bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extra‐adrenal production of corticosteroids
Authors: Davies Eleanor , MacKenzie Scott M 
Published: December 2004

Summary1. The major corticosteroids aldosterone and cortisol (corticosterone in rodents) are secreted from the adrenal cortex under the regulation of the renin–angiotensin system and the hypothalamic–pituitary–adrenal axis.2. In addition to their accepted roles in such processes as blood pressure regulation, glycogenesis, hepatic glyconeogenesis and immunosuppression, the corticosteroids have been implicated in the development of cardiac fibrosis, modulation of hippocampal neuron excitability, memory formation and neurodegeneration.3. The advent of sensitive molecular biological techniques has produced a wealth of evidence to support the existence of extra‐adrenal corticosteroidogenic systems. Most attention has been paid to the cardiovascular system and the central nervous system, where the full array of enzymes required for the de novo synthesis of corticosteroids from cholesterol has been identified.4. Although the evidence for local corticosteroid production is strong, the quantities of steroid would be small compared with adrenal production. Therefore, it is still a matter of debate as to whether extra‐adrenal corticosteroids are of any physiological significance. This will depend on factors such as local concentration, proximity to target cells and, possibly, to tissue‐specific control mechanisms.
Comparison of the Zeiss IOLMaster and applanation A‐scan ultrasound: biometry for intraocular lens calculation
Authors: Rose Loreto T , Moshegov Con N 
Published: December 2004

Abstract Purpose: A comparison of axial length estimates using applanation A‐scan ultrasound and the Zeiss IOLMaster was conducted. The accuracy in predicting postoperative refraction determined by each method was also compared. Methods: A cross‐sectional study was performed on 51 eyes in 46 patients presenting to clinical practice for cataract surgery assessment. Preoperative measurement of axial length was performed with applanation ultrasound and the IOLMaster. The IOLMaster measurements were used to determine the intraocular lens power based on the SRK/T formula. Postoperative refractive outcomes were obtained and spherical equivalent calculated and compared to the predicted refractive error with each biometric method. Results: On average the axial lengths measured by the IOLMaster were longer by 0.15 mm compared to ultrasound biometry (P < 0.01). Using the IOLMaster over applanation ultrasound biometry significantly improved the postoperative refractive outcome from 0.65 D to 0.42 D (P = 0.011). Conclusions: The IOLMaster provides an accurate axial length measurement and results in accurate intraocular lens power calculation based on the SRK/T formula. It is quick and easy to use and provides a non‐contact technique with no risk of infection or corneal abrasion.
Topical anaesthesia: a risk factor for post‐cataract‐extraction endophthalmitis?
Authors: Ellis Mark F 
Published: December 2004

Abstract Purpose: To investigate if the incidence of postoperative endophthalmitis in temporal clear corneal cataract surgery is influenced by the use of topical anaesthesia compared to retrobulbar anaesthesia. Methods: A retrospective study was conducted of one surgeon's cataract surgery between October 1997 and October 2001. Results: Between October 1997 and May 2000, there were 633 cataract extractions performed with 219 patients operated under topical anaesthesia and 414 under retro­bulbar injection. The selection criteria were that surgically easier cases underwent topical anaesthesia. There were five patients who suffered postoperative endophthalmitis in their first week, of which four cases were under topical anaesthesia. This was shown to be borderline significance of P = 0.05 using the Fischer exact 2‐tailed test. There was a complicated case, operated under retrobulbar anaesthesia, who had a low‐grade endophthalmitis in the second postoperative week. The four topical cases and the case from the second week all grew Staphylococcus epidermidis. The retrobulbar case developing endophthalmitis in the first week grew alpha haemolytic Streptococcus. After May 2000, there was a change to performing all cataract surgery under retrobulbar anaesthesia and the next 453 cases had no incidence of endophthalmitis. Conclusion: Topical anaesthesia techniques in temporal clear corneal cataract extraction may be a factor in endophthalmitis.
Blepharophimosis: a recommendation for early surgery in patients with severe ptosis
Authors: Beckingsale Peter S , Sullivan Timothy J , Wong Vincent A , Oley Christine 
Published: December 2004

