bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long strictureplasty is as safe and effective as short strictureplasty in small‐bowel Crohn's disease
Authors: Shatari T. , Clark M. A. , Yamamoto T. , Menon A. , Keh C. , Alexander‐Williams J. , Keighley M. 
Published: December 2004

AbstractBackground  For the past 20 years it has been shown that intestinal strictureplasty is safe and effective in the management of short strictureplasty. Long strictureplasty (> 20 cm) may be an alternative to resection in some patients, especially in diffuse disease or after previous extensive resections. We reviewed the outcome of long strictureplasty for Crohn's Disease, to examine safety and recurrence rates, compared with conventional short strictureplasty.Methods  Sixty‐two patients have undergone single strictureplasty for jejunoileal Crohn's disease since 1974. Median follow‐up was 121 (range 7–253) months. Twenty‐one operations involved a single long strictureplasty, and 41 operations had a single short strictureplasty.Results  No significant differences were identified between the groups. The postoperative complications in long strictureplasty included 2 abscesses only and after short strictureplasty there was one anastomotic leak and one postoperative abscess. The median hospital stay was 10 days after long strictureplasty and 9 days after short strictureplasty. Three‐, 5‐ and 10‐year disease‐free rates for long and short strictureplasty, respectively, were 3‐year 80.4% and 62.1%; 5‐year 55.2% and 49.8% and 10‐year 49.1% and 33.5% (NS).Conclusions  These data indicate that long strictureplasty is safe and produces equivalent results to conventional (short) strictureplasty.
Shorter hospital stay associated with fastrack postoperative care pathways and laparoscopic intestinal resection are not associated with increased physical activity
Authors: Zutshi M. , Delaney C. P. , Senagore A. J. , Fazio V. W. 
Published: December 2004

AbstractObjective  Recent prospective studies have shown that ‘fast track’ postoperative care protocols (FT) can reduce hospitalization after major intestinal surgery to 4.5 days, as compared to the 7–10 days with traditional management (TR) and 2.5 days after laparoscopic surgery (LC). We used computerized actigraphy (CA) to evaluate physical activity using TR, FT and LC approaches.Methods  Fifteen patients undergoing intestinal resection by LC, TR and FT were recruited. CA devices were placed on the wrist and ankle of each patient from day1 until hospital discharge. Intra‐patient and intergroup analyses were performed using 24 h evaluations, and periods from 0800–2000h. Results are presented for, level of activity (LOA; activity counts per minute), activity index (AI;% epochs with activity) and acceleration index (ACI; change in activity rate during analysis period) for 0800–2000 h.Results  Levels of activity measured by wrist and ankle CA devices for the three different care protocols were: LC, 6263 ± 8008 (wrist), 1640 ± 3795 (ankle); FT 7874 ± 8550 (wrist), 2153 ± 4838 (ankle); LC 8526 ± 9917 (wrist), 2326 ± 4905 (ankle). Length of hospital stay was significantly shorter in LC than FT and TR patients (P < 0.01). There was no significant increase in wrist or ankle LOA for FT or LC patients. Similarly, there was no difference in AI or ACI.Conclusion  Although CA is an easily standardized method of evaluating physical activity after major abdominal surgery, no difference can be demonstrated between activity levels in patients managed by differing care pathways. Reductions in stay may be associated with factors other than a change in the level of physical activity after surgery.
Impact of national guidelines about the management of colorectal cancer on Australian surgeons' awareness of evidence: a pre/post survey
Authors: Cooney A. , Gattellari M. , Donnelly N. , Ward J. 
Published: December 2004

