bluuebunny/crossref_metadata_2025 huggingface dataset:
The Case of the Red Lingerie – Chromhidrosis Revisited
Authors: Cilliers J. , de Beer C.
Published: April 2003

Chromhidrosis or the production of coloured sweat is a rare clinical finding. A 26-year-old female presented with marked pink staining of her uniform and lingerie. Extractions of clothing, skin surface samples, eccrine sebum, urine and a fast food product were spectrophotometrically analysed to identify the pink staining pigment. Three water-soluble colouring agents have been idenfified. An eccrine route of excretion probably produced chromhidrosis. An overview is presented.
IgG Autoantibodies from a Lichen planus pemphigoides Patient Recognize the NC16A Domain of the Bullous Pemphigoid Antigen 180
Authors: Skaria M. , Salomon D. , Jaunin F. , Friedli A. , Saurat J.-H. , Borradori L.
Published: April 2003

Lichen planus pemphigoides (LPP) most likely encompasses a heterogeneous group of subepidermal autoimmune blistering disorders occurring in association with lichen planus. We describe the case of a 49-year-old patient with features characteristic of LPP. Direct immunofluorescence microscopy studies demonstrated linear deposits of C3 along the cutaneous basement membrane, while circulating IgG autoantibodies directed against the epidermal side of skin separated by 1 M NaCl were detected. The patient’s serum contained IgG autoantibodies immunoblotting a recombinant form of bullous pemphigoid antigen 180 (BP180), but not the COOH-terminus of BP230. By using deletion mutants, it was found that IgG reactivity was restricted to the NC16A domain of BP180, the region harboring the major antigenic sites targeted by IgG autoantibodies from patients with the bullous pemphigoid group of disorders. Our findings provide support to the idea that a subset of patients with LPP have a distinct form of bullous pemphigoid associated with lichen planus.
Clinical, Histological and Immunopathological Features of 58 Patients with Subacute Cutaneous Lupus erythematosus
Authors: Parodi Aurora , Caproni Marzia , Cardinali Carla , Bernacchi Elisabetta , Fuligni Alessandra , De Panfilis Giuseppe , Zane Cristina , Papini Manuela , Veller Farnase Cleto , Vaccaro Mario , Fabbri Paolo
Published: April 2003

Background: Subacute cutaneous lupus erythematosus (SCLE) is a distinct subset of cutaneous lupus erythematosus clinically characterized by psoriasiform and/or annular lesions and by a mild or absent systemic involvement. Objective: The Italian Group of Immunodermatology of the Italian Society of Dermatology and Venereology reviewed the cases of SCLE seen in 10 years (1987–1996). Patients: Forty-six women and 12 men have been retrospectively studied, 42% had annular lesions, 39% psoriasiform ones and 16% both. Results: Lesions were mainly localized on the neck and face and relapsed in spring and autumn. Seventeen patients had 4 or more American College of Rheumatology criteria and could be classified as having systemic lupus erythematosus. The most frequent histopathological alterations were epidermal atrophy, hydropic degeneration of the basal layer and perivascular lymphocytic infiltrate. Deposits of immunoglobulins and C3 at the dermo-epidermal junction on the clinically involved skin were present in 86% of the patients. Dust-like particles in the epidermis were only found in 3% of cases. Anti-Ro/SSA antibodies were found in 71% of the cases and anti-dsDNA only in 5% of cases. Conclusions: SCLE is a particular subset of cutaneous lupus erythematosus with peculiar clinical and immunopathological features.
Leg Ulcers in Patients with Myeloproliferative Disorders: Disease- or Treatment-Related?
Authors: Bader U. , Banyai M. , Böni R. , Burg G. , Hafner J.
Published: April 2003

Leg ulcers are a relatively frequent problem in patients with myeloproliferative disorders under treatment with hydroxyurea (HU). The pathogenesis is currently unknown and may be multifactorial. Concomitant arterial or venous disease may play a contributing role in the development of these wounds. Vasculitis, cryoglobulinemia and pyoderma gangrenosum should be considered if typical clinical signs are present. We report on 3 patients with myeloproliferative disorders who developed HU-induced leg ulcers and review the literature. HU-induced leg ulcers share clinical features which can help to differentiate them from leg ulcers of other etiologies: occurrence under long-term treatment with HU at a dose of at least 1 g/day, localization in the malleolar region and spontaneous healing when HU is discontinued. We conclude that differentiation between disease-related and treatment-induced leg ulcers can be difficult and may not always be possible. In HU-induced leg ulcers, cessation of the drug typically leads to wound healing.
Continuous Topical Administration of a Petrolatum Formulation by a Novel Disposable Diaper
Authors: Odio Mauricio R. , O’Connor Robert J. , Sarbaugh Frank , Baldwin Sue
Published: April 2003

