bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conservative management of follicular non‐Hodgkin's lymphoma in childhood
Authors: Atra  , Meller  , Stevens  , Hobson  , Grundy  , Carter  , Pinkerton  
Published: March 2003

Among 447 children with non‐Hodgkin's lymphoma (NHL) on the childhood U.K. registry, seven children with follicular (NHL) were identified. Four were male and their age ranged from 4.25 to 13.5 years (median 7.5); all had localized disease, Murphy's stage I (n = 4) and II (n = 3). Sites involved at presentation were cervical lymph nodes and tonsils (n = 5), ileum (n = 1) and parotid gland (n = 1). Three had complete surgical excision only and four had complete (n = 1) or incomplete excision (n = 3) followed by a short multi‐agent chemotherapy regimen (UKCCSG 9001 protocol). With a median follow‐up of 1.5 years (range 0.25–5 years) from diagnosis, six are alive in complete remission (CR) including three who had no chemotherapy.These results confirm previous reports that follicular lymphomas in children are rare (1.5%) and tend to be localized at presentation. Their rarity makes it difficult to produce guidelines about treatment, but in localized cases a period of non‐intervention may be justified.
Delayed haemolytic transfusion reaction due to anti‐M antibody
Authors: Sancho Juan Manuel , Pujol Misericordia , FernÁndez Francesc , Soler Manuel , Manzano Pedro , Feliu Evarist 
Published: March 2003

A female patient with delayed haemolytic transfusion reaction due to anti‐M antibody is described. Diagnosis was based on laboratory evidence of haemolysis and on characteristic serological findings. Anti‐M was detected in the recipient's serum 7 d after the last transfusion episode. This alloantibody had not been present in the pretransfusion serum. In addition, the direct antiglobulin test was positive on post‐transfusion testing and the implicated antibody was eluted from post‐transfused red cells.Delayed haemolytic transfusion reactions have long been recognized as a potencial hazard of transfusion therapy, but such cases due to anti‐M are extremely rare.
Early haemorrhagic morbidity and mortality during remission induction with or without all‐trans retinoic acid in acute promyelocytic leukaemia
Authors: Di Bona Eros , Avvisati Giuseppe , Castaman Giancarlo , Luce Vegna Maria , De Sanctis Vitaliana , Rodeghiero Francesco , Mandelli Franco ,   for the Gruppo Italiano per le Malattie Ematologiche dell'Adulto
Published: March 2003

A total of 622 consecutive patients with acute promyelocytic leukaemia (APL) treated within the Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA) group during 1989–97 have been reviewed to assess the clinical effectiveness of all‐trans retinoic acid (ATRA) on the incidence of early haemorrhagic deaths and on APL‐associated coagulopathy. Of them, 499 were treated with idarubicin plus ATRA (study A) and 123 with Idarubicin alone (study B). In both studies, similar guidelines for supportive treatment were used. Haemorrhagic symptoms were evaluated according to a reproducible score system. Deaths occurring within 10 d of starting treatment were 19 (3.8%) in study A and nine (7.3%) in study B (P = 0.09), with 15 (3%) and five (4.1%) (P not significant) due to haemorrhage. Overall, induction mortality was 7.6% and 16.2% respectively (P < 0.003). In study A, days with platelet counts ≤ 20 × 109/l or with fibrinogen ≤ 1 g/L were reduced by about 30%, the haemorrhagic score by 50% and the consumption of blood products by about 40%, and fewer patients were treated with antihaemorrhagic drugs (39% vs. 61%; P < 0.001). On multivariate analysis, early deaths were influenced by blast count at diagnosis > 30 × 109/l (P < 0.001) in both studies, and by a haemorrhagic score of 3 in study A (P < 0.001).Although the reduction of early fatal haemorrhages was not significant, a substantial clinical improvement was evident in terms of reduction of the severity of bleeding symptoms, blood product consumption and overall induction mortality when ATRA was combined with idarubicin.
Ex vivo generation of human cytomegalovirus‐specific cytotoxic T cells by peptide‐pulsed dendritic cells
Authors: Kleihauer Annette , Grigoleit Ulrich , Hebart Holger , Moris Arnaud , Brossart Peter , Muhm Alexandra , Stevanovic Stefan , Rammensee Hans Georg , Sinzger Christian , Riegler Susanne , Jahn Gerhard , Kanz Lothar , Einsele Hermann 
Published: March 2003

