bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of Foxb1 Reveals Two Strategies for the Formation of Nuclei in the Developing Ventral Diencephalon
Authors: Alvarez-Bolado Gonzalo , Zhou Xunlei , Cecconi Francesco , Gruss Peter
Published: April 2003

Fork head b1 (Foxb1; also called Fkh5, HFH-e5.1, Mf3) is a winged helix transcription factor gene whose widespread early expression in the developing neural tube is soon restricted to the ventral and caudal diencephalon. During diencephalic neurogenesis, Foxb1 is expressed in one patch of neuroepithelium comprising a large mammillary portion and a smaller tuberal portion. The labeled cells coming from this patch contribute to nuclear formation by means of two different strategies: (1) caudally, the young neurons aggregate and settle immediately, giving rise to the nuclei of the mammillary body; (2) rostrally, the young neurons separate from the neuroepithelium forming a trail of cells which spans the mantle layer mediolaterally and which will give rise to two separate cell groups (the dorsal premammillary and part of the lateral hypothalamic area). Our results show the elaborate, regionalized histogenetic mechanisms necessary for the differentiation of the caudal diencephalon; moreover, they suggest that specifically labeled populations, arising from specifically labeled neuroepithelial patches and giving place to specific brain nuclei could be a common mechanism to build complex, nonlaminar regions of the forebrain.
Axons Crossing in the Ventral Commissure Express L1 and GAD65 in the Developing Rat Spinal Cord
Authors: Tran Tracy S. , Phelps Patricia E.
Published: April 2003

The neural cell adhesion molecule, L1, is thought to play a critical role in the formation and fasciculation of axon tracts during development. In the chick, the L1 cell adhesion molecule is expressed on both ipsi- and contralateral portions of commissural axons and perturbation studies produced a defasciculation of the ipsilateral commissural fibers. Yet in the rat, L1 is reported along commissural axons only after they have reached the contralateral marginal zone. When this species variation was reexamined, L1 was found to be expressed on rat commissural axons in a pattern similar to that observed in the chick. In addition, L1 is detected along commissural axons as early as embryonic day 12 in rats and maintained on both the ipsi- and contralateral surfaces during embryonic development. Other molecular markers that identify commissural axons in rats are TAG-1 (transiently expressed axonal glycoprotein) and DCC (deleted in colorectal cancer), and thus the pattern of L1 staining was compared with that of these other members of the immunoglobulin superfamily. Commissural axons emerging from dorsally located neurons are identified with TAG-1 and DCC, whereas L1 is detected only on ventrally located commissural axons. The pattern of L1 expression overlaps that of the more numerous laterally and ventromedially located GABAergic commissural axons. Furthermore, some of the GABAergic commissural axons express L1 on their surfaces. While commissural axons are often considered as a single population, differences in the combination of adhesion-type molecules on their surfaces and in their neurotransmitter phenotypes may signify distinctive neuronal subgroups.
Microglial Cells in Culture Express a Prominent Glutathione System for the Defense against Reactive Oxygen Species
Authors: Hirrlinger Johannes , Gutterer Jan Mirko , Kussmaul Lothar , Hamprecht Bernd , Dringen Ralf
Published: April 2003

To obtain information on the glutathione metabolism of microglial cells, the content of glutathione and activities of enzymes involved in the defense against peroxides were determined for microglia-rich cultures from rat brain. These cultures contain approximately 90% microglia cells as determined by immunocytochemical staining for glial markers, by the phagocytosis activity of the cells and by the production of superoxide after stimulation of the cells with phorbolester. For these cultures, a glutathione content of 41.2 ± 11.2 nmol/mg protein and a specific activity of glutathione reductase of 15.2 ± 3.2 nmol/(min × mg protein) were determined. These values are significantly higher than those found for astroglial or neuronal cultures. In addition, with 68.7 ± 23.5 nmol/(min × mg protein), the specific activity of glutathione peroxidase in microglial cultures was 78% higher than in cultured neurons. The specific catalase activity of microglial cultures was less than 40% that of astroglial or neuronal cultures. Microglial cultures contain only marginal amounts of oxidized glutathione. However, on application of oxidative stress by incubation of microglial cultures with hydrogen peroxide or with the superoxide-producing hypoxanthine/xanthine oxidase system, cellular glutathione was rapidly oxidized. These results demonstrate that microglial cells have a prominent glutathione system, which is likely to reflect the necessity for self-protection against reactive oxygen species when produced by these or surrounding brain cells.
Transport of L-Citrulline in Neural Cell Cultures
Authors: Schmidlin Andreas , Fischer Susanne , Wiesinger Heinrich
Published: April 2003

