bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient adhesion refractoriness of circulating platelets under shear stress: the role of partial activation and microaggregate formation by suboptimal ADP concentration
Authors: Savion Naphtali , Shenkman Boris , Tamarin Ilya , Dardik Rima , Frojmovic Mony , Varon David 
Published: March 2003

Exposure of whole blood (WB) to subendothelial extracellular matrix (ECM) under shear stress in the cone and plate(let) analyser (CPA) results in platelet adhesion, followed by release reaction and aggregation of circulating platelets on the adherent platelets. The properties of circulating non‐adhered platelets in the CPA was studied by exposure of WB to ECM at a high shear rate (1300/s) for 2 min (1st run), followed by transfer of the suspension to a new ECM‐coated well for a second run (2nd run) under similar conditions. The results of the 2nd run demonstrated transient adhesion refractoriness associated with platelet microaggregate formation in the suspension. The adhesion refractoriness was dependent on platelet activation during the 1st run and was prevented by addition of apyrase (ADP scavenger) or ADP receptor inhibitor, suggesting a role for ADP in mediating this response. Furthermore, exposure of WB samples to suboptimal concentrations of ADP (0·4–1 μmol/l) or a thrombin receptor activating peptide (TRAP) (5 μmol/l) for 2 min resulted in a similar transient platelet adhesion refractoriness to ECM under flow conditions. The transient platelet refractoriness and microaggregate formation induced by ADP was associated with a transient reduction in glycoprotein (GP)Ib, increased P‐selectin expression and increased fibrinogen binding by circulating platelets. These data suggest a role for platelet agonists at suboptimal concentrations in modulating platelet function and limiting the expansion of the thrombus.
Acute myeloid leukaemia in human immunodeficiency virus‐infected adults: epidemiology, treatment feasibility and outcome
Authors: Sutton Laurent , Guénel Pascal , Tanguy Marie‐Laure , Rio Bernard , Dhedin Nathalie , Casassus Philippe , Lortholary Olivier ,   for the French Study Group on Acute Myeloid Leukaemia in HIV‐infected Patients
Published: March 2003

The epidemiology and clinical outcome of acute myeloid leukaemia in human immunodeficiency virus (HIV)‐infected adults is poorly documented. We retrospectively surveyed all French haematology centres for adult acute myeloid leukaemia (AML) cases diagnosed between January 1990 and July 1996 who were found to be HIV‐seropositive before or at the time of AML diagnosis. Medical charts were reviewed to determine the stage of HIV infection, the characteristics of AML and the response of AML to chemotherapy. Sixteen cases of AML (13 men, three women) were reported by 12 haematology units. Based on assumptions on the size, age and sex distribution of the HIV‐infected population in France, the estimated risk of AML in 1990 to 1996 among HIV‐infected adults was twice that of the general population (standardized incidence ratio = 2·05; 95% confidence interval, 1·17–3·34). Two other cases occurring before 1990 were spontaneously notified to the authors and were included in the clinical analysis. At AML diagnosis, the median CD4+ cell count was 275 × 106/l and nine patients had acquired immune deficiency syndrome (AIDS). Fifteen patients were scheduled for remission‐induction therapy of AML. No deaths were related to AML treatment. Complete remission was obtained in 11 out of 15 patients. Three patients were long‐term survivors: two remain alive in complete remission at 8 years and 9 years, respectively, and the third died of AIDS at 8 years. A CD4+ cell count above 200 × 106/l at AML diagnosis was predictive of longer survival (log‐rank test: P = 0·004). Like many other malignancies, the incidence of AML appears to be increased in HIV‐infected patients. Our results show a twofold higher incidence, although this needs to be confirmed in a specifically designed prospective epidemiological study. Such patients, especially those with CD4+ cell counts above 200 × 106/l at AML diagnosis, should receive remission‐induction therapy, which can confer long‐term survival.
Evidence that natural killer cells express mini P‐glycoproteins but not classic 170 kDa P‐glycoprotein
Authors: Trambas Christina , Wang Zemin , Cianfriglia Maurizio , Woods Greg 
Published: March 2003

