bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring the importance of attributes that influence consumer attitudes to colorectal cancer screening
Authors: Salkeld Glenn P. , Solomon Michael J. , Short Leonie , Ward Jeanette
Published: December 2004

Background:  The aim of the present study was to rate the importance of attributes of screening for bowel cancer.

Method:  Randomly selected households in central Sydney were contacted to identify men and women aged 50−70 years who were then asked to complete a self‐administered questionnaire about bowel cancer screening and related issues. Seven hundred and ninety‐one residents (362 men and 429 women) returned questionnaires. Respondents were asked to rate the extent to which each of 34 attributes would encourage them to participate in bowel cancer screening.

Results:  The three most highly rated attributes were: if the test was recommended by their general practitioner (GP; 94% either ‘strongly agreed’ or ‘agreed’); if the test identified early cancers (92%); and if the test would avert a premature death due to bowel cancer (90%). Having a friend or relative with bowel cancer (61%), advertising (41%) or famous people promoting the program (62%) were less influential. Respondents who were unemployed or on a pension were less likely to participate in screening than those who were employed if there was an ‘out of pocket’ charge of $15.00 (χ2 = 7.56, 2df, P = 0.006). Respondents with higher levels of education were significantly more concerned than respondents with lower levels of education about test accuracy (χ2 = 15.76, 2df, P < 0.001), its availability from their local chemist (χ2 = 16.96, 2df, P < 0.001), being able to return the test kit by post (χ2 = 21.9, 2df, P < 0.001) or deposit it with their local chemist (χ2 = 10.0, 2df, P < 0.01). They were also less likely to be influenced by a famous person promoting bowel cancer screening (χ2 = 18.87, 2df, P < 0.001).

Conclusions:  Our results endorse the role of the GP in bowel cancer screening. However, the study also has demonstrated that test accuracy, the convenience of the screening service and notification of test results are valued differently by subgroups in the community, according to their level of education.
The effect of indole‐3‐carbinol and sulforaphane on a prostate cancer cell line*
Authors: Frydoonfar Hamid R. , McGrath Daniel R. , Spigelman Allan D.
Published: December 2004

Background:  Cruciferous vegetable consumption is inversely related to the incidence of prostate cancer. We examined the effect of indole‐3‐carbinol (I3C) and of sulforaphane (constituents of cruciferous vegetables) on cell proliferation of a PC‐3 prostate cancer cell line, in order to observe if an inhibitory effect might be detected in vitro.

Methods:  PC‐3 prostate cancer cells were cultured in 96‐well microtitre plates. Indole‐3‐carbinol concentrations ranging from 0.1 mmol/L to 0.8 mmol/L or sulforaphane concentrations ranging from 0.01 mmol/L to 0.06 mmol/L were added to the wells. Cell proliferation was measured by colorimetric assay and results were based on the mean value of triplicate experiments. Data are ­presented as medians and interquartile ranges and were analysed using the Mann−Whitney U‐test.

Results:  Cell proliferation in PC‐3 prostate cancer cells was significantly inhibited by I3C and sulforaphane at media concentrations of 0.2 mmol/L and 0.02 mmol/L, respectively.

Conclusion:  Both compounds inhibited the proliferation of prostate cancer cells in a dose‐dependant manner. These findings may help explain the observed protective effect of cruciferous vegetables in relation to prostate cancer.
Fluoropolymer coated Dacron or polytetrafluoroethylene for femoropopliteal bypass grafting: a multicentre trial
Authors: Robinson Brett I. , Fletcher John P. ,   the Australian and New Zealand Femoropopliteal Graft Trial Participants
Published: December 2004

Background:  This trial was designed to compare graft patency between expanded polytetrafluoroethylene (PTFE) and fluoro­polymer coated Dacron for femoropopliteal bypass in patients in whom saphenous vein was unavailable.

Methods:  A multicentre prospective trial randomized 129 patients (74 men, 55 women) who underwent femoropopliteal bypass using either a PTFE or fluoropolymer coated Dacron graft. The indication for operation was disabling claudication in 68 (52.7%) and critical limb ischaemia in 61 (47.3%) patients. Distal anastomosis was above the knee in 76 (58.9%) and below the knee in 53 (41.1%) patients.

Results:  Primary patency at 6, 12 and 24 months was 71%, 56% and 47% for PTFE and 50%, 36% and 36% for fluoropolymer coated Dacron (P = 0.002), respectively. Secondary patency at 6, 12 and 24 months was 77%, 60% and 48% for PTFE and 66%, 49% and 46% for fluoropolymer coated Dacron (P = 0.13), respectively. The superior primary patency of PTFE over fluoropolymer coated Dacron was most evident in patients with poor prognostic indicators for graft survival: critical limb ischaemia (P = 0.001); below‐knee anastomosis (P = 0.01); and smaller (6 mm) diameter grafts (P = 0.002). Graft thrombosis developed in the first month in 22 of 61 (36%) patients receiving fluoropolymer coated grafts compared to six of 68 (8.8%) patients receiving PTFE, which accounts for the difference in primary patency. Successful thrombectomy in 10 of the 22 fluoropolymer coated grafts resulted in similar secondary patency.

Conclusion:  Polytetrafluoroethylene has superior primary patency and similar secondary patency to fluoropolymer coated Dacron. These results support the preferential use of PTFE in patients with critical limb ischaemia, especially when a below‐knee distal anastomosis and smaller diameter graft is required.
Endoluminal stent grafts for aortic diseases: experience at a major teaching hospital in Hong Kong
Authors: Ting Albert C. W. , Cheng Stephen W. K. , Ho Pei
Published: December 2004

Background:  The purpose of the present paper was to review the initial experience of an endovascular aortic stent graft program at a major teaching hospital in Hong Kong.

