bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of anatomical wrap position on the outcome of Nissen fundoplication
Authors: Donkervoort S C , Bais J E , Rijnhart-de Jong H , Gooszen H G 
Published: July 2003

Abstract

Background
The importance of anatomical reposition and fixation of the type I hiatal hernia during antireflux surgery has often been emphasized. It is not known whether the initial anatomical repair withstands the test of time and whether this repair is necessary for a successful outcome.

Methods
The relationship between the objective anatomical and subjective symptomatic outcome of Nissen fundoplication was investigated prospectively in 57 patients. Findings of herniation, telescoping and obstruction at the level of the lower oesophageal sphincter on barium swallow were scored 2 years after operation by investigators who were unaware of the symptoms, and were related to symptoms and patient satisfaction evaluated by a standard questionnaire.

Results
According to strict criteria, some 55 per cent of patients had some degree of anatomical failure; if only complete herniation, significant telescoping and signs of obstruction were scored as abnormal, 27 per cent had anatomical failure. There was no relation to subjective outcome; relief was reported by 48 of 49 patients, 25 of whom were cured and 23 significantly improved.

Conclusion
Anatomical repair during antireflux surgery does not stand the test of time. Although this has no demonstrable influence on the subjective outcome, the authors do not recommend deviating from well designed surgical guidelines. Current theories on the mechanism of antireflux surgery require further evaluation.
Magnetic resonance imaging for primary fistula in ano
Authors: Buchanan G N , Halligan S , Williams A B , Cohen C R G , Tarroni D , Phillips R K S , Bartram C I 
Published: July 2003

Abstract

Background
This was a prospective study designed to determine the therapeutic impact of magnetic resonance imaging (MRI) in primary fistula in ano, and to assess its effect on outcome.

Methods
Thirty patients with suspected primary fistula in ano underwent preoperative MRI, and the findings were revealed during surgery following examination under anaesthesia (EUA). Any effect on operative approach was noted. Outcome was assessed at a median of 12 months.

Results
Two patients had sinuses, one had no sepsis and 27 had fistulas: five superficial, seven intersphincteric, 14 trans-sphincteric and one suprasphincteric. MRI and EUA agreed in 15 patients and MRI findings altered the surgical approach in a further three (10 per cent); two of the latter patients were believed to have a sinus at EUA, which MRI correctly identified as a fistula, allowing definitive treatment. The therapeutic impact of MRI was therefore 10 per cent. Persisting disagreement between MRI and EUA in 12 patients mostly related to minor discrepancies in classification. Only one patient required further unplanned surgery, which was for skin-bridging rather than any new sepsis.

Conclusion
In experienced hands, MRI has a therapeutic impact of 10 per cent for primary fistula in ano, precipitating surgery that is likely to reduce recurrence in a small, but important, proportion of patients.
Randomized clinical trial of ultrasonicversuselectrocautery dissection of the gallbladder in laparoscopic cholecystectomy
Authors: Janssen I M C , Swank D J , Boonstra O , Knipscheer B C , Klinkenbijl J H G , van Goor H 
Published: July 2003

AbstractBackgroundLaparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and intraoperative consequences.MethodsBetween January 1998 and January 2000, 200 patients undergoing elective laparoscopic cholecystectomy were randomized to electrocautery or ultrasonic dissection of the gallbladder. The main outcome measures were gallbladder perforation, operating time and the number of times the lens was cleaned. Univariate and multivariate analyses were performed.ResultsThe perforation rate differed significantly: 16 per cent for ultrasonic dissection (n = 96) and 50 per cent for electrocautery (n = 103) (P &lt; 0·001). The operating time of the least experienced surgeons, who had performed fewer than ten laparoscopic cholecystectomies, was significantly shorter when ultrasonic dissection was used, compared with electrocautery. The number of times the lens needed to be cleaned was significantly lower when ultrasonic dissection was used in complicated gallbladders (P &lt; 0·035). At logistic regression analysis, the risk of perforation in the electrocautery group was about four times higher (odds ratio 0·26, P &lt; 0·001) than that in the ultrasonic group. When the groups were matched for prognostic factors, including body mass index and surgical experience, the results were similar to those obtained with univariate and multivariate analysis.ConclusionThe use of ultrasonic dissection in laparoscopic cholecystectomy reduces the incidence of gallbladder perforation and helps the operation to progress. Less experienced surgeons benefit most from ultrasonic dissection, particularly in complicated intraoperative circumstances.
Perioperative detection of disseminated tumour cells is an independent prognostic factor in patients with colorectal cancer
Authors: Bosch B , Guller U , Schnider A , Maurer R , Harder F , Metzger U , Marti W R 
Published: July 2003

