bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical and laboratory findings in children with neutropenic enteropathy
Authors: Tireli G A , Özbey H , Eryilmaz E , Salman T , Anak S 
Published: March 2003

Abstract

Background
The term neutropenic enteropathy (NE) is used to describe inflammatory conditions of the gastrointestinal system in patients who receive chemotherapy for haematological malignancy. Although the initial treatment of choice in NE is non-operative, with bowel rest, decompression, nutritional support and broad-spectrum antibiotics, operative intervention is needed in patients with the advent of the disease. The surgical and laboratory findings of seven patients with NE who required surgical treatment are presented.

Methods
Patients' medical records were reviewed to obtain age, sex, diagnosis, laboratory findings with neutrophil counts, blood cultures and the surgical findings. The onset of neutropenia and the diagnosis of NE were recorded for each patient.

Results
There were four girls and three boys, with a mean age of 6 years (range 9 months to 16 years). The primary diseases were acute myelocytic leukaemia in two, acute lymphocytic leukaemia in one and lymphoma in four patients. In all but two patients, the neutrophil counts were less than 1000 mm−3, with positive blood cultures at diagnosis. The onset of the NE was determined as mean(s.d.) 3(2) days after the onset of neutropenia. Haemorrhage, marked oedema, patchy inflammation and multiple adhesions of the bowel, perforation and localized abscess were the main operative findings. The lesions were mostly localized in the terminal ileum and the ascending colon. After resection of the affected segment of bowel, stomas (three) and end-to-end anastomoses (three) were performed. Primary repair of the perforation site was performed in one patient with gastric perforation. Four patients recovered with rapid resolution of neutropenia, while three patients with persistent neutropenia died.

Conclusion
A favourable outcome for patients with NE is related to early recognition of the intra-abdominal infection, appropriately timed surgical intervention and a prompt postoperative return of normal circulating levels of neutrophils.
Microbiology of postoperative peritonitis
Authors: Röhrborn A , Potreck O , Ebener C , Wolf A , Goretzki P 
Published: March 2003

Abstract

Background
The microbiology of secondary peritonitis is well known and standards of antibiotic therapy are established. In contrast, little is known about the bacteriology of postoperative peritonitis. Resistant strains could be involved and patients may have had previous antibiotic treatment.

Methods
The intraoperative and postoperative bacteriology (10 days after operation) of all 88 cases of postoperative peritonitis occurring between September 1994 and May 1999 were documented. Resistances were used to determine effective antibiotic therapy.

Results
Compared with secondary peritonitis, enterococci outnumbered Escherichia coli in postoperative peritonitis. While E. coli showed no advanced resistance, the different pattern of bacterial findings (e.g. enterococci, Enterobacter, Gram-positive bacteria) leads to failures of standard therapy for secondary peritonitis. Imipenem–cilastatin failed in 20 per cent, piperacillin–tazobactam in 31, aminoglycosides in 31, ciprofloxacin in 37 and third-generation cephalosporins in 47 per cent (the latter three combined with metronidazole).

Conclusion
Cephalosporins, the ‘gold standard’ in secondary peritonitis, fail in postoperative cases. Carbapenems are the drugs of choice. Aminoglycosides should be avoided in these patients.
Inflammatory response regulation by tacrolimus in an experimental model of multiorgan failure induced by bacterial translocation
Authors: Garcia-Criado F J , Lozano F S , Lorenzo M F , Parreño F C , Valdunciel J J , Gómez-Alonso A 
Published: March 2003

Abstract

Background
Bacterial translocation may induce multiorgan failure (MF), an infrequent but very serious clinical situation. This study used the immunosuppressant tacrolimus to control the inflammatory response in order to avoid MF, and also aimed to elucidate its mode of action.

Methods
Male Wistar rats were divided into three groups: sham group, control MF group (zymosan intraperitoneal injection and studies at 2, 12 and 24 h) and tacrolimus group (different times of administration and studies at 2, 12 and 24 h). Survival, renal and hepatic function, microbiological cultures, neutrophil infiltration, oxygen free radicals, cytokines, cellular adhesion molecules and intracellular transcriptional mechanisms were studied in both renal and hepatic tissue.

