bluuebunny/crossref_metadata_2025 huggingface dataset:
Halfe the world knowes not how the other halfe lies: Investigation of verbal and non‐verbal signs of deception exhibited by criminal offenders and non‐offenders
Authors: Porter Stephen , Doucette Naomi L. , Woodworth Michael , Earle Jeff , MacNeil Bonnie
Published: March 2007

Purpose. This study examined the verbal and non‐verbal behaviours exhibited by criminal offender and non‐offender participants while they related planned truthful and deceptive accounts about emotional autobiographical events.

Methods. In a 2 × 2 (participant group × veracity) quasi‐experimental design, offenders (N = 27) and university students (N = 38) provided videotaped accounts of four autobiographical emotional events: two honest and two fabricated (counterbalanced). Patterns of behaviour exhibited during the truthful and the deceptive accounts were then compared.

Results. In general, offenders and non‐offenders showed similar patterns of deceptive behaviour. Deceptive accounts by both groups contained fewer details than honest accounts. Deception was associated with an increase in illustrator usage and self‐manipulations; however, univariate analyses indicated only that offenders exhibited significantly more self‐manipulations when lying. A significant interaction emerged in which offenders showed a reduction in smiles when lying about the emotional events, while students showed no difference.

Conclusions. Offenders and students showed similar patterns of lying on most cues. However, unlike non‐offenders, offenders smiled less and showed an increase in self‐manipulations when lying. We theorize that offenders may have been aware that smiling and laughing are negatively related to perceived credibility in the speaker and used self‐manipulations to distract listeners from the content of their lies.
Aspirations for Older Age in the 21st Century: What is Successful Aging?
Authors: Bowling Ann
Published: March 2007

The literature on successful aging reveals a wide range of definitions, generally reflecting the academic discipline of the investigator. Biomedical models primarily emphasise physical and mental functioning as successful aging; socio-psychological models emphasise social functioning, life satisfaction and psychological resources as successful aging. Several studies also identify these factors as the precursors of successful aging. Moreover, research shows that older people consider themselves to have aged successfully, but classifications based on traditional medical models do not. Fewer studies have explored lay views, and most of these have been exploratory or restricted to specific groups of areas. A model of successful aging needs to be multi-dimensional, incorporate a lay perspective for social significance, use a continuum rather than dichotomous cut-offs for “success” and lack of, and distinguish clearly between predictor and constituent variables.
Pump Therapy for Children: Weighing the Risks and Benefits
Authors: Klingensmith Georgeanna J. , Temple-Trujillo Rita , Johnson DeAnn
Published: March 2007

In Brief

Continuous subcutaneous insulin infusion therapy can provide improved diabetes care and improve quality of life for some children with diabetes. However, insulin pump therapy in children poses unique problems not faced in adult diabetes management. Appropriate supervision of pump therapy in a young child requires an adult who is motivated, educated, and available at all times to manage the insulin pump.
Energy Therapies and Diabetes Mellitus
Authors: Guthrie Diana W. , Gamble Maureen
Published: March 2007

In Brief

People with diabetes require multiple interventions to reach their glycemic goals. Energy therapies have been a useful aid in improving health and well-being. Clinical interventions involve energy exchange in some form. This article focuses on energy therapies that involve the presence of a therapist, whether local or long distance, to support and aid in the healing process. The literature on diabetes and healing therapies is sparse, but there is potential for energy therapy to assist individuals with diabetes in reaching goals for normoglycemia and high quality of life.
Biological Complementary Therapies: A Focus on Botanical Products in Diabetes
Authors: Shane-McWhorter Laura
Published: March 2007

In Brief

Several botanical and biological products claim to lower blood glucose or decrease complications of diabetes, and some of these are being used by people with diabetes. Products thought to lower blood glucose include gymnema, fenugreek, bitter melon, ginseng, and nopal. Claims have also been made for aloe, bilberry, and milk thistle, but there is less evidence in support of these. Botanical products thought to decrease diabetes complications include γ-linolenic acid, ginkgo biloba, and garlic. A vitamin-like substance, α-lipoic acid, has been used to treat neuropathic complications.
Negotiating the Barrier of Hypoglycemia in Diabetes
Authors: Cryer Philip E. , Childs Belinda P.
Published: March 2007

Hypoglycemia is the limiting factor in the glycemic management of diabetes. It is a barrier to quality of life and even survival in the short term and to true glycemic control, with its established microvascular and potential macrovascular benefits, in the long term. Although it is possible to both improve glycemic control and minimize the risk of hypoglycemia in many patients with currently available regimens—by applying the principles of aggressive therapy and practicing hypoglycemia risk reduction—people with diabetes need treatment methods that provide glucose-regulated insulin secretion or replacement if euglycemia is to be maintained safely over a lifetime of diabetes.
Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome
Authors: Umpierrez Guillermo E. , Murphy Mary Beth , Kitabchi Abbas E.
Published: March 2007

In Brief

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome.
Glucose Control During and After Pancreatic Transplantation
Authors: Shokouh-Amiri M. Hosein , Stratta Robert J. , Latif Kashif A. , Gaber Osama
Published: March 2007

