bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis
Authors: Lemaire E , O'Toole D , Sauvanet A , Hammel P , Belghiti J , Ruszniewski P 
Published: July 2002

Abstract

Background
The aim was to evaluate pancreatic exocrine and endocrine function, pancreatic atrophy and main pancreatic duct dilatation in the pancreatic remnant following pancreaticoduodenectomy and pancreaticogastrostomy.

Methods
Nineteen patients who underwent pancreaticoduodenectomy and pancreaticogastrostomy for benign or malignant pancreatic tumours with a histologically normal pancreatic resection margin were studied prospectively. The median interval between operation and evaluation was 32 (range 12–120) months. Pancreatic exocrine insufficiency was assessed by measuring 72-h faecal fat concentrations and faecal-1 elastase. Fasting blood glucose, haemoglobin A1c, serum peptide C and insulin levels were used to assess endocrine function. Pancreatic parenchymal thickness and main pancreatic duct diameter were measured before operation and at evaluation using computed tomography (CT).

Results
Faecal fat excretion was raised in 16 of 17 patients; faecal-1 elastase was reduced in all 17 patients. None of the 17 non-diabetic patients had developed diabetes mellitus at follow-up. A significant decrease in pancreatic parenchymal thickness and increased dilatation of the main pancreatic duct were observed on CT at evaluation (P = 0·01 and P = 0·01 respectively). Pancreatic atrophy, assessed by subtracting the diameter of the pancreatic duct from the total gland thickness, tended to develop over time, but at the limit of statistical significance (P = 0·06).

Conclusion
A median of 3 years following pancreaticoduodenectomy and pancreaticogastrostomy, patients remained free from diabetes but developed marked pancreatic exocrine insufficiency.
Influence of allograft size to recipient body-weight ratio on the long-term outcome of renal transplantation
Authors: Nicholson M L , Windmill D C , Horsburgh T , Harris K P G 
Published: July 2002

Abstract

Background
The critical nephron mass needed to meet the metabolic demands of an individual depends on the body-weight. This study evaluated the effect of the kidney transplant ultrasonographic size to recipient body-weight ratio (Tx/W) on the outcome of kidney transplantation.

Methods
A consecutive series of 104 cadaveric renal transplants was studied. Transplant cross-sectional area (TXSA) was measured ultrasonographically in the first week after transplantation as an index of renal size. A ‘nephron dose’ index (Tx/W) was calculated by dividing TXSA by recipient weight and was used to define three groups of patients, with high (more than 0·45), medium (0·3–0·45) or low (less than 0·3) Tx/W ratios. Isotope glomerular filtration rate (GFR) measurements were made at 1, 6 and 12 months after transplantation.

Results
The serum creatinine level was significantly lower in the first 5 years after transplantation in patients with a high Tx/W ratio than in those with a medium or low ratio. GFR measurements were marginally higher in the groups with a high and medium Tx/W ratio compared with the low Tx/W group. A statistically significant association between Tx/W ratio and graft survival was not found.

Conclusion
The renal transplant size to recipient weight ratio was an important determinant of long-term renal allograft function in this study. Extreme mismatching between allograft and recipient size should be avoided where possible, but the findings presented require confirmation in larger studies before clear recommendations can be made about size matching and kidney allocation.
Changes in pancreatic resection for chronic pancreatitis over 28 years in a single institution
Authors: Falconi M , Valerio A , Caldiron E , Salvia R , Sartori N , Talamini G , Bassi C , Pederzoli P 
Published: July 2002

Abstract

Background
Because of advances in knowledge over recent years there is reason to believe that surgical attitudes towards patients with chronic pancreatitis may have changed.

Methods
Some 547 patients were treated surgically for chronic pancreatitis from 1971 to June 1998. Anastomoses were performed in 80 per cent (438 patients) and resections in 20 per cent (109 patients). Indications and type of operation were analysed, as were mortality and morbidity rates and long-term follow-up results, in patients undergoing resection both over the period as a whole and after dividing the series into two subperiods of 14 years.

