bluuebunny/crossref_metadata_2025 huggingface dataset:
A new look at the anal transitional zone with reference to restorative proctocolectomy and the columnar cuff
Authors: Thompson-Fawcett M W , Warren B F , Mortensen N J McC
Published: March 2003

Background

The anal transitional zone (ATZ) is of interest in relation to anorectal function and its fate during the operation of restorative proctocolectomy. There are only a few studies describing the anatomy of this structure. This study applied new techniques to quantify the ATZ in normal and inflammatory bowel disease states.

Methods

The epithelial linings of 28 anal canals were analysed by two techniques: whole-mount Alcian blue staining and a new method of creating a computer map of the histological findings based on longitudinal sections taken every 3 mm. The Alcian blue pictures and the histology maps were measured and compared using image analysis software.

Results

The ATZ usually commences just above the dentate line, which is situated a median of 1·05 cm above the lower border of the internal sphincter. The median length of the ATZ measured from computer maps of the histology was 0·45 cm. This was significantly smaller than the 0·73 cm obtained by the Alcian blue technique, which overestimates the length of the ATZ. The amount of columnar epithelium in the ATZ is very small. The median lowest point of columnar epithelium in the anal canal was 1·1 cm above the lower border of the internal sphincter.

Conclusion

The ATZ is only half the length described previously. After double-stapled restorative proctocolectomy there is a 1·5–2·0-cm cuff of diseased columnar epithelium remaining in the upper anal canal above the ATZ. This is suitably termed the ‘columnar cuff’ and is an important consideration in long-term follow-up.
Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials
Authors: Song F , Glenny A-M
Published: March 2003

Background

A systematic review was carried out to assess the relative efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery.

Methods

MEDLINE, EMBASE, the Cochrane Trials Register and the references cited in retrieved studies were searched to identify relevant trials published between 1984 and 1995.

Results

Some 147 relevant trials were identified. The quality of trials has improved over the past 12 years. The results confirm that the use of antimicrobial prophylaxis is effective for the prevention of surgical wound infection after colorectal surgery. There was no significant difference in the rate of surgical wound infections between many different regimens. However, certain regimens appear to be inadequate (e.g. metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin plus erythromycin on the day before operation). A single dose administered immediately before the operation (or short-term use) is as effective as long-term postoperative antimicrobial prophylaxis (odds ratio 1·17 (95 per cent confidence interval (c.i.) 0·90–1·53)). There is no convincing evidence to suggest that the new-generation cephalosporins are more effective than first-generation cephalosporins (odds ratio 1·07 (95 per cent c.i. 0·54–2·12)).

Conclusion

Antibiotics selected for prophylaxis in colorectal surgery should be active against both aerobic and anaerobic bacteria. Administration should be timed to make sure that the tissue concentration of antibiotics around the wound area is sufficiently high when bacterial contamination occurs. Guidelines should be developed locally in order to achieve a more cost-effective use of antimicrobial prophylaxis in colorectal surgery.
Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996
Authors: Nilsson E , Haapaniemi S , Gruber G , Sandblom G
Published: March 2003

Background

Difficulties in obtaining and analysing outcome measures in hernia surgery may be an obstacle to necessary progress in non-specialized hospitals. Against this background a voluntary register was initiated in 1992 with the aim of describing and evaluating hernia surgery in participating units.

Methods

Prospective registration of all hernia operations carried out in participating hospitals was undertaken using identification codes specific for each individual. Repair technique, complications, day surgery, type of anaesthesia, and reoperation for recurrence were recorded. Actuarial analysis was used to determine the cumulative incidence of reoperation. Relative risk for reoperation was estimated by the Cox proportional hazards model.

Results

The number of participating hospitals and registered operations increased from eight and 1689 respectively in 1992 to 21 and 4056 in 1996. The use of mesh increased from 7 per cent of all operations in 1992 to 51 per cent in 1996. The proportion of operations done for recurrent hernia remained constant at 16–17 per cent throughout the 5-year study period. For all 12 542 herniorrhaphies registered, the cumulative incidence of reoperation at 2 years was 3 (95 per cent confidence interval 3–4) per cent. Postoperative complications, recurrent hernia, direct hernia and absorbable suture were associated with increased risk of reoperation for recurrence. An increased incidence of reoperation, although not statistically significant, was noted for conventional open repairs (Bassini, McVay, Marcy and others) versus the Shouldice technique.

Conclusion

In this prospective audit an increasing use of mesh was observed for open and laparoscopic surgery, especially for bilateral and recurrent hernia operations. Reoperation rates decreased significantly between 1992 and 1995.
Experience with the Mainz modification of ureterosigmoidostomy
Authors: Gerharz E W , Köhl U N , Weingärtner K , Kleinhans B J , Melekos M D , Riedmiller H
Published: March 2003

Background

The purpose of this study was to report experience with the revived surgical concept of ureterosigmoidostomy in its low pressure modification and to discuss its value within the current spectrum of urinary diversion.

Methods

Between February 1992 and September 1997 modified ureterosigmoidostomy (rectosigmoid pouch; Mainz pouch II) was performed in 34 patients aged 1·9–76·9 (mean 55·8) years as a primary urinary diversion after radical cystectomy for bladder cancer (n = 30) and benign conditions (bladder exstrophy, three patients; intractable urinary incontinence, one). All patients were followed prospectively according to a standard protocol including assessment of continence, renal function and acid–base balance.

