bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is prophylactic colectomy indicated in patients with MYH‐associated polyposis?
Authors: Leite J. S. , Isidro G. , Martins M. , Regateiro F. , Albuquerque O. , Amaro P. , Romãozinho J. M. , Boavida G. , Castro‐Sousa F. 
Published: June 2005

AbstractObjectives  The MYH gene has recently been associated with multiple colorectal tumours. It participates in the DNA base‐excision‐repair, avoiding mutations in other genes, namely the APC and Ki‐ras. Recently, biallelic MYH mutations have been described in patients with attenuated polyposis and in 7.5% with classic polyposis and no detectable APC mutation. The aim of this study was to analyse the incidence of germ‐line MYH mutations in selected Portuguese families recorded in a hereditary tumour registry and to evaluate the risk of colorectal cancer in this syndrome.Patients and methods  Nineteen APC mutation negative patients, 13 presenting attenuated polyposis and 6 with classic familial adenomatous polyposis (> 100 adenomas), were screened for germline biallelic MYH mutations.Results  Biallelic germline mutations in MYH were identified in 9 of the attenuated polyposis and in one of the classic polyposis patients. The mean age at the clinical diagnosis was 50.6 years (from 35 to 69 years); six were men and four women. Five patients belonged to families with affected siblings; three showed evidence for vertical transmission and two had no evidence for familial transmission of the disease. No extra‐colonic manifestations were reported. All patients had surgical resections: five total colectomies, four reconstructive proctocolectomies and one left hemicolectomy. Eight patients had associated malignant degeneration: three T3N+, four T3N0 and one T1N+. In the follow‐up two patients died due to tumour recurrence.Conclusion  A large frequency of biallelic MYH mutations (69%) was found in APC mutation negative patients belonging to families with attenuated polyposis; the highest percentage was observed in families presenting evidence for horizontal transmission of the disease. The high percentage of degeneration found in these patients suggests that colonoscopy with polypectomies is not sufficient and prophylactic colectomy is recommended. The identification of MYH associated polyposis is important to evaluate the level of risk, particularly for the siblings.
A prospective analysis of extended endoscopic mucosal resection for large rectal villous adenomas: an alternative technique to transanal endoscopic microsurgery
Authors: Hurlstone D. P. , Sanders D. S. , Cross S. S. , George R. , Shorthouse A. J. , Brown S. 
Published: June 2005

AbstractIntroduction  Endoscopic mucosal resection is a safe resection tool for selected flat, sessile and lateral spreading tumours of the colon. Transanal microsurgical resection of select rectal neoplastic lesions is another accepted modality. Recent data suggests transanal microsurgery may have high complication rates. We conducted a prospective clinicopathological evaluation of an extended endoscopic mucosal resection technique for highly selected lesions of the rectum and assessed outcome data over a maximal 24‐month period.Patients and methods  Eighty‐three patients with known rectal neoplastic lesions underwent chromoscopic colonoscopy and on‐table staging using a high‐frequency (12.5 MHz) mini‐probe EUS by a single endoscopist. Patients with T2 or node positive disease were referred for surgery. Following extended endoscopic mucosal resection patients were followed‐up at 3, 6, 12 and 24 months post ‘index’ resection with chromoscopic endoscopy and EUS. Procedural complications, recurrence rates and outcome data were collected.Results  Sixty‐two patients fulfilled inclusion criteria. Median procedure time was 48 mins (range32–126). Lateral spreading tumours (median diameter 30 mm; range 18–42 mm) and sessile lesions (median diameter 38 mm; range 25–86 mm) accounted for 19% and 81% of lesions, respectively. Ninety‐seven percent of patients undergoing EMR were discharged within 6‐h of procedure. Thirty‐day re‐admission and death rate was 0%. Bleeding complications occurred in 5/62 (8%) of patients with all achieving complete haemostasis using endo clips. None required transfusion. There were no procedural related complications or perforations. Overall ‘cure’ rate at a median follow‐up of 16 months was 98%.Conclusions  Extended endoscopic mucosal resection for rectal neoplastic lesions can achieve superior results to those of per‐anal excision and trans‐anal microsurgery with regard to complications and recurrence rates. Extended endoscopic mucosal resection may be an alternative therapeutic modality in selected patients.
Correlation of birth injury with maternal height and birthweight
Authors: Gudmundsson Saemundur , Henningsson Anne‐Charlotte , Lindqvist Pelle 
Published: June 2005

