bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications and functional outcome following artificial anal sphincter implantation
Authors: Ortiz H , Armendariz P , DeMiguel M , Ruiz M D , Alós R , Roig J V 
Published: March 2003

Abstract

Background
The postoperative complications and functional outcome following 24 consecutive implantations of an artificial anal sphincter were assessed prospectively.

Methods
A total of 24 artificial anal sphincters (Acticon Neosphincter®) were implanted in 22 patients (mean age 47 years). The mean follow-up period was 28 (range 6–48) months. Results were assessed prospectively by two independent observers at 4-month intervals. The cumulative probability of artificial anal sphincter removal was analysed by the Kaplan–Meier method.

Results
Five patients were free of complications. During the postoperative period, complications occurred in nine patients, two of whom required reoperation. During follow-up, complications developed in ten patients, nine of whom were reoperated. Definitive device explantation was necessary in seven patients. The cumulative probability of device explantation was 44 per cent at 48 months. The 15 patients with functioning implants were followed up for a mean of 26 (range 7–48) months. Continence grading improved from a mean of 18 (range 14–20) in the preoperative period to 4 (range 0–14) after operation (P &lt; 0·001). Resting anal canal pressure in patients with a functioning implant increased from a mean of 35 (range 8–87) mmHg before operation to 54 (range 34–70) mmHg after implantation (P &lt; 0·01).

Conclusion
An artificial anal sphincter is a useful alternative for refractory faecal incontinence but the incidence of late postoperative complications is high.
Prospective multicentre study of the natural history of atherosclerotic renal artery stenosis in patients with peripheral vascular disease
Authors: Pillay W R , Kan Y M , Crinnion J N , Wolfe J H N 
Published: March 2003

Abstract

Background
Many patients with peripheral vascular disease have coincident renal artery stenosis. The present study characterized the natural history of the condition.

Methods
Some 98 patients (71 men) with more than 50 per cent atherosclerotic renal artery stenosis (unilateral 64, bilateral 34) were recruited prospectively. Measurements of serum creatinine, blood pressure and renal size were recorded at baseline and every 6 months, for a minimum of 2 years.

Results
Data were available for 85 patients with a minimum follow-up of 2 years. The mean age was 71 (range 51–87) years. All 52 patients with unilateral renal artery stenosis were managed conservatively (group 1); 21 of the 33 patients with bilateral disease had no intervention (group 2) and the remaining 12 had angioplasty or reconstruction (group 3). The overall mortality rate was 32 per cent at 2 years (27 patients) and this was similar in all three groups. In only three patients was death related directly to renovascular disease; coronary disease accounted for the majority of deaths. All three patients who needed dialysis died within 1 year. In survivors from groups 1 and 3 there was a significant increase in serum creatinine concentration at follow-up. Blood pressure did not increase significantly.

Conclusion
Patients with renal artery stenosis and peripheral vascular disease had a poor prognosis, but this was not directly attributable to renal failure.
Laparoscopic transperitoneal procedure for routine repair of groin hernia
Authors: Bittner R , Schmedt C-G , Schwarz J , Kraft K , Leibl B J 
Published: March 2003

Abstract

Background
Laparoscopic transperitoneal hernioplasty (TAPP) repair of inguinal hernias is thought to be a difficult surgical technique with high complication rates. The present study evaluated TAPP based on prospective documentation.

Methods
The primary aim of the study was analysis of the individual learning curve, comparing consultants with trainees. Secondary endpoints included postoperative morbidity, time of disability and rate of recurrence.

Results
A total of 8050 TAPP repairs have been performed since 1993. By 2001, 99·9 per cent of all hernia repairs were done by TAPP. The median operation time dropped from 50 min in the first 600 cases to 42 min thereafter. The morbidity rate decreased from 9·3 to 2·6 per cent, and the rate of recurrence from 4·8 to 0·4 per cent. Within the same interval the proportion of training procedures increased from 1·7 to 44·9 per cent in 2001. Morbidity and recurrence rates were similar for trainees and consultants.

