bluuebunny/crossref_metadata_2025 huggingface dataset:
Employee development:an organizational justice perspective
Authors: McDowall A. , Fletcher C.
Published: January 2004

The present study examined possible links between elements of perceived procedural justice, global fairness perception and attitudinal measures in a review/development context. Organizational justice and possible correlates were reviewed resulting in four hypotheses. Data was collected from 132 employees of the UK arm of an international new media agency via a web‐based survey. It was found that a psychometric instrument based on Gilliland's (Gilliland, S.W., “The perceived fairness of selection systems: an organizational justice perspective”,Academy of Management Review, Vol. 18 No. 4, 1993, pp. 694‐734) ten rules of procedural justice proved a valuable framework in a review and development context once condensed to a smaller number of factors. Of these, two factors relating to interpersonal effectiveness and formal system characteristics respectively were found to be of importance in predicting fairness ratings of the development process. The impact of 360‐degree feedback on procedural justice perceptions was also examined in between group comparisons. Implications for further research into development techniques using organizational justice frameworks and recommendations for practice were discussed.
Perceptions of executive search and advertised recruitment attributes and service quality
Authors: Fish Alan , Macklin Robert
Published: January 2004

This paper reviews the results of an exploratory study designed to examine the perceptions of a random selection of Australian human resource professionals regarding the attributes required of and the quality of service provided by executive search firms (ESFs) and advertised recruitment agencies (ARAs). A total of 109 useable responses were entered and a four‐factor solution was derived employing three factor extraction techniques (principal components analysis (PCA), principal axis factoring (PFA) and maximum likelihood (ML)) for both ESFs and ARAs. Some marginal differences between ESFs and ARAs were identified with respect to required attributes. More importantly the quality of service provided by both ESFs and ARAs was found to be below that required on all factorial attributes and on most individual attributes. Quality differences were found to be significant on all but one factor, and on most individual attributes. In short, the clients of both ESFs and ARAs did not believe the service they received met their requirements. Whilst results should be read with caution due to a relatively low response rate, factorial results do hold up across three factorial extraction techniques and a number of significant results (p<0.001) were derived on paired‐sample t‐tests associated with comparisons of attribute importance and service levels provided. Findings are discussed and the implications for professional practice and future research reviewed.
The use of workplace innovations in Ireland: a review of the evidence
Authors: McCartney John , Teague Paul
Published: January 2004

This paper reviews a number of studies that has examined the use of workplace innovations in the Republic of Ireland. It is argued that despite having quite different sampling and technical properties, the surveys reach similar findings on many matters – the high degree of experimentation with innovative work practices, and the piecemeal nature of workplace reform in most companies for example. Yet disagreement has occurred about how these findings should be interpreted. One view is sceptical about whether the surveys point to meaningful innovations in enterprise level employment systems in Ireland. A less pessimistic perspective suggests that the high level of experimentation occurring on new employment practices should be seen as significant as most organisations adopt an evolutionary approach to workplace reform.
The effects of change programs on employees’ emotions
Authors: Eriksson Carin B.
Published: January 2004

This article focuses on an organization that has spent many years attempting to make fundamental changes to its corporate identity and the ideals on which the organization was built. The objective is to discuss the effects of change programs on employees’ emotions. The study shows that the change programs have resulted in employees exhibiting signs of depression. The employees have lost their trust in the ability to turn the organization; they see no future within the organization; they tend to concentrate on failures instead of successes; and they feel emotionally fatigued. The paper discusses how emotions can become an obstacle to change and how people that are unable to mobilize and act in a changed way become less receptive to discussions about change.
X‐engineering: ex cathedra?
Authors: Collins David
Published: January 2004

This paper offers a critical analysis of X‐engineering – an approach to management, which it is claimed refines and extends business process reengineering (BPR) to offer sustainable benefits to business and to the various communities, which constitute modern business organizations. Noting that academic critiques of guru theorising in general and academic critiques of BPR in particular have done little to exercise the minds of practitioners, the paper offers two critical accounts of X‐engineering. The first follows a familiar concern with the production of X‐engineering as it seeks to debunk the ideas and concepts, which constitute this body of knowledge. The second offers an alternative account of guru theorising, which focuses upon the nature of managerial work and on the consumption of management knowledge as it attempts to develop a line of critique, which can reflect and yet intrude upon the complexities of managerial work. Building upon this analysis of the consumption of guru theorising, the paper seeks to provide counter‐arguments and analysis for the constituencies, which can be expected to bear the brunt of X‐engineering.
Libraries and democracy – management implications
Authors: Byrne Alex
Published: January 2004

Libraries are frequently described in such terms as the “cornerstones of liberty” and as a “democratic institution”. These descriptions offer lofty aspirations which have considerable support among both many librarians and many library users. They are expressed in a number of international and national statements including the IFLA UNESCO Public Library Manifesto. But their fulfilment poses challenges for management. Through modelling the democratic ideal, and defending it in difficult times, libraries and their managers can make a major contribution to the promotion and strengthening of democracy.
Bridging the digital divide: a review of current progress
Authors: Law Derek
Published: January 2004

