bluuebunny/crossref_metadata_2025 huggingface dataset:
Macrophages in Human Reproductive Tissues Contain Luteinizing Hormone/Chorionic Gonadotropin Receptors
Authors: Zhang Y. M. , Rao Ch. V. , Lei Z. M.
Published: March 2003

PROBLEM: To determine whether macrophages in human reproductive tissues contain luteinizing hormone (LH)/human chorionic gonadotropin (hCG) receptor mRNA and receptor protein that can bind 125I‐hCG.

METHOD OF STUDY: Macrophages isolated from term pregnancy human decidua were used for LH/hCG receptor detection by in situ hybridization for receptor mRNA and immunocytochemistry for a macrophage marker, CD68, performed alone and in combination, reverse transcription‐nested polymerase chain reaction, Western and ligand blotting. The LH/hCG receptor presence in macrophages in late luteal phase human endometria and corpora lutea was determined by sequential performance of in situ hybridization and immunocytochemistry.

RESULTS: The macrophages present in term pregnancy human decidua and late luteal phase human endometria and corpora lutea contain LH/hCG receptors.

CONCLUSIONS: This is the first demonstration of macrophages present in human reproductive tissues containing LH/hCG receptors. The receptor presence suggests that LH and hCG may regulate macrophage functions in gonadal as well as in non‐gonadal target tissues.
Successful Pregnancy with Low Molecular Weight Heparin in Two Women with Recurrent Miscarriage of Unknown Etiology
Authors: Miyashita Yoshihiro , Waguri Masako , Nakanishi Isao , Suehara Noriyuki , Fujita Tomio
Published: March 2003

We report here two cases of recurrent miscarriages that were successfully treated with continuous intravenous administration of low molecular weight heparin (LMWH). One patient experienced 11 spontaneous abortions, and the other eight abortions. Previous treatments including prednisone, aspirin and mononuclear‐cell immunization were all unsuccessful. They were negative for anticardiolipin antibodies and lupus anticoagulant, and had no inherited thrombophilic disorder. Intravenous administration of LMWH, 4800 units of dalteparin, was started as soon as the conception was confirmed, and was continued until 34 weeks of gestation. They were delivered of live born infants.
Protective effect of Copalite surface coating on mercury release from dental amalgam following treatment with carbamide peroxide
Authors: Rotstein I. , Dogan H. , Avron Y. , Shemesh H. , Mor C. , Steinberg D.
Published: March 2003

Abstract – The effect of Copalite coating on mercury release from dental amalgam following treatment with 10%, 20%, 30% and 40% carbamide peroxide was assessed in vitro, using a cold‐vapour atomic absorption Mercury Analyzer System. Eighty samples of dental amalgam were automatically mixed in a dental amalgamator and condensed into silicon embedding molds. Forty amalgam samples were coated with three uniform layers of Copalite intermediary varnish and the other 40 samples were left uncoated. The coated and non‐coated amalgam samples were exposed for 24 h to 10%, 20%, 30% or 40% carbamide peroxide preparations and compared with samples exposed to phosphate buffer. In the non‐coated samples a significant increase of mercury concentration in solution was found following exposure to all carbamide peroxide preparations tested. Mercury concentration was directly related to carbamide peroxide concentration. In the Copalite‐coated samples, significantly lower concentrations of mercury in solution were found as compared to the non‐coated samples (P<0.01). In conclusion, exposure of amalgam restorations to 10%–40% carbamide peroxide‐based bleaching agents increased the mercury release. Pre‐coating of the external amalgam surfaces with Copalite significantly reduced the release of mercury.
The lateral periodontal cyst: aetiology, clinical significance and diagnosis
Authors: Kerezoudis N. P. , Donta‐Bakoyianni C. , Siskos G.
Published: March 2003

Abstract – The lateral periodontal cyst (LPC) is a relatively uncommon but widely recognized odontogenic cyst of developmental origin. It is found mostly in adults and has no sex predilection. LPC is usually discovered during routine radiographic examination, is located mainly between the roots of vital mandibular canines and premolars, and seldom causes pain or other clinical symptoms. The defect appears on radiographs as a round or teardrop‐shaped, well circumscribed radiolucency. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. In this paper, two cases of lateral periodontal cysts are presented. In the first case, the patient (woman, 62 years old) complained of an asymptomatic gingival swelling in the region between the right maxillary canine and premolar. The radiographic examination revealed a well circumscribed radiolucency with a radiopaque margin between the roots of the canine and premolar. The adjacent teeth had vital pulp. Surgical enucleation of the lesion was performed and the histological examination revealed that the lesion was a “lateral periodontal cyst of developmental origin”. In the second case, the patient (woman, 44 years old) compained of a swelling in the area of tooth 32. During radiographic examination a well circumscribed radiolucency between the roots of the lateral incisor and the canine was discovered. Surgical enucleation of the lesion was performed and the histological examination revealed that the lesion was a “lateral periodontal cyst of developmental origin”.
Dentine chips produced by nickel‐titanium rotary instruments
Authors: Guppy D. R. , Curtis R. V. , Ford T. R. Pitt
Published: March 2003

