bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cholecystectomy: does subspecialization alter workload?
Authors: Goodfellow P B , Thomas W E G , Majeed A W , Johnson A G 
Published: July 2002

Abstract

Aims
Cholecystectomy is a common operation. This study reviewed the changes in workload and practice in a teaching hospital over a 4-year period, during which a hepatobiliary subspecialist unit was developed.

Methods
Computerized demographic data, and details of operations and inpatient events were reviewed for all patients undergoing cholecystectomy in a single teaching hospital from 1993 to 1997. For statistical analysis the consultants were grouped into those with a hepatobiliary interest (n = 3) and those with other primary interests (n = 6); and the workload for the first 12 months of the study was compared with that of the last 12-month period.

Results
Between April 1993 and April 1997, 1121 cholecystectomies were performed, of which 75 were excluded because they were performed with other simultaneous procedures. Of the remaining operations, 911 involved cholecystectomy alone (mean patient age 52·9 years), and 135 (12·9 per cent) comprised cholecystectomy with exploration of the common bile duct (ECBD) (mean age 60·1 years). Between the first and last years studied, the rate of ECBD rose significantly from 7·4 to 14·9 per cent (P &lt; 0·01, χ2 test), and the proportion of ECBD procedures being performed by hepatobiliary specialists rose from 31·6 to 52·7 per cent, but this was not statistically significant (P = 0·13). However, for cholecystectomy in the same period the proportion performed by hepatobiliary surgeons rose from 40·4 to 58·5 per cent, representing a highly significant trend (P &lt; 0·001). Following cholecystectomy alone there was a significantly shorter stay associated with patients treated by hepatobiliary surgeons (P = 0·002, F test), although the median postoperative hospital stay was 2 days for both groups of surgeons (interquartile range 1–3 days for hepatobiliary and 1–4 days for non-hepatobiliary surgeons).

Conclusions
Although cholecystectomy is not viewed as a specialist procedure, the trend in this teaching hospital reveals a steady increase in the proportion of cholecystectomies being performed by teams with a biliary interest. The data indicate that this practice is associated with a shorter hospital stay.
Specialized intestinal metaplasia: analysis of prevalence, risk factors and association with gastro-oesophageal reflux disease
Authors: Carton E , Mulligan E D , Keeling P W N , Tanner A , McDonald G , Reynolds J V 
Published: July 2002

Abstract

Aims
There is an increasing awareness that short (less than 3 cm) segments of Barrett's epithelium and macroscopically normal cardia epithelium may harbour specialized intestinal metaplasia (SIM), a premalignant phenotype. This was a prospective study of both the prevalence of SIM in an unselected population of patients attending for endoscopy, and the association of SIM with symptoms, lifestyle, medication, endoscopic oesophagitis and carditis.

Methods
Two hundred consecutive patients underwent endoscopy. Biopsies taken from just below the squamocolumnar junction were stained for SIM, and were analysed for carditis and Helicobacter pylori infection. A detailed questionnaire of symptoms, tobacco consumption and the use of proton pump inhibitors was completed.

Results
Forty-two patients (21 per cent) had SIM, 19 of 126 (15 per cent) in an endoscopically normal oesophagus, 15 of 63 (24 per cent) in a short segment of Barrett's epithelium and eight of 11 in classical Barrett's oesophagus. Comparative analysis between the SIM positive and negative groups with respect to potential risk factors is outlined below.

Conclusions
SIM is prevalent in patients undergoing endoscopy, does not correlate with symptoms or with H. pylori infection, but is significantly associated with endoscopic and pathological markers of gastro-oesophageal reflux.
Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma
Authors: Kondo S , Nimura Y , Hayakawa N , Kamiya J , Nagino M , Uesaka K 
Published: July 2002

Abstract

Background
There have been no reports on the routine use of regional and para-aortic lymphadenectomy for gallbladder cancer. The aim of this study was to elucidate nodal status, its prognostic influence and the efficacy of lymphadenectomy.

Methods
A retrospective analysis was made of 60 patients who underwent radical resection and routine regional and para-aortic lymphadenectomy.

Results
Of the 60 patients, 73 per cent had node-positive disease and 38 per cent had positive para-aortic nodes. Postoperative survival was extremely poor in patients with minimal distant metastasis, and similarly in patients with para-aortic disease. The survival of patients with metastasis limited to the regional nodes was significantly better than that of those with distant metastasis (P = 0·029) or para-aortic disease (P = 0·017) and was not significantly different from that of patients with no metastasis (P = 0·82).