In Brief

Pancreas transplantation is considered the best treatment option for patients with type 1 diabetes and renal failure. In this article, the authors describe perioperative glucose control in patients undergoing pancreas or kidney-pancreas transplantation.
Avoiding High-Risk Behaviors: Smoking Prevention and Cessation in Diabetes Care
Authors: Tibbs Tiffany L. , Haire-Joshu Debra
Published: March 2007

In Brief

Smoking and other high-risk behaviors can result in devastating health consequences for patients with diabetes, in addition to patients with cardiovascular disease and cancer. The prevention and treatment of smoking should be a high priority for diabetes care providers. Effective strategies to implement behavioral change are discussed.
Improving Adherence to Diabetes Self-Management Recommendations
Authors: Schechter Clyde B. , Walker Elizabeth A.
Published: March 2007

In Brief

Improved health outcomes for individuals with diabetes depend on integrating self-management into daily life. A wide variety of educational, behavioral, and affective interventions are available that individually produce modest improvements in patient adherence to treatment recommendations in diabetes and related chronic illnesses and that work somewhat better when used in combination. A summary of selected successful interventions is presented.
Evolving Roles: From Diabetes Educators to Advanced Diabetes Managers
Authors: Valentine Virginia , Kulkarni Karmeen , Hinnen Debbie
Published: March 2007

In Brief

The evolution of advanced practice in diabetes management has emulated the advanced practice efforts of nursing groups. However, many disciplines are involved in the care and education of people with diabetes. This article reviews the expanded role of health professionals in diabetes and describes the development of a new clinical management credential for nurses, dietitians, and pharmacists with advanced degrees and advanced practice experience in diabetes.
Tips for Running a Successful Group
Authors: Zrebiec John
Published: March 2007

In Brief

Groups are a useful and common method for helping people with diabetes. Well-designed, functional groups require thoughtfulness about the institutional setting, purpose of the group, role of the leader, and recruitment of members. This article provides basic guidelines and techniques for running a successful group.
Psychosocial Group Interventions in Diabetes Care
Authors: van der Ven Nicole
Published: March 2007

In Brief

Psychosocial issues are now acknowledged as important in dealing with the daily demands of diabetes. This article provides an overview of the ways in which group interventions are used to assist people in dealing with these issues and the effectiveness of these interventions.
Group Education in Diabetes: Effectiveness and Implementation
Authors: Mensing Carolé R. , Norris Susan L.
Published: March 2007

In Brief

Groups offer a forum for people with diabetes to gather and learn together. Group attendees and educators have an opportunity to use creative approaches to learning. This article defines groups, discusses related constructs, reviews effectiveness research and some of its unanswered questions, describes implementation challenges, and offers skill-building suggestions to educators who use groups as a part of an educational practice.
Coronary Heart Disease in Women With Diabetes
Authors: Koerbel Glory , Korytkowski Mary
Published: March 2007

In Brief

The increased risk for coronary heart disease in women with either type 1 or type 2 diabetes has been well documented. Interventions directed towards primary, secondary, and tertiary prevention should be promptly implemented in these women to improve long-term outcomes.
Biopsychosocial Factors Affecting Metabolic Control Among Female Adolescents With Type 1 Diabetes
Authors: Jack Leonard
Published: March 2007

In Brief

Emerging research emphasizes the importance of an integrative approach to treating type 1 diabetes among adolescent females. This review discusses important biological, psychological, behavioral, and sociocultural factors that must be considered when providing diabetes care. A summary of recommendations to assist health care professionals in delivering care to their patients is provided.
Food, Identity, and African-American Women With Type 2 Diabetes: An Anthropological Perspective
Authors: Liburd Leandris C.
Published: March 2007

In Brief

Dietary practices are deeply rooted in history and culture. Anthropologists have long recognized that food choices and modes of eating reflect many symbolic, affective, familial, and gender-specific associations. African-American women with type 2 diabetes may find that modifying their dietary patterns is particularly challenging given the highly ritualized nature of eating and food selection and the meanings encoded in foods and food-centered events in the African-American experience. When health care providers understand the historical and social shaping of food patterns, they can work in partnership with people with type 2 diabetes to shift cultural norms toward healthy eating.
Factors and Processes Associated With Physical and Psychological Health of African-American Mothers With Type 2 Diabetes: A Heuristic Model
Authors: Murry Velma McBride , Owens Michelle D. , Brody Gene H. , Black Angela R. , Willert Amanda S. , Brown Anita C.
Published: March 2007

In Brief

This article examines the influence of social and personal stressors on the physical and psychological functioning of African-American mothers with type 2 diabetes. The conceptual model presented proposes that exposure to multiple stressors may lead some African-American women to implement exaggerated coping behaviors to prove their competence, which in turn may prevent them from seeking and accepting the help they need. The negative consequences for health of this “superwoman syndrome” are emphasized. The moderating or buffering effect of social support and maternal psychological resources on the links between stressors, coping behaviors, and health are also considered.
Obesity Treatments and Controversies
Authors: Kazaks Alexandra , Stern Judith S.
Published: March 2007

