bluuebunny/crossref_metadata_2025 huggingface dataset:
Erosive esophagitis in the Philippines: A comparison between two time periods
Authors: Sollano Jose D , Wong Stephen N , Andal‐Gamutan Teresita , Chan Melchor M , Carpio Ramon E , Tady Celina S , Ismael Albert E , Judan‐Ruiz Estelita A , Ang Victorio N , Go Johnny T , Lim Victoriano Y , Perez Jesus Y , Alvarez Sol Z
Published: May 2006

Background:  In Asia, the incidence of gastroesophageal reflux disease diagnosed through endoscopy has increased from 3–9% to 14–16% in the last decade. The aim of this study was to determine the prevalence of erosive esophagitis (EE) over a span of 10 years in a tertiary care facility in the Philippines.

Methods:  All patients diagnosed with EE from 1994 to 1997 (period A) and from 2000 to 2003 (period B) were included in the study. The modified Savary–Miller and Los Angeles classifications were used to grade EE for periods A and B, respectively.

Results:  A total of 15 981 upper endoscopies were evaluated for this study. There was no significant difference in the male: female ratio (period A 1.43:1 vs period B 1.25:1, P = 0.459) and in the mean age of patients with EE (period A 46.4 vs period B 47.5, P = 0.395). The prevalence of EE was significantly higher (P < 0.0001) in period B (6.3%) as compared to period A (2.9%). However, despite a higher prevalence, more patients had mild esophagitis in period B as compared to period A. Conversely, there were more patients with esophageal ulcers (18.6%vs 5.9%, P < 0.001), esophageal strictures (2.3%vs 0%, P = 0.003), and hiatal hernia (15.8%vs 7.5%, P = 0.001) in period A. The presence of concomitant Barrett’s esophagus was not significantly different between the two time periods (period A 3.2%vs period B 5%, P = 0.367).

Conclusions:  The prevalence of EE was higher in 2000–2003 than in 1994–1997, although the complications associated with the disease diminished. The prevalence of concomitant Barrett’s esophagus remained stable.
Biopsy forceps: Reusable or disposable?
Authors: Fireman Zvi
Published: May 2006

Reusable and disposable biopsy forceps are both widely available for use in gastrointestinal endoscopy units. Biopsy forceps have design and material features that may interfere with cleaning, and reusable devices must be designed to function safely and effectively following sterilization in a healthcare setting. During the last decade, endoscopic accessories have evolved from reusable to disposable in many parts of the world. Although use of disposable devices helps reduce the potential risk of cross‐contamination and spread of infection, there remains the factor of cost. Major concerns for reuse of endoscopic accessories center on two main areas: sterility, and the capability of the equipment to perform its function satisfactorily after repeated uses and sterilizations. Reusable biopsy forceps perform a designated number of procedures, thus becoming more cost‐effective than disposable forceps, which are impossible to clean and sterilize. The potential risk of infectious disease transmission must be taken into account. There is also the consideration that reprocessing of disposable forceps may damage or destroy the fragile devices.
Gastric tube cancer: Immunohistochemical study of 10 lesions in six patients
Authors: Takeo Hiroaki , Matsukuma Susumu
Published: May 2006

Background and Aim:  Gastric tube cancer (GTC), defined as carcinoma arising in the reconstructed gastric tube after esophagectomy, has been increasingly reported, but its pathogenesis remains unclear. Therefore, the aim of this study was to examine clinically and pathologically 10 GTCs in six patients.

Methods:  In addition to examination of the clinicopathological features of GTCs, the adjacent gastric tube mucosa was also evaluated immunohistochemically using gastric foveolar markers (MUC5AC and human gastric mucin), pyloric gland markers (MUC6 and M‐GGMC‐1), and intestinal markers (MUC2 and CD10).

Results:  All patients were men and three patients had multiple GTCs. All GTCs were located on the middle to lower portion of the gastric tube. Nine GTCs had tubular and/or papillary adenocarcinoma components, and another was signet‐ring cell carcinoma. Intestinal metaplasia was found in non‐neoplastic mucosa adjacent to nine GTCs. Metaplastic goblet cells adjacent to five GTCs expressed both gastric and intestinal markers, which were similar to the corresponding GTC cells, indicating a close association between the GTCs and metaplastic goblet cells. The other three GTCs expressed only intestinal markers, which may support the suggestion that the intestinal phenotype is expressed later in cancerous development.

Conclusion:  Pathogenesis of GTCs could be identical to that of ordinary gastric cancer. Cancerous multiplicity associated with esophageal cancer may also play a role in the development of GTCs.
Multidetector‐row computed tomography in the management of hepatocellular carcinoma with transcatheter arterial chemoembolization
Authors: Guan Yong‐Song , Hu Ying , Liu Yuan
Published: May 2006

With the introduction of spiral computed tomography and the development of novel imaging technology in recent years, multidetector–row computed tomography (MDCT) has increasingly been used for the diagnosis of various lesions, especially hepatocellular carcinoma (HCC), due to its volume acquisitions, short scanning time, and especially its double‐phase scanning nature, which takes advantage of the dual blood supply of liver. Multidetector–row computed tomography is used to classify HCC into several types based on the blood supply and the histological characteristics of HCC. The evaluation of HCC by MDCT provides crucial clues for the doctors to adopt correct clinical management strategies such as the selection of the appropriate dose of lipiodol before transcatheter arterial chemoembolization (TACE) and the prediction of the prognosis of HCC after TACE. The MDCT scanning allows doctors to choose the region of interest and to evaluate the blood supply according to the lipiodol uptake in order to decide whether there is recrudescence and whether a repeated therapy should be taken. This review describes MDCT, its biphasic scanning, its evaluation of blood supply in HCC and the subsequent classification of HCC, its therapeutic significance before TACE and the prognostic value after TACE.
Comparison of new generation motion‐resistant pulse oximeters
Authors: Townshend Jennifer , Taylor Barry J , Galland Barbara , Williams Sheila
Published: May 2006

Aim:  To compare the performance of pulse oximeters during movement and brachial artery occlusion.

