Cent Of Group Research Articles

Randomized clinical trial of tissue glue versus absorbable sutures for mesh fixation in local anaesthetic Lichtenstein hernia repair

Chronic pain may be a long-term problem related to mesh fixation and operative trauma after Lichtenstein hernioplasty. The aim of this study was to compare the feasibility and safety of tissue cyanoacrylate glue versus absorbable sutures for mesh fixation in Lichtenstein hernioplasty. Lichtenstein hernioplasty was performed under local anaesthesia as a day-case operation in one of three hospitals. The patients were randomized to receive either absorbable polyglycolic acid 3/0 sutures (Dexon(®); 151 hernias) or 1 ml butyl-2-cyanoacrylate tissue glue (Glubran(®); 151 hernias) for fixation of lightweight mesh (Optilene(®)). Wound complications, pain, discomfort and recurrence were identified at 1 and 7 days, 1 month and 1 year after surgery. A total of 302 patients were included in the study. The mean(s.d.) duration of operation was 34(12) min in the glue group and 36(13) min in the suture group (P = 0·113). The need for analgesics was similar during the first 24 h after surgery. Five wound infections (3·4 per cent) were detected in the glue group and two (1·4 per cent) in the suture group (P = 0·448). The recurrence rate at 1 year was 1·4 per cent in each group (P = 1·000). The rates of foreign body sensation, acute and chronic pain were similar in the two groups. Logistic regression analysis showed that the type of mesh fixation did not predict chronic pain 1 year after surgery. Mesh fixation without sutures in Lichtenstein hernioplasty was feasible without compromising postoperative outcome. NCT00659542 (http://www.clinicaltrials.gov).

Late follow-up of a randomized trial of routine duplex imaging before varicose vein surgery

Routine preoperative duplex examination led to an improvement in results 2 years after surgery for primary varicose veins. The aim of the present study was to evaluate the impact of preoperative duplex imaging after 7 years, in relation to other risk factors for varicose vein recurrence. Patients with primary varicose veins were randomized to operation with (group 1), or without (group 2) preoperative duplex imaging. The same patients were invited to attend follow-up with interview, clinical examination and duplex imaging. Quality of life (QoL) was measured with the Short Form 36 questionnaire. Some 293 patients (343 legs) were included initially; after 7 years 227 were interviewed, or their records reviewed: 114 in group 1 and 113 in group 2. One hundred and ninety-four legs (95 in group 1 and 99 in group 2) were examined clinically and with duplex imaging. Incompetence was seen at the saphenofemoral junction and/or saphenopopliteal junction in 14 per cent of legs in group 1 and 46 per cent in group 2 (P < 0.001). QoL was similar in both groups. After a mean follow-up of 7 years (and including patients who underwent surgery after the review), 15 legs in group 1 needed reoperation and 38 in group 2 (P = 0.001). Routine preoperative duplex imaging improved the results of surgery for primary varicose veins for at least 7 years.

Aortic Root Surgery Does Not Increase the Operative Risk of Acute Type A Aortic Dissection

Controversy exists regarding aortic root reconstruction in the management of acute type A aortic dissection (AAD). One hundred fifty-four patients (mean age 56.9 ± 11.3 years) with AAD had surgical repair between 1996 and 2007. Group 1 (n = 110) required no aortic root surgery. Seventy-one patients had ascending aortic replacement. The aortic valve was repaired in 37 patients (34%) and replaced in one. Group 2 (n = 44) had aortic root surgery. Thirty-four patients had composite root replacement, and seven had a valve-sparing root replacement. Root reconstruction and separate valve replacement was accomplished in three. Hemiarch replacement was included in 39 (35.4%) Group 1 patients and in 12 (27.9%) Group 2 patients. Forty-nine of the 154 patients presented in cardiogenic shock. Multiple risk factors for operative mortality were analyzed. The overall operative mortality was 9.7 per cent: 11 per cent for Group 1 and 6.8 per cent for Group 2 (P = NS). By multivariate analysis, preoperative shock (P = 0.03, odds ratio [OR] = 5.48), postoperative ventricular arrhythmias (P = 0.002, OR = 4.62), and packed red blood cell transfusion (P = 0.002, OR = 1.15) were independent predictors of hospital death. Prompt surgical treatment of AAD before cardiogenic shock ensues can improve the outcome of patients. When indicated, aortic root surgery can be performed without increased mortality and morbidity.

