British Journal of Surgery

Veronesi, U

doi: 10.1046/j.1365-2168.1999.00984.xpmid: 10027351

References 1 Morton DL , Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK et al. Technical details of intraoperative lymphatic mapping for early stage melanoma . Arch Surg 1992 ; 127 : 392 – 9 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Giuliano AE , Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy . Ann Surg 1995 ; 222 : 394 – 401 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Barnwell JM , Arredondo MA, Kollmorgen D, Gibbs JF, Lamonica D, Carson W et al. Sentinel node biopsy in breast cancer . Ann Surg Oncol 1998 ; 5 : 126 – 30 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Veronesi U , Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes . Lancet 1997 ; 349 : 1864 – 7 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Albertini JJ , Lyman GH, Cox C, Yeatman T, Balducci L, Ku N et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer . JAMA 1996 ; 276 : 1818 – 22 . Google Scholar Crossref Search ADS PubMed WorldCat 6 Krag DN , Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel node in breast cancer using a gamma probe . Surg Oncol 1993 ; 2 : 335 – 40 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Veronesi U , Rilke F, Luini A, Sacchini V, Galimberti V, Campa T et al. Distribution of axillary node metastases by level of invasion. An analysis of 539 cases . Cancer 1987 ; 59 : 682 – 7 . Google Scholar Crossref Search ADS PubMed WorldCat 8 International (Ludwig) Breast Cancer Study Group . Prognostic importance of occult axillary lymph node micrometastases from breast cancers . Lancet 1990 ; 335 : 1565 – 8 . PubMed OpenURL Placeholder Text WorldCat 9 Turner RR , Ollila DW, Krasne DL, Giuliano AE. Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma . Ann Surg 1997 ; 226 : 271 – 8 . Google Scholar Crossref Search ADS PubMed WorldCat 10 Jannink I , Fan M, Nagy S, Rayudu G, Dowlatshahi K. Serial sectioning of sentinel nodes in patients with breast cancer: a pilot study . Ann Surg Oncol 1997 ; 5 : 310 – 14 . Google Scholar Crossref Search ADS 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

Ruckley, C V

doi: 10.1046/j.1365-2168.1999.01003.xpmid: 10027352

References 1 Naylor AR , Ruckley CV. Complications after carotid endarterectomy. In: Campbell B, ed. Complications in Arterial Surgery . Oxford : Butterworth–Heinemann , 1996 : 73 – 88 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2 Makhdoomi KR , McBride K, Bradbury AW, Ruckley CV. A prospective study of internal carotid artery plication during carotid endarterectomy: early clinical and duplex outcome . Br J Surg 1998 ; 85 ( Suppl 1 ): 17 . Google Scholar OpenURL Placeholder Text WorldCat 3 European Carotid Surgery Triallists Collaborative Group . MRC European Carotid Artery Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis . Lancet 1991 ; 337 : 1236 – 43 . OpenURL Placeholder Text WorldCat 4 Jorgenson LG , Schroeder TV. Defective cerebrovascular autoregulation after carotid endarterectomy . Eur J Vasc Surg 1993 ; 7 : 370 – 9 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Schroeder T , Sillesen H, Sorensen O, Engell HC. Cerebral hyperperfusion following carotid endarterectomy . J Neurosurg 1987 ; 66 : 824 – 9 . Google Scholar Crossref Search ADS PubMed WorldCat 6 Naylor AR , Wildsmith JAW, McClure J, Jenkins AMcL, Ruckley CV. Transcranial Doppler monitoring during carotid endarterectomy . Br J Surg 1991 ; 78 : 1264 – 8 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Takkolander R , Bergentz SE, Bergqvist D, Persson NH. Management of early neurological deficits after carotid endarterectomy . Eur J Vasc Surg 1987 ; 1 : 67 – 71 . 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

Luck, A J; Maddern, G J

doi: 10.1046/j.1365-2168.1999.00990.xpmid: 10027353

BackgroundUltrasonography during abdominal surgery has been reported since the 1960s, but its use did not become widespread until the recent availability of high-frequency, high-resolution transducers. This review discusses the application of intraoperative ultrasonography to open and laparoscopic abdominal surgery.MethodsA literature search (Medline) was undertaken. All papers pertaining to the subject matter that were located were included in the review.ResultsIntraoperative ultrasonography influences surgical strategy in up to 50 per cent of liver resections for malignancy. It is the single most sensitive technique for the detection of occult hepatic metastases at the time of primary colorectal resection. In pancreatic surgery, intraoperative ultrasonography is of value in the localization of islet cell tumours and in the assessment of resectability of adenocarcinoma. The technique may also have a role in staging laparoscopy, and in the operative management of kidney and gastrointestinal diseases.ConclusionUltrasonography is an ideal operative tool as it is safe, reproducible and requires no special patient preparation or positioning. It should be regarded as an essential component of major hepatobiliary and pancreatic procedures. The recent availability of flexible laparoscopic probes is likely to lead to a similar impact on minimal access surgery.

