bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Nocardiosis of the Chest Wall and Pleura – 10-Year Consequences of a Hand Actinomycetoma
Authors: Saarinen Kari A. , Lestringant Giles G. , Czechowski Janusz , Frossard Philippe M.
Published: April 2003

We report an unusual case of primary cutaneous nocardiosis due to Nocardia otitidiscaviarum presenting first as a mycetoma of the right hand and wrist. The patient refused treatment and was lost to follow-up until he showed up 10 years later with numerous discharging large sinuses and abscesses on the upper right quadrant of the chest wall and in the right armpit. Roentgenograms revealed pleural masses. Histology was in keeping with the diagnosis of mycetoma. Treatment with amikacin, rifampicin and co-trimaxole proved to be successful.
Onychomycosis and Other Superficial Fungal Infections of the Foot in the Elderly: A Pan-European Survey
Authors: Piérard Gérald
Published: April 2003

Background: The escalating ageing population in the western world has led to an increased incidence of superficial fungal infections. The most common infections include onychomycosis, tinea pedis and tinea cruris. With the increasing life expectancy, the prevalence of onychomycosis and other superficial fungal infections is likely to increase further without adequate prevention and treatment. Objective: To study the prevalence of foot mycoses in Europe. Method: The Achilles project represents a survey of 90,085 subjects from 16 European countries. Results: Approximately half of the total screened population had evidence of fungal foot infection, with tinea pedis and onychomycosis affecting one quarter of these individuals. Advancing age showed an unfavourable effect on the prevalence of these infections. Conclusion: As the number of aged people in developed countries continues to increase, skin diseases will constitute a greater pharmaco-economic concern of worldwide healthcare. Better recognition by clinicians and patients of mycotic foot disease will help prevent direct morbidity and further complications.
Acute Herpes zoster Neuralgia: Retrospective Analysis of Clinical Aspects and Therapeutic Responsiveness
Authors: Haas N. , Holle E. , Hermes B. , Henz B.M.
Published: April 2003

Background: Although the efficacy of modern antiviral agents for the treatment of herpes zoster is unquestioned, their ability to affect the associated pain remains controversial. Objective: We have therefore evaluated the inpatient hospital records of 550 patients with herpes zoster with regard to pain-related clinical aspects and therapeutic responsiveness. Methods: Intensity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number of tablets used in each category. Results: The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly higher values in women and in patients with 3 or more associated diseases. It was lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significant differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of observation, irrespective of the route of administration or the dose of aciclovir and the individual patient’s PEI value. The groups were otherwise closely similar with regard to basic demographic and clinical data. 23.3% predominantly aged female patients with more associated diseases than the total patient population had a persistently elevated PEI and stayed in hospital beyond 21 days (mean 35.1 days), representing patients who went on to postherpetic neuralgia. Conclusion: These data further delineate clinical aspects of acute herpes zoster neuralgia, underline the unsolved therapeutic problems associated with this condition despite otherwise effective antiviral treatment, and characterise a subgroup of patients at risk to develop postherpetic neuralgia.
Bilateral Carpal Tunnel Syndrome as a Clue for the Diagnosis of Systemic Amyloidosis
Authors: Nestle Frank O. , Burg Günter
Published: April 2003

A 60-year-old Swiss woman presented with a 1-year history of periorbital hemorrhagic papules, a tendency to develop hematoma due to minor trauma and shortness of breath. The personal medical history included surgery for bilateral carpal tunnel syndrome (CTS) 2 years ago. Clinical and laboratory findings included macroglossia, Bence-Jones proteinuria, reticular lung infiltrates, thickening of the ventricular walls in echocardiography and increase in atypical plasma cells in the bone marrow. The coexistence of the specific symptoms of CTS, macroglossia and cutaneous lesions should immediately alert the physician to the probable existence of plasma-cell-dyscrasia-related systemic amyloidosis.
Alopecia syphilitica: Report of Two Cases in Geneva
Authors: Friedli A. , Chavaz P. , Harms M.
Published: April 2003

Two patients with alopecia syphilitica are presented. Moth-eaten alopecia is the most typical look of secondary syphilis on the scalp. With the decrease in syphilis cases in western countries, this rarer clinical manifestation tends to be misdiagnosed.
Acquired Nevoid Telangiectasia
Authors: Wollina Uwe , Barta Ute , Uhlemann Christine , Oelzner Peter
Published: April 2003

Background: Acquired nevoid telangiectasia (ANT) is a segmental dilatation of papillary plexus vessels. Objective: In the present study, the frequency of ANT and its associations with collagen vascular and spinal disease have been investigated. Methods: 188 unselected patients, seen at an interdisciplinary dermatorheumatologic outpatient clinic, were clinically examined for the presence of ANT and possible associations to preexisting disease. Results: ANT was seen in 17% of patients, all females. The mean age of ANT patients was 57.5 ± 8.2 years. Most common diseases were lupus erythematosus and scleroderma. Twenty-four of them suffered from generalized fibromyalgia, 8 had spondylitis deformans, 1 suffered from thoracal syringomyelia and 1 had a spine trauma. Two types of ANT have been seen: the cervicothoracal transition type and the lumbosacral transition type. Conclusions: ANT is not uncommon among patients attending a dermatorheumatologic outpatient clinic. ANT indicates spinal or neuromuscular complaints, but is not related to collagen vascular disease itself.
Detection of HTLV-I Proviral DNA in Sarcoidosis
Authors: Yajima Ayumi , Kawada Akira , Aragane Yoshinori , Tezuka Tadashi
Published: April 2003

