Feasibility, reliability and validity of a new assessment form for use with basic surgical trainees.

Background: To establish feasibility, reliability and validity of a newly designed basic surgical training (BST) assessment form.

Methods: The assessment form was evaluated among trainees on the South-east Scotland BST rotation over 18 months. Feasibility was indicated by response rate.

Birth weight and cognitive function at age 11 years: the Scottish Mental Survey 1932.

Aims: To examine the relation between birth weight and cognitive function at age 11 years, and to examine whether this relation is independent of social class.

Methods: Retrospective cohort study based on birth records from 1921 and cognitive function measured while at school at age 11 in 1932. Subjects were 985 live singletons born in the Edinburgh Royal Maternity and Simpson Memorial Hospital in 1921.

Hepatocyte growth factor (HGF) protects c-met-expressing Burkitt's lymphoma cell lines from apoptotic death induced by DNA damaging agents.

The relative sensitivity of neoplastic cells to DNA damaging agents is a key factor in cancer therapy. In this paper, we show that pretreatment of Burkitt's lymphoma cell lines expressing the c-met protooncogene with hepatocyte growth factor (HGF) protects them from death induced by DNA damaging agents commonly used in tumour therapy. This protection was observed in assays based on morphological assessment of apoptotic cells and DNA fragmentation assays.

The cancer cachexia syndrome.

The provision of additional calories and protein alone has not been shown to be efficacious in patients with cancer cachexia. Although primary research continues to unravel the complex metabolic derangements and diverse mediator pathways underlying cancer cachexia, the future lies in drugs and neutracenticals that may modulate this altered metabolism and enable conventional nutritional support to effectively replenish vital lean tissue.

The role of hepatocyte growth factor and its receptor c-met in interactions between lymphocytes and stromal cells in secondary human lymphoid organs.

Secondary lymphoid tissue consists of two major populations of cells: lymphoid cells and stromal cells. It is generally accepted that these two cell populations influence each other however, factors mediating these processes are poorly understood. In this paper we characterize one of the possible means of communication between stroma and lymphocytes namely through hepatocyte growth factor/c-met receptor interactions.

Leptin and its relation to weight loss, ob gene expression and the acute-phase response in surgical patients.

Background: Patients with cachexia suffer from anorexia, weight loss and hypermetabolism. This study examined the relationship between plasma leptin concentration, leptin gene expression, weight loss and the acute-phase response in a group of surgical patients.

Methods: Body composition, plasma leptin, interleukin (IL) 6, soluble tumour necrosis factor receptor (sTNF-R) 55, sTNF-R75 and C-reactive protein were analysed in a cohort of 28 patients undergoing elective surgery.

Long-term clinical course of proximal deep venous thrombosis and detection of recurrent thrombosis.

Symptomatic proximal deep vein thrombosis of lower extremities carries a high risk for recurrent venous thromboembolism that persists for many years. This risk is dependent on readily identifiable risk factors, being low after a trauma or a surgical intervention and higher in all the other patient categories. Moreover, postthrombotic sequelae will develop in one of every three patients, this risk being strongly related to the development of ipsilateral thrombosis.

Proteolysis-inducing factor regulates hepatic gene expression via the transcription factors NF-(kappa)B and STAT3.

A novel protein, proteolysis-inducing factor (PIF), has been isolated from the urine of patients with pancreatic cancer and is capable of inducing muscle proteolysis in vitro. Only adult skeletal muscle and liver exhibit substantial binding of PIF. We have investigated the effect of PIF on hepatic gene expression.

Nonphlogistic clearance of late apoptotic neutrophils by macrophages: efficient phagocytosis independent of beta 2 integrins.

Neutrophils undergo constitutive death by apoptosis, leading to safe nonphlogistic phagocytosis and clearance by macrophages. Recent work has shown that before secondary necrosis, neutrophils exhibiting classical features of apoptosis can progress to a morphologically defined late apoptotic state. However, whether such neutrophils could be safely cleared was unknown.

The relationship between abdominal aortic aneurysm distensibility and serum markers of elastin and collagen metabolism.

Background: abdominal aortic aneurysm (AAA) distensibility may be an independent predictor of growth and rupture, possibly because it reflects changes in aortic wall structure and composition.

Aim: to determine whether AAA distensibility is related to circulating markers of elastin and collagen metabolism.

Methods: sixty-two male patients of median age (IQR) 68 (65-72) years with asymptomatic AAA of median (IQR) diameter 42 (37-45) mm were prospectively studied.

Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms.

Objective: To establish the accuracy of virtual hepatic resection using three-dimensional (3D) models constructed from computed tomography angioportography (CTAP) images in determining the liver volume (LV) resected during resectional liver surgery.

Summary Background Data: The ability to measure LV before surgery could be useful in determining the extent and nature of hepatic resection. Accurate assessment of LV and an estimate of liver function may also allow prediction of postoperative liver failure in patients undergoing resection, assist in volume-enhancing embolization procedures, help with the planning of staged hepatic resection for bilobar disease, and aid in selection of living-related liver donors.

Preliminary studies on the effect of dehydroepiandrosterone (DHEA) on both constitutive and phytohaemagglutinin (PHA)-inducible IL-6 and IL-2 mRNA expression and cytokine production in human spleen mononuclear cell suspensions in vitro.

In order to gain further insight into the potential immunological benefits of oral administration of DHEA we have examined its effects on the constitutive and PHA-inducible expression by human spleen cell suspensions in vitro of IL-6 and IL-2. This was studied at both the mRNA and protein levels. The quantification of specific mRNA was undertaken using commercially available quantitative polymerase chain reaction kits.

Role for CD40-CD40 ligand interactions in the immune response to solid tumours.

