bluuebunny/crossref_metadata_2025 huggingface dataset:
An audit of quality of life and functional outcome following restorative proctocolectomy and ileoanal pouch surgery in familial polyposis coli
Authors: Daniels  , Beynon  , Carr
Published: March 2003

We have audited the quality of life and functional outcome from restorative proctocolectomy and ileoanal pouch surgery in patients with familial adenomatous polyposis coli (FAP). By assessing the effect on employment, leisure activity, social life, and sexual function using a questionnaire derived from a modified McMaster Inflammatory Disease Questionnaire we have assessed the functional outcome of the pouch [ 1]. We have shown that although quality of life is maintained from the results of the questionnaire, over 50% of the patients felt that the pouch had not improved their lives. It has been shown that colitic patients have less complete function than polyposis patients, although the former were more satisfied with the results of their surgery [
2]. Perhaps then the realization of the nature of FAP is not an incentive to surgery, when your life is to be ruled by your bowels. Therefore perhaps we should consider the outcomes in patients with FAP to be different from those in patients who have lived with colitis.
The unopened loop ileostomy
Authors: Woodcock  , Qureshi  , MacFie
Published: March 2003

Objective

A defunctioning loop ileostomy is often fashioned to protect distal colorectal anastomoses, with the aim of limiting the effect of any breakdown that may occur. However, its creation and subsequent closure may be associated with significant morbidity. The aim of this study was to evaluate the alternative use of an unopened loop ileostomy.

Patients and methods

Patients undergoing colorectal resection and distal anastomosis were given an unopened loop ileostomy instead of a conventional ileostomy. Any complications associated with the stoma and ease of closure were recorded for each patient.

Results

Complications occurred in seven (58%) of the 12 patients included in the study. Replacement of the ileal loop was difficult in five patients, one patient developed a wound abscess and pseudomembranous colitis, and a further patient had a persistent post‐operative pyrexia of unknown cause.

Conclusion

Despite the theoretical advantages of an unopened loop ileostomy, the results of this small study do not support the routine use of such a stoma as an adjunct to high risk colorectal anastomoses.
Transanal excision of early rectal carcinoma—review of a personal series
Authors: Budhoo  , Hancock
Published: March 2003

Transanal excision of small rectal tumours is a relatively minor procedure that is potentially curable and can be employed in selected cases of rectal cancer. The outcome of 22 cases treated by local excision was reviewed. This represented 9% of patients treated for rectal cancer over the study period. All patients had a transanal excision with curative intent and included three patients who were medically unfit for a major procedure. Follow up was for a minimum of 5 years or until death if this was earlier. The mean age was 65.7 years with 10 males and 12 females. The 5‐year recurrence rate was 27% (five of 22). The crude 5‐year survival for curative resection was 77%. Of the 22 local excisions, 10 were T1 and 12 were T2. The size of tumour varied from 0.5 cm to 3.5 cm. Eight were well differentiated, 10 moderate and two poorly differentiated. Two of the earlier cases in the series were unclassified. There were six recurrences, all of which were extraluminal. Three recurrences were in less than 3 years (early recurrence) and three beyond this time. Of the recurrences, one presented with liver metastases within 2 months of surgery, one was unfit for a major procedure and subsequently died of a myocardial infarction. The remaining patients with recurrences had salvage surgery. Three are still alive and one died over 5 years after a local excision, with the presence of recurrence. All recurrences were of T2 stage, with moderate (n=5) or poor differentiation (n=1). Three of the six tumours measuring > 3 cm recurred compared with three of the 16 tumours between 0.5 cm and 3 cm. Analysis of these cases demonstrates that local resection of small rectal tumours can give good results and salvage operation is possible in the event of recurrence. Long term follow up is recommended because of risks of late recurrence. The best prognosis group appears to be with the well‐differentiated T1 tumours with no involved margins.
The benefit of geriatric intervention in surgery—increased throughput does not necessarily need more beds
Authors: Dunn R. B. , Lewis P. A. , Allen S. , Britton D. C. , Williamson M. E. R.
Published: March 2003

Objective

Three years ago a consultant geriatrician began regular visits to the coloproctology and general surgery wards of an acute Trust every weekday, to assist staff with the medical management, rehabilitation and discharge planning of patients aged 65 years and above. The length of stay of these patients in the first 10 months of the appointment was compared with younger concurrent controls and with historical controls in the preceding 10 months.

Results

The mean length of stay for the 4146 patients aged 16 years and above in a 10‐month intervention period was 1.3 days shorter (95% confidence interval (CI) 0.86–1.74 days) than for the 4002 patients in the 10‐month control period. This pattern was consistent across all ages and types of surgery, including major colorectal resection.

Conclusion

There was an important benefit to the availability of coloproctology and general surgical beds in this acute Trust. More efficient rehabilitation of elderly patients reduces ‘bed blockage’ post‐operatively, and allows more effective use of available resources. Co‐ordination of the geriatric service with the specialized stoma support service allows earlier discharge of the elderly, and their relocation to appropriate premises where long‐term changes in bowel habit and problems with stoma care can be managed away from the acute surgical unit.
Does anorectal manometry predict clinical outcome after laparoscopic ACE procedures in children with spina bifida?
Authors: Wing N. A. , Findlay F. J. , Beasley S. W. , Frizelle F. A. , Dobbs B. R. , Robertson R. W.
Published: March 2003

Purpose

The laparoscopic antegrade continence enema (LACE) procedure is used for the treatment of faecal incontinence in children with spina bifida. The purpose of this study was to relate the outcome of the LACE procedure to anorectal function, as determined by anorectal manometry.

