bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Dissection of Hepatitis C Virus Expression
Authors: Okoshi Shogo , Takeda Yasuo , Takimoto Mitsuhiro , Shimotohno Kunitada , Asakura Hitoshi , Jay Gilbert
Published: April 2003

Objective: The 5′ untranslated region (5′ UTR) of the hepatitis C virus genome is thought to be important for the control of viral gene expression and a likely target for therapeutic interception. A functional role of this viral gene segment was analyzed both in vivo and in vitro. Methods: Transgenic mice carrying a reporter gene that contains the complete 5′ UTR sequence were made. Cellular protein(s) which associate with the 5′ UTR were analyzed by gel shift analysis and a following affinity purification. Results: Transgenic mice revealed protein accumulation only in periportal hepatocytes around the portal triad and not in perivenous hepatocytes around the central vein. Gel shift analysis using mouse liver extracts provides further evidence that trans-acting proteins, which recognize a specific cis-acting element with the 5′ UTR (an apparent stemmed structure formed by two noncontiguous RNA sequences), are present in adult mice but not in young mice. A similar 5′ UTR RNA-protein complex was also detected with human liver extracts. Conclusion: The presence of cellular factor(s) which allow HCV 5′ UTR to express in tissue and differentiation state-specific manner was suggested.
Electron Microscopic Study of Persistent Dengue Virus Infection: Analysis Using a Cell Line Persistently Infected with Dengue-2 Virus
Authors: Takasaki Tomohiko , Takada Kazuo , Kurane Ichiro
Published: April 2003

We investigated persistent infection of Epstein-Barr virus (EBV)-transformed lymphoblastoid cells with dengue virus using a transmission electron microscope. Most of the infected cells kept an intact morphology with only a few virus particles in the cytoplasm, but without any indication of active viral replication. Some cells were apoptotic and a few dengue virus particles were present in these apoptotic cells. Raji cells acutely infected with dengue-2 virus showed degenerative morphology. There were membranous tubular structures and many virus particles around and within the infected cells. Approximately 95% of the cells were dengue viral antigen positive in the persistently infected EBV-transformed cell line. It is likely that persistent infection is maintained mainly by the division of infected cells without cytopathic effect by dengue-2 virus.
HBV Core Particles as a Carrier for B Cell/T Cell Epitopes
Authors: Pumpens Paul , Grens Elmars
Published: April 2003

In the middle 80s, recombinant hepatitis B virus cores (HBc) gave onset to icosahedral virus-like particles (VLPs) as a basic class of non-infectious carriers of foreign immunological epitopes. The recombinant HBc particles were used to display immunodominant epitopes of hepatitis B, C, and E virus, human rhinovirus, papillomavirus, hantavirus, and influenza virus, human and simian immunodeficiency virus, bovine and feline leukemia virus, foot-and-mouth disease virus, murine cytomegalovirus and poliovirus, and other virus proteins, as well as of some bacterial and protozoan protein epitopes. Practical applicability of the HBc particles as carriers was enabled by their ability to high level synthesis and correct self-assembly in heterologous expression systems. The interest in the HBc VLPs was reinforced by the resolution of their fine structure by electron cryomicroscopy and X-ray crystallography, which revealed an unusual α-helical organization of dimeric units of HBc shells, alternative packing into icosahedrons with T = 3 and T = 4 symmetry, and the existence of long protruding spikes. The tips of the latter seem to be the optimal targets for the display of foreign sequences up to 238 amino acid residues in length. Combination of numerous experimental data on epitope display with the precise structural information enables a knowledge-based design of diagnostic, and vaccine and gene therapy tools on the basis of the HBc particles.
Evaluation of New Approaches to Prophylactic and Therapeutic Vaccinations against Hepatitis B Viruses in the Woodchuck Model
Authors: Lu Mengji , Roggendorf Michael
Published: April 2003

The woodchuck model is most suitable for vaccine studies of prophylaxis and therapeutic treatment of hepatitis B virus infection. Recently, methodological advances allowed the examination of antigen-specific T cell responses in woodchucks during woodchuck hepatitis virus (WHV) infection and vaccinations. Similar to hepatitis B virus infection in humans, multispecific T-cell responses to WHV occur during acute self-limiting infection in woodchucks. Immunizations with WHV core antigen (WHcAg) or DNA vaccines expressing WHcAg demonstrated that priming of specific T-cell responses leads to the control of WHV infection. B-cell responses but no T-cell responses to WHV surface antigens (WHsAg) were induced in chronically WHV-infected woodchucks by the therapeutic immunizations with WHsAg. Breaking T-cell tolerance appears to be critical for immunotherapeutic approaches to chronic hepatitis B.
DNA Vaccines for Hepatitis C Virus
Authors: Brinster Carine , Inchauspé Geneviève
Published: April 2003

Hepatitis C virus is an RNA encoded virus of the Flaviviridae family. In most cases, infections develop into a chronic carrier stage that can result in the onset of cirrhosis and hepatocellular carcinoma over a 20- to 30-year period. Because existing therapies are still of limited benefit and expensive, the development of a vaccine represents a priority to prevent further spreading of the infection. Immune correlates of protection remain poorly defined although increasing evidence suggests that both humoral and cellular immune responses are likely to contribute to protection and/or neutralization of the virus. Current DNA-based vaccines, while capable of generating the latter, appear limited in their capacity to induce a strong and long-lasting antibody response.
Development of New Vaccines against Dengue Fever and Japanese Encephalitis
Authors: Kinney Richard M. , Huang Claire Y.-H.
Published: April 2003

