bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement
Authors:   QUOROM Group, Moher David , Cook Deborah J , Eastwood Susan , Olkin Ingram , Rennie Drummond , Stroup Donna F 
Published: March 2003

Abstract

Background
The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs).

Methods
The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items.

Findings
The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with ‘trial flow’, study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials.

Interpretation
We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Incidence of benign lesions in patients resected for suspicious hilar obstruction
Authors: Gerhards M F , Vos P , van Gulik T M , Rauws E A J , Bosma A , Gouma D J 
Published: March 2003

Abstract

Background
The differentiation between benign and malignant strictures at the hepatic hilum is difficult. The aim of this study was to assess the clinical and radiographical features of hilar lesions in a series of patients resected for a presumed cholangiocarcinoma.

Methods
Of 132 consecutive patients undergoing resection for a suspicious lesion at the hepatic hilum, 20 (15 per cent) had a histopathologically proven benign tumour, diagnosed as chronic fibrosing or erosive inflammation, sclerosing cholangitis, or a granular cell tumour. All medical files and radiological examinations of the patients were reassessed.

Results
Clinical symptoms were considered suspicious in 16 of 19 patients. At ultrasonography only one of 16 patients had an unsuspicious examination. In 14 of 18 patients cholangiographic images were considered suspicious. Overall reassessment confirmed a suspicious lesion in all 20 patients.

Conclusion
Because of the limitations of current diagnostic tools, a false-positive preoperative diagnosis of malignancy resulted in a 15 per cent resection rate of benign lesions in this series of suspicious hilar strictures.
Training in infrainguinal bypass surgery for severe leg ischaemia
Authors: Papp L , Evans S M , Kelman J , Chalmers R T A , Murie J A , Bradbury A W 
Published: March 2003

Abstract

Background
Recent changes in surgical training in the UK mean that operative experience must be gained more efficiently. However, it is important to demonstrate that improved training opportunities are not associated with inferior patient outcomes. The aim was to examine changes in training in infrainguinal bypass surgery and to compare the outcomes of operations performed by consultants and trainees.

Methods
A prospectively gathered, computerized database of 1077 consecutive infrainguinal bypasses performed on 1003 patients for chronic severe leg ischaemia between 1 January 1983 and 31 December 1998 was analysed.

Results
Consultants performed 733 (68 per cent) infrainguinal bypasses to the following distal sites: 347 (47 per cent) above-knee popliteal artery, 257 (35 per cent) below-knee popliteal artery, 121 (17 per cent) to a crural artery and eight (1 per cent) other. Trainees performed 344 operations: 170 (49 per cent) were to the above-knee popliteal artery, 122 (35 per cent) to the below-knee popliteal artery, 48 (14 per cent) crural and four (1 per cent) other. The operative mortality rate was 27 (4 per cent) of 733 for consultants and 11 (3 per cent) of 344 for trainees (P &gt; 0·05, χ2 test). There were no significant differences in patency or limb salvage at 36 months after operation between consultants and trainees, regardless of the site of distal anastomosis and the type of conduit used.

Conclusion
With appropriate case selection and supervision, training in infrainguinal bypass grafting does not compromise early or long-term patient outcomes.
Presented to the Vascular Surgical Society, Leicester, 24 November 1999, and published in abstract form as Br J Surg 2000; 87: 490
Potential of laparoscopic ultrasonography as an alternative to operative cholangiography in the detection of bile duct stones
Authors: Tranter S E , Thompson M H 
Published: March 2003

Abstract

Background
Intraoperative cholangiography (IOC) is time consuming, requires radiation and sometimes fails. In contrast, laparoscopic ultrasonography (LUS) is a comparatively quick, safe and non-invasive technique. The aim of this study was to assess the potential of LUS as an alternative to IOC.

Methods
LUS was performed on 367 patients undergoing laparoscopic cholecystectomy. Laparoscopic duct exploration was performed in the presence of duct stones. Data were collected prospectively. The presence or absence and number of duct stones detected by LUS were recorded. The maximum bile duct diameter determined by LUS was compared with a preoperative ultrasonographic measurement according to age and the presence of duct stones. The final arbiter was the demonstration of stones removed at laparoscopic duct exploration (59 patients) or subsequently by endoscopic retrograde cholangiopancreatography (two patients).

