bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized prospective comparison of postoperative pain control and respiratory complications following midline or transverse laparotomy for aortic surgery
Authors: Tekkis P P , Krysa J , Chan S , Challiner A , South L M , Andrews S M
Published: March 2003

Background

Transverse abdominal incisions are thought to be less painful and followed by fewer pulmonary complications than midline incisions, but reports remain controversial. This study compared midline and transverse incisions for elective transabdominal aortic aneurysm repair with respect to postoperative pain, respiratory function and pulmonary complications.

Methods

Sixty patients were randomized to midline laparotomy and transverse incisions, and evaluated before and after operation for 7 days at regular intervals. Analgesia was provided via a thoracic epidural and pain scores were recorded by means of a visual analogue scale. Respiratory function (peak expiratory flow rate, forced expiratory volume in 1 s and forced vital capacity) and pulmonary complications were monitored as well as patient characteristics, operating time, blood loss, operative exposure, and length of stay on the intensive care unit (ITU) and in hospital.

Results

The two groups included a similar number of patients (n = 30 per group) and basic characteristics such as age and preoperative risk factors. Linear analogue pain scores were significantly lower in the transverse group of patients (P < 0·001). There was no significant difference between the two groups with regard to postoperative ventilatory function and respiratory complications as well as analgesic requirements, operating time, blood loss, and length of ITU and hospital stay.

Conclusion

The direction of incision does not seem to influence the incidence of respiratory complications. However, a transverse incision in combination with a high epidural analgesia seems to offer better postoperative pain control.
Risk assessment and outcome in endoluminal aortic aneursym repair: effect of the learning curve
Authors: Chataway A , Brown V , Brabdner B , Barnard B , Baranowsky A , Raphael M , Brooks J , Adiseshiah M
Published: March 2003

Background

The aim was to investigate the effect of risk categorization on outcome from endoluminal aneurysm repair (ER) and to note changes in outcome with increasing experience.

Methods

Clinical and operative details of the first 70 patients undergoing ER (1995–1999) were analysed. American Society of Anesthesiologists (ASA) grade and POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score were determined. The cohort was divided arbitrarily into two groups: group 1 included the first 35 patients, and group 2 the second 35.

Results

Median age was 73 (55–93) years; 65 of the patients were men. The overall 30-day mortality rate was seven of 70 (10 per cent). No deaths were directly attributable to the anaesthesia; four deaths were due to myocardial infarction. There was no difference in ASA grade or POSSUM score between the groups. Fourteen patients (20 per cent) were converted to open surgery, nine during the same period of anaesthesia as the ER.

The odds ratio (OR) for conversion comparing groups 1 and 2 was significant, but the OR for total mortality and for mortality in those who had successful ER was not significant.

Conclusion

ASA grading and POSSUM scoring has not changed with time. There was a learning curve, due largely to improvement in surgical technique. Four of the 14 patients undergoing conversion died; only one conversion occurred in the later experience. However, there was no statistically significant difference in total or ER mortality.
Endothelial integrity and nitric oxide synthase sources are better maintained in saphenous vein harvested by a ‘no-touch’ technique
Authors: Tsui J , Souza D , Filbey D , Bomfim V , Baker D , Dashwood M
Published: March 2003

Background

The saphenous vein (SV) is a commonly used conduit in bypass procedures. Early graft occlusion rates are greater than 20 per cent in both infrainguinal vein grafts and coronary artery bypass grafts (CABGs). Contributing factors include adventitial and endothelial damage, which may reduce nitric oxide availability in grafts. Nitric oxide has important vasorelaxant and thromboresistant properties beneficial to graft patency. Conventionally, during SV harvest, the perivascular tissue is stripped and the graft distended. A ‘no-touch’ technique has been described in which the SV is harvested together with a cushion of surrounding tissue without vein distension. This study compared endothelial integrity and the potential role of nitric oxide synthase (NOS) in segments of SV harvested by the two techniques.

Methods

SV was harvested from ten patients undergoing CABG. Distal and proximal ends of the SV were harvested using the no-touch technique, while the middle portion was stripped of the adventitia and distended. Sections of SV were cut and endothelial integrity was assessed with CD31 immunohistochemistry and quantified by morphometric analysis. Putative NOS was identified by reduced nicotinamide adenine dinucleotide phosphate (NADPH)–diaphorase histochemistry and autoradiographic localization of [3H]l-NG-nitroarginine binding.

Results

More dense CD31 staining was seen on the luminal aspect and vasa vasorum of vessels harvested by the no-touch technique. Morphometric analysis revealed a significant reduction in luminal CD31 staining in conventional compared with no-touch grafts (P < 0·05, Student's t test). NADPH staining was almost continuous on the luminal aspect, and was also present in the adventitia of no-touch vessels, compared with poor staining of conventionally harvested vessels. The pattern of NADPH staining corresponded to endothelial cells lining the vessel lumen as well as vasa vasorum and paravascular nerves in the adventitia. Autoradiographic analysis of specific [3H]nitroarginine binding also showed greater binding in the no-touch vessels.