AbstractObjective  To evaluate the immediate impact of national evidence‐based guidelines about colorectal cancer on Australian surgeons' self‐reported practice and their deficits in awareness of scientific evidence underpinning clinical management practices.Design  Pre/post evaluation, comprising preguidelines survey (November 1998) and postguidelines survey (February 2001).Methods  One hundred and fourteen Australian surgeons returned postguidelines surveys, of whom 103 (90%) agreed to matching of their pre‐ and postguidelines responses. National distribution of the CRC guidelines occurred in November 1999. Over the ensuing year, dissemination strategies included seminars, presentations at conferences and journal articles.The main outcome measures used were changes in awareness of evidence for each of 23 clinical recommendations, changes in overall awareness score (maximum possible 23), changes in subscore for nine items for which evidence was compelling and predictors of change.Results  Of those surgeons followed up, 95% were aware of the guidelines and 32% had read them in detail. Only 47% recalled the consumer version. The three most highly rated topics in the guidelines were: high–risk familial syndromes (45%); screening based on family history of colorectal cancer (40%); population screening for colorectal cancer (25%). Compared with baseline, there was a modest improvement in the mean overall awareness score (P = 0.02). Paired analyses of awareness of the evidence for each of 23 individual topics revealed significant improvement only in five. For two, awareness significantly decreased.Conclusions  Our pre/post findings are not inconsistent with the expectation that dissemination of the CRC guidelines has had some short‐term impact. However, definitive evidence acquired through more rigorously designed controlled trials will be needed to determine first, whether surgical practice has changed and, second, whether implementation of the CRC guidelines or some other secular event caused such change.
Residual urine volume after total mesorectal excision: an indicator of pelvic autonomic nerve preservation? Results of a case‐control study
Authors: Kneist W. , Junginger T. 
Published: December 2004

AbstractObjective  The rate of bladder dysfunctions after total mesorectal excision (TME) for rectal cancer can be decreased by bilateral pelvic autonomic nerve preservation (PANP). However, it is not clear yet, how often partial nerve impairment may lead to bladder dysfunction. It was the aim of a case‐control study, to examine the residual urine volume in patients before and after TME with and without complete PANP, in order to clarify, whether this parameter allows conclusions on the quality of PANP.Patients and methods  Regarding bladder function, a case group (n = 26) without complete PANP was compared with a control group (n = 26) with complete identification and nerve preservation according to standadized intra‐operative documentation. Twenty‐six match pairs were established, identical regarding gender, wall infiltration depth, tumour site, operation procedure and operation extent. Rates of neoadjuvant therapy, R0‐classification, anastomotic leakage, wound and urinary tract infection were equally distributed for both the case‐ and control group (P > 0.05). Residual urine volume was pre‐ and post‐operatively determined by sonography.Results  Pre‐operatively, residual urine volumes differed neither between the pairs nor between both groups with and without nerve preservation. In the case group with incomplete PANP there was a difference between pre‐ and post‐operative residual urine volume (median; quartil: 2.5 ml; 0.0–32.5 ml vs 130 ml; 0.0–317 ml; P = 0.001). In the control group there was no difference (median; quartile: 0.0 ml; 0.0–20 ml vs 15.5 ml; 0.0–62.0 ml; P = 0.07). The difference between the postoperatively measured volumes of the case and control group were significant (P = 0.001). With residual urine volume = 100 ml, the risk of incomplete PANP was 14 times higher (odds ratio).Conclusions  Residual urine volume is an indicator of the completeness of PANP during TME. It should be determined pre‐ and post‐operatively, and besides the recording of the neurogenic bladder, serve as a quality control.
Lowering the doses of mifepristone and gemeprost for early abortion: a randomised controlled trial
Authors:   World Health Organization Task Force on Post‐ovulatory Methods for Fertility Regulation,   Participants are listed on page 742
Published: December 2004

Objective To test the efficacy of lower doses of mifepristone and gemeprost for medical induction of early abortion.Design Randomised controlled trial. Participants were blinded as to the therapy and physicians to the dose of mifepristone.Setting Thirteen hospital gynaecological units in different continents.Participants 1224 healthy pregnant women requesting medical abortion at <57 days from last menses.Intervention Random allocation to one of four regimens: mifepristone 50 mg by mouth followed by either 0.5 mg or 1.0 mg gemeprost vaginally on day 3; mifepristone 200 mg by mouth followed by either 0.5 mg or 1.0 mg gemeprost vaginally. We concealed the allocation sequence from clinicians enrolling participants, and maintained double blinding throughout.Main outcome measures Incidence of complete abortion; subordinate outcome measures included side effects such as vomiting and fall in haemoglobin, as well as the need for emergency curettage and blood transfusion.Results The success rate was significantly related to the dose of mifepristone. The relative risk of failure to have a complete abortion with the lower dose of mifepristone was 1.6 (95% CI: 1.1‐2.3) times that with the higher dose. The relative risk of failure with the lower dose of gemeprost (1.3; 95% CI: 0.9‐1.8) did not reach statistical significance.Conclusions A single dose of mifepristone 50 mg followed by gemeprost is inadequate for early medical abortion. There was no significant difference in side effects between the four treatment groups.
Spousal physical violence against women during pregnancy
Authors: Peedicayil Abraham , Sadowski Laura S. , Jeyaseelan Lakshman , Shankar Viswanathan , Jain Dipty , Suresh Saradha , Bangdiwala Shrikant I. ,   the IndiaSAFE Group
Published: December 2004