Results
Use of tacrolimus before the systemic inflammatory response regulated this response (less production of free radicals, P &lt; 0·01; of cytokines, P &lt; 0·01; of neutrophil infiltration, P &lt; 0·05) by control of nuclear factor κB activation which induces minor expression of cellular adhesion molecules and minor production of the inflammatory mediators controlled by κB.

Conclusion
The use of prophylactic antiflammatory therapy in MF may be useful and tacrolimus has been demonstrated to be a powerful regulator of this situation.
Effects of systemic and intraperitoneal chemotherapy on bacterial translocation and peritoneal defence mechanisms
Authors: Çerci C , Agalar C , Ergin Ç , Eroglu E , Bulbul M , Agalar F 
Published: March 2003

Abstract

Background
The aim of this study was to evaluate the effects of intraperitoneal and systemic chemotherapy on peritoneal defence mechanisms and bacterial translocation.

Methods
Four groups of adult male Wistar Albino rats (n = 10) were used in the study. The groups consisted of intraperitoneal chemotherapy (5-fluorouracil 20 mg kg−1 day−1 for 3 days), systemic chemotherapy (5-fluorouracil 20 mg kg−1 day−1 for 3 days) and their controls (systemic and intraperitoneal isotonic saline solution). Eight hours after the last dose of chemotherapy 10 ml sodium caseinate was applied intraperitoneally and 16 h later laparotomy was done under sterile conditions. During laparotomy 10 ml phosphate-buffered saline was applied and approximately 8 ml of this solution was collected. Phagocytic activity, bactericidal activity, peritoneal total cell numbers and morphology, peripheral blood leucocyte count and bacterial translocation were studied in this peritoneal solution. Tissue samples of mesenteric lymph node, liver, spleen and caecum were taken and homogenized for culturing. Statistical analyses were done with Student's t test for independent samples.

Results
In the systemic chemotherapy group phagocytic activity (36 versus 52 per cent in control) and bactericidal activity (decreased in seven versus two in control) were significantly decreased. Peripheral and peritoneal leucocyte numbers were also decreased in the systemic chemotherapy group. Peritoneal cell morphology was not affected. Bacterial translocation occurred in mesenteric lymph nodes of five rats in this group. Intraperitoneal chemotherapy significantly decreased the phagocytic activity (33 versus 56 per cent in control). Peripheral and peritoneal leucocyte numbers were also decreased but the bactericidal activity and peritoneal cell morphology were not affected. In contrast to the systemic chemotherapy group, bacterial translocation was not detected.

Conclusion
Systemic chemotherapy caused bacterial translocation. Both systemic and intraperitoneal chemotherapy have detrimental effects on peritoneal defence mechanisms under experimental conditions.
Macrophage migration inhibitory factor as a counter-regulatory mediator of cortisol during septic shock
Authors: Beishuizen A , Vermes I , Haanen C , Thijs L G 
Published: March 2003

Abstract

Background
Migration inhibitory factor (MIF) is a widely expressed protein that is secreted in response to inflammatory or hormonal stimuli. MIF is both an endocrine hormone and immunological mediator that counter-regulates glucocorticoid (GC) action. The anti-inflammatory and immunosuppressive properties of GC are often beneficial but host homeostasis requires counter-regulatory systems for which MIF has been proposed.

Methods
Using a time-resolved fluorometric immunoasssay to detect serum MIF levels in patients with septic shock or multitrauma, the relation of MIF to cortisol and adrenocorticotrophic hormone (ACTH) was studied. Serum MIF, cortisol and ACTH were measured serially over 14 days in patients with septic shock (n = 28) and multitrauma (n = 5), and in healthy controls (n = 41). Haemodynamics, Acute Physiology and Chronic Health Evaluation II scores and intensive care unit deaths were also recorded.

Results
MIF levels were raised significantly on day 1 in septic shock (mean(s.d.) 12·5(3·7) ng ml−1) compared with trauma (3·1(1·7) ng ml−1) and controls (2·5(2·1) ng ml−1). The time course of both MIF and cortisol showed persistently high levels in sepsis, independent of shock reversal or haemodynamics. Non-survivors had higher MIF levels than survivors from septic shock (P &lt; 0·05). Regression analysis showed a significant correlation between MIF and cortisol levels (r = 0·72), but no correlation was found between MIF and other variables.

