bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical assessment of positron emission tomography for the diagnosis of local recurrence in colorectal cancer
Authors: Takeuchi O , Saito N , Koda K , Sarashina H , Nakajima N
Published: March 2003

Background

The clinical value of positron emission tomography (PET) for the diagnosis of local pelvic recurrence of colorectal cancer was evaluated.

Methods

Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis were performed at regular intervals in 23 patients who had undergone resection for colorectal cancer. The 23 patients had a total of 25 lesions. PET images of the 25 lesions and of six primary lesions in patients with rectal cancer were obtained. A differential absorption ratio (DAR) was calculated in order to examine the accumulation of [18F]2-fluoro-2-deoxy-d-glucose (18FDG) on PET images. Histological diagnoses of the pelvic masses were obtained by CT-guided needle biopsy.

Results

On CT or MRI, a pelvic mass with a spicular shape (n = 1) was non-recurrent, whereas a nodular or lumpy shape indicated a locally recurrent lesion (n = 10). Masses with a nodulospicular shape (n = 12) did not correlate with the histological features. On PET, 15 of 16 histologically proven local recurrences were imaged positively. By setting a DAR of 2·8 as a cut-off value, local recurrences could be diagnosed with 100 per cent accuracy.

Conclusion

PET is a clinically useful tool for the detection of local recurrence of colorectal cancer, particularly for distinguishing between recurrence and granulation tissues in the pelvic cavity.
Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial
Authors: Chetty U , Jack W , Prescott R J , Tyler C , Rodger A
Published: March 2003

Background

In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately.

Methods

Patients with operable breast cancer were randomized to have level III axillary node clearance (232 patients) or axillary node sample (234 patients). Radiotherapy to the axilla was given selectively. Radiotherapy was not given to those who had an axillary clearance. In the early part of the study all patients who had node sample were treated by radiotherapy (54 patients); subsequently this was modified to include only those who were node positive. The morbidity to the shoulder and arm was assessed before and after operation by measuring upper limb volume and circumference, and combined glenohumeral and scapular movement and muscle power.

Results

Comparing the two surgical policies, no difference was found in local (axillary clearance 14 versus sample 15), axillary (eight versus seven) or distant (29 versus 29) recurrence. There was no statistically significant difference in 5-year survival rate (clearance 82·1 versus sample 88·6 per cent). Morbidity was least in those who had a node sample and no radiotherapy to the axilla. Radiotherapy to the axilla in patients who had a node sample resulted in a significant reduction in range of movement of the shoulder, e.g. mean(s.e.) 2·2(0·6) cm reduction in lateral rotation at 3 years. Surgical axillary clearance was associated with significant lymphoedema of the upper limb, e.g. 4·1(0·7) per cent increase in arm volume at 3 years.

Conclusion

A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.
Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer
Authors: Geh J I , Crellin A M , Glynne-Jones R
Published: March 2003

Background

Oesophageal cancer carries a poor prognosis. The 5-year survival rate following resection ranges from 10 to 35 per cent. Recent evidence suggests that the addition of non-surgical treatments to surgery may improve resection rates, reduce the risk of recurrence and improve survival. This review examines the role of preoperative chemoradiotherapy (CRT) in oesophageal cancer.

Methods

A Medline-based literature review (1980–2000) was performed using the key words ‘neoadjuvant or preoperative’ and ‘chemoradiotherapy or radiochemotherapy’. Additional literature was obtained from original papers and published meeting abstracts.

Results

Forty-six non-randomized and six randomized trials of preoperative CRT were found. Resection rates, pathological complete response (pCR), treatment-related mortality rates and relapse patterns are documented. Improved 5-year survival rates approaching 60 per cent may be achieved following pCR. Three of the six randomized trials show a benefit in either overall survival or disease-free survival compared with surgery alone. Treatment-related toxicity can be significant.

Conclusion

Preoperative CRT may improve survival. Emerging evidence suggests that CRT alone can achieve similar survival rates to surgery alone. New imaging modalities may help to select which patients require surgery. Larger randomized trials of preoperative CRT or chemotherapy are needed to define optimal regimens and produce higher pCR rates with acceptable toxicity.
Fracture of the penis
Authors: Eke N
Published: March 2003

Background

Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial.

Methods

A Medline search from January 1966 to July 2001 using the terms ‘fracture of penis’, ‘penile trauma’ and ‘coital injuries’ was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome.

Results

In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction.

Conclusion

Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.
Pathogenesis of colonic diverticula
Authors: Simpson J , Scholefield J H , Spiller R C
Published: March 2003

Background

Diverticula are herniations through the colonic wall and are therefore likely to be due to a weakness within the wall, an alteration in intracolonic pressures or a combination of these factors. This article reviews these aspects in relation to the pathogenesis of colonic diverticula.

Methods

Medline and Science Citation Index searches were performed to locate English language articles relating to the pathogenesis of colonic diverticulosis published since 1960. Manual cross-referencing was also performed and some historical articles were included.

