bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of peripheral nerves using acellular nerve grafts with implanted cultured Schwann cells
Authors: Frerichs Onno , Fansa Hisham , Schicht Christoph , Wolf Gerald , Schneider Wolfgang , Keilhoff Gerburg 
Published: October 2002

AbstractThe bridging of nerve gaps is still one of the major problems in peripheral nerve surgery. The present experiment describes our attempt to engineer different biologic nerve grafts in a rat sciatic nerve model: cultured isogenic Schwann cells were implanted into 2‐cm autologous acellular nerve grafts or autologous predegenerated nerve grafts. Autologous nerve grafts and predegenerated or acellular nerve grafts without implanted Schwann cells served as controls. The regenerated nerves were assessed histologically and morphometrically after 6 weeks. Predegenerated grafts showed results superior in regard to axon count and histologic appearance in comparison to standard grafts and acellular grafts. The acellular nerve grafts showed the worst histologic picture, but axon counts were in the range of standard grafts. The implantation of Schwann cells did not yield significant improvements in any group. In conclusion, the status of activation of Schwann cells and the stadium of Wallerian degeneration in a nerve graft might be key factors for regeneration, rather than total number of Schwann cells. Predegenerated nerve grafts are therefore superior to standard grafts in the rat model. Acellular grafts are able to bridge nerve gaps of up to 2 cm in the rat model, but even the addition of cultivated Schwann cells did not lead to results as good as in the group with autologous nerve grafts. © 2002 Wiley‐Liss, Inc. MICROSURGERY 22:311–315 2002
Replantation of a crush amputation of distal tibia followed by lengthening with Ilizarov circular external fixator: Two‐year follow‐up
Authors: Ni̇şanci Mustafa , Er Ergin , Yildiz Cemil , Türegün Murat , Atealp Sabri , Şengezer Mustafa 
Published: October 2002

AbstractA 20‐year‐old male sustained a severe crush injury to his left leg, resulting in amputation of the foot at the level of the distal tibia. Despite 12‐h warm ischemia, replantation was attempted after radical debridement, bone shortening, and proximal fasciotomies. The replanted part survived totally. Four months later, a 13‐cm shortness of the extremity was managed by 10‐cm lengthening with distraction osteogenesis, using Ilizarov's circular external fixator and by means of a special shoe. Two‐year follow‐up of the patient revealed acceptable functional and sensorial recovery. Success of replantation despite the excessive warm‐ischemia time was attributed to the sparse muscle content of the distal tibia and foot. Fasciotomies performed on the proximal segment of the leg ensured the patency of anastomoses by maintaining adequate blood flow distally despite increasing edema after the crush injury. Debridement and bone shortening at the proximal stump eliminated the vein and nerve grafts to bridge the gap. In conclusion, considering the functional outcome of our case, replantation of distal parts of a lower extremity should be attempted first, even if the nature of the injury is unfavorable and the ischemia time is longer than the documented ischemia‐tolerance. © 2002 Wiley‐Liss, Inc. MICROSURGERY 22:295–299 2002
Health care needs diabetes model — description of a practical tool
Authors: Bottomley J , Duggan A , Williams R 
Published: October 2002

AbstractPrimary care organisations (PCOs) have a responsibility to deliver quality services to meet health needs. This responsibility, in relation to services for people with diabetes, will be further clarified when the Diabetes National Service Framework (NSF) is published. This paper describes the first example of a practical model, the health care needs assessment (HCNA)—diabetes model, in use in the NHS today, which is interactive, flexible and evidence based and which is being used to improve services for designated populations.The HCNA—diabetes model provides a population focus for the provision of services to meet local healthcare needs. It compares local provision of care to national standards and allows the option of designing a bespoke model of care for the selected population. The implication of this in terms of resource use, costs and staffing levels required to provide the service (of either current care, a model of care, or ‘your own model of care’) is described.The model can be customised to reflect local circumstances or be modified to reflect health needs in other countries, by overriding the default data with local data.The authors believe the HCNA—diabetes model will help PCOs manage the planning of quality services, now and following the publication of the NSF, to meet the needs of selected populations of people with diabetes. Copyright © 2002 John Wiley & Sons, Ltd.
Short‐term antioxidant supplementation reduces oxidative stress in elderly patients with type 2 diabetes mellitus—a pilot study
Authors: Nuttall SL , Martin U , Kendall MJ , Dunne F 
Published: October 2002