‘Sarcoidosis-lymphoma syndrome’ is known as an association of sarcoidosis with malignant lymphoma. We report a 56-year-old woman with systemic sarcoidosis who was seropositive for antibody against human T cell lymphoma/leukemia virus type I (HTLV-I). This patient showed integration of HTLV-I proviral DNA within cutaneous sarcoid nodules, but not in peripheral blood mononuclear cells. Neither atypical lymphocytes nor a T cell receptor β1 gene rearrangement were observed in peripheral blood mononuclear cells or in cutaneous nodules, indicating that the patient did not have a smouldering type of adult T cell lymphoma/leukemia. Detection of integration of HTLV-I proviral DNA in cutaneous sarcoid nodules could suggest that the sarcoid nodules might have been generated as a protective response to chronic stimuli of HTLV-I.
Vitamin B12 Cream Containing Avocado Oil in the Therapy of Plaque Psoriasis
Authors: Stücker Markus , Memmel Ulrike , Hoffmann Matthias , Hartung Joachim , Altmeyer Peter
Published: April 2003

Background: There are already many effective topical therapies available for use in the treatment of chronic plaque psoriasis. Unfortunately, these treatments are often associated with a rather significant risk of undesirable effects. Objective and Methods: In this randomized, prospective clinical trial, the effects of the vitamin D3 analog calcipotriol were evaluated against those of a recently developed vitamin B12 cream containing avocado oil in an intraindividual right/left-side comparison. The trial population consisted of 13 patients, 10 men and 3 women, with chronic plaque psoriasis. The observation period was 12 weeks; the effects of therapy were assessed on the basis of a PASI score adapted to the right/left-side comparison technique, the subjective evaluations of the investigator and patients and the results of 20-MHz sonography. Results: There was a more rapid development of beneficial effects with the use of calcipotriol in the initial 8 weeks, although differences in effects were significant only at the time point of therapy week 8 (p < 0.05). After 12 weeks, neither the PASI score nor 20-MHz sonography showed significant differences between the two treatments. While the efficacy of the calcipotriol preparation reached a maximum in the first 4 weeks and then began to subside, the effects of the vitamin B12 cream containing avocado oil remained at a constant level over the whole observation period. This would indicate that the vitamin B12 preparation containing avocado oil may be suitable for use in long-term therapy, a hypothesis further supported by the fact that the investigator and the patients assessed the tolerability of the vitamin B12 cream containing avocado oil as significantly better in comparison with that of calcipotriol. Conclusion: The results of this clinical trial provide evidence that the recently developed vitamin B12 cream containing avocado oil has considerable potential as a well-tolerated, long-term topical therapy of psoriasis.
Calcipotriol Solution for the Treatment of Scalp Psoriasis: Evaluation of Efficacy, Safety and Acceptance in 3,396 Patients
Authors: Thaçi D. , Daiber W. , Boehncke W.H. , Kaufmann R.
Published: April 2003

Background: Psoriasis of the scalp is a very common disease, cosmetically disturbing and therapeutically difficult to manage. Objective: The aim of our study was to investigate the efficacy, safety and cosmetic acceptance of calcipotriol solution in a large number of patients with mild to moderate scalp psoriasis and to compare this treatment with previous therapies used. Methods: In this multicentre prospective observational cohort study 3,396 patients were treated with calcipotriol solution (50 µg/ml) twice daily over an 8-week period either alone or in combination with other treatments. The psoriasis scalp severity index (PSSI) and investigator/patient global assessment were used for the evaluation of clinical response. Results: All psoriasis severity parameters measured were reduced with a significant decrease in PSSI scores from 18.4 to 5.6 after 8 weeks of therapy (p < 0.001). About 80% of the patients showed very good or good clinical improvement. Combination of calcipotriol solution with other treatment modalities e.g. corticosteroids or salicylic acid, showed an increased treatment response. In only 2.4% of the patients side effects occurred (e.g. irritation). Conclusion: Calcipotriol solution is an effective, safe, well-tolerated and cosmetically acceptable treatment modality. By patients and physicians, this treatment was found to be a valuable supplement to previously available and established treatments for scalp psoriasis.
Proteus Syndrome
Authors: Yasuda Hiroshi , Yamamoto Osamu , Hirokawa Hisatada , Asahi Masakazu , Kashimura Masamichi , Sakai Akinori
Published: April 2003

A case of Proteus syndrome is presented, in which severe hemihypertrophy of the left trunk and left lower extremity, scoliosis, endometriosis and huge bizarre-shaped body tumors were observed. Up to 22.6 kg of tumorous tissue was excised. This syndrome was first described in 1983. The name Proteus comes from a Greek mythical sea god who was able to change his body form freely. This syndrome has numerous features including hemihypertrophy, macrodactyly, various subcutaneous masses, scoliosis and other minor abnormalities. Although diagnostic criteria have been established for Proteus syndrome, which is very difficult to differentiate from other congenital hamartomatous syndromes, more case reports are needed to define such a rare disorder. Our patient is the 6th Japanese case in the English literature.
Transient and Partial Effect of High-Dose Intravenous Immunoglobulin in Polyarteritis nodosa
Authors: Kroiss Maximilian , Hohenleutner Ulrich , Gruss Claus , Glaessl Alexander , Landthaler Michael , Stolz Wilhelm
Published: April 2003

