bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of traumatic injuries treated in the pedodontic clinic of Ankara University, Turkey, during 18 months
Authors: Şaroğlu Işıl , Sönmez Hayriye
Published: March 2003

Abstract   –  The purpose of this study was to evaluate the type and prevalence of dental injuries referred to Ankara University, School of Dentistry, Department of Pedodontics, Turkey. One hundred and forty‐seven patients with 234 traumatized teeth presented during 18‐month interval. Of the 147 patients, 85 were boys and 62 were girls. The most frequent trauma occurred in the age of 11 years. The maxillary central incisors were found to be the most affected tooth in both primary and permanent dentition injuries. The maxillary arch is involved in a higher percentage of trauma cases (95.72%). The most common cause of injuries are falls (67.34%). In the primary dentition, the most common type of injury is extrusive luxation (38.23%) and in the permanent dentition, it is fracture of enamel–dentin without pulpal involvement (50.5%). From 147 patients, only 82 presented to our clinic within 1 h and 10 days after the injury time. It reveals that there is a need to inform the public of what they should do in cases of dental trauma, and how important it is to contact a dentist immediately.
The role of endodontics in the treatment of luxated permanent teeth
Authors: Barnett Frederic
Published: March 2003

Abstract  – Pulp necrosis is a common complication following traumatic dental injuries and is related to the type and severity of the injury, as well as to the stage of development of the injured tooth. Endodontic intervention is required when there are clinical and radiographic signs of pulpal infection and its sequelae. Arrested tooth development with periradicular pathosis, external inflammatory root resorption, sinus tract formation and pain on percussion are indicative of root‐canal infection in the post‐traumatized teeth, and require immediate endodontic treatment. The use of calcium hydroxide in the treatment of teeth with post‐traumatic pulp necrosis and its sequelae has been shown to be extremely beneficial for the long‐term retention of the injured teeth. Calcium hydroxide has been shown to arrest and repair external inflammatory root resorptive defects, eliminate the endodontopathic microorganisms from the root canal system and induce hard‐tissue barrier formation at the apex of non‐vital immature teeth. This paper reviews the endodontic treatment required by post‐traumatic non‐vital permanent teeth.
The effect of intracanal Ledermix on root resorption of delayed‐replanted monkey teeth
Authors: Wong Kian Seong , Sae‐Lim Varawan
Published: March 2003

Abstract  
–
 Progressive root resorption is one of the common sequelae in replanted teeth, which is detrimental to their long‐term prognosis. Ledermix paste, with its composition of triamcinolone acetonide and demethylclortetracycline, has been shown to inhibit inflammation and the associated hard tissue resorption. This study evaluated the effect of immediate intracanal Ledermix on root resorption of delayed‐replanted monkey teeth. A total of 36 roots were root canal treated. For the experimental group, intracanal Ledermix was placed prior to extraction and replantation after 1‐h bench dry. The positive control group was root filled and replanted after 1 h while the negative control group was root filled and replanted immediately. The monkeys were sacrificed after 12 weeks. The H&E histological tissue specimens were prepared and evaluated using a method modified from that of Andreasen's morphometric analysis, as favorable or complete healing and unfavorable healing, comprising inflammatory root resorption and replacement resorption. The results were analyzed using Kruskal–Wallis and Mann–Whitney U‐tests as well as Wilcoxon signed ranks test. The negative control group produced highly significant favorable healing and unfavorable healing as compared to the Ledermix group (P = 0.000). The Ledermix group only showed significantly higher occurrence of complete healing (35.46%) compared to the positive control group (16.58%) (P = 0.037) but there were no significant differences in the inflammatory root resorption and replacement resorption. Nevertheless, when the latter two unfavorable healing patterns were combined, there was a significantly lower overall unfavorable healing in the Ledermix group (64.54%) when compared to the positive control group (83.43%) (P = 0.037). This unfavorable healing outcome in the Ledermix group, however, was not significantly different from the favorable healing outcome with the same treatment modality (P = 0.110).
Dental emergencies presenting to a dental teaching hospital due to complications from traumatic dental injuries
Authors: Al‐Jundi Suhad H.
Published: March 2003

Abstract  – In Jordan, only two surveys of dental trauma have been carried out. The aim of this study was to determine the incidence and pattern of dental emergencies resulting from traumatic injuries, as well as treatment provided to children presenting with these dental emergencies. Over a 1‐year period, 620 children presented to our pediatric dental clinics with dental emergencies; 195 (31%) of these emergencies were a consequence of dental trauma to 287 teeth and were included in the study. The average time between the trauma and the dental emergency was 5 months. Pain or sensitivity was the most frequent presenting symptom (31.3%) followed by swelling or sinus tract (17.4%). The age of these patients ranged from 15 months to 14 years, with an average age of 9.3 years. Males accounted for 75.4% of the children in the samples, whereas females accounted for only 24.6%. The main cause of dental trauma was falling during play (58.5%); the least common cause was motor vehicle accidents, accounting for only 1.5% of all injuries. Most of the dental injuries occurred at home (41.5%), around noon time. The most commonly involved teeth were permanent maxillary central incisors accounting for 79.5% of all teeth involved by dental trauma. The most frequently encountered type of trauma in this sample was crown fracture seen in 76.6% of the teeth . Soft tissue injuries were estimated to occur in 16.9% of the children. The treatment received by the children in the sample ranged from no active treatment (6.2%) to elaborate dental procedures such as pulp therapy (41.3%) and prosthetic replacement of missing teeth (5.1%).
Inner city maxillofacial fractures due to road traffic accidents
Authors: Fasola A.O. , Lawoyin J.O. , Obiechina A.E. , Arotiba J.T.
Published: March 2003

