bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Accuracy in 2,351 Patients Undergoing Appendicectomy for Suspected Acute Appendicitis: A Retrospective Study 1986–1993
Authors: Styrud J. , Eriksson S. , Segelman J. , Granström L.
Published: April 2003

Aims: To investigate the pre-operative findings, accuracy, perforation rate and complication rate in 2,351 patients who underwent appendicectomy during 1986–1993. Method: The 2,351 records from patients who underwent surgery were analysed to determine whether the pre-operative investigations introduced can improve the diagnostic accuracy when analysed in total. Results: The total diagnostic accuracy which was 70.9% in 1986 increased to a statistically significant figure of 87.1% in 1993. In female patients, the figure increased from 61.7 to 82.4% and in males from 82.0 to 91.2% during the studied period. The complication rate was in total 10.4% including a mortality of 0.21% (5 patients). Conclusion: We believe that with a combination of increased interest in patients with acute appendicitis, a wider use of active in-hospital observation, a more standardised pre-operative laboratory investigation and the use of ultrasonography, a high diagnostic accuracy could be reached without an increased rate of complications and perforations.
Platelet-Activating Factor and Platelet-Activating Factor Antagonists in Acute Pancreatitis
Authors: Johnson C.D.
Published: April 2003

Introduction: Acute pancreatitis causes platelet-activating factor (PAF) to be released which induces systemic effects that contribute to circulatory disturbances and multiple organ failure. PAF has also been implicated as a key mediator in the progression of severe acute pancreatitis, which can lead to complications and unacceptably high mortality rates. Mode of Action of PAF in Acute Pancreatitis: Synthesis of PAF is sensitive to biologically active mediators seen in many inflammatory processes. PAF significantly potentiates pancreatic tissue damage; it causes serum amylase and lipase levels to rise significantly, causes scattered haemorrhages and may serve as a primary mediator of inflammation. PAF Antagonists: Several classes of compounds show significant PAF antagonisms, and all have shown significant local and systemic effects to reduce inflammatory changes. Only lexipafant, however, has been studied in human acute pancreatitis. Lexipafant specifically binds to the PAF receptor and is more potent than other PAF antagonists. In clinical trials lexipafant reduces organ failure and suppresses some aspects of the inflammatory response. Conclusion: Our understanding of the pathology of systemic complications, and of a central role of PAF in mediating an inappropriate inflammatory response has improved in recent years. Confirmation of clinical findings with lexipafant will indicate an effective new therapy for the treatment of severe acute pancreatitis.
Specific Prognostic Factors for Secondary Pancreatic Infection in Severe Acute Pancreatitis
Authors: Armengol-Carrasco M. , Oller B. , Escudero L.E. , Roca J. , Gener J. , Rodríguez N. , delMoral P. , Moreno P.
Published: April 2003

Background/Aims: The aim of the present study was to investigate whether there are specific prognostic factors to predict the development of secondary pancreatic infection (SPI) in severe acute pancreatitis in order to perform a computed tomography-fine needle aspiration with bacteriological sampling at the right moment and confirm the diagnosis. Methods: Twenty-five clinical and laboratory parameters were determined sequentially in 150 patients with severe acute pancreatitis (SAP) and univariate, and multivariate regression analyses were done looking for correlation with the development of SPI. Results: Only APACHE II score and C-reactive protein levels were related to the development of SPI in the multivariate analysis. A regression equation was designed using these two parameters, and empiric cut-off points defined the subgroup of patients at high risk of developing secondary pancreatic infection. Conclusion: The results showed that it is possible to predict SPI during SAP allowing bacteriological confirmation and early treatment of this severe condition.
Highly Aggressive Behavior and Poor Prognosis of Small-Cell Carcinoma in the Alimentary Tract: Flow-Cytometric Analysis and Immunohistochemical Staining for the p53 Protein and Proliferating Cell Nuclear Antigen
Authors: Kimura Hironobu , Konishi Kohji , Maeda Kiichi , Yabushita Kazuhisa , Tsuji Masahiko , Miwa Atsuo
Published: April 2003

The purpose of this study was to determine the clinical course, and effects of the histopathologic characteristics of specific tumors, including DNA contents and immunohistochemical aspects, in patients with small-cell carcinoma of the alimentary tract. Medical records of 14 patients who presented with small-cell carcinoma of the alimentary tract were retrospectively reviewed. Primary tumors were studied by immunohistochemical and flow cytometric analyses. Of these 14 small-cell carcinomas, 4 were esophageal, 8 gastric, and 2 colonic tumors. DNA aneuploidy was observed in 8 tumors. Staining for the p53 product was positive in 57.1% of all the tumors. The average proliferating cell nuclear antigen (PCNA) labeling rate (LR) was 72.4 ± 11.6%. The average PCNA LR was significantly higher for the p53-positive group (p < 0.05). The estimated median survival was 253 days for all patients. Noncurative resection was associated with a significantly less favorable prognosis (p < 0.01). Distant metastases were observed in 13 of 14 patients. A higher PCNA LR of small-cell carcinoma may be an unfavorable characteristic of biological behavior. The patients with disseminated disease should undergo a symptomatically palliative operation combined with chemotherapy.
Hemoperitoneum due to a Ruptured Gastric Stromal Tumor
Authors: Pera M. , Sáenz A. , Fernández-Cruz L.
Published: April 2003

