bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Ulceration after Injection of Polyethylene-Glycol-Modified Interferon Alpha Associated with Visual Disturbances in a Melanoma Patient
Authors: Heinzerling Lucie , Dummer Reinhard , Wildberger Hannes , Burg Günter
Published: April 2003

Interferons are used in the therapy of multiple sclerosis, Kaposi’s sarcoma, hepatitis and melanoma. Their short half-life that requires frequent injections can be increased by polyethylene glycol (PEG) modification. A 50-year-old patient was diagnosed as having an acrolentiginous melanoma (Breslow >5 mm, Clark level IV) and inguinal lymph node metastases. After surgical excision and lymphadenectomy, immune therapy with 6.0 μg pegylated interferon α2b/kg body weight, s.c., was started. Cutaneous ulcerations at the injection sites developed 9 months after treatment initiation. The patient also developed blurred vision and presented with binasal scotomas and pathological visually evoked potentials and electroretinogram. The cutaneous ulcerations slowly healed under local therapy and reduction of the concentration of the PEG-modified interferon from 0.86 to 0.43 mg/ml. The dosage was maintained. Two months later, the therapy was stopped due to disease progression. Vision subsequently recovered. Cutaneous reactions evolved at the sites of subcutaneous injections of PEG-modified interferon α2b. Changes in vision can probably be attributed to immunotherapy.
Investigation of Annexin V Binding to Lymphocytes after Extracorporeal Photoimmunotherapy as an Early Marker of Apoptosis
Authors: Gerber Annegret , Bohne Marisela , Rasch Janet , Struy Heinz , Ansorge Siegfried , Gollnick Harald
Published: April 2003

Background: Induction of programmed cell death is assumed to be a possible effect of extracorporeal photoimmunotherapy (ECPI). Objective: In the present study lymphocytes of patients with cutaneous T cell lymphoma undergoing ECPI were investigated for early apoptotic events. Methods: Annexin V, known for its selective affinity to phospholipids, was used to detect early phases of apoptosis. Simultaneous staining with propidium iodide binding to DNA allowed detection of late apoptotic/necrotic cells. Results: At 1 h after ECPI, an increase in early apoptotic cells was found indicating a direct effect of ECPI. At 20 h after each ECPI session, a delayed increase in the number of apoptotic lymphocytes was observed in early apoptotic annexin-stained cells and in late apoptotic cells, whereas in nonirradiated cells no remarkable changes were found. Apoptosis was confirmed by altered light scattering properties and DNA fragmentation. Conclusion: The apoptotic cell death of reinfused lymphocytes is supposed to be a therapeutic effect of ECPI.
Blastoid NK Cell Leukemia/Lymphoma with Cutaneous Involvement
Authors: Ginarte M. , Abalde M.T. , Peteiro C. , Fraga M. , Alonso N. , Toribio J.
Published: April 2003

Malignant neoplasms from natural killer (NK) cells are characterized by their positivity for CD56 and absence of monoclonal TCR gene rearrangement. Recently, they have been classified into four main types (nasal and nasal-type NK cell lymphoma, aggressive NK cell leukemia/lymphoma, and blastoid NK cell leukemia/lymphoma), based on clinical features, racial predisposition, presence of azurophilic granules, immunophenotype and association with Epstein-Barr virus (EBV) infection. A 72-year-old Caucasian man presented with a malignant neoplasm comprised of blastoid cells without azurophilic granules in the Giemsa stain, with positivity for CD2, CD4, HLA-DR, CD45 and CD56, and negativity for CD3 (surface and cytoplasmic) and CD5. In situ hybridization for EBV and PCR analysis of rearrangement of the T cell receptor gene were negative. Based on these results, a diagnosis of blastoid NK cell lymphoma was made. In this case the first clinical manifestations were the cutaneous lesions, and, although the disease was already advanced at the diagnosis, the patient responded completely to the treatment and remains asymptomatic 14 months after diagnosis.
Skin Manifestations Associated with Toxocariasis: A Case-Control Study
Authors: Humbert Philippe , Niezborala Michel , Salembier Rachel , Aubin François , Piarroux Renaud , Buchet Stéphane , Barale Thérèse
Published: April 2003

Background: Human toxocariasis is one of the most common zoonotic helminthiases. The recent development of sensitive and specific diagnostic laboratory tests has led to identify a large spectrum of diseases, including cutaneous diseases, induced by Toxocara infection. Objective: The purpose of our study was to assess the risk of having a positive Toxocara ELISA test in patients with different cutaneous symptoms. Methods: The diagnosis of toxocariasis was based on an ELISA test which was performed in 653 patients suffering from different skin conditions during a prospective case-control study. Results: The excess of risk (adjusted odds ratio) of having a positive result in the Toxocara ELISA was statistically significant for 134 patients with urticaria (whatever the clinical presentation) and for 22 patients with prurigo compared to a control group (249 patients). No statistical excess of risk was observed for patients with atopic dermatitis, pruritus or non-atopic eczema. Conclusion: The authors conclude that patients suffering from urticaria or prurigo should be tested for Toxocara infection. Whether these patients should be treated with anthelminthic drugs remains to be determined in further studies.
Cocaine-Related Stevens-Johnson Syndrome
Authors: Hofbauer G.F.L. , Burg G. , Nestle F.O.
Published: April 2003