Mosquito-borne dengue (DEN) and Japanese encephalitis (JE) viruses are the leading causes of arthropod-transmitted viral disease in humans. A licensed tetravalent vaccine that provides effective, long-term immunity against all four serotypes of DEN virus is needed, but is currently unavailable. Improvements to currently available JE vaccines are also needed. Past and recent strategies for the development of new DEN and JE vaccines include inactivated and live attenuated viruses, engineered viruses and chimeric viruses derived from infectious cDNA clones of DEN or JE virus, recombinant poxviruses, recombinant baculoviruses, protein expression in Escherichia coli, and naked DNA vaccines. This report summarizes some of the recent developments in DEN and JE vaccinology, particularly vaccine strategies that involve live attenuated viruses, engineered viruses derived from infectious cDNA clones, and naked DNA vaccines.
Nucleotide Sequence of the Precore/Core Gene and X Gene of Hepatitis B Virus DNA in Asymptomatic Hepatitis B Virus Carriers Who Are Negative for Serum Hepatitis B Core Antibody
Authors: Terada Tadashi , Moriyama Mitsuhiko , Uchida Toshikazu , Arakawa Yasuyuki
Published: April 2003

A hepatitis B virus (HBV) carrier who is positive for hepatitis B surface (HBs) antigen but negative for hepatitis B core (HBc) antibody despite persistent HBV infection, is designated has having hepatitis B virus 2 (HBV2). HBV2 is reported to be induced by mild-grade hepatitis. Patients with HBV2 have been reported in Taiwan and Senegal. In the present study, we determined the nucleotide (nt) sequence of the precore/core gene coding region and X gene region of the HBV DNA sequence in 7 subjects who were positive for HBs antigen and negative for HBc antibody. HBV DNA was detected by nested polymerase chain reaction (PCR). Nested PCR was carried out to amplify the precore/core and X open reading frames (ORFs) of HBV DNA. The second PCR products were sequenced, followed by investigation of nt homology. There were no deletions nor insertions in the nt sequence of the precore/core and X ORFs in the HBV DNA of these 7 patients, and mutations were found only sporadically in the 7 patients. Also, there were no common amino acid substitutions in the examined regions of the amino acid sequence of HBV in the 7 patients, and we could not find a common mutation in the examined regions of HBV DNA that could potentially contribute to the development of negativity for HBc antibody. Thus, it is suggested that negativity for HBc antibody in patients with HBV2 is due to an immune response abnormality in the host.
Complete Nucleotide Sequence and the Genome Organization of Patchouli Mild Mosaic Virus RNA1
Authors: Ikegami M. , Onobori Y. , Sugimura N. , Natsuaki T.
Published: April 2003

The nucleotide sequence of the RNA1 of Patchouli mild mosaic virus (PatMMV) has been determined. It contains 5,957 nucleotides excluding the 3′-terminal poly(A) tail and contains a single long open reading frame (ORF) of 5,613 nucleotides extending from nucleotide 235 to 5847. The predicted polyprotein encoded by the long ORF is 1,870 amino acids in length with a molecular weight of 210 kD. The conserved residues of RNA-dependent RNA polymerase, cysteine protease, purine NTP-binding domain and a cofactor for viral protease are present in a 210-kD polyprotein. As PatMMV RNA showed high sequence identity (81–97%) with BBWV-2 RNA, PaMMV may be one strain of BBWV-2.
Comparative Analysis of the Prion Protein Open Reading Frame Nucleotide Sequences of Two Wild Ruminants, the Moufflon and Golden Takin
Authors: Seo Sung Wook , Hara Kazuhiro , Kubosaki Atsutaka , Nasu Yukiko , Nishimura Takuya , Saeki Keiichi , Matsumoto Yoshitsugu , Endo Hideki , Onodera Takashi
Published: April 2003

The prion protein (PrP) nucleotide sequences of two ruminants were determined in order to elucidate the differences in susceptibility to spongiform encephalopathy agents in each species. The nucleotide sequences of PrP coding regions of the moufflon and the golden takin encompassed 771 bp in length. The PrP gene sequences of the golden takin were closely related to those of sheep with one amino acid difference. The PrP gene sequence of the moufflon was identical to that of sheep. The similarities between the PrP genes of these two animals and sheep imply that the species barriers between these animals are small or non-existent. These PrP genes could be used to establish transgenic mice with higher susceptibility to prion-related diseases.
Optimised Conditions for the Production of Hepatitis B Virus from Cell Culture
Authors: Glebe Dieter , Berting Andreas , Broehl Sigrun , Naumann Heike , Schuster Ralph , Fiedler Nicola , Tolle Tanja K. , Nitsche Sylvia , Seifer Maria , Gerlich Wolfram H. , Schaefer Stephan
Published: April 2003

In chronically infected patients, hepatitis B virus (HBV) particles reach numbers as large as >109 genome equivalents (GE)/ml of serum. However, expression of infectious HBV particles in cell culture only yields 105–106 GE/ml, which is insufficient for many studies. HBV transcription and possibly replication is dependent on hepatocyte-specific differentiation. Thus, we tested several cell culture parameters that have been reported to enhance the expression of hepatocyte-specific markers, such as growth on different extracellular matrices, different cell culture media, low concentrations of fetal calf serum (FCS) and the addition of dimethyl sulfoxide (DMSO) to the medium. Lower concentrations of FCS, growth on collagen and inclusion of DMSO in the medium only moderately enhanced HBV production in vitro when applied individually. However, combinations of these parameters optimised cell culture conditions and reproducibly increased the release of HBV particles about 100-fold to titres >108 GE/ml of culture medium.
Genital Herpes Simplex Virus Type 1 Infection: New Fields for an Old Acquaintance?
Authors: Lippelt Lars , Braun Rüdiger W. , Kühn Joachim E.
Published: April 2003

