bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advancement sleeve flaps for treatment of severe perianal Crohn's disease
Authors: Marchesa P , Hull T L , Fazio V W 
Published: March 2003

Abstract

Background
Traditionally proctectomy has been the treatment for severe, complex fistula in ano from Crohn's disease. However, based on the success of rectal advancement flaps in Crohn's disease, circumferential transanal sleeve advancement flaps (TSAFs) were proposed for this subgroup of patients with severe fistula.

Methods
From 1991 to 1995, 13 patients (12 women) with severe perianal Crohn's disease and multiple fistula tracts underwent a TSAF procedure. Data were collected retrospectively using a standard data sheet.

Results
There were no postoperative deaths or major morbidity. One year after surgery, the fistula had healed in eight of 13 patients (with three requiring additional surgery before healing). Of patients in whom the procedure failed, three underwent proctectomy for progression of disease and the other two had recurrence of a rectovaginal fistula 6 and 8 months after surgery. Of six variables evaluated (previous procedure, steroid use, steroid dosage, associated Crohn's disease, associated procedures and diverting stoma), only associated procedures were significantly related to a successful outcome (P = u0·008).

Conclusion
Some patients with severe perianal Crohn's fistula and a relatively normal rectum can be offered TSAFs. Even with successful outcome in eight of 13 patients, this may still be a viable option if the only alternative would be total proctocolectomy and a permanent stoma.
Genetic detection of lymph node micrometastases in patients with colorectal cancer
Authors: Dorudi S , Kinrade E , Marshall N C , Feakins R , Williams N S , Bustin S A 
Published: March 2003

Abstract

Background
Undetected micrometastases represent the single most important cause of treatment failure in patients undergoing putatively curative resection for colorectal cancer because current staging techniques are unable to identify patients with minimal residual disease.

Methods
A highly sensitive reverse transcription–polymerase chain reaction technique has been used to amplify tissue-specific messenger RNA from lymph nodes classified as tumour-free using both conventional histopathology and immunohistochemistry.

Results
Four of 15 patients were restaged after genetic diagnosis of lymph node micrometastases, while in a further two additional positive nodes were detected.

Conclusion
Sensitive genetic techniques that detect minimal residual disease merit further study, particularly as there is evidence that patients may benefit from adjuvant chemotherapy.
Experimental study of the effect of preoperative 5-fluorouracil on the integrity of colonic anastomoses
Authors: Kuzu M A , Köksoy C , Kale T , Demirpençe E , Renda N 
Published: March 2003

Abstract

Background
Despite curative resection for colorectal cancer, many patients develop recurrence at the primary site or distant organs. These patients are candidates for (neo)-adjuvant chemotherapy. Very little is known about the effect of preoperative 5-fluorouracil (FU) on the healing of colonic anastomoses. The aim of this study was to assess this in a rat model.

Methods
Eighty male Wistar rats, weighing 160–215 g, were divided into three groups; (1) a control group underwent left colon resection and primary anastomosis (n = 20); (2) a sham group received 1 ml saline intraperitoneally (n = 30); (3) a study group received 5-FU intraperitoneally (20 mg kg−1). Both saline and 5-FU injections were given intraperitoneally for 5 days before operation.

Results
There was no difference in the rate of wound complications, intraperitoneal adhesions and anastomotic complications among the groups. Three and seven days after operation, mean bursting pressure of the anastomosis was 36·5 and 198 mmHg in group 1, 34 and 200 mmHg in group 2, and 39 and 190 mmHg in group 3 respectively (P not significant). Although the myeloperoxidase and hydroxyproline content were significantly lower after 5-FU therapy (P &lt; 0·01, compared with others), the clinical outcome was similar.