Observes that electronic information is a part of the established order of things, but almost from the beginning its arrival has created a whole series of wars, accusations and debates on how what is effectively a new system of scholarly communication is to be organised, managed and funded. Looks at the future of scholarly publishing, the “Internet solution”, and the reactions to the new technology of commercial publishers and many other stakeholders in academia.
Informing Parliament
Authors: Brian Rob
Published: January 2004

One significant feature of both old and new democracies is that their Parliaments all have parliamentary library and research services in one form or another. In a totalitarian State, parliamentary libraries appear to be an unnecessary luxury. In the developed and many developing countries the parliamentary library and research service is a vital element. Describes the workings of the library and research service of The Parliament of New South Wales and how the Members’ needs for information are met and measured.
Diffusing information for democracy: an insight of the South African Parliament
Authors: Mostert Janneke
Published: January 2004

Traces the relationship between democracy and access to information among parliamentarians. Investigates the South African parliamentary situation concerning information‐seeking patterns among parliamentarians, as well as their ability to trace information sources. The paper concludes that democracy can only be sustained if information is freely available, and utilised to its fullest potential by the legislators so as to be enabled to actively participate in all the parliamentary functions.
Information skills of undergraduate business students – a comparison of UK and international students
Authors: Varga‐Atkins Tünde , Ashcroft Linda
Published: January 2004

Summarises the results of a study aimed at measuring the information skills of UK and international students pursuing an undergraduate course in business studies. Investigates the hypothesis that international students studying in the UK might be disadvantaged as a consequence of their different educational backgrounds. The recent higher education curriculum shift towards a more learning‐centred approach and an emphasis on independent learning means that information skills are now far more fundamental to a student’s survival and success. No significant difference between the information skills of UK and international students was found. Only about one‐quarter of students performed well on the test, while three‐quarters had inadequate information skills. The majority of students feel negative or neutral towards library and information skills – with international students having a more positive attitude than home students. One of the main sources of negative attitudes cited was the inability to find information without help.
Quality management initiatives in Balme Library: possibilities, challenges and constraints for top management commitment
Authors: Dadzie Perpetua S.
Published: January 2004

The study stressed the important role of top management in an organization and examined the possibilities, challenges and constraints posed to librarians in the provision of quality service to the university community in Ghana. Using a case study approach, the study concluded that top management were fairly committed but were too financially handicapped to fulfill all the strategies and policies outlined.
Management musings 15: looking ahead: how far?
Authors: Line Maurice B.
Published: January 2004

Reflects on short‐term thinking, its long‐term consequences and failure to foresee effects, at the levels of governments, organizations and individuals. In the same vein, considers the constraints on librarians to plan ahead for their libraries.
Continuing professional development and workplace learning 6: HRD and organisational learning
Authors: Smith Ian W.
Published: January 2004

Outlines several models of organisational learning and emphasises the importance of the development of a culture of organisational learning in achieving effective human resource development outcomes.
Please, Marry Me! An Experimental Study of Risking a Joint Venture
Authors: Güth Werner , Ivanova‐Stenzel Radosveta , Tjotta Sigve
Published: January 2004

Empirical studies in family economics usually rely on questionnaires, statistical data or panel data. Here we try to study experimentally some crucial aspects of engaging in a marriage. The female partner can end the relationship or suggest one of two forms of joint venture where more labor division makes her more exploitable by her partner. More specifically, the random profit of the joint venture is allocated by ultimatum bargaining in the case of a full engagement whereas marriage bargaining is procedurally fair in the case of a low engagement. Our treatment variables are her and his outside options representing different attitudes to investing in human capital.
Uncertainty and Endogenous Selection of Economic Equilibria
Authors: Scaramozzino Pasquale , Vulkan Nir
Published: January 2004

This paper presents a model of coordination failures based on market power and local oligopoly. The economy exhibits a multiplicity of Pareto‐ranked equilibria. The introduction of uncertainty generates an endogenous equilibrium selection process, due to a strategic use of information by firms. The economy is more likely to settle on some equilibria than on others. We argue that a full understanding of these robustness criteria is needed before any policy which is intended to help coordinate the level of activity to a Pareto‐dominant outcome can be successfully implemented.
Consumer Substitution Effects under Full Industry Equilibrium
Authors: Steedman Ian
Published: January 2004

To be of practical use comparative statics must be able to compare long‐period equilibria. Such equilibria will almost never have price vectors that are proportional with respect to all prices but one—yet such price vectors are precisely those underlying the usual substitution effect analysis. We consider how this tension may be resolved.
The Temporal Single‐system Interpretation of Marx's Economics: A Critical Evaluation
Authors: Veneziani Roberto
Published: January 2004

The temporal single‐system (TSS) quantitative approach to Marx's economics is analysed. It is shown that TSS models lack a clear equilibrium concept and a coherent (dis)equilibrium methodology, and that Marx's propositions on value and exploitation are tautologically obtained (i) by constructing a money costs theory of value, where by assumption values are equal to market prices, apart possibly from short‐run deviations; and (ii) by arbitrarily assuming that the undefined monetary expression of labour time is positive. In general, the shortcomings of the analytical framework make TSS claims, including the proofs of the law of the tendential fall in the profit rate, unwarranted.
Expression of transforming growth factor‐beta 1 (TGF‐beta 1) in odontogenic cysts
Authors: Piattelli A. , Rubini C. , Fioroni M. , Favero L. , Strocchi R.
Published: January 2004

Aim  To evaluate the positivity to transforming growth factor‐beta 1 (TGF‐beta 1) in different types of odontogenic cysts.

