bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytolysis following chemoembolization for hepatocellular carcinoma
Authors: Paye F , Farges O , Dahmane M , Vilgrain V , Flejou J F , Belghiti J
Published: March 2003

Background

Lipiodolized chemoembolization of hepatocellular carcinoma (HCC) can induce fever and cytolysis, defined as an increase in serum levels of liver transaminases, which is frequently assumed to result from tumour necrosis. This study aimed to assess the causes of this syndrome, reviewing preoperative data, intraoperative findings, tumour necrosis and the status of non-tumorous liver.

Methods

A retrospective study was undertaken of 29 patients treated by neoadjuvant lipiodolized chemoembolization before surgical resection of HCC. Tumour necrosis was assessed in the resected specimen and scored in four stages: absent, 50 per cent or less, more than 50 per cent, and complete. The status of non-tumorous liver parenchyma was classified as either fibrotic or cirrhotic.

Results

Cytolysis occurred following chemoembolization in 16 patients and was associated with fever in 11. Postchemoembolization cytolysis with or without fever was more likely to develop in patients with minor fibrotic changes than in those with cirrhosis (14 of 21 with fibrosis versus two of four with cirrhosis, P < 0·05). In contrast, the extent of tumour necrosis did not correlate with the occurrence of symptoms.

Conclusion

These results suggest that fever and cytolysis following chemoembolization of HCC are an indication not of tumour necrosis but of injury to the non-tumorous liver.
Immunoglobulin A antibodies against Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysm
Authors: Lindholt J S , Juul S , Vammen S , Lind I , Fasting H , Henneberg E W
Published: March 2003

Background

The aim of this study was to examine the possible association between the progression of small abdominal aortic aneurysm (AAA) and chronic infection with Chlamydia pneumoniae.

Methods

Patients from a hospital-based mass screening programme for AAA with annual follow-up (mean 2·7 years) were included. After initial interview, 139 men aged 65–73 years with a small AAA underwent examination and blood sampling. Immunoglobulin (Ig) G and IgA titres against C. pneumoniae were measured by a microimmunofluorescence test.

Results

Some 83 (95 per cent confidence interval 74–93) per cent of the men had an IgA titre of 20 or more, or an IgG titre of 32 or more. Men with an IgA titre of 20 or more had a 48 per cent higher AAA expansion rate than those with a titre of less than 20 (3·1 versus 2·1 mm/year; P< 0·05). Multiple linear and logistic regression analyses showed that an IgA titre of 20 or more was a significant independent predictor of increased AAA expansion, adjusted for known risk factors of expansion. Initial AAA size and serum total cholesterol level were also predictors of expansion.

Conclusion

A high proportion of men with a small AAA had signs of chronic infection with C. pneumoniae. Aneurysm progression correlated with evidence of chronic C. pneumoniae infection.
Role of superficial venous surgery in the treatment of venous ulceration
Authors: Bello M , Scriven M , Hartshorne T , Bell P R F , Naylor A R , London N J M
Published: March 2003

Background

The aim of this study was to determine the ability of superficial venous surgery to heal venous ulcers in lower legs with isolated superficial venous incompetence.

Methods

This was a prospective study of patients recruited from a venous ulcer assessment clinic. Ulcers were considered venous if the ankle: brachial pressure index was greater than 0·8 and duplex imaging showed venous reflux. Patients with isolated superficial venous incompetence were offered saphenofemoral and/or saphenopopliteal surgery. Neither perforator surgery, skin grafting nor postoperative compression hosiery or bandaging was used.

Results

A total of 122 legs with normal deep veins underwent superficial venous surgery. Ninety procedures (74 per cent) were done under local and 32 (26 per cent) under general anaesthesia. Sixty operations (49 per cent) were done as a day case. The median time to healing was 18 (95 per cent confidence interval 14–21) weeks and the cumulative 6-, 12- and 18-month healing rates were 57, 74 and 82 per cent respectively.

Conclusion

In patients with venous ulceration and isolated superficial venous incompetence, superficial venous surgery can produce ulcer healing in the majority of patients without the need for perforator surgery, postoperative compression bandaging or skin grafting.
Popliteal artery entrapment syndrome
Authors: Lambert A W , Wilkins D C
Published: March 2003

Background

Popliteal artery entrapment syndrome (PAES) is rare and may be underdiagnosed. Improved specialized, non-invasive imaging techniques are producing detailed topographical evidence of the anomaly.

Methods

A historical review of the literature and Medline search was performed with reference to the diagnosis and treatment of the condition. In addition, embryologically based theories for the condition have been postulated.

Results and conclusion

PAES may be the result of abnormal development of the popliteal artery or a consequence of excessive cranial migration of the medial head of the gastrocnemius muscle. Magnetic resonance imaging appears to be the most useful single investigation to demonstrate the anomaly. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated.
Diaphragmatic dysfunction secondary to experimental lower torso ischaemia–reperfusion injury is attenuated by thermal preconditioning
Authors: McLaughlin R , Kelly C J , Kay E , Bouchier-Hayes D
Published: March 2003

Background

Preconditioning describes the process whereby tissue exposure to a subcritical stress confers protection from subsequent injuries. This study assessed diaphragmatic muscle function after lower torso ischaemia–reperfusion (IR) and the role of thermal preconditioning in attenuation of this injury.

