bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cloning of Baeyer‐Villiger monooxygenases from Comamonas, Xanthobacter and Rhodococcus using polymerase chain reaction with highly degenerate primers
Authors: Van Beilen Jan B. , Mourlane Frédéric , Seeger Markus A. , Kovac Jasminka , Li Zhi , Smits Theo H. M. , Fritsche Urban , Witholt Bernard 
Published: March 2003

SummaryTo clone novel type 1 Baeyer‐Villiger monooxygenase (BVMO) genes, we isolated or collected 25 bacterial strains able to grow on alicyclic compounds. Twelve of the bacterial strains yielded polymerase chain reaction (PCR) fragments with highly degenerate primers based on the sequences of known and putative BVMOs. All these fragments were found to encode peptides homologous to published BVMO sequences. The complete BVMO genes and flanking DNA were cloned from a Comamonas, a Xanthobacter and a Rhodococcus strain using the PCR fragments as probes. BVMO genes cloned from the first two strains could be expressed to high levels in Escherichia coli using standard expression vectors, and the recombinants converted cyclopentanone and cyclohexanone to the corresponding lactones. The Rhodococcus BVMO, a putative steroid monooxygenase, could be expressed after modification of the N‐terminal sequence. However, recombinants expressing this protein did not show activity towards progesterone. An esterase homologue located directly upstream of the Xanthobacter BVMO gene and a dehydrogenase homologue encoded directly downstream of the Comamonas sp. NCIMB 9872 BVMO gene were also expressed in E. coli and shown to specify lactone hydrolase and cyclohexanol dehydrogenase activity respectively.
Confirmation of complete colonoscopy without intubation of the ileum
Authors: Clark  , Rocker  , Reddy  , Aslam  , Owen  
Published: March 2003

ObjectivesTo establish whether biopsy of the ileocaecal valve from the caecum provides an alternative to the more technically demanding procedure of terminal ileal intubation and biopsy to document completion of colonoscopy.Subjects and methodsFifty‐three patients underwent colonoscopy at which the terminal ileum was intubated and biopsied and, after withdrawal of the endoscope tip into the caecum, the ileocaecal valve was then biopsied. To replicate the situation in which the ileum is not intubated, another group of 30 patients had ileocaecal valve biopsies taken from the caecum before ileal intubation was attempted.ResultsAll of the terminal ileal biopsies obtained before ileocaecal valve biopsy showed small bowel mucosa, as did 51 (96%) of the ileocaecal valve specimens from this group. When ileocaecal valve biopsy was obtained first, 16 (53%) specimens contained small bowel mucosa.ConclusionIleocaecal valve biopsies were significantly more likely to yield small bowel mucosa if taken after ileal intubation (P < 0.001, Fisher’s exact test). Nevertheless, about half of ileocaecal valve biopsies taken without ileal intubation contained small bowel mucosa, providing evidence of complete colonoscopy in these cases. Terminal ileal intubation and biopsy, however, remains the only reliable way to document complete colonoscopy.
The unopened loop ileostomy
Authors: Woodcock  , Qureshi  , MacFie  
Published: March 2003

ObjectiveA defunctioning loop ileostomy is often fashioned to protect distal colorectal anastomoses, with the aim of limiting the effect of any breakdown that may occur. However, its creation and subsequent closure may be associated with significant morbidity. The aim of this study was to evaluate the alternative use of an unopened loop ileostomy.Patients and methodsPatients undergoing colorectal resection and distal anastomosis were given an unopened loop ileostomy instead of a conventional ileostomy. Any complications associated with the stoma and ease of closure were recorded for each patient.ResultsComplications occurred in seven (58%) of the 12 patients included in the study. Replacement of the ileal loop was difficult in five patients, one patient developed a wound abscess and pseudomembranous colitis, and a further patient had a persistent post‐operative pyrexia of unknown cause.ConclusionDespite the theoretical advantages of an unopened loop ileostomy, the results of this small study do not support the routine use of such a stoma as an adjunct to high risk colorectal anastomoses.
The benefit of geriatric intervention in surgery—increased throughput does not necessarily need more beds
Authors: Dunn R. B. , Lewis P. A. , Allen S. , Britton D. C. , Williamson M. E. R. 
Published: March 2003