Adoptive transfer of donor‐derived human cytomegalovirus (HCMV)‐specific T‐cell clones can restore protective immunity after stem cell transplantation. Ex vivo induction of HCMV‐specific T cells using HCMV‐infected fibroblasts as stimulator cells confines this approach to HCMV‐seropositive donors and requires the presence of infectious virus during the stimulation procedure. In this study, we describe a potential alternative strategy to generate HCMV‐specific T cells ex vivo for adoptive immunotherapy. Generation of HCMV‐specific cytotoxic T lymphocytes (CTLs) ex vivo was investigated using peptide‐pulsed dendritic cells as antigen‐presenting cells. HCMV‐specific T cells were generated and sufficiently expanded for adoptive immunotherapy in 6 out of 14 HCMV‐seropositive and 2 out of 11 HCMV‐seronegative donors. The CTLs recognized HCMV‐infected autologous fibroblasts. No lysis was observed with either non‐infected autologous or HLA‐mismatched infected fibroblasts. Staining with tetrameric HLA/peptide complexes revealed significant enrichment for peptide‐specific T cells of up to 28% and > 90% of CD8+ T cells after three and five specific stimulations respectively. In addition, the expansion rates indicated that ex vivo generation of > 1 × 109 HCMV‐specific T cells was possible after 6–7 weeks when cultures were initiated with 1–5 × 106 responder cells. Thus, the approach with peptide‐pulsed DCs to generate HCMV‐specific CTLs is feasible for clinical application after allogeneic stem cell transplantation.
Accumulation of γ‐globin mRNA and induction of erythroid differentiation after treatment of human leukaemic K562 cells with tallimustine
Authors: Bianchi Nicoletta , Chiarabelli Cristiano , Borgatti Monica , Mischiati Carlo , Fibach Eitan , Gambari Roberto 
Published: March 2003

Human leukaemic K562 cells can be induced in vitro to erythroid differentiation by a variety of chemical compounds, including haemin, butyric acid, 5‐azacytidine, cytosine arabinoside, mithramycin and chromomycin, cisplatin and cisplatin analogues. Differentiation of K562 cells is associated with an increase of expression of embryo‐fetal globin genes, such as the ζ‐, ε‐ and γ‐globin genes. The K562 cell line has been proposed as a very useful in vitro model system to determine the therapeutic potential of new differentiating compounds as well as to study the molecular mechanism(s) regulating changes in the expression of embryonic and fetal human globin genes. Inducers of erythroid differentiation stimulating γ‐globin synthesis could be considered for possible use in the therapy of haematological diseases associated with a failure in the expression of normal β‐globin genes. We have analysed the effects of tallimustine and distamycin on cell growth and differentiation of K562 cells. The results demonstrated that tallimustine is a potent inducer, while distamycin is a weak inducer, of K562 cell erythroid differentiation. Erythroid differentiation was associated with an increase of accumulation of γ‐globin mRNA and of production of both haemoglobin (Hb) Gower 1 and Hb Portland. In addition, tallimustine‐mediated erythroid induction occurred in the presence of activation of the apoptotic pathway. The reasons for proposing tallimustine as an inducer of γ‐globin gene expression are strongly sustained by the finding that this compound stimulates fetal haemoglobin production in human erythroid precursor cells from normal subjects.
Internal jugular vein thrombosis after assisted conception therapy
Authors: Arya Roopen , Shehata Hassan A. , Patel Raj. K. , Sahu Satyajit , Rajasingam Daghni , Harrington Kevin F. , Nelson‐Piercy Catherine , Parsons John H. 
Published: March 2003

Superovulation therapy during assisted conception may result in a hypercoagulable state. Five cases of upper extremity venous thrombosis were identified in women who conceived after ovarian stimulation for in vitro fertilization (IVF). They presented between 7 and 10 weeks' gestation with neck pain and swelling. Three had been treated for ovarian hyperstimulation syndrome and two had evidence of inherited thrombophilia. Four patients received thromboprophylaxis before presentation. Although thrombosis is an uncommon complication of IVF, patients should be counselled before treatment. Thrombophilia screening may be considered for ‘high‐risk’ patients, although current regimes for thromboprophylaxis remain suboptimal.
Histone deacetylase inhibitors induce caspase‐dependent apoptosis and downregulation of daxx in acute promyelocytic leukaemia with t(15;17)
Authors: Amin Hesham M. , Saeed Shahnaz , Alkan Serhan 
Published: March 2003

