bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors in surgical patients with intra-abdominal Candida infection in intensive care
Authors: Bouchantouf T , Meis J F G M , Neeleman C , Kuiper D R , van Goor H 
Published: March 2003

Abstract

Background
Candida species have been isolated with increasing frequency during intra-abdominal infection, yet their role as pathogens or co-pathogens and as determinants for outcome, especially in patients who are frequently reoperated on, is not well understood. Furthermore, the value of antimycotic therapy is the subject of discussion.

Methods
Candida cultures from the abdomen of surgical patients over the past 10 years (1989–1999) were documented. Medical records of the patients were reviewed for risk factors for morbidity and death.

Results
Some 72 patients (45 men, 27 women), of mean age 60 (range 18–88) years, had Candida cultured from the abdomen during operation. Indications for surgery included duodenal ulcer perforation in 15 patients (21 per cent), gastrointestinal malignancy in 15 (21 per cent), pancreatitis in nine (12 per cent) and various disorders in the remaining 33. A total of 361 relaparotomies was performed in 72 patients (mean 5, range 0–48). Cultures were positive at the first laparotomy in 19 patients, at the first relaparotomy in 20 patients and in 33 patients at the second or more relaparotomy. All but one patient were treated in the intensive care unit. Some 45 (62 per cent) of 72 patients died a mean of 44 (range 3–234) days after the first laparotomy. Risk factors for death, which appeared not to be significant, are shown in the Table.

Conclusion
The number of relaparotomies among patients with Candida-positive cultures was high. No significant risk factors for death could be identified in surgical patients with intra-abdominal Candida infection in intensive care.
Translocation of Enterococcus in jaundiced and anergic rats
Authors: Cainzos M , Prieto D , Mena E , Lage P , Seoane R , Viñuela J , Mora M 
Published: March 2003

Abstract

Background
Translocation of bacteria from the gut to other organs is one cause of systemic complications in obstructive jaundice. Furthermore, hyperbilirubinaemia appears to cause anergy. This study investigated whether these responses (translocation of gut bacteria and anergy) increase the postoperative mortality rate in rats in which obstructive jaundice is induced surgically by ligature of the bile duct.

Methods
Some 88 male Wistar rats were divided into six groups. All rats except those in group 1 received gentamicin by the oral route (0·7 mg in 1 ml water, daily for 6 days) to ensure intestinal decontamination. On day 7, all rats except those in groups 1 and 2, which had vehicle only, received Enterococcus. Statistical analysis was by Student's test and Fishers's exact test.
All animals underwent standard blood testing, delayed hypersensitivity tests, haematimetry and serum endotoxin determinations. Flow cytometry was used to count CD3-, CD4- and CD8-positive lymphocytes. On the day 5 after surgery, these assays were repeated and, in addition, the rats were killed for microbiological analysis of gut and viscera contents (liver, spleen, mesentery and lung).

Results
Five days after surgery, mean bilirubin levels in groups 5 and 6 were greater than 14 mg dl−1. In addition, all rats in groups 5 and 6 showed absence of the delayed hypersensitivity response, indicating anergy. Lymphocyte counts in each group are shown in the Table.
The mean proportion of CD8-positive lymphocytes in rats that had received Enterococcus (groups 3–6) was 16 per cent compared with 25 per cent in groups 1 and 2 (P &lt; 0·05). The mean percentage of CD3-positive lymphocytes in groups 5 and 6 was 51 per cent, but 71 per cent in all other groups (P &lt; 0·05). Likewise, the mean percentage of CD4-positive lymphocytes in groups 5 and 6 was 32 per cent, but 47 per cent in all other groups (P &lt; 0·05). The postoperative mortality rate in group 4 (17 per cent) was significantly lower than that in the obstructive jaundice groups 5 and 6 (62 per cent) (P &lt; 0·01). Post-mortem microbiological analyses revealed translocation of Enterococcus only in groups 5 (80 per cent) and 6 (70 per cent). Enterococci were most frequently present in the mesentery (80 and 70 per cent respectively), followed by the liver (40 and 40 per cent), spleen (20 and 20 per cent) and lungs (10 and 10 per cent).

