bluuebunny/crossref_metadata_2025 huggingface dataset:
Unidimensional Scale for Dementia
Authors: Kashima Haruo , Tanemura Jun , Hasegawa Tsuneo , Oda Eisei , Muramatsu Taro , Kusunoki Tadashi
Published: April 2003

A cognitive test comprising 27 subscales was administered to 262 demented patients and 92 normal subjects. Principal factor analysis followed by varimax and Harris-Kaiser rotation and Guttman’s scalogram analysis was performed. The analysis yielded three factors, i.e. ‘recent memory’, ‘immediate memory or attention’ and ‘remote memory’. The relationships between the three-dimensional distribution of the scores and the DSM-IIIR grade of dementia indicated the existence of a continuum of dementia severity. Scalogram analysis showed unidimensionality in the difficulty level of the subscales as well as in the severity of the cases. Thus, the simple summary score can be used as a good measure of the severity of dementia.
Treatment of Alzheimer’s Disease with Clioquinol
Authors: Regland Björn , Lehmann Werner , Abedini Iraj , Blennow Kaj , Jonsson Michael , Karlsson Ingvar , Sjögren Magnus , Wallin Anders , Xilinas Michel , Gottfries Carl-Gerhard
Published: April 2003

As heavy metal ions may be implicated in the formation of senile plaques in Alzheimer-afflicted brains, treatment with clioquinol was tested in 20 patients with Alzheimer’s disease. Clioquinol is a chelator that crosses the blood-brain barrier and has greater affinity for zinc and copper ions than for calcium and magnesium ions. Treatment was given for 21 days at doses of 20 mg/day to 10 patients and 80 mg/day to another 10 patients. The study was blind to the dosages but included no controls. Cerebrospinal fluid (CSF) investigations revealed a significant increase at day 7 and a decrease at day 21 in Tau protein and growth-associated protein (GAP43). These proteins are increased in Alzheimer’s disease and considered as rather stable markers. The initial increase may indicate a temporary cytotoxicity to the brain and/or an increased release into the CSF from stores in the tissue, possibly from senile plaques where the proteins are accumulated. The levels of CSF-Tau protein correlated positively and significantly with the serum levels of copper and also with the serum copper/zinc ratio. Clinical ratings showed slight improvement after 3 weeks treatment with clioquinol in this open study.
Clostridium difficile Infection: Risk Factors, Medical and Surgical Management
Authors: Klingler Paul , Metzger Philip , Seelig Matthias , Pettit Paul , Knudsen John , Alvarez Salvador
Published: April 2003

Background:Clostridium difficile has become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Methods: Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well as C. difficile infection were included. We addressed established and potential risk factors for C. difficile disease such as an impaired immune system and cost benefits of different diagnostic tests. An algorithm is outlined for diagnosis and both medical and surgical management of mild, moderate and severe C. difficile disease. Results: Diagnosis of C. difficile infection should be suspected in patients with diarrhea, who have received antibiotics within 2 months or whose symptoms started after hospitalization. A stool specimen should be tested for the presence of leukocytes and C. difficile toxins. If this is negative and symptoms persist, stool should be tested with ‘rapid’ enzyme immunoabsorbent and stool cytotoxin assays, which are the most cost-effective tests. Endoscopy and other imaging studies are reserved for severe and rapidly progressive courses. Oral metronidazole or vancomycin are the antibiotics of choice. Surgery is rarely required for selected patients refractory to medical treatment. The threshold for surgery in severe cases with risk factors including an impaired immune system should be low. Conclusion:C. difficile infection has been recognized with increased frequency as a nosocomial infection. Early diagnosis with immunoassays of the stool and prompt medical therapy have a high cure rate. Metronidazole has supplanted oral vancomycin as the drug of first choice for treating C. difficile infections.
Approach to the Management of Bleeding Esophageal Varices: Role of Somatostatin
Authors: Avgerinos Alec
Published: April 2003

Various treatment strategies have been used to control variceal bleeding, including drugs, esophageal tamponade, endoscopic sclerotherapy (ES), endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt and emergency surgery. None of these procedures are ideal and treatment frequently requires a combination of techniques. Sclerotherapy is one of the most widely used methods to control variceal bleeding; however, success is largely dependent on an experienced endoscopist. Vasoactive drugs act by decreasing pressure and blood flow in the gastroesophageal collaterals and they offer the advantage of being administered by inexperienced personnel. Drugs currently used in the treatment of variceal hemorrhage include vasopressin, terlipressin, somatostatin and octreotide. In the clinical studies to date, somatostatin was more effective than vasopressin and as effective as terlipressin in the control of bleeding esophageal varices (BEV), with an improved safety profile. In contrast, octreotide has shown conflicting results and more data are required to support the drug in this indication. More recently the ABOVE (Acute Bleeding Esophageal Variceal Episodes) study has provided further evidence that early administration of vasoactive drugs such as somatostatin is significantly more effective than placebo in the overall control of acute BEV episodes in cirrhotic patients undergoing ES. Therefore, the administration of a vasoactive drug as early as possible before emergency sclerotherapy is recommended for the effective management of BEV.
Pathogenesis and Treatment of Chronic Hepatic Encephalopathy
Authors: Häussinger Dieter
Published: April 2003

