectum is performed then it would be exceptional for the cancer to recur locally.

Methods
A total of 122 consecutive patients with rectal cancer underwent extrafascial excision of the rectum. The operation involved mobilizing the rectum outside its fascia propria and removing not only the rectum and its mesorectum posteriorly but also the fat, blood vessels, nerves and lymphatics in front and laterally. Resection was considered curative unless there were distant metastases or the tumour had involved the resection margins.

Results
There was one postoperative death. The cumulative cancer-free survival rate at 5 years was 68 per cent. In 100 patients in whom the operation was considered to be curative, the cumulative cancer-free survival rate was 81 per cent. Eighty-four of these patients were available for a minimum follow-up of 24 (median 73, range 24–193) months. Three (4 per cent) developed local recurrence. In two patients this was at the anastomosis.

Conclusion
If the cancer is contained within the fascial tube surrounding the rectum and complete extrafascial excision has been performed, local recurrence will be minimal.
Role of arteriography in the selection of patients for carotid endarterectomy
Authors: Bain D J , Fergie N , Quin R O , Greene M 
Published: March 2003

Abstract

Background
Duplex ultrasonography is used increasingly to select patients for carotid endarterectomy. This study aims to clarify whether arteriography is still required.

Methods
A total of 272 patients in whom duplex imaging indicated significant disease of the internal carotid artery underwent arteriography and the results were compared. Regarding the arteriogram as the ‘gold standard’, three aspects were considered: the accuracy of duplex ultrasonography in detecting significant stenosis, the ability of duplex imaging to identify patients who should have arteriography and whether the arteriogram provided important additional information that might influence a decision to operate.

Results
Three patients (1 per cent) suffered a permanent neurological deficit as a result of arteriography. Of the 272 patients with significant stenosis identified by duplex ultrasonography, 241 (89 per cent) were confirmed as significant on arteriography. Duplex imaging was not able to predict accurately which arteriograms would provide useful additional information (sensitivity 59 per cent, specificity 65 per cent), whereas 89 arteriograms (33 per cent) contained information that might have influenced subsequent management.

Conclusion
Duplex imaging is unable to detail the anatomy or determine the extent of carotid disease and may therefore lead to an inappropriate decision to perform carotid endarterectomy. Duplex imaging alone is not adequate before carotid endarterectomy.
Laparoscopy and laparoscopic ultrasonography in staging of oesophageal and cardial carcinoma
Authors: Romijn M G , van Overhagen H , Spillenaar Bilgen E J , Ijzermans J N M , Tilanus H W , Laméris J S 
Published: March 2003

Abstract

Background
The ideal method for staging tumours of the oesophagus and gastric cardia is not known. This paper was designed to assess the value of laparoscopy and laparoscopic ultrasonography in the staging of oesophageal and cardial carcinoma.

Methods
From October 1993 to January 1996, 60 patients in whom no metastases were seen on gastroscopy, ultrasonography of the abdomen and supraclavicular region, helical computed tomography of the chest and abdomen or endosonography were scheduled for laparoscopy and laparoscopic ultrasonography.

Results
Some 40 patients had carcinoma of the oesophagus, in one of whom liver metastases were found at laparoscopy and proven histologically. On laparoscopic ultrasonography metastases were found in four patients but were impossible to biopsy. These lymph node metastases were confirmed at exploratory laparotomy. Twenty patients had carcinoma of the gastric cardia; distant metastases were found in four at laparoscopy. On laparoscopic ultrasonography metastases were present in four further patients, all proven by biopsy.

Conclusion
In this study laparoscopy was not an effective staging technique for oesophageal carcinoma. The inclusion of laparoscopic ultrasonography was of little benefit. A problem that was encountered was biopsy under laparoscopic guidance. In carcinoma of the gastric cardia, laparoscopy was more effective; adding laparoscopic ultrasonography doubled the number of patients seen to have metastatic disease.
Sentinel node localization in patients with breast cancer
Authors: Flett M M , Going J J , Stanton P D , Cooke T G 
Published: March 2003

Abstract

Background
Intraoperative lymphatic mapping and identification of the first draining lymph node (the sentinel node) may allow some patients with breast cancer to avoid the morbidity of formal axillary clearance. The aim of this pilot study was to establish the reliability of the technique in predicting axillary node status.

Methods
Sixty-eight consecutive patients with breast cancer, 38 undergoing mastectomy and 30 wide local excision, were included. Some 2–4 ml of 2·5 per cent Patent Blue dye was injected into adjacent breast tissue on the axillary side of the primary tumour. After 5–10 min, the axilla was explored. Blue-stained lymphatics were dissected to the sentinel node, which was removed for frozen-section examination, followed by routine histology. Formal axillary dissection was then completed.

Results
A sentinel lymph node was identified successfully in 56 (82 per cent) of 68 patients. Histology of the sentinel node accurately predicted axillary node status in 53 (95 per cent). There were three false negatives (5 per cent). In each case, only a single non-sentinel node was tumour positive. Sensitivity and specificity were 83 and 100 per cent respectively.