Conclusion

Endothelial integrity is better maintained by the no-touch technique. NOS sources on the endothelium and adventitia are preserved, suggesting that nitric oxide availability is retained by these grafts. This technique may therefore lead to improved early patency rates of SV grafts in bypass surgery.
Radiological intervention to the iliac segments for patients with claudication and coexistent significant infrainguinal disease
Authors: Phillips D , Handa A , Phillips-Hughes J , Boardman P , Perkins J , Hands L , Collin J
Published: March 2003

Background

The policy with regard to patients with lifestyle-limiting intermittent claudication is to investigate with duplex ultrasonography and then to treat suitable lesions in the aortoiliac system with balloon angioplasty with or without stenting. In those with coexistent infrainguinal disease, further management is conservative. The aim of this study was to assess the outcome of iliac intervention in this group of patients.

Methods

Over 30 months 600 patients with intermittent claudication were assessed; 110 subsequently underwent balloon angioplasty (87 aortoiliac and 23 infrainguinal). Of those undergoing aortoiliac angioplasty 47 also had significant infrainguinal disease. These 47 had a median claudication distance of 80 m and median maximum walking distance 180 m. They underwent angioplasty of 61 arterial segments (one aorta, 32 common iliac, 28 external iliac), with 11 stents deployed in eight patients. There were no immediate complications and a technically satisfactory result was obtained in all but one patient. All patients were reassessed at 6 weeks.

Results

The Table gives the findings at 6 weeks.

Fifteen patients (32 per cent) had a pain-free walking distance greater than 450 m and a further two were limited by angina rather than claudication. Overall the 47 patients had a median claudication distance of 270 m and median maximum walking distance of 420 m.

Conclusion

Even in the presence of significant infrainguinal disease, angioplasty in the aortoiliac segments at least doubles the claudication distance in 70 per cent of patients, and appears to be safe. Radiological intervention in these patients is worthwhile.
Treatment of the hostile groin: 5-year follow-up of the obturator foramen bypass
Authors: Coker J , Sobeh M S , Grahn M , Chaloner E J , Ham R J
Published: March 2003

Background

Infection in the groin threatens both life and limb. In recent times virulent organisms, especially methicillin-resistant staphylococci, have proved difficult to treat. The obturator foramen bypass, although performed infrequently, represents an extra-anatomical solution to the ‘hostile groin’. The aim of the study was to examine the primary and secondary graft patency rates in 26 patients (28 procedures) performed in one hospital over 10 years.

Methods

There were 17 men and nine women with mean age of 65 (range 49–78) years. All procedures except one were performed with expanded polytetrafluoroethylene (6 mm in 24 patients; 8 mm in three). Twenty-one patients had critical ischaemia with rest pain or tissue loss. The inflow vessel was the common iliac artery in 25 patients and the lower abdominal aorta in three. The distal anastomosis was to the profunda in two grafts, to the suprageniculate popliteal artery in 24 grafts and to the infrageniculate popliteal in two.

Results

Patency rates were calculated with the Kaplan–Meier life-table method.

There were nine primary failures (five in the first year and the remaining four between 2 and 5 years). All failed bypasses were re-explored. Three of nine bypasses required intraoperative angioplasty of the inflow, and one graft had angioplasty of the distal anastomosis. Six patients eventually had amputations, four above knee and two below knee, one of whom had a patent graft.

Conclusion

The obturator foramen bypass, although technically demanding, is a viable solution in the individual with groin sepsis and ischaemia. Frequently these patients have good calibre vessels above and below the problem groin.
Vein interposition grafting is a safe and durable method of repairing carotid arteries that are not suitable for standard endarterectomy
Authors: Lauder C , Naylor A R , Hayes P
Published: March 2003

Background

Standard carotid endarterectomy (CEA) and patch angioplasty is an effective method of reducing the risk of stroke associated with carotid atherosclerosis. If the posterior wall of the carotid artery becomes excessively thinned following endarterectomy, or the vessel is exceptionally tortuous, this standard approach to repair is not always appropriate. A different approach may also be necessary when an existing carotid patch becomes infected. In a number of these cases the authors have utilized a vein interposition graft to repair the vessel. This study examined the safety and durability of this procedure.

Methods

During the 5-year study, a standard operative protocol was followed including routine shunting and peri-operative monitoring. All data were collected prospectively. Long saphenous vein harvested from the groin was used as a graft. Patients were entered into a regular duplex graft surveillance programme.

Results

Forty patients had a vein graft inserted (4·3 per cent of all CEAs performed). Age, sex and presentation were not significantly different from those in patients undergoing routine CEA. There were no vein graft ruptures or deaths. The 30-day any stroke or death rate was 5 per cent. The operation was not significantly lengthened relative to standard CEA. The median length of follow-up was 29 (range 4–48) months. Five patients required subsequent angioplasty to treat stenosis in the graft of more than 70 per cent; this is significantly higher than with standard CEA (P < 0·001). One patient developed an asymptomatic occlusion. At 1-year follow-up, 11 per cent of patients had a stenosis greater than 70 per cent, and at 2 years this was 6 per cent.