A 57-year-old male patient suffered from polyarteritis nodosa. He presented with articular pain, polyneuropathy, subcutaneous nodules and nodes on the lower legs. After several immunosuppressive agents (methotrexate, mycophenolate mofetil and prednisolone) had proven to be ineffective, 2 g intravenous immunoglobulin (IVIG) per kilogram body weight were administered within 2 days in combination with 10 mg prednisolone per day. Subsequently, 6 cycles of IVIG were applied in increasing intervals from 4 to 6 weeks resulting in a minimum dosage of 0.33 g/kg/week IVIG. The polyarteritis improved within a few days after the first IVIG application. The intensity of polyneuropathy and arthralgia of polyarteritis decreased during the period of IVIG treatment. Finally, a dose reduction of less than 0.25 g/kg/week IVIG resulted in recurring polyarteritis nodosa, which could not be controlled by further administration of IVIG. Therefore, our data indicate that: (1) IVIG is partially effective in cases of polyarteritis nodosa, but the therapeutic effect is only transient; (2) the success of treatment may be correlated with the dose of IVIG per body weight and week; (3) the efficacy/cost ratio of IVIG in polyarteritis nodosa appears to be low.
Microbiological Quality of Topical Drug Formulations: Efficacy of Antimicrobial Preservation against Paecilomyces lilacinus
Authors: Schwarb F.P. , Gabard B. , Bieli E. , Schwab S. , Surber C.
Published: April 2003

Background: Microbiological quality of topical products comprises both, the microbiological purity of the unopened product and the efficacy of the antimicrobial preservation system. Objective: Subsequent to an outbreak of invasive Paecilomyces lilacinus mycosis among patients of an isolation ward, probably caused by a contaminated skin care product, the microbiological quality of different skin care products from the market was investigated. Methods: The different products were investigated for their efficacy of antimicrobial preservation in general and especially against P. lilacinus according to a pharmacopoeial routine method slightly adopted for the purpose of this investigation. Results: The products did partially not comply with the British Pharmacopoeia 1993 test for efficacy of antimicrobial preservation. The antimicrobial preservation systems were less effective against P. lilacinus than against the pharmacopoeial reference germs. The antimicrobial preservation efficacy decreased towards the end of the shelf-life of the product. A decreased P. lilacinus inoculum dose was related to an increased growth of the micro-organisms. Conclusion: Topical products are, unless not labelled otherwise, non-sterile preparations and their preservation systems are only tested against pharmacopoeial key micro-organisms. The microbiological behaviour following contamination with other germs remains unknown.
The Oedema-Protective Effect of Lycra® Support Stockings
Authors: Jonker M.J. , de Boer E.M. , Adèr H.J. , Bezemer P.D.
Published: April 2003

Background: Oedema may be an early sign of chronic venous insufficiency (CVI), but swelling of the lower legs is a common phenomenon in many people. The distinction between physiological swelling and CVI is not clear. There is a gradual transition between healthy legs and the early stages of CVI. In case of CVI, medical elastic compression stockings are used in order to prevent oedema completely. In case of healthy people without demonstrable CVI, no medical stockings are required in the prevention of oedema but stockings exerting less compression. Objective: The aim of this study was to investigate the effect of mild compression on the development of swelling of the legs and the effect on subjective complaints in healthy subjects. Methods: The diurnal volume change (DVC) of the lower legs during full working days was monitored with an optical leg volume meter in 118 healthy volunteers (60 males, 58 females) without objective symptoms of CVI. The DVCs after wearing two kinds of class I support stockings (X: average pressure at the ankle of almost 14 mm Hg; Y: almost 18 mm Hg) were compared with the DVC after wearing a control stocking (Z: almost 6 mm Hg). Also, the effect on subjective feelings of the legs was noted. Results: It appeared that healthy people have a mean daily volume increase of the legs of 2.3% in females and 1.6% in males. Mild compression stockings reduced this daily increase with 31 and 18% in males and females, respectively, by stocking X and 37 and 32% by stocking Y. Subjective feelings occurred in 57% of all cases. A beneficial effect on subjective feelings, in particular of tired and swollen legs, was found. A difference in this beneficial effect between stocking X and Y was not obvious. Conclusions: Mild compression stockings reduce diurnal oedema and unpleasant feelings of the legs in healthy individuals.
Tattoo Pigment Mimics Positive Sentinel Lymph Node in Melanoma
Authors: Moehrle M. , Blaheta H.J. , Ruck P.
Published: April 2003

A 42-year-old man with metastasizing melanoma from an unknown primary is presented. Initially a subcutaneous metastasis in the scapular region and a single lung metastasis were resected. Thorough examinations did not show any evidence of a primary tumour. From the site of the metastasis on the right scapular region, lymphoscintigraphy with axillary sentinel lymph node biopsy was performed. One axillary lymph node could be identified intra-operatively with the gamma probe as sentinel node. The sentinel node and 4 adjacent lymph nodes clinically showed black pigmentation. However, histopathological examination of the lymph nodes did not detect micrometastases. The pigmentation of the lymph nodes was due to decorative tattoos of the scapular skin.
Decreased Oxidative State in Non-Lesional Skin of Atopic Dermatitis
Authors: Antille Christophe , Sorg Olivier , Lübbe Jann , Saurat Jean-Hilaire
Published: April 2003