Background/Aims: Gastrointestinal stromal tumors form a group of uncommon neoplasms originated from pluripotential mesenchymal cells. Many patients are asymptomatic and the tumor is discovered during an abdominal operation. Massive intraperitoneal bleeding is an exceptional complication associated with high mortality rates. Our aim is to report a case of a gastric stromal tumor in an 83-year-old patient presenting with intraperitoneal hemorrhage and hypovolemic shock, successfully operated. Methods: Emergency laparotomy showed a hemoperitoneum caused by rupture of a large exogastric tumor attached to the greater curvature. Total gastrectomy and esophagojejunostomy was performed. Results: Histological examination revealed proliferation of spindle-shaped cells but immunocytochemistry failed to identify specific markers of smooth muscle and neural cells. Diagnosis of a gastric stromal tumor was made. Postoperative evolution was uncomplicated. Conclusion: Gastric stromal tumor is a relatively rare neoplasm of mesenchymal origin whose nature and prognosis is unclear.
Internal Drainage of Infected Pancreatic Pseudocysts: Safe or Sorry?
Authors: Boerma Djamila , van Gulik Thomas M. , Obertop Huug , Gouma Dirk J.
Published: April 2003

Background: External drainage is the traditional surgical therapy for infected pancreatic pseudocyst, although associated with high morbidity and mortality rates. In this study it was determined whether internal drainage is feasible with acceptable postoperative morbidity and recurrence rates. Methods: A retrospective comparison was made of the outcome of internal versus external drainage of infected pseudocysts in 15 patients. All patients were known to have a (sterile) pseudocyst and presented with symptoms suggestive of infection of the cyst, proven by positive cultures and Gram staining. Results: Internal drainage was performed in 8 and external drainage in 7 patients. Patient characteristics appeared comparable, as was the time of sterile cyst presence before infection occurred (6 and 9 weeks, respectively). No major complications occurred, although hospital stay was prolonged after external drainage due to development of pancreaticocutaneous fistulas along the drain tract in 4 patients. Enteric microorganisms were cultured in 11 patients, of whom 10 had undergone ERCP just prior to infection. During follow-up no pseudocyst recurred. Conclusion: Surgical internal drainage of an infected pseudocyst is safe and effective and, in selected patients, is first-choice treatment. ERCP seems to play an important role in the secondary infection of pseudocysts.
Wound Complications after Major Gastrointestinal Operations
Authors: Gislason Hjörtur , Søreide Odd , Viste Asgaut
Published: April 2003

Background: Wound complications occur quite often after abdominal operations. Numerous studies have been performed in the last decades focusing on closure methods, incisions and suture materials. However, the most important factor, the individual surgeon, has hardly been taken into account in these studies. Methods: This study presents results from a prospective randomised study on abdominal wall closure focusing on the results of the individual surgeon. Results/Conclusions: We found no differences in the complication rate between different suture materials or between continuous and interrupted closure techniques. There are marked individual differences in complication rates between surgeons. Regular audit with feedback to individual surgeons is an important instrument for quality improvement.
Prognosis Factors in Carcinoma of the Head of the Pancreas
Authors: Wenger F.A. , Peter F. , Zieren J. , Steiert A. , Jacobi C.A. , Müller J.M.
Published: April 2003

Background: Due to a low survival rate even after a R0 resection of cancer of the head of the pancreas, a strict indication for a pancreaticoduodenectomy seems to be sensible. We have therefore analyzed our patients for possible prognosis factors. Methods: In a retrospective trial the courses of disease of all patients (1981–1996) with resected histologically proven carcinoma of the head of the pancreas were analyzed. The following patient-specific parameters were evaluated and examined in a single or multivariate analysis of prognosis factors: age, gender, tumor size (T status), lymph node involvement (N status), dimension of resection, operation method, time of operation, morbidity, clinic lethality and survival rate. Results: Between 1981 and 1996, 500 patients with ductal adenocarcinoma of the head of the pancreas were treated surgically. The rate of resection increased from 32.1% (1981–1986) to 37.8% (1991–1996) whereas the mortality rate decreased from 13.3 to 7.3%. The 5-year survival rate after resection was 11.8% with a median survival time of 13.8 months. In a multivariate analysis, only small tumors (T1, p < 0.016), the R0 status (p < 0.017) and the resection had a significant influence on the survival rate. Conclusion: Prognosis factors in the treatment of pancreatic cancer were tumor size (T1), tumor resection and R0 status.
Rubber Band Ligation of Symptomatic Internal Hemorrhoids: Results of 500 Cases
Authors: Komborozos Vassilios A. , Skrekas George J. , Pissiotis Christos A.
Published: April 2003

