bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of old and new TNM systems for nodal staging in adenocarcinoma of the gastro-oesophageal junction
Authors: de Manzoni G , Pedrazzani C , Verlato G , Roviello F , Pasini F , Pugliese R , Cordiano C 
Published: February 2004

Abstract

Background
Adenocarcinoma of the gastro-oesophageal junction is considered a distinct clinical entity, although the current pathological tumour node metastasis (pTNM) classification does not consider this tumour specifically. A prospective study was undertaken to determine the prognostic importance of lymph node involvement in adenocarcinoma of the gastro-oesophageal junction, analysing both a number- and site-based classification, in order to develop a clinically useful nodal staging system.

Methods
Two classification systems were analysed in 116 patients who underwent resection for adenocarcinoma of the gastro-oesophageal junction from January 1988 to August 2001. The Cox regression model was used to evaluate the prognostic significance of the site and number of positive nodes.

Results
The number- and site-based staging systems coincided only in 42 (56 per cent) of 75 patients; in particular, the old pN1 classification was upstaged in 13 of 41 patients and the old pN2 was downstaged in 13 of 34 patients. Lymph node involvement was the most important prognostic factor in both classifications (P &lt; 0·001). The risk of death was significantly influenced by the site of nodal metastasis among patients with a similar number of involved nodes (relative risk with respect to pN0: 2·18 for pN1 with one to six nodes; 6·53 for pN2 with one to six nodes; 7·53 for pN1 with more than six nodes; 39·13 for pN2 with more than six nodes).

Conclusion
Adenocarcinoma of the gastro-oesophageal junction requires a specific lymph node classification which should take into account both the number and site of nodal metastases.
Hand-assisted laparoscopic live donor nephrectomy
Authors: Maartense S , Idu M , Bemelman F J , Balm R , Surachno S , Bemelman W A 
Published: February 2004

Abstract

Background
Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN.

Methods
Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided.

Results
The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1·0–4·5) min and the median blood loss was 50 (range 20–500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis.

Conclusion
Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.
Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer
Authors: Wu C W , Hsiung C A , Lo S S , Hsieh M C , Shia L T , Whang-Peng J 
Published: February 2004

Abstract

Background
A randomized comparison of D1 (level 1 lymphadenectomy) and D3 (levels 1, 2 and 3 lymphadenectomy) dissection was performed to evaluate morbidity and effects on survival from gastric cancer.

Methods
A total of 221 patients were studied after resection for gastric cancer, 110 after D1 surgery and 111 after D3 surgery.

Results
The morbidity rate was higher after D3 than after D1 resection (17·1 (95 per cent confidence interval (c.i.) 10·1 to 24·1) versus 7·3 (95 per cent c.i. 2·4 to 12·2) per cent respectively; P = 0·012). The difference was largely related to abdominal abscess (8·1 per cent after D3 versus none after D1 resection; P = 0·003). The D3 group had an anastomotic leak rate of 4·5 per cent whereas there was no leakage in the D1 group (P = 0·060). All anastomotic leaks were minor and were managed non-operatively with nutritional support. Patients who had D3 resection had longer operating times, greater blood loss and postoperative drain outputs, and more patients needed blood transfusion. There was no death in either group. The hospital stay was longer after D3 than D1 surgery (mean(s.d.) 19·6(13·9) (range 10–98) versus 15·0(4·0) (range 10–30) days; P = 0·001).

Conclusion
Extended lymphadenectomy for gastric cancer is associated with more complications than limited lymphadectomy but this does not lead to significant mortality.
Convalescence after inguinal herniorrhaphy
Authors: Bay-Nielsen M , Thomsen H , Andersen F Heidemann , Bendix J H , Sørensen O K , Skovgaard N , Kehlet H 
Published: February 2004

Abstract

Background
Convalescence after inguinal herniorrhaphy is usually 3–4 weeks and is an important outcome parameter of hernia surgery. The aim of this study was to describe in detail the consequences of recommending a short convalescence, including the risk of recurrence.