Conclusion
(1) Obstructive jaundice in rats leads to immunological alterations including anergy. (2) Obstructive jaundice in rats favours translocation of enterococci from the gut to other organs. (3) The postoperative mortality rate in jaundiced rats was much higher than that in sham-operated rats.
Bacterial lipoprotein induces tolerance in human THP-1 monocytes with reduced tumour necrosis factor α production via a CD14-independent pathway
Authors: Doyle M , Wang J H , Wu Q D , Blankson S , Redmond H P 
Published: March 2003

Abstract

Background
Endotoxin (lipopolysaccharide; LPS) tolerance is characterized by diminished production of tumour necrosis factor (TNF) α during prolonged exposure to LPS, and therefore represents an essential control mechanism during sepsis. However, it is unknown whether bacterial lipoprotein (BLP), another major component of bacterial walls, can cause tolerance. This study sought to determine whether BLP pretreatment can induce tolerance in human THP-1 monocytes.

Methods
Human THP-1 monocytic cells were pretreated with culture medium alone and medium containing LPS 10 ng ml−1 or BLP 10 ng ml−1 for 24 h. Cells were further stimulated with high doses (0·1–1 mg ml−1) of LPS or BLP for 6 h. TNF-α levels were determined by enzyme-linked immunosorbent assay. CD14 receptor expression on THP-1 monocytes was assessed by flow cytometry.

Results
When THP-1 cells were incubated with culture medium, BLP stimulation resulted in much higher TNF-α levels than LPS stimulation (P &lt; 0·05). Following LPS pretreatment, LPS stimulation-induced TNF-α production was significantly attenuated, whereas BLP stimulation still produced a small amount of TNF-α. However, BLP pretreatment prevented both LPS and BLP stimulation-induced TNF-α production from THP-1 cells. FACScan analysis revealed that THP-1 monocytes do not express CD14 receptor.

Conclusion
These results demonstrate that BLP has a more potent effect than LPS on THP-1 monocyte TNF-α production. Furthermore, BLP pretreatment is capable of inducing both BLP as well as LPS tolerance via a CD14-independent pathway, indicating a unique ability to cause cross-tolerance.
Decreased incidence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa over 3 years
Authors: Fiore M , van Nieuwenhoven C A , Ramsay G 
Published: March 2003

Abstract

Background
Ventilator-associated pneumonia (VAP) is a frequently occurring infection among critically ill patients. Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli are the most common micro-organisms causing VAP. The aim of this study was to ascertain the incidence of VAP diagnosed with bronchoalveolar lavage (BAL) by these possible pathogenic micro-organisms (PPMOs). Because VAP is often preceded by colonization of the oropharynx with the causative pathogen, sputum cultures were compared with the BAL cultures.

Methods
Over a 3-year period, all ventilated patients in two intensive care units (n = 1136) were reviewed for pneumonia. A VAP was present when the bacterial count of the BAL was more than 104 colony-forming units ml−1. The microbial results of all patients with a VAP (polymicrobial or monomicrobial) were recorded.

Results
The mean incidence of VAP was 8 per cent (n = 92), decreasing only slightly during the period (P &gt; 0·05). The most frequent aetiological agents were P. aeruginosa (n = 34), S. aureus (n = 22), E. coli (n = 16) and K. pneumoniae (n = 10). The percentage of VAPs due to P. aeruginosa has declined progressively from 53 to 31 per cent. Concurrently, the incidence of Pseudomonas colonizing the sputum culture has declined (from 54 to 44 per cent). On the other hand, the incidence of VAP due to E. coli has increased from 13 (n = 2) to 36 per cent (n = 6). Colonization of the sputum with E. coli has similarly increased (from 13 to 27 per cent).

Conclusion
The incidence of VAP in the intensive care unit is in accordance with the literature, when diagnosed with strict criteria. No significant change in the incidence of VAP was noted during the 3-year period. Neither the decrease in incidence of VAP caused by P. aeruginosa nor the increase in E. coli pneumonia can be explained by a change in antibiotic regimens in the period studied. Hypothetically, cross-colonization of PPMOs by healthcare personnel can be influenced by hand-washing and wearing gloves. This can especially influence colonization by P. aeruginosa, thus explaining the decrease.
Evidence of a prognostic value for platelet surface antigen expression in severe abdominal sepsis
Authors: Salat A , Kroess S , Felfenig-Boehm D , Schmidt D , Sautner T , Mueller M R , Fuegger R 
Published: March 2003

Abstract

Background
There is evidence for the involvement of platelets under septic conditions. Alterations of platelet surface antigen expression at the onset of septic shock have been reported previously. The aim of this study was to investigate platelet activation as well as changes in platelet receptors during the course of severe sepsis.

