bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic management of acute peritonitis
Authors: Navez B , Tassetti V , Scohy J J , Mutter D , Guiot P , Evrard S , Marescaux J
Published: March 2003

Background

The presence of peritonitis has previously been considered to be a contraindication for the laparoscopic approach because of the theoretical risk of malignant hypercapnia and toxic shock syndrome. The aim of this retrospective study was to demonstrate that laparoscopy is feasible, safe and efficient in cases of peritonitis.

Methods

From January 1990 to July 1995, 231 patients had a laparoscopy for acute peritonitis in two centres (91 appendicular peritonitis, 69 gastroduodenal perforated ulcers, 35 perforations of the colon, 36 miscellaneous).

Results

The diagnostic accuracy of laparoscopic exploration was 84·8 per cent. The clinical preoperative diagnosis was changed by laparoscopic exploration in 25·1 per cent of patients. An unnecessary laparotomy was avoided in 6·5 per cent of patients and the site of traditional incision was modified in 8·7 per cent. Conversion rates were 25 per cent for appendicular peritonitis, 16 per cent for gastroduodenal perforation and 83 per cent (29 of 35 patients) for colonic perforation. The overall mortality rate was 3·9 per cent. No malignant hypercapnia occurred. Two patients (0·9 per cent) had postoperative septic shock but survived.

Conclusion

Laparoscopy is feasible and safe in cases of peritonitis. Laparoscopic treatment is particularly effective in the case of appendicular and gastroduodenal perforation. In the case of colonic perforation, the conversion rate remains high but with growing experience and surgical skill, more of these cases will be treated laparoscopically in the future.
Results of pancreatogastrostomy after pancreatoduodenectomy in 160 consecutive patients
Authors: Fabre J M , Arnaud J P , Navarro F , Bergamaschi R , Cervi C , Marrel E , Domergue J
Published: March 2003

Background

The advantages of pancreatogastrostomy over pancreatojejunostomy after pancreaticoduodenectomy are still debated. This study analyses the results of pancreatogastrostomy to identify factors that could influence immediate outcome.

Methods

During a 10-year period, 160 consecutive patients underwent a pancreatogastrostomy. There were 109 men (68 per cent) and 51 women (32 per cent) with a mean(s.d.) age of 59(10) (range 22–82) years; 27 patients were older than 70 years. The following parameters were assessed: mortality rate, morbidity, reasons for reoperation, length of hospital stay, duration of nasogastric tube and drainage.

Results

Hospital mortality rate was 3 per cent; overall morbidity rate was 30 per cent. The reoperation rate was 12 per cent, mainly because of bleeding at the pancreatic margin. Delayed gastric emptying occurred in 36 patients. The overall rate of pancreatic fistula was 2·5 per cent. Age, sex, indications for pancreatoduodenectomy, and the texture of the pancreatic remnant did not influence the occurrence of pancreatic fistula or delayed gastric emptying.

Conclusion

This study confirmed that pancreatogastrostomy is a safe procedure with low mortality and morbidity rates.
Risk factors for rebleeding and death from peptic ulcer in the very elderly
Authors: Chow L W , Gertsch P , Poon R T P , Branicki F J
Published: March 2003

Background

Ageing populations are increasing in many countries and bleeding peptic ulcers in patients older than 60 years carry a greater risk of rebleeding and death. This study aimed to identify the risk factors for rebleeding and death in very elderly patients with peptic ulcer bleeding. The efficacy of treatment in preventing recurrent bleeding and death in this group of patients was also studied by means of prospective data collection and analysis.

Methods

Data relating to 1744 patients treated between September 1985 and January 1994 for peptic ulcer bleeding were collected prospectively and analysed. Patients were stratified by age to one of three groups: group 1 (less than 60 years, n = 833), group 2 (60–79 years, n = 706) and group 3 (80 or more years, n = 205).

Results

Univariate and multivariate analyses of 21 factors possibly affecting either rebleeding or death identified age greater than 80 years as one of the factors significantly affecting rebleeding and death. In a comparison of groups 1, 2 and 3, the likelihood of rebleeding and death was significantly greater in group 3. Univariate and multivariate analyses for rebleeding and death were performed for each group. The severity of initial bleeding had a marked bearing on subsequent rebleeding rates for all three groups. In group 3, however, large ulcer size and impaired liver function were additional factors which correlated significantly with final outcome. No rebleeding or morbidity occurred when endoscopic treatment was performed early for patients in group 3 but there was a significantly greater risk of further recurrent haemorrhage and treatment-related morbidity when treatment was performed after the onset of rebleeding.

Conclusion

Patients aged 80 years or greater had the highest risk of rebleeding and death. For patients below 80 years of age, significant factors related to a fatal outcome included co-morbid illness, complications and the need for mechanical ventilation. For patients aged 80 years or older, the significant factors were ulcer size greater than 2 cm and admission with serum bilirubin level above 20 mmol/l. Endoscopic treatment for the very elderly was effective if carried out early.
Role of magnetic resonance angiography for assessment of abdominal aortic aneurysm before endoluminal repair
Authors: Nasim A , Thompson M M , Sayers R D , Boyle J R , Hartshorne T , Moody A R , Bell P R F
Published: March 2003

Background

A detailed knowledge of the morphology of the aorta and iliac arteries is an important prerequisite for successful endoluminal abdominal aortic aneurysm (AAA) repair. The best method of preoperative evaluation remains to be determined.

