bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of early antigen BZLF1/ZEBRA protein of Epstein–Barr virus can predict the effectiveness of antiviral treatment in patients with post‐transplant lymphoproliferative disease
Authors: Oertel Stephan H. , Anagnostopoulos Ioannis , Hummel Manfred W. , Jonas Sven , Riess Hanno B.
Published: March 2003

Summary.  Epstein–Barr virus (EBV)‐associated B‐cell lymphoproliferations may arise in solid organ transplant recipients. In these patients, an insufficient control of EBV‐infected B cells commonly occurs. Antiviral treatment against EBV may represent a causal, relatively low‐toxic treatment option. Treatment with foscarnet, an inhibitor of viral‐DNA polymerase, in three patients with EBV‐associated post‐transplant lymphoproliferative disease (PTLD) after heart (n = 2) and heart/kidney transplantation (n = 1), who did not respond to, or were not eligible for reduction of immunosuppression, resulted in complete remission (48+, 27 and 15 months respectively). Response of PTLD to antiviral treatment correlated with the expression of lytic phase antigen BZLF1/ZEBRA protein, an early antigen of lytic EBV‐activity, in the biopsied PTLD specimens.
Haemophagocytic lymphohistiocytosis: proposal of a diagnostic algorithm based on perforin expression
Authors: Aricò Maurizio , Allen Michaela , Brusa Simona , Clementi Rita , Pende Daniela , Maccario Rita , Moretta Lorenzo , Danesino Cesare
Published: March 2003

Summary. Haemophagocytic lymphohistiocytosis (HLH) is a rare, fatal disorder of early infancy. Mutations of the PRF1 gene have been identified in a subset of patients. However, the distinction between the different genetically determined and environmental subtypes of the disease remains a major issue to be solved. This may result in delayed or inappropriate application of bone marrow transplantation (BMT). We propose an algorithm that uses a combination of three rapid laboratory tests, i.e. perforin expression by peripheral lymphocytes, assessment of the behaviour of the 2B4 lymphocyte receptor and natural killer (NK) cell activity, to identify the different subgroups of HLH. In 19 patients diagnosed according to current criteria, we tested perforin expression, 2B4 receptor function and NK cell activity. PRF1 mutations were found in all seven patients showing absent perforin expression. In one male with abnormal behaviour of the 2B4 receptor, SH2D1A mutation confirmed the diagnosis of X‐linked lymphoproliferative disease. Four patients with normal NK cell activity had evidence of associated infections. Of the seven with impaired NK cell activity, two had a probable genetically determined subtype of HLH and five appeared as sporadic, infection‐associated cases. Improving the diagnostic approach may restrict the use of BMT, the only recognized curative treatment, to HLH patients with a documented poor prognosis while patients with milder disorders may be treated less intensively. Our flow chart could also lead to better selection of patients for specific gene analysis.
Induction of the CD163‐dependent haemoglobin uptake by macrophages as a novel anti‐inflammatory action of glucocorticoids
Authors: Schaer Dominik J. , Boretti Felicitas S. , Schoedon Gabriele , Schaffner Andreas
Published: March 2003

Summary.  Highly efficient systems remove toxic and pro‐inflammatory haemoglobin (Hb) from the circulation and local sites of tissue damage. Macrophages are major Hb‐clearing cells; CD163 was recently recognized as the specific haemoglobin–haptoglobin scavenger receptor (HSR). We show that dexamethasone strongly induced the specific uptake of haemoglobin–haptoglobin complexes, CD163 mRNA transcription (13‐fold) and cell surface expression (10‐fold) by human macrophages. In contrast, the TH2‐cytokine interleukin 4 (IL‐4) completely suppressed functional CD163 expression. The range of functional receptor modulation reached a factor of 100 after 4 h of macrophage–ligand interaction. Based on these results, we propose the augmentation of Hb clearance as a novel anti‐inflammatory action of glucocorticoids.
Nephrotic proteinuria associated with high‐dose pamidronate in multiple myeloma
Authors: Desikan Raman , Veksler Yuliya , Raza Syed , Stokes Barry , Sabir Tariq , Li Zu Jun , Jagannath Sundar
Published: March 2003

Summary. Five patients receiving increased dose or frequency of pamidronate beyond the recommended dose (90 mg/monthly) exhibited nephrotic proteinuria (range 3·96–24 g/24 h). On dose reduction or discontinuation, three of these patients showed decreased proteinuria to normal levels (< 1 g/24 h), and proteinuria decreased to 4·5 g/24 h from a peak of 24 g/24 h in one patient. One patient on haemodialysis (hence not evaluable) had proteinuria of 2 g/24 h and elevated creatinine levels. One other patient continued to show elevated creatinine levels (272·8 µmol/l). Renal biopsies obtained in two patients revealed focal segmental glomerulosclerosis.
Bone marrow angiogenesis in multiple myeloma: effect of therapy
Authors: Kumar Shaji , Fonseca Rafael , Dispenzieri Angela , Lacy Martha Q. , Lust John A. , Witzig Thomas E. , Gertz Morie A. , Kyle Robert A. , Greipp Philip R. , Rajkumar S. Vincent
Published: March 2003