Objective  To determine the prevalence of physical violence during pregnancy and the factors associated with it.Design  A population‐based, multicentre, cross sectional household survey.Setting  Rural, slum and urban non‐slum areas of Bhopal, Chennai, Delhi, Lucknow, Nagpur, Trivandrum and Vellore, in India.Participants  A total of 9938 women who were 15 to 49 years of age and living with a child younger than 18 years old.Methods  Probability proportionate to size sampling of households was performed in three strata. Trained field workers administered a structured questionnaire. Women who reported domestic violence were asked about violence during pregnancy. Outcome variables included six violent behaviours: slap, hit, kick, beat, use of weapon and harm in any other way. Moderate to severe violence was defined as experience of any one or more of the following behaviours: hit, beat or kick. Odds ratios were calculated for risk and protective factors of violence during pregnancy using logistic regression.Main outcome measures  Physical spousal violence.Results  The lifetime experience, during pregnancy, of being slapped was 16%, hit 10%, beat 10%, kicked 9%, use of weapon 5% and harmed in any other way 6%. Eighteen percent of women experienced at least one of these behaviours and 3% experienced all six. The overall prevalence of moderate to severe violence during pregnancy was 13%. Logistic regression showed that the factors determining whether a woman experienced moderate to severe violence during pregnancy were: husband accusing wife of an affair (OR 7.1; 95% CI 5.1 to 9.8), dowry harassment (OR 4.1; 95% CI 2.8 to 6.1), husband having an affair (OR 3.7; 95% CI 2.8 to 4.8), husband being regularly drunk (OR 3.2; 95% CI 2.6 to 4.1), low education of husband (OR 2.8; 95% CI 1.4 to 5.6), substance abuse by husband (OR 2.6; 95% CI 1.3 to 5.5), no social support (OR 1.8; 95% CI 1.1 to 3.0), three or more children (OR 1.6; 95% CI 1.2 to 2.1) and household crowding (OR 1.1; 95% CI 1.0 to 1.2).Conclusion  In this study, 12.9% of women experienced moderate to severe physical violence during pregnancy. Suspicion of infidelity, dowry harassment, husband being regularly drunk and low education of husband were the main risk factors for violence during pregnancy.
Evaluation of the effect of uterine artery embolisation on menstrual blood loss and uterine volume
Authors: Khaund A. , Moss J.G. , McMillan N. , Lumsden M.A. 
Published: December 2004

Objective  To evaluate the effect of uterine artery embolisation (UAE) on menstrual blood loss (MBL) and uterine volume in women with symptomatic uterine fibroids.Design  Prospective observational study.Setting  West of Scotland gynaecology and radiology departments.Population  Fifty women (mean age 43 years) with symptomatic fibroids undergoing UAE between January 1999 and June 2003.Methods  Women collected sanitary protection from one menses pre‐embolisation and at regular intervals thereafter. This allowed objective measurement of MBL using the alkaline haematin technique. Uterine volume was calculated using magnetic resonance imaging (MRI) before and six months following embolisation. Interventional radiologists performed bilateral UAE. The Wilcoxon's signed rank test was used for statistical analysis of data.Main outcome measures  Post‐embolisation MBL and uterine volume changes.Results  Median pretreatment MBL was 162 mL (mean 234, range 9–1339). The median MBL decreased to 60 mL at 3 months (n= 34, range 0–767, P < 0.001), 70 mL at 6–9 months (n= 34, range 0–1283, P < 0.001), 37 mL at 12–24 months (n= 25, range 0–265, P < 0.001), 18 mL at 24–36 months (n= 17, range 0–205, P < 0.001) and 41 mL at 36–48 months (n= 6, range 0–66, P < 0.05). The median reduction in uterine volume was 40% (n= 46, 95% CI 33.0–49.7, P < 0.001).Conclusions  UAE causes a statistically significant reduction in objectively measured MBL. UAE is also associated with a statistically significant reduction in uterine volume at six months. There was no relationship between the changes in uterine volume and MBL.
Preventing ectopic pregnancies: how often does transperitoneal transmigration of sperm occur in effecting human pregnancy?
Authors: Nahum Gerard G. , Stanislaw Harold , McMahon Connette 
Published: December 2004