Methods

Sprague–Dawley rats were randomized into three groups (24 per group): a control group, an IR group that had aortic cross-clamping for 1 h followed by reperfusion, and a third group that received thermal preconditioning 18 h before IR. Diaphragmatic function was assessed at 24 h, 48 h and 7 days.

Results

IR resulted in significant diaphragmatic twitch and tetanic dysfunction compared with control muscle. Thermal preconditioning significantly attenuated this injury (P < 0·05). Mean(s.e.m.) muscle twitch and tetanic forces in the IR group were 204·9(17·2) and 282·7(19·2) g respectively at 24 h. Corresponding twitch and tetanic forces in preconditioned muscle were 270·4(25·1) and 552·0(35·2) g.

Conclusion

This study demonstrated that systemic IR injury produced a respiratory muscle mechanical dysfunction that was attenuated by thermal preconditioning, at 24 h, 48 h and 7 days. Preconditioning may have a role in clinical practice, particularly before elective surgery.
Effect of intraportal adoptive immunotherapy on liver metastases after resection of pancreatic cancer
Authors: Kobari M , Egawa S , Shibuya K , Sunamura M , Saitoh K , Matsuno S
Published: March 2003

Background

The prognosis of patients with resected pancreatic cancer remains poor. This study evaluated the effect of adoptive immunotherapy (AIT) using intraportal infusion of lymphokine-activated killer (LAK) cells after curative resection and intraoperative radiation therapy (IORT) on advanced pancreatic cancer.

Methods

Twenty-nine consecutive patients with advanced pancreatic cancer (Japan Pancreas Society stage III or IV) were divided into two groups. The control group (n = 17) underwent tumour resection and IORT. The treatment group (n = 12) underwent resection, IORT and intraportal infusion of LAK cells combined with recombinant interleukin 2 (rIL-2). The incidence of liver metastasis and the survival rate of these two groups were compared.

Results

Although the overall survival between groups was not statistically different (P = 0·082), there were more patients (four) alive 3 years after operation in the test group (36 per cent versus zero), and the incidence of liver metastases in the treatment group was significantly lower (three of 12 versus ten of 15; P < 0·05). LAK therapy influenced survival positively in multivariate analysis.

Conclusion

These preliminary observations suggest that AIT warrants further study as a possible adjuvant for patients undergoing curative resection and IORT for pancreatic cancer.
Topical diltiazem ointment in the treatment of chronic anal fissure
Authors: Knight J S , Birks M , Farouk R
Published: March 2003

Background

Chronic anal fissure has traditionally been treated surgically. Initial enthusiasm for chemical sphincterotomy has waned because of poor outcomes with glyceryl trinitrate ointment. In this study the use of topical 2 per cent diltiazem ointment has been investigated as an alternative method of chemical sphincterotomy.

Methods

A prospective assessment of 71 consecutive patients with a chronic anal fissure treated with 2 per cent topical diltiazem ointment for a median duration of 9 (range 2–16) weeks was performed.

Results

Fifty-one patients (75 per cent) experienced healing of the fissure after 2–3 months of treatment with topical diltiazem. Seventeen patients who did not heal were treated for a further 8 weeks with topical diltiazem. Eight of these patients subsequently healed with diltiazem. Fifty-nine of 67 patients who completed follow-up therefore healed on diltiazem ointment. Four patients experienced perianal dermatitis and one patient experienced headaches. No other side-effects were recorded. After a median of 32 (range 14–67) weeks' follow-up following completion of treatment, 27 of 41 patients available remain symptom free. Six of seven patients with recurrent fissure were treated successfully by repeat chemical sphincterotomy.

Conclusion

Topical 2 per cent diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates but does not have a significant side-effect profile, which may aid compliance to treatment. Early recurrences are common but usually amenable to further chemical sphincterotomy.
Experimental study of peritoneal blood flow and insufflation pressure during laparoscopy
Authors: Brundell S M , Tsopelas C , Chatterton B , Touloumtzoglou J , Hewett P J
Published: March 2003

Background

Port-site metastases after laparoscopic surgery may occur with greater frequency than would be expected following open resection of intra-abdominal malignancies, but the causal mechanism for this is incompletely understood. The possibility that insufflation may increase peritoneal blood flow producing a wound environment conducive to the formation of metastases was investigated.

Methods

The effects of insufflation gas type and pressure were studied in 30-kg female pigs. Pigs were divided into five groups, which were subjected to insufflation at 12 mmHg pressure with helium, insufflation at 12, 8 or 4 mmHg pressure with carbon dioxide, or laparotomy. A microsphere technique utilizing two distinct radiotracers, 99mTc-labelled macroaggregated albumin (MAA) and 51Cr-labelled MAA, was used to study blood flow to the peritoneum, liver and kidneys.

Results

Insufflation with carbon dioxide or helium gases had no effect on renal (P < 0·09) or hepatic blood flow (P = 0·54). However, insufflation significantly increased peritoneal blood flow when carbon dioxide (P < 0·05), but not when helium (P = 0·99), was used as the insufflating gas.