Results

There were no perioperative deaths. In one patient dislocation of a ureteral stent in the early postoperative course required insertion of a percutaneous nephrostomy. All patients were continent during the day. One patient experienced night-time incontinence but rejected a conversion procedure. In one case ureterosigmoidostomy was replaced by an ileal conduit after several episodes of septicaemia. One nephrectomy was performed for ureterointestinal obstruction. Mild hyperchloraemic acidosis was seen in two patients.

Conclusion

Bowel frequency and urge incontinence, the major weaknesses of classical ureterosigmoidostomy, can be overcome by detubularization of the rectum. As the modified procedure is quick, safe and easy to perform with highly satisfactory results, the rectosigmoid pouch has potential in reconstructive urology.
Cost-effectiveness in the management of patients with oesophageal cancer
Authors: Farndon M A , Wayman J , Clague M B , Griffin S M
Published: March 2003

Background

The aim of this study was to assess the relationship between clinical outcome, quality of life and cost for treatment modalities commonly employed in the management of oesophageal carcinoma.

Methods

A series of 51 patients diagnosed with oesophageal carcinoma in a 6-month period was used to derive a cost analysis profile for their treatment. All patients underwent quality of life assessment. Patients diagnosed in 1993 and managed in Newcastle upon Tyne were identified from the Northern Cancer Registry and Hospital Episode Statistics. Intervention profiles were documented for a 3-year follow-up period and cost analysis was conducted. A further 51 patients were recruited prospectively for quality-of-life studies.

Results

Some 139 individuals were identified retrospectively. Median survival was significantly better in patients treated by resection (n = 31; median 20 months) than in those receiving palliative treatments (n = 108; median 6 months) (P < 0·0001). Median cost was significantly greater in individuals who underwent resection (£8070) than for patients subjected to a palliative strategy (radiotherapy £4720, brachytherapy £1790, laser £3540, intubation £2450, no treatment £1390) (P < 0·01). When considering the median cost per month of life (after treatment) resection (£457) compared favourably with the palliative options (range £342–1125).

Conclusion

Surgical resection for oesophageal carcinoma confers greatest benefit in terms of survival. Costs are inherently greater in individuals undergoing resection but, allowing for time, resection is at least as cost-effective as other treatment modalities.
Amelioration of liver injury by ischaemic preconditioning
Authors: Yoshizumi T , Yanaga K , Soejima Y , Maeda T , Uchiyama H , Sugimachi K
Published: March 2003

Background

Ischaemic preconditioning, i.e. preparatory brief ischaemia before subsequent long ischaemia, can effectively protect the heart from ischaemia–reperfusion injury in animals. The purpose of this study was to demonstrate the same phenomenon in the liver.

Methods

Using warm ischaemia–reperfusion of 70 per cent of the liver followed by resection of the non-ischaemic portion in rats, livers with 10 min of ischaemic preconditioning, i.e. 10 min of warm ischaemia and reperfusion, were compared with those that had not been subjected to such a manoeuvre.

Results

At 120 min after reperfusion following 40 min of warm ischaemia, the livers with 10 min of ischaemic preconditioning had a significantly lower mean (s.d.) serum alanine aminotransferase level (492 (217) versus 1236 (695) units/l; P < 0·005) and lactic dehydrogenase level (7905 (4002) versus 15 066 (9201) units/l; P < 0·05), as well as a higher bile output (0·12 (0·03) versus 0·09 (0·04) ml per g liver; P < 0·05) and liver tissue adenosine 5§-triphosphate level (78 (13) versus 61 (11) per cent; P < 0·05) than the control livers. The necrosis rate, histologically defined as the percentage of necrotic area in given liver sections, was reduced significantly by this manoeuvre (mean (s.d.) 1·3 (1·3) versus 5·3 (1·7) per cent; P < 0·05).

Conclusion

Ischaemic preconditioning exerts a protective effect on hepatic warm ischaemia–reperfusion injury. Such a manoeuvre may be useful for hepatic resection in the clinical setting.
Ultrasonographically-guided fine-needle aspiration cytology in the diagnosis of colonic lesions
Authors: Heriot A G , Kumar D , Thomas V , Young M , Pilcher J , Joseph A E A
Published: March 2003

Background

The use of fine-needle aspiration cytology (FNAC) in the diagnosis of colonic lesions was investigated.

Methods

Some 22 patients (median age 71 years) with a colonic lesion identified on abdominal ultrasonography underwent ultrasonographically-guided FNAC using a 21-G needle. The sample was checked immediately by a cytopathologist for adequacy.