Methods:  Demographics, operative details, complications and follow‐up data of all the patients receiving endovascular repair for aortic disease were recorded prospectively.

Results:  Between July 1999 and December 2001, endovascular repairs were attempted in 39 patients with aortic disease. The procedural success rate was 97.4%. Thirty‐three procedures were for abdominal aorto‐iliac aneurysms. Graft configuration was bifurcated in 28 patients (85%) while an aorto‐uni‐iliac device with a femoro‐femoral bypass was carried out in the remaining five patients. Thoracic procedures were carried out for one thoracic aortic aneurysm, two traumatic thoracic aortic injuries, one thoracic aortic dissection, and one thoracic aortic pseudoaneurysm with aorto‐oesophageal fistula. There was one hospital mortality (2.6%) from a type A thoracic aortic dissection with cardiac tamponade. Postoperative complications were seen in seven patients (18%). With a mean follow‐up of 11.6 ± 8.1 months, there was no open conversion or rupture. The endoleak rate was 27% at discharge, 15% at 6 months and 5% at 12 months postoperatively. For aneurysm endografts, the aneurysm sac decreased in size in 21 patients (62%), and remained static in 13 patients (38%).

Conclusions:  The endoluminal stent graft appears to be a promising device that can be used safely in selected patients with aortic disease. Continued follow‐up is required to monitor the presence of endoleak and the size of the aneurysm sac.
Surgical trainees’ attitudes to specialization in breast surgery
Authors: Kollias James , Rainsbury Richard
Published: December 2004

Background:  Subspecialization in general surgery is being encouraged by various surgical societies. The aim of this study was to view attitudes of Royal Australasian College of Surgeons (RACS) trainees to subspecialization in surgery, in particular, breast ­surgery.

Methods:  A postal questionnaire survey of registered RACS basic and advanced surgical trainees was conducted in February 2002. Trainees were asked to nominate their preferred specialty and to indicate the level of support and interest for subspecialty training in breast surgery. Trainees indicating breast surgery as their preferred career choice were then asked to nominate their reasons for choosing breast surgery, preferred options for cross‐specialty training and for vocation specifications such as a continuing ‘on‐call’ responsibility.

Results:  Trainees returned 291 of 1049 (28%) completed questionnaires. One hundred and sixty‐nine trainees felt that the concept of breast subspecialization in general surgery was reasonable (58%). For all respondents, the most popular specialty choices were plastic surgery (15.8%), orthopaedics (15.5%) and general surgery (15.4%). Breast surgery was chosen by 14 of 291 (4.8%) respondents as their first specialty preference and a further 25 respondents as their second specialty preference. Of 189 trainees who did not choose breast surgery as their preferred specialty, 45% stated repetitive stress, escalating litigation or demanding patients as deterrent factors. Only 36% of trainees interested in breast surgery were interested in undertaking after hours ‘on‐call’ work as a consultant, although 36 of 39 (92%) were interested in other forms of general or subspecialty elective surgical operating (i.e., endocrine surgery, surgical oncology) after completion of their training. According to trainees with an interest in breast surgery, the two most important aspects requiring inclusion in the proposed provisional training program were breast reconstruction (38%) and breast screen assessment (34%).

Conclusion:  Breast surgery is an unpopular subspecialty for RACS trainees. Breast surgery is likely to experience increasing ­problems with recruitment unless the skill base is reviewed and revised in line with the aspirations and needs of today's trainees.
Clinical governance: its effect on surgery and the surgeon
Authors: Spark James I. , Rowe Siobhan
Published: December 2004

Audit is the process by which clinical staff collectively review, evaluate and improve their clinical practice with the common aim of improving standards. Modern audit has developed from the initial concept promoted in the 1980s and is now part of the concept of clinical governance. Clinical governance is a framework through which health service organizations are accountable for continuously improving the quality of their services. Clinicians have always been accountable for maintaining high quality care; clinical governance merely imposes structure in this and makes it explicit. The features of this are: (i) full participation in audit by all hospital doctors; (ii) support and use evidence‐based practice, including risk management, quality assurance and clinical effectiveness; and (iii) continuing professional development.
Endoscopic stapling for pharyngeal pouch: does it make the cut?
Authors: Aly Ahmad , Devitt Peter G. , Watson David I. , Jamieson Glyn G. , Bessell Justin R. , Chew Andrew , Krishnan Suren
Published: December 2004

Background:  Endoscopic stapling to treat pharyngeal pouch is a relatively new technique with the potential to reduce the morbidity associated with the open approach for pharyngeal pouch. Despite enthusiasm for the endoscopic approach there have been no series reported in Australia, and descriptions of outcomes and benefits are currently anecdotal. The aim of the present study was to determine the outcome associated with endoscopic stapling of pharyngeal pouch in an Australian setting.

Methods:  All patients admitted for endoscopic stapling for a pharyngeal pouch between 1998 and 2002 by surgeons from the Adelaide and Flinders Universities were identified, and their medical records were reviewed for clinical and operative details. All patients were interviewed by telephone using a structured questionnaire to determine symptom resolution and patient satisfaction. The Likert scale was used to assess the impact of preoperative and postoperative symptoms upon quality of life.

