bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic quality control of oral anticoagulant therapy comparing the short‐acting acenocoumarol and the long‐acting phenprocoumon
Authors: Gadisseur Alain P. A. , Van Der Meer Felix J. M. , Adriaansen Henk J. , Fihn Stephan D. , Rosendaal Frits R.
Published: March 2003

Summary.  To investigate whether the different pharmacokinetics of acenocoumarol (t1/2 = 11 h) and phenprocoumon (t1/2 = 140 h) result in a different quality of anticoagulation, we studied patients from the Leiden anticoagulation clinic treated between 1998 and 1999 for more than 16 weeks. Two hundred and twenty‐eight pairs were closely matched for indication for oral anticoagulant therapy (OAT), age, sex and date of start of treatment. Four hundred and fifty six patients with 7245 International Normalized Ratio (INR) checks yielded 230 patient‐years. Quality of OAT calculated over the whole treatment period was higher with phenprocoumon as expressed by the number of INR checks in the therapeutic range (phenprocoumon: 42·7%, acenocoumarol: 36·5%, difference: 6·1%, CI95 of the difference: 3·0–9·3%) and by time in range (phenprocoumon: 46·6%, acenocoumarol: 41·6%, difference: 5·0%, CI95 of the difference: 1·3–8·6%). After the initial 6 weeks of OAT, the differences became more pronounced (difference: 6·1%, CI95: 1·8–10·4%). The incidence of severe bleeding complications was similar (phenprocoumon: 0·04/patient/year vs acenocoumarol: 0·03/patient/year) with a slight excess of minor bleeds with phenprocoumon (0·19/patient/year vs 0·06/patient/year). We conclude that phenprocoumon leads to a better quality of OAT than acenocoumarol. As there is no difference in major bleeding complications and only a small difference in minor bleeding complications, phenprocoumon is preferable to acenocoumarol for prolonged OAT.
CD95 (Fas) expression is regulated by sequestration in the Golgi complex in B‐cell lymphoma
Authors: Haynes Andrew P. , Daniels Ian , Abhulayha Abdulmunem M. , Carter G. Ian , Metheringham Rachel , Gregory Christopher D. , Thomson Brian J.
Published: March 2003

Summary. The CD95 (Fas) molecule transmits apoptotic signals important in B‐cell development and the genesis of B‐cell lymphoma. We have investigated the surface and intracellular expression of CD95 in Burkitt's lymphoma (BL) cells, an important non‐Hodgkin's lymphoma of B‐cell origin. Group I BL cells did not express CD95 at the cell surface, but contained high levels of this receptor in the cytoplasm. In contrast, group III BL cells expressed CD95 intracellularly and at the cell surface. In group I and group III BL cells, cytoplasmic CD95 was localized to the Golgi complex, as assessed by confocal immunofluorescence microscopy and subcellular fractionation followed by immunoblotting. Trafficking through the Golgi complex is regulated by elements within the target protein and cellular sorting mechanisms. CD95 contains candidate signals for interaction with trafficking machinery. Group I BL cells can be induced to upregulate surface expression of CD95 following CD40 ligation and certain group I BL cell lines drift invitro to a group III phenotype, with consequent surface expression of CD95. Taken together, these observations show that CD95 can either be retained in the Golgi complex or exported to the cell surface, and suggest that membrane trafficking has an important and previously unrecognized role in regulating CD95 expression in B lymphocytes.
Glycophorin A‐mediated haemolysis of normal human erythrocytes: evidence for antigen aggregation in the pathogenesis of immune haemolysis
Authors: Brain Michael C. , Prevost Jay M. , Pihl Carin E. , Brown Christopher B.
Published: March 2003

Summary. The inexplicable severity of anti‐Pr autoimmune haemolytic anaemia led us to test the hypothesis that the haemolysis was primarily due to a change in the function of glycophorin A, on which the Pr antigen is located. The lectins Maclura pomifera and wheat germ agglutinin that bind to glycophorin A induced the haemolysis of normal erythrocytes in vitro. Lectin binding led to an increase in erythrocyte membrane permeability to sodium and potassium, the former resulting in an influx of water and subsequent haemolysis. The response was glycophorin A specific as Concanavalin A, which binds to band 3, did not cause haemolysis and peanut agglutinin only did so after removal of erythrocyte sialic acid. The lectin‐induced cation leak was not mediated by activation of cation channels as the inhibitors, tetrodotoxin, amiloride and 4,4′ diisothiocyanate stilbene 2,2′disulphonate, had no effect, suggesting that the haemolysis was due to exacerbation of the inherent cation permeability of the erythrocyte membrane. A human IgAK anti‐Pr autoantibody and a mouse anti‐human glycophorin A antibody increased erythrocyte permeability to sodium. The role of glycophorin A in stabilizing and, upon aggregation, destabilizing the phospholipid bilayer is discussed. Our findings may help explain the severity of anti‐Pr autoimmune haemolytic anaemia and other pathophysiological changes in human erythrocytes.
Autocrine and/or paracrine growth of adult T‐cell leukaemia tumour cells by interleukin 15
Authors: Kukita Toshimasa , Arima Naomichi , Matsushita Kakushi , Arimura Kosei , Ohtsubo Hideo , Sakaki Yoshimune , Fujiwara Hiroshi , Ozaki Atsuo , Matsumoto Tadashi , Tei Chuwa
Published: March 2003

