ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02840.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02866.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThe role of laparoscopic surgery in the management of patients with suspected appendicitis is still debated despite a number of recent randomized controlled trials (RCTs).MethodsA systematic review has been undertaken of all published RCTs comparing laparoscopic appendicectomy with open appendicectomy. Studies were identified through Medline and supplemented with a manual search of relevant journals and meeting abstracts. Data were extracted and analysed according to predefined criteria.ResultsTen studies were identified, seven of which reported results on an intention‐to‐treat basis. Laparoscopic appendicectomy was associated with a longer operating time (8–29 min), a minimal reduction in hospital stay and, probably, an earlier return to normal activity. It was also associated with a reduced risk of wound infection (odds ratio 2·6) with no increase in other complications. However, bias, particularly resulting from lack of blinding, makes some of these results difficult to interpret.ConclusionLaparoscopic appendicectomy was associated with some advantages and no obvious disadvantages, apart from prolonged operating time. Future RCTs should be blinded to minimize bias, document adequate follow‐up and analyse results on an intention‐to

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02848.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundTumour necrosis factor (TNF) is a pleiotropic cytokine produced largely by macrophages and T lymphocytes. It has been implicated in the pathogenesis of numerous immunoinflammatory processes. Recently, a number of studies have indicated that anti‐TNF antibodies may be of value in the treatment of inflammatory bowel disease.MethodThe literature is reviewed regarding the role of TNF in the pathogenesis of inflammatory bowel disease and the results of administering TNF inhibitors.Results and conclusionsTNF may have a role in the pathogenesis of inflammatory bowel disease. The effects of TNF inhibitors are complex and incompletely understood. Anti‐TNF antibody strategies may have a role in the treatment of acute exacerbations of the disease but are unlikely to be appropriate therapies for long‐term manag

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02860.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundRaised plasma fibrinogen levels and markers of fibrin turnover or endothelial disturbance are associated with cardiovascular disease.MethodsThis is a critical review of the English language literature relating to fibrinogen, fibrin degradation products and endothelial products in peripheral arterial disease and revascularization surgery.Results and conclusionAltered levels of plasma fibrinogen and endothelial products are associated with atherosclerosis and some studies h'ave shown an association with poor outcome following revascularization surgery. Randomized clinical trials of therapies that modify thrombotic pathways in patients undergoing surgery for peripheral arterial occlusive disease are therefore required.

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02857.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractFor this quarter's digest, Professor Christian Herfarth and Dr Thomas Lehnert have selected the best from the January to March 1997 issues ofDer Chirurg. A digest for theBJSfor the same period, written by Mr Colin Johnson, appears in the German journal.

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.00105.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThe association of human immunodeficiency virus (HIV) infection with lung cancer remains unclear. The presence of multiple risk factors in patients with HIV infection makes it difficult to identify a direct cause‐effect relationship.MethodsA retrospective study of patients with lung cancer who were diagnosed, treated and followed at Harlem Hospital Center, New York, between January 1990 and December 1994 was performed. Eleven HIV‐seropositive and 116 HIV‐indeterminate patients with histologically proven lung cancer were identified. The two groups were compared with regard to age, sex, race, predisposing factors, stage of presentation, histological type of the tumours and survival.ResultsHIV‐infected patients with lung cancer were predominantly male smokers who were significantly younger than the control HIV‐indeterminate patients with lung cancer. Although adenocarcinoma was seen more frequently in the HIV‐seropositive group, the difference was not statistically significant. Survival in HIV‐infected patients was shorter than that in HIV‐indeterminate patients, suggesting that the cancer may be more aggressive in HIV‐infected patients or that the progression of immunoincompetence in these patients may influence survival.ConclusionA direct cause‐effect relationship between lung cancer and HIV infection is difficult to establish in the presence of other risk factors, but the incidence of lung cancer may be increasing