Conclusion
TAPP is an effective and safe technique. It can be performed in a standard way for all inguinal and femoral hernias. The present results indicate that TAPP is possible in a routine setting, as well as in the training situation for young surgeons.
Enhanced antitumour efficacy by combining conventional chemotherapy with angiostatin or endostatin in a liver metastasis model
Authors: te Velde E A , Vogten J M , Gebbink M F G B , van Gorp J M , Voest E E , Borel Rinkes I H M 
Published: March 2003

Abstract

Background
Tumour-induced microvascular networks have become attractive targets in cancer therapy. Strategies that target both tumour cells and vasculature have not been investigated in models of early metastatic colorectal disease. The efficacy of a combination of conventional chemotherapy with a potent angiogenesis inhibitor (endostatin or angiostatin) in a murine model of early colorectal liver metastasis was studied.

Methods
Sixty-six mice were subjected to intrasplenic injection of C26 tumour cells to induce colorectal liver metastases. Control animals received phosphate-buffered saline (n = 8) or citrate buffer (n = 8). Treatment included conventional chemotherapy (n = 9), endostatin (n = 8), high-dose (n = 5) or low-dose (one-tenth of optimal dose; n = 10) angiostatin, as well as the combination of either of these drugs with chemotherapy (n &gt; 5). Clinical appearance was scored daily using a semiquantitative scale. Liver weight, macroscopic and histological tumour involvement (hepatic replacement area; HRA) were measured upon death at day 12.

Results
Treated mice displayed significantly better clinical scores than controls, except for those animals treated with low-dose angiostatin with or without chemotherapy. Treatment with conventional chemotherapy resulted in a decrease in HRA from 42·3 to 29·1 per cent (P &lt; 0·001). The addition of angiostatin or endostatin to conventional chemotherapy improved antitumoral efficacy, in a multiplicative manner, resulting in a HRA of approximately 3·5 per cent (P &lt; 0·001).

Conclusion
The addition of angiostatin or endostatin to conventional chemotherapy enhanced antitumoral efficacy in a murine model of early colorectal liver metastasis.
Surgical management of and long-term survival after adenocarcinoma of the cardia
Authors: Mariette C , Castel B , Toursel H , Fabre S , Balon J M , Triboulet J-P 
Published: March 2003

AbstractBackgroundThe choice of surgical strategy for patients with adenocarcinoma of the oesophagogastric junction is controversial. This study was performed to analyse the surgical results of a 20-year experience with these lesions.MethodsFrom January 1981 to January 2001, 126 patients with adenocarcinoma of the cardia underwent resection in the authors' institution. The treatment of choice was oesophagectomy for type I tumours, and extended gastrectomy for type II and III lesions. Morbidity, mortality and survival were determined retrospectively.ResultsFifty-six patients (44·4 per cent) had type I tumours, 44 (34·9 per cent) type II and 26 (20·6 per cent) type III. Primary resection was performed in 113 patients (89·7 per cent). Oesophagectomy with resection of the proximal stomach was carried out in 65 patients (51·6 per cent) and extended total gastrectomy with transhiatal resection of the distal oesophagus in 61 (48·4 per cent). In-hospital mortality and morbidity rates were 4·8 and 34·1 per cent respectively. The overall 3- and 5-year survival rates were 40·9 and 25·1 per cent respectively, and were not affected by the surgical approach. Survival was significantly associated with R0 resection, pathological node-positive category, postoperative complications and tumour differentiation.ConclusionPostoperative mortality, morbidity and long-term survival did not appear to be affected by surgical approach. Further prospective studies are needed to confirm the equivalence between transthoracic and transabdominal approaches.
Acute colonic diverticulitis in patients under 50 years of age
Authors: Biondo S , Parés D , Martí Ragué J , Kreisler E , Fraccalvieri D , Jaurrieta E 
Published: March 2003

Abstract

Background
There is ongoing controversy concerning the virulence and management of diverticulitis in young patients. This study reports on the management of acute diverticulitis with reference to the virulence and outcome of the disease with respect to age.

