bluuebunny/crossref_metadata_2025_split huggingface dataset:
Untreatable faecal incontinence: colostomy or colostomy and proctectomy?
Authors: Catena F. , Wilkinson K. , Phillips R. K. S. 
Published: March 2003

PurposeTo determine the frequency of rectal symptoms and secondary proctectomy in patients undergoing elective permanent end sigmoid colostomy for faecal incontinence and determine risk factors.MethodsA retrospective chart review of patients undergoing elective end sigmoid colostomy for faecal incontinence at St Mark’s Hospital between January 1991 and December 1998. Patients were divided into three groups: A, symptoms leading to subsequent proctectomy; B, symptomatic but avoiding proctectomy; C, asymptomatic.ResultsThere were 44 patients (80% women, average age 57 years): Group A 12 (27%); Group B 13 (30%); Group C 19 (43%). Group A were on average younger than Group C (45 years vs 64 years, P < 0.05). No other risk factor for symptoms or proctectomy was evident, and in particular a prior history of obstructed defaecation/anal digitation was not related. Only half the patients undergoing proctectomy had histological evidence of defunctioned proctitis in the resected rectum.ConclusionsData are insufficient presently to recommend primary proctectomy in this group of patients (even if it were to be performed laparoscopically).
Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome?
Authors: Moscovitz I. , Rotholtz N. A. , Baig M. K. , Zhao R. H. , Lam D. T. Y. , Nogueras J. J. , Weiss E. G. , Singh J. J. , Wexner S. D. 
Published: March 2003

AbstractBackground  The importance of the overlapping scar in an anterior sphincteroplasty is often emphasized. The aim of this study was to identify the tissue type used in overlapping sphincter repair based upon ultrasound images, and to correlate these results with the immediate clinical outcome.Methods  Data were collected prospectively on all patients with faecal incontinence who underwent anterior overlapping sphincteroplasty between June 1998 and May 1999. Continence was assessed by a standardized incontinence score ranging from 0 to 20. Pre‐operative ultrasound images were compared to intraoperative ultrasound findings for each patient. In each case the surgeon performed an overlap of what was grossly felt to represent scar after which a single blinded observer performed intraoperative ultrasound. The degree of overlap was measured and classified as hyperechoic over hyperechoic (muscle over muscle; Type 1), hyperechoic over or under hypoechoic (muscle over or under scar; Type 2), hypoechoic over hypoechoic (scar over scar; Type 3). The patient follow‐up included incontinence score that was obtained by telephone interview; suboptimal outcome was considered as an incontinence score ≥ 6. Statistical analysis was performed using the Mann–Whitney test and Wilcoxon matched‐pairs test.Results  Fourteen female patients with a mean age of 51.6 (range 28–79) years were evaluated. The mean pre‐operative incontinence score was 17.1 (range 7–20) and 13 of the 14 (93%) patients had an incontinence score ≥ 15. All pre‐operative ultrasound images were hypoechoic which correlated with the surgeon's intraoperative findings of scar. The operative appearance included two Type 1, four Type 2, and eight Type 3 images. Larger pre‐operative ultrasound image defects were statistically significantly related to intraoperative Type 3 ultrasound images. At a mean follow up of 7.5 (range 2–16) months the mean postoperative incontinence score was 4.5 (range 0–12). In patients with Type 1 and Type 2 images, the mean postoperative score was 8.6 (range 4–12) whereas in patients with Type 3 it was 1.3 (range 0–5) (P < 0.003); 7 of the 8 patients in Type 3 (87.5%) had an incontinence score ≤ 2.Conclusion  These preliminary results show a significant immediate benefit to the overlap of scar over scar, however, such overlapping may not always be achieved despite the surgeon's intent. Furthermore, larger pre‐operative defects may predispose to more extensive anterior scarring and thus a better chance of achieving this desired overlap.
Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel
Authors: Loffeld R. J. L. F. , Van Der Putten A. B. M. M. 
Published: March 2003