Although there is general agreement that hepatic encephalopathy (HE) is functional in nature, its pathogenesis has not yet been elucidated. A variety of mechanisms have been implicated such as the action of ammonia and other neurotoxins, disturbances of the blood-brain barrier and alterations of various neurotransmitter systems and their receptors [for reviews, see 1–3]. Further, manganese deposition in the basal ganglia and zinc deficiency have been discussed. Undoubtedly, ammonia plays a decisive role and pathogenetic models of HE have to explain why HE in chronic liver disease is precipitated by quite different factors, such as bleeding, infections, sedatives, diuretics, electrolyte disturbances and trauma. This brief article focuses on some new aspects on the pathogenesis of HE and its treatment.
Prevention of Transjugular Intrahepatic Portosystemic Stent Shunt Thrombosis
Authors: Sauer Peter , Theilmann Lorenz
Published: April 2003

The transjugular intrahepatic portosystemic stent shunt (TIPS) is being increasingly used in cirrhotic patients with complications of portal hypertension. Clinical trials using this nonsurgical method of decompressing the portal system have been shown to lead to control of acute variceal bleeding, prevention of recurrent hemorrhage [1–6] and improvement of ascites, refractory to medical treatment [7–9].
Serum Tests for Diagnosis and Follow-Up of Hepatocellular Carcinoma after Treatment
Authors: Trojan J. , Raedle J. , Zeuzem S.
Published: April 2003

Hepatocellular carcinoma (HCC) is a well-established complication of liver cirrhosis with an annual incidence of 2–7% [1]. Since patients with HCC are prone to develop recurrent and second liver tumors after potentially curative therapy, it is mandatory to screen these patients using several diagnostic methods, including ultrasonographyand appropriate serological tumor markers. In the past years, a variety of new tumor markersother than α-fetoprotein have been proposed for diagnosis and follow-up of HCC.
Regional Chemotherapy and Transcatheter Arterial Chemoembolization
Authors: Gallkowski U. , Low A. , Hirner A.
Published: April 2003

Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide. Its incidence ranges between 1.8/100,000 in Norway and 113/100,000 in Central Africa. The incidence shows a strong correlation to the rate of hepatitis B and C in the population as well as to the amount of aflatoxin in food. In 70–80% of cases HCC is combined with a liver cirrhosis.
Prevention of Second Primary Tumors by an Acyclic Retinoid, Polyprenoic Acid, in Patients with Hepatocellular Carcinoma
Authors: Muto Yasutoshi , Moriwaki Hisataka , Shiratori Yoshimune
Published: April 2003

Retinoid is a collective term which indicates vitamin A (retinol) and its derivatives. Retinoid has a variety of functions such as growth promotion, maintenance of reproduction and dark adaptation. Retinoid also regulates cell differentiation and tissue morphogenesis. Sinceabnormality in the differentiation induces cellular atypia and that of the morphogenesis induces structural atypia, retinoid has important effects which inhibit carcinogenesis.
A Framework for the Aetiogenesis of Chronic Pancreatitis
Authors: Braganza Joan M.
Published: April 2003

The traditional ductal model for the development of chronic pancreatitis leaves many questions unanswered and it has not facilitated management. An alternate philosophy centres on the acinar cell as the site of mounting oxidant stress, usually as a result of steady exposure to xenobiotics that induce cytochrome P450 mono-oxygenases while depleting glutathione: ductal changes are regarded as secondary, disease-compounding manifestations of the oxidant environment. Within this framework each burst of oxidant stress jeopardises exocytosis, to trigger an attack of pancreatitis by interfering with the methionine-to-glutathione transsulphuration pathway, which interacts closely with ascorbate and selenium. The resulting diversion of free radical oxidation products into the pancreatic interstitium causes mast cells to degranulate, thereby provoking inflammation, the activation of nociceptive axon reflexes, and profibrotic interactions.
Xenobiotic Metabolism, Oxidant Stress and Chronic Pancreatitis
Authors: Wallig Matthew A.
Published: April 2003

Chronic pancreatitis, although relatively rare in the Western World, is common in certain tropical zones where staple crops such as cassava are rich in cyanogenic glycosides. This paper reviews the evidence for a cyanide connection, with reference to experimental studies using another plant nitrile, crambene; and then examines the hypothesis that chronic pancreatitis represents a manifestation of uncoordinated detoxification reactions between pancreatic cytochrome P450 mono-oxygenases and phase II conjugating enzymes, resulting in the irreversible consumption of glutathione in the acinar cell. The conclusion is that the central role of disrupted pancreatic glutathione status, as a result of ‘xenobiotic stress’, in the evolution of chronic pancreatitis cannot be overestimated. This position contrasts with that in acute pancreatitis, in which glutathione depletion has a pivotal role too, but occurs as a result of ‘stress’ from reactive oxygen species.
Assessment and Treatment of Severe Pancreatitis
Authors: Bassi Claudio , Falconi Massimo , Caldiron Erminia , Salvia Roberto , Sartori Nora , Butturini Giovanni , Contro Conrado , Marcucci Stefano , Casetti Luca , Pederzoli Paolo
Published: April 2003

