bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural history of adhesional small bowel obstruction: counting the cost
Authors: Wilson M S , Hawkswell J , McCloy R F 
Published: March 2003

Abstract

Background
The aim of this study was to identify patients admitted with adhesional obstruction to determine if there was an identifiable pattern to the type of initial operation, the type of treatment used for the obstructive episode and the subsequent need for further treatment.

Methods
Patients with adhesional obstruction were identified retrospectively in a cross-sectional study using ICD codes relating to admissions in the years 1990 to 1996. The case notes were used to assess their outcome.

Results
Fifty-nine case notes from a total of 175 identified initially satisfied the inclusion criteria. These patients had a mean age at presentation of 51 (range 16–88) years and had undergone a total of 122 operations. Thirty-one patients (53 per cent) had a single previous operation with a median time to presentation with obstruction of 5·5 years (range 11 days to 34·7 years); 33 patients (56 per cent) were treated conservatively on their first admission. There was no statistically significant difference in the outcome in patients who received either conservative or surgical treatment. The length of stay in patients treated surgically (median 11 (range 2–47) days) was significantly longer than that for those treated conservatively (median 6 (range 1–39) days) (P &lt; 0·001). A flow chart was constructed demonstrating the eventual outcome of the patients in the study, enabling the cost of adhesional obstruction to be calculated.

Conclusion
This type of approach could be used to assess the potential effect of different treatment strategies for adhesional obstruction.
Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery
Authors: Bergenfelz A , Isaksson A , Lindblom P , Westerdahl J , Tibblin S 
Published: March 2003

Abstract

Background
The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.

Methods
Intraoperative levels of PTH were measured in 119 patients during 121 operations (including 14 reoperations) for pHPT. The mean(s.d.) preoperative serum calcium level was 2·79(0·21) mmol/l. Blood samples were drawn before, and at 5 and 15 min after, excision of the first enlarged parathyroid gland. PTH was analysed electively in 61 patients and on-line by a modified assay for intact PTH in 48 patients. Both procedures were used in ten patients.

Results
The mean(s.d.) decline in PTH concentration in 101 patients with primary exploration due to solitary adenoma was 63(17) per cent after 5 min (n = 84) and 83(10) per cent after 15 min. The patients with primary exploration because of multiglandular disease (n = 6) were correctly predicted not to have parathyroid adenoma.

Conclusion
Measurement of PTH levels during surgery for pHPT is a highly sensitive method for differentiating between single and multiple gland disease. The on-line monitoring of PTH is clinically useful in patients who have undergone previous neck surgery. Its role in pHPT surgery at primary exploration should be evaluated in prospective trials.
Influence of ischaemia–reperfusion injury on CD44 expression in rat small intestine
Authors: Heel K , Blennerhassett L , Kong S-E , McCauley R , Hall J 
Published: March 2003

Abstract

Background
CD44 is an adhesion molecule expressed by neutrophils and lymphocytes which is involved in cell–cell and cell–matrix binding. In this study, the effect of ischaemia–reperfusion injury on CD44 messenger RNA (mRNA) and cell surface immunohistochemical expression of CD44 in the rat small intestine was evaluated.

Methods
Wistar rats (n = 16) were randomized to either serve as controls (sham surgery) or to be subjected to a standardized ischaemia–reperfusion injury (suprarenal aorta occluded for 1 h followed by 1 h of reperfusion). Standardized segments of jejunum were harvested after ischaemia–reperfusion injury (ischaemic and reperfused samples) to measure the mucosal protein and DNA content, mRNA expression of CD44 and the immunohistochemical expression of CD44.

Results
Reperfusion significantly damaged the jejunal mucosa, e.g. mucosal protein content was lower after reperfusion compared with that in the control group (z = −2·31, P = 0·02) and the ischaemic samples (z = −2·52, P = 0·01). The expression of cell surface CD44 protein was also significantly decreased after ischaemic injury (z = −1·99, P = 0·04); this coincided with a decrease in the amount of cytoplasmic CD44 mRNA within isolated enterocytes (z = −2·31, P = 0·02).

