bluuebunny/crossref_metadata_2025 huggingface dataset:
CD8+ Lymphocytes in the Blister Fluid of Severe Acute Cutaneous Graft-versus-Host Disease: Further Similarities with Toxic Epidermal Necrolysis
Authors: Correia O. , Delgado L. , Barbosa I.L. , Domingues J.C. , Azevedo R. , Vaz C.P. , Pimentel P.
Published: April 2003

Background: Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow transplantation (BMT). In the acute form of the disease, the differential diagnosis includes viral rash and drug eruptions. Methods: We report two patients with chronic myeloid leukemia submitted to allogeneic BMT who developed a severe form of acute cutaneous GvHD, with clinical and histological pictures mimicking toxic epidermal necrolysis (TEN). Results: We found a predominance of peripheral CD8+ T lymphocytes and, at the same time, studying the cellular profile of the blister fluid, just in the beginning of blister eruption, we also found a high proportion of CD8+ T lymphocytes, mainly CD8+CD57–. Conclusion: These data are in agreement with previous reports of the presence of CD8+ T cells in the blister fluid of patients with TEN, further emphasizing similar immunoinflammatory pathways in both diseases.
Superficial Lymphangitis with Interface Dermatitis Occurring Shortly after a Minor Injury: Possible Involvement of a Bacterial Infection and Contact Allergens
Authors: Kano Yoko , Inaoka Miyuki , Shiohara Tetsuo
Published: April 2003

Background: Linear supralymphatic eruptions with epidermal involvement have rarely been reported. Objective: A search was made for apparent anatomical reasons and for external factors to explain the unique distribution pattern and clinical course in three cases in which the linear lesions occurred shortly after a minor injury. Methods: Efforts to search for its etiology include careful outlining of the localization, bacterial culture from the site of traumatic injury, patch tests, and skin biopsies. Results: Linear lesions developed along superficial lymphatic vessels and the presence of eczematous conditions around the injured sites and isolation of Staphylococcus aureus from the site were observed concomitantly. The histopathological findings showed interface dermatitis. Conclusion: Our cases provide a unique example of the combined effects of a bacterial infection and contact allergens in the development of the linear supralymphatic eruptions.
Depression, Anxiety Levels and General Psychological Profile in Behçet’s Disease
Authors: Calikoglu Emel , Onder Meltem , Cosar Behcet , Candansayar Selcuk
Published: April 2003

Background: Behçet’s disease (BD) is a multisystem disease with unknown etiology. Until today, the role of emotional stress and the real incidence of psychiatric symptoms in this disease have not been clarified yet. Objective: In this study, we aimed to evaluate the general psychological profile of the patients diagnosed as having BD as well as their depression and anxiety levels in order to investigate the psychiatric aspects of this disease. Material and Methods: Twenty-three patients with BD and 17 patients with chronic plaque-type psoriasis who made up the control group were examined by the Beck Depression (BDI), Beck Anxiety (BAI) and Brief Symptom Inventories (BSI). Results: The mean BDI score of the BD group was 11.69 ± 6.93, and the corresponding value was 9.11 ± 7.34 for the psoriasis group. The mean BAI score of the BD group was 21.39 + 13.68 and this level was 12.41 ± 10.70 for psoriasis patients. The mean BSI score of the BD group was 61.30 ± 43.66 and it was 30.41 ± 28.77 for the control group. The mean BDI, BAI and BSI scores of the patients diagnosed as having BD were significantly higher than those of the control group (F = 0.234, F = 0.508, F = 0.549 and p < 0.05). Conclusion: BDI, BAI and BSI scales are useful to evaluate the psychiatric aspects of BD. The results of our study revealed that the collaboration of a dermatologist and psychiatrist is essential for the follow-up of patients with BD.
Warty Carcinoma of the Anus: A Variant of Squamous Cell Carcinoma Associated with Anal Intraepithelial Neoplasia and Human Papillomavirus Infection
Authors: Noël J.C. , Sornin de Leysat C. , Pény M.O. , van de Stadt J. , Fayt I. , De Dobbeleer G.
Published: April 2003

Warty carcinoma (WC) is a rare variant of squamous cell carcinoma primarily described in the vulva in younger women and classically associated with human papillomavirus (HPV) infection. The gross findings are similar to those of verrucous carcinoma with large, exophytic tumors with a papillomatous surface. Microscopically, the tumor is papillated and contains fibrovascular cores covered by hyperkeratotic epithelium showing presence of koilocytes. We report a case of anal squamous cell carcinoma showing similar features, occurring in a young immunosuppressed male patient with a history of multifocal anal intraepithelial neoplasia (AIN). HPV-16 has been demonstrated both in the WC and in adjacent AIN, but the HPV status appears different in the two lesions: integrated in WC and episomal in AIN lesions. We also have demonstrated by immunohistochemistry that both WC and AIN are highly proliferative entities sharing the same MIB-1 pattern, and that WAF1/CIP1 protein expression is common in the two lesions irrespective of p53 protein expression.
Cutaneous Angiomyolipoma
Authors: Obata Chikage , Murakami Yoshiyuki , Furue Masutaka , Kiryu Hiromaro
Published: April 2003

