bluuebunny/crossref_metadata_2025 huggingface dataset:
PDGF receptor as a specific in vivo target for low Mr phosphotyrosine protein phosphatase
Authors: Chiarugi Paola , Cirri Paolo , Raugei Giocanni , Camici Guido , Dolfi Fabrizio , Berti Andrea , Ramponi Giampietro
Published: July 2002

Low M
r phosphotyrosine protein phosphatase (LMWPTP) is a 18 kDa cytosolic enzyme widely distributed in eukaryotic cells. LMW‐PTP catalyses the hydrolysis of phosphotyrosine residues and overexpression of the enzyme in normal and transformed cells inhibits cell proliferation. Site directed mutagenesis, together with crystallographic studies, have contributed to clarify the catalytic mechanism, which involves the active site signature sequence C12XXXXXR18, a main feature of all PTPase family members. In order to identify the LMW‐PTP substratels we have expressed in NIH‐3T3 cells a catalytically inert Cys12 to Ser phosphatase mutant which has preserved its capacity for substrate binding. Overexpression of the mutant phosphatase leads to enhanced cell proliferation and serum induced mitogenesis, indicating that the mutation results in the production of a dominant negative protein. Analysis of mutant LMW‐PTP expressing cells has enabled us to demonstrate an association between LMW‐PTP and platelet derived growth factor receptor that appears to be highly specific. Our data suggest a catalytic action of LMW‐PTP on the phosphorylated platelet derived growth factor receptor.
Amino acid sequence and expression of the hepatic glycogen‐binding (GL‐subunit of protein phosphatase‐1
Authors: Doherty Martin J. , Moorhead Greg , Morrice Nick , Cohen Philip , Cohen Patricia T.W.
Published: July 2002

A full‐length cDNA encoding the putative hepatic glycogen‐binding (GL) subunit of protein phosphatase‐1 (PP1) was isolated from a rat liver library. The deduced amino acid sequence (284 residues, 32.6 kDa) was 23% identical (39% similar) to the N‐terminal region of the glycogen‐binding (GM) subunit of PP1 from striated muscle. The similarities between GM and GL were most striking between residues 63–86, 144–166 and 186–227 of human GM (∼40% identity), nearly all the identities with the putative yeast homologue GAC1 being located between 144–166 and 186–227. The cDNA was expressed in E. coli, and the expressed protein transformed the properties of PP1 to those characteristic of the hepatic glycogen‐associated enzyme. These experiments establish that the cloned protein is GL.
Cytochalasin D induces changes in cell shape and promotes in vitro chondrogenesis: A morphological study
Authors: Loty Sabine , Forest Nadine , Boulekbache Habib , Sautier Jean‐Michel
Published: July 2002

Summary— One of the initial events required for the expression of cartilage‐specific macromolecules in monolayer cultures is the reversion to the initial round shape of chondrocytes. Thus, considerable research efforts have focused on developing reliable procedures to maintain a round morphology of cultured chondrocytes. Our study focuses on evaluating the response of dedifferentiated fetal rat chondrocytes to cytochalasin D, an actin‐disrupting agent, with special emphasis on the morphological events. Immediately after exposure to the drug, cells round up but flatten again after removing the agent. However, immunocytochemical procedures revealed a disorganization of microfilaments and intermediate filaments. Phase‐contrast and scanning electron microscopic observations revealed that on day 6 of culture, cells located at the top of the cell layer adopted a spherical morphology. Prominent differences were noted in control cultures where cells had to aggregate prior to overt chondrogenesis. Transmission electron microscopy confirmed the round morphology of the cells situated at the top layer but also revealed the presence of cell contacts between the cells. In addition, cells located at the central part of the cell layer displayed a typical morphology of mature chondrocytes, separated by an extensive extracellular matrix. These morphological changes occurred parallel to the expression of type II collagen and chondroitin sulfate, both hallmarks of the chondrocyte phenotype strong in experimental cultures, relatively weak in control cultures, and only restricted on areas of polygonal cellular aggregates. Furthermore, [35S]‐sulfate incorporation into sulfated glycosaminoglycans increased rapidly with the period of culture to a maximum after 7 days and was then two‐fold in treated cultures. Taken together, these findings indicated that cytochalasin D stimulates chondrogenesis in response to modification of cytoskeleton architecture and the subsequent rounding up of the cells.
International Diversification for the Individual
Authors: Madura Jeff , O’Brien Thomas J.
Published: July 2002

Thispaper reviews aspects ofthe literature on international investing that should be of interest to individual investors. Three modern issues are covered: (I) the bene$ts of international diversij- cation as the global markets continue to integrate; (2) the problem of currency exposure; and (3) effective means of achieving international diversijcation. Strategies are discussed which enable the individual to apply suggestions from the research. By restricting the scope of the review to issues of most interest to the individual, we do not review research on international asset pricing theory and international market eficiency and “anomalies.”
Abstracts of Articles on Individual Financial Management
Authors: Myers Phyllis Schiller
Published: July 2002

NA
Index
Authors: Mandell Lewis
Published: July 2002

NA
An Empirical Analysis of the Use of Money Orders, the Payment System of the Poor
Authors: Daniels Kenneth N. , Murphy Neil B. , O’Toole Dennis M.
Published: July 2002