Several lines of evidence including reverse transcription polymerase chain reaction, immunoreactivity and their ability to efflux rhodamine 123 have implied the existence of P‐glycoprotein in natural killer (NK) cells. It has been a natural tendency to assume that NK‐cell P‐glycoprotein is identical to the P‐glycoprotein of multidrug resistant (MDR) cell lines, however, the present study uncovered major differences. Functionally, NK cells demonstrated a restricted substrate profile, being unable to transport daunorubicin and calcein acetoxymethylester while efficiently transporting other P‐glycoprotein substrates. Furthermore, physical differences in NK‐cell P‐glycoprotein were established by differential reactivity with P‐glycoprotein antibodies. NK cells demonstrated strong reactivity with C494 and JSB‐1, but did not react appreciably with C219. In addition, NK cells were unable to bind to the antibody MM4·17 unless they had been fixed and permeabilized, yet this antibody normally recognizes an extracellular epitope of P‐glycoprotein. These differences culminated in the demonstration using Western analysis that NK cells did not express detectable levels of 170 kDa P‐glycoprotein. Instead, NK cells expressed small‐molecular‐weight ‘mini P‐glycoprotein’ products, of approximately 70 and 80 kDa. Collectively, these data indicate that the predominant P‐glycoprotein species of NK cells are novel mini P‐glycoproteins and not the classic P‐glycoprotein of MDR models.
The investigation and management of neonatal haemostasis and thrombosis*
Authors: Williams Michael D. , Chalmers Elizabeth A. , Gibson Brenda E. S. 
Published: March 2003

SummaryThese guidelines address developmental aspects of neonatal haemostasis and thrombosis, the laboratory investigation of the neonate, and the diagnosis and clinical management of haemostatic and thrombotic conditions occurring in this period (defined as the first 4 weeks of life following birth). Relevant scientific papers were identified by a systematic literature review from Medline 1975–2000 using index terms which incorporated the various component subjects of these guidelines. Further publications were obtained from the references cited and from reviews known to the members of the working party and to the Haemostasis and Thrombosis Task Force. Evidence and graded recommendations presented in these guidelines are in accordance with the US Agency for Health Care Policy and Research, as described in the Appendix. It will be noted that there is a lack of a strong evidence base for many of the recommendations suggested, as the appropriate clinical and laboratory trials have not been and perhaps never will be undertaken in neonates. Most of the recommendations are therefore of Grade C evidence levels IV: higher levels are mentioned specifically throughout the document when relevant.
Adrenal-sparing surgery for phaeochromocytoma
Authors: Neumann H P H , Bender B U , Reincke M , Eggstein S , Laubenberger J , Kirste G 
Published: March 2003

Abstract

Background
Adrenalectomy is the current treatment for phaeochromocytoma. Consequently, patients with bilateral adrenal phaeochromocytoma become steroid dependent. An adrenal-sparing surgical technique was introduced in 1985. The results of this treatment have been reviewed.

Methods
Since 1985, 39 patients with adrenal phaeochromocytoma (16 men and 23 women, aged 10–76 years) have been treated. Thirty-three patients had unilateral and six had bilateral phaeochromocytomas. Seven of the former 33 had a contralateral adrenal tumour resected previously. All 39 patients were re-evaluated biochemically and clinically for ipsilateral recurrence.

Results
Adrenal-sparing surgery was performed successfully in 37 of the 39 patients. In one, adrenal-sparing resection was impossible anatomically and total adrenalectomy was necessary. Another patient with bilateral tumours had retroperitoneal haemorrhage and became steroid dependent. None of the remaining 12 patients who had bilateral adrenal surgery required steroid replacement. Adrenocortical function was normal in eight and mildly impaired in two of the ten patients who had evaluation by adrenocorticotrophic hormone stimulation. After a mean follow-up of 73 months, one patient with von Hippel–Lindau disease developed a recurrence in the ipsilateral adrenal gland. Genetic testing revealed that 26 of the 39 patients, including half of those with a unilateral tumour, had hereditary phaeochromocytoma.

Conclusion
Adrenal-sparing surgery is safe and effective, and may become the treatment of choice in patients with hereditary phaeochromocytoma.
Audit of methods of laparoscopic cholecystectomy
Authors: Chitre V V , Studley J G N 
Published: March 2003

Abstract

Background
The operation of laparoscopic cholecystectomy began the modern era of laparoscopic surgery. Refinements in technique continue to appear. The techniques currently favoured by British surgeons have been reviewed.

