bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and epidemiologic analysis of giant cell (temporal) arteritis from a nationwide survey in 1998 in Japan: The first government‐supported nationwide survey
Authors: Kobayashi Shigeto , Yano Tetsuro , Matsumoto Yoshifuji , Numano Fujio , Nakajima Nobuyuki , Yasuda Keishu , Yutani Chikao , Nakayama Toshiko , Tamakoshi Akiko , Kawamura Takashi , Ohno Yoshiyuki , Inaba Yutaka , Hashimoto Hiroshi
Published: August 2003

Objective

To elucidate epidemiologic and clinical manifestations of Japanese patients with giant cell arteritis (GCA), the first nationwide survey for GCA was conducted in 1998 in Japan.

Methods

The first questionnaire on GCA for patients treated in 1997 was sent to 10,717 medical departments in Japan. A total of 177 patients were reported. Among the 177 patients, 66 GCA patients with detailed clinical and epidemiologic features on second survey were analyzed.

Results

Prevalence in patients 50 years of age and older in 1997 was 1.47 per 100,000 population in Japan. The average age at onset was 71.5 years old. The male:female ratio was 1:1.7. The association with permanent and complete visual loss (6.5%), jaw claudication (15.2%), and polymyalgia rheumatica (PMR) (30.3%) were low in frequency compared with those reported from other countries. All patients were treated with corticosteroids. Only 3 (4.5%) patients were reported as deceased due to other causes.

Conclusion

The prevalence of GCA in Japan was revealed to be extremely low compared with other countries. Clinical findings of permanent and complete visual loss, jaw claudication, and PMR were infrequent among Japanese patients with GCA.
The relationship between self‐report and performance‐related measures: Questioning the content validity of timed tests
Authors: Stratford Paul W. , Kennedy Deborah , Pagura Sonia M. C. , Gollish Jeffrey D.
Published: August 2003

Objective

To examine the determinants of the modest correlation between self‐report and performance‐related measures in patients with osteoarthritis of the hip or knee.

Methods

Measures included the Lower Extremity Functional Scale (LEFS), the self paced walk, timed up‐and‐go, and stair test. Each performance measure consisted of 3 domains: time, pain (visual analog scale), and exertion (Borg scale). Activity specificity was assessed by examining correlations between the LEFS with single activity and multiple activity time scores. Domain specificity was examined by comparing correlations between the LEFS and single and multiple domain scores. The impact of measurement error was considered.

Results

Increasing the number of activity time scores had no effect. Forming a composite performance score based on time, pain, and exertion substantially increased the correlation from 0.44 (composite timed score) to 0.59 (pooled domain and activity score) (P = 0.009).

Conclusion

Performance scores based on time alone appear to inadequately represent the breadth of health concepts associated with functional status.
Physical function and health‐related quality of life of Spanish patients with ankylosing spondylitis
Authors: Ariza‐Ariza Rafael , Hernández‐Cruz Blanca , Navarro‐Sarabia Federico
Published: August 2003

Objective

To determine the physical function and the quality of life (QOL) of Spanish patients with ankylosing spondylitis (AS), and to study the reliability of the Spanish version of the Bath Ankylosing Spondylitis Functional Index (BASFI).

Methods

Clinimetric variables, including Spanish BASFI (test‐retest), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), QOL instruments (Short Form 36 [SF‐36] and European Quality of Life Questionnaire [EuroQol]), Bath Ankylosing Spondylitis Metrology Index (BASMI), and chest expansion, were assessed.

Results

A total of 92 patients were included: 69 males (75%), age (mean ± SD) 40.7 ± 9.1 years, and disease duration 11 ± 7.8 years. The scores (mean ± SD) were (from 0 the best to 10 the worst): BASFI 4.3 ± 2.4; BASDAI 4.5 ± 2.2; global SF‐36 5.5 ± 2.1; SF‐36 physical function 3.8 ± 2.5; SF‐36 physical scale 4.9 ± 2.7; SF‐36 mental scale 3.7 ± 2.7; SF‐36 physical role limitations 5.6 ± 4.4; SF‐36 general health 5.5 ± 2.1; SF‐36 pain 5.4 ±2.8; SF‐36 vitality 5.1 ± 2; EuroQoL rating scale 3.9±2.1; EuroQol health profile (from 0 the best to 2 the worst) 0.6 ± 0.4; and BASMI 4.7 ± 1.6. Significant association was found between BASFI and SF‐36 physical function domain (r = 0.75, R2 = 0.56, P < 0.0001). BASFI Cronbach's alpha was 0.92, Spearman's rho = 0.91, P < 0.0001.

Conclusions

Physical function and QOL are deteriorated in AS. The physical domain is more impaired than the mental one. The SF‐36 and the health profile of the EuroQol may be used as generic instruments to measure health‐related QOL. Spanish BASFI index is a reliable instrument.
Socioeconomic impact of osteoarthritis in Hong Kong: Utilization of health and social services, and direct and indirect costs
Authors: Woo Jean , Lau Edith , Lau Chak Sing , Lee Polly , Zhang James , Kwok Timothy , Chan Cynthia , Chiu P. , Chan Kai Ming , Chan A. , Lam D.
Published: August 2003

Objective

To determine the direct and indirect cost of osteoarthritis (OA) according to disease severity, and to estimate the total cost of the disease in Hong Kong.

