bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of the Kupffer cell response to exogenous endotoxin in a rodent model of obstructive jaundice
Authors: Kennedy J A , Clements W D B , Kirk S J , McCaigue M D , Campbell G R , Erwin P J , Halliday M I , Rowlands B J 
Published: March 2003

Abstract

Background
Sepsis and endotoxaemia occur frequently in biliary obstruction. Impaired Kupffer cell endocytosis is implicated in these events. Tumour necrosis factor and interleukin 6, secreted by Kupffer cells, are important mediators of sepsis. Kupffer cell clearance of endotoxin and secretion of cytokines in experimental obstructive jaundice were investigated.

Methods
Wistar rats were randomized to bile duct ligation, sham operation or control. Groups (n = 8) were studied 1 and 3 weeks after operation. Kupffer cell function was assessed using in situ hepatic perfusion.

Results
Clearance of endotoxin was significantly depressed 1 week (median (interquartile range) 20·3 (10·5–27·1) per cent) and 3 weeks (22·1 (20·2–23·2) per cent) after bile duct ligation compared with that in respective sham animals (35·5 (29·9–41·6) and 40·9 (37·7–47·0) per cent) and controls (39·5 (37·3–46·8) per cent). Secretion of tumour necrosis factor was significantly greater 1 week (1113·7 (706·5–1436·8) pg/ml) and 3 weeks (1118·2 (775·7–1484·1) pg/ml) following bile duct ligation compared with that in respective sham animals (114·3 (0–178·5) and 107·6 (63·7–166·4) pg/ml) and controls (0 (0–20·7) pg/ml). Interleukin 6 was not secreted by sham or control animals but was present in the perfusate from jaundiced animals at 1 and 3 weeks (52·5 (9·9–89·5) and 66·2 (60·2–193·1) pg/ml).

Conclusion
These data demonstrate simultaneous impairment of Kupffer cell clearance of endotoxin and increased secretion of proinflammatory cytokines in experimental obstructive jaundice. These diverse responses may contribute to the development of sepsis-related complications in biliary obstruction.
Laparoscopically assisted colorectal surgery in the elderly
Authors: Stewart B T , Stitz R W , Lumley J W 
Published: March 2003

Abstract

Introduction
Open colorectal surgery in elderly patients is associated with increased morbidity and mortality rates compared with those in younger age groups. It also requires more intensive postoperative support, longer hospitalization, and in many cases leads to prolonged rehabilitation or institutionalization. Because of its less invasive nature, laparoscopically assisted colorectal surgery may lead to a reduced period of convalescence. However, the safety of advanced laparoscopic surgical techniques in the elderly has not been established, so this prospective comparative study was undertaken.

Methods
All patients aged 80 years or more who were undergoing an elective laparoscopic or open colorectal procedure between 1 January 1992 and 30 June 1997 were assessed prospectively. Patients having simple stoma formation were excluded. Perioperative care, operative results and subsequent function were analysed.

Results
There were 42 patients in the laparoscopic group and 35 in the open group, with a median age of 84 years in each group. Five patients undergoing laparoscopic surgery required conversion to an open procedure. No complications related to laparoscopy occurred. Three patients died after operation in the laparoscopic group and four in the open group, with morbidity in seven and 15 patients respectively. Median hospital stay was 9 (range 4–21) days for patients having the laparoscopic operation, and 17 (range 7–28) days in the open cases. At 4 weeks after operation 30 of the 35 independent patients surviving the operation in the laparoscopic group and 16 of 28 in the open group were back to preoperative activity levels.

Conclusion
In this series laparoscopically assisted colorectal surgery was safe and was associated with a low incidence of complications, short hospitalization and a rapid return to preoperative activity levels when compared with open colorectal resections in this age group.
Outcome after surgical resection for high-grade anal intraepithelial neoplasia (Bowen's disease)
Authors: Brown S R , Skinner P , Tidy J , Smith J H , Sharp F , Hosie K B 
Published: March 2003

Abstract

Background
High-grade anal intraepithelial neoplasia (Bowen's disease) may predispose to anal carcinoma. Treatment options include surgical resection but effectiveness remains uncertain. This paper reports long-term follow-up of patients with high-grade anal intraepithelial neoplasia treated by surgical resection.