Abstract –  A prospective study of 159 patients seen with maxillofacial fractures as a result of road traffic accidents in a Nigerian inner city was performed. The male to female ratio was 2.9 : 1 and the dominant age group was 21–30 years. Occupants of commercial vehicles were the ones mostly involved; involvement of rear seat occupants was high. Increased numbers of patients were seen on Saturdays and in the month of June. This study substantiates the fact that there is added risk of sustaining facial fractures during the rainy and leisure periods. Therefore, there is a need to stress the importance of common restraint devices and good road habits during these ‘high risk’ periods to reduce the incidence of maxillofacial fractures due to the road traffic accidents.
Spontaneously healed root fracture: report of a case
Authors: Artvinli Leyla Berna , Dural Sema
Published: March 2003

Abstract  – Blows to the facial region can cause root fractures especially in anterior teeth. Fractures below the alveolar crest have a very high potential for healing and treatment consists of reduction and rigid splinting immediately after trauma. The aim of the treatment is to obtain reunion of the fragments. Although the fracture can heal spontaneously, the prognosis will not be as good as the correctly treated ones. The purpose of this paper is to report a case of spontaneously healed root fracture.
The effects of subanaesthetic concentrations of xenonin volunteers*
Authors: Bedi A. , McCarroll C. , Murray J. M. , Stevenson M. A. , Fee J. P. H.
Published: March 2003

This study reports the subjective, psychomotor and physiological properties of subanaesthetic concentrations of xenon. Ten healthy male volunteers received either xenon or nitrous oxide in a randomised crossover study design. The subjects breathed either xenon (Xe) or nitrous oxide (N2O) from a closed circuit breathing system, according to a randomised, double‐blind protocol. The concentration of xenon required to produce sedation, ranged between 27 and 45%(median 35%). All subjects completed the xenon protocol. Subjects were tested using the Critical Flicker Fusion test and derived electroencephalogram parameters, however, neither test was found to reliably predict sedation. The respiratory rate decreased markedly during sedation with xenon. The subjects did not experience any airway irritability (coughing, breath‐holding or laryngospasm) during administration of either gas. One subject required anti‐emetic treatment in the N2O group compared to none in the Xe group. Eight subjects reported that they found sedation with xenon pleasant and preferable to nitrous oxide. Xenon sedation was well tolerated and was not associated with any adverse physiological effects, however, it was reported to be subjectively dissimilar to nitrous oxide.
Non‐obstetric surgery during gestation: Risk factors for lower birthweight
Authors: Jenkins Thomas M. , Mackey Suzanne F. , Benzoni Elisa M. , Tolosa Jorge E. , Sciscione Anthony C.
Published: March 2003

Objective: To assess the risk for preterm birth and low birthweight for women undergoing non‐obstetric surgery during gestation.

Design: Two perinatal tertiary care centres.

Population: Women undergoing non‐obstetric surgery during gestation between January 1989 and June 1999.

Materials and methods: A chart review was carried out. Cervical cerclages, procedures carried out under local anaesthesia or intravenous sedation, or carried out in combination with Caesarean delivery were excluded.

Main outcome measures: Preterm birth (<37 weeks), birthweight.

Results: A total of 116 of 69 800 women (0.2%) underwent non‐obstetric surgery, with 96 women delivering under our care. Procedures were more commonly carried out in the second trimester (53%), versus the first (23%) or third trimester (24%). Surgery in the second trimester resulted in the lowest rate of preterm birth (11%). The overall preterm birth rate was 21% (20/96), with 13 out of 20 (65%) occurring between 35 and 37 weeks. The mean interval from surgery to delivery was 18.7 weeks. Rates of preterm birth were similar for either intra‐ versus extra‐abdominal procedures, or general versus regional anaesthetic. Use of a general anaesthetic was associated with a significant decrease in birthweight (3053 vs 3515 g, P = 0.01) despite similar gestational ages at delivery (37.6 vs 38.6 weeks, P = 0.08). Multiple linear regression controlled for gestational age showed that general anaesthesia, longer surgery duration, and intra‐abdominal procedures were all significant independent risk factors for lower birthweight.

