bluuebunny/crossref_metadata_2025 huggingface dataset:
Interhospital provision of emergency vascular services for a large population: early outcomes and clinical results
Authors: Baird R N , Baker A R , Hine C , Lamont P M , Lear P A , Loveday E , Mitchell D M , Morse M , Munro E N , Murphy K P , Rees M R , Smith F C T , Thornton M J
Published: March 2003

Background

In 1999 an emergency vascular service for Bristol and Avon (including Weston-Super-Mare) (population approximately 1 million) was initiated.

Methods

Collaboration between Bristol Royal Infirmary, Frenchay and Southmead Hospitals provides week-on–week-off vascular cover for patients requiring urgent and emergency interventions within 24 h. The rota accommodates National Confidential Enquiry into Perioperative Deaths and Vascular Surgical Society of Great Britain and Ireland recommendations, governance issues, and enhances emergency vascular care for Avon residents. Prospectively collected data for the first year (May 1999 to April 2000) are reviewed.

Results

There were 289 emergency admissions. (In-hospital referrals were not transferred but contributed up to 40 per cent of the extra emergency workload per unit.) Referrals were also accepted from seven Trusts outside the designated catchment area. Caseload included 86 patients with a ruptured or acutely symptomatic aortic aneurysm, of whom 69 underwent operation (30 per cent mortality rate); 17 patients were not operated on. Some 136 patients had critical leg ischaemia (43 acute, 93 chronic); angiography or duplex ultrasonography was performed in 105 cases (77 per cent); 39 patients (29 per cent) had undergone previous intervention for peripheral vascular disease; the mortality rate was 18 (13 per cent) of 136; 18 (13 per cent) of 136 patients required an amputation. Other cases included: upper limb ischaemia, 20 (7 per cent); paediatric emergency, seven (2 per cent); symptomatic carotid disease, five (2 per cent; four endarterectomies with no death or stroke). Some 5 per cent of referrals were inappropriate (venous ulcer, spinal stenosis, etc.). No outcomes were compromised by interhospital transfers. Vascular surgeons operated on nine high-risk patients away from their ‘base’ hospital. A consultant was the principal or assistant operator in more than 95 per cent of operations but, despite trainee rota adjustments, a designated vascular trainee was present in only about 40 per cent of cases.

Conclusion

Interhospital provision of emergency vascular services for a large population is feasible, does not compromise quality of care, and regulates emergency workload. Further attention to training issues is indicated.
Sentinel node biopsy with technetium-99m colloidal rhenium sulphide in patients with breast cancer
Authors: Watanabe T , Kimijima I , Ohtake T , Tsuchiya A , Shishido F , Takenoshita S
Published: March 2003

Background

Sentinel node biopsy is emerging as a technique to replace routine axillary lymph node dissection. The lymphatic mapping technique is still at a developmental stage and no standard technique exists. This study used technetium-99m colloidal rhenium sulphide with a mean particle size of 100 (range 50–200) nm for sentinel node mapping.

Methods

Eighty-seven patients with breast cancer, but no clinical evidence of axillary metastasis, were studied. One day before operation technetium-99m colloidal rhenium sulphide was injected at four points into breast tissue surrounding the tumour. Lymphoscintigraphy was performed 2 h after injection, and surgery was usually performed after 20 h. A hand-held γ probe guided sentinel node biopsy.

Results

Lymphoscintigraphy revealed axillary hot spots in all patients. During operation, the sentinel node was identified in all 87 patients (100 per cent). The number of sentinel nodes per patient ranged from 1 to 5 (mean 2). Metastatic sentinel nodes were identified in 37 of 87 patients. There were no false negatives.

Conclusion

This study suggests that technetium-99m rhenium sulphide is a suitable agent for sentinel node mapping in patients with breast cancer.
Extended preservation of non-heart-beating donor livers with normothermic machine perfusion
Authors: St Peter S D , Imber C J , Lopez I , Hughes D , Friend P J
Published: March 2003

Background

Non-heart-beating donor (NHBD) livers represent an important organ pool, but are seldom utilized clinically and require rapid retrieval and implantation. Experimental work with oxygenated perfusion during preservation has shown promising results by recovering function in these livers. This study compared sanguinous perfusion with cold storage for extended preservation of the NHBD liver in a porcine model.