Methods
Between 1989 and 1996, 46 patients were identified with high-grade anal intraepithelial neoplasia. Thirty-four underwent local excision of all macroscopically abnormal disease and the resulting defect was left open, closed primarily or skin grafted. Regular follow-up subsequently included anoscopy and biopsy of any suspicious lesions.

Results
Median follow-up was 41 (range 12–104) months. Total excision was difficult; 19 patients had histological evidence of incomplete excision at the time of initial resection. Some 12 of 19 had histo-logically proven recurrent high-grade intraepithelial neoplasia within 1 year. Even with microscopically complete excision two of 15 patients subsequently developed recurrent high-grade intraepithelial neoplasia at 6 and 32 months after operation. No patient developed carcinoma but five had complica-tions of anal stenosis or faecal incontinence.

Conclusion
Although no definite recommendations can be made for the treatment of high-grade anal intraepithelial neoplasia, these results illustrate some potential drawbacks of surgical excision with a high potential for incomplete excision and persistent disease, even after complete excision in some patients, and a high morbidity rate.
Mesenteric vein thrombosis due to factor V Leiden gene mutation
Authors: Bergenfeldt M , Svensson P J , Borgström A 
Published: March 2003

Abstract

Background
Mesenteric venous thrombosis is a rare cause of acute abdominal pain that may be the result of coagulation abnormalities.

Methods
Four consecutive patients with mesenteric venous thrombosis underwent haematological evaluation.

Results
All four had activated protein C resistance resulting from a single mutation in the gene coding for coagulation factor V. Three had surgery; in one patient the diagnosis was made by ultrasonography. One of the patients who had surgery died but the other three survived and were treated with long-term anticoagulation.

Conclusion
Activated protein C resistance may be an important pathogenetic factor in primary mesen-teric vein thrombosis.
Marimastat inhibits elastin degradation and matrix metalloproteinase 2 activity in a model of aneurysm disease
Authors: Treharne G D , Boyle J R , Goodall S , Loftus I M , Bell P R F , Thompson M M 
Published: March 2003

Abstract

Background
Abdominal aortic aneurysms are characterized by degradation of the extracellular matrix, with a reduction in the elastin concentration of the arterial media. These changes have been linked to increased levels of endogenous metalloproteinases (MMPs) within the aorta, particularly MMP-2 and MMP-9. This provides a potential therapeutic target for pharmacological agents aimed at reducing the growth rate of small aneurysms. In this study, the ability of marimastat (an MMP inhibitor) to reduce matrix degradation was assessed in a previously described model of aneurysm disease.

Methods
Porcine aortic segments (n = 12) were preincubated in exogenous pancreatic elastase for 24 h before culture in standard conditions for 13 days with marimastat 10−5, 10−6 and 10−7 mol/l. Control segments were cultured both without marimastat and without elastase. At the termination of culture, MMPs were extracted from the tissue and quantified by substrate gel enzymography. The volume fractions of elastin and collagen were determined by stereological analysis of sections stained with Miller's elastin and van Gieson's stain.

Results
Stereological analysis demonstrated preservation of elastin in aorta treated with marimastat at 10–6 and 10–5 mol/l; this was significant at the latter concentration (P = 0·007). This was accompanied by a significant reduction in active MMP-2 activity in the samples treated with marimastat 10–5 mol/l (P &lt; 0·01).

