bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed Generalized Allergic Reactions to Corticosteroids
Authors: Bircher Andreas J. , Bigliardi Paul , Zaugg Thomas , Mäkinen-Kiljunen Soili
Published: April 2003

A 37-year-old patient presented with a severe allergic local reaction upon inhalation of budesonide for asthma. Skin tests were positive for budesonide and amcinonide (group B) and elicited a strong local reaction and a disseminated macular exanthema. Corticosteroids from other groups were well tolerated. A 38-year-old male patient had first an allergic contact dermatitis to topically applied prednisolone acetate and then a disseminated eczematous exanthema upon oral intake of prednisone. A delayed-type sensitization to corticosteroids from group A such as hydrocortisone, prednisone and tixocortol pivalate was identified. A detailed diagnosis in patients with allergic reactions to corticosteroids is crucial with regard to their use in emergency therapy.
Thromboangiitis obliterans:A Rare Cause of a ReversibleRaynaud’s Phenomenon
Authors: Noël B. , Krayenbühl B. , Cerottini J.-P. , Guggisberg D. , Buxtorf K. , Pires A. , Panizzon R.G.
Published: April 2003

A 25-year-old woman with progressive Raynaud’s phenomenon and digital necrosis is presented. Systemic sclerosis and other connective tissue disorders as well as atherosclerosis and arterial emboli were excluded with appropriate laboratory examinations. Arteriography revealed multiple palmar and digital occlusions with corkscrew-shaped vessels. Based on these characteristic arteriographic and clinical findings, the diagnosis of thromboangiitis obliterans was finally retained. With intravenous perfusion of the prostacyclin analogue iloprost (2 ng/kg/min, 6 h daily during 21 days), a complete healing of Raynaud’s phenomenon and of the digital necrosis was observed. There was no recurrence during the 1-year follow-up. This observation demonstrates that thromboangiitis obliterans is a potential reversible cause of severe Raynaud’s phenomenon in young women even in the absence of lower limb involvement. Early recognition is important to avoid irreversible complications such as loss of digits.
Bullosis diabeticorum in a Newly Discovered Type 2 Diabetes mellitus
Authors: Derighetti M. , Hohl D. , Krayenbühl B.H. , Panizzon R.G.
Published: April 2003

Bullosis diabeticorum (BD), although a rare manifestation, is characteristic of diabetes mellitus. The exact origin of BD is unknown. We report another case of a 54-year-old man who developed a blistering lesion on his left leg. Histopathological examination revealed a microangiopathy with hyalinosis of the blood vessel walls.
Mucocutaneous Junctional and Flexural Paresthesias Caused by the Holoplanktonic Trachymedusa Liriope tetraphylla
Authors: Mianzan Hermes , Sorarrain Dora , Burnett Joseph W. , Lutz Linda L.
Published: April 2003

Multiple stages of Liriope tetraphylla caused paresthesias leading to chafing and excoriations in swimmers along the Southern Uruguayan and Northern Argentinean Atlantic coasts. These episodes appear seasonally in the summer and affect groups of bathers in shallow water (1–3 m).
Renbök Phenomenon in Alopecia areata
Authors: Bon Anita M. , Happle Rudolf , Itin Peter H.
Published: April 2003

We present a second case of alopecia areata sparing a congenital nevus of the eyebrow. This inverse counterpart of perinevoid alopecia is discussed and placed in context to the recently described Renbök phenomenon. According to the present definition of a nevus as a genetic mosaic, a genetically determined resistance to alopecia areata is suggested in our case.
Tufted Angioma of Adult Onset, Revealing Abundant Eccrine Glands and Central Regression
Authors: Ban Masanori , Kamiya Hideki , Kitajima Yasuo
Published: April 2003

Tufted angioma (angioblastoma) usually occurs in infancy. Some lesions reveal proliferation of eccrine glands and some undergo spontaneous regression. We report a lesion from the left lateral chest of a 58-year-old male, which had appeared 5 years ago and gradually increased in size. Its color had faded out centrally. Histological examination showed many angiomatous lobules on the border of the lesion but few in the central portion. Abundant eccrine sweat glands, small venules and dense connective tissue were seen in both areas. The histology and the clinical course suggested that central regression occurred in the lesion. Out of 211 reported cases, we found 4 cases that had annular lesions spreading centrifugally. Though these lesions were not examined histologically, they were suspected to regress in the central portions. We suggest that central regression can rarely occur in tufted angioma.
Differentiation between Merkel Cell Carcinoma and Malignant Melanoma: An Immunohistochemical Study
Authors: Kontochristopoulos G.J. , Stavropoulos P.G. , Krasagakis K. , Goerdt S. , Zouboulis Ch.C.
Published: April 2003

Background: Although Merkel cell carcinoma (MCC) exhibits specific clinical and histologic features, differentiation from other cutaneous neoplasms, such as lymphoma, metastatic oat cell carcinoma and malignant melanoma (MM), may sometimes be difficult. Objective: The aim of our study was to immunohistochemically differentiate MCC from MM. Methods: Paraffin sections from 6 cases of primary MCC and 6 cases of primary MM were investigated. For immunostaining, the APAAP method was used. Results: Neuron-specific enolase was positive in all cases of MCC, as well as in 2 cases of MM. Marked positivity for cytokeratins 18, 20 and chromogranin A was observed in the MCC group, whereas a complete absence of expression of these three markers was noted in the MM group. Immunostaining with HMB45 and NKI/C3 was positive in all cases of MM and negative in all cases of MCC. S-100 protein was positive in all but 1 case of MM. In contrast, only 1 case of MCC reacted with S-100 protein. Conclusion: Our results underline the role of immunohistochemistry in the diagnosis and differential diagnosis of MCC. In particular, the combination of neuron-specific enolase, cytokeratins 18, 20 and chromogranin A positivity for MCC and HMB45, NKI/C3 and S-100 protein positivity for MM is of great value in the distinction between these two cutaneous neoplasms.
Thickness and Echogenicity of the Skin in Children as Assessed by 20-MHz Ultrasound
Authors: Seidenari Stefania , Giusti Giulia , Bertoni Laura , Magnoni Cristina , Pellacani Giovanni
Published: April 2003

