bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy
Authors: Ho Y-H , Seow-Choen F , Tsang C , Eu K-W 
Published: March 2003

Abstract

Background
Conventional stapled haemorrhoidectomy involves the use of a large circular anal dilator (DL technique), which may cause anal sphincter injuries. This study compared whether the procedure can be effectively performed without this dilator (ND technique), with better sphincter preservation.

Methods
Fifty-eight patients with symptomatic prolapsed irreducible haemorrhoids were randomized to DL (n = 29) and ND (n = 29) groups. Preoperative continence scoring, anorectal manometry and endoanal ultrasonography were performed. These were repeated at up to 14 weeks after operation, with additional pain scores, analgesic requirements and quality of life assessments.

Results
DL haemorrhoidectomy took significantly longer to perform (P = 0·02). However, there were fewer residual skin tags (P = 0·044) and less perianal pruritis (P = 0·007) at 2 weeks, although such symptoms subsided to an equivalent level in both groups afterwards. Internal anal sphincter fragmentation persisting to at least 14 weeks was found in four patients after DL, but not after ND haemorrhoidectomy (P = 0·038). However, these were asymptomatic and no differences were found in continence scores and anal pressures. The pain scores, satisfaction scores, quality of life assessments and time off work were similar.

Conclusion
The large circular anal dilator used for stapled haemorrhoidectomy increased the risk of anal sphincter injuries, which may become problematic with ageing.
Estimating the benefits of adjuvant systemic therapy for women with early breast cancer
Authors: Grogan M , Tabar L , Chua B , Chen H-H , Boyages J 
Published: March 2003

Abstract

Background
Prognostic factors are commonly used to help identify women with node-negative breast cancer at high risk of recurrence. Although many are available, knowing which risk factor or combination of factors to use to estimate prognosis for an individual woman is often difficult. This study documented the baseline prognoses for a group of women with node-negative breast cancers, and estimated the potential benefits of adjuvant systemic therapy.

Methods
Ten-year, actuarial, cause-specific survival based on tumour size and histological grade using data from the Swedish Two-County Trial of mammographic screening was calculated for 1200 women with node-negative cancers of less than 30 mm diameter. The benefits of adjuvant systemic therapy for these women were then estimated using the published odds reductions in death from adjuvant systemic therapy from the Early Breast Cancer Trialists' Collaborative Group overview.

Results
The absolute 10-year survival benefits for subgroups of women based on tumour size and histological grade were estimated for women aged under 50 years by the addition of chemotherapy, and over 50 years by the addition of tamoxifen and/or chemotherapy.

Conclusion
Decisions about adjuvant systemic therapy in women with node-negative breast cancer need to be individualized, taking into account treatment efficacy and toxicity. The quantitative methods presented in this paper facilitate such decisions.
Ileoanal pouch function is related to postprandial pouch tone
Authors: Steens J , Bemelman W A , Meijerink W J H J , Griffioen G , van Hogezand R A , Masclee A A M 
Published: March 2003

Abstract

Background
Functional impairments are frequently observed in patients with an ileoanal pouch. Meal ingestion increases pouch tone and motility. Little is known, however, about the influence of meal-stimulated pouch characteristics on pouch function. The aim was to characterize basal and postprandial pouch motor and sensory characteristics in relation to clinical pouch function in patients with an ileoanal pouch.

Methods
Nineteen patients with an ileoanal pouch, without faecal incontinence but with either a high stool frequency (n = 8) or an adequate stool frequency (n = 11), underwent pressure distension of the pouch, by which pouch compliance and sensitivity characteristics were assessed using an electronic barostat. A set pressure procedure was performed to assess the influence of a meal on pouch tone and motility.

Results
Mean(s.d.) compliance was 10(6) and 11(4) ml/mmHg in the groups with poor and adequate pouch function respectively (P not significant). Mean(s.d.) visual analogue scale scores (0–10 cm) for urge at the highest pressure of 28 mmHg were 2·3(1·0) versus 2·3(2·4) cm respectively (P not significant); those for pain were 0·8(1·0) versus 0·5(0·7) (P not significant). Postprandially mean(s.d.) pouch volume decreased by 70(24) per cent in the group with poor pouch function and 29(25) per cent in the group with adequate pouch function (P &lt; 0·01). The frequency and amplitude of phasic pouch contractions increased significantly postprandially, but no differences in motility characteristics were observed between the two groups.