In Brief

The ideal model of obesity treatment is a comprehensive intervention including dietary, activity-related, behavioral, pharmacological, and/or surgical components that is geared toward individual needs, similar to the ideal treatment for diabetes. The main focus of any obesity intervention should be on health improvement instead of just body weight reduction. To resolve the controversies surrounding obesity, we must invest much more in research into the prevention of obesity and to ascertain those lifestyle or medical approaches that will make it easier for anyone to maintain a healthful energy balance.
The Importance of Physical Activity and Cardiorespiratory Fitness for Patients With Type 2 Diabetes
Authors: Blair Steven N. , Church Timothy S.
Published: March 2007

In Brief

Physical inactivity and low cardiorespiratory fitness increase the risk of developing type 2 diabetes and are associated with higher rates of cardiovascular disease and mortality in people with type 2 diabetes. Clinicians are encouraged to promote adoption of the consensus public health recommendation for physical activity for their sedentary and unfit patients and to stress that the benefit is improved health—not necessarily weight loss. Recent advances in behavioral intervention approaches can make clinicians more successful in helping their sedentary patients become and stay more physically active.
Cost Savings and Clinical Effectiveness of an Extension Service Diabetes Program
Authors: Christensen Nedra K. , Williams Pauline , Pfister Roxane
Published: March 2007

Objective. To evaluate the cost savings and clinical effectiveness of a Cooperative Extension Service diabetes education program for improving nutrition knowledge, food portioning skills, hemoglobin A1c (A1C),and anthropometric indices.

Design. Clients with type 1 or type 2 diabetes enrolled in a 3-month diabetes education course focused on food portioning skills. Pre- and post-course anthropometric measurements, a written food portion test, an observational food portioning skill test, and an A1C test were administered and scored. Paired t tests were calculated between pre- and post-course scores to measure statistical significance.

Results. Data analysis showed improvement in food portion knowledge written test scores (49.67% pre- and 59.56% post-course, P = 0.004),food portioning skills (out of a possible score of 5, 2.43 pre-, 4.29 post-course, P = 0.023), A1C results (7.16% pre-, 6.43% post-course, P = 0.000), body mass index (BMI) (32.60 kg/m2 pre-, 31.78 kg/m2 post-course, P = 0.000), weight (202.58 lb pre-,199.74 lb post-course, P = 0.000), waist circumference (42.43 inches pre-, 41.16 inches post-course, P = 0.000), hip circumference (45.96 inches pre-, 45.36 inches post-course, P = 0.000), and waist-to-hip ratio (0.92 pre-, 0.91 post-course, P = 0.000).

Conclusions/Applications. Evaluation of the Utah State University Extension Service diabetes education program showed improved nutrition knowledge, anthropometric measures, and glucose control. These improvements have been estimated to reduce medical costs by $94,010.
Developing and Using Interactive Health CD-ROMs as a Complement to Primary Care: Lessons From Two Research Studies
Authors: King Diane K. , Bull Sheana Salyers , Christiansen Steve , Nelson Candace , Strycker Lisa A. , Toobert Deborah , Glasgow Russell E.
Published: March 2007

Interactive health technologies (IHTs), whether used as an adjunct to clinical care or as a stand-alone program, provide a means to efficiently deliver both standardized information and tailored health interventions to a large number of patients. This article describes the benefits and drawbacks to the use of read-only memory compact disks (CD-ROMs) to facilitate diabetes self-management, using the experience from two efficacy trials with CD-ROMs as the primary modality for intervention. The CD-ROMs were designed to promote health behavior change and prevent complications by increasing attention to diabetes care guidelines and providing tailored self-management plans to patients with type 2 diabetes.

Lessons learned from these two studies are shared to answer the question:does the use of CD-ROMs as an intervention tool address the key barriers to using a self-management approach in primary care? We conclude by discussing the advantages and limitations of using CD-ROMs to deliver health interventions, along with recommendations for maximizing the potential of IHTs.
Nutrition Care for Hospitalized Individuals With Diabetes
Authors: Swift Carrie S. , Boucher Jackie L.
Published: March 2007

In Brief Medical nutrition therapy (MNT) is an integral component in maintaining glycemic control for hospitalized patients with diabetes and must address special challenges related to illness, changes in medications, and erratic meal schedules. A team approach is required to ensure that patients'nutrition care plans work with their medical plan, not against it. This article reviews MNT goals for hospitalized patients, the need for screening and referral of inpatients for MNT services, and the process of providing MNT in the hospital.
Detection, Prevention, and Treatment of Hypoglycemia in the Hospital
Authors: Tomky Donna
Published: March 2007

In Brief Hypoglycemia is a worrisome condition for hospitalized patients. Nurses, physicians, and other health care workers must be vigilant in detecting, treating, and most of all preventing hypoglycemia in diabetic patients. Systems and protocols for treating patients with diabetes guide the health care team in achieving glycemic goals for healing and health promotion while providing a safe environment.
Patient Education in the Hospital
Authors: Nettles Anne T.
Published: March 2007

