bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute non-traumatic arm ischaemia
Authors: Eyers P , Earnshaw J J 
Published: March 2003

Abstract

Background
Much attention has been paid to the management of acute leg ischaemia. Acute arm ischaemia is perceived as less of a problem because the risk of limb loss is lower. After conservative treatment up to half the patients have late symptoms, such as forearm claudication.

Methods
This study was a review of all published English language data on acute arm ischaemia. The entire Medline database was searched and other references were derived from the material perused. There were no randomized or controlled studies.

Results
The incidence of acute arm ischaemia is one-fifth that of acute leg ischaemia. Patients with arm ischaemia tended to be older with a mean age of 74 years compared with 70 years for acute leg ischaemia. Since the development of the embolectomy catheter, embolectomy can be performed in most patients under local anaesthetic. Collected outcome included successful restoration of the circulation in 65–94 per cent of patients and amputation in 0–18 per cent. The mortality rate ranged from 0 to 19 per cent, despite the use of local anaesthesia, mostly from associated cardiac disease. Management by a vascular specialist may be beneficial, particularly in complex cases.

Conclusion
An active approach to the management of acute arm ischaemia is safe and effective and reduces the risk of late disabling symptoms.
Current management of acute leg ischaemia: results of an audit by the vascular surgical society of Great Britain and Ireland
Authors: Campbell W B , Ridler B M F , Szymanska T H 
Published: March 2003

Abstract

Background
Management of acute leg ischaemia has changed in recent years. This study aimed to elucidate current practice throughout the UK and Ireland.

Methods
Surgeons and audit departments were asked to return a questionnaire about every episode of acute leg ischaemia seen in the hospital between 1 January and 31 March 1996.

Results
A total of 539 episodes were reported in 474 patients (248 men) aged 19–96 (median 73) years. Common causes were thrombosis in situ (41 per cent), embolism (38 per cent) and graft or angioplasty occlusion (15 per cent). Vascular surgical advice was requested in 95 per cent of cases. Initial management was: immediate embolectomy in 21 per cent, anticoagulants in 13 per cent and no vascular intervention in 10 per cent. Arteriography was done in 56 per cent, followed by 186 endovascular and 165 surgical interventions. At 30 days, 70 per cent of limbs were definitely viable and 16 per cent had been amputated. The mortality rate was 22 per cent. Cases were reported by 86 of 182 hospitals contacted, but some referred no patients, and a supplementary audit of 54 cases (10 per cent size of the original sample) from non-contributing hospitals showed no important differences.

Conclusion
Patients with acute leg ischaemia are generally treated by vascular specialists, with modern methods and acceptable results. This is being achieved despite insufficient vascular surgeons and radiologists for formal emergency rotas in most hospitals.
Current surgical practice in screening for colorectal cancer based on family history criteria
Authors: Scholefield J H , Johnson A G , Shorthouse A J 
Published: March 2003

Abstract

Background
As awareness about colorectal cancer increases there has been a steady rise in the number of referrals of relatives of patients with colorectal cancer to colorectal surgeons for screening investigations based on family history criteria. Surgeons are generally not trained in either risk assessment of inherited colorectal cancer or genetic counselling. As this is a relatively new area of service, there is likely to be variation in the management of these individuals.

Methods
This study investigated the family history criteria used and the colonic screening practices employed by a group of consultant colorectal surgeons by means of a postal questionnaire distributed and collected through their specialist association.

Results
The results show not only wide variation in the practice of colorectal screening based on family history criteria, but also a considerable waste of resources in the provision of illogical and inappropriate investigations.

Conclusion
Given the lack of evidence on which to base this clinical practice and the current financial difficulties in the health service, the authors question whether it is appropriate for surgeons to continue to provide such a service.
Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction
Authors: Chen S-C , Lin F-Y , Lee P-H , Yu S-C , Wang S-M , Chang K-J 
Published: March 2003

Abstract

Background
Background The optimal period of conservative treatment for adhesive small bowel obstruction remains controversial. This study sought to determine whether a 24-h abdominal radiograph after oral Urografin is a reliable indicator for operation in patients with adhesive small bowel obstruction.

