bluuebunny/crossref_metadata_2025 huggingface dataset:
Additional chromosome abnormalities confer worse prognosis in acute promyelocytic leukaemia
Authors: HIORNS LYNNE R. , SWANSBURY G. JOHN , MEHTA JAYESH , MIN TOON , DAINTON MELISSA G. , TRELEAVEN JENNIE , POWLES RAYMOND L. , CATOVSKY DANIEL
Published: December 2004

Acute promyelocytic leukaemia (APL) has been associated with a favourable prognosis in many studies of acute myeloid leukaemia. A series of 54 patients treated at the Royal Marsden Hospital between 1979 and 1996, with APL and the t(15;17) chromosome translocation at pres‐entation, was examined for the effect of additional chromosome abnormalities in their presentation karyotype on survival.

The patients were aged between 2 and 62 years with a median age of 31 years. There were approximately equal numbers of males and females. Presentation white cell count ranged from 0.7 to 156 × 109/l with a median of 1.0 × 109/l. 39% of patients (21/54) had additional chromosome abnormalities at presentation. Statistical analyses were performed for factors thought to influence survival such as age, sex, white cell count, and number of courses of chemotherapy required to enter remission. These showed that the presence of additional chromosome abnormalities has an adverse effect on prognosis, independent of other prognostic indicators, reducing it to the level of patients with AML from less‐favourable cytogenetic subgroups. These data indicate that additional therapeutic strategies may be required in patients with APL who demonstrate cytogenetic aberrations over and above the t(15;17) at presentation. The biological basis for the more aggressive nature of these cases remains to be determined.
Successful autografting in chronic myelogenous leukaemia using Philadelphia negative blood progenitor cells mobilized with rHuG‐CSF alone in a patient responding to alpha‐interferon
Authors: CARRERAS ENRIC , SIERRA JORGE , ROVIRA MONTSERRAT , URBANO‐ISPIZUA ALVARO , MARTÍNEZ CARMEN , NOMDEDEU BENET , CERVANTES FRANCISCO , MARıN PEDRO , ROZMAN CIRIL , MONTSERRAT EMILIO
Published: December 2004

Several non‐randomized studies suggest a possible survival advantage for chronic myelogenous leukaemia (CML) patients treated with an autologous stem‐cell transplantation. Due to the possible contribution of residual leukaemic cells present in the inoculum in post‐transplant relapse, several methods are being evaluated to eliminate neoplastic cells or to select ‘normal’ (Ph1 negative) progenitor cells for autografting. Recently, several studies have shown that Ph1 negative blood progenitor cells can be mobilized by rHuG‐CSF alone in patients who have a cytogenetic response to alpha‐interferon (IFN). We describe the first case, as far as we are aware, of a CML patient responding to IFN autografted by using blood progenitor cells collected by rHuG‐CSF alone.
Multigenetic lesions in infant acute leukaemias: correlations with ALL‐1 gene status
Authors: CIMINO GIUSEPPE , LANZA CARLO , ELIA LOREDANA , LO COCO FRANCESCO , GAIDANO GIANLUCA , BIONDI ANDREA , PASTORE CRISTINA , SERRA ANNA , CANAANI ELI , CRPCE CARLO MARIA , MAMDEO FRAMCP , SAGLIO GIUSEPPE
Published: December 2004

In this study we investigated the presence of structural lesions in the ALL‐1, p53 and p16 (cyclin‐dependent kinase 4 inhibitor) genes in leukaemic cells obtained from 22 patients with infant acute leukaemia (aged <18 months). Of these, 18 cases were classified as acute lymphoblastic leukaemia (ALL) and four as acute myeloid leukaemia (AML). Tumour DNAs were analysed by a combination of Southern blot, polymerase chain reaction (PCR), single‐strand conformation polymorphism (SSCP), and direct sequence analyses.

The results showed ALL‐1 gene rearrangements in 15/22 (68%) cases, p53 gene mutations in 5/22 (26%), and a homozygous deletion of p16 in a single T‐ALL case. p53 and p16 alterations were all found in the group of patients with ALL‐1 gene rearrangements. p53 mutations were more often associated with a myeloid phenotype (3/5).

In summary, multiple molecular alterations were found in 6/15 (40%) infant acute leukaemias with ALL‐1 rearrangements. As to the clinical course, patients with additional lesions had similar clinical outcome with respect to patients with ALL‐1 gene rearrangement as the sole genetic aberration. This may support the hypothesis that ALL‐1 alterations are genetic events per se sufficient to confer a fully malignant phenotype to the leukaemic clone.
Administration of G‐CSF to healthy subjects: the effects on eosinophil counts and mobilization of eosinophil granule proteins
Authors: KARAWAJCZYK M. , HO¨GLUND M. , ERICSSON J. , VENGE P.
Published: December 2004