Background: Cutaneous problems are commonly associated with the use of diapers. Aiming to help reduce them, we have explored the use of the inner layer of diapers as a means to deliver to the skin dermatological formulations intended to help protect it from overhydration and irritation. Objective: To determine the feasibility of using the inner layer of the diaper as a vehicle for topical delivery of a petrolatum-based formulation and to determine its impact on skin surface microtopography. Methods: Two independent, blinded, randomized clinical trials were conducted, on children 16–24 months of age. All comparisons were done versus a control diaper, identical to the test product except for the absence of the petrolatum formulation. The studies determined the effects of the novel diaper on transfer of formulation to the skin and skin surface microtopography. Results: During normal diaper use, formulation transfer from the diaper to the skin occurred in a cumulative, time-dependent manner and use of the formulation-treated diaper was associated with significant reductions in skin surface roughness compared to the control diaper. Conclusions: The results demonstrated the feasibility and skin surface benefits associated with continuous topical administration of a petrolatum-based formulation by this novel diaper. This unprecedented dosimetric approach offers new avenues to reduce further the dermatological problems commonly associated with diaper use.
Long-Term Effects of Interferon Alpha 2A Treatment in Behçet’s Disease
Authors: Boyvat A. , Şişman-Solak C. , Gürler A.
Published: April 2003

Background: Between May 1995 and April 1996, 20 patients with Behçet’s disease were successfully treated with interferon α2a (IFN-α2a) 9 million IU/day three times a week and 16 patients with colchicine 1.5 mg/day orally for 3 months. Objective: To study the long-term effects of IFN treatment in Behçet’s disease. Methods: Between the years of 1996 and 1999, the patients were followed up every 3 months or whenever indicated. Retrospective evaluation was performed. Results: In 56% of the patients with complete remission or partial remission at the end of IFN-α2a treatment, long-term remissions ranging from 36 to 48 months were observed. Conclusion: IFN-α2a treatment is an effective treatment modality in Behçet’s disease with the advantage of inducing prolonged remissions.
Difference in Hepatic Tissue Oxygenation between Total Vascular Exclusion and Inflow Occlusion of the Liver and the Possible Role of Hepatic Venous Blood under Liver Ischemia
Authors: Sato Tsutomu , Asanuma Yoshihiro , Kusano Tomoyuki , Sasaki Noriaki , Shindo Yoshiaki , Koyama Kenji
Published: April 2003

The difference between total vascular exclusion (TVE) and inflow occlusion (IO) of the liver was assessed by the extent of DNA injury in rats and by hepatic tissue oxygen saturation (SahtO2) in pigs. Moreover, the role of hepatic venous blood under liver ischemia was discussed. Seventy percent of the rat livers were exposed to complete IO (hepatic artery + portal vein) or to TVE (IO + hepatic vein) for 30 or 60 min. DNA strand breaks following blood flow interception were measured using the in situ nick translation technique as an indicator of liver damage. IO/TVE were performed on pigs as well under portosystemic bypass, and the oxygen saturation of the hepatic venous blood (SahvO2) was altered by changing the fraction of inspiratory oxygen or by oxygenating the inferior caval blood using an extracorporeal membrane oxygenator. The changes in SahtO2 were measured sequentially using near-infrared spectroscopy. The results were as follows: (1) DNA injury occurred more severely under TVE than under IO of the rat liver at the end of ischemia, as well as 30 min after revascularization. (2) SahtO2 during TVE was significantly lower than that during IO. (3) The increase in SahvO2 by oxygenation of the inferior caval blood resulted in the elevation of SahtO2 under IO. In conclusion, TVE could cause greater damage to the liver than IO due to the lack of the hepatic venous blood. Hepatic venous blood might play an important role in hepatic tissue oxygenation in the case of hepatic blood flow interception.
Colorectal Follow-Up Planning Modified on the Basis of Our Personal Experience
Authors: Li Destri Giovanni , Rinzivillo Calogero , Craxi Giuseppe , La Greca Gaetano , Di Cataldo Antonio , Puleo Stefano , Licata Antonio
Published: April 2003

Background: The authors, evaluating the disappointing follow-up results in patients suffering from colorectal carcinoma who had undergone surgery for cure, tried a more rational follow-up. Methods: In a retrospective review about 232 patients who adhered to the follow-up protocol, we evaluated the accuracy rates of CEA, liver ultrasonography and abdominal CT. In the same group of patients, we evaluated the type of correlation between the neoplastic recurrence rate and Astler-Coller’s classification. Results: (1) In detecting hepatic metastases CEA levels furnished sensitivity and negative predictive value more than liver ultrasonography (83.3 vs. 77.8% and 98.4 vs. 98%, respectively); (2) in our series, we obtained a lower recurrence rate in classes A+B1 (7.5%) and B2 (20.8%) and higher in C1+C2 (44.4%) and D (66.7%) (p < 0.01). Conclusion: According to these data we decided to eliminate postoperative liver ultrasonography and customize follow-up protocol on tumor staging and timing of cancer relapse. The authors believe that these changes will not modify the results, but cause less psychophysical stress for the patients and reduce costs by 50%.
The Pneumoperitoneum and Its Role in Tumor Seeding
Authors: Reymond M.A. , Schneider C. , Hohenberger W. , Köckerling F.
Published: April 2003