Methods:  Three machines (MasimoSET, using MasimoSET LNOP Pdt paediatric sensor, Mars 2001 using Novametrix paediatric sensor no. 6455 and Nellcor 595 using Nellcor 595 Oximax‐P paediatric sensor and Nellcor 595 MAX‐FAST adhesive forehead reflectance sensor) were used simultaneously on the left hand and forehead. The subjects were 18 healthy children aged 6–10 years. Interventions were 20 sequential 90° body turns from mimicking normal movements while asleep followed by step increases in brachial artery occlusion. Mean heart rate (HR) from the four machines was compared with ECG HR. Haemoglobin O2 saturation was compared with a baseline saturation and the proportion of epochs with false (low) saturation values.

Results:  The mean difference from ECG HR was not clinically significantly different for any machine but the limits of agreement were such that the Mars Model 2001 and Nellcor 595 (forehead) could have clinically important differences from ECG‐derived HR (−20.04–15.00 and −14.95–14.04, respectively). Only the Nellcor 595 with finger probe had limits of agreement within the a priori set value of 4%. The prevalence of epochs with an haemoglobin O2 saturation of greater than 4% below baseline values was lowest for the Nellcor 595 finger probe (1.59%) and highest for the Nellcor forehead probe (20.45%). During brachial artery occlusion, all machines performed well up to within 20 mmHg of total occlusion.

Conclusion:  Current motion‐resistant pulse oximeters performed well but only the Nellcor 595 with finger probe achieved our a priori set standards.
Successful treatment of cytomegalovirus‐associated haemophagocytic syndrome following paediatric orthotopic liver transplantation
Authors: Hardikar Winita , Pang Ken , Al‐Hebbi Homoud , Curtis Nigel , Couper Richard
Published: May 2006

Abstract:  Haemophagocytic syndrome (HPS) following orthotopic liver transplantation is a rare event which is often fatal. We report here a case of HPS in association with cytomegalovirus (CMV) reactivation. The patient was treated with a combination of antiviral agents, immunomodulatory and supportive therapy which resulted in suppression of CMV infection and resolution of the haemophagocytosis.
Cushing syndrome, adrenal suppression and local corticosteroid use
Authors: Hameed Rubina , Zacharin Margaret R
Published: May 2006

Abstract:  Adrenal suppression can occur following use of intra‐articular corticosteroid injection for treatment of arthritis. If unrecognised, this can result in major medical illness, shock or death. We report two children who developed Cushingoid features and severe adrenal suppression after joint injection. Paediatricians caring for children who have intra‐articular corticosteroid injections should be aware of this potential complication. Monitoring of cortisol levels after injection should be considered.
Initial report on identification and toxicity of Microcystis in King Talal Reservoir, Jordan
Authors: Al‐Jassabi S. , Khalil A. M.
Published: May 2006

The cyanobacteria Microcystis aeruginosa forms extensive summer blooms in the King Talal Reservoir, the largest water body in Jordan. The occurrence of the blooms is a function of the water temperature, light intensity and nutrient concentration, with the nitrogen and phosphorus levels being critical factors. This initial study indicated that the time of the seasonal maximum and intensity of Microcystis blooms in the King Talal Reservoir vary significantly from month to month, with a peak reached in summer. The low nutrient concentrations were observed prior to the summer season. There was a rapid, extensive proliferation of M. aeruginosa during the summer of the same year, especially from 1–30 June to 30 November. The LD50 of microcystin in Balb/c was found to be 50 µL kg−1. Additional studies will provide further information on various aspects of the identification and toxicity of the selected cyanobacterial species.
Application of knowledge management to environmental management projects: A case study for lake management
Authors: Sekino Tatsuki , Nakamura Masahisa
Published: May 2006

Although environmental management projects typically must collect large quantities of data and information from a variety of related fields, these data and information often are not used effectively. In this study, an experimental version of a knowledge management system (Learning Acceleration and Knowledge Enhancement System) was developed to solve problems related to the acquisition and accumulation of large quantities of information being applied to an international project on lake management. Two functions were incorporated in the system, including (i) a function for previewing retrieved documents so that the information obtained using a specific search word could be easily accessed; and (ii) a thesaurus function to facilitate the sourcing and understanding by decision‐makers and other stakeholders of information in unfamiliar, but related, fields of study. As these functions enable users to search for data and information in fields that might be unfamiliar to them, the application of knowledge management to projects involving environmental issues can be a valuable tool for such projects in the future.
Application of ecological engineering principles in lake management
Authors: Jørgensen S. E.
Published: May 2006