Results

Eighteen patients had colonic carcinoma; aspiration cytology detected malignant epithelial cells consistent with colonic carcinoma in 17 patients and severely dysplastic cells in one patient. The sensitivity and specificity of ultrasonographically-guided FNAC in the diagnosis of colonic carcinoma was 94 and 100 per cent respectively. The remaining four patients had a diagnosis of ileocaecal tuberculosis, ileocaecal Crohn's disease, and metastatic adenocarcinoma in the liver with no identifiable primary (two patients). One demonstrated granulomata, grew acid-fast bacilli and the patient was treated for tuberculosis. One had inflammatory cells and the patient was found to have Crohn's disease on histology. The remaining two patients had confirmed metastatic adenocarcinoma in the liver on aspiration cytology but suspected colonic lesions were found to be benign on cytological examination and no primary lesion was subsequently demonstrated. There were no complications of FNAC and patients complained of minimal discomfort. There has been no evidence of tumour recurrence with a median follow-up of 12 (range 1–25) months.

Conclusion

Ultrasonographically-guided FNAC is a valid method for the diagnosis of colonic tumours.
Advancement sleeve flaps for treatment of severe perianal Crohn's disease
Authors: Marchesa P , Hull T L , Fazio V W
Published: March 2003

Background

Traditionally proctectomy has been the treatment for severe, complex fistula in ano from Crohn's disease. However, based on the success of rectal advancement flaps in Crohn's disease, circumferential transanal sleeve advancement flaps (TSAFs) were proposed for this subgroup of patients with severe fistula.

Methods

From 1991 to 1995, 13 patients (12 women) with severe perianal Crohn's disease and multiple fistula tracts underwent a TSAF procedure. Data were collected retrospectively using a standard data sheet.

Results

There were no postoperative deaths or major morbidity. One year after surgery, the fistula had healed in eight of 13 patients (with three requiring additional surgery before healing). Of patients in whom the procedure failed, three underwent proctectomy for progression of disease and the other two had recurrence of a rectovaginal fistula 6 and 8 months after surgery. Of six variables evaluated (previous procedure, steroid use, steroid dosage, associated Crohn's disease, associated procedures and diverting stoma), only associated procedures were significantly related to a successful outcome (P = u0·008).

Conclusion

Some patients with severe perianal Crohn's fistula and a relatively normal rectum can be offered TSAFs. Even with successful outcome in eight of 13 patients, this may still be a viable option if the only alternative would be total proctocolectomy and a permanent stoma.
Genetic detection of lymph node micrometastases in patients with colorectal cancer
Authors: Dorudi S , Kinrade E , Marshall N C , Feakins R , Williams N S , Bustin S A
Published: March 2003

Background

Undetected micrometastases represent the single most important cause of treatment failure in patients undergoing putatively curative resection for colorectal cancer because current staging techniques are unable to identify patients with minimal residual disease.

Methods

A highly sensitive reverse transcription–polymerase chain reaction technique has been used to amplify tissue-specific messenger RNA from lymph nodes classified as tumour-free using both conventional histopathology and immunohistochemistry.

Results

Four of 15 patients were restaged after genetic diagnosis of lymph node micrometastases, while in a further two additional positive nodes were detected.

Conclusion

Sensitive genetic techniques that detect minimal residual disease merit further study, particularly as there is evidence that patients may benefit from adjuvant chemotherapy.
Experimental study of the effect of preoperative 5-fluorouracil on the integrity of colonic anastomoses
Authors: Kuzu M A , Köksoy C , Kale T , Demirpençe E , Renda N
Published: March 2003

Background

Despite curative resection for colorectal cancer, many patients develop recurrence at the primary site or distant organs. These patients are candidates for (neo)-adjuvant chemotherapy. Very little is known about the effect of preoperative 5-fluorouracil (FU) on the healing of colonic anastomoses. The aim of this study was to assess this in a rat model.

Methods

Eighty male Wistar rats, weighing 160–215 g, were divided into three groups; (1) a control group underwent left colon resection and primary anastomosis (n = 20); (2) a sham group received 1 ml saline intraperitoneally (n = 30); (3) a study group received 5-FU intraperitoneally (20 mg kg−1). Both saline and 5-FU injections were given intraperitoneally for 5 days before operation.

Results

There was no difference in the rate of wound complications, intraperitoneal adhesions and anastomotic complications among the groups. Three and seven days after operation, mean bursting pressure of the anastomosis was 36·5 and 198 mmHg in group 1, 34 and 200 mmHg in group 2, and 39 and 190 mmHg in group 3 respectively (P not significant). Although the myeloperoxidase and hydroxyproline content were significantly lower after 5-FU therapy (P < 0·01, compared with others), the clinical outcome was similar.

Conclusion

Preoperative 5-FU for 5 consecutive days before operation had no effect on the healing of colonic anastomoses.
Acrylate yellow filters in operating lights protect against photosensitization tissue damage
Authors: Hinnen P , de Rooij F W M , Voortman G , Tilanus H W , Wilson J H P , Siersema P D
Published: March 2003

Background

Photosensitized patients are exposed to bright lights when undergoing intraoperative photodynamic therapy or fluorescence measurements. Acrylate yellow filters might reduce unwanted tissue damage.

Methods

To investigate the protective value of these filters, the spectral power distribution of the operating lights and light energy densities with and without an acrylate yellow filter were measured. Subsequently the effects of light exposure on the survival of a human hepatocellular carcinoma cell line and the photodamage induced in pig tissues after the administration of 5-aminolaevulinic acid were also studied.

Results

The light energy density in the ultraviolet and blue region of the light spectrum emitted by the operating light was reduced up to 50 per cent by the acrylate yellow filter. The survival of photosensitized cells was longer and photodamage induced in pig tissues was less when exposed to filtered light.