Summary. Recent studies have demonstrated that angiogenesis has a role in haematological malignancies, including multiple myeloma. Multiple myeloma is characterized by inevitable relapse after standard or high‐dose chemotherapy. To study the effect of chemotherapy on bone marrow angiogenesis in patients with multiple myeloma, we used two methods to evaluate bone marrow angiogenesis in patients with newly diagnosed multiple myeloma, comparing these findings with those from bone marrow obtained after standard chemotherapy. Before therapy, an increased degree of bone marrow angiogenesis and a high bone marrow plasma cell labelling index (PCLI) were predictive of poorer survival. As estimated by microvessel density (MVD), the median survivals for patients with low‐grade, intermediate‐grade and high‐grade angiogenesis were 77, 30 and 14 months respectively. After therapy, the MVD did not change significantly. However, when patients with at least a partial response were considered separately, they showed a decrease in MVD. Post‐therapy PCLI was predictive of survival, but post‐therapy MVD was not. There was good correlation between angiogenesis estimated by visual grading and that determined by MVD assessment. We conclude that the degree of bone marrow angiogenesis is a prognostic marker in patients with multiple myeloma and does not decrease significantly after therapy.
Imatinib mesylate has limited activity against the central nervous system involvement of Philadelphia chromosome‐positive acute lymphoblastic leukaemia due to poor penetration into cerebrospinal fluid
Authors: Takayama Nobuyuki , Sato Norihide , O'Brien Stephen G. , Ikeda Yasuo , Okamoto Shin‐ichiro
Published: March 2003

Summary. A 32‐year‐old woman with relapsed Philadelphia chromosome‐positive acute lymphoblastic leukaemia was treated with imatinib mesylate (formerly STI571), a selective inhibitor of BCR/ABL tyrosine kinase. Although the initial marrow response was good and stably maintained, she subsequently relapsed with extensive infiltration of leukaemic cells into the central nervous system (CNS). After controlling her CNS disease with additional intrathecal chemotherapy, we measured the concentration of imatinib in cerebrospinal fluid (CSF) and blood simultaneously. The concentration of imatinib in CSF was about 92‐fold lower than that in blood. These results suggest that imatinib poorly penetrates the blood–brain barrier and has limited activity against CNS leukaemia.
Reliability of point‐of‐care prothrombin time testing in a community clinic: a randomized crossover comparison with hospital laboratory testing
Authors: Shiach Caroline R , Campbell Bonnie , Poller Leon , Keown Michelle , Chauhan Nikhil
Published: March 2003

Summary. The success in achieving therapeutic international normalized ratio (INR) targets in the control of warfarin using a whole‐blood point‐of‐care testing (POCT) monitor (CoaguChek) in a community clinic was compared with hospital laboratory coagulometer prothrombin time (PT) testing in a randomized crossover study. Forty‐six patients were randomized into two groups. At each visit, capillary blood was taken for the POCT monitor and venous blood for the laboratory coagulometer. In Group 1, for 6 months, dosage was based on the CoaguChek and for the second 6 months on the coagulometer. In the second group, the order was reversed. Dosages were determined using the dawn ac computer programme. Success was assessed by the percentage of time patients were maintained within the INR targets. Agreement between laboratory and monitor INR, and patient satisfaction were also assessed. Results with the POCT monitor compared well with the hospital coagulometer. Time in INR target range between the groups was similar, with 60·9% on the POCT monitor and 59·3% with the laboratory coagulometer in Group 1 and in Group 2, respectively, 64·3% and 63·4% with no significant difference in mean INR. An INR above 4·0 gave some discrepant results. International Sensitivity Index calibrations of the two test systems indicated that the INRs were dependable. Patient questionnaires showed greater satisfaction with community POCT monitoring.
Treatment results of aggressive B non‐Hodgkin's lymphoma in advanced age considering comorbidity
Authors: Sonnen Ruth , Schmidt Wolf‐Peter , Kuse Rolf , Schmitz Norbert
Published: March 2003

Summary. The aim of this retrospective single institution study was to investigate the long‐term outcome of sequential chemotherapy (CHT) and radiotherapy (RT) in patients ≥ 70 years old, considering the International Prognostic Index (IPI) for high‐grade non‐Hodgkin's lymphoma (NHL) and comorbidity. The study involved 106 patients aged 70 years and above, treated between 1986 and 1998, for diffuse large B‐cell NHL (DLBCL); 57% had localized disease (stage I or II) and 43% had advanced disease (stage III or IV). All patients received four to six cycles of CHOP (cyclophosphamide, hydroxy‐daunorubicin, oncovin, prednisone) CHT at 14–21 d intervals, followed in 69 cases by extended‐field or involved‐field RT. Complete response rate was 65%; overall survival probability at 5 years was 41% in all stages. Five‐year survival was 62% in patients with localized and 12% in advanced disease. There were 3% treatment‐related deaths. The 5‐year survival rate was 70% in patients with IPI low risk, 46% with low‐intermediate risk, 28% with high‐intermediate risk and 0% with high risk. Patients with cardiac problems and advanced disease were more susceptible to treatment‐related toxicity. Patients with hypertension showed a high rate of vinca alkaloid‐associated polyneuropathy. Most patients with localized DLBCL achieved long‐term remission after CHT and RT regimens despite advanced age and frequent comorbidities. Advanced disease increased the risk for treatment‐related complications and efficacy of treatment seemed limited.
Suppressed intrinsic fibrinolytic activity by monoclonal anti‐beta‐2 glycoprotein I autoantibodies: possible mechanism for thrombosis in patients with antiphospholipid syndrome
Authors: Takeuchi Rie , Atsumi Tatsuya , Ieko Masahiro , Amasaki Yoshiharu , Ichikawa Kenji , Koike Takao
Published: March 2003