Port site recurrences (PSR) are abdominal wall recurrences that occur within a trocar site after cancer laparoscopy and that are not associated with peritoneal carcinosis. The short clinical delay of occurrence of PSR (median 190 days in colorectal cancer) suggests a massive cell seeding into the abdominal wall (over 106 cells) during the operation. In human and animal studies, CO2 was not able to aerosolize large numbers of tumor cells using pressures of 8–15 mm Hg, even though isolated mesothelial cells have been found in the aerosol. Such large numbers of tumor cells have only been demonstrated on instruments and trocars. PSR occur not only after CO2 laparoscopy, but also after thoracoscopy, where no CO2 is used. Gaseless laparoscopy was able to reduce, but not to eliminate port site contamination in animal models. Tumor growth was enhanced in numerous animal models using CO2, suggesting an adjuvant effect on tumor growth in the trocar wound. Nevertheless, reported clinical incidences between 0 and 21% suggest that PSR might be a surgeon-related variable dependent mainly on experience and technical expertise. Technical measures have been proposed that might reduce the incidence of PSR.
Central Bisegmentectomy of the Liver plus Caudate Lobectomy for Carcinoma of the Gallbladder
Authors: Ogura Yoshifumi , Matsuda Shinsuke , Sakurai Hiroyuki , Kawarada Yoshifumi , Mizumoto Ryuji
Published: April 2003

Central bisegmentectomy of the liver is recommended as a radical surgical procedure for patients with liver-bed gallbladder carcinoma, which tends to directly invade the hepatic parenchyma through the liver bed. In this article, we describe the indications and our surgical techniques for central bisegmentectomy of the liver plus caudate lobectomy for carcinoma of the gallbladder. We employ combined resection of the caudate lobe, because the caudate lobe often becomes involved even in patients with liver-bed carcinoma. Resection of the extrahepatic bile duct is also required to achieve complete lymphadenectomy within the hepatoduodenal ligament, because tumor invasion of the hepatoduodenal ligament is frequently found. Extensive lymphadenectomy around the head of the pancreas together with removal of the para-aortic lymph nodes should be performed in patients with extensive lymph node metastases.
Ultrasound-Guided Percutaneous Cholecystostomy as an Initial Treatment for Acute Cholecystitis in Elderly Patients
Authors: Lee King-Teh , Wong Sen-Ren , Cheng Jong-Shyong , Ker Chen-Guo , Sheen Pai-Ching , Liu Yueh-Er
Published: April 2003

Background/Aims: Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of servere co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we performed ultrasound-guided percutaneous transhepatic cholecystostomy (PC) on elderly patients with acute cholecystitis for both initial treatment and subsequent diagnosis of their biliary tract disorders. Methods: Those being more than 70 years old, had acute episode of cholecystitis for more than 48 h and still had positive Murphy’s signs and distended gallbladders were candidates for ultrasound-guided PC. Results: Forty-two elderly patients underwent ultrasound-guided PC. Once the condition of each patient showed signs of improvement and stability, cholangiography was performed via PC tube. The results of the cholangiography showed 20 patients with gallbladder stones, 16 with common bile duct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients with acalculous cholecystitis had the PC tube removed 3 weeks later, without further surgery. Two patients had gallbladder stones removed by choledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occurred in 5 patients (11.9%), no instance of operative mortality was found. Conclusion: Our findings lead us to conclude that the use of PC in the early treatment of acute cholecystitis in elderly patients can decrease postoperative morbidity and mortality.
Pancreas-Preserving Total Duodenectomy
Authors: Tsiotos Gregory G. , Sarr Michael G.
Published: April 2003

The concept of operations to be ‘as resective as necessary and as organ-preserving as possible’ has led to the novel technique of resection of the entire duodenum, with complete preservation of the head of the pancreas, as a better alternative to the classic pancreaticoduodenectomy. This operation requires meticulous technique and precise knowledge of pancreatic and peripancreatic anatomy. Indications include benign or premalignant conditions confined to the duodenal mucosa, usually familial adenomatous polyposis. When appropriately performed, pancreas-preserving total duodenectomy leads to shorter operative time, requires less and safer anastomoses, and optimizes postoperative endoscopic surveillance. The available long-term results are encouraging.
Left Colon Substitution with His’ Angle following Total Gastrectomy
Authors: Ohwada Susumu , Ogawa Tetsushi , Nakamura Seiji , Satoh Yoshihiro , Takeyoshi Izumi , Iwazaki Shigeru , Izumi Masaru , Iino Yuichi , Morishita Yasuo
Published: April 2003

To resolve the disadvantages of jejunal Roux-en-Y reconstruction following total gastrectomy, we attempted the use of left colon substitution with all anastomoses conducted using mechanical stapling devices. A His’ angle was formed to reduce regurgitation esophagitis. About 25 cm of the left colon with the ascending branch of the left colic artery with an adequate blood supply was brought up to the remnant esophagus without tension on the mesentery. The colon graft was interposed between the esophagus and duodenum in an isoperistaltic fashion. Three anastomoses, esophagocolic, duodenocolic and colocolic, were completed with a circular stapling device. An end-to-side esophagocolonostomy was positioned about 3 cm distal from the blind end of the proximal colon stump. The proximal end of the left colon was pexied to the esophagus using 3–4 stitches to make a new His’ angle. Gastrointestinal continuity was restored by a side-to-end colonoduodenostomy and an end-to-end colonocolonostomy. Fifteen gastric cancer patients underwent left colon substitution following total gastrectomy. The circular staple used for esophagocolonostomy and colonoduodenostomy was 25 mm in all patients, and for colonocolonostomy was 29 mm in 9 patients and 33 mm in 6 patients. No problems were encountered in any steps of the procedure, and faulty stapling was avoided. Neither anastomotic leakage nor necrosis of the interposed colon segment was seen, nor was late anastomotic stricture, in any patient. Barium radiograms of the interposed colon segment showed that the capacity and passage of the interposed colon were adequate, and regurgitation did not occur. Diet volume was satisfactory and weight loss minimal.
Parietal Mesh Abscess as an Original Presentation of Cancer of the Caecum
Authors: Bouillot Jean-Luc , Aouad Khalil , Alexandre Jean-Henri
Published: April 2003