Results and conclusion

Several theories now exist about the development of colonic diverticula. The majority of the evidence suggests that the morphological changes are the response to a lifelong consumption of a low-residue diet. However, there are complex relations between colonic structure, motility and dietary factors, and it is likely that all of these (and possibly genetic influences) play a role in the pathogenesis to a greater or lesser degree.
Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision
Authors: Law W L , Chu K W , Choi H K
Published: March 2003

Background

The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following low anterior resection with total mesorectal excision for rectal cancer.

Methods

Patients who required proximal diversion after low anterior resection with total mesorectal excision were randomized to have either a loop ileostomy or a loop transverse colostomy. Postoperative morbidity, stoma-related problems and morbidity following closure were compared.

Results

From April 1999 to November 2000, 42 patients had a loop ileostomy and 38 had a loop transverse colostomy constructed following low anterior resection. Postoperative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P = 0·037). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma-related complications after discharge from hospital. A total of seven patients had intestinal obstruction from the time of stoma creation to stoma closure (six following ileostomy and one following colostomy; P = 0·01).

Conclusion

Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.
Surgical treatment of incisional hernia
Authors: Cassar K , Munro A
Published: March 2003

Background

Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repaired using open suture, open mesh or laparoscopic mesh techniques. This review examines the results of these methods of repair.

Methods

A Medline literature search was performed to identify articles relating to ‘incisional hernia’, ‘ventral hernia’ and ‘wound failure’. Relevant papers from the reference lists of these articles were also sought.

Results

The recurrence rate after open suture repair may be as high as 31–49 per cent; for open mesh repair it is between 0 and 10 per cent. Comparative studies show that recurrence is significantly more frequent after open suture repair than after open mesh repair; complication rates are similar for both procedures. Recurrence rates after laparoscopic mesh repair vary from 0 to 9 per cent. Comparative studies show that laparoscopic mesh repair is at least as safe and effective as open mesh repair.

Conclusion

Open suture repair for incisional hernia carries an unacceptably high recurrence rate. The results of open mesh and laparoscopic mesh techniques are encouraging. There is scope for a large multicentre randomized clinical trial to compare laparoscopic and open mesh repair.
Systematic review of the efficacy and safety of colorectal stents
Authors: Khot U P , Lang A Wenk , Murali K , Parker M C
Published: March 2003

Background

Colorectal stents are being used for palliation and as a ‘bridge to surgery’ in obstructing colorectal cancers.

Methods

A systematic review of the published data on stenting for the treatment of colorectal obstruction was carried out by searching Medline and other online databases for the period from January 1990 to December 2000. A total of 58 publications (case series, single case reports and reviews) was found, of which 29 case series were included in the analysis. Technical and clinical success, complications and reobstruction, both in palliation and as a ‘bridge to surgery’, were assessed. Both descriptive statistics and pooled analyses were carried out.

Results

Pooled results showed that stent insertion was attempted in 598 instances. Technical success was achieved in 551 (92 per cent) and clinical success in 525 (88 per cent). Palliation was achieved in 302 (90 per cent) of 336 cases, while 223 (85 per cent) of 262 insertions succeeded as a ‘bridge to surgery’ (95 per cent had a one-stage surgical procedure). There were three deaths (1 per cent). Perforation occurred 22 times (4 per cent). Stent migration was reported in 54 (10 per cent) of 551 technically successful cases. The rate of stent reobstruction was 52 (10 per cent) of 525, mainly in the palliative group.

Conclusion

Evidence suggests that colorectal stents offer good palliation, and are safe and effective as a ‘bridge to surgery’. Stent usage can avoid the need for a stoma, and is associated with low rates of mortality and morbidity. Dilatation of malignant strictures at the time of stent placement appears to be dangerous and should be avoided.
Evaluation of POSSUM in patients with oesophageal cancer undergoing resection
Authors: Zafirellis K D , Fountoulakis A , Dolan K , Dexter S P L , Martin I G , Sue-Ling H M
Published: March 2003

Background

The Physiogical and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) has been used to produce a numerical estimate of expected mortality and morbidity after a variety of general surgical procedures. The aim of this study was to evaluate the ability of POSSUM to predict mortality and morbidity in patients undergoing oesophagectomy.

Methods

POSSUM predictor equations for morbidity and mortality were applied retrospectively to 204 patients who had undergone oesophagectomy for cancer. Observed morbidity and mortality rates were compared with rates predicted by POSSUM using the Hosmer–Lemeshow goodness-of-fit test. Evaluation of the discriminative capability of POSSUM predictor equations was performed using receiver–operator characteristic (ROC) curve analysis.