We report a rare case of angiomyolipoma located in the subcutis on the nose. A 54-year-old female first noticed a small, asymptomatic mass on her nose in 1994 and underwent tumor excision in April 1999. Histopathological examination revealed a typical form of angiomyolipoma, showing a proliferation of mature adipocytes, smooth muscle fascicles, and small- to medium-sized blood vessels.
Mutations of the PH Domain of Protein Kinase B (PKB/AKT) Are Absentin Human Epidermal Skin Tumors
Authors: Waldmann Volker , Wacker Jörg
Published: April 2003

Background: While for most human solid tumors genetic alterations of few distinct genetic regions have been found, studies on basal cell carcinomas (BCC) have shown the prevalence of several abnormalities including alterations of the three ras genes, GAP (GTPase activating protein), p53, PTCH (the human homologue of Drosophila patched) and SMOH (the human homologue of Drosophila smoothened). On the other hand, during the last decade, a new oncogene, protein kinase B (PKB/AKT), has been characterized and found to be overexpressed in certain human tumors. In vivo activation of PKB/AKT necessitates its recruitment to the cell membrane mediated by the N-terminal pleckstrin homology (PH) domain. Objective: We investigated whether mutations of this mandatory domain are present in a subset of human epidermal skin tumors. Methods: RNA of 19 human skin tumors including 13 BCC, 4 squamous cell carcinomas (SCC; including 1 keratoacanthoma) and 2 neurofibromas of different size and tumor stage were used for reverse transcription and subsequent PCR amplification of the PH domain of PKB/AKT. Results: Cycle sequencing of the purified PCR products did not reveal any mutation of the PH domain of PKB/AKT. Conclusion: In human BCC and SCC, mutations of the PH domain of PKT/AKT do not play a major role during the carcinogenesis of these tumors.
Erythema multiforme Associated with Cytomegalovirus Infection in Nonimmunosuppressed Patients
Authors: Seishima Mariko , Oyama Zuiei , Yamamura Mahiro
Published: April 2003

Background: It is widely known that cytomegalovirus (CMV) primarily brings about subclinical and asymptomatic infection in the early stages of life and can cause various dermatological and systemic disorders under immunosuppressed conditions. Nonimmunosuppressed individuals very rarely present with cutaneous CMV involvement. Objective: In the present study, we described the clinical characteristics of 5 nonimmunosuppressed adult patients with positive IgM antibody to CMV. Methods: The systemic symptoms and dermatological features of these 5 patients were described. Laboratory examinations including blood cell counts, liver and renal functions were performed. IgG and IgM antibodies to CMV were also examined at the first consultation and 2–3 months after the skin eruption. Polymerase chain reaction for CMV DNA was performed in the skin samples of the patients. Results: All 5 patients had fever and complained of a sore throat. Multiple exudative erythema and target lesions with itching were observed mainly on the extremities. These symptoms and eruptions disappeared within 1 week after the onset and IgM antibody titers significantly decreased after 2–3 months. IgG antibody to CMV was already positive in 3 cases but was negative in 2 cases at the initial consultation. Conclusion: We propose that CMV infection may cause erythema multiforme by primary, recurrent infections or reactivation of CMV even in nonimmunosuppressed adults.
Skin Signs in Anorexia nervosa
Authors: Strumìa R. , Varotti E. , Manzato E. , Gualandi M.
Published: April 2003

Background: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. Objective: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. Methods: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. Results: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell’s sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell’s sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. Conclusion: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.
Recurrent Focal Epithelial Hyperplasia due to HPV13 in an HIV-Positive Patient
Authors: Moerman Mieke , Danielides Vasilis G. , Nousia Christina-Sophia , van Wanzeele Filip , Forsyth Ramses , Vermeersch Hubert
Published: April 2003

There are few reports on focal epithelial hyperplasia (FEH) in association with human immunodeficiency virus (HIV) infection; thus the relationship between them has not been completely clarified yet. We present a case of recurrent FEH in an HIV-positive man (the first described in Belgium), which, according to the PCR-DNA testing, was due to human papilloma virus type 13 (HPV13). To our knowledge, based on the accessible literature, this type of HPV has not been detected in any other documented study of FEH in HIV-positive patients before. Our patient experienced three recurrences of FEH in 1 year. It is therefore suggested that immunodeficiency due to HIV infection is responsible for the HPV-related FEH and the subsequent recurrences. In order to support the consideration of FEH as an oral manifestation of an HIV-related opportunistic infection, every new ‘HPV-type’ oral lesion in HIV-positive patients must be completely documented.
Transposable Elements and the Lines of Blaschko: A New Perspective
Authors: Happle Rudolf
Published: April 2003

Background: Transposable elements or retrotransposons are particles of retroviral origin that are interspersed in large numbers in the genome of plants and animals. They may affect the activity of adjacent genes by methylation or demethylation, resulting in silencing or activation of gene expression. In animals such as mice or dogs, retrotransposons may give rise to phenotypic variation in the form of variegated coat patterns reminiscent of the lines of Blaschko as observed in human skin. Objective and Methods: Because the human genome does likewise contain large amounts of retrotransposons, it is conceivable that these elements may cause similar skin lesions in human skin. The group of genodermatoses following the lines of Blaschko was therefore screened for phenotypes suggesting such an epigenetic origin. Results: As possible examples, the inflammatory linear verrucous epidermal nevus as well as cases of pigmentary mosaicism arranged in hypermelanotic or hypomelanotic streaks following the lines of Blaschko may be taken into consideration. Such phenotypes usually occur sporadically but may affect, by way of exception, several members of a family. Conclusion: These linear skin disorders would possibly visualize the action of a transposable element that is partly expressed and partly silenced at an early developmental stage.
Postmenopausal Aging of the Sebaceous Follicle: A Comparison between Women Receiving Hormone Replacement Therapy or Not
Authors: Piérard-Franchimont C. , Piérard G.E.
Published: April 2003

