bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term outcome after colectomy in severe idiopathic constipation
Authors: Nylund G. , Öresland T. , Fasth S. , Nordgren S. 
Published: March 2003

ObjectiveThe specific aim of the investigation was to assess the long‐term results of subtotal colectomy with ileorectal anastomosis in patients with severe idiopathic constipation.Patients and methods40 patients with severe idiopathic constipation were operated on between 1981 and 1993. Patients were accepted for a colectomy and an ileo‐rectal anatomosis after a thorough gastro‐intestinal investigation. Pre‐operative bowel frequency was less than 2 movements per week, and slow transit was documented. Postoperative complications occurred in eight patients. Early re‐operation was performed in 2 patients for small bowel obstruction.ResultsMean follow‐up was 11 (range 5–16) years. The defaecation frequency at follow‐up was 3.0 ± 1.9 per day. Twenty‐nine patients stated that they were satisfied and 11 were dissatisfied with the procedure. The outcome did not correlate with observed signs of outlet obstruction, blunted rectal sensation or presence of a psychiatric diagnosis. At 5–16 years after the procedure 33 patients still retain the ileo‐rectal anastomosis. Seven patients have had further procedures: Five patients have an ileo‐anal pouch, one has a continent ileostomy and one has a conventional ileostomy. Small bowel obstruction was encountered in 17 patients, in 10 of these surgical treatment was necessary.ConclusionIt is concluded that colectomy and ileorectal anastomosis for the treatment of severe idiopathic constipation causes an increase in the number of bowel motions, but is deemed successful only by 3 out of 4 patients. Secondary morbidity is considerable.
The effectiveness of new criteria for colorectal fast track clinics
Authors: Harinath G. , Somasekar K. , Haray P. N. 
Published: March 2003

IntroductionFast Track Colorectal Clinics are becoming a requirement to meet the government's 10‐day rule for patients with suspected cancers to be seen by a specialist. However, such clinics soon tend to get overwhelmed by huge numbers of referrals, many of them inappropriate. The Association of Coloproctology of Great Britain and Ireland has published criteria for appropriate referral. We evaluated the sensitivity of these criteria and attempted to recommend appropriate changes.MethodsData of 50 consecutive colorectal cancers from our DGH since January 2000 has been collected in relation to demographics, presenting signs and symptoms, haemoglobin levels as well as treatment. The new Criteria were then applied strictly to these cases and we evaluated whether these patients would have been eligible for fast track referral, if these criteria had been in force since January 2000.ResultsForty‐one (82%) of 50 patients would have been eligible for referral as follows: 11 (22%) rectal bleeding with diarrhoea; 8(16%) persistent diarrhoea without bleeding (>60 years), 12 (24%) bleeding without anal symptoms (>60 years), 0 (0%) palpable right sided abdominal mass, 7 (14%) palpable rectal mass, 16 (32%) iron deficiency anaemia (<11 g/dl in men & <10 g/dl in women), 10 (20%) patients qualifying on more than one criterion. However, 9 (18%) patients had presenting features that would have excluded them from a fast track referral as follows: 4 (8%) only abdominal pain + weight loss (48, 54, 72, 75 years old), 2 (4%) change in bowel habit + no rectal bleeding (54, 57 years old), 1 (2%) palpable mass at a site other than the right side of the abdomen.ConclusionsWe feel that this study, although small, highlights the dangers of having very rigid criteria for such clinics. The new criteria though high in specificity have low sensitivity for safety. We recommend some modifications to the criteria as follows: rectal bleeding without anal symptoms >50 years instead of 60 years; patients with a palpable mass anywhere on the abdomen; and the adddition of a new criterion of abdominal pain with weight loss. These modifications would significantly increase the sensitivity from 82% to 94%.
Histological tumour response to pre‐operative combined modality therapy in locally advanced rectal cancer
Authors: Morgan M. J. , Koorey D. J. , Painter D. , Findlay M. , Tran K. , Stevens G. , Solomon M. J. 
Published: March 2003

