bluuebunny/crossref_metadata_2025 huggingface dataset:
Didymosis aplasticosebacea: Coexistence of Aplasia cutis congenita and Nevus sebaceus May Be Explained as a Twin Spot Phenomenon
Authors: Happle Rudolf , König Arne
Published: April 2003

Background: Co-occurrence of aplasia cutis congenita and nevus sebaceus has sometimes been observed. Objective: We propose a genetic mechanism that may explain this coexistence of two different congenital skin disorders. Methods and Results: We review 15 cases as reported in the literature and present an additional case. To explain the temporal and spatial proximity of the two skin lesions we advance the concept of twin spotting for which we propose the term didymosis (Greek didymos = twin). In an embryo heterozygous for two different recessive mutations localized on either of a pair of homologous chromosomes, an event of somatic recombination would occur at an early developmental stage, giving rise to two different cell clones homozygous for either mutation. Conclusion: The concept of didymosis aplasticosebacea is so far hypothetical. Future molecular research may show whether this concept holds true.
Basal Cell Carcinoma in Association with Multiple Trichoepitheliomas
Authors: Misago Noriyuki , Narisawa Yutaka
Published: April 2003

We report the case of a basal cell carcinoma (BCC) associated with multiple trichoepitheliomas (TEs) and include the results of histopathological and immunohistochemical studies. The patient had a large, pigmented nodule associated with 4 flesh-colored papules in the central facial area. Two of the 4 flesh-colored papules and the large pigmented nodule were excised. Histopathologically, the pigmented nodule was diagnosed as BCC and 2 of the papular lesions were diagnosed as TEs. In both the BCC and TEs, almost all of the basaloid aggregations were diffusely positive for cytokeratin (CK) 19, CK8 and CK8/18. Based on these clinicopathological observations and reports in the recent literature, these two neoplasms are considered to be highly related. BCC appears to differentiate toward follicular germinative cells, and TE is its benign counterpart.
Usefulness of Histological Examination for the Diagnosis of Onychomycosis
Authors: Gianni Claudia , Morelli Valeria , Cerri Amilcare , Greco Consuelo , Rossini Patrizia , Guiducci Antonio , Braidotti Paola , Calcaterra Roberta , Papini Manuela
Published: April 2003

Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis can yield false-negative results, and confirmation of the pathogenic agent, especially in non-dermatophyte infections, is often a lengthy process. Objective: The aim of this study was to investigate the usefulness of the histological examination of nail clipping samples in supplementing the standard microscopic and culture techniques for the diagnosis of onychomycosis. Patients and Methods: One hundred and seventy-two subjects affected by nail alterations suggestive of onychomycosis were evaluated. Nail specimens were studied with 3 different techniques: direct microscopic examination of a 40% KOH clarified preparation, fungal culture and histological examination. Patients positive for fungal infection were re-evaluated with the same techniques after treatment with oral terbinafine, fluconazole or itraconazole and topical application of bifonazole or ciclopirox for 2 months. Results: Direct microscopy was positive in 102 (59.3%) nail specimens. The culture test was positive in 90 cases (52.9%), showing a dermatophyte in 45, a yeast in 23 and a mould in 22 samples. The histological examination was positive in 94 (54.6%) samples. In 4 cases, it was the only investigation confirming the clinical diagnosis of nail mycosis. In most of the cases, the morphological aspect of the hyphae and/or spores suggested also to which group of pathogens (dermatophytes, yeasts or moulds) the mycetes observed in the histological sections could be ascribed. The concurrent presence of a dermatophyte and a mould was evidenced in a few specimens. The control histological examination at the end of the treatment showed negative results or residual non-vital hyphae and/or spores. Conclusions: Results of the present study indicate that the histological examination of nail clipping specimens is a relatively inexpensive, rapid and easily performed procedure. It is useful to confirm or refute the results of routine microscopy and culture tests. Moreover, nail histopathological observation may help in ascribing a pathogenic role of non-dermatophyte isolates and evaluating the effectiveness of antifungal treatment.
Asthma, Rhinitis and Dermatitis Triggered by Fungal Infection: Therapeutic Effects of Terbinafine
Authors: Hürlimann A. , Fäh J.
Published: April 2003

We report 2 atopic patients suffering from tinea unguium caused by Trichophyton rubrum. In addition, both patients had symptoms of allergies: one had perennial rhinoconjunctivitis and bronchial asthma, the other had chronic dermatitis of the face and neck. In both cases, their allergy symptoms improved dramatically during oral therapy with the antifungal agent terbinafine (250 mg/day) and relapsed after its discontinuation.
Cowden Syndrome – Diagnostic Skin Signs
Authors: Hildenbrand C. , Burgdorf W.H.C. , Lautenschlager S.
Published: April 2003

Cowden syndrome is a rare autosomal dominant familial cancer syndrome with a high risk of breast cancer. The most important clinical features include carcinomas of the breast and thyroid, and hamartomatous polyps of the gastrointestinal tract. There are characteristic mucocutaneous features which allow early recognition of the disease and are generally present before internal malignancies develop. We report on a woman in whom the diagnosis of Cowden syndrome was first made after she had been treated for both breast cancer and melanoma.
Mal de Meleda: From Legend to Reality
Authors: Fatović-Ferenčić Stella , Holubar Karl
Published: April 2003

