bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colorectal Follow-Up Planning Modified on the Basis of Our Personal Experience
Authors: Li Destri Giovanni , Rinzivillo Calogero , Craxi Giuseppe , La Greca Gaetano , Di Cataldo Antonio , Puleo Stefano , Licata Antonio 
Published: April 2003

<b>Background:</b> The authors, evaluating the disappointing follow-up results in patients suffering from colorectal carcinoma who had undergone surgery for cure, tried a more rational follow-up. <b>Methods:</b> In a retrospective review about 232 patients who adhered to the follow-up protocol, we evaluated the accuracy rates of CEA, liver ultrasonography and abdominal CT. In the same group of patients, we evaluated the type of correlation between the neoplastic recurrence rate and Astler-Coller’s classification. <b>Results:</b> (1) In detecting hepatic metastases CEA levels furnished sensitivity and negative predictive value more than liver ultrasonography (83.3 vs. 77.8% and 98.4 vs. 98%, respectively); (2) in our series, we obtained a lower recurrence rate in classes A+B1 (7.5%) and B2 (20.8%) and higher in C1+C2 (44.4%) and D (66.7%) (p < 0.01). <b>Conclusion:</b> According to these data we decided to eliminate postoperative liver ultrasonography and customize follow-up protocol on tumor staging and timing of cancer relapse. The authors believe that these changes will not modify the results, but cause less psychophysical stress for the patients and reduce costs by 50%.
The Pneumoperitoneum and Its Role in Tumor Seeding
Authors: Reymond M.A. , Schneider C. , Hohenberger W. , Köckerling F. 
Published: April 2003

Port site recurrences (PSR) are abdominal wall recurrences that occur within a trocar site after cancer laparoscopy and that are not associated with peritoneal carcinosis. The short clinical delay of occurrence of PSR (median 190 days in colorectal cancer) suggests a massive cell seeding into the abdominal wall (over 10<sup>6</sup> cells) during the operation. In human and animal studies, CO<sub>2</sub> was not able to aerosolize large numbers of tumor cells using pressures of 8–15 mm Hg, even though isolated mesothelial cells have been found in the aerosol. Such large numbers of tumor cells have only been demonstrated on instruments and trocars. PSR occur not only after CO<sub>2</sub> laparoscopy, but also after thoracoscopy, where no CO<sub>2</sub> is used. Gaseless laparoscopy was able to reduce, but not to eliminate port site contamination in animal models. Tumor growth was enhanced in numerous animal models using CO<sub>2</sub>, suggesting an adjuvant effect on tumor growth in the trocar wound. Nevertheless, reported clinical incidences between 0 and 21% suggest that PSR might be a surgeon-related variable dependent mainly on experience and technical expertise. Technical measures have been proposed that might reduce the incidence of PSR.
Ultrasound-Guided Percutaneous Cholecystostomy as an Initial Treatment for Acute Cholecystitis in Elderly Patients
Authors: Lee King-Teh , Wong Sen-Ren , Cheng Jong-Shyong , Ker Chen-Guo , Sheen Pai-Ching , Liu Yueh-Er 
Published: April 2003

<b>Background/Aims:</b> Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of servere co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we performed ultrasound-guided percutaneous transhepatic cholecystostomy (PC) on elderly patients with acute cholecystitis for both initial treatment and subsequent diagnosis of their biliary tract disorders. <b>Methods:</b> Those being more than 70 years old, had acute episode of cholecystitis for more than 48 h and still had positive Murphy’s signs and distended gallbladders were candidates for ultrasound-guided PC. <b>Results:</b> Forty-two elderly patients underwent ultrasound-guided PC. Once the condition of each patient showed signs of improvement and stability, cholangiography was performed via PC tube. The results of the cholangiography showed 20 patients with gallbladder stones, 16 with common bile duct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients with acalculous cholecystitis had the PC tube removed 3 weeks later, without further surgery. Two patients had gallbladder stones removed by choledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occurred in 5 patients (11.9%), no instance of operative mortality was found. <b>Conclusion:</b> Our findings lead us to conclude that the use of PC in the early treatment of acute cholecystitis in elderly patients can decrease postoperative morbidity and mortality.
Left Colon Substitution with His’ Angle following Total Gastrectomy
Authors: Ohwada Susumu , Ogawa Tetsushi , Nakamura Seiji , Satoh Yoshihiro , Takeyoshi Izumi , Iwazaki Shigeru , Izumi Masaru , Iino Yuichi , Morishita Yasuo 
Published: April 2003