Method

Eleven children with spina bifida who had the LACE procedure underwent anorectal manometry (ARM) to document their anorectal function, and its relationship to the level of continence obtained following surgery.

Results

There was a consistently high level of functional continence achieved following surgery despite wide variability in the parameters of anorectal manometry. There was no demonstrable correlation between the outcome of the LACE procedure and anorectal function as assessed by manometry.

Conclusion

Anorectal function as determined by manometry failed to predict outcome after the laparoscopic ACE procedure in children with spina bifida.
Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma
Authors: Merkel S. , Wang W. Y. , Schmidt O. , Dworak O. , Wittekind CH. , Hohenberger W. , Hermanek P.
Published: March 2003

Objective

Anastomotic leakage is a serious complication after anterior resection for rectal carcinoma. It is controversial whether anastomotic leakage influences the rate of locoregional recurrence and therefore survival.

Patients and methods

The data of 940 patients with invasive rectal carcinoma stage I–III treated by curative anterior resection from 1978 to 1996 at the Department of Surgery of the University of Erlangen were analysed. Patients who received neoadjuvant or adjuvant treatment were excluded as well as patients who died postoperatively. 89 out of 814 patients (10.9%) developed an anastomotic leakage after anterior resection.

Results

The rate of locoregional recurrence during the first five postoperative years of all patients was 13.6%. In patients with anastomotic leakage the rate of locoregional recurrence was 22.0%, significantly higher than in patients without anastomotic leakage which was 12.5%, (P=0.018). On multivariate Cox regression analysis anastomotic leakage was shown to be an independent risk factor for locoregional recurrence (relative risk: 1.7, CI 95%: 1.02–2.75, P=0.042). Also cancer‐related survival was influenced significantly by anastomotic leakage in univariate analysis as well as in multivariate analysis (relative risk: 1.6, CI 95%: 1.1–2.2, P=0.017).

Conclusion

Anastomotic leakage after anterior resection for rectal carcinoma is a risk factor for locoregional recurrence and decreases cancer‐related survival.
Non‐specific colitis, is it a justifiable diagnosis?
Authors: Haboubi N. Y. , Kamal F.
Published: March 2003

Objective

The terms non‐specific and chronic colitis are often used by histopathologists. The aim of this study is to look into the validity of the label non‐specific chronic colitis (NSCC), the consistency of its reporting, as well as its clinical usefulness in patients who, on review, have shown to have normal biopsies.

Methods

Colonic and rectal biopsies from 35 patients who presented with acute onset diarrhoea, were initially diagnosed as nonspecific chronic colitis (NSCC) by a number of pathologists in one Department, and were reviewed by an outside pathologist (NYH) without the knowledge of the clinical details. A previously described set of histological criteria in reporting colonic biopsies in inflammatory conditions were used.

Results

Normal biopsies were found in 13 of the 35 patients (37%). These patients recovered without clinical intervention. In a further seven patients there was active inflammation with no features of chronicity, in 12 patients there were features of chronicity, in two patients there were hyperplastic polyps, and in one patient there were features of solitary ulcer syndrome.

Conclusion

NSCC was used, without consistency, to cover a variety of conditions, including normal biopsies, sometimes relaying a wrong message. We suggest that histological criteria for chronicity should be adhered to when this label is used and the term Non‐Specific Colitis should no longer be used.
Bacterial translocation in a non‐lethal rat model of peritonitis
Authors: Yao V. , Cooper D. , McCauley R. , Platell C. , Hall J.
Published: March 2003

Background

Bacterial translocation from the gut may occur under a variety of different clinical circumstances and has been implicated in the development of multiple organ failure. The aim of this study was to determine the distribution of bacterial translocation occurring in a model of chemically induced peritonitis. We also sought to document the degree of the associated immune and inflammatory response.

Methods

Though a midline laparotomy, rats were injected with 5 mg of zymosan (in 0.2 ml of saline) into the subomental space. After 4, 18, 24, 48 and 96 h, a number of endpoints evaluated: intraperitoneal cellular influx, TNF‐α and interleukin‐6 concentrations and myeloperoxidase activity. Bacterial cultures were initiated from the free peritoneal fluid, mesenteric lymph nodes, liver, lung, and kidney. Imprints were also made of the peritoneal mesothelial surface to determine its integrity.

Results

When comparing rats injected with zymosan with the controls, there was evidence of a peritoneal inflammatory response within 4 hours. Facultative gram negative bacteria were found to be growing in the mesenteric lymph nodes and in the peritoneal fluid at 48 h. Anaerobic organisms were also cultured from the peritoneal fluid at 48 h. No organisms were cultured from the liver, lung or kidneys. In addition there was a significant increase in intraperitoneal cell numbers (predominantly neutrophils, P < 0.05), myeloperoxidase activity (P < 0.05) and TNF‐α and IL‐6 concentrations (P < 0.05). There was extensive loss of the peritoneal mesothelial cells. The peritoneal inflammatory changes and bacterial translocation had resolved by 96 h.