Luca Stulli of Dubrovnik (Ragusa), 1772–1828, was one of the first to make epidemiologic studies of heritable skin disorders. His treatise of what became the ‘mal de Meleda’ on the Adriatic island of Mljet (Meleda) is a classic in the dermatologic literature. The present study documents his life, his birth record, his portrait and recalls his original publication (in Italian).
Collision of Squamous-Cell Carcinoma with Melanoma in situ in a Child with Xeroderma pigmentosum
Authors: Hofer A. , Kaddu S. , Seidl H. , Kerl H. , Wolf P.
Published: April 2003

Coexistence (collision) of two different neoplasms in the same lesion has previously been documented by several authors. In this report, we describe a 13-year-old boy with xeroderma pigmentosum presenting with squamous-cell carcinoma and melanoma arising at the same site on the nose. Histopathologically, the melanoma component of the lesion was located mainly eccentrically to the squamous-cell carcinoma component. Immunohistochemical stains confirmed the histopathologic findings. Mutations for p53 assessed using single-strand conformation polymorphism, and sequencing analysis revealed a CC-to-TT transition at codon 159 of the p53 gene in the squamous-cell component but not in the melanoma component. This finding suggests a possible role for UV in the pathogenesis of at least the squamous-cell component of the tumor. To the best of our knowledge, this is the first report of a collision tumor comprising squamous-cell carcinoma and melanoma arising in childhood.
Cazenave, Kaposi and Lupus erythematosus
Authors: Holubar Karl , Fatović-Ferenčić Stella
Published: April 2003

A review is presented calling attention to the first naming and publication of the term ‘lupus erythematosus’ and to the dermatologist (M. Kaposi) who first detected the systemic nature of this disease.
Multicenter Randomized Comparative Double-Blind Controlled Clinical Trial of the Safety and Efficacy of Zinc Gluconate versus Minocycline Hydrochloride in the Treatment of Inflammatory Acne vulgaris
Authors: Dreno Brigitte , Moyse Dominique , Alirezai Mohsen , Amblard Pierre , Auffret Nicole , Beylot Claire , Bodokh Isaac , Chivot Martine , Daniel François , Humbert Philippe , Meynadier Jean , Poli Florence
Published: April 2003

Background: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. Objective: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. Methods: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). Results: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and weremoderate (5 dropouts with zinc gluconate and 4 with minocycline). Conclusion: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.
Large B-Cell Lymphoma of the Leg – Complete Remission with Perilesional Interferon Alpha
Authors: Wollina Uwe , Mentzel Thomas , Graefe Tim
Published: April 2003

We present the case of an 85-year-old woman with cutaneous and subcutaneous nodules on the lower and upper leg showing the characteristic histological features of a large B-cell lymphoma of the leg. Investigations for non-Hodgkin’s lymphoma with the prognostic markers matrix metalloproteinase 2 and soluble intercellular adhesion molecule 1 revealed an increased serum level of the latter. Monotherapy with perilesional interferon α2a 3 × 9 million units/week was well tolerated. The final outcome was a complete remission after 14 months with an overall survival of more than 17 months.
Leukotriene Receptor Antagonists – A Novel Therapeutic Approach in Atopic Dermatitis?
Authors: Kägi Martin K.
Published: April 2003

Cysteinyl leukotrienes have been shown to be important in the pathogenesis of both asthma and rhinitis. Improvement of skin manifestations in atopic dermatitis has been reported with leukotriene receptor antagonists. This article reviews current data on the experimental evidence and clinical efficacy of leukotriene receptor antagonists in the treatment of atopic dermatitis.
Epiluminescence Microscopy for Port-Wine Stains: Pretreatment Evaluation
Authors: Procaccini Enrico Maria , Argenziano Giuseppe , Staibano Stefania , Ferrara Gerardo , Monfrecola Giuseppe
Published: April 2003

Background: Port-wine stains (PWSs) are characterized by an increased number of ectatic vessels. The treatment of choice is the use of some lasers such as pulsed dye lasers. However, some lesions are nonresponsive to laser treatment. Perhaps the vessels’ depth and diameter and the thickness of the vessel wall are important factors influencing the effectiveness of the laser treatment. Methods: To investigate whether epiluminescence microscopy (ELM) could be useful in determining the effectiveness of laser treatment of PWSs, we studied a group of patients with PWSs using both ELM and histological analysis. Results: A correlation existed between a gray-whitish veil seen by ELM and the vessel depth judged by histology: when the veil was absent, the vessels were always found to be located only in the upper third of the dermis. Conclusion: We think that the gray-whitish veil is a distinctive dermoscopic feature that is able to differentiate between superficial vessels (absence of veil) and deeper vessels (presence of veil).
Evidence-Based Dermatology: A Need to Reset the Agenda
Authors: Naldi Luigi , Braun Ralph , Saurat Jean-Hilaire
Published: April 2003

Evidence-based medicine (EBM) emphasises the role of clinical research in guiding clinical decisions. The aim is to integrate medical research into clinical practice in the most efficient way. In spite of EBM pointing to basic requirements for optimal patient care, the formalisation of an EBM approach is still at a developing stage in many areas of medicine, including dermatology. EBM should avoid becoming a specialised separate discipline with its own jargon and peculiar literature, i.e. secondary publications and systematic reviews. Ideally, the emphasis should be moved from so-called secondary to primary research, and an agreement on what constitutes research priorities should be reached on an international level with large-scale independent clinical studies being mounted by the dermatological community on unaddressed issues.
Topical Steroids under Wet-Wrap Dressings in Atopic Dermatitis – A Vehicle-Controlled Trial
Authors: Schnopp Christina , Holtmann Christiane , Stock Sybille , Remling Roland , Fölster-Holst Regina , Ring Johannes , Abeck Dietrich
Published: April 2003