Background: The stratum corneum (SC), as the skin layer most exposed to various environmental factors, is particularly susceptible to oxidative stress. Due to the high lipid content of the SC, lipophilic antioxidants such as α-tocopherol are expected to play a major role in scavenging reactive oxidant intermediates produced during oxidative stress. Objectives: Since the skin of atopic dermatitis patients has an impaired barrier function, we wondered if they were more susceptible to environmental oxidative stress than healthy subjects. Methods: SC was collected by scraping the forearm of 14 healthy volunteers and 14 patients with atopic dermatitis; then, α-tocopherol and lipid peroxide concentrations were assessed by high-performance liquid chromatography and ferrous oxidation, respectively. Results: The SC from atopic patients showed a higher concentration of α-tocopherol (16.1 ± 2.2 nmol/g) as compared to healthy controls (7.7 ± 0.9 nmol/g; p < 0.01), as well as a slightly but significantly lower concentration of lipid peroxides (1,353 ± 128 and 1,818 ± 154 nmol/g for atopic dermatitis patients and healthy controls, respectively; p < 0.05). Conclusions: These results show that the SC of atopic dermatitis patients exhibits a significantly less pronounced oxidative state. This may be the consequence of an increase in cutaneous antioxidant defences due to chronic inflammation.
Multinodular Pilomatrixoma
Authors: Simón Raquel S. , Sánchez-Yus Evaristo
Published: April 2003

A hard deep nodule, 6 × 3 mm in size, was excised from the cheek of a 12-year-old girl. The histological sections showed a multinodular cyst-like proliferation, each nodule showing the typical structure and cytology of pilomatrixoma. A comparison is made between this case and the budding phenomenon that has been described in isthmus-catagen (tricholemmal) cyst.
Lymphocytes Treated by Extracorporeal Photopheresis Demonstrate a Drop in the Bcl-2/Bax Ratio: A Possible Mechanism Involved in Extracorporeal-Photopheresis-Induced Apoptosis
Authors: Bladon J. , Taylor P.C.
Published: April 2003

Background: Recently, apoptosis has been identified in treated lymphocytes, prior to their re-infusion, when tested ex vivo. Previous work has demonstrated a close association between the genes p53, Bcl-2 and Bax and apoptosis induced by UV irradiation. Objectives: We wanted to establish whether the expression of the protein product of these genes was altered in lymphocytes treated with extracorporeal photopheresis (ECP) prior to re-infusion and therefore possibly implicated in the early apoptosis observed. Method: Lymphocytes were isolated immediately before treatment and immediately prior to re-infusion and tested for intracellular levels of p53, Bcl-2 and Bax proteins. Results: No increase in p53 expression was observed at re-infusion; however, the mean fluorescent intensity ratio of the apoptotic inhibitor protein Bcl-2 to the apoptosis-inducing protein Bax dropped significantly. Conclusion: The early apoptosis observed in ECP-treated lymphocytes at re-infusion might be attributed to dysregulation in the expression of the apoptotic genes Bcl-2 and Bax.
Primary Cutaneous Cryptococcosis in an Immunocompetent Host: Case Report and Review of the Literature
Authors: Revenga F. , Paricio J.F. , Merino F.J. , Nebreda T. , Ramírez T. , Martínez A.M.
Published: April 2003

We report a 46-year-old male who developed cellulitis of his third right finger after being injured with a metallic object. Cryptococcus neoformans var. neoformans was isolated from both the skin and the metallic object. Systemic cryptococcosis and immunosuppression was excluded by appropriate tests. Complete healing was achieved after 10 months of itraconazole 100 mg/12 h and surgical excision of the remaining lesion. Our literature review shows another 16 cases of primary cutaneous cryptococcosis in nonimmunocompromised hosts. The clinical, mycological and therapeutic characteristics of these patients are reviewed.
Interventional Treatment of Gastrointestinal Neuroendocrine Tumours
Authors: Ahlman H. , Wängberg B. , Jansson S. , Friman S. , Olausson M. , Tylén U. , Nilsson O.
Published: April 2003

Neuroendocrine (NE) tumours of the gastrointestinal tract (carcinoids and endocrine pancreatic tumours) are rare diseases. In the presence of liver metastases these patients may suffer from disabling symptoms due to hormone overproduction. Patients with localized disease can be resected for cure and also patients with liver metastases can undergo potentially curative tumour resection. However, long-term follow-up of the latter cases indicates frequent recurrence of tumour. Using close biochemical monitoring of tumour markers combined with newer techniques for tumour visualization, these recurrences can often be diagnosed at an early stage so that repeat surgical procedures can be performed. During the last years very active surgery has been recommended for NE tumours, many of which have a relatively slow growth. Even in patients not amenable to curative liver surgery, debulking can be considered if the main tumour burden can be safely excised. The primary aim of this type of treatment is palliation of hormonal symptoms. An important question is whether the aggressive treatment actually prolongs survival. No prospective studies have been performed. Such studies are hampered by the lack of strict surgical programs running over long periods and the relative rarity of NE tumours. Liver transplantation may be another treatment modality in selected cases.
Effects of Lansoprazole on Human Gastric Lipase Secretion and Intragastric Lipolysis in Healthy Human Volunteers
Authors: Renou C. , Carrière F. , Ville E. , Grandval P. , Joubert-Collin M. , Laugier R.
Published: April 2003

