bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mutations in ras proto‐oncogenes are associated with lower mdr1 gene expression in adult acute myeloid leukaemia
Authors: Schaich M. , Ritter M. , Illmer T. , Lisske P. , Thiede C. , Schäkel U. , Mohr B. , Ehninger G. , Neubauer A. 
Published: March 2003

Mutations in ras genes have been found to be the most frequent genetic aberrations in adult myeloid leukaemia (AML). Some reports have shown an improved outcome of ras‐mutated AML. In order to understand the biology of ras mutation in AML, we studied a cohort of patients treated in a prospective multicentre trial for ras mutational status and resistance gene expression. Blast samples from 162 adult patients with de novo or secondary AML were examined for resistance gene expression (mdr1, mrp1 and lrp) and ras mutations using reverse transcription‐polymerase chain reaction and protein nucleic acid‐competitive polymerase chain reaction strategies respectively. Ras mutations were confirmed using DNA sequencing. Ras mutations leading to an exchange of amino acids were found in 40 (25%) patients. Thirty AML patients had N‐ras mutations and nine patients had K‐ras mutations. One patient showed both N‐ras and K‐ras mutations. Resistance gene expression was positive for mdr1 in 30%, for mrp1 in 43% and for lrp in 62% of patients. There was a strong inverse correlation between the presence of ras mutation and mdr1 expression (P = 0·005). However, no significant difference was seen between patients with or without ras mutations and mrp1 or lrp expression. Whereas mdr1 expression was associated with a lower complete remission rate (P < 0·04), ras mutations had no significant influence on remission status. Neither ras mutation nor mdr1 expression had a significant impact on overall or disease‐free survival to date. For the first time, there is evidence that activated ras genes are associated with lower mdr1 expression in AML.
Activation of coagulation factor XI, without detectable contact activation in dengue haemorrhagic fever
Authors: Van Gorp Eric C. M. , Minnema Monique C. , Suharti Catharina , Mairuhu Albert T. A. , Brandjes Dees P. M. , Ten Cate Hugo , Hack C. Erik , Meijers Joost C. M. 
Published: March 2003

A prospective cohort study was performed in 50 patients with dengue haemorrhagic fever (DHF) to determine the potential role of the contact activation system and factor XI activation (intrinsic pathway) in the coagulation disorders in DHF. To establish whether TAFI (thrombin‐activatable fibrinolysis inhibitor) was involved in the severity of the coagulation disorders, the TAFI antigen and activity levels were also determined. Markers of contact activation (kallikrein‐C1‐inhibitor complexes), the intrinsic pathway of coagulation (factor XIa–C1‐inhibitor complexes) and TAFI were measured and correlated to thrombin generation markers (thrombin–anti‐thrombin complexes (TAT), prothrombin fragment 1+2 (F1+2)) and a marker for fibrinolysis [plasmin–α2–anti‐plasmin complexes (PAP)]. Activation of the intrinsic pathway of coagulation was clearly demonstrated by elevated levels of factor XIa–C1‐inhibitor complexes, without evidence of contact activation, reflected by undetectable kallikrein–C1‐inhibitor complexes. Both TAFI antigen and activity levels were decreased in all patients, which may contribute to the severity of bleeding complications in DHF because of the impaired capacity of the coagulation system to protect the fibrin clot from fibrinolysis. These findings in a human viral infection model are in accordance with earlier findings in bacterial sepsis.
Flow cytometric analysis of the association between blood group‐related proteins and the detergent‐insoluble material of K562 cells and erythroid precursors
Authors: Gane Pierre , Le Van Kim Caroline , Bony Viviane , Nemer Wassim El , Mouro Isabelle , Nicolas Virginie , Colin Yves , Cartron Jean‐Pierre 
Published: March 2003