Methods
A questionnaire-based survey was carried out among surgeons with a special interest in minimal access surgery. The data collected were entered into a database and analysed. Current literature relating to surgical technique was reviewed.

Results
Many aspects were evaluated and the results have shown that there is no uniform approach. It is interesting that only 30·8 per cent of surgeons use the open (Hasson) technique for peritoneal access. In addition, the use of intraoperative cholangiography continues to vary, with 65·8 per cent using the technique in selected cases. Fascial repair is not undertaken by 12·2 per cent of surgeons.

Conclusion
Some trends are clearly discernible. There is a greater willingness than previously to perform intraoperative cholangiography, but the consensus seems to be against performing it in all cases. Similarly, British surgeons seem to be largely unimpressed by the dangers of the Veress needle; the Hasson technique has not been widely adopted. The need to prevent port-site herniation seems to be generally accepted, with most surgeons performing fascial repair.
Outcome of primary radiocephalic fistula for haemodialysis
Authors: Golledge J , Smith C J , Emery J , Farrington K , Thompson H H 
Published: March 2003

Abstract

Background
Patient characteristics may help select the most appropriate type of permanent vascular access for haemodialysis. The aim of this study was to assess the influence of patient-related variables on the outcome of radiocephalic fistulas.

Methods
Over 3 years 107 consecutive patients underwent formation of a radiocephalic fistula for permanent haemodialysis access. Patients receiving prosthetic, ulnar, brachial or secondary fistulas were excluded. Patients were followed prospectively until access failure, transplantation or death, or for a minimum of 6 months (median follow-up 24 months).

Results
Primary patency was 69 per cent at 12 months and 56 per cent at 24 months. Endovascular and surgical intervention led to limited improvement in secondary patency to 63 per cent at 24 months. Regression analysis showed that fistula failure was more common in women (P = 0·02), diabetics (P = 0·03) and young patients (P = 0·02). By life-table analysis, primary and secondary patency were significantly better (P = 0·01) for men and non-diabetics, while the outcome was similar for all age groups.

Conclusion
One-third of radiocephalic fistulas fail irreversibly within 2 years. Failure is more likely in women and diabetic patients.
Treatment of colorectal liver metastases
Authors: Geoghegan J G , Scheele J 
Published: March 2003

Abstract

Background
Surgical resection is the only potentially curative treatment for colorectal liver metastases, with 5-year survival rates approaching 40 per cent. However, at present only 20–25 per cent of such lesions are deemed resectable. This review examines developments in neoadjuvant and adjuvant treatments of colorectal liver metastases that aim to improve the results of surgical management of this disease.

Methods
A literature review was undertaken based on a Medline search from 1970 to May 1998.

Results
Further evolution in surgical technique is unlikely to lead to a dramatic increase in the resectability rate of colorectal liver metastases. Recent developments in neoadjuvant and adjuvant chemotherapy schedules, together with a range of interventional radiological procedures and interstitial lytic techniques, show promise in terms of extending the limits of resectability and decreasing recurrence rates associated with these lesions. Using multimodality regimens 5-year survival rates of 40 per cent are now being reported for lesions that were initially considered irresectable.

Conclusion
Patients with colorectal liver metastases should be assessed in units that can offer all the specialist techniques necessary to deliver optimum care. Incorporation of newer neoadjuvant and adjuvant treatments into management strategies should occur in the setting of randomized trials.
Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-d-glucose for the differentiation of chronic pancreatitis and pancreatic cancer
Authors: Imdahl A , Nitzsche E , Krautmann F , Högerle S , Boos S , Einert A , Sontheimer J , Farthmann E H 
Published: March 2003

Abstract

Background
The clinical presentation of patients with pancreatic cancer may resemble the clinical picture of chronic pancreatitis. A definitive preoperative diagnosis is not always obtained in patients with a history of chronic pancreatitis despite the use of modern imaging techniques. Operative strategy therefore remains unclear before operation in these patients.

Methods
Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG) was introduced recently into clinical oncology because of its ability to demonstrate metabolic changes associated with various disease processes. The impact of FDG-PET on the differentiation of chronic pancreatitis and pancreatic cancer was investigated. FDG-PET was performed in 48 patients with chronic pancreatitis (n = 12), acute pancreatitis (n = 3) and pancreatic cancer (n = 27), and in controls (n = 6). Histological examination was undertaken in all cases except controls. The FDG-PET results were obtained without knowledge of results of other imaging procedures. The results were then compared with those of computed tomography, ultrasonography, endoscopic retrograde cholangiopancreaticography, operative findings and histology. PET images were analysed semiquantitatively by calculating a standard uptake value (SUV) 90 –120 min after application of the tracer.

