bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidermolysis bullosa acquisita with Combined Features of Bullous Pemphigoid and Cicatricial Pemphigoid
Authors: Wieme N. , Lambert J. , Moerman M. , Geerts M.L. , Temmerman L. , Naeyaert J.M.
Published: April 2003

Epidermolysis bullosa acquisita (EBA) is an acquired subepidermal blistering disease associated with autoantibodies against type VII collagen. The classical or mechanobullous form of EBA is characterized by skin fragility, trauma-induced blisters and erosions with mild mucous membrane involvement and healing with scars. Furthermore, bullous-pemphigoid-like and cicatricial pemphigoid-like features have been described. We report a patient who developed a bullous skin disease with upper airway obstruction requiring tracheotomy. The diagnosis of EBA was established by immunoblot, showing a band at 290 kD (collagen VII), and NaCl-split skin immunofluorescence (IgG deposition at the floor of the split). This case presented with clinical features of both bullous pemphigoid and cicatricial pemphigoid which to our knowledge is the first report of such a combination in EBA. The patient also presented tracheal involvement that has never been described either.
Topical Calcipotriol Combined with Phototherapy for Psoriasis
Authors: Molin L.
Published: April 2003

Background: Calcipotrial has a well-documented effect in the treatment of psoriasis. Objective: To confirm the beneficial effect of the combination of calcipotriol and UVB and to demonstrate that the combination is safe and well tolerated. Methods: Data from two randomized right/left studies were analysed. Patients included in the studies had chronic stable plaque-type psoriasis with symmetrical lesions on the arms, the legs and/or the trunk. In one study, 101 patients were treated with calcipotriol on one side and calcipotriol + UVB on the other side of the body (open study). In the other study, 77 patients were treated with calcipotriol + UVB on one side and vehicle + UVB on the other side of the body (double-blind study). Calcipotriol ointment, 50 μg/g, was applied twice daily and UVB 3 times weekly for 8 weeks. UVB was increased from 0.7 MED before treatment in rapid steps up to the erythema threshold. Result: In both treatment series the therapeutic effect of the combination of calcipotriol and UVB was enhanced as compared to calcipotriol alone and UVB alone. In the first series there was a significant reduction of the psoriasis area and severity index (PASI) with the combination after 2 weeks as compared to calcipotriol alone. At the end of treatment significantly more sides were cleared after calcipotriol + UVB than after calcipotriol alone. In the other series there was a significantly faster onset of improvement on the sides treated with calcipotriol + UVB than on those treated with vehicle + UVB. After 2 weeks there was a significant difference in PASI in favour of calcipotriol + UVB. At the end of treatment, however, there was no difference between the treatments. There was a similar adverse event profile with either treatment. The addition of UVB to calcipotriol did not alter the tolerability or safety of topically applied calcipotriol. Conclusions: The result indicates a beneficial effect of combining calcipotriol and phototherapy. The findings are compared to other published studies.
Multiple Familial Keratoacanthoma of Witten and Zak – A Report of Three Siblings
Authors: Agarwal M. , Chander R. , Karmakar S. , Walia R.
Published: April 2003

Three out of 11 siblings of a nonconsanguineous marriage suffering from biopsy-proven multiple small eruptive keratoacanthoma (KA) of Grzybowski as well as large nodular KA of Ferguson-Smith are reported. The response to oral methotrexate was not encouraging. Intravenous 5-fluorouracil (5-FU) at a dose of 12 mg/kg/day in isotonic saline given in weekly 5-day cycles resulted in almost complete resolution of small eruptive lesions and signs of involution in older large agglomerate noduloulcerative KA after 6 cycles. Thus, intravenous 5-FU was found to be an effective therapeutic modality for the Witten and Zak type of KA.
Linear Cutaneous Lupus erythematosus in an Adult
Authors: Bouzit N. , Grézard P. , Wolf F. , Balme B. , Perrot H.
Published: April 2003

We report on a 32-year-old female with a 3-year history of an asymptomatic erythema of the forehead. The lesion had a linear distribution following the lines of Blaschko. Histopathological findings and direct immunofluorescence allowed to establish the diagnosis of cutaneous lupus erythematosus. Treatment with local corticosteroid and antimalarial agents given for 2 months resulted in a complete remission.
Paronychia with Pyogenic Granuloma in a Child Treated with Indinavir: The Retinoid-Mediated Side Effect Theory Revisited
Authors: Sass J.O. , Jakob-Sölder B. , Heitger A. , Tzimas G. , Sarcletti M.
Published: April 2003

Background: The introduction of HIV-1 protease inhibitors into the treatment of patients infected with HIV-1 has had a major influence on clinical practice. However, the use of protease inhibitors is frequently associated with the development of resistance and several side effects and interactions with other drugs have been reported. Observations: We present the first pediatric patient with paronychia with pyogenic granuloma associated with the administration of the protease inhibitor indinavir. Clinical findings are discussed in view of a possible interference of indinavir with endogenous retinoid metabolism. Conclusion: Considerable evidence advocates the mediation of indinavir side effects by impaired oxidative metabolism of retinoic acid through the inhibition of cytochromes P450 3A by indinavir rather than by impaired formation of 9-cis-retinoic acid.
Primary Atrophic Profound Linear Scleroderma
Authors: Blaszczyk Maria , Krysicka-Janiger Kamila , Jabłońska Stefania
Published: April 2003