Background: Lansoprazole is a potent proton-pump inhibitor (PPI) of parietal cells, which reduces the secretion of gastric acid. Although human gastric lipase (HGL) is produced only by the chief cells of the stomach, the possibility that interactions may occur between lansoprazole and HGL has never been addressed so far in humans. The aim of this study was therefore to quantify the effects of lansoprazole on HGL secretion and intragastric lipolysis during the ingestion of test meals by healthy human volunteers. Methods: Six healthy volunteers were intubated twice with a gastric and a duodenal tube, before ingesting a standard liquid test meal alone (–PPI experiments) and after 7 days of lansoprazole treatment (+PPI experiments). The HGL concentration was assessed in gastric and duodenal samples by measuring the lipase activity using a pH-stat, and the lipolysis products were quantified by performing thin layer chromatography. The level of intragastric lipolysis was defined as the percentage acyl chains released from the meal triglycerides. The pyloric outputs of HGL and lipolysis products were calculated, based on the use of a non-absorbable marker added to the meal. Results: The pH of the gastric contents was significantly higher in the +PPI experiments than in the –PPI experiments (p < 0.05), since mean values of 4.3 ± 2.5 and 2.2 ± 1.6, respectively, were recorded at the end of the gastric emptying of the meal. The HGL concentrations recorded during the meal were found to be higher in the experiments with lansoprazole (p < 0.05) than in those without lansopra- zole, but the HGL secretion levels (–PPI: 15.4 ± 8.0 mg; +PPI: 19.0 ± 7.4 mg) and the intragastric lipolysis (–PPI: 24.0 ± 8.0%; +PPI: 23.6 ± 6.8%) were not significantly affected by lansoprazole (p > 0.05 in both cases). Conclusion: Lansoprazole affected neither the HGL secretion nor the intragastric lipolysis levels, although an increase was observed in the intragastric pH at the end of the gastric emptying of the meal. The HGL concentration increased, however, due to the decrease in the acid secretion process, resulting in less diluted gastric contents.
New Insights into Mechanism of Inflammatory and Allergic Diseases in Mucosal Tissues
Authors: Kweon Mi-Na , Takahashi Ichiro , Kiyono Hiroshi
Published: April 2003

The gastrointestinal immune system is a major component of the mucosal barrier to foreign antigens including microbial and dietary antigens. Under normal circumstances, the mucosal immune system employs tightly regulated dynamic mucosal intra- and internets for the maintenance of an appropriate immunological balance between the host and gut environments. For example, mucosally induced tolerance is usually induced against enteric commensal bacterial and/or dietery antigens. However, in some cases, the break down of these tightly regulated mucosal immune responses led to hyper-responsiveness against these gut environmental antigens. To this end, numerous disorders could evoke in the gastrointestinal tissues, such as inflammatory bowel disease (IBD) and allergic gastroenteropathy. Recently, many studies have described possible molecular and cellular mechanisms of those dysfunctions in the gastrointestinal tissues. In this review, we have briefly summarized some of the current interesting and exciting findings for gastrointestinal diseases, especially IBD and intestinal allergic diseases from our group, which can be applied for the development of new mucosal immune therapy.
Role of Complement Activation and Mast Cell Degranulation in the Pathogenesis of Rapid Intestinal Ischemia/Reperfusion Injury in Rats
Authors: Andoh Akira , Fujiyama Yoshihide , Araki Yoshio , Kimura Toshio , Tsujikawa Tomoyuki , Bamba Tadao
Published: April 2003

The aim of this study is to define the putative role of complement activation and mucosal mast cell (MMC) degranulation in the pathogenesis of rapid ischemia-reperfusion (I/R) injury. We prepared complement activity-depleted rats by the administration of the anti-complementary agent K-76COONa. To assess the role of MMC degranulation, we used the MMC stabilizer MAR-99 and genetically mast cell-deficient Ws/Ws rats. Autoperfused segments of the jejunum were exposed to 60 min of ischemia, followed by 60 min reperfusion. The epithelial permeability was assessed by 51Cr-EDTA clearance rate, and the number of MMC was immunohistochemically assessed. I/R treatment induced a marked increase in mucosal permeability and MMC degranulation. The treatment with K-76COONa and MAR-99 significantly attenuated these changes. Furthermore, in Ws/Ws rats the increase in mucosal permeability and MMC degranulation was significantly attenuated. These findings indicate the role of complement activation and MMC activation in the pathogenesis of rapid intestinal I/R injury. A regulation of the complement activation and MMC degranulation may be one of the clinical strategies for prevention of I/R-induced mucosal injury.
Effect of Lipopolysaccharide on Peptide Transporter 1 Expression in Rat Small Intestine and Its Attenuation by Dexamethasone
Authors: Shu Hong-Jin , Takeda Hiroaki , Shinzawa Haruhide , Takahashi Tsuneo , Kawata Sumio
Published: April 2003