Although money orders hove been available in the United States since the Civil War, until the mid 1970’s and thefailure of United States ~avigatioa Company and ~m’versa~Money Orders, there had been little analysis of the money order market. This study emperically investigates the determinants of moneyorder usage by household. The results of the study, which utilizes two large national samples, indicate that money orders are clearly an inferior good which have a high probability of being purchased by a low income, young, ethnic minority.
A Practitioner’s Perspective
Authors: Poole Barbara S.
Published: July 2002

NA
Kinetics of the Pectin Methylesterase Catalyzed De‐Esterification of Pectin in Frozen Food Model Systems
Authors: Terefe Netsanet Shiferaw , Hendrickx Marc
Published: July 2002

The pectin methylesterase (PME) catalyzed de‐esterification of pectin was studied in four frozen food model systems based on sucrose, fructose, maltodextrin, and carboxymethylcellulose (CMC) in a temperature range from –24 to 20 °C, with the aim of elucidating the applicability of the theory of “food polymer science” on the kinetics. The rate substantially decreased around the glass transition temperature in the case of CMC, while very low rates were observed far above the glass transition temperature in the case of maltodextrin, fructose, and sucrose model systems. In general, the kinetics of this reaction was found to be influenced more by factors such as the characteristics of the component solutes, freeze concentration, the possible viscosity enhancement due to a particular combination of solutes, and the molecular size of the substrate molecule rather than the glass transition process. The Arrhenius equation described the temperature dependence of kinetics both in the liquid state of all the systems studied ( r2 ≥ 0.97) and the glassy state of CMC ( r2 = 0.95). A clear break in the Arrhenius plot was observed as the temperature decreased to subfreezing temperatures. The Arrhenius equation could describe the kinetics reasonably well in the rubbery state for fructose and sucrose model systems ( r2 > 0.992). In the case of maltodextrin and CMC, the Arrhenius plots showed a slight curvature followed by a break at the glass transition temperature for CMC. The WLF equation with system‐dependent coefficients better described the kinetics in the rubbery state of the CMC and part of the maltodextrin system. A linear relationship between the logarithm of the rate and T – Tg′ described the kinetics in the sucrose as well as fructose model systems ( r2 = 0.9928 and 0.993, respectively).
Bioreactor Strategies for the Treatment of Growth‐Inhibitory Waste: An Analysis of Thiodiglycol Degradation, the Main Hydrolysis Product of Sulfur Mustard
Authors: Lee Tsu‐shun , Pham Minh Q. , Weigand William A. , Harvey Steven P. , Bentley William E.
Published: July 2002

The microbial degradation of thiodiglycol, the primary hydrolysis product of sulfur mustard, by a pure culture of Alcaligenes xylosoxydans ssp. xylosoxydans (SH91) was accomplished in laboratory scale stirred tank reactors. This is a major component of the overall biodegradation process proposed for the complete mineralization of sulfur mustard. Several configurations were evaluated for degradation efficiency including batch, repeated batch, continuous stirred tank reactor (CSTR), and two‐stage series CSTR. The repeated batch reactor provided the highest degradation rate of thiodiglycol. Further, this method degraded thiodiglycol in the liquid broth to below the detection limits (0.03 mM). Both batch and repeated batch experiments were simulated by an unstructured mathematical model. Simulation results were in agreement with the experimental data, particularly at low TDG concentration (around 30 mM). This study demonstrates the degradation of thiodiglycol using bioreactors and, more generally, is an experimental study of bioreactor designs for the degradation of growth‐inhibitory substances.
Design of Affinity Tags for One‐Step Protein Purification from Immobilized Zinc Columns
Authors: Pasquinelli Richard S. , Shepherd Rex E. , Koepsel Richard R. , Zhao Adam , Ataai Mohammad M.
Published: July 2002

Affinity tags are often used to accomplish recombinant protein purification using immobilized metal affinity chromatography. Success of the tag depends on the chelated metal used and the elution profile of the host cell proteins. Zn(II)‐iminodiacetic acid (Zn(II)‐IDA) may prove to be superior to either immobilized copper or nickel as a result of its relatively low binding affinity for cellular proteins. For example, almost all Escherichia coli proteins elute from Zn(II)‐IDA columns between pH 7.5 and 7.0 with very little cellular protein emerging at pH values lower than 7.0. Thus, a large portion of the Zn(II)‐IDA elution profile may be free of contaminant proteins, which can be exploited for one‐step purification of a target protein from raw cell extract. In this paper we have identified several fusion tags that can direct the elution of the target protein to the low background region of the Zn(II)‐IDA elution profile. These tags allow targeting of proteins to different regions of the elution profile, facilitating purification under mild conditions.
Pediatric kidney transplantation: Historic hallmarks and a personal perspective
Authors: Papalois Vassilios E. , Najarian John S.
Published: July 2002

Abstract: Over the last five decades, pediatric kidney transplantation (Tx) has proved to be a viable therapeutic alternative for children with end‐stage renal disease. Patient and graft survival rates, as well as long‐term quality of life, have improved dramatically during this time, as a result of advances in surgical techniques, immunosuppression, and pre‐ and post‐operative care. The inspired, hard work of multi‐disciplinary clinical teams, combined with the determination and courage of the young patients and their families, have fueled the success of pediatric kidney Tx. It is with similar optimism and drive that we face the great challenges of the future, such as maximizing the donor pool and inducing tolerance.
HIV-1 Tat-associated RNA polymerase C-terminal domain kinase, CDK2, phosphorylates CDK7 and stimulates Tat-mediated transcription
Authors: NEKHAI Sergei , ZHOU Meisheng , FERNANDEZ Anne , LANE William S. , LAMB Ned J.C. , BRADY John , KUMAR Ajit
Published: July 2002