Methods

Porcine livers were subjected to 60 min of in vivo total warm ischaemia before flushing, after which they were preserved by one of two methods: group 1 (n = 4), University of Wisconsin (UW) solution by standard cold storage for 24 h; group 2 (n = 4), oxygenated autologous blood perfusion on an extracorporeal circuit for 24 h. All livers were subsequently tested on the circuit during a 24-h reperfusion phase.

Results

Livers in group 1 showed no evidence of viability during the reperfusion phase with no bile production or glucose utilization; they also displayed massive necrosis. Livers in group 2 demonstrated recovery of function by synthetic function, substrate utilization and perfusion haemodynamics; these livers displayed less cellular injury by hepatocellular enzymes. All differences in parameters between the two groups were statistically significant (P < 0·05). These findings were supported by histological examination.

Conclusion

Warm ischaemia for 1 h and simple cold storage (UW solution) for 24 h renders the liver non-viable. Oxygenated, sanguinous perfusion as a method of preservation recovers liver function to a viable level after 24 h of preservation.
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

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 < 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 < 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

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

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

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 > 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 < 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 < 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

Background

The 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.

Methods

From 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.

Results

Fifty-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.

Conclusion

Postoperative 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

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 < 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 < 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

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

Background

Liver 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.

Methods

Data collected from 52 consecutive patients over a 10-year interval were examined to identify best practice in the management of these injuries.

Results

The 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.

Conclusion

Most 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

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

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

Background

Leucocyte 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.

Methods

The 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.

Results

Thirty 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.

Conclusion

A 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.
Okadaic acid suppresses TPA‐induced differentiation by stimulating G1/S transition in human myeloblastic leukaemia ML‐1 cells
Authors: Reinach P. S. , Li T. , Lu L.
Published: March 2003

The association between the phosphorylation status of the retinoblastoma protein, pRb and changes in cell cycle control caused by either protein kinase C (PKC) or protein kinase A (PKA) stimulation was evaluated in human myeloblastic leukaemia ML‐1 cells. TPA‐induced PKC activation resulted in dephosphorylation of pRb and subsequently induced ML‐1 differentiation based on morphological changes and CD14 expression. In the present study, we showed that inhibition of protein phosphatases (PP‐1 and PP‐2a) prevented the TPA‐induced differentiation in ML‐1 cells. Preinhibition of PP‐1 and PP‐2a activities with 1–100 nM okadaic acid dose‐dependently blunted the decrease in the phosphorylation status of pRb obtained with TPA and overrode cell cycle arrest. PKA stimulation with 8‐chlorophenylthio‐cAMP (100 µM) decreased cell proliferation by 65% and the distribution of cells in the G1 phase significantly increased from 38% to 83% concomitant with a 34% decline in the number of cells present in the S phase. In addition, PKA stimulation significantly decreased the pRb phosphorylation status but did not elicit CD14 expression, indicating that cAMP‐induced dephosphorylation of pRb cannot by itself trigger differentiation in ML‐1 cells.
A subset of cells expressing SV40 large T antigen contain elevated p53 levels and have an altered cell cycle phenotype
Authors: Sladek T. L. , Laffin J. , Lehman J. M. , Jacobberger J. W.
Published: March 2003

Cells transformed by the simian virus 40 (SV40) large T antigen (Tag) contain elevated levels of cellular p53 protein. To quantify this relationship, levels of p53 were measured in NIH 3T3 cells that expressed different concentrations of Tag. Using immunoblotting, average p53 levels were shown to increase linearly with Tag concentrations in these cell lines. Single‐cell measurements were also performed using flow cytometry to measure p53 immunofluorescence. Surprisingly, the flow cytometry experiments showed that two distinct cell populations, based on p53 content, were present in cells expressing high levels of Tag. One cell population contained elevated p53 levels. A second population did not contain elevated p53, even though high concentrations of Tag were present in the cells. This latter cell population did not appear to arise because of mutations in either Tag or p53. The two cell populations also had phenotypic differences. In exponentially growing cells, Tag alters the cell cycle distribution (decreases the percentage of G1 phase cells and increases the percentages of S and G2 + M phase cells). This phenotype was maximum in the cell population containing elevated p53. A lesser phenotype was found in the cell population that did not contain elevated p53. These data show, firstly, that cells can express significant levels of Tag and not contain elevated levels of p53 and, secondly, that elevated p53 correlates with the altered cell cycle distribution produced by Tag in growing cells.
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.
A continuum model to analyse spatial cell fluxes from positional labelling data applied to cell migration in oral mucosa
Authors: Barthel D. , Meineke F. A. , Potten C. S. , Loeffler M.
Published: March 2003

