bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thromboembolic events after carotid endarterectomy are not prevented by aspirin, but are due to the platelet response to adenosine 5′-diphosphate
Authors: Hayes P D , Box H , Tull S , Gaunt M E , Bell P R F , Goodall A H , Naylor A R 
Published: December 2004

Abstract

Background
Aspirin therapy fails to prevent a number of postprocedural thrombotic events, yet it still remains the standard antiplatelet regimen in most vascular surgical centres. After carotid endarterectomy (CEA), thrombosis of the endarterectomized vessel is preceded by increasing numbers of microemboli that can be detected with transcranial Doppler (TCD). The number and rate of emboli is highly predictive of thrombotic stroke. It was hypothesized that a preoperative test of platelet function might identify the mechanism(s) underlying post-CEA thrombosis.

Methods
Blood was taken from 120 patients using a standardized phlebotomy technique. Platelet fibrinogen binding was measured by whole blood flow cytometry, in unstimulated samples, and in response to adenosine 5′-diphosphate (ADP) (10−5−10−7 mol l−1) and thrombin (0·02–0·16 units ml−1). Platelet aggregation was measured using ADP (4–20 × 10−7 mol l−1). The ability of aspirin to inhibit platelets was assessed by the aggregation induced by arachidonic acid. For the first 3 h after operation, the number of emboli occurring was quantified using TCD.

Results
Of the 120 patients studied, 110 were monitored by TCD. These were divided into patients with more than 25 postoperative emboli (n = 22) and those with fewer than 25 emboli (n = 88). The degree of platelet inhibition induced by aspirin was not significantly different between the two groups (P = 0·89). However, platelets from the group with high rates of embolization bound 58 per cent more fibrinogen on flow cytometry in response to stimulation with a physiological dose of ADP (10−7 mol l−1) (P = 0·006). Aggregation of platelets from this group was also increased in response to ADP (35 per cent) relative to the group with few emboli (P = 0·001). ADP also induced more rapid aggregation in the patients with more than 25 emboli (P = 0·04). There was no difference in the activity of resting platelets (P = 0·4) or platelets stimulated by thrombin (P = 0·43), between the two groups of patients.

Conclusion
These data suggest that it is the platelet response to ADP which is important in arterial thrombotic complications rather than products of the cyclo-oxygenase pathway. This observation could have significant therapeutic implications for other vascular or interventional procedures in which the endothelium is disrupted.
Abdominal tuberculosis in children
Authors: Tireli G A , Özbey H , Salman T 
Published: December 2004

Abstract

Background
Abdominal tuberculosis (AT) is a rare cause of abdominal infection in children. Surgical intervention is rarely indicated, other than for obtaining a specimen for histopathological diagnosis or for the treatment of complications.

Methods
The medical records of 13 patients who were operated on with the diagnosis of AT, between 1983 and 1999, were reviewed retrospectively.

Results
The median age was 7 years (range 6 months to 10 years). The clinical signs and symptoms were as follows: abdominal pain (eight patients), loss of weight (seven), abdominal mass (six), vomiting (four) and night fever (four). Twelve patients were operated on, while diagnostic laparoscopy was perfomed in one. Patients operated on with the diagnosis of acute abdomen were diagnosed immediately at laparotomy. Surgery was limited to sampling of peritoneum and/or lymph node biopsy and ascites. The reason for surgical intervention was intestinal obstruction (eight), abdominal mass or ascites (six), psoas abscess (one) and intussusception (one). In all patients the diagnosis was confirmed by either histopathological or microbiological examination. In eight patients the AT was defined as intestinal and mesenteric type, in three patients it was localized to the peritoneum and in two the disease was diffuse. All patients were treated with INH, rifampicin and streptomycin–pyrazinamide combination. Two patients, one with a faecal fistula and one with malnutrition, came from another hospital. All patients survived and were treated successfully except the patient with a faecal fistula.