Methods
One hundred and sixty-one patients who suffered from adhesive intestinal obstruction without clinical evidence of strangulation or gangrene underwent a Urografin study. Some 40 ml Urografin mixed with 40 ml distilled water was administered either orally or via a nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 8, 16 and 24 h later. If an earlier plain radiograph showed that contrast medium had reached the ascending colon, subsequent radiographs were not taken.

Results
Contrast medium reached the colon within 24 h in 112 patients (70 per cent). These patients were all treated successfully with non-operative methods. Contrast medium was not observed in the colon within the first 24 h in 49 patients (30 per cent). Operation was performed in 47 of these patients and non-operative treatment was given in two. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Urografin reaching the colon within 24 h as an indicator for non-operative treatment were 98, 100, 99, 100 and 96 per cent respectively.

Conclusion
All patients with evidence of Urografin reaching the colon within 24 h were treated successfully with non-operative methods. The results of this prospective study suggest that patients with adhesive intestinal obstruction in whom contrast medium fails to reach the colon within 24 h should receive prompt surgical intervention.
Influence of study design on reported mortality and morbidity rates after abdominal aortic aneurysm repair
Authors: Blankensteijn J D , Lindenburg F P , Van Der Graaf Y , Eikelboom B C 
Published: March 2003

Abstract

Background
The mortality and morbidity rates of elective abdominal aortic aneurysm (AAA) surgery, as reported over the past 12 years, were graded and analysed by levels of evidence.

Methods
Articles on elective AAA surgery published between 1985 and 1996 were retrieved and classified into five levels of evidence. Level 1 contains prospective studies and is subdivided into population-based (level 1a) and hospital-based (level 1b) studies. Level 2 includes retrospective studies, subdivided into population-based studies (level 2a), hospital-based studies (level 2b) and hospital-based studies concerning a specified group of selected patients (level 2c). Operative mortality and systemic and local/vascular complication rates with 95 per cent confidence intervals were calculated for each level of evidence.

Results
Seventy-two articles describing a total of 37 654 patients could be included: two level 1a studies (692 patients), nine level 1b studies (1677 patients), 13 level 2a studies (21 409 patients), 32 level 2b studies (12 019 patients) and 16 level 2c studies (1857 patients). The mean 30-day mortality rates of the two population-based levels were similar: 8·2 (95 per cent confidence interval 6·4–10·6) per cent for the prospective (1a) and 7·4 (7·0–7·7) per cent for the retrospective (2a) series. These figures were significantly higher than the remarkably similar hospital-based mortality rates: 3·8 (3·0–4·8) per cent for the prospective (1b), 3·8 (3·5–4·2) per cent for the retrospective (2b) and 3·5 (2·8–4·4) per cent for selected patient group (2c) studies. The most frequent complication was of cardiac origin. In the population-based series the cardiac complication rates were 10·6 (8·5–13·2) and 11·1 (9·1–13·6) per cent for levels 1a and 2a respectively. This compared well with 12·0 (10·5–13·9) per cent for the prospective hospital-based series (level 1b). The cardiac complication rates in the retrospective hospital-based studies were significantly lower: 8·9 (8·4–9·5) and 6·1 (4·9–7·6) per cent for levels 2b and 2c respectively.

Conclusion
There is a clear and consistent disagreement in reported mortality rates between hospital-based and population-based studies of elective surgery for AAA. Prospective studies give the best documentation of postoperative morbidity.
Scanning laser Doppler flowmetry and intraluminal recirculating gas tonometry in the assessment of gastric and jejunal perfusion during oesophageal resection
Authors: Boyle N H , Pearce A , Hunter D , Owen W J , Mason R C 
Published: March 2003

Abstract

Background
The ability of the new techniques of scanning laser Doppler flowmetry and recirculating gas tonometry to measure changes in gastric serosal and mucosal blood flow respectively during oesophageal resection was assessed.

Methods
Changes in regional and total gastric blood flow were assessed in 16 patients undergoing oesophagectomy at three stages of the procedure. Laser Doppler images were analysed and perfusion expressed as mean perfusion units. Tonometric measurements of gastric and jejunal intramucosal pH (pHi) were made synchronously.