AbstractBackgroundThe objective of the present investigation was to assess the prognostic significance of disseminated tumour cells in peritoneal lavage, and peripheral and mesenteric venous blood in patients undergoing curative resection of colorectal cancer.MethodsThe prognostic impact of perioperative cytological and immunocytochemical detection of disseminated colorectal cancer cells was evaluated prospectively. Peritoneal lavage fluid, and peripheral and mesenteric venous blood from 53 consecutive patients undergoing curative surgery for colorectal cancer were analysed. The dichotomous results (positive versus negative) from the cytological and immunocytochemical analysis were used as a predictor along with other co-variates in proportional hazard regression models of disease-free and overall survival.ResultsDisseminated colorectal cancer cells were found in 13 of 53 patients (25 per cent) using cytology (CYT) and/or immunocytochemistry (ICC). The median follow-up at the time of the analysis was 37 months. In multivariate proportional hazard regression models CYT/ICC status was a significant predictor for disease-free (P = 0·002) and overall (P = 0·006) survival.ConclusionDisseminated tumour cells detected by CYT and ICC represent an independent prognostic factor in patients undergoing surgery for colorectal cancer and may identify patients at high risk of recurrence.
Value of the Glasgow Aneurysm Score in predicting the immediate and long-term outcome after elective open repair of infrarenal abdominal aortic aneurysm
Authors: Biancari F , Leo E , Ylönen K , Vaarala M H , Rainio P , Juvonen T 
Published: July 2003

AbstractBackgroundThis study aimed to explore the value of the Glasgow Aneurysm Score in predicting the immediate and long-term outcome after elective open repair of abdominal aortic aneurysm (AAA).MethodsSome 403 patients underwent elective open repair of an infrarenal AAA and were classified retrospectively according to the criteria of the Glasgow Aneurysm Score (risk score = (age in years) + (7 for myocardial disease) + (10 for cerebrovascular disease) + (14 for renal disease)).ResultsFourteen patients (3·5 per cent) died after operation, 23 (5·7 per cent) had a myocardial infarction and six (1·5 per cent) had a stroke. One hundred and nine patients (27·0 per cent) experienced severe postoperative complications. The Glasgow Aneurysm Score was predictive of postoperative death (area under the receiver–operator characteristic curve (AUC) 0·80, 95 per cent confidence interval (c.i.) 0·71 to 0·90), severe postoperative complications (AUC 0·67, 95 per cent c.i. 0·61 to 0·73), myocardial infarction (AUC 0·72, 95 per cent c.i. 0·62 to 0·82), myocardial infarction-related postoperative death (AUC 0·78, 95 per cent c.i. 0·63 to 0·94) and stroke (AUC 0·84, 95 per cent c.i. 0·74 to 0·95). Univariate analysis showed that this risk index was also predictive of long-term survival.ConclusionThe Glasgow Aneurysm Score is a good predictor of outcome after elective open repair of AAA. Its simplicity and accuracy make it useful for preoperative risk stratification.
Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers
Authors: O'Brien J F , Grace P A , Perry I J , Hannigan A , Clarke Moloney M , Burke P E 
Published: July 2003

Abstract

Background
The aim of this study was to compare the cost-effectiveness of four-layer compression bandaging for venous leg ulcers with that of other available treatments.

Methods
In this pragmatic trial, 200 patients with a venous leg ulcer were randomized either to four-layer bandaging (intervention group; n = 100) or to continue their usual system of care (control group; n = 100). The follow-up for each patient was 12 weeks. Analysis was by intention to treat; the main outcome measures were time to healing and cost to the health board per leg healed.