Methods

A prospective study was undertaken between January 1994 and July 1995 to assess the ability of computed tomography (CT), magnetic resonance angiography (MRA), colour duplex imaging and intra-arterial digital subtraction angiography (IA-DSA) to visualize AAA morphology.

Results

Eighty-two consecutive patients (64 men, 18 women) with AAA were assessed with MRA, contrast-enhanced CT, colour duplex imaging and IA-DSA. Median age was 74 (range 59–87) years and median AAA diameter was 5·7 (range 3·5–9·7) cm. Five patients were unable to tolerate CT or MRA examination. Seventy-seven patients underwent both CT and MRA. Of these, 55 also had a colour duplex scan and 32 underwent arteriography. The scans were assessed by an independent blinded observer. MRA was significantly better (P < 0·01) at visualizing AAA morphology compared with CT and colour duplex imaging. There was no statistically significant difference between MRA and arteriography.

Conclusion

MRA is useful in patient selection for endoluminal AAA repair, as it avoids use of iodinated contrast medium and ionizing radiation.
Lichtenstein inguinal hernia repair in a primary healthcare setting
Authors: Lafferty P M , Malinowska A , Pelta D
Published: March 2003

Background

Given the generally accepted poor outcome of inguinal hernia repair when using nylon darn, and the recent interest in low-tension mesh repair, an attempt was made to demonstrate the feasibility, outcome and patient perception of providing Lichtenstein inguinal hernia repair, using local anaesthesia, wholly within the primary healthcare sector.

Methods

A prospective study reviewed clinical outcome and patient perception in 100 adults referred with inguinal hernia only. No selection was made regarding age, sex, American Society of Anesthesiologists status or previous repairs. Recurrence, pain, infection, return to full function and associated complications were assessed at 24 h, 1 and 6 weeks, and 1 year. Local Community Health Councils assessed patient perception.

Results

In the first 100 patients (age range 21–83 (mean(s.d.) 60(14·7)) years; 58 of employable age; 92 men; ten recurrent hernias), no recurrences have occurred at 1 year. Infection rate was 3 per cent. Pain was maximal in the first 24–48 h (median visual analogue scale 5, range 0–10) and reduced rapidly (median 1) at 1 week. Mean time to return to work or full normal activity was 8 days. Some 85 operations were performed within 1 month of diagnosis. In all, 86 patients returned the patient satisfaction questionnaire and 98 per cent of these were ‘very pleased’ with the service.

Conclusion

In highly motivated primary healthcare centres, inguinal hernia repair can be undertaken effectively, providing high patient satisfaction, minimal complications and low recurrence rates using the Lichtenstein technique.
Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis
Authors: Lai P B S , Kwong K H , Leung K L , Kwok S P Y , Chan A C W , Chung S C S , Lau W Y
Published: March 2003

Background

The aim of this prospective randomized study was to define the optimum management between early and delayed laparoscopic cholecystectomy for patients with acute cholecystitis.

Methods

Patients were randomized to receive either early laparoscopic cholecystectomy within 24 h of randomization or initial conservative treatment followed by delayed laparoscopic cholecystectomy 6–8 weeks later.

Results

There were 53 patients in the early group and 51 in the delayed group. There was no significant difference in conversion rate (early 21 per cent versus delayed 24 per cent), postoperative analgesic requirement (1 versus 2 doses) and postoperative complications. However, the early group had significantly longer operating time (122·8 versus 106·6 min, P = 0·04) and shorter total hospital stay (7·6 versus 11·6 days, P < 0·001).

Conclusion

Early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay. Apart from a shorter operating time, treating patients with delayed laparoscopic cholecystectomy does not offer additional benefit.
Lack of telomerase in desmoids occurring sporadically and in association with familial adenomatous polyposis
Authors: Scates D K , Clark S K , Phillips R K S , Venitt S
Published: March 2003

Background

Telomerase activity may be required for unlimited growth of cells and is repressed in most somatic tissues, but is detectable in immortal cell lines, germ cells, many malignancies and some benign lesions. Desmoids are proliferative, locally invasive, non-metastasizing fibromatous tumours which rarely regress. They occur frequently in familial adenomatous polyposis (FAP), causing significant morbidity and death. Telomerase activity was assayed in desmoids from patients with and without FAP to assess the role of telomerase in the development of these lesions, and its potential as a prognostic marker and possible target for treatment.

Methods

Protein extracts from 11 desmoids from nine patients with FAP, and ten desmoids from ten patients without FAP, were analysed for telomerase activity by the telomeric repeat amplification protocol, a sensitive polymerase chain reaction-based assay. Six fibrosarcomas and a fibrosarcoma cell line were used as positive controls; all displayed telomerase activity.

Results

No telomerase activity was detected in any of the 21 desmoids studied.

Conclusion

These results indicate that desmoid tumours are one of the intriguing exceptions to the emerging view that re-expression of telomerase activity accompanies the development of preneoplastic and neoplastic tissues, and suggest that alternative mechanisms may operate in these proliferative neoplasms.
Antibiotic prophylaxis in the initial management of severe acute pancreatitis
Authors: Powell J J , Miles R , Siriwardena A K
Published: March 2003

Background

The role of antibiotic prophylaxis in the initial management of patients with acute pancreatitis is an area of major controversy. Contrary to earlier clinical trials, recent experimental and clinical studies have accrued evidence that warrants reappraisal of current clinical practice. This article reviews these recent advances in knowledge.