Any influence of G‐CSF on eosinophils is mostly negative, although reports which have studied this relationship are few with varied results. The aim of this study was to investigate the influence of G‐CSF administration to healthy subjects on eosinophils in peripheral blood. Blood eosinophil counts, serum levels of eosinophil cationic protein (ECP), eosinophil peroxidase (EPO) and eosinophil protein X (EPX), as well as cell morphology were studied. 14 healthy volunteers received 7.5 μg (n = 8) or 10 μg/kg body weight (n = 6) G‐CSF daily for six consecutive days. ECP and EPX were assessed by specific RIAs and EPO by a specific FEIA. Cell morphology was examined by electron microscopy.  During G‐CSF administration, eosinophil counts increased from 0.22 ±0.04 ×109/l to 0.61 ± 0.098 × 109/l (P = 0.001), serum ECP from 12.39 ± 2.45 μg/l to 61.82 ± 7.38 μg/l (P = 0.0014), serum EPX from 28.05 ±4.54 μg/l to 87.96 ±9.84 μg/l (P =0.002) and serum EPO from 8.89 ±2.2 μg/l to 19.98 ± 5.1 μg/l (P = 0.003). All variables returned gradually to initial values after discontinuation of G‐CSF. Distinct changes in the morphology of secondary granules were observed 24 h after G‐CSF administration. The granules became irregular and their matrix less electron dense. We conclude that administration of G‐CSF to healthy humans increases the number of circulating eosinophils and affects the mobilization of eosinophil granule proteins.
N‐linked sialyated sugar receptors support haematopoietic cell‐osteoblast adhesions
Authors: Crean S. M. , Meneski J. P. , Hullinger T. G. , Reilly M. J. , DeBoever E. H. , Taichman R. S.
Published: December 2004

Haematopoietic progenitor cells proliferate and develop predominantly when they adhere to bone marrow stromal cells such as osteoblasts. Therefore, changes in adhesion may be a common mechanism by which stem cells survive, mature and properly traffic between the bone marrow and the circulation. To characterize these adhesion molecules, we reduced the bone marrow cavity to a simple adhesion assay between KG1a (a CD34+ haematopoietic cell line) and osteosarcoma monolayers (MG‐63 or SaOS‐2). The data demonstrated that adhesion was mediated by cell‐to‐cell rather than cell‐to‐matrix contact, was sensitive to trypsin, calcium chelators and glycosylation inhibitors. Selective pretreatment attributed the constitutive binding to N‐linked glycans on KG1a. When carboprocessing was inhibited later at the high mannose intermediate (via deoxymannojirimycin), adhesion was retained. Surprisingly, binding of KG1a to SaOS‐2 increased past constitutive levels as doses of tunicamycin or deoxymannojirimycin dropped. Selective pretreatment suggested that this ‘inducible’ binding resides with molecule(s) on SaOS‐2. If the terminal sialic acid was digested (via neuraminidase), this induced response was duplicated. These data, verified in primary cells, suggest that the initial tethering between blood and bone cells in this model is probably due to heavily glycosylated, rapidly processed protein(s) on both cell types.
Retroviral transduction of acute myeloid leukaemia‐derived dendritic cells with OX40 ligand augments their antigen presenting activity
Authors: Yanagita Soshi , Hori Toshiyuki , Matsubara Yasushi , Ishikawa Takayuki , Uchiyama Takashi
Published: December 2004

Recent studies have shown that human myeloid leukaemia cells can differentiate into dendritic cell (DC)‐like cells (leukaemia‐DCs) when cultured with a combination of cytokines. In the present study, we examined whether the transduction of leukaemia‐DCs with OX40 ligand (OX40L), a member of the tumour necrosis factor (TNF) family, resulted in augmentation of their antigen presenting activity. Bicistronic retroviral vectors expressing both human OX40L and enhanced green fluorescent protein (EGFP) or EGFP alone were generated and used for transduction. Fresh leukaemic cells from five patients with acute myeloid leukaemia (AML) were isolated and retrovirally transduced with OX40L during the culture with a combination of cytokines from stem cell factor, fms‐like tyrosine kinase (Flt)‐3 ligand, granulocyte‐macrophage colony stimulating factor (GM‐CSF), interleukin‐4 (IL‐4) and TNF‐α. After 7 d, the majority of cells showed DC‐like morphology, and expressed higher levels of CD80, CD86 and HLA‐DR than fresh leukaemic cells. The transduction efficiency was 8·5–27·2%. Leukaemia‐DCs transduced with OX40L elicited higher proliferative response of allogeneic CD4+ T cells than fresh leukaemic cells, non‐transduced, or mock‐transduced leukaemia‐DCs. Co‐culture of allogeneic CD4+ T cells with OX40L‐transduced leukaemia‐DCs was superior in the generation of interferon (IFN)‐γ producing CD4+ T cells and in production of IFN‐γ. Furthermore, OX40L‐transduced leukaemia‐DCs could elicit significant proliferative response of human leucocyte antigen‐matched T cells from the donor in allogeneic stem cell transplantation. These results indicate that retroviral transduction of leukaemia‐DCs with OX40L augments their antigen presenting cell activity and thus renders them more suitable for tumour vaccines or ex vivo stimulation of leukaemia‐specific T cells.
The use of a national transplant registry to benchmark transplant outcome for patients undergoing autologous and allogeneic stem cell transplantation in the United Kingdom and Ireland
Authors: Russell N. H. , Szydlo R. , McCann S. , Potter M. N. , Craddock C. , Towlson K. , Apperley J. F. ,   British Society for Blood and Marrow Transplantation
Published: December 2004

