bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of life in patients with benign anorectal disorders
Authors: Sailer M , Bussen D , Debus E S , Fuchs K H , Thiede A 
Published: March 2003

Abstract

Background
Benign proctological conditions are very common in Western civilization. However, to date quality of life in these patients has not been evaluated comprehensively. The aim of this study was to investigate whether the Gastrointestinal Quality of Life Index (GIQLI) is a useful instrument for measuring quality of life in these patients, and subsequently to establish baseline values for different anorectal disorders.

Methods
The questionnaire was completed by 325 consecutive patients (182 men; mean age 49 years) seen at the proctology outpatient clinic. For further analysis patients were classified into nine subgroups according to the primary diagnosis: group 1, haemorrhoids (n = 96); group 2, anal fissure (n = 38); group 3, fistula in ano (n = 22); group 4, severe constipation (n = 14); group 5, faecal incontinence (n = 35); group 6, symptomatic anterior rectocele (n = 12); group 7, perianal abscess (n =7); group 8, perianal thrombosis (n = 7); and group 9, miscellaneous conditions (e.g. skin tags, anal papillomas, mild constipation, rectal polyps) (n = 94). The GIQLI scores were compared between the subgroups. In addition the GIQLI scores of age-matched healthy controls, derived from data in the literature, were compared with the patients' scores.

Results
The mean GIQLI score for all patients was 113 (78·5 per cent of the maximum score of 144). Mean scores for the nine diagnostic subgroups were: group 1, 120; group 2, 104; group 3, 119; group 4, 94; group 5, 93; group 6, 112; group 7, 115; group 8, 129; and group 9, 117. Age-matched controls from a series published previously had a significantly higher GIQLI score compared with all patients (P &lt; 0·0001). However, only the subgroups of patients with miscellaneous conditions, fissures, severe constipation and faecal incontinence had a significantly poorer quality of life than age-matched healthy individuals.

Conclusion
The GIQLI is a valuable instrument for measuring quality of life in patients with benign anorectal disorders. Although certain diseases do not seem to affect quality of life profoundly, certain subgroups of patients, most notably those with incontinence and severe constipation, are extremely compromised. Severely constipated individuals exhibit the same poor quality of life as patients with faecal incontinence.
Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery
Authors: Sørensen L T , Jørgensen T , Kirkeby L T , Skovdal J , Vennits B , Wille-Jørgensen P 
Published: March 2003

Abstract

Background
Several studies have examined the association between anastomotic leakage and intraoperative risk factors in colorectal surgery, but only a few have taken patients' lifestyle into account. The aim of this study was to assess the association between anastomotic leakage and lifestyle factors such as smoking habits and alcohol consumption.

Methods
Between January 1993 and October 1996, 333 unselected consecutive patients in one surgical department underwent colonic or rectal resection with anastomosis. The association between clinical anastomotic leakage and 24 variables related to patient history, diagnosis and surgery was assessed retrospectively and analysed by logistic regression.

Results
The rate of clinical anastomotic leakage was 15·9 per cent (53 of 333 patients). Multiple regression analysis showed that smokers, compared with non-smokers, had an increased risk of anastomotic leakage (relative risk (RR) 3·18 (95 per cent confidence interval (c.i.) 1·44–7·00)), as did alcohol abusers compared with abstainers (RR 7·18 (95 per cent c.i. 1·20–43·01)). In the analysis, well known risk factors for anastomotic leakage such as site of anastomosis, age and stage of training of the surgeon were taken into account.