Methods
This was a multicentre prospective questionnaire study in patients given a recommendation for short convalescence (1 day); information was recorded on expected length of convalescence, employment status, physical workload and limiting factors. The reoperation rate in patients included in the study (group 1, n = 1059) was compared with that for comparable patients treated in participating departments but not part of the study group (group 2, n = 1306) and patients in the Danish Hernia Database (group 3, n = 8297).

Results
The median time off work was 7 days and the time interval before carrying out the most strenuous leisure activity was 14 days. After 30 days, 6·8 per cent of patients had not resumed employment and 17·0 per cent had not yet resumed strenuous leisure activity. Important reasons for not resuming work and leisure activity were pain (approximately 60 per cent of patients) and wound problems (approximately 20 per cent). The reoperation rate in group 1 at the median observation time was 0·7 per cent, which was no different to that in group 2 (1·6 per cent) (P = 0·186) or group 3 (1·4 per cent) (P = 0·092).

Conclusion
Reduced convalescence after inguinal herniorrhaphy may be recommended without incurring a risk of higher reoperation rates. Pain and wound problems remain the most important factors for not resuming work or leisure activity as recommended.
Microvessel density, cyclo-oxygenase 2 expression, K-ras mutation and p53 overexpression in colonic cancer
Authors: Liang J-T , Huang K-C , Jeng Y-M , Lee P-H , Lai H-S , Hsu H-C 
Published: February 2004

Abstract

Background
Tumour angiogenesis, cyclo-oxygenase (COX) 2 expression, K-ras mutation and p53 overexpression are commonly involved in colorectal tumorigenesis, but their interrelationship and clinicopathological effects remain inconclusive.

Methods
Clinicopathological data from 114 consecutive patients with primary stage III colorectal cancer were evaluated prospectively. Microvessel density (MVD) of the tumour was defined by counting the number of microvessels in hotspots, visualized by immunocytochemical staining of endothelial CD34. K-ras mutation was analysed by the restriction enzyme cleavage method. COX-2 expression and p53 overexpression were determined by immunocytochemistry.

Results
Increased MVD in hotspots was significantly associated with COX-2 expression (P &lt; 0·001), K-ras mutation (P = 0·007) and p53 overexpression (P = 0·006). COX-2 expression was not associated with either K-ras mutation or p53 overexpression. Clinicopathologically, greater MVD and COX-2 expression were significantly associated with vascular invasion of cancer cells (MVD, P = 0·027 and COX-2 expression, P = 0·006), but p53 overexpression and K-ras mutation were not. Multivariate analysis indicated that greater MVD (P = 0·002) and p53 overexpression (P = 0·016) were significant independent predictors of tumour recurrence, whereas COX-2 expression (P = 0·634) and K-ras mutation (P = 0·356) were not.

Conclusion
Tumour angiogenesis may be associated with tumour metastasis and is significantly influenced by K-ras mutation, p53 overexpression and COX-2 expression in patients with colonic cancer.
Impact of radiofrequency ablation on the management of patients with hepatocellular carcinoma in a specialized centre
Authors: Lam C-M , Ng K K-C , Poon R T-P , Ai V , Yuen J , Fan S-T 
Published: February 2004

Abstract

Background
Radiofrequency ablation (RFA) has been used increasingly in the treatment of hepatocellular carcinoma (HCC). The aim of this study was to investigate changes in the treatment pattern of primary HCC following the implementation of RFA in a specialized surgical centre.

Methods
This was a retrospective analysis of all 894 patients admitted for treatment of primary HCC over 36 months.

