bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increase in the incidence of oesophagogastric carcinoma in the South Thames region: an epidemiological study
Authors: Kocher H M , Patel S , Linklater K , Ellul J P M 
Published: July 2002

Abstract

Aims
There is some evidence to indicate that the incidence of gastric and oesophageal carcinoma is changing rapidly in the West. However, to study the true magnitude of the problem (to help in planning health and cancer strategies over the next decades), this epidemiological study was performed.

Methods
The Thames Cancer Registry database for the years 1960–1995 was searched for all oesophageal and gastric cancers in the South Thames region, and was analysed for all subsites for both sexes separately. Statistical analysis using the age-standardized ratio (ASR) (world) and χ2 test for trend for each subgroup was performed.

Results
The overall incidence of carcinoma of the oesophagus for both sexes saw a marked rise in the period studied, while the overall incidence of gastric cancer fell. In the upper two-thirds of the oesophagus, the increase in incidence was more dramatic for women (from 0·30 in 1960 to 0·70 in 1996; χ2trend = 18·7, P = 0·00015) than men (from 0·59 in 1960 to 1·09 in 1996; χ2trend = 4·4, P = 0·0354). In the lower third of the oesophagus, there was a rise in men (ASR from 0·93 in 1960 to 3·43 in 1996; χ2trend = 466·3, P &lt; 0·0001) as well as in women (ASR from 0·42 in 1960 to 0·91 in 1996; χ2trend = 51·4, P &lt; 0·0001). For the gastric cardia, the incidence in men increased (ASR from 1·24 in 1960 to 2·41 in 1996; χ2trend = 109·8, P &lt; 0·0001), while in women it remained unchanged (ASR from 0·33 in 1960 to 0·55 in 1996; χ2trend = 0·0, P = 0·8281). The incidence of distal gastric carcinoma has decreased in men (ASR from 2·47 in 1980 to 0·63 in 1996; χ2trend = 264·7, P &lt; 0·0001) and women (from 1·14 in 1980 to 0·43 in 1996, χ2trend = 131·8, P &lt; 0·0001). For cancers of other subsites of the stomach (fundus, lesser and greater curvature, and body), there was a fall in incidence in both sexes.

Conclusions
There has been a twofold to threefold increase over 36 years in the incidence of cancer of the oesophagogastric junction with a decreasing incidence in the distal stomach. There was also an increase in the incidence of upper oesophageal cancers, and a decrease in the incidence of cancers of other subsites of the stomach. Studies to cope with this increase and resources to cope with the treatment of these patients are required.
Biliary complications associated with laparoscopic cholecystectomy: analysis of common misconceptions
Authors: Bingham J , McKie L D , McLoughlin J , Diamond T 
Published: July 2002

Abstract

Aims
General surgeons often express the view that the majority of biliary complications following laparoscopic cholecystectomy are caused by trainee surgeons; complications occur most often in the presence of difficult anatomy or pathology; biliary injuries occur more proximally in the biliary tree than at open cholecystectomy; most injuries are recognized at the time of surgery; and most complications can be managed non-operatively. The aim of this study was to determine if these views are substantiated in clinical practice.

Methods
Thirty consecutive patients were referred to a specialist hepatobiliary unit over a 7-year period with biliary complications following laparoscopic cholecystectomy. The mode of presentation, management and outcome of these patients were analysed.

Results
In 21 cases the initial operator was a consultant. Four of the 30 complications occurred in the presence of an anatomical variation or unusually difficult pathology. Only patients in whom a previous attempt at repair had been made had injuries at or proximal to the bile duct confluence; the only two deaths occurred in this group. Only 41 per cent of injuries were detected at the time of surgery and 89 per cent required further surgical intervention, hepaticojejunostomy being the most common procedure performed (75 per cent).

Conclusions
The majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy or pathology, do not occur in the proximal biliary tree, are not recognized at the time of the initial operation and often require major reconstructive procedures for their management.
Pattern of recurrence following subtotal oesophagectomy with two field lymphadenectomy
Authors: Dresner S M , Wayman J , Shenfine J , Harris A , Hayes N , Griffin S M 
Published: July 2002

Abstract

Aims
Despite increasingly radical surgery for oesophageal cancer many patients continue to represent with recurrent disease. This study aimed to evaluate the pattern of failure following attempted curative oesophagectomy with mediastinal and upper abdominal lymphadenectomy.