The linkage between blood group‐related cell surface proteins and the detergent‐insoluble material (DIM) was estimated by flow cytometry using a panel of specific monoclonal antibodies (mAbs) as a comparison of the antibody‐binding capacity of intact and Triton‐X100‐treated cells. Studies were performed with K562 cells expressing endogenous or recombinant proteins and with human erythroid progenitors during their proliferation and differentiation in vitro. Glycophorin C (GPC) was found to be Triton‐insoluble in both cellular models. When expressed (erythroid progenitors), Band 3 remained Triton‐insoluble. Glycophorin A (GPA), however, behaved as Triton‐soluble or insoluble according to the absence (K562) or the presence (erythroid progenitors) of Band 3 respectively. Comparison of the cellular models regarding the proteins that compose the Rh complex also indicated that Rh(D), RhAG and CD47 were resistant to Triton extraction in cells lacking Band 3. Similarly, RhAG and CD47 remained predominantly Triton‐insoluble in K562 cells and early progenitors before Rh and Band 3 expression. Further analysis showed that the Kell protein was DIM‐associated. In contrast, CD99 and DARC (Fy) proteins were not, or were very poorly, DIM‐associated. Additionally, the adhesion molecules CD44 and Lu were completely or partially resistant to detergent extraction respectively. Deletion of the Lu cytoplasmic tail or its replacement by the cytoplasmic domain of GPC resulted in significant increase or decrease of the Triton solubility of the transfected proteins respectively. These data suggest that Triton insolubility of Lu results in part from direct attachment of its cytoplasmic tail with the cytoskeleton. We assume that this method should provide a useful tool to map interaction sites localized in the cytoplasmic domain of recombinant transmembrane proteins.
Hb H hydrops foetalis syndrome: a case report and review of literature
Authors: Lorey Fred , Charoenkwan Pimlak , Witkowska H. Ewa , Lafferty John , Patterson Margaret , Eng Barry , Waye John S. , Finklestein Jerry Z. , Chui David H. K. 
Published: March 2003

Haemoglobin H (Hb H) disease is caused by deletion or inactivation of three α‐globin genes, leaving only one intact and active α‐globin gene. People with Hb H disease usually have moderate anaemia, but are generally thought to be asymptomatic. Some Hb H disease patients require transfusions, and there are reports of fetuses with Hb H disease who have severe anaemia in utero resulting in fatal hydrops foetalis syndrome. We now report a case of Hb H hydrops foetalis syndrome, caused by the inheritance of a hitherto novel α‐globin gene point mutation (codon 35 TCC→CCC or Serine→Proline) and an α‐thalassaemia deletion of the Filipino type removing all ζ‐α‐globin genes on the other chromosome 16. The infant was delivered prematurely because of pericardial effusion and fetal distress, and was found to have severe anaemia and congenital anomalies. A review of the relevant literature on this syndrome is presented, and serves to underscore the phenotypic variations of Hb H disease and the need for surveillance for this condition among newborns and genetic counselling in communities with a high proportion of at‐risk populations.
Dynamic graciloplasty for severe anal incontinence
Authors: Christiansen J , Rasmussen O Ø , Lindorff-Larsen K 
Published: March 2003

Abstract

Background
The surgical options for the treatment of anal incontinence where standard procedures have failed include transposition of striated muscles, primarily gracilis and gluteus maximus, and implantation of artificial sphincters. Due to a high proportion of fatigue-prone fibres in striated muscles, the results of transposition without stimulation have been disappointing. This study presents the results of stimulated graciloplasty in 13 patients with severe anal incontinence in whom other surgical procedures had failed.

Methods
The gracilis muscle was transposed around the anal canal according to a previously described technique. Eight weeks later the intramuscular electrodes were implanted into the gracilis at the site of the nerve entry and a neurostimulator was placed in a subcutaneous pocket in the abdominal wall. The patients were followed from 7 to 27 months.

Results
Six patients obtained satisfactory continence and five showed marked improvement. Two patients were considered failures. Rectal evacuation problems occurred in three patients, in one so severe that the patient, in spite of satisfactory continence, considered the treatment a failure.

Conclusion
Dynamic graciloplasty is a viable option in carefully selected patients with severe anal incontinence where other methods have failed.
Late results of paraoesophageal hiatus hernia repair with fundoplication
Authors: Luostarinen M , Rantalainen M , Helve O , Reinikainen P , Isolauri J 
Published: March 2003

Abstract

Background
Most published reports on results of surgical treatment for paraoesophageal hiatus hernia have been based on patient questionnaires, and seldom included endoscopy or barium meal examinations.

Methods
Eight pure and 14 mixed-type paraoesophageal hernias were evaluated a median of 37 (range 2–241) months after surgical repair. An antireflux procedure was done in 19 cases. Before operation all had endoscopy or barium meal (20 and 19 patients respectively); after operation 19 had endoscopy and 12 also had barium meal examination. Oesophageal 24 h pH monitoring was done in five cases before surgery, and in 11 afterwards.

