bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild endotoxaemia during low arginine plasma levels reduces blood flow to the small intestine
Authors: Prins H A , Houdijk A P J , Teerlink T , van Lambalgen A , Thijs L G , van Leeuwen P A M 
Published: March 2003

Abstract

Background
Arginine is the sole precursor in the generation of the vasodilating agent nitric oxide. Plasma levels of arginine are low in situations associated with endotoxaemia such as major trauma, sepsis and experimental obstructive jaundice. The aim of the study was to evaluate haemodynamics at low arginine plasma levels during low-grade endotoxaemia.

Methods
Rats were assigned randomly to receive (at t = 0 min) an intravenous infusion of 1·5 ml sodium chloride 0·9 per cent (SAL, n = 12) or 1·5 ml arginase solution (3200 units) (ASE, n = 17) over 20 min. After the SAL or ASE infusion, rats were randomly assigned to receive an intravenous endotoxin (lipopolysaccharide; LPS; 150 μg kg−1 in 1·0 ml 0·9 per cent sodium chloride) challenge (ASE-LPS, n = 10 and SAL-LPS, n = 6) or a control infusion of 1·0 ml 0·9 per cent sodium chloride (ASE-SAL, n = 7 and SAL-SAL, n = 6) at t = 30 min. Organ blood flow was measured at t = 270 min, using radiolabelled microspheres.

Results
At 270 min arginine plasma levels were lower in the ASE-treated rats (ASE-SAL versus SAL-SAL and ASE-LPS versus SAL-LPS, both P &lt; 0·005). Cardiac output, mean arterial pressure and therefore total peripheral resistance were similar for all groups. In the LPS-treated animals (SAL-LPS and ASE-LPS) cardiac output was maintained by a higher heart rate compensating for the lower stroke volume. Organ blood flow to the small intestine and splanchnic blood flow were lower in the ASE-LPS-treated rats (both P &lt; 0·05 compared with other groups). Total liver blood flow was similar for all groups; the lower splanchnic blood flow was compensated for by a higher hepatic arterial blood flow.

Conclusion
This study shows that low plasma levels of arginine do not influence organ blood flow while, during low-grade endotoxaemia, low arginine plasma levels result in reduced blood flow to the small intestine.
Pilot surveillance in the Netherlands of sepsis related to central vascular catheters
Authors: de Boer A S , Talsma E , Batenburg J , Geubbels E L P E , Mintjes-de Groot A J , van den Berg J M J 
Published: March 2003

Abstract

Background
The aim was to study the feasibility of surveillance of sepsis related to central vascular catheters (CVCs) in the PREZIES network of hospitals in the Netherlands.

Methods
A national expert team developed a surveillance protocol. Ten hospitals conducted the surveillance during 3 months in 1999. The plot was evaluated in an interview with the infection control practitioner (ICP) of each hospital and by analysing the data collected.

Results
ICPs considered this surveillance labour intensive and made recommendations on issues such as further clarifying the case definition and standardization of culturing of blood and catheters. Of 874 patients with one or more CVCs, 29 (3·3 per cent) had CVC sepsis. Most frequently infusion catheters were studied. Median length of stay was 5 days. Catheters in the femoral artery or vein, with more than one lumen, for parenteral feeding, or in place for more than 48 h were associated with CVC sepsis.

Conclusion
The surveillance of CVC sepsis in PREZIES hospitals is feasible and can generate useful reference values.
Moderate hypothermia prevents cell injury in rats with severe haemorrhagic shock
Authors: Güven H , Amanvermez R , Kaya E , Malazgirt Z , Altintop L , Özkan K 
Published: March 2003

Abstract

Background
This study aimed to evaluate a possible protective and therapeutic effect of mild to moderate hypothermia in severe haemorrhagic shock. Brainstem is one of the most sensitive tissues to oxidative stress in the early phase of haemorrhagic shock. The haemorrhagic oxidative stress at various core temperatures was studied using reduced glutathione (GSH) levels and thiobarbituric acid reactive substances (TBARS) as markers of lipid peroxidation in brainstem homogenate.

Methods
Forty rats were divided into four groups, of which one constituted the non-bleeding normothermia control group. In all of the three study groups, the rats were bled to 40 per cent of their estimated blood volume while they were being held at normothermia, mild (32°C) or moderate (28°C) hypothermia. Mean arterial pressure, rectal temperature, heart and breathing rates were recorded during the procedures. After 1 h of shock, tissue samples were removed by craniectomy.

