bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diaphragmatic dysfunction secondary to experimental lower torso ischaemia–reperfusion injury is attenuated by thermal preconditioning
Authors: McLaughlin R , Kelly C J , Kay E , Bouchier-Hayes D 
Published: March 2003

Abstract

Background
Preconditioning describes the process whereby tissue exposure to a subcritical stress confers protection from subsequent injuries. This study assessed diaphragmatic muscle function after lower torso ischaemia–reperfusion (IR) and the role of thermal preconditioning in attenuation of this injury.

Methods
Sprague–Dawley rats were randomized into three groups (24 per group): a control group, an IR group that had aortic cross-clamping for 1 h followed by reperfusion, and a third group that received thermal preconditioning 18 h before IR. Diaphragmatic function was assessed at 24 h, 48 h and 7 days.

Results
IR resulted in significant diaphragmatic twitch and tetanic dysfunction compared with control muscle. Thermal preconditioning significantly attenuated this injury (P &lt; 0·05). Mean(s.e.m.) muscle twitch and tetanic forces in the IR group were 204·9(17·2) and 282·7(19·2) g respectively at 24 h. Corresponding twitch and tetanic forces in preconditioned muscle were 270·4(25·1) and 552·0(35·2) g.

Conclusion
This study demonstrated that systemic IR injury produced a respiratory muscle mechanical dysfunction that was attenuated by thermal preconditioning, at 24 h, 48 h and 7 days. Preconditioning may have a role in clinical practice, particularly before elective surgery.
Effect of intraportal adoptive immunotherapy on liver metastases after resection of pancreatic cancer
Authors: Kobari M , Egawa S , Shibuya K , Sunamura M , Saitoh K , Matsuno S 
Published: March 2003

Abstract

Background
The prognosis of patients with resected pancreatic cancer remains poor. This study evaluated the effect of adoptive immunotherapy (AIT) using intraportal infusion of lymphokine-activated killer (LAK) cells after curative resection and intraoperative radiation therapy (IORT) on advanced pancreatic cancer.

Methods
Twenty-nine consecutive patients with advanced pancreatic cancer (Japan Pancreas Society stage III or IV) were divided into two groups. The control group (n = 17) underwent tumour resection and IORT. The treatment group (n = 12) underwent resection, IORT and intraportal infusion of LAK cells combined with recombinant interleukin 2 (rIL-2). The incidence of liver metastasis and the survival rate of these two groups were compared.

Results
Although the overall survival between groups was not statistically different (P = 0·082), there were more patients (four) alive 3 years after operation in the test group (36 per cent versus zero), and the incidence of liver metastases in the treatment group was significantly lower (three of 12 versus ten of 15; P &lt; 0·05). LAK therapy influenced survival positively in multivariate analysis.

Conclusion
These preliminary observations suggest that AIT warrants further study as a possible adjuvant for patients undergoing curative resection and IORT for pancreatic cancer.
Topical diltiazem ointment in the treatment of chronic anal fissure
Authors: Knight J S , Birks M , Farouk R 
Published: March 2003

Abstract

Background
Chronic anal fissure has traditionally been treated surgically. Initial enthusiasm for chemical sphincterotomy has waned because of poor outcomes with glyceryl trinitrate ointment. In this study the use of topical 2 per cent diltiazem ointment has been investigated as an alternative method of chemical sphincterotomy.

Methods
A prospective assessment of 71 consecutive patients with a chronic anal fissure treated with 2 per cent topical diltiazem ointment for a median duration of 9 (range 2–16) weeks was performed.

Results
Fifty-one patients (75 per cent) experienced healing of the fissure after 2–3 months of treatment with topical diltiazem. Seventeen patients who did not heal were treated for a further 8 weeks with topical diltiazem. Eight of these patients subsequently healed with diltiazem. Fifty-nine of 67 patients who completed follow-up therefore healed on diltiazem ointment. Four patients experienced perianal dermatitis and one patient experienced headaches. No other side-effects were recorded. After a median of 32 (range 14–67) weeks' follow-up following completion of treatment, 27 of 41 patients available remain symptom free. Six of seven patients with recurrent fissure were treated successfully by repeat chemical sphincterotomy.