Methods

This study is a retrospective, cross‐sectional, nonrandom, cohort design, with subjects stratified according to disease severity based on functional limitation and the presence or absence of joint prosthesis. Subjects were recruited from primary care, geriatric medicine, rheumatology, and orthopedic clinics. There were 219 patients in the mild disease category, 290 patients in the severe category, and 65 patients with joint replacement. A questionnaire gathered information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. Costs were calculated as direct and indirect.

Results

Low education and socioeconomic class were associated with more severe disease. OA affected family or close relationships in 44%. The average cost incurred as a result of side effects of medication is similar to the average cost of medication itself. Excluding joint replacement, the direct costs ranged from Hong Kong (HK) dollar $11,690 to $40,180 per person per year and indirect costs, HK $3,300–$6,640. The direct costs are comparable to those reported in Western countries; however, the ratio of direct to indirect costs is much higher than 1, in contrast to the greater indirect versus direct costs reported in whites. The total cost expressed as a percentage of gross national product is also much lower in Hong Kong.

Conclusions

The socioeconomic impact of OA in the Hong Kong population is comparable to Western countries, but the economic burden is largely placed on the government, with patients having relatively low out‐of‐pocket expenditures.
Treatment of primary sjögren's syndrome with low‐dose human interferon alfa administered by the oromucosal route: Combined phase III results
Authors: Cummins Martin J. , Papas Athena , Kammer Gary M. , Fox Philip C.
Published: August 2003

Objective

This study tested the safety and efficacy of human interferon (IFN) alfa for treatment of salivary hypofunction and dry mouth symptoms in primary Sjögren's syndrome patients.

Methods

Combined results are reported from 2 phase III clinical trials in which a total of 497 subjects with primary Sjögren's syndrome received 150 international units of human IFN alfa or matching placebo 3 times per day for 24 weeks by the oromucosal route.

Results

Subjects given IFN alfa had a significantly (P = 0.01) greater mean increase in unstimulated whole saliva (UWS) flow, compared with subjects given placebo. In IFN alfa patients, increases in UWS correlated positively and significantly with improvements noted in 7 of 8 symptoms associated with oral and ocular dryness. The coprimary endpoints of stimulated whole saliva flow and oral dryness were not significantly improved in the IFN alfa group relative to placebo. No significant differences were found between the groups with respect to overall adverse event incidence or severity.

Conclusion

IFN alfa given at low dosage by the oromucosal route can significantly increase UWS flow in patients with primary Sjögren's syndrome, without causing significant adverse events.
Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services
Authors: Jacobi Catharina E. , Mol Geert D. , Boshuizen Hendriek C. , Rupp Ines , Dinant Huibert J. , Van den Bos Geertrudis A. M.
Published: August 2003

Objective

To quantify the impact of socioeconomic status (SES) among patients with rheumatoid arthritis on 1) health outcomes and related health care utilization in relation to disease duration and 2) changes in health outcomes and related health care utilization over a 2‐year period.

Methods

A questionnaire survey was conducted among 878 patients with rheumatoid arthritis (RA), varying in disease duration from 0 to more than 15 years. To determine the impact of SES on the health outcomes and health care use, patients were compared within and between 3 disease duration groups. Additionally, longitudinal changes in health outcomes and health care use were assessed with a followup questionnaire sent out 2 years later.

Results

Patients with low SES have worse disease activity, physical health, mental health, and quality of life than patients with high SES. These differences, however, decreased over time. Regarding health care use, we found that patients with low SES made considerably less use of allied health care than patients with high SES.

Conclusion

Efforts should be undertaken in health care to alleviate the health disadvantages of RA patients in lower socioeconomic groups. In particular, the access to allied health care could be improved.
Predicting the onset of forearm pain: A prospective study across 12 occupational groups
Authors: Nahit Elizabeth S. , Taylor Stewart , Hunt Isabelle M. , Silman Alan J. , Macfarlane Gary J.
Published: August 2003

Objective

To determine, among workers free of forearm pain, the role of mechanical and psychosocial factors in predicting future onset.

Methods

A prospective cohort study was conducted among 782 newly employed workers from 12 occupational groups. At baseline, a cohort of 782 workers free of forearm pain was identified and measurement was made about physical and psychosocial aspects of their job and working environment. Subjects were recontacted after 1 year to determine new onsets of forearm pain. A sample of those reporting new onset forearm pain underwent a structured examination of the upper limb.

Results

One year after baseline, 666 (85%) subjects were followed up. The overall prevalence of new onset forearm pain was 8.3% (n = 55). The strongest mechanical risk factor was frequent repetitive movements of the arm or wrist (odds ratio [OR] 2.9, 95% confidence interval [95% CI] 1.6–5.2). The strongest psychosocial risk factors were work considered monotonous at least half of the time (OR 3.0, 95% CI 1.6–5.7) or work with little autonomy (OR 2.6, 95% CI 1.1–6.1). Three specific independent risk factors (monotonous work, repetitive wrist movement, working with hands above shoulder level) could distinguish groups of subjects at substantially different risks of onset.

