bluuebunny/crossref_metadata_2025 huggingface dataset:
Biliary Parasites
Authors: Osman Maher , Bach Lausten Susanne , El-Sefi Talaat , Boghdadi Ibrahim , Rashed M-Yousri , Lindkær Jensen Steen
Published: April 2003

Parasitic diseases of the biliary tract occur frequently in tropical and subtropical areas and cause high morbidity and mortality. In general, neither the clinical presentation nor the general laboratory findings are sufficiently unique to raise the possibility of a parasitic biliary infestation in the mind of the surgeon. Once considered, however, the presence of a parasitic biliary infestation is easily confirmed. Most commonly this is accomplished by the identification of the parasite in stools or duodenal contents. Ultrasonography, CT and MRI are not only important in the diagnosis of parasitic biliary diseases but also in the follow-up and surveillance. ERCP is an excellent diagnostic tool for demonstrating the presence of parasites in the biliary tree. Furthermore, ERCP is also used in the therapy of biliary parasitic infestations and carries less morbidity and mortality than the surgical approach. Surgery is only indicated in complicated cases. Mechanisms that may be effective against parasites include: antibodies; cytotoxic T cells; T-cell-induced activated macrophages; natural killer cells, and a variety of cells that mediate antibody-dependent cell-mediated cytotoxicity and modulators of the immune system such as cytokines. Future research has to focus on the importance of these mechanisms for the immune evasion by parasites.
Factors Predictive of Bile Duct Stones in Patients with Acute Calculous Cholecystitis
Authors: Hammarström Lars-Erik , Ranstam Jonas
Published: April 2003

The objective of the study was to investigate the accuracy of using preoperative data for the prediction of bile duct calculi in patients operated on for acute cholecystitis. 279 consecutive patients underwent cholecystectomy with peroperative cholangiography for acute calculous cholecystitis in the Department of Surgery, Lund University Hospital, between 1985 and 1991. The correlation between 13 preoperative clinical and laboratory variables, and the incidence of bile duct calculi was studied. Among the 13 variables tested, serum bilirubin concentration and serum γ-glutamyltransferase activity were independent factors of predictive significance. These two factors were used for constructing an additive prognostic index for the presence of bile duct stones. Thus, three groups of patients could be identified having a 3, 7–9 or 59% risk of harboring bile duct stones, corresponding to a sensitivity of 61% and a specificity of 93% in predicting the presence of bile duct stones in the ‘high-risk’ group. Logistic regression analysis permits accurate preoperative identification of bile duct stones in patients with acute calculous cholecystitis.
Effect of Moderate Exercise on Blood Flow in the Gastrointestinal Tract in Trained Conscious Miniature Swine
Authors: Mortensen Frank Viborg , Bayat Mohsen , Friis-Andersen Hans , Jespersen Stig Mindedal , Høy Kristian , Christensen Kirsten Østergård , Lindblad Bent Erling , Hansen Ebbe Stender
Published: April 2003

Aim: To examine how moderate exercise affects the blood flow in the gastrointestinal tract. Materials and Methods: Twelve miniature swine weighing 38–43 kg were used. All animals were trained on a cardiac exercise treadmill. Blood flow measurements were done on conscious animals using labeled microspheres with a diameter of 16.5 ± 0.1 (SD) µm. The first flow was measured while the animal was awake and resting, the second flow after 15 min of exercise, the third flow after 30 min of rest. Results: Flow in the oesophagus at rest was 19.5 ± 1.3 (SEM) ml/min/100 g. During exercise the flow decreased to 13.3 ± 1.2 (SEM) ml/min/100 g (ns). After 30 min of rest the flow was 9.9 ± 1.2 (SEM) ml/min/100 g (p < 0.05 when comparing the flow before and after exercise). Flow in the cardia at rest was 23.1 ± 1.3 (SEM) ml/min/100 g. During exercise the flow decreased to 14.0 ± 1.2 (SEM) ml/min/100 g (p < 0.05). After 30 min of rest the flow was 15.0 ± 1.2 (SEM) ml/min/100 g. Flow in the pylorus at rest was 38.9 ± 1.1 (SEM) ml/min/100 g. During exercise the flow decreased to 24.6 ± 1.1 (SEM) ml/min/100 g (p < 0.01). After 30 min of rest the flow was 26.9 ± 1.2 (SEM) ml/min/100 g. Blood flow in the small and large intestine was mainly unaffected by moderate exercise. Conclusion: Under moderate exercise, blood flow in the upper part of the gastrointestinal tract declines while it is mainly unaffected in the duodenum, small and large intestine.
Glucagon Ameliorates Pancreatic Subcellular Redistribution of Lysosomal Enzyme in Rats with Acute Pancreatitis of Closed Duodenal Loop
Authors: Hirano Tetsuya , Hirano Kimiko
Published: April 2003