Conclusion

Bacterial translocation can be induced by the presence of an acute inflammatory focus in the peritoneal cavity. The translocation and inflammatory changes were associated with extensive loss of mesothelial cells. Nonetheless, these changes all resolved, indicating that the peritoneal cavity has a significant capacity to deal with such insults. A clearer understanding of the cellular and molecular events involved in the resolution phase could lead to improvements in the treatment of peritonotis.
Immunoscintigraphy and intra‐operative radioimmunodetection in the treatment of colorectal carcinoma
Authors: Hladik P. , Vizda J. , Bedrna J. , Simkovic D. , Strnad L. , Smejkal K. , Voboril Z.
Published: March 2003

Purpose

Intra‐operative radioimmunodetection of malignant involved lymph nodes follows the pre‐operative immunoscintigraphy in the treatment of patients with colorectal carcinoma. The aims of this clinical study were to determine the sensitivity of the method, to compare the results in study when using Oncoscint and CEA‐Scan and to evaluate the importance of the method of surgery and postoperative adjuvant therapy.

Patients and methods

121 patients with colorectal tumours (106 primary and 15 recurrent) were operated on using radioimmunoguided surgery (RIGS). The study compared results of pre‐operative immunoscintigraphy, intra‐operative radioimmunodetection and postoperative histological examination. Histological investigation used classical H&E staining. In histologically negative and RIGS positive cases the immunohistochemical investigation was supplemented. Two radiopharmaceuticals were used Oncoscint CR 103 (MAb B72.3, Satumomab Pendetide), labelled with 111In in 56 patients and CEA‐Scan (IMMU 4‐Fab′ fragments MAb against CEA, Arcitumomab), labelled with 99mTc in 65 patients.

Results

The relationship between RIGS positive results and histological examination was statistically assessed after 38 operations and the most acceptable RIGS evaluating index was determined. All subsequent results were evaluated by this index. Immunoscintigraphy of tumour was positive in 112 cases (92.6%). Fifty‐five RIGS positive cases of malignant infiltrated lymph nodes were confirmed by 43 histologically positive examinations (78%). In this group 9 cases were discovered only by immunohistochemistry. Sixty‐six remaining RIGS negative results were confirmed in 62 (94%) cases by negative histology.

Conclusions

Both immunoscintigraphy and RIGS enable one to make a more accurate diagnosis. While treating the primary disease the use of RIGS may help in assessment of necessary extent of operation performance and in staging of the disease by revealing occult lymph nodes involved. Pre‐operative immunoscintigraphy seems to be a useful diagnostic method for detection of tumour recurrence. When comparing two radiopharmaceuticals used, CEA‐Scan seems to be more suitable for diagnostic studies, but using the Oncoscint for tumour recurrence detection had some specific benefit, too.
Long‐term results of modified graciloplasty for sphincter replacement after rectal excision
Authors: Rosen H. R. , Urbarz C. , Novi G. , Zöch G. , Schiessel R.
Published: March 2003

Objective  Restoration of the anal sphincter by means of electrically stimulated (dynamic) graciloplasty is a new therapeutic option for patients with severe faecal incontinence or those having abdomino‐perineal resection (APR) of the anorectum. The present study reviews the outcome of total anorectal reconstruction (TAR) after APR for low rectal cancer or recurrent anal cancer.

Methods  From 1992 to 2000, 35 of 64 patients treated with dynamic graciloplasty had a TAR performed either synchronously (n = 26) or as a secondary procedure one to five years after rectal excision (n = 9).

Results  The most frequent complication was injury or erosion of the neorectum (n = 9) which, was avoided with increasing surgical experience. Defaecation disorders and consequent incontinence were the most common functional problem and had to be treated with periodical enemas.

Conclusion  Although sphincter replacement by means of TAR after APR led to poorer functional results than those achieved in patients treated with dynamic graciloplasty for faecal incontinence, TAR remains a valid treatment option for patients who do not tolerate a permanent stoma.
An analysis of the accuracy of P‐POSSUM scoring for mortality risk assessment after surgery for colorectal cancer
Authors: Menon K. V. , Farouk R.
Published: March 2003

Objective

To compare predicted vs. observed mortality using P‐POSSUM and determine whether this scoring system reflected observed surgical outcomes.

Patients and methods

Consecutive patients who underwent a colorectal resection for cancer over a 12‐month period were scored using P‐POSSUM to estimate mortality risk and POSSUM to calculate predicted morbidity. This was then compared with observed outcomes. The main outcome measurements were 30 day postoperative mortality and postoperative morbidity.

Results

173 patients underwent a colorectal resection for cancer during the study period. The observed mortality rate was 8.7% compared with a P‐POSSUM predicted mortality rate of 15.6% (P < 0.01). Observed morbidity was 29% whereas the predicted morbidity rate was 32% (P=0.1).

Conclusions

P‐POSSUM allows for standardization of physiological and operative variables. Risk of postoperative mortality may be overestimated by the scoring system however.
The colonic J‐pouch in colo‐anal anastomosis
Authors: Mathur P. , Hallan R I.
Published: March 2003

Anastomosis of the colon to the anal canal is now an accepted technique in the surgical management of low and mid rectal cancers. Although significant postoperative bowel disturbance is often seen with straight colo‐anal anastomosis, controversy exists over the benefit of adding a colonic pouch for low anastomoses.