Results:  A total of 31 patients were identified. The mean age of the group was 75 years (range: 35–91 years) and half the patients had an American Society of Anesthesiologists physical status score of 3 or greater. In four patients the procedure was abandoned; (for three because of inability to pass the diverticuloscope and for one because the pouch was too small). Standard open surgery was undertaken in these patients. Of the 27 procedures completed endoscopically, interview follow up was obtained in 23, at a mean follow up of 17 months (range: 2–68 months). Outcome was very good or excellent in 21 (91%), with significant symptom resolution, reduction in Likert scores and high patient satisfaction. Three patients had previously had pouch surgery and endoscopic stapling was straightforward in these patients. Recurrence of a symptomatic pouch occurred in three patients. There was no significant morbidity related to the procedure.

Conclusions:  The early experience of endoscopic stapling for pharyngeal pouch in Adelaide is encouraging. The procedure achieves excellent control of symptoms and can be undertaken with minimal morbidity. Recurrence may be a problem, although repeat endoscopic stapling can be undertaken without difficulty.
Breast volume replacement using the latissimus dorsi miniflap
Authors: Nano Maria Teresa , Gill P. Grantley , Kollias James , Bochner Melissa A.
Published: December 2004

Background:  Mastectomy is often recommended to women with early breast cancer who have large tumours or where the breast volume requiring resection to achieve adequate tumour clearance is too great to allow for a satisfactory cosmetic result after breast conservation surgery. The use of a latissimus dorsi muscular flap (latissimus dorsi miniflap (LDMF)) to replace the volume loss after major breast sector resection is an option where the tumour to breast volume ratio is large. The present study describes the technique and evaluates the experience of the LDMF at Royal Adelaide Hospital, Adelaide, Australia.

Methods:  Between August 1997 and April 2002, 18 women aged 37–64 years underwent wide local excision for primary breast cancer with LDMF reconstruction. Tumour characteristics, breast specimen weight and postoperative sequelae were assessed. Quality of life measurements and objective assessments of aesthetic outcome were evaluated.

Results:  Tumour diameter ranged from 13 to 80 mm (median 30 mm). Nine patients had multifocal or extensive intraductal component positive tumours. The weight of the resected specimens ranged from 75 to 395 g (median 130 g). There were no major postoperative complications, with a range of inpatient stay of 3–10 days. Seromas were aspirated in 14 patients but did not delay adjuvant treatment. Quality of Life results showed high patient satisfaction in all but one patient. A satisfactory cosmetic result was achieved in all but one patient who subsequently required mastectomy.

Conclusion:  The LDMF procedure allows breast conservation to be achieved in women with large tumour to breast volume ratios, with satisfactory resection margins and good cosmetic and functional results. In the present experience standard oncological adjuvant treatment is not compromised.
Transplantation: fantasy, fiction and fact
Authors: Magee Reginald
Published: December 2004

Today organ transplantation is considered a routine surgical procedure. The idea of transferring tissues from one person to another has been inspiring to the minds of artists depicting the Saints Cosmos and Damian and also writers such as Mary Shelley. Early attempts at tissue transplantation were unsuccessful but in the last 50 years medical research has brought it into reality. The present paper looks at the subject from the realms of fantasy through the works of fiction and finally into everyday fact.
Complications after discharge for surgical patients
Authors: Kable Ashley , Gibberd Robert , Spigelman Allan
Published: December 2004

Aim:  To measure the type and frequency of complications for surgical patients 1 month after discharge.

Methods:  A post‐discharge patient survey was conducted in 2000 for patients who had undergone one of five elective operations: transurethral resection of the prostate, hysterectomy, major joint replacement, cholecystectomy, herniorrhaphy. Two hundred and fourteen patients (74%) returned the survey forms, which were sent 1 month after surgery. Patients were recruited from two teaching hospitals in the Hunter Area Health Service, New South Wales, Australia.

Results:  One hundred and thirty‐five (63%) patients reported one or more complications and 78 (37%) received treatment for 109 complications. Eighty‐six per cent reported pain after discharge and 41% reported moderate to severe pain. Seventeen per cent reported infections after discharge and 94% of these patients were given treatment. Twenty‐eight per cent reported bleeding after discharge and 20% of these were given treatment. Eleven (5%) patients were readmitted for treatment of problems related to their surgery including four who required further surgery. One hundred and seventy‐two patients accessed a range of health services during the first month after discharge, resulting in 266 occasions of service. Twenty‐eight per cent of post‐discharge services were unplanned.

Conclusions:  The lack of post‐discharge monitoring conceals information about surgical outcomes. Patient reporting is an effective method of monitoring post‐discharge outcomes. There is scope to develop post‐discharge services to improve the quality of care in the areas of post‐discharge pain management, the use of prophylactic measures and to provide treatment for complications that occur during this period.
Total glossectomy: is it justified?
Authors: Bova Ronaldo , Cheung Ian , Coman William
Published: December 2004

Background:  The treatment of advanced malignancies of the tongue with total glossectomy is controversial.

Methods:  The present study retrospectively reviews 20 patients that had total glossectomy with or without laryngectomy performed at the Princess Alexandra Hospital (Woolloongabba, QLD, Australia) over the past 10 years. The clinicopathologic parameters, perioperative morbidity and mortality were assessed.

Results:  The 5 years disease free and disease specific survival rates were 34% and 38%, respectively. Ninety per cent of patients acquired independent oral feeding prior to discharge, while 57% of patients that had laryngeal preservation performed achieved satisfactory vocal rehabilitation.