We report the case of a 26-year-old student with erosive skin changes on his oral and genital mucosa and skin as well as on his thighs twice after cocaine snorting. The second of these two episodes was documented histologically, and other underlying causes of disease were excluded. A diagnosis of recurring Stevens-Johnson syndrome was made. Treatment was initiated with bed rest, systemic prednisone at 1 mg/kg body weight and liquid nutrition. Mucosal changes resolved within 4 days. On follow-up the patient remained free of symptoms while abstaining from the particular cocaine street mix in question. Cocaine has been involved in seizures, headaches, ischemic strokes, intracerebral hemorrhage, cerebral vasculitis, Churg-Strauss vasculitis, palpable purpura and Henoch-Schönlein vasculitis. Bullous skin disease in association with cocaine has been reported in 1 patient. To our knowledge, we report the first case of Stevens-Johnson syndrome associated with cocaine snorting.
Effect of Cisapride on Gastroduodenal Reflux and Gall Bladder Motility in Patients with Gallstones
Authors: Baxter P.S. , Maddern G.J.
Published: April 2003

The aim of this work was to assess the effect of 10 mg of cisapride twice daily for 1 week on symptoms, gastroduodenal reflux and gall bladder emptying in patients undergoing cholecystectomy. Seventy-seven patients, 29 male and 48 female, underwent a randomized, double-blind, placebo-controlled trial with a 1-week treatment period between studies before cholecystectomy. Fifty-one of these patients were suitable for gall bladder emptying ejection fraction analysis. Gastroduodenal reflux and gall bladder emptying were assessed using Milk 99Tcm DIDA scans. Cisapride did not significantly alter gastroduodenal reflux but gall bladder motility was altered after cisapride treatment (p < 0.05).
Late Focal Pancreatic Metastasis of Renal Cell Carcinoma
Authors: Sahin Mustafa , Foulis Alan A.K. , Poon Fat Wui , Imrie Clement W.
Published: April 2003

Metastatic carcinoma to the pancreas is uncommon. Pancreatic metastasis from a renal cell carcinoma is exceptional, but may occur many years after the initial diagnosis and treatment of the primary tumor. Presentation of our patient mimicked a head of the pancreas carcinoma so well that it was only after the resectional phase of a Whipple operation that the diagnosis of metastatic renal carcinoma was made 18 years after left nephrectomy. The patient is alive and well 18 months after surgery, having gained weight.
Laparoscopy versus Laparotomy:Compari son of Adhesion-Formation after Bowel Resection in a Canine Model
Authors: Schippers E. , Tittel A. , Öttinger A. , Schumpelick V.
Published: April 2003

Aim: The purpose of the study was to compare adhesions following laparoscopic and conventional operations. Methods: In 14 dogs cecal resection and a deserosation of the abdominal wall were performed laparoscopically (n = 7) or by laparotomy (n = 7). After 8 days all dogs were reexamined and the adhesions were quantified by computer-aided measurements. The significance of any differences were tested using Student’s t test. Results: The extent of adhesions after laparoscopy (630 ± 360 mm2) and after laparotomy (3,300 ± 1,007 mm2) differed significantly (p < 0.0001). Extensive adhesions to the abdominal incision and interenteric adhesions were found after conventional operations. Identical manipulations, such as cecal resection or deserosation of the lateral wall, led to the same frequency and extent of adhesions in both operation groups. Conclusion: Laparoscopic procedures are associated with significantly less adhesions in comparison to conventional operations. Therefore the risk of adhesion-related complications should be reduced after laparoscopic operations.
Management of T Tubes for Common Bile Duct Stones: A New Technique
Authors: Stein David E. , Sclafani Salvatore J.A. , Kral John G.
Published: April 2003

Background: The optimal treatment of common bile duct (CBD) stones is controversial, and depends on local expertise, the patient’s medical condition and the time of diagnosis. Current practice entails a wide variation in the duration of leaving T tubes in place, anywhere from 7 to 30 days, and in the time to postoperative cholangiogram. Here we present a new technique for T-tube placement and management of secondary or retained CBD calculi that reduces T-tube duration to ≤ 5 days. Materials and Methods: After CBD exploration and clearance, we place a 10- to 18-French T tube through a 22- to 34-French straight rubber catheter with side holes acting as a sheath. The two tubes are exteriorized together, with the sheath protruding 1–2 cm. We place a colostomy bag for collecting possible abdominal drainage over the site and run the T tube through the colostomy bag into a bile bag. Results: Our method allows early removal of the T tube in patients with cleared ducts and early radiologic instrumentation of the CBD through the sheath to extract retained calculi. This obviates the need for postoperative endoscopic retrograde cholangiopancreaticography. Conclusion: This method reduces the length of hospital stay, the number of outpatient office visits and postoperative studies, and the duration of T-tube drainage, potentially decreasing the incidence of complications of T tubes, improving patient satisfaction.
Colorectal Carcinoma: Is Lymphadenectomy Useful?
Authors: Curti G. , Maurer C.A. , Büchler M.W.
Published: April 2003

In order to define the role of lymph node excision in the treatment of colorectal neoplasms, the literature of the past 20 years and the historic publications on this specific subject were reviewed. Special attention was given to statistical relevance, different types of operations, survival and recurrence rates and an attempt was made to decide on the usefulness of lymphadenectomy and which operation is the best to treat colorectal cancer.
Intractable Ascites following Surgery for Gastric Carcinoma
Authors: Kumagai Kazuhide
Published: April 2003

