bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost analysis of transanal endoscopic microsurgery for rectal tumours
Authors: Maslekar S. , Pillinger S. H. , Sharma A. , Taylor A. , Monson J. R. T. 
Published: January 2007

AbstractObjective  Transanal endoscopic microsurgery (TEM) is considered to be a safe and effective treatment for selected rectal neoplasms. We demonstrate that in addition to the recognized clinical benefits of the less invasive TEM approach, there are substantial economic benefits.Method  We reviewed our prospective database of patients undergoing TEM excision of a rectal lesion between July 1997 and December 2003. A cost analysis was undertaken, including procedural and related costs of TEM and compared with the relevant open procedures.Results  124 patients (80 men, 44 women) with a median age of 71.5 years underwent TEM excision of rectal lesions (52 cancers and 72 adenomas). The morbidity rate was 8% and mortality was zero. A controlled case series of 52 patients undergoing open resection for early rectal cancers with similar characteristics as above was compared in terms of clinical outcome. The morbidity rate in these patients was 29.5%. The cost analysis comparison was undertaken using National Health Service mean reference costs for major large intestinal surgery, Intensive care unit/high dependency unit and hospital accommodation for each procedure. The average cost of open resection was £4135, vs£567 for TEM excision. Our total saving over the series was £525 576. Although the initial capital cost of the TEM equipment is high at approximately £40 000 given the massive cost savings, these initial equipment costs are recovered within a rapid time frame.Conclusion  This study has shown that TEM is a safe and extremely cost‐effective approach for excision of selected rectal tumours including rectal adenomas and early well differentiated rectal cancers (pTis & pT1).
Intermediate sized adenomas may represent an increased cancer risk
Authors: Pearson T. E. , Lewis G. , Bugg W. , Bright P. , Lillie J. , Marks C. 
Published: January 2007

Objective:  The purpose of colonoscopic polypectomy is cancer prevention. Multiple or large adenomas require intensive follow up but solitary or smaller lesions are considered safer and less frequent examinations are necessary. The aim of this study was to test if these principles are supported in practice.Method:  Individuals with polyps but no family history of CRC, where pathology and endoscopy reports could be cross‐referenced to confirm size, number and histological classification were included. Cases of colorectal cancer were identified from records of repeat examinations. Follow up interval and number of subsequent examinations was determined. A control population of individuals with a normal initial colonoscopy were also studied.Results:  In total 0.05% of individuals with a normal initial colonoscopy developed CRC. The cancer incidence following numerous or large polyps was not significantly higher than the controls although on average more examinations were performed (see table). Individuals with a single small adenoma did not appear to have increased risk of cancer with fewer colonoscopies, but there were significantly higher numbers of cancers where intermediate sized polyps had been identified.

First Exam result
Number
Follow up (months)
Number of exams
Metachronous cancers

Normal
4935
88.7 (1–201)
1.2
24 (0.05%)

Single (<5 mm)
74
64.3 (7–148)
1.3
1 (1.4%)
χ2 = 1.1 P = 0.29

Between 5 mm and 10 mm
73
73.4 (6–165)
1.5
3 (4.1%)
χ2 = 17.61 P < 0.0001

More than 3
27
68.1 (6–152)
2.5
0 (0%)
χ2 = 0.13 P = 0.72

Larger than 10 mm
114
73.7 (3–170)
2.9
1 (0.9%)
χ2 = 0.35 P = 0.56

Conclusion:  Risk of cancer is reduced in large or numerous polyps by frequent examinations. Intermediate sized polyps appear to need more intensive follow‐up protocols than small single adenomas for effective cancer prevention.
Magnetic resonance imaging predicts circumferential resection margin status in patients receiving preoperative chemoradiotherapy for rectal cancer
Authors: Hancock L. , Forde C. , Bradbury J. , Mortensen N. , Gleeson F. 
Published: January 2007

