bluuebunny/crossref_metadata_2025 huggingface dataset:
Gallbladder cancer in northern Jordan
Authors: BANI‐HANI KAMAL E , YAGHAN RAMI J , MATALKA ISMAIL I , SHATNAWI NAWAF J
Published: July 2003

Background and Aim:  To highlight the epidemiological, clinical, and pathological features of gallbladder cancer in Jordan as a model for the Middle East. Only scattered reports are available from this region.

Methods:  The histopathological reports and the hospital records for all cholecystectomies performed at Princess Basma Teaching Hospital between 1994–2000 were retrospectively reviewed to identify all patients with gallbladder carcinoma. All the histological slides for the cancer group were reviewed and reclassified by a single pathologist.

Results:  Of 4502 cholecystectomies performed, 33 cases (0.73%) of gallbladder carcinoma were found. The mean age was 61.4 years (range 39–80 years). The male : female ratio was 1 : 3.7. Biliary colic and/or acute cholecystitis were the main presentations. Gallstones were present in 88% (29/33) of the patients. The spectrum of histological subtypes was similar to other series. Only three cases were diagnosed preoperatively, making the incidence of incidental gallbladder cancer 0.66% (30/4502). Simple cholecystectomy was performed for 13 patients. The remaining 20 patients underwent cholecystectomy and portal lymphadenectomy with (five cases) or without (15 cases) extrahepatic resection of the bile ducts. The mean follow up was 22 months (SD ± 18.95 months; range 1–96 months). The 2‐year survival rates for stages I, II, III, and IV were 100%, 42.9%, 10.8%, and 0%, respectively (P = 0.0013).

Conclusions:  The importance of a high index of suspicion when dealing with cholelithiasis in elderly patients, particularly with large sized stones, cannot be over‐emphasized. Proper gross inspection in the theater should be a routine procedure performed by all surgeons. Routine ultrasound for suspected gallbladder stones should always be performed under the supervision of senior radiologists.
Simplified acute physiology score II: A valid role in the assessment of patients with medically refractory upper gastrointestinal bleeding?
Authors: HURLSTONE DAVID P , SANDERS DAVID S , CARTER MARTIN J , GOODMAN‐JONES BETHAN , BATTEN JANE , JOHNSON ALAN G , LOBO ALAN J
Published: July 2003

Background and Aim:  Medically refractory upper gastrointestinal hemorrhage (UGIH) is a complex clinical problem. Selection of patients suitable for surgery is difficult and often involves subjective clinical judgment. The simplified acute physiology score (SAPS) II is a validated predictor of mortality in the intensive care setting. Our aim was to assess the SAPS II score in patients with medically refractory UGIH who were referred for a surgical opinion. Patients were subsequently classed as ‘accepted’ or ‘declined’ for surgery and SAPS II scores were compared between these two groups.

Methods:  From July 1996 to July 1999, patients referred for surgical intervention with UGIH were included (varices excluded). The SAPS II was calculated at the time of surgical referral. This was converted into a mortality probability using multiple regression analysis. Clinical outcome was defined as either survival to discharge or death while an inpatient.

Results:  Ninety‐nine patients were referred for surgical review. Sixty‐five patients were accepted for surgery and 34 were declined. The mean SAPS II score for those who were accepted was 31.7 (mortality probability 0.16, actual mortality 15.4%, 10/65) and 30.2 (mortality probability 0.15, actual mortality 29.4%, 10/34) for those who were declined.

Conclusion:  The SAPS II scores were no different between the two groups. Observed mortality was consistent with mortality predicted in the operated group but twice that predicted in those where surgical intervention was declined. This suggests that clinical selection criteria for patients undergoing surgery for UGIH are inconsistent.
Acute pancreatitis associated with biliary disease in children
Authors: CHOI BO HWA , LIM YEAN JUNG , YOON CHONG HYUN , KIM ELLEN AI‐RAN , PARK YOUNG SEO , KIM KYUNG MO
Published: July 2003

Background and Aims:  Biliary disease is one of the most common causes of acute pancreatitis in adults; however, this cause and outcome in children have rarely been described in the literature. Therefore, the present study was conducted to evaluate the role of biliary disease as a cause of acute pancreatitis in children.

Methods:  The present study included 56 children with acute pancreatitis, of which 16 (29%) cases were associated with biliary disease. The 16 cases consisted of four boys and 12 girls ranging in age from 2 to 13 years. The underlying causes of the biliary disease were evaluated, as well as its clinical presentations, management modalities, and outcomes.

Results:  The causes of biliary disease in the 16 children included choledochal cyst in seven, biliary sludge in six, gallstone in two, and anomalous pancreaticobiliary junction in one. Acute pancreatitis with biliary disease showed increased presentation of jaundice and abnormalities in a liver‐function test. Therapeutic interventions were performed more frequently in acute pancreatitis associated with biliary disease. All seven children with choledochal cysts needed hepaticojejunostomy. Of eight children with biliary sludge or gallstones, five children remained free of and two suffered from repeated attacks of pancreatitis after endoscopic papillotomy. Mortality did not occur.