AbstractAimsThe aim of this pilot study was to determine what dose of which antioxidants might be studied in clinical trials by assessing the impact of vitamin (C and E) supplementation on markers of oxidative stress and LDL subfractions in patients with type 2 diabetes mellitus.MethodsNine elderly patients with type 2 diabetes took a moderate dose combination of vitamins C (500 mg) and E (400 IU) for 4 weeks. Following a 4 week washout, the patients had a further 4 weeks of supplementation with a higher dose combination of vitamins C (1000 mg) and E (800 IU). Blood was sampled pre‐ and post‐supplementation for vitamin E by high‐performance liquid chromatography (HPLC), total antioxidant capacity by enhanced chemiluminescence, total cholesterol and lipid hydroperoxides by colour spectrophotometry and LDL subfraction profile by disc polyacrylamide gel electrophoresis.ResultsVitamin E was increased, after the moderate dose combination (59.8 ± 6 versus 36.4 ± 4 µmol/L, p < 0.001) and increased further by the higher dose (72.7 ± 11 versus 30.8 ± 5 µmol/L, p < 0.001). Total antioxidant capacity was significantly increased above baseline after both doses (508.2 ± 33 versus 436.4 ± 31, p < 0.01 (moderate); 519.3 ± 48 versus 440.8 ± 34 µmol/L trolox eq., p < 0.01 (high)). Lipid hydroperoxides were reduced more after the moderate dose combination than after the high dose (6.1 ± 1 versus 12.1 ± 2, p < 0.01; 8.0 ± 1 versus 11.6 ± 1 µmol/L, p < 0.05). LDL subfraction score showed a non‐significant reduction after both periods of supplementation.ConclusionsThis study has demonstrated that supplementation with modest doses of the antioxidant vitamins C and E can significantly increase antioxidant defences and reduce oxidative damage in elderly patients with type 2 diabetes. Copyright © 2002 John Wiley & Sons, Ltd.
Basal insulin—answers from analogues?
Authors: Barnett AH 
Published: October 2002

AbstractThis review discusses the role of basal insulin therapy in the treatment of patients with type 1 and type 2 diabetes in the light of the availability of a new long‐acting analogue, insulin glargine. The critical role of basal insulin therapy is described, together with an overview of current and future basal insulin provision. Copyright © 2002 John Wiley & Sons, Ltd.
An unusual presentation of type 2 diabetes mellitus
Authors: McAulay V , Ibrahim BA , Campbell IW , Nawroz I 
Published: October 2002

AbstractA 53 year old male was diagnosed as having diabetes mellitus secondary to haemochromatosis. The patient died 27 months after presentation from a hepatoma. Haemochromatosis is reviewed with regard to its clinical presentation, diagnosis, treatment and prognosis. New information with regard to genotypic testing is discussed and screening for haemochromatosis in diabetic subjects and in relatives of patients with diagnosed haemochromatosis is reviewed. Copyright © 2002 John Wiley & Sons, Ltd.
Analysis of a retinal screening database to investigate the relationship between intraocular pressure and diabetic retinopathy
Authors: Barton DM , Daneshvar C , Carrington D , Buch HN , Macleod AF , West TET 
Published: October 2002

AbstractAimsTo investigate whether there is a relationship between intraocular pressure (IOP) and diabetic retinopathy.MethodsRetrospective analysis of a retinal screening database of 5838 patients with diabetes compiled over 5 years giving information on 20 091 eye examinations.ResultsLower mean IOP was associated with the presence of hard exudates alone (p < 0.005) and hard exudates with cotton wool spots (p < 0.001). There was no statistically significant association between IOP and other grades of retinopathy.ConclusionsThe mean IOP reductions observed in exudative retinopathy, although statistically significant, were probably too small to measure conventionally. The effect of low IOP on development of retinopathy may be mediated by higher ocular perfusion pressure, but why this would be specific to exudative disease is unclear. Copyright © 2002 John Wiley & Sons, Ltd.
Forensic evidence collection for sexual assault: a South African perspective
Authors: Martin L.J 
Published: November 2002