Methods
Between January 1994 and June 1999, 327 patients were treated for acute left colonic diverticulitis. Patients were divided in two groups: those aged 50 years or less (group 1, 72 patients) and those older than 50 years (group 2, 255 patients). The diagnosis was confirmed histologically or radiologically in all patients.

Results
There were differences in gender distribution related to age (P &lt; 0·001). During the first hospital stay, 226 patients (69·1 per cent) had successful conservative treatment, 78 (23·9 per cent) needed emergency surgery and 23 (7·0 per cent) had a semielective operation (P = 0·47). The recurrence rate was 25·5 per cent in group 1 and 22·3 per cent in group 2 (P = 0·93). The type of surgical procedure and grade of peritonitis in emergency patients were similar in the two groups. Overall the mortality rate in patients who underwent an operation was 16·3 per cent. The mortality rate was zero in group 1 and 2·2 per cent in group 2 after elective or semielective operation (P = 1·0), and zero in group 1 and 34·9 per cent in group 2 after emergency operation (P &lt; 0·001).

Conclusion
Diverticulitis in young patients does not have a particularly aggressive course and the risk of recurrence is similar to that of older patients.
Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism
Authors: Sywak M , Pasieka J L 
Published: March 2003

Abstract

Background
The purpose of this study was to evaluate the long-term efficacy of adrenalectomy on blood pressure control in patients with primary hyperaldosteronism (HA), and to analyse the cost of adrenalectomy compared with non-surgical management of HA over the patient's lifetime.

Methods
All patients who underwent an adrenalectomy for HA were recalled to the endocrine surgical clinic. Data gathered included blood pressure, aldosterone: renin ratios and medication. Total costs for adrenalectomy and ongoing medications were compared with the estimated costs of lifelong medical therapy alone.

Results
Twenty-four adrenalectomies were performed for HA, with one death. The mean follow-up was 42 (range 13–97) months. Long term, there was a significant decrease in both the mean diastolic and systolic blood pressure. The aldosterone: renin ratio decreased in 21 patients. Of these patients, 20 were either off all antihypertensives (eight) or had a reduction in medication (12). An increased aldosterone: renin ratio occurred in two patients, both of whom required an increase in antihypertensive medication. Using the predicted life expectancy, the mean estimated cost savings over the lifetime of each patient undergoing adrenalectomy compared with medication alone was Canadian $31 132.

Conclusion
Adrenalectomy for HA resulted in significant long-term reduction in blood pressure. Adrenalectomy for HA is a significantly less expensive than long-term medical therapy alone.
A 10-year experience of complex liver trauma
Authors: Brammer R D , Bramhall S R , Mirza D F , Mayer A D , McMaster P , Buckels J A C 
Published: March 2003

AbstractBackgroundLiver trauma is a relatively rare surgical emergency but mortality and morbidity rates remain significant. It is likely that surgeons outside specialist centres will have limited experience in its management; therefore best practice should be identified and a specialist approach developed.MethodsData collected from 52 consecutive patients over a 10-year interval were examined to identify best practice in the management of these injuries.ResultsThe majority of injuries occurred as a result of road traffic accidents; 39 (75 per cent) of the 52 patients were stable at presentation to the referring hospital. In 36 patients (69 per cent) the liver injury was a component of multiple trauma. Ultrasonography, computed tomography or no radiological investigation was used in the referring hospital in 18 (35 per cent), 25 (48 per cent) and nine (17 per cent) patients respectively. Operative management was undertaken in the referring hospital in 26 patients (50 per cent). The overall mortality rate was 23 per cent (12 of 52 patients), and increased with increasing grade of severity. Eight of 26 patients managed surgically at the referring hospital died, compared with four of the 26 patients managed without operation (P not significant). The median time from arrival at the referring hospital to operation was 4 h for haemodynamically stable patients and 3 h for those who were haemodynamically unstable.ConclusionMost patients with liver trauma can be managed conservatively. Operative management carried out in non-specialized units is associated with high mortality and morbidity rates. Abdominal injuries should raise a high index of suspicion of liver injury, and the data suggest that computed tomography of the abdomen should precede laparotomy (even in some haemodynamically unstable patients) to facilitate discussion with a specialist unit at the earliest opportunity.
Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer
Authors: Quah H M , Jayne D G , Eu K W , Seow-Choen F 
Published: March 2003

Abstract

Background
Bladder and sexual dysfunction, secondary to pelvic nerve injury, are recognized complications of rectal resection. This study investigated the frequency of these complications following laparoscopically assisted and conventional open mesorectal resection for cancer.

