bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preperitoneal approach to parastomal hernia with coexistent large incisional hernia
Authors: Egun A. , Hill J. , MacLennan I. , Pearson R. C. 
Published: March 2003

ObjectiveTo assess the outcome of preperitoneal mesh repair of complex incisional herniae incorporating a stoma and large parastomal hernia.MethodsFrom 1994 to 1998, symptomatic patients who had repair of combined incisional hernia and parastomal hernia were reviewed. Body mass index, co‐morbidity, length of hospital stay, patient satisfaction and outcomes were recorded.ResultsTen patients (seven females and three males), mean age 62 (range 48–80) years underwent primary repair. All had significant comorbidities (ASA grade 3) and mean body mass index was 31.1 (range 20–49). Median hospital stay was 15 (range 8–150) days. Complications were of varying clinical significance (seroma, superficial infection, major respiratory tract infection and stomal necrosis). There were no recurrences after a mean follow up of 54 (range 22–69) months.ConclusionThe combination of a parastomal hernia and generalised wound dehiscence is an uncommon but difficult problem. The application of the principles of low‐tension mesh repair can provide a satisfactory outcome and low recurrence rate. This must be tempered by recognition of the potential for significant major postoperative complication.
The outcome of surgery for complex anal fistula
Authors: Joy H. A. , Williams J. G. 
Published: March 2003

AbstractObjective  The aim of this study was to examine the results of surgery for complex anal fistulas treated by a variety of techniques, in terms of fistula healing, recurrent anal sepsis and effect of surgery on anal continence.Patients and methods  This study included 63 patients with complex fistulas treated between November 1995 and September 1999. A variety of techniques were employed, including short‐term loose seton drain (12), long‐term loose seton drain (11), cutting seton (17), and rectal advancement flap (19). Outcome was assessed at clinic review and continence was further assessed by detailed questionnaire sent to the patients sometime after surgery.Results  Healing occurred in 9 (75%) patients treated with a short‐term, loose drainage seton; 16 (94%) patients treated with a cutting seton and 17 (89%) patients in the rectal advancement flap group. Incontinence reported at clinic review seemed to be more frequent in the advancement flap group. However, a detailed continence questionnaire revealed that 50% of patients reported episodes of incontinence to flatus or liquid after all techniques, which had not been detected at routine clinical review. Incontinence to solids was only reported by two of the patients who had been treated with a cutting seton.Conclusions  Complex fistulas may be successfully treated by a variety of techniques. Disturbed anal continence following surgery is common and worse than clinic assessment would suggest.
Treatment of enterocele by abdominal colporectosacropexy – efficacy on pelvic pressure
Authors: Jean F. , Tanneau Y. , Le Blanc‐Louvry I. , Leroi A. M. , Denis P. , Michot F. 
Published: March 2003

AbstractObjective  Enterocele induces pelvic pressure, obstructed defaecation, lower abdominal pain and/or false urge to defaecate in patients. The aim of this study was to evaluate the efficacy of abdominal colporectosacropexy in these symptoms, especially on pelvic pressure.Methods  Sixty‐two consecutive women with enterocele were included. All patients were symptomatic because they had: pelvic pressure (n = 62), obstructed defaecation (n = 40), lower abdominal pain (n = 8) or faecal incontinence (n = 16). Defaecography confirmed enterocele in all patients. The surgical procedure was performed by the same surgeon and was an abdominal colporectosacropexy with a nonabsorbable Prolene® mesh. After surgery, clinical evaluation (62/62 patients) and a telephone questionnaire (56/62 patients) were performed, respectively, 3 months and 27 ± 13 months after surgery.Results  Defaecography showed rectal abnormalities associated with enterocele in 59/62 patients (rectocele, rectal prolapse). No recurrence of enterocele was observed 3 months after surgery, but 1 patient demonstrated recurrence 10 months after surgery. Pelvic pressure was less frequent after abdominal colporectosacropexy, than before surgery (P < 0.01): pelvic pressure totally disappeared in 41/56 patients, and partially in 10/56 patients. The number of patients with obstructed defaecation, lower abdominal pain, or faecal incontinence was not different before and 27 months after surgery. The number of patients with urinary incontinence was also not different before and after surgery (30 and 27 patients).Conclusions  This study of a large number of patients with enterocele shows that abdominal colporectosacropexy improves pelvic pressure in most patients and does not modify urinary status.
Intra‐operative injection of Patent Blue V dye to facilitate nodal staging in colorectal cancer
Authors: Gandy C. P. , Biddlestone L. R. , Roe A. M. , O'Leary D. P. 
Published: March 2003