Conclusions

Along with repetitive movements of the arms and wrists, mechanical postural factors and psychosocial factors also are important risk factors for onset of forearm pain. Our study emphasizes the multifactorial nature of risks for onset of forearm pain, and provides leads as to possible mechanisms for prevention.
Assessment of depression in rheumatoid arthritis: A modified version of the center for epidemiologic studies depression scale
Authors: Martens Matthew P. , Parker Jerry C. , Smarr Karen L. , Hewett James E. , Slaughter James R. , Walker Sara E.
Published: August 2003

Objective

The Center for Epidemiologic Studies Depression Scale (CES‐D) is an instrument commonly used to assess depressive symptoms. Although the psychometric properties of the instrument are well established, the instrument's ability to identify confirmed cases of major depression has been unclear. The purpose of this study was to evaluate the ability of cutoff scores from both a full scale and a modified CES‐D to detect major depression in people with rheumatoid arthritis (RA).

Method

Data were analyzed from 457 persons with RA, including 91 who met criteria for major depression.

Results

Results indicated that, in general, a full scale cutoff score of 19 was the most efficient in identifying cases of major depression; the cutoff score of 19 outperformed a variety of other cutoff scores from the modified scale. Even the most efficient cutoff scores, however, demonstrated problems in accurately identifying people with depression.

Conclusion

The CES‐D, while potentially useful as a screening tool, should not be used to identify cases of major depression.
Assessment of damage in juvenile‐onset systemic lupus erythematosus: A multicenter cohort study
Authors: Ravelli Angelo , Duarte‐Salazar Carolina , Buratti Silvia , Reiff Andreas , Bernstein Bram , Maldonado‐Velazquez Maria Rocio , Beristain‐Manterola Rosalia , Maeno Nobuaki , Takei Syuji , Gerloni Valeria , Spencer Charles H. , Pratsidou‐Gertsi Polyxeni , Ruperto Nicolino , Pistorio Angela , Martini Alberto
Published: August 2003

Objective

To investigate the prevalence of cumulative organ damage in patients with juvenile‐onset systemic lupus erythematosus (SLE) and its association with demographic and clinical variables, medication use, and quality of life.

Methods

The occurrence of organ system damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), was determined for 387 patients consecutively enrolled in pediatric rheumatology centers from Europe, the US, Mexico, and Japan. Risk factors for damage included demographic variables; clinical manifestations at diagnosis; previous corticosteroid, immunosuppressive, and antimalarial therapies; disease activity; and quality of life.

Results

Overall, 195 (50.5%) patients had damage within a mean of 5.7 years after disease onset. Renal (21.8%) and neuropsychiatric (15.8%) system involvement were observed most frequently, followed by musculoskeletal (11.7%), ocular (10.9%) and skin (9.6%) system involvement, with a mean SDI score of 1.1. In multivariate models, the occurrence of neuropsychiatric manifestations at diagnosis, a longer disease duration, and a greater number of intravenous cyclophosphamide pulses showed the strongest association with the presence of damage.

Conclusion

We found evidence of cumulative organ damage, as measured by the SDI, in half of the patients with juvenile‐onset SLE. Damage was significantly more likely in patients who had experienced neuropsychiatric manifestations at diagnosis, had a longer disease duration, and had received more intravenous pulses of cyclophosphamide.
The use of rheumatoid arthritis health‐related quality of life patient questionnaires in clinical practice: Lessons learned
Authors: Russak Simcha M. , Croft Joseph D. , Furst Daniell E. , Hohlbauch Andriana , Liang Matthew H. , Moreland Larry , Ofman Joshua J. , Paulus Harold , Simon Lee S. , Weisman Michael , Tugwell Peter
Published: August 2003

Objective

The utilization of health‐related quality of life (HRQOL) patient questionnaires by clinical rheumatologists is limited. Yet, considerable literature exists defining the value of such data. In an effort to understand this apparent paradox, we performed a literature review and conducted a survey to describe what has been learned over the past 2 decades concerning the use of these measures in clinical care and explore the reasons for their underutilization.

Methods

A panel of rheumatologists with extensive clinical experience was convened to review the relevant literature pertaining to the use of HRQOL patient instruments in clinical practice. Additionally, a survey of all American College of Rheumatology practicing clinicians was conducted to assess the use of and beliefs about these measures.

Results

The literature provided evidence to support the use of HRQOL patient measures in clinical practice. Forty‐seven percent of the responding rheumatologists stated that none of their patients complete HRQOL patient questionnaires. The majority of respondents (63%) reported that such information is “somewhat valuable.” The most frequently reported reason for the underutilization was that such instruments “require too much staff time.”

Conclusions

The literature supports the potential value of HRQOL patient questionnaires in clinical practice. Few rheumatologists routinely gather such information as part of patient care. Reasons for this discrepancy between utility and use are given along with recommendations intended to help increase their utilization in clinical care.
The combination of insulin‐like growth factor 1 and osteogenic protein 1 promotes increased survival of and matrix synthesis by normal and osteoarthritic human articular chondrocytes
Authors: Loeser Richard F. , Pacione Carol A. , Chubinskaya Susan
Published: August 2003

Objective

Although growth factor therapy could be an attractive method for stimulating the repair of damaged cartilage matrix, there is evidence that with aging and/or with the development of osteoarthritis (OA), articular chondrocytes may become unresponsive to growth factor stimulation. The aim of the current study was to compare the ability of insulin‐like growth factor+(IGF‐1) and osteogenic protein+(OP‐1), alone and in combination, to stimulate human normal and OA chondrocytes in culture.