Background: Skin anatomy and physiology undergo modifications throughout the whole lifespan. In children the skin appears with structural characteristics, as evaluated by histology, which differ from those of adults, especially in the first years of life. Objective: The aim of our study was to evaluate skin thickness and echogenicity at different sites in children by 20-MHz ultrasound. Methods: Eight skin sites of 42 children and 30 young adults were studied with a 20-MHz B scanner. Skin thickness and mean echogenicity were evaluated. The echographic images were processed and segmented by a dedicated program: the 0–30 amplitude interval, which marks the hypoechogenic parts of the tissue, and the 201–255 range, highlighting the hyperreflecting areas, have been selected. Results and Conclusion: Whereas skin thickness shows a gradual increase from birth to adulthood, maturation of the skin leads to variations in the intensity of its echogenicity, depending on the different skin areas. Whereas on the face and the trunk it appears lower in adults with respect to children, a gradual increase can be observed on the limbs with growing age. The distribution of skin reflectivity also greatly varies in different phases of life.
Extraperitoneal Retrograde Transhepatic Biliary Drainage for Common Bile Duct Exploration for Prevention of Tube Dislodgment and Its Earlier Removal
Authors: Goseki Narihide , Methaste Asada , Gen Tokichi , Ito Koji , Endo Mitsuo
Published: April 2003

Primary bile duct closure with retrograde transhepatic biliary drainage (RTBD) using an RTBD tube (RTBDT) is a feasible surgical technique after common bile duct exploration in choledocholithiasis in comparison to conventional T-tube insertion. But, unfortunately, this technique is not popular because of the difficulty to introduce a catheter into a proposed intrahepatic bile duct branch without hepatic injury. In addition, the time for its safe removal is not shorter than that with T-tube insertion. So, we have devised a special needle-attached RTBDT (n-RTBDT) to guide the tube via the intrahepatic bile duct of the liver with minimal hepatic injury, and proposed a new surgical technique, namely extraperitoneal RTBD (Ep-RTBD), using the n-RTBDT providing earlier removal without fistula formation in the general peritoneal cavity. In all patients with common bile duct calculi who underwent this surgical procedure, the tube could be revoved within 10 postoperative days with no complication.
Primary Liver Adenomatosis
Authors: Cristaldi Massimo , Rovati Marco , Conte Dario , Elli Marco , Lesma Alessandro , Mezzabotta Maurizio , Vago Luca , Taschieri Angelo Maria
Published: April 2003

Background/Aims: Liver adenomatosis is an uncommon condition and so far only 13 cases fulfilling the requirements for its diagnosis have been reported in the literature. Optimal treatment of the disease and follow-up criteria are still the subject of debate. Methods: We report on 2 cases of liver adenomatosis. In both cases definite diagnosis was obtained only intraoperatively on biopsy. Results: In neither case was liver transplantation done, due either to patient refusal or foreseeable poor compliance. Prolonged strict follow-up failed to demonstrate malignant changes. Conclusions: Removal of the huge masses often responsible for abdominal pain is the only real indication for resective surgery. Orthotopic liver transplantation should be reserved for those cases in which malignant changes are suspected due to elevation of the α-fetoprotein concentration or gross modifications in the shape of the hepatic lesions.
Laparoscopic Assisted Spine Surgery
Authors: Heini P.F. , Krähenbühl L. , Schwarzenbach O. , Lottenbach M.
Published: April 2003

Background: Evaluation of the technical aspects and clinical outcome of laparoscopic assisted interbody fusion (LAIF) using the BAK technique. Method: 17 patients with chronic low back pain due to degenerative disc disease at L5–S1 and L4–L5 were treated with LAIF using the BAK technique. Surgical time, blood loss and intraoperative problems were assessed. The short-term clinical and radiological outcome was measured. Results: The technical part of the procedure depends on a learning curve. However, in collaboration with a laparoscopic surgeon no complications related to the technique occurred. The limits of the technique are due to the anatomical situation at the L4–L5 level. 14/17 patients had an improvement in their lower back pain. Conclusion: The technique of LAIF is demanding. The L5–S1 level can be addressed with ease; however, transabdominal fusion of L4–L5 is not recommended. Patient selection remains the keystone. LAIF is the least invasive measure in order to stabilize and fuse a motion segment.
Port Site Recurrences after Laparoscopic Surgery
Authors: Schaeff B. , Paolucci V. , Thomopoulos J.
Published: April 2003