To resolve the disadvantages of jejunal Roux-en-Y reconstruction following total gastrectomy, we attempted the use of left colon substitution with all anastomoses conducted using mechanical stapling devices. A His’ angle was formed to reduce regurgitation esophagitis. About 25 cm of the left colon with the ascending branch of the left colic artery with an adequate blood supply was brought up to the remnant esophagus without tension on the mesentery. The colon graft was interposed between the esophagus and duodenum in an isoperistaltic fashion. Three anastomoses, esophagocolic, duodenocolic and colocolic, were completed with a circular stapling device. An end-to-side esophagocolonostomy was positioned about 3 cm distal from the blind end of the proximal colon stump. The proximal end of the left colon was pexied to the esophagus using 3–4 stitches to make a new His’ angle. Gastrointestinal continuity was restored by a side-to-end colonoduodenostomy and an end-to-end colonocolonostomy. Fifteen gastric cancer patients underwent left colon substitution following total gastrectomy. The circular staple used for esophagocolonostomy and colonoduodenostomy was 25 mm in all patients, and for colonocolonostomy was 29 mm in 9 patients and 33 mm in 6 patients. No problems were encountered in any steps of the procedure, and faulty stapling was avoided. Neither anastomotic leakage nor necrosis of the interposed colon segment was seen, nor was late anastomotic stricture, in any patient. Barium radiograms of the interposed colon segment showed that the capacity and passage of the interposed colon were adequate, and regurgitation did not occur. Diet volume was satisfactory and weight loss minimal.
Early Gastrointestinal Regulatory Peptide Response to Intestinal Resection in the Rat Is Stimulated by Enteral Glutamine Supplementation
Authors: Wirén M. , Adrian T.E. , Arnelo U. , Permert J. , Staab P. , Larsson J. 
Published: April 2003

<i>Background:</i> Intestinal resection stimulates the synthesis and release of gastrointestinal peptides that regulate the growth and adaptation of the mucosa. Luminal nutrients are necessary for optimal proliferation and glutamine is the preferential nutrient to the small bowel. The interplay between glutamine and regulatory peptides could be important in treating short bowel syndrome. <i>Methods:</i> 63 Sprague-Dawley rats were divided into 3 groups: resection; transection, or controls. After intestinal resection animals were orally fed either a diet without glutamine or a glutamine-supplemented diet for 2 days. Transected animals and controls without prior surgery were fed the same two diets. Epidermal growth factor (EGF), transforming growth factor-α, insulin-like growth factors I and II (IGF-I and IGF-II), peptide YY (PYY), and enteroglucagon were analyzed in mucosa from the proximal jejunum, distal ileum as well as in portal plasma when the animals were euthanized 72 h after surgery. <i>Results:</i> Intestinal resection resulted in an early increase in portal plasma concentrations of PYY, EGF, enteroglucagon, and mucosal IGF-II and EGF content that were significant in glutamine-treated animals. Glutamine significantly increased PYY in portal blood after resection (p < 0.05). <i>Conclusion:</i> Glutamine could be of importance for the functional adaptation of residual small bowel mucosa by increasing PYY release.
Acute Abdomen and <i>Clostridium difficile</i> Colitis: Still a Lethal Combination
Authors: Klipfel Adam A. , Schein Moshe , Fahoum Bashar , Wise Leslie 
Published: April 2003