ObjectiveThree years ago a consultant geriatrician began regular visits to the coloproctology and general surgery wards of an acute Trust every weekday, to assist staff with the medical management, rehabilitation and discharge planning of patients aged 65 years and above. The length of stay of these patients in the first 10 months of the appointment was compared with younger concurrent controls and with historical controls in the preceding 10 months.ResultsThe mean length of stay for the 4146 patients aged 16 years and above in a 10‐month intervention period was 1.3 days shorter (95% confidence interval (CI) 0.86–1.74 days) than for the 4002 patients in the 10‐month control period. This pattern was consistent across all ages and types of surgery, including major colorectal resection.ConclusionThere was an important benefit to the availability of coloproctology and general surgical beds in this acute Trust. More efficient rehabilitation of elderly patients reduces ‘bed blockage’ post‐operatively, and allows more effective use of available resources. Co‐ordination of the geriatric service with the specialized stoma support service allows earlier discharge of the elderly, and their relocation to appropriate premises where long‐term changes in bowel habit and problems with stoma care can be managed away from the acute surgical unit.
Does anorectal manometry predict clinical outcome after laparoscopic ACE procedures in children with spina bifida?
Authors: Wing N. A. , Findlay F. J. , Beasley S. W. , Frizelle F. A. , Dobbs B. R. , Robertson R. W. 
Published: March 2003

PurposeThe laparoscopic antegrade continence enema (LACE) procedure is used for the treatment of faecal incontinence in children with spina bifida. The purpose of this study was to relate the outcome of the LACE procedure to anorectal function, as determined by anorectal manometry.MethodEleven children with spina bifida who had the LACE procedure underwent anorectal manometry (ARM) to document their anorectal function, and its relationship to the level of continence obtained following surgery.ResultsThere was a consistently high level of functional continence achieved following surgery despite wide variability in the parameters of anorectal manometry. There was no demonstrable correlation between the outcome of the LACE procedure and anorectal function as assessed by manometry.ConclusionAnorectal function as determined by manometry failed to predict outcome after the laparoscopic ACE procedure in children with spina bifida.
Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma
Authors: Merkel S. , Wang W. Y. , Schmidt O. , Dworak O. , Wittekind CH. , Hohenberger W. , Hermanek P. 
Published: March 2003

ObjectiveAnastomotic leakage is a serious complication after anterior resection for rectal carcinoma. It is controversial whether anastomotic leakage influences the rate of locoregional recurrence and therefore survival.Patients and methodsThe data of 940 patients with invasive rectal carcinoma stage I–III treated by curative anterior resection from 1978 to 1996 at the Department of Surgery of the University of Erlangen were analysed. Patients who received neoadjuvant or adjuvant treatment were excluded as well as patients who died postoperatively. 89 out of 814 patients (10.9%) developed an anastomotic leakage after anterior resection.ResultsThe rate of locoregional recurrence during the first five postoperative years of all patients was 13.6%. In patients with anastomotic leakage the rate of locoregional recurrence was 22.0%, significantly higher than in patients without anastomotic leakage which was 12.5%, (P=0.018). On multivariate Cox regression analysis anastomotic leakage was shown to be an independent risk factor for locoregional recurrence (relative risk: 1.7, CI 95%: 1.02–2.75, P=0.042). Also cancer‐related survival was influenced significantly by anastomotic leakage in univariate analysis as well as in multivariate analysis (relative risk: 1.6, CI 95%: 1.1–2.2, P=0.017).ConclusionAnastomotic leakage after anterior resection for rectal carcinoma is a risk factor for locoregional recurrence and decreases cancer‐related survival.
Non‐specific colitis, is it a justifiable diagnosis?
Authors: Haboubi N. Y. , Kamal F. 
Published: March 2003