Conclusion
Topical 2 per cent diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates but does not have a significant side-effect profile, which may aid compliance to treatment. Early recurrences are common but usually amenable to further chemical sphincterotomy.
Experimental study of peritoneal blood flow and insufflation pressure during laparoscopy
Authors: Brundell S M , Tsopelas C , Chatterton B , Touloumtzoglou J , Hewett P J 
Published: March 2003

Abstract

Background
Port-site metastases after laparoscopic surgery may occur with greater frequency than would be expected following open resection of intra-abdominal malignancies, but the causal mechanism for this is incompletely understood. The possibility that insufflation may increase peritoneal blood flow producing a wound environment conducive to the formation of metastases was investigated.

Methods
The effects of insufflation gas type and pressure were studied in 30-kg female pigs. Pigs were divided into five groups, which were subjected to insufflation at 12 mmHg pressure with helium, insufflation at 12, 8 or 4 mmHg pressure with carbon dioxide, or laparotomy. A microsphere technique utilizing two distinct radiotracers, 99mTc-labelled macroaggregated albumin (MAA) and 51Cr-labelled MAA, was used to study blood flow to the peritoneum, liver and kidneys.

Results
Insufflation with carbon dioxide or helium gases had no effect on renal (P &lt; 0·09) or hepatic blood flow (P = 0·54). However, insufflation significantly increased peritoneal blood flow when carbon dioxide (P &lt; 0·05), but not when helium (P = 0·99), was used as the insufflating gas.

Conclusion
These data suggest that blood flow within the peritoneum is influenced by insufflation with carbon dioxide. It is conceivable that such hyperaemia could increase the propensity for implanted tumour cells to metastasize in these sites following laparoscopy.
The surgical risk scale as an improved tool for risk-adjusted analysis in comparative surgical audit
Authors: Sutton R , Bann S , Brooks M , Sarin S 
Published: March 2003

Abstract

Background
Comparative surgical audit is becoming increasingly important although it is fraught with difficulties due to risk-adjusted analysis. Methods have been proposed to solve this problem and allow meaningful comparison of patient outcome. None has been described without faults, making such comparison flawed or overtly complicated. An alternative risk scoring system incorporating the Confidential Enquiry into Perioperative Deaths (CEPOD) grade, the American Society of Anesthesiologists (ASA) grade and the British United Provident Association (BUPA) operative grade was formulated and assessed.

Methods
This was a prospective audit of 4308 patients admitted under the care of three surgeons between May 1997 and October 1999, creating an initial data set of 3144 procedures with 134 deaths. Each procedure was allocated a score on the basis of the CEPOD, BUPA and ASA grade. The Surgical Risk Scale (SRS) was devised by adding together the values of the three variables, which generated a scale ranging from 3 to 14. Multivariate logistic regression analysis involving the three variables and univariate analysis of the SRS score were undertaken. Receiver–operator characteristic and calibration curves were formulated. This process was validated on another data set (2780 patients) derived from all admissions to the same surgeons between November 1999 and December 2000.

Results
Univariate logistic analysis of the SRS score revealed it to be significantly predictive of death (β = 0·84, P &lt; 0·001); it did not overpredict mortality for low-risk procedures.

Conclusion
The SRS is easy to use, formulate and interpret, and provides an accurate prediction of death in general surgical patients across the entire risk spectrum.
Matrix metalloproteinases and atherosclerotic plaque instability
Authors: Loftus I M , Naylor A R , Bell P R F , Thompson M M 
Published: March 2003

AbstractBackgroundThere is growing interest in the role of matrix metalloproteinases in atherosclerosis. Excessive tissue remodelling and increased matrix metalloproteinase activity have been demonstrated during atherosclerotic plaque disruption, a frequent predeterminant of ischaemic cardiac events and stroke. These enzymes represent a potential target for therapeutic intervention to modify vascular pathology.MethodsThe core of this review is derived from a Medline database literature search.ResultsThere is convincing evidence of increased matrix metalloproteinase activity during acute plaque disruption. Evidence for an imbalance promoting increased matrix degradation is less well documented. However, studies of matrix metalloproteinase inhibition in models of vascular disease suggest a potential therapeutic benefit.ConclusionIn vivo studies of matrix metalloproteinase inhibition are required to study the potential for reversal or deceleration of the excessive tissue remodelling that accompanies acute plaque disruption.
Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury
Authors: Al-Ghnaniem R , Benjamin I S 
Published: March 2003

Abstract

Background
Hepaticojejunostomy is the ‘gold standard’ procedure for repairing iatrogenic bile duct injuries. The aim of this study was to examine the long-term outcome following hepaticojejunostomy for iatrogenic bile duct injury and the utility of routine construction of an access loop.

