bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of sacral neuromodulation for faecal incontinence on sexual activity
Authors: Jarrett M. E. D. , Nicholls R. J. , Kamm M. A. 
Published: August 2005

AbstractIntroduction  Faecal incontinence affects a percentage of the population and can have a significant effect on their ability to establish and maintain sexual relations.Patients and methods  Sixteen consecutive patients with permanent sacral neuromodulation (SNM) for faecal incontinence completed a ‘Sex Life Questionnaire’ at their follow up visit to ascertain whether there was any improvement in this aspect of their life.Results  Nine of the sixteen patients was sexually active. These nine patients (median age 56 (35–61) years) had a significant reduction in faecal incontinence episodes per week from a median of 12 (1–55) to 1.5 (0–8.5) (P = 0.008). All nine patients reported that their sex life had been affected by feacal incontinence prior to SNM and seven had felt benefit from implantation. The median improvement in their sex life was 40% (1–100) and the percentage improvement was inversely correlated to age (r = −0.834, P = 0.005).Conclusion  SNM improves the quality of sexual activity in 78% of patients. More improvement seems to be gained the younger the patients.
Modified technique for parastomal hernia repair in patients with intractable stoma‐care problems
Authors: Van Sprundel T. C. , Gerritsen van der Hoop A. 
Published: August 2005

AbstractObjective  Although stoma relocation is generally the first choice of treatment for parastomal hernia, a repair using polypropylene prosthetic mesh is sometimes employed in cases of parastomal hernia recurrence. Use of this mesh, however, has been associated with a high risk of bowel erosion, adhesions formation, and fistulization. We therefore began to use expanded polytetrafluoroethylene (ePTFE) mesh to perform an onlay parastomal hernia repair. Our initial clinical experience with this procedure is described.Patients and methods  Sixteen patients aged 39–70 years with intractable stoma problems underwent a modified intra‐abdominal onlay technique with implantation of a large (26 × 36 cm) sheet of ePTFE mesh.Results  During a median follow‐up of 29 months (range, 5–52 months), no mesh‐related bowel erosion, fistulization, or adhesion formation were observed. Two patients had a recurrence of the hernia due to technical failure. Re‐operation in one of these resulted in wound dehiscence and removal of the contaminated mesh. Another patient developed intestinal obstruction postoperatively. The mesh was removed, and a gastrointestinal stromal tumour was found. Finally, a nonmesh related small bowel erosion required removal of the mesh in one patient. All other patients had full relief of symptoms.Conclusion  The modified onlay technique using a large sheet of ePTFE prosthetic mesh is a feasible option for treatment of parastomal hernia recurrence. Possible advantages of the procedure include stoma preservation, strengthening of the abdominal wall, and a reduced risk of recurrence, contamination, fistulization, and bowel adhesions and erosion.
How has the ‘two‐week wait’ rule affected the presentation of colorectal cancer?
Authors: Chohan D. P. K. , Goodwin K. , Wilkinson S. , Miller R. , Hall N. R. 
Published: August 2005

AbstractObjective  To assess the impact of the ‘two‐week wait’ rule on the presentation of colorectal cancer.Methods  A retrospective study of all patients referred to a fast‐track clinic in a colorectal cancer centre over an 18‐month period, documenting outcome, especially colorectal cancer diagnosis. Comparison was made with patients diagnosed with colorectal cancer presenting via other routes in the same time period.Results  Over an 18‐month period, 462 patients were seen in the fast‐track clinic and 64 (13.8%) were diagnosed with colorectal cancer. A further 131 patients with colorectal cancer presented to the department in the same time period through other means; 66 via standard out‐patient letters, 26 from other departments and 39 (20%) as emergency admissions. Median (range) time to first clinic was 12 (2–28) days for fast‐track and 24 (1–118) days for standard referrals (P < 0.0001); median time to first treatment was a further 36 (9–134) and 36.5 (1–226) days, respectively. The fast‐track cohort had more advanced staging than those referred by standard letter. There were 19 Dukes' B, 22 Dukes' C and 14 Dukes' D cancers in the fast‐track group compared with 28 Dukes' B, 25 Dukes' C and 6 Dukes' D in the standard referral group. After patient interview, only 337 (73%) of 462 fast‐track patients appeared to fulfil the referral criteria but of the 64 diagnosed with cancer, 59 (92%) satisfied the criteria. Of the 66 patients with cancer referred by standard letter, 61 (92%) fulfilled the criteria.Conclusion  Patients referred to the fast‐track clinic were seen quicker than those referred by standard letter, but they tended to have more advanced disease. The fast‐track referral criteria were fulfilled by most patients with cancer (whether or not they were referred to the fast track clinic), confirming their validity. After detailed interview in the clinic, a quarter of fast‐track referrals were found not to satisfy referral criteria, suggesting that prioritization in primary care could be improved.
Long‐term outcome of per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer
Authors: Yoo J.‐H. , Hasegawa H. , Ishii Y. , Nishibori H. , Watanabe M. , Kitajima M. 
Published: August 2005