Conclusion

Photodamage induced by operating lights can be reduced by filtering out ultraviolet and blue light by means of acrylate yellow filters.
Haemobilia
Authors: Green M H A , Duell R M , Johnson C D , Jamieson N V
Published: March 2003

Background

This review aims to establish whether increased use of invasive procedures and the trend toward conservative management of major trauma has resulted in an increased incidence of haemobilia.

Method

A Medline (http://igm.nlm.nih.gov/)-based search of the English language literature from January 1996 to December 1999 inclusive was performed using the keywords haemobilia, hemobilia, haematobilia and hematobilia. The presentation, aetiology, investigation, management and outcome of 222 cases were reviewed.

Results

Two-thirds of cases were iatrogenic while accidental trauma accounted for 5 per cent. Haemobilia may be major, constituting life-threatening haemorrhage, or minor; it may present many weeks after the initial injury. Diagnosis is most commonly confirmed by angiography. Management is aimed at stopping bleeding and relieving biliary obstruction; 43 per cent of cases were managed conservatively and 36 per cent were managed by transarterial embolization (TAE). Surgery was indicated when laparotomy was performed for other reasons and for failed TAE. The mortality rate was 5 per cent.

Conclusions

Although the incidence of iatrogenic haemobilia has risen considerably, the bleeding is often minor and can be managed conservatively. When more urgent intervention is required, TAE is usually the treatment of choice. There is no evidence that the conservative management of accidental liver trauma increases the risk of haemobilia.
Homocysteine and occlusive arterial disease
Authors: O'Grady H , Kelly C , Bouchier-Hayes D , Leahy A
Published: March 2003

Background

An increased plasma level of homocysteine has been proposed as an independent risk factor for atherosclerosis; this review examines the evidence.

Methods

A Medline search was undertaken for English language articles on homocysteine and vascular disease. Further papers were identified by cross-referencing from the reference lists of relevant major articles.

Results

Although much interest has been generated about homocysteine and atherosclerotic disease, contradictory data exist regarding its role in disease progression. There is insufficient current evidence to regard increased homocysteine level as a causative factor in atherosclerotic disease.

Conclusion

It is not known whether lowering plasma homocysteine concentration will reduce cardiovascular risk in the long term. Until such data become available, there is no evidence for the widespread use of folic acid therapy to reduce cardiovascular disease risk.
Permanent sacral nerve stimulation for treatment of idiopathic constipation
Authors: Kenefick N J , Nicholls R J , Cohen R G , Kamm M A
Published: March 2003

Background

Constipation can usually be managed using conservative therapies. A proportion of patients require more intensive treatment. Surgery provides variable results. This paper describes an alternative approach, in which the neural control of the bowel and pelvic floor is modified, using permanent sacral nerve stimulation.

Methods

Four women (aged 27–36 years), underwent temporary and then permanent stimulation. All had idiopathic constipation, resistant to maximal therapy, with symptoms for 8–32 years. Clinical evaluation, bowel diary, Wexner constipation score, symptom analogue score, quality of life questionnaire and anorectal physiology were completed.

Results

There was a marked improvement in all patients with temporary, and in three with permanent, stimulation. Median follow-up was 8 (range 1–11) months. Bowel frequency increased from 1–6 to 6–28 evacuations per 3 weeks. Improvement occurred, at longest-follow-up, in median (range) evacuation score (4 (0–4) versus 1 (0–4)), time with abdominal pain (98 (95–100) versus 12 (0–100) per cent), time with bloating (100 (95–100) versus 12 (5–100) per cent), Wexner score (21 (20–22) versus 9 (1–20)), analogue score (22 (16–32) versus 80 (20–98)) and quality of life. Maximum anal resting and squeeze pressures increased. Rectal sensation was altered. Transit time normalized in one patient.

Conclusion

Permanent sacral nerve stimulation can be used to treat patients with resistant idiopathic constipation.
Use of electrolysis as an adjunct to liver resection
Authors: Fosh B G , Finch J G , Lea M , Black C , Wong S , Wemyss-Holden S , Maddern G J
Published: March 2003

Background

Patients with hepatic metastases are potentially curable if all the diseased tissue can be resected. Unfortunately, only 10–20 per cent of patients are suitable for curative resection. Electrolysis is a novel non-thermal method of tissue ablation. When used in conjunction with surgery it may increase the number of resectable liver tumours with curative treatment.

Methods

All patients had been deemed inoperable using currently accepted criteria. Nine patients with hepatic deposits from colorectal carcinoma underwent combined surgical resection and electrolytic ablation of metastases.

Results

The treatment was associated with minimal morbidity. Within the electrolytically treated area seven patients had no radiological evidence of recurrence at a median follow-up of 9 (range 6–43) months; local recurrence was detected in two patients. Six of the nine patients had metastases elsewhere in the liver with four having extrahepatic metastases. Three patients remain tumour free. Three patients died. The median survival was 17 (range 9–24) months from the time of treatment.