Summary. β2‐glycoprotein I (β2GPI) bears the epitope(s) for autoimmune anticardiolipin antibodies (aCL) frequently present in patients with antiphospholipid syndrome (APS). β2GPI is involved in coagulation and fibrinolytic systems, including inhibition of contact activation. Coagulation factor XII is an initiator of intrinsic coagulation and also of intrinsic fibrinolysis. We investigated the effect of aCL (= anti‐β2GPI antibodies), regarding intrinsic fibrinolysis using autoimmune monoclonal anti‐β2GPI antibodies derived from a patient with APS or from an NZW/BXSB‐F1 mouse. We developed a chromogenic assay system to determine intrinsic fibrinolytic activity. The reaction was activated by kaolin in the euglobulin fraction. Exogenous β2GPI slightly suppressed intrinsic fibrinolytic activity of the euglobulin fraction from normal plasma. Human monoclonal anti‐β2GPI antibody (EY2C9) and mouse monoclonal anti‐β2GPI antibody (WBCAL‐1) in the presence of β2GPI decreased the activity. In this system, the suppression remained significant in the presence of an excess of exogenous activated factor XII. Euglobulin fractions from APS patients' plasma paralleled low activities of intrinsic fibrinolysis compared with those from healthy subjects. Our results suggest that β2GPI and anti‐β2GPI antibodies suppress intrinsic fibrinolytic activities. This suppression was not only due to inhibition of factor XII activation but was also related to function of activated factor XII (XIIa). These phenomena partly explain the mechanisms of thrombosis in APS.
Etoposide‐mediated deregulation of the G2M checkpoint in myeloid leukaemic cell lines results in loss of cell survival
Authors: Higginbottom Karen , Cummings Michele , Newland Adrian C. , Allen Paul D.
Published: March 2003

Summary. The K562 leukaemic cell line expresses an inherent survival signal due to the antiapoptotic properties of Bcr‐abl, which is, in part, mediated by prolonging the G2M checkpoint and allowing DNA repair mechanisms to operate post genotoxic insult. Arrest of the cell cycle is mediated by retaining an inactivating state of phosphorylation of cyclin‐dependent kinase 1 (Cdk1) on tyrosine 15. Our data confirmed that cell survival in K562 was promoted by cell cycle arrest at G2M in response to the genotoxin etoposide. There was no predicted cell cycle arrest in Bcr‐abl‐positive derivative cell lines of K562 that did not survive the same genotoxic insult but, paradoxically, Cdk1 tyrosine phosphorylation was enhanced to a higher extent compared with the parental cell line where arrest of the cell cycle was observed. To ascertain that this was not an anomaly of the derivative lines, HL60 cells were treated with concentrations of etoposide that induced arrest of the cell cycle or apoptosis. Only HL60 cells that subsequently underwent apoptosis elicited the same effect of increased Cdk1 tyrosine phosphorylation. It is proposed that the augmented tyrosine phosphorylation status of Cdk1 is associated with the abolition of cell survival, in addition to the previously reported induction of cell cycle arrest in myeloid cell lines.
Granulocyte colony‐stimulating factor administration upregulates telomerase activity in CD34+ haematopoietic cells and may prevent telomere attrition after chemotherapy
Authors: Szyper‐Kravitz Martine , Uziel Orit , Shapiro Hava , Radnay Judith , Katz Tami , Rowe Jacob M. , Lishner Michael , Lahav Meir
Published: March 2003

Summary. Hematopoietic reconstitution could be associated with premature ageing of the transplanted cells and a high frequency of myelodysplastic syndrome and secondary leukaemia. Telomere length decreases with cell divisions and age, and at a crucial length it is associated with chromosomal instability and cell senescence. Telomerase is a reverse transcriptase enzyme that adds nucleotides to chromosomal ends. Most somatic cells lack telomerase activity yet haematopoietic stem cells retain low levels of telomerase. Some studies have found that chemotherapy and stem cell transplantation lead to the accelerated shortening of telomere length. As granulocyte colony‐stimulating factor (G‐CSF) is routinely used in the mobilization of stem cells for transplantation, we evaluated its effects on telomerase activity and regulation, and on telomere dynamics, in normal donors and selected lymphoma patients. Administration of G‐CSF increased telomerase activity in CD34+ haematopoietic cells compared with controls. In marrow‐derived CD34+ cells, telomerase activity increased sevenfold, compared with a 14‐fold increase in peripheral‐blood‐mobilized CD34+ cells. A parallel increase in the expression of human telomerase enzyme reverse transcriptase RNA and protein kinase C α occurred. In addition, G‐CSF administration to five lymphoma patients after consecutive courses of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy, resulted in telomere length preservation or elongation, as opposed to marked attrition in patients who did not receive growth factors. We conclude that the in vivo administration of G‐CSF prevents or attenuates telomere attrition associated with chemotherapy administration. This attenuation may contribute to the preservation of telomere integrity inG‐CSF‐primed transplanted stem cells.
Expression of co‐stimulatory molecules on acute myeloid leukaemia blasts may effect duration of first remission
Authors: Whiteway Alastair , Corbett Tim , Anderson Robert , Macdonald Ian , Prentice H. Grant
Published: March 2003

