British Journal of Surgery

Gouma, D J; Obertop, H

doi: 10.1046/j.1365-2168.1999.01275.xpmid: 10583277

References 1 Gudjonsson B . Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting . J Am Coll Surg 1995 ; 181 : 483 – 503 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 2 Edge SB , Schmieg RE, Rosenlof LK, Wilhelm MC. Pancreas cancer resection outcome in American University centers in 1989–90 . Cancer 1993 ; 71 : 3502 – 8 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Gordon TA , Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure . Ann Surg 1995 ; 221 : 43 – 9 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Lieberman MD , Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital Volume among patients undergoing pancreatic resection for malignancy . Ann Surg 1995 ; 222 : 638 – 45 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Neoptolemos JP , Russell RCG, Bramhall S, Theis B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group . Br J Surg 1997 ; 84 : 1370 – 6 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 6 Gouma DJ , De Wit LT, Van Berge Henegouwen MI, Van Gulik TM, Obertop H. Ziekenhuiservaring en ziekenhuissterfte na partiele pancreatoduodenectomie . Ned Tijdschr Geneeskd 1997 ; 141 : 1738 – 41 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 7 Begg CB , Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital Volume on operative mortality for major cancer surgery . JAMA 1998 ; 280 : 1747 – 51 . Google Scholar Crossref Search ADS PubMed WorldCat 8 Sosa JA , Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD et al. Importance of hospital Volume in the overall management of pancreatic cancer . Ann Surg 1998 ; 228 : 429 – 38 . Google Scholar Crossref Search ADS PubMed WorldCat 9 van Berge Henegouwen MI , De Wit LT, Van Gulik TM, Obertop H, Gouma DJ. Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant . J Am Coll Surg 1997 ; 185 : 18 – 24 . Google Scholar Crossref Search ADS PubMed WorldCat 10 Gollub MJ , Panicek DM, Bach AM, Penalver A, Castellino RA. Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center . Radiology 1999 ; 210 : 109 – 12 . Google Scholar Crossref Search ADS PubMed WorldCat Article PDF first page preview Close This content is only available as a PDF. © 1999 British Journal of Surgery Society Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 1999 British Journal of Surgery Society Ltd

Scholefield, J H

doi: 10.1046/j.1365-2168.1999.01291.xpmid: 10583278

References 1 Scholefield JH , Hickson W, Smith JH, Rogers K, Sharp F. Anal intraepithelial neoplasia: part of a multifocal disease process . Lancet 1992 ; 340 : 1271 – 3 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Ogunbiyi OA , Scholefield JH, Robertson G, Smith JH, Sharp F, Rogers K. Anal human papillomavirus infection and squamous neoplasia in patients with invasive vulvar cancer . Obstet Gynecol 1994 ; 83 : 212 – 16 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 3 Fenger C , Nielsen VT. Intraepithelial neoplasia in the anal canal. The appearance and relation to genital neoplasia . Acta Pathol Microbiol Immunol Scand A 1986 ; 94 : 343 – 9 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 4 Penn I . Cancer is a complication of severe immunosuppression . Surg Gynecol Obstet 1986 ; 162 : 603 – 10 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 5 McIndoe WA , McLean MR, Jones RW, Mullins PR. The invasive potential of carcinoma in situ of the cervix . Obstet Gynecol 1984 ; 64 : 451 – 8 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 6 Scholefield JH , Ogunbiyi OA, Smith JH, Rogers K, Sharp F. Treatment of anal intraepithelial neoplasia . Br J Surg 1994 ; 81 : 1238 – 40 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Frisch M , Melbye M, Møller H. Trends in incidence of anal cancer in Denmark . BMJ 1993 ; 306 : 419 – 22 . Google Scholar Crossref Search ADS PubMed WorldCat 8 Scholefield JH , Johnson J, Hitchcock A, Kocjan G, Smith JH, Smith PA et al. Guidelines for anal cytology – to make cytological diagnosis and follow up much more reliable . Cytopathology 1998 ; 9 : 15 – 22 . Google Scholar Crossref Search ADS PubMed WorldCat 9 Marchesa P , Fazio VW, Oliart S, Goldblum JR, Lavery IC. Perianal Bowen's disease – a clinicopathologic study of 47 patients . Dis Colon Rectum 1997 ; 40 : 1286 – 93 . Google Scholar Crossref Search ADS PubMed WorldCat 10 Skinner PP , Ogunbiyi OA, Scholefield JH, Start RD, Smith JFH, Sharp F et al. Skin appendage involvement in anal intraepithelial neoplasia . Br J Surg 1997 ; 84 : 675 – 8 . Google Scholar PubMed OpenURL Placeholder Text WorldCat Article PDF first page preview Close This content is only available as a PDF. © 1999 British Journal of Surgery Society Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 1999 British Journal of Surgery Society Ltd

Lambert, A W; Wilkins, D C

doi: 10.1046/j.1365-2168.1999.01257.xpmid: 10583279

BackgroundPopliteal artery entrapment syndrome (PAES) is rare and may be underdiagnosed. Improved specialized, non-invasive imaging techniques are producing detailed topographical evidence of the anomaly.MethodsA historical review of the literature and Medline search was performed with reference to the diagnosis and treatment of the condition. In addition, embryologically based theories for the condition have been postulated.Results and conclusionPAES may be the result of abnormal development of the popliteal artery or a consequence of excessive cranial migration of the medial head of the gastrocnemius muscle. Magnetic resonance imaging appears to be the most useful single investigation to demonstrate the anomaly. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated.