Abstract. A novel method is presented which allows the estimation of the velocity of migrating cells from positional 3HTdR labelling data in spatially organized epithelial tissues. In a continuum approach, wave‐like profiles of labelling index (LI) data, which travel away from the basal layer, are followed and compared with experimental LI profiles. The method yields estimates of migration velocity, cell flow, and turnover time. Results for the ventral tongue mucosa in a group of 55 BDF1 mice that were labelled at the same time of the day and culled at different time points within a 24‐h period have been analysed. The results show a strong circadian rhythm in the migration velocity and the related parameters.
Inner and outer worlds: a psychosocial framework for child and family social work
Authors: Schofield Gillian
Published: March 2003

Social workers need a framework for understanding and helping children and families which takes into account the inner world of the self and the outer world of the environment, both in terms of relationships and in terms of practicalities such as housing. It is the capacity of social workers to be aware of and integrate in their practice these different areas of concern which defines the distinctive nature of their professional identity. This paper argues that in order to address both inner and outer worlds, social workers need to use relationship‐based practice at all stages of their professional involvement with families. It considers what this psychosocial approach means in relation to individual case examples, where the assessment of need and the offering of help can only be achieved in the context of a relationship. At a time when social work is being defined in terms of case management and service provision, it is necessary to reflect on traditional social work skills and values in order to defend what the professional social worker offers as a service in herself.
Family centres: a focus for the children in need debate
Authors: Batchelor  , Gould  , Wright
Published: March 2003

The development of child care policy has been characterized by debates organized along various intersecting constructs such as universal vs. selective services and prevention vs. treatment. Family centres, as a site of service delivery, represent a point of intersection of many of these arguments. Their role is contested between protagonists of all positions within the child care policy debates: whether they should be professionally managed, led by service users, provide a service to referred families, or offer a universal resource for local communities. This paper argues that a needs‐led approach to family centre development may supersede the sterile dichotomies of many of these debates. A case study is presented of an evaluation research project, designed to inform a needs‐led family centre policy for an urban unitary social services department. The methodology utilizes an approach combining quantitative analyses of geographical distributions of family need with qualitative presentation of the perspectives of actual and potential centre users, and agency stakeholders. The outcome is a family centre model which, by focusing on need, seeks to transcend the limited oppositions of the child care debates.
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

The 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.
The British Paediatric Surveillance Unit — a pioneering method for investigating the less common disorders of childhood. Report of a seminar held in June 1995
Authors: Hall  , Nicoll
Published: March 2003

The British Paediatric Surveillance Unit (BPSU) of the Royal College of Paediatrics and Child Health is an ‘active’ case reporting scheme set up in 1986 to facilitate the investigation of uncommon childhood conditions of public health and clinical importance in the UK and Ireland. Its methodology involves the monthly mailing of a card containing a menu of up to 12 reportable conditions to all clinically active paediatricians in the British Isles. Respondents either indicate any cases seen in the past month or make a nil return. The BPSU forwards details of respondents reporting cases to the investigators, who when obtain information from the clinician. The menu changes from time to time and studies undergo a rigorous selection process. In 1995, the BPSU held an international seminar to review lessons learned during its first decade which would improve and develop surveillance of paediatric disorders. Over the 9 years to mid‐1995 a total of 34 studies took place (25 completed, nine still in progress) with a high respondent response rate (e.g. 90% in 1994). Under‐ascertainment had been addressed by seeking, in parallel, other sources of cases, e.g. death registrations, laboratory reports, other relevant clinical specialists, and by use of capture‐recapture techniques. Other specialities and countries have since followed the BPSU example providing opportunity for multispeciality and international studies. The latter were valuable, but required careful planning to standardize case definitions and laboratory techniques, otherwise geographical differences in the incidence of study disorders were difficult to interpret. The BPSU has facilitated studies which increased knowledge about a range of disorders and informed national policy decisions. It also increased diagnostic awareness and showed itself able to respond to public health emergencies. Its emulation in further countries will have similar benefits.
Community‐based early intervention: The Coimbra Project (Portugal)
Authors: Boavida J , Espe‐Sherwindt M , Borges L
Published: March 2003