Conclusion
Smoking and alcohol abuse are important predictive factors for anastomotic leakage after colonic and rectal resection.
Systematic review of the use of fibrin sealant to minimize perioperative allogeneic blood transfusion
Authors: Carless P A , Anthony D M , Henry D A 
Published: March 2003

AbstractBackgroundFibrin sealants have become popular in improving perioperative haemostasis and reducing the need for allogeneic red cell transfusion.MethodsA systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants in reducing perioperative blood loss and allogeneic red blood cell transfusion. Studies were identified by computer searches of Medline, Embase, Current Contents, the Cochrane Library, manufacturer websites (to January 2001), and bibliographic searches of published articles. Trials were eligible for inclusion if they involved adult elective surgery and reported quantitative data on blood loss, the proportion of patients exposed to allogeneic red cell transfusion and/or the volume of blood transfused.ResultsTwelve trials met the criteria for inclusion. Fibrin sealants reduced the rate of allogeneic blood transfusion (relative risk 0·40 (95 per cent confidence interval (c.i.) 0·26 to 0·61); five trials with 275 subjects) and reduced blood loss (weighted mean difference −151·68 (95 per cent c.i. −251·91 to −51·46) ml; seven trials with 391 subjects). Generally, the trials were small and of poor methodological quality.ConclusionOverall the results suggest that fibrin sealants are efficacious. Owing to lack of blinding, transfusion practices may have been influenced by knowledge of the patient's treatment status. This raises concern about blood transfusion practice as a response variable. Large methodologically rigorous trials of fibrin sealants with clinical outcomes are needed.
Botulinum neurotoxin and other treatments for fissure-in-anoand pelvic floor disorders
Authors: Maria G , Sganga G , Civello I M , Brisinda G 
Published: March 2003

AbstractBackgroundThe management of disorders of the lower gastrointestinal tract, such as chronic anal fissure and pelvic floor dysfunction, has undergone re-evaluation recently. To a large extent this is due to the advent of neurochemical treatments, such as botulinum neurotoxin injections and topical nitrate ointment.Methods and resultsThis review presents, inter alia, current data on the use of botulinum neurotoxin to treat lower gastrointestinal tract diseases, such as chronic anal fissure for which it promotes healing and symptom relief in up to 70 per cent of cases. This agent has also been used selectively to weaken the external anal sphincter and puborectalis muscle in constipation and in Parkinson's disease. Symptomatic improvement can also be induced in anterior rectocele by botulinum neurotoxin injections.ConclusionBotulinum neurotoxin appears to be a safe therapy for anal fissure. It is more efficacious than nitrate application and does not require patient compliance to complete treatment. While it may also be a promising approach for the treatment of chronic constipation due to pelvic floor dysfunction, further investigation of its efficacy and safety in this role is needed before general usage can be advocated.
Revascularization of the superior mesenteric artery after acute thromboembolic occlusion
Authors: Björck M , Acosta S , Lindberg F , Troëng T , Bergqvist D 
Published: March 2003

Abstract

Background
The outcome and prognostic factors after revascularization of acute thromboembolic occlusion of the superior mesenteric artery (SMA) are poorly documented.

Methods
Sixty patients with acute thromboembolic occlusion of the SMA had revascularization procedures at 21 hospitals from 1987 to 1998. They were registered prospectively in the Swedish Vascular Registry. Patient files were analysed retrospectively.

Results
The median age of the patients was 76 years; 73 per cent suffered from cardiac disease and 23 per cent had previous vascular surgery. Onset of symptoms was classified as sudden (30 per cent), acute (33 per cent) or insidious (37 per cent). The occlusions were thought to be either embolic (67 per cent) or thrombotic (33 per cent). The diagnosis was suspected on first examination in 32 per cent of patients, a group whose median time to operation was shorter (P = 0·01). Fifty-eight patients had an exploratory laparotomy and subsequent revascularization, and two were treated with thrombolysis alone. Second-look laparotomy was performed in 41, and third look in eight patients; 19 required an additional bowel resection. The overall mortality rates were 43, 52, 60 and 67 per cent at 30 days, discharge, 1 and 5 years, respectively. No patient was dependent on intravenous nutrition after 1 year. Previous vascular surgery resulted in a higher institutional mortality rate (79 per cent; P = 0·02). Patients who had a sudden onset of symptoms outside hospital had a better outcome (mortality rate 27 per cent; P = 0·02).