Histone deacetylase (HDAC) appears to play an important role in the pathogenesis of acute promyelocytic leukaemia (APL) as it is recruited by both PML–RARα and PLZF/RARα in leukaemic cells with t(15;17) and t(11;17) respectively. Recent studies have demonstrated that HDAC inhibitors can be therapeutically used in various neoplastic disorders including APL. Cell differentiation was considered the major mechanism of the anti‐leukaemic effects of HDAC inhibitors in APL. However, most of these studies either evaluated the effect of HDAC inhibitors in combination with all‐trans retinoic acid (ATRA) or focused on the less common form of APL with t(11;17). To investigate the cellular effects of HDAC inhibitors, including sodium butyrate, trichostatin A, and suberoylanilide hydroxamic acid (SAHA), we used two APL cell lines, NB4 and the ATRA‐resistant derivative NB4.306. Moreover, primary cells from five patients with cytogenetic evidence for t(15;17) were also studied. Our results demonstrated that HDAC inhibitors induce distinct caspase‐dependent apoptosis in APL, which showed both concentration‐and time‐dependence. In addition, changes in the apoptosis‐regulatory proteins, daxx, bcl‐2 and bax were analysed. HDAC inhibitors induced downregulation of daxx, but no significant changes were detected in bcl‐2 or bax. In conclusion, apoptosis induced by HDAC inhibitors in APL could provide an effective strategy for treatment of patients with t(15;17).
Factor XIII activity levels in patients with allogeneic haematopoietic stem cell transplantation and acute graft‐versus‐host disease of the gut
Authors: Pihusch Rudolf , Salat Christoph , Göhring Peter , Hentrich Markus , Wegner Holger , Pihusch Markus , Hiller Erhard , Kolb Hans‐Jochem , Ostermann Helmut 
Published: March 2003

Summary. Severe graft‐versus‐host disease (GvHD) of the gut clinically resembles Crohn's disease and ulcerative colitis. As low plasma levels of factor XIII (FXIII) have been described in chronic inflammatory bowel disease (CIBD) and as beneficial effects of FXIII concentrates in CIBD have been reported, we studied the FXIII plasma activity levels in patients undergoing allogeneic stem cell transplantation (SCT). In 20 of 22 patients with an uncomplicated course of SCT, FXIII stayed within the normal range (median 102	iu/dl, range 74–122), but was significantly reduced with the lowest FXIII levels on d 0 and 7 (d 0: median 83 iu/dl, range 55–165, d 7: median 83, range 70–101). In 20 of 22 patients with histologically proven GvHD of the gut, FXIII levels far below the normal range were observed (median 50, range 21–87) with a strong correlation between FXIII activity levels and degree of GvHD (r = −0·908; P < 0·001). We conclude that FXIII is consumed in patients with GvHD of the gut. As FXIII plays a a crucial role in haemostasis and wound healing, a study on the potential benefit of FXIII substitution in patients with severe GvHD of the gut might be rewarding.
Pattern of lymph node metastases in papillary thyroid carcinoma
Authors: Gimm O , Rath F W , Dralle H 
Published: March 2003

Abstract

Background
Incidence and pattern of lymph node metastasis (LNM) were evaluated in 35 patients who underwent primary surgery for papillary thyroid carcinoma.

Methods
Total thyroidectomy with systematic cervicocentral lymphadenectomy was performed routinely. Additionally, 22 patients underwent lymphadenectomy of the ipsilateral cervicolateral compartment. Sternotomy was performed in four patients.

Results
Primary tumour status was: pT1, n = 7; pT2, n = 12; pT3, n = 4; pT4, n = 12. Twenty-four patients had LNM in the ipsilateral cervicocentral compartment (pT1, n = 2; pT2, n = 8; pT3, n = 4; pT4, n = 10). Nineteen had LNM in the ipsilateral cervicolateral compartment (pT1, n = 4; pT2, n = 6; pT3, n = 2; pT4, n = 7). Contralateral cervicocentral LNM was restricted to patients with pT3 tumours (n = 2) or pT4 tumours (n = 3). No patient had LNM in the contralateral cervicolateral compartment. Only one patient (pT3 tumour) had mediastinal LNM.