Residents' Perceptions of Environmental and Security Issues at the 2012 London Olympic Games

Staging a mega sport event such as the Olympic Games has been traditionally viewed as a ‘golden’ opportunity for urban regeneration and economic development. Research into residents' perceptions of environmental impacts and security risks at Olympic Games is limited. This paper discusses residents' perceptions of environmental and security issues associated with the London 2012 Olympic Games. The study used a purposive sample of local residents (n = 100) of which 50% were in the age range of 18–34 years (Group A) and 50% were 35–55 years or over (Group B). Forty-two per cent of Group A and 28% of Group B lived in London. Data were collected through self-administered questionnaires. Findings showed that the majority of respondents in both groups overwhelmingly supported the 2012 Games and were filled with a sense of national pride and excitement for London being the host city. However, findings also demonstrated differences between the age groups in their perceptions of the environmental impacts of the 2012 Games. Group B expressed consistently more negative attitudes compared with Group A with regards to pollution, traffic congestion and parking availability. Both groups were equally concerned about the inadequacies of the transport system. Group B respondents also perceived increased security risks during the Games that could negatively affect attendance at the Games. Both groups showed a lack of confidence that security would be ensured at the Games. These findings contradict planned environmental and security initiatives that are currently underway and indicate that 2012 stakeholders need to improve communication and public consultation to raise public awareness and instil confidence.

Radiofrequency thermal ablation versus ‘cold steel’ for supra-auricular excision of preauricular sinus: comparative study

To compare the results of radiofrequency thermal ablation versus 'cold steel' excision, for supra-auricular excision of preauricular sinus. Prospective study. Observations included recurrence, intra-operative bleeding, operation time and ease of dissection. Tertiary referral hospital. Sixty cases of preauricular sinus were assigned randomly to two groups (30 cases each). Group one patients underwent cold steel sinus excision, whereas group two patients underwent radiofrequency-assisted sinus excision. Fifty patients were operated upon, with a mean age of 12.26 years. Most patients were aged between zero and five years (40 per cent). The average patient follow-up time was 15 months (range, six to 24 months). Recurrence rates were 23 per cent in group one and 3 per cent in group two; this difference was statistically significant (p = 0.016). Dissection of the sinus tract was reported to be much easier in the radiofrequency group, compared with the cold steel group (p = 0.023), with minimal bleeding. From our observations, radiofrequency-assisted, local, wide excision appears to be preferable for treatment of preauricular sinus, compared with cold steel excision, as it allows better peri-operative visualisation, easier dissection, minimal bleeding and a lower subsequent recurrence rate (3.3 per cent).

Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy

This study assessed the feasibility of a protocol-driven written clinical pathway for multidisciplinary postoperative management after oesophagectomy for oesophageal neoplasia, and examined whether the application of such a protocol could shorten hospital stay and reduce postoperative morbidity and mortality. Consecutive patients undergoing transthoracic oesophagectomy for oesophageal neoplasia were divided into those treated between 2003 and 2008 to whom a clinical pathway was applied for postoperative management (group 1), and a control group treated between 1998 and 2002 when no clinical pathway was applied (group 2). There were 74 patients in each group. Morbidity rates were similar in the two groups: 31 per cent in group 1 and 38 per cent in group 2. There were more pulmonary complications in group 2 (23 versus 14 per cent; P = 0.025). One patient (1 per cent) in group 1 and four (5 per cent) in group 2 died after surgery (P = 0.010). The median (range) length of hospital stay was 9 (5-98) days for group 1 and 13 (8-106) days in group 2 (P = 0.012). Use of a written clinical pathway in patients undergoing oesophageal resection significantly reduced pulmonary complications, postoperative mortality and hospital stay.

Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer

To address issues regarding the fractionation of radiotherapy (RT) and timing of surgery for rectal cancer, a multicentre trial has randomized patients to preoperative short-course RT with two different intervals to surgery, or long-course RT with delayed surgery. The present interim analysis assessed feasibility, compliance and complications after RT and surgery. Some 303 patients were randomized to either short-course RT (5 x 5 Gy) and surgery within 1 week (group 1), short-course RT and surgery after 4-8 weeks (group 2) or long-course RT (25 x 2 Gy) and surgery after 4-8 weeks (group 3). Demographic data were similar between groups and there were few protocol violations (5.0-6 per cent). Eight patients (2.6 per cent) developed radiation-induced acute toxicity. There were no significant differences in postoperative complications between groups (46.6, 40.0 and 32 per cent in groups 1, 2 and 3 respectively; P = 0.164). Patients receiving short-course RT with surgery 11-17 days after the start of RT had the highest complication rate (24 of 37). Compliance was acceptable and severe acute toxicity was low, irrespective of fractionation. Short-course RT with immediate surgery had a tendency towards more postoperative complications, but only if surgery was delayed beyond 10 days after the start of RT. NCT00904813 (http://www.clinicaltrials.gov).

Bond strength of ceramic brackets bonded to enamel with amorphous calcium phosphate-containing orthodontic composite

The aim of this in vitro study was to compare the shear bond strength (SBS) and failure modes of a conventional resin-based composite with a recently developed amorphous calcium phosphate (ACP)-containing orthodontic composite system. Forty freshly extracted human maxillary premolar teeth were randomly divided into two equal groups. Conventional composite (group 1; Transbond-XT; 3M Unitek) and ACP-containing orthodontic composite (group 2; Aegis-Ortho; Harry J. Bosworth Co.) were used for bonding ceramic orthodontic brackets. The SBS of these brackets were measured and recorded in megapascals (MPa). Adhesive remnant index (ARI) scores were determined after bracket failure. Data were analysed with a Student's t-test for two independent variables and Pearson's chi-square tests. Statistical analysis showed that the bond strength of group 1 (mean: 36.7 +/- 6.8 MPa) was significantly higher than group 2 (mean: 24.2 +/- 5.4 MPa; P < 0.01). Although a greater percentage of the fractures were cohesive at the composite interface (Score 1 + Score 2 = 70 per cent in group 1 and 90 per cent in group 2), statistically significant differences were observed between the groups (P < 0.05). The ACP system is suitable for bonding ceramic orthodontic brackets due to the lower SBS values compared with conventional composite. The ACP-containing composite is recommended for use in clinical orthodontic practice in order to achieve lower decalcification scores under ceramic orthodontic brackets.

Chronic epididymitis: is epididymectomy a valid surgical treatment?

Chronic scrotal pain (>or=3 months) is multi-factorial in nature and difficult to treat. Epididymectomy for chronic epididymal pain is rarely performed because of perceived poor outcome. We retrospectively audited our results, when published 'cure' following testicular denervation is 97%. The records of 32 males (35 consecutive epididymectomies) were retrospectively analysed. Thirteen had previous scrotal surgery. Eight (group one) had palpable painful epididymal abnormalities on clinical examination, nine (group two) had ultrasonic abnormalities but no palpable abnormality and 15 (group three) had neither. Pain response was recorded as: cured, improved, recurred or no change/worse. The mean time to operation was 23.83 months (2-121) and follow-up was 15.57 months (1-84). There were no significant aetiological differences between groups. In group one, 87.5% were cured with the remainder improved. Sixty-seven per cent of group two had a satisfactory outcome. Of group three, 20% were cured and a further 33% improved. Prior scrotal surgery, duration of symptoms and age were not predictive of outcome (Kruskal-Wallis) in terms of pain relief. Epididymectomy for structural abnormalities had excellent results. Those with chronic pain, normal examination and ultrasound had at best, a 55% chance of improvement. This group must be counselled about the low risk of success. The identification of the optimal surgical management of this difficult problem requires a multi-national registry study.