Herpes simplex virus (HSV)-2 is the principal agent of chronic remittent genital herpes. Worldwide, only 10–20% of genital isolates are HSV-1. Studies from the British Isles and Scandinavia indicate, however, that HSV-1 is responsible for a significant proportion or even the majority of first clinical episodes of genital herpes in young women. Actual data show that a trend towards genital HSV-1 infections may also hold true for Germany. This article summarizes possible reasons for and consequences of the observed changes in the epidemiology of genital HSV infections.
Improved Survival in Small Pancreatic Cancer
Authors: Pantalone Desiree , Ragionieri Ilaria , Nesi Gabriella
Published: April 2003

Background: Although the incidence of pancreatic cancer is relatively low compared with other tumors (2.4%), the death rate is high. Tumor detection and treatment at an early stage is necessary to improve the poor prognosis of patients, as is demonstrated by some reports showing a 5-year survival rate varying between 19 and 41% for patients undergoing radical pancreatectomy with the highest survival in patients with small tumors. Methods: In our study we retrospectively reviewed the histologic and demographic data of 596 patients who were admitted to the surgical units of the Careggi Hospital (University of Florence-AOC of Florence) between 1988 and 1994 with the incoming diagnosis of pancreatic cancer. Results: Results are reported as the mean ± standard deviation. The postoperative survival rate was calculated by the Kaplan-Meier method and statistical analysis was performed by the log rank test (significance p < 0.05). 247 patients had surgery, 110 with a curative intent. Postoperative mortality was 5.45%. The crude 5-year survival rate for patients who underwent curative surgery was 16.36% (18 patients), but for patients with small lesions confined to the pancreas (T1N0M0, 29 patients) this was even 31.03% (9 patients; p < 0.01, χ2 test). Conclusions: Our results indicate that it seems reasonable to consider these cancers as ‘small’, with survival reported in literature from 35 to 41%, so they probably represent the only curable condition at the present time.
Lactobacillus plantarum Reduces Infection of Pancreatic Necrosis in Experimental Acute Pancreatitis
Authors: Mangiante Gerardo , Colucci Gianluca , Canepari Pietro , Bassi Claudio , Nicoli Nicola , Casaril Andrea , Marinello Peter , Signoretto Caterina , Bengmark Stig
Published: April 2003

Background: Infection is the commonest cause of death in acute pancreatitis. Early reduction of commensal flora (particularly Lactobacillus species) and, at the same time, overgrowth of Enterobacteriaceae, especially Escherichia coli, have recently been described during acute pancreatitis. Lactobacillus plantarum has been shown to be effective in reducing the egress of endotoxin and microbial translocation in several experimental models such as chemically induced hepatitis and ulcerative colitis. Aim: The aim of the study was to determine whether L. plantarum 299v (Lp 299v) is capable of effectively reducing microbial translocation in experimental pancreatitis. Methods: Acute pancreatitis was induced by isolation and ligation of the biliopancreatic duct in Lewis rats weighing 250–350 g. The animals were divided into 3 groups: group A, sham operation; group B, induction of pancreatitis and no further treatment, and group C, induction of pancreatitis + daily administration by gavage of a 5-ml/day suspension of Lp 299v at 0.5–1.0 × 109 bacteria/ml for 8 days, 4 days before and 4 days after induction of pancreatitis. All animals were sacrificed after 96 h. Histological studies and microbiological analyses were performed. Results: At sacrifice, 40/55 animals showed signs of severe pancreatitis. Since acute pancreatitis was the specific disease investigated, only these animals were subjected to further study. In group B, we found pathogenic micro-organisms in the mesenteric lymph nodes in 14/20 animals and in the pancreatic tissue in 10/20. The bacterial flora consisted predominantly of E. coli, Enterococcus faecalis, Pseudomonas and Proteus species. In contrast, when the animals were kept under an ’umbrella’ of Lp 299v, growth of E. faecalis or E. coli were detected only in 4/20 mesenteric lymph node cultures and in 3/20 pancreatic tissue cultures. Conclusions:Lp 299v is effective in reducing microbial translocation in experimental pancreatitis. Treatment with probiotic bacteria seems to be a promising alternative to antibiotic therapy.
Is D2 Lymphadenectomy in Gastrectomy Safe with Regard to the Skill of the Operator?
Authors: Moriwaki Yoshihiro , Kobayashi Syunsuke , Kunisaki Chikara , Harada Hirofumi , Imai Sinsuke , Kido Yasuhiro , Kasaoka Chitaka
Published: April 2003

Background/Aims: D2 gastrectomy has been regarded as an inconvenient procedure with high morbidity and no survival benefit in the West. Recent western studies, however, especially from specialist centers, have shown a survival benefit and the safety of D2 gastrectomy. The aim of this study is to clarify the safety of D2 gastrectomy (defined by the Japanese Research Society for the Study of Gastric Cancer), even if carried out by a junior surgeon, and to show that it is not a particularly difficult or special procedure. Methods: Patients who underwent a typical distal gastrectomy (DG) with D2 resection (n = 344) and total gastrectomy (TG) with D2 resection (n = 111) were analyzed. The subjects were divided into 3 groups according to the postgraduate year of the operator (group I = the surgeon’s postgraduate experience was less than 5 years; group II = surgeons with more than 5 years and less than 10 years postgraduate experience; group III = surgeons with more than 10 years postgraduate experience). The rate of postoperative complications and the 5-year survival rate were compared among the 3 groups. Results: The overall operative mortality rate, hospital death rate and the overall rate of postoperative complications were 1.2, 2.0 and 10.2% in DG patients, and 14.4, 0 and 1.8% in TG patients, respectively. There was no significant difference in the operative blood loss, the rate of operative mortality, hospital death rate and postoperative complications among the 3 groups. There was no significant difference in the 5-year survival rate among the 3 groups in each stage. Conclusion: The postoperative mortality rate, morbidity rate and 5-year survival rate after a typical D2 gastrectomy were independent of the experience of the operator. It is considered to be a safe and useful procedure in view of the rate of postoperative complications and the long-term survival rate, even if performed by a junior trainee under the supervision of experienced surgeons in a nonspecialized hospital.
Complications of Milligan-Morgan Hemorrhoidectomy
Authors: Sayfan J.
Published: April 2003

Based on a retrospective review of a personal experience with 500 modified Milligan-Morgan hemorrhoidectomies, technical suggestions for avoiding early and late complications are presented. The problems of early and delayed bleeding, anal verge and mucosal stenosis, pain and prolonged healing due to persistent anal ulcer are discussed
Self-Expandable Metallic Stent Therapy of Esophagojejunal Stricture in a Stapled Anastomosis: A Case Report and Review of the Literature
Authors: Üstündaǧ; Yücel , Koseoglu Tankut , Çetin Faruk , Eroglu Abdullah , Soran Atilla , Eskioglu Erdal
Published: April 2003

The introduction of the stapler apparatus has provided safe and effective gastrointestinal anastomotic surgical operations for most surgeons. However, the major disadvantage of stapler surgery is an increased risk of anastomotic stricture formation. Treatment of this kind of stricture is performed mainly by using endoscopic balloon dilators. However, this therapy may fail or the patient may become reactive or uncooperative during dilatation sessions. Herein, we present a case to show the successful and uncomplicated insertion of a self-expanding metallic stent into an esophagojejunal anastomotic stricture which developed 1 month after total gastrectomy and stapled esophagojejunal anastomosis in a patient with gastric carcinoma. This is the 3rd report in the literature.
Granulomatous Appendicitis Revisited: Report of a Case
Authors: Higgins M.J. , Walsh M. , Kennedy S.M. , Hyland J.M.P. , McDermott E. , O’Higgins N.J.
Published: April 2003

Background: Isolated granulomatous appendicitis is uncommon and previously was considered to be a form of localised Crohn’s disease. However more recent series have noted that relapse is rare after appendicectomy and concluded that the condition is a distinct entity unrelated to Crohn’s disease. Following a case of granulomatous appendicitis at St. Vincent’s University Hospital Dublin, the condition was reviewed and the results are detailed herein. Methods: A case of granulomatous appendicitis is presented with discussion of 4 previous cases encountered in our practice and the literature is reviewed. Results: The clinical presentation was sub-acute appendicitis with a mass palpable in the right iliac fossa. At operation an enlarged, inflamed appendix with a broad base was noted and appendicectomy performed. Histopathology showed numerous granulomata on microscopic examination. The yersinia serology tests were negative. Review of computerised histopathology records in the hospital for the last 7 years showed 4 additional cases of granulomatous appendicitis. This is a total of 5 of 1,615 appendicectomies (an incidence of 0.31%). In all cases, the post-operative course was uneventful and the patients have had no further complaints. Conclusion: This small series provides further evidence that granulomatous appendicitis is a distinct clinical entity unrelated to Crohn’s disease and is cured by appendicectomy. It should be suspected when there is a sub-acute onset of appendicitis and an enlarged, broad-based appendix is found at operation.
Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance
Authors: Liakakos Theodoros , Thomakos Nikolaos , Fine Paul M. , Dervenis Christos , Young Ronald L.
Published: April 2003

Aim: To summarize the most common etiologic factors and describe the pathophysiology in the formation of peritoneal adhesions, to outline their clinical significance and consequences, and to evaluate the pharmacologic, mechanical, and surgical adjuvant strategies to minimize peritoneal adhesion formation. Methods: We performed an extensive MEDLINE search of the internationally published English literature of all medical and epidemiological journal articles, textbooks, scientific reports, and scientific journals from 1940 to 1997. We also reviewed reference lists in all the articles retrieved in the search as well as those of major texts regarding intraperitoneal postsurgical adhesion formation. All sources identified were reviewed with particular attention to risk factors, pathophysiology, clinical manifestations, various methods, and innovative techniques for effectively and safely reducing the formation of postsurgical adhesions. Results: The formation of postoperative peritoneal adhesions is an important complication following gynecological and general abdominal surgery, leading to clinical and significant economical consequences. Adhesion occur in more than 90% of the patients following major abdominal surgery and in 55–100% of the women undergoing pelvic surgery. Small-bowel obstruction, infertility, chronic abdominal and pelvic pain, and difficult reoperative surgery are the most common consequences of peritoneal adhesions. Despite elaborate efforts to develop effective strategies to reduce or prevent adhesions, their formation remains a frequent occurrence after abdominal surgery. Conclusions: Until additional information and findings from future clinical investigations exist, only a meticulous surgical technique can be advocated in order to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery.
Splenic Artery Aneurysm Rupture
Authors: Fotopoulos Nikos , Kyriakidis Alexandros , Dimopoulos Konstantinos , Karkaletsis Athanasios , Faros Euthimios , Dalamarinis Konstantinos , Raitsiou Bogdan , Antsaklis Georgios
Published: April 2003

Background: Splenic artery aneurysms are uncommon even though they are second only to those of the aorto-iliac system. There is also controversy regarding their management. Methods: We report the case of a 50-year-old patient with ruptured splenic artery aneurysm and review the literature regarding its diagnosis and management. Results: The patient underwent emergency laparotomy and splenectomy was performed. Conclusion: Resuscitation and an aggressive surgical approach should be taken in order to save the life of the patients.
Focal Intraperitoneal Fat Infarction
Authors: ter Meulen Ph.H. , Repelaer van Driel O.J. , Ooms H.W.A.
Published: April 2003

Focal intraperitoneal fat infarction, e.g. epiploic appendagitis and segmental omentum infarction, may mimic almost every acute abdominal condition. The symptoms of this benign and self-limiting disease will disappear without treatment. The etiology, symptoms, diagnosis (mainly with ultrasound and CT scan) and course of the disease are being described. An atypical case history with uneventful recovery without medical or surgical treatment is presented.
Carcinoma of the Colon Metastatic to the Lower Gingiva
Authors: Tomikawa Morimasa , Higuchi Yoshinori , Saku Motonori , Takeshita Morishige , Yoshida Koji , Sugimachi Keizo
Published: April 2003

A case of carcinoma of the colon that metastasized to the lower gingiva is described. The patient who had carcinoma of the colon developed a proliferating lesion at the site of a recent tooth extraction. A few days later, the primary site of the malignancy appeared. The clinical features in such cases were reviewed in studies by others, most of which were of oral and dental surgery. Thus, because of our case, gastroenterologists should consider the possibility of gingival metastasis from malignant disease such as colorectal cancer.
Dermoid Cyst of the Colon
Authors: Fujita Koichiro , Akiyama Norio , Ishizaki Masatoshi , Tanaka Shigefumi , Ohsawa Kiyotaka , Sugiyama Hiroyuki , Kanoh Ken-ichi , Toki Fumiaki , Asao Takayuki , Kuwano Hiroyuki
Published: April 2003

Dermoid cysts are benign cystic teratomas lined by skin and epidermal appendages. We report a dermoid cyst occurring in a 26-year-old female whose chief complaint was irregular vaginal bleeding. Abdominal magnetic resonance image demonstrated a space-occupying lesion in the right lower abdomen. The mass showed hyperintensity on the T2 image and the signal was homogeneous for the interior. During abdominal surgery we made the diagnosis of subserous tumor of the colon and resected the ileocecal portion of the colon. The tumor measured 5.4 × 4.8 × 3.5 cm and was soft and elastic. On cross section, a unilocular cyst filled with atheromatous material was found. Pathological examination revealed a dermoid cyst. In the view of this diagnosis, a simple excision would have been an adequate treatment.
Problems of Reconstruction during Pancreatoduodenectomy
Authors: Sakorafas George H. , Friess Helmut , Balsiger Bruno M. , Büchler Markus W. , Sarr Michael G.
Published: April 2003

Pancreatoduodenectomy may be a difficult operation, not only during the resectional part of the procedure, but also during reconstruction. Usually, these problems are due to local conditions of the organs/tissues, such as small diameter of the common bile duct or pancreatic duct, friable soft pancreas, vascular anomalies, etc. Reconstruction may also be problematic because of the hemodynamic instability of the patient during surgery (subsequent to massive hemorrhage), and in those unusual cases, delayed reconstruction may be a life-saving, wise choice.
The Contribution of Follow-Up Programs in the Reduction of Mortality of Rectal Cancer Recurrences
Authors: Komborozos Vassilios A. , Skrekas George J. , Pissiotis Christos A.
Published: April 2003

Aim: The aim of this study is to investigate whether patients, who have undergone curative surgery for rectal cancer and present with recurrence of the disease, could have a better chance of radical reoperation and increased survival if they were diagnosed earlier due to a screening program, when they were still asymptomatic, than those who were not followed up and their recurrence is discovered by its symptoms. Methods: 113 patients, 52 men and 61 women (mean age 64.19 years, SD 10.76), who presented recurrence of the disease after radical resection for rectal carcinoma were evaluated in a follow-up period of 5 years. 53 of them (46.9%, group I) were asymptomatic and their recurrence was detected in a routine follow-up examination. The remaining 60 patients (53.1%, group II) were not followed up regularly and the recurrence was diagnosed by the development of symptoms. Results: The two groups were comparable with regard to patients’ sex, type of operation, postoperative morbidity, tumor stage, histologic differentiation, size of primary tumors, the distance from the anal ring and distal margin. There was no difference in the disease-free period between the two groups (17.3 ± (SD) 9.9 months in group I versus 20.3 ± (SD) 14.4 months in group II, p = 0.1). 24 out of 53 patients in group I (45.2%) and 24 out of 60 patients in group II (40%) underwent surgery for their recurrence, but only in 8 and 9 cases, respectively, could the operation be considered as curative. The mean postrecurrence survival was 13.14 ± (SD) 23.8 months for group I and 10.97 ± (SD) 18.03 months for group II (p = 0.113). There was no difference in survival between the two groups after surgical treatment of the recurrence (p = 0.14). Conclusions: Our data show that if we exclude the palliative treatment of symptoms such as hemorrhage or obstruction, only a small percentage of patients with recurrent colorectal cancer will benefit from the treatment and achieve an increased survival, which is independent of the postoperative follow-up program.
Simultaneous Pancreaticoduodenal-Kidney Transplantation in Rats
Authors: Yongping Gu , Jianyun Gu , Jieshou Li
Published: April 2003

Aims: To establish a stable and simple simultaneous pancreaticoduodenal-kidney transplantation model in rats. Methods: Pancreaticoduodenal-kidney (left) and 1 cm of the inferior vena cava (IVC) with 0.5 cm left and right iliac communis vein were harvested from donors. We performed ‘cuff’ anastomoses between (1) portal vein and right iliac communis vein and (2) left kidney vein and left iliac communis vein, converging donor portal vein and left kidney vein into IVC together. Next, we performed an anastomosis of donor arterial segment and recipient abdominal aorta and a ‘cuff’ anastomosis between donor IVC and recipient left kidney vein. Results: Of 40 transplanted rats in which diabetes was induced, 33 survived over 7 days, and 31 rats have survived over 4 months. 30 rats’ nonfasting plasma glucose levels were euglycemic. Conclusions: We performed three ‘cuff’ anastomoses to simplify the surgical procedure and to shorten the ischemic period of the graft. The recipient vein system has an integrated membrane to avoid thrombi in venous anastomosis sites, enhancing the transplantation success rate.
Perforation Peritonitis in Primary Intestinal Tuberculosis
Authors: Šefr R. , Rotterová P. , Konečný J.
Published: April 2003

Primary intestinal tuberculosis is unusual in European and North American countries today. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. The authors present a rare case of severe stercoral peritonitis caused by multiple intestinal perforations in a patient with primary ileocecal tuberculosis. Initial clinical and laboratory investigations led to the suspicion of inflammatory bowel disease. The subsequent diagnostic workup included colonoscopic examination of the cecal and terminal region of the ileum with multiple biopsies. After the pathologist had assessed the specimen as indicating Crohn’s disease, appropriate therapy was initiated. Several days later, however, the patient was readmitted to a surgical intensive care unit with clinical signs of peritonitis and immediately operated on. The final diagnosis from a resection specimen confirmed the diagnosis of primary intestinal tuberculosis. The follow-up was complicated by a subhepatic abscess formation with the necessity for surgical drainage. The patient’s recovery was uneventful, she underwent intensive antituberculotic therapy and is asymptomatic at present. Surgeons caring for patients with acute abdomen should be aware of tuberculous perforation peritonitis even in non-risk groups of patients.
Comparison between 99mTc-Methoxyisobutyl Isonitrile and 99mTc-Methylenediphosphonate Scintimammography for Detection ofBreast Carcino ma
Authors: Chen Shao-Liang , Liu Wenguan , Mao Ying , Zhu Weimin , Yao Zhifeng , Sun Xiaoguang , Xiu Yan , Yin Yiqing , Chen Junxue
Published: April 2003

Objective: The goal of the study was to assess the values of scintimammography with 99mTc-methoxyisobutyl isonitrile (99mTc-MIBI) and 99mTc-methylenediphosphonate (99mTc-MDP) in detecting breast cancer. Methods: A total of 35 women with clinical findings of suspicious breast lesions were studied with both 99mTc-MIBI and 99mTc-MDP scintimammography. All patients underwent surgery within 1 week, and the results of the histopathological diagnosis were obtained. Results: Eighteen of 35 abnormalities of the breast were pathologically confirmed as primary breast cancer and 17 as benign lesions. In this group of patients, the sensitivity, specificity and accuracy of 99mTc-MIBI scintimammography were 77.8, 88.2 and 82.9%, respectively, while those of 99mTc-MDP scintimammography were 72.2, 88.2 and 80.8%, respectively. There was no significant difference between the results of 99mTc-MIBI and 99mTc-MDP scintimammography. Conclusion: This study demonstrated a high diagnostic accuracy of both 99mTc-MIBI and 99mTc-MDP scintimammography in detecting breast cancer. Both radiopharmaceuticals can be used as an adjunct method for the noninvasive assessment of breast cancer prior to surgery. However, 99mTc-MDP is less expensive and more readily available than 99mTc-MIBI.
Role of Nitric Oxide and Prostaglandin E2 in Gastroprotection Induced by Lipopolysaccharide in Ethanol-Mediated Damage in Rats
Authors: Franco L. , Doria D.
Published: April 2003

Objective: This study was designed to investigate the role of endogenous nitric oxide (NO) and prostaglandin E2 (PGE2) in the gastroprotection induced by lipopolysaccharide (LPS). Methods: Ethanol was used to induce gastric lesions in control rats and in rats pretreated with graded doses of LPS administered at different time intervals and with inhibitors of NO synthase or prostaglandin synthesis. The ethanol-induced damage on gastric mucosa was assessed by measuring the extent of the lesion. We evaluated nitrite, a breakdown of NO, and PGE2 accumulation in ex vivo gastric mucosa. Results: The ex vivo production of both NO and PGE2 was increased in a dose-dependent manner by LPS injected 5 h before ethanol. Pretreatment with L-N6-(1-iminoethyl)lysine(dihydrochloride) inhibited the protection associated with LPS and the ex vivo increase of both NO and PGE2. Indomethacin was ineffective in suppressing LPS-mediated protection against ethanol-induced damage and in suppressing ex vivo increase of nitrite whereas the ex vivo increase of PGE2 was prevented in a dose-dependent manner. When ethanol was administered 30 min after LPS, there was a lack of protection and a lack of increase of NO and PGE2. Conclusion: These results indicate that the reduction in ethanol-mediated damage in LPS-treated rats depends on endogenous PGE2 formation and on endogenous NO produced by stimulation of inducible NO synthase.
Correlates of Job Satisfaction among Health Care Professionals in Kuwait
Authors: Shah M.A. , Al-Enezi N. , Chowdhury R.I. , Shah N.M.
Published: April 2003

Objectives: Job satisfaction of health care providers (physicians, nurses, pharmacists, and medical laboratory technologists) was analyzed in relation to specific background and work environment characteristics in a multicultural setting. Methods: A stratified random sample was used to collect the data from six general hospitals in Kuwait. Data were collected through a self-administered questionnaire distributed to 500 health care providers, of whom 370 (74%) responded. Results: In bivariate analysis, nationality, education, age, and total experience were found to be significant determinants of job satisfaction. However, in multivariate analysis, three work environment characteristics emerged as significant determinants of job satisfaction. The nationality of the supervisor and in-service training showed a positive relationship with job satisfaction while the existence of unhealthy competition decreased job satisfaction. Conclusions: In view of the findings, employee job satisfaction can be improved through control of unhealthy competition, provision of an orientation to the job, and provision of effective in-service training.
A Review of Telehealth
Authors: Loane M. , Wootton R.
Published: April 2003

Telehealth is an exciting new technique for improving access to specialist care, especially in underserviced areas. As with any new health care intervention, proper evaluations must be carried out to ensure that limited health care resources are employed appropriately. Evidence suggests that the most successful telehealth initiatives are those that have focussed on organisational and deployment issues, rather than on the technology itself. In the right circumstances, telehealth offers a cost-effective alternative to the traditional methods of health care delivery.
The in vitro Antimycotic Activity and Acute Toxicity of Third-Generation Bezylidenetetralones and Heteroarylidenetetralones
Authors: Al-Nakib Tahsin M. , Lóránd Tamás , Földesi András , Varghese Ramani
Published: April 2003

Objectives: A new series of E-2-arylmethylene-1-tetralones and E-2-heteroarylmethylene-1-tetralones (third generation) were designed as potential antimycotic agents against human pathogenic yeasts. Methods: The new compounds were obtained by aldol condensation of 1-tetralone with the appropriately substituted aldehydes in either acid- or base-catalysed conditions. These compounds were tested for their in vitro antimycotic activity against 24 strains of Cryptococcus neoformans, Candida spp. and Trichosporon cutaneum by a microtitre well technique in a liquid casitone medium, using a double dilution method. The toxicity of the new compounds was determined in vitro in cultured HeLa cells, in HeLa growth medium and in vivo in MFI mice. Results: Nineteen new E-2-benzylidine-1-tetralones were prepared, and 16 of the tested compounds showed superior antimycotic activity when compared to the first-generation E-2-benzylidine-1-tetralones synthesised previously. Twelve of these third-generation compounds were more active against different strains of yeasts than 6 commercial antimycotic agents similarly tested. An in vitro toxicity study and an in vivo acute toxicity study in MFI mice showed that these compounds were severalfold less toxic than most of the commerical antimycotics, with 4 being comparable to or less toxic than the least toxic of the commercial agents (amphotericin B) tested by the same procedures. Conclusions: Twelve members of this new E-2-benzylidine-1-tetralone class of compounds are promising candidates for antimycotic agents worthy of further investigation.
Abnormal Coagulation during Pediatric Craniofacial Surgery
Authors: Williams Glyn D. , Ellenbogen Richard G. , Gruss Joseph S.
Published: April 2003

Introduction: This prospective study of children undergoing major craniofacial surgery was undertaken to determine whether abnormal hemostasis occurred and to characterize any coagulopathy found. Methods: Coagulation tests, blood loss and blood product transfusions were recorded perioperatively. Packed red blood cells (PRBC) were transfused to maintain target hematocrit. Patients with blood loss >100 ml/kg (group A, n = 5) were compared to patients with blood loss <100 ml/kg (group B, n = 22) using Mann-Whitney U test (p < 0.05). Results: Twenty-seven children (age range 2.9–27.9 months) had median total blood loss of 64 ml/kg. At completion of surgery, median coagulation values differed significantly between groups for prothrombin time (A: 16.6 s; B: 13.8 s), partial thromboplastin time (A: 44 s; B: 29 s), thrombin time (A: 28 s; B: 23 s), thromboelastograph reaction time (A: 7 mm; B: 4 mm), prothrombin fragment F1.2 (A: 1.9 nmol/l; B: 3.3 nmol/l) and platelet count (A: 174 K/mm–3; B: 239 K/mm–3). Fibrinolysis was not associated with blood loss. Median units transfused were in group A 3 units and group B 1 unit (p = 0.001). All patients received PRBC transfusions but only group A patients received other blood products (fresh frozen plasma, platelets). Conclusion: Children transfused with PRBC during craniosynostosis repair can become coagulopathic from coagulation factor depletion when hemorrhage approaches 1.5 times estimated blood volume.
Sudden Death from Fulminant Acute Cerebellitis
Authors: Levy Elad I. , Harris Anthony E. , Omalu Bennet I. , Hamilton Ronald L. , Branstetter IV Barton F. , Pollack Ian F.
Published: April 2003