Background: The endocrine control of sebaceous follicles is complex in women. During aging, a decline in sebum output is often experienced. However, some women report increased seborrhea after the menopause. Objective: In this study, the follicular reservoir function was studied during the first decade following the menopause. Methods: Four evaluations were made at 3-week intervals in two parallel age-matched groups of 50 postmenopausal women receiving hormone replacement therapy (HRT) or not. The Sebumeter served to measure the casual sebum level and the sebum excretion rate on the forehead. In addition, a Visioscan® equipped with an ultraviolet-recording camera was used with and without lipid-sensitive tapes interposed between the camera and the skin surface. Follicular openings and sebum pore patterns were studied by image analysis. Results: There was enormous diversity among individual values of sebum output at the skin surface. In untreated women, a significant decline in sebum excretion rate accompanied by an increase in both the sebum replacement time and the mean pore size were evidenced during the first decade after the menopause. The sebum excretion rate and casual level showed a wide range of interindividual differences early after the menopause. These physiological changes were less prominent in women receiving HRT. Conclusion: Postmenopausal aging affects the sebum production, but HRT does not significantly control the complex process of seborrhea. However, HRT mitigates the progressive enlargement of the openings of the sebum follicular reservoir.
Psoriatic Lesional Keratinocytes Promote the Maturation of Human Monocyte-Derived Langerhans Cells
Authors: Yu Yizhi , Tang Ling , Wang Jianli , Liu Shuxun , Wang Wengya , An Huazhang , Qi Runzi , Zhang Minghui , Cao Xuetao
Published: April 2003

Background: Langerhans cells (LCs) are important antigen-presenting cells in the epidermis and may play a key role in the pathogenesis of psoriasis. It has been proven that LCs isolated from psoriatic lesions are abnormal. However, the mechanism of the abnormality has not been reported so far. Objective: In the present study, we investigated the effect of psoriatic lesional keratinocytes on the maturation of LCs. Methods: Monocytes isolated from healthy peripheral blood could differentiate into LCs in the presence of granulocyte-macrophage colony-stimulating factor, interleukin (IL) 4 and transforming growth factor β1 for 5 days. Then, human monocyte-derived LCs were cultured with supernatants from psoriatic lesional keratinocytes for another 2 days. Their phenotypes and phagocytic capacity were analyzed by flow cytometry. IL-12 secreted by LCs was determined by ELISA. Results: Supernatants from psoriatic lesional keratinocytes could up-regulate the expression of HLA-DR and CD86 on LCs more significantly than supernatants from healthy keratinocytes, but less powerfully than lipopolysaccharide. The levels of IL-12 secreted by LCs also increased. In contrast, the expression of CD1a on LCs and their phagocytic capacity were reduced. Conclusion: Human monocyte-derived LCs cultured with supernatants from psoriatic lesional keratinocytes displayed the characteristics of maturation. This suggests that psoriatic lesional keratinocytes might secrete some factors that could promote the maturation of LCs, which may play important roles in immune reactions related to psoriasis.
Cell Proliferation and Lipid Formation in Hamster Sebaceous Gland Cells
Authors: Akimoto N. , Sato T. , Sakiguchi T. , Kitamura K. , Kohno Y. , Ito A.
Published: April 2003

Background: The development of sebocytes and lipogenesis are known to be dependent on androgens. However, it is not fully understood whether growth factors are involved in the regulation of cell proliferation and lipid formation in sebaceous glands. Objective: This study was designed to evaluate the effect of growth factors such as epidermal growth factor (EGF), transforming growth factor α (TGF-α), basic fibroblast growth factor (bFGF) and keratinocyte growth factor (KGF) on cell proliferation and lipogenesis in cultured hamster sebocytes. Methods: Cell proliferation and intracellular lipid accumulation in these hamster sebocytes treated with growth factors were examined. Results: EGF, TGF-α and bFGF augmented the proliferation of hamster sebocytes for 8 days in a time- and dose-dependent manner. However, KGF had no effect on their proliferation. Moreover, the accumulation of intracellular lipids consisting mainly of triglycerides was suppressed in EGF-, TGF-α-, bFGF- and KGF-treated hamster sebocytes. Conclusion: EGF, TGF-α and bFGF, but not KGF, have mitogenic activity on hamster sebocytes, and all these growth factors act as antilipogenic factors. Moreover, it is likely that the formation of intracellular lipid droplets is independent of cell proliferation in hamster sebocytes.
Onychomycosis due to Exophiala jeanselmei
Authors: Boisseau-Garsaud Anne-Marie , Desbois Nicole , Guillermin Marie-Laurence , Ossondo Marlène , Gueho Evelyne , Cales-Quist Danielle
Published: April 2003