Uptake of L-[14C]citrulline was studied in cell culture models of the main neural cell populations, in astroglia-rich primary cultures derived from neonatal rat brain, in rat glioma cells C6-BU-1, in cells of the murine microglial clone N11 and in the glioma × neuroblastoma hybrid cell line 108CC15 with neuronal properties. For comparison, cells of the peripheral macrophage cell line RAW 264.7 were also investigated. A saturable component of uptake was found in all cases with KM values between 0.4 and 3.4 mM and Vmax values between 15 and 35 nmol· min–1·(mg protein)–1. A nonsaturable component dominated uptake at high concentrations of extracellular citrulline. Rates of uptake of L-citrulline were not affected when Na+ or Cl– were omitted from the incubation medium or in the presence of depolarizing concentrations of K+. Saturable uptake of citrulline was strongly inhibited by an excess of histidine or β-2-aminobicyclo-(2.2.1)-heptane-2-carboxylic acid; excess amounts of arginine, creatine, glutamate, cysteic acid or N-methyl-α-aminoisobutyric acid did not reduce citrulline uptake. Preincubation of the cells with bacterial lipopolysaccharide and interferon γ did not stimulate transport of citrulline. The results suggest that at physiological concentrations citrulline is taken up by neural cells with the help of transport system L for large neutral amino acids. Therefore, in the brain, effective utilization of extracellular citrulline as part of an intercellular trafficking of intermediates of an NO/citrulline cycle depends on the concentrations of all neutral amino acids present.
Simple Models of Threshold Curves in the Expression of Inborn Errors of Metabolism: Application to some Experimental Observations
Authors: Mazat Jean-Pierre , Rossignol Rodrigue , Malgat Monique , Letellier Thierry
Published: April 2003

The expression of an enzymatic deficiency in a metabolic network can present a biochemical threshold. This threshold can be characterised thus: (1) a low activity of the enzyme can sustain a normal flux, but (2) a minute further decrease of its activity makes the flux collapse. We give simple mathematical models displaying such a behaviour, and we apply the models to some examples of oxidative phosphorylation dependency on respiratory chain complex deficiency.
Metabolism of 3-13C-Malate in Primary Cultures of Mouse Astrocytes
Authors: Alves Paula M. , Nunes Rita , Zhang Chenhong , Maycock Christopher D. , Sonnewald Ursula , Carrondo Manuel J. T. , Santos Helena
Published: April 2003

Malate, specifically labeled with carbon 13 on C3, was synthesized by chemical means and used to study malate metabolism by primary cultures of mouse cortical astrocytes. 3-13C-Malate in combination with glucose as well as 3-13C-malate alone were used as substrates; the effect of 3-nitropropionic acid, an inhibitor of succinate dehydrogenase and fumarase was also examined. The consumption of malate was only 0.26 μmol/mg of protein, approx. 25-fold lower than the consumption of glucose. Besides lactate, glutamine and fumarate were the two major metabolites released to the medium. Very low and similar levels of isotopic enrichment were detected on C2 and C3 of lactate; glutamine was labeled on C2 and C3 to a similar extent as well and labeling on C4 was only detected when glucose was not added. These labeling studies suggest that cytosolic malic enzyme is not active in primary astrocytes and support the occurrence of pyruvate recycling in astrocytes.
Effects of Ammonia Exposition on Glioma Cells: Changes in Cell Volume and Organic Osmolytes Studied by Diffusion-Weighted and High-Resolution NMR Spectroscopy
Authors: Zwingmann Claudia , Flögel Ulrich , Pfeuffer Josef , Leibfritz Dieter
Published: April 2003

NH4Cl (10 mM) caused a sustained increase in the cell volume in immobilized, perfused F98 glioma cells to approx. 125% of control after 3 h, as measured by diffusion-weighted 1H NMR spectroscopy. Concomitantly, the glutamine (Gln) concentration increased by 130%, accompanied by a marked decrease in cytosolic osmolytes, i.e. myo-inositol and taurine, determined from 1H NMR spectra of PCA extracts. Inhibition of Gln synthetase partially prevented the increase in water content. While losses of organic osmolytes are also observed under hypotonic conditions, the rapid cell swelling is followed by the regulatory cell volume decrease (RVD), and is accompanied by decreased cytosolic Gln. We suggest that the rise in intracellular osmolarity, which is attributed to NH4Cl metabolism to Gln, but also to alanine (Ala), is not compensated by the release of other osmolytes, and causes cell swelling without RVD.
Diet, Lipids and Brain Development
Authors: Salvati S. , Attorri L. , Avellino C. , Di Biase A. , Sanchez M.
Published: April 2003

Brain development is a sequential anatomical process characterised by specific well-defined stages of growth and maturation. One of the fundamental and necessary events in the normal development of the central nervous system in vertebrates is the formation of a myelin sheath. It is becoming more evident that this process is influenced by dietary lipids. A number of findings have indicated that the administration of a diet deficient in essential fatty acids during development causes hypomyelination in the rat brain. Our studies have shown that lipids can also play a role in accelerating myelinogenesis in the brain of rats whose mothers had been fed, during pregnancy and lactation, a lipid fraction extracted from yeast grown on n-alkanes. Further studies have shown that accelerated myelinogenesis is connected to a precocious appearance of behavioural reflexes. Thus, the use of particular lipids in human nutrition must be carefully screened for possible effects on brain development.
Effect of Docosahexaenoic Acid Content of Maternal Diet on Auditory Brainstem Conduction Times in Rat Pups
Authors: Stockard Janet E. , Saste Monisha D. , Benford Valerie J. , Barness Lewis , Auestad Nancy , Carver Jane D.
Published: April 2003

