bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antireflux surgery in the laparoscopic era
Authors: Watson D I , Jamieson G G 
Published: March 2003

Abstract

Background
The recent development of laparoscopic techniques for fundoplication has created renewed interest in surgery for gastro-oesophageal reflux disease, leading to reports of large clinical series from many centres. However, controversy remains about technical aspects of laparoscopic antireflux surgery, with no consensus yet reached about a standard operative technique. It is important, therefore, to reassess critically the results of laparoscopic surgery for reflux disease, so that its current status can be determined.

Methods
Published outcome studies for laparoscopic antireflux surgery, as well as selected studies from the era of open antireflux surgery, were reviewed to assess outcomes.

Results
The results of case series for laparoscopic antireflux surgery with short- and medium-term follow-up, as well as the early results of randomized trials, confirm that this approach reduces the early overall morbidity of surgery for reflux disease. However, certain complications may be more common, for instance paraoesophageal hiatus herniation, pneumothorax and oesophageal perforation, requiring surgeons to use specific strategies which can help to avoid these problems. Published studies and trials do not support the routine or selective application of a posterior partial fundoplication technique or routine division of the short gastric vessels during Nissen fundoplication.

Conclusion
At present, a short loose Nissen fundoplication performed laparoscopically, with or without division of the short gastric vessels, is an appropriate surgical approach for gastro-oesophageal reflux disease. However, long-term outcomes following laparoscopic antireflux surgery will not be available for some years, and must be awaited before the final status of the various laparoscopic techniques can be confirmed.
d-lactate as an early marker of intestinal ischaemia after ruptured abdominal aortic aneurysm repair
Authors: Poeze M , Froon A H M , Greve J W M , Ramsay G 
Published: March 2003

AbstractBackgroundPatients with a ruptured abdominal aortic aneurysm (AAA) are at risk of developing colonic ischaemia after surgery. It is difficult to diagnose this ischaemia at an early stage. d-lactate is produced by intestinal bacteria after ischaemia. L-lactate is released in increased amounts during hypoxia by anaerobic metabolism. This study investigated both variables as a marker for intestinal ischaemia in patients with a ruptured AAA.MethodsTwenty-four patients with ruptured AAA were divided retrospectively into two groups with and without ischaemic complications, as verified by colonoscopy. Blood had been taken on admission to the intensive care unit (ICU). Median time to colonoscopy was 9 days after surgery. As controls, four patients with pneumonia, six healthy subjects, five patients with an elective AAA repair, and six patients with sepsis and acute tubular necrosis were included.Resultsd-lactate level on admission was significantly increased in patients with colonic ischaemia after ruptured AAA compared with the level in patients without ischaemia (P &lt; 0·05), patients with sepsis (P &lt; 0·001), those with pneumonia and healthy subjects (P &lt; 0·01). L-lactate concentration was similar in the group with intestinal complications and in patients without colonic ischaemia; however, L-lactate levels were higher in patients with pneumonia and sepsis than in healthy subjects (P &lt; 0·05).ConclusionOn admission to the ICU, d-lactate, but not L-lactate, levels may predict later colonic ischaemia following repair of a ruptured AAA.
Repair of ventral hernias with expanded polytetrafluoroethylene patch
Authors: Balén E M , Díez-Caballero A , Hernández-Lizoáin J L , Pardo F , Torramadé J R , Regueira F M , Cienfuegos J A 
Published: March 2003

Abstract

Background
Operations for large and recurrent abdominal hernias have a high associated recurrence rate, although it is lower when prosthetic material is used. Expanded polytetrafluoroethylene (ePTFE) seems to be the best tolerated prosthetic material in surgery.

Methods
A series of 45 ventral hernias repaired using ePTFE for closure or reinforcement of the herniorrhaphy has been evaluated prospectively. Thirty-six were midline incisional hernias and nine were transverse or pararectal ventral hernias. There were 13 recurrent ventral hernias and three defects were operated as an emergency procedure. The patch was sutured to the anterior aponeurosis with a running non-absorbable suture. Some other kind of intra-abdominal procedure was undertaken in 12 cases.

Results
ePTFE was well tolerated. Complications occurred in five patients. Major complications were found in three patients: cutaneous necrosis requiring a myocutaneous flap; and infection of the prosthesis (primary, and secondary to enterocutaneous fistula due to diverticulitis, both requiring removal of the patch). Mean follow-up was 39 months and hernia recurrence occurred in only one patient.

