bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of life after total colectomy with ileorectal anastomosis or proctocolectomy and ileal pouch—anal anastomosis for familial adenomatous polyposis
Authors: van Duijvendijk P , Slors J F M , Taat C W , Oosterveld P , Sprangers M A G , Obertop H , Vasen H F A 
Published: March 2003

Abstract

Background
Knowledge of postoperative health status is important in decision-making about the type of operation necessary in patients with familial adenomatous polyposis (FAP). This study compared the quality of life (QoL) between patients with an ileorectal anastomosis (group 1) and those with an ileal pouch–anal anastomosis (group 2).

Methods
QoL was assessed with both a generic questionnaire (Short Form-36 Health Survey; SF-36) and a disease-specific questionnaire (European Organization for Research and Treatment of Cancer Colorectal QoL Questionnaire; EORTC QLQ-CR38). The SF-36 consists of 36 items representing eight generic health domains, and the EORTC QLQ-CR38 comprises 38 items representing disease-specific health domains. Both questionnaires were distributed among 323 patients with FAP known at the Dutch Polyposis Registry who had previously undergone either operation. The results of the SF-36 were compared with the scores of age- and sex-matched respondents from the general population.

Results
Some 279 patients (86 per cent), 161 in group 1 and 118 in group 2, completed the questionnaire. Generic and disease-specific QoL was the same for groups 1 and 2. The SF-36 scores of both groups were significantly lower than those of the general population.

Conclusion
There were no differences with respect to health status between patients in groups 1 and 2, and preference for either procedure cannot be based on QoL.
Experimental study of faecal continence and colostomy irrigation
Authors: O'Bichere A , Sibbons P , Doré C , Green C , Phillips R K S 
Published: March 2003

Abstract

Background
Colostomy irrigation is a useful method of achieving faecal continence in selected conditions, but remains largely underutilized because it is time consuming. This study investigated the effect of modifying irrigation technique (route, infusion regimen and pharmacological manipulation) on colonic emptying time in a porcine model.

Methods
An end-colostomy and caecostomy were fashioned in six pigs. Twenty markers were introduced into the caecum immediately before colonic irrigation. Irrigation route (antegrade or retrograde), infusion regimen (tap water, polyethylene glycol (PEG), 1·5 per cent glycine) and pharmacological agent (glyceryl trinitrate (GTN) 0·25 mg/kg, diltiazem 3·9 mg/kg, bisacodyl 0·25 mg/kg) were assigned to each animal at random. Colonic transit was assessed by quantifying cumulative expelled markers (CEM) and stool every hour for 12 h.

Results
Mean CEM at 6 h for bisacodyl, GTN and diltiazem were 18·17, 12·17 and zero respectively; all pairwise differences in means were significant (P &lt; 0·001). The difference at 12 h between the two routes (P = 0·001) and three fluids (tap water 6·75, glycine 14·83, PEG 16·33; P &lt; 0·001) was significant, but not for PEG versus glycine and bisacodyl versus GTN. Cumulative output was significantly more with the antegrade than retrograde route using PEG, but the difference in mean cumulative output for bisacodyl and GTN at 12 h was not significant.

Conclusion
Colonic emptying is more efficient with antegrade than retrograde irrigation. PEG and glycine enhance emptying similar to bisacodyl and GTN solution. These findings show promise for improved faecal continence by colostomy irrigation and may justify construction of a Malone conduit at the time of colostomy in selected patients who wish to irrigate.
Cholecystectomy, peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and gastric cardia
Authors: Freedman J , Lagergren J , Bergström R , Näslund E , Nyrén O 
Published: March 2003

Abstract

Background
Gastro-oesophageal reflux is a strong risk factor for oesophageal adenocarcinoma. Bile and pancreatic enzymes may be particularly carcinogenic. Cholecystectomy causes an increased gastric level of these constituents. A decreased risk of oesophageal adenocarcinoma has been observed in persons infected with cagA-positive Helicobacter pylori. There is a strong correlation between ulcer disease and Helicobacter pylori infection. The aim of this study was to determine whether previous cholecystectomy or peptic ulcer disease affects the risk of oesophageal carcinoma.

