bluuebunny/crossref_metadata_2025 huggingface dataset:
Pylorus-Preserving Total Pancreatectomy
Authors: Wagner M. , Z’graggen K. , Vagianos C.E. , Redaelli C.A. , Holzinger F. , Sadowski C. , Kulli C. , Zimmermann H. , Baer H.U. , Büchler M.W.
Published: April 2003

Background/Aims: Preservation of the pylorus is an accepted alternative procedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse. Methods: A prospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99. Results: 11 patients underwent total pancreatectomy with preservation of the pylorus. Histopathological examination revealed pancreatic adenocarcinoma in 16 cases and duodenal adenocarcinoma in 1 patient, 5 patients had other types of pancreatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidity was 59% and reoperations were performed in 9.1% of cases (n = 2). Median follow-up was 37 months (range 5–66). 62% of patients (n = 13) developed tumor recurrence and 13 patients died during the follow-up period with 10 deaths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-preserving total pancreatectomy or pancreatectomy with gastrectomy. However, postoperative body weight was increased 3, 6, 9 and 12 months following preservation of the pylorus. Conclusion: Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term survival but improved nutritional recovery compared with standard total pancreatectomy.
Treatment of Devastating Postgastrectomy Symptoms: The Potential Role of Jejunal Pouch Reconstruction
Authors: Liedman Bengt , Hugosson Irene , Lundell Lars
Published: April 2003

After gastrectomy a few patients develop severe symptoms and malnutrition. There are probably several reasons for this, such as insufficient gastric reservoir function, malassimilation, diarrhea and dumping. The patient presented here developed severe malnutrition after partial gastrectomy and his weight gradually decreased from 95 to 40 kg during the first 6 postoperative years. His major complaint was postprandial vomiting and early satiety. During the course of his illness, he was repeatedly investigated with computerized tomography scans, repeated endoscopies with biopsies, barium examinations, etc. Finally the only positive finding was bacterial intestinal overgrowth, but antibiotic treatment did not improve his condition. After repeated periods of parenteral nutrition or enteral tube feeding, an S-shaped jejunal pouch was attached to the gastric remnant. Dual-energy X-ray absorptiometry was used to examine the body composition and bone density in the immediate postoperative period and 1 year after the operation. During the first postoperative year he gained 11 kg weight and reported an essentially normal food intake. Both laboratory and clinical parameters improved and a gain in lean body mass was recorded. Patients with severe postgastrectomy symptoms, with no other plausible explanation than nonexistent or insufficient gastric reservoir function, may benefit from re-reconstruction with a jejunal pouch.
Multiple Idiopathic Small Bowel Strictures: Report of Three Cases
Authors: García-Granero Eduardo , Miró F. , Sabater Luis , Millán Monica , Lledó Salvador
Published: April 2003

Multiple strictures of the small bowel are relatively rare. In many cases, a distinct cause can be defined, but some strictures are unexplainable by any specific mechanism and have been termed ’idiopathic’ small bowel strictures. We present 3 cases of multiple small bowel strictures in which the affected segments were studied with perioperative photoplethysmography, in vivo specimen angiography and pathology. Neither photoplethysmographic alterations nor structural vascular lesions were found.
Dye-Staining Stereomicroscopic Examinations for Fine Mucosal Structures of the Gallbladder
Authors: Aoki Tatsuya , Inoue Keiichiro , Tsuchida Akihiko , Kasuya Kazuhiko , Koyanagi Yasuhisa
Published: April 2003

Background: In order to diagnose an unsuspected gallbladder carcinoma and to examine whether a differential diagnosis could be made between cancer and noncancerous lesions during surgery, we evaluated the findings of fine structures of various types of gallbladder mucosa. Methods: We used stereomicroscopy with a dye-contrast technique under water and measured the maximum blood vessel diameters of the gallbladder mucosa: normal gallbladder, chronic cholecystitis, and carcinoma. Results: All normal gallbladders showed fine-reticular-type findings. In chronic cholecystitis, 5.8% of the specimens (n = 69) had fine reticular type, 87.0% had rough reticular type, and 7.2% had atrophic type. All the cases of adenomyomatosis (n = 16) showed rough reticular type. In eight specimens of pancreaticobiliary maljunction, 75% of them showed high reticular type, and the other 25% showed papillary type. The two adenoma specimens showed fine granular type. In five gallbladder carcinomas, the lattice-like pattern completely disappeared and showed rough granular type. The average of maximum vessel diameters in the gallbladder mucosa were 41.0 µm in normal gallbladders, 99.1 µm in patients with chronic cholecystitis, and 614.8 µm in patients with a carcinoma. There were significant differences among them (p < 0.05). Conclusion: This study showed that differential diagnosis between cancer and noncancerous lesion is possible by dye-staining mucosal pattern and measurement of maximum vessel diameters by stereoscopic examination.
The Corrugated Esophagus, a Sign of Severe Reflux Disease: Radiographic and Endoscopic Appearance
Authors: Low Vincent H.S. , O’Connor J. Barry
Published: April 2003