Results
There were significant falls in gastric perfusion measured with scanning laser Doppler flowmetry in all subjects between each measurement. Mean perfusion of the stomach fell 41 per cent after mobilization. There was a gradient of reduced perfusion between the antrum (mean fall 25 per cent) and the area used for the anastomosis in the fundus (mean fall 55 per cent). Before mobilization mean gastric and jejunal pHi were 7·37 and 7·46 respectively. These fell to 7·18 and 7·37 respectively after mobilization and to 7·29 and 7·38 after anastomosis.

Conclusion
These new techniques could be employed at operation, appear to overcome the limitations of single-point laser Doppler flowmetry and saline tonometry, and have measured significant changes in gastric perfusion. They may have widespread clinical application.
Changing trends in the management of phaeochromocytoma
Authors: Geoghegan J G , Emberton M , Bloom S R , Lynn J A 
Published: March 2003

Abstract

Background
The recent experience of a specialist endocrine surgery unit in the management of phaeochromocytoma is reviewed.

Methods
Over a 14-year period (June 1978 to June 1992) 43 patients (14 men, 29 women) with a mean age of 42 years were referred with phaeochromocytoma.

Results
Biochemical confirmation was usually by measurement of 24-h urinary vallinylmandelic acid. From 1980 venous sampling was replaced by computed tomography as the primary localizing procedure. 131I-meta-iodobenzylguanidine scintigraphy was used in all patients between 1984 and 1987, but selectively after that. With regard to the operative approach used, between 1978 and 1983 midline or flank incisions were used, and from 1984 to 1992 subcostal or posterior approaches were used predominantly. There was one operative (30-day) death. One patient died 24 months after operation from recurrent malignant phaeochromocytoma, and three patients died during follow-up from unrelated causes. The remaining patients (mean follow-up 30 months) have no evidence of recurrent phaeochromocytoma, although four remain on antihypertensive medication.

Conclusion
Improved imaging of phaeochromocytoma obviates the need for transperitoneal exploration, allowing selected phaeochromocytomas to be successfully managed using an extraperitoneal approach.
Investigation of oesophageal reflux symptoms after gastric surgery with combined pH and bilirubin monitoring
Authors: Marshall R E K , Anggiansah A , Owen W A , Owen W J 
Published: March 2003

Abstract

Background
Little is known about the role of bile in gastro-oesophageal reflux disease in patients with previous gastric surgery. This has partly been due to a lack of suitable techniques for identifying bile reflux objectively.

Methods
Some 28 patients with reflux symptoms and previous gastric surgery underwent oesophageal manometry, and 24-h ambulatory oesophageal pH and bilirubin monitoring.

Results
A wide variety of operations had been performed, most commonly Pólya gastrectomy (seven patients), vagotomy and pyloroplasty (six) and vagotomy and gastrojejunostomy (four). Three patients had isolated acid reflux, eight had isolated bile reflux, six had combined acid and bile reflux, and 11 patients had no reflux. Two-thirds of heartburn symptoms were not associated with reflux. However, one-quarter were associated with acid reflux and only 7 per cent with bile reflux. Erosive oesophagitis was present in five patients: two with combined acid and bile reflux, and three with isolated bile reflux.

Conclusion
Acid and/or bile reflux can be present after a wide variety of gastric operations. Symptoms are more frequently associated with acid reflux than with bile reflux. Erosive oesophagitis can occur in the presence of isolated bile reflux. Combined pH and bilirubin monitoring determines the nature of the refluxate, and may help in the management of these patients.
Assessment of potential donors for living related liver transplantation
Authors: Baker A , Dhawan A , Devlin J , Mieli-Vergani G , O'Grady J , Williams R , Rela M , Heaton N 
Published: March 2003

Abstract

Background
Living related liver transplantation has been developed as an important potential source of organs for treatment of children with acute and chronic liver disease. A single UK centre performing living related liver transplantation was established in 1993.

Methods
Parents who were potential donors for their children for living related liver transplantation were assessed for suitability according to a protocol based on one developed and published by the University of Chicago Transplant Group. Records kept by the transplant coordinators were retrieved and data were extracted.

