bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indications for performing transanal endoscopic microsurgery (TEM) in rectal cancer patients
Authors: Ikeda  , Mori  , Abe  , Koyanagi  , Akahoshi  , Sugimachi  
Published: March 2003

ObjectiveThe aim of this study was to clarify the application of a local excision using TEM for rectal cancer.Patients and methodsFifteen patients were preoperatively diagnosed to have cancer invasion in the submucosa (T1) and thus were treated by TEM, while 13 others were preoperatively diagnosed to have cancer invasion reaching the muscularis propria (T2) and thus were treated by a radical operation. Surgical specimens from all 28 patients were pathologically examined and compared with the preoperative evaluation.ResultsThe mean operating time for TEM was 53 min. The accuracy of the preoperative evaluation for the depth of cancer invasion was 68% (19/28). In the 15 patients with preoperative evaluation of T1 cancer, two pathologically showed cancer invasion into muscularis propria. In the 13 patients with a preoperative evaluation of T2 cancer, three pathologically showed cancer invasion within the submucosa.ConclusionSince some patients with a preoperative evaluation of T2 rectal cancer showed the possibility of a complete cure with a local excision, preoperative T2 stage rectal cancer is considered to be a good candidate for a local excision using TEM.
Physiological assessment of epithelial function in damaged rat colon
Authors: Kumagai  , Tomioka  , Hayashi  
Published: March 2003

ObjectiveTo assess colonic damage quantitatively by electrophysiological parameters such as membrane potential difference, short circuit current and transepithelial resistance, and by colonic membrane permeability (permeation clearance) of FITC‐labelled dextran 4000.Materials and methodsFor experimental colitis models of rats, trinitrobenzene sulphonic acid‐, acetic acid‐, and dextran sulphate sodium‐induced models were employed. The Ussing‐type chamber was used for determination of the electrophysiological parameters and permeation clearance of FITC‐labelled dextran 4000.ResultsReductions of all the above electrophysiological parameters were observed in trinitrobenzene sulphonic acid‐ and acetic acid‐induced models. No good correlation between the reduction in the parameters and the intestinal damage score was found in any of the models. This shows that damage scores do not necessarily reflect precise changes in physiological epithelial function. In contrast, the electrophysiological parameters were well correlated with membrane permeability. The reduction in transepithelial resistance, i.e. reduction in barrier function, was supported by an increase in permeation clearance of FITC‐labelled dextran 4000 and the plasma appearance of endotoxin in the trinitrobenzene sulphonic acid‐induced model. Through the recovery of transepithelial resistance and permeation clearance of FITC‐labelled dextran 4000 to control values in the acetic acid‐induced model, automatic recovery of the model to normal occurred.ConclusionExamination of the electrophysiological parameters and permeation clearance of FITC‐labelled dextran 4000 can provide a useful method of assessment of epithelial damage.
Perineal wound morbidity following proctectomy for inflammatory bowel disease (IBD)
Authors: Adam  , Shorthouse  
Published: March 2003

ObjectiveDelayed perineal wound healing following ‘conventional’ excision of the rectum for IBD is common—up to 58% in patients with ulcerative colitis (UC) and 72% in those with Crohn’s disease (CD) 6 months following proctectomy. The risk of perineal wound morbidity is increased if anorectal sepsis is present at the time of proctectomy. The aim of this study was to establish the incidence of perineal wound sepsis in a consecutive series of patients treated by close rectal and intersphincteric anal canal dissection to preserve the pelvic floor and suction drainage to minimize the residual pelvic dead space.Patients and methodsAnorectal sepsis if present was drained preoperatively. Omental transposition was used selectively to occlude residual cavities after fistula tracks had been laid open. Between 1989 and 1996, 46 patients (median age 56 years) underwent rectal excision, 27 for UC and 19 for CD. In seven patients the faecal stream was diverted at least 2 months prior to proctectomy. In all but five patients primary closure of the perineum was carried out (89.1%).ResultsUncomplicated wound healing occurred in 37/46 (80.4%) patients. All patients in whom the perineum was left open healed within 6 months without subsequent chronic sinus formation. At a median follow up of 3.4 years (2.1–7.4 years), no patient with UC had further perineal wound problems and only 2/19 (10.5%) of CD patients had a persistent chronic perineal sinus. Preoperative faecal diversion had no influence on the incidence of subsequent perineal wound morbidity.ConclusionUncomplicated perineal wound healing after rectal excision for IBD appears more likely to occur after preoperative control of anorectal sepsis, minimizing dead space in the pelvis by perimuscular rectal excision, use of suction drainage, intersphincteric dissection of the anal canal and selective use of omental transposition.
Clinical and physiological heterogeneity in slow transit constipation: a review of 122 patients
Authors: Knowles  , Scott  , Williams  , Lunniss  
Published: March 2003

