bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Systemic Blockade of Nitric Oxide Synthases on Pulsatile LH, Prolactin, and GH Secretion in Adult Male Rats
Authors: Pinilla L. , González L.C. , Tena-Sempere M. , Bellido C. , Aguilar E.
Published: April 2003

Background: Nitric oxide (NO) has emerged as an important neurotransmitter involved in the control of the neuroendocrine function. NO acts at hypothalamic, pituitary, and gonadal levels. Previous data from our laboratory showed that blockade of NO generation, after systemic administration of a NO synthase inhibitor (Nω-nitro-arginine methyl ester, NAME), increased the luteinizing hormone (LH) secretion in intact and ovariectomized females, whereas a blockade of spontaneous and steroid-induced LH and prolactin surges after NO synthase inhibition has been also described. Methods and Results: Adult male rats were implanted with chronic intra-auricular cannulae and 5 days later sampled at 15-min intervals during 6 h (10.00–16.00 h). Administration of NAME (40 mg/kg at 08.00 and 13.00 h) stimulated significantly (p ≤ 0.01) the LH secretion, increasing LH pulse amplitude (0.58 ± 0.14 vs. 0.08 ± 0.01 ng/ml in controls), mean LH levels (0.64 ± 0.15 vs. 0.15 ± 0.03 ng/ml in controls), and area under curve (239 ± 56 vs. 57 ± 13 in controls). This effect was blocked by coadministration of sodium nitroprusside (SNP), a NO donor (0.5 mg/kg). The action of NAME was observed 3 h after administration, in contrast to the earlier response detected in female rats, and it appeared selective for LH, as prolactin and growth hormone secretion remained unchanged. Further analysis was carried out to determine whether the effect of NAME on the LH secretion was indirect and mediated by changes in testosterone release. To this end, adult male rats were decapitated 2 h after administration of NAME (40 mg/kg), SNP (0.5 mg/kg), or L-nitro-arginine methyl ester (L-AME), a substrate for NOS (1 g/kg). The serum testosterone concentrations were unchanged after NAME administration, but inhibited by SNP and L-AME. Finally, the effect of NAME and SNP on in vitro testosterone secretion was analyzed. NAME (10 mM) did not affect basal testosterone production, but inhibited the human chorionic gonadotropin stimulated testosterone secretion. Conclusions: These data strongly suggest that the stimulatory effect of NAME on LH secretion is not due to an inhibition of testosterone release and is exerted at the hypothalamic-pituitary level.
Cardiac Performance in Turner’s Syndrome Patients on Growth Hormone Therapy
Authors: Radetti Giorgio , Crepaz Roberto , Milanesi Ornella , Paganini Claudio , Cesaro Alessandra , Rigon Franco , Pitscheider Walter
Published: April 2003

Objectives: To investigate possible cardiac morphofunctional alterations observed in 26 Turner’s syndrome (TS) patients on prolonged high-dose growth hormone (GH) therapy. Study Design: We examined 26 TS subjects treated with rhGH (1 U/kg/week) for a mean period of 4.9 years (range 1–7.8) and 37 age-, weight- and height-matched healthy girls. Left ventricular volume, mass, systolic function, cardiac index, systemic vascular resistance and diastolic function were evaluated by two-dimensional and Doppler echocardiography. Results: Heart rate and systolic blood pressure (BP) were higher in TS patients than in controls, while diastolic BP was lower. Left ventricular volumes, ejection fraction, mass index, M/V ratio and cardiac index did not differ significantly; systemic vascular resistance was slightly decreased. Left ventricular fractional shortening and mean velocity of circumferential shortening were slightly increased while end-systolic meridional stress was decreased in TS. Contractile state was normal in TS. Diastolic function assessment showed a shortening of isovolumetric relaxation and diastolic filling times with an increased atrial contribution and a normal pulmonary venous flow. Conclusion: Cardiac morphology in TS patients on GH therapy is similar to controls. The observed changes in left ventricular systolic and diastolic function should be interpreted as an adaptation to the higher heart rate and reduced peripheral vascular resistance induced by GH therapy.
Extraovarian Steroid Cell Tumor ‘Not Otherwise Specified’ as a Rare Cause of Virilization in Twelve-Year-Old Girl
Authors: Dumić Miroslav , Šimunić Velimir , Ilić-Forko Jadranka , Cvitanović Marijana , Plavšić Vesna , Janjanin Nevena , Ille Jasenka
Published: April 2003

Background: We present a 12-year-old girl with a 5-year history of progressive virilization. Results: Regarding elevated plasma levels of 17-hydroxyprogesterone (17-OHP) and androgens, normal ultrasound and CT scan of ovaries and adrenal glands, the nonclassic form of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency was presumed the cause of virilization. As the glucocorticoid therapy did not normalize high levels of 17-OHP and androgens, and the DNA analysis did not demonstrate a mutation causing CAH, a laparotomy was performed. Near the right ovary a tumor was found and extirpated. Pathohistological studies determined it to be a rare steroid cell tumor, ‘not otherwise specified’. Within the next months the signs of virilization resolved and menarche occurred. Conclusions: Steroid cell tumor should be considered in differential diagnosis of virilization in childhood. Regarding the age of our patient and pathohistological findings of the tumor, her prognosis is favorable.
Successful Pregnancy in a Woman with Ovarian Failure Associated with Mutation in the β-Subunit of Luteinizing Hormone
Authors: Takahashi Kentaro , Ozaki Tomoya , Kanasaki Haruhiko , Miyazaki Kohji
Published: April 2003