AbstractObjective  The authors have performed per anum intersphincteric rectal dissection. With direct coloanal anastomosis for cases of lower rectal cancer in which the distal surgical margin is difficult to secure by the double stapling technique. The aim of this study was to evaluate the long‐term outcome and to clarify the surgical indications for this operation.Patients and methods  Between 1993 and 2002, 31 patients underwent per anum intersphincteric rectal dissection with direct coloanal anastomosis. Of these, two patients (one stage 0 and one stage IV) were excluded from the analysis of oncological outcome. The remaining 29 patients formed the basis of this study. The median follow‐up was 57 months (range 6–106 months).Results  Local recurrence and distant metastasis developed in 9 and 3 patients, respectively. Local recurrence rate for pT1 was significantly lower than that for pT2/T3 disease. The local recurrence rate cases with tumours less than 3 cm was significantly lower than that for tumours sized 3 cm or more. The distant metastasis rate for cases with lymph node metastasis was significantly higher than that for cases without lymph node metastasis. There was an association between distant metastasis and TNM or pT stage. The overall survival rates for stage I, II and III were 85%, 80% and 89%, respectively. No significant defference was seen in total Cleveland Clinic incontinence score between per anum intersphincteric rectal dissection with direct coloanal anastomosis and the double stapling technique.Conclusion  The surgical indications of this operation should be limited to patients with T1 rectal cancer or tumours less than 3 cm.
Double‐blind randomised trial comparing 5‐fluorouracil plus leucovorin to placebo for metastatic colorectal carcinoma
Authors: Madden M. , Goldberg P. , Geddes C. , Van Der Merwe L. 
Published: August 2005

AbstractObjective  Previous randomised trials of chemotherapy for metastatic colorectal cancer have not concealed the allocation of treatment from participants. Most of these unblinded trials showed improved survival with chemotherapy. This trial used a double‐blind design to test the hypothesis that there is no difference between the effect of 5‐fluorouracil plus leucovorin and the effect of placebo on the survival of subjects with metastatic colorectal cancer.Patients and methods  In one hospital, 147 subjects with metastatic colorectal cancer were studied from 1989 to 2001. 73 were allocated chemotherapy with 5‐fluorouracil plus leucovorin. 74 were allocated placebo. The primary end point was survival after randomization. Secondary end points were performance score, quality of life, serum level of carcinoembryonic antigen (CEA) and toxicity of treatment.Results  One hundred and forty‐two patients were followed up until death. The median survival time in the chemotherapy group was 8.7 months (95% confidence interval (CI) 6.9–11.0 months) compared to 6.7 months in the placebo group (95% CI 5.3–7.9 months). Chemotherapy did not affect performance status but slowed the rise of CEA and caused appreciable toxicity.Conclusions  In this double‐blind trial, chemotherapy with 5‐fluorouracil plus leucovorin did not improve survival, did not impair performance, but caused appreciable toxicity.
Feasibility and morbidity of reversal of Hartmann's
Authors: Banerjee S. , Leather A. J. M. , Rennie J. A. , Samano N. , Gonzalez J. G. , Papagrigoriadis S. 
Published: August 2005