We report a case of cancer of the caecum in a 71-year-old male who presented with parietal mesh abscess. Two years before, he was treated for a right inguinal hernia by insertion of a Dacron mesh. CT scan then colonoscopy determined the existence of a voluminous caecal tumor perforated in the abdominal wall with an important abscess around the mesh. Right colectomy and parietal muscles excision were performed completed with postoperative radiochemotherapy. At 2 years, there is no evidence of recurrence. Atypical features with a hernia mesh repair associated with a sudden change in the patient’s condition should alert the clinician to the possibility of a further subjacent pathological process.
Juvenile Polyposis: Case Report and Assessment of the Neoplastic Risk in 271 Patients Reported in the Literature
Authors: Agnifili Alessio , Verzaro Roberto , Gola Piersante , Marino Maria , Mancini Ermanno , Carducci Giuseppe , Ibi Italo , Valenti Marco
Published: April 2003

A case of juvenile polyposis is reported and 271 cases are collected from the literature. The risk for neoplasia is analyzed and the endoscopic or surgical therapy is discussed. The authors conclude that juvenile polyposis should be considered as a challenge to the surgeon with regard to familial adenomatous syndromes, and strongly recommend a close follow-up of patients with juvenile polyposis.
Prognostic Significance of Tumor Ploidy and Histomorphological Parameters in Adenocarcinoma of Barrett’s Esophagus
Authors: Böttger T. , Dutkowski Ph. , Kirkpatrick C.J. , Junginger T.
Published: April 2003

Background: Despite recent advances in surgical and multidisciplinary treatment, the prognosis for patients with adenocarcinoma of Barrett’s esophagus remains poor. The low prognostic accuracy of even surgical pathologic TNM staging suggests that additonal parameters are necessary in determining the prognosis. Method: In a retrospective analysis of 50 patients who underwent transhiatal or transthoracic esophageal resection due to adenocarcinoma of Barrett’s esophagus, a quantitative DNA analysis using image cytometry was performed in addition to the TNM classification and usual morphological criteria. At the time of DNA analysis the histomorphological parameters and survival time were not known. Results: The main prognostic parameter was the curativity (R classification) of the operation. Considering only patients after R0 resection, a multivariate analysis identified the DNA ploidy, the depth of tumor infiltration and distant metastases of prognostically independent factors. Furthermore, within pT2 and pT3 tumors, which account for 80% of all the tumors, DNA ploidy allows an additional prognostic differentiation which is not possible with pT stage alone. Conclusion: Patients with a diploid or tetraploid tumor without distant metastasis and a tumor stage pT1–pT3 should have curative (R0) resection. In case of an aneuploid DNA content or a pT4 tumor resection alone shows no advantage as compared to palliative nonoperative procedures.
Early Gastrointestinal Regulatory Peptide Response to Intestinal Resection in the Rat Is Stimulated by Enteral Glutamine Supplementation
Authors: Wirén M. , Adrian T.E. , Arnelo U. , Permert J. , Staab P. , Larsson J.
Published: April 2003

Background: Intestinal resection stimulates the synthesis and release of gastrointestinal peptides that regulate the growth and adaptation of the mucosa. Luminal nutrients are necessary for optimal proliferation and glutamine is the preferential nutrient to the small bowel. The interplay between glutamine and regulatory peptides could be important in treating short bowel syndrome. Methods: 63 Sprague-Dawley rats were divided into 3 groups: resection; transection, or controls. After intestinal resection animals were orally fed either a diet without glutamine or a glutamine-supplemented diet for 2 days. Transected animals and controls without prior surgery were fed the same two diets. Epidermal growth factor (EGF), transforming growth factor-α, insulin-like growth factors I and II (IGF-I and IGF-II), peptide YY (PYY), and enteroglucagon were analyzed in mucosa from the proximal jejunum, distal ileum as well as in portal plasma when the animals were euthanized 72 h after surgery. Results: Intestinal resection resulted in an early increase in portal plasma concentrations of PYY, EGF, enteroglucagon, and mucosal IGF-II and EGF content that were significant in glutamine-treated animals. Glutamine significantly increased PYY in portal blood after resection (p < 0.05). Conclusion: Glutamine could be of importance for the functional adaptation of residual small bowel mucosa by increasing PYY release.
Open Biliary Tract Surgery: Multivariate Analysis of Factors Affecting Mortality
Authors: Larraz-Mora Elena , Mayol Julio , Martínez-Sarmiento Javier , Alvarez-Bartolomé Mercedes , Larroque-Derlon Miguel , Fernández-Represa Jesús A.
Published: April 2003