Background: We report a successful pregnancy in a woman with severe ovarian dysfunction and infertility associated with a variant β-subunit of luteinizing hormone (LH). Method/Outcome: A 35-year-old woman consulted our unit for infertility. Laparoscopy and ultrasonography showed obstruction of the right tube and ovulation from the right ovary only. Human menopausal gonadotrophin (hMG) therapy was used for six subsequent cycles, but did not result in conception. Subsequently, marked elevation of follicle-stimulating hormone (FSH) and testosterone, together with polycystic ovary (PCO) were noted. The patient failed to respond to ovarian stimulation by hMG. Severe ovarian dysfunction such as premature ovarian failure (POF) was strongly suspected. Sequence analysis of the LH β-subunit gene indicated heterozygosity for point mutations Trp8 to Arg8 and Ile15 to Thr15 in the coding sequence. LH hypersecretion resembling that seen in PCO syndrome was observed. Induction of ovulation by hMG was successful in the first cycle in which the basal LH and FSH were well controlled with gonadotrophin-releasing hormone analog following estrogen-progesterone replacement. She conceived and delivered a healthy male infant at term. Conclusion: Clinicians should be clinically aware of patients with immunologically anomalous LH variant who might be at risk of developing ovarian failure within a relatively short time span. Pertinent treatment should be applied without delay in such cases.
Mechanism of Bradykinin-Induced Ca2+ Mobilization in MG63 Human Osteosarcoma Cells
Authors: Wang Jun-Wen , Su Warren , Law Yee-Ping , Lu Cheng-Hsien , Chen Yu-Chih , Wang Jue-Long , Chang Hsin-Ju , Chen Wei-Chung , Jan Chung-Ren
Published: April 2003

Background: The effect of bradykinin on intracellular free Ca2+ levels ([Ca2+]i) in MG63 human osteosarcoma cells was explored using fura-2 as a Ca2+ dye. Methods/Results: Bradykinin (0.1 nM–1 µM) increased [Ca2+]i in a concentration-dependent manner with an EC50 value of 0.5 nM. The [Ca2+]i signal comprised an initial peak and a fast decay which returned to baseline in 2 min. Extracellular Ca2+ removal inhibited the peak [Ca2+]i signals by 35 ± 3%. Bradykinin (1 nM) failed to increase [Ca2+]i in the absence of extracellular Ca2+ after cells were pretreated with thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor; 1 µM). Bradykinin (1 nM)-induced intracellular Ca2+ release was nearly abolished by inhibiting phospholipase C with 2 µM 1-(6-((17β-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl)-1H-pyrrole-2,5-dione (U73122). The [Ca2+]i increase induced by 1 nM bradykinin in Ca2+- free medium was abolished by 1 nM HOE 140 (a B2 bradykinin receptor antagonist) but was not altered by 100 nM Des-Arg-HOE 140 (a B1 bradykinin receptor antagonist). Pretreatment with 1 pM pertussis toxin for 5 h in Ca2+ medium inhibited 30 ± 3% of 1 nM bradykinin-induced peak [Ca2+]i increase. Conclusions: Together, this study shows that bradykinin induced [Ca2+]i increases in a concentration-dependent manner, by stimulating B2 bradykinin receptors leading to mobilization of Ca2+ from the thapsigargin-sensitive stores in a manner dependent on inositol-1,4,5-trisphosphate, and also by inducing extracellular Ca2+ influx. The bradykinin response was partly coupled to a pertussis toxin-sensitive G protein pathway.
Neonatal Screening Program for Congenital Adrenal Hyperplasia: Adjustments to the Recall Protocol
Authors: Gruñeiro-Papendieck Laura , Prieto Laura , Chiesa Ana , Bengolea Sonia , Bossi Graciela , Bergadá César
Published: April 2003

Objective: To evaluate the influence of gestational age (GA) and birth weight (BW) on 17α-OH-progesterone (17-OHP) levels with respect to their impact on the recall rate of neonatal screening programs for congenital adrenal hyperplasia (CAH). Patients and Methods: In June 1997 we began a pilot screening program for CAH measuring 17-OHP using a fluoroimmunoassay method (DELFIA) on dried blood spots. Until September 1999, 24,153 babies were screened. Among them, we analyzed the levels of 17-OHP in 1,313 samples from healthy preterm babies (23–36 weeks) and 1,500 term babies (>37 weeks), grouped according to GA and BW. All preterm babies underwent another sampling in their 2nd week of life. Results: 5 CAHs were detected. The 30-nmol/l cutoff limit for 17-OHP in blood corresponded to the calculated 99th percentile in term newborns, while in preterm babies higher levels were found. GA and BW correlated inversely with 17-OHP levels. Conclusion: GA and BW were useful tools to adjust cutoff levels, obtaining a significant reduction in follow-up testing and psychological stress for families. The high false-positive recall rate in preterm babies can be substantially lowered with adjusted GA and/or BW criteria.
Effects of Long-Term Enalapril and Losartan Therapy of Hypertension on Cardiovascular Aldosterone
Authors: Li Shumei , Wu Pingsheng , Zhong Shishun , Guo Zhigang , Lai Wenyan , Zhang Yuanhui , Liang Xinwei , Xiu Jiancheng , Li Jianhua , Liu Yili
Published: April 2003