Results
The tissue levels of TBARS increased significantly in normothermic and mildly hypothermic haemorrhagic shock groups (10·74 and 8·26 nmol g−1) compared with control (3·50 nmol g−1) (P &lt; 0·001). However, the tissue TBARS level in the moderately hypothermic group was only minimally increased (4·53 nmol g−1). GSH levels fell slightly in normothermic and mildly hypothermic bleeding rats, and were unchanged in moderately hypothermic rats.

Conclusion
The TBARS level, which was a predictor of oxidant damage, changed slightly during severe haemorrhagic shock when the rats were moderately hypothermic. Hypothermia had a protective effect against cell injury during haemorrhagic shock. Tissue TBARS levels correlated well with the degree of tissue damage; lower levels suggested hypothermic protection.
Role of liver-produced prostaglandins in experimental intra-abdominal sepsis
Authors: Cokek A , Huseyinov A , Sevinc A , Coker I , Sagol O , Sokmen S , Terzi C 
Published: March 2003

Abstract

Background
While the cyclo-oxygenase (Cox) 1 pathway has physiological effects such as maintaining endothelial integrity, Cox-2 also has pathological effects. The role of liver-produced prostaglandins and their specificity were studied in an experimental sepsis model.

Methods
Some 28 male Wistar rats were divided into five groups. In all groups intra-abdominal sepsis was created by caecal ligation and puncture. Group 1 (IASG) comprised five rats and all had intra-abdominal sepsis only. In group 2 (MG; n = 5) all rats received meloxicam 5 mg kg−1. Group 3 (NG; n = 5) received nimesulid 2 mg kg−1. In group 4 (APG; n = 5) antiplatelet activating factor (PAF) agent was administered. Group 5 (MAPG) received meloxicam and anti-PAF. Following 24 h of intra-abdominal sepsis, all rats underwent reoperation. Peritonitis was confirmed pathologically and liver biopsies were performed. The levels of prostaglandin (PG) E2 and PGF2α as prototypic end-products of the Cox-1 and -2 pathway were measured in the biopsy specimens.

Results
The mean PGF2α levels were 539·2, 17·8, 194·4, 341·0 and 229·2 pg per mg liver tissue protein in groups 1–5 respectively. The respective mean PGE2 levels were 422·6, 438·0, 272·6, 331·4 and 205 pg mg−1. PGF2α values in MG were significantly different from those in all other groups (P &lt; 0·001), and those in NG and MAPG were different from those in IASG and APG. On the other hand, PGE2 levels were significantly lower in NG, MAPG and APG than in IASG and MG. Liver tissue PAF was also detected in all groups except NG. Mean PAF levels in IASG, MG, APG and MAPG were 44·4, 33·2, 12·2 and 14·6 pg per mg tissue protein respectively.

Conclusion
(1) PAF is an important mediator in intra-abdominal sepsis. (2) Liver PGF2α may play a role in intra-abdominal sepsis independently from PAF. (3) Anti-PAF agent alone may help healing in peritoneal sepsis, but the main therapeutic agents are PGF2α blocking agents.
Cytokines and myeloperoxidase as markers of purulent-septic complications of acute pancreatitis
Authors: Perejaslov A , Chooklin S 
Published: March 2003

Abstract

Background
Purulent-septic complications often determine the outcome of severe acute pancreatitis. Unfortunately, there are no useful markers that can predict the contamination of necrotic foci.

Methods
Thirty-eight patients with severe pancreatitis were treated. The plasma levels of interleukin (IL) 1, IL-6, IL-8 and myeloperoxidase (MPO) were studied in all patients on days 1, 3, 7, 14 and 21 after the onset of acute pancreatitis.

Results
Raised levels of all inflammatory mediators were observed in all patients on the first day. A gradual decrease in cytokine and MPO levels was noted in patients with sterile necrosis and a favourable course of acute pancreatitis (17 patients). Contamination of the necrotic foci was accompanied by a rise in IL-8 (140·0 pg ml−1 or more) and MPO (11·0 nmol ml−1 or more) levels, which preceded the clinical manifestation of purulent complications. These results were confirmed by ultrasonographically guided aspiration. Two types of purulent-septic complications were identified: local and disseminating. Local purulent-septic complications (nine patients) were characterized by a moderate increase in cytokine levels and were associated with a good prognosis. The disseminating purulent-septic complications group (12 patients) was characterized by highest levels of proinflammatory cytokines, significant multiple organ failure and a poor prognosis. Eight patients with widespread purulent-septic complications died.