Previous studies of dietary docosahexaenoic acid (DHA; 22:6n–3) effects on neurodevelopment have focused mainly on effects on the visual system; these studies may be confounded by effects on the retina rather than on neural pathways. Auditory brainstem conduction times (ABCTs) provide an alternate measure of central neural development. We conducted a dose-response study in which ABCTs were measured in pups whose dams were fed diets containing one of three levels of DHA (2, 4 or 6% of total fatty acids) from a single cell oil. Diets were fed during pregnancy and lactation, and pups were randomly cross-fostered on postnatal day 3 to minimize litter effects. ABCTs showed a dose-response effect, with higher levels of dietary DHA being associated with longer conduction times on postnatal day 31 (p < 0.05). Higher dietary DHA was reflected in pup cerebrums collected on postnatal days 3 and 31, and levels of arachidonic acid (AA, 20:4n–6) were inversely related to levels of DHA. This study demonstrated that the auditory brainstem response is sensitive for identifying effects of diet on neurodevelopment, and that supplementing the maternal diet with high levels of DHA may negatively impact development of the central auditory system of offspring.
Bacterial Resistance in Acne
Authors: Eady E.A.
Published: April 2003

Antibiotics play a major role in acne therapy. Physicians base treatment choices on personal perceptions of efficacy, cost-effectiveness or risk-benefit ratios and rarely take bacterial resistance into account. It is well documented that resistant strains of coagulase-negative staphylococci within the resident skin flora increase in both prevalence and population density as duration of therapy increases. Acne patients represent a considerable reservoir of resistant strains of these important nosocomial pathogens which can be transferred to close contacts. Resistance in cutaneous propionibacteria has received scant attention in view of the central role of Propionibacterium acnes in inflammatory acne. Isolates resistant to one or more anti-acne antibiotics (most commonly erythromycin) have been reported in Europe, the USA, Japan and New Zealand. Carriage of resistant strains results in therapeutic failure of some but not all antibiotic regimens. In our region, skin carriage of resistant strains by 60% of acne patients and 1 in 2 of their close contacts suggests that resistant strains are widely disseminated. We are beginning to gain an understanding of those factors which encourage resistance development and can identify those patients most likely to possess resistant propionibacterial floras. Recommendations for the use of antibiotics in acne therapy to help prevent the emergence of resistance in P. acnes include the implementation of antibiotic usage policies and the encouragement of improved prescribing habits.
Hereditary Hypotrichosis simplex
Authors: Just M. , Ribera M. , Fuente M.J. , Bielsa I. , Ferrándiz C.
Published: April 2003

Hypotrichosis is a relatively common feature of a number of complex hereditary syndromes. However, the isolated variant, called hereditary hypotrichosis simplex (HHS), is especially uncommon. We present a Spanish family with 8 of 19 persons covering 4 generations affected by HHS. No associated ectodermal or other defects were noted. The pedigree was compatible with an autosomal dominant inheritance with variable penetrance.
Nevus psiloliparus: A Distinct Fatty Tissue Nevus
Authors: Happle R. , Küster W.
Published: April 2003

Background: Encephalocraniocutaneous lipomatosis is usually associated with a peculiar type of fatty tissue nevus which represents a smoothly surfaced and hairless lesion involving the scalp. This disorder has so far not been recognized as a cutaneous entity. Objective: The purpose of this article is to describe the characteristic features of this nevus and to give it a name. Method: From the study of two cases and from a review of the literature we delineate the clinical and histopathological criteria of this disorder for which we propose the term ‘nevus psiloliparus’. This name is derived from the Greek words psilós = hairless and liparós = fatty, and describes the two most characteristic features of the disorder. Results: A comprehensive comparison shows that nevus psiloliparus can be distinguished from other types of fatty tissue nevi by clinical criteria such as localization on the scalp, a flat smooth surface and absence of hair follicles, by the histopathological feature of isolated arrector pili muscles and by the presence of associated extracutaneous features in the form of encephalocraniocutaneous lipomatosis. In particular, nevus psiloliparus can be separated from the Hoffmann-Zurhelle nevus that has so far never been observed in cases of encephalocraniocutaneous lipomatosis. Conclusion: The presently available data suggest that nevus psiloliparus represents a distinct cutaneous entity. Future clinical and genetic research should show whether this concept holds true.
Dystrophic Calcinosis cutis in Subacute Lupus
Authors: Marzano A.V. , Kolesnikova L.V. , Gasparini G. , Alessi E.
Published: April 2003

Dystrophic calcinosis cutis is known to be associated with various connective tissue disorders but to the best of our knowledge has never been reported in subacute cutaneous lupus erythematosus (SCLE), a distinctive cutaneous subset in the spectrum of lupus erythematosus. It occurs without calcium and phosphorus metabolic abnormalities and may be localized or generalized. We report a patient with SCLE who developed calcinosis cutis and had normal serum calcium and phosphorus levels and, interestingly, a normal concentration of blood ionized calcium. This latter, which represents the active form in the total amount of blood calcium, is a parameter only rarely assessed in patients with dystrophic calcinosis cutis. Thus, other pathogenic factors should be investigated to clarify the pathophysiology of the dystrophic type of calcification.
Is There a Relation between Risk Groups or Initial CD4 T Cell Counts and Prevalence of Seborrheic Dermatitis in HIV-Infected Patients?
Authors: Schaub N.A. , Drewe J. , Sponagel L. , Gilli L. , Courvoisier S. , Gyr N. , Rufli T. , Battegay M. , Itin P.
Published: April 2003

Objectives: (i) To investigate whether there is a difference in the prevalence of seborrheic dermatitis (SD) between homo- or bisexual HIV-infected patients and HIV-infected intravenous drug users, (ii) to study whether the initial CD4 T cell count at the first positive HIV test is of any significance for the prevalence of SD and furthermore to analyze whether (iii) antiretroviral treatment influences the prevalence and time course of SD. Patients and Methods: Since 1992 we have been following, within the scope of the Swiss HIV Cohort Study, a group of individuals with proven HIV infection. In this study all HIV-infected patients belonging either to the risk group of homo- or bisexuals or that of intravenous drug users were included for further analysis. Results: We included 226 men and 51 women. The ages ranged from 17 to 68 years (mean 30.1). One hundred and forty-four were homo- or bisexual men and 133 (82 men and 51 women) were intravenous drug users. Out of these 277 HIV-infected patients, 66 (23.8%) had SD at baseline and 7 (2.5%) developed SD during the observation period (male:female = 68:5). Conclusion: In our study we found that (i) the risk group influences the prevalence and time course of SD, yet that (ii) neither the initial CD4 T cell count nor (iii) antiretroviral treatment is of any significance.
Short-Time Extracorporeal Photochemotherapy in the Treatment of Drug-Resistant Autoimmune Bullous Diseases
Authors: Wollina U. , Lange D. , Looks A.
Published: April 2003

Background: Bullous pemphigoid (BP) and pemphigus vulgaris (PV) are potentially severe diseases. In drug-resistant PV and pemphigus foliaceus, long-term adjuvant treatment with extracorporeal photochemotherapy (photopheresis, ECP) has been reported to induce remission. Only limited numbers of patients have been reported so far. No information about the effectiveness in drug-resistant BP is available. Patients and Methods: Seven patients with drug-resistant autoimmune bullous diseases have been referred to the photopheresis center of Jena (3 × PV, 3 × BP, 1 × pemphigus foliaceus). The age ranged from 31 to 85 years. ECP was performed on 2 consecutive days once a month. Oral 8-methoxypsoralen was used as photosensitizer. Previous immunosuppressive treatment with either prednisolone or prednisolone/ azathioprine was continued. Results: Complete remission (absence of skin or mucous membrane lesions) was achieved in the 6 patients with PV and BP after 1–4 cycles. In the patient suffering from pemphigus foliaceus, a partial remission (> 50% improvement) was observed; in all except this patient, the immunosuppressive treatment could be tapered. Long-term remission was achieved. No severe side effects were observed. The treatment was well tolerated. Conclusions: Short-time ECP is an effective and safe adjuvant treatment for patients with drug-resistant autoimmune bullous diseases. It can induce remission and allows dose tapering of the immunosuppressive drugs.
Recurrent Contagious Ecthyma (Orf) in an Immunocompromised Host Successfully Treated with Cryotherapy
Authors: Degraeve C. , De Coninck A. , Senneseael J. , Roseeuw D.
Published: April 2003

A 48-year-old patient under immunosuppressive therapy for renal transplantation had contagious ecthyma which relapsed after excision. Stable healing was obtained by cryotherapy.
Subcorneal Pustular Dermatosis Treated with PUVA Therapy
Authors: Bauwens M. , De Coninck A. , Roseeuw D.
Published: April 2003

Background: Subcorneal pustular dermatosis (SPD) is a chronic recurrent pustular dermatosis of unknown etiology. Many treatments have been proposed, none of which has been uniformly successful. Objective: Our purpose is to report a patient with SPD successfully treated by PUVA and to review the literature concerning phototherapy treatment of SPD. Methods: A patient suffering from SPD resistant to diaminodiphenylsulphone (dapsone) responded well to a combination therapy consisting of dapsone and PUVA. He received 50 mg/day and 3 PUVA sessions a week. Photographs were taken at baseline and after 15 sessions. Results: The lesions were virtually cleared after 15 sessions. The patient remained free of lesions with a maintenance therapy of dapsone (50 mg/ day) and 1 PUVA session a week. Conclusion: The therapeutic value of phototherapy for the treatment of SPD still has to be confirmed and could be a valuable alternative for treatment-resistant patients.
Cutaneous Reaction to Ultraviolet Irradiation in Human-Immunodeficiency-Virus-Infected Patients
Authors: Aubin F. , Parriaux N. , Robert C. , Blanc D. , Drobacheff C. , Laurent R. , Humbert Ph.
Published: April 2003

Background: HIV-infected patients, like renal transplant recipients, are at increased risk of developing skin cancer in photoexposed areas. Previous studies demonstrated that prolonged ultraviolet (UV)-induced erythema and a decreased and delayed tanning could be correlated with an increased risk of skin cancers. Objective: As HIV-infected patients are at an increased risk of developing skin cancers, we aimed to assess the cutaneous response to UV irradiation in these patients. Methods: Twelve HIV-infected patients and 12 healthy volunteers were included in a prospective case-control study. No patient or volunteer had a history of skin cancer or photodermatosis. The minimal erythemal dose (MED) was determined using a solar simulator UV source, and, then, each subject underwent an exposure of 6 MED. The erythemal and pigmentation responses were studied using a visual scale and a tristimulus colorimeter over a 4-week period. Results: We failed to demonstrate any significant differences between HIV-infected patients and controls for erythema and delayed pigmentation. No difference was found for MED between the two groups although most HIV-infected patients received potentially photosensitive drugs. Conclusions: Our results suggest that, as a group, the HIV-infected patients without a history of photosensitivity or skin cancer did not demonstrate a greater susceptibility to intense UV irradiation in terms of erythema and pigmentation induced by intense UV exposition.
Comparative Effects of Retinoic Acid, Glycolic Acid and a Lipophilic Derivative of Salicylic Acid on Photodamaged Epidermis
Authors: Piérard G.E. , Kligman A.M. , Stoudemayer T. , Lévêque J.L.
Published: April 2003

Background: Studies comparing purported antiaging compounds are rare. Objective: To compare in a randomized, placebo-controlled double-blind study 10% glycolic acid (GA), 2% 2-hydroxy-5-octanoyl benzoic acid (β-lipohydroxy acid, LSA) and 0.05% all-trans-retinoic acid (RA). Methods: Women volunteers treated one forearm twice daily with one of the active products and the other one with the vehicle. Comparative evaluations of efficacy were made using histochemistry and quantitative immunohistochemistry. Results: Improvement in the various epidermal compartments was the most prominent finding at the RA-treated site. The LSA-treated site also exhibited similar positive changes, although to a lesser degree. GA showed no significant effect. Conclusion: In the presently tested concentrations and formulations, RA had a beneficial impact upon the aging epidermis. LSA mimicked RA but with somewhat lesser efficacy. By contrast, GA appeared almost inactive.
Clinical Efficacy of Narrow-Band UVB (311 nm) Combined with Dithranol in Psoriasis
Authors: Carrozza P. , Häusermann P. , Nestle F.O. , Burg G. , Böni R.
Published: April 2003

Background: For UVB, the most effective wavelength in clearing psoriatic lesions was found to be of 313 nm. The efficacy of whole body exposure to narrow-band UVB (311 nm) combined with dithranol in psoriasis has not been evaluated to date. Objective: Evaluation of the clinical efficacy of phototherapy with narrow-band UVB (311 nm) and dithranol for psoriasis by means of whole body exposures and analysis of the mean cumulative irradiation dose. Methods: In this open pilot study, 13 patients were treated for 4–5 weeks. Evaluation of the therapeutic efficacy was performed by comparing the Psoriasis Area and Severity Index (PASI) scores at baseline and after 4 weeks of treatment. The cumulative irradiation dose was also calculated. Results: Evaluation of the PASI scores showed a significant overall reduction of psoriatic lesions after 4 weeks of treatment. The cumulative irradiation dose was similar or lower to those found for phototherapy with narrow-band UVB alone. Discussion: In patients with widespread psoriasis, treatment with narrow-band UVB (311 nm) combined with dithranol is safe and effective, allowing reduction of the cumulative irradiation dose.
Adamantiades-Behçet’s Disease: Serum IL-8 Is a More Reliable Marker for Disease Activity than C-Reactive Protein and Erythrocyte Sedimentation Rate
Authors: Katsantonis Joannis , Adler Yael , Orfanos Constantin E. , Zouboulis Christos C.
Published: April 2003

Background: Interleukin 8 (IL-8) has recently been under focused investigation because of its possible participation in the evolution of Adamantiades-Behçet’s disease. Objective: The reliability of IL-8 as a serological marker for the activity of the disease was investigated in a prospective consecutive trial of 34 cases. Methods: The activity of the disease was clinically evaluated by the number of actively involved organ systems registered on the day of blood sampling and by the presence of oral aphthous ulcers. Serum IL-8 levels were compared to C-reactive protein (CRP) values and the erythrocyte sedimentation rate. Results: An association of IL-8 levels with the activity of the disease was detected when compared with both the number of active clinical signs (p = 0.024) and the presence of oral aphthous ulcers (p = 0.002). In contrast, no association of CRP and sedimentation rate with the activity of the disease could be detected. A weak correlation of IL-8 levels with sedimentation rate values at 2 h was found (R = 0.37, p = 0.032). Conclusion: Our results confirm previous data concerning the significance of IL-8 and, in addition, they provide first evidence for the reliability of IL-8 as a serological marker for assessment of the activity of Adamantiades-Behçet’s disease in the follow-up of clinical and therapeutic studies.
Hepatectomy: Preoperative Analysis of Hepatic Function and Postoperative Liver Failure
Authors: Zimmermann Heinz , Reichen Jürg
Published: April 2003

Most authors reporting on hepatectomy stress the importance of preoperative assessment of liver function and functional reserve to minimize the surgical risk, especially in patients with liver cirrhosis, jaundice or those undergoing prolonged chemotherapy [1] since it is these patients who have a markedly increased risk of developing liver failure [2–5]. According to a recent review, liver failure is the major cause of death after hepatectomy followed in importance by intraoperative and postoperative hemorrhage and sepsis accounting for 38, 29 and 21% of deaths, respectively [6]. For this reason it is of paramount importance to estimate liver function preoperatively and to predict postoperative remaining functional liver parenchymal mass and its reserve.
Intraoperative Laser Doppler Flowmetry: A Predictor of Ischemic Injury in Acute Mesenteric Infarction
Authors: Redaelli Claudio A. , Schilling Martin K. , Büchler Markus W.
Published: April 2003

