bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasminogen mediates liver regeneration and angiogenesis after experimental partial hepatectomy
Authors: Drixler T A , Vogten J M , Gebbink M F B G , Carmeliet P , Voest E E , Borel Rinkes I H M 
Published: October 2003

Abstract

Background
Plasmin system components are upregulated after partial hepatectomy, but their contribution to surgery-induced hepatic angiogenesis and regeneration is unclear. Liver regeneration and angiogenesis after partial hepatectomy were examined in mice lacking plasminogen or urokinase plasminogen activator (uPA).

Methods
Mice with a single-gene deletion of plasminogen or uPA were subjected to 70 per cent partial hepatectomy. Liver regeneration was measured as relative liver weight and cell proliferation index. Angiogenesis was quantified by determining hepatic microvessel density after staining for sinusoidal endothelial cells.

Results
The liver remnant weight was significantly reduced in mice lacking plasminogen or uPA compared with that in wild-type mice on days 2 and 7 after partial hepatectomy. This correlated with impaired cell proliferation. In wild-type mice, regeneration was accompanied by a significant increase in microvessel density after hepatectomy; this increase was impaired in plasminogen-deficient mice.

Conclusion
Plasminogen and uPA are essential for optimal liver regeneration. In addition, plasminogen appears to be a major determinant in regeneration-associated hepatic angiogenesis.
Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer
Authors: Martling A , Holm T , Bremmer S , Lindholm J , Cedermark B , Blomqvist L 
Published: October 2003

Abstract

Background
Despite radiotherapy and improved surgical techniques, local recurrence rates after treatment of rectal cancer still vary between 3 and 30 per cent. Tumour involvement of the circumferential resection margin (CRM) predicts a high risk of local recurrence. Magnetic resonance imaging (MRI) allows accurate description of the tumour and its spread within the mesorectum. The aim of this study was to assess the prognostic impact of an involved CRM identified at preoperative MRI in patients with rectal cancer.

Methods
Preoperative MRI was performed in 115 patients with rectal cancer between 1995 and 1999. The images were evaluated retrospectively. The shortest distance from the tumour to the CRM was measured, correlated with patient outcome and compared with histopathological findings.

Results
The risk of any recurrence in patients with or without a tumour-involved margin on MRI was nine of 29 and nine of 57 respectively (P = 0·036). Overall survival at 5 years was 43 and 77 per cent (P = 0·012) respectively. Twenty-four of 30 patients who had an involved CRM on histopathology were correctly identified by MRI.

Conclusion
Patients with a potentially involved CRM identified by MRI had a significantly higher risk of recurrence and cancer-related death. Preoperative MRI may be of prognostic value in rectal cancer and may be used to select patients for neoadjuvant radiochemotherapy and/or more radical surgery.
Removal of two sentinel nodes accurately stages the axilla in breast cancer
Authors: Kennedy R J , Kollias J , Gill P G , Bochner M , Coventry B J , Farshid G 
Published: October 2003

Abstract

Background
Assessment of lymph node status in breast cancer is still necessary for staging. Sentinel lymph node biopsy (SNB) may provide accurate staging with less morbidity than axillary clearance. The aim of this study was to assess the effect of the number of sentinel nodes removed on the false-negative rate.

Methods
Data were collected prospectively from 395 women undergoing SNB for breast cancer, between June 1995 and December 2001. All nodes that were hot and/or blue were removed and analysed.

Results
During this interval 136 patients who had SNB were lymph node positive. The median number of sentinel nodes removed was two (range one to five). The overall false-negative rate of SNB in these women was 7·1 per cent. If only one sentinel node had been removed, the false-negative rate would have been 16·5 per cent. The removal of more than two nodes had no effect on axillary staging in all but two women.

