bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective randomized trial of consultant‐led injection sclerotherapy compared with nurse practitioner‐led noninvasive interventions in the management of patients with first and second degree haemorrhoids
Authors: Porrett T. R. C. , Lunniss P. J. 
Published: March 2003

ObjectiveTo determine whether nurse practitioner (NP)‐led advice in relation to bowel and defaecatory habits in haemorrhoidal disease is as effective as local invasive treatment (sclerotherapy) in the management of patients with symptomatic 1st and 2nd degree haemorrhoids, with respect to both alleviation of presenting symptoms and relapse rate, and patients’ understanding of their condition.Patients and methodsIn a prospective randomized trial, 25 patients with bleeding haemorrhoids were allocated to receive either standard medical injection sclerotherapy (Group 1, n=13) or NP‐led advice, information and bowel habit retraining (Group 2, n=12). Bulking agents were offered, when deemed appropriate, to patients in both groups. Treatment was administered by two clinicians only. Patients were assessed at 8 weeks, 4 months and finally at 6 months post treatment and any symptoms present were graded.ResultsAt 6 months, symptomatic improvement was similar in both groups (mean range 3 points) with a patient expected to get better with a good degree of confidence (C.I: 2–4 points). However those patients in Group 2 would be expected to have a slightly better minimum level of improvement (GP 1 P=0.004 GP 2 P=0.0005). At six months, there was no statistical difference between the two groups with regard to the patient’s perception of the amount of information given, the clarity of the explanation, and the ability of the patient to understand and discuss their problem. In relation to understanding the cause of their problem patients in Group 2 felt they had a higher level of understanding of the cause of their problem (U=13, NA=7, NB=10, P=0.05) and felt more able to prevent their problem returning (U=12, NA=7, NB=10, P=0.05).ConclusionA bulking agent and Nurse led education, advice and bowel habit retraining is as effective in reducing the incidence of bleeding from 1st and 2nd degree haemorrhoids as injection sclerotherapy. Patients who consult a NP with symptomatic 1st and 2nd degree haemorrhoids feel more empowered in the long term. Non‐invasive bowel retraining methods should be offered as an alternative to more traditional, invasive treatments for patients with symptomatic early haemorrhoidal disease.
Long‐term results of faecal diversion for refractory perianal Crohn’s disease
Authors: Régimbeau J. M. , Panis Y. , Cazaban L. , Pocard M. , Bouhnik Y. , Matuchansky C. , Valleur P. 
Published: March 2003

Background and aimsFaecal diversion (FD) for refractory anoperineal Crohn’s disease (APCD) is thought to be unsatisfactory with a low overall rate of defunctioning stoma closure. However, only a few patients have so far been reported in the literature. The aim of this study was to reassess the long‐term efficiency of FD for APCD.MethodsAmong 136 patients who were operated for APCD over a 18‐year period, 17 underwent FD. The factors assessed were the mortality and morbidity of stoma formation, the evolution of anoperineal Crohn’s disease after FD, and predictive factors of FD effectiveness.ResultsMean follow‐up after FD was 135 ± 79 months (range 20–328). Initial healing of APCD was observed in 11 patients (65%), allowing stoma closure after 14 ± 9 months (range 3–52). The 6 other patients underwent abdominoperineal resection (APR) for persistent APCD. Three of the 11 patients with normal bowel continuity underwent secondary APR for APCD recurrence. Thus, at the end of follow up 9 (53%) patients had definitive end ileostomy and 8 (47%) continued to have normal bowel continuity with a mean follow up of 124 ± 90 months (range 12–292) after stoma closure. The presence of rectal lesions at the time of FD was the only predictive factor of poor outcome: 8/9 (89%) patients with rectal lesions underwent APR vs 1/8 (13%) patients without rectal lesion (P < 0.01).ConclusionsFaecal diversion for anoperineal Crohn’s disease produced a high initial rate of anoperineal lesion healing. After long‐term follow‐up, results of faecal diversion are good (normal bowel continuity was restored in 89%) in patients without associated rectal lesions. However, in patients with associated rectal lesions, the prospects for restoring continuity were limited, thus making faecal diversion a questionable procedure.
Colonic malignancy arising in colitis – a single unit experience
Authors: Armstrong A. M. , Khosraviani K. , Irwin S. T. , Maxwell R. J. 
Published: March 2003