Several short and long‐term studies have demonstrated the early functional superiority of pouch‐anal over straight anastomosis. Pouch construction does not compromise anal physiological parameters. It is recommended the pouch be constructed from a length of descending colon and be small (5 cm) in size to adequately act as a neo‐rectum; long‐term evacuatory difficulties are encountered with the construction of large pouches (10 cm). Anastomotic complications appear to be less frequent with pouch surgery; construction of a pouch does not significantly add to operative time, patient morbidity and mortality. At present there is no compromise to long‐term oncological survival. The data supporting these statements is weak and based largely upon retrospective studies. Furthermore the impact of improved function with pouch‐anal anastomosis on overall quality of life has been poorly investigated. Further prospective randomized studies are required to ascertain whether the potential benefits of a colonic pouch are realized in the randomized setting.
Severe dysplastic lesions in the colon – how aggressive should we be?
Authors: Arumugam P. J. , Joseph A. , Sweerts M. , Haray P. N.
Published: March 2003

Introduction Biopsies of colonic lesions are often reported as showing dysplasia, though in reality some lesions may harbour invasive malignancy.

Aim To assess the risk of underlying invasive malignancy in sessile polyps where biopsies had shown severe dysplasia and also to attempt to define a management strategy in such patients.

Methods Between 1997 and 2001, 30 patients were diagnosed as having severe dysplasia using Morson's criteria in colonic lesions not amenable for endoscopic polypectomy. Severely dysplastic lesions were completely excised by appropriate surgical measures.

Results Out of 30 patients, 15 had invasive cancers. Surgical intervention involved anterior resections, endoanal excisions, sigmoid colectomies, or abdomino‐perineal excisions as deemed appropriate. The lesions ranged in size from 0.5 cm to 13 cm (mean 3.4 cm). There were nine T1 lesions (one of which was T1N1) and two each of T2, T3, T4 lesions (10 Dukes' A, 3 Dukes' B, 2 Dukes' C). Complete resection was confirmed histologically in all cases. One patient had a leak following endoanal excision, which required intervention. There was no mortality.

Discussion This study demonstrates that endoscopic sampling can be misleading and severely dysplastic sessile lesions should be managed along the same principles as followed for invasive cancers, rather than adopting a ‘wait and watch’ policy with repeated endoscopies, biopsies or piece‐meal polypectomies.
Delayed sphincter repair for obstetric ruptures: Analysis of failure
Authors: Pinta T. , Kylänpää‐Bäck M.‐L. , Salmi T. , Järvinen H. J. , Luukkonen P.
Published: March 2003

Objective  The aim of this study was to examine the clinical results after anterior anal sphincter repair in patients with obstetric trauma and to evaluate possible risk factors for poor outcome.

Patients and methods  In years 1990–99 anterior anal sphincter repair for anal incontinence due to obstetric trauma was performed in 39 patients at Helsinki University Central Hospital. Clinical examination with Parks' classification and patients' questionnaire with endoanal ultrasound (EAUS) were done before and after surgery. Pudendal nerve terminal motor latency (PNTML) was measured postoperatively. The median follow‐up time after the operation was 22 months (range 2–99).

Results   The follow‐up results of the patients' questionnaire for 12 patients (31%) were good, for 15 patients (38%) acceptable and for 12 patients (31%) poor. Postoperative EAUS showed sphincter overlap in 28 (72%) patients but a defect was still found in 11 (28%) patients. A defect found on postoperative EAUS correlated with poor clinical result according to Parks' (R = 0.8, P < 0.01) and patients' questionnaire results (R = 0.7, P < 0.01). Patients with poor clinical results (Parks III/IV) were statistically significantly older (median 63 years, range 26–73) than those with favourable results (Parks I/II) (median 45 years, range 27–79) (P < 0.05). Further, the duration of incontinence symptoms correlated with poor functional results (R = 0.4, P < 0.05).

Conclusion  After obstetric trauma anterior anal repair gives acceptable short‐term clinical results. EAUS investigation is easy and harmless to perform and should be used pre‐ and post‐operatively. Advanced age, pre‐operative signs of perineal descent, long‐lasting severe incontinence symptoms and a persistent defect on postoperative EAUS seem to be related to poor clinical result.
What are the barriers to medical care for patients with newly diagnosed diabetes mellitus?
Authors: Burge M. R. , Lucero S. , Rassam A. G. , Schade D. S.
Published: March 2003

Context: Few data are available describing factors that prevent patients with newly diagnosed diabetes from seeking medical care.

Objective  To identify socioeconomic factors that act as barriers to healthcare among such patients.

Setting  A community‐wide diabetes screening programme.

Participants  One hundred and eighteen patients with newly identified diabetes mellitus out of 1824 total screenings.

Interventions  Each newly identified person with diabetes was instructed to contact a physician for follow‐up care.

Design  A follow‐up survey was obtained from 89 (75%) subjects 9 ± 7 months after diagnosis.

Main outcome measure: Whether or not subjects had obtained follow‐up care for their diabetes.

Results  Of seven variables examined, only lack of health insurance correctly predicted those patients who failed to seek medical care for their diabetes by multivariate analysis.