AbstractThe incidence of rape in South Africa is approximately 300 per 100 000 women, with a conviction rate of approximately 10% of cases. Poor medical evidence is responsible in part for the low conviction rate. The district surgeon system that was responsible for medico‐legal procedures and examinations is being phased out which has left the examination of sexual offences to all state employed medical practitioners. Lack of training and expertise make the present system untenable. There are several proposals being considered and implemented in the Western Cape Province to address this deficiency, which include the formation of ‘one‐stop centers’, training, and complete evidence collection kits.
Extracorporeal liver support by recirculating albumin dialysis: analysing the effect of the first clinically used generation of the MARSystem
Authors: Klammt S , Stange J , Mitzner SR , Peszynski P , Peters E , Liebe S. , Klammt S , Stange J , Mitzner S. R. , Peszynski P , Peters E , Liebe S 
Published: October 2002

Abstract: Albumin dialysis with the MARSystem is used in many hospitals to support excretory hepatic function in acute or acute on chronic liver failure. Potential pathogenic albumin bound substances accumulated in excretory liver insufficiency can be removed from patients blood by dialysis against albumin solution. A specific membrane enables the selective transport of albumin bound metabolites to the albumin containing dialysate compartment, where the loaded transport albumin is cleared and regenerated at the same time by adsorption columns and a second dialyser. Between 1993 and 1995 different membranes, set‐ups and components in albumin dialysis were tested and led finally to the recirculating MARSystem with a modified polysulphone based membrane (P3/5S Gambro, Hechingen) and two adsorption columns (N350 and BR 350, ASAHI Medical Ltd.), which showed the best performance at this time. This first generation of MARSystems was used clinically between 1995 and 1998 with only minor changes in 15 patients with acute (n = 1) or acute deterioration of chronic liver disease in our department until the improved next generation of MARSystems has been available (MARS set and monitor, Teraklin AG, Rostock, Germany). Changes in blood tests pre/post during 95 single MARS treatments and in clinical status over treatment period were evaluated retrospectively.Results: A significant decrease of albumin bound substances (average reduction during single MARS treatments: bilirubin −18%, bile acids −43.7%) as well as of water soluble metabolites (creatinine −32%, urea −31%) was observed. During extracorporeal therapy also a significant drop in platelets (− 15.4%) and a prolongation of activated prothrombin time (− 21%) was documented, whereas haemoglobin, WBC, electrolytes as well as transaminases and albumin were not affected significantly. Conclusion: Albumin dialysis with the first generation of MARS enables the removal of albumin bound and water soluble toxins. Unwanted side‐effects and changes in laboratory tests are comparable to conventional haemodialysis (drop of platelets and prolongation of coagulation tests). The elimination of albumin bound and water soluble substances was accompanied by an improvement of clinical status.
Amino acid dysbalance in liver failure is favourably influenced by recirculating albumin dialysis (MARS)
Authors: Loock J , Mitzner SR , Peters E , Schmidt R , Stange J. , Loock J. , Mitzner S. R. , Peters E. , Schmidt R. , Stange J. 
Published: October 2002

Abstract: Introduction: Dysbalance between branched chain (BCAA) and aromatic amino acids (AAA), which can be quantified by a low Fischer's Index (ΣBCAA/ΣAAA), as well as elevated levels of free tryptophan in plasma are common in hepatic failure and may contribute to the development of hepatic encephalopathy.Aim: To evaluate the influence of a new extracorporeal detoxification system for liver failure (Molecular Adsorbents Recirculating System, MARS®, i.e. dialysis against a recirculating albumin solution cleaned online by charcoal and an anion exchange resin) on plasma tryptophan and Fischer's Index.Methods: Plasma samples were taken before, during and after MARS treatments (n = 11, mean blood flow 135 ml/min, mean dialysate flow 120 ml/min, high flux polysulfone membrane). Simultaneous to blood sampling, aliquots of the albumin dialysate were taken between the elements of the dialysate circuit.Results: Fischer's Index in systemic blood increased during MARS by 24% (from 1.44 to 1.79, P < 0.001; mean treatment duration, 5.5 h). Systemic tryptophan level was significantly reduced at the same time (−25%, n = 8). Amino acid removal rates from plasma during a single dialyser passage ranged from 10 to 53%. In particular, AAA were preferentially removed (42–44% throughout treatment), while BCAA removal was 28–46% initially and later declined to 24–28%. A maximum concentration gradient between plasma and dialysate was maintained for the AAA throughout treatment through their apparently complete removal by the charcoal adsorber. Conversely, BCAA removal at both adsorbers was only minor. As a result, Fischer's Index showed a significant increase in the processed plasma, which became even more pronounced with increasing treatment duration.Conclusions: MARS enables an elevation of a pathologically decreased Fischer's Index as well as a reduction of systemic tryptophan levels in patients with liver failure. The effects of MARS on plasma amino acid dysbalance may contribute to an improvement of hepatic encephalopathy.
Albumin dialysis: single pass vs. recirculation (MARS)
Authors: Peszynski P , Klammt S , Peters E , Mitzner S , Stange J , Schmidt R. , Peszynski P. , Klammt S. , Peters E. , Mitzner S. , Stange J. , Schmidt R. 
Published: October 2002