ObjectiveThe terms non‐specific and chronic colitis are often used by histopathologists. The aim of this study is to look into the validity of the label non‐specific chronic colitis (NSCC), the consistency of its reporting, as well as its clinical usefulness in patients who, on review, have shown to have normal biopsies.MethodsColonic and rectal biopsies from 35 patients who presented with acute onset diarrhoea, were initially diagnosed as nonspecific chronic colitis (NSCC) by a number of pathologists in one Department, and were reviewed by an outside pathologist (NYH) without the knowledge of the clinical details. A previously described set of histological criteria in reporting colonic biopsies in inflammatory conditions were used.ResultsNormal biopsies were found in 13 of the 35 patients (37%). These patients recovered without clinical intervention. In a further seven patients there was active inflammation with no features of chronicity, in 12 patients there were features of chronicity, in two patients there were hyperplastic polyps, and in one patient there were features of solitary ulcer syndrome.ConclusionNSCC was used, without consistency, to cover a variety of conditions, including normal biopsies, sometimes relaying a wrong message. We suggest that histological criteria for chronicity should be adhered to when this label is used and the term Non‐Specific Colitis should no longer be used.
Bacterial translocation in a non‐lethal rat model of peritonitis
Authors: Yao V. , Cooper D. , McCauley R. , Platell C. , Hall J. 
Published: March 2003

BackgroundBacterial translocation from the gut may occur under a variety of different clinical circumstances and has been implicated in the development of multiple organ failure. The aim of this study was to determine the distribution of bacterial translocation occurring in a model of chemically induced peritonitis. We also sought to document the degree of the associated immune and inflammatory response.MethodsThough a midline laparotomy, rats were injected with 5 mg of zymosan (in 0.2 ml of saline) into the subomental space. After 4, 18, 24, 48 and 96 h, a number of endpoints evaluated: intraperitoneal cellular influx, TNF‐α and interleukin‐6 concentrations and myeloperoxidase activity. Bacterial cultures were initiated from the free peritoneal fluid, mesenteric lymph nodes, liver, lung, and kidney. Imprints were also made of the peritoneal mesothelial surface to determine its integrity.ResultsWhen comparing rats injected with zymosan with the controls, there was evidence of a peritoneal inflammatory response within 4 hours. Facultative gram negative bacteria were found to be growing in the mesenteric lymph nodes and in the peritoneal fluid at 48 h. Anaerobic organisms were also cultured from the peritoneal fluid at 48 h. No organisms were cultured from the liver, lung or kidneys. In addition there was a significant increase in intraperitoneal cell numbers (predominantly neutrophils, P < 0.05), myeloperoxidase activity (P < 0.05) and TNF‐α and IL‐6 concentrations (P < 0.05). There was extensive loss of the peritoneal mesothelial cells. The peritoneal inflammatory changes and bacterial translocation had resolved by 96 h.ConclusionBacterial translocation can be induced by the presence of an acute inflammatory focus in the peritoneal cavity. The translocation and inflammatory changes were associated with extensive loss of mesothelial cells. Nonetheless, these changes all resolved, indicating that the peritoneal cavity has a significant capacity to deal with such insults. A clearer understanding of the cellular and molecular events involved in the resolution phase could lead to improvements in the treatment of peritonotis.
Immunoscintigraphy and intra‐operative radioimmunodetection in the treatment of colorectal carcinoma
Authors: Hladik P. , Vizda J. , Bedrna J. , Simkovic D. , Strnad L. , Smejkal K. , Voboril Z. 
Published: March 2003

PurposeIntra‐operative radioimmunodetection of malignant involved lymph nodes follows the pre‐operative immunoscintigraphy in the treatment of patients with colorectal carcinoma. The aims of this clinical study were to determine the sensitivity of the method, to compare the results in study when using Oncoscint and CEA‐Scan and to evaluate the importance of the method of surgery and postoperative adjuvant therapy.Patients and methods121 patients with colorectal tumours (106 primary and 15 recurrent) were operated on using radioimmunoguided surgery (RIGS). The study compared results of pre‐operative immunoscintigraphy, intra‐operative radioimmunodetection and postoperative histological examination. Histological investigation used classical H&E staining. In histologically negative and RIGS positive cases the immunohistochemical investigation was supplemented. Two radiopharmaceuticals were used Oncoscint CR 103 (MAb B72.3, Satumomab Pendetide), labelled with 111In in 56 patients and CEA‐Scan (IMMU 4‐Fab′ fragments MAb against CEA, Arcitumomab), labelled with 99mTc in 65 patients.ResultsThe relationship between RIGS positive results and histological examination was statistically assessed after 38 operations and the most acceptable RIGS evaluating index was determined. All subsequent results were evaluated by this index. Immunoscintigraphy of tumour was positive in 112 cases (92.6%). Fifty‐five RIGS positive cases of malignant infiltrated lymph nodes were confirmed by 43 histologically positive examinations (78%). In this group 9 cases were discovered only by immunohistochemistry. Sixty‐six remaining RIGS negative results were confirmed in 62 (94%) cases by negative histology.ConclusionsBoth immunoscintigraphy and RIGS enable one to make a more accurate diagnosis. While treating the primary disease the use of RIGS may help in assessment of necessary extent of operation performance and in staging of the disease by revealing occult lymph nodes involved. Pre‐operative immunoscintigraphy seems to be a useful diagnostic method for detection of tumour recurrence. When comparing two radiopharmaceuticals used, CEA‐Scan seems to be more suitable for diagnostic studies, but using the Oncoscint for tumour recurrence detection had some specific benefit, too.
Long‐term results of modified graciloplasty for sphincter replacement after rectal excision
Authors: Rosen H. R. , Urbarz C. , Novi G. , Zöch G. , Schiessel R. 
Published: March 2003