<i>Background:</i> With the steadily prevalent appropriate and inappropriate use of antimicrobial agents, <i>Clostridium difficile</i> colitis has continued to be noticed as a common problem in hospitalized patients. The aim of this communication is to highlight a subset of <i>C. difficile</i> colitis patients who presented with an acute abdomen. <i>Methods:</i> This is a retrospective study of 10 patients who underwent laparotomy for an ‘acute abdomen’ with an intraoperative or postoperative diagnosis of <i>C. difficile</i> colitis. <i>Results:</i> All patients received antibiotics (mean 9.5 days) for other illnesses. The mean APACHE II score was 18.8 (range 8–25) and the mortality rate was 80%. Two patients had colostomies created. One patient underwent a subtotal colectomy, and another underwent a Hartmann procedure; the rest had a nontherapeutic procedure. <i>Conclusion:</i> We conclude that <i>C. difficile</i> colitis presenting as an ‘acute abdomen’ still represents a lethal entity. Patients who present with an ‘acute abdomen’, with a history of recent or current antibiotic intake, and without findings which mandate an exploration should have <i>C. difficile</i> colitis urgently excluded. Timely diagnosis of <i>C. difficile</i> colitis through bedside sigmoidoscopy or a CT scan could spare the critically ill patient an unneccessary and risky operation. Furthermore, if laparotomy is subsequently needed then having a preoperative diagnosis of <i>C. difficile</i> colitis will allow appropriate surgical therapy to be implemented.
Prostaglandin E<sub>1</sub> Continuous Hepatic Arterial Infusion in the Treatment of Postoperative Acute Liver Failure
Authors: Sato Tsutomu , Asanuma Yoshihiro , Kurokawa Toshiaki , Kato Takeshi , Yasui Ouki , Kusano Tomoyuki , Koyama Kenji 
Published: April 2003

<i>Aim:</i> In the treatment of severe liver damage, it is of greater advantage to administer prostaglandin E<sub>1</sub> (PGE<sub>1</sub>) directly to the liver compared with systemic intravenous infusion, because of its high inactivation rate in the lungs. In comparison with intraportal infusion, hepatic arterial infusion is more advantageous because of its easier and safer accessibility. This study was designed to prove the superiority of hepatic arterial infusion to intravenous infusion. <i>Methods:</i> Changes in hepatic hemodynamics and oxygen delivery accompanying PGE<sub>1</sub> infusion using both methods were investigated in pigs. In addition, continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure, for patients in whom other conventional treatments like plasma exchange failed to improve the functioning of the liver. <i>Results:</i> Hepatic arterial flow increased significantly accompanying hepatic arterial infusion of PGE<sub>1</sub> at a rate of 0.1 μg/kg/min compared with intravenous infusion at the same rate in pigs. Such an increase resulted in elevation of total hepatic blood flow and oxygen delivery to the liver. Correspondingly, bile flow significantly increased accompanying hepatic arterial infusion of PGE<sub>1</sub>. Continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure. The infusion was continued for 7–9 days at a rate of 0.01 μg/kg/min without any complications through heparin-coated catheters inserted via the femoral artery. Significant increase in bile flow was observed in 2 cases in whom bile was collected, serum total bilirubin began to decrease in all these 3 cases, and the patients recovered from acute liver failure. <i>Conclusion:</i> Hepatic arterial infusion of PGE<sub>1</sub> is very useful and effective in the treatment of acute liver failure.
Glial Cell Line-Derived Neurotrophic Factor Stimulates Ureteric Bud Outgrowth and Enhances Survival of Ureteric Bud Cells in vitro
Authors: Towers P.R. , Woolf A.S. , Hardman P. 
Published: April 2003

Development of epithelial organs requires co-ordinated interactions between epithelial and mesenchymal tissues. Studies using null mutant mice have indicated that the ret receptor and its ligand, glial cell line-derived neurotrophic factor (GDNF), are crucial for initiation of development of the metanephric kidney. However, the role of this signalling system in other branching organs has not been analysed. Here we describe detailed expression studies of ret, GDNF, and a co-receptor for GDNF (GDNFRα) in the developing mouse metanephros, lung, and submandibular salivary gland. Also, we examined the role of this signalling system in the development of these organs in vitro. In situ hybridisation revealed differences in the spatial distribution of the three transcripts in the different organs. At the initiation of metanephric development, late on embryonic day 10 (E10), ret and GDNFRα were detected in the Wolffian duct (including the presumptive ureteric bud) whilst the presumptive metanephric mesenchyme expressed GDNFRα and GDNF. Later in development, all three transcripts were restricted to the nephrogenic zone. In contrast, expression in the lung was not detectable by in situ hybridisation until after initiation of development, at E13.5. At this time ret was expressed throughout the epithelium; GDNF was detected throughout the mesenchyme, and GDNFRα was present in the proximal epithelium and mesenchyme only. Ret and GDNF were not detected in the epithelium or mesenchyme of the developing salivary gland, however, GDNFRα was expressed in the mesenchyme at E13.5 and E16.5. Functional studies demonstrated that in organ culture, GDNF significantly increased branching morphogenesis of the E11.5 metanephros, and induced the formation of ectopic ureteric buds from the base of the bud and from the Wolffian duct. The development of lung and salivary primordia were not affected under similar growth conditions. In a novel ureteric bud primary culture system, GDNF significantly increased cell numbers at 24 and 48 h. In cells cultured on laminin this increase was due to increased survival and proliferation, whereas in cells cultured on fibronectin, only survival was enhanced. Our data suggest that GDNF stimulates outgrowth of the ureteric bud, in part, by enhancing cell survival and possibly by increasing proliferation.
Localization by Immunoelectron Microscopy of Schistosoma mansoni Antigens in the Glomerulus of the Hamster (Mesocricetus auratus) Kidney
Authors: De Brito T. , Carneiro Célia Regina W. , Nakhle Maria Cristina , Lima Dirce M.C. , Abrantes-Lemos Clarice P. , Sandoval Marina , Silva Ana Maria G. 
Published: April 2003