Background: Plasma aldosterone escape is found during long-term angiotensin-converting enzyme inhibitor therapy. Evidence for aldosterone production in cardiovascular tissues raised the question of whether or not aldosterone escape occurs in these tissues. Method: Spontaneously hypertensive rats were treated with enalapril (20 mg/kg/day) and losartan (50 mg/kg/day) for 20 weeks; untreated spontaneously hypertensive and Wistar rats were used as positive and normal controls, respectively. Ex vivo mesenteric artery and heart perfusion, high-performance liquid chromatography, and radioimmunoassay for aldosterone were performed. Results: The results showed that enalapril failed to significantly inhibit aldosterone production in mesenteric artery, myocardium and plasma. Losartan significantly inhibited aldosterone production to that of Wistar rats in the mesenteric artery, myocardium and plasma. Conclusion: This study provides the first evidence that long-term angiotensin-converting enzyme inhibition therapy induces aldosterone escape in hypertensive cardiovascular tissues, and angiotensin II subtype 1 receptor antagonist does not induce aldosterone escape in mesenteric artery, myocardium and plasma of spontaneously hypertensive rats.
Modulation of Gene-Gun-Mediated Th2 Immunity to Hepatitis B Surface Antigen by Bacterial CpG Motifs or IL-12
Authors: Schirmbeck Reinhold , Reimann Jörg
Published: April 2003

Using different DNA vaccination techniques, we studied the IgG1/IgG2a antibody and MHC-I-restricted cytotoxic T lymphocyte (CTL) responses to the hepatitis B surface antigen (HBsAg) in mice. A single intramuscular injection of 100 µg HBsAg-encoding pCI/S plasmid DNA efficiently primed IgG2a antibody (IgG1/IgG2a ratio <0.3) and CTL responses to HBsAg (Th1 immunity). In contrast, a single intradermal injection of 1 µg of particle-coated pCI/S DNA with the gene-gun-primed IgG1 antibody responses to HBsAg (IgG1/IgG2a ratio >80) but there was no CTL response (Th2 immunity). Injection of immune-stimulating CpG-containing oligodeoxy-nucleotides (ODN) into the skin area used for gene-gun-mediated pCI/S DNA delivery shifted the polarization of the response towards Th1 immunity. A similar shift from Th2 to Th1 immunity was observed when the skin area used for gene-gun-mediated DNA transfer was conditioned by injection of recombinant IL-12. DNA vaccination can thus prime polarized immunity to HBsAg. The polarization of immunity is determined by the technique of plasmid DNA delivery as well as by conditions of the tissue into which DNA is inoculated. Th1 immunity to HBsAg (primed by injection of naked pCI/S DNA) dominated Th2 immunity (primed by gene-gun-mediated pCI/S DNA). In contrast, an established HBsAg-specific Th2 immunity was readily shifted towards Th1 immunity (including specific CTL priming) by an intramuscular boost injection of pCI/S DNA. These data contribute to the rational design of DNA vaccination strategies to efficiently prime anti-viral Th1 immune effector specificities using the gene gun.
Emergence of Rotavirus G4P8 Strain among Children Suffering from Watery Diarrhea in Calcutta, India
Authors: Khetawat Dimple , Dutta Phalguni , Gupta Sanjeev , Chakrabarti Sekhar
Published: April 2003

Rotavirus RNAs from the fecal samples were hybridized with cDNAs specific for G1 and G2 genotypes. 59 out of 138 samples (42.7%) did not hybridize with either probe. The cDNAs coding for VP7 and VP4 from one such sample, SC134, were synthesized by combined reverse transcriptase/polymerase chain reaction (PCR) using specific oligonucleotide primers and were used as probes to screen those local isolates which did not hybridize with either G1 or G2. 26/59 (44%) of fecal RNA hybridized with these cDNAs indicating a possible emergence of this strain in this part of India. The VP7 and VP4 genotype specificity of SC134 was found to be G4P8 by multiplex PCR. The VP7 gene of SC134 was cloned and characterized in detail by restriction enzyme digestion and DNA sequence analysis. Comparison of nucleotide and predicted amino acid sequence of the VP7 gene of SC134 with other serotypes revealed that the VP7 gene of SC134 was closely related to G4. However, amio acids within the VP7 sequence differed in seven positions with that of both the subtype ‘A’ and ‘B’ of the G4 serotype. To establish the relation of this emerging strain with the other reported G4 strains, a phylogenetic tree was constructed and SC134 was found to be more closely related to the ST3 strain isolated in England and included in the tetravalent vaccine formulation along with two Japanese strains, although all four were distinct and did not form any cluster as was evident by the horizontal distance separating them. The VP7 gene sequence of SC134 was submitted to EMBL and was assigned the accession number AJ278217.
Recombination Hot Spot of Hepatitis B Virus Genome Binds to Members of the HMG Domain Protein Family and the Y Box Binding Protein Family; Implication of These Proteins in Genomic Instability
Authors: Kajino Kazunori , Yamamoto Toshiki , Hayashi Junpei , Umeda Tomoyuki , Takahara Tomoko , Hino Okio
Published: April 2003

Objective: Previously we hypothesized that the occurrence of hepatocellular carcinoma (HCC) is enhanced by genomic instability induced by the integrated hepatitis B virus (HBV) DNA. Using an in vitro recombination assay, we showed that a subgenomic fragment of HBV DNA designated 15AB (nt1855–1914) is indispensable for in vitro recombination, and also showed the existence of 15AB binding protein. On the assumption that the 15AB binding protein may be a candidate cellular recombinogenic protein which accelerates genomic instability and hepatocarcinogenesis, we tried to isolate it by southwestern screening. Results and Conclusion: We obtained several positive clones including mouse upstream binding factor (UBF) and DNA binding protein A (dbpA). UBF belongs to an HMG domain protein family and dbpA belongs to a Y box binding protein family. 15AB binding seemed to be mediated by the conserved DNA binding domains in these families, because other members in the families such as HMG1 and YB-1 also bound to 15AB. We report them here because several documents have already suggested the possible association of these families and DNA recombination.
Respiratory Syncytial Virus Enhances the Expression of CD11b Molecules and the Generation of Superoxide Anion by Human Eosinophils Primed with Platelet-Activating Factor
Authors: Tachibana Atsushi , Kimura Hirokazu , Kato Masahiko , Nako Yasushi , Kozawa Kunihisa , Morikawa Akihiro
Published: April 2003

