bluuebunny/crossref_metadata_2025_split huggingface dataset:
Micrometastasis in regional lymph nodes of extirpated colorectal carcinoma: immunohistochemical study using anti‐cytokeratin antibodies AE1/AE3
Authors: Palma R. T. , Waisberg J. , Bromberg S. H. , Simão A. B. , Godoy A. C. 
Published: December 2004

AbstractObjective The main objectives of this study were to identify, by immunohistochemistry, possible micrometastasis in the regional lymph nodes previously considered free by conventional histopathological examination, and to assess their influence on the survival of patients with colorectal cancer that had been extirpated in a radical manner.Patients and methods From 38 patients with Dukes B staging (Colorectal Carcinoma Stage II (T3 N0 M0 or T4 N0 M0)) colorectal carcinoma, 383 lymph nodes were studied in paraffin blocks that had previously been considered free by conventional histopathological examination. These were submitted to immunohistochemical study using AE1/AE3 anti‐cytokeratin monoclonal antibodies to identify neoplastic epithelial cells.Results Seven lymph nodes (1.82%) in six patients (15.78%) contained micrometastasis. The survival of the patients with extirpated colorectal carcinoma staged as Dukes B who had lymph node metastasis was less than in the group of patients without micrometastasis, although these values were not statistically significant.Conclusion This immunohistochemical method can be employed successfully in the detection of neoplastic cells in lymph nodes previously considered free. In this study, there was a trend towards lower survival in node‐positive patients but this did not reach statistical significance.
Does the need to self‐digitate or the presence of a large or nonemptying rectocoele on proctography influence the outcome of transanal rectocoele repair?
Authors: Stojkovic S. G. , Balfour L. , Burke D. , Finan P. J. , Sagar P. M. 
Published: December 2004

AbstractIntroduction Transanal repair of anterior rectocoele is a well described technique with variable success rate. In our department we offer repair to patients who fit the following criteria; the need to self digitate (transvaginal or perineal); a large rectocoele; a nonemptying rectocoele. Using these selection criteria previous authors have shown excellent results. The aim of our study was to review our results using this selective approach and also to determine whether the need to self digitate, the presence of a large rectocoele and the degree of emptying could predict which patients would achieve a successful result.Methods Fifty‐five patients underwent repair over a three‐year period. The main presenting symptom was noted for each patient and also whether self‐digitation was required in order to achieve successful evacuation. Dynamic evacuation proctography was performed on all patients. Size of rectocoele, percentage of paste expelled and other proctographic abnormalities were noted for each patient. Follow up was at 6 weeks and 6 months at which point patients were asked whether their symptoms had resolved, improved, remained the same or had worsened.Results Complete data were available for 48 of the patients (median age 52 years, IQR 43–63). The presenting complaint was constipation in 22 patients, obstructive defeacation in 15, incomplete evacuation in 5, postdefaecation soiling in 4 and dyspareunia in 2. Thirty‐eight patients noted the need to self‐digitate, 10 did not. Proctography revealed a large rectocoele (> 4 cm) in 22 patients and a medium or small rectocoele (< 4 cm) in 26 patients. There was a rectocoele alone in 34 patients, in combination with perineal descent in 11 and with intussusception in 3. Median percentage of paste expelled was 70% (range 20–95).At 6 weeks postoperatively, 43 patients had complete resolution of their symptoms whilst 5 reported only some or no improvement. At 6 months, 37 patients sustained complete resolution of their symptoms and 11 did not. Pre‐operative factors were compared for these two groups of patients. There was no difference in age (P > 0.05, Mann–Whitney U‐test) between the two groups There was also no difference in size of rectocoele, degree of emptying, the presence of another proctographic abnormality and the need to self‐digitate between the two groups (P > 0.05, Fisher's exact test).Discussion No factors were seen to distinguish between the successful and unsuccessful groups of patients following rectocoele repair, however, an overall success rate of 75% was achieved using our selection criteria. This figure is in keeping with reported success rates in the literature.
Neoadjuvant antiangiogenic therapy with tamoxifen does not impair gastrointestinal anastomotic repair in the rat
Authors: McNamara D. A. , Walsh T. N. , Kay E. , Bouchier‐Hayes David J. 
Published: December 2004