Background  Infant or maternal injury during vaginal delivery is a constant threat to all involved, but difficult to predict.Objective  To estimate the risk of birth injuries in an institution favouring trial of vaginal birth when there was doubt of the best mode of delivery.Design  A retrospective cohort study.Setting  University Hospital.Population  Singleton 14,359 vaginal deliveries in cephalic presentation during 5½ years.Methods  The total caesarean section rate during this period was 9%. The likelihood of injury was evaluated by logistic regression analysis with injury as the dependent variable and maternal height and child birthweight as explanatory variables in birth injury risk estimation.Main outcome measures  Infant injury defined as one of the following: shoulder dystocia, clavicle fracture or brachial plexus injury; and maternal injury as anal sphincter rupture (ASR).Results  There were a total of 318 infant injuries in 282 infants and 423 ASRs. A strong correlation was found between injury and both fetal macrosomia and short maternal stature, but macrosomia was a stronger indicator of injury. Birth injury risk estimation curves were constructed based on maternal height and birthweight.Conclusions  The present results confirm a strong correlation between fetal macrosomia and short maternal stature and the likelihood of injury during vaginal birth. Risk estimation curves were constructed that might be of great value for the obstetrician in choosing the mode of delivery in these cases.
Outcome of pregnancy in a woman with an increased body mass index
Authors: Usha Kiran T.S. , Hemmadi S. , Bethel J. , Evans J. 
Published: June 2005

Objective  To show the increased risk of adverse outcomes in labour and fetomaternal morbidity in obese women (BMI > 30).Design  A population‐based observational study.Setting  University Hospital of Wales. The study sample was drawn from the Cardiff Births Survey, a population‐based database comprising of a total of 60,167 deliveries in the South Glamorgan area between 1990 and 1999.Population  Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation of 37 or more weeks of gestation with accurate information regarding height and weight recorded at the booking visit (measured by the midwives) were included in the study.Methods  Comparisons were made between women with a body mass index of 20–30 and those with more than 30. SPSS version 10 was used for statistical analysis. Student's t test, χ2 and Fisher's exact tests were used wherever appropriate.Main outcome measures  Labour outcomes assessed were risk of postdates, induction of labour, mode of delivery, failed instrumental delivery, macrosomia and shoulder dystocia. Maternal adverse outcomes assessed were postpartum haemorrhage, blood transfusion, uterine and wound infection, urinary tract infection, evacuation of uterus, thromboembolism and third‐ or fourth‐degree perineal tears. Fetal wellbeing was assessed using Apgar <7 at 5 minutes, trauma and asphyxia, cord pH < 7.2, babies requiring neonatal ward admissions, tube feeding and incubator.Results  We report an increased risk [quoted as odds ratio (OR) and confidence intervals CI)] of postdates, 1.4 (1.2–1.7); induction of labour, 1.6 (1.3–1.9); caesarean section, 1.6 (1.4–2); macrosomia, 2.1 (1.6–2.6); shoulder dystocia, 2.9 (1.4–5.8); failed instrumental delivery, 1.75 (1.1–2.9); increased maternal complications such as blood loss of more than 500 mL, 1.5 (1.2–1.8); urinary tract infections, 1.9 (1.1–3.4); and increased neonatal admissions with complications such as neonatal trauma, feeding difficulties and incubator requirement.Conclusion  Obese women appear to be at risk of intrapartum and postpartum complications. Induction of labour appears to be the starting point in the cascade of events. They should be considered as high risk and counselled accordingly.
TOCOX—A randomised, double‐blind, placebo‐controlled trial of rofecoxib (a COX‐2‐specific prostaglandin inhibitor) for the prevention of preterm delivery in women at high risk
Authors: Groom Katie M. , Shennan Andrew H. , Jones Bryony A. , Seed Paul , Bennett Phillip R. 
Published: June 2005