Conclusion
The cervicocentral compartment was most commonly involved with metastases, although the ipsilateral cervicolateral compartment was almost as often affected. In some patients ipsilateral cervicolateral LNM was present in the absence of cervicocentral LNM. Contralateral cervicolateral and upper mediastinal LNM, however, were rare. This study helps to plan radical surgery for papillary thyroid carcinoma.
Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch–anal anastomosis
Authors: Dehni N , Schlegel R D , Cunningham C , Guiguet M , Tiret E , Parc R 
Published: March 2003

Abstract

Background
Anal sphincter function is increasingly preserved following rectal excision for cancer and provides a better quality of life for patients than does a permanent colostomy. However, anastomotic complications may cause considerable morbidity and mortality. This retrospective study examined the incidence of anastomotic complications following two forms of reconstruction after resection for mid-rectal cancer: colonic pouch–anal anastomosis (CPAA) and low colorectal anastomosis (LCRA).

Methods
Some 258 consecutive patients with mid-rectal cancers between 6 and 11 cm from the anal verge underwent proctectomy with mesorectal excision and either CPAA or LCRA. The incidence of clinical and radiological leaks was determined in these patients who were considered in three groups: LCRA (defunctioning stoma), LCRA (no defunctioning stoma) and CPAA (all defunctioned).

Results
In the LCRA group without a defunctioning stoma, a clinical leak occurred in 17·0 per cent, compared with two of 30 in the LCRA group with a defunctioning stoma. In the CPAA group a clinical leak occurred in 4·9 per cent of patients, which was not significantly different from the rate in those with a defunctioned LCRA. Patients with a non-defunctioned LCRA were more likely to suffer a clinical anastomotic leak (P=0·01), peritonitis (P=0·001) and require unscheduled reoperation (P=0·006) than those with a defunctioned LCRA and/or CPAA.

Conclusion
The use of a protective defunctioning stoma is advocated in conjunction with LCRAs.
POSSUM and Portsmouth POSSUM for predicting mortality
Authors: Prytherch D R , Whiteley M S , Higgins B , Weaver P C , Prout W G , Powell S J 
Published: March 2003

Abstract

Background
There is a need for an accurate measure of surgical outcomes so that hospitals and surgeons can be compared properly regardless of case mix. POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) uses a physiological score and an operative severity score to calculate risks of mortality and morbidity. In a previous small study it was found that Portsmouth POSSUM (P-POSSUM; a modification of the POSSUM system) provided a more accurate prediction of mortality.

Methods
Some 10 000 general surgical interventions (excluding paediatric and day cases) were studied prospectively between August 1993 and November 1995. The POSSUM mortality equation was applied to the full 10 000 surgical episodes. The 10 000 patients were arranged in chronological order and the first 2500 were used as a training set to produce the modified P-POSSUM predictor equation. This was then applied prospectively to the remaining 7500 patients arranged chronologically in five groups of 1500.

Results
The original POSSUM logistic regression equation for mortality overpredicts the overall risk of death by more than twofold and the risk of death for patients at lowest risk (5 per cent or less) by more than sevenfold. The P-POSSUM equation produced a very close fit with the observed in-hospital mortality.

Conclusion
P-POSSUM provides an accurate method for comparative surgical audit.
Postoperative intussusception in children
Authors: de Vries S , Sleeboom C , Aronson D C 
Published: March 2003

Abstract

Background
Postoperative intussusception is an uncommon and sometimes forgotten cause of postoperative intestinal obstruction in children.

Methods
Eleven consecutive cases of postoperative intussusception during a period of 16 years (1981–1997) were analysed retrospectively.

Results
Symptoms developed after a median period of 5 days after operation. With one exception, postoperative intussusception was not diagnosed before reoperation. In ten of the 11 cases the intussusception was successfully treated with intraoperative manual reduction.

Conclusion
Postoperative intussusception is a rare but typical complication in the paediatric age group and should be kept in mind.
Cytolysis following chemoembolization for hepatocellular carcinoma
Authors: Paye F , Farges O , Dahmane M , Vilgrain V , Flejou J F , Belghiti J 
Published: March 2003

Abstract

Background
Lipiodolized chemoembolization of hepatocellular carcinoma (HCC) can induce fever and cytolysis, defined as an increase in serum levels of liver transaminases, which is frequently assumed to result from tumour necrosis. This study aimed to assess the causes of this syndrome, reviewing preoperative data, intraoperative findings, tumour necrosis and the status of non-tumorous liver.