Methods
The study population included six patients with severe sepsis because of peritonitis or necrotizing pancreatitis. Platelet investigations were performed daily. For analysis three characteristic time points during the course were defined restrospectively (A, onset of septic shock; B, significant clinical improvement; C, last sample before death). A double-colour flow cytometric assay was performed in whole blood to determine platelet surface expression of CD63, CD62P, CD42B, CD36 and CD31.

Results
At the onset of septic shock (A) all patients showed similar antigen expression (CD63, 1·24; CD62P, 0·59; CD42B, 30·9; CD36, 28·0; CD31, 18·2). In surviving patients (B, n = 2) antigen expression was lower (CD63, 0·70; CD62P, 0·38; CD42B, 27·8; CD31, 12·4) or higher (CD36, 27·6) than in patients (C, n = 4) who died (CD63, 1·55; CD62P, 0·72; CD42B, 36·5; CD36, 24·1; CD31, 21·1).

Conclusion
Although the study population was very small and heterogeneous, these results point to a correlation of platelet surface antigen expression with clinical outcome (survival). It is hypothesized that platelet surface antigen expression, reflecting platelet activation, might be a predictive factor in the course of severe sepsis.
Hepatitis B virus transmission from a surgeon to patients during high-risk as well as low-risk procedures: unnoticed transmissions over a 4-year period
Authors: Spijkerman I J B , van Doorn L J , Janssen M H W , Wijkmans C J , Bilkert-Mooiman M A J , Coutinho R A , Weers-Pothoff G 
Published: March 2003

Abstract

Background
Three cases of reported acute hepatitis B virus (HBV) led to the identification of a chronically HBV-infected surgeon, with a high viral load, who was a non-responder after vaccination.

Methods
A retrospective cohort study was conducted on 1564 patients operated on by this surgeon over a 4-year period.

Results
Forty-nine patients (3·1 per cent) were positive for HBV markers. Based on HBV DNA sequencing and epidemiological data, transmission from the surgeon was confirmed in eight, probable in two, possible in 18 and excluded in 21 patients. One case of secondary transmission was identified from a patient to his wife, who died, presumably from fulminant hepatitis. A case–control study identified the duration of operation, the potential risk of the surgical procedure and the occurrence of complications during or after surgery as significant risk factors for HBV infection. At least eight of the 28 patients were infected during low-risk procedures.

Conclusion
Transmission from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons. It also requires revision of policies allowing HBV-infected surgeons to perform presumed ‘low-risk’ procedures.
Transforming growth factor β-mediated inhibition of src kinases is regulated by SHP-1
Authors: Sir Ö , Choudhry M A , Sayeed M M 
Published: March 2003

Abstract

Background
Transforming growth factor (TGF) β has been shown to suppress T cell effector functions. Although the mechanisms of such T cell suppression are not known, a disuption of the balance between protein tyrosine kinases (PTKs) and protein tyrosine phosphatases (PTPs) has been implicated. The present study investigated the roles of the src-related PTKs, P59fyn and P56lck, and the PTPs SHP-1 and SHP-2 in TGF-β-mediated T cell suppression.

Methods
Splenic T cells from rats were pretreated with TGF-β 25 ng ml−1 and subsequently stimulated with either anti-CD3 or anti-CD3 plus pervanadate (a PTP inhibitor). After incubation with specific antibodies and immunoprecipitation, the kinase activity of the PTKs was assessed by in vitro kinase assay. Phosphorylation of the PTPs was assessed using antiphosphotyrosine antibodies and immunoblotting.

Results
Incubation of T cells with TGF-β resulted in decreased activity of P59fyn and P56lck. Although TGF-β treatment resulted in a concomitant increase in SHP-1 activity, no change in SHP-2 activity was observed. When T cells were stimulated with anti-CD3 in the presence of pervanadate, the TGF-β-mediated decrease in P59fyn and P56lck activity was completely prevented.

Conclusion
These findings show that TGF-β treatment of T cells results in suppression of src kinases, and suggests that such inhibition of kinase activity is mediated by upregulation of SHP-1.
Hypertonic saline–dextran is ineffective for resuscitation after thoracic blast and haemorrhage
Authors: Sawdon M , Kirkman E , Ohnishi M , Stapley S A , Watkins P 
Published: March 2003

Abstract

Background
Small-volume resuscitation using hypertonic solutions is increasing in popularity for the treatment of hypovolaemia. However, its effect in the blast casualty is unknown. The present study compared the effects of resuscitation with hypertonic saline–dextran with those of whole blood and colloid (Haemaccel) in an experimental model of blast injury and haemorrhage.