Background:Exophiala jeanselmei is a dematiaceous fungus that may cause invasive diseases, particularly among immunocompromised hosts. Most reports mention cutaneous or subcutaneous lesions, but no case of nail involvement due to this fungus has been reported until now. Case Report: A 60-year-old man presented with hyperkeratosis and black coloration of the nails of the two thumbs and the two big toes of 4 years’ duration. He was a renal transplant recipient and had been treated with prednisone and azathioprine. E. jeanselmei was present on direct examination, then isolated in cultures on repeated samplings from all pathologic nails. He was cured after 6 months of treatment with itraconazole. Commentary: We describe the first case of nail infection due to E. jeanselmei. Itraconazole, which provides a broad spectrum of action on fungal species and achieves high levels of active substance in many tissues, including the nails, appeared to be efficient upon such a nail localization of E. jeanselmei.
Imaging Procedures in Neuroendocrine Tumours
Authors: Ricke J. , Klose K.-J.
Published: April 2003

Purpose: To give recommendations for diagnostic imaging workflow in suspected neuroendocrine tumours. Materials and Methods: Recommendations for imaging workflow were elaborated by consensus of researchers in neuroendocrine tumours. Results: Workflow charts are presented for: (1) nonfunctional and functional endocrine tumours of the pancreas (except insulinoma); (2) insulinoma; (3) ECL cell tumour; (4) assessment of unknown primaries in functional and nonfunctional neuroendocrine tumours of the gut; (5) assessment of metastases in functional and nonfunctional neuroendocrine tumours of the gut. Conclusions: The workflow charts facilitate diagnosis of neuroendocrine tumours as well as the design of controlled studies.
OctreoTherTM: Ongoing Early Clinical Development of a Somatostatin-Receptor-Targeted Radionuclide Antineoplastic Therapy
Authors: Smith M. Charles , Liu Jingou , Chen Tianling , Schran Horst , Yeh Ching-Ming , Jamar François , Valkema Roelf , Bakker Willem , Kvols Larry , Krenning Eric , Pauwels Stanislas
Published: April 2003

OctreoTherTM (90Y-DOTA-D-Phe1-Tyr3-octreotide, a.k.a. 90Y-SMT 487) consists of a somatostatin peptide analogue (Tyr3-octreotide), coupled with a complexing moiety (DOTA), and labeled with a tightly bound beta-emitter (yttrium-90). By targeting somatostatin receptor-positive tumors (as imaged by OctreaScan®) it may deliver a tumoricidal dose of radiation. Phase I clinical trials, conducted in patients with neuroendocrine tumors, established the safety and tolerability of the dose selected for further study and demonstrated the capacity of OctreoTher to deliver radiation doses to tumors that resulted in significant neuroendocrine tumor shrinkage. Novartis-sponsored phase II studies will soon begin to test the efficacy of OctreoTher in breast and small cell lung cancer. A fixed-dose regimen of 120 mCi/cycle × 3 cycles administered with concomitant amino acid infusion has been chosen for the study. Phase I data and published literature support that this fixed dose regimen will be safely tolerated.
Diagnostic Accuracy of 13C-Urea Breath Test in the Diagnosis of Helicobacter pylori Infection in Patients with Partial Gastric Resection due to Peptic Ulcer Disease
Authors: Schilling D. , Jakobs R. , Peitz U. , Sulliga M. , Stolte M. , Riemann J.F. , Labenz J.
Published: April 2003

Aims: We investigated the diagnostic properties of the 13C-urea breath test (13C-UBT) prospectively. These are well validated in nonresected patients before and after treatment of Helicobacter pylori infection but not in patients with partial gastric resection due to peptic ulcer disease. Methods: Hospitalized patients with previous gastric resection and indications for upper gastrointestinal endoscopy were recruited for the study. Biopsy specimens were obtained from the fundus mucosa and the gastric remnant adjacent to the gastroenteric anastomosis for histological examination and rapid urease test (HUT test). Histological slides were evaluated after hematoxylin and eosin and Warthin-Starry dye staining. 200 ml orange juice was given orally after two baseline breath samples had been taken, and 30 min after ingestion of 75 mg 13C urea two more breath samples were obtained and analyzed by ratio mass spectrometry. The Warthin-Starry dye-stained sample was taken as reference. Results: 68 patients (47 male, 21 female, mean age 62 years; 52 Billroth II resection, 17 Billroth I resection) were included in the study. The overall prevalence of histologically proven H. pylori infection was 36.7%. The sensitivity of the 13C-UBT was 52%, the specificity 93%. The positive predictive value was 81.25%, the negative predictive value 76.9% and the accuracy was 77.9%. The sensitivity of the HUT test reached 60%, and the specificity 97%. Conclusion: The diagnostic accuracy of 13C-UBT compared with the Warthin-Starry dye staining is low. The breath test, performed in the above-described manner, cannot be recommended as a noninvasive diagnostic tool for diagnosis of H. pylori infection in patients after partial gastrectomy as a result of peptic ulcer disease.
Exocrine Pancreatic Insufficiency in Tropical Sprue
Authors: Morales Miguel , Galván Elba , Mery Carlos M. , Castro Graciela , Uscanga Luis F. , Robles-Díaz Guillermo
Published: April 2003

