bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy
Authors: Ortiz H , Marzo J , Armendariz P 
Published: October 2002

Abstract

Background
The aim of this study was to compare the results of stapled haemorrhoidopexy (commonly called stapled haemorrhoidectomy) with those of conventional diathermy haemorrhoidectomy.

Methods
Fifty-five patients with symptomatic third- and fourth-degree haemorrhoids were randomized to either stapled haemorrhoidopexy (n = 27) or conventional diathermy haemorrhoid ectomy (n = 28). Operating time, postoperative pain, time to return to work, postoperative complications and effectiveness of haemorrhoidal symptom control were recorded. The mean follow-up was 15·9 months in the stapled haemorrhoidopexy group and 15·2 months in the conventional haemorrhoidectomy group.

Results
Mean pain intensity was significantly less in the stapled group (P = 0·001). There were no significant differences in the total number of complications, the length of absence from work or control of symptoms. Seven patients in the stapled group re-presented with prolapse compared with none in the conventional haemorrhoidectomy group (P = 0·004). This difference was also observed in the subset of patients with fourth-degree haemorrhoids (P = 0·003).

Conclusion
The stapled operation was significantly less painful than conventional haemorrhoidectomy. However, the rate of recurrent prolapse was higher after stapled haemorrhoidopexy than after conventional diathermy haemorrhoidectomy.
Meta-analysis of techniques for closure of midline abdominal incisions
Authors: van 't Riet M , Steyerberg E W , Nellensteyn J , Bonjer H J , Jeekel J 
Published: October 2002

Abstract

Background
Various randomized studies have evaluated techniques of abdominal fascia closure but controversy remains, leaving surgeons uncertain about the optimal method of preventing incisional hernia.

Method
Medline and Embase databases were searched. All trials with a follow-up of at least 1 year that randomized patients with midline laparotomies to closure of the fascia by different suture techniques and/or suture materials were subjected to meta-analysis. Primary outcome was incisional hernia; secondary outcomes were wound dehiscence, wound infection, wound pain and suture sinus formation.

Results
Fifteen studies were identified with a total of 6566 patients. Closure by continuous rapidly absorbable suture was followed by significantly more incisional hernias than closure by continuous slowly absorbable suture (P &lt; 0·009) or non-absorbable suture (P = 0·001). No difference in incisional hernia incidence was found between slowly absorbable and non-absorbable sutures (P = 0·75), but more wound pain (P &lt; 0·005) and more suture sinuses (P = 0·02) occurred after the use of non-absorbable suture. Similar outcomes were observed with continuous and interrupted sutures, but continuous sutures took less time to insert.

Conclusion
To reduce the incidence of incisional hernia without increasing wound pain or suture sinus frequency, slowly absorbable continuous sutures appear to be the optimal method of fascial closure.
Chronic pain after laparoscopic and open mesh repair of groin hernia
Authors: Kumar S , Wilson R G , Nixon S J , Macintyre I M C 
Published: October 2002

AbstractBackgroundThe aim of this study was to compare the incidence of chronic pain or discomfort after laparoscopic totally extraperitoneal (TEP) repair and open mesh repair of groin hernia, and to assess the impact of such pain on patients' physical activity.MethodsA postal questionnaire was sent to patients who had TEP or open mesh repair of groin hernia between January 1998 and December 1999. The patients were asked about any persistent pain or discomfort in relation to the groin hernia repair and whether this pain or discomfort restricted their ability to undertake physical or sporting activity.ResultsOf the 560 available patients 454 (81·1 per cent) replied. Laparoscopic TEP repair was performed in 240 patients (52·9 per cent) and open mesh repair in 214 (47·1 per cent). Of the 454 patients, 136 (30·0 per cent) reported chronic groin pain or discomfort, which was significantly more common after open repair than after laparoscopic repair (38·3 versus 22·5 per cent; P &lt; 0·01). Chronic groin pain or discomfort restricted daily physical or sporting activity in 18·1 per cent of the patients. The patients who had open repair complained of significantly more restriction of daily physical activity than patients who underwent laparoscopic repair (walking, P &lt; 0·05; lifting a bag of groceries, P &lt; 0·01).ConclusionChronic pain or discomfort was reported by 30·0 per cent of patients after groin hernia repair and was significantly more common after open mesh repair than after laparoscopic TEP repair. It restricted physical or sporting activities in 18·1 per cent of the patients and significantly more so after open mesh repair.
Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer
Authors: Mullaney P J , Wadley M S , Hyde C , Wyatt J , Lawrence G , Hallissey M T , Fielding J W L 
Published: October 2002

