bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical resection of colorectal liver metastases
Authors: Memon M. A. , Beckingham I. J. 
Published: March 2003

BackgroundLiver metastases are a major cause of death in patients with colorectal carcinoma. The only curative option available at present is surgery. This review article discusses the current state of evidence for the effectiveness of liver resection for patients with liver metastases from colorectal cancer.MethodsMedline, Embase, Current Contents and Science Citation Index databases were used to search English language articles published on the subject of liver resection for colorectal metastases in the last 20 years.ResultsLiver resection has a five year survival of 16–49% and 10 year survival of 17–33% with an operative mortality rate of 0–9%. Two factors appear to be clearly associated with poorer outcome – involved resection margins and the presence of extrahepatic disease (including hilar and coeliac axis lymph nodes) at the time of liver resection. None of the other factors related to the patients, their primary tumour or the metastases themselves have been conclusively shown to adversely effect long‐term survival.ConclusionsLiver resection is a feasible, safe and effective procedure which carries an acceptable morbidity and mortality and does have a major impact on the survival of these patients. The decision on resectability of colorectal metastases should be decided by the ability to leave at least 2–3 segments of liver free from metastases with uninvolved resection margins, together with the general fitness of the patient to undergo a major surgical procedure.
The efficacy of chemoradiation therapy in HIV seropositive patients with squamous cell carcinoma of the anus
Authors: Efron J. E. , Pikarsky A. J. , Gervaz P. , Locker G. , Weiss E. G. , Wexner S. D. , Nogueras J. J. 
Published: March 2003

ObjectiveThe aim was to assess the efficacy of chemoradiation therapy for squamous cell carcinoma of the anal canal in HIV seropositive patients.Patients and methodsA retrospective review of all patients with squamous cell carcinoma of the anus treated primarily with combined chemotherapy (5‐fluorouracil and mitomycin) and radiotherapy or local excision was undertaken comparing HIV seropositive to HIV seronegative patients.ResultsThirteen HIV seronegative patients were compared with 6 HIV seropositive patients. The HIV positive group included a higher proportion of males and a significantly greater history of prior treatment for condyloma. There was no difference in the median radiation dose (5020 cGy vs 4500 cGy, P=0.10). There was a trend towards higher local tumour recurrence in the HIV seropositive patients although this was not statistically significant (30% vs 66%). The CD4 count of HIV positive patients did not correlate either with their ability to complete the prescribed treatment regimen or with subsequent recurrence.ConclusionCombined chemoradiation is feasible in HIV positive patients, however, local recurrence rates in HIV positive patients may be higher. Tolerance of this therapy in HIV seropositive patients or recurrence after therapy are not related to the patient’s CD4 cell count.
A prospective audit of fistula‐in‐ano at St. Mark’s hospital
Authors: Malouf A. J. , Buchanan G. N. , Carapeti E. A. , Rao S. , Guy R. J , Westcott E. , Thomson J. P. S. , Cohen C. R. G. 
Published: March 2003

ObjectiveTo conduct a prospective audit of all patients presenting with anal fistula at St. Mark’s Hospital during one calendar year and to compare the presentation and outcome of this cohort with previous reports from this institution.Patients and methodsAll patients undergoing examination under anaesthetic (EUA) for anal fistula during 1997 were studied. All fistulae were anatomically classified and operative procedures recorded. During a mean follow‐up period of 14 months details of healing, recurrence and function were gathered.Results98 patients with a mean age of 43.7 years were assessed. 86 (88%) patients had fistulae of cryptoglandular (idiopathic) origin. Fistulae were superficial in 11 (11%) patients, intersphincteric in 30 (31%) patients, trans‐sphincteric in 52 (53%) patients, suprasphincteric in 3 (3%) patients and extra‐sphincteric in 2 (2%) patients. 49 (50%) fistulae were classified as complex. Eradication of fistulae with preservation of function was achieved in 89 (91%) patients. Fistula recurrence occurred in 4 (4%) cases. Ten (10%) patients had some degree of incontinence, 9 (9%) of whom had undergone previous fistula surgery. Nine (9%) patients still had setons in situ at the end of the follow‐up period.ConclusionsA greater proportion of difficult fistulae was seen during the year compared with previous studies from St. Mark’s. Despite this a satisfactory outcome was achieved in the vast majority with a relatively low rate of disturbed function. Previous fistula surgery is a risk factor for incontinence, which can usually be managed conservatively.
Colorectal cancer in patients with chronic renal failure: the effect of dialysis or renal transplantation
Authors: Ho Hanh‐Tam , Russ G. , Stephens J. , Rieger N. 
Published: March 2003