BackgroundPre‐operative combined modality therapy (CMT) is used in locally advanced rectal cancer. Its use affects the clinicopathological staging based on the resected specimen. Assessment of the tumour response in the resected specimen may provide prognostic information. This study was undertaken to determine the histological response to pre‐operative chemoradiation and to assess the interobserver reliability of a newly developed tumour response grading system for rectal cancer.MethodsPre‐operative biopsy specimens and the resected specimens of 21 patients with low rectal cancer were assessed. The patients underwent pre‐operative CMT consisting of radiotherapy (45 Gy) with 5‐FU either as a continuous infusion or as a bolus intravenous infusion with leucovorin. After four to six weeks tumour response was assessed by comparing pre‐operative transrectal ultrasound (TRUS) findings (uT1‐4, uN0‐1) with postoperative histopathological assessment (pT1‐4, pN0‐1) using UICC TNM characteristics. Tumour response was defined as a decrease in T status. The histological response to CMT was based on the tumour regression grade (TRG) and ranged from fibrosis extending through the rectal wall with no residual cancer (TRG 1), to no evidence of tumour response (TRG 5). Inter‐observer reliability was assessed using weighted and unweighted kappa statistics.ResultsLocal downstaging was demonstrated in 11/21 (52%) of patients. Three of 21 patients had a TRG 1 response. Thirteen of 21 (62%) patients had TRG 1–3 responses to CMT. There was no significant correlation between local downstaging and TRG. The interobserver correlation coefficient for assessment of TRG was 0.88 (unweighted kappa).ConclusionsLocal downstaging by pre‐operative CMT can be demonstrated if pre‐operative TRUS staging is compared to standard pathology staging in patients with rectal cancer. Local downstaging is not directly related to histologic response as assessed by TRG. Inter‐observer reporting of tumour regression grade (TRG) is reliable.
The influence of a colorectal service on the outcome of patients with colorectal cancer
Authors: Platell C. 
Published: March 2003

AbstractObjective  To perform a prospective audit of outcomes and survival of all patients presenting to a colorectal service with colorectal cancer, and to compare these results with an historical control group.Patients and methods  At a community based teaching hospital, a prospective audit of outcomes and survival of patients with colorectal cancer was compared with a historical control. The study included all patients referred to a colorectal service with colorectal cancer from 1996 to 2000 (5‐year period). The control group was a retrospective review of patients presenting to the same hospital with colorectal cancer from 1989 to 1994 (6‐year period). A Kaplan‐Meier survival analysis compared the overall survival (all‐cause mortality) between the two groups.Results  When comparing the study periods 1989–95 (n = 477) to 1996–2000 (n = 323), there has been a significant reduction in postoperative stay (16.2 vs 8.0 days, P < 0.05), and a reduction in postoperative mortality (4.5%vs 2.7%, n.s.). There was a significant increase in the overall 2 years survival for patients with colorectal cancer (62% to 71%, P < 0.01). There was also a significant increase in the overall 2 years survival of patients with rectal cancer (66% to 74%, P < 0.01), patients with ACPS C colon cancers (64% to 83%, P < 0.05), and ACPS C rectal cancers (74% to 85%, P < 0.01).Conclusions  There have been significant gains in the survival of patients presenting to a community based teaching hospital with colorectal cancer. These improvements have been most notable in patients with nodal metastases at the time of diagnosis.
Stapled anoplasty for haemorrhoids: a comparison of ambulatory vs. in‐patient procedures
Authors: Guy R. J. , Ng Cho Eng , Eu Kong‐Weng 
Published: March 2003

AbstractObjective  Haemorrhoids are commonly seen in colorectal practice. Stapled anoplasty is a novel approach to the treatment of this condition and is usually performed as an in‐patient procedure. The aim of this study was to investigate the suitability of this technique for ambulatory surgery.Patients and methods  Fifty consecutive patients undergoing stapled anoplasty under general anaesthesia as day cases (DC) (mean age 41 years; 27 females) by a single consultant surgeon over a 12‐month period were compared with 50 consecutive patients undergoing the same procedure as in‐patients (mean age 44 years; 25 females) (IP) during the same period.Results  Eight DC patients (16%) were admitted overnight from the day surgery unit for urinary retention (3), pain (2), bleeding (2) and anaesthetic reasons (1). Three other DC patients were re‐admitted after a mean period of 4 days with bleeding (2), one of which required surgical haemostasis, and a septic complication (1). Mean hospital stay for IP cases was 2.6 (range 1–9) days. Two IP cases were re‐admitted after 4 and 11 days for bleeding and wound infection, respectively. At review 2–4 weeks after discharge, satisfaction in both groups was high. Minor staple‐line strictures were seen in 1 DC and 2 IP cases but all were easily dilated digitally. Mean costs incurred were significantly less for day surgery patients.Conclusions  Stapled anoplasty is suitable for use in day‐case surgery as it is a quick and relatively painless procedure. The advantages, particularly financial, support the technique for use in an ambulatory setting, preferably in the morning, and provided detailed patient advice is given.
Clenbuterol stimulates neurotrophic support in streptozotocin‐diabetic rats
Authors: Riaz S. S. , Tomlinson D. R. 
Published: March 2003