Purpose: To present the appearance of esophageal scarring resulting in a corrugated configuration seen on barium radiographs and through the endoscope. Materials and Methods: Barium radiographs and endoscopic images obtained in 8 patients with a fixed deformity of the esophagus which resulted in a corrugated pattern were retrospectively reviewed. All patients (6 males, 2 females) presented long histories of gastroesophageal reflux disease; they were aged 29–84 (mean 46.0) years. Six patients complained of obstructive symptoms (dysphagia or recurrent food impactions). Results: All of the lesions occurred in the mid or distal esophagus, with an average length of 11.1 (range 4–22) cm, and an average diameter of 15.4 (range 9–22) mm. Additional findings included hiatal hernia (n = 6), distal esophageal scarring (n = 3), esophageal fold thickening (n = 1) and intramural pseudodiverticula (n = 1). Conclusion: The finding of a corrugated pattern of the esophagus is suggestive of chronic severe gastroesophageal reflux disease. The reduction in esophageal caliber as a consequence often leads to symptomatic dysphagia.
Surgical Management of Paraesophageal Hernias: Outcome and Quality of Life Analysis / with Invited Commentary
Authors: Velanovich Vic , Karmy-Jones Riyad
Published: April 2003

Background: Paraesophageal hernias (PEHs) have protean clinical manifestations, and a variety of surgical approaches may be appropriate. We report both surgical and quality-of-life (QoL) outcomes for PEH repairs. Methods: All patients undergoing elective repair of PEHs were evaluated preoperatively for symptoms and the radiologic appearance of the PEH. In addition, patients undergoing elective repair completed the SF-36, a generic QoL instrument, preoperatively and postoperatively. Short-term postoperative complications were recorded. Symptomatic outcomes and QoL outcomes were assessed. Results: Over a 50-month period, 44 PEH repairs were completed. 3 patients represented emergently – 2 with gastric ischemia, 1 with frank gastric necrosis. The most common presenting symptoms were heartburn (48%), chest pain (27%), abdominal pain (20%), regurgitation (20%), dysphagia (18%), and microcytic anemia (18%). Only 4 patients (9%) were truly asymptomatic. 31 repairs were attempted laparoscopically, 5 were converted to open procedures. There were no gastric or esophageal perforations. 91% of patients had resolution of preoperative symptoms. The only death was in a patient with gastric necrosis. 5 of 8 patients treated by crural repair without fundoplication developed postoperative heartburn. Patients treated laparoscopically had superior QoL scores than patients treated by open surgery in the domains of physical functioning (90 vs. 65), role-physical (100 vs. 0), role-emotional (100 vs. 66.7), vitality (80 vs. 55), and social functioning (100 vs. 75). However, there were 3 symptomatic recurrences in the laparoscopic group (11.5%), all in patients with large, type-III hiatal hernias. Conclusions: PEH is a potentially life-threatening disease. Although most can be repaired laparoscopically, specific principles must be individualized to each patient to minimize complications and recurrences. A fundoplication should be added to all repairs. Laparoscopic repairs can produce superior QoL results: however, patients with large, type-III hernias may not be appropriate candidates for laparoscopic repair.
Has the Incidence of Perforated Peptic Ulcer Decreased over the Last Decade? / with Invited Commentary
Authors: Sánchez-Bueno F. , Marín P. , Ríos A. , Aguayo J.L. , Robles R. , Piñero A. , Fernández J.A. , Parrilla P.
Published: April 2003

Background: The therapeutic use of new drugs for inhibiting gastric secretion together with Helicobacter pylori antimicrobe therapy has given rise to controversy over the current incidence of perforated peptic ulcer (gastroduodenal peptic ulcer, GDPU). The aim of this study is to analyze the incidence of ulcer perforation over the last 12 years in our health area and the influence of new medical treatments. Material and Methods: Our series includes 246 patients operated on for perforated peptic ulcer during a 12-year period (January 1987 to December 1998) in our health area. The mean patient age was 55.2 ± 18.1 (16–93) years, and there was a predominance of males (199/246; 80.9%). The ulcer was located fundamentally in the pylorus (48.3%) and duodenal bulb (39.1%), and the most frequent surgical technique was bilateral truncal vagotomy associated with pyloroplasty (85.3%). Results: During the 1987–1992 period, 152 patients underwent surgery, whereas 94 patients were operated on between 1993 and 1998, which reveals a statistically significant difference (p < 0.001). Furthermore, if we divide the study into four 3-year periods (1987–1989, 1990–1992, 1993–1995 and 1996–1998), we see that there were 74 and 78 GDPUs in the first two periods, with no statistical differences between each other, and 48 and 46 cases in the last two periods, also with no statistical differences between each other, but statistically significant when compared to the first two periods. Conclusion: The incidence of perforated GDPU has dropped by half over the last 6 years due fundamentally to the use of proton pump inhibitors.
Laparoscopic Cholecystectomy in Cirrhotic Patients
Authors: Leone N. , Garino M. , de Paolis P. , Pellicano R. , Fronda G.R. , Rizzetto M.
Published: April 2003

Background/Aims: Laparoscopic cholecystectomy has become the procedure of choice for symptomatic cholelithiasis. A study to evaluate the benefits and risks of laparoscopic cholecystectomy in cirrhotic patients was performed. Methods: Between January 1994 and December 2000, 1,100 laparoscopic cholecystectomies for symptomatic gallbladder diseases were performed. There were 24 cirrhotic patients (group A) and 72 age- and sex-matched controls (group B). All patients had well-compensated cirrhosis (Child’s class A or B). Results: There was no operative mortality in either group and the postoperative complication rates were 20.8 and 9.72% in groups A and B, respectively (p < 0.000001). Operative time in group A was 89.16 vs. 68.41 min in group B (p < 0.000001). The estimated intraoperative blood loss in group A was 106.25 vs. 37.08 ml in group B (p < 0.000001). The average transfusion requirement was 0.155 and 0.0 units in groups A and B, respectively (p < 0.025). The hospital stay in groups A and B was 4.7 and 3.61 days, respectively (p < 0.0500). Conclusion: Laparoscopic cholecystectomy in patients with compensated cirrhosis is safe and should be the treatment of choice for these patients. Laparotomy should be applied only if the surgeon considers the operation inadequate to be continued laparoscopically.
Trends, Patterns and Correlates of Contraceptive Use among Kuwaitis, 1984–1999
Authors: Shah Nasra M. , Shah Makhdoom A. , Al-Rahmani Eqbal , Behbehani Jaafar , Radovanovic Zoran , Menon Indu
Published: April 2003