We present 3 unusual cases of deep linear, primary atrophic scleroderma, not preceded by inflammatory reaction and sclerosis, involving the subcutis and deeper tissues. These cases differ in the course and prognosis from typical profound scleroderma since they do not lead to disfiguration and crippling deformities. In contrast to the atrophies left after regression of morphea or linear scleroderma, they do not involve the dermis, which does not show discoloration or changes in texture. Infiltrates in the endomysium, involvement of deeper tissues and the progressive character of the disease argue for atypical primary atrophic profound scleroderma. The coexistence in one case of primary facial hemiatrophy appears to indicate also its relationship with primary linear atrophies of the limbs.
Primary Mucinous Carcinoma of the Scalp
Authors: Breier Friedrich , Clabian Markus , Pokieser Wolfgang , Feldmann Robert , Pelzl Marianne , Kosak Dieter , Volc-Platzer Beatrix , Kolbabek Heinrich , Gschnait Friedrich
Published: April 2003

Primary cutaneous mucinous carcinoma (MC) is a rare epithelial neoplasm derived from the sweat glands. Herein, we report a case of MC located on the head. A 66-year-old woman underwent excision of a nodular tumor with a reddish brown surface on the left parietal region. Histopathology revealed a neoplasm extending from the reticular dermis into the subcutaneous fat. The tumor cell aggregates showed cribriform and solid lobules and were embedded in lakes of mucin, separated by thin, fibrous septae. Focally single neoplastic cells were arranged in an Indian-file pattern. The tumor cells displayed an eosinophilic cytoplasm, large basophilic nuclei and some discrete nuclear atypia. Vascular spaces, filled by densely packed erythrocytes between the septae, were also observed. We compared the mucinous component with the tumor cell and the stromal component by light microscopy. Analyzing the tumor by an image analysis system in Alcian-blue-stained serial sections, we found the averaged total tumor area measuring 99.7 mm2. The area of the mucinous component measured 92.4 mm2, that of the tumor cells 3.7 mm2 and that of the stromal component 3.6 mm2. The extensive checkup of the patient disclosed no evidence for a further malignant neoplasm. After excision of the tumor an adjuvant radiotherapy was performed. The patient was free of recurrence and metastatic spread of the mucinous carcinoma during a 4-year follow-up.
Photo-Accentuated Eruption and Vascular Deposits of Immunoglobulin A Associated with Hepatitis A Virus Infection
Authors: Kano Yoko , Kokaji Tomoko , Shiohara Tetsuo
Published: April 2003

Skin rash associated with hepatitis A virus infection has rarely been reported. We describe a patient with hepatitis A virus infection who presented a rubelliform rash markedly accentuated in sun-exposed areas; direct immunofluorescence studies of the lesion revealed immunoglobulin (Ig) A deposition on the endothelial cells in the upper dermis. Oral rechallenge tests of the previously administered drugs failed to reproduce the eruption. The preferential setting of immune complexes containing IgA at sites of sun exposure and sunlight as a triggering factor might have been responsible for the development of the eruption in this patient. Eruptions associated with hepatitis A virus infections may be more frequent than commonly thought. Because of difficulty to exclude the possibility of drug eruptions, these cases might have been overlooked. In patients with such a disorder, a careful clinical workup such as IgM antibodies for hepatitis A virus at diagnosis and during follow-up is especially recommended.
The Efficacy, Safety and Tolerance of Calcitriol 3 μg/g Ointment in the Treatment of Plaque Psoriasis: A Comparison with Short-Contact Dithranol
Authors: Hutchinson P.E. , Marks R. , White J.
Published: April 2003

Objective: A comparison of efficacy, safety and tolerance of a twice-daily application of calcitriol 3 μg/g ointment with dithranol cream. Methods: The study was an 8-week, prospective, randomised, open, parallel-group trial with 114 patients. Subjects received either 3 μg/g calcitriol ointment (twice daily) or 0.25–2% dithranol cream (once daily for 30 min). Results were measured using global improvement, global severity, PASI, quality of life (QOL) and Psoriasis Disability Index scores. Safety was determined from reports of adverse events and blood chemistry analysis. Results: At final assessment, calcitriol and dithranol were comparably efficacious. Skin irritation was reported by 5% of calcitriol and 72% of dithranol patients. Patients rated QOL and overall acceptability of calcitriol more highly. Conclusions: Twice-daily calcitriol ointment (3 μg/g) is equally effective as a once-daily, short-contact dithranol regimen. However, calcitriol is better tolerated than dithranol, and provides a better QOL and a greater patient acceptability.
High Prevalence of Seborrhoeic Dermatitis on the Face and Scalp in Mountain Guides
Authors: Moehrle Matthias , Dennenmoser Bernhard , Schlagenhauff Bettina , Thomma Sybille , Garbe Claus
Published: April 2003

Background: High incidence rates of seborrhoeic dermatitis (SD) have been reported in HIV-infected individuals, indicating immunosuppression to be involved in the pathogenesis. Objective: To establish the prevalence of SD in mountain guides who have a high occupational exposure to solar UV radiation. Patients and Methods: In November 1999, 283 mountain guides were physically examined on the face and scalp for symptoms of SD in Austria (n = 75), Switzerland (n = 123) and Germany (n = 85); they were 21.3–93.1 years of age (median age 41.4 years). Results: Forty-six of 283 (16.3%) mountain guides when examined clinically were found to have SD. The median age of mountain guides with SD was 41.2 years. There were similar incidence rates in all three countries. Conclusion: SD affects mountain guides in a clearly higher percentage as the general population. We suggest UV-induced immunosuppression due to occupational sun exposure as a pathogenetic factor.
Successful Treatment of Discoid Lupus erythematosus with Argon Laser
Authors: Kuhn Annegret , Becker-Wegerich Petra Maria , Ruzicka Thomas , Lehmann Percy
Published: April 2003