Discussion

Electrolysis with resection may confer a disease-free and overall survival benefit. The small size of this initial study precludes statistical analysis, but preliminary results are encouraging.
Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer
Authors: O'Donnell C A , Fullarton G M , Watt E , Lennon K , Murray G D , Moss J G
Published: March 2003

Background

There is little evidence of the clinical and cost effectiveness of self-expanding metallic stents in the palliation of oesophageal cancer. The aims of this randomized trial were to evaluate the immediate and medium-term clinical outcomes following palliative intubation, examine patient quality of life, and evaluate costs and benefits from the perspective of the health service.

Methods

Fifty patients with inoperable oesophageal cancer were randomly allocated a metallic stent (n = 25) or plastic endoprosthesis (n = 25). Patients were followed up monthly until death.

Results

There was no significant difference in procedure-related complications or mortality rate between the two groups. There was a trend towards significance in favour of metallic stents with respect to quality of life and survival (median survival 62 versus 107 days for plastic prosthesis and metallic stent respectively). The cost of the initial placement of metallic stents was significantly higher than that of plastic endoprostheses (£983 versus£296). After 4 weeks, cost differences were no longer significant.

Conclusion

Metallic stents may contribute to improved survival and quality of life in patients with oesophageal cancer. Although initially more expensive, this cost difference does not last beyond 4 weeks. A larger trial involving approximately 300 patients would be required to detect a quality of life benefit of the magnitude observed in this trial.
Causative factors, surgical treatment and outcome of incisional hernia after liver transplantation
Authors: Janßen H , Lange R , Erhard J , Malagó M , Eigler F W , Broelsch C E
Published: March 2003

Background

Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair.

Methods

A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months. Follow-up data were obtained from medical records and the outpatient service. Patients were evaluated for various clinical and surgical factors. Hernias were analysed with respect to localization, type of surgical repair and recurrence rate.

Results

Some 17 per cent of the transplanted patients experienced an incisional hernia. Risk factors were acute rejection with affiliated steroid bolus therapy (P = 0·025), a low platelet count after transplantation (P = 0·048), and a transverse abdominal incision with upper midline approach (P = 0·04). Hernias were mainly located at the junction of the transverse and midline incision (P < 0·001) and the recurrence rate was highest here (P = 0·007). Prosthetic hernia repair achieved the lowest rate of recurrence and did not increase the incidence of infectious complications.

Conclusion

Improved immunosuppression should avoid early steroid bolus therapy after transplantation. A low platelet count promotes herniation. Transverse abdominal incision seems to be the best approach for liver transplantation. Prosthetic hernia repair does not increase the complication rate.
Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer
Authors: Ike H , Shimada H , Togo S , Yamaguchi S , Ichikawa Y , Tanaka K
Published: March 2003

Background

Multiple organ metastases from colorectal carcinoma may be considered incurable, but long survival after both liver and lung resection for metastases has been reported.

Methods

A retrospective analysis of 48 patients who underwent lung resection for metastatic colorectal cancer between 1992 and 1999 was undertaken. Twenty-seven patients had lung metastasis alone, 15 had previous partial hepatectomy, and six had previous resection of local or lymph node recurrence. The relationship of clinical variables to survival was assessed. Survival was calculated from the time of first pulmonary resection.

Results

Five-year survival rates after resection of lung metastasis were 73 per cent in patients without preceding recurrence, 50 per cent following previous partial hepatectomy and zero after resection of previous local recurrence. Independent prognostic variables that significantly affected survival after thoracotomy were primary tumour histology and type of preceding recurrence. There was no significant difference in survival after lung resection between patients who had sequential liver and lung resection versus those who had lung resection alone.

Conclusion

Sequential lung resection after partial hepatectomy for metastatic colorectal cancer may lead to long-term survival.
Predictive value of internal anal sphincter thickness for diagnosis of rectal intussusception in patients with solitary rectal ulcer syndrome
Authors: Marshall M , Halligan S , Fotheringham T , Bartram C , Nicholls R J
Published: March 2003

Background

The aim of this study was to determine any association between a thickened internal anal sphincter (IAS) on anal endosonography and high-grade rectal intussusception on evacuation proctography in patients with solitary rectal ulcer syndrome.

Methods

Anal endosonography was performed in 20 patients with solitary rectal ulcer syndrome and IAS thickness defined as normal or abnormal depending on age. Sphincter thickness was compared with the presence or absence of high-grade intussusception on subsequent evacuation proctography to determine any relationship between the two.

Results

Thirteen patients had an abnormally thick IAS, two of whom were unable to evacuate. Of the remaining 11 patients, ten showed high-grade intussusception (positive predictive value 91 per cent). Only three of seven patients with a normal IAS had high-grade intussusception (negative predictive value 57 per cent). Patients with a thick IAS were significantly more likely to have proctographic evidence of high-grade intussusception (P = 0·047).

Conclusion

Sonographic findings of a thick IAS are highly predictive for high-grade rectal intussusception in patients with solitary rectal ulcer syndrome.
Outcome of segmental colonic resection for slow-transit constipation
Authors: Lundin E , Karlbom U , Påhlman L , Graf W
Published: March 2003

Background

The standard surgical treatment for slow-transit constipation (STC) is subtotal colectomy and ileorectal anastomosis. A segmental resection may serve the same purpose, but with a reduced risk of side-effects such as diarrhoea or incontinence. The aim of this study was to evaluate the functional results following segmental resection in a consecutive series of patients with STC.