AbstractObjective  Reversal of Hartmann's is a major surgical procedure and associated with substantial morbidity and mortality.Method  This study retrospectively analysed the data at a single centre over an eight‐year period to assess the clinical results and morbidity of reversal of Hartmann's.Results  One hundred and ten Hartmann's procedures were performed during the period. Only 66 (61%) of patients had a reversal. Advanced age and comorbidity were the primary reasons for not reversing. Complications among the 66 patients (36 males and 30 females) who underwent reversal occurred in 26 (41%). There were no deaths. Patients who underwent reversal were ASA 2 (60%), ASA 3 (25%) and ASA 4 (4.6%). Univariate analysis demonstrated a significant association between complications following reversal and ASA grade (P =0.01), and hypertension (P = 0.03) There was no correlation between the patient variables and anastomotic leakage. Multiple logistic regression analysis showed a significant influence of hypertension, smoking and ASA grade on complications.Conclusions  About 40% of patients who undergo Hartmann's procedure will not have a reversal. Reversal is a feasible operation for selected patients, but there is a high complication rate.
Response to neoadjuvant therapy for rectal cancer: influence on long‐term results
Authors: Biondo S. , Navarro M. , Marti‐Rague J. , Arriola E. , Pares D. , Del Rio C. , Cambray M. , Novell V. 
Published: August 2005

AbstractObjective  Pre‐operative treatment with chemoradiotherapy (CRT) seems to improve local control and overall survival in patients with rectal cancer. The aims of the study were to analyse the impact on overall, disease free and cancer related survival of tumour response to pre‐operative CRT and to analyse the influence of the degree of response on long‐terms results.Patients and methods  Patients with a locally advanced rectal cancer, treated by pre‐operative CRT were studied. A radical resection of the rectal tumour with mesorectal excision was performed within 6–8 weeks. Judged on the final TNM classification patients were considered responders when the tumour showed histologically a complete response, microscopic residual disease or a partial response. Non‐responders were those in whom the extent of disease remained stable or progressed.Results  Radical excision was performed in 103 patients, and a palliative resection in five. Forty‐three patients underwent abdominoperineal resection and 65 anterior resection of the rectum. Seventy‐one (65.7%) patients showed a response to CRT, while 37 (34.3%) did not. The overall local and distant recurrence rates were 6.8% and 21.3%. Tumour recurrence (P < 0.008) and disease free survival (P < 0.007) were significantly different in responders and nonresponders. Of the 71 responders, 16 had a pathological complete response, 27 had persisting microscopic disease and 28 had macroscopic residual disease. No differences in cancer specific outcome were observed in these groups.Conclusion  Pathological response to pre‐operative CRT is associated with improved tumour recurrence and disease‐free survival rates. Any response to pre‐operative CRT appears to improve outcomes as much as a complete response.
Evolution of the two‐week rule pathway – direct access colonoscopy vs outpatient appointments: one year's experience and patient satisfaction survey
Authors: Maruthachalam K. , Stoker E. , Chaudhri S. , Noblett S. , Horgan A. F. 
Published: August 2005

AbstractObjectives  The aim of this study was to compare the effectiveness of Direct access colonoscopy (DAC) vs outpatient appointments for two‐week rule colorectal cancer referrals and to evaluate the satisfaction of patients referred through these routes.Patients and methods  Data were collected prospectively from January 2003 to December 2003 on patients who were referred for DAC or outpatient appointments at the discretion of the referring General practitioner via the Lower GI two‐week rule pathway. A postal questionnaire was used to survey patient satisfaction.Results  Six hundred and thirty‐nine patients were referred via the two‐week rule pathway; 188 patients underwent colonoscopy at their initial hospital visit and 19 (10.1%) colorectal cancers were diagnosed; 442 patients had an outpatient appointment and 32 (7.2%) colorectal cancers were identified. There were 7 (1%) inappropriate referrals and 2 patients refused investigations. All outcome parameters measured were reduced for patients referred directly for colonoscopy including time to definitive investigations (Median 9 vs 52 days P < 0.0001), time to histological diagnosis (Median 14 vs 42 days P < 0.0001) and time to treatment (Median 55 vs 75 days P < 0.0483). One hundred and seventy patients were surveyed by the postal questionnaire of whom 127 (75%) responded. Ninety‐eight percent of patients were satisfied with the service provided. Four (6.6%) of 60 patients who had undergone direct access colonoscopy expressed a desire to be seen at the outpatient department initially.Conclusions  Direct access colonoscopy results in significantly reduced times to histological diagnosis and definitive treatment in patients with colorectal cancer. Patients can be directly admitted for investigations bypassing the outpatient clinic without affecting patient satisfaction.
A technically difficult endorectal ultrasound is more likely to be inaccurate
Authors: Zammit M. , Jenkins J. T. , Urie A. , O'Dwyer P. J. , Molloy R. G. 
Published: August 2005