Abstract – This study aimed to compare the cross‐sectional shape of two nickel‐titanium rotary instruments, namely ProFile and Quantec files, both ISO 25, 0.06 taper, and sought to relate this to the chips produced by cutting dentine. A limited comparison was made with stainless steel engine reamers. First, five files of each type were sectioned transversely at 12 mm, 8 mm and 4 mm from the tip and examined by scanning electron microscopy. The cutting angles were assessed by a direct measurement technique which allowed for the inclination of a cutting edge to the root canal. Second, eight samples of cutting debris were collected from instrumentation by each type of nickel‐titanium file and four samples from the engine reamers. The major and minor axis, area and roundness of the dentine chips in each sample were measured using computerized particle analysis. The results demonstrated that all files had a negative cutting angle which varied at the different levels (ProFiles range 69.4° to 58.4° and Quantec range 74.8° to 56.8°). The consistency within files of the same type was good as demonstrated by low standard deviations, except for Quantec files at the 4 mm level where higher standard deviations of 4.1° and 5.5° for the two blades were found. The chip analysis showed significant differences between chips produced by ProFile and Quantec files (P<0.05). The latter were larger and rounder. The chips from the ProFile and the engine reamer chips were similar in dimension (P>0.05). No simple relationship existed between file geometry and the dentine chips produced during instrumentation.
Dental trauma in children presenting for treatment at the Department of Dentistry for Children and Orthodontics, Budapest, 1985–1999
Authors: Gábris Katalin , Tarján Ildikó , Rózsa Noémi
Published: March 2003

Abstract – Data on children with dental trauma who presented for treatment at the Department of Dentistry for Children and Orthodontics in Budapest over a period of 15 years were analysed. The WHO guidelines were used to classify the traumatic injuries. A total of 590 children were involved, 810 teeth being affected. Children aged 7–14 years made up 88% of the cohort. The male:female ratio was 58:42. The permanent:primary ratio for the affected teeth was 90:10. The teeth most commonly affected were the maxillary central incisors. In 70% of the cases, only one tooth was traumatised. The incidence of dental trauma peaked at 10 years of age. The most common injury type observed was enamel‐dentin crown fracture. The decreasing sequence of frequency of etiological factors was playing, sports, falls, cycling, road accidents and fighting. Of the accidents, 65% occurred at school or at home. Seventy seven per cent of the patients presented for medical care in the first 3 days after the accident.
Treatment of traumatized permanent incisors with crown and root fractures: a case report
Authors: Gomes Ana Paula Martins , De Araujo Elaine Aparecida Félix , De Paiva Gonçalves Sérgio Eduardo , Kräft Rosângela
Published: March 2003

Abstract – A case report of the treatment of permanent incisors with crown and root fractures is presented. A radiolucent lesion at the fracture lines was treated with calcium hydroxide in the coronal fragments for 18 months. Clinically, the teeth became firm and the radiographic results after 2 years showed healing of the lesion and hard tissue filling in the space at the fracture lines.
Aged endothelial nitric oxide synthase knockout mice exhibit higher mortality concomitant with impaired open‐field habituation and alterations in forebrain neurotransmitter levels
Authors: Dere E. , De Souza Silva M. A. , Topic B. , Fiorillo C. , Li J.‐S. , Sadile A. G. , Frisch C. , Huston J. P.
Published: March 2003

Endothelial nitric oxide synthase (eNOS) has been implicated in various brain and peripheral pathologies such as renal failure, heart failure or stroke. Consequently, the mortality rate of aged eNOS knockout mice (eNOS–/–) was higher than that of age‐matched (18–22 months old) controls. Only seven of the original 14 eNOS–/– animals that participated in the study reached the age of 18 months or older, whereas no control mice died during this life span. In order to assess the behavioral and neurochemical consequences of chronic eNOS deficiency we examined whether the surviving aged eNOS–/– mice showed changes in terms of motor, emotional, exploratory and neurochemical parameters. Aged eNOS–/– mice showed reduced exploratory activity in the open‐field with no habituation observable neither within sessions nor after repeated exposures. Pole test performance of eNOS–/– mice was comparable to controls. In the elevated plus‐maze eNOS–/– mice did not differ from controls in terms of time spent in and entries into arms, but showed less locomotion on the open arms. The most prominent neurochemical alterations in the forebrains of aged eNOS–/– mice were: (a) increased acetylcholine levels in the neostriatum; (b) decreased noradrenaline concentrations in the ventral striatum; and (c) lower serotonin levels in the frontal cortex and ventral striatum. The present findings suggest that mice which survived chronic eNOS‐deficiency into old age, show some behavioral and neurochemical phenotypes distinct from adult eNOS–/– mice.
Memory retrieval after contextual fear conditioning induces c‐Fos and JunB expression in CA1 hippocampus
Authors: Strekalova T. , Zörner B. , Zacher C. , Sadovska G. , Herdegen T. , Gass P.
Published: March 2003