Over the past 11 years, I have experienced a few patients with intractable ascites after extended radical surgery for gastric carcinomas, which accounted for 1.0% (4 of 394) of all gastric carcinomas resected in our institute. These 4 patients underwent total or subtotal gastrectomy with extended lymphadenectomy, including the lymph nodes of the hepatoduodenal ligament. Histopathologic examination of an intraoperative liver biopsy specimen revealed chronic hepatitis or liver cirrhosis. The characteristics of the ascites led me to conclude that the ascites comprised liver lymphatic fluid. Surgeons must recognize that intractable ascites due to leakage of liver lymphatic fluid after gastrectomy with extended lymphadenectomy is likely to occur in patients with chronic hepatitis or liver cirrhosis.
Effects of Closed-SystemDrain in Surgery:Focus on Methicillin-ResistantStaphylococcus aureus
Authors: Tokunaga Yukihiko , Nakayama Noboru , Nishitai Ryota , Hata Koichiro , Kaganoi Junichi , Ohsumi Kiyosi
Published: April 2003

Objective: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has made a strong impact on the strategy of peri-operative antibiotic prophylaxis, since MRSA has become one of the most common causative organisms of nosocomial infection in recent years. In this study, we conducted a bacteriological evaluation of surgical drains before and after introducing strategies to decrease MRSA infection rates. Design and Patients: Between January 1987 and December 1994, we performed a total of 2,755 surgical operations on inpatients, including 1,635 major and 1,120 minor operations. Almost all surgical drains were examined bacteriologically when they were removed. The number of drains examined was 460 ± 47 (mean ± SEM) per year. Since the increased incidence of MRSA infection, we started exclusively using a closed drainage system and first-generation cephalosporins in 1991. The strategy was evaluated by comparing the positive rates of drain cultures, changes in bacteriological features, and incidence of MRSA infection for the 4-year periods before and after 1991. Results: The positive rate of bacteria in the drains decreased significantly (p < 0.01) from 25 ± 2 to 16 ± 1%. Bacteriologically, the positive rate of Staphylococcus spp. decreased significantly (p < 0.05) from 7 ± 2 to 3 ± 0.3%. Positive rates of MRSA decreased significantly (p < 0.05) from 2.1 ± 0.3 to 1.3 ± 0.3%. Streptococcus declined dramatically from 3.0 ± 0.3 to 0.3 ± 0.1%. Of gram-negative strains, Pseudomonas and Escherichia coli were most often isolated. They showed no significant difference in positive rates between the terms. Conclusion: A closed drainage system and thorough use of the first-generation cephalosporins for prophylaxis were effective in decreasing positive bacterial culture of drains and reducing the incidence of MRSA on drains after surgery.
Long-Term Measurement of Liver Microcirculation in Dogs and Humans
Authors: Kotzampassi K. , Koufogiannis D. , Farmakis H. , Herodotou A. , Eleftheriadis E.
Published: April 2003

Background: We verified the possibility of using laser Doppler fluxmetry for prolonged monitoring of hepatic perfusion; we confirm the ability of an implantable laser Doppler microprobe to be in constant ‘optical contact’ with the liver and thus to transmit a stable microcirculatory signal for a prolonged period of time, and we correlate the response of liver microcirculation to the hepatic artery blood flow reduction in order to estimate this flow by continuous monitoring of microcirculation. Method: Hepatic microcirculation was recorded by a single-fiber microprobe implanted in the livers of 8 dogs and of 5 surgical ICU patients. In another 7 dogs, liver microcirculation as well as hepatic artery blood flow were recorded digitally, while an occluder was used to decrease hepatic artery flow. Results: Analysis of the initial data of microcirculation revealed a nonsignificant variation between consecutive time segments, a finding confirming the hypothesis that laser Doppler gives a very stable signal over a long period of time. Polynomial regression analysis, performed on data pairs obtained from microcirculation and hepatic artery blood flow revealed a regression coefficient y = –54.22 + 1.07x + 0.0046x2 (y = hepatic artery blood flow, x = liver microcirculation). Conclusion: This finding means that it is possible to watch the hepatic artery flow values continuously by the use of this equation and simple monitoring of liver microcirculation. Thus, the use of laser Doppler fluxmetry with implantable microprobes seems promising as a novel method for continuous assessment of hepatic artery blood flow.
Laparoscopic Approach to Hepatic Hydatid Disease
Authors: Ertem Metin , Uras Cihan , Karahasanoglu Tayfun , Erguney Sabri , Alemdaroglu Kemal
Published: April 2003

Background: The aim of this paper is to present our brief experience on laparoscopic hydatid cyst surgery; we estimated the reproducibility of used techniques in conventional surgery with this relatively recent and attractive method. Methods: Fifteen cysts in 12 selected hydatid disease patients were treated laparoscopically. Cystotomy, partial cystectomy and drainage were performed in 9 patients. Omentoplasty was added to the procedure in the remaining 3 cases. Results: The mean postoperative hospital stay was 4.9 days. There was no mortality, and 1 patient developed bile leakage. Mean follow-up is 18 months. No recurrence was observed during this period. Conclusion: We suggest that laparoscopic treatment of hydatid disease is feasible in selected patients respecting the principles of open surgery and seems beneficial concerning postoperative comfort, hospital stay and return to daily activities.
Clinical Presentation, Diagnosis and Survival of Resected Distal Bile Duct Cancer
Authors: Zerbi Alessandro , Balzano Gianpaolo , Leone Biagio E. , Angeli Enzo , Veronesi Paolo , Di Carlo Valerio
Published: April 2003