As part of its clinical governance programme the British Society for Blood and Marrow Transplantation (BSBMT) undertook an analysis of transplant outcome for adults undergoing human leucocyte antigen – identical sibling allogeneic transplantation for chronic myeloid leukaemia (CML) in first chronic phase (CP1) or autologous transplantation for Hodgkin's disease (HD). The study aimed to compare transplant‐related mortality (TRM) and survival for patients reported to the BSBMT with patients transplanted in the rest of Europe, reported to the European Group for Blood and Marrow Transplantation (EBMT). The outcomes for 104 allogeneic transplants for CML in 24 UK/Irish centres were compared with 775 allografts in 145 other European centres. For HD, 241 autografts from 38 UK/Irish centres were compared with 1145 transplants in 239 other European centres. For both diseases, the cohorts were broadly matched with the exception of CML, where 85% of patients were transplanted <1 year from diagnosis in the UK/Ireland compared with 68% in the EBMT (P = 0·001). Cox regression analysis was undertaken using known delineated variables affecting transplant outcome in addition to the registry of origin. The adjusted survival curves for CML showed no significant differences between the two groups, with 3‐year survival probabilities of 70·2% and 67·1% for the EBMT and BSBMT cohorts respectively. Likewise, the analysis for HD showed overlapping survival curves, with 3‐year survival probabilities of 71·8% (EBMT) and 70·8% (BSBMT). TRM was not statistically different in either disease. This study demonstrates the potential for using national registries to benchmark transplant outcome against the EBMT registry.
High plasma levels of factor VIII and risk of recurrence of venous thromboembolism
Authors: Cristina Legnani , Benilde Cosmi , Michela Cini , Mirella Frascaro , Giuliana Guazzaloca , Gualtiero Palareti
Published: December 2004

The aim of this study was to evaluate the relationship between factor VIII (FVIII) levels, measured by chromogenic and clotting assays, and risk of venous thromboembolism (VTE) recurrence. A total of 564 patients underwent clinical follow‐up after oral anticoagulant withdrawal (total follow‐up = 924·4 years). Recurrent VTE developed in 39 of 309 (12·6%) patients with a first idiopathic VTE and in 14 of 255 (5·5%) patients whose first event was secondary. In patients with a first idiopathic VTE, the risk of recurrence was more than fivefold higher in patients with FVIII levels exceeding the 90th percentile [chromogenic FVIII: relative risk (RR) 5·43 (95% CI 1·76–16·8); clotting FVIII: RR 6·21 (95% CI 1·57–24·5)] after adjustment for all possible confounding variables. In patients with a first secondary VTE, the risk of recurrence was slightly higher in patients with high FVIII levels [chromogenic FVIII: RR 2·62 (95% CI 0·34–19·9); clotting FVIII: RR 1·74 (95% CI 0·25–12·1)], but, given the low number of recurrences, the 95% CI were very large. In conclusion, this study shows that high FVIII levels are associated with increased risk of VTE recurrence in patients with a first idiopathic VTE. Although the measurement of FVIII levels by a specific chromogenic assay might, in principle, be preferred to avoid the risk of aspecific clotting effects, no significant differences in results obtained by chromogenic or clotting methods were found.
Dialysis of saliva improves accuracy of saliva lithium determinations
Authors: El‐Mallakh Rif S , Linder Mark , Valdes Roland , Looney Stephen
Published: December 2004

Background:  Saliva lithium (Li) determinations have been explored as a potential alternative to plasma levels. Unfortunately, this method has been shown to be unreliable. Saliva has two major components: the aqueous and the mucopolysaccharide portions.

Methods:  Since Li is likely to distribute only in the aqueous fraction, we dialyzed the saliva through a 3000 Da filter to isolate the aqueous component and determine the Li level in it.

Results:  Lithium levels in the dialyzed saliva agreed more closely with plasma levels (Spearman's rho = 0.901, p < 0.001) than did whole saliva (Spearman's rho = 0.775, p = 0.012).

Conclusion:  Dialysis of saliva may contribute to more accurate saliva Li levels.
Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature
Authors: Shapira Avraham , Shiloh Roni , Potchter Oded , Hermesh Haggai , Popper Miriam , Weizman Abraham
Published: December 2004

Objective:  We intended to identify a relationship, if exists, between various climatic factors and the admission rates of bipolar affective disorder depressed patients (BPD) or major depressive disorder patients (unipolar) (UPD) to psychiatric hospitals, as well as potential seasonal variability in hospitalization rates of this population.

Methods:  Data on admissions of ICD‐9 BPD and UPD patients to Tel Aviv's seven public psychiatric hospitals during 11 consecutive years were collected along with concomitant meteorological information

Results:  Admissions of 4117 patients with BPD and 1036 with UPD who fulfilled our specific inclusion criteria were recorded. Bipolar depressed, but not UPD, patients exhibited significant seasonal variation (higher spring and summer versus winter mean monthly admission rates), and the admission rates of patients with BPD, but not UPD, correlated significantly with mean maximal monthly environmental temperature

Conclusions:  Increased environmental temperature may be a risk factor for evolvement of major depressive episode in patients with bipolar disorder with psychiatric co‐morbidity, at least in cases that necessitate hospitalization and at the examined geographic/climatic region of Israel. Further large‐scale studies with bipolar depressed patients with and without co‐morbid disorders are needed to substantiate our findings and to determine the role of seasonal and climatic influence on this population, as well as its relationship to the pathophysiology of bipolar disorder.
Short‐term fluoxetine monotherapy for bipolar type II or bipolar NOS major depression – low manic switch rate
Authors: Amsterdam Jay D , Shults Justine , Brunswick David J , Hundert Miriam
Published: December 2004

Objectives:  Current guidelines for the initial treatment of bipolar type II (BP II) major depressive episode (MDE) recommend using either a mood stabilizer alone or a combination of a mood stabilizer plus a selective serotonin re‐uptake inhibitor (SSRI). This recommendation is the result of concern over antidepressant‐induced manic switch episodes. However, recent evidence suggests that the manic switch rate may be low in BP II MDE during SSRI therapy.