Background/Aim: In this prospective study the results of rubber band ligation (RBL) of symptomatic hemorrhoids in 500 consecutive patients with 2nd (255 cases), 3rd (218 cases) and 4th degree (27 cases) hemorrhoids are presented. Methods: The patients’ symptoms were hemorrhage in 142 cases (28.4%), prolapse in 33 cases (6.6%) and both hemorrhage and prolapse in 325 cases (65%). Sixteen patients with hemorrhoids had liver cirrhosis and portal hypertension. RBL was performed using the St Marks’ applicator (Seward) on an outpatient basis. Multiple ligations in two (259 cases) or three (190 cases) sessions were undertaken in 449 patients (89.8%), while a single ligation was done in 51 cases (10.2%). Results: Successful results were achieved in 440 cases (88%) in a 24-month follow-up. A total of 94 patients (18.8%) had complications which required no hospitalization. Pain and hemorrhage were the most frequent complications. RBL proved to be safe in 16 patients with coagulation disorders due to liver cirrhosis. Two years after RBL, symptomatic recurrence was 11.9% (53/445) with repeat RBL or surgery in 9.2% (41/445). Conclusions: RBL is a useful, safe and successful method for treating symptomatic 2nd and 3rd degree hemorrhoids, which can be applied successfully in selected cases with 4th degree hemorrhoids, but with an increased rate of recurrence and additional treatment requirements. Also, RBL seems to be safe in patients with liver cirrhosis and portal hypertension.
Fibrin Glue-Antibiotic Mixture in the Treatment of Anal Fistulae: Experience with 69 Cases
Authors: Patrlj Leonardo , Kocman Branislav , Martinac Miran , Jadrijević Stipislav , Šoša Tomislav , Šebećić Božidar , Brkljaćić Boris
Published: April 2003

Background/Aims: To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. Materials and Methods: This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts ≤3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. Results: After a follow-up of 18–36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a ≤3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). Conclusion: The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract ≤3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.
Three-Year Evaluation of a Rapid-Access Coloproctology Clinic
Authors: Lamah M. , Ahmad S.M. , Charalampopoulos A. , Ho J. , Leicester R.J.
Published: April 2003

Background/Aims: Evolving surgical practice has placed increasing pressures on surgical outpatient clinics. This article provides a prospective evaluation of a rapid-access coloproctology clinic over a 3-year period. Methods: Primary care physicians (PCP) were circulated details of the clinic, and invited to refer any patient presenting with colorectal or anorectal symptoms, or with a family history of bowel cancer wishing advice about screening. Data were collected prospectively and patients and the referring PCPs were invited to complete a self-administered structured questionnaire. Results: In all, 3,119 patients were referred, the main indications being rectal bleeding (67%), abdominal pain (16%) and change in bowel habit (15%). The average time interval between PCP visit and specialist consultation was 2 days and neoplastic disease was detected in 7.1% of patients. 70% of patients with haemorrhoids and 39% of those with other minor diseases were discharged back to their PCPs after definitive treatment at the time of their visit to the clinic. The majority of PCPs and patients expressed satisfaction with the service as evidenced by the returned questionnaires. Conclusion: These data show that a more universal implementation of such clinics may result in improved care of colorectal disease and considerable savings of outpatient time and resources.
Cost-Effectiveness Study of Imipenem/Cilastatin versus Meropenem in Intra-Abdominal Infections
Authors: Attanasio Ermanno , Russo Pierluigi , Carunchio Gabriella , Basoli Antonio , Caprino Luciano
Published: April 2003

Background: The efficacy of two carbapenems, imipenem/cilastatin (I/C, 1.5 g daily) versus meropenem (3 g daily) in intra-abdominal infections was assessed in a recent multicenter randomized clinical trial. The aim of this article is to perform a cost-effectiveness analysis as in real-world practice according to the findings of this clinical trial. Methods: A decision tree was used to estimate the clinical outcomes and direct costs of treating intra-abdominal infections using the two carbapenems from the perspective of the Italian National Health Service (INHS) or a private insurance company (PIC). Results: In a population of 30,000 patients with intra-abdominal infections in Italy, it was estimated that 97 potential deaths/year could be avoided if these patients were treated with I/C versus meropenem. In addition, from the perspective of INHS, the total costs of treatment were estimated as ITL 106,874 million and 134,042 million for I/C and meropenem, respectively. In favor of the PIC point of view, the total costs were estimated as ITL 110,500 million and 135,899 million for I/C and meropenem, respectively. Conclusion: The treatment of intra-abdominal infections with I/C is shown to be more effective (97 deaths avoided/year) and less costly than with meropenem (with a saving of ITL 27,168 and 25,399 million/year for INHS and PIC, respectively).
Proximal and Distal Segments of the Possum Sphincter of Oddi Respond Differently to Neural and Cholecystokinin Octapeptide Stimulation in vitro
Authors: Woods C.M. , Schloithe A.C. , Simula M.E. , Toouli J. , Saccone G.T.P.
Published: April 2003

Background/Aims: Previous studies have demonstrated separate pancreatic duct (PD) and bile duct (BD) components of the sphincter of Oddi (SO) and suggested distinct proximal and distal functional segments. This study was designed to determine if proximal and distal segments of the BD component of the SO (BD-SO) and PD component of the SO (PD-SO) responded equally to (1) activation of SO-duodenal neural pathways, and (2) exogenous cholecystokinin octapeptide (CCK-8). Methods: Intact SO-duodenum preparations from Australian brush-tailed possums (n = 6) were mounted in organ baths. SO activity was recorded from the proximal and distal segments of BD-SO and PD-SO ± electrical activation of duodenal nerves at two separate sites. Full thickness muscle strips from the proximal and distal segments of the BD-SO and PD-SO were prepared (n = 8), mounted in organ baths, and exposed to CCK-8 (10–9– 10–6 M), ± tetrodotoxin. Results: Activation of duodenal nerves evoked different responses in some segments of the BD-SO and PD-SO, depending on the site of duodenal electrical stimulation. CCK-8 induced a concentration-dependent, tetrodotoxin-insensitive decrease in the contraction amplitude of SO muscle strips from the proximal but not the distal SO. BD-SO and PD-SO strips were not different. Conclusions: The SO is composed of BD and PD components each of which contains proximal and distal segments that can respond independently to appropriate stimuli.
Sacral Magnetic Stimulation in Paradoxical Puborectalis Syndrome
Authors: Shafik Ahmed
Published: April 2003