Conclusion
Regional and para-aortic lymphadenectomy provides no survival benefit for patients with para-aortic disease, which has an influence on poor prognosis equivalent to that of distant metastasis. It has the potential to bring survival benefit only in selected patients with metastasis limited to the regional nodes. A sampling biopsy of the para-aortic nodes before starting radical surgery is recommended because they are involved more frequently than expected.
Prospective randomized multicentre double-blind placebo-controlled trial of the use of aprotonin in ruptured abdominal aortic aneurysm repair
Authors: Robinson J , Nawaz S , Whitbread T , Beard J D 
Published: July 2002

Abstract

Background
This study assessed whether the use of aprotonin affects the number of blood products transfused, and the morbidity and mortality rates associated with the repair of a ruptured abdominal aortic aneurysm (AAA).

Methods
Nine centres with local ethics committee approval for the trial were involved in the recruitment of 77 patients. A bolus of either 2 million units of aprotonin, followed by an infusion of 500 000 units every 30 min, or placebo, was prepared and aprotonin was administered to 38 patients, with 39 receiving the placebo. The number of blood products transfused during surgery and in the first 12 h after operation was noted, along with the incidence of complications, mortality rates and length of hospital stay. Analysis of the difference between blood product transfusion was by the Kruskal–Wallis test.

Results
Seventeen of the 38 patients receiving aprotonin and 17 of the 39 given placebo died within 30 days, with an overall mortality rate of 44 per cent. The median amount of blood given to the aprotonin group after operation was 1 (range 0–14) units, while for the placebo group it was 3 (range 0–13) units (P = 0·02). In the aprotonin group, ten patients developed renal failure and ten had respiratory complications. The corresponding figures for the placebo group were nine and 17 respectively. For survivors, the median hospital stay was 12 (range 7–33) days for the aprotonin group and 15 (range 8–52) days for the placebo group.

Conclusion
The use of high-dose aprotonin in ruptured AAA repair leads to less requirement for blood products. It does not appear to affect survival or the incidence of postoperative complications.
Surgery reduces long-term recurrence rate in chronic venous leg ulcers
Authors:   Gloucestershire Vascular Group, Barwell J R , Taylor M , Ghauri A S K , Phillips L K , Whyman M R , Poskitt K R 
Published: July 2002

Abstract

Background
Surgical correction of isolated superficial venous reflux in ulcerated legs reduces short-term recurrence rates but little is known about long-term recurrence. This study aimed to assess the influence of venous reflux pattern and appropriate surgical correction on ulcer healing and long-term recurrence.

Methods
Patients with chronic leg ulcers were assessed prospectively at a one-stop clinic over 4 years to July 1999. Patients with an ankle: brachial pressure index (ABPI) greater than 0·85, including those with diabetes mellitus and rheumatoid arthritis, were treated with weekly four-layer bandaging in community leg ulcer clinics. Venous duplex studies in all ulcerated legs assessed venous reflux pattern and patients with isolated superficial reflux were offered surgery. Patients were advised to wear class 2 elastic compression stockings after healing and were reviewed at 1, 3, 6 and 9 months, and at 1, 2 and 3 years. Ipsilateral ulceration following healing was designated as recurrence.

Results
Some 766 ulcerated legs in 689 patients were assessed; 633 legs had an ABPI greater than 0·85. Venous duplex assessment revealed 8 per cent of these legs to have pure deep, 38 per cent pure superficial and 43 per cent a mixed reflux pattern. Ten per cent of legs had no demonstrable reflux. Some 131 of 241 limbs with pure superficial reflux underwent surgery. Healing rates at 12 and 24 weeks for all legs with an ABPI greater than 0·85 were 48 and 68 per cent respectively. Neither venous pattern nor surgery affected ulcer healing rates. Overall 1-, 2- and 3-year recurrence rates for venous ulcers were 25, 31 and 38 per cent respectively. The influence of venous reflux pattern and surgery on ulcer recurrence is summarized in Table.