Methodology  A total of 30 radicular cysts (RCs), 27 follicular cysts (FCs) and 28 odontogenic keratocysts (OKCs) were evaluated for immunohistochemical analysis of TGF‐beta 1. TGF‐beta 1 was evaluated in blood vessels, stromal cells (fibroblasts) and pluristratified squamous epithelium. TGF‐beta 1 expression was determined by evaluating the number of positive elements. TGF‐beta 1 expression was determined by evaluating 1000 cells in the pluristratified squamous epithelium (500 in the basal and parabasal layers, and 500 in the superficial layer) and 500 cells (the fibroblasts in the stroma) for each specimen, and counting the number of positive cells. The number of positive vessels was evaluated in 10 high power fields (HPF). The Chi‐square test was used to evaluate differences between the two groups (RC + FC and OKC). A P‐value <0.05 was considered to indicate statistical significance.

Results  A higher and statistically significant positivity was found in the basal–suprabasal epithelial layers (P = 0.0011), superficial epithelium (P = 0.053) and stromal cells (P = 0.0002) of orthokeratotic and parakeratotic OKC as compared with RC and FC.

Conclusions  These differences suggest that control of the cell cycle may be abnormal in orthokeratotic OKCs. These OKCs may have an intrinsic growth potential not present in other cyst types.
Dissolution of pulp tissue by aqueous solution of chlorhexidine digluconate and chlorhexidine digluconate gel
Authors: Okino L. A. , Siqueira E. L. , Santos M. , Bombana A. C. , Figueiredo J. A. P.
Published: January 2004

Aim  To evaluate the activity of various root canal irrigants on bovine pulp tissue.

Methodology  The irrigants tested were: 0.5, 1.0 and 2.5% sodium hypochlorite; 2% aqueous solution of chlorhexidine digluconate; 2% chlorhexidine digluconate gel (Natrosol™); and distilled water as control. Bovine pulp fragments were weighed and placed in contact with 20 mL of each tested substance in a centrifuge at 150 r.p.m. until total dissolution. Dissolution speed was calculated by dividing pulp weight by dissolution time. Statistical analysis was performed using the Kruskal–Wallis test.

Results  Distilled water and both solutions of chlorhexidine did not dissolve the pulp tissue within 6 h. Mean dissolution speeds for 0.5, 1.0 and 2.5% sodium hypochlorite solutions were 0.31, 0.43 and 0.55 mg min−1, respectively. The solvent ability of chlorhexidine solutions was similar to that of distilled water. The results for sodium hypochlorite solutions, chlorhexidine solutions and distilled water were statistically different (P > 0.01).

Conclusions  Both chlorhexidine preparations and distilled water were not able to dissolve pulp tissue. All sodium hypochlorite solutions were efficient in dissolving pulp tissue; the dissolution speed varied with the concentration of the solution.
Resolution of persistent periapical infection by endodontic surgery
Authors: Ferreira F. B. A. , Ferreira A. L. , Gomes B. P. F. A. , Souza‐Filho F. J.
Published: January 2004

Aim  To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms.

Summary  The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where Propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced.

Key learning points

Persistent extraradicular infections are not affected by the action of antimicrobial agents such as irrigants and medicaments used during root canal treatment.

Apical surgery is a suitable alternative for definitive removal of an established refractory infection, promoting repair of difficult cases.
Determination of pH and calcium ion release provided by pure and calcium hydroxide‐containing AHPlus
Authors: Duarte M. A. H. , De O. Demarchi A. C. C. , De Moraes I. G.
Published: January 2004

Aim  To compare in vitro the pH and calcium ion release provided by pure and calcium hydroxide‐containing AHPlus.

Method  Pure and modified AHPlus, the latter containing 5 and 10% (w/w) calcium hydroxide added during spatulation, were used. The material was spatulated and stored in 10 tubes that were 1 cm long and 1.5 mm in diameter, and then immersed in 20 mL deionized water before the materials had set. Ten tubes with zinc oxide and eugenol were used as controls. Four millilitres of water was removed from the flasks after 24 and 48 h, and after 7, 14 and 30 days, and pH and calcium release were measured with a pH meter and by atomic absorption spectrophotometry, respectively. The results obtained at each time point were compared statistically.

Results  A more alkaline pH for AHPlus supplemented with 5 and 10% calcium hydroxide was recorded when compared to pure AHPlus; there were significant differences at 14 and 30 days (P < 0.05). The results of calcium ion release showed no significant difference between pure AHPlus and zinc oxide plus eugenol (P > 0.05). The comparisons between the AHPlus containing 10% calcium hydroxide with AHPlus containing 5% calcium hydroxide, pure AHPlus, zinc oxide plus eugenol demonstrated significant differences (P < 0,05) at all periods. The comparisons between AHPlus containing 5% calcium hydroxide with pure AHPlus and zinc oxide plus eugenol demonstrated significant differences (P < 0,05) at all periods of evaluation.

