bluuebunny/crossref_metadata_2025_split huggingface dataset:
A single normal ultrasonographic scan at age 65 years rules out significant aneurysm disease for life in men
Authors: Crow P , Shaw E , Earnshaw J J , Poskitt K R , Whyman M R , Heather B P 
Published: July 2002

Abstract

Background
Screening for abdominal aortic aneurysm (AAA) has been carried out in Gloucestershire since 1990. All men in the county are offered aortic ultrasonography in their 65th year. Men with an aortic diameter of less than 26 mm are considered ‘normal’ and no follow-up is arranged. The aim of this study was to ascertain if men with ‘normal’ aortic diameters at age 65 years ever develop a clinically significant aneurysm.

Methods
A cohort study was performed on 223 65-year-old men who had an aorta of less than 26 mm in diameter in 1988. These men had repeat ultrasonography in 1993 and 2000. The causes of death in men who died during this interval were investigated.

Results
Eight men were lost to follow-up. As far as it was possible to ascertain, none of the 86 men who died over the 12-year interval did so from ruptured AAA. There was no clinically significant increase in mean aortic diameter in the remaining 129 men who had three serial ultrasonographic scans over the 12-year interval.

Conclusion
A single, ‘normal’ ultrasound scan at age 65 years effectively rules out the risk of clinically significant aneurysm disease for life in men.
Influence of blood components and faeces on the in vitro cancericidal activity of povidone–iodine
Authors: Basha G , Penninckx F , Yap P 
Published: July 2002

Abstract

Background
Tumoricidal agents have been used to kill viable exfoliated tumour cells following colorectal cancer surgery. Recent in vivo experiments have thrown some doubt on the tumoricidal activity of povidone–iodine.

Methods
The cytotoxic effect of distilled water and of povidone–iodine at 0·04, 0·4, 0·8, 2 and 4 per cent final concentrations on human SW620 colonic cancer cells in the presence of red blood cells, purified haemoglobin and red blood cell (RBC) membranes, plasma, albumin, faeces and bacteria was investigated. Cell viability was assessed using the trypan blue assay and MTT test.

Results
The presence of albumin and plasma decreased the tumoricidal activity of povidone–iodine except for the highest concentration tested. Bacterial suspension did not influence the efficacy of povidone–iodine. Faecal material was found to have an intrinsic tumoricidal effect. Both intact and lysed RBCs very strongly inhibited the tumoricidal activity of all povidone–iodine concentrations tested. This inhibitory effect was due to haemoglobin, but not to RBC membranes.

Conclusions
Low concentrations of povidone–iodine fail to kill all ‘exfoliated’ cancer cells in the presence of proteins, intact or lysed RBCs. Therefore, washing out of these organic materials before application of a relatively high povidone–iodine concentration (e.g. 5 per cent or greater) may be more useful in killing viable exfoliated tumour cells during surgery for colorectal cancer.
The missing mammographic abnormality
Authors: Kerin M J , Monson J R T 
Published: July 2002

Abstract
On completion of a diagnostic stereotactic localization excision biopsy and check specimen radiograph, no abnormality to correlate with a preoperative mammogram is found. How should this clinical problem be handled? Mr M. J. Kerin and Professor J. R. T. Monson of the University of Hull reply.
In vitro DNA synthesis in freshly separated human breast cancer cells assessed by tritiated thymidine incorporation assay: relationship to the long-term outcome of patients
Authors: Nio Y , Tamura K , Kan N , Inamoto T , Ohgaki K , Kodama H 
Published: July 2002

Abstract

Background
Tumour growth rate has a significant effect on the clinical course of various malignancies. The present study was designed to assess whether in vitro DNA synthesis in freshly separated breast cancer cells is a useful marker in evaluating growth rates and in predicting the clinical outcome of patients.

Methods
From 1982 to 1992, DNA synthesis was assessed by [3H]thymidine incorporation in 97 samples of primary lesions from 94 patients with breast cancer. The patients were followed for 5–15 years and their outcome was surveyed in January 1998.