The protective effects of glucagon on the exocrine pancreas were investigated in rats with a closed duodenal loop (CDL). A CDL in rats caused marked hyperamylasemia, pancreatic edema and pancreatic histological damage such as acinar cell vacuolization and interstitial edema. A CDL also caused redistribution of the lysosomal enzyme, cathepsin B, from the lysosomal fraction to the zymogen fraction as well as the activation of trypsinogen in pancreatic tissue. Moreover, a CDL caused a marked motality rate (40% at 48 h). However, treatment with glucagon at a dose of 1.0 mg/kg (subcutaneous injection) every 8 h (3 times) significantly inhibited these pancreatic injuries, improving the survival rate (95% at 48 h). These results indicate the important role of lysosomal enzymes in the pathogenesis of severe acute pancreatitis, and also suggest the possible usefulness of glucagon in the treatment of clinical pancreatitis.
Role of Chemoembolization in Synchronous Liver Metastases from Pancreatic Endocrine Tumours
Authors: Falconi M. , Bassi C. , Bonora A. , Sartori N. , Procacci C. , Talamini G. , Mansueto G.C. , Pederzoli P.
Published: April 2003

Endocrine tumours of the pancreas, even in case of liver involvement, are generally characterized by a slower evolution and a better prognosis, if compared with ductal carcinoma. This fact gives reason to a radical surgical approach, whenever possible, and to the research of any effective adjuvant treatment. For this purpose, hepatic transarterial chemoembolization (TACE) has been proposed in recent years for the treatment of metastatic endocrine tumours. Out of 80 patients suffering from endocrine tumours of the pancreas, observed between January 1985 and December 1996, 28 (35%) presented liver metastases at the time of diagnosis. Twelve of these patients were submitted to palliative resection of pancreatic tumour and one or more cycles of TACE. Overall survival was 50% (6/12); median survival was 35.4 months (range 4–75). These results suggest that chemoembolization, combined with surgical resection of primary malignancy, appears to be able to control the disease for a certain time and to increase the survival rate.
Glucagonoma Syndrome: Survival 24 Years following Diagnosis
Authors: Nightingale K.J. , Davies M.G. , Kingsnorth A.N.
Published: April 2003

The symptoms of necrolytic migratory erythema, diabetes, stomatitis, weight loss and diarrhoea represent the glucagonoma syndrome which has been recognized since the early 1970s. Because of its rarity (1 case/20–200 million population) late diagnosis is frequent which leads to a poor prognosis. The case described, originally reported in 1974, is the longest survivor to be documented in the literature, and is one of the original patients with a glucagonoma that helped to define the syndrome.
Effective Intra-Arterial Chemotherapy for Acinar Cell Carcinoma of the Pancreas
Authors: Ukei Toshisada , Okagawa Kazuhiro , Uemura Yoshio , Miyauchi Keisuke , Kaneko Tadashi , Mizunoya Sumio , Monden Morito
Published: April 2003

A 41-year-old man with a huge pancreatic tumor (acinar cell carcinoma) was treated by intra-arterial infusion chemotherapy with 5-fluorouracil (5-FU), mitomycin C (MMC) and cisplatin (CDDP). The tumor was significantly reduced, and he underwent a pancreaticoduodenectomy with complete excision of the tumor. Unfortunately multiple metastatic liver tumors were noted 5 months after resection. These tumors could also be markedly reduced by intra-arterial chemotherapy and the survival period was prolonged to 18 months. He suddenly died of sepsis but not from the pancreatic carcinoma. This case shows that intra-arterial infusion chemotherapy with 5-FU, MMC and CDDP can be an effective regimen for the treatment of acinar cell carcinoma of the pancreas.
Multimodal Treatment of Neuroendocrine Tumors of the Pancreas and the Ampulla of Vater
Authors: Mantke R. , Manger T. , Schulz H.-U. , Ridwelski K. , Pross M. , Günther T. , Lippert H.
Published: April 2003

Neuroendocrine tumors are not seen frequently. They are most commonly located in the small bowel including the vermiform appendix. Neuroendocrine tumors of pancreatic origin are extremely rare. Symptoms caused by excessive hormone production by large liver metastases often lead to their diagnosis. Preoperative diagnostics include analysis of specific hormones in serum and urine, ultrasound, CT and somatostatin receptor scintigraphy. Liver metastases of neuroendocrine tumors of the pancreas are common at the time of diagnosis. Curative resection should be performed whenever possible, although patients often benefit from debulking procedures, too. Liver metastases can be subjected to surgical resection, embolization, regional chemotherapy or local procedures such as alcohol injection or cryoablation. As an exception, liver transplantation can be considered in selected cases where radical surgery for the primary tumor could be performed and extrahepatic metastases are not present. Supplementary or alternative options include octreotide and/or interferon-α administration. In this article, we report on 6 patients suffering from primary neuroendocrine tumors of the pancreas or the ampulla of Vater who were treated at our department over the past 5 years. In addition, we discuss our own experience with this rare condition in the light of the recent literature.
Splenic Infarction Complicating Ligation of a Gastroduodenal Artery Aneurysm
Authors: Schweizer W. , Gries N.C. , Maddern G. , Triller J.
Published: April 2003