Conclusion
Ischaemia–reperfusion injury decreases the expression of CD44 within the jejunal mucosa. This may contribute to the failure of the gut barrier after such injury.
Comprehensive 1-year cost analysis of open antireflux surgery in Nordic countries
Authors: Lundell L , Dalenbäck J , Janatuinen E , Hattlebakk J , Levander K , Miettinen P , Myrvold H E , Pedersen S A , Thor K , Andersson A , Stålhammar N O 
Published: March 2003

Abstract

Background
Antireflux surgery is a highly effective treatment option in patients with severe gastro-oesophageal reflux disease. However, because of the increasing pressure of cost containment within health care, cost aspects must also be added to the decision-making process.

Methods
The aim of this analysis was to assess the total cost of open antireflux surgery during the first year after operation in 178 patients with chronic reflux, who were recruited into a controlled, prospective clinical trial. The study was carried out in 17 hospitals in the Nordic countries.

Results
The cost of the operation represented more than 90 per cent of the direct medical costs which amounted to approximately US $5700. For a patient in the work force the indirect cost, i.e. loss of production, represented 47 per cent of the total cost, which was about US $10 800.

Conclusion
The total cost profile of open antireflux surgery has now been established prospectively and can form a basis for future comparisons.
Chlamydia pneumoniae and vascular disease
Authors: Gibbs R G J , Carey N , Davies A H 
Published: March 2003

Abstract

Background
There is an increasing body of evidence linking the human pathogen Chlamydia pneumoniae with atherosclerosis.

Methods
A Medline-based review of the literature was carried out.

Results and conclusion
Seroepidemiological studies have revealed the possibility that evidence of infection with C. pneumoniaeand atherosclerotic disease are related. Studies on human tissue have demonstrated that evidence of the organism can be found in human atherosclerotic tissue by both direct and indirect methods significantly more often than in control vascular tissue. Using animal models it is possible to show that C. pneumoniae can be disseminated haematogenously following pulmonary infection and that it shows a tropism for atherosclerotic tissue. In vitro work has demonstrated that the organism is capable of infecting, surviving and multiplying in cells of the human vascular wall, and that it can provoke a cell-mediated cytokine response which has implications both locally and systemically. Two clinical trials of macrolide antibiotics have demonstrated that they confer increased cardiovascular protection in patients following myocardial infarction. Adequately powered trials are needed to establish the therapeutic role of antibiotics in peripheral arterial disease.
Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence
Authors: Carapeti E A , Kamm M A , Phillips R K S 
Published: March 2003

Abstract

Background
Anal incontinence due to internal sphincter dysfunction is not amenable to simple surgical repair. The α-adrenergic agonist phenylephrine produces contraction of the internal sphincter and raises resting pressure when applied topically in healthy volunteers. The effect of topical phenylephrine in the treatment of faecal incontinence due to internal sphincter dysfunction was investigated.

Methods
Thirty-six patients (22 women) aged 28–81 (mean 58) years with faecal incontinence and ultrasonographically structurally normal anal sphincter muscles were treated with topical 10 per cent phenylephrine and placebo gels, allocated in random order in a double-blind crossover study. Maximum resting anal sphincter pressure and anodermal blood flow were measured. A symptom questionnaire was completed and incontinence score determined using a validated scale.

Results
There were no significant differences in incontinence score, resting anal pressure and anodermal blood flow between the active and placebo treatments. Six patients on active treatment and two on placebo experienced more than 75 per cent subjective improvement. Three patients developed allergic dermatitis to phenylephrine.

Conclusion
This is the first study of the use of a topical pharmacological agent to treat faecal incontinence. This concentration of topical phenylephrine did not produce a significant improvement in symptoms or function. A subgroup of patients may respond. Further studies are required with increased concentrations.
Reduced endothelin-3 expression in sporadic Hirschsprung disease
Authors: Kenny S E , Hofstra R M W , Buys C H C M , Vaillant C R , Lloyd D A , Edgar D H 
Published: March 2003

Abstract

Background
Enteric aganglionosis in Hirschsprung disease has been linked to genes coding for endothelin-3 (EDN3) and the endothelin B receptor (EDNRB), but there is no such linkage in most patients with sporadic Hirschsprung disease. However, the similarity between the distal colonic aganglionosis in Hirschsprung disease and that due to EDN3 or EDNRB mutations led to the hypothesis that levels of expression of these genes might be affected in the absence of mutation, thus causing the Hirschsprung disease phenotype. The aim of this study was to determine EDN3 and EDNRB messenger RNA (mRNA) levels in tissue samples from patients with sporadic Hirschsprung disease.