ObjectiveThis study reports the characteristics and surgical outcome of colorectal cancer in patients with chronic renal failure treated either by renal transplantation or dialysis.MethodsTwo thousand four hundred and seventeen patients with CRF (1387 transplant and 1030 dialysis) were treated at The Queen Elizabeth Hospital, South Australia, between January 1967 and September 2000.ResultsFourteen have developed colorectal cancer and had their clinical records reviewed. Nine patients were renal transplant recipients and 5 patients were treated with dialysis. Eight patients had surgery. Chemotherapy was given palliatively to 3 patients. One patient died in hospital postoperatively. Seven patients with a renal transplant had notes available. Six presented with late stage disease and all were dead within 9 months of presentation from their disease. In the dialysis patients, tumour stage at presentation was not so advanced and although all the patients have died, the cause of death was secondary to the colorectal cancer in only 2 patients.ConclusionsThis study highlights the poor outcome of patients who have had renal transplant and develop colorectal cancer. Immunosuppression and late diagnosis are implicated in this poor outcome.
Topical 0.2% glyceryl trinitrate ointment for anal fissures: long‐term efficacy in routine clinical practice
Authors: Jonas M. , Lund J. N. , Scholefield J. H. 
Published: March 2003

AbstractObjective  Randomized controlled trials have reported fissure healing rates of 60–70% using topical 0.2% GTN ointment, but the effectiveness of this therapy in routine clinical practice, particularly in the long term, is uncertain. This study aimed to evaluate the efficacy of topical GTN for anal fissures in an outpatient setting.Patients and methods  A case note review and postal questionnaire survey were undertaken for patients with a diagnosis of anal fissure dispensed 0.2% GTN ointment from one hospital pharmacy over a two year period (June 1996–May 1998).Results  Ninety‐three patients (53 male) applied 0.2% GTN ointment twice daily to the anoderm for anal fissure. They were reviewed on average 8 (2–16), weeks later, by which time 57 (61%) fissures had healed, 33 persisted and 3 patients were lost to follow up. Seventy‐two patients (41male), median age 42 (22–83) years, returned completed questionnaires (77% response rate). Forty‐nine (68%) had healed with GTN, but 25 had recurrent symptoms after a median of 6 (1–18) months. Sixteen of those patients reporting symptomatic recurrence were prescribed further GTN for a recurrent fissure: 14 (88%) healed, but 2 persisted, and had surgery. In the other nine patients symptoms resolved spontaneously. Thirty‐five (49%) experienced headaches, 3 (4%) discontinuing treatment as a result. The median follow up was 25 (13–36) months.Conclusion  0.2% GTN heals 60% of fissures in the outpatient setting but half the patients develop headaches. Up to one third of healed fissures may recur within 18 months but the majority respond to further GTN. Only 4% of patients initially healed with GTN later require sphincterotomy for recurrences.
Does perifascial rectal excision (i.e. TME) when combined with the autonomic nerve‐sparing technique interfere with operative radicality?
Authors: Maeda K. , Maruta M. , Utsumi T. , Hosoda Y. , Horibe Y. 
Published: March 2003