Summary Background: The diabetic neuropathies are characterized by axonal degeneration of peripheral nerves. The commonest variant of this condition is distal symmetrical polyneuropathy, in which the principal presenting features can be explained by impaired neurotrophic support of sensory neurones. Aims: The aims of these experiments were to determine whether deficits in nerve growth factor (NGF) content and the products of its target genes (substance P and calcitonin‐gene related peptide; CGRP) in the sciatic nerve of streptozotocin‐induced rats could be prevented using clenbuterol, which has been demonstrated to induce NGF synthesis in vitro. Results: Diabetes of 8 weeks duration produced a reduction in measurable sciatic nerve NGF‐like immunoreactivity (NGF‐LI) content of 53% (p < 0.01). This was accompanied by depletion of substance P (of 43%; p < 0.01) and CGRP (of 45%; p < 0.01). Treatment with clenbuterol (30 μg/kg, 100 μg/kg and 300 μg/kg; daily subcutaneous injection) significantly increased the NGF‐LI and neuropeptide content of the sciatic nerve, with 30 μg/kg of clenbuterol normalising the levels in diabetic animals. The alterations in steady state sciatic nerve NGF‐LI were proportionally related to the amount of NGF‐LI delivered to the primary afferent neurones via retrograde transport. Thus, there was a significant reduction in accumulation of NGF‐LI distal to a 12‐h ligature in diabetic untreated rats (p < 0.01), which was normalized by clenbuterol (30 μg/kg; p < 0.05). Treatment of control or diabetic rats with clenbuterol did not affect the local production of NGF‐LI in the sciatic nerve adjacent to and triggered by an occluding ligature. The change in NGF‐LI content of neuronal tissue in the clenbuterol treated rats was a reflection of the capture of NGF derived from the peripheral targets of the sciatic nerve. The soleus and EDL muscles showed reductions in NGF‐LI in untreated diabetic animals. Clenbuterol significantly (p < 0.05) increased NGF‐LI in the soleus muscle. Conclusion: Clenbuterol could be a useful tool in alleviating the deficits in neurotrophin support in diabetes.
Glucose and fatty acid metabolism in type 2 diabetes mellitus: an assessment using low‐dose insulin infusion and the hyperinsulinaemic euglycaemic clamp
Authors: Webber J. , Whitelaw D. , Smith J. M. , Nattrass M. 
Published: March 2003

Summary Aim: To assess whether resistance to the effects of insulin on lipid metabolism in type 2 diabetes mellitus parallels that demonstrated for glucose metabolism. Methods: Thirteen patients with type 2 diabetes were studied (mean age 56.2 years, mean body mass index (b.m.i.) 28.7 kg m–2). The hyperinsulinaemic euglycaemic clamp (2 mU insulin kg–1 min–1) and a low‐dose insulin infusion technique were used in order to assess insulin effects on both glucose and lipid metabolism. Results: Using the low‐dose insulin infusion there were significant correlations between measures of insulin sensitivity for glucose metabolism and those for NEFA (r = 0.82, p < 0.01) and glycerol (r = 0.73, p < 0.01). Mean clamp glucose disposal was 33.4 μmol kg b.w.–1 min–1. There was no correlation between clamp glucose disposal and insulin sensitivity derived from the low‐dose insulin infusion. Conclusions: At low insulin concentrations, insulin’s effects on glucose metabolism (mainly suppression of hepatic glucose output) mirror those on inhibition of lipolysis. At the high insulin concentrations seen during the clamp, stimulation of glucose uptake provides a measure of maximal insulin action which does not parallel its physiological effects shown at lower concentrations.
Gliclazide reduces the induction of human monocyte adhesion to endothelial cells by glycated albumin
Authors: Desfaits A. ‐C. , Serri O. , Renier G. 
Published: March 2003