Conclusion

Interposition vein grafts can be used safely to repair the carotid artery when the standard technique does not appear appropriate. There is an increased rate of restenosis in this group and patients therefore require regular duplex surveillance of the graft.
Causes of re-recurrence after polytetrafluoroethylene patch saphenoplasty for recurrent varicose veins (Br J Surg 2000; 87: 1356–60)
Authors: Chandrasekar T S , Balasubramanian S P
Published: March 2003

The Editors welcome topical correspondence from readers relating to articles published in the Journal. Letters should be no more than 250 words in length and should be typed on A4-sized paper in double spacing
Revisiting transtibial amputation with the long posterior flap
Authors: Allcock P A , Jain A S
Published: March 2003

Background

The long posterior flap has been the procedure of choice for transtibial amputation for many years, but recently its theoretical basis has been challenged. This study assessed the results with the long posterior flap for leg amputation.

Methods

A prospective cohort study was performed. All patients who were referred to the Dundee Limb Fitting Centre for leg amputation between 1987 and 1996 had details of diagnosis, investigations, procedure, and both operative and functional outcome recorded contemporaneously.

Results

Some 126 patients required a transfemoral amputation and 445 needed a transtibial procedure. Fifty patients having the transtibial operation, who would otherwise have required a transfemoral amputation, had a medially based flap; the remaining 395 patients underwent a transtibial amputation by the long posterior flap technique. Primary healing was achieved in 317 patients, and 11 amputations healed by secondary intention. Fifty-one patients required a local wedge resection and 16 had a secondary transfemoral amputation.

Conclusion

These results compare favourably with those of other published series. The long posterior flap remains to be bettered for routine transtibial amputation.
Experimental study of the material composition of laparoscopic ports on tumour cell adherence
Authors: Brundell S , Tucker K , Chatterton B , Hewett P J
Published: March 2003

Background

Laparoscopic resection of intra-abdominal malignancies has yet to be widely adopted, partly because of concerns over the possible increase in the rate of port-site metastasis. The aetiology of these is unclear, but the laparoscopic instrumentation used may influence the deposition of tumour cells at the port sites during operation. An in vitro model to examine tumour cell adherence to laparoscopic ports and to port sites was developed to examine this hypothesis.

Methods

A pilot study (study 1) was performed in which six smooth plastic, six ribbed plastic and six metal ports were introduced through the shaved abdominal wall of a cadaveric sheep and suspended in a water-bath containing radiolabelled LIM 1215 human colonic cancer cells for 30 min. Radioactivity on both ports and port sites was measured and the number of cells adherent to each structure was calculated. The study was expanded to include a further 36 smooth plastic ports and 36 metal ports (study 2).

Results

In study 1 metal ports were found to have significantly more adherent cells than plastic ports (P = 0·004), as did ribbed ports when compared with smooth ports (P < 0·05). In study 2 increased numbers of cells were again detected on metal ports (P < 0·001) when compared with plastic ports. Significantly greater numbers of cells were also detected on the sites through which metal ports had passed than on sites through which plastic ports had passed (P = 0·03).

Conclusion

In this model, the use of metal ports as opposed to plastic ports resulted in increased deposition of tumour cells on both ports and port sites.
Medium-term results of permanent sacral nerve stimulation for faecal incontinence
Authors: Kenefick N J , Vaizey C J , Cohen R C G , Nicholls R J , Kamm M A
Published: March 2003

Background

Anal sphincter surgery for faecal incontinence is associated with significant morbidity and a variable outcome. Sacral nerve stimulation may provide a good functional outcome with minimal morbidity. This paper reports the experience in a single centre over 5 years.

Methods

Fifteen consecutive patients (14 women), median age 60 (range 37–71) years, underwent temporary, and subsequent permanent, stimulation. All had incontinence to solid or liquid stool; the aetiology was obstetric injury (seven patients), scleroderma (four), idiopathic (two), fistula surgery (one) and repaired rectal prolapse (one). Median duration of symptoms was 6 (range 2–15) years. Clinical evaluation, endoanal ultrasonography, bowel diary, quality of life questionnaire (Short Form (SF) 36) and anorectal physiological testing were performed before and after stimulation.

Results

Continence had improved in all patients at median follow-up of 24 (range 3–60) months. Eleven patients were fully continent. Episodes of faecal incontinence decreased from median (range) 11 (2–30) per week before stimulation to 0 (0–4) per week after permanent stimulation (P < 0·001). Urgency improved in all patients (median (range) ability to defer less than 1 (0–1) versus 8 (1–15) min; P = 0·01). ‘Social function’ and ‘role-physical’ subscales of the SF36 improved significantly. Mean resting pressure (35 versus 49 cmH2O with temporary stimulation; P < 0·05) and squeeze pressure increment (43 versus 69 cmH2O with permanent stimulation; P < 0·01) increased. Rectal sensitivity to initial distension changed (mean 47 versus 34 ml air; P < 0·05). There were no major complications.

