bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asthma and protracted bronchitis: Who fares better during an acute respiratory infection?
Authors: Petsky Helen L , Acworth Jason P , Clark Ronald , Thearle Donna M , Masters Ian B , Chang Anne B 
Published: January 2009

Aim:  Acute respiratory infections (ARI) are common in children, and symptoms range from days to weeks. The aim of this study was to determine if children with asthma have more severe ARI episodes compared with children with protracted bronchitis and controls.Methods:  Parents prospectively scored their child's next ARI using the Canadian acute respiratory illness and flu scale (CARIFS) and a validated cough diary (on days 1–7, 10 and 14 of illness). Children were age‐ and season‐matched.Results:  On days 10 and 14 of illness, children with protracted bronchitis had significantly higher median CARIFS when compared with children with asthma and healthy controls. On day 14, the median CARIFS were: asthma = 4.1 (interquartile range (IQR) 4.0), protracted bronchitis = 19.6 (IQR 25.8) and controls = 4.1 (IQR 5.25). The median cough score was significantly different between groups on days 1, 7, 10 and 14 (P < 0.001). A significantly higher proportion of children with protracted bronchitis (63%) were still coughing at day 14 in comparison with children with asthma (24%) and healthy controls (26%).Conclusion:  Children with protracted bronchitis had the most severe ARI symptoms and higher percentage of respiratory morbidity at day 14 in comparison with children with asthma and healthy controls.
Macular polypoidal choroidal vasculopathy with a remote lesion
Authors: Tsujikawa Akitaka , Nakanishi Hideo , Ojima Yumiko , Iwama Daisuke , Tamura Hiroshi , Otani Atsushi , Yoshimura Nagahisa 
Published: January 2009

AbstractPurpose:  To report cases of the macular type of polypoidal choroidal vasculopathy with a remote lesion.Methods:  We report six patients (seven eyes) with polypoidal choroidal vasculopathy who had macular and remote lesions. These eyes were examined with angiography and tomography.Results:  All seven eyes showed an exudative macular lesion beneath the fovea. In addition, all eyes showed remote polypoidal lesions that were not connected to the macular lesions; the remote lesion was detected outside of the vascular arcade in five eyes, superotemporally beside the optic disc in one eye and on the nasal side of the optic disc in one eye. Indocyanine green angiography, fluorescein angiography and optical coherence tomography failed to reveal any sign of a branching vascular network or choroidal neovascularization that connected the macular lesion with the more remote lesion. At the initial visit, visual acuity in the seven eyes ranged from 6/150 to 6/9 (median, 6/15). Four eyes underwent photodynamic therapy to the exudative macular lesion. During 27.6 ± 14.3 months of follow up, no worsening was detected in any of the remote lesions. Median visual acuity was 6/60 at the final visit.Conclusions:  Some patients with macular polypoidal choroidal vasculopathy also have a remote lesion, although the remote lesion seems to have only a minor effect on visual outcome.
Changes of aqueous vascular endothelial growth factor and interleukin‐6 after intravitreal triamcinolone for branch retinal vein occlusion
Authors: Park Sung P , Ahn Jae K 
Published: January 2009

AbstractBackground:  To investigate sequential changes of aqueous vascular endothelial growth factor (VEGF) and interleukin (IL)‐6 in macular oedema secondary to branch retinal vein occlusion after single intravitreal injection of triamcinolone acetonide (IVTA).Methods:  We recruited 10 healthy controls and 30 patients at Chonnam National University Hospital, Gwangju, Korea. Aqueous and plasma levels of VEGF and IL‐6 were measured by enzyme‐linked immunosorbent assay at the time of IVTA and 3 months later. Non‐response to IVTA was defined as showing persistent macular oedema based on a reduction of central macular thickness by less than 20% from baseline measurements by optical coherence tomography and vision improvement by less than 0.3 logMAR. Fluorescein angiography was performed 6 months after IVTA. We compared aqueous levels of VEGF and IL‐6 between responders and non‐responders.Results:  The aqueous levels of VEGF and IL‐6 were significantly higher in 12 non‐responders than in 18 responders at baseline measurements (511 ± 245 pg/mL vs. 230 ± 108 pg/mL, P < 0.001; 38 ± 31 pg/mL vs. 16 ± 13 pg/mL, P < 0.001, respectively). Aqueous levels of VEGF were still higher in non‐responders (312 ± 64 pg/mL) 3 months after IVTA, and aqueous levels of VEGF in responders returned to normal (86 ± 21 pg/mL, P < 0.001). Aqueous levels of IL‐6 normalized in all patients 3 months after IVTA. Fluorescein angiography revealed that non‐responders showed higher frequencies of macular ischaemia and ischaemic branch retinal vein occlusion.Conclusions:  IL‐6‐independent VEGF secretion may contribute to persistent macular oedema associated with ischaemic BRVO after IVTA.
Lifestyle factors and colorectal cancer risk (1): systematic review and meta‐analysis of associations with body mass index
Authors: Harriss D. J. , Atkinson G. , George K. , Tim Cable N. , Reilly T. , Haboubi N. , Zwahlen M. , Egger M. , Renehan A. G. ,   the C‐CLEAR group
Published: January 2009