Results

The observed and predicted mortality rates were 12·7 and 19·1 per cent respectively, and the respective morbidity rates were 53·4 and 62·3 per cent. However, the POSSUM model showed a poor fit with the data both for the observed 30-day mortality (χ2 = 16·26, P = 0·002) and morbidity (χ2 = 63·14, P < 0·001) using the Hosmer–Lemeshow test. ROC curve analysis revealed that POSSUM had poor predictive accuracy both for mortality (area under curve 0·62) and morbidity (area under curve 0·55).

Conclusion

These data suggest that POSSUM does not accurately predict mortality and morbidity in patients undergoing oesophagectomy and must be modified.
Peritoneal carcinomatosis from colorectal cancer
Authors: Jayne D G , Fook S , Loi C , Seow-Choen F
Published: March 2003

Background

Aggressive therapeutic regimens have been advocated for the treatment of peritoneal carcinomatosis from colorectal cancer. It is essential to understand the clinical and histological features that govern the natural history of this condition if the efficacies of novel therapeutic approaches are to be assessed adequately.

Methods

A database of 3019 colorectal cancers was used to identify patients with synchronous peritoneal carcinomatosis, patients who developed metachronous peritoneal carcinomatosis, and those without carcinomatosis. Clinical, histological and survival data for the groups were collated and subjected to statistical analysis.

Results

Some 349 patients (13 per cent) with peritoneal carcinomatosis were identified; 214 had synchronous disease and 135 had metachronous carcinomatosis. Some 125 patients (58 per cent) in the synchronous group were free of systemic metastases; 80 of these patients had localized disease. Liver metastases, tumour (T) stage, nodal stage, and venous and perineural invasion were independent predictors of metachronous carcinomatosis. The median survival of patients with synchronous disease was 7 months; survival was adversely affected by the extent of peritoneal carcinomatosis and the T stage of the primary cancer.

Conclusion

Peritoneal carcinomatosis is a common mode of disease progression in patients with colorectal cancer. For the majority of patients the prognosis is poor, but a small number with localized disease may be suitable for further aggressive therapy.
The opioid growth factor, [Met5]‐enkephalin, inhibits DNA synthesis during recornification of mouse tail skin
Authors: Wilson R. P. , McLaughlin P. J. , Lang C. M. , Zagon I. S.
Published: March 2003

Opioid peptides serve as tonically active negative growth regulators in renewing and regenerating epithelia. To examine the involvement of opioids in renewal of the stratum corneum after tape stripping of tail skin, C57BL/6 J mice were given systemic injections of the potent opioid antagonist, naltrexone (NTX, 20 mg/kg i.p.) following injury. Blockade of opioidreceptor interaction by NTX for 4 h resulted in an elevation of 36–;66% in basal cell DNA synthesis measured 24 h after injury. Injection of the endogenous opioid peptide, [Met5]‐enkephalin (OGF, 10 mg/kg i.p.) 4 h before termination, suppressed radiolabelled thymidine incorporation in the basal cell layer by 37–46%at 24 h after wounding. The magnitude of the effects on DNA synthesis of OGF, but not NTX, depended on the timing of administration with respect to injury. OGF maximally depressed basal cell labelling (72%) when given 16 h after tape stripping. Concomitant administration of naloxone (10 mg/kg) with OGF blocked the inhibition of DNA synthesis; naloxone alone at the dosage utilized had no effect on cell labelling. Both OGF and its receptor, OGFr, were detected by immunocytochemistry in the basal and suprabasal cell layers, but not the cornified layer of tape stripped and uninjured tail skin. These results indicate: (a) a native opioid peptide and its receptor are expressed in epidermal cells of injured and uninjured mouse tail skin; (b) removal of the stratum corneum by tape stripping does not disrupt the function of the endogenous opioid growth system; (c) the proliferative response to wounding of the tail is tonically inhibited by the receptor‐mediated action of an endogenous opioid peptide; and (d) DNA synthesis by basal cells can be elevated by disrupting opioid peptidereceptor interactions.
The effects of keratinocyte growth factor in preclinical models of mucositis
Authors: Farrell C. L. , Rex K. L. , Chen J. N. , Bready J. V. , DiPalma C. R. , Kaufman S. A. , Rattan A. , Scully S. , Lacey D. L.
Published: March 2003

Abstract. The epithelium of the oral cavity and small intestine of the gastrointestinal tract have a high rate of cell renewal and as such, are sensitive to cytotoxic therapies that kill rapidly dividing cells. Mucositis is a complication of cancer therapy where impairment of the regenerative capacity of the epithelium leads to atrophy, ulceration and a loss of barrier function. Keratinocyte growth factor (KGF) is an epithelial cell‐specific growth and differentiation factor that is trophic for the mucosal epithelium of the gastrointestinal tract. In this study, KGF in normal animals caused epithelial thickening in the squamous epithelium of the oral cavity and increased crypt depth and villus height of the small intestine. It also appeared to regulate gene expression in these tissues including that of some antioxidant enzymes and intestinal trefoil protein. KGF has been shown to be efficacious in several preclinical models of mucositis where KGF pretreatment reduced weight loss typically seen during and after the course of therapy and significantly improved survival. At a tissue level KGF reduced atrophy, accelerated regrowth, and decreased ulcer formation of the oral epithelium after irradiation, and improved crypt survival and prevented villus atrophy in the small intestine of irradiated or chemotherapy‐treated mice. Preliminary studies suggest that its efficacy may be partly a consequence of the growth and differentiation effect, and also partly due to regulation of the expression of genes that play a role in mucosal protection. These data suggest that KGF may be useful for the prevention or treatment of mucositis in patients treated with regimens of cancer therapy that have gastrointestinal toxicity.
The over‐representation of Black children in the child protection system: possible causes, consequences and solutions
Authors: Chand
Published: March 2003