Background: Aneurysms of visceral arteries are rare, but may lead to dramatic situations of intraabdominal or retroperitoneal hemorrhage in case of rupture. Case Report: We report the case of a 72-year-old patient who developed a hemorrhagic shock following a total hip replacement due to the rupture of an aneurysm of the gastroduodenal artery. Angiography also demonstrated a high-grade stenosis of the celiac trunk. The ruptured aneurysm was ligated as a live-saving procedure, but due to the stenosis in the celiac trunk the patient developed a splenic infarction followed by partial tissue liquification. This was treated conservatively and after 3 months, the computed tomography showed an atrophic residual spleen. Summary: Diagnostic and therapeutic approaches to visceral vascular aneurysms are discussed including the potential complications of splenic infarction.
Must ERCP Be Routinely Performed if Choledocholithiasis Is Suspected?
Authors: Hoyuela C. , Cugat E. , Bretcha P. , Collera P. , Espinós J. , Marco C.
Published: April 2003

Objective: To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC). Patients and Methods: A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data. Results: ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP. Conclusions: A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.
Protein C Activation during the Initial Phase of Experimental Acute Pancreatitis in the Rabbit
Authors: Ottesen L.H. , Bladbjerg E.M. , Osman M. , Lausten S.B. , Jacobsen N.O. , Gram J. , Jensen S.L.
Published: April 2003

Background: Disturbances of coagulation and fibrinolysis are well-known systemic effects of acute necrotising pancreatitis (ANP). The purpose of this experimental study was to evaluate the initial events in the haemostatic activation during ANP in an animal model with relevance to the human situation. Methods: ANP was introduced in 7 rabbits by infusion of chenodeoxycholic acid in the pancreatic duct. Seven rabbits served as sham-operated controls. Serial measurements of coagulation variables (prothrombin time, activated partial thromboplastin time, FVII activity, fibrinogen, tissue factor activity), anticoagulant proteins (protein C, antithrombin) and fibrinolytic factors (tissue plasminogen activator, plasminogen activator inhibitor-1) were performed for 5 h. Results: ANP was confirmed by elevated serum amylase, development of ascites, and histological changes of the pancreas. A moderate activation of the coagulation system was found in both study groups. A significant decrease in protein C concentration from 1 h after the induction of ANP was found, whereas the response of antithrombin and the inhibition of the fibrinolytic system were similar in the 2 study groups. Microthrombosis of the lungs or kidneys was found in 2 rabbits with ANP. Conclusion: An immediate activation of protein C is a specific characteristic of the haemostatic activation in ANP in rabbits. This activation has not been described previously and the possible therapeutic implications ought to be studied.
Beta-Cell Function of the Pancreas after Necrotizing Pancreatitis
Authors: Buscher H.C.J.L. , Jacobs M.L. , Ong G.L. , van Goor H. , Weber R.F.A. , Bruining H.A.
Published: April 2003

Aim: To investigate the late sequellae of necrotizing pancreatitis on the endocrine function of the pancreas. Patients and Methods: Twenty patients, 15 men (mean ± SEM age 52.2 ± 2.6 years and BMI 26.8 ± 0.8 kg/m2) and 5 women (age 51.0 ± 7.6 years and BMI 26.7 ± 0.8 kg/m2) were submitted to a glucagon stimulation test 63 (range 8–136) months after an attack of pancreatitis. All nondiabetic patients (n = 15) were also submitted to an oral glucose tolerance test. For comparison, 16 healthy volunteers, 8 men (age 56.0 ± 0.9 years and BMI 26.3 ± 0.4 kg/m2) and 8 women (age 50.5 ± 1.0 years and BMI 28.2 ± 0.6 kg/m2), were also studied. Results: Five patients (25%) had diabetes mellitus and needed insulin treatment, 6 patients (30%) had an impaired glucose tolerance (IGT). Nondiabetic patients (IGT included) had a significantly higher basal insulin level (15.8 ±1.9 vs. 10.9 ± 2.2 mU/l, p < 0.05) and a lower glucose/insulin ratio (p < 0.05) compared with controls. The serum concentrations of insulin and C peptide, after stimulation with glucagon, calculated as peak value, maximal increment and as area under the curve were not significantly different in the nondiabetic patients compared to controls. The subgroup of IGT patients had a significantly higher basal C peptide (p < 0.05) and a reduced maximal increment (p < 0.05). Conclusions: After nonresectional therapy for necrotizing pancreatitis, there is a high prevalence of disturbances in glucose metabolism. Patients with IGT have signs of both loss of β-cell function and insulin resistance.
Multidisciplinary Approach to Palliation of Obstructive Jaundice Caused by a Central Hepatocellular Carcinoma
Authors: Läuffer J.M. , Mai G. , Berchtold D. , Curti C.G. , Triller J. , Baer H.U.
Published: April 2003

Background/Aims: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). Methods: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. Results: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. Conclusion: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.
Ischemia/Reperfusion-Induced Pancreatitis
Authors: Sakorafas George H. , Tsiotos Gregory G. , Sarr Michael G.
Published: April 2003