Abstract Purpose: To determine the optimal age for surgical correction of blepharophimosis. Associated features and their effects on incidence of amblyopia were also investigated. Methods: The study was a retrospective case series of 28 patients with blepharophimosis, ptosis and epicanthus inversus syndrome presenting to a tertiary referral eyelid, lacrimal and orbital clinic. Results: Amblyopia was present in 39% of patients. Patients with coexistent strabismus had a 64% incidence of amblyopia compared to 24% for those without strabismus. Hypermetropia was present in 43% of patients and 7% were myopic. Significant astigmatism was found in 40% of patients, but these factors did not increase the risk of amblyopia. Patients with severe ptosis had lower rates of amblyopia than those with moderate ptosis but had their ptosis corrected at a median age of 2 years compared to 5 years for those with moderate ptosis. There was an 18% incidence of nasolacrimal drainage problems. A good to excellent cosmetic outcome was achieved in 86% of patients. A positive family history was noted in 75% of patients, usually with paternal inheritance. Conclusions: Patients with blepharophimosis have a high rate of amblyopia. Co‐existent strabismus doubles the risk of amblyopia. Ptosis alone causes mild to moderate amblyopia only. Patients with severe ptosis should have their ptosis corrected before 3 years of age, and all other patients should undergo surgery before 5 years of age.
Confocal imaging of the human keratocyte network using the vital dye 5‐chloromethylfluorescein diacetate
Authors: Poole C Anthony , Brookes Nigel H , Clover Gillian M 
Published: December 2004

Abstract Background: The human corneal stroma consists of intercalated layers of collagen and keratocytes. These cells are known to maintain the stroma and aid in repair but it is likely they have other crucial roles throughout the cornea. The complexity of their anatomy is revealed in this study by ex vivo in situ images of the human keratocyte covering a range of ages. Methods: Human donor corneas of different ages were stained with 5‐chloromethylfluorescein diacetate (CMFDA), a dye that is anchored and retained within the cell cytoplasm. The tissue was fixed, sectioned, mounted, and then imaged using a confocal laser scanning microscope at various magnifications and tissue planes. The digital image sets were transferred to multifunction image processing software for analysis and production of 3‐D stereo images of keratocyte networks throughout the stroma. Results: High quality images of CMFDA‐stained cells revealed differences in the structure and orientation of keratocytes in the anterior, central and posterior stroma, which did not differ throughout the age‐range studied. This method reveals very fine cell process ramifications not previously visualized, orientated in lateral and antero­posterior directions, and it confirms the potential for multidirectional communication between keratocyte networks. Conclusions: This qualitative study found consistency of keratocyte morphology in the normal human cornea throughout life. It confirmed differences in keratocyte anatomy, and the potential for rapid cellular communication by multiple interconnecting processes supporting cohesive keratocyte activity. This high‐resolution 3‐D microscopic study should assist in identifying gross deviant cellular behaviour in post‐surgical and disease states.
Five‐year follow‐up study after Helicobacter pylori eradication: Reinfection and peptic ulcer status
Authors: ZHOU Li Ya , LIN San Ren , SHEN Zu Yao , ZHONG Shang Zhi , DING Shi Gang , HUANG Xue Biao , WANG Li Xin , XIA Zhi Wei , JIN Zhu , CAO Shi Zhi 
Published: December 2004