SummaryObjective: To examine the kinetic of human monocyte adhesion to endothelial cells stimulated by glycated albumin, the contributive role of cell adhesion molecules to this effect, and the effect of gliclazide–an hypoglycemic drug with antioxidant properties–on these parameters.Methods: In‐vitro experiments performed in the presence and absence of gliclazide consisted of: (1) time‐dependent determination of human monocyte adhesion to human endothelial cells (ECs) pre‐exposed to glycated albumin; (2) evaluation of adhesion after incubation of ECs with antibodies against cell surface adhesion molecules; and (3) determination of EC surface adhesion molecules and of the activity of the transcription factor NF‐κB.Results: Exposition of human ECs for 1–48 h to 100 μg/ml glycated albumin led to a time‐dependent increase in human monocyte adhesion to endothelium. Pretreatment of ECs with 10 μg/ml gliclazide significantly decreased the glycated albumin‐stimulated monocyte adhesion to these cells. Anti‐antibodies against E‐selectin (ELAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1) and intercellular adhesion molecule‐1 (ICAM‐1) also reduced the stimulatory effect of glycated albumin on monocyte adhesion. In glycated albumin‐treated ECs, an induction of both soluble and cell associated expression of ELAM‐1, VCAM‐1 and ICAM‐1, an augmentation in the levels of these molecule transcripts and an increase in the DNA binding activity for NF‐κB in the promoters of these antigens were observed. Gliclazide markedly inhibited the induction of all these parameters.Conclusions: Glycated albumin stimulates human monocyte adhesion to ECs by inducing cell associated ELAM‐1, ICAM‐1 and VCAM‐1. Gliclazide effectively inhibits monocyte adhesion to ECs by reducing glycated albumin induction of EC adhesion molecules and NF‐κB activation. These results suggest that gliclazide may be beneficial in the prevention of endothelial disturbances associated with hyperglycemia in diabetic patients.
Intracerebroventricularly administered corticotropin‐releasing factor inhibits food intake and produces anxiety‐like behaviour at very low doses in mice
Authors: Momose K. , Inui A. , Asakawa A. , Ueno N. , Nakajima M. , Fujimiya M. , Kasuga M. 
Published: March 2003

Summary Aim: Previous studies have demonstrated that corticotropin‐releasing factor (CRF) produces behavioural, physiological and immunological responses similar to those induced by stress. However, these findings have been validated largely in laboratory rats. Methods: We examined the effects of intracerebroventricular (i.c.v.) administration of CRF on anxiety and food intake in mice. Using the elevated‐plus maze, we measured anxiety levels after i.c.v. CRF in mice. We also measured food intake for 2 h after i.c.v. CRF. Results: CRF increased the normal preference for the closed arms of the maze at a very low dose of 3 pmol, indicating an anxiogenic effect. CRF powerfully suppressed food intake at the doses of 3–300 pmol for over 2 h. Conclusion: Our results demonstrate that i.c.v. CRF evokes anxiogenic behaviour and suppresses feeding with the same dose–response relationships in mice. CRF may thus play a role in integrating the overall responses to stress through co‐ordinated actions in the brain of this species.
Carbohydrate depletion has profound effects on the muscle amino acid and glucose metabolism during hyperinsulinaemia
Authors: Ebeling P. , Tuominen J. A. , Laipio M. L. , Virtanen M. A. , Koivisto E. , Koivisto V. A. 
Published: March 2003

SUMMARY Aim  We investigated the effect of carbohydrate availability and euglycaemic hyperinsulinaemia on intramuscular and plasma amino acids in 14 healthy men (age 26.5 ± 0.9 years, b.m.i. 22.9 ± 0.5 kg/m2).Methods  Insulin was infused (1.5 mU/kg/min) for 240 min both after a carbohydrate depleting exercise and after carbohydrate loading. Muscle samples were taken before and after hyperinsulinaemia. Plasma and intramuscular amino acid concentrations were measured.Results  Insulin‐mediated glucose disposal was similar after carbohydrate depletion (65.2 ± 1.9 μmol/kg/min) and loading (66.9 ± 2.8 μmol/kg/min). Carbohydrate depletion was associated with decreased alanine and increased branched chain amino acid (BCAA) concentrations in muscle and plasma. Blood lactate was lower after carbohydrate depletion (477 ± 25 μmol/l) than loading (850 ± 76 μmol/l, p < 0.001). In carbohydrate depletion, hyperinsulinaemia resulted in a greater increase in intramuscular (from 927 ± 48 nmol/g muscle to 2029 ± 104 nmol/g muscle, p < 0.001), than plasma (from 197 ± 6.7 μmol/l to 267 ± 11 μmol/l, p < 0.001) alanine. After carbohydrate loading muscle alanine did not rise significantly (from 1546 ± 112 nmol/g muscle to 1781 ± 71 nmol/g muscle) whereas plasma alanine decreased (from 339 ± 26 μmol/l to 272 ± 13 μmol/l, p < 0.05).Conclusions  (1) Carbohydrate availability has profound effects on the interrelationship between glucose and amino acid metabolism and on the form of storage for glucose‐derived carbons. (2) For most amino acids changes in plasma levels of amino acids are not related to changes in concentrations of intramuscular amino acids during hyperinsulinaemia.
The effects of magnesium sulphate and EDTA in the hypercholesterolaemic rabbit
Authors: Evans D. A. Price , Tariq M. , Sujata B. , McCann G. , Sobki Samia 
Published: March 2003