Conclusion:  Total glossectomy is an oncologically sound surgical procedure that should only be performed in carefully selected patients with advanced malignancies affecting the tongue.
Cumulative sum control charts for assessing performance in arterial surgery
Authors: Beiles C. Barry , Morton Anthony P.
Published: December 2004

Background:  The Melbourne Vascular Surgical Association (Melbourne, Australia) undertakes surveillance of mortality following aortic aneurysm surgery, patency at discharge following infrainguinal bypass and stroke and death following carotid endarterectomy. Quality improvement protocol employing the Deming cycle requires that the system for performing surgery first be analysed and optimized. Then process and outcome data are collected and these data require careful analysis. There must be a mechanism so that the causes of unsatisfactory outcomes can be determined and a good feedback mechanism must exist so that good performance is acknowledged and unsatisfactory performance corrected. A simple method for analysing these data that detects changes in average outcome rates is available using cumulative sum statistical control charts.

Methods:  Data have been analysed both retrospectively from 1999 to 2001, and prospectively during 2002 using cumulative sum control methods. A pathway to deal with control chart signals has been developed.

Results:  The standard of arterial surgery in Victoria, Australia, is high. In one case a safe and satisfactory outcome was achieved by following the pathway developed by the audit committee.

Conclusion:  Cumulative sum control charts are a simple and effective tool for the identification of variations in performance standards in arterial surgery. The establishment of a pathway to manage problem performance is a vital part of audit activity.
Cytotoxicity of topical antimicrobial agents used in burn wounds in Australasia
Authors: Fraser John F. , Cuttle Leila , Kempf Margit , Kimble Roy M.
Published: December 2004

Background:  Burn sepsis is a leading cause of mortality and morbidity in patients with major burns. The use of topical antimicrobial agents has helped improve the survival of these patients. Silvazine (Sigma Pharmaceuticals, Melbourne, Australia) (1% silver sulphadiazine and 0.2% chlorhexidine digluconate) is used exclusively in Australasia, and there is no published study on its cytotoxicity. This study compared the relative cytotoxicity of Silvazine with 1% silver sulphadiazine (Flamazine (Smith & Nephew Healthcare, Hull, UK)) and a silver‐based dressing (Acticoat (Smith & Nephew Healthcare, Hull, UK)).

Methods:  Dressings were applied to the centre of culture plates that were then seeded with keratinocytes at an estimated 25% confluence. The plates were incubated for 72 h and culture medium and dressings then removed. Toluidine blue was added to stain the remaining keratinocytes. Following removal of the dye, the plates were photographed under standard conditions and these digital images were analysed using image analysis software. Data was analysed using Student’s t‐test.

Results:  In the present study, Silvazine is the most cytotoxic agent. Seventy‐two hour exposure to Silvazine in the present study results in almost no keratinocyte survival at all and a highly statistically significant reduction in cell survival relative to control, Acticoat and Flamazine (P < 0.001, P < 0.01, P < 0.01, respectively). Flamazine is associated with a statistically significant reduction in cell numbers relative to control (P < 0.05), but is much less cytotoxic than Silvazine (P < 0.005).

Conclusion:  In this in‐vitro study comparing Acticoat, Silvazine and Flamazine, Silvazine shows an increased cytotoxic effect, relative to control, Flamazine and Acticoat. An in‐vivo study is required to determine whether this effect is carried into the clinical setting.
Severe acute respiratory syndrome mimicking acute abdomen
Authors: Tjiu Cheung San , Leung Kam Fung , Leong Heung Tat
Published: December 2004

Severe acute respiratory syndrome (SARS) is a novel epidemic disease. The clinical presentation can sometimes be very non‐specific. The present study reports a case of SARS, which presented as acute abdomen, warranting laparotomy. The atypical presentation in the present case reminded us of the importance of strict infection control measures in all surgery‐related specialist workplaces.
Evaluation of Platelet Damage in Two Different Centrifugal Pumps Based on Measurements of α‐Granule Packing Proteins
Authors: Mohara Jun , Kawahito Koji , Misawa Yoshio , Fuse Katsuo
Published: December 2004

Abstract Mechanical trauma caused by centrifugal pumps is usually evaluated in terms of hemolysis. However, platelet damage caused by centrifugal pumps has not been studied well. We evaluated platelet damage in 2 different centrifugal pumps, the Medtronic BioMedicus BP‐80 and the Terumo Capiox, in vitro and compared the results in terms of hemolysis. To evaluate platelet damage, the rate of increase (RI) for β ‐thromboglobulin (β‐TG) and platelet factor‐4 (PF‐4) were measured by enzyme immunoassay. RI was defined as follows: RI for β‐TG is Δβ‐TG/ΔN and RI for PF‐4 is Δ PF‐4/ΔN where Δβ‐TG is the increase in β‐TG, ΔPF‐4 is the increase in PF‐4, and ΔN is the increase of the passing number, which is defined in the following equation: N = Qr/V (t, time; V, priming volume; Q, flow rate). Each pump was tested in a mock circuit for 3 h under a flow rate of 5 L/min and a pressure head of 100 mm Hg using fresh human heparinized blood (n = 5). For comparison, the normalized index of hemolysis (NIH) values were calculated for both pumps. The NIH values did not indicate a significant difference between the Capiox and the BP‐80 pumps (Capiox vs. BP‐80, 0.0021 ± 0.0004 vs. 0.0034 ± 0.0007, NS). However, the RI values for β‐TG and PF‐4 in the Capiox were significantly lower than in the BP‐80 (β‐TG, 0.198 ± 0.047 vs. 0.376 ± 0.049; PF‐4, 0.080 ± 0.014 vs. 0.268 ± 0.043, p < 0.05). In conclusion, although there was no significant difference between the 2 pumps in terms of hemolysis, the Capiox centrifugal pump induced less platelet damage than the BP‐80. The results suggest that measurements of RI for β‐TG and PF‐4 are more sensitive parameters than NIH values for evaluating blood cell damage.
Artificial Organ Treatment for Multiple Organ Failure, Acute Renal Failure, and Sepsis: Recent New Trends
Authors: Tetta C. , Bellomo R. , Ronco C.
Published: December 2004