Conclusion
In patients with uniform pouch design and follow-up after pouch construction, pouch compliance and sensitivity were no different between patients with normal and high stool frequency; however, postprandial pouch tone was increased significantly in patients with a high stool frequency.
‘Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery
Authors: Delaney C P , Fazio V W , Senagore A J , Robinson B , Halverson A L , Remzi F H 
Published: March 2003

Abstract

Background
A combination of factors has emphasized the need to reduce postoperative stay after surgery. Multimodal care plans may shorten hospital stay, but have been associated with high readmission rates and are generally reserved for straightforward, non-complicated colonic (not rectal) resections. This study evaluated a ‘fast track’ protocol in patients undergoing major colonic and rectal surgery.

Methods
Sixty consecutive patients (median age 44·5 (range 13–70) years) underwent major procedures over a 6-week period on one colorectal service. Nasogastric tubes and epidural anaesthesia were not used. Patients participated in a protocol of early diet and early ambulation, and were discharged after meeting defined criteria.

Results
Fifty-eight patients (97 per cent) were deemed suitable for the ‘fast track’ approach at the time of surgery and stayed for a mean(s.d.) of 4·3(1·6) days after operation. Patients in diagnosis-related group (DRG) 148 (colorectal resection with co-morbidity; n = 40) stayed for 4·6(1·7) days, which was longer than those in DRG 149 (without co-morbidity; n = 18) who stayed 3·5(0·8) days (P = 0·01). Three patients (5 per cent) required a nasogastric tube for vomiting. There were no readmissions directly attributable to ‘fast track’ failure, although four patients (7 per cent) were readmitted within 30 days of operation for other reasons. Eight poorly compliant patients stayed for 5·1(1·1) days (P = 0·02 versus compliant patients). ‘Fast track’ patients had a shorter length of stay than patients receiving traditional care on other colorectal services during the same time period (compared by DRG 148, DRG 149 and for all patients) (P &lt; 0·0001).

Conclusion
The ‘fast track’ protocol allows patients with high levels of co-morbidity undergoing complex colorectal and reoperative pelvic surgery to benefit from a rapid recovery and early discharge from hospital. The approach is safe and has low readmission rates.
Immune therapy in inflammatory bowel disease and models of colitis
Authors: Singh B , Powrie F , Mortensen N J McC 
Published: March 2003

Abstract

Background
A proliferation of animal models has not only improved our understanding of inflammatory bowel disease, it has also formed the basis of new treatment strategies.

Methods
A search was conducted using the National Library of Medicine for articles discussing immune therapies for inflammatory bowel disease. This was supplemented by findings from the authors' own laboratory.

Results
An overview of the different animal models is presented. These models are used to highlight the recent human trials of immune therapies. Potential future therapies are also discussed.

Conclusion
Immune therapies have altered the management of patients with inflammatory bowel disease. In future they will influence not only the indications for surgery but also its timing and outcome.
Rising incidence of post-transplant lymphoproliferative disease in kidney transplant recipients
Authors: Libertiny G , Watson C J E , Gray D W R , Welsh K I , Morris P J 
Published: March 2003

Abstract

Background
The purpose of this study was to determine whether the incidence of post-transplant lymphoproliferative disease (PTLD) has been increasing in renal transplant recipients in this centre.

Methods
Prospectively gathered data were analysed to establish trends in the epidemiology of PTLD in 1537 patients.

Results
Overall, PTLD occurred in 2·3 per cent of renal transplant recipients. An increase in its incidence coincided with the introduction of cyclosporin in the 1980s. However, there was a further increase in the incidence of PTLD in the 1990s when the only change in immunosuppressive policy was the abandonment of pretransplantation blood transfusion. The latter increase was particularly pronounced in patients with early-onset PTLD in whom it presented within 600 days after transplantation.

Conclusion
The incidence of PTLD has been increasing in renal transplant recipients. The recent increase appears to be independent of cyclosporin and may reflect the reduction in pretransplant blood transfusion. Changes in the incidence of PTLD may also mirror changes in the epidemiology of non-Hodgkin lymphoma in the general population.
Impact of total mesorectal excision on the results of surgery of distal rectal cancer
Authors: Law W L , Chu K W 
Published: March 2003

Abstract

Background
This study reviewed the results of surgery for distal rectal cancer (tumours within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution.

Methods
Two hundred and five patients who had undergone surgical resection of rectal cancer within 6 cm of the anal verge were included. The demographic, operative and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures.

Results
Abdominoperineal resection (APR) was performed in 27·8 per cent of patients, falling from 36·0 per cent in the first 3 years to 20·0 per cent in the last 3 years of the study. The overall operative mortality rate was 1·5 per cent and the morbidity rate 30·2 per cent. With a mean follow-up of 36 months, local recurrence occurred in 28 of the 185 patients who had curative resection. The 5-year actuarial local recurrence rates for double-stapled anastomosis, peranal coloanal anastomosis and APR were 11·2, 34·6 and 23·5 per cent respectively. The local recurrence rate was significantly lower for double-stapled low anterior resection than for the other types of operation. The overall 5-year survival rate in patients with low anterior resection and APR was 69·1 and 51·1 per cent respectively (P = 0·12).

