bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of repeat anal sphincter repair
Authors: Pinedo G , Vaizey C J , Nicholls R J , Roach R , Halligan S , Kamm M A 
Published: March 2003

Abstract

Background
Patients with a poor outcome from anterior sphincter repair may be candidates for dynamic graciloplasty, artificial bowel sphincter implantation or a secondary repair. This study examines the outcome of repeat overlap repairs in these patients.

Methods
Twenty-six of 235 patients undergoing a sphincter repair (median age 43 (range 23–63) years) underwent repeat repair from May 1994 to April 1997. Twenty-three patients were available for follow-up. Clinical evaluation included a satisfaction scale from 1 to 10, the patient's assessment of percentage improvement, ability to defer defaecation before and after operation, and Wexner continence scores before and after operation. Manometric studies were performed in 21 patients before and 17 patients after operation, and anal ultrasonography was undertaken in 17 patients before and 14 patients after operation. External sphincter defects were present on all preoperative scans.

Results
At a median follow-up of 20 (range 5–42) months, 15 patients felt that they were 50 per cent or more improved after operation. On the satisfaction scale of 1–10 the median score was 7 (range 1–10). There was a significant improvement in the Wexner continence score from 19 (range 17–20) before operation to 12 (range 1–20) after operation (P &lt; 0·001). Ability to defer defaecation improved significantly from less than 5 min in all patients before operation to greater than 15 min in six patients after operation. Ultrasonography showed good overlap of the external sphincter muscle in eight of 14 patients. All patients who failed to improve showed a residual defect on ultrasonography.

Conclusion
Repeat anterior repair produces a significant improvement in continence score and ability to defer defaecation in patients with obstetric sphincter damage. Clinical improvement correlates closely with an improvement in the appearance on endoanal ultrasonography.
Sequential hepatic and pulmonary resections for metastatic colorectal cancer
Authors: Lehnert T , Knaebel H P , Dück M , Bülzebruck H , Herfarth C 
Published: March 2003

Abstract

Background
Resection of pulmonary or hepatic colorectal metastases is associated with a 5-year survival rate of 25–40 per cent. This report analyses outcome following sequential resection of colorectal metastases to both organs.

Methods
Seventeen patients with histologically confirmed colorectal adenocarcinoma and resection of liver and lung metastases were identified from a prospective database.

Results
The median interval between resection of the primary tumour and first metastasis was 21 (range 0–64) months. The interval between resection of the first and subsequent metastases was 18 (range 1–74) months. No patient died in the postoperative period and there were two perioperative complications. The overall survival rate in 17 patients was 70 per cent at 2 years from resection of metastasis to the second organ, but the disease-free survival rate at 2 years was only 24 per cent.

Conclusion
Although few long-term survivors were observed in this small series, sequential resection of hepatic and pulmonary metastases is warranted in a highly selected group of patients.
Surveillance for Barrett's oesophagus in the UK
Authors: Smith A M , Maxwell-Armstrong C A , Welch N T , Scholefield J H 
Published: March 2003

Abstract

Background
Endoscopic screening for Barrett's oesophagus is being offered without evidence of efficacy Barrett's oesophagus is not an ideal candidate for a screening programme, as the natural history is unclear, uncertainties surround the indication for intervention and the treatment is associated with high morbidity and mortality rates.

Methods
To determine the practices that clinicians employ in the management of Barrett's oesophagus in the UK, postal questionnaires were sent in May 1997 to 297 randomly selected members of the British Society of Gastroenterology asking for details of their current practice.

Results
Of 152 respondents, 106 (70 per cent) performed surveillance for Barrett's oesophagus; 46 (30 per cent) did not carry out screening. There was no difference in the practices carried out by physicians or surgeons, teaching or acute general hospital clinicians, or those with an upper gastrointestinal interest. There was a wide disparity in screening interval: just over half (52 per cent) screen at yearly intervals. Only nine (8 per cent) took four quadrant biopsies per 2 cm of Barrett's oesophagus. Nearly half (49 per cent) manage mild dysplasia by increasing the frequency of endoscopy; only seven (7 per cent) prescribed patients a proton pump inhibiting agent. Faced with severe dysplasia, 33 (31 per cent) offered surgery immediately; 22 (21 per cent) simply followed the patient by endoscopy. Those not choosing to perform screening most frequently cited lack of evidence of efficacy as the reason behind their decision.

