bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome following Pancreaticoduodenectomy in Patients Undergoing Preoperative Biliary Drainage / with Invited Commentary
Authors: Srivastava S. , Sikora S.S. , Kumar A. , Saxena R. , Kapoor V.K.
Published: April 2003

Objective: To assess the role of preoperative biliary drainage (PBD) in the early outcome following pancreaticoduodenectomy (PD) for periampullary tumors. Design: Retrospective analysis of prospective database. Patients and Methods: 121 PDs were performed for periampullary tumors between 1989 and 1998. 54 patients were operated following a PBD (group A) while 67 patients were operated without PBD. 50 patients underwent internal biliary drainage while 4 patients underwent external biliary drainage. Of the 67 patients without PBD, serum bilirubin was >10 mg% in 41 patients (group B) while 26 patients had bilirubin level of <10 mg% (group C). Result: Patients were well matched for age, sex distribution, presence of medical risk factors, duration of surgery, operative blood loss and stage of disease. Group A patients had a higher incidence of wound infection (43 vs. 24%; p = 0.03), intra-abdominal abscess (28 vs. 15%; p = 0.06), pancreaticojejunal anastomotic leak (20 vs. 5%; p = 0.01) and overall infective complications (52 vs. 29%; p = 0.01) compared to group B patients, and a higher overall infective complication rate than group C patients (52 vs. 27%; p = 0.02). Group B patients had a higher incidence of intra-abdominal bleeding compared to group A (20 vs. 6%; p = 0.01) and group C patients (20 vs. 4%; p = 0.03). Reoperation rate was significantly higher in group B compared to group A patients (27 vs. 13%; p = 0.04). The mortality rates were not significantly different in the three groups. Conclusion: Patients with jaundice (>10 mg%) have a higher risk of bleeding complications while those with PBD have more infective complications. PBD should be judicially employed in selected patients.
Small Bowel Obstruction following Extended Right Hemicolectomy and Subtotal Colectomy: Assessing the Benefit of Prophylactic Tube Splinting / with Invited Commentary
Authors: Meissner K.
Published: April 2003

Background/Aims: Small bowel obstruction (SBO) is a frequent complication of extended right hemicolectomy and subtotal colectomy. This study was conducted to assess the prophylactic effectiveness of intestinal tube splinting. Methods: Sixteen patients (study group) undergoing extended right hemicolectomy or subtotal colectomy were treated with and 18 patients (controls) without splinting. Clinical, operative and outcome data were entered into a maintained database. The main endpoint was subsequent SBO. Results: After a follow-up of 2–13 (median 6.5) years, the study group remained free from SBO. After 1–16 years (median 2), four complete and one partial early and one complete and one complete recurrent late SBO occurred in controls. Conclusion: Intestinal tube splinting was comparatively easy and expeditious from a technical point of view after extended hemicolectomy and subtotal colectomy. The procedure eliminated early and up to date also late postoperative SBO in this study and can be considered as a prophylaxis against SBO in this subset of patients.
Current Practices in Left-Sided Colonic Emergencies
Authors: Goyal Ajay , Schein Moshe
Published: April 2003

Background: The paradigms in the surgical management of obstruction and perforation of the left colon – once considered absolute contraindications to primary resection and anastomosis – are changing. The aim of this survey was to poll American Gastrointestinal surgeons on their current approach to left colonic emergencies. Methods: A questionnaire was sent to 500 US-based surgeons, randomly selected members from the membership list of the Society for Surgery of the Alimentary Tract. It surveyed the surgeons on how they would approach ‘good-risk’ and ‘poor-risk’ patients with left colonic obstruction or perforation. Results: 215 (43%) surgeons responded to the questionnaire; 180 fully completed questionnaires (36%) were analyzed. Sigmoid obstruction: 96 responders (53%) selected a one-stage procedure in ‘good-risk’ patients; 78 preferred sigmoid resection with (n = 46) or without (n = 32) ‘on-table’ colonic lavage and 18 opted for a subtotal colectomy and ileo-rectal anastomosis. Most (94%) responders preferred a staged procedure in ‘high-risk’ patients: a Hartmann resection (n = 120) or a transverse colostomy (n = 46). Sigmoid diverticular perforation: only one third of the responders recommended a one-stage procedure in ‘good-risk’ patients: 58 would perform a sigmoidectomy with (n = 19) or without (n = 39) ‘on-table’ colonic lavage; only two opted for subtotal colectomy with ileo-rectal anastomosis. In ‘high-risk’ patients most surgeons opted for a Hartmann’s (88%) procedure or a diverting colostomy (7%). Conclusions: This survey suggests that a half and one-third of the responders would perform a one-stage resection and anastomosis in ‘good-risk’ patients with left colonic obstruction and perforation, respectively. In ‘poor-risk’ patients most responders would still opt for a staged procedure.
Intussusception of the Appendix Secondary to Mucinous Cystadenoma
Authors: Rudek B. , von Herbay A. , Schmidt J.
Published: April 2003

Intussusception of the appendix vermiformis in adults is an unusual entity. We present a 52-year-old male patient with intussusception of the appendix due to a mucinous cystadenoma, and discuss the clinical features, preoperative diagnosis, classification and therapy of this condition together with a review of the literature.
Hepatectomy Using the Coagulating Shears Type of Ultrasonically Activated Scalpel
Authors: Okamoto T. , Nakasato Y. , Yanagisawa S. , Kashiwagi H. , Yamazaki Y. , Aoki T.
Published: April 2003

