bluuebunny/crossref_metadata_2025_split huggingface dataset:
Young age is not a poor prognostic marker in colorectal cancer
Authors: Chung Y F A , Eu K-W , Machin D , Ho J M S , Nyam D C N K , Leong A F P K , Ho Y H , Seow-Choen F 
Published: March 2003

Abstract

Background
There is still considerable controversy and debate regarding the features and prognosis of colorectal cancer in young patients.

Methods
One hundred and ten patients (5·1 per cent) under the age of 40 years with colorectal cancer (group Y; male: female ratio 48:62) were compared with 2064 patients with colorectal cancer aged 40 years or more (group O; 917 women, 1147 men). Mode of presentation, stage at diagnosis, tumour characteristics and survival were analysed.

Results
Predisposing malignant conditions and family history of colorectal cancer were present in 20·9 per cent of patients in group Y versus 2·2 per cent in group O (P &lt; 0·001). Common chief complaints included change in bowel habits, bleeding from the rectum and a significantly higher incidence of abdominal pain in group Y. There was no difference in stage at presentation between the two groups (the proportion of Dukes stage A, B, C and ‘D’ lesions in group Y was 8·2, 24·5, 37·3 and 30·0 per cent respectively versus 10·5, 27·9, 33·4 and 28·1 per cent in group O). Tumour site and characteristics were similar in both groups. The incidence of mucinous/signet ring cell and poor grade tumours was 6·9 and 11·8 per cent respectively in group Y and 4·5 and 10·5 per cent in group O. With a mean follow-up of 31·8 months, the overall 5-year survival rate was 54·8 per cent in group Y and 54·1 per cent in group O. Comparing stage for stage, survival was not significantly different in the two groups. However, the adjusted hazard ratios of the age groups Y, M (40–59 years), S (60–79 years), and E (80 years and above) were 1·3, 1 (baseline for calculations), 1·4 and 2·4 respectively, suggesting an adverse outcome for patients in group Y compared with patients aged 40–59 years.

Conclusion
This study revealed no difference in tumour characteristics and survival in patients with colorectal cancer aged less than 40 years compared with those aged above 40 years. However, a higher hazard ratio in the youngest group may connote a worse prognosis than that for those aged 40–59 years. A significant family history of colorectal cancer and predisposing conditions in the young warrants aggressive screening, surveillance and treatment of the underlying conditions. The detection of colorectal cancer in young patients should be no different from that in the old but demands a high index of suspicion.
Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy
Authors: Dugue L , Sauvanet A , Farges O , Goharin A , Le Mee J , Belghiti J 
Published: March 2003

Abstract

Background
The management of chylothorax complicating oesophagectomy remains controversial. Even if medical management alone can be successful, some authors advocate early reoperation. The aim of this retrospective study was to identify the clinical variables associated with a high probability of full recovery with medical treatment.

Methods
Among 850 Lewis procedures performed for oesophageal carcinoma, 23 patients (2·7 per cent) developed postoperative chylothorax despite systematic preventive ligation of the main thoracic duct. Patients who responded to conservative management were compared with those requiring reoperation for preoperative radiotherapy, unilateral versus bilateral pleural effusion, delay of occurrence of the chylothorax, and ratio of mean chylous output to body-weight 1 and 5 days after its onset.

Results
Conservative management was successful in 14 patients with a mean(s.d.) delay of 12(5) (range 7–21) days and there were no hospital deaths. Reoperation was necessary in nine patients; there were two postoperative deaths and no recurrence of the chylothorax. The only significant difference between reoperated and medically treated patients was the mean(s.d.) chylous output at day 5: 23·5(16·6) versus 6·7(5·5) ml per kg body-weight (P&lt;0·001). At this time, the output was less than 10 ml/kg in 12 of 14 patients in whom medical treatment was successful (sensitivity 86 per cent), and equal to or greater than this cut-off value in all the patients who underwent reoperation (specificity 100 per cent).

Conclusion
The ratio of chylous output to body-weight on the fifth day after the onset of a chylothorax complicating oesophagectomy seems to reliably predict the success of continuing medical treatment.
Clinical assessment of positron emission tomography for the diagnosis of local recurrence in colorectal cancer
Authors: Takeuchi O , Saito N , Koda K , Sarashina H , Nakajima N 
Published: March 2003

Abstract

Background
The clinical value of positron emission tomography (PET) for the diagnosis of local pelvic recurrence of colorectal cancer was evaluated.