Summary. We previously demonstrated that interleukin 2 (IL‐2) autocrine/paracrine growth in adult T‐cell leukaemia (ATL) cells was closely correlated with clinical aggressiveness. In the present study, we compared the significance of IL‐15 and IL‐2 in growth of ATL cells and clinical aggressiveness. Thirty‐seven patients with ATL were examined: 19 acute and 18 chronic. Autonomous growth and IL‐2‐ or IL‐15‐responsive growth activities of ATL cells were measured by [3H]‐thymidine incorporation after 24 h cultures in vitro. All of the autonomous, IL‐15‐ and IL‐2‐responsive growth activities of acute‐type cells were higher than those of chronic type (P = 0·04, P = 0·03 and P = 0·02 respectively). IL‐15‐ and IL‐2‐responsive growth activities were highly correlated (P = 0·0001, R2 = 0·837). Enzyme‐linked immunosorbent assay (ELISA) showed detectable serum levels of IL‐15 and IL‐2 in 18 out of 19 and 14 out of 17 patients respectively. Reverse transcription polymerase chain reaction (RT‐PCR) revealed IL‐15 and IL‐2 mRNA expression in 8 out of 11 patients' cells. Anti‐IL‐2 antibody partially inhibited autonomous growth of ATL cells; anti‐IL‐15 antibody was less effective. In situ immunochemistry detected IL‐15 in cells of three patients and was consistent with the results of RT‐PCR. These results suggest that ATL cells grow in an IL‐15 autocrine/paracrine manner and that this growth is related to disease aggressiveness in a manner similar to IL‐2.
The upregulation of CC chemokine receptor 7 and the increased migration of maturing dendritic cells to macrophage inflammatory protein 3β and secondary lymphoid chemokine is mediated by the p38 stress‐activated protein kinase pathway
Authors: Ardeshna Kirit M. , Pizzey Arnold R. , Walker Simon J. , Devereux Stephen , Khwaja Asim
Published: March 2003

Summary. Using the p38 stress‐activated protein kinase (p38SAPK) inhibitor, SB203580, increased responsiveness of monocyte‐derived dendritic cells (MoDCs) to secondary lymphoid chemokine (SLC) and macrophage inflammatory protein 3β (MIP3β), following lipopolysaccharide‐induced MoDC maturation, was shown to be mediated by the p38SAPK pathway. This was due to the complete abrogation of upregulation of CC chemokine receptor 7, the receptor for MIP3β/SLC. Once mature, MoDCs utilized both the p38SAPK and phosphoinositide‐3 kinase pathways to migrate in response to SLC or MIP3β. These findings have implications for the mechanism of action of p38SAPK inhibitors, currently in use in clinical trials for patients with autoimmune diseases.
ChlVPP chemotherapy in children with stage IV Hodgkin's disease: results of the UKCCSG HD 8201 and HD 9201 studies
Authors: Atra Ayad , Higgs Elizabeth , Capra Michael , Elsworth Ann , Imeson John , Radford Martin , Hewitt Martin ,   on behalf of the UKCCSG/Hodgkin's Disease Group
Published: March 2003

Summary. We reviewed the results of two consecutive United Kingdom Childrens' Cancer Study Group (UKCCSG) studies of children with stage IV Hodgkin's Disease (HD) treated between January 1982 and December 1999. Among 697 children with HD, 67 were diagnosed to be stage IV. The median age at diagnosis was 12·7 years (range 4·4–16·2). Thirty‐five (52%) were boys. Thirty‐nine patients (58%) had B symptoms at diagnosis. All were treated with 6–8 cycles of ChlVPP chemotherapy regimen (Chlorambucil, Vinblastine, Procarbazine and prednisolone) and only 12 had radiotherapy. The overall survival (OS) at 5 and 10 years was 80·8% and 77·2%, respectively, whilst the event‐free survival (EFS) at the same time intervals was 55·2% and 48·8% respectively. Twenty‐eight patients (41·79%) relapsed/progressed, 18 (64%) survived after further chemotherapy with or without high‐dose therapy and stem cell rescue. Twelve patients died, seven of HD, three from infections and one from secondary acute myeloblastic leukaemia (AML). Although the EFS in this study was lower than other studies, 64% of relapsed patients were salvaged with second‐line therapy. It is also anticipated that survivors treated with this non‐anthracycline‐containing regimen will have less long‐term toxicity.
Protein A Sepharose immunoadsorption can restore the efficacy of platelet concentrates in patients with Glanzmann's thrombasthenia and anti‐glycoprotein IIb–IIIa antibodies
Authors: Martin Isabelle , Kriaa Fayçal , Proulle Valérie , Guillet Benoît , Kaplan Cécile , D'Oiron Roseline , Debré Marianne , Fressinaud Edith , Laurian Yyes , Tchernia Gil , Charpentier Bernard , Lambert Thierry , Dreyfus Marie
Published: March 2003