Methods
A retrospective study was undertaken of 29 patients treated by neoadjuvant lipiodolized chemoembolization before surgical resection of HCC. Tumour necrosis was assessed in the resected specimen and scored in four stages: absent, 50 per cent or less, more than 50 per cent, and complete. The status of non-tumorous liver parenchyma was classified as either fibrotic or cirrhotic.

Results
Cytolysis occurred following chemoembolization in 16 patients and was associated with fever in 11. Postchemoembolization cytolysis with or without fever was more likely to develop in patients with minor fibrotic changes than in those with cirrhosis (14 of 21 with fibrosis versus two of four with cirrhosis, P &lt; 0·05). In contrast, the extent of tumour necrosis did not correlate with the occurrence of symptoms.

Conclusion
These results suggest that fever and cytolysis following chemoembolization of HCC are an indication not of tumour necrosis but of injury to the non-tumorous liver.
Immunoglobulin A antibodies against Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysm
Authors: Lindholt J S , Juul S , Vammen S , Lind I , Fasting H , Henneberg E W 
Published: March 2003

Abstract

Background
The aim of this study was to examine the possible association between the progression of small abdominal aortic aneurysm (AAA) and chronic infection with Chlamydia pneumoniae.

Methods
Patients from a hospital-based mass screening programme for AAA with annual follow-up (mean 2·7 years) were included. After initial interview, 139 men aged 65–73 years with a small AAA underwent examination and blood sampling. Immunoglobulin (Ig) G and IgA titres against C. pneumoniae were measured by a microimmunofluorescence test.

Results
Some 83 (95 per cent confidence interval 74–93) per cent of the men had an IgA titre of 20 or more, or an IgG titre of 32 or more. Men with an IgA titre of 20 or more had a 48 per cent higher AAA expansion rate than those with a titre of less than 20 (3·1 versus 2·1 mm/year; P&lt; 0·05). Multiple linear and logistic regression analyses showed that an IgA titre of 20 or more was a significant independent predictor of increased AAA expansion, adjusted for known risk factors of expansion. Initial AAA size and serum total cholesterol level were also predictors of expansion.

Conclusion
A high proportion of men with a small AAA had signs of chronic infection with C. pneumoniae. Aneurysm progression correlated with evidence of chronic C. pneumoniae infection.
Role of superficial venous surgery in the treatment of venous ulceration
Authors: Bello M , Scriven M , Hartshorne T , Bell P R F , Naylor A R , London N J M 
Published: March 2003

Abstract

Background
The aim of this study was to determine the ability of superficial venous surgery to heal venous ulcers in lower legs with isolated superficial venous incompetence.

Methods
This was a prospective study of patients recruited from a venous ulcer assessment clinic. Ulcers were considered venous if the ankle: brachial pressure index was greater than 0·8 and duplex imaging showed venous reflux. Patients with isolated superficial venous incompetence were offered saphenofemoral and/or saphenopopliteal surgery. Neither perforator surgery, skin grafting nor postoperative compression hosiery or bandaging was used.

Results
A total of 122 legs with normal deep veins underwent superficial venous surgery. Ninety procedures (74 per cent) were done under local and 32 (26 per cent) under general anaesthesia. Sixty operations (49 per cent) were done as a day case. The median time to healing was 18 (95 per cent confidence interval 14–21) weeks and the cumulative 6-, 12- and 18-month healing rates were 57, 74 and 82 per cent respectively.

Conclusion
In patients with venous ulceration and isolated superficial venous incompetence, superficial venous surgery can produce ulcer healing in the majority of patients without the need for perforator surgery, postoperative compression bandaging or skin grafting.
Popliteal artery entrapment syndrome
Authors: Lambert A W , Wilkins D C 
Published: March 2003

Abstract

Background
Popliteal artery entrapment syndrome (PAES) is rare and may be underdiagnosed. Improved specialized, non-invasive imaging techniques are producing detailed topographical evidence of the anomaly.

Methods
A historical review of the literature and Medline search was performed with reference to the diagnosis and treatment of the condition. In addition, embryologically based theories for the condition have been postulated.

Results and conclusion
PAES may be the result of abnormal development of the popliteal artery or a consequence of excessive cranial migration of the medial head of the gastrocnemius muscle. Magnetic resonance imaging appears to be the most useful single investigation to demonstrate the anomaly. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated.