bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early flexible sigmoidoscopy in the evaluation of acute left iliac fossa pain
Authors: Tan  , Senapati  , Thompson  
Published: March 2003

ObjectiveTo evaluate the feasibility, safety and diagnostic yield of flexible sigmoidoscopy as an early diagnostic tool in the investigation of the colonic causes of acute left iliac fossa pain.Patients and methodsA 1‐year prospective study was conducted in which flexible sigmoidoscopy was performed as soon as possible by two consultant coloproctologists within their normal theatre sessions on all emergency patients admitted with acute left iliac fossa pain. The clinical details, flexible sigmoidoscopy findings and subsequent outcome were recorded on a proforma.ResultsIt was possible to perform early flexible sigmoidoscopy on 86% (62/72) of patients referred during their in‐patient stay at a median delay of 4 days from time of admission. Eighty‐four percent of the examinations resulted in a diagnosis or exclusion of a colonic cause for their acute left iliac fossa pain. There was low morbidity and one unrelated death in the study.ConclusionThis study has shown that it is feasible to use early flexible sigmoidoscopy as a first line investigation for patients presenting with acute left iliac fossa pain. Flexible sigmoidoscopy is a quick and safe procedure in skilled hands with a high diagnostic yield, although the potential risks involved in performing this procedure in the acute period mandate that it should only be undertaken by experts.
Is laparotomy mandatory for parastomal hernia repair?
Authors: Baig  , Wexner  , Uriburu  , Moscovitz  , Singh  , Weiss  , Nogueras  , Zhao  
Published: March 2003

ObjectiveA parastomal hernia is an incisional hernia at the site of an intestinal stoma. The incidence varies, as do techniques for repair and their associated rates of success. The aim of this study was to evaluate the methods of parastomal hernia repair and their outcome.Patients and methodsBetween 1988 and 1998, 33 patients who underwent elective parastomal hernia repair were identified by the use of a computerized database. Information was collected on the indication and type of reparative procedure, as well as any morbidity or recurrence, post‐operative complications and recurrence. The operative procedures performed included reanastomosis and ipsilateral and contralateral relocation with hernia repair. Additional data were collected on whether a laparotomy was required or mesh was placed.ResultsThe commonest operation was relocation without laparotomy or mesh (36%), followed by laparotomy still without mesh (21%); the overall recurrence rate was 9% (3/33) at a mean follow up of 55.2 months (range 10–108 months).ConclusionParastomal hernia repair without laparotomy or mesh is a safe and effective method of repair.
What determines the outcome after total mesorectal excision for rectal carcinoma—15 years experience of a specialist surgical unit
Authors: Marks  , Reid  , Lewis  , Jackson  , Cook  
Published: March 2003

ObjectivesOutcome after surgery for rectal cancer is often correlated with surgical technique, without detailed pathological examination of the specimen. Measurement of the number of lymph nodes by a fat clearance technique, mesorectal spread and involvement of the circumferential margins together with clinical findings at operation are correlated with outcome in a consecutive series of patients treated by a specialist surgeon.Patients and methodsThe effect of prognostic factors on patients’ survival was analysed using Cox’s proportional hazards regression models. Survival curves and 5‐year survival rates were calculated using Kaplan–Meier analysis.ResultsAfter curative procedures, 78.6% (95% confidence interval (CI) 72.8–84.3) of patients survived compared with 6.0% (95% CI 0.7–11.4) after palliative procedures; the hazard of dying was 1.5 times higher for patients with Dukes’ B tumours and 6.4 times higher for those with Dukes’ C compared with those with Dukes’ A (P < 0.0001). Patients with four or more lymph nodes involved had a two‐fold increase in the hazard of dying compared with those with three or less involved lymph nodes.ConclusionThe strongest predictor of 5‐year survival for patients with rectal carcinoma was whether the operation was deemed curative or palliative. Neither the extent of mesorectal spread nor the involvement of the circumferential resection margin had a significant effect on survival, after surgery in a specialist unit, compared with published series after conventional surgery.
A retrospective analysis of palliative colonic stent placement in an elderly population
Authors: Buchanan  , Khawaja  , Okojie  , Rowe  , Saunders  , Stoodley  , Anderson  
Published: March 2003