Background: The wet-wrap dressing technique has proved to be beneficial in cases of exacerbated atopic dermatitis (AD) skin lesions. Objective: The effect of wet-wrap dressings was investigated in a controlled trial comparing a steroid (mometasone furoate 0.1%)-containing and a steroid-free (vehicle) preparation in an in-patient comparison study. Methods: 20 children aged 2–17 years with exacerbated AD were treated twice daily with wet-wrap dressings over a 5-day period. Results: AD in treated areas significantly improved in both study arms; however, the effect was significantly better in the mometasone-treated group (p < 0.01). Transepidermal water loss improved in both arms without any significant differences. Staphylococcus aureus colonization decreased during the first 3 days of active treatment independently of the therapeutic modalities chosen. At day 5, colony counts further dropped on the steroid-treated lesions. Conclusion: Application of the wet-wrap dressing technique for exacerbated AD lesions is effective, combination with a topical steroid being superior to a steroid-free application without bearing the risk of a bacterial superinfection.
Localized Lymphomatoid Papulosis
Authors: Kagaya M. , Kondo S. , Kamada A. , Yamada Y. , Matsusaka H. , Jimbow K.
Published: April 2003

A 50-year-old Japanese male visited our clinic in April 1999 with a 2-year history of self-healing, reddish papules on his right palm. On examination, there were grouped erythematous papules, 2–4 mm in size, which formed a relatively well-circumscribed erythematous plaque. A biopsy specimen showed a wedge-shaped, dense dermal infiltrate consisting of variously sized mononuclear lymphoid cells mixed with few large CD30-positive cells and inflammatory cells, suggesting the diagnosis of regional lymphomatoid papulosis (LyP). Analysis of the T cell receptor gene revealed a polyclonal pattern on lesional skin. Only 5 cases of LyP presenting in a regional distribution have been reported previously. Although the etiology of localized LyP remains unknown, considering that 2 of 5 reported patients developed widespread lesions regional LyP may be the initial presentation of typical LyP.
Immunohistochemical Findings in Notalgia paresthetica
Authors: Şavk E. , Dikicioğlu E. , Çulhaci N. , Karaman G. , Şendur N.
Published: April 2003

Background: Notalgia paresthetica (NP) is a sensory neuropathy the pathogenesis of which is not yet completely elucidated. Objective: The aim of this study was to investigate the histopathological changes in NP with special emphasis on cutaneous innervation. Methods: Along with site-matched biopsies from 5 healthy individuals, lesional skin biopsies from 14 cases of NP and biopsies from contralateral nonlesional skin in 9 of these cases were stained with hematoxylin-eosin and Congo red. For immunohistochemical analysis, all samples were stained with two general neural markers (S-100 protein and protein gene product 9.5) and two neuropeptides (vasoactive intestinal polypeptide and substance P). Results: Light microscopy was compatible with postinflammatory hyperpigmentation. Immunohistochemistry did not reveal a significant difference in the staining pattern of lesional skin and control tissue (p > 0.05). Although not reaching statistical significance, the percentage of cases which showed no staining was higher in the group of patients with more chronic NP. Conclusion: The finding of less immunohistochemical staining in cases with more chronicity could be of clinical importance and is worth investigating further.
Eccrine Squamous Syringometaplasia and Syringomatous Hyperplasia in Association with Linear Scleroderma
Authors: Sakai Hiroyuki , Satoh Katsuhiko , Manabe Akira , Nakane Hiroshi , Ishida-Yamamoto Akemi , Iizuka Hajime
Published: April 2003

It is now well recognized that syringomatous hyperplasia with squamous syringometaplasia is a type of pseudoepitheliomatous hyperplasia responding to a variety of stimuli. We report a case of linear scleroderma with this process. Histopathology of the lesion showed numerous solid and cystic epithelial structures with squamous metaplasia within typical sclerodermatous skin lesions. Although the pathogenesis of the process remains unclear, dermal-derived growth factors in scleroderma and/or the mechanical effect of sclerosis could stimulate the proliferative response of eccrine epithelium. To the best of our knowledge, the association of syringomatous hyperplasia with eccrine squamous syringometaplasia and linear scleroderma has not been described previously.
Tumor Markers in Neuroendocrine Tumors
Authors: Eriksson Barbro , Öberg Kjell , Stridsberg Mats
Published: April 2003

Most neuroendocrine tumors produce and secrete a multitude of peptide hormones and amines. Some of these substances cause a specific clinical syndrome: carcinoid, Zollinger-Ellison, hyperglycemic, glucagonoma and WDHA syndrome. Specific markers for these syndromes are basal and/or stimulated levels of urinary 5-HIAA, serum or plasma gastrin, insulin, glucagon and vasoactive intestinal polypeptide, respectively. Some carcinoid tumors and about one third of endocrine pancreatic tumors do not present any clinical symptoms and are called ‘nonfunctioning’ tumors. Therefore, general tumor markers such as chromogranin A, pancreatic polypeptide, serum neuron-specific enolase and subunits of glycoprotein hormones have been used for screening purposes in patients without distinct clinical hormone-related symptoms. Among these general tumor markers chromogranin A, although its precise function is not yet established, has been shown to be a very sensitive and specific serum marker for various types of neuroendocrine tumors. This is because it may also be elevated in many cases of less well-differentiated tumors of neuroendocrine origin that do not secrete known hormones. At the moment, chromogranin A is considered the best general neuroendocrine serum or plasma marker available both for diagnosis and therapeutic evaluation and is increased in 50–100% of patients with various neuroendocrine tumors. Chromogranin A serum or plasma levels reflect tumor load, and it may be an independent marker of prognosis in patients with midgut carcinoids.
Chemotherapy in the Treatment of Neuroendocrine Malignant Tumors
Authors: Rougier Philippe , Mitry Emmanuel
Published: April 2003

