The unrecognized prevalence of chronic kidney disease in diabetes.

Background: Diabetes mellitus and chronic kidney disease (CKD) are common and exhibit synergistic associations with premature mortality. Current diabetes guidelines in the UK recommend annual urinary albumin and serum creatinine determinations to screen for diabetic kidney disease. The aim of this study was to estimate the burden of CKD in patients with diabetes and examine the ability of serum creatinine and albuminuria to detect clinically meaningful CKD compared with estimated glomerular filtration rate (eGFR).

Severe acute renal failure in adults: place of care, incidence and outcomes.

Background: Department of Health guidelines recommend specialist critical care facilities for patients with severe single-organ failure such as acute renal failure (ARF). Prospective studies examining incidence, causes and outcomes of ARF outside of intensive care settings are lacking.

Aim: To determine the incidence, causes, place of care and outcomes of severe single-organ ARF.

Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

Aims: To standardize the pathological analysis of total mesorectal excision specimens of rectal cancer following neoadjuvant chemoradiotherapy for locally advanced disease (T3/T4), including tumour regression.

Methods And Results: Standardized dissection and reporting was used for 60 patients who underwent total mesorectal excision following long-course chemoradiotherapy. Tumour regression was scored by two pathologists (K.

The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): a manual review of 500 medical records.

Background: We conducted a search of 12 practices' routinely collected computer data in three localities across the UK and found that 4.9% of the registered population had an estimated glomerular filtration rate (GFR) of <60 ml/min/1.73 m(2) (equivalent to stages 3-5 CKD).

Diagnosis and treatment of enterovesical fistulae.

Objective: Enterovesical fistulae are a recognized complication of a variety of inflammatory and neoplastic conditions. Despite advances in imaging and treatment the diagnosis may be delayed and the management remains diverse. We describe our experience with their diagnosis and management.

Mycophenolate mofetil for remission induction in severe lupus nephritis.

Background: Mycophenolate mofetil (MMF) is a potential alternative immunosuppressive to cyclophosphamide or azathioprine for the treatment of lupus nephritis. It has a superior toxicity profile to cyclophosphamide and is more effective than azathioprine when used in combination with cyclosporin for renal transplantation.

Methods: This open label study assessed the safety and efficacy of an induction regimen of MMF and prednisolone in 24 patients, with active WHO Class III, IV or V lupus nephritis, without previous exposure to cyclophosphamide or MMF.

Identifying patients with chronic kidney disease from general practice computer records.

Background: Chronic kidney disease (CKD) is an important predictor of end-stage renal disease, as well as a marker of increased mortality. The New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) project aimed to assess whether people with undiagnosed CKD who might benefit from early intervention could be identified from GP computer records.

Methods: The simplified Modification of Diet in Renal Disease (MDRD) equation was used to estimate glomerular filtration rate (GFR) and determine stage of CKD in patients from 12 practices in Surrey, Kent and Greater Manchester with SCr recorded in their notes.

Regional differences in the provision of adult renal dialysis services in the UK.

Background: Provision of renal dialysis varies between UK regions.

Aim: To analyse these differences in provision and investigate their causes.

Design: Questionnaire-based survey.

A survey of breast cancer awareness and knowledge in a Western population: lots of light but little illumination.

There are conflicting data on breast cancer awareness and knowledge in specific population groups. We assessed awareness and knowledge of breast cancer in the general Irish population to identify sources of information on breast cancer and determine factors associated with knowledge and awareness of the disease. Participants (n=2355, 53% female) completed a multi-part questionnaire.

Negotiations of surface: archaeology within the early strata of psychoanalysis.

Freud's "The Aetiology of Hysteria" (1896) begins with the description of an excavation. With this passage as a point of departure, the role of archaeology in Freud's early psychoanalytic formulations is examined. The archaeological imagery in his later writings and the collection of ancient objects that came to fill his consulting room and library are well known, but the passage must be contextualized in its own moment to show the influences that led Freud to articulate an "expanse of ruins" at this particular time.

CD4+CD8+ human small intestinal T cells are decreased in coeliac patients, with CD8 expression downregulated on intra-epithelial T cells in the active disease.

Background/objective: The intestinal lesion of coeliac disease is thought to be initiated and exacerbated by dysregulation of local T-lymphocyte sub-populations. This study examines changes in intestinal T cells from coeliac patients, with a particular focus on CD4CD8 T cells, immunoregulatory cells normally found in relatively high proportions in the small intestine.

Methods: Cells were obtained from duodenal biopsies from active and treated coeliac patients using chelating and reducing agents (epithelial layer) followed by collagenase treatment (lamina propria).

Diverse populations of T cells with NK cell receptors accumulate in the human intestine in health and in colorectal cancer.

