bluuebunny/crossref_metadata_2025 huggingface dataset:
Exposure at Home to Airborne Concentrations of Nitrogen Mustard during Topical Application for the Treatment of Mycosis fungoides: A Case Study
Authors: Snell Jon , Lillquist Dean R. , Lewis-Younger Cynthia , Wallace David O.
Published: April 2003

Background: Although effective at treating mycosis fungoides (MF), nitrogen mustard (HN2) creates potential exposure risks to those who administer it, including health care workers and family members. Objective: The main objective was to examine the potential for nontarget individuals to be exposed to HN2 vapors during and shortly after treatment with HN2 in a home environment. Methods: Air concentrations of HN2 were measured during the topical treatment of MF in a patients home. Results: The results demonstrate that eye and mucous membrane irritation may occur at HN2 levels commonly encountered during the treatment of MF in the home, hospital or health clinic. Because no exposure thresholds have been developed for HN2, the exposure thresholds of a surrogate chemical (sulfur mustard) were used. Conclusions: The study findings show that eye and mucous membrane irritation may occur at HN2 levels below the exposure thresholds of the surrogate chemical. Recommendations for controlling exposures to HN2 in the home are given.
Coincidence of Multiple, Disseminated, Tardive-Eruptive Blue Nevi with Cutis marmorata teleangiectatica congenita
Authors: Krause Markus H. , Bonnekoh Bernd , Weisshaar Elke , Gollnick Harald
Published: April 2003

A 71-year-old woman reported a slow progression of multiple bluish dark asymptomatic macules and papules on the pretibial region of both lower legs for over 30 years. At birth a left-sided hypoplasia of the leg including the buttock accompanied by a connatal vascular nevus had been diagnosed. The ipsilateral deep veins of the pelvis and leg had a normal anlage. Histopathological examination revealed multiple blue nevi of the common type. The association of multiple blue nevi and cutis marmorata teleangiectatica congenita with limb hypoplasia has not previously been reported and is discussed in this paper. One could speculate whether these symptoms represent a new syndrome, because by thorough examination the NAME syndrome could be ruled out.
Takayasu Arteritis and Cutaneous Necrotizing Vasculitis
Authors: Skaria A.M. , Ruffieux P. , Piletta P. , Chavaz P. , Saurat J.-H. , Borradori L.
Published: April 2003

Takayasu arteritis (TA) is an inflammatory arteriopathy involving predominantly the aorta and its main branches. The disease evolves in two phases: a first, nonspecific inflammatory stage and a late ‘pulseless’ stage, in which complications related to arterial stenosis and aneurysm formation predominate. In both phases, skin manifestations, such as inflammatory nodules, erythema-nodosum- and pyoderma-gangrenosum-like ulcers, have been described. We report 2 patients with TA, who had cutaneous necrotizing vasculitis as presenting manifestation of the disease. A review of the literature revealed 8 similar cases. TA does not only involve large arteries, but also small blood vessels. The observation that in TA the inflammatory process of the large arteries affects regions of the walls supplied by the vasa vasorum, the anatomy of which bears resemblance to the cutaneous vessel system, suggests that primary involvement of small vessels contributes to the development of the clinicopathological features of TA. Knowledge of the skin manifestations associated with TA remains important for its diagnosis and prompt instauration of life-saving treatment.
An X-Linked Gene Involved in Androgenetic Alopecia: A Lesson to Be Learned from Adrenoleukodystrophy
Authors: König A. , Happle R. , Tchitcherina E. , Schaefer J.R. , Sokolowski P. , Köhler W. , Hoffmann R.
Published: April 2003

Background: Adrenoleukodystrophy (ALD), including its adult variant adrenomyeloneuropathy (AMN), is an X-linked recessive trait characterized by progressive demyelinization of the nervous system. The gene defect involves a peroxisomal transporter protein, resulting in accumulation of very-long-chain fatty acids in the brain and other organs such as the adrenal glands. Affected men show various endocrine disorders. Moreover, disturbances of hair growth are frequently mentioned in reports on ALD/AMN. Objective: This study was performed to delineate further the hair status and type of hair loss in men with AMN. Methods: We examined and documented the status of hair growth in 16 men suffering from AMN. A meticulous history with particular regard to hair changes was taken from all patients and their family members. Results: The age of the patients varied between 27 and 62 years, their mean age was 39.8 years. Twelve men showed male-pattern androgenetic alopecia (AGA), Hamilton grades IV–VIII, 3 men had a female-pattern AGA (Ludwig grade I or II). Ten of the patients with male-pattern AGA had reached Hamilton stage VII or VIII. The remaining scalp hair was unusually scarce and thin in 11 cases, regardless of the grade of AGA. Moreover, in 10 of 16 patients the eyelids showed pronounced madarosis. The remaining body hair was found to be normal. If present, endocrine manifestations had started prior to the onset of alopecia, and in 11 of 12 patients hair loss was apparent before neurological symptoms were noted. Conclusion: ALD/AMN gives rise to two different types of hair loss. Firstly, affected men show diffuse hair loss involving the entire scalp and the eyelashes. Secondly, they tend to develop AGA more frequently and earlier and in a severer form. Paradoxically, pronounced AGA is present although the patients may simultaneously show some degree of hypogonadism. Hence, the X-linked ALD mutation can be taken as a well-defined gene within the polygenic spectrum of genes responsible for AGA. This may be of theoretical importance for the elucidation of the pathogenetic pathways of AGA.
Biophysical Assessment of Persistent Effects of Moisturizers after Their Daily Applications: Evaluation of Corneotherapy
Authors: Tabata N. , O’Goshi K. , Zhen Y.X. , Kligman A.M. , Tagami H.
Published: April 2003