Background/Aim: The peptide transporter (PepT1) activity is upregulated or preserved under certain pathological conditions. The aim of this study was to investigate the PepT1 expression during lipopolysaccharide (LPS) treatment and the effect of dexamethasone on PepT1 expression. Methods: Rats were injected daily for 3 days with (1) LPS; (2) LPS plus dexamethasone; (3) dexamethasone, and (4) saline only. Mucosal specimens were used for Northern blot and Western blot analyses. Tissues of small intestine were taken for histological studies. In addition, tumor necrosis factor alpha and interleukin 1β levels were determined 3 h after single injections of the above mediators. Results: Northern blot analysis revealed that LPS treatment significantly decreased the expression of mRNA for PepT1 (32–62% of controls) at different time points. In the LPS + dexamethasone group, it was 66–95% of controls. The protein level of PepT1 in the jejunum was consistent with the mRNA expression level. Imunohistochemistry also showed a reduction of PepT1 immunoreactivity in the LPS group. LPS treatment resulted in increased tumor necrosis factor alpha and interleukin 1β levels, but dexamethasone treatment profoundly counteracted the cytokine production. Conclusions: This is the first report that LPS treatment reduces PepT1 expression in the rat small intestine. Short-term treatment with dexamethasone attenuated the effects of LPS by decreasing the cytokine levels.
CCK-Stimulated Changes in Pancreatic Acinar Morphology Are Mediated by Rho
Authors: Kiehne Karlheinz , Herzig Karl H. , Fölsch Ulrich R.
Published: April 2003

Background/Aims: Treatment of isolated pancreatic acini with high concentrations of cholecystokinin (CCK) is known to induce rapid changes in the cellular morphology. The signalling pathways remain to be characterized. Methods: Pancreatic acini were permeabilized by digitonin and incubated with various agents. The acinar morphology was investigated by microscopy. The activation of p125 focal adhesion kinase was determined by Western blot analysis. Amylase was measured photometrically. Results: The functionality of the permeabilized acini was tested by measuring stimulated amylase release. 300 µM GTPγS was almost as efficient as CCK to stimulate amylase release, while 300 µM GDPβS inhibited the CCK-stimulated amylase release. Stimulation of permeabilized acini with 0.1 µM CCK induced similar morphological changes as in unpermeabilized acini. Incubation of permeabilized acini with GTPγS mimicked the CCK-induced changes, whereas a preincubation with GDPβS prevented the CCK effects on the acinar morphology. Inhibition of the small G protein rho, which activates p125 focal adhesion kinase, by Clostridium botulinum C3 transferase also prevented the CCK-stimulated morphological changes. Preincubation of intact acini with cell-permeable inhibitors of protein kinase C, MEK or p38MAPK, or with the intracellular calcium chelator BAPTA/AM was without significant effect on the CCK-stimulated changes. Conclusion: The CCK-induced morphological changes seem to be mediated by G protein signalling via the small G protein rho and the associated activation of p125 focal adhesion kinase.
Two Surgical Procedures for Strictures at Finney Strictureplasty for Small Bowel Crohn’s Disease
Authors: Yamamoto Takayuki , Mylonakis Emmanouil , Keighley Michael R.B.
Published: April 2003

In patients with Crohn’s disease, long small bowel strictures are sometimes treated by a Finney strictureplasty. Strictures at an entrance and exit of a previous Finney strictureplasty are associated with severe obstructive symptoms and sometimes blind loop syndrome. Those strictures are difficult to manage. We herein introduce two different surgical procedures: one is a continuous T-shaped strictureplasty and the other is anastomosis between the Finney pouch and the divided small bowel. Both procedures immediately relieved obstructive symptoms and required no major resection of the bowel. After a 2-year follow-up, there has been no recurrence at the previous Finney strictureplasty.
Laparoscopic Appendectomy in Switzerland: A Prospective Audit of 2,179 Cases
Authors: Schäfer Markus , Krähenbühl Lukas , Frei Edgar , Büchler Markus W.
Published: April 2003

Background/Aims: Since its introduction in 1983, laparoscopic appendectomy (LA) has not replaced the conventional open procedure. The patient benefit seems limited to a decreased wound infection rate, and the overall morbidity and mortality rates remain equal to those of open appendectomy. Methods: The data (collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery) from 2,179 patients undergoing LA at 84 surgical institutions in Switzerland between January 1995 and December 1997 were retrospectively analyzed. Results: More than 90% of all patients had no intra- or postoperative complications. However, perforated appendicitis was associated with more complications, in particular a threefold increased wound infection rate (9.2 vs 3.5%). Furthermore, the conversion and reoperation rates of perforated appendicitis were significantly increased compared to ’simple’ acute appendicitis (25.5 and 10.4% vs 4.8 and 2.1%, respectively). LA performed with a stapling device is superior to LA performed with loops, although the difference is not significant. Conclusion: Therefore, LA is a safe and effective procedure. The postoperative morbidity and mortality rates are comparable to those of open appendectomy, which is still the most commonly used procedure in Switzerland. The question of whether perforated appendicitis is better treated laparoscopically or by the open procedure cannot be answered with our data.
Cecal Diverticulitis: A Diagnostic Challenge
Authors: Keidar Sergey , Pappo Itzhak , Shperber Yehuda , Orda Ruben
Published: April 2003