Conclusion
Increased serum MIF levels occurred in septic shock compared with trauma and controls. In septic shock a clear correlation was found between MIF and cortisol levels, suggesting a parallel increase of MIF with cortisol and indicating a counter-regulatory activity of MIF to dampen the protective effects of GC. Non-survivors had higher MIF levels at most time points, indicating that MIF might be a potential prognostic marker in septic shock.
Impairment of renal blood flow after renal ischaemia–reperfusion is not aggravated by low plasma levels of arginine
Authors: Nijveldt R J , Prins H A , Rauwerda J A , van Lambalgen A A , Teerlink T , van Leeuwen P A M 
Published: March 2003

Abstract

Background
The fundamental role of the l-arginine–nitric oxide pathway has not been established for maintaining renal blood flow. Plasma levels of arginine appear to be rate limiting for nitric oxide synthesis in various cell types. Low plasma levels of arginine are seen after major surgery, trauma and sepsis. The present study was designed to establish the effects of low arginine plasma levels on renal blood flow during the initial phase of renal ischaemia–reperfusion.

Methods
In this unilateral renal ischaemia–reperfusion model, male Wistar rats were used. Arginase infusion (ASE) was used to lower arginine plasma levels to 50 per cent of normal; control rats received saline infusion (SAL). After an ischaemic period of 90 min, the kidney was perfused for 150 min (IR kidney). The contralateral kidney was left in situ and served as a control (CL kidney). Blood flow measurement was performed at the end of the experiment using radiolabelled microspheres. Blood samples were taken for amino acid analysis (high-pressure liquid chromatography).

Results
Infusion of arginase efficiently decreased plasma levels of arginine (ASE mean(s.d.) 45·3(4·8) μmol/dm3 versus SAL 107·5(6·0) μmol/dm3; P &lt; 0·0001). In both SAL and ASE rats, a significantly lower blood flow was found in the IR kidney compared with the (non-ischaemic) CL kidney. Lowering arginine plasma levels by arginase did not influence renal blood flow compared with SAL, in both IR and CL kidneys.

Conclusion
In this acute, unilateral renal ischaemia–reperfusion model, low arginine plasma levels did not further aggravate renal blood flow.
Jejunal interposition to prevent postgastrectomy syndromes
Authors: Morii Y , Arita T , Shimoda K , Yasuda K , Matsui Y , Inomata M , Kitano S 
Published: March 2003

Abstract

Background
Postgastrectomy syndromes include reflux gastritis and oesophagitis, dumping syndrome, intractable diarrhoea and afferent loop syndrome. To prevent such syndromes, since January 1994 jejunal interposition has been used following distal gastrectomy. The aim of this study was to evaluate the benefit of this procedure.

Methods
A consecutive series of 42 patients who underwent distal gastrectomy for gastric cancer was studied. Twenty-two patients had a Billroth I procedure before January 1994, and 20 patients had isoperistaltic jejunal interposition using a 10–12-cm segment after January 1994.

Results
The mean operating time was 260 min for Billroth I and 352 min for jejunal interposition. No serious postoperative complications arose. Reflux gastritis occurred in 19 patients after Billroth I but in none after jejunal interposition. Five patients in the Billroth I group had complaints consistent with dumping syndrome, compared with none after jejunal interposition. The barium gastric emptying time was significantly shorter after Billroth I (mean(s.d.) 269(225) s) than after jejunal interposition (736(479) s) (P &lt; 0·01).

Conclusion
Jejunal interposition prevented reflux gastritis and inhibited rapid gastric emptying. Postgastrectomy syndromes were effectively prevented by this reconstruction procedure.
Lymphoedema following surgery for breast cancer
Authors: Pain S J , Purushotham A D 
Published: March 2003

Abstract

Background
Lymphoedema is a common complication of breast cancer treatment, affecting approximately a quarter of patients. Those affected can have an uncomfortable, unsightly and sometimes functionally impaired limb prone to episodes of superficial infection. The aetiology, pathophysiology and management of these patients is poorly understood.

Methods
This is a systematic review of all published literature on lymphoedema following treatment for breast cancer, using the Medline and Cinahl databases with cross-referencing of major articles on the subject up to the end of 1999.