Port site metastasis has been a surprising event after laparoscopic procedures in cancer patients. No clear data exist about this phenomenon. The aim of this study is to summarize current epidemiologic knowledge about the risk of this complication. A review of all case reports about port site recurrences was undertaken. To date, 164 cases of port site metastases after videoscopic procedures have been reported in 90 papers. We found 108 cases of implantation after laparoscopy for digestive tumors, 23 after thoracoscopy, 29 after gynecological and 4 after urological laparoscopy. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization to the trocars and instruments. Also low-staged and highly differentiated tumors have been reported to cause post-laparoscopy tumor seeding. The temporary data of the CAE registry ‘port site metastases’ (Workgroup for Surgical Endoscopy of the German Society of Surgery) are also reported. The analysis of 80 histologically confirmed cases of port site recurrence shows a particular frequency after laparoscopic cholecystectomy for unsuspected gallbladder cancer (n = 59). Postoperative specimen examination revealed a T1 carcinoma in 9 cases (15%), T2 carcinoma in 33 (21%), T3 in 3 (5%) and T4 in 1 case (1.7%). The mean time to clinical tumor relapse was 6 months. Similar patterns were found in a lower number of port site metastases after laparoscopy for colon cancer (n = 2) and for other cancers (n = 9).Clinical evidence that laparoscopy with CO2 pneumoperitoneum can enhance tumor dissemination is given. Port site metastases seem to be secondary to multiple factors including the gas used, local trauma, tumor manipulation, biologic properties of the tumor, and individual surgical skills.
Effect of Multidisciplinary Treatment with High Dose Rate Intraluminal Brachytherapy on Survival in Patients with Unresectable Esophageal Cancer
Authors: Iwasa Masato , Ohmori Yoshinobu , Iwasa Yoshie , Yamamoto Akira , Inoue Atsushi , Maeda Hironori , Kume Motohiko , Ogoshi Shohei , Nishioka Akihito , Ogawa Yasuhiro , Yoshida Shoji
Published: April 2003

Background: Since carcinoma of the esophagus is usually diagnosed at an advanced stage, many cases of esophageal cancer are beyond possible radical resection and only palliative treatment can be performed in such cases. Therefore, a great deal of discussion has taken place concerning indications for treatment modality, and various procedures have been performed to palliate such patients. The prognosis for such patients is still poor, even though many kinds of palliation have already been developed and applied. To improve the prognosis of such patients we developed a multidisciplinary treatment which includes high dose rate intraluminal brachytherapy (HDR-ILBRT) and evaluated its effectiveness, especially the HDR-ILBRT component. Patients and Treatment Methods: Sixty-six patients with unresectable esophageal cancer enrolled in this study. Twenty-seven patients underwent bypass operations. Seven of the 27 patients received external irradiation only (group BE), 11 received external irradiation and HDR-ILBRT (group BEH), while the remaining 9 did not receive radiotherapy (group B). Another 39 patients without bypass operations were all treated with radiotherapy, 22 with external irradiation only (group E) and 17 were treated with external irradiation and HDR-ILBRT (group EH). After completion of radiotherapy, all patients received chemotherapy with 5-FU (2,500 mg/body) and CDDP (100 mg/body). Results: Mean survival time and the 5-year survival rate of group BEH (13.3 ± 1.5 months and 20%) were significantly improved compared with group BE + B (p < 0.05). In the patients without bypass operations, there were significant differences in the mean survival time and the 3-year survival rate in groups EH and E (group EH 16.5 ± 2.5 months, 21.8%, group E 9.0 ± 1.3 months, 0%, p < 0.05). The bypass operation itself and chemotherapy did not significantly affect the prognosis of patients with unresectable esophageal cancer. Conclusion: These results strongly suggest the use of HDR-ILBRT, as a component of multidisciplinary treatment for unresectable esophageal cancer, was significantly effective and HDR-ILBRT contributed to improve outcomes in patients with advanced esophageal cancer. HDR-ILBRT should be established as a component of treatments for unresectable esophageal cancer.
Carcinoma of the Cystic Duct Leading to Obstructive Jaundice
Authors: Holzinger Fernando , Schilling Martin , Z’graggen Kaspar , Stain S. , Baer Hans U.
Published: April 2003

Only 34 cases of primary cystic duct carcinoma have previously been published in the literature. Most of these cases presented with upper abdominal pain and a palpable mass in the right upper quadrant due to gallbladder hydrops or cholecystitis. We report a case of cystic duct carcinoma with the clinical presentation of obstructive jaundice. The patient was treated by cholecystectomy, resection of the common bile duct and a Roux-en-Y hepaticojejunostomy. An extended lymph node dissection was not performed. Fourteen months after the operation the patient died with local carcinoma recurrence. A literature review comparing clinical signs, surgical treatment, and outcome of 14 Japanese and 21 reported Western cases, including ours, was performed. Extended lymph node dissection in addition to combined resection of the gallbladder and ductus hepaticocholedochus appears to offer a better prognosis and larger survival, including the chance of potential cure.
Consolidation of a Friable Pancreas for Pancreaticojejunal Anastomosis
Authors: Landen S.
Published: April 2003

Management of the pancreatic remnant following pancreaticojejunostomy remains a technical challenge particularly when the pancreas is soft. A simple technique that consolidates the pancreas in preparation for pancreaticojejunostomy is described. Application of this technique in patients for whom a difficult anastomosis was anticipated has yielded good results.
Cholelithoptysis: An Unusual Complication following Laparoscopic Cholecystectomy
Authors: Chan S.Y.Y. , Osborne A.W. , Purkiss S.F.
Published: April 2003