Conclusion
Preoperative 5-FU for 5 consecutive days before operation had no effect on the healing of colonic anastomoses.
Acrylate yellow filters in operating lights protect against photosensitization tissue damage
Authors: Hinnen P , de Rooij F W M , Voortman G , Tilanus H W , Wilson J H P , Siersema P D 
Published: March 2003

Abstract

Background
Photosensitized patients are exposed to bright lights when undergoing intraoperative photodynamic therapy or fluorescence measurements. Acrylate yellow filters might reduce unwanted tissue damage.

Methods
To investigate the protective value of these filters, the spectral power distribution of the operating lights and light energy densities with and without an acrylate yellow filter were measured. Subsequently the effects of light exposure on the survival of a human hepatocellular carcinoma cell line and the photodamage induced in pig tissues after the administration of 5-aminolaevulinic acid were also studied.

Results
The light energy density in the ultraviolet and blue region of the light spectrum emitted by the operating light was reduced up to 50 per cent by the acrylate yellow filter. The survival of photosensitized cells was longer and photodamage induced in pig tissues was less when exposed to filtered light.

Conclusion
Photodamage induced by operating lights can be reduced by filtering out ultraviolet and blue light by means of acrylate yellow filters.
Haemobilia
Authors: Green M H A , Duell R M , Johnson C D , Jamieson N V 
Published: March 2003

AbstractBackgroundThis review aims to establish whether increased use of invasive procedures and the trend toward conservative management of major trauma has resulted in an increased incidence of haemobilia.MethodA Medline (http://igm.nlm.nih.gov/)-based search of the English language literature from January 1996 to December 1999 inclusive was performed using the keywords haemobilia, hemobilia, haematobilia and hematobilia. The presentation, aetiology, investigation, management and outcome of 222 cases were reviewed.ResultsTwo-thirds of cases were iatrogenic while accidental trauma accounted for 5 per cent. Haemobilia may be major, constituting life-threatening haemorrhage, or minor; it may present many weeks after the initial injury. Diagnosis is most commonly confirmed by angiography. Management is aimed at stopping bleeding and relieving biliary obstruction; 43 per cent of cases were managed conservatively and 36 per cent were managed by transarterial embolization (TAE). Surgery was indicated when laparotomy was performed for other reasons and for failed TAE. The mortality rate was 5 per cent.ConclusionsAlthough the incidence of iatrogenic haemobilia has risen considerably, the bleeding is often minor and can be managed conservatively. When more urgent intervention is required, TAE is usually the treatment of choice. There is no evidence that the conservative management of accidental liver trauma increases the risk of haemobilia.
Homocysteine and occlusive arterial disease
Authors: O'Grady H , Kelly C , Bouchier-Hayes D , Leahy A 
Published: March 2003

Abstract

Background
An increased plasma level of homocysteine has been proposed as an independent risk factor for atherosclerosis; this review examines the evidence.

Methods
A Medline search was undertaken for English language articles on homocysteine and vascular disease. Further papers were identified by cross-referencing from the reference lists of relevant major articles.

Results
Although much interest has been generated about homocysteine and atherosclerotic disease, contradictory data exist regarding its role in disease progression. There is insufficient current evidence to regard increased homocysteine level as a causative factor in atherosclerotic disease.

Conclusion
It is not known whether lowering plasma homocysteine concentration will reduce cardiovascular risk in the long term. Until such data become available, there is no evidence for the widespread use of folic acid therapy to reduce cardiovascular disease risk.
Permanent sacral nerve stimulation for treatment of idiopathic constipation
Authors: Kenefick N J , Nicholls R J , Cohen R G , Kamm M A 
Published: March 2003

Abstract

Background
Constipation can usually be managed using conservative therapies. A proportion of patients require more intensive treatment. Surgery provides variable results. This paper describes an alternative approach, in which the neural control of the bowel and pelvic floor is modified, using permanent sacral nerve stimulation.

Methods
Four women (aged 27–36 years), underwent temporary and then permanent stimulation. All had idiopathic constipation, resistant to maximal therapy, with symptoms for 8–32 years. Clinical evaluation, bowel diary, Wexner constipation score, symptom analogue score, quality of life questionnaire and anorectal physiology were completed.