Conclusion

These data suggest that blood flow within the peritoneum is influenced by insufflation with carbon dioxide. It is conceivable that such hyperaemia could increase the propensity for implanted tumour cells to metastasize in these sites following laparoscopy.
The surgical risk scale as an improved tool for risk-adjusted analysis in comparative surgical audit
Authors: Sutton R , Bann S , Brooks M , Sarin S
Published: March 2003

Background

Comparative surgical audit is becoming increasingly important although it is fraught with difficulties due to risk-adjusted analysis. Methods have been proposed to solve this problem and allow meaningful comparison of patient outcome. None has been described without faults, making such comparison flawed or overtly complicated. An alternative risk scoring system incorporating the Confidential Enquiry into Perioperative Deaths (CEPOD) grade, the American Society of Anesthesiologists (ASA) grade and the British United Provident Association (BUPA) operative grade was formulated and assessed.

Methods

This was a prospective audit of 4308 patients admitted under the care of three surgeons between May 1997 and October 1999, creating an initial data set of 3144 procedures with 134 deaths. Each procedure was allocated a score on the basis of the CEPOD, BUPA and ASA grade. The Surgical Risk Scale (SRS) was devised by adding together the values of the three variables, which generated a scale ranging from 3 to 14. Multivariate logistic regression analysis involving the three variables and univariate analysis of the SRS score were undertaken. Receiver–operator characteristic and calibration curves were formulated. This process was validated on another data set (2780 patients) derived from all admissions to the same surgeons between November 1999 and December 2000.

Results

Univariate logistic analysis of the SRS score revealed it to be significantly predictive of death (β = 0·84, P < 0·001); it did not overpredict mortality for low-risk procedures.

Conclusion

The SRS is easy to use, formulate and interpret, and provides an accurate prediction of death in general surgical patients across the entire risk spectrum.
Matrix metalloproteinases and atherosclerotic plaque instability
Authors: Loftus I M , Naylor A R , Bell P R F , Thompson M M
Published: March 2003

Background

There is growing interest in the role of matrix metalloproteinases in atherosclerosis. Excessive tissue remodelling and increased matrix metalloproteinase activity have been demonstrated during atherosclerotic plaque disruption, a frequent predeterminant of ischaemic cardiac events and stroke. These enzymes represent a potential target for therapeutic intervention to modify vascular pathology.

Methods

The core of this review is derived from a Medline database literature search.

Results

There is convincing evidence of increased matrix metalloproteinase activity during acute plaque disruption. Evidence for an imbalance promoting increased matrix degradation is less well documented. However, studies of matrix metalloproteinase inhibition in models of vascular disease suggest a potential therapeutic benefit.

Conclusion

In vivo studies of matrix metalloproteinase inhibition are required to study the potential for reversal or deceleration of the excessive tissue remodelling that accompanies acute plaque disruption.
Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury
Authors: Al-Ghnaniem R , Benjamin I S
Published: March 2003

Background

Hepaticojejunostomy is the ‘gold standard’ procedure for repairing iatrogenic bile duct injuries. The aim of this study was to examine the long-term outcome following hepaticojejunostomy for iatrogenic bile duct injury and the utility of routine construction of an access loop.

Methods

Patients with iatrogenic biliary injuries were treated with hepaticojejunostomy and access loop by a single surgeon. Injuries were classified according to the Bismuth level. An ‘excellent’ outcome was achieved if the patient never experienced jaundice or cholangitis in the follow-up period, and the outcome was ‘good’ if the patient developed symptoms but was asymptomatic for more than 12 months.

Results

Forty-eight patients underwent such operation. There was one operative death. Thirty-three patients were followed for 3 years or more (mean follow-up 80·4 (range 46–118) months). Thirteen of the 33 injuries were Bismuth level II, 13 were Bismuth level III and seven were Bismuth level IV. Outcome was dependent on the Bismuth level (P < 0·001). It was excellent in all 13 patients with Bismuth level II injuries, excellent in seven and good in six of the 13 patients with Bismuth level III injuries, and excellent in one and good in six of the seven patients with Bismuth level IV injuries. Moreover, the need for access loop intervention was dependent on the Bismuth level (P < 0·001). No patient with Bismuth level II injury required intervention, compared with five of 13 with Bismuth level III and six of seven with Bismuth level IV injuries.

Conclusion

Biliary reconstruction affords satisfactory long-term outcome. The likelihood of needing the access loop for radiological intervention is dependent on the Bismuth level. The authors recommend that an access loop be constructed in all patients with Bismuth level III and IV injuries.
Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma
Authors: Yeh C-N , Lee W-C , Jeng L-B , Chen M-F , Yu M-C
Published: March 2003

Background

Hepatocellular carcinoma (HCC) is a common disease in Taiwan. Ruptured HCC is an uncommon and potentially fatal complication of the condition. Information on the impact of ruptured HCC on hepatic resection is, however, limited.

Methods

The clinical features of 60 patients with ruptured HCC who underwent hepatic resection from 1986 to 1998 were reviewed. Clinical features and factors influencing the outcome of 475 patients with non-ruptured HCC were used for comparison.