Conclusion
The diagnosis of AT is difficult before presentation with complications of intra-abdominal infection. In patients with suspected AT, aggressive surgery should be avoided and surgical intervention should be limited to tissue and/or fluid sampling.
Bacterial lipoprotein induces endotoxin-independent tolerance to the systemic inflammatory response syndrome in vivo and in vitro
Authors: Doyle M , Wang J H , Redmond H P 
Published: December 2004

Abstract

Background
Sublethal doses of endotoxin (lipopolysaccharide; LPS) induce tolerance in vivo and in vitro, and protect against the lethal effects of a further LPS challenge. Tolerance is characterized by diminished production of tumour necrosis factor (TNF) α. Bacterial lipoprotein (BLP), another bacterial wall component, might induce tolerance against its own lethal effects as well as those of endotoxin.

Methods
Ninety male MF-1 mice (mean(s.d.) weight 18(2) g) were randomized into three groups (n = 30 per group). Mice in group 1 received a single BLP-tolerant dose (10 mg kg−1) by intraperitoneal injection, whereas mice in group 2 received a second BLP-tolerant dose (10 mg kg−1) after 24 h. Following induction of tolerance, all mice were challenged with high doses of LPS 45 mg kg−1, BLP 45 mg kg−1 or a combination of LPS 30 mg kg−1 plus BLP 30 mg kg−1. Mice in group 3 were treated with a high dose of the above agents only. Mortality was assessed at 24 and 48 h. Macrophages were isolated from mice and pretreated in vitro with culture medium alone or culture medium containing LPS 10 ng ml−1 or BLP 10 ng ml−1 for 24 h. The cells were then stimulated with high doses (100–1000 ng ml−1) of LPS, BLP or LPS plus BLP for 6 h. The cell culture supernatants were collected and TNF-α levels were determined using enzyme-linked immunosorbent assay.

Results
BLP-induced tolerance significantly improved survival compared with that of mice without tolerance (P &lt; 0·05). In vitro, pretreatment of murine macrophages with BLP significantly attenuated LPS, BLP and LPS plus BLP stimulation-induced TNF-α production.

Conclusion
BLP mimics LPS in the development of the systemic inflammatory response syndrome. Furthermore, BLP is capable of inducing tolerance, both in vivo and in vitro, which subsequently prevents BLP- and LPS plus BLP-induced death.
Association between intraplaque haemorrhage in the carotid atherosclerotic lesion, the degree of internal carotid artery stenosis and timing of ischaemic neurological events
Authors: Mofidi R , Crotty T , Fulton G F , Powell T , MacErlaine D , Sheehan S J , Mehigan D , Keaveny T V 
Published: December 2004

Abstract

Background
Expansion of carotid atherosclerotic plaques as a result of intraplaque haemorrhage has been implicated in the development of ischaemic neurological events. The relationship between the quantity of haemorrhage in the dominant atherosclerotic lesion, the degree of internal carotid artery (ICA) stenosis and the chronology of patients' symptoms was examined.

Methods
Consecutive patients undergoing carotid endarterectomy were included. The nature and timing of symptoms were recorded. Aortic arch injection digital subtraction angiography was performed before operation. Carotid endarterectomy specimens were serially sectioned and examined histologically. The amount of intraplaque haemorrhage was measured with digital image analysis. The influence of timing of symptoms on the quantity of intraplaque haemorrhage was compared with Kaplan–Meier analysis. Correlation between degree of ICA stenosis and quantity of intraplaque haemorrhage was assessed by means of regression analysis.

Results
Seventy-four patients (20 asymptomatic, 54 symptomatic) were included. The median latency of symptoms was 28 (1–600) days. Intraplaque haemorrhage was common: 54 (73 per cent) of 74 patients. Mean(s.e.m.) cumulative symptom-free survival before operation for patients with no intraplaque haemorrhage was 0·71(0·11), compared with 0·58(0·11) in those exhibiting haemorrhage in less than 50 per cent of the plaque area, and 0·20(0·07) in lesions with over 50 per cent (P = 0·002). A close correlation was observed between the degree of ICA stenosis and haemorrhagic content of the dominant atherosclerotic lesion (r2 = 0·433, P &lt; 0·001).