Background: Cecal diverticulitis is frequently indistinguishable from acute appendicitis preoperatively and is sometimes mistaken for carcinoma at laparotomy. The surgeon must be aware of the possibility of diverticulitis of the cecum in the operating room and choose the appropriate treatment. Purpose: Because there is no universal therapeutic approach to these patients, we decided to assess the presenting symptoms, clinical findings, preoperative diagnosis, operative findings determining the proper management of these patients. Methods: A retrospective chart review of 13 patients with pathologically confirmed cecal diverticulitis, who underwent surgery in our department from 1984 to 1998, was undertaken. Results: The mean age of patients was 43.5 years. Right lower quadrant pain and local tenderness were the only clinical findings in 92.3%, with preoperative diagnosis of acute appendicitis in 84.6% of patients. The operative finding in most cases was inflammatory mass of the cecum; in 6 cases it was indistinguishable from perforated cecal carcinoma. Six patients underwent right hemicolectomy, 5 had ileocecectomy, 1 patient was treated by tube cecostomy, and 1 had diverticulectomy. There were three minor postoperative complications: pneumonia, wound infection and lower limb superficial thrombophlebitis. Conclusions: Cecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. We suggest that the operative therapy should be ileocecectomy. The surgical specimen should be examined during surgery and only if carcinoma is found should the patient have a formal colectomy.
Control of Major Hemorrhage from the Spleno-Mesenteric Vein Junction during Pancreaticoduodenectomy: Successful Use of an Occlusion Balloon Catheter
Authors: Fujino Yasuhiro , Ku Yonson , Nakamura Takeshi , Iwasaki Takeshi , Kuroda Yoshikazu
Published: April 2003

Background/Aims: Vascular disruption is sometimes associated with intractable hemorrhage due to either vessel fragility or increased blood flow rates in patients with chronic pancreatitis during surgical operation. This paper describes the successful use of an occlusion catheter for repairing a major laceration at the spleno-mesenteric vein junction. Methods: A 14-Fr Fogarty occlusion balloon catheter was directly inserted into the splenic vein through the site of venous laceration and inflated to stop blood flow from the splenic vein. Results: This procedure perfectly controlled massive hemorrhage from the spleno-mesenteric vein junction. The injured site was repaired with a continuous suture in 5 min. Conclusion: The direct insertion of a balloon catheter to the injured site is simple and expeditious to control major hemorrhage from the spleno-mesenteric vein junction when the situation is otherwise unmanageable.
Migrating Site of Bleeding in a Right Colon Demonstrating Angio-Dysplasia following a Segmental Resection of the Colon
Authors: Oshiro Takashi , Tamai Osamu , Nosato Eiji , Shiraishi Masayuki , Kusano Toshiomi , Muto Yoshihiro
Published: April 2003

Background/Aim: A case of angiodysplasia of the right colon presenting with a migrating site of bleeding following a segmental resection of the colon in a 38-year-old Japanese is herein reported. Methods: The case records of a patient with severe intestinal bleeding and multiple surgeries were reviewed, and then the histologic features were compared with the operative findings. The patient received many units of packed red blood cells and had also undergone three segmental colectomies and most recently a curative ileocolostomy. Despite an exhaustive evaluation, the bleeding sites could not be detected clinically. Results: Ectatic, tortuous submucosal veins were presented in four sections of the colon (cecum, ascending colon and transverse colon, respectively) out of a total of 30 sections that were examined. These veins pierced the proper muscle layer of the colon, but did not traverse the muscularis mucosa. Our case of segmental microscopic angiodysplasia may represent a previously unreported unique variant, because the angiodysplastic lesions were present in the segmental colon and they developed bleeding from the distal remnant colon immediately after each segmental colectomy until an extended right hemicolectomy containing the oral part of the descending colon was done. In spite of the severe bleeding, the mucosa of the colon appeared to be essentially normal during a macroscopic inspection. Conclusion: Gastrointestinal bleeding from angiodysplasia is generally assumed to arise from macroscopically visible vascular lesions within the mucosa. However, angiodysplastic lesions are often unrecognizable and multiple in the gastrointestinal tract, and especially tend to affect both the cecum and ascending colon. When this disease process is recognized, a subtotal colectomy may thus be called for to control bleeding.
Herniation of the Small Bowel through the Port Site following Removal of Drains during Laparoscopic Surgery
Authors: Komuta Ko , Haraguchi Masashi , Inoue Keiji , Furui Junichiro , Kanematsu Takashi
Published: April 2003

Background/Aims: Generally, the port site is used as the delivery route for drainage after laparoscopic abdominal surgery. We report this case because of the rarity of the complication related to laparoscopic procedures. Methods: A 75-year-old woman underwent a laparoscopic-assisted sigmoid colectomy for early stage cancer. Results: After the operation, her postoperative course was uneventful. However, just after removing the drains, the small bowel was found to have herniated through the port site used as the insertion route for the drains. An emergency relaparotomy was done and a segment of the necrotic small bowel had to be resected. Conclusion: To prevent this complication, we suggest that, first of all, in elderly and thin patients smaller trocar insertion sites (<10 mm) should be utilized as insertion routes for the drains and, secondly, the fascial defect should be closed just after removing the drains whenever the defect measures 10 mm or more in size.
Indications for Portal Vein Embolization Combined with Major Hepatic Resection for Advanced-Stage Hepatocellular Carcinomas
Authors: Wakabayashi Hisao , Yachida Shinichi , Maeba Takashi , Maeta Hajime
Published: April 2003