Conclusion
IL-8 and MPO plasma levels are valuable markers of infected necrosis in acute pancreatitis.
Dexamethasone in hyperdynamic sepsis in children
Authors: Martino F E , Klein S , Nasatsky E G , Martino G D 
Published: March 2003

Abstract

Background
A recent study analysed the usefulness of dexamethasone (DX) in hyperdynamic sepsis in children. This prospective study was performed in order to confirm or refute the conclusions obtained previously.

Methods
A prospective, randomized and sequential study was performed in 38 patients of both sexes with a mean age of 10 years. Patients had at least five of the following clinical features to be included in the study: hyperthermia, oliguria, tachycardia, tachypnoea, cyanosis or another sign of hypoxaemia, impaired consciousness (confusion, meningeal signs, psychomotor excitation, delirium) and digestive disturbance (haemorrhage, vomiting, diarrhoea). Criteria for exclusion were: previous organ failure (adrenal or renal insufficiency), diabetes, tuberculosis, systemic mycosis, corticosteroid sensibility and immunodeficiency. Patients were divided into two equal groups: placebo control and DX, the latter with forward contribution to the dose of 3 mg kg−1 each time, repeated at 12 and 24 h. In all cases, clinic and laboratory variables used commonly in intensive care were monitored. The evaluations were immediately before, and at 48 and 72 h after, the first dose of DX.

Results
There was no significant difference between the two groups.

Conclusion
The application of macrodoses of DX in hyperdynamic sepsis in children is not indicated.
Macrophages that have ingested apoptotic neutrophils release tissue inhibitor of matrix metalloproteinase 1
Authors: Power C , Wang J H , Street J , Higgins G , Redmond H P 
Published: March 2003

Abstract

Background
Apoptosis of neutrophils (PMNs) in vivo is followed by their rapid uptake into adjacent phagocytic cells, a critical process in tissue remodelling, regulation of the immune response and resolution of inflammation. Tissue inhibitor of matrix metalloproteinase (TIMP) 1 is crucial in regulating the matrix-degrading properties of matrix metalloproteinases released by activated PMNs in inflammatory foci. The aim was to elucidate whether mononuclear-derived phagocytes (MDPs) release TIMP-1 and/or MMP-9 after phagocytosis of apoptotic PMNs.

Methods
MDPs were prepared from peripheral blood monocytes after isolation by culture in well plates for 7–10 days. PMNs were isolated from similarly healthy volunteers. PMN apoptosis was induced by 10 min of ultraviolet irradiation at 254 nm. After a further 6 h of incubation apoptosis was assessed and was routinely greater than 50 per cent. Apoptotic PMNs were then added to MDPs in specific ratios. After 1 h non-phagocytosed PMNs were washed away. RPMI was added to MDPs in well plates and 18 h later the supernatant was collected. Phagocytosis of opsonized zymosan, exposure to tumour necrosis factor (TNF) α and lipopolysaccharide (LPS), and finally MDPs alone were used as controls. TIMP-1 was quantified by enzyme-linked immunosorbent assay.

Results
TIMP-1 was released by MDPs after phagocytosis of apoptotic PMNs and opsonized zymosan. MDPs also produced TIMP-1 after stimulation with TNF-α–LPS. Levels of TIMP-1 from these MDPs were significantly different from those in MDPs alone.

Conclusion
Phagocytosis of apoptotic PMNs is an integral part of the host's attempt to resolve inflammation in altered immune states such as the systemic inflammatory response syndrome in which PMNs persistently release proinflammatory substances damaging the local microenvironment. This study has demonstrated that MDPs release TIMP-1 after phagocytosis of apoptotic PMNs and that this may play a role in the regulation of tissue remodelling and repair in response to inflammation.
Novel animal model of septic shock following smoke inhalation
Authors: Murakami K , Bjertnaes L J , Soejima K , Traber L D , Traber D L 
Published: March 2003

Abstract

Background
The lesions of smoke inhalation often progress in the context of sepsis and other complications of the burn illness to a critical state consistent with acute respiratory distress syndrome (ARDS). The aim of this study was to develop a standardized and reproducible model of sepsis after smoke inhalation in sheep.

Methods
Merino ewes (n = 21) were surgically prepared for the study. Five to seven days later, animals received a tracheostomy and 48 breaths of cotton smoke. Pseudomonas aeruginosa was suspended in 30 ml saline, which contained 2–5 × 1011 colony-forming units, and injected into the right lobe (20 ml) and into the left lobe (10 ml) using a bronchoscope. After the bacterial challenge, the animals were ventilated mechanically with 100 per cent oxygen. Body temperature, haemodynamic parameters, blood gas and blood culture were monitored for 48 h.