Conclusion
This technique would allow a selective policy of formal axillary dissection in only node-positive patients; however, further experience and refinement are needed.
Laparoscopy in the management of the impalpable undescended testis
Authors: Humphrey G M E , Najmaldin A S , Thomas D F M 
Published: March 2003

Abstract

Background
This study evaluates the role of laparoscopy for managing the intra-abdominal testis.

Methods
Over 30 months, 48 children (six with previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 years.

Results
Eleven children required insertion of ‘working ports’ for mobilization of obscuring colon before the diagnosis could be established. Twenty-eight children had an absent testis. In nine, vas and vessels entered the internal ring. In 19, vas and vessels ended blindly above the internal ring. Twenty children had an intra-abdominal testis. Ten underwent a laparoscopic single-stage orchidopexy (eight without and two with ligation of vessels); at a minimum follow-up of 2 years, one testis in this group had atrophied, three were located in the lower half of the scrotum and six in the upper half. The remaining ten children underwent a laparoscopic two-stage Fowler–Stephens operation. At a minimum follow-up of 6 months, eight of these testes were palpable in the lower half and two in the upper half of the scrotum.

Conclusion
In the majority of cases, laparoscopy obviates the need for groin exploration. Technically a first-stage Fowler–Stephens procedure can be performed easily and effectively via the laparoscope. However, the second-stage Fowler–Stephens procedure or single-stage orchidopexy requires laparoscopic skills and may not necessarily provide sufficient length to the testicular attachment.
Geographical inequality in the provision of carotid endarterectomy in Scotland
Authors: Adam D J , Bain M , Shanks E , Bradbury A W 
Published: March 2003

Abstract

Background
Carotid endarterectomy (CEA) is a proven method of stroke prevention in patients with symptomatic and asymptomatic high-grade internal carotid artery stenosis. This study examined whether site of residence affects access to CEA in Scotland.

Methods
Scottish Morbidity Record hospital discharge data were collected by the Information and Statistics Division of the National Health Service in Scotland and analysed for the interval 1 January 1989 to 31 December 1995. The number of CEAs performed in the hospitals of each of the 15 regional Health Boards, and CEA rate per 100 000 population resident in each Health Board region, were determined.

Results
In 1989, 65 CEAs were performed in the hospitals of five Health Boards and in 1995, 431 CEAs were performed in nine Health Boards. In 1989, the CEA rate per 100 000 resident population varied between 0 (four regions) and 4 (one region), with one region significantly different from Scotland as a whole (P&lt;0·01). In 1995, the CEA rate varied between 0 (two regions) and 19 (one region), with two regions significantly different from Scotland as a whole (P&lt;0·01).

Conclusion
Despite a sixfold increase in the number of CEAs being performed, and a rise in the number of centres performing CEA, there is increasing geographical inequality in the provision of CEA in Scotland.
Management of hepatobiliary and pancreatic Ascaris infestation in adults after failed medical treatment
Authors: Beckingham I J , Cullis S N R , Krige J E J , Bornman P C , Terblanche J 
Published: March 2003

Abstract

Background
The roles of endoscopy and surgery in the management of Ascaris lumbricoides affecting the hepatobiliary and pancreatic system in adults were determined.

Methods
All patients undergoing endoscopic retrograde pancreatography for ascariasis of the biliary or pancreatic system unresponsive to standard medical therapy were analysed. Worms were extracted using snare, Dormia basket or biopsy forceps. Success was defined as clearance of worms and eradication of symptoms.

Results
Endoscopic extraction was performed in 25 patients with success in 19. Failures occurred in one patient with Ascaris in the gallbladder, and in five with associated strictures or stones. All six patients were treated successfully by surgery.

Conclusion
Endoscopy was successful in the treatment of Ascaris infestation resistant to medical therapy in 19 of 25 patients. Surgery remains important in the management of infestations complicated by biliary or pancreatic strictures and stones, or worms in the gallbladder.
Upper gastrointestinal disease in patients with familial adenomatous polyposis
Authors: Wallace M H , Phillips R K S 
Published: March 2003

Abstract

Background
Upper gastrointestinal disease has become an important aspect in the management of patients with familial adenomatous polyposis (FAP).

Methods
A review of the literature was carried out using Medline. Epidemiology, pathology and treatment options are considered.

Results and conclusion
Despite the fact that over 90 per cent of patients with FAP develop duodenal adenomas, only 5 per cent go on to develop cancer. In the absence of methods to detect who is at risk of cancer, all patients undergo regular endoscopic surveillance at present. Chemoprevention in the form of drug therapy may be the answer to controlling the disease.
Metabolic response to severe injury
Authors: Hill A G , Hill G L 
Published: March 2003

Abstract

Background
Severe injury is associated with a complex sequence of metabolic events. The accurate quantification of these changes and a developing understanding of their aetiology has been the product of much work by researchers over the past 60 years. An understanding of these phenomena is vital to the practising surgeon because of the plethora of new metabolic modulators threatening to become part of clinical practice.