Results and Conclusion
The aetiology and pathophysiology of lymphoedema in patients with breast cancer appear to be multifactorial and are still not fully understood. Although conservative treatment techniques can be very successful in controlling symptoms, they do not afford a cure. The place of surgical and pharmacological therapy remains unclear. Improved understanding of the pathophysiology may assist in reducing the incidence of this condition, or help to identify those at greatest risk, in whom early initiation of conservative treatment measures may prove effective.
Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis
Authors: Yin X -Y , Lai P B S , Lee J F Y , Lau J W Y 
Published: March 2003

Abstract

Background
Hepatic blood inflow occlusion during hepatectomy may influence postoperative liver regeneration. The aim of this study was to investigate the influence of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in thioacetamide-induced cirrhotic rats.

Methods
Forty-three cirrhotic Wistar–Furth rats were randomly assigned to three groups. Rats in group 1 underwent 64 per cent hepatectomy alone, those in group 2 were subjected to 15 min hepatic blood inflow occlusion followed by 64 per cent hepatectomy, and animals in group 3 were subjected to 30 min inflow occlusion followed by 64 per cent hepatectomy. Liver function, 5-bromo-2′-deoxyuridine (BrdU) labelling index and percentage of initial liver weight on days 1, 2 and 7 posthepatectomy were assessed.

Results
Rats in groups 1 and 2 had a significantly higher serum albumin level and a markedly lower alanine aminotransferase level than animals in group 3 on day 1 posthepatectomy (P &lt; 0·05). There was no significant difference in the serum level of total bilirubin of the three groups on days 1, 2 and 7. The BrdU labelling index was significantly higher in groups 1 and 2 than in group 3 animals on day 1 posthepatectomy (P &lt; 0·01 and P &lt; 0·05 respectively). Percentages of initial liver weight were similar in groups 1, 2 and 3 on days 1, 2 and 7 after hepatectomy.

Conclusion
Hepatic blood inflow occlusion for up to 30 min suppressed DNA synthesis and hepatocyte proliferation at an early posthepatectomy stage and consequently delayed recovery of liver function in cirrhotic rats. However, it did not affect restoration of liver mass or survival after 64 per cent hepatectomy.
Vasoactive and proliferative effects of parathyroid hormone and parathyroid hormone-related peptide on human vascular smooth muscle
Authors: Chadwick D R , Harrison B J , Chan P , Chong L , Peachell P 
Published: March 2003

Abstract

Background
Hyperparathyroidism is associated with an increased incidence of hypertension and cardiovascular disease. Experiments in rats suggest that this results from desensitization of the normally inhibitory effects of parathyroid hormone-related peptide (PTHrP) on vascular smooth muscle cells (VSMCs) by previous exposure to parathyroid hormone (PTH).

Methods
Isometric tension in vitro was measured in segments of vessels obtained at neck surgery from six normotensive patients with hyperparathyroidism and 12 eucalcaemic controls undergoing thyroid surgery. Vessels were precontracted with noradrenaline to allow the vasodilatory effects of PTH and PTHrP to be observed. Human VSMCs were cultured in 0·5, 5 and 15 per cent serum with or without PTH (10−11 to 10−7 nmol l−1) and proliferation was assessed by cell counts after 14 days.

Results
Vasodilatation of arterial segments produced by both PTH 20 nmol l−1 and PTHrP 100 nmol l−1 did not differ significantly between control and hyperparathyroidism groups (P &gt; 0·08, Mann–Whitney U test). Vasodilatation by PTHrP was not reduced by preincubation of vessels in vitro with PTH 50 nmol l−1 for 1 h (P &gt; 0·36, Wilcoxon test). No effects of PTH on serum-induced proliferation of human VSMCs were observed.

Conclusion
These data imply that homologous desensitization to PTHrP is not implicated in the pathogenesis of vascular disease in patients with hyperparathyroidism.
Differential effects of cyclosporin and tacrolimus on the expression of fibrosis-associated genes in isolated glomeruli from renal transplants
Authors: Bicknell G R , Williams S T , Shaw J A , Pringle J H , Furness P N , Nicholson M L 
Published: March 2003

Abstract

Background
Chronic allograft nephropathy is characterized by an excessive accumulation of extracellular matrix proteins leading to glomerular and interstitial fibrosis. The aim of this study was to determine the effects of two different immunosuppressive agents (cyclosporin and tacrolimus) on the expression of the genes controlling extracellular matrix deposition in renal transplant glomeruli.

