bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged ambulatory recording of antroduodenal motility in slow-transit constipation
Authors: Penning C , Gielkens H A J , Hemelaar M , Delemarre J B V M , Bemelman W A , Lamers C B H W , Masclee A A M 
Published: March 2003

Abstract

Background
Slow-transit constipation may be part of a pan-enteric motor disorder. To test this hypothesis 24-h ambulatory antroduodenal manometry was performed and orocaecal transit time determined in patients with slow-transit constipation and in healthy controls.

Methods
Antroduodenal motility was recorded with a five-channel solid-state catheter. Postprandial motility was recorded after consumption of two standardized test meals and interdigestive motility was recorded nocturnally. Manometry tracings were analysed for quantitative and qualitative abnormalities. Orocaecal transit time was determined by means of the lactulose hydrogen breath test.

Results
Postprandial motility was no different between patients and controls. However, some minor changes of interdigestive motility were observed. The proportion of phase II activity of the nocturnal cycles of the interdigestive migrating motor complex was increased in patients while phase I activity was decreased. The total number of observed phase III fronts was no different in patients and controls, although the number of phase III fronts with antral onset was decreased. Furthermore, the amplitude of phase III activity of duodenal onset was also decreased. Specific motor abnormalities such as retrograde propagation of phase III fronts were more frequent in patients. Orocaecal transit time was delayed in patients.

Results
In patients with slow-transit constipation, orocaecal transit time is delayed but antroduodenal motility is generally well preserved with only minor alterations.
Long-term results of arteriovenous fistulas using transposed autologous basilic vein
Authors: Murphy G J , White S A , Knight A J , Doughman T , Nicholson M L 
Published: March 2003

Abstract

Background
The transposed autologous basilic vein to brachial artery arteriovenous fistula provides vascular access in the absence of adequate superficial vein. The long-term patency and complication rates of this conduit are largely unreported.

Patients and methods
Seventy-four brachiobasilic fistulas were performed in 65 patients. This was a secondary or tertiary access procedure in 84 per cent of patients.

Results
Of the 74 fistulas performed, 50 were successfully used for dialysis (68 per cent) and 24 (32 per cent) were never used, including 13 fistulas that failed without being used for dialysis. Of the 74 fistulas, 46 per cent failed (n = 34), 10 patients died with a functioning fistula (n = 10) and five were transplanted. The 30-day secondary patency was 73 per cent at 1 year, 53 per cent at 2 years and 43 per cent at 3 years rate was 96 per cent. Cumulative secondary patency was 73 per cent at 1 year, 53 per cent at 2 years and 43 per cent at 3 years. Nineteen (26 per cent) fistulas underwent a further 19 operative procedures. Fifty-one (69 per cent) fistulas developed complications. The most common complications were arm oedema (24 per cent), thrombosis (22 per cent) and bleeding (18 per cent).

Conclusion
In high-risk patients the autologous transposed brachiobasilic fistula has equivalent patency and lower complication rates than those reported for polytetrafluoroethylene interposition grafts.
Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy
Authors: Sarli L , Costi R , Sansebastiano G , Trivelli M , Roncoroni L 
Published: March 2003

Abstract

Background
Postoperative shoulder-tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder-tip pain.

Methods
Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low-pressure (group A) and normal-pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pneumoperitoneum during most of the operation, and those in group B (n = 44) had laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation.

Results
The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P &lt; 0·05). Mean shoulder-tip pain scores at 12 and 24 h and postoperative analgesia requirements were also significantly lower in the low-pressure laparoscopic cholecystectomy group (P &lt; 0·001).

Conclusion
A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.
E-cadherin—catenin cell—cell adhesion complex and human cancer
Authors: Wijnhoven B P L , Dinjens W N M , Pignatelli M 
Published: March 2003

Abstract

Background
The E-cadherin–catenin complex plays a crucial role in epithelial cell–cell adhesion and in the maintenance of tissue architecture. Perturbation in the expression or function of this complex results in loss of intercellular adhesion, with possible consequent cell transformation and tumour progression. Recently, much progress has been made in understanding the interaction between the different components of this protein complex and how this cell–cell adhesion complex is modulated in cancer cells.