Abstract: Sepsis remains the major cause of mortality worldwide, claiming millions of lives each year. The past decade has seen major advances in the understanding of the biological mechanisms involved in this complex process. Unfortunately, no definitive therapy yet exists that can successfully treat sepsis and its complications. At variance with targeting single mediators, therapeutic intervention aimed at the nonselective removal of pro‐ and anti‐inflammatory mediators seems a rational concept and a possible key to successful extracorporeal therapies. A further advantage may lie in the continuous nature of such therapy. With such continuous therapy, sequentially appearing peaks of systemic mediator overflow may be attenuated and persistently high plasma levels reduced. This theoretical framework is proposed as the underlying biological rationale for a series of innovative modalities in sepsis. In this editorial, we will review recent animal and human trials that lend support to this concept. We will also review the importance of treatment dose during continuous renal replacement therapy as a major factor affecting survival in critically ill patients with acute renal failure. Additionally, we will review novel information related to other blood purification techniques using large pore membranes or plasma filtration with adsorbent perfusion. Although these approaches are still in the early stages of clinical testing, they are conceptually promising and might represent an important advance.
A Polyurethane Vascular Access Graft and a Hybrid Polytetrafluoroethylene Graft as an Arteriovenous Fistula for Hemodialysis: Comparison with an Expanded Polytetrafluoroethylene Graft
Authors: Matsuda Hiroaki , Miyazaki Masashi , Oka Yoshinari , Nakao Atsunori , Choda Yasuhiro , Kokumai Yoshiaki , Kunitomo Keiichi , Tanaka Noriaki
Published: December 2004

Abstract:  Aim: We evaluated a polyurethane vascular access graft (TVAG), a hybrid polytetrafluoroethylene graft (hPTFEG), and an expanded polytetrafluoroethylene graft (ePTFEG) for postoperative complications and graft patency in their use as prosthetic devices of vascular access for hemodialysis. Methods: Between August 1993 and October 2001, we treated 200 patients in whom A‐V fistulas were placed by the same surgeon. These were divided into the following four groups according to the type of blood access: 27 cases of ePTFEG, 23 cases of TVAG, 22 cases of hPTFEG, and 128 cases of an autogenous A‐V fistula. We calculated the cumulative patency rates by the Kaplan‐Meier method, including primary (problem‐free) and secondary (revised or functional) patency rates. Results: The hPTFEG group experienced few thromboses. The absence of perigraft edema in the TVAG group permitted the early use of the TVAG within a few postoperative days for hemodialysis. Among the three graft groups, the primary patency was the best in the hPTFEG group (94.7% at 1 year and 86.1% at 2 years), with a significant difference versus the ePTFEG group. In regard to secondary patency, hPTFEG had an excellent patency of 100% at 1 year and 90.9% at 2 years, and TVAG had a comparable patency with that of ePTFEG. Conclusion: The hPTFEG was considered superior to ePTFEG in terms of being complication‐free and had the excellent 2 year secondary patency of 90.9%. TVAG, with a patency equal to that of ePTFEG, could be used immediately after implantation due to the absence of limb edema.
Effects of Cell Density on Proliferation and Matrix Synthesis of Chondrocytes Embedded in Atelocollagen Gel
Authors: Iwasa Junji , Ochi Mitsuo , Uchio Yuji , Katsube Kenichi , Adachi Nobuo , Kawasaki Kenzo
Published: December 2004

Abstract: The effects of cell density on the proliferation and chondroitin sulfate synthesis of chondrocytes embedded in Atelocollagen gel were examined. Chondrocytes of 21 10‐week‐old Japanese white rabbits isolated by collagenase digestion were embedded in Atelocollagen gel and cultured in Dulbecco's modified Eagles medium at cell densities of 2 × 105 cells/ml (105 group) , 2 × 106 cells/ml (106 group), and 2 × 107 cells/ml (107 group) for 4 weeks. Chondrocytes in the 105 group gradually proliferated more than the other two groups. In contrast, most chondrocytes in the 107 group showed increased capability to produce chondroitin 6‐sulfate. Cartilage‐like tissue was produced from high‐density cultures (107 cells/ml), although a decrease in cell number was seen. Even in three‐dimensional cultures, the proliferation and chondroitin sulfate synthesis of chondrocytes were influenced by the cell density. These results are informative for the clinical application of chondrocyte transplantation in three‐dimensional cultures for cartilage repair.
An Alternative Design of Locked Percutaneous Device for Skeletal Extension Through Skin
Authors: Yu Chang , Harris Glenn D. , Sun Yousu
Published: December 2004