AbstractObjective  Excess body weight, defined by body mass index (BMI), may increase the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we undertook a systematic review and meta‐analysis of prospective observational studies to quantify colorectal cancer risk associated with increased BMI and explore for differences by gender, sub‐site and study characteristics.Method  We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. Random‐effects meta‐analyses and meta‐regressions of study‐specific incremental estimates were performed to determine the risk ratio (RR) and 95% confidence intervals (CIs) associated with a 5 kg/m2 increase in BMI.Results  We analysed 29 datasets from 28 articles, including 67 361 incident cases. Higher BMI was associated with colon (RR 1.24, 95% CIs: 1.20–1.28) and rectal (1.09, 1.05–1.14) cancers in men, and with colon cancer (1.09, 1.04–1.12) in women. Associations were stronger in men than in women for colon (P < 0.001) and rectal (P = 0.005) cancers. Associations were generally consistent across geographic populations. Study characteristics and adjustments accounted for only moderate variations of associations.Conclusion  Increasing BMI is associated with a modest increased risk of developing colon and rectal cancers, but this modest risk may translate to large attributable proportions in high‐prevalence obese populations. Inter‐gender differences point to potentially important mechanistic differences, which merit further research.
Lifestyle factors and colorectal cancer risk (2): a systematic review and meta‐analysis of associations with leisure‐time physical activity
Authors: Harriss D. J. , Atkinson G. , Batterham A. , George K. , Tim Cable N. , Reilly T. , Haboubi N. , Renehan A. G. ,   The Colorectal Cancer, Lifestyle, Exercise And Research Group
Published: January 2009

AbstractObjective Increased physical activity may decrease the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we performed a systematic review and meta‐analysis of prospective observational studies to quantify gender‐specific risk associated with increased leisure‐time physical activity (LT‐PA).Method We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. We used random‐effects meta‐analyses to estimate summary risk ratios (RR) and 95% confidence intervals (95% CI) for uppermost vs lowermost categories of physical activity. To investigate dose–response, we explored risks ratios as a function of cumulative percentiles of physical activity distribution.Results Fifteen datasets from 14 articles, including 7873 incident cases, were identified. For colon cancer, there were inverse associations with LT‐PA for men (RR: 0.80; 95% CI: 0.67–0.96) and women (0.86; 0.76–0.98). LT‐PA did not influence risk of rectal cancer. The dose–response analysis was consistent with linear pattern reductions in risk of colon cancer in both genders. There was evidence of moderate between‐study heterogeneity but summary estimates were broadly consistent across potential confounding factors.Conclusion Increased LT‐PA is associated with a modest reduction in colon but not rectal cancer risk; a risk reduction, which previously may have been overstated. LT‐PA only interventions in public health cancer prevention strategies are unlikely to impact substantially on colorectal cancer incidences.
The evolution of analgesia in an ‘accelerated’ recovery programme for resectional laparoscopic colorectal surgery with anastomosis
Authors: Zafar N. , Davies R. , Greenslade G. L. , Dixon A. R. 
Published: January 2009