Results
Preoperative symptoms of reflux were reported by 18, and were often accompanied by dysphagia, postprandial vomiting or epigastric pain. Symptoms improved after operation, and 21 of the 22 patients were satisfied with the result. At follow-up examination, a recurrent hernia was found in eight of the 19 patients examined. Four of these hernias were sliding, two were mixed type and two purely paraoesophageal.

Discussion
Recurrence of symptoms was associated with persistence of reflux rather than hernia recurrence. Concomitant antireflux procedure is recommended in all operations for mixed-type hiatus hernia, but it should also be considered for purely paraoesophageal hernia if reflux cannot be excluded before operation, or if retro-oesophageal dissection is needed.
In vivo assessment of the influence of cold preservation time on microvascular reperfusion injury after experimental small bowel transplantation
Authors: Massberg S , Gonzalez A P , Leiderer R , Menger M D , Messmer K 
Published: March 2003

Abstract

Background
This study describes the impact of prolonged cold storage on microvascular reperfusion injury of transplanted rat small bowel isografts.

Methods
In vivo fluorescence microscopy was used to assess intestinal microcirculation after 6, 12, 18 and 24 h of cold (4°C) ischaemia in University of Wisconsin solution and 20–90 min of reperfusion. Sham-operated animals served as controls.

Results
Whereas 6 and 12 h of ischaemia did not affect functional capillary density of the intestinal graft mucosa, villous perfusion was significantly impaired after 18 and 24 h of cold preservation. Similarly, microvascular perfusion of circular and longitudinal muscle was not affected after 6 h, but deteriorated following prolonged cold ischaemia. Leucocyte–endothelial cell interaction in submucosal venules was significantly enhanced after 6 h of ischaemia with peak values after 12 and 18 h. A progressive reduction of lymphatic capillary drainage indicated an ischaemia time-related deterioration in graft function.

Conclusion
The results provide evidence that leucocyte–endothelial cell interaction in submucosal venules of the transplanted intestine is a primary step in the manifestation of reperfusion injury following short periods of cold ischaemia.
Popliteal vein reflux reduces the healing of chronic venous ulcer
Authors: Brittenden J , Bradbury A W , Allan P L , Prescott R J , Harper D R , Ruckley C V 
Published: March 2003

Abstract

Background
The relationship between deep and superficial venous reflux and healing of venous ulceration by non-operative compression therapy has not been studied previously.

Methods
A total of 155 patients with chronic venous ulcers underwent duplex ultrasonography before treatment with compression bandaging at a hospital-based venous clinic.

Results
At 24 weeks, 104 (67 per cent) of ulcers had healed. There was no significant difference in the pattern of either deep or superficial venous reflux between healed and non-healed ulcers except with respect to the popliteal vein. In healed ulcers, 39 scans (38 per cent) indicated competence of the above-knee popliteal vein compared with five (10 per cent) in the non-healing group (P &lt; 0·001, χ2 test). Similarly, 43 scans (42 per cent) showed below-knee popliteal vein competence in the healed ulcers compared with only five (10 per cent) performed in legs remaining ulcerated (P &lt; 0·001, χ2 test).

Conclusion
Popliteal vein incompetence is an indicator of poor response to compression therapy for venous ulceration.
Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection
Authors: Sánchez-Bueno F , Garcia-Marcilla J A , Perez-Flores D , Pérez-Abad J M , Vicente R , Aranda F , Ramirez P , Parrilla P 
Published: March 2003

Abstract

Background
Gastric cancer has a poor prognosis. The aim of this study was to determine the influence of several clinicopathological variables on outcome in a series of 297 Western patients undergoing surgical resection for gastric adenocarcinoma.

Methods
The results were analysed retrospectively and prognostic factors were identified in a univariate and Cox proportional hazards regression model. Mean patient age at the time of operation was 61·9 years; 65·7 per cent were men. Mean follow-up was 7·8 (range 1–15) years. Of the 297 patients undergoing surgery, 70 per cent had subtotal gastrectomy, 26·3 per cent underwent total gastrectomy and 3·7 per cent had proximal gastrectomy.