ObjectiveTo study the prevalence of diverticula and presence of concomitant pathology in consecutive patients undergoing endoscopic examination of the colon.MethodsA cross‐sectional analysis of the endoscopy reports of all patients sent for endoscopic evaluation of the colon in a period of 8.5 years.ResultsA total of 9086 endoscopies were performed. Of these 2259 (24.7%) were undertaken for follow‐up. Diverticula were seen in 1849 patients (27%) (739 male, 1110 female, mean age 69 year). In 4978 patients (73%)(2162 male, 2816 female, mean age 52 year) no diverticula were seen, of these 2303 (46%) had no abnormalities in their colon. Patients with diverticula were significantly older, 69 vs 46.7 years (P < 0.001). No difference was present in gender. Colorectal cancer and inflammatory bowel disease were significantly more common in patients without diverticula, while polyps were more often seen in patient with diverticula. Patients with diverticula had a significantly lower incidence of colorectal cancer. In addition, the number of cancers located proximal to the splenic flexure was statistically higher in the group of patients presenting with diverticula (P < 0.001).ConclusionsThe overall prevalence of diverticular disease in patients undergoing endoscopy is 27%, and increases with age. Patients with diverticulosis have significantly lower incidence of colorectal cancer and if cancer is detected then it is more common proximal to the splenic flexure.
Safety of the temporary loop ileostomy
Authors: Hallböök O. , Matthiessen P. , Leinsköld T. , Nyström P.‐O. , Sjödahl R. 
Published: March 2003

AbstractObjective To evaluate the complications of the temporary loop ileostomy.Method A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch‐anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow‐up period of 15 months.Results Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re‐operation was done due to small bowel obstruction (n = 5) or intra‐abdominal abscess (n = 2). Elective re‐operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra‐abdominal sepsis and heart failure.Conclusion In this series closure of the ostomy wasassociated with one death (0.5%) and overall ostomy‐related morbidity included the need to re‐operate in 6%.
Effects of antihyperglycaemic therapies on proinsulin and relation between proinsulin and cardiovascular risk factors in type 2 diabetes
Authors: Hermann L. S. , Ranstam J. , Vaaler S. , Melander A. 
Published: March 2003

Summary Aim: To assess the effect of oral antihyperglycaemic therapy on fasting proinsulin and the relation between proinsulin levels and cardiovascular risk factors in type 2 diabetes. Methods: One hundred and sixty‐five patients with type 2 diabetes, fasting blood glucose concentration (FBG) ≥ 6.7 mmol/l, were recruited from five diabetes outpatient clinics in primary health care. Diet and antihyperglycaemic medication, aiming at FBG <6.7 mmol/l, was maintained for 6 months after completed dose titration in a randomized, double‐blind, double‐dummy trial with metformin (M), glibenclamide (G) and primary combination of both drugs (MG). The study compared M, G and MG in low dose (MGL) and also different high‐dose regimens, i.e. G added to M (M/G), M added to G (G/M) and primary combination (MGH). Outcome measures were fasting proinsulin, glycaemia, body mass index, blood pressure, lipids, insulin and C‐peptide. Results: Lower proinsulin levels were found when therapy was initiated with metformin (M vs. G, p = 0.013 and M/G vs. G/M, p = 0.033). M and G were equally effective on glucose levels. In the group as a whole FBG decreased from (mean ± s.d.) 10.2 ± 2.7 to 7.0 ± 1.2 mmol/l with no change in proinsulin. Proinsulin was associated with cardiovascular risk factors, linking high proinsulin to an atherogenic risk marker profile. Mean proinsulin change from baseline was inconsistently associated with markers of insulin resistance. Meal‐stimulated glucose (net AUC) decreased after treatment only in those with low baseline proinsulin levels. Conclusion: It may be advantageous to initiate oral antihyperglycaemic therapy with metformin rather than with sulphonylurea. High proinsulin levels are associated with an atherogenic‐risk marker profile and an impaired therapeutic postprandial glucose response after treatment in patients with type 2 diabetes. Proinsulin change after therapy is inconsistently associated with markers of insulin resistance and unrelated to fasting blood glucose reduction.
A new air displacement plethysmograph for the determination of Japanese body composition
Authors: Miyatake N. , Nonaka K. , Fujii M. 
Published: March 2003