Since the ultrasonically activated scalpel (UAS) incorporates multiple functions, we have used it for hepatectomies. The present study discusses the noteworthy points and problems of use, and shows initial results. Intraoperative ultrasonography is an important tool for comprehending the positional relationship between the plane of division and the main blood vessels. It allows initial adjustment of coagulation and cutting effects according to the rigidity of the liver parenchyma by means of variable ultrasound levels and exchangeable blade tips, and offers good visibility of the cut surface in deep sites as long as adequate tension on the tissue and an upper position for the blade are maintained. 30 patients underwent hepatectomies using the UAS. The amount of blood loss for lobectomy was significantly less than that for partial lobectomy in normal livers in addition to a significant difference between normal and damaged livers in each group according to the extent of resection. There were no serious complications seen in all cases during the operation. The incidence of positive bile leakage was high. It is recommended that bile leakage testing be carried out as thoroughly as possible. There were 3 postoperative bile fistulas and 1 postoperative hemorrhage. In conclusion, although a dramatic improvement in blood loss and shortened operating time could not be obtained in all procedures, the safety and usefulness were demonstrated in lobectomy. The UAS can be considered as a surgical device that can contribute to the efficiency of hepatectomy, depending on the indications selected.
Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary
Authors: Bassi Claudio , Falconi Massimo , Salvia Roberto , Mascetta Giuseppe , Molinari Enrico , Pederzoli Paolo
Published: April 2003

Pancreaticoduodenectomy (PD) is still a difficult procedure with significant morbidity. We report 150 consecutive PDs performed during a 3-year period. All the cases have been prospectively evaluated with regard to the surgical outcome. Mortality in this series was 3/150 (2%) with a re-operation rate of 5/150 (3.3%); surgical complications were experienced in 57/150 (38%). The most frequent complications were collections in 25/150 (16.6%) and pancreatic fistulas in 16/150 (10.7%). The majority of these complications were conservatively managed: only one abscess and one fistula due to an anastomotic dehiscence required re-operation. The complication most responsible for mortality was haemorrhage secondary to arterial pseudoaneurysms in patients with severe post-operative pancreatitis. The continued high morbidity of PDs is compensated by the ability to treat complications non-operatively, resulting in a surgical risk that should now be considered medium to low in high volume centres.
Pyogenic Liver Abscess: An Audit of 10 Years’ Experience and Analysis of Risk Factors / with Invited Commentary
Authors: Lee King-Teh , Wong Sen-Ren , Sheen Pai-Ching
Published: April 2003

Background/Aims: Despite continuous improvement in image modalities, availability of potent antibiotics and advancement in the knowledge and treatment of pyogenic liver abscess, mortality remains high. The high mortality rate has underlined the important role of prognostic factors and prompts a number of studies to identify the risk factors. The present study aims to audit our experience in managing patients with pyogenic hepatic abscess during the period of 1989–1999, and to document changes in etiology, bacteriology and outcome, and to identify any risk factor associated with mortality. Methods: One hundred and thirty-three patients with pyogenic hepatic abscess were studied to determine the demographic characteristics, clinical features, laboratory, bacteriological findings, methods of treatment, final outcome and risk factor analysis. All patients were treated with parenteral antibiotics. One hundred and twelve patients were subjected to ultrasound-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in all patients. Laparotomy was done in 21 patients. Results: The overall hospital mortality rate was 6% (8/133). Biliary tract disease was the most frequently identified cause. Leukocytosis, hypoalbuminemia and hyperbilirubinemia were common laboratory findings. The most common microorganism cultured was Klebsiella pneumoniae. The most common concomitant disease was diabetes mellitus. On univariate analysis, large abscess, diabetes mellitus and sepsis were significantly associated with hospital mortality. On multivariate logistic regression analysis, the presence of sepsis (p = 0.0031) was found to be an independent risk factor. Conclusions: In addition to early diagnosis and prompt treatment, making every effort to treat patients with adverse prognostic factors and systemic complications, the hospital mortality rate will be decreased significantly.
CT-Based Navigation Systems for Intraoperative Radiotherapy Using the Afterloading-Flab Technique
Authors: Tonus Carolin , Debertshäuser Detlev , Strassmann Gerd , Kolotas Christos , Walter Stephan , Zamboglou Nikolaos , Nier Helmut
Published: April 2003

Introduction: The fact that conventional intraoperative radiotherapy does not give the opportunity to exactly document the radiation volume applied and the dose distribution has been criticized in many ways. We would like to introduce a system for surgical navigation and documentation of flap positioning in intraoperative brachytherapy using the afterloading flap technique. Methods: Our system consists of an electromagnetic 3D-digitizer and a PC workstation. Spiral CT scans of the tumor region taken preoperatively are used for navigation and documentation of flap positioning, analogous to the procedure in neuronavigation. Registration is done via an external reference system which is attached to the iliac bone of the patient. Results: The mean accuracy of digitalization of the 100 spheres in a pelvis model is about 2.6 ± 0.5 to 3.7 ± 9.9 mm. The mean navigation accuracy is 2.4 ± 0.8 to 3.3 ± 0.8 mm. These figures correspond to the clinical experience of our surgeons. Discussion: The optimization of flab positioning by CT-guided navigation and the more accurate documentation of the dose volume and distribution in the patient is an important step on the way to improving the quality of individual radiation therapy. We are of the opinion that surgical navigation in the pelvic region should be subject to additional investigation in order to optimize the procedure.
Cytogenetic and Immunohistochemical Characterization of Fragile X Syndrome in a Kuwaiti Family: Rapid Antibody Test for the Diagnosis of Mental Retardation Patients
Authors: Alkhalaf Moussa , Verghese Lilly , Mushtaq Syed Khaja
Published: April 2003