AbstractObjectives  Routine histopathology may understage colorectal cancer by failing to detect involved lymph nodes. This study examined the feasibility of dye staining those lymph nodes most likely to harbour metastases.Patients and methods  Patent Blue V dye 2.5% was injected intra‐operatively into left‐sided colorectal carcinomas prior to resection in 19 patients.Results  Blue‐stained nodes were found in 12/19 patients (63%). Examination of blue‐stained nodes alone correctly identified overall nodal status in 11 (92%) of these 12 patients.Conclusion  The technique needs to be refined further. Nonetheless, intra‐operative lymph node staining using blue dye offers the prospect of improving the ease and accuracy of nodal staging in colorectal cancer.
Serum leptin levels are not influenced by physical training in type 2 diabetes mellitus patients
Authors: Ligtenberg P. C. , Hoekstra J. B. L. , Frölich M. , Meinders A. E. , Erkelens D. W. 
Published: March 2003

Summary Aim: To investigate the effect of physical training on leptin levels in elderly, obese patients with type 2 diabetes mellitus. Methods: Twenty men and 38 women with type 2 diabetes mellitus with a body mass index (BMI) of > 25 kg/m2 participated in a prospective randomized study. Patients were either on oral glucose lowering drugs (n = 39) or insulin therapy (n = 19). Physical training consisted of a guided, standardized, 6‐week training programme performed in the hospital on a cyclo ergometer followed by a 6‐week period of guided training at home and ended in a 12‐week period of training at home without supervision. Clinical data and laboratory samples including fasting insulin and leptin levels and maximal aerobic capacity were assessed at the start of the study and at 6 and 26 weeks thereafter. Results: Physical training resulted in significantly positive changes in maximal aerobic capacity (VO2max) and maximum work load. No effects of physical training on serum leptin levels and insulin concentrations were detected. Leptin levels were strongly correlated with body mass index (r = 0.63), body fat content (r = 0.61), and fasting insulin concentrations (r = 0.38). Women had threefold higher leptin levels than men. No differences in leptin levels between patients on insulin therapy and patients on oral glucose lowering drugs were found. Conclusions: No effect of physical training on leptin levels was detectable in elderly, obese type 2 diabetes mellitus patients.
Effect of acarbose on additional insulin therapy in type 2 diabetic patients with late failure of sulphonylurea therapy
Authors: Standl E. , Baumgartl H. J. , Füchtenbusch M. , Stemplinger J. 
Published: March 2003

Summary Aim: The present study investigated the effect of acarbose on insulin requirements and glycaemic control in patients with type 2 diabetes receiving exogenous insulin due to secondary failure of maximum dose sulphonylurea therapy. Methods: A single‐centre, double‐blind, randomized, placebo‐controlled study was performed in 48 type 2 diabetic patients with late‐term failure following at least 3 years of sulphonylurea therapy requiring additional insulin therapy to determine the impact of acarbose on glycaemic control and insulin requirements. The primary end points were glycaemic response rate (responders being predefined as patients who achieve a decrease in HbA1c to less than 8% or a reduction by at least 15% as compared to the baseline values) and the daily insulin dose at 6 months. Secondary parameters assessed included postprandial changes in blood glucose, serum insulin and C‐peptide during the treatment period. Results: There were significantly more responders in the acarbose‐treated group comparedwith the placebo group (20/24 patients vs. 10/19 patients; p < 0.05). The mean daily insulin dose after 24 weeks of treatment was 16.4 ± 10.1 IU in the acarbose group and 22.4 ± 12.2 IU in the placebo group (mean ± s.d.; p < 0.07). Postprandial increases in blood glucose, insulin and C‐peptide were consistently lower in the acarbose‐treated group than in the placebo group. For example, the mean increase in 2‐h postprandial serum insulin remained almost unchanged in the acarbose group at the end of 24 weeks of treatment compared to an increase to 43 ± 29 μU/ml (mean ± s.d.) at the end of the study period for the placebo group. Conclusions: The findings of this study suggest that the addition of acarbose to sulphonylurea/insulin combination therapy can improve glycaemic control in type 2 diabetic patients. Acarbose may also reduce insulin resistance and hyperinsulinaemia.
Effect of diabetes on vitamin B6 requirement in experimental animals
Authors: Okada M. , Shibuya M. , Yamamoto E. , Murakami Y. 
Published: March 2003