Objective  To assess the safety and efficacy of the long term prophylactic use of rofecoxib (a COX‐2‐specific inhibitor) in women at high risk of preterm delivery.Design  A randomised, double‐blind, placebo‐controlled trial.Setting  Queen Charlotte's and Chelsea Hospital, London and Guys and St Thomas' Hospitals, London.Population  Ninety‐eight singleton pregnancies at high risk of preterm labour.Methods  Treatment from 16 to 32 weeks. Weekly ultrasound surveillance.Main outcome measures  Fetal renal function and ductus arteriosus blood flow changes. Preterm delivery rates and neonatal outcome.Results  Rofecoxib caused a reduction in hourly fetal urine production rates (−34%, 95% CI −13 to −50%, P= 0.004) and amniotic fluid index (−2.2, 95% CI −3.2 to −1.2, P < 0.001). This effect did not increase with time on treatment and reversed in all cases on discontinuation of treatment. Rofecoxib had an effect on the ductus arteriosus, increasing maximum systolic velocity (0.1 m/s, 95% CI 0.03–0.16, P= 0.02) and minimum diastolic velocity (0.007 m/s, 95% CI 0.0007–0.013, P= 0.03). This effect increased with time on treatment but was reversed with discontinuation of treatment and had no long term clinical sequelae. There was no difference in preterm delivery rates <30 weeks (28% on placebo vs 33% on rofecoxib, Mantel–Haensel [M–H]‐adjusted risk 1.11, 95% CI 0.67–1.87). There were more deliveries <37 weeks in those on rofecoxib (40%vs 67%, M–H‐adjusted risk 1.59, 95% CI 1.09–2.32). Rates of preterm prelabour rupture of membranes (PPROM) were higher in those on rofecoxib (RR 2.5, 95% CI 1.3–4.7).Conclusion  Rofecoxib has a significant but reversible effect on fetal renal function and the ductus arteriosus. It does not reduce the incidence of early preterm delivery <30 weeks and is associated with an increased risk of delivery before 37 weeks in women at high risk.
Editorials: Will Peritoneal Dialysis be Left Behind?
Authors: Prichard Sarah 
Published: June 2005

ABSTRACTPeritoneal dialysis (PD) enjoyed huge growth in the 1980s, followed by a rapid decline in the late 1990s, and a now persistently low utilization rate in many countries, including the United States. Recent clinical data indicate a survival advantage for patients started on PD. Residual renal function is better preserved with PD. Adequacy targets are being revised and will likely allow PD prescriptions to be simplified. The physiology of the peritoneum is better understood and treatment strategies reflect that understanding. New solutions have been developed in response to studies that have assessed the impact of conventional PD dialysate on the structure and function of the peritoneum. A remaining challenge is to ensure that nephrology trainees and nephrologists in practice are fully informed of the advantages of PD for many patients and of the advances in the therapy. If this can be achieved, PD should start to grow again.
Editorial Focus: Transplant Nephrectomy: At the Peril of Dialysis Patients: Ignoring the Failed Transplant
Authors: Ayus Juan Carlos , Achinger Steven G. 
Published: June 2005

ABSTRACTRecently it has been shown that patients returning to hemodialysis (HD) following kidney transplant loss have poor survival, though the factors responsible for these poor outcomes remain largely unknown. In the past, we have shown that occult infection of clotted arteriovenous grafts (AVGs) leads to a chronic inflammatory state characterized by erythropoietin resistance, hypoalbuminemia, elevated C‐reactive protein (CRP), and poor outcomes. It is well known that failed renal allografts induce graft intolerance syndrome, a clinical syndrome of pain, fever, and anemia, in the majority of patients. Similarly we have shown that failed renal allografts, by their nature as a nidus of chronic immunoreactivity, also induce a chronic inflammatory state. We speculate that this chronic inflammatory state, characterized by biochemical markers of poor HD outcomes, may be responsible for the excess mortality in this group. It is currently standard practice to leave failed kidney transplants in place upon return to HD and to treat symptomatic graft intolerance syndrome with immunosuppression. While this approach may reduce clinical symptoms in the short term, treatment failure and ultimately transplant nephrectomy occur in the majority of cases. There is also evidence that continued immunosuppression can even be dangerous. It should be noted that medical treatment of graft intolerance syndrome has not been shown to reduce chronic inflammation or decrease mortality. Similarly embolization of failed kidney transplants, another option for handling failed kidney transplants, has a high rate of treatment failure, has not been shown to reduce chronic inflammation, and nothing is known about the long‐term safety of this approach. Therefore failed kidney transplants in patients with biochemical markers of chronic inflammation (as is the case for infected, clotted AVGs) should be removed prior to the development of clinical symptoms in order to eliminate the chronic inflammatory state.
The Management of the Failed Renal Allograft: An Enigma with Potential Consequences
Authors: Langone Anthony J. , Chuang Peale 
Published: June 2005