Objectives: To study a Kuwaiti family with fragile X mental retardation syndrome and present a rapid, noninvasive antibody test to be used for fragile X syndrome diagnosis on all mentally retarded patients in Kuwait. Methods: For cytogenetic analysis, the fragile site was induced by culturing blood lymphocytes in a medium containing a low concentration of folate (M199) or by adding 0.1 µM of fluorodeoxyuridine to the culture media. For the immunohistochemical test on blood smears, monoclonal antibodies against fragile X mental retardation (FMR1) gene product were used. The test is based on the presence of the protein in lymphocytes from normal individuals and its absence in lymphocytes from fragile X patients. Results: A Kuwaiti family with fragile X syndrome in 4 affected males is described. The immunohistochemical study with the monoclonal antibodies against FMR protein gave conclusive results on the same day for the affected males. Conclusion: To our knowledge, this is the first report describing a large Kuwaiti family with the fragile X syndrome. These data suggest that the immunohistochemical test used is an ideal method for the diagnosis of fragile X syndrome in mentally retarded patients in Kuwait.
Bile Duct Injuries in Laparoscopic Cholecystectomy
Authors: Wahby Mahmoud , Nur Ali , Al-Wafai Ibrahim
Published: April 2003

Objectives: Bile duct injuries were analysed in a prospective study of 1,250 cases of laparoscopic cholecystectomy. The aim of the study was to identify the incidence and causes of bile duct injuries in the course of laparoscopic cholecystectomy, and to recommend the possible ways to avoid this serious complication. Materials and Methods: Special computer forms were created to record detailed patient pre-operative, operative, and postoperative follow-up data for later study. Operative cholangiography was done only on a selective basis. Bile duct injuries were classified according to the Bismuth classification. Results: Four cases (0.3%) of bile duct injuries were encountered in the study: 2 of them were classified as major (Bismuth classification grade II) and the other 2 as minor (diathermy puncture). All injuries were attributed to distortion of Calot’s triangle and failure to clearly identify the anatomy. A recent history of acute cholecystitis, a history of jaundice, pancreatitis and repeated or technically difficult endoscopic retrograde cholangiopancreatography (ERCP) were associated with local inflammatory changes that had possibly contributed to the distorted anatomy at Calot’s triangle and consequently to the injury. All injuries were detected during surgery and immediately repaired. Major bile duct injuries were repaired by choledocho-enterotomy, while minor injuries were treated by simple sutures around the T tube in the common bile duct. All patients were asymptomatic with normal liver function tests on follow-up for a period up to 3 years after surgery. Conclusions: The incidence of bile duct injuries in laparoscopic cholecystectomy is comparable to open surgery. Patients with a clinical history of acute cholecystitis, or a recent history of jaundice and repeated ERCP should be considered for operative cholangiography in order to help reduce the chances of bile duct injuries.
Effect of Acute Exercise on Plasma Nitric Oxide Level in Humans
Authors: Franco L. , Doria D. , Mattiucci F.
Published: April 2003

Objective: Since nitric oxide (NO) plays an important role in regulating vascular tone and changes in the plasma concentration of the end product of NO (nitrite/nitrate) have been observed during exercise, we studied the influence of acute exercise on nitrite/nitrate plasma levels in a group of semiprofessional football players and in younger and older sedentary subjects. Methods: The subjects exercised for 10 min on a cycle ergometer and blood samples were obtained at rest and immediately after exercise. Plasma samples were analysed for nitrite/nitrate. Results: The acute physical exercise induced a significant increase in nitrite/nitrate plasma levels both in sedentary and in active subjects. No difference was evident between the younger and older subjects, both in the basal level and after exercise, indicating that the changes could not be due to age. The higher basal plasma level of nitrite/nitrate observed in the active subjects compared with sedentary groups indicates that the state of physical conditioning had an effect on resting NO concentration. Conclusion: It seems that either acute exercise, even for a short time, or training can induce an increase in circulating NO.
Neonatal Septicemia in Al-Jahra Hospital, Kuwait: Etiologic Agents and Antibiotic Sensitivity Patterns
Authors: Gomaa Huda H.A. , Udo Edet E. , Rajaram Usha
Published: April 2003