Vascular lesions with telangiectasias on visible areas, such as the face, are common in discoid lupus erythematosus (DLE); however, an efficient management of these skin lesions can sometimes be difficult. Since argon laser light is able to specifically coagulate vascular structures, it has been used in the treatment of various vascular skin malformations. Therefore, we addressed the issue whether argon laser treatment could be a therapeutic alternative for this disease. Here, we report on a patient with DLE, who suffered from long-standing erythematous, telangiectatic plaques on the face refractory to standard regimens of therapy. After 2 laser applications, a significant improvement was observed and after 5 sessions of argon laser therapy the treated skin lesions had completely resolved with an excellent cosmetic result. The patient tolerated the laser treatment well without any short-term side effects. These data indicate that argon laser therapy might be a powerful alternative approach in the treatment of vascular skin lesions of DLE.
Relationship between Doubling Time of Liver Metastases from Colorectal Carcinoma and Residual Primary Cancer
Authors: Nomura Kazuhiko , Miyagawa Shinichi , Harada Haruhisa , Kitamura Hiroshi , Seki Hitoshi , Shimada Ryou , Kobayashi Akira , Noike Terumasa , Kawasaki Seiji
Published: April 2003

Background: The doubling times of liver metastases were calculated in order to clarify their usefulness in predicting the presence of residual cancer in the abdominal cavity in patients who had undergone curative resection of primary colorectal cancer. Patients and Methods: Tumor doubling times were calculated retrospectively in 22 patients by serial measurement of the size of their liver metastases. Results: Patients with a tumor doubling time of less than 92.4 days had a significantly poorer prognosis than those with a doubling time more than or equal to 92.4 days (p < 0.05). Local recurrence or peritoneal dissemination was significantly more likely to occur when the tumor doubling time was less than 92.4 days than when it was more than or equal to 92.4 days (p < 0.01). Conclusion: The doubling time of hepatic metastases in patients with colorectal carcinoma may be a useful prognostic indicator, with patients who have a shorter tumor doubling time carrying a greater risk of residual primary cancer in the abdominal cavity.
Comparison of Adhesion Formation in Open and Laparoscopic Surgery
Authors: Schäfer M. , Krähenbühl L. , Büchler M.W.
Published: April 2003

The development of postoperative adhesions remains an almost inevitable consequence of visceral and gynecological surgery, appearing in 50–95% of all patients. The pathogenetical sequence from peritoneal injury, with locally released cytokines and inflammatory reaction, to permanent fibrous adhesions has been elucidated in recent years. Early and late bowel obstruction, chronic abdominal pain, and infertility are the main clinical complications, and they also increase the socio-economic costs. Laparoscopic surgical procedures with their minimal access to the abdominal cavity are associated with fewer postoperative adhesions compared to open surgery, although adhesion formations cannot be entirely prevented.
Salvage Esophagectomy after Unsuccessful Curative Chemoradiotherapy for Squamous Cell Cancer of the Esophagus
Authors: Meunier Bernard , Raoul Jean-Luc , Le Prisé Elisabeth , Lakéhal Mohamed , Launois Bernard
Published: April 2003

Surgery was performed on 6 patients after unsuccessful chemoradiotherapy for squamous cell cancer of the esophagus. The operation was very difficult due to post-irradiation sequelae in 5. The postoperative period was uneventful in 4 patients. Median intensive care unit stay and hospitalization were 5 and 47 days, respectively. Survival after surgery reached 44 months in 1 patient (59 months after diagnosis). Outcome was better in patients who had surgery after recurrence rather than after nonresponse to chemoradiotherapy. Salvage esophagectomy can be beneficial, in selected patients, after unsuccessful chemoradiotherapy for cancer of the esophagus by providing longer survival and better quality of life despite operative and postoperative morbidity.
Diffuse Peritonitis in Steroid-Treated Patients
Authors: Menegaux Fabrice , Chenard Xavier , Wechsler Bertrand , Boutin Zhou , Chigot Jean-Paul
Published: April 2003

Patients on systemic steroid therapy are at increased risk of diffuse peritonitis, specially from gastrointestinal perforation. We performed a retrospective study of 37 patients on systemic steroid therapy who underwent surgery for diffuse peritonitis. Clinical presentation of peritonitis was usually aspecific, making the diagnosis difficult. The median interval between onset of symptoms and surgery was 3.3 days, reduced to 2.0 days between hospitalization and surgery. The mortality rate was 46% (17 of 37 patients). We emphasize aggressive diagnostic efforts and early abdominal exploration in front of any persisting abdominal pain in patients on systemic steroid therapy.
Botulin Toxin in the Treatment of Nonrelaxing Puborectalis Syndrome
Authors: Shafik Ahmed , El-Sibai Olfat
Published: April 2003

