bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metallic stents in large bowel obstruction: experience in a District General Hospital
Authors: Syn Wing‐Kin , Patel M. , Ahmed M. M. 
Published: December 2004

AbstractIntroduction  Metallic stents are used increasingly in the palliation of malignant large bowel obstruction. Stenting has also been used in the setting of acute obstruction, allowing appropriate patient preparation for an elective colectomy.Methods  Uncovered metallic stents were inserted using a combined endoscopic/radiological technique in patients presenting with large bowel obstruction.Results  Seventeen patients (10 female, mean age 75.2 years) presented with large bowel obstruction, 14 due to malignancy and 3 secondary to diverticular stricture. Technical success was achieved in 13/17 with clinical success in 12 of these 13. There were no perforations or procedure related deaths. One stented patient had elective surgery. The five patients with clinical/technical failure required emergency surgery.Conclusion  The result of our preliminary experience in the use of metallic stents is encouraging. Metallic stents should be available in all hospitals as part of a multimodality approach in treating large bowel obstruction.
Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients
Authors: Eriksen M. T. , Wibe A. , Norstein J. , Haffner J. , Wiig J. N. ,   the Norwegian Rectal Cancer Group
Published: December 2004

AbstractObjective  Mesorectal excision is successfully implemented as the standard surgical technique for rectal cancer resections in Norway. This technique has been associated with higher rates of anastomotic leakage (AL) and the purpose of this study was to examine AL in a large national cohort of patients.Methods  This was a prospective national cohort study of 1958 patients undergoing rectal cancer surgery with anterior resection in Norway from November 1993 to December 1999.Results  The overall rate of AL was 11.6% (228 of 1958 patients). In a multivariate analysis, the risk of AL was significantly higher in males (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1–2.2), in patients receiving pre‐operative radiotherapy (OR 2.2, CI 1.0–4.7) and in low level (4–6 cm) (OR 3.5, CI 1.6–7.7) and ultra‐low level (≤ 3 cm) anastomoses (OR 5.4, CI 2.3–12.9). The presence of a diverting stoma was associated with a 60% reduction in the risk of AL (OR 0.4, CI 0.3–0.7) for anastomoses 6 cm and below. 30‐day mortality was significantly higher for the patients with AL (7.0%, CI 3.7–10.3) compared with no AL (2.4%, CI 1.7–3.2) AL had no significant effect on local recurrence rate (log rank P = 0.608).Conclusion  Low anastomoses should be defunctioned to avoid AL and the associated high perioperative mortality. No effect of AL on local recurrence was found in this large cohort.
Multicentre prospective audit of surgical outcomes and acute complications following short course pre‐operative radiotherapy for resectable rectal cancer
Authors: Giridharan S. , Vakkalanka B. , Anwar M. S. , Geh J. I. , Glaholm J. , Churn M. , Adab F. , Grieve R. , McConkey C. , Hartley A. 
Published: December 2004

AbstractBackground  The addition of short course pre‐operative radiotherapy to total mesorectal excision reduces local recurrence in resectable adenocarcinoma of the rectum. In a previous retrospective study potential factors associated with early complications following this combination were identified. The aim of this study was to examine these relationships in a prospective multicentre audit.Methods  One hundred and seven patients who received short course pre‐operative radiotherapy in four cancer centres between 1 October 2001 and 30 September 2002 were included. Data including patient age, radiotherapy field length, overall treatment time, operation type, surgical outcomes and complications occurring within 3 months of the 1st day of radiotherapy were collected. These were compared and combined with the previously studied cohort of 176 patients treated at one centre between 1st January 1998 and 31st December 1999.Results  In the prospective cohort only patient age (P = 0.001) was significantly associated with acute complications. However, both the overall treatment time (median 9.0 vs 11.0 days P < 0.0001) and field length (median 16.6 vs 17.0 cm P = 0.03) were significantly shorter in this cohort when compared to the previous retrospective study. In patients from both studies (n = 283), increasing age (P = 0.002) and field length (independent of operation type) (P = 0.02) were independently associated with an increased risk of acute complications.Conclusions  This study suggests that meticulous selection of patients for short course pre‐operative radiotherapy and smaller planning target volumes may be associated with a lower risk of acute complications. The use of MRI scanning to stage pelvic disease may reduce the number of patients with R1 resections receiving short course pre‐operative radiotherapy.
Laparoscopic anterior resection and uterine manipulation: why make things difficult?
Authors: Varey A. H. R. , Darweish A. , Pandey S. , Dixon A. R. 
Published: December 2004