Conclusion
With the practice of total mesorectal excision, APR was necessary in only 27·8 per cent of patients with rectal cancer within 6 cm of the anal verge. The local recurrence rate was much lower in patients with double-stapled low anterior resection than in those treated with APR or peranal anastomosis.
Plasma concentration of tissue inhibitor of matrix metalloproteinase 1 in patients with colorectal carcinoma
Authors: Yukawa N , Yoshikawa T , Akaike M , Sugimasa Y , Takemiya S , Yanoma S , Noguchi Y , Takanashi Y 
Published: March 2003

Abstract

Background
The expression of tissue inhibitor of matrix metalloproteinase (TIMP) 1 in tumour tissue from patients with colorectal carcinoma has been reported to be related to disease progression. However, the clinical significance of plasma TIMP-1 has not been fully elucidated.

Methods
The plasma level of TIMP-1 protein was determined by enzyme-linked immunosorbent assay in samples from 54 patients who underwent resection of the primary tumour.

Results
Plasma TIMP-1 levels were associated significantly with depth of invasion and metastasis to lymph nodes and liver. Circulating TIMP-1 levels were significantly higher in patients with serosal invasion, liver metastases and Dukes' stage C tumours. Using a cut-off value of 160 ng/ml, serosal invasion and Dukes' C stage could be predicted with an accuracy of 68·5 per cent. With a cut-off value of 170 ng/ml, metastasis to the lymph node and liver could be predicted with an accuracy of 66·7 and 70·4 per cent respectively. These values were greater than those for carcinoembryonic antigen and CA19-9.

Conclusion
These data suggest that the plasma concentration of TIMP-1 correlates with both invasion and metastasis in patients with colorectal carcinoma.
Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis
Authors: Tulchinsky H , McCourtney J S , Rao K V Subba , Chambers W , Williams J , Wilkinson K H , Nicholls R J 
Published: March 2003

Abstract

Background
The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken.

Methods
Twenty-five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty-two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview.

Results
Median operating time was 225 (range 170–340) min and median hospital stay was 15 (range 8–48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow-up was 22·5 (range 4–114) months. Median 24-h frequency before and after operation was 12 (range 4–20) and 6 (range 3–12) respectively, and median night-time frequency was 4 (range 0–8) and 0·5 (range 0–4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life.

Conclusion
Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch–rectal anastomosis should be avoided.
Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer
Authors: Camilleri-Brennan J , Steele R J C 
Published: March 2003

Abstract

Background
Little is known of how the quality of life of patients with rectal cancer changes after surgery, and whether or not quality of life is associated with and predictive of survival. The aims of this study were to address these issues.

Methods
The Medical Outcomes Study Short Form 36 (SF-36), and the European Organization for the Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 quality of life questionnaires were administered to patients before surgery for rectal cancer, on discharge home and at 3-month intervals after operation for up to 1 year. Survival was measured in days from the time of surgery to death.

Results
Sixty-five patients with a median age of 67 years participated. Most quality of life scores dropped significantly below baseline in the early postoperative period. From the third month onwards some scores, such as the global quality of life score and emotional function score on the QLQ-C30, improved. Other scores, including role function, fatigue and pain on the QLQ-C30, were similar to baseline values after 3–6 months and remained unchanged. However, scores such as sexual enjoyment and male sexual problems on the QLQ-CR38 were worse than baseline in the early postoperative period and remained poor thereafter. Stepwise regression analyses showed that preoperative quality of life dimension scores for physical function, nausea/vomiting and sexual enjoyment, together with age, predicted postoperative 1-year survival with an accuracy of 76·8 per cent.

Conclusion
The findings of this study confirm that quality of life after rectal cancer surgery changes with time. It is generally worst in the early postoperative period. Preoperative quality of life is a good predictor of survival at 1 year.
Randomized clinical trial of patient-controlled versus fixed regimen feeding after elective abdominal surgery
Authors: Han-Geurts I J M , Jeekel J , Tilanus H W , Brouwer K J 
Published: March 2003

Abstract

Background
Although studies have shown that early oral feeding after abdominal surgery is feasible, many surgeons still advocate a careful, slow introduction of postoperative oral feeding. This study was conducted to investigate whether patient-controlled postoperative feeding is possible in patients undergoing colonic or aortic surgery.