Abstract: The single pass albumin dialysis (SPAD) was reported to be an alternative to the Molecular Adsorbent Recirculating System (MARS) for the effective removal of protein bound substances in liver failure. Three SPAD experiments using different albumin concentrations and dialysate flow rates were performed. In each experiment, 1000 ml human donor plasma, spiked with 250 mg unconjugated bilirubin, 200 mg sulfobromophthalein (BSP) and 115 mg glycocholic acid (N‐[3α,7α,12α‐trihydroxy‐24‐oxycholan‐24‐yl]glycine) – a conjugated bile acid (BA), circulated in a closed loop with 150 ml/min and was dialysed against albumin solution. These substances are bound to the different binding sites of albumin and have different association constants. For the comparison, the standard MARS experiment was performed using the same plasma flow rate of 150 ml/min. Moreover, the clearances of bilirubin for MARS and SPAD during clinical treatments were calculated using own data and those reported by Seige, Kreymann, Jeschke, et al. in Transplant Proc 1999; 31: 1371–5. The concentrations of bilirubin, BSP and BA were measured in plasma and dialysate and for these substances clearances (Cl) were calculated. It is known that the elimination rate of bilirubin is not very high during albumin dialysis in comparison to other substances, like bile acids, due to the high association constant. An increase of albumin concentration or the flow rate improved the efficacy but also raised the costs substantially. In this study, we have shown that MARS is the more effective kind of albumin dialysis for the important substances like bile acids. By SPAD an improvement of efficacy can be reached only by dramatic increase of the costs. Also, the earlier experiments showed that MARS is safer because of the removal of the stabilizers, which are normally included in the commercial albumin solutions.
Molecular Adsorbent Recirculating System: clinical experience in patients with liver failure based on hepatitis B in China
Authors: Chen S , Zhang L , Shi Y , Yang X , Wang M. , Chen Shibin , Zhang Lunli , Shi Yufei , Yang Xiaolan , Wang Minmin 
Published: October 2002

Abstract: The aim of this study is to evaluate the effect of treatment with the Molecular Adsorbent Recirculating System (MARS) on liver failure based on HBV. In 25 patients (median age, 36.3 years, range, 22–67 years, bilirubin level > 255 µmol/l) admitted with liver failure based on HBV, the 6–8h MARS intermittent treatments were performed without any adverse events, A significant decrease in bilirubin, ammonia and urea levels were observed (P < 0.05). All patients achieved a remarkable neurologic recovery, particularly 2 HE‐III and 3 HE‐IVpatients regained normal consciousness, respectively. The survival rate for the patients whose treatments kept to the MARS art strategy was 76.9% (10/13), while the others only had the survival rate of 16.7% (2/12) due to their giving up sequential MARS treatments after the first time. The rebounding rate of the bilirubin level in the patients after a single MARS treatment was significantly lower than that of patients, who underwent a single plasma‐exchange treatment (P < 0.01). It is concluded that MARS method can contribute to the optimistic treatment of liver failure patients based on HBV which being the major epidemic liver disease in China.
The Molecular Adsorbent Recirculating System in patients with severe liver failure: clinical results at the K.U. Leuven
Authors: Wilmer A , Nevens F , Evenepoel P , Hermans G , Fevery J. , Wilmer Alexander , Nevens Frederik , Evenepoel Pieter , Hermans Greet , Fevery Johan 
Published: October 2002