Background/Aim: The overall mortality rate in patients undergoing supraduodenal choledochotomy for benign biliary tract disease is around 3%. The aim of this study is to identify and quantify factors affecting the mortality in a group of patients undergoing open common bile duct exploration for benign biliary disease. Methods: Patients (n = 158) who underwent common bile duct exploration during a 5-year period in a teaching hospital were retrospectively reviewed. Results: Univariate and multivariate statistical analyses were performed. The former identified four statistically significant variables: age (p < 0.001), acute cholangitis on admission (p < 0.001), heart disease (p < 0.05), and a dilated common bile duct on preoperative ultrasound scan (p < 0.05). Multivariate analysis identified three variables which independently increased operative mortality: age (p = 0.05), heart disease (p = 0.03), and cholangitis (p = 0.008). The latter was associated with the greatest operative mortality, since it increased almost eight times the risk to die after surgical intervention. Conclusion: We conclude that an adequate perioperative cardiovascular management may be important in order to improve surgical outcome. Appropriate antibiotic prophylaxis and subsequent treatment after routine operative bile cultures may reduce septic complications and mortality. Finally, an alternative procedure, such as endoscopic sphincterotomy, may be indicated in high-risk patients in order to drain the common bile duct preoperatively and to decrease the risk of unresponsive biliary sepsis.
Molecular Aspects of Pancreatic Cancer and Future Perspectives
Authors: Friess Helmut , Kleeff Jörg , Korc Murray , Büchler Markus W.
Published: April 2003

Pancreatic cancer has one of the worst prognoses of all human malignancies and the molecular mechanisms underlying this aggressive disease have been extensively investigated in the past years. Tyrosine kinase growth factor receptors and their ligands act to influence tumor cell growth, differentiation, invasion, metastasis, and angiogenesis. In pancreatic cancer a variety of these growth factor receptors and ligands are expressed at increased levels and this overexpression influences the clinical course of the disease. For example, the concomitant presence of the EGF receptor and its ligands EGF, TGF-α, and/or amphiregulin is associated with enhanced tumor aggressiveness and shorter survival periods following tumor resection. Furthermore, the growth inhibitory effects of the TGF-β superfamily of serine-threonine kinase receptors and their ligands are often blocked in pancreatic cancer cells. In addition to these alterations, mutations of the p53 tumor-suppressor gene, the K-ras proto-oncogene, and the Smad4 gene are frequently present in these tumors. Taken together, the abundance of growth-promoting factors, the disturbance of growth inhibitory pathways, and the presence of gene mutations combine to give pancreatic cancer cells a distinct growth advantage which clinically results in rapid tumor progression and poor survival.
Ambulatory Radical Hemorrhoidectomy: Personal Experience with 1,530 Milligan-Morgan Operations with Follow-Up of 2–15 Years
Authors: Argov S.
Published: April 2003

Background/Aim: The aim of this study is to document experience in performing ambulatory hemorrhoidectomy under local anesthesia and to examine its feasibility. Method: 1,530 patients with symptomatic grade III–IV internal hemorrhoids underwent surgical hemorrhoidectomy (Milligan-Morgan) between 1976 and 1991. This was done in the jackknife position under local anesthesia. Result/Conclusion: The Milligan-Morgan hemorrhoidectomy is radical and easy to perform in a jackknife position under local anesthesia in an ambulatory setting.
Results of Surgical Treatment of Gastric Cancer
Authors: Llanos Osvaldo , Guzman Sergio , Pimentel Fernando , Ibañez Luis , Duarte Ignacio
Published: April 2003

Background/Aim: The extent of gastric resection and the role of lymphadenectomy in the treatment of gastric cancer are controversial. Methods: This study evaluates the results of radical gastric resection (D2 lymphadenectomy) in 375 patients with a gastric carcinoma operated according to a prospective protocol. Results: Total gastrectomy was performed in 196 and a subtotal gastrectomy in 179 patients, with an operative mortality of 3.5 and 2.8%. The presence of lymph node metastasis was related to the depth of the tumor in the gastric wall. The cumulative 5-year survival was dependent on the depth of tumoral invasion in the gastric wall and also on the presence of lymphatic metastasis. Curative resection had a significantly better 5-year survival (72%) than noncurative resection (26%). Conclusion: Although it is difficult to prove the benefits of extended lymphadenectomy in the surgical treatment of gastric carcinoma, the results of these series seem to support its usefulness.
Angiolipoma of the Colon with Right Lower Quadrant Abdominal Pain
Authors: Kato Kazuya , Matsuda Minoru , Onodera Kazuhiko , Sakata Hiromi , Kobayashi Tatsuo , Kasai Shinichi
Published: April 2003