Methods
Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis were performed at regular intervals in 23 patients who had undergone resection for colorectal cancer. The 23 patients had a total of 25 lesions. PET images of the 25 lesions and of six primary lesions in patients with rectal cancer were obtained. A differential absorption ratio (DAR) was calculated in order to examine the accumulation of [18F]2-fluoro-2-deoxy-d-glucose (18FDG) on PET images. Histological diagnoses of the pelvic masses were obtained by CT-guided needle biopsy.

Results
On CT or MRI, a pelvic mass with a spicular shape (n = 1) was non-recurrent, whereas a nodular or lumpy shape indicated a locally recurrent lesion (n = 10). Masses with a nodulospicular shape (n = 12) did not correlate with the histological features. On PET, 15 of 16 histologically proven local recurrences were imaged positively. By setting a DAR of 2·8 as a cut-off value, local recurrences could be diagnosed with 100 per cent accuracy.

Conclusion
PET is a clinically useful tool for the detection of local recurrence of colorectal cancer, particularly for distinguishing between recurrence and granulation tissues in the pelvic cavity.
Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial
Authors: Chetty U , Jack W , Prescott R J , Tyler C , Rodger A 
Published: March 2003

Abstract

Background
In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately.

Methods
Patients with operable breast cancer were randomized to have level III axillary node clearance (232 patients) or axillary node sample (234 patients). Radiotherapy to the axilla was given selectively. Radiotherapy was not given to those who had an axillary clearance. In the early part of the study all patients who had node sample were treated by radiotherapy (54 patients); subsequently this was modified to include only those who were node positive. The morbidity to the shoulder and arm was assessed before and after operation by measuring upper limb volume and circumference, and combined glenohumeral and scapular movement and muscle power.

Results
Comparing the two surgical policies, no difference was found in local (axillary clearance 14 versus sample 15), axillary (eight versus seven) or distant (29 versus 29) recurrence. There was no statistically significant difference in 5-year survival rate (clearance 82·1 versus sample 88·6 per cent). Morbidity was least in those who had a node sample and no radiotherapy to the axilla. Radiotherapy to the axilla in patients who had a node sample resulted in a significant reduction in range of movement of the shoulder, e.g. mean(s.e.) 2·2(0·6) cm reduction in lateral rotation at 3 years. Surgical axillary clearance was associated with significant lymphoedema of the upper limb, e.g. 4·1(0·7) per cent increase in arm volume at 3 years.

Conclusion
A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.
Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer
Authors: Geh J I , Crellin A M , Glynne-Jones R 
Published: March 2003

Abstract

Background
Oesophageal cancer carries a poor prognosis. The 5-year survival rate following resection ranges from 10 to 35 per cent. Recent evidence suggests that the addition of non-surgical treatments to surgery may improve resection rates, reduce the risk of recurrence and improve survival. This review examines the role of preoperative chemoradiotherapy (CRT) in oesophageal cancer.

Methods
A Medline-based literature review (1980–2000) was performed using the key words ‘neoadjuvant or preoperative’ and ‘chemoradiotherapy or radiochemotherapy’. Additional literature was obtained from original papers and published meeting abstracts.

Results
Forty-six non-randomized and six randomized trials of preoperative CRT were found. Resection rates, pathological complete response (pCR), treatment-related mortality rates and relapse patterns are documented. Improved 5-year survival rates approaching 60 per cent may be achieved following pCR. Three of the six randomized trials show a benefit in either overall survival or disease-free survival compared with surgery alone. Treatment-related toxicity can be significant.

Conclusion
Preoperative CRT may improve survival. Emerging evidence suggests that CRT alone can achieve similar survival rates to surgery alone. New imaging modalities may help to select which patients require surgery. Larger randomized trials of preoperative CRT or chemotherapy are needed to define optimal regimens and produce higher pCR rates with acceptable toxicity.
Fracture of the penis
Authors: Eke N 
Published: March 2003

Abstract

Background
Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial.

Methods
A Medline search from January 1966 to July 2001 using the terms ‘fracture of penis’, ‘penile trauma’ and ‘coital injuries’ was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome.

Results
In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction.

Conclusion
Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.
Pathogenesis of colonic diverticula
Authors: Simpson J , Scholefield J H , Spiller R C 
Published: March 2003

Abstract

Background
Diverticula are herniations through the colonic wall and are therefore likely to be due to a weakness within the wall, an alteration in intracolonic pressures or a combination of these factors. This article reviews these aspects in relation to the pathogenesis of colonic diverticula.