AbstractObjective  Endorectal ultrasound (ERUS) is well established as an accurate modality for local staging of rectal tumours. The aim of this study was to identify reasons for inaccurate staging of tumours, and to assess whether difficulties encountered during scanning are likely to influence accuracy.Patients and methods  ERUS was performed by a single operator using a 10 MHz rigid instrument. One hundred and seventeen patients that had both ERUS and surgery are included in this study (patients that had pre‐operative radiotherapy were excluded). During ERUS, procedural conditions and limiting factors were recorded. Data was collected prospectively.Results  In 78 (66.7%) patients no technical difficulty was encountered during ERUS. In this group accuracy was 80% for T‐stage and 77% for N‐stage. Specific reasons for inaccuracy identified in this group were: inflammatory lymph nodes (from a tumour associated abscess and a colovesical fistula) and deep biopsy causing a submucosal defect with intramural haemorrhage in benign lesions (2 cases). In the remaining 39 (33.3%), the following problems were encountered: stenotic lesions (23), patient discomfort (8), poor bowel preparation (6), and scarring from previous surgery (2). In 11 patients from this group, the scan was considered inconclusive and no stage could be determined. For the other 28, the accuracy for T‐stage was 68% and for N‐stage 67%.Conclusion  A technically difficult ERUS is likely to give an inconclusive or inaccurate result for both T‐stage (P = 0.001) and N‐stage (P = 0.003). In this situation a repeat scan may be considered (where appropriate). Alternatively, further assessment by MRI or flexible endoscopic ultrasound may be considered.
Management of the rectal stump after emergency sub‐total colectomy: which surgical option is associated with the lowest morbidity?
Authors: Trickett J. P. , Tilney H. S. , Gudgeon A. M. , Mellor S. G. , Edwards D. P. 
Published: August 2005

AbstractObjective  To identify the preferred surgical management of the rectal stump after emergency subtotal colectomy (ESC) for acute severe colitis by assessing the morbidity associated with each option.Patients and methods  Consecutive patients undergoing ESC at a district general hospital between 1999 and 2004 were retrospectively audited for pathology, rectal stump complications and length of postoperative hospital stay (POS).Results  Thirty‐seven ESCs were performed, 34 were undertaken for disease refractory to medical treatment, 2 for toxic mega colon and 1 for perforation. Thirty‐four cases were for ulcerative colitis, 2 Crohn's colitis and 1 infective colitis. Twenty‐seven had an intraperitoneal and 10 a subcutaneously placed closed rectal stump. The median POS for patients with a subcutaneously placed stump was shorter than for those with an intraperitoneal stump, 8 and 15 days, respectively (P = 0.04). Two patients had leakage from an intraperitoneal stump, prolonging POS (33 and 193 days). Three of the subcutaneous stumps leaked causing wound infection but not prolonging the POS (6, 7 and 16 days).Conclusion  Avoiding a second stoma by closing the rectal stump after ESC has been confirmed as acceptable practice by studies over the last 15 years, reporting no overall increase in complications. The location of a closed rectal stump appears to influence the incidence of pelvic sepsis. The lowest pelvic sepsis rate is associated with subcutaneous placement; despite a higher wound infection rate this option appears to be associated with a lower total morbidity reflected in a shorter POS.
Use of libraries and electronic information resources by primary care staff: outcomes from a survey
Authors: Doney Liz , Barlow Helen , West Joe 
Published: August 2005