Methods

All papers derived from a Medline search for the years 1990–1997 inclusive using the text words ‘acute’, ‘pancreatitis’, ‘antibiotic’ and ‘antibiotics’ were studied. Additional papers were derived from reference lists within papers identified by the Medline search. Only experimental and clinical papers relevant to the issue of prophylactic antibiotic therapy in acute pancreatitis are included in the review.

Results and conclusion

Current experimental evidence favours the use of prophylactic antibiotics in severe acute pancreatitis. The results of contemporary randomized clinical trials restricted to patients with prognostically severe acute pancreatitis have demonstrated improvement in outcome associated with antibiotic treatment.
Port-site metastases following laparoscopic surgery
Authors: Neuhaus S J , Texler M , Hewett P J , Watson D I
Published: March 2003

Background

Application of laparoscopy to the resection of malignancy has been followed by a literature describing cases of metastatic involvement at laparoscopic port sites. These include patients who underwent surgery for early stage carcinoma and instances following laparoscopic procedures during which tumours were not dissected.

Methods

Recently published clinical and experimental studies, and case reports related to this problem are reviewed; their relevance is discussed.

Results

Experimental studies incorporating bench top and large animal models have confirmed that tumour cells may be redistributed to port sites during laparoscopic surgery either directly from contaminated instruments or indirectly via the insufflation gas. Small animal models suggest that the incidence of wound metastasis is increased following conventional laparoscopic surgery, and that it may be decreased by gasless laparoscopy or helium insufflation. This evidence suggests that the development of port-site metastases depends not only on the physical redistribution of tumour cells but also on the specific insufflation gas used, possibly because of influences on local metabolic or immune factors acting at the wound site.

Conclusion

Further research in this area is urgent. Until the issue is better understood, patients undergoing laparoscopic surgery for malignancy should be entered into clinical trials.
Natural history of adhesional small bowel obstruction: counting the cost
Authors: Wilson M S , Hawkswell J , McCloy R F
Published: March 2003

Background

The aim of this study was to identify patients admitted with adhesional obstruction to determine if there was an identifiable pattern to the type of initial operation, the type of treatment used for the obstructive episode and the subsequent need for further treatment.

Methods

Patients with adhesional obstruction were identified retrospectively in a cross-sectional study using ICD codes relating to admissions in the years 1990 to 1996. The case notes were used to assess their outcome.

Results

Fifty-nine case notes from a total of 175 identified initially satisfied the inclusion criteria. These patients had a mean age at presentation of 51 (range 16–88) years and had undergone a total of 122 operations. Thirty-one patients (53 per cent) had a single previous operation with a median time to presentation with obstruction of 5·5 years (range 11 days to 34·7 years); 33 patients (56 per cent) were treated conservatively on their first admission. There was no statistically significant difference in the outcome in patients who received either conservative or surgical treatment. The length of stay in patients treated surgically (median 11 (range 2–47) days) was significantly longer than that for those treated conservatively (median 6 (range 1–39) days) (P < 0·001). A flow chart was constructed demonstrating the eventual outcome of the patients in the study, enabling the cost of adhesional obstruction to be calculated.

Conclusion

This type of approach could be used to assess the potential effect of different treatment strategies for adhesional obstruction.
Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery
Authors: Bergenfelz A , Isaksson A , Lindblom P , Westerdahl J , Tibblin S
Published: March 2003

Background

The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.

Methods

Intraoperative levels of PTH were measured in 119 patients during 121 operations (including 14 reoperations) for pHPT. The mean(s.d.) preoperative serum calcium level was 2·79(0·21) mmol/l. Blood samples were drawn before, and at 5 and 15 min after, excision of the first enlarged parathyroid gland. PTH was analysed electively in 61 patients and on-line by a modified assay for intact PTH in 48 patients. Both procedures were used in ten patients.

Results

The mean(s.d.) decline in PTH concentration in 101 patients with primary exploration due to solitary adenoma was 63(17) per cent after 5 min (n = 84) and 83(10) per cent after 15 min. The patients with primary exploration because of multiglandular disease (n = 6) were correctly predicted not to have parathyroid adenoma.

Conclusion

Measurement of PTH levels during surgery for pHPT is a highly sensitive method for differentiating between single and multiple gland disease. The on-line monitoring of PTH is clinically useful in patients who have undergone previous neck surgery. Its role in pHPT surgery at primary exploration should be evaluated in prospective trials.
Influence of ischaemia–reperfusion injury on CD44 expression in rat small intestine
Authors: Heel K , Blennerhassett L , Kong S-E , McCauley R , Hall J
Published: March 2003

Background

CD44 is an adhesion molecule expressed by neutrophils and lymphocytes which is involved in cell–cell and cell–matrix binding. In this study, the effect of ischaemia–reperfusion injury on CD44 messenger RNA (mRNA) and cell surface immunohistochemical expression of CD44 in the rat small intestine was evaluated.