Background: Although effective moisturizers can improve xerotic skin changes immediately, their effects are only transient, because the materials applied to the stratum corneum (SC) are easily shed from the skin surface by the daily desquamation process. However, there are a few lines of clinical as well as experimental evidence suggesting that, once application of effective moisturizers is repeated daily, they may produce persistent effects without being influenced by the desquamation of the skin surface. If we can expect such pharmacological effects by simple repeated applications of moisturizers on the skin surface, it will provide a great motivation for the introduction of corneotherapy into the treatment of xerotic skin problems. Objective: This study was designed not only to confirm the feasibility of corneotherapy but to propose a practical method to assess such long-lasting effects of moisturizers by using biophysical methods. Methods: We conducted applications of various moisturizers twice daily to different areas of the flexor surface of the forearms for the initial 5 days of the first week. Thereafter, we performed biophysical measurements of the SC of these areas in the second week, namely 3, 5 and 7 days after their last applications. Results: Daily repeated applications of moisturizers did not induce any change in the water barrier function of the SC or in the size of desquamating corneocytes, a parameter for turnover rate of the SC. However, they substantially increased high-frequency conductance, a parameter for the hydration state of the skin surface, for several days in both normal individuals and patients with atopic xerosis, although the lasting effects were shorter in the latter. The obtained data enabled us to rank the efficacy of moisturizers either according to the duration of the lasting effects or the magnitude of an increase in the hydration levels of the SC. Conclusion: The present results confirmed the feasibility of corneotherapy, in which even simple application of moisturizers targeted at the SC can produce unexpected persistent clinical effects after their repeated treatments. The method described in this study constitutes a practical assay system to evaluate the efficacy of topical agents used for dry skin problems objectively and quantitatively.
Typical Features of Calciphylaxis in a Patient with End-Stage Renal Failure, Diabetes mellitus and Oral Anticoagulation
Authors: Streit M. , Paredes B.E. , Rüegger S. , Brand C.U.
Published: April 2003

We report a multimorbid patient with end-stage renal failure showing a large necrosis and livedo racemosa on the right thigh. Histology revealed medial calcification of the small arteries typical of calciphylaxis. We found the typical features of the disease with different risk factors like elevated calcium-phosphate product, diabetes mellitus and oral anticoagulation. On account of the location of the skin lesions, a bad prognosis was expected. In spite of therapeutical measures with lowering of the calcium and phosphate levels, the patient died 1 month after the diagnosis had been made.
Mycosis fungoides: Review of Epidemiological Observations
Authors: Morales Suárez-Varela M.M. , Llopis González A. , Marquina Vila A. , Bell J.
Published: April 2003

Background: Mycosis fungoides (MF) is a chronic cutaneous T-cell lymphoma characterized by small cells with cerebriform nuclei that usually express a mature peripheral T-helper cell (CD4+) immunophenotype. Its evolution is typically quite slow, with years between the first manifestations and development of advanced stages of disease. Objective: The purpose of the present paper is to contribute to the material about MF already present in the literature. The review articles that have appeared to date fundamentally address the morphological characteristics, diagnostic criteria and treatment of the disease; in contrast, the present study centers on the evolution of the incidence of MF and on the knowledge of the possible risk factors implicated in its development. Methods: Review of published papers about MF epidemiology. Results: The evidence suggests that the incidence is increasing, but this may be artifactual due to improved diagnostic techniques. The risk of MF is limited to gender and race, being higher in males and in blacks. Survival is highly stage dependent, but 90% of patients survive 15 years with only 10% of cutaneous involvement. Few risk factors have been identified, but several studies have found an association with industrial exposure, particularly to oils. Conclusion: MF is a rare disease and its risk factors have not been studied in any great detail. A European case-control study in progress will substantially increase the evidence available and progress towards identifying a prevention strategy.
Two Cases of Segmental Multiple Glomangiomas in a Family: Type 1 or Type 2 Segmental Manifestation?
Authors: Peña-Penabad C. , García-Silva J. , del Pozo J. , Yebra-Pimentel M.T. , Fonseca E. , Cuevas J. , Contreras F.
Published: April 2003

Several autosomal dominant skin diseases may manifest cutaneous mosaicism. Two types of segmental arrangement can be distinguished: type 1 is characterized by segmental lesions with similar severity to that observed in the diffuse phenotype, the remaining skin being normal; type 2 is characterized by segmental lesions showing a major degree of severity and milder lesions diffusely arranged. Multiple glomus tumours have recently been included in the group of genodermatoses showing type 2 segmental involvement. A family with 2 cases of multiple glomangiomas arranged in a segmental fashion is reported. A 12-year-old girl presented multiple nodular glomangiomas on her right buttock and thigh, in a band-like distribution. A sister of her paternal grandfather showed plaque-like multiple glomangiomas on her left thigh and various glomangiomas on her right buttock and arm. No other family members were known to be affected. Two new cases of familial segmental multiple glomangiomas are reported, with the particularity that one of these exhibited type 2 segmental manifestation and the other type 1 from a clinical point of view.
Contact Urticaria from Latex in Healthcare Workers
Authors: Valsecchi R. , Leghissa P. , Cortinovis R. , Cologni L. , Pomesano A.
Published: April 2003