Conclusion
In early breast cancer, when there were multiple sentinel nodes, removal of two sentinel nodes significantly reduced the false-negative rate compared with removal of one node. Removing more than two sentinel nodes did not significantly reduce the false-negative rate further.
Sequential physiology scoring facilitates objective assessment of resuscitation in patients with an intra-abdominal emergency
Authors: O'Dair G N , Leaper D J 
Published: October 2003

AbstractBackgroundPatients who present with an intra-abdominal emergency often require urgent surgery. Before surgery a period of resuscitation is undertaken pre-emptively, or to correct any overt physiological derangement. The assessment of response to resuscitation and the decision when to operate is subjective. This study examined the role of sequential physiology scores in assessing the response to resuscitation objectively.MethodsSequential physiology scores were recorded in 92 patients with abdominal pathology that subsequently required urgent or emergency surgery. The physiology component of the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM), Acute Physiology And Chronic Health Evaluation (APACHE) II and III, and Simplified Acute Physiology Score (SAPS) II were determined at presentation, during resuscitation and immediately before surgery.ResultsThere were 76 survivors;16 patients died. All scoring systems showed an improvement during resuscitation but subsequent deterioration before surgery. The POSSUM, and APACHE II and III physiology scores differentiated more effectively between survivors and patients who died than SAPS II.ConclusionSequential physiology scores may facilitate the assessment of patients' response to resuscitation. Patients who fail to respond to resuscitation when identified may benefit from more expedient surgery.
Abdominal aortic aneurysms in the New Zealand Maori population
Authors: Rossaak J I , Sporle A , Birks C L , van Rij A M 
Published: October 2003

Abstract

Background
Abdominal aortic aneurysm (AAA) is believed to be a rare disease in people of non-European descent. Maori, New Zealand's indigenous people, are thought to originate from South East Asia, so their incidence of AAA might also be expected to be low. The aim was to investigate the incidence and phenotypic factors associated with AAA in the New Zealand Maori population.

Methods
A retrospective study was performed using the audit database of the New Zealand Society of Vascular Surgeons. Age-standardized rates of admission and death were calculated for Maori and non-Maori.

Results
Maori comprised 3·9 per cent of the population who had an AAA repaired, similar to the percentage of the Maori population aged over 65 years. However, the death rate from AAA in Maori was 2·4 times the rate in non-Maori. Maori were younger at diagnosis than non-Maori (65·2 versus 71·8 years; P &lt; 0·001), had more emergency procedures (46·6 versus 30·2 per cent; P = 0·018) and a significantly higher proportion of Maori admissions were for a ruptured aneurysm.

Conclusion
Maori had a higher mortality rate from AAA than non-Maori New Zealanders. Although admission rates between Maori and non-Maori were similar, the earlier age of onset and the increased proportion of ruptured aneurysms may indicate that the disease is more severe in Maori.
Isolated hepatic perfusion with high-dose melphalan for the treatment of colorectal metastasis confined to the liver
Authors: Rothbarth J , Pijl M E J , Vahrmeijer A L , Hartgrink H H , Tijl F G J , Kuppen P J K , Tollenaar R A E M , van de Velde C J H 
Published: October 2003

Abstract

Background
Isolated hepatic perfusion (IHP) involves complete vascular isolation of the liver to allow treatment with doses that would be toxic if delivered systemically. A phase II study of IHP in patients with colorectal metastases confined to the liver was performed.

Methods
Seventy-three patients with irresectable colorectal metastases underwent IHP with high-dose melphalan (200 mg) for 1 h. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria and tumour response was assessed according to World Health Organization criteria.

Results
Seventy-one patients were perfused according to the protocol. Four patients died within 30 days after IHP, resulting in an operative mortality rate of 5·6 per cent. Sixteen patients (22·5 per cent) experienced grade 3–4 hepatotoxicity 1 week after IHP, which was transient and resolved within 3 months in all patients. The tumour response rate (complete or partial remission) was 59 per cent. Median time to progression was 7·7 (range 2·3–31·4) months. Overall median survival after IHP was 28·8 months with a 3-year survival rate of 37 per cent.

Conclusion
IHP for irresectable colorectal metastases confined to the liver resulted in good response rates and long-term survival in a selected group of patients.
Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma
Authors: Ginzburg E , Cohn S M , Lopez J , Jackowski J , Brown M , Hameed S M 
Published: October 2003

Abstract

Background
After trauma, up to 60 per cent of immobilized patients have been reported to develop a silent deep vein thrombosis (DVT). No large, prospective randomized trials have tested the efficacy of intermittent pneumatic compression (IPC) devices in these patients.