ObjectivesColorectal malignancy complicating inflammatory bowel disease constitutes 1% of all colorectal malignancies. Although its overall numbers are low it represents the greatest cause of colitis related mortality in these patients. This paper describes the management of 24 patients presenting to a single unit over a period of 10 years.MethodsThe names of patients were collected prospectively when they presented with malignancy. Clinical details were collected by retrospective review of charts.ResultsIn all, 24 patients with 27 malignancies were identified. The median age of presentation with malignancy was 56 years. Most patients were treated with proctocolectomy. Other patients were treated with segmental colectomy. In these patients the surgical procedure was dictated by the stage of the cancer, the age and comorbid state of the patient and the severity of ongoing colitis.ConclusionsMalignancy arising in colitis will constitute only a small part of a colorectal practice. The optimum method for detecting early, and potentially curable, disease has not been defined. Surgery should be tailored to the individual needs of the patient.
Management of recurrent colorectal carcinoma
Authors: Brethauer S. A. , Magrino T. J. , Riffenburgh R. H. , Johnstone P. A. S. 
Published: March 2003

AbstractBackground/objective  The records of patients treated for adenocarcinoma of the colon and rectum between 1 January 1988 and 31 December 1995 at Naval Medical Center San Diego were reviewed. Analysis was made of patients who developed recurrences after potentially definitive primary therapy.Methods  A retrospective review of 410 patients diagnosed with colorectal cancer at our institution was conducted. The focus of this review was to identify patients with recurrent disease after curative initial procedures, and to determine how recurrences were detected and treated. Survival data for 48 patients undergoing various curative and palliative procedures, or no therapy, were generated.Results  The decision to re‐operate with curative intent was made after a multidisciplinary review of restaging studies. Laparoscopy was not used in this determination. Curative resection of recurrence confers increased survival over non‐curative surgery and no surgery (P < 0.001). This is misleading because of patient selection; several patients undergo potentially curative surgery but are determined intraoperatively to best be palliated, or to have further surgery aborted. Analysis of results in patients undergoing potentially curative surgery vs. those undergoing planned palliation vs. those not operated reveals that these also provide significantly different outcomes (P < 0.003).Conclusions  Proper delineation of resectable lesions in patients with recurrent colorectal cancer contributes to better outcomes for them. That determination is difficult, and efforts are underway in our institution and elsewhere to better delineate which patients are optimal preoperatively. We consider multidisciplinary Tumor Board evaluation to be central to this process.
The management of persistent and recurrent chronic anal fissures
Authors: Brown S. R. , Taylor A. , Adam I. J. , Shorthouse A. J. 
Published: March 2003

AbstractThere are numerous definitive reviews concerning aetiology and management of acute and chronic anal fissures. The problem of persistence and recurrence after surgical and nonsurgical therapy has not been specifically addressed and there is little evidence‐based guidance for the management of this difficult group of patients. A review of the literature with particular reference to persistence and recurrence of chronic anal fissures is presented and an algorithm of management incorporating evidence‐based data is suggested.
Palliative stenting of malignant large bowel obstruction
Authors: Seymour K. , Johnson R. , Marsh R. , Corson J. 
Published: March 2003

ObjectiveUntreated malignant large bowel obstruction is rapidly fatal. Short‐term palliation of symptoms can be achieved by formation of a stoma in those patients for whom resection surgery is inappropriate. In the final months of life, a stoma represents a significant burden for both patients and carers. Palliative endoluminal stenting may therefore be an attractive alternative option for this poor prognosis group. In this paper, we examine our experience of palliative endoluminal colonic stenting.PatientsTwenty patients, 11 males and 9 females of median age 81 years were referred for stenting. All had left sided colonic cancers. Ten patients had confirmed metastases on presentation, four had fixed rectal cancers and the remainder had severe comorbidity limiting surgical options. Stents were placed endoscopically using a radiologically controlled `stent over wire' technique.ResultsStenting successfully relieved the obstruction in 18 of the 20 patients attempted. In one patient the stricture could not be negotiated and the procedure was abandoned. Eleven patients have died of their disease, their median duration of palliation was 50 days (3–152 days). The rest of the patients continue in follow‐up and have had 80 days median palliation (14–257 days). One stent‐related complication has been observed in a patient who suffered anal pain due to fracture and migration of part of a stent into the low rectum. This complication occurred after 250 days and the distal stent fragment was removed with further symptom relief.ConclusionCarefully selected patients benefit from colonic endoluminal stenting with relief of obstructive symptoms. They may be spared the potential problems associated with palliative stoma formation.
Colonic resection for colovesical fistula: 5‐year follow‐up
Authors: Walker K. G. , Anderson J. H. , Iskander N. , McKee R. F. , Finlay I. G. 
Published: March 2003