HIV-1 gene expression is regulated by a viral transactivator protein (Tat) which induces transcriptional elongation of HIV-1 long tandem repeat (LTR). This induction requires hyperphosphorylation of the C-terminal domain (CTD) repeats of RNA polymerase II (Pol II). To achieve CTD hyperphosphorylation, Tat stimulates CTD kinases associated with general transcription factors of the promoter complex, specifically TFIIH-associated CDK7 and positive transcription factor b-associated CDK9 (cyclin-dependent kinase 9). Other studies indicate that Tat may bind an additional CTD kinase that regulates the target-specific phosphorylation of RNA Pol II CTD. We previously reported that Tat-associated T-cell-derived kinase (TTK), purified from human primary T-cells, stimulates Tat-dependent transcription of HIV-1 LTR in vivo [Nekhai, Shukla, Fernandez, Kumar and Lamb (2000) Virology 266, 246–256]. In the work presented here, we characterized the components of TTK by biochemical fractionation and the function of TTK in transcription assays in vitro. TTK uniquely co-purified with CDK2 and not with either CDK9 or CDK7. Tat induced the TTK-associated CDK2 kinase to phosphorylate CTD, specifically at Ser-2 residues. The TTK fraction restored Tat-mediated transcription activation of HIV-1 LTR in a HeLa nuclear extract immunodepleted of CDK9, but not in the HeLa nuclear extract double-depleted of CDK9 and CDK7. Direct microinjection of the TTK fraction augmented Tat transactivation of HIV-1 LTR in human primary HS68 fibroblasts. The results argue that TTK-associated CDK2 may function to maintain target-specific phosphorylation of RNA Pol II that is essential for Tat transactivation of HIV-1 promoter. They are also consistent with the observed cell-cycle-specific induction of viral gene transactivation.
Lower limb ischaemia–reperfusion injury causes endotoxaemia and endogenous antiendotoxin antibody consumption but not bacterial translocation
Authors: Yassin M M I , Barros D'Sa A A B , Parks T G , Soong C V , Halliday M I , Mccaigue M D , Erwin P J , Rowlands B J
Published: July 2002

Background

It has been suggested that reperfusion of the acutely ischaemic lower limb alters gut permeability. The effect of lower limb ischaemia–reperfusion on systemic endotoxin and antiendotoxin antibody concentrations and the incidence of bacterial translocation was investigated.

Methods

Systemic endotoxin and antiendotoxin antibody concentrations were measured in five groups of male Wistar rats: control, after 3 h of bilateral hind limb ischaemia alone, and after 3 h of bilateral hind limb ischaemia followed by 1, 2 or 3 h of reperfusion. A second experiment examined translocation of indigenous bacteria following 2 h of reperfusion in a similar model.

Results

Ischaemia followed by reperfusion for 1, 2 or 3 h caused a significant increase in plasma endotoxin concentration to mean(s.e.m.) 10·0(3·0), 44·8(19·2) and 20·2(6·2) pg/ml compared with that in control animals (2·58(0·91) pg/ml) or animals in the ischaemia alone group (1·2(0·9) pg/ml) (P < 0·05). This was associated with a significant reduction in endogenous antiendotoxin antibody (immunoglobulin (Ig) G and IgM) concentration. No significant bacterial translocation was detected in any of the groups studied.

Conclusion

These results demonstrate that a remote and isolated ischaemia–reperfusion injury to the lower limb, in the absence of infection or bacterial translocation, causes endotoxaemia. Further studies are needed to evaluate the role of endogenous antiendotoxin antibodies in this situation.
Digest
Authors: Herfarth C , Lehnert T
Published: July 2002

For this quarter's digest, Professor Christian Herfarth and Dr Thomas Lehnert have selected the best from the January to March 1998 issues of Der Chirurg. A digest for the BJS for the same period, written by Mr Colin Johnson, appears in the German journal.
Combining the strength–duration curve of the external anal sphincter with manometry for the assessment of faecal incontinence
Authors: Monk D N , Mills P , Jeacock J , Deakin M , Cowie A , Kiff E S
Published: July 2002

Background

The strength–duration curve of a muscle is thought to be a measure of its innervation. This study was designed to evaluate the ability of the strength–duration curve of the external anal sphincter to discriminate between controls and patients with faecal incontinence.

Methods

Forty-three women with faecal incontinence due to sphincter weakness were studied together with 45 age-matched women with no disorders of defaecation. Strength–duration curves of the external anal sphincter and anorectal manometry were recorded for all subjects with the additional measurement of pudendal nerve terminal motor latency in the incontinent group.

Results

Logistic regression was performed using resting and voluntary squeeze pressures and current strengths at 28 different pulse durations to develop a predictive equation for incontinence. Only currents at 1 and 6 ms were significant predictors. When anorectal manometry data were included, only the current required to elicit contraction at 1 ms was necessary. The following regression equation can be applied to predict continence in this population with a sensitivity of 95 per cent and a specificity of 100 per cent: logit(P) = 4·1605 − (0·0559 × squeeze pressure) − (0·1755 × resting pressure) + 0·8622I1 ms. A negative value indicates continence.