This paper considers the controversial area of child protection with Black families. It begins by addressing the question of
why the issue of child protection and ethnicity is important to social work. It then goes on to consider the current and related research in this field, and supports the arguments that Black families are likely to be over‐represented in the child protection system. The reasons for this over‐representation are explored in‐depth as themes: these include issues around language and interpreting services; child‐rearing differences; poverty; and social work assessments. Racism and discrimination are central concepts that underpin each theme. The final section looks at ways forward for social workers and their agencies with regard to working sensitively and appropriately with Black families.
Parents’ perceptions of their children in a context of shared political uncertainty
Authors: Shamai Michal
Published: March 2003

The study describes the differences and similarities between parents’ feelings and their perception of their children’s feelings in a politically uncertain situation. The study focuses on Israeli families living in Judaea and Samaria (the West Bank) during two periods: the Intifada and the post‐Oslo Agreements years during the first phase of the peace process with the Palestinians. The research combines qualitative and quantitative methods. The results show that most of the feelings evoked by the uncertainty are negative emotions, such as fear, anger, hate, the desire for revenge, and avoidance. These emotions are experienced by parents and, according to the parents’ perceptions, by their children as well. In addition to the correlation between parents’ own experiences and their appraisal of their children’s, the children were perceived as having more negative feelings than the parents. Systemic analysis of the results indicates that the children are often a channel for expression of their parents’ emotions. Based on this finding, suggestions are made regarding intervention with children that takes family processes into account. Some direction for applying the findings of this specific study in other contexts of shared political uncertainty, such as Northern Ireland, are suggested.
Independent fostering agencies uncovered: the findings of a national study
Authors: Sellick Clive , Connolly Jo
Published: March 2003

This paper presents the findings of a survey of independent fostering agencies (IFAs) in England, Scotland and Wales. Information was gathered about their operational arrangements, services, fees, staffing, foster carers and the children and young people in placement. This information is supplemented by an earlier evaluation of one large English IFA and by reference to the available relevant literature. The expansion of the IFAs has been generally greeted with hostility by local authority managers because of what is perceived as the loss of foster carers to the independent sector, the costs of the IFAs and their position outside the public welfare sector. This paper questions the validity of these views following an examination of the status of the agencies, the background of their foster carers and the circumstances surrounding the placements of the children and young people. It concludes by identifying gaps in our knowledge and areas for future research.
Educational success for children in public care: advice from a group of high achievers
Authors: Martin Pearl Y. , Jackson Sonia
Published: March 2003

ABSTRACT

Research over the past 20 years has consistently shown that children in public care fall behind at school, seldom achieve good qualifications, and are much less likely than their peers to go on to further or higher education. However, a small minority of looked‐after children do well academically. This paper examines the opinions of 38 high‐achieving young people who spent at least a year in residential or foster care on what they think are the best ways to enhance the educational experience of looked‐after children. An evaluation of four key questions from a semistructured interview highlighted the importance of foster carers, residential workers, social workers and teachers in providing support and encouragement for academic achievement. On the other hand, many of these individuals emphasized their dislike of being ‘singled out’ by the teacher. A third of the participants believed that negative stereotypes and low expectations of children in care among professionals and care providers were major obstacles to their educational success. Over half the sample reported that in many children’s homes basic necessities such as books, a desk and a quiet place to do homework were lacking. In addition their opportunity to engage in outside interests and hobbies was severely limited. By contrast, for these individuals foster care had provided better opportunities. On entering higher education the majority of the participants had faced severe problems. They stressed the need for continuing financial support and adequate year‐round accommodation, because, unlike most students, these care leavers usually have no parental home to return to during university vacations. A third of participants also felt a strong desire for a ‘guardian angel’ to support and encourage them during their time at university. The paper concludes that the views of these thoughtful and resilient individuals should be taken very seriously and translated into improvements in policy and practice. Official guidance now highlights the importance of education for looked‐after children, but changing attitudes and priorities at ground level presents a major challenge.
‘Undeserving’ mothers? Practitioners’ experiences working with young mothers in/from care
Authors: Rutman Deborah , Strega Susan , Callahan Marilyn , Dominelli Lena
Published: March 2003