Methods

Chondrocytes isolated by enzymatic digestion of cartilage obtained from subjects undergoing knee replacement for OA (n = 6) or from normal ankle joints of tissue donors (n = 7) were cultured in alginate beads in serum‐free medium and treated for 21 days with 100 ng/ml IGF‐1, 100 ng/ml OP‐1, or both. Controls were treated with vehicle alone. The cultures were evaluated for cell survival, cell number by DNA analysis, matrix production by particle exclusion assay, and level of accumulated proteoglycan by dimethylmethylene blue assay.

Results

After 21 days in serum‐free alginate culture, survival of cells from OA cartilage was 65 ± 2% (mean ± SEM), while survival of cells from normal cartilage was significantly greater (82 ± 3%). Treatment with either IGF‐1 or OP‐1 alone minimally improved survival, while the combination IGF +OP significantly improved survival, to 87 ± 2% for OA cells and 95±1% for normal cells. Cell proliferation was noted only in the IGF+OP group; this was significant for both normal and OA cells (∼2‐fold increase in DNA levels). Matrix production, assessed by particle exclusion and by proteoglycan accumulation, was greatest in the cells treated with IGF + OP in both normal and OA cultures. When proteoglycan levels were corrected for cell numbers (mg proteoglycan/ng DNA), a significant increase over control was noted with OP‐1 alone and IGF IGF‐1 alone, in both normal and OA cultures, with the greatest levels in the combination group (3‐fold increase over control).

Conclusion

OP‐1 was more potent than IGF‐1 in stimulating proteoglycan production in both normal and OA cells. However, the best results were obtained with the combination, suggesting that combined therapy with IGF‐1 and OP‐1 may be an effective strategy for treating OA cartilage damage.
Arthritis self‐management education programs: A meta‐analysis of the effect on pain and disability
Authors: Warsi Asra , LaValley Michael P. , Wang Philip S. , Avorn Jerry , Solomon Daniel H.
Published: August 2003

Objective

Some reports suggest that education programs help arthritis patients better manage their symptoms and improve function. This review of the published literature was undertaken to assess the effect of such programs on pain and disability.

Methods

Medline and HealthSTAR were searched for the period 1964–1998. The references of each article were then hand‐searched for further publications. Studies were included in the meta‐analysis if the intervention contained a self‐management education component, a concurrent control group was included, and pain and/or disability were assessed as end points. Two authors reviewed each study. The methodologic attributes and efficacy of the interventions were assessed using a standardized abstraction tool, and the magnitude of the results was converted to a common measure, the effect size. Summary effect sizes were calculated separately for pain and disability.

Results

The search strategy yielded 35 studies, of which 17 met inclusion criteria. The mean age of study participants was 61 years, and 69% were female. On average, 19% of patients did not complete followup (range 0–53%). The summary effect size was 0.12 for pain (95% confidence interval [95% CI] 0.00, 0.24) and 0.07 for disability (95% CI 0.00, 0.15). Funnel plots indicated no significant evidence of bias toward the publication of studies with findings that showed reductions in pain or disability.

Conclusion

The summary effect sizes suggest that arthritis self‐management education programs result in small reductions in pain and disability.
Bone mineral density in juvenile dermatomyositis: Assessment using dual x‐ray absorptiometry
Authors: Stewart W. A. , Acott P. D. , Salisbury S. R. , Lang B. A.
Published: August 2003

Objective

To determine the bone mineral density (BMD) status of our juvenile dermatomyositis (DM) population and to compare the frequency of osteopenia in patients with active disease requiring corticosteroids with that in patients with inactive disease who are not receiving corticosteroids.

Methods

Medical charts of all children diagnosed as having juvenile DM at our institution between 1989 and 1999 were reviewed for demographic and clinical data, including disease activity and duration of corticosteroid therapy. BMD measurements of the lumbar spine (L1–L4) were performed using dual x‐ray absorptiometry (DXA). Z scores were calculated from the BMD data for comparison with published normative data.

Results

A total of 15 patients were assessed: 10 with active disease, and 5 with inactive disease who had not taken corticosteroids for an average of 6.0 years (range 3.4–8.1 years). Baseline BMD measurements demonstrated osteopenia or frank osteoporosis in the majority of patients, including 6 of the 10 patients with active disease and 4 of the 5 patients whose disease was in remission. Fourteen patients had serial BMD measurements. Persistent or worsening osteopenia was documented in all patients who had ongoing active disease, except for 3 patients who had been treated with bisphosphonates because of vertebral compression fractures.

Conclusion

Osteopenia is common in patients with juvenile DM, and it usually worsens with ongoing disease. It can persist for many years after the disease enters remission. Bisphosphonates appeared to beneficially affect bone mineralization in our patients. Treatment to prevent the long‐term complications of osteoporosis in patients with juvenile DM should be considered and requires further study.
Interstitial laser coagulation with temporary hepatic artery occlusion for patients with cirrhosis and irresectable hepatoma
Authors: Verhoef C , Kuiper J W , Heisterkamp J , de Man R A , Pattynama P M T , IJzermans J N M
Published: August 2003

Background

The aim was to determine the degree of local control of hepatocellular carcinoma (HCC) in patients with cirrhotic liver disease when treated with ultrasonographically guided interstitial laser coagulation (ILC) with temporary hepatic artery occlusion.