Results
Cut-off values were validated as follows: SUV greater than 4·0 for pancreatic cancer, SUV of 3·0 – 4·0 for chronic pancreatitis, and SUV of less than 3·0 for controls. Sensitivity and specificity of PET imaging were 0·96 and 1·0 for pancreatic cancer, and 1·0 and 0·97 for chronic pancreatitis. In five cases only FDG-PET led to the correct preoperative diagnosis.

Conclusion
The results give further evidence that FDG-PET is an important non-invasive method for the differentiation of chronic pancreatitis and pancreatic cancer. Delayed image acquisition in the glycolysis plateau phase permits improved diagnostic performance. This imaging technique is extremely helpful before operation in patients with an otherwise unclear pancreatic mass, despite its costs.
Three-dimensional endoanal sonography in assessing anal canal injury
Authors: Gold D M , Bartram C I , Halligan S , Humphries K N , Kamm M A , Kmiot W A 
Published: March 2003

Abstract

Background
Instrument design limits endosonography of the anal canal to the axial plane, with no capability for longitudinal imaging or measurement. Using three-dimensional reconstructions, the relationship between the radial and linear extent of an anal sphincter tear has been explored, and sex differences in anal canal and sphincter length have been established.

Methods
Three-dimensional reconstructions were performed in 20 controls and 24 patients with faecal incontinence found to have 25 external and five internal sphincter defects. The radial and linear extent of any sphincter tear was measured. In controls the length of the sphincters was compared with the total anal canal length, and the maximum and mean internal sphincter thickness was compared.

Results
The radial angle of an internal or external sphincter defect was significantly related to its length (R2 = 96·8 per cent and R2 = 84·4 per cent respectively; both P&lt; 0·001). The anal canal was longer in men than in women (mean(s.d.) 32·6(5·3) versus 25·1(3·4) mm; P&lt; 0·001). The internal anal sphincter was also longer in men (25·6(6·3) versus 19·8(4·0) mm; P&lt; 0·02), but the mean internal sphincter length as a percentage of total anal canal length did not differ (78·3 versus 78·7 per cent; P not significant). The anterior external anal sphincter was longer in men than in women (32·6(5·3) versus 15·3(2·8) mm; P&lt; 0·001), and formed a greater percentage of total anal canal length (100 versus 62·9 per cent; P&lt; 0·001).

Conclusion
Multiplanar imaging has revealed a direct relationship between the length of a sphincter tear and its radial extent as shown on axial scanning. Marked sex differences in sphincter configuration have been demonstrated. In women the shorter anterior sphincter length highlights the risk of complete sphincter disruption with extensive tears.
Evaluation of pylorus-preserving pancreatoduodenectomy with the Imanaga reconstruction by hepatobiliary and gastrointestinal dual scintigraphy
Authors: Hishinuma S , Ogata Y , Matsui J , Ozawa I 
Published: March 2003

Abstract

Background
Following pylorus-preserving pancreatoduodenectomy (PPPD), most surgeons use gastrointestinal reconstruction with an end-to-side duodenojejunostomy placed distally to the pancreatojejunostomy and choledochojejunostomy. In contrast, the authors have consistently used PPPD with the Imanaga reconstruction (PPPD-Imanaga) which consists of end-to-end duodenojejunostomy, end-to-side pancreatojejunostomy and choledochojejunostomy, performed in that order. In this study, the movement of bile and food after PPPD-Imanaga was evaluated to document the functional advantages of this method.

Methods
Twenty-four patients who had undergone PPPD-Imanaga were subjected to hepatobiliary and gastrointestinal dual scintigraphy. The interval between operation and scintigraphy ranged from 28 days to 67 months. Six of the 24 patients underwent repeated dual scintigraphy for the observation of temporal changes in gastrointestinal function.

Results
The incidence of biliogastric reflux and bile stasis in the jejunal loop was markedly decreased at times later than 2 months after operation. Delay of gastric emptying and bile evacuation, sometimes accompanied by stasis in the jejunal loop, affected the mixing status of bile and food at 1 h after the beginning of imaging. A majority of the patients, however, had a satisfactory mixing status at 2 h.