ABSTRACTThe number of patients returning to dialysis after their renal allograft fails is increasing in absolute numbers year after year. The management of the failed allograft that is not immediately symptomatic remains controversial. Surgical mortality and morbidity, a rising number of circulating antibodies, reduced erythropoietin, and diuresis are among the arguments to support simply observing the failed allograft. Chronic inflammation, potential for malignancy, infection, and the need for low‐dose immunosuppression are concerns that might goad one into performing a preemptive nephrectomy. Based on the current literature and our own clinical experience, we believe allograft nephrectomies should not be routinely performed. They should be reserved for those patients who develop particular symptoms attributable to the allograft or those who require space for retransplantation. Future studies that address this issue in addition to testing various immunosuppression attrition rates may be able to discern a protocol that minimizes drug exposure while leading to reduced nephrectomy rates after returning to dialysis.
Reviews: Uremic Toxins: A New Focus on an Old Subject
Authors: Yavuz Asuman , Tetta Ciro , Ersoy F. Fevzi , D’intini Vincent , Ratanarat Ranistha , De Cal Massimo , Bonello Monica , Bordoni Valeria , Salvatori Gabriella , Andrikos Emilio , Yakupoglu Gulsen , Levin Nathan W. , Ronco Claudio 
Published: June 2005

ABSTRACTThe uremic syndrome is characterized by an accumulation of uremic toxins due to inadequate kidney function. The European Uremic Toxin (EUTox) Work Group has listed 90 compounds considered to be uremic toxins. Sixty‐eight have a molecular weight less than 500 Da, 12 exceed 12,000 Da, and 10 have a molecular weight between 500 and 12,000 Da. Twenty‐five solutes (28%) are protein bound. The kinetics of urea removal is not representative of other molecules such as protein‐bound solutes or the middle molecules, making Kt/V misleading. Clearances of urea, even in well‐dialyzed patients, amount to only one‐sixth of physiological clearance. In contrast to native kidney function, the removal of uremic toxins in dialysis is achieved by a one‐step membrane‐based process and is intermittent. The resulting sawtooth plasma concentrations of uremic toxins contrast with the continuous function of native kidneys, which provides constant solute clearances and mass removal rates. Our increasing knowledge of uremic toxins will help guide future treatment strategies to remove them.
Renal Replacement Therapy in Patients with Chronic Liver Disease
Authors: Howard Clancy S. , Teitelbaum Isaac 
Published: June 2005

ABSTRACTAs the prevalence of chronic liver disease and chronic kidney disease (CKD) increase, clinicians are likely to be increasingly faced with difficult diagnostic, treatment, and ethical challenges when facing both of these diseases in a single patient. Alterations in creatinine formation and elimination in cirrhotic patients render creatinine‐based estimates of glomerular filtration rate and dialysis adequacy less accurate in this population. Furthermore, differentiating signs and symptoms of uremia from hepatic disease may be difficult and clear indications for renal replacement therapy (RRT) in these patients have not been defined. Hemodialysis is associated with a high rate of complications and has not been shown to prolong life in cirrhotic patients with acute renal failure (ARF), but has not been carefully examined in those with CKD. Peritoneal dialysis is, similarly, unhelpful in chronic liver disease complicated by ARF, but has been found to be a viable option in some cirrhotic patients with CKD. Continuous RRT is generally tolerated by patients with decompensated cirrhosis and either acute or chronic renal failure and may act to bridge patients to liver transplantation. Given the poor underlying survival of cirrhotic patients with renal failure, clinicians should carefully consider the utility of RRT in each patient.
Viewpoint: How Do Calcimimetics Fit Into the Management of Parathyroid Hormone, Calcium, and Phosphate Disturbances in Dialysis Patients?
Authors: Shahapuni Irina , Mansour Janet , Harbouche Laïd , Maouad Bechir , Benyahia Mohamed , Rahmouni Khelifa , Oprisiu Roxana , Bonne Jean‐François , Monge Matthieu , El Esper Najeh , Presne Claire , Moriniere Philippe , Choukroun Gabriel , Fournier Albert 
Published: June 2005