From the theoretical point of view, antiproteolytic therapy would seem to be the rationale for acute pancreatitis management. Unfortunately, clinical human trials studying the role of antiproteases in the treatment of acute pancreatitis differ in several respects in terms of their basic design. As a consequence, any form of homogeneous analysis of the reported data as a whole is impossible. Considering the data emerging from a meta-analysis of five trials a rational use of antiproteases may result in a reduction of complications requiring surgery and of patient management costs only in selected cases, meaning by that severe and necrotic forms. As regards presumptive applications, over 400 patients were prospectively tested versus placebo in a double-blind trial with the aim of preventing acute pancreatitis after ERCP. The complication incidence was significantly lower among the pretreated patients; anyway, also in this field of protease inhibitor clinical application it is necessary to identify the patients with the greatest risk to develop post-ERCP acute pancreatitis. In conclusion, antiproteases can still play a role when given prophylactically or when used in the very early phases of the disease; moreover a ‘multiple drugs approach’ (including, for example, suitable antibiotics) seems to represent nowadays the most modern and rational treatment of acute pancreatitis.
Role of Early Continuous Regional Arterial Infusion of Protease Inhibitor and Antibiotic in Nonsurgical Treatment of Acute Necrotizing Pancreatitis
Authors: Takeda K. , Sunamura M. , Shibuya K. , Kobari M. , Matsuno S.
Published: April 2003

This paper reviewed our experience with the nonsurgical management of acute necrotizing pancreatitis (ANP) by continuous regional arterial infusion (CRAI) of protease inhibitor (nafamostat mesilate, 240 mg/day) and antibiotic (imipenem, 0.5 g every 12 h). 47 patients with ANP admitted within 7 days were treated with intensive care and CRAI for 5 days prospectively. 40 patients responded to CRAI therapy and the mortality rate in these patients was 2.5%. 7 patients (14.9%) did not respond to CRAI. 5 of 7 nonresponders died of multiple organ failure although pancreatic necrosis was persistently sterile. The remaining 2 patients who underwent necrosectomy for infected pancreatic necrosis recovered after surgery. In 34 patients treated with CRAI in the early stage within 72 h after the onset, 31 (91.2%) responded. The mortality rate was 5.9% and the incidence of infected pancreatic necrosis was 2.9% in these 34 patients. These results demonstrated that most patients with ANP responded to conservative management combined with CRAI with nafamostat and imipenem when employed within 72 h after the onset. Early intervention of CRAI with protease inhibitor and antibiotic has a significant role in the nonsurgical management of ANP.
Prospective Study of a Protocol for Selection of Treatment of Acute Pancreatitis Based on Scoring of Severity
Authors: Yokoi Hajime , Naganuma Tatsushi , Higashiguchi Takashi , Isaji Shuji , Kawarada Yoshifumi
Published: April 2003

Background/Aim: Since July 1994, we have been conducting a prospective study of a protocol for selection of treatment of acute pancreatitis based on scoring of severity. Methods: From July 1994 to June 1998, 56 patients with acute pancreatitis were enrolled in this study. The protocol employed was based on the results of our retrospective study. On admission, the prognosis score (scoring of severity of acute pancreatitis based on the criteria of the Ministry of Health and Welfare of Japan) and APACHE II score were calculated, and early treatment was selected according to the protocol. Results: All of the 26 patients with gallstone pancreatitis and 28 of 30 patients with non-gallstone pancreatitis were successfully treated and had good outcome. There were 2 deaths in non-gallstone pancreatitis. In selection of early treatment according to the scoring of severity, we suggested that when the prognosis score is 2 or more and the APACHE II score of 8 or more, gallstone pancreatitis should be treated by biliary drainage, and non-gallstone pancreatitis by peritoneal lavage. When infected pancreatic necrosis is exhibited, surgery is indicated. Conclusion: Our new management protocol for acute pancreatitis based on the prognosis score and APACHE II score appear to be useful for accurately scoring severity and selecting the treatment methods.
A Novel Synthetic Anti-Acute Pancreatitis Agent, IS-741
Authors: Yotsuya Shuichi , Shikama Hiroshi , Nakano Ichiro , Sakai Kimie , Kato Masanari , Sugi Hideo , Takada Hiroshi , Koga Yoshihiko
Published: April 2003

A novel synthetic drug, IS-741, inhibited cell adhesion in vitro and neutrophil in vivo. Thus, IS-741 inhibited the magnification of pancreatic lesion as well as progression to multiple organ failure in acute pancreatitis models. Furthermore, IS-741 at identical plasma concentrations equally improved the survival rates in animals of various species with severe acute pancreatitis. Based on these observations, it was considered that IS-741 inhibited tissue destruction by neutrophil after inhibiting neutrophil infiltration into the pancreas or other important organs in acute pancreatitis. It was also considered that IS-741 demonstrated various anti-acute pancreatitis effects by interrupting a vicious cycle of inflammation. Therefore, IS-741 is expected to become a useful drug for treating acute pancreatitis and multiple organ failure in clinical settings.
The Novel Carboxamide Derivative IS-741 Reduces Neutrophil Chemoattractant Production by Bronchoalveolar Macrophages in Rats with Cerulein-Induced Pancreatitis Complicated by Sepsis
Authors: Yamaguchi Yasuo , Okabe Kazutoshi , Liang Jian , Matsumura Fujio , Akizuki Eiji , Matsuda Teishi , Ohshiro Hajime , Nakano Shogo , Ishihara Kohjiroh , Ogawa Michio
Published: April 2003