Results
The level of DNA synthesis did not correlate with the patients' age, clinical stage or expression of oestrogen receptor. However, it correlated significantly with the histological grade. In 89 patients, whose outcome was reported, the survival rate in the group with a high rate of DNA synthesis (log10c.p.m. 3·0 or more) was significantly lower than that in the low-level group; the 5- and 10-year survival rates were 84 and 74 per cent for the low synthesis group (n = 46), and 60 and 46 per cent for the high synthesis group (n = 43) respectively. This was also noted in patients with stage 1 or 2 cancers, for whom the 5- and 10-year survival rates were 100 and 90 per cent for the low synthesis group (n = 25), and 75 and 70 per cent for the high synthesis group (n = 35). Multivariate analysis supported this significant correlation for DNA synthesis in the prognosis of patients after mastectomy. Furthermore, the level of DNA synthesis was significantly higher in 18 patients who died from a recurrence within 3 years after operation than in 56 survivors, and the level of DNA synthesis also correlated significantly with the survival period in the 33 patients who died.

Conclusion
The level of DNA synthesis in breast cancer was variable, and was independent of the clinical stage or oestrogen receptor status. However, a high level of DNA synthesis was a positive indicator of a high risk of recurrence after operation, especially for stage 1 or 2 breast cancer. In vitro DNA synthesis may account for some of the clinical characteristics of breast cancers.
Radical resection of hilar bile duct carcinoma and predictors of survival
Authors: Todoroki T , Kawamoto T , Koike N , Takahashi H , Yoshida S , Kashiwagi H , Takada Y , Otsuka M , Fukao K 
Published: July 2002

Abstract

Background
Patients with carcinoma of the main hepatic duct have a poor prognosis. This study attempted to identify clinicopathological predictors of survival after resection.

Methods
A retrospective review was performed of 114 patients who presented with hepatic ductal carcinoma between 1976 and 1998. Of the 114 patients, 98 had a radical resection, three underwent palliative resection and 13 were not treated surgically. Forty-six patients with stage IVA disease had microscopic tumour residue after resection. Of these, 28 patients were treated with radiotherapy and the remaining 18 had resection alone.

Results
The overall operative morbidity and mortality rates were 14 and 4 per cent respectively. The overall 5-year survival rate after resection was 28 per cent. Nineteen patients survived for more than 5 years, including ten with stage IVA disease. The main prognostic factors were performance status; jaundice; tumour location; gross appearance; histological grade; T, N and M categories in tumour node metastasis (TNM) classification; TNM stage; and residual tumour. Adjuvant radiotherapy, tumour extension into the hepatic ducts, histological grade, N and residual tumour were independent predictive factors by multivariate Cox analysis.

Conclusion
This study suggests that radical resection provides the best survival rate for patients with hilar bile duct carcinoma. For patients with stage IVA disease, following complete gross resection radiotherapy improved treatment outcome.
Treatment of recurrent colorectal liver metastases by interstitial laser photocoagulation
Authors: Shankar A , Lees W R , Gillams A R , Lederman J A , Taylor I 
Published: July 2002

Abstract

Background
Hepatic resection improves survival in selected patients with colorectal liver metastases. The treatment of recurrent hepatic metastases after resection is controversial. Interstitial laser photocoagulation, performed under local anaesthesia, offers a minimally invasive option to repeat resection. The first series of patients with recurrent colorectal liver metastases treated with photocoagulation is reported.

Methods
Nineteen patients (five women and 14 men, median age 57 (range 44–71) years) who developed recurrent colorectal liver metastases after hepatectomy (five with bilateral disease) were treated with photocoagulation between 1993 and 1997. Fifteen patients also received chemotherapy (14 systemic, one hepatic arterial) before photocoagulation.

Results
There were no major complications or deaths related to the treatment. Six patients developed minor complications related to the procedure but did not require any form of intervention. Median survival from commencement of photocoagulation was 16 (range 4–36) months.

Conclusion
Photocoagulation is a safe, minimally invasive therapy that may be used as an adjunct to chemotherapy and repeat resection in the treatment of recurrent colorectal liver metastases, and may lead to improved survival.
Pain after laparoscopic cholecystectomy
Authors: Wills V L , Hunt D R 
Published: July 2002

Abstract

Background
Although laparoscopic cholecystectomy (LC) results in less pain than open chole-cystectomy, it is not a pain-free procedure. Many methods of analgesia for pain after laparoscopy have been evaluated.