OBJECTIVE:  To investigate the prevalence of peptic ulcers and Helicobactor pylori reinfection 5 years after H. pylori eradication.METHODS:  One thousand and six adults were randomly sampled from the general population in a high‐incidence region of gastric cancer. Of these, 552 subjects were confirmed to be H. pylori‐positive by using both the rapid urease test and the Warthin−Starry stain. All H. pylori‐positive subjects were randomly divided into two groups: (i) the eradication group, who received 1 week of omeprazole‐based triple therapy; and (ii) the control group, who received placebo tablets. Four weeks after the cessation of treatment, 13C‐urea breath tests demonstrated that H. pylori had been successfully eradicated in 88.9% of patients in the eradication group, whereas 96.4% of patients remained H. pylori positive in the control group. Subjects in both groups were followed up using endoscopy at the end of the first and fifth year after treatment. The H. pylori infection status was determined by using the rapid urease test and Warthin−Starry staining.RESULTS:  The response rates to endoscopy at the end of the first and fifth year were 89.3 and 83.11%, respectively. The prevalence of peptic ulcers in the eradication group and control group were 9.87 and 7.61% before treatment, 3.70 and 12.58% 1 year after treatment (P < 0.05), and 5.86 and 14.93% 5 years after treatment (P < 0.05), respectively. The recurrence rates of peptic ulcers in the eradication group and the control group were 3.70 and 38.10% 1 year after treatment, and 14.81 and 42.86% 5 years after treatment, respectively. The rates of H. pylori infection 1 and 5 years after treatment in the eradication group were 13.58, and 19.82%, respectively. In the control group, the rates of H. pylori infection were 91.97 and 83.26% 1 and 5 years after treatment, respectively.CONCLUSIONS:  The prevalence of peptic ulcers decreased significantly after the eradication of H. pylori. The reinfection rate after H. pylori eradication was 4−5% per year. Helicobacter pylori infection status remained constant in almost 85% of cases.
Management of severe acute pancreatitis: The Peking Union Medical College Hospital experience from 1984 to 2001
Authors: DENG Rui Xue , LU Xing Hua , LIU Da Wei , ZHONG Shou Xian , ZHAO Yu Pei 
Published: December 2004

OBJECTIVE:  To discuss recent advances in diagnostic techniques for severe acute pancreatitis. To discuss recent changes in the treatment of severe acute pan­creatitis, and to evaluate their effects.METHODS:  Sixty‐two patients who were admitted to Peking Union Medical College Hospital with severe acute pancreatitis between April 1984 and June 2001 were reviewed.RESULTS:  From 1984 to 1993, the main treatment was early surgical débridement, and the mortality rate was 38.5% (15/39). Since 1994 computed tomo‐graphy has been used as a diagnostic tool, and treatment has shifted to aggressive intensive medical care, with specific criteria for operative and non‐operative interventions. The mortality rate during this period was 17.4% (4/23).CONCLUSIONS:  The prognosis of patients with severe acute pancreatitis has improved greatly because of advances in diagnosis and treatment. Computed tomography is an important and effective non‐invasive diagnostic technique.
Iron‐deficiency anaemia and delay in the diagnosis of colorectal cancer
Authors: Acher P. L. , Al‐Mishlab T. , Rahman M. , Bates T. 
Published: December 2004

AbstractAims  Iron‐deficiency anaemia (IDA) is a recognized complication of colorectal cancer (CRC) especially with right‐sided tumours, and failure to investigate the anaemia in older patients may lead to a delay in diagnosis. The aims of this study were to establish the proportion of patients with CRC shown to have an IDA for more than six months before diagnosis and to establish the proportion of patients with IDA who subsequently prove to have CRC.Methods  All patients presenting with confirmed CRC in a health district (catchment population 280000) in the 4 years 1996–9 were identified from the pathology database after ethical approval. The criteria for IDA were haemoglobin (Hb) < 10.1 g/dl plus mean corpuscular volume < 78 fl and/or mean corpuscular Hb concentration < 32 g/dl.The haematology data‐base serving the same population was searched for evidence of: 1. IDA at diagnosis of CRC; 2. IDA more than 6 months and more than one year before the diagnosis of CRC; 3. The number of haematology referrals per annum in women over 55 and men over 50 years of age meeting the criteria for IDA.Results  Of 440 patients with colorectal cancer, 166 (38%) had IDA at diagnosis and of the latter 54 (12%) were known to have IDA for more than six months before diagnosis and 26 (6%) had IDA more than one year before diagnosis. IDA was more common in right sided tumours (65%) than in those arising in the left side of the colon and rectum (26%). The annual incidence of IDA in the sampled population was 1366 in the stated age group.Conclusion  The investigation of iron‐deficiency anaemia in older patients is important but in order to detect 26 patients with colorectal cancer a year earlier, the investigation of approximately 5000 patients would be required – a detection rate of less than 1%.
Local excision of rectal carcinoma not‐exceeding the muscularis layer
Authors: Kosciñski T. , Malinger S. , Drews M. 
Published: December 2004