Results
LUS visualized the CBD in 99 per cent of patients and the common hepatic duct in 92 per cent. It identified stones in 56 of the 61 patients with duct stones. No stones were demonstrated in the remaining 306 patients (sensitivity 92 per cent, specificity 100 per cent, positive predictive value 100 per cent, negative predictive value 98 per cent). LUS underestimated the total number of stones in 18 per cent of patients with common duct stones. The mean common bile duct diameter was 5·0 mm before operation and 5·9 mm during the procedure in patients without duct stones, rising significantly to a mean of 9·2 mm before operation and 11·2 mm at LUS in those with duct stones (P &lt; 0·0001).

Conclusion
The combination of the demonstration of duct stones and bile duct diameter measurement makes LUS a potential replacement for IOC. Improved demonstration of the common hepatic duct would be advantageous.
Use of cadaveric superior mesenteric artery as interpositional vascular graft in orthotopic liver transplantation
Authors: Muiesan P , Rela M , Heaton N D 
Published: March 2003

Abstract

Background
Hepatic artery thrombosis remains the most common technical complication that causes graft failure following orthotopic liver transplantation. The development of split liver and living related liver transplantation has led to the use of shorter and smaller arteries for arterial reconstruction to the graft. The present aim was to assess the effectiveness of the superior mesenteric artery as an interpositional graft in arterial reconstruction during liver transplantation.

Methods
Cadaveric superior mesenteric artery was used to reconstruct small and short or multiple hepatic arteries in 35 liver transplants including 29 split, three living related, two whole liver transplants and one emergency revascularization post-transplantation.

Results and conclusion
A low incidence of hepatic artery thrombosis (one of 35 patients) was achieved utilizing cadaveric superior mesenteric artery as an interpositional vascular graft in liver transplantation.
Treatment of ruptured hepatocellular adenoma
Authors: Terkivatan T , de Wilt J H W , de Man R A , van Rijn R R , Tilanus H W , IJzermans J N M 
Published: March 2003

Abstract

Background
As the morbidity and mortality rates associated with emergency resection in patients with a ruptured hepatocellular adenoma are high, the authors have favoured initial non-operative management in haemodynamically stable patients.

Methods
A retrospective study was performed to evaluate the treatment of ruptured hepatocellular adenoma.

Results
Over a 21-year interval, 12 patients presented with a ruptured hepatocellular adenoma. Haemodynamic observation and support was the initial management in all 12 patients. Three underwent urgent laparotomy and gauze packing because of haemodynamic instability; no emergency liver resection was necessary. Eight patients had definitive surgery; three developed postoperative complications but none died. Regression of the tumour was observed in three of four patients treated conservatively.

Conclusion
The initial management of a ruptured hepatocellular adenoma should be haemodynamic stabilization. Definitive resection is required for rebleeding or for tumours exceeding 5 cm in diameter. A conservative approach may well be justified in case of regression of an asymptomatic adenoma.
Incidence of acquired immune deficiency syndrome (AIDS)-related disorders at laparotomy in patients with AIDS
Authors: Chambers A J , Lord R S A 
Published: March 2003

Abstract

Background
Patients with acquired immune deficiency syndrome (AIDS) present for surgical management of abdominal conditions that are complications of advanced human immunodeficiency virus (HIV) infection or that are caused by other disease not related to AIDS. This study compared the clinical details and postoperative outcomes of patients with AIDS-related diseases found at laparotomy with those of patients with non-AIDS-related disorders.

Methods
The medical records of 30 consecutive patients with AIDS who underwent laparotomy were examined retrospectively.

Results
Fourteen patients had AIDS-related pathologies found at laparotomy, 13 had disease processes that were not AIDS related and three had no abnormal findings at laparotomy. Patients with AIDS-related conditions at laparotomy had lower mean body-weight, serum albumin concentration and CD4 lymphocyte count, and required a longer hospital admission than those who had non-AIDS-related disease. The duration of HIV infection and the number of complications and deaths were similar in the two groups. Complications occurred in 21 patients and there were five deaths (30-day mortality rate 17 per cent).

Conclusion
AIDS-related pathologies are commonly found at laparotomy in patients with HIV/AIDS. An AIDS-related diagnosis does not confer a greater risk of complication or postoperative death than other conditions.
Portal vein embolization: rationale, technique and future prospects
Authors: Abdalla E K , Hicks M E , Vauthey J N 
Published: March 2003

Abstract

Background
Advances in surgery have reduced the mortality rate after major liver resection, but complications resulting from inadequate postresection hepatic size and function remain. Portal vein embolization (PVE) was proposed to induce hypertrophy of the anticipated liver remnant in order to reduce such complications. The techniques, measurement methods and indications for this treatment remain controversial.

Methods
A Medline search was performed to identify papers reporting the use of PVE before hepatic resection. Techniques, complications and results are reviewed.