AbstractBackgroundIn the surgical management of gastric carcinoma, regional lymphatic spread is of prognostic importance. The fifth edition of the Union Internacional Contra la Cancrum classification has been shown to be reproducible, practical and of significant prognostic use. The tumour node metastasis (TNM) system requires at least 15 lymph nodes to be acquired and examined for staging to be accurate. This has raised concern over the consistency with which the requisite numbers of nodes would be acquired. This study was performed to assess how consistently surgically managed cases of gastric cancer in the West Midlands fulfilled this requirement to allow accurate staging.MethodsData from the West Midlands Cancer Intelligence Unit on all cases of gastric cancer registered from 1998 to 1999 were obtained and the number of lymph nodes documented for each surgically managed case was assessed.ResultsOverall, only 31.0 per cent of surgically resected cases could be assessed accurately according to the TNM system. The proportion staged accurately varied widely across hospitals from 10·9 to 76·0 per cent.ConclusionThese results reflect the need for improved N staging across the region to aid the appropriate multimodal treatment of patients.
Effects of the combination of rapamycin with tacrolimus or cyclosporin on experimental intimal hyperplasia
Authors: Waller J R , Murphy G J , Bicknell G R , Toomey D , Nicholson M L 
Published: October 2002

Abstract

Background
Allograft vasculopathy remains the leading cause of late allograft failure following transplantation and can be inhibited by the antiproliferative drug rapamycin. This study assessed the efficacy of combining rapamycin therapy with calcineurin inhibition.

Methods
Male Sprague–Dawley rats received rapamycin 0·05 mg/kg daily and either tacrolimus 0·1 mg/kg or cyclosporin 5 mg/kg daily, and findings were compared with those in an untreated control group. Animals underwent left common carotid artery balloon angioplasty; the artery was explanted after 2 weeks. Morphometric analysis was performed on transverse sections and the intima: media ratio was calculated. Profibrotic gene expression was measured with competitive reverse transcriptase–polymerase chain reaction at 14 and 28 days. Proliferation was determined with proliferating cell nuclear antigen at 14 and 28 days. Extracellular matrix deposition was quantified with Sirius red.

Results
The combination of rapamycin and tacrolimus was associated with the greatest reduction in intimal thickening. Furthermore, treatment with rapamycin and tacrolimus significantly attenuated extracellular matrix deposition compared with rapamycin and cyclosporin (P &lt; 0·02).

Conclusion
The effects of rapamycin in combination with tacrolimus were better than those observed with rapamycin and cyclosporin.
Pathogenesis and clinical management of hereditary non-polyposis colorectal cancer
Authors: Lawes D A , SenGupta S B , Boulos P B 
Published: October 2002

Abstract

Background
Hereditary non-polyposis colorectal cancer (HNPCC) is an inherited genetic condition associated with microsatellite instability; it accounts for around 5 per cent of all cases of colorectal cancer. This review examines recent data on management strategies for this condition.

Methods
A Medline-based literature search was performed using the keywords ‘HNPCC’ and ‘microsatellite instability’. Additional original papers were obtained from citations in articles identified by the initial search.

Results and conclusion
The Amsterdam criteria identify patients in whom the presence of an inherited mutation should be investigated. Those with a mutation should be offered counselling and screening. The role of prophylactic surgery has been superseded by regular colonoscopy, which dramatically reduces the risk of colorectal cancer. Screening for extracolonic malignancy is also advocated, but the benefits are uncertain. Chemoprevention may be of value in lowering the incidence of bowel cancer in affected patients, but further studies are required.
Cryotherapeutic ablation of liver tumours
Authors: Sheen A J , Poston G J , Sherlock D J 
Published: October 2002

Abstract

Background
This paper reports a 7-year experience of cryoablation for colorectal and non-colorectal liver metastases.

Methods
A retrospective review was undertaken of patients treated in two adjacent UK centres in the north-west of England.

