bluuebunny/crossref_metadata_2025_split huggingface dataset:
Apoptosis in the Uterus of Mice with Pregnancy Loss
Authors: SAVION S. , LEPSKY E. , ORENSTEIN H. , CARP H. , SHEPSHELOVICH J. , TORCHINSKY A. , FEIN A. , TODER V. 
Published: March 2003

PROBLEM: The mechanisms mediating pregnancy loss induced by various agents are far from being understood. Thus, we investigated the possible involvement of one such mechanism, the apoptotic process, in pregnancy loss induced by lipopolysaccharide (LPS) or cyclophosphamide (CP) as well as the associated changes in the apoptosis‐regulating gene products p53 and bcl‐2.METHOD OF STUDY: Pregnancy loss was induced by LPS or CP on days 9 or 12 of pregnancy, respectively. LPS‐ or CP‐associated apoptosis was assessed by the TdT mediated dUTP‐biotin nick end labeling (TUNEL) method as well as by DNA fragmentation analysis, while p53 or bcl‐2 expression was evaluated by immunohistochemistry.RESULTS: Lipopolysaccharide treatment initiated a resorption process that was accompanied by the appearance of apoptotic cells in the uterus, which increased in number by 24 hr after treatment. Induction of pregnancy loss with CP resulted in the appearance of some apoptotic cells in the uterus, reaching a peak at 72 hr after treatment. DNA fragmentation analysis revealed a DNA ladder at 24 hr after LPS as well as 72 hr after CP treatment. Immunohistochemical analysis demonstrated a continuous p53 expression in the uterus of LPS‐ or CP‐treated mice, which was somewhat elevated at the peak of the apoptotic process. On the other hand, bcl‐2 expression in LPS‐treated mice could be reciprocally correlated with the apoptotic process, appearing only at its initiation or completion, while in CP‐treated mice it was continuously expressed except for some elevation at the completion of the apoptotic process.CONCLUSIONS: Our results suggest a possible role for the apoptotic process in mechanisms mediating pregnancy loss and indicate an involvement of p53 and bcl‐2 in its regulation.
Genetic Contribution of the Interleukin‐10 Promoter Polymorphism in Endometriosis Susceptibility
Authors: KITAWAKI JO , OBAYASHI HIROSHI , OHTA MITSUHIRO , KADO NORIKO , ISHIHARA HIROAKI , KOSHIBA HISATO , KUSUKI IZUMI , TSUKAMOTO KATSUMI , HASEGAWA GOJI , NAKAMURA NAOTO , YOSHIKAWA TOSHIKAZU , HONJO HIDEO 
Published: March 2003

PROBLEM: Interleukin‐10 (IL‐10) is an important immunomodulatory cytokine. The aim of this study was to investigate whether polymorphisms of the IL‐10 gene promoter polymorphisms may be responsible in part for genetic susceptibility to endometriosis.METHODS OF STUDY: Polymorphisms at position −1082 and −592 in the IL‐10 promoter region were determined in 196 patients with endometriosis and 160 fertile healthy women by polymerase chain reaction (PCR)‐restriction fragment length polymorphism (RFLP).RESULTS: There were no statistically significant differences in the genotype and allele frequencies of IL‐10 promoter polymorphism between the endometriosis and control groups. However, when subgrouped according to clinical features, the frequencies of the −592*CC genotype and −592*C allele were significantly increased in patients with autoantibodies to carbonic anhydrase II (anti‐CA II ab) compared with controls.CONCLUSION: IL‐10 promoter polymorphisms were associated with the production of anti‐CA II ab in patients with endometriosis, suggesting a role in the genetic susceptibility for endometriosis.
Macrophages in Human Reproductive Tissues Contain Luteinizing Hormone/Chorionic Gonadotropin Receptors
Authors: Zhang Y. M. , Rao Ch. V. , Lei Z. M. 
Published: March 2003