The efficacy of chemotherapy in digestive neuroendocrine tumors (NET) depends on primary site and histological differentiation. Many reports have suggested a superior activity of chemotherapy for pancreatic NET than for metastatic carcinoid tumors with response rates ranging from 40 to 60% compared to 20%. The standard chemotherapy for pancreatic NET is a combination of adriamycin and streptozocin and to a lesser extent a combination of 5FU and streptozocin. In contrast, there is no clear standard chemotherapy for carcinoid tumors and if most oncologists use a combination of 5FU and streptozocin in the case of advanced, progressive and nonresectable carcinoid tumors, the results are mostly poor and the benefit seldom counterbalances its toxicity. In these carcinoid tumors the combination of hepatic artery ischemia alternating with chemotherapy has given impressive results in one study, which, however, have never been confirmed. Tumor cell differentiation is a major prognostic factor and some reports have suggested a higher chemosensitivity for undifferentiated or poorly differentiated NET with tumor response rates ranging from 41 to 69% when a VP16-CDDP combination is used. This chemosensitivity is, unfortunately, as in small cell lung carcinomas, of short duration. Related to this special problem and the number of other active treatments in NET, the place of chemotherapy always has to be discussed in a multidisciplinary fashion. Surgical excision, chemoembolization, interferons and somatostatin analogues have to be emphasized and eventually combined with chemotherapy, especially in slowly growing tumors. New active chemotherapy regimens have to be tested clearly in this orphan group of tumors which does not hold much interest to the pharmaceutical companies.
Hepatic Arterial Chemoembolization in the Management of Advanced Digestive Endocrine Tumors
Authors: Ruszniewski P. , Malka D.
Published: April 2003

The management of advanced digestive endocrine tumors is often challenging. Liver metastases are usually diffuse at the time of diagnosis, and surgical resection is rarely feasible. Objective response rates with systemic chemotherapy are disappointing. Arterial hypervascularization of most liver metastases from digestive endocrine tumors argues in favor of hepatic arterial chemoembolization (HACE). It is assumed that embolization-induced ischemia sensitizes tumor cells to cytotoxic drugs, whose tumor concentrations are increased by blood flow slowing down. The aims of HACE are: (1) to control otherwise untractable hormone-related symptoms, particularly the carcinoid syndrome (>50% urinary 5-HIAA decrease: 57–91%) and insulinoma-related life-threatening hypoglycemias; (2) to inhibit tumor growth (objective response rates: 33–80%; mean duration: 6–42.5 months), and (3) to improve patients’ survival. The postembolization syndrome, usually mild and transient, is the commonest side effect. Major extrahepatic complications are rare. In conclusion, HACE seems to be an attractive alternative treatment for diffuse (unresectable) and progressive metastases confined to the liver in patients with digestive endocrine tumors, mainly following unsuccessful systemic chemotherapy. Further studies assessing the long-term results of HACE and comparing it to other treatments, particularly systemic chemotherapy, are needed.
Effect of Lactobacillus GG Supplementation on Antibiotic-Associated Gastrointestinal Side Effects during Helicobacter pylori Eradication Therapy: A Pilot Study
Authors: Armuzzi A. , Cremonini F. , Ojetti V. , Bartolozzi F. , Canducci F. , Candelli M. , Santarelli L. , Cammarota G. , De Lorenzo A. , Pola P. , Gasbarrini G. , Gasbarrini A.
Published: April 2003

Background: One-week triple therapy is currently regarded as the reference of anti-Helicobacter pylori treatment. However, antibiotic-associated gastrointestinal side effects are among the major pitfalls of such regimens. Probiotic supplementation may be regarded as a therapeutic tool to prevent or reduce these troublesome drug-related manifestations. Aim: To determine whether the addition of the probiotic Lactobacillus GG to an anti-H. pylori standard triple therapy could help to prevent or minimize the occurrence of gastrointestinal side effects. Methods: One hundred and twenty healthy asymptomatic subjects screened positive for H. pylori infection and deciding to receive eradication therapy were randomized either to 1-week pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), tinidazole (500 mg b.i.d.) or to the same regimen supplemented with Lactobacillus GG for 14 days. Patients filled in validated questionnaires during follow-up to determine the type and severity of side effects and to judge overall tolerability. Results: Bloating, diarrhea and taste disturbances were the most frequent side effects during the eradication week and were significantly reduced in the Lactobacillus GG-supplemented group (RR = 0.4, CI 0.2–0.8; RR = 0.3, CI 0.1–0.8; RR = 0.3, CI 0.1–0.7, respectively). The same pattern was observed throughout the follow-up period. Overall assessment of treatment tolerability showed a significant trend in favor of the Lactobacillus GG-supplemented group (p = 0.03). Conclusions:Lactobacillus GG supplementation beneficially affects H. pylori therapy-related side effects and overall treatment tolerance.
Towards a Novel Treatment Strategy for Acute Pancreatitis
Authors: Braganza Joan M.
Published: April 2003

Despite more than a century of research endeavour, there is no specific medical treatment for acute pancreatitis and early mortality is high – 20% of fatalities by the day after admission. I do not see any realistic prospect that today’s focus on immunomodulation will provide a breakthrough either. The signs are that the outcome of acute pancreatitis is determined almost at its inception, and that those unfortunate individuals in whom the seeds for a precipitous course are sewn do not declare themselves until it is too late. This reappraisal of the evidence on disease aetiogenesis has been undertaken in an effort to fathom why this might be.
Oxygen Metabolites in Immune- Stimulated Ion Transport in Rat Colon: Modulation by Taurine
Authors: Skelly Maeve M. , O’Donoghue Diarmuid P. , Baird Alan W.
Published: April 2003