Background/Purpose: Our earlier studies have demonstrated that sacral magnetic stimulation (MS) in the canine model, in healthy volunteers and in constipated subjects brought about a rise in rectal pressure and a decline in rectal neck (anal canal) pressure as well as rectal evacuation. Based on these results, we studied the effect of sacral MS on defecation in patients with paradoxical puborectalis syndrome (PPS). Methods: Eleven subjects (8 women, 3 men; age 36–53 years) with PPS were enrolled in the study. The magnetic coil was placed on the back with its center located between L4 and L5. Stimulation parameters were set at 70% of maximum intensity, 40 Hz frequency and 2 s burst length with 2 s off. During MS, the rectal neck and gastric (intra-abdominal) pressures were measured. The procedure was performed in the empty and the full rectum using the balloon expulsion test in the latter. Results:  MS of the empty and balloon-filled rectum brought about a rise in the rectal pressure (p < 0.001), decline in rectal neck pressure (p < 0.001) and no significant change in intragastric pressure (p > 0.05). The balloon was expelled by all patients. Conclusions: Sacral MS succeeded in expelling the water-filled rectal balloon. The method is simple, easy, noninvasive, nonradiologic and can be performed on an outpatient basis in the treatment of PPS.
The Initial Approach to Anorectal Abscesses: Fistulotomy Is Safe and Reduces the Chance of Recurrences
Authors: Knoefel Wolfram Trudo , Hosch Stefan B. , Hoyer Björn , Izbicki Jakob R.
Published: April 2003

Background/Aims: Anorectal abscesses are most frequently based on a coexistent fistula in ano. Whether these should be searched for and excised initially or not remains controversial. Our aim was to determine which approach has less recurrences and carries a lower risk of continence disorders. Methods: 158 patients with an anorectal abscess or anal fistula were identified in our institution over a period of 75 consecutive months. The records and follow-up questionnaires of 131 patients were evaluable. The mean follow-up period was 40 (range 3–78) months. Results: When fistulotomy was performed at the time of draining the abscess, the recurrence rate could be reduced, in comparison to incision and drainage alone, from 34 to 4% (p = 0.007). In the group of patients undergoing surgery for a recurrence, the recurrence rate could even be reduced from 67 to 0% (p = 0.03) by simultaneous fistulotomy. A total of 4 of the 131 patients (3%) developed incontinence of liquid stool and flatus, but no incontinence of solid stool occurred. Incontinence did only occur after recurrent disease. Conclusions:  The number of recurrences requiring surgery can be significantly reduced by initial fistulotomy. The risk to develop incontinence increases with recurrent anorectal disease, not with careful fistulotomy.
Superior Mesenteric and Portal Vein Thrombosis following Laparoscopic Nissen Fundoplication
Authors: Kemppainen Esko , Kokkola Arto , Sirén Jukka , Kiviluoto Tuula
Published: April 2003

This case report describes superior mesenteric and portal vein thrombosis after laparoscopic Nissen fundoplication. As a thromboembolic prophylaxis, 2,500 IU of dalteparin was given preoperatively. After postoperative day 19, the patient experienced gradually increasing abdominal pain, mostly related to meals. Physical examination and laboratory tests were normal. CT scan revealed a portal and superior mesenteric vein thrombosis. Dalteparin and warfarin treatment was started, and symptoms relieved rapidly. In a control Doppler ultrasound 1 month after the onset of the treatment, a good flow in the portal and superior mesenteric vein was seen. Possible mechanisms are discussed.
What’s New with Tumor Markers for Colorectal Cancer?
Authors: Pokorny Richard M. , Hunt Louise E. , Galandiuk Susan
Published: April 2003

Background/Aims: Many tumor markers have been utilized in the follow-up care of colorectal cancer patients. No marker, however, has proven reliably accurate in detecting recurrent disease. Methods: The strengths and weaknesses of currently available tumor markers are reviewed, with attention to related cost and efficacy. Results: Tumor antigens, enzymes, and genetic markers have been used as tumor markers. CEA and CA 19.9 are the most widely utilized; however, genetic markers are the most promising for the future. Conclusions: Currently available markers have significant limitations. Development of genetic markers may greatly enhance our ability to predict prognosis and the need for adjuvant therapy. Marker-guided therapy may play an increasing role in this disease.
Combined Hepatic Artery and Segmental Portal Vein Occlusion in Antiphospholipid Syndrome
Authors: Praseedom Raaj Kumar , Jalan Rajiv , Allan Paul , McGilchrist Alastair , Roddie Huw , Madhavan Krishna Kumar
Published: April 2003

Antiphospholipid syndrome can have various clinical presentations, two of the most common being arterial and venous thrombosis. It is, however, unusual for them to occur in combination. We report here a case of combined hepatic artery and segmental portal venous occlusion in a 32-year-old patient who was shown to have a lupus anticoagulant. There have been no previous reports of thrombosis occurring simultaneously in the coeliac axis and the portal vein. Computerised tomography, Doppler ultrasound scanning and selective visceral angiography were used to demonstrate the anatomical lesions. The patient was treated medically with unfractionated heparin leading to a favourable clinical outcome. The diagnosis and management of this case is discussed with reference to the current literature on visceral thrombosis and antiphospholipid antibody syndrome.
Intoxication, the Law and Criminal Responsibility – A Sparkling Cocktail at Times: The Case Studies of Canada and Germany
Authors: Fischer Benedikt , Rehm Jürgen
Published: April 2003