Conclusion

Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when conventional treatment has failed. There is minimal morbidity. The benefit is maintained in the medium term.
Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis
Authors: Oláh A , Belágyi T , Issekutz Á , Gamal M E , Bengmark S
Published: March 2003

Background

Microbial infection of the pancreatic tissue in patients with severe acute pancreatitis increases the morbidity and mortality rates. Colonization of the lower gastrointestinal tract and oropharynx with Gram-negative, but sometimes also Gram-positive, bacteria precedes contamination of the pancreas. The aim of this study was to determine whether lactic acid bacteria such as Lactobacillus plantarum 299 could prevent colonization of the gut by potential pathogens and thus reduce the endotoxaemia associated with acute pancreatitis.

Methods

Patients with acute pancreatitis were randomized into two double-blind groups. The treatment group received a freeze-dried preparation containing live L. plantarum 299 in a dose of 109 organisms, together with a substrate of oat fibre, for 1 week by nasojejunal tube. The control group received a similar preparation but the Lactobacillus was inactivated by heat.

Results

A total of 45 patients completed the study. Twenty-two patients received treatment with live and 23 with heat-killed L. plantarum 299. Infected pancreatic necrosis and abscesses occurred in one of 22 patients in the treatment group, compared with seven of 23 in the control group (P = 0·023). The mean length of stay was 13·7 days in the treatment group versus 21·4 days in the control group (P not significant).

Conclusion

Supplementary L. plantarum 299 was effective in reducing pancreatic sepsis and the number of surgical interventions.
Effect on outcome of early intensive management of geriatric trauma patients
Authors: Demetriades D , Karaiskakis M , Velmahos G , Alo K , Newton E , Murray J , Asensio J , Belzberg H , Berne T , Shoemaker W
Published: March 2003

Background

Despite significant injuries elderly patients (aged 70 years or more) often do not exhibit any of the standard physiological criteria for trauma team activation (TTA), i.e. hypotension, tachycardia or unresponsiveness to pain. As a result of these findings the authors' TTA criteria were modified to include age 70 years or more, and a protocol of early aggressive monitoring and resuscitation was introduced. The aim of the present study was to assess the effect of the new policy on outcome.

Methods

This trauma registry study included patients aged 70 years or more with an Injury Severity Score (ISS) greater than 15 who were admitted over a period of 8 years and 8 months. The patients were divided into two groups: group 1 included patients admitted before age 70 years and above became a TTA criterion and group 2 included patients admitted during the period when age 70 years or more was a TTA criterion and the new management protocol was in place. The two groups were compared with regard to survival, functional status on discharge and hospital charges.

Results

There were 336 trauma patients who met the criteria, 260 in group 1 and 76 in group 2. The two groups were similar with respect to mechanism of injury, age, gender, ISS and body area Abbreviated Injury Score. The mortality rate in group 1 was 53·8 per cent and that in group 2 was 34·2 per cent (P = 0·003) (relative risk (RR) 1·57 (95 per cent confidence interval 1·13 to 2·19)). The incidence of permanent disability in the two groups was 16·7 and 12·0 per cent respectively (P = 0·49) (RR 1·39 (0·59 to 3·25)). In subgroups of patients with an ISS of more than 20 the mortality rate was 68·4 and 46·9 per cent in groups 1 and 2 respectively (P = 0·01) (RR 1·46 (1·06 to 2·00)); 12 of 49 survivors in group 1 and two of 26 in group 2 suffered permanent disability (P = 0·12) (RR 3·18 (0·77 to 13·20)).

Conclusion

Activation of the trauma team and early intensive monitoring, evaluation and resuscitation of geriatric trauma patients improves survival.
Pathological appraisal of lines of resection for bile duct carcinoma
Authors: Ebata T , Watanabe H , Ajioka Y , Oda K , Nimura Y
Published: March 2003

Background

The aim of this study was to determine the most appropriate line of resection for extrahepatic bile duct carcinoma.

Methods

A retrospective review was carried out of 253 resected specimens of extrahepatic bile duct carcinoma. Carcinomas were classified histologically as invasive or non-invasive in addition to assessment of the resection margin.

Results

Tumour was present microscopically at the resection margin in 80 (31·6 per cent) of 253 cases, with 46 showing marginal involvement by non-invasive carcinoma, 20 showing invasive carcinoma at a margin, and 14 showing both. Involvement of the resection margin by invasive carcinoma was encountered only when the margin was shorter than 10 mm, whereas non-invasive carcinoma was encountered even when the margin length reached 40 mm. The observed length of microscopic extension of invasive carcinoma beyond the macroscopically evident tumour mass was limited to 10·0 mm. Median microscopic extension of non-invasive carcinoma beyond the mass was 10 mm (75th percentile 19·5 and 14·5 mm in proximal and distal directions respectively; maximum 52 mm). Margins of 20 mm could be assured to be negative proximally in 89·0 per cent of cases and distally in 93·8 per cent.

Conclusion

For eradication of invasive extrahepatic bile duct carcinoma, a 10-mm margin is required. However, additional removal of any non-invasive component requires a 20-mm margin. These guidelines should be followed in any operation performed with curative intent.
Laparoscopicin situablation of liver cancer with cryotherapy and radiofrequency ablation
Authors: Tait I S , Yong S M , Cuschieri Sir A
Published: March 2003

Background

In situ ablation has potential for the treatment of patients with liver cancer either as a single-modality treatment or in combination with liver resection.