Background/Aims: Activation of cells within the lamina propria can cause electrogenic chloride secretion across intestinal epithelia by release and/or synthesis of mediator molecules, including reactive oxygen metabolites (ROMs). In this investigation we examined whether indirect (immune) stimulation of ion transport across rat colon was ROM-mediated. Methods: Paired segments of rat colon, stripped of underlying smooth muscle, were mounted on Ussing chambers in order to measure electrogenic ion transport. Changes in short circuit current (SCC) were used as a measure of net electrogenic ion transport measured in response to the bacterial tri-peptide formyl-Met-Leu-Phe (fMLP) which was used to activate lamina propria neutrophils. The effect of the established anti-oxidants catalase and diethyldithiocarbamate (DDTC) and the putative anti-oxidant taurine upon immune-stimulated ion transport was examined. Results: The anti-oxidant DDTC but not catalase significantly attenuated ion transport responses to fMLP. Taurine applied basolaterally reduced ion transport response to fMLP but not to the directly acting secretagogues forskolin. Taurine applied apically enhanced ion transport responses to fMLP. Conclusion: Anti-oxidants, including taurine, may be useful in treatment of colitis. The enhancement of effect seen when taurine was applied apically may have negative implications regarding the therapeutic usefulness of taurine administration to the lumenal compartment.
Comparison of Pantoprazole 20 mg to Ranitidine 150 mg b.i.d. in the Treatment of Mild Gastroesophageal Reflux Disease
Authors: Kaspari S. , Biedermann A. , Mey J.
Published: April 2003

Background: Despite a high prevalence of mild gastroesophageal reflux disease (GERD), few studies investigated efficacy and safety of proton pump inhibitors in this indication. This randomized double-blind study compares pantoprazole to ranitidine in GERD 0 and I, i.e. reflux without esophagitis or with confined lesions only. Methods: Patients received either pantoprazole 20 mg o.a.d. or ranitidine 150 mg b.i.d. Outcome was assessed after 2 and 4 weeks. Primary criterion was relief of leading symptoms, i.e. heartburn, acid eructation and pain on swallowing, after 4 weeks of treatment. Results: According to the per-protocol (PP) analysis, 69% (100/144) and 80% (115/144) of patients in the pantoprazole group were relieved of leading symptoms after 2 and 4 weeks, respectively. The rates in the ranitidine group were 47% (62/133) and 65% (86/133). Thus, superiority of pantoprazole could be proven. Quality-of-life parameters improved more in the pantoprazole group and patients’ assessment of treatment was more favorable. Analysis for Helicobacter pylori status showed infection to lead to higher symptom relief rates. Both study medications were well tolerated. Conclusion: Pantoprazole 20 mg demonstrated superior efficacy with faster relief of reflux symptoms and similar tolerability compared to ranitidine 150 mg in the treatment of mild GERD.
Aggravating Effect of Cigarette Smoke Exposure on Experimental Colitis Is Associated with Leukotriene B4 and Reactive Oxygen Metabolites
Authors: Guo Xin , Ko Joshua K.S. , Mei Qi-Bing , Cho Chi-Hin
Published: April 2003

Background/Aims: Cigarette smoking is closely related to the development and recurrence of inflammatory bowel disease (IBD). The present study aimed to investigate the underlying mechanisms of the adverse action of cigarette smoke (CS) exposure on trinitrobenzene sulfonic acid (TNBS)-induced IBD. Methods: Rats were preexposed to CS once daily for 4 days before receiving a TNBS enema, and they were killed 24 h afterwards. The colonic myeloperoxidase (MPO) and xanthine oxidase (XO) activities, leukotriene B4 (LTB4) and glutathione (GSH) levels, as well as the production of reactive oxygen metabolites (ROMs) were measured. Results: CS preexposure significantly augmented the adverse effects of the TNBS enema on colonic damage and increase in MPO activity, while it did not significantly alter the XO activity. Meanwhile, the elevation of ROM production and LTB4 concentration in colonic tissues after the TNBS enema was also markedly enhanced by CS exposure. In contrast, the depressive action of the TNBS enema on cellular antioxidant GSH levels was reduced further by CS exposure. Pretreatment with a specific LTB4 antagonist, ONO-4057, protected against colonic damage, particularly in the CS group. Conclusion: CS exposure aggravated experimental IBD. This adverse action could be due to the depletion of GSH together with overproduction of LTB4, followed by the accumulation of neutrophils and ROMs in the colonic tissue.
Effect of Omeprazole on Regional and Temporal Variations in Intragastric Acidity
Authors: Viani F. , Verdú E.F. , Idström J.P. , Cederberg C. , Fraser R. , Fried M. , Blum A.L. , Armstrong D.
Published: April 2003