Background: Pancreatic insufficiency may appear secondary to several intestinal disorders. It may contribute to malabsorption in tropical sprue (TS). Methods: The exocrine pancreatic function was evaluated with the indirect pancreolauryl test (PT) in 56 patients with TS. The PT results were analyzed and correlated with serum albumin levels, degree of intestinal atrophy, and steatorrhea. Results: Abnormally low values were found in 36 (64.2%) cases. A significant relationship was not observed between PT and hypoalbuminemia. Patients with more severe damage by intestinal biopsy tended to have lower PT values. No relationship was found between pancreatic insufficiency and steatorrhea (expressed as g/24 h), but patients with pancreatic insufficiency had increased stool fat concentrations (expressed as percentage of wet stool weight). All patients responded favorably to treatment with folic acid and tetracycline. Fifteen patients with abnormal initial PT values underwent a repeat PT after a 6-week therapy; all of them showed normalization of PT values. Conclusions: The abnormal exocrine pancreatic function found with an indirect test in patients with TS is probably secondary to a low pancreatic hormonal stimulation due to intestinal damage, as occurs in celiac sprue. These abnormalities are reversible after specific treatment for TS.
Effects of n–3 Polyunsaturated Fatty Acids and Vitamin E on Colonic Mucosal Leukotriene Generation, Lipid Peroxidation, and Microcirculation in Rats with Experimental Colitis
Authors: Shimizu Toshiaki , Igarashi Jun , Ohtuka Yoshikzu , Oguchi Satoshi , Kaneko Kazunari , Yamashiro Yuichiro
Published: April 2003

Aims: We investigated the effect of n–3 polyunsaturated fatty acids (PUFAs) on mucosal levels of leukotrienes (LTs) and lipid peroxide (LPO), and on mucosal microcirculation, in rats with experimental colitis induced by dextran sulfate sodium (DSS). Methods: We fed Wistar rats a perilla oil-enriched diet containing α-linolenic acid (63.2% of total fatty acids) with various doses of vitamin E for 4 weeks, with 4% DSS added to the drinking water during the last week. Control rats were fed a diet produced from soybean oil containing α-linolenic acid (5.1% of total fatty acids). Colonic mucosal blood flow was measured with a laser Doppler flowmeter. Results: The mucosal level of arachidonic acid was significantly lower and that of eicosapentaenoic acid was significantly higher in the experimental group. The mucosal level of LPO in the experimental group fed a trace or ordinary dose of vitamin E was significantly higher than that of the controls. The production of LTB4 and LTC4 from the colonic mucosa in the experimental group was significantly lower than that in controls. However, only the experimental group fed a vitamin E dose 4-fold higher than that given to the controls showed a significant increase in mucosal blood flow. Conclusion: These results suggest that n–3 PUFAs increase mucosal blood flow by inhibiting LT production when there is sufficient vitamin E to inhibit lipid peroxidation in rats with experimental colitis.
Percutaneous Liver Biopsy: A Safe Outpatient Procedure?
Authors: Montalto G. , Soresi M. , Carroccio A. , Bascone F. , Tripi S. , Aragona F. , Di Gaetano G. , Notarbartolo A.
Published: April 2003

Following the discovery of hepatitis C virus, more liver biopsies (LB) than before are being performed to assess the severity of liver disease. In this study, following the recommendations for outpatient LB made by the Patient Care Committee of the American Gastroenterological Association, we assessed the feasibility and benefits of LB performed as an outpatient versus inpatient procedure over the last 7 years in our centre. The study included 1,581 patients consecutively examined in our institute; all LBs were performed by a single operator with a 16-gauge needle using the Menghini technique, and in all cases the puncture site was determined using prebiopsy ultrasound. Liver lesions were classified using grading and staging scores. Ultrasound-guided LB of focal lesions were excluded from this study. LB was performed on 1,318 outpatients and 263 hospitalized patients. The mean age of the hospitalized patients was higher than that of the outpatients (p < 0.0001). As major side effects, one death and one haemoperitoneum requiring blood transfusion were recorded in the hospitalized patients. As minor side effects, one haemorrhage occurred in the hospitalized patients, whereas a case of haemobilia and 2 cases of subcapsular haematoma were recorded in the outpatients. In both groups pain at the puncture site was the most frequent minor complication which easily resolved after non-steroid drug administration. Severe histological diagnoses, both in terms of grading and staging, were significantly associated with hospitalized patients. In conclusion, by carefully selecting patients and using prebiopsy ultrasound to assess the puncture site, outpatient LB can be safely performed in most cases; this procedure should be more widely used, because it has met with the favour of patients who are able to return home the same day and reduces public health care service costs.
Towards a Novel Treatment Strategy for Acute Pancreatitis
Authors: Braganza Joan M.
Published: April 2003

In part 1 it was argued that a ‘free radical-mast cell’ template for the aetiogenesis of acute pancreatitis accommodates the evidence, whereas the prevailing ‘trypsin-cytokine’ template does not. In this sequel I examine the ramifications of the new philosophy in relation to speedier diagnosis, prognostic aids and, above all, a programme of active treatment which – once validated in experimental studies – could be implemented by the first medical respondent.
Patients with Constipation-Predominant Irritable Bowel Syndrome (IBS) May Have Elevated Serotonin Concentrations in Colonic Mucosa as Compared with Diarrhea-Predominant Patients and Subjects with Normal Bowel Habits
Authors: Miwa Jun , Echizen Hirotoshi , Matsueda Kei , Umeda Noritsugu
Published: April 2003