AbstractObjectives  The outcome of colovesical fistula management may be unsatisfactory; complications are reported in up to 45% of patients. Published studies are retrospective and tend to lack standardized management strategies and long‐term follow‐up. This cohort study assesses a policy of resection of colovesical fistulae in continuity with any distal colorectal stricture, and includes 5‐year follow‐up.Method  All patients undergoing surgery in our institution for colovesical fistula between February 1991 and April 1995 were entered into the study. The fistulae were resected in continuity with any distal bowel stricture, according to a standard single‐stage operative protocol. Postoperative mortality and morbidity were recorded, and prospective review was undertaken at April 2000.Results  Nineteen consecutive patients entered the study. The source of the fistula was diverticular disease (n = 14), colorectal cancer (n = 3), trauma (n = 1) or Crohn's (n = 1) disease. Thirteen patients had a colorectal stricture. One patient died due to ischaemic colitis within 30 days of surgery. Eleven other patients died of unrelated causes before April 2000, in whom there was no evidence of fistula recurrence before death at a median of 37 months after operation (range 2–95 months). At 5‐year follow‐up there was no evidence of fistula recurrence in the seven remaining patients.Conclusions  A policy of resection of the fistula and associated colorectal stricture with primary bowel anastomosis and bladder drainage, resulted in no recurrences and low morbidity. However comorbidity is important in this patient population, most of whom will die from unrelated causes within a few years.
The impact of bowel cancer awareness week
Authors: Pullyblank A. M. , Dixon N. , Dixon A. R. 
Published: March 2003

AbstractObjectives  To assess knowledge of Bowel Cancer Awareness Week (BCAW) amongst patients attending their general practice surgery and to identify whether BCAW could increase knowledge of colorectal cancer symptoms.Method  Questionnaire study with ethics committee approval. Patients attending non‐emergency clinics in a single general practice during the week following BCAW were given a questionnaire. Respondents were asked for knowledge of colorectal cancer symptoms, sources of this information and awareness of BCAW compared to similar knowledge of breast cancer.Results  Seventy‐seven patients responded (96% response rate, median age 42, 40% male). Eighty‐five percent could name a breast cancer symptom compared to only 44% who could name a colorectal cancer symptom (McNemar's χ2, P < 0.0001). Respondents identified more sources of information for breast than colorectal cancer. Only 21% had heard of BCAW and none could name any symbol for bowel cancer awareness whereas 69% were aware of Breast Cancer Awareness Month and 28% could name its symbol (McNemar's χ2, P < 0.0001). Multivariate analysis demonstrated that patients who were aware of BCAW were 4.6 times more likely to have knowledge of colorectal cancer symptoms (95% CI 1.25–17.1).Conclusions  Despite their similar incidence, knowledge of colorectal cancer is much less than breast cancer. In part this may be due to the greater publicity given to breast cancer. BCAW can increase knowledge of colorectal cancer symptoms but currently, too few people are aware of it.
Diabetes and vascular disease
Authors: Garber Alan J. 
Published: March 2003

SummaryCardiovascular and cerebrovascular disease are two of the most important causes of morbidity and mortality in the USA and worldwide. The impact of these conditions is even more profound in patients with diabetes. The aims of the Vascular Disease Working Group in the articles that follow are to review the impact of cerebrovascular and cardiovascular disease in the general population, and, specifically, in the patient with diabetes, and to suggest appropriate treatment. Important steps to decreasing the risk of these diseases in diabetic patients are strict glycaemic control, control of hypertension, and modification of dyslipidaemia.
Variations in plasma soluble tumour necrosis factor receptors after diet‐induced weight loss in obesity
Authors: Bastard J. ‐P. , Jardel C. , Bruckert E. , Vidal H. , Hainque B. 
Published: March 2003