Purpose: To evaluate the results of botulin toxin injection in the external anal sphincter for the treatment of nonrelaxing puborectalis syndrome. Method: 15 patients (13 women, 2 men; aged 36–48 years) were treated with botulinum A toxin injection, using a dose of 25 IU diluted in 1 ml normal saline injected into the top loop of the external anal sphincter at the 3 and 9 o’clock positions. The mean follow-up period was 14.6 ± 3.3 (SD) months. Results: Two patients did not respond to the treatment while improvement occurred in 13. Straining at defecation disappeared and stool frequency was normalized. Improvement was maintained for a mean of 4.8 ± 1.4 SD months, after which time reinjection needed to be done. No adverse side effects were encountered. Conclusions: Botulin toxin injection is a simple, easy and safe method for the treatment of nonrelaxing puborectalis syndrome. It is to be considered after biofeedback has failed.
Radiation-Associated Rectal Cancer: Report of Four Cases
Authors: Tamai Osamu , Nozato Eiji , Miyazato Hiroshi , Isa Tsutomu , Hiroyasu Shungo , Shiraishi Masayuki , Kusano Toshiomi , Muto Yoshihiro , Higashi Masahiro
Published: April 2003

Background/Aims:  Radiation-associated rectal cancer is a remarkable clinical entity. We demonstrate 4 patients (mean age 68 years, range 63–74) who had undergone pelvic radiotherapy for cervical cancer. We indicate some characteristics of radiation-associated rectal cancer. Results:  Two patients had received intracavitary and external pelvic radiotherapy, while the remaining 2 had external pelvic radiotherapy following hysterectomy. The mean total radiation dose was 63 Gy, though radiation dose information was not available for 1 patient. Colorectal cancer developed at a mean time of 20.7 years (range 11–30) after radiation therapy. All patients presented with chronic radiation colitis, and 3 demonstrated abnormal tumor markers. Colonoscopy revealed an ulcerative, localized well-differentiated adenocarcinoma of the rectosigmoid colon in 1 patient, and diffusely infiltrating cancers of the lower rectum, one signet-ring cell carcinoma and two mucinous carcinomas in the remaining 3. One case was stage I, 2 were stage IIIa, and the remaining case was stage IV. Three patients underwent abdominoperineal resection. The remaining patient was felt to be inoperable. The colorectal wall demonstrated the changes of chronic radiation injury. Two patients died within a short time because of their advanced cancers. Conclusion:  Radiation-associated rectal cancer has a tendency to be diagnosed in the advanced stage and to have a poor prognosis. A literature review and our case report suggest that since there are no reliable clinical or laboratory indicators of the presence of a curable colorectal cancer in the setting of chronic radiation proctocolitis, surveillance with a colonoscope should be done 10 years after irradiation in patients with previous pelvic radiotherapy.
Occurrence of Implantation Metastases after Resection of Klatskin Tumors
Authors: ten Hoopen-Neumann H. , Gerhards M.F. , van Gulik T.M. , Bosma A. , Verbeek P.C.M. , Gouma D.J.
Published: April 2003

Background: We found a high proportion of patients with implantation metastases during follow-up after resection of a proximal cholangiocarcinoma. A remarkable fact was that all these patients had undergone preoperative endoscopic retrograde cholangiopancreatography (ERCP) with placement of a stent. ERCP is frequently used in the assessment of the proximal extension of Klatskin tumors and is usually followed by stent insertion for biliary drainage. The aim of this study was to analyze the possible risk factors leading to implantation metastases in this series of patients. Methods: Fifty-two patients who had undergone resection of a Klatskin tumor were divided into 2 groups, comparing patients who had had preoperative ERCP and stent placement (n = 41) and patients without preoperative drainage (n = 11). Results: Eight patients developed implantation metastases within 1 year after resection, all of whom had undergone preoperative stent placement (8/41, 20%). None of the patients without preoperative stenting developed implantation metastases. In 22 patients bile samples were taken during operation. Sixteen (72.7%) patients had malignant cells and 4 (18.2%) patients atypical cells in the bile sample. There was no difference in cytology results between the 2 groups. Conclusion: This study suggests that preoperative ERCP with biliary drainage is associated with a higher frequency of implantation metastases after resection of Klatskin tumors. A properly planned prospective study, however, is needed to determine whether bile duct stenting in patients with resectable bile duct tumors is a true risk factor for the development of implantation metastases.
Role of TNF-α in Local Surgical Trauma-Induced Microvascular Dysfunction
Authors: Yamauchi Jun-ichiro , Vollmar Brigitte , Wolf Beate , Menger Michael D.
Published: April 2003

Background/Aim: The aim of this study was to gain insight into the mechanisms of microvascular dysfunction after local surgical trauma. Methods: The effect of anti-tumor necrosis factor (TNF)-α antibody (Ab) on microvascular function, including arteriolar diameter response, nutritive perfusion, leukocyte-endothelial cell interaction and endothelial integrity disruption, was studied in hamster skinfold chamber preparations using intravital fluorescence microscopy. Results: Directly after the surgical procedure, arteriolar diameters were found to be markedly (p < 0.05) reduced, but recovered significantly at 8 h and reached plateau levels after 24 h. Surgical trauma further induced a strong inflammatory response characterized by a significant (p < 0.05) increase in leukocyte adherence to the endothelium of postcapillary venules. This inflammatory response was associated with an increase in microvascular permeability, indicating endothelial integrity disruption. Anti-TNF-α Ab had no significant effect on the surgical trauma-induced arteriolar vasomotor dysfunction; however, it effectively (p < 0.05) reduced venular leukocyte adherence and attenuated the increase in microvascular permeability. Conclusion: Our study indicates that arteriolar constriction, leukocyte-endothelial cell interaction and endothelial macromolecular leakage have to be considered as the characteristic microvascular response after local surgical trauma. It is conceivable that TNF-α plays a role in mediating the inflammatory response, but not the dysfunction of vasomotor control.
Laparoscopic Prosthetic Reinforcement of Hiatal Herniorrhaphy
Authors: Carlson Mark A. , Richards Christina G. , Frantzides Constantine T.
Published: April 2003