Background: Serotonin (5-HT) may play an important role in the regulation of colonic motility in humans. However, it is not known whether alterations in the colonic 5-HT system are involved in the pathophysiology of irritable bowel syndrome (IBS). Methods: Colonic mucosal specimens ranging from the ascending colon to the rectum were obtained from patients with diarrhea- or constipation-predominant IBS (n = 7 and n = 8, respectively) and from subjects with normal bowel habits (n = 7) by endoscopic biopsy in order to determine whether patients with different clinical manifestations of IBS have different mucosal disposition of 5-HT. The tissue concentrations of 5-HT and its major metabolite, 5-hydroxyindoleacetic acid, were determined by reversed-phase high-performance liquid chromatography with fluorescence detection. Results: In all study groups, the mean mucosal 5-HT concentrations obtained from the rectum were significantly (p < 0.05) higher than those obtained from more cephalic regions of the colon. In addition, the overall mean mucosal 5-HT concentrations obtained from patients with constipation-predominant IBS were significantly (p < 0.05) higher than those obtained from the control subjects and patients with diarrhea-predominant IBS. No significant differences were observed in 5-hydroxyindoleacetic acid concentrations among the three groups. Conclusions: The mucosal 5-HT concentrations in the colon showed an ascending cephalocaudal gradient in all study groups. Although the mucosal 5-HT concentrations were elevated in patients with constipation-predominant IBS as compared with those with diarrhea-predominant IBS and the control subjects, further studies are necessary to determine whether the elevated mucosal 5-HT is a cause or a result of abnormal colonic motility.
Induction of Gastric Ornithine Decarboxylase in Early Weaning Rats
Authors: Lin Chuan-Hao , Lyons Hernando , Seelbach Megan S. , Tolia Vasundhara , Vijesurier Roy
Published: April 2003

Background/Aims: Early weaning has been shown to induce intestinal ornithine decarboxylase (ODC) activities and cell proliferation in rats. No information is available about the effect of early weaning on ODC activity in the stomach. Methods: Suckling rats were prematurely weaned on postnatal day 15 and followed through day 21. Oxyntic gland mucosa of stomach was obtained on postnatal days 15, 16, 18 and 21 (days 0, 1, 3 and 6 after early weaning) and assayed for ODC activity, DNA, protein and pepsinogen activity. α-Difluoromethyl ornithine (DFMO), a specific ODC inhibitor, was given orally to early-weaned pups and its resultant effects were assessed on days 1 and 6 after early weaning. Results: Stomach mucosal wet weight, DNA, protein and pepsinogen activities significantly increased on day 6 after early weaning. ODC activity increased on days 1, 3, and 6 after early weaning, with the highest increase (3-fold) on day 1 when compared to controls. The increases of ODC activity, DNA and protein contents as induced by early weaning were significantly suppressed when pups were exposed to DFMO. However, no suppression of pepsinogen activity was observed. Conclusions: Our study shows that early weaning induces ODC activity and functional growth in the stomach. Gastric ODC activity is essential in gastric mucosal growth processes but not in differentiation. The induction of stomach ODC may act as an early marker in the growth of stomach mucosa induced by early weaning in rats.
Beneficial Effects of Batimastat (BB-94), a Matrix Metalloproteinase Inhibitor, in Rat Experimental Colitis
Authors: Di Sebastiano Pierluigi , di Mola Fabio F. , Artese Luciano , Rossi Cosmo , Mascetta Giuseppe , Pernthaler Heinz , Innocenti Paolo
Published: April 2003

Background and Aims: Matrix metalloproteinases (MMPs) represent a group of enzymes that regulate cell-matrix composition playing a major role in the inflammatory response. In the present study we evaluated the ability of the MMP inhibitor Batimastat (BB-94) to modify the course of experimental colitis induced in the rat by trinitrobenzensulfonic acid (TNB). Methods: Colitis was induced in 40 rats by intracolonic administration of TNB. Animals were divided into four groups of ten rats each: group 1 received only intracolonic TNB, group 2 received TNB+5 mg/kg intraperitoneal BB-94, group 3 TNB+10 mg/kg BB-94 and group 4 TNB+20 mg/kg BB-94. The MMP inhibitor was administered 30 min before induction of colitis and twice daily until death. Ten rats receiving only intracolonic 0.9% saline served as controls. Animals were killed after seven days; segments of colon were removed and used for histological score of inflammation and myeloperoxidase (MPO) activity. Results: Rats receiving only intracolonic 0.9% saline showed no evidence of colitis. The inflammation score was 0.9, MPO activity 0.235 U/mg. Group 1 (TNB-treated rats) exhibited a high inflammation score (12.4) and MPO activity (0.715 U/mg). Conversely, BB-94-treated rats showed, compared to the TNB group, a significantly lower inflammation score and MPO activity in a dose-dependent fashion. Group 2: inflammatory score 10.1, MPO activity 0.474 (p < 0.05 vs. TNB); group 3: inflammatory score 8.3, MPO activity 0.287 (p < 0.01 vs. TNB); group 4: inflammatory score 5.0, MPO activity 0.256 (p < 0.01 vs. TNB). Conclusions: Treatment with BB-94 has dose-dependent beneficial effects on the inflammatory alterations in rat experimental colitis. Thus, the inhibition of MMPs may represent a novel therapeutic approach for treatment of intestinal inflammation.
Existence of Variant γδT Cells in Crohn’s Disease
Authors: Ishiguro Yoh , Kanazawa Hiroshi , Yamagata Kazufumi , Sakuraba Hirotake , Munakata Akihiro
Published: April 2003