AbstractThe uterus continues to be a source of difficulty in mobilization of the rectum. These difficulties are compounded in laparoscopic operations, particularly anterior resection, proctectomy and vaginal sacrocolpopexy. Techniques to overcome this have in general proved unsatisfactory. We have adopted a technique of using an extended Vesellum forceps from gynaecological practice and recommend its use by all. The technique is described.
Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results
Authors: Aldean I. , Shankar P. J. , Mathew J. , Safarani N. , Haboubi N. Y. 
Published: December 2004

AbstractObjective  Pilonidal sinus (PNS) is a common condition, which warrants surgical intervention. A number of surgical options have been suggested with variable recurrence rate. This study proposes a modification of a standard method.Methods  A total of 51 patients with sacrococcygeal PNS were sequentially treated by the standard method devised by one Consultant Colorectal Surgeon (IA). The principle is based on: 1, after excising the PNS ensure obliteration of the natal cleft by releasing the fat pad from the gluteal fascia; 2, avoid tension and 3, encourage patients to lie on their back immediately after the operation.Results  Follow‐up was available from 51 patients ranging from 14 to 49 months. All patients were discharged within 48 h. There was only one recurrence, which was successfully treated.Conclusion  Our results suggest that PNS can be successfully treated by our hitherto undescribed method, patients can be discharged early and there is very low recurrence rate.
Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance
Authors: Di Cianni G. , Miccoli R. , Volpe L. , Lencioni C. , Ghio A. , Giovannitti M. G. , Cuccuru I. , Pellegrini G. , Chatzianagnostou K. , Boldrini A. , Del Prato S. 
Published: December 2004

AbstractObjective  To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance.Research design and methods  We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3‐h 100‐g oral glucose tolerance test (OGTT) at 27th ± 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight.Results  Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 ± 0.77 mmol/l) as compared with NGT (1.99 ± 0.64 mmol/l) or IGT (1.98 ± 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear‐cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre‐pregnancy BMI (r2 = 0.067), weight gain during pregnancy (r2 = 0.062), fasting serum TG (r2 = 0.09), and 2‐h post‐OGTT glucose levels (r2 = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre‐pregnancy BMI (F‐test = 7.26, P < 0.01), and fasting serum TG (F‐test = 4.07, P < 0.01) were independently associated with birth weight.Conclusions  Pre‐pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.
A rational clinical approach to suspected insulin allergy: status after five years and 22 cases
Authors: Bodtger U. , Wittrup M. 
Published: December 2004

AbstractAims  Allergy to recombinant human (rDNA) insulin preparations is a rare complication of insulin therapy. However, insulin preparations contain several allergens, and several disorders can resemble insulin allergy. Studies evaluating the diagnostic procedures on suspected insulin allergy are extremely few.Methods  Since January 1998, we have used a standardized investigative procedure during admittance to the medical ward allowing observation and repeated recording of reactions to intradermal skin test (performed with a commercially available kit containing isolated insulin allergens). Data on all investigated cases until April 2003 were collected retrospectively, and self‐reported efficacy of intervention was compared to clinical data.Results  Twenty‐two patients were included. In nine (41%) cases, non‐insulin allergic causes were discovered and successfully treated: poor injection technique (n = 5), skin disease (n = 3) and other systemic allergy (n = 1). Nine other patients were found to be allergic to protamine (n = 3) or rDNA insulin (n = 6), and specific treatment was associated with relief in 8 patients (89%). Four patients had local reactions of unknown causes but symptom relief was obtained in three cases by unspecific therapy. Overall, 20 (91%) reported relief of symptoms.Conclusion  Our standardized investigative procedure of suspected insulin preparation (IP) allergy was associated with relief of symptoms in > 90% of patients. IP allergy was diagnosed in 41%, and intradermal testing with isolated insulin allergens was a prerequisite in identification of culprit allergen and targeting of treatment.
Measurement of insulin sensitivity in Type 2 diabetes mellitus: comparison between KITT and HOMA‐%S indices and evaluation of their relationship with the components of the insulin resistance syndrome
Authors: Inchiostro S. 
Published: December 2004