Conclusion

The strength–duration curve, when used in conjunction with anorectal manometry, may have a role in the investigation of faecal incontinence.
Early ascorbic acid depletion is related to the severity of acute pancreatitis
Authors: Bonham M J D , Abu-Zidan F M , Simovic M O , Sluis K B , Wilkinson A , Winterbourn C C , Windsor J A
Published: July 2002

Background

Ascorbic acid (AA) is an important endogenous antioxidant in plasma and has been shown to be decreased at the time of hospital admission in patients with acute pancreatitis. The aim of this study was to determine whether plasma AA concentration continues to decrease after admission and whether the extent of decrease is related to the severity of pancreatitis.

Methods

Consecutive patients with mild (n = 62) and severe (n = 23) acute pancreatitis had plasma AA concentration measured on the day of recruitment and on days 2 and 5 by high-performance liquid chromatography.

Results

The plasma AA concentration in patients with acute pancreatitis was significantly less than that in normal volunteers on days 0, 2 and 5 (P < 0·0001) and this was more marked in those with severe disease. There was a decrease in plasma AA concentration from day 0 to day 2 in patients with mild (P < 0·0001) and severe (P = 0·0005) pancreatitis, and from day 2 to day 5 in patients with severe pancreatitis (P = 0·023).

Conclusion

Endogenous plasma AA continues to decrease over the first 5 days in hospital and the extent is related to the severity of acute pancreatitis.

Presented to a meeting of the Australasian Surgical Research Society, Auckland, New Zealand, August 1995 and published in abstract form as Aust N Z J Surg 1996; 66: 243
Prevalence of aortic aneurysm in men with a history of inguinal hernia repair
Authors: Pleumeekers H J C M , de Gruijl A , Hofman A , van Beek A J , Hoes A W
Published: July 2002

Background

Population-based screening for abdominal aortic aneurysm (AAA) is still a subject of debate. This study examined whether subjects with a history of inguinal hernia were at increased risk sufficient to justify screening.

Methods

The prevalence of AAA was documented in 156 men aged 55 years and older, discharged after inguinal hernia surgery, and compared with the prevalence in 1771 men without a history of inguinal hernia who were participating in a screening survey for AAA. The influence of age and smoking status was assessed.

Results

The prevalence of AAA in men with a history of inguinal hernia was 12·2 (95 per cent confidence interval (c.i.) 7·0–17·4) per cent and 3·7 (95 per cent c.i. 2·8–4·6) per cent in those without such a history; prevalence ratio 3·3 (95 per cent c.i. 2·0–5·3). In current smokers the prevalence of abdominal aneurysm was 4·2 (95 per cent c.i. 2·1–8·2) times higher in those with compared with those without a history of inguinal hernia. In non-smokers the prevalence ratio was 1·9 (95 per cent c.i. 0·5–7·0).

Conclusion

Men with a history of inguinal hernia are at increased risk of AAA, most notably if they are cigarette smokers. Ultrasonographic screening could be considered before operation for inguinal hernia.
Postoperative outcome and sites of recurrence in patients following curative resection of gastric cancer
Authors: Maehara Y , Hasuda S , Koga T , Tokunaga E , Kakeji Y , Sugimachi K
Published: July 2002

Background

Recurrence occurs in a variety of forms and in different organs after ‘curative resection’ of gastric cancer. This study investigated the postoperative prognosis for each type of recurrence.

Methods

From 1969 to 1988, 939 patients with gastric cancer underwent curative resection; data on 130 of 207 patients who died with recurrence were analysed. Attention was focused on the site of recurrence and the postoperative outcome.

Results

Haematogenous recurrence was evident in 54 per cent (70 of 130 patients), peritoneal recurrence in 43 per cent (56 of 130), lymph node recurrence in 12 per cent (16 of 130) and local recurrence in 22 per cent (29 of 130). Thirty-three patients (25 per cent) had recurrences at multiple sites. Peritoneal and local recurrences were related to infiltrative growth, in contrast to haematogenous and lymphatic recurrences. There were no statistical differences in survival time among each type of recurrence and survival was not related to the number of sites of recurrence. Survival did not depend on factors of sex, age, tumour location, tumour size, depth of invasion, tissue differentiation, histological growth pattern, lymphatic and vascular involvement, lymph node metastasis and extent of lymph node dissection.

Conclusion

The clinicopathological characteristics of gastric cancer determine the type of recurrence, although the clinical outcome is the same for each type of tumour and is not related to the number of sites of recurrence.
Relationship of carotenoid and vitamins A and E with the acute inflammatory response in acute pancreatitis
Authors: Curran F J M , Sattar N , Talwar D , Baxter J N , Imrie C W
Published: July 2002

Background

Inflammation and oxidative stress are believed to be important in the development of the systemic complications of acute pancreatitis. The fat-soluble vitamins A and E, and the carotenoids have antioxidant properties. The aim of this study was to assess the effect of acute pancreatitis on serum concentrations of vitamin antioxidants and to relate such changes to the degree of the inflammatory response.

Methods

Thirteen consecutive patients with predicted severe acute pancreatitis were compared with 26 matched healthy controls. Five patients developed severe acute pancreatitis and three of these died. Vitamin antioxidant and C-reactive protein (CRP) levels were measured daily for up to 7 days.

Results

Patients had significantly lower levels of antioxidants throughout the course of the study (P < 0·017). In patients there was a significant correlation between peak CRP and trough antioxidant levels (P < 0·01). In patients with mild acute pancreatitis, the concentrations of retinol and β-carotene at final review were significantly higher than those in patients with severe acute pancreatitis (P < 0·05). This coincided with a reduction in CRP level.