Objective  Transperitoneal transmigration of sperm constitutes the mechanism by which ectopic pregnancies occur in unilaterally obstructed fallopian tubes. This study was undertaken to determine how often sperm transmigrate across the peritoneal cavity to effect human pregnancy.Design  In women with non‐communicating rudimentary uterine horn pregnancies, the ratio of total uterine horn pregnancies to prior contralateral hemi‐uterine pregnancies was calculated to infer the overall transperitoneal sperm transmigration rate. The prior parity frequency distribution was also determined to calculate the best‐fit per‐pregnancy probability of attaining a rudimentary horn pregnancy with each subsequent gestation using maximum likelihood estimation.Setting  20th century.Sample  Non‐communicating rudimentary uterine horn pregnancies reported from 40 countries.Methods  Two hundred and seventy‐two cases were identified using manual and computerised searches of Index Medicus, Excerpta Medica, the Index‐Catalogue of the Library of the Surgeon‐General's Office and standard reference tracing.Main outcome measures  The ratio of total prior non‐rudimentary uterine horn pregnancies to rudimentary uterine horn pregnancies and the frequency distribution of prior maternal parities.Results  Prior to the incident 272 uterine horn pregnancies, the number of observed pregnancies was 292 (ratio = 0.93), implying an aggregate sperm transmigration rate of 0.48. Using the prior parity frequency distribution, the best‐fit probability of attaining a rudimentary horn gestation per‐pregnancy was 0.51 (95% CI 0.48–0.56).Conclusions  Intraperitoneal sperm transmigration occurs approximately half the time in effecting spontaneous human pregnancies. To minimise the risk of ectopic tubal pregnancy in woman with unilaterally damaged fallopian tubes, salpingectomy should be the preferred surgical treatment, rather than attempting tubal salvage and repair.
Myo‐inositol, glucose and zinc status as risk factors for non‐syndromic cleft lip with or without cleft palate in offspring: a case–control study
Authors: Krapels Ingrid P.C. , van Rooij Iris A.L.M. , Wevers Ron A. , Zielhuis Gerhard A. , Spauwen Paul H.M. , Brussel Wim , Steegers‐Theunissen Régine P.M. 
Published: December 2004

Objective  To investigate myo‐inositol, glucose and zinc status in mothers and their infants on cleft lip with or without cleft palate risk (CLP).Design  Case–control study.Setting  University Medical Centre Nijmegen, the Netherlands.Population  Eighty‐four mothers and their CLP child and 102 mothers and their healthy child.Methods  Venous blood samples were obtained to determine serum myo‐inositol and glucose and red blood cell zinc concentrations in mothers and children. Geometric means were calculated and compared between the groups. The blood parameters were dichotomised with cutoff points based on control values, <P10 for myo‐inositol and zinc concentrations and >P90 for glucose concentrations.Main outcome measures  Geometric means (P5–P95) and odds ratios (95% confidence intervals).Results  The CLP children (P= 0.003) and their mothers (P= 0.02) had significantly lower red blood cell zinc concentrations than controls. A low maternal serum myo‐inositol concentration (<13.5 μmol/L) and a low red blood cell zinc concentration (<189 μmol/L) increased CLP risk [odds ratio 3.0 (95% CI 1.2–7.4) and 2.0 (95% CI 0.8–4.8), respectively]. Children with low myo‐inositol (<21.5 μmol/L ) or low red blood cell zinc concentrations (<118 μmol/L) were more likely to have CLP [odds ratio 3.4 (95% CI 1.3–8.6) and 3.3 (95% CI 1.3–8.0), respectively]. Glucose was not a risk factor for CLP in mothers and children. Maternal and child myo‐inositol as well as zinc concentrations were slightly, albeit significantly correlated, rPearson= 0.33 (P= 0.0006) and rPearson= 0.23 (P= 0.01), respectively.Conclusion  This study demonstrates for the first time that zinc and myo‐inositol are important in the aetiology of CLP.
Severe complications of hysterectomy: the VALUE study
Authors: McPherson K. , Metcalfe M.A. , Herbert A. , Maresh M. , Casbard A. , Hargreaves J. , Bridgman S. , Clarke A. 
Published: December 2004