Conclusions  The addition of 5 and 10% calcium hydroxide to AHPlus cement favoured a more alkaline pH and greater calcium ion release.
A clinical radiographic retrospective assessment of the success rate of single‐visit root canal treatment
Authors: Field J. W. , Gutmann J. L. , Solomon E. S. , Rakusin H.
Published: January 2004

Aim  To determine retrospectively the clinical and radiographic success rate of single‐visit root canal treatment performed in a busy endodontic practice using contemporary techniques of canal cleaning, shaping and obturation.

Summary  Seven hundred and sixty‐eight single‐visit cases, of which 223 presented for a re‐examination appointment ranging from 6 months to 4 years from the day of treatment, were considered. Four endodontists provided examinations for both root canal treatment and re‐examinations. Clinical and radiographic data were used to form an overall impression of the outcomes for each case at the time of re‐examination. Available demographics and treatment information of these 223 cases were compiled for comparison. The number of treatment visits was not determined by a pretreatment diagnosis or a re‐assessment of the pulp status upon entry into the tooth; therefore both vital and necrotic cases, as well as those with and without periradicular pathosis, were included. Statistical analysis was carried out using Chi‐square tests and considered variations in failure rates based on gender, provider, tooth type, position and arch. A t‐test was used to evaluate data on age. The overall success rate was 89.2%. No statistically significant differences were seen based on gender, age, arch or provider. Statistically, anterior teeth were more successful than posterior teeth.

Key learning points 

The success rate of single‐visit root canal treatment in this study is comparable to previous studies of teeth treated in a single visit, as well as those treated in multiple visits, with the placement of interappointment calcium hydroxide.

The provision of single‐visit root canal treatment using modern techniques of root canal cleaning, shaping and obturation can be considered as a viable method for the retention of natural teeth within contemporary treatment planning concepts.

Future studies on the outcomes of contemporary endodontic treatment should be designed and implemented to use prospective, randomized clinical trials in which the re‐examination rate is high.
A COMPARISON OF TWO BOWEL PREPARATIONS IN A COLORECTAL CANCER SCREENING PROGRAMME USING VIRTUAL COLONOSCOPY
Authors: Edwards John Thomas , Foster Noellene Mary , Murray Dianne , Mendelson Richard Marvin , Forbes Geoffrey Millar
Published: January 2004

Aims  The ideal bowel preparation for virtual colonoscopy (VC) is not defined. Our aim was to compare a magnesium citrate + sodium picosulfate (picolax) preparation with a picolax + polyethylene glycol (colonlytely) preparation.

Methods  Asymptomatic average risk subjects aged 50–54 or 65–69 years were invited to participate in a colorectal cancer screening programme using VC. Participants were randomly assigned one of either: ‘X’ prep (n = 67): Mg citrate at 12.00 h and picolax at 16.00 and 19.00 h or ‘Y’ prep (n = 80): 1 L colonlytely at 16.30 h and picolax at 17.30 and 19.30 h. Each was preceded by a low residue diet. At VC, segments of bowel were rated for distension, fluid and faeces by a gastroenterologist blinded to the preparation. All subjects completed a written questionnaire regarding the preparation.

Results  Quality of preparation (each category out of 40)

Distension
Fluid
Faeces
Total

X median
38
37
39
113

Y median
37
37
39
112.5

Tolerability (%)

Taste (%)

X
Y
X
Y

Easy/good
38
27
32
14

Tolerable
49
50
59
71

Slight difficulty
8
18
4
15

Extremely difficult
1
4
0
0

Unable to finish
4
1
4
1

There was no significant difference between the preparations in reported degree of nausea, pain, bloating and headache. The vast majority (> 90%) of subjects reported either no symptoms or a mild degree of these symptoms. Vomiting occurred in 6 and 1.5% of preparation X and Y subjects, respectively. Three X patients (4.5%) had severe adverse events (two syncopal episodes, one severe vasovagal episode and palpitations) requiring discontinuation of the preparation.

Conclusion  Both preparations resulted in satisfactory bowel preparation for reading VC and were generally well tolerated. The picolax/colonlytely preparation is safer.
APPENDICECTOMY FOR REFRACTORY ULCERATIVE COLITIS: PRELIMINARY ANALYSIS OF THE LYMPHOID COMPARTMENT IN THE COLITIS APPENDIX
Authors: Rajaraman Eri
Published: January 2004

Background and aims  We have recently confirmed the negative association between ulcerative colitis (UC) and appendicectomy (appy) but also demonstrate that prior appy is associated with ‘benign’ disease including a reduced need for immunosuppression and/or colectomy (P = 0.015). We hypothize: patients with proximal constipation and distal UC are at increased risk of appendiceal inflammation, which may contribute significantly to on‐going inflammation. We have commenced a study of laparoscopic (lap.) apply for patients with refractory UC, and our initial aims were to confirm correct targeting of the UC patients and to assess appendiceal lymphocyte populations using FACS compared with their peripheral blood, using patients as their own controls. A small number of controls have also been assessed.

Methods  Patients were recruited from the IBD clinic and controls were those admitted to the RBH/RCH with suspected appendicitis. Tissue was taken for histopathology and remaining appendiceal tissue passed through a sieve to release lymphocytes by nonenzymatic means. Cells were washed, counted and viability checked. Staining for FACS analysis was undertaken by standard methods using antibodies to: CD4, CD8, CD3, TCR‐ab, CD19, CD56, CD45RA, CD45RO, and CD69.