The aim of the study was the definition of the clinical features and survival of 27 resected cases of distal bile duct carcinoma. This neoplasm accounted for 14% of all periampullary malignancies treated by pancreaticoduodenectomy between 1990 and 1996. Jaundice was present in 96% of patients, but was the first symptom only in 78%. Preoperative investigations allowed to recognize distal bile duct cancer in a minority of patients (41%). Operative mortality and morbidity were 3.7 and 44%, respectively. Most patients (88%) were assigned to UICC stage IV-A. Postoperative survival was not significantly better than survival of 101 patients undergoing pancreaticoduodenectomy for pancreatic ductal carcinoma; median survival was 22 months, with a 13% 5-year survival rate. Determinants of a better prognosis were UICC stage <IV-A (p = 0.05) and absence of lymphatic invasion (p < 0.01); prognostic significance of nodal involvement, tumor grading, perineural invasion, tumor size, pylorus preservation and adjuvant therapies could not be proven. Lymphatic invasion was the strongest determinant of survival on multivariate analysis (p < 0.01).
Possibilities and Shortcomings of Maintenance Therapy in Gastroesophageal Reflux Disease
Authors: Tytgat G.N.J.
Published: April 2003

An overview is given of the current possibilities and shortcomings of medical therapy in reflux disease. With H2-receptor antagonists and prokinetics, roughly 60% of the patients can be maintained in remission; with proton pump inhibitors, remission can be maintained in approximately 90%. Whether there is a specific symptom pattern that benefits from cisapride is insufficiently evaluated. H2-receptor antagonists insufficiently reduce food-stimulated acid secretion and suffer from a degree of tachyphylaxis. Proton pump inhibitors suffer from acid rebound and occasionally cannot prevent nocturnal acid breakthrough. In general, medical intractability is virtually nonexistent with the current pharmaceutical possibilities and is therefore no longer per se an indication for surgery.
Laparoscopic Antireflux Surgery –It’s a Wrap!
Authors: Hinder R.A. , Smith S.L. , Klingler P.J. , Branton S.A. , Floch N.R. , Seelig M.H.
Published: April 2003

The surgical management of gastroesophageal reflux disease has been simplified by the availability of minimally invasive techniques to treat this condition. The indications and selection of patients remain the same as for open surgery and initial results with laparoscopic antireflux surgery show long-term results equal to, or better than open procedure. These procedures are technically demanding requiring surgeons skilled in advanced laparoscopy. The evaluation of patients, selection of patients for surgery, surgical techniques and anticipated outcomes are discussed.
Effect of a Microwave Coagulator on Implanted Liver Neoplasms in Rats
Authors: Chen H.H. , Cooper A. , Taylor I. , Johnson C.D.
Published: April 2003

An experimental study was conducted to determine the applicability of a microwave (MW) source for coagulation and dissection of metastatic tumour and liver parenchyma. Twenty PVG rats were studied after implantation of MC28 tumour cells into the liver. Eleven days later they underwent sham laparotomy (control) MW coagulation of the tumour deposit, local resection of the tumour deposit with 2 mm clearance or resection of the tumour with MW coagulation of the resection zone. The control animals all died with blood-stained ascites and heavy tumour burden in the liver. After MW coagulation, tumours disappeared in all but one rat. Local resection also led to tumour clearance in 4 of 5 rats. MW coagulation of the resection zone allowed rapid bloodless resection, and no tumour recurrence was observed after 40–89 days. We conclude that MW coagulation is a potentially useful tool for ablation of hepatic metastasis and as an adjunct to hepatic resection.
Locoregional Dissemination and Extended Lymphadenectomy in Pancreatic Cancer
Authors: Fernández-Cruz Laureano , Johnson Colin , Dervenis Christos
Published: April 2003

Carcinoma of the pancreas is characterized by the high frequency of intrapancreatic (from 75 to 100%) and extrapancreatic neural invasion (from 64 to 69%). Even small-sized tumors (T1) show plexus invasion. Carcinoma of the pancreas is also associated with a high incidence (76%) of lymph node metastasis. The knowledge of local and regional tumor spread is mandatory in the planning of rational surgical treatment with the intention to cure. At present, it does not seem possible to predict the direction of lymph drainage leading to nodal involvement in different anatomical areas. However, the anterior and posterior pancreaticoduodenal areas are generally involved at first and nodes farther away from the primary tumor mostly show metastases only after involvement of the nearer nodes. We believe, radical pancreatoduodenectomy should be based on three aspects: wide lymph node dissection; radical retroperitoneal dissection, and pancreatectomy with an extirpation line left of the coeliac axis for tumors of the head and left pancreatectomy for tumors of the body and tail of the pancreas. Conclusions: Cure or long-term palliation of pancreatic cancer is generally possible only after complete erradication of the primary tumor, including its local and regional extensions.
Prevention and Treatment of Complications in Pancreatic Cancer Surgery
Authors: Berberat Pascal O. , Friess Helmut , Kleeff Jörg , Uhl Waldemar , Büchler Markus W.
Published: April 2003