Conclusion:  The present study suggests that biliary disease can be one of the causes of acute pancreatitis in children and has the clinical characteristics of jaundice and/or abnormalities in a liver‐function test. Appropriate therapeutic interventions should be considered as the treatment modality.
Recent increase in antibiotic‐resistant microorganisms in patients with spontaneous bacterial peritonitis adversely affects the clinical outcome in Korea
Authors: PARK YOUNG HWAN , LEE HAN CHU , SONG HEE GON , JUNG SAERA , RYU SOO HYUNG , SHIN JUNG WOO , CHUNG YOUNG‐HWA , LEE YUNG SANG , SUH DONG JIN
Published: July 2003

Background and Aim:  Recently, antibiotic‐resistant microorganisms have been increasingly noted in Korean patients with spontaneous bacterial peritonitis (SBP). The present study investigated the changing pattern of antibiotic resistance and its effects on the clinical outcome in treating SBP.

Methods:  The present study retrospectively analyzed 87 episodes of SBP in 1995, 222 in 1998, and 271 in 1999. The isolated microorganisms and their antibiotic susceptibility were compared, and prognostic factors for survival were analyzed.

Results:  Microorganisms were isolated in 41% of total episodes. The three most frequently isolated organisms were Escherichia coli (48%), Klebsiella pneumoniae (15%), and Aeromonas (8%). Strains that were resistant to cefotaxime in Gram‐negative bacilli significantly increased from 7% in 1995 to 28% in 1999, and those to ciprofloxacin increased from 10% to 32%. Treatment failure also increased from 6% to 23%. Combined hepatocellular carcinoma and SBP caused by extended‐spectrum β‐lactamase‐producing strains were two independent prognostic factors for survival.

Conclusion:  Considering the increase in antibiotic‐resistant microorganisms related to SBP, measures to prevent the in‐hospital spread of resistant strains and the indiscriminate use of antibiotics should be instituted more stringently.
Balloon‐occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension
Authors: MIYAMOTO YASUNAO , OHO KAZUHIKO , KUMAMOTO MASAFUMI , TOYONAGA ATSUSHI , SATA MICHIO
Published: July 2003

Background and Aim:  Balloon‐occluded retrograde transvenous obliteration (B‐RTO) is a novel therapeutic method for the treatment of large gastric fundal varices with spontaneous splenorenal shunt (SRS). However, the effects of B‐RTO on liver function remain unknown.

Methods:  Fourteen patients with portal hypertension and gastric varices with SRS were studied, consisting of four patients with acute bleeding, five with high‐risk varices, and five with refractory portosystemic encephalopathy. Hepatic venous catheterization was performed to evaluate hepatic blood flow and liver function using the continuous indocyanine green (ICG) infusion method. To assess the metabolic activity of the hepatocyte, the intrinsic clearance of ICG was calculated. In all patients, endoscopic study was performed before and 1 week and 1 month after the B‐RTO, and followed every 6 months thereafter. After baseline measurements, B‐RTO was performed. Four weeks after the B‐RTO, the same catheter measurements were repeated.

Results:  The B‐RTO was successful in all patients. Contrast‐enhanced computed tomography showed complete obliteration of the SRS prior to the follow‐up measurements. Endoscopic eradication of the fundal varices was obtained 6 months after B‐RTO in all patients and encephalopathy was improved within 1 week after B‐RTO. Following the B‐RTO, hepatic blood flow (441 ± 214 vs 668 ± 299 mL/min, P < 0.0001) and the intrinsic clearance of ICG (233 ± 123 vs 285 ± 148 mL/min, P < 0.05) were significantly increased. Furthermore, intrahepatic resistance decreased after the B‐RTO (P < 0.005).

Conclusion:  From short‐term assessment, B‐RTO increases hepatic blood flow and improves the metabolic activity of the liver in patients with portal hypertension.
Combined passive and active immunoprophylaxis for preventing perinatal transmission of the hepatitis B virus carrier state in Shizuoka, Japan during 1980–1994
Authors: NOTO HIROSHI , TERAO TOSHIHIKO , RYOU SHIGEO , HIROSE YASUYUKI , YOSHIDA TAKAMI , OOKUBO HIDEO , MITO HIDETOSHI , YOSHIZAWA HIROSHI ,   FOR THE SPECIAL COMMITTEE FOR PREVENTING HEPATITIS B IN SHIZUOKA
Published: July 2003

Background:  Efficacy and limits in preventing perinatal infection with hepatitis B virus (HBV) have been examined in a model area in Japan.