The 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.
Young school children working together: a measure of individualism/collectivism
Authors: Lewis A , Maras P , Simonds L
Published: March 2003

Co‐operation and group working are key aspects of the National Curriculum, reinforced by recent moves towards redefining the primary school curriculum with a greater emphasis on ‘citizenship’. There is little research on individual differences between children’s preferences for group and individual working or young children’s abilities to work in, and generalize from, group experiences. Furthermore, there are no reliable measures of these factors in children. The study reported in this paper was the first stage in research, the overall aim of which was to look at individual and group differences in young children working cooperatively and competitively in groups and alone. The aim of this study was to develop a new measure of individualism/collectivism and the associated factors: sociability and altruism. Some 152 children from two primary schools in England participated in this study. The mean age of the children was 5 years 5 months (range 4 years 11 months to 6 years 9 months). A new measure of individualism/collectivism based on instruments for use with adults was administered to the participating children. Two stable factors, individualism/collectivism and sociability, were identified and were both found to be reliable. The importance of the measure as a tool for use with other methods for evaluating the effectiveness of group work in classrooms is considered.
Early detection of speech and language delays in the Netherlands. The case for integrating primary and secondary prevention
Authors: Maas W
Published: March 2003

The early detection of speech and language delays has been an important feature of the child health services in the Netherlands for some 15 years. During this period ideas about both the purpose of screening and the methods themselves have changed considerably. There are four key outstanding issues: What is the best age to identify children? What screening measures are available? How can we detect speech and language delays in multilingual children? Which groups are best able to detect speech and language difficulties: parents, teachers, playgroup leaders, doctors, nurses, or speech and language therapists? These questions are influenced by social, demographic developments and an increase in the understanding of language delay. This article examines the Dutch solutions to these problems. The conclusion reached is that early language screening can only be part of the answer to early detection both because the available measures are not yet sufficiently accurate and because the growing group of multilingual children (e.g. in Amsterdam more than 50% of the children under the age of 4 years are multilingual) makes the application of specific measures at a population level unworkable. An alternative method is suggested, namely primary prevention by giving information and support to parents, playgroup leaders, doctors, etc.
Assessment of infant physiology and neuronal development using magnetic resonance imaging
Authors: Morgan B. , Finan A. , Yarnold R. , Petersen S. , Horsfield M. , Rickett A. , Wailoo M.
Published: March 2003

Previous work has demonstrated both that there are substantial individual differences in the rate of physiological development, and that infants with risk factors for Sudden Infant Death Syndrome (SIDS) develop more slowly, suggesting that their increased vulnerability may be due to delayed neuronal development associated with compromised development in fetal or early neonatal life. This project aims to test the hypothesis that individual differences in the rate of physiological development of infants correlate with measurable differences in the rate of brain development as assessed by magnetic resonance imaging (MRI).

Sixty infants were recruited to this study in three different groups that are known to have differing rates of physiological development. MRI was performed successfully in 49 cases at 6 weeks of age without sedation. Forty‐one of these cases had full follow‐up (15 normal; 19 IUGR; 11 ‘high risk’). Postnatal physiological development was assessed by measuring age‐related deep body temperature patterns during sleep. Neuronal development was assessed by subjective analysis of MRI images and objective measurements relating to myelination using T1 and diffusion weighted (23 cases) MRI images.

As expected the normal group acquired the adult temperature pattern earlier, but this was not statistically significant. All MRI scan appearances were within normal limits. Ranking cases subjectively in order of maturity revealed no significant pattern. The normal group had a significantly higher myelination score than the IUGR and ‘high risk’ groups (P = 0.001). This trend was also shown by the diffusion weighted myelination score but did not reach statistical significance. No significant differences were seen in both the subjective and objective MRI measurements and development of nocturnal temperature patterns.