Methods
Data were collected as a nationwide population-based case–control study in Sweden between 1995 and 1997. Multivariate adjusted odds ratios (ORs) were calculated with logistic regression.

Results
There was no statistically significant association between cholecystectomy and the risk of oesophageal carcinoma. Among persons with previous peptic ulcer, the adjusted OR for oesophageal adenocarcinoma was below unity (OR = 0·6, 95 per cent confidence interval 0·3–1·1). The relative risk estimates for cardia adenocarcinoma and oesophageal squamous cell carcinoma were close to unity.

Conclusion
Cholecystectomy, despite its effect on the composition of gastric juice, does not appear to increase the risk of adenocarcinoma of the oesophagus or gastric cardia. While the data do not contradict a protective effect of H. pylori, the results are also consistent with absence of such an effect.
Severity of acute pancreatitis: a multivariate analysis of oxidative stress markers and modified Glasgow criteria
Authors: Abu-Zidan F M , Bonham M J D , Windsor J A 
Published: March 2003

Abstract

Background
It is unknown whether measurement of markers of oxidative stress can improve the prediction of severity of acute pancreatitis.

Methods
Consecutive patients admitted with a diagnosis of acute pancreatitis were divided into mild (n = 62) and severe (n = 23) groups based on the Atlanta classification. Plasma oxidative stress markers were measured within 24 h of admission and included ascorbic acid (endogenous antioxidant), protein carbonyl (a marker of protein oxidation), thiobarbituric acid reactive substances (a marker of lipid peroxidation) and myeloperoxidase (a neutrophil enzyme that produces oxidants). Canonical correlation analysis was used to describe the relationship between these markers and the modified Glasgow criteria. Canonical variate analysis was used to define the best variables that could discriminate mild and severe pancreatitis.

Results
There was a significant correlation between markers of oxidative stress and the modified Glasgow criteria (first canonical correlation 0·69, P &lt; 0·0001, Wilk's lambda test). Blood urea, serum albumin and white cell count were the best variables that discriminated mild and severe acute pancreatitis, and all were better than the oxidative stress markers.

Conclusion
The markers of oxidative stress were highly correlated with the severity of pancreatitis. They are unlikely to be better than the modified Glasgow criteria in predicting it.
Pancreatic fistula after pancreatic head resection
Authors: Büchler M W , Friess H , Wagner M , Kulli C , Wagener V , Z'graggen K 
Published: March 2003

Abstract

Background
Pancreatic resections can be performed with great safety. However, the morbidity rate is reported to be 40–60 per cent with a high prevalence of pancreatic complications. The aim of this study was to analyse complications after pancreatic head resection, with particular attention to morbidity and pancreatic fistula.

Methods
From November 1993 to May 1999, perioperative and postoperative data from 331 consecutive patients undergoing pancreatic head resection were recorded prospectively. Data were analysed and grouped according to the procedure performed: classic Whipple resection, pylorus-preserving pancreatoduodenectomy (PPPD) or duodenum-preserving pancreatic head resection (DPPHR).

Results
Pancreatic head resection had a mortality rate of 2·1 per cent; the difference in mortality rate between the three groups (0·9–3·0 per cent) was not significant. Total and local morbidity rates were 38·4 and 28 per cent respectively. DPPHR had a lower morbidity, both local and systemic, than pancreatoduodenectomy. The prevalence of pancreatic fistula was 2·1 per cent in 331 patients, and was not dependent on the procedure or the aetiology of the disease. Reoperations were performed in 3·9 per cent of patients, predominantly for bleeding and non-pancreatic fistula. None of the patients with pancreatic fistula required reoperation or died in the postoperative course.

Conclusion
A standardized technique and a continuing effort to improve perioperative management may be responsible for low mortality and surgical morbidity rates after pancreatic head resection. Pancreatic complications occur with Whipple, PPPD and DPPHR procedures with a similar prevalence. Pancreatic fistula no longer seems to be a major problem after pancreatic head resection and rarely necessitates surgical treatment.
Role of a defunctioning stoma in the management of large bowel Crohn's disease
Authors: Edwards C M , George B D , Jewell D P , Warren B F , Mortensen N J McC , Kettlewell M G W 
Published: March 2003

Abstract

Background
The faecal stream plays a significant role in the pathogenesis of Crohn's disease. This retrospective study aimed to assess the effect of faecal diversion on the natural history of refractory Crohn's colitis (RCC) and severe perianal disease (PAD).