SummaryA new device based on the plethysmographic measurement of body volume, named the BOD POD Body Composition System, was developed for the purpose of estimating body composition. The performance, reliability, validity, and clinical application of this system were evaluated in Japanese subjects. The coefficient variation (CV:%) in same‐day tests was 2.48, in three separate‐day tests it was 2.27, and for independent operators it was 4.53, respectively. There was a clear correlation between the results from BOD POD and those from dual energy X‐ray absorptiometry (DEXA) (r = 0.910, p < 0.01). Finally, the fat body composition of 4489 subjects (1499 men, 2990 women) was clinically measured by BOD POD. The findings indicate that the BOD POD is a highly reliable and valid method for determining body fat percentage. This new method has several advantages, e.g. it is quick, simple to operate and may accommodate wide populations.
The association between insulin resistance and endotheliopathy
Authors: Tooke J. 
Published: March 2003

SummarySummary. Vascular endothelium is involved in the regulation of vascular tone, vessel permeability, and angiogenesis. Vessel tone is determined by the balance of various paracrine vasodilatory and vasoconstrictor factors, most notably nitric oxide (NO) and endothelin‐1. Not surprisingly, endothelial dysfunction is believed to be crucial in the development of the chronic vascular complications of diabetes.Endothelial dysfunction, which may be examined by studying endothelial‐dependent vasodilatation in humans, is also disturbed by many of the individual features of the insulin resistance syndrome including hypertension, dyslipidaemia, and hyperglycaemia. Therefore, it may be possible that endothelial dysfunction could be closely associated with, or even a common antecedent of, the insulin resistance syndrome (IRS). There is emerging evidence that impaired endothelial‐dependent vasodilatation is present in populations at future risk of diabetes and even in children of low birth weight, who may exhibit features of the insulin resistance syndrome in later life.Endothelial dysfunction is an obvious therapeutic target if the vascular pathology associated with insulin resistance and type 2 diabetes is to be ameliorated.
Disturbed release of gastrointestinal peptides in anorexia nervosa and in obesity
Authors: Baranowska B. , Radzikowska M. , Wasilewska‐Dziubinska E. , Roguski K. , Borowiec M. 
Published: March 2003

Summary Aim: It is commonly accepted that some neuropeptides play an important role in the control of appetite and hormonal secretion. Several gastrointestinal peptides may affect on central control of appetite via vagal and spinal nerves. The aim of this study was to evaluate the release of gastrointestinal peptides in anorexia nervosa and in obesity, because in these diseases the disturbances in the control of appetite and hormonal secretion were found. Material consisted of 30 women with anorexia nervosa aged 16–29 years (mean 22 years) and 23 women with obesity aged 19–33 years (mean 29 years) and 25 lean women of control group. Methods: In women with anorexia nervosa as compared with control group we observed a significant increase of plasma vasoactive intestinal peptide (VIP) levels (p < 0.0 1) and a significant decrease of leptin (p < 0.001), β‐endorphin (p >< 0.01), gastrin (p < 0.05), cholecystokinin (CCK; p < 0.05) and somatostatin (S‐S; p < 0.01). In obese women we found a significant increase of neuropeptide Y (NPY; p < 0.001), leptin (p> < 0.01), galanin (p < 0.001), β‐endorphin (p < 0.001), gastrin (p < 0.01), CCK (p < 0.001) and S‐S (p < 0.01) and a significant decrease of VIP concentrations (p < 0.001) as compared with control group. Conclusion: Our results indicate that the release of gastrointestinal peptides is disturbed in obesity and in anorexia nervosa. These findings suggests that dysfunction of brain–gut axis may be also an important factor in the abnormal control of appetite axcept of hypothalamic dysfunction.
Effect of four‐week metformin treatment on plasma and erythrocyte antioxidative defense enzymes in newly diagnosed obese patients with type 2 diabetes
Authors: Pavlović D. , Kocić R. , Kocić G. , Jevtović T. , Radenković S. , Mikić D. , Stojanović M. , Djordjević P. B. 
Published: March 2003