Methods
Male Wistar rats (235–264 g body-weight) were used in three groups of six animals anaesthetized with intravenous alphadolone–alphaxalone 19–21 mg kg−1 h−1. Heart period (HP) was measured from the electrocardiogram and mean arterial blood pressure (MBP) via the tail artery. Body temperature was maintained at 38·0°C. At the end of the study the animals were killed with an overdose of anaesthetic. Each group received a blast wave focused on the ventral thorax. Some 10 min after the blast all groups received a haemorrhage of 40 per cent total estimated blood volume (BV, 6·06 mg kg−1) at 2 per cent BV min−1.

Results
Blast (group 1) induced a significant bradycardia (HP increasing to mean(s.e.m.) 543(64) ms from 155(4) ms; P &lt; 0·05, analysis of variance) and hypotension (fall in MBP to 35(3) mmHg from 106(4) mmHg). Thereafter there was partial recovery before subsequent haemorrhage significantly reduced MBP to 26(3) mmHg and increased HP to 189(15) ms. The response in groups 2 and 3 was not significantly different from that in group 1. Some 20 min later resuscitation with 40 per cent prehaemorrhage blood volume using autologous blood (group 1) or colloid (group 2) restored MBP to 113(7) and 98(2) mmHg respectively. The effects of blood and colloid were maintained for the remaining 30 min of the study. Although resuscitation with 7·5 per cent saline−6 per cent dextran 70 (4 ml kg−1) in group 3 increased MBP to 92(5) mmHg initially, it fell significantly within 5 min, reaching 43(5) mmHg 30 min after resuscitation. This was associated with a significant tachycardia (HP 127(4) ms), which was not seen in the other groups.

Conclusion
These data provide no support for the use of hypertonic saline–dextran in resuscitation following blast and haemorrhage.
Operative treatment of pseudocysts in patients with chronic pancreatitis
Authors: Usatoff V , Brancatisano R , Williamson R C N 
Published: March 2003

Abstract

Background
Pseudocysts associated with chronic pancreatitis are generally intrapancreatic and associated with parenchymal disease. They tend to persist and cause complications. Minimally invasive methods of treatment challenge the traditional techniques of operative management. Surgical operation allows definitive treatment of the pseudocyst with the option of dealing appropriately with the diseased pancreas and excluding a neoplastic process. The aim of this study was to review the safety and efficacy of a surgical approach to the management of pseudocysts associated with chronic pancreatitis.

Methods
A personal series of 112 consecutive patients operated for pseudocysts in the setting of chronic pancreatitis was reviewed. Chronic pancreatitis was confirmed by imaging studies in association with exocrine and/or endocrine failure. Cysts were multiple in 31 patients and presented with complications other than pain in 47. Data were collected prospectively regarding the clinical presentation, the nature of the operation and its outcome.

Results
Forty-eight patients (43 per cent) underwent drainage procedures, 56 (50 per cent) had a resection and eight (7 per cent) had a combination. Larger cysts and those located in the head and neck tended to be drained, while smaller and distal cysts were more often resected. The morbidity rate was 28 per cent and the operative mortality rate was 1 per cent. The cyst recurrence rate was 3 per cent and pain was relieved in 74 per cent of patients.

Conclusion
Operative management of pseudocysts associated with chronic pancreatitis is effective with low morbidity and mortality rates. The introduction of newer minimally invasive techniques will have to withstand comparison to this traditional approach.
Endoscopic stent placement for pancreaticocutaneous fistula after surgical drainage of the pancreas
Authors: Boerma D , Rauws E A J , van Gulik T M , Huibregtse K , Obertop H , Gouma D J 
Published: March 2003

Abstract

Background
Spontaneous closure of an external pancreatic fistula is unlikely when a concomitant downstream obstruction of the pancreatic duct inhibits downstream flow. Early endoscopic retrograde pancreatography (ERP) and stent insertion may enhance fistula closure in these patients.

Methods
The results of endoscopic stenting of the pancreatic duct were evaluatedin 15 patients with an external pancreatic fistula that developed after operative necrosectomy and debridement of the pancreas (seven men and eight women, median age 45 (range 25–68) years).

Results
Median drainage before ERP was 50–800 ml/day, with an amylase content of 21 000–493 000 units/l. ERP was performed after a median time of 35 days and revealed leakage of the duct and a downstream obstruction in all patients. An endoprosthesis was inserted beyond the site of obstruction. Within a median time of 10 (range 2–64) days drainage stopped in all patients. In one patient ERP failed and pancreaticojejunostomy was performed. During follow-up (median 24 (range 2–55) months) three patients required resection of the pancreatic tail because of pseudocyst formation, all of whom originally had leakage from the tail area.