Using specific polyclonal antisera against c‐Fos, JunB, c‐Jun and JunD, we tried to identify the candidate transcription factors of the immediate early gene family which may contribute to the molecular processes during contextual memory reconsolidation. For that purpose we analyzed the expression of these proteins in the hippocampus after contextual memory retrieval in a mouse model of fear conditioning. A single exposure to a foot shock of 0.8 mA was sufficient to induce robust contextual fear conditioning in C57Bl/6N mice. In these mice context dependent memory retrieval evoked a marked induction of c‐Fos and JunB, but not of c‐Jun and JunD, in pyramidal CA1 neurons of the dorsal hippocampus. In contrast, mice exposed and re‐exposed only to the context, without foot shock, did not show behavioral signs of contextual fear conditioning and exhibited significantly less expression of c‐Fos and JunB in CA1 neurons. Mice which received a foot shock but were not re‐exposed to the context revealed no immediate early gene induction. These results demonstrate that contextual memory retrieval is associated with de novo synthesis of specific members of the Fos/Jun transcription factor family. Therefore we suggest that these genes may contribute to plasticity and reconsolidation accompanying the retrieval process. The specific activation of CA1 neurons during the retrieval of contextual fear associations supports the postulated concept of a mnemonic role of this hippocampal subsector during the retrieval of contextual informations.
The margin of safety associated with the use of cuffed paediatric tracheal tubes
Authors: Ho A. M.‐H. , Aun C. S. T. , Karmakar M. K.
Published: March 2003

Summary There is increasing interest in the use of cuffed paediatric tracheal tubes, these tubes have a number␣of advantages and disadvantages. One disadvantage is the decreased margin of safety associated with the use of cuffed tracheal tubes. When using an uncuffed tube, the margin of safety␣is approximately the length of the trachea, however, for a cuffed tube, this margin is reduced and is the length of the trachea minus the distance between the proximal edge of the cuff and the␣tip␣of the tube. We have found that, compared with traditional uncuffed tubes, cuffed tubes␣may␣be associated with a reduced margin of safety of approximately 50% or more.
Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway*
Authors: Pandit J. J. , MacLachlan K. , Dravid R. M. , Popat M. T.
Published: March 2003

Summary We compared the times to intubate the trachea using three techniques in 60 healthy patients with normal airways: (i) fibreoptic intubation with a 6.0‐mm reinforced tracheal tube through a standard laryngeal mask airway (laryngeal mask−fibreoptic group); (ii) fibreoptic intubation with a dedicated 7.0‐mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask−fibreoptic group); (iii) blind intubation with the dedicated 7.0‐mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask−blind group). Mean (SD) total intubation times were significantly shorter in the intubating laryngeal mask−blind group (49 (20) s) than in either of the other two groups (intubating laryngeal mask−fibreoptic 74 (21) s; laryngeal mask−fibreoptic group 75 (36) s; p < 0.001). However, intubation at the first attempt was less successful with the intubating laryngeal mask−blind technique (15/20 (75%)) than in the other two groups (intubating laryngeal mask−fibreoptic 19/20 (95%) and laryngeal mask−fibreoptic 16/20 (80%)) although these differences were not statistically significant. We conclude that in this patient group, all three techniques yield acceptable results. If there is a choice of techniques available, the intubating laryngeal mask−blind technique would result in the shortest intubation time.
Obstetric anaesthetists' workload*
Authors: Wee M. Y. K. , Yentis S. M. , Thomas P.
Published: March 2003

Summary The current recommendation of one consultant session per 500 deliveries with full sessional cover␣for units over 3000 deliveries is arbitrary and is not based on workload. The Audit Commission has questioned the wide variability of anaesthetic staffing on labour wards. The aim of this study was to investigate whether there is a relationship between current workload and obstetric anaesthetic staffing in five maternity units. In 1998, a 2‐week diary of workload in the participating obstetric units was assessed in terms of staffing and clinical and nonclinical activities. The busiest time was 08:00 to 12:30. The working patterns between consultants and trainees varied considerably. Time spent on nonclinical activity by consultants averaged 51%. Any calculation of consultant sessions will need to take into account nonclinical activities. Other factors requiring consideration are the number of high‐risk cases, as well as the number and experience of trainees.
The influence of induction technique on intubating conditions 1 min after rocuronium administration: a comparison of a propofol‐ephedrine combination and propofol
Authors: Tan C. H. , Onisong M. K. , Chiu W. K. Y.
Published: March 2003

We conducted a double blind, prospective, controlled trial comparing intubating conditions after induction with a propofol‐ephedrine combination or propofol alone, followed by rocuronium. One hundred adult patients were randomly assigned to receive either propofol 2.5 mg.kg−1 and ephedrine 15 mg in combination or propofol 2.5 mg.kg−1 given over 30 s, followed by rocuronium 0.6 mg.kg−1 given over 5 s. Tracheal intubation was performed 1 min later. Jaw relaxation, vocal cord position and diaphragmatic response were used to assess intubation conditions. Tracheal intubation was successful and acceptable in all patients. There was a significantly higher proportion of intubating conditions graded as ‘excellent’ in the propofol‐ephedrine group (84%) than in the propofol group (32%) (p < 0.0001). Vocal cord position and response to intubation were significantly better in the propofol‐ephedrine group, although jaw relaxation was similar. Mean arterial pressure was maintained at pre‐induction levels in the propofol‐ephedrine group. In conclusion, induction with propofol and ephedrine in combination provided significantly better intubating conditions than propofol alone, when followed by rocuronium.
Identification of a novel WT1‐derived peptide which induces human leucocyte antigen‐A24‐restricted anti‐leukaemia cytotoxic T lymphocytes
Authors: Azuma Taichi , Makita Masanori , Ninomiya Kanji , Fujita Shigeru , Harada Mine , Yasukawa Masaki
Published: March 2003