The Ecological Engineering and Ecosystem Restoration previously presented 19 ecological principles that can be used for all ecotechnological projects. This report discusses how all projects that incorporate or involve engineering and management of ecosystems should be guided by these previously noted ecological principles. The principles also can be used as a checklist for ensuring that all relevant ecological considerations are taken into account in the development and implementation of ecotechnology and ecological management projects. This report demonstrates how these 19 principles can be applied in lake management issues. It is shown that the principles also are useful as a checklist for lake management efforts. This report further identifies general and 12 specific recommendations for lake management efforts, which are based on the 19 principles.
Relationship between water flow volume and in‐lake total phosphorus concentrations via dissolved oxygen concentrations and temperature in a warm temperate reservoir: Implications by path analysis
Authors: Tüzün İlhami , İnce Özlem
Published: May 2006

The effects of water inflow–outflow volumes on the in‐lake total phosphorus (TP) concentrations was investigated for the deep, stratified Çubuk II Dam Lake. The fluctuations in the TP concentrations followed a seasonal pattern, with lower values found during the summer, and peak values during wet seasons. Both the seasonal pattern and the horizontal/vertical heterogeneities in the TP concentrations were usually found to be in accordance with those of the water flow parameters. The vertical differences in the TP concentrations provided evidence that an interflow formed at the 5 m and 10 m depths by the water inflow resulted in higher mean TP concentrations at these depths. In contrast, the water outflows had a reducing effect on the TP concentrations, particularly at the 15 m depth, by promoting net TP export. Although the horizontal distribution of the TP concentrations differed slightly between the riverine, transition and lacustrine zones, the differences did not indicate any statistical significance (P > 0.05, multivariate analysis of variance). The path analysis performed on the vertical data proved to be a promising tool in estimating the direct correlations between water flow dynamics and TP concentrations when the decomposition of indirect correlations via dissolved oxygen concentrations and temperature was accounted for in these mutual associations.
What should non‐US behavioral health systems learn from the USA?: US behavior health services trends in the 1980s and 1990s
Authors: KISHI YASUHIRO , KATHOL ROGER G. , MCALPINE DONNA D. , MELLER WILLIAM H. , RICHARDS STEVEN W.
Published: May 2006

Abstract  Several countries, such as the USA, inadvertently created a different behavioral health payment system from the rest of medicine through the introduction of diagnostic‐related group exemptions for psychiatric care. This led to isolation in the administration and delivery of care for patients with mental health and substance abuse disorders from other medical services with significant, yet unintended, consequences. To insure an efficient and effective health‐care system, it is necessary to recognize the problems introduced by segregating behavioral health from the rest of medical care. In this review, the authors assess trends in behavioral health services during the last two decades in the USA, a period in which independently managed behavioral health care has dominated administrative practices. During this time, behavioral health has been an easy target for aggressive cost cutting measures. There have been no clinically significant improvements in the number of adults receiving minimally adequate treatment or in the percentage of the population with behavior health problems receiving psychiatric care with the possible exception of depression. While decreased spending for behavioral health services has been well documented during this period, these savings are offset by costs shifted to greater medical service use with a net increase in the total cost of health care. Targeting behavioral health for reduction in health‐care spending through independent management, starting with diagnostic procedure code or diagnostic‐related group exemption may not be the wisest approach in addressing the increasing fiscal burden that medical care is placing on the national economy.
Comparison of completed and attempted suicide in Akita, Japan
Authors: FUSHIMI MASAHITO , SUGAWARA JUNYA , SAITO SEIJI
Published: May 2006

Abstract  To determine the factors underlying suicide in Akita prefecture, a questionnaire survey was conducted among members of the Akita Prefectural Medical Association (APMA), regarding suicide cases they attended. During the investigation period (1 July 2001–30 June 2002), the total number of suicide cases was 243 (138 completed, 105 attempted). Significant differences were identified between completed and attempted suicide groups in terms of gender, age distribution, and suicidal methods. Specifically, in the completed suicide group, the number of male completers exceeded that of female completers, the number of middle‐aged or elderly completers was high, and the majority of completed suicide cases involved hanging as the suicide method. Conversely, in the attempted suicide group, the number of female attempters exceeded that of male attempters, younger attempters were frequent, hanging was rare, and drug overdose or cutting was common. In addition, the number of cases involving a history of previous suicide attempts was significantly higher in the attempted suicide group than in the completed suicide group. The results of the present study support the concept that the completed and attempted suicide groups are essentially of a different nature. Furthermore, the number of cases involving a history of previous suicide attempts was found to be significantly lower in the completed suicide group than in the attempted suicide group. This result indicates the difficulty in decreasing the number of completed suicides by simply providing intervention and care for individuals who have attempted suicide.
Egalitarian sex role attitudes among Japanese human service professionals: Confirmatory factor analytic study
Authors: UJI MASAYO , SHONO MASAHIRO , SHIKAI NORIKO , HIRAMURA HIDETOSHI , KITAMURA TOSHINORI
Published: May 2006

Abstract The psychometric properties of the short form of the Scale of Egalitarian Sex Role Attitudes (SESRA‐S) were studied among human service professionals. An exploratory factor analysis yielded two factors interpreted as reflecting women’s rights (e.g. women at home and men at work [a reverse item]) and women’s independence (e.g. working outside is equally important for women [a non‐reverse item]), respectively. Confirmatory factor analysis showed a good fit. Impact of participant age, sex, residential area, and type of profession on sex role egalitarianism were examined by four‐way layoutanova. Men in rural areas had the lowest score in the women’s rights subscale and psychiatrists in rural areas had the lowest score in the women’s independence subscale.
Association of minimal thickness of the medial temporal lobe with hippocampal volume, maximal and minimal hippocampal length: Volumetric approach with horizontal magnetic resonance imaging scans for evaluation of a diagnostic marker for neuroimaging of Alzheimer’s disease
Authors: UOTANI CHIGUSA , SUGIMORI KAORU , KOBAYASHI KATSUJI
Published: May 2006