Methods
This is an update of the role of the E-cadherin–catenin complex in human cancers. It emphasizes new features and the possible role of the complex in clinical practice, discussed in the light of 165 references obtained from the Medline database from 1995 to 1999.

Results
More evidence is now appearing to suggest that disturbance in protein–protein interaction in the E-cadherin–catenin adhesion complex is one of the main events in the early and late steps of cancer development. An inverse correlation is found between expression of the E-cadherin–catenin complex and the invasive behaviour of tumour cells. Therefore, E-cadherin–catenin may become a significant prognostic marker for tumour behaviour. Besides its role in establishing tight cell–cell adhesion, β- catenin plays a major role in cell signalling and promotion of neoplastic growth. This suggests its dual role as a tumour suppressor and as an oncogene in human cancers.

Conclusion
Recent developments show that the E-cadherin–catenin complex is more than a ‘sticky molecular complex’. Further studies may yield greater insight into the early molecular interactions critical to the initiation and progression of tumours. This should aid the development of novel strategies for both prevention and treatment of cancer.
Fungal prophylaxis in biliopancreatic surgery in immunocompromised patients
Authors: Emparan C , Iturburu I , Diaz-Aguirregoitia J , Beyga Z , Perdigo L F 
Published: March 2003

Abstract

Background
Fungal infection is a devastating complication with an increased incidence in the past decade. Immune-depressed patients undergoing high-risk procedures have an increased incidence of surgical infection, particularly due to fungal colonization.

Methods
Twenty patients undergoing pancreas transplantation, 20 kidney transplant patients undergoing biliary tract surgery, 20 patients with human immunodeficiency virus (HIV) undergoing biliary tract surgery and 20 patients undergoing pancreatic resection for neoplasms were enrolled in a prospective study concerning perioperative surgical infection. All patients underwent surgical procedures by the same surgeon. All had preoperative blood counts, assay of CD lymphocyte populations, complete nutritional evaluation and similar antibiotic prophylaxis. Perioperative care was done to a similar standard and only patients undergoing pancreas transplantation received fungal prophylaxis (nystatin wash and swallow). In patients with clinical signs of infection, cultures were sent with special consideration to fungal infection.

Results
Two of the patients undergoing pancreas transplantation (one of whom died from disseminated candidiasis), three of the kidney transplant patients (two on the wound, one in the catheter), three patients with HIV (two on bile culture, one in the bloodstream) and one of the patients undergoing pancreatic resection (pancreatic fistula and bloodstream) had fungal infection. All patients had concomitant bacterial infections at the time of fungal infection (60 per cent Staphylococcus epidermidis). Patients with fungal infection had increased levels of immunosuppression with decreased CD4 recounts (pancreas transplants and patients with HIV), increased perioperative levels of blood glucose requiring insulin treatment, prolonged antibiotic therapy with broad-spectrum antibiotics (piperacillin–tazobactam), previous positive cultures from the bile of the biliary tract or the duodenum of the transplanted pancreas, and concomitant bacterial infections (especially opportunistic).

Conclusion
Surgical patients with positive cultures from surgical specimens, prolonged broad-spectrum antibiotic therapy and severely decreased lymphocyte immune function had an increased incidence of fungal infection with significant morbidity and mortality rates. Fungal prophylaxis is strongly recommended in these high-risk patients undergoing biliopancreatic tract surgery.
pH-dependent activity of amphotericin B
Authors: Verweij P , Mouton J , Rijs A , Meis J 
Published: March 2003

Abstract

Background
Abscesses caused by Aspergillus spp. are a rare presentation of invasive disease but commonly occur in patients with chronic granulomatous disease (CGD). Although amphotericin B (AmB) is considered standard treatment for these patients, up to 85 per cent of patients fail to respond. Several patients have been reported to respond after treatment was changed to antifungal azoles including itraconazole (ITZ) and voriconazole (VCZ). Although the underlying defect in the host defence is the most important cause of failure, the activity of AmB might be reduced in the local environment inside the abscess. Since pH has been shown to be low in abscesses, the effect of pH on the in vitro activity of AmB and ITZ was investigated.