Conclusion
There is wide variation in surveillance practices for Barrett's oesophagus. Some methods are ineffectual. The recommendations made by the Barrett's Oesophagus Working Party in 1991 are not followed, possibly because they are not practical. New workable guidelines based on available evidence and a consensus of expert opinion should be established; this was suggested by 38 per cent of respondents who performed screening.
Liver metastases after curative resection in patients with distal bile duct cancer
Authors: Takao S , Shinchi H , Uchikura K , Kubo M , Aikou T 
Published: March 2003

Abstract

Background
Curative resection cannot ensure long-term survival for patients with distal bile duct cancer. The aim of this study was to determine the most frequent mode of recurrence after curative resection and to analyse its risk factors.

Methods
Clinical details for 64 consecutive patients with distal bile duct cancer who underwent surgical resection between 1980 and 1997 were reviewed. Modes of recurrence and clinicopathological findings were analysed based on the residual tumour (R) classification.

Results
The overall actuarial 5-year survival rate was 32 per cent. Of 42 patients undergoing R0 resection 10 were alive at 5 years, of 17 having R1 resection one was alive at 5 years, and none of the five patients having R2 resection survived for 5 years (R0versus R1, P = 0·02). In the R0 group, the incidence of liver recurrence (14 of 42 patients) was similar to that in the R1 resection group (six of 17), although there were fewer lymph node and peritoneal recurrences than in patients who had R1 resection (P &lt; 0·05). The high-risk factor for liver metastasis was microscopic vascular involvement. Important factors for survival were lymph node metastasis, microscopic vascular involvement and age. In addition, microscopic vascular involvement was the only independent factor for survival in the R0 group.

Conclusion
R0 resection provided significant survival benefit but had no effect on liver recurrence. Therefore, new agents or strategies to prevent liver metastasis are necessary for improvement of survival.
Mechanism of action of antireflux procedures
Authors: Rydberg L , Ruth M , Lundell L 
Published: March 2003

Abstract

Background
To define the clinical role of antireflux surgical procedures a proper understanding of their mode of action is required. The aim of this study was to investigate the impact of total or posterior partial fundoplication on the function of the lower oesophageal sphincter (LOS) in the basal state as well as during stimulation.

Methods
Patients with chronic reflux (n = 24) were randomized either to a total fundic wrap or to a posterior partial (Toupet) fundoplication. Basal LOS function was investigated as well as the response to inhibitory stimuli 4 years after operation. Inhibitory stimulation was elicited by water swallows and by gas distension (750 ml air insufflation into the stomach).

Results
Basal LOS tone was substantially higher (P = 0·01) after a total than a partial wrap, as was the nadir pressure after water swallows (10·1 versus 3·4 mmHg). Body position did not affect this difference. Transient LOS relaxations occurred only occasionally in the basal state. The frequency of transient LOS relaxation increased somewhat during the first 10 min of stomach distension with more occurring in patients who underwent a Toupet procedure. Common oesophagogastric cavities were more often seen in this latter group of patients after gas distension of the stomach.

Conclusion
These physiological observations on the LOS after total and posterior partial fundoplication explain the observed clinical differences in favour of the latter operation. The partial fundoplication seems to restore the physiology of the gastro-oesophageal junction more adequately, allowing air to be vented from the stomach without jeopardizing the antireflux barrier.
Topographical distribution of blood supply to the anal canal
Authors: Lund J N , Binch C , McGrath J , Sparrow R A , Scholefield J H 
Published: March 2003

Abstract

Background
It has been suggested that anal fissure is an ischaemic ulcer caused by a combination of poor blood supply to the posterior midline of the anal canal and spasm of the internal anal sphincter. This study investigated the topographical distribution of blood supply to quadrants of the anal canal above and below the dentate line.