Conclusions  Lack of health insurance coverage is the primary reason that patients with newly diagnosed diabetes fail to seek medical care.
Impressive lipid changes following hypolipidaemic drug administration can unveil subclinical hyperthyroidism
Authors: Liberopoulos E. , Miltiadous G. , Elisaf M.
Published: March 2003

It is well known that thyroid hormones modulate lipoprotein metabolism. Thus, the presence of clinical or subclinical hyperthyroidism may influence lipid parameters of dyslipidaemic patients and the efficacy of hypolipidaemic therapy. Here we present a patient with mixed hyperlipidaemia whose impressive improvement of his lipid profile following ciprofibrate administration pointed towards the diagnosis of asymptomatic underlying subclinical hyperthyroidism.
Metformin improves lipid metabolism and attenuates lipid peroxidation in high fructose‐fed rats
Authors: Anurag P. , Anuradha C. V.
Published: March 2003

Aim: Insulin resistance, hyperinsulinaemia and disturbances in glucose metabolism can be produced in normal rats by feeding them a fructose‐enriched diet. Metformin, an antidiabetic drug, enhances insulin sensitivity in type 2 diabetic patients. Previous studies have shown that metformin improves insulin sensitivity in fructose‐fed rats. The aim of this study was to determine the effect of metformin treatment on overall lipid metabolism and lipid peroxidation in rats that were fed a fructose‐enriched diet, which leads to insulin resistance. The relationship between hyperinsulinaemia and hyperglycaemia with lipid peroxide levels was also investigated.

Materials and Methods: The animals were divided into two batches. One batch received a standard diet and the other was fed a fructose‐enriched diet (72 g/100 g feed). After 2 weeks, each batch of rats was subdivided into two groups. One group received metformin (50 mg/kg per day in water) and the other received the standard diet and served as control.

Results: High fructose feeding resulted in hyperinsulinaemia, hyperglycaemia and alterations in lipids and lipid metabolism, and plasma and tissue lipid peroxides were significantly elevated. Administration of metformin (50 mg/kg/day) was associated with significant normalization of plasma insulin level and lipid alterations. These rats also showed significantly higher lipoprotein lipase (LPL) and lecithin cholesterol acyl transferase (LCAT) activities in plasma than untreated, fructose‐fed rats. Lipid peroxides content was also decreased in plasma and tissues. Significant positive correlations were observed between the levels of plasma insulin and plasma glucose with plasma lipid peroxides.

Conclusions: We conclude that enhanced lipid peroxidation occurs in addition to disturbances in lipid metabolism in fructose‐fed rats. Plasma insulin level probably contributes to this increased peroxidation. Improved insulin action in metformin‐treated rats could be responsible for the amelioration of these abnormalities induced by fructose feeding.
Effects of a water‐soluble extract of maitake mushroom on circulating glucose/insulin concentrations in KK mice
Authors: Manohar V. , Talpur N. A. , Echard B. W. , Lieberman S. , Preuss H. G.
Published: March 2003

Aim: We examined benefits of a water‐soluble extract of maitake mushroom designated as Fraction X (FXM) on the glucose/insulin metabolism of insulin‐resistant KK mice, and compared the results of FXM with those of a sulphonylurea, Glipizide.

Design: In several acute studies, insulin‐resistant KK mice were gavaged with a single dose of varying concentrations of FXM, or a single dose of one concentration of the oral hypoglycaemic drug, Glipizide. In the one chronic study, KK mice were gavaged with FXM, Glipizide, or an equal volume of isotonic saline (baseline control) twice daily. Retro‐orbital blood was drawn on the morning of the 4th and 7th days before the early gavage. Blood glucose was measured by routine laboratory procedures, and serum insulin was estimated by a radioimmunoassay (RIA) assay developed specifically for rodents.

Results: At a dose of FXM (140 mg/mouse), a statistically significant lowering of circulating glucose concentrations was again seen at 8–12 h and 16–18 h after oral gavage. The lowering approximated 25% of the original concentration. Oral gavage of Glipizide resulted in statistically significantly lower values of circulating glucose (25–37% lower compared with baseline) at 8–24 h post dosing. In the chronic study, the circulating concentrations of glucose and insulin of mice taking 140 mg FXM per day were decreased significantly at days 4 and 7.

Conclusions: FXM, a natural extract obtained from maitake mushroom, favourably influences glucose/insulin metabolism in insulin‐resistant KK mice. The lowering of both circulating glucose and insulin concentrations suggests that FXM works primarily by enhancing peripheral insulin sensitivity.
Rosiglitazone amplifies the benefits of lifestyle intervention measures in long‐standing type 2 diabetes mellitus
Authors: Reynolds L. R. , Konz E. C. , Frederich R. C. , Anderson J. W.
Published: March 2003

Aims: To evaluate the efficacy of a lifestyle intervention programme including meal replacements and increased physical activity upon body weight, diabetes control and other cardiovascular risk factors in obese, poorly controlled, insulin‐treated, type‐2‐diabetic individuals and to assess the impact of concomitant rosiglitazone (RSG) therapy.

Methods: This 6‐month intervention study included 21 patients with type 2 diabetes mellitus (DM) requiring insulin therapy with haemoglobin A1c (HbA1c) > 7% and with a body mass index (b.m.i.) > 27. All subjects were enrolled in a 6‐month lifestyle intervention programme and randomized to placebo or RSG 4 mg/day. Participation in the lifestyle programme included meal replacements, increased intake of fruits and vegetables and increased daily physical activity. Measured end‐points included body weight, waist circumference, blood pressure, HbA1c and serum lipids, before entry into the study.