Mesenteric ischemia following intestinal infarction caused by occlusion of the superior mesenteric artery is a rare and devastating disease. The overall mortality is a high as 80%. The purpose of this prospective study was to investigate erythrocyte flux to defined areas of the intestine immediately after laparotomy by using laser Doppler flowmetry (LDF) assessment. We tried to predict the intestinal viability and recovery of the small bowel, and further tried to define the level of critical perfusion below which intestinal resection is indicated. 13 patients undergoing surgery for acute mesenteric ischemia were prospectively studied. Multiple LDF assessment of bowel blood flow (4 records/segment) were performed on 48 ischemically injured bowel segments intraoperatively. All patients underwent a second-look procedure within 48 h to define the viability of the previously suspicious segments. All 18 resected bowel segments were histologically evaluated for the extent of ischemia. In addition clinical judgement as well as histological findings were compared with the laser Doppler records. There was a 19% (9 of 48) incidence of histologically proven nonviable bowel segments with a significant decrease in intestinal erythrocyte flux below 50 perfusion units intraoperatively in all those patients. But there was a 50% (9 of 18) incidence of nonviable segments among the clinically proven viable and subsequently resected segments, only. Therefore, clinical judgement alone had a overall accuracy of 87% and a predictive value of only 69%, compared to the 100% overall accuracy, sensitivity and predictive values of LDF assessment. The results of this study demonstrate that LDF is a sensitive guide and feasible method to evaluate and define the viability of ischemically injured intestine.
Update: What Is Left for Laparoscopic Hernia Repair?
Authors: Bittner R. , Leibl B. , Kraft K. , Schwarz J. , Schmedt C.-G.
Published: April 2003

The risks, benefits and costs of laparoscopic hernia repair are still being debated. According to a current survey on the situation of hernia surgery in Germany in 1996, laparoscopic hernioplasty was done in about 60% of the answering hospitals; about a quarter of all hernia repairs are done laparoscopically. Since April 1993, about 2,700 laparoscopic hernia repairs were done at Marienhospital Stuttgart. The operating time was on the average 50 min. The rate of complications was about 3%. The postoperative period of disablement was a median of 20 days; included in this time was the postoperative hospital stay. The recurrence rate was about 1%. It is remarkable that laparoscopic hernia repair was equally efficient in repairing unilateral primary hernias, recurrent hernias or bilateral hernias. The cost analysis showed that the application of multipath articles will make the operation costs of laparoscopic hernia repair only about DM 100 higher than for a conventional operation.
Update: Total versus Partial Laparoscopic Fundoplication
Authors: Watson A.
Published: April 2003

Since the introduction of Nissen fundoplicaton in 1956, there has been concern about the incidence of troublesome mechanical complications, which has necessitated several modifications reducing the overall incidence to around 15%. Increasing knowledge of the pathophysiology of Nissen fundoplication has revealed that these complications are associated with a supracompetent high pressure zone (HPZ) which relaxes incompletely on swallowing and is associated with abolition of gas reflux and physiological acid reflux. Partial fundoplication procedures, which augment various constituents of the valvuloplasty component of competence and utilise a lesser degree of fundoplication, are associated with a very low incidence of mechanical complications, but debate has ensued that reflux control may be suboptimal and less durable than after Nissen fundoplication. However, several good, objective comparative studies and three prospective randomised trials have confirmed that a well conducted partial fundoplication procedure is at least as effective and durable in reflux control as Nissen fundoplication, whilst being associated with a lower incidence of mechanical complications. The debate has intensified since the advent of laparoscopic fundoplication, as several reports have highlighted the increased incidence of mechanical complications following Nissen fundoplication when performed laparoscopically compared with the open approach, with a higher incidence of impaired HPZ relaxation, believed to be associated with altered geometry and other factors inherent in laparoscopic fundoplication. This has resulted in re-operation rates for complications of laparoscopic Nissen fundoplication of 1–7%, and in the laparoscopic era, mechanical complications have overtaken recurrent reflux as the principal reason for revisional fundoplication. Several non-randomised series have shown that laparoscopic partial fundoplication procedures are associated with a similarly low incidence of mechanical complications and a negligible re-operation rate as at open operation, with retention of physiologial HPZ relaxation. These factors have resulted in increasing deployment of partial fundoplication procedures, and increasing support for the ‘tailored’ approach to anti-reflux surgery. Several prospective randomised studies between laparoscopic partial and total fundoplication procedures are currently in progress, and early results favour partial fundoplication because of the considerably lower incidence of mechanical complications. The continuance of these studies, as well as those underway which compare different partial fundoplication procedures and include economic and quality-of-life assessment, should enable the rational choice of the most appropriate laparoscopic anti-reflux procedure to be placed on a firm scientific footing.
Endoscopic Retroperitoneal Surgery
Authors: Himpens J.
Published: April 2003

A minimally invasive approach to the retroperitoneum is described. Basic anatomy, techniques of access and pitfalls related to the technique are discussed. Available procedures are outlined. Extended retroperitoneoscopy is an expanding field and constitutes a safe alternative to the more debilitating open approach in selected indications.
Monocyte Function before and after Surgical Trauma
Authors: Haupt W. , Riese J. , Mehler C. , Weber K. , Zowe M. , Hohenberger W.
Published: April 2003