Methods
Cadaveric anal canals were removed and 1-cm blocks were cut above and below the dentate line. Blocks were sectioned at 10 µm and every 25th section was mounted. Using the technique of systematic random sampling, fields in the subanodermal space and the internal anal sphincter in posterior, lateral and anterior quadrants of the anal canal were chosen. The numbers of small arterioles in each field were counted. Mean counts were compared for both subanodermal space and internal anal sphincter between quadrants and levels above and below the dentate line using Page's L test for trends.

Results
Anal canals from eight cadavers were examined. There was a significant trend to an increasing number of arterioles from posterior to anterior in the subanodermal space at all levels and at two of three levels in the internal anal sphincter.

Conclusion
The arteriolar density is less in the posterior quadrant throughout the anal canal. It may be that this poor blood supply predisposes to the development of anal fissures at their most common site in the posterior midline.
Inhibition of platelet-activating factor, intercellular adhesion molecule 1 and platelet endothelial cell adhesion molecule 1 reduces experimental pancreatitis-associated gut endothelial barrier dysfunction
Authors: Wang X , Sun Z , Börjesson A , Andersson R 
Published: March 2003

Abstract

Background
Endothelial barrier dysfunction is a critical link in the development of tissue injury and organ dysfunction, via upregulation and exposure of adhesion molecules, intercellular signals and leucocyte–endothelial cell interactions. Inhibitors of inflammatory mediators and receptors have been suggested as a means of downregulating the cascade of both local and systemic inflammation.

Methods
The potential therapeutic inhibition of platelet-activating factor (PAF), intercellular adhesion molecule (ICAM) 1 and platelet endothelial cell adhesion molecule (PECAM) 1 was investigated in pancreatitis-associated gut endothelial dysfunction in rats, by treatment with a PAF antagonist (lexipafant, BB-882) and monoclonal antibodies against rat ICAM-1 (anti-ICAM1-Mb) and PECAM (anti-PECAM1-Mb). Alterations in gut endothelial barrier dysfunction and leucocyte recruitment, and systemic levels of interleukins were evaluated.

Results
Plasma exudation measured by the albumin leakage index and tissue leucocyte recruitment in the distal small intestine and colon increased significantly 12 h after induction of pancreatitis and treatment with saline. These alterations were to varying degrees counteracted by treatment with lexipafant, anti-ICAM1-Mb or anti-PECAM1-Mb. Alterations in levels of interleukin (IL) 1 paralleled the changes in gut endothelial barrier dysfunction and leucocyte trapping.

Conclusion
Treatment with lexipafant and monoclonal antibodies against ICAM-1 or PECAM-1 reduced the severity of pancreatitis-associated gut endothelial dysfunction, and decreased systemic concentrations of IL-1 and local leucocyte recruitment.
Factors influencing survival of patients undergoing hepatectomy for colorectal metastases
Authors: Yamamoto J , Shimada K , Kosuge T , Yamasaki S , Sakamoto M , Fukuda H 
Published: March 2003

Abstract

Background
The extent of surgical margin is still a matter of controversy with regard to outcome after liver resection for metastatic disease. The aim of this study was to clarify the significant prognostic factors after hepatectomy for colorectal metastases, with special reference to the surgical margin.

Methods
Ninety-six patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1992 and 1994 were studied.

Results
Overall 1-, 3- and 5-year survival rates were 94, 61 and 51 per cent respectively. All of the independent factors associated with poor prognosis after hepatic resection were tumour-related factors, such as the number of tumours (four or more), presence of portal vein invasion, hepatic vein invasion and absence of a fibrous pseudocapsule. A positive resection margin was not an independent prognostic factor, because of its strong relationship with the number of tumours resected.

Conclusion
A generous surgical margin is not essential for curative hepatic resection, although positive surgical margins should be avoided. New potential risk factors which affect survival, such as the presence of portal vein or hepatic vein invasion and the absence of a pseudocapsule, may be helpful for defining the indications for postoperative adjuvant treatment.
Dietary intake after pancreatectomy
Authors: Maskell C , Daniels P , Johnson C D 
Published: March 2003

Abstract

Background
Nutritional intake after pancreatectomy may be impaired. The extent of the problem and the effect on intake of specific nutrients is unknown.