Results
Baseline characteristics were well matched in the two groups. The Kaplan–Meier estimate of the healing rate at 3 months was 54 per cent with four-layer bandaging and 34 per cent in the control group. Throughout the 3 months, four-layer bandaging healed leg ulcers significantly earlier (P = 0·006). There was a significant reduction in the median cost per leg healed with four-layer bandaging (€210 versus €234; P = 0·040).

Conclusion
Four-layer bandaging is currently the most effective method of treating venous leg ulcers in a community setting.
Mid-term results for second-generation thoracic stent grafts
Authors: Bell R E , Taylor P R , Aukett M , Sabharwal T , Reidy J F 
Published: July 2003

Abstract

Background
Thoracic stent grafts offer an alternative to open surgery for thoracic aortic disease, but their long-term durability is unknown. This report includes mid-term follow-up for commercially available thoracic devices.

Methods
Data were collected prospectively for a series of endoluminal grafts used to treat thoracic aortic pathology.

Results
Between July 1997 and October 2002, 67 patients received thoracic stent grafts. Elective procedures incurred a 30-day mortality rate of 2 per cent (one of 42 patients) and urgent repair 16 per cent (four of 25). Paraplegia affected three (4 per cent) of 67 patients and three patients had a stroke. The median follow-up was 17 (range 2–64) months; four patients were lost. There were six late deaths, two from aneurysm rupture (rupture of a mycotic aneurysm at 5 months and stent migration at 28 months). Other device-related complications comprised three proximal endoleaks, one of which required open surgical correction with removal of the stent graft, and two distal endoleaks, which were successfully treated with distal extension cuffs.

Conclusion
In the mid term, endoluminal repair of thoracic aortic pathology appears to be a safe alternative to open surgery, but continued surveillance is essential.
Thromboprophylaxis can be omitted in selected patients undergoing varicose vein surgery and hernia repair
Authors: Enoch S , Woon E , Blair S D 
Published: July 2003

Abstract

Background
There is no current agreement on the routine use of thromboprophylaxis in patients undergoing varicose vein surgery and hernia repair. In the authors' hospital, prophylaxis is given only to those considered to be at an increased risk. A retrospective review was conducted to determine whether it was safe to omit prophylaxis in low-risk patients.

Methods
Data were extracted from the hospital database about all patients who underwent the above procedures between January 1997 and December 2001. The case notes of patients who developed venous thromboembolism (VTE) within 3 months of surgery were reviewed. The pharmacy database was then analysed to determine the effect of prophylaxis.

Results
A total of 4670 patients were identified. Some 2186 patients had varicose vein surgery; 1283 patients received prophylaxis, of whom four developed VTE. None of the 903 patients who did not receive prophylaxis developed VTE. A total of 2484 patients had hernia repair, of whom 1854 patients received prophylaxis and 630 did not; one patient from each group developed VTE.

Conclusion
Low-risk patients having hernia and vein surgery do not need thromboprophylaxis.
Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition
Authors: Dobbins B M , Catton J A , Tighe M J , Miller G V , Martin I G , McMahon M J 
Published: July 2003

Abstract

Background
The contribution of glyceryl trinitrate (GTN) to prevention of peripheral vein thrombophlebitis (PVT) during peripheral intravenous nutrition delivered by fine-bore midline intravenous catheter is unclear. The aim of this study was to establish its role.

Methods
Two consecutive randomized clinical trials were conducted. In trial 1 patients were randomized to receive standard peripheral intravenous nutrition containing heparin and hydrocortisone with or without the placement of a topical GTN patch (triple therapy or dual therapy). In trial 2 patients were randomized to receive standard peripheral intravenous nutrition with either dual therapy or topical GTN alone (monotherapy).

Results
Dual therapy was as effective as triple therapy in preventing PVT (incidence 10 of 37 versus 11 of 39 patients respectively). Dual therapy reduced the incidence and increased the time to onset of PVT compared with monotherapy (14 of 41 versus 22 of 35 patients respectively, P = 0·012; median 17·3 (95 per cent confidence interval (c.i.) 13·4 to 21·1) versus 8·9 (95 per cent c.i. 6·7 to 11·0) days, P = 0·007).