Methods

Laparoscopy and intraoperative ultrasonography was used to target cryotherapy and radiofrequency ablation. Thirty-eight patients with 146 liver lesions were treated between January 1995 and December 2000 using cryotherapy alone (nine patients), combined cryotherapy and radiofrequency (eight), radiofrequency alone (15) and in situ ablation with liver resection (six). Cancers treated were metastases from colorectal tumours (n = 25), hepatocellular carcinoma (n = 5), and neuro endocrine (n = 5), melanoma (n = 2) and renal cell (n = 1) metastases. Complications and survival after in situ ablation were compared with age- and disease-matched controls treated with systemic chemotherapy.

Results

The mean age was 61·6 years. At mean follow-up of 26·6 (range 3–62, median 26) months, 22 patients were alive. Survival was increased following in situ ablation compared with that in controls (P < 0·001). Local recurrence at the ablation site was noted in 12 of 44 lesions following cryotherapy and in 20 of 102 lesions after radiofrequency ablation, and new disease in the liver was found in six of 17 and six of 29 patients respectively. The complication rate was higher with cryotherapy than with radiofrequency ablation (four of 17 versus one of 29). Intraoperative ultrasonography identified 14 new hepatic lesions (10 per cent) not seen on preoperative imaging.

Conclusion

Laparoscopic in situ ablation should include ultrasonography to stage the disease. In situ ablation appears to have a survival benefit and should be considered for the treatment of liver cancer in appropriate patients.
Purine nucleotides modulate proliferation of brown fat preadipocytes
Authors: Potten Christopher , Darzynkiewicz Zbigniew , Sasaki Kohsuke , Wilson S. M. , Barsoum M. J. , Wilson B. W. , Pappone P. A.
Published: March 2003

Abstract. The hypothesis that purine nucleotides and nucleosides affect brown fat preadipocyte proliferation was tested using isolated rat interscapular brown fat preadipocytes in culture. Daily addition of 100 μM adenosine triphosphate (ATP) (n= 4) to cultures enhanced the relative DNA content by 1.5‐fold compared to control cultures (P < 0.05) measured using CyQUANT‐GR fluorescence. Higher concentrations of ATP inhibited growth and 500 (n= 2) or 1000 μM ATP (n= 3) almost completely inhibited growth. ATP (100 μM) did not affect while 250–1000 μM ATP decreased protein content relative to control cultures. Adenosine (100 μM; n= 3) did not affect DNA or protein content, but 500 μM and 1000 μM adenosine suppressed brown adipocyte proliferation and inhibited protein synthesis. Cultured brown adipocytes quickly removed or degraded ATP in the culture media as determined by luciferin–luciferase bioluminescence, suggesting that the inhibitory effects of high ATP concentrations may result from its breakdown to adenosine. The results support the conclusion that ATP promotes and adenosine inhibits brown adipocyte proliferation.
Nuclear chromatin texture and sensitivity to DNase I in human leukaemic CEM cells incubated with nanomolar okadaic acid
Authors: Yatouji S. , Liautaud‐Roger F. , Dufer J.
Published: March 2003

It is now known that the analysis of chromatin texture can be used in oncology as a sensitive detection method, either to define diagnostic classifications or to locate a lesion along a defined trend curve. However, the functional significance of these variations in textural features remains sometimes unclear. Several drugs have been shown to be able to modulate chromatin structure. Among them, the phosphatase inhibitor okadaic acid at low concentration can increase accessibility to DNA in chromatin of carcinoma cells. This paper demonstrates that short exposures (0–3h) to a 10‐nM dose of okadaic acid induced an increased sensitivity to DNase I digestion in human CEM leukaemic cell nuclei and that this sensitization was associated to variations of nuclear texture characteristics, as evaluated by image cytometry. CEM cells treated with okadaic acid for 0–3h displayed changes in chromatin supraorganization with a more homogeneous and fine chromatin texture, as compared to control cells. This suggests that the appearance of an open configuration of chromatin structure as evaluated by biochemical methods corresponds to a more decondensed texture of nuclei measured by image cytometry. Longer exposures (6–24h) of CEM cells to 10nM okadaic acid lead to apoptosis. As reported previously for camptothecin‐treated HL60 cells, okadaic acid‐treated CEM cells display biphasic nuclear chromatin texture changes, i.e. a decondensation phase followed by the appearance of typical apoptotic cells with a smaller nuclear area and a highly condensed chromatin. Finally, using the multidrug‐resistant CEM‐VLB cell line, it was confirmed that these multidrug‐resistant cells also display cross‐resistance to okadaic acid, as this compound was unable to induce either increased DNase I sensitivity, apoptosis, or altered nuclear texture in this particular cell line.
Forecasting the growth of multicell tumour spheroids: implications for the dynamic growth of solid tumours
Authors: Chignola R. , Schenetti A. , Andrighetto G. , Chiesa E. , Foroni R. , Sartoris S. , Tridente G. , Liberati D.
Published: March 2003