Background/Aim: The pancreas is an organ highly susceptible to ischemic damage. This discussion reviews the role of ischemia as an etiologic factor in acute pancreatitis. Methods: Literature review. Results: The susceptibility of the pancreas to ischemia/reperfusion injury has been demonstrated in experimental studies and in clinical settings such as cardiopulmonary bypass, hemorrhagic shock, and transplantation of the pancreas. Oxygen free radicals, activation of polymorphonuclear leukocytes, failure of microvascular perfusion, cellular acidosis, and disturbance of intracellular homeostasis appear to be important factors/mechanisms in the pathogenesis of ischemia/reperfusion-induced acute pancreatitis. In clinical practice, the diagnosis of ischemic pancreatitis is difficult and often delayed, especially during the postoperative period after cardiac or major vascular surgery. Conclusions: Ischemia appears to be one important factor in acute pancreatitis. The management of ischemic pancreatitis is similar to that of acute pancreatitis of any etiology.
Urgent Transjugular Retrograde Obliteration for Prophylaxis of Rebleeding from Gastric Varices in Patients with a Spontaneous Portosplenorenal Shunt
Authors: Chikamori Fumio , Kuniyoshi Nobutoshi , Shibuya Susumu , Takase Yasuhiro
Published: April 2003

Background: Bleeding isolated gastric varices with a spontaneous portosplenorenal shunt are difficult to control. The urgent use of transjugular retrograde obliteration (TJO) to prevent early rebleeding and to improve early mortality has not yet been demonstrated. We report our experience with this technique in patients with isolated gastric varices after treatment of acute bleeding. Methods: We reviewed our experience of 6 patients with isolated gastric varices with a spontaneous portosplenoral shunt treated with TJO after treatment of acute bleeding. We basically applied endoscopic glue embolization using cyanoacrylate monomer for treatment of acute bleeding. TJO was a method using an occlusive balloon catheter to control a spontaneous portosplenorenal shunt flow while injecting sclerosant retrograde into the gastric varices. Results: Treatment of acute bleeding was achieved immediately by endoscopic glue embolization, endoscopic variceal ligation, and ligating the varices with sutures following anterior gastrotomy in 4, 1 and 1 patients, respectively, and then TJO was performed. Permanent hemostasis and variceal eradication was achieved in these 6, and they all survived. They were alive for 6–66 months without gastric variceal recurrence. Conclusions: We conclude that urgent TJO is effective in the prophylaxis of early and late rebleeding from isolated gastric varices in patients with a spontaneous portosplenorenal shunt.
Adenocarcinoma of the Distal Bile Duct
Authors: Bortolasi Luca , Burgart Lawrence J. , Tsiotos Gregory G. , Luque-de León Enrique , Sarr Michael G.
Published: April 2003

Background/Aims: Primary distal bile duct adenocarcinomas (DBDAs) are unusual neoplasms, necessitating pancreaticoduodenectomy for cure. The aims of this study were to evaluate the prognostic importance of lymphatic and perineural invasion, long-term outcome of patients after resection, and differences in outcome with hilar cholangiocarcinoma and pancreatic carcinoma. Methods: The medical records and histopathological slides of 15 patients (8 men and 7 women) with documented DBDA after curative pancreaticoduodenectomy were reviewed. Results: Nine standard and 6 pylorus-preserving pancreaticoduodenectomies were performed. TNM staging included 1, 3, 2, 8, and 1 patient in stages I, II, III, and IVA and IVB, respectively. Lymphatic and perineural invasion was present in 4 (27%) and 9 (60%) patients, respectively. With multivariate analysis only serum bilirubin was a significant prognostic factor. Median survival was 21 months, and 2- and 5-year actuarial survivals were 40 and 20%, respectively. Median survival with adjuvant therapy (n = 6) was 21 months, with 5-year survival of 33%. Five-year actuarial survivals when lymphatic or perineural invasion was present were 0 and 11%, respectively. Conclusion: DBDA is aggressive, but entails a better prognosis than pancreatic ductal or more proximal bile duct carcinoma. Lymphatic and/or perineural invasion worsen survival.
Randomized Trial of Oral Sodium Phosphate Compared with Oral Sodium Picosulphate (Picolax) for Elective Colorectal Surgery and Colonoscopy
Authors: Yoshioka K. , Connolly A.B. , Ogunbiyi O.A. , Hasegawa H. , Morton D.G. , Keighley M.R.B.
Published: April 2003

Background: Sodium picosulphate (Picolax) is considered by most British surgeons as standard preparation for colonoscopy and elective surgery. Oral sodium phosphate may be better tolerated and more efficient as bowel preparation. Methods: A randomized trial was performed to compare oral sodium phosphate (n = 76) with Picolax (n = 77) as bowel preparation for elective colorectal surgery. A parallel study randomized colonoscopy patients to sodium phosphate (n = 51) or Picolax (n = 52). Patient acceptability was measured for seven symptoms with a linear analogue score. Quality of preparation was graded by the surgeon and faecal residue was measured in resection specimens. During colonoscopy, bowel preparation has graded 0–24 using an endoscopic score. Results: Abdominal pain, nausea, vomiting, embarrassment, fear and fatigue did not differ significantly between the groups. Surgeons grade of quality was judged poor or awful in 5 of 76 in the sodium phosphate group (9%) compared with 13 of 73 in the Picolax group (18%, p = 0.084). Mean faecal residue in the resection specimen was 0.1 g/cm after sodium phosphate compared with 0.45 g/cm after Picolax (p < 0.01). The endoscopic score was significantly lower using sodium phosphate (2.0 ± 2.2) than picolax (3.1 ± 2.9; p < 0.05). Conclusions: These results suggest that oral sodium phosphate is well tolerated and superior to Picolax in elective colorectal surgery and colonoscopy.
Poor Outcome of a Defunctioning Stoma after Pouch Construction for Ulcerative Colitis
Authors: Körsgen Stephan , Keighley Michael R.B.
Published: April 2003