The monocyte/macrophage plays a key role in the network of immune reactions. Dependent on activation, it is able to produce various cytokines which act on other cells of the immune system in the sense of upregulation or downregulation. In addition, it presents antigens by the HLA-DR molecule as an initial trigger of an antigen-specific T-cell response. Monocyte function is affected by surgical disease and further affected by surgical trauma. We found the monocyte to be activated in a subgroup of patients before the operation, related to an increased rate of postoperative septic complications. After the operation, plasma concentrations of IL-6 and IL-10 were increased indicating the activation of an immune response. After surgery HLA-DR expression decreased as well as LPS-stimulated TNFα and IL-6 production, the latter indicating a hyporesponsiveness of peripheral blood cells (presumably monocytes) to further stimulation. On the other hand, continuously high plasma concentrations of activation markers like neopterin and IL-6 in the postoperative course were associated with complications and poor outcome. In postoperative septic shock monocytes may be almost areactive towards natural stimuli like bacteria and endotoxin, since IL-6 and TNFα production decreased to very low amounts. Adequate pre- and postoperative monocyte function is related to an uneventful postoperative course after major surgical operations. Surgical trauma affects monocyte function rendering it less reactive, which is a potential risk factor for postoperative septic complications.
The Impact of Laparoscopy with Carbon Dioxide versus Helium on Immunologic Function and Tumor Growth in a Rat Model
Authors: Jacobi C.A. , Wenger F. , Sabat R. , Volk T. , Ordemann J. , Müller J.M.
Published: April 2003

Background: The pathogenesis of port site recurrences after laparoscopic surgery for malignant disease is still unknown. Whether different gases used to establish pneumoperitoneum have an influence on immunologic function and therefore on promotion of tumor growth has not yet been investigated. Methods: Tumor growth of colon adenocarcinoma DHD/K12/TRb was evaluated in a rat model after insufflation either with CO2 (n = 25) or helium (n = 25) and in a control group (n = 25). Tumor growth was measured subcutaneously and intraperitoneally 5 weeks after insufflation. Beside tumor growth, immunologic changes (peripheral leukocyte subpopulations, plasma levels of TNFα and IL-10) were evaluated during the perioperative course in all animals. Results: Subcutaneous tumor growth was promoted by the CO2 (99 ± 55 mg; p < 0.01) compared to the helium (40 ± 41 mg) and control groups (36 ± 33 mg). Total intraperitoneal tumor weight was 718 ± 690 mg in the CO2 group compared to the helium (549 ± 233 mg) and control groups (521 ± 221 mg). While peripheral leukocyte subpopulations only differed between the laparoscopic groups and the control group during the perioperative course, TNFα plasma levels were significantly decreased and IL-10 plasma levels significantly increased in the CO2 group compared to the helium and control groups in the postoperative course. Conclusion: The insufflation of CO2 promotes tumor growth compared to the helium and control groups in a rat model. In addition, increased tumor growth was associated with a significant increase in IL-10 and a decrease in TNFα plasma levels.
Laparoscopic Colorectal Surgery and Cancer
Authors: Wexner Steven D. , Latulippe Jean-François
Published: April 2003

Laparoscopy has become a part of the surgeon’s armamentarium in benign colorectal diseases. Expected advantages include better cosmesis, shorter hospital stay and earlier return to preoperative status than similar open surgery. The advisability of performing laparoscopy for cure of colorectal malignancy has been challenged because the recurrence rates and overall cure rates remain unknown. Therefore, laparoscopy for colorectal cancer should be offered within the confines of a prospective randomized trial in order to resolve these issues.
Standardized Technique of Laparoscopic Surgery in the Rat
Authors: Gutt Carsten N. , Riemer Vivian , Brier Christoph , Berguer Ramon , Paolucci Vittorio
Published: April 2003

The evolution of advanced laparoscopic techniques requires animal models for instrument development, evaluation of the physiopathological correlation and physician training. Selection of surgical models is primarily based on cost, availability, anatomic and physiologic considerations, and housing and anesthetic methods. The use of large animals is becoming increasingly difficult due to restrictive legislation, public concern, and economic factors. A standardized technique of laparoscopic surgery in the rat has been developed to perform procedures in all abdominal regions including fundoplication, splenectomy, nephrectomy, liver resection, herniorraphy, colotomy, colectomy, and retroperitoneal exploration. The equipment consists of a specially designed small animal operating table, a standard arthroscope and micro-instruments. The rat model gives the opportunity to investigate the physiopathological relations and immune functions of laparoscopic procedures, to develop micro-instruments under realistic conditions of a live organism, and it is an excellent training model especially for pediatric and microsurgery. Besides low costs and easy availability, the rat model requires less logistic and financial efforts.
Laparoscopic Hernia Surgery:An Ov erview
Authors: Krähenbühl L. , Schäfer M. , Feodorovici M.A. , Büchler M.W.
Published: April 2003

Despite the fact that laparoscopic hernia repair was already described in 1979, its value has still not been well defined. The standard treatment for uncomplicated primary hernia repair in Europe is an open anterior approach (i.e. Shouldice), and ‘tension-free’ mesh plug repair in the USA. At present, posterior mesh insertion is used to repair so-called complicated hernias with a complete myopectineal defect, and recurrent and bilateral hernias. Laparoscopic hernia repair (transabdominally and extraperitoneally) mimics this posterior mesh insertion and is therefore mostly used for treating complicated hernias. Whether or not a transabdominal or extraperitoneal approach is used depends on the type and size of the hernia, the risk to the patient, previous abdominal operations and the surgeon’s experience. However, the extraperitoneal approach is now recommended because of its lower complication rate compared to the transabdominal approach. Compared to open surgical procedures the laparoscopic approach shows significant advantages in terms of less postoperative pain, decreased time off work and decreased overall costs. The disadvantages are increased operating time as well as difficulty in performing the procedure itself. A recent large randomized series has for the first time been able to demonstrate the advantages of the laparoscopic approach in a long-term follow-up. However, further studies are needed to define the exact place of laparoscopic hernia repair in the treatment of groin hernias.
Gastrin and the Enterochromaffin-Like Cell: An Acid Update
Authors: Kidd Mark , Modlin Irvin M. , Tang Laura H.
Published: April 2003