Conclusion
These results confirm the association between intraplaque haemorrhage and the degree of ICA stenosis. They further demonstrate an association between the size of haemorrhage and timing of neurological events, suggesting a causative role for intraplaque haemorrhage in the development of ischaemic neurological events.
Cytoreduction including total gastrectomy for pseudomyxoma peritonei
Authors: Sugarbaker P H 
Published: December 2004

AbstractBackgroundCytoreductive surgery supplemented by perioperative intraperitoneal chemotherapy is a therapeutic option for selected patients with pseudomyxoma peritonei syndrome. In some patients, the stomach and/or its vascular supply are so covered by mucinous tumour that total gastrectomy is required for complete resection.MethodsForty-five patients underwent total gastrectomy with a temporary diverting jejunostomy as part of the surgical treatment of pseudomyxoma peritonei syndrome of appendiceal origin. Heated intraoperative intraperitoneal chemotherapy with mitomycin was used in all patients, and 36 had early postoperative intraperitoneal 5-fluorouracil. To date, 39 patients have had second-look surgery and stoma closure; 37 had additional perioperative intraperitoneal chemotherapy. A prospective database was maintained on all patients.ResultsThe median age was 47 (range 33–66) years. Median interval from diagnosis of pseudomyxoma peritonei to definitive cytoreductive surgery was 23 (range 0–140) months. Six patients presented with intestinal obstruction. The need for gastrectomy was predicted before operation by abdominal computed tomography. Mean operative time was 13 (range 9–17) h. Mean intraoperative requirement for packed red blood cells was 3·0 units, and that for fresh frozen plasma was 9·9 units. Six peritonectomy procedures, including total gastrectomy, were required for complete cytoreduction. All except seven patients were maintained on parenteral nutrition before second-look surgery for jejunostomy closure. All but two patients have resumed oral nutrition with discontinuation of parenteral feeding. There was one postoperative death and one late death. Thirty-seven patients are alive and disease-free, 0–56 months after initiation of treatment.ConclusionTotal gastrectomy with a temporary diverting jejunostomy may be used to facilitate complete cytoreduction in patients with advanced pseudomyxoma peritonei syndrome.
Effects of experimental lower-limb ischaemia–reperfusion injury on the mesenteric microcirculation
Authors: Wehrens X H T , Rouwet E V , oude Egbrink M G A , Slaaf D W , Ramsay G 
Published: December 2004

Abstract

Background
Ischaemia–reperfusion (I-R) of the leg is associated with functional and structural changes in the intestine. This study assessed whether acute hind-limb I-R in rats induced a reduction in perfusion and/or signs of an inflammatory response in the intestine.

Methods
Rats were subjected to 2 h of unilateral hind-limb ischaemia followed by 2 h of reperfusion (I-R group, n = 9) or to a sham procedure (control group, n = 9). Mesenteric microvascular diameters, red blood cell velocity, blood flow and leucocyte–vessel wall interactions during reperfusion were measured using intravital microscopy.

Results
Blood pressure and heart rate decreased from 30 min of reperfusion onwards in the I-R group compared with controls. From 15 min after the start of reperfusion, mesenteric arteriolar and venular red blood cell velocity and blood flow decreased by 40–50 per cent. Microvascular diameters and leucocyte–vessel wall interactions did not change.

Conclusion
Restoration of blood flow to an acutely ischaemic hind limb led to a significant decline in the splanchnic microcirculatory blood flow. There were, however, no signs of an early inflammatory response in the gut.
Significance of immunohistochemical nodal micrometastasis as a prognostic indicator in potentially curable oesophageal carcinoma
Authors: Komukai S , Nishimaki T , Suzuki T , Kanda T , Kuwabara S , Hatakeyama K 
Published: December 2004