Methods:  As part of a randomized, double‐blind, placebo‐controlled relapse‐prevention study of fluoxetine monotherapy in BP II MDE, 37 patients received open‐label fluoxetine 20 mg every day for up to 8 weeks. Outcome measures included the Hamilton Depression Rating (HAM‐D 17) rating and the Young Mania Rating (YMR) scale.

Results:  Eleven of 23 patients (48%) who completed 8 weeks of fluoxetine treatment showed a HAM‐D 17 reduction of ≥50%, while 14 (38%) of all treated patients had ≥50% reduction in baseline HAM‐D 17 score. Using a conservative YMR score of ≥8 to identify hypomanic symptoms, the frequency of patients with YMR score ≥8 during fluoxetine did not differ from that seen during the screen and baseline period. Only three patients (7.3%) had symptoms suggestive of hypomania, and only one patient stopped treatment because of a rapid mood swing into depression.

Limitations:  Fluoxetine was given at a fixed dose of 20 mg everyday. Fluoxetine was prescribed in an open‐label manner, and the sample size was limited.

Conclusions:  These observations support the findings of a low manic switch rate during SSRI monotherapy of BP II MDE, and suggest that fluoxetine monotherapy may be a safe and effective initial treatment of BP II MDE.
A review of antidepressant‐induced hypomania in major depression: suggestions for DSM‐V
Authors: Chun Benjamin JDH , Dunner David L
Published: December 2004

Objectives:  To determine if the classification of ‘antidepressant‐induced hypomania’ in DSM‐IV is supported by available data.

Methods:  We reviewed the available scientific literature to examine the incidence of mania and hypomania in non‐bipolar patients who were treated with antidepressants.

Results:  Eighty‐nine per cent of studies of antidepressants in major depressive disorder patients reported no cases of treatment‐induced hypomania. No instances of treatment‐induced hypomania were reported in three large studies of patients with chronic forms of depression.

Conclusions:  The rate of antidepressant‐induced hypomania in major depressive disorder is within the rate of misdiagnosis of bipolar depression as unipolar. Depressed patients who experience antidepressant‐associated hypomania are truly bipolar.
Using technology to improve longitudinal studies: self‐reporting with ChronoRecord in bipolar disorder
Authors: Bauer Michael , Grof Paul , Gyulai Laszlo , Rasgon Natalie , Glenn Tasha , Whybrow Peter C
Published: December 2004

Objectives: Longitudinal studies are an optimal approach to investigating the highly variable course and outcome associated with bipolar disorder, but are expensive and often have missing data. This study validates patient self‐reported mood ratings using a home computer‐based system (ChronoRecord) with clinician mood ratings on the Hamilton Depression Rating scale (HAMD) and Young Mania Rating scale (YMRS), and investigates the patient acceptance of the technology.

Methods: After brief training, outpatients with bipolar disorder were given the software version of an established paper based self‐reporting form (ChronoSheet) to install on a home computer. Every day for 3 months, patients entered mood, medications, sleep, life events, and menstrual data. Weight was entered weekly.

Results: Eighty of 96 (83%) patients returned 8662 days of data. The mean days of data returned was 114.7 ± 32.3 SD The mean percentage of days missing for mood data was 6.1% ± 9.3 SD, equivalent to missing 7.3 day of the 114.7 days. Self‐reported ratings were strongly correlated with clinician HAMD ratings (−0.683, p < 0.001).

Conclusions: This study demonstrates concurrent validity between ChronoRecord and HAMD. Patients with bipolar disorder showed high acceptance of a computer‐based system for self‐reporting of daily data. Automation of data collection can reduce missing data and eliminate errors associated with data entry. This technology also enables on‐going feedback for both patient and researcher during a long‐term study.
Pharmacotherapy of bipolar II disorder: a critical review of current evidence
Authors: Hadjipavlou George , Mok Hiram , Yatham Lakshmi N
Published: December 2004

Objectives:  There is much controversy surrounding the diagnosis and treatment of patients with bipolar II disorder (BP II). To address the growing need to find effective treatment strategies for patients with BP II, this article identifies and summarizes available published evidence specific to the pharmacotherapy of BP II.

Methods:  Using the keywords, ‘bipolar disorder’, ‘type II’ or ‘type 2’, ‘bipolar II’, ‘hypomania’, and ‘bipolar spectrum’, a search of the databases Medline (via PubMed), the Cochrane Central Register of Controlled Trials (via Ovid), and PsychInfo was conducted for the period January 1994 to January 2003. Articles deemed directly relevant to the treatment of BP II were selected. Studies that included both BP I and II patients were excluded if results for BP II patients were not analyzed and reported separately.

Results:  Fourteen articles were selected for the review period. There are no double blind, randomized controlled trials (RCT) involving only BP II patients. Most studies investigating the pharmacotherapy of BP II are methodologically limited, having observational or retrospective designs and small samples. For long‐term treatment, lamotrigine has the strongest quality of evidence (double blind RCT), while lithium is the best studied. With regard to short‐term treatment, there is some limited support for the use of risperidone in hypomania, and for divalproex, fluoxetine and venlafaxine in treating depression.

Conclusions:  There is a paucity of sound evidence to help guide clinicians treating BP II patients. Decisions about pharmacotherapy should be made on a case‐by‐case basis; overall, broad recommendations that are based on available evidence cannot be adequately made. More quality research is needed to delineate effective treatment strategies.
Lithium prevents colchicine‐induced apoptosis in rat cerebellar granule neurons
Authors: Jordà EG , Verdaguer E , Morano A , Jiménez A , Canudas AM , Camins A , Pallàs M
Published: December 2004

Objectives:  Here we evaluated the neuroprotective effects of two well‐known mood stabilizers, lithium and valproic acid (VPA), against colchicine neurotoxicity in cerebellar granule cells (CGNs).