Conclusion
Based on these data, an active approach for external pancreatic fistula seems warranted. Early ERP and stent insertion enhances fistula resolution, facilitates wound care and surgery is postponed or even avoided.
Helix-loop transcription factor, Id1, is overexpressed in medullary thyroid cancer
Authors: Kebebew E , Treseler P A , Duh Q-Y , Clark O H 
Published: March 2003

Abstract

Background
The helix-loop transcription factor (Id1) protein inhibits differentiation, enhances cell proliferation and is required for cell-cycle progression. Id1 is highly expressed in a variety of tumour-derived cell lines, increases following mitogenic stimuli and is overexpressed in some human neoplasms. It was therefore reasoned that the Id1 gene may play a role in medullary thyroid carcinogenesis.

Methods
Id1 protein expression in human medullary thyroid cancer (MTC) and corresponding normal thyroid tissue was determined by Id1 immunohistochemistry. Calcitonin immunohistochemistry was used to determine the cellular localization of Id1 immunostaining. In a well characterized human MTC cell line (TT), the effects of growth stimulation (with serum) and redifferentiation (with phorbol esters) on Id1 expression were determined by Northern blot analysis.

Results
Id1 immunostaining intensity in MTC (n = 9; six sporadic MTCs, two familial MTCs and one multiple endocrine neoplasia type 2A MTC) was moderate to strong whereas in the corresponding normal thyroid tissues (n = 9) it was absent or faint in the C cells and follicular cells. Id1 immunostaining was significantly higher in MTC than the corresponding normal thyroid tissue based on the percentage of positive cells and immunostaining intensity (P = 0·002, rank sum test). The 1·2-kilobase Id1 transcript was expressed in the TT cell line under basal culture conditions. Interestingly, Id1 messenger RNA (mRNA) expression was markedly upregulated (4·0 fold) following growth stimulation with 10 per cent fetal bovine serum. In addition, phorbol ester (which is known to induce redifferentiation of the TT cell line) downregulated Id1 mRNA expression in the TT cell line.

Conclusion
Id1 is overexpressed in MTC. Furthermore, increased Id1 expression is associated with an enhanced proliferative potential in MTC. The inappropriate proliferation and dedifferentiation of the C cells that lead to MTC, at least in part, may be regulated by the Id1 gene.
Multiple endocrine neoplasia type 2A c804 RET mutation as an indication for prophylactic thyroidectomy
Authors: Frohnauer M K , Bigos S T , Peacock M L , Decker R A 
Published: March 2003

Abstract

Background
Missense mutations in five exons of the RET proto-oncogene have been found to cosegregate with the inherited cancer syndrome, multiple endocrine neoplasia type 2A (MEN2A). Sequence abnormalities involving c804 in exon 14 occur rarely and to date have been found in five kindreds. Initial reports linked the c804 mutation to a mild C-cell disease phenotype with low penetrance and an indolent course, and questioned the appropriateness of aggressive strategies such as prophylactic thyroidectomy in early childhood. The purpose of this study is to report the clinical correlates of five additional MEN2A kindreds that harbour the c804 RET mutation, with the intention of clarifying therapeutic recommendations in asymptomatic carriers.

Methods
Thirty-eight members from five distinct kindreds at risk for the c804 mutation underwent genetic analysis using genomic DNA and direct DNA sequencing. Operative and pathology reports were reviewed. Detection of C-cell hyperplasia (CCH) or medullary thyroid carcinoma (MTC) was accomplished biochemically by baseline or pentagastrin-stimulated calcitonin determinations.

Results
Twenty-three gene carriers were identified. The predisposing c804 missense mutation in each case resulted in a TTG, ATG or CTG substitution. Of the 23 patients testing genetically positive, 14 proceeded to thyroidectomy. At operation, MTC was found in seven patients (age 6–56 years), CCH in six patients (age 13–40 years) and normal thyroid histology was present in a single patient (age 27 years). One of the seven patients with MTC died from widespread metastases at age 12 years. Nine of the 23 gene carriers delayed operative intervention. Four of the nine patients have undergone biochemical testing. Three of the four patients have a raised calcitonin level and a single patient remains clinically and biochemically negative at age 40 years.

Conclusion
Penetrance of the c804 mutation is highly variable. In contrast to initial reports, however, MTC associated with sequence abnormalities at this site has aggressive potential. Therefore, prophylactic thyroidectomy remains a reasonable approach in children testing genetically positive.