bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histopathology of stapled haemorrhoidectomy specimens: a cautionary note
Authors: George B. D. , Shetty D. , Lindsey I. , Mortensen N. J. Mc. C. , Warren B. F. 
Published: March 2003

AbstractObjective  Stapled haemorrhoidectomy is a new technique with encouraging early results. The aim of this study was to examine the tissue removed during stapled haemorrhoidectomy, in particular to check on the presence or absence of transitional or squamous anal canal mucosa and internal anal sphincter muscle.Methods  Twenty‐six consecutive patients undergoing stapled haemorrhoidectomy were studied. Resected tissue was examined histologically according to a standardized histological protocol.Results  All 26 specimens contained columnar mucosa. Twelve specimens also contained anal transitional and stratified squamous epithelium. Two specimens contained columnar and transitional mucosa. Twenty‐two of 26 specimens contained smooth muscle as well as mucosa (median maximum diameter 7.5 mm, range 2–20 mm). In 11 specimens this was circular muscle only; in 11 circular and longitudinal smooth muscle were present. In 10 specimens smooth muscle was seen to be lying beneath stratified squamous or transitional epithelium, suggesting that it was from the internal anal sphincter.Conclusions  Stapled haemorrhoidectomy results in resection of stratified squamous mucosa or part of the internal anal sphincter in a significant proportion of patients. Surgeons should be aware that this technique may result in damage to the internal anal sphincter.
Formaldehyde application for haemorrhagic radiation‐induced proctitis: a clinical and histological study
Authors: Chautems R. C. , Delgadillo X. , Rubbia‐Brandt L. , Deleaval J. P. , Marti M. ‐CL. , Roche B. 
Published: March 2003

AbstractObjectives  Haemorrhagic radiation‐induced proctitis is a serious complication of radiotherapy of pelvic organs. In severe cases, massive haemorrhage may necessitate hospitalization and repeated transfusions. Application of formaldehyde under direct vision is one of the most efficient treatments. The aim of this study was to evaluate the results of this treatment as well as the histological changes induced by formaldehyde on the rectal mucosa.Material and methods  From January 1991 to September 2001, 13 patients who presented a haemorrhagic radiation‐induced proctitis have been treated in our outpatient clinic with 4% formaldehyde cotton soaked applications. They were followed up to one year after the treatment. Endoscopic biopsies were performed before, immediately after the application, 1 month later, as well as at the one‐year follow‐up.Results  In eight cases bleeding stopped after the first application. In two patients a second application was necessary to control the haemorrhage and in two other patients bleeding ceased definitively after the fourth application. Follow‐up evaluation at 12 months showed no sign of acute proctitis or rebleeding. One asymptomatic patient had a mild stenosis of the rectum. Baseline biopsies showed signs of acute inflammation. Those performed after the application of formaldehyde showed fresh thromboses of the vessels of the mucosa. Biopsies at 1 month and 1 year showed only chronic changes secondary to the radiotherapy.Conclusion  Local application of 4% formaldehyde for the treatment of haemorrhagic radiation‐induced proctitis gives good results, is well tolerated and easy to perform. Formaldehyde applied selectively causes thromboses of the bleeding vessels, without deep lesions or extended necrosis.
Clustering of cardiovascular risk factors in type 2 diabetes mellitus: prognostic significance and tracking
Authors: Kaukua J. , Turpeinen A. , Uusitupa M. , Niskanen L. 
Published: March 2003