AbstractBackgroundThe number of positive lymph nodes is an important prognostic predictor in patients with oesophageal cancer. However, the significance of nodal micrometastasis in patients with overt nodal metastasis is unknown. The aim of this study was to clarify the clinical implications of nodal micrometastasis in patients undergoing curative oesophagectomy for oesophageal cancer.MethodsCervical, mediastinal and abdominal lymph nodes systematically removed from 104 patients with oesophageal cancer were examined immunohistochemically to detect cells that stained positively for cytokeratins with the monoclonal antibody cocktail AE1/AE3. The postoperative course and survival rates were compared among patients with and without micrometastases, after numerical classification of overt metastatic nodes (none, between one and four, five or more).ResultsUnivariate analysis showed T stage, nodal micrometastasis and number of overt nodal metastases to be significant prognostic factors after oesophagectomy. Multivariate analysis revealed nodal micrometastasis and number of overt nodal metastases to be independent prognostic factors. The presence of micrometastases had a significant adverse effect on postoperative survival in patients with no overt metastasis and in patients with one to four overt metastatic nodes, but no such impact in patients with five or more overt metastatic nodes.ConclusionAssessment of nodal status by both histological examination for overt metastases and immunohistochemical examination for micrometastases is useful in stratifying patients undergoing curative oesophagectomy.
Litigation for pneumothorax as a complication of fine-needle aspiration of the breast
Authors: Bates T , Davidson T , Mansel R E 
Published: December 2004

Abstract

Background
Pneumothorax is a rare but recognized complication of diagnostic needle aspiration of the breast. Two recent court cases alleging negligence have reached opposing opinions on very similar findings.

Methods
A Medline literature search was carried out.

Results
The reported incidence of pneumothorax after diagnostic aspiration of the breast in seven series varied between three in 100 and one in 10 000, but the weight of evidence tended towards the latter rate. Two studies reported that the complication is more common in the hands of trainees. It is not always possible to maintain the aspirating needle parallel or tangential to the chest wall. Pleural puncture may be more common than is apparent, and is most common in the tail of the breast in a thin woman.

Conclusion
It is important that breast clinicians are aware of the risk of pneumothorax but, provided proper care has been taken, this complication is not the result of a negligent act.
Extensive surgery for carcinoma of the gallbladder
Authors: Kondo S , Nimura Y , Hayakawa N , Kamiya J , Nagino M , Uesaka K 
Published: December 2004

Abstract

Background
The purpose of this study was to clarify the efficacy of, and define the indications for, extensive surgery for gallbladder carcinoma.

Methods
Between 1979 and 1994, 116 patients with gallbladder carcinoma underwent operation. Radical resection was performed in 80 patients.

Results
In 68 patients with stage III or IV disease, extensive resection including extended right hepatectomy (n = 40), pancreaticoduodenectomy (n = 23) and/or portal vein resection (n = 23) was employed to achieve complete tumour excision. The hospital mortality rate was 18 per cent. The postoperative 3- and 5-year survival rates were 44 and 33 per cent respectively in the patients with stage III disease (n = 9), and 24 and 17 per cent respectively in patients with stage IV (M0) disease (n = 29). In contrast, the postoperative survival rate for the 30 patients with stage IV (M1) disease (7 per cent at 3 years and 3 per cent at 5 years) was worse than that for patients with stage III and stage IV (M0) disease (P = 0·009 and P = 0·062 respectively).

Conclusion
Radical resection should be undertaken for stage III and stage IV (M0) gallbladder cancer. Although portal vein resection and/or pancreaticoduodenectomy did not contribute to long-term survival, better survival was obtained than that for the unresected patients.
Who Takes Care of Education? Looked after children's perceptions of support for educational progress
Authors: Harker Rachael M , Dobel‐Ober David , Lawrence Julie , Berridge David , Sinclair Ruth 
Published: December 2004

ABSTRACTThis paper documents the views of a sample of 80 children and young people, aged 10–18 years, living in foster and residential care placements in England, regarding their educational experience whilst being looked after. The children were interviewed as part of an ongoing evaluation of the Taking Care of Education project, a development programme designed to facilitate improvements in the education of looked after children, co‐ordinated by the National Children's Bureau and funded by the Gatsby Charitable Foundation. Interviews with the sample asked children to assess their current educational progress and identify individuals who supported or hindered their education, as well as the availability of educational support in care placements. Teaching staff were frequently mentioned as providers of support, whilst social workers were often associated with hindering educational progress. Children and young people had access to a range of educational supports in care placements, and these were more widely available in residential settings than in foster care. Children offered a range of pertinent suggestions as to how the educational experience of those in the public care system might be improved.
Protecting children in Scotland: examining the impact of the Children (Scotland) Act 1995
Authors: McGhee Janice , Francis Joe 
Published: December 2004