In Brief Recent concern about the optimum management of hyperglycemia for hospital patients has heightened awareness of necessary standards of care. Publications have confirmed that diabetes is not diagnosed or treated when detected in acute care settings, and opportunities for education are missed. Hospitalization presents an opportunity to address patients' unique urgent learning needs. In centers where quality diabetes management is a priority, education is readily available, roles are clear, and quality is monitored, evidence supports the notion that inpatient education is related to earlier discharge and improved outcomes following discharge.
Rapid Progression From Pre-diabetes to Severely Ill Diabetes While Under“Expert Care”: Suggestions for Improved Screening for Disease Progression
Authors: Danish Robert K. , West Beverly B.
Published: March 2007

In Brief

Obesity is associated with an increased risk for the development of insulin resistance and subsequent pre-diabetes and type 2 diabetes. This article reports a case of a 16-year-old obese African-American male with metabolic syndrome and pre-diabetes that progressed rapidly over 7.5 weeks while under expert care to complicated type 2 diabetes requiring intensive care management. This case points out limitations in recommended clinical monitoring and patient education that can lead to delays in the implementation of more aggressive therapies. The authors then suggest low-cost methods of screening patients at high risk for progression to pre-diabetes and type 2 diabetes.
Cellulase digestibility of pretreated biomass is limited by cellulose accessibility
Authors: Jeoh Tina , Ishizawa Claudia I. , Davis Mark F. , Himmel Michael E. , Adney William S. , Johnson David K.
Published: March 2007

Attempts to correlate the physical and chemical properties of biomass to its susceptibility to enzyme digestion are often inconclusive or contradictory depending on variables such as the type of substrate, the pretreatment conditions and measurement techniques. In this study, we present a direct method for measuring the key factors governing cellulose digestibility in a biomass sample by directly probing cellulase binding and activity using a purified cellobiohydrolase (Cel7A) from Trichoderma reesei. Fluorescence‐labeled T. reesei Cel7A was used to assay pretreated corn stover samples and pure cellulosic substrates to identify barriers to accessibility by this important component of cellulase preparations. The results showed cellulose conversion improved when T. reesei Cel7A bound in higher concentrations, indicating that the enzyme had greater access to the substrate. Factors such as the pretreatment severity, drying after pretreatment, and cellulose crystallinity were found to directly impact enzyme accessibility. This study provides direct evidence to support the notion that the best pretreatment schemes for rendering biomass more digestible to cellobiohydrolase enzymes are those that improve access to the cellulose in biomass cell walls, as well as those able to reduce the crystallinity of cell wall cellulose. Biotechnol. Bioeng. 2007; 98: 112–122. © 2007 Wiley Periodicals, Inc.
Microscopic analysis of corn fiber using starch‐ and cellulose‐specific molecular probes
Authors: Porter Stephanie E. , Donohoe Bryon S. , Beery Kyle E. , Xu Qi , Ding Shi‐You , Vinzant Todd B. , Abbas Charles A. , Himmel Michael E.
Published: March 2007

Ethanol is the primary liquid transportation fuel produced from renewable feedstocks in the United States today. The majority of corn grain, the primary feedstock for ethanol production, has been historically processed in wet mills yielding products such as gluten feed, gluten meal, starch, and germ. Starch extracted from the grain is used to produce ethanol in saccharification and fermentation steps; however the extraction of starch is not 100% efficient. To better understand starch extraction during the wet milling process, we have developed fluorescent probes that can be used to visually localize starch and cellulose in samples using confocal microscopy. These probes are based on the binding specificities of two types of carbohydrate binding modules (CBMs), which are small substrate‐specific protein domains derived from carbohydrate degrading enzymes. CBMs were fused, using molecular cloning techniques, to a green fluorescent protein (GFP) or to the red fluorescent protein DsRed (RFP). Using these engineered probes, we found that the binding of the starch‐specific probe correlates with starch content in corn fiber samples. We also demonstrate that there is starch internally localized in the endosperm that may contribute to the high starch content in corn fiber. We also surprisingly found that the cellulose‐specific probe did not bind to most corn fiber samples, but only to corn fiber that had been hydrolyzed using a thermochemical process that removes the residual starch and much of the hemicellulose. Our findings should be of interest to those working to increase the efficiency of the corn grain to ethanol process. Biotechnol. Bioeng. 2007; 98: 123–131. © 2007 Wiley Periodicals, Inc.
Common femoral artery Doppler wave-forms: A comparison of three methods of objective analysis with direct pressure measurements
Authors: MacPherson D S , Evans D H , Bell P R F
Published: March 2007

Doppler maximum frequency wave-forms recorded from the femoral arteries of 50 patients with arterial disease have been submitted to three methods of objective analysis in an attempt to quantify the degree of proximal narrowing. The methods were compared with direct femoral artery pressure measurements at rest and during hyperaemia. There was marked overlap between the results of both pulsatility index and Laplace transform damping when compared with pressure assessment. Principal component analysis, however, produced significantly better agreement than Laplace transform damping (χ2 = 5·8, P<0·02) and in addition was found to be sensitive to the presence or absence of disease in the superficial femoral artery. Principal component analysis appears to be the most powerful method of Doppler wave-form analysis so far described and may have a place in the non-invasive assessment of the aorto-iliac segment.
Urinary hydroxyproline and prognosis in human breast cancer
Authors: Grant C S , Hoare S A , Millis R R , Hayward J L , Wang D Y
Published: March 2007

The excretion of urinary hydroxyproline has been measured before mastectomy in 342 patients presenting with breast cancer for the first time to Guy's Hospital. The first 106 women were maintained on a gelatine-free diet whilst the remainder were on unrestricted diet.