Results
Complications of PVE typically occur in less than 5 per cent of patients. No specific substance (cyanoacrylate, thrombin, coils or absolute alcohol) emerged as superior. The increase in remnant liver volume averages 12 per cent of the total liver. The morbidity rate of resection after treatment is less than 15 per cent and the mortality rate is 6–7 per cent with cirrhosis and 0–6·5 per cent without cirrhosis. Embolization is currently used for patients with a normal liver when the anticipated liver remnant volume is 25 per cent or less of the total liver volume, and for patients with compromised liver function when the liver remnant volume is 40 per cent or less.

Conclusion
This treatment does not increase the risks associated with major liver resection. It may be indicated in selected patients before major resection. Future prospective studies are needed to define more clearly the indications for this evolving technique.
Transvaginal repair of pouch–vaginal fistula
Authors: Burke D , van Laarhoven C J H M , Herbst F , Nicholls R J 
Published: March 2003

Abstract

Background
The results of surgery for ileoanal pouch–vaginal fistula have been disappointing. Intra-anal procedures result in fistula healing in, at best, approximately 50 per cent of patients. A transvaginal approach was developed to achieve direct access to the internal opening, enabling closure without damage to the anal sphincter.

Methods
Fourteen patients were treated between January 1992 and December 1998. All had had restorative proctocolectomy for ulcerative colitis and all were defunctioned. Histological review confirmed the diagnosis in all patients.

Results
Median age was 40 (range 25–52) years. Median follow-up was 18 (range 6–60) months. The operation was successful in 11 of the 14 patients, after one attempt in six patients, after two attempts in four, and after three attempts in one patient. The operation failed in three patients, who had a permanent ileostomy. The number of bowel actions in the patients who had successful closure ranged from 2 to 10 (median 6) in 24 h, with no faecal incontinence reported.

Conclusion
This simple technique achieved healing in 11 of 14 patients. This compares favourably with the poor results in 28 patients treated by other procedures in the same hospital, with certain healing in five and definite failure in 20.
Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit
Authors: Smedh K , Olsson L , Johansson H , Åberg C , Andersson M 
Published: March 2003

Abstract

Background
Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques.

Methods
All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993–1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144).

Results
The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P &lt; 0·001). Surgical complications dropped from 37 to 11 per cent (P &lt; 0·001). The relaparotomy rate fell from 11 to 4 per cent (P &lt; 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P &lt; 0·001).

Conclusion
The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.
Preliminary study of D-dimer as a possible marker of acute bowel ischaemia
Authors: Acosta S , Nilsson T K , Björck M 
Published: March 2003

Abstract

Background
Occlusion of the superior mesenteric artery (SMA) demands prompt recognition and diagnosis. No accurate diagnostic method is available. The aim of this study was to determine whether the fibrinolytic marker D-dimer is a useful early marker of acute bowel ischaemia.

Methods
Fourteen patients suspected of having acute bowel ischaemia were analysed for an increase in plasma D-dimer level.

Results
Six patients had embolic or thrombotic occlusion of the SMA and all had significantly higher D-dimer levels than those without thromboembolic occlusion (P &lt; 0·05). Four patients with strangulation of the small bowel due to adhesions and one with a ruptured aortic aneurysm also had raised D-dimer values.

Conclusion
In patients with suspected thromboembolic occlusive disease of the SMA, a raised level of D-dimer indicated the presence of acute bowel ischaemia, whatever the cause. A more extensive prospective study is needed to evaluate a potential survival benefit using the test as a marker of the need for urgent laparotomy.
Randomized clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy
Authors: Cheong W K , Seow-Choen F , Eu K W , Tang C L , Heah S M 
Published: March 2003

Abstract

Background
Opioids are often used to decrease pain following laparotomy but are associated with unwanted side-effects. The effectiveness of local perfusion of bupivacaine 0·5 per cent following laparotomy was studied.

Methods
A prospective randomized study involving patients undergoing laparotomy for major colorectal surgery using a left iliac fossa skin crease incision was undertaken. Patients were randomized to receive either intermittent intravenous morphine infusion on demand with patient-controlled analgesia (PCA group) or continuous wound perfusion of local bupivacaine 0·5 per cent for 60 h (LA group).

Results
Seventy patients were recruited, 35 in each group. Patient demographics, surgical and recovery variables and complications were comparable in the two groups. The wound lengths were similar (median 14 cm in both groups). There was no statistically significant difference in postoperative pain scores at rest and with movement between the two groups, except for pain scores at rest on the first postoperative day (P = 0·03). The median total amount of morphine used was significantly greater in the PCA group (median 38 versus 0 mg in the LA group; P &lt; 0·001).