Summary. We previously reported the establishment of a Wilms' tumour (WT)1‐derived peptide (CMTWNQMNL)‐specific and human leucocyte antigen (HLA)‐A24‐restricted anti‐leukaemia cytotoxic T lymphocyte (CTL) line, TAK‐1. In this study, we have established a novel WT1‐derived peptide (RWPSCQKKF)‐specific CD8+ CTL line, designated NIM‐1. NIM‐1 lysed HLA‐A24‐positive leukaemia cells, but not HLA‐A24‐negative leukaemia cells or normal cells. The effects of TAK‐1 and NIM‐1 on cytotoxicity against leukaemia cells were not synergistic, suggesting that recognition of a single epitope on the tumour‐specific antigen by CTLs is sufficient to exert maximal cytotoxic activity against tumour cells.
von Willebrand factor‐cleaving protease inhibitor in a patient with human immunodeficiency syndrome‐associated thrombotic thrombocytopenic purpura
Authors: Sahud Mervyn A. , Claster Susan , Liu Lucy , Ero Michael , Harris Kathryn , Furlan Miha
Published: March 2003

Summary. Antibodies that inhibit von Willebrand Factor (VWF)‐cleaving protease activity occur in patients with acute thrombotic thrombocytopenic purpura (TTP) and often persist in the chronic phase. A deficiency of this protease is likely to be responsible for the generation of ultrahigh VWF multimers and influence the formation of intra‐arterial platelet aggregates that result in microangiopathic haemolytic anaemia, thrombocytopenia and end in organ failure. This report demonstrates complete deficiency of VWF‐cleaving protease and the presence of a concentration‐dependent IgG1 inhibitor in the plasma of a patient with acquired immunodeficiency syndrome (AIDS). These data may contribute to understanding the pathophysiology of human immunodeficiency syndrome (HIV)‐related TTP.
Patient accuracy of reporting on hereditary non-polyposis colorectal cancer-related malignancy in family members
Authors: Katballe N , Juul S , Christensen M , Ørntoft T F , Wikman F P , Laurberg S
Published: March 2003

Background

The cancer family history is important in identifying individuals with hereditary non-polyposis colorectal cancer (HNPCC). The accuracy of a suspected HNPCC family history reported by patients with colorectal cancer was evaluated.

Methods

This was a prospective population-based study including consecutive patients with colorectal cancer. A questionnaire covering the occurrence of malignancy among relatives was completed.

Results

A total of 1200 patients with colorectal cancer completed the questionnaire. Fulfilment of Amsterdam criteria I or II according to the patients' reports was rejected in three of 14 cases (false-positive rate 21 per cent). Furthermore, seven of 18 probands whose families met the Amsterdam criteria I or II after verification were identified by further exploration in families who, according to the probands, met weaker criteria (false-negative rate 39 per cent).

Conclusion

The present study suggests that family studies on HNPCC are not reliable unless the diagnoses of family members are verified from official sources. If endoscopic screening is offered entirely on the basis of unverified information from patients with colorectal cancer, there is a risk that a large proportion of the families will not be offered relevant surveillance.
Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults
Authors: Arroyo A , García P , Pérez F , Andreu J , Candela F , Calpena R
Published: March 2003

Background

Prosthetic repair has become the standard method for inguinal hernia and has excellent results. The question remains of whether the mesh technique could also improve results for umbilical defects.

Methods

The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adult patients with a primary umbilical hernia. Patients at high anaesthetic risk (American Society of Anesthesiologists (ASA) grade IV) or those who needed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean age at presentation of 57 years. Some 173 patients were ASA grade I–II and 27 were ASA III. The anaesthetic technique of choice was local anaesthetic infiltration plus sedation (98 per cent).

Results

There were no significant anaesthetic complications or surgical deaths. The mean duration of surgery was greater for mesh than for suture repair (45 versus 38 min). Rates of early complications such as seroma, haematoma or wound infection were similar in the two groups. The hernia recurrence rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0·0015).

Conclusion

Prosthetic repair could become the standard treatment for primary umbilical hernia in adults.
Anatomy of the anal canal and perianal structures as defined by phased-array magnetic resonance imaging
Authors: Morren G L , Beets-Tan R G H , van Engelshoven J M A
Published: March 2003

Background

The anatomy of the anal canal and perianal structures has been imaged using endoluminal magnetic resonance imaging (MRI). Phased-array MRI avoids the use of an endoluminal coil that may distort anatomy. The aim of this study was to describe the anatomy of the anal canal and perianal structures using phased-array MRI.

Methods

Imaging was performed in 14 men and 19 nulliparous women. The dimensions of the anal canal, puborectalis, external anal sphincter, perineal body, superficial transverse perineal muscle, bulbospongiosus, ischiocavernosus and anococcygeal body were measured in different planes, and sex differences were calculated.

Results

The lateral canal was significantly longer than its anterior and posterior part (P < 0·001). The anterior external anal sphincter was shorter in women than in men (P = 0·01) and occupied, respectively, 30 and 38 per cent of the anal canal length (P = 0·001). The caudal ends of the external anal sphincter formed a double layer. The perineal body was thicker in women than in men (P < 0·001) and easier to define. The superficial transverse muscles had a lateral and caudal extension to the ischiopubic bones. The bulbospongiosus was thicker in men than in women (P < 0·001). The ischiocavernosus and anococcygeal body had the same dimensions in both sexes.