Methods
Medline and Science Citation Index searches were performed to locate English language articles relating to the pathogenesis of colonic diverticulosis published since 1960. Manual cross-referencing was also performed and some historical articles were included.

Results and conclusion
Several theories now exist about the development of colonic diverticula. The majority of the evidence suggests that the morphological changes are the response to a lifelong consumption of a low-residue diet. However, there are complex relations between colonic structure, motility and dietary factors, and it is likely that all of these (and possibly genetic influences) play a role in the pathogenesis to a greater or lesser degree.
Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision
Authors: Law W L , Chu K W , Choi H K 
Published: March 2003

Abstract

Background
The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following low anterior resection with total mesorectal excision for rectal cancer.

Methods
Patients who required proximal diversion after low anterior resection with total mesorectal excision were randomized to have either a loop ileostomy or a loop transverse colostomy. Postoperative morbidity, stoma-related problems and morbidity following closure were compared.

Results
From April 1999 to November 2000, 42 patients had a loop ileostomy and 38 had a loop transverse colostomy constructed following low anterior resection. Postoperative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P = 0·037). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma-related complications after discharge from hospital. A total of seven patients had intestinal obstruction from the time of stoma creation to stoma closure (six following ileostomy and one following colostomy; P = 0·01).

Conclusion
Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.
Surgical treatment of incisional hernia
Authors: Cassar K , Munro A 
Published: March 2003

AbstractBackgroundIncisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repaired using open suture, open mesh or laparoscopic mesh techniques. This review examines the results of these methods of repair.MethodsA Medline literature search was performed to identify articles relating to ‘incisional hernia’, ‘ventral hernia’ and ‘wound failure’. Relevant papers from the reference lists of these articles were also sought.ResultsThe recurrence rate after open suture repair may be as high as 31–49 per cent; for open mesh repair it is between 0 and 10 per cent. Comparative studies show that recurrence is significantly more frequent after open suture repair than after open mesh repair; complication rates are similar for both procedures. Recurrence rates after laparoscopic mesh repair vary from 0 to 9 per cent. Comparative studies show that laparoscopic mesh repair is at least as safe and effective as open mesh repair.ConclusionOpen suture repair for incisional hernia carries an unacceptably high recurrence rate. The results of open mesh and laparoscopic mesh techniques are encouraging. There is scope for a large multicentre randomized clinical trial to compare laparoscopic and open mesh repair.
Systematic review of the efficacy and safety of colorectal stents
Authors: Khot U P , Lang A Wenk , Murali K , Parker M C 
Published: March 2003

Abstract

Background
Colorectal stents are being used for palliation and as a ‘bridge to surgery’ in obstructing colorectal cancers.

Methods
A systematic review of the published data on stenting for the treatment of colorectal obstruction was carried out by searching Medline and other online databases for the period from January 1990 to December 2000. A total of 58 publications (case series, single case reports and reviews) was found, of which 29 case series were included in the analysis. Technical and clinical success, complications and reobstruction, both in palliation and as a ‘bridge to surgery’, were assessed. Both descriptive statistics and pooled analyses were carried out.

Results
Pooled results showed that stent insertion was attempted in 598 instances. Technical success was achieved in 551 (92 per cent) and clinical success in 525 (88 per cent). Palliation was achieved in 302 (90 per cent) of 336 cases, while 223 (85 per cent) of 262 insertions succeeded as a ‘bridge to surgery’ (95 per cent had a one-stage surgical procedure). There were three deaths (1 per cent). Perforation occurred 22 times (4 per cent). Stent migration was reported in 54 (10 per cent) of 551 technically successful cases. The rate of stent reobstruction was 52 (10 per cent) of 525, mainly in the palliative group.

Conclusion
Evidence suggests that colorectal stents offer good palliation, and are safe and effective as a ‘bridge to surgery’. Stent usage can avoid the need for a stoma, and is associated with low rates of mortality and morbidity. Dilatation of malignant strictures at the time of stent placement appears to be dangerous and should be avoided.
Evaluation of POSSUM in patients with oesophageal cancer undergoing resection
Authors: Zafirellis K D , Fountoulakis A , Dolan K , Dexter S P L , Martin I G , Sue-Ling H M 
Published: March 2003

Abstract

Background
The Physiogical and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) has been used to produce a numerical estimate of expected mortality and morbidity after a variety of general surgical procedures. The aim of this study was to evaluate the ability of POSSUM to predict mortality and morbidity in patients undergoing oesophagectomy.