Results
There was no difference in the age, sex ratio, liver function according to Child–Pugh grade, serum α-fetoprotein concentration, hepatitis B surface antigen status and tumour size among patients before and after the introduction of RFA therapy. Fifty-one patients (10·6 per cent) with primary HCC received RFA treatment after its implementation. There was a 6·8 per cent reduction in the number of patients who had supportive treatment (P = 0·041) and a 3·2 per cent reduction in surgical treatment. The hospital mortality rates for RFA and surgery were 2·0 and 4·9 per cent respectively. The overall survival rates at 6, 12 and 18 months for patients treated with RFA were 92·2, 73·4 and 61·2 per cent respectively. The corresponding survival rates for the 213 patients who had surgery were 88·0, 77·0 and 71·5 per cent. These values were no different from those in patients who had RFA (P = 0·718). Patients treated with RFA or surgery survived longer than those who had other treatments.

Conclusion
RFA had a significant impact on the management of primary HCC, increasing the number of patients suitable for liver-directed therapy and leading to survival benefit. RFA may become the treatment of choice for patients with irresectable HCC.
Carcinogenic potential of commonly used hernia repair prostheses in an experimental model
Authors: Witherspoon P , Bryson G , Wright D M , Reid R , O'Dwyer P J 
Published: February 2004

Abstract

Background
The purpose of this study was to assess the carcinogenic potential of commonly used hernia repair prostheses in an animal model.

Methods
Three types of prosthetic material (monofilament polypropylene, multifilament polypropylene and expanded polytetrafluoroethylene) were implanted in CBA/H mice. Flat (1 cm2) and rolled pieces of the same material were placed subcutaneously in either flank, and a further flat piece was placed in the preperitoneal space. Owing to a high incidence of mesh extrusion in the polypropylene groups, the study protocol was modified to allow only preperitoneal placement of the material. A fourth, control, group had the pockets for the prostheses created but no material implanted. After modification of the protocol there were approximately 60 mice in each group. The mice were followed for 2 years, then killed and assessed histologically for tumour development.

Results
No sarcoma developed at the site of mesh implantation in any of the groups.

Conclusion
This study indicates that the risk of sarcoma formation at the site of hernia repair prostheses is very low.
Drawbacks of endoscopic thoracic sympathectomy
Authors: Ojimba T A , Cameron A E P 
Published: February 2004

Abstract

Background
Endoscopic thoracic sympathectomy (ETS) has come into widespread use for palmar hyperhidrosis and other complaints of the upper limb and of the head and neck, but there are concerns about its safety. This review highlights the operative complications and long-term side-effects that may occur.

Methods
A Medline search was carried out using the terms ‘thoracoscopic sympathectomy’, ‘endoscopic thoracic sympathectomy’ and ‘complications’. References from identified articles were handsearched for further relevant articles. The senior author's experience and personal communications were also taken into account.

Results and conclusion
No death following ETS has ever been reported in the literature, but nine anecdotal fatalities are known, five resulting from major intrathoracic bleeding and three from anaesthetic mishap. Significant intrathoracic bleeding may occur in up to 5 per cent of patients but only a minority require thoracotomy; pneumothorax occurs in 2 per cent of patients and two instances of brain damage are known. In the longer term compensatory hyperhidrosis is extremely common and 1–2 per cent of patients regret having had surgery because of its severity. Horner's syndrome, on the other hand, is rare. Improvements in instrumentation, adequate training and careful patient selection may help reduce the drawbacks of ETS.
Chronic anal fissure
Authors: Lindsey I , Jones O M , Cunningham C , Mortensen N J McC 
Published: February 2004

Abstract

Background
The treatment of chronic anal fissure has shifted in recent years from surgical to medical.

Methods
A Medline search of studies relevant to modern management of chronic anal fissure was undertaken.

Results
Traditional surgery that permanently weakens the internal sphincter is associated with a risk of incontinence. Medical therapies temporarily relax the internal sphincter and pose no such danger, but their limited efficacy has led to displacement rather than replacement of traditional surgery. Emerging medical therapies promise continued improvement and new sphincter-sparing surgery may render traditional surgery redundant.