Results  Four patients have undergone lap. apply for UC. Mean age at diagnosis 21.25 years, 3/4 female, all patients had rectosigmoid disease confirmed by colonoscopy and histology preoperatively, and 1/4 had AOI. All four patients suffered proximal constipation clinically and radiologically. 3/4 patients were on full treatment (steroids, immunosuppression, 5‐ASA) and 1/4 was on steroids alone. There are six controls: four disease controls [two total colitis (colectomy), two CD (resection)] and two children (mean age 12 months). Histology showed ‘colitis‐type’ inflammation in all four UC patients and was normal in controls. Cell yield from the appendices was a mean of 4 × 106, and viability > 95%. The early FACS data indicate a highly activated appendiceal lymphocyte population (CD69+, 36–75%) in the UC group of which only a minority costain for B or T cell markers.

The over all cell ratio is 0.65–1.3 and there is a majority of naïve, CD45RA+ cells (64–76%). In the controls, the level of CD69 staining is much lower (11–22%) and in the four normal appendices there is a pattern of B cell predominance in the children (ratio 0.24–0.4).

Conclusions  These early observations confirm that the appendix represents an active skip lesion in distal colitis. This is supported by preliminary FACS data, but further patients and controls are required to establish the significance of these cells and their contribution to on‐going inflammation.
APPENDICECTOMY, PRIMARY SCLEROSING CHOLANGITIS (PSC) and ULCERATIVE COLITIS (UC)
Authors: Florin Timothy , Cayzer Catherine , Purdie David , Fawcett Jonathan , Radford‐Smith Graham
Published: January 2004

The relationship between PSC and inflammatory bowel disases (IBD) remains largely unexplained. The most usual IBD phenotype reported with PSC is clinically mild UC pancolitis. Primary sclerosing cholangitis is not improved by colectomy (+ contemporaneous appendicectomy). We have shown that appendicectomy has a strong negative association with UC and a more benign UC phenotype. In animal models, early appendicectomy results in a significant reduction in mucosal Ig production, and in models of colitis the same early intervention protects the animal from the disease. The human appendix has a large complement of activated B cells which may seed the intestine with IgA‐secreting plasma cells in a similar way to these models. IgA will exclude bacteria from the gut epithelium. If there is impaired IgA‐mediated bacterial exclusion, then there may be not only a diluted intestinal mucosal immune response but an increased bacterial load in the portal circulation that requires a second‐line immune response by the liver. Thus, removal of an appendix in patients who are susceptible to UC may predispose to a more benign UC phenotype and PSC.

Hypothesis  Appendicectomy is associated with PSC.

Materials and methods  Review the Brisbane IBD database and interrogation of the Brisbane PSC transplant patient database for appendicectomy, age at surgery, age at diagnosis of UC and PSC, disease phenotype, smoking status (known to influence UC). Appendicectomy prevalence compared with age‐ and cohort‐matched controls randomly selected from a large population‐based twin registry (one twin selected from each pair). At this stage, the control population has been age‐ and cohort‐matched to the Brisbane IBD database only.

Results  The frequency of appendicectomy in patients with PSC prior to diagnosis of either the PSC or IBD is 17 of 67 (25.4%). This is significantly higher than the appendicectomy rate in UC alone 19 of 300 (6.3%), Fisher's exact test, P < 0.0001. The 25.4% rate in PSC is similar to the controls, 235 of 897 (26%), P = 1.0.

Conclusions  The preliminary data support the hypothesis that appendicectomy is more likely in UC patients with PSC. Reported prevalences of appendicectomy in PSC vs. UC without PSC (Erpecum, Gastroenterology 2000, 110:1503 and Griffin & Selby JGH 1999 Supp A121) support our findings. The appendicectomy prevalence may not be different from a matched control population. Further analysis controlling for smoking habit and a control group matched with the combined databases are ongoing.
ASSOCIATION OF SPORADIC MSI‐H COLORECTAL CANCER and SMOKING IN AN AUSTRALIAN POPULATION
Authors: Chong AK , Young JP , Howlett M , Leggett BA , Jass JR
Published: January 2004

Background  High level microsatellite instability (MSI‐H) is present in 15% of all colorectal cancers. Some of these occur in the setting of hereditary nonpolyposis colorectal cancer (HNPCC) and are due to the germline mutations in one of the mismatch repair (MMR) genes hMLH1, hMSH 2, hMSH6 or hPMS2. The remainder comprise sporadic msi‐h tumours, largely attributable to hypermethylation of hMLH1. A recent study has suggested an association between msi‐h tumours and smoking. However, familial and sporadic msi‐h tumours were not differentiated.

Aims  To explore the association between MSI‐H colorectal cancers and smoking in a well characterised cohort of sporadic colorectal cancer patients.

Methods  DNA was extracted from frozen tumour specimens obtained from three centres over an 11‐year period. Accurate family histories were obtained. Subjects with significant family histories, loss of hMSH2 or hMSH6 on immunohistochemistry, or patients under 55 years with loss of hMLH‐1 on immunohistochemistry were considered to have HNPCC and excluded from this study. MSI status was determined using a panel of six microsatellite markers consisting of mononucleotide (BAT26, BAT25, c‐myb T22) and higher order repeats (D5S346, D2S123, MYCL). MSI‐H was defined as instability at two or more markers including at least one mononucleotide repeat. Fifty‐two patients with MSI‐H tumours were identified. This study population was age and sex matched with a control group of 115 patients with microsatellite stable tumours (MSS). Smoking history was obtained from patient records and categorised into two groups (never smoked vs. current or ex‐smokers).