Methods
A randomized clinical trial compared patient-controlled postoperative oral feeding (PC group) with a fixed regimen (FR group). Patients in the PC group (n = 56) received oral feeding when they requested it; patients in the FR group (n = 49) started a normal diet on day 5. Endpoints were time to tolerance of a diet similar to the preoperative diet, reinsertion of a nasogastric tube, complications and duration of hospitalization.

Results
Median time to resumption of a normal diet was 3 days in the PC group and 5 days in the FR group (P &lt; 0·001). Reinsertion of a nasogastric tube was required in nine patients in each group (P not significant). The incidence of complications was similar in both groups: 12 of 56 in the PC group and 13 of 49 in the FR group. There was no significant difference in duration of hospital stay between the groups.

Conclusion
Most patients tolerate a normal diet on the third day after operation. Patient-controlled postoperative feeding is safe and leads to earlier resumption of a normal diet.
Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers
Authors: Meyer F J , Burnand K G , Lagattolla N R F , Eastham D 
Published: March 2003

Abstract

Background
Many venous ulcers are healed by the application of external compression. It has been suggested that bandages capable of producing greater compression enhance healing. The aim of this study was to compare the time to total healing of venous ulcers in two groups of patients treated with different compression regimens in a randomized prospective trial.

Methods
A total of 112 patients was studied and all were treated with a zinc-impregnated paste bandage applied directly to the ulcer. Fifty-seven patients had the paste covered by Tensopress™ and 55 by Elastocrepe™ bandages. Both groups had a tubular bandage applied over the top to retain the bandage in place. All ulcers were stratified and randomized within one of three size groups. The ‘venous’ aetiology of the ulcer was confirmed on completion by calf pump function tests.

Results
By 26 weeks, 58 per cent of the patients treated with Tensopress™ and 62 per cent of those treated with Elastocrepe™ bandages were healed. The median healing times were 9 and 9·5 weeks respectively. Similar numbers of patients were excluded or withdrawn from both groups. Large ulcers healed significantly more slowly than small ulcers.

Conclusion
There was no significant improvement in venous ulcer healing using higher compression elastic bandages.
Risk modelling study for carotid endarterectomy
Authors: Kuhan G , Gardiner E D , Abidia A F , Chetter I C , Renwick P M , Johnson B F , Wilkinson A R , McCollum P T 
Published: March 2003

Abstract

Background
The aims of this study were to identify factors that influence the risk of stroke or death following carotid endarterectomy (CEA) and to develop a model to aid in comparative audit of vascular surgeons and units.

Methods
A series of 839 CEAs performed by four vascular surgeons between 1992 and 1999 was analysed. Multiple logistic regression analysis was used to model the effect of 15 possible risk factors on the 30-day risk of stroke or death. Outcome was compared for four surgeons and two units after adjustment for the significant risk factors.

Results
The overall 30-day stroke or death rate was 3·9 per cent (29 of 741). Heart disease, diabetes and stroke were significant risk factors. The 30-day predicted stroke or death rates increased with increasing risk scores. The observed 30-day stroke or death rate was 3·9 per cent for both vascular units and varied from 3·0 to 4·2 per cent for the four vascular surgeons. Differences in the outcomes between the surgeons and vascular units did not reach statistical significance after risk adjustment.

Conclusion
Diabetes, heart disease and stroke are significant risk factors for stroke or death following CEA. The risk score model identified patients at higher risk and aided in comparative audit.
Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancer
Authors: Bergkvist L , Frisell J , Liljegren G , Celebioglu F , Damm S , Thörn M 
Published: March 2003

Abstract

Background
Sentinel node biopsy has recently evolved as a means of staging the axilla in breast cancer with minimal surgical trauma. The aim of this prospective multicentre study was to identify factors that influencd the detection and false-negative rates during the learning phase.

Methods
Data on all 498 sentinel node biopsies performed between August 1997 and December 1999 in Sweden were collected.

Results
A sentinel node was found in 450 patients (90 per cent). Preoperative scintigraphy visualized 83 per cent of all sentinel nodes. The detection rate was higher with same-day injection of tracer than with injection the day before (96 versus 86 per cent; P &lt; 0·01). Dye injected less than 5 min or more than 30 min before the start of the operation lowered the detection rate (less than 60 per cent versus more than 65 per cent; P = 0·02). The detection rate varied from 61 to 100 per cent between surgeons. The false-negative rate was 11 per cent. The presence of multiple tumour foci and a high S-phase fraction increased the risk of a false-negative sentinel node, whereas the number of operations performed by each surgeon was less important.

Conclusion
Training of the individual surgeon influenced the detection rate, as did timing of tracer and dye injection. The false-negative rate seemed to be related to biological factors.