Methods

Selection criteria included prolonged segmental transit on oral 111In-labelled diethylene triamine penta-acetic acid scintigraphic transit study, and disabling symptoms resistant to medical therapy and treatment of outlet obstruction. Twenty-eight patients (26 women, median age 52 years) were treated with segmental resection and followed prospectively with a validated questionnaire.

Results

After a median of 50 (range 16–78) months, 23 patients were pleased with the outcome. The median (range) stool frequency increased from 1 (0–7) to 7 (0–63) per week (P < 0·001). The number of patients passing hard stools and straining excessively decreased (P = 0·016 and P = 0·041, respectively). The median incontinence score was unchanged. Rectal sensory thresholds were higher in patients in whom the treatment failed (P < 0·001).

Conclusion

With a symptomatic relief comparable to that after ileorectal anastomosis and less severe side-effects, segmental colectomy may be a better alternative for selected patients with STC. Thorough preoperative evaluation is important and impaired rectal sensation may predict a poor outcome.
Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival
Authors: Ohtsuka M , Ito H , Kimura F , Shimizu H , Togawa A , Yoshidome H , Miyazaki M
Published: March 2003

Background

The results of surgical treatment for intrahepatic cholangiocarcinoma (ICC) and specific factors influencing survival are still unclear.

Methods

Between 1984 and 2001, 62 patients with ICC underwent laparotomy, with a 77 per cent (48 patients) resectability rate. The tumours in these 48 patients were reviewed retrospectively to examine the relationship between gross appearance (mass forming, periductal infiltrating, intraductal growth, and mass forming plus periductal infiltrating) and patient survival, as well as the manner of recurrence. In patients with mass-forming and mass-forming plus periductal infiltrating types, univariate and multivariate analyses of potential prognostic factors were performed.

Results

The 1-, 3- and 5-year survival rates were 62, 38 and 23 per cent respectively. All patients with the intraductal growth type remained alive after intervals ranging from 8 to 72 months. Univariate analysis showed multiple hepatic lesions, liver capsule invasion, presence of cancer cells in the resection margin, and high serum carbohydrate antigen (CA) 19-9 level to be significant negative prognostic factors. Lymph node involvement, however, was not identified as a significant prognostic factor. With multivariate analysis, multiple hepatic lesions and high serum CA19-9 concentration were found to be significantly related to prognosis. The most frequent recurrence site was the remnant liver.

Conclusion

These results suggest that the intraductal growth type of tumour should be treated as a distinct entity compared with other types of ICC. Multiple tumours and high serum CA19-9 level were signs of dismal prognosis, whereas not all patients with lymph node involvement had a poor prognosis.
Differential effects of opioid and adrenergic agonists on proliferation in a cultured cell line
Authors: Agarwal D. , Glasel J.A.
Published: March 2003

Abstract. A novel clonal cell line transfected with the δ‐opioid receptor (δ‐OR) encoding gene was used to study agonist‐activated regulation of cell proliferation. In this cell line, endogenous β2‐adrenergic receptors (β2‐ARs) are coexpressed with the exogenous δ‐ORs. Upon individual acute treatments with morphine and procaterol (a selective β2‐AR agonist), both the δ‐OR and β2‐AR are coupled to differential modulation of cyclic AMP (cAMP) levels in accord with the classical second messenger response patterns to these agonists in the normal cellular settings of the receptors. But chronic morphine activation of the δ‐OR inhibits cellular proliferation, while chronic procaterol activation of the δ2‐AR stimulates it. Chronic treatment with the individual agonists is accompanied by differential activation of the mitogen‐activated protein kinase (MAPK) isozymes, extracellular‐regulated kinase (ERK) and c‐Jun N‐terminal kinase (JNK). The findings suggest that chronic β2‐AR activation stimulates proliferation by interacting with the ERK signalling cascade independent of a cAMP‐mediated pathway. In contrast to treatment with individual agonists, chronic dual agonist treatment suppresses procaterol‐induced stimulation of ERK activity and stimulation of proliferation indicating that a cross‐regulatory interaction occurs between the δ‐OR and β2‐AR signalling systems in the cells under these conditions.
Overexpression of insulin‐like growth factor II (IGFII) in ZR‐75‐1 human breast cancer cells: higher threshold levels of receptor (IGFIR) are required for a proliferative response than for effects on specific gene expression
Authors: Abdul‐Wahab K. , Corcoran D. , Perachiotti A. , Darbre P. D.
Published: March 2003