Methods
A total of 170 patients with rectal cancer was identified from a previous randomized trial of laparoscopic versus open resection. A retrospective analysis of bladder and sexual function before and after operation was performed by means of postal questionnaires and telephone interviews.

Results
At the time of the study, 111 (65 per cent) of the 170 patients were alive, of whom 80 (72 per cent) responded. Of the responders, 40 patients had undergone laparoscopically assisted resection and 40 had had an open operation. No significant deterioration in bladder function following operation was observed, although two patients in the laparoscopic group required long-term intermittent self-catheterization. A significant difference in male, but not female, sexual function was noted, with seven of 15 sexually active men in the laparoscopic group reporting impotence or impaired ejaculation, compared with only one of 22 patients having an open operation (P = 0·004). All patients with bladder or sexual dysfunction in the laparoscopic group had resection of either bulky or low rectal cancers.

Conclusion
Laparoscopically assisted rectal resection is associated with a higher rate of male sexual dysfunction, but not bladder dysfunction, compared with the open approach. This has implications, particularly for sexually active males with bulky or low rectal cancers, when deciding the best operative approach.
Benefit of operative mortality reduction on colorectal cancer survival
Authors: Mitry E , Bouvier A-M , Esteve J , Faivre J 
Published: March 2003

Abstract

Background
The aim of this study was to determine trends in operative mortality after colorectal cancer surgery over a 20-year period in a well defined population, and consequences on overall survival.

Methods
Some 4745 new cases of colorectal adenocarcinoma were registered between 1976 and 1995 in a French region containing 500 000 people. Among these, 84·3 per cent were operated on, of whom 78·1 per cent were resected.

Results
The overall operative mortality rate decreased from 17·7 to 8·1 per cent between 1976–1979 and 1992–1995. Corresponding rates after curative surgery were 12·6 and 6·2 per cent respectively. Period of diagnosis, age and subsite were factors independently associated with operative mortality. Applying the operative mortality rates for the interval 1976–1979 to the 1992–1995 cohort, the expected 5-year survival rate after curative surgery would have been 40·0 per cent, compared with an observed rate of 51·0 per cent. This corresponds to a 27·5 per cent improvement in 5-year overall survival. Applying this result to the French population as a whole, it was estimated that almost 3000 deaths are avoided each year in France as a result of the reduction in operative mortality.

Conclusion
Operative mortality decreased dramatically over the 20 years of the study. It was associated with a significant improvement in survival after surgery for cure.
Allopurinol and superoxide dismutase protect against leucocyte–endothelium interactions in a novel model of colonic ischaemia–reperfusion
Authors: Riaz A A , Wan M X , Schäfer T , Dawson P , Menger M D , Jeppsson B , Thorlacius H 
Published: March 2003