Background: Restorative proctocolectomy for ulcerative colitis can have complications necessitating a later defunctioning ileostomy with uncertain outcome. This analysis was undertaken to assess the outcome in patients needing a later defunctioning ileostomy after pouch construction in patients with ulcerative colitis. Method: The notes of our series of 154 patients who underwent restorative proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis were reviewed and 28 patients identified who needed a later defunctioning ileostomy to deal with complications. Results: A later defunctioning ileostomy was necessary in 28 patients to deal with the following complications: sepsis in 11 patients (5 pouches failed), fistulas in 7 (5 pouches failed), poor function including ileoanal stenosis in 5 (all 5 failed), postoperative intraabdominal bleeding in 2 (both saved), pouchitis in 2 (1 excised) and small bowel obstruction in 1 (saved). 16 pouches were eventually excised or permanently defunctioned (59%). Conclusion: Complications necessitating a later defunctioning stoma after pouch construction carry a poor prognosis, especially when used for ileoanal stenosis and fistulae.
‘Free Omental Plug’: A Nostalgic Look at an Old and Dependable Technique for Giant Peptic Perforations
Authors: Sharma Dhananjaya , Saxena A. , Rahman H. , Raina V.K. , Kapoor J.P.
Published: April 2003

Peptic perforation is a serious complication of peptic ulcer disease. The defect in the intestinal wall usually does not present a difficult technical problem of surgical management, in most cases perforation can be closed primarily. On rare occasions an extremely large defect (giant peptic perforation – defined as any perforation greater than 2.5 cm in size) cannot be closed by these simple techniques. Modalities of treatment advocated for such an ulcer over the years are: free omental plug in the form of a mushroom; serosal patch technique; jejunal pedicle graft, partial gastrectomy, and finally the possible addition of proximal gastrojejunostomy. The omental plug is a simple procedure which does not require expertise and can even be performed in a very short time by a trainee general surgeon in a seriously ill patient in emergency. We review 7 cases of giant peptic perforations closed by a free omental plug.
Carcinoid Tumour in a Caecal Duplication Cyst
Authors: Jain S. , Lobo D.N. , Clelland C.A. , Williams C.B.
Published: April 2003

Intestinal duplication cysts are rare congenital anomalies that may occasionally undergo neoplastic change. We report the case of a 30-year-old woman who was diagnosed to have a caecal duplication cyst. The cyst was excised and histology revealed the presence of a 10 mm diameter carcinoid tumour within the cyst wall. There was no evidence of metastatic spread and the patient remains well after 2 years follow-up. The 3 previously reported cases of carcinoid tumour arising within duplication cysts are reviewed.
Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones
Authors: Coelho Júlio C.U. , Vizzoto Jr. Alvo  O. , Salvalaggio Paolo R.O. , Tolazzi André R.D.
Published: April 2003

Background/Aims: The management of patients with silent or asymptomatic gallstones remains controversial. The objective of this study is to determine the complications of laparoscopic cholecystectomy performed to treat patients under 50 years of age with asymptomatic gallstones. Method: 207 patients, 13–49 years of age with asymptomatic gallstones, were subjected to laparoscopic cholecystectomy. There were 161 (78%) women and 46 (22%) men. Results: Operative time varied from 25 to 95 min, with an average of 42 min. The length of hospitalization varied from 12 h to 2 days. In no patient was the operation converted to laparotomy. There was neither mortality nor major complications. The following minor complications were observed: vomiting in 43 patients (20.7%), fever in 16 (7.7%), minor skin infection in 7 (3.3%), and keloid in 2 (0.9%). Conclusion: It is concluded from this study that laparoscopic cholecystectomy is a safe procedure in the treatment of patients under 50 years of age with asymptomatic gallstones.
The History Is Important in Patients with Suspected Acute Appendicitis / with Invited Commentary
Authors: Körner Hartwig , Söndenaa Karl , Söreide Jon Arne , Nysted Arne , Vatten Lars
Published: April 2003