Background/Aims: The priming mechanism of macrophages to secrete cytokines in acute pancreatitis is important for remote organ failure following septic complication. The effects of novel carboxamide derivative, IS-741, on neutrophil chemoattractant production by bronchoalveolar macrophages were studied in rats with cerulein-induced pancreatitis complicated by sepsis. Methods: Pancreatitis was induced by four intramuscular injections of cerulein (50 µg/kg at 1-hour intervals). Pancreatitis rats were injected intraperitoneally with 10 mg/kg of lipopolysaccharide (LPS) 6 h following the first cerulein injection as a septic challenge. Pancreatitis rats received a continuous intravenous injection of IS-741 (3 mg/kg/h) 30 min before the septic challenge. Results: Intense mononuclear cell infiltration and lung hemorrhage occurred in untreated pancreatitis rats complicated with sepsis, but hemorrhage was not seen in septic pancreatitis rats receiving a continuous intravenous injection of IS-741 shortly before sepsis induction. The IS-741-treated rats had lower serum concentrations of cytokine-induced neutrophil chemoattractant (CINC), as well as fewer the pulmonary neutrophils and infiltrates immunoreactive for CINC or Mac-1 (CD11b/CD18). Conclusion: The novel carboxamide derivative IS-741 reduced CINC production by bronchoalveolar macrophages and effectively prevented pancreatitis-associated lung injury following the septic challenge.
New Approaches to Acute Pancreatitis: Role of Inflammatory Mediators
Authors: Norman James G.
Published: April 2003

Regardless of whether the initiating event is alcohol, gallstones or some other less common cause, acute pancreatitis progresses in a predictable manner eventually leading to failure of multiple unrelated organs. Very quickly following the inciting event, a local inflammatory process is initiated which results in the local production of inflammatory mediators. Virtually all patients with acute pancreatitis will experience some symptoms related to this local inflammation, with some resolving completely at this point. Most patients will go on to develop a systemic hyperinflammatory state expressed as the development of fever, tachycardia, tachypnea, and mild acid-base disturbances. Although this systemic hyperinflammatory state is usually mild, occasionally it may be very severe resulting in overt distant organ failure. With a more thorough understanding of the inflammatory mediators responsible for this hyperinflammatory state, many new therapeutic approaches are on the horizon.
Potential Role of Cholecystokinin in the Development of Acute Pancreatitis
Authors: Beglinger Christoph
Published: April 2003

Evidence based on animal studies suggests that cholecystokinin (CCK) is involved in the induction and development of acute experimental pancreatitis. However, the results obtained with CCK or CCKA receptor antagonists in different species (rats, mice) and different models of acute pancreatitis (cerulein pancreatitis, hemorrhagic pancreatitis induced by choline-deficient, ethionine-supplemented diet, arginine-induced pancreatitis, sodium taurocholate-induced pancreatitis) produced variable results. The route of administration, the specificity and potency of compounds and the design of the study are predictive for the outcome. Based on the available information, CCK appears to play a contributory role in the development of acute experimental pancreatitis in mice and rats. No conclusions can be drawn from these results with respect to the human disease.
Therapeutic Effects of Loxiglumide on Experimental Acute Pancreatitis Using Various Models
Authors: Satake Katsusuke , Kimura Kunio , Saito Takasi
Published: April 2003

We investigated the therapeutic effects of a cholecystokinin A (CCK-A) receptor antagonist, loxiglumide, on various models of experimental pancreatitis. This study shows that loxiglumide ameliorated caerulein-induced acute pancreatitis in mice as previously reported. The effects of loxiglumide on hemorrhagic and necrotizing acute pancreatitis is controversial. This study, however, shows that loxiglumide improves the survival rates in necrotizing acute pancreatitis induced by intraductal injection of taurocholate, followed by caerulein injection. In addition, the administration of loxiglumide improved both the biochemical and pathological changes of edematous acute pancreatitis induced by a closed duodenal loop in rats. It is concluded that the CCK-A receptor antagonist, loxiglumide, has therapeutic and/or prophylactic effects on acute pancreatitis in various models of experimental acute pancreatitis.
Role of Cholecystokinin in the Development and Progression of Acute Pancreatitis and the Potential of Therapeutic Application of Cholecystokinin Receptor Antagonists
Authors: Niederau Claus , Grendell JamesH.
Published: April 2003

This presentation reviews the role of cholecystokinin (CCK) as a contributory factor for the development and progression of acute pancreatitis (AP) and the perspective of CCK receptor antagonists for treatment of AP. High, supraphysiological concentrations of CCK induce AP in various species including man. There is also evidence that physiological increases in plasma CCK deteriorates AP in several animal models. The latter findings support the hypothesis that CCK plays a contributory or permissive role for the development of AP. The majorities of experimental studies show that the prophylactic and therapeutic use of CCK antagonists ameliorates AP. The latter effects were clearly shown for models of biliary AP in which plasma CCK is increased due to a feedback mechanism. However, CCK antagonists also had beneficial effects in models in which plasma CCK is not increased. In animal strains which do not have a CCK-A-receptor due to a genetic abnormality AP induced by a certain noxious factor does not develop to the same severity when compared to animals with a normal CCK-A-receptor. Thus, CCK acts as a permissive or contributory factor for the development and progression of AP. There is also evidence that CCK antagonists have a potential therapeutic benefit. Clinical studies will evaluate their therapeutic potential for patients with AP.
Clinical Evaluation of Cholecystokinin-A- Receptor Antagonist (Loxiglumide) for the Treatment of Acute Pancreatitis
Authors: Ochi Kouji , Harada Hideo , Satake Katsusuke
Published: April 2003