Oesophageal acid hypersensitivity is not a contraindication to Nissen fundoplication

The Rome III criteria classify patients with a positive relationship between symptoms and reflux episodes but a physiological oesophageal acid exposure time as having gastro-oesophageal reflux disease (GORD) with an acid hypersensitive oesophagus. The long-term outcome of antireflux surgery in these patients was investigated. Outcomes of Nissen fundoplication in 28 patients with GORD refractory to proton-pump inhibitors (PPIs) and oesophageal acid hypersensitivity (group 1) were compared with those of 126 patients with pathological acid exposure (group 2). Fundoplication had a similar effect in both groups. Three months after surgery, total acid exposure time and the prevalence of oesophagitis had decreased, whereas mean lower oesophageal pressure had increased. The percentage of patients using PPIs was reduced from 83 to 4 per cent in group 1 and from 86.1 to 7.4 per cent in group 2 (both P < 0.001). Quality of life measured on a scale from 0 to 100 improved from 52 to 69 (P = 0.009) and 64 (P < 0.001) respectively. The percentage of patients with resolved or improved symptoms at 5 years was similar. Patients with oesophageal acid hypersensitivity benefit from Nissen fundoplication as much as those with pathological acid exposure.

The rate of dosage increase of clonazepam.

The relationship between the rate of dosage increase of clonazepam (Ro 5-4023) and the number of patients with side-effects was investigated, with special reference to the number of cases in which clonazepam had to be discontinued. Out-patients in the age group of 18 to 50 years treated for non-symptomatic epilepsy with an insufficient result were included. The patients were allocated to one of two groups. The initial dose was 1 mg. The maintenance dose, 8 mg, was reached within 1 week in group 1, and within 3 weeks in group 2. Side-effects were registered in 96 per cent of the patients in group 1, in 85 per cent in group 2. Of the 26 patients in group 1, 11—i.e. 42 per cent—had the drug discontinued owing to severe side-effects. Group 2 included 27 patients. Clonazepam had to be stopped in 3 cases, i.e. 11 per cent. In the study of Birket-Smith et al. (1972) 36 patients were given the same initial dose as in this study. They reached the maintenance dose of 6 mg within 2 weeks. Considering the number of cases in which clonazepam had to be stopped, a highly significant difference was found between our one-week group and the two-weeks group mentioned. The difference between our one-week and our three-weeks group was also significant, whereas no difference was found between the two-weeks and the three-weeks group. It is concluded justifiable to prefer a schedule according to which the maintenance dose is reached within 2 weeks. However, individualizing the rate of increasing the dose will often be indicated.

Maternal and neonatal outcomes in early glucose tolerance testing in an obstetric population in New York city

Women with risk factors for diabetes are screened early in pregnancy. At our institution we obtain a GCT (glucose challenge test) at first prenatal visit. We sought to compare pregnancy outcomes in women who were diagnosed with GDM early in pregnancy with those diagnosed at the standard 24-28 weeks' gestation. An inner city population receiving prenatal care from August 2003 to May 2007 participated in the study. Patients were screened during the first trimester when able (group 1) or during the standard 24-28 weeks' gestation (group 2). Patient demographics, maternal and neonatal outcome data were collected and analyzed. Of 340 GDM patients identified, 99 were diagnosed early and 241 at the standard time. Eighty per cent of group 2 were treated with diet alone and 20% required pharmacological therapy. Fifty per cent of group 1 were treated with diet and 45% with pharmacological therapy (P<0.001). Comparison between the early and late diagnosis groups for preterm delivery and hypertensive disorders were statistically non-significant. Cesarean delivery was 45% in group 1 and 24% in group 2. Both macrosomia (13% vs. 6%) and large-for-gestational-age (18% vs. 6%) was statistically higher in the early GTT group. The adverse perinatal outcome is significantly higher in the early diagnosis group despite early identification and management implying greater severity of GDM.

Treatment strategy after non-curative endoscopic resection of early gastric cancer

Endoscopic resection (ER) is indicated for patients with early gastric cancer who have a negligible risk of lymph node metastasis (LNM). Histological examination of the resected specimen may indicate a possible risk of LNM or a positive resection margin. These patients are considered to have undergone non-curative ER. The aim of this study was to determine the appropriate treatment strategy for such patients. A total of 298 patients who had non-curative ER were classified into those with a positive lateral margin only (group 1; 72 patients) and those with a possible risk of LNM (group 2; 226 patients). Surgery was performed within 6 months of non-curative ER in 19 patients in group 1 and 144 in group 2. In group 1, nine patients were found to have local residual tumours, all limited to the mucosal layer without LNM. In Group 2, 13 patients had residual disease, including four local tumours without LNM, two local tumours with LNM and seven cases of LNM alone. The rate of LNM after surgery was 6.3 per cent in group 2. Surgery remains the standard treatment after non-curative ER in patients with a possible risk of LNM.