Results  Twenty‐five (48%) patients with MSI‐H cancers were current or ex‐smokers compared with 34 (30%) of patients with MSS cancers (P = 0.014, χ2 test).

Conclusions  In our population of patients with sporadic colorectal cancer, subjects with MSI‐H cancers were significantly more likely to be current or ex‐smokers than those with MSS cancers. Cigarette smoke may predispose to methylation of MMR genes in sporadic MSI‐H cancers.
AUSTRALIAN CROHN'S DISEASE: ANALYSIS OF THE IBD1 FRAMESHIFT MUTATION
Authors: Cavanaugh J , Adams K , Quak E , Bryce M , Rodgers H
Published: January 2004

The inflammatory bowel diseases are amongst the most common complex genetic diseases with a combined prevalence of ∼200 per 100 000. Approximately 10% of affected individuals have an affected family member; disease modelling suggests that there are a number of susceptibility genes interacting with environmental triggers. Genome scans from around the world have implicated > 5 separate genetic localisations; one, the IBD1 locus on chromosome 16, was confirmed in an international collaborative effort1. That study reported a combined multipoint LOD score of 5.79 across 613 families and showed that the locus was Crohn's disease‐specific. This validation preceded the recent isolation and characterisation of IBD1 – the first complex disease gene to be fully described at the molecular level2,3. A number of functional mutations have been described in European and American populations that occur at twice the frequency in affected individuals as in controls. In those populations, linkage evidence offered variable support for the localisation, with the MLS varying from 3.4 to 2.5. In the Australian population however, the MLS is 6.3, suggesting that this gene and its mutations are of greater importance for the expression of the phenotype in Australian patients4. Using > 200 Australian multiplex IBD families, > 100 sporadic cases, and 100 normal individuals, we demonstrate that the IBD1 frameshift mutation occurs in ∼30% of CD cases. This is in contrast to the much lower percentage (ca. 8–10%) reported in European and American populations2,3. We relate these data to age of onset, disease type and site data.
CHANGES IN DUODENAL IRON TRANSPORT GENE EXPRESSION IN RATS FOLLOWING A SWITCH TO AN IRON DEFICIENT DIET OCCUR BEFORE ALTERATIONS IN BODY IRON STORES
Authors: Frazer DM , Wilkin SJ , Becker EM , Murphy TL , Cleghorn GJ , Anderson GJ
Published: January 2004

Introduction and aims  The level of body iron stores is an important factor controlling the rate of intestinal iron absorption but how storage iron influences intestinal iron transport is unclear. A switch from a control diet to an iron deficient diet results in an increase in iron absorption within 5 days; long before any changes in body iron stores or haematological parameters. To investigate the mechanism by which this occurs, we have studied the adaptation in expression of iron transport genes in rat duodenum following the change to an iron deficient diet.

Methods  Adult Sprague–Dawley rats on a control diet were switched to an iron deficient diet and duodenal tissue was taken after 0, 2, 4, 6, 10 and 14 days. RNA was extracted and the expression of iron transport genes was determined by ribonuclease protection assay. Intestinal iron absorption was determined by measuring the retention of an oral dose of 59Fe.

Results  Intestinal iron absorption in rats on a control diet was approximately 10%, but by 6 days following a change to an iron deficient diet it had increased to near maximal levels of approximately 60%. No change in haematological status or hepatic iron stores was evident over this time period. Analysis of duodenal gene expression revealed a large increase in the expression of the brush border ferric reductase DcytB and iron transporter DMT1 (IRE form) within the first 6 days on a deficient diet. The expression of DMT1 (non‐IRE) and the basolateral transporter Ireg1 increased to a lesser extent, but the expression of hephaestin, which is also involved in basolateral iron transport, remained unchanged. The changes in intestinal iron transporter expression parallel the observed increase in iron absorption.

Conclusions  These results demonstrate that the expression of duodenal iron transport genes can be influenced by the amount of iron in the diet before body iron stores and red blood cell production are affected. Further studies will be required to determine whether the mechanism involves local changes in intestinal iron status or involves a systemic signal that is responsive to dietary iron content.
CHARACTERISTICS OF SHIGA TOXIN‐PRODUCING E. COLICAUSING HUS IN AUSTRALIA
Authors: Elliot EJ , Robins‐Browne R , Hogg G ,   O'LOUGHLIN,   THE AUSTRALIAN PAEDIATRIC SURVEILLANCE UNIT (APSU) HAEMOLYTIC URAEMIC SYNDROME STUDY GROUP and CONTRIBUTORS TO THE APSU
Published: January 2004

Infection with Shiga toxin‐producing E. coli (STEC) may be asymptomatic or may result in gastroenteritis or hemorrhagic colitis. Haemolytic uraemic syndrome is a rare complication of gastrointestinal infection with STEC seen mainly in children. It is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. In Europe, North America and Japan, STEC O157:H7 is commonly implicated as the cause of HUS. Shigella dysenteriae is frequently implicated in developing communities.