Methods
Two A. fumigatus isolates and one A. nidulans isolate were cultured from patients with CGD. Two of these patients had failed to respond to treatment with AmB and had responded to treatment with VCZ. Serial twofold dilutions of AmB and ITZ were made in RPMI-1640 and buffered with MOPS at a pH of 4·0, 5·0, 6·0 and 7·0. The minimum inhibitory concentration (MIC) for each isolate was determined after 24 and 48 h of incubation by visual reading.

Results
For all isolates, the MIC of AmB and ITZ at pH 7·0 was 0·25 and 0·06 mg l−1 respectively. The MIC of AmB increased significantly with decreasing pH resulting in a MIC of 16 mg 1−1 at pH 4·0. However, the MIC of ITZ was not affected by the pH of the medium. Although breakpoints have not been established for AmB, MIC values above 0·5 mg 1−1 correspond to clinical failure in patients with yeast infection.

Conclusion
The reduced activity of AmB at low pH might contribute to the failure of patients with fungal abscesses to respond to treatment with AmB. Primary therapy with azoles may be warranted.
Immunomodulation with granulocyte–macrophage colony-stimulating factor and interleukin 2 in an experimental model of sepsis
Authors: Corso V , Fattori L , Torselli L , Assisi A , Papotti R , Nespoli A 
Published: March 2003

Abstract

Background
Previous studies have demonstrated that immunomodulation with granulocyte–macrophage colony-stimulating factor (GM-CSF) reduces the mortality rate in an experimental model of sepsis, decreases levels of tumour necrosis factor in the serum and in the liver, and enhances neutrophil activity. It was also demonstrated recently that immunoprophylaxis with interleukin (IL) 2 can reduce the mortality rate in rats that have undergone caecal ligature and puncture (CLP). In fact, IL-2 is the major activator of the specific immune response (B and T lymphocytes). The aim of this study was to investigate whether IL-2 and GM-CSF together might further decrease the mortality rate in an experimental model of peritonitis in rats, which resembles the clinical situation of bowel perforation and mixed bacterial peritonitis.

Methods
Peritonitis was induced by CLP in four groups of Sprague–Dawley male rats (250 g). Each group included 30 rats. Group 1 underwent CLP and postoperative antibiotic therapy with tobramycin and clindamycin (12·5 μg g−1 day−1 and 4 mg g−1 day−1 respectively for 72 h after operation). Group 2 underwent preoperative intraperitoneal IL-2 injection (1.000.000 units), then CLP and postoperative antibiotic therapy with the same regimen. Group 3 underwent CLP and intraperitoneal GM-CSF injection (l ng g−1 day−1 for 48 h after operation). Group 4 received IL-2, CLP and GM-CSF with the same regimen and antibiotic therapy. Deaths were recorded within 72 h after CLP.

Results
After CLP group 1 (antibiotics) had a mortality rate of 70 per cent; group 4 (IL-2, GM-CSF, antibiotics) had a mortality rate of only 3 per cent which was significantly lower than in that in group 2 (IL-2 and antibiotics) and group 3 (GM-CSF and antibiotics), 33 and 25 per cent respectively (P &lt; 0·0001).