AbstractObjective  The study set out to analyse the outcomes of an evolving accelerated recovery programme after laparoscopic colorectal resection (LCR).Method  The results of a prospective electronic database (March 2000 – April 2008) were analysed.Results  There were 353 consecutive patients undergoing ‘three port’ high anterior resection (AR) (237 without covering stoma) and 166 a right hemicolectomy (RHC). One hundred thirty‐eight had postoperative analgesia using paracetamol IV and oral analgesia (IVP); 27 (16.3%) received additional parenteral morphine and were excluded. Patient controlled morphine analgesia (PCA) was used in 138. Transversus abdominis plane (TAP) blocks, supplemented by IV paracetamol and oral analgesia were used in the last 50 patients.The time to the resumption of diet was significantly reduced with TAP analgesia (median 12 h) and IVP (median 12 h) compared with PCA median (36 h) (χ2 = 143; 4df: P < 0.001). The postoperative hospital stay was significantly reduced with TAP analgisia (median 2 days) and IVP (median 3 days) compared with PCA (median 5 days); χ2 = 73; 2df: P < 0.001. Seventeen (34%) TAP and nine (6.5%) IVP patients were discharged within 24 h of surgery compared with no patient in the PCA group. Ninety‐three per cent of PCA, 35% IVP and 10% TAP patients were discharged in more than 3 days. The movement towards ‘accelerated recovery’ was not associated with any increased risk of urinary retention, return to theatre, readmission and/or 30 day mortality.Conclusion  Laparoscopic surgery utilizing IV paracetamol and TAP blocks for postoperative analgesia aids safe effective ‘accelerated recovery’ in an unselected patient population undergoing right hemicolectomy and high anterior resection. Routine epidural anaesthesia is unnecessary for LCR. Morphine PCA is associated with delayed recovery.
Understanding the anatomy of lymphatic drainage and the use of blue‐dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues
Authors: Bell S. , Sasaki J. , Sinclair G. , Chapuis P. H. , Bokey E. L. 
Published: January 2009

AbstractObjective  This paper reviews the literature on the pathways of lymphatic drainage of the rectum and their significance in radical cancer surgery.Method  This paper reviews some of the seminal works on the lymphatic drainage of the rectum and its surgical implications when operating on patients with rectal cancer. Publications were searched via Medline, sourced from reference lists and by cross referencing with the most widely cited papers.Results  The classical European description of the anatomy of the lymphatic drainage of the rectum is presented. Early lymphatic mapping techniques and the role of newer technologies in lymphatic mapping, including sentinel lymph node mapping are discussed. The differing philosophies between Western practice, of dissection in the plane of the fascia propria and the Japanese wider pelvic lymphadenectomy are discussed.Conclusions  A clear understanding of the regional lymphatic drainage of the rectum and precise anatomical mobilisation of the rectum is the surgical cornerstone to excellent locoregional control of rectal cancer. The success of the differing Western and Japanese philosophies on the degree of pelvic lymphadenectomy suggests a possible role for ‘selective wide pelvic lymphadectomy’. Mapping lateral lymphatic drainage pathways could augment the selection process for radiotherapy.
The use of symptoms to predict colorectal cancer site. Can we reduce the pressure on our endoscopy services?
Authors: Kent A. J. , Woolf D. , McCue J. , Greenfield S. M. 
Published: January 2009

AbstractObjective  Our objective was to determine the value of gastrointestinal symptoms and signs in predicting the site of colorectal cancer (CRC). These symptoms can subsequently be used in determining first‐line investigation with either sigmoidoscopy or colonoscopy.Method  We interrogated the endoscopic and CRC databases (‘Infoflex’), for patients diagnosed with CRC between April 2005 and March 2006 inclusive. These patients were cross‐referenced with the pathology database and patient records. Information gathered from these databases include: age, gender, symptoms, site of cancer, histology, Duke’s grading, blood parameters, diagnostic tool and treatment.Results  One hundred fifty‐three patients were diagnosed with CRC between April 2005 and March 2006. One hundred twenty‐six were initially seen in the out‐patient department, of whom 38 (29%) were right‐sided (proximal to the splenic flexure), and 88 (70%) were left‐sided (splenic flexure and beyond). Change in bowel habit (diarrhoea and constipation) and rectal bleeding were significantly associated with left‐sided cancers (P < 0.0024 and P < 0.0001, respectively). Haemoglobin (P < 0.0001) and mean corpuscular volume (P < 0.0001) were significantly lower in right‐sided cancers. Weight loss, pain and obstruction were not associated with cancer site. C‐reactive protein, albumin and carcinoembryonic antigen are not predictive of cancer site, Duke’s stage or influenced by patient age or gender.Discussion  Symptoms can accurately predict site of cancer, allowing investigations to be tailored accordingly. We would recommend that patients with altered bowel habit and/or rectal bleeding, and no other symptoms, risk factors or anaemia, can be investigated with a flexible sigmoidoscopy to confirm or refute a diagnosis of colorectal cancer.
Multiple synchronous colonic anastomoses: are they safe?
Authors: Holubar S. D. , Wolff B. G. , Poola V. P. , Soop M. 
Published: January 2009