Aim  To determine the aetiology of HUS in Australia and the type and virulence characteristics of stool pathogens.

Methods  Active, national surveillance for HUS with monthly reporting by paediatricians. Stool culture, serotyping and virulence characteristics (production of Shiga toxin [Stx] 1 & 2 and enterohaemolysin, and carriage of eae gene) of isolates in specialised laboratories.

Results  Between July 1994–December 2000, 134 children with HUS were identified (114 with ‘diarrhoea‐associated’ HUS (20 comprised an outbreak) and 20 with ‘atypical’ HUS. Of 114 cases with gastrointestinal symptoms, 59 were male, mean (SD) age 50 (43) months, range 2–169 months (71% < 5 years). All had anaemia and acute renal failure. Symptoms included diarrhoea (96%), bloody diarrhoea (47%), and vomiting 78%. Stool +/or sera were received from 74 (65%) STEC serotypes from 44 cases included O111:H‐ (26), O113:H21 (5), O157:H‐ (2), O157:H? (2), and one each of O26:H‐, O111:H8, O76:H7, O15:H‐, O130:H11, O1:H7, OR:H9, ONT:H7, ONT:H‐. The most common isolate was O111:H‐, which also caused the outbreak. All O111:H‐ produced Stx1, Stx2 and enterohaemolysin and carried eae. Other isolates had ≥1 but not all these virulence characteristics.

Conclusions  A heterogeneous group of STEC was associated with HUS in Australia and differs from that described elsewhere. In particular, STEC O111:H‐ predominated and no STEC O157:H7 was isolated. These findings have implications for laboratory diagnosis and epidemiological tracing of STEC‐associated infections.
CHOLINERGIC and TACHYKININERGIC NEUROTRANSMISSION IN ADULT TRANSVERSE and SIGMOID COLONIC CIRCULAR MUSCLE
Authors: Stanton MP , Bornstein JC , Hutson JM , Keck J , Southwell BR
Published: January 2004

Aim  There have recently been reports of reduced tachykinin (TK) levels in the colonic circular muscle (CCM) in both children and adults with slow‐transit constipation (STC), suggesting a relationship between TK deficiency and impaired colonic motility. In this study, we have examined the role of TKs and acetylcholine in mediating contraction in the adult colon, in order to determine the relative importance of these excitatory neurotransmitters.

Methods  Isotonic contractile responses to carbachol (cholinomimetic, 10 μm), NKA (neurokinin A receptor agonist, 100 nmol) and electrical field stimulation (EFS) were measured, in transverse (n = 5) and sigmoid (n = 7) colon. EFS was repeated in hyoscine (2 μm); NK1, NK2 and NK3 receptor antagonists (SR 140333, SR 48968, SR 142801, 200 μm); and NOLA (NOS inhibitor, 100 μm). Responses were re‐tested with tetrodotoxin (TTX, 1 mm).

Results  Carbachol and NKA dose‐dependently induced contractions in all specimens. The maximal NKA induced contraction was similar to the maximal carbachol contraction in sigmoid colon, but only 1/4 of the maximal carbachol contraction in transverse colon. EFS alone elicited similar responses in the sigmoid and the transverse CCM (40 and 32% of the maximal carbachol response, respectively). Hyoscine reduced the contractile response to EFS by 2/3 in sigmoid CCM, and by 1/2 in transverse CCM. NOLA caused a small increase in EFS‐induced contraction in both sigmoid and transverse CCM. Individually, the TK antagonists did not produce significant changes in contractile responses elicited by EFS. However, when incubated together, the three TK antagonists produced a large reduction in EFS‐induced contraction, by 1/4–3/4 in sigmoid, and by 1/4 in transverse CCM. EFS‐induced responses were abolished in TTX, suggesting that responses were neuro‐neuronal.

Conclusion  There is both a muscarinic cholinergic and tachykininergic input to contraction in the human colon. Muscarinic input produces at least 1/2 of EFS‐induced contraction. Tachykinins produce at least 1/4 of the contraction in response to EFS in transverse colon. Tachykinins have an even greater input to EFS‐induced contraction in the sigmoid colon.
CLINICAL CHARACTERISTICS and PROGNOSIS OF COLORECTAL SIGNET‐RING CELL CARCINOMA
Authors: Lee Kook Lae , Kim Tae Ho , Lee Dong Ho , Kim Joo Sung , Jung Hyun Chae , Song In Sung
Published: January 2004

Background/aims  Colorectal signet‐ring cell carcinoma (SRCC) is uncommon tumor. The aim of this study was to evaluate the clinical characteristics of primary and metastatic colorectal SRCC.

Methods  We retrospectively examined the records of patients who had undergone surgery for colon cancer and was diagnosed pathologically as colorectal SRCC from 1988 to 2000.