AbstractAims  The identification of alternative methods of the euglycaemic–hyperinsulinaemic clamp to estimate the insulin‐sensitivity is a continuous challenge. The aim of the study was to evaluate the agreement between the short Insulin Tolerance Test (ITT) and the Homeostatic Model Assessment (HOMA), and their relationship with the components of the insulin resistance syndrome, in recently diagnosed Type 2 diabetic patients.Methods  Two hundred and forty‐seven patients, aged 26–65 years, consecutively recruited, were studied. The subjects underwent the ITT and HOMA tests to calculate the KITT and the HOMA‐%S indices, along with the measurement of the components of the insulin resistance syndrome.Results  The correlation between KITT and HOMA‐%S was highly significant, but the correlation coefficient and the explained variance were rather low (r = 0.44, R2 = 0.19, P‐value < 0.0001) as well as the agreement among tertiles of the two indices (kappa = 0.26). The strength of the association was similar in subgroups of subjects defined by sex, type of hypoglycaemic therapy, presence of hypertension or antihypertensive therapy, fasting blood glucose, whereas it was better in obese compared with non‐obese patients. Nonetheless, both KITT and HOMA‐%S correlated significantly with the components of the insulin resistance syndrome (P‐value < 0.05–0.001).Conclusions  The association between HOMA‐%S and KITT was significant but quite low. Therefore the two measures could not be considered interchangeable estimates of insulin sensitivity. However, as both indices showed significant associations with the components of the insulin resistance syndrome, probably they represent different metabolic aspects of the insulin resistance.
Interstitial glucose in skeletal muscle of diabetic patients during an oral glucose tolerance test
Authors: Frossard M. , Blank D. , Joukhadar Ch. , Bayegan K. , Schmid R. , Luger A. , Müller M. 
Published: December 2004

AbstractAim  The presence of a transcapillary arterial–interstitial gradient for glucose (AIGglu) in skeletal muscle may be interpreted as a consequence of intact cellular glucose uptake. We hypothesized that the AIGglu decreases in Type 2 diabetes mellitus as a consequence of insulin resistance, whereas it remains intact in Type 1 diabetes.Methods  Glucose concentrations were measured in serum and interstitial space fluid of skeletal muscle during an oral glucose tolerance test (OGTT) in patients with Type 1 and Type 2 diabetes and in young and middle‐aged healthy volunteers, using microdialysis.Results  The area under the curve for glucose in serum (AUCSE) was higher than in interstitial space fluid of skeletal muscle (AUCMU) in healthy young (AUCSE = 1147 ± 332 vs. AUCMU = 633 ± 257 mM/min/ml; P = 0.006), healthy middle‐aged volunteers (AUCSE = 1406 ± 186 vs. AUCMU = 1048 ± 229 mM/min/ml; P = 0.001) and in Type 1 diabetic patients (AUCSE = 2273 ± 486 vs. AUCMU = 1655 ± 178 mM/min/ml; P = 0.003). In contrast, in Type 2 diabetic patients AUCSE (2908 ± 1023 mM/min/ml) was not significantly different from AUCMU (2610 ± 722 mM/min/ml; P = NS).Conclusion  The present data indicate that AIGglu is compromised in Type 2 diabetes in contrast to Type 1 diabetes where it appears to be normal. Because no changes in muscle blood flow were detected, insulin resistance appears to be the main cause for the observed decreased AIGglu in skeletal muscle in Type 2 diabetic patients.
Prevalence of diabetes and impaired glucose regulation in 45‐ to 64‐year‐old individuals in three areas of Finland
Authors: Ylihärsilä H. , Lindström J. , Eriksson J. G. , Jousilahti P. , Valle T. T. , Sundvall J. , Tuomilehto J. 
Published: December 2004