Summary Aim: In the diabetic state, energy must be supplied mainly by amino acids and fat; therefore the metabolic processes are very similar to those of animals fed a high‐protein diet. Vitamin B6‐dependent enzymes, which are highly involved in amino acid metabolism, are important in diabetics. We investigated vitamin B6 content, and aspartate aminotransferase and glycogen phosphorylase activities, in several tissues of streptozotocin‐induced diabetic and control rats. Methods: The rats were fed a vitamin B6‐free diet and administered an equivalent amount of pyridoxine based on body weight. Results: Vitamin B6 content in all tisues examined, except for the liver, was lower in the diabetics than in controls. Aspartate aminotransferase activity was higher in the liver of diabetics than in the controls, but not in the other tissues. Glycogen phosphorylase activity in the gastrocnemius muscle of diabetics decreased to two‐thirds of the control level. Conclusions: These data might indicate that diabetic animals should have a higher intake of vitamin B6 because a diabetic state can lead to a vitamin B6‐deficiency.
Ethnicity and risk factors for coronary heart disease in diabetes mellitus
Authors: Game F. L. , Jones A. F. 
Published: March 2003

Summary Introduction: The Framingham equation can be used to predict the risk of coronary heart disease (CHD) and so to target risk factor intervention. Reservations have been applied to its use in south Asian populations since the high CHD mortality in this group may not be accounted for by traditional risk factors. Methods: We applied the Framingham equation to 1826 patients with diabetes of whom 1215 were of white Caucasian and 611 south Asian origin. Having calculated the 10‐year CHD risks the contribution of risk factors were compared between ethnic groups. Results: Mean 10‐year CHD risk was the same in the two ethnic groups (20.7 vs. 21.5%, white Caucasian vs. south Asian men and 16.5 vs. 15.9%, white Caucasian vs. south Asian women). However, the risk factor profile was different between the two groups. Mean total cholesterol was lower in south Asians (5.23 vs. 5.41 mmol/l, south Asian vs. white Caucasian men (p = 0.01) and 5.38 vs. 5.68 mmol/l, south Asian vs. white Caucasian women (p < 0.001)). HDL cholesterol levels were also lower (median HDL cholesterol 0.94 vs. 1.11 mmol/l, south Asian vs. white Caucasian men (p < 0.001) and 1.07 vs. 1.3 mmol/l, south Asian vs. white Caucasian women (p < 0.0001)) leading to higher total : HDL cholesterol ratios (5.48 vs. 4.78, south Asian vs. white Caucasian men (p = 0.032) and 4.91 vs. 4.26, south Asian vs. white Caucasian women (p < 0.001). Conclusion: Calculated 10‐year CHD risks are the same in south Asian and white Caucasian diabetic patients but the factors contributing to this risk differ. Different management of these risk factors may account for the higher mortality from CHD in those of south Asian origin.
Metabolic and haemodynamic effects of metformin in patients with type 2 diabetes mellitus and hypertension
Authors: Uehara M. H. , Kohlmann N. E. B. , Zanella M. T. , Ferreira S. R. G. 
Published: March 2003

SUMMARY Background  Since metformin improves insulin sensitivity, it has been indicated for patients with diabetes and hypertension, which are insulin‐resistant conditions. In contrast to its well‐known effects on carbohydrate metabolism, its potential for reducing blood pressure (BP) and its effect on leptin levels have been investigated less frequently.Patients and Methods  A double‐blind, randomized, placebo‐controlled trial was carried out with 26 overweight diabetic subjects with mild‐to‐moderate hypertension to assess the effects of metformin‐induced glycaemic control on BP and metabolic parameters. After a 4‐week placebo period, when BP was stabilized by calcium channel blockers, they received either metformin (MG) or placebo (PG) for 12 weeks.Results  Neither group showed any change in weight throughout the study. Only metformin‐treated patients reduced fasting plasma glucose (8.54 + 1.72 to 7.54 + 1.33 mmol/l, p < 0.05), although HbA1c had decreased in both groups (PG: 6.7±3.0 to 5.9±2.6%; MG: 5.3±1.5 to 4.6±0.9%; p < 0.05). The initial office mean BPs were similar and decreased at the end of the treatment period in both groups, reaching statistical significance only in MG (105.7±8.0 to 99.2±9.3 mmHg, p < 0.05). No difference was observed when comparing baseline and final values obtained by 24‐h ambulatory BP monitoring. Metformin induced a reduction in both insulinaemia (71.0±62.4 to 38.0±23.0 pmol/l, p < 0.05) and the insulin resistance index (3.5±2.7 to 1.8±1.0, p < 0.05). The two groups had similar baseline leptin levels which remained unchanged after treatment (PG: 16.8±7.9 to 21.4±14.6 μg/l; MG: 18.5±10.3 to 18.4±8.9 μg/l). Dopamine levels increased significantly only in metformin‐treated subjects.Conclusions  Reductions in both the insulin levels and the resistance index reinforced metformin capacity to improve peripheral sensitivity. Moreover, such benefits were not accompanied by any hypotensive effects. Since leptin levels were affected neither by metformin per se nor by the induced insulinaemia reduction, our data support the role of body weight as the major determinant of circulating leptin levels.
Miglitol combined with metformin improves glycaemic control in type 2 diabetes
Authors: Van Gaal L. , Maislos M. , Schernthaner G. , Rybka J. , Segal P. 
Published: March 2003