Conclusion
This clinical experience shows that ePTFE is a very reliable prosthetic material for the repair of abdominal wall hernias.
Co-existing abdominal aortic aneurysm and intra-abdominal malignancy: reflections on the order of treatment
Authors: Morris H L , da Silva A F 
Published: March 2003

Abstract

Background
The management of simultaneously occurring abdominal aortic aneurysm and intra-abdominal malignancy is controversial. It is unclear whether to treat the aneurysm first or the malignancy, or both simultaneously. If the malignancy is resected first there is a risk of postoperative rupture of the aneurysm. If simultaneous surgery is performed there is a risk of prosthetic graft infection from contamination by gastrointestinal or urinary tract contents.

Methods
Relevant papers from 1960 to 1996, identified from Medline and manual searching, were reviewed.

Results and conclusion
The literature supports the conclusion that the lesion of greater priority is that posing the greater threat to the patient; this is usually the aneurysm, especially if it is over 6 cm in diameter. For renal malignancies simultaneous surgery is the treatment of choice, but for bladder cancer the best management is unclear. Large aneurysms should usually be resected in preference to colorectal cancer unless the cancer is locally advanced, perforated or likely to result in early intestinal obstruction. If both lesions are complicated there may be a case for simultaneous treatment.
Experimental study of the effect of intra-abdominal pressure during laparoscopy on tumour growth and port site metastasis
Authors: Jacobi C A , Wenger F A , Ordemann J , Gutt C , Sabat R , Müller J M 
Published: March 2003

Abstract

Background
The influence of raised intraperitoneal pressure during laparoscopy on tumour growth and port site metastasis is still unknown.

Methods
Tumour growth of colonic adenocarcinoma DHD/K12/TRb was measured after laparoscopy with carbon dioxide at different pressures (0, 5, 10 and 15 mmHg) in a rat model. Cell kinetics were determined after incubation with carbon dioxide (0, 5, 10 and 15 mmHg) in vitro (n = 60). Additionally, tumour growth was measured subcutaneously and intraperitoneally 4 weeks after laparoscopy at different intraperitoneal pressures (5, 10 and 15 mmHg) (n = 100).

Results
In vitro tumour growth decreased significantly after incubation with carbon dioxide at 10 and 15 mmHg compared with a pressure of 0 or 5 mmHg. In vivo, mean(s.d.) intraperitoneal tumour weight was significantly increased after laparoscopy at 5 mmHg (919(1085) mg) and at 10 mmHg (1274(1523) mg) (P &lt; 0·05), but decreased again after laparoscopy with an intraperitoneal pressure of 15 mmHg (731(929) mg) compared with the control group (365(353) mg) (P = 0·3). Mean(s.d.) subcutaneous tumour growth was promoted after laparoscopy at 5 mmHg (172(234) mg), at 10 mmHg (190(253) mg) and at 15 mmHg (178(194) mg) compared with controls (48(33) mg) (P &lt; 0·05).

Conclusion
In vitro, raised intraperitoneal pressure leads to suppression of tumour growth. In vivo, intraperitoneal tumour growth is suppressed only by higher pressure (15 mmHg). Subcutaneous tumour growth is stimulated by carbon dioxide independently of the intraperitoneal pressure.
Hepatocellular carcinoma
Authors: Akriviadis E A , Llovet J M , Efremidis S C , Shouval D , Canelo R , Ringe B , Meyers W C 
Published: March 2003

Abstract

Background
Hepatocellular carcinoma is one of the world's most common malignancies. The aims of the present paper are to review data on (1) epidemiology and screening programmes for the early detection of the tumour and (2) advances in the diagnostic imaging and management.

Methods
Relevant English language articles, published between January 1985 and December 1997, were reviewed. Articles were identified through Medline search, using the key words ‘hepatocellular carcinoma’. Articles cited in the bibliographies of these articles were searched manually.

Results
Hepatocellular carcinoma has a heterogeneous geographical distribution. Although its risk factors have been identified, the efficacy of screening programmes remains uncertain. Imaging has improved substantially with the recent application of dual-phase helical computed tomography and magnetic resonance imaging employing specific contrast agents. The comparative efficacy of conservative therapy and surgical resection is uncertain, since well controlled trials are lacking.