Methods
A prospective randomized trial was performed of 442 patients who received thromboprophylaxis using either an IPC device or low molecular weight heparin (LMWH). Duplex imaging was performed on both legs on admission, and was repeated weekly thereafter until discharge, at 30 days or when there was a thrombotic event, whichever occurred first.

Results
There were no significant differences in time spent in intensive care, or the proportion of patients with pelvic fractures, spinal cord or head injuries between the two groups. Six patients (2·7 per cent) developed a DVT in the IPC group and one (0·5 per cent) in the LMWH group (P = 0·122). Pulmonary embolism occurred in one patient in each group. There were 13 minor bleeding episodes (four in the IPC group and nine in the LMWH group) and eight major bleeding episodes (four in each group), none of which required operative intervention.

Conclusion
The low rate of thromboembolic complications and the cost savings suggest that IPC might be used safely and effectively for thromboprophylaxis in trauma patients.
Percutaneous transhepatic choledochoscopic removal of intrahepatic stones
Authors: Cheung M-T , Wai S-H , Kwok P C-H 
Published: October 2003

Abstract

Background
Treatment of hepatolithiasis is complex and difficult. With the advent of biliary endoscopy and radiological intervention, percutaneous choledochoscopic removal of intrahepatic stones has become a well established procedure.

Methods
Seventy-nine patients with intrahepatic stones that were removed by percutaneous transhepatic choledochoscopy (PTCS) between 1993 and 2001 were studied retrospectively. The results of the procedure and the long-term outcome of these patients were analysed.

Results
The success rate of choledochoscopic removal of intrahepatic stones was 76·8 per cent. Complications occurred in 17 patients (21·5 per cent). Removal of stones predominantly on the right side was difficult using this method. Cholangitis occurred in about one third of patients within 3–5 years after PTCS. For patients with a stricture, cholangitis recurred gradually over the years of follow-up.

Conclusion
Intrahepatic stricture was the major determinant for the recurrence of stones or symptoms. Hepatic resection should be offered to these patients if the disease is localized in one liver segment or lobe. In other cases, percutaneous choledochoscopy and stricture dilatation is a useful solution, and may reduce further damage to the liver.
Effect of neoadjuvant chemoradiotherapy on angiogenesis in oesophageal cancer
Authors: McDonnell C O , Bouchier-Hayes D J , Toomey D , Foley D , Kay E W , Leen E , Walsh T N 
Published: October 2003

Abstract

Background
Vascular endothelial growth factor (VEGF) levels are raised in the serum of patients with oesophageal carcinoma. The aim of this study was to evaluate the tumour microvasculature and the role of tumour-associated macrophages in VEGF production after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer.

Methods
Sections from 92 consecutively resected oesophageal tumours were stained for VEGF, von Willebrand factor and CD68. Twenty-seven patients received preoperative chemoradiation and 65 underwent surgical excision alone. The cellular source of VEGF was determined by parallel-section staining. Microvessel density and macrophage count were determined for each tumour by means of image analysis software.

Results
There were no significant differences between the two groups in age, sex or tumour type. Local downstaging of disease was evident in most specimens of tumours that had received preoperative chemoradiation. All tumours stained positive for VEGF, including those demonstrating a complete pathological response. Staining of parallel sections confirmed macrophages as the principal source of VEGF. Mean microvessel density was 6·4 per high-power field (h.p.f.) in tumours that received preoperative chemoradiation compared with 5·3 per h.p.f. in those treated by surgery alone (P = 0·130). A significant increase in tumour-associated macrophage infiltration was noted in tumours treated with neoadjuvant chemoradiation (22·1 per h.p.f.) compared with those treated by surgery alone (14·3 per h.p.f.) (P = 0·042).