Background/Aims: The clinical diagnosis of acute appendicitis is incorrect in 20–30% of patients undergoing surgery. We analysed the clinical importance of nine commonly used symptoms and signs in 544 consecutive patients with regard to the correct diagnosis of acute appendicitis. Methods: Open population-based prospective study. The degree of the surgeon’s certainty of the preoperative diagnosis was assessed. The final diagnosis was based on histology. Logistic regression was used to analyze the independent value of nine symptoms and signs to predict acute appendicitis by calculating odds ratio (OR) with 95% confidence intervals (CI). Results: In 434 of 544 patients (80%) acute appendicitis was confirmed. A history of nausea or vomiting (OR = 2.3; CI = 1.11 to 4.76) and pain migration to right iliac fossa (OR = 1.9; CI = 1.12 to 3.22) were significant predictors of acute appendicitis. Pain migration was found to be an independent predictor in females and nausea or vomiting in males. In the group of patients (29%) with an uncertain preoperative diagnosis, pain migration predicted a correct diagnosis in females (OR = 4.7; CI = 1.2 to 18), while tenderness over McBurney’s point was a significant predictor in males (OR = 8.3; CI = 1.1 to 63). Conclusions: A history of pain migration and nausea or vomiting were independent predictors for the correct diagnosis of acute appendicitis in patients undergoing surgery. Thus, patient history is important in this patient group.
Substance Use, Abuse and Dependence in Germany
Authors: Perkonigg Axel , Lieb Roselind , Wittchen Hans-Ulrich
Published: April 2003

To provide background information about previous findings about the prevalence of use, abuse and dependence of various substances (nicotine, alcohol, prescription and illicit drugs) findings of available epidemiological studies in Germany from the 1980s and 1990s are summarized and critically evaluated. Focusing on findings of substance use surveys in adolescents and young adults the review indicates: (a) a considerable number of large scale questionnaire surveys in general population samples documenting the frequency of use and patterns of use of most substances; (b) indications of increasing rates of drug use particularly in East Germany; (c) high rates of illicit drug use, mainly of cannabinoids, but also stimulants and hallucinogens, among young age groups. No data are available from substance use surveys or from clinical epidemiological studies allowing the determination of how frequent substance abuse and substance dependence diagnoses are in the general population or in adolescents and young adults. Priorities for future research to ameliorate this unsatisfactory situation are outlined with emphasis on research in adolescents and young adults.
Prevalence of Use, Abuse and Dependence of Illicit Drugs among Adolescents and Young Adults in a Community Sample
Authors: Perkonigg Axel , Lieb Roselind , Wittchen Hans-Ulrich
Published: April 2003

Prevalence findings for 1995 of illicit drug use as well as DSM-IV abuse and dependence are reported from a representative population sample of 3,021 respondents from Munich, Germany, aged 14–24 years. Results are based on personal interviews using the M-Composite International Diagnostic Interview (M-CIDI) with its DSM-IV diagnostic algorithms. Findings indicate that more than 30% of the adolescents and young adults are or have been using one or more illicit drugs at least once in their life. Men were slightly more likely to ever use drugs and used them more frequently than women. Cannabinoids were by far the most frequently used type of drug, followed by various stimulating drugs and hallucinogens. There is also considerable polysubstance use among 14- to 24-year-olds. Criteria for DSM-IV abuse without dependence were met by 4.1% of all men and 1.8% of all women, a dependence syndrome of any type of illicit drug was diagnosed in 2.5% of the men and 1.6% of the women. Cumulative age of onset incidence analyses suggest that substance use starts early, in about one-third before the age of 16 years and continues to rise for most drugs throughout adolescence and young adulthood. Overall these findings suggest that substance use and substance disorders are more prevalent than suggested in most previous German studies.
Recent Changes in Danish Law on Drugs and Drug Offences
Authors: Jepsen Jørgen , Laursen Lau
Published: April 2003

The article recounts changes in Danish Drug Law and Enforcement since the beginning of the 1990s and relates them to general trends in Danish criminal policy during the period. In addition to the implementation of EU directives, e.g. on money laundering and growth hormones, legislation has been passed to curb conspicuous dealing of drugs in the streets of Copenhagen. This part of the legislation is seen as a reaction to public fears and reactions to visible aliens dealing in drugs in a conspicuous way, albeit in minor quantities. The legal changes imply a considerable rise in penalties for repeated dealings in minor quantities and easier access to deportation of aliens. The latter has been criticized as potential violation of the human rights of aliens. This and other recent changes in criminal law and related legislation is seen as an indication of politicians’ concerns with voters’ anxieties, possibly at the edge of moral panics.
Alcohol and Disinhibition
Authors: Källmén Håkan , Gustafson Roland
Published: April 2003

This review investigates research evaluating the disinhibition hypothesis. This hypothesis postulates that in a sober state behavior is inhibited. When people are influenced by alcohol the inhibitions are supposed to be weakened and the motivating drives are postulated to become disinhibited and potent to influence behavior. This report reviews the effect of alcohol on nerve functions, on human sexuality, aggression, eating behavior, psychological conflicts, fluency in talk, social anxiety, violent crimes and the interaction of alcohol and social norms. It has been shown that individual subjective experiences sometimes indicate disinhibition (reduction of the forces holding back impulses) and objective behavior in some respects was different when the subject was intoxicated, but the mechanism that mediates behavior is not clear. It seems to be difficult to measure independently the forces restraining (inhibiting) the driving forces (uncontrolled impulses) at the same time as measuring these driving forces. The review concludes that there is no unambiguous support of the disinhibition hypothesis. An alternative hypothesis that seems to explain many behaviors in an inebriated individual is the ‘time out’ hypothesis which states that drunken behavior is influenced more by norms about what it should be than by the pharmacological effect of alcohol.
Synthesis of Qualitative Research on Drug Use in the European Union: Report on an EMCDDA Project
Authors: Fountain Jane , Griffiths Paul
Published: April 2003

This paper is a synthesis of the information in the report Inventory, Bibliography and Synthesis of Qualitative Research in the European Union which was co-ordinated for the European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal, by the National Addiction Centre, London, UK. It is based on the work of a network of qualitative researchers from the European Union. The report includes detailed information from each member state on current qualitative projects, relevant publications from the last 10 years and a directory of those researchers active in this area. The paper introduces the project, outlines its future direction and discusses what can be defined as ‘qualitative research’. Historical developments and the role of qualitative methodology in relation to research into drug use are examined. A summary of the project’s findings is presented, and the relevance of qualitative research for policy-making is discussed. Finally, the methodology used to collect data for the project is described.
Therapeutic Drug Monitoring for Methadone: Scanning the Horizon
Authors: Wolff Kim , Strang John
Published: April 2003

The initial assessment and subsequent monitoring of compliance in methadone treatment programmes are excessively reliant on the accuracy of self-report from opiate addicts themselves. Given the central position of methadone treatment in the therapeutic options currently available and with the increasing number of opiate addicts requiring treatment, improved methods of judging optimal methadone treatment are required. This paper explores the possible future options for assessing the adequacy of methadone prescribing from the analysis of methadone levels in urine, blood, hair and saliva. The particular promise of plasma therapeutic drug monitoring for methadone is explored, accompanied by an account of the state of the art at the time of writing.
The Use of Lofexidine by Drug Dependency Units in the United Kingdom
Authors: Akhurst Jacqueline S.
Published: April 2003

Data were collected on 1,074 opiate detoxifications conducted with lofexidine, from 40 drug dependency units in the United Kingdom. 671 patients (62.5%) attempted a detoxification in the community, with the remainder attempting an inpatient detoxification. Patients completing the detoxification started on a mean dose of 0.8 mg/day (median 0.6 mg/day), titrating to a mean dose of 2.2 mg/day (median 1.6 mg/day) and detoxifying in a mean of 10 days (median 10 days). Overall 614 patients (60.4%) successfully completed the detoxification. The most frequently recorded adverse events were dry mouth (5.3%), dizziness (8.5%) and sedation (6.6%). In conclusion, lofexidine is widely and successfully used to rapidly detoxify patients from a range of opiates.
Can Light or Moderate Drinking Benefit Mental Health?
Authors: Chick Jonathan
Published: April 2003

Observational studies in several cultures show light and moderate drinking to be associated with better emotional and social adjustment than abstinence. However, adjustments for pre-existing personality characteristics and socialisation need to be made, and abstainers who are ex-drinkers must be excluded. There is still insufficient evidence to suggest that emotional health can be improved by light or moderate drinking. For cognition, consumption of up to 65 g/day is not associated with chronic inefficiencies. With regard to cognitive decline in older people, emerging evidence suggests the possibility that such decline may be reduced by light drinking. The elderly in institutions probably benefit from a ‘social hour’ when alcoholic beverage is available. Doctors considering giving advice to drink to improve health should be very cautious and note a number of caveats.
Drug Treatment Systems and Policy Frameworks: A Comparative Social Policy Perspective
Authors: MacGregor Susanne
Published: April 2003

The article offers a discussion of drug treatment systems from a social policy perspective. Comparative studies of social policy have utilised typologies to aid analysis. These are briefly characterised in this article. Current analysis of social policy points to changes in the shape of policy regimes. How are these changes impacting on drug treatment systems? Key principles around which policy forms are organised are the desire to effect social control, the desire to meet human need, and the need to minimise harm from risks present in the environment. In practice, these principles operate in tension and different outcomes are observable in different societies. The article argues that, in spite of these historical and cultural differences, some convergence is observable in systems as they adapt to global influences. There remains however an urgent need for more detailed empirical research on policy responses in different countries, utilising the case-study approach adopted by the ISDRUTS collaborators.
Recent Trends in Drug Treatment in Europe
Authors: Kinnunen Aarne , Nilson Margareta
Published: April 2003

The article describes the recent developments in drug treatment systems in several European countries. The article is based on the up-dated papers delivered in the closing meeting of the ISDRUTS-project (International Study of the Drug Treatment Systems) in Lisbon, October 7–9, 1998. In the article latest trends in drug situation and drug-related harm in different countries are represented. Also recent changes in legal measures, the proceeding of the harm reduction measures, the situation with heroin trials, the implosion of the drug treatment system into the alcohol treatment system and alternatives to imprisonment and other diversion mechanisms for addicts are described. In the concluding chapter recent trends in drug treatment are analysed in the framework of the political climate in Europe.
The Contextualization of Drug Treatment – Future Research Perspectives and Concepts
Authors: Bergmark Anders
Published: April 2003