AbstractObjective  Restoration of the anal sphincter by means of electrically stimulated (dynamic) graciloplasty is a new therapeutic option for patients with severe faecal incontinence or those having abdomino‐perineal resection (APR) of the anorectum. The present study reviews the outcome of total anorectal reconstruction (TAR) after APR for low rectal cancer or recurrent anal cancer.Methods  From 1992 to 2000, 35 of 64 patients treated with dynamic graciloplasty had a TAR performed either synchronously (n = 26) or as a secondary procedure one to five years after rectal excision (n = 9).Results  The most frequent complication was injury or erosion of the neorectum (n = 9) which, was avoided with increasing surgical experience. Defaecation disorders and consequent incontinence were the most common functional problem and had to be treated with periodical enemas.Conclusion  Although sphincter replacement by means of TAR after APR led to poorer functional results than those achieved in patients treated with dynamic graciloplasty for faecal incontinence, TAR remains a valid treatment option for patients who do not tolerate a permanent stoma.
An analysis of the accuracy of P‐POSSUM scoring for mortality risk assessment after surgery for colorectal cancer
Authors: Menon K. V. , Farouk R. 
Published: March 2003

ObjectiveTo compare predicted vs. observed mortality using P‐POSSUM and determine whether this scoring system reflected observed surgical outcomes.Patients and methodsConsecutive patients who underwent a colorectal resection for cancer over a 12‐month period were scored using P‐POSSUM to estimate mortality risk and POSSUM to calculate predicted morbidity. This was then compared with observed outcomes. The main outcome measurements were 30 day postoperative mortality and postoperative morbidity.Results173 patients underwent a colorectal resection for cancer during the study period. The observed mortality rate was 8.7% compared with a P‐POSSUM predicted mortality rate of 15.6% (P < 0.01). Observed morbidity was 29% whereas the predicted morbidity rate was 32% (P=0.1).ConclusionsP‐POSSUM allows for standardization of physiological and operative variables. Risk of postoperative mortality may be overestimated by the scoring system however.
The colonic J‐pouch in colo‐anal anastomosis
Authors: Mathur P. , Hallan R I. 
Published: March 2003

AbstractAnastomosis of the colon to the anal canal is now an accepted technique in the surgical management of low and mid rectal cancers. Although significant postoperative bowel disturbance is often seen with straight colo‐anal anastomosis, controversy exists over the benefit of adding a colonic pouch for low anastomoses.Several short and long‐term studies have demonstrated the early functional superiority of pouch‐anal over straight anastomosis. Pouch construction does not compromise anal physiological parameters. It is recommended the pouch be constructed from a length of descending colon and be small (5 cm) in size to adequately act as a neo‐rectum; long‐term evacuatory difficulties are encountered with the construction of large pouches (10 cm). Anastomotic complications appear to be less frequent with pouch surgery; construction of a pouch does not significantly add to operative time, patient morbidity and mortality. At present there is no compromise to long‐term oncological survival. The data supporting these statements is weak and based largely upon retrospective studies. Furthermore the impact of improved function with pouch‐anal anastomosis on overall quality of life has been poorly investigated. Further prospective randomized studies are required to ascertain whether the potential benefits of a colonic pouch are realized in the randomized setting.
Severe dysplastic lesions in the colon – how aggressive should we be?
Authors: Arumugam P. J. , Joseph A. , Sweerts M. , Haray P. N. 
Published: March 2003