Objective: To document the changes in trends and patterns of contraceptive use from 1984 to 1999 and analyze the sociodemographic correlates of contraceptive use. Methods: A nationally representative household survey of Kuwaiti women of reproductive age was conducted in 1999 and compared with published data from three earlier national surveys. Results: About 52% of Kuwaiti women were currently using some form of contraception and 79% had used it at some time in their life (ever-use). Three fourths were using a modern method of contraception at the time of the survey. Oral contraceptive pills were the leading method, followed by IUCDs. Oral contraceptive use declined from 79 to 45% in the period 1984–1999. Use of withdrawal increased from 2% in 1987 to 11% in 1999. Multivariate analysis indicated that a higher age and parity, a higher level of education of both spouses, urban residence, and a lower desired fertility were associated with higher contraceptive use. Conclusion: Contraception is generally used for spacing children, with the wife being the main user. There is a continuing need to provide services and accurate information about the various methods of contraception.
Spinal Intramedullary Ependymal Cyst
Authors: Kumar Raj , Nayak Suresh R. , Krishnani N. , Chhabra D.K.
Published: April 2003

Two pediatric patients (4 and 5 years of age) with spinal intramedullary ependymal cysts located at the cervical and dorsal cord are reported here. One patient was admitted with subtle signs, while the other had disabling spastic quadriparesis. In both patients, MRI depicted a well-demarcated, localized, nonenhancing intramedullary lesion isointense with CSF on T1- and T2-weighted images. Total excision of the covering membrane of the cyst was not possible in either case. The child with spastic quadriparesis had a remarkable recovery, while the subtle signs of the other patient regained normalcy at the follow-up of 4 and 5 months, respectively.
Neurosurgical Interventions in Children with Maroteaux-Lamy Syndrome
Authors: Vougioukas V.I. , Berlis A. , Kopp M.V. , Korinthenberg R. , Spreer J. , van Velthoven V.
Published: April 2003

This paper reports the case of a 14-year-old child with Maroteaux-Lamy syndrome (mucopolysaccharidosis type 6) who was treated consecutively for compressive damage of the optic nerves, hydrocephalus communicans and progressive spastic tetraparesis within 2 years. The clinical course of the patient is presented and the pathophysiologic mechanisms of disease progression in patients with Maroteux-Lamy syndrome are discussed and reviewed.
Maternal Lung Adenocarcinoma Metastatic to the Scalp of a Fetus
Authors: Harpold Terri L. , Wang Michael Y. , McComb J. Gordon , Monforte Hector L. , Levy Michael L. , Reinisch John F.
Published: April 2003

Maternal malignancy metastatic to the fetus is a rare event, with most neoplasms being either melanocytic or hematopoietic in origin. This report is the first known case of a maternal lung adenocarcinoma metastatic to a fetus. At 2 months of age, this male infant developed multiple scalp masses that were locally resected but rapidly recurred. The histology of the scalp lesions and that of a biopsy of the mother’s tumor were both adenocarcinoma and were remarkably similar in appearance. In situ hybridization of tumor cells from this male infant found many large nuclei with XX signals indicating that the tumor was of maternal origin. This patient is alive, well and free of malignancy 5 years after a wide local resection of the scalp and skin grafting.
Acute Spinal Cord Swelling in a Child with Chiari II Malformation
Authors: Galarza Marcelo , Gravori Toraj , Lazareff Jorge A.
Published: April 2003

We report on a patient with Chiari II malformation who developed acute cervical myelopathy and brainstem dysfunction following a shunt failure. A brain and spine magnetic resonance image obtained immediately after admission evidenced swelling of the medulla and upper cervical spinal cord. After emergency placement of an external ventricular drain, the swelling receded, the child’s respiratory pattern improved and the motor function of his upper and lower extremities progressively returned to its normal condition. The case reported here suggests that in patients with Chiari type II malformation, spinal cord swelling might have a similar pathophysiology to the periventricular edema observed in the supratentorial compartment, and thus may be independent of the early stages of syringomyelia or syringobulbia.
Congenital Middle Fossa Arachnoid Cysts May Cause Global Brain Ischaemia: A Study with 99Tc-Hexamethylpropyleneamineoxime Single Photon Emission Computerised Tomography Scans
Authors: Sgouros S. , Chapman S.
Published: April 2003

