bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre‐operative assessment of anal fistulas using endoanal ultrasound
Authors: Lengyel A. J. , Hurst N. G. , Williams J. G. 
Published: March 2003

AbstractObjective  To study the accuracy of endoanal ultrasound in pre‐operative assessment of cryptoglandular anal fistulas, with respect to the site of the internal opening, type and depth of the fistula tract.Patients and methods  A consecutive series of 151 patients with anal sepsis underwent pre‐operative endoanal ultrasound assessment of a suspected anal fistula. Hydrogen peroxide was used to define the tract when there was doubt as to the course of the fistula. All patients subsequently had surgical exploration under anaesthesia, irrespective of findings at sonography. The site of the internal opening, depth and type of fistula were recorded at surgery, and concordance with the ultrasound was assessed.Results  One hundred and forty‐five patients were subsequently shown to have a fistula at surgical exploration. Type of fistula: Two thirds were transsphincteric (63%) and one third were inter sphincteric (32%), with a few submucosal, and supra sphincteric fistulas. Ultrasound correctly predicted surgical findings in 82% of patients (124/151). Concordance was highest for transsphincteric fistulas (87%). Internal opening: Accuracy of predicting the site of the internal opening was 93% (140/151). The commonest site for the internal opening was the midline posteriorly (49%), followed by the midline anteriorly (25%), the rest lay laterally. Fistula depth: Ultrasound and surgical assessment of the depth of fistulas was concordant in 120 of 145 patients (83%).Conclusions  Endoanal ultrasound has a high accuracy of predicting the site of internal opening of an anal fistula. Endoanal ultrasound is able to assess the type and depth of a fistula. This information is useful for pre‐operative planning of fistula treatment.
Patients with familial adenomatous polyposis experience better bowel function and quality of life after ileorectal anastomosis than after ileoanal pouch
Authors: Günther K. , Braunrieder G. , Bittorf B. R. , Hohenberger W. , Matzel K. E. 
Published: March 2003

AbstractObjective  To evaluate the quality of life with emphasis on bowel function in patients undergoing either total colectomy with ileorectal anastomosis (IRA) or restorative proctocolectomy with ileal pouch‐anal anastomosis (IPAA) for familial adenomatous polyposis (FAP).Patients and methods  All 151 patients operated on in our department between 1971 and 2000 were analysed retrospectively. Since 42 patients had to undergo reoperations, a total of 194 bowel procedures were performed. The final operative breakdown was: 48 IRA, 62 IPAA, 33 total proctocolectomies and 8 other procedures. By the end of the period under consideration, 40 patients had died, 28 had been lost to follow‐up, 83 patients were still alive and of these 76 were analysed. Continence function and quality of life with emphasis on overall bowel function (Wexner (WS)‐, Jostarndt (JS)‐, Öresland (ÖS)‐ and Pemberton (PS)‐scores) were recorded in 59 patients (22 IRA and 37 IAP).Results  Continence and bowel function were significantly better after IRA than after IPAA (mean scores: WS, 1.1 vs 5.4, P = 0.001; JS, 32.5 vs 24.7, P = 0.0001; ÖS, 2.9 vs 7.9, P = 0.0001), as was quality of life (PS, 25.6 vs 19.6, P = 0.001). The mean values for each single item of all 4 scores were consistently better after IRA. Neither gender, age nor type of pouch‐anal anastomosis (stapled vs hand‐sewn) had a significant influence on outcome. IPAA patients with uneventful follow‐up (n = 27) had better mean values for all 4 scores (WS, 4.2 vs 7.3; JS, 26.1 vs 23.1; PS, 20.4 vs 17.7; ÖS, 6.6 vs 9.9) than those with postoperative complications (n = 10; 27%), but statistical significance was reached only in the ÖS (P = 0.026). No such difference was seen after IRA (14% complication rate).Conclusion  The significantly better continence after IRA resulting in superior patient comfort and quality of life must be balanced against the oncological disadvantage of this procedure. On the basis of large patient population studies, genotype‐phenotype correlations with respect to the risk for rectal cancer may need to be taken into account. Postoperative complications may have a lasting negative effect on outcome after IPAA.
Cilostazol, a phosphodiesterase inhibitor, improves insulin sensitivity in the Otsuka Long‐Evans Tokushima Fatty Rat, a model of spontaneous NIDDM
Authors: Nakaya Y. , Minami A. , Sakamoto S. , Niwa Y. , Ohnaka M. , Harada N. , Nakamura T. 
Published: March 2003