Results
There was a marked improvement in all patients with temporary, and in three with permanent, stimulation. Median follow-up was 8 (range 1–11) months. Bowel frequency increased from 1–6 to 6–28 evacuations per 3 weeks. Improvement occurred, at longest-follow-up, in median (range) evacuation score (4 (0–4) versus 1 (0–4)), time with abdominal pain (98 (95–100) versus 12 (0–100) per cent), time with bloating (100 (95–100) versus 12 (5–100) per cent), Wexner score (21 (20–22) versus 9 (1–20)), analogue score (22 (16–32) versus 80 (20–98)) and quality of life. Maximum anal resting and squeeze pressures increased. Rectal sensation was altered. Transit time normalized in one patient.

Conclusion
Permanent sacral nerve stimulation can be used to treat patients with resistant idiopathic constipation.
Use of electrolysis as an adjunct to liver resection
Authors: Fosh B G , Finch J G , Lea M , Black C , Wong S , Wemyss-Holden S , Maddern G J 
Published: March 2003

Abstract

Background
Patients with hepatic metastases are potentially curable if all the diseased tissue can be resected. Unfortunately, only 10–20 per cent of patients are suitable for curative resection. Electrolysis is a novel non-thermal method of tissue ablation. When used in conjunction with surgery it may increase the number of resectable liver tumours with curative treatment.

Methods
All patients had been deemed inoperable using currently accepted criteria. Nine patients with hepatic deposits from colorectal carcinoma underwent combined surgical resection and electrolytic ablation of metastases.

Results
The treatment was associated with minimal morbidity. Within the electrolytically treated area seven patients had no radiological evidence of recurrence at a median follow-up of 9 (range 6–43) months; local recurrence was detected in two patients. Six of the nine patients had metastases elsewhere in the liver with four having extrahepatic metastases. Three patients remain tumour free. Three patients died. The median survival was 17 (range 9–24) months from the time of treatment.

Discussion
Electrolysis with resection may confer a disease-free and overall survival benefit. The small size of this initial study precludes statistical analysis, but preliminary results are encouraging.
Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer
Authors: O'Donnell C A , Fullarton G M , Watt E , Lennon K , Murray G D , Moss J G 
Published: March 2003

Abstract

Background
There is little evidence of the clinical and cost effectiveness of self-expanding metallic stents in the palliation of oesophageal cancer. The aims of this randomized trial were to evaluate the immediate and medium-term clinical outcomes following palliative intubation, examine patient quality of life, and evaluate costs and benefits from the perspective of the health service.

Methods
Fifty patients with inoperable oesophageal cancer were randomly allocated a metallic stent (n = 25) or plastic endoprosthesis (n = 25). Patients were followed up monthly until death.

Results
There was no significant difference in procedure-related complications or mortality rate between the two groups. There was a trend towards significance in favour of metallic stents with respect to quality of life and survival (median survival 62 versus 107 days for plastic prosthesis and metallic stent respectively). The cost of the initial placement of metallic stents was significantly higher than that of plastic endoprostheses (£983 versus£296). After 4 weeks, cost differences were no longer significant.

Conclusion
Metallic stents may contribute to improved survival and quality of life in patients with oesophageal cancer. Although initially more expensive, this cost difference does not last beyond 4 weeks. A larger trial involving approximately 300 patients would be required to detect a quality of life benefit of the magnitude observed in this trial.
Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation
Authors: Janßen H , Lange R , Erhard J , Malagó M , Eigler F W , Broelsch C E 
Published: March 2003

Abstract

Background
Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair.

Methods
A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months. Follow-up data were obtained from medical records and the outpatient service. Patients were evaluated for various clinical and surgical factors. Hernias were analysed with respect to localization, type of surgical repair and recurrence rate.