Objective:  Accurate tumour re‐assessment after down‐sizing preoperative chemoradiotherapy (CRT) for locally advanced middle and lower rectal cancer provides valuable prognostic information prior to surgical resection. We assessed the accuracy of post‐CRT magnetic resonance imaging (MRI) in predicting circumferential resection margin status. The accuracy of MRI in staging chemoradiation down‐sized rectal tumours was also assessed.Method:  Patients from a single tertiary referral centre who received preoperative CRT for biopsy‐proven rectal cancer between January 2003 and February 2005 were identified from a database. All patients received long‐course CRT (50Gy over 5 weeks and five‐fluorouracil/leucovorin) prior to surgery. A comprehensive MRI reporting proforma was completed for each patient and results were compared directly with histological specimens.Results:  A total of 50 patients were eligible for the study. The overall accuracy for predicting circumferential resection margin status was 76% (38/50, P = 0.006, sensitivity = 96.9%, specificity = 73.8%, negative predictive value = 96.9%). For T staging MRI was accurate in 52% (26/50) and for nodal staging MRI was correct in 60% (30/50). Venous invasion was predicted in 66% (33/50, P = 0.04). A radiological rectal cancer regression grade was derived and this correlated with histological rectal cancer regression grade in 65% (32/49).Conclusion:  This study demonstrates that post‐CRT MRI is accurate in predicting the circumferential resection margin status which provides useful prognostic information prior to surgery.
Acute diverticulitis – clinical presentation and differential diagnostics
Authors: Laurell H. , Hansson L.‐E. , Gunnarsson U. 
Published: January 2007

AbstractObjective  To describe the clinical presentation of acute diverticulitis in an emergency department and to characterize the natural history of diverticulitis in the short perspective. Comparisons are made with an important differential diagnosis, nonspecific abdominal pain (NSAP).Method  Patients admitted to our hospital with abdominal pain of up to 7 days’ duration were registered prospectively using a detailed schedule for history, symptoms and signs, from 1 February 1997 to 1 June 2000. Of 3349 patients initially included, 3073 (92%) were eligible for follow up after 1–3 years.Results  Acute diverticulitis was the final diagnosis in 145 patients and NSAP in 1142 patients. The incidence of hospitalized patients with diverticulitis was 47 per year and 100 000 population, with a mean hospital stay of 3.3 days. Patients with diverticulitis, more frequently than NSAP, had a longer history and laboratory signs of inflammatory activity. Isolated left abdominal tenderness was more common in diverticulitis, whereas isolated right abdominal tenderness was more common in NSAP. Duration of symptoms on arrival was independent of age and was not correlated to C‐reactive protein, leucocytes or body temperature. Sensitivity of diverticulitis as primary diagnosis was 64% and specificity 97%. Corresponding figures for NSAP were 43% and 90% respectively. Age and gender did not influence diagnostic accuracy or risk of surgery.Conclusion  Diverticulitis differs significantly from NSAP in clinical presentation and laboratory parameters. Sensitivity of primary diagnosis for diverticulitis and NSAP was low.
Long‐term results of perianal silicone injection for faecal incontinence
Authors: Maeda Y. , Vaizey C. J. , Kamm M. A. 
Published: January 2007

AbstractObjective  Perianal injection of bulking agents is a simple method for treating passive faecal incontinence. To date only short‐term results of treatment are available. This study is the first to determine the efficacy of silicone biomaterial (PTQTM; Uroplasty BV, Geleen, The Netherlands) injection in the long term.Method  Six patients, median age 53 years at the time of injection with PTQ, were followed up at 61 months. A validated faecal incontinence score, treatment‐specific questionnaire and SF‐36 health survey questionnaire were completed.Results  At 61‐month follow up one patient had undergone a colostomy for faecal incontinence. In the remaining five patients the incontinence score was little changed: 11 (8–20) vs 13 (9–19) [pre v at 61 months, median (range)]. However, there was a substantial improvement in physical and social function on the SF‐36 scores. Satisfaction scores were high at a median 7 of 10 (range: 0–8). Subjectively, three patients were improved; one of these had undergone a further set of injections and one improved after a course of biofeedback. After the follow‐up period one of the five patients had a colostomy for recto‐vaginal fistula.Conclusion  The results of perianal injection of PTQ for passive faecal incontinence are variable in the long term. More extensive evaluation in the short term, and possibly repeated treatment, may be required.
A comparison of quality of life and postoperative results from combined PPH and conventional haemorrhoidectomy in different cases of haemorrhoidal disease
Authors: Martinsons A. , Narbuts Z. , Brunenieks I. , Pavars M. , Lebedkovs S. , Gardovskis J. 
Published: January 2007