Methods
A 1-week weighed dietary food intake (using digital scales and a food diary) was studied in 15 patients, a median of 4 (range 1–30) months after pancreatectomy. Results were expressed as a percentage of estimated average requirement (EAR), reference nutrient intake (RNI) or lower RNI (LRNI) values.

Results
The median energy intake was 1914 (range 1154–2804) kcal/day, representing a median of 88 (56–154) per cent of EAR. Fat intake was low (72 (60–123) g/day); protein intake was adequate (139 (99–219) per cent of RNI). Deficiencies were observed in the intake of vitamin D (17 (6–56) per cent of LRNI) and, in some patients, selenium (107 (19–203) per cent of LRNI).

Conclusion
Nutritional intake in the months after pancreatectomy could be improved by increasing fat intake (with enzyme supplements as appropriate). This 7-day study also suggests that these patients may require vitamin D and possibly selenium supplementation.
Factors leading to local recurrence or death after surgical resection of phyllodes tumours of the breast
Authors: de Roos W K , Kaye P , Dent D M 
Published: March 2003

Abstract

Background
Local recurrence and death from metastases are occasional, but consistent, themes in reports of patients with phyllodes tumours. Factors that might contribute to these outcomes were sought.

Methods
Data from 38 patients with a phyllodes breast tumour were reviewed retrospectively, reclassifying the pathological material using the Pietruszka and Barnes criteria.

Results
At a median of 12 months, nine patients had developed a local recurrence and four had died from metastases. Following local excision in 24 patients (for diagnosis in 13, for ‘fibroadenoma’ in nine and for phyllodes tumour in two patients), 13 had no further surgery and five had local recurrence (three of eight benign tumours, two of two malignant tumours). Wide local excision or mastectomy in 18 patients was followed by four recurrences (one of eight borderline tumours, three of ten malignant tumours). All patients with recurrence had margin involvement on histological examination, but not all patients with margin involvement developed recurrence. Lack of statistical correlation between local recurrence and age, delay, size, grade or type of surgery was confounded by selection bias for more extensive surgery for malignant tumours. Death correlated with size (P = 0·05) and grade (P= 0·03) of tumour.

Conclusion
Inadequate preoperative diagnosis (‘fibroadenoma’ or failure of triple assessment) frequently led to local excision with positive margins. Without revision this often resulted in local recurrence. Local recurrence of any grade was usually followed by further recurrence. Death was related to tumour size and histological grade, confirming these as prognostic factors.
Colonic motility before surgery for rectal prolapse
Authors: Brown A J , Horgan A F , Anderson J H , McKee R F , Finlay I G 
Published: March 2003

Abstract

Background
Abdominal rectopexy remains the operation of choice for patients with rectal prolapse. Recurrence rates are low but the functional results are poor. Hindgut motility was measured before abdominal rectopexy to determine whether an underlying neuropathy might explain these poor results.

Methods
Seven women of mean(s.d.) age 56(10) years had a multilumen catheter inserted in the colon before abdominal rectopexy. Colonic intraluminal pressure was recorded for a mean(s.d.) of 19(3) h; the number of peaks over 5 and 50 mmHg, motility and high-amplitude propagated contractions (HAPCs) were measured before and after a meal and compared with the findings in five controls.

Results
Patients had high numbers of contractions greater than 5 mmHg and high motility before meals. Controls responded to meals by increasing motility, unlike patients. HAPCs were seen in one patient but in all controls.

Conclusion
These data show that patients with rectal prolapse have a hindgut motility abnormality before abdominal rectopexy, similar to that observed in spinal cord injury. This may explain the poor functional results after surgery, offering a rationale for colonic resection.
Changing strategy for rectal cancer is associated with improved outcome
Authors: Dahlberg M , Glimelius B , Påhlman L 
Published: March 2003

Abstract

Background
In 1980, surgery for rectal cancer at the Department of Surgery, Uppsala University Hospital was concentrated to a colorectal unit and a more systematic use of adjuvant radiotherapy began. In 1985, total mesorectal excision was introduced. The aim of this study was to determine whether these changes had an impact on the overall treatment outcome.