Background: Criteria for selection of patients for portal vein embolization (PVE) before major hepatectomy for advanced-stage hepatocellular carcinoma (HCC) have not been clarified in detail. This study was aimed at defining those benefiting from this therapy in a retrospective fashion. Patients and Methods: Firstly, to determine liver functional criteria for applying this approach 26 patients with stage III (17 patients) or IV (9 patients) disease, who underwent major hepatectomies after PVE, were divided into those without major complications (20 patients) and a postoperative liver failure group (6 patients). Clinical, analytical, and hemodynamic parameters obtained before and after PVE were compared between the groups. Secondly, to define the application of this approach with regard to tumor progression survival rates of patients were also obtained, taking into account factors which affect tumor development, i.e. lesion size, intrahepatic metastasis and vascular invasion. Results: With regard to liver function 4 nonindications were obtained: (1) a portal pressure measured right after PVE >25 cm H2O; (2) post-PVE serum hyaluronate >200 ng/ml; (3) pre-PVE serum cholinesterase <150 U/l; (4) post-PVE serum cholinesterase <150 U/l. In view of the tumor progression in patients with HCCs featuring intrahepatic metastasis spread to more than 3 segments (IM3) 1-, 3- and 5-year survival rates were low (42.9, 28.6 and 0%) with a statistical significance, compared to those in patients with intrahepatic metastasis limited in the same lobe (76.9, 46.2 and 24.6%). Conclusions: When laboratory data fulfill 3 or more of the criteria, the extent of hepatic resection may have to be carefully reconsidered. Patients with HCCs featuring IM3 intrahepatic metastasis may not benefit from the aggressive approach described here.
Total Gastrectomy Is Not Always Necessary for Advanced Gastric Cancer of the Cardia
Authors: Kobayashi Toshihiko , Sugimura Haruhiko , Kimura Taizo
Published: April 2003

Background: It is unclear whether total gastrectomy (TG) is always necessary for gastric cancer of the cardia. We therefore investigated whether cardiac cancers treated by TG would have been cured by proximal gastrectomy (PG). Methods: Photocopies of the resected stomachs of 55 patients who had received TG for cardiac cancer were reviewed. A simulated resection line for PG was drawn connecting a point 5 cm from the pyloric ring on the lesser curvature with a point 15 cm from the pyloric ring on the greater curvature. The distal surgical margin between the tumor edge and the simulated resection line was measured, and lymph nodes (LN) dissected surgically were examined for tumor involvement. Results: Tumor location fell into three categories, upper-middle (UM, n = 28), upper (U, n = 18), and upper-esophagus (UE, n = 9). The means of the simulated surgical margins were 1.0 cm for UM, 4.7 cm for U, and 5.7 cm for UE tumors. UE tumors had no metastasis to No. 4d, 5, or 6 LN, and only one U tumor showed metastasis to No. 4d and 5 LN. In contrast, UM tumors had a higher incidence of these nodes involved. Conclusion: Advanced gastric cancer located in the U or UE regions is mostly curable by PG.
Clinical Experience with Different Techniques of Pancreatic Head Resection for Chronic Pancreatitis / with Invited Commentary
Authors: Kelemen D. , Horváth Ö.P.
Published: April 2003

Background/Aims: Recently organ-saving procedures have become popular in the treatment of chronic pancreatitis with head enlargement. The purpose of this study is to compare the results of three different procedures. Methods: Between 1991 and 1998, 32 Beger operations, 13 Frey procedures and 21 pylorus-preserving pancreatoduodenectomies (PPPDs) were performed. The pre-, intra- and postoperative data were detailed. During the follow-up examination the quality of life, body weight, consumption of alcohol and enzymes, as well as the carbohydrate metabolism were checked. Results: Considering the operative and late mortality and reoperation rate, there was no difference between the procedures. The postoperative hospitalization time was the shortest after the duodenum-preserving pancreatic head resections (Beger and Frey). While the rate of early morbidity was higher after PPPDs, there was no difference in late morbidity between the groups. The condition of the patients was better and the development rate of diabetes was lower after the Beger procedure than after PPPDs. Conclusion: Consequently duodenum-preserving pancreatic head resections seem to be more advantageous than PPPD. Nevertheless the latter operation is the only possibility in some situations.
Management of Fistulas in Crohn’s Disease
Authors: Ikeuchi Hiroki , Shoji Yasutugu , Yamamura Takehira
Published: April 2003

Aim: This study was conducted to clarify operative indications, surgical treatment, and postoperative complications of intra-abdominal fistulas in Crohn’s disease. Methods: Of 213 patients undergoing surgical treatment for Crohn’s disease in our institution between 1972 and 2000, 55 patients (25.8%) found to have 81 intra-abdominal fistulas were retrospectively reviewed. Results: The most common indication for surgery was intestinal obstruction. A fistula represented a single indication for surgical treatment in 9 operations (15.5%). All patients with intra-abdominal fistulas underwent resection of the diseased intestinal segment. Closure of the fistulous defect of the affected lesion was achieved by suture (n = 27), stapled fistulectomy (n = 12), or resection (n = 11). Resection of the diseased bowel was achieved by en bloc removal of the fistula in 15 cases. When the fistula opened through the abdominal wall (n = 12), the diseased portion of the intestine was resected, and the fistulous tract was debrided. Only 1 patient died postoperatively from multiple organ failure because of anastomotic breakdown. Conclusions: The surgical treatment of an intra-abdominal fistula in Crohn’s disease is based on resection of the diseased intestinal segments, and the affected lesion can be sutured. This procedure can be achieved safely, and the incidence of postoperative complications is low.