Background/Aims: Primary repair of a large hiatal hernia is associated with a published recurrence rate of up to 10%; anecdotal rates even higher than this have been reported to the authors. The use of prosthetic material in the repair of other abdominal wall defects has often produced better results than primary repair. We wanted to compare laparoscopic primary repair of large hiatus hernias with laparoscopic primary repair reinforced with prosthetic. Methods: Thirty-one patients with symptomatic gastroesophageal reflux and a hiatal defect 8 cm or greater were randomized to Nissen fundoplication with posterior cruroplasty (n = 16) or Nissen cruroplasty, and onlay of polytetrafluoroethylene (PTFE) mesh (n = 15). All patients underwent preoperative esophagogastroduodenoscopy (EGD) and barium esophagography. After posterior cruroplasty with interrupted nonabsorbable suture, the mesh reinforcement group had an onlay of PTFE placed around the hiatus. A radial slit with 3 cm ‘keyhole’ (to accommodate the esophagus) was cut into the PTFE. The prosthetic was stapled to the diaphragm, and the two leaves of the slit were stapled to each other. All patients underwent EGD at 3 months and all had esophagrams every 6 months postoperatively. Follow-up ranged from 12 to 36 months. Results: Length of hospital stay was equal in both groups (2 days). The average cost to the patient with PTFE was USD 1,050 higher than to the patient with primary repair. There were 2 complications (1 pneumonia, 1 urinary retention) in the PTFE group, and 1 complication (pneumothorax) in the primary repair group. There were 3 recurrences (18.8%) in the primary group (p = 0.08, χ2 test). Conclusion: The use of PFTE reinforcement for primary repair of large hiatal hernias may result in a lower rate of recurrent herniation compared to primary repair alone.
Small Bowel Ischemia following Laparoscopic Cholecystectomy
Authors: Andrei Valeriu E. , Schein Moshe , Wise Leslie
Published: April 2003

Background: Among a myriad of physiological adverse affects of pneumoperitoneum-associated intra-abdominal hypertension, compromise of the mesenteric circulation is well documented. Methods: After experiencing a case of fatal small bowel ischemia in the aftermath of laparoscopic cholecystectomy, the literature was reviewed. Results: A Medline and Index Medicus search revealed at least 6 cases of small bowel ischemia following laparoscopic cholecystectomy. Conclusions: Mesentric ischemia should be considered in the differential diagnosis of patients developing nonspecific abdominal symptoms after laparoscopic procedures.
Mesenteric Cysts
Authors: de Perrot Marc , Bründler Marie-Anne , Tötsch Martin , Mentha Gilles , Morel Philippe
Published: April 2003

Objective: Mesenteric cysts are rare intra-abdominal masses generally omited or briefly reported in textbooks. Their rarity had fostered a lack of information and difficulty in classification. The goal of the study is to present a simple, comprehensive, and reproducible classification of mesenteric cysts. Methods: A large review of the literature with particular attention to recent series was performed in order to identify and characterize the different groups of mesenteric cysts. Results: Although cysts of lymphatic and mesothelial origin are those most frequently encountered, they were confounded or omitted in previous classifications. However, their distinction is important because their incidence and mode of presentation differ. Lymphangiomas predominate in male children, may cause acute abdominal pain, and frequently require resection of adjacent structures. In contrast, cysts of mesothelial origin such as benign cystic mesothelioma are seen more frequently in young and middle-aged women, usually present with more indolent symptoms, and often recurs. Conclusions: A new classification based essentially on histopathological features should include the 6 following groups: (1) cysts of lymphatic origin (simple lymphatic cyst and lymphangioma); (2) cysts of mesothelial origin (simple mesothelial cyst, benign cystic mesothelioma, and malignant cystic mesothelioma); (3) cysts of enteric origin (enteric cyst and enteric duplication cyst); (4) cysts of urogenital origin; (5) mature cystic teratoma (dermoid cysts), and (6) pseudocysts (infectious and traumatic cysts).
Effects of Perioperative Protease Inhibitor on Inflammatory Cytokines and Acute-Phase Proteins in Patients with Hepatic Resection
Authors: Ambiru S. , Miyazaki M. , Sasada K. , Ito H. , Kimura F. , Nakagawa K. , Shimizu H. , Ando K. , Nakajima N.
Published: April 2003

Aim: The objective of this study was to examine the effects of perioperative administration of ulinastatin, or urinary trypsin inhibitor (UTI), on inflammatory cytokines and acute-phase proteins induced by inflammatory cytokines in patients who had undergone hepatic resection. Method: Twenty patients admitted to the hospital for hepatic resection were equally randomized to one of two groups: the UTI group, those who were administered perioperative UTI, and the control group. Results: The UTI group had no adverse effects from using UTI. Production of serum interleukin-6 (IL-6) tended to be attenuated in the UTI group when compared with the control group. Moreover, the UTI group had significantly decreased positive acute-phase C-reactive protein (p < 0.05) and significantly increased negative acute-phase protein prealbumin and retinol-binding protein (p < 0.05). Serum IL-6 levels significantly correlated with serum C-reactive protein levels on postoperative day 1 (r = 0.70, p < 0.01). Conclusion: These results suggest that perioperative administration of UTI might deserve further assessment for use in modulating acute-phase responses without adverse effects in patients who have undergone hepatic resection.
Ampullary but Not Periampullary Duodenal Diverticula Are an Etiologic Factor for Chronic Pancreatitis
Authors: Naranjo-Chavez Julio , Schwarz Michael , Leder Gerhard , Beger Hans G.
Published: April 2003