Abstract  A 3‐D volumetric study of the medial temporal lobe (MTL) was performed to evaluate how a minimum thickness of the MTL (mtMTL), a visually estimated measure, is associated with other MTL measures, maximal and minimal hippocampal length (max‐HL, min‐HL) and hippocampal volume, all measured with a 3‐D device, Neurolucida, in 33 patients with Alzheimer’s disease (AD), seven patients with mild cognitive impairment (MCI), and 20 age‐matched controls. Cognitive impairment was evaluated with Mini‐Mental State examination (MMSE). The T1‐weighted horizontal magnetic resonance imaging (MRI) scans with slices 5 mm thick were analyzed with Neurolucida and the mtMTL was measured with visual estimation. The MTL was divided into the amygdala and hippocampus. Max‐HL on both sides was longer in controls than in AD and MCI, whereas min‐HL and mtMTL were longer in controls than in AD, and no difference was observed between MCI and controls. Similarly hippocampal volume was larger in controls than in AD, and no differences were seen within the MCI and controls. No difference in amygdala and midbrain volumes was observed among AD, MCI and controls. Correlation of MMSE score with min‐HL and mtMTL was higher than that with max‐HL. Although hippocampal and MTL measures examined here failed to show significant difference between AD and MCI, max‐HL could be a diagnostic neuroimaging sign of AD. The high correlation of MMSE with mtMTL as well as with min‐HL compared with that with max‐HL, also will support neuroimaging diagnosis of AD.
Prevalence and profile of methamphetamine users in adolescents at a juvenile classification home
Authors: MIURA HIDEKI , FUJIKI MASUMI , SHIBATA ARIHIRO , ISHIKAWA KENJI
Published: May 2006

Abstract  The objective of the present study was to investigate the prevalence and risk factors of methamphetamine use in adolescents at a juvenile classification home. The present subjects were 1362 adolescents (1172 male and 190 female) who had been admitted to the Nagoya Juvenile Classification Home. The participants were divided into two groups, a methamphetamine user group and a control group, based on history of methamphetamine use. The presence of methamphetamine use was analyzed in terms of gender, age, number of admissions, violence (types of crime), history of psychiatric treatment, family history (crime, drug misuse and/or alcohol‐related disorder), and experience of being abused by their parents or by the persons who were responsible for raising them. The prevalence of methamphetamine use was 6.8% (93/1362). Multivariate logistic regression analyses indicated that gender (female; odds ratio [OR]: 8.1; 95% confidence interval [CI]: 4.6–14.3), age (OR: 1.8, 95%CI: 1.5–2.1), number of admissions (>2, OR: 2.9, 95%CI: 1.8–4.8), violence (OR: 0.4, 95%CI: 0.2–0.7), history of psychiatric treatment (OR: 8.7, 95%CI: 4.0–19.0), and family history of drug misuse (OR: 4.0, 95%CI: 1.6–9.6) were all significantly associated with methamphetamine use. Approximately 7% of participants used methamphetamine. Female gender was a risk factor. Higher age and multiple admissions suggest the persistency and repetition of delinquency. Methamphetamine users were less violent than control subjects. Psychosocial environment (family history of drug misuse) and psychiatric problems (history of psychiatric treatment) were also related to methamphetamine use.
Quantitative magnetic resonance spectroscopy of schizophrenia: Relationship between decreased N‐acetylaspartate and frontal lobe dysfunction
Authors: TANAKA YOKO , OBATA TAKAYUKI , SASSA TAKESHI , YOSHITOME EIJI , ASAI YOSHIYUKI , IKEHIRA HIROO , SUHARA TETSUYA , OKUBO YOSHIRO , NISHIKAWA TORU
Published: May 2006

Abstract  Numerous studies using proton magnetic resonance spectroscopy (1H‐MRS) have detected signal changes in schizophrenia. However, most studies investigated relative concentrations such as N‐acetylaspartate/creatine plus phosphocreatine (NAA/Cre) and choline‐containing compounds/creatine plus phosphocreatine (Cho/Cre), and individual metabolite concentrations have not been clarified. Using absolute quantification measurement of 1H‐MRS, the aim of the present paper was to demonstrate the changes in metabolite concentrations in the frontal lobe of patients with chronic schizophrenia. The 1H‐MRS was performed in the left frontal lobe in 14 patients with schizophrenia and in 13 healthy comparison subjects. Individual MRS peak concentration was quantified based on a frequency‐domain fitting program: LCModel. The scores on the Positive and Negative Symptoms Scale and Wisconsin Card Sorting Test were used for clinical assessment. The NAA concentration was reduced in schizophrenic patients (average, 7.94 mmol/L, t = 2.28, P < 0.05) compared with healthy subjects (average = 8.45 mmol/L) while choline, creatine or NAA/Cre ratio did not show any differences. The reduction in NAA concentration had a significant correlation with the severity of negative symptoms (r =−0.536, P < 0.05) and poor performance in Wisconsin Card Sorting Test (r = −0.544, P < 0.05). Using quantitative MRS, decreased NAA concentration was confirmed in the left frontal lobe of schizophrenic patients and was demonstrated to be correlated with negative symptoms and cognitive dysfunction in schizophrenia.
Topiramate for smoking cessation
Authors: KHAZAAL YASSER , CORNUZ JACQUES , BILANCIONI ROMAIN , ZULLINO DANIELE FABIO
Published: May 2006