Background: Human respiratory syncytial virus (RSV) infection in infancy and early childhood causes acute bronchiolitis and exacerbates bronchial asthma. Eosinophil infiltration may contribute to airway obstruction in RSV infection. Objective: We hypothesized that RSV affects eosinophil function. Methods: Eosinophil activation was evaluated by chemiluminescent detection of superoxide anion (O–2) generation. Expression of CD11b on eosinophils was determined by flow cytometry. Results: Although RSV did not induce O–2 generation by resting eosinophils, RSV enhanced O–2 generation of eosinophils primed with platelet-activating factor (PAF). Enhancement was significantly inhibited by either continuous agitation to prevent eosinophil adhesion to test tube surfaces or by pretreating cells with anti-CD18 antibody, suggesting that the stimulatory effects of RSV on eosinophils depend on cell adhesion via β2-integrins. In fact, RSV enhanced PAF-induced CD11b expression by eosinophils. Conclusion: These findings suggest that RSV enhances eosinophil CD11b expression and O–2 generation induced by PAF. Thus, RSV infection may exacerbate airway inflammation by enhancing mediator release from eosinophils.
Distinct Mutational Drug Resistance Profiles of HIV-1 RNA in Plasma and Culture Isolates of Patients Receiving Antiretroviral Therapy
Authors: Debiaggi Maurizia , Bruno Raffaele , Sacchi Paolo , Achilli Giorgio , Romero Egidio , Filice Gaetano
Published: April 2003

The differences in profiles of HIV mutational drug resistance between paired plasma samples and culture isolates were analyzed in treated and untreated HIV-infected patients. The DNA sequence of the entire protease gene and codons 1–320 of the reverse transcriptase gene was analyzed from the paired plasma samples and viral isolates. Differences in the distribution of resistance mutations from the two sources were detected in 13 of 14 patients receiving antiretroviral therapy. Some excess mutations, observed in plasma samples but not in culture isolates, are reportedly associated with resistance to antiretroviral drugs. These results emphasize the need for standardization and clinical laboratory use of phenotypic assays that avoid extensive cocultivation.
Profound Sex-Specific Effects on Incubation Times for Transmission of Bovine Spongiform Encephalopathy to Mice
Authors: Abiola Oduola O. , Iyegbe Conrad , Lantos Peter , Plomin Robert , Anderton Brian H. , Whatley Stephen A.
Published: April 2003

Four strains of mice were inoculated intracerebrally with a primary isolate of bovine spongiform encephalopathy (BSE) and the cloned mouse-adapted scrapie strain ME7. Clinical prion disease diagnosis was made at the appearance of three or more neurological symptoms and their persistence for 3 consecutive weeks and confirmed by neuropathological criteria. For BSE, incubation periods were profoundly different between the sexes in all four mouse strains, being longer in the females. In contrast, ME7 scrapie incubation times were similar between the sexes. Our results indicate that sex-specific processes are involved in the course of primary BSE transmission. Research into this phenomenon may provide clues to the prophylaxis of BSE and have possible implications for new variant Creutzfeldt-Jakob disease in humans.
Ileal Neobladder for Urinary Bladder Replacement following Total Pelvic Exenteration for Rectal Carcinoma
Authors: Yamamoto Shunji , Yamanaka Nozomu , Maeda Toshiki , Uchida Yasuyuki , Yabe Shin-ichi , Nakano Masato , Sakano Sigeru , Yamada Yuji , Takenaka Atsushi , Yamamoto Masayuki
Published: April 2003

Objective: The aim of this study was to determine the feasibility of using the ileal neobladder as a substitute for the urinary bladder following total pelvic exenteration for rectal carcinoma. Patients and Methods: Between 1992 and 1998, we performed total pelvic exenteration with ileal neobladder in 5 men with rectal carcinoma. Four patients had primary tumors, and one had recurrent disease after low anterior resection for rectal carcinoma. Histological types were adenocarcinoma in 4 and squamous cell carcinoma in 1. Invaded organs were: the urinary bladder in 1, the urinary bladder and prostate in 2, the prostate and seminal vesicle in 1, and the prostate in 1. Results: There was no operative death. In 1 patient, an ileal conduit was needed because of partial necrosis of the neobladder. Minor leakage on the dorsal wall of the neobladder occurred in 2 patients, which was successfully stopped with simple closure and a gluteus maximus fasciocutaneous flap, respectively. All except one patient with the ileal conduit could void via the urethra. Complete daytime urinary continence was achieved, but nocturnal continence was maintained with voiding once or twice per night. As the urodynamic state, the mean maximum flow rate was 20.9 ml/s (range 9.0–34.1), the mean average flow rate was 7.7 ml/s (range 3.0–11.0), and the mean voided volume was 285.5 ml (range 160–432). The mean length of follow-up was 47.8 months. One patient died of local recurrence 38 months postoperatively, and 1 died of pneumonia 10 months postoperatively. Both patients could void via the urethra until death. The other three patients are currently alive without any evidence of recurrence. Conclusions: Although total pelvic exenteration is a laborious surgical procedure, an ileal neobladder could be a good alternative to the urinary bladder enabling the patients to void via the urethra with urinary continence.
Resection of Spleno-Renal Shunt Resulting in Enhanced Liver Volume in a Patient with Congenital Portosystemic Shunt Concomitant with Early Gastric Cancer
Authors: Sato Yoshinobu , Mitsuma Chieko , Iwaya Akira , Kurosaki Isao , Shirai Yoshio , Hatakeyama Katsuyoshi
Published: April 2003

A 73-year-old man recurring hepatic encephalopathy due to a congenital splenorenal shunt concomitant with early gastric cancer was successfully treated by surgical intervention. The portal pressures before and after the shunt resection were 13.5 and 18 cm H2O, respectively. The liver was slightly atrophic and the histological specimen showed slight fibrosis and mild infiltration of lymphocytes in the portal area. After the operation, the encephalopathy was improved and the several factors of liver function also recovered. Interestingly, the liver volume estimated by abdominal CT clearly increased 1 month after the shunt resection. The encephalopathy in congenital portosystemic shunt might result from chronic liver ischemia and atrophy. Moreover, the shunt resection may enlarge the functional liver volume by increasing the portal blood flow.
Pancreatoblastoma: Ultrastructural and Image DNA Cytometric Analysis
Authors: Riesener Klaus-Peter , Kasperk Reinhard , Füzesi Laszlo , Schumpelick Volker
Published: April 2003

Background: Since the first description of a pancreatoblastoma as a malignant pancreatic tumour of childhood in 1957, approximately 60 cases have been reported. We present the symptoms, pathology, and therapy of this rare tumour in a 17-year-old girl. Case Report: The patient initially presented with upper gastro-intestinal bleeding. During laparotomy a 16-cm (diameter) tumour was recognized in the pancreatic tail. Open biopsy and radical resection, followed by histological and immunohistochemical examinations, confirmed the diagnosis of a pancreatoblastoma. The results of single-cell DNA cytometry underlined the low DNA grade of malignancy of the primary tumour. In spite of adjuvant chemotherapy with cisplatin and adriamycin, the patient returned 22 months later with many hepatic and peritoneal metastases measuring up to 5 cm in diameter. Peritoneal tumour debulking and an extended hemihepatectomy were performed as a palliative treatment. Unfortunately, the patient died 18 months later from further tumour progression. Conclusions: A review of the literature reveals that a pancreatoblastoma in childhood has to be considered malignant, but usually shows a favourable prognosis in contrast to pancreatic neoplasms in adult patients. The treatment of choice is radical resection. Adjuvant chemotherapy or radiotherapy should be considered because of the metastatic potential of the tumour.
Preoperative Biliary Drainage before Resection in Obstructive Jaundice
Authors: Aly E.A.H. , Johnson C.D.
Published: April 2003

Background: Surgery for patients with malignant obstructive jaundice carries high morbidity and mortality rates. Preoperative biliary drainage (PBD) has been used in an attempt to improve the outcome in these patients. Aim: To review the evidence in the literature on whether PBD improves postoperative morbidity and mortality in obstructive jaundice patients. Method: Using Medline a literature search was performed for papers published in English from January 1980 to October 2000, using the text words ‘obstructive jaundice’, ‘preoperative’, ‘drainage’ and ‘stent’. All retrieved papers which reported experimental or clinical observations relevant to the study aim were carefully analysed and the findings are summarised in this review. Results and Conclusion: There is no evidence in the literature to support the view that routine PBD improves postoperative morbidity and mortality in patients with obstructive jaundice undergoing resection. PBD has its own complications that cancel out its benefits. However, PBD could be beneficial in patients presenting with sepsis, coagulation abnormalities or malnutrition.
Anterior versus Posterior Slippage: Two Different Types of Eccentric Pouch Dilatation in Patients with Adjustable Laparoscopic Gastric Banding
Authors: Wiesner Walter , Weber Markus , Hauser Renward S. , Hauser Markus , Schoeb Othmar
Published: April 2003

Purpose: To describe two different types of band dislocation that may occur in morbidly obese patients following adjustable laparoscopic gastric banding (ALGB) with the LAP-BAND. Materials and Methods: 170 morbidly obese patients were treated with an LAP-BAND at our institution. In the first 20 patients the band was positioned transbursally, which means that the lesser sac is penetrated during laparoscopic band implantation. In the following 150 patients the operation technique was changed to suprabursal band positioning where the lesser sac is not penetrated. Plain radiographs and single contrast studies of all patients who developed band instability in the follow-up were analyzed retrospectively and compared to the clinical and intraoperative findings and to the operation technique used. Results: Over a time period of 3.5 years ‘posterior slippage’ occurred in all 20 patients with transbursal band placement, but it never occurred after suprabursal band placement. Never- theless 4 patients with suprabursal band placement presented with an eccentric pouch dilatation, secondary to ‘anterior slippage’ after the seromuscular stitches had burst on the anterior and superior surface of the band. All these patients presented with food intolerance and all of them had to be reoperated. The radiographic findings were pathognomonic for each type of band dislocation. Conclusion: Band dislocation is a known major complication that may occur following ALGB and it may present in two different forms. While ‘posterior slippage’ can be avoided if the band is placed suprabursally, ‘anterior slippage’ may still occur. It is important to be familiar with both types of band dislocation since they require early detection and surgical band replacement or band refixation.
Proximal Gastric Diverticulum after Anterior Lesser Curve Seromyotomy
Authors: Cruz C. , Siriwardena A.K.
Published: April 2003

A case of gastric diverticulum arising in a patient who had previously undergone anterior lesser curve seromyotomy for chronic duodenal ulcer disease is reported. The endoscopic appearance of this lesion is described and the potential mechanisms of causation are reviewed. The clinical relevance of this rare finding is examined with emphasis on the need for an index of awareness of this abnormality on the part of endoscopists and in particular, on the risks of injudicious biopsy of such a diverticulum.
Acute Cholecystitis Secondary to Hemobilia after Percutaneous Liver Biopsy
Authors: Coelho Júlio C.U. , Bonin Eduardo A. , da Costa Marco A.R. , da Cunha Andréia G.P. , Sartor Marcio A.
Published: April 2003

A case of obstructive acute cholecystitis following percutaneous liver biopsy is presented. The patient complained of intense and continuous pain in the right upper quadrant of the abdomen 2 days after the liver biopsy. On abdominal examination, Murphy’s sign was present. Hemogram revealed a fall in the hematocrit level from 44 to 38 because of hemobilia. Ultrasonography showed a dilated gallbladder with moderate thickness of the wall and a blood clot of 20 × 9 mm inside. The patient was subjected to laparoscopic cholecystectomy. The acute inflammation of the gallbladder was secondary to obstruction of the cystic duct by the blood clot. The postoperative period was uneventful.
Arthritis as a Rare Extra-Intestinal Manifestation of Acute Sigmoid Diverticulitis
Authors: Alba Sergio , Nascimbeni Riccardo , Di Betta Ernesto , Villanacci Vincenzo , Salerni Bruno
Published: April 2003

Background: A causal association between acute diverticulitis of the sigmoid colon and arthritis has rarely been reported. Case Report: We report the case of a 60-year-old patient who developed migrating arthritis of the knee and ankle during the recurring episode of acute diverticulitis of the sigmoid colon. Treatment with NSAIDs and antibiotics had little effect on joint disease, but medical treatment was successful in reducing the diverticulitis-related symptoms. Arthritis promptly improved after surgical resection of the sigmoid colon, and 30 months later the patient is free of symptoms in the previously affected joints. Conclusions: Five cases of diverticulitis-associated arthritis have been reported. The similar case reported here reconfirms that joint disease has a limited response to medical approaches. Colon resection is recommended for patients with diverticulitis-associated arthritis which does not respond promptly to antibiotic therapy.
Interposed Colon between Remnants of the Small Intestine Exhibits Small Bowel Features in a Patient with Short Bowel Syndrome
Authors: Kono Koji , Sekikawa Takayoshi , Iizuka Hidehiko , Takahashi Akihiro , Amemiya Hideki , Takehana Takuo , Ooi Akishi , Fujii Hideki , Matsumoto Yoshiro
Published: April 2003

We describe herein the case of a 48-year-old man who underwent emergency massive resection of the small intestine due to a strangulated ileus, which led to short bowel syndrome (SBS), as he was left with only 7 cm of jejunum and 8 cm of ileum with ileocecal valve. He then received interposition of a colon segment between the jejunum and ileum remnants isoperistaltically. For 24 months after the operation, he has been able to tolerate oral intake, but still requires partial home parenteral nutritional support during the night on a bimonthly basis. Biochemical and nutritional parameters, including the analysis of minerals and trace elements, indicated that the patient was in relatively good health. Histological examination revealed that the mucosa of the interposed colon showed hypertrophy and hyperplasia of the crypt glands, and cells resembling Paneth cells which are usually seen in the small intestine, suggesting that the colon segment exhibits adaptive changes to the small intestine. Colon interposition may be a useful technique in patients with SBS when the small bowel is too short for the other surgical considerations.
Novel Operative Management of Primary Mesenteric Volvulus
Authors: Kreisler-Marino E. , Reid M.E. , Gordon P.H.
Published: April 2003

Mesenteric volvulus is a potentially life-threatening condition. Little information is available for the recommended treatment of viable bowel and virtually no information is available for the suggested elective treatment of a mesenteric volvulus. This communication details a series of enteropexies that were successful in the management of this disorder.
Surgical Treatment of Intrabiliary Rupture of Hydatid Cysts of Liver: Comparison of Choledochoduodenostomy with T-Tube Drainage
Authors: Elbir Orhan , Gundogdu Haldun , Caglikulekci Mehmet , Kayaalp Cuneyt , Atalay Fuat , Savkilioglu Metin , Seven Canbek
Published: April 2003

Background: Intrabiliary rupture is one of the most serious complications of liver hydatid cysts (LHC). The kind of surgery for these patients is still controversial. T-tube drainage and choledochoduodenostomy (CD) are used by most of the surgeons. But there is no comparative study in the literature. Methods: Eighty patients with symptomatic intrabiliary rupture were treated between 1980 and 1995. All patients had jaundice. In addition to treatment of the cyst cavity, T-tube drainage of the common bile duct (CBD) was performed in 53 patients, 25 patients underwent a CD for biliary drainage and two patients were treated by a T-tube placed in the CBD without treating the cyst. The T-tube drainage and CD groups were compared in regard to morbidity, mortality, duration of the operation, rate of relaparatomy and duration of postoperative hospital stay. Results: The morbidity rate was 40% (10/25) after CD and 18.1% (10/55) after T-tube drainage. Relaparatomy was necessary in 8% (2/25) and 1.8% (1/55) of patients treated with CD and T-tube drainage, respectively. T-tube drainage was performed much more rapidly than CD (p < 0.05). The length of hospital stay for both groups was the same. One patient who was treated with CD died postoperatively. Conclusion: Our results suggest that T-tube drainage is superior to CD for intrabiliary rupture of LHC in most cases.
Lipoma of the Liver Associated with Hepatocellular Carcinoma and Polycystic Liver Disease
Authors: Jover J.M. , Carabias A. , Ramos J.L. , Ortega P. , Ruiz de Adana J.C. , Azcoita Moreno
Published: April 2003

Background/Aims: We report on a patient with lipoma of the liver associated with hepatocellular carcinoma (HCC) and polycystic liver disease. Methods: Clinical features of a patient with lipoma, HCC and polycystic liver disease are presented. A right liver lobectomy was performed. Results: Histological examination revealed a poorly differentiated multicentric HCC, as well as bile duct cysts and an encapsulated tumor of adipose tissue. The postoperative course was uncomplicated. The patient died 4 years after surgery with local recurrence of HCC. Conclusion: We find the report to be of interest because of the unusual nature of this association and the low prevalence of lipoma of the liver. The association of liver polycystic disease with other types of tumor is discussed and the literature dealing with lipomas of the liver reviewed.
Behçet’s Disease and Diverticulosis
Authors: Sahan Cem , Akpolat Tekin , Üçer Tanja , Güner Ertuğrul , Dilek Melda , Danaci Murat
Published: April 2003

Behçet’s disease (BD) is a multisystem disorder characterized by vasculitis. The aim of this report is to present a patient with BD and diverticular disease of the colon and discuss the possible association between BD and diverticulosis. To our knowledge, diverticular disease of the colon has not been previously reported in a patient with BD. We conclude that the significance of this association between BD and diverticulosis needs to be clarified.
Isolated Duodeno-Pancreatic Involvement due to Metastatic Dysgerminoma Ovary and Its Management by a Modified Pancreatico-Duodenal Resection
Authors: Ramesh H. , Philip Mathew , Jacob George , Lekha V. , Venugopal A. , Mahadevan Pushpa
Published: April 2003

Dysgerminomas of the ovary rarely metastasize to abdominal viscera and when they do, the involvement is a part of a disseminated disease. A 30-year-old woman developed isolated duodenopancreatic dysgerminoma 14 years after salpingo-oophorectomy. The clinical picture was complicated by the presence of tuberculous lesions in the liver which mimicked metastatic disease. Surgical excision was carried out using a modified pancreatic head resection.
Psychiatric Morbidity among Medical Out-Patients in Kuwait: Evaluation of a Somatic Inventory to Identify the Psychiatric from the Non-Psychiatric Patients
Authors: Zahid M.A. , Motaal M.A.A. , Razik M.A.
Published: April 2003

Objectives: The aim of this study was to evaluate the Bradford Somatic Inventory (BSI), a 21-item questionnaire, to identify psychiatric patients attending a general hospital medical clinic in Kuwait. Methods: The sample consisted of 100 new general hospital medical out-patient clinic attendees. All patients were administered the BSI, and their psychiatric status was established by administration of the Present State Examination. All the patients who met the criteria of the International Classification of Diseases, 10th revision (ICD-10), were grouped as ‘psychiatric’ while the remaining subjects were regarded as ‘non-psychiatric’ patients. The frequency of endorsement and the total BSI scores were computed to determine sensitivity, specificity and positive predictive values of the BSI. Results: Fifty-one of the psychiatric patients met the ICD-10 diagnostic criteria. The psychiatric group reported a significantly higher number of BSI symptoms and had a significantly higher mean BSI total score than the non-psychiatric patients. Using a cut-off score of 13/14, the BSI-21 yielded a sensitivity rate of 72.5% and a specificity rate of 73.47%. Evaluation of a shorter version, the BSI-15, comprising the most frequently endorsed items by the psychiatric patients, revealed similar results. Conclusions: The findings suggest that the BSI-21 is a potentially useful screening instrument to identify psychiatric patients attending general medical out-patient clinics. The shorter version, BSI-15, is easier to administer and equally effective in discriminating the psychiatric from the non-psychiatric group of medical patients.
Percutaneous Catheter Drainage of Pancreatic Pseudocysts: Five Years Experience
Authors: Al Saeed Osama M. , Casillas Javier , Sheikh Mehraj
Published: April 2003

Objective: Pancreatic pseudocysts are common complications of pancreatitis. Pseudocysts can be treated by various drainage procedures such as endoscopic cystenterostomy or transpapillary drainage, percutaneously with image guidance or operatively. We report our experience with image-guided percutaneous evacuation of pancreatic pseudocysts. Materials and Methods: This retrospective study was conducted on 37 consecutive patients who underwent 45 percutaneous catheter placements for the drainage of pseudocysts. The catheters were introduced under ultrasound or computerized tomography guidance. The patients were followed up with a fluoroscopic catheter check for evaluation of size of collection, communication with gastrointestinal tract and the pancreatic duct. The catheter was removed when the patient was asymptomatic and the output from the catheter was less than 10 cm3 in 24 h. Results: Forty-five procedures of percutaneous drainage of pancreatic pseudocysts were performed in 37 consecutive patients. The size of the cysts ranged between 4 and 20 cm. Drainage was performed on cysts larger than 5 cm in diameter. Forty-eight percent of the patients had communication with the pancreatic duct. Percutaneous drainage was successful in 95% of the cases in our study regardless of pseudocyst communication with the main pancreatic duct. The average duration of catheter drainage was 30 days in cases without communication versus 33 days in patients with communication with the pancreatic duct. Conclusion: Percutaneous drainage is a safe and effective alternative to surgery in patients with pancreatic pseudocysts. The duration of catheter drainage in cases with or without communication with the pancreatic duct was nearly the same.
Adrenal Contribution to Polycystic Ovary Syndrome
Authors: Bayoumy H.A. , Alothman A.N.
Published: April 2003

Objective: To examine further the dynamics of adrenal steroidogenesis in selected groups of patients with polycystic ovary syndrome (PCOS) compared to normal ovulatory women of the same age. Materials and Methods: Serum cortisol, testosterone, dehydroepiandrosterone sulphate (DHEAS), androstenedione (A), luteinizing hormone (LH), follicle-stimulating hormone, prolactin, 17-hydroxyprogesterone (17-OHP) and sex hormone-binding globulin (SHBG) were measured in the early follicular phase of the period. In addition, 2-day dexamethasone suppression and short adrenotropic hormone (ACTH) stimulation tests were performed for the study group and controls. Results: Serum testosterone (4.3 ± 1.8 nmol/l), LH (7.6 ± 1.9 IU/l), and 17-OHP (4.7 ± 2.3 nmol/l) were higher while SHBG (24.7 ± 14.2 nmol/l) was lower in patients than the control. Testosterone was significantly suppressed after dexamethasone suppression test while the level of 17-OHP increased significantly in patients more than the control after 60 min of ACTH stimulation. In the PCOS, the ratio of 17-OHP/A showed a significant increase after ACTH stimulation while that of DHEAS/A decreased when compared to controls. Conclusion: The study suggests a contribution of adrenal cytochrome P-450C dysregulation in PCOS. This suggestion could lead to another method of treating some PCOS patients when the usual anti-androgens might not be fully effective in controlling most of the symptoms.
Intravenous Immunoglobulins in Lupus Nephritis
Authors: Gupta R.K. , Nampoory M.R.N. , Johny K.V. , Costandi J. , Francis I.
Published: April 2003