SUMMARY Aim  To investigate the efficacy and safety of miglitol vs. placebo in type 2 diabetic outpatients insufficiently controlled (HbA1c between 7.5 and 10.5%) with diet and metformin.Methods  Patients treated with diet and metformin (1500–2250 mg/day) were randomized to receive additional treatment with either miglitol or placebo for 32 weeks. The dosages were force‐titrated: 4 weeks at 25 mg miglitol t.i.d., 12 weeks at 50 mg miglitol t.i.d., and 16 weeks at 100 mg miglitol t.i.d. or matching placebo. If the highest dosage could not be tolerated, patients could be down‐titrated to 50 mg t.i.d. The primary efficacy criterion was the change in glycated haemoglobin (HbA1c). Secondary efficacy parameters included fasting and 1 h postprandial blood glucose, serum insulin, and fasting and 1 h postprandial triglyceride levels. Safety and tolerability were evaluated by the incidence of adverse events and changes in vital signs or routine biochemical and haematological parameters.Results  One hundred and fifty‐two patients were valid for the intent‐to‐treat (ITT) analysis. There was a significant decrease in HbA1c on adding miglitol to metformin compared to adding placebo (miglitol treatment effect, − 0.21%; placebo treatment effect, + 0.22%; p = 0.011). Postprandial blood glucose declined in both the miglitol/metformin and placebo/metformin groups with a statistically significant difference in favour of miglitol/metformin (end of treatment adjusted means 13.8 mmol/l for miglitol vs. 15.8 mmol/l for placebo, p = 0.0007). Adverse events (AEs) were reported by only 8% more patients in the miglitol/metformin group than placebo/metformin. No cases of hypoglycaemia were reported.Conclusions  Miglitol can safely and effectively be added to diet and metformin in patients whose type 2 diabetes is insufficiently controlled, and improves glycaemic control by significantly reducing HbA1c and postprandial blood glucose levels.
Orexin reverses cholecystokinin‐induced reduction in feeding
Authors: Asakawa A. , Inui A. , Inui T , Katsuura G. , Fujino M. A. , Kasuga M 
Published: March 2003

Aim: This study was designed to investigate the effect of orexin on anorexia induced by cholecystokinin (CCK),a peripheral satiety signal.Methods: We administered orexin A (0.01–1 nmol/mouse) and CCK‐8 (3 nmol/mouse) to mice. Food intake was measured at different time‐points: 20 min, 1, 2 and 4 h post‐intracerebroventricular (i.c.v.) or intraperitoneal (i.p.) administrations.Results: Intracerebroventricular‐administered orexin significantly increased food intake in a dose‐dependent manner. The inhibitory effect of i.p.‐administered CCK‐8 on food intake was significantly negated by the simultaneous i.c.v. injection of orexin in a dose‐dependent manner.Conclusions: Orexin reversed the CCK‐induced loss of appetite. Our results indicate that orexin might be a promising target for pharmacological intervention in the treatment of anorexia and cachexia induced by various diseases.
Metabolic disorders associated with uncontrolled hypertension
Authors: Bøg‐Hansen E. , Lindblad U. , Gullberg B. , Melander A. , Råstam L. 
Published: March 2003