Conclusion
Many non-diagnostic radiological examinations were performed and a routine second-look is warranted. The results suggest that attempts at revascularization procedures for acute mesenteric ischaemia may improve the outcome.
The mystery of liver regeneration
Authors: Court F G , Wemyss-Holden S A , Dennison A R , Maddern G J 
Published: March 2003

Abstract

Background
Partial hepatectomy is the strongest stimulator of hepatic regeneration. The process of initiation and the control of the final size of the regenerated liver have been the subject of research for many years. A better understanding of this process and the effect of disease may allow better selection of patients for partial hepatectomy. It may also allow an insight into the possible application of clinical stimulation of regeneration.

Methods
Data were reviewed from the published literature using the Medline database.

Results
Most knowledge comes from in vitro studies and the study of resection in the rat model. A variety of cytokines, hormones and growth factors are involved in regeneration but very few have been found capable of stimulating regeneration in vitro. The exact interactions are not known, but there is probably a cascade involving different factors at differing stages of regeneration.

Conclusion
Further in vivo research should allow greater understanding of liver regeneration, thereby providing a potential therapeutic tool in patients for whom regeneration has failed, or is likely to fail. Such research is also important in respect of liver support devices, which may inhibit liver regeneration by filtration of many of the factors involved.
Experience in the management of conjoined twins
Authors: Spitz L , Kiely E M 
Published: March 2003

Abstract

Background
Conjoined twins occur in approximately one in 200 000 live births. Their management is often extremely complex and experience with large numbers is restricted to a few centres worldwide.

Methods
An analysis of 17 sets of symmetrical conjoined twins managed by a single team of surgeons over a 16-year period was undertaken.

Results
Management could be divided into three groups. Those in group 1 (n = 5) had non-operative management, owing to cardiac fusion or gross anatomical union, and all died. Those in group 2 (n = 7) underwent emergency separation, when one twin was dead or threatening the survival of the sibling or where there was a correctable life-threatening associated anomaly (four of 14 survived). Twins in group 3 (n = 5) underwent elective separation, allowing time for detailed preoperative investigation and planning (eight of ten survived).

Conclusion
Accurate preoperative investigation, a team approach, previous experience, and meticulous operative and postoperative management contributed to the success rate achieved in this series.
Outcome of patients with severe chronic pain following repair of groin hernia
Authors: Courtney C A , Duffy K , Serpell M G , O'Dwyer P J 
Published: March 2003

Abstract

Background
Chronic pain is the most serious long-term complication that can occur after repair of a groin hernia. The aim of this study was to assess the outcome of patients who report severe or very severe pain 3 months after groin hernia repair.

Methods
This was a population-based study of all patients who underwent repair of a groin hernia between April 1998 and March 1999 in Scotland. All received a postal questionnaire 3 months after hernia repair and those who reported severe or very severe pain at the operation site were asked to complete a further questionnaire 2·5 years later. The main outcome measure included the number of patients with persistent pain and the effect of pain on daily activities and quality of life.

Results
Of 5506 patients who underwent repair of a groin hernia, 4062 (74 per cent) returned the first questionnaire and 125 (3 per cent) reported severe or very severe pain. Eight-six (72 per cent) of 120 patients (five had died or could not be contacted at the original address) replied to the second questionnaire; 61 (71 per cent) still reported pain, which was severe or very severe pain in 22 (26 per cent) and mild or very mild in 39 (45 per cent). Twenty-nine (48 per cent) sought further medical help from their general practitioner or surgeon. Nine (15 per cent) attended a pain clinic while five (8 per cent) had further surgery. Chronic pain had significant effects (P &lt; 0·001) on all daily activities including walking, work, sleep, relationships with other people, mood and general enjoyment of life.