Conclusion: While non‐obstetric surgery appears to be relatively safe during gestation, general anaesthesia, longer surgery time, and intra‐abdominal procedures are associated with lower birthweights.
Management of labour among women with epidural analgesia
Authors: Roberts Christine L. , Raynes‐Greenow Camille H. , Upton Alexis , Douglas Ian D. , Peat Brian
Published: March 2003

To assess current practices in the labour management of low risk primiparous women with epidural analgesia we surveyed delivery suites in New South Wales (NSW) that annually provide at least 100 epidurals to ‘standard primipara’. Epidural rates among ‘standard primipara’ at these hospitals ranged from 14 to 85% (median 46%). Continuous epidural infusion was the most commonly used technique (63%). For ‘standard primipara’ with an epidural 62% of units usually augmented labour with oxytocin, 89% discontinued the epidural in second stage and 67% had policies of delayed pushing. There is wide variation in epidural availability and in labour management, perhaps reflecting the limited evidence for effective interventions to reduce any unintended effects of epidural analgesia.
Elevation of serum thrombopoietin precedes thrombocytosis in acute infections
Authors: Ishiguro Akira , Suzuki Yoko , Mito Mari , Shimbo Toshikazu , Matsubara Kousaku , Kato Takashi , Miyazaki Hiroshi
Published: March 2003

Summary.  To clarify the mechanisms underlying thrombocytosis secondary to infections, we longitudinally studied serum levels of thrombopoietin (TPO) and interleukin (IL)‐6 in 15 infants and young children with prominent thrombocytosis (platelets > 700 × 109/l) following acute infections and 116 age‐matched controls using an enzyme‐linked immunosorbent assay. The subjects included nine patients with bacterial infections, three with viral infections and three with non‐determined pathogens. TPO values in the controls were 2·24 ± 0·87 fmol/ml (mean ± SD) with a 95% reference interval of 0·85–4·47 fmol/ml. In the first week of infection, platelet counts were normal, but TPO values increased (∼10·73 fmol/ml). TPO levels peaked on day 4 ± 2 at 6·44 ± 2·37 fmol/ml and then fell gradually. When platelet counts peaked in the second and third weeks, TPO levels were similar to the controls. IL‐6 levels in the first week rose and dropped more rapidly than TPO. Serum TPO values were significantly correlated with C‐reactive protein levels (r = 0·688, P < 0·001) and IL‐6 levels (r = 0·481, P = 0·027). These results suggest that TPO contributes to thrombocytosis following infections in conjunction with IL‐6, arguing for additional regulatory mechanisms of blood TPO levels.
Long‐haul flights and deep vein thrombosis: a significant risk only when additional factors are also present
Authors: Arya Roopen , Barnes Jules A. , Hossain Upal , Patel Raj K. , Cohen Alexander T.
Published: March 2003

Summary. To address the association between travel and deep vein thrombosis (DVT) we examined the risk factors for DVT in 568 consecutive patients with suspected DVT attending King's College Hospital in London. No significant link between DVT and long‐haul travel was demonstrable in this cohort, with an odds ratio of 1·3 (CI 0·6–2·8). Risk of DVT was only increased in long‐haul travellers if one or more additional risk factors were present, with an odds ratio of 3·0 (CI 1·1–8·2). Such individuals may benefit from prophylactic measures to minimize risk.
Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic
Authors: Timmers Gert Jan , Van Der Zwet Wil C. , Simoons‐Smit Ina M. , Savelkoul Paul H. M. , Meester Helena H. M. , Vandenbroucke‐Grauls Christina M. J. E. , Huijgens Peter C.
Published: March 2003

Summary. We describe an outbreak of vancomycin‐resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case–control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE‐negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25·8 versus 10·1 d, P=0·02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9·5, 95% confidence interval (CI95) 2·4–32·2] and higher grades of mucositis (P=0·03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13·0, CI95 2·1–80·5, P=0·006) and low albumin levels at baseline (OR 1·2, CI95 1·1–1·3, P=0·02) to be independent risk factors. Four patients with VRE‐bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid®). Control of the outbreak was achieved by step‐wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.
Ex vivo expansion of megakaryocyte progenitor cells from normal bone marrow and peripheral blood and from patients with haematological malignancies
Authors: Blair Allison , Baker Caroline L. , Pamphilon Derwood H. , Judson Philip A.
Published: March 2003

Summary. A number of haematological and non‐haematological malignancies can be successfully treated using high‐dose chemotherapy ± irradiation followed by haematopoietic progenitor cell transplantation. Post transplant, thrombocytopenia and neutropenia always occur and patients require platelet transfusions. It may be possible to reduce the period of thrombocytopenia by re‐infusion of ex vivo expanded megakaryocyte progenitors (MP), derived from the progenitor cell graft. We have investigated the expansion of MP from CD34+ enriched cells from normal bone marrow (NBM) and peripheral blood (PB) and remission BM or PB samples from patients with haematological malignancies. CD34+ cells were cultured in serum‐free medium supplemented with thrombopoietin (TPO), interleukin 1 (IL‐1), IL‐6 and stem cell factor (SCF) for 7 d, then cell proliferation was assessed by flow cytometry using lineage‐specific markers. It was possible to significantly expand the number of MP cells from all sources. There were no major differences in yields of MP from normal BM or PB, or BM from multiple myeloma and non‐Hodgkin's lymphoma patients. However, expansion of MP in acute myeloid leukaemia samples was lower than all other samples and the number of megakaryocyte colony‐forming units was reduced. Several cytokine combinations were evaluated to optimize MP expansion from NBM. Equivalent yields of MP were obtained using TPO and one of IL‐1, IL‐3, granulocyte–macrophage colony‐stimulating factor or SCF, suggesting that large cytokine combinations are not necessary for this procedure. It should be possible to scale up the culture conditions described to produce effective MP doses for clinical transplantation.
Clinical significance of vascular endothelial growth factor and hepatocyte growth factor in multiple myeloma
Authors: Iwasaki Tsuyoshi , Hamano Teruaki , Ogata Atsushi , Hashimoto Naoaki , Kitano Masayasu , Kakishita Eizo
Published: March 2003