The growth dynamics of multicell tumour spheroids (MTS) were analysed by means of mathematical techniques derived from signal processing theory. Volume vs. time trajectories of individual spheroids were fitted with the Gompertz growth equation and the residuals (i.e. experimental volume determinations minus calculated values by fitting) were analysed by fast fourier transform and power spectrum. Residuals were not randomly distributed around calculated growth trajectories demonstrating that the Gompertz model partially approximates the growth kinetics of three‐dimensional tumour cell aggregates. Power spectra decreased with increasing frequency following a 1/fδ power‐law. Our findings suggest the existence of a source of ‘internal’ variability driving the time‐evolution of MTS growth. Based on these observations, a new stochastic Gompertzian‐like mathematical model was developed which allowed us to forecast the growth of MTS. In this model, white noise is additively superimposed to the trend described by the Gompertz growth equation and integrated to mimic the observed intrinsic variability of MTS growth. A correlation was found between the intensity of the added noise and the particular upper limit of volume size reached by each spheroid within two MTS populations obtained with two different cell lines. The dynamic forces generating the growth variability of three‐dimensional tumour cell aggregates also determine the fate of spheroid growth with a strong predictive significance. These findings suggest a new approach to measure tumour growth potential.
Increased cellular hypoxia and reduced proliferation of both normal and leukaemic cells during progression of acute myeloid leukaemia in rats
Authors: Jensen P.Ø. , Mortensen B.T. , Hodgkiss R.J. , Iversen P.O. , Christensen I.J. , Helledie N. , Larsen J.K.
Published: March 2003

The microenvironmental changes in the bone marrow, spleen and liver during progression of the transplantable promyelocytic leukaemia in the Brown Norwegian rat (BNML) have been studied. We used flow cytometry to estimate cellular hypoxia and proliferation based on in vivo pulse‐labelling with a mixture of 2‐nitroimidazole linked to theophylline (NITP) and bromodeoxyuridine (BrdUrd). The leukaemic cells were identified with the RM124 antibody. In rats inoculated with leukaemic cells the fraction of RM124+ cells was significantly increased from day 20 onwards in the spleen and from day 27 in the bone marrow and liver, reaching a level of 65–87% in these organs at day 32. At day 32, the NITP+ fraction of RM124+ cells had increased significantly in the bone marrow and spleen to 88% and 90%, respectively. The corresponding fractions of NITP+ normal cells reached 63% and 65%, respectively. From day 13 to day 32, the DNA‐synthesizing (BrdUrd+) fraction of RM124+ cells in the bone marrow decreased significantly from 52% to 25%, and of normal cells from about 20% to 6%. In the bone marrow and spleen at day 27 and 32, the S‐phase and G2/M‐phase fractions according to DNA content were higher for the NITP+ than for the NITP− cells. This could partly be explained by an impaired cell cycle progression due to hypoxia. Nevertheless, we found indications of leukaemic cells that were simultaneously labelled with NITP and BrdUrd, in the bone marrow and spleen. These latter findings suggest that in contrast to normal cells some of the leukaemic cells can proliferate even during hypoxia, and this subpopulation may consequently renew and expand the leukaemic cell load.
Human glioma PKC‐ι and PKC‐βII phosphorylate cyclin‐dependent kinase activating kinase during the cell cycle
Authors: Acevedo‐Duncan M. , Patel R. , Whelan S. , Bicaku E.
Published: March 2003

Cell cycle phase transition is regulated in part by the trimeric enzyme, cyclin‐dependent kinase activating kinase (CAK) which phosphorylates and activates cyclin‐dependent kinases (cdks). Protein kinase C (PKC) inhibitors prevent cell cycle phase transition, suggesting a fundamental role for PKCs in cell cycle regulation. We report that in glioma cells, CAK (cdk7) is constitutively associated with PKC‐ι. In vitro phosphorylation, co‐immunoprecipitation, and analysis of phosphorylated proteins by autoradiography indicate that CAK (cdk7) is a substrate for PKC‐ι and PKC‐βII hyperphosphorylation. These results establish a role for PKC‐ι and PKC‐βII in the activation of CAK during the glioma cell cycle.
Cell kinetic studies in the murine ventral tongue epithelium: mucositis induced by radiation and its protection by pretreatment with keratinocyte growth factor (KGF)
Authors: Potten C. S. , Booth D. , Cragg N. J. , Tudor G. L. , O'Shea J. A. , Booth C. , Meineke F. A. , Barthel D. , Loeffler M.
Published: March 2003