Methods

Wistar rats (n = 16) were randomized to either serve as controls (sham surgery) or to be subjected to a standardized ischaemia–reperfusion injury (suprarenal aorta occluded for 1 h followed by 1 h of reperfusion). Standardized segments of jejunum were harvested after ischaemia–reperfusion injury (ischaemic and reperfused samples) to measure the mucosal protein and DNA content, mRNA expression of CD44 and the immunohistochemical expression of CD44.

Results

Reperfusion significantly damaged the jejunal mucosa, e.g. mucosal protein content was lower after reperfusion compared with that in the control group (z = −2·31, P = 0·02) and the ischaemic samples (z = −2·52, P = 0·01). The expression of cell surface CD44 protein was also significantly decreased after ischaemic injury (z = −1·99, P = 0·04); this coincided with a decrease in the amount of cytoplasmic CD44 mRNA within isolated enterocytes (z = −2·31, P = 0·02).

Conclusion

Ischaemia–reperfusion injury decreases the expression of CD44 within the jejunal mucosa. This may contribute to the failure of the gut barrier after such injury.
Comprehensive 1-year cost analysis of open antireflux surgery in Nordic countries
Authors: Lundell L , Dalenbäck J , Janatuinen E , Hattlebakk J , Levander K , Miettinen P , Myrvold H E , Pedersen S A , Thor K , Andersson A , Stålhammar N O
Published: March 2003

Background

Antireflux surgery is a highly effective treatment option in patients with severe gastro-oesophageal reflux disease. However, because of the increasing pressure of cost containment within health care, cost aspects must also be added to the decision-making process.

Methods

The aim of this analysis was to assess the total cost of open antireflux surgery during the first year after operation in 178 patients with chronic reflux, who were recruited into a controlled, prospective clinical trial. The study was carried out in 17 hospitals in the Nordic countries.

Results

The cost of the operation represented more than 90 per cent of the direct medical costs which amounted to approximately US $5700. For a patient in the work force the indirect cost, i.e. loss of production, represented 47 per cent of the total cost, which was about US $10 800.

Conclusion

The total cost profile of open antireflux surgery has now been established prospectively and can form a basis for future comparisons.
Chlamydia pneumoniae and vascular disease
Authors: Gibbs R G J , Carey N , Davies A H
Published: March 2003

Background

There is an increasing body of evidence linking the human pathogen Chlamydia pneumoniae with atherosclerosis.

Methods

A Medline-based review of the literature was carried out.

Results and conclusion

Seroepidemiological studies have revealed the possibility that evidence of infection with C. pneumoniaeand atherosclerotic disease are related. Studies on human tissue have demonstrated that evidence of the organism can be found in human atherosclerotic tissue by both direct and indirect methods significantly more often than in control vascular tissue. Using animal models it is possible to show that C. pneumoniae can be disseminated haematogenously following pulmonary infection and that it shows a tropism for atherosclerotic tissue. In vitro work has demonstrated that the organism is capable of infecting, surviving and multiplying in cells of the human vascular wall, and that it can provoke a cell-mediated cytokine response which has implications both locally and systemically. Two clinical trials of macrolide antibiotics have demonstrated that they confer increased cardiovascular protection in patients following myocardial infarction. Adequately powered trials are needed to establish the therapeutic role of antibiotics in peripheral arterial disease.
Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence
Authors: Carapeti E A , Kamm M A , Phillips R K S
Published: March 2003

Background

Anal incontinence due to internal sphincter dysfunction is not amenable to simple surgical repair. The α-adrenergic agonist phenylephrine produces contraction of the internal sphincter and raises resting pressure when applied topically in healthy volunteers. The effect of topical phenylephrine in the treatment of faecal incontinence due to internal sphincter dysfunction was investigated.

Methods

Thirty-six patients (22 women) aged 28–81 (mean 58) years with faecal incontinence and ultrasonographically structurally normal anal sphincter muscles were treated with topical 10 per cent phenylephrine and placebo gels, allocated in random order in a double-blind crossover study. Maximum resting anal sphincter pressure and anodermal blood flow were measured. A symptom questionnaire was completed and incontinence score determined using a validated scale.

Results

There were no significant differences in incontinence score, resting anal pressure and anodermal blood flow between the active and placebo treatments. Six patients on active treatment and two on placebo experienced more than 75 per cent subjective improvement. Three patients developed allergic dermatitis to phenylephrine.

Conclusion

This is the first study of the use of a topical pharmacological agent to treat faecal incontinence. This concentration of topical phenylephrine did not produce a significant improvement in symptoms or function. A subgroup of patients may respond. Further studies are required with increased concentrations.
Reduced endothelin-3 expression in sporadic Hirschsprung disease
Authors: Kenny S E , Hofstra R M W , Buys C H C M , Vaillant C R , Lloyd D A , Edgar D H
Published: March 2003

Background

Enteric aganglionosis in Hirschsprung disease has been linked to genes coding for endothelin-3 (EDN3) and the endothelin B receptor (EDNRB), but there is no such linkage in most patients with sporadic Hirschsprung disease. However, the similarity between the distal colonic aganglionosis in Hirschsprung disease and that due to EDN3 or EDNRB mutations led to the hypothesis that levels of expression of these genes might be affected in the absence of mutation, thus causing the Hirschsprung disease phenotype. The aim of this study was to determine EDN3 and EDNRB messenger RNA (mRNA) levels in tissue samples from patients with sporadic Hirschsprung disease.