Summary. Angiogenesis is a crucial process in the progression of multiple myeloma (MM). Vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) are multifunctional cytokines that potently stimulate angiogenesis including tumour neovascularization. Serum levels of VEGF and HGF were measured in 52 patients with MM by enzyme‐linked immunosorbent assay (ELISA). Serum levels of VEGF and HGF were elevated in MM patients compared with healthy controls (VEGF: mean 0·31 ng/ml and 0·08 ng/ml respectively, P < 0·01; HGF: mean 2·17 ng/ml and 0·45 ng/ml, respectively, P < 0·001). In serial samples taken after chemotherapy, serum VEGF and HGF levels were correlated with M‐protein levels. Serum levels of VEGF were higher in patients with extramedullary plasmacytomas than in patients without them (P < 0·05). They were also significantly higher in a group of patients who showed poor response to chemotherapy (P < 0·01). Serum levels of HGF were higher in patients with complications such as anaemia, hypercalcaemia and amyloidosis than in patients without these complications (P < 0·01, P < 0·05, P < 0·05 respectively). Both serum VEGF and HGF levels were significant predictors of mortality (P = 0·01, P = 0·02, respectively, log‐rank test). The present study demonstrated that serum levels of VEGF and HGF are significantly elevated and dependent on the severity of MM, suggesting that measurement of VEGF and HGF may be useful for assessing disease progression and for predicting the response to chemotherapy in MM patients.
Follow-up confirms sustained benefit of circumferential stapled anoplasty in the management of prolapsing haemorrhoids
Authors: Beattie G C , Loudon M A
Published: March 2003

Background

Circumferential stapled anoplasty is gaining popularity as a safe and effective treatment in the surgical management of haemorrhoids and mucosal prolapse. However, little is known about the medium- and long-term durability of this procedure. The aim of this study was to evaluate the medium-term results of stapled anoplasty in maintaining symptom remission and to identify possible procedure-related adverse effects.

Methods

Of a consecutive series of 85 stapled anoplasties in 83 patients, 64 patients were eligible for 6-month review; 50 patients were seen in surgical outpatient clinics and seven were contacted by telephone. All patients attending the outpatient clinic were questioned about current symptoms and overall satisfaction with the procedure. The staple line was palpated digitally and inspected at proctoscopy.

Results

Median (interquartile range) symptom scores were 6 (5–8) before operation compared with 0 (0–1) at 6 months (P < 0·01). There was no deterioration in symptoms between 6-week and 6-month follow-up. No recurrences and no procedure-related adverse effects, in particular impaired continence or persistent anal pain, were identified.

Conclusion

The initial promising results of circumferential stapled anoplasty in effectively treating haemorrhoidal symptoms appear to be sustained at 6-month follow-up.
Endocoil magnetic resonance imaging quantification of external anal sphincter atrophy
Authors: Williams A B , Bartram C I , Modhwadia D , Nicholls T , Halligan S , Kamm M A , Nicholls R J , Kmiot W A
Published: March 2003

Background

Anal function depends on the integrity and quality of the sphincter muscles. The diagnosis of external anal sphincter atrophy on endocoil magnetic resonography has been associated with poor outcome from sphincter repair, although the imaging criteria for atrophy remain unclear.

Methods

Women with intact sphincters on endosonography and either normal (more than 60 cmH2O) (n = 9) or low (n = 16) squeeze pressures had endocoil magnetic resonography and electromyography. The area and fat content of the external anal sphincter and puborectalis were measured on mid-coronal magnetic resonography and images were graded as showing normal, intermediate or advanced atrophy. The definition of the external anal sphincter on endosonography and the thickness of the internal anal sphincter were also assessed.

Results

Women with a normal anal squeeze pressure had a larger external anal sphincter cross-sectional area (mean(s.d.) 240(56) versus 193(62) mm2; P = 0·01) with a lower mean fat content (mean(s.d.) 23(4) versus 30(6) per cent; P < 0·001) than those with low squeeze pressures. There was an overall correlation between squeeze pressure, cross-sectional area (r = 0·32, P = 0·02) and fat content (r = − 0·51, P < 0·001). Patients with a thin (less than 2 mm) internal anal sphincter and/or a poorly defined external sphincter on endosonography were more likely to have atrophy (positive predictive value 74 per cent).