PROBLEM: To determine whether macrophages in human reproductive tissues contain luteinizing hormone (LH)/human chorionic gonadotropin (hCG) receptor mRNA and receptor protein that can bind 125I‐hCG.METHOD OF STUDY: Macrophages isolated from term pregnancy human decidua were used for LH/hCG receptor detection by in situ hybridization for receptor mRNA and immunocytochemistry for a macrophage marker, CD68, performed alone and in combination, reverse transcription‐nested polymerase chain reaction, Western and ligand blotting. The LH/hCG receptor presence in macrophages in late luteal phase human endometria and corpora lutea was determined by sequential performance of in situ hybridization and immunocytochemistry.RESULTS: The macrophages present in term pregnancy human decidua and late luteal phase human endometria and corpora lutea contain LH/hCG receptors.CONCLUSIONS: This is the first demonstration of macrophages present in human reproductive tissues containing LH/hCG receptors. The receptor presence suggests that LH and hCG may regulate macrophage functions in gonadal as well as in non‐gonadal target tissues.
The influence of induction technique on intubating conditions 1 min after rocuronium administration: a comparison of a propofol‐ephedrine combination and propofol
Authors: Tan C. H. , Onisong M. K. , Chiu W. K. Y. 
Published: March 2003

Summary We conducted a double blind, prospective, controlled trial comparing intubating conditions after induction with a propofol‐ephedrine combination or propofol alone, followed by rocuronium. One hundred adult patients were randomly assigned to receive either propofol 2.5 mg.kg−1 and ephedrine 15 mg in combination or propofol 2.5 mg.kg−1 given over 30 s, followed by rocuronium 0.6 mg.kg−1 given over 5 s. Tracheal intubation was performed 1 min later. Jaw relaxation, vocal cord position and diaphragmatic response were used to assess intubation conditions. Tracheal intubation was successful and acceptable in all patients. There was a significantly higher proportion of intubating conditions graded as ‘excellent’ in the propofol‐ephedrine group (84%) than in the propofol group (32%) (p < 0.0001). Vocal cord position and response to intubation were significantly better in the propofol‐ephedrine group, although jaw relaxation was similar. Mean arterial pressure was maintained at pre‐induction levels in the propofol‐ephedrine group. In conclusion, induction with propofol and ephedrine in combination provided significantly better intubating conditions than propofol alone, when followed by rocuronium.
Patient accuracy of reporting on hereditary non-polyposis colorectal cancer-related malignancy in family members
Authors: Katballe N , Juul S , Christensen M , Ørntoft T F , Wikman F P , Laurberg S 
Published: March 2003

Abstract

Background
The cancer family history is important in identifying individuals with hereditary non-polyposis colorectal cancer (HNPCC). The accuracy of a suspected HNPCC family history reported by patients with colorectal cancer was evaluated.

Methods
This was a prospective population-based study including consecutive patients with colorectal cancer. A questionnaire covering the occurrence of malignancy among relatives was completed.

Results
A total of 1200 patients with colorectal cancer completed the questionnaire. Fulfilment of Amsterdam criteria I or II according to the patients' reports was rejected in three of 14 cases (false-positive rate 21 per cent). Furthermore, seven of 18 probands whose families met the Amsterdam criteria I or II after verification were identified by further exploration in families who, according to the probands, met weaker criteria (false-negative rate 39 per cent).

Conclusion
The present study suggests that family studies on HNPCC are not reliable unless the diagnoses of family members are verified from official sources. If endoscopic screening is offered entirely on the basis of unverified information from patients with colorectal cancer, there is a risk that a large proportion of the families will not be offered relevant surveillance.
Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults
Authors: Arroyo A , García P , Pérez F , Andreu J , Candela F , Calpena R 
Published: March 2003

Abstract

Background
Prosthetic repair has become the standard method for inguinal hernia and has excellent results. The question remains of whether the mesh technique could also improve results for umbilical defects.

Methods
The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adult patients with a primary umbilical hernia. Patients at high anaesthetic risk (American Society of Anesthesiologists (ASA) grade IV) or those who needed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean age at presentation of 57 years. Some 173 patients were ASA grade I–II and 27 were ASA III. The anaesthetic technique of choice was local anaesthetic infiltration plus sedation (98 per cent).

Results
There were no significant anaesthetic complications or surgical deaths. The mean duration of surgery was greater for mesh than for suture repair (45 versus 38 min). Rates of early complications such as seroma, haematoma or wound infection were similar in the two groups. The hernia recurrence rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0·0015).