Objectives  To model the determinants of serious operative and post‐operative complications of hysterectomy and their potential risk factors.Design  A prospective cohort of women undergoing hysterectomies for benign indications in 1994/1995, with a six‐week postsurgery follow up.Population and setting  A total of 37,512 women from 276 NHS and 145 private hospitals in England, Wales and Northern Ireland, originally recruited to compare the outcomes of endometrial destruction with those of hysterectomy.Methods  Gynaecologists reported hysterectomies for non‐malignant indications carried out during a 12‐month period beginning in October 1994 and follow up data were obtained at outpatient follow up six weeks postsurgery. Odds ratios of severe complications by indication and method, adjusting for measured intrinsic risk factors, were calculated.Main outcome measures  Severe operative and post‐operative complications.Results  Severe operative complications occurred in 3%. The risk decreased with age and increased with greater parity and history of serious illness. Women with symptomatic fibroids (4.4%, 95% CI 3.9–4.9) experienced more complications than women with dysfunctional uterine bleeding (3.6%, 3.2–3.8), adjusted odds ratio (OR) = 1.3 (95% CI 1.1–1.6). Laparoscopic procedures (6.1%) doubled the risk of operative complications of abdominal hysterectomy (3.6%) (adjusted OR = 1.9, 1.5–2.5). Post‐operative complications occurred in around 1% of women, with a slight decrease with increasing age, and the strongest risk factor was a history of operative complications. Relative to dysfunctional uterine bleeding (1.0%), a higher risk for fibroids (1.2%) persisted after adjustments (RR = 1.5, 1.1–2.0). Both vaginal (1.2%) and laparoscopic (1.7%) techniques had significantly higher adjusted risks than abdominal operations (0.9%), RR = 1.4 (1.0–1.9) and RR = 1.6 (1.0–2.7). There were no operative deaths; 14 women died within the six‐week postsurgery (a crude mortality rate of 3.8/1000, 2.5–6.4).Conclusions  Hysterectomy is a common, routine surgery with comparatively rare serious complications. However, younger women, women with more vascular pelvises, who undergo hysterectomy, especially laparoscopically assisted vaginal surgery for symptomatic fibroids, are at most risk of experiencing severe complications both operatively and post‐operatively. Therefore, a less invasive alternative treatment for symptomatic fibroids could particularly benefit this group of women, while less invasive treatments for dysfunctional uterine bleeding, such as various methods of endometrial ablations or resections, would need to meet the current low levels of clinical complications in order to replace hysterectomy.
von Willebrand disease in women with menorrhagia: a systematic review
Authors: Shankar Meena , Lee Christine A. , Sabin Caroline A. , Economides Demetrios L. , Kadir Rezan A. 
Published: December 2004

Objective  To determine the prevalence of von Willebrand disease in women presenting with menorrhagia.Design  Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia.Setting  Hospital outpatient clinics (mainly gynaecological) and population surveys.Population  Women presenting with menorrhagia.Methods  Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences.Main outcome measures  Number of women with von Willebrand disease.Results  Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty‐one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11–15.6%). The prevalence was higher in the European studies—18% (95% CI 15–23%) compared with that in North American studies—10% (95% CI 7.5–13%). This difference (P= 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race‐ and ABO blood group‐specific values for von Willebrand factor.Conclusions  The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.