Abstract  Due to its AMPA (α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid)/kainate antagonism, topiramate would be particularly interesting in addiction treatment. Flexible‐dose topiramate was prescribed to 13 smokers (10 smokers who wanted to stop smoking, and three who received topiramate for other reasons). Six out of 13 smokers were abstinent at 2 months and two more subjects had reduced their cigarette consumption by >50%. With one exception, temporary reduction of the number of smoked cigarettes preceded definitive abstinence at month 2. Three more subjects who achieved a momentary reduction had, however, to interrupt the treatment due to intolerable side‐effects. Controlled trials are needed to confirm these preliminary observations.
Successful treatment for obsessive‐compulsive disorder with addition of low‐dose risperidone to fluvoxamine: Implications for plasma levels of catecholamine metabolites and serum brain‐derived neurotrophic factor levels
Authors: YOSHIMURA REIJI , KANEKO SACHIKO , SHINKAI KOJI , NAKAMURA JUN
Published: May 2006

Abstract  The authors report on the successful treatment of obsessive‐compulsive disorder (OCD) in three patients with the addition of risperidone to ongoing fluvoxamine treatment. Plasma homovanillic acid (HVA), but not 3‐methoxy‐4‐hydroxyphenylglycol (MHPG) levels decreased after risperidone administration, and plasma levels of fluvoxamine did not change. In addition, serum brain‐derived neurotrophic factor (BDNF) levels were not altered after the recovery from obsessive‐compulsive symptoms, indicating that serum BDNF levels might not predict the patient’s response to risperidone treatment. Taken together, a combination treatment of risperdone and fluvoxamine might improve obsessive‐compulsive symptoms. In short, fluvoxamine enhances the activity of the serotonergic system by inhibiting serotonin transporters, and risperidone decreases that of the dopaminergic system by blocking D2 receptors.
Stress barometer at diagnoses in children with school non‐attendance
Authors: KANO KENICHI , ARISAKA OSAMU
Published: May 2006

Background: School non‐attendance is a major social problem in Japan. Many children stop attending school for a variety of reasons. The authors previously reported stress barometer values for healthy Japanese children. In this study, the authors examined the stress barometer values of children with school non‐attendance.

Methods: The authors measured stress barometer values, that is, urinary 17‐hydroxycorticosteroids (17‐OHCS) and 17‐ketosteroid sulfates (17‐KS‐S) in 65 children (40 girls and 25 boys; 7–15 years of age) with school non‐attendance, except for pervasive developmental disorder and mental retardation, who attended the outpatient department of Dokkyo University School of Medicine Hospital, Tochigi, Japan, during the past 4 years.

Results: A total of 24 (36.9%) of the 65 children had urinary 17‐OHCS values above 2SD, and 14 (21.5%) had urinary 17‐OHCS below 2SD. In total, 10 (15.4%) children had urinary 17‐KS‐S values above 2SD, and four (6.2%) had urinary 17‐KS‐S below 2SD. Five (7.7%) children had urinary 17‐KS‐S/17‐OHCS values above 2SD, and 10 (15.4%) had urinary 17‐KS‐S/17‐OHCS below 2SD.

Conclusion: The stress barometer values appear to be clinically useful for evaluating objectively whether children with school non‐attendance have emotional stress.
Risk of obesity enhanced by poor physical activity in high school students
Authors: BABA REIZO , IWAO NOBUKO , KOKETSU MASAAKI , NAGASHIMA MASAMI , INASAKA HIROSHI
Published: May 2006

Background: The aim of this study was to elucidate the interactions between a family history of obesity and poor physical activity.

Methods: A case‐control study was performed based on medical check data for all first year high school students admitted to Aichi Prefectural public high schools in the 2004 academic year. Prior to the post‐admission medical check up, all students received an interview sheet containing questions on family history of obesity and extent of physical activity. Experienced nurses measured body mass and height. Valid answers and measurements were obtained from 20 155 boys and 19 682 girls.

Results: A family history of obesity, reluctance to exercise, current and recent past sedentary lifestyles each significantly increased risk of obesity (body mass index [BMI] ≥ 25) and severe obesity (BMI ≥ 30) in both boys and girls. Two‐way ANOVA revealed that a family history of obesity, associated with poor exercise, positively affected BMI in both boys and girls. Moreover, significant positive interaction was found between a family history of obesity and each of the unfavorable physical activity conditions. Synergistic effects (synergy indexes > 1) increasing risk of obesity were noted in both boys and girls when a family history of obesity overlapped with reluctance to exercise, current physical inactivity, or recent physical inactivity.

Conclusion: Overlapping of family history of obesity and exercise risk factors synergistically increase the BMI and risk of obesity in both boys and girls. Intervention to promote exercise in adolescents who have obese family member(s) should be encouraged.
Surgical closure of patent ductus arteriosus reduces the cerebral tissue oxygenation index in preterm infants: a near‐infrared spectroscopy and Doppler study
Authors: ZARAMELLA PATRIZIA , FREATO FEDERICA , QUARESIMA VALENTINA , FERRARI MARCO , BARTOCCI MARCO , RUBINO MAURIZIO , FALCON ELENA , CHIANDETTI LINO
Published: May 2006

Background: The aim of this study was to investigate the effects of patent ductus arteriosus (PDA) ligature on cerebral oxygen saturation, cerebral blood volume (CBV) and cerebral blood flow velocity by means of near‐infrared spectroscopy (NIRS) and transcranial Doppler simultaneous examinations.