Methods
POSSUM predictor equations for morbidity and mortality were applied retrospectively to 204 patients who had undergone oesophagectomy for cancer. Observed morbidity and mortality rates were compared with rates predicted by POSSUM using the Hosmer–Lemeshow goodness-of-fit test. Evaluation of the discriminative capability of POSSUM predictor equations was performed using receiver–operator characteristic (ROC) curve analysis.

Results
The observed and predicted mortality rates were 12·7 and 19·1 per cent respectively, and the respective morbidity rates were 53·4 and 62·3 per cent. However, the POSSUM model showed a poor fit with the data both for the observed 30-day mortality (χ2 = 16·26, P = 0·002) and morbidity (χ2 = 63·14, P &lt; 0·001) using the Hosmer–Lemeshow test. ROC curve analysis revealed that POSSUM had poor predictive accuracy both for mortality (area under curve 0·62) and morbidity (area under curve 0·55).

Conclusion
These data suggest that POSSUM does not accurately predict mortality and morbidity in patients undergoing oesophagectomy and must be modified.
Peritoneal carcinomatosis from colorectal cancer
Authors: Jayne D G , Fook S , Loi C , Seow-Choen F 
Published: March 2003

Abstract

Background
Aggressive therapeutic regimens have been advocated for the treatment of peritoneal carcinomatosis from colorectal cancer. It is essential to understand the clinical and histological features that govern the natural history of this condition if the efficacies of novel therapeutic approaches are to be assessed adequately.

Methods
A database of 3019 colorectal cancers was used to identify patients with synchronous peritoneal carcinomatosis, patients who developed metachronous peritoneal carcinomatosis, and those without carcinomatosis. Clinical, histological and survival data for the groups were collated and subjected to statistical analysis.

Results
Some 349 patients (13 per cent) with peritoneal carcinomatosis were identified; 214 had synchronous disease and 135 had metachronous carcinomatosis. Some 125 patients (58 per cent) in the synchronous group were free of systemic metastases; 80 of these patients had localized disease. Liver metastases, tumour (T) stage, nodal stage, and venous and perineural invasion were independent predictors of metachronous carcinomatosis. The median survival of patients with synchronous disease was 7 months; survival was adversely affected by the extent of peritoneal carcinomatosis and the T stage of the primary cancer.

Conclusion
Peritoneal carcinomatosis is a common mode of disease progression in patients with colorectal cancer. For the majority of patients the prognosis is poor, but a small number with localized disease may be suitable for further aggressive therapy.
Parents’ perceptions of their children in a context of shared political uncertainty
Authors: Shamai Michal 
Published: March 2003

ABSTRACTThe study describes the differences and similarities between parents’ feelings and their perception of their children’s feelings in a politically uncertain situation. The study focuses on Israeli families living in Judaea and Samaria (the West Bank) during two periods: the Intifada and the post‐Oslo Agreements years during the first phase of the peace process with the Palestinians. The research combines qualitative and quantitative methods. The results show that most of the feelings evoked by the uncertainty are negative emotions, such as fear, anger, hate, the desire for revenge, and avoidance. These emotions are experienced by parents and, according to the parents’ perceptions, by their children as well. In addition to the correlation between parents’ own experiences and their appraisal of their children’s, the children were perceived as having more negative feelings than the parents. Systemic analysis of the results indicates that the children are often a channel for expression of their parents’ emotions. Based on this finding, suggestions are made regarding intervention with children that takes family processes into account. Some direction for applying the findings of this specific study in other contexts of shared political uncertainty, such as Northern Ireland, are suggested.
Independent fostering agencies uncovered: the findings of a national study
Authors: Sellick Clive , Connolly Jo 
Published: March 2003

ABSTRACTThis paper presents the findings of a survey of independent fostering agencies (IFAs) in England, Scotland and Wales. Information was gathered about their operational arrangements, services, fees, staffing, foster carers and the children and young people in placement. This information is supplemented by an earlier evaluation of one large English IFA and by reference to the available relevant literature. The expansion of the IFAs has been generally greeted with hostility by local authority managers because of what is perceived as the loss of foster carers to the independent sector, the costs of the IFAs and their position outside the public welfare sector. This paper questions the validity of these views following an examination of the status of the agencies, the background of their foster carers and the circumstances surrounding the placements of the children and young people. It concludes by identifying gaps in our knowledge and areas for future research.