Conclusion
Only one of 30 rats that had CLP and were treated with IL-2, GM-CSF and antibiotics died. Immunomodulation offers a new option in the treatment of sepsis related to peritonitis; in this experimental model treatment with IL-2 and GM-CSF enhanced host resistance to sepsis and decreased the mortality rate.
Prospective randomized trial demonstrates that postoperative administration of glycyl-glutamine alleviates the reduction in human leucocyte antigen DR expression on human monocytes induced by surgery
Authors: Sautner T , Bergmann M , Gornikiewicz A , Manhart N , Spittler A , Götzinger P , Függer R , Roth E 
Published: March 2003

Abstract

Background
The surface expression of major histocompatibility complex class II antigens (human leucocyte antigen (HLA) DR) on monocytes is a major indicator of the immunocompetence of these cells. Surgery, trauma and inflammation lead to a reduction in HLA-DR expression on monocytes, which is associated with an increased susceptibility to infection and sepsis. The authors have shown surface expression of HLA-DR on human monocytes in vitro. Following trauma or surgery, glutamine synthesis and secretion from skeletal muscle is increased; intracellular concentrations of glutamine, however, are significantly decreased. It was therefore hypothesized that postoperative infusion of glutamine dipeptides might prevent the decrease in HLA-DR expression on monocytes.

Methods
Thirty patients undergoing major abdominal surgery were allocated randomly to receive either 1500 ml Vamin (an amino acid solution containing no glutamine) (controls) or an isonitrogenic formulation containing Vamin and glycyl-glutamine (35 g glutamine) (GLY-GLN) or Vamin and alanyl-glutamine (35 g glutamine) (ALA-GLN) as a continuous infusion over 48 h after operation. The operations performed included oesophagectomy (three), gastrectomy (four), partial pancreatoduodenectomy (ten), hemihepatectomy (one) and drainage surgery of the biliary/pancreatic duct (ten). Immediately after the operation and 48 h later blood samples were collected for determination of HLA-DR expression of monocytes in vitro by flow cytometry.

Results
The groups were comparable with respect to age, sex distribution and operating time. In the GLY-GLN group mean HLA-DR expression of monocytes at 48 h was significantly better preserved than in controls.

Conclusion
Postoperative infusion of GLY-GLN alleviates the immunosuppression induced by surgery. GLY-GLN may be superior to ALA-GLN because of the distinct immunological effect of glycine and alanine. The observed GLY-GLN-specific preservation of HLA-DR on monocytes following surgery may contribute to the prevention of infectious complications in patients undergoing major abdominal surgery.
Influence of antibiotic prophylaxis on perioperative risk in traumatology with the new concept of clinic modelling randomized trials in animals
Authors: Celik I , Junge A , Krüger A , Seitz S , Brück E , Gotzen L , Lorenz W 
Published: March 2003

Abstract

Background
Surgical outcome depends not only on different therapies, but also on different additionally applied measures like prophylaxis (antibiotics, heparin, etc.) and their complex interaction. The aim of this study was to establish a new concept of clinic modelling randomized trials (CMRTs) in rats (haemorrhagic shock model) to investigate the harmful or beneficial effects of antibiotic prophylaxis in trauma patients (evidence-based medicine). Elements of the clinical scenario and methodology of randomized trials were modelled as accurately as possible in this CMRT.

Methods
Conditions of the rat model (CMRT) were adapted to the methodology of clinical trials and the clinical scenario with respect to sample size calculation, blinding and randomized allocation in a two-block design (n = 20 animals per group), anaesthesia with fentanyl–droperidol, standardized operation (soft tissue damage, tibia fracture and nailing), antibiotic prophylaxis 1 h before operation (intravenous cefuroxime 20 mg kg−1 versus placebo (sodium chloride)), volume substitution (Ringer) and postoperative analgesia. The clinical situation of healthy (American Society of Anesthesiologists (ASA) grade I and II) and severely injured (ASA III and IV) patients was simulated in the CMRT by sham operation and preoperative blood-letting, respectively, to initiate a relevant shock (1·5 h of mean arterial pressure 50 mmHg, blood pressure measured in the femoral artery). The shock period was followed by resuscitation (volume loading) with Ringer solution 40 ml kg−1. The endpoint was the 21-day mortality rate. Fracture healing was documented by radiography.