Conclusion
Hepatocellular carcinoma is commonly a problem of two diseases, the malignancy itself and cirrhosis. This renders treatment rarely curative, even when surgical resection can be applied in a technically successful sense. Liver transplantation could be a definitive treatment but this is plagued by limited donor resources.
Diagnosis and conservative management of intrathoracic leakage after oesophagectomy
Authors: Sauvanet A , Baltar J , Le Mee J , Belghiti J 
Published: March 2003

Abstract

Background
Although intrathoracic leakage is a major complication of oesophagectomy, precise data concerning diagnostic features and results of conservative treatment are lacking.

Methods
From 1986 to 1994, 409 oesophagectomies with stapled oesophagogastrostomy were performed, including 358 Lewis–Tanner and 51 Sweet procedures. A water-soluble contrast swallow was routinely performed on day 7 or later, before oral intake was begun. All patients except one received conservative non-surgical treatment, including nutritional support and perianastomotic drainage.

Results
Leaks were diagnosed in 38 patients (9·3 per cent). The leakage rate was 7·8 per cent after the Lewis–Tanner procedure and 20 per cent after the Sweet procedure (P &lt; 0·01). Eleven patients had no symptoms. Seven of the 27 patients with symptoms had a contrast swallow that was normal, and subsequently developed a confirmed fistula after the onset of oral intake. Five patients had to undergo reoperation. All asymptomatic patients and 18 symptomatic patients recovered. Nine patients died, mainly from multiple organ failure, including three who had reoperation for resection of the gastroplasty.

Conclusion
The potential presence of clinically silent fistula and the deleterious role of oral intake still justify routine detection of leakage after oesophageal resection. Conservative treatment results in survival with preservation of the gastroplasty in most patients, unless multiple organ failure occurs.
A new look at the anal transitional zone with reference to restorative proctocolectomy and the columnar cuff
Authors: Thompson-Fawcett M W , Warren B F , Mortensen N J McC 
Published: March 2003

Abstract

Background
The anal transitional zone (ATZ) is of interest in relation to anorectal function and its fate during the operation of restorative proctocolectomy. There are only a few studies describing the anatomy of this structure. This study applied new techniques to quantify the ATZ in normal and inflammatory bowel disease states.

Methods
The epithelial linings of 28 anal canals were analysed by two techniques: whole-mount Alcian blue staining and a new method of creating a computer map of the histological findings based on longitudinal sections taken every 3 mm. The Alcian blue pictures and the histology maps were measured and compared using image analysis software.

Results
The ATZ usually commences just above the dentate line, which is situated a median of 1·05 cm above the lower border of the internal sphincter. The median length of the ATZ measured from computer maps of the histology was 0·45 cm. This was significantly smaller than the 0·73 cm obtained by the Alcian blue technique, which overestimates the length of the ATZ. The amount of columnar epithelium in the ATZ is very small. The median lowest point of columnar epithelium in the anal canal was 1·1 cm above the lower border of the internal sphincter.

Conclusion
The ATZ is only half the length described previously. After double-stapled restorative proctocolectomy there is a 1·5–2·0-cm cuff of diseased columnar epithelium remaining in the upper anal canal above the ATZ. This is suitably termed the ‘columnar cuff’ and is an important consideration in long-term follow-up.
Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials
Authors: Song F , Glenny A-M 
Published: March 2003

Abstract

Background
A systematic review was carried out to assess the relative efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery.

Methods
MEDLINE, EMBASE, the Cochrane Trials Register and the references cited in retrieved studies were searched to identify relevant trials published between 1984 and 1995.

Results
Some 147 relevant trials were identified. The quality of trials has improved over the past 12 years. The results confirm that the use of antimicrobial prophylaxis is effective for the prevention of surgical wound infection after colorectal surgery. There was no significant difference in the rate of surgical wound infections between many different regimens. However, certain regimens appear to be inadequate (e.g. metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin plus erythromycin on the day before operation). A single dose administered immediately before the operation (or short-term use) is as effective as long-term postoperative antimicrobial prophylaxis (odds ratio 1·17 (95 per cent confidence interval (c.i.) 0·90–1·53)). There is no convincing evidence to suggest that the new-generation cephalosporins are more effective than first-generation cephalosporins (odds ratio 1·07 (95 per cent c.i. 0·54–2·12)).