Conclusion
Chronic pain persists in most patients who report severe or very severe pain at 3 months after hernia repair, and has a significant effect on the patients' daily activities and quality of life.
Tumour thickness as a predictor of occult lymph node metastases in patients with stage I and II melanoma undergoing sentinel lymph node biopsy
Authors: Lens M B , Dawes M , Newton-Bishop J A , Goodacre T 
Published: March 2003

AbstractBackgroundSentinel lymph node biopsy (SLNB) is a minimally invasive procedure used accurately to stage nodal basins at risk of occult metastases. There are no data as yet to show a survival benefit from SLNB and its use remains controversial. If Breslow thickness of the tumour correlates well with positive SLNB, it could be used to select patients for SLNB.MethodsA quantitative systematic review of published studies on SLNB in patients with melanoma available by September 2001 was performed.ResultsTwelve studies containing 4218 patients with stage I and II melanoma were identified; 17·8 (95 per cent confidence interval 16·7 to 19·0) per cent of patients had nodal micrometastases detected by SLNB. The incidence of micrometastasis in sentinel nodes correlated directly with Breslow tumour thickness; it was 1·0 per cent for lesions of less than or equal to 0·75 mm, 8·3 per cent for 0·76–1·50 mm, 22·7 per cent for 1·51–4·0 mm and 35·5 per cent for more than 4·0 mm.ConclusionThe Breslow thickness of primary melanoma predicts the presence of a sentinel node metastasis. The published data are not sufficient to demonstrate a correlation between other known prognostic indicators and a positive SLNB.
Meta-analysis of relaparotomy for secondary peritonitis
Authors: Lamme B , Boermeester M A , Reitsma J B , Mahler C W , Obertop H , Gouma D J 
Published: March 2003

Abstract

Background
Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis.

Methods
The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on-demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in-hospital mortality.

Results
No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta-analysis. These eight studies were heterogeneous on clinical and statistical grounds (χ2 = 40·7, d.f. = 7, P &lt; 0·001). Using a random-effects approach, the combined odds ratio for in-hospital mortality was 0·70 (95 per cent confidence interval 0·27 to 1·80) in favour of the on-demand strategy.

Conclusion
The combined results of observational studies show a statistically non-significant reduction in mortality for the on-demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random-effects model. Owing to the non-randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive.
Influence on antiproliferative activity of structural modification and conjugation of gonadotropin‐releasing hormone (GnRH) analogues
Authors: Kálnay A. , Pályi I. , Vincze B. , Mihalik R. , Mezõ I. , Pató J. , Seprõdi J. , Lovas S. , Murphy R.F. 
Published: March 2003

AbstractThe effect of various GnRH analogues, and their conjugates on proliferation, clonogenicity and cell cycle phase distribution of MCF‐7 and Ishikawa human cancer cell lines was studied. GnRH‐III, a sea lamprey GnRH analogue reduced cell proliferation by 35% and clonogenicity by 55%. Structural modifications either decreased, or did not alter biological activity. Conjugation of GnRH analogues including MI‐1544, MI‐1892, and GnRH‐III with poly(N‐vinylpyrrolidone‐co‐maleic acid) (P) through a tetrapeptide spacer GFLG(X) substantially increased the inhibitory effect of the GnRH analogues. The conjugate P‐X‐GnRH‐III induced significant accumulation of cells in the G2/M phase; from 8% to 15.6% at 24 h and 9.8% to 15% at 48 h. It was concluded that conjugation of various GnRH analogues substantially enhanced their antiproliferative activity, strongly reduced cell clonogenicity and retarded cell progression through the cell division cycle at the G2/M phase.
In vitro proliferation of achondroplastic and normal mouse chondrocytes, before and after basic fibroblast growth factor stimulation
Authors: Argentin G. , Cicchetti R. 
Published: March 2003

Achondroplasia in mice is a recessive genetic disorder, characterized by disproportionate dwarfism with reduced bone growth. The cause of this chondrodystrophy is unknown.In this study normal and achondroplastic mouse chondrocytes were cultured in monolayer primary culture, their differentiation was verified by immunofluorescence and their growth was compared.The results showed that achondroplastic cells exhibited a higher proliferative activity than control cells of the same age, confirmed also by a thymidine incorporation assay. Furthermore, basic fibroblast growth factor treatment was found to induce a strong increase in growth of normal mouse chondrocytes, while it did not stimulate statistically significant proliferation of achondroplastic mouse cells.We suppose that this different growth rate could play a role in achondroplastic phenotype development.
The geometry of proliferating dicot cells
Authors: Korn R.W. 
Published: March 2003