AbstractObjective  To compare the early postoperative results and late patient‐related postoperative results by a Short‐Form 36 quality of life survey after conventional haemorrhoidectomy and PPH procedure with additional surgical intervention in noncomplicated, complicated and delayed cases of the disease.Method  The comparison was made between comparable patient groups after conventional haemorrhoidectomy (n = 168) and after PPH with additional surgical intervention (n = 142). The early and late postoperative results and quality of life analysis according to SF‐36® questionnaire were compared.Results  The length of procedure was significantly shorter after the PPH procedure (37.4 vs 49.4 min). The amount of postoperative nonopiate analgesics was similar, but consumption of opiates was more in the conventional group. The rate of early postoperative complications was similar. In the PPH group significant improvement in all quality of life parameters was ascertained 6 months after operation, but 6 weeks after surgery several parameters in this group were lower. In the conventional group improvement was ascertained only for several parameters. The significant improvement of quality of life after PPH operations was ascertained especially at a mean period of 6 weeks.Conclusion  The PPH procedure performed in complex cases of the disease and combined with other surgical intervention because of the anorectal comorbidity assures better early postoperative results and better postoperative quality of life in a 6‐month follow up in comparison with conventional haemorrhoidectomy. The continuation of quality of life studies with a longer follow up is required concerning Longo operation.
Long‐term outcome in 445 patients after diagnosis of diverticular disease
Authors: Moreno A. M. , Wille‐Jørgensen P. 
Published: January 2007

AbstractObjective  To describe the long‐term outcome after primary diagnosis of diverticular disease (DD) with respect to demographics, lifestyle, severity of disease and primary treatment.Method  Retrospective cohort study of all 445 consecutive patients admitted to the department during 1989–1995 with the diagnosis DD with prospective follow up. Follow up was performed on all patients during May 2002 by searching the Danish Patient Register and National Register. Logistic regression analyses were applied for defining risk factors for readmission or death. For defined risk factors Kaplan–Meier survival statistics was performed.Results  The male/female ratio was 30/70. Median age was 75 years (men being younger than women, P < 0.01). About 73% received conservative treatment primarily. At follow up 35.3% had suffered clinical recurrence of DD, of these 15.9% were subsequently operated. However, 3.6% of the patients died of causes related to diverticulitis. Possible high‐risk groups for recurrence were males and their age above 70 years.Conclusion  Age and sex are possible predictors for recurrence of DD. Elective surgery seems not to be justified after just one attack of DD.
l‐Alanin‐l‐glutamine supplementation improves the outcome after colorectal surgery for cancer
Authors: Oguz M. , Kerem M. , Bedirli A. , Mentes B. B. , Sakrak O. , Salman B. , Bostanci H. 
Published: January 2007

AbstractObjective  To investigate the effect of l‐alanine‐l‐glutamine (Gln) on postoperative complication rate and duration of hospitalization in patients operated for colorectal cancer.Method  A total of 109 patients operated with the diagnosis of colorectal cancer and given enteral nutrition between January 2001 and January 2005 were prospectively analysed. The patients were randomized and analysed in two groups; Gln group (n = 57): patients were given parenteral Gln (1 g/kg/day, Dipeptiven, Fresenuis Kabi, Germany) together with enteral nutrition (Ensure; Abbott, Zwolle, The Netherlands) and the control group (n = 52) only received enteral nutrition (Ensure; Abbott), which was a standard isonitrogenous and isocaloric formula. The supplemental enteral nutrition was provided for at least 5 days pre‐ and postoperatively according to the nutritional status of the patients. Age, gender, subjective global assessment (SGA), body mass index (BMI), serum albumin, protein, associated disorders, localization of pathology, techniques of anastomosis, postoperative complications and length of hospital stay were analysed for each patient.Results  The duration of nutritional support in the Gln group was 6 ± 2 and 5 ± 1 days pre‐ and postoperatively; while it was 7 ± 1 and 6 ± 1 days for the control group, and there were no significant difference among the groups (P > 0.05). Age, gender, SGA, BMI, levels of serum albumin and protein, localization of pathology and techniques of anastomosis were also similar (P > 0.05). Wound infection (P = 0.038), intraabdominal abcess formation (P = 0.044) and wound dehiscence (P = 0.044) were significantly higher in the control group than in the Gln group. There was no significant difference in terms of anastomotic leakage and other complications between both groups (P > 0.05). Hospital stay was significantly shorter in the Gln group (P < 0.001).Conclusion  Supplementation of parenteral Gln decreased the postoperative complications and hospital stay and in the patients undergoing the colorectal surgery for cancer.
The proportion of cores with high‐grade prostatic intraepithelial neoplasia on extended‐pattern needle biopsy is significantly associated with prostate cancer on site‐directed repeat biopsy
Authors: Akhavan Ardavan , Keith Jonathan D. , Bastacky Sheldon I. , Cai Chao , Wang Yun , Nelson Joel B. 
Published: January 2007

