bluuebunny/crossref_metadata_2025_split huggingface dataset:
Somatostatin receptor scintigraphy useful in stage I–II Hodgkin's disease: more extended disease identified
Authors: Lugtenburg P. J. , Krenning E. P. , Valkema R. , Oei H. Y. , Lamberts S. W. J. , Eijkemans M. J. C. , Van Putten W. L. J. , Löwenberg B. 
Published: March 2003

Somatostatin receptor (SS‐R) scintigraphy successfully shows primary cancers and metastases in patients with a variety of SS‐R‐positive tumours. In vitro studies have shown that SS‐Rs are present in lymph nodes from patients with Hodgkin's disease (HD). We performed a prospective study in 126 newly diagnosed patients with HD and compared the results of SS‐R scintigraphy with conventional staging procedures, i.e. physical examination, computerized tomography (CT) scanning and other imaging techniques. We report positive scintigraphy in all patients. The lesion‐related sensitivity was 94% and varied from 98% for supradiaphragmatic lesions to 67% for infradiaphragmatic lesions. In comparison with CT scanning and ultrasonography, SS‐R scintigraphy provided superior results for the detection of Hodgkin's localizations above the diaphragm. In the intra‐abdominal region, the CT scan was more sensitive than the SS‐R scan. A false‐positive scan was rarely seen. In stages I and II supradiaphragmatic HD patients, SS‐R scintigraphy detected more advanced disease in 18% (15 out of 83) of patients, resulting in an upstaging to stage III or IV, thus directly influencing patient management. Our data would support the validity of SS‐R scanning as a powerful imaging technique for the staging of patients with HD.
X‐linked cerebellar ataxia and sideroblastic anaemia associated with a missense mutation in the ABC7 gene predicting V411L
Authors: Maguire Andrew , Hellier Kate , Hammans Simon , May Alison 
Published: March 2003

Two brothers with X‐linked ataxia (XLA) were found to have hypochromic red cells and increased erythrocyte protoporphyrin despite normal iron stores. The mother was unaffected by ataxia and had normal iron stores but showed evidence of some red cell hypochromia with heavy basophilic stippling that stained positive for iron. Bone marrow biopsy confirmed the presence of ring sideroblasts in one of the brothers. The absence of mutations in the ALAS2 gene and the predominance of zinc over free protoporphyrin led to a search using a combination of DNA and cDNA analysis for the presence of mutations in the ABC7 gene. ABC7 encodes a mitochondrial half‐type ATP Binding Cassette transporter involved in iron homeostasis. The published cDNA sequence was used to search databases for the genomic sequence of which 12 exons spanning 23·4 kb were mapped leaving the most 5′ nucleotides unaccounted for. The identified exons and their exon–intron boundaries were amplified from DNA while the most 5′ sequence including the initiation codon was amplified from cDNA of peripheral blood cells. Direct sequencing revealed hemizygosity in the brothers and heterozygosity in the mother for a G→C transversion at position 1299 of the published cDNA. This predicts a V411L substitution at the beginning of the last of six putative transmembrane regions of the protein. Restriction enzyme digestion confirmed the presence of this mutation in the three family members but could not detect it in 200 normal alleles. An uncle affected by ataxia also carried this mutation. This study supports the recently hypothesized involvement of the ABC7 gene in XLSA/A and highlights a protein structure region of importance to this syndrome.
High expression of the chemokine receptor CXCR4 predicts extramedullary organ infiltration in childhood acute lymphoblastic leukaemia
Authors: Crazzolara Roman , Kreczy Alfons , Mann Georg , Heitger Andreas , Eibl Günther , Fink Franz‐Martin , Möhle Robert , Meister Bernhard 
Published: March 2003