CD40-mediated interactions play an important role in the response to infections, transplantation, and cancer by affecting the development, activation, proliferation and differentiation of a variety of immune cells. In the current study we examined the role of CD40-mediated interactions in immune responses to bladder, pancreatic and breast carcinomas as well as melanoma cell lines using soluble human CD40L (rhCD40L) or anti-CD40 mAb in vitro. CD40 expression was readily detected in a large proportion of the cell lines and was augmented but not induced de novo by treatment with IFNgamma.

Training in infrainguinal bypass surgery for severe leg ischaemia.

Background: Recent changes in surgical training in the UK mean that operative experience must be gained more efficiently. However, it is important to demonstrate that improved training opportunities are not associated with inferior patient outcomes. The aim was to examine changes in training in infrainguinal bypass surgery and to compare the outcomes of operations performed by consultants and trainees.

Corpse clearance defines the meaning of cell death.

While philosophers seek the meaning of life, cell biologists are becoming ever more interested in the meaning of death. Apoptosis marks unwanted cells with 'eat me' signals that direct recognition, engulfment and degradation by phagocytes. Far from being the end of the story, these clearance events allow scavenger cells to confer meaning upon cell death.

Are we still performing inappropriate carotid endarterectomy?

Objectives: the 1998 ECST final report suggests that the decision to operate on patients with greater than 70% symptomatic stenosis should be based on a statistical model incorporating age, sex and degree of stenosis. The aim of this study was to identify patients operated on the basis of the 1991 reports who would not now be offered surgery according to the 1998 ECST recommendations and to determine the surgical morbidity and mortality arising from these <<<>>> CEAs.

Methods: interrogation of a prospectively gathered database of all CEAs performed for symptomatic stenosis between 1st January 1994 and 1st May 1998.

Immune recognition of glomerular antigens.

Autoimmunity is thought to cause most varieties of glomerulonephritis including membranous nephropathy, minimal-change nephropathy, Goodpasture's disease and possibly IgA nephropathy. Much effort has been and is directed at understanding the mechanisms of immune system driven inflammation and of the consequent renal injury and repair or scarring. The purpose of this article is to focus attention on the way the immune system recognizes kidney autoantigens, a process that must be a pivotal in the initiation of autoimmune kidney disease.

The influence of gender on outcome after ruptured abdominal aortic aneurysm.

Background: The influence of gender on the management of coronary artery disease is well documented, but few reports exist regarding the influence of gender on the management of peripheral arterial disease.

Objective: The purpose of this study was to examine the influence of gender on selection for and short-term and long-term outcomes of repair of ruptured abdominal aortic aneurysm (RAAA) in a regional vascular surgery unit.

Methods: Analysis of the prospectively gathered Lothian Surgical Audit database identified 692 patients (542 male and 150 female) admitted with RAAA between January 1, 1983, and December 31, 1995.

Properties of HLA class II molecules divergently associated with Goodpasture's disease.

Goodpasture's disease provides an opportunity to analyse molecular mechanisms that may underlie MHC class II associations with autoimmune disease because it is caused by autoimmunity to a defined antigen [the 230 amino acid NC1 domain of the alpha3 chain of type IV collagen (alpha3(IV)NC1)] and has strong HLA class II associations. We compared the alpha3(IV)NC1 peptide binding of class II molecules with strong positive (DR15) and dominant negative (DR7/1) associations using an inhibition binding assay and short synthetic peptides spanning the sequence of alpha3(IV)NC1. DR15 in general bound the peptides with low affinity (three of 23 < 100 nM) compared to DR1 and DR7 (12 and 10 < 100 nM respectively), and no peptide bound DR15 with much higher affinity (>10-fold) than both DR1 and DR7.

The relationship between the number, competence, and diameter of medial calf perforating veins and the clinical status in healthy subjects and patients with lower-limb venous disease.

Purpose: The role of medial calf perforating veins in the pathogenesis of the skin changes of chronic venous insufficiency (CVI) remains controversial. This study examined the relationship between abnormal medial calf perforating vein structure and function and the clinical severity of CVI.

Methods: Duplex ultrasound was used as a means of determining the number, flow characteristics, and diameter of medial calf perforating veins, and the presence of deep and superficial main stem reflux or occlusion in 50 limbs with no clinical or duplex evidence of venous disease (clinical, etiological, anatomical, and pathological grade [CEAP] 0), 95 limbs with varicose veins only (CEAP 2/3), 58 limbs affected by lipodermatosclerosis but not ulcer (CEAP 4), and 108 limbs affected by healed or open venous ulcer (CEAP 5/6).

Elevated levels of soluble tumor necrosis factor receptors are associated with increased mortality rates in patients who undergo operation for ruptured abdominal aortic aneurysm.

Purpose: Elevated levels of soluble tumor necrosis factor receptors (sTNF-Rs) are associated with multiple organ failure and increased mortality rates in critically ill patients. Paradoxically, experimental data suggest exogenous sTNF-Rs may improve outcome in patients who undergo elective abdominal aortic aneurysm (AAA) repair. This study examines, for the first time, changes in sTNF-R levels during repair of ruptured and nonruptured AAA.

Ultrasonic measurement of abdominal aortic aneurysm wall compliance: a reproducibility study.

Purpose: The purpose of this study was to examine the intraobserver and interobserver error associated with ultrasonic echo-tracking compliance measurement in patients with abdominal aortic aneurysm.

Methods: Two observers independently measured brachial blood pressure by sphygmomanometer and maximum aortic diameter, pressure strain elastic modulus (Ep) and stiffness using an ultrasonic echo-tracker. The observer was blind to several variables: pulse pressure, diameter change, Ep, and stiffness.

Training in abdominal aortic aneurysm (AAA) repair: 1987-1997.

Objectives: in the U.K. a decrease in working hours has led to shortening of surgical training.