Adult worm antigen (AWA) and soluble egg antigen (SEA) were localized ultrastructurally by immunoelectron microscopy using two monoclonal antibodies in the glomeruli of hamsters infected with <i>Schistosoma mansoni</i> cercariae or injected with <i>S. mansoni </i>eggs. AWA was detected in all cercaria-infected groups from the 30th day on and was present mainly in cytoplasm of mesangial cells, mesangial matrix, and glomerular basement membrane, either as isolated gold particles or in small electron-dense deposits of probable immune origin. AWA was encountered also on the inner side of the glomerular basal membrane, close to endothelial cells, and in the foot processes of the glomerular epithelial cells. SEA was detected at similar sites, apparently in lesser amounts, in uninfected hamsters inoculated with <i>S. mansoni </i>eggs into the jugular vein. Schistosomal antigens are apparently processed mainly by mesangial cells which are considered to be critical in the pathogenesis of <i>S. mansoni </i> associated glomerulopathy. Mesangioproliferative glomerulonephritis, immunoglobulin (IgG and IgM), and C<sub>3</sub> deposits were observed in hamsters in which AWA and SEA were visualized. During early phases of the infection and in hamsters in which granulomatous pneumonitis was induced by <i>S. mansoni </i>eggs, glomeruli were unchanged or showed a slight mesangial proliferation. Our findings suggests that egg antigens also contribute to the pathogenesis of experimental glomerulopathy in the hamster.
Defective Proximal Tubule Lysosomal Acidification by Bence Jones Proteins
Authors: Nicastri Ana Lucia , Brandão de Almeida Prado Maria José , Sesso Antonio , Brandão de Almeida Prado Euthymia 
Published: April 2003

Proximal tubule handling of two human Bence Jones proteins (neutral and acidic BJP) was evaluated using protein A-gold labelling. After 30 min of acute light-chain infusion into 6 rats (alone or in combination with dinitrophenyl-aminopropyl-methylamine [DAMP]), kidney biopsies were processed for immunoelectron microscopy. Antibodies directed at monoclonal lambda light chains, mannose-6-phosphate cation-independent receptor (MPR) and DAMP were used.Labelling density (number of pA-gold particles/µm<sup>2</sup>), expressed as median (25–75 percentiles), differed (p < 0.05) between the two BJP, being 94.5 (32.9–212.5) vs. 19.4 (3.7–45.6) pA-gold/µm<sup>2</sup> in endocytic vacuoles, and 297.3 (207.1–382.1) vs. 83.2 (16.6–197.0) pA-gold/µm<sup>2</sup> in non-vacuolar electrondense endosome-lysosome structures. Labelling density for MPR was 47.7 (22.2–84.6) vs. 4.0 (2.7–6.3) pA-gold/µm<sup>2</sup>. The area of MPR-labelled structures was also different, i.e.: 0.2 (0.1–0.4) vs. 0.9 (0.5–1.8) µm<sup>2</sup>. The endosome-lysosome pH distribution range differed significantly: 6.8 (6.4–7.0) vs. 6.3 (5.8–7.0). There was a significant accumulation of neutral BJP in endocytic structures, an acidification deficit of pre-lysosomes/lysosomes and MPR retention, suggestive of defective receptor recycling with this BJP. Interference with the physiological process of lysosomal acidification may be an important mechanism of higher nephrotoxicity in some BJP.
A Comparative Kinetic RT/-PCR Strategy for the Quantitation of mRNAs in Microdissected Human Renal Biopsy Specimens
Authors: Del Prete D. , Forino M. , Gambaro G. , D’Angelo A. , Baggio B. , Anglani F. 
Published: April 2003