Results: The baseline mean b.m.i. was 36.4 and the mean HbA1c was 9.0%. The greatest weight losses occurred during the first 12 weeks (19 lbs for RSG, 13.4 lbs for placebo) with a greater weight loss at each point for the group receiving RSG. Waist circumference declined by 2.8 and 4.0 inches for the placebo and RSG groups. Systolic BP declined 16.2 mmHg in the placebo group and 14.3 mmHg in the RSG group. Diastolic blood pressure decreased by 12.8 mmHg in the placebo group. HbA1c was reduced significantly by 1.3% for the placebo group and 1.1% in the RSG group.

Discussion: This study demonstrates the benefits of lifestyle intervention using meal replacements and increased physical activity with resultant modest weight loss in long‐standing, poorly controlled type 2 diabetes. RSG did not impede weight loss and, in fact, amplified some of the positive benefits of lifestyle intervention.
Relationship of glycation, antioxidant status and oxidativestress to vascular endothelial damage in diabetes
Authors: Wen Y. , Skidmore J. C. , Porter‐Turner M. M. , Rea C. A. , Khokher M. A. , Singh B. M.
Published: March 2003

Aims: To examine the inter‐relationships of various microvascular pathogenic mechanisms in diabetic patients.

Methods: Patients with diabetes (n = 18) and non‐diabetic subjects (n = 18) were studied.

Results: Blood markers of glycaemic control and glycation differed between the two groups (glucose 10.9 ± 7.6 vs. 4.7 ± 0.63 mmol/l, p < 0.01; HbA1c 7.0 ± 1.3 vs. 4.5 ± 0.3%, p < 0.001; glycated LDL 8.8 ± 2.5 vs. 6.1 ± 1.2%, p < 0.001) but plasma antioxidant status did not. LDL oxidation resistance, measured as lag time to maximum oxidation initiated by copper ions, was decreased in diabetes (58. ± 14.3 vs. 76.3 ± 21.5 min, p < 0.01). Both soluble intercellular adhesion molecule‐1 (ICAM‐1) and vascular cell adhesion molecule‐1 (VCAM‐1), markers of endothelial dysfunction, were significantly higher in diabetes (ICAM 491 ± 128 vs. 403 ± 131 µg/l, p < 0.05; VCAM 546 ± 157 vs. 393 ± 106 µg/l, p < 0.01). Linear correlations were significant between HbA1c and lag time of LDL oxidation (r = −0.39, p < 0.05), ICAM (r = 0.40, p < 0.05) and VCAM (r = 0.38, p < 0.05). LDL oxidizability correlated with vitamin C (r = 0.51, p < 0.01) but not any adhesion molecule. In multivariate analysis, both ICAM and VCAM correlated with HbA1c only (r2 = 0.16, F = 6.3, p < 0.01; r2 = 0.14, F = 5.4, p < 0.01 respectively).

Conclusion: In diabetes, glycation, tissue oxidation and endothelial function are all abnormal and predisposing to microvascular complications but interrelationships are complex with glycation appearing most direct.
Aldose reductase gene polymorphism is associated with progression of diabetic nephropathy in Japanese patients with type 1 diabetes mellitus
Authors: Yamamoto T. , Sato T. , Hosoi M. , Yoshioka K. , Tanaka S. , Tahara H. , Nishizawa Y. , Fujii S.
Published: March 2003

Aim: The objective of this study was to investigate cross‐sectionally and longitudinally whether polymorphism of the (A‐C)n dinucleotide repeat sequence of the aldose reductase (AR) gene may modulate risk for diabetic nephropathy or retinopathy in Japanese patients with type 1 diabetes.

Methods: We obtained DNA samples from 101 patients followed up after the onset of type 1 diabetes and analysed a (A‐C)n dinucleotide repeat polymorphic marker in the AR gene by polymerase chain reaction (PCR) method.

Results: Ten alleles ranging from Z−10 (128 bp) to Z+8 (146 bp) in repeat number were identified. In cross‐sectional studies, the prevalence of the Z+2 allele was higher than that of any other allele in patients with diabetic nephropathy (37.5% of patients in a microalbuminuria group, and 41.7% of those in a macroalbuminuria group including patients with chronic renal failure and maintenance haemodialysis treatment). Prevalence of the Z+2 allele was not increased in patients with diabetic retinopathy. In longitudinal Kaplan–Meier plots, the cumulative incidence of nephropathy was significantly associated with homozygosity for the Z+2 allele (log rank test, p = 0.031); respective prevalence of nephropathy after diabetes durations of 10 and 15 years was 42.9% and 100% in Z+2 homozygotes (n = 8), 17.6% and 27.4% in Z+2 heterozygotes (n = 44), and 6.1% and 17.4% in patients without the Z+2 allele (n = 49). However, occurrence of retinopathy was not influenced by the Z+2 allele (log rank test, p = 0.926).

Conclusions: Homozygosity for the Z+2 allele was associated with accelerated early progression of diabetic nephropathy in Japanese type 1 diabetic patients.
Establishment of mouse as an animal model for study of diabetic cataracts: biochemical studies
Authors: Hegde K. R. , Henein M. G. , Varma S. D.
Published: March 2003

Aim: The primary aim of this study was to understand the pathogenesis of diabetic cataracts at biochemical level in an animal model where lens aldose reductase (AR) activity is low, similar to that in the human lens.

Methods: Mouse, which is known to have low lens AR, was selected for these studies. Diabetes was induced by intraperitoneal administration of streptozotocin. Biochemical changes in the lens were monitored in freshly isolated lenses with standard chromatographic, enzymatic and culture experiments described in the section on methods.