Summary AimLittle attention has been paid to the prognostic significance and tracking effect of risk factor clusters characteristic of type 2 diabetes mellitus. We studied the clustering of eight cardiovascular risk factors (smoking, high body mass index, elevated systolic blood pressure, high serum, low density lipoprotein (LDL) cholesterol, high serum LDL triglycerides, low serum, high density lipoprotein (HDL) cholesterol, high fasting blood glucose and high plasma insulin concentration) and their effect on the prognosis and the tracking effect.MethodsThis study is a population‐based prospective follow‐up of newly diagnosed type 2 diabetic subjects (n = 133, aged 45–64 years) in Eastern Finland. The following end points were used: all‐cause mortality, cardiovascular mortality, and incidences of first myocardial infarction and first stroke. Furthermore, we studied the ‘tracking effect’ of the risk factor clusters during the 10‐year follow‐up period.ResultsWhen the clustering of risk factors typical of type 2 diabetes mellitus was taken into account, all‐cause mortality increased from 28.6% to 50.0% (p < 0.05) and cardiovascular disease mortality increased from 14.3% to 50.0% (p < 0.01) depending on the number of risk factors present. The incidence of first myocardial infarction increased from 0% to 40.0% (p < 0.05) as the number of risk factors increased from 0 to 5. In survivors, the proportion of individuals with no risk factors decreased and the proportion on individuals with three to four risk factors increased during the 10‐year follow‐up period despite the high mortality among the group with many risk factors.ConclusionsThe risk factor clusters among type 2 diabetic subjects are of great predictive value and when not aggressively treated, show a relentless increase despite selective mortality.
Effects of granulocyte‐colony stimulating factor in the treatment of diabetic foot infection
Authors: Yönem A. , Çakir B. , Güler S. , Azal Ö. , Çorakçi A. 
Published: March 2003

SUMMARY Aims  Foot infections and the subsequent amputation of a lower extremity are the most common cause of hospitalization among patients with diabetes mellitus. Although there are several reasons for susceptibility to infection in diabetic patients, white blood cell dysfunction is considered to be an important cause for this tendency. Granulocyte‐colony stimulating factor (G‐CSF) increases the release of neutrophils from the bone marrow and improves neutrophil functions. Based on this knowledge, the aim of the present study was to investigate the effects of addition of G‐CSF to the treatment of foot infections in diabetic patients.Methods  Thirty diabetic patients with foot infection were included in the study. Fifteen of the patients received standard treatment consisting of local wound care and antibiotics (standard goup), and the other 15 patients received G‐CSF besides standard treatment (G‐CSF group). The objectives of this study were to determine the time to resolution of infection, time to hospital discharge, need for surgical intervention, and the effects of G‐CSF on phagocytosis and respiratory burst of neutrophils.Results  Treatment with G‐CSF led to significantly higher neutrophil counts on the 5th and 10th days, and at the end of treatment in the G‐CSF treated group compared to the standard group. Respiratory burst of neutrophils increased significantly in both the G‐CSF group (from 1.6 ± 0.3 to 2.3 ± 0.5, p = 0.001) and the standard group (from 2.0 ± 0.4 to 2.3 ± 0.4, p = 0.02) with treatment. But, while phagocytosis of neutrophils increased significantly in the G‐CSF group (from 70.4 ± 2.0 to 74.5 ± 1.9, p = 0.004), it did not change significantly in the standard group (from 68.1 ± 0.2 to 69.4 ± 1.9, p = 0.3) with treatment. Duration of hospitalization (26.9 ± 2.0 vs. 28.3 days, p < 0.05), duration of parenteral antibiotic administration (22.9 ± 2.0 vs. 23.3 ± 1.9 days, p < 0.05), time to resolution of infection (23.6 ± 1.8 vs. 22.3 ± 1.7 days, p < 0.05), and need for amputation (13.3% vs. 20%, p > 0.05) were similar between the G‐CSF and the standard groups.Conclusions  Although G‐CSF improves neutrophil function as well as increasing the absolute numbers, this improvement is not associated with shortening of duration of antibiotic administration, duration of hospital stay or need for amputation in diabetic foot infection.
Oral gavage of oleoyl‐oestrone has a stronger effect on body weight in male Zucker obese rats than in female
Authors: Grasa M. M. , Esteve M. , Masanés R. M. , Yubero P. , Blay M. , López‐Martí J. , Cabot C. , Vilà R. , Fernández‐López J. A. , Remesar X. , Alemany M. 
Published: March 2003