The therapeutic effects of loxiglumide on human acute pancreatitis was investigated in 104 Japanese institutes from October 1992 to March 1994. Acute pancreatitis was diagnosed by the Japanese Criteria of Acute Pancreatitis. Soon after the diagnosis was made, one of three doses of loxiglumide (100, 300 and 500 mg/day) were injected intravenously twice a day for 14 days. The efficacy of the treatment was evaluated by clinical signs, physical signs, and biochemical findings. 189 patients were included in this trial. The clinical signs, such as abdominal pain, disappeared in 20% of the patients on the 1st day after treatment, and the rate of improvements increased thereafter. Physical signs also improved. Serum amylase levels returned to normal within 3 days after treatment, and serum lipase showed almost the same changes as serum amylase levels, but serum lipase levels in the high-dose group (500 mg/day) returned to normal more quickly compared with the other two doses. It is concluded that the cholecystokinin A receptor antagonist, loxiglumide, may become a useful drug in the treatment of acute pancreatitis in man, although more detailed investigations are needed.
What to Do when a Patient with Exocrine Pancreatic Insufficiency Does Not Respond to Pancreatic Enzyme Substitution
Authors: Lankisch P.G.
Published: April 2003

In the majority of patients, pancreatin microsphere preparations containing 25,000–40,000 FIP units of lipase will lead to a clinical improvement and reduction of steatorrhea in patients with exocrine pancreatic insufficiency. In patients failing to respond, the following stepwise procedure is recommended: increasing enzyme dosage; checking the patient’s compliance; reevaluating the diagnosis; and as a last resort to decrease fat intake or adding H2-blockers or proton pump inhibitors. Although this stepwise procedure is time-consuming, it is necessary to prevent in patients not responding to pancreatic enzyme substitution the development of late complications of exocrine pancreatic insufficiency.
Diagnosis of Chronic Pancreatitis and Newer Aspects of Pain Control
Authors: Imrie C.W. , Menezes N. , Carter C.R.
Published: April 2003

The diagnosis of chronic pancreatitis in the UK largely rests on the combination of the clinical presentation which usually features pain which is often provoked by food and/or alcohol. There is usually a 30 to 40-min delay between the stimulus and the pain and, after exclusion of other causes of pain, an ERCP is performed. A minority of patients will have pancreatic function tests carried out while increasingly the diagnosis is being made by MR scanning. The control of pain is often the most important aspect of management to the patient. In those with large ducts due to compression of focal areas of the duct system surgical by-pass therapy is indicated. There is a bigger problem in patients with small ducts and chronic pancreatitis in whom extensive resection may be inappropriate. Our experience with minimally invasive thoracoscopic splanchnicectomy has been encouraging over the last three years. Having previously tried both percutaneous coeliac ganglion block and surgical excision of this nerve tissue, it is a great deal easier to carry out this procedure which ususally takes only 15–20 min per side. Patients are usually only admitted for 48 h and the immediate beneficial effect usually results in opiate analgesia being discontinued with considerable improvement in the quality of life. While there is a slight drop-off in benefit between 6 and 12 months post-operatively, the clinical effectiveness of this approach is to be commended and the author’s experience will be presented to support this view.
Modified Standard Pancreaticoduodenectomy for the Treatment of Pancreatic Head Cancer
Authors: Kawarada Yoshifumi , Yokoi Hajime , Isaji Shuji , Naganuma Tatsushi , Tabata Masami , Machishi Hideki , Das BidhanChandra , Takahashi Koji , Murabayashi Koji
Published: April 2003

Since 1980 extended surgery has been used to treat pancreatic cancer in many institutions in Japan in the hope of achieving curative resection and a good outcome. The resection rate increased, but the final outcome was unsatisfactory, and the question of postoperative quality of life (QOL) following extended surgery has instead become the central issue. During the past 22 years (October 1976 to June 1998) 169 of the 188 patients with invasive pancreatic ductal carcinoma at Mie University Hospital were treated surgically. A standard operation was performed in the early period (October 1976 to April 1981, n = 34), an extended operation was performed in the middle period (May 1981 to March 1993, n = 100), and a modified standard operation was performed in the late period (April 1993 to June 1998, n = 35). ‘Standard operation’ means pancreaticoduodenectomy (PD) with D1 lymph node dissection (regional), and ‘extended operation’ means PD with D2–D3 lymph node dissection. Our ‘modified standard operation’ consists of PD with lymph node dissection limited to the anterior pancreaticoduodenal (APD), posterior pancreaticoduodenal (PPD), pyloric (PY), hepatoduodenal ligament (HDL), common hepatic artery (CH) and right half of the superior mesenteric (SM) nodes. Thus, the extent of lymph node dissection in the modified standard procedure lies between the level in the standard and extended procedure, but the PD is the same, with only slight modification in the reconstruction procedure. We consider the standard operation to be a less curative procedure and the extended operation to be a very stressful procedure and accordingly we have modified it (modified standard operation) in our recent cases out of consideration for patients’ QOL. We found that postoperative QOL and survival were much better in the late period than in the early and middle periods.
Treatment Strategy for Pancreatic Head Cancer: Pylorus-Preserving Pancreatoduodenectomy, Intraoperative Radiotherapy and Portal Catheterization
Authors: Takahashi Shin , Aiura Kouichi , Saitoh Junichi , Hayatsu Sigeo , Kitajima Masaki , Ogata Yoshiro
Published: April 2003