Results: The present studies provide evidence of significant biochemical changes associated with such cataract formation despite very low levels of aldose reductase. The level of glycated proteins increased to 9 mg/100 mg of total water‐soluble lens protein in the diabetic lenses, as compared with the normal lenses where it was only about 1.3 mg/100 mg of total protein. Glutathione (GSH), the major antioxidant in the lens, decreased from 2.35 µmol/g in the normal lenses to about 1.17 µmol/g in the diabetic lenses. Malonadehyde, a product of lipid peroxidation, increased from 50 µmol/100 g in the normal to 70 µmol/100 g in the diabetic lens. The level of adenosine triphosphate (ATP), an indicator of the overall metabolic status of the tissue, also decreased from 962 ± 154 nmol/g in the normal to 487 ± 130 nmol/g in the diabetic lenses. The function of the Na+–K+ ATPase was also adversely affected in diabetes, as indicated by the ability of the lens to accumulate 86rubidium ions against its concentration gradient. The transport activity, expressed as CL/CM, was 24 in the normal lens, whereas it was only 12 in the diabetic lens. The level of sorbitol in the diabetic lens was only in the micromolar region. Hence, it was considered osmotically insignificant.

Conclusion: Overall, the results suggest that induction of cataracts in diabetes can be related to multiple biochemical effects such as oxidative stress and glycation. Sorbitol accumulation in low aldose reductase situations, being minor, could, however, act synergistically with other factors.
Bivalves with ‘concrete overcoats’: Granicorium and Samarangia
Authors: Taylor J. D. , Glover E. A. , Braithwaite C. J. R.
Published: March 2003

Two veneroidean bivalves Granicorium indutum from Australia and Samarangia quadrangularis from the tropical Indo‐Pacific region, cement a thick, hard layer of sand over most of their shells. In Granicorium this layer forms low commarginal ribs while in Samarangia it forms more prominent radial features. Sand grains are cemented to the shell and to each other with growths of a crystalline aragonitic cement similar in morphology to inorganic marine cements. Both species secrete mucus layers at the growing shell margin which initially hold the sediment grains together and form a substrate for the nucleation and growth of calcium carbonate crystals. The ribs of Samarangia are formed by the accretion of successive sheets of spherulitic growths. In G. indutum, the middle and outermost of two inner mantle folds are large, glandular and capable of considerable extension beyond the shell margin. Mucus secreted by the folds contains abundant bacteria and small calcium carbonate crystals. It is proposed that initial nucleation of the calcium carbonate cement takes place within this biofilm possibly mediated by the bacteria. The function of the sand layers is unknown but predation resistance and protection of the shells from endobionts are the most likely possibilities.
Histology of the fusion area between the parasitic male and the female in the deep‐sea anglerfish Neoceratias spinifer Pappenheim, 1914 (Teleostei, Ceratioidei)
Authors: Munk Ole
Published: March 2003

The article deals primarily with the histology of the fusion area between the head of the male and the skin of the female in two female Neoceratias spinifer, each of which had a single parasitic male attached. In this area, comprising the whole flattened upper part of the male head, the dermis of the male is completely fused with that of the female, leaving no remnants of the epidermis of either. In all other known cases permanent attachment of the parasitic male is accomplished by fusion of separate outgrowths from the male snout and lower jaw and the female skin. In the fusion area of N. spinifer two interconnected blood vascular plexus are present, the one located in the connective tissue of the male head, the other in that of the female skin. It is not known, however, whether the plexus in the female skin is provided with blood from the female blood vascular system, i.e. there is no critical proof of a real continuity between the female blood vascular system and that of the male. The eyes of both parasitic males are very degenerate. There is no histological evidence of degenerative changes in the male digestive system, heart or gills.
Sperm storage in females of the smooth newt (Triturus v. vulgaris L.): II. Ultrastructure of the spermathecae after the breeding season
Authors: Sever David M. , Halliday Tim , Moriarty Emily C. , Araño Begona
Published: March 2003

Sperm storage in cloacal spermathecae was studied in females of Triturus v. vulgaris from southern England killed at the end of the breeding season in June. This species mates and oviposits eggs in ponds from March to June. Included in the sample were 12 unmated females collected in terrestrial situations in March and mated in the laboratory. Some of these females oviposited viable eggs in the laboratory whereas others did not oviposit after mating. In addition, we examined five females with unknown mating histories that were collected from a breeding pond in June. We found that all of the specimens contained some stored sperm and were similar in spermathecal ultrastructure. The spermathecae exhibited characteristics of secretory epithelium at the end of a cycle, including irregular heterochromatic nuclei surrounded by scant cytoplasm, absence of organelles involved in synthetic activities, few secretory vacuoles, and wide intercellular canaliculi. Spermiophagy by the spermathecal epithelium was extensive. In contrast, spermathecae from females at the beginning of the breeding season as reported in our previous study were actively producing a PAS+ secretion and did not exhibit spermiophagy. Spermiophagy is a means of eliminating sperm prior to the next breeding season.
Ultrastructure of opisthosomal chaetae in Vestimentifera (Pogonophora, Obturata) and implications for phylogeny
Authors: Schulze Anja
Published: March 2003

Schulze, A. 2000. Ultrastructure of opisthosomal chaetae in Vestimentifera (Pogonophora, Obturata) and implications for phylogeny. —Acta Zoologica(Stockholm)82: 127–135