In both dietary groups hydroxyproline levels or the ratio of hydroxyproline to urinary creatinine were not related to pathological stage or histological grade.

The time between initial presentation and subsequent bone metastases was negatively and significantly associated with hydroxyproline excretion (P < 0.05) and the ratio of hydroxyproline to creatinine (P < 0.01) in women on a gelatine-free diet. A similar, but not significant, trend was observed in patients on unrestricted diet.

Although hydroxyproline excretion was related to the time to onset of bone metastases the amount of hydroxyproline excreted by these patients was not significantly different from patients who had recurrences at sites other than bone or patients who were disease-free up to 5 years after initial diagnosis.

The conclusion is that hydroxyproline is of little value in the early detection of bone metastases.
Laser recanalization of obstructing foregut cancer
Authors: Swain C P , Bown S G , Edwards D A W , Kirkham J S , Salmon P R , Clark C G
Published: March 2007

Palliative treatment of upper gastrointestinal tract obstruction was undertaken by endoscopic laser therapy in 6 patients with carcinoma of the oesophagus or stomach. All had dysphagia for solids on admission and were considered unsuitable for surgery or radiotherapy. Three were in sites unsuitable for placement of an endoscopic prosthesis. The tumours occluded up to 90 per cent of the lumen (2 squamous and 4 adeno-carcinomas). Treatment was carried out under direct vision, the laser wave guide being passed through the biopsy channel of a standard endoscope. Superficial tumour vaporized immediately using energies of 2–10 000 J per session, whereas deeper layers sloughed over the succeeding 2–3 days. Two to six treatments were required to relieve dysphagia and there were no major complications. Quantitative barium studies before and after treatment showed a significant increase in luminal diameter. These patients could eat solid food after treatment and all were able to go home.
Pancreatic abscess: A review of seventeen cases
Authors: Kaushik S P , Vohra R , Verma G R , Kaushik S , Sabharwal A
Published: March 2007

Seventeen patients out of a total of 190 cases of acute pancreatitis, over a period of 12 years, developed the rare but serious complication of pancreatic abscess. Presence of toxaemia, fever, tachycardia and a tender epigastric mass suggested the possibility of abscess formation. Significant hyperamylasaemia was present in 2 patients only. Barium enema examination showed colonic changes due to direct involvement in 3 patients. Pre-operative management included complete rest to the gastrointestinal tract, correction of fluid and electrolyte imbalance, monitoring of vital signs and other parameters and antibiotic cover with penicillin in combination with broad spectrum antibiotic. In recent years Metronidazole was added in 7 patients, and this resulted in significant improvement of results. Surgical drainage was performed in all cases. The postoperative course was stormy and a significant number of patients developed both local as well as systemic complications with multiorgan failure. Residual/recurrent abscess was seen in one case only. Ten patients died in the immediate postoperative period. The survival rate was 41 per cent.
The long-term results of polyvinyl alcohol (Ivalon) sponge for rectal prolapse in young patients
Authors: Boulos P B , Stryker S J , Nicholls R J
Published: March 2007

The long-term outcome of Ivalon sponge rectopexy for rectal prolapse in a group of young patients was reviewed. Thirty-two patients under the age of 40 underwent Ivalon sponge rectopexy between 1961 and 1975 with no mortality and one early complication. Twenty-five patients (9 men; 16 women) aged 13–39 years (median 28 years) at the time of operation were interviewed and examined in the Out-Patient Department between 5 and 20 years (median 10 years) after the operation. Five (20 per cent) had developed recurrence which occurred at 1, 1, 5, 6 and 9 years. There was no significant change in bowel habit postoperatively, with the exception of 3 patients with diarrhoea who reverted to normal. There was some disturbance in faecal continence pre-operatively in 20 patients, of whom 15 (75 per cent) were improved by rectopexy. All patients had normal urinary and sexual function, and there was no disturbance of menstruation in females following rectopexy. Three men who wished to have children were successful. Three of six women who attempted to conceive post-operatively had normal pregnancies and deliveries. The three women who failed to do so had already been investigated for infertility before the operation. No patient developed pelvic malignancy.
Cryotherapy for advanced haemorrhoids: A prospective evaluation with 2-year follow-up
Authors: Traynor O J , Carter A E
Published: March 2007