Methods
Patients with iatrogenic biliary injuries were treated with hepaticojejunostomy and access loop by a single surgeon. Injuries were classified according to the Bismuth level. An ‘excellent’ outcome was achieved if the patient never experienced jaundice or cholangitis in the follow-up period, and the outcome was ‘good’ if the patient developed symptoms but was asymptomatic for more than 12 months.

Results
Forty-eight patients underwent such operation. There was one operative death. Thirty-three patients were followed for 3 years or more (mean follow-up 80·4 (range 46–118) months). Thirteen of the 33 injuries were Bismuth level II, 13 were Bismuth level III and seven were Bismuth level IV. Outcome was dependent on the Bismuth level (P &lt; 0·001). It was excellent in all 13 patients with Bismuth level II injuries, excellent in seven and good in six of the 13 patients with Bismuth level III injuries, and excellent in one and good in six of the seven patients with Bismuth level IV injuries. Moreover, the need for access loop intervention was dependent on the Bismuth level (P &lt; 0·001). No patient with Bismuth level II injury required intervention, compared with five of 13 with Bismuth level III and six of seven with Bismuth level IV injuries.

Conclusion
Biliary reconstruction affords satisfactory long-term outcome. The likelihood of needing the access loop for radiological intervention is dependent on the Bismuth level. The authors recommend that an access loop be constructed in all patients with Bismuth level III and IV injuries.
Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma
Authors: Yeh C-N , Lee W-C , Jeng L-B , Chen M-F , Yu M-C 
Published: March 2003

Abstract

Background
Hepatocellular carcinoma (HCC) is a common disease in Taiwan. Ruptured HCC is an uncommon and potentially fatal complication of the condition. Information on the impact of ruptured HCC on hepatic resection is, however, limited.

Methods
The clinical features of 60 patients with ruptured HCC who underwent hepatic resection from 1986 to 1998 were reviewed. Clinical features and factors influencing the outcome of 475 patients with non-ruptured HCC were used for comparison.

Results
Of 535 surgically resected HCCs, 60 (11·2 per cent) were ruptured. Univariate analysis showed that sudden onset of abdominal pain, physical signs of haemodynamic unstability, reduced haemoglobin level and a raised aspartate aminotransferase level were more frequently found in patients with ruptured HCC than in those with non-ruptured tumours. Multivariate stepwise logistic regression analysis revealed sudden-onset abdominal pain to be the only independently significant factor in patients in the ruptured HCC group. The 1-, 3- and 5-year survival rates of patients with non-ruptured HCC were 72·1, 47·3 and 33·9 per cent, and those of patients with ruptured HCC were 54·2, 35·0 and 21·2 per cent respectively. Similar overall survival rates were found in patients with ruptured and non-ruptured HCC, although patients in the non-ruptured HCC group had a significantly better disease-free survival rate (P = 0·023).

Conclusion
The presence of sudden-onset abdominal pain is the only independent indicator of ruptured HCC. Hepatic resection, when feasible, is the treatment of choice and can result in an overall survival rate comparable to that of patients with non-ruptured HCC.
Role of magnetic resonance imaging in the diagnosis and single-stage surgical resection of invasive lobular carcinoma of the breast
Authors: Munot K , Dall B , Achuthan R , Parkin G , Lane S , Horgan K 
Published: March 2003

Abstract

Background
Conventional imaging with mammography and ultrasonography has a low sensitivity for diagnosis and a tendency to underestimate the extent of invasive lobular carcinoma (ILC) of the breast. The aim was to determine whether magnetic resonance imaging (MRI) had any advantages for the characterization of ILC.

Methods
Twenty patients with histologically proven ILC underwent preoperative imaging with MRI. MRI was performed to aid detection of malignancy in six patients with a clinically suspicious presentation but normal or indeterminate imaging on mammography and ultrasonography. In 14 patients MRI was performed to determine tumour extent.