Conclusion
Direct continuous local wound perfusion of bupivacaine 0·5 per cent is as effective as PCA for postoperative pain relief after laparotomy. It is a safe and feasible alternative to parenteral opioids.
Management of aortic aneurysm in the presence of a horseshoe kidney
Authors: Stroosma O B , Kootstra G , Schurink G W H 
Published: March 2003

Abstract

Background
The coexistence of an aortic aneurysm and a horseshoe kidney poses a technical challenge to the vascular surgeon at the time of aneurysm repair. The aim of this review is to develop a guideline for the treatment of patients with this dual pathology.

Method
A literature review combined with local experience provided a total of 176 cases. These were divided into two groups: asymptomatic aneurysms (134) and ruptured aneurysms (42), both in combination with a horseshoe kidney.

Results
Six types of operative approach were described: transperitoneal approach with or without separation of the renal isthmus, retroperitoneal approach, placement of a stent-graft, aneurysmal wrap and exploration without exclusion of the aneurysm. Diagnosis of the horseshoe kidney was made before operation in 81 per cent of patients in the asymptomatic group, and in 55 per cent (23 of 42) in the ruptured group. Computed tomography proved to be the most reliable diagnostic procedure. Occlusion of renal arteries originating from the aneurysm was reported in 51 per cent in the asymptomatic group, and in 74 per cent (23 of 31) in the ruptured group.

Conclusion
The preferred surgical options for asymptomatic patients with an aortic aneurysm and a horseshoe kidney are the placement of a stent-graft or a retroperitoneal approach; both avoid many of the technical difficulties related to the presence of the horseshoe kidney. The approach of choice for a ruptured aneurysm is transperitoneal. Separation of the renal isthmus should be avoided.
Neoadjuvant chemoradiotherapy for operable oesophageal carcinoma: preliminary results from Sheffield
Authors: Welch I McL , Fisher P M , Stoddard C J , Wyman A 
Published: March 2003

Abstract

Background
Surgical resection is the mainstay of treatment for potentially curable oesophageal carcinoma but the long-term survival rate remains 10–20 per cent. Neoadjuvant administration of chemoradiotherapy (NCR) may improve these values. In this study the authors reviewed their preliminary experience with NCR in Sheffield.

Methods
Twenty-five patients with potentially resectable oesophageal carcinoma embarked on a regimen of NCR, with resection planned 4–6 weeks later. Chemotherapy incorporated two cycles of intravenous cis-platinum and 5-fluorouracil with external-beam radiotherapy administered synchronously (30–45 Gy).

Results
Twenty-two of the 25 patients suffered side-effects from NCR, including one death, and seven patients failed to complete NCR as planned. The median interval from diagnosis to surgery was 121 days. Twelve out of 24 patients had significant postoperative complications, including two deaths. Seven patients had a complete histological response to NCR (three out of 15 for adenocarcinoma, four out of nine for squamous carcinoma).

Conclusion
The complete histological response rate to NCR in these patients compares favourably with previous studies, as does the postoperative mortality, but this was at the expense of substantial morbidity and was associated with long delays from diagnosis to operation. At present it is not possible to predict which patients will respond favourably to NCR and whether they will benefit with improved survival.
Oesophageal diverticula
Authors: Thomas M L , Anthony A A , Fosh B G , Finch J G , Maddern G J 
Published: March 2003

Abstract

Background
Oesophageal pulsion diverticula, excluding pharyngeal types, are uncommon sequelae of oesophageal dysmotility. Current opinion favours myotomy as effective therapy, but the role of diverticulectomy, myotomy selection and placement, and the need for fundoplication remain unresolved.

Methods
A Medline search and review of references identified relevant English language articles. Data on epidemiology, aetiology, oesophageal motility, pathology, symptomatology, investigations, surgical management and outcome were examined.

Results
Data were largely retrospective. Significant morbidity and mortality were associated with pulmonary aspiration and diverticulectomy site leaks. Surgical outcome was similar whether or not a diverticulectomy was added to a myotomy, but a myotomy clearly reduced the risk of leaks. Fundoplication reduced the incidence of postcardiomyotomy reflux symptoms. Results from minimally invasive techniques were similar to those of open surgery.

Conclusion
Surgery should be reserved for symptomatic patients; asymptomatic patients may benefit from surveillance. Pulmonary aspiration mandates surgical intervention. Myotomy remains the mainstay of treatment and an adequate subdiverticular extension is crucial in relieving obstruction. A partial fundoplication is preferred in selected patients. Minimally invasive techniques should become the routine approach for oesophageal pulsion diverticula.