Conclusion
The Imanaga reconstruction appears to be a recommendable procedure following PPPD, in light of the bile and food movement achieved in the gastrointestinal tract.
Surgery may be curative for patients with a localized perforation of rectal carcinoma
Authors: Kagda F H Y , Nyam D C N K , Ho Y H , Eu K W , Leong A F P K , Seow-Choen F 
Published: March 2003

Abstract

Background
Perforation at the time of operation adversely affects the prognosis of rectal cancer. These procedures have been termed ‘palliative’ or ‘non-curative’. The long-term outcome of generalized perforations may be different from that of localized or contained perforations. Although the oncological results may be compromised when the tumour is perforated, results in cases where the perforation is contained may not be as bad as previously thought. An attempt was made to examine the intermediate and long-term results for locally contained perforated rectal cancers.

Methods
Some 848 patients with rectal cancer were operated on between March 1989 and December 1995. Of these, 42 (5 per cent) had a locally contained perforation of the rectum. Median follow-up was 23 (range 12–74) months.

Results
The survival of patients with locally contained tumour perforation who underwent resection without macroscopic residual disease (40 per cent at 5 years) was significantly better than that of patients with metastatic disease at the time of surgery (zero at 4 years) (P &lt; 0·01). The survival of patients in whom the tumour was inadvertently perforated during operation was similar to that of patients with locally contained spontaneous tumour perforations. The incidence of local recurrence in these perforated cases was low provided that a wide tumour clearance was achievable at the time of operation. Operative mortality and morbidity rates were not significantly different but the incidence of postoperative wound infection was marginally higher among patients with perforation.

Conclusion
If clear margins can be obtained at the time of operation the prognosis of locally contained perforated rectal cancers is good and approaches that of a potentially curative resection.
Laparoscopy extends the indications for liver resection in patients with cirrhosis
Authors: Abdel-Atty M Y , Farges O , Jagot P , Belghiti J 
Published: March 2003

Abstract

Background
Clinical or biological evidence of liver failure is usually considered a contraindication to open liver surgery as it is associated with a prohibitive risk of postoperative death.

Methods
This report describes three patients who had resection of a superficial hepatocellular carcinoma suspected either to be ruptured, or at high risk of rupture, using the laparoscopic approach. All three patients had intractable ascites, in two superimposed on active hepatitis. Surgery was per- formed under continuous carbon dioxide pneumoperitoneum with intermittent clamping of the hepatic pedicle.

Results
Intraoperative blood loss was between 100 and 400 ml; no blood transfusion was required. The postoperative course was uneventful except for a transient leak of ascites through the trocar wounds. Duration of in-hospital stay was 6–10 days. Liver function tests had returned to preoperative values within 1 month of surgery in all patients.

Conclusion
The laparoscopic approach may enable liver resection in patients with cirrhosis and evidence of liver failure that would contraindicate open surgery.
Oral nifedipine reduces resting anal pressure and heals chronic anal fissure
Authors: Cook T A , Humphreys M M Smilgin , Mortensen N J McC 
Published: March 2003

Abstract

Background
Topical preparations have been used in the treatment of anal fissure. However, they are not universally successful and there is confusion over the site and dose of application. This study assessed the effectiveness of oral nifedipine in reducing resting anal pressure and on fissure healing.

Methods
Anal manometry was performed on eight healthy volunteers and 15 patients with chronic anal fissure before and after oral administration of nifedipine 20 mg. Nifedipine was taken twice daily. Fissure healing was assessed over an 8-week period and pain scores were monitored.

Results
Oral nifedipine produced an initial reduction in maximum resting anal pressure (MRP) of 35 per cent (P &lt; 0·001) and of 28 per cent after 5 days (P &lt; 0·001) in healthy volunteers. A reduction in MRP of 36 per cent (P &lt; 0·001) was observed in patients with fissure. Pain scores were significantly reduced during the treatment period. Healing was complete in nine patients after 8 weeks and a further three were asymptomatic. Ten patients experience flushing and four had mild headaches. There were no episodes of postural hypotension or incontinence.

Conclusion
Oral nifedipine reduces resting anal pressure. It is well tolerated and offers an alternative treatment for chronic anal fissure.