bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical presentation of the pseudomyxoma peritonei syndrome
Authors: Esquivel J , Sugarbaker P H 
Published: July 2002

Abstract

Background
Pseudomyxoma peritonei syndrome is characterized by a gradual expansion of mucoid tumour and fluid at specific sites within abdominopelvic regions as a result of a perforated appendiceal adenoma. The aim was to analyse the presenting symptoms and signs of patients with this condition.

Methods
Of 410 patients with appendiceal tumours 217 had the diagnosis of pseudomyxoma peritonei syndrome with histological confirmation. A retrospective review of the clinical characteristics that determine presentation was performed.

Results
Overall, suspected acute appendicitis was the most common presentation (27 per cent). For women the diagnosis was most commonly made while being evaluated for an ovarian mass (39 per cent). Increasing abdominal girth was the second most common presentation overall (23 per cent). Thirty patients (14 per cent) presented with new-onset hernia, of which the majority (26) were inguinal hernias.

Conclusion
Consideration of appendicitis, increased abdominal girth, ovarian mass and new-onset hernia as caused by this syndrome may facilitate diagnosis and definitive treatment.
Localization of matrix metalloproteinase 2 within the aneurysmal and normal aortic wall
Authors: Crowther M , Goodall S , Jones J L , Bell P R F , Thompson M M 
Published: July 2002

Abstract

Background
Current research has shed new light on the role of matrix metalloproteinase (MMP) 2 in the development of abdominal aortic aneurysms (AAAs). MMP-2 is a major protease in the wall of small aneurysms and is produced at increased levels by smooth muscle cells derived from AAAs compared with normal controls. In vivo, MMP-2 is produced as an inactive proenzyme that is activated predominantly by the cell membrane-bound enzyme, membrane type 1 matrix metalloproteinase (MT1-MMP). This study investigated the production of the MMP-2–MT1-MMP–tissue inhibitor of metalloproteinases (TIMP) 2 system within the wall of aortic aneurysms and in age-matched control arterial tissue.

Methods
Arterial tissue from four patients with aortic aneurysms and four age-matched aortic samples was examined for the production and expression of MMP-2, TIMP-2 and MT1-MMP protein using immunohistochemistry, in situ hybridization and in situ zymography.

Results
All components of the MMP-2–TIMP-2–MT1-MMP enzyme system were detected in the arterial wall of both aneurysm and control samples, specifically in the medial tissue. The enzymes co-localized with medial smooth muscle cells. Gelatinolytic activity was localized to elastin fibres in normal and aneurysmal aorta.

Conclusion
The presence of MT1-MMP within the media of arterial tissue suggests a powerful pathway for the activation of MMP-2. The localization of the MMP-2–TIMP-2–MT1-MMP enzyme system to the medial layer of the arterial wall gives support to the concept that this system may play an aetiological role in the pathogenesis of AAAs.
Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis
Authors: Powell J J , Murchison J T , Fearon K C H , Ross J A , Siriwardena A K 
Published: July 2002

Abstract

Background
Recent evidence suggests that intestinal dysfunction has a role in sustaining the systemic inflammatory response in acute pancreatitis and may be ameliorated by the introduction of enteral nutrition. This study therefore assessed the effect of early enteral nutrition on the systemic inflammatory response in patients with prognostically severe acute pancreatitis.

Methods
Patients with prognostically severe acute pancreatitis within 72 h of disease onset were randomized to receive either enteral nutrition or conventional therapy consisting of a nil-by-mouth regimen. Serum interleukin (IL) 6, soluble tumour necrosis factor receptor I (sTNFRI) and C-reactive protein (CRP) were used as markers of the inflammatory response. Intestinal function was assessed using a differential sugar permeability technique.