Results
Some 17 per cent of the transplanted patients experienced an incisional hernia. Risk factors were acute rejection with affiliated steroid bolus therapy (P = 0·025), a low platelet count after transplantation (P = 0·048), and a transverse abdominal incision with upper midline approach (P = 0·04). Hernias were mainly located at the junction of the transverse and midline incision (P &lt; 0·001) and the recurrence rate was highest here (P = 0·007). Prosthetic hernia repair achieved the lowest rate of recurrence and did not increase the incidence of infectious complications.

Conclusion
Improved immunosuppression should avoid early steroid bolus therapy after transplantation. A low platelet count promotes herniation. Transverse abdominal incision seems to be the best approach for liver transplantation. Prosthetic hernia repair does not increase the complication rate.
Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer
Authors: Ike H , Shimada H , Togo S , Yamaguchi S , Ichikawa Y , Tanaka K 
Published: March 2003

Abstract

Background
Multiple organ metastases from colorectal carcinoma may be considered incurable, but long survival after both liver and lung resection for metastases has been reported.

Methods
A retrospective analysis of 48 patients who underwent lung resection for metastatic colorectal cancer between 1992 and 1999 was undertaken. Twenty-seven patients had lung metastasis alone, 15 had previous partial hepatectomy, and six had previous resection of local or lymph node recurrence. The relationship of clinical variables to survival was assessed. Survival was calculated from the time of first pulmonary resection.

Results
Five-year survival rates after resection of lung metastasis were 73 per cent in patients without preceding recurrence, 50 per cent following previous partial hepatectomy and zero after resection of previous local recurrence. Independent prognostic variables that significantly affected survival after thoracotomy were primary tumour histology and type of preceding recurrence. There was no significant difference in survival after lung resection between patients who had sequential liver and lung resection versus those who had lung resection alone.

Conclusion
Sequential lung resection after partial hepatectomy for metastatic colorectal cancer may lead to long-term survival.
Predictive value of internal anal sphincter thickness for diagnosis of rectal intussusception in patients with solitary rectal ulcer syndrome
Authors: Marshall M , Halligan S , Fotheringham T , Bartram C , Nicholls R J 
Published: March 2003

Abstract

Background
The aim of this study was to determine any association between a thickened internal anal sphincter (IAS) on anal endosonography and high-grade rectal intussusception on evacuation proctography in patients with solitary rectal ulcer syndrome.

Methods
Anal endosonography was performed in 20 patients with solitary rectal ulcer syndrome and IAS thickness defined as normal or abnormal depending on age. Sphincter thickness was compared with the presence or absence of high-grade intussusception on subsequent evacuation proctography to determine any relationship between the two.

Results
Thirteen patients had an abnormally thick IAS, two of whom were unable to evacuate. Of the remaining 11 patients, ten showed high-grade intussusception (positive predictive value 91 per cent). Only three of seven patients with a normal IAS had high-grade intussusception (negative predictive value 57 per cent). Patients with a thick IAS were significantly more likely to have proctographic evidence of high-grade intussusception (P = 0·047).

Conclusion
Sonographic findings of a thick IAS are highly predictive for high-grade rectal intussusception in patients with solitary rectal ulcer syndrome.
Outcome of segmental colonic resection for slow-transit constipation
Authors: Lundin E , Karlbom U , Påhlman L , Graf W 
Published: March 2003

Abstract

Background
The standard surgical treatment for slow-transit constipation (STC) is subtotal colectomy and ileorectal anastomosis. A segmental resection may serve the same purpose, but with a reduced risk of side-effects such as diarrhoea or incontinence. The aim of this study was to evaluate the functional results following segmental resection in a consecutive series of patients with STC.

Methods
Selection criteria included prolonged segmental transit on oral 111In-labelled diethylene triamine penta-acetic acid scintigraphic transit study, and disabling symptoms resistant to medical therapy and treatment of outlet obstruction. Twenty-eight patients (26 women, median age 52 years) were treated with segmental resection and followed prospectively with a validated questionnaire.