Methods
Some 423 consecutive patients with rectal cancer had surgery between 1974 and 1995 and were followed up until 1 January 1998. Outcome analysis was made according to the following predefined intervals of diagnosis: 1974–1979, 1980–1984 and 1985–1995.

Results
The overall local recurrence rate was 47 per cent in the first interval, and 13 and 11 per cent during the second and third respectively (P &lt; 0·001). In the third interval, of 119 patients who received preoperative irradiation and underwent radical resection, only three (3 per cent) had locally recurrent rectal cancer. There was improved cancer-specific survival between the first and the last intervals of the study (P = 0·03).

Conclusion
These data are consistent with the interpretation that the results of treatment can be improved by concentration of surgery to a colorectal team.
Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours
Authors: Midwinter M J , Beveridge C J , Wilsdon J B , Bennett M K , Baudouin C J , Charnley R M 
Published: March 2003

Abstract

Background
Spiral computed tomography (CT) allows high-resolution examination of the pancreas, surrounding vascular structures, lymph nodes and liver. Endoscopic ultrasonography (EUS) also allows high-resolution imaging of the pancreas and adjacent structures but is an invasive procedure. With the availability of spiral CT, the role of EUS in the investigation of patients with suspected pancreatic or ampullary tumours is unclear.

Methods
Forty-eight patients with clinical suspicion of a pancreatic or ampullary tumour underwent both spiral CT and EUS. Thirty-four patients had surgical exploration, of whom 17 underwent pancreatic resection and 17 had biliary and gastric bypass. The results of spiral CT and EUS were compared with the operative findings.

Results
The final histological diagnosis was ductal adenocarcinoma (24 patients), ampullary carcinoma (six), serous cystadenoma (two) and chronic pancreatitis (two). EUS demonstrated 33 and spiral CT 26 of the 34 primary lesions. EUS was particularly useful in the assessment of small resectable tumours missed by spiral CT. The sensitivity and specificity of EUS and spiral CT for detecting involvement by the tumour of the superior mesenteric vein, portal vein and lymph nodes were similar, but EUS was less effective at evaluating the superior mesenteric artery.

Conclusion
EUS is an important additional investigation after spiral CT in patients with a suspected pancreatic or ampullary tumour.
Primary myocutaneous flap closure following resection of locally advanced pelvic malignancies
Authors: Radice E , Nelson H , Mercill S , Farouk R , Petty P , Gunderson L 
Published: March 2003

Abstract

Background
Perineal wounds, created at the time of extended resection for locally advanced malignancy and following chemoradiation, are at risk of serious complications.

Methods
To determine whether immediate myocutaneous flap closure prevents complications, 57 patients treated with multimodality therapy and proctectomy (35 perineal wounds) or sacrectomy (22 posterior wounds) were studied. Patients were categorized according to whether they underwent primary skin and pelvic closure (group 1; n = 20); primary skin and omental pelvic closure (group 2; n = 24); or immediate myocutaneous flap closure (group 3; n = 13).

Results
Groups were similar with respect to age and sex; however, group 1 had more primary tumours and required less radical surgery and chemoirradiation than groups 2 and 3. Groups 1 and 2 experienced more complications overall (eight of 20, nine of 24 and three of 13 patients in groups 1, 2 and 3 respectively), more acute wound complications (seven of 20, nine of 24 and two of 13), delayed wound healing (three of 20, six of 24 and one of 13) and more reoperations for perineal wound problems (five of 20, seven of 24 and zero of 13). Patients in group 2 had a significantly longer hospital stay than those in group 1. Flap closure (group 3) did not increase the length of stay. The routine use of primary flap closure reduced overall wound complications (eight of 31 versus ten of 26 patients) and length of hospitalization (13 versus 17 days).

Conclusion
Complete wound healing was achieved in all patients; however, immediate myocutaneous flap closure reduced the need for readmission and reoperation.