Pancreatic cancer is the disease of gastrointestinal cancer with the poorest prognosis. At present, in addition to surgery, multimodality treatment combining a variety of therapeutic methods is used. We usually employ the following combination of surgery, radiotherapy and chemotherapy: D2 surgery with pylorus-preserving pancreatoduodenectomy (PPPD), intraoperative radiotherapy (IORT), and portal catheterization (PC) with fluorouracil as the chemotherapy. In this study, we made a historical comparison of PPPD and PD and obtained the following findings: (1) PPPD allows almost the same extent of D2 dissection as conventional PD, and achieves radical treatment without any problems; (2) suppression of local recurrence by IORT cannot be expected from the results of the comparison between the four approaches, i.e. surgery alone, surgery + IORT, surgery + PC and surgery + IORT + PC, and (3) the rate of liver metastasis in patients treated by PC was significantly low.
The Role of Octreotide in the Prevention of Complications following Pancreatic Resection
Authors: Berberat Pascal O. , Friess Helmut , Büchler Markus W.
Published: April 2003

Postoperative complications following major pancreatic surgery are mainly due to the difficulties of performing a safe and proper anastomosis between the stomach or small bowel and the pancreas. Continuous pancreatic juice secretion and the often soft structure of the pancreatic parenchyma are major risk factors. The present paper summarizes the results of six previously published, placebo-controlled, double-blind trials and one open randomized trial analyzing the efficacy of octreotide in preventing postoperative complications in patients who undergo major pancreatic surgery. Patients were given either octreotide (3×100–150 µg subcutaneously/day) or a placebo perioperatively for 5–7 days starting at least 1 h before operation. The patients were monitored postoperatively for typical postoperative complications such as: leakage of the anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, pulmonary insufficiency, renal insufficiency, bleeding, postoperative pancreatitis, and death. Six of the seven studies showed significantly fewer postoperative complications in the octreotide group in comparison with the placebo group (p<0.05). The effectiveness of octreotide was most apparent in the prevention of secretion-related complications such as fistula, fluid collection and leakage of the anastomosis. These studies demonstrated that inhibition of perioperative pancreatic secretion is a viable treatment concept in patients undergoing major pancreatic surgery. The perioperative and prophylactic application of octreotide in patients who undergo major pancreatic resection reduces the postoperative complication rate significantly.
Somatostatin or Octreotide in Acute Variceal Bleeding
Authors: Hadengue Antoine
Published: April 2003

In patients with cirrhosis, somatostatin or octreotide administration is followed by a transient decrease in the hepatic venous pressure gradient and azygos blood flow. Although no clear-cut changes in variceal pressure are observed and the exact mechanisms of acute hemodynamic changes induced by somatostatin or its derivatives are still unknown, this provided the rationale for its use in patients with variceal hemorrhage. The only known sustained hemodynamic effect of octreotide is to prevent increases in hepatic venous gradient or azygos blood flow in response to food intake. Somatostatin infusion can be as effective as sclerotherapy in the initial control of bleeding esophageal varices in patients with cirrhosis and is associated with fewer complications. Octreotide also seems to be as effective as endoscopic therapy in the control of acute variceal bleeding, although larger studies should be performed before its efficacy and safety profile can be fully evaluated. The combination of somatostatin or long-acting analogues to endoscopic therapy has recently been delineated as one of the most promising approaches in these patients. Early somatostatin administration with repeat boluses, starting several hours before sclerotherapy is combined, eases the endoscopic procedure and reduces bleeding control failure rate. Although two studies also showed that octreotide, when started at the time of sclerotherapy or variceal banding, also improves bleeding control, a conclusion on octreotide use in these patients is premature. Optimal administration schedules and doses of somatostatin or octreotide are still unknown. The safety of octreotide in patients with variceal bleeding, which has recently been challenged, should be assessed in larger trials. Recent data suggesting that octreotide combination to β-blockers or sclerotherapy may represent a useful approach for long-term prevention of rebleeding in these patients will have to be confirmed.
Causes of Oxidative Stress in the Pre- and Perinatal Period
Authors: Gitto Eloisa , Reiter Russel J. , Karbownik Malgorzata , Tan Dun-xian , Gitto Placido , Barberi Salvatore , Barberi Ignazio
Published: April 2003

Oxidative stress may be defined as an imbalance between pro-oxidant and antioxidant forces resulting in an overall pro-oxidant insult. Pregnancy is a physiological state accompanied by a high energy demand of many bodily functions and an increased oxygen requirement. Because of the increased intake and utilization of oxygen, augmented levels of oxidative stress would be expected. Arguments for a role of oxidative stress/oxidative lipid derivatives in the pathogenesis of preeclampsia are documented in many papers and evidence continues to accumulate that oxidative stress is a mediator of endothelial dysfunction and thus contributes to the cardiovascular complications of preeclampsia. Also other conditions, such as toxic substance exposure, smoking and asphyxia likewise induce oxidative stress. The oxidized lipid products generated as a consequence of these conditions are highly reactive and cause damage to cells and cell membranes. Thus, increased oxidative stress accompanied by reduced endogenous defences may play a role in the pathogenesis of a number of diseases in the newborn.
Cherry Angiomas Associated with Exposure to Bromides
Authors: Cohen Arnon D. , Cagnano Emanuela , Vardy Daniel A.
Published: April 2003