Background: Duodenal diverticula are common incidental findings. Although a definite treatment is rarely required, an association with biliary and pancreatic diseases is often suggested. Our aim was to determine the frequency of complications in relation to the location of the diverticulum. Methods: We reviewed 64 patients with extraluminal duodenal diverticula. In 24 of these patients the diverticulum was treated surgically. The incidence of symptoms and complications is analyzed and follow-up in 88% of operated patients is presented. Results: Thirty-one patients presented with ampullary, 36 patients with periampullary diverticula. Three patients had both types of diverticula. The indication for surgery in 24 patients was chronic pancreatitis (n = 12), chronic pain (n = 6), diverticular perforation (n = 3), bleeding (n = 2), or jaundice (n = 1). In 7 out of 31 patients with ampullary and none out of 36 patients with periampullary diverticula, chronic pancreatitis was considered to be induced by the diverticulum. Morbidity in 24 operated patients was 17%, no patient died. At follow-up all patients were free of symptoms. Conclusion: Extraluminal duodenal diverticula are frequently found. They rarely cause symptoms and need no surgical treatment. While ampullary duodenal diverticula can cause chronic pancreatitis, periampullary duodenal diverticula are no etiologic factor.
Prospective Multicenter Study of Antibiotic Prophylaxis in Operative Treatment of Appendicitis
Authors: Koch A. , Zippel R. , Marusch F. , Schmidt U. , Gastinger I. , Lippert H.
Published: April 2003

Background/Aims: A prospective, multicenter observation study was conducted to investigate the effectiveness of antibiotic prophylaxis in the operative treatment of appendicitis. Methods: Between June 1996 and May 1997, a total of 4,968 patients underwent an operation for appendicitis at 34 East German hospitals. 41.4% (n = 2,424) received perioperative antibiotic prophylaxis whereas in 58.9% of the cases this was not given. The patients who received antibiotic prophylaxis constituted a negative selection, both with regard to risk factors and to the stage of inflammation. Results: In the total test group, the rate for septic disorders of wound healing amounted to 2.5% (n = 120). The use of antibiotic prophylaxis makes it possible to significant lower the incidence of postoperative septic disorders of wound healing (p < 0.001). In both conventional (0.7% with prophylaxis vs. 3.8% without) and in laparoscopic appendectomy (0 vs. 1.0%) the rate for septic disorders of wound healing can be reduced (p < 0.001). The global comparison irrespective of possible antibiotic prophylaxis shows a significant advantage for appendectomies which started with laparoscopy (p = 0.008), but in the subgroups with prophylaxis this advantage is completely neutralized (p = 0.78). Conclusion: From this one can deduce that conventional appendectomy with antibiotic prophylaxis comprises no higher risk of wound infection than laparoscopy, since the risk of conversion exists for every operation begun by laparoscopy. These results would lead to the conclusion that antibiotic prophylaxis should be given before every appendectomy, whether by laparoscopy or conventional methods.
Noninfectious Gas Accumulation in an Infarcted Spleen
Authors: Barzilai Menashe , Schlag-Eisenberg Dorit , Peled Nathan , Bitterman Arie
Published: April 2003

Background: Intentional selective occlusion of the arterial blood supply to tumors of abdominal organs is a well established therapeutic procedure. Several reports described gas accumulation at the infarcted sites. These gas collections are usually nonsuppurative; however, the differential diagnosis should include abscess formation. Case Report: We present a 59-year-old patient in whom the splenic artery was accidentally ligated during gastrectomy surgery, with resultant splenic infarction. Gas accumulation was diagnosed by sonography and CT studies. To the best of our knowledge this is the first report ever published in the English medical literature describing nonsuppurative gas formation within an abdominal organ, caused by accidental ligation of its main arterial supply during surgery. Summary: Possible theories regarding this noninfectious gas accumulation are discussed and the differential diagnosis between abscess formation and noninfectious gas accumulation is emphasized. Establishing the correct diagnosis is of big clinical importance as the treatment of choice is completely different in each one of these entities although the imaging features, in ultrasound as well as in CT, are somewhat similar.
Cannabis Psychosis and Acute Schizophrenia
Authors: Basu Debasish , Malhotra Anil , Bhagat Achal , Varma Vijoy K.
Published: April 2003

Twenty cases of cannabis psychosis were compared with a control group of 20 patients with ‘acute schizophrenic episode’ on a number of demographic, clinical, illness-related and outcome variables in a case-control study design using a retrospective chart review. The two groups were comparable on demographic, past and family histories of mental illness, premorbid personality, psychomotor activity, Schneiderian first-rank symptoms and mild cognitive deficits. The cases, in contrast to the control group, had a psychosis of shorter duration characterized by reactive and congruent affect, relative absence of schizophrenic formal thought disorder and a predominantly polymorphic clinical picture. Relapse was always preceded by cannabis use. This study suggests that, in spite of certain overlaps, ‘cannabis psychosis’ may still be considered nosologically distinct from schizophrenia in India. The implication of the study is that the role of cannabis in any acute psychosis should be investigated carefully so as to prevent an overdiagnosis of schizophrenia.
Screening for Concomitant Alcohol Abuse in Schizophrenia: Clinical Significance of the Munich Alcoholism Test and Laboratory Tests
Authors: Agelink Marcus W. , Ullrich Heiko , Lemmer Wimar , Dirkes-Kersting Astrid , Zeit Thomas
Published: April 2003