Abstract: A skeletal extension bar (SEB) through the skin may be involved with many treatments of orthopedic diseases. A new locked percutaneous device (LPD), LPD‐III, was designed for the SEB not only to allow the skin to bind onto the SEB, similarly to the LPD, but also to allow the skin binding to shift up or down the SEB while the body changes weight. Two designs of LPD‐III were tried. The LPD‐III‐F was made from a formation of nylon hooks, fixed directly onto the SEB surface. Soft tissue can lock and shift onto the hook formation naturally. The LPD‐III‐S was made by attaching a stainless steel spring as a single row of rings on a nylon sleeve. Tissue can lock through the spring rings and the nylon sleeve can be manually shifted on the SEB to follow the change of thickness of soft tissue. The SEB is a stainless steel bar implanted in the sheep ilium through the skin and buttock. Two sheep were employed, both implanted with a SEB with LPD‐III‐F in one ilium and another SEB with LPD‐III‐S in the other ilium. Our experiment demonstrates that: first, both designs, LPD‐III‐F and LPD‐III‐S, function well as a skin junction shifting device; second, the LPD‐III‐F has abilities to re‐bind the skin that not only repair damaged binding junction but also shift the skin binding up to overcome skin downgrowth; and third, powerful evidence certifies again that the mechanical connection exists in LPD.
Inflammatory Response of Rat and Human Neutrophils Exposed to Di‐(2‐ethyl‐hexyl)‐phthalate‐Plasticized Polyvinyl Chloride
Authors: Gourlay Terence , Samartzis Ioannis , Stefanou Demetrios , Taylor Kenneth
Published: December 2004

Abstract: A series of in vitro studies were designed to determine whether di‐(2‐ethyl‐hexyl)‐phthalate (DEHP)‐plasticized polyvinyl chloride (PVC) and DEHP itself initiated an inflammatory response in both human and rat blood. Additionally, the effect of methanol washing of the PVC on the inflammatory response was studied in both blood types. Blood from both species was exposed to first, no material; second, ground DEHP‐plasticized PVC; third, methanol‐washed ground DEHP‐plasticized PVC; and fourth, known concentrations of DEHP. The expression of the integrin CD11b was employed as a marker of the inflammatory response. After 20 minutes’ exposure to PVC, CD11b expression increased to 210 ± 32% of baseline in human blood and to 238 ± 21.7% in rodent blood. Both blood types showed an increase in CD11b expression with increasing concentrations of DEHP (214 ± 40.8% of baseline levels in human blood and 237 ± 14.5% in rodent blood at the highest concentration). Methanol washing resulted in a significant moderation in CD11b upregulation in both blood types; 117 ± 27% of baseline in human and 150 ± 14.7% in rodent. These results support the hypothesis that DEHP‐plasticized PVC and DEHP itself are proinflammatory in blood from both species, and suggest that the rodent is an appropriate model for studies of this nature.
A New Method to Prepare Multicellular Spheroids in Cancer Cell Lines Using a Thermo‐Reversible Gelation Polymer
Authors: Tsukikawa Satoshi , Matsuoka Hiromitsu , Kurahashi Yuko , Konno Yasushi , Satoh Koh , Satoh Ryotaroh , Isogai Akiko , Kimura Kanako , Watanabe Yasuharu , Nakano Suehiro , Hayashi Junya , Kubota Sunao
Published: December 2004

Abstract: The purpose of this study is to utilize the thermo‐reversible gelation polymer in which the sol‐gel transitting phase is reversibly changed by temperature in a three‐dimensional culture system. Human cancer cells have been observed to form multicellular spheroids, whereas fibroblasts slowly develop into small spheroids with the culture medium including this polymer. This polymer has some advantages for use as a culture material, as follows: first, cancer cells grow three‐dimensionally in the aqueous solution of this polymer; second, it is easy to harvest cells or spheroids in the aqueous solution of this polymer by simply cooling down the temperature; and third, the culture medium including this polymer is so translucent that the cells or spheroids can be observed through a phase‐contrast microscope. We thus conclude that this polymer is a very useful material for three‐dimensional cultures.
In Vitro Biocompatibility Evaluation of the Dynamic Bubble Trap
Authors: Taborski Uwe , Urbanek Petr , Erhardt Gunther , Schönburg Markus , Basser Svetlana , Wohlgemuth Larisa , Heidinger Kathrin , Klövekorn Wolf‐Peter
Published: December 2004

Abstract:  The goal of this study was to evaluate the biocompatibility of the dynamic bubble trap (DBT) prior to the clinical trial. It was set up as an in vitro model, which simulates physiological conditions. Twenty runs were performed (ten with the DBT, ten without the DBT) at a blood flow of 3 L/min, each lasting 180 min. Fifteen blood parameters (hemogram, hemostasis, complement system, and cytokines) were measured at five time intervals. None of the tested parameters showed a statistically significant difference between the DBT and control group. The data assessed in this in vitro model show that the DBT has no adverse influence on hemocompatibility. It may be concluded that the DBT is a safe tool to be used in vivo.
Methods for Biofilm Analysis on Silicone Tubing of Dialysis Machines
Authors: Marion‐Ferey K. , Enkiri F. , Pasmore M. , Husson G.P. , Vilagines R.
Published: December 2004

Abstract: We describe an analytical protocol to study biofilms that develop inside silicone tubing of dialysis machines. This protocol has been set up with the help of a dynamic testing device reproducing dialysis conditions. The methodology includes direct microscopic observation, biofilm removal with an original mechanical biofilm scraper, quantitative analysis with culturable and total bacteria counting, and endotoxin level measurement using the LAL chromogenic kinetic assay. The analytical protocol has been assessed on 13 different clinical tubing samples. Most samples were contaminated by adherent cells and the thickest biofilms were found at the connection between the dialysis water distribution loop and the dialysis machine. The less contaminated samples had been removed from dialysis machines that were decontaminated with citric acid and autoclaving, showing the importance of the decontamination procedure for the prevention of biofilm development. This article shows that easy, rapid, reproducible, and economical methods are applicable for a routine analysis of biofilms that develop on dialysis systems and should be included in the regular control of the microbiological quality of dialysis liquids.
Collagen‐Hydroxyapatite/Tricalcium Phosphate Microspheres as a Delivery System for Recombinant Human Transforming Growth Factor‐β 1
Authors: Sun Jui‐Sheng , Lin Feng‐Huei , Wang Yng‐Jiin , Huang Yi‐Chau , Chueh Shan‐Chang , Hsu Fu‐Yin
Published: December 2004