Cherry angiomas are the most common vascular proliferation; however, little is known about the pathogenesis and etiology of these lesions. We present two laboratory technicians who were exposed to brominated compounds for prolonged periods and who developed multiple cherry angiomas on the trunk and extremities. We suggest that the association between exposure to bromides and cherry angiomas should be investigated by a controlled study.
Facts and Myths about Electrical Measurement of Stratum corneum Hydration State
Authors: Martinsen Ørjan G. , Grimnes Sverre
Published: April 2003

Some of the views presented in the chapter on ‘Examination of stratum corneum hydration state by electrical methods’ in Skin Bioengineering – Techniques and Applications in Dermatology and Cosmetology (Karger, 1998) are in strong disagreement with the results from basic research that has been conducted on skin impedance measurement over the last decades. This research has e.g. non-ambiguously shown that the frequency response of the stratum corneum does not obey the Cole equation and that measurement depth is strongly dependent on measurement frequency. One consequence of these findings is that multifrequency electrical measurements on stratum corneum are impossible to achieve in vivo with any electrode system known today. Hence, electrical measurements of stratum corneum hydration must be conducted at one single, low frequency.
Surgical Techniques for Vitiligo: A Review
Authors: van Geel N. , Ongenae K. , Naeyaert J.-M.
Published: April 2003

Although the treatment of vitiligo has improved during the last decade, therapy is still not satisfying for many patients. This is probably due to the fact that the aetiopathogenesis is unknown. Several treatment modalities, such as PUVA, UVB and local corticosteroids are currently used in the treatment of active vitiligo. However, these treatments usually induce incomplete repigmentation. Surgical methods intended to repigment leucoderma are an interesting therapeutic option if patients have stable disease. Two types of surgical techniques are available: tissue grafts and cellular grafts, with in between autologous cultured epithelial grafts. Tissue grafts are full-thickness punch grafts, split-thickness grafts and suction blister grafts. With tissue grafts, only a limited surface area can be treated but with good results in the majority of cases. Cellular grafts include non-cultured keratinocytes/melanocytes and cultured melanocytes. The exact success rate of repigmentation with cellular grafts is still unknown, since only a small number of studies have been published. Starting from autologous cellular suspensions, epithelial grafts of various compositions can be cultured in vitro. They can be used for larger areas. The purpose of this review is to describe the applications of different surgical techniques used to treat recalcitrant vitiligo.
Syndactyly/Brachyphalangy and Nail Dysplasias as Marker Lesions for Sclerosteosis
Authors: Itin Peter H. , Keserü Borbala , Hauser Vital
Published: April 2003

Sclerosteosis describes an autosomal recessive form of hyperostosis corticalis generalisata (MIM 239100). Sclerosteosis is primarily a disorder of osteoblast hyperactivity and metabolic abnormalities are not present. Besides generalized bone changes the presence of asymmetric cutaneous syndactyly of the index and middle fingers is characteristic. In many cases this syndactyly is associated with nail dysplasia and therefore dermatologists should recognize this clinical finding as a possible marker of this entity. We report on a 36-year-old female of Greek origin who had had finger and nail dysplasias and facial asymmetry since birth. The patient was hospitalized on the Neurology ward because of increasing spastic and ataxic gait disturbances. Physical examination revealed numerous neurological problems resulting from bony compression of nerves. Furthermore the patient had remarkably deformed fingers with hypoplasia of the second finger on both sides. The nails were dysplastic, especially on both index fingers. All laboratory results concerning metabolic diseases were normal. It has been shown that sclerosteosis is clinically and radiographically very similar to van Buchem disease. Through a genome-wide search with a highly polymorphic microsatellite the gene responsible for van Buchem disease has been mapped to 17q12–q21, and Balemans et al. (1999) assigned the locus for sclerosteosis to the same region providing genetic support for the hypothesis of allelism. Dermatologists should be able to interpret such syndactyly associated with nail deformities as a possible hint for the diagnosis of sclerosteosis in patients with hyperostotic features.
Toxic Epidermal Necrolysis Treated with Intravenous High-Dose Immunoglobulins: Our Experience
Authors: Stella Maurizio , Cassano Pompeo , Bollero Daniele , Clemente Alessandra , Giorio Giusy
Published: April 2003

Background: Toxic epidermal necrolysis (TEN) is a rare severe acute exfoliative drug-induced skin disorder which has recently been ascribed to alterations in the control of keratinocyte apoptosis, mediated by an interaction between the cell surface death receptor Fas and its respective ligand. A therapeutic approach with intravenous immunoglobulins (IVIG) associated with pulse methylprednisolone, based on the inhibition of Fas-mediated keratinocyte death by naturally occurring Fas-blocking antibodies included in human immunoglobulin preparations, has produced good preliminary results. Objective: To analyse the efficacy of IVIG in the treatment of TEN. Patients: Nine patients with erythematous body surface area ranging from 38 to 85% and dermo-epidermal detachment from 4 to 37% were treated. Results: Eight patients were healed and 1 died of septic shock and multiple organ failure. Interruption of further epidermal detachment occurred after an average of 4.8 days from the onset of IVIG therapy. Complete wound healing occurred after an average of 12 days. Concerning complications, 3 out of 8 surviving patients had acute respiratory failure requiring mechanical ventilation and 1 acute renal failure was treated with dialysis. Late sequelae were limited to dyschromia and nail dystrophies. No hypertrophic scars were observed. Conclusion: IVIG therapy represents a safe and valid approach for TEN.
Mycophenolate Mofetil Is Ineffective in the Treatment of Mucocutaneous Adamantiades-Behçet’s Disease
Authors: Adler Y.D. , Mansmann U. , Zouboulis Ch.C.
Published: April 2003