Methods

Sixteen patients with 24 HCC tumours were treated. Follow-up was by computed tomography or magnetic resonance imaging every 3 months.

Results

Nineteen of 24 tumours showed complete necrosis immediately after treatment, and there was no tumour recurrence during follow-up (mean 14 months, median 12 months). No effect on liver function was observed after 1 week and there was no death. In 13 of the 16 patients, new HCC foci developed at other sites.

Conclusion

Percutaneous ILC combined with temporary hepatic artery occlusion during a single session is an effective local treatment for HCC nodules smaller than 5 cm. However, new HCC lesions develop in the majority of patients, which underscores the need for adjuvant therapy or repeated treatment in these patients.
Laparoscopic surgery for recurrent Crohn's disease
Authors: Hasegawa H , Watanabe M , Nishibori H , Okabayashi K , Hibi T , Kitajima M
Published: August 2003

Background

The aim of this study was to assess the feasibility of laparoscopic surgery for recurrent Crohn's disease, and the role of repeated laparoscopy in reoperation.

Methods

Between January 1994 and May 2002, 61 laparoscopic operations were attempted in 52 patients with ileal or ileocolonic Crohn's disease. Of these, 16 procedures were performed for recurrence at the anastomotic site (recurrent group). The remaining 45 operations were performed as primary procedures (control group). The median follow-up was 48 (range 3–90) months.

Results

The median time to reoperation was 46 months. The incidence of enteric fistula and the conversion rate did not differ significantly between the two groups. Although the operating time was significantly longer in the recurrent group, there were no differences in the rate of postoperative complications (three in the recurrent group and six in the control group) and hospital stay (both median 8 days).

Conclusion

Laparoscopic surgery for recurrent Crohn's disease is feasible in selected patients without an increase in conversion rate or postoperative complications.
Protection against experimental small intestinal ischaemia–reperfusion injury with oxygenated perfluorochemical
Authors: Fujino Y , Suzuki Y , Kakinoki K , Tanioka Y , Ku Y , Kuroda Y
Published: August 2003

Background

Intestinal ischaemia–reperfusion (IR) injury frequently occurs in abdominal surgery. Perfluorochemical (PFC) can be used to oxygenate intestinal organs directly and allows adenosine 5′-triphosphate (ATP) production within the submerged organs during ischaemia. This study was designed to evaluate the protective effect of PFC in IR injury, focusing on cytokine production in rat small intestine.

Methods

The superior mesenteric artery was occluded in rats for 60 min and the small bowel placed in an intestinal bag containing either normal saline (group 1), oxygenated saline (group 2) or oxygenated PFC (group 3). The arterial clip was subsequently removed, allowing reperfusion. The number of rats that survived for 7 days, tissue ATP levels, biochemical variables, tissue lipid peroxidation (LPO), bacterial cultures and histological changes were examined after reperfusion.

Results

The use of oxygenated PFC in group 3 improved survival compared with the other groups. Serum creatine phosphokinase and lactate dehydrogenase levels in groups 1 and 2 reflected small intestinal damage, and plasma levels of tumour necrosis factor α and interleukin 6 were raised. In contrast, oxygenated PFC decreased these levels, and reduced LPO, bacterial translocation and augmented apoptosis of the small intestine after reperfusion.

Conclusion

An intestinal bag containing oxygenated PFC showed protective effects during bowel ischaemia.
Colonic anastomotic strength and matrix metalloproteinase activity in an experimental model of bacterial peritonitis
Authors: de Hingh I H J T , de Man B M , Lomme R M L M , van Goor H , Hendriks T
Published: August 2003

Background

Clinical studies report conflicting results on the safety of primary intestinal anastomoses in the presence of peritonitis, and comprehensive experimental data are lacking. The present study investigated whether the strength of experimental colonic anastomoses is affected if surgery is performed in the presence of pre-existing bacterial peritonitis.

Methods

Colonic anastomoses were constructed in Wistar rats 24 h after caecal ligation and puncture or a sham procedure. Anastomotic strength was assessed by measuring breaking strength and bursting pressure during the first 5 days after operation. Anastomotic hydroxyproline levels were measured and matrix metalloproteinase (MMP) activity was analysed by quantitative gelatin zymography.

Results

Anastomotic strength was lowered in the presence of bacterial peritonitis but in a minor and transient way. The breaking strength was lower only immediately after construction of the anastomosis (− 15 per cent, P = 0·011) and the bursting pressure only on the third postoperative day (− 33 per cent, P = 0·038); no anastomotic dehiscence was observed. At 3 days after operation increased levels of MMP activity were observed but anastomotic hydroxyproline content was not affected by bacterial peritonitis.

Conclusion

The influence of bacterial peritonitis on the development of anastomotic strength is limited. This experimental finding lends support to recent clinical studies that have demonstrated the feasibility of constructing a primary anastomosis under these conditions.
Detection of disseminated tumour cells in blood and bone marrow samples of patients undergoing hepatic resection for metastasis of colorectal cancer
Authors: Vlems F A , Diepstra J H S , Punt C J A , Ligtenberg M J L , Cornelissen I M H A , van Krieken J H J M , Wobbes T , van Muijen G N P , Ruers T J M
Published: August 2003

Background

In 50–60 per cent of patients who undergo hepatic resection for metastasis of colorectal cancer the first site of tumour recurrence is extrahepatic, indicating the presence of more extensive disease at the time of resection. The aim of this study was to evaluate whether the presence of disseminated tumour cells in blood and bone marrow could predict extrahepatic tumour recurrence.