Heriot, A G; Grundy, A; Kumar, D

doi: 10.1046/j.1365-2168.1999.00996.xpmid: 10027354

BackgroundThe development of treatment modalities for rectal cancer, including local excision, total mesorectal excision and preoperative radiotherapy, has increased the importance of accurate preoperative staging to allow the optimum treatment to be selected.MethodsA literature review was undertaken of methods of preoperative staging of rectal carcinoma and the evidence for each was evaluated critically.ResultsClinical assessment of rectal carcinoma may give an indication of fixity but is not accurate for staging. Endoanal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), radioimmunoscintigraphy and positron emission tomography have all been used for staging. The extent of tumour spread through the bowel wall (T stage) is most accurately assessed by endoanal ultrasonography, although this technique is poor at assessing tumour extension into adjacent organs for which both CT and MRI are more accurate. No method accurately determines lymph node involvement, but endoanal ultrasonography is the best available. Liver metastases may be assessed by abdominal ultrasonography, CT, MRI and CT portography (with increasing sensitivity and cost in that order).ConclusionEndoanal ultrasonography is the most effective method of local tumour staging, with the addition of either CT or MRI if adjacent organ involvement is suspected. Abdominal ultrasonography or CT is recommended for routine preoperative assessment of the liver.

de Perrot, M; Berney, T; Bühler, L; Delgadillo, X; Mentha, G; Morel, P

doi: 10.1046/j.1365-2168.1999.00983.xpmid: 10027355

BackgroundBleeding pseudoaneurysm is a rare but frequently fatal complication in patients with pancreatitis.MethodThe medical records of ten patients who presented to this institution with a bleeding pseudoaneurysm between 1978 and 1997 were reviewed retrospectively. Six patients had chronic pancreatitis and four had acute pancreatitis. The splenic artery was involved in six cases, a pancreaticoduodenal artery in two, the gastroduodenal artery in one and the cystic artery in one.ResultsComputed tomography (CT) revealed the bleeding pseudoaneurysm in all patients (n = 6) with chronic pancreatitis but in only one of three with acute pancreatitis. Arteriography always gave the correct diagnosis. Seven patients underwent pancreatic resection as an emergency (n = 3) or within 48 h (n = 4), and survived. Three patients presenting with acute pancreatitis and massive bleeding underwent transcatheter arterial embolization. Two of them had a favourable outcome and one died from a recurrent haemorrhage 7 days later. Overall, two patients suffered significant perioperative complications and one died.ConclusionCT is accurate in the diagnosis of pseudoaneurysms complicating pseudocysts. Primary resection of the pseudoaneurysm, which frequently requires pancreatic resection, is the treatment of choice. Angiography followed by transcatheter embolization is effective, but should be rapidly followed by operation.

McCarthy, M J; Nydahl, S; Hartshorne, T; Naylor, A R; Bell, P R F; London, N J M

doi: 10.1046/j.1365-2168.1999.00972.xpmid: 10027356

BackgroundIt has been suggested that ultrasonography could replace diagnostic arteriography in the assessment of patients who present with leg ischaemia. This study investigated a group of consecutive patients who had femorodistal bypass and who were assessed before operation with colour-coded duplex and dependent Doppler insonation alone.MethodsThirty-seven consecutive patients with critical lower limb ischaemia underwent surgical exploration with a view to femorodistal bypass. Results of preoperative colour-coded duplex and dependent Doppler insonation were compared with intraoperative arteriograms and surgical findings.ResultsThere was very good agreement between colour-coded duplex imaging and dependent Doppler insonation with intraoperative angiography and surgical findings in the prediction of the optimal run-off vessel (κ = 1·0) and the site of the distal anastomosis (κ = 0·85; 95 per cent confidence interval 0·71–1·0). There was also very good agreement between dependent Doppler insonation and intraoperative arteriography (κ = 1·0) in predicting pedal arch patency and the predominant feeding vessel.ConclusionAssessment of leg arteries before femorodistal bypass can be performed accurately with non-invasive colour-coded duplex imaging and dependent Doppler insonation alone, thus obviating the need for preoperative arteriography.