Summary Aim: Angiotensin converting enzyme inhibitors and α1‐adrenergic blockers improve insulin sensitivity, the mechanism of which was considered, at least in part, to be due to the increased blood flow to muscle. The present study aimed to clarify whether cilostazol, a phosphodiesterase inhibitor, improves insulin sensitivity in a model of spontaneous non‐insulin dependent diabetes mellitus (NIDDM), Otsuka Long‐Evans Tokushima Fatty (OLETF) rat. Methods: OLETF rats were divided into the two groups at the age of 16 weeks: the cilostazol‐supplemented group (cilostazol 40 mg/kg/day) and the normal‐diet group. As a non‐diabetic control, we used Long‐Evans‐Tokushima‐Otsuka rats (non‐diabetic rats). Oral glucose tolerance test and hyperinsulinemic euglycemic clamp was performed at the ages of 23 and 25 weeks, respectively. Serum levels of lipids and leptin were measured. Results: Body weight and abdominal fat was increased in OLETF rats but cilostazol supplementation did not alter them. Insulin sensitivity, as measured by the hyperinsulinemic euglycemic clamp technique, was significantly decreased in OLETF rats (glucose infusion rate: 73.5 ± 10.0 vs. 41.5 ± 9.8 μmol/min/kg body weight, p < 0.01). Cilostazol supplementation improved insulin sensitivity partially but significantly 51.0 ± 5.7 μmol/min/kg body weight, p < 0.05) in OLETF rats at 25 weeks of age, although it did not decrease serum levels of glucose, lipids or leptin. However, this effect was not observed in non‐diabetic rats. Conclusion: Cilostazol, which is used in diabetic patients for the treatment of obstructive disease of artery, is expected to have a beneficial effect on insulin sensitivity in NIDDM.
Non‐enzymatic glycation of lens proteins and haemoglobin–inhibition by pyruvate: an in‐vivo study
Authors: Devamanoharan P. S. , Ali A. H. , Varma S. D. 
Published: March 2003

Summary Aim: Previous studies have demonstrated that pyruvate can prevent protein glycation and oxidative stress under in‐vitro conditions. The aim of this study was to examine the in‐vivo effectiveness of this metabolite against glycation of lens crystallins and haemoglobin in galactosemic rats. Methods: Sprague‐Dawley rats were maintained on a 30% or 50% galactose‐containing diet in the absence or presence of 2% or 5% pyruvate in food and water, respectively. The animals were killed subsequently and the extent of glycation of lens crystallins and haemoglobin was determined using an affinity column chromatograpic technique. Results: Maintenance of rats on the high galactose diet resulted in a significant increase in glycation of both the proteins. The increase was faster and more substantial in the animals maintained on the 50% galactose diet than that in the animals fed a 30% galactose diet. The increase in the latter was also very significant. Supplementation with pyruvate inhibited the process. Conclusion: The inhibition is attributable to a competitive binding of pyruvate to the protein NH2 groups as well as to the antioxidant effect of the compound. The studies therefore suggest that this and other α‐keto‐acids may be physiologically useful in minimizing glycation and oxidative stress induced tissue pathology by the hyperglycaemic conditions, such as diabetes and galactosemia. The results are also considered pharmacologically significant.
Leptin concentrations are related to glycaemic control, but do not change with short‐term oral antidiabetic therapy in female patients with type 2 diabetes mellitus
Authors: Güler S. , & B. ,   Ccedilakır, Demirba$scedil B. , Gürsoy G. , Serter R. , Aral Y. 
Published: March 2003

SummaryThis study evaluated the relation of leptin with glycaemic control and the effect of 14 days of diet, or diet combined with gliclazide, glipizide‐GITS or metformin treatment, on leptin concentration in 51 female patients with type 2 diabetes mellitus. Leptin levels were similar both at baseline and after treatment in diabetic and control groups. Diabetic patients with basal fasting plasma glucose (FPG) < 10 mmol/l or with basal postprandial plasma glucose (PPPG) < 13.9 mmol/l had significantly higher leptin levels than diabetic patients with basal FPG ≥ 10 mmol/l or with basal PPPG ≥ 13.9 mmol/l (19.6 ± 8.7 vs. 13.65 ± 5.4 μg/l, p < 0.05; and 20.2 ± 7.9 vs. 12.9 ± 5.2 μg/l, p < 0.05, respectively). Mode of treatment did not influence leptin levels. Δ leptin showed a weak correlation with basal FPG (r = 0.346; p < 0.05), basal and post‐treatment PPPG (r = 0.335, p < 0.05 and r = 0.325, p < 0.05, respectively) and a moderate correlation with post‐treatment FPG (r = 0.391, p < 0.01). In conclusion, leptin level is not affected by the presence of type 2 diabetes mellitus and by short‐term treatment with diet or oral antidiabetic drugs but is directly related to glycaemic control in female patients with type 2 diabetes mellitus.
Energy metabolism and substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin
Authors: Avignon A. , Lapinski H. , Rabasa‐Lhoret R. , Caubel C. , Boniface H. , Monnier L. 
Published: March 2003