Results
In the second 14-year period, there was a significant reduction in the percentage of resections compared with anastomoses (28 per cent (69 of 244 patients) versus 13 per cent (40 of 303); P &lt; 0·0001), and a significant change in the type of resection with a substantial increase in resections of the head compared with those of the body and tail. Statistically significant reductions occurred in operating times, number of units of blood transfused (mean(s.d.) 4·7(3·6) versus 1·2(1.6) units; P = 0·0001) and mean hospital stay (18 versus 14 days for pylorus-preserving and 12 versus 8 days for left pancreatectomy with splenectomy; P &lt; 0·01); mortality and morbidity rates also tended to decrease, but not significantly.

Conclusion
A different pattern has emerged over the years as regards both the type and number of resections performed.
Audit of time to emergency trauma laparotomy
Authors: Henderson K I M , Coats T J , Hassan T B , Brohi K 
Published: July 2002

Abstract

Background
An analysis of the process of care may improve quality of care within a trauma system. Early operative control of haemorrhage is vital and any delay before surgery may adversely affect outcome.

Methods
Times from activation of the aeromedical team to arrival in the emergency department and the operating room for patients with liver or spleen injury were analysed to identify factors that delayed laparotomy. These results were compared with those of a national database.

Results
The median time from emergency call to operation was 127 min (140 min for blunt and 86 min for penetrating injuries). Time from arrival in the emergency department to the operating room was 54 min (56 min for blunt and 37 min for penetrating injuries). An audit filter, set at the upper quartile of the emergency call to operating room time, selected 21 patients whose records were examined; five correctable delays were identified. Compared with the national trauma database, these patients had longer on-scene times, but significantly shorter times to operation from the emergency call (127 versus 161 min) and arrival at the emergency department (54 versus 115 min), although the patients were more severely injured (median Injury Severity Score 34 versus 24).

Conclusion
The time to emergency trauma laparotomy may be used effectively as an audit of process for the clinical governance of a trauma system.
Randomized clinical trial of haemorrhoidectomy under a mixture of local anaesthesia versus general anaesthesia
Authors: Ho K S , Eu K W , Heah S M , Seow-Choen F , Chan Y W 
Published: July 2002

Abstract

Background
Application of a topical anaesthetic agent may facilitate infiltration of local anaesthetic at haemorrhoidectomy.

Methods
A randomized clinical trial of 53 consecutive patients requiring elective haemorrhoidectomy was carried out. One group underwent haemorrhoidectomy under general anaesthesia, while the second group had topical anaesthetic cream (containing lignocaine and prilocaine) applied followed by local anaesthetic infiltration for surgical anaesthesia.

Results
There were no differences between the two groups in terms of operating time, postoperative pain, nausea or vomiting, pain-free interval after operation, analgesic requirements or patients' satisfaction with the method of anaesthesia. Postoperative oxygen saturation and pulse rate were similar in the two groups.

Conclusion
Topical anaesthetic and local anaesthesia can be used effectively for haemorrhoidectomy and provide an alternative to general anaesthesia.
Differences in cognitive function and S100 production after carotid endarterectomy under local or general anaesthetic
Authors: Calvey T A J , Bollom P , Cruickshank J , Waterman M , Mavor A I D , Homer-Vanniasinkam S , Gough M J 
Published: July 2002

Abstract

Background
Previous studies reported both improved (enhanced cerebral perfusion after carotid endarterectomy (CEA)) and diminished (intraoperative ischaemic injury) cognitive function (CF) following CEA. These studies were not adequately controlled for anxiety, general health and learning (repeated testing), and the influence of anaesthetic technique was not assessed.

Methods
This study assessed CF (trained psychologist, seven computerized tests) before operation, and at 5 and 90 days after CEA performed under local anaesthesia (LA) (n = 34) or general anaesthesia (GA) (n = 13). Similar measurements in patients undergoing lower limb revascularization (n = 14) and unoperated subjects with asymptomatic carotid stenosis greater than 70 per cent (n = 16) tested twice, 3 months apart, controlled for the effects of anaesthesia, surgery and carotid arteriosclerosis. Additionally, jugular venous S100 levels (neuronal protein released following cerebral injury) were measured (before carotid clamping, and 1, 4 and 24 h after clamp release) in 18 of these patients (nine LA, nine GA).