Methods:  The CGNs were differentiated for 7 days, pretreated with lithium or VPA for 24 h and after colchicine 1 μM was added. Cellular damage was assessed with 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl tetrazolium (MTT) method and apoptosis in CGNs was characterized by chromatin condensation and DNA fragmentation.

Results:  Incubation with lithium (1–5 mM) attenuated this apoptosis markedly, in a dose–dependent way however, the addition of VPA (0.5–2 mM) did not protect CGNs. Colchicine‐induced apoptosis is mediated through the activation of caspase‐3. An increase in caspase‐3 activity was detected within 18 h and was blocked in presence of lithium 5 mM.

Conclusions:  Our data indicate that lithium treatment is selectively neuroprotective; however, in our experimental conditions VPA did not protect CGNs from apoptosis induced by colchicine. Our results support the hypothesis that distinct pathways mediate the neuroprotective effects of lithium and VPA.
A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders
Authors: Joffe Russell T , MacQueen Glenda M , Marriott Michael , Trevor Young L
Published: December 2004

Background:  There is a recent appreciation that patients with bipolar disorder spend a substantial period of time with minor or subsyndromal mood symptoms both manic and depressive. This study examined time spent in minor and subsyndromal mood states as well as with mania and depression in a cohort of well characterized bipolar I and II patients who were followed prospectively for an average of three years.

Method:  Detailed life‐charting data were obtained from 138 patients with bipolar disorder. Mood states were characterized as euthymic, subsyndromal, minor or major affective episodes based on rigorously defined criteria. The amount of time spent in these mood states during follow‐up was examined.

Results:  Patients in the total sample and within each bipolar subtype spent approximately half of their time euthymic. The remainder of the time was spent in varying severity of mood states. However, the majority of time was spent with minor and subsyndromal symptoms, both manic and depressive. Bipolar I patients differ from bipolar II in that significantly more time was spent with subsyndromal, minor and manic symptoms. There was no difference in time spent with depressive symptoms between the two groups.

Conclusions:  Patients with bipolar disorder spend a substantial proportion of time with depressive or manic symptoms with the preponderance being minor or subsyndromal. Awareness of subthreshold symptoms in bipolar disorders and treatment of such symptoms may be improved by establishing guidelines that specifically outline appropriate strategies for reducing the duration of subsyndromal symptoms in bipolar disorder.
Acute generalized peritonitis in adult African patients: Assessment of severity using APACHE II score
Authors: Adesunkanmi Abdul Rashid K. , Badmus Tajudeen A. , Agbakwuru E. Augustine , Ogunronbi Akinwumi B.
Published: December 2004

Background:  Generalized surgical acute abdomen is a significant cause of morbidity and mortality in the Nigerian environment. Severity assessment is useful in order to prioritize treatment and reduce morbidity and mortality. High severity scores are often faced with high morbidity and mortality; these patients, often require more intensive treatment than those with low severity scores. The purpose of this study was to assess the severity of generalized surgical acute abdomen in adult patients using the Acute Physiological and Chronic Ill Health Evaluation (APACHE II) score.

Methods:  All patients (184) aged 16 years and above, admitted and operated for generalized acute abdomen over a period of 6 years from January 1993 to December 1998 were prospectively studied. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Severity of illness was assessed using APACHE II parameters. Postoperative outcome and severity of illness were compared to determine the significance of severity of illness on postoperative outcome.

Results:  Thirty‐one patients (17%) died and 78 (42.4%) developed other postoperative complications. The APACHE II scores significantly correlated with the mortality and such other postoperative complications as residual intra‐abdominal abscess, abdominal sepsis, chest infection and faecal fistula (P < 0.05) and the duration of hospital stay (P < 0.05). The APACHE II scores ranged from 0 to 18, the mean score for survivors was 5.7, while it was 12.3 for those who did not survive. Only three (4%) patients who scored 0–5 died, six (9.4%) patients who scored 6–10, 15 (50%) patients who scored 11–15 and seven patients (87.5%) died who scored 16–20.

Conclusion:  The study showed that the severity of generalized peritonitis can be suitably assessed by APACHE II score in our environment and may serve as means of objective assessment of the quality of care. APACHE II score predicted mortality and morbidity in the patients studied. A further study is needed involving a larger number of patients to further validate our findings. We recommend to surgeons practicing in an environment similar to ours and to use the APACHE II scoring system in the assessment of patients with acute generalized peritonitis.
Surgical treatment of thyrotoxicosis: a local institution's perspective
Authors: Chow Tam‐Lin , Li Hok‐Nam , Chan Frank Chi‐Ho , Kwok Samuel Po‐Yin
Published: December 2004

Objective:  The most optimal form of thyroidectomy for thyrotoxicosis is controversial. Geographical factor, possibly due to the difference in iodine intake, can profoundly influence the therapy outcomes. The results of different forms of thyroidectomy in a local hospital for thyrotoxicosis is presented. Their pros and cons were evaluated.

Methods:  From January 1995 to December 2001, 69 patients with toxic goitres treated surgically were retrospectively studied. The factors potentially affecting the postoperative thyroid function were also analysed.