Although teen pregnancy is on the rise in Canada, and while adolescent mothering in general has received considerable recent attention from researchers, there is a paucity of information about the particular experiences of young women who become mothers while in government care. Emerging out of a study guided by a grounded theory methodology to address this knowledge gap, this paper examines the experiences and perspectives of government‐based social workers who work with young mothers in/from care. Our findings indicated that social workers reflect prevailing middle class values, including norms about ‘good’ and ‘bad’ parenting, and centred around the belief that adolescent pregnancy is, in and of itself, bad. One of the most significant ramifications of workers’ values was their belief about the inevitability of ‘the cycle’: of children in care begetting children who ultimately came into care. Ironically, though workers and young mothers were both preoccupied by the concept of ‘the cycle’, and each were determined to break it, the two groups had very different ideas about what the cycle was all about and what perpetuated it. Unfortunately, this disjunction in perspectives, along with major recent shifts in the direction of child welfare policy and practice and related constraints in the resources at workers’ disposal, conjoined to create significant barriers to what workers and young women both recognized as supportive practice with youth in care.
An audit of care provided for children with epilepsy in the South Tees area
Authors: Stewart  , Matthews  , Foley  , Aszkenasy
Published: March 2003

This study examined the knowledge carers of children with epilepsy have of the condition and its management. It also examined their experience of medical services for their child and the attitude of staff at their schools. A school nursing sister using a semi‐structured technique interviewed 48 carers of 53 children. A majority expressed dissatisfaction with outpatient medical care, especially that outpatient visits did not improve their knowledge of the condition or its treatment. Twenty‐eight carers were not satisfied with the attitude of staff at schools. Ways to improve the service are discussed, including the role of the specialist community children's nurse and the need to see children with epilepsy in a dedicated clinic.
Maternal report of attention deficit hyperactivity disorder symptoms in preschool children
Authors: Gimpel G A , Kuhn B R
Published: March 2003

Two hundred and fifty‐three mothers were surveyed regarding attention deficit hyperactivity disorder (ADHD) symptoms in their preschool children (aged 2–6 years). Twenty‐four children (9.5%) met DSM‐IV criteria (criterion A only) for ADHD based solely on parent report. Mean ratings of the three core symptoms of ADHD (hyperactivity, impulsivity, and inattentiveness) were in the mid‐range on a 1–7 point scale, with mothers indicating their children were most likely to be impulsive. Positive parental endorsement of the 18 individual DSM‐IV symptoms of ADHD ranged from 4% for ‘loses things necessary for tasks’, to 28.4% for ‘is on the go or acts as if driven by a motor’. Males and children of less‐educated parents were more likely to receive endorsement of ADHD symptoms. There were no differences with respect to age of the child or birth order (first vs later born). Global ratings of hyperactivity and inattentiveness predicted overall ratings of ADHD but when classification rates were examined, high global ratings were not predictive of diagnosis. These results lend support to the notion that relying solely on parents’ verbal reports of isolated ADHD symptoms may lead to over‐identification of the disorder. Thus, using full DSM‐IV diagnostic criteria and including standardized behaviour rating scales across multiple informants and settings, is recommended.
Screening for developmental language disability in 3‐year‐old children. Experiences from a field study in a Swedish municipality
Authors: Westerlund M , Sundelin C
Published: March 2003

This study evaluates a screening instrument for identification of severe developmental language disability (DLD) in 3‐year‐old children, which is used as a routine assessment at several child health centres (CHCs) in Sweden. The results are reported in terms of clinical outcome (false‐ and true‐positive rates), kind and extent of DLD, signs of comorbidity and relation between nurses’ and parents’ observations. More than 60 CHC nurses, all with experience of the screening instrument, assessed in all 2359 3‐year‐old children (98% of the whole population) by direct observation of their language comprehension, language production and level of co‐operation. In addition to the screening parents answered a questionnaire. Children who failed the screening had their hearing assessed and were clinically examined by trained speech and language therapists. Forty‐four (34 boys and ten girls) of the 65 referred children were clinically examined. Apart from two false‐positive cases most of them were diagnosed as generally and severely language disabled. According to the nurses’ observations attention deficit was common among the referred boys, which was later confirmed by the speech therapist in two‐thirds of them. Agreement between nurses and parents was poor and only half of the parents were concerned about their child’s language development. In the light of this result, continued application of the screening and the use of parent questionnaires is discussed.
Sleep problems in primary school children: comparison between mainstream and special school children
Authors: Quine L
Published: March 2003