Conclusion
Ulcer healing rates are not influenced by venous reflux pattern or surgery. Surgical correction of superficial venous reflux in the presence of chronic leg ulceration reduces long-term ulcer recurrence rates.
Prevalence and treatment of hypercholesterolaemia in patients with peripheral vascular disease
Authors: Evans S M , Twomey P , Haggart P C , Mackenzie R , Walker S , Bradbury A W 
Published: July 2002

Abstract

Background
Hypercholesterolaemia is a recognized risk factor for the development of arteriosclerosis. There is compelling evidence to support the use of lipid-lowering strategies in all hypercholesterolaemic patients with arteriosclerotic disease. In peripheral arterial disease (PAD), national guidelines recommend treatment if total cholesterol exceeds 5·0 mmol l−1. The prevalence of hypercholesterolaemia in patients with PAD was determined and the adequacy of lipid management before vascular referral was examined.

Methods
This was a prospective study of 233 consecutive patients admitted electively to this vascular surgery unit between December 1997 and December 1998. Some 68 patients were admitted with carotid disease, 81 with an aneurysm and 84 with intermittent claudication. A fasting venous blood sample was obtained from each patient.

Results
There were 175 men and 58 women, of median age 67 (range 37–85) and 68 (range 47–85) years respectively. Only 35 patients (15 per cent) were previously known to be hypercholesterolaemic; all but one were receiving treatment (one dietary, 33 statin). Of the remaining 198 patients, 124 (63 per cent) had a serum cholesterol level above 5·0 mmol l−1. A further 17 patients (9 per cent) had total cholesterol/high-density lipoprotein: cholesterol ratio greater than 5·0; these patients may also benefit from lipid-lowering therapy. In total, 141 (80 per cent) of 176 hypercholesterolaemic patients were undiagnosed at the time of hospital admission.

Conclusion
Hypercholesterolaemia is an important and correctable risk factor found in the majority of patients with PAD, but despite national guidelines and clear evidence from randomized controlled trials it is simply not being diagnosed in primary care. All elective patients with PAD should be screened for hypercholesterolaemia during their admission.
Randomized trial of rifampicin-bonded Dacron grafts for extra-anatomic vascular reconstruction: 2-year results
Authors: Earnshaw J J , Whitman B , Heather B P 
Published: July 2002

Abstract

Background
Serious infection complicates a small proportion of prosthetic vascular grafts and usually follows implantation of bacteria at the time of graft insertion. The aim of this study was to determine whether the use of a rifampicin-bonded, gelatin-coated Dacron graft (Gelsoft/Gelseal; Sulzer Vascutek) could reduce the rate of infective complications after extra-anatomic bypass.

Methods
In a multicentre study involving 14 vascular units, 257 patients underwent extra-anatomic bypass. There were 178 men and 79 women, of median age 69 (range 43–92) years. Some 132 (51 per cent) had no risk factors for wound or graft sepsis, 82 (32 per cent) had one and 43 (17 per cent) had two or more risk factors. Patients were randomized to rifampicin bonding (rifampicin 1 mg ml−1 soak for 15 min before insertion) (n = 123) or control (n = 134). The authors have previously reported small, but not statistically significant, reductions in total perioperative wound complications, antibiotic requirements and delayed hospital discharge in favour of patients with bonded grafts.

Results
Of 257 patients originally randomized, follow-up to 2 years or death is available for 197 patients; 60 have died. A total of ten patients have had serious wound or graft infections (Szilagyi grade III), four with unbonded and six with bonded grafts (P not significant). All occurred within 6 months of operation. The graft fabric was involved in eight patients. Treatment and outcome are listed in the Table below.

Conclusion
It has not been possible to show any advantage for the routine use of antibiotic bonding for extra-anatomic reconstruction.
Durability of femoropopliteal transluminal angioplasty for claudication
Authors: Oshodi T O , Shackcloth M , Ashleigh R , Charlesworth D 
Published: July 2002

Abstract

Background
Some 200 consecutive femoropopliteal transluminal percutaneous angioplasties (PTAs) in patients with claudication were followed up to ascertain the long-term patency.

Methods
One hundred and forty-six patients (200 angioplasties) who underwent PTA were followed up between 1991 and 1997. Clinical symptoms, ankle: brachial pressure index (ABPI) and duplex scan assessment were recorded. Mean follow-up was 43·2 months.