Methods: This is an observational study considering 16 babies of gestational age 24–34 weeks diagnosed with PDA who underwent surgical ligation. The cerebral oxygen saturation, CBV and blood gases values were obtained 35 min before ligation, so also around the 14th and 27th min after the clip’s insertion.

Results: Cerebral oxygen saturation, measured as tissue oxygenation index (TOI), decreased significantly after PDA ligation from a basal value of 61.1 (3.8) before surgery to 56.6 (3.3) and 55.8 (2.6)%, for the 14th and 27th min, respectively (P < 0.04). CBV before and after clipping was unvaried. A negative correlation was found between ΔpH and ΔCBV after ligation (R = 0.52, P = 0.03), whilst a positive correlation was found between ΔCBV and ΔPaCO2 (R = 0.62, P = 0.009). pH increased at the 27th min post‐ligation.

Conclusions: NIRS is a tool for obtaining information on cerebral oxygen saturation and CBV changes during surgical PDA ligation at the bedside. A fall in TOI suggests an increased oxygen extraction during PDA surgery. The lack of increase in ΔCBV or in diastolic flow velocity show that the PDA before the clipping did not limit cerebral blood flow, the drop in TOI suggests increased oxygen consumption over the clip and the need for accurate monitoring of oxygen utilization after the surgical treatment.
Guidelines for the treatment of Crohn’s disease in children
Authors:   WORKING GROUP OF THE JAPANESE SOCIETY FOR PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION, KONNO MUTSUKO , KOBAYASHI AKIO , TOMOMASA TAKESHI , KANEKO HIROAKI , TOYODA SHIGERU , NAKAZATO YUTAKA , NEZU RIICHIRO , MAISAWA SHUN‐ICHI , MIKI KAZUNORI
Published: May 2006

This paper shows guidelines for the treatment of Crohn’s disease in children by the Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (Chair: Akio Kobayashi). The points in which these guidelines differ from those for adult patients are as follows. (i) Total enteral nutrition in the form of an elemental formula is indicated as primary therapy for children with Crohn’s disease at onset as well as the active stage. Oral mesalazine is used together. (ii) Total parenteral nutrition (TPN) with oral mesalazine is required for children with serious illness. The use of a corticosteroid should be withheld for at least 1 week after TPN has been started. (iii) When TPN is not considered to be effective, additional corticosteroid is used. Full doses of corticosteroid should be used for at least 2 weeks after clinical improvement has been achieved, and then the dose of the corticosteroid should be tapered carefully. (iv) When surgery is indicated in pediatric patients with stricture or fistula formation and complicated by persistent growth failure despite medical therapy, the optimum time for surgery is thought to be before epiphyseal plates have been closed.
Toxic factors in human urine that injure urothelium
Authors: RAJASEKARAN MAHADEVAN , STEIN PAUL , PARSONS C. LOWELL
Published: May 2006

Aim:  Loss of the lower urinary permeability barrier and passive potassium cycling into tissue are an initiating event in interstitial cystitis. We tested whether a low molecular weight cytotoxic fraction from normal urine causes sensitivity to intravesical potassium in rats and whether the sulfated anionic polysaccharide pentosan polysulfate can neutralize this fraction's cytotoxic activity.

Methods:  A low molecular weight (> 100 < 3500) toxic urinary fraction was prepared from normal human urine by dialysis and the lyophilized, salt free product (toxic factor) further investigated. Anaesthetized adult male Sprague–Dawley rats received intravesical sodium or potassium, and urodynamic parameters, including number of voids and non‐voiding contractions, were recorded. Then protamine sulfate, rehydrated toxic factor, or toxic factor plus pentosan polysulfate was infused, followed by potassium, and urodynamic measurements repeated. The toxic factor was evaluated in a commercial cytotoxicity protocol using cultured rat urothelial cells.

Results:  Rat bladder non‐voiding contractions increased markedly over baseline when potassium was infused after toxic factor (1.681 ± 0.1131 non‐voiding contractions/min; P = 0.0004) but not after toxic factor premixed with pentosan polysulfate. Toxic factor had a significant (P < 0.001) cytotoxic effect in cultured rat bladder epithelial cells; toxic factor plus pentosan polysulfate was significantly less cytotoxic than toxic factor alone (P < 0.007).

Conclusions:  Normal urine contains a cationic cytotoxic factor that increases urothelial permeability by injuring the mucosa, allowing potassium to penetrate the urothelium and depolarize the underlying nerves and muscles. Pentosan polysulfate neutralizes the toxic factor, attenuates urothelial damage, and suppresses potassium‐mediated bladder hyperactivity.
Outcome of mid‐urethral sling procedures in Korean women with stress urinary incontinence according to body mass index
Authors: KU JA HYEON , OH JIN GYU , SHIN JAE WOOK , KIM SOO WOONG , PAICK JAE‐SEUNG
Published: May 2006

Background:  The objective of this study was to determine whether the outcome of mid‐urethral sling procedures is influenced by the body mass index of Korean women suffering from stress urinary incontinence (SUI).

Methods:  A total of 285 women, ranging in age from 28 to 80 years (mean 55.4), all of whom were followed up for at least 6 months, were ultimately included in this study. The patients were classified as follows: normal weight, 18.5–23 kg/m2; overweight, 23–27.5 kg/m2; obesity, 27.5 kg/m2 or higher.