ObjectiveSelf‐expanding metal stents (SEMS) have added a new dimension to the management of colonic malignant obstruction. We present our experience of palliative colonic stent insertion in a group of patients unsuitable for surgery.Patients and methodsSince 1995 11 patients (median age 82 years) with strictures of the rectosigmoid region underwent SEMS placement at this Hospital. The indications for stent placement were large bowel obstruction (n=6), overflow incontinence (n=4) and faecal fistula (n=1). The selection criteria included five patients with disseminated disease and six who were deemed unfit for surgery. SEMS insertion was performed under fluoroscopic control in all patients, and colonoscopic assistance was required in four patients where fluoroscopy alone failed.ResultsSEMS placement was successful in nine patients with resulting bowel decompression and immediate symptomatic relief, but failed in two patients. Where SEMS placement was unsuccessful, the stricture was impassable in one instance and in the other the patient withdrew consent. Stent migration occurred in three out of nine patients. The median survival time after stent placement was 5 months; one patient is still alive at 14 months.ConclusionSEMS placement resulted in the successful palliation of symptoms in patients with obstructive lesions deemed unfit for surgery—however, it is not always successful and there are complications.
Multiplanar anal endosonography – normal anal canal anatomy
Authors: Williams A. B. , Bartram C. I. , Halligan S. , Marshall M. M. , Nicholls R. J. , Kmiot W. A. 
Published: March 2003

IntroductionVolume acquisition during anal ultrasound enables multiplanar imaging of the anal canal. The normal ultrasonic multiplanar appearance of the anal canal is described and gender differences in canal anatomy are highlighted.MethodsTen male and 12 female normal volunteers (mean ages 31.5 years (s.d. 5.9) and 31.2 (s.d. 6.7)) had three‐dimensional anal endosonography (3‐D AES). Each volume dataset was seeded in the axial plane facilitating multiplanar identification of known anatomical structures.ResultsThe anterior external anal sphincter (EAS) was significantly longer in men than women 30.1 mm (3.9) vs 16.9 mm (7.4) (P < 0.001). There was no difference in the length of the puborectalis 24.7 mm (6.4) vs 24 mm (5) (P=0.78) in men compared with women. The cranial extent of the anterior EAS was tilted forward in both sexes. The angle formed by the anterior EAS and the longitudinal axis of the anal canal was more acute in men than in women (11.1°vs 18.6°; P=0.007). Dataset volume seeding of familiar structures in the axial plane allowed the multiplanar endosonographic anatomy to be described.ConclusionsMultiplanar AES has enabled detailed longitudinal measurement of the components of the anal canal and has revealed important gender differences. The multiplanar ultrasonic appearance of the normal anal canal has been described for the first time.
Life table analysis of hernia following end colostomy construction
Authors: Mylonakis E. , Scarpa M. , Barollo M. , Yarnoz C. , Keighley M. R. B. 
Published: March 2003

ObjectiveTo study the long‐term hernia rate and risk factors after end colostomy construction.Patients and methods86 patients with a permanent end colostomy constructed over 5 years were examined and interviewed. There were 35 men and the mean age was 56.5 (28–87) years. Risk factors which were analysed included emergency operation, age over 60 years, obesity, steroids, cancer, infection at the stoma site, smoking and chronic obstructive airways disease.ResultsPara‐colostomy hernia occurred in 12/86 cases (13.9%). The cumulative recurrence rose with duration of follow up. Overall 10/45 patients (22%) over 60 years developed hernia vs. 2/41 patients (4.8%) less than 60 years (P=0.02). There were no other risk factors that correlated with para‐colostomy hernia.ConclusionsThese data indicate that the incidence of colostomy related hernia increases with follow up and is significantly higher in patients over the age of 60. Other risk factors, particularly obesity and coexisting cardiorespiratory disease, have no impact.
Long‐term results of subtotal colectomy for severe slow‐transit constipation in patients with normal rectal function
Authors: Aldulaymi B. H. , Rasmussen O. Ø. , Christiansen J. 
Published: March 2003