Conclusion
Preoperative chemoradiation had little effect on the local angiogenic profile of the tumour in patients with oesophageal cancer. Tumour-infiltrating macrophages seem to be the source of persistent VEGF production after chemoradiotherapy and might explain the raised serum levels. Addition of an antiangiogenic agent to this regimen may be worthwhile in patients with oesophageal carcinoma.
Laparoscopic donor nephrectomy
Authors: Handschin A E , Weber M , Demartines N , Clavien P-A 
Published: October 2003

AbstractBackgroundLiving kidney donation represents an important source of organs for patients with end-stage renal failure. Over the past decade, laparoscopic donor nephrectomy has replaced the conventional open procedure in many transplant centres. Using evidence-based methods, this study examines the current status of laparoscopic donor nephrectomy.MethodA Medline literature search (PubMed database, 1999–2002) and manual cross-referencing were performed to identify all articles relating to laparoscopic donor nephrectomy. Safety and efficacy criteria were analysed systematically for each study. Studies included were categorized using an evidence-based level grading system.ResultsOf 687 publications, 20 studies with level I–II evidence and 12 with level III evidence were analysed. Only one level I study could be identified. Level I and level II evidence suggests superiority of the laparoscopic approach in regard to postoperative analgesic consumption, hospital stay and return to work. Other safety and efficacy criteria, including donor and recipient outcomes, were similar between the two techniques.ConclusionLaparoscopic donor nephrectomy has gained community acceptance by physicians and patients over the past decade. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the ‘gold standard’ for donor nephrectomy in the near future.
Meta-analysis to determine the incidence of obstetric anal sphincter damage
Authors: Oberwalder M , Connor J , Wexner S D 
Published: October 2003

Abstract

Background
The reported incidence of anal sphincter injury after first (11·5–35·0 per cent) and subsequent (3·4–12·1 per cent) vaginal deliveries varies widely. In addition, the reported incidence of associated faecal incontinence ranges from zero to 68·2 per cent. The aim of this study was to perform a meta-analysis of reported incidences of postpartum anal sphincter defect diagnosed by endoanal ultrasonography (EAUS) and associated incidences of faecal incontinence.

Methods
A Medline search yielded five studies with more than 100 subjects who underwent EAUS after childbirth for evaluation of anal sphincter disruption and who were questioned about symptoms of faecal incontinence, defined as any impairment in flatus and stool control but not including urgency of defaecation. A Bayesian meta-analysis was performed to produce one inference while accounting for potential heterogeneity among the five study populations.

Results
Meta-analysis of 717 vaginal deliveries revealed a 26·9 per cent incidence of anal sphincter defect in primiparous women and an 8·5 per cent incidence of new sphincter defects in multiparous women. Overall, 29·7 per cent of anal sphincter defects were symptomatic. Some 3·4 per cent of women experienced postpartum faecal incontinence without an anal sphincter defect. In a Bayesian calculation, the probability of postpartum faecal incontinence due to a sphincter defect was 76·8–82·8 per cent.

Conclusion
The incidence of occult anal sphincter disruption following vaginal delivery is much higher than commonly estimated. However, at least two-thirds of occult defects are asymptomatic postpartum. The probability of faecal incontinence associated with an anal sphincter defect was 76·8–82·8 per cent.
Determination of the ﬂavone tricin in human plasma by high‐performance liquid chromatography
Authors: Cai Hong , Verschoyle Richard D. , Steward William P. , Gescher Andreas J. 
Published: October 2003

AbstractTricin is a ﬂavone constituent of brown rice and rice bran, which interferes potently with the survival of human‐derived breast and colon cancer cells in vitro. A speciﬁc and simple high‐performance liquid chromatographic (HPLC) method was developed for the determination of tricin in human plasma with UV–visible detection. HPLC separation on Hypersil‐BDS C18 (4.6 × 250 mm) was carried out with an isocratic mobile phase of 52% methanol in 0.1 m ammonium acetate, pH 5.10, containing 0.27 mm disodium ethylenediamine tetraacetic acid and detection at 355 nm. The retention times of tricin and quercetin (internal standard) were 14.2 and 7.8 min, respectively. The assay was linear in the range 1–100 µg/mL (r2 ≥ 0.995). Tricin in plasma was efﬁciently extracted with 0.1 m acetic acid in acetone, and the recoveries were in the range 92.6–102.8% (n = 6) with relative standard deviation below 10% for three concentrations of tricin, 5, 10 and 100 µg/mL. The lower limit of quantitation (relative standard deviation <20%) was 1 µg/mL. Copyright © 2003 John Wiley & Sons, Ltd.
An HPLC‐MS method for simultaneous estimation of α,β‐arteether and its metabolite dihydroartemisinin, in rat plasma for application to pharmacokinetic study
Authors: Rajanikanth M. , Madhusudanan K. P. , Gupta R. C. 
Published: October 2003