AbstractObjectives:  To assess the use of existing libraries; usage of the Internet and biomedical databases; and need for training on use of the Internet and biomedical databases for primary care staff.Methods:  A postal survey of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Nottingham and Rotherham, UK.Results:  Overall, 243 questionnaires were used. The response rate in Nottingham was 24%, in Rotherham it was 34%. Reported use of libraries was low (30%), with PNs reporting significantly higher usage (65%) than others (P < 0.01). Most respondents reported using the Internet (81%), but fewer (44%) reported using databases. GPs and PNs were significantly more likely to report using databases than PMs (P < 0.01). Lack of training was the most reported barrier to using the Internet (67%) and databases (52%). Overall, 52% of respondents reported wanting Internet training, 64% wanted database training. The percentages requesting training on databases were high among GPs and PNs, but significantly lower for PMs (P = 0.02).Conclusions:  There are differences in the usage of libraries and electronic resources among the primary care team, and in reported training needs. While the reported levels of usage of the Internet and biomedical databases are encouraging, our study identified a training need. If met, this could increase usage further.
Information‐seeking behaviour and use of the Internet by French general practitioners: a qualitative study
Authors: Boissin Florence Gonod 
Published: August 2005

AbstractBackground:  Numerous studies deal with the use of computers and the Internet in the health sector. Most of these studies show an increase in the use of the new technologies in searching for medical information—particularly by patients—but these uses remain very heterogeneous and depend on the studies.Aims:  The aim of this work was to consider the use of computers by French general practitioners (GPs) and to analyse the impact that computerization could have on their information‐seeking behaviour.Methods:  The nature of the approach used is qualitative using interviews.Results:  Most of the GPs interviewed are equipped with a computer. The policies of the government were supposed to give financial incentives for GPs to start using computers for the management of administrative procedures, but many physicians do not know how to use the new tools properly. Their computers are, in most cases, underused for searching for medical information. Most of the time, the Internet sources are thought to be unreliable.Conclusion:  This study sheds light on the use of computers and the preferences of GPs in searching for medical information.
Efficacy of the 5‐HT1A Agonist, Buspirone Hydrochloride, in Migraineurs With Anxiety: A Randomized, Prospective, Parallel Group, Double‐Blind, Placebo‐Controlled Study
Authors: Lee Soon‐Tae , Park Jong‐Ha , Kim Manho 
Published: August 2005

Objective.—To examine the efficacy of buspirone, a 5‐HT1A agonist, for migraine combined with anxiety disorder.Background.—Modulation of the 5‐hydroxytryptamine (5‐HT) system is used for the neuropharmacology of migraine treatment; however, the involvement of the 5‐HT1A system in migraine is not fully understood.Methods.—Seventy‐four outpatients aged 20 to 70 years (mean, 46.4; SD, 12.8) were analyzed. All subjects were diagnosed to have migraine according to the International Headache Society criteria and anxiety disorder according to DSM‐IV. Subjects were randomly assigned to treatment with either buspirone (10 mg/day) or placebo for 6 weeks. Efficacy variables included changes in headache frequency, headache intensity, Hamilton Anxiety Rating Scale (HAM‐A), Headache Self‐Efficacy Scale (HMSE), and Headache Disability Inventory (HDI). The correlation between the headache improvement and the anxiolytic effect was analyzed.Results.—Headache frequency showed a 43.3% reduction in the buspirone‐treated group, but by only 10.3% in the placebo group. HAM‐A and HDI were also significantly more lowered in buspirone‐treated patients than in placebo‐treated patients. However, headache intensity and HMSE score were unchanged. Correlation analysis of the relation between headache frequency reduction and HAM‐A improvement, revealed no significant association.Conclusions.—In this study, buspirone showed a prophylactic effect in migraine with anxiety disorder, which was not secondary to its anxiolytic effect. This suggests that the agonistic action for 5‐HT1A can be directly effective in migraine prophylaxis. However, more long‐term study is warranted before concluding the efficacy.