ObjectiveThe outcome of subtotal colectomy for severe constipation may be difficult to predict. One factor, which probably is of major importance for the functional outcome, is rectal function. The aim of the study has been to evaluate long‐term results after subtotal colectomy with ileo‐rectal anastomosis in a group of patients with severe slow‐transit constipation but without evidence of impaired rectal emptying.Patients and methodsOf 273 patients with constipation referred for surgical evaluation 18 (7%) fulfilled our criteria for subtotal colectomy. Slow‐transit was confirmed by radio‐opaque marker studies and normal rectal function by emptying of viscous fluid and normal emptying at defecography.ResultsAt follow up between 3 and 9 years 15 patients had a bowel frequency between 2 and 6 daily. One patient, who had an ileostomy because of anastomotic leak, had not wanted bowel continuity restored. One patient with opiate abuse became less constipated with 2–3 bowel movements a week. One patient was still constipated one year after the operation and subsequently had an ileal pouch–anal anastomosis. This patient who had normal rectal emptying had a very high volume tolerability with a maximum tolerable volume of 700 ml. In 4 of 7 patients abdominal pain persisted after the operation, and 3 developed diarrhoea, which required daily intake of loperamide.ConclusionSubtotal colectomy for severe slow‐transit constipation is justified provided anorectal function is normal. In spite of normal rectal emptying very high rectal volume tolerability may be an indicator of functional megarectum and impaired rectal emptying postoperatively.
Objective assessment of morbidity and quality of life after surgery for low rectal cancer
Authors: Camilleri‐Brennan J. , Steele R. J. C. 
Published: March 2003

ObjectiveTo determine whether an anterior resection for low rectal cancer is associated with less morbidity and a better quality of life than an abdominoperineal resection.Patients and methodsFifty‐three patients who had anterior resection for low rectal cancer were individually matched with 53 other patients, who had an abdominoperineal resection during the same period of time, for gender, age and socioeconomic status. There was no evidence of tumour recurrence in these patients. All patients answered three quality of life questionnaires at least one year after surgery: Short Form 36 version 2, EORTC QLQ‐C30 and EORTC QLQ‐CR38. Details on short‐term and long‐term complications were collected prospectively.ResultsThere was no significant difference in both the short‐term and the long‐term complication rates between the two groups of patients. There was also no difference in the global quality of life score on the QLQ‐C30. However, patients who had an anterior resection had a better perception of body image than those who had an abdominoperineal resection, as measured on the QLQ‐CR38 questionnaire (P=0.009), but were more prone to suffer from constipation (P=0.001).ConclusionsThe overall similarities in quality of life between the two groups is probably a reflection of better stoma care, although problems with body image still persist in stoma patients.
Inhibition of proliferation of a colon cancer cell line by indole‐3‐carbinol
Authors: Frydoonfar H. R. , McGrath D. R. , Spigelman A. D. 
Published: March 2003

ObjectiveTo observe the effect of Indole‐3‐carbinol (I3C), a naturally occurring component of cruciferous vegetables, on cell proliferation of a colon cancer cell line.MethodsCell proliferation was measured using three different methods; 3H‐thymidine incorporation, cell count and colourimetric assay.ResultsEach method of measurement revealed that I3C significantly reduced cell proliferation at concentrations of > 0.1 mM.ConclusionThe present study demonstrates for the first time the capacity of indole‐3‐carbinol to inhibit cell proliferation of a colon cancer cell line.
Transanal endoscopic microsurgery – lessons from a single UK centre series
Authors: Lloyd G. M. , Sutton C. D. , Marshall L. J. , Baragwanath P. , Jameson J. S. , Scott A. D. N. 
Published: March 2003