Abstract. Previous transfection experiments using a zinc‐inducible expression vector have shown that overexpression of insulin‐like growth factor II (IGFII) in MCF7 human breast cancer cells can reduce dependence on oestrogen for cell growth in vitro (DALY RJ, HARRIS WH, WANG DY, DARBRE PD. (1991) Cell Growth Differentiation2, 457–464.). Parallel transfections now performed into another oestrogen‐dependent human breast cancer cell line (ZR‐75‐1) yielded three clones of transfected ZR‐75‐1 cells that produced levels of zinc‐inducible IGFII mRNA and secreted mature IGFII protein similar to those found in the transfected MCF7 cells. However, unlike in MCF7 cells, no resulting effects were found on cell growth in the ZR‐75‐1 clones, even though the ZR‐75‐1 clones possessed receptors capable of binding 125I‐IGFI and showed a growth response to exogenously added IGFII. Medium conditioned by the ZR‐75‐1 clones could stimulate growth of untransfected MCF7 cells, indicating that the secreted IGFII protein was bioactive. Furthermore, zinc‐induced IGFII was capable of increasing both pS2 mRNA levels and CAT activity from a transiently transfected AP1‐CAT gene in the ZR‐75‐1 clones. Constitutive co‐overexpression of the protein processing enzyme PC2 resulted in reduced levels of large forms of zinc‐inducible IGFII, but zinc treatment still produced no effect on cell growth rate. Finally, however, constitutive cooverexpression of the type I IGF receptor (IGFIR) did result in zinc‐inducible increased basal cell growth and reduced dependence on oestrogen for cell growth. These results demonstrate that while overexpression of IGFII per se was sufficient to deregulate MCF7 cell growth, the ZR‐75‐1 cells are limited in their proliferative response by their intrinsic receptor levels. However, although the proliferative response was limited, molecular responses (expression of pS2 and AP1‐CATA) were not limited, indicating that different cellular responses can have different threshold receptor level requirements.
The kinetic origins of the restriction point in the mammalian cell cycle
Authors: Aguda B. D. , Tang Y.
Published: March 2003

Abstract. A detailed model mechanism for the G1/S transition in the mammalian cell cycle is presented and analysed by computer simulation to investigate whether the kinetic origins of the restriction point (R‐point) can be identified. The R‐point occurs in mid‐to‐late G1 phase and marks the transition between mitogendependent to mitogen‐independent progression of the cell cycle. For purposes of computer simulations, the R‐point is defined as the first point in time after mitosis where cutting off mitogen stimulation does not prevent the cell reaching the threshold activity of cyclin‐E/cdk2 required for entry into S phase. The key components of the network that generate a dynamic switching behaviour associated with the R‐point include a positive feedback loop between cyclin‐E/cdk2 and Cdc25A, along with the mutually negative interaction between the cdk inhibitor p27Kip1 and cyclin‐E/cdk2. Simulations of the passage through the R‐point were carried out and the factors affecting the position of the R‐point in G1 are determined. The detailed model also shows various points in the network where the activation of cyclin‐E/cdk2 can be initiated with or without the involvement of the retinoblastoma protein.
Effect of myenteric denervation on intestinal epithelium proliferation and migration of suckling and weanling rats
Authors: Hernandes L. , Zucoloto S. , Parisi Alvares E.
Published: March 2003

The effects of myenteric denervation on the cell kinetics of the intestinal epithelium of suckling and weanling rats were investigated. The myenteric plexus of an ileal segment was partially ablated by serosal application of benzalkonium chloride (BAC) in three groups of rats: those that underwent surgery at 13 days and were killed 15 (13/28‐day‐old) or 23 (13/36‐day‐old) days after treatment, and those that were operated at 21 days (21/36‐day‐old) and were killed 15 days after treatment. The extent of denervation was assessed in whole‐mount preparations. The cell bodies of myenteric neurones were stained by NADH‐diaphorase histochemical technique. Cell proliferation was estimated by the mitotic index (MI) and morphometric analysis of villus and crypt lengths using an image analysis system. Thickness of the muscle layers was also assessed by morphometry. Cell migration on the villi was estimated by the position of the leading labelled cell 24 h after tritiated thymidine injection. The number of neurones was reduced by around 80% in rats operated at 13 days, and reduced by 98% in those operated at 21 days. The thickness of the muscle layers was increased in all groups of treated animals. MI was significantly higher 15 days after BAC‐treatment in the 13/28 group. Morphological changes in the intestinal mucosa were observed 15 days after BAC‐treatment, when there was an increase in villus height (13/28 group) and crypt depth (13/28 and 21/36 groups). Cell migration rate was accelerated in the 21/36 group. No differences where found in the 13/36 group. These results show the strong effect of myenteric ablation on cell proliferation and migration in the ileal epithelium in the first 15 days of treatment in suckling and in weanling rats, and the subsequent recovery of intestinal mucosa homeostasis later on.
Cell kinetic status of haematopoietic stem cells
Authors: Mackey M. C.
Published: March 2003

The haematopoietic stem cell (HSC) population supports a tremendous cellular production over the course of an animal’s lifetime, e.g. adult humans produce their body weight in red cells, white cells and platelets every 7 years, while the mouse produces about 60% of its body weight in the course of a 2 year lifespan. Understanding how the HSC population carries this out is of interest and importance, and a first step in that understanding involves the characterization of HSC kinetics. Using previously published continuous labelling data (of Bradford et al. 1997 and Cheshier et al. 1999) from mouse HSC and a standard G0 model for the cell cycle, the steady state parameters characterizing these HSC populations are derived. It is calculated that in the mouse the differentiation rate ranges between about 0.01 and 0.02, the rate of cell re‐entry from G0 back into the proliferative phase is between 0.02 and 0.05, the rate of apoptosis from the proliferative phase is between 0.07 and 0.23 (all units are days−1), and the duration of the proliferative phase is between 1.4 and 4.3 days. These values are compared with previously obtained values derived from the modelling by Abkowitz and colleagues of long‐term haematopoietic reconstitution in the cat (Abkowitz et al. 1996) and the mouse (Abkowitz et al. 2000). It is further calculated using the estimates derived in this paper and other data on mice that between the HSC and the circulating blood cells there are between 17 and 19.5 effective cell divisions giving a net amplification of between ~170 000 and ~720 000.
Comparison of several techniques for the detection of apoptotic astrocytes in vitro
Authors: Micoud F. , Mandrand B. , Malcus‐Vocanson C.
Published: March 2003