Dawson, I; van Bockel, J H

doi: 10.1046/j.1365-2168.1999.00970.xpmid: 10027357

BackgroundProgression of atherosclerosis and graft-related complications are common indications for late vascular intervention. The aim of this study was to determine the cumulative risk of late reintervention or death after infrainguinal bypass grafting.MethodsSome 205 consecutive patients with limb-threatening ischaemia were included. All data were recorded prospectively. The principal endpoint was reintervention for a graft-related complication or recurrent leg ischaemia. Mean follow-up was 3·3 years. Life-table and multivariate analyses were employed to estimate the cumulative risk of reintervention or death during follow-up and to assess factors influencing this risk.ResultsBeyond 30 days after insertion of the infrainguinal bypass, 67 patients (33 per cent) had 112 subsequent vascular interventions in the ipsilateral extremity. The cumulative reintervention rate was 25 per cent at 1 year and 40 per cent at 5 years. Poor run-off (P < 0·005) and prosthetic grafts (P < 0·001) were significant and independent risk factors. Long-term survival was poor and affected by the presence of diabetes (P < 0·01) and renal insufficiency (P < 0·01).ConclusionLate reinterventions are common after infrainguinal bypass for limb-threatening ischaemia, and contribute to morbidity and discomfort. Such information is of particular relevance to patients in high-risk groups and should be explained as an integral part of informed consent.

Chiou, T S-M; Chen, S-C

doi: 10.1046/j.1365-2168.1999.00992.xpmid: 10027358

BackgroundThis report examines the intermediate-term results of endoscopic transaxillary T2 sympathectomy for palmar hyperhidrosis.MethodsA retrospective review was carried out of 91 consecutive patients, 38 men and 53 women, with a mean age of 23 years. Attention was focused on patient satisfaction, late complications and morbidity.ResultsAfter operation, no patient died or developed Horner's syndrome. Nine of 21 patients with craniofacial, five of 16 with axillary and 17 of 73 with plantar hyperhidrosis showed simultaneous improvement. Fifteen patients (16 per cent) developed recurrent sweating, but none required reoperation. The overall mean satisfaction rate was 78 per cent with a median 80 per cent improvement using a visual linear analogue scale from 0 (poor) to 100 per cent (excellent). Twelve patients (13 per cent) were dissatisfied with the operative results, mainly owing to compensatory hyperhidrosis, which occurred in 88 patients (97 per cent) within the first year.ConclusionThe results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.

Hellberg, A; Rudberg, C; Kullman, E; Enochsson, L; Fenyö, G; Graffner, H; Hallerbäck, B; Johansson, B; Anderberg, B; Wenner, J; Ringqvist, I; Sörensen, S

doi: 10.1046/j.1365-2168.1999.00971.x

Knowles, C H; Scott, S M; Wellmer, A; Misra, V P; Pilot, M-A; Williams, N S; Anand, P

doi: 10.1046/j.1365-2168.1999.00994.xpmid: 10027360

BackgroundSlow-transit constipation (STC) is a severe disorder of unknown aetiology, which may result from an autonomic or sensory neuropathy. This study aimed to investigate patients with STC for the presence of neural dysfunction, and relate the findings to other factors, including any familial associations.MethodsThirty-three patients with STC were studied using standard neurophysiological tests and a range of quantitative sensory and autonomic tests. The findings were compared with those of 20 matched control subjects and nine diabetic patients with gastrointestinal symptoms.ResultsTwenty of the 33 patients with STC gave a family history of constipation, including an affected identical twin and Hirschsprung's disease (n = 3). None had abnormalities on neurological examination or nerve conduction studies. Fifteen of the 33 patients had abnormalities on quantitative tests, including all six who required a colectomy. Eleven patients with STC had reduced axon-reflex sweating in the presence of normal sweat gland responses (P< 0·001, all patients with STC versus controls). Twelve patients with STC had small sensory fibre dysfunction, with significantly increased thermal thresholds (cool, P< 0·05; warm, P< 0·01); these included six of nine patients with STC and rectal hyposensation. There were similar findings on quantitative testing in diabetic patients.ConclusionQuantitative tests in patients with STC provide evidence of a small fibre neuropathy. The high incidence of a positive family history, particularly a possible association with Hirschsprung's disease, suggests a genetic basis, which deserves further investigation.