SummaryThis study was carried out to determine the effect of sex and oral administration of oleoyl‐oestrone on body weight of 12‐week‐old female and male Zucker obese (fa/fa) rats initially weighing 350–380 g and 405–420 g, respectively. The rats were maintained in standard conditions and given a daily oral gavage of 0.2 ml oleoyl‐oestrone dissolved in sunflower oil at a dose of 10 μmol/kg/day for 10 days, and their body weight and food intake was monitored. They were then killed, and their carcass composition (water, lipid, protein and total energy), liver lipids and glycogen and plasma chemistry, insulin, free and total oestrone were measured. Oral administration of oleoyl‐oestrone via gavage resulted in significant losses of fat, energy and–ultimately–weight. Treatment with oleoyl‐oestrone decreased food intake; the energy expenditure was kept close to that of controls at the expense of internal fat stores. Nevertheless, body protein and plasma metabolite homeostasis were preserved. The slimming effects were more marked in males than in females. Treatment increased circulating acyl‐oestrone and reduced to normal levels the high insulin observed in controls. Treatment of genetically obese rats with a daily oral gavage of oleoyl‐oestrone resulted in the loss of fat reserves with little modification of other metabolic parameters, except for lower plasma glucose and insulin levels. The results suggest that oleoyl‐oestrone, in addition to its slimming effects may be effective as an antidiabetic agent in type 2 diabetes.
Overexpression of the A1 adenosine receptor in adipose tissue protects mice from obesity‐related insulin resistance
Authors: Dong Q. , Ginsberg H. N. , Erlanger B. F. 
Published: March 2003

Summary In‐vitro studies have implicated the A1 adenosine receptor (A1AR) of adipocytes in inhibition of lipolysis, stimulation of lipogenesis and enhancement of the action of insulin on glucose metabolism. To determine whether any of these activities were physiologically relevant in an intact animal, A1AR was overexpressed in adipose tissue of transgenic mice. Lower plasma free fatty acid (FFA) levels were observed in the transgenic mice relative to the litter‐matched controls, supporting a significant physiological role for adipocyte A1AR in the control of lipolysis. However, no differences were observed in body weights or body composition. On a high fat diet, both the transgenic mice and the litter matched controls, male and female, became equally obese. Unlike the control mice, however, the transgenic mice did not develop insulin resistance, as demonstrated by serum glucose and insulin levels and glucose and insulin tolerance tests. These findings demonstrate that adipocyte A1AR plays an important physiological role in the control of insulin sensitivity in an intact animal and therefore should be considered to be a potential therapeutic target for the treatment of obesity‐related insulin resistance and type 2 diabetes.
Long‐term glycaemic improvement after addition of metformin to insulin in insulin‐treated obese type 2 diabetes patients
Authors: Hermann L. S. , Kalén J. , Katzman P. , Lager I. , Nilsson A. , Norrhamn O. , Sartor G. , Ugander L. 
Published: March 2003