Background/Aim: An angiolipoma is a common benign neoplasm with a characteristic vascular component that occurs in the subcutaneous tissue and rarely in the gastrointestinal tract. We report on a 69-year-old man with a submucosal angiolipoma in the cecum. Methods: This patient was treated with a laparoscopy-assisted ileocecostomy, and a side-to-side anastomosis was performed extracorporeally. Results: A light microscopic study supported the diagnosis of an angiolipoma of the colon. After 5 years of follow-up, the patient has no symptoms or signs of recurrence. Conclusion: The colonic angiolipoma was successfully removed using a minimally invasive laparoscopic technique.
Liver Anatomy: Portal (and Suprahepatic) or Biliary Segmentation
Authors: Couinaud C.
Published: April 2003

Background/Aims: In liver anatomy and surgery, is portal and hepatic vein segmentation (French segmentation) to be preferred over arteriobiliary segmentation (Healey and Schroy, North American segmentation)? Methods: Several embryological arguments and an analysis of anatomical data from a personal collection of 110 vasculobiliary casts were made. Results: Embryological arguments: Portal vein branching appears first, arteriobiliary branching secondly follows the portal vein distribution. Segment II (the left lateral sector) is the development of the right lateral embryological lobe. The umbilical vein enters the left portion of the middle embryological lobe, forming segment IV on the right and segment III on the left: this is the left paramedian sector. So the left portal fissure (between left and middle lobes) transversally crosses the classical left lobe, which is not a portal unit. Segment VI is a late secondary prominence of segment VII, reaching the anterior margin of the liver only in man. Anatomical arguments: hepatic vein segmentation must be added to portal segmentation; the academic left lobe is the left hepatic vein sector, and the left hepatic fissure separates the classical right and left lobes. Portal vein segmentation must be preferred: portal vein duplication of branches of first order occurs only in 23.5% of the cases, while arteriobiliary duplication of first-order branches is noted in 50% of the livers, portal segmentation being much simpler. Conclusions: Portal and hepatic vein segmentation seems to be much more accurate.
Effectiveness of Intestinal Tube Splinting: A Prospective Observational Study
Authors: Meissner K.
Published: April 2003

Background/Aims: To assess the effectiveness of intestinal tube splinting. Patients and Methods: The clinical, operative and outcome data of 186 patients undergoing 200 intestinal splinting procedures from 1973 until 1996 were accumulated in a prospective database. Endpoints were perioperative morbidity, mortality and the incidence of subsequent small bowel obstruction (SBO). The latest follow-up performed in 1998 updated the outcome of 197 procedures after 1–25 (median 7) years. Results: In the early postoperative period, the overall incidence of complications was 9%, procedural complications 2%, and repeat surgery 3%. Three patients died during the index hospitalization. No patient suffered early SBO. Between 1 and 13 years after splinting, 6 complete SBOs (3%) necessitated reoperation and 5 incomplete SBOs (2.5%) were managed conservatively. After splinting for late SBO, freedom from complete SBO was 0.989 and of incomplete SBO 0.906, after splinting for early SBO 0.872 and 0.972, respectively, and for segmental peritonitic SBO freedom from complete SBO 0.8. No obstruction followed prophylactic splinting. Conclusions: Splinting was a reasonably safe procedure with comparatively low morbidity and mortality. The procedure prevented early SBO in all indicatory subgroups, reduced the rate of late recurrent SBO in patients treated for late adhesive SBO as compared with historical outcome data of simple enterolysis and prevented late SBO when performed prophylactically.
Unusual ‘Recurrence’ Sites for Colorectal Cancer
Authors: Isbister William H.
Published: April 2003

Five patients are reported. Four underwent major ‘curative’ restorative colorectal resections and developed perineal ‘recurrence’, 2 developed ‘recurrence’ in the distal ends of previously identified fistulae in ano and 2 developed ‘recurrence’ at the site of a previously performed haemorrhoidectomy. The fifth patient developed metastasis to a fistula track prior to surgical intervention. The danger of implantation of exfoliated tumour cells in patients with distally situated ‘raw’ mucosal sites is recognized and anorectal procedures should not be performed prior to resection. Minor anorectal procedures should not be performed at the same time as colorectal resections for carcinoma in these patients either. Some ‘recurrences’, such as those described in this paper, may be inevitable and in fact really represent preoperative metastases. Routine flexible sigmoidoscopy prior to the performance of any anorectal procedure might identify patients at risk of such ‘recurrences’ but this may not be cost-effective.
Acute Abdomen and Clostridium difficile Colitis: Still a Lethal Combination
Authors: Klipfel Adam A. , Schein Moshe , Fahoum Bashar , Wise Leslie
Published: April 2003

Background: With the steadily prevalent appropriate and inappropriate use of antimicrobial agents, Clostridium difficile colitis has continued to be noticed as a common problem in hospitalized patients. The aim of this communication is to highlight a subset of C. difficile colitis patients who presented with an acute abdomen. Methods: This is a retrospective study of 10 patients who underwent laparotomy for an ‘acute abdomen’ with an intraoperative or postoperative diagnosis of C. difficile colitis. Results: All patients received antibiotics (mean 9.5 days) for other illnesses. The mean APACHE II score was 18.8 (range 8–25) and the mortality rate was 80%. Two patients had colostomies created. One patient underwent a subtotal colectomy, and another underwent a Hartmann procedure; the rest had a nontherapeutic procedure. Conclusion: We conclude that C. difficile colitis presenting as an ‘acute abdomen’ still represents a lethal entity. Patients who present with an ‘acute abdomen’, with a history of recent or current antibiotic intake, and without findings which mandate an exploration should have C. difficile colitis urgently excluded. Timely diagnosis of C. difficile colitis through bedside sigmoidoscopy or a CT scan could spare the critically ill patient an unneccessary and risky operation. Furthermore, if laparotomy is subsequently needed then having a preoperative diagnosis of C. difficile colitis will allow appropriate surgical therapy to be implemented.
Accuracy of Endoscopic Ultrasonography in Preoperative Staging of Esophageal Carcinoma
Authors: Heidemann Jan , Schilling Martin K. , Schmassmann Adrian , Maurer Christoph A. , Büchler Markus W.
Published: April 2003