Three children with middle fossa arachnoid cysts, presenting with non-specific symptoms and otherwise well, were investigated before and after surgery with magnetic resonance and 99Tc-hexamethylpropyleneamineoxime single photon emission computerised tomography scans, to assess the effect of the cysts on cerebral blood flow. All patients had evidence of a reduction in cerebral blood flow at presentation, even in the hemisphere contralateral to the middle fossa cyst, implied by perfusion defects seen centrally in the deep white matter of both cerebral hemispheres. After successful surgical excision of the cyst, the perfusion defects disappeared. This was associated with general improvement of pre-existing non-specific symptoms. These findings indicate that middle fossa arachnoid cysts may cause global impairment of brain function by interfering with its blood supply. This does not support the generally held view that such cysts are benign in nature when ‘asymptomatic’.
Changes in Intracranial Pressure after Calvarial Expansion Surgery in Children with Slit Ventricle Syndrome
Authors: Eide Per Kristian , Helseth Eirik , Due-Tønnessen Bernt , Lundar Tryggve
Published: April 2003

The effect of calvarial expansion on symptom relief and intracranial pressure (ICP) in three children with slit ventricle syndrome (SVS) and intracranial hypertension despite a functioning ventricular shunt is reported. These children presented with a clinical picture of SVS, accompanied by slit-like ventricles on cranial computer tomography scan and intracranial hypertension. Calvarial expansion was performed by mans of an anterior approach in one case and a posterior approach (modified tiara plastic) in the other two cases. After calvarial expansion, symptoms of intracranial hypertension were abolished in one case and markedly reduced in two cases (observation period 25–36 months). Comparison of ICP before and after surgery was performed by means of new software (Sensometrics™ Pressure Analyser, version 1.2) that revealed a significant reduction in the number of abnormal ICP elevations after surgery. The results were not accompanied by changes in the size of the cerebral ventricles. This study demonstrates that in children with SVS and intracranial hypertension despite a functioning shunt, calvarial expansion may reduce ICP and produce long-lasting symptom relief. In these cases, we suggest that intracranial hypertension was caused by compromised intracranial volume.
The Treatment of Cerebrospinal Fluid Shunt Infections
Authors: Whitehead William E. , Kestle John R.W.
Published: April 2003

It is our impression that the management strategy for infected cerebrospinal fluid (CSF) shunts varies significantly among pediatric neurosurgeons. The purpose of this paper is to present the results of a practice survey on the treatment of shunt infections which was distributed to all active members of the American Society of Pediatric Neurosurgeons (ASPN). Eighty-four of 129 ASPN members (65%) responded to the survey. Most ASPN members remove the shunt and place an external ventricular drain (EVD) to treat Staphylococcus epidermidis (59.5%), S. aureus (64.3%) and gram-negative rod infections (67.9%). The second most common method of treatment was externalization of the shunt (33.3, 29.8 and 25%, respectively). The duration of antibiotic treatment was extremely variable. When the shunt was removed and an EVD inserted, the duration of antibiotic treatment for S. epidermidis and S. aureus ranged from 5 to 21 total days (2–21 days of sterile cultures). For gram-negative rod infections treated with shunt removal and an EVD, the total duration of antibiotic therapy ranged from 5 to 24 days (2–37 days of sterile cultures). The majority of ASPN members remove the infected CSF shunt and place an EVD for the management of shunt infections. Significant variation exists in the duration of antibiotic therapy. Determining the most effective duration of antibiotic therapy in an effort to shorten hospitalization and minimize complications without sacrificing efficacy will require further study.
Fludrocortisone Treatment in a Child with Severe Cerebral Salt Wasting
Authors: Kinik Sibel Tulgar , Kandemir Nurgun , Baykan Ali , Akalan Nejat , Yordam Nurşen
Published: April 2003

Hyponatremia is a common complication of intracranial disease or surgery. An evaluation should be undertaken to determine whether cerebral salt wasting (CSW) or inappropriate secretion of antidiuretic hormone is present as a cause. Since the treatment principles are completely different in the two pathological states, differential diagnosis is very important. CSW is defined as the renal loss of sodium leading to hyponatremia and decreased extracellular fluid volume. In the literature, it has been noted that mineralocorticoid administration can be useful in CSW cases. We herein present an 11-year-old boy who developed hyponatremic seizures after intracranial tumor resection. He was diagnosed with CSW on the basis of high urinary sodium excretion and increased urine output, together with signs and symptoms of dehydration. Despite intensive fluid and salt therapy, we were unable to decrease the urinary output. Therefore, fludrocortisone therapy was administered and his urinary output and sodium excretion were decreased and his serum sodium level was normalized. In conclusion, in addition to fluid and salt replacement, mineralocorticoid supplementation also seems to be a safe and effective treatment for CSW.
Medulloblastoma in a Child with Rubenstein-Taybi Syndrome: Case Report and Review of the Literature
Authors: Taylor Michael D. , Mainprize Todd G. , Rutka James T. , Becker Lawrence , Bayani Jane , Drake James M.
Published: April 2003

Although medulloblastoma is usually sporadic, there are a number of uncommon predisposing germline mutation syndromes, including: Gorlin’s Syndrome, Turcot’s Syndrome and Li-Fraumeni Syndrome. Patients with Rubenstein-Taybi Syndrome secondary to mutation/deletion of the CBP gene on chromosome 16 are predisposed to a variety of developmental anomalies as well as cancer. We report a child with Rubenstein-Taybi syndrome who developed a cerebellar medulloblastoma and review the literature on Rubenstein-Taybi Syndrome and pediatric medulloblastoma. As the product of the CBP gene functions in a variety of signaling pathways, we discuss the molecular implications of findings a medulloblastoma in a child with Rubenstein-Taybi Syndrome.
Development of Lumbosacral Spina bifida: Three-Dimensional Computer Graphic Study of Human Embryos at Carnegie Stage Twelve
Authors: Haque Moududul , Ohata Kenji , Takami Toshihiro , Branco Soares Jr. Sergio , Nunta Aree Sarun , Hak uba Akira , Hara Mitsuhiro
Published: April 2003