Results:  The mean follow‐up duration was 22.6 ± 17.2 months. The incidence of permanent vocal cord palsy and hypoparathyroidism were 0 and 2.9%, respectively. Remission, hypothyroidism, and recurrent hyperthyroidism occurred in 39, 52.5 and 8.5% respectively, of patients who have undergone either subtotal thyrodiectomy or Dunhill procedure (hemithyroidectomy plus contralateral subtotal lobectomy). Only the size of the remnant was found to be a significant factor of postoperative hypothyroidism (P = 0.048).

Conclusion:  Subtotal thyroidectomy or Dunhill procedure are efficacious in treating thyrotoxicosis with acceptable incidence of operative complications and recurrent hyperthyroidism. A significant portion of patients were rendered euthyroid without the need of thyroxine replacement.
Cystic squamous cell carcinoma metastasis to the neck masquerading as branchiogenic carcinoma
Authors: Ying Shun‐yuen , Ho Wai‐sun , Ahuja Anil , To Ka‐fai
Published: December 2004

Primary branchiogenic carcinoma was previously a debated entity for its existence. It was a popular diagnosis for any cystic carcinoma in the neck until in 1950 Martin et al. proposed specific and strict diagnostic criteria for this condition. Only a handful of cases successfully fulfilled all the criteria were reported afterwards. We report the management of a case who was diagnosed to have cystic squamous cell metastasis from a tonsillar origin. We suggest carrying out thorough search of the upper aero digestic tract for occult primaries upon finding of a cystic metastasis in the neck. Random biopsies in the region of Waldeyer's ring are of particular importance in this situation. Bilateral tonsillectomies should be carried out in doubtful cases. Radical neck dissection and postoperative radiotherapy to the diseased side is recommended.
Should we replace the mercury in glass thermometer with the tympanic thermometer?
Authors: Lo Siu‐Fai , Lau Lan‐Hing , Law In‐Chak , Yip Andrew Wai‐Chun
Published: December 2004

Objective:  The tympanic thermometer is very popular and has been recently introduced to the hospitals of the Hospital Authority of Hong Kong. However, disagreement between the tympanic thermometer and the traditional mercury in glass thermometer is quite frequent. We attempt to explore the feasibility of using the tympanic thermometer in surgical patients and analyse if this thermometer is mature enough to replace the mercury in glass thermometer.

Method:  Fifty consecutive febrile and afebrile patients admitted into the surgical ward of a regional hospital were enrolled. Temperature was recorded by both thermometers. Mean differences and averages of the recordings were analysed.

Results:  A mean difference of 0.018 ± 0.54°C was found between the readings of the two thermometers in afebrile patients. Clinically, this translates to a difference of 0.54°C above or below the oral temperature. For febrile patients the mean difference was 0.24 ± 0.53°C. Thus, this translates to a difference of 0.67°C above or below the oral temperature.

Conclusions:  There was almost 1°C discrepancy between the tympanic thermometer and the mercury in glass thermometer. Whether this will affect clinical management is not known. Further clinical study is required. We do not recommend the replacement of the traditional mercury in glass thermometer by the tympanic thermometer.
Laparoscopic inguinal hernia repair in children
Authors: Cheung Tan‐To , Chan Kwong‐Leung
Published: December 2004

Childhood inguinal hernia is a result of a congenital patent processus vaginalis. In order to prevent strangulation of viscera trapped in the defect, surgery is necessary. Conventional operation for childhood inguinal hernia involves the use of a skin incision over the groin to dissect out the sac, taking care not to injure the adjacent important structures, namely the vas deferens and testicular vessels. The sac is then divided and the proximal end transfixed. With the advance in minimally invasive surgery, laparoscopic repair of childhood inguinal hernia has been attempted. Modification of the technique by injecting normal saline extraperitoneally before the purse‐string closure of the neck of the processus vaginalis has made the procedure safer. An advantage of the laparoscopic procedure is that it allows detection and repair of the contralateral hernia. Randomised controlled trials are still required to verify the suggested advantages of better cosmesis outcome and more efficient pain control. Long‐term follow up in a large‐scale study is also desirable, to evaluate the cost‐effectiveness and possible complications of this mode of treatment.
Internal hernia traversing the lesser sac
Authors: Nikfarjam Mehrdad , Christophi Christopher
Published: December 2004

Congenital internal hernias are a rare cause of small bowel obstruction in adults and often present with complications. A high index of suspicion, occasionally aided by appropriate radiological imaging, may lead to early surgical intervention and reduce morbidity and mortality. A 25‐year‐old man presented with colicky abdominal pain and minimal signs on abdominal examination. Computed tomography showed features of a small bowel obstruction and prompted surgery. This revealed an internal hernia traversing the lesser sac through defects in both the gastrocolic ligament and lesser omentum. A gangrenous segment of small bowel incarcerated in the lesser omentum was resected and the patient made a full recovery. The published reports relating to lesser sac hernias are reviewed and features that may lead to early diagnosis identified.
Percutaneous endoscopic gastrostomy for recurrent gastric volvulus after laparoscopic gastropexy
Authors: Chi Ng Wing‐ , Yin Cheung Ka‐ , Tat Leong Heng
Published: December 2004

A 44‐year‐old lady with an acute gastric volvulus was initially treated by laparoscopic anterior gastropexy after gastric decompression and derotation. She developed recurrent volvulus 4 weeks after the initial laparoscopic surgery. Double percutaneous endoscopic gastrostomy (PEG) fixation of the stomach was carried out to prevent recurrent volvulus. Unfortunately, one of the PEG tubes migrated out of the stomach 4 weeks later. Another PEG fixation was carried out on the patient. There has been no recurrence of gastric volvulus 9 months after the removal of the PEG tubes. The reasons of failure in laparoscopic and endoscopic gastropexy are discussed in the present report. Repeated PEG fixation of stomach is a feasible and less invasive option in preventing recurrent gastric volvulus after failure of laparoscopic and endoscopic gastropexy.
New orthodontic and orthopaedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting
Authors: Liou Eric Jein‐Wein , Chen Philip Kwo‐Ting
Published: December 2004