Methods
This review describes the clinical picture of the metabolic response to severe injury and then outlines modern understanding of the underlying processes.

Results and conclusion
The need for further research before introduction of new technologies is emphasized.
Diet, reflux and the development of squamous cell carcinoma of the oesophagus in Africa
Authors: Sammon A M , Alderson D 
Published: March 2003

Abstract

Background
Squamous cancer of the oesophagus has reached epidemic proportions in Africa in the past few decades. There are many known associations but as yet no well established theory of causation.

Methods
Relevant literature was found by manual review of appropriate journals and literature, Medline searches and cross-referencing. Published theories of causation of endemic cancer of the oesophagus were assessed in the light of available evidence. A hypothesis based on that evidence was formulated.

Results and conclusion
A predominantly maize-based diet is high in linoleic acid, a precursor for gastric prostaglandin synthesis. In combination with low intake of other fatty acids and riboflavin, high levels of prostaglandin E2 are produced in gastric mucosa, leading to reduced gastric acid secretion, relaxation of the pylorus and a reduction in lower oesophageal sphincter pressure. These events result in combined reflux of duodenal and gastric juices low in acidity into the oesophagus. Resulting dysplasia strongly predisposes to local squamous carcinogenesis. This is now a fertile area for research, which may open the way for preventive action.
Clinical features and investigations in patients with columnar-lined oesophagus
Authors: Martínez de Haro L , Ortiz A , Parrilla P , Aguilar J , Bermejo J , Molina J 
Published: March 2003

Abstract

Background
It is unclear why some patients with a columnar-lined oesophagus present with intestinal metaplasia and others do not. The physiopathological and clinical implications of the length of the metaplastic segment are also controversial. The aim of the study was to determine whether the length of the metaplasia and the presence of intestinal epithelium are related to the clinical, manometric and pHmetric data in patients with columnar-lined oesophagus.

Methods
A comparison of clinical, endoscopic, pathological, manometric and pHmetric data was made between patients with columnar-lined oesophagus of 3–5 cm (n = 31) and those with a metaplastic segment of 5 cm or more (n = 28); the same comparison was made between patients who had specialized intestinal metaplasia (n = 37) and those who did not (n = 22).

Results
No significant difference was found in any of the variables studied except for associated inflammatory lesions above the columnar epithelium which were more frequent in patients with a shorter metaplastic segment (P &lt; 0·05).

Conclusion
Neither the length of the metaplastic segment nor the presence of intestinal metaplasia was related to a more evolved gastro-oesophageal reflux disease, a poorer oesophageal clearing function or higher acid reflux rates.
Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review
Authors: Nieuwenhuijzen M , Reijnen M M P J , Kuijpers J H C , van Goor H 
Published: March 2003

Abstract

Background
The aim of this retrospective study was to determine the cumulative incidence of adhesive small bowel obstruction (SBO) after total or subtotal colectomy and to investigate the site of the obstructive adhesions in the abdominal cavity.

Methods
The records of 234 patients who underwent colectomy from 1985 to 1994 were reviewed for SBO, potential risk factors for SBO, and the site of adhesions causing obstruction. Mean follow-up, which was complete in 215 patients, was 63 months.

Results
SBO occurred in 56 patients (24 per cent) of whom 42 (18 per cent) had adhesive obstruction. The risk of SBO due to adhesions within 1 year was 11 per cent, increasing to 30 per cent 10 years after colectomy. With univariate analysis no risk factor for adhesive SBO, including previous laparotomies, septic complications and omental resection, was identified. The most common site of obstructing adhesions was the pelvis (ten of 28 patients).

Conclusion
The incidence of SBO after colectomy is high. Colectomy may be a suitable model for studies of adhesion prevention.
Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer
Authors: Abdullah T I , Iddon J , Barr L , Baildam A D , Bundred N J 
Published: March 2003

Abstract

Background
Complications of axillary surgery occur due to severance of the intercostobrachial nerve (ICBN). The feasibility and benefit of preserving the ICBN to prevent sensory loss was studied prospectively.

Methods
Sensory symptoms and deficits were documented, and shoulder movement and arm circumference were measured at discharge and 3 months later in 120 patients randomized to either preservation or division of the ICBN.

Results
Preserving the ICBN was feasible in 39 (65 per cent) of the 60 patients randomized to the preservation group. Preserving the nerve prolonged the procedure by a median of 5 min. No difference in sensory symptoms between the groups was seen at 3 months. At 3 months 53 per cent of patients randomized to ICBN preservation had a sensory deficit compared with 84 per cent of those randomized to ICBN sacrifice (P ≤ 0·05).

Conclusion
Preserving the ICBN reduces the incidence of sensory deficit (but not symptoms) in patients after axillary clearance.