Results
The sheep showed a hyperkinetic response and fall in arterial partial pressure of oxygen similar to that seen in severe sepsis in humans. These changes were more severe than in animals with smoke inhalation alone (Fig. 1).

Conclusion
This would be a good animal model of sepsis and ARDS.
Improved survival of tumour necrosis factor-deficient mice during zymosan-induced multiple organ dysfunction syndrome
Authors: Volman T J H , Hendriks T , Kullberg B J , Goris R J A 
Published: March 2003

Abstract

Background
Tumour necrosis factor (TNF) is believed to be a crucial mediator in systemic inflammation and the multiple organ dysfunction syndrome (MODS). Previous studies in this laboratory with a murine model have shown that interventions directed at TNF could mitigate the symptoms of zymosan-induced MODS. The present study aimed to investigate the course of MODS in the absence of TNF.

Methods
Twenty-four TNF/LT-knockout (−/−) mice and 25 wild-type (+/+) mice received an intraperitoneal dose of lipopolysaccharide 40 μg, followed by zymosan 1 mg per g body-weight 6 days later (day 0). Survival, body-weight and body temperature were monitored. At day 22 ten −/− mice and five +/+ mice were killed, and organs were collected and weighed. The remaining animals were followed until day 48, when all were killed and their organs harvested for histological examination.

Results
In all animals zymosan induced an acute sterile peritonitis phase followed by an apparent recovery. From day 8 onwards the +/+ mice entered a third, MODS-like, phase, characterized by loss of body-weight, decreased body temperature and significant mortality rate. At day 22, survival in the −/− mice was 92 per cent, which was significantly (P &lt; 0·05) higher than that in the +/+ mice (60 per cent). In addition, mean body temperature and mean relative body-weight (versus weight at day 0) were 33·3°C and 84 per cent respectively in the +/+ mice. Data for the −/− mice were 35·9°C and 100 per cent respectively (P &lt; 0·05). However, at this time point, both the +/+ mice and the −/− mice showed significant and similar organ damage, indicated by an increase in absolute and relative (versus body-weight) weight of lung, spleen and liver (the last organ only in the −/− mice). Moreover, at day 48 histopathological examination of liver, lungs, spleen and kidneys from the surviving animals showed a similar degree of microscopic damage in both the −/− and +/+ mice.

Conclusion
TNF-deficient mice exhibit significantly improved survival during zymosan-induced MODS and their clinical condition appears to be better than that of wild-type animals. However, surviving animals from both groups eventually display a similar degree of organ damage. Thus, in this murine model, the absence of TNF does not completely protect against MODS.
Experimental model of anorectal transplantation
Authors: O'Bichere A , Shurey S , Sibbons P , Green C , Phillips R K S 
Published: March 2003

Abstract

Background
Anorectal transplantation with pudendal nerve anastomosis after rectal excision is a possible strategy that would avoid a colostomy and recreate potentially normal anorectal function. This study investigates the technical feasibility of anorectal transplantation with pudendal nerve and inferior mesenteric artery and vein anastomosis in a porcine model.

Methods
Four female pigs (22–42 kg) provided donor anorectum for four male recipients (29–39 kg) under standard general anaesthesia. The donor operation involved abdominoperineal excision of rectum (APR) taking the anal sphincter, pudendal neurovascular bundle and inferior mesenteric vessels. The recipient underwent APR, transperineal introduction of the donor graft, anastomoses of the rectum, inferior mesenteric vessels and pudendal neurovascular bundle, and perineal closure. Recorded variables were duration of each step of transplantation, ischaemic time, dimensions of anastomosed structures and postoperative graft viability. Animals were killed at 24 h, the state of the graft was noted and tissue was taken for confirmatory histology.

Results
Mean operation time was 372 (range 303–435) min. Mean ischaemic time was 118 (100–130) min. Before death, observation at laparotomy revealed two pink grafts, one slightly dusky but healthy graft and one outright failure, reflecting the state of the mesenteric vessels, which were patent in three and thrombosed in one. Histological examination showed no difference between control biopsies and the three cases with satisfactory mesenteric flow. Gross ischaemia was present histologically in the failed case.

Conclusion
Anorectal transplantation is technically feasible in a pig model. Longer-term studies are now needed to assess return of function and overcome rejection issues.
Surgical treatment of adult primary hepatic sarcoma
Authors: Poggio J L , Nagorney D M , Nascimento A G , Rowland C , Kay P , Young R M , Donohue J H 
Published: March 2003

Abstract

Background
Primary sarcomas of the liver are extremely rare in adults. Optimal therapeutic approaches remain unclear.

Methods
Twenty consecutive adult patients who had surgical treatment for primary hepatic sarcomas were reviewed. Patient age ranged from 23 to 80 years. Other than one patient with primary hepatic angiosarcoma who had a history of thorium dioxide colloid (Thorotrast) exposure 23 years before diagnosis, no predisposing causes were apparent. Nineteen patients had hepatic resection and one patient had an orthotopic liver transplant. No patient received neoadjuvant chemotherapy or radiotherapy but radiotherapy was delivered intraoperatively in one patient.

Results
Leiomyosarcoma was the most common histological type of sarcoma diagnosed (five of 20 patients), followed by malignant solitary fibrous tumour (four) and epithelioid haemangioendothelioma (three). Fourteen tumours were high-grade sarcomas and six were low grade malignancies. Thirteen patients developed a recurrence. Distant metastases (ten patients) and intrahepatic recurrence (six) were the predominant sites of initial treatment failure. Six patients received salvage chemotherapy. Histological grade was the only factor significantly associated with overall patient survival (P = 0·03). With complete resection, patients with high-grade tumours had a 5-year survival rate of 18 (95 per cent confidence interval 5–62) per cent compared with 80 (52–100) per cent for patients with low-grade tumours. The 5-year survival rate for all 20 patients was 37 (20–60) per cent.

Conclusion
Surgical resection is the only effective therapy for primary hepatic sarcomas at present. Better adjuvant therapy is necessary, especially for high-grade malignancies, owing to the high failure rate with operation alone.
Safety of a single duplex scan to exclude deep venous thrombosis
Authors: Wolf B , Nichols D M , Duncan J L 
Published: March 2003

Abstract

Background
Guidelines advocate that a negative ultrasonographic scan needs to be followed by venography, or a repeat scan after 1 week, to detect potentially missed calf vein thrombosis. This study aimed to evaluate whether anticoagulation can safely be withheld on the basis of a single negative duplex scan in patients presenting with suspected deep venous thrombosis (DVT).

Methods
Duplex scan reports, case notes and questionnaires returned by general practitioners of patients with suspected DVT were analysed retrospectively. The main outcome measure was occurrence of an adverse thromboembolic event, a symptomatic DVT or a pulmonary embolism, within 3 months after a negative duplex scan.

Results
Some 537 patients had 706 leg scans performed, the majority because of leg symptoms or to look for indirect evidence of pulmonary embolism. Among 352 patients, who had 429 negative leg scans, four possible adverse events were identified. The rate of adverse outcome was therefore 1·1 per cent per patient and 0·9 per cent per leg.

Conclusion
Withholding anticoagulation in patients who had a single, complete, negative duplex scan is safe. A repeat scan should be performed if there is ongoing high clinical suspicion and considered in patients in whom the calf veins could not be visualized.
Results of surgical treatment for faecal incontinence
Authors: Österberg A , Eeg-Olofsson K Edebol , Graf W 
Published: March 2003

Abstract

Background
This prospective study was designed to evaluate the results of anterior levatorplasty and sphincteroplasty for faecal incontinence with respect to symptomatic and physiological outcome.

Methods
Thirty-one patients with idiopathic (neurogenic) faecal incontinence underwent anterior levatorplasty and 20 patients with traumatic anal sphincter injury underwent anal sphincteroplasty. The outcome of repair was evaluated at 3 and 12 months using a validated questionnaire and anorectal manometry/manovolumetry.

Results
Eighteen of 31 patients in the levatorplasty group reported continence to solid and liquid stools 1 year after operation compared with two patients before surgery (P &lt; 0·01). The corresponding figures in the sphincteroplasty group were ten and two of 20 respectively (P &lt; 0·05). The incontinence score was improved in both groups after 1 year, from a median score of 14 to 3 in the levatorplasty group (P &lt; 0·001) and from 8·5 to 3·5 in the sphincteroplasty group (P &lt; 0·01). Improvements in the degree of social and physical handicap were also observed in both groups. No changes were seen in anal canal pressures or rectal sensation in either group.

Conclusion
Despite different aetiologies and surgical approaches, anterior levatorplasty and sphincteroplasty yielded similarly successful results in patients with faecal incontinence. Although a marked symptomatic improvement was seen in both groups, no associated physiological alterations could be detected. The reason for the improvement is thus unclear, but it may result from a stenosing effect in the anal canal.