AbstractObjective  To evaluate short‐term outcomes after construction of synchronous colonic anastomoses without fecal diversion.Method  Using a prospective procedural database, all adult general surgery patients who underwent two synchronous segmental colon resections and anastomoses without ostomy at our institution from 1992–2007 were identified. Demographics, operative techniques, and 30‐day outcomes are reported. Results are number (percent) of patients or median (interquartile range).Results  Over 15 years, 69 patients underwent double colonic anastomoses [40 males, age 63 (45–76) years, BMI 25.3 (22.9–28.7) kg/m2]. Multiple colonic anastomoses were performed in one of every 201 colectomies during the study period (0.5%). The operation was an emergency in two (3%) cases; most cases were clean‐contaminated 56 (81%). Ten (17%) cases were laparoscopic‐assisted with a 44% conversion rate. Length of stay was seven (5–10) days. Overall 30‐day morbidity was 36% including nine (13%) surgical site infections, two (2.9%) intra‐abdominal abscesses requiring percutaneous drainage, and one (1.4%) wound dehiscence. There were no anastomotic leaks or fistulas, and two patients (2.9%) died within 30 days from pulmonary sepsis and complications from a distal anastomotic hemorrhage, respectively.Conclusions  Synchronous colon anastomoses without fecal diversion do not appear to be associated with an increased risk of complications and can be safely constructed in selected patients.
Combined surgery in pelvic organ prolapse is safe and effective
Authors: Riansuwan W. , Hull T. L. , Bast J. , Hammel J. P. 
Published: January 2009

AbstractObjective  In women, rectal prolapse is often accompanied by other signs of generalized pelvic floor weakness including uterine and bladder prolapse. The purpose of this study was to compare whether there are differences in outcomes of rectal prolapse surgery between women having combined pelvic organ prolapse (POP) surgery with a urologist or urogynecologist (CS) vs those having abdominal rectal prolapse surgery alone (RP).Method  Charts were reviewed to collect perioperative data on those having surgery from 1995 to 2001. Phone surveys were conducted to obtain Cleveland Clinic Foundation (CCF) Incontinence score, Knowles‐Eccersley‐Scott‐Symptom (KESS) Constipation Score, Short Form 36 (SF‐36) quality of life score and recurrence rate. Appropriate statistical analysis was performed.Results  Ninety‐four operations were performed (23 CS and 71 RP). Forty‐six (49%) could be contacted by phone. Mean follow‐up was similar in both groups (CS 4.1 vs RP 3.6 years; P = 0.796). There were no significant differences between both groups regarding age, American Society of Anesthesiology classification Score, complications, length of hospital stay, CCF Incontinence score, KESS Constipation Score, SF‐36 Score and recurrence rate of rectal prolapse. The operative time (CS 226 vs RP 122 min; P < 0.001) and blood loss (CS 377 vs RP 183 ml; P < 0.001) were significantly increased in the CS group.Conclusion  Combined surgery for POP is safe and effective when considering outcomes of rectal prolapse surgery. Therefore surgeons should not hesitate to address all pelvic floor issues during the same operation by working in partnership with the anterior pelvic floor colleagues.
Assessment of urodynamic and detrusor contractility variables in patients with overactive bladder syndrome treated with botulinum toxin‐A: is incomplete bladder emptying predictable?
Authors: Sahai Arun , Sangster Philippa , Kalsi Vinay , Khan Mohammad S. , Fowler Clare J. , Dasgupta Prokar 
Published: January 2009

OBJECTIVETo assess whether incomplete bladder emptying and the need for clean intermittent self‐catheterization (CISC) is predictable, by analysing urodynamic and detrusor contractility variables in patients treated with botulinum toxin‐A (BTX‐A) for refractory idiopathic detrusor overactivity (IDO).PATIENTS AND METHODSSixty‐seven patients (mean age 50.3) with IDO, from two centres, had bladder injections of 200 U BTX‐A. Patients with difficulty in emptying their bladder and/or persistent overactive bladder symptoms, with postvoid residual volumes (PVR) of >150 mL after treatment were started on CISC. Urodynamics were conducted at baseline, 4 and 12–16 weeks after injection with BTX‐A. Detrusor contractility was assessed using the projected isovolumetric pressure (PIP1) in women and bladder contractility index (BCI) in men.RESULTSThere were improvements in the mean maximum cystometric capacity, bladder compliance and maximum detrusor pressures during filling cystometry after BTX‐A injections. The PVR was significantly increased at 4 but not at 12 weeks. Nineteen patients required CISC and when compared with those not needing CISC their pretreatment maximum flow rate (15 vs 22 mL/s, P = 0.003), PIP1 (43 vs 58, P = 0.02) and BCI (113 vs 180, P = 0.001) were lower. Receiver operator characteristic curve analysis suggested that a PIP1 of ≤50 in women (sensitivity 0.83; specificity 0.70; area under the curve 0.822) and BCI ≤120 (sensitivity 0.7; specificity 0.79; area 0.879) might predict the need for CISC.CONCLUSIONThe maximum flow rate, PIP1 and BCI were significantly lower in patients who required CISC after BTX‐A treatment than in those who did not. A PIP1 of ≤50 in women and a BCI of ≤120 might be predictive of a need for CISC in this setting, and might help when counselling patients.
Radiotherapy to bone metastases from renal cell carcinoma with or without zoledronate
Authors: Kijima Toshiki , Fujii Yasuhisa , Suyama Taisuke , Okubo Yuhei , Yamamoto Shinya , Masuda Hitoshi , Yonese Junji , Fukui Iwao 
Published: January 2009