Background: Latex allergy is an important medical problem for an increasing number of patients. It has been documented as causing immediate hypersensitivity reactions ranging from mild urticaria to life-threatening anaphylaxis after cutaneous, mucosal or visceral exposure. Recent studies in northern Europe and the USA suggest that between 2.8 and 16.9% of healthcare workers are affected by latex hypersensitivity type I reactions. Objectives: To test the prevalence of contact urticaria from latex gloves in a group of healthcare workers, to examine the factors associated with latex allergy and to evaluate some diagnostic methods used in latex allergy. Methods: A total of 929 employees of the surgical units who used latex gloves on a regular basis, at least once a day, were invited to participate in this study including administration of a questionnaire, a prick test with a commercial extract of latex, a prick test with latex glove eluate, a use test, RAST and an immunoblotting system; moreover, a prick test with a group of common inhalant allergens and a prick-by-prick test with fresh fruit (banana, kiwi, avocado, chestnut) were employed. Results: Of the 929 staff sent questionnaires, 313 (33.5%) replied; of those who responded, 118 gave a history of hand problems such as itch, erythema, wheals when wearing gloves, dryness and irritation most marked on the backs of the hands. Among these 118 workers, 16 refused skin testing and examination of blood, so 102 subjects were studied for latex allergy; 21/118 (17.8%) healthcare workers were found to be latex allergic. Eighty-one staff members gave a history of hand problems worsened by wearing gloves but were not latex allergic on testing. Those healthcare workers who completed the questionnaire and answered negatively (195/313) were not tested for latex allergy. Prick tests with the commercial solution were positive in 11 of the 21 subjects studied; prick tests with the eluate of glove, RAST and the use test were positive in all workers; 10 of the 21 sera showed positive immunoblot results. Atopy and a preexisting irritant contact eczema of the hands were present in a high percentage of the workers. Conclusion: In this study of healthcare personnel, we found that allergic contact urticaria from latex was present in 21 workers of the 313 (6.7%) who responded to the questionnaire and of the 102 (20.5%) who were tested for latex allergy. Atopy and irritant contact eczema of the hands were frequent in these subjects. Skin prick testing with latex glove eluate and the use test seem to be more sensitive than in vitro testing, particularly immunoblotting, and are biologically more relevant; skin testing with glove eluate must be preferred to testing with a commercial extract.
Matting of Hair: A Multifactorial Enigma
Authors: Al Ghani Mohamed A. , Geilen Christoph C. , Blume-Peytavi Ulrike , Orfanos Constantin E.
Published: April 2003

For matting of hair, multifactorial mechanisms are responsible. Thereby physical conditions, chemical agents and behavioural factors play the main roles. It seems evident that hair matting is not a hair disease; consequently, cutting off the affected hair and avoiding all possible trigger factors are the therapy of choice.
Unraveling the Patterns of Subclinical Pheomelanin-Enriched Facial Hyperpigmentation: Effect of Depigmenting Agents
Authors: Hermanns J.F. , Petit L. , Martalo O. , Piérard-Franchimont C. , Cauwenbergh G. , Piérard G.E.
Published: April 2003

Background: During photoaging, the density of melanin chromatophores is heterogeneous in the epidermis. Aims: To define the patterns of pheomelanin-enriched melanotic hypermelanosis of the face in phototype II subjects and to assess the effect of depigmenting agents. Azelaic acid and glycolic acid were tested as well as a soy extract, reported to reduce pigmentation through interaction with the protease-activated receptor 2 (PAR-2) of keratinocytes. Method: Evaluations were made by image analysis of high magnification pictures obtained by a video camera equipped with an internal ultraviolet-emitting unit (Visioscan®). Results: Three patterns of subclinical facial hypermelanosis were recognized including the spotty perifollicular type, the accretive globular type and the elongated type of the sunny side of wrinkles. Azelaic acid and the soy extract led to significant skin lightening after a 3-week treatment. By contrast, glycolic acid showed an inconsistent effect. Conclusion: Sensitive fluorescence video recording combined with image analysis represents an advance in the noninvasive assessment of the mottled subclinical skin pigmentation. The depigmenting effect observed with the soy extract indicates that the inhibition of PAR-2 may be a novel way to approach certain pigmentary disorders of the skin.
Alterations in Distribution of Tenascin, Fibronectin and Fibrinogen in Vulval Lichen sclerosus
Authors: Farrell A.M. , Dean D. , Charnock F.M. , Wojnarowska F.
Published: April 2003