The combination of intoxication and criminal responsibility has been a problem field for legal theory and practice for quite some time. While it has been argued in certain contexts that intoxication reduces or denies criminal responsibility, elsewhere it has been reasoned that intoxicated offenders should be held as (or even more so) legally responsible as sober ones. But even in legal systems where the criminal responsibility of intoxicated offenders is emphasized, legal theory and practice are confronted with the challenge of converting such values into workable jurisprudence, since many intoxicated offenders naturally lack one of the key premises for responsibility for a criminal act, namely mens rea. This article compares the very different legal philosophies and practices that have evolved around the issue of intoxication and criminal responsibility in Canada and Germany. While the Canadian system has long and in a variety of ways tried to reconcile the inherent tensions between the principles of legal culpability and the intent to punish intoxicated offenders in material law, the German system has produced a set of legal tools that allow for a pragmatic and ends-oriented approach. This article concludes that the evolution and profile of these legal schemes is likely linked to the cultural status of alcohol and drinking in the respective system context.
Psychiatric Comorbidity in Opiate Addicts
Authors: Krausz Michael , Verthein Uwe , Degkwitz Peter
Published: April 2003

The present study investigates whether a correlation exists between mental symptoms and opiate dependency. During a 5-year follow-up study in Hamburg, of 350 opiate addicts who were in contact with the help system at the time of the initial investigation, 219 (63%) could be interviewed three times at 1-year intervals. The investigation instruments were standardized questionnaires such as EuropASI, CIDI, SCL-90-R and BDI. The general life situation of the investigated persons had, on the whole, improved in the course of the last 2–3 years. Drug consumption had markedly decreased. One third of the opiate addicts were in a comparatively good mental condition on all three survey interviews, for 17% there was a worsening of the condition, and for another 17% the negative mental condition was reinforced. A correlation can be established between mental disorders/symptoms and drug addiction or drug-related problems. The more unfavorable the course of the mental symptoms, the greater the problems of the client’s current life situation. There is also an overall relationship between increased drug consumption and mental symptoms like depressivity and anxiety, and the psychosocial functioning level. However, the expected correlations between mental disorders and the extent of drug consumption are not very marked. This indicates that specific constellations of drug consumption and mental disorders are not isolated but are related, as elements of a complex behavioral pattern, to the development of other life areas of the client.
The German Monitoring and Reporting System for the Treatment of Substance-Related Problems: A National System on the Basis of Aggregated Data
Authors: Simon Roland , Hoch Eva , Holz Antonius
Published: April 2003

The German treatment monitoring and reporting system EBIS for out-patient centres treating clients with substance-related problems and disorders was set up in 1980. A parallel system for in-patient treatment was added in 1993 under the name of SEDOS. Together they are based nation-wide on more than 600 specialised treatment centres which collect diagnosis- and treatment-related data as well as information on socio-economic and family background. As part of the data relate to the end of treatment, also evaluative elements are included. In EBIS and SEDOS, aggregated data are the basis of the national and regional statistics produced, which offers a very high level of data protection for the clients treated. The revision of the national system implementing the Treatment Demand Indicator Protocol as the European Monitoring Centre for Drugs and Drug Addiction standard has already been started.
Economic Evaluation of Campral® (Acamprosate) Compared to Placebo in Maintaining Abstinence in Alcohol-Dependent Patients
Authors: Annemans L. , Vanoverbeke N. , Tecco J. , D’Hooghe D.
Published: April 2003

We compared the costs of acamprosate in maintaining abstinence in weaned alcoholic patients, to no pharmaceutical treatment over a 24-month period. A controlled trial (n=448) involving a 12-month treatment with acamprosate and a 12-month follow-up showed a significant advantage of acamprosate over placebo in the prevention of relapse. For the economic analysis, the average costs of relapses from the health insurance perspective were calculated based on a Belgian survey among general practitioners and on an observational prospective Belgian trial among specialists. Calculations resulted in net cost savings of 21,301 BEF (528 Euro) per patient over a 24-month period for acamprosate compared to no pharmaceutical treatment, explained by fewer acute hospitalisations for detoxification and less institutionalised rehabilitation. A global anticipated net saving of 70 million BEF (1.74 million Euro) over 2 years was estimated for the Belgian health insurance.
No Association between Mannose-Binding Lectin Alleles and Susceptibility to Chronic Hepatitis B Virus Infection in German Patients
Authors: Höhler Thomas , Wünschel Markus , Gerken Guido , Schneider Peter M. , Meyer zum Büschenfelde Karl-H. , Rittner Christian
Published: April 2003

Variants of the mannose-binding lectin (MBL) have been shown to be associated with low serum concentrations of the protein and to predispose to bacterial, fungal and viral infections. A recent small study on 33 Caucasian patients had suggested that a mutation at codon 52 of the MBL gene is associated with chronic hepatitis B virus (HBV) infection. Exon 1 of the MBL gene was amplified by PCR in 61 patients with chronic HBV infection, 28 patients with acute infection and in 60 controls. MBL variants were detected by subsequent restriction enzyme digestion and agarose gel electrophoresis. The occurrence of the codon 52 mutation in patients with chronic HBV infection did not differ significantly from that in controls or patients with acute infection (9 vs. 7%), nor were there any significant differences for the codon 54 mutation. The frequency of MBL variants at codon 52 and 54 is not increased in patients with chronic HBV infection. Thus, the previously reported association of MBL deficiency with chronic HBV infection in adults could not be confirmed.
C1q Knock-Out Mice for the Study of Complement Deficiency in Autoimmune Disease
Authors: Botto Marina
Published: April 2003

In humans, homozygous deficiency of the first component of the classical pathway of complement, C1q, is a powerful disease susceptibility factor for the development of systemic lupus erythematosus (SLE). This strong association indicates that a functional activity of C1q protects from the development of SLE. Studies in vitro have shown that C1q can bind apoptotic keratinocytes suggesting that it may have an important role in the clearance of apoptotic cells. C1q-deficient mice, generated by gene targeting, showed an increased mortality and 25% of the mice had histological evidence of glomerulonephritis characterised by multiple apoptotic cell bodies and immune deposits, assessed by immunofluorescence and electron microscopy. These observations are compatible with the hypothesis that C1q deficiency causes autoimmunity by an impaired clearance of apoptotic cells.
Reference Typing Report for Complement Receptor 1 (CR1)
Authors: Moulds J.M. , Brai M. , Cohen J. , Cortelazzo A. , Cuccia M. , Lin M. , Sadallah S. , Schifferli J. , Bala Subramanian V. , Truedsson L. , Wu G.W. , Zhang F. , Atkinson J.P.
Published: April 2003

A total of 100 Chinese blood donors (50 from Shen-Zhen and 50 from Taiwan) were studied by the participants in addition to 9 reference samples. A new nomenclature for the CR1 structural alleles was recommended by the participants which would use a numbering system, e.g. CR1*1. The structural allele frequencies in the Chinese were: CR1*1 (190 kD) 0.96, CR1*2 (220 kD) 0.03, CR1*3 (160 kD) 0.01 and CR1*4 (250 kD) 0.00. The HindIII expression polymorphism was also studied and the high expressing allele had a gene frequency of 0.71 while the low expressor gene frequency was 0.28. Erythrocyte copy numbers were quantified and compared between laboratories with good correlation (R = 0.55–0.88). The mean (± SD) erythrocyte copy number was 463 (± 229) in the Taiwan donors and 446 (± 207) in the Mainland Chinese.
Rheumatoid Arthritis – A Gene Transfer Disease
Authors: Grubb Rune , Grubb Anders , Kjellén Lars , Lycke Erik , Åman Pierre
Published: April 2003

Sera from patients with rheumatoid arthritis (RA) were from the very start instrumental in detecting and delineating the human immunoglobulin (Ig) allotypes in the Gm system. Knowledge that human Ig production is under Mendelian control and not determined by templates of antigen would not have come to the fore if it were not for RA patients. Worldwide experience shows that RA patients are prone to mount an immune response to human Ig allotypes. Major Gm allotypes are defined at the amino acid and nucleotide levels. Gene technology has been developed for defining these allotypes. Studies of the Gm allotypes and anti-Gms have led to two apparently paradoxical findings: (1) In conflict with Mendelian law, non-nominal or hidden allotypes have been observed and recently documented at the DNA level. (2) In RA, an immune response to other individuals’ Mendelian allotypes is prevalent, although RA is generally considered an autoimmune disease. These findings led us to conclude that RA is not initially an autoimmune disease but a gene transfer disease. A brief review of viral high-jacking and transfer of human genes is given along with reasons for considering the herpesvirus family in particular. Genes determining incompatible Ig allotypes are transferred. We have shown that these genes are expressed in RA synovia. Ig-anti-Ig complexes arise and may have arthritogenic potential, as observed in serum sickness.
No Quantitative Relationship between CR1 and Lutheran Expression on Erythrocytes: In(Lu) Gene Product Is Not a Common Regulator of CR1 Expression on Erythrocytes
Authors: Oudin S. , Lepennec P.-Y. , Dervillez X. , Tonye-Libyh M. , Tabary T. , Philbert F. , Bougy F. , Reveil B. , Pennaforte J.-L. , Rouger P. , Cohen J.H.M.
Published: April 2003

The density of CR1, the C3b/C4b receptor (CD35), on erythrocytes (E) (CR1/E) is genetically determined. However, the broad distribution of CR1/E within a given genotype suggests that other genetic elements might contribute to the regulation of CR1/E. In some pathological conditions, including systemic lupus erythematosus (SLE), AIDS and hemolytic anemia, CR1 deficiency parallels the severity of the disease. When compared to healthy individuals, an accelerated decrease in CR1/E in these patients has been demonstrated, but other mechanisms interfering with CR1 density regulation during erythropoiesis might also contribute. In exceptional circumstances, CR1/E can be dramatically decreased in healthy individuals by the effect of a regulatory gene, In(Lu), that switches off various surface molecules on E, the structure genes of which are located on four different chromosomes, suggesting a transcription regulatory role for In(Lu) gene products. The hypothesis that products of this gene could physiologically regulate the surface density of all these molecules has been tested by determining Lub density on E (Lub/E) using quantitative flow cytometry. Lub antigenic sites were then compared to CR1/E among healthy individuals of the different CR1 density phenotypes, SLE patients with and without CR1 deficiency, and an exceptional SLE patient totally lacking CR1/E and reticulocytes. No quantitative relationship was found between CR1 and Lub expression in either normal or pathological conditions. These data establish that In(Lu) products are not involved in normal or pathological CR1 density regulation.
Complement-Mediated Regulation of Trichomonas vaginalis Infection in Mice
Authors: Caterina P. , Lynch D. , Ashman R.B. , Warton A. , Papadimitriou J.M.
Published: April 2003

Trichomonas vaginalis is a flagellated protozoan which causes trichomoniasis, a sexually transmitted disease of the human genitourinary tract. The importance of the alternative complement pathway in host defence against T. vaginalis was investigated in vitro. Kinetic studies utilising immunofixation following electrophoresis showed that both a strongly and weakly virulent strain of T. vaginalis activated murine serum C3. In vivo studies with congenic-resistant, C5-deficient, B10.D2/OSn- and C5-sufficient, B10.D2/nSn mice showed that the presence of C5 is a significant factor in the innate host resistance to primary infection with a strongly virulent, but not a weakly virulent trichomonad strain.
Molecular, Serological and Population Studies of the Alleles and Products of HLA-B*41
Authors: Darke C. , Winkler S. , Guttridge M.G. , Street J. , Thomas M. , Thompson J. , McNamara S.
Published: April 2003

The HLA-B41 specificity was first identified over 25 years ago and, although both serological and biochemical studies have suggested its subdivision, it is only recently that two HLA-B*41 alleles (B*4101 and B*4102) have been identified and sequenced. We designed three oligonucleotide primers, combined in two mixtures to define these alleles by PCR using sequence-specific primers (PCR-SSP) in a random normal population of 9,464 HLA-A, B, DR, DQ typed Northern European Caucasoid donors from the Welsh Bone Marrow Donor Registry. The HLA-B41 phenotype frequency was 0.835%, and of the 79 HLA-B41 subjects 22 (27.85%) were B*4101 and 57 (72.15%) were B*4102. The phenotype frequencies of B*4101 and B*4102 were 0.232 and 0.602%, respectively, and the gene frequencies were 0.00116 and 0.00301, respectively. Formal two-locus linkage disequilibrium (LD) analysis demonstrated significant associations between B*4101 and A30 and DR11, and between B*4102 and A66 and DR13. LD analysis of three loci showed significant associations between B*4101, DR7, DQ2 and B*4101, DR11, DQ7 (DQB1*0301/0304) and between HLA-A3, B*4102, DR13; A66, B*4102, DR7; A66, B*4102, DR13; B*4102, DR13, DQ6 and B*4102, DR13, DQ7. Examination of the HLA phenotypes (including HLA-C) of the B*41 subjects, together with the LD analysis findings, suggested four different HLA haplotypes bearing B*4101 and five B*4102 haplotypes. The most frequent B*4101 haplotype was: HLA- A30 or other A allele, Cw*1701, B*4101, DRB1*1102, DQB1*0301 and the most freqent B*4102 haplotype was: A*6601 or A3 or other A allele, Cw*1701, B*4102, DRB1*1303, DQB1*0301. In addition, the well-known association of A66 with B41 was between A*6601 and B*4102, and although both B*41 alleles were commonly in association with Cw*1701, B*4101 was found with Cw*07. One-dimensional isoelectric focusing (1D-IEF) analysis of HLA-B proteins from 2 B*4101 and 2 B*4102 subjects clearly showed that the B41.1 and B41.2 1D-IEF variants, identified in the 10th International Histocompatibility Workshop, corresponded to B*4101 and B*4102 products, respectively. Serological titration studies, with 59 lymphocytotoxic pregnancy antisera, containing an HLA-B41 component and stimulated by up to five different HLA-B specificities, were unable to differentiate the two groups of B*41 subjects. This suggests that partition of the HLA-B41 specificity will not normally be achieved by classical serological methods. It is suggested that the previous alleged serological subdivision of HLA-B41 was founded on the unwitting use of antisera detecting the HLA-Cw*17 products.
MHC Class I Cross-Talk with CD2 and CD28 Induces Specific Intracellular Signalling and Leads to Growth Retardation and Apoptosis via a p56lck-Dependent Mechanism
Authors: Ruhwald Morten , Pedersen Anders E. , Claesson Mogens H.
Published: April 2003

Ligation of the major histocompatibility complex class I molecules (MHC-I) on human T lymphoma cells (Jurkat) initiates p56lck-dependent intracellular signalling events (phosphotyrosine kinase activity; [Ca2+]i) and leads to augmented growth inhibition and apoptosis. MHC-I ligation in concert with ligation of CD2 or CD28 augments, changes or modifies the pattern of activation. Ligation of MHC-I and CD2 alone resulted in growth inhibition, whereas CD28 ligation alone had no effect on cell proliferation. Ligation of MHC-I together with CD2 augmented growth inhibition and enhanced the level of apoptosis. In parallel experiments with the p56lck-negative Jurkat mutant cell, JCaM1.6, cross-linking neither influenced cell signalling nor cellular growth functions, indicating a cardinal role of the src kinases in signal transduction via MHC-I, CD2 and CD28 molecules. The results presented here provide evidence for the involvement of MHC-I molecules in the modulation of signal transduction via the CD2 and CD28 costimulatory molecules.
The Human T Cell Receptor Alpha Joining (TRAJ) Genes
Authors: Scaviner Dominique , Lefranc Marie-Paule
Published: April 2003

‘Human T cell Receptor Alpha Joining Genes’, the 9th report of the ‘IMGT Locus in Focus’ section, comprises 3 tables: (1) ‘Human germline TRAJ genes’; (2) ‘Human TRAJ allele table’; and (3) ‘Nucleotide and protein displays of the human TRAJ alleles (overview)’. These tables are available on the IMGT Marie-Paule page from IMGT, the international ImMunoGeneTics database (http://imgt.cines.fr:8104) created in 1989 by Marie-Paule Lefranc, Université Montpellier II, CNRS, France.
Characteristics of HLA Class I and Class II Polymorphisms in Rwandan Women
Authors: Tang Jianming , Naik Eknath , Costello Caroline , Karita Etienne , Rivers Charles , Allen Susan , Kaslow Richard A.
Published: April 2003

Objective: To define HLA class I and class II polymorphisms in Rwandans. Methods: PCR-based HLA genotyping techniques were used to resolve variants of HLA-A, B, and C to their 2- or 4-digit allelic specificities, and those of DRB1 and DQB1 to their 4- or 5-digit alleles. Results: Frequencies of 14 A, 8 C, and 14 B specificities and of 13 DRB1 and 8 DQB1 alleles were ≥0.02 in a group of 280 Rwandan women. These major HLA factors produced 6 haplotypes extending across the class I and class II regions: A*01-Cw*04-B* 4501-DRB1*1503-DQB1*0602 (A1-Cw4-B12- DR15 - DQ6), A * 01 - Cw * 04 - B * 4901 -DRB1 * 1302-DQB1*0604 (A1-Cw4-B21-DR13-DQ6), A*30 - Cw*04 - B*15 - DRB1*1101 - DQB1*0301 (A19-Cw4-B15-DR11-DQ7), A*68-Cw*07-B* 4901-DRB1*1302-DQB1*0604(A28-Cw7-B21- DR13 - DQ6), A*30 - Cw*07 - B*5703 - DRB1* 1303-DQB1*0301(A19 - Cw7 - B17 - DR13 - DQ7), and A*74-Cw*07-B*4901-DRB1*1302-DQB1* 0604 (A19-Cw7-B21-DR13-DQ6), respectively. Collectively, these extended haplotypes accounted for about 19% of the total. Other apparent class I-class II haplotypes (e.g., Cw*17-B*42-DRB1*0302-DQB1*0402, Cw*06- B*58-DRB1*1102-DQB1*0301, and Cw*03- B*15-DRB1*03011-DQB1*0201) did not extend to the telomeric HLA-A locus, and other 3-locus class I haplotypes (e.g., A*68-Cw*04-B*15, A*74-Cw*04-B*15, and A*23-Cw*07-B*4901) completely or partially failed to link with any specific class II alleles. Discussion: Frequent recombinations appeared to occur between the three evolutionarily conserved HLA blocks carrying the class I and class II loci. The HLA class I profile seen in Rwandans was not directly comparable with those known in the literature, although the class II profile appeared to resemble those in several African populations. These data provide additional evidence for the extensive genetic diversity in Africans.
The Mouse (Mus musculus) T Cell Receptor Beta Variable (TRBV), Diversity (TRBD) and Joining (TRBJ) Genes
Authors: Bosc Nathalie , Lefranc Marie-Paule
Published: April 2003

‘The Mouse (Mus musculus) T cell Receptor Beta Variable (TRBV), Diversity (TRBD), and Joining (TRBJ) Genes’, the 14th report of the ‘IMGT Locus in Focus’ section, comprises 8 tables entitled: (1) ‘Number of mouse (Mus musculus) germline TRBV genes at 6A–C and potential repertoire’; (2) ‘Mouse (Mus musculus) germline TRBV genes at 6A–C’; (3) ‘Mouse (Mus musculus) TRBV allele table’; (4) ‘Mouse (Mus musculus) germline TRBD genes and alleles’; (5) ‘Mouse (Mus musculus) germline TRBJ genes’; (6) ‘Mouse (Mus musculus) TRBJ allele table’; (7) ‘Correspondence between the different mouse (Mus musculus) TRBV gene nomenclatures’; (8) ‘Mouse (Mus musculus) TRBV genes and related human TRBV genes’. These tables are available at the IMGT Marie-Paule page from IMGT, the international ImMunoGeneTics database (http://imgt.cines.fr:8104) created by Marie-Paule Lefranc, Université Montpellier II, CNRS, Montpellier, France.
Factors Influencing Informed Choice of Prenatal Diagnosis: Women’s Feelings and Attitudes
Authors: Crang-Svalenius Elizabeth , Dykes Anna-Karin , Jörgensen Connie
Published: April 2003

Objective: To obtain knowledge about factors that could influence women’s informed choice and extent of prenatal diagnosis, her feelings when implementing it, and her satisfaction. Method: A questionnaire including Visual Analogue Scale was given to 823 women and replies received from 662 (80.4%). Ease of choice was the basis for the statistical analysis. Results: The factors that most often influenced choice were the fetus health, maternal age, and knowledge of the consequences. The choice was easy to make, only 2% finding it very difficult. The time period from the amniocentesis until the results were available was the most difficult time reported. Conclusions: The choice of method for prenatal diagnosis was very easy for most women. Satisfaction with choice was high (98%). Extra support can be needed while awaiting results of invasive prenatal diagnosis.