Results
Of 64 potential donors for 32 potential recipients ten were excluded at a preliminary stage. Fourteen ultimately became donors. Of 54 parents who began evaluation 23 were finally considered to be suitable. There were 19 non-disease-related reasons for unsuitability: blood group mismatch (eight cases), size discrepancy (six), pregnancy (two), oral contraceptive medication (one), vascular anatomy variant (one) and age (one). Sixteen were unsuitable because disease was found, namely fatty liver (four), thyroid disease (two), hepatitis B positivity (two), cardiac murmur (one), anaemia (one), glucose-6-phosphate dehydrogenase deficiency (one), diabetes mellitus (one) and psychological problems (one), and three parents were affected by the same disorder as the child (Alagille syndrome, one; mitochondrial disorder, one; recurrent cholestasis, one). Three parents were rejected for more than one reason. Both parents were unsuitable for donation in 21 per cent of cases.

Conclusion
Parents approach living related liver transplantation with enthusiasm. They should be advised of the high chance of unsuitability, including the finding of significant pathology. The limitation of living related liver transplantation as the major source of organs for children is recognized.
Indicators of recurrence following cryotherapy for hepatic metastases from colorectal cancer
Authors: Seifert J K , Morris D L 
Published: March 2003

Abstract

Background
This retrospective review aimed to assess the incidence of local recurrence at the cryosite, hepatic and extrahepatic recurrence and the corresponding disease-free intervals. Prognostic indicators following hepatic cryotherapy were also identified.

Methods
Eighty-five patients underwent complete cryotreatment of colorectal liver metastases between April 1990 and May 1997. Possible prognostic indicators were tested for their impact on the disease-free interval at the cryosite, liver disease-free survival and overall disease-free survival with univariate and multivariate analysis.

Results
At a median follow-up of 22 months 66 patients developed tumour recurrence: 18 in the liver only; 15 in the liver and lung; 22 in the liver and extrapulmonary areas; and 11 at extrahepatic sites only. Local recurrence at the cryosite occurred in 28 patients. Cryotreated metastases larger than 3 cm were associated with a shorter disease-free interval at the cryosite and liver disease-free survival; persistently raised serum carcinoembryonic antigen (CEA) levels after operation were associated with shorter liver disease-free and overall disease-free intervals in multivariate analysis.

Conclusion
Improvements in probe placement and monitoring of the freezing process are required to allow successful treatment of large liver metastases. A failure in complete postoperative CEA response indicates that hepatic or extrahepatic disease was not detected before operation, which may be avoided with better staging procedures.
Differences in contractile properties of anorectal smooth muscle and the effects of calcium channel blockade
Authors: Cook T A , Brading A F , Mortensen N J McC 
Published: March 2003

Abstract

Background
Pharmacological manipulation of the anal sphincter is hampered by a lack of specificity. This study aimed to determine differences in the role of intracellular and extracellular calcium in the development of tone and agonist-induced contractions between internal anal sphincter (IAS) and rectal circular muscle which might allow targeted manipulation.

Methods
Smooth muscle strips from the IAS and rectal circular muscle of 24 Large White pigs were mounted for isometric tension recording in a superfusion organ bath in the presence of different perfusates.

Results
IAS developed tone and spontaneous activity that were abolished by nifedipine, which also reduced contractions to noradrenaline to 72 per cent of control values. Rectal smooth muscle developed spontaneous activity but no tone. Nifedipine abolished the activity and reduced contractions to carbachol to 17 per cent of control. Contractile activity was abolished in both tissues in calcium-free solution. Transient exposure to a high calcium concentration reloaded the stores, and the ability of agonists to release stored calcium was tested after 3 min in calcium-free solution. In IAS, noradrenaline contraction was 76 per cent of control and in rectal circular muscle carbachol contraction was 57 per cent of control. Store loading was prevented by nifedipine in rectal smooth muscle but not IAS. Cyclopiazonic acid reduced store filling in both tissues.