SummaryThe principal metabolic effect of metformin–an oral antihyperglycaemic agent–is the improvement in the sensitivity of peripheral tissues and liver to insulin. This study examined the effect of metformin monotherapy on antioxidative defence system activity in erythrocytes and plasma in diabetic patients. We studied the effect of metformin treatment on the activities of Cu, Zn‐superoxide dismutase (EC 1. 15. 1. 1.), catalase (EC 1. 11. 1. 6.) and glutathione peroxidase (EC 1. 11. 1. 9.) in relation to lipid peroxidation products and reduced glutathione level in plasma and erythrocytes. In this study we also examined erythrocytes' susceptibility to H2O2‐induced oxidative stress during metformin therapy. Although metformin monotherapy ameliorated the imbalance between free radical‐induced increase in lipid peroxidation (by reducing the MDA level in both erythrocytes and plasma) and decreased plasma and cellular antioxidant defences (by increasing the erythrocyte activities of Cu, Zn, SOD, catalase and GSH level) and decreased erythrocyte susceptibility to oxidative stress, it had negligible effect to scavenge Fe ion‐induced free radical generation in a phospholipid‐liposome system.
Effects of chronic treatment with acarbose on glucose and lipid metabolism in obese diabetic Wistar rats
Authors: Carrascosa J. M. , Molero J. C. , Fermín Y. , Martínez C. , Andrés A. , Satrústegui J. 
Published: March 2003

SummaryAims  The effect of chronic treatment with acarbose on fasting plasma glucose, insulin, triglyceride, cholesterol and free fatty acid (FFA) concentrations, as well as on the glucose and insulin excursions during oral glucose tolerance test (OGTT), in obese diabetic Wistar (WDF) rats was investigated.Methods  Forty‐five mature male WDF rats were randomly distributed to one of the three treatment groups (no acarbose, 20 mg and 40 mg of acarbose/100 g of chow, respectively). After 3.5, 7.5 and 11.5 months, animals were tested for glucose tolerance by means of an OGTT, and their respective metabolic profiles were determined. Control determinations were done in obese and age‐matched lean animals before the start of the trial.Results  The WDF rats exhibit higher body weight and fasting blood glucose, insulin, triglyceride and cholesterol concentrations compared to lean animals. Moreover, they show marked glucose intolerance as indicated by the glucose and insulin excursions during OGTT. Interestingly, in both treated and untreated animals, a reversion of the hyperglycaemic state as well as an improvement of the glucose tolerance is observed. However, whereas in the group receiving no acarbose this is accounted for by dramatic increases in fasting plasma insulin concentrations and insulin secretion during OGTT (as indicated by the ΔInsulin area), in rats treated with acarbose the reversion of the diabetic state takes place without increments in hormone concentration. In addition, rats treated with acarbose for 3.5 and 7.5 months show lower plasma triglyceride and FFA concentrations, and the same was observed for cholesterol at the highest dosage of the drug.Conclusions  Chronic treatment with acarbose of WDF rats improves the glycaemic and lipidic control as well as the glucose tolerance, with a lower demand of pancreatic insulin than in untreated rats. This data suggests that the long‐term modulation of glucose and insulin excursions after meals improves the insulin sensitivity in this rat strain.
Dyslipidaemia in African Americans, Hispanics and Whites with type 2 diabetes mellitus and hypertension
Authors: Sharma M. D , Pavlik V. N 
Published: March 2003

Summary AimTo study the pattern of dyslipidaemia in African American, Hispanic, and White patients with type 2 diabetes mellitus and/or hypertension.MethodsThe data were collected retrospectively on 6450 patients followed in the Harris County Hospital District Community Clinics. The information collected from review of the charts included each patient's age, sex, race, body mass index (b.m.i.), duration of type 2 diabetes mellitus and hypertension, medications, fasting plasma glucose, haemoglobin A1c, and fasting lipid profile. Mean lipid and haemoglobin A1c levels in the three ethnic groups were compared. The risk of abnormal cholesterol and triglyceride levels was assessed with logistic regression analysis.ResultsThe results show that in patients with type 2 diabetes mellitus after correcting for age, sex and b.m.i., African Americans have the lowest serum triglyceride concentrations and Whites have the highest values. This trend holds true even in patients with hypertension and in patients with both hypertension and type 2 diabetes mellitus. The risk of having abnormal triglycerides is 74% lower in African Americans, and 42% lower in Hispanics than Whites based on logistic regression model. Despite better glycaemic control, Whites have a greater increase in serum triglyceride concentrations than Hispanics and African Americans.ConclusionsAlthough African Americans are known to be at higher risk for cardiovascular complications than Whites or Hispanics, they appear to have lower triglyceride concentrations than Whites or Hispanics in the presence of type 2 diabetes mellitus. This suggests that an increased prevalence of other adverse factors must contribute to their heightened cardiovascular risk.
Hormone replacement therapy for postmenopausal women with diabetes
Authors: Palin S. L. , Kumar S. , Sturdee D. W. , Barnett A. H. 
Published: March 2003