Childhood acute lymphoblastic leukaemia (ALL) is a malignancy with the potential to infiltrate the liver, spleen, lymph nodes and brain. Such extramedullary presentation is important for understanding the biology of childhood ALL and also for developing new prognostic parameters. A potential mechanism in the trafficking of leukaemia cells is the interaction of the chemokine receptor CXCR4, which is expressed on ALL cells, and its ligand stromal cell‐derived factor‐1 (SDF‐1), produced by stromal cells in bone marrow and extramedullary organs. Functionality of CXCR4 was demonstrated by a high correlation between cell surface density of CXCR4 and transendothelial migration of leukaemia blasts towards a gradient of SDF‐1 (r = 0·73, P = 0·001). Inhibition of SDF‐1‐induced migration by an anti‐CXCR4 monoclonal antibody (78·33 ± 23·86% inhibition) evidenced the specificity of CXCR4 to SDF‐1. In order to evaluate clinical significance of CXCR4 expression, lymphoblasts from the bone marrow of 73 patients with and without extramedullary organ infiltration were compared. Multiparameter flow cytometry revealed that lymphoblasts from patients with high extramedullary organ infiltration, defined as ultrasonographically measured enlargement of liver or spleen, expressed the CXCR4 receptor at higher fluorescence intensity (median 66·12 ± 66·17) than patients without extramedullary organ infiltration (median 17·56 ± 19·29; P < 0·001). Consequently, high expression of CXCR4 was strongly predictive for extramedullary organ involvement, independently of the peripheral lymphoblast count. Highest CXCR4 expression was seen in mature B ALL (median 102·74 ± 92·13; P < 0·003), a disease characterized by a high incidence of extramedullary bulky disease. As high expression of the chemokine receptor CXCR4 predicts extramedullary organ infiltration in childhood ALL, we suggest that CXCR4 and its ligand play an essential role in extramedullary invasion.
Novel approach to the treatment of intestinal fistula in the inaccessible abdomen: transbursal end-to-side duodenogastrostomy
Authors: Bosscha K , van Vroonhoven Th J M V 
Published: March 2003

Abstract

Background
Treatment of enterocutaneous fistula in patients with intra-abdominal sepsis and a surgically inaccessible abdomen is frequently unsuccessful.

Methods
A new approach has been devised: total disconnection of the proximal digestive tract, which can be performed through the bursa omentalis without entering the scarred abdomen.

Results
The procedure was carried out in four patients with high-output small bowel fistula and an inaccessible abdomen. Output of fistulas stopped promptly, recovery from intra-abdominal sepsis was achieved, the abdomens became accessible again and continuity of the digestive tract could be restored in all patients after intervals of 2–5·5 months.

Conclusion
Transbursal end-to-side duodenogastrostomy is a useful procedure when traditional surgical interventions have failed or cannot be applied.
Laparoscopic stoma formation for faecal diversion
Authors: Hollyoak M A , Lumley J , Stitz R W 
Published: March 2003

Abstract

Background
Laparoscopic creation of an intestinal stoma may be preferable to open operation when intervention is required solely for faecal diversion.

Methods
Experience with laparoscopic intestinal stoma formation for faecal diversion from a single institution is presented.

Results
A total of 55 stomas were studied, 40 laparoscopic and 15 open. The conversion rate from laparoscopic to open operation was 5 per cent. Mean(s.e.m.) operating time was significantly reduced for laparoscopic stomas (54(4·7) versus 72(8·7) min). Time to return of bowel function was significantly reduced (1·6(0·3) versus 2·2(0·2) days). Mean(s.e.m.) hospital stay was significantly reduced in the laparoscopic group (7·4(0·5) versus 12·6(2·5) days).

Conclusion
Morbidity and mortality appeared to be reduced in patients undergoing laparoscopic stoma formation. The technique was found to be safe, suitable for the majority of patients and to give results superior to those of open surgery.
Flap advancement and core fistulectomy for complex rectal fistula
Authors: Miller G V , Finan P J 
Published: March 2003

Abstract

Background
The treatment of low fistula in ano is well accepted but controversy surrounds the management of high trans-sphincteric fistulas and more complex fistulas. This study assesses the clinical results of advancement flap techniques in association with core fistulectomy for complex fistula in ano.

Methods
A retrospective analysis of the use of advancement flap techniques together with core fistulectomy in 25 patients (26 fistulas) was performed. Clinical outcome was assessed in terms of fistula healing, continence, failure and technical problems.

Results
Successful healing of 20 of the 26 complex fistulas was achieved using this technique with no disturbance of continence and minimal (technical) complications.