Background: The pathophysiology of lichen sclerosus remains uncertain. The clinical features, including increased fragility and scarring, and the histology suggest that significant reorganisation of the extracellular matrix is occurring. Tenascin, fibrinogen and fibronectin are extracellular matrix components that play a significant role in tissue remodelling, for example during wound repair. Aim: To examine the distribution of tenascin, fibrinogen and fibronectin in vulval lichen sclerosus. Materials and Methods: Immunohistochemical staining was performed to study the distribution of tenascin, fibronectin and fibrinogen in 16 specimens of untreated vulval lichen sclerosus and 1 specimen of extragenital lichen sclerosus. Haematoxylin and eosin staining of the specimens was also performed to identify the position of the pale staining homogenous zone/zone of sclerosis and the inflammatory infiltrate below this. The control tissues studied included biopsies taken from the uninvolved thigh of 13 of the lichen sclerosus patients and 6 samples of normal vulva tissue obtained during gynaecological procedures from women of similar age to the lichen sclerosus women. Results: All the lichen sclerosus specimens demonstrated increased immunostaining of tenascin in the upper dermis and comparing this with the haematoxylin and eosin staining this corresponded to the zone of sclerosis with relatively little tenascin staining associated with the inflammatory band. In 14 out of the 16 vulval lichen sclerosus specimens and the extragenital lichen sclerosus specimen fibrinogen immunostaining was increased in the upper dermis which corresponded – in haematoxylin and eosin staining – to the zone of sclerosis. There was also slightly increased fibrinogen staining in the mid dermis which corresponded to the inflammatory band. Fibronectin staining was reduced in the upper dermis of 12 of the vulval lichen sclerosus specimens and the extragenital lichen sclerosus specimen which corresponded to the zone of sclerosis. However, in 14 of the vulval lichen sclerosus specimens and the extragenital lichen sclerosus specimen, fibronectin was slightly increased in the mid and deeper dermis which corresponded to the zone of inflammatory cells and the area below this. There was also increased fibronectin staining around blood vessel walls both in the mid dermis and within the zone of sclerosis. Conclusion: The distribution of tenascin, fibrinogen and fibronectin is altered in lichen sclerosus and the alteration in these extracellular matrix components may be relevant to the initiation of scarring in lichen sclerosus and the associated increased skin fragility.
Generalized Cutaneous Depigmentation following Sulfamide-Induced Drug Eruption
Authors: Martínez-Ruiz Esperanza , Ortega Carmen , Calduch Luis , Molina Inmaculada , Montesinos Encarna , Revert Angeles , Cardá Carmen , Navarro Virgilio , Jordá Esperanza
Published: April 2003

A 41-year-old male developed a generalized drug eruption following sulfamide therapy, with progressive albino-like generalized cutaneous depigmentation. Electron microscopy showed the absence of melanocytes, and clear cells with Langerhans cell characteristics were seen along the basal layer. The present case constitutes a unique reaction to sulfamides not previously reported in the literature.
Surgical Treatment of Locally Advanced Rectal Cancer
Authors: Aleksic M. , Hennes N. , Ulrich B.
Published: April 2003

Aims: The results of surgical treatment of locally advanced rectal cancer with special regard to multivisceral resections and preoperative radiotherapy should be analyzed. Methods: From 10/86 until 12/95, 40 patients with preoperatively assessed T4 stage rectal cancer were treated in our department whose data were evaluated retrospectively. Results: Apart from 10 nonresecting procedures we performed 30 resections in which the mortality rate was 7%. In 50% of these patients a multivisceral resection was conducted. A R0 situation could be achieved in 70%. But only in 53% the operation was carried out with curative approach due to distant metastasis. After extended resections more frequent urological complications resulted in prolonged hospitalization. Survival time was markedly longer in patients without tumor residuals or metastasis. Following preoperative radiotherapy a higher number in tumor free patients and better prognosis was noticed. Conclusions: In accordance to the literature it is suggested to submit patients with T4-stage rectal cancer to preoperative radiation to improve the overall outcome.
Scintigraphic Assessment of Double Tract Reconstruction after Total Gastrectomy
Authors: Fujiwara Yoshinori , Kusunoki Masato , Nakagawa Kazuhiko , Tanaka Tsuneki , Yamamura Takehira , Utsunomiya Joji
Published: April 2003

Background/Aims: This study was carried out to evaluate the clinical significance of double tract reconstruction after total gastrectomy. Methods: 25 patients, 14 with jejunal pouch double tract reconstructions and 11 with ρ-double tract reconstructions, were studied. Scintigraphy was used to evaluate duodenal and jejunal passage, and the jejunal/duodenal ratio was calculated. The patients were classified into 3 groups based on this ratio: group A (n = 14) ratio <1; group B (n = 6) ratio 1–2, and group C (n = 5) ratio >2. The reflux score, scintigraphic reflux index, emptying time of the jejunal pouch or ρ-limb, and various nutritional parameters were compared between the 3 groups. Results: The emptying time was shortest in group B, but there was no significant difference among the 3 groups in the Sigstad dumping scores. The reflux score, scintigraphic reflux index, and most nutritional parameters also showed no significant differences between the 3 groups. Leakage at the duodenojejunostomy did not occur in any patient. Conclusion: Our findings suggest that there was no preferential passage via the duodenum or jejunum after double tract reconstruction. This method is also useful for decompression of the duodenal stump and group B seemed to have the ideal reconstruction on the basis of emptying time.
Patients’ Assessment and Recall of Surgical Information after Laparoscopic Cholecystectomy
Authors: Kriwanek S. , Armbruster C. , Beckerhinn P. , Blauensteier W. , Gschwantler M.
Published: April 2003