Conclusion

In acute pancreatitis, circulating concentrations of vitamin antioxidants are reduced and are inversely related to the rise in CRP level.
Increase in the incidence of oesophagogastric carcinoma in the South Thames region: an epidemiological study
Authors: Kocher H M , Patel S , Linklater K , Ellul J P M
Published: July 2002

Aims

There is some evidence to indicate that the incidence of gastric and oesophageal carcinoma is changing rapidly in the West. However, to study the true magnitude of the problem (to help in planning health and cancer strategies over the next decades), this epidemiological study was performed.

Methods

The Thames Cancer Registry database for the years 1960–1995 was searched for all oesophageal and gastric cancers in the South Thames region, and was analysed for all subsites for both sexes separately. Statistical analysis using the age-standardized ratio (ASR) (world) and χ2 test for trend for each subgroup was performed.

Results

The overall incidence of carcinoma of the oesophagus for both sexes saw a marked rise in the period studied, while the overall incidence of gastric cancer fell. In the upper two-thirds of the oesophagus, the increase in incidence was more dramatic for women (from 0·30 in 1960 to 0·70 in 1996; χ2trend = 18·7, P = 0·00015) than men (from 0·59 in 1960 to 1·09 in 1996; χ2trend = 4·4, P = 0·0354). In the lower third of the oesophagus, there was a rise in men (ASR from 0·93 in 1960 to 3·43 in 1996; χ2trend = 466·3, P < 0·0001) as well as in women (ASR from 0·42 in 1960 to 0·91 in 1996; χ2trend = 51·4, P < 0·0001). For the gastric cardia, the incidence in men increased (ASR from 1·24 in 1960 to 2·41 in 1996; χ2trend = 109·8, P < 0·0001), while in women it remained unchanged (ASR from 0·33 in 1960 to 0·55 in 1996; χ2trend = 0·0, P = 0·8281). The incidence of distal gastric carcinoma has decreased in men (ASR from 2·47 in 1980 to 0·63 in 1996; χ2trend = 264·7, P < 0·0001) and women (from 1·14 in 1980 to 0·43 in 1996, χ2trend = 131·8, P < 0·0001). For cancers of other subsites of the stomach (fundus, lesser and greater curvature, and body), there was a fall in incidence in both sexes.

Conclusions

There has been a twofold to threefold increase over 36 years in the incidence of cancer of the oesophagogastric junction with a decreasing incidence in the distal stomach. There was also an increase in the incidence of upper oesophageal cancers, and a decrease in the incidence of cancers of other subsites of the stomach. Studies to cope with this increase and resources to cope with the treatment of these patients are required.
Biliary complications associated with laparoscopic cholecystectomy: analysis of common misconceptions
Authors: Bingham J , McKie L D , McLoughlin J , Diamond T
Published: July 2002

Aims

General surgeons often express the view that the majority of biliary complications following laparoscopic cholecystectomy are caused by trainee surgeons; complications occur most often in the presence of difficult anatomy or pathology; biliary injuries occur more proximally in the biliary tree than at open cholecystectomy; most injuries are recognized at the time of surgery; and most complications can be managed non-operatively. The aim of this study was to determine if these views are substantiated in clinical practice.

Methods

Thirty consecutive patients were referred to a specialist hepatobiliary unit over a 7-year period with biliary complications following laparoscopic cholecystectomy. The mode of presentation, management and outcome of these patients were analysed.

Results

In 21 cases the initial operator was a consultant. Four of the 30 complications occurred in the presence of an anatomical variation or unusually difficult pathology. Only patients in whom a previous attempt at repair had been made had injuries at or proximal to the bile duct confluence; the only two deaths occurred in this group. Only 41 per cent of injuries were detected at the time of surgery and 89 per cent required further surgical intervention, hepaticojejunostomy being the most common procedure performed (75 per cent).

Conclusions

The majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy or pathology, do not occur in the proximal biliary tree, are not recognized at the time of the initial operation and often require major reconstructive procedures for their management.
Pattern of recurrence following subtotal oesophagectomy with two field lymphadenectomy
Authors: Dresner S M , Wayman J , Shenfine J , Harris A , Hayes N , Griffin S M
Published: July 2002

Aims

Despite increasingly radical surgery for oesophageal cancer many patients continue to represent with recurrent disease. This study aimed to evaluate the pattern of failure following attempted curative oesophagectomy with mediastinal and upper abdominal lymphadenectomy.

Methods

Some 212 consecutive patients undergoing R0 resection for malignancy between 1 April 1990 and 1 April 1999 were followed up for evidence of recurrence. Clinical evaluation was supported by ultrasonography, computed tomography, isotope scan, endoscopy and laparotomy with biopsy assessment if appropriate. Patients were excluded if recurrence was diagnosed on clinical grounds alone. Statistical analysis was performed using χ2 and log rank tests.

Results

Some 142 patients with adenocarcinoma and 70 with squamous carcinoma (SCC) were followed up for a median of 14 (range 1–108) months. Sex and age distribution were similar for both histological subtypes (men: women 3: 1; median age 64 (30–79) years). Twenty patients died from non-cancer related causes, including 11 (5 per cent) from postoperative complications. Some 89 patients (42 per cent) developed proven recurrent disease of which seven are alive and 82 dead. The median time to recurrence was 11 (2–40) months with a median time to death thereafter of 3 (1–21) months. The pattern of recurrence was locoregional in 23 per cent (oesophageal bed 15 per cent, upper abdominal 3 per cent, upper mediastinal 3 per cent, cervical 2 per cent) and haematogenous in 18 per cent (comprising liver 8 per cent, bone 4 per cent, cerebral 3 per cent, lung 2 per cent, skin 1 per cent) with peritoneal dissemination in 1 per cent. While there was no difference in the overall pattern of dissemination for each histological subtype, the incidence of cervical and upper mediastinal recurrence was significantly higher for adenocarcinoma compared with SCC (χ2 = 5·9, 1 d.f., P < 0·02). The timing of recurrence was similar for both histological subtypes: 60 per cent of all recurrence occurred within 12 months of surgery, with distant and locoregional recurrence occurring at a median of 10 (2–40) and 11 (2–32) months respectively.