Background: With the advent of stage-adapted multimodal regimens for many gastrointestinal malignancies, accurate staging has become of utmost importance. In esophageal cancer, endoscopic ultrasonography (EUS) emerged as standard to determine T and N stage. Objective: Since growth patterns of squamous carcinoma (SC) differs from adenocarcinoma (AC) and lymph nodes are located at various distances from the esophagus in a horizontal plane, we studied the accuracy of esophageal EUS as a function of tumor type and localization of the tumor within the esophagus. Results: Overall staging accuracy was 79% for T and for N staging. Staging was more accurate for T3/4, when compared to T1/2 tumors, and for SC when compared to AC. Histological T1/2 stages were overstaged by EUS in 8/17 patients, mostly in patients with AC (6/10). The sensitivity of retrosternal pain and of dysphagia for extramural disease was 57 and 92% respectively, the specificity of pain for extramural disease was 73%, and of dysphagia 36%. Preoperative weight loss in this series correlated linearly with tumor stages. Conclusions: The accurate preoperative staging of T2 esophageal endodermal malignancies is crucial for treatment stratification but difficult to achieve by visual analysis of endosonography alone. Postacquisition processing of echoendosonographic images might further increase the accuracy of echoendosonography and aid in the critical differentiation of T2 versus T3 esophageal malignancies. Preoperative weight loss and retrosternal pain are good clinical indicators of extramural disease.
Simple Closure or Vagotomy and Pyloroplasty for the Treatment of a Perforated Duodenal Ulcer: Comparison of Results
Authors: Gutiérrez de la Peña C. , Márquez R. , Fakih F. , Domínguez-Adame E. , Medina J.
Published: April 2003

Background/Aims: Treatment of the perforated duodenal ulcer continues to be a controversial subject. The purpose of our study was to compare the results of simple closure of perforated duodenal ulcer versus treatment by truncal vagotomy and pyloroplasty. Methods: We present a prospective and randomized study of 207 patients who underwent surgical treatment due to perforated duodenal ulcer. In 117 patients the surgical treatment was simple closure and postsurgery medical treatment with proton pump inhibitors for 1 month, and in 90 patients vagotomy and pyloroplasty with no additional medical treatment. Results: We applied the Visick scale in order to compare postsurgery results. The postoperative morbidity and mortality rates were the same with both techniques. Statistically, in both cases, no significant differences were found in postsurgery symptomatology. The different rates of recurrent ulcers and the reinterventions due to recurrent ulcers presented no significant statistical values. Conclusion: We conclude that simple closure remains the selected treatment in the majority of patients who present with a perforated duodenal ulcer. The operation is a simple and safe procedure.
Prostaglandin E1 Continuous Hepatic Arterial Infusion in the Treatment of Postoperative Acute Liver Failure
Authors: Sato Tsutomu , Asanuma Yoshihiro , Kurokawa Toshiaki , Kato Takeshi , Yasui Ouki , Kusano Tomoyuki , Koyama Kenji
Published: April 2003

Aim: In the treatment of severe liver damage, it is of greater advantage to administer prostaglandin E1 (PGE1) directly to the liver compared with systemic intravenous infusion, because of its high inactivation rate in the lungs. In comparison with intraportal infusion, hepatic arterial infusion is more advantageous because of its easier and safer accessibility. This study was designed to prove the superiority of hepatic arterial infusion to intravenous infusion. Methods: Changes in hepatic hemodynamics and oxygen delivery accompanying PGE1 infusion using both methods were investigated in pigs. In addition, continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure, for patients in whom other conventional treatments like plasma exchange failed to improve the functioning of the liver. Results: Hepatic arterial flow increased significantly accompanying hepatic arterial infusion of PGE1 at a rate of 0.1 μg/kg/min compared with intravenous infusion at the same rate in pigs. Such an increase resulted in elevation of total hepatic blood flow and oxygen delivery to the liver. Correspondingly, bile flow significantly increased accompanying hepatic arterial infusion of PGE1. Continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure. The infusion was continued for 7–9 days at a rate of 0.01 μg/kg/min without any complications through heparin-coated catheters inserted via the femoral artery. Significant increase in bile flow was observed in 2 cases in whom bile was collected, serum total bilirubin began to decrease in all these 3 cases, and the patients recovered from acute liver failure. Conclusion: Hepatic arterial infusion of PGE1 is very useful and effective in the treatment of acute liver failure.
Granular Cell Tumor at the Hepatic Duct Confluence Mimicking Klatskin Tumor
Authors: te Boekhorst Dennis S. , Gerhards Michael F. , van Gulik Thomas M. , Gouma Dirk J.
Published: April 2003