Results:  We noted bladder perforations in 11 cases (4.9%, 3.8% and 2.2% in the normal weight, overweight, and obesity groups, respectively; P = 0.449). We determined there to be no significant differences among the three groups with regard to cure rate (P = 0.173). The rates of postoperative urinary retention were 9.9% in the normal weight group, 10.1% in the overweight group, and 15.6% in the obesity group (P = 0.396). We determined there to be no significant differences among the three groups with regard to the persistence of urgency (P = 0.312). Seventy‐nine patients (27.7%) exhibited symptoms indicative of voiding disorder (hesitancy, poor flow, or sensations of incomplete emptying). The postoperative development of these voiding symptoms was not significantly different among the three groups (P = 0.106).

Conclusion:  Our results demonstrate both the feasibility and the safety of mid‐urethral sling procedures for obese Korean women who suffer from SUI. Additional studies, including prospective randomized trials with longer follow‐up periods, will be required in order to confirm these findings.
Follow up of surgical repair of female pelvic floor disorders by a mailed questionnaire
Authors: MATSUYAMA HIDEYASU , HIRATA HIROSHI , TOMIMATSU TAKESHI , YAMAKAWA GEN‐ICHRO , TATSUMURA MASATO , NAITO KATSUSUKE
Published: May 2006

Background:  This study was conducted to determine whether surgical repair of pelvic prolapse enhances patients’ quality of life (QOL) in the long term.

Methods:  A total of 91 patients (median age, 68.0 years) with pelvic prolapse including cystoceles underwent bladder neck suspension with anterior/posterior colporrhaphy between 1997 and 2003. Postoperative QOL was longitudinally assessed by three disease‐specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health‐related QOL (HR‐QOL) item.

Results:  A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow up of 65.5 months, although poor HR‐QOL was significantly higher in patients whose age was more than 70 years at surgery (P = 0.0234, Fisher's test). Multivariate analysis revealed update urinary incontinence, update obstructive symptoms, and basic comorbidity to be independent prognostic factors for predicting postoperative moderate‐to‐poor HR‐QOL.

Conclusions:  Longer follow up with adequate assessment of patients’ QOL may be crucial for the management of postoperative patients, in particular those having basic comorbidity and aged 70 years or more at surgery.
Chlamydial seminal vesiculitis without symptomatic urethritis and epididymitis
Authors: FURUYA RYOJI , TAKAHASHI SATOSHI , FURUYA SEIJI , TAKEYAMA KOH , MASUMORI NAOYA , TSUKAMOTO TAIJI
Published: May 2006

Abstract  We previously reported that seminal vesiculitis was associated with acute epididymitis, and that Chlamydia trachomatis was the major causative pathogen for infection of the seminal vesicle, suggesting that seminal vesiculitis was a discrete disease entity. In this paper, we report two patients with bacteriologically and cytologically proven seminal vesiculitis who had asymptomatic urethritis but not epididymitis. The clinical courses of these patients suggest that chlamydial seminal vesiculitis may be a cause of asymptomatic infection of the urethra or subsequent development of acute epididymitis.
Source of plasma adrenomedullin in a patient with pheochromocytoma receiving hemodialysis
Authors: NOMURA TAKEO , YAMASAKI MUTSUSHI , SATOH FUMINORI , NOMURA YOSHIO , MIMATA HIROMITSU
Published: May 2006

Abstract  A 45‐year‐old man on long‐term hemodialysis (HD) was incidentally discovered to have a pheochromocytoma and underwent successful resection. This patient was normotensive, and had no symptoms suggesting pheochromocytoma. The plasma concentrations of total adrenomedullin (AM‐T) and mature AM (AM‐m) were higher than those in normal controls. To elucidate the source of AM, we measured plasma AM levels by immunoradiometric assay before and 3 weeks after surgery in addition to plasma adrenaline, noradrenaline and dopamine. AM expression was also assessed by immunoblot and immunohistochemical analyses on normal adrenal and tumor tissues. After surgery, elevated plasma adrenaline levels returned to the normal range; however, the levels of AM‐T and AM‐m remained almost the same as the preoperative values. Furthermore, although AM was expressed in both normal adrenal and tumor tissues, the AM expression level was less in tumor. In this case, it was suggested that elevation in plasma AM level might be a factor associated with normotensive blood pressure; however, adrenal pheochromocytoma was not a major source of circulating AM. To our knowledge, this is the first case of pheochromocytoma in patient with HD associated with AM in the literature.
Staged treatment of hypoplastic bladder: A case with single ectopic ureter in a solitary kidney
Authors: SHIMADA KENJI , MATSUMOTO FUMI , KAWAYOE MARI , NAGAHARA AKIRA
Published: May 2006

Abstract  We report on a successful treatment of hypoplastic bladder in a 5‐month‐old girl with single ectopic ureter in a solitary kidney. Side‐to‐side anastomosis was performed first between the urethral ectopic ureter and side wall of the bladder. Nine months later when the bladder capacity increased to 70 ml, ureterocystoneostomy was done through psoas hitch procedure. She retains urine of about 270 ml and evacuate completely at 14 years of age.
Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cyst
Authors: MATSUOKA YOH , ARAI GAKU , ISHIMARU HISASHI , TAKAGI KENTARO , AIDA JUNKO , OKADA YUME
Published: May 2006