Methods
Some 212 consecutive patients undergoing R0 resection for malignancy between 1 April 1990 and 1 April 1999 were followed up for evidence of recurrence. Clinical evaluation was supported by ultrasonography, computed tomography, isotope scan, endoscopy and laparotomy with biopsy assessment if appropriate. Patients were excluded if recurrence was diagnosed on clinical grounds alone. Statistical analysis was performed using χ2 and log rank tests.

Results
Some 142 patients with adenocarcinoma and 70 with squamous carcinoma (SCC) were followed up for a median of 14 (range 1–108) months. Sex and age distribution were similar for both histological subtypes (men: women 3: 1; median age 64 (30–79) years). Twenty patients died from non-cancer related causes, including 11 (5 per cent) from postoperative complications. Some 89 patients (42 per cent) developed proven recurrent disease of which seven are alive and 82 dead. The median time to recurrence was 11 (2–40) months with a median time to death thereafter of 3 (1–21) months. The pattern of recurrence was locoregional in 23 per cent (oesophageal bed 15 per cent, upper abdominal 3 per cent, upper mediastinal 3 per cent, cervical 2 per cent) and haematogenous in 18 per cent (comprising liver 8 per cent, bone 4 per cent, cerebral 3 per cent, lung 2 per cent, skin 1 per cent) with peritoneal dissemination in 1 per cent. While there was no difference in the overall pattern of dissemination for each histological subtype, the incidence of cervical and upper mediastinal recurrence was significantly higher for adenocarcinoma compared with SCC (χ2 = 5·9, 1 d.f., P &lt; 0·02). The timing of recurrence was similar for both histological subtypes: 60 per cent of all recurrence occurred within 12 months of surgery, with distant and locoregional recurrence occurring at a median of 10 (2–40) and 11 (2–32) months respectively.

Conclusions
The low incidence of upper mediastinal and cervical recurrence suggests that more extensive lymphadenectomy is unlikely to impact upon survival. Improved staging modalities are required to identify the significant number of patients who develop early recurrence in the first year following surgery in order to offer them multimodality therapies of non-surgical palliation.
Prognostic value of quality of life scores in patients with oesophageal cancer
Authors: Blazeby J M , Brookes S T , Alderson D 
Published: July 2002

Abstract

Aims
Quality of life (QL) data are useful in evaluating treatment, in screening or psychosocial morbidity and there is accumulating evidence to show that they predict survival. This study investigated if baseline QL scores are prognostic for patients with oesophageal cancer.

Methods
Between 1993 and 1995, 89 consecutive new patients with oesophageal cancer completed baseline QL assessments with the EORTC QLQ-C30 questionnaire and the dysphagia scale from the oesophageal cancer module. Cox's proportional hazards models were used to assess the impact of QL variables on survival (82 patients have died).

Results
Univariate analyses revealed that better baseline physical and role function scores were significantly associated with increased survival (P ≤ 0·001) and worse fatigue, appetite loss and constipation scores were significantly associated with shorter survival (P &lt; 0·01). Multivariate analysis, taking account of associations between the QL scores and adjusting for age, tumour node metastasis classification T, N and M stage, showed that only physical function at baseline remained significantly associated with survival (P = 0·002); adjusting for sex, histology and comorbid disease did not alter the findings.

Conclusions
There is evidence to suggest that QL parameters may be important prognostic factors for patients with oesophageal cancer. Stronger evidence may be gained from a more highly powered study, and further understanding of the associations between QL variables and clinical data is needed.
Changing patterns in the management of gastric volvulus over 14 years
Authors: Teague W J , Ackroyd R , Watson D I , Devitt P G 
Published: July 2002

Abstract

Background
Gastric volvulus is an uncommon condition, which can be difficult to diagnose and treat. This study represents a large series of patients with the condition.

Methods
All patients presenting with gastric volvulus over a 14-year period were reviewed.