OBJECTIVETo determine whether the predictive value of isolated high‐grade prostatic intraepithelial neoplasia (HGPIN) for an unsampled prostate cancer on an extended biopsy is lower due to more thorough prostate sampling, and whether the proportion of cores with HGPIN is associated with prostate cancer, as isolated HGPIN on sextant prostate biopsy is associated with a 27–57% risk of prostate cancer on repeat biopsy.PATIENTS AND METHODSAll extended prostate biopsies taken by one urologist over 6 years were reviewed for patients with isolated HGPIN on initial biopsy. Biopsies were evaluated for histological features and the proportion of cores with HGPIN. The clinical characteristics and pathological findings from subsequent biopsies were determined.RESULTSOf 577 men having extended biopsies, 48 had isolated HGPIN, followed by one to four site‐directed repeat biopsies. Although only 10 (21%) had cancer on the first repeat biopsy, overall 15 (31%) had cancer. Those with cancer on repeat biopsy had a significantly higher proportion of cores with HGPIN, i.e. 29% vs 15%, cancer vs no cancer, respectively (P = 0.04).CONCLUSIONSIsolated HGPIN on extended biopsy conferred a 31% risk of unsampled prostate cancer. The proportion of cores with HGPIN on initial biopsy was significantly associated with the risk of cancer. The same was not true for age, race, prostate‐specific antigen level, or the findings on digital rectal examination. The significant association between the proportion of cores with HGPIN and the risk of cancer suggests that patients with unifocal HGPIN on extended biopsy be managed expectantly, whereas those with multifocal HGPIN be re‐biopsied.
Payout Policy Pedagogy: What Matters and Why
Authors: DeAngelo Harry , DeAngelo Linda 
Published: January 2007

Abstract This paper argues that we should abandon

MM (1961)

irrelevance as the foundation for teaching payout policy, and instead emphasise the need to distribute the full value generated by investment policy (‘full payout’). Because MM's assumptions restrict payouts to an optimum, their irrelevance theorem does not provide the appropriate prescription for managerial behaviour. A simple example clarifies why the correct prescription is ‘full payout’, and why both payout and investment policy matter even absent agency costs (

DeAngelo and DeAngelo, 2006

). A simple life‐cycle generalisation explains the main stylised facts about the payout policies of US and European firms.
Capital Cash Flows, APV and Valuation
Authors: Booth Laurence 
Published: January 2007

Abstract This paper examines three different methods of valuing companies and projects: the adjusted present value (APV), capital cash flows (CCF) and weighted average cost of capital (WACC) methods. It develops the appropriate WACC and beta leveraging formulae appropriate for each valuation model, so that given a particular valuation model the correct APV and CCF values can be determined from the WACC value and vice versa. Further it goes on to show when the perpetuity formulae give poor estimates of the value of individual cash flows, even though the overall values are correct. The paper cautions that the APV and CCF models require more information than is currently known, such as the value of the corporate use of debt, and consequently can give misleading results, particularly in sensitivity analyses.
The Validity of the Economic Value Added Approach: an Empirical Application
Authors: Kyriazis Dimitris , Anastassis Christos 
Published: January 2007