AbstractIntroduction  Antiangiogenic therapy has the potential to moderate tumour and micrometastatic growth. Its use in the perioperative period is attractive but its potential to compromise wound and anastomotic healing is a cause for concern. Tamoxifen is antiangiogenic but also favourably modifies some aspects of wound healing. We hypothesised that tamoxifen would not adversely affect skin wound and gut anastomotic healing.Methods  A previously established model of tamoxifen, administered orally at antiangiogenic doses (20 mg/ml arachais oil/day), was used. Animals received two days pretreatment prior to laparotomy and small bowel anastomosis. Treatment was continued until completion of the study. The principal outcome measures are survival, macroscopic wound and anastomotic healing, anastomotic bursting pressure and PVA sponge granuloma hydroxyproline (OHP) content.Results  Tamoxifen treated animals had fewer complications of skin wound healing than controls (4.5%vs. 19.5%; χ2 4.65, 1 d.f., P < 0.05). There was no significant difference in adhesion formation or macroscopic complications of anastomotic healing. Anastomotic bursting pressure was greater in tamoxifen treated animals at postoperative day 3 (39 ± 4.4 vs. 22.5 ± 3.5 mmHg; P < 0.01) and equal to that of controls on postoperative day 5 (144.4 ± 9.4 vs. 127.3 ± 10.9 mmHg; P = ns). Tamoxifen treated animals weighed significantly less than placebo controls from postoperative day 3 with no difference in mortality between groups (χ2 = 0.06, 1df, P = ns). PVA sponge granuloma OHP content on day 7 was higher in tamoxifen‐treated animals (2.93 ± 0.4 vs. 1.4 ± 0.4 mg OHP/mg dry sponge weight; P = 0.03).Conclusion  Antiangiogenic therapy with tamoxifen has no demonstrable adverse effects on wound or anastomotic repair and its perioperative use is compatible with successful early surgical outcomes.
Quality of life before and after proctocolectomy and IPAA in patients with ulcerative proctocolitis – a prospective study
Authors: Berndtsson I. , Öresland T. 
Published: December 2004

AbstractObjective  The principal aim of the present investigation was to study the general QoL and disease‐specific adjustment before, and one‐year after, operation with an ileal pouch anal‐anastomosis (IPAA) in a consecutive series of patients with ulcerative colitis (UC).Patients and method  Eleven patients were medically treated and 31 patients underwent colectomy with ileostomy. The patients were interviewed before the IPAA operation and again one‐year after closure of the covering loop ileostomy. General quality of life was estimated with a Swedish instrument (according to Kajandi, score range 16–96) and a VA‐scale. The instrument for disease‐specific adjustment contained specific questions with five factors (score range 34–204). Open questions about quality of life were used to identify areas of concern, which were not included in the other instruments. Postoperative function was described in terms of a functional score (score range 0–15).Results  The results of the general quality of life assessments did not differ significantly when comparing pre‐operative to postoperative values. Disease‐specific adjustment showed that the medically treated patients had a score of 162; interquartile range (IQR) 145–176. The patients with ileostomy scored 164; IQR 141–180. Postoperatively there was a statistically significant improvement in both groups to 189 (IQR 172–199), an increase of 15%. The open questions revealed restrictions in daily life for both patient groups pre‐operatively with improvements after IPAA. The median grading of functional outcome according to the score system was 2. The most frequent problems were: patients who had occasional bowel movements at night, 40%; intermittent perianal soreness, 51%; antidiarrhoeal medication use, 61%.Conclusion  General QoL did not change after IPAA. The bowel‐specific adjustment in most factors improved in the majority of patients after IPAA. However, half of the IPAA patients had occasional bowel movements at night perianal soreness, and used antidiarrhoeal medication.
Surgery for carcinoid tumours of the lower gastrointestinal tract
Authors: Goede A. C. , Winslet M. C. 
Published: December 2004