Methods

RNA and DNA were isolated from the ganglionic and aganglionic colonic segments of ten children with sporadic Hirschsprung disease, and from the colon of ten age-matched controls. The DNA was analysed for mutations in the genes coding for endothelin-3 (ET-3) and endothelin B receptor (ET-B) proteins. Relative levels of EDN3 and EDNRB mRNA were determined by semi-quantitative transcriptase–polymerase chain reaction.

Results

Three children had sequence variants in EDN3 and EDNRB. In the remaining seven patients, EDN3 mRNA levels were reduced in both the ganglionic and aganglionic colon compared with levels in controls; there was no difference in expression of EDNRB between groups.

Conclusion

In the absence of mutation, EDN3 is downregulated in short-segment Hirschsprung disease, suggesting that this may be a common step leading to aganglionosis.
Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm: results from the UK Small Aneurysm Trial
Authors: Brady A R , Fowkes F G R , Greenhalgh R M , Powell J T , Ruckley C V , Thompson S G
Published: March 2003

Background

In regional and population studies, the mortality rate within 30 days of elective surgical repair of abdominal aortic aneurysm is approximately 8 per cent. Identification of preoperative factors associated with this mortality risk is important for informing surgical policy and may suggest suitable preoperative interventions.

Methods

In the UK Small Aneurysm Trial, 820 patients aged 60–80 years underwent elective open surgical repair of an abdominal aortic aneurysm. The relationship between 30-day mortality rate and 13 prespecified potential prognostic factors was investigated. The value of a published clinical prediction rule was also evaluated.

Results

The postoperative mortality rate was 5·6 per cent overall (46 deaths in 820 patients). Postoperative mortality risk was significantly associated with older age (P = 0·03), higher serum creatinine level (P = 0·002) and lower forced expiratory volume in 1 s (FEV1) (P = 0·003) in univariate analyses. Evidence of a relationship between age and postoperative death was weakened (P = 0·08) after adjustment for creatinine level and FEV1. The predicted postoperative mortality risk ranged from 2·7 per cent in younger patients with below average creatinine levels and above average FEV1, to 7·8 per cent in older patients with above average creatinine levels and below average FEV1. The published clinical prediction rule did not validate well on these data; observed risk did not correlate with predicted risk except for a small group of high-risk patients.

Conclusion

Poor preoperative lung and renal function was strongly associated with postoperative death. Age was less important once these two important prognostic factors had been taken into account. The potential for preoperative improvement in lung and renal function to reduce postoperative mortality rates should be addressed in future studies.
Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery
Authors: Motomura K , Inaji H , Komoike Y , Kasugai T , Nagumo S , Noguchi S , Koyama H
Published: March 2003

Background

The purpose of the present study was to evaluate the usefulness of intraoperative imprint cytology and frozen sectioning of sentinel lymph nodes in patients with clinically node-negative breast cancer.

Methods

Sentinel node biopsy was performed in 101 patients with stage I or II breast cancer with clinically negative nodes using a dye-guided method. Intraoperative evaluation of sentinel node involvement by imprint cytology and frozen sectioning was compared with the final histopathological results of permanent sections. Tumour-negative nodes in paraffin sections stained by haematoxylin and eosin were further studied using an anticytokeratin antibody.

Results

The results of imprint cytology and frozen-section analysis were compared with those of haematoxylin and eosin-stained sections. The sensitivity, specificity and overall accuracy of imprint cytology were 96·0, 90·8 and 92·1 per cent respectively, and those of frozen-section examination were 52·0, 100 and 88·1 per cent. Ten sentinel nodes were tumour positive on imprint cytology and tumour negative on stained paraffin sections. Micrometastasis was found in eight of these nodes on immunohistochemistry. Taking these immunohistological results into consideration, the final sensitivity, specificity and overall accuracy of imprint cytology were 90·9, 98·5 and 96·0 per cent respectively.

Conclusion

Intraoperative imprint cytology is a useful method for evaluating the status of sentinel nodes and is more accurate than frozen-section analysis. In addition, imprint cytology can detect micrometastasis more accurately than conventional haematoxylin and eosin-stained sectioning.
Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology
Authors: Daltrey I R , Kissin M W
Published: March 2003

Background

Breast fine-needle aspiration cytology (FNAC) is an invasive investigation which can be uncomfortable or distressing. This randomized study investigated the discomfort of breast FNAC and the effect of different techniques.

Methods

Some 116 FNAC samples were taken from 98 women with a palpable breast mass. Each patient was randomized to one of four study groups; aspiration was performed using a green-hub (21 G) or blue-hub (23 G) needle, either with or without local anaesthetic. Each patient scored the pain of the whole procedure using a visual analogue scale.

Results

A green-hub needle caused significantly more discomfort (mean(s.e.m.) pain score 5·1(0·4) cm) than a blue-hub needle (2·9(0·4) cm), or either a blue- or green-hub needle with local anaesthetic (3·0(0·4) and 2·1(0·4) cm respectively) (F = 10·28, 3112 d.f., P < 0·01, analysis of variance).