Results
Some 36 patients (median age 75 years) were identified. Volvulus, usually secondary to a hiatus hernia, presented acutely in 29 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal haemorrhage. The most useful investigations were barium contrast studies and upper gastrointestinal endoscopy, which were helpful in 21 of 25 and 11 of 18 patients respectively. Treatment was conservative in five patients, by open surgery in 13 and laparoscopic repair in 18 (three converted to open operation). There were no major complications and no deaths. Median hospital stay was shorter in patients treated by laparoscopic rather than open surgery (6 (range 4–36) versus 14 (7–50) days; P &lt; 0·05).

Conclusion
Acute and chronic gastric volvulus can be treated successfully by either open or laparoscopic surgery. However, laparoscopic surgery now represents a safe and acceptable approach, with minimal morbidity and a significantly shorter hospital stay. This is likely to be of considerable benefit for the treatment of a predominantly elderly population, often with significant co-morbidity.
Carotid duplex imaging: variation and validation
Authors: Perkins J M T , Galland R B , Simmons M J , Magee T R 
Published: July 2002

Abstract

Background
Duplex imaging is increasingly used as the only investigation before carotid endarterectomy, but many different criteria exist in the literature for the detection of a severe (70–99 per cent) carotid stenosis. This study aimed to investigate current practice in carotid duplex imaging in Great Britain and Ireland.

Methods
A postal questionnaire was sent to 86 vascular surgical units.

Results
The median number of scans performed per year was 450 (range 60–4500). Thirty-six per cent of units who responded used peak systolic: end diastolic velocity ratio to calculate carotid stenosis. Overall, nine different major duplex criteria were used to grade carotid stenosis in 14 different systems of percentage bands. Only 51 per cent of units verified their duplex criteria against angiography. Eighteen per cent of units used two or more different types of duplex scanner and applied the same diagnostic criteria to each machine.

Conclusion
A wide variation in diagnostic duplex criteria and methods of grading stenosis exists among vascular units. Internal validation is not performed routinely. Standardization of duplex criteria would ensure greater consistency, but would not replace the need for validation of results within each unit.
Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy
Authors: Takano S , Ito Y , Watanabe Y , Yokoyama T , Kubota N , Iwai S 
Published: July 2002

Abstract

Background
Pancreaticogastrostomy (PG) after pancreaticoduodenectomy has been reported to have a lower incidence of pancreatic fistula than pancreaticojejunostomy (PJ) but this was not confirmed in a recent prospective randomized study.

Methods
Different methods of reconstruction after pancreaticoduodenectomy were used between January 1994 and January 1999 in two university-affiliated hospitals, PJ (n = 69) in one hospital and PG (n = 73) in the other. Operations at both hospitals were performed by the same surgical team. All pancreatic anastomoses were carried out in two layers with pancreatic duct stents. Pancreatic fistula was identified by the presence of more than 1000 units/l of amylase-rich fluid in the drains 7 days or more after operation, by radiography from the pancreatic duct stent and by water-soluble contrast upper gastrointestinal studies.

Results
The two groups of patients were similar in terms of age, sex, findings at preoperative assessment, disease status, operative time, intraoperative blood loss and nature of non-tumorous pancreatic tissue. The amylase level in ascites at 7 days after operation was significantly lower after PG than PJ (P = 0·032). The incidence of pancreatic fistula in the PG group (zero) was significantly less than that after PJ (13 per cent) (P = 0·014). Intra-abdominal haemorrhage and intra-abdominal abscess occurred in three (4 per cent) and four patients (6 per cent) respectively, with two hospital deaths (3 per cent) in the PJ group, but these complications did not occur after PG.

Conclusion
This controlled clinical study supports the hypothesis that PG is safer than PJ, particularly with regard to the incidence of pancreatic fistula.
Ruptured abdominal aortic aneurysm: difference in selection criteria for surgery between vascular surgeons in district general and teaching hospitals
Authors: Dimitri S , Bakran A 
Published: July 2002

Abstract

Background
This audit was devised in order to examine outcome following presentation with ruptured abdominal aortic aneurysm (AAA) in one Deanery. Identification of differences in practice and outcome were sought.