Results
The animal model was established successfully. The required blood-letting for relevant shock was 20 ml kg−1. The mortality rate in animals without blood-letting simulating healthy patients (ASA I and II) was zero in the cefuroxime and in placebo groups (n = 20 per group). In the experiment with preoperative blood-letting (ASA III and IV, n = 20 per group) a clear but not significant trend in the mortality rate for the cefuroxime group (20 per cent) versus placebo (40 per cent) could be observed (1 d.f., P &gt; 0·05, χ2 test). Disturbances of fracture healing did not occur.

Conclusion
The clinical impact (evidence based) of antibiotic prophylaxis in traumatology was demonstrated in these experiments. The influence of other currently used antibiotics in trauma patients could be investigated in such animal models (CMRTs) instead of expensive and time-consuming clinical trials. The results of this study suggest the advantage of prophylaxis with cefuroxime in severely injured patients. Other antibiotics and the pathophysiological mechanisms will be investigated in further studies.
Sterile pancreatic necrosis is not a clinical entity
Authors: Kriwanek S , Beckerhinn P , Armbruster C , Roka R 
Published: March 2003

Abstract

Background
The question of whether to operate or not in patients with sterile pancreatic necrosis (SPN) is controversial. The basis for this discussion has been the assumption that SPN represents a clinical entity. The aim of the present study was to question this hypothesis.

Methods
All patients with SPN diagnosed by contrast-enhanced computed tomography and negative bacterial cultures were included in the study. A retrospective analysis of prospectively collected data, including organ function, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, duration of intensive care therapy and hospitalization, and death, was performed.

Results
From 1990 to 1999, 43 patients were treated for SPN. All patients had to undergo intensive care therapy. There were two clearly different types of patient: (1) a group of 20 patients with less severe disease treated successfully without operation and (2) 23 patients with progressive organ dysfunction despite intensive care, who had to undergo surgery. The rates of organ dysfunction (18 versus 100 per cent), median APACHE II scores (7 versus 17), mortality rate (zero versus 26 per cent), duration of intensive care (9 versus 23 days) and hospital stay (26 versus 45 days) were significantly different between the two groups.

Conclusion
According to this study SPN is not a clinical entity. Future discussions on therapeutic strategies should take this finding into consideration.
Isolation of lysogenic staphylophage and its potential use as a treatment of methicillin-resistant Staphylococcus aureus surgical infections
Authors: Rapson M E , Salovska L P , Mann N H 
Published: March 2003

Abstract

Background
The aim was to develop a new cost-effective, accessible method for treating multidrug-resistant bacterial infections in which the possibility for emergence of resistant strains is greatly reduced. Methicillin-resistant Staphylococcus aureus (MRSA) surgical wound infection was used as a model for these studies.

Methods
A collection of lysogenic bacteriophage was made by isolating Staphylococcus-specific bacteriophage (staphylophage) from clinical MRSA samples from England, Bulgaria and Poland. The phage was selected and characterized according to host range, source, morphology and stability. Resistance profiles of the S. aureus isolates (SAIs) for 16 antibiotics, including methicillin, were determined.

Results
Some 86 per cent of the SAIs were multidrug resistant. When the 152 SAIs were incubated with eight different S. aureus cultivating strains 79 per cent produced at least one phage able to infect at least one of the cultivating strains. 72·4 per cent were able to infect two or more.

Conclusion
Lysogenic MRSA isolates are a characterizable, widely available source of staphylophage that can be used as an alternative to the traditional environmental sources. A specific pattern for geographical distribution of lysogenic staphylophage has been demonstrated which further facilitates the isolation process. The narrow host range of bacteriophage compared with chemotherapeutic agents ensures a minimal effect on non-pathogenic bacteria within the patient. This is an ongoing study and these are preliminary results. At the end of the study a method for isolation and development of therapeutic phage will be available for use in the industrial and hospital setting.