SUMMARY Aim   To assess the adjunct effect of metformin to insulin in type 2 diabetes.Methods   Obese and overweight type 2 diabetes patients treated with insulin for at least 1 year, and with poor glycaemic control (HbA1c > upper reference level + 2%), were included in a randomised, double‐blind, placebo‐controlled study. Patients were treated for 12 months with either metformin (850 mg b.i.d.) or placebo added to their usual insulin, which was stabilized during a 3‐month placebo run‐in period, but thereafter attempted to be unchanged.Results   Thirty‐seven patients were included. Two patients dropped out during run‐in. There were no differences between the metformin (n = 16) and placebo (n = 19) group at baseline. Most patients received multiple insulin injections. Metabolic control was improved by addition of metformin. Mean change in HbA1c from baseline showed highly significant difference between groups at 3, 6, 9 and 12 months. Mean change (percentage units ± s.d.) at 12 months was −1.1 ± 0.7% vs. + 0.3 ± 0.8% (p < 0.001) for HbA1c and −1.4 ± 2.1 mmol/l vs. + 0.6 ± 2.2 mmol/l (p = 0.025) for fasting blood glucose. Mean low density lipoprotein (LDL) cholesterol change differed slightly at 6 months, but not at 12 months. There were no changes in insulin dose, blood pressure, body weight, triglycerides, total‐ and high density lipoprotein (HDL) cholesterol, fibrinogen, C‐peptide and laboratory safety variables, including serum B12. Combination therapy was well‐tolerated with the same adverse event rate as insulin alone, but more patients with diarrhoea.Conclusion   Addition of metformin to insulin induced and maintained clinically significant and consistent long‐term reduction of hyperglycaemia in obese, insulin‐treated type 2 diabetes patients.
The NEPI Antidiabetes Study (NANSY). 1: Short‐term dose–effect relations of glimepiride in subjects with impaired fasting glucose*
Authors: Lindblad U. , Lindwall K. , Sjöstrand Å. , Ranstam J. , Melander And A. 
Published: March 2003

SUMMARY Aim  NANSY is a randomised, placebo‐controlled Swedish‐Norwegian study which aims to include 2 × 1112 male and female subjects with impaired fasting glucose (IFG), to assess whether conversion to type 2 diabetes can be delayed by addition of sulphonylurea to dietary regulation and increased exercise. This pilot study was conducted to find the optimum dose of glimepiride in NANSY.Methods  In a double blind trial in primary care 25 IFG subjects were in random order exposed to single doses and one‐week treatments with 0 (placebo), 0.5, 1.0 and 2.0 mg glimepiride once daily. The optimum dose was assessed by measuring blood glucose during oral 75 g glucose tolerance test (OGTT), comparing fasting blood glucose, and the area under the blood glucose curve (AUC), and by monitoring hypoglycaemic events.Results  With single doses, there was a clear dose–response relationship for the reduction in AUC, with a statistically significant difference only between placebo (mean 1981, 95% confidence intervals (CI) 1883–2078) and 2 mg glimepiride (mean 1763, 95% CI 1665–1861). However, following 1‐week treatments, the only significant difference was between placebo (mean 1934, 95% CI 1856–2012) and 1 mg glimepiride (mean 1714, 95% CI 1637–1792). Correspondingly, the only statistically significant difference in fasting blood glucose day 7 was between placebo (5.87 mmol/l, 95% CI 5.68–6.05 mmol/l) and 1 mg glimepiride (5.42 mmol/l, 95% CI 5.21–5.62 mmol/l). Chemical hypoglycaemia was common but hypoglycaemic symptoms were rare and similar between the active doses, and easily countered by the subjects.Conclusions  The sulphonylurea dose–effect curve may be bell‐shaped, perhaps due to down regulation of sulphonylurea receptors during chronic exposure. Alternatively, the finding could be a rebound phenomenon, secondary to preceding hypoglycaemia. The optimum dose for NANSY was found to be 1 mg glimepiride.
Losartan modifies glomerular hyperfiltration and insulin sensitivity in type 1 diabetes
Authors: Nielsen S. , Hove K. Y. , Dollerup J. , Poulsen P. L. , Christiansen J. S. , Schmitz O. , Mogensen C. E. 
Published: March 2003