AbstractObjectives  Transanal endoscopic microsurgery (TEM), a minimally invasive technique has been employed in the excision of benign and selected malignant rectal tumours since 1983. We present a single surgeon's series of 102 procedures.Patients and methods  A retrospective case note review of 102 procedures performed over a 6‐year period between 1996 and 2001.Results  One hundred and two TEM procedures were performed on 100 patients. 68 for adenomas, 19 potentially curative excisions for carcinoma, 13 palliative procedures for advanced carcinoma and 2 for solitary rectal ulcer syndrome (SRUS). Four adenomas recurred and were successfully treated by various procedures. None went on to develop malignancy, or a further recurrence. Of the cancers, six T1 and 10 T2 were excised with curative intent. Three T3 cancers were excised before endorectal ultrasound was available in the unit and went on to have definitive procedures. One T1 and two T2 carcinomas were not completely histologically excised. These patients were offered definitive procedure and there have been no recurrences. 11 patients underwent palliative TEM procedures, 2 went on to have a recurrence of symptoms. Both underwent a successful second TEM procedure.Conclusions  Although longer term follow up is still required, TEM appears to be an effective method of excising benign tumours and T1 carcinomas of the rectum. The role of TEM in the treatment of T2 carcinomas is, as yet, unclear and needs further evaluation although the results of our series and others are encouraging.
Histological changes associated with the use of intravenous cyclosporin in the treatment of severe ulcerative colitis may mimic dysplasia
Authors: Hyde G. M. , Jewell D. P. , Warren B. F. 
Published: March 2003

AbstractBackground  During six years experience of intravenous cyclosporin (iv Cy) for severe ulcerative colitis we have noted that changes of villous architecture and epithelial regeneration occur even when the disease fails to enter clinical remission and colectomy is required.Objective  To describe the histological changes in patients who received iv Cy and steroids compared with those treated with iv steroids alone.Patients and methods  Two groups of histological sections were reviewed. The first group was of 23 colectomy specimens from patients who had been treated with iv Cy and steroids. For 11 patients pre‐Cy histological sections were available. The second group was of 10 colectomy specimens from patients who had received iv steroids alone. Biopsies were scored for their histological disease activity (HDAI), villous architecture and epithelial regeneration. The HDAI assesses the degree of acute and chronic inflammation.Results  The post‐Cy group had higher median scores for villous architecture and epithelial regeneration compared to the pre‐Cy and poststeroid groups. For the patients where both pre‐ and post‐Cy histological sections were available 63% increased their villous score post‐Cy and 82% increased their epithelial regeneration score post‐Cy.Conclusion  Although villous transformation and epithelial regeneration may be seen in UC they are more frequent and more severe in those patients who received iv Cy and iv steroids, compared to controls who received iv steroids alone. These histological changes may mimic dysplasia. Increased awareness of this potential mimic of dysplasia is crucial for patient management.
Acute rectal obstruction after PPH stapled haemorrhoidectomy
Authors: Cipriani S. , Pescatori M. 
Published: March 2003

AbstractAn unusual case of acute intestinal obstruction following a PPH stapled haemorrhoidectomy is reported: the complication was due to an almost complete interruption of the rectal lumen tightened by a purse‐string suture anchored by staples. The stricture was dilated and the suture released thus restoring intestinal continuity. Surgeons should be aware that such troublesome complication may occur and can be treated successfully by a transanal approach.
Dysplasia in the ileoanal pouch
Authors: Duff S. E. , O'Dwyer S. T. , Hultén L. , Willén R. , Haboubi N. Y. 
Published: March 2003

AbstractFormation of an ileo‐anal pouch is an accepted technique following colectomy in the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The configuration of pouches and anastomotic techniques has varied over the last two decades. The increased use of stapling devices in formation of the pouch‐anal anastomosis avoids the need for endoanal mucosal stripping and may contribute to improved functional results, but leaves a ‘columnar cuff’ of residual rectal mucosa in situ. Concerns regarding the long‐term safety of the ileo‐anal pouch have been raised by reports of the occurrence of dysplasia in the pouch mucosa and 15 cases of adenocarcinoma. In UC, persistence of underlying disease in the residual rectal mucosa, anal transition zone and columnar cuff provides the site for development of dysplasia and malignancy. Pouchitis is unlikely to be a major cause of dysplasia or malignancy, as long‐term follow‐up of patients with Koch pouches has demonstrated. In FAP, any persistent rectal mucosa and mucosa of the small intestine is at risk of adenomatous dysplasia due to the genetic alterations causing the disease. Long‐term surveillance should focus on all FAP pouch patients, and in UC patients should be directed towards the diagnosis of residual rectal mucosa in the area distal to the pouch anastomosis. Specialist histopathological opinion is essential in the diagnosis of dysplasia in the ileo‐anal pouch.
Health related quality of life in Crohn's proctocolitis does not differ from a general population when in remission
Authors: Andersson P. , Olaison G. , Bendtsen P. , Myrelid P. , Sjödahl R. 
Published: March 2003