Methods
Forty-two randomized controlled trials assessing interventions to reduce pain after LC are reviewed, as are the mechanisms and nature of pain after this procedure.

Results
Non-steroidal anti-inflammatory drugs, wound local anaesthetic, intraperitoneal local anaesthetic, intraperitoneal saline, a gas drain, heated gas, low-pressure gas and nitrous oxide pneumo-peritoneum have been shown to reduce pain after LC. The clinical significance of this pain reduction is questionable.

Conclusion
Pain after LC is multifactorial. Although many methods of analgesia produce short-term benefit, this does not equate with earlier discharge or improved postoperative function. However, single trials evaluating low-pressure insufflation, heated gas and multimodal analgesia suggest that clinically relevant benefits can be achieved.
Aminoguanidine attenuates endotoxin-induced mesenteric vascular hyporeactivity
Authors: Kavuklu B , Iskit A B , Guc M O , Ilhan M , Sayek I 
Published: July 2002

Abstract

Background
The aim of this study was to investigate the effects of inducible nitric oxide synthase inhibition by aminoguanidine on endotoxin-induced reduction in mesenteric blood flow.

Methods
Twenty Sprague–Dawley rats (180–230 g) allocated into four groups were administered either Escherichia coli endotoxin 1 mg/kg intraperitoneally or its solvent saline and were pretreated with either aminoguanidine (15 mg/kg intraperitoneally 20 min before and 2 h after endotoxin injection) or saline. Some 4 h after endotoxin injection, animals were anaesthetized, arterial blood pressure and mesenteric blood flow were measured and the resistance in the mesenteric vascular beds was then calculated. The effect of phenylephrine (1–30 µg/kg intravenously) on these parameters was also investigated.

Results
Endotoxin did not significantly modify the mean arterial blood pressure but decreased mesenteric blood flow by increasing the vascular resistance (mean(s.e.m.) 7·8(1·0) versus 13·7(1·2) mmHg per min per ml for control versus endotoxin groups; n = 5, P = 0·0099). Aminoguanidine alone had no effect on either the mean arterial blood pressure or mesenteric blood flow, but it completely blocked the effects of endotoxin. On the other hand, endotoxin significantly attenuated the responsiveness to phenylephrine which was restored by aminoguanidine.

Conclusion
The present results indicate that endotoxin decreases the mesenteric vascular blood flow by increasing vascular resistance and decreases responsiveness to phenylephrine. The effects of endotoxin were inhibited by aminoguanidine. The mesenteric vasoconstriction in response to endotoxin might not be explained by the overproduction of nitric oxide; other actions of aminoguanidine may explain its inhibitory effect.
Association of tumour necrosis factor microsatellite haplotypes with chronic pancreatitis
Authors: O'Reilly D A , Sargen K D , Dunlop S , Demaine A G , Kingsnorth A N 
Published: July 2002

Abstract

Aims
Recent evidence implicates the immune system in having a primary pathogenic role in the development of chronic pancreatitis (CP). This study examined the relationship between the tumour necrosis factor (TNF) gene and susceptibility to CP.

Methods
DNA was extracted from the blood of 40 patients with CP, 107 ethnically matched normal controls and 33 patients with alcohol-induced liver disease (alcoholic controls). Three microsatellite polymorphisms at the TNF locus were examined by the polymerase chain reaction, gel electrophoresis and autoradiography.

Results
The TNFa6 allele was significantly over-represented in patients with CP compared with normal controls (χ2 = 4·09, P = 0·043), and in those with alcoholic CP (n = 24) compared with alcoholic controls (χ2 = 4·63, P = 0·031). The three locus haplotypes 6–5−1 and 2–5−2 were significantly over-represented (χ2 = 4·14, P = 0·042) and under-represented (χ2 = 4·63, P = 0·042) respectively in patients with alcoholic CP compared with alcoholic controls.