Results
After a median of 50 (range 16–78) months, 23 patients were pleased with the outcome. The median (range) stool frequency increased from 1 (0–7) to 7 (0–63) per week (P &lt; 0·001). The number of patients passing hard stools and straining excessively decreased (P = 0·016 and P = 0·041, respectively). The median incontinence score was unchanged. Rectal sensory thresholds were higher in patients in whom the treatment failed (P &lt; 0·001).

Conclusion
With a symptomatic relief comparable to that after ileorectal anastomosis and less severe side-effects, segmental colectomy may be a better alternative for selected patients with STC. Thorough preoperative evaluation is important and impaired rectal sensation may predict a poor outcome.
Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival
Authors: Ohtsuka M , Ito H , Kimura F , Shimizu H , Togawa A , Yoshidome H , Miyazaki M 
Published: March 2003

Abstract

Background
The results of surgical treatment for intrahepatic cholangiocarcinoma (ICC) and specific factors influencing survival are still unclear.

Methods
Between 1984 and 2001, 62 patients with ICC underwent laparotomy, with a 77 per cent (48 patients) resectability rate. The tumours in these 48 patients were reviewed retrospectively to examine the relationship between gross appearance (mass forming, periductal infiltrating, intraductal growth, and mass forming plus periductal infiltrating) and patient survival, as well as the manner of recurrence. In patients with mass-forming and mass-forming plus periductal infiltrating types, univariate and multivariate analyses of potential prognostic factors were performed.

Results
The 1-, 3- and 5-year survival rates were 62, 38 and 23 per cent respectively. All patients with the intraductal growth type remained alive after intervals ranging from 8 to 72 months. Univariate analysis showed multiple hepatic lesions, liver capsule invasion, presence of cancer cells in the resection margin, and high serum carbohydrate antigen (CA) 19-9 level to be significant negative prognostic factors. Lymph node involvement, however, was not identified as a significant prognostic factor. With multivariate analysis, multiple hepatic lesions and high serum CA19-9 concentration were found to be significantly related to prognosis. The most frequent recurrence site was the remnant liver.

Conclusion
These results suggest that the intraductal growth type of tumour should be treated as a distinct entity compared with other types of ICC. Multiple tumours and high serum CA19-9 level were signs of dismal prognosis, whereas not all patients with lymph node involvement had a poor prognosis.
Cell kinetic status of haematopoietic stem cells
Authors: Mackey M. C. 
Published: March 2003

Abstract.The haematopoietic stem cell (HSC) population supports a tremendous cellular production over the course of an animal’s lifetime, e.g. adult humans produce their body weight in red cells, white cells and platelets every 7 years, while the mouse produces about 60% of its body weight in the course of a 2 year lifespan. Understanding how the HSC population carries this out is of interest and importance, and a first step in that understanding involves the characterization of HSC kinetics. Using previously published continuous labelling data (of Bradford et al. 1997 and Cheshier et al. 1999) from mouse HSC and a standard G0 model for the cell cycle, the steady state parameters characterizing these HSC populations are derived. It is calculated that in the mouse the differentiation rate ranges between about 0.01 and 0.02, the rate of cell re‐entry from G0 back into the proliferative phase is between 0.02 and 0.05, the rate of apoptosis from the proliferative phase is between 0.07 and 0.23 (all units are days−1), and the duration of the proliferative phase is between 1.4 and 4.3 days. These values are compared with previously obtained values derived from the modelling by Abkowitz and colleagues of long‐term haematopoietic reconstitution in the cat (Abkowitz et al. 1996) and the mouse (Abkowitz et al. 2000). It is further calculated using the estimates derived in this paper and other data on mice that between the HSC and the circulating blood cells there are between 17 and 19.5 effective cell divisions giving a net amplification of between ~170 000 and ~720 000.