Methods

Cytokeratin 20 (CK20) reverse transcriptase–polymerase chain reaction was used to study the presence of tumour cells in preoperative peripheral blood and bone marrow samples from 41 patients with liver metastasis scheduled for surgical resection.

Results

CK20 expression was detected in six of 41 peripheral blood samples and in eight of 32 bone marrow samples. There was no correlation between CK20-positive samples and subsequent extrahepatic recurrence. Positive blood samples did, however, correlate with high serum carcinoembryonic antigen level and large tumour volume. None of the 14 patients previously treated with chemotherapy had CK20-positive samples, whereas six of 27 blood and eight of 20 bone marrow samples were positive in the chemotherapy-naive group.

Conclusion

Although the number of patients in this study is limited, the presence of disseminated tumour cells did not predict subsequent extrahepatic recurrence. The results strongly suggest that the presence of circulating tumour cells in peripheral blood may reflect transient shedding of tumour cells related to large tumour volume.
Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers
Authors: Meyer F J , McGuinness C L , Lagattolla N R F , Eastham D , Burnand K G
Published: August 2003

Background

Both four-layer and three-layer paste bandages are widely used in the treatment of venous leg ulcers. The aim of this study was to compare the efficacy of these two bandaging regimens.

Methods

The study was a prospective, randomized, open comparison of a consecutive cohort of 133 patients with venous ulcers. Participants were stratified by ulcer size into one of three groups and were randomized within each group to receive either three-layer paste or four-layer bandages. All patients were followed for 1 year. The time taken to complete ulcer healing was the primary endpoint. The time taken to apply the bandages, comfort, tolerability and cost were also assessed. Analysis was performed on the basis of intention to treat.

Results

Ulcers healed completely in 51 (80 per cent) of 64 patients treated with three-layer paste bandages compared with 45 (65 per cent) of 69 patients treated with the four-layer regimen (P = 0·031). This difference developed only after 20 weeks of treatment. The median times to complete healing were 12 weeks for three-layer and 16 weeks for four-layer treatment (P = 0·040). Results of venous function tests, including half-refilling times, were similar in the two groups.

Conclusion

Three-layer paste bandages were significantly more effective at healing venous ulcers than the four-layer regimen in this study.
Randomized clinical trial comparing consultant-led or open access investigation for large bowel symptoms
Authors: MacKenzie S , Norrie J , Vella M , Drummond I , Walker A , Molloy R , Galloway D J , O'Dwyer P J
Published: August 2003

Background

Referral of patients with large bowel symptoms is common and increasing. Currently most of these referrals are assessed at an outpatient clinic to determine the need and priority for investigation.

Methods

Over 21 months, 1131 patients referred by the general practitioner with large bowel symptoms were randomized. Patients in the consultant-led group were assessed by surgeons with a colorectal interest while those in the open access group underwent colonoscopy if they were 55 years or older and flexible sigmoidoscopy if younger.

Results

The most common symptom among referred patients was rectal bleeding (69·1 per cent) followed by change in bowel habit (48·8 per cent) and abdominal pain (32·3 per cent). There was a significant trend (P < 0·001) for patients in the consultant-led to have more investigations, and more patients in this group had no investigations (P < 0·001). Despite this, the percentage of patients with colonic or other pathology diagnosed was the same in both groups, 63·6 per cent in the consultant-led group compared with 61·8 per cent in the open access group (P = 0·558). Likewise the percentage of patients with cancer or other significant pathology was similar in both groups (13·9 versus 15·4 per cent; P = 0·532). The mean(s.d.) time to diagnose cancer or other significant pathology was 55·1(39·2) days in the consultant-led group compared with 57·4(33·6) days in the open access group (P = 0·514). The cost per patient was almost £105 more for patients in the consultant-led group.

Conclusion

Patients referred by the general practitioner with large bowel symptoms should go directly to a properly managed and staffed open access large bowel investigation unit. This would enable most patients to have their investigations completed at one hospital attendance.
Origin of symptoms in diverticular disease
Authors: Simpson J , Scholefield J H , Spiller R C
Published: August 2003

Background

A significant number of patients with colonic diverticula experience unexplained, recurrent, short-lived but often debilitating abdominal pain and alteration in bowel habit. Such patients account for many medical consultations every year but, as our understanding of the cause of their symptoms remains imperfect, treatment options are limited. This article reviews the possible mechanisms that may be responsible for the symptoms of diverticular disease.

Methods

Medline and Science Citation Index searches were performed to locate English language articles relating to colonic diverticula and symptoms published between January 1966 and July 2002. Manual cross-referencing was also performed and some historical articles were included.