ObjectiveThe outcome of surgery in patients with slow transit constipation (STC) is unpredictable. This may reflect clinical and physiological heterogeneity within this group of patients. This study attempts to identify subgroups of patients with STC according to clinical history, and compares the pathophysiological findings between the two largest: including patients with chronic idiopathic STC, and those with symptoms acquired after pelvic surgery or childbirth (post‐pelvic intervention STC).Patients and methodsReview of clinical and gastrointestinal pathophysiological findings of 122 consecutive patients with slow colonic transit.ResultsSix subgroups of patients were defined according to the time and nature of onset of symptoms. Pathophysiological comparison of the two main groups: chronic idiopathic STC (n=65 (53%)) and post‐pelvic intervention STC (n=22 (18%)), yielded three main conclusions: (i) the pattern of colonic transit is similar in both groups, i.e. predominantly (approximately 70%) generalized; (ii) the prevalence of a rectal evacuatory disorder is significantly higher in patients with post‐pelvic intervention STC (77% vs 32%, P=0.004); and (iii) small bowel motility disturbances occur in both groups (overall 48%), and are therefore not limited to patients with chronic idiopathic STC.ConclusionThere are pathophysiological similarities and differences between the main two subgroups of STC. Such findings may help our understanding of the pathogenesis and have implications in the future management of these patients.
Inter‐observer variability in the reporting of dynamic evacuation proctography
Authors: Stojkovic S. G. , Ireland I. W. , Holmfield J. H. , Sagar P. M. , Finan P. J. 
Published: March 2003

ObjectiveTo determine the degree of inter‐observer variability between two reporters of dynamic evacuation proctography (DEP).Patients and methodsThe videotapes of 136 patients who had undergone the investigation of DEP in a 1‐year period were retrospectively and independently reported by two of the authors. The authors recorded the presence or absence of an anterior rectocoele (as well as size—small, medium or large), an intussusception, a rectal prolapse and any degree of non‐relaxing puborectalis syndrome (NRPS).ResultsThe results were analysed using the κ statistic. I.W.I. reported 18% of the proctograms as normal. S.G.S. reported 26% of the proctograms as normal. κ scores for agreement on the presence or absence of rectal prolapses, NRPS, intussusception and anterior rectocoeles between the two reporters were 0.79, 0.70, 0.54 and 0.82, respectively.ConclusionUsefulness of an investigation is dependent upon its reproducibility and hence on the degree of inter‐observer variability in its reporting. Our study shows that DEP is a useful investigation for delineating the mechanics of the pelvic floor and that consistency of reporting in our Department is good.
Comparison of the Moskowitz criteria and the pouchitis disease activity index (PDAI) for diagnosis of ileoanal pouch inflammation
Authors: Evgenikos N. , Bartolo D. C. C. , Hamer‐Hodges D. W. , Ghosh S. 
Published: March 2003