Methods
RNA and DNA were isolated from the ganglionic and aganglionic colonic segments of ten children with sporadic Hirschsprung disease, and from the colon of ten age-matched controls. The DNA was analysed for mutations in the genes coding for endothelin-3 (ET-3) and endothelin B receptor (ET-B) proteins. Relative levels of EDN3 and EDNRB mRNA were determined by semi-quantitative transcriptase–polymerase chain reaction.

Results
Three children had sequence variants in EDN3 and EDNRB. In the remaining seven patients, EDN3 mRNA levels were reduced in both the ganglionic and aganglionic colon compared with levels in controls; there was no difference in expression of EDNRB between groups.

Conclusion
In the absence of mutation, EDN3 is downregulated in short-segment Hirschsprung disease, suggesting that this may be a common step leading to aganglionosis.
Risk factors for postoperative death following elective surgical repair of abdominal aortic aneurysm: results from the UK Small Aneurysm Trial
Authors: Brady A R , Fowkes F G R , Greenhalgh R M , Powell J T , Ruckley C V , Thompson S G 
Published: March 2003

Abstract

Background
In regional and population studies, the mortality rate within 30 days of elective surgical repair of abdominal aortic aneurysm is approximately 8 per cent. Identification of preoperative factors associated with this mortality risk is important for informing surgical policy and may suggest suitable preoperative interventions.

Methods
In the UK Small Aneurysm Trial, 820 patients aged 60–80 years underwent elective open surgical repair of an abdominal aortic aneurysm. The relationship between 30-day mortality rate and 13 prespecified potential prognostic factors was investigated. The value of a published clinical prediction rule was also evaluated.

Results
The postoperative mortality rate was 5·6 per cent overall (46 deaths in 820 patients). Postoperative mortality risk was significantly associated with older age (P = 0·03), higher serum creatinine level (P = 0·002) and lower forced expiratory volume in 1 s (FEV1) (P = 0·003) in univariate analyses. Evidence of a relationship between age and postoperative death was weakened (P = 0·08) after adjustment for creatinine level and FEV1. The predicted postoperative mortality risk ranged from 2·7 per cent in younger patients with below average creatinine levels and above average FEV1, to 7·8 per cent in older patients with above average creatinine levels and below average FEV1. The published clinical prediction rule did not validate well on these data; observed risk did not correlate with predicted risk except for a small group of high-risk patients.

Conclusion
Poor preoperative lung and renal function was strongly associated with postoperative death. Age was less important once these two important prognostic factors had been taken into account. The potential for preoperative improvement in lung and renal function to reduce postoperative mortality rates should be addressed in future studies.
Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery
Authors: Motomura K , Inaji H , Komoike Y , Kasugai T , Nagumo S , Noguchi S , Koyama H 
Published: March 2003

Abstract

Background
The purpose of the present study was to evaluate the usefulness of intraoperative imprint cytology and frozen sectioning of sentinel lymph nodes in patients with clinically node-negative breast cancer.

Methods
Sentinel node biopsy was performed in 101 patients with stage I or II breast cancer with clinically negative nodes using a dye-guided method. Intraoperative evaluation of sentinel node involvement by imprint cytology and frozen sectioning was compared with the final histopathological results of permanent sections. Tumour-negative nodes in paraffin sections stained by haematoxylin and eosin were further studied using an anticytokeratin antibody.

Results
The results of imprint cytology and frozen-section analysis were compared with those of haematoxylin and eosin-stained sections. The sensitivity, specificity and overall accuracy of imprint cytology were 96·0, 90·8 and 92·1 per cent respectively, and those of frozen-section examination were 52·0, 100 and 88·1 per cent. Ten sentinel nodes were tumour positive on imprint cytology and tumour negative on stained paraffin sections. Micrometastasis was found in eight of these nodes on immunohistochemistry. Taking these immunohistological results into consideration, the final sensitivity, specificity and overall accuracy of imprint cytology were 90·9, 98·5 and 96·0 per cent respectively.