Results and conclusion

Several theories now exist about the mechanisms underlying the symptoms of diverticular disease. Initial studies suggested that they may be due to alterations in the intracolonic pressure, extrapolating earlier thoughts on the likely pathogenesis of diverticula. It seems more likely, however, that several inter-related processes, such as muscular dysfunction, visceral hypersensitivity and inflammation, are involved in symptom generation.
Staging of rectal cancer
Authors: Wiggers T
Published: August 2003

Should be based on the next step in decision making
Options for sphincter preservation in surgery for low rectal cancer
Authors: Tytherleigh M G , Mortensen N J McC
Published: August 2003

Background

Abdominoperineal excision of the rectum with a permanent end-sigmoid colostomy was the classical operation for cancer of the distal third of the rectum. A number of factors have recently led to a more conservative approach, allowing sphincter preservation when excising tumours that are not invading the anal sphincter.

Methods

The review is based on the published literature of the treatment of low rectal cancers accessed by searching Medline and other online databases. It includes a description of all the surgical options currently available for low rectal tumours, and a discussion of the advantages and disadvantages of the types of anastomosis and reconstruction.

Results and conclusion

It is now technically possible to remove rectal cancer that is extending into the anal canal with preservation of the anal sphincter mechanism and with a satisfactory oncological outcome. Ultra-low colorectal and coloanal anastomosis, together with a colonic pouch or coloplasty, produces acceptable function in many patients. However, there is still controversy about the risk of tumour implantation, the place of downsizing neoadjuvant therapy, and true long-term functional outcome. Despite these concerns, surgeons should strive to perform rectal resection with sphincter preservation for low-lying rectal cancer whenever possible.
Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery (Br J Surg 2003; 90: 340-345)
Authors: Khoury G
Published: August 2003

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The relationship between total sialic acid levels and antioxidant status in the tadpoles of Bufo viridis and Rana ridibunda ridibunda
Authors: Çavaş Levent , Tarhan Leman
Published: August 2003

Total sialic acid levels (TSA), antioxidant enzymes activities such as superoxide dismutase (SOD), catalase (CAT) and lipid peroxidation (LPO) levels were investigated during the developmental period in tadpoles of the predominantly terrestrial amphibian B. viridis and the predominantly aquatic amphibian R. r. ridibunda. Maximum TSA levels were observed in B. viridis and R. r. ridibunda at the fifth and third week of their development, respectively. SOD and CAT activity variations during development in B. viridis were higher than in R. r. ridibunda. Although SOD activity in B. viridis was higher than R. r. ridibunda at the eighth week, SOD activity increased 19.2‐fold in R. r. ridibunda and 10.4‐fold in B. viridis between the first and eighth week. CAT activity in R. r. ridibunda did not significantly change (p > 0.001) until the fifth week then increased, whereas in B. viridis CAT increased after the third week. In contrast to the rise in the antioxidant enzyme activites, LPO levels tended to decrease during the developmental period. Levels of LPO showed a similar trend until the third week for both species. The minimum LPO levels in B. viridis and R. r. ridibunda were 23 ± 1.2 and 146 ± 7.3 nmol MDA g−1 tissue, at the eighth week, respectively. While decreasing LPO levels correlated with increasing antioxidant enzyme activities, TSA tended to decrease after reaching a maximum point. Copyright © 2003 John Wiley & Sons, Ltd.
A combination of alpha‐tocopherol, vitamin C and N‐acetyl cysteine increases unsaturated fatty acid levels in hydrogen peroxide‐induced Candida tropicalis (ATCC 13803)
Authors: Yılmaz Ökkeş , Çeli̇k Sait
Published: August 2003

This research was aimed at evaluating the antioxidant effects of combinations of alpha lipoic acid (LA), vitamin C (VC), N‐acetyl cysteine (NAC) and alpha‐tocopherol (TOC) on lipid level and fatty acid composition of C. tropicalis (ATCC 13803) against hydrogen peroxide toxicity. According to the experimental results, the cell density of C. tropicalis increased significantly in NAC + LA + H2O2, NAC + TOC + H2O2 and NAC + VC + H2O2 groups (p < 0.001) at the end of 48 and 72 h incubation times. The total lipid level in H2O2 and H2O2 + antioxidant‐supplemented groups was lower than that of the control group. In the fatty acid composition of C. tropicalis, the palmitic acid level was raised in the NAC group (p < 0.05), whereas its level was reduced in the other supplemented groups. While the oleic acid level increased in NAC + TOC + H2O2 and NAC + VC + H2O2 (p < 0.001) groups, its level slightly decreased in the H2O2 group. The linolenic acid level was low in all the supplemented groups, but linoleic acid and total mono‐unsaturated fatty acid (MUFA) levels were high in these groups compared with the control group. Total polyunsaturated fatty acid level (PUFA) decreased in NAC and H2O2 groups (p < 0.01), but its level increased in NAC + LA + H2O2 and NAC + TOC + H2O2 groups (respectively, p < 0.01, p < 0.001). Total saturated fatty acid level decreased significantly in NAC + TOC +  H2O2, NAC + H2O2 and NAC + VC + H2O2 (p < 0.001) groups (p < 0.01), whereas total unsaturated fatty acid level increased in NAC, NAC + H2O2, NAC + LA + H2O2, NAC + TOC + H2O2 and NAC + VC + H2O2 groups. In conclusion, our data showed that the levels of total unsaturated fatty acid, MUFA and PUFA were raised with the combinations of NAC and TOC, LA and VC in C. tropicalis cells subjected to hydrogen peroxide toxicity. Copyright © 2003 John Wiley & Sons, Ltd.
Changes in adenosine deaminase activity in ageing cultured human cells and the role of zinc
Authors: Ghneim H. K. , Al‐Saleh S. S. , Al‐Shammary F. J. , Kordee Z. S.
Published: August 2003