At the age of mixed dentition, a downward or laterally displaced premaxilla with a wide alveolar cleft in patients with bilateral cleft lip and palate remains a dilemma both for orthodontists and surgeons. These premaxillary deformities not only make the alveolar bone grafting difficult but also aesthetically and functionally unacceptable. The purpose of the present article is to introduce three new orthodontic and orthopaedic techniques for solving these premaxillary deformities and facilitating alveolar bone graft through a non‐surgical approach. These techniques are the premaxillary orthopaedic intrusion for correcting a downward displaced premaxilla, the premaxillary orthopaedic repositioning for correcting a laterally displaced premaxilla, and maxillary orthopaedic protraction by alternate rapid maxillary expansions and constrictions for minimizing a wide alveolar cleft. They were evaluated clinically and cephalometrically for their treatment effects. The results revealed that the premaxillary and cleft deformities were corrected in a short period of time and therefore the alveolar bone grafting could be carried out without difficulty in all of the patients who received the treatment. The treatment effects were mostly orthopaedic and partly orthodontic. No growth disturbance on the maxilla was observed throughout the treatment. These new orthodontic and orthopaedic techniques are very effective for solving the difficult‐to‐treat premaxillary deformities and facilitating the alveolar bone grafting in the patients with bilateral cleft.
A double‐blind placebo controlled study of tamsulosin in the management of benign prostatic hyperplasia in an Indian population
Authors: Mohanty Nayan Kumar , Nayak Rajiba L. , Malhotra Vineet , Arora Rajender Prakash
Published: December 2004

Objective:  Benign prostatic hyperplasia is a common disorder in ageing males worldwide affecting one out of four males over 50 years of age. The aim of the present study is to demonstrate safety and efficacy of tamsulosin in its medical management.

Methods:  A total of 72 patients were enrolled; 38 patients given tamsulosin and 34 in the placebo group were enrolled. The mean age group was 61 years. Patients with an International Prostate Symptom Score (IPSS) of> 10, maximum flow rate < 13 mL/s and average flow rate < 6 mL/s with post residual urine volume (PRUV) > 100 mL and prostate‐specific antigen < 4 ng/mL, were given 0.4 mg of tamsulosin/placebo daily on a randomized double‐blind controlled study for 2 months. Patients with renal or hepatic failure, carcinoma prostate, stricture urethra, neurogenic bladder were excluded. All patients were followed up at the end of the second, fourth and eighth week.

Results:  There were three dropouts leaving 69 patients for evaluation. Improvement in the IPSS score was significantly greater with tamsulosin compared with the placebo. Similarly there was significant improvement in uroflowrate with tamsulosin compared to the placebo. The PRUV decreased by 38.8% with tamsulosin compared with the placebo. No significant change in blood biochemistry was noted between the two groups excepting for blood pressure, which showed a fall with tamsulosin compared to placebo. Adverse reaction was noted in five patients (7%), but none were withdrawn from the study.

Conclusions:  Our study confirms tamsulosin as a very effective and safe drug in the management of benign prostatic hyperplasia patients not having absolute indication for surgery with excellent patient compliance.
Neuromast formation in the prehatching embryos of the Japanese flounder (Paralichthys olivaceus)
Authors: Otsuka Machiko
Published: December 2004

The present paper clarifies the initial development of the lateral line organs in the embryonic Japanese flounder, Paralichthys olivaceus. The first appearances of lateral line primordia, and the proliferation, distribution and morphological development of the free neuromasts, including nerve ending formation: establishment of hair cell innervations via the formation of synapses, were examined by light microscopy, scanning and transmission electron microscopy. The first pair of neuromast primordia appeared in the otic region ≈ 30 h prior to hatching and subsequently differentiated into free neuromasts, otic neuromasts, after ≈ 8 h. At hatching, a pair of free neuromasts and three pairs of neuromast primordia were present on the head, and three pairs of neuromast primordia were present on the trunk. The hair cell polarity of the otic neuromast until just prior to hatching was radial, but not bi‐directional. The typical afferent and efferent nerve endings in the otic neuromasts had formed by the time of hatching, suggesting that the otic neuromasts are functional prior to hatching. The three neuromast primordia located on each side of the trunk were derived from a long, narrow ectodermal cell cluster and erupted through the epidermis after hatching.
Epidermal ciliary ultrastructure of adult and larval sipunculids (Sipunculida)
Authors: Lundin Kennet , Schander Christoffer
Published: December 2004

The ultrastructure of the ciliary apparatus of multiciliated epidermal cells in larval and adult sipunculids is described and the phylogenetic implications discussed. The pelagosphera of Apionsoma misakianum has a dense cover of epidermal cilia on the head region. The cilia have a long, narrow distal part and two long ciliary rootlets, one rostrally and one vertically orientated. The adult Phascolion strombus has cilia on the nuchal organ and on the oral side of the tentacles. These cilia have a narrow distal part as in the A. misakianum larva, but the ciliary rootlets have a different structure. The first rootlet on the anterior face of the basal body is very short and small. The second, vertically orientated rootlet is long and relatively thick. The two ciliary rootlets present in the larval A. misakianum are similar to the basal metazoan type of ciliary apparatus of epidermal multiciliated cells and thus likely represent the plesiomorphic state. The minute first rootlet in the adult P. strombus is viewed as a consequence of a secondary reduction. No possible synapomorphic character with the phylogenetically troublesome Xenoturbella was found.
The sperm ultrastructure of Merluccius merluccius (Teleostei, Gadiformes): phylogenetic considerations
Authors: Medina Antonio , Megina César , Abascal Francisco J. , Calzada Alfonso
Published: December 2004