Conclusions

The low incidence of upper mediastinal and cervical recurrence suggests that more extensive lymphadenectomy is unlikely to impact upon survival. Improved staging modalities are required to identify the significant number of patients who develop early recurrence in the first year following surgery in order to offer them multimodality therapies of non-surgical palliation.
Prognostic value of quality of life scores in patients with oesophageal cancer
Authors: Blazeby J M , Brookes S T , Alderson D
Published: July 2002

Aims

Quality of life (QL) data are useful in evaluating treatment, in screening or psychosocial morbidity and there is accumulating evidence to show that they predict survival. This study investigated if baseline QL scores are prognostic for patients with oesophageal cancer.

Methods

Between 1993 and 1995, 89 consecutive new patients with oesophageal cancer completed baseline QL assessments with the EORTC QLQ-C30 questionnaire and the dysphagia scale from the oesophageal cancer module. Cox's proportional hazards models were used to assess the impact of QL variables on survival (82 patients have died).

Results

Univariate analyses revealed that better baseline physical and role function scores were significantly associated with increased survival (P ≤ 0·001) and worse fatigue, appetite loss and constipation scores were significantly associated with shorter survival (P < 0·01). Multivariate analysis, taking account of associations between the QL scores and adjusting for age, tumour node metastasis classification T, N and M stage, showed that only physical function at baseline remained significantly associated with survival (P = 0·002); adjusting for sex, histology and comorbid disease did not alter the findings.

Conclusions

There is evidence to suggest that QL parameters may be important prognostic factors for patients with oesophageal cancer. Stronger evidence may be gained from a more highly powered study, and further understanding of the associations between QL variables and clinical data is needed.
Changing patterns in the management of gastric volvulus over 14 years
Authors: Teague W J , Ackroyd R , Watson D I , Devitt P G
Published: July 2002

Background

Gastric volvulus is an uncommon condition, which can be difficult to diagnose and treat. This study represents a large series of patients with the condition.

Methods

All patients presenting with gastric volvulus over a 14-year period were reviewed.

Results

Some 36 patients (median age 75 years) were identified. Volvulus, usually secondary to a hiatus hernia, presented acutely in 29 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal haemorrhage. The most useful investigations were barium contrast studies and upper gastrointestinal endoscopy, which were helpful in 21 of 25 and 11 of 18 patients respectively. Treatment was conservative in five patients, by open surgery in 13 and laparoscopic repair in 18 (three converted to open operation). There were no major complications and no deaths. Median hospital stay was shorter in patients treated by laparoscopic rather than open surgery (6 (range 4–36) versus 14 (7–50) days; P < 0·05).

Conclusion

Acute and chronic gastric volvulus can be treated successfully by either open or laparoscopic surgery. However, laparoscopic surgery now represents a safe and acceptable approach, with minimal morbidity and a significantly shorter hospital stay. This is likely to be of considerable benefit for the treatment of a predominantly elderly population, often with significant co-morbidity.
Carotid duplex imaging: variation and validation
Authors: Perkins J M T , Galland R B , Simmons M J , Magee T R
Published: July 2002

Background

Duplex imaging is increasingly used as the only investigation before carotid endarterectomy, but many different criteria exist in the literature for the detection of a severe (70–99 per cent) carotid stenosis. This study aimed to investigate current practice in carotid duplex imaging in Great Britain and Ireland.

Methods

A postal questionnaire was sent to 86 vascular surgical units.

Results

The median number of scans performed per year was 450 (range 60–4500). Thirty-six per cent of units who responded used peak systolic: end diastolic velocity ratio to calculate carotid stenosis. Overall, nine different major duplex criteria were used to grade carotid stenosis in 14 different systems of percentage bands. Only 51 per cent of units verified their duplex criteria against angiography. Eighteen per cent of units used two or more different types of duplex scanner and applied the same diagnostic criteria to each machine.

Conclusion

A wide variation in diagnostic duplex criteria and methods of grading stenosis exists among vascular units. Internal validation is not performed routinely. Standardization of duplex criteria would ensure greater consistency, but would not replace the need for validation of results within each unit.
Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy
Authors: Takano S , Ito Y , Watanabe Y , Yokoyama T , Kubota N , Iwai S
Published: July 2002

Background

Pancreaticogastrostomy (PG) after pancreaticoduodenectomy has been reported to have a lower incidence of pancreatic fistula than pancreaticojejunostomy (PJ) but this was not confirmed in a recent prospective randomized study.

Methods

Different methods of reconstruction after pancreaticoduodenectomy were used between January 1994 and January 1999 in two university-affiliated hospitals, PJ (n = 69) in one hospital and PG (n = 73) in the other. Operations at both hospitals were performed by the same surgical team. All pancreatic anastomoses were carried out in two layers with pancreatic duct stents. Pancreatic fistula was identified by the presence of more than 1000 units/l of amylase-rich fluid in the drains 7 days or more after operation, by radiography from the pancreatic duct stent and by water-soluble contrast upper gastrointestinal studies.