Results

Of 535 surgically resected HCCs, 60 (11·2 per cent) were ruptured. Univariate analysis showed that sudden onset of abdominal pain, physical signs of haemodynamic unstability, reduced haemoglobin level and a raised aspartate aminotransferase level were more frequently found in patients with ruptured HCC than in those with non-ruptured tumours. Multivariate stepwise logistic regression analysis revealed sudden-onset abdominal pain to be the only independently significant factor in patients in the ruptured HCC group. The 1-, 3- and 5-year survival rates of patients with non-ruptured HCC were 72·1, 47·3 and 33·9 per cent, and those of patients with ruptured HCC were 54·2, 35·0 and 21·2 per cent respectively. Similar overall survival rates were found in patients with ruptured and non-ruptured HCC, although patients in the non-ruptured HCC group had a significantly better disease-free survival rate (P = 0·023).

Conclusion

The presence of sudden-onset abdominal pain is the only independent indicator of ruptured HCC. Hepatic resection, when feasible, is the treatment of choice and can result in an overall survival rate comparable to that of patients with non-ruptured HCC.
Role of magnetic resonance imaging in the diagnosis and single-stage surgical resection of invasive lobular carcinoma of the breast
Authors: Munot K , Dall B , Achuthan R , Parkin G , Lane S , Horgan K
Published: March 2003

Background

Conventional imaging with mammography and ultrasonography has a low sensitivity for diagnosis and a tendency to underestimate the extent of invasive lobular carcinoma (ILC) of the breast. The aim was to determine whether magnetic resonance imaging (MRI) had any advantages for the characterization of ILC.

Methods

Twenty patients with histologically proven ILC underwent preoperative imaging with MRI. MRI was performed to aid detection of malignancy in six patients with a clinically suspicious presentation but normal or indeterminate imaging on mammography and ultrasonography. In 14 patients MRI was performed to determine tumour extent.

Results

MRI accurately identified malignancy in five of six patients with normal or indeterminate conventional imaging. In seven of 14 patients in whom MRI was performed to determine tumour extent, it provided significant additional information. These included four patients in whom conventional imaging grossly underestimated tumour size, two patients in whom MRI identified an unsuspected contralateral breast tumour and one patient in whom MRI predicted tumour invasion of the pectoral muscle. The correlation between tumour size on histological examination was better with MRI (r = 0·967) than with mammography (r = 0·663) and ultrasonography (r = 0·673).

Conclusion

MRI can provide considerable additional information in the detection and characterization of ILC.
Low-cost laparoscopic cholecystectomy
Authors: Champault A , Vons C , Dagher I , Amerlinck S , Franco D
Published: March 2003

Background

Hospital managers are continually trying to decrease the cost of patient care. The aim of this prospective study was to propose changes that would decrease the operating room costs of laparoscopic cholecystectomy without affecting clinical results.

Methods

The study included 112 consecutive patients who underwent an elective cholecystectomy between January 1997 and December 2000. The procedure was changed in eight ways: the American position, open laparoscopy, reusable trocars, reusable instruments, bipolar coagulation of the cystic artery, intracorporeal ligature of the cystic duct, no use of suction lavage apparatus, and use of a surgical glove as a bag to extract the gallbladder. Complete compliance with the procedure, whether any abnormal operative events or complications occurred, the duration of hospitalization, and the material and labour costs of the procedure were recorded.

Results

There were no abnormal operative events. Only two patients suffered from postoperative complications. The mean duration of hospitalization was 55·8 h. Fifteen patients (13·4 per cent) were not hospitalized overnight. The operating costs fell from 560 euros before the study to 330 euros in 2000.

Conclusion

By applying simple measures, it is possible to decrease the operating room cost of laparoscopic cholecystectomy whilst maintaining good results. Such measures should be applied to other laparoscopic procedures.
Preclinical studies of gene transfer for the treatment of desmoid disease in familial adenomatous polyposis
Authors: Bright-Thomas R M , Agrawal A , Hargest R
Published: March 2003

Background

Familial adenomatous polyposis (FAP) arises following mutation or loss of the adenomatous polyposis coli (APC) gene. Desmoid tumours are proliferations of fibroblasts and occur as an extracolonic manifestation of FAP. They are a leading cause of death after colectomy. The aim of this study was to assess the potential for APC gene transfer into fibroblasts in vitro and in vivo as a basis for consideration of gene therapy in the prevention or treatment of desmoid tumours.

Methods

The APC gene was transferred by lipofection into fibroblasts in tissue culture and into peritoneum and small bowel mesentery in vivo. Reverse transcriptase–polymerase chain reaction was used to determine whether or not transfection was successful.

Results

Transgene expression was recorded in vitro to 7 days after transfection. High levels of transgene expression were also seen in samples of peritoneum (all eight mice), small bowel mesentery (seven of eight), liver (seven of eight) and intestinal tissues (five to six of eight) following intraperitoneal treatment. Interestingly, transgene expression in gonadal tissues was occasionally noted.