Conclusions
A TNF haplotype has been defined that is associated with CP. This is consistent with a genetically determined role for TNF in the immunopathogenesis of CP.
Early outcome after laparoscopic and open floppy Nissen fundoplication
Authors: Ferguson J I , Palmer K , Dresner S M , Griffin S M , Paterson-Brown S 
Published: July 2002

Abstract

Aims
There remains debate regarding the best operative procedure for gastro-oesophageal reflux. For those who advocate a full ‘floppy’ Nissen fundoplication there is some scepticism that this can be completed effectively laparoscopically with division of all the short gastric vessels. This study therefore compared the results of patients operated on in two different hospitals in which floppy Nissen fundoplication was carried out either laparoscopically (hospital 1) or by open surgery (hospital 2).

Methods
All patients undergoing antireflux surgery in both hospitals were recorded prospectively and perioperative data were collected retrospectively from the case records. A postoperative questionnaire was sent to each patient to determine the modified DeMeester score and the impact of surgery on daily activities, which were then analysed anonymously by an independent clinician.

Results
Operating time was significantly longer (median 150 versus 75 min; P &lt; 0·001), but postoperative stay (2 versus 4 days; P &lt; 0·001) and return to normal activities (14 versus 25 days; P &lt; 0·002) were shorter for the laparoscopic approach. There was no difference in gas bloat (both groups median 1·0, range 0–3), dysphagia (median 1·0 versus 0·0, range 0–3) or modified DeMeester score (both groups median 1·0, range 0–9) between the two techniques (median follow-up 10 and 15 months).

Conclusions
As the postoperative results were comparable this study confirms that a ‘floppy’ Nissen fundoplication with complete mobilization of the gastric fundus can be performed laparoscopically. The advantages of a shorter hospital stay and earlier return to normal activities are offset by a longer operating time.
Acute severe pancreatitis and multiple organ failure: total parenteral nutrition is still required in a proportion of patients
Authors: Schneider H , Boyle N , McCluckie A , Beal R , Atkinson S 
Published: July 2002

Abstract

Aims
Enteral nutrition (EN) is increasingly advocated as the favoured means of nutritional support in patients with multiple organ failure resulting from acute severe pancreatitis. In a proportion of patients, however, EN may not be feasible either because of gastrointestinal stasis and high nasogastric aspirates or because of superseding complications of pancreatitis such as fistulation. In these cases total parenteral nutrition (TPN) is indicated.

Methods
Patients with acute severe pancreatitis admitted to the intensive care unit (ICU) were commenced on either nasogastric or, where established, jejunostomy EN. Rates of EN were controlled by protocol and volumes of nasogastric aspirate. TPN was commenced when volumes of EN were persistently inadequate or when this route was contraindicated (e.g. high-volume small bowel fistula). Physiological and outcome data were collected prospectively and included severity of illness scoring (Acute Physiology and Chronic Health Evaluation (APACHE) II), length of stay, duration of EN and TPN, and hospital outcome.

Results
Of 69 patients with acute severe pancreatitis, 31 were transferred from other ICUs. The median APACHE II score was 18 (range 4–40) and the overall hospital mortality rate was 39 per cent. Seventeen patients (25 per cent) were managed with EN alone, ten (14 per cent) with TPN alone and 19 (28 per cent) with a combination of both. Twenty-three (33 per cent) did not have any nutritional support during their ICU stay. The mortality rate was worse among patients who received TPN only than in those who had EN (60 versus 24 per cent).

Conclusions
EN is likely to remain the route of choice for nutritional support in the ICU. However, in high-risk patients with acute severe pancreatitis EN may not be feasible and TPN is often required. This may reflect a greater severity of illness.
Need for staging laparoscopy in patients with gastric cancer
Authors: Bhalla R , Formella L , Kerrigan D D 
Published: July 2002

Abstract

Aims
The aim of preoperative staging in gastric cancer is to correctly identify patients with advanced disease who should not be subjected to surgery and to allow the treatment of those who are admitted for operation to be planned accurately. This study assessed the impact of a policy of selective staging laparoscopy in patients deemed suitable for curative or palliative surgery, to ascertain whether the selective approach increased the frequency of abandoned or unplanned surgical procedures.

Methods
Fifty consecutive patients with gastric or type III gastro-oesophageal junction cancer staged by computed tomography (CT) alone, in whom surgery was felt to be appropriate for ‘cure’ or palliative symptom control, were studied. Specific CT, endoscopic and biochemical criteria were applied prospectively to select out a subgroup of 18 patients who also underwent preoperative staging laparoscopy. The overall accuracy of staging and operative outcomes were assessed.