A 75-year old lady underwent a routine laparoscopic cholecystectomy during which stones were spilled into the peritoneal cavity. Despite peritoneal lavage the patient developed chronic right upper quadrant discomfort and a pleural effusion over several months. Following the production of a pigmented bilirubin stone in her sputum the patient’s symptoms resolved. Cholelithoptysis is a rare complication of laparoscopic cholecystectomy, the diagnosis should be considered in patients with prolonged chest symptoms after surgery.
Diffuse Cavernous Hemangioma of the Rectum and Sigmoid Colon
Authors: Demircan Orhan , Sönmez Husnu , Zeren Sinan , Coşar Ediz , Bicakci Kenan , Ozkan Suavi
Published: April 2003

We present an 18-year-old man with painless rectal bleeding, hematuria and diffuse cavernous hemangioma of the rectum and sigmoid colon. Thirty units of blood were transfused during the interval preceding definitive surgery. Low anterior resection and partial cystectomy were performed. During the postoperative period no rectal bleeding occurred, but he died of massive intracerebral bleeding 10 months after the operation.
Management of Large Rectal Wall Defects with Open Pedicle Grafts of Small Intestine
Authors: Demetriades Ch. , Botsios D. , Tsalis K. , Manafis K. , Zisiadis A. , Dadoukis J.
Published: April 2003

The aim of this study was to evaluate the possible repair of large rectal wall defects using an open pedicle ileal graft as a mucosal patch. This experiment was carried out in 14 adult mongrel dogs. By excision of a portion of the antimesenteric wall comprising 50–70% of the circumference and measuring 5–6 cm in length, a suitable full thickness defect was created in the lower part of the rectum. A segment of the distal ileum was then isolated on a mesenteric pedicle and opened from its antimesenteric border. This was sutured over the defect in two layers. The animals were observed for a period of 15 days to 12 months. All the animals survived the operation apart from 1 dog that died of fecal peritonitis. Function of the rectum generally remained normal. Barium X-ray did not show any obstruction, shrinkage of the patch, lumen dilatation or extravasation. At the time of autopsy pedicles of ileal grafts appeared intact and pulsating. On gross examination there was no evidence of focal hemorrhage, ulceration or any cicatricial thickening of the grafts. Healing was good and the ileal mucosa retained its villi and general characteristics without any major inflammatory reactions. There was an increase in the number of goblet cells which returned to normal in 6 months.
The Bile Duct Anastomosis in Liver Transplantation
Authors: Seiler Ch.A.
Published: April 2003

In spite of the dramatic improvement of survival after orthotopic liver transplantation over the last decades, biliary tract complications are still the ‘achilles heal’ of liver transplantation with a potential risk of significant morbidity and mortality. Biliary leaks or strictures, the major types of biliary complications, may occur after direct choledocho-choledochostomy (CC) or Roux-Y choledocho-jejunostomy (CRY). The majority of these biliary complications, however, are often a consequence of surgical technique and therefore potentially amenable to improved surgical technique.
Long-Term Effects on the Regulation of Pancreatic Secretion after Gastric Surgery
Authors: Hedberg Mats , Janzon Lars , Rehfeld Jens F. , Borgström Anders
Published: April 2003

Background: Apart from smoking, known risk factors for the development of pancreatic carcinoma are few, gastric resection being proposed as one. The trophic effect of cholecystokinin (CCK) on the pancreatic gland is well known from animal experience and increased concentrations of CCK in plasma have been shown to induce pancreatic neoplasia experimentally. In several studies the release of CCK in response to food ingestion has been shown to be increased following gastric surgery. However, in those studies, the time between surgery and investigation of the CCK response was short, and methods of CCK analysis have since improved. Patients and Methods: In patients, partially gastrectomized 8 years (median) earlier, we studied the plasma concentrations of CCK, insulin and gastrin, as well as some specific pancreatic enzymes. The findings were compared to an age-matched control group of individuals not subjected to gastric surgery. Results: Basal CCK concentrations in the operated group were found to be lower, but increased postprandially to the same level as in controls. Serum levels of specific pancreatic enzymes were equal in the 2 groups. Conclusion: It is possible that a disturbed regulation of pancreatic secretion, or a secretory dysfunction within the gland, following partial gastrectomy, could contribute to the development of pancreatic carcinoma. However, our findings do not favor the idea of plasma CCK as a promotor of pancreatic carcinoma.
Dearterialization of Colorectal Liver Cancer: Institutional Experience
Authors: Ohlsson B. , Lindell G. , Lundstedt C. , Jeppsson B. , Persson B. , Bengmark S. , Tranberg K.-G.
Published: April 2003

Background/Aims: Preliminary clinical trials have suggested that dearterialization (interruption of arterial blood supply) is beneficial to patients with liver tumours. The aim of this report was to review the outcome of all patients undergoing dearterialization for colorectal liver metastases and to analyze whether refinement of the technique was followed by improvement in outcome. Methods: Retrospective review of 57 patients undergoing temporary (16 h) dearterialization during 1972–1984 (n = 24) or repeated transient dearterialization (1–2 h once or twice daily) during 1985–1995 (n = 33). Results: The median survival after start of treatment was 1.1 years, and the 5-year survival rate was 0%. There was no significant difference in survival between temporary and repeated transient dearterialization. Liver tumour volume and extrahepatic metastases varied negatively with survival. The temporary dearterialization procedure was followed by hepatic or intra-abdominal abscess formation in 6 patients (24%), leading to postoperative death in 2 patients (operative mortality 8%). Complications after repeated transient dearterialization were related mainly to technical problems with the occluder device. Conclusion: Although this was not a randomized study, it appears that dearterialization is of no benefit in colorectal liver cancer.
Late Radiogenic Small Bowel Damage: Guidelines for the General Surgeon
Authors: Meissner K.
Published: April 2003