T cells expressing NK cell receptors (NKR) display rapid MHC-unrestricted cytotoxicity and potent cytokine secretion and are thought to play roles in immunity against tumors. We have quantified and characterized NKR+ T cells freshly isolated from epithelial and lamina propria layers of duodenum and colon from 16 individuals with no evidence of gastrointestinal disease and from tumor and uninvolved tissue from 19 patients with colorectal cancer. NKR+ T cell subpopulations were differentially distributed in different intestinal compartments, and CD161+ T cells accounted for over one half of T cells at all locations tested.

Teaching social skills to adults with intellectual disabilities: a comparison of external control and problem-solving interventions.

We compared the effectiveness of a problem-solving and an external control intervention to teach social skills to five adults with mild intellectual disabilities. The social skills of "responding to corrective feedback" and "managing conflict" were targeted for intervention. Each participant received the problem-solving intervention with one social skill and the external control intervention with the other social skill.

Expression of Cathepsin B and L antigen and activity is associated with early colorectal cancer progression.

Cathepsin B and Cathepsin L are cysteine proteases important in the process of invasion and metastasis. The aim of our study was to assay antigen and activity levels of these enzymes and to correlate these with established clinical and pathological prognostic parameters including patient survival. 99 patients undergoing operations for colorectal cancer were included in this study.

An evaluation of left sided colonic polyps as a marker for right sided cancers.

The detection of a left-sided polyp on flexible sigmoidoscopy has been suggested as providing a heralding sign for right-sided tumours. We assessed our own experience with right-sided colonic cancers with reference to detection modality, surgical intervention and their association with left-sided polyps. We performed a retrospective review of a prospectively collected colorectal cancer database, with endoscopic and radiological records.

Identification of benzene metabolites in dermal fibroblasts as nonphenolic: regulation of cell viability, apoptosis, lipid peroxidation and expression of matrix metalloproteinase 1 and elastin by benzene metabolites.

The skin is exposed to benzene and its derivatives, prevalent environmental chemicals. They may impair the structural integrity of the skin by increased expression of matrix metalloproteinase 1 (MMP-1; degrades structural collagen) and elastin, synthesized primarily by the dermal fibroblasts. We examined the metabolism of benzene in dermal fibroblasts and identified the benzene metabolites as toluene, benzaldehyde, aniline and benzoic acid.

Serious adverse incidents with the usage of low molecular weight heparins in patients with chronic kidney disease.

Background: The aim of the study is to describe serious adverse events in patients with renal insufficiency administered low molecular weight heparins (LMWHs).

Methods: Systematic case note review from July 2002 to March 2003, Hope Hospital, Salford, UK, was used.

Results: Ten patients experienced an adverse incident on LMWH therapy.

Percutaneous endoscopic gastrostomy: 5 years of clinical experience on 238 patients.

Since Percutaneous Endoscopic Gastrostomy (PEG) feeding was introduced, 20 years ago it has been increasingly utilised in medical practice. The aim of this study was to assess the current indications and complications associated with PEG feeding. This study was a retrospective review of hospital charts dealing with PEG placement over a period of five years.

Variation in dialysis patient mortality by Health Authority.

Background: Maintenance dialysis is a relatively low prevalence, highly specialized, and labour-intensive treatment, which is usually delivered at regional centres serving many different health authorities. It is unknown whether a patient's health authority, in many ways an accident of birth, influences long-term dialysis outcomes.

Aim: To study survival patterns in patients starting maintenance dialysis therapy in the north-west of England between 1990 and 1999.

Anaemia in patients with diabetes: unrecognised, undetected and untreated?

Background: Diabetes mellitus is one of the two most common causes of end-stage renal disease and significant proportions of patients with diabetes mellitus develop renal complications. Anaemia is a key indicator of renal disease yet most patients with diabetes are rarely tested for anaemia and are unaware of the link between anaemia and kidney disease.

Patients And Methods: A pan-European study was undertaken to assess patients' level of awareness and understanding of anaemia and of the complications of diabetes mellitus, and to determine the impact of anaemia on quality of life.

Neurokinin-1 receptor (NK-1R) expression is induced in human colonic epithelial cells by proinflammatory cytokines and mediates proliferation in response to substance P.

We have previously shown that the receptor for substance P (SP), neurokinin-1 receptor (NK-1R), is a marker of human mucosal but not peripheral mononuclear cells. In the present study, we investigate NK-1R expression in the human colonic mucosa in vivo, particularly in the epithelial cells. We investigate the influence of proinflammatory Th1 cytokines and SP on expression and function of NK-1R in colonic epithelial cells in vitro.

From dinosaurs to DNA: a history of colorectal cancer.

The roots of colorectal cancer date back to antiquity. In this short history of colorectal cancer we trace its clinical and research origins from ancient times through the dark ages, middle ages, to the scientific and medical advances of the seventeenth to twentieth centuries and into the twenty-first century.