Results
Of 27 patients, 13 received enteral nutrition. A median of 21 (range 0–100) per cent of calorific requirements was delivered over the first 4 days by enteral nutrition. There were no significant complications of enteral nutrition. The introduction of enteral nutrition did not affect the serum concentrations of IL-6 (P = 0·28), sTNFRI (P = 0·53) or CRP (P = 0·62) over the first 4 days of the study. Although there were no significant differences in intestinal permeability between the two patient groups at admission (χ2 = 2·33, d.f. = 1, P = 0·13), by day 4 abnormal intestinal permeability occurred more frequently in patients receiving enteral nutrition (χ2 = 4·94, d.f. = 1, P = 0·03)

Conclusion
Early enteral nutrition did not ameliorate the inflammatory response in patients with prognostically severe acute pancreatitis. Furthermore, it did not have a beneficial effect on intestinal permeability.
Causes of re-recurrence after polytetrafluoroethylene patch saphenoplasty for recurrent varicose veins
Authors: Bhatti T S , Whitman B , Harradine K , Cooke S G , Heather B P , Earnshaw J J 
Published: July 2002

Abstract

Background
The aim of this study was to determine whether a polytetrafluoroethylene (PTFE) patch sutured over the religated saphenofemoral junction could reduce the rate of recurrence after operation for recurrent varicose veins.

Methods
Fifty patients who had surgery for recurrent long saphenous incompetence (81 legs had a small PTFE patch sutured over the religated saphenofemoral junction. There were no major complications following surgery. Three patients had a wound infection or delayed healing. All patients were invited for clinical examination and duplex imaging at a median of 19 (range 6–39) months after operation.

Results
Some 38 of 43 patients (70 legs) remained satisfied with the results of surgery; 16 (23 per cent) of 70 legs had visible veins on inspection and eight of these (11 per cent) involved symptomatic recurrence. Duplex imaging showed that recurrence was due to saphenofemoral junction incompetence in ten legs; two appeared to have a major groin connection but the other eight appeared to have neovascularization. Other causes were thigh perforator reflux (three legs) and cross-groin collaterals (three). Eleven of the 16 legs with recurrence had varicography but in two the procedure was a technical failure. Two legs had evidence of a significant connection (more than 3 mm) and two a minor connection (less than 3 mm) to the femoral vein at the level of the PTFE patch, but in the remainder recurrence was due to upper thigh perforating veins. There was good concordance between duplex imaging and varicography.

Conclusion
PTFE patch saphenoplasty appears to be safe. Although these are early results, the technique seems potentially as effective as other barrier methods that have been investigated; in ten legs (12 per cent) recurrence was attributed to failure at the level of the PTFE patch.
Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy
Authors: Khalil K H , O'Bichere A , Sellu D 
Published: July 2002

Abstract

Background
Stapled haemorrhoidectomy does not involve dissection, with its attendant potential morbidity, required to perform closed haemorrhoidectomy. This study compared haemorrhoidectomy with (sutured) and without (stapled) preliminary dissection.

Methods
Forty patients with prolapsed symptomatic haemorrhoids were randomly assigned to sutured (n = 20) or stapled (n = 20) haemorrhoidectomy. Preoperative assessment was by proctoscopy, sigmoidoscopy and anal manometry. Stapled and diathermy haemorrhoidectomies with wound suture were performed, and excised tissue was examined histologically. Pain scores, complications, wound healing and patient satisfaction were recorded. Follow-up was weekly for 4 weeks, and at 3 and 6 months; anal manometry was repeated at the last two visits.

Results
Postoperative resting and squeeze pressures were reduced by the stapled method at 3 months (P = 0·02 and P = 0·03 respectively), returning to baseline by 6 months. Stapled haemorrhoidectomy was quicker but initial access into the anus was hampered by the bulky stapler. Isolated muscle fibres were identified equally in both groups, but incontinence did not occur. The stapled technique resulted in less postoperative pain (P = 0·04), a greater degree of satisfaction (P = 0·01) and faster wound healing (P &lt; 0·001), but was more expensive. There was no significant difference in complications.

Conclusion
Despite the higher cost and difficult access, stapled haemorhoidectomy results in less postoperative pain, faster wound healing and greater patient satisfaction than the sutured technique.
Short-term results of femoropopliteal subintimal angioplasty
Authors: McCarthy R J , Neary W , Roobottom C , Tottle A , Ashley S 
Published: July 2002

Abstract

Background
Subintimal angioplasty may be more successful than conventional (intraluminal) angioplasty for treatment of long femoropopliteal occlusions. This study assessed the clinical and haemodynamic outcome of subintimal angioplasty.