SummaryThe aim of this study was to investigate the variations in the plasma levels of the soluble tumour necrosis factor receptor type‐I (sTNFR‐I) and type‐II (sTNFR‐II) during weight loss which was induced by 3 weeks on a very low calorie diet (3.9 ± 0.1 MJ/day), in 17 non‐diabetic obese women. Plasma sTNFR‐I concentrations decreased significantly after weight loss (p < 0.05), but there was no significant change in plasma sTNFR‐II. As the diet was associated with a significant decrease in body fat mass (≈2.5 kg), this result supports the emerging concept that adipose tissue can produce significant amounts of sTNFR‐I and that this production can be modified by weight loss in human obesity
The effects of intensive glycaemic control on body composition in patients with type 2 diabetes
Authors: Bagg W. , Plank L. D. , Gamble G. , Drury P. L. , Sharpe N. , Braatvedt G. D. 
Published: March 2003

SUMMARY Aim  To examine the effects of improved glycaemic control over 20 weeks on the type and distribution of weight change in patients with type 2 diabetes who at baseline have poor glycaemic control.Methods  Forty‐three patients with type 2 diabetes and HbA1c > 8.9% were randomised to either intensive glycaemic control (IC) n = 21 or usual glycaemic control (UC) n = 22 for 20 weeks. Dual energy X‐ray absorptiometry was used to assess the type and distribution of weight change during the study.Results  After 20 weeks HbA1c was significantly lower in patients randomised to IC than UC (HbA1c IC 8.02 ± 0.25% vs. UC 10.23 ± 0.23%, p < 0.0001). In the IC group weight increased by 3.2 ± 0.8 kg after 20 weeks (fat‐free mass increased by 1.8 ± 0.3 kg) compared to 0.02 ± 0.70 kg in UC (p = 0.003). The gain in total body fat mass comprised trunk fat mass (IC 0.94 ± 0.5 kg vs. UC 0.04 ± 0.4 kg, p = 0.18) and peripheral fat mass (total body fat – trunk fat) (IC 0.71 ± 0.32 kg vs. UC −0.21 ± 0.28 kg, p = 0.04). Blood pressure and serum lipid concentrations did not change over time in either group.Conclusions  Intensive glycaemic control was associated with weight gain which was distributed in similar proportions between the central and peripheral regions and consisted of similar proportions of fat and fat‐free mass. Blood pressure and serum lipid concentrations were not adversely affected.
Expression of resistin in the adipose tissue is modulatedby various factors including peroxisome proliferator‐activated receptor α
Authors: Fukui Y. , Motojima K. 
Published: March 2003

Aim: Resistin has been suggested to link obesity to diabetes by antagonizing insulin action. However, this model is based on limited observations and how resistin links the two complex processes is not known. In this study, we investigated the effects of various factors on the expression of resistin and examined the generality of the proposal.Methods: Total RNA was isolated from the adipose tissues of lean, obese and peroxisome proliferator‐activated receptor (PPAR)α‐null mice fed a control diet or that contained a PPAR ligand, and analysed by Northern blotting using cDNAs for resistin, leptin, aP2 and other mRNAs as probes. For quantitative analysis, an image analyser was used.Results: Basal expression of resistin mRNA was suppressed by obesity, but the extent of suppression differed significantly among the mouse strains and types of adipose tissue examined. Anti‐diabetic thiazolidinediones induced resistin expression in the lean mice and showed smaller effects in obese mice. Furthermore, PPARα was shown to play an important role in constitutive expression of resistin in the adipose tissue.Conclusion: Our results indicated that diverse factors modulate the expression of resistin in the adipose tissues of mice, and suggested that resistin is not a master hormone linking obesity to diabetes.
Morphology of the nasal capsule of Heloderma suspectum with comments on the systematic position of helodermatids (Squamata: Helodermatidae)
Authors: Bernstein Peter 
Published: March 2003