Results
Compared with controls, test performance in patients who had CEA under GA improved in one (executive CF 90 days; P = 0·028), but deteriorated in another (working memory 90 days; P = 0·038) while patients who had LA improved in three of seven tests (executive function, working memory) at 5 days (P = 0·03, 0·048, 0·036) and 90 days (P = 0·01, 0·05, 0·006). Further, a greater than 25 per cent improvement in one or more tests was more likely 90 days after CEA under LA (22 of 34 versus four of 13; P &lt; 0·04) with improved executive function, speed and accuracy. S100 levels were lower after CEA under LA (1 h: 0 (0–30) versus 29 (8–98) µg ml−1, P &lt; 0·05; 4 h: 0 (0–6) versus 22 (2–95) µg ml−1, P &lt; 0·05; 24 h: 0 (0–1) versus 35 (14–77) µg ml−1, P &lt; 0·01).

Conclusion
This study demonstrated improved CF following CEA under LA which was associated with lower jugular venous S100 levels (marker of cerebral injury). These differences may reflect improved cerebral oxygenation (preservation of cerebral autoregulation).
Intraoperative change in baroreceptor function during carotid endarterectomy
Authors: Gaunt M E , Sigaudo-Roussel D , Panerai R , Evans D H , London N L , Naylor A R , Bell P R F 
Published: July 2002

Abstract

Background
Labile blood pressure following carotid endarterectomy (CEA) is common and is associated with perioperative myocardial infarction and intracranial haemorrhage. Previous studies have identified that alteration in carotid baroreceptor function is responsible for the blood pressure changes although the mechanism remains unclear. This study aimed to identify the mechanism by which CEA affects baroreceptor function.

Methods
Fifty patients were recruited prospectively and underwent estimation of baroreceptor sensitivity (BRS) during a 10-min period of supine bed rest using electrocardiography and Finapres, 2 days before and 2 days to 6 weeks after surgery. During surgery continuous measurements of blood pressure (intra-arterial) and heart rate were recorded on to digital audio tape for postoperative analysis. During analysis the operation was divided into different stages to identify at which stage baroreceptor function altered. Particular attention was paid to initial clamping of the carotid artery, performance of the endarterectomy and final restoration of blood flow. In addition the carotid sinus area was stimulated by stroking the inside of the artery before and after removal of the plaque. Autonomic activity was calculated using power spectral analysis of beat-to-beat blood pressure and the R–R interval from the electrocardiograph. BRS was estimated by calculation of the square root of the ratio of the powers of R–R interval and systolic blood pressure to give the alpha index which has been shown to correlate well with BRS calculated by means of standard pharmacological techniques.

Results
For this cohort of patients BRS was significantly reduced 2 days after surgery compared with the preoperative recordings (2·8(0·4) to 5·6(0·8)). Six weeks after operation BRS had improved but had not achieved preoperative levels (3·8(0·6) to 5·6(0·8)). During surgery, patients with good baroreceptor function identified before operation experienced a rise in blood pressure on initial carotid clamping indicating that dissection had not affected the baroreceptor mechanism. Similarly, intraluminal stimulation of the carotid sinus area with the plaque in situ produced a decrease in blood pressure indicating good baroreceptor function. After removal of the plaque, repeating the intraluminal stimulation did not produce a decrease in blood pressure indicating disruption of the baroreceptor mechanism.

Conclusion
Removal of the atheromatous plaque during CEA adversely affects carotid baroreceptor function. The baroreceptor mechanism is disrupted but not completely destroyed and gradually improves in the weeks following surgery.
Indications of infection with Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysm
Authors: Scott R A P , Ashton H , Lindholt J S 
Published: July 2002

Abstract

Background
This was a study of the possible association between the progression of abdominal aortic aneurysm (AAA) and indicators of infection with Chlamydia pneumoniae.

Methods
Blood samples were taken from patients with AAA (3 cm diameter or greater detected by an aneurysm screening programme) who had been followed prospectively for up to 11·5 (mean 4·1) years. A sex- and age-matched control group was also recruited. Immunoglobulin (Ig) G and IgA antibodies against C. pneumoniae were measured by a microimmunofixation test. Analysis of variance, multiple linear regression and logistic regression were used for statistical analysis. Ninety men and ten women with a small AAA and 20 age-matched male controls were investigated. Outcome measures studied were AAA expansion, and IgA and IgG titres of antibodies against C. pneumoniae.