AbstractThis manuscript reports, the development and validation of a sensitive and selective assay method for simultaneous determination of α,β‐arteether and its metabolite dihydroartemisinin (DHA) in rat plasma by liquid chromatography–mass spectrometry. Chromatographic separations were achieved by gradient elution of the analytes with an initial composition of methanol–potassium acetate buffer (pH 4; 73:27, v/v) to 100% methanol in 3 min and maintained for 5 min on a Spheri‐10, RP18 (100 × 4.6 mm i.d.) column following an RP18 (30 × 4.6 mm i.d.) guard column. The total efﬂuent from the column was split so that one‐tenth was injected into the electrospray LC/MS interface. ESI‐MS analysis was performed using a Micromass Quattro II Triple Quadrupole Mass Spectrometer equipped with an electrospray source. The MS analysis was carried out at cone voltage of 22 V with a scan range of 200–500 Da. The analytes were quantiﬁed from the [M+ K]+ ion chromatograms of α,β‐arteether at m/z 352, DHA at m/z 323, artemisinin at m/z 321 and propyl ether analogue of arteether at m/z 365. Liquid–liquid extractions with a combination of n‐hexane and hexane–ethyl acetate (8:2) were used to isolate α,β‐arteether and DHA from rat plasma. The method was validated and gave good accuracy and precision for the studied domain. Linearity in serum was observed over the range 4.375–70 ng/mL for a‐arteether and 10–160 ng/mL for β‐arteether and DHA. Percentage bias (accuracy) and within‐ and between‐assay precision were well within the acceptable range. This method was applied to study the pharmacokinetics following oral administration of α,β‐arteether (30 mg/kg) in rats. Copyright © 2003 John Wiley & Sons, Ltd.
HPLC investigation of free and bound propofol in human plasma and cerebrospinal ﬂuid
Authors: Dawidowicz Andrzej L. , Kalityński Rafał 
Published: October 2003

AbstractThe paper compares the total propofol concentration in the cerebrospinal ﬂuid (CSF) with the free drug concentration in plasma measured in 35 humans scheduled for elective neurosurgical procedures during propofol anaesthesia. The concentrations of total and free propofol in the blood and CSF samples were measured by means of HPLC using liquid–liquid extraction and ultraﬁltration in the sample preparation procedure. The arterial blood and CSF samples (collected from intraventricular drainage) were taken at the same time. According to the obtained results, the usually expected equality between free drug concentration in plasma and its total concentration in CSF is not valid for propofol: the unbound propofol concentration in plasma is not equal to its total concentration in CSF (p < 0.05). This difference suggests a substantial contribution of active transport in propofol transfer from blood into CSF. Moreover, the paper shows the presence of bound propofol in CSF, which is a novel ﬁnding. Copyright © 2003 John Wiley & Sons, Ltd.
Simple high‐performance liquid chromatographic assay for melphalan in perfusate, rat liver and tumour tissue
Authors: Sparidans Rolf W. , Silvertand Linda , Dost Frits , Rothbarth Joost , Mulder Gerard J. , Schellens Jan H. M. , Beijnen Jos H. 
Published: October 2003

AbstractA simple, sensitive and selective reversed‐phase liquid chromatographic assay has been developed and validated for the anti‐cancer agent melphalan in perfusate, liver and tumour tissue originating from isolated rat liver perfusion studies. Melphalan was extracted from the matrix using ice‐cold methanol. The drug and the internal standard, propylparaben, were detected using ultraviolet absorbance at 262 nm. The assay has been validated in the 0.05–25 µg/mL range for perfusate; the lower limit of quantiﬁcation (LLQ) is 0.05 µg/mL in perfusate and 0.25 ng/mg in liver and tumour tissues. Accuracies ranged from 89 to 110% and the inter‐assay precisions were all below 15% (20% at the LLQ). Melphalan in a biological matrix has to be processed between 0 and 4°C and is stable under all relevant processing and storage conditions tested. The assay has been exhaustively used in isolated liver perfusion studies with the drug demonstrating its applicability. Copyright © 2003 John Wiley & Sons, Ltd.