Methods
Some 18 consultant vascular surgeons in eight district general hospitals (DGHs) and one university hospital (UH) participated in a prospective audit of ruptured AAA from March 1997 to February 1998.

Results
Some 159 patients were included in the audit. Outcome is shown in the Table below.
There was no difference in operative mortality rate between the UH and DGHs nor was there an increased mortality rate in the group of patients transferred from hospital to hospital despite the time delay incurred. In 47 patients admitted to the UH serum creatinine was the only laboratory test which correlated with outcome.

Conclusion
This audit clearly highlighted the differing attitude to selection of patients for surgery between the vascular surgeons in the UH and DGHs, although there was no overall statistical difference in outcome.
Influence of sex on the outcome of ruptured abdominal aortic aneurysm
Authors: Norman P 
Published: July 2002

Abstract

Background
Mortality rates from ruptured abdominal aortic aneurysm (AAA) in men and women were compared.

Methods
Patients were identified from a population-based database using the relevant ICD-9-CM codes and were divided into three groups for analysis: those dying without admission to hospital, those admitted to hospital with ruptured AAA but not undergoing surgery, and those who underwent surgery for ruptured AAA.

Results
Ruptured AAA occurred in 648 men and 225 women over the age of 55 years during the decade 1985–1994. The proportion of women increased with age from 13·8 per cent for those aged 60–69 years, to 42·3 per cent for those over 80 years of age. Only 49·7 per cent of women (112 of 225), compared with 58·9 per cent of men (382 of 648), with ruptured AAA were admitted to hospital (χ2 = 5·35, P = 0·02). Of those admitted to hospital, only 36·6 per cent of women (41 of 112) underwent surgery compared with 63·3 per cent of men (242 of 382) (χ2 = 8·71, P = 0·003). The mortality rate in women undergoing surgery was 44 per cent (18 of 41) compared with 34·7 per cent (84 of 242) in men (χ2 = 5·35, P = 0·021). The overall mortality rate from ruptured AAA was 89·8 per cent in women (202 of 225) and 75·6 per cent in men (490 of 648) (χ2 = 50·34, P &lt; 0·0001). Although women were on average older than men, age-specific analysis showed that this unfavourable pattern occurred in all age groups.

Conclusion
Women with ruptured AAA are more likely to die than men. The cause of the poor outcome in women is unclear but may be due to the use of thresholds for intervention that are based on aortic diameters in men.
Differential expansion rates of small abdominal aortic aneurysms between the apolipoprotein E genotypes
Authors: Lindholt J S , Gerdes L U , Vammen S , Henneberg D W , Fasting H 
Published: July 2002

Abstract

Background
Carriers of the E4 allele for the gene encoding apolipoprotein E (apoE) have an increased risk of atherosclerosis. The distribution of apoE genotypes among men with a small abdominal aortic aneurysm (AAA) was compared with that among healthy men, and any differences between the genotypes in aneurysm expansion measured over 2–4·5 years were examined.

Methods
The patients originate from a population ultrasonographic screening programme with about 4800 participating 65–73-year-old men in a defined geographical region. Of 191 patients diagnosed, 57 of 77 who have been followed for 2 years or more were genotyped. Aneurysm expansion rates were determined from linear regression of diameter versus time of examination. The influence of apoE genotype on expansion rate was analysed using analysis of variance, with initial aneurysm size and smoking status as covariates.

Results
The E4E4 genotype was not seen among patients with an AAA, whereas three patients had the rare E2E4 genotype. These patients had higher expansion rates than patients with the common genotype E3E3 (P = 0·009), whereas patients with the genotype E3E4 had lower rates (P = 0·034) (see Table over).