Conclusion

Potential endosonographic markers for external anal sphincter atrophy are suggested, and a visual scale for endocoil magnetic resonographic assessment has been validated.
Prediction of prognosis by echocardiography in patients with midgut carcinoid syndrome
Authors: Westberg G , Wängberg B , Ahlman H , Bergh C H , Beckman-Suurküla M , Caidahl K
Published: March 2003

Background

The association between malignant midgut carcinoid tumours and right-sided cardiac lesions is well known, but the pathogenetic link between tumour secretion and valvular disease is still obscure. The purpose of this investigation was to describe the morphological and functional changes of valvular heart disease in a large patient series and to correlate these findings with hormonal secretion and prognosis.

Methods

Of 64 consecutive patients with the midgut carcinoid syndrome followed between 1985 and 1998, valvular heart disease was evaluated in 52 patients by two-dimensional echocardiography, Doppler estimation of valvular regurgitation and flow profiles. A majority was also evaluated with exercise electrocardiography and spirometry.

Results

Structural and functional abnormalities of the tricuspid valve were found in 65 per cent of patients, while only 19 per cent had pulmonary valve regurgitation. Long-term survival was related to excessive urinary excretion of 5-hydroxyindole acetic acid of over 500 µmol in 24 h, but the main predictor of prognosis was the presence of severe structural and functional abnormalities of the tricuspid valve. Although advanced tricuspid abnormalities were prevalent in this series, only one patient died from right ventricular heart failure.

Conclusion

Tricuspid valvular disease is a common manifestation of the midgut carcinoid syndrome and advanced changes are associated with poor long-term survival. Active surgical and medical therapy of the tumour disease reduced the hormonal secretion and, combined with cardiological surveillance, made right ventricular heart failure a rare cause of death in these patients.
Criteria for extramural perineural invasion as a prognostic factor in rectal cancer
Authors: Ueno H , Hase K , Mochizuki H
Published: March 2003

Background

An abundant extramural autonomic nerve network is an anatomical feature of the rectum. Extramural perineural invasion (PNI) may influence the prognosis after resection of rectal cancer, however, few assessment criteria exist.

Methods

PNI was investigated in 364 patients who underwent curative surgery for rectal cancer penetrating the muscular layer. A grading system was established based on the ‘intensity’ (number of PNI foci in a 20-power field) and ‘depth’ (distance from the muscularis propria) of PNI. PNI-0 was defined as without PNI, PNI-1 as ‘intensity’ of less than five foci and ‘depth’ less than 10 mm, and PNI-2 as five or more foci or 10 mm or greater ‘depth’ of invasion.

Results

PNI was observed in 52 patients (14 per cent) and strongly correlated with pathological tumour node metastasis (pTNM) stage. Five-year survival was related to PNI grade (74 per cent in PNI-0, 50 per cent in PNI-1 and 22 per cent in PNI-2). The rate of local recurrence was also related to PNI stage: 43 per cent in PNI-2 and 9 per cent in both PNI-0 and PNI-1. Multivariate analyses showed that graded PNI was associated both with local recurrence and long-term survival, independent of tumour depth (pTNM T) and nodal involvement (pTNM N).

Conclusion

The PNI grading system may be useful in prognosis and allow case selection for intensive postoperative adjuvant therapy.
Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease
Authors: Mofidi R , Crotty T B , McCarthy P , Sheehan S J , Mehigan D , Keaveny T V
Published: March 2003

Background

Angiogenesis is a recognized feature of the atherosclerotic process and has been described in the context of unstable coronary atherosclerotic lesions. The aim of this study was to assess the association between angiogenesis in atherosclerotic carotid plaques and microscopic features of plaque instability, in particular intraplaque haemorrhage.

Methods

Consecutive patients undergoing carotid endarterectomy were included. Endarterectomy specimens were divided into their constituent atherosclerotic lesions. Histological sections were prepared and stained with haematoxylin and eosin, and immunohistochemically with an endothelial cell marker (CD34). The quantity of intraplaque haemorrhage was measured in transverse histological sections using computerized image analysis. Microvessel counts were performed in CD34-stained sections and were verified through computerized image analysis.

Results

Some 239 atherosclerotic lesions from 73 patients were available for analysis; 73 were early lesions, 74 were raised fibroatheromas and 92 were unstable atherosclerotic plaques. One hundred and fifty lesions were not haemorrhagic; 89 exhibited intraplaque haemorrhage, of which 28 involved less than 50 per cent of the plaque sectional area. There were higher microvessel counts in plaques containing over 50 per cent haemorrhage (P < 0·0001), unstable atherosclerotic lesions (P < 0·0001) and atherosclerotic lesions obtained from symptomatic patients (P < 0·001).

Conclusion

There are strong associations between plaque vascularity, quantity of intraplaque haemorrhage and presence of symptomatic carotid occlusive disease.
Chronic pain and quality of life following open inguinal hernia repair
Authors: Poobalan A S , Bruce J , King P M , Chambers W A , Krukowski Z H , Smith W C S
Published: March 2003

Background

The aim was to determine the frequency and characteristics of chronic pain following open inguinal hernia repair and to identify risk factors for its development.