Background and Objectives: γδT cell populations are well-known for their unique distribution (e.g. intra-epithelial lymphocytes). Though their ligands play a major role in the immune response they have remained largely obscure. To shed light on this issue, we have analyzed in this study the complementarity determining region (CDR) 3 of the T cell receptor (TCR) Vδ2 chains. This provides an insight into the antigenic immune response in the intestinal mucosa in sickness and health. Methodology: Total RNA was extracted from surgically resected intestinal mucosa of patients with Crohn’s disease (CD) and controls. TCR Vδ2 cDNA was PCR-amplified using Vδ2 sense primer and Cδ antisense primer. The PCR products were then subcloned in pUC18 plasmid. From each sample, 20 subclones were randomly selected and subjected to nucleotide sequence analysis. Results: Sequence analysis revealed that the CDR3 sequences of the TCR Vδ2 chains were unique to each individual. The evidence also showed a significant restriction of the junctional diversity of the TCR Vδ2 chains while no such restriction was found for CD. Conclusions: The marked complexity of the TCR Vδ2 junctional sequences and the oligoclonality of the TCR Vδ2 genes in the control subjects are indicative of a positive selection and expansion of specific T cells in the normal, healthy condition. In CD patients, however, the expression of distinct, non-overlapping TCR Vδ2 clonotypes can be found, suggesting polyclonal activation of γδT cells in the diseased colon of CD patients. These findings have led us to conclude that accumulation of multiple γδT cell clonotypes may be involved in the pathogenesis of CD.
Role of P-Selectin and Intercellular Adhesion Molecule-1 in TNB-Induced Colitis in Rats
Authors: Yoshida Norimasa , Yamaguchi Taiji , Nakagawa Shuji , Nakamura Yasunari , Naito Yuji , Yoshikawa Toshikazu
Published: April 2003

It has been proposed that neutrophil-endothelial cell interactions mediated by adhesion molecules are involved in the pathogenesis of inflammatory bowel disease. The objective of the present study was to determine the effects of monoclonal antibodies (MAbs) directed against endothelial adhesion molecules, P-selectin and intercellular adhesion molecule-1 (ICAM-1), in rats with colitis induced by 2,4,6-trinitrobenzene sulfonic acid (TNB). Colonic inflammation was induced by administering an enema of TNB dissolved in 50% ethanol (120 mg/ml) to male Wistar rats (at a total volume of 0.25 ml per rat) after a 48-hour fast. Anti-P-selectin MAb or anti-ICAM-1 MAb was injected via the tail vein at a dose of 1 mg/kg after the induction of colitis. Rats in the control group received nonbinding mouse immunoglobulin G1. The plasma level of soluble P-selectin showed an increase within 48 h after the TNB enema. Colonic inflammation was assessed at 1 week after TNB administration. The colonic damage score and the wet weight of the colon were significantly decreased by treatment with either MAb. The increase of myeloperoxidase (MPO) activity, an index of neutrophil accumulation, and the increase of thiobarbituric acid-reactive substances (TBA-RS), an index of lipid peroxidation, in the colonic mucosa were inhibited by both MAbs. These results suggest that neutrophil-endothelial cell interactions via P-selectin and ICAM-1 play an important role in the development of TNB-induced colitis in rats.
Effect of Fasting on Diarrhoea in Collagenous Colitis
Authors: Bohr Johan , Järnerot Gunnar , Tysk Curt , Jones Ian , Eriksson Sune
Published: April 2003

Background/Aim: Diarrhoea in collagenous colitis has been considered as secretory though the pathophysiology has been studied thoroughly in only a few patients. The result of fasting is one way to distinguish between secretory and osmotic diarrhoea. Our aim was to investigate the effect of fasting on diarrhoea in collagenous colitis. Methods: Fourteen patients with collagenous colitis were admitted to the hospital for investigation. All were female. Five of these did not have diarrhoea during admission and were excluded. Stools were examined for weight, electrolytes, pH, fat and osmolality during a period on a normal diet and during fasting. Results: During the fasting period the faecal weight was significantly reduced from median 757 (440–3,198) to 191 (22– 2,197) g. The faecal sodium concentration was also reduced, though not significantly, during fasting from median 65 (29–85) to 45 (19–88) mmol/l. The osmotic gaps varied according to the method of calculation applied. Conclusions: The data indicate that the cause of the diarrhoea in collagenous colitis could be multifactorial. In some patients an osmotic factor dominates and in others a secretory factor, while in some patients a combination of both seems to exist.
Human Islet Autotransplantation to Prevent Diabetes after Pancreas Resection
Authors: White Steven A. , Robertson Gavin S.M. , London Nick J.M. , Dennison Ashley R.
Published: April 2003

In severe cases of chronic pancreatitis pain relief can often only be achieved by pancreas resection, however this may render the patient diabetic. In an effort to prevent diabetes some patients may be suitable for a simultaneous islet autotransplant. The last report from the International Islet Transplant Registry has reported 222 cases. This review discusses the current progress in human islet autotransplantation.
Evaluation of J-Pouch Reconstruction after Total Gastrectomy: ρ-Double Tract vs. J-Pouch Double Tract
Authors: Fujiwara Yoshinori , Kusunoki Masato , Nakagawa Kazuhiko , Tanaka Tsuneki , Hatada Takuya , Yamamura Takehira
Published: April 2003