Summary. Many solid tumours have been shown to lack expression of either of the immune co‐stimulatory molecules CD80 (B7·1) or CD86 (B7·2), which is thought to be one of the ways in which tumours may escape immune recognition. We have examined the surface expression of CD80, CD86, human leucocyte antigen (HLA) class I and II, CD11a, CD54, and CD58 on the blast cells from patients with acute myeloid leukaemia (AML) at presentation. CD80 was only rarely expressed on AML blasts and, in those leukaemic cells expressing CD80, the level of expression was low. In contrast, expression of CD86 was detected on the AML blasts in more than half of the samples tested and, in some cases, the level of expression was equivalent to that of mature monocytes and activated B lymphocytes. The percentage of leukaemic blasts expressing CD86 was higher in the M4 and M5 French–American–British (FAB) types, and expression of CD11a and HLA class II was higher in the M4 FAB type. There was no difference in expression of CD80, CD54, CD58, or HLA Class I between different FAB subgroups. There was no significant difference in duration of first remission with expression of CD80, CD86, CD11a, CD54 or HLA class II. However, when expression of CD80 and CD86 were considered together, a significantly longer duration of remission was found. We suggest that these molecules may play a role in immunosurveillance, resulting in prolonged remission in some patients treated for AML.
l‐arginine levels are diminished in adult acute vaso‐occlusive sickle cell crisis in the emergency department
Authors: Lopez Bernard L. , Kreshak Allyson A. , Morris Claudia R. , Davis‐Moon Linda , Ballas Samir K. , Ma Xin‐liang
Published: March 2003

Summary. Paediatric studies have demonstrated that l‐arginine (l‐arg), the precursor to nitric oxide, is diminished in vaso‐occlusive crisis (VOC). This study aimed to determine whether l‐arginine levels are altered in adult VOC in the emergency department. Plasma l‐arg and nitric oxide metabolite (NOx) levels were obtained in adult VOC patients presenting to the emergency department. Fifty patients had significantly low plasma l‐arg (29·78 μmol/l ± 11·21, P < 0·05 vs steady‐state control = 41·16 μmol/l ± 5·04) and significantly low plasma NOx (12·33 μmol/l ± 10·28, P < 0·05 vs steady‐state control = 25·2 ± 2·6 µmol/l). Neither l‐arg nor NOx levels could predict VOC clinical course.
Burkitt's and Burkitt‐like lymphoma in children and adolescents: a review of the Children's Cancer Group Experience*
Authors: Cairo Mitchell S. , Sposto Richard , Perkins Sherrie L. , Meadows Anna T. , Hoover‐Regan Margo L. , Anderson James R. , Siegel Stuart E. , Lones Mark A. , Tedeschi‐Blok Nicole , Kadin Marshall E. , Kjeldsberg Carl R. , Wilson John F. , Sanger Warren , Morris Erin , Krailo Mark D. , Finlay Jonathan L.
Published: March 2003

Summary. Historically, the survival of children and adolescents with Burkitt's and Burkitt‐like lymphoma had been poor. Recently, short and intensive chemotherapy appears to have improved disease outcome. We therefore reviewed the results of four successive Children's Cancer Group trials conducted on 470 children with disseminated Burkitt's and Burkitt‐like lymphoma. Of the patients studied, the median age was 8 years (0–21 years), the male:female ratio was 4:1, 58% had lactate dehydrogenase (LDH) ≥ 500 IU/l, 23% had M2 or M3 bone marrow (BM), and 12% demonstrated central nervous system involvement. In a multivariate analysis, the 4‐year event‐free survival (EFS) in patients ≥ 15‐years‐old compared with < 15‐year‐old was 34 ± 7 versus 59 ± 2% (P < 0·05), the 4‐year EFS of M2/M3 compared with M1 BM was 38 ± 5 versus 63 ± 3% (P < 0·001), and the 4‐year EFS with LDH ≥ 500 IU/l compared with LDH < 500 IU/l was 49 ± 3 versus 71 ± 4% (P < 0·001). Furthermore, patients treated on the most recent protocol, which was short and more intensive, had a significantly improved survival compared with those on previous trials (4‐year EFS 80 ± 6 versus 54 ± 2%, P < 0·001). In summary, the outcome for childhood Burkitt's and Burkitt‐like lymphoma has recently improved with the use of short and intensive B‐cell non‐Hodgkin's lymphoma‐directed therapy.
A pilot study of antithymocyte globulin (ATG) in the treatment of patients with ‘low‐risk’ myelodysplasia
Authors: Killick Sally B. , Mufti Ghulam , Cavenagh Jamie D. , Mijovic Alex , Peacock Janet L. , Gordon‐Smith Edward C. , Bowen David T. , Marsh Judith C. W.
Published: March 2003

Summary. We report 30 ‘low‐risk’ patients with myelodysplasia (MDS) (defined as < 10% bone marrow blasts) who were treated with antithymocyte globulin (ATG). In total, 20 patients were evaluable at the study end‐point (response to treatment at 6 months). The diagnosis in these 20 patients was refractory anaemia (RA) in 13, RA with excess blasts in four, and RA with ringed sideroblasts in three. Median age was 54·5 years (range, 31–73 years). There were two cases of secondary MDS. The bone marrow was hypocellular in eight cases and cytogenetics were abnormal in four cases. All patients received lymphoglobuline (horse ATG; Sangstat, France) at a dose of 1·5 vials/10 kg/day for 5 d. The treatment was well tolerated. Three patients in the study died (disease progression, invasive aspergillosis and lung carcinoma respectively); 10 out of 20 evaluable patients (50%) responded to treatment and became transfusion independent; eight out of 13 (62%) patients with RA responded. The median duration of response was 15·5 months (2–42+ months) at the time of analysis.
Outcome of autologous transplantation for mantle cell lymphoma: a study by the European Blood and Bone Marrow Transplant and Autologous Blood and Marrow Transplant Registries
Authors: Vandenberghe Elisabeth , Ruiz de Elvira Carmen , Loberiza Fausto R. , Conde E , López‐Guillermo A. , Gisselbrecht C. , Guilhot F. , Vose Julie M. , Biesen Koen van , Rizzo J. Douglas , Weisenburger Dennis D. , Isaacson Peter , Horowitz Mary M. , Goldstone Anthony H. , Lazarus Hillard M. , Schmitz Norbert
Published: March 2003