There is still some controversy as to whether sacral spina bifida in humans is the result of a defect of the primary or secondary neural tube. As somites are related to the development of vertebrae and the primary neural tube is related to the development of the spinal cord in embryos, it is very important to determine the number of somites in normal human embryos at the time of closure of the primary neural tube to understand the contribution of primary neural tube defects to the development of spina bifida. However, in the literature, the number of somites in stage 12 human embryos is still controversial. The aim of this study is to find the number of somites in human embryos at Carnegie stage 12. Four human embryos at Carnegie stage 12 were selected from the laboratory of the Congenital Anomaly Research Center in Japan. The neural tube and somites were reconstructed from their slices by a three-dimensional computer graphic reconstruction technique. The reconstructed embryos were examined from multidirectional magnified images. Thirty-three pairs of somites were present in all these reconstructed embryos. As the 33rd pair of somites corresponds to the fifth sacral segment, the presence of 33 pairs of somites at Carnegie stage 12 suggests that spina bifida develops from defects of the primary neural tube.
Distal Airspace Enlargement in the Fawn-Hooded Rat: Influences of Aging and Alveolar Wall Destruction
Authors: Morio Yoshiteru , Muramatsu Masashi , Takahashi Kazuhisa , Teramoto Shinji , Oka Teruaki , Fukuchi Yoshinosuke
Published: April 2003

Background: A recent study has revealed that the peripheral airspace in the lungs of the fawn-hooded rat (FHR) is enlarged. However, morphological and functional factors of the FHR lung have not been fully investigated. Objective: The purpose of our study was to examine the structural and functional changes in the FHR lung and to investigate the influence of aging on this process. Furthermore, morphological and functional measurements of the lungs of FHRs (4–48 weeks of age) were performed and the results compared with those of age-matched Wistar control rats (WCRs). Methods: All animals were studied under controlled conditions, and morphological and functional changes of the lungs were examined. Measurements of body and lung weights were recorded, and the lungs were subjected to morphological evaluation. Morphological measurements: mean linear intercept (MLI) and destructive index were determined. Functional evaluation of the lungs: total lung capacity, pressure-volume curve, and exponential constant (K) which describes the shape of the curve were analyzed. In addition, right ventricular hypertrophy measurements were performed to assess the severity of pulmonary hypertension. Statistical analysis was performed using the unpaired t test, analysis of variance, and the Fisher post hoc test (p < 0.05). Results: Morphological analysis revealed a significant increase in airspace size (MLI) in all FHRs as compared with the WCRs which was evident from an early age (4 weeks). The increase in MLI did not progress age dependently in the FHR, whereas a tendency for an age-dependent increase in MLI was observed in the WCR. The destructive index measurements revealed that the increase in MLI of FHR was not accompanied by alveolar wall destruction. Concerning the functional examination, a leftward and upward shift of the pressure-volume curve was observed in the FHRs as compared with the WCRs at all ages. As compared with the WCRs, a higher K value was observed in all FHRs which was evident from an early age (4 weeks). Age-dependent changes similar to those in MLI were observed in the K in both rat strains. Conclusions: The results of our study suggest that FHRs manifest characteristics of distal airspace enlargement accompanied by increased lung distensibility without alveolar wall destruction at an early age and that the changes do not progress age dependently. Neither an accelerated aging process nor destruction of the alveolar walls appears to be the mechanism responsible for the enlarged airspace in this rat strain.
Nearly Fatal Complications of Cervical Lymphadenitis following BCG Immunotherapy for Superficial Bladder Cancer
Authors: Geldmacher Henning , Taube Christian , Markert Ulrich , Kirsten Detlef K.
Published: April 2003

This report describes the case of a 68-year-old man with bilateral cervical lymphadenitis and chorioretinitis due to bacille Calmette-Guérin (BCG), originating from BCG immunotherapy for treatment of superficial bladder cancer 2 years ago. During antimycobacterial therapy a fistula between the right-sided lymph node and an aneurysm of the carotid artery developed. This led to life-threatening spontaneous bleeding which required vascular graft surgery. Like other known systemic side effects, cervical lymphadenitis may also occur following intravesical BCG immunotherapy, and life-threatening complications cannot be excluded despite adequate medical treatment.
Effects of Amphotericin B Gargles on Oral Colonization of Candida albicansin Asthmatic Patients on Steroid Inhalation Therapy
Authors: Fukushima Chizu , Shimoda Terufumi , Kawano Tetsuya , Tomari Sinnya , Mitsuta Kazuko , Obase Yasushi , Matsuo Nobuko , Matsuse Hiroto , Kohno Shigeru
Published: April 2003