Conclusion

The discomfort of breast FNAC is dependent upon the gauge of the needle and the use of local anaesthetic. A blue-hub needle without local anaesthetic should be first choice for breast FNAC.
Intraoperative scrape cytology of the sentinel lymph node in patients with breast cancer
Authors: Smidt M L , Besseling R , Wauters C A P , Strobbe L J A
Published: March 2003

Background

Intraoperative examination of the sentinel lymph node (SLN) may detect metastatic disease, allowing immediate axillary lymph node dissection and therefore avoiding the need for reoperation. The aim of this study was to evaluate the accuracy of scrape cytology of the SLN in patients with early breast cancer.

Methods

Sentinel node biopsy was performed in 148 patients with clinical T1–2 N0 breast cancer. After harvesting, the SLN was bisected and cells from both halves were scraped with a scalpel blade on to a slide and stained with a Papanicolaou and Giemsa stain. Scrape cytology results were compared with the results of paraffin sections stained with haematoxylin and eosin and with immunohistochemistry.

Results

The intraoperative diagnosis was correct in 126 patients (85 per cent). Sensitivity and specificity were 67 and 98 per cent respectively; positive and negative predictive values were 95 and 81 per cent.

Conclusion

Scrape cytology is a useful method for intraoperative evaluation of the SLN in patients with breast cancer.
Influence of the G2 cell cycle block abrogator pentoxifylline on the expression and subcellular location of cyclin B1 and p34cdc2 in HeLa cervical carcinoma cells
Authors: Theron T. , öhm L. B.
Published: March 2003

The progression of cells from G2 into mitosis is mainly controlled by formation of the cyclin B1/p34cdc2 complex. The behaviour of this complex in the irradiation‐induced G2 cell cycle delay is still unclear. A prior study demonstrated that the expression of the cyclin B1 protein is reduced by irradiation, and restored to control levels by the methylxanthine drug pentoxifylline, which is a potent G2 block abrogator. The present study shows that irradiation, and 2 mM pentoxifylline affect the expression of the cyclin‐dependent kinase p34cdc2 in HeLa cells. Irradiation induces p34cdc2 levels to increase and cyclin B1 levels to decrease. Addition of pentoxifylline at the G2 maximum reverses these trends. This is also evident from the cyclin B1/p34cdc2 ratios which decline after irradiation and are rapidly restored to control levels upon addition of pentoxifylline. It is concluded that cyclin B1 and p34cdc2 protein expression are important events and act in concert to control the irradiation induced G2 block. Analysis of cyclin B1 expression in whole cells and in isolated nuclei furthermore show that cyclin B1 is translocated from the nucleus into the cytoplasm when the G2 block is abrogated by pentoxifylline.
An endogenous melanocyte‐inhibiting tripeptide pyroGlu‐Phe‐GlyNH2 delays in vivo growth of monoclonal experimental melanoma
Authors: Gembitsky D. S. , De Angelis P. M. , Reichelt K. L. , Elgjo K.
Published: March 2003

The melanocyte‐inhibiting tripeptide (MTP) pyroGlu‐Phe‐GlyNH2 is present in tissue cultures of non‐transformed melanocytes and melanoma cells and influences melanocyte growth in vitro. The objective of the present study was to investigate a possible effect of MTP on the in vivo growth of B16A2, a monoclonal experimental melanoma. The B16A2 clone was established by the limited dilution technique. It has a reduced DNA content and displays slower growth both in vivo and in vitro compared to the parent cell line (B16). B16A2 cells were injected subcutaneously into hairless mice at four sites (300 000 cells in 0.25 ml buffer/site). MTP was given by i.p. injection 3 times a week at two concentrations (1 pmol and 1 nmol/animal). The control animals received the equal volume of solvent. The animals were sacrificed 1 and 2 weeks after tumour transplantation, and all tumours were weighed. One week after transplantation, the animals who received 1 pmol MTP had fewer tumours and a reduced tumour load. Two weeks after the transplantation, the differences between control and treated animals were no longer observed. The results indicate that MTP temporarily delays in vivo tumour growth.
Molecular cloning and sequence analysis of the promoter region of mouse cyclin D1 gene: implication in phorbol ester‐induced tumour promotion
Authors: Eto I.
Published: March 2003

Cyclin D1 is a cell cycle regulatory protein, which acts as a growth factor sensor to integrate extracellular signals with the cell cycle machinery, particularly during G1 phase of the cell cycle. Previous study using promotion‐sensitive JB6 mouse epidermal cells, an in vitro model of the promotion stage of multistage carcinogenesis, showed that the expression of cyclin D1 is stimulated in the presence (but not in the absence) of 12‐O‐tetradecanoylphorbol‐13‐acetate (TPA) in these cells maintained under anchorage‐independent culture conditions. In the present study, to explore the molecular basis of this observation, the promoter region of mouse cyclin D1 gene was cloned and sequenced (GenBank accession number AF212040). Dot matrix comparison of mouse, human and rat promoter sequences indicated that the mouse promoter is homologous to the human and more so to the rat promoters. The mouse promoter, like human and rat promoters, lacks canonical TATA‐box or TATA‐like sequence, but it has one or possibly two initiator (Inr) or Inr‐like sequences. Energy dot plot analysis predicted that the mouse promoter consists of three domains: (1) the 3′ domain contains NF‐κB response element, cAMP‐response element (CRE), Inr or Inr‐like elements, Sp1 binding site and Oct 1 (2) the middle domain contains another Sp1 binding site, E‐box and E2F binding site and (3) the 5′ domain contains TPA‐response element (TRE) and a tandem silencer element. The cyclin D1 promoter sequence of either promotion‐sensitive or resistant JB6 mouse epidermal cells was, except for a few minor differences, essentially identical to the sequence determined for a mouse genomic clone. Since TPA is capable of stimulating the expression of cyclin D1 not only through TRE but also through CRE and NF‐κB response element in the promoter, we tentatively propose a sequence of events that possibly leads to TPA‐induced, anchorage‐independent synthesis of cyclins D1 and A in the promotion‐sensitive JB6 mouse epidermal cells.
Effects of 5‐fluorouracil on cell cycle arrest and toxicity induced by X‐irradiation in normal mammalian cells
Authors: Nylén U. , Cekan E. , Jonasson G.‐B. , Lewin F. , Skog S.
Published: March 2003