AbstractBackgroundLeucocyte recruitment is a key feature in ischaemia–reperfusion (I/R)-triggered tissue injury. However, the mechanisms underlying leucocyte–endothelium interactions in the large bowel remain elusive because of a previous lack of models to examine the colonic microcirculation. The aim of this study was to develop and validate a novel method for studying reperfusion-induced leucocyte–endothelium interactions in the colon.MethodsThe superior mesenteric artery was occluded for 30 min in male C57/Bl6 mice and leucocyte responses were analysed in colonic venules after 30–240 min of reperfusion. Analysis of leucocyte rolling and adhesion in colonic venules was made possible by an inverted approach using intravital fluorescence microscopy.ResultsThirty minutes of ischaemia and 120 min of reperfusion induced the strongest and most reproducible increase in leucocyte rolling and adhesion. This was associated with a significant increase in colonic levels of malondialdehyde (MDA). Administration of allopurinol and superoxide dismutase reduced I/R-induced leucocyte responses in a dose-dependent manner. Pretreatment with allopurinol attenuated the tissue content MDA in the colon by more than 60 per cent.ConclusionA new method for examining I/R-induced leucocyte responses in the colonic microcirculation is described. Oxygen free radicals play an important role in triggering leucocyte rolling and adhesion in colonic venules.
CP27 affects viability, proliferation, attachment and gene expression in embryonic fibroblasts
Authors: Luan X. , Diekwisch T. G. H. 
Published: March 2003

Abstract. CP27 is a gene that has been cloned from an E11 early embryonic library and has been suggested to mediate early organogenesis (Diekwisch et al., 1999, Gene 235, 19). We have hypothesized that CP27 exhibits its effects on organogenesis by affecting individual cell function. Based on the CP27 expression pattern we have selected the CP27 expressing embryonic fibroblast cell line BALB/c 3T3 to determine the effects of CP27 on cell function. CP27 loss of function strategies were performed by adding 5, 12.5 or 25 µg/ml anti‐CP27 antibody to cultured BALB/c 3T3 cells and comparing the results to controls in which identical concentrations of rabbit serum were added to the culture medium. Other controls included an antibody against another extracellular matrix protein amelogenin (negative control) and anti‐CP27 antibodies directed against other areas of the CP27 molecule (positive control). Following cell culture, cell viability, apoptosis, cell proliferation, cell shape, cellular attachment and fibronectin matrix production were assayed using MTT colourimetric assay, BrdU staining, morphometry, immunostaining and western blot analysis. Block of CP27 function using an antibody strategy resulted in the following significant changes: (i) reduced viability, (ii) increased number of apoptotic cells, (iii) reduced proliferation, (iv) alterations in cell shape, (v) loss of attachment, and (vi) reduction in fibronectin matrix production. There was also a redistribution in fibronectin matrix organization demonstrated by immunohistochemistry. We conclude that CP27 plays an important role in the maintance of normal cell function and that CP27 block leads to significant changes in cellular behaviour.
Developing creative solutions to the problems of children and their families: communicative reason and the use of forum theatre
Authors: Houston Stan , Magill Tom , McCollum Mark , Spratt Trevor 
Published: March 2003

ABSTRACTThe paper represents a further development of work previously reported in this journal by Spratt & Houston (1999) and Spratt et al. (2000). The authors have sought to develop ways of understanding current social work with children and families in line with the critical theory of Jurgen Habermas. This analysis has been complemented by an adoption of the methodology of the radical dramatist, Augusto Boal. In synthesizing Habermas's analysis of communicative discourses with the consciousness raising methodology of Boal, the authors have already demonstrated the effectiveness of this hybrid in problem‐solving exercises with social workers. The present paper reports on an application of this developing theory to practice, utilizing the centrepiece of Boal's method, forum theatre. A forum theatre project, concerned with the issue of bullying, is described and evaluated. It is argued that the project provides an exemplar of an innovative, democratizing and effective methodology that might profitably be utilized in social work with children and families. Finally, suggestions are made as to how these ideas could be developed in practice.
Community‐based early intervention: The Coimbra Project (Portugal)
Authors: Boavida J , Espe‐Sherwindt M , Borges L 
Published: March 2003

SummaryThe Coimbra Early Intervention Project was undertaken to develop the first co‐ordinated, multidisciplinary, interagency programme involving health care, education and social services, using existing resources in the community. The programme operates region wide and supports annually about 160 families and children with disabilities or at risk. Thirty‐three per cent of the 601 children served so far had developmental delay, 22% belonged to high‐risk families and 45% had risk factors and disabilities. In spite of difficulties, the programme success has increased awareness of the need to integrate and co‐ordinate multiple community services and to develop legislation for the provision of early intervention services.