Results
Over a 7-year period (1993–2000), 57 patients underwent cryotherapy for malignant hepatic tumours (41 colorectal, 16 non-colorectal). In the patients with colorectal metastases, preoperative carcinoembryonic antigen (CEA) levels fell significantly, from a mean of 444·1 to 6·22 µg/l (P = 0·002). One patient died, two developed cryoshock and six had cardiorespiratory complications. All patients with colorectal metastases subsequently received 5-fluorouracil-based chemotherapy. The remaining 16 patients with non-colorectal tumours (seven neuroendocrine metastases, five hepatocellular carcinomas, three sarcomas, one cholangiocarcinoma) all received cryotherapy alone, with no major complications. The median survival for patients with non-colorectal metastases was 37 months, compared with 22 months for those with colorectal metastases (P = 0·005).

Conclusion
Hepatic cryotherapy is effective and safe, as demonstrated by the significant reduction in postoperative CEA concentration and the low risk of complications. However, this initial short-term success was not reflected in 5-year survival rates. Cryotherapy for non-colorectal metastases had a greater long-term survival benefit and is a useful means of controlling symptoms.
Emergency surgeon-performed hepatobiliary ultrasonography
Authors: Kell M R , Aherne N J , Coffey C , Power C P , Kirwan W O , Redmond H P 
Published: October 2002

Abstract

Background
Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined.

Methods
A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2–5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2–5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses.

Results
Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94·3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95·2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96·2 per cent of patients. Time to scan was significantly shorter following SUS (3·1 versus 12·0 h, P &lt; 0·05).

Conclusion
SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.
Different expression of surfactant protein B mature peptide and proprotein at 21 weeks’ gestation in human fetal pulmonary epithelial cells
Authors: Mori Kazuhiro , Ikeda Kazushige , Tanaka Mamoru 
Published: October 2002

Abstract
Aim
: The aim of this study is to evaluate the maturation of pulmonary epithelial cells in human fetal lungs at 21 weeks’ gestation.
Methods
: Eight fetuses at 21 weeks’ gestation were evaluated. The maturation of pulmonary epithelial cells was assessed by immunohistochemical examination for surfactant proteins and by electron microscopy.
Results
: Surfactant protein B mature peptide was detected slightly in the epithelial lining of the bronchioles, but was totally absent in the terminal airways. Surfactant protein B proprotein was clearly detected in the epithelial lining of both bronchioles and terminal airways. Transmission electron microscopy of terminal airway cells showed abundant glycogen granules and few intracellular organelles.
Conclusions
: The production of mature surfactant protein B in terminal airways is scarce at 21 weeks’ gestation, which is associated with the immature mechanism of proprotein processing in the cytoplasm.
Prevalence of Mycoplasma pneumoniae in children in Diyarbakir, the south‐east of Turkey
Authors: Bosnak Mehmet , Dikici Bunyamin , Bosnak Vuslat , Dogru Omer , Ozkan Ilker , Ceylan Ali , Haspolat Kenan 
Published: October 2002

Abstract
Background
: Mycoplasma pneumoniae is a well known causative agent of infection in childhood but clinical presentation may be variable. History and physical examination may not be so helpful for the diagnosis. It is difficult to culture this infectious agent, with the culture technique for the multiplication of the organism for routine investigation hard to obtain. The determination of exposure and prevalence of the disease of any region should be helpful for clinical diagnosis. In this study, we aimed to determine the seroprevalence of M. pneumoniae in children aged 0−14 years in Diyarbakir and establish the distribution of infection prevalence of various age groups of children.
Methods
: Thirty streets were determined according to the cluster method for the 0−6 years age group. In this age group, a total of 180 blood samples were collected; so that there were 30 samples for each age. For children aged 7−14 years, elementary school children were selected. There were 70 elementary schools in the city and 14 schools were randomly selected according to the randomized numbers table with a 20% sample. Finally, 276 blood samples were collected. Mycoplasma pneumoniae was determined by using the enzyme immunoassay method. For this method MELOTEST Mycoplasma IgG reagent was used.
Results
: The highest seropositivity rate was encountered at 10 years of age (65%) and lowest was at 2 years of age (0%). The overall M. pneumoniae seropositivity was 27% when all ages were considered together. The first 2 years of age excluded this rate and was 31.9%. A sudden increase of seropositivity was observed at 7 years of age.
Conclusions
: Increasing seroprevalence rates of M. pneumoniae after 2 years of age should alert clinicians to consider the organism in the differential diagnosis of infectious diseases in this age group. The low seroprevalence rates in the first 2 years of age was thought to be due to low risk of community‐based spread of the organism in this age group. The most prominent increase in seroprevalence was at 10 years of age. This data indicated that M. pneumoniae should be kept in mind while making differential diagnosis of infections. The spreading of disease and community‐based transmission is also important to consider. In our study, seroprevalence rates increased at 6 and 7 years of age, at the beginning of the school age as community‐based transmission takes place most commonly in crowded circumstances. In conclusion, M. pneumoniae should be thought as an important infectious agent in childhood for all age groups.
Comparison of treatments of chronic hepatitis B in children with lamivudine and α‐interferon combination and α‐interferon alone
Authors: Dikici Bunyamin , Bosnak Mehmet , Bosnak Vuslat , Dagli Abdullah , Davutoglu Mehmet , Yagci Rasit Vural , Haspolat Kenan 
Published: October 2002