Conclusion
First-line use of medical therapy cures most chronic anal fissures cheaply and conveniently. The few non-responders can be targeted for sphincter assessment before traditional surgery. If the initial good results of new sphincter-sparing surgery are confirmed, it may be possible to avoid any risk of incontinence, while achieving high rates of fissure healing.
Letter 1: Preoperative treatment of hepatocellular carcinoma with intra-arterial injection of 131I-labelled lipiodol (Br J Surg 2003; 90: 1379-1383)
Authors: Rai R , Rai S 
Published: February 2004

Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk.
Morphological studies for retrusive movement of the human adult tongue
Authors: Saigusa Hideto , Yamashita Kazuo , Tanuma Kumiko , Saigusa Makoto , Niimi Seiji 
Published: February 2004

AbstractThis study identified the anatomical and close functional relationship between the transverse lingual and superior pharyngeal constrictor muscle. Two en bloc samples (including the tongue and mid‐pharyngeal wall) and four whole tongues were obtained from adult human cadavers. We found that fibers of the superior pharyngeal constrictor muscle connected with fibers of the transverse lingual muscle, forming a ring of muscle at the base of the tongue. The average diameters of the transverse muscle fibers increased in size gradually as they approached the base of the tongue. Distribution of the muscle spindles in the transverse lingual muscle and the genioglossus muscle also increased as they reached posteriorly near the base of the tongue. These findings suggest that a ring of muscle formed by the postero‐inferior portion of the transverse lingual muscle and the superior pharyngeal constrictor may be largely responsible for the retrusive movement of the tongue and the constrictive movement of the pharyngeal cavity as an antagonist of the genioglossus muscle. Clin. Anat. 17:93–98, 2004. © 2004 Wiley‐Liss, Inc.
Distribution pattern of the human lingual nerve
Authors: Zur Karen B. , Mu Liancai , Sanders Ira 
Published: February 2004

AbstractThe tongue is an intricate organ with many functions. Despite the knowledge of the presence of muscular and neural connections in the tongue, a detailed neuroanatomical depiction of the nerves' topography in the tongue has not been demonstrated. The topography, branching patterns and neuronal interconnections of the lingual nerve were studied in five postmortem human tongues. They were stained with Sihler's stain, a technique that renders most of the tongue tissue translucent while counterstaining nerves. The lingual nerve reaches the tongue posterolaterally. There are two main branches off of the main trunk: the medial branch sends 2–4 small branches to the medial part of the ventrolateral tongue and the lateral branch runs along the lateral tongue border and sends 3–4 large branches to the anterior tip of tongue. Each subdivision gives off 2–5 distal branches. Both medial and lateral branches have interconnections with the proximal part of the hypoglossal nerve. One of the unexpected discoveries in this study was the high density of nervous fibers in the lateral aspect of the tongue as compared to the midline region. The average diameter of the main trunk of the lingual nerve is 3.5 mm. The medial and lateral branches average 1 mm in diameter, the more distal subdivisions measure 0.5–0.75 mm, and the lingual‐hypoglossal interconnections measure 0.125–0.250 mm. In summary, this study provides the first detailed depiction of the topography of the human lingual nerve and its branches in situ, confirmation of lingual‐hypoglossal nerve connection, and the first depiction of the high density of lingual nerve innervation in the lateral tongue. Clin. Anat. 17:88–92, 2004. © 2004 Wiley‐Liss, Inc.
In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region
Authors: Weninger Wolfgang J. , Prokop Mathias 
Published: February 2004

AbstractAs tissue dissections carried out on formaldehyde‐fixed anatomical specimens demonstrate, the parasellar region (PSR), traditionally referred to as the cavernous sinus, is composed of three distinct compartments: orbital, pterygopalatine, and lateral sellar. The aim of our study was to identify and measure these compartments in the living and to describe the topography of their adipose body tissues. For this purpose data sets of 35 patients, who had undergone thin‐section multislice computed tomography (CT), were examined using 3D‐reconstruction software. The pterygopalatine and orbital compartments of the PSR could be identified in the images by their adipose bodies. We provide more exacting measurements of their size than have been presented in earlier studies. Furthermore, we include data about the uni‐ and bilateral presence of the single compartments and analyze the topography of the adipose tissue bodies in the orbital apex region. Our quantitative data and topographical descriptions confirm the compartmentalization concept of the PSR, allow for correct interpretation of CT scans of the orbital apex and anterior PSR, and provide baseline information for individual planning of surgical and radiological interventions. Clin. Anat. 17:112–117, 2004. © 2004 Wiley‐Liss, Inc.
Fenestration of the superior medullary velum as treatment for a trapped fourth ventricle: A feasibility study
Authors: Tubbs R. Shane , Wellons John C. , Salter George , Oakes W. Jerry 
Published: February 2004