Objective: The study is aimed at demonstrating the effectiveness of intravenous immunoglobulin (IVIg) in resistant lupus nephritis. Lupus nephritis was considered resistant when it failed to show adequate clinical and laboratory response to treatment with steroid, azathioprine and pulse cyclophosphamide in combination for a period not less than 1 year. Methods: During the past 7 years 4 subjects (M = 1, F = 3) with systemic lupus erythematosus (SLE) and lupus nephritis WHO IV were selected to receive IVIg. Their age ranged from 19 to 48 years. The 3 female patients had severe extrarenal manifestations including skin rash, photosensitivity, fever, headache and severe polyarthralgia requiring large doses of analgesics. The male patient had steroid-dependent, relapsing autoimmune hemolytic anemia (AIHA) in addition to extrarenal manifestations. All subjects had microscopic hematuria, proteinuria (2–6 g/24 h), hypoalbuminemia (24–33 g/l), mild renal impairment (serum creatinine 90–160 µmol/l) and active serology for SLE. These patients had not responded satisfactorily to several courses of steroids, azathioprine and pulses of intravenous cyclophosphamide in 23–180 months. All 4 patients were started and continued on IVIg as per our protocol. Results: During the 9 months to 7.5 years of follow-up, these patients showed excellent response to IVIg. Their extrarenal symptoms had totally disappeared, serological activity subsided, proteinuria decreased (0.5–2 g/24 h), serum albumin improved (30–42 g/l) and renal function remained stable. The subject with AIHA did not suffer any further relapses and his hemoglobin remained above 110 g/l with only 10 mg of prednisolone daily. Repeat renal biopsy done in 2 patients showed definite histological reversal of active lesions. Clinical and immunological improvements might be related to the modulation of macrophage T cell function and enhancement of suppressor T cell function. Conclusion: IVIg has shown excellent therapeutic effect as an alternative drug in treatment of renal and extrarenal manifestations of SLE, which are resistant to other modalities of treatment.
Aspergillus Spinal Epidural Abscess
Authors: Gupta Praveen K. , Mahapatra Ashok K. , Gaind Rajni , Bhandari Satish , Musa Mohamed M. , Lad Santosh D.
Published: April 2003

Spinal abscess due to Aspergillus is rare. A young boy with chronic granulomatous disease and aspergillosis of the rib had been treated with antifungal treatment 3 months earlier. The patient presented with a brief history of progressive paraparesis. Imaging showed D9–11 vertebral involvement and destruction of the D10 vertebral body with angulation and a large dorsally placed, multiloculated epidural abscess extending from D6 to L2. There was also extensive granulation anterior to and on either side of the vertebrae. The patient underwent extensive laminectomy and decompression of all the loculi and partial removal of the granulation tissue. Aggressive medical treatment was started. The authors recommend an aggressive surgical and medical approach in such cases of disseminated invasive aspergillosis, even though the result may not be very satisfactory. This report discusses the full clinical profile and management of Aspergillus spinal epidural abscess and emphasizes the need to follow up these cases to detect recurrence and new lesions, even if the patients are on adequate medical treatment. In spite of all efforts, high morbidity and mortality is common in such patients.
Membranous Obstruction of the Fourth Ventricle Outlet
Authors: Huang Yin-Cheng , Chang Cheng-Nen , Chuang Huo-Li , Scott R. Michael
Published: April 2003

We report the case of a 15-year-old girl with amenorrhea and a several-week history of headache. After the diagnosis of membranous obstruction of the foramen of Magendie suggested by MRI, suboccipital craniotomy for removal of the membrane was carried out. The patient made an excellent postoperative recovery, and postoperative phase-contrast MRI demonstrated patent cerebrospinal fluid (CSF) pathways at the level of the foramina of Magendie and Luschka. We believe that this case is of interest because of the unequivocal evidence on MRI studies of the occlusion of the foramen of Magendie preoperatively, and because of the dramatic postoperative MRI findings demonstrating the effectiveness of the surgical procedure both in terms of ventricular size and CSF flow characterization.
Occipital Aneurysmal Bone Cyst Secondary to Eosinophilic Granuloma
Authors: Roncaroli Federico , Consales Alessandro , Galassi Ercole , Bernardi Bruno , Valeri Barbara
Published: April 2003

We describe the case of a 2-year-old male patient with an aneurysmal bone cyst (ABC) of the occiput secondary to unifocal eosinophilic granuloma (EG). The lesion presented as a painless mass of the scalp which had grown rapidly over the 2 weeks prior to admission. Radiologically, the lesion was osteolytic and multicystic with fluid-fluid levels. On histology, the cyst wall contained hemosiderin-laden histiocytes, spindle cells, multinucleated giant cells, Langerhans’ cells and eosinophils. Surgical treatment consisted of en bloc resection. Fourteen months after surgery, the patient was well with no local recurrence. Association between EG and ABC is rare. To our knowledge, this is the first case involving the skull.