Conclusion

Phased-array MRI is a non-invasive technique that allows an accurate description of the normal anatomy of the anal canal and perianal structures.
Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse
Authors: Solomon M J , Young C J , Eyers A A , Roberts R A
Published: March 2003

Background

The objectives of this study were to compare both subjective clinical outcomes and the objective stress response of laparoscopic and open abdominal rectopexy in patients with full-thickness rectal prolapse. Abdominal rectopexy for patients with rectal prolapse is well suited for a laparoscopic approach as no resection or anastomosis is necessary.

Methods

Forty patients with a full-thickness rectal prolapse were randomized before operation to a laparoscopic group and an open group. They agreed to conform to a clinical pathway (CP) of liquid diet (CP1) and full mobility (CP2) on day 1, solid diet (CP3) on day 2 and discharge (CP4) before day 5. Their compliance was monitored by an assessor blinded to the operative group, who also rated pain and mobility. Patient-controlled morphine use was documented. Neuroendocrine and immune stress response and respiratory function were measured.

Results

Some 75 per cent of all clinical pathway objectives of early recovery were achieved in the laparoscopic group compared with 37 per cent in the open group (P < 0·01). Significant differences in favour of laparoscopy were noted with regard to narcotic requirements, and pain and mobility scores. Differences in objective measures of stress response favouring laparoscopy were found for urinary catecholamines, interleukin 6, serum cortisol and C-reactive protein. No differences were noted in respiratory function but significant respiratory morbidity was greater in the open group (P < 0·05). None of the measured outcomes, subjective or objective, favoured the open group apart from operating time, which was significantly shorter (153 versus 102 min; P < 0·01).

Conclusion

This study has demonstrated significant subjective and objective differences in favour of a laparoscopic technique for abdominal rectopexy. The advantages were all short term but no evidence of any adverse effect on longer-term outcomes was observed.
Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment
Authors: Engel A F , Eijsbouts Q A J , Balk A G
Published: March 2003

Background

Although lateral sphincterotomy heals chronic fissure in ano in over 90 per cent of cases it is a surgical technique with inherent complications. To avoid such complications, chronic fissure in ano was treated by fissurectomy in this study. To enhance postoperative tissue perfusion allowing stable wound healing, fissurectomy was combined with temporary chemical sphincterotomy by a nitric oxide donor cream.

Methods

Seventeen consecutive patients (ten women) with chronic fissure in ano not responding to conservative management underwent diathermy fissurectomy. After operation patients used a 1 per cent isosorbide dinitrate cream. Postoperative follow-up continued until wounds had healed, at which time anal endosonography was performed. A telephone inquiry into fissure recurrence and continence status was made.

Results

Seventeen patients underwent fissurectomy, without postoperative complications. All wounds had healed within 10 weeks. No fissure recurrence was seen after a median follow-up of 29 months. Histopathology showed non-specific scar tissue without signs of internal anal sphincter fibrosis. Postoperative endosonography showed no evidence of new internal sphincter defects.

Conclusion

In the treatment of chronic anal fissure not responding to chemical sphincterotomy with nitric oxide donors, fissurectomy in combination with isosorbide dinitrate cream may be a sphincter-sparing surgical technique.
Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia
Authors: Korenkov M , Sauerland S , Arndt M , Bograd L , Neugebauer E A M , Troidl H
Published: March 2003

Background

Since conventional suture repair for incisional hernia is associated with high recurrence rates, alloplastic and autoplastic prosthetic techniques have been suggested.

Methods

In a randomized trial, 160 patients with simple or complex hernias underwent either suture repair, autodermal skin graft or onlay polypropylene mesh repair. Suture repair was not done in complex hernias. This report concerns a planned interim analysis.

Results

At mean follow-up of 16 months, there were 17 hernia recurrences that were distributed similarly between the surgical techniques. There were fewer infectious complications after suture repair (three of 33 patients) than after skin graft or mesh repair (seven of 39 and five of 28 for simple hernias; seven of 31 and ten of 29 respectively for complex hernias) (P not significant). The severity of infections after polypropylene mesh implantation prompted the trial committee to discontinue the study. No differences were noted in duration of stay in hospital and quality of life. However, pain was significantly more frequent after polypropylene mesh repair (pooled risk ratio 2·9 and 1·8 at 6 weeks and 1 year respectively).

Conclusion

Suture repair was safe for small incisional hernias. Both autoplastic and alloplastic hernia repair yielded comparably low recurrence rates, but led to a high rate of wound infection.
Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis
Authors: Buter A , Imrie C W , Carter C R , Evans S , McKay C J
Published: March 2003

Background

All patients with organ dysfunction are currently classified as having severe acute pancreatitis. The aim of this study was to characterize the systemic inflammatory response syndrome (SIRS) and early organ dysfunction in patients with acute pancreatitis and the relationship with overall mortality.

Methods

Patients with predicted severe acute pancreatitis of less than 48 h duration had daily organ dysfunction scores and SIRS criteria calculated. These features were then correlated with outcome.

Results

Of 121 patients, 68 (56 per cent) did not develop organ dysfunction; only two of these patients died (mortality rate 3 per cent). Fifty-three (44 per cent) had early organ dysfunction, of whom 11 died (21 per cent). Organ dysfunction and persistent SIRS were both associated with an increased mortality rate, but on multivariate analysis only deteriorating organ dysfunction was an independent determinant of survival.