ABSTRACTThis paper discusses findings from a small‐scale study of the impact on child protection practice following implementation of the Children (Scotland) Act 1995. The Act introduced three new measures to allow the state to intervene in families to protect a child where there is a risk of significant harm. These include the child protection order, the child assessment order and the exclusion order. The child protection order provides for the removal of a child to (or his or her retention in) a place of safety. In the first two years of the operation of the 1995 Act fewer applications were made for this order compared with similar provisions under the previous legislation. This reduction in applications appears to be related to unfamiliarity with new legislation; greater scrutiny resulting from the more formal application to the sheriff court; and the introduction of a new legal criterion for intervention, the presence or likelihood of ‘significant harm’. The introduction of the ‘no order’ principle into Scottish child care law is also likely to be a factor.
Informing parents of visually impaired children: who should do it and when?
Authors: Speedwell L. , Stanton F. , Nischal K. K. 
Published: December 2004

AbstractBackground  Parents of sick or disabled children are likely to be more stressed than parents of non‐disabled children and may benefit from being given information about their child's condition and its implications, but the stage at which parents should receive such information and who should provide it has not been fully investigated.The impact of written information on stress levels of parents of visually impaired children, seen in the ophthalmology clinic of a children's hospital, was explored in this study and the question of who parents thought should provide information, and at what stage, was also investigated.Methods  A longitudinal, experimental intervention study was conducted to compare the effect on perceived stress levels of providing information about the implications of visual impairment to parents. Effects were compared according to the child's age and explored in relation to baseline stress levels. The study included a frequency analysis about parents’ knowledge of visual impairment and how it relates to education, and their response to being given written information.Results  The results did not show an effect on levels of parental stress but did find that parents of school age children were more stressed than those of preschool age. Over 80% of participants considered that information was given too late and suggested it should be given soon after diagnosis. Of the controls, 32.6% thought the general practitioner should provide information on education although participants were more likely to expect the hospital to provide it.Conclusions  The majority of parents would prefer to receive information soon after diagnosis of their child's visual impairment. Most parents do not know who to approach for information on education. Giving them access to patient liaison teams who could advise about the repercussions of visual impairment in children would be beneficial.
Which factors explain the lower prevalence of atopy amongst farmers' children?
Authors: Remes S. T. , Iivanainen K. , Koskela H. , Pekkanen J. 
Published: December 2004

SummaryBackground The inverse association between farming and atopy in children has been attributed to microbial exposure, especially through livestock. Very little is known about other potential explanatory factors.Objective To explore potential differences in lifestyle and environmental factors between farmer and non‐farmer families, and whether these factors could explain the association between farming and childhood atopy.Methods A cross‐sectional study, including 366 farmers' and 344 non‐farmers' children in eastern Finland. Information regarding exposure and background characteristics was gathered by a written questionnaire. Atopy was defined as having one or more positive skin prick test reactions (> 3 mm) against the six common aeroallergens.Results Regardless of the current farming type, atopy was less frequent among the farmers' children than the non‐farmers' children (aOR 0.56, 95% CI 0.40–0.78). Remarkable differences were seen in many lifestyle factors (including diet) between the farmer and non‐farmer families, but only a few of the explored factors were associated with atopy. The frequency of current livestock contacts seemed to have an inverse, dose–dependent association with atopy (aOR 0.46, 95% CI 0.22–0.97 for daily vs. no contact). Having lived on a dairy farm in infancy (aOR 0.51, 95% CI 0.28–0.93), or having had cats or dogs in infancy (aOR 0.60, 95% CI 0.42–0.85), decreased the risk of atopy at school age. The inverse association between farming and atopy was not explained by the sociodemographic factors, or by differences in conventional risk factors of atopy. Animal contacts explained partially, but not completely, the association.Conclusion Higher frequency of animal contacts is one factor, but probably not the only one, explaining the inverse association of farming and atopy in children. The importance of early life exposures may have recently been over‐emphasized, and current exposures discounted, when studying the risk factors of childhood atopy.