SummaryObjective: To compare substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin. Methods: Plasma glucose (PG), plasma insulin (PI) and substrates oxidation rates measured by indirect calorimetry were compared during a test day at 8.00 a.m. (before breakfast), 11.00 a.m. (before the lunch), 2.00 p.m. (2 h after the lunch) and at 5.00 p.m. in 56 diabetic patients treated with diet (group C, n = 14), sulphonylurea (group S, n = 14) or with a sulphonylurea‐metformin combination (group SM, n = 28). Results: The three groups were comparable for age, body mass index (b.m.i.), body composition and PG levels. Mean glucose oxidation (Gox) was increased since mean lipid oxidation (Lox) was decreased in group S in comparison both with group C (3.02 ± 0.08 vs. 2.62 ± 0.08 g/min/kg/103, p < 0.05; 0.53 ± 0.04 vs. 0.88 ± 0.09 g/min/kg/103, p < 0.01). Mean Lox was also decreased in group S in comparison with group SM (0.88 ± 0.06 vs. 0.53 ± 0.04 g/min1/kg1/103, p< 0.0001) whereas the difference in Gox between these latter two groups was only significant in the basal state (1.94 ± 0.17 vs. 2.47 ± 0.17 g/min1/kg1/103, p< 0.05). Mean respiratory quotient (RQ) was increased in group S (0.90 ± 0.01) in comparison both with group C (0.86 ± 0.01, p < 0.001) and with group SM (0.86 ± 0.01, p < 0.001). Mean energy expenditure was lower in group S than in group SM (21.4 ± 0.6 vs. 23.6 ± 0.6 kcal/min/kg/103, p < 0.05). Substrates oxidative patterns, RQ values and energy expenditure were similar in group C and in group SM. Conclusions: When compared to patients treated with a sulphonylurea‐metformin bitherapy, patients treated with a sulphonylurea monotherapy have a shift in their ratio of fat to carbohydrate oxidation that could make body weight loss more difficult in this latter group.
Implications of cardiovascular risk in patients with type 2 diabetes who have abnormal lipid profiles: is lower enough?
Authors: Garber Alan J. 
Published: March 2003

AbstractPatients with type 2 diabetes are at high risk for coronary heart disease (CHD); frequently, these patients have abnormal lipid profiles, placing them at even greater risk. A syndrome of insulin resistance, hyperinsulinaemia, hypertension, and high levels of fibrinogen and plasminogen activator inhibitor contributes to cardiovascular risk, which is not sufficiently decreased by glycaemic control alone. In several large interventional trials, CHD risk in patients with diabetes was substantially reduced by aggressive lipid‐lowering therapy. In patients with diabetes, CHD, low high‐density lipoprotein levels, and normal low‐density lipoprotein levels, gemfibrozil reduced fatal and non‐fatal CHD events. For lipid‐lowering in patients with diabetes and CHD, pravastatin and simvastatin are the only HMG‐CoA reductase inhibitors shown to reduce fatal and non‐fatal CHD events. Of these, pravastatin has less potential for drug–drug interactions and may be safer to use, particularly for combination therapy with fibric acid derivatives, as may now be important for CHD prevention in mixed dyslipidaemias.
The impact of cerebrovascular disease
Authors: Brass Lawrence M. 
Published: March 2003

AbstractStroke may be affected by pathologic conditions such as atherosclerosis, vascular injury, coagulopathy, and increased platelet aggregability. Knowledge of the pathophysiology of stroke is critical in order to effectively prevent or treat this disabling state.Cerebrovascular disease is the third leading cause of death in the USA. It is also associated with significant morbidity, leading to extremely high health care costs and lost productivity. Total estimated costs of stroke are estimated to be more than $45 billion annually. This is an especially important issue for patients with diabetes, who are at higher risk for stroke and have a worse clinical outcome than non‐diabetic patients.This review describes the impact of vascular disease, particularly cerebrovascular disease, and describes the pathophysiology of the disease. Interventions that result in reduction of stroke will likely result in decreased health care costs and improved clinical outcomes.
Nateglinide improves glycaemic control when added to metformin monotherapy: results of a randomized trial with type 2 diabetes patients
Authors: Marre M. , Van Gaal L. , Usadel K‐H. , Ball M. , Whatmough I. , Guitard C. 
Published: March 2003

Aims/hypothesis: This study evaluated the addition of nateglinide, a d‐phenylalanine derivative that restores early phase insulin release, to metformin in type 2 diabetes patients stabilized on high‐dose metformin.Methods: This multicentre, double‐blind, parallel group trial included 467 metformin‐treated patients with glycosylated haemoglobin (HbA1c) between 6.8% and 11%. Patients were randomized to add nateglinide 60 mg, 120 mg or placebo before three meals to metformin 1000 mg b.i.d. for 24 weeks.Results: HbA1c was significantly reduced with nateglinide 60 mg and 120 mg plus metformin compared with metformin control (−0.36%, p = 0.003; −0.59%, p < 0.001 respectively). Greater benefits occurred if patients had elevated HbA1c at baseline (−1.38% with nateglinide 120 mg in patients with HbA1c > 9.5%). A modest fasting plasma glucose reduction was observed. Most symptoms suggestive of hypoglycaemia occurred in patients with low HbA1c levels (≤ 8%) at baseline, although no confirmed cases of hypoglycaemia occurred with nateglinide 60 mg in this patient group. Events suggestive of hypoglycaemia were confirmed in 1.1% of cases (plasma glucose ≤ 3.3 mmol/l). Weight gain over 24 weeks was 0.9 kg with nateglinide 120 mg vs. metformin alone, and plasma lipids remained unchanged.Conclusions/interpretation: In patients stabilized on high‐dose metformin, the addition of nateglinide improved glycaemic control. The combination of these agents was well tolerated and both doses of nateglinide proved effective. The efficacy of nateglinide 60 mg and the low rate of hypoglycaemia observed at this dose make it suitable for patients close to their therapeutic target on metformin monotherapy.
Glucose screening during active labour for the detection of undiagnosed hyperglycaemia and newborn malformations in a population without prenatal care
Authors: Hernandez‐Valencia M. , Carrillo Pacheco A. 
Published: March 2003

Aim: This prospective study was undertaken to look at the frequency of hyperglycaemia in pregnant women who were without health benefits and did not receive prenatal specialist care, and to examine the relationship between fetal complications and the prenatal care received.Methods: The subjects consisted of 304 pregnant women, divided into two groups. Group I included 176 women who had inadequate prenatal care (73 women with irregular care, and 103 women without any specialist care.) with a mean of 1.1 visits to a specialist. Group II included 128 women who had regular prenatal care with a mean of 6.5 consultations per patient.Results: There were no statistical differences between the two groups in relation to maternal age, obstetrical history and gestational weeks. The familial antecedent of diabetes was found in 30.1% of women in group I and 19.5% of women in group II (p < 0.05). Hyperglycaemia was found in 55 (31.2%) patients in group I and 4 (3.1%) patients in group II (p < 0.001) with mean blood glucose levels of 163 and 130 mg/dL respectively. Clinical characteristics of newborns show statistically significant increased abnormalities in 15.9% of babies whose mothers had inadequate prenatal care vs. 3.9% of babies whose mothers had regular prenatal care. The abnormalities seen were myelomeningocele, cleft lip and palate, oesophageal atresia, polydactyly, phocomelia and encephalocele.Conclusions: The frequency of hyperglycaemia in pregnant women with inadequate prenatal care was higher than in pregnant women with regular prenatal care. Additionally newborn abnormalities and complications occurred more frequently in babies of mothers with inadequate prenatal care. The benefits of prenatal care are evident and it is important to improve and start instituting new programmes and ways of making health information available to women in primary care clinics to educate the general population and stress the importance of regular visits to a prenatal care specialist.
Glyburide/metformin combination product is safe and efficacious in patients with type 2 diabetes failing sulphonylurea therapy
Authors: Blonde L , Rosenstock J , Mooradian A. D. , Piper B‐A. , Henry D. 
Published: March 2003

Aim: To compare the efficacy, safety and tolerability of a fixed combination glyburide/metformin preparation with those of glyburide or metformin alone in patients with type 2 diabetes inadequately controlled by sulphonylurea, diet and exercise.Methods: In this 16‐week, randomized, double‐blind, parallel group study, 639 patients with inadequate glycaemic control on at least half‐maximal dose of sulphonylurea were randomly assigned to: glyburide 10 mg b.i.d. (n = 164); metformin 500 mg (n = 153); glyburide/metformin 2.5 mg/500 mg (n = 160); or glyburide/metformin 5 mg/500 mg (n = 162). Titration was allowed to maximum doses of 2000 mg for metformin or 10 mg/2000 mg and 20 mg/2000 mg for glyburide/metformin 2.5 mg/500 mg and 5 mg/500 mg respectively. The primary outcome measure was HbA1c level after 16 weeks; secondary end‐points included fasting and 2‐h post‐prandial plasma glucose. Adverse events (AEs) were recorded and summarized by treatment group.Results: Both strengths of glyburide/metformin equally reduced mean HbA1c by 1.7% more than did glyburide alone (p < 0.001), and by 1.9% more than did metformin alone (p < 0.001). Final mean fasting plasma glucose concentrations were also lower in both glyburide/metformin groups than in the glyburide (−2.8 mmol/l, −51.3 mg/dl; p < 0.001) and metformin groups (−3.6 mmol/l, −64.2 mg/dl; p < 0.001). Safety and tolerability were similar across all treatment groups, except for a higher incidence of gastrointestinal AEs in the metformin monotherapy group, and more patients reporting mild or moderate symptoms of hypoglycaemia while taking glyburide/metformin.Conclusions: Both glyburide/metformin tablet strengths produced, with equal efficacy, significantly better glycaemic control than monotherapy with either agent. These data also confirm that glycaemic efficacy does not require maximal sulphonylurea doses in combination with metformin.
Influence of treatment with acarbose or glibenclamide on insulin sensitivity in type 2 diabetic patients
Authors: Fischer S. , Patzak A. , Rietzsch H. , Schwanebeck U. , Köhler C. , Wildbrett J. , Fuecker K. , Temelkova‐Kurktschiev T. , Hanefeld M. 
Published: March 2003

Aim: The aim of our double‐blind, placebo‐controlled study was to compare the effect of acarbose and glibenclamide on the insulin sensitivity in type 2 diabetes.Methods: We investigated 77 patients (mean age 58.7 years, mean BMI 27.3 kg/m2), treated by diet alone for at least 4 weeks. The subjects were randomized into three treatment groups for 16 weeks: 100 mg t.i.d. acarbose (n = 25) or 1 mg t.i.d. glibenclamide (n = 27) or one t.i.d. placebo (n = 25). Before and after therapy, the levels of fasting plasma glucose, glycosylated haemoglobin, fasting insulin, plasma glucose and insulin 1 h after a standardized breakfast were measured and insulin sensitivity determined by euglycaemic hyperinsulinaemic clamp test.Results: After the treatment period, BMI in the acarbose and placebo group decreased significantly, whereas in the glibenclamide group a significant increase was observed. Fasting plasma glucose was only significant reduced under glibenclamide. The postprandial glucose decreased significantly after acarbose (13.8 vs. 11.4 mmol/l, p < 0.05) and glibenclamide treatment (14.6 vs. 11.4 mmol/l, p < 0.05) and was unchanged under placebo (13.8 vs. 13.7 mmol/l). The fasting insulin levels remained unchanged in all three groups, whereas postprandial insulin values increased significantly under glibenclamide. Neither acarbose nor glibenclamide significantly changed insulin sensitivity [acarbose: glucose disposal rate before treatment 2.3 mg/kg body weight/min/insulin, after treatment 3.2; glibenclamide 2.2 vs. 2.1; placebo 2.6 vs. 3.0].Conclusions: Our results show a more substantial improvement of glucose control under glibenclamide than under acarbose which, however, was not associated with an increase of insulin sensitivity.
Morphology of the bourgueticrinid and isocrinid aboral nervous system and its possible phylogenetic implications (Echinodermata, Crinoidea)
Authors: Bohn J. M. , Heinzeller T. 
Published: March 2003

Bohn, J. M. & Heinzeller, T. 1999. Morphology of the bourgueticrinid and isocrinid aboral nervous system and its possible phylogenetic implications (Echinodermata, Crinoidea). —Acta Zoologica (Stockholm) 80: 241‐249.On the basis of semithin serial sections the aboral nervous system within the calyx of five bourgueticrinid and one isocrinid species was reconstructed using the computer programm NIH Image. The aboral nervous system of all bourgueticrinids belongs to a common type which is proposed to be called ‘Bathycrinus‐type’ (B‐type), that differs from the ‘Isocrinus‐type’ (I‐type). The morphology of the B‐type and the I‐type are described and differences are discussed. Together with the B‐type there are now six aboral nervous system types well established and the consequences regarding phylogeny are discussed. Conclusions: 1) The morphology of the aboral nervous system may be a useful tool for the clarification of relationships between crinoid groups; 2) All known aboral nervous system types can be derived from the I‐type, which seems to be the most primitive one; 3) The B‐type aboral nervous system is probably a synapomorphic feature charac‐terizing a monophyletic group within the Bourgueticrinida.