Conclusion

Early organ dysfunction in acute pancreatitis usually resolves and in itself has no significant influence on mortality. In contrast, worsening organ dysfunction was associated with death in more than half of the patients (11 of 20); it is this group of patients who should be classified as having severe acute pancreatitis.
Breast reconstruction in the United Kingdom and Ireland
Authors: Callaghan C J , Couto E , Kerin M J , Rainsbury R M , George W D , Purushotham A D
Published: March 2003

Background

Although it is becoming more common, previous surveys have identified concerns regarding the safety of immediate reconstruction following mastectomy. The aims of this study were to define current practice of breast reconstruction in the UK and Ireland, and to identify the characteristics of surgeons who use immediate breast reconstruction.

Methods

A postal questionnaire survey of 498 consultant breast surgeons in the UK and Ireland was performed in January 2000.

Results

There were 376 responses (response rate 76 per cent). Eighty-eight per cent of surgeons ‘always’ or ‘usually’ discuss reconstruction with patients due to undergo mastectomy; clinicians with a heavy caseload were significantly more likely to discuss it (odds ratio (OR) 18·45 (95 per cent confidence interval 1·99 to 171·07)). The majority of respondents (57 per cent) preferred delayed to immediate breast reconstruction; 70 per cent believed that immediate reconstruction has disadvantages, most commonly that it interferes with adjuvant therapy (56 per cent). Older surgeons were significantly less likely to perform immediate reconstruction (OR 5·18 (2·21 to 12·11)), and were significantly more likely to believe that immediate breast reconstruction has disadvantages (OR 2·02 (1·01 to 4·05)). Surgeons from Ireland were less likely to discuss and perform breast reconstruction (OR 0·20 (0·10 to 0·43) and 0·27 (0·12 to 0·60) respectively), or to have access to a plastic surgeon (OR 0·22 (0·11 to 0·44)).

Conclusion

Significant variation exists in the delivery of breast reconstruction after mastectomy in the UK and Ireland. The age, workload and personal characteristics of the surgeon are important in determining reconstructive practice.
Incidence and pattern of long saphenous vein duplication and its possible implications for recurrence after varicose vein surgery
Authors: Corrales N E , Irvine A , McGuinness C L , Dourado R , Burnand K G
Published: March 2003

Background

The incidence of long saphenous vein (LSV) duplication has not been clearly established. This anomaly could have implications for recurrence after varicose vein surgery.

Methods

Some 103 saphenograms obtained in 85 patients being considered for peripheral arterial bypass surgery were reviewed. Non-ionic contrast medium was injected directly into the vein or its tributaries at the ankle. Duplications of the LSV and their relation to thigh and calf perforator veins were assessed and recorded by two independent observers.

Results

There was evidence of duplication of the LSV in 50 (49 per cent) of the 103 saphenograms. Most duplications were present in the thigh (88 per cent) and the most common pattern was a closed loop (54 per cent). Perforator veins were connected to one branch of the duplication in 42 per cent of the legs (20 per cent of all 103 legs); in half the perforator vein was connected to the non-dominant branch of the duplication. Only ten of the 18 patients who had bilateral saphenograms had duplications in both legs, and only one patient had the same pattern of duplication on both sides.

Conclusion

The incidence of LSV duplications is higher than previously reported.
Surgical repair of ruptured thoracic and thoracoabdominal aortic aneurysms
Authors: Lewis M E , Ranasinghe A M , Revell M P , Bonser R S
Published: March 2003

Background

Rupture is the single most common cause of death in patients with thoracic aortic and thoracoabdominal aneurysm (TAA/TAAA) and is almost uniformly fatal.

Methods

This was a retrospective review of patients admitted to a single practice with rupture of a TAA/TAAA between 1993 and 2000.

Results

Twenty-two consecutive patients with a leaking TAA/TAAA were identified. The aetiology of rupture was either secondary to a degenerative TAAA or a type B dissection. Seventeen patients underwent surgery; one had a Crawford extent I, seven an extent II, one an extent III and two an extent IV TAAA. Six patients had an acute type B dissection with rupture in the upper descending thoracic aorta. The 30-day survival rate was 88 per cent (15 of 17 patients). Actuarial survival at 1 year in patients who had surgery was 65 per cent. Survival at 1 year for all presenting patients who consented to surgery was 40 per cent. Median survival was greater than 36 months.

Conclusion

As a result of improving medical care, more patients with a contained rupture of a TAA/TAAA may present for treatment. Surgery is complex and requires specialist teams for optimal care.
Positron emission tomography for staging and management of malignant melanoma
Authors: Prichard R S , Hill A D K , Skehan S J , O'Higgins N J
Published: March 2003

Background

The incidence of malignant melanoma is rising; it now has an incidence of ten per 100 000 per annum in the UK. The development of metastases is unpredictable, but prognosis is linked directly to the initial stage at diagnosis. Positron emission tomography (PET) can allow the detection of malignant cells at a relatively early stage.

Methods

A review of the literature was undertaken by searching the Medline database for the period 1980–2000 without any language restrictions.

Results

The overall sensitivity and specificity of PET are 74–100 and 67–100 per cent respectively. PET has a reduced sensitivity and specificity for thinner lesions (less than 1·5 mm). Comparison with computed tomography and magnetic resonance imaging has shown a higher sensitivity and specificity for PET in all regions of the body except the thorax.

Conclusion

Currently the accepted indication for PET is recurrent melanoma when surgical intervention is being considered. However, other potential indications include the detection of occult or distant metastasis at initial presentation and the clarification of abnormal radiological findings at follow-up. The routine use of PET for American Joint Commission on Cancer stage I or II disease is of uncertain benefit and is not indicated at present.
Impact of diagnostic laparoscopy on the management of gastric cancer: prospective study of 120 consecutive patients with primary gastric adenocarcinoma
Authors: Lehnert T , Rudek B , Kienle P , Buhl K , Herfarth C
Published: March 2003

Background

Peritoneal seeding or liver metastases found at laparotomy usually preclude curative treatment in patients with gastric adenocarcinoma. Such exploratory laparotomies may be avoided by diagnostic laparoscopy. However, routine diagnostic laparoscopy does not benefit those patients who proceed to laparotomy after negative laparoscopy. The aim of this study was to evaluate prospectively the selective use of laparoscopy in uncertain situations.

Methods

One hundred and twenty consecutive patients with primary gastric adenocarcinoma were studied prospectively. Diagnostic laparoscopy was performed in patients with clinical T4 tumours or suspected metastases, unless laparotomy was required for symptomatic disease.

Results

Ninety-six of 120 patients were selected for immediate laparotomy with curative intent (n = 81) or for palliation (n = 15). In two of the 81 patients gastrectomy was abandoned because of unexpected peritoneal carcinomatosis. Fifteen patients underwent diagnostic laparoscopy, which identified intra-abdominal metastases in six; the other nine patients proceeded to laparotomy, which revealed peritoneal metastases not detected at laparoscopy in four patients. The remaining nine patients had overt metastases and were referred for systemic chemotherapy without abdominal exploration.

Conclusion

Diagnostic laparoscopy in selected patients effectively limits the number of unnecessary invasive staging procedures. Routine use of diagnostic laparoscopy in all patients with gastric adenocarcinoma is not warranted.
Butyrate affects differentiation, maturation and function of human monocyte-derived dendritic cells and macrophages
Authors: MILLARD A L , MERTES P M , ITTELET D , VILLARD F , JEANNESSON P , BERNARD J
Published: March 2003

We studied the in vitro effects of butyric acid on differentiation, maturation and function of dendritic cells (DC) and macrophages (MΦ) generated from human monocytes. A non-toxic dose of butyrate was shown to alter the phenotypic differentiation process of DC as assessed by a persistence of CD14, and a decreased CD54, CD86 and HLA class II expression. The more immature differentiation stage of treated cells was confirmed further by their increased phagocytic capability, their altered capacity to produce IL-10 and IL-12, and their weak allostimulatory abilities. Butyrate also altered DC terminal maturation, regardless of the maturation inducer, as demonstrated by a strong down-regulation of CD83, a decreased expression of CD40, CD86 and HLA class II. Similarly, butyrate altered MΦ differentiation, down-regulating the expression of the restricted membrane antigens and reducing the phagocytic capacity of treated cells. To investigate further the mechanism by which butyrate hampers the monocyte dual differentiation pathway, we studied the effects of 1,25(OH)2D3 alone or in combination with butyrate on the phenotypic features of DC. Unlike 1,25(OH)2D3, butyrate inhibited DC ­differentiation without redirecting it towards MΦ. Combined treatment gave rise to a new cell subset (CD14high, CD86 and HLA-DRlow) phenotypically distinct from monocytes. These results reveal an alternative mechanism of inhibition of DC and MΦ differentiation. Altogether, our data demonstrate a novel immune suppression property of butyrate that may modulate both inflammatory and immune responses and support further the interest for butyrate and its derivatives as new immunotherapeutic agents.
The human oesophageal squamous epithelium exhibits a novel type of heat shock protein response
Authors: Yagui‐Beltran Adam , Craig Ashley L. , Lawrie Laura , Thompson Devon , Pospisilova Sarka , Johnston David , Kernohan Neil , Hopwood David , Dillon John F. , Hupp Ted R.
Published: March 2003

The human oesophageal epithelium is subject to damage from thermal stresses and low extracellular pH that can play a role in the cancer progression sequence, thus identifying a physiological model system that can be used to determine how stress responses control carcinogenesis. The classic heat shock protein HSP70 is not induced but rather is down‐regulated after thermal injury to squamous epithelium ex vivo; this prompted a longer‐term study to address the nature of the heat shock response in this cell type. An ex vivo epithelial culture system was subsequently used to identify three major proteins of 78, 70, and 58 kDa, whose steady‐state levels are elevated after heat shock. Two of the three heat shock proteins were identified by mass spectrometric sequencing to be the calcium‐calmodulin homologue transglutaminase‐3 (78 kDa) and a recently cloned oesophageal‐specific gene called C1orf10, which encodes a 53‐kDa putative calcium binding protein we have named squamous epithelial heat shock protein 53 (SEP53). The 70‐kDa heat shock protein (we have named SEP70) was not identifiable by mass spectrometry, but it was purified and studied immunochemically to demonstrate that it is distinct from HSP70 protein. Monoclonal antibodies to SEP70 protein were developed to indicate that: (a) SEP70 is induced by exposure of cultured cells to low pH or glucose starvation, under conditions where HSP70 protein was strikingly down‐regulated; and (b) SEP70 protein exhibits variable expression in preneoplastic Barrett's epithelium under conditions where HSP70 protein is not expressed. These results indicate that human oesophageal squamous epithelium exhibits an atypical heat shock protein response, presumably due to the evolutionary adaptation of cells within this organ to survive in an unusual microenvironment exposed to chemical, thermal and acid reflux stresses.
Calcium‐binding by p26olf, an S100‐like protein in the frog olfactory epithelium
Authors: Miwa Naofumi , Shinmyo Yukiko , Kawamura Satoru
Published: March 2003

Frog p26olf is a novel S100‐like Ca2+‐binding protein found in olfactory cilia. It consists of two S100‐like domains aligned sequentially, and has a total of four Ca2+‐binding sites (known as EF‐hands). In this study, to elucidate the mechanism of Ca2+‐binding to each EF‐hand (named EF‐A, ‐B, ‐C and ‐D from the N‐terminus of p26olf), we examined Ca2+‐binding in wild‐type p26olf and also in its mutants in which a glutamate at the –z coordinate position within each Ca2+‐binding loop was substituted for a glutamine. Flow dialysis experiments showed that the wild‐type binds nearly four Ca2+ per molecule maximally, while all the mutants bind approximately three Ca2+. Although EF‐B and ‐D are p26olf‐specific EF‐hands and their role in Ca2+‐binding is not known, the result unequivocally showed that they actually bind Ca2+. The overall Ca2+‐binding affinity decreased in the three mutants. The decrease was very large in the mutants of EF‐A and ‐B, which suggested that the Ca2+‐affinities are high in EF‐A and ‐B in the wild‐type. Assuming the presence of four steps of Ca2+‐binding, we determined the dissociation constant of each step in wild‐type p26olf. To assign which step takes place at which EF‐hand, we measured the antagonistic effect of K+ on each step, as the effect of K+ is thought to be a function of the number of the carboxyl groups in an EF‐hand. Although the actual Ca2+‐binding mechanism may not be so simple, this study together with the mutation study suggested a tentative Ca2+‐binding model of p26olf: the order of Ca2+‐binding to p26olf is EF‐B, EF‐A, EF‐C and EF‐D. Based on these results, we speculate that similar Ca2+‐binding takes place in an S100 dimer.
The NADH oxidase from Pyrococcus furiosus
Authors: Ward Donald E. , Donnelly Christopher J. , Mullendore Michael E. , van der Oost John , de Vos Willem M. , J. Crane III Edward
Published: March 2003

A wealth of H2O‐producing NADH oxidase (NOX) homologues have been discovered in the genomes of the hyperthermophilic Archaea, including two homologues in the genome of Pyrococcus furiosus which have been designated as NOX1 and NOX2. In order to investigate the function of NOX1, the structural gene encoding NOX1 was cloned from the genome of P. furiosus and expressed in Escherichia coli, and the resulting recombinant enzyme (rNOX1) was purified to homogeneity. The enzyme is a thermostable flavoprotein that can be reconstituted only with FAD. rNOX1 catalyzes the oxidation of NADH, producing both H2O2 and H2O as reduction products of O2 (O2 + 1–2NADH + 1–2H+ → 1–2NAD+ + H2O2 or 2H2O). To our knowledge, this is the first NADH oxidase found to produce both H2O2 and H2O. The enzyme exhibits a low Km for NADH (< 4 µm), and shows little or no reaction with NADPH. Transcriptional analyses demonstrated that NOX1 is constitutively expressed regardless of the carbon source and a single promoter was identified 25 bp upstream of the nox1 gene by primer extension. Although P. furiosus is a strict anaerobe, it may tolerate oxygen to some extent and we anticipate NOX1 to be involved in the response to oxygen at high temperatures.
Cyclic AMP regulates expression of the RIα subunit of cAMP‐dependent protein kinase through an alternatively spliced 5′ UTR
Authors: Dahle Maria K. , Knutsen Helle K. , Taskén Kristin A. , Pilz Renate , Taskén Kjetil
Published: March 2003

The present study examines novel mechanisms that regulate levels of the RIα subunit of cAMP‐dependent protein kinase. We found that RIα protein is induced threefold by 8‐(4‐chlorophenyl)thio‐cAMP in hormone responsive rat Sertoli cells, while total RIα mRNA is not correspondingly induced. Two RIα mRNA isoforms with different 5′ untranslated sequences (RIα1a and RIα1b) are produced from the RIα gene in Sertoli cells. Deletion/mutation analysis of the cAMP‐response‐element‐containing promoter upstream of the RIα exon 1b revealed that while mutation of the cAMP response element had no effects on cAMP‐mediated induction, a 73‐bp region of the RIα exon 1b itself conferred a fivefold to eightfold induction of reporter activity to homologous and heterologous promoters. The responsiveness of this region was dependent on a sense orientation downstream of the promoter start sites and had no effect on reporter mRNA, indicating that the cAMP‐mediated induction occurs at the post‐transcriptional level. Modeling of the RIα1b 5′ UTR secondary structure revealed a 5′ CAP‐proximal, strong stem‐loop presenting an element similar to multiple start‐site element downstream‐1 (GCTCGG) in the loop region. RNA‐EMSAs performed with the labeled RIα1b 5′ UTR showed stabilization of a protein/RNA complex in extracts from 8‐(4‐chlorophenyl)thio‐cAMP stimulated Sertoli cells. This complex was abolished by mutation of the multiple start‐site element downstream‐1‐like element. Our findings indicate that there is a cAMP‐mediated induction of RIα expression at the post‐transcriptional level, dependent on the 5′ UTR of RIα1b mRNA.