Results
The overall survival rate was 38·9 per cent at 5 years. In the univariate analysis, survival-related factors were weight loss (P &lt; 0·05), abdominal mass (P &lt; 0·01), dysphagia (P &lt; 0·001), type of gastrectomy (subtotal gastrectomy versus total gastrectomy, P &lt; 0·001), intention of resection (curative versus palliative resection, P &lt; 0·001), tumour site (P &lt; 0·001), histopathological grade (low versus high grade, P &lt; 0·05), tumour diameter less than 3 cm (P &lt; 0·001), degree of gastric wall invasion (P &lt; 0·001), degree of lymph node invasion (P &lt; 0·001) and stage of the neoplasia (P &lt; 0·001). Other variables had no significant influence. In the multivariate analysis, degree of gastric wall invasion, lymph node invasion, tumour size and dysphagia at presentation were the only independent prognostic variables.

Conclusion
From these data it was possible to derive a prognostic index with which patients could be classified as at low, intermediate or high risk.
Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma
Authors: Shimada M , Takenaka K , Fujiwara Y , Gion T , Shirabe K , Yanaga K , Sugimachi K 
Published: March 2003

Abstract

Background
The aim of this study was to clarify the risk factors for morbidity as well as to establish an optimum surgical strategy for hepatocellular carcinoma (HCC).

Methods
The risk factors linked to postoperative complications were analysed in 388 patients over a 10-year period, according to the kind of operative procedure.

Results
Stepwise regression analysis revealed that the most important factors related to postoperative morbidity were: age, creatinine level and the histological grade of fibrosis for the bisegmentectomy; the presence of diabetes mellitus, blood urea nitrogen level, the indocyanine green dye retention rate at 15 min and blood loss for the segmentectomy; the presence of diabetes mellitus and blood loss for subsegmentectomy; the presence of diabetes mellitus, the aspartate aminotransferase level, and the total operating time for resection less than subsegmentectomy.

Conclusion
The most important risk factors were not always related to liver function tests, but instead to other coexisting conditions such as diabetes mellitus and operation stress including operating time and blood loss. Therefore, any future treatment strategy of hepatic resection for HCC should make every effort both to evaluate coexisting conditions carefully and to reduce operative stress as far as possible.
Continuous antibiotic treatment for experimental abdominal sepsis: effects on organ inflammatory cytokine expression and neutrophil sequestration
Authors: Mercer-Jones M A , Hadjiminas D J , Heinzelmann M , Peyton J , Cook M , Cheadle W G 
Published: March 2003

Abstract

Background
Tumour necrosis factor (TNF) α and interleukin (IL) 1β are produced in the lung after peritonitis and may contribute to neutrophil-mediated organ injury. It was hypothesized that, during experimental peritonitis, continuous rather than intermittent antibiotic therapy would reduce lung expression of TNF-α and IL-1β messenger RNA (mRNA) and neutrophil sequestration.

Methods
After caecal ligation and puncture, mice received either intermittent or continuous cefoxitin, or continuous metronidazole or aztreonam. Cytokine mRNAs were determined by reverse transcription differential polymerase chain reaction and lung neutrophil content by myeloperoxidase (MPO) assay.

Results
Continuous cefoxitin reduced median (interquartile range (i.q.r.)) lung IL-1β mRNA expression ((ratio to β-actin): continuous 0·18 (0·14–0·34), intermittent 0·46 (0·44–0·49), saline 0·43 (0·38–0·53), P &lt; 0·05) and median (i.q.r.) lung MPO content (continuous 22·5 (9·7–40), intermittent 65 (57·5–76), saline 47 (41–64), P &lt; 0·05) compared with intermittent therapy and saline controls. Continuous infusion was also associated with reduced bacteraemia (P &lt; 0·05) but not serum TNF-α or endotoxin levels. Both continuous metronidazole and aztreonam reduced lung MPO concentration (P &lt; 0·05) and TNF-α and IL-1β mRNA expression (P &lt; 0·05) compared with those in saline controls. These effects were dependent on a reduction in the number of susceptible bacteria rather than serum TNF-α or endotoxin levels.

Conclusion
The stimulus for organ inflammatory cytokine production and neutrophil sequestration during peritonitis is the level of bacteraemia present, which is more effectively controlled with continuous antibiotic therapy.
Comparison of computed tomography and duplex imaging in assessing aortic morphology following endovascular aneurysm repair
Authors: Thompson M M , Boyle J R , Hartshorn T , Maltezos C , Nasim A , Sayers R D , Fishwick G , Bell P R F 
Published: March 2003

Abstract

Background
Computed tomography (CT) has been used to assess patients following endovascular aneurysm repair to determine the need for secondary endoluminal or operative procedures. This prospective study compared CT and duplex imaging to evaluate aneurysm morphology following endoluminal aortic grafting.