From clinical studies in cancer patients and experimental in vitro studies, there is evidence of an increased cytotoxic effect, and even synergy, when irradiation is combined with 5‐fluorouracil (5‐FU). The mechanism for this is unclear.

Materials and Methods:

Mouse fetuses (C3H) have been exposed in vivo to X‐irradiation and 5‐fluorouracil (5‐FU) as single agents or in combination. Cell proliferation, cell cycle progression, fetal survival and incidence of fetal malformations have been studied.

Purpose:

The aim of this study was to determine possible synergistic cytotoxic effects when 5‐FU and ionizing radiation were combined, particularly concerning the regulation of cell cycle progression in proliferating, non malignant mammalian cells in vivo.

Results:

The combination of low‐toxic doses of X‐irradiation and 5‐FU had a synergistic toxic effect in nonmalignant mouse fetuses in vivo. The cell cycle regulation was perturbed and the radiation‐induced G2‐arrest was eradicated by 5‐FU during the initial hours.

Conclusions:

The time for repair of radiation induced DNA‐damage is probably reduced, which may explain the increased toxicity of this combination.
Lipid peroxide‐induced redox imbalance differentially mediates CaCo‐2 cell proliferation and growth arrest
Authors: Gotoh Yudai , Noda Takahiro , Iwakiri Ryuichi , Fujimoto Kazuma , Rhoads Carol A. , Aw Tak Yee
Published: March 2003

Abstract. Dietary oxidants like lipid hydroperoxides (LOOH) can perturb cellular glutathione/glutathione disulphide (GSH/GSSG) status and disrupt mucosal turnover. This study examines the effect of LOOH on GSH/GSSG balance and phase transitions in the human colon cancer CaCo‐2 cell. LOOH at 1 or 5 µm were noncytotoxic, but disrupted cellular GSH/GSSG and stimulated proliferative activity at 6 h that paralleled increases in ornithine decarboxylase activity, thymidine incorporation, expression of cyclin D1/cyclin‐dependent kinase 4, phosphorylation of retinoblastoma protein, and cell progression from G0/G1 to S. At 24 h, LOOH‐induced sustained GSH/GSSG imbalance mediated growth arrest at G0/G1 that correlated with suppression of proliferative activity and enhanced oxidative DNA damage. LOOH‐induced cell transitions were effectively blocked by N‐acetylcysteine. Collectively, the study shows that subtoxic LOOH levels induce CaCo‐2 GSH/GSSG imbalance that elicits time‐dependent cell proliferation followed by growth arrest. These results provide insights into the mechanism of hydroperoxide‐induced disruption of mucosal turnover with implications for understanding oxidant‐mediated genesis of gut pathology.
Elevated Ki‐67 expression is correlated with TNFα‐ and IFNγ‐induced apoptosis in tumour cells
Authors: Baisch Heinz
Published: March 2003

Abstract. The expression of Ki‐67 in tumour cells induced to apoptosis by tumour‐necrosis‐factor α (TNFα) and interferon γ (IFNγ) was studied. Ki‐67 is known as a proliferation marker which is expressed in cycling cells, but not in resting quiescent or Go cells. In numerous studies, the proportion of tumours expressing Ki‐67 was determined and related to tumour grade or prognosis. A high percentage of Ki‐67 expressing cells and a low apoptotic index were regarded as an indication of a progressive tumour. This implied that Ki‐67 expression and apoptosis were contrary traits. In this study, the level of Ki‐67 expression in human tumour cells in culture was measured after induction of apoptosis. The Ki‐67 level was determined by flow cytometry and apoptosis was measured by various methods including PARP degradation (western blot) in detached and floating cells. While the floating cells were all apoptotic, more than 80% of the attached cells showed no apoptotic signs. The Ki‐67 level of apoptotic cells was elevated about 3‐fold compared to viable attached control cells. However, the cytokine‐treated attached cells also expressed Ki‐67 at similar high levels to the apoptotic floating cells, depending on sensitivity. The plot of Ki‐67 level vs. remaining cells after treatment revealed a strong correlation between the level of Ki‐67 expression and the sensitivity to cytokine‐induced apoptosis. This implies that proliferation pathways and apoptotic signal transduction are connected.
The rate of apoptosis in post mitotic neutrophil precursors of normal and neutropenic humans
Authors: Mackey M. C. , Aprikyan A. A. G. , Dale D. C.
Published: March 2003