Conclusion
Prosthetic repair could become the standard treatment for primary umbilical hernia in adults.
Anatomy of the anal canal and perianal structures as defined by phased-array magnetic resonance imaging
Authors: Morren G L , Beets-Tan R G H , van Engelshoven J M A 
Published: March 2003

Abstract

Background
The anatomy of the anal canal and perianal structures has been imaged using endoluminal magnetic resonance imaging (MRI). Phased-array MRI avoids the use of an endoluminal coil that may distort anatomy. The aim of this study was to describe the anatomy of the anal canal and perianal structures using phased-array MRI.

Methods
Imaging was performed in 14 men and 19 nulliparous women. The dimensions of the anal canal, puborectalis, external anal sphincter, perineal body, superficial transverse perineal muscle, bulbospongiosus, ischiocavernosus and anococcygeal body were measured in different planes, and sex differences were calculated.

Results
The lateral canal was significantly longer than its anterior and posterior part (P &lt; 0·001). The anterior external anal sphincter was shorter in women than in men (P = 0·01) and occupied, respectively, 30 and 38 per cent of the anal canal length (P = 0·001). The caudal ends of the external anal sphincter formed a double layer. The perineal body was thicker in women than in men (P &lt; 0·001) and easier to define. The superficial transverse muscles had a lateral and caudal extension to the ischiopubic bones. The bulbospongiosus was thicker in men than in women (P &lt; 0·001). The ischiocavernosus and anococcygeal body had the same dimensions in both sexes.

Conclusion
Phased-array MRI is a non-invasive technique that allows an accurate description of the normal anatomy of the anal canal and perianal structures.
Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse
Authors: Solomon M J , Young C J , Eyers A A , Roberts R A 
Published: March 2003

Abstract

Background
The objectives of this study were to compare both subjective clinical outcomes and the objective stress response of laparoscopic and open abdominal rectopexy in patients with full-thickness rectal prolapse. Abdominal rectopexy for patients with rectal prolapse is well suited for a laparoscopic approach as no resection or anastomosis is necessary.

Methods
Forty patients with a full-thickness rectal prolapse were randomized before operation to a laparoscopic group and an open group. They agreed to conform to a clinical pathway (CP) of liquid diet (CP1) and full mobility (CP2) on day 1, solid diet (CP3) on day 2 and discharge (CP4) before day 5. Their compliance was monitored by an assessor blinded to the operative group, who also rated pain and mobility. Patient-controlled morphine use was documented. Neuroendocrine and immune stress response and respiratory function were measured.

Results
Some 75 per cent of all clinical pathway objectives of early recovery were achieved in the laparoscopic group compared with 37 per cent in the open group (P &lt; 0·01). Significant differences in favour of laparoscopy were noted with regard to narcotic requirements, and pain and mobility scores. Differences in objective measures of stress response favouring laparoscopy were found for urinary catecholamines, interleukin 6, serum cortisol and C-reactive protein. No differences were noted in respiratory function but significant respiratory morbidity was greater in the open group (P &lt; 0·05). None of the measured outcomes, subjective or objective, favoured the open group apart from operating time, which was significantly shorter (153 versus 102 min; P &lt; 0·01).

Conclusion
This study has demonstrated significant subjective and objective differences in favour of a laparoscopic technique for abdominal rectopexy. The advantages were all short term but no evidence of any adverse effect on longer-term outcomes was observed.
Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment
Authors: Engel A F , Eijsbouts Q A J , Balk A G 
Published: March 2003

Abstract

Background
Although lateral sphincterotomy heals chronic fissure in ano in over 90 per cent of cases it is a surgical technique with inherent complications. To avoid such complications, chronic fissure in ano was treated by fissurectomy in this study. To enhance postoperative tissue perfusion allowing stable wound healing, fissurectomy was combined with temporary chemical sphincterotomy by a nitric oxide donor cream.

Methods
Seventeen consecutive patients (ten women) with chronic fissure in ano not responding to conservative management underwent diathermy fissurectomy. After operation patients used a 1 per cent isosorbide dinitrate cream. Postoperative follow-up continued until wounds had healed, at which time anal endosonography was performed. A telephone inquiry into fissure recurrence and continence status was made.