OBJECTIVETo investigate the rate of objective response and the skeletal‐related event (SRE)‐free survival after combined therapy with radiotherapy (RT) and zoledronate in patients with bone metastases from renal cell carcinoma (RCC).PATIENTS AND METHODSIn all, 23 patients with RCC metastatic to bone were included in this retrospective study, of whom 13 had RT to bone metastases with no bisphosphonate therapy between 2000 and 2006, while the remaining 10 had combined therapy with RT and zoledronate (RT + Z) in 2006 and 2007. Significant calcifications of osteolytic metastases and/or shrinkage of bone lesions, as measured by computed tomography, were defined as a partial response. SREs were defined as any of pathological fracture, spinal cord compression, bone surgery, or additional RT to the bone.RESULTSIn the RT + Z group, six patients had a partial response, showing evidence of calcification of their osteolytic bone metastases, while in the RT group, only one patient did (P = 0.019). One patient in the RT + Z group had an SRE, while 10 in the RT group had SREs (P = 0.003). The median SRE‐free survival time was not reached in the RT + Z group, but in the RT group it was 18.7 months (P = 0.046).CONCLUSIONCombined therapy as RT + Z achieved a higher objective response rate (six of 10) and prolonged SRE‐free survival than RT alone in patients with bone metastases from RCC.
Lymphangiogenesis occurs in upper tract urothelial carcinoma and correlates with lymphatic tumour dissemination and poor prognosis
Authors: Bolenz Christian , Fernández Mario I. , Trojan Lutz , Hoffmann Katja , Herrmann Edwin , Steidler Annette , Weiss Christel , Ströbel Philipp , Alken Peter , Michel Maurice Stephan 
Published: January 2009

OBJECTIVETo describe the lymphatic vessel density and to determine the functional and prognostic significance of tumoral lymphatic vessels in upper tract urothelial carcinoma (UTUC).PATIENTS AND METHODSThe study included 65 patients who had a radical nephroureterectomy (RNU) for UTUC between 1997 and 2004. All pathological slides were re‐evaluated by one reference pathologist and clinical data were reviewed. Lymphatic endothelial cells (LECs) were stained immunohistochemically using D2‐40. The lymphatic vessel density (LVD) was described in representative intratumoral (ITLVD), peritumoral (PTLVD) and non‐tumoral (NTLVD) areas. Random samples were selected for double‐immunostaining with D2‐40 and CD‐34 (to distinguish blood and lymphatic vessels) and the proliferation marker Ki‐67 to detect lymphangiogenesis. The primary outcome measures were disease‐specific survival (DSS) and disease recurrence (urothelial and/or distant).RESULTSThe median (interquartile range) PTLVD was 4.0 (3.0–6.3), and significantly higher than that for ITLVD, of 0.3 (0–1.7) (P < 0.001), and NTLVD, of 3 (2.0–3.7) (P < 0.001). Both a higher ITLVD and PTLVD, the presence of lymphovascular invasion (LVI) (each P < 0.001) and a high tumour grade (P = 0.004) were associated with reduced DSS on univariate analysis. A higher PTLVD (P = 0.028) and the presence of LVI (P = 0.020) independently predicted reduced DSS on multivariate analysis. IT and PT lymphatic vessels showed proliferating LECs in all analysed samples.CONCLUSIONLymphangiogenesis is present in UTUC, as shown by a significantly increased PTLVD and proliferating LECs. Our findings suggest functional relevance of PT lymphatic vessels during lymphatic tumour spread. PTLVD is a potential novel prognostic factor for DSS in UTUC, and further prospective studies will be needed to determine the effect of its routine evaluation on clinical outcomes of this malignancy.