Abstract This study investigates the relative explanatory power of the Economic Value Added (EVA) model with respect to stock returns and firms' market value, compared to established accounting variables (e.g. net income, operating income), in the context of a small European developing market, namely the Athens Stock Exchange, in its first market‐wide application of the EVA measure. Relative information content tests reveal that net and operating income appear to be more value relevant than EVA. Additionally, incremental information tests suggest that EVA unique components add only marginally to the information content of accounting profit. Moreover, EVA does not appear to have a stronger correlation with firms' Market Value Added than the other variables, suggesting that – for our Greek dataset – EVA, even though useful as a performance evaluation tool, need not necessarily be more correlated with shareholder's value than established accounting variables.
Measuring Value‐at‐Risk in Project Finance Transactions
Authors: Gatti Stefano , Rigamonti Alvaro , Saita Francesco , Senati Mauro 
Published: January 2007

Abstract Despite the remarkable importance of project finance in international financial markets, no quantitative models to measure and quantify the risk associated with a deal for the project's lenders have been developed yet. The topic has recently become crucial, since the New Basle Capital Accord gives banks a choice of whether to adopt simpler (but possibly higher) standard capital requirements or to develop internal rating models for project finance transactions. The paper proposes how Monte Carlo simulations may be used to derive a Value‐at‐Risk estimate for project finance deals and discusses the critical issues that must be considered when developing such a model.
Dynamics of immediate early gene and neuropeptide gene response to prolonged immobilization stress: evidence against a critical role of the termination of exposure to the stressor
Authors: Trnečková Lenka , Rotllant David , Klenerová Věra , Hynie Sixtus , Armario Antonio 
Published: January 2007

AbstractStress‐induced expression of immediate early genes (IEGs) appears to be transient even if the exposure to the stressor persists. However, there are some exceptions which suggest that particular characteristics of stressors can affect the dynamics of IEG expression. We studied in selected telencephalic, diencephalic and brainstem regions the mRNA levels of two clearly distinct IEGs (c‐fos and arc) during prolonged exposure to a severe stressor such as immobilization (IMO) and after releasing the rats from the situation. Although regional differences were observed with the two IEGs, overall, c‐fos mRNA levels progressively declined over the course of 4 h of continuous exposure to IMO, whereas arc mRNA levels were maintained at high levels in the brain regions that express this gene under stress (telencephalon). Levels of CRF hnRNA in the hypothalamus paraventricular nucleus only slightly declined during prolonged exposure to IMO. Surprisingly, termination of exposure to IMO did not modify CRF gene expression in the paraventricular nucleus or the pattern of IEGs expression, with the exception of c‐fos in the lateral septum. Thus, putative signals associated to the termination of exposure to IMO were unable to modify either IEG expression in most brain areas or CRF gene expression in the paraventricular nucleus.
Dopaminergic toxicity associated with oral exposure to the herbicide atrazine in juvenile male C57BL/6 mice
Authors: Coban A. , Filipov N. M. 
Published: January 2007

AbstractThe herbicide atrazine (ATR) is a very commonly used pesticide in the United States. and a major ground water contaminant. It has also been recently implicated as a potential basal ganglia toxicant. In the present study, our objective was to determine the effects of ATR exposure on striatal neurochemistry, on the number of dopaminergic neurons in the substantia nigra pars compacta (SNpc), and, as a reference, in the ventral tegmental area (VTA) of male juvenile C57BL/6 mice. Oral exposure to ATR for 14 days dose‐dependently decreased the levels of dopamine (DA) and its metabolites in the striatum for up to a week post‐treatment. ATR exposure also time‐ and dose‐dependently decreased the number of tyrosine hydroxylase‐positive (TH+) dopaminergic neurons in both SNpc and VTA (with effects being slightly more prominent in SNpc), such that the decreases were most evident at 7 weeks post‐cessation of exposure to ATR. Together, these data indicate that, in the juvenile male C57BL/6 mouse, the neurotoxic effects of ATR appear to cause transient neurochemical alterations, whereas the loss of TH+ neurons appears to be persistent, possibly confined to basal ganglia dopaminergic neurons, but not exclusive to the SNpc.