Background/Aims: The majority of late radiogenic small bowel injuries presents with obstruction or peritonitis. Owing to an average latency period of years, many of these patients are admitted to community hospitals and treated by general surgeons, who in turn see only a few pertinent patients in their professional lifetime. This study intends to provide the general surgeon with comprehensive guidelines for safer surgical management. Material and Methods: Forty-one publications were analyzed in a search for clinical, procedural and outcome data. Results: After a mean interval of 3.4 years following radiotherapy, patients with a mean age of 57 years present with obstruction (71%), fistula (17%), perforation (10%) or hemorrhage (2%) due to small bowel radiation injury. 22% have associated colorectal injury. The intestinal compartments most frequently affected are lower ileum, cecum and rectosigmoid, whereas the midgut and transverse colon are usually free. Consequently, the dehiscence rate of resection and ileoileostomy is 26%, jejunoileostomy 12%, ileoascendostomy 9% and ileotransversostomy 4%, and the pertinent rate of progressive radiation injury is 9.1%. Bypass procedures yield an overall dehiscence rate of 9%, ileotransverse bypass 1.6%, and the rate of progressive radiation injury is 37%. The lethality of suture line insufficiency is 85%. Lysis carries a lethal perforation rate of 6%. Only 58% of patients survive over 2 years, and of those not succumbing to unrelated disease, 37% die from progressive radiation injury and 63% from tumor progression. Conclusion: If resection is warranted, a reasonably extended ileal resection, right hemicolectomy and ileotransversostomy, is safe. Likewise, ileotransverse anastomosis is the best choice for bypass. Lysis should not be inforced in radiation-injured bowel compartments. Terminal enterostomy with distal mucous fistula alleviates otherwise untreatable fistulae.
Long Tube for Obstructing Left-Sided Colon Cancer
Authors: Adachi Yosuke , Okita Keishi , Nozoe Tadahiro , Iso Yasunori , Yoh Rinken , Matsumata Takashi
Published: April 2003

Background: Obstructing left-sided colon cancer is now managed by immediate resection and primary anastomosis using intraoperative mechanical bowel irrigation. The aim of this study was to describe our new technique using a long tube for preoperative bowel decompression and intraoperative antegrade irrigation. Methods: A long nasointestinal tube was inserted and a balloon was inflated with distilled water. The tube gradually went forward to the ileum end by peristalsis, and the small intestine became fully decompressed. At operation, antegrade colonic irrigation with warm saline was performed through this long tube without insertion of a Foley catheter. Results: Immediate colonic resection and primary end-to-end anastomosis using layer-to-layer interrupted sutures was successfully performed in 4 patients with obstructing sigmoid colon cancer. Conclusions: This method avoids opening and closure of the cecum or ileum, and minimizes bacterial contamination. The technique is simple and easy, and useful for immediate resection and primary anastomosis of obstructing left-sided colon cancer.
Complications of Pancreatic Surgery and the Role of Perioperative Nutrition
Authors: Di Carlo Valerio , Gianotti Luca , Balzano Gianpaolo , Zerbi Alessandro , Braga Marco
Published: April 2003

Background: According to international guidelines, artificial nutrition may be indicated after pancreaticoduodenectomy (PD). This clinical study was designed to evaluate whether the route of administration and the composition of the postoperative nutritional support could affect outcome. Methods: One hundred patients who underwent PD for cancer of the pancreatic head were prospectively studied. Patients were randomized to receive a standard enteral formula (SEN; n = 35) or immunonutrition with an enteral formula enriched with arginine, ω-3 fatty acids, and RNA (IEN group; n = 33), or total parenteral nutrition (TPN; n = 32). Postoperative feeding was started within 12 h after surgery. The three regimens were isoenergetic and isonitrogenous. Tolerance of enteral feeding, rate and severity of postoperative complications, and length of hospital stay (LOS) were evaluated. Results: Full nutritional goal (25 kcal/kg) was achieved in 84% of enterally fed patients versus 96% in the parenteral group (p = NS). The rate of postoperative complications was lower in the IEN group (33%) than in the SEN (40%) and TPN groups (59%). The severity of infectious complications (sepsis score) was lower in the IEN (5.5) than the SEN (7.9) and TPN groups (10.4; p < 0.05). LOS was shorter in the IEN than in the SEN and TPN groups (16.3 vs. 17.8 vs. 19.3 days, respectively; p < 0.05). Conclusions: In patients undergoing PD the established nutritional goal can be obtained by enteral feeding. Immunonutrition seems to improve outcome.
False-Positive Cytology in Diagnostic Laparoscopy due to Ectopic Pancreas
Authors: Sloots C.E.J. , de Brauw L.M. , Bot F.J. , Greve J.W.M.
Published: April 2003

Background: Report on a case of incorrect diagnosis after laparoscopy and peritoneal fluid sampling. Methods: Case description and literature review. Results: Diagnostic laparoscopy is a frequently used tool. In a patient with chronic abdominal pain, a diagnostic laparoscopy was performed, and a peritoneal fluid sample was taken. Cytology of the aspirated peritoneal fluid revealed an adenocarcinoma. At laparotomy, ectopic pancreas was found as the source of the false-positive cytology. Conclusion: In the diagnosis of adenocarcinomas from peritoneal fluid aspirates without an obvious clinical location (tumor), ectopic pancreatic tissue should be considered in the differential diagnosis.
Asymptomatic Gastric Perforation by a Toothpick
Authors: Porcu Alberto , Dessanti Antonio , Feo Claudio F. , Dettori Giuseppe
Published: April 2003

Background: Many cases of gastric perforation with peritonitis, pylephlebitis, hepatic abscesses, or lethal bleeding, caused by ingested long and sharp objects, are reported in the literature. Methods: During a right hepatectomy for a giant hemangioma, a wooden toothpick was found between the two layers of the hepatogastric ligament. It was not possible to find the passage of the foreign body through the gastric wall. The patient did not report any correlated symptoms. Results: There was no sign of inflammation around the toothpick, which was enveloped in thin scar tissue. The removal of the foreign body was performed without complications. Conclusions: The peculiarity of our case is the total absence of symptoms during and after the perforation. Despite the benign evolution of our case, toothpicks must be considered as potentially dangerous, like other pointed objects, and, therefore, removed immediately.
A Surgical Treatment of Infected Pancreatic Necrosis: Retroperitoneal Laparotomy
Authors: Nakasaki Hisao , Tajima Tomoo , Fujii Kohichi , Makuuchi Hiroyasu
Published: April 2003

Background/Aims: Due to the anatomical location of the pancreas, sufficient drainage of a pancreatic necrosis by laparotomy may be unsatisfactory. Methods: CT and helical CT have provided extremely useful information on the surgical treatment of necrotic pancreatitis. The retroperitoneal approach (RPA) allows direct and complete removal of necrotic tissues. Results: RPA was used to treat 8 patients with infected pancreatic necrosis. Excision of necrotic tissues was effective and could minimize the complications often associated with laparotomy such as bleeding and intestinal injuries. Conclusion: By CT and helical CT, three-dimensional images of pancreatic necrosis are obtained. These investigations have greatly facilitated RPA, which has advantages over laparotomy in the treatment of infected pancreatic necrosis.
Blood Supply Routes of Recurrent Esophageal Varices following Endoscopic Embolization
Authors: Chikamori Fumio , Nishio Sadao , Kuniyoshi Nobutoshi , Shibuya Susumu , Takase Yasuhiro
Published: April 2003

Background/Aim: The blood supply routes of recurrent esophageal varices following complete endoscopic embolization (EE) are not yet known. The purpose of this study is to identify these blood supply routes by comparing endoscopic varicography and percutaneous transhepatic portography (PTP). Methods: Eleven cases of recurrent esophageal varices following EE are included in this study. The blood supply routes of primary and recurrent varices were analyzed by comparing the varicography obtained at the initial and repeat EE with PTPs before and after the initial EE. Results: Endoscopic varicography at the time of initial EE could show the vessels of the left gastric vein (LGV) system, such as the cardiac branch of the LGV, and the cardiac venous plexus (CP) in 100% of cases, and the trunk of the LGV in 73% (8/11) of cases, whereas the posterior gastric vein was seen in only 18% (2/11) of cases. PTP performed 2 weeks after the initial EE confirmed that the routes visualized by endoscopic varicography could be obliterated in 10 of 11 cases. The blood supply routes of recurrent varices, demonstrated by varicography, were the vessels of the short gastric vein (SGV) system, such as the fundic branch of the SGV or the posterior gastric vein in 82% (9/11) of cases, and the partially reformed fine CP in 27% (3/11) of cases. Varicography revealed the remnant vessels of the LGV in only 1 case. Conclusions: The primary esophageal varices are supplied with blood mainly from the cardiac branch of the LGV through the CP. However, the blood supplies of recurrent varices following EE come from the fundic branch of the SGV or the posterior gastric vein. We conclude that three-dimensional obliteration of esophageal varices and their feeders, the LGV and SGV systems, is completed by initial and repeat EEs.
Perforated Gastric Ulcer
Authors: Wysocki A. , Biesiada Z. , Beben P. , Budzynski A.
Published: April 2003

Background/Aims: Reports about perforated gastric ulcer are scarce and thus it is difficult to settle for a uniform model of operative management. The purpose of the study was to review our experience with perforated gastric ulcer and evaluate the results of gastric resection vs. oversewing of the perforation. Methods: Within 36 years 77 patients with peritonitis caused by histologically confirmed perforated gastric ulcer were operated. Furthermore, in another 7 microscopic examination revealed that perforation occurred within the gastric cancer. There were twice as many male as female patients. Results: Recently, the overall postoperative mortality (20.8%) tended to decrease markedly. 32 patients (mean age 49.9 years) were submitted to gastric resection and this procedure was associated with 2.9% mortality. All 3 subjects in whom vagotomy, pyloroplasty and wedge resection of the ulcer had been performed survived. In 40 patients (mean age 61.5 years) only a suture of the ulcer was performed. This procedure was associated with high mortality (1/3 of patients died). Selection criteria included poor general medical status, age, comorbidities, and substantial progression of the inflammatory process. Conclusion: Authors believe that emergency gastrectomy is a safe procedure; however, it might be performed without excessive operative risk in only half of the patients.
Influence of Gastrointestinal Hormones on Tumor Microcirculation of Experimental Pancreatic Cancer in the Rat
Authors: Schmidt Jan , Ryschich Eduard , Maksan Sasa-Marcel , Werner Jens , Gebhard Martha Maria , Herfarth Christian , Klar Ernst
Published: April 2003