Conclusion
Agonist-induced contraction of IAS is largely due to release of stored calcium and L-type calcium channels are not needed for store filling. Rectal circular smooth muscle depends more on extracellular calcium and uses L-type calcium channels for agonist-induced contraction and store filling. These differences suggest that targeted manipulation may be possible in patients with anorectal disorders.
Day-case haemorrhoidectomy
Authors: Hunt L , Luck A J , Rudkin G , Hewett P J 
Published: March 2003

Abstract

Background
Ligation excision haemorrhoidectomy is usually performed on an inpatient basis. This study was designed to assess the feasibility of day-case haemorrhoidectomy.

Methods
Patients fulfilling criteria for day surgery underwent ligation excision haemorrhoidectomy with the intention of a same-day discharge from hospital. A standardized protocol for anaesthesia, perioperative analgesia and antiemesis was followed. Patients received daily home nursing visits until they felt both comfortable and confident. Staff recorded pain and nausea scores on a visual analogue scale (range 1–10) until the first bowel action. Patient satisfaction was assessed independently after operation.

Results
Fifty-one patients underwent planned day-case haemorrhoidectomy. Forty-two (82 per cent) were discharged on the day of surgery. All patients were discharged within 26 h of surgery. Four patients required readmission, two with reactive bleeding, one with urinary retention and one for pain control. Pain and nausea were well controlled. Forty-four patients (86 per cent) were totally or very satisfied with their overall care.

Conclusion
Ligation excision haemorrhoidectomy can be performed successfully as a day-case procedure.
Value of magnetic resonance cholangiopancreatography in demonstrating major bile duct injuries following laparoscopic cholecystectomy
Authors: Yeh T-S , Jan Y-Y , Tseng J-H , Hwang T-L , Jeng L-B , Chen M-F 
Published: March 2003

Abstract

Background
Conventionally, recognition of bile duct injuries after laparoscopic cholecystectomy largely relies on endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). However, these invasive procedures are not without risk. Preliminary experience with use of magnetic resonance cholangiopancreatography (MRCP) to identify these injuries is reported.

Methods
The medical records of five patients who had undergone laparoscopic cholecystectomy and had suspected major bile duct injuries were reviewed. All five patients underwent MRCP, followed by conventional cholangiography: either ERCP or PTC, or both. The findings of MRCP and conventional cholangiography were compared.

Results
Four patients had proven bile duct injuries. The remaining patient had gallstones dislodged into the common bile duct (CBD) during laparoscopic cholecystectomy, which presented as transient jaundice mimicking a bile duct injury. The MRCP images were of higher diagnostic value than conventional cholangiographic images in four patients with frank bile duct injury. For these patients, ERCP showed only the cut-off sign of the CBD, and PTC was needed to visualize the upper biliary system. MRCP, however, demonstrated the entire biliary system proximal and distal to the amputated or stenotic sites simultaneously. In the remaining patient with dislodged gallstones, the two techniques yielded similar diagnostic information.

Conclusion
This preliminary study suggests that MRCP is an ideal diagnostic test whenever bile duct injury following laparoscopic cholecystectomy is suspected.
Gastrointestinal stromal sarcomas
Authors: Lev D , Kariv Y , Issakov J , Merhav H , Berger E , Merimsky O , Klausner J M , Gutman M 
Published: March 2003

Abstract

Background
Gastrointestinal stromal sarcomas are a rare group of malignancies originating in the bowel wall.

Methods
The treatment of 12 patients with gastrointestinal stromal sarcoma who underwent operation between 1994 and 1998 was reviewed.

Results
Eight tumours originated in the stomach; others were in the small bowel or rectum. Five of the tumours were of myogenic origin, two were gastrointestinal autonomic nerve tumours, one was a mixed neural–myoid tumour, and four could not be differentiated. Complete resection was possible in ten patients; in two of the ten en bloc resection of adjacent organs was required to ensure adequate margins. The tumours in the remaining two patients were irresectable because of diffuse intra-abdominal metastatic disease. All patients who underwent complete resection were alive after 4–48 (median 14) months. Two of the ten patients developed recurrence, which was reresected completely. The patients with metastatic disease died less than 1 year after operation.

Conclusion
Aggressive surgical resection, achieving complete resection, can lead to prolongation of life and may be a potential cure for patients with gastrointestinal stromal sarcoma.