Background: Conventional techniques for measuring gastric acidity have demonstrated the decrease in gastric acidity produced by proton pump inhibitors (PPI); however, such techniques do not detect transient or localized pH changes which may modify the intragastric environment without affecting the therapeutic efficacy of PPIs. Aim: To investigate local and temporal variations in intragastric pH and to test the hypothesis that omeprazole produces prolonged, generalized gastric anacidity (pH >6). Methods: A single-blind study was conducted with triple-point 24-hour gastric pH-metry on days 7, 14 and 21 in 14 healthy, Helicobacter pylori-negative volunteers (7 M; 20–46 years) who received placebo for 7 days, followed by omeprazole 20 mg daily for 14 days. Results: Omeprazole increased the median 24-hour pH significantly in the distal corpus (placebo: 1.3 (95% CI 1.1 to 1.6); omeprazole week 1: 4.0 (2.6–5.0); omeprazole week 2: 4.0 (2.8–4.6)) and at all other gastric recording sites (p < 0.01). At both corpus sites, nocturnal pH was lower and mealtime pH was higher than the non-meal daytime pH during placebo and both omeprazole administration periods; in the antrum, however, the major difference noted was that meal-time pH was higher than non-meal daytime pH. Antral pH was lower during meals and higher at night than proximal corpus pH. During placebo, gastric pH >6.0 was observed at 1 site only for 1.7% (median; 95% CI 0.4–3.3%), at 2 sites simultaneously for 0.24% (0.0–1.0%) and at 3 sites for 0.0% (0.0–0.28%), respectively, of the recording periods; during the second week of omeprazole, the equivalent results were 7.7% (1.4–14.0%), 4.9% (0.21–15.7%) and 4.7% (0.0–9.9%), respectively. Conclusions: Omeprazole, 20 mg daily, does not produce gastric anacidity despite significant increases in median 24-hour pH values. The time-, meal- and site-related variations in gastric pH observed under normal physiological conditions are seen to persist, with prolonged periods of low pH throughout the stomach and preservation of the normal, meal-related rise and nocturnal fall in gastric pH during omeprazole administration.
Relevance of Underlying Disease and Bacterial vacA and cagA Status on the Efficacy of Helicobacter pylori Eradication
Authors: Rudi Jochen , Reuther Susanne , Sieg Andreas , Hoerner Martin , Stremmel Wolfgang
Published: April 2003

Aim: To study the effects of Helicobacter pylori associated diseases and the bacterial vacA and cagA statuses on the efficacy of H. pylori eradication. Methods: A prospective study in a consecutive series of outpatients of a gastroenterological institution and of a primary practice. A series of 146 H. pylori positive patients with peptic ulcer disease (PUD; n = 40) or nonulcer dyspepsia (NUD; n = 106) were evaluated. H. pylori vacA genotpyes and cagA status were determined directly in gastric biopsy specimens by polymerase chain reaction. The patients were treated with triple-therapy regimens consisting of a proton pump inhibitor and two antibiotics twice daily for 7 days. Reevaluation of H. pylori was determined 4–5 weeks later by endoscopy or 13C urea breath test. Results: 123 patients completed the study. In 8 patients, colonization with two or more H. pylori strains was found. The overall cure rate was 84.6% (104/123). The eradication rates were significantly higher in patients with PUD (94.4%, 34/36) than in those with NUD (81.6%, 71/87; p < 0.05). In patients with cagA-positive H. pylori strains, the eradication rate was 89.0% (73/82) as compared with 78.8% (26/33) in those with cagA-negative strains (p = 0.15). The vacA genotype had no effect on the efficacy of H. pylori eradication. Conclusion: Using 1-week triple-therapy regimens, treatment of H. pylori infection is more effective in patients with PUD than in those with NUD.
Relationship between the Effects of Cisapride on Gastric Emptying and Plasma Glucose Concentrations in Diabetic Gastroparesis
Authors: Horowitz Michael , Jones Karen L. , Harding Philip E. , Wishart Judith M.
Published: April 2003

Background/Aims: The effect of erythromycin on gastric emptying is attenuated during hyperglycaemia. The aim of this study was to determine in patients with diabetic gastroparesis whether the effect of cisapride on gastric emptying of solids and liquids is influenced by the plasma glucose concentration. Methods: Nineteen patients with type 1 diabetes mellitus, who had delayed gastric emptying of solids and/or liquids, were studied. On 2 separate days, each patient received cisapride (20 mg) or placebo orally 60 min before scintigraphic measurement of gastric emptying of a mixed solid (ground beef) and liquid (dextrose) meal. The plasma glucose concentrations were measured at –5, 30, 60, 90, and 120 min during each gastric emptying measurement. Results: Cisapride accelerated both solid (retention at 100 min 43 ± 4 vs. 69 ± 4%, p < 0.001) and liquid (T50 27 ± 2 vs. 39 ± 2 min, p < 0.001) gastric emptying. The mean plasma glucose level was not significantly different after placebo when compared with cisapride (19.5 ± 1.1 vs. 18.2 ± 1.0 mmol/l). The change in the 50% emptying time (T50) for liquid, but not solid, emptying was related (r = 0.55, p = 0.01) to the change in the plasma glucose AUC from 0 to 30 min between the placebo and cisapride tests, i.e., the acceleration was greater if the plasma glucose concentration was relatively less during the gastric emptying test performed on cisapride. Conclusion: The effect of cisapride on gastric emptying, at least that of liquids, in patients with diabetic gastroparesis appears to be dependent on the plasma glucose concentration.
Effect of the Somatostatin Analogue Lanreotide on Meal-Stimulated Portal Blood Flow in Patients with Liver Cirrhosis
Authors: Schiedermaier Peter , Harrison Phillip , Arthur Michael , Grandt Daniel , Sutton Robert , Drewe Jürgen , Larsen Finn , Sieber Cornel
Published: April 2003