Abstract
Background
: The aim of this study was to compare the efficacy of the α‐interferon treatment with treatment using α‐interferon and lamivudine in combination for cases of childhood chronic hepatitis B infection.
Methods
: Patients were evaluated in two groups retrospectively. In group 1, 27 patients were simultaneously given α‐interferon 2b 10 MU/m2, 3 days a week by s.c. injection plus lamivudine 4 mg/kg a day (maximum 100 mg) for 12 months. In group 2, there were 13 patients who only received the same dosage of α‐interferon and no lamivudine over the same period of time.
Results
: In group 1 the initial mean value of alanine aminotransferase (ALT) was 121 ± 66 IU/L and decreased to 27.8 ± 11.5 IU/L; in group 2, initial mean values of ALT was 129 ± 46 IU/L and decreased to 60 ± 6 IU/L at the end of the twelfth month of the therapy (P < 0.05). Hepatitis B virus DNA (HBV‐DNA) clearance was obtained in all group 1 patients and six of 13 patients in group 2 at the end of the therapy (P < 0.001). The rates of hepatitis B early (HBe) antigen clearance and anti‐HBe seroconversion were 59 and 37% in group 1 and 46 and 30.7% in group 2 (P > 0.05). The number of patients with complete response was found to be 10 out of 27 (37%) in group 1 and four out of 13 cases (30.7%) in group 2, 6 months after the end of the therapy. There was no statistically significant difference between both groups (P > 0.05).
Conclusion
: α‐Interferon and lamivudine combination therapy had a more beneficial effect than α‐interferon monotherapy in normalization of ALT and clearance of HBV‐DNA; however, the complete response rate at 6 months after the end of the therapy was not statistically significantly different between both groups.
Response of anti‐oxidant enzymes mRNA in the neonatal rat liver exposed to 1,2,3,4‐tetrachlorodibenzo‐p‐dioxin via lactation
Authors: Kono Yumi , Okada Shin’ichi , Tazawa Yusaku , Kanzaki Susumu , Mura Tetsuo , Ueta Etsuko , Nanba Eiji , Otsuka Yuzuru 
Published: October 2002