AbstractAim  The aim of the study was to compare the results of treatment by local excision of two different clinical stages of the rectal cancer.Material and methods  Fifty‐eight patients with early rectal carcinoma were operated on during the last 26 years using different methods of local exscision. The carcinomas were initially assessed as not‐exceeding the muscularis layer of the rectal wall. The tumours, localized up to 12 cm from the anal margin, were removed by means of ‘parachute’ excision (47 patients). In 6 patients, carcinoma localized in the central part of rectum, was excised by means of the Localio method. Transanal endoscopic microsurgery was applied in 5 cases of carcinoma localized on the depth of 5–20 cm from the anal margin.Results  After local excision the patients were divided into two groups: I, tumours of low degree of malignancy, not exceeding submucosal layer (26 patients); II, tumours of low or median degree of malignancy with infiltration of muscularis layer (32 patients). There was a significant difference in cancer relapses between groups I and II. One patient in group I and 9 in group II developed local recurrences (P < 0.05) and 5 patients in group II had neoplastic dissemination (15.6%).Conclusions  Best results were obtained in patients with carcinoma not exceeding submucosal membrane. In cases of rectal muscular layer infiltrations, the risk of carcinoma relapses was markedly higher. The use of transanal endoscopic microsurgery has permited removal of tumours from the upper rectum.
Colorectal transport in normal defaecation
Authors: Krogh K. , Olsen N. , Christensen P. , Madsen J. L. , Laurberg S. 
Published: December 2004

AbstractObjective  Colorectal luminal transport during defaecation can be assessed by means of scintigraphy. However, normal values remain to be established and inter‐ and intra‐subjective variation is unknown. The aim of the study was to describe colorectal transport during normal defaecation by means of a new method for colorectal scintigraphy and to determine inter‐ and intrasubjective variation.Methods  Thirty healthy volunteers (18 men and 12 women, age 22–46 years; median 31) took 2 MBq 111In on two consecutive days (days 0 and 1). On days 1 and 2 an abdominal scintigraphy was done before and after defaecation. Changes in colorectal contents were computed in two ways: firstly, assuming ordered evacuation, the extent of colorectal emptying was computed; secondly, antegrade and retrograde transport within the colorectum was computed for each colorectal segment.Results  Median colorectal emptying during normal defaecation was 99% of the rectosigmoid (range: 60% of the rectosigmoid to complete emptying of the rectosigmoid, descending colon, transverse colon and 19% of the caecum/ascending colon). There was no difference between men (median 99% of the rectosigmoid) and women (98% of the rectosigmoid). Day to day variation was large (dispersion = 52%) with a trend towards larger defaecation on day 2 than on day 1 (P = 0.09). Large antegrade and retrograde movements of colorectal contents were observed within the colorectum during defaecation. Antegrade transport involved the rectosigmoid (median 99%), the descending colon (median 53%), the transverse colon (median 46%), and the caecum/ascending colon (median 11%). Retrograde transport was mainly from the transverse colon and the descending colon. Colorectal emptying was significantly correlated to the subjective description (P < 0.01) but not to total gastrointestinal or segmental colorectal transit times determined by means of radioopaque markers.Conclusions  Colorectal scintigraphy before and after defaecation provides detailed information about colorectal emptying and intracolonic antegrade or retrograde transport during defaecation. Inter‐ and intraindividual variations are large and antegrade and retrograde transport within the colorectum is common.
Effects of intraperitoneal 4% icodextrin solution on the healing of bowel anastomoses and laparotomy incisions in rabbits
Authors: Rodgers K. E. , Verco S. J. S. , DiZerega G. S. 
Published: December 2004