Aim:  To examine the prevalence and characteristics of uncontrolled hypertension (HT).Methods:  A cross‐sectional community‐based study (1992–93) was carried out in Skara, Sweden, including 894 patients who consecutively underwent an annual follow‐up at the hypertension outpatient clinic in primary care. Controlled HT was defined as diastolic blood pressure (DBP) ≤90 mmHg and systolic blood pressure (SBP) ≤160 mmHg and was used as reference. Uncontrolled DBP was defined as DBP >90 mmHg regardless of SBP level, and isolated uncontrolled SBP was defined as SBP >160 mmHg and DBP ≤90 mmHg. Proportions were age‐standardized using the Skara population as reference.Results:  The prevalence of uncontrolled HT was 43% (isolated uncontrolled SBP 18% and uncontrolled DBP 25%). Both men and women with isolated uncontrolled SBP were older (73 years, CI: 70–75; and 73 years; CI: 72–75) than patients with controlled HT (64 years, CI: 63–66; and 65 years, CI: 64–66). Men and women with known cardiovascular disease (CVD) less often had isolated uncontrolled SBP (OR: 0.4, CI: 0.2–0.9; and OR: 0.5, CI: 0.3–0.9), whereas men and women with known diabetes more often had uncontrolled DBP (OR: 2.3, CI: 1.3–4.1; and OR: 3.3, CI: 1.9–5.7). Men with known CVD less often had uncontrolled DBP (OR: 0.5, CI: 0.3–1.0, p = 0.04), and men with fasting blood glucose >5.5 mmol/l more often had isolated uncontrolled SBP (OR: 1.9, CI: 1.0–3.5, p = 0.04). In women, the following high risk factor levels were associated with uncontrolled DBP: fasting blood glucose >5.5 mmol/l (OR: 1.4, CI: 1.1–1.8), fasting triglycerides ≥1.7 mmol/l (OR: 1.4, CI: 1.1–1.8), body mass index (BMI) >30 kg/m2 (OR: 1.5, CI: 1.1–1.9), waist/hip ratio (WHR) >0.85 cm/cm (OR: 1.7, CI: 1.3–2.2), insulin resistance (homeostasis model assessment (HOMA) >third quartile) (OR: 1.4, CI: 1.1–1.9) and microalbuminuria (OR: 3.2, CI: 1.7–6.2).Conclusion:  Uncontrolled DBP is in both sexes related to type 2 diabetes, whereas isolated uncontrolled SBP is related to older age. In women, uncontrolled DBP, furthermore, is related to several other CVD risk factors of the metabolic syndrome. Patients with uncontrolled DBP should be carefully evaluated for metabolic disorders.
Detection of insulin resistance in Turkish adults: a hospital‐based study
Authors: Gokcel A. , Baltali M. , Tarim E. , Bagis T. , Gumurdulu Y. , Karakose H. , Yalcin F. , Akbaba M. , Guvener N. 
Published: March 2003

Aim: The aim of the present study was to investigate the usefulness of insulin sensitivity check indices in our hospital population.Methods: Both HOMA (insulin X glucose in mmol/l/22.5) and QUICKI (1/log insulin in μu/ml + log glucose in mg/dl) indices were calculated from fasting values in 1774 subjects from the medical records of Baskent University Adana Hospital.Results: Subjects with diabetes, hyperlipidaemia and central obesity were characterized by significantly higher HOMA and lower QUICKI indices than those of healthy subjects. A fall in the QUICKI index (0.3469 ± 0.028 in healthy subjects and 0.3247 ± 0.025 in non‐obese diabetics) as well as an increase in HOMA index (2.24 ± 1.26 in healthy subjects and 3.59 ± 2.08 in non‐obese diabetics) corresponded to metabolic and clinical manifestations of insulin resistance in various groups of subjects. Age, low HDL cholesterol, male sex, type 2 DM and hypertension were independent risk factors for CAD. Age, male sex, waist circumference and CAD were found to be risk factors for hypertension. Fasting insulin and glucose levels contain sufficient information to assess insulin sensitivity over a wide range in a diverse population. The following can be accepted as mean values to assess insulin resistance in our hospital population: 0.3469 ± 0.028 for the QUICKI index and 2.24 ± 1.26 for the HOMA indexConclusions: HOMA and QUICKI indices are simple and reproducible methods for determining insulin sensitivity in humans.
Antennal sensilla of the ground beetle Bembidion lampros Hbst (Coleoptera, Carabidae)
Authors: Merivee Enno , Ploomi Angela , Rahi Märt , Luik Anne , Sammelselg Väino 
Published: March 2003

AbstractAntennal sensilla typology, number and distribution pattern were studied in the ground beetle Bembidion lampros Hbst (Coleoptera, Carabidae) using scanning electron microscopy. The 1.6–1.8 mm long filiform antennae of both sexes consist of the scape, pedicel and of the flagellum composed of nine flagellomeres. In both sexes, three types of sensilla chaetica, two types of sensilla trichodea, five types of sensilla basiconica, one type of sensilla coeloconica, one type of sensilla campaniformia and Böhm sensilla were distinguished. The possible function of the sensilla was discussed and three types of sensilla were considered as olfactory, sensilla trichodea type 2 and sensilla basiconica types 1 and 2. Olfactory sensilla occupy dorsal and/or ventral areas of the flagellomeres and occur sparsely (sensilla basiconica type 1) or not at all (sensilla basiconica type 2 and sensilla trichodea type 2) outside these areas. No remarkable sexual differences in the types, numbers and distribution of antennal sensilla were found.