Results
Forty-four (95 per cent confidence interval (c.i.) 31–55) per cent of the men with an AAA had IgA greater than 64 or IgA above 28 compared with 10 per cent of the women with an AAA (odds ratio (OR) 7·2 (95 per cent c.i. 1·0–160·8)) and 25 per cent of the controls (OR 2·24 (95 per cent c.i. 0·67–7·93)). IgA greater than 128 was significantly associated with greater expansion (5·3 versus 2·6 mm per year), even after adjustment for initial AAA size and age. A significant dose–response reaction was found between IgA titre and mean annual expansion (R = 0·45 (95 per cent c.i. 0·24–0·62)). The significant positive correlation remained after adjusting for initial AAA size and age. Finally, IgG greater than 128 was present significantly more often in patients with expansion above 1 cm annually (OR 12·6 (95 per cent c.i. 1·4–293)).

Conclusion
A high proportion of men with AAA have signs of infection by C. pneumoniae. The progression of AAAs correlated with the presence of indicators of C. pneumonia infection, and a dose–response reaction between IgA titre and expansion was observed.
Population screening reduces the total community mortality rate from aortic aneurysms
Authors: Shaw E , Poskitt K , Earnshaw J , Whyman M , Heather B 
Published: July 2002

Abstract

Background
Screening of the male population for unsuspected abdominal aortic aneurysm (AAA) has been taking place in a single UK county (population 520 000) since 1990.

Methods
The general practitioner surgery-based programme involves ultrasonographic examination of each year's new batch of 65-year-old men, excluding those who were older than this when the programme started. This method of screening has resulted in a gradually enlarging cohort of screened men, so that by the end of 1998 all men between the ages of 65 and 73 years had been offered an ultrasound scan, with 85 per cent accepting and over 21 000 men examined. Total aneurysm-related deaths in the community have been quantified by examining inpatient records and post-mortem results for the county's hospitals, together with computerized death certificate records held by the health authority (available for 1994 onwards). This figure thus includes deaths at home from ruptured AAA, in-hospital deaths from ruptured AAA with or without emergency surgery and all deaths following elective AAA surgery.

Results
The 65–73-year-old age group has been progressively influenced by AAA screening as new 65 year olds are examined each year. Total aneurysm-related deaths in this age range have shown a progressive, year by year fall between 1994 and 1998, with an overall reduction in deaths by two-thirds during this 5-year period. In contrast, aneurysm-related deaths in men aged below 65 and over 73 years have tended to show a slight increase in the same period.

Conclusion
These figures clearly demonstrate that population screening reduces overall deaths from aortic aneurysms.
Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm
Authors: Powell J T 
Published: July 2002

Abstract

Background
In regional and national studies death within 30 days of elective open surgical repair of an abdominal aortic aneurysm has been reported to be 7–8 per cent or even higher. Identification of preoperative factors associated with this mortality risk is important for informing surgical policy and may suggest suitable preoperative interventions.

Methods
During the course of the UK Small Aneurysm trial, 820 patients aged 60–80 years underwent elective open surgical repair of an abdominal aortic aneurysm. The relationship between 30-day mortality rate and 13 prespecified potential prognostic factors (including age, sex, aneurysm diameter, electrocardiographic evidence of myocardial ischaemia, lung function, creatinine level, hospital centre and tube or bifurcated graft) was studied.

Results
The postoperative mortality rate was 5·6 per cent overall (46 deaths in 820 patients). In univariate analyses postoperative mortality risk was associated significantly with higher serum creatinine (P = 0·002), poor lung function with low forced expiratory volume in 1 s (FEV1) (P = 0·003) and older age (P = 0·03). Evidence of the relationship between age and postoperative death was weaker (P = 0·08) after adjustment for creatinine and FEV1. The predicted postoperative mortality risk ranged from 2·7 per cent in younger patients with a low creatinine level and high FEV1 to 7·8 per cent in older patients with above average creatinine levels and below average FEV1. There was no evidence of between-hospital or between-surgeon variability in postoperative risk.