Summary. Type I Glanzmann's thrombasthenia is a rare congenital platelet function disorder, characterized by undetectable platelet membrane glycoprotein IIb–IIIa (GPIIb–IIIa). Severe bleeding is controlled by transfusion of normal platelets, leading in some cases to the occurrence of anti‐GPIIb–IIIa isoantibodies, which induces a loss of transfused platelet efficacy. We used immunoadsorption on protein A Sepharose (IA‐PA), which has been shown to be efficient in decreasing the titre of antibodies in several immune diseases, in three patients with Glanzmann's thrombasthenia and anti‐GPIIb–IIIa isoantibodies on five different occasions. IA‐PA was well tolerated with no deleterious side‐effects reported. It induced a dramatic decrease of total immunoglobulin (Ig)G, including anti‐GPIIb–IIIa isoantibody levels, as assessed by the monoclonal antibody‐specific immobilization of platelet antigens test and the ex vivo inhibition of normal platelet aggregation induced by the patient's platelet‐rich or platelet‐poor plasma. Elimination of the antibody was associated with a correction of the bleeding time following platelet transfusion. IA‐PA combined with platelet transfusion made it possible to control two life‐threatening haemorrhages, and allowed two surgical procedures and one bone marrow transplantation to be performed safely. Our experience suggests that IA‐PA, which restores the haemostatic efficacy of platelet transfusion, is a valuable therapeutic strategy in patients with Glanzmann's thrombasthenia and anti‐GPIIb–IIIa isoantibodies.
Clonal T cell‐mediated cyclic thrombocytopenia
Authors: Füreder Wolfgang , Mitterbauer Gerlinde , Thalhammer Renate , Geissler Klaus , Panzer Simon , Krebs Michael , Simonitsch‐Klupp Ingrig , Sperr Wolfgang R. , Lechner Klaus , Kyrle Paul A.
Published: March 2003

Summary. Cyclic thrombocytopenia is a rare disorder characterized by periodic platelet count fluctuations of unknown aetiology. We report on a female patient with cyclic changes of platelet counts ranging from 6 × 109/l to 753 × 109/l in 4‐week intervals. Platelet counts were inversely correlated to thrombopoietin levels suggesting production failure. Reticulocyte counts and neutrophil counts showed similar, but less prominent, fluctuations. Clonal T‐cell receptor rearrangement was detected in bone marrow samples as well as in peripheral blood. Cell typing of blood lymphocytes revealed a relative increase in CD3+ T cells. Treatment with cyclosporine A resulted in a substantial improvement of platelet counts. Taken together, we provide evidence for clonal T‐cell mediated bone marrow failure with cyclic impairment of thrombopoiesis responsive to cyclosporine therapy.
Effect of tamoxifen on venous thrombosis risk factors in women without cancer: the Breast Cancer Prevention Trial
Authors: Cushman Mary , Costantino Joseph P. , Bovill Edwin G. , Wickerham D. Lawrence , Buckley Lenore , Roberts John D. , Krag David N.
Published: March 2003

Summary. Tamoxifen reduces breast cancer incidence among healthy women, but is associated with an increased risk of venous thrombosis. We studied the 6 month effects of tamoxifen on venous thrombosis risk factors in women without cancer. One hundred and eleven women at one centre who were participants in a multicentre breast cancer prevention trial were randomized, in double‐blind fashion, to receive 20 mg/d of tamoxifen or placebo. The activated protein C (APC) ratio and concentrations of antithrombin, protein C antigen, and total protein S were measured at baseline and 6 months of treatment. None of the factors changed over 6 months in placebo‐treated women. Among tamoxifen‐treated women, antithrombin and protein S, but not protein C or APC ratio were reduced. Sequential antithrombin concentrations with tamoxifen were 114% and 104% (P = 0·001 compared with placebo). Sequential protein S concentrations with tamoxifen were 18·42 and 17·30 µg/ml (P = 0·02 compared with placebo). Reductions in antithrombin and protein S were greater in postmenopausal women, but did not differ by other risk factors for venous thrombosis, such as body mass index. Reductions of antithrombin and protein S, but not protein C or APC resistance, might relate to the increased risk of venous thrombosis associated with tamoxifen treatment.
Comparison of five biochemical markers of bone resorption in multiple myeloma: elevated pre‐treatment levels of S‐ICTP and U‐Ntx are predictive for early progression of the bone disease during standard chemotherapy
Authors: Abildgaard Niels , Brixen Kim , Kristensen Jens E. , Eriksen Erik F. , Nielsen Johan L. , Heickendorff Lene
Published: March 2003

Summary. Increased osteoclastic bone resorption is the major causal factor of bone disease in multiple myeloma. Recently, non‐invasive methods have been developed for the estimation of bone resorptive activity. To evaluate the biological sensitivity and clinical usefulness of five biochemical assays for measuring the C‐terminal telopeptide of collagen I (ICTP) in serum (β‐Crosslaps ELISA and ICTP radioimmunoassay) and urinary creatinine‐adjusted excretions of pyridinoline (PYR), deoxypyridinoline (DPD) and N‐terminal telopeptide of collagen I (Ntx), we performed a study of 34 consecutive newly diagnosed myeloma patients. Serum and morning‐fasting, second‐void urine samples were taken before the start of treatment. In total, 40 age‐ and sex‐adjusted healthy individuals served as controls. Results were expressed as Z‐scores. All test variables were highly significantly elevated in the patients (P < 0·001). Serum (S)‐ICTP was elevated (Z‐score > 2) in most patients (85%) and showed significantly higher Z‐score values than the other markers. S‐ICTP remained more sensitive than the urinary assays when patients with impaired renal function were excluded from analysis. S‐ICTP and the urinary metabolites correlated significantly with skeletal morbidity. S‐β‐Crosslaps correlated with the bone morbidity only when patients with renal insufficiency were excluded from the analysis. High levels of S‐ICTP and urinary (U)‐Ntx correlated with an increased risk for early progression of bone lesions during standard melphalan–prednisolone treatment. U‐Ntx and S‐ICTP are sensitive tools for estimating the increased bone resorption in multiple myeloma and are clinically useful for identifying patients with increased risk of early progression of bone disease.
Inhibition of factor VIIa generation and prothrombin activation by treatment with enoxaparin in patients with unstable angina*
Authors: Gerotziafas Grigoris T. , Zafiropoulos Athanasios , Van Dreden Patrick , Karavaggeli Eli , Goutzoumas Nikos , Nikolaidis Paschalis , Combot Caroline , Lagoudaki Pervez , Zervas Kostas , Arzoglou Pantelis , Samama Meyer Michel
Published: March 2003

Summary. Factor VIIa (FVIIa) and thrombin generation occur in patients suffering an acute coronary event. We studied the effect of treatment with enoxaparin on FVIIa and prothrombin activation in patients with unstable angina. Anti‐Xa activity, FVIIa, FVII coagulant activity (FVII:C) and FVII antigen (FVII:Ag), free tissue factor pathway inhibitor (TFPI), and prothrombin fragments 1 + 2 (F1+2) were measured in patients' plasma, over a 24‐h treatment period with enoxaparin. All 14 patients recruited in the study (mean age 68 years) were treated with a subcutaneous injection of enoxaparin, 1 mg/kg twice daily. Blood was drawn just before, and at different time intervals after, the first injection. Before enoxaparin administration, the levels of FVIIa (4·02 ± 0·8 ng/ml) and F1+2 (2·68 ± 0·2 nmol/l) were significantly increased as compared with control subjects (2·3 ± 0·3 ng/ml and 0·9 ± 0·1 nmol/l respectively, P < 0·05). Free TFPI, FVII:C and FVII:Ag were within normal ranges. One hour after the first injection of enoxaparin, FVIIa and F1+2 levels decreased by 65% and 50%, respectively, and no significant fluctuations were noted throughout the observation period. The concentrations of FVII:C and FVII:Ag were not modified as compared with baseline values. After each injection, the peak concentrations of free TFPI and anti‐Xa activity were observed at 2 and 4 h respectively. The kinetics of FVIIa and F1+2 inhibition did not follow those of anti‐Xa activity and TFPI release.
Two novel mutations, Q1053H and C1060R, located in the D3 domain of von Willebrand factor, are responsible for decreased FVIII‐binding capacity
Authors: Hilbert Lysiane , Jorieux Sylvie , Proulle Valérie , Favier Rémi , Goudemand Jenny , Parquet Armelle , Meyer Dominique , Fressinaud Edith , Mazurier Claudine ,   and the INSERM Network on Molecular Abnormalities in von Willebrand Disease
Published: March 2003

Summary. In type 2N von Willebrand disease (VWD), von Willebrand factor (VWF) is characterized by a markedly decreased affinity for Factor VIII (FVIII), and the mutations responsible are essentially located in the D′ domain of VWF. We report the identification, in seven unrelated French families, of two novel type 2N VWD mutations, Q1053H and C1060R (Gln290His and Cys297Arg in mature VWF sequence), in exon 24 of the VWF gene. These missense mutations have been identified in the heterozygous, homozygous or hemizygous states. Using site‐directed mutagenesis and transient expression in COS‐7 cells, we showed that both mutations, although located in the D3 domain of VWF, outside the tryptic fragment containing the FVIII domain, dramatically decrease the binding of VWF to FVIII. In contrast, the R924Q substitution, which was identified in a patient who was heterozygous for C1060R, was shown to be a polymorphism.
ATP‐dependent vesiculation in red cell membranes from different hereditary stomatocytosis variants
Authors: Turner E. Jane H. , Jarvis Helen G. , Chetty Margaret C. , Landon Giorgio , Rowley Peter S , Ho M. M. , Stewart G. W.
Published: March 2003

Summary.The hereditary stomatocytoses are a group of dominant haemolytic anaemias that show two main features: invaginated, ‘stomatocytic’ morphology; and a membrane leak to the univalent cations Na and K. A patient with the most severe variant of these conditions was reported to show a defect in anin vitroprocess of ATP‐dependent endocytic vesiculation (ADEV), which is found in normal red cells. We have examined this endocytosis process in 11 leaky red cell pedigrees available to us in the UK. ADEV in broken membranes was absent only in the two most severely affected, ‘overhydrated’ pedigrees studied, both of which showed a deficiency in the membrane raft protein, stomatin. The process was present, although typically diminished by about 10–20% compared with normal red cells, in all others. The cross‐linker dimethyl adipimate (DMA), which could correct the cation leak in some of these patients, also corrected the ADEV defect in the same patients. In those patients in whom DMA had no effect on the ion leak, ADEV was not absent. In normal cells, this process of vesiculation was inhibited by inhibitors of membrane ‘raft’ function, by an antistomatin antibody and by vanadate and N‐ethyl maleimide, but not by inhibitors of a number of kinases. These data highlight the heterogeneity of these conditions. A mechanism is discussed by which a defect in raft‐based endocytosis could lead to the exaggerated surface exposure of an ion channel, which could then function constitutively, i.e. ‘leak’.
Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome
Authors: Hong J J , Cohn S M , Perez J M , Dolich M O , Brown M , McKenney M G
Published: March 2003

Background

Intra-abdominal hypertension has been recognized as a source of morbidity and mortality in the traumatized patient following laparotomy. Multiple organ dysfunction attributable to intra-abdominal hypertension has been called the abdominal compartment syndrome. The epidemiology and characteristics of these processes remain poorly defined.

Methods

Intra-abdominal pressure was measured prospectively in all patients admitted to a trauma intensive care unit over 9 months. Data were gathered on all patients with intra-abdominal hypertension.

Results

Some 706 patients were evaluated. Fifteen (2 per cent) of 706 patients had intra-abdominal hypertension. Six of the 15 patients with intra-abdominal hypertension had abdominal compartment syndrome. Half of the patients with abdominal compartment syndrome died, as did two of the remaining nine patients with intra-abdominal hypertension. Patients with abdominal compartment syndrome had a mean intra-abdominal pressure of 42 mmHg compared with 26 mmHg in patients with intra-abdominal hypertension only (P < 0·05).

Conclusion

The incidence of intra-abdominal hypertension and abdominal compartment syndrome was 2 and 1 per cent respectively. Intra-abdominal hypertension did not necessarily lead to abdominal compartment syndrome, and often resolved without clinical sequelae. Abdominal compartment syndrome did not occur in the absence of earlier laparotomy. Abdominal compartment syndrome was associated with a marked increase in intra-abdominal pressure (above 40 mmHg).
Surgical technique and outcome of gasless video endoscopic transanal rectal tumour excision
Authors: Nakagoe T , Ishikawa H , Sawai T , Tsuji T , Tanaka K , Ayabe H
Published: March 2003

Background

Transanal endoscopic microsurgery (TEM) is unpopular because of its high cost and most surgeons' unfamiliarity with microscopic surgery. This report describes an experience with a modification of TEM, gasless video endoscopic transanal rectal tumour excision (gasless VTEM), which incorporates a standard laparoscopic video camera and requires no carbon dioxide insufflation system.

Methods

One hundred and one patients with 105 rectal tumours underwent gasless VTEM between 1993 and 2000.

Results

Histological examination revealed 18 adenomas, 75 carcinomas (Tis, 47; T1, 23; T2, five), 11 carcinoid tumours and one lymphoma. The median height above the dentate line and maximum tumour diameter was 5·0 (range 2–14) cm and 2·0 (range 0·4–8·0) cm respectively. The peritoneal cavity was opened intraoperatively in two patients. The median operating time was 53 (range 15–202) min. Bleeding, suture dehiscence and transient incontinence developed after operation in four patients. There was no operative death. Median hospital stay was 5 (range 1–21) days. Eleven patients with T1/T2 staging underwent subsequent radical resection. The median duration of follow-up was 52·3 months. One patient with a carcinoma developed a recurrence.

Conclusion

Gasless VTEM is a feasible, safe and minimally invasive procedure for the treatment of selected rectal adenomas and early carcinomas. The suggested modifications may make the procedure more widely available.
Long-term results of surgery for early gastric cancer
Authors: Popiela T , Kulig J , Kolodziejczyk P , Sierzega M
Published: March 2003

Background

Gastrectomy for early gastric cancer is widely accepted as an adequate therapeutic method. Recent developments of less invasive procedures require the identification of patients who will benefit from such an approach.

Methods

A retrospective study was undertaken of 238 patients with early gastric cancer who underwent gastrectomy from 1977 to 1999. Clinicopathological data relating to survival were evaluated.

Results

Analysis of 33 node-positive patients (14 per cent) revealed a tumour diameter greater than 20 mm (P = 0·011), depressed macroscopic type (P < 0·05), diffuse histological type (P < 0·001), poor tumour differentiation (P < 0·001) and infiltration of the submucosal layer (P < 0·002) as factors associated with lymph node metastasis. Multivariate analysis found diffuse histological type to be an independent risk factor. The overall 5-year survival rate was 87 per cent, and was significantly better in patients who underwent radical lymphadenectomy than in those who had regional lymph node dissection (92 versus 78 per cent; P < 0·01). Similarly, patients younger than 65 years had a more favourable 5-year survival rate (90 per cent) than older ones (77 per cent). Multivariate analysis with the Cox proportional hazards model confirmed patient age and type of lymphadenectomy as independent prognostic factors.

Conclusion

The findings suggest that extended lymph node dissection may be beneficial for some patients with early gastric cancer, although randomized clinical trials are needed to evaluate this observation further.
Phenotypic and genotypic alterations characterize patients bearing plasma cell dyscrasias with a high M‐component
Authors: Greco C. , Ameglio F. , Alvino F. , Mosiello A. , Cianciulli A. M. , Venturo I. , Del Monte G. , Giampaolo M. , Tong A. W. , Gandolfo G. M.
Published: March 2003

Abstract. As at present only a long‐term follow‐up can fully determine whether monoclonal gammapathies of undetermined significance (MGUS) will evolve into multiple myeloma (MM), this study attempted to identify other variables connected with the amount of monoclonal component (MC), generally considered as the most reliable marker of malignant evolution. Thirty‐four MGUS subjects showing a high MC (≥ 15.0 g/l) but without clinical evidence of MM (MGUS group b), were characterized for their phenotypic and genotypic profile by comparing them either with 40 MM patients or with 24 subjects affected by a benign form of monoclonal gammapathy (MGUS group a) according to the standard criteria. In addition to the usual laboratory markers, the levels of expression of a panel of CD membrane subsets were measured on B and T lymphocytes. Also, the serum level of the p53 mutant protein and the structural alterations of the c‐myc oncogene were evaluated. The results show that for MGUS group b patients, an increased M‐protein was accompanied by significantly increased levels of peripheral blood CD3+ T cells and oncogenetic aberrations in c‐myc. Since a high serum MC level seems to indicate a greater likelihood of malignant transformation for MGUS patients, these findings suggest that this relationship may be a result of the concomitant alterations observed at a phenotypic and genotypic level. Such alterations may be potentially useful as surrogate markers for the transition of benign to malignant (MM) plasma cell dyscrasia.
Overexpression of Raidd cDNA inhibits differentiation of mouse preadipocytes
Authors: Felmer R. , Horvat S. , Clinton M. , Clark A. J.
Published: March 2003

Abstract. RAIDD (RIP‐associated ICH‐1 homologous protein with a death domain) is an adaptor molecule that mediates the action of cysteine proteases involved in apoptosis. To study the possibility of a novel system of cell ablation mediated by RAIDD, a preadipocyte cell line (3T3L1) was stably transfected with a plasmid containing the murine Raidd cDNA under the control of the adipocyte specific promoter aP2. Instead of the expected apoptosis, a blockage to differentiation upon hormonal induction was observed as judged by an absence of lipid accumulation, a lack of expression of adipocyte‐specific genes and a fibroblastic appearance. Proliferation rate of Raidd‐transfected clones remained unaffected. Overexpression of Raidd cDNA in 3T3L1 cell therefore inhibited differentiation, suggesting that Raidd plays a role in controlling differentiation of mouse preadipocytes and, perhaps, in other cell types, in addition to its established role in apoptosis.
Being there: a family centre worker’s role as a secure base for adolescent girls in crisis
Authors: Schofield  , Brown
Published: March 2003

Childcare social work practice with troubled adolescent girls can benefit from drawing on attachment theory, not only as a frame‐work for understanding their relationship history and current behaviour but also as a framework for defining the nature and potential value of a specific kind of relationship provided by the social worker. This paper offers an analysis of the relevance of attachment theory for work with adolescent girls, particularly models of secure and insecure attachments, and examines practice experience in a family centre setting. The young women referred to the family centre had experienced a range of adversities, including sexual, physical and emotional abuse, which had seriously affected their development. They were drifting outside the systems of family, education and local authority care, because none of these could hold onto them. The paper describes how the social worker aimed to change their internal working model by offering them a different kind of relationship experience. She provided a secure base from which they could begin to develop trust, to repair their self‐esteem and to build a sense of self‐efficacy – the necessary ingredients for resilience and for more successful future relationships.
Children with relatives abroad: assessment for placement
Authors: Forrest  , Rushton
Published: March 2003

This study investigated a sample of children being considered for placement with relatives abroad where there were no relatives in the UK, or where the immediate family could no longer provide the care they needed. International Social Service is frequently asked to arrange for reports to be written on the suitability of relatives abroad to care for the child. The survey, based on questionnaires completed by local authority social workers, showed that following reports related to 108 sample children, 37% were placed abroad and 63% remained in the UK. Although the majority remained in the UK, the proportion of children placed abroad was higher than had been expected. The two most significant factors predicting placement were whether or not the relative abroad was offering to provide care and the impression of the relatives given by the report writer. Older children and black, Asian and mixed parentage children were more likely to remain in the UK. The paper ends with a discussion of these findings and implications for practice, policy and legislation.
Partnership and core groups in the risk society
Authors: Christie  , Mittler
Published: March 2003

In this paper, partnerships between parents/carers, children and professionals within child protection social work are critically assessed in relation to Beck’s (1992) concept of the ‘risk society’. Partnerships within core groups provide the specific focus for this paper, as in the authors’ view these groups provide particular opportunities for the development of partnerships between professionals, parents/carers and children. In the risk society new dangers and risks are constantly being created and (re)discovered, the status of professional and lay expertise is questioned and professional judgement is often mediated through discourses of risk. In this environment reflexivity becomes an essential element of professional practice. Two case studies of child protection are used to link theory and practice, and to raise questions for professional practice in core groups.
Bridging the gap: feminist theory and practice reality in work with the perpetrators of child sexual abuse
Authors: Lancaster  , Lumb
Published: March 2003

Child sexual abuse has been a focus of concern for feminist writers for over a decade, and social work and probation practitioners are spending an increasing amount of time undertaking intervention with men who sexually abuse children. This paper uses a review of feminist literature which identifies three contested areas in the feminist discussion: theory, power and the fixity of gender, and discusses whether these debates are reflected in any way in the interventions being undertaken with men who sexually abuse children. The conclusion reached is of a distance between theory which draws on a radical patriarchal analysis of child sexual abuse and the practice of those who attempt to work with the perpetrators of such abuse. Although some workers frame their intervention in terms of a patriarchal understanding of society and of the nature of power within this – to this extent following a radical feminist approach – there is a sense in which practitioners’ use of feminist theory is only partial. Thus feminist theory is often presented as unitary and there is a sense in which practitioners who say they are espousing feminism are not in touch with the subtleties of feminist analysis revealed in the literature review. In addition, the logic of the radical feminist perspective is not followed through in practice as there is evidence of a sensitivity to difference which may be aligning practitioners with a post‐modern/post‐structural interpretation of men’s sexual violence towards children.
Child care social work and the role of state employees
Authors: Huntington
Published: March 2003

Provision of statutory social work services to children and their families has a long and contentious history as conflicting ideas about appropriate interventions, in what is still largely characterized as the private sphere of the family, define the terrain for practice. More recently, staff in social services departments have had to meet the challenges of contemporary practice at a time of major restructuring. Implementing the National Health Service & Community Care Act 1990, and meeting the demands of Audit/Social Services Inspectors, leaves departments struggling to meet externally imposed criteria focused on particular interpretations of the nature of economy, efficiency and effectiveness in the public sector. In general staff have had to respond to competing imperatives as they offer services in ways that reflect shifting priorities, priorities that are inevitably shaped by ideological, political, economic and technological agendas as well as by professional concerns. In the process the role and task for social work is once again being redefined. This paper seeks to challenge dominant narratives, through exploration of the contemporary context for practice, and reassert the importance of social work input even as individuals’ working lives change around them.
A seamless service: meeting the needs of children with disabilities through a multi‐agency approach
Authors: Cigno  , Gore
Published: March 2003

Recent research and child care legislation has brought about a change in emphasis in services for families where there is a child with disabilities. The multi‐disciplinary approach, where different agencies and professionals work together to provide a holistic service, has become of paramount importance. This study reports the results of an evaluation of a multi‐agency Children’s Centre which was attempting to put the rhetoric into practice. A multi‐method research design, incorporating quantitative and qualitative techniques, was used. The main aim was to assess how far the Centre was carrying out an integrated approach in order to meet the needs of children and carers. The results indicate that while staff felt that there was still some way to go to provide a seamless service, the vast majority of parents felt that the Centre did meet its aims. While the reasons for these differences are explored, and the authors caution against complacency, the overall conclusion is that there is evidence that professionals can successfully work together in close proximity with one shared aim; and that such multi‐agency centres work for families.
Outcomes of permanent family placement for children of minority ethnic origin
Authors: Moffatt P.G. , Thoburn J.
Published: March 2003

The paper explores the outcomes of permanent family placement for children of minority ethnic origin, using a sample of 254 placements drawn, in the main, from a cohort of 1165 British children placed between 1980 and 1985. Statistical techniques are used to explore the relationship between ‘success’ (defined, for the purposes of this paper, as the placement not known to have broken down) and a range of variables, including the characteristics of the child, the birth parents and the adoptive parents, and the type of placement. In most respects, the findings are consistent with those of similar studies. Age at placement is found to have an important effect, with success least likely for children placed in the middle age range. Lack of problem behaviours in the children at the time of placement is also found to be associated with success. Variables which are found to have no effect on the probability of success include ethnic origin of the child, whether it is an adoptive or permanent foster placement, and whether contact with birth parents continued after placement. There was an interesting gender effect in that boys did better in ‘transracial’ than in ‘matched’ placements, but the opposite was the case for girls.
Findings on the impact of treatment for childhood acute lymphoblastic leukaemia on family relationships
Authors: McGrath Pam
Published: March 2003

Paediatric acute lymphoblastic leukaemia (ALL) has provided a landmark in cancer therapy as the first disseminated and otherwise lethal malignancy to be curable in the majority of patients. Although the success rate is high, this benefit is achieved through a long, invasive and very arduous treatment process. The experience of undergoing such intensive treatments affects not only the child, but the entire family. To date, however, psychosocial research is only beginning to describe the depth and breadth of the impact on families of this experience. This paper presents findings from a recent qualitative study of families coping with the initial stage (induction remission) of treatment for childhood ALL. The findings indicate that the experience is so profoundly disturbing and disruptive that it challenges the families' sense of normalcy and stability. These findings provide evidence of significant hardship and stress, with the consequent indication of the need for social work support. Above all, such families need to hear the comforting message from social workers that what they are experiencing is normal under the circumstances. Along with practical assistance, they need reassurance about the intensity of feelings they will experience and an affirmation of the difficulty of the challenges they face.
Strategies for survival: users' experience of child welfare in three welfare regimes
Authors: Hetherington Rachael , Piquardt Rolf
Published: March 2003

This paper draws on research into child welfare services in France, Germany and England which compares the subjective experience of mothers who have been in contact with family support and child protection agencies in the three countries. The mothers' stories suggest that successful help‐achieving strategies differ according to the nature of the child welfare regime, and that behaviour which is effective in getting a good response in one country may work less well elsewhere. The stories of two mothers in each of the countries have been chosen to demonstrate how the structures of different social welfare regimes affect the efforts of welfare users to get the help they need.
‘Contact Irregular’: a qualitative analysis of the impact of visiting patterns of natural parents on foster placements
Authors: Browne Deborah , Moloney Ann
Published: March 2003

Over the years there has been much debate about the effect of parental visiting on children in foster care. While some contend that it is essential to maintain attachment bonds to the birth family, others argue that contact undermines the new relationship with the foster family. By studying descriptions of visiting patterns of 113 foster placements this study attempts to examine how parental access affects the foster child. A qualitative analysis of the written accounts offered by social workers yielded four distinct visiting patterns: Regular and Frequent, Regular but Infrequent, Infrequent, and No Access. The nature of the analysis also allowed for a redefinition of placement outcome into three categories: Successful placements, Ambiguous placements and Crisis placements. Because the categories that emerged from the qualitative analysis were mutually exclusive it was possible to examine, using chi square, whether there was a quantitative relationship between the variables ‘Placement status’ and ‘Visiting patterns’. Analysis of the categorical data showed a statistically significant relationship between visiting patterns and placement outcome. This relationship, however, was not based on how visiting related to Successful or Crisis placements. Instead it was evident that those placements categorized as Ambiguous were far more likely to report Infrequent visiting patterns. Case examples offer an opportunity to examine possible reasons for this relationship. The paper also describes qualitative accounts of how children reacted to the visits. The unique approach to defining placement status in this study may help explain the conflicting findings on this topic over recent years.
Do the younger siblings of learning‐disabled children see them as similar or different?
Authors: Hames
Published: March 2003

Pre‐school siblings' comments about, and behaviour towards, their older, learning‐disabled brothers and sisters are reported. Initially, some of the very young siblings want to be similar, and attempt to imitate their brothers and sisters, particularly if he or she is also physically disabled; this may be because of the immediate visibility of physical disability, which makes it appear interesting and important to the younger child. Before they are 2 years old, children are able to recognize that their older brothers and sisters are different, and often imitate the parents' behaviour towards the older child.
Communication about parental illness with children who have learning disabilities and behavioural problems: three case studies
Authors: Barnes J , Kroll L , Lee J , Jones A , Stein A
Published: March 2003

Parental illness can have a profound impact on family relationships and children's behaviour. The amount and nature of communication between parents and children about the illness can play an important role, both positively and negatively, in mediating the outcomes. When children have a disability, families can be reluctant to communicate with them about family difficulties. They are often concerned about the impact that parental unavailability may have on their child's life. This paper reports on three families in which the mother was diagnosed with breast cancer and one child in the family had a disability. The extent and specific characteristics of their communication about the maternal illness with their children, behavioural changes in the children, explanations of communication strategies and attributions of behavioural changes are described. Family coping strategies are examined with reference to Lazarus's process model of stress and coping and the use of either problem‐focused or emotion‐focused strategies. Implications for possible clinical interventions are proposed. In particular it is suggested that families be offered consultation about: what children might understand ways in which to communicate effectively and strategies for coping with the long‐term implications of serious parental illness.
Six month follow‐up: the crucial test of multidisciplinary developmental assessment
Authors: Glaun D E , Cole K E , Reddihough D S
Published: March 2003

Participation of parents in the developmental assessment process is thought to be beneficial in promoting understanding of their child's disability, and improving consensus between parents and professionals about appropriate intervention programmes. If costly multidisciplinary assessments are to be justified, it is necessary to establish long‐term benefits for the child. This highlights a need for research identifying how families use services after diagnostic assessment and what they understand to be important for their child. Poor parent–professional agreement about diagnosis may be a factor contributing to low compliance with recommendations. The major purpose of the current study was to follow‐up families 6 months after developmental assessment, in order to investigate use of recommended intervention services. In addition, mothers’ opinions about diagnostic findings, recommendations and early intervention services were examined. Subjects were 40 pre‐school children who presented for developmental assessment, and their mothers. The majority were diagnosed with developmental problems in multiple domains. Results indicated that most mothers recalled and agreed with their child's diagnosis, but underestimated the severity of developmental delay. Families had not accessed the range of multidisciplinary intervention programmes recommended, given the complexity of their children's disabilities. Speech therapy was considered the service of highest priority by mothers, and was the treatment most frequently received. Mothers recognized a need for more therapeutic interventions for their child. An unexpected finding was the high prevalence of families who organized nonprescribed therapies. Possible explanations of the findings and implications for service delivery are discussed.
The development of a community child and family mental health service
Authors: Day C , Davis H , Hind R
Published: March 2003

The Community Child and Family Service is a primary care and community‐based child mental health service working in a socio‐economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community‐ and hospital‐based child mental health services is discussed, as is the future direction of the Service.