Bosscha, K; van Vroonhoven, Th J M V; van der Werken, Ch

doi: 10.1046/j.1365-2168.1999.01258.xpmid: 10583280

BackgroundDespite advances in diagnosis, surgery, antimicrobial therapy and intensive care support, the mortality rate associated with severe secondary peritonitis remains unacceptably high. This article presents various surgical treatment strategies for severe secondary peritonitis, emphasizing the role of open management of the abdomen and planned relaparotomies.MethodsMaterial was identified from previous review articles, references cited in original papers and a Medline search of the literature.Results and conclusionSurgical treatment of severe secondary peritonitis is highly demanding and very complex. The combination of improved surgical techniques, antimicrobial therapy and intensive care support has improved the outcome of such peritonitis following perforation or anastomotic disruption of the digestive tract, or infected necrotizing pancreatitis. However, aggressive surgical treatment strategies, such as open management of the abdomen and planned relaparotomies, may have reached their limits.

doi: 10.1046/j.1365-2168.1999.01294.xpmid: 10583281

Professor Seiki Matsuno, Chief Editor of Surgery Today (The Japanese Journal of Surgery), has selected from the January to March 1999 issues of the journal for this quarter's digest. A digest of BJS for the same period written by Mr Colin Johnson, Development Officer, appears in the Japanese journal.

Decadt, B; Sussman, L; Lewis, M P N; Secker, A; Cohen, L; Rogers, C; Patel, A; Rhodes, M

doi: 10.1046/j.1365-2168.1999.01239.xpmid: 10583282

BackgroundAbdominal pain of uncertain aetiology (non-specific abdominal pain; NSAP) is the commonest reason for emergency surgical admission. The aim of this study was to examine the role of early laparoscopy in the management of NSAP.MethodsSome 120 patients, admitted between November 1995 and October 1998 with acute abdominal pain of uncertain aetiology, were randomized into two groups: group 1 had laparoscopy during the first 18 h of admission and group 2 had close observation, conventional investigation and surgical intervention if signs of peritonism developed. Outcome measures were diagnosis, operative procedures, duration of hospital stay, readmission rate, morbidity and death, patient satisfaction and total number of investigations performed.ResultsMedian hospital stay was 2 (range 1–13) days in both groups (P = 0·87). A diagnosis was established in 48 (81 per cent) of 59 patients in group 1 compared with 22 (36 per cent) of 61 in group 2 (P < 0·0001). The morbidity rate was 14 (24 per cent) of 59 in group 1 and 19 (31 per cent) of 61 in group 2 (P = 0·3629). The readmission rate at a median follow-up of 21 (range 1–35) months was 17 (29 per cent) of 59 in group 1 compared with 20 (33 per cent) of 61 in group 2 (P = 0·6375). Well-being scores improved from 134 on admission to 149 of 177 6 weeks later in group 1 (P = 0·007) and from 132 to 143 of 177 in group 2 (P = 0·089).ConclusionEarly laparoscopy provided a higher diagnostic accuracy and improved quality of life in patients with NSAP.

Caillot, J-L; Côte, C; Abidi, H; Fabry, J

doi: 10.1046/j.1365-2168.1999.01266.xpmid: 10583283

BackgroundBreakdown of the surgeon–patient barrier represents a risk for transmission of infectious disease. Such breakdowns are frequently not recognized by the surgical team. The protection afforded by double gloving under normal operating conditions was evaluated.MethodsAn electronic device detected breakdown of the surgeon–patient barrier in a series of 80 surgical procedures, randomly assigned to either double or single gloving. Fluid contact due to glove perforation, porosity or gown wetting was recorded during 151 individual surgeon episodes covering 238 operator-hours. Surgical procedures were called superficial for incisions of less than 10 cm.ResultsDouble gloving reduced the number of perforation and porosity alarms twofold in both superficial and deep surgical procedures. Deep procedures carried a sevenfold increased risk of barrier breakdown compared with superficial procedures, the risk being greatest for the principal operator.ConclusionWithout electronic detection, a large majority of barrier breakdowns would remain undetected by the surgical team and lead to prolonged contact with potentially contaminating body fluids. The use of double gloving provides real protection against such contamination risks.