Results  Among 1812 patients with colorectal cancer examined, the number of patients with SRCC was 28 (1.5%); eight patients (28.6%) were metastatic and 20 patients (71.4%) were primary. Male to female ratio was 19:9 and mean age was 44.2 (primary, 42.5; metastatic, 48.3). Mean age of primary SRCC of rectosigmoid area was lower than that of ascending colon (37.4 vs. 54.5). The topographic incidences of primary SRCC were nine patients in rectum; five patients in sigmoid colon; six patients in ascending colon. Metastatic SRCC's were mostly found in splenic flexure and rectosigmoid area. Biopsy positive rate at first was 13 of 18 in primary SRCC, and 3 of 5 in metastatic SRCC. Five cases (55.6%) of primary rectal SRCC showed linitis plastica type. The stage of primary SRCC showed a preponderance of Astler–Coller C2 lesions; 3 (15%) were in B2, 1 (5%) was in C1, 14 (70%) were in C2, 2 (10%) were in D. One and two years survival of primary SRCC were 62.7 and 45.7%, respectively.

Conclusions  Colorectal SRCC is rare among colon cancer and common in young age group especially which is primary or occurs in rectosigmoid area. The primary SRCC's were mostly found in advanced stage, and the prognosis might be poor.
CLINICAL COURSE and RELAPSE RATE IN INTESTINAL BEHCET'S DISEASE
Authors: Kim TI , Kim WH , Lee J‐H , Lee CR , Kang JK , Kim NK , Bang D
Published: January 2004

Behçet's disease is a multisystemic recurrent inflammatory disease. Gastrointestinal tract involvement in Behçet's disease has been identified throughout the alimentary tract and causes diverse symptoms. Various treatment have been utilized to induce or maintain remission. However, little is known about clinical course and prognosis in Behçet's disease with intestinal involvement. The aims of this study were to evaluate the clinical course and relapse rate in intestinal Behçet's disease and to investigate factors that may affect relapse.

Methods  Clinical course and characteristics, including demographic parameters, gastrointestinal symptoms as well as systemic manifestations, laboratory data, endoscopic findings, and treatment strategies for the induction of remission, of 97 patients (49 male, 48 female) with intestinal Behçet's disease were retrospectively reviewed. Cumulative relapse free rate and factors related with relapse were analysed by Kaplan–Meier method and log–rank test, respectively.

Results  The median duration of the relapse free period was 7 months (ranges from 1 to 171 months). One, two, and five year relapse free rates were 41.2, 29.7 and 10.2%, respectively. Sex, clinical subtype of Behçet's disease, symptom and laboratory data at onset, colonoscopic findings, such as distribution of lesions as well as number, size, depth, and shape of ulcer, and initial treatment (medical vs. surgical) did not affect relapse rate. However, large ulcers (> 20 mm) and young age at onset (< 37 years old) were factors significantly related with higher relapse rate (P < 0.05, log–rank test).

Conclusion  High relapse rate in intestinal Behçet's disease was identified. Age at onset and size of the ulcer are factors related with long‐term prognosis of intestinal Behçet's disease.
A PROSPECTIVE RANDOMISED TRIAL COMPARING ARGON PLASMA COAGULATION WITH TOPICAL FORMALIN APPLICATION IN THE TREATMENT OF RADIATION PROCTITIS
Authors: Tam William CE , Moore James WE , Conroy‐Hiller Tiffany A , Schoeman Mark N
Published: January 2004

Argon plasma coagulation (APC) and topical formalin have both been shown to be effective in the treatment of radiation proctitis.

Aim  To compare APC with topical formalin in the treatment of rectal bleeding due to radiation proctitis in a prospective randomised trial.

Methods  Nineteen treatment‐naive patients (17 M) with proven radiation proctitis and troublesome rectal bleeding were randomised to receive day‐case APC or 4% topical formalin. A visual analogue scale (VAS) was used to assess rectal bleeding (0–10; 0 = no bleeding, 10 = severe bleeding) and well being (0–10; 0 = very unwell, 10 = very well). Anorectal function (urgency, incontinence) was assessed with the modified Wexner/Cleveland Continence Score (0–24; 0 = normal anorectal function, 24 = complete incontinence with severe urgency). Hemoglobin (Hb) and transfusion requirements were recorded. Treatment was given at 6‐weekly intervals until rectal bleeding had improved to VAS ≤ 2.5.

Results  [Table, median (range)] The effects of APC and topical formalin were similar, with significant improvement in rectal bleeding after a median of 2 (1–3) treatment sessions. Haemoglobin increased in patients treated with APC. Four patients were transfusion‐dependent before treatment, all of whom did not require transfusions after treatment (three APC, one formalin). Patient well‐being and continence score did not change significantly after either treatment, although a trend was seen in well‐being score after APC. Two patients treated with APC developed minor rectal strictures, which were readily treated with dilatation.

Conclusions  Argon plasma coagulation and topical formalin are equally effective in reducing rectal bleeding from radiation proctitis. Risk of rectal strictures may be higher after thermocoagulation with APC.

APC  Pre‐treatment
Post‐treatment
Formalin  Pre‐treatment
Post‐treatment

Well‐being score
6.8 (5–9.7)
7.5 (5–10)
5.9 (4.9–8.7)
6 (2.5–9.1)

Bleeding score
6 (4–7.6)
1.4 (0–2.5)*
5 (4.6–10)
1.5 (0–2.5)*

Continence score
7.5 (3–18)
7.5 (0–17)
6 (1–17)
6 (1–13)

Haemoglobin (g/L)
120.5 (71–159)
135.5 (82–164)*
143 (82–164)
144 (116–167)

Follow‐up (weeks)
45.5 (22–114)

27 (9–100)

P < 0.05.