Conclusion
Antibiotics selected for prophylaxis in colorectal surgery should be active against both aerobic and anaerobic bacteria. Administration should be timed to make sure that the tissue concentration of antibiotics around the wound area is sufficiently high when bacterial contamination occurs. Guidelines should be developed locally in order to achieve a more cost-effective use of antimicrobial prophylaxis in colorectal surgery.
Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996
Authors: Nilsson E , Haapaniemi S , Gruber G , Sandblom G 
Published: March 2003

Abstract

Background
Difficulties in obtaining and analysing outcome measures in hernia surgery may be an obstacle to necessary progress in non-specialized hospitals. Against this background a voluntary register was initiated in 1992 with the aim of describing and evaluating hernia surgery in participating units.

Methods
Prospective registration of all hernia operations carried out in participating hospitals was undertaken using identification codes specific for each individual. Repair technique, complications, day surgery, type of anaesthesia, and reoperation for recurrence were recorded. Actuarial analysis was used to determine the cumulative incidence of reoperation. Relative risk for reoperation was estimated by the Cox proportional hazards model.

Results
The number of participating hospitals and registered operations increased from eight and 1689 respectively in 1992 to 21 and 4056 in 1996. The use of mesh increased from 7 per cent of all operations in 1992 to 51 per cent in 1996. The proportion of operations done for recurrent hernia remained constant at 16–17 per cent throughout the 5-year study period. For all 12 542 herniorrhaphies registered, the cumulative incidence of reoperation at 2 years was 3 (95 per cent confidence interval 3–4) per cent. Postoperative complications, recurrent hernia, direct hernia and absorbable suture were associated with increased risk of reoperation for recurrence. An increased incidence of reoperation, although not statistically significant, was noted for conventional open repairs (Bassini, McVay, Marcy and others) versus the Shouldice technique.

Conclusion
In this prospective audit an increasing use of mesh was observed for open and laparoscopic surgery, especially for bilateral and recurrent hernia operations. Reoperation rates decreased significantly between 1992 and 1995.
Experience with the Mainz modification of ureterosigmoidostomy
Authors: Gerharz E W , Köhl U N , Weingärtner K , Kleinhans B J , Melekos M D , Riedmiller H 
Published: March 2003

Abstract

Background
The purpose of this study was to report experience with the revived surgical concept of ureterosigmoidostomy in its low pressure modification and to discuss its value within the current spectrum of urinary diversion.

Methods
Between February 1992 and September 1997 modified ureterosigmoidostomy (rectosigmoid pouch; Mainz pouch II) was performed in 34 patients aged 1·9–76·9 (mean 55·8) years as a primary urinary diversion after radical cystectomy for bladder cancer (n = 30) and benign conditions (bladder exstrophy, three patients; intractable urinary incontinence, one). All patients were followed prospectively according to a standard protocol including assessment of continence, renal function and acid–base balance.

Results
There were no perioperative deaths. In one patient dislocation of a ureteral stent in the early postoperative course required insertion of a percutaneous nephrostomy. All patients were continent during the day. One patient experienced night-time incontinence but rejected a conversion procedure. In one case ureterosigmoidostomy was replaced by an ileal conduit after several episodes of septicaemia. One nephrectomy was performed for ureterointestinal obstruction. Mild hyperchloraemic acidosis was seen in two patients.

Conclusion
Bowel frequency and urge incontinence, the major weaknesses of classical ureterosigmoidostomy, can be overcome by detubularization of the rectum. As the modified procedure is quick, safe and easy to perform with highly satisfactory results, the rectosigmoid pouch has potential in reconstructive urology.
Cost-effectiveness in the management of patients with oesophageal cancer
Authors: Farndon M A , Wayman J , Clague M B , Griffin S M 
Published: March 2003

Abstract

Background
The aim of this study was to assess the relationship between clinical outcome, quality of life and cost for treatment modalities commonly employed in the management of oesophageal carcinoma.

Methods
A series of 51 patients diagnosed with oesophageal carcinoma in a 6-month period was used to derive a cost analysis profile for their treatment. All patients underwent quality of life assessment. Patients diagnosed in 1993 and managed in Newcastle upon Tyne were identified from the Northern Cancer Registry and Hospital Episode Statistics. Intervention profiles were documented for a 3-year follow-up period and cost analysis was conducted. A further 51 patients were recruited prospectively for quality-of-life studies.