Methods
All patients with femoropopliteal occlusions treated by subintimal angioplasty over a 3-year period at two centres were reviewed. Clinical assessment and colour duplex imaging were carried out.

Results
Sixty-nine procedures were performed in 33 men and 33 women of median age 74 (range 47–92) years. Indications for treatment were intermittent claudication in 26 (38 per cent) and critical limb ischaemia in 43 (62 per cent). Median occlusion length was 10 (range 2–50) cm. Primary technical success was achieved in 51 occlusions (74 per cent). There were 11 complications (16 per cent); the majority were minor but surgical intervention was required in two patients (3 per cent). At 6 months the cumulative symptomatic and haemodynamic primary patency rates were 60 and 51 per cent respectively, analysed on an intention-to-treat basis. The symptomatic and haemodynamic patency rates for technically successful procedures were 80 and 77 per cent respectively.

Conclusion
In this series the short-term clinical success of subintimal angioplasty was poor because of a high incidence of reocclusion and restenosis, despite a relatively high initial technical success rate.
Chronic dysphagia following laparoscopic fundoplication
Authors: Bessell J R , Finch R , Gotley D C , Smithers B M , Nathanson L , Menzies B 
Published: July 2002

Abstract

Background
Many surgeons practise tailored laparoscopic antireflux surgery in an attempt to prevent postoperative dysphagia. The aim of this study was to determine the effect of 360° fundoplication (Nissen) or 270° fundoplication (Toupet), and the influence of abnormal oesophageal peristalsis, upon postoperative dysphagia.

Methods
This was a cohort study from three tertiary referral centres, using dysphagia before laparoscopic fundoplication and 1 year after operation as the main outcome variable. Preoperative oesophageal manometry was performed on all patients.

Results
Some 761 patients underwent Nissen and 85 underwent Toupet fundoplication. Only 2 per cent reported severe postoperative dysphagia. There was a significant selection bias towards the Toupet operation for patients with abnormal oesophageal motility (P &lt; 0·001). For patients whose oesophageal manometric findings were normal there was a significant improvement in dysphagia after Nissen fundoplication (P = 0·02), and no significant change following Toupet fundoplication. There was no significant change in the rate of dysphagia following either method of fundoplication amongst other subgroups in which oesophageal manometry was stratified as non-specific motor disorder, low-amplitude peristalsis, or aperistalsis.

Conclusion
A tailored approach to the degree of fundoplication is unnecessary as patients with dysmotility suffer no more dysphagia after full laparoscopic Nissen fundoplication than those who have a partial Toupet wrap.
Cost–utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial
Authors:   Medical Research Council Laparoscopic Groin Hernia Trial Group, McIntosh E 
Published: July 2002

Abstract

Background
This study was a pragmatic economic evaluation carried out alongside a multicentre randomized controlled trial comparing laparoscopic with open groin hernia repair. The primary economic evaluation framework employed was a cost–utility analysis.

Methods
At 26 hospitals in the UK and Ireland, 928 patients with a groin hernia were assigned randomly to laparoscopic or open repair. Cost data were identified and measured both within and outwith the trial. Cost data were combined with quality-adjusted life years (QALYs) from the EQ-5D questionnaire to obtain cost-per-QALY ratios.

Results
The mean cost of laparoscopic hernia repair was £1112·64, compared with £788·79 for the open operation. The extra cost of £323·85 in the laparoscopic group was mainly due to additional theatre time and increased equipment and sterilization costs. The estimated incremental cost per QALY of the laparoscopic over the open method was £55 548·00 (95 per cent confidence interval £47 216·00–£63 885·00).

Conclusion
While the results show that a high cost was incurred to produce an additional QALY by using laparoscopic over open hernia repair, sensitivity analyses show that there are specific situations in which laparoscopic repair may be a viable alternative, such as when reusable equipment is employed.
The effects of nymphaeid (Nuphar lutea) density and predation by perch (Perca fluviatilis) on the zooplankton communities in a shallow lake
Authors: MOSS Brian ,   RYSZARD KORNIJOW,   And G. J. MEASEY
Published: July 2002

1. The effects of addition of juvenile perch (Perca fluviatilis) on the microcrustacean and rotifer communities associated with nymphaeid beds were studied, at three different plant densities [high (normal), medium (reduced by a half) and low (reduced to a third of normal)], in eighteen 2 m × 1 m enclosures in a shallow lake.2. At the low and medium densities of lilies, Daphnia densities were high in the absence of perch but very low in the presence of perch. They increased, even in the presence of perch, to high densities (comparable with those in the absence of perch) at the highest plant density. Body sizes of Daphnia hyalina were consistent with high predation by perch at low and medium plant densities but reduced predation at high plant densities. Patterns of chlorophyll a concentration, in the presence of perch, inversely reflected those of D. hyalina density.3. At naturally high densities but not at reduced densities, the plants appeared to act as refuges against predation for the Daphnia. Reductions in oxygen concentrations in the plant beds were not responsible for the refuge effect, nor could there be avoidance of the beds by the fish. The mechanism of the refuge effect must therefore lie in frustration of the process of capture of the Daphnia by the fish.4. Numbers of other small Crustacea and rotifers were mostly unaffected by fish predation. Numbers of Asplanchna sp., Chydorus sphaericus and copepodites were higher in the presence of fish and, although there was no main effect of fish on numbers of Diaphanosoma brachyurum, there was a plant–fish interaction, with this species being less abundant in the presence of fish at low plant densities but more abundant in the presence of fish at medium and high plant densities. Main effects of plants were few, with only Asplanchna sp. and Keratella sp. decreasing in numbers with increasing plant density. Most taxa changed in numbers with time but interaction effects between time and plants, and fish and plants, were few.
A method for the estimation of the global population sizes of plant species – the Area‐abundance‐index
Authors: Hoffmann Matthias H. , Welk Erik 
Published: July 2002

SummaryThe aim of this study is to establish a practical index that considers both the size of the global range, and the mean relative abundance of species within their range. Detailed general distribution maps provide the basis for a classification of ranges into nine size categories. The abundance data are arranged into five categories, ranging from very rare to very common. These categories are derived directly from floristic literature. The Area‐abundance‐index is calculated using an empirical formula, i.e. by the addition of the mean relative global abundance and the range size category number. Values of the index range from 2 (very rare and range ≤10 km2) to 13 (very common throughout and range > 107 km2). The main advantage of the index is that species become comparable in terms of their global population sizes. Frequently, regional Red Lists contain species that are common elsewhere and occupy wide areas, or may not include locally abundant species that occupy only very small geographical ranges. The application of the Area‐abundance‐index for the prioritizing of species within Red List categories and, hence, a varying assignment of conservational efforts, is discussed. Furthermore, the application of the index on a local scale, and the regional responsibility for species conservation or monitoring are discussed.
Measuring the Quality of Supervision and the Training Experience in Psychiatry
Authors: Clarke David M. 
Published: July 2002

Objective: The aim of this study was to develop and trial a method of trainee evaluation of the supervision and training experience. Method: A questionnaire was developed and applied at the end of each of four 6-month clinical rotations. Results: The evaluation demonstrated areas of strength (punctuality and reliability, encouragement, educational value, clinical guidance) and weakness (journal club, clinical meetings). Many supervisors were not observing diagnostic or management interviews of trainees. Psychotherapy supervision received the highest ratings. Conclusions: Because of the privacy of supervision and the occasional nature of evaluations, reliability of scores cannot be demonstrated. However, within the context of a model of quality improvement, and supplemented by the education and supervision of supervisors, trainee evaluations can be useful in targeting specific areas of deficiency in training and supervision.
Classifications in Psychiatry: A Conceptual History
Authors: Berrios German E. 
Published: July 2002

Background: Historical accounts of psychiatric classifications have hitherto been written in terms of a ‘received view’. This contains two assumptions, that: (i) the activity of classifying is inherent to the human mind; and (ii) psychiatric ‘phenomena’ are stable natural objects. Objectives: The aim of this article is to provide an outline of the evolution of psychiatric classifications from the perspective of conceptual history. This is defined as a theoretical and empirical inquiry into the principles, sortal techniques and contexts in which alienists carried out their task. It assumes that all psychiatric classifications are cultural products, and endeavours to answer the question of whether classificatory models imported from the natural sciences can be applied to man-made constructs (such as mental illness) definitionally based on ‘personalised semantics’. Methods: Exemplars of classificatory activity are first mapped and contextualised. Then, it is suggested that in each historical period crafting classifications has been like playing a game of chess with each move being governed by rules. This is illustrated by offering an analysis of the 1860–1861 French debate on classification. Results and Conclusions: (1) Medicine is not a contemplative but a modificatory activity and hence classifications are only valuable if they can release new information about the object classified. (2) It should not be inferred from the fact that psychiatric classifications are not working well (i.e. that they only behave as actuarial devices) that they must be given up. Conceptual work needs to continue to identify ‘invariants’ (i.e. stable elements that anchor classifications to ‘nature’. (3) Because mental disorders are more than unstable behavioural epiphenomena wrapped around stable molecular changes, ‘neurobiological’ invariants may not do. Stability depends upon time frames. Furthermore, it is unlikely that gene-based classifications will ever be considered as classifications of mental disorders. For once, they would have low predictive power because of their lack of information about the defining codes of mental illness. ‘Social’ and ‘psychological’ invariants have problems of their own.
Brain Imaging Technologies: How, What, When and Why?
Authors: Gordon Evian 
Published: July 2002

Objective: Innovations in physics and computing technology over the past two decades have provided a powerful means of exploring the overall structure and function of the brain using a range of computerised brain imaging technologies (BITs). These technologies offer the means to elucidate the patterns of pathophysiology underlying mental illness. The aim of this paper is to explore the current status and some of the future directions in the application of BITs to psychiatry. Method: Brain imaging technologies provide unambiguous measures of brain structure (computerised tomography and magnetic resonance imaging [MRI]) and also index complementary measures of when (electroencephalography, event related potentials, magnetoencephalography) and where (functional MRI, single photon emission computed tomography, positron emission tomography) aspects of brain activity occur. Results: The structural technologies are primarily used to exclude a biological cause in cases of a suspected psychiatric disorder. The functional technologies show considerable potential to delineate subgroups of patients (that may have different treatment outcomes), and evaluate objectively the effects of treatment on the brain as a system. What is seldom emphasised in the literature are the numerous inconsistencies, the lack of specificity of findings and the simplistic interpretation of much of the data. Conclusion: Brain imaging technologies show considerable utility, but we are barely scratching the surface of this potential. Simplistic over-interpretation of results can be minimised by: replication of BIT findings, judicious combination of complementary methodologies, use of appropriate activation tasks, analysis with respect to large normative databases, control for performance, examining the data ‘beyond averaging’, delineating clinical subtypes, exploring the severity of symptoms, specificity of findings and effects of treatment in the same patients. The technological innovation of BITs still far outstrips the sophistication of their use; it is essential that the meaning and mechanisms underlying BITmeasures are always evaluated with respect to prevailing models of brain function across disciplines.
Hubris and Humility in the Life of the Schizophrenia Researcher
Authors: Copolov David 
Published: July 2002

Objective: The goal of this paper is to provide a personal view of the challenges and satisfactions associated with schizophrenia research in the late 1990s. Method: Consideration is given to the successes and frustrations associated with several important discoveries relevant to psychiatry in the context of personal reflections on the ‘maturity’ of schizophrenia research as a field of scientific endeavour. Conclusion: Schizophrenia research provides many opportunities for its practitioners to experience and exercise their modesty. Despite impressive advances in the disciplines which are germane to it, our field is, for example, still far from identifying specific aetiological factors which operate in even a substantial minority of our patients. Historical examples illustrate how important it may be to maintain an attitude of single-mindedness, especially in the early phases of research in which seemingly bold but ultimately correct conjectures are unaccompanied by data that are sufficiently compelling to convince the wider scientific community. Considerable hubris is required in order to believe that one's conjectures are likely to be as correct as those that have led to substantive advances in our field.