Conclusion
Poor preoperative lung and renal function were associated strongly with postoperative death. Age was less important once these two prognostic indicators were taken into account. The potential for preoperative improvement in lung and renal function to reduce the postoperative mortality rate should be addressed in future studies.
Outcome of 112 consecutive patients with an abdominal aortic aneurysm greater than 5·5 cm turned down for elective repair at a university hospital
Authors: Conway K , Byrne J , Lane I F 
Published: July 2002

Abstract

Background
The UK Small Aneurysm study has demonstrated the low risk of rupture in aneurysms less than 5·5 cm in diameter. However, the natural history of aneurysms greater than 5·5 cm remains unresolved. Questions of equipoise probably preclude another trial in patients with an AAA over 5·5 cm. In this centre, the authors prospectively maintain records of all patients refused elective aneurysm surgery. This study aimed to document the outcome of all patients referred with an AAA greater than 5·5 cm in diameter, and to determine the cause of death and risk of rupture in all patients.

Methods
Details of all patients presenting with an AAA from 1989 to 1999 were recorded and demographic details on all patients with an AAA greater than 5·5 cm were collected. The endpoint was 1 May 1999. Copies of death certificates for deceased patients were obtained from the Office of National Statistics, local in-hospital patient records and general practitioner records. Results of post-mortem examinations were also retrieved. Aneurysms were stratified according to size at presentation (5·5–5·9, 6·0–7·0, more than 7·0 cm) and reasons for non-intervention were documented.

Results
Some 112 patients were turned down over 10 years (11·4 per year). The mean(s.d.) age of this patient group was 77·7(7·7) years; there were 74 men and 38 women. Crude mortality data are shown in the Fig. below (Kaplan–Meier curve). At the end of the study period, 87 patients (76 per cent) were dead, 26 (30 per cent) from a ruptured AAA. Mean survival times were: 23 months (5·5–5·9 cm), 20 months (6·0–7·0 cm) and 15 months (greater than 7·0 cm).

Conclusion
While recognizing the problems with death certification, rupture still seems to be a significant cause of death in patients with untreated AAAs greater than 5·5 cm. While little difference is observed in 5·5–7·0-cm range, patients with an AAA greater than 7·0 cm seem to have a much poorer prognosis.
Methicillin-resistant Staphylococcus aureus infection in vascular patients
Authors: Nasim A , Thompson M M , Naylor A R , Bell P R F , London N J M 
Published: July 2002

Abstract

Background
The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is a major threat in arterial surgery and poses a considerable therapeutic challenge. The aim of this study was to assess the prevalence of MRSA infection in patients treated in the vascular unit.

Methods
A retrospective case-note review was undertaken to identify the nature of the infection and the outcome.

Results
During 1993–1998, a total of 115 patients (4 per cent of the total) were positive for MRSA. Of these, 67 were colonized and 48 were infected by MRSA. The number of MRSA infections increased yearly (1 per cent in 1994 to 5 per cent in 1998). Of the 48 patients infected by MRSA, one had wound infection following brachial embolectomy which eventually resolved. Two patients had undergone carotid endarterectomy necessitating removal of an infected Dacron patch, one of whom developed a hemiparesis. Eleven patients had undergone elective abdominal aortic aneurysm (AAA) repair (five developed pneumonia, two septicaemia, two wound infection, one a false aneurysm at the site of insertion of an endovascular stent, and one developed crossover graft infection after endovascular AAA repair and died). Five patients had undergone ruptured AAA repair (two developed pneumonia, one wound infection and two developed graft infection and died). Four patients undergoing reconstruction for aortic occlusive disease developed MRSA infection, two of whom died. Twenty-five patients with MRSA infection had undergone lower limb procedures. Five of these had graft infection leading to amputation in three and death in two. One patient developed primary arterial infection following embolectomy resulting in arterial rupture.

Conclusion
These results suggest that the prevalence of MRSA infection in vascular patients is increasing. Infection of aortic grafts appears to be uniformly fatal and lower limb graft infection is associated with a high rate of limb loss.