Results

The two groups of patients were similar in terms of age, sex, findings at preoperative assessment, disease status, operative time, intraoperative blood loss and nature of non-tumorous pancreatic tissue. The amylase level in ascites at 7 days after operation was significantly lower after PG than PJ (P = 0·032). The incidence of pancreatic fistula in the PG group (zero) was significantly less than that after PJ (13 per cent) (P = 0·014). Intra-abdominal haemorrhage and intra-abdominal abscess occurred in three (4 per cent) and four patients (6 per cent) respectively, with two hospital deaths (3 per cent) in the PJ group, but these complications did not occur after PG.

Conclusion

This controlled clinical study supports the hypothesis that PG is safer than PJ, particularly with regard to the incidence of pancreatic fistula.
Ruptured abdominal aortic aneurysm: difference in selection criteria for surgery between vascular surgeons in district general and teaching hospitals
Authors: Dimitri S , Bakran A
Published: July 2002

Background

This audit was devised in order to examine outcome following presentation with ruptured abdominal aortic aneurysm (AAA) in one Deanery. Identification of differences in practice and outcome were sought.

Methods

Some 18 consultant vascular surgeons in eight district general hospitals (DGHs) and one university hospital (UH) participated in a prospective audit of ruptured AAA from March 1997 to February 1998.

Results

Some 159 patients were included in the audit. Outcome is shown in the Table below.

There was no difference in operative mortality rate between the UH and DGHs nor was there an increased mortality rate in the group of patients transferred from hospital to hospital despite the time delay incurred. In 47 patients admitted to the UH serum creatinine was the only laboratory test which correlated with outcome.

Conclusion

This audit clearly highlighted the differing attitude to selection of patients for surgery between the vascular surgeons in the UH and DGHs, although there was no overall statistical difference in outcome.
Influence of sex on the outcome of ruptured abdominal aortic aneurysm
Authors: Norman P
Published: July 2002

Background

Mortality rates from ruptured abdominal aortic aneurysm (AAA) in men and women were compared.

Methods

Patients were identified from a population-based database using the relevant ICD-9-CM codes and were divided into three groups for analysis: those dying without admission to hospital, those admitted to hospital with ruptured AAA but not undergoing surgery, and those who underwent surgery for ruptured AAA.

Results

Ruptured AAA occurred in 648 men and 225 women over the age of 55 years during the decade 1985–1994. The proportion of women increased with age from 13·8 per cent for those aged 60–69 years, to 42·3 per cent for those over 80 years of age. Only 49·7 per cent of women (112 of 225), compared with 58·9 per cent of men (382 of 648), with ruptured AAA were admitted to hospital (χ2 = 5·35, P = 0·02). Of those admitted to hospital, only 36·6 per cent of women (41 of 112) underwent surgery compared with 63·3 per cent of men (242 of 382) (χ2 = 8·71, P = 0·003). The mortality rate in women undergoing surgery was 44 per cent (18 of 41) compared with 34·7 per cent (84 of 242) in men (χ2 = 5·35, P = 0·021). The overall mortality rate from ruptured AAA was 89·8 per cent in women (202 of 225) and 75·6 per cent in men (490 of 648) (χ2 = 50·34, P < 0·0001). Although women were on average older than men, age-specific analysis showed that this unfavourable pattern occurred in all age groups.

Conclusion

Women with ruptured AAA are more likely to die than men. The cause of the poor outcome in women is unclear but may be due to the use of thresholds for intervention that are based on aortic diameters in men.
Differential expansion rates of small abdominal aortic aneurysms between the apolipoprotein E genotypes
Authors: Lindholt J S , Gerdes L U , Vammen S , Henneberg D W , Fasting H
Published: July 2002

Background

Carriers of the E4 allele for the gene encoding apolipoprotein E (apoE) have an increased risk of atherosclerosis. The distribution of apoE genotypes among men with a small abdominal aortic aneurysm (AAA) was compared with that among healthy men, and any differences between the genotypes in aneurysm expansion measured over 2–4·5 years were examined.

Methods

The patients originate from a population ultrasonographic screening programme with about 4800 participating 65–73-year-old men in a defined geographical region. Of 191 patients diagnosed, 57 of 77 who have been followed for 2 years or more were genotyped. Aneurysm expansion rates were determined from linear regression of diameter versus time of examination. The influence of apoE genotype on expansion rate was analysed using analysis of variance, with initial aneurysm size and smoking status as covariates.

Results

The E4E4 genotype was not seen among patients with an AAA, whereas three patients had the rare E2E4 genotype. These patients had higher expansion rates than patients with the common genotype E3E3 (P = 0·009), whereas patients with the genotype E3E4 had lower rates (P = 0·034) (see Table over).

Conclusion

The findings suggest that the common polymorphism of the apoE gene influences the prognosis in patients with a small AAA. As regards the E3E4 genotype, the findings are unexpected, when compared with the known influence of E4 on the risk of atherosclerosis. This may partly explain the familial tendency of AAA, and inconsistent finding of coexisting atherosclerosis in patients with AAA. However, an impact of selection bias, due to differential survival or referral to surgery of patients with AAA, cannot be excluded.
Risk factors for aneurysm rupture: results from the UK small aneurysm study and trial
Authors: Greenhalgh R M , Brown L C , Powell J T
Published: July 2002

Background

The UK Small Aneurysm Trial has shown that ultrasonographic surveillance is a safe management option for patients with small abdominal aortic aneurysms (4·0–5·5 cm in diameter), with an annual rupture rate of 1 per cent. In this study risk factors associated with aneurysm rupture have been investigated using both patients randomized into the UK Small Aneurysm Trial and those monitored for aneurysm growth in the associated study.