The early and long-term results of treating 125 patients with advanced haemorrhoids by cryotherapy have been studied. Hospitalization requirements were brief; 54 per cent of patients were hospitalized for less than 24 h. The only significant early postoperative problem was a profuse serous discharge (67 per cent of patients). Bleeding, pain, or pruritus were rarely encountered. Ninety-three per cent of patients returned to work within 3 weeks. The principal long-term disadvantage was residual peri-anal skin tags and these were excised 6 months postoperatively in 18 patients. Four patients had first or second degree haemorrhoids at 2 years but only one patient (0.8 per cent) had prolapsing piles which required operation. Factors which might have influenced the results have been discussed. It is concluded that cryotherapy is an effective low cost method of dealing with advanced haemorrhoids.
Endoscopic screening for premalignant changes 25 years after gastrectomy: Results of a five-year prospective study
Authors: Mortensen N J McC , Thomas W E G , Jones S M , Savage Ann
Published: March 2007

Sixty-three partial gastrectomy patients an average 20 years after surgery were reviewed by endoscopy and biopsy in 1977. No cases of invasive carcinoma were found. The patients were then divided into two groups. Those with moderate epithelial dysplasia (13 patients) were reviewed at 6–12 monthly intervals. One patient developed severe dysplasia but none developed an invasive carcinoma. The remaining patients with either no or mild dysplasia were offered endoscopy after 5 years and 24 agreed. Of the 12 patients with no dysplasia at the outset: 5 still had no dysplasia 5 years later, 3 had mild dysplasia and 4 now had moderate dysplasia. There were 12 with mild dysplasia at the first endoscopy, 9 remained unchanged at the review and 3 had moderate dysplasia. If dysplastic changes in gastric mucosa are pre-malignant, progression to invasive carcinoma would appear to be slow. Even 25 years after gastrectomy only a modest deterioration in the grade of dysplasia was found and no invasive cancer.
The effect of a segmental gastrectomy with proximal gastric vagotomy on gastric secretion and gastric emptying
Authors: de Oliveira R B , Ceneviva R , de Almeida Troncon L E , Castro e Silva O , Meneghelli U G
Published: March 2007

Gastric acid secretory responses to graded doses of pentagastrin were measured in duodenal ulcer patients before and after either proximal gastric vagotomy (17 patients) or proximal gastric vagotomy associated with a segmental gastrectomy (11 patients). Calculated maximal output of acid and responsiveness of the acid-secreting cells to pentagastrin were reduced by both operations; after surgery, maximal acid output was lower in the proximal gastric vagotomy plus segmental gastrectomy group than in the proximal gastric vagotomy group. Gastric emptying of a liquid meal was assessed before and after either proximal vagotomy (13 patients) or proximal gastric vagotomy plus segmental gastrectomy (9 patients). The early phase of emptying was equally accelerated by both operations, and at later stages the emptying was only slightly, but not significantly, faster following proximal gastric vagotomy associated with segmental gastrectomy.
Postoperative fatigue and changes in nutritional status
Authors: Christensen T , Kehlet H
Published: March 2007

Subjective feeling of fatigue was quantified before and 10, 20 and 30 days after elective uncomplicated abdominal surgery in 36 otherwise healthy patients, using a constructed fatigue scale model. One third of the patients had a remarkable increase in fatigue which continued throughout the first postoperative month. The fatigued patients showed a more pronounced postoperative loss in weight (P < 0·001), triceps skinfold caliper (P < 0·001) and arm muscle circumference (n.s.) and had lower levels in serum transferrin (P < 0·02). No correlation was found between postoperative fatigue and postoperative changes in blood haemoglobin, lymphocyte count, plasma albumin, electrolytes and various minerals. Development of late postoperative fatigue was unpredictable from pre-operative nutritional status, serum transferrin, albumin, electrolytes, haemoglobin, lymphocyte count and various minerals, as well as from age, sex and duration of surgery. These results suggest future therapeutic measures against the postoperative fatigue syndrome.
Seeding Dacron arterial prostheses with peritoneal mesothelial cells: A preliminary morphological study
Authors: Clarke J M F , Pittilo R M , Nicholson L J , Woolf N , Marston A
Published: March 2007

A preliminary laboratory study has been undertaken using dogs, in which porous Dacron arterial prostheses have been seeded with autologous peritoneal mesothelial cells before implantation into the arterial system. These cells were harvested from omentum by collagenase digestion and were introduced into the graft at the time of preclotting. Examination of the grafts by scanning and transmission electron microscopy one month after insertion showed no organized cellular lining in the control graft. In three seeded grafts there was a lining of mesothelial cells which extended over the whole surface of the grafts up to 1 cm from the suture lines. Selected areas of the grafts have been analysed morphometrically. In the seeded grafts there is a cellular layer which on average covers 94 per cent of the luminal surface. These results suggest that mesothelial cells, which both secrete prostacyclin and possess fibrinolytic activity, present a possible alternative to endothelium as a cellular lining for prosthetic grafts.
Deep venous insufficiency after postoperative thrombosis diagnosed with 125I-labelled fibrinogen uptake test
Authors: Lindhagen A , Bergqvist D , Hallböök T
Published: March 2007