AbstractAims  To determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) and possible regional differences in Finnish adults aged between 45 and 64 years.Methods  A population sample of 2642 subjects aged between 45 and 64 years living in three geographical areas in Finland was invited to an oral glucose tolerance test.Results  The glucose tolerance status of 2087 subjects (79.0%) was determined. The age‐standardized prevalence of DM in men and women was 10.2% and 7.4%, respectively (P = 0.020 for difference between sexes), and that of IGT 10.5% in men and 9.2% in women. IFG in men was more than twice as common as in women (13.5% vs. 5.0%, respectively, P < 0.001). Abnormal glucose tolerance was most common in southern compared with southwestern and eastern Finland. Of all diabetic subjects, 44% were previously undiagnosed.Conclusions  The age‐standardized prevalence of DM in 45‐ to 64‐year‐old Finns was within the range defined in previous studies on Europid populations. DM and IFG were more common in men than in women. Regional differences in the prevalence of abnormal glucose regulation suggest differences in lifestyle within an ethnically homogenous population.
Misoprostol for second trimester pregnancy termination in women with prior caesarean section
Authors: Daskalakis George J. , Mesogitis Spyros A. , Papantoniou Nikolaos E. , Moulopoulos George G. , Papapanagiotou Angeliki A. , Antsaklis Aris J. 
Published: December 2004

Objective  To examine whether a previous caesarean section increases the risk for complications in women undergoing a mid‐trimester pregnancy termination by labour induction.Design  Retrospective analysis of case records between 1997 and 2002.Setting  Fetal Medicine Unit of a large teaching hospital.Population  One hundred and eight women with a previous caesarean section (study group) and 216 women without such a history (controls), who underwent a second trimester termination of pregnancy.Methods  All the terminations were performed between 17 and 24 weeks of gestation by using 400 μg of oral administration of misoprostol in combination with 400 μg of intravaginal misoprostol. The same dose of intravaginal misoprostol was repeated every 6 hours for a maximum of five doses.Main outcome measures Severe haemorrhage requiring blood transfusion, post‐abortal infection, retained placenta and uterine rupture.Result  Complications occurred in 16 out of 108 women of the study group (15%) and in 26 out of 216 of the controls (12%), with only one ruptured uterus in the control group.Conclusion  We found no evidence that a previous caesarean delivery affects the incidence of complications when women with such a history undergo a mid‐trimester pregnancy termination with misoprostol.
Accuracy of fetal echocardiography in the routine detection of congenital heart disease among unselected and low risk populations: a systematic review
Authors: Randall P. , Brealey S. , Hahn S. , Khan K.S. , Parsons J.M. 
Published: December 2004