Methods

The cohort of patients included 1090 from the trial and 1167 from the associated study. In this cohort of 2257 patients (79 per cent men), aged 59–77 years, 103 instances of abdominal aortic aneurysm rupture were identified during the 7-year follow-up (1991–1998). The relationship between rupture and ten prespecified risk factors (including age, sex, aneurysm diameter, smoking status, plasma cholesterol, lung function and ankle: brachial pressure index) was investigated using Kaplan–Meier survival and Cox regression analysis.

Results

Almost all patients (98 per cent) had initial aneurysm diameters in the range 3–6 cm and the majority of ruptures (76 per cent) occurred in patients with aneurysms known to be larger than 5 cm in diameter. Kaplan–Meier survival and Cox regression analysis were used to identify baseline risk factors associated with aneurysm rupture. After 3 years, the annual rate of aneurysm rupture was 2·2 (95 per cent confidence interval 1·7–2·8) per cent. The risk of rupture was independently and significantly associated with female sex (P < 0·001), larger initial aneurysm diameter (P < 0·001), lower FEV1 (P = 0·004), current smoking (P = 0·01) and higher mean blood pressure (P = 0·01). Age, body mass index, serum cholesterol concentration and ankle: brachial pressure index were not associated with an increased risk of aneurysm rupture.

Conclusion

Within this cohort of patients women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.
Protease expression in human aneurysmal and occlusive atherosclerotic aortas
Authors: Carrell T W G , Smith A , Burnand K G
Published: July 2002

Background

Atherosclerosis is implicated in the pathogenesis of abdominal aortic aneurysm (AAA), yet often causes aortic occlusive disease (AOD). Proteolysis of elastin and collagen, the major structural proteins of the aortic wall, must occur for an aneurysm to dilate. The matrix metalloproteinases (MMPs) are a class of enzymes that degrade elastin and collagen in the extracellular matrix and are believed to play a central role in the pathogenesis of AAA. However, some MMPs have also been found in atherosclerotic occlusive disease, in the absence of dilating disease. Differences in the expression of MMPs may determine whether an atherosclerotic aorta dilates or occludes. The expression of MMPs and their natural inhibitors (TIMPs) in human abdominal aortic aneurysm and stenosing atherosclerotic aortas was measured.

Methods

Samples of aortic wall were obtained from eight patients with AAA and eight with AOD. Expression of the MMPs was estimated with the reverse transcription polymerase chain reaction using a synthetic multicompetitor standard as a robust internal control. The standard allowed assay of 14 MMPs and three TIMPs.

Results

AAA wall expressed significantly more of the collagenolytic enzyme stromelysin 1 (MMP-3) and TIMP-3 than AOD wall (stromelysin 1: mean(s.d.) log (MMP-3/GAPDH) −1·97(0·52) in AAA versus −3·36(0·77) in AOD, P < 0·01; TIMP-3: −1·79(0·69) versus −2·84(0·78), P < 0·01). The elastolytic enzymes matrilysin, macrophage metalloelastase (MMP-7 and MMP-12), gelatinases 2 and 9, and membrane-type metalloproteinase 1 were expressed in both AAA and AOD.

Conclusion

There is expression of most elastolytic and collagenolytic MMPs in both aneurysms and occlusive disease, but expression of stromelysin 1 is greatly increased in aneurysms. Stromelysin 1 may be responsible for collagen breakdown in aneurysm disease and provide a target for pharmacological intervention.
Vascular Surgical Society operative outcome study: preoperative physiology predicts outcome
Authors: Prytherch D , Beard J D , Ridler B F , Earnshaw J J
Published: July 2002

Background

This was an audit of operative outcome conducted by the Vascular Surgical Society of Great Britain and Ireland (VSSGBI).

Methods

Some 121 surgeons (all members of the VSSGBI) completed data questionnaires on patients undergoing arterial surgery under their care (mean 12, range 1–49) in May and June 1998. A total of 1480 completed data records were available for logistic regression analysis using the Portsmouth modification of the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM) methodology. Information collected included all POSSUM data items plus other factors thought to have a significant bearing on patient outcome: VSSGBI ‘extra items’. The main outcome measures were death within hospital admission and major postoperative complications. The data records were checked for consistency and the remaining 1313 were divided into two sets for analysis. The first ‘training’ set was used to obtain logistic regression models that were applied prospectively to the second ‘test’ data set for various combinations of the POSSUM physiological and operative scores and the VSSGBI ‘extra items’ found to be significantly associated with outcome.

Results

Using POSSUM data items alone, it was possible to predict both death and morbidity after vascular reconstruction using P-POSSUM analysis. Addition of the VSSGBI ‘extra items’ found significant in regression analysis did not significantly improve the accuracy of prediction. The most accurate model predicting both death and morbidity was derived from the preoperative physiology components of the POSSUM data items alone.

Conclusion

P-POSSUM methodology can be used to predict outcome after arterial surgery across a range of surgeons in different hospitals and could form the basis of a national outcome audit. The most startling finding was that the preoperative physiology scores alone were predictive of both death and major morbidity after vascular reconstruction.