Pancreatic cancer is the fourth leading cause of death from malignant disease in Western industrialized countries. It is a devastating disease with a very poor prognosis and has a death rate roughly equal to its incidence rate. As this tumor is resistant to all medical treatment options, such as radio- and chemotherapy, radical surgical resection is the only chance of cure so far. Significant advances have been made over the past decades in pancreaticoduodenectomy, which is the standard operation in patients with pancreatic head cancer or periampullary cancer. In specialized centers the operative mortality has fallen under 5%. However, the postoperative complication rates after this demanding procedure are still between 30 and 40%. Complications are mainly due to the technical difficulty of performing a safe and proper anastomosis between the stomach or small bowel and the soft pancreas. This article reviews the treatment of the complications most frequently occurring after pancreatic cancer surgery, such as leakage of pancreatic anastomosis, pancreatic fistula, abscess and hemorrhage. Furthermore, we discuss the management of these complications and how complications following pancreatic surgery can be prevented.
Pancreaticogastrostomy after Subtotal Pancreatectomy for Cancer
Authors: Ihse Ingemar , Axelson Jan , Hansson Lars
Published: April 2003

Background: Failure of the pancreaticodigestive anastomosis after pancreatoduodenectomy is still a major clinical problem. Pancreaticogastrostomy has recently been suggested to be associated with a low risk of leakage. The aim of this report was to add to previously reported experience. Methods: Data on the postoperative course were prospectively registered in 19 patients operated on with subtotal pancreatectomy because of periampullary cancer. They all had a duct-to-mucosa pancreaticogastrostomy. Results: There were no recognizable leakages from the pancreaticogastrostomy. However, the overall postoperative complication rate was 47% (9/19), the most common complications being delayed gastric emptying (26%, 5/19), wound infection (21%, 4/19), and wound rupture (11%, 2/19). Excluding delayed gastric emptying, the rate of intra-abdominal complications was 16% (3/19). There was 1 in-hospital death. Conclusion: The results support the opinion that pancreaticogastrostomy can be done with a low risk of leakage.
Polypoid Hamartoma of Brunner’s Gland of the Duodenum
Authors: Bastounis Elias , Pikoulis Emmanouil , Leppäniemi Ari , Tsetis Demitrios , Tsetis Andreas
Published: April 2003

Background/Aims: Brunner’s gland adenoma is an extremely rare but important entity. Controversy exists over its etiology and pathogenesis, but the present view is that it is a duodenal hamartoma with a predominance of Brunner’s gland elements. Methods: A case of a 76-year-old woman with a reddish pedunculated polyp prolapsing between the bulb and the second part of the duodenum seen at endoscopy and removed surgically through a longitudinal duodenotomy is presented. Results: The cut surface of the tumor had a grayish color, revealing multiple cystic spaces which on microscopic examination proved to be enlarged Brunner’s glands. The hyperplastic glands formed lobules which were surrounded by bundles of fibromuscular and connective tissue. In the adjacent duodenum, large numbers of lobules of well-differentiated Brunner’s glands with mucus-secreting epithelial cells were seen. Conclusion: The reported case supports the theory that Brunner’s gland adenomas are duodenal hamartomas with a predominance of Brunner’s gland elements and further shows that a continuity exists in Brunner’s glands of the tumor and those of the adjacent duodenum.
Successful Nonoperative Management of Bleeding Hepatic Artery Pseudoaneurysm following Pancreaticoduodenectomy
Authors: Aranha Gerard V. , O’Neil Stephen , Borge Marc A.
Published: April 2003

Background/Aims: To report the management of a hepatic artery pseudoaneurysm presenting 35 days following a Whipple procedure. Methods: The case study of a patient with a bleeding pseudoaneurysm is presented. Results: Computed tomography demonstrated a pseudoaneurysm which was successfully embolized. Conclusions: Acute gastrointestinal bleeding from a pseudoaneurysm in the hepatic artery following Whipple procedure can be successfully managed with transcatheter embolization.
Beneficial Effects of Lexipafant, a PAF Antagonist on Gut Barrier Dysfunction Caused by Intestinal Ischemia and Reperfusion in Rats
Authors: Sun Zhengwu , Wang Xiangdong , Deng Xiaoming , Lasson Åke , Soltesz Vasile , Börjesson Anna , Andersson Roland
Published: April 2003

Background: Platelet-activating factor (PAF) may play a pivotal role in the pathogenesis of intestinal ischemic injury. Methods: The potential role of PAF in intestinal ischemia and reperfusion (I/R) and the development of gut endothelial and epithelial barrier dysfunction and distant organ injury were investigated by pretreatment with a PAF antagonist, lexipafant. Bidirectional permeability of the intestinal barrier, enteric bacterial translocation, protease-antiprotease balance and mucosal histology, and also changes in pulmonary and liver endothelial barrier permeability were measured following intestinal ischemia for 40 min with 6 h of reperfusion in rats. Results: Intestinal mucosal endothelial and epithelial permeabilities significantly increased in animals with I/R. Lexipafant prevented the increase in albumin leakage from blood to the mucosal interstitium and the intestinal lumen during reperfusion, and the mucosal albumin leakage from the gut lumen to blood during I/R. Bacterial translocation was frequently noted in animals with I/R, while only a few positive cultures were obtained in animals with I/R administered lexipafant. Less leakage of fluorescein isothiocyanate dextran 70,000 into the interstitial space and gut lumen in I/R animals with lexipafant pretreatment was found under fluorescein microscopy. Lexipafant also partly prevented C1 inhibitor, prekallikrein, and factor X consumption in I/R animals and partly prevented changes in pulmonary and liver albumin leakage. Conclusions: PAF seems to play an important role in I/R-associated intestinal dysfunction and the development of distant organ dysfunction, probably by triggering endothelial and epithelial barrier dysfunction. Furthermore, PAF seems to be partly involved in activation of the protease-antiprotease system. The use of PAF antagonists may provide a mode of treatment against I/R-associated organ dysfunction.
Abdominal Stoma Fashioned by a Used Circular Stapler
Authors: Koltun L. , Benyamin N. , Sayfan J.
Published: April 2003

A method of application of a used circular stapler in abdominal stoma formation is described. The procedure is rapid, simple, carries less tissue trauma than the conventional methods and does not involve any additional cost. It allows for a precise circular aperture in the abdominal wall which may be optimally adjusted to the bowel diameter. This method seems to minimize the occurrence of stomal complications and particularly the incidence of troublesome parastomal hernias.
Hepatectomy Using an Ultrasonically Activated Scalpel for Hepatocellular Carcinoma
Authors: Ouchi Kiyoaki , Mikuni Junichi , Sugawara Tohoru , Ono Hidemaro , Fujiya Tsuneaki , Kamiyama Yasuhiko , Kakugawa Yoichiro , Yamanami Hideaki , Nakagawa Kunitoshi
Published: April 2003

Background: The first retrospective studies were performed to compare the efficacy of the ultrasonic cavitational aspirator (aspirator group) and the ultrasonically activated scalpel (scalpel group) for hepatic resection in patients with hepatocellular carcinoma. Patients and Methods: The aspirator group consisted of 8 patients (6 with liver cirrhosis and 2 with chronic hepatitis in the nontumorous liver), and the scalpel group of 7 patients (6 with liver cirrhosis and 1 with chronic hepatitis). All patients underwent limited hepatic resection, and the intermittent Pringle maneuver was applied during hepatic transection. Results:  There were no significant differences in preoperative hepatic function, type of hepatectomy, tumor size and maximum cross-sectional area of the resected specimen between the 2 groups. The amount of intraoperative blood loss was significantly less in the scalpel group than in the aspirator group (684 versus 1,859 ml, p < 0.05). The operation time was significanly shorter in the scalpel group than in the aspirator group (176 versus 262 min, p < 0.05). There were no significant differences in postoperative liver function and morbidity between the 2 groups. Conclusions: The ultrasonically activated scalpel is effective in reducing blood loss and in shortening the time of operation, and can be employed during limited resection of the liver with cirrhosis or chronic hepatitis.
Effects of Perioperative Treatment with TNP-470 on the Resistance of Colonic Anastomoses in Rats
Authors: García-Olmo D.C. , Payá J. , García-Olmo D.
Published: April 2003

Aims: The present study was designed to evaluate the effects of perioperative treatment with TNP-470 on the resistance of colonic anastomoses. TNP-470 is a drug that was developed as an inhibitor of angiogenesis. Methods: A colonic anastomosis was constructed in Sprague-Dawley rats. From 4 days before surgery to 4 days afterwards, each animal received daily intraperitoneal treatment that differed according to the group to which it belonged: the control group, which received gum arabic, or the TNP group, which received 30 mg/kg TNP-470 in gum arabic. The size of the cecum and the diameters of the pre-anastomotic and post-anastomotic colon were measured at operation and 4 days after surgery, when all animals were sacrificed. At this time the presence of adhesions was also investigated. Each segment containing an anastomosis was removed and the bursting pressure (BP) and bursting wall tension (BWT) were determined. Results: Loss of cecum caliber and decreases in pre-anastomotic diameter were significantly greater in the TNP group than in the control group (p = 0.017 and p = 0.004, respectively). Dilatation and obstruction of the colon were more frequent in the control group, but the difference between the groups was significant only with respect to dilatation (p = 0.005). Moreover, loss of body weight was greater in the TNP group than in the control group (p < 0.001). BP and BWT were significantly lower in animals that had received TNP-470 (p = 0.04 and p = 0.005, respectively). With respect to post-anastomotic diameter, general adhesions and adhesions to the anastomotic line, there were no statistically significant differences between the groups. Conclusions: Perioperative treatment with TNP-470, an inhibitor of angiogenesis, affects the healing and reduces the resistance of colonic anastomoses.
No Effect of Bolus Glutamine Supplementation on the Postresectional Adaptation of Small Bowel Mucosa in Rats Receiving Chow ad libitum
Authors: Yang Hua , Larsson Jörgen , Permert Johan , Braaf Ylva , Wirén Mikael
Published: April 2003

Objective: Early postoperative enteral feeding has been reported to stimulate intestinal mucosa proliferation. Dietary components influence the intestinal adaptive response after resection and glutamine is a preferential nutrient to enterocytes. The purpose of this study was to evaluate the effects of bolus glutamine supplementation on intestinal adaptation. Methods: Male Wistar rats underwent a 65% small bowel resection. The rats were divided into three groups receiving glutamine 2 g/kg/day, isonitrogenous glycine or saline by gavage for 10 days. All the rats were provided with ordinary rat chow ad libitum. Sampling was done 10 days after resection. Animals fed ordinary rat chow without surgery or specific treatment served as control. Results: Mucosal wet weight, DNA, RNA, protein contents and sucrose activity, as well as villus height increased in the ileal remnant. No significant differences in any of these parameters or body weight could be found between the three groups. Conclusion: Postoperative enteral bolus glutamine supplementation at a dose of 2 g/kg b.w. did not enhance the adaptation of the residual intestine 10 days after massive intestinal resection in the rat.
In-Continuity Fundic Bypass for Palliation in Unresectable Carcinoma of the Oesophagus: A Previously Unreported Procedure
Authors: Sharma Dhananjaya , De Silva James , Saxena Arjun , Agrawal Sunil , Raina Vijay K.
Published: April 2003

Surgical bypass for the palliation of dysphagia in patients with unresectable oesophageal carcinoma continues to be an option in developing countries, as the cost of a good quality endo-prosthesis is well beyond the means of most patients. One such case is presented in which an in-continuity fundic bypass (without resection of the lesser curvature and cardia, thereby not disconnecting the oesophago-gastric junction) was made with gratifying results with regard to quality of life. Awareness of this previously unreported procedure is important because it adds to the armamentarium of surgeons wanting to provide palliation for dysphagia and aspiration in patients with unresectable carcinoma of the oesophagus.
Two-Step Selective Clamping of IVC for Removal of Hepatocellular Carcinoma with Intracaval Extension
Authors: Togo Shinji , Shimada Hiroshi , Tanaka Kuniya , Fujii Yoshiro , Takeda Kazuhisa , Endo Itaru , Sekido Hitoshi , Kamimukai Nobuyuki , Nagahori Kaoru
Published: April 2003

Hepatocellular carcinoma (HCC) with retrohepatic intracaval extensions are difficult to treat. HCC may sometimes extend into the inferior vena cava (IVC) through two routes: via the right hepatic vein and via the inferior right hepatic vein. In such cases, in which tumor emboli are located both above and below the confluence of the hepatic vein with the IVC, we first remove the upper embolus during THVE, and then remove the lower one while the IVC is clamped obliquely in order to preserve the residual liver circulation.
Drainage of the Common Bile Duct by the Axial Transomphalic Extraperitoneal Route
Authors: Bratucu E. , Ungureanu F.D. , Ungurianu L.
Published: April 2003

Aim: A retrospective analysis was made of results obtained in 169 patients with axial transomphalic external biliary drainage, operated between 1984 and 1998. However, the authors’ experience with this method covers a total of 773 cases in which this type of drainage was used between 1966 and 1998. Method: The technique is described in detail. The use of the omphalic ligament provides a completely extraperitoneal trajectory for biliary drainage tubing inserted between the two peritoneal layers of the ligament. Results: Postoperative mortality and morbidity in the patients presented here were not related to the drainage procedure, but were related to the background illness, associated disturbances and the surgical procedures applied. Axial transomphalic biliary drainage has many indisputable advantages in comparison with other types of external biliary drainage. Indications and counterindications of the method are summarized. Conclusion: The technique is especially valuable because it protects biliary-digestive anastomoses and common biliary duct sutures, facilitating implantation of prostheses and reconstruction of the main biliary pathway, as well as benign and malignant stenoses.
Pelvic Actinomycosis Presenting as Ureteric and Rectal Stricture
Authors: Haj Mahmoud , Nasser Gattas , Loberant Norman , Cohen Isaac , Nesser Elias , Eitan Arieh
Published: April 2003

Background/Aims: Simultaneous ureteric and rectal stricture due to pelvic actinomycosis is very rare and only a few cases of either rectal or ureteric stricture have been reported. Our aim is to report a case of stricture of the rectum and the right ureter due to pelvic actinomycosis infection in a 63-year-old man. Methods: Explorative laparotomy and biopsies of the inflammatory pelvic mass were the only procedures that led to the definitive diagnosis of actinomycosis. Temporary diverting colostomy, drainage of the right ureter by a pigtail catheter and postoperative treatment with appropriate antibiotics were successful in eradicating the inflammatory process. Conclusions: Extensive pelvic masses involving pelvic viscera should be biopsied before undertaking any major surgery because of the possibility of pelvic actinomycosis.
Structure, Content and Reliability of the Munich-Composite International Diagnostic Interview (M-CIDI) Substance Use Sections
Authors: Lachner Gabriele , Wittchen Hans-Ulrich , Perkonigg Axel , Holly Alexandra , Schuster Peter , Wunderlich Ursula , Türk Dilek , Garczynski Ela , Pfister Hildegard
Published: April 2003

After reviewing currently available diagnostic assessment instruments for substance use disorders this paper describes the format and structure of the Munich-Composite International Diagnostic Interview (M-CIDI) substance disorder section. In addition, the test-retest reliability of diagnoses and criteria for nicotine, alcohol, illegal and prescription drugs, is reported. Findings obtained in community sample of adolescents and young adults indicate that the substance section is acceptable for almost all types of respondents, efficient in terms of time and ease of administration as well as reliable in terms of consistency of findings over time. The test-retest reliability over a period of an average of 1 month, as examined by two independent interviewers indicates good-to-excellent kappa values for all substance disorders assessed, with significant kappa values ranging between 0.55 for drug abuse and 0.83 for alcohol abuse. There was also fairly consistently high agreement for the assessment of single DSM-IV diagnostic criteria for abuse and dependence as well as the M-CIDI quantity-frequency and time-related questions. To conclude, although – unlike previous studies – this study was conducted in a community sample and not in patients and used considerably longer time intervals of more than a month between investigations, our M-CIDI reliability findings are at least as high as those from previous studies.
Reliability of the Romanian Version of the Alcohol Module of the WHO Alcohol Use Disorder and Associated Disabilities: Interview Schedule – Alcohol/Drug-Revised
Authors: Vrasti Radu , Grant Bridget F. , Chatterji Somnath , Üstün Bedirhan T. , Mager Doug , Olteanu Ioan , Badoi Marina
Published: April 2003