AbstractIntroduction Biopsies of colonic lesions are often reported as showing dysplasia, though in reality some lesions may harbour invasive malignancy.Aim To assess the risk of underlying invasive malignancy in sessile polyps where biopsies had shown severe dysplasia and also to attempt to define a management strategy in such patients.Methods Between 1997 and 2001, 30 patients were diagnosed as having severe dysplasia using Morson's criteria in colonic lesions not amenable for endoscopic polypectomy. Severely dysplastic lesions were completely excised by appropriate surgical measures.Results Out of 30 patients, 15 had invasive cancers. Surgical intervention involved anterior resections, endoanal excisions, sigmoid colectomies, or abdomino‐perineal excisions as deemed appropriate. The lesions ranged in size from 0.5 cm to 13 cm (mean 3.4 cm). There were nine T1 lesions (one of which was T1N1) and two each of T2, T3, T4 lesions (10 Dukes' A, 3 Dukes' B, 2 Dukes' C). Complete resection was confirmed histologically in all cases. One patient had a leak following endoanal excision, which required intervention. There was no mortality.Discussion This study demonstrates that endoscopic sampling can be misleading and severely dysplastic sessile lesions should be managed along the same principles as followed for invasive cancers, rather than adopting a ‘wait and watch’ policy with repeated endoscopies, biopsies or piece‐meal polypectomies.
Delayed sphincter repair for obstetric ruptures: Analysis of failure
Authors: Pinta T. , Kylänpää‐Bäck M.‐L. , Salmi T. , Järvinen H. J. , Luukkonen P. 
Published: March 2003

AbstractObjective  The aim of this study was to examine the clinical results after anterior anal sphincter repair in patients with obstetric trauma and to evaluate possible risk factors for poor outcome.Patients and methods  In years 1990–99 anterior anal sphincter repair for anal incontinence due to obstetric trauma was performed in 39 patients at Helsinki University Central Hospital. Clinical examination with Parks' classification and patients' questionnaire with endoanal ultrasound (EAUS) were done before and after surgery. Pudendal nerve terminal motor latency (PNTML) was measured postoperatively. The median follow‐up time after the operation was 22 months (range 2–99).Results   The follow‐up results of the patients' questionnaire for 12 patients (31%) were good, for 15 patients (38%) acceptable and for 12 patients (31%) poor. Postoperative EAUS showed sphincter overlap in 28 (72%) patients but a defect was still found in 11 (28%) patients. A defect found on postoperative EAUS correlated with poor clinical result according to Parks' (R = 0.8, P < 0.01) and patients' questionnaire results (R = 0.7, P < 0.01). Patients with poor clinical results (Parks III/IV) were statistically significantly older (median 63 years, range 26–73) than those with favourable results (Parks I/II) (median 45 years, range 27–79) (P < 0.05). Further, the duration of incontinence symptoms correlated with poor functional results (R = 0.4, P < 0.05).Conclusion  After obstetric trauma anterior anal repair gives acceptable short‐term clinical results. EAUS investigation is easy and harmless to perform and should be used pre‐ and post‐operatively. Advanced age, pre‐operative signs of perineal descent, long‐lasting severe incontinence symptoms and a persistent defect on postoperative EAUS seem to be related to poor clinical result.
What are the barriers to medical care for patients with newly diagnosed diabetes mellitus?
Authors: Burge M. R. , Lucero S. , Rassam A. G. , Schade D. S. 
Published: March 2003

SummaryContext: Few data are available describing factors that prevent patients with newly diagnosed diabetes from seeking medical care.Objective  To identify socioeconomic factors that act as barriers to healthcare among such patients.Setting  A community‐wide diabetes screening programme.Participants  One hundred and eighteen patients with newly identified diabetes mellitus out of 1824 total screenings.Interventions  Each newly identified person with diabetes was instructed to contact a physician for follow‐up care.Design  A follow‐up survey was obtained from 89 (75%) subjects 9 ± 7 months after diagnosis.Main outcome measure: Whether or not subjects had obtained follow‐up care for their diabetes.Results  Of seven variables examined, only lack of health insurance correctly predicted those patients who failed to seek medical care for their diabetes by multivariate analysis.Conclusions  Lack of health insurance coverage is the primary reason that patients with newly diagnosed diabetes fail to seek medical care.