Abstract: The purpose of this study is to evaluate the carrier capability of collagen‐hydroxyapatite/tricalcium phosphate (Col‐HA/TCP) microspheres to the rhTGF‐β 1 (recombinant human transforming growth factor‐β 1). After anesthesia, a bone defect (7.0 mm in diameter and 10.0 mm in depth) was created at the distal femoral condyles of New Zealand white rabbits. These defects were then completely filled with the implant materials. After 5, 7, 9, 11, 13, and 15 weeks, the animals were sacrificed and histological evaluations were performed. The results showed that when the defects were treated with Col‐HA/TCP microspheres without rhTGF‐β 1, there was only spotty new bone formation during the 15 week experimental period and most of the defect was filled with fibrous tissue and inflammatory cells, whereas active bone formation with mature marrow tissue formation was evident in the defect treated with Col‐HA/TCP microspheres containing rhTGF‐β 1. Collagen‐hydroxyapatite/tricalcium phosphate microspheres were expected to be replaced by the regenerated bone structure as the bone reconstruction and bone‐remodeling process occurred. It was apparent that bone regeneration was influenced by the addition of rhTGF‐β 1. Collagen‐hydroxyapatite/tricalcium phosphate microspheres were a good carrier for rhTGF‐β 1.
Survival of Hemodialysis Patients and Uremic Toxin Removal
Authors: Vanholder R. , Smet R. De , Glorieux G. , Dhondt A.
Published: December 2004

Abstract: Uremic toxin removal based on diffusion and/or convection allows eliminating solutes with negative metabolic impact. Uremic solutes can be classified as small and water‐soluble compounds, larger “middle” molecules, or protein bound solutes. The question arises whether more removal of each of these solute classes affects patient survival. Kt/V of urea is currently used as a surrogate for small water‐soluble solute removal. There is ample evidence that Kt/V and survival are correlated, but the threshold Kt/V remains a matter of debate. Probably, the actually proposed threshold of 1.2 is too low. This impact of Kt/V is in contradiction with the low toxicity of urea and points to a role for other water‐soluble solutes, e.g., potassium. More removal of middle molecules results in a lower morbidity and also in a lower mortality. In addition, a relationship has been demonstrated between the use of membranes with large pore size and a decrease of inflammatory status, by itself an important factor related to mortality. One of the problems is that large pore membranes are at the same time more biocompatible and reflect more dialysate impurities, compared to many small pore membranes, whereas they also reflect more dialysate impurities. It remains uncertain which one of these factors, if any, has a predominant effect. Recent studies point to a separate effect of pore size but await confirmation. Protein bound toxins inhibit several biochemical functions. Their removal pattern is totally different from that of classical markers such as urea. In analogy with drugs, it is essentially the free unbound fraction that exerts biological action; this free fraction is inversely related to serum albumin, another inflammatory marker related to survival. In a final section of this presentation, attention will be drawn to the relationship in uremic patients between inflammation, malnutrition, cardiovascular disease, and mortality, and some of the potential culprits are discussed. Virtually all of these molecules have a high molecular weight or are protein bound. It is concluded that both small and middle molecule removal have an impact on survival, so that more than urea removal alone should be pursued.
The Effect of Vitamin E–Bonded Dialyzer Membrane on Red Blood Cell Survival in Hemodialyzed Patients
Authors: Nakatan Tatsuya , Takemoto Yoshiaki , Tsuchida And Kenji
Published: December 2004

Abstract: Reduced red blood cell (RBC) survival due to oxidative damage is one of the causes of anemia in patients under long‐term hemodialysis. Recently, it has been shown that vitamin E–bonded dialyzer membrane is able to reduce the oxidative stress during hemodialysis. In humans, creatine content in RBC is used to measure RBC life span and erythropoietic capacity, since it rapidly declines as the RBCs become old. Therefore this study aimed to elucidate the effect of vitamin E–bonded dialyzer membrane on RBC life span by measuring creatine content in RBC.
Vascular Access and Patient Outcomes in Hemodialysis: Questions Answered in Recent Literature
Authors: Añel Ramon L. , Yevzlin Alexander S. , Ivanovich And Peter
Published: December 2004

Abstract: Hemodialysis is not possible without access to the vascular system to provide an adequate and reliable source of blood flow through the hemodialyzer. Since maintenance hemodialysis therapy became a reality in the latter half of the twentieth century, no vascular access has exceeded the success and reliability of arteriovenous fistulae (AVF). They have the lowest infection and thrombosis rates, have the longest patency rates, and are associated with the best morbidity and mortality outcomes of any access modality. In the United States, the majority of patients starting hemodialysis do not have a primary AVF, which may explain why vascular access complications represent almost 20% of the total spending for hemodialysis. In addition, as much as 50% of hospitalization costs for end‐stage renal disease are related to access issues. Every effort must be directed in the U.S. as well as elsewhere to promote the use of AVF whenever possible. In some European countries, more than 90% of patients have AVF as their hemodialysis access when nephrologists perform placement of vascular access. Already, some programs in the U.S. have recognized the need for trained nephrologists to provide these services. U.S. interventional nephrologists should be given the opportunity to learn AVF placement procedures to emulate their European counterparts, and thus improve U.S. dialysis outcomes.
Decreased 2,3‐Diphosphoglycerate Concentration in Low Cardiac Output Patients and Its Influence on the Determination of In Vivo P50
Authors: Piccioni Marilde A. , Cestari Idágene A. , Strunz Célia M.C. , Auler José O.
Published: December 2004