Results
Seventeen patients underwent fissurectomy, without postoperative complications. All wounds had healed within 10 weeks. No fissure recurrence was seen after a median follow-up of 29 months. Histopathology showed non-specific scar tissue without signs of internal anal sphincter fibrosis. Postoperative endosonography showed no evidence of new internal sphincter defects.

Conclusion
In the treatment of chronic anal fissure not responding to chemical sphincterotomy with nitric oxide donors, fissurectomy in combination with isosorbide dinitrate cream may be a sphincter-sparing surgical technique.
Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia
Authors: Korenkov M , Sauerland S , Arndt M , Bograd L , Neugebauer E A M , Troidl H 
Published: March 2003

Abstract

Background
Since conventional suture repair for incisional hernia is associated with high recurrence rates, alloplastic and autoplastic prosthetic techniques have been suggested.

Methods
In a randomized trial, 160 patients with simple or complex hernias underwent either suture repair, autodermal skin graft or onlay polypropylene mesh repair. Suture repair was not done in complex hernias. This report concerns a planned interim analysis.

Results
At mean follow-up of 16 months, there were 17 hernia recurrences that were distributed similarly between the surgical techniques. There were fewer infectious complications after suture repair (three of 33 patients) than after skin graft or mesh repair (seven of 39 and five of 28 for simple hernias; seven of 31 and ten of 29 respectively for complex hernias) (P not significant). The severity of infections after polypropylene mesh implantation prompted the trial committee to discontinue the study. No differences were noted in duration of stay in hospital and quality of life. However, pain was significantly more frequent after polypropylene mesh repair (pooled risk ratio 2·9 and 1·8 at 6 weeks and 1 year respectively).

Conclusion
Suture repair was safe for small incisional hernias. Both autoplastic and alloplastic hernia repair yielded comparably low recurrence rates, but led to a high rate of wound infection.
Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis
Authors: Buter A , Imrie C W , Carter C R , Evans S , McKay C J 
Published: March 2003

Abstract

Background
All patients with organ dysfunction are currently classified as having severe acute pancreatitis. The aim of this study was to characterize the systemic inflammatory response syndrome (SIRS) and early organ dysfunction in patients with acute pancreatitis and the relationship with overall mortality.

Methods
Patients with predicted severe acute pancreatitis of less than 48 h duration had daily organ dysfunction scores and SIRS criteria calculated. These features were then correlated with outcome.

Results
Of 121 patients, 68 (56 per cent) did not develop organ dysfunction; only two of these patients died (mortality rate 3 per cent). Fifty-three (44 per cent) had early organ dysfunction, of whom 11 died (21 per cent). Organ dysfunction and persistent SIRS were both associated with an increased mortality rate, but on multivariate analysis only deteriorating organ dysfunction was an independent determinant of survival.

Conclusion
Early organ dysfunction in acute pancreatitis usually resolves and in itself has no significant influence on mortality. In contrast, worsening organ dysfunction was associated with death in more than half of the patients (11 of 20); it is this group of patients who should be classified as having severe acute pancreatitis.
Breast reconstruction in the United Kingdom and Ireland
Authors: Callaghan C J , Couto E , Kerin M J , Rainsbury R M , George W D , Purushotham A D 
Published: March 2003

Abstract

Background
Although it is becoming more common, previous surveys have identified concerns regarding the safety of immediate reconstruction following mastectomy. The aims of this study were to define current practice of breast reconstruction in the UK and Ireland, and to identify the characteristics of surgeons who use immediate breast reconstruction.

Methods
A postal questionnaire survey of 498 consultant breast surgeons in the UK and Ireland was performed in January 2000.

Results
There were 376 responses (response rate 76 per cent). Eighty-eight per cent of surgeons ‘always’ or ‘usually’ discuss reconstruction with patients due to undergo mastectomy; clinicians with a heavy caseload were significantly more likely to discuss it (odds ratio (OR) 18·45 (95 per cent confidence interval 1·99 to 171·07)). The majority of respondents (57 per cent) preferred delayed to immediate breast reconstruction; 70 per cent believed that immediate reconstruction has disadvantages, most commonly that it interferes with adjuvant therapy (56 per cent). Older surgeons were significantly less likely to perform immediate reconstruction (OR 5·18 (2·21 to 12·11)), and were significantly more likely to believe that immediate breast reconstruction has disadvantages (OR 2·02 (1·01 to 4·05)). Surgeons from Ireland were less likely to discuss and perform breast reconstruction (OR 0·20 (0·10 to 0·43) and 0·27 (0·12 to 0·60) respectively), or to have access to a plastic surgeon (OR 0·22 (0·11 to 0·44)).