Background: Neonatal septicemia (NNS) occurs frequently in neonatal intensive care units (NICU) and is often associated with high morbidity and mortality. However, information on its incidence and causative agents in Kuwait hospitals is scanty. Objectives: To investigate the bacterial causative agents of NNS in a NICU and their susceptibility patterns to antimicrobial agents. Methods: Between May 1 and December 31, 1996, blood cultures were performed on all admissions to the Neonatal Unit, Al-Jahra Hospital, Kuwait, with the Bactec 9240 instrument (Becton Dickinson, USA). Microorganisms were identified by cultural characteristics, Gram stain and biochemical profiles and antimicrobial susceptibility patterns performed by disk diffusion and by measuring their minimum inhibitory concentrations. Results: From a total of 995 neonates admitted to the neonatal unit during the study period, 117 (11.7%) had positive blood cultures. Eighty-seven (8.7%) of the neonates had confirmed septicemia. Gram-positive organisms were cultured from 65 (75%) and gram-negative organisms from 22 (25%) of them. The most frequent organisms isolated were Staphylococcus epidermidis (34%), Streptococcus viridans (28%) and Candida species (14%). Resistance to ampicillin and cephalosporins was detected in both gram-positive and gram-negative organisms associated with sepsis. Conclusions: The study identified the common bacterial pathogens associated with NNS in a neonatal unit, their susceptibility patterns to antimicrobial agents and emphasized the importance of understanding local epidemiology of NNS in formulating an antibiotic policy.
Comparative Antimicrobial Activities of Linezolid and Vancomycin against Gram-Positive Clinical Isolates from Hospitals in Kuwait
Authors: Phillips O.A. , Udo E.E. , Ali A.A.M. , Mokaddas E.M.
Published: April 2003

Objectives: The increasing prevalence of resistant gram-positive bacteria, emergence of vancomycin-resistant enterococci and the isolation of vancomycin-intermediate resistant Staphylococcus aureus have emphasized the need for new antimicrobial agents to treat infections caused by these organisms. We studied the comparative antimicrobial activities of linezolid, a new and totally synthetic oxazolidinone antibacterial agent and vancomycin against resistant gram-positive clinical isolates from four hospitals in Kuwait. Methods: The organisms were isolated from clinical samples including throat and wound swabs, urine and blood, and identified by cultural and biochemical characteristics. The minimum inhibitory concentration (MIC) of linezolid and vancomycin against S. aureus, coagulase-negative staphylococci, Streptococcus pneumoniae and enterococci was determined by the agar dilution method. Results: Linezolid demonstrated MIC ranges of 0.5–4 mg/l against methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus, 1–4 mg/l against methicillin-resistant coagulase-negative staphylococci (MR-CNS) and methicillin-sensitive coagulase-negative staphylococcal strains, and a narrow range of 0.5–1 mg/l against penicillin-resistant S. pneumoniae (PRSP). The range of vancomycin MICs against MRSA, MR-CNS and PRSP was 0.5–4, 0.5–1 and 0.25–0.5 mg/l, respectively. The MIC values of linezolid and vancomycin against vancomycin-susceptible enterococci were 1–2 and 0.5–4 mg/l, respectively. However, linezolid demonstrated a lower MIC of 2 mg/l against vancomycin-intermediate resistant enterococci and vancomycin-resistant enterococci than vancomycin (MICs of 8 and >512 mg/l, respectively). Conclusion: The results indicated that linezolid demonstrated activity comparable to vancomycin against all staphylococcal, vancomycin-susceptible enterococci and PRSP strains, but demonstrated superior activity against vancomycin-intermediate resistant enterococci and vancomycin-resistant enterococci. In addition, linezolid was highly effective against all multidrug-resistant gram-positive clinical isolates from hospitals in Kuwait.
Rapid Normalization of Marked Dilatation of the Cerebral Duro-Venous System in a Newborn Infant Mimicking a Great Vein of Galen Varix
Authors: Komiyama Masaki , Kitano Shouhei , Sakamoto Hiroaki , Ehara Eiji , Miyagi Nobuhiro , Kusuda Satoshi
Published: April 2003

A newborn infant with a marked dilatation of the cerebral duro-venous system is presented. The patient was diagnosed as having a vein of Galen aneurysmal varix by a cranial ultrasound examination immediately following delivery. Computed tomographic angiography on the following day, however, showed a marked dilatation of the cerebral duro-venous system, including the great vein of Galen, superior sagittal sinus, torcular herophili and transverse sinuses. There were no arteriovenous fistulas at the vein of Galen. Dilatation of the duro-venous system and concomitant heart failure subsided rapidly after intravenous administration of indomethacin for the treatment of the patent ductus arteriosus on the fourth day of life. Dilatation of the duro-venous system in a newborn infant should be differentiated from any form of vein of Galen aneurysm.
Primary Endobronchial Leiomyosarcoma
Authors: Lee Sin Hyung , Shim Jae Jeong , Shin Jae Seung , Baek Man Jong , Choi Young Ho , Kim Min Kyung , Kim Cheol Hwan , Lee Sang Youb , Jo Jae Youn , In Kwang Ho , You Se Hwa , Kang Kyung Ho
Published: April 2003

A case is presented with spontaneous expectoration of a small piece of solid tissue. Pathologic examination of the expectorated tissue was found to be consistent with leiomyosarcoma. After further work-up, there was no evidence of another primary site of leiomyosarcoma except for the right lower lobe. Right lower lobectomy was performed. The surgical specimen showed a tumor that was histologically identical to the patient’s previous expectorated tissue. To the authors’ knowledge, this is the first report of partial expectoration of a primary endobronchial leiomyosarcoma.
Improvement in Right Lung Atelectasis (Middle Lobe Syndrome) following Administration of Low-Dose Roxithromycin
Authors: Kawamura Masahide , Arai Yasumichi , Tani Masato
Published: April 2003