Background: Early use of inhaled steroids is recommended for bronchial asthma. The side effects are rare, but oral discomfort and candidiasis are clinically important complications. Most previous studies reported that the use of spacer and water gargling was necessary to prevent oral complications. However, in some patients, this may fail to prevent such complications. Objective: To compare the effects of water gargling with those of amphotericin B, in the prevention of oral complications in asthmatics using inhaled steroids. Methods: Pharyngeal swab samples were obtained aseptically from the posterior pharyngeal wall of 128 asthmatics who have been using inhaled steroids (beclomethasone dipropionate) for more than 1 year. The amount of Candida albicans in cultured swabs was evaluated based on the following criteria: oral symptoms, method of gargling, dose of inhaled steroids, type of spacer and serum cortisol level. Results: The number of isolated C. albicans was significantly higher in asthmatics with oral symptoms than in those free of symptoms. It was also significantly higher in patients who gargled with water or 1,000 times dilution than in those who gargled with 100 or 50 times dilutions of amphotericin B. Moreover, it was significantly higher in patients with low levels of serum cortisol than in those with normal serum cortisol. Conclusion: We demonstrated that at least in a subgroup of asthmatics using steroid inhalers, gargling with water or even weak concentrations of amphotericin B does not prevent colonization of the throat with C. albicans. This group at high risk of developing oral candidiasis should gargle with amphotericin B at concentrations higher than 100 times dilution that can prevent clinically detectable oral candidiasis.
Ethnic and Gender Differences in Cough Reflex Sensitivity
Authors: Dicpinigaitis Peter V. , Allusson Valerie R.C. , Baldanti Annmarie , Nalamati Jhansi R.
Published: April 2003

Background: Although recent studies have suggested that the cough reflex is more sensitive in women than in men, ethnic differences in cough reflex sensitivity have not previously been investigated. Objectives: To evaluate ethnic and gender differences in cough reflex sensitivity. Methods: We performed capsaicin cough challenge testing in 182 healthy volunteers of three distinct ethnic groups: Caucasian (white, non-Hispanic, of European origin), Indian (originating from the Indian subcontinent) and Chinese. The concentration of capsaicin inducing 2 or more (C2) and 5 or more coughs (C5) was determined in each subject. Results: Mean (±SEM) values for log C5 demonstrated that, within each ethnic group, the cough reflex was more sensitive in women: p = 0.00002 for Caucasian subjects; p = 0.003 for Indian volunteers; and p = 0.002 for Chinese subjects. Examination of C2 data yielded similar results. When subjects were evaluated by gender, multivariate analysis of variance demonstrated no ethnic differences in sensitivity to capsaicin. Conclusion: Our data do not support the presence of significant ethnic differences in cough reflex sensitivity, but do confirm previous data demonstrating lower cough thresholds in women.
Effect of Continuous Positive Airway Pressure Therapy on Infectious Complications in Patients with Obstructive Sleep Apnea Syndrome
Authors: Sanner Bernd M. , Fluerenbrock Nicole , Kleiber-Imbeck Anja , Mueller Jochen B. , Zidek Walter
Published: April 2003

Background: Nasal continuous positive airway pressure (CPAP) is a well-established, widely used and effective treatment of obstructive sleep apnea syndrome (OSAS). Unfortunately, side effects are frequent during CPAP treatment. Objectives: Little is known about the effects of CPAP on infectious complications in patients with OSAS. Methods: We retrospectively analyzed the kinds and rate of infections of the upper airway in 246 consecutive patients (mean age, 59.7 years) with polysomnographically verified OSAS using CPAP with or without a heated humidifier and compared them with OSAS patients who received non-CPAP therapy. Results: Of the 246 patients, 40 received conservative therapy and 206 CPAP treatment, 36 of them with a heated humidifier. The mean follow-up period of the study group was 165.4 ± 92.1 weeks and did not differ between the three groups. Infectious diseases were frequent in all three groups, but patients using CPAP without humidifier suffered from upper airway infections significantly more frequently than controls (42.9 vs. 25%; p < 0.05), and more patients on CPAP therapy with humidifier than controls (22.2 vs. 2.5%; p < 0.01) reported an increased rate of upper airway infections since initiation of CPAP therapy or diagnosis of OSAS. Especially patients using a hot water bath humidifier who cleaned their devices inadequately had significantly more upper airway infections since diagnosis (57.1 vs. 20%; p < 0.05) or during the past 6 months (52.4 vs. 13.3%; p < 0.05) than patients who regularly cleaned CPAP machines, humidifiers and ventilatory circuits. Conclusions: Our results suggest that patients using CPAP therapy either with or without heated humidity seem to be at an increased risk of upper airway infections compared to conservatively treated patients.
Ventilatory Insufficiency due to Asbestos-Related Diffuse Pleural Fibrosis Successfully Treated with Noninvasive Home Mechanical Ventilation
Authors: Muñoz Xavier , Roger Alex , Pallisa Esther , Martí Sergi , Ferrer Jaume
Published: April 2003

A 54-year-old man with diffuse pleural fibrosis due to previous asbestos exposure developed hypercapnic respiratory failure. Noninvasive mechanical ventilation (NIMV) was started at the hospital and maintained at the patient’s home, achieving reversal of the respiratory failure. During a 2-year follow-up, NIMV has been well tolerated by the patient and no relapse in ventilatory failure has occurred. Home NIMV can be considered as an alternative to pleural decortication in asbestos-related diffuse pleural fibrosis with ventilatory insufficiency.
Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea
Authors: Alchanatis Manos , Tourkohoriti Georgia , Kakouros Stavros , Kosmas Epaminondas , Podaras Stylianos , Jordanoglou John B.
Published: April 2003