Conclusion
Marimastat significantly inhibited elastin degradation and active MMP-2 production within aortic organ cultures.
Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection
Authors: Bokey E L , Öjerskog B , Chapuis P H , Dent O F , Newland R C , Sinclair G 
Published: March 2003

Abstract

Background
The wide variability of reported local recurrence rates after curative resection of rectal cancer without adjuvant therapy may be a consequence of many different factors. However, few studies have investigated the potential effects of such factors on local recurrence by multivariate analysis. The present study examined clinical and tumour characteristics, operation type and operative technique as potential predictors of local recurrence in patients treated by surgery alone.

Methods
Prospective data were analysed by bivariate and multivariate methods including actuarial survival and proportional hazards regression.

Results
Local recurrence (pelvic or pelvic and systemic) was diagnosed in 59 of 596 patients. The 5-year actuarial local recurrence rate was 11·1 (95 per cent confidence interval 8·7–14·3) per cent. Independent predictive factors for local recurrence were: positive nodes (hazard ratio (HR) 5·5, P &lt; 0·01); distal margin of 1 cm or less (HR 3·8, P &lt; 0·01); venous invasion (HR 2·0, P = 0·02) and total anatomical dissection of the rectum (HR 2·0, P = 0·01). There was no difference in local recurrence between patients who had the mesorectum divided and those in whom it was totally excised.

Conclusion
Nodal involvement is the most potent predictor of local recurrence. In patients in whom total anatomical dissection is performed, total mesorectal excision confers no additional protection against local recurrence.
Experimental study of intraperitoneal suramin on the healing of colonic anastomoses
Authors: Hendriks J M H , Hubens G , Wuyts F L , Vermeulen P , Hubens A , Eyskens E 
Published: March 2003

Abstract

Introduction
The effect of the antiangiogenic agent suramin on the healing of colonic anastomoses was studied in a rat model.

Methods
Rats underwent an end-to-end colonic anastomosis and its healing was tested by measuring bursting pressure, hydroxyproline content and number of newly formed vessels. For the bursting pressure experiment suramin was given intraperitoneally in a dose of 200 mg/kg (maximal tolerable dose) and 100 mg/kg. Hydroxyproline content and vessel density were only tested at 100 mg/kg since the toxicity at this dose was lower whereas bursting pressure was still diminished.

Results
There were no deaths. On the fourth day after operation bursting pressure in the control group was significantly higher than that in rats treated with suramin 200 mg/kg (P = 0·006) and 100 mg/kg (P = 0·002). Rupture occurred at the anastomotic line. On day 7, this difference was not statistically significant. Four days after the operation, the hydroxyproline content and vessel density were significantly below that in control segments (hydroxyproline: 10·3 versus 7·8 μg per mg dry weight; vessel content: 85·7 versus 49·6 vessels per × 100 field for control and suramin-treated rats respectively). On the seventh day no difference in hydroxyproline levels was seen but the vessel density was still diminished significantly (P = 0·04).

Conclusion
Experimentally, suramin significantly inhibits and delays healing of colonic anastomoses.
Comparison of the expression of fibrosis-associated genes in glomeruli after renal transplantation between conventional cadaveric and non-heart-beating donors
Authors: Jain S , Bicknell G R , White S A , Williams S T , Furness P N , Nicholson M L 
Published: March 2003

Abstract

Background
The main difference between cadaveric heart-beating donors and non-heart-beating donors (NHBDs) is the degree of warm ischaemia to which the kidney is subjected. This study was designed to see if this affected the expression of fibrosis-associated genes in the early period after transplantation.

Methods
A series of 29 cadaveric and 19 NHBD renal transplants was studied. Patients underwent protocol needle-core renal transplant biopsies at 1 week, 3 months and 6 months after transplantation. At least two individual glomeruli were isolated from each biopsy. Messenger RNA was extracted and genes of interest were amplified by reverse transcriptase–polymerase chain reaction, then quantified in an enzyme-linked immunosorbent assay system.

Results
Delayed graft function was common in NHBD (17 of 19) compared with cadaveric transplants (six of 29) (P &lt; 0·0001). Acute rejection rates were similar. The level of tissue inhibitor of metalloproteinase 1, an inhibitor of extracellular matrix degradation, was higher in kidneys from NHBDs at 1 week (P = 0·02). There were no other statistically significant differences in the expression of fibrosis-associated genes between the two groups.