ObjectiveTo prospectively compare two indices for diagnosis of pouchitis: Moskowitz criteria and pouchitis disease activity index (PDAI).Patients and methodsFifty‐six consecutive patients with an ileoanal pouch for ulcerative colitis were recruited. A clinical questionnaire was composed and the Öresland functional score calculated. Pouchoscopy and biopsy were performed after cleansing of the pouch.ResultsSeven patients had pouchitis according to both Moskowitz and PDAI (‘positive’ group). Five patients had PDAI ≥ 7, but did not fulfil the Moskowitz criteria (‘negative’ group). The pouchoscopy and Öresland functional scores were similar between the two groups. The biopsy neutrophilia and ulceration were more prominent in the ‘positive’ group (χ2=5.18, P < 0.05), whereas urgency (χ2=8.4, P < 0.001), evacuation difficulties (χ2=5.18, P < 0.05) and history of bleeding per pouch (χ2=4.18, P < 0.05) were more pronounced in the ‘negative’ group.ConclusionMoskowitz criteria may be broadly in agreement with the PDAI; these, however, cannot be regarded as interchangeable.
Island flap perineoplasty decreases the incidence of wound breakdown following overlapping anterior sphincter repair*
Authors: Draganic B. , Eyers A. A. , Solomon M. J. 
Published: March 2003

ObjectiveOverlapping anterior sphincter repair is the accepted treatment for faecal incontinence resulting from sphincter disruption, however, wound breakdown has been reported to occur in up to 30% of patients. The aim of this study was to assess whether the type of wound closure affected the incidence of wound breakdown, and in particular whether island flap perineoplasty decreased this incidence.MethodsAn historical control study was performed evaluating wound outcomes in patients undergoing different methods of wound closure after sphincter repair. Data were obtained from a prospectively collected database.Results85 patients who underwent overlapping sphincter repair were studied. Five patients had their wounds left open to heal by granulation. Of the remaining 80 patients, wound dehiscence occurred in 33 patients (41%). When wound breakdown did occur, the mean time to healing was 9.1 weeks. Wound dehiscence was found to occur significantly less frequently in patients having an island flap perineoplasty than in those having other forms of wound closure (15 vs 54%; P=0.0015). The presence of a complex injury such as cloacal defect or recto‐vaginal fistula was also found to increase the incidence of wound breakdown, however, performing additional operations at the time of sphincter repair such as levator‐plasty, gynaecological procedures or defunctioning colostomy did not affect the incidence of wound disruption.ConclusionsWound disruption following overlapping anterior sphincter repair occurs in a significant proportion of patients and results in prolonged healing. Island flap perineoplasty significantly decreases the incidence of wound disruption in comparison to other forms of wound closure.
In vitro and preclinical studies of targeted alpha therapy (TAT) for colorectal cancer
Authors: Rizvi S. M. A. , Allen B. J. , Tian Z. , Goozee G. , Sarkar S. 
Published: March 2003

IntroductionEffective targeted cancer therapy requires high selectivity and cytotoxicity of the labelled product. We report the preparation and testing of anticolorectal cancer monoclonal antibody c30.6 radioimmunoconjugates (RIC) labelled with alpha‐emitting Bismuth‐213 and positron emitting Terbium‐152 using two chelators, viz. Cyclic dianhydride of diethylenetriaminepentacetic acid (DTPA) and CHX‐A′′ (a DTPA derivative).MethodsSelectivity and stability of the RIC were tested in vitro (flow cytometry) and in vivo (biodistribution, organ/tumour uptake and retention). Cytotoxicity assays were carried out using tritiated thymidine uptake (inhibition of DNA synthesis) and MTS assay.ResultsHigh labelling efficiency (ranging between 89 and 91%) and stability over 2–5 half‐lives of the isotopes were seen. Kidney retention was not seen in contrast to high uptake and retention of both conjugates in tumours. Flow cytometry studies showed high specificity of the antibody before and after labelling and this unchanged targeting behaviour was reflected in cytotoxicity assays. These assays showed that only alpha‐labelled antibody could selectively kill the cancer cells for activities as low as 2–3 μCi. The study also revealed that free isotopes or isotopes bound to nonspecific antibodies did not kill cancer cells.ConclusionThe stability of the RICs and outstanding cytotoxicity of the alpha emitter, together with no kidney retention and high tumour uptake and retention of the radiolabel, offers a new approach for the potential control of colorectal cancer.
Success and failure after repair of rectovaginal fistula in Crohn’s disease: analysis of prognostic factors
Authors: Penninckx F. , Moneghini D. , D'Hoore A. , Wyndaele J. , Coremans G. , Rutgeerts P. 
Published: March 2003