Methods
All patients undergoing a defunctioning stoma without resection for RCC or PAD between 1970 and 1997 were studied. Indications for surgery, acute clinical response, subsequent outcome and stoma rates were recorded.

Results
Some 73 patients underwent a defunctioning stoma (55 RCC and 18 PAD). Acute remission was achieved in 63 patients (48 RCC, 15 PAD). Twenty-nine patients had subsequent closure of the defunctioning stoma (25 of 48 acute responders with RCC and four of 15 acute responders with PAD). Eleven patients with RCC and two with PAD achieved good long-term function without disease relapse (median follow-up 36 months). Overall 52 patients have undergone proctocolectomy or remain with a defunctioning stoma (37 with RCC and 15 with PAD).

Conclusion
Faecal diversion is associated with acute clinical remission in the majority of patients with RCC and PAD, but sustained benefit occurs less often. For selected patients, diversionary surgery alone offers a realistic alternative to major bowel resection.
Role of xanthine oxidase in small bowel mucosal dysfunction after surgical stress
Authors: Anup R , Susama P , Balasubramanian K A 
Published: March 2003

Abstract

Background
The small intestine is highly susceptible to surgical stress even at remote locations. An earlier study using a rat model indicated that oxidative stress plays an important role in this process. The enzyme xanthine oxidase is an important source of free radicals in the small intestine. The role of this enzyme in intestinal damage after surgical stress was examined.

Methods
Rats pretreated with xanthine oxidase inhibitors were subjected to surgical stress by opening the abdomen and handling the intestine, as done during laparotomy. Enterocytes at various stages of differentiation were isolated and the protection offered by xanthine oxidase inhibitors against damage due to surgical stress was determined and compared with normal controls. Protection against ultrastructural changes to the mucosa, as well as mitochondrial function was examined.

Results
Surgical stress affected both the villus as well as crypt cells, causing increased superoxide generation, accompanied by increased activity of xanthine oxidase. Xanthine oxidase inhibitors ameliorated the increased superoxide generation, and protected against mitochondrial damage and ultrastructural changes in the intestine.

Conclusion
Surgical stress affects both the villus and crypt cell populations in the small intestine. The enzyme xanthine oxidase maybe an important mediator of surgical stress in the intestine.
Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus
Authors: Bollschweiler E , Schröder W , Hölscher A H , Siewert J R 
Published: March 2003

Abstract

Background
The outcome after oesophagectomy depends not only on the surgical procedure itself but can be improved by the selection of patients based on a preoperative risk score.

Methods
In order to compare the preoperative risk for different histological subtypes of oesophageal carcinoma, 221 patients with a squamous cell carcinoma (SCC) and 104 patients with an adenocarcinoma (AC) were enrolled in a prospective study. The preoperative assessment included socioeconomic status, alcohol and tobacco consumption, general and nutritional status, and pulmonary, cardiovascular, hepatic and renal function.

Results
More patients with an SCC were ‘blue collar’ and with an AC were ‘white collar’ workers (P &lt; 0·001). Alcohol and tobacco consumption was higher in patients with an SCC (P &lt; 0·01 and P &lt; 0·05 respectively). The preoperative forced expiratory volume, arterial partial pressure of oxygen and the aminopyrine breath test showed more severely compromised pulmonary and hepatic function in patients with an SCC (P &lt; 0·05 for all variables). Some 50 per cent of patients with an AC were overweight with a higher body mass index (P &lt; 0·001). More patients with an AC had severely impaired cardiac function (P &lt; 0·01).

Conclusion
Patients with SCC and AC of the oesophagus differed regarding their socioeconomic and preoperative risk factors for surgery.
Population screening reduces mortality rate from aortic aneurysm in men
Authors: Heather B P , Poskitt K R , Earnshaw J J , Whyman M , Shaw E 
Published: March 2003

Abstract

Background
Rupture of an unsuspected abdominal aortic aneurysm is a major cause of death in men over the age of 65 years. A significant reduction in deaths is likely to result only from higher rates of detection and increased numbers of elective aneurysm repairs. Screening of men reaching the age of 65 years has been taking place in the county of Gloucestershire, UK since 1990 and the aim of this study was to investigate any change in the mortality rate from aortic aneurysm in the screened portion of the population.