Conclusion
The findings suggest that the common polymorphism of the apoE gene influences the prognosis in patients with a small AAA. As regards the E3E4 genotype, the findings are unexpected, when compared with the known influence of E4 on the risk of atherosclerosis. This may partly explain the familial tendency of AAA, and inconsistent finding of coexisting atherosclerosis in patients with AAA. However, an impact of selection bias, due to differential survival or referral to surgery of patients with AAA, cannot be excluded.
Risk factors for aneurysm rupture: results from the UK small aneurysm study and trial
Authors: Greenhalgh R M , Brown L C , Powell J T 
Published: July 2002

Abstract

Background
The UK Small Aneurysm Trial has shown that ultrasonographic surveillance is a safe management option for patients with small abdominal aortic aneurysms (4·0–5·5 cm in diameter), with an annual rupture rate of 1 per cent. In this study risk factors associated with aneurysm rupture have been investigated using both patients randomized into the UK Small Aneurysm Trial and those monitored for aneurysm growth in the associated study.

Methods
The cohort of patients included 1090 from the trial and 1167 from the associated study. In this cohort of 2257 patients (79 per cent men), aged 59–77 years, 103 instances of abdominal aortic aneurysm rupture were identified during the 7-year follow-up (1991–1998). The relationship between rupture and ten prespecified risk factors (including age, sex, aneurysm diameter, smoking status, plasma cholesterol, lung function and ankle: brachial pressure index) was investigated using Kaplan–Meier survival and Cox regression analysis.

Results
Almost all patients (98 per cent) had initial aneurysm diameters in the range 3–6 cm and the majority of ruptures (76 per cent) occurred in patients with aneurysms known to be larger than 5 cm in diameter. Kaplan–Meier survival and Cox regression analysis were used to identify baseline risk factors associated with aneurysm rupture. After 3 years, the annual rate of aneurysm rupture was 2·2 (95 per cent confidence interval 1·7–2·8) per cent. The risk of rupture was independently and significantly associated with female sex (P &lt; 0·001), larger initial aneurysm diameter (P &lt; 0·001), lower FEV1 (P = 0·004), current smoking (P = 0·01) and higher mean blood pressure (P = 0·01). Age, body mass index, serum cholesterol concentration and ankle: brachial pressure index were not associated with an increased risk of aneurysm rupture.

Conclusion
Within this cohort of patients women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.
Protease expression in human aneurysmal and occlusive atherosclerotic aortas
Authors: Carrell T W G , Smith A , Burnand K G 
Published: July 2002

Abstract

Background
Atherosclerosis is implicated in the pathogenesis of abdominal aortic aneurysm (AAA), yet often causes aortic occlusive disease (AOD). Proteolysis of elastin and collagen, the major structural proteins of the aortic wall, must occur for an aneurysm to dilate. The matrix metalloproteinases (MMPs) are a class of enzymes that degrade elastin and collagen in the extracellular matrix and are believed to play a central role in the pathogenesis of AAA. However, some MMPs have also been found in atherosclerotic occlusive disease, in the absence of dilating disease. Differences in the expression of MMPs may determine whether an atherosclerotic aorta dilates or occludes. The expression of MMPs and their natural inhibitors (TIMPs) in human abdominal aortic aneurysm and stenosing atherosclerotic aortas was measured.

Methods
Samples of aortic wall were obtained from eight patients with AAA and eight with AOD. Expression of the MMPs was estimated with the reverse transcription polymerase chain reaction using a synthetic multicompetitor standard as a robust internal control. The standard allowed assay of 14 MMPs and three TIMPs.

Results
AAA wall expressed significantly more of the collagenolytic enzyme stromelysin 1 (MMP-3) and TIMP-3 than AOD wall (stromelysin 1: mean(s.d.) log (MMP-3/GAPDH) −1·97(0·52) in AAA versus −3·36(0·77) in AOD, P &lt; 0·01; TIMP-3: −1·79(0·69) versus −2·84(0·78), P &lt; 0·01). The elastolytic enzymes matrilysin, macrophage metalloelastase (MMP-7 and MMP-12), gelatinases 2 and 9, and membrane-type metalloproteinase 1 were expressed in both AAA and AOD.

Conclusion
There is expression of most elastolytic and collagenolytic MMPs in both aneurysms and occlusive disease, but expression of stromelysin 1 is greatly increased in aneurysms. Stromelysin 1 may be responsible for collagen breakdown in aneurysm disease and provide a target for pharmacological intervention.