Methods
Fifty-one renal transplant recipients were randomized to receive immunosuppression with either microemulsion cyclosporin or tacrolimus. Isolated glomeruli were plucked from protocol transplant biopsies performed 1 week, 3 months and 6 months after transplantation. Expression of the genes for collagen IVα2, collagen III, matrix metalloproteinase 2, tissue inhibitor of metalloproteinases (TIMP) 1 and TIMP-2, tenascin and transforming growth factor (TGF) β1 was studied by quantitative reverse transcriptase–polymerase chain reaction.

Results
The expression of messenger RNA (mRNA) for collagen III and TIMP-1 was significantly higher in patients receiving cyclosporin therapy than in those having tacrolimus (P &lt; 0·01); this finding was accounted for by differences in the biopsy material at 1 week. A significant difference in collagen III, TIMP-1 and TIMP-2 mRNA expression was also detected between patients depending on the source of renal donor (cadaveric or living). There were no significant differences in the level of glomerular TGF-β1.

Conclusion
The data provide new in vivo evidence that tacrolimus may exert a less fibrogenic influence on transplant glomeruli than cyclosporin.
Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease
Authors: Trondsen E , Mjåland O , Raeder J , Buanes T 
Published: March 2003

Abstract

Background
Based on a series of successful outpatient laparoscopic cholecystectomies, day-case laparoscopic fundoplication for gastro-oesophageal reflux disease was introduced in January 1997. The initial results are reported.

Methods
Inclusion criteria were American Society of Anesthesiologists grade I–II, living within 30 min travel from the hospital, and adult company at home. Initially only selected patients were offered day-case treatment, but later it was adopted as routine. The patients underwent general intravenous anaesthesia with propofol and remifentanil, and were given ketorolac, propacetamol, droperidol and ondansetron as prophylaxis against postoperative pain and nausea. The surgical procedure was Nissen–Rosetti fundoplication or semifundoplication depending on oesophageal manometric results.

Results
Forty-five patients were included. Four patients were admitted; 41 were discharged as planned 3–8 h after operation, and five of these patients were readmitted. One underwent reoperation for necrosis of the gastric fundus. A further five patients visited the outpatient department without need for admission. At follow-up 31 patients were satisfied with the day-case treatment, five were indifferent, and five were dissatisfied because of pain. If offered a similar operation in the future, 26 patients would have preferred and seven would have accepted day-case treatment, and eight would not.

Conclusion
Outpatient laparoscopic fundoplication is safe and well tolerated by the majority of patients.
Gender differences in the longitudinal pressure profile of the anal canal related to anatomical structure as demonstrated on three-dimensional anal endosonography
Authors: Williams A B , Cheetham M J , Bartram C I , Halligan S , Kamm M A , Nicholls R J , Kmiot W A 
Published: March 2003

Abstract

Background
Anal canal squeeze pressure is assumed to be due to external sphincter contraction, but the contribution of other muscles has not been explored.

Methods
Ten male and ten nulliparous female asymptomatic subjects had three-dimensional anal endosonography and manometry. Incremental squeeze pressures at 0·5-cm intervals, expressed as a percentage of the maximum pressure recorded anywhere in the canal, were related to the following anatomical levels: puborectalis, overlap between external anal sphincter (EAS) and puborectalis, external and internal anal sphincters, and external anal sphincter only. Levels were determined by coronal and sagittal endosonographic reconstructions.

Results
Puborectalis was the same length in men and women (median 23·9 versus 27·1 mm) but represented a greater proportion of the anal canal in women (45 versus 61 per cent; P = 0·02). At the level of puborectalis alone, the pressure generated as a proportion of maximum anal canal pressure was 71 (range 32–100) per cent in men and 62 (range 32–100) per cent in women. At the level of the EAS alone, the pressure was 60 (4–98) per cent in men and 82 (41–100) per cent in women; where the external sphincter was overlapped by puborectalis, the pressure was 98 (60–100) per cent in men and 75 (47–100) per cent in women.

Conclusion
Maximal anal canal squeeze pressure is found where the puborectalis overlaps the EAS. This segment represents a significant proportion of anal canal length in women.