A serially sectioned embryonic head of Heloderma suspectum formed the basis for a three‐dimensional reconstruction of the cartilaginous nasal capsule and its membrane bones. Further, the soft parts of the nasal capsule were analysed microscopically. The embryonic nasal capsule is described and compared to the morphological conditions in other lizards, especially the varanids, which many recent authors believe to be their closest relatives.The results support the close affinities between the helodermatids and the varanids. Both groups have a well developed recessus lateralis in a cartilaginous capsule, entered by the nasal concha. Further, in both groups a fragmentation of the cartilago paraseptalis occurs in a comparable location and form. Heloderma has no double lacrimal duct, in contrast to previous accounts, but the two canaliculi at the origin of the duct fuse noteworthy far ahead (in other squamates they fuse in front of the bulbus oculi). In the varanids the two branches of the lacrimal duct remain separate and open separately.Some unique features of Heloderma are presented as well, above all the presence of a second concha.
Structure of ovarioles in Adelges laricis, a representative of the primitive aphid family Adelgidae
Authors: Szklarzewicz Teresa , Wne k Agnieszka , Biliński Szczepan M. 
Published: March 2003

AbstractThe structure of ovaries has been analysed in advanced aphids only. In this paper we report the results of ultrastructural studies on the ovarioles of Adelges laricis, a representative of the primitive aphid family, Adelgidae. The ovaries of the studied species are composed of five telotrophic‐meroistic ovarioles that are subdivided into a terminal filament, tropharium (= trophic chamber) and vitellarium. The tropharium houses trophocytes (= nurse cells) and arrested oocytes. The vitellarium consists of one or two ovarian follicles. The total number of germ cells (trophocytes + oocytes) in the ovarioles analysed varies from 50 to 92 and is substantially higher than in previously studied aphids. The centre of the tropharium is occupied by a cell‐free region, termed a trophic core, which is connected both with trophocytes and oocytes. Trophocytes are connected to the core by means of cytoplasmic strands, whereas oocytes by nutritive cords. Both trophic core and nutritive cords are filled with parallel arranged microtubules. In the light of obtained results the anagenesis of hemipteran ovaries is discussed.
Rotifer muscles as revealed by phalloidin‐TRITC staining and confocal scanning laser microscopy
Authors: Kotikova Elena A. , Raikova Olga I. , Flyatchinskaya Ludmila P. , Reuter Maria , Gustafsson Margaretha K. S. 
Published: March 2003

AbstractBy combining phalloidin‐TRITC staining with confocal scanning laser microscopy (CSLM), the pattern of the musculature in two species of Rotifera, Euchlanis dilatata unisetata and Brachionus quadridentatus is revealed. The same general muscle pattern prevails in both species. The major components of the body wall musculature are: 1. retractor muscles (5 pairs in E. dilatata unisetata and 3 pairs in B. quadridentatus); 2. Two pairs of dorso‐ventral muscles; 3. Two pairs of perpendicular muscles (in E. dilatata unisetata); 4. retractors of the corona (median, lateral and ventral); 5. Foot retractors. In addition, three pairs of cutaneo‐visceral muscles and visceral muscles (including mastax muscles) are described. The sphincter of the corona was found only in B. quadridentatus. The high degree of muscle differentiation points to a high level of development of rotifer muscular system.
Structure of the ovary in Nannochorista neotropica Navás (Insecta: Mecoptera: Nannochoristidae) with remarks on mecopteran phylogeny
Authors: Simiczyjew Bożena 
Published: March 2003

AbstractPreliminary histological analysis showed that the ovaries in Nannochorista neotropica are composed of numerous ovarioles of panoistic type. In the ovaries of adult females each ovariole consists of a terminal filament, vitellarium and pedicle while a germarium is absent. Morphological observations supported by simple histochemical tests revealed the presence of multiple nucleoli in the oocyte nucleus. The appearance of multiple nucleoli suggests that the extrachromosomal amplification of ribosomal DNA may take place in the oocytes of Nannochorista. The results show that in the structure of the ovariole and the course of oogenesis nannochoristids share noteworthy derived features with boreids, but differ significantly from all other mecopterans. These findings indicate the possible monophyly of an assemblage comprising the Nannomecoptera, Neomecoptera and Siphonaptera.