Wu, C-C; Ho, W-L; Chen, J-T; Tang, J-S; Yeh, D-C; P'eng, F-K

doi: 10.1046/j.1365-2168.1999.01272.xpmid: 10583284

BackgroundHepatitis B and C viruses are the main causative agents of hepatocellular carcinoma (HCC). The influence of hepatitis viral status on liver resection for HCC remains undetermined.MethodsPatients who underwent curative resection for HCC were divided into four groups: group 1, seronegative for hepatitis B surface antigen (HBsAg) and antihepatitis C antibody (HCVAb); group 2, seropositive for HBsAg only; group 3, seropositive for HCVAb only; and group 4, seropositive for HBsAg and HCVAb. The clinicopathological characteristics and surgical results of the four groups were compared. Resection of HCC was determined according to liver functional reserve and tumour extent.ResultsThere were 40, 131, 70 and 20 patients in groups 1, 2, 3 and 4 respectively. Due to patient selection bias, there were significant differences in some background features, resectional extent and pathological characteristics among the four groups. Postoperative morbidity and mortality, as well as the Union Internacional Contra la Cancrum tumour node metastasis stages, did not differ. Patients in group 1 had a higher disease-free survival rate than those in group 2 (P = 0·02). The actuarial survival rates of patients in groups 2 and 4 were lower than those of groups 1 and 3.ConclusionWith careful patient selection, the hepatitis viral status does not influence the surgical risks of hepatectomy for HCC. After liver resection for HCC, the long-term survival rate of patients seronegative for HBsAg is greater than that of patients seropositive for HBsAg.

Abdel-Atty, M Y; Farges, O; Jagot, P; Belghiti, J

doi: 10.1046/j.1365-2168.1999.01283.xpmid: 10583285

BackgroundClinical or biological evidence of liver failure is usually considered a contraindication to open liver surgery as it is associated with a prohibitive risk of postoperative death.MethodsThis report describes three patients who had resection of a superficial hepatocellular carcinoma suspected either to be ruptured, or at high risk of rupture, using the laparoscopic approach. All three patients had intractable ascites, in two superimposed on active hepatitis. Surgery was per- formed under continuous carbon dioxide pneumoperitoneum with intermittent clamping of the hepatic pedicle.ResultsIntraoperative blood loss was between 100 and 400 ml; no blood transfusion was required. The postoperative course was uneventful except for a transient leak of ascites through the trocar wounds. Duration of in-hospital stay was 6–10 days. Liver function tests had returned to preoperative values within 1 month of surgery in all patients.ConclusionThe laparoscopic approach may enable liver resection in patients with cirrhosis and evidence of liver failure that would contraindicate open surgery.

Hauet, T; Goujon, J M; Tallineau, C; Carretier, M; Eugene, M

doi: 10.1046/j.1365-2168.1999.01233.xpmid: 10583286

BackgroundProton nuclear magnetic resonance (NMR) spectroscopy can be used as a non-invasive tool to measure renal damage. In the present investigation, proton NMR spectroscopy of urine was assessed in order to detect cellular damage after different periods of cold ischaemia in two standard preservation solutions.MethodsThe isolated perfused pig kidney was used to assess initial renal function after in situ cold flush and cold storage (CS) for 24 or 48 h in two standard preservation solutions: EuroCollins (EC) and University of Wisconsin (UW) solutions. Kidneys flushed with cold heparinized saline and immediately perfused were used as a control group. Kidneys were perfused for 2 h at 37·5°C for functional evaluation. During reperfusion, renal perfusion flow rate was measured. Glomerular filtration rate (GFR), tubular reabsorption of sodium ions, and lactate dehydrogenase (LDH) and N-acetyl-β-d-glucosaminidase (NAG) excretion were determined. Impairment caused by ischaemia and reperfusion was also determined by histological techniques and proton NMR spectroscopy.ResultsThe perfusion flow rate, GFR and tubular reabsorption of sodium were significantly decreased in experimental groups compared with the control group. There was no significant difference between experimental groups after 24 h of CS. The perfusion flow rate was significantly decreased in the EC group after 48 h of cold ischaemia compared with that in the UW group. After 48 h of CS, GFR and tubular reabsorption of sodium were significantly reduced in the EC group compared with those in the UW group. The release of LDH into the effluent and the urinary excretion of NAG were not significantly different after 24 h of CS. After more than 45 and 60 min of reperfusion respectively, LDH and NAG excretion was no different in the 48-h CS groups. The most relevant resonances determined by proton NMR spectroscopy were of citrate, trimethylamine-N-oxide, lactate, acetate and amino acids. Excretion of these markers was significantly more accurate and efficient to assess renal ischaemia–reperfusion injury than that of biochemical markers. A resonance (P) detected particularly in the EC group after 48 h of CS was identified and correlated well with renal dysfunction. After CS for 48 h and 2 h of reperfusion, renal injury was histologically more pronounced in EC groups than in UW groups. However, the difference was not significant after CS for 24 h.ConclusionNMR spectroscopy, which is a non-invasive and non-destructive technique, is more accurate and efficient when assessing kidney damage after cold ischaemia and reperfusion when compared to conventional histological and biochemical analysis.