Objective  To determine among unselected and low risk populations the accuracy with which fetal echocardiography during the second trimester detects congenital heart disease.Design  A systematic review of studies that assess the accuracy of fetal echocardiography.Setting  District General Hospital and Tertiary referral centres.Population  Women during the second trimester attending for ultrasound assessment.Methods  General bibliographic databases (e.g. MEDLINE, EMBASE) and specialist computerised databases (e.g. Cochrane Library, National Research Register), grey literature, manual searching of reference lists of primary and review articles and personal contact with experts were used to identify studies. Studies were included if fetal echocardiography among unselected or low risk pregnant women was compared against a postnatal reference standard. Data were extracted on quality, study design and characteristics, and accuracy data to construct 2 × 2 tables. Data were synthesised qualitatively, and sensitivity and specificity with 95% confidence intervals were calculated.Main outcome measure  Sensitivity and specificity.Results  Five primary studies met the inclusion criteria and comprised 60,901 subjects. One study assessed the accuracy of fetal echocardiography among an unselected population and four studies among low risk populations. All eligible studies found that fetal echocardiography helped to correctly diagnose normal fetus among unselected and low risk populations. Correct diagnosis of babies for congenital heart defects was higher among the unselected population (85%) than among the low risk populations (range from 35% to 86%); however, the potential for ascertainment bias and the choice of reference standard limits the validity of this finding. The variation in sensitivity across studies was not explainable by clinical factors such as scanning regime, operator skill and equipment.Conclusions  The evidence from this review about the accuracy of fetal echocardiography does not lend support to its routine use among unselected and low risk populations during the second trimester to detect congenital heart disease.
Seroprevalence, incidence of prenatal infections and reliability of maternal history of varicella zoster virus, cytomegalovirus, herpes simplex virus and parvovirus B19 infection in South‐Western Finland
Authors: Alanen Anna , Kahala Kaisa , Vahlberg Tero , Koskela Pentti , Vainionpää Raija 
Published: December 2004

Objective  To study seroprevalence and incidence and fetal transmission of varicella zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV) types 1 and 2 and parvovirus B19 infections during pregnancy and to evaluate the reliability of maternal past history of VZV, HSV and parvovirus infections.Design  Prospective study of parturient women.Setting  South‐Western Finland.Participants  Five hundred and fifty‐eight parturient women.Methods  IgG and IgM antibodies against VZV, CMV, HSV‐1 and ‐2, and parvovirus B19 were measured from maternal serum in the first trimester and at delivery and from cord serum, mother's own information of her past infections was compared with her serological status.Main outcome measures  Seroprevalence, seroconversions and fetal transmission of VZV, CMV, HSV and parvovirus B19, reliability of maternal history of VZV, HSV and parvovirus B19.Results  Seroprevalences were 96.2% for VZV, 56.3% for CMV, 54.3% for HSV, 46.8% for HSV‐1, 9.3% for HSV‐2 and 58.6% for parvovirus B19. Parity was associated with CMV seropositivity, maternal age differed only between HSV‐2 seropositive and seronegative women, while area of residence (urban or rural) had no effect. Six seroconversions were observed: two VZV, one CMV and three parvovirus infections. No cases of primary HSV infections occurred. Fetal transmission was observed in two cases of parvovirus infection. No infants with anti‐CMV IgM antibodies were born to CMV immunised women. False positive history of chickenpox was given only by 1.5% of the women, history of herpes infections was less reliable, and history of parvovirus infection was unreliable.Conclusions  Seroprevalence and the risk of viral infections during pregnancy cannot be extrapolated from one pregnant population to another.
Smell perception during early pregnancy: no evidence of an adaptive mechanism
Authors: Swallow Brian L. , Lindow Stephen W. , Aye Mo , Masson Ewan A. , Alasalvar Cesarettin , Quantick Peter , Hanna Jon 
Published: December 2004

Objective It has been suggested that nausea and vomiting in pregnancy is an evolutionary adaptive mechanism to avoid the ingestion of potentially harmful foods. It has also been suggested that the mechanism that triggers nausea and vomiting in pregnancy may be olfaction and that olfactory senses are invoked to provide this protection. This study aimed to test this theory in a systematic design.Design Cross sectional study.Setting The antenatal department of a maternity hospital in the north of England.Sample Three groups of participants: pregnant women (n= 55), non‐pregnant women (n= 42) and men (n= 48).Methods Sensitivity was tested towards the odours of six standard stimuli (half safe and half associated with potentially harmful compounds).Main outcome measures Odour rating of likeness, strength and pleasantness.Results Pregnant women rated safe and odours with potentially harmful compounds differently but not more so than men or non‐pregnant women. There was no evidence that pregnancy changed the olfactory processes from the non‐pregnant state and only slight differences between pregnant women and men were recorded.Conclusions There was no evidence that olfactory processes had undergone any adaptation during pregnancy. The ability to differentiate safe from potentially harmful compounds was common to all three groups studied.