The results suggest there may be differences in neurodevelopment between the different groups at 6 weeks of age but these are not linked to late development of temperature patterns. It is therefore unlikely that this related to a global delay in maturation.
Sleeping O2 saturation levels in infants
Authors: Jackson J. A. , Wailoo M. P.
Published: March 2003

Longitudinal recording of O2 saturation during night‐time sleep of 82 infants show significantly more falls below 93% in females and infants of mothers who smoke. Implications are discussed.
Patterns of symptoms in siblings of Sudden Infant Death Syndrome infants
Authors: Wailoo M. , Thompson J. R. , Waite A. J. , Coombs R. C. , Jackson J. A.
Published: March 2003

Longitudinal day‐to‐day recordings of symptoms in the siblings of Sudden Infant Death Syndrome (SIDS) infant show a wide variety of symptoms varying with season and days of years. Implications are discussed.
Deep body temperature changes in twins
Authors: North R. , Jackson J. A. , Wailoo M. P. , Petersen S. A.
Published: March 2003

Twins show differences in physiological maturity within and between twin sets; where one infant is 5‐weeks later than its sibling; while one pair may both be slow but develop together. Zygosity, birth weight and sex may be contributory but not causative factors. How vulnerability to illness may be affected, is discussed.
Experience of respiratory and allergic illness in children attending childcare
Authors: Slack‐Smith Linda M. , Read Anne W. , Stanley Fiona J.
Published: March 2003

Objectives

To describe previous illness for children attending two types of formal childcare (130 family daycare homes and 11 child daycare centres).

Design

A questionnaire was completed by the parents of 846 children, which provided information about previous illness and associated factors. The questionnaire was conducted in Perth, Western Australia.

Results

Of all children, 39% had experienced otitis media, 11% glue ear and 26% allergies; 18% had been diagnosed with asthma; 10% had been admitted to hospital with respiratory illness, and 9% had experienced more than six respiratory conditions in the previous year. Attending centre daycare compared with family daycare was more likely to be associated with some of the previous illness outcomes (more than six respiratory illnesses in the past year, asthma, otitis media and glue ear) but, for all children, the major predisposing factors associated with these illnesses were a family history of atopy or bronchitis.

Conclusions

Children with a history of respiratory illness or otitis media are more likely to be attending centre than family daycare, but family history of respiratory illness is an important risk factor for all children in childcare.
Child psychiatric skills in primary healthcare – self‐evaluation of Finnish health centre doctors
Authors: Heikkinen A. , Puura K. , Ala‐Laurila E.‐L. , Niskanen T. , Mattila K.
Published: March 2003

Objective To study Finnish general practitioners’ (GP’s) perceptions of their child psychiatric skills.

Methods The study sample consisted of physicians (n = 755) working in health centres

situated in the special response area of the Tampere University Hospital, Finland.

They were requested to assess their competence in 16 areas on a four‐step Likert

scale. The response rate was 66.1% (n = 499).

Results Physicians evaluated their child psychiatric skills as inadequate on many issues. The ability to identify depression was poorer the younger the child in question. Only a minority (14%) felt they were well able to identify a depressed infant. Many physicians considered themselves poorly skilled in assessing the relationship between infant and parents (39.8%), in assessing a child’s need for psychiatric treatment (42.7%) and in identifying a child with attention‐deficit disorder (40.7%). A majority (75.9%) rated their skills poor in co‐operating with daycare personnel or school staff in matters concerning a child with conduct disturbance. Only 26.8% could assess the necessity of taking a child into custody. Women gave higher ratings of their skills in identifying depressed infants and in assessing the infant–parent relationship than men, whereas men assessed their skills as better in cases in which there were problems in co‐operation with parents.

Conclusions In order to provide good psychiatric services for children, attention should be paid to the GPs’ child psychiatric skills.
Parents as experts: the position of parents of children with profound multiple disabilities
Authors: De Geeter K. I. , Poppes P. , Vlaskamp C.
Published: March 2003

Background  Parents of children with disabilities are increasingly considered as experts in the field of care. Their expertise can deliver an important contribution towards planning their child's care and education. The law is increasingly taking this factor into consideration. On the one hand, parents already possess an abundance of know‐how; on the other, they still have to increase their knowledge and sometimes their skills too.

Aim  The purpose of this study is to demonstrate the supposition that co‐operation between parents and professionals must meet certain criteria if parents are to receive a proper chance of using their existing knowledge, while at the same time adding to their skills.

Design  A questionnaire was sent to 723 parents of children with profound multiple disabilities enquiring about their relationship with the professionals at their child's school for special education. Subsequently, for one group of parents, a method that recognizes the parents’ expertise and assigns them a formal role was introduced. For the other group, no change in method occurred.

Results  The results demonstrate that parents regard co‐operation in a favourable light. Comparing both groups after a year, the expected effect of the method (a better rating of the co‐operation by the parents) could not be demonstrated. This is probably a result of a problem with the questionnaire used in this study.

Conclusion  Other studies, however, appear to support our supposition.