Results
MRI accurately identified malignancy in five of six patients with normal or indeterminate conventional imaging. In seven of 14 patients in whom MRI was performed to determine tumour extent, it provided significant additional information. These included four patients in whom conventional imaging grossly underestimated tumour size, two patients in whom MRI identified an unsuspected contralateral breast tumour and one patient in whom MRI predicted tumour invasion of the pectoral muscle. The correlation between tumour size on histological examination was better with MRI (r = 0·967) than with mammography (r = 0·663) and ultrasonography (r = 0·673).

Conclusion
MRI can provide considerable additional information in the detection and characterization of ILC.
Low-cost laparoscopic cholecystectomy
Authors: Champault A , Vons C , Dagher I , Amerlinck S , Franco D 
Published: March 2003

Abstract

Background
Hospital managers are continually trying to decrease the cost of patient care. The aim of this prospective study was to propose changes that would decrease the operating room costs of laparoscopic cholecystectomy without affecting clinical results.

Methods
The study included 112 consecutive patients who underwent an elective cholecystectomy between January 1997 and December 2000. The procedure was changed in eight ways: the American position, open laparoscopy, reusable trocars, reusable instruments, bipolar coagulation of the cystic artery, intracorporeal ligature of the cystic duct, no use of suction lavage apparatus, and use of a surgical glove as a bag to extract the gallbladder. Complete compliance with the procedure, whether any abnormal operative events or complications occurred, the duration of hospitalization, and the material and labour costs of the procedure were recorded.

Results
There were no abnormal operative events. Only two patients suffered from postoperative complications. The mean duration of hospitalization was 55·8 h. Fifteen patients (13·4 per cent) were not hospitalized overnight. The operating costs fell from 560 euros before the study to 330 euros in 2000.

Conclusion
By applying simple measures, it is possible to decrease the operating room cost of laparoscopic cholecystectomy whilst maintaining good results. Such measures should be applied to other laparoscopic procedures.
Preclinical studies of gene transfer for the treatment of desmoid disease in familial adenomatous polyposis
Authors: Bright-Thomas R M , Agrawal A , Hargest R 
Published: March 2003

Abstract

Background
Familial adenomatous polyposis (FAP) arises following mutation or loss of the adenomatous polyposis coli (APC) gene. Desmoid tumours are proliferations of fibroblasts and occur as an extracolonic manifestation of FAP. They are a leading cause of death after colectomy. The aim of this study was to assess the potential for APC gene transfer into fibroblasts in vitro and in vivo as a basis for consideration of gene therapy in the prevention or treatment of desmoid tumours.

Methods
The APC gene was transferred by lipofection into fibroblasts in tissue culture and into peritoneum and small bowel mesentery in vivo. Reverse transcriptase–polymerase chain reaction was used to determine whether or not transfection was successful.

Results
Transgene expression was recorded in vitro to 7 days after transfection. High levels of transgene expression were also seen in samples of peritoneum (all eight mice), small bowel mesentery (seven of eight), liver (seven of eight) and intestinal tissues (five to six of eight) following intraperitoneal treatment. Interestingly, transgene expression in gonadal tissues was occasionally noted.

Conclusion
Liposomal transfection of APC gave prolonged high-level expression of the transgene, an important basis for gene therapy. No adverse effects were recorded. Further work is needed in animal models of desmoid disease to assess the clinical effects of gene therapy.
Pattern of self‐organization in tumour systems: complex growth dynamics in a novel brain tumour spheroid model
Authors: Deisboeck T. S. , Berens M. E. , Kansal A. R. , Torquato S. , Stemmer‐Rachamimov A. O. , Chiocca E. A. 
Published: March 2003