Results
Using this selective approach the resection rate was 98 per cent, although three patients in each group had their planned procedure altered to a less radical (two in each group) or more radical (one in each group) resection (P = 0·23). Overall, 41 of 50 patients were staged correctly (accuracy 82 (95 per cent confidence interval 69–90) per cent) and 86 per cent of patients underwent the planned surgical procedure. The only abandoned operation occurred in the staging laparoscopy group.

Conclusions
It is possible to plan a patient's operation accurately without the need for a staging laparoscopy in all cases.
Current nature and management of cancer of the oesophagus and cardia
Authors: Gillison E W , Powell D J , McConkey C , Spychal R T 
Published: July 2002

Abstract

Aims
To inform the debate about upper gastrointestinal cancer care in the UK, the incidence of cancer of the oesophagus and cardia (OGJ) was determined in the West Midlands, a region covering 10 per cent of England and Wales, with particular reference to the methods of treatment.

Methods
The case-notes of 2776 patients diagnosed with oesophageal and OGJ cancer in the 5 years from 1 January 1992 to 31 December 1996 were scrutinized by one experienced surgeon. Tumour types were classified by histology and site, and treatment modalities assessed for 30-day mortality rate together with life-table analyses.

Results
Oesophageal cancer was identified in 2188 patients (61 per cent lower, 34 per cent middle, 4 per cent upper), including 999 squamous carcinomas (27 per cent lower, 64 per cent middle, 9 per cent upper) and 995 adenocarcinomas (97 per cent lower, 3 per cent middle), while there were 588 cases of OGJ cancer (94 per cent adenocarcinomas). Resection was the commonest treatment (865 cases; 31 per cent), with a mortality rate of 10 per cent for oesophageal and 4 per cent for OGJ cancer. Palliative resection had a higher mortality rate than radiotherapy (9 versus 3 per cent), compared with 22 per cent for endoscopic palliation, while the 30-day mortality rate was 30 per cent for the 308 patients given no treatment.

Conclusions
Squamous carcinomas and adenocarcinomas of the oesophageal body are now equally common; lower-third and OGJ tumours are predominantly adenocarcinomas. This study provides baseline data for critical appraisal of potential changes in the delivery of upper gastrointestinal cancer in the UK.
Development of an EORTC module to improve quality of life assessment in patients with gastric cancer
Authors: Vickery C W , Blazeby J M , Conroy T , Johnson C D , Alderson D 
Published: July 2002

Abstract

Aims
A valid measure of quality of life (QL) that is sensitive to clinically significant changes in health is important for the assessment of patients with gastric cancer. The aims of this study were to examine whether the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 core questionnaire alone could distinguish between two clinically different groups of patients and to design a module, which included relevant patient-defined gastric cancer-specific variables.

Methods
The QLQ-C30 was completed by patients with potentially curable disease and those undergoing palliative treatment, and the results were compared between the two groups. A disease-specific module was then developed in four distinct phases according to EORTC guidelines. Relevant issues were identified from a literature search and structured interviews with patients and healthcare professionals, and worded into a provisional questionnaire which was pretested to determine any problems in its content, before formal validation.

Results
All of the subscales and single items within the QLQ-C30 were scored similarly by 144 patients, 86 with operable disease and 58 having palliative treatment, except constipation (P = 0·001). On the basis of interviews with 58 patients and 24 professionals, from the UK, France, Germany and Spain, 43 issues were reduced to produce a provisional questionnaire consisting of 24 items and pretested in 114 patients undergoing radical gastrectomy, palliative resection or other supportive measures. The resulting questionnaire, containing 22 items divided into five scales (dysphagia, pain, reflux, dietary restrictions and specific emotional problems related to gastric cancer and its treatment) and four single items, is undergoing validation.

Conclusions
The EORTC QLQ-C30 is a valid generic instrument, but does not address all factors constituting QL in patients with gastric cancer. A specific module has been developed, which includes issues volunteered by patients to increase sensitivity and improve the evaluation of treatments for a disease where QL is important.