AbstractObjective  Peri‐operative lavage and postoperative instillation of a 4% icodextrin solution reduces de novo formation and reformation of peritoneal adhesions following abdominal surgery. This experimental study evaluated the effects of 4% icodextrin treatment on the healing of bowel anastomoses and laparotomy incisions.Materials and methods  Female New Zealand White rabbits (weight 2.21–2.77 kg) were randomised by ascending weight to one of 3 surgical treatments, each with 2 termination points (6 groups of 8 animals). The treatments were anastomotic bowel surgery alone or with lavage and postoperative instillation of either 4% icodextrin solution or Lactated Ringer's Solution (LRS). The solutions were coded A and B by the supplier, so that the study personnel were blinded to their identity. After the abdomen was opened, 30 ml of solution A or B was instilled and removed by aspiration prior to surgery. The ascending colon was then transected 5 cm aboral to the ileocaecal junction and the ends anastomosed. During surgery, 5 ml of the solution was applied 4 times at the surgical site, and a further 30 ml was administered and aspirated as a postoperative lavage. Just prior to closure of the abdominal wall, 50 ml of the solution was administered as a postoperative instillate. Duplicate treatment groups were terminated 7 and 21 days after surgery and the anastomotic sites inspected for adhesion and/or abscess formation. In 6 animals per group, an 8–12 cm length of colon including the anastomotic site was removed for measurement of bursting pressure, and a section of the abdominal wall including the incision line was tested for breaking strength. The other 2 animals per group provided tissue for histological analysis of wound healing at the bowel and incision sites.Results  There was no significant difference between the 3 treatment groups for any parameter (P > 0.05). Compared with the surgical control at either day 7 or 21 after surgery, the administration of solutions A or B did not affect the formation of abscesses or adhesions, the bursting strength of the bowel, or the tear strength of the abdominal wall incision. Histological assessment of the quality of wound healing showed no differences between treatment groups in inflammatory cell infiltration, fibroblast density, blood vessel formation or collagen maturity.Conclusions  The use of a 4% icodextrin solution for peri‐operative lavage and postoperative instillation in a rabbit model of bowel anastomotic healing did not result in any difference from either LRS treated or untreated surgical controls.
Short‐term pre‐operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial
Authors: Sørensen Lars Tue , Jørgensen Torben 
Published: December 2004

AbstractBackground  Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers. We tested the hypothesis that short‐term pre‐operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications.Methods  From February 1998 to March 2001, 60 patients, who smoked daily, undergoing colorectal resection were randomly assigned 2–3 weeks before scheduled surgery to either abstinence from smoking, counselling and nicotine replacement therapy or maintenance of daily smoking habits. Postoperative tissue and wound complications necessitating surgical or medical treatment were evaluated at discharge and 30 days after surgery by blinded outcome assessment.Results  In the pre‐operative period of 15 days (8–24) (median, interquartile range (IQR)), 89% of the patients in the intervention group vs. 13% in the control group abstained from smoking or reduced by more than half (P < 0.05). In the postoperative period of 11 days (10–13), the corresponding figures were 92% and 50%, respectively (P < 0.05). Postoperative tissue and wound complications occurred in 33% (9 of 27) of the patients in the intervention group compared to 27% (8 of 30) in the control group (NS). Likewise, no difference in overall postoperative complication rate was found between the groups.Conclusion  Short‐term cessation of smoking does not reduce the risk of complicated tissue and wound healing or other complications in colorectal surgery.
Angiogenesis in anal warts, anal intraepithelial neoplasia and anal squamous cell carcinoma
Authors: Mullerat J. , Wong Te Fong L. F. , Davies S. E. , Winslet M. C. , Perrett C. W. 
Published: December 2004

AbstractIntroduction  Most cases of anal carcinoma seem to develop from high grade anal intraepithelial neoplasia (AIN) caused by persistent anal warts. Similar pre‐invasive epithelial genital lesions (e.g. those of the cervix and vulva) have been shown to be associated with increased angiogenesis. In this study we examined biopsies of anal lesions ranging from warts to invasive anal carcinoma, with the aim of assessing the degree of angiogenesis in pre‐invasive anal lesions.Method  Samples from 70 patients (51 male) who had undergone excision biopsy or resection of anal wart lesions (20), low grade AIN (12), high grade AIN (27) and anal squamous cell carcinoma (SCC) (11) were studied. Samples (6) from normal HIV‐anal skin were used as controls. The samples were stained for von Willebrand factor, a specific marker of endothelial cells. Angiogenesis was measured by microvessel density (MVD) analysis, quantifying the microvessels in the stroma adjacent to the epithelial lesion.Results  There was a statistically significant (P < 0.001) progressive increase in MVD between low grade AIN, high grade AIN and anal SCC. The difference in MVD between normal skin, warts and low grade AIN was not statistically significant.Conclusion  There are progressive abnormal patterns of angiogenesis in highly dysplastic lesions, similar to those found in cervical and vulvar pathology. These findings may have biological, prognostic and therapeutic implications.