SUMMARY Background  Recent studies have shown only 17% of postmenopausal women in the UK receive prescriptions for hormone replacement therapy (HRT), with diabetic women being prescribed HRT 30% less often than non‐diabetic women. Up to 80% of women experience menopausal symptoms, however, so it is expected that by using HRT many would gain benefit from symptom relief, in addition to benefiting from its effects in disease prophylaxis.Methods  We conducted a questionnaire survey of the attitudes to HRT prescribing of 178 local general practitioners (GPs) and 47 hospital doctors, working in diabetes and gynaecology.Results  Responses were received from 98 (55%) GPs and 39 (83%) hospital doctors. One hundred and thirty‐six (99%) would advise HRT for menopausal symptoms, with 133 (97%) advising HRT for a spontaneous premature menopause and 126 (92%) for a surgically induced menopause. One hundred and thirty‐four (98%) would advise HRT for diabetic women with menopausal symptoms, with 122 (89%) indicating that HRT had no adverse effect on glycaemic control. For disease prophylaxis, all hospital doctors and 93 (95%) GPs would advise HRT for prevention of osteoporosis, although only 91 (93%) GPs would advise HRT to diabetic women for this indication. Thirty‐three (85%) hospital doctors would advise HRT as prophylaxis against cardiovascular disease compared with 66 (67%) of GPs. For this indication in diabetic women, 32 (82%) hospital doctors and 67 (68%) GPs would advise HRT. Oral HRT was the most widely recommended preparation although GPs also frequently recommended patches. Topical gel, implants and other preparations were less commonly advised. Hospital doctors predominantly advised HRT for menopausal symptoms to be continued for between 1 and 5 years, although more GPs recommended HRT to be continued for longer than 5 years. The majority of doctors from both groups advised that HRT used for disease prophylaxis be continued for more than 5 years.Conclusion  More doctors than anticipated indicated they would recommend HRT, especially to diabetic women. Concerns among doctors about the side‐effects of HRT and, in particular, the metabolic effects of HRT, do not appear to deter them from advising HRT. Willingness to prescribe a drug, however, is different from actually prescribing it and responses to questionnaires tend to be those regarded as being acceptable. Low patient demand for HRT due to fear or lack of awareness may also be contributing. Organizational change with the development of more menopause clinics may facilitate wider use of HRT.
Comparative accuracy of cardiovascular risk prediction methods in patients with diabetes mellitus
Authors: Game F. L. , Bartlett W. A. , Bayly G. R. , Jones A. F. 
Published: March 2003

SUMMARY Objective  To compare the accuracy of cardiovascular risk prediction methods based on equations derived from the Framingham Heart Study in a cohort of patients with diabetes mellitus.Research design and methods  Risk factor data was collected prospectively from 906 patients with diabetes mellitus. Absolute cardiovascular risks were calculated using the Framingham equation, and estimated with the currently available Framingham‐based risk tables and charts. The sensitivity, specificity, positive and negative predictive values of the tables and charts to assess cardiovascular risk were assessed using calculation of risk from the full Framingham equation as the reference method.Results  In all, 146 subjects (16.1%) had calculated 10‐year coronary heart disease (CHD) risks ≥ 30%, and 585 (64.6%) had risks ≥ 15%. For identification of those at 10‐year CHD risk ≥ 30%, the original Sheffield tables had a sensitivity of 43% (95% confidence intervals (CI) 19.9–61.7%) and specificity of 94% (CI 90.8–96.7%). Modifications of the Sheffield tables improve sensitivity (95% CI 93.9–97%) but reduce specificity (90% CI 85.6–95.7%). The Joint British Guidelines' charts have a moderate sensitivity (69.5% CI 51.8–81.9%) and high specificity (99.7% CI 98.9–100%). For identification of individuals at a 10‐year CHD risk ≥ 27%, the Framingham categorical tables had a sensitivity of 95% (CI 91.6–97.8%), but a specificity of only 83% (95% CI 79.1–85.5%).Conclusions  The Joint British charts appear to have the best performance in a cohort of patients with diabetes mellitus, however, calculation of CHD/CVD (cardiovascular disease) risks with personal or laboratory computers using the full Framingham equation remains the most accurate way to assess cardiovascular risk in a primary prevention setting.