Conclusion

Liposomal transfection of APC gave prolonged high-level expression of the transgene, an important basis for gene therapy. No adverse effects were recorded. Further work is needed in animal models of desmoid disease to assess the clinical effects of gene therapy.
Kinetics of T cell turnover following thymectomy
Authors: Norwich K. H. , Ramanathan S. , Poussier P.
Published: March 2003

Abstract. We develop a mathematical formula that provides the number of cells in an isolated population that have divided k times in n days (0 ≤k≤n). This differential cell division formula is applied to the kinetics of peripheral T cells in the diabetes‐prone BB rat following thymectomy. These rats received daily intraperitoneal injections of the DNA precursor, bromodeoxyuridine (BrdUrd), over a period of 12–13 days. As the cells divided, they incorporated BrdUrd progressively into their DNA molecules, and the differential formula provides a close prediction of the fraction of BrdUrd‐positive T cells present each day during this ‘pulse’ phase. No further BrdUrd was administered after 13 days, and the diminishing fraction of BrdUrd‐positive cells was recorded for several more weeks. The differential cell division formula was capable of describing the rather complex form of the retention curve as BrdUrd‐tagged DNA molecules passed to progeny cells during this ‘chase’ phase. We believe that this simple formula may be found generally useful in describing cell kinetic data in mitotically active cells.
Sodium butyrate modulates cell cycle‐related proteins in HT29 human colonic adenocarcinoma cells
Authors: Coradini D. , Pellizzaro C. , Marimpietri D. , Abolafio G. , Daidone M. G.
Published: March 2003

Sodium butyrate (NaB), a product of colonic fermentation of dietary fibre, has been shown to inhibit cell proliferation by blocking cells in the G0/G1 phase of the cell cycle through a mechanism of action still not completely understood. We investigated the effect of NaB on the level of some G1 phase‐related proteins in a colon carcinoma cell line (HT29). In particular, we addressed our attention to cyclin D1 (the key regulator of G1S progression), p21waf1/cip1 (the main inactivator of the cyclin D/cdk complex), and p53 (the most important regulator of p21waf1/cip1 gene transcription). At inhibitory concentrations (higher than 1 mM) NaB reduced cyclin D1 and p53 level in a dose‐dependent manner and sustained the synthesis of p21waf1/cip1, probably in a p53‐independent way, accounting for the G0/G1 block observed by flow cytometry. Present results provide further evidence on the molecular mechanism at the basis of the physiological role of NaB and support the hypothesis that an unbalanced diet, poor in carbohydrates and therefore in NaB, could result in functional alterations with clinical and carcinogenic implications.
Cell cycle checkpoints and their inactivation in human cancer
Authors: Molinari M.
Published: March 2003

Checkpoints are mechanisms that regulate progression through the cell cycle insuring that each step takes place only once and in the right sequence. Mutations of checkpoint proteins are frequent in all types of cancer as defects in cell cycle control can lead to genetic instability. This review will focus on three major areas of cell cycle transition control, with particular attention to the alterations found in human cancer. These areas include the G1/S transition, where most cancer‐related defects occur, the G2/M checkpoint and its activation in response to DNA damage, and the spindle checkpoint.
Pattern of self‐organization in tumour systems: complex growth dynamics in a novel brain tumour spheroid model
Authors: Deisboeck T. S. , Berens M. E. , Kansal A. R. , Torquato S. , Stemmer‐Rachamimov A. O. , Chiocca E. A.
Published: March 2003

We propose that a highly malignant brain tumour is an opportunistic, self‐organizing and adaptive complex dynamic biosystem rather than an unorganized cell mass. To test the hypothesis of related key behaviour such as cell proliferation and invasion, we have developed a new in vitro assay capable of displaying several of the dynamic features of this multiparameter system in the same experimental setting. This assay investigates the development of multicellular U87MGmEGFR spheroids in a specific extracellular matrix gel over time. The results show that key features such as volumetric growth and cell invasion can be analysed in the same setting over 144 h without continuously supplementing additional nutrition. Moreover, tumour proliferation and invasion are closely correlated and both key features establish a distinct ratio over time to achieve maximum cell velocity and to maintain the system’s temporo‐spatial expansion dynamics. Single cell invasion follows a chain‐like pattern leading to the new concept of a intrabranch homotype attraction. Since preliminary studies demonstrate that heterotype attraction can specifically direct and accelerate the emerging invasive network, we further introduce the concept of least resistance, most permission and highest attraction as an essential principle for tumour invasion. Together, these results support the hypothesis of a self‐organizing adaptive biosystem.
Formaldehyde promotes and inhibits the proliferation of cultured tumour and endothelial cells
Authors: Tyihák E. , Bocsi J. , Timár F. , Rácz G. , Szende B.
Published: March 2003

Formaldehyde was applied in various doses (0.1–10.0 mm) to HT‐29 human colon carcinoma and HUV‐EC‐C human endothelial cell cultures. Cell number, apoptotic and mitotic index as well as proportion of cells in S‐phase was investigated by morphological methods and flow cytometry. Ten mM of formaldehyde caused high degree of cell damage and practically eradicated the cell cultures. One mM of formaldehyde enhanced apoptosis and reduced mitosis in both types of cell cultures, in a moderate manner. The low dose (0.1 mm) enhanced cell proliferation and decreased apoptotic activity of the cultured cells, the tumour cells appeared to be more sensitive. The possible role of this dose‐dependent effect of formaldehyde in various pathological conditions, such as carcinogenesis and atherogenesis is discussed with emphasis on the eventual interaction between formaldehyde and hydrogen peroxide.
Human red blood cells have an enhancing effect on the relative expansion of CD8+ T lymphocytes in vitro
Authors: Porto B. , Fonseca A. M. , Godinho I. , Arosa F. A. , Porto G.
Published: March 2003