AbstractObjective  All treatment in Crohn's disease, although palliative, aims at restoring full health. The objective of this study was to compare health‐related quality of life and psychosocial conditions in patients with Crohn's proctocolitis with a general population.Patients and methods  One hundred and twenty‐seven patients with Crohn's proctocolitis (median age 44 years, 44.1% men) were compared with 266 controls (median age 45 years, 50.7% men). A questionnaire consisting of the Short Form‐36 (SF‐36), the Psychological General Well‐Being Index (PGWB) and a visual analogue scale (VAS) evaluating general health as well as questions regarding psychosocial conditions was used. Disease activity was evaluated by Best's modification of the classical Crohn's Disease Activity Index.Results  Patients in remission had a health related quality of life similar to controls according to the SF‐36 apart from general health where scores were lower (P < 0.01). Patients with active disease scored lower in all aspects of the SF‐36 (P < 0.001 or P < 0.0001) as well as the PGWB (P < 0.0001). In a model for multiple regression including age, gender, concomitant small bowel disease, permanent stoma, previous colonic surgery, disease activity, duration, and aggressiveness, disease activity was the only variable negatively predicting all 8 domains of the SF‐36 in the patient group (P < 0.001). The mean annual sick‐leave for patients and controls were 33.9 and 9.5 days (P < 0.0001), respectively. Sixty‐eight percent of the patients and 78.4% of the controls (P = 0.04) were married or cohabited, 67.7% and 78.0% (P = 0.04), respectively, had children.Conclusion  The health related quality of life for patients with Crohn's proctocolitis in remission does not differ from the general population. The disease has, however, a negative impact on parenthood, family life and professional performance.
Acarbose vs. bedtime NPH insulin in the treatment of secondary failures to sulphonylurea‐metformin therapy in type 2 diabetes mellitus
Authors: López‐Alvarenga J. C. , Aguilar‐Salinas C. A. , Velasco‐Perez M. L. , Arita‐Melzer O. , Guillen L. E. , Wong B. , Brito G. , Mercado V. , Gómez‐Pérez F. J. , Rull‐Rodrigo J. A. 
Published: March 2003

Summary Objective: To evaluate the efficacy of acarbose in the treatment of secondary failures to sulphonylurea‐metformin therapy, its comparison against bedtime NPH insulin, and to measure the changes in postprandial metabolism resulting from both treatments. Methods: One hundred type 2 diabetic patients in a secondary failure were included. The study begun with a run‐in diet period of 6 weeks, in which an isocaloric diet was prescribed. Only subjects who continued hyperglycaemic were randomly assigned to placebo and acarbose (n = 17) or bedtime NPH insulin (n = 12). Acarbose (300 mg/day) or placebo were administered using a randomized, double blind, crossover design. Treatment periods of 3 months were separated by a3‐week washout period. Insulin was administered during 3 months. At the beginning and the end of each treatment period, an i.v. glucose tolerance test and a meal test were performed. Safety tests were done every 4 weeks. Results: Acarbose resulted in a small but significant improvement in fasting plasma glucose (13.5 ± 2.4 vs. 11.3 ± 3.9 mmol/l, p = 0.05), HbA1c (11.1 ± 3.4 vs. 10.3 ± 2.5%, P = 0.3) and in a decreased plasma glucose during the meal test. Bedtime insulin significantly decreased fasting plasma glucose (13.1 ± 2.9 vs. 8.2 ± 2.3 mmol/l, p < 0.01), HbA1c (11.7 ± 2.9 vs. 9.4 ± 2.7%, p < 0.01) and plasma cholesterol. No change in insulin secretion resulted from insulin and acarbose treatment. Conclusions: Acarbose decreases blood glucose in secondary failure to sulphonylurea‐metformin therapy; however, the decrease is not enough to reach the desired metabolic control. Bedtime NPH insulin is, by far, a more effective alternative.