Methods

This was a questionnaire survey of a historical cohort of patients who underwent inguinal hernia surgery in Aberdeen. The sample comprised all patients (n = 351) who underwent surgery between January 1995 and December 1997, and who were alive and resident in Grampian in October 1999. Outcome measures included self-report of pain persisting for more than 3 months after operation. Pain was characterized by means of the McGill Pain Questionnaire, and quality of life was assessed with the Short Form 36 (SF-36).

Results

A total of 226 patients (64 per cent) completed the questionnaire, 67 (30 per cent) of whom reported chronic pain. Reported pain was predominantly neuropathic in character. Patients at increased risk of chronic pain were under 40 years old (P < 0·001), had day-case surgery (P = 0·004), had subsequent surgery on the same side (P < 0·005) and recalled pain before operation (P = 0·005). The SF-36 scores were significantly different in the social functioning, mental health and pain dimensions in patients with chronic pain.

Conclusion

Chronic pain occurred in 30 per cent of patients after open hernia repair, a higher frequency than has been reported previously. Several risk factors were identified and further prospective research is recommended.
Liver regeneration after major hepatectomy for biliary cancer
Authors: Nagino M , Ando M , Kamiya J , Uesaka K , Sano T , Nimura Y
Published: March 2003

Background

The aim of this study was to evaluate serial changes in liver volume after major hepatectomy for biliary cancer and to elucidate clinical factors influencing liver regeneration.

Methods:  

Serial changes in liver volume were determined, using computed tomography, in 81 patients with biliary cancer who underwent right hepatic lobectomy or more extensive liver resection with or without portal vein resection and/or pancreatoduodenectomy. Possible factors influencing liver regeneration were evaluated by univariate and multivariate analyses.

Results

The remnant mean(s.d.) liver volume was 41(8) per cent straight after hepatectomy. This increased rapidly to 59(9) per cent within 2 weeks, then increased more slowly, finally reaching a plateau at 74(12) per cent about 1 year after hepatectomy. The regeneration rate within the first 2 weeks was 16(8) cm3/day and was not related to the extent of posthepatectomy liver dysfunction. On multivariate analysis, the extent of liver resection (P < 0·001), body surface area (P = 0·02), combined portal vein resection (P = 0·024) and preoperative portal vein embolization (P = 0·047) were significantly associated with the liver regeneration rate within the first 2 weeks. In addition, body surface area (P < 0·001) and liver function expressed as plasma clearance rate of indocyanine green (P = 0·01) were significant determinants of final liver volume 1 year after hepatectomy.

Conclusion

The liver regenerates rapidly in the first 2 weeks after major hepatectomy for biliary cancer. This early regeneration is influenced by four clinical factors. Thereafter, liver regeneration progresses slowly and stops when the liver is three-quarters of its original volume, approximately 6 months to 1 year after hepatectomy.
Glove powder promotes adhesion formation and facilitates tumour cell adhesion and growth
Authors: van den Tol M P , Haverlag R , van Rossen M E E , Bonthuis F , Marquet R L , Jeekel J
Published: March 2003

Background

The presence of foreign material in the abdominal cavity irritates the peritoneal surface, leading to an inflammatory response. This defensive mechanism can provoke adhesion formation. The same peritoneal defence cascade is thought to play a role in the process of intra-abdominal tumour recurrence. The aim of this study was to evaluate whether glove powder produced peritoneal adhesions in a rat adhesion model and whether it promoted intra-abdominal tumour recurrence in a rat tumour cell adhesion and growth model.

Methods

A reproducible model that allowed semiquantitative scoring of adhesion formation or tumour load was used in three different groups of rats. One group was treated by intra-abdominal application of powder obtained from starch-powdered gloves, one by application of pure starch and in one group no powder was used.

Results

Application of glove powder or pure starch on minimally and severely traumatized peritoneum gave rise to significantly greater adhesion formation and intra-abdominal tumour load than peritoneal trauma alone (both P < 0·001).

Conclusion

Starch-induced peritoneal trauma leads not only to more adhesion formation but also to increased adhesion and growth of tumour cells. Since good powder-free alternatives are available there is no longer any justification for the use of powdered gloves during intra-abdominal surgery.
Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma
Authors: O'Leary D P , Fide C J , Foy C , Lucarotti M E
Published: March 2003

Background

Low anterior resection (LAR) with total mesorectal excision (TME) may be the optimal operation for carcinoma of the mid or lower rectum. Routine formation of a temporary defunctioning stoma has been recommended with TME. The impact of this strategy on health-related quality of life (HRQOL) has not been addressed.

Methods

A prospective longitudinal study was conducted among 24 patients undergoing LAR with TME and loop ileostomy for rectal cancer. Clinical outcomes were documented. HRQOL was assessed using Short Form 36 (SF-36). Twenty-three patients undergoing high anterior resection (HAR) for rectosigmoid cancer were studied concurrently to determine the effects of major colorectal resection without a stoma.

Results

Time to resume normal diet, length of stay in hospital and time to return to non-work activities were similar after HAR or LAR with TME and loop ileostomy. Twelve weeks after HAR SF-36 scores were stable or improved compared with preoperative levels. In contrast, 12 weeks after LAR + TME patients had a reduction in physical functioning scores on SF-36. SF-36 scores improved after ileostomy closure. Ileostomy closure increased total hospital stay and time off non-work activities.