Conclusion
Use of a topical GTN patch confers no benefit when peripheral intravenous nutrition is delivered via a fine-bore midline intravenous catheter.
Parastomal hernia
Authors: Carne P W G , Robertson G M , Frizelle F A 
Published: July 2003

Abstract

Background
Parastomal hernia following formation of an ileostomy or colostomy is common. This article reviews the incidence of hernia, the technical factors related to the construction of the stoma that may influence the incidence, and the success of the different methods of repair.

Methods
A literature search using the Medline database was performed to locate English language articles on parastomal hernia. Further articles were obtained from the references cited in the literature initially reviewed.

Results
Parastomal hernia affects 1·8–28·3 per cent of end ileostomies, and 0–6·2 per cent of loop ileostomies. Following colostomy formation, the rates are 4·0–48·1 and 0–30·8 per cent respectively. Site of stoma formation (through or lateral to rectus abdominis), trephine size, fascial fixation and closure of lateral space are not proven to affect the incidence of hernia. The role of extraperitoneal stoma construction is uncertain. Mesh repair gives a lower rate of recurrence (0–33·3 per cent) than direct tissue repair (46–100 per cent) or stoma relocation (0–76·2 per cent).

Conclusion
The incidence of parastomal hernia is between 0 and 48·1 per cent, depending on the type of stoma and length of follow-up. No technical factors related to the construction of the stoma have been shown to prevent herniation. If repair is required, a prosthetic mesh technique should be considered. Further randomized clinical trials (particularly of extraperitoneal stoma construction) are needed.
Extracorporeal shockwave lithotripsy in the management of salivary calculi (Br J Surg 2003; 90: 482–485)
Authors: Mahawar K K 
Published: July 2003

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.
A fully hydrodynamic model for three‐dimensional, free‐surface flows
Authors: Chen XinJian 
Published: July 2003

AbstractThe hydrostatic pressure assumption has been widely used in studying water movements in rivers, lakes, estuaries, and oceans. While this assumption is valid in many cases and has been successfully used in numerous studies, there are many cases where this assumption is questionable. This paper presents a three‐dimensional, hydrodynamic model for free‐surface flows without using the hydrostatic pressure assumption. The model includes two predictor–corrector steps. In the first predictor–corrector step, the model uses hydrostatic pressure at the previous time step as an initial estimate of the total pressure field at the new time step. Based on the estimated pressure field, an intermediate velocity field is calculated, which is then corrected by adding the non‐hydrostatic component of the pressure to the estimated pressure field. A Poisson equation for non‐hydrostatic pressure is solved before the second intermediate velocity field is calculated. The final velocity field is found after the free surface at the new time step is computed by solving a free‐surface correction equation.The numerical method was validated with several analytical solutions and laboratory experiments. Model results agree reasonably well with analytical solutions and laboratory results. Model simulations suggest that the numerical method presented is suitable for fully hydrodynamic simulations of three‐dimensional, free‐surface flows. Copyright © 2003 John Wiley & Sons, Ltd.
Microbial controls on methane fluxes from a polygonal tundra of the Lena Delta, Siberia
Authors: Wagner D. , Kobabe S. , Pfeiffer E.‐M. , Hubberten H.‐W. 
Published: July 2003