Abstract.We propose that a highly malignant brain tumour is an opportunistic, self‐organizing and adaptive complex dynamic biosystem rather than an unorganized cell mass. To test the hypothesis of related key behaviour such as cell proliferation and invasion, we have developed a new in vitro assay capable of displaying several of the dynamic features of this multiparameter system in the same experimental setting. This assay investigates the development of multicellular U87MGmEGFR spheroids in a specific extracellular matrix gel over time. The results show that key features such as volumetric growth and cell invasion can be analysed in the same setting over 144 h without continuously supplementing additional nutrition. Moreover, tumour proliferation and invasion are closely correlated and both key features establish a distinct ratio over time to achieve maximum cell velocity and to maintain the system’s temporo‐spatial expansion dynamics. Single cell invasion follows a chain‐like pattern leading to the new concept of a intrabranch homotype attraction. Since preliminary studies demonstrate that heterotype attraction can specifically direct and accelerate the emerging invasive network, we further introduce the concept of least resistance, most permission and highest attraction as an essential principle for tumour invasion. Together, these results support the hypothesis of a self‐organizing adaptive biosystem.
Formaldehyde promotes and inhibits the proliferation of cultured tumour and endothelial cells
Authors: Tyihák E. , Bocsi J. , Timár F. , Rácz G. , Szende B. 
Published: March 2003

Abstract.Formaldehyde was applied in various doses (0.1–10.0 mm) to HT‐29 human colon carcinoma and HUV‐EC‐C human endothelial cell cultures. Cell number, apoptotic and mitotic index as well as proportion of cells in S‐phase was investigated by morphological methods and flow cytometry. Ten mM of formaldehyde caused high degree of cell damage and practically eradicated the cell cultures. One mM of formaldehyde enhanced apoptosis and reduced mitosis in both types of cell cultures, in a moderate manner. The low dose (0.1 mm) enhanced cell proliferation and decreased apoptotic activity of the cultured cells, the tumour cells appeared to be more sensitive. The possible role of this dose‐dependent effect of formaldehyde in various pathological conditions, such as carcinogenesis and atherogenesis is discussed with emphasis on the eventual interaction between formaldehyde and hydrogen peroxide.
Human red blood cells have an enhancing effect on the relative expansion of CD8+ T lymphocytes in vitro
Authors: Porto B. , Fonseca A. M. , Godinho I. , Arosa F. A. , Porto G. 
Published: March 2003

Abstract.The present study was designed to analyse the effect of red blood cells on T‐cell proliferation and expansion. A comparative study was done in peripheral blood cell cultures stimulated with phytohemagglutinin, with or without red blood cells. The presence of red blood cells had a consistent enhancing effect on T lymphocyte proliferation, as determined by an increase in both the mitotic index and thymidine uptake. Phenotypic characterization of T cell blasts by flow cytometry revealed that, in the presence of red blood cells, expanding cells were preferentially CD8+ cells. Accordingly, proliferation of CD8+ lymphocytes from two patients with CD8+ hyperlymphocytosis was dependent on the presence of red blood cells. In contrast, proliferation of CD4+ lymphocytes from two patients with CD4+ hyperlymphocytosis was strongly inhibited by the presence of red blood cells. This is the first reported evidence that human red blood cells have an enhancing effect on the expansion of CD8+ lymphocytes in vitro.
X‐irradiation effects on thymidine kinase (TK): I. TK1 and 2 in normal and malignant cells
Authors: He Q. , Skog S. , Welander I. , Tribukait B. 
Published: March 2003

Abstract. The effect of radiation on TK is more complicated than would be expected from earlier results on bone marrow cells (Feinendegen et al. 1984, Int. J. Radiat. Biol. 45, 205). TK activity increased at 0.01 Gy and then decreased up to 1 Gy in mouse spleen. In contrast to the results for the spleen, an increase in activity at 0.1 Gy was seen in mouse thymus. The activity of dephosphorylated TK1 (TK1a) in both spleen and thymus was reduced to 50% after irradiation at 0.5–1 Gy. The degree of phosphorylation (TK1b/TK1a ratio) changed in spleen, but not in thymus. The activity of TK2 in mouse liver increased at 3 h after 5 Gy by about 60%. In mouse ascites tumour, a dose‐independent (1–5 Gy) oscillating TK1 activity was found up to 24 h, especially for TK1a and TK1b. The amount of TK1 was unchanged up to 12 h, but decreased at 24 h. This suggests that the differences in the changes in the degree of phosphorylation of TK1 after irradiation among spleen, thymus and ascites tumour further underline the complexity of the response of TK1 activity to irradiation. The dramatic change in the activities of TK1a and TK1b may illustrate that both of them are more radiosensitive than TK‐h, a variant with mixed TK1 and TK2 properties.