SummaryNumerous clinical reports suggest the beneficial effects of chelation therapy for the treatment of atherosclerosis. However, the results of these studies are inconclusive and controversial. The purpose of this present study was to examine the prophylactic and therapeutic effects of chelation liquid (CHL) in experimental atherosclerosis. Twenty New Zealand white rabbits were fed a 1% cholesterol‐supplemented diet for 45 days. In the prophylactic phase of the study subcutaneous 300 mg EDTA + 500 mg magnesium sulphate (MgSO4) injections (five rabbits) and isotonic saline (five rabbits) were given to test and control groups, respectively, along with cholesterol rich diet. The CHL treatment ameliorated the rise of serum cholesterol and serum triglyceride concentrations, lowered serum calcium concentrations and reduced the aortic atheroma. In the therapeutic phase of the experiment the cholesterol diet was stopped and the remaining 10 animals were returned to normal diet. Five of these rabbits were given CHL injections and other five animals were given isotonic saline injections for 121 days. Although the level of cholesterol and triglyceride were not significantly different in the two groups, the serum calcium concentration and the percentage of the area of flate aortic specimen occupied by atheroma were significantly lower in the CHL treated rabbits as compared to controls. It is concluded that CHL injections have a definite prophylactic effect on atherogenesis in the cholesterol‐fed rabbit, and may have some therapeutic value in the regression phase. Further confirmatory studies are suggested.
Effects of adenovirus‐mediated liver‐selective overexpression of protein tyrosine phosphatase‐1b on insulin sensitivity in vivo
Authors: Wang J. , Cheung A. T. , Kolls J. K. , Starks W. W. , Martinez‐Hernandez A. , Dietzen D. , Bryer‐Ash M. 
Published: March 2003

Aim: Protein tyrosine phosphatase‐1B (PTP‐1B) is an intracellular PTP known to dephosphorylate and inactivate upstream tyrosine phosphoproteins in the insulin signalling cascade. We and others reported increased abundance of catalytically impaired PTP‐1B in tissue lysates from obese human subjects with and without type 2 diabetes, while genetic knockout of PTP‐1B improves insulin sensitivity and prevents nutritionally mediated insulin resistance and obesity. The aim of the present work was to further elucidate the role of PTP‐1B in glucose metabolism in vivo. Methods: We used adenoviral constructs incorporating cDNAs for either wild‐type (W/T) or a catalytically inactive C215S (C/S) mutant PTP‐1B to achieve liver‐selective PTP‐1B overexpression in young Sprague–Dawley rats using tail vein injection, based on the high degree of hepatotropism of adenovirus 5 (Ad5). An Ad5‐lacZ construct encoding β‐galactosidase was used as a control for viral effects alone. A hyperinsulinaemic euglycaemic clamp was used to study whole body glucose disposal and endogenous glucose production rates. Results: Control studies in HIRcB cells confirmed catalytic activity and inactivity of W/T and C/S respectively. Mean PTP‐1B abundance was 2.24 ± 0.02‐ and 2.33 ± 0.04‐fold of saline‐treated control in liver lysates of W/T and C/S rats respectively. Liver selective overexpression was confirmed by analysis of tissue lysates from liver, fat and muscle tissues. Ad5 treatment did not result in a statistically or clinically significant liver injury, as determined by serum alanine aminotransferase and histological examination. Seven days post injection, no significant difference in rate of weight gain, fasting blood glucose or insulin levels were seen in any group. Similarly, under steady‐state glucose clamp conditions, glucose disposal rate (Rd), endogenous glucose production rate (EGP) and serum insulin levels were similar in all groups. Conclusion: We conclude that moderate medium‐term overabundance, to a degree resembling that seen in insulin‐resistant states, of PTP‐1B in liver tissue does not alter insulin action on glucose metabolism and that the major site of action of PTP‐1B is presumably at insulin‐responsive target tissue or tissues other than the liver.