Abstract:  We investigated whether 2,3‐diphosphoglycerate (2,3‐DPG) is altered in patients with low cardiac output and the influence of its concentration on the calculation of in vivo P50. Biochemical and blood gas analysis were performed along with the measurement of cardiac output and body temperature in 13 patients submitted to cardiopulmonary bypass surgeries without the use of donor blood. In vivo P50 was calculated using the measured (P50m) and the estimated 2,3‐DPG (P50e). 2,3‐DPG concentration was lower in these patients when compared to the values obtained in normal volunteers (6.9 ± 2.2 vs. 11.9 ± 2.4 μmol/gHb). P50m was lower than P50e (21.6 ± 1.1 vs. 30.1 ± 1.2 mm Hg) at all time points. Our data show that in patients with low cardiac output, 2,3‐DPG concentration is reduced. Therefore, in these patients, the use of standard values for this variable may introduce an error in the calculation of in vivo P50.
Soluble Fas: A Novel Marker of Inflammation in Uremia
Authors: Dalboni Maria Aparecida , Sardenberg Camila , Andreoli Maria Claudia , Watanabe Renato , Canziani Maria Eugênia , Santos Bento F.C. dos , Liangos Orfeas , Jaber Bertrand L. , Draibe Sérgio , Cendoroglo Miguel
Published: December 2004

Abstract:  Background: Inflammation has been associated with atherosclerotic cardiovascular disease (CVD) and anemia in patients with end‐stage renal disease (ESRD). Recent studies have shown that serum levels of soluble Fas (sFas), an antiapoptotic and proinflammatory molecule, are elevated in patients with cardiac disease and patients with ESRD. We therefore sought to investigate serum levels of sFas in uremic patients and its correlation with known markers of inflammation, anemia and CVD. Methods: The study included 25 ESRD patients (14 on hemodialysis, 11 on CAPD), 27 patients with chronic kidney disease (CKD; creatinine clearance <50 ml/min/1.73 m2), and 14 normal control subjects. We measured serum levels of sFas, C‐reactive protein (CRP), and albumin. We also investigated the association of serum sFas levels with the presence of CVD and with erythropoietin (EPO) dosage. Results: Levels of sFas were elevated in CKD and ESRD patients compared to controls. sFas levels correlated negatively with creatinine clearance. In the dialysis patients, we observed that sFas levels were higher among those with CVD. Serum levels of sFas correlated with serum levels of CRP (r=0.31; P=0.03), serum levels of albumin (r=−0.35, P=0.02), and EPO dosage (r=0.51; P=0.009). Conclusion: These results suggest that sFas may be a marker of inflammation in CKD and ESRD patients.
Glutaraldehyde‐treated Bovine Pericardium: Effects of Lyophilization on Cytotoxicity and Residual Aldehydes
Authors: Maizato Marina J.S. , Higa Olga Z. , Mathor Mônica B. , Camillo Maria A.P. , Spencer Patric J. , Pitombo Ronaldo N. , Zavaglia Cecília A.C. , Leirner Adolfo A.
Published: December 2004

Abstract:  This work assesses the effect of lyophilization on the cytotoxicity and residual aldehyde concentra‐ tion of glutaraldehyde‐treated and lyophilized bovine pericardium (group A), comparing it to conventional glutaraldehyde‐treated bovine pericardium (group B). Cytotoxicity was measured by incubating a pericardium sample from each group in saline and assessing the eluant's influence on cellular growth. Residual aldehydes were measured by HPLC. Although both groups’ eluants exhibited some cytotoxicity, the eluant from group A was less cytotoxic, with a cytotoxicity index (IC50(%)) of 41%. Group B eluants all had marked cytotoxic effects; cell growth was 24.15% of the negative control at the most dilute eluant concentration (6.25%). The mean residual glutaraldehyde level was less in group A than in group B (2.36 ± 0.11 and 9.90 ± 3.70 g/l, respectively; n=3, P < 0.05), but residual formaldehyde levels did not differ. These results demonstrate that compared with conventional glutaraldehyde‐treated bovine pericardium, lyophilized pericardium is less cytotoxic, with fewer glutaraldehyde residues.
The Meaning of the Turning Point of the Index of Motor Current Amplitude Curve in Controlling a Continuous Flow Pump or Evaluation of Left Ventricular Function
Authors: Endo G.J. , Kojima K. , Nakamura K. , Matsuzaki Y. , Onitsuka T.
Published: December 2004

It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future

Abstract: In this series, we investigated the meaning of the t‐point of index of motor current amplitude (ICA) curve from a point of view of flow rate on in vitro and in vivo studies. On mock circulation loop and left ventricular assist device (LVAD)–equipped pigs, we detected the t‐point and compared the pump flow at the t‐point with the simultaneous cardiac output. The pump flow at the t‐point showed high correlation against the simultaneous cardiac output for in vitro or in vivo study. By detection of the t‐point of the ICA curve and measuring or estimating the pump flow at t‐point, the cardiac output may be assessed without any sensor in various cardiac conditions.