Effects of anabolic and therapeutic doses of dexamethasone on thymus morphology and apoptosis in veal calves

Three groups of 10 veal calves were treated, respectively, with 5 mg of dexamethasone-21-isonicotinate administered intramuscularly on days 0 and 7 (group A); 0·4 mg/day of dexamethasone-21-phosphate administered orally for...

Practices of Hong Kong building contractors in strategic asset allocation process: longitudinal approach

PurposeThe purpose of the paper is to report the investigation results of current practices of strategic asset allocation process, which consists of capital budget planning, monitoring, and control of Hong Kong building contractors. The changes of the said practices are compared with the results of the two similar surveys undertaken in the past longitudinally.Design/methodology/approachA total of 157 questionnaires were sent to about 1,000 approved Hong Kong building contractors (classified as group A, B, C in accordance with their maximum capacities). The total response rate was 30.7 per cent. Statistical techniques, a two‐dimensional contingency table, and discriminant function analysis (DA) were deployed to analyze the survey data via SPSS.FindingsOnly the practice of a regular review of the minimum rate of return of major projects was popular. For monitoring aspect, 100 per cent of surveyed contractors monitor project performance once operational. The result of post‐completion audits on major projects was 63 per cent. For the results of the longitudinal study, 66.7 per cent of group C firms employed the practices of intermediate and long‐term capital budgets and 71.4 per cent of large firms had a formal body for screening investment proposals compared with 54.8 per cent and 63.3 per cent of the same group's practices in 1994 respectively. DA results showed that the patterns within the three different groups (A, B, and C) were very similar, and group A and group B were active in capital budgeting monitoring and control.Practical implicationsPlanning was the weakest and data showed that Hong Kong building contractors had tight control of the projects.Originality/valueThis paper reports the investigation results of current practices of strategic asset allocation process, which consists of capital budget planning, monitoring, and control of Hong Kong building contractors.

The effect of casein phosphopeptide‐amorphous calcium phosphate on remineralization of artificial caries‐like lesions: an in vitro study

The aims of this study were to investigate the efficacy of CPP-ACP containing Tooth Mousse on the remineralization of enamel lesions and to compare its efficacy to that of a fluoride-containing toothpaste. Permanent teeth were placed in demineralizing solution for 96 hours to produce artificial caries-like lesions 120-200 microm in depth. They were sectioned into 100-150 microm thick samples and randomly assigned to five groups: for Group A, a fluoridated toothpaste (1100 ppm) was used as a positive control and in Group B, a non-fluoridated toothpaste was used as a negative control. Tooth Mousse containing CPP-ACP was tested by three different means: as a toothpaste (Group C); as a topical coating (Group D); and (Group E) as a topical coating after treating the sections with the same fluoridated toothpaste as in Group A. The lesion depth decreased significantly by 7 per cent in Group A, 10.1 per cent in Groups C and D, and 13.1 per cent in Group E (Paired t- test, p < 0.05), while in Group B the lesion depth increased significantly by 23 per cent. Based on the data obtained, CPP-ACP containing Tooth Mousse remineralized initial enamel lesions and it showed a higher remineralizing potential when applied as a topical coating after the use of a fluoridated toothpaste.

Excision of residual skin tags during stapled anopexy does not increase postoperative pain

We studied whether excision of residual external skin tags causes additional pain in patients undergoing a stapled anopexy for muco-anal prolapse. Seventeen patients in whom skin tags had been excised were compared with 24 patients having no excision. The patients were selected from a prospective database of haemorrhoid surgery if they had submitted a diary with self-reported postoperative pain scores as well as a self-reported symptom questionnaire preoperatively and postoperatively. The tags were excised with preservation of the subdermal fascia. There were 41 patients who fulfilled the criteria for inclusion. Seventeen (group 1) had tags excised and 24 (group 2) did not. Fifty-nine per cent in group 1 and 67% in group 2 experienced preoperative prolapse needing manual reposition. The mean height of the staple line was 2 cm above the dentate line in both groups. Daily average postoperative pain recorded as the sum of a self-reported VAS rating over 14 days was 26 points in both groups. The peak pain experienced was 42 and 43 points respectively (not significant). Resolution of postoperative pain over 14 days was identical. The preoperative and postoperative symptom score was comparable in both groups. Excision of anal skin tags should be carried out at the time of stapled anopexy.

Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases

Hepatic surgery is the treatment of choice for resectable colorectal liver metastases. Neoadjuvant chemotherapy can downstage the tumour and enable surgery in up to 38 per cent of patients whose tumours were initially considered irresectable. This prospective study included 150 patients who underwent hepatic resection over a 4-year period. One hundred and sixteen patients had resection without neoadjuvant chemotherapy (group 1) and 34 had chemotherapy before liver surgery (group 2). Perioperative features, survival and pattern of recurrence were compared. Median follow-up was 35.1 months. The in-hospital mortality rate was zero. Three-year overall survival in the two groups was comparable (P = 0.232). The 3-year disease-free survival rate was 21 per cent in the neoadjuvant group compared with 50.5 per cent in the immediate resection group (P < 0.001). Recurrence rates were 94 per cent (32 of 34) in group 1 and 66.4 per cent in group 2 (P = 0.001); extrahepatic recurrence, alone or associated with recurrence in the liver, was significantly more common in group 2 than in group 1 (78 versus 55 per cent; P = 0.016). Multivariate analysis revealed that resection of the recurrence was the most important independent prognostic factor for improved disease-free survival (relative risk 0.2; P < 0.001). Patients in group 2 had reduced disease-free survival (RR 1.8; P = 0.012). The recurrence rate among patients who had neoadjuvant chemotherapy and surgery for initially irresectable liver metastases was extremely high. Re-resection should be attempted whenever feasible.

Long-term outcome of resection of large hepatocellular carcinoma

The role of hepatectomy in the treatment of large hepatocellular carcinoma (HCC) is still controversial. This retrospective study evaluated whether the long-term outcome of hepatectomy for large HCC improved over 14 years in one centre. Data from 2102 patients who underwent hepatectomy for large HCC were collected prospectively and divided into two time intervals for analysis: before end of December 1996 (group 1) and after December 1996 (group 2). Clinicopathological data for the two groups were compared, and factors associated with long-term prognosis were further analysed. Cumulative 1-, 3- and 5-year overall survival rates were 71.2, 58.8 and 38.7 per cent respectively in group 2, and were significantly better than respective rates of 67.8, 50.7 and 27.9 per cent in group 1. Cumulative 1-, 3- and 5-year disease-free survival rates were 61.5, 38.6 and 23.8 per cent respectively in group 2, and 56.5, 34.7 and 18.9 per cent in group 1. There was a significant difference in median survival time after recurrence between groups 2 and 1 (17 and 10 months respectively; P = 0.043). Hepatic resection in patients with large HCC has improved overall and disease-free survival during the past decade at this institute. Long-term survival can be improved significantly by aggressive treatment of recurrent tumours.

Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head.

Of 176 patients with carcinoma of the pancreatic head region 156 underwent standard pancreatoduodenectomy (group 2) and 20 with macroscopic suspicion of invasion of the portal vein or superior mesenteric vein (SMV) underwent pancreatoduodenectomy with partial resection of the portal vein or SMV (group 1). In 16 patients in group 1 end-to-end anastomosis was used for reconstruction of the vein. The morbidity rate in groups 1 and 2 was similar (55 versus 63 per cent). The hospital mortality rate was 15 per cent in group 1 and 7 per cent in group 2 (P = 0.22). Histological examination confirmed tumour invasion of the portal vein or SMV in ten patients in group 1. Invasion of the portal vein or SMV was significantly more frequent in patients with pancreatic cancer than in those with distal bile duct or ampullary carcinoma. Of the 20 patients in group 1 only three underwent curative resection with tumour-free margins. The median survival time after resection of the portal vein or SMV was 8 months; the 2-year survival rate was 19 per cent. Comparison of survival in group 1 with survival in subgroups of patients undergoing standard pancreatoduodenectomy, matched for all histological parameters, showed no significant difference. It is concluded that partial resection of the portal vein or SMV in patients undergoing pancreatoduodenectomy who are suspected of having tumour invasion of the portal vein or SMV does not improve either the rate of curative resection or survival.