The present study was designed to analyse the effect of red blood cells on T‐cell proliferation and expansion. A comparative study was done in peripheral blood cell cultures stimulated with phytohemagglutinin, with or without red blood cells. The presence of red blood cells had a consistent enhancing effect on T lymphocyte proliferation, as determined by an increase in both the mitotic index and thymidine uptake. Phenotypic characterization of T cell blasts by flow cytometry revealed that, in the presence of red blood cells, expanding cells were preferentially CD8+ cells. Accordingly, proliferation of CD8+ lymphocytes from two patients with CD8+ hyperlymphocytosis was dependent on the presence of red blood cells. In contrast, proliferation of CD4+ lymphocytes from two patients with CD4+ hyperlymphocytosis was strongly inhibited by the presence of red blood cells. This is the first reported evidence that human red blood cells have an enhancing effect on the expansion of CD8+ lymphocytes in vitro.
X‐irradiation effects on thymidine kinase (TK): I. TK1 and 2 in normal and malignant cells
Authors: He Q. , Skog S. , Welander I. , Tribukait B.
Published: March 2003

Abstract. The effect of radiation on TK is more complicated than would be expected from earlier results on bone marrow cells (Feinendegen et al. 1984, Int. J. Radiat. Biol. 45, 205). TK activity increased at 0.01 Gy and then decreased up to 1 Gy in mouse spleen. In contrast to the results for the spleen, an increase in activity at 0.1 Gy was seen in mouse thymus. The activity of dephosphorylated TK1 (TK1a) in both spleen and thymus was reduced to 50% after irradiation at 0.5–1 Gy. The degree of phosphorylation (TK1b/TK1a ratio) changed in spleen, but not in thymus. The activity of TK2 in mouse liver increased at 3 h after 5 Gy by about 60%. In mouse ascites tumour, a dose‐independent (1–5 Gy) oscillating TK1 activity was found up to 24 h, especially for TK1a and TK1b. The amount of TK1 was unchanged up to 12 h, but decreased at 24 h. This suggests that the differences in the changes in the degree of phosphorylation of TK1 after irradiation among spleen, thymus and ascites tumour further underline the complexity of the response of TK1 activity to irradiation. The dramatic change in the activities of TK1a and TK1b may illustrate that both of them are more radiosensitive than TK‐h, a variant with mixed TK1 and TK2 properties.
Focal adhesion kinase tyrosine phosphorylation is associated with myogenesis and modulated by insulin
Authors: Goel H. L. , Dey C. S.
Published: March 2003

Abstract. Focal adhesion kinase (FAK) was heavily phosphorylated as a function of differentiation of C2C12 mouse skeletal muscle cells. Insulin caused increases in FAK phosphorylation before stabilization in proliferated cells, while in differentiated cells there was a consistent transient inhibition of FAK phosphorylation before stimulation. The expression level of FAK was unaltered. Specific inhibition of insulin receptor tyrosine kinase activity abolished the insulin‐mediated dephosphorylation of FAK. The data strongly indicate that FAK tyrosine phosphorylation, necessary for skeletal muscle differentiation, is modulated by insulin. Thus, for the first time, we report the differential regulation of FAK tyrosine phosphorylation by insulin during skeletal muscle differentiation.
Proliferative and nutritional dependent regulation of glyceraldehyde‐3‐phosphate dehydrogenase expression in the rat liver
Authors: I. R. Corbin , Y. Gong , M. Zhang , G. Y. Minuk
Published: March 2003

Abstract. Glyceraldehyde‐3‐phosphate dehydrogenase is a multifunctional protein possessing numerous cytoplasmic and nuclear functions associated with cellular proliferation. Despite the emerging role of glyceraldehyde‐3‐phosphate dehydrogenase in regulating the proliferative process, there is a paucity of data regarding its expression and intracellular distribution in non‐malignant proliferating hepatocytes. Thus the aim of the present study was to document the intracellular distribution of glyceraldehyde‐3‐phosphate dehydrogenase protein in proliferating hepatocytes derived from regenerating rat livers, and glyceraldehyde‐3‐phosphate dehydrogenase gene expression in fasted and re‐fed rats following partial hepatectomy (PHx). Glyceraldehyde‐3‐phosphate dehydrogenase mRNA and protein expression were documented by Northern and Western blot analyses, respectively, at various times following 70% PHx in adult Sprague–Dawley rats. At 24 h post‐surgery, glyceraldehyde‐3‐phosphate dehydrogenase mRNA expression was significantly increased in both PHx and sham operated rats (P < 0.001), respectively. Despite the increase in glyceraldehyde‐3‐phosphate dehydrogenase mRNA expression in both groups, only PHx rats had a significant increase in the nuclear fraction of glyceraldehyde‐3‐phosphate dehydrogenase protein (threefold increase compared to sham and baseline levels, P < 0.01), cytoplasmic levels of glyceraldehyde‐3‐phosphate dehydrogenase protein remained unaltered in both groups. In terms of the effects of feeding and fasting on rats there were no significant differences in glyceraldehyde‐3‐phosphate dehydrogenase mRNA levels, whether fasted or refed, in rats that had undergone PHx, 8 h earlier. On the other hand, glyceraldehyde‐3‐phosphate dehydrogenase mRNA levels were significantly increased in refed compared to fasted sham operated rats 8 h following surgery. Serum insulin concentrations were higher in the refed PHx and sham groups compared to their fasted counterparts. The results of this study indicate that although glyceraldehyde‐3‐phosphate dehydrogenase mRNA are altered to the same extent in PHx and sham‐operated rats following surgery, increases in the nuclear fraction of glyceraldehyde‐3‐phosphate dehydrogenase protein only occur in PHx rats. The results also indicate that glyceraldehyde‐3‐phosphate dehydrogenase expression is affected by the nutritional status of animals undergoing abdominal sham surgery.
Epithelial cell proliferation in oral lichen planus
Authors: Taniguchi Y. , Nagao T. , Maeda H. , Kameyama Y. , Warnakulasuriya K. A. A. S.
Published: March 2003