Aim: The effect of the angiotensin II receptor antagonist losartan on renal haemodynamics and insulin‐mediated glucose disposal was examined in normotensive, normoalbuminuric type 1 diabetic patients using a double‐blind, placebo‐controlled, cross‐over design.Methods: Diurnal blood pressure, glomerular filtration rate (GFR, determined using [125I]‐iothalamate), renal plasma flow (RPF, determined using [131I]‐hippuran) and urinary albumin excretion rate (UAE) were measured, and a hyperinsulinaemic, euglycaemic clamp with indirect calorimetry was performed in nine patients (age 30 ± 7 years (mean ± s.d.), HbA1c 8.1 ± 1.1%) following 6 weeks' administration of either losartan 50 mg/day or placebo.Results: Diurnal blood pressure was significantly reduced after losartan compared with placebo (122/70 ± 11/8 vs. 130/76 ± 12/6 mmHg, p < 0.05). A significant decline in GFR (133 ± 23 vs. 140 ± 22 ml/min, p < 0.05) and filtration fraction (FF; GFR/RPF) (24.6 ± 3.5 vs. 26.2 ± 3.6%, p < 0.05) was observed in the losartan vs. placebo groups. RPF and UAE did not change. Isotopically determined glucose disposal rates were similar after losartan and placebo in the basal (2.61 ± 0.53 vs. 2.98 ± 0.93 mg/kg/min) and insulin‐stimulated states (6.84 ± 2.52 vs. 6.97 ± 3.11 mg/kg/min). However, the glucose oxidation rate increased significantly after losartan vs. placebo in the basal state (1.72 ± 0.34 vs. 1.33 ± 0.18, mg/kg/min, p < 0.01) and during insulin stimulation (2.89 ± 0.75 vs. 2.40 ± 0.62 mg/kg/min, p < 0.03). Basal and insulin‐stimulated non‐oxidative glucose disposal tended to decrease after losartan; however, this was not significant. Endogenous glucose production and lipid oxidation were unchanged after treatment and similarly suppressed during hyperinsulinaemia. Glycaemic control, total cholesterol, high‐density lipoprotein (HDL)‐cholesterol and triglycerides were stable in both losartan and placebo groups.Conclusions: Losartan reduces blood pressure, glomerular hyperfiltration and FF, and improves basal and insulin‐stimulated glucose oxidation in normotensive, normoalbuminuric type 1 diabetic patients.
Lipoic acid increases glucose uptake by skeletal muscles of obese‐diabetic ob/ob mice
Authors: Eason R. C. , Archer H. E. , Akhtar S. , Bailey C. J. 
Published: March 2003

Aim: Alpha‐lipoic acid has been reported to increase glucose disposal in diabetic states. This study has examined the effect of α‐lipoic acid on glucose uptake by cultured L6 muscle cells and different types of skeletal muscles in normal lean (+/+) and severely insulin‐resistant, obese‐diabetic (ob/ob) mice.Methods: Glucose uptake was measured in L6 muscle cells using the non‐metabolized glucose analogue 2‐deoxy‐d‐glucose (2DG), and in isolated muscles by glucose disappearance from the incubation medium.Results: In L6 muscle cells, short‐term incubations (2–12 h) with 10−3 mα‐lipoic acid increased glucose uptake by 40–80%, approximately the same extent as 10−6 m insulin. Combination of the two agents produced a slightly greater increase (120% at 12 h) than either alone. Red quadriceps (mainly type 1 fibres), diaphragm (similar proportions of type 1 and 2 fibres) and abdominal muscle (mainly type 2 fibres) from normal mice incubated with 10−3 mα‐lipoic acid showed increased glucose uptake to a similar extent as 10−6 m insulin in each of the three muscles. Muscles from ob/ob mice, which showed little response to insulin, showed a substantial increase (approximately 300%, p < 0.05–0.01) in glucose uptake when 10−3 mα‐lipoic acid was added in the presence of insulin. The α‐lipoic acid also increased glucose uptake in red quadriceps (approximately 300%, p < 0.01) from ob/ob mice without added insulin.Conclusion: The results suggest that α‐lipoic acid can increase glucose uptake by a range of normal muscle types and improve the response to insulin by insulin‐resistant skeletal muscles of ob/ob mice.
Evaluation of the safety and efficacy of sibutramine, orlistat and metformin in the treatment of obesity
Authors: Gokcel A. , Gumurdulu Y. , Karakose H. , Melek Ertorer E. , Tanaci N. , Bascil Tutuncu N. , Guvener N. 
Published: March 2003