Conclusion
Flap advancement and core fistulectomy is a safe, effective procedure for complex rectal fistulas with good functional results and minimal or no disturbance of continence, and should be considered for the treatment of complex perianal fistulas.
Expression of c-myc oncoprotein represents a new prognostic marker in cutaneous melanoma
Authors: Ross D A , Wilson G D 
Published: March 2003

Abstract

Background
Overexpression of the c-myc oncoprotein has been observed to be of prognostic significance in several human cancers. This study was undertaken to establish whether c-myc has any prognostic significance in melanoma.

Methods
Expression of c-myc oncoprotein was studied in a prospective series of primary and secondary malignant melanomas. Ethanol-fixed tissue was digested into nuclei and stained for flow cytometric analysis using a pan-myc antibody.

Results
Overexpression of the c-myc oncoprotein was prevalent in both disease stages. In primary disease, overexpression was associated with tumour thickness and with the presence of ulceration, age and reduced disease-free interval. Of most importance, high expression of c-myc predicted poor outcome in both primary and metastatic disease. In addition, c-myc was able to discriminate prognosis in melanomas uniformly stratified as thick (greater than 3 mm) lesions.

Conclusion
These results indicate an important role for c-myc in melanoma which may lead to better prognostic information and identification of new therapeutic strategies.
Experience with transcranial Doppler monitoring reduces the incidence of particulate embolization during carotid endarterectomy
Authors: Smith J L , Evans D H , Gaunt M E , London N J M , Bell P R F , Naylor A R 
Published: March 2003

Abstract

Background
The aim of this study was to investigate whether the introduction of routine transcranial Doppler (TCD) ultrasonography during carotid endarterectomy reduces the incidence of microembolization by altering operative technique.

Methods
The number and nature of microemboli detected during the first 75 consecutive carotid endarterectomies performed with TCD monitoring during 1992–1993 (group 1) were compared with those in a similar series of 75 consecutive patients undergoing carotid endarterectomy in 1995 (group 2), after substantial experience (210 patients) with TCD monitoring. Emboli were classified as either particulate or gaseous.

Results
In patients with evidence of particulate emboli during the dissection phase of the operation, the total number of particulate emboli fell significantly in patients in group 2 (P = 0·019). Similarly, in patients in whom microembolization was detected on immediate opening of the shunt, the total number of microemboli also fell significantly in group 2 (P = 0·003). Overall, the median (95 per cent confidence interval) number of particulate emboli detected during the entire procedure fell significantly from 21 (16–29) in group 1 to 9 (7–14) in group 2 (P = 0·0008).

Conclusion
TCD monitoring plays an important role in the training and quality control of carotid endarterectomy and helps significantly to reduce the amount of microembolization.
Increased plasma levels of atrial natriuretic peptide and endocrine markers of volume depletion in patients with obstructive jaundice
Authors: Gallardo J M , Padillo J , Martín-Malo A , Miño G , Pera C , Sitges-Serra A 
Published: March 2003

Abstract

Background
Hypovolaemia may cause renal dysfunction in obstructive jaundice. This study investigated whether, in patients with obstructive jaundice: (1) atrial natriuretic peptide (ANP) is increased; (2) fluid-regulating hormones are altered; and (3) biliary drainage improves fluid homoeostasis.

Methods
Forty-three patients with obstructive jaundice were investigated. A renal profile was obtained and levels of ANP, renin, aldosterone and vasopressin were determined. In a subset of 18 patients, studies were repeated 3 days after endoscopic biliary drainage and changes in extracellular volume were measured.

Results
Creatinine clearance was impaired in ten of 30 patients. Patients with obstructive jaundice had higher mean levels of ANP (118 versus 40 pg/ml, P = 0·0001) and aldosterone (156 versus 43 pg/ml, P = 0·0001) than matched controls. Increased renin levels were observed in ten of the 43 patients and were associated with impaired creatinine clearance. After biliary drainage ANP concentration decreased (110 versus 67 pg/ml, P = 0·004) as well as aldosterone level (182 versus 85 pg/ml, P = 0·0002) and the mean extracellular volume increased (20·5 versus23·1 per cent of body-weight, P = 0·001).