Background/Aims: Gastrointestinal hormones influence the microcirculation in the normal pancreas. In the present study, we studied the effect of cerulein and somatostatin on pancreatic cancer microcirculation after orthotopic and nonorthotopic tumor implantation. Methods: In 36 male Lewis rats (150–180 g) induction of a ductlike pancreatic cancer was achieved by intrapancreatic or intraperitoneal tumor fragment interposition between two inert transparent polymethyl methacrylate plates. After 4 weeks, intravital microscopy of the tumor microcirculation was performed in a temperature-controlled immersion chamber. The animals received 5 μg/kg cerulein or 3 mg/kg somatostatin for 1 h intravenously. The erythrocyte velocity in normal pancreatic capillaries or in tumor vessels was measured. Results: The erythrocyte velocity in the capillaries of the normal pancreas was 1.01 ± 0.11 mm/s at baseline and increased to 1.64 ± 0.09 mm/s after cerulein stimulation (p = 0.007). Pancreatic cancer vessels demonstrated no increase in erythrocyte velocity after orthotopic (baseline 0.95 ± 0.14 mm/s, after 1 h 0.86 ± 0.13 mm/s; n.s.) and nonorthotopic tumor implantation (baseline 0.91 ± 0.12 mm/s, after 1 h 0.95 ± 0.14 mm/s; n.s.) after cerulein stimulation. Somatostatin decreased the erythrocyte velocity both in normal pancreas (baseline 0.87 ± 0.02 mm/s, after 1 h 0.60 ± 0.07 mm/s; p = 0.01) and in pancreatic cancer (baseline 0.85 ± 0.20 mm/s, after 1 h 0.63 ± 0.18 mm/s; p = 0.02) after orthotopic tumor implantation. There was no effect of somatostatin after nonorthotopic tumor implantation (baseline 0.90 ± 0.10 mm/s, after 1 h 0.88 ± 0.14 mm/s; n.s.). Conclusion: These data suggest that pancreatic cancer microcirculation lacks physiological blood flow control by stimulatory hormones, in contrast to the normal pancreas.
Rare Case of Left-Sided Ureteroduodenal Fistula
Authors: Shiff Brian M. , Welling Richard E. , Rege Pramod
Published: April 2003

Background/Aims: Ureteroduodenal fistulas are rare and only 11 cases have been reported in the literature since 1918. Diagnosis requires careful observation of symptoms. Methods: The case presented demonstrates a 68-year-old female with left-sided ureteroduodenal fistula confirmed by CT scan. A duodenal fistula was localized and an atrophic left kidney was identified and repaired. Results: Nephroureterectomy was performed and an omental patch was used for the repair. No complications were encountered during the postoperative course. Conclusions: Recurrent chronic urinary tract infection, pyuria and hematuria can indicate this rare disease. Early testing and detection can improve the chances of renal preservation.
Short-Term Hemodynamic Effects of Transjugular Retrograde Obliteration of Gastric Varices with Gastrorenal Shunt
Authors: Chikamori Fumio , Kuniyoshi Nobutoshi , Shibuya Susumu , Takase Yasuhiro
Published: April 2003

Objectives: The purpose of this study was to investigate the short-term effects on portal hemodynamics of transjugular retrograde obliteration (TJO) of gastric varices with gastrorenal shunt. Methods: Thirty patients with gastric varices and a gastrorenal shunt were included in this study. The patients ranged in age from 42 to 75 years (16 men and 14 women), and according to Child’s classification, class A, B and C cirrhosis was seen in 1, 13 and 16 patients, respectively. The portal blood flow was measured by an ultrasonic duplex Doppler system, and the wedged hepatic venous pressure was measured by hepatic venous catheterization, before and after TJO. Results: Complete obliteration of the gastrorenal shunt and gastric varices was revealed by retrograde inferior phrenic venography and computed tomography after TJO in all cases. The wedged hepatic venous pressure was significantly increased the day after TJO compared with that before therapy (257 ± 71 vs. 307 ± 73 mm H2O, p < 0.01). The portal venous flow was significantly increased 1 week after TJO compared with that before therapy (744 ± 190 vs. 946 ± 166 ml/min, p < 0.01). The serum albumin levels before and after TJO were 3.0 ± 0.4 and 3.1 ± 0.5 g/dl, respectively, and the total bilirubin levels were 1.5 ± 0.7 and 1.5 ± 0.8 mg/dl, respectively, neither of these parameters changing significantly. The plasma ammonia levels before and after TJO were 109 ± 62 and 67 ± 31 μg/dl, and the indocyanine green retention rates at 15 min were 31 ± 13 and 24 ± 13%, both showing a significant change (p < 0.01 and p < 0.05, respectively). Conclusions: We conclude that TJO increases portal blood flow which contributes to the decrease in plasma ammonia levels and the indocyanine green retention rate, although increasing the wedged hepatic venous pressure.
Fatal Intestinal Perforation Secondary to Fragmentation of a Celestin Tube
Authors: Evans James D. , Halloran Christopher M. , Mansour Paul , Zeiderman Michael R.
Published: April 2003