Postoperative thrombosis detected with the 125I-labelled fibrinogen uptake test (FUT) is frequent. FUT correlates well with phlebography and a positive FUT is associated with high incidence of pulmonary embolism. This study has been performed to evaluate venous function 3–5 years after FUT-detected thrombosis. A follow-up examination was performed in 381 patients who had been studied after operation with FUT. The follow-up included a questionnaire, clinical examination, venous occlusion strain-gauge plethysmography, ambulatory strain-gauge plethysmography, venous pressure examination and, in some cases, Doppler ultrasound examination of venous valve function in the leg. No statistically significant differences were found in any parameters used between legs with and without FUT-detected postoperative thrombosis, except that more FUT-positive logs had an abnormal venous pressure decrease during exercise than FUT-negative legs. The frequency of deep venous insufficiency was equal in FUT-positive and FUT-negative legs. Moreover the frequency of deep venous insufficiency was not affected by the site of the FUT-detected thrombosis or by the different kinds of prophylactics used. The frequency of venous insufficiency was high.
Porcine dermal collagen repair of incisional herniae
Authors: Sarmah B D , Holl-Allen R T J
Published: March 2007

Dermal collagen implants have been used to repair large incisional hernias in 11 patients (7 women, 4 men). The youngest was 37 years and the oldest 67, with a mean age of 49·9 years. Single-, or double-layered dermal collagen was used to bridge the defect, secured with interrupted 3/0 Prolene. Postoperatively, three patients required single aspiration of seromas and one, exploration of a sinus to remove a suture. There were no recurrences during a median follow-up period of 4·75 years. It is suggested that collagen implants are a good alternative to other methods of repair.
Segmental phenolization of ingrowing toenails: A randomized controlled study
Authors: Morkane A J , Robertson R W , Inglis G S
Published: March 2007

One hundred and three patients, on whom 107 procedures for ingrowing toenails were performed, were randomly allocated into one of two treatment groups: segmental or angular phenolization and wedge excision. There were 53 wedge excisions and 54 segmental phenolizations. Post-treatment discomfort was assessed on a linear analogue scale of 10 cm. There was no difference between the two groups one week after treatment. Over a mean follow-up period of 14 months a total of 20 nail spikes occurred, 4 in the phenolized group and 16 in the wedge excision group, this being a significant difference at the one per cent level.
Delayed spontaneous recanalization of the vas deferens
Authors: Sherlock D J , Holl-Allen R T J
Published: March 2007

Eight patients were identified who had undergone successful vasectomy a mean of 4·6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy. Histological examination of the excised portions revealed the presence of spermatozoa in the distal end of one side; but also the presence of a well formed sperm granuloma in continuity with both divided ends of the vas. There does not appear to be any correlation with the suture previously used, nor incidence of infections or injury. Although recanalization is a recognized complication of vasectomy, the majority have occurred within months of the operation. The association of the delayed recanalization with sperm granuloma formation in these cases suggests an aetiological link, it being previously reported that such granuloma can develop up to six years postoperatively.
Penetrating neck trauma with tracheal and oesophageal injuries
Authors: Shama D M , Odell J
Published: March 2007

Failure to recognize early that penetrating neck wounds include the cervical oesophagus greatly increases morbidity and mortality. From an analysis of experience over 5 years (1978–1983) it emerges that, while tracheal wounds are usually recognized early, cervical oesophageal injuries are not. It is empyema which complicates such oesophageal injury and which prompts referral to a Department of Thoracic Surgery, the patients by this time being mortally ill, with septicaemia and malnutrition. Neck penetration is usually left-sided, the injuring agent usually a knife, driven downwards and medially by a right-handed assailant. Empyema is usually right-sided. Early recognition and prompt referral are associated with a low morbidity and low mortality. Late recognition and late referral carry a high morbidity rate, prolonged convalescence in those who survive, and a mortality rate of nearly 25 per cent.
The effect of tetracyline lavage and trauma on visceral and parietal peritoneal ultrastructure and adhesion formation
Authors: Phillips R K S , Dudley H A F
Published: March 2007

The clinical efficacy of tetracycline lavage (1 mg/ml) in the management of abdominal sepsis has led to advocacy of its use in potentially contaminated cases. Yet at higher concentrations (6 mg/ml), tetracycline is a pleural sclerosant. The possibility of early ultrastructural peritoneal damage and later adhesion formation has been examined in syngeneic female Wag rats.

At high concentration (10 mg/ml), tetracycline caused adhesions in the absence of peritoneal trauma and there was an associated loss of serosal microvilli. Lavage with low concentration tetracycline (1 mg/ml) or saline after clean abdominal surgery led to more adhesions than if no lavage was employed. There was an unexplained paradoxically low incidence of adhesions if prior mild contamination of the peritoneal cavity with 1 ml 105 E. coli had been performed.
Postoperative peritonitis due to gastric and duodenal fistulas. Operative management by continuous intraluminal infusion and aspiration: Report of 23 cases
Authors: Levy Etienne , Cugnenc P H , Frileux P , Hannoun L , Parc R , Huguet C , Loygue J
Published: March 2007