Summary. Mantle cell lymphoma (MCL) has an aggressive clinical course with a median survival < 3 years and is incurable with conventional chemotherapy. A large multicentre study with adequate follow‐up may clarify the role of significant factors affecting outcome in autologous stem cell transplantation for MCL. Patients receiving an autologous transplant for MCL between 1988 and 1998, and reported to the European Blood and bone Marrow Transplant (EBMT) registry or Autologous Blood and Marrow Transplant Registry (ABMTR), were included. Expert haematopathology review was required on all identified patients. Disease and transplant details were requested from the transplant centres, and the final cohort of patients with verified pathology, adequate clinical information and follow‐up was analysed. One hundred and ninety‐five patients were included in the analyses (149 EBMT, 46 ABMTR) with a median follow‐up of 3·9 years. The 2 year and 5 year overall survival were 76% and 50%, and progression free survival was 55% and 33% respectively. Disease status at transplant was the most significant factor affecting survival: patients with chemosensitive disease but not in first complete remission (CR1) were 2·99 times (95% CI: 1·66–5·38, P < 0·001) more likely to die than patients transplanted in CR1. Autologous transplantation probably improves survival in patients with MCL especially if performed in first CR.
Dynamic graciloplasty for severe anal incontinence
Authors: Christiansen J , Rasmussen O Ø , Lindorff-Larsen K
Published: March 2003

Background

The surgical options for the treatment of anal incontinence where standard procedures have failed include transposition of striated muscles, primarily gracilis and gluteus maximus, and implantation of artificial sphincters. Due to a high proportion of fatigue-prone fibres in striated muscles, the results of transposition without stimulation have been disappointing. This study presents the results of stimulated graciloplasty in 13 patients with severe anal incontinence in whom other surgical procedures had failed.

Methods

The gracilis muscle was transposed around the anal canal according to a previously described technique. Eight weeks later the intramuscular electrodes were implanted into the gracilis at the site of the nerve entry and a neurostimulator was placed in a subcutaneous pocket in the abdominal wall. The patients were followed from 7 to 27 months.

Results

Six patients obtained satisfactory continence and five showed marked improvement. Two patients were considered failures. Rectal evacuation problems occurred in three patients, in one so severe that the patient, in spite of satisfactory continence, considered the treatment a failure.

Conclusion

Dynamic graciloplasty is a viable option in carefully selected patients with severe anal incontinence where other methods have failed.
Late results of paraoesophageal hiatus hernia repair with fundoplication
Authors: Luostarinen M , Rantalainen M , Helve O , Reinikainen P , Isolauri J
Published: March 2003

Background

Most published reports on results of surgical treatment for paraoesophageal hiatus hernia have been based on patient questionnaires, and seldom included endoscopy or barium meal examinations.

Methods

Eight pure and 14 mixed-type paraoesophageal hernias were evaluated a median of 37 (range 2–241) months after surgical repair. An antireflux procedure was done in 19 cases. Before operation all had endoscopy or barium meal (20 and 19 patients respectively); after operation 19 had endoscopy and 12 also had barium meal examination. Oesophageal 24 h pH monitoring was done in five cases before surgery, and in 11 afterwards.

Results

Preoperative symptoms of reflux were reported by 18, and were often accompanied by dysphagia, postprandial vomiting or epigastric pain. Symptoms improved after operation, and 21 of the 22 patients were satisfied with the result. At follow-up examination, a recurrent hernia was found in eight of the 19 patients examined. Four of these hernias were sliding, two were mixed type and two purely paraoesophageal.

Discussion

Recurrence of symptoms was associated with persistence of reflux rather than hernia recurrence. Concomitant antireflux procedure is recommended in all operations for mixed-type hiatus hernia, but it should also be considered for purely paraoesophageal hernia if reflux cannot be excluded before operation, or if retro-oesophageal dissection is needed.
In vivo assessment of the influence of cold preservation time on microvascular reperfusion injury after experimental small bowel transplantation
Authors: Massberg S , Gonzalez A P , Leiderer R , Menger M D , Messmer K
Published: March 2003

Background

This study describes the impact of prolonged cold storage on microvascular reperfusion injury of transplanted rat small bowel isografts.

Methods

In vivo fluorescence microscopy was used to assess intestinal microcirculation after 6, 12, 18 and 24 h of cold (4°C) ischaemia in University of Wisconsin solution and 20–90 min of reperfusion. Sham-operated animals served as controls.

Results

Whereas 6 and 12 h of ischaemia did not affect functional capillary density of the intestinal graft mucosa, villous perfusion was significantly impaired after 18 and 24 h of cold preservation. Similarly, microvascular perfusion of circular and longitudinal muscle was not affected after 6 h, but deteriorated following prolonged cold ischaemia. Leucocyte–endothelial cell interaction in submucosal venules was significantly enhanced after 6 h of ischaemia with peak values after 12 and 18 h. A progressive reduction of lymphatic capillary drainage indicated an ischaemia time-related deterioration in graft function.

Conclusion

The results provide evidence that leucocyte–endothelial cell interaction in submucosal venules of the transplanted intestine is a primary step in the manifestation of reperfusion injury following short periods of cold ischaemia.
Popliteal vein reflux reduces the healing of chronic venous ulcer
Authors: Brittenden J , Bradbury A W , Allan P L , Prescott R J , Harper D R , Ruckley C V
Published: March 2003

Background

The relationship between deep and superficial venous reflux and healing of venous ulceration by non-operative compression therapy has not been studied previously.

Methods

A total of 155 patients with chronic venous ulcers underwent duplex ultrasonography before treatment with compression bandaging at a hospital-based venous clinic.

Results

At 24 weeks, 104 (67 per cent) of ulcers had healed. There was no significant difference in the pattern of either deep or superficial venous reflux between healed and non-healed ulcers except with respect to the popliteal vein. In healed ulcers, 39 scans (38 per cent) indicated competence of the above-knee popliteal vein compared with five (10 per cent) in the non-healing group (P < 0·001, χ2 test). Similarly, 43 scans (42 per cent) showed below-knee popliteal vein competence in the healed ulcers compared with only five (10 per cent) performed in legs remaining ulcerated (P < 0·001, χ2 test).

Conclusion

Popliteal vein incompetence is an indicator of poor response to compression therapy for venous ulceration.
Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection
Authors: Sánchez-Bueno F , Garcia-Marcilla J A , Perez-Flores D , Pérez-Abad J M , Vicente R , Aranda F , Ramirez P , Parrilla P
Published: March 2003

Background

Gastric cancer has a poor prognosis. The aim of this study was to determine the influence of several clinicopathological variables on outcome in a series of 297 Western patients undergoing surgical resection for gastric adenocarcinoma.

Methods

The results were analysed retrospectively and prognostic factors were identified in a univariate and Cox proportional hazards regression model. Mean patient age at the time of operation was 61·9 years; 65·7 per cent were men. Mean follow-up was 7·8 (range 1–15) years. Of the 297 patients undergoing surgery, 70 per cent had subtotal gastrectomy, 26·3 per cent underwent total gastrectomy and 3·7 per cent had proximal gastrectomy.

Results

The overall survival rate was 38·9 per cent at 5 years. In the univariate analysis, survival-related factors were weight loss (P < 0·05), abdominal mass (P < 0·01), dysphagia (P < 0·001), type of gastrectomy (subtotal gastrectomy versus total gastrectomy, P < 0·001), intention of resection (curative versus palliative resection, P < 0·001), tumour site (P < 0·001), histopathological grade (low versus high grade, P < 0·05), tumour diameter less than 3 cm (P < 0·001), degree of gastric wall invasion (P < 0·001), degree of lymph node invasion (P < 0·001) and stage of the neoplasia (P < 0·001). Other variables had no significant influence. In the multivariate analysis, degree of gastric wall invasion, lymph node invasion, tumour size and dysphagia at presentation were the only independent prognostic variables.

Conclusion

From these data it was possible to derive a prognostic index with which patients could be classified as at low, intermediate or high risk.
Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma
Authors: Shimada M , Takenaka K , Fujiwara Y , Gion T , Shirabe K , Yanaga K , Sugimachi K
Published: March 2003

Background

The aim of this study was to clarify the risk factors for morbidity as well as to establish an optimum surgical strategy for hepatocellular carcinoma (HCC).

Methods

The risk factors linked to postoperative complications were analysed in 388 patients over a 10-year period, according to the kind of operative procedure.

Results

Stepwise regression analysis revealed that the most important factors related to postoperative morbidity were: age, creatinine level and the histological grade of fibrosis for the bisegmentectomy; the presence of diabetes mellitus, blood urea nitrogen level, the indocyanine green dye retention rate at 15 min and blood loss for the segmentectomy; the presence of diabetes mellitus and blood loss for subsegmentectomy; the presence of diabetes mellitus, the aspartate aminotransferase level, and the total operating time for resection less than subsegmentectomy.

Conclusion

The most important risk factors were not always related to liver function tests, but instead to other coexisting conditions such as diabetes mellitus and operation stress including operating time and blood loss. Therefore, any future treatment strategy of hepatic resection for HCC should make every effort both to evaluate coexisting conditions carefully and to reduce operative stress as far as possible.
Continuous antibiotic treatment for experimental abdominal sepsis: effects on organ inflammatory cytokine expression and neutrophil sequestration
Authors: Mercer-Jones M A , Hadjiminas D J , Heinzelmann M , Peyton J , Cook M , Cheadle W G
Published: March 2003

Background

Tumour necrosis factor (TNF) α and interleukin (IL) 1β are produced in the lung after peritonitis and may contribute to neutrophil-mediated organ injury. It was hypothesized that, during experimental peritonitis, continuous rather than intermittent antibiotic therapy would reduce lung expression of TNF-α and IL-1β messenger RNA (mRNA) and neutrophil sequestration.

Methods

After caecal ligation and puncture, mice received either intermittent or continuous cefoxitin, or continuous metronidazole or aztreonam. Cytokine mRNAs were determined by reverse transcription differential polymerase chain reaction and lung neutrophil content by myeloperoxidase (MPO) assay.

Results

Continuous cefoxitin reduced median (interquartile range (i.q.r.)) lung IL-1β mRNA expression ((ratio to β-actin): continuous 0·18 (0·14–0·34), intermittent 0·46 (0·44–0·49), saline 0·43 (0·38–0·53), P < 0·05) and median (i.q.r.) lung MPO content (continuous 22·5 (9·7–40), intermittent 65 (57·5–76), saline 47 (41–64), P < 0·05) compared with intermittent therapy and saline controls. Continuous infusion was also associated with reduced bacteraemia (P < 0·05) but not serum TNF-α or endotoxin levels. Both continuous metronidazole and aztreonam reduced lung MPO concentration (P < 0·05) and TNF-α and IL-1β mRNA expression (P < 0·05) compared with those in saline controls. These effects were dependent on a reduction in the number of susceptible bacteria rather than serum TNF-α or endotoxin levels.

Conclusion

The stimulus for organ inflammatory cytokine production and neutrophil sequestration during peritonitis is the level of bacteraemia present, which is more effectively controlled with continuous antibiotic therapy.
Comparison of computed tomography and duplex imaging in assessing aortic morphology following endovascular aneurysm repair
Authors: Thompson M M , Boyle J R , Hartshorn T , Maltezos C , Nasim A , Sayers R D , Fishwick G , Bell P R F
Published: March 2003

Background

Computed tomography (CT) has been used to assess patients following endovascular aneurysm repair to determine the need for secondary endoluminal or operative procedures. This prospective study compared CT and duplex imaging to evaluate aneurysm morphology following endoluminal aortic grafting.

Methods

Twenty patients were evaluated at regular intervals following successful endoluminal aneurysm repair. CT and duplex scanning were compared in their ability to determine aneurysm and aortic diameter, the presence of perigraft extravasation (endoleaks) and technical defects in the endograft.

Results

In 20 patients who were assessed 6 months after operation, duplex imaging identified four endoleaks (two early, two late; one proximal, three distal). In three cases, the aneurysm diameter progressively increased after operation. In patients with a thrombosed aneurysm sac, the aneurysm regressed at a median of 0·40 (range 0·13–0·8) cm per year. The CT findings were similar (median regression 0·43 (range 0–1·0) cm per year), although CT was unable to predict the site of the leak as accurately as duplex imaging. CT demonstrated that the diameter of the juxtarenal aorta increased following endografting.

Conclusion

Duplex imaging is a less invasive, less costly alternative to CT in the follow-up of patients after endoluminal aortic surgery. Increase in size of the aneurysm sac following endovascular aneurysm repair strongly suggests the presence of an endoleak.
Anatomical variants during axillary dissection
Authors: Kutiyanawala M A , Stotter A , Windle R
Published: March 2003

Background

This study was done to document the variations encountered in the anatomy of the axilla because of the difficulty they can cause during dissection.

Methods

A record was made of the anatomy of the axilla in 100 patients with breast cancer who had an axillary dissection.

Results

The variants from the described normal included double axillary veins, abnormal bands of muscle from the latissimus dorsi stretching across the axilla and a medial lying thoracodorsal nerve.

Conclusion

Damage to important structures in the axilla during axillary dissection can be minimized with an awareness of the possible anatomical variations.
Vaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis
Authors: Poen A C , Felt-Bersma R J F , Cuesta M A , Meuwissen S G M
Published: March 2003

Background

Anal endosonography is an established technique in the evaluation of anorectal disease. However, it is sometimes difficult to visualize the anterior part of the sphincter complex and anal endosonography may be impossible when anal pain or stenosis is present. The aim of this study was to evaluate vaginal endosonography in the diagnosis of faecal incontinence and perianal sepsis.

Methods

Anal and vaginal endosonography were performed in 56 women with faecal incontinence (n = 36) or perianal sepsis (n = 20). The technique and pelvic floor anatomy were described, anal sphincter measurements with anal and vaginal endosonography were compared, and the additive value of vaginal over anal endosonography in the diagnosis of faecal incontinence and perianal sepsis was assessed.

Results

The pelvic floor was clearly imaged with vaginal endosonography. However, after a relatively short learning curve it was still not possible to image the anal sphincters in three of 28 patients. Except for external anal sphincter thickness, which was significantly lower, all anal canal structure measurements were greater with vaginal than with anal endosonography. Concerning the diagnosis of either faecal incontinence or perianal sepsis, vaginal endosonography added important information in comparison with anal endosonography in 14 (25 per cent) of 56 patients.

Conclusion

Vaginal endosonography provides reliable images of the anal sphincters in an undistorted fashion, thereby increasing the diagnostic yield of faecal incontinence and perianal sepsis in 25 per cent of patients. Therefore, endosonographists should become acquainted with this technique.
Laparoscopic drainage of liver abscesses
Authors: Tay K H , Ravintharan T , Hoe M N Y , See A C H , Chng H C
Published: March 2003

Background

The mainstay of the management of liver abscesses has been intravenous antibiotics and radiologically guided percutaneous drainage. However, not all abscesses are treated successfully in this way, and some require surgical drainage. Laparoscopic drainage of liver abscesses may be an alternative to open surgical drainage.

Methods

Twenty consecutive patients with liver abscesses treated by laparoscopic drainage in combination with intravenous antibiotics were studied prospectively. Fifteen had had failed percutaneous drainage previously.

Results

There were 13 right lobe and seven left lobe abscesses ranging from 6 to 25 cm in diameter. Mean operating time was 38 min. Seventeen patients were drained successfully. Three patients developed recurrent symptoms of which two resolved with conservative measures, but one required a second laparoscopic procedure. There were no intraoperative or other postoperative complications in the 20 patients. Follow-up ranged from 5 to 12 months.

Conclusions

Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics, is a safe and viable alternative in all patients who require surgical drainage following failed medical or percutaneous treatment, and in those with large abscesses.
Carcinoma of the head of the pancreas arising from the uncinate process
Authors: Birk D , Schoenberg M H , Gansauge F , Formentini A , Fortnagel G , Beger H G
Published: March 2003

Background

Carcinoma located in the uncinate process (CUP) of the pancreatic head is considered to be rare. Exact epidemiological data, however, are not available because the series published so far consist of fewer than ten patients. The purpose of this prospective study was to evaluate the clinical appearance of CUP and to compare findings with those of patients with carcinoma in the ventral aspect of the pancreatic head (VPC), which represents the most frequent localization.

Results

Some 39 (8 per cent) of 506 evaluated patients suffered from CUP. Mean age was 63·3 years. The most frequent complaints were upper abdominal pain (n = 32) and weight loss (n = 35). Jaundice was seen in only five patients and was never an early symptom. The level of CA19-9 was raised in 33 patients. The best diagnostic procedure to detect CUP was computed tomography (CT) (sensitivity 93 per cent), whereas endoscopic retrograde cholangiopancreatography was not useful (sensitivity 21 per cent). Vascular involvement was significantly (P < 0·01) more common in CUP (n = 19) than in VPC (48 versus 19 per cent). This finding and the fact that most patients with CUP were diagnosed at a late stage with distant metastasis or severe vascular involvement present (n = 21) are responsible for the significantly lower rate of operation (n = 25) (64 versus 92 per cent, P < 0·05) and the significantly shorter median survival time (5 versus 11 months, P < 0·05).

Conclusion

Patients with CUP have a poor prognosis as a result of the lack of early symptoms (jaundice) and early vascular involvement due to the proximity of the uncinate process to the mesenteric root. A raised level of CA19-9, together with weight loss and/or upper abdominal pain, should prompt CT.
Simple laparoscopic gastropexy as the initial treatment of paraoesophageal hiatal hernia
Authors: Agwunobi A O , Bancewicz J , Attwood S E A
Published: March 2003

Background

Paraoesophageal hiatal hernia is relatively rare compared with sliding hernia but it is associated with serious complications. Its clinical management presents a major challenge since many patients are elderly and unfit for a formal repair. This paper describes a laparoscopic method aimed at reducing the complications of open repair.

Methods

Thirteen patients treated for symptomatic paraoesophageal hernia were included in the study. Eleven patients successfully underwent a simple laparoscopic modification of the Boerema anterior gastropexy. Two patients required an open anterior gastropexy through a minilaparotomy because of incomplete reduction of the hernia. A five-puncture technique was used. The stomach and any other contents of the sac were reduced into the abdomen and the stomach was firmly fixed to the fascia of the anterior abdominal wall with Gore-Tex sutures tied extracorporeally.

Results

There was one postoperative death due to spontaneous intrathoracic perforation of the posterior aspect of the stomach in an elderly woman with severe cardiac disease. There was no postoperative morbidity. Eight of the ten patients who went home following laparoscopic gastropexy have remained asymptomatic on follow-up. In three patients, two in the laparoscopic group and one in the open group, symptoms recurred.

Conclusion

While anterior gastropexy has a significant incidence of recurrent herniation, the clinical results of this simple procedure in a high-risk population support its use as the initial surgical option.
Randomized placebo-controlled trial of local anaesthetic infusion in day-case inguinal hernia repair
Authors: Oakley M J , Smith J S , Anderson J R , Fenton-Lee D
Published: March 2003

Background

This study investigated the efficacy of local anaesthetic wound perfusion following day-case inguinal hernia repair.

Methods

Seventy-two patients entered a randomized controlled trial with three patient groups: group 1, pump containing bupivacaine; group 2, pump containing normal saline; and group 3, control group without a pump. All patients had a Lichtenstein hernia repair together with ilioinguinal and iliohypogastric nerve blocks and were prescribed oral analgesia. Postoperative pain was assessed over 5 days using a visual analogue scale.

Results

Patients who had a local anaesthetic infusion had significantly less pain than either the placebo or control groups. This was greatest during the first 48 h (day 1, P = 0·028 and 0·011 respectively; day 2, P = 0·012 and 0·037 respectively).

Conclusion

A portable infusion pump for the delivery of local anaesthetic reduced pain after day-case inguinal hernia repair.
Total vascular exclusion of the liver for the resection of lesions in contact with the vena cava or the hepatic veins
Authors: Berney T , Mentha G , Morel Ph
Published: March 2003

Background

This study reviews experience with total vascular exclusion of the liver (TVE), for the resection of tumours in contact with the hepatic veins or the vena cava.

Methods

A retrospective study was carried out of 366 hepatic resections performed over 13 years. Forty-one patients (11 per cent) were operated under TVE.

Results

Twenty-four patients were operated for malignancy and 17 for benign disease. Major hepatectomy was performed in 26 patients and minor hepatectomy in 15. The technique allowed vascular repair in eight patients. Median intraoperative blood transfusion was 2 (range 0–26) units; 14 patients required none. Median duration of TVE was 29 (range 5–58) min. No deaths occurred. Significant complications occurred in ten patients. Morbidity was related to the malignant nature of the lesion, duration of surgery and volume of blood transfusion, but not to duration of TVE.

Conclusion

TVE facilitates resection of critically located hepatic lesions with safety and minimal blood loss. Within the limits of 1 h, prolonged TVE does not increase morbidity.