Abstract  Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease. It is difficult to make a preoperative diagnosis of focal xanthogranulomatous pyelonephritis with widespread involvement that is caused by non‐calculous urinary tract obstruction.
Embryonal carcinoma producing DU‐PAN‐2 with burned‐out phenomenon in the testis
Authors: FUJITA KAZUHIKO , ITOH YUKIO , WADA RYO , NAGAO KEIJI , FUJIME MAKOTO
Published: May 2006

Abstract  A burned‐out testicular tumor with lung and lymph node metastases presented high serum levels of DU‐PAN‐2. However, the serum levels of CA19‐9, alpha‐fetoprotein, beta‐human chorionic gonadotropin, and sialyl Lewis X were normal. A biopsy of the cervical lymph nodes revealed embryonal carcinoma. Four courses of chemotherapy, including cisplatin, etoposide, and bleomycin, normalized the level of DU‐PAN‐2, and the metastatic lesions disappeared. This is the second reported case of an embryonal carcinoma producing DU‐PAN‐2. The secretor and Lewis gene typings, which affect the normal serum ranges of CA19‐9 and DU‐PAN‐2, were determined.
An unusual case of multilocular cystic nephroma with prominent renal pelvis involvement
Authors: BOUHAFS AMINE , CHERRADI NADIA , LAMAALMI NAJAT , BELKACEM RACHID , BARAHIOUI MOHAMMED
Published: May 2006

Abstract  Multilocular cystic nephroma (MCN) is a relatively rare, benign tumor of uncertain etiology. It typically arises from the renal parenchyma and is often treated with nephrectomy. We report a case of MCN with unusual prominent renal pelvis extension. A left nephrectomy was performed. A multilocular cystic lesion was found in the removed specimen, which had a direct tumor extension into the renal pelvis. There were no signs of malignancy. The tumor extension into the renal pelvis has been found in very few reports. This growth pattern might be one of the characteristics of this benign renal tumor.
A case of Sweet's syndrome following septic pulmonary emboli after high‐dose chemotherapy for advanced testicular cancer
Authors: HARA ISAO , MIURA TETSUYA , YAMANAKA KAZUKI , TANAKA KAZUSHI , YAMADA YUJI , FUJISAWA MASATO
Published: May 2006

Abstract  A 33‐year‐old man with advanced testicular cancer underwent high‐dose chemotherapy combined with peripheral blood stem cell transplantation. After administration of granulocyte colony‐stimulating factor (G‐CSF), multiple infiltrative erythema was identified on the face, thigh, and lower leg. A dermatologist diagnosed this as Sweet's syndrome caused by G‐CSF; consequently G‐CSF administration was stopped. When the skin lesions had improved, phlebitis was found at the injection site of the peripheral vein catheter. The patient then suffered from sudden left chest pain and dyspnea. Chest computed tomography showed the characteristic findings of septic pulmonary emboli (SPE). He was treated by the administration of vancomycin, fluconazole, and pazufloxacin mesilate. Although Sweet's syndrome and SPE are rare diseases, the presence of these diseases must be considered when performing chemotherapy for urological malignancy.
Renal transplant patient with polyoma virus bladder infection and subsequent polyoma virus nephropathy
Authors: WEINREB DAVID B , DESMAN GARRETT T , BURSTEIN DAVID E , DIKMAN STEVEN H , JOHNSON EDWARD M
Published: May 2006

Abstract  Polyoma virus nephropathy (PVN) is a significant cause of renal allograft dysfunction in transplant patients. A 58‐year‐old male received a cadaveric renal transplant and 12 weeks later presented with fever, diarrhea, and dysuria. He was diagnosed with a polyoma virus infection of the bladder by a transurethral bladder biopsy. One year post‐transplant, he presented with renal allograft dysfunction and was diagnosed by biopsy with PVN of the non‐native kidney. The diagnosis of a polyoma virus infection was confirmed by immunoreactivity to the polyoma T‐antigen. We suggest that polyoma virus infection of the bladder be included in the differential diagnosis of urinary dysfunction in post‐transplant patients, as such infections might be an under‐recognized comorbidity in individuals with PVN.
Two cases of chyloretroperitoneum following retroperitoneoscopic nephroureterectomy
Authors: NEGORO HIROMITSU , OKA HIROYA , KAWAKITA MUTSUSHI
Published: May 2006

Abstract  Post‐operative chyloretroperitoneum is a rare complication in urological surgery. We experienced two cases of post‐operative chyloretroperitoneum following retroperitoneoscopic left nephroureterectomy. Both cases were treated successfully with drainage, low fat diet, total parenteral nutrition (case 1 only), sclerotherapy and somatostatin analog. Laparoscopic procedures are supposed to have a higher risk of chylous complications, as CO2 pressure appears to make the operator overlook suppressing the lymphatic leakage from the resected lymphatic channels.
MAKING A VIRTUE OF NECESSITY: MANAGING THE OPEN ABDOMEN
Authors: De Costa Alan
Published: May 2006

Background:  The open abdomen, or laparostomy, is becoming increasingly used in the management of critically ill surgical patients.

Methods:  The published work on laparostomy is reviewed, in the light of personal experience, with particular attention to the history and pathophysiology associated with laparostomy.

Results and Conclusion:  The combination of an inert plastic sheet in contact with the viscera, and the application of subatmospheric pressure on the wound, is an effective combination to maximize the prospects of delayed primary wound closure while minimizing the chance of fistula and ventral hernia.