Gastrin is synthesized and secreted mostly in a heptadecapeptide form from neurocrine G cells located in the antrum. The biologically active sequence of the molecule is a C-terminal pentapeptide, which has been conserved across many species. Transcriptional regulation of gastrin mRNA synthesis is positively regulated by transforming growth factor-α (TGF-α) and inhibited by somatostatin (SST). The inactive precursor form is converted to the active molecule by several posttranslation processing steps which include cleavage, C-terminal amidation, glycosylation, phosphorylation and sulfation. Aberrations in processing steps generate incompletely processed forms, particularly glycosylated progastrin, which may act as autocrine growth factors for gastrointestinal neoplasms. Gastrin release is stimulated by luminal aromatic amino acids and inhibited by a decrease in luminal pH. Other gastrin agonists include β-adrenergic agents, acetylcholine, gastrin-releasing peptide (bombesin), TGF-α, and possibly the gastric pathogen, Helicobacter pylori. The principal peptide inhibitor of gastrin release is SST. The major physiological roles of gastrin include stimulation of acid secretion, regulation of mucosal cell lineage and mucosal cell proliferation. The fundic enterochromaffin-like (ECL) cell is the principal cellular transducer of the gastrin-acid signal. Activation of its gastrin/CCKB receptor results in histamine synthesis and release with consequent activation of the fundic parietal cell H2 receptor. An increase in luminal pH caused by acid inhibitory pharmacotherapy agents (particularly proton pump inhibitors) results in hypergastrinemia and ECL cell hyperplasia. Gastric carcinoids however appear occur in patients with multiple endocrine neoplasia type I syndrome, suggesting that an associated genomic defect is necessary. Gastrin is thus both a potent gastrointestinal trophic and histamine secretory agent. As a hormone it is a paradigm in the elucidation of both cellular secretory and growth factor induced cell proliferation.
Collagen Variation during Experimental Acute Obstruction of the Left Colon
Authors: Aguilar-Nascimento J.E. , Mathie R.T. , Man W.K. , Williamson R.C.N.
Published: April 2003

Background/Aims: The colonic response to obstruction is poorly understood. Thickening of the proximal bowel following colonic stricture may be due to increased protein synthesis. We have investigated the colonic morphology and collagen concentration during the development of left-sided colonic obstruction in an animal model. Methods: Twelve male Wistar rats received either a silk ligature obstruction of the colon 2.5 cm above the peritoneal reflection (n = 6) or manipulation of the left colon (controls, n = 6). Twenty-four hours later, three colonic specimens from the ligature zone and from 1 cm proximal and distal to this site, or from equivalent regions in controls, were assayed for hydroxyproline concentration. Results: In controls there was no difference in hydroxyproline concentration between colonic sites. In obstructed rats, the hydroxyproline concentration was greater both at the ligature and distally, when compared with the proximal region. The hydroxyproline concentration was higher (p < 0.05) than corresponding control values at the ligature site (14.95 ± 2.76 vs. 10.97 ± 1.95 µg/mg of dry tissue; mean ± s.d.) but not on either side. Conclusion: The colonic collagen concentration is equivalent or raised near an obstruction, demonstrating that obstructed colon may possess an enhanced capacity to hold sutures.
Major Rectal Perforations Caused by Enema: Is Surgery Mandatory?
Authors: Madhala Osnat , Greif Franklin , Cohen Maia , Lelcuk Shlomo
Published: April 2003

Background: Current methods of large bowel preparation prior to colonoscopy, barium enema and surgery are extremely effective in cleaning the bowel of feces. We rationalize, therefore, that under these conditions rectal perforations secondary to barium and cleansing enema could be treated expectantly, namely either defer or completely avoid immediate surgery. Patients: Two female patients with major rectal perforations secondary to barium and cleansing enema who had thoroughly prepared large bowel were treated conservatively. Results: Both patients did well without surgery and were discharged without any long-term sequela. Conclusion: Since a large number of iatrogenic perforations of the rectum occur in patients with well-prepared and clean bowel immediate surgery can be deferred or avoided all together without compromising them.
Acute Necrotizing Meckel Diverticulitis due to Biliary Enterolithiasis
Authors: Emparan C. , Ortiz J. , Iturburu I. , Bilbao J.E. , Mendez J.
Published: April 2003

Background: Acute abdominal pain due to complicated Meckel’s diverticulum is an unusual event. Even the presence of biliary enterolithiasis at the onset of inflamed congenital diverticulum has rarely been reported previously. Results: Despite this unusual presentation, an episode of gallstone passage through the biliary tract has not yet been described. Conclusions: Whether the stones were primarily formed in the diverticulum as enterolithiasis, or secondary to gallstone passage is discussed. The complications of Meckel’s diverticulum requiring surgical treatment are reviewed, focusing on the unusual finding of biliary stones in Meckel’s diverticulum and the etiogenic mechanism of enterolithiasis.