Abstract:Background: The Molecular Adsorbent Recirculating System (MARS) is a novel extracorporeal technique for liver support. We report the clinical results in the first 13 patients with severe liver failure treated at our institution. Methods: Patients with acute or acute on chronic liver failure of various aetiologies were treated with varying numbers of MARS sessions of six hours duration. Results: Mean APACHE II score was 18. In general, patients with multiple organ failure faired poorly even with MARS treatment. Five patients (38%) survived the hospitalisation. Eight patients (62%) fulfilled criteria for UNOS type I or 2 A status. Two of these patients survived. Five patients had a UNOS 2B status and three survived. In proportion, patients with severe itch, patients with primary non‐function and those where MARS was used as a bridge to transplantation seemed to profit most from the treatment. The median reduction in bilirubin concentrations after the treatment period was −28.2%. In survivors, the median reduction was −37.7% and in patients who died was −15.9%. The median encephalopathy score improved from 1.7 to 0.5. Conclusion: The molecular adsorbent recycling system (MARS) might be lifesaving in patients with severe liver failure of different aetiologies.
Extracorporal albumin dialysis (MARS) improves cholestasis and normalizes low apo A‐I levels in a patient with benign recurrent intrahepatic cholestasis (BRIC)
Authors: Sturm E , Franssen CFM , Gouw A , Staels B , Boverhof R , De Knegt RJ , Stellaard F , Bijleveld CMA , Kuipers F. , Sturm E. , Franssen C. F. M , Gouw A , Staels B , Boverhof R , De Knegt R. J , Stellaard F , Bijleveld C. M. A , Kuipers F 
Published: October 2002

Abstract: The familial cholestatic diseases Benign Recurrent Intrahepatic Cholestasis (BRIC) and Progessive Familial Intrahepatic Cholestasis type 1 (PFIC1) are characterized by intermittent or permanently elevated plasma bile salt levels, therapy‐resistant extreme pruritus and peculiar biochemical abnormalities including low apolipoprotein apo A‐I. Previously, symptomatic improvement has been demonstrated in BRIC patients after extracorporal albumin dialysis (MARS). We hypothesized that MARS improves cholestasis, induces changes in the bile salt profile and normalizes apo A‐I serum levels in BRIC. A 17‐year‐old‐female patient with BRIC experienced an episode of cholestasis lasting for more than 6 months with extreme pruritus and diarrhoea not responding to standard therapy. During a period of five days the patient was treated 3 × 8 h with MARS. The procedures were well tolerated and resulted in reduction of plasma bile salts by 58%. The plasma bile salt profile changed into a more hydrophilic composition after MARS. Diarrhoea discontinued and the pruritus improved significantly from 9 to 4 on a subjective scale. These effects lasted 4 months until a relapse occurred. Low plasma apo A‐I levels (0.52 g/l) normalized after MARS (0.98 g/l). The procedures were well tolerated. Fatigue was noted as the only transient side‐effect. In conclusion, MARS may induce a long‐term symptomatic improvement and decrease of cholestatic markers in BRIC. Further studies evaluating efficacy and mechanism of MARS in patients with BRIC are needed.
Clinicopathological analysis of early gastric cancer with solitary lymph node metastasis
Authors: Arai K , Iwasaki Y , Takahashi T 
Published: October 2002

Abstract

Background
The sentinel node concept has not yet been established in gastric cancer.

Methods
Fifty-four patients with early gastric cancer who had only one lymph node metastasis were regarded retrospectively as patients with a possible sentinel node metastasis, and the morphological features of these nodes were assessed. The level I nodes in seven patients with a possible skip metastasis at routine haematoxylin and eosin staining were re-examined using cytokeratin (CK) immunostaining.

Results
The shape of the gastric cancer lesion could be examined in 53 of the patients; more than one-third (20 of 53) were microfocal type. Concerning the intranodal cancer foci, the marginal sinus type was found in 32 affected nodes, medullary sinus type in 14 and mixed type in seven. Forty-three per cent of suspected sentinel nodes were the largest in size among all nodes from the station. CK immunostaining of seven non-metastatic nodes with haematoxylin and eosin revealed that three were CK positive.

Conclusion
These findings suggest that possible sentinel nodes detected by conventional means may not always be primary portions of any metastasis. Adoption of sentinel node biopsy in gastric cancer must await the development of improved procedures for diagnosis during surgery.