Objective: Various enteric reservoirs have been advocated to improve the quality of life after total gastrectomy. We evaluated the advantages of pouch reconstruction compared with traditional ρ-double tract reconstruction. Design: Prospective randomized study. Setting: Second Department of Surgery, Hyogo College of Medicine, Japan. Subjects: Forty patients who underwent total gastrectomy for cancer of the stomach were studied. Intervention: Forty patients were randomly divided into two groups: 20 patients received ρ-double tract reconstruction (RDT group), and 20 underwent J-pouch double tract reconstruction (PDT group) group. Main Outcome Measures: We compared the body weight, serum nutritional parameters, reflux score, scintigraphic esophageal reflux, food intake, and emptying time of the J-pouch or ρ-limb between the two groups. Results: No difference was noted between the two groups with regard to body weight, but food intake tended to be higher in the PDT group than in the RDT group. Total protein and albumin levels were higher in the PDT group than in the RDT group, while scintigraphic reflux was significantly less prominent in the PDT group. Conclusions: J-pouch reconstruction was superior with respect to protein metabolism, food intake and reduction of reflux esophagitis compared with the traditional RDT method. However, use of pouch reconstruction did not improve postoperative weight gain.
Multiple Gastric Carcinomas 21 Years after Gastrojejunostomy without Gastrectomy
Authors: Takeno Shinsuke , Noguchi Tsuyoshi , Sato Tetsuro , Uchida Yuzo , Yokoyama Shigeo
Published: April 2003

We report a case of gastric carcinoma after gastrojejunostomy (GJ-stomy) without gastrectomy. Multiple gastric carcinomas were discovered 21 years after GJ-stomy without gastrectomy which had been performed for treatment of pyloric stenosis due to severe gastric ulcer. Multiple gastric carcinomas were found in the stomach, or the esophagocardiac junction, and in the corpus and anastomotic lesion of the GJ-stomy. Under the light microscope, intestinal metaplasia was detected in the antral mucosa and the area around the anastomosis. In immunohistochemical analysis, p53-specific antibodies gave a positive reaction in every gastric carcinoma and in the noncancerous gastric glands around the carcinoma at the anastomosis and in the corpus. Cells positive for immunostaining with Ki-67-specific antibodies were more numerous in all gastric carcinomas and in the area around the anastomotic lesion than in the normal gastric mucosa. Hsp70-specific antibodies reacted with cells in the noncancerous glands around the carcinoma in the anastomotic area. Mucosal injury and the potential for carcinogenesis due to exposure to gastroduodenal reflux are discussed. The results of this study suggest that similar cases with gastroduodenal reflux should be followed carefully.
Erythromycin and Position Facilitated Placement of Postpyloric Feeding Tubes in Burned Patients
Authors: Komenaka Ian K. , Giffard Kimberley , Miller Julie , Schein Moshe
Published: April 2003

Background: One of the main difficulties encountered in enteral nutrition in critically ill patients is the impaired gastric emptying: while the small bowel is ready the stomach is still ‘lazy’. This paper describes a simple bedside method for postpyloric feeding tube placement, using a gastric prokinetic agent, erythromycin, and patient positioning. Methods: In eight critically ill, burned patients a gastric feeding tube was placed in a reverse Trendelenburg, right lateral decubitus position. A dose of 250 mg of erythromycin was administered intravenously. Results: In 13 out of 14 attempts, the tube passed into the duodenum, a success rate of 92%. Conclusions: Combining the prokinetic effects of erythromycin with proper patient positioning allows a rapid bedside transpyloric placement of feeding tubes.
Angiogenesis Predicts Poor Prognosis in Gastric Carcinoma
Authors: Erenoglu Cengiz , Akin Mehmet L. , Uluutku Haldun , Tezcan Levent , Yildirim Sukru , Batkin Ahmet
Published: April 2003

Background/Aims: New prognostic factors in gastric carcinoma to determine the prognosis of the disease or to identify patients who will benefit from adjuvant therapy are being researched. The aim of this study is to investigate the correlation between microvessel count (MVC) and various clinicopathologic features in gastric carcinoma in order to evaluate the role of angiogenesis on the prognosis of gastric cancer. Methods: Fifty-seven patients who underwent surgical intervention for gastric carcinoma between 1993 and 1997 were reviewed retrospectively. The relationship between MVC and various clinicopathological features was assessed. The effect of angiogenesis on overall survival and the role of MVC and other prognostic factors on distant metastases were assessed by multivariate analysis. Microvessels were outlined by anti-factor VIII, which is a specific monoclonal antibody to factor VIII in vessel endothelial cells, using the streptavidin-biotin method and counted under light microscopy ×200 magnification. Results: There was no correlation between MVC and age or sex of the patient, duration of symptoms or tumor size. Proximally located, undifferentiated, diffuse type, serosal invasion positive, lymph node invasion positive, advanced stage, or distantly metastasized tumors had higher MVCs. Higher MVCs affected the overall survival adversely. Lymph node metastasis, serosal invasion and MVC were found as independent prognostic factors affecting distant metastases. MVC was the sole factor affecting recurrent liver metastasis. Conclusion: It is concluded that MVC in gastric carcinoma may be a valuable prognostic factor to predict patients at high-risk for possible recurrences and to decide on postoperative adjuvant therapy.