ABSTRACTAs suggested by its American brand name (Sensipar), the calcimimetic cinacalcet sensitizes the parathyroid cells to the extracellular calcium signal, suppressing parathyroid hormone (PTH) release and synthesis and preventing parathyroid cell proliferation. This primary PTH suppression decreases the release of calcium and phosphate from bone without increasing intestinal absorption of calcium and phosphate. Therefore cinacalcet decreases the risk of hypercalcemia and hyperphosphatemia in contrast to 1α‐OH vitamin D derivatives. Compared with calcium‐containing oral phosphate binder (OPB), it increases the risk of hypocalcemia and may decrease the PTH‐mediated phosphaturia in predialysis patients. This justifies its combined use with calcium‐containing OPB in order to prevent hypocalcemia and enhance the hypophosphatemic effect of the latter, while improving PTH suppression. The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) has recommended restriction of supplemental elemental calcium to 1.5 g/day, a recommendation that we believe should be revised. No pathophysiologic or randomized trial data have yet evidenced the absolute necessity for systematically using 1α‐OH vitamin D derivatives and noncalcium‐containing OPB rather than higher doses of calcium‐containing OPB alone in uremic patients without vitamin D insufficiency. In patients with hyperparathyroidism as severe as in the “Treat to Goal Study,” the Durham study showed that a calcium carbonate dose more than three times the K/DOQI limit could decrease PTH into the recommended range, with the advantage of a lower calcium‐phosphate product compared with the combination of calcitriol and noncalcium OPB. Besides the efficient PTH suppression associated with lower calcium‐phosphate product and a good gastrointestinal tolerance, long‐term data suggest that cinacalcet may decrease the risk of parathyroidectomy and fracture, while high bone turnover lesions are improved. However, no long‐term data on bone mineral density and cardiovascular calcification and complications are yet available. Such studies, along with those comparing cinacalcet and 1α‐OH vitamin D‐based approaches to hyperparathyroidism, are needed.
Is There a Place for Duplex Screening of the Brachial Artery in the Maturation of Arteriovenous Fistulas?
Authors: Lomonte Carlo , Casucci Francesco , Antonelli Maurizio , Giammaria Bernardo , Losurdo Nicola , Marchio Giovanni , Basile Carlo 
Published: June 2005

ABSTRACTClinically there are some autogenous arteriovenous fistulas (AVFs) that are obviously mature. The real problem in clinical evaluation is in predicting the ultimate outcome of AVFs that are not clearly mature. Thus it would be advantageous to develop objective quantitative criteria to be applied early after vascular access placement in order to evaluate the suitability of AVFs for dialysis. The goal of this study was to document the blood flow rate modifications that the construction and maturation of a radiocephalic wrist AVF produce in the brachial artery by means of duplex Doppler ultrasonography. All incident uremic patients who needed the construction of a radiocephalic wrist AVF in the last 9 months of 2003 were enrolled in the study: 18 patients underwent such an operation. A linear color Doppler ultrasound scan was performed with a 7.0 MHz imaging/5.0 MHz Doppler probe by sampling the brachial artery 2 cm above the elbow: the internal diameter of the artery was measured and its blood flow rate calculated just before AVF construction and 1, 7, 28 days, and at least 6 months after AVF construction. The internal diameter and blood flow rate of the brachial artery were, respectively, 4.3 ± 0.7 mm and 56.1 ± 19.2 ml/min at baseline. A new AVF was constructed in one patient whose brachial artery blood flow rate was 80.0 ml/min at 28 days. When excluding this AVF, the mean brachial artery blood flow rate of the 17 AVFs was 720.4 ± 132.8 ml/min (median 750 ml/min, range 480–890 ml/min) at 28 days and 997.6 ± 259.7 ml/min 258.0 ± 63.0 days after AVF construction. When analyzing the percent increase in brachial artery blood flow rate of the 17 AVFs at the different time points, the most dramatic one occurred at day 1 compared to the baseline (549.0%; mean blood flow rate at day 1, 365.0 ± 129.3 ml/min). Thus the blood flow rate at day 1 represents more than half (50.7%) of the blood flow rate that will be measured at day 28. Then the increase was less steep, with a 20.1% increase between day 7 and day 1 (mean blood flow rate at day 7, 438.4 ± 86.0 ml/min), a 64.3% increase between day 28 and day 7, and a 38.5% increase at 258.0 ± 63.0 days compared to 28 days. The present study was able to document the changes in brachial blood flow rate consequent to a radiocephalic wrist AVF maturation by means of duplex Doppler ultrasonography of the brachial artery. This measure may be helpful in monitoring which AVFs will probably fail. This screening should integrate clinical assessment, thus allowing sound judgment of the level of maturation of an AVF and of its outcome.