AbstractPermafrost soils of high‐latitude wetlands are an important source of atmospheric methane. In order to improve our understanding of the large seasonal fluctuations of trace gases, we measured the CH4 fluxes as well as the fundamental processes of CH4 production and CH4 oxidation under in situ conditions in a typical polygon tundra in the Lena Delta, Siberia. Net CH4 fluxes were measured from the polygon depression and from the polygon rim from the end of May to the beginning of September 1999. The mean flux rate of the depression was 53.2 ± 8.7 mg CH4 m−2 d−1 with maximum in mid‐July (100–120 mg CH4 m−2 d−1), whereas the mean flux rate of the dryer rim part of the polygon was 4.7 ± 2.5 CH4 m−2 d−1. The microbial CH4 production and oxidation showed significant differences during the vegetation period. The CH4 production in the upper soil horizon of the polygon depression was about 10 times higher (38.9 ± 2.9 nmol CH4 h−1 g−1) in July than in August (4.7 ± 1.3 nmol CH4 h−1 g−1). The CH4 oxidation behaved exactly in reverse: the oxidation rate of the upper soil horizon was low (1.9 ± 0.3 nmol CH4 h−1 g−1) in July compared to the activity in August (max. 7.0 ± 1.3 nmol CH4 h−1 g−1). The results indicated clearly an interaction between the microbiological processes with the observed seasonal CH4 fluctuations. However, the CH4 production is primarily substrate dependent, while the oxidation is dependent on the availability of oxygen. The temperature plays only a minor role in both processes, probably because the organisms are adapted to extreme temperature conditions of the permafrost. For the understanding of the carbon dynamics in permafrost soils, a differentiated small‐scale view of the microbiological processes and the associated modes of CH4 fluxes is necessary, especially at key locations such as the Siberian Arctic. Copyright © 2003 John Wiley & Sons, Ltd.
Dissolved organic carbon fluxes in a discontinuous permafrost subarctic alpine catchment
Authors: Carey Sean K. 
Published: July 2003

AbstractThe sources and fluxes of dissolved organic carbon (DOC) were investigated within a subarctic catchment with discontinuous permafrost (Granger Basin, Yukon) from 23 June 2001 to 22 June 2002. During spring freshet, stream DOC increased rapidly on the rising limb of the hydrograph, peaked prior to maximum discharge, then declined exponentially to pre‐baseflow levels while flows remained high. During summer storms, a similar pattern was observed whereby DOC increased on the ascending hydrograph limbs and peaked prior to maximum flows. Suction lysimeter and well data indicate that most of the DOC was mobilized from within near‐surface organic soils. Comparisons between permafrost and seasonal frost slopes indicate that permafrost slopes are a greater source of DOC due to their thicker organic soils and wetter antecedent conditions that promote lateral flow in the shallower soil layers of the active layer. In contrast, slopes with seasonal frost encourage percolation and sorption of DOC in deeper mineral layers. Mass balance estimates of DOC export using actual and extrapolated data from regressions of DOC versus discharge indicate that 1.64 g C m−2 was exported from Granger Basin during the study year, 69% of this occurred during the 13 May to 22 June snowmelt period. Copyright © 2003 John Wiley & Sons, Ltd.
Impact of the timing and duration of seasonal snow cover on the active layer and permafrost in the Alaskan Arctic
Authors: Ling Feng , Zhang Tingjun 
Published: July 2003

AbstractVariations in the timing and duration of seasonal snow cover are critical to the ground thermal regime at high latitudes, due to changes in surface conditions and the associated ground surface energy balance. This study uses a one‐dimensional heat transfer model with phase change, combined with a surface energy balance equation to analyse the impact of changes in the timing and duration of seasonal snow cover on the thermal regime of the active layer and permafrost. Based on meteorological data collected at Barrow, Alaska, a series of simulation cases was conducted by varying the snowpack onset date in autumn and the disappearance date in spring during 1997–98. Results show that the ground thermal regime is sensitive to variations in the timing and duration of seasonal snow cover. Delaying the snow cover onset date by 10 days in autumn and the disappearance date by 10 days in spring results in a decrease in ground temperature. The maximum ground temperature decreases at depths of 0.0, 0.5, 1.0, and 2.0 m were 9.0, 2.9, 2.0, and 1.1°C, respectively, and the mean annual ground temperature decreases were 0.7, 0.5, 0.4, and 0.4°C. Advancing the snow cover disappearance date by 10 days in spring leads to an increase in ground temperature. The maximum ground temperature increases at depths of 0.0, 0.5, 1.0, and 2.0 m were 6.6, 2.2, 1.5, and 0.7°C, and the mean annual ground temperature increases were 0.2, 0.2, 0.1, and 0.1°C, respectively. Variations in the timing and duration of seasonal snow cover also have an influence on active layer thickness, but the effect is limited. Copyright © 2003 John Wiley & Sons, Ltd.