Abstract. Radiation kills or reduces reproductive capacity of proliferating cells, including stem cells. In the oral mucosae this can result in a decline in the number of cells in the tissue which, if severe enough, will result in the formation of an ulcer when the cellularity essentially reaches zero. We have used histometric measurements of cellularity following exposure to radiation in mouse ventral tongue epithelium as a model for oral mucositis (ulcer development). Here we provide further measurements of cellularity changes in the basal layer and in the epithelium as a whole at various times following 15, 20 or 25 Gy doses. The protective effects of prior treatment with keratinocyte growth factor (KGF) are also investigated. 20 Gy of 300 kV X‐rays has become our standard reference dose and the changes in cellularity seen following this dose are highly reproducible, with minimum values being observed 6 days following irradiation. A higher dose results in a greater reduction of cellularity, although the minimum value also occurs at 6 days. A lower dose (15 Gy) results in a much shallower curve, with a minimum value being observed about 1 day earlier. These changes in cellularity can be related to the less sensitive index of mucositis, namely epithelial thickness. There is also a sharp peak in proliferation about 1 day after the minimum in cellularity, i.e. on day 7. The peak following a lower dose of radiation occurs a little earlier and, following the higher dose, the peak tends to be broader. Previous work and data presented in the preceding paper in this series has shown that KGF, given over a period of 3 days, results in a dramatic increase in epithelial thickness in oral mucosa, including the ventral tongue. As a result of the increased cellularity induced by KGF given before radiation, a delay in the fall in cellularity results, which is the consequence of the increased number of cells in the epithelium at the beginning of the study.
Whispers in the library: a response to Liz Trinder's article on the state of social work research
Authors: Little Michael
Published: March 2003

In this journal, Liz Trinder (1996) helpfully describes three types of social work research. Using examples from studies undertaken by the Dartington Social Research Unit over a 30‐year period, this reply explores the overlap and complimentarity between types of research and suggests ways in which several sources of evidence will lead to a common conceptual framework in UK children's services.
The importance of schools and teachers in child welfare
Authors: Gilligan Robbie
Published: March 2003

The article begins by challenging what is considered to be the relative neglect by child and family social work of the importance for children of school and teachers. Key roles of school in children's lives are conceptualized. School is argued to have potential as an ally for children, a guarantor of basic protection, a capacity builder, a secure base from which to explore the self and the world, an integrator into community and culture, a gateway to adult opportunities and a resource for parents and communities. It is suggested that school can have a special supportive value for children experiencing adversity, including those in state care or under supervision, those whose parents have divorced, and those recovering from abuse or neglect. The implications of the central importance of schools and teachers for child and family social work are discussed with reference to the child as client, work with teachers, work with the wider school and community, and policies in social work agencies and in education and training programmes for social workers and teachers.
It was more difficult than we thought: a reflection on 50 years of child welfare practice
Authors: Stevenson Olive
Published: March 2003

This article discusses the struggle in the years since the Children Act 1948 to establish a sense of confidence and direction in the practice of social work with children and families. It argues that although there were important achievements in the early years and many examples of sensitive and committed practice in the period under review, the service has not fulfilled its early promise. It has failed to develop a coherent, indigenous theoretical framework for practice. The reasons for this and some of its consequences and the opportunities which now arise for professional refocusing are discussed.
Taking mothering seriously: the implications for child protection
Authors: Featherstone
Published: March 2003

This paper explores feminist writings on mothering, highlighting recent writings which argue that it is important for children’s well‐being that mothers are subjects in their own right and that mothers should not just be looked at in terms of how they impact upon children. It argues that exploring how children impact upon mothers allows a fuller understanding of mothers’ stories today and could be helpful for social work practices where particular children are in danger. It calls for fuller debates within social work generally about the complexities of mothering and offers evidence that such debates are being urgently requested by workers and service users alike.
Need as an operating concept: the case of social work with children and families
Authors: Sheppard  , Woodcock
Published: March 2003

Need is widely regarded as central to social work practice, yet is equally regarded as far from unproblematic as a concept. Considerable debate has occurred at two levels: the policy/service delivery level and an abstract conceptual level which considers the nature of need. It is suggested here, however, that between these two levels lies an ‘operating concept’. This focuses on the problem of defining and identifying need in the immediate circumstances of practice. At this level, two concepts of need are put forward: a ‘deficit concept’ and a ‘differentiated concept’. It is argued that the latter provides a more coherent conceptualization of need. In this concept, need is the superordinate concept which contains within it three subconcepts: problems, supports and resources, which are connected. These are analysed, and their potential as a basis for developing a system of need classification which may be used in practice is explored.
Culture, cultural identity, and cultural sensitivity in child and family social work
Authors: O’Hagan
Published: March 2003

Child care legislation, policy, and procedures increasingly emphasize the obligations of social workers to give due consideration to the culture and cultural background of children and their families. This paper explores the implications of those obligations. It seeks the meaning of these terms, and critically examines meanings attributed to them. There are many obstacles in the way of fulfilling these specific statutory obligations in child and family social work: there is a history of neglect, confusion, and negativity towards culture in social work literature, and a current attempt to subsume culture within the concept of ethnicity; racism has often been regarded as a more significant issue than culture; the cultural heritage of clients and their families has been perceived as oppressive, and culture has been misinterpreted to explain and to tolerate unacceptable behaviour. Other disciplines, for example anthropology, sociology, and cultural studies, perceive culture and cultural identity differently. They have much to offer social work. The paper provides a definition of culture and cultural identity which reflects much of what has been learnt in the literature generally. It should contribute towards an enhancement of cultural sensitivity, and a fulfilment of statutory obligations relating to culture in child and family social work.
Developing critical social work in theory and in practice: child protection and communicative reason
Authors: Spratt  , Houston
Published: March 2003