Results
The median age of patients was 66 (range 49–86) years, with a mean claudication distance of 68 (range 10–274) m. Primary patency at 1, 3 and 5 years was 72, 54 and 32 per cent respectively. Stenosis rather than occlusion, ABPI greater than 0·8 after angioplasty and immediate symptomatic improvement were associated with favourable outcome. Diabetes adversely affected patency. Twenty-one patients (11 per cent) required bypass surgery following a failed PTA.

Conclusion
In contrast to some reports in recent literature, long-term patency following PTA is poor in claudicants.
Prosthetic femoropopliteal bypass: randomized comparison of polytetrafluoroethylene and heparin-bonded Dacron
Authors: Devine C , McCollum C N 
Published: July 2002

Abstract

Background
Dacron was largely abandoned for femoropopliteal bypass 30 years ago as saphenous vein achieved better patencies. As patency in prosthetic above-knee (AK) femoropopliteal bypass in patients on aspirin is equivalent to that with saphenous vein, heparin-bonded Dacron (HBD) and polytetrafluoroethylene (PTFE) have been compared in a randomized trial involving ten hospitals which also included below-knee (BK) popliteal or tibioperoneal trunk bypass where the long saphenous vein was absent or inadequate.

Methods
Over a 28-month recruitment period, 209 patients undergoing femoropopliteal bypass (180 AK, 29 BK) were randomized by the method of minimization to HBD (n = 106) or PTFE (n = 103). Aspirin 300 mg day−1 was started before surgery and continued unless the patient was intolerant.

Results
Mean follow-up was 34 (range 19–48) months. Fifteen patients (7 per cent) died with patent grafts and three (1 per cent) infected grafts were removed. Patency (measured by Kaplan–Meier survival analysis) was 70, 63 and 55 per cent at 1, 2 and 3 years for HBD, compared with 56, 46 and 42 per cent respectively for PTFE (P = 0·0444). Patency at 3 years for AK bypass was significantly better than that for BK bypass. A total of 70 interventions were performed on 47 patients, achieving long-term patency in only three. Amputations were performed in 23 patients, six with HBD and 17 with PTFE grafts (P = 0·015, Fisher's exact test).

Conclusion
In femoropopliteal bypass, primary patency was better with HBD than PTFE, and HBD was associated with a lower amputation rate.
Complications of percutaneous transluminal angioplasty in the legs: analysis of 1379 procedures
Authors: Axisa B , Loftus I , Bolia A , Fishwick G , Bell P R F , Thompson M M 
Published: July 2002

Abstract

Background
Percutaneous transluminal angioplasty has firmly established itself as a useful adjunct to surgery in the management of patients with peripheral vascular disease. A large series has been reviewed to assess the impact of the increase in the number of procedures performed as well as the improvements in technique on the complication rate of the procedure.

Methods
The complications of all percutaneous transluminal angioplasty procedures carried out between 2 October 1995 and 29 September 1998 were recorded and analysed prospectively.

Results
There were 1379 procedures carried out on 988 patients. There were 551 men (55·8 per cent) and 437 women (44·2 per cent), with a mean age of 62·5 years. A total of 1756 vessel segments were dilated. The indications for angioplasty included claudication (620 patients, 62·8 per cent), critical ischaemia (270, 27·3 per cent) and bypass graft complications (98, 9·9 per cent). The major complications were retroperitoneal bleed (0·2 per cent), false aneurysm (0·2 per cent), myocardial infarction (0·4 per cent), acute limb ischaemia (1·5 per cent), pulmonary embolism (0·1 per cent), renal failure (0·4 per cent), stroke and transient ischaemic attack (0·4 per cent) and respiratory failure (1·0 per cent). Minor complications were haematoma in 0·9 per cent, perforation in 1·7 per cent, wound infection in 1·0 per cent and catheter complications in 0·6 per cent. The overall rate of significant complications was 4·2 per cent and that of minor complications was 4·2 per cent. The overall incidence of complications needing surgical intervention was 2·2 per cent. The overall amputation rate due to complications was 0·6 per cent.

Conclusion
The sharp rise in the number of angioplasties in recent years has not been accompanied by a similar rise in the number of complications, despite broadening of the referral spectrum.
Surgical management of thoracic outlet syndrome
Authors: Monbaliu D , Talbot N , Ragi E , Niblett P G , Peters A , Thompson J F 
Published: July 2002

Abstract

Background
The role of surgical decompression for thoracic outlet syndrome (TOS) is not clearly established, especially for the neurological (N-TOS) or venous (V-TOS) variants. Reports lack objective diagnostic criteria and follow-up. American series almost exclusively describe N-TOS. In the authors' practice, arterial TOS (A-TOS) is much more common. Patients are treated by a multidisciplinary team and surgery is reserved for those failing to respond to conservative measures.