The anacrosomal aquasperm of the gadiform Merluccius merluccius is ultrastructurally similar to the advanced type II spermatozoa (perciform‐type sperm) typically found in most Perciformes. The perciform‐type spermatozoon is characterized by the lateral insertion of the flagellum and the location of the centrioles outside the nuclear fossa. Apart from these characteristics, the spermatozoon of M. merluccius is remarkable because of the mutually parallel arrangement of the centrioles, a rare feature among fishes, which is considered an apomorphic condition for animal sperm cells. Within the superorder Paracanthopterygii, which contains a large diversity of sperm patterns resulting from a high number of apomorphies, a perciform‐type sperm is present only in the order Gadiformes. The significance of the presence of perciform‐type spermatozoa in the three investigated gadiform families is discussed in a phylogenetic context.
First description of collar receptors in Temnocephalidae (Platyhelminthes)
Authors: De León Rodrigo Ponce , Volonterio Odile
Published: December 2004

Two species of Temnocephala (Platyhelminthes, Temnocephalida, Temnocephalidae), namely Temnocephala iheringi and Temnocephala haswelli, have collar receptors in the epidermis of the tentacles and general body surface, but not in the sucker region. These receptors were seen associated with clusters of 20–22 monociliary receptors. All collar receptors found in these temnocephalids bore six stereocilia. Other neoophoran platyhelminths have a constant number of eight stereocilia per collar receptor, the only exception being members of another family of Temnocephalida, the Didymorchidae, where collar receptor cells with five and six stereocilia have been recorded. Therefore, the presence of a lower number of stereocilia per collar receptor is likely to be an apomorphic trait of the Temnocephalida.
Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome
Authors: Prollius A. , de Vries C. , Loggenberg E. , du Plessis A. , Nel M. , Wessels P.H.
Published: December 2004

Objective  The aim of this study was to evaluate the efficacy of uterine artery embolisation (UAE) in myomatous uteri larger than 24 week's gestation (780 cm3).

Design  Prospective case contro study.

Setting  Universitas Hospital, University of the Free State, Bloemfontein, South Africa.

Population  Sixty‐one women, who underwent UAE, were included in the study. The study group comprised of 12 women with uteri ≥780 cm3 and the control group 49 women with uteri <780 cm3.

Methods  UAE was performed and the difference in outcome for the two groups was determined at 12 months.

Main outcome measure  Symptomatic improvement with embolisation of the large uterus.

Results  Reduction of dysmenorrhoea, menorrhagia and pressure effects was similar for both groups. The median reduction in uterine volume (pre‐ to post‐embolisation) was 188 cm3 (range 28–2038 cm3) with a 95% CI for the median difference for paired data of 146.5 and 236. Only 66% of the study group had, however, a reduction in volume to <780 cm3. The complication rates were similar for the two groups with regards to post‐embolisation syndrome, fibroid slough, haematoma formation, infection, hysterectomy and failure to embolise. Satisfaction was similar between the two groups, with 91% of women satisfied with the procedure.

Conclusion  The large uterus does not decrease UAE's efficacy. Although 33.3% of the study group still had a uterus of ≥780 cm3, symptom reduction was still similar for both groups. Women may thus still be left with a large uterine volume but without symptoms. This must be taken into consideration when counselling women with an extremely large uterus for UAE.
Does Postpartum Length of Stay Affect Breastfeeding Duration? A Population‐Based Study
Authors: Heck Katherine E. , Schoendorf Kenneth C. , Chávez Gilberto F. , Braveman Paula
Published: December 2004

Abstract: Background: Short postpartum hospital stays may leave inadequate time for women to receive assistance with breastfeeding. Women leaving the hospital early may also have household responsibilities that could interfere with breastfeeding. This study examined the relationship between postpartum length of stay and breastfeeding cessation.

Methods: This study used data from 10,519 respondents to the California Maternal and Infant Health Assessment (MIHA) surveys from 1999 to 2001. MIHA is an annual statewide stratified random sample, population‐based study of childbearing women in California. Survival analysis was used to examine the relationship between length of stay and length of time breastfeeding. Women were asked about the number of nights their infant stayed in the hospital at birth, whether they breastfed, and if so, the age of the child when they stopped. Hospital stay was defined in three categories: standard (2 nights for a vaginal delivery, 4 nights for a cesarean section), or shorter or longer than the standard stay.

Results: Approximately 88 percent of women initiated breastfeeding. Unadjusted predictors of breastfeeding cessation included short or long postpartum stay; young maternal age; Hispanic, African American, or Asian/Pacific Islander race/ethnicity; being unmarried; low income or education level; primiparity; being born in the 50 United States or the District of Columbia; smoking during pregnancy; and low infant birthweight. After adjustment for potential confounders, women with a short stay remained slightly more likely to terminate breastfeeding than women with a standard stay (relative risk, 1.11, 95% confidence interval 1.01, 1.23).

Conclusion: Women who leave the hospital earlier than the standard recommended stay are at somewhat increased risk of terminating breastfeeding early. (BIRTH 30:3 September 2003)