AbstractObjective  The lymphatic drainage from the rectum was studied to evaluate if the autonomic nerve sparing dissection may interfere with the operative radicality and might result in metastatic lymph nodes being overlooked and left in situ.Patients and methods  50 consecutive patients had an extended extrafascial rectal excision resection for cancer. In 19 of the 50 patients activated carbon particles (CH40) were injected preoperatively into the rectum. The autonomic nerves with surrounding connective tissue were serially dissected from the resected specimen, carefully sliced at 5‐mm intervals and collected for histological study. Lymph nodes along the axial and lateral drainage routes were examined, and the inclusion of CH40 in the nodes was microscopically studied according to the site of CH40 injection.Results  Lymph nodes within the connective tissue along the dissected autonomic nerves were demonstrated in 47 of the 50 cases. Two of 50 cases had positive nodes along preaortic plexus or pelvic plexus, and a case with nodal involvement along the pelvic plexus had poor prognosis in spite of nerve excision. CH40 when injected into the rectum above the peritoneal reflection was demonstrated in the vast majority of the axial nodes, while in only one lymph node along the preaortic plexus when injected in the rectum above the peritoneal reflection. On the other hand when injected in the rectum below the peritoneal reflection, CH40 was demonstrated both in axial and lateral nodes as well as in lymph nodes along bilateral pelvic plexuses, right hypogastric nerve, superior hypogastric plexus, preaortic plexus and mesenteric plexus as well.Conclusions  When located above the peritoneal reflection a rectal carcinoma will spread preferentially along the upper axial route, while a carcinoma located below the peritoneal reflection will also spread laterally and along the autonomic nerves. It was inferred that lymphatic flow along the autonomic nerves came up from the rectum below the peritoneal reflection mainly through a so‐called lateral ligament but its clinical significance was negligible. Therefore doing TME with autonomic nerve preservation does not imply a less radical surgery from the point of lymphatic spread.
Demonstrating the clinical and cost effectiveness of adhesion reduction strategies
Authors: Wilson M. S. , Menzies D. , Knight A. D. , Crowe A. M. 
Published: March 2003

AbstractObjective  To examine the feasibility of conducting Randomized Controlled Trials (RCT) in lower abdominal surgery to demonstrate a reduction in adhesion‐related admissions following use of an adhesion reduction product, and to model the cost effectiveness of such products.Methods  The number of patients in each limb of a RCT comparing an adhesion reduction product to a control has been estimated based on 25% and 50% reductions in adhesion‐related readmissions one year after surgery, for P = 0.05 at a power of 80% and P = 0.01 at a power of 90%. A cost effectiveness model based on the Surgical and Clinical Adhesions Research Group (SCAR) database has been developed which calculates the percentage reduction in readmissions required of an adhesion reduction product to return the cost of investment. It also estimates the cumulative costs of adhesion‐related readmissions for lower abdominal surgery and the cost savings associated with an adhesion reduction policy using a low or high cost product.Results  7.2% of patients undergoing lower abdominal surgery will readmit due to adhesions in the first year after surgery. To demonstrate a 25% reduction in readmissions one year after surgery, it is calculated that a RCT would require between 5686 (P = 0.05, power = 80%) and 7766 (P = 0.01, power = 90%) lower abdominal surgery patients followed‐up for one year. A cost effectiveness analysis demonstrates that routine use of adhesion reduction products costing £50 per patient will payback the cost of such investment if they reduce adhesion‐related readmissions by 16% after 3 years. A product costing £200 will need to offer a 64.1% reduction in readmissions after 3 years. For the estimated 158 000 lower abdominal surgery operations conducted in the UK each year, the cumulative costs of adhesion‐related readmissions over 10 years are estimated at £569 Million.Conclusion  Demonstrating the clinical effectiveness of adhesion reduction products in the RCT setting is unlikely to be feasible due to the large number of patients required. Products costing £200 or more are unlikely to payback their direct costs.
The role of topical diltiazem in the treatment of chronic anal fissures that have failed glyceryl trinitrate therapy
Authors: Griffin N. , Acheson A. G. , Jonas M. , Scholefield J. H. 
Published: March 2003