ObjectiveTo compare the healing rate after several types of surgical repair of rectovaginal fistula (RVF) in Crohn’s disease, and to identify factors predicting a successful outcome.Patients and methodsA Medline review of the literature since 1980 and analysis of our results in 32 consecutive patients was done.ResultsAll types of repair (rectal, vaginal, anocutaneous advancement flap, or perineoproctotomy with fistula closure) seem to be equally effective. Healing after a first repair is observed in 58 (46–71)%. Healing can still be obtained at subsequent attempts in 62 (40–71)% of the patients. The reported overall healing rate is 75 (56–93)%. The need for proctectomy after an attempt to repair was 6 (0–27)% in these series. Using a tailored surgical approach, we observed primary healing in 57%, healing after one or more supplementary procedures in 71%, for a total ‘definitive’ closure rate of 75%. Anal continence was never compromised and all temporary stomas (12 patients) could be closed. Univariate analysis identified number of Crohn’s sites, presence of extra‐intestinal disease and previous Crohn’s proctitis to be related with problematic healing after a surgical repair. A positive relation was found between extra‐intestinal disease and the number of repairs needed to ultimately obtain healing, whereas the relation with previous right hemicolectomy was negative. Multivariate analysis revealed the number of Crohn’s sites as the only factor predicting problematic healing. A defunctioning stoma was not related to the healing rate and had its intrinsic morbidity with supplementary hospitalization (9.6 days). After a median follow‐up of 40.4 (range 8–87) months, we observed 4 late recurrences in 25 patients with healed RVF (16%).ConclusionClosure of a RVF in Crohn’s disease should not be considered an easy undertaking, especially in patients with several Crohn’s sites. In this very heterogeneous group of patients the technique is adapted to the nature and the extent of accompanying anorectal disease. Construction of a temporary stoma is not mandatory and can be limited to complex cases. Healing can be obtained in 75% of all patients, although a late recurrence might occur.
Assessment and classification of never operated and recurrent cryptoglandular fistulas‐in‐ano using hydrogen peroxide enhanced transanal ultrasound
Authors: Sloots C. E. J. , Felt‐Bersma R. J. F. , Poen A. C. , Cuesta M. A. 
Published: March 2003

ObjectiveClassification and visualization of fistula‐in ano is used to determine surgical treatment according to the type of fistula, predict the recurrence rate and incontinence risk and compare the results of treatment published in literature. Hydrogen peroxide enhanced transanal ultrasound (HPUS) with the peroxide introduced through the external opening of the fistula gives a clear and accurate visualization of the track in relation to the sphincters. The aim of this study was to review never operated and recurrent cryptoglandular fistulas‐in‐ano visualized with the aid of HPUS in order to establish the anatomical differences.Patients and methodsEighty‐one patients with never operated (48) or recurrent (33) cryptoglandular fistulas‐in‐ano were assessed by clinical examination and HPUS.ResultsNever operated fistulas were single track, trans‐ or inter‐sphincteric fistulas in 80%. In 15%, the tracks were sinus with no connection to the pectinate line. Two patients (5%) had a transsphincteric fistula with a ramification. No supra‐ or extra‐sphincteric fistulas were found in the never operated fistula group. In the recurrent fistula patients, 57% had a single trans or intersphincteric track, 15% of the patients had a single track supra or extrasphincteric fistula and 27% had a ramified fistula.ConclusionsAll never operated cryptoglandulair fistulas‐in‐ano were inter‐ or trans‐sphincteric. An extra track was found in 5%. Recurrent fistulas‐in‐ano were supra or extrasphincteric in 15% and ramified in 27%. Therefore, never operated fistula‐in‐ano does not require any special investigation before surgical treatment. However, before treating recurrent fistulas, visualization by HPUS is recommended to detect supra or extrasphincteric fistulas or ramification.
Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without a reservoir
Authors: Nesbakken A. , Nygaard K. , Lunde O. C. 
Published: March 2003