This paper reports on a study of the prevalence and social correlates of dyssomnias, features associated with obstructive sleep apnoea, and parasomnias in primary school children aged 4–12. Head teachers of schools selected randomly from lists of local primary and special schools were contacted by telephone and asked to distribute a questionnaire package to the parents of all pupils aged 4–12 years. In all, 890 parents of children from mainstream schools and 300 from special schools were approached. The response rates were 64.7% and 60%, respectively. The results showed that significantly higher proportions of children in special schools than in mainstream schools presented four of the five dyssomnias investigated and all of the features associated with obstructive sleep apnoea. In contrast, only two of the seven parasomnias were presented by higher proportions of the children in special schools. Age and gender differences for the two groups of children are presented. Finally, multiple correlations were computed between a range of child, family, and environmental characteristics and the three problems most frequently reported: frequency of settling problems; sleeping in the parents' bed; and night waking. The findings are discussed with reference to other studies of children's sleep problems, and the implications for treatment are considered.
A psychosocial follow‐up study of deaf preschool children using cochlear implants
Authors: Preisler G. , Tvingstedt A.‐L. , Ahlström M.
Published: March 2003

The aim of the study was to explore patterns of communication between 22 children with cochlear implants (CI) and their parents, teachers and peers in natural interactions over a 2‐year period. The children, between 2 and 5 years old when implanted, had used the implant between 1 and 3.5 years at the end of the study. Analyses of videorecorded interactions showed that meaningful oral communication was more easily obtained in the home setting than in the preschool setting. Patterns of communication between parent–child, content and complexity of dialogues, quality of peer interactions, communicative styles of adults, and the use of sign language in communication turned out to be important factors when explaining the result of the CI on the individual child's development. The children with the best oral skills were also good signers.
Coping with chronic disease from the perspective of children and adolescents – a conceptual framework and its implications for participation
Authors: Schmidt S. , Petersen C. , Bullinger M.
Published: March 2003

In medical and health psychology, efforts have increasingly been made to assess coping of children and adolescents with chronic conditions. In contrast to the study of coping in adults, approaches to define and assess adaptational processes in children pose a number of problems because coping and development are inherently connected with each other. Issues arising when applying theoretical concepts from developmental psychology to the area of coping in children and adolescents are highlighted. The most prominent approaches to conceptualize and assess coping with chronic disease in childhood and adolescence are illustrated. In future research, there is a need to focus the situational context and content of coping rather than to assess the effort employed and level of a particular coping strategy. Coping is not only a way of regulating emotions, but has an interpersonal meaning, depending on its interactional context. In the medical field, coping has a mediating function for participation and shared medical decision‐making in health care processes.
Olive pollen allergy: searching for immunodominant T‐cell epitopes on the Ole e 1 molecule
Authors: CÁrdaba  , Del Pozo  , Jurado  , Gallardo  , Cortegano  , Arrieta  , Del Amo  , TramÓN  , Florido  , Sastre  , Palomino  , Lahoz
Published: March 2003

Background

The amino‐acid and nucleotide sequence of Ole e 1 (the major antigen of olive pollen) has been described and the IgE antibody response to this major allergen was associated with DR7/DQ2 antigens. With this previous data we try to define the T‐cell epitopes implicated in Ole e 1 reactivity.

Objectives

To study the recognition of T cells (derived from allergic and non‐allergic Ole e 1 patients) to Ole e 1 synthetic peptides in order to define immunodominant T‐cell epitopes.

Methods

We have compared the proliferative response of the peripheral blood mononuclear cells from Ole e 1 sensitized patients vs. non‐sensitized controls, induced by 14 Ole e 1 synthetic peptides. Thirty subjects were classified in two groups: group 1 (non‐responders against Ole e 1, n = 16) and group 2 (Ole e 1 responders, n = 14), according to their clinical parameters and the presence or not in their sera of the significant Ole e 1 IgE antibody levels.

Results

Our results shown that it is possible to find T cells reactive to Ole e 1 peptides in patients with and without significant levels of Ole e 1 IgE antibodies. However, the percentage of response was higher in patients with IgE antibodies 71.4% vs 25%), and the recognition profile was different: the control group showed a broad reactivity pattern, in contrast, the response by the ‘Ole e 1 responders’ group was mainly directed against three peptides of the carboxi‐terminal region, peptides 10 (91–102), 12 (109–120) and 13 (119–130), with a response frequency of 35.7, 28.5 and 28.5%, respectively. By direct and inhibition test no antibody response was found against the synthetic peptides.

Conclusions

Our data suggest that the regions between 91 and 102 and 109–130 amino‐acids on the Ole e 1 molecule are immunodominant T‐cell epitopes. These epitopes are not recognized by IgE antibodies.
Increased interleukin‐6 production during the acute phase of the syndrome of episodic angioedema and hypereosinophilia
Authors: Tillie‐Leblond  , Gosset  , Janin  , Salez  , Prin  , Tonnel
Published: March 2003

Background

The Gleich syndrome is rare and associates recurrent angioedema, urticaria, fever, weight gain and blood hypereosinophilia, underlying systemic and local inflammation. The pathogenesis of those symptoms remains unclear.

Objective

We wanted to address the possible implication of Interleukin‐6 (IL‐6) in the development of those clinical features, and to identify the cells involved in its production.