Abstract. Although the pathogenesis of oral lichen planus (OLP) is not clear, a small proportion of cases with OLP are reported to transform to cancer. We examined the epithelial cell proliferation status of OLP to relate the labelling index to microscopic features surveyed routinely in pathology. Mucosal biopsies obtained from 44 cases diagnosed with OLP with an intact oral epithelium and 10 normal control specimens from Japanese subjects were immunohistochemically stained with MIB and p53 antibodies. The Ki67 labelling index (LI) was significantly higher in OLP compared with normal controls. A particularly large number of OLP lesions (64%) were p53 positive. No association was, however, found with p53 expression and the Ki67 LI. Atrophic and flat epithelia had a quantitatively higher LI, which did not significantly differ from acanthotic biopsies. Increased cell proliferation in OLP is likely to be a secondary phenomenon due to the damage inflicted on keratinocytes by infiltrating mononuclear cells in the submucosa.
Social work supervision of young people
Authors: Triseliotis John , Borland Moira , Hill Malclom , Lambert Lydia
Published: March 2003

This paper summarizes findings on 50 teenagers supervised by local authority social services (work) departments. Interviews were held with social workers, young people and parents at the start of intervention and about a year later. Pre‐tests and post‐tests were also used to complement other statistical and qualitative data. After identifying the main reasons for the teenagers being on formal or informal supervision, the paper moves on to discuss the process, content and outcome of supervision as perceived by each of the three key actors. It also outlines what the young people and their parents found positive and helpful about supervision. Finally the paper demonstrates that forms of help and control need not be opposites and that social workers can help some very troubled teenagers. However, in order for services to have an impact, they have to be deployed as part of a package rather than as alternatives.
Placed and paid for: a national overview of the use of private and voluntary day care facilities for children in need
Authors: Dillon  , Statham
Published: March 2003

This paper examines day care provision for children in need, who are placed and paid for by local authorities in non local authority services. The England and Wales Children Act 1989 placed a new duty on local authorities to provide day care services for children who are defined as being ‘in need’, and the guidance accompanying the Act encourages the use of independent sector services for this purpose. This paper brings together the main findings from a survey of all English local authorities, an analysis of local authority documentation and secondary analysis of government statistics to provide a national overview of the use of sponsored day care places for children ‘in need’. It concludes that the majority of English local authorities value the contribution of independent day care providers, but that there are potential problems with adopting a market approach to welfare services, such as low levels of training and support for such providers, and a shortage of suitable service provision in the areas where they are most needed. These require further consideration by policy makers and local authorities.
Constructions of pupil absence in the British education service
Authors: Hoyle D.
Published: March 2003

‘Truants’ and ‘truancy’ have been construed as ‘problems’ in schools and the British education system since the introduction of compulsory schooling in the late 19th century. A review of the literature about ‘truancy’ reveals four principal perspectives which construe the ‘problem’ of absence as an outcome of: individual ‘pathology’; ‘defective’ parenting; a failure to identify and meet the ‘needs’ of a child; and, nonhuman factors within the process of schooling (e.g. the National Curriculum). Findings are presented from a research project into the work of an education welfare service (EWS), which explored the social careers of pupils referred to the service. On the basis of these findings it is argued that particular ‘regimes’ and ‘myths’ in the education service provide a context within which decisions are made about children who do not attend school regularly. It is suggested that these ‘myths’ constrain the services which it is legitimate for agencies to provide for some of the most marginalised and vulnerable children, and families in British society; and legitimise a morally based, selective operational masking of the complex, multilayered factors from which a child's surface ‘deviance’ originates.
Children’s participation in reviews and planning meetings when they are ‘looked after’ in middle childhood
Authors: Thomas  , O’Kane
Published: March 2003

This paper is based on a study of participation by children aged 8–12 in decisions when they are ‘looked after’ by local authorities. The research established that more children in this age group are attending reviews and planning meetings, but that the likelihood of their attendance varies with age and other factors. The paper explores reasons why some children are more likely to attend meetings than others, and uses material from interviews with children and adults to understand the part which children take in meetings when they do attend. The attendance of children at review meetings has exposed some ambiguity in their purpose, and the paper argues for a re‐evaluation of the place of reviews in relation to other processes. It concludes by calling for a combination of rights‐based and relationship‐based approaches to empowering children.
Mothering and child protection practice: rethinking risk assessment
Authors: Krane  , Davies
Published: March 2003

In recent years, across North America and the UK, child protective service agencies have increasingly begun to rely on bureaucratic, technocratic, and regulatory mechanisms for detecting and managing abuse and neglect. Coupled with a shift from concern for the general social welfare of children to a heightened preoccupation with risk or dangerousness to children, risk assessment systems are becoming integral to child protection practice.