Background: Lanreotide, a new long-acting somatostatin analogue, has been shown to inhibit the meal-stimulated increase of splanchnic blood flow in healthy volunteers. To date, similar data in patients with liver cirrhosis have not been available. We have examined the effect of lanreotide compared with placebo on meal-stimulated portal blood flow in patients with liver cirrhosis using Doppler ultrasound. Methods: 20 cirrhotic patients (placebo n = 12, lanreotide n = 8) with proven portal hypertension were studied after an overnight fast. Lanreotide, at a dose of 100 µg/h, was infused intravenously over 7 h after a 1-hour basal period. In parallel to the intravenous infusion, a liquid test meal (Ensure plusTM, 1.5 kcal/min) was perfused for 7 h through an intraduodenal tube at a rate of 3 ml/min. Blood pressure, heart rate and portal vein blood flow (PVF, ml/min, Doppler technique) were determined at regular intervals. Results: Baseline PVF amounted to 725 ± 182 ml/min in the placebo and to 917 ± 252 ml/min in the lanreotide group (n.s.). The meal-stimulated increase in PVF was blunted by lanreotide (AUC, %·min): 62,709.6 ± 6,817 (placebo) vs. 45,237 ± 2,507 (lanreotide), p < 0.05. Lanreotide also blunted the postprandial increase in heart rate for the first 2 h of meal perfusion. Conclusions: Because of potent inhibition of postprandial splanchnic hyperemia in patients with liver cirrhosis, lanreotide may be useful in the treatment of complications of portal hypertension.
Use of Different Absorbable Sutures for Continuous Single-Layer Anastomosis in the Gastrointestinal Tract
Authors: Oláh Attila , Belágyi Tibor , Neuberger György , Gamal Eldin M.
Published: April 2003

Background and Aims: A prospective, randomized study was designed to test the safety of the single-layer continuous anastomosis technique in gastrointestinal surgery. Results from the use of two different sutures were compared in relation to postoperative complications. Material and Methods: The safety of a single-layer continuous technique using two different types of absorbable suture was studied in 247 anastomoses performed on 183 patients between 1996 and 1997. There were 26 gastric, 117 small-bowel, 32 colonic, 29 pancreatic and 43 biliary anastomoses in the study. In 134 cases, Poliglecaprone 25 (Monocryl, Johnson & Johnson) was used, and in 113 cases Glycomer 631 (Biosyn, USSC). All procedures were carried out by the same surgeon. Results: Anastomosis-related complications were detected in 7 patients (2.8%). Anastomotic failures including minor leakage occurred in 5 cases (2.0%). Reoperation was required in only 1 patient (0.4%), and there were no deaths. No difference was found in the dehiscence rate between the two types of absorbable material (1.5% with Monocryl and 2.6% with Biosyn; p = 0.5). Conclusion: Compared with other techniques used for gastrointestinal anastomosis, this technique is safe and easy to apply using either suture material.
Persistent Occurrence of Bradycardia during Laparoscopic Cholecystectomies in Low-Risk Patients
Authors: Reed Jr. Donald N. , Duff Jenny L.
Published: April 2003

Background/Aims: A debate has arisen about the use of carbon dioxide to distend the abdomen because of certain negative effects on venous return to the heart, and declining cardiac output. We previously reported 4 cases of bradycardia that occurred during 725 laparoscopic cholecystectomies. Now, we describe 6 cases of bradycardia that occurred in a 1-year period (May 31, 1997 to June 1, 1998) during CO2 pneumoinsufflation at the beginning of planned, elective laparoscopic cholecystectomies. These patients appeared not to be at any special cardiac risk. To determine the frequency, and possible underlying common denominators, we reviewed the laparoscopic cholecystectomies. Methods: We completely reviewed the patients’ records to find any common denominators. Also, we calculated the frequency of bradycardia during laparoscopic cholecystectomies. Results: Six patients experienced bradycardia during laparoscopic cholecystectomies. None had known cardiac disease or symptoms. These cases occurred during the year’s 127 laparoscopic cholecystectomies (4.7% approximately). There were no common denominators between the patients. Conclusions: Although cardiac changes were noted during laparoscopic gynecologic surgery approximately 20 years ago, only in the last few years have cardiovascular changes been noted during laparoscopic cholecystectomies. Surgeons should be prepared to encounter such cardiovascular changes even with low-risk patients as it appears that bradycardia is a persistent occurrence during laparoscopic cholecystectomies.
Hypercalcitoninemia in a Sporadic Asymptomatic Neuroendocrine Tumor of the Pancreatic Tail
Authors: Machens Andreas , Haedecke Jutta , Hinze Raoul , Thomusch Oliver , Schneyer Ulrich , Dralle Henning
Published: April 2003

Background/Aim: Asymptomatic neuroendocrine tumors of the gastroenteropancreatic tract represent a significant challenge in terms of postoperative monitoring. Methods: A case report of a calcitonin-secreting asymptomatic neuroendocrine tumor of the pancreatic tail is presented. Results:  Hypercalcitoninemia was noted in the 76-year-old Caucasian man who had a recurrent neuroendocrine tumor of the pancreatic tail. Upon pentagastrin stimulation, basal calcitonin increased only moderately from 82.3 (<10) to 100.9 and 125 pg/ml after 2 and 5 min, respectively. Surgical removal of the neuroendocrine tumor resulted in postoperative normalization of both basal and stimulated serum calcitonin levels. On immunohistochemistry, the neuroendocrine tumor was positive for calcitonin. Conclusion:  Routine measurements of serum calcitonin might be a highly sensitive adjunct capable of identifying a subset of neuroendocrine tumors in which calcitonin monitoring may aid in the early detection of postoperative recurrence.
Embolism of a Metallic Clip: An Unusual Complication following Laparoscopic Cholecystectomy
Authors: Ammann Karlheinz , Kiesenebner Johannes , Gadenstätter Michael , Mathis Gebhard , Stoss Franz
Published: April 2003