Conclusion
Plasma ANP concentration is increased in obstructive jaundice. Endocrine markers of hypovolaemia are activated in obstructive jaundice. After biliary drainage there is an improvement of endocrine and fluid derangements.
Comparison of endoanal magnetic resonance imaging with surgical findings in perirectal sepsis
Authors: Zbar A P , de Souza N M , Puni R , Kmiot W A 
Published: March 2003

Abstract

Background
A small percentage of patients presenting with perirectal sepsis will have complicated or recurrent disease. In these cases, clinical examination may be difficult or unreliable and accurate preoperative imaging may be of value

Methods
A prospective study using a specially designed internal coil for magnetic resonance imaging (MRI) was carried out in ten patients with simple cryptogenic perirectal sepsis and in 11 patients with complex recurrent disease. Fistulas and abscesses were classified independently by a colorectal surgeon unaware of the results of MRI and a radiologist unaware of the operative findings.

Results
In patients with simple perirectal infection, endoanal MRI accurately detected all abscesses and four of five fistulas. In complicated cases (multiple recurrences, sepsis secondary to inflammatory bowel disease or where the fistula track(s) traversed the main sphincter complex), endoanal MRI identified six of seven abscesses with confirmation of abscess site and horseshoe configuration when present in all cases. Surgical and radiological concordance was present in 12 of 14 fistulas with identification by MRI of the internal opening in nine of 12 cases.

Conclusion
Endoanal MRI provides high-resolution images of the relationship of collections and tracks to the levator plate and is recommended in the evaluation of complex or recurrent perirectal sepsis.
Restenting malignant oesophageal strictures
Authors: Lagattolla N R F , Rowe P H , Anderson H , Dunk A A 
Published: March 2003

Abstract

Background
Self-expanding metal stents are used to palliate malignant strictures of the oesophagus. This study was designed to identify the characteristics of patients requiring restenting of malignant oesophageal strictures.

Methods
Fifty-three stents were inserted in 42 patients. Thirty-two patients did not require further stenting (once-stented group). Ten patients received second stents for recurrent oesophageal obstruction (restented group), with one patient requiring restenting a second time. Comparisons were drawn between the once-stented and restented groups with regard to survival, patient, tumour and procedural characteristics.

Results
There were no significant differences with regard to tumour grade, tumour type, involvement of the cardia, procedural difficulties or the need for postprocedural oesophageal dilatation between the two groups. Survival from initial stenting was significantly greater in the restented group (median 24 (range 4–43) weeks) than in the once-stented group (median 9·5 (range 1–84) weeks) (P &lt; 0·05). The mean length of stents used in the once-stented group was significantly greater than that of the initial stents used in the restented group (12 versus 10 cm, P = 0·032).

Conclusion
Inserting a covered stent through a previously inserted uncovered stent is an uncomplicated and well tolerated technique which maintains palliation from obstructing oesophageal carcinoma. The need for restenting cannot be predicted on the basis of tumour characteristics alone.
Management of acute leg ischaemia in the elderly
Authors: Braithwaite B D , Davies B , Birch P A , Heather B P , Earnshaw J J 
Published: March 2003

Abstract

Background
Peripheral thrombolysis is advocated by some as the best initial treatment for acute leg ischaemia, but this may not be true for elderly patients. This study reviewed the management of acute leg ischaemia in patients aged over 75 years.

Methods
Over a 5-year interval, 91 events of acute leg ischaemia in 84 patients were managed in a single district general hospital according to a local protocol. There were 60 women and 24 men of median age 81 (range 75–100) years. Fifteen patients were too elderly and infirm for active treatment and received anticoagulation alone. Some 76 events (84 per cent) occurred in patients suitable for active therapy: 33 were managed by initial surgery and 43 by peripheral thrombolysis with tissue plasminogen activator.

Results
Overall outcome after 30 days was limb salvage in 48 (53 per cent), amputation in five (5 per cent) and death in 38 (42 per cent). In actively treated patients the corresponding values were 43 (57 per cent), four (5 per cent) and 29 (38 per cent). Initial successful revascularization was more likely following surgery (29 of 33 versus 25 of 43 events with thrombolysis, P &lt; 0·01), but the 30-day outcome was similar in the actively treated groups owing to subsequent morbidity and mortality.