Conclusion
Intraoperative imprint cytology is a useful method for evaluating the status of sentinel nodes and is more accurate than frozen-section analysis. In addition, imprint cytology can detect micrometastasis more accurately than conventional haematoxylin and eosin-stained sectioning.
Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology
Authors: Daltrey I R , Kissin M W 
Published: March 2003

Abstract

Background
Breast fine-needle aspiration cytology (FNAC) is an invasive investigation which can be uncomfortable or distressing. This randomized study investigated the discomfort of breast FNAC and the effect of different techniques.

Methods
Some 116 FNAC samples were taken from 98 women with a palpable breast mass. Each patient was randomized to one of four study groups; aspiration was performed using a green-hub (21 G) or blue-hub (23 G) needle, either with or without local anaesthetic. Each patient scored the pain of the whole procedure using a visual analogue scale.

Results
A green-hub needle caused significantly more discomfort (mean(s.e.m.) pain score 5·1(0·4) cm) than a blue-hub needle (2·9(0·4) cm), or either a blue- or green-hub needle with local anaesthetic (3·0(0·4) and 2·1(0·4) cm respectively) (F = 10·28, 3112 d.f., P &lt; 0·01, analysis of variance).

Conclusion
The discomfort of breast FNAC is dependent upon the gauge of the needle and the use of local anaesthetic. A blue-hub needle without local anaesthetic should be first choice for breast FNAC.
Intraoperative scrape cytology of the sentinel lymph node in patients with breast cancer
Authors: Smidt M L , Besseling R , Wauters C A P , Strobbe L J A 
Published: March 2003

AbstractBackgroundIntraoperative examination of the sentinel lymph node (SLN) may detect metastatic disease, allowing immediate axillary lymph node dissection and therefore avoiding the need for reoperation. The aim of this study was to evaluate the accuracy of scrape cytology of the SLN in patients with early breast cancer.MethodsSentinel node biopsy was performed in 148 patients with clinical T1–2 N0 breast cancer. After harvesting, the SLN was bisected and cells from both halves were scraped with a scalpel blade on to a slide and stained with a Papanicolaou and Giemsa stain. Scrape cytology results were compared with the results of paraffin sections stained with haematoxylin and eosin and with immunohistochemistry.ResultsThe intraoperative diagnosis was correct in 126 patients (85 per cent). Sensitivity and specificity were 67 and 98 per cent respectively; positive and negative predictive values were 95 and 81 per cent.ConclusionScrape cytology is a useful method for intraoperative evaluation of the SLN in patients with breast cancer.
Effects of 5‐fluorouracil on cell cycle arrest and toxicity induced by X‐irradiation in normal mammalian cells
Authors: Nylén U. , Cekan E. , Jonasson G.‐B. , Lewin F. , Skog S. 
Published: March 2003

Abstract.From clinical studies in cancer patients and experimental in vitro studies, there is evidence of an increased cytotoxic effect, and even synergy, when irradiation is combined with 5‐fluorouracil (5‐FU). The mechanism for this is unclear.Materials and Methods:Mouse fetuses (C3H) have been exposed in vivo to X‐irradiation and 5‐fluorouracil (5‐FU) as single agents or in combination. Cell proliferation, cell cycle progression, fetal survival and incidence of fetal malformations have been studied.Purpose:The aim of this study was to determine possible synergistic cytotoxic effects when 5‐FU and ionizing radiation were combined, particularly concerning the regulation of cell cycle progression in proliferating, non malignant mammalian cells in vivo.Results:The combination of low‐toxic doses of X‐irradiation and 5‐FU had a synergistic toxic effect in nonmalignant mouse fetuses in vivo. The cell cycle regulation was perturbed and the radiation‐induced G2‐arrest was eradicated by 5‐FU during the initial hours.Conclusions:The time for repair of radiation induced DNA‐damage is probably reduced, which may explain the increased toxicity of this combination.
Lipid peroxide‐induced redox imbalance differentially mediates CaCo‐2 cell proliferation and growth arrest
Authors: Gotoh Yudai , Noda Takahiro , Iwakiri Ryuichi , Fujimoto Kazuma , Rhoads Carol A. , Aw Tak Yee 
Published: March 2003