Methods
Total number of deaths from all aortic aneurysm-related causes in the county's population was calculated from hospital and post-mortem records, together with computerized death certificate records, for the years 1994–1998. The overall number of aneurysm-related deaths in men aged 65–73 years, who have been progressively influenced by the screening programme, was compared with that for men of all other ages.

Results
The total number of aneurysm-related deaths in men aged 65–73 years decreased progressively year by year between 1994 and 1998; this reduction is highly statistically significant (P &lt; 0·001). No such change was observed in the unscreened part of the population.

Conclusion
Screening for asymptomatic abdominal aortic aneurysm results in a significant reduction in numbers of deaths from all aneurysm-related causes in the screened portion of the male population.
Expression and processing of gastrin in pancreatic adenocarcinoma
Authors: Caplin M , Savage K , Khan K , Brett B , Rode J , Varro A , Dhillon A 
Published: March 2003

Abstract

Background
Gastrin is a trophic hormone and promotes growth of gastrointestinal and non-gastrointestinal cancers. Studies both in vitro and in vivo have suggested that pancreatic cancer cells not only have the ability to respond to circulating forms of gastrin but also to respond to the autocrine production of gastrin and its precursors. The aim of this study was to identify the expression of CCK-B/gastrin receptor, progastrin, glycine-extended gastrin and amidated gastrin in both normal pancreas and pancreatic adenocarcinoma.

Methods
Tissue sections from patients with normal pancreas (n = 10) and pancreatic cancer (n = 22) were assessed using immunohistochemical methods for CCK-B/gastrin receptor, progastrin, glycine-extended gastrin and amidated gastrin expression.

Results
Normal pancreas showed no expression of receptor or gastrin isoforms except for occasional cells in the islets. Definite expression of CCK-B/gastrin receptor, progastrin, glycine-extended gastrin and amidated gastrin was observed in 95, 91, 55 and 23 per cent of sections from patients with pancreatic cancer respectively.

Conclusion
Pancreatic cancer cells express CCK-B/gastrin receptor and gastrin precursor forms in most patients. Expression of the gastrin precursor forms is probably related to autocrine production. New therapeutic strategies need to be developed for the management of pancreatic cancer. Targeting gastrin and its receptor may provide a novel treatment option.
Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients
Authors: Wullstein C , Gross E 
Published: March 2003

Abstract

Background
The morbidity and mortality associated with colorectal surgery results partly from anastomotic leakage. Animal experiments have shown some advantages of sutureless anastomosis over conventional colorectal anastomosis. Compression anastomosis follows the same biological principles as sutureless anastomosis.

Methods
The compression anastomosis AKA-2 was evaluated in a prospective consecutive audit of 442 patients between September 1989 and August 1998.

Results
Anastomoses were performed in 372 elective and 70 emergency situations. The indication for operation was colorectal cancer (56·3 per cent) and diverticulitis (23·5 per cent). A defunctioning colostomy was performed in 110 patients (24·9 per cent). Fourteen patients died (3·2 per cent). Death was related to anastomotic complications in three patients (0·7 per cent). Twenty-four patients (5·4 per cent) developed intra-abdominal complications. There were 11 symptomatic (2·5 per cent) and six asymptomatic (1·4 per cent) leakages. Anastomoses that were more than 10 cm from the anal verge leaked in seven (2·4 per cent) of 291 cases, while anastomoses between 5 and 10 cm leaked in three (2·6 per cent) of 116 cases and those less than 5 cm from the anal verge leaked in one (3 per cent) of 35 cases.

Conclusion
The low incidence of anastomotic complications demonstrates good biological healing of compression anastomoses. The compression anastomosis AKA-2 is safe in both high and low anterior resection and can therefore be recommended for use in colorectal surgery.
Effect of contralateral disease on duplex measurements of internal carotid artery stenosis
Authors: Ray S A , Lockhart S J M , Dourado R , Irvine A T , Burnand K G 
Published: March 2003

Abstract

Background
Duplex ultrasonography is increasingly used as the sole method of imaging before carotid endarterectomy. This study investigated the measured degree of stenosis in the contralateral carotid artery before and after operation.