AbstractWe developed a novel approach for fenestration of the trapped fourth ventricle utilizing the superior medullary velum (valve of Vieussens). Trapped fourth ventricles, which are seen often in the pediatric hydrocephalic population, are troublesome entities surgically. A right burr hole was carried out in 10 adult cadavers with no gross intracranial pathology and the superior medullary velum was fenestrated to the quadrigeminal cistern with the aid of an endoscope. This technique was carried out easily in all cadaveric specimens. With endoscopy, no vascular insult was appreciated either before or after fenestration of the superior medullary velum. These preliminary findings demonstrate that fenestration of the superior medullary velum may provide a good alternative to the present therapy of shunting trapped fourth ventricles, a therapy wrought with complications. Clin. Anat. 17:82–87, 2004. © 2004 Wiley‐Liss, Inc.
Anatomy of the pelvic plexus and innervation of the prostate gland
Authors: Ali M. , Johnson I.P. , Hobson J. , Mohammadi B. , Khan F. 
Published: February 2004

AbstractWe have examined the anatomy of the pelvic (inferior hypogastric) plexus in six male cadavers, paying particular attention to gross anatomical landmarks that might aid in locating it and have used immunohistochemistry to study the small branches of the plexus that supply the prostate gland. The pelvic plexus was found two finger breadths lateral to the third anterior sacral foramina, lying deep to a line drawn from third sacral vertebra, the conventional level of the recto‐sigmoid junction, and the palpable posterior superior surface of the pubic symphysis. Immunohistochemical staining showed small nerve branches from the pelvic plexus entering the prostate gland and the presence of ganglia within the prostate gland that contained both tyrosine hydroxylase positive and negative neuronal cell bodies. This information may be useful in nerve‐sparing surgical procedures and in discussions of the functional implications of perturbations of prostate innervation. Clin. Anat. 17:123–129, 2004. © 2004 Wiley‐Liss, Inc.
Fossa navicularis: Anatomic variation at the skull base
Authors: Cankal F. , Ugur H.C. , Tekdemir I. , Elhan A. , Karahan T. , Sevim A. 
Published: February 2004

AbstractThe fossa navicularis is a relatively rare anatomic variation of the skull base. Awareness of its existence will avoid misinterpretations of radiological images and unnecessary investigations. This study describes the appearance of the fossa navicularis, and investigates its incidence and whether it is related to pathology at the basiocciput. We studied 492 dry human skulls and 525 computer tomography (CT) images of patients. Dry skulls showing a fossa navicularis were investigated by CT scan, whereas patients identified as having a fossa navicularis were further examined with magnetic resonance imaging (MRI). To document the position of the fossa more precisely, measurements were made between the fossa navicularis and certain anatomic landmarks such as the foramen ovale, the pharyngeal tubercle, the posterior border of the vomer, the foramen lacerum, the carotid canal, and the occipital condyle. Upon examination, 26 of 492 skulls (5.3%) were found to have a fossa navicularis. Twelve were <2 mm in depth and the other 14 had a depth of ≥2 mm. Of the 525 patients, 16 (3.0%) were identified as having a fossa navicularis in CT images. Evaluation of MRIs showed no soft tissue lesions in any of these patients. Comprehensive anatomic details of the fossa navicularis have not been reported in the literature. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base. Clin. Anat. 17:118–122, 2004. © 2004 Wiley‐Liss, Inc.