This paper argues that a critical analysis of the ideologies that inform contemporary child care has been missing from the ‘re‐focusing debate’. Such an analysis points up the necessity of reasserting a critical social work position in order to provide a basis for reconstructing practice and engaging with other social actors and their ideologies in an open and creative fashion compatible with Habermas’ aspiration of ‘communicative reason’.
Mental health of parents with young children in Hong Kong: the roles of parenting stress and parenting self‐efficacy
Authors: Kwok  , Wong
Published: March 2003

This study aimed to explore the sources of parenting stress and the mental health of parents with kindergarten and primary school children in Hong Kong. It also examined the intervening effects of parenting self‐efficacy on mental health of parents. Results indicated that parents who perceived their children as more demanding, less acceptable and less reinforcing had more parenting stress. Those who found their parental roles to be more restrictive also had more parenting stress. Lastly, parenting self‐efficacy moderated the effects of parenting stress on the mental health of parents. Cultural and social factors were put forward to explain these findings and suggestions were made towards reducing the parenting stress experienced by parents with younger children in Hong Kong.
Sharing the care: the qualities sought of social workers by foster carers
Authors: Fisher  , Gibbs  , Sinclair  , Wilson
Published: March 2003

Given that foster carers are a scarce resource it is essential that every effort is made to retain their services. This paper considers the role played by social workers in this endeavour. The results reported here form part of larger study, involving seven local authorities, concerned with the wider issues of supporting foster placements. The paper describes the qualities sought of social workers by foster carers and discusses the relationship between these qualities and the likelihood that carers will continue fostering. It was found that carers are highly satisfied with the job of fostering, are committed to it and view social workers as a vital source of support. Promoting good relationships between social workers and foster carers is therefore an important element in any strategy that aims to retain good foster carers.
Overcoming barriers to effective practice in child care
Authors: Randall J. , Cowley P. , Tomlinson P.
Published: March 2003

This paper describes the work of three Action Learning Sets – two groups of child care social workers and one group of health visitors. Given the substantial investment in child care research and its dissemination, we wanted to examine barriers to effective practice from the vantage point of workers themselves. Our core question was: ‘What can we do about the things that get in the way of effective practice?’ The method, based on that of ‘co‐operative inquiry’, sought to engage front‐line practitioners as active collaborators in the research. While several of the barriers can be seen as part of the common predictable experience of professionals working in large public sector organizations, a key message is the importance of re‐invigorating models of supervision that can sustain high quality practice. What emerges is a contemporary picture of the pressures on child care workers and of the struggles to make sense of professional roles in different organizational landscapes. We are committed to evidence‐based practice, practice that is derived from the best knowledge available. We would simultaneously stress the importance of ‘holding environments’ to promote effective learning. Our experience suggests that Action Learning offers a constructive method for encouraging such environments and facilitating better practice.
Constructing women in child protection work
Authors: Scourfield J.B.
Published: March 2003

This paper is based on an ethnographic study of the occupational culture of a social work team in the UK. It is a discussion of some key aspects of social workers’ construction of women as clients. Data were collected from observation of routine case talk, reading of case files and in‐depth interviews with social workers. The conclusion of the research is that three defining discourses can be identified in the culture of the social work office: women as oppressed, women as responsible for protection, and women as making choices.
Everybody needs good neighbours: an evaluation of an intensive project for families facing eviction
Authors: Hill Malcolm , Dillane Jennifer , Bannister Jon , Scott Suzie
Published: March 2003

This paper presents details of a largely qualitative evaluation of an intensive multi‐method Project, with a residential component, which aims to help families facing eviction to overcome their housing‐related difficulties. The families served by the Project had a host of other problems related to parenting, with child care and protection issues, addictions and mental health difficulties figuring prominently. Just over half the referrals came from the local authority housing services, with nearly all the remainder coming from the social work department. The majority of families made good progress, but in some cases it proved harder to have an impact on parenting than on tenancy‐related matters. Nevertheless, the Project was deemed to have helped some families stay together or be reunited, resulting in substantial financial savings for social work services. Crucial ingredients were good management, stable staff, shared ‘ownership’ by other agencies, a repertoire of challenging methods, and a holistic approach.
Using the ‘Looking After Children’ dimensions to collect aggregate data on well‐being
Authors: Bailey Sue , Thoburn June , Wakeham Hilary
Published: March 2003

The Department of Health has funded the development of a set of schedules for collating information on and monitoring the progress of children looked after by local authorities. An additional aspiration underlying official encouragement of the use of these ‘Looking After Children’ (LAC) materials was that they would provide aggregate data to feed into national and local policy and planning. Progress on this aim has been slow, in part because instruments designed to aid practice in individual cases have not adapted easily to the hoped for dual role, and in part because completion rates have been patchy and often poor. This paper describes an action research project designed to use the children's reviewing system to collect aggregate data on the LAC dimensions of well‐being. It comments on the viability of this method of aggregate data collection as well as locating the information on a cohort of 96 children in the context of other studies, and debates about whether the state can be a ‘good parent’.