A 32-year-old woman underwent laparoscopic cholecystectomy during which there was severe bleeding from the bed of the gallbladder. As application of metallic clips to control the bleeding was not successful, the operation was converted to an open laparotomy. Cholecystectomy was successfully completed without further complications, and the post-operative course was uneventful and the patient was discharged. Eighteen months later, the patient complained of dyspnea. Plain radiograph and computed tomography of the thorax showed a metallic clip in the branch of the pulmonary artery supplying the posterior basal segment of the inferior lobe of the left lung. There was no connection between the patient’s symptoms and the clip embolism. Nevertheless, clip migration or embolism could cause severe complications. Therefore, metallic clips should not be used to stop bleeding from the gallbladder bed.
Efficacy and Safety of Weight-Adapted Nadroparin Calcium vs. Heparin Sodium in Prevention of Clinically Evident Thromboembolic Complications in 1,190 General Surgical Patients
Authors: Egger Bernhard , Schmid Stefan W. , Naef Markus , Wildi Stephan , Büchler Markus W.
Published: April 2003

Aims: In a prospective, randomized, single, general surgery center trial, comparison of the safety and efficacy of two low molecular weight heparin (LMWH; anti-Xa heparin sodium and weight-adapted nadroparin calcium) regimens was made. Patients and Methods: Eleven hundred and ninety patients undergoing various elective and emergency operations were randomized to receive daily either a fixed dose of 3,000 IU anti-Xa heparin sodium or a variable body weight-dependent dose of nadroparin calcium (weight <50 kg, 2,050 IU anti-Xa (WHO); 51–80 kg, 3,075 UI; 81–100 kg, 4,100 UI, and >100 kg, 6,150 UI) once until discharge. The first injection was administered 2.5–6 h before elective and emergency operations, respectively. Patients with clinical suspicion of deep venous thrombosis (DVT) underwent phlebography. Patients with signs of pulmonary embolism (PE) were further investigated by a ventilation-perfusion scan. Results: Statistically, there were no significant differences in the incidence of clinically evident DVT, PE or LMWH-related complications between both prophylactic regimens. Only 4 of the total of 15 hemorrhagic complications (4 wound hematomas in the nadroparin calcium group) were not classified as clearly surgically related, Two DVTs were confirmed by phlebography (both in the nadroparin calcium group). PE was confirmed by ventilation-perfusion scans (1 fatal, 1 on autopsy) in 1 patient with heparin sodium and in 6 patients with nadroparin calcium. Conclusions: Both regimens were equally safe and the risk of clinically evident DVT and PE was similar.
Cost of Pelvic Floor Repair for Faecal Incontinence
Authors: Buttafuoco A. , Keighley M.R.B.
Published: April 2003

Background: Pelvic floor repair is often unsuccessful for the treatment of incontinence. Some patients undergo repeated operations, and a few may require a stoma that can result in further operations. Method: We have examined the cost of two forms of pelvic floor repair: post-anal repair (PAR; n = 47) and total pelvic floor repair (TPFR; n = 32). Results: Persistent incontinence, which had an impact on the quality of life, occurred in 23 patients (29%); this was more common after PAR (21 patients; 45%) than after TPFR (2 patients; 6%), but the follow-up period was longer (9.7 years) after PAR than after TPFR (6.6 years), and incontinence tended to deteriorate with time. Twenty-two patients required repeat operations for incontinence (20 patients having 56 re-operations after PAR, and 2 patients who had repeated operation after TPFR). The average number of admissions was 1.92 (PAR 2.42, TPFR 1.18). The total number of operations was 141 (average 1.78), being greater after PAR (104; average 2.12) than after TPFR (37; average 1.15). The total hospital stay was 1,631 days; average 20.64, being longer following PAR (994 days; average 21.1) than after TPFR (637; average 19.9). The total hospital cost based on hospital stay, number of operations, operating time, complexity of surgery and out-patient visits was C∈ 294,216 (average C∈ 3,724), being higher after PAR (C∈ 190,062; average C∈ 4,043) as compared with TPFR (C∈ 104,154; average C∈ 3,254). The extra financial burden was largely borne by 9 individuals, all requiring a stoma, having repeated procedures (more than 2 operations) in whom the average cost was twice that of the index operation. Conclusion: We conclude that end-stage faecal incontinence is a huge burden on hospital budgets, since over time many patients require repeated operations.
Malignant Peripheral Nerve Sheath Tumor of the Esophagus
Authors: Manger T. , Pross M. , Haeckel C. , Lippert H.
Published: April 2003

Background: Sarcomas of the esophagus are rare representing 0.1–1.5% of all esophageal tumors. We report a case of malignant peripheral nerve sheath tumor (MPNST) of the esophagus in a 60-year-old woman. Methods: The diagnosis was made preoperatively on endoscopic biopsy and confirmed after tumor resection by immunohistochemistry as well as electron microscopy. The patient underwent abdominal-thoracicen bloc esophagectomy with mediastinal lymphadenectomy and intrathoracic esophagogastrostomy. Results: Our therapeutic concept for the first case of a high-grade MPNST (malignant schwannoma) of the esophagus resulted in a recurrence-free interval of 4 years. Conclusion: The therapy of choice was abdominal-thoracic en bloc esophagectomy with tumor-free resection margins and esophageal reconstruction with the stomach. After R0-resection we found no indication for adjuvant radio- and/or chemotherapy.