Background: Limited information exists regarding the development of pulmonary hypertension in patients with obstructive sleep apnea (OSA) in the absence of lung and heart comorbidity. Objectives: The aims of this study were to investigate whether OSA patients without any other cardiac or lung disease develop pulmonary hypertension, and to assess the effect of continuous positive airway pressure (CPAP) treatment on pulmonary artery pressure (PPA). Methods: Twenty-nine patients aged 51 ± 10 years with OSA and 12 control subjects were studied with pulsed-wave Doppler echocardiography for estimation of PPA before and after 6-month effective treatment with CPAP. Results: A significantly higher mean PPA was found in OSA patients as compared to control subjects (17.2 ± 5.2 vs. 12.1 ± 1.9 mm Hg, p < 0.001). Six out of the 29 OSA patients had mild pulmonary hypertension (PPA ≧ 20 mm Hg). Significant differences were observed between pulmonary hypertensive and normotensive OSA patients with respect to age (62 ± 4 vs. 48 ± 15 years, respectively, p < 0.05), body mass index (41 ± 7 vs. 32 ± 4 kg/m2, p < 0.02) and daytime PaO2 (81 ± 9 vs. 92 ± 9 mm Hg, p < 0.05). CPAP treatment was effective in reducing mean PPA in both groups of pulmonary hypertensive and normotensive OSA patients (decreases in PPA from 25.6 ± 4.0 to 19.5 ± 1.5 mm Hg, p < 0.001; from 14.9 ± 2.2 to 11.5 ± 2.0 mm Hg, respectively, p < 0.001). Conclusions: A proportion (20.7%) of OSA patients without any other lung or heart disease and characterized by older age, greater obesity and lower daytime oxygenation develop mild pulmonary hypertension which has been partially or completely reversed after 6-month CPAP treatment. In conclusion, OSA alone constitutes an independent risk factor for the development of pulmonary hypertension.
Natural Killer Cell Activity in Multidrug-Resistant Pulmonary Tuberculosis
Authors: Yildiz Pınar , Kadakal Figen , Tütüncü Yıldız , Deniz Günnur , Gürel Nuray , Adın Suzan , Yilmaz Veysel
Published: April 2003

Background: Multidrug-resistant pulmonary tuberculosis (MDRTB), a major problem in developing countries, may result from either insufficiency of host cellular immune response or mycobacterial mechanisms which has been more intensively investigated so far. Objectives: The aim of the study was to investigate natural killer cell activity (NKA) and T lymphocyte subsets in HIV– patients with secondary MDRTB. Methods: 20 male patients with MDRTB (mean age 38 ± 8 years), 15 nonresistant tuberculosis male patients (NRTB) (mean age 36 ± 11 years) and 12 healthy male controls (mean age 35 ± 8 years) were included. The percentages of CD3+, CD4+, CD8+, CD25+, CD11b+ and CD16+56+ cells were measured by flow-cytometric analysis of peripheral blood lymphocytes (PBL). NKA was evaluated using the anticandidal index method. Results: The mean tuberculin response was higher in MDRTB and NRTB patients compared to controls (15.4 ± 3.8, 15.1 ± 3.3 and 10.9 ± 2.8 mm, respectively; p < 0.001). There was no significant correlation between PPD response and PBL subsets or NKA. The percentages of both CD3+ and CD3+CD4+ T lymphocytes were significantly lower in MDRTB (62.4 ± 12.1 and 33.9 ± 9.0%) compared to NRTB (70.8 ± 7.5 and 42.9 ± 8.6%; p < 0.05). Patients with MDRTB had significantly lower NKA compared to NRTB and controls (30.9 ± 11.3, 49.7 ± 15.5 and 40.0 ± 8.5%, respectively; p < 0.01). Conclusion: This reduction in NKA may suggest a role for impaired NK function in the pathogenesis of MDRTB in HIV– patients.
The Effect of Erythromycin on Mucociliary Transportability and Rheology of Cystic Fibrosis and Bronchiectasis Sputum
Authors: Shibuya Yasuhiro , Wills Peter J. , Cole Peter J.
Published: April 2003

Background: Erythromycin has been shown to diminish sputum production in hypersecretory states by a mechanism that is still unclear. Objectives and Methods: We have investigated the effect of erythromycin on the ciliary transportability of cystic fibrosis and non-cystic fibrosis bronchiectasis sputum in vitro using the mucus-depleted bovine trachea. Results: Additional erythromycin in concentrations up to 20 µg/g did not significantly alter the ciliary transportability of sputum from 6 cystic fibrosis and 6 bronchiectasis patients. Sputum viscoelasticity measured with parallel-plate rheology was also little changed. These erythromycin concentrations also had little effect on the beating frequency of bovine tracheal cilia. Conclusions: These results suggest that the presence of erythromycin in sputum neither alters the physical properties of the gel nor the activity of cilia. The clinical effects of erythromycin on pulmonary hypersecretory states therefore have another explanation.
Prognostic Parameters Determining Survival in Pancreatic Carcinoma and, in Particular, after Palliative Treatment
Authors: Ridwelski Karsten , Meyer Frank , Ebert Matthias , Malfertheiner Peter , Lippert Hans
Published: April 2003