Methods
Data regarding assessment, diagnosis (clinical, radiology, electromyography, duplex) are collected prospectively on a database (Paradox). Independent follow-up has categorized surgical results by structured questionnaire.

Results
Of 129 patients (104 women; median age 37 years), 91 underwent transaxillary first rib resection (50 A-TOS, 31 N-TOS, ten V-TOS), 24 had a supraclavicular scalenectomy (rib resection; all N-TOS) and 14 had a combined procedure (five A-TOS, nine N-TOS). Eleven were reoperations. Early results (6 months) were available for 122 patients.
Overall 91 per cent of patients with A-TOS rated the outcome as excellent/good, compared with 72 per cent of those with N-TOS and nine of ten with V-TOS. Life-table analysis confirmed a durable outcome at up to 6 years. Of 30 patients with A-TOS for whom data were complete, postoperative duplex imaging was normal in 28.

Conclusion
Careful patient selection following a concerted effort at conservative management yields good results. These data are useful for counselling patients who may be facing surgery for this disabling condition.
Thoracic aortic stent grafts
Authors: Taylor P R , McGuinness C L , Reidy J F 
Published: July 2002

Abstract

Background
Open surgical intervention for aneurysms of the distal arch and descending thoracic aorta is associated with high morbidity and mortality rates. Stent grafts offer an attractive alternative treatment for these aneurysms.

Methods
Thirteen patients were treated from July 1997 to August 1999. Eight patients had atheromatous aneurysms; five were elective and three urgent for dysphagia, stridor and back pain. The mean age of these patients was 77 (range 64–90) years. Another five urgent cases comprised transection (two), traumatic dissection (one), acute dissection (one) and secondary aorto-oesophageal fistula (one). The mean age of these patients was 43 (range 18–77) years. The types of stent graft used were Excluder (six), AneuRx (five), Vanguard (one) and Stenford (one). Additional surgical procedures included carotid-to-carotid bypass, exposure of the common iliac artery (as the device was too short to reach the proximal descending thoracic aorta) and repair of a symptomatic infrarenal aortic aneurysm.

Results
One patient with acute aortic dissection 1 month after myocardial infarction died from pulmonary embolus and myocardial reinfarction (mortality rate 8 per cent). One patient who suffered a stroke with good recovery was discharged on day 21 but died from pneumonia at 8 weeks. All aneurysms were excluded on computed tomography apart from the traumatic dissection in which perfusion of the false lumen continued retrogradely. No patient suffered paraplegia or renal failure. No ward patient required admission to the intensive care unit.

Conclusion
Thoracic stent grafts offer a realistic alternative to open surgery, but long-term follow-up is required to assess durability.
Factors influencing the functional outcome of restorative proctocolectomy in ulcerative colitis
Authors: Karlbom U , Raab Y , Ejerblad S , Graf W , Thörn M , Påhlman L 
Published: July 2002

Abstract

Background
Restorative proctocolectomy is considered to be the procedure of choice in the operative treatment of ulcerative colitis. The aim of this study was to evaluate the functional outcome following operation and to identify possible predictive factors.

Methods
Some 168 patients (median age 32 years, 102 men) with ulcerative colitis underwent restorative proctocolectomy. The functional outcome was evaluated by a symptom index created from a questionnaire at a median of 29 (13–123) months of follow-up. The records of these patients were reviewed, and preoperative, peroperative and postoperative variables were registered and related to outcome.

Results
The response rate to the questionnaire was 155 (92 per cent) of 168. The symptom index was related to patients' overall assessment of outcome. In spite of a perceived good result many patients experienced a number of symptoms. Age over 50 years (P &lt; 0·01), presence of extraintestinal manifestations (P &lt; 0·05) and late complications, such as anastomotic stricture (P &lt; 0·05), pouchitis (P &lt; 0·01) and anal pain (P &lt; 0·05), were related to a less favourable outcome.

Conclusion
While preoperative data may help in selecting patients suitable for restorative proctocolectomy, prevention of late complications seems most important in improving the functional outcome.