Aim: Some of our obese patients who were receiving 10 mg/day sibutramine reported feeling hunger at night. To address this, we designed a randomized, prospective clinical trial to study the efficacy and safety of 10 mg sibutramine twice daily (bid), and compare this treatment with 120 mg orlistat three times daily (tid) and 850 mg metformin (bid).Methods: A total of 150 female patients with body mass index (b.m.i.) > 30 kg/m2 were included. The subjects were all out‐patients at the Başkent University Endocrinology and Metabolism Clinic. Each individual was assigned randomly to receive 10 mg sibutramine bid (group 1; n = 50; mean age 42.27 ± 1.40 years), 120 mg orlistat tid (group 2; n = 50; mean age 42.13 ± 1.32 years) or 850 mg metformin bid (group 3; n = 50; mean age 43.58 ± 1.40 years). All patients took the medications for 6 months. Two patients from the sibutramine group and two from the orlistat group were withdrawn from the study because of side‐effects.Results: After 6 months of treatment, the sibutramine, orlistat, and metformin groups all showed significantly reduced b.m.i. (13.57%, 9.06% and 9.90% respectively); waist circumference (10.43%, 6.64%, and 8.10% respectively); fasting and postprandial blood glucose levels; insulin resistance as assessed by the homeostasis model for assessment of insulin resistance (HOMA)(38.63%, 32.73% and 39.28%, respectively); levels of total cholesterol, low‐density lipoprotein (LDLC) cholesterol, very low‐density lipoprotein (VLDLC) cholesterol, triglyceride, lipoprotein (a), and apolipoprotein B; uric acid level; pulse rate; and systolic and diastolic blood pressure. None of the groups showed any significant changes in levels of high‐density lipoprotein (HDLC) cholesterol, or apolipoprotein A1. There was a significantly greater fall in b.m.i. in the sibutramine group than in either of the other groups (p < 0.0001).Conclusions: The results of this study confirm that sibutramine, orlistat and metformin are all effective and safe medications that reduce cardiovascular risk and can decrease the risk of type 2 diabetes mellitus in obese females. Overall, treatment with 10 mg sibutramine bid is more effective than orlistat or metformin therapy in terms of weight reduction.
Diabetic ketoacidosis associated with Metabolife: a report of two cases
Authors: Case C. C. , Maldonado M. 
Published: March 2003

Aim: To describe two cases of diabetic ketoacidosis in newly diagnosed type 1‐ and type‐2‐diabetic individuals associated with Metabolife‐356®.Methods: We report the acute hospitalizations and clinical courses of two individuals with diabetic ketoacidosis taking Metabolife‐356®.Results: Both patients presented without a previous diagnosis of diabetes mellitus. One patient clinically has type 1 diabetes (positive islet cell antibodies and subnormal pancreatic beta cell function to glucagon stimulation) and is treated with insulin. The second patient, after 5 days of treatment with intravenous insulin of up to 25 units per hour, is now treated with oral medications. Several possible mechanisms may exist, including the increases in catecholamines and in blood glucose after ingestion of the ingredients of these supplements. Recent clinical trial data shows an increase in blood glucose (in non‐diabetics) with these supplements despite significant weight loss at 8 weeks, although no association with diabetes mellitus has been shown in these closely monitored studies.Conclusions: Although no precipitating factor of diabetic ketoacidosis was found in these individuals, the dietary supplement Metabolife cannot be established as a precipitant. However, patients with diabetes should take this supplement only after consultation with their health care provider, as stated on the product label. Most individuals using this supplement meet the current criteria for screening to detect undiagnosed diabetes mellitus and should consider these tests.