Prognosis and outcome of patients with pancreatic carcinoma is poor. The aim of the study was to investigate (1) which factors of medical history and clinical status as well as which laboratory parameters determine survival in pancreatic carcinoma and (2) whether specific data can be used as prognostic parameters or for early diagnosis of pancreatic carcinoma. In total, 287 patients with pancreatic carcinoma were enrolled in the study. In 193 subjects, only palliative treatment was possible. Survival was assessed using univariate survival probability curves by Kaplan-Meier. Comparison of patient groups with regard to survival was achieved using the log-rank test. Multivariate analysis was carried out using the Cox regression model. Overall, 22 factors, showing a significant impact on survival in pancreatic carcinoma were found, e.g., tumor-associated factors such as (1) tumor stage according to the UICC classification including TNM-based staging, grading, tumor site, and vascular infiltration; (2) preoperative habits and signs and symptoms (physical condition, pain, loss of appetite, ethanol consumption); (3) change of laboratory parameters (CA 19-9, bilirubin, prothrombin time, urea, C-reactive protein), and (4) type of intervention (surgical approach, R0/1/2 resection). Using multivariate analysis, seven factors (UICC tumor stage and site, surgical intervention including number of resected lymph nodes, chemotherapy, occurence of a carcinoma in relatives, preoperative physical condition, night sweat) were determined. In the 193 patients with palliative treatment, only ten factors (among them UICC tumor stage including the presence of metastases; data from the medical history such as physical condition, loss of appetite, and carcinoma in relatives, and laboratory parameters including prothrombin time, protein content, and aspartate aminotransferase levels) were found to be important. Chemotherapy had the strongest impact on survival which was confirmed by multivariate analysis, followed by tumor stage (UICC) and preoperative appetite. Besides tumor-associated determinants, data from the medical history, and pathological laboratory parameters, the prognosis in pancreatic carcinoma is considerably determined by the treatment such as interventional and/or using antineoplastic agents.
Impact of Helicobacter pylori Virulence on the Outcome of Gastroduodenal Diseases: Lessons from the Microbiologist
Authors: Mégraud Francis
Published: April 2003

Two main pathogenic factors have been described in Helicobacter pylori strains: the cag pathogenicity island (cag PAI) and the vacuolating cytotoxin VacA. The cag PAI is comprised of approximately 40 open reading frames probably originating from another species. It encodes a type IV secretion system, i.e., an apparatus derived from pili which may contribute to the transfer of bacterial molecules to epithelial cells. One of the most well known is the CagA protein which is involved in cell actin rearrangement. Another important property is the induction of interleukin 8, a proinflammatory mediator, which is the consequence of other cag PAI genes. VacA has also been the subject of numerous studies. In vitro, it leads to vacuoles in epithelial cells from the late endosome compartment. However, its main impact could be to induce apoptosis by acting on mitochondria, as was shown in a recent study. The presence of cag PAI as well as VacA has been associated with a higher pathogenic potential of H. pylori strains. Indeed, both are often found simultaneously, but it may well be that the combination of the two, with specific adherence properties, increases even more the pathogenicity of the strains.
New Helicobacter Species in Humans
Authors: Andersen Leif Percival
Published: April 2003

During the last decade several new Helicobacter species have been isolated from human gastric mucosa, fecal samples, liver, and gallbladder. Gastric corkscrew-shaped Helicobacter species: H. heilmannii is usually seen in the gastric foveolae in 0.2–0.6% of histological sections from the gastric mucosa of patients with dyspepsia in Western Europe, but it has only been cultured once. It is genetically and morphologically closely related to H. bizzozeronii and H. salmonis which are common in dogs and cats. It causes constantly active chronic gastritis and is regularly associated with peptic ulcer. Intestinal Helicobacter species: H. cinaedi, H. fennelliae, H. pullorum, H. westmeadii, H. canadensis, and ‘H. rappini’ have been isolated from patients with enteritis and proctitis. H. fennelliae, H. cinaedi, H. westmeadii, and ‘H. rappini’ have been isolated also from patients with septicemia. Studies indicate that H. cinaedi is transmitted from hamsters and that H. pullorum is common in chickens. ‘H. rappini’ has been isolated from sheep, dogs, and mice, whereas no animal reservoir has been found for H. fennelliae. Except for the cases of septicemia, none of these Helicobacter species have yet been proven to cause human disease, but they are suspected to play a role in inflammatory bowel diseases. Hepatobiliary Helicobacter species include several Helicobacter species isolated from bile and liver of animals, but only H. bilis has been isolated from the human gallbladder and H. pylori from the human liver. H. bilis has been isolated from dogs, cats, mice, and rats. Nonpylori Helicobacter species are usually difficult to culture and may be more frequently causes of human disease than realized today.
Impact of H. pylori Infection on the Management of Dyspepsia
Authors: Rokkas T.
Published: April 2003

This review article refers to the impact which Helicobacter pylori infection has on the management of dyspepsia. The answer to the question of whether H. pylori eradication is clinically useful in dyspeptic patients or not remains a controversial and debatable subject. Nontheless, the recent Maastricht 2 – 2000 Consensus Report, taking into account all the available data so far, concluded that a ‘test-and-treat’ approach to dyspepsia should be used in adult patients with persistent dyspepsia under the age of 45 years (the cutoff age may vary locally), having excluded those with predominantly gastroesophageal reflux disease symptoms, nonsteroidal anti-inflammatory drug users, and patients with alarm symptoms or a family history of gastric cancer.
Helicobacter pylori Therapy: First-Line Options and Rescue Regimen
Authors: Gisbert Javier P. , Pajares José María
Published: April 2003

In the present paper, several points regarding Helicobacter pylori treatment are reviewed, with the following conclusions: (1) all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) ranitidine bismuth citrate is equal to or, in some cases with antibiotic resistance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibiotics; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, provided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas where the prevalence of metronidazole resistance is high, triple therapy including a PPI, clarithromycin, and amoxicillin is the best option, and (7) quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recommended second-line therapy after PPI-clarithromycin-amoxicillin failure, although replacing the PPI and the bismuth compound by ranitidine bismuth citrate achieves also good results.