Molecular biology techniques, to be applicable to a diagnostic renal biopsy specimen, should (1) be highly sensitive to be performed on a very small quantity of tissue; (2) be quantitative because they have to analyze genes normally expressed in the tissue and (3) allow the analysis of as large a number of genes as possible. Among different methods, only the reverse-transcriptase polymerase chain reaction (RT/-PCR) might comply with previous requisites, but the few RT/-PCR examples on renal biopsies in the literature do not allow starting RNA quantification and quality control; furthermore they have the drawback of analyzing only few genes. In an ongoing study to assess the expression of a number of genes in glomeruli and in tubulointerstitium of patients with different nephropathies, we developed a comparative RT/-PCR kinetic strategy based on the purification and quantification of total glomerular and tubulointerstitial RNA and on the use of an internal standard, the housekeeping gene G3PDH. We demonstrate that in microdissected diagnostic renal biopsies (1) glomerular and interstitial starting RNA can be quantified; (2) the G3PDH gene may be used both as an internal standard and as an indirect marker of RNA integrity; (3) as low as 28 ng of total RNA is sufficient to obtain PCR products of eight genes, and (4) it is worth to operate on microdissected biopsy specimens because of the different expression of genes in the two renal compartments.
mRNA Expression of Renal Urea Transporters in Normal and Brattleboro Rats: Effect of Dietary Protein Intake
Authors: Hu Ming Chang , Bankir Lise , Trinh-Trang-Tan Marie-Marcelle 
Published: April 2003

Differences in dietary protein level induce differences in fractional excretion of urea, in arginine vasopressin (AVP) plasma level, and in urine concentrating activity (in which intervene the renal urea transporters (UT)). The abundance of mRNA for UT-A1 (of the inner medullary collecting duct, IMCD) UT-A2 (of the descending thin limb) and UT-B1 (of descending vasa recta) was determined by Northern analysis of total RNA extracted from medullary subregions of Sprague-Dawley rats fed for 1 week, a low, normal, or high protein diet. The implication of AVP was then examined by studying AVP-deprived (Brattleboro) rats. Our results show that none of these transporters is affected by the level of protein intake, except UT-A1 that is reduced in terminal IMCD by low protein diet in the absence of AVP (Brattleboro rats). These data suggest that (1) the previously reported effect of kidney medulla hypertonicity on UT-A2 and UT-B1 mRNA expression is somehow obliterated by protein intake deficiency or excess, and (2) AVP influences the mRNA abundance of the UT-A1 of the terminal IMCD during protein deficiency.
Acute and Chronic Effects of Hyperosmolality on mRNA and Protein Expression and the Activity of Na-K-ATPase in the IMCD
Authors: Takayama Masanobu , Nonoguchi Hiroshi , Yang Tianxin , Machida Kenji , Terada Yoshio , Owada Akira , Tomita Kimio , Marumo Fumiaki 
Published: April 2003

We investigated acute and chronic effects of hyperosmolality on mRNA and protein expressions of Na-K-ATPase α and β isoforms and Na-K-ATPase activity in the rat inner medullary collecting duct (IMCD). Incubation of IMCD in hypertonic medium for 30 min reduced the Na-K-ATPase activity by 50%. The Na-K-ATPase activity of dehydrated rats measured in isotonic medium was decreased, and incubation in hypertonic medium did not further decrease the activity. Incubation of IMCD in hypertonic medium for 6 h did not change α<sub>1</sub> mRNA. In contrast, dehydration decreased α<sub>1</sub> subunit mRNA and protein and β<sub>1</sub> protein expressions without changing β<sub>1</sub> mRNA. These data show (1) that acute hyperosmolality decreases Na-K-ATPase activity in IMCD without changing α<sub>1</sub> and β<sub>1</sub> mRNA and (2) that 2 days of dehydration decreased Na-K-ATPase activity by reducing α<sub>1</sub> and β<sub>1</sub> proteins. Thus, the mechanisms for the inhibition of the Na-K-ATPase activity in IMCD is defferent between acute and chronic exposure to hyperosmolality.