A new surgical procedure is presented for the management of postoperative peritonitis due to a leak from a suture line in the stomach or the duodenum. At re-operation, an intraluminal unit made of three silicone tubes is inserted through the fistula into the bowel lumen. Extraluminal drains are placed near the fistula. A Witzel jejunostomy is constructed in order to provide continuous high energy enteral support. Intraluminal infusion and aspiration starts immediately after operation. Twenty-three patients have been treated according to this technique. Five died (22 per cent): one from mediastinitis and four from complications unrelated to the fistula. Three (13 per cent) patients developed recurrent abdominal abscesses and underwent re-operation for drainage with no mortality. In the first 2 weeks after operation, most of the discharge was collected by the extraluminal drains. Thereafter the intraluminal unit collected the majority of the fluid, thus allowing the extraluminal drains to be removed. At an average time of 27 days after operation the intraluminal unit was withdrawn. The external fistula created by this technique healed spontaneously in 15 of the 18 survivors, and was surgically closed in three, with no complication. This procedure prevents the recurrence of intra-abdominal sepsis and local complications due to the enzymatic action of the gastroduodenal secretions.
Large bowel cancer: Surgical pathology and its relationship to survival
Authors: Phillips R K S , Hittinger Rosemary , Blesovsky Lynda , Fry J S , Fielding L P
Published: March 2007

Modifications of Dukes' (1932) classification of rectal tumours have led to confusion. From the data of 2518 patients who had undergone curative colorectal surgery the interrelationships between tumour penetration, grade, vascular invasion and pattern of lymph node involvement have been examined and their individual relevance to survival determined. Subdivision of Dukes' A cases into those confined to the muscularis mucosae (A) and those penetrating into, but not through, the bowel wall (B1) should be abandoned. Despite interrelationships between lymph node status, grade of tumour and vascular invasion, they all contribute prognostic information independent of each other. Apical lymph node involvement, more than four lymph nodes involved and extensive primary tumours with nodal involvement all carry a bad prognosis. Although interrelated each variable is individually relevant. However, subgroups of patients with Dukes' C tumours have an observed survival significantly better than expected. When few lymph nodes are involved or the primary tumour is confined to the bowel wall but lymph nodes are involved, the expectation of life is equivalent to Dukes' B.
Faecal incontinence after anal dilatation
Authors: Snooks S , Henry M M , Swash M
Published: March 2007

We have studied 10 patients with faecal incontinence occurring after anal dilatation. Abnormalities were found in the external anal sphincter in clinical and manometric tests in five patients and in single fibre EMG tests in four patients. Internal anal sphincter function was impaired in eight patients. These findings have implications for prevention of faecal incontinence after this procedure.
A prospective study of end-to-side vs. side-to-side arteriovenous fistulas for haemodialysis
Authors: Wedgwood K R , Wiggins P A , Guillou P J
Published: March 2007

In an attempt to determine the optimum configuration of arteriovenous (A–V) fistulas for haemodialysis, 71 patients were prospectively randomized to undergo either a side-to-side or end-of-vein to side-of-artery A–V fistula. Nine months after operation, the patency rates on dialysis were almost identical in the two groups (79.2 per cent and 78.6 per cent respectively). However, 7 of the 32 side-to-side fistulas developed hyperaemia of the hand, three of which required revisional surgery. Hyperaemia of the hand has not been seen with end-to-side fistulas. In addition, peroperative measurements of fistula flow appeared to have prognostic value with end-to-side but not with side-to-side fistulas. It is suggested that the end-to-side configuration is the one of choice for the formation of A–V fistulas for haemodialysis.
Randomized prospective trial of the Angelchik anti-reflux prosthesis
Authors: Gear M W L , Gillison E W , Dowling B L
Published: March 2007

Fifty-two patients with reflux oesophagitis resistant to medical treatment were randomized at operation to receive either the Angelchik prosthesis or a fundoplication. All patients were assessed postoperatively by a physician unaware of the nature of the operation. Forty-two patients have been followed up for 1–2 years; ten patients for 3–9 months. Ninety-six per cent of the Angelchik patients had satisfactory or excellent results compared with 81 per cent with a fundoplication. There were no failures to control reflux with the Angelchik prosthesis whereas 6 patients (23 per cent) of the fundoplication group have persisting reflux. Operating times for insertion of the prosthesis averaged a little over half that recorded for fundoplication. Complication rates were similar. The results of the trial encourage the use of the prosthesis in patients with gastro-oesophageal reflux, where medical treatment has failed. The prosthesis should not be used if the gut is opened during operation either inadvertently or deliberately, as in making a suture line or anastomosis, because of the risk of sepsis.
Pancreatic abscesses
Authors: Shi E C P , Yeo B W , Ham J M
Published: March 2007

This paper presents the clinical features and problems in the management of 34 patients with pancreatic abscesses. In the majority of patients the abscesses developed following an attack of pancreatitis due to alcohol or gallstones. The abscesses were usually multilocular, and often had spread widely in the retroperitoneal space. Invasion into surrounding viscera or the peritoneal cavity occurred in 12 instances, and eight patients developed major bleeding into the abscess cavity. Obstructive complications (affecting bowel, common bile duct and large veins) occurred in eight patients. Twelve of the 34 patients (35 per cent) died, most deaths being due to failure to control sepsis (seven patients) or to massive bleeding from the abscess cavity (three patients). The mortality of this condition is likely to remain high, but may be reduced by better drainage techniques at the initial exploration. The importance of the inframesocolic approach for drainage is emphasized.