Methods
Twenty patients were evaluated at regular intervals following successful endoluminal aneurysm repair. CT and duplex scanning were compared in their ability to determine aneurysm and aortic diameter, the presence of perigraft extravasation (endoleaks) and technical defects in the endograft.

Results
In 20 patients who were assessed 6 months after operation, duplex imaging identified four endoleaks (two early, two late; one proximal, three distal). In three cases, the aneurysm diameter progressively increased after operation. In patients with a thrombosed aneurysm sac, the aneurysm regressed at a median of 0·40 (range 0·13–0·8) cm per year. The CT findings were similar (median regression 0·43 (range 0–1·0) cm per year), although CT was unable to predict the site of the leak as accurately as duplex imaging. CT demonstrated that the diameter of the juxtarenal aorta increased following endografting.

Conclusion
Duplex imaging is a less invasive, less costly alternative to CT in the follow-up of patients after endoluminal aortic surgery. Increase in size of the aneurysm sac following endovascular aneurysm repair strongly suggests the presence of an endoleak.
Anatomical variants during axillary dissection
Authors: Kutiyanawala M A , Stotter A , Windle R 
Published: March 2003

Abstract

Background
This study was done to document the variations encountered in the anatomy of the axilla because of the difficulty they can cause during dissection.

Methods
A record was made of the anatomy of the axilla in 100 patients with breast cancer who had an axillary dissection.

Results
The variants from the described normal included double axillary veins, abnormal bands of muscle from the latissimus dorsi stretching across the axilla and a medial lying thoracodorsal nerve.

Conclusion
Damage to important structures in the axilla during axillary dissection can be minimized with an awareness of the possible anatomical variations.
Vaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis
Authors: Poen A C , Felt-Bersma R J F , Cuesta M A , Meuwissen S G M 
Published: March 2003

Abstract

Background
Anal endosonography is an established technique in the evaluation of anorectal disease. However, it is sometimes difficult to visualize the anterior part of the sphincter complex and anal endosonography may be impossible when anal pain or stenosis is present. The aim of this study was to evaluate vaginal endosonography in the diagnosis of faecal incontinence and perianal sepsis.

Methods
Anal and vaginal endosonography were performed in 56 women with faecal incontinence (n = 36) or perianal sepsis (n = 20). The technique and pelvic floor anatomy were described, anal sphincter measurements with anal and vaginal endosonography were compared, and the additive value of vaginal over anal endosonography in the diagnosis of faecal incontinence and perianal sepsis was assessed.

Results
The pelvic floor was clearly imaged with vaginal endosonography. However, after a relatively short learning curve it was still not possible to image the anal sphincters in three of 28 patients. Except for external anal sphincter thickness, which was significantly lower, all anal canal structure measurements were greater with vaginal than with anal endosonography. Concerning the diagnosis of either faecal incontinence or perianal sepsis, vaginal endosonography added important information in comparison with anal endosonography in 14 (25 per cent) of 56 patients.

Conclusion
Vaginal endosonography provides reliable images of the anal sphincters in an undistorted fashion, thereby increasing the diagnostic yield of faecal incontinence and perianal sepsis in 25 per cent of patients. Therefore, endosonographists should become acquainted with this technique.
Laparoscopic drainage of liver abscesses
Authors: Tay K H , Ravintharan T , Hoe M N Y , See A C H , Chng H C 
Published: March 2003

Abstract

Background
The mainstay of the management of liver abscesses has been intravenous antibiotics and radiologically guided percutaneous drainage. However, not all abscesses are treated successfully in this way, and some require surgical drainage. Laparoscopic drainage of liver abscesses may be an alternative to open surgical drainage.

Methods
Twenty consecutive patients with liver abscesses treated by laparoscopic drainage in combination with intravenous antibiotics were studied prospectively. Fifteen had had failed percutaneous drainage previously.

Results
There were 13 right lobe and seven left lobe abscesses ranging from 6 to 25 cm in diameter. Mean operating time was 38 min. Seventeen patients were drained successfully. Three patients developed recurrent symptoms of which two resolved with conservative measures, but one required a second laparoscopic procedure. There were no intraoperative or other postoperative complications in the 20 patients. Follow-up ranged from 5 to 12 months.

Conclusions
Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics, is a safe and viable alternative in all patients who require surgical drainage following failed medical or percutaneous treatment, and in those with large abscesses.