AbstractObjective  The treatment of anal fissures has evolved over the last 5 years with the development of topical treatments aimed at reducing sphincter hypertonia. This is thought to improve anal mucosal blood flow and promote healing of the fissure. This study reports the use of topical diltiazem in patients with chronic anal fissures that have failed previous treatment with topical 0.2% glyceryl trinitrate (GTN).Patients and methods  Forty‐seven patients with chronic anal fissure who had previously failed at least one course of topical GTN were recruited prospectively from a single centre. Patients were instructed to apply 2 cm (approximately 0.7 g) of 2% diltiazem cream to the anal verge twice daily for eight weeks. Symptoms of pain, bleeding and itching were recorded on a linear analogue score prior to starting the cream and then repeated at 2 weekly intervals. Patients were asked to report side‐effects throughout the study period. Healing of the fissure was assessed after 8 weeks of treatment.Results  Forty‐six patients completed treatment; of these, 22 had healed fissures (48%). Ten of the 24 patients with persistent fissures were symptomatically improved and wished no further treatment. Of the 14 patients who remained symptomatic, one was given a repeat course of 0.2% glyceryl trinitrate with subsequent healing of the fissure, 10 were recruited into an ongoing study involving injections of botulinum toxin into the internal anal sphincter and three were referred for surgery.Conclusion  This study shows that topical 2% diltiazem is an effective and safe treatment for chronic anal fissure in patients who have failed topical 0.2% GTN. The need for sphincterotomy can be avoided in up to 70% of cases.
Variability in serotonin and enterochromaffin cells in patients with colonic inertia and idiopathic diarrhoea as compared to normal controls
Authors: Baig M. K. , Zhao R. H. , Woodhouse S. L. , Abramson S. , Weiss J. J. Singh, E. G. , Nogueras J. J. , Wexner S. D. 
Published: March 2003

AbstractAim To evaluate differences in distribution, density and staining intensity of enterochromaffin cells (EC) and serotonin cells (SC) in the colonic mucosa of patients with colonic inertia (CI), idiopathic diarrhoea (ID) and a control group.Methods Three groups were studied: 19 patients' colons after subtotal colectomy for CI, and 17 patients' biopsies for diarrhoea (>3 bowel movements/day) with histological findings of normal mucosa (excluding microscopic, eosinophillic and collagenous colitis). The third group included 15 patients who underwent colonoscopy and biopsy for indications other than constipation, inflammatory bowel disease, diarrhoea or neoplasm (control group). Specimen blocks were obtained in each case from the right and left colon. Immunohistochemical staining for EC and SC were done on 4 µm sections from Hollandes fixed, paraffin embedded tissues with primary rabbit antibody against chromagranin A or serotonin, and biotynylated secondary antibody and enzyme labelled streptavidin.Results The number of EC in the mucosa of the left colon in patients with CI (16.8 ± 10.2) and ID (19.9 ± 9.7) were significantly higher than they were on the right side (CI: 9.4 ± 6.0, ID: 12.1 ± 5.3). However, there were no significant differences between the left and right sides in the control group (L: 10.3 ± 5.3; R: 13.4 ± 7.6). Although the quantity of EC in the left colon in both patients with CI (P < 0.05) and ID (P < 0.01) were significantly higher than in the controls, there was no significant difference between CI and ID. In both the right and left colon, the percentage of EC with low positive density was significantly higher (P < 0.01) while those cells with moderate or low staining intensity were significantly lower in patients with CI than in either patients with ID or control group. In patients with CI, the quantity of SC in the mucosa of the left colon (12.1 ± 6.4) was higher than in the right (CI: 7.9 ± 3.6; control 4.6 ± 3.3; ID 4.6 ± 2.9) (P = 0.0057). In contrast there was no significant difference in SC in either the ID or control groups. The quantity of SC in both sides of the colon was significantly higher both in patients with CI as compared to the control group (P < 0.01) and patients with CI vs. patients with ID (L = P < 0.01; R = P < 0.05). There was a significantly positive correlation between the numbers of EC and SC in patients with CI (L: r = 0.5425, P < 0.05; R: r = 0.745, P < 0.01).Conclusion In patients with CI, EC increases possibly due to an increase in SC. Conversely, in patients with ID, the EC increase results from peptides other than SC. Our results suggest that different aetiological factors contribute to ID and CI.
Creation of a treatment protocol for nurse‐led management of anal fissure
Authors: Porrett T. , Knowles C. H. , Lunniss P. J. 
Published: March 2003