Conclusion
Although the increased ischaemic injury in kidneys retrieved from NHBDs leads to a higher rate of delayed graft function, this does not translate into increased expression of fibrosis-associated genes after the first week.
Improved management of infrainguinal bypass graft infection with methicillin-resistant Staphylococcus aureus
Authors: Chalmers R T A , Wolfe J H N , Cheshire N J W , Stansby G , Nicolaides A N , Mansfield A O , Barrett S P 
Published: March 2003

Abstract

Background
There is considerable debate over the management of infected infrainguinal grafts. This report describes recent experience in this field and documents the change in clinical practice needed to deal with methicillin-resistant Staphylococcus aureus (MRSA).

Methods
All infected infrainguinal grafts between January 1991 and July 1997 were reviewed. In the light of the findings, clinical practice was modified considerably. A further 1 year was audited prospectively up to August 1998.

Results
Twenty-six patients were treated for 27 infrainguinal graft infections (25 prosthetic, two vein). Twenty were treated by complete graft excision as the initial therapy; graft preservation was attempted in six patients. Before 1995, the infecting organisms were predominantly Pseudomonas aeruginosa or methicillin-sensitive staphylococci. Subsequently all 14 patients treated up to 1997 had infection with MRSA. The overall amputation rate was 17 of 26; ten amputations were in patients with MRSA. Four patients died, all with MRSA sepsis. As a result of this experience a policy of complete isolation was adopted for all patients infected with MRSA. In the 12 months since this policy was introduced, 77 infrainguinal grafts (61 vein, 16 prosthetic) have been inserted. Two grafts (3 per cent) have become infected, necessitating graft excision and amputation.

Conclusion
MRSA infection of an infrainguinal graft is a serious complication with high associated amputation and mortality rates. Isolation and barrier nursing appeared to contain the problem.
Audit of surgical technique during carotid endarterectomy by intraoperative duplex ultrasonography: trainees compared with consultant
Authors: Padayachee T S , Brooks M D , Self G , Moderesi K B , Taylor P R 
Published: March 2003

Abstract

Background
There has been increasing interest in audit of outcome following surgery. A previous study reported a significant difference in clinical outcome between consultant and trainees but there is no information on technical factors. Duplex ultrasonography before wound closure was used to compare clinical and technical outcome for consultant and trainees.

Methods
Patients underwent endarterectomy (89 by consultant, 60 by six trainees). In the consultant group nine vessels were patched and 36 patients underwent shunting compared with seven and 31 respectively for trainees.

Results
In the consultant group there were two deaths, one stroke, one transient ischaemic attack (TIA) and two cranial nerve injuries. The neurological event rate was 2 per cent, and overall stroke and death rate 3 per cent. There were ten residual flaps (11 per cent) (three re-explored) and eight kinks (9 per cent). The residual stenosis rate was 10 per cent (nine of 89) and following re-exploration this reduced to 7 per cent. In the trainee group there was one death, two strokes, one TIA and one cranial nerve injury. The neurological event rate was 5 per cent, and the overall stroke and death rate 3 per cent. There were nine flaps (15 per cent) (four re-explored) and 13 kinks (22 per cent). The residual stenosis rate was 22 per cent (13 of 60) which reduced to 15 per cent (nine of 60) following re-exploration. There was no significant difference in clinical outcome between consultant and trainees but there was an increased incidence of technical problems among the trainees (t = 2·12, P &lt; 0·05).