Abstract
Background
: The aim of this study was to assess the response to dioxin‐induced oxidative stress in neonates via lactation in the model we have described previously.
Methods
: Maternal rats were treated with a single dose of 50 or 100 µmol/kg 1,2,3,4‐tetrachlorodibenzo‐p‐dioxin (TCDD) on the first day postpartum (day 1). Messenger RNA levels of the key anti‐oxidant enzymes (AOE), phospholipid hydroperoxide‐glutathione peroxidase (PH‐GPx), cellular‐glutathione peroxidase (cell‐GPx), copper‐zinc superoxide dismutase (CuZn SOD), manganese superoxide dismutase (Mn SOD) and catalase (CAT) in the neonatal and maternal livers were determined by a competitive reverse transcription− polymerase chain reaction method.
Results
: Lactational transfer of 1,2,3,4‐TCDD induced an inhibition of PH‐GPx and cell‐GPx mRNA in the neonatal liver on day 2 to 68 (P < 0.01) and 62% (P < 0.05) of the control at 100 µmol/kg, respectively. Both GPx mRNA returned to control levels on day 6 and thereafter increased to levels higher than the controls on day 10. In the dam rat, 10 days after the treatment, no remarkable change of PH‐GPx or cell‐GPx mRNA was observed. Copper‐zinc superoxide dismutase and CAT mRNA of neonates on day 2 were also suppressed at 100 µmol/kg and then slightly increased on day 10. However, Mn SOD mRNA was not suppressed, but increased to a 2.1‐fold level of the control (P < 0.05) on day 10 with 100 µmol/kg 1,2,3,4‐TCDD.
Conclusion
: Quantitative analysis of AOE mRNA showed that PH‐GPx and cell‐GPx mRNA, as well as CuZn SOD and CAT mRNA in the neonatal liver were suppressed for a short period of time by 1,2,3,4‐TCDD exposure via lactation. Dioxin induced oxidative stress by lactational transfer may alter pretranslation regulation of protective AOE in neonates.
Prevalence of gastro‐esophageal reflux‐related symptoms in Japanese infants
Authors: Miyazawa Reiko , Tomomasa Takeshi , Kaneko Hiroaki , Tachibana Atsushi , Ogawa Tetsushi , Morikawa Akihiro 
Published: October 2002

Abstract
Background
: To obtain precise information on the natural course of gastro‐esophageal reflux (GER)‐related symptoms in Japanese children, we surveyed the prevalence of regurgitation or vomiting and other GER‐related symptoms and complications in infants visiting for healthy baby check‐ups.
Methods
: We interviewed the mothers of 921 infants who had visited for baby check‐ups at 1, 4, 7 and 12 months after birth, about the number of regurgitation or vomiting episodes per day, other GER‐related symptoms, milk volume, feeding interval, and the body position after feeding.
Results
: Of 1‐month‐old infants, 47.1% had one or more regurgitation or vomiting episode per day. This proportion decreased to 28.8% at 4 months old and 6.4% at 7 months old. The proportion of infants with three or more episodes of these symptoms per day showed a similar pattern. There was no significant difference in the prevalence of regurgitation or vomiting between breast‐fed infants and formula‐fed or mixed‐feeding infants either at 1 or 4 months of age. There was no significant difference in the bodyweight gain of 3‐month‐old infants among those with various degrees of regurgitation. There was no significant difference in the frequency of regurgitation or vomiting episodes between infants placed in a vertical position and those placed in a horizontal position after feeding. No infant had a history of chronic coughing, wheezing, bleeding or other serious conditions.
Conclusions
: Regurgitation is a common symptom in Japanese infants and decreases spontaneously with age. The natural history of GER must be taken into consideration when deciding the treatment.
Randomized controlled trial of magnesium sulfate infusion for severe birth asphyxia
Authors: Ichiba Hiroyuki , Tamai Hiroshi , Negishi Hirokuni , Ueda Toru , Kim Tae‐Jang , Sumida Yutaka , Takahashi Yukihiro , Fujinaga Hideshi , Minami For The Kansai Magnesium Study Group Hirotaka 
Published: October 2002

AbstractObjective: To determine whether postnatal MgSO4infusion (250 mg/kg per day) for 3 days is both safe and able to improve outcome in infants with severe birth asphyxia, as had been suggested by a small pilot study.Methods: A multicenter randomized controlled trial was conducted. Entry criteria included 5‐min Apgar score of seven or less and either failure to initiate spontaneous respiration at 10 min after birth because of asphyxia, or occurrence of clinically apparent seizures within 24 h after birth. Number of subjects was calculated to detect a 50% reduction in incidence of adverse outcomes.Results: Distributions of perinatal factors, neonatal baseline characteristics and severity of hyoxic‐ischemic encephalopathy were similar in treated and control groups. No significant differences were observed in duration of clinical seizures, or need for assisted ventilation. Survival with normal results of cranial computed tomography, electroencephalography and establishment of oral feeding by 14 days of age, was significantly more frequent in the treated group than in the control group (12/17vs5/16,P = 0.04). No significant differences in blood pressure, heart rate or respiratory rate were observed between groups.Conclusion: Postnatal MgSO4infusion as above is safe and can improve short‐term outcome in infants with severe birth asphyxia.