Background: While patients’ needs for adequate preoperative information are generally recognized, data evaluating the effectiveness of the consultation before laparoscopic cholecystectomy have not been published until today. This prospective study was performed to investigate the success of preoperative information. Methods: A combination of oral and written information was given to all patients in two interviews. Information concentrated on indications for surgery, operative procedures, and risks. Patients were asked to answer questionnaires 5 days after the operation. Results: From January 1996 to January 1997, 200 patients were interviewed. Ninety-seven percent indicated to wish detailed information. Eighty-four percent indicated a high level of satisfaction with the presented information. While the levels of knowledge concerning indications for surgery and procedures were satisfactory in 85 and 51% respectively, only 30% were able to name at least one risk factor of laparoscopic cholecystectomy. Conclusion: This study demonstrated that patients’ evaluation of their surgical knowledge and the process by which it was communicated to them did not correspond to their ability to recall this information after surgery.
Changes in Gastric Intramucosal pH following Mesenteric Traction in Patients Undergoing Pancreas Surgery
Authors: Brinkmann Alexander , Seeling Wulf , Rockemann Michael , Junge JörgHelge , Radermacher Peter , Wiedeck Heidemarie , Büchler MarkusW. , Georgieff Michael
Published: April 2003

Background/Aim: During major abdominal surgery, mesenteric traction (MT) may result in hemodynamic instability mainly due to endogenous prostacyclin release. Gastric intramucosal pH (pHi) and PiCO2 are indicators of splanchnic tissue perfusion with a predictive value for the postoperative outcome. We investigated the influence of MT on gastric pHi and on postoperative outcome in patients undergoing pancreas surgery. Methods: Forty-six consecutive patients scheduled for pancreas surgery were investigated. We registered hemodynamics and pHi by gastric tonometry and documented postoperative outcome (complications, hospital stay). Baseline data (T0) were recorded after skin incision. Further assessments followed 30, 60 and 120 min after intentional MT (T1–3) and at the end of surgery (T4). Results: Thirty-three patients demonstrated a decrease in mean arterial pressure (MAP) following MT, whereas 13 patients showed entirely stable hemodynamics. The significant reduction in MAP in patients with an MT response was not associated with changes in pHi as compared to patients with no response (stable MAP) (T0 7.34 ± 0.08 vs. 7.35 ± 0.06; T1 7.34 ± 0.05 vs. 7.32 ± 0.07; T2 7.32 ± 0.05 vs. 7.31 ± 0.08; T3 7.32 ± 0.05 vs. 7.32 ± 0.07; T4 7.26 ± 0.1 vs. 7.27 ± 0.08; mean ± SD, MT response vs. no response). Neither MT response nor gastric intramucosal acidosis as evidenced by a pHi <7.32 at the end of surgery predicted postoperative complications or longer hospital stay. Conclusion: No deterioration of gastric pHi was found, which could reflect acceptable splanchnic perfusion and oxygenation despite systemic blood pressure reactions in patients experiencing an MT response.
Distal Pancreatectomy in Chronic Pancreatitis
Authors: Schoenberg M.H. , Schlosser W. , Rück W. , Beger H.G.
Published: April 2003

Background: The indications for a resective procedure in chronic pancreatitis are severe pain and local complications. The aim of this study, based on prospectively assessed data, was to evaluate distal pancreatectomy in patients suffering from chronic pancreatitis localized in the corpus and cauda of the pancreatic gland. Methods: Seventy-four patients undergoing distal pancreatectomy were evaluated pre- and postoperatively (after a median observation period of 58 months) for pain, professional status, alcohol consumption, and endocrine function as measured by the glucose tolerance test preoperatively. Results: The indication for operation was severe therapy-resistant pain in nearly all patients and an inflammatory tumor or pancreatic pseudocysts in over 50% of the patients. One fourth of the patients were operated in order to exclude malignancy. Ninety-five percent of the patients underwent distal pancreatectomy, only in 4 cases (5%) was a subtotal (Child) resective procedure performed. In 34% of patients undergoing distal pancreatectomy a splenectomy could be avoided. The early postoperative complications were few and mostly due to the severe comorbidity of the patients. During the median observation period of 58 months 14.7% of the patients died due to diseases not related to distal pancreatectomy. Six percent of the patients could not be reevaluated and were lost to follow-up. In the remaining 59 patients 88% had significantly less pain and 66% had an increase in median body weight of 8 kg. Fifty percent of the patients had full or partial professional rehabilitation, one fourth was unemployed and 24% had retired due to age. 51.7% had a normal endocrine function as assessed by the glucose tolerance test, 16.2 and 21.6% had a latent or manifest diabetes mellitus, respectively. In 74.5% of all patients the endocrine function did not worsen during the observation period. Conclusion: In comparison to conservative treatment distal pancreatectomy is a suitable therapeutic measure in patients with severe pain and local complications. It significantly improves the quality of life of patients without compromising endocrine function. Postoperative lethality is lower than in conservatively treated patients and is not related to distal pancreatectomy.
Disturbed Enterogastric Inhibitory Reflex after Esophageal Resection and Narrow Gastric Tube Reconstruction
Authors: Logeman F. , Borm J.J.J. , van Lanschot J.J.B. , Tiel-van Buul M.M.C. , Akkermans L.M.A. , Obertop H.
Published: April 2003

Background/Aims: The gastric emptying pattern after esophageal resection and narrow gastric tube reconstruction is determined by multiple factors. One of the possible factors is a disruption in the neurohumoral enterogastric inhibitory reflex. The aim of the present study was to determine the possible alterations of this reflex after esophageal resection and narrow gastric tube reconstruction. Methods: Nine patients each underwent two gastric tube emptying studies, one without and one with high caloric duodenal tube feeding. The dual isotope scintigraphic data were corrected for subject movement, radionuclide decay, downscatter and gamma-ray attenuation. Results: The median gastric tube emptying rate of solid food was 57%/h (range 27–195). The median T½ of liquid food was 67 (range 4–>80) min. Both for solid and for liquid food, the gastric tube emptying patterns without and with duodenal tube feeding were not significantly different. Conclusion: The neurohumoral enterogastric inhibitory reflex is disrupted after esophageal resection and narrow gastric tube reconstruction, which may contribute to disturbed gastric emptying.
Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis
Authors: Hoemke M. , Treckmann J. , Schmitz R. , Shah S.
Published: April 2003

Background: The Hartmann procedure remains the standard concerning the surgical treatment of acute complicated sigmoid diverticulitis. The aim of this study was to prove the possibility of performing a secure primary anastomosis without colostomy in patients with complicated acute diverticulitis. Methods: From June 1988 to October 1996, 113 patients suffering from acute complicated sigmoid diverticulitis were included in this prospective study. Within 24–48 h of hospital admission, when symptoms of the illness persisted despite the use of antibiotic therapy, the patients underwent primary resection of the sigmoid. In all patients primary anastomosis was performed, using CEEA staplers, avoiding colostomy and intraoperative colon irrigation. Results: During the observation period of 19 days, there was no anastomotic leakage found either by radiological methods or clinical parameters. Two patients died of early septic complications, 1 of therapy-resistant endocarditis. Conclusion: The results of this study demonstrate the safety of primary anastomosis after primary resection of the sigmoid under antibiotic conditions, avoiding the disadvantages associated with two-stage procedures.
A Continuing Role for Surgical Bypass in the Palliative Treatment of Pancreatic Carcinoma
Authors: Isla A.M. , Worthington T. , Kakkar A.K. , Williamson R.C.N.
Published: April 2003

Background: The use of palliative surgery for irresectable pancreatic cancer has been challenged by the advent of non-operative stenting, but it may still be appropriate for selected patients. Methods: Single-loop biliary and gastric bypass was carried out in 56 patients (mean age 60 years) with carcinomas of the pancreatic head that were irresectable because of vascular invasion or distant spread. In 42 patients without a preoperative tissue diagnosis, ductal carcinoma was confirmed by biopsy of the primary (n = 20) or secondary (n = 22) tumour. Preoperative biliary decompression in 31 patients led to positive bile cultures in 22 of 24 patients sampled. Results: There were no deaths in hospital or within 30 days. Complications in 20 patients (35%) included three biliary leaks, two of which required temporary percutaneous stents. The median postoperative hospital stay was 14 days. No re-operations were required before death, though 2 patients required percutaneous stenting of the biliary anastomosis for recurrent jaundice, 1 of whom had a radiation-induced stricture. The median survival was 6 (range 2–21) months. Conclusion: Combined biliary and gastric bypass can be carried out with reasonable safety and remains a useful option for patients with potentially resectable tumours and an anticipated life expectancy of at least 6 months.
Use, Abuse and Dependence of Prescription Drugs in Adolescents and Young Adults
Authors: Lieb Roselind , Pfister Hildegard , Wittchen Hans-Ulrich
Published: April 2003

Lifetime prevalence estimates of psychotropic medicine use as well as prevalence of DSM-IV prescription drug use disorders from the baseline investigation of the Early Developmental Stages of Psychopathology (EDSP) Study are presented. Use of prescription medication at some time in their life was reported by 27.4% of the respondents. Illicit use of prescription drugs, which means an intake without medical legitimation, was reported by 4.5% of the sample. The findings suggest that abuse of and dependence on prescription drugs, with most cases reporting polysubstance use, is quite rare in the 14- to 24-year-olds. DSM-IV abuse was more prevalent than dependence (0.5 vs. 0.3%). In general, women reported higher prevalence rates of prescription drug use, whereas men reported higher prevalence rates of prescription drug disorders. This result suggests that men have a higher risk to develop a substance-use-related disorder.
Effectiveness of Inpatient Drug Detoxification: Links between Process and Outcome Variables
Authors: Hättenschwiler Josef , Rüesch Peter , Hell Daniel
Published: April 2003

The Psychiatric University Hospital of Zürich offers a 2-week residential detoxification treatment program for patients abusing illegal drugs. 96 out of 160 patients were interviewed at three intervals: upon admission, on the 10th day of treatment, and about 1 month after leaving the clinic. Approximately 17% of the patients were completely abstinent 1 month after treatment. About 50% of the patients could give up the consumption of particular drugs. For around one third of the dependents, the drug consumption remained the same or had increased. The analysis of the predictors of drug consumption after treatment stresses the importance of the social integration of the dependents before detoxification as well as of characteristics of the treatment process (relapse, dropping out of treatment, and referral to a follow-up program).
Pathways to Abstinence: Two-Year Follow-Up Data on 60 Abstinent Former Opiate Addicts Who Had Been Turned Away from Treatment
Authors: Bacchus Loraine , Strang John , Watson Penny
Published: April 2003

Structural changes in the organization of drug treatment services in the northwest of England during the early 80s provided a unique opportunity to study a group of opiate addicts who were turned away from treatment. This paper reports on 60 opiate addicts who were abstinent at follow-up (2–3 years after their original referral). For the majority of subjects, any treatment received in the intervening period had been from a range of local, non-specialist treatment providers, including: general practices (n = 24) and local hospitals (n = 32). The subjects had also received assistance from non-statutory agencies (n = 35). Informal sources of support were drawn upon in the form of friends, family, and voluntary agencies. Social acceptance, legal problems, financial difficulties, and imprisonment were frequently cited as motivational factors that led to abstinence. At follow-up, improvements were reported in personal relationships and family circumstances, although there was less progress in relation to employment, finances, and housing. Increased involvement with the criminal justice system was significantly associated with a greater use of treatment services at follow-up. This paper presents the treatment and non-treatment pathways that led to abstinence amongst this group of opiate addicts. It also points to the importance of including non-treatment samples in evaluations of treatment interventions.
IMGT Locus on Focus
Authors: Lefranc Marie-Paule
Published: April 2003

IMGT, the international ImMunoGeneTics database (http:// imgt.cnusc.fr:8104) is an integrated database specialising in immunoglobulins (Ig), T-cell receptors (TcR) and major histocompatibility complex (MHC) of all vertebrate species, created by Marie-Paule Lefranc, CNRS, Montpellier II University, Montpellier, France (lefranc@ligm.crbm.cnrs-mop. fr). IMGT includes three databases: LIGM-DB for Ig and TcR, MHC/HLA-DB, and PRIMER-DB (the last two in development). The new section of Experimental and Clinical Immunogenetics, ‘IMGT locus on focus’, will give the more updated and extensive overview of the current status of the different Ig, TcR and MHC genes in IMGT, with standardization of gene nomenclature, functionality, and allele polymorphism according to the IMGT rules and unique numbering.
MHC Class II Ligation Induces CD58 (LFA-3)-Mediated Adhesion in Human T Cells
Authors: Nielsen Mai-Britt , Gerwien Jens , Nielsen Mette , Geisler Carsten , Röpke Carsten , Svejgaard Arne , Ødum Niels
Published: April 2003

MHC class II positive T cells found in areas of inflammation are believed to play an important pathogenetic role in autoimmunity. In experimental models , class II molecules have been shown to regulate adhesion between human T cells. It is, however, not known in detail how class II molecules are functionally linked to adhesion molecules. Some data suggest that β2 integrin (CD11a/CD18) molecules play a role in class-II-induced homotypic adhesion in B cells, monocytes, and virus-transformed or neoplastic cell lines. We have previously obtained evidence that adhesion molecules other than β2 integrins might play a role in class-II-mediated adhesion in T cells. To study further class-II-mediated adhesion in T cells, we have taken advantage of (allo)antigen-specific β2-integrin-negative, CD4-positive T cell lines obtained from a leukocyte adhesion deficiency patient. We show that class II ligation induces homotypic adhesion in both β2-integrin-positive and negative, CD4-positive T cell lines. Anti-CD18 monoclonal antibody (mAb) weakly inhibited the adhesion response in β2-integrin-positive T cells and had no effect on β2-integrin-negative T cells. In contrast, an anti-CD58 (LFA-3) mAb almost completely inhibited the adhesion response in β2-integrin-negative T cells. Antibodies against the CD58 ligand, CD2, partly inhibited the adhesion response in β2-integrin-negative T cells whereas antibodies against other adhesion molecules did not. The adhesion response in β2-integrin-positive T cells was partly inhibited by antibodies against CD58 and CD2. Taken together, these data provide the first evidence that CD58 molecules are involved in class-II-induced homotypic adhesion between T cells.
Reference Typing Report for Complement Components C6, C7 and C9 Including Mutations Leading to Deficiencies
Authors: Würzner R. , Witzel-Schlömp K. , Tokunaga K. , Fernie B.A. , Hobart M.J. , Orren A.
Published: April 2003

The results of the present (VIIth Complement Genetics Workshop and Conference, Mainz, May 1998) and past reference typing workshops for the terminal complement components C6, C7 and C9 are compiled and discussed both on the protein level and on the DNA level. This report also focusses on the molecular bases of expressed and silent polymorphisms and reviews the molecular bases of subtotal and complete deficiencies of these proteins and their associations with protein and DNA markers. The results of the protein typing for C6 are published in the following paper of this issue.
Analysis of Two IL-4 Promoter Polymorphisms in a Cohort of Atopic and Asthmatic Subjects
Authors: Hook Sarah , Cheng Ping , Holloway John , Riley Greta , Sawyer Gillian , Le Gros Graham , Beasley Richard
Published: April 2003

The Th2 cytokine interleukin 4 (IL-4) has been identified as having a central role in driving the inflammatory immune responses which are present in atopic airway disease. This study examined the distribution of two putative IL-4 promoter polymorphisms (–285 C-T and –81 A-G) in groups of patients with severe and moderate asthma, non-asthmatic atopy and control subjects. Neither polymorphism was identified in any of the samples tested. The data suggest that either the polymorphisms are present at very low frequencies or are artefacts of the B cell lines from which they were identified.
Modulation of C5a-Mediated Effector Functions of Human Polymorphonuclear Leukocytes by Tumor Necrosis Factor alpha and Granulocyte Macrophage Colony-Stimulating Factor
Authors: Binder Rolf , Kress Alexander , Kirschfink Michael
Published: April 2003

At the site of acute inflammation, leukocytes are confronted with multiple mediators which are expected to modulate each other with respect to cell responses to the individual ligand. In the present study, we compared the effects of the classical chemoattractants FMLP, PAF and LTB4, of the chemokine IL-8 and of TNFα, GM-CSF, IFN-γ and IL-1β on C5a-induced chemotaxis, degranulation, oxidative burst and expression of adhesion molecules of human neutrophils in vitro. Upon preincubation, TNFα as well as GM-CSF dose-dependently inhibited C5a-mediated chemotaxis, but augmented the release of elastase as well as respiratory burst activity. The effects of the two cytokines were accompanied by a downregulation of C5a receptors as determined by Scatchard analysis using 125I-labeled C5a. Compared on a molar basis, TNFα was more effective than GM-CSF. C5a-induced expression of β2-integrins was only moderately influenced by TNFα and GM-CSF. C5a itself diminished chemotaxis as well as degranulation and oxidative burst in response to a second dose of the same ligand (homologous desensitization), whereas heterologous desensitization by FMLP and IL-8 was restricted to C5a-induced degranulation or not observed (PAF, LTB4]. The cytokine effects are likely to be a consequence of altered C5a receptor expression as well as of postreceptor events. In concert with C5a, certain cytokines may shift neutrophil effector functions from migration to exocytosis, an essential step within the sequence of events in a coordinated inflammatory response.
Protein Displays of the Human Immunoglobulin Heavy, Kappa and Lambda Variable and Joining Regions
Authors: Scaviner Dominique , Barbié Valérie , Ruiz Manuel , Lefranc Marie-Paule
Published: April 2003

‘Protein displays of the Human Immunoglobulin Heavy, Kappa and Lambda Variable and Joining Regions’, the 6th report of the ‘IMGT Locus on Focus’ section, comprises 4 figures: (1) ‘Protein display of human IGH V-REGIONs’; (2) ‘Protein display of human IGK V-REGIONs’; (3) ‘Protein display of human IGL V-REGIONs and V-PREB REGION’; (4) ‘Protein display of human IGH, IGK and IGL J-REGIONs’, and 1 table entitled: ‘FR-IMGT and CDR-IMGT length of the human IGHV, IGKV, IGLV and V-PREB genes’. These figures and table are available at the IMGT Marie-Paule page from IMGT, the international ImMunoGeneTics database (http://imgt.cnusc.fr: 8104) created by Marie-Paule Lefranc, Université Montpellier II, CNRS, France.
The Teleostei Immunoglobulin Heavy IGH Genes
Authors: Artéro Sylvaine , Lefranc Marie-Paule
Published: April 2003

‘Teleostei Immunoglobulin Heavy IGH Genes’, the eleventh report of the ‘IMGT Locus in Focus’ section, comprises four tables: (1) ’Teleostei IGHV genes’; (2) ‘Teleostei germline IGHJ genes’; (3) ’Teleostei IGHC genes and alleles’; (4) ‘FR-IMGT and CDR-IMGT length of the Teleostei IGHV genes’. These tables are available at 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.
The Telostei Immunoglobulin Light IGL1 and IGL2 V, J and C Genes
Authors: Artéro Sylvaine , Lefranc Marie-Paule
Published: April 2003

‘Teleostei Immunoglobulin Light IGL1 and IGL2 V, J and C Genes’, the 12th report of the ‘IMGT Locus in Focus’ section, comprises 8 tables: (1) ‘Teleostei IGL1V genes’; (2) ‘Teleostei germline IGL1J genes’; (3) ‘Teleostei IGL1C genes and alleles’; (4) ‘Teleostei IGL2V genes’; (5) ‘Teleostei germline IGL2J genes’; (6) ‘Teleostei IGL2C genes and alleles’; (7) ‘FR-IMGT and CDR-IMGT length of the Teleostei IGL1V genes’, and (8) ‘FR-IMGT and CDR-IMGT length of the Teleostei IGL2V genes’. 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.
Regeneration Processes in the Kidney after Acute Injury: Role of Infiltrating Cells
Authors: Ghielli Manuela , Verstrepen Walter A , Nouwen Etienne J. , De Broe Marc E.
Published: April 2003

The transient presence of infiltrated leukocytes in the kidney during acute renal failure as well as the location of these cells within the renal interstitium suggest their association with tubular injury and/or regeneration. To date, however, neither a positive nor a negative contribution of these cells to the pathophysiology of this disease could be unambiguously demonstrated. Ill-defined methods for identifying interstitial leukocytes have added to the controversy concerning the role of inflammatory cells in renal regeneration. The current literature survey presents a qualitative description of the renal interstitial accumulation of leukocytes as observed in some acute renal failure models, with special attention to those displaying acute tubular necrosis of particular nephron subsegments. We conclude that lethal or sublethal injury to renal tubular epithelial cells following toxic or ischemic insults leads to the manifestation of an interstitial mononuclear cell infiltrate. Whereas macrophages and T lymphocytes almost invariably take part, the former being the dominant cell population with respect to both magnitude and presence over time, polymorphonuclear cells seem to be significantly increased only in the case of pyelonephritis. Infiltrating cells have often been regarded rather harmful to the tissue, mainly due to the quite well understood injuring capacity of the latter. On the other hand, we speculate mononuclear leukocytes through their potential of producing different cytokines and growth factors (FGF, TGF-α, EGF-like, IL-2, etc.) might well play an initiating and mediating role in renal regeneration after acute tubular necrosis. Therefore, the role of infiltrating leukocytes in the injury/regeneration process during acute renal failure remains highly controversial and should be further elucidated.