Background/Aims: Oesophageal intubation remains one of the principal methods of palliation for an obstructing oesophageal carcinoma. We present a case which illustrates a rare but fatal complication of this procedure. Methods: A 60-year-old female with oesophageal cancer presented with total dysphagia 9 months following insertion of a Celestin tube for palliation. Oesophagoscopy revealed a bolus obstruction which was successfully cleared. Two days later she developed generalised peritonitis and subsequently died. Results: A post-mortem examination demonstrated fragmentation and displacement of the distal part of the Celestin tube resulting in perforation of the small bowel. Conclusion: Celestin tube disintegration is a risk associated with long-term use, and routine replacement is indicated in patients with a prolonged survival to avoid this complication.
Needle Perforation of the Appendix
Authors: Renner Karl , Holzer Brigitte , Hochwarter Gerhard , Weihsbeck Erhard , Schiessel Rudolf
Published: April 2003

Background/Aims: Needles are among the most frequently swallowed foreign bodies. In most cases they are excreted per vias naturales, but in some cases needles can lead to perforation of the stomach or duodenum in adults. Methods: We report a case of acute appendicitis after perforation of the appendix by a swallowed needle. An appendectomy was performed without any knowledge of the reason for perforation. Results: Inspection of the resected appendix demonstrated a needle of 1.5 cm length inside the lumen of the appendix, which had caused a perforation of the distal end of the appendix. Conclusion: As seen in this case a longer-lasting nondiagnosed perforation can lead to extensive local inflammation which could have been avoided by early surgical treatment which should also be considered if the patient has very few symptoms, as in this case.
The Design and Effectiveness of Therapeutic Community Research in Europe: An Overview
Authors: Broekaert Eric , Raes Veerle , Kaplan Charles D. , Coletti Maurizio
Published: April 2003

An overview of the state of the art of research on the treatment services of the therapeutic community for drug addicts in Europe is presented. This research tradition has largely been fragmented and local in its implementation. There has been a scientific gap concerning evaluation research and the treatment services offered by the therapeutic community. The American research antecedents to the European tradition are reviewed. The essential European groups, research designs and results are presented for each country with something greater than an ad hoc study experience. The strengths and weaknesses of the research designs, results and organizations are critically assessed. Recommendations for future research are presented and referenced to specific recommendations for therapeutic community research coming out of an American National Institute on Drug Abuse Technical Review. Among the conclusions of the overview is the need for more qualitative phenomenological research to complement the existing quantitative approach.
Drug Treatment in the Baltic Countries
Authors: Subata Emilis
Published: April 2003

Illegal drug use was already a problem in the Baltic countries in the Soviet era, when the Iron Curtain was still in place. At independence the Baltic countries inherited drug treatment system, operated mainly by psychiatrists and based on inpatient system. As the Soviet treatment model was abandoned and professionals in the Baltic countries turned to the West, the drug treatment field became open to the Western drug treatment experience, especially from European countries and USA. Unexpectedly, they were to be exposed to different and often conflicting concepts of treatment modalities, which usually competed with one another in claims of being the most effective and useful. The question remains open as to which programs will be developed to meet the growing demand for treatment in each country and how widely they will be adopted.
The Dutch National Alcohol and Drugs Database: Progress in Monitoring, Monitoring in Progress
Authors: Ouwehand A.W. , van Alem V.C.M.
Published: April 2003

The Dutch Alcohol and Drug Information System (LADIS) has been operational since 1986 and covers 95% of all alcohol and drug treatment out-patient services in the Netherlands. From 1994 it has been operating as a population-based register in which contact episodes of individual clients can be linked over time with a unique code made anonymous by encryption methods. With the acceptance of the welfare law in 1998, the flow of various categories of data (diagnostic, demographic, treatment and evaluation) and the continuity of LADIS have been secured. Data capture, processing and quality control are highly automated. The information from LADIS concerns annual reports as well as numerous profiles of various groups of clients. The implementation of LADIS and the high degree of standardisation of the data collected have been strongly facilitated by the use of the underlying institutional application ADDICTIS. Within the LADIS framework, almost 95% of the (European) Treatment Demand Indicator Protocol data set on drugs can be collected.
Drug Injectors and the Cleaning of Needles and Syringes
Authors: Hughes R.A.
Published: April 2003

When people share needles and syringes they risk transmitting human immunodeficiency virus (HIV) and other infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). Cleaning needles and syringes can help to reduce, although not eliminate, these risks. This article begins by engaging with some of the literature on the cleaning of needles and syringes. Drawing on qualitative research conducted with drug injectors in England, the article then goes on to explore drug injectors’ perceptions and experiences of cleaning needles and syringes inside and outside prison. The article concludes by highlighting the implications for future research and policy making. Ultimately there should be a stronger policy response to reduce the risks associated with sharing needles and syringes inside prison, which should include the piloting of prison needle and syringe exchange schemes.
Craving Shift in Chronic Alcoholics
Authors: Junghanns Klaus , Veltrup Clemens , Wetterling Tilman
Published: April 2003

In order to investigate changes in the consumption of substances that stimulate the reward system, 222 recently detoxified alcoholics were asked about their consumptional habits before as compared to after detoxification (mixed prospective and retrospective design). Seventy-eight point two percent reported an increase in consumption of coffee, cigarettes, chocolate and other sweets, while 34.9% managed to reduce at least one of these substances. The increase was significant for coffee, chocolate and other sweets. The desire for consumption of these substances was correlated with the maximum ever experienced desire for alcohol (0.232 for coffee, 0.213 for cigarettes, 0.193 for chocolate and 0.176 for other sweets), and the actual consumption of coffee, cigarettes and sweets was correlated with the actual desire for alcohol (0.172, 0.157 and 0.245, respectively). The results lend some support to the hypothesis that psychotropic substances might serve as a kind of self-regulation against craving in this group. A possible link to biochemical theories is discussed.