The posterior segmented body region of Vestimentifera bears rows of uncini that function to anchor the animal within its tube. SEM studies of five vestimentiferan species reveal intraspecific and interspecific variation in the number of chaetigerous segments and the arrangement of uncini within a given segment. The portion of an uncinus that extends beyond the epidermis comprises two opposing groups of teeth that probably correspond to the capitium and subrostral process of polychaete uncini, and a distinct protuberance between them, interpreted as a rostrum. InRidgeia piscesae, the uncini are formed by chaetal follicles, consisting of a chaetoblast, a follicle cell and an epidermis cell. The chaetal shaft is elongate and composed of up to 40 hollow cylinders that are invaded at their base by microvilli from the apical part of the chaetoblast. Opisthosomal chaetae in perviate Pogonophora are usually restricted to four per segment and are of a rod‐shaped type. It is hypothesized that the rod‐shaped chaetae represent reduced hooked chaetae probably derived from a condition such as found in Monilifera. Uncini of Pogonophora, Sabellida, Terebellida and Oweniida are considered homologous but details of chaetal design may be due to functional adaptations and thus do not represent reliable characters for phylogenetic studies on higher taxonomic levels than genera or potentially families.
Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi
Authors: El‐Anany F.G. , Hammouda H.M. , Maghraby H.A. , Elakkad M.A.
Published: March 2003

Objective To assess the efficacy and safety of the retrograde ureteropyeloscopic holmium laser for treating renal stones that are too large to treat with extracorporeal shock wave lithotripsy (ESWL).

Patients and methods Thirty patients (22 men and eight women, mean age 43 years, range 18–62) with a renal stone burden of > 2 cm were selected for laser treatment. The stones were in the renal pelvis in 16 patients, lower calyx in five, middle calyx in two, upper calyx in one and multiple pelvic and calyceal in six. Lithotripsy was undertaken using a holmium laser through 550 µm and 200 µm laser fibres passed through a semi‐rigid fibre‐optic long ureteroscope or the actively deflectable flexible ureteropyeloscope, respectively. Success was defined as total fragmentation of the stone to < 2 mm in diameter and/or clear imaging on renal ultrasonography and plain films within the 3‐month follow‐up. Patients in whom the treatment failed received either alternative therapy or complementary ESWL.

Results Endoscopic access and complete stone fragmentation was achieved in 23 of the 30 patients (77%). The treatment failed in seven patients because of poor visualization, the initial presence of stones in, or migration of their large fragments to, an inaccessible calyx. There were no major intraoperative complications. Minor complications after treatment included haematuria that persisted for 2 days in one patient and high‐grade fever in two patients; all were treated conservatively.

Conclusion Large renal calculi that are not amenable to ESWL monotherapy can be safely and effectively treated with a retrograde endoscopic technique that seems to compete well with the more invasive percutaneous or open surgical manoeuvres.
Further experience with the tubularized‐incised urethral plate technique for hypospadias repair
Authors: Elbakry A.
Published: March 2003

Objectives To report further experience of hypospadias repair using the tubularized‐incised urethral plate (TIP) technique and to evaluate the role of postoperative neourethral dilatation as a method of preventing complications.

Patients and methods The study included 64 patients (aged 2–18 years) who underwent TIP repair of hypospadias; 47 required a primary and 17 a secondary repair. After removing the stent they were randomized into two groups; group 1 (38 patients) underwent regular neourethral dilatation for 12 weeks and group 2 (26 patients) did not. Patients were followed for a mean (range) of 28 (6–52) months.

Results The functional and cosmetic results were excellent in all patients in group 1, except for slight meatal regression in one patient (3%). In group 2, 17 patients had excellent results; eight (31%) were re‐operated upon to correct complications, six developed a fistula (four of which were associated with meatal stenosis) and two developed a neourethral stricture.

Conclusions TIP urethroplasty is a versatile technique that provides an excellent functional and cosmetic outcome. Regular urethral calibration after repair should be considered as an integral part of the technique, to prevent neourethral and/or meatal stenosis with subsequent fistula formation.
Testicular implants and patient satisfaction: a questionnaire‐based study of men after orchidectomy for testicular cancer
Authors: Adshead J. , Khoubehi B. , Wood J. , Rustin G.
Published: March 2003

Objectives To assess the satisfaction of men with their testicular implants after undergoing orchidectomy for testicular cancer, and to determine their reasons for accepting or declining a prosthesis.

Patients and methods In all, 424 men who had undergone radical orchidectomy and were part of the testicular cancer follow‐up programme were sent an anonymous questionnaire comprising 10 questions covering two main areas. First, the reasons for accepting or declining an implant and second (if they received an implant) their satisfaction with the size, position, feel, shape and overall comfort; 234 men (55%) responded.

Results About a third (71 men) accepted an implant, a third declined and a third were not offered the choice. Of the men who replied 91% felt that it was extremely important to be offered an implant at the time of surgery. Of the 71 who received an implant, 19 (27%) were dissatisfied and felt that they had an average or poor cosmetic result. The reasons for this dissatisfaction are presented and discussed.

Conclusions All men undergoing orchidectomy should be offered a testicular implant, irrespective of age. Sample implants in all sizes should be available in the outpatient department. This will give men realistic expectations and allow them to choose a suitable size of implant. The dimensions of the available implants should be improved to create a more elliptical prosthesis, to avoid dissatisfaction with the shape. Adequate fixation to the base of the scrotum is important to avoid the ‘high riding’ implant.