ObjectiveThe anal sphincters, neorectal capacity and motility may be affected by injury to the autonomic nerves during rectal resection. Anorectal function also depends on the method used for restoration of intestinal continuity, and colonic reservoir reconstruction has been recommended in ultralow anastomosis. This study was undertaken to evaluate the results after nerve preserving mesorectal excision and colorectal anastomosis without a reservoir.Patients and methodsThirty‐five consecutive patients who underwent low anterior resection with primary healing of the anastomosis, were included. Anal manometry with stationary pull through technique, rectal volumetry and symptom scoring (written questionnaires with visual analogue scales) were performed prior to and 12 months after surgery. Anal sphincter function was evaluated in all patients, but five patients with a colonic reservoir were excluded from the other evaluations. Thirty patients entered the main study; 14 patients having a total mesorectal excision (TME) and a low anastomosis (LA) (4–6 cm) and 16 patients a partial mesorectal excision (PME) and a high anastomosis (HA) (7–11 cm from the anal verge).ResultsAnal resting and squeeze pressure and rectal sensibility (threshold volume) were unchanged after the operation. The rectal volume eliciting urge to defecate was reduced from median 95 ml to 70 ml (P < 0.01), and the maximum tolerable rectal volume was reduced from 200 to 135 ml (P < 0.01) after the operation. The maximum tolerable volume was significantly lower in patients with LA than in patients with HA (P < 0.01). Overall functional results were good. The patients reported problems with complete bowel emptying (median VAS‐score reduction from 90 to 60, P < 0.01), and minor incontinence problems (median VAS‐score reduction from 100 to 90, P= 0.03). The reduction of VAS‐scores was more pronounced in LA than HA patients (without reaching statistical significance).ConclusionsAnal sphincter function was preserved after mesorectal excision. Neorectal capacity was reduced, most pronounced in patients with LA. The overall functional results were satisfactory and slightly better in patients with HA than in those with LA.
Femoral nerve injury as a complication of pelvic surgery
Authors: Schofield P. F. 
Published: March 2003

AbstractFemoral nerve injury is a rare complication of pelvic surgery but may lead to medicolegal actions. The common cause is the use of a long‐bladed self‐retaining pelvic retractor. The injury is not well recognised in coloproctology practice and this brief article is to draw attention to this complication.
Lowering of circulating insulin and leptin is closely associated following weight reduction after vertical banded gastroplasty in obese women
Authors: Guldstrand M. , Backman L. , Adamson U. , Lins P. E. , Ahrén B. 
Published: March 2003

Summary Aim: To explore whether the lowering of insulin relates to changes in leptin following weight reduction after vertical banded gastroplasty (VBG) in seven grossly obese women (BMI 45.9 ± 1.5 kg/m2). Results: At 6–24 months after VBG, BMI was reduced to 31.3 ± 0.9 kg/m2 (p < 0.018), leptin from 43 ± 9 to 12 ± 2 ng/ml (p < 0.018) and insulin from 172 ± 19 to 71 ± 2 pmol/l (p=0.018). The reduction in leptin correlated to the reduction in insulin (r = 0.94, p = 0.002) but not to that of BMI (r = 0.05, NS). Conclusion: Reduction in insulin seems more important for reduction in leptin than lowering of BMI, suggesting a close association between leptin and insulin in obese subjects.
Insulin resistance: the fundamental trigger of type 2 diabetes
Authors: Groop L. C. 
Published: March 2003

Summary Summary. Type 2 diabetes is a heterogeneous condition that is not attributable to a single pathophysiological mechanism. In general, both insulin resistance and impaired insulin secretion are required for the disease to become manifest. Thus, as long as the pancreatic β cells can compensate for the degree of insulin resistance, glucose tolerance remains normal. Clustering of type 2 diabetes in certain families and ethnic populations points to a strong genetic background for the disease. However, environmental factors such as obesity and a sedentary lifestyle are usually required to unmask the genes.