Abstract. Dietary oxidants like lipid hydroperoxides (LOOH) can perturb cellular glutathione/glutathione disulphide (GSH/GSSG) status and disrupt mucosal turnover. This study examines the effect of LOOH on GSH/GSSG balance and phase transitions in the human colon cancer CaCo‐2 cell. LOOH at 1 or 5 µm were noncytotoxic, but disrupted cellular GSH/GSSG and stimulated proliferative activity at 6 h that paralleled increases in ornithine decarboxylase activity, thymidine incorporation, expression of cyclin D1/cyclin‐dependent kinase 4, phosphorylation of retinoblastoma protein, and cell progression from G0/G1 to S. At 24 h, LOOH‐induced sustained GSH/GSSG imbalance mediated growth arrest at G0/G1 that correlated with suppression of proliferative activity and enhanced oxidative DNA damage. LOOH‐induced cell transitions were effectively blocked by N‐acetylcysteine. Collectively, the study shows that subtoxic LOOH levels induce CaCo‐2 GSH/GSSG imbalance that elicits time‐dependent cell proliferation followed by growth arrest. These results provide insights into the mechanism of hydroperoxide‐induced disruption of mucosal turnover with implications for understanding oxidant‐mediated genesis of gut pathology.
The rate of apoptosis in post mitotic neutrophil precursors of normal and neutropenic humans
Authors: Mackey M. C. , Aprikyan A. A. G. , Dale D. C. 
Published: March 2003

Abstract. Using data on the fraction of post‐mitotic neutrophil precursors (CD15+ cells) displaying positive markers for apoptosis in 12 normal humans, and a simple mathematical model, we have estimated the apoptotic rate to be about 0.28/day in this compartment. This implies that the influx of myelocytes into the post‐mitotic compartment exceeds twice the granulocyte turnover rate (GTR), and that about 55% of the cells entering this compartment die before being released into the blood. The normal half life of apoptotic post‐mitotic neutrophil precursors is calculated to be 10.4 h. Comparable calculations for patients indicate apoptosis rates in the post‐mitotic compartment of about 17 times normal for one myelokathexis patient and rates of about 13 times normal for the one cyclical neutropenic patient and two severe congenital neutropenic patients. The estimated half life for apoptotic post‐mitotic neutrophil precursors in the myelokathexis patient was about 0.4 h, 1.4 h in the cyclical neutropenia patient, and about 0.6 h in the severe congenital neutropenic patients.
Response to: ‘New Directions in child protection and family support in Western Australia: a policy initiative to re‐focus child welfare practice’
Authors: McCallum Sharon , Eades Di 
Published: March 2003

ABSTRACTThis paper is a response to ‘New Directions in child protection and family support in Western Australia: a policy initiative to re‐focus child welfare practice’, written by Nigel Parton and Richard Mathews and published in Volume 6(2) of Child and Family Social Work. Parton and Mathews’ paper describes the policy and provides an analysis of its impact on child protection practice. They find the policy to have been successful on a number of different dimensions. This paper subjects their findings to a broader lens of analysis and arrives at conclusions somewhat different to those of the authors.
Research with children: sharing the dilemmas
Authors: Cree Viviene E. , Kay Helen , Tisdall Kay 
Published: March 2003

ABSTRACTThis paper identifies a number of significant gaps between the principles of good practice in research with children and the practical realities of conducting a research project with children. The context of the discussion is an ongoing research study of children and young people in Scotland with a parent or carer with HIV. The paper argues that conducting research with what is a hidden (and in many ways secret) population throws into sharp relief some difficulties and contradictions that are at the heart of the research process. The paper does not intend to present easy answers to the complex questions that it raises: the research project it describes is ongoing and not yet at the stage of disseminating findings in any definitive way. Moreover, it seems likely that there are no answers to the questions raised, but that the act of posing the questions may contribute to the development of better, more reflexive research with children.