Acute cerebellitis is postulated to result from viral and/or autoimmune etiologies. This disease has been reported to have a variable course. We report a case of sudden death from acute fulminant cerebellitis in a 13-year-old ballet dancer. Serial CT and MRI demonstrated rapid progression of the disease. Histopathologic correlation is provided. The etiologies, clinical course, therapeutic interventions and postmortem evaluation of this potentially life-threatening condition are briefly reviewed.
Repeat Cerebrospinal Fluid Shunt Infection in Children
Authors: Kulkarni Abhaya V. , Rabin Doron , Lamberti-Pasculli Maria , Drake James M.
Published: April 2003

Background: In this study, we investigated the treatment of cerebrospinal fluid (CSF) shunt infection and the risk factors for repeat shunt infection (RSI) in a cohort of children treated at the Hospital for Sick Children, Toronto, Canada. Methods: Between 1996 and 2000, a total of 51 children were identified with shunt infection (mean age 5.8 years). The medical records of these children were reviewed to identify cases of RSI within 6 months of the initial shunt infection (ISI). Results: In the 51 ISIs, the infecting organisms were coagulase-negative Staphylococcus (43.1%), Staphylococcus aureus (37.3%) and others (19.6%). The initial mode of treatment of the shunt infection was using an external ventricular drain (EVD) with removal of the shunt apparatus (54.9%), externalization of the shunt (37.3%) or shunt removal only (7.8%). The mean number of days of external CSF drainage (either EVD or externalized shunt) was 11.2 days. Ten patients (19.6%) developed RSI. The actuarial risk of RSI plateaued after 90 days at 24.4%. The following variables were tested as risk factors for RSI using survival analysis, although none reached statistical significance: initial organism (p = 0.09), age (p = 0.42), etiology of hydrocephalus (p = 0.45), number of days of CSF drainage (p = 0.45), type of surgical treatment of the ISI (p = 0.58) and the presence of bacteriologically positive CSF at ISI (p = 0.85). Conclusions: The risk of RSI is substantial and greater effort needs to be directed towards understanding the risk factors. Such studies will need a greater sample size in order to obtain sufficient statistical power.
Infectious Aneurysm Clipping by an MRI/MRA Wand-Guided Protocol
Authors: Harris Anthony , Levy Elad , Kanal Emanuel , Pollack Avram , Cayhill Anne Marie , Omalu Bennet I. , Albright A. Leland
Published: April 2003

Infectious aneurysms are potentially deadly sequelae of multiple etiologies, typically associated with subacute bacterial endocarditis (SBE). Since these aneurysms tend to be distal, there are no consistent landmarks by which to localize them, in contrast to more typical aneurysms that occur on the circle of Willis or proximal, large cerebral vessel bifurcations. In addition, they tend to be extremely friable and may be obscured by blood if intracranial hemorrhage (ICH) has already occurred. These factors make clipping these aneurysms technically difficult, and searching for easily ruptured aneurysms without standard landmarks adds risk to the procedure. In this report, we describe the case of a 9-year-old boy with SBE and subsequent ICH secondary to a mycotic aneurysm. This aneurysm was localized to within millimeters by the MRI protocol described herein. The aneurysm was excised and the patient recovered without incident. Thus, MRI/MRA-guided frameless stereotaxy may be useful for localizing distal mycotic aneurysms, improving patient outcome by decreasing morbidity and mortality.
Posterior Cranial Fossa Dermoid in Association with Craniovertebral and Cervical Spinal Anomaly: Report of Two Cases
Authors: Muzumdar Dattatraya , Goel Atul
Published: April 2003

Two patients, a 12-year-old girl and an 8-year-old boy, with congenital craniovertebral anomaly and Klippel-Feil syndrome also had a posterior cranial fossa dermoid. The association of these two discrete pathological lesions in the same individual is extremely rare. As both lesions are related to an embryological disorder, issues regarding the possible stage of dysgenesis are analyzed. The treatment options in such cases are discussed.
Morbidity of Second-Look Surgery in Pediatric Central Nervous System Tumors
Authors: Khan Raja B. , Sanford Robert A. , Kun Larry E. , Thompson Stephen J.
Published: April 2003

The extent of brain tumor resection affects survival. Second-look surgery (resection of residual tumor before radiographic progression) may improve survival by reducing the tumor burden, but the morbidity of the procedure is not known. On chart review of 280 patients with two or more brain tumor operations treated between January 1985 and June 1998, we identified 47 patients with second-look surgery. Lansky and Eastern Cooperative Oncology Group (ECOG) performance scores, as well as perioperative complications were recorded. There were 21 gliomas (6 malignant), 12 medulloblastomas, 3 craniopharyngiomas, 3 ependymomas and 8 miscellaneous tumors. Median time to second surgery was 50 days. Perioperative complications occurred in 45% of patients. There was no significant change in the mean Lansky and ECOG scores 4 and 24 weeks after surgery. Gross total resection (GTR) was achieved in 62% of patients and near total resection (NTR) in 23%, and 15% of patients had subtotal resection. GTR or NTR was achieved in 66% of medulloblastomas and 100% of gliomas. We conclude that second-look surgery by experienced pediatric neurosurgeons has an acceptable morbidity and should be considered in patients with residual tumors.