Implication of apoptosis in numerous physiological and pathological processes has resulted in the development of numerous methods to detect apoptosis, but none of them is adapted to all cell types. In this study, we induced apoptosis on murine immortalized astrocytes with urine from multiple sclerosis (MS) patients. Among techniques allowing the detection of apoptotic cells, only a few are adapted to adherent cells such as astrocytes. We compared several techniques (propidium iodide labelling and flow cytometry analysis, TUNEL and annexin V labelling in immunofluorescence, DNA ladder, ELISA tests to detect nucleosomes) in order to choose the method best adapted to our adherent cellular model and to discuss their practicability for the detection of apoptosis on adherent cells.

For technical course, propidium iodide labelling followed by flow cytometry analysis as a quantitative technique, and TUNEL in IF (easier and quicker than propidium iodide) as a semiquantitative test were both retained as best adapted to our case.

Moreover, in our model, we have observed that phosphatydilserine externalization and DNA fragmentation were concomittant after induction of apoptosis.

Techniques studied in this article would allow an enlarged study of the apoptotic mechanism in several pathologies by culture of adherent cells sensitive to apoptosis in vitro.
Differential mitogenic responses of human macrovascular and microvascular endothelial cells to cytokines underline their phenotypic heterogeneity
Authors: Lang I. , Hoffmann C. , Olip H. , Pabst M.‐A. , Hahn T. , Dohr G. , Desoye G.
Published: March 2003

A variety of growth factors promote the complex multistep process of angiogenesis. The mitogenic activity of vascular endothelial growth factors (VEGFs) and placental growth factors (PlGFs), known as cytokines acting predominantly on endothelial cells, was tested on human umbilical vein endothelial cells (HUVEC) and microvascular endothelial cells (MIEC) and compared with the potency of the universally acting basic fibroblast growth factor (FGF‐2). The cells were seeded at different cell numbers and incubated with various doses of growth factors for a period of 24–72 h in culture medium ± serum. Proliferation was determined by measuring the optical density after staining the cells with the tetrazolium salt WST‐1.

VEGF121 and VEGF165 increased the number of HUVEC and MIEC at low and high seeding densities various doses and incubation times. The efficiency of FGF‐2 was less pronounced at high seeding densities of the cells under serum‐free conditions. PlGF‐1 and PlGF‐2 stimulated mitogenesis on HUVEC only at low cell numbers and after a short incubation time by 125 ± 3% and 102 ± 5% (P < 0.001), respectively. Longer incubation times with the lower seeding density in the absence of FCS did not induce a significant stimulatory effect of the PlGFs. MIEC responded stronger to all growth factors. In particular under serum free conditions, PlGF‐1 and PlGF‐2 effectively stimulated cell proliferation by 247 ± 54% (P < 0.01) and 288 ± 40% (P < 0.05) at low cell numbers, and by 81 ± 13% (P < 0.05) and 49 ± 13% (P < 0.01), respectively, at high cell numbers. The addition of fetal calf serum caused a reduced proliferative response of all growth factors on both cell types related to the controls. In conclusion, MIEC and HUVEC differ in their proliferative response to VEGFs, PlGFs and FGF‐2.
Regulating child care: from the Children Act 1948 to the present day
Authors: Ball Caroline
Published: March 2003

This article reflects selectively on the development of the legal regulation of child care practice in England and Wales since the Children Act 1948. Two main themes are identified: the burgeoning burden of the statutory responsibilities of local authorities throughout the period, and the controls more recently imposed on the discretionary exercise of statutory powers. The impact of the latter on particular areas of practice is discussed within the context of the growing influence of international treaty obligations, the concept of children's rights, and the outcomes of research on the legal framework of child care practice.
Inter‐agency practice in suspected cases of Munchausen Syndrome by Proxy (Fictitious Illness by Proxy): dilemmas for professionals
Authors: Horwath
Published: March 2003

Munchausen Syndrome by Proxy (MSBP) or Fictitious Illness by Proxy, the fabrication or induction of illness in a child, is a recognized form of child abuse in many countries. As such it is subject to inquiry under child protection legislation. Child protection legislation and practice guidance in Australia, the USA and most European countries requires professionals from a variety of disciplines to work together regarding the recognition, investigation and short and long‐term assessment of the case. However, practitioners and managers find cases of MSBP difficult to manage at personal, professional and organizational levels. This paper identifies some of the tensions and dilemmas encountered by professionals when working with suspected cases of MSBP. Consideration is given to the impact that this has on multi‐disciplinary practice in terms of working in partnership with other professionals and the family. The paper includes suggestions for promoting effective inter‐agency practice to protect children who are the victims of this form of abuse.