AbstractIntroduction  Carcinoid tumours are rare neoplasms that originate from neuroendocrine cells of the primitive gastrointestinal tract. Mid‐ and hind‐gut tumours comprise the majority of these rare tumours. With many recent advances in medical treatment the role and importance of surgery and the surgeon needs to be assessed.Method  A Medline, Pubmed and Embase databases search was undertaken. All relevant articles were cross‐referenced.Results and conclusions  Incidental findings of carcinoid tumours should be treated at initial surgery whilst elective surgery and further management should be undertaken in specialist centres by a multidisciplinary team. Asymptomatic patients have a better prognosis than those with symptoms. In advanced cases surgery combined with chemotherapy and liver resection is appropriate. The outlook for the majority of cases is good.
Results following conservative lateral sphincteromy for the treatment of chronic anal fissures
Authors: Garcea G. , Sutton C. , Mansoori S. , Lloyd T. , Thomas M. 
Published: December 2004

AbstractIntroduction  Lateral sphincterotomy is now the standard surgical treatment for fissure‐in‐ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate.Materials and methods  A total of 65 patients undergoing conservative lateral sphincterotomy under a single operator between January 1996 and January 2002 were reviewed. Specific questions were asked regarding overall success of the operation, leakage of fluid, faeces or flatus and recurrence of fissure symptoms. Supplemental data was obtained from a retrospective analysis of the patients' case notes to ascertain demographics, length of hospital stay and complication rate.Results  Sixty of 65 patients responded to our postal questionnaire. The male to female ratio was 1 : 1 and the mean age 40.3 years of age. No complications were recorded and 97% of patients had achieved fissure healing by the time of their out‐patient follow‐up (mean 6.9 weeks). Two patients reported new incontinence following their procedure; one patient experienced incontinence of fluid and flatus (1.7%) and the remaining patient complained of incontinence to flatus only. No patients experienced incontinence of faeces. Eleven patients experienced persistent symptoms of pain and bleeding but only 6 of these patients required treatment from their general practitioner which consisted of stool softeners and topical analgesia. No patients required re‐operation.Conclusion  A conservative division of the internal anal sphincter results in adequate fissure healing and a much lower incontinence rate than that previously recorded in the literature for more traditional divisions of the internal anal sphincter.
Screening the average risk population for colorectal cancer: the Israeli experience 1985–97
Authors: Niv Yaron 
Published: December 2004

AbstractIntroduction  Five prospective, controlled trials of CRC screening, 4 of them randomized, using the Hemoccult test in large populations, have been reported from Europe and USA. In all the series stage shifting was documented, and mortality from CRC was reduced by 12–33%. In comparison with this large experience, the Israeli screening programs in the average risk population are very modest, started as case findings and expanded to nation‐wide recommendation for FOBT in 1999. In this study the Israeli experience between 1985 and 1997 was documented.Methods  Medline search of the last 22 years for screening programs in Israel was performed, as well as personal contact with all the Israeli investigators. Reports to the Israeli Cancer Association (ICA) were collected, reviewed and summarized.Results  Since 1985 8 papers about faecal occult blood test (FOBT) and 5 papers about flexible sigmoidoscopy (SIG) screening in average risk population have been published. 35 685 people have been screened, 110 cases of CRC and 546 cases of adenoma were found. The yield of SIG was 4 times that of FOBT for CRC. In addition, since 1990 80 084 people were screened according to the reports to the ICA. Five hundred and six cases of CRC and 2714 cases of adenoma were found. In the only prospective, controlled study, CRC incidence and mortality were significantly decreased in participants of a FOBT screening program, an effect lasting 11 years. Refusers were more likely to be male, of Asia‐Africa decent, smokers, and consumer of more coffee and less tea or dairy food.Conclusion  FOBT may protect against CRC for prolonged periods. Individuals who refuse FOBT have significantly higher CRC incidence and mortality rates than those who accept testing. The Israeli experience, thus small, supports a comprehensive screening campaign for early detection of CRC in Israel.
A study of the complications and pelvic visceral function after restorative proctocolectomy and W pouch construction
Authors: Fowler A. L. , Turner B. N. , Thomson W. H. 
Published: December 2004

AbstractObjective Aspects of ileal pouch surgery remain controversial. The authors' single practice experience of 107 operations illustrates many of them. It was hoped that its study would contribute usefully to the debate.Patients and methods Details of all 107 restorative proctocolectomies carried out since the operation was started in Gloucester in 1984 until the study period ended have been kept prospectively. All patients had proctectomy by mesorectal dissection, and 106 had W pouch restoration. Four suffered functional failure requiring reversion to ileostomy and three patients have died. The remaining 99 were sent a questionnaire concerning pelvic visceral function and evidence of pouchitis. Records of all but one of the patients have been reviewed.Results Surgical morbidity was low with neither chronic pelvic sepsis, pouch related fistula, pouch haemorrhage nor pouch ischaemia. Mucosectomised patients had similar bowel control to the stapled group. The policy change from routine to selective protective ileostomy proved satisfactory. W pouch function was found to be comparable to that reported from major J pouch series, although anti‐diarrhoeal usage was reduced, and was not influenced by either gender, age or time since surgery.Conclusion None of the following reasonably intuitive assumptions seem supported by our findings: that mesorectal excision necessarily poses a greater danger to pelvic visceral function than close rectal dissection, that the greater capacity of W pouches will be reflected in markedly less frequency, that mucosectomy would impair anal control, or that a defunctioning ileostomy is a mandatory precaution. Pouch frequency is less if wind can be passed separately; otherwise functional outcome seems determined by other, non‐technical, factors.
Obstructed defecation
Authors: D'Hoore A. , Penninckx F. 
Published: December 2004

AbstractBackground In the last decade our understanding of pelvic floor function and dysfunction has improved significantly. A more rational diagnostic and therapeutic approach is now possible for the group of patients with constipation due to obstructed defecation (OD).Methods The review is based on a literature search using the PubMed database focusing mainly on recent literature addressing the subject.Results Obstructed defecation occurs in about 7% of the adult population. Different pathophysiological mechanisms, either functional or anatomical, eventually lead to OD. Different tests (defecography, balloon evacuation test, manometry, electromyography, colonic transit time measurementmanometry) play an important role to quantify the problem. These tests are not without problems as abnormal results are also found in asymptomatic controls. Also, there is poor agreement between different tests and a poor correlation with symptomatology. Thus, for most syndromes conservative treatment including biofeedback is appropriate. Surgery can yield excellent results in selected cases.Conclusion Validation of scoring systems and quantitative tests is still needed. More uniform and strict criteria for anismus should be applied to make therapeutic approaches comparable. Appropriate selection of patients for surgery is the key to success.
The incidence and causes of permanent stoma after anterior resection
Authors: Bailey C. M. H. , Wheeler J. M. D. , Birks M. , Farouk R. 
Published: December 2004

AbstractAims Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this.Methods All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively.Results Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5–6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01).Conclusion Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre‐operatively.
Continuous real‐time ambulatory urodynamic monitoring in infants and young children using infrared telemetry
Authors: Yeung C.K. 
Published: December 2004

ObjectiveTo assess the feasibility of continuous real‐time ambulatory bladder monitoring in infants and young children using a specially developed ambulatory urodynamic data logger with built‐in infrared telemetric on‐line facilities.Patients and methodsTwenty‐nine infants and young children (mean age 3.9 years, range 7 weeks to 9.5 years) with various types of bladder dysfunction underwent urodynamic studies performed using an ambulatory urodynamic recorder with a specially developed integral transmitter that converts digital pressure signals to modulated infrared waves (935 nm). A receiver mounted on the ceiling of the room receives the signals emitted from the recorder. During the investigation, the infant can conduct normal activities, be totally mobile and be accompanied by the mother undisturbed in a private cubicle. The urodynamicist in the next room can observe all the patient’s activities through a one‐way mirror while continuous real‐time on‐line pressure signal displays are recorded and monitored using a computer, with event markers placed as necessary. For security, the data recorded during ambulatory investigation are stored in the internal memory of the ambulatory recorder.ResultsAll 29 infants and young children completed the urodynamic studies using the new system; the results were satisfactory and reliable, with no data lost during ambulatory recording. The results obtained using infrared telemetry were not significantly different from conventional natural‐filling urodynamic studies performed with a cabled on‐line urodynamic recorder.ConclusionThe infrared telemetry system provides a reliable and effective way of performing continuous real‐time ambulatory urodynamic monitoring in infants and young children. With the development of more powerful telemetric data transmission technologies, such a method could be extended in the near future to a truly ambulatory urodynamic recording with real‐time on‐line facilities, either at home or in the clinic, both for adults and for children.
Regular dilatation is unnecessary after tubularized incised‐plate hypospadias repair
Authors: Lorenzo A.J. , Snodgrass W.T. 
Published: December 2004

ObjectiveTo determine if patients who undergo tubularized incised‐plate (TIP) urethroplasty need regular dilatation to prevent neourethral strictures or meatal stenosis.Patients and methodsThe follow‐up of two consecutive series of patients who underwent primary TIP hypospadias repair by one surgeon was reviewed. The first 72 patients (group 1) had periodic neourethral calibrations for 1 year after repair, while the next 62 patients (group 2) had no routine dilatation, except for six patients (10%) in whom the meatus appeared to be small. Urethroscopy was performed in both groups at the time of fistula repair, skin revisions or during anaesthesia for unrelated procedures.ResultsThere was no evidence of scarring in group 1; one case of meatal stenosis and one neourethral stricture were detected in group 2. The difference in outcome was not statistically significant (P = 0.4). Overall, the incidence of meatal stenosis was low (0.7%) and comparable with most recent series in which postoperative calibration was not used routinely.ConclusionDilatation of the neourethra is unnecessary after TIP urethroplasty. Calibration or uroflowmetry 6 months after surgery may be useful to detect subclinical obstruction.
Gene amplification and overexpression of HER2 in renal cell carcinoma
Authors: Latif Z. , Watters A.D. , Bartlett J.M.S. , Underwood M.A. , Aitchison M. 
Published: December 2004

Objective To determine the frequency of HER2 genetic abnormalities in renal cell carcinoma (RCC) and hence assess the potential suitability of Herceptin™ immunotherapy. Patients and methods Tumours from 27 patients with RCC were assessed; all patients had undergone nephrectomy. Benign renal tissue from the nephrectomy specimens was studied in seven patients. Gene amplification was assessed using fluorescent in‐situ hybridization, and protein over‐expression using immunohistochemistry. Results Twenty‐four patients had clear cell renal carcinoma, two had papillary renal carcinoma and one a sarcomatoid variant carcinoma. There was no HER2 amplification in the tumours or the benign renal tissue. Polysomy 17 was detected in 11 of 27 tumours (41%) and increased HER2 copy number in seven (26%). Both polysomy 17 and increased HER2 copy number were absent in the benign renal tissue. Three tumours (11%) and six of the seven benign renal tissue samples over‐expressed the HER2 protein. Conclusions
HER2 amplification is absent and protein over‐expression uncommon in RCC. This casts doubt on the suitability of Herceptin™ in the treatment of RCC.