For the early and correct diagnosis of the comorbidity of schizophrenia and alcoholism, a valid laboratory marker would be most helpful in clinical practice. Seventy schizophrenics admitted to a general psychiatric unit of an urban hospital located in a large industrial area in Germany prospectively underwent a detailed addiction history, the Munich Alcoholism Test (MALT) and determinations of serum γ-glutamyltransferase (γGT) and carbohydrate-deficient transferrin (CDT). Cutoff levels for laboratory tests represented the 95th percentile of data obtained from 100 matched healthy controls. Using the MALT, we found evidence of concomitant alcohol consumption in 42.8% of the study patients. The sensitivities of γGT and CDT for detecting alcohol abuse (confirmed using DSM III-R criteria) were 70.6 and 58.8%, respectively. Our data suggest that the MALT can be used as a reliable screening test for alcohol use in schizophrenia. In neuroleptic-treated schizophrenics with pathological γGT, but low MALT scores, the corresponding CDT may serve as a highly specific marker to verify a concomitant alcohol abuse.
UK Monitoring of Problem Drug Users: The Drug Misuse Database – A System Based on Regional Centres
Authors: Donmall M.
Published: April 2003

UK drug treatment policy aims to reduce the harm to individuals and communities resulting from drug misuse through multidisciplinary community services, prescribing, detoxification and rehabilitation facilities. Drug Misuse Databases (DMD) were set up in England, Wales and Scotland in 1990 to monitor treatment demand; that in Northern Ireland is under development. The regional base of these DMDs provides good local context and data specificity, while periodic collation of regional data by the Department of Health provides national analyses. DMD will be able to deliver the TDI dataset with only minor adjustments, following harmonisation between the constituent UK countries.
Alcohol Consumption during Methadone Maintenance Treatment
Authors: Rittmannsberger H. , Silberbauer Ch. , Lehner R. , Ruschak M.
Published: April 2003

Alcohol consumption during methadone maintenance treatment (MMT) often becomes a problem. We investigated a group of 68 patients undergoing MMT in our care. Mean duration of MMT was 50 months. A set of risk factors for problematic alcohol use (‘alcohol indicators’) was set up consisting of patients’ account and laboratory parameters. 52% of patients were positive for these ‘alcohol indicators’ and 32% of patients fulfilled more severe criteria for alcohol abuse. There was exactly the same proportion of patients with ‘alcohol indicators’ at the start of MMT as at follow-up examination. In 79% of these patients ‘alcohol indicators’ were found on both occasions, testifying that alcohol problems were a stable trait. While patients without ‘alcohol indicators’ showed an improvement of liver parameters over time, those with ‘alcohol indicators’ suffered a considerable deterioration, indicating that the amount of alcohol consumption had increased.
Alcohol Use Disorders in French University Hospital Patients
Authors: Ganry O. , Joly J.P. , Stan-Quintin I. , Queval M.-P. , Beaudot J.M. , Dubreuil A.
Published: April 2003

The adult patients of the somatic departments of Amiens University Hospital were screened on a randomly selected day by interviewers who examined them using a structured questionnaire regarding lifestyle, with the CAGE questionnaire, and their daily alcohol consumption. The medical histories of all patients were collected. A patient was considered having an alcohol problem if one or more of the following criteria was fulfilled: (1) a CAGE questionnaire score of 2 or more positive answers; (2) an alcohol-related diagnosis. In total, 869 patients fulfilled the entry criteria (377 patients were excluded owing to predefined exclusion criteria). A hundred and sixty-seven patients (19.2%) fulfilled 1 or 2 of the criteria for an alcohol problem. Eighty-eight patients (10.1%) had an alcohol-related discharge diagnosis. The prevalence of patients with a positive CAGE score was 13.5% and was significantly higher among male patients (22.7%) than among female patients (5.5%). The frequency of a higher socioeconomic status or the status of ‘living alone’ increased significantly with alcohol consumption.
Measuring Met and Unmet Need of Drug Misusers: Integration of Quantitative and Qualitative Data
Authors: Fountain Jane , Strang John , Griffiths Paul , Powis Beverly , Gossop Michael
Published: April 2003

This paper reports on the combination of qualitative and quantitative methods which were used to record the attitudes to, and perceptions of, drug treatment services by current, ex-, and potential clients in south-east London. Three research instruments were employed: a structured current client satisfaction survey (n = 333); a questionnaire which included open-ended questions, administered to drug users not currently in treatment (n = 88), and focus groups for young drug users not in treatment (n = 14), women in treatment (n = 7) and men in treatment (n = 11). The data thus collected were used to construct a picture of local met and unmet need and obstacles to the uptake of health care, which is supported by more than one perspective, and which can reasonably be used as the basis for the planning of local health care purchase. Three major concerns were revealed by the data: the inadequacy of existing GP drug services; the deterrent effect of long waiting lists for methadone treatment, and the role of treatment services in relation to those drug users who acknowledge that their drug use is problematic, but believe that treatment services have nothing to offer them.
The Immunogenic Properties of Melanoma-Associated Antigens Recognized by Cytotoxic T Lymphocytes
Authors: Kirkin Alexei F. , Dzhandzhugazyan Karine , Zeuthen Jesper
Published: April 2003