Results
Some 139 individuals were identified retrospectively. Median survival was significantly better in patients treated by resection (n = 31; median 20 months) than in those receiving palliative treatments (n = 108; median 6 months) (P &lt; 0·0001). Median cost was significantly greater in individuals who underwent resection (£8070) than for patients subjected to a palliative strategy (radiotherapy £4720, brachytherapy £1790, laser £3540, intubation £2450, no treatment £1390) (P &lt; 0·01). When considering the median cost per month of life (after treatment) resection (£457) compared favourably with the palliative options (range £342–1125).

Conclusion
Surgical resection for oesophageal carcinoma confers greatest benefit in terms of survival. Costs are inherently greater in individuals undergoing resection but, allowing for time, resection is at least as cost-effective as other treatment modalities.
Amelioration of liver injury by ischaemic preconditioning
Authors: Yoshizumi T , Yanaga K , Soejima Y , Maeda T , Uchiyama H , Sugimachi K 
Published: March 2003

Abstract

Background
Ischaemic preconditioning, i.e. preparatory brief ischaemia before subsequent long ischaemia, can effectively protect the heart from ischaemia–reperfusion injury in animals. The purpose of this study was to demonstrate the same phenomenon in the liver.

Methods
Using warm ischaemia–reperfusion of 70 per cent of the liver followed by resection of the non-ischaemic portion in rats, livers with 10 min of ischaemic preconditioning, i.e. 10 min of warm ischaemia and reperfusion, were compared with those that had not been subjected to such a manoeuvre.

Results
At 120 min after reperfusion following 40 min of warm ischaemia, the livers with 10 min of ischaemic preconditioning had a significantly lower mean (s.d.) serum alanine aminotransferase level (492 (217) versus 1236 (695) units/l; P &lt; 0·005) and lactic dehydrogenase level (7905 (4002) versus 15 066 (9201) units/l; P &lt; 0·05), as well as a higher bile output (0·12 (0·03) versus 0·09 (0·04) ml per g liver; P &lt; 0·05) and liver tissue adenosine 5§-triphosphate level (78 (13) versus 61 (11) per cent; P &lt; 0·05) than the control livers. The necrosis rate, histologically defined as the percentage of necrotic area in given liver sections, was reduced significantly by this manoeuvre (mean (s.d.) 1·3 (1·3) versus 5·3 (1·7) per cent; P &lt; 0·05).

Conclusion
Ischaemic preconditioning exerts a protective effect on hepatic warm ischaemia–reperfusion injury. Such a manoeuvre may be useful for hepatic resection in the clinical setting.
Ultrasonographically-guided fine-needle aspiration cytology in the diagnosis of colonic lesions
Authors: Heriot A G , Kumar D , Thomas V , Young M , Pilcher J , Joseph A E A 
Published: March 2003

Abstract

Background
The use of fine-needle aspiration cytology (FNAC) in the diagnosis of colonic lesions was investigated.

Methods
Some 22 patients (median age 71 years) with a colonic lesion identified on abdominal ultrasonography underwent ultrasonographically-guided FNAC using a 21-G needle. The sample was checked immediately by a cytopathologist for adequacy.

Results
Eighteen patients had colonic carcinoma; aspiration cytology detected malignant epithelial cells consistent with colonic carcinoma in 17 patients and severely dysplastic cells in one patient. The sensitivity and specificity of ultrasonographically-guided FNAC in the diagnosis of colonic carcinoma was 94 and 100 per cent respectively. The remaining four patients had a diagnosis of ileocaecal tuberculosis, ileocaecal Crohn's disease, and metastatic adenocarcinoma in the liver with no identifiable primary (two patients). One demonstrated granulomata, grew acid-fast bacilli and the patient was treated for tuberculosis. One had inflammatory cells and the patient was found to have Crohn's disease on histology. The remaining two patients had confirmed metastatic adenocarcinoma in the liver on aspiration cytology but suspected colonic lesions were found to be benign on cytological examination and no primary lesion was subsequently demonstrated. There were no complications of FNAC and patients complained of minimal discomfort. There has been no evidence of tumour recurrence with a median follow-up of 12 (range 1–25) months.

Conclusion
Ultrasonographically-guided FNAC is a valid method for the diagnosis of colonic tumours.