Abstract. Using data on the fraction of post‐mitotic neutrophil precursors (CD15+ cells) displaying positive markers for apoptosis in 12 normal humans, and a simple mathematical model, we have estimated the apoptotic rate to be about 0.28/day in this compartment. This implies that the influx of myelocytes into the post‐mitotic compartment exceeds twice the granulocyte turnover rate (GTR), and that about 55% of the cells entering this compartment die before being released into the blood. The normal half life of apoptotic post‐mitotic neutrophil precursors is calculated to be 10.4 h. Comparable calculations for patients indicate apoptosis rates in the post‐mitotic compartment of about 17 times normal for one myelokathexis patient and rates of about 13 times normal for the one cyclical neutropenic patient and two severe congenital neutropenic patients. The estimated half life for apoptotic post‐mitotic neutrophil precursors in the myelokathexis patient was about 0.4 h, 1.4 h in the cyclical neutropenia patient, and about 0.6 h in the severe congenital neutropenic patients.
Treatment and treatment outcomes in children’s homes
Authors: Gibbs  , Sinclair
Published: March 2003

A follow‐up study of 141 young people in 48 children’s homes examined changes in their moods, relationships with their family and adjustment. The average scores of the group on these variables changed little between first interview and follow‐up 6–9 months later. However, some individuals improved and others deteriorated. Improvements in family relationships were more likely in homes where the head of home could describe strategies for fostering family ties. Improvements in adjustment were also more likely in homes where the head of home could articulate ways of enabling change in key areas of the residents’ lives. Residents who spoke of attempts to bully them were more distressed at the time of the first interview and less adjusted at follow‐up. The study underlines the damaging effects of bullying and the key role of the head of home.
Lost for words
Authors: Cross
Published: March 2003

The literature suggests that many children suffer from both emotional and behavioural problems and speech and language difficulties. There are also many children with emotional and behavioural problems who have undetected communication difficulties ( Cohen et al. 1993
). Undetected communication problems have previously been found in child psychiatric populations (
Giddan et al. 1996
) and special educational classes for children with emotional and behavioural problems (
Burgess & Bransby 1990). A small‐scale study reported here also found ‘looked after’ children who had previously unsuspected communication difficulties. This paper considers why communication problems and emotional and behavioural difficulties often occur together and then reflects on the implications of undetected communication problems for the care of such children. Since communication problems impact on emotional and educational development, there are also suggestions of ways to identify speech and language difficulties in school‐age children.
Understanding exceptionality: differing perceptions of the family assistance order
Authors: Sturgeon‐Adams  , James
Published: March 2003

This paper discusses the findings of a research project (funded by the Joseph Rowntree Foundation) which set out to explore the ways in which family assistance orders (Children Act 1989) are used in providing help to families after separation and divorce. The research findings are based upon extensive fieldwork with family court welfare teams and members of the judiciary in eight areas with varying rates of use of family assistance orders. In particular, the paper focuses on the notion of exceptionality (given that the orders may only be made in exceptional circumstances) and the different ways that this notion is conceptualized by the various professionals involved in the process of promoting the welfare of children after the separation of their parents. We highlight the difficulties of reaching a common understanding of exceptional circumstances and the issues and problems this raises in relation to those whose responsibility it is to safeguard the welfare of children.
‘Children in need’ or ‘young offenders’? Hardening ideology, organizational change and new challenges for social work with children in trouble
Authors: Goldson
Published: March 2003

Throughout the 1990s youth crime has comprised a major site of state policy formation. Policy and practice responses have essentially been predicated upon a particular construction of the ‘young offender’ and have been underpinned by punitive and retributive priorities. Within this context the Crime and Disorder Act 1998 provides for the most radical restructuring of the youth justice system in England and Wales for 50 years. This paper critically analyses the burgeoning punitive drift of policy and practice. By drawing upon recently completed research in Merseyside, and by situating the findings alongside a wider research literature, the discussion re‐engages with the concept of the ‘child in need’. The paper considers key issues relating to children, and professional social work practice with children and families, within the ‘new’ approach to ‘youth offending’.
The reasons why young children are placed for adoption: findings from a recently placed sample and a discussion of implications for subsequent identity development
Authors: Neil E.
Published: March 2003

It is widely accepted that the processing of identity issues can be problematic for some adopted children. Needing to know why placement for adoption was necessary is often central to adopted people’s identity concerns. Adoption practices have altered and children are now placed for adoption for different reasons and from different backgrounds than were children in the past. This study aims to present an up to date picture of the reasons why children are placed for adoption. Using information from questionnaires completed by social workers, the circumstances of a sample of 168 young (mean age at placement = 18 months), recently adopted children are examined. Children fall into three groups according to the reason for their adoption: relinquished infants (14%), those whose parents had requested adoption in complex circumstances (24%), and those children required to be adopted by social services and the courts (62%). Child and birthparent characteristics and openness arrangements are examined and are found to differ significantly between the three groups, indicating that children will have different types of information to appraise and differing capacities to make sense of their personal histories. Because of the multiplicity of difficulties in children’s backgrounds, it is concluded that resolving identity issues is likely to be challenging for many children, and professionals will need to take this into account when working with adopters and birth relatives.