Background: Cyclosporine A and azathioprine are effective on mucocutaneous lesions in Adamantiades-Behçet’s disease. Mycophenolate mofetil (MMF) is a drug resembling their activity but with comparably negligible adverse reactions. Objective: A prospective clinical proof-of-principle study was conducted to investigate the effectiveness and toxicity of MMF in mucocutaneous Adamantiades-Behçet’s disease. Methods: Thirty patients were to be treated with MMF 2 g/day p.o. for 6 months, in combination with prednisolone 30 mg/day p.o. during the first month of treatment. Inefficacy was followed by an increase in MMF dose to 3 g/day. The primary efficacy variable was the decrease in the disease activity index (DAI) according to a modified variant of the Iran Behçet’s Disease Dynamic Activity Measure system. Results: The study was interrupted due to inefficacy of the compound after the intermediate evaluation of the first 6 patients (aged 37.0 ± 7.7 years with disease duration of 10.0 ± 8.9 years) as required by the ethical committee. Although an improvement of the DAI from 5.2 ± 3.5 to 1.3 ± 0.5 was found after the first month of combination treatment, withdrawal of prednisolone led to quick relapses with a new index increase (3.0 ± 3.5). The treatment was discontinued in 3 patients after 3 months, in 2 patients after 4 months and in another one after 5 months due to deterioration of the disease. Introduction of interferon α2a (3 × 9 million IU 3×/week s.c.) in 3 patients decreased the activity index from 4.0 ± 1.0 to 0.0 ± 0.0. No adverse effects were detected under MMF treatment. Conclusion: MMF (2–3 g/day) is unable to control the signs of mucocutaneous Adamantiades-Behçet’s disease.
Aquagenic Syringeal Acrokeratoderma (Transient Reactive Papulotranslucent Acrokeratoderma)
Authors: Itin Peter H. , Lautenschlager Stephan
Published: April 2003

In 1996, English and McCollough described an unusual entity in 2 sisters characterized by a transient and recurrent keratoderma exclusively on the palms after water exposure. The condition developed 3–5 min after exposure to water and resolved within a short time after drying. This finding was associated with a tightening sensation. Yan et al. coined the term ‘aquagenic palmoplantar keratoderma’, and the designation ‘aquagenic syringeal acrokeratoderma’ was suggested by MacCormack et al. Until now, a total of 8 cases have been reported. We documented 2 new cases with acquired aquagenic syringeal acrokeratoderma. A 25-year-old female had observed within the last 3 months a burning sensation on the palms after some minutes of water contact. Physical examination revealed a perfectly normal skin on the palms. Three minutes after water immersion of 20°C, a whitish discoloration appeared on the palms and a thickening of the palmar skin was visible. In addition, the eccrine pores were much more prominent. Few minutes after drying the skin, the situation returned to a normal state. The second patient, a 33-year-old female noticed a painful whitish discoloration of the skin on the palms after a short period of water immersion. Sometimes the white skin could be peeled off. In the last year, hyperhidrosis developed, and a more reddish aspect of the palms appeared. In our office after rinsing the hands with water at room temperature, a whitish discoloration in the center of the palms appeared which was associated with a painful sensation. After drying, the whitish lesions disappeared almost completely within 30 min. Aquagenic palmar keratoderma describes an acquired and transient condition which occurs after brief exposure to water and disappears after drying within minutes to an hour. Only rarely may a slight hyperkeratosis remain for a longer time. The possible pathophysiology and treatment options are discussed.
Dermatitis herpetiformis in Japan: An Update
Authors: Shibahara Mariko , Nanko Hiroko , Shimizu Mina , Kanda Naoko , Kubo Masahide , Ikeda Michiko , Matsumoto Masao , Nonaka Shuko , Shimizu Hiroshi
Published: April 2003

Background: Although dermatitis herpetiformis (DH) is a relatively common disease in Caucasian populations, it is rare in Asian populations including the Japanese. We encountered a Japanese case of DH which showed granular IgA and C3 deposits in the papillary dermis and which was associated with gluten-sensitive enteropathy but no HLA-B8/DR3/DQ2. Objective: The purpose of this study is to describe the characteristics of Japanese DH cases, since most of them have been reported in Japanese language and dermatologists outside Japan are not familiar with the characteristics of Japanese DH. Methods: We have reviewed all 34 Japanese DH cases reported previously. Results: We found several features of Japanese DH compared with Caucasian DH, such as a high frequency of the fibrillar pattern, rarity of gluten-sensitive enteropathy and an absence of the HLA-B8/DR3/DQ2 haplotype. Conclusion: There might be significant differences in pathophysiology between Caucasian and Japanese DH cases.
The Coexistence of Photosensitive Psoriasis with Chronic Actinic Dermatitis
Authors: Sahoo Bijaylaxmi , Kumar Bhushan
Published: April 2003

A 57-year-old-male who had been a known case of psoriasis vulgaris for 30 years had a history of summer exacerbation of the disease. Subsequently in the course of the disease process, he developed lesions of chronic actinic dermatitis (CAD) on the face and dorsum of both hands. The association of CAD with photosensitive psoriasis is very rare. Only one case report is known till now. It may suggest that there is a relationship between the two diseases.