Middle lobe syndrome is a distinct clinical entity characterized by right middle lobe atelectasis. Prompt diagnosis and initiation of medical therapy including the administration of antibiotics and the avoidance of irritating agents may be effective. However, abnormal shadows on chest radiography remain unchanged even when acute symptoms have disappeared, suggesting latent lesional inflammation or recurrence. We describe 2 cases of atelectasis in the middle lobe of the right lung which resolved completely after administration of low-dose roxithromycin. Thus, low-dose therapy with a macrolide could be of interest or some value in these cases, but it is too early to draw a definite conclusion.
How and Why Exercise Is Impaired in COPD
Authors: Aliverti Andrea , Macklem Peter T.
Published: April 2003

Published data indicate that exercise in COPD is more often limited by leg effort than breathlessness. This casts some doubt on the classical belief that inability to ventilate limits exercise performance. In fact, symptoms limiting exercise appear to be essentially the same in COPD and in health or congestive heart failure, where exercise is limited by inadequate energy supply to locomotor muscles. In COPD, impaired O2 delivery to locomotor muscles is suggested by: (1) the O2 cost (v̇O2) of breathing may be ∼50% of whole body v̇O2; (2) decreasing the work of breathing improves performance and v̇O2 of locomotor muscles, and (3) locomotor muscle v̇O2 is greater when it is the only muscle exercising than during whole body exercise. Excessive expiratory pressures when expiratory flow is limited may lead to decreased venous return and contribute importantly to exercise limitation.
Pulmonary Alveolar Lithiasis in Two Siblings
Authors: Erelel Mustafa , Kiyan Esen , Cuhadaroglu Çaǧlar , Yilmazbayhan Dilek , Kiliçaslan Zeki
Published: April 2003

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology and is characterized by the deposition of calcium phosphate microliths within the alveolar airspaces. We report 2 asymptomatic siblings, a 7-year-old girl and her 13-year-old brother, with PAM. In the girl, chest X-ray and computed tomography revealed diffuse interstitial changes but no uptake of technetium 99m (99mTc) on bone scan was noted in the lung. Microliths stained pink with Papanicolaou dye in bronchoalveolar lavage fluid (BALF) but did not stain with von Kossa. In the brother, characteristic radiological findings and 99mTc uptake in the lung were detected. The microliths stained pink with Papanicolaou in BALF and black with von Kossa as well. We hypothesize that the first case is in the early phase of PAM because of lack of 99mTc uptake.
Comparison of a New Desktop Spirometer (Diagnosa®) with a Laboratory Spirometer
Authors: Maree D.M. , Videler E.A. , Hallauer M. , Pieper C.H. , Bolliger C.T.
Published: April 2003

Background: The Diagnosa is a fully integrated system, able to determine spirometry, ECG, blood pressure and body composition. Real time data can be transferred via Internet to a remote receiving center. Objectives: The aim of this study was to perform biological testing of the spirometry component in subjects with normal and pathological pulmonary function. Methods: A group of 45 patients (mean age 43.3 years, 30 males) was tested on both the Diagnosa and the standard Jaeger Masterlab spirometer according to the guidelines of the American Thoracic Society. Three subgroups of 15 subjects each (normal spirometry, obstructive and restrictive airflow limitation) were selected. Results: All measurements performed with the Diagnosa (FVC, FIVC, FEV1, PEF, FEF25, FEF50, FEF75) correlated closely (r = 0.92–0.99) with those performed with the Jaeger spirometer and showed good limits of agreement (the largest difference between the two devices being 0.2 liter for FEV1). Analysis of the 3 subgroups showed no difference for any parameters compared to the overall group. Electronic transfer of all data was successful. Conclusions: The Diagnosa spirometer is comparable to a standard laboratory spirometer and can be used reliably for telemedicine purposes.
Is There a Need for Another Inhalative β2-Agonist besides Formoterol in Patients with Asthma?
Authors: Matthys Heinrich
Published: April 2003

Formoterol can substitute the rapid- and short-acting β2-agonists as well as the slow- and long-acting salmeterol. Therefore formoterol in a fixed combination with an inhalant steroid reduces the aerosol devices necessary for asthma control to only one, to be used for regular ‘controller’ and, as needed, ‘rescue therapy’. The side effect profile of formoterol is comparable to the short-acting β2-agonists which makes the combination with a topically active glucocorticoid applicable in patients of any asthma severity as long as they are able to perform an inspiratory vital capacity maneuver
Serum Levels of Vascular Endothelial Growth Factor and Cavity Formation in Active Pulmonary Tuberculosis
Authors: Abe Yoshiyuki , Nakamura Masato , Oshika Yoshiro , Hatanaka Hiroyuki , Tokunaga Tetsuji , Ohkubo Yasuyuki , Hashizume Toshinori , Suzuki Kuninori , Fujino Tadahiko
Published: April 2003

Background: In active pulmonary tuberculosis, certain cytokines have been postulated to be related to cavity formation, although the detailed mechanism of cavity formation is not yet known. Objective: We examined the relationship between cavity formation in pulmonary tuberculosis and vascular endothelial growth factor (VEGF), which functions as an angiogenesis factor. Methods: Forty-eight patients with active pulmonary tuberculosis were divided into two groups according to cavity formation as evaluated by chest high-resolution computed tomography. We evaluated serum VEGF levels by enzyme immunoassay. Results: Group A (with cavities) was comprised of 22 patients and group B (without cavities) was comprised of 26 patients. The serum levels of VEGF were significantly higher in group B (58.733 ± 21.612 pg/ml) than those in normal individuals (8.739 ± 3.656 pg/ml) and in group A (13.053 ± 8.670 pg/ml) (Mann-Whitney U test, p = 0.0149 and p = 0.0481, respectively). Serum levels of interleukin-8 and tumor necrosis factor-α were not significantly different between the two groups. Conclusion: These findings suggested that increased serum VEGF levels subdue cavity formation in active pulmonary tuberculosis.
The Value of Small-Bore Catheter Thoracostomy in the Treatment of Malignant Pleural Effusions
Authors: Şahin Ünal , Ünlü Mehmet , Akkaya Ahmet , Örnek Zafer
Published: April 2003

Background: Malignant pleural effusions can cause severe debilitating symptoms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore catheters has been studied. Objectives: To assess the efficacy and safety of small-bore catheter (Pleuracan®) thoracostomy combined with talc sclerotherapy for palliative treatment of malignant pleural effusions. Methods:Between May 1998 and March 2000, 24 consecutive patients presenting at our inpatient clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurodesis was performed to assess the response rates. Results: Of the 24 patients included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not undergo 30-day postpleurodesis radiography. The remaining 19 patients made up the study group to assess the response rates (8 men, 11 women). Overall response rates of talc pleurodesis via small-bore catheter were found to be 84.2% [complete response (CR): 68.4%, partial response (PR): 15.8%] at 30-day and 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively. One patient reported moderate pain during catheter placement. Four patients experienced mild to moderate pleuritic chest pain, shortness of breath, or both within 4 h after instillation. Seven of the 22 patients (31.8%) had a transient fever (≤39.0°C) 6–24 h after talc instillation that lasted less than 24 h and was successfully treated with acetaminophen. One patient had significant subcutaneous emphysema that resolved in 24 h. Four patients died because of tumor progress (2 patients in the 1st month and 2 patients between 30 and 90 days). Conclusion:Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a ‘standard’ 16- to 24-french chest drain, should be performed.
Factors Influencing Improvement and Remission Rates after Thymectomy for Myasthenia gravis
Authors: de Perrot Marc , Licker Marc , Spiliopoulos Anastase
Published: April 2003

Background: Thymectomy has become an accepted option in the treatment of myasthenia gravis (MG). However, the optimal selection of patients for surgery remains controversial. Objective: The objective of the study is to define factors influencing improvement and remission rates after thymectomy for MG. Methods: We retrospectively reviewed our experience in the surgical management of patients with MG over the last 20 years, and analyzed if patient’s age, sex, preoperative Osserman Stage, thymic histology, duration of symptoms, or radiological findings influenced outcome. Results: There were 25 women and 10 men. Most of them presented with Osserman stage IIA (n = 12) and stage IIB (n = 17). Hyperplasia of the thymus was observed in 15 patients (43%), thymoma in 12 (34%), and atrophic or normal thymus in 8 (23%). Computed tomography (CT) had a positive predictive value of 91% in detecting thymoma and of 80% in detecting thymic hyperplasia. Over a mean follow-up of 96 months, MG improved markedly in 26 patients. Postoperative improvement was significantly greater in patients with advanced MG (stage IIB, III and IV), whereas a higher rate of remission occurred in patients with mild MG (stage I and IIA), and in those with thymic hyperplasia. No relation was observed between outcome and age, sex, duration of symptoms and abnormal CT findings. Conclusions: The beneficial effects of thymectomy are characterized by postoperative clinical improvement in most patients with moderate to severe preoperative myasthenic involvement and by a higher remission rate in patients with thymic hyperplasia and/or mild myasthenic symptoms.
Replacing the Last Week of a Motivational Inpatient Alcohol Withdrawal Programme by a Day-Clinic Setting
Authors: Reymann G. , Danziger H.J.
Published: April 2003

The impact on the motivation to treatment of a qualified alcohol withdrawal programme was evaluated in a pre/post setting. Over a period of 2 years we compared the results of replacing the last week of an inpatient setting by day-clinic treatment. In the first year, 202 patients were treated in a 3-week inpatient setting, whereas in the second year, 149 patients out of 212 (70.3%) changed into day-care for the third week. The total treatment period was nearly equal in both years (16.2–17.4 days) and the average costs of detoxication were reduced by 8%. The amount of irregular discharges (21.7 vs. 23.6%) was almost unchanged. As a severe disadvantage the overall rate of patients who agreed to enter a succeeding stringent long-term treatment regressed significantly from 45.0 to 34.4% (p < 0.05).
Understanding Heroin as a ‘Rational Addiction’
Authors: Bridges John F.P.
Published: April 2003

This paper makes some interpretations on the Becker and Murphy model of rational addiction so as to consider policy issues beyond the discussion of the effects of price on heroin consumption. Through the model of the rational heroin user, this paper argues that heroin use is a symptom of other factors. The focus of the analysis is placed on the negative life events that underpin heroin consumption. Thus, policy makers who want to stop heroin use may find it more effective to first stop the underlying problems that are the cause of the catalytic consumption of heroin use. It may prove better to promote other religious, family and educational activities than to actively discourage heroin use.
Sports Activities in the Prevention of Heroin Dependency
Authors: Okruhlica L. , Kaco J. , Klempova D.
Published: April 2003

The aim of this study was to find out more about the role played by sports activities in the prevention of illicit drug abuse. We administered a simple questionnaire to a group of 215 patients with heroin dependency. Their average age was 23 years (SD = 4.3, range 15–42); 163 (76%) of them were males and 52 (24%) females. Another group was formed by 231 student adolescents with a mean age of 15 years (SD = 1.0, range 14–18); 65 (28%) were males and 166 (72%) were females. One hundred and sixty-one (75%) of the heroin users and 169 (69%) of the students took part in regular physical training (at least two times weekly in a sport club) and competitive sports activities until the age of 15. Due to the fact that there was a statistically significant difference in the male/female ratio between the two groups, the comparison of males and females was done separately. There were no statistically significant differences between the males, nor between the females from these two groups in their histories of sports activities until the age of 15. Thirty-one (17%) of the patients started with illicit drug use prior to the termination of their sports activities.
Challenges and Approaches to Estimating Mortality Attributable to the Use of Selected Illicit Drugs
Authors: Warner-Smith Matthew , Lynskey Michael , Hall Wayne , Monteiro Maristela
Published: April 2003

A number of unique challenges are faced when attempting to estimate mortality attributable to illicit drugs. The hidden nature of illicit drug use creates difficulties in quantifying the prevalence of such use; identifying adverse health effects associated with exposure, and calculating the risk of these effects. The use of cohort studies of drug users allows the identification of causes of mortality associated with drug use and the determination of the risk of these causes. This risk estimate can then be used in conjunction with estimates of the prevalence of drug use to extrapolate the burden of mortality. We identify a number of such studies and present some solutions to the major challenges faced when attempting to estimate the global burden of mortality attributable to illicit drug use.
Negative Outcome Factors for Addicted Migrants
Authors: Haasen Christian , Yagdiran Oktay , Toprak Mehmet Ali
Published: April 2003

Several risk factors as well as protective factors are discussed in the development of mental disorders among migrants. With respect to addiction there are reports of an increased prevalence despite a higher threshold for utilisation of the treatment system. A case report is presented that exemplifies psychosocial and legal factors affecting the development and treatment possibilities of addicted migrants. It calls for a closer co-ordination between institutions and authorities in favour of the addicted individual.
Management of Renal Angiomyolipoma in Complex Clinical Situations
Authors: Khaitan A. , Hemal A.K. , Seth A. , Gupta N.P. , Gulati M.S. , Dogra P.N.
Published: April 2003

Renal angiomyolipoma (AML) is associated with complex clinical situations such as tumour in a solitary kidney, bilateral, large or multicentric tumours or those associated with tuberous sclerosis (TS) or pregnancy. Management in these situations may be challenging. Fifteen patients (20 kidneys) were admitted with symptomatic AML over last 10 years. Eleven patients had one or the other complicating factor. Ten patients had a tumour of >10 cm, 4 had TS, 5 had multiple and bilateral tumours, 1 patient was pregnant and 1 had a solitary functioning kidney. With the newer imaging modalities correct diagnosis was possible in 12 cases and renal cell carcinoma (RCC) was suspected in 3 cases. Selective angioembolization (SAE) was done in 3 patients, which successfully controlled bleeding in all. Nephron-sparing surgery (NSS) was performed in 5 patients. Total nephrectomy was done in 4 cases, in 3 due to suspicion of RCC and in 1 due to extensive involvement of the kidney. Three patients with multiple and bilateral tumours were chosen for conservative treatment and none developed recurrence of bleeding on strict follow-up. In a pregnant patient, bleeding was successfully controlled with angioembolization. However, 1 patient with a solitary functioning kidney with large-sized tumour (20 × 18 cm) underwent NSS. In conclusion, the basis of management of AML is preservation of renal tissue, which can be effectively achieved with SAE or NSS. In a solitary functioning kidney, NSS or SAE is the ideal treatment, if feasible. The patients in the TS group are usually more complicated and require life-long follow-up after initial management with NSS or SAE. Pregnant AML patients can be safely managed with SAE. Conservative treatment without any intervention and regular follow-up may be more helpful in some patients with multiple, bilateral extensive tumours.
Urinary Composition and Lithogenic Risk in Normal Subjects following Oligomineral versus Bicarbonate-Alkaline High Calcium Mineral Water Intake
Authors: Coen Giorgio , Sardella Daniela , Barbera Giovanni , Ferrannini Michele , Comegna Carmela , Ferazzoli Flora , Dinnella Angela , D’Anello Emanuela , Simeoni Piergiorgio
Published: April 2003

Objective: A normal dietary calcium intake to reduce intestinal oxalate absorption is essential to avoid recurrence of calcium oxalate stone formation. It is also important in the prevention of osteopenia in idiopathic hypercalciuria. The calcium content of waters used for hydration may vary from very low to relatively high and is an important factor in prevention or additional risk of stone formation. Therefore, the effect of drinking mineral waters of different calcium concentrations on lithogenic risk factors was studied in normal volunteers. Materials and Methods: Normal subjects were divided into two groups of 11 and 10 individuals each. All followed a prescribed diet with an average calcium content of 800 mg/day. The water intake for hydration consisted of 2 liters of an oligomineral water with a low calcium content, <20 mg/l (group A) or of a bicarbonate alkaline water with a high calcium content, 370 mg/l (group B). Results: Diuresis increased similarly in both groups; urine calcium increased by about 80 mg/day in group B. A rise in urine oxalate was observed in both groups, along with the increased urine volume. Osmolar excretion increased in group B; urine osmolality decreased significantly only in group A. In spite of the increase in calciuria in group B, Ca/citrate ratio was constant, due to an increase in citrate excretion. Inter-group differences in terms of activity products of calcium phosphate, calculated according with Tiselius’s methods, were found. The differences in AP(CaP) index 1 and AP(CaP) index 2 were significant, with higher values in group B, who drank the bicarbonate alkaline mineral water. Conclusions: Increased water intake between meals to prevent renal stone recurrence should preferably be achieved with a relatively low calcium water and calcium-rich mineral waters should be avoided.
Are Adverse Effects of Sildenafil also Caused by Inhibition of Diamine Oxidase?
Authors: Wantke F. , Hemmer W. , Focke M. , Stackl W. , Götz M. , Jarisch R.
Published: April 2003

Background: Sildenafil citrate (Viagra), a drug used to treat erectile dysfunctions, causes adverse reactions such as headache, flushing or nasal congestion. Sildanefil’s potency as inhibitor of diamine oxidase was investigated, as side effects may also be induced by histamine itself due to an impaired histamine metabolism. Methods: Placental diamine oxidase inhibition experiments were performed with consecutive dilutions of sildenafil citrate (10–5 to 10–9 mol/l). In 9 male volunteers in vivo diamine oxidase inhibition was investigated after taking 100 mg sildenafil (Viagra). Results: Sildenafil citrate did not inhibit placental diamine oxidase either in vitro or in vivo. However, infusion of 300 mg of cimetidine inhibited diamine oxidase activity by 27 ± 7% 15 min after infusion, demonstrating that drugs may inhibit diamine oxidase in vivo. Conclusion: As side effects of sildenafil are not caused due to inhibition of diamine oxidase, sildenafil citrate seems to be harmless for patients suffering from histamine intolerance.
Supramaximal Stimuli Do Not Evoke a Maximal Contraction in Urinary Bladder Smooth Muscle Fibers
Authors: Minekus Joanne , Visser Anna J. , van Mastrigt Ron
Published: April 2003

Background: Smooth muscle fibers can be stimulated with an electrical field, high potassium or carbachol. We studied the effect of combined, supramaximal stimulation on the isometric force and the maximum shortening velocity of the pig urinary bladder. Materials and Methods: After determining the dose response curve of each stimulation type, we stimulated 8 fibers with cumulative addition of supramaximal stimuli. Results: The isometric force elicited with either potassium, carbachol or electrical field stimulation alone was the same for each stimulus. After addition of a second or third different supramaximal stimulus, the force further increased to a value that was on average 40% higher. Conclusions: Carbachol, high potassium or electrical field stimulation work through different stimulation pathways. Maximum stimulation with one of the stimuli does not result in a maximum isometric force development and maximum shortening velocity.
Multidisciplinary Treatment of Advanced Testicular Tumor with Bulky Liver Metastasis
Authors: Minowada Shigeru , Okano Yoshinori , Miyazaki Jun , Homma Yukio , Kitamura Tadaichi
Published: April 2003

A 21-year-old man with far-advanced nonseminomatous germ cell tumor of the left testis is presented. He had multiple bulky metastases in the liver and retroperitoneum with an extraordinarily elevated serum α-fetoprotein (23,500 ng/ml). He received multidisciplinary treatment consisting of systemic chemotherapy, cytoreductive left hepatic lobectomy, percutaneous ablation therapy, transarterial chemoembolization, and external beam irradiation for median segments of the liver. The efficient combination treatment normalized the tumor markers within 6 months and has maintained complete serological remission for 4.7 years.
Imperative Indications for Conservative Surgery for Renal Cell Carcinoma: 20 Years’ Experience
Authors: Gacci M. , Rizzo M. , Lapini A. , Serni S. , Stefanucci S. , Carini M.
Published: April 2003

Introduction: Radical nephrectomy is the treatment of first choice for unilateral renal cell carcinoma (RCC) with a healthy contralateral kidney; however, the current standard for dealing with RCC in patients with a solitary kidney, bilateral tumor and renal or systemic disease inducing a progressive impairment of renal function is nephron-sparing surgery. Materials and Methods: Between January 1974 and July 1996, 62 patients (39 men and 23 women, 33–77 years old, mean age 60.6 years) with RCC underwent nephron-sparing surgery. The patients were divided in to two groups according to treatment indication: 46 patients with bilateral tumor (n = 21) or solitary kidney (n = 25) and 16 patients with renal or systemic disease that could damage the contralateral kidney. Survival curves were calculated according to the Kaplan-Meyer method. Results: In the first group 3 patients died postoperatively, and 3 were lost to follow-up; 12 patients (27.9%) had malignant recurrence and 5 (11.6%) died of local recurrence or systemic diffusion. The probability of local or systemic tumor recurrence was 9.9% at 2 years, 20.2% at 5 years and 24.7% at 10 years; the probability of survival was 100% at 2 years, 91.9% at 5 years and 81.9% at 10 years. In the second group 3 patients died of unrelated causes and 1 was lost to follow-up; 4 patients (25%) had a malignant recurrence and 2 (12.5%) died of systemic diffusion of RCC. The probability of tumor recurrence was 13.0% at 2 years, 19.7% at 5 years and 26.4% at 10 years, the probability of survival was 100% at 2 years, 93.3% at 5 years and 86.1% at 10 years. Conclusions: In our experience nephron-sparing surgery seems justified in patients with a solitary kidney, bilateral tumor or a disease that potentially damages renal function. Tumor diameter and stage, incidental or symptomatic tumor presentation and specific indication for conservative surgery determine the prognosis.