Conclusion

LAR with TME and temporary loop ileostomy for rectal cancer results in a long total hospital stay and impairs aspects of HRQOL. Prompt stoma closure should be a priority in these patients.
Effects of adenosine on ischaemia–reperfusion injury associated with rat pancreas transplantation
Authors: Pi F , Badosa F , Sola A , Roselló Catafau J , Xaus C , Prats N , Gelpí E , Hotter G
Published: March 2003

Background

During cold preservation, cellular consumption of adenosine triphosphate leads to the accumulation of nucleotides and nucleosides. The precise role of adenosine in modulating the inflammatory response of cold-preserved pancreas after reperfusion remains to be elucidated. The aim of this study was to assess the influence of adenosine on the inflammatory response associated with the process of ischaemia–reperfusion in rat pancreas transplantation.

Methods

The effect of adenosine from preservation solution on the levels of high-energy nucleotides and their breakdown products after cold ischaemic preservation was determined. In addition, the inflammatory response associated with the process of ischaemia–reperfusion in pancreas transplantation was quantified with and without pretreatment with the adenosine antagonist theophylline, and during preservation of the organ in University of Wisconsin solution with and without adenosine.

Results

Adenosine from preservation solution is able to modify the nucleotide and nucleoside content of preserved pancreas, indicating that adenosine is incorporated and metabolized in tissue. Administration of the adenosine antagonist to transplanted rats moderated the increases in nitrite and nitrate, myeloperoxidase activity and lipoperoxidation levels in the pancreas.

Conclusion

Adenosine in the preservation solution may enhance the inflammatory response in rat pancreas transplantation.
Influence of the number of lymph nodes examined on staging of gastric cancer
Authors: Lee H K , Yang H-K , Kim W H , Lee K U , Choe K J , Kim J-P
Published: March 2003

Background

Nodal staging for gastric cancer according to the 1997 Union Internacional Contra la Cancrum tumour node metastasis classification is based on the number of metastatic lymph nodes. The aim of this study was to evaluate whether the number of lymph nodes examined affected staging of gastric cancer.

Methods

A retrospective study was performed in 4789 consecutive patients with gastric cancer, who had undergone curative resection (R0) from 1986 to 1995. Patients were classified according to the number of nodes examined. The number of metastatic lymph nodes and stage-stratified survival were compared.

Results

There were significant differences in the number of metastatic lymph nodes and survival in stage IIIA between patients with 15 or more lymph nodes and those with fewer than 15 nodes. In analysis restricted to patients with 15 or more nodes, stage-stratified survival did not vary significantly with lymph node yields for any stage except IIIB, in which there was a significant difference between the subgroup with fewer than 20 examined lymph nodes and patients with 35 or more nodes.

Conclusion

The number of lymph nodes examined did not significantly affect node staging of gastric cancer as long as at least 15 nodes were examined. For stage IIIB, more than 15 lymph nodes may be required for optimal staging.
Conservative management of appendix mass in children
Authors: Gillick J , Velayudham M , Puri P
Published: March 2003

Background

The management of an appendix mass in children is controversial. An experience of conservative management of appendix masses in a paediatric population over the last 19 years is reviewed.

Methods

The medical records of all children who presented with an appendix mass to one of three children's hospitals between 1982 and 2000 were reviewed. In that interval 427 children with a mean age of 7·3 years (range from 2 months to 18 years) presented with an appendix mass. Sixteen children had an immediate appendicectomy. The remaining 411 children were treated conservatively by close observation and antibiotics, with intravenous fluids and nasogastric suction if required. Once the child was well enough for discharge home, elective appendicectomy was booked for 4–6 weeks later.

Results

Three hundred and forty-six (84·2 per cent) of the children responded to initial conservative management and were discharged after a median stay of 6 (range 3–24) days. The children returned 4–6 weeks later for elective appendicectomy. The complication rate for elective appendicectomy was 2·3 per cent (eight patients). Those who had an uncomplicated elective appendicectomy had a median hospital stay of 3 (range 1–6) days. Histological examination demonstrated acute or subacute inflammation in 50·8 per cent of appendices removed at elective appendicectomy.

Conclusion

Non-operative management of an appendix mass followed by elective appendicectomy is a safe and effective method of management.
Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer
Authors: Sarela A I , Guthrie J A , Seymour M T , Ride E , Guillou P J , O'Riordain D S
Published: March 2003

Background

Excision of primary colorectal cancer associated with irresectable synchronous metastases confers high morbidity and mortality with uncertain benefit.

Methods

For patients with incurable stage IV colorectal cancer, minimally symptomatic primary tumours were left in situ and 5-fluorouracil-based chemotherapy was administered systemically. Primary tumour-specific complications and survival were monitored.