Methods
Duplex-derived peak systolic velocity (PSV), end-diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) velocity ratios were measured in the contralateral unoperated ICA before 131 consecutive unilateral endarterectomies and compared with preoperative angiographic findings. Three months later duplex scans were repeated to assess whether there had been any alteration in the severity of the stenosis in the contralateral unoperated artery.

Results
Bilateral ICA disease (greater than 50 per cent stenosis) was present in 50 patients (38 per cent). Three months after operation, ultrasonography of the 105 unoperated, patent, contralateral arteries showed a decrease in mean(s.d.) PSV (1·21(0·83) versus 1·07(0·69) m/s; P &lt; 0·01) and EDV (0·41(0·29) versus 0·35(0·24) m/s; P &lt; 0·01). This resulted in 14 (42 per cent) of 33 patients with contralateral disease being downgraded to a less severe category of stenosis. Use of the ICA/CCA velocity ratio prevented overestimation in eight of the 14 patients, while preoperative angiography correctly classified 13 of the 14 patients.

Conclusion
Bilateral carotid artery disease can cause overestimation of the severity of stenosis by duplex ultrasonography if absolute velocity is used as the main criterion.
Hereditary pancreatitis and mutations of the cationic trypsinogen gene
Authors: O'Reilly D A , Kingsnorth A N 
Published: March 2003

Abstract

Background
Mutations of the cationic trypsinogen gene have been detected in hereditary pancreatitis. This article reviews current understanding of their function and clinical significance.

Methods
An unrestricted Medline search was conducted using the key words ‘hereditary pancreatitis’ and ‘cationic trypsinogen’. Additional material was obtained from references cited in original papers and recently published abstracts of meetings.

Results and conclusion
Cationic trypsinogen mutations have been identified in most, but not all, families with hereditary pancreatitis. This confirms existing evidence that premature trypsinogen activation plays a central role in the pathogenesis of human pancreatitis. Patients currently clinically defined as having hereditary pancreatitis should be screened for the presence of cationic trypsinogen mutations. A subgroup of patients with non-hereditary pancreatitis may also benefit from being screened for these mutations. Patients with hereditary pancreatitis should be entered into prospective, multicentre trials investigating secondary screening for pancreatic cancer. Gene therapy for hereditary pancreatitis is beyond current technological capability but remains a future therapeutic prospect for this often debilitating condition.
Diagnosis and management of cystic pancreatic tumours with mucin production
Authors: Shima Y , Mori M , Takakura N , Kimura T , Yagi T , Tanaka N 
Published: March 2003

Abstract

Background
To aid selection of the most appropriate treatment for intraductal tumours (IDTs) and mucinous cystic tumours (MCTs) of the pancreas, this study describes the clinical and diagnostic features of these tumours and compares the clinicodiagnostic features of malignant and benign tumours and hyperplasia.

Methods
The clinical features of 28 IDTs (four cases of hyperplasia, six adenomas and 18 adenocarcinomas) and six MCTs (four adenomas and two adenocarcinomas) were studied.

Results
An IDT was found in 24 men and four women with a mean age of 64·5 years, whereas all patients with an MCT were women, with a mean age of 50·8 years. Twenty IDTs were located in the pancreatic head, whereas all MCTs were in the pancreatic body–tail. The mean size of IDTs was smaller than that of MCTs (4·4 versus 7·7 cm). The mean size of hyperplastic lesions, adenomas and adenocarcinomas in IDTs were 1·7, 2·9 and 5·4 cm respectively. Hyperplastic IDT lesions were smaller than 2 cm without either mural nodules or dilatation of the main pancreatic duct. IDTs larger than 3 cm with mural nodules and mucin secretion from an enlarged papilla orifice and dilatation of the main pancreatic duct were often adenocarcinomas.

Conclusion
Although follow-up of intraductal hyperplasia is a reasonable approach, other types of IDT and MCT require surgical treatment.