Alcohol Use Disorder and Associated Disabilities Interview Schedule – Alcohol/Drug-Revised (AUDADIS-A/D-R) is a fully structured, standardized and precoded instrument designed to evaluate alcohol and drug use disorders according to DSM-III-R, DSM-IV, and ICD-10 criteria. The AUDADIS-A/D-R has shown good to excellent reliability in both large clinical and general population samples, but prior to the conduct of the present study no data on the reliability of the Romanian version of the AUDADIS-A/D-R existed. The purpose of the present study was to examine the test-retest reliability of the alcohol module of the AUDADIS-A/D-R in a general population and clinical sample in Romania. The overall reliability of ICD-10 and DSM-IV abuse, harmful and dependence diagnoses, was found to be good to excellent, but was somewhat lower for abuse and harmful use diagnoses. The results are discussed in terms of the cultural applicability of the symptom items and within the context of the analysis of discrepant responses between the test and retest interviews.
National Treatment Systems in Global Perspective
Authors: Klingemann Harald , Klingemann Hans-Dieter
Published: April 2003

Drug policy development is mostly viewed as emerging within the nation state. Processes of diffusion of innovative policies have been neglected to a large extent. The comparative study of public policy has demonstrated, however, that diffusion is an important predictor of early policy adaptation. Thus, the analysis asks the general question of the relative importance of endogenous and exogenous effects on the development of drug policies in various countries. Specifically it describes the Swiss debate leading to the popular initiative on ‘Youth Without Drugs’ as well as the international reactions regarding its liberal outcome. Results of an expert survey show two broad types of reactions. There is one set of countries where chances for the introduction of limited heroin-prescription trials during the next 5 years are considered probable and a second set of countries which seems to be strictly status quo oriented. In the concluding section a model is suggested which systematically considers endogenous as well as exogenous predictors of ‘soft’ or ‘hard’ drug policy adoption. Results of a first tentative test of the model are encouraging for future empirical research on diffusion processes of drug policies.
Monitoring Treatment Demand for Drug Abuse in Spain: Perspective over a Decade
Authors: Alvarez-Requejo Ana , Suelves Josep M. , Brugal M. Teresa , Correa J. Francisco
Published: April 2003

The Spanish Information System on Drug Abuse (SEIT) was established in 1987 by the National Plan on Drugs, based on three indirect indicators that reflect the health effects of drug use: treatment, emergency and mortality. The treatment indicator is the core of the system, the one with the best consolidation, higher coverage and greater quantity of reliable data accumulated. The configuration of the system has a regional basis (Autonomous Communities), which strongly influences its potentialities, operation, results, strengths and limitations. Only outpatient treatment admissions, reported by ambulatory treatment centres and prison units, are recorded. Double counting is eliminated at the regional level. Over a decade of existence, the SEIT, and mainly its treatment indicator, has proven to be an excellent tool for public health action, planning and decision making, as well as for research and co-operation between regions.
An Open Study with Acamprosate in Belgium and Luxemburg: Results on Sociodemographics, Supportive Treatment and Outcome
Authors: Ansoms Constant , Deckers Frieda , Lehert Philippe , Pelc Isidore , Potgieter Adriaan
Published: April 2003

This open study on 614 alcohol-dependent patients from 51 centres in Belgium over 24 weeks collected data on the sociodemographic, medical and drug safety profiles and the type of psychosocial support most commonly associated with acamprosate. Psychiatric problems (34%) and gastro-intestinal ulcers (15%) were the most frequent other medical diagnoses. As supportive treatment, 48% of patients received individual psychotherapy, 25% group therapy, 16% relapse prevention and coping skills, 9% brief intervention and 2% family therapy. Fifteen (29%) centres used only 1 form of supportive treatment, 14 (27%) used 2 forms of support, 16 (31%) used 3 forms, 4 (8%) used 4 and only 2 centres (4%) used all 5 supportive treatment options. Three hundred and fifty-nine patients dropped out of the study. At any moment during the treatment period, up to 11% relapsed, 9% had binge drinking and 9% had drinking lapses. The quantity of alcohol consumption during relapse, lapse or binge drinking showed a considerable drop in the mean number of drinks per day, from 19.53 before treatment to 4.23–7.83 drinks for lapse drinking, 9.27–14.62 drinks for binge drinking and 4.96–10.29 drinks per day for relapse. All 8 dimensions of the SF36 quality of life questionnaire improved over the treatment period. Acamprosate was well tolerated by all patients.
Reference Typing Report for Complement Component C6: Protein Typing
Authors: Schröder H. , Correns A.
Published: April 2003

Within the C6/C7/C9 Session of the VIIth Complement Genetics Workshop and Conference, various C6 protein allotypes collected from four laboratories were examined using polyacrylamide gel isoelectric focusing (PAGIF) followed by direct immunofixation. Nineteen different variants including 17 recognized allotypes and introducing two new allotypes were distinguished besides the two common allotypes C6 A and C6 B. They were designated basically according to the previous statement on C6 nomenclature. Details on C6 DNA markers and associations of C6 markers with deficiencies of terminal complement components are published in the preceding paper of this issue.