Results

There were 13 men and 11 women with primary tumours in the right colon (eight), transverse colon (one), sigmoid colon (eight) or rectum (seven). Eleven patients had metastases limited to the liver (liver replacement less than 25 per cent in one, 25–50 per cent in four and more than 50 per cent in six) and 13 patients had extrahepatic disease (lung or peritoneum). Four patients with sigmoid colon tumours developed bowel obstruction, which required an uncomplicated operation in two and deployment of colonic stents in two patients, at 1, 3, 12 and 20 months from diagnosis. Three further patients underwent right hemicolectomy for abdominal pain of uncertain aetiology, with poor symptomatic relief, and another had a potentially curative operation following disease downstaging. The overall median survival was 10·3 months with a 1-year actuarial survival rate of 44 per cent.

Conclusion

A policy to defer resection of minimally symptomatic primary colorectal cancer is associated with a low risk of complications before death from progressive systemic disease.
Role of the neutrophil in the development of systemic inflammatory response syndrome and sepsis following abdominal aortic surgery
Authors: Spark J I , Scott D J A
Published: March 2003

Introduction

There is evidence to suggest that the polymorphonuclear neutrophil (PMN) plays a critical early step in the development of the ischaemia–reperfusion syndrome, the systemic inflammatory response syndrome (SIRS) and sepsis. The PMN receptor CD16 plays an important role in phagocytosis, cell-mediated cytotoxicity and the release of free radicals and proteolytic enzymes. The aim of this study was to determine whether there is any relationship between PMN CD16 expression, phagocytosis and the development of sepsis.

Methods

Fifty patients who underwent elective infrarenal abdominal aortic aneurysm repair were studied. Venous blood was taken before operation, throughout surgery and for 7 days after operation. CD16 expression was measured, unstimulated and following further stimulation, by means of flow cytometry. Phagocytosis was determined using flow cytometry.

Results

Some 36 patients had an uncomplicated recovery; 14 developed SIRS or sepsis. There was no difference between the two groups with respect to nutritional, co-morbid or technical factors. In the group that developed septic complications after operation, the level of PMN CD16 expression was significantly higher before surgery (mean channel fluorescence (MCF) 30·2 versus 10·4; P < 0·05, Mann–Whitney U test) and throughout the postoperative period. Surgery produced no change in CD16 expression. After operation, stimulation of PMNs in the septic group resulted in a fall in CD16 expression (40·8 versus 20·4 MCF; P < 0·05, Mann–Whitney U test); surgery produced no change in the level of expression in the uncomplicated group.

Conclusion

This study provides evidence of phenotypic and functional differences in neutrophil behaviour in patients who develop sepsis following aneursym surgery.
Anti-human epidermal growth factor receptor 2 monoclonal antibody therapy for breast cancer
Authors: Leonard D S , Hill A D K , Kelly L , Dijkstra B , McDermott E , O'Higgins N J
Published: March 2003

Background

Advances in molecular biology and improved understanding of tumour biology have led to the development of novel treatments for cancer. Trastuzumab (Herceptin; Genentech, San Francisco, California, USA) is a monoclonal antibody directed against human epidermal growth factor receptor (HER) 2 protein, which is overexpressed in a wide variety of human cancers, including 20–30 per cent of human breast cancers. HER-2 plays an important role in oncogenic transformation, tumorigenesis and metastatic spread. Overexpression is associated with a poor prognosis and predicts a poor response to several treatment modalities.

Method

Literature relating to the monoclonal antibody was identified by a Medline literature search and by cross-referencing from the references of seminal articles on the subject. Four major clinical trials were identified and reviewed.

Results and conclusion

In clinical trials approximately 15–20 per cent of patients with HER-2-overexpressing tumours benefited from treatment with trastuzumab. In sensitive patients the antibody appeared to have intrinsic anticancer activity when given as a single agent. In combination chemotherapy it appeared to act synergistically with other agents. Ongoing research is evaluating trastuzumab in combination with numerous standard chemotherapy regimens and with other novel chemotherapeutic agents. Clinical trials have also revealed several serious side-effects of monoclonal antibody therapy. Most notable is an unpredictable cardiotoxicity, especially when used in combination with anthracycline-based chemotherapy regimens.
Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer
Authors: Purushotham A D , McLatchie E , Young D , George W D , Stallard S , Doughty J , Brown D C , Farish C , Walker A , Millar K , Murray G
Published: March 2003

Background

Women undergoing surgery for primary breast cancer routinely have suction drains inserted deep to the wounds, which are removed approximately 6–8 days after operation, requiring a period of stay of that duration in hospital. The aim of this study was to perform a prospective randomized clinical trial to evaluate a new surgical technique of suturing flaps without wound drainage, combined with early discharge, in women undergoing surgery for breast cancer.

Methods

A total of 375 patients undergoing surgery for breast cancer were randomized to conventional surgery or suturing of flaps with no drain. The main outcome measures were length of hospital stay, surgical morbidity, psychological morbidity and health economics.

Results

Suturing of flaps and avoiding wound drainage in women undergoing surgery for breast cancer resulted in a significantly shorter hospital stay. Adopting this surgical technique with early discharge did not lead to any difference in surgical or psychological morbidity. Health economic benefits to the National Health Service resulted from saved bed days with no impact on community costs.

Conclusion

Wound drainage following surgery for breast cancer can be avoided, thereby facilitating early discharge with no associated increase in surgical or psychological morbidity.