Abstract.The distributions of cell size and cell cycle duration were studied in two‐dimensional expanding plant tissues. Plastic imprints of the leaf epidermis of three dicot plants, jade (Crassula argentae), impatiens (Impatiens wallerana), and the common begonia (Begonia semperflorens) were made and cell outlines analysed. The average, standard deviation and coefficient of variance (CV = 100 × standard deviation/average) of cell size were determined with the CV of mother cells less than the CV for daughter cells and both are less than that for all cells. An equation was devised as a simple description of the probability distribution of sizes for all cells of a tissue. Cell cycle durations as measured in arbitrary time units were determined by reconstructing the initial and final sizes of cells and they collectively give the expected asymmetric bell‐shaped probability distribution. Given the features of unequal cell division (an average of 11.6% difference in size of daughter cells) and the size variation of dividing cells, it appears that the range of cell size is more critically regulated than the size of a cell at any particular time.
Blast colony‐forming cell binding from CML bone marrow, or blood, on stromal layers pretreated with G‐CSF or SCF
Authors: Gidáli J. , László E. , Halm G. , Fehér I. 
Published: March 2003

Abstract.Blast colony‐forming cells (CFU‐BL) represent a specific subpopulation of special primitive progenitors characterized by colony formation only in close contact with a preformed stromal layer. CFU‐BL derived from bone marrow of chronic myeloid leukaemia (CML) patients have been proved to adhere poorly to bone marrow derived stromal layers suggesting that the appearance of progenitors and precursors in the circulation is due to a defective adhesion of these cells to the bone marrow microenvironment. In the present experiments the effect of short‐term incubation of preformed normal bone marrow stroma on the adherence of CML derived CFU‐BL was studied. For stroma cultures bone marrow cells were cultured in microplates in the presence of hydrocortisone. Cultures were used when stromal layers became confluent and no sign of haemopoiesis could be observed. CFU‐BL were studied by panning plastic non‐adherent mononuclear (PNAMNC) bone marrow or blood cells. 8.9 ± 2.4 colonies/103 PNAMNC (six experiments) were formed from normal bone marrow on stromal layers and 4.8 ± 2.1 colonies/103 PNAMNC (five experiments) from CML bone marrow. Colony formation from normal bone marrow was not increased if stromal layers were incubated with 100 ng/mL granulocyte colony‐stimulating factor (G‐CSF) or stem cell factor (SCF). Incubation of stroma with G‐CSF or SCF, however, increased the colony formation of PNAMNC from CML bone marrow or blood significantly. These findings suggest that local concentration of haemopoietic growth factors at the time of panning may influence the attachment of CML progenitors to the stroma.
Mandatory reporting of child abuse and neglect: does it really make a difference?
Authors: Ainsworth Frank 
Published: March 2003

ABSTRACTMandatory reporting of child abuse and neglect has its origins in the USA, where model statutes for laws designed to introduce this process were first drafted in the early 1960s. Indeed, every state and the District of Columbia passed a child abuse reporting law between 1963 and 1967. Some 10 years later, in 1977, New South Wales was the first Australian state to pass comparable legislation. Mandatory reporting of suspected cases of child abuse and neglect is now in place in all Australian states and territories, with the exception of Western Australia. The question considered in this paper is: ‘What evidence is there that children are abused and neglectedlessin jurisdictions where mandatory reporting exists by comparison with jurisdictions where it does not exist?’ This question is examined by way of a comparison between two states, New South Wales and Western Australia. This paper also raises questions about the cost of mandatory reporting and the extent to which it diverts financial resources away from support services for families. There is also a question about the new New South Wales child protection legislation that extends mandatory reporting and possible negative consequences for ordinary families. The final question is about the role assigned to health care and education professionals under this legislation.