Conclusion
Intraoperative duplex ultrasonography is a valuable method for assessing surgical technique; it gives immediate feedback to the surgeon, enables corrective measures to be taken and may facilitate training.
Thrombelastography can differentiate ischaemic from haemorrhagic stroke
Authors: Handa A , Platts A , Tone S , Hamilton G 
Published: March 2003

Abstract

Background
Thrombolysis could be a major step forward in the treatment of acute ischaemic stroke. Early treatment is essential to maximize therapeutic benefit. Imaging by computed tomography (CT) or magnetic resonance imaging is mandatory to exclude haemorrhagic stroke before initiation of therapy. Thrombelastography (TEG), a test of global haemostasis, produces a characteristic tracing over 15–30 min. The potential of TEG to differentiate patients with ischaemic from haemorrhagic stroke was investigated.

Methods
Fifteen patients with a clinical diagnosis of acute stroke were studied. Fibrinogen levels and lipid profiles were measured, and CT of the brain, coagulation screens and TEG were performed. The CT scans were interpreted by a single radiologist. TEG data were classified as normal (index less than 2), hypercoagulable (index 2–3) or profoundly hypercoagulable (index greater than 3).

Results
There was no correlation between any of the parameters studied other than TEG with CT findings. Both patients with a haemorrhagic stroke showed normal findings on TEG. Eleven of the 12 patients with ischaemic stroke were hypercoagulable or profoundly hypercoagulable.

Conclusion
TEG is capable of differentiating haemorrhagic from ischaemic stroke. It has the potential to target thrombolytic therapy for those patients most likely to benefit.
Impact of spontaneous embolization on cognitive function
Authors: Lloyd A J , Smith J L , Loftus I M , Hayes P , Bell P R F , Naylor A R 
Published: March 2003

Abstract

Background
Although microembolization may not be associated with focal neurological events following carotid endarterectomy (CEA), it might contribute towards cognitive impairment.

Methods
Forty-nine patients undergoing CEA underwent 30 min of preoperative ipsilateral transcranial Doppler (TCD) monitoring and a battery of tests of cognitive function, and the results were compared with those of age-matched normal controls.

Results
Seven patients who were spontaneously embolizing had significantly worse preoperative cognitive function scores than 42 patients with no recorded emboli (P = 0·03). Overall, patients undergoing CEA had a significant cognitive deficit compared with age-matched normal controls.

Conclusion
Patients who have evidence of spontaneous preoperative embolization on TCD monitoring have a greater degree of preoperative cognitive impairment. This finding underlines the potential clinical importance of microembolization and suggests that this phenomenon should be investigated further.
Systemic effects of exercise in claudicants are associated with neutrophil activation
Authors: Lewis D R , Day A , Jeremy J Y , Newcombe P V , Brookes S T , Baird R , Smith F C T , Lamont P M 
Published: March 2003

Abstract

Background
Claudication induces potentially harmful systemic effects which may be mediated through free radicals and neutrophil activation. This study examined the impact of these mechanisms on renal tubular function.

Methods
Flow cytometry was used to determine CD11b expression by neutrophils and monocytes, and expression of P selectin (CD62P) by platelets, in 16 patients with intermittent claudication and eight matched controls before and at intervals after exercise. Total antioxidant capacity (TAC) and von Willebrand factor (vWF) were measured at similar intervals. Renal tubular function was assessed before and 60 min after exercise by assay of retinol binding protein: creatinine ratio (RBP: Cr) in urine. All patients and none of the controls had a significant exercise-induced fall in ankle pressure. Fluorescein isothiocyanate-labelled monoclonal antibodies against CD11b and CD62P were added to blood and analysis was performed on the flow cytometer within 72 h.

Results
There were no significant differences in monocytes, platelets or vWF between patients and controls over time. There was a significant change in RBP: Cr following exercise in patients (median 4·2 (95 per cent confidence interval 2·4–85·2); P ≤ 0·01, Wilcoxon test) but not controls (2·7 (–1 to 7·5); P not significant). See Table above.

Conclusion
Renal tubular function was adversely affected by acute exercise in claudicants. TAC was higher in claudicants at rest and was increased after exercise suggesting an increased free radical challenge. Neutrophil activation is significantly different between claudicants and controls before and after exercise, and may provide a link between free radical generation and renal tubular injury.