Background: Granular cell tumors are rare tumors most often located in the oral cavity, skin or subcutaneous tissue. The occurrence of this tumor in the biliary tree is extremely rare. Methods: Two patients are described presenting with biliary obstruction due to a tumor at the hepatic duct confluence. One patient is a 38-year-old white male with concomitant cutaneous granular cell tumors, and the other a 50-year-old white female. Results: Hilar excision was performed in both patients. Histopathology of the tumors revealed a proliferation of cells with granular cytoplasm, diagnosed as granular cell tumor. Conclusion: At preoperative examination, hilar granular cell tumors are difficult to differentiate from cholangiocarcinoma, sclerosing cholangitis or more common benign biliary tumors. Treatment consists of surgical excision after which prognosis is favorable.
Splenic Abscess
Authors: Smyrniotis V. , Kehagias D. , Voros D. , Fotopoulos A. , Lambrou A. , Kostopanagiotou G. , Kostopanagiotou E. , Papadimitriou J.
Published: April 2003

Background/Aims: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. Method: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. Results: The mean age of patients was 43 years (range 7–79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. Conclusion: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available.
Early Developmental Stages of Psychopathology Study (EDSP): Objectives and Design
Authors: Wittchen Hans-Ulrich , Perkonigg Axel , Lachner Gabriele , Nelson Christopher B.
Published: April 2003

The primary and secondary objectives of the Early Developmental Stages of Substance Abuse Study (EDSP) are described along with a detailed description of the overall design, special design features and instruments used. The EDSP is a 5-year prospective study with three waves of assessments. Special design features are the linkages with family genetic investigations as well as neuroendocrinological stress tests in high-risk subjects. Overall, 3,021 adolescents and young adults aged 14–24 years are included. The response rate for the baseline investigation was 71%. Diagnostic assessments were made by using a modified lifetime (baseline) and 12-month change version of the WHO-CIDI, adjusted for DSM-IV. Modifications refer to a more detailed quantitative assessment of symptoms and substance use variables as well as the inclusion of questions to assess course of disorders and subthreshold diagnostic conditions.
Is the Use of Ecstasy and Hallucinogens Increasing?
Authors: Schuster Peter , Lieb Roselind , Lamertz Christina , Wittchen Hans-Ulrich
Published: April 2003

This report presents findings of a community survey of 3,021 adolescents and young adults aged 14–24 years in Munich, Germany, carried out to determine the prevalence of use and abuse of and dependence on ecstasy, amphetamines and hallucinogens. The response rate was 71%. Results: (1) In 1995, 4% of the male and 2.3% of the female respondents aged 14–24 reported the use of ecstasy. Ecstasy-related substances (amphetamines and chemically related substances) were reported by 3.6% of men and 1.6% of women. Hallucinogens were reported slightly less frequently by 3% of men and about 2% of women (LSD combined with others). (2) Compared to findings from a 1990 survey this constitutes a substantial, at least twofold, increase in consumption rate of both types of substances. (3) Among lifetime users of both ecstasy and related substances as well as hallucinogens about two thirds could be regarded as regular users. (4) The prevalence of DSM-IV abuse and dependence on ecstasy and related substances is about 1%, identical to rates of hallucinogen abuse and dependence. Findings also point to a significant dependence potential for both substances. (5) Furthermore, considerable overlap between the two substances was found. Conclusion: Our study suggests a substantial increase in both the use of ecstasy and related substances as well as hallucinogens. The data further suggest that the increase is strongest in younger age groups, but the risk of first use of these substances continues to be present up to the age of 24 years. The higher proportion of women contributing to this increase is noteworthy.
Drugs on Prescription – The Swedish Experiment of 1965–67 in Retrospect
Authors: Lenke Leif , Olsson Börje
Published: April 2003

The programme of prescribing amphetamines and opiates to drug users in Stockholm carried out from 1965 to 1967 has frequently been referred to in the European drug policy debate. In this article, originally presented at the Conference on Drug Use and Drug Policy in Amsterdam in September 1996, the programme is described with regard to design, setting and outcome. The relevance of the programme for the general policy debate is discussed and a comment is given on the programme’s impact on the Swedish drug epidemic and Swedish drug policy.
Characteristics of Long-Term Cannabis Users in Sydney, Australia
Authors: Swift Wendy , Hall Wayne , Copeland Jan
Published: April 2003

Two hundred long-term cannabis users (58% male) were interviewed on their characteristics and experience of use. Respondents had been regularly using cannabis for an average of 11 years and more than half used daily (56%). The most common route of administration was in a waterpipe, and nearly all (93%) smoked the flowering heads ot the plant. One in 5 (21%) had a cannabis-related conviction. The benefits of use were perceived to be its relaxing, mood-enhancing effects, and its ability to alter consciousness. The most commonly cited negative aspects of use were cost, negative psychological effects and legal status. Polydrug use was common, with alcohol and tobacco almost universally used on a regular basis. More than half the drinkers in the sample were consuming alcohol at hazardous or harmful levels.