Though risk assessment systems aim to enhance the effectiveness of child protection investigations and service provision, as well as filter out high risk cases from the rest, such systems may foster and reproduce often concealed relations of gender, race, and class. This paper presents a review of the risk assessment trend in child welfare, its general objectives, and some criticisms raised to date. Through a feminist analysis of the social construction of mothering, we re‐examine risk assessment. We argue that the risk assessment trend has the potential to entrench oppressive relations of gender, race, and class in child welfare practice with mothers. We suggest that an approach to risk assessment which incorporates a ‘mothering narrative’ might offer a more thorough evaluation of the conditions that shape the context within which risk to children emerges.
‘Good lesbian, bad lesbian…’: regulating heterosexuality in fostering and adoption assessments
Authors: Hicks
Published: March 2003

The paper examines the assessment of lesbians who apply to foster or adopt, using data generated from 30 interviews with local authority social workers. Using feminist and queer theories, the author suggests that lesbian applicants pose a challenge to the discourse of ‘compulsory gender and heterosexuality’ which structures fostering and adoption work. It is argued that this discourse relies upon a series of assumptions about the automatic fitness of heterosexual applicants, especially concerning the idea of gender and sexuality role models needed for children’s development. Further, this ‘heteronormative’ discourse relies upon the continuing need to make ‘other’ the categories ‘lesbian’ or ‘gay’. The article considers how ‘the lesbian’ is constructed as a ‘threat’, as ‘militant’, or as ‘automatically safe’ in assessments, and makes the point that social work is productive of versions of the lesbian subject. The author argues that only certain versions are likely to be approved to foster or adopt, particularly that which is termed ‘the good lesbian’.
Professionals’ attitudes to children’s participation in decision‐making: dichotomous accounts and doctrinal contests
Authors: Shemmings
Published: March 2003

The attitude of professionals to the involvement of children in decision‐making is unclear. This paper discusses a recent research study that utilized qualitative and quantitative methods to explore the views of professionals working in family support and child protection about two different aspects of children’s participation in decision‐making: the age at which children should make decisions and whether or not they should be involved in child protection conferences. The results showed that social workers tended to favour one of two diametrically opposed viewpoints about the age at which young people should make decisions and then in discussions with colleagues they sought to persuade others to change their perspective. Social workers who believed that young people should not make decisions until much older nevertheless thought that they should be involved in conferences whereas non‐social workers did not make this distinction: for them, children who were not old enough to make decisions for themselves should not be involved in conferences. The results are discussed in the light of some of the implications for practice. The paper concludes by outlining how the results informed the design of a training pack commissioned by the Department of Health concerning the involvement of young people.
Intensive family preservation services: an examination of critical service components
Authors: Bagley  , LaChance
Published: March 2003

A treatment programme for child victims of sexual abuse within the family has been evaluated in terms of psychological and behavioural outcomes for the young people two years after beginning therapy. The Canadian programme was based on principles established by Giarretto in his Child Sexual Abuse Treatment Program (CSATP). Screening by child protection workers selected potential candidates. However, because of limited resources, referral of less than half of the originally screened families was made, even though they were judged suitable for participation. This made available an untreated comparison group (n = 30), similar in many ways to the treated families (n = 27). After two years the treated adolescents had largely recovered levels of self‐esteem obtained in normative samples, and depressive affect had diminished markedly, as had problem behaviours. By contrast, the untreated adolescents had retained low levels of self‐esteem, and high levels of depression. Negative behaviours (delinquency, running away from home, acts of deliberate self‐harm) had deteriorated after two years. This was linked both to further within‐family abuse (in a fifth), followed by a drift in some into street life. Despite its apparent success, the CSATP could not be continued because of lack of funding, and problems in maintaining a community development model for supporting a humanistic programme.
Age at placement and adult adopted people's experience of being adopted
Authors: Howe David , Shemmings David , Feast Julia
Published: March 2003

Older age at placement has long been recognized as a risk factor in successful adoption outcomes. The findings of the present study emerged as part of a larger study that looked at the adoption experiences and reunion outcomes of 472 adults who had either searched for or been sought by one or more of their birth relatives. As part of the investigation, adopted adults were asked to evaluate their adoption experience. Age at placement was used as a key variable in examining whether or not adopted people felt different to their adoptive family, felt they belonged in their adoptive family, and felt loved by their adoptive parents while growing up. Respondents were also asked to evaluate their overall experience of being adopted. Older age at placement significantly increased the risk of adopted people viewing major aspects of their adoption experience with either mixed or negative feelings.