AbstractObjective  To create a protocol for colorectal nurse‐led management of patients with idiopathic anal fissure.Patients and methods  The outcome of 135 patients with anal fissure presenting over a 3‐year period to one (half time equivalent) Colorectal Surgeon in a District General Hospital, in whom initial management was centred on the use of 0.2% glyceryl trinitrate (GTN) was audited. Patients unavailable for complete follow‐up, those with fissures of a specific aetiology and those in whom GTN was contra‐indicated were excluded. 44% of patients were initially seen by a suitably trained and supported Nurse Practitioner (NP).Results  Succes rates for fissure healing with 0.2% GTN were similar to those reported in other studies. There were no differences in outcome between those patients managed by the NP and those managed by the Consultant/Specialist Registrar. As a result of the audit, a treatment protocol for use by Nurse Practitioners (as well as surgical staff), a patient information leaflet, and policy documents relating to NP management of anal fissures have been developed.Conclusion  It has been possible to construct a treatment protocol allowing rational management of patients with anal fissure by suitably trained and supported nurse specialists within their own clinic. This may be adapted to encompass future treatment developments.
Management of colorectal liver metastases
Authors: Fusai G. , Davidson B. R. 
Published: March 2003

AbstractHepatic metastases occur in 60% of patients following resection for colorectal cancer. Liver resection is the only curative option, with one third of resected patients alive at five years. In those developing recurrence in the liver following resection, further liver surgery may be curative, with similar 5 years survival rates of about 30%. Until recently surgery was feasible in only 15–25% of patients with colorectal liver metastases. New strategies, such as downstaging chemotherapy, portal vein embolization and two‐stage hepatectomy, may increase the resectability rate by 15%.Earlier detection of liver metastases would increase resectability, although good follow‐up trials are lacking. Once suspected, colorectal liver metastases are staged by spiral CT, CT portography and MRI, which have similar overall accuracies.Mortality following liver resection is less than 5% in major centres, with a morbidity rate of 20% to 50%. Prognostic scoring systems can be used to predict the likely cure rate with resection.Pulmonary metastases occur in 10–25% of patients with resected colorectal cancer, but are limited to the lung in only 2% of cases. In these selected cases surgery provides long‐term survival in 20–40%, and repeat lung resection has shown similar rates.For patients with unresectable disease, chemotherapy and ablation techniques have been demonstrated to prolong survival, although chemotherapy alone has been shown to improve quality of life.
Rosiglitazone monotherapy improves glycaemic control in patients with type 2 diabetes: a twelve‐week, randomized, placebo‐controlled study
Authors: Patel J. , Anderson R. J. , Rappaport E. B. 
Published: March 2003

Summary Aim: Rosiglitazone is the most potent of the thiazolidinediones, a novel class of oral antidiabetic agents that reduce blood glucose levels by sensitizing peripheral tissues to insulin. This study was designed to identify doses of rosiglitazone that would lower fasting plasma glucose (FPG) in patients with type 2 diabetes. Methods: In this 12‐week, double‐blind, multicentre study, 380 patients with FPG values ≥7.8 mmol/L (140 mg/dL) and ≤13.3 mmol/L (240 mg/dL) were randomly assigned to receive treatment with placebo or rosiglitazone, 0.05, 0.25, 1.0, or 2.0 mg twice daily. The primary efficacy parameter was changed in FPG from baseline after 12 weeks of treatment. Secondary endpoints were changes in HbA1c, fructosamine, C peptide, insulin, lipid levels, and body weight (b.w.). Safety monitoring included clinical laboratory evaluations, electrocardiography, and echocardiography. Results: Rosiglitazone 1.0 and 2.0 mg b.i.d. produced significant decreases in FPG (p=0.0001). Fructosamine also decreased in patients treated with these two dosages (p=0.003 in the 2.0 mg b.i.d. group). Rosiglitazone 2.0 mg b.i.d. significantly reduced plasma insulin levels (p=0.0044) and free fatty acids (p=0.0014) compared with placebo. Total cholesterol (p=0.0001), HDL (p=0.0009), and LDL (p=0.0001) increased in the rosiglitazone 2.0 mg b.i.d. group, but there was no significant change in the total cholesterol/HDL ratio or triglyceride levels in any rosiglitazone treatment group. Clinically insignificant dose‐dependent increases in b.w. were observed in the rosiglitazone 1.0 and 2.0 mg b.i.d. treatment groups. Conclusions: Twelve weeks of treatment with rosiglitazone 2.0 mg b.i.d. significantly decreases fasting plasma glucose, fructosamine, plasma insulin, and free fatty acids in patients with type 2 diabetes. Longer studies using higher doses will be needed to assess the efficacy and safety of rosiglitazone in patients with type 2 diabetes mellitus.