Conclusion
Significant variation exists in the delivery of breast reconstruction after mastectomy in the UK and Ireland. The age, workload and personal characteristics of the surgeon are important in determining reconstructive practice.
Incidence and pattern of long saphenous vein duplication and its possible implications for recurrence after varicose vein surgery
Authors: Corrales N E , Irvine A , McGuinness C L , Dourado R , Burnand K G 
Published: March 2003

AbstractBackgroundThe incidence of long saphenous vein (LSV) duplication has not been clearly established. This anomaly could have implications for recurrence after varicose vein surgery.MethodsSome 103 saphenograms obtained in 85 patients being considered for peripheral arterial bypass surgery were reviewed. Non-ionic contrast medium was injected directly into the vein or its tributaries at the ankle. Duplications of the LSV and their relation to thigh and calf perforator veins were assessed and recorded by two independent observers.ResultsThere was evidence of duplication of the LSV in 50 (49 per cent) of the 103 saphenograms. Most duplications were present in the thigh (88 per cent) and the most common pattern was a closed loop (54 per cent). Perforator veins were connected to one branch of the duplication in 42 per cent of the legs (20 per cent of all 103 legs); in half the perforator vein was connected to the non-dominant branch of the duplication. Only ten of the 18 patients who had bilateral saphenograms had duplications in both legs, and only one patient had the same pattern of duplication on both sides.ConclusionThe incidence of LSV duplications is higher than previously reported.
Surgical repair of ruptured thoracic and thoracoabdominal aortic aneurysms
Authors: Lewis M E , Ranasinghe A M , Revell M P , Bonser R S 
Published: March 2003

Abstract

Background
Rupture is the single most common cause of death in patients with thoracic aortic and thoracoabdominal aneurysm (TAA/TAAA) and is almost uniformly fatal.

Methods
This was a retrospective review of patients admitted to a single practice with rupture of a TAA/TAAA between 1993 and 2000.

Results
Twenty-two consecutive patients with a leaking TAA/TAAA were identified. The aetiology of rupture was either secondary to a degenerative TAAA or a type B dissection. Seventeen patients underwent surgery; one had a Crawford extent I, seven an extent II, one an extent III and two an extent IV TAAA. Six patients had an acute type B dissection with rupture in the upper descending thoracic aorta. The 30-day survival rate was 88 per cent (15 of 17 patients). Actuarial survival at 1 year in patients who had surgery was 65 per cent. Survival at 1 year for all presenting patients who consented to surgery was 40 per cent. Median survival was greater than 36 months.

Conclusion
As a result of improving medical care, more patients with a contained rupture of a TAA/TAAA may present for treatment. Surgery is complex and requires specialist teams for optimal care.
Positron emission tomography for staging and management of malignant melanoma
Authors: Prichard R S , Hill A D K , Skehan S J , O'Higgins N J 
Published: March 2003

AbstractBackgroundThe incidence of malignant melanoma is rising; it now has an incidence of ten per 100 000 per annum in the UK. The development of metastases is unpredictable, but prognosis is linked directly to the initial stage at diagnosis. Positron emission tomography (PET) can allow the detection of malignant cells at a relatively early stage.MethodsA review of the literature was undertaken by searching the Medline database for the period 1980–2000 without any language restrictions.ResultsThe overall sensitivity and specificity of PET are 74–100 and 67–100 per cent respectively. PET has a reduced sensitivity and specificity for thinner lesions (less than 1·5 mm). Comparison with computed tomography and magnetic resonance imaging has shown a higher sensitivity and specificity for PET in all regions of the body except the thorax.ConclusionCurrently the accepted indication for PET is recurrent melanoma when surgical intervention is being considered. However, other potential indications include the detection of occult or distant metastasis at initial presentation and the clarification of abnormal radiological findings at follow-up. The routine use of PET for American Joint Commission on Cancer stage I or II disease is of uncertain benefit and is not indicated at present.