During the last 6 years significant progress has been achieved in the identification of melanoma-associated antigens recognized by cytotoxic T lymphocytes. These antigens belong to three main groups: tumor-associated testis-specific antigens (MAGE, BAGE, GAGE and PRAME), melanocyte differentiation antigens (tyrosinase, Melan-A/MART-1, gp100, TRP-1 and TRP-2) and mutated or aberrantly expressed antigens (MUM-1, CDK4, β-catenin, gp100-in4, p15 and N-acetylglucosaminyltransferase V). In this review, we have summarized the available data concerning the characterization of melanoma-associated antigens with focus on their immunogenic and protective properties. The development of a strong immune response against differentiation antigens is limited by the existence of tolerance against these ‘self’ antigens, permitting the involvement of only T cells with low affinity T cell receptors. Among the melanoma differentiation antigens, only gp100 has been shown to be a tumor regression antigen. The testis-specific antigens such as MAGE and PRAME should potentially be highly immunogenic antigens. They contain several potential HLA class I binding epitopes and are present only in the testes which are not accessible to the cells of the immune system due to the lack of direct contact with the immune cells and the lack of HLA class I expression on the surface of germ cells. But only 2 patients have been found who responded to these antigens in vivo, indicating their genuinely low immunogenicity. A comparison of the predicted secondary structures of these two groups of antigens (testis-specific and differentiation antigens) revealed enrichment of long α-helical stretches in the testis-specific antigens. We hypothesize that such highly organized structures could diminish the efficiency of the protein unfolding – a necessary step in the proteolytic cleavage by proteasomes – and, therefore, could be responsible for the low immunogenicity of these proteins. In this case, modifications decreasing the stability of these proteins might be a means to improve the immune response against these potentially therapeutically useful antigens.
The Major Histocompatibility Complex and Mate Choice: Inbreeding Avoidance and Selection of Good Genes
Authors: Grob B. , Knapp L.A. , Martin R.D. , Anzenberger G.
Published: April 2003

It has been known for decades that MHC genes play a critical role in the cellular immune response, but only recent research has provided a better understanding of how these molecules might affect mate choice. Original studies in inbred mouse strains revealed that mate choice was influenced by MHC dissimilarity. Detection of MHC differences between individuals in these experiments was related to olfactory cues, primarily in urine. Recent studies in humans have shown an analogous picture of MHC-based mating. Taken together, these findings could support either the hypothesis of MHC-based inbreeding avoidance or the hypothesis of MHC-related avoidance of reproductive failure, since studies in mice, humans and pigtailed macaques have shown that parental sharing of certain MHC alleles correlates with frequent spontaneous abortion or prolonged intergestational intervals. Data from many mammalian species clearly demonstrate that reproductive failure occurs as a result of inbreeding. Therefore, MHC similarity might serve as an indicator of genome-wide relatedness. In contrast, increased fitness due to the presence of individual MHC alleles in a pathogenic environment could explain MHC-based selection of currently good genes. Specifically, the physical condition of long-living animals depends on the ability to respond to immunological challenge and an individual’s MHC alleles determine the response, since, unlike the T cell receptors, MHC alleles are not somatically recombined. Therefore, sexual selection of condition-dependent traits during mate choice could be used to select successful MHC alleles, thereby providing offspring with a higher relative immunity in their pathogenic environment.
Reference Typing Report for Complement Factor B
Authors: Geserick G. , Otremba P. , Schröder H. , Stradmann-Bellinghausen B. , Schneider P.M.
Published: April 2003

Factor B (BF) reference typing was carried out on the occasion of the VIIth Complement Genetics Workshop in Mainz, May 1998. Two different sets of samples were analysed by agarose electrophoresis and/or isoelectric focusing at the protein level, and by PCR-RFLP analysis at the DNA level. These results confirmed the reliability of the standard agarose electrophoresis technique for the identification of the major BF alleles as well as for the identification of cathodic and anodic variants. However, the exact alphanumeric designation of individual variants relative to the reference distance between alleles S and F1 turned out to be more difficult. Using PCR-RFLP analysis, the common alleles F and S as well as the FA and FB subtypes in 6 samples containing an F allele were all assigned correctly. However, the variants F1 and S07 were not detected by this method, as they could not be distinguished from the accompanying S allele. Therefore, a combined application of all three typing methods is recommended for a reliable identification of factor B alleles, variants and FA/FB subtypes.
Normal Swallowing Physiology as Viewed by Videofluoroscopy and Videoendoscopy
Authors: Logemann Jeri A. , Rademaker Alfred W. , Pauloski Barbara Roa , Ohmae Yukio , Kahrilas Peter J.
Published: April 2003

This study examines normal oropharyngeal swallow physiology in 8 young adult males with concurrent videofluoroscopy and videoendoscopy. Twelve swallows were examined for each subject, 3 swallows each of 1 and 5 ml of thin liquid at each of two endoscopic positions: (1) the tip of the endoscope just at or below the tip of the uvula (high position), and (2) the tip of the endoscope just below the tip of the epiglottis (low position). Results indicate that if the clinician is interested in laryngeal events occurring before and after swallow, videoendoscopy with the endoscope in the low position is the procedure of choice. To evaluate pharyngeal anatomy and/or the presence of food in the pharynx before or after swallow, either endoscopy with the endoscope in the high position or videofluoroscopy can be used. However, if the clinician is interested in pharyngeal physiology during swallow, videofluoroscopy is a better diagnostic procedure.