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02805.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundA novel system of complete portal venous isolation and charcoal haemoperfusion (PVI‐CHP) has been developed in an attempt to increase dose intensity while minimizing the systemic toxicity of the cytotoxic agent during intra‐arterial chemotherapy of the pancreas.MethodsMongrel dogs were given doxorubicin (3 mg kg−1), infused over a 5‐min period via the splenic artery, together with PVI‐CHP (group 1;n =5) or without PVI‐CHP (group 2;n =5). Plasma doxorubicin concentrations were determined in serial samples obtained from the inlet and outlet of the CHP filter and in samples obtained from the left jugular vein (systemic levels) for up to 30 min after initiation of drug infusion. Subsequently, specimens were obtained from the pancreas, liver and heart to determine tissue doxorubicin levels.ResultsThe mean(s.d.) peak systemic concentration of doxorubicin in group 1 was 0·78(0·03) μg ml−1, significantly lower than that in group 2 of 3·49(1·15) pg ml−1(P<0·01). The peak concentration of doxorubicin in group 1 was significantly lower (more than 90 per cent) than that before filtration (P<0·01). Tissue doxorubicin concentration in the pancreas was similar in both groups. However, concentrations in the liver and heart were significantly lower in group 1 than in group 2 (P<0·05).ConclusionThese results indicate that PVI‐CHP can produce a significant reduction in systemic drug exposure and may allow dose intensification during intra‐arterial ch

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02710.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundLiver resection for metastatic colorectal cancer has been established. Nevertheless, it is still controversial whether the surgical margin from the tumour edge to the cut surface of the liver is a significant prognostic factor in hepatic resection for colorectal metastatic liver cancer.MethodsTo clarify the prognostic risk factors in hepatic resection for colorectal metastasis, univariate and multivariate analyses were performed. Between April 1985 and April 1995, 31 patients underwent curative hepatic resection for metastatic colorectal cancer. The clinical and pathological factors were examined retrospectively.ResultsOverall 1‐, 3‐ and 5‐year survival rates of the patients were 92, 42 and 39 per cent respectively. Pathological study of 16 resected specimens with a solitary liver tumour revealed hepatic vein invasion by cancer cells in two of 16 cases, portal vein invasion in three, microsatellite lesions in two and biliary tract invasion in six cases. In resected specimens with a solitary tumour measuring less than 4 cm in diameter, one of these factors was observed in only two of nine cases, whereas in specimens with a solitary tumour measuring more than 4 cm in diameter, these factors were observed in six of seven patients (P<0.05). The distance from the tumour edge to the intrahepatic invasion was less than 10 mm. With univariate analysis, tumour size of 4 cm or more in diameter, an interval of 6 months or less between colorectal and hepatic resection, four or more gross tumours, bilobar involvement and a resection margin from the tumour of less than 10 mm were found to be significant factors indicating a poor prognosis. Cox's proportional hazards model identified a tumour of 4 cm or more in diameter and a resection margin from the tumour of less than 10 mm as poor prognostic factors (P<0·05).ConclusionIn treating metastatic colorectal cancer to the liver, the surgical margin should be more than 10 mm because occult intrahepatic invasion was always found to be located within 10 mm from the edge of the

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02743.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY

摘要:

AbstractBackgroundThe indication for surgical resection of colorectal liver metastases should be guided by technical feasibility and expected prognostic benefit. The aim of the present study was to analyse the frequency and prognostic significance of lymph node involvement of the hepatoduodenal ligament in the resection of colorectal liver metastases.Methods Aseries of 126 prospectively documented patients who underwent hepatectomy for metastases of colorectal carcinoma was analysed. The prognostic factors of patients with complete resection (R0) of the metastases were studied by multivariate analysis.ResultsR0resection was achieved in 94 per cent. The 30‐day mortality rate was 2 per cent. In all patients, lymph nodes were excised from the hepatoduodenal ligament, and histological evaluation demonstrated tumour infiltration in 28 per cent of the patients. Multivariate analysis revealed nodal involvement of the hepatoduodenal ligament (P<0·0001) and synchronous or metachronous appearance of liver metastases (P<0.005) as independent prognostic factors. The 3‐ and 5‐year survival rates were 3 and 0 per cent for lymph node‐positive patients compared with 48 and 22 per cent respectively for the node‐negative group.ConclusionInfiltration of lymph nodes in the hepatoduodenal ligament is the most important prognostic factor following R0resection of colorectal liver

ISSN:0007-1323    

DOI:10.1046/j.1365-2168.1997.02813.x

出版商:John Wiley&Sons, Ltd.    

年代:1997

数据来源: WILEY