The level of adenosine deaminase ( ADA; EC 3.5.4.4 ) was estimated at different passages in six confluent fibroblast cultures established from forearm skin biopsies of healthy adult normal volunteers. After determination of the zinc concentration in standard growth medium, ADA activity was estimated at different passages of subculture in media with different zinc concentrations. The results indicated that the specific activity of ADA in control confluent skin fibroblast cultures (passage 2) cultivated in standard growth medium containing 15.4 μM zinc (similar to that present in normal human plasma) was equal to 226.6±19.64 μmol min−1 mg−1 protein. The results showed that there were no significant changes in ADA specific activity in any of the control cultures as the zinc concentration of the medium was increased. To characterize the passage of subculture at which fibroblasts enter the ageing phase, three marker enzymes were assayed namely, phosphofructokinase, lactate dehydrogenase and glycogen phosphorylase. The result showed that the cells enter the ageing phase at passage 20 and beyond. Further investigation showed that ADA activity of serially subcultured confluent cultures cultivated in standard growth medium significantly dropped at passages 20, 25 and 30. ADA activity however was not significantly altered in cells at passage 2, 10 and 15 cultivated in standard growth medium and in the presence of higher zinc levels ( 23.1, 34.6, 53.8 and 73.1 μM). Furthermore there was significant lowering of ADA activities in cells at passages 20, 25 and 30 when cells were cultured in the presence of 15.4, 23.1 and 34.6 μM zinc. Such lowered activities of ADA were restored to normal when the cells were cultured in the presence of higher zinc concentration equal to 53.8 and 73.1 μM. From the results we concluded that it is possible to restore ADA activity in aged skin fibroblasts to normal levels by raising the zinc concentration in the culture medium to four or five times the control normal plasma zinc level. Copyright © 2003 John Wiley & Sons, Ltd.
Effects of caffeic acid phenethyl ester and alpha‐tocopherol on reperfusion injury in rat brain
Authors: Irmak M. Kemal , Fadillioglu Ersin , Sogut Sadik , Erdogan Hasan , Gulec Mukaddes , Ozer Mustafa , Yagmurca Murat , Gozukara M. Engin
Published: August 2003

Oxygen‐derived free radicals have been implicated in the pathogenesis of cerebral injury after ischaemia–reperfusion. Caffeic acid phenethyl ester (CAPE), an active component of propolis extract, exhibits antioxidant properties. The purpose of the present study was to investigate the effects of ischaemia and subsequent reperfusion on rat brain and to investigate the effects of two free radical scavengers, CAPE and alpha‐tocopherol, on this in vivo model of cerebral injury. Ischaemia was induced by bilateral occlusion of the carotid arteries for 20 min and reperfusion was achieved by releasing the occlusion to restore the circulation for 20 min. Control rats underwent a sham operation. CAPE at 10 μ;mol kg−1 or alpha‐tocopherol at 25 μmol kg−1 was administered intraperitoneally before reperfusion. Reperfusion led to significant increase in the activity of xanthine oxidase and higher malondialdehyde levels in the brain. Acute administration of both CAPE and alpha‐tocopherol suppressed ischaemia–reperfusion‐induced cerebral lipid peroxidation and injury, but CAPE seems to offer a better therapeutic advantage over alpha‐tocopherol. Copyright © 2003 John Wiley & Sons, Ltd.
Antioxidant status and lipid peroxidation in type II diabetes mellitus
Authors: Memısoğullari Ramazan , Taysı Seyithan , Bakan Ebubekir , Capoglu Ilyas
Published: August 2003

Diabetes Mellitus (DM), a state of chronic hyperglycaemia, is a common disease affecting over 124 million individuals worldwide. In this study, erythrocyte glutathione levels, lipid peroxidation, superoxide dismutase, catalase, and glutathione peroxidase and some extracellular antioxidant protein levels of patients with type II diabetes mellitus and healthy controls were investigated. Thirty‐eight patients (21 males; with age of mean ± SD, 53.1 ± 9.7 years) and 18 clinically healthy subjects (10 males; with age of mean ± SD, 49.3 ± 15.2 years) were included in the study. Levels of erythrocyte lipid peroxidation, serum ceruloplasmin and glucose levels, HbA1C levels, and erythrocyte catalase activity were significantly increased, whereas serum albumin and transferrin levels, erythrocyte glutathione levels, and glutathione peroxidase activity were significantly decreased compared to those of controls. There was no significant difference in superoxide dismutase activity compared to controls. The results suggest that the antioxidant deficiency and excessive peroxide‐mediated damage may appear in non‐insulin dependent diabetes mellitus. Copyright © 2003 John Wiley & Sons, Ltd.
Messenger DNA in higher plants
Authors: Gahan Peter B.
Published: August 2003

Evidence is presented that, as in animal and human cells, plant cells can release a newly‐synthesized DNA which can freely circulate in the plants. This DNA enters cells and their nuclei where it may be integrated and be expressed so acting, apparently, as a messenger‐DNA. Copyright © 2003 John Wiley & Sons, Ltd.