In the article the growing interest of studies on treatment systems rather than specific treatment modalities is taken as a starting point for a discussion and outlook on how the research agenda of drug treatment research will develop in the near future. The relative absence of research that provides substantial guidance in the search for treatment effects has opened up for studies on larger, ‘natural’ entities, which are examined from composite, and theoretically elaborated, standpoints. The article argues that there is much to be done when it comes to research on treatment from a client’s perspective and that a development of that particular path is a necessity for a more profound description and understanding of treatment. The need for theoretical input is emphasized and exemplified with ideas from organizational theory and discussions related to the concept of globalization. Finally the article identifies a need for more attention to some definitional issues that must be addressed in order to empirically develop comparative research on drug treatment systems.
The EMCDDA/Pompidou Group Treatment Demand Indicator Protocol: A European Core Item Set for Treatment Monitoring and Reporting
Authors: Simon Roland , Donmall Michael , Hartnoll Richard , Kokkevi Ana , Ouwehand A.W. , Stauffacher Michael , Vicente Julian
Published: April 2003

Over the last decades inside and outside of Europe, treatment-based data have been used in epidemiological research on drugs and drug abuse. They offer information on hidden populations and allow to follow socially stigmatised behaviour. As this type of research can be done on rather low budgets, there are long-term projects run in many countries. Experts from the national systems in several EU member states have been working together to develop a common standard on the basis of the Pompidou Group (PG) Definitive Protocol. The items and basic definitions of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)/PG Treatment Demand Indicator Protocol are described, which plays an important role in the process of harmonisation of data collection for the EMCDDA. Implementation strategies are described, and future steps are discussed.
A Comparison of Heroin Chasers with Heroin Injectors in Switzerland1
Authors: Stohler Rudolf , Dürsteler-Mac Farland Kenneth M. , Gramespacher Claudia , Petitjean Sylvie , Battegay Raymond , Ladewig Dieter
Published: April 2003

In a cross-sectional multicentre study, we compared the characteristics of heroin chasers and heroin injectors. Subjects were 162 primarily opioid-dependent volunteers for whom either chasing (n = 85) or injecting (n = 77) was the principal route of heroin administration. Each subject was rated by means of the Swiss version of the European Addiction Severity Index. Additionally, subjects completed a questionnaire battery including the Severity of Dependence Scale, the Symptom Checklist SCL-90-R, a self-constructed peergroup questionnaire and a semantic differential list to assess the connotative meaning of heroin chasers and injectors. The heroin injectors were older and more likely to use one or more other drugs besides heroin than the chasers. They had longer heroin-using careers, a longer duration of detention and a higher prevalence of some type of hepatitis. In conclusion, the differences between chasers and injectors were rather related to a longer history of heroin use than to the route of heroin administration.
Gluten Stimulation Induces an in vitro Expansion of Peripheral Blood Tγδ Cells from HLA-DQ2-Positive Subjects of Families of Patients with Celiac Disease
Authors: Lio Domenico , Bonanno Cesira T. , D’Anna Claudia , De Luca Salvatore , Gervasi Francesco , Cavataio Francesca , Iacono Francesco , Salerno Alfredo
Published: April 2003

The intestinal gluten sensitivity formally known as celiac disease (CD) is characterized by an evident involvement of local immune response and it is associated with the expression of HLA-DQ2 allele. The major role in the disease seems to be played by the T lymphocyte population bearing γδ T cell receptor (Tγδ cells) which are increased both in peripheral blood and intestinal mucosae of celiac patients. In this paper data on the effects of in vitro gluten stimulation on lymphocytes expressing the Tγδ phenotype are reported. Gluten seems to be able to induce the expansion of the Tγδ cell population both in CD patients and their HLA-DQ2-positive asymptomatic relatives, in spite of the absence of clinical evidence of the disease. In addition, the evaluation of gluten-induced cytokine production shows that interleukin-4 could be implied in the early phases of pathogenesis of CD.
Cytokine-Driven Immortalization of in vitro Activated Human T Lymphocytes
Authors: Kaltoft Keld
Published: April 2003

Like other normal human somatic cells, T lymphocytes are believed to have a finite in vitro life span. However, continuous T lymphocyte cell lines can often be established from chronic inflammatory skin diseases when the culture medium is supplemented with IL-2 and IL-4 but without antigen and accessory cells added. Based on the assumption that these continuous T lymphocyte cell lines were activated by antigen during the chronic inflammation taking place in vivo, I investigated whether peripheral blood T lymphocytes could be induced to cytokine-dependent continuous growth following antigen activation. Upon allostimulation, peripheral blood CD4+ T lymphocytes reproducibly escape from cellular senescence. These IL-2- and IL-4-dependent continuous T cell lines show high telomerase activity. Withdrawal of either IL-2 or IL-4 results in cell growth arrest concomitant with down-regulation of telomerase activity. When cultured continuously, these CD4+ human T lymphocytes gradually lose expression of CD28.