Conclusion
A group of patients (mostly women) with emboli could be identified, using clinical criteria, who had a high chance of successful revascularization following embolectomy. Late outcome remained poor due to associated co-morbid conditions. Thrombolysis is associated with substantial risk in the elderly, and with high complication rates.
Screening for gastric cancer by Helicobacter pylori serology: a retrospective study
Authors: Whiting J L , Hallissey M T , Fielding J W L , Dunn J 
Published: March 2003

Abstract

Background
Screening by serology for Helicobacter pylori in young dyspeptic patients has been shown to be effective in reducing demand for endoscopy. H. pylori has been implicated in the causation of gastric cancer and the reported seropositivity rate in patients with gastric cancer ranges from 69 to 94 per cent. The aim of this study was to assess the potential value of Helicobacter antibodies as a method of selecting dyspeptic patients over the age of 45 years for endoscopy.

Methods
A retrospective comparison of the antibody status to H. pylori was made between 154 patients with gastric cancer and a sex- and date of birth-matched dyspeptic control group. Results from the former group were correlated with demographic data and tumour characteristics.

Results
Significantly more patients with gastric cancer were seropositive than controls (77 versus 66 per cent). H. pylori was not related to the Laurén classification of the tumour. Tumour site was significant: body and antrum tumours were associated with Helicobacter whereas cardial tumours appeared to be unrelated.

Conclusion
Screening by antibody assays to H. pylori would miss more than 30 per cent of current gastric cancers. The increasing incidence of cardial cancer would cause this percentage to rise in the future.
Quality of life after pouch excision
Authors: Tan H T , Morton D , Connolly A B , Pringle W , White M , Keighley M R B 
Published: March 2003

Abstract

Background
Pouch excision is a devastating experience for patients having restorative proctocolectomy for ulcerative colitis.

Methods
The quality of life among patients having pouch excision for ulcerative colitis was compared with that in those having proctocolectomy and ileostomy for ulcerative colitis using a validated standardized self-administered questionnaire.

Results
After pouch excision patients (n = 9) had more troublesome bowel symptoms (mainly from liquid stoma output) than those in the proctocolectomy group (n = 14) (mean(s.d.) score 5·64(0·92) versus 6·13(0·37), P = 0·03). However, the mean scores for the other parameters (systemic symptoms, functional, social and emotional impairment) did not differ significantly.

Conclusion
Patients having pouch excision for ulcerative colitis have more liquid ileostomy loss but a comparable quality of life to those treated by standard proctocolectomy and ileostomy.
Management of symptomatic locoregional recurrence during regional chemotherapy for colorectal liver metastases
Authors: Davies M M , Fordy C , Burke D , Allen-Mersh T G 
Published: March 2003

Abstract

Background
The incidence of symptomatic locoregional recurrence is doubled in patients receiving regional chemotherapy with hepatic arterial floxuridine infusion (HAI) compared with that in those with colorectal liver metastases treated by symptom control. This study assessed the management of symptomatic locoregional recurrence in HAI-treated patients with colorectal liver metastases.

Methods
A retrospective review of all patients with colorectal liver metastases treated by HAI in one hospital over a 10-year period was carried out and the management of those who developed symptomatic locoregional recurrence was studied.

Results
Twenty-three (14 per cent) of 166 HAI-treated patients with colorectal liver metastases developed symptoms of locoregional recurrence. Liver metastases were responding to HAI at the onset of symptoms in 19 (ten abdominal, nine pelvic recurrence) of the 23 patients. Resection of abdominal recurrence was possible in seven of the ten patients, with a median hospital stay of 14 days; there was one perioperative death. Resected patients survived a median of 15 months after resection of the recurrence, with five of seven remaining free of symptoms of locoregional recurrence. In contrast, six of nine HAI-responding patients with pelvic recurrence treated by external beam radiotherapy died from uncontrolled symptomatic pelvic disease.

Conclusion
Resection of abdominal recurrence achieved worthwhile palliation in patients with HAI-controlled liver metastases, but palliation of pelvic recurrence by irradiation was unsatisfactory.