Methods

A 26‐year‐old man suffering of this disease was referred in hospital. During an acute attack with weight gain, fever and a diffuse oedema, a marked increase in eosinophils count (42700/mm3 was observed. Serum ECP was elevated at 47 μg/L (normal less than 16). Corticosteroid therapy administrated on the 7th day was followed by a rapid remission. Blood samples were collected (before, during the attack and under corticosteroid therapy) for measurements of serum IL‐6 (ELISA, Immunotech, Marseille, France) and plasma histamine (RIA, Immunotech, Marseille, France). Blood monocytes and eosinophils were isolated and a skin biopsy was performed during the attack.

Results

The plasma histamine level was within normal range. The level of IL‐6 in sera peaked to 74 pg/mL, concomitant with the peak of eosinophilia at the acute phase phase of the attack. Under corticosteroids, we observed a drop in the IL‐6 serum level to 29 pg/mL, concomitant with the clinical remission. During the attack, an increase in IL‐6 production was observed in 24 h blood monocyte supernatants (11.103 pg/mL compared with 2.4 ± 0.8.103 pg/mL for BM from controls) as well as in skin endothelial cells but not in the blood and skin eosinophils. In vitro, when endothelial cells were incubated in eosinophils supernatants of the patient, liberation of IL‐6 was observed (3.3 103 pg/mL compared with controls: 2.1 103 pg/mL)

Conclusion

Serum IL‐6 elevation may be related to an increased production by blood monocytes and endothelial cells, possibly stimulated by eosinophil mediator during the acute phase of the disease, and might participate in the inflammatory reaction of this syndrome.
Regulation of interleukin‐8 binding and function by heparin and α2‐macroglobulin
Authors: Ramdin  , Perks  , Sheron  , Shute
Published: March 2003

Background

Increased expression of interleukin‐8 (IL‐8), a potent neutrophil chemoattractant, is associated with a number of inflammatory diseases. Interleukin‐8 binds to the glycosaminoglycan (GAG) heparin and the protease inhibitor α2‐macroglobulin, molecules which regulate the function of a number of cytokines. Heparan sulphate was previously shown to enhance neutrophil chemotactic responses to IL‐8.

Objective

The purpose of this study was to investigate the effect of heparin, heparan sulphate and α2‐macroglobulin on IL‐8 binding to neutrophils and subsequent functional effects in vitro.

Methods

The binding of 125I‐IL‐8 to normal neutrophils at 4 °C was studied and the IL‐8 induced neutrophil chemotactic response was investigated using micro‐Boyden chambers. Complexation of IL‐8 with α2‐macroglobulin was confirmed using gel filtration chromatography.

Results

Heparin, but not heparan sulphate, inhibited the binding of 125I‐IL‐8 to neutrophils (IC50 = 26 μg/mL) and IL‐8 induced neutrophil chemotactic responses (IC50 = 4 μg/mL). The specific inhibitory effect of heparin was apparently due to an interaction with IL‐8 which was charge‐dependent, since dextran sulphate had a greater inhibitory effect on chemotactic responses (IC50 = 2 μg/mL) and FITC‐heparin did not bind to neutrophils. The heparin‐induced inhibition of IL‐8 binding and chemotactic responses was reversed in a dose‐dependent manner in the presence of α2‐macroglobulin. The binding of 125I‐IL‐8 to neutrophils in the presence of α2‐macroglobulin appears to be, in part, through the specific IL‐8 receptor.

Conclusion

These results point to an anti‐inflammatory role for heparin and a novel, potentially, pro‐inflammatory role for α2‐macroglobulin which together indicate the importance of cytokine‐binding macromolecules in determining net cytokine function.
Airborne house dust particles and diesel exhaust particles as allergen carriers
Authors: Ormstad  , Johansen  , Gaarder
Published: March 2003

Background

Indoor suspended particulate matter (SPM) consists of many different types of particles, the vast majority of which are less than 2.5 μm in diameter. The question arises how these particles may contribute to asthma and respiratory symptoms. One possibility is that airborne dust particles act as carriers of allergens into the airways, as several allergens have been found to be associated with inhalable airborne dust particles.

Objective

We studied the presence of three different allergens on the surface of SPM, i.e. Can f 1 (dog), Bet v 1 (birch pollen) and Der p 1 (house dust mite). We also examined the ability of diesel exhaust particulates (DEP) to attach these allergens and Fel d 1 (cat) in vitro.

Methods

SPM was collected on polycarbonate filters and an immunogold labelling technique was used to detect the allergens on the particles. The specimens were examined in the backscatter mode of a scanning electron microscope. The same technique was used to examine the binding of the allergens to DEP, after exposing DEP to either crude allergen extracts or partly purified allergens.

Results

Both Can f 1 and Bet v 1 allergens were detected on the surface of the soot particles in SPM mixtures, although to a lesser degree than previously found with Fel d 1. Der p 1 (house dust mite), however, did not show any significant binding to SPM particles. Furthermore, DEP had the ability to adsorb all four allergens in vitro, although to a varying extent.

Conclusion

Soot particles in airborne house dust may act as carriers of several allergens in indoor air. Furthermore, DEP has the ability to bind all the four allergens investigated under aqueous conditions in vitro.
Isolation and characterization of proteic allergens in refined peanut oil
Authors: Olszewski  , Pons  , MoutÉTÉ  , Aimone‐Gastin  , Kanny  , Moneret‐Vautrin  , GUÉant
Published: March 2003

Allergic reactions to peanut oil are very much debated, even if the responsibility of peanut oil has been evoked in several cases of adverse reactions, including death related to severe asthma. The aim of the present study was to investigate the presence of allergenic proteins in peanut oil. Proteins were extracted from commercial refined peanut oil, with a relative content in the order of 0.1–0.2 μg per g of oil, and molecular sizes ranging from 14 up to 76 kDa in SDS‐PAGE. Eight protein bands were systematically observed in crude, neutralized and refined oils, with a molecular mass ranging from ≈ 14 to 76 kDa, including one at 18 kDa which was identified by Western blot performed with serum from two allergic patients. The protein extract gave positive IgE‐RIA with patient sera, positive in vitro leucocyte histamine release tests and positive skin‐prick tests in allergic patients. The allergenic protein was purified by HPLC and [125I] iodide‐labelled. It had an isoelectric point at 4.5 in isoelectrofocusing. In conclusion, we have demonstrated the presence of allergenic proteins in crude and refined peanut oil. These proteins are the same size as two allergens previously described in peanut protein extracts.
Allergic eye disease – a clinical challenge
Authors: Buckley
Published: March 2003

Currently, six basic allergic eye diseases are recognized. In seasonal (SAC) and perennial allergic conjunctivitis (PAC), the allergic response is mediated predominantly by mast cells, whereas the more severe conditions, vernal (VKC) and atopic keratoconjunctivitis (AKC) and giant papillary conjunctivitis (GPC), are associated with a preponderance of T cells. Acute allergic conjunctivitis (AAC) occurs when a large quantity of allergen inoculates the eye and is usually self‐limiting. SAC, the most common ocular allergy, is the ocular component of hayfever. PAC in the UK is most commonly caused by the house‐dust mite (HDM); diagnosis is confirmed by skin‐prick tests, eosinophils in the conjunctival smear, and raised tear or serum total IgE. SAC and PAC can usually be managed with chromone eyedrops and antihistamines. VKC usually presents in children under 10 years of age and mainly affects boys. Sufferers frequently have a personal or family history of atopy. Corneal involvement can occur in VKC, making it potentially sight‐threatening. AKC occurs in atopic adults, and like VKC it affects the cornea. VKC and AKC require steroid treatment under specialist supervision; minimization of the steroid dose can often be achieved with use of a chromone. GPC occurs due to repeated contact of the conjunctival surface with a foreign surface, such as contact lenses. Attention to lens hygiene or switching to different lenses and treatment with a chromone are frequently effective. In all allergic eye diseases contact with the precipitating allergen should be avoided as far as possible.
Reciprocal age‐related patterns of allergen‐specific T‐cell immunity in normal vs. atopic infants
Authors: Prescott  , Macaubas  , Smallacombe  , Holt  , Sly  , Loh  , Holt
Published: March 2003

By adulthood there is almost universal immunological memory to aeroallergens, and the presence of allergic disease appears to be related to the nature of the underlying T‐helper (Th) cell cytokine responses. The hypothesis of this study is that adult patterns of allergen specific Th‐cell memory (Th‐2 polarized in atopics vs. Th1 in non‐atopics) can be determined in early infancy.

 Mononuclear cell cytokine responses to house‐dust mite were measured at 6‐monthly intervals from birth to 2 years of age, using ELISA (IL‐10, IL‐13, IFN‐γ) and sqRT/PCR (IL‐4, IL‐5, IL‐9, IFN‐γ) in normal infants (n = 14) with no family history or allergic symptoms, and infants with a family history and definite atopy by 2 years (n = 16).

 Both normals and atopics showed low‐level Th2 skewed allergen‐specific responses at birth with little accompanying IFN‐γ. The Th2 responses to house‐dust mite were higher in normal newborns, who then show a rapid downregulation of these responses in the first year of life. Atopic infants instead show a consolidation of their neonatal patterns of Th2 polarized allergen specific immunity.

 Earlier studies indicate that neonates at high risk of atopy display diminished capacity for production of the Th1 cytokine IFN‐γ. The present study suggests for the first time that neonates who subsequently develop atopy also initially have reduced capacity to mount Th2 responses. However, in contrast to non‐atopics who selectively downregulate their fetal Th2 polarized allergen‐specific responses, atopic children display age‐associated upregulation of Th2 immunity.