Methods:  In Shizuoka (population of 3.6 million), immunoprophylaxis of perinatal HBV infection was started in 1980 in four institutions (Hamamatsu Medical College, Shimada City Hospital, Shizuoka Kodomo Hospital and Numazu City Hospital). Babies born to carrier mothers with hepatitis B e antigen (HBeAg) in serum received hepatitis B immune globulins at birth and 2 months thereafter and vaccines at 2, 3 and 5 months after birth.

Results:  Overall, 980 of the 1030 babies born to HBeAg‐positive carrier mothers were protected by the immunoprophylaxis during the 15 years from 1980 to 1994 with an efficacy of 95.1%. From 1986 to 1994 while the national immunoprophylaxis was conducted, 329 674 of the 346 637 (95.1%) expectant mothers were tested, and 2081 (0.63%) of them were positive for hepatitis B surface antigen (HBsAg). The immunoprophylaxis was given only to babies born to 764 (36.7%) of the 2081 mothers who tested positive for HBeAg. Of the 494 babies receiving immunoprophylaxis, in whom HBsAg was followed monthly after birth, 462 (93.5%) were protected. The HBV carrier state developed in the remaining 32 (6.5%) babies, 10 of whom (31.3% of the 32) turned positive for HBsAg within 1 month after birth, most likely owing to infection in utero.

Conclusions:  Passive–active immunoprophylasxis of high‐risk babies was highly efficacious in preventing perinatal transmission of the HBV carrier state. Most failures (approximately 70%) occurred in the high‐risk babies who were exposed to HBV after birth, and would have been avoided by careful and extensive execution of the immunoprophylaxis.
Pleuropulmonary complications of esophageal variceal sclerotherapy with absolute alcohol
Authors: SETHY PRADEEPTA K , KOCHHAR RAKESH , BEHERA DIGAMBAR , BHASIN DEEPAK K , RAJA KAISER , SINGH KARTAR
Published: July 2003

Background:  Esophageal variceal sclerotherapy (EVS) is an effective means of controlling variceal hemorrhage. However, it causes a wide variety of local and systemic complications. The present study was performed to document pleuropulmonary complications of EVS with absolute alcohol.

Methods:  Twenty‐six patients of portal hypertension of different etiologies were subjected to EVS with absolute alcohol. Baseline arterial blood gas analysis (PaO2, PaCO2, pH, HCO3, SaO2), chest X‐ray and pulmonary function tests (forced expiratory volume at 1 s (FEV1), forced expiratory vital capacity (FVC), FEV1/FVC, maximum mid‐expiratory flow rate (MMFR), and peak expiratory flow rate (PEFR)) were performed 4–6 h before the first session of EVS. These investigations were repeated within 24 h of EVS. Patients were asked to maintain a symptom diary and to record symptoms such as fever, chest pain, dysphagia and dyspnea during the study period.

Results:  Ten patients (38.46%) had chest pain and four patients (15.68%) had fever after sclerotherapy. Eight patients (30.54%) complained of dyspnea and six patients (23.08%) developed pleural effusion. There was a significant decline in FVC and FEV1 after EVS as compared with baseline values. However, FEV1/FVC ratio, MMFR and PEFR did not have any significant change.

Conclusions:  Chest pain (38.46%), dyspnea (30.54%) and fever (15.68%) were the common symptoms after EVS while chest X‐ray showed pleural effusion in 23.08%. Pulmonary function tests revealed a significant decline in FEV1 and FVC without change in FEV1/FVC ratio after EVS, suggesting a restrictive type of defect.
Expression of adhesion molecules in the rectum‐associated lymph nodules of pre‐ and postnatal specific pathogen‐free rats
Authors: ICHIKAWA SANAE , YAMASHITA AKIRA
Published: July 2003

Background and Aim:  The developmental process of lymphoid tissues in the gastrointestinal tract is still unclear. The aim of the present study was to explore the expression of adhesion molecule in rectum‐associated lymph nodules (RALN) of specific pathogen‐free (SPF) rats at fetal and early postnatal periods of development.

Methods:  Immunohistochemical analysis was carried out of select adhesion molecules and lymphocyte subsets in lymph nodules of the rat rectal region.

Results:  Mucosal addressin cell adhesion molecule (MAdCAM)‐1 expression was detected in the colonic mucosa on day 16 of gestation. Expression was strong in endothelial cells of all blood vessels in the entire colonic mucosa until day 7 after birth. On day 10 after birth, MAdCAM‐1 was strongly expressed and confined to the high endothelial venule (HEV) in the submucosa of RALN, and was rarely detected in the blood vessels other than the HEV. In contrast, intercellular adhesion molecule (ICAM)‐1 expression was absent in fetal colonic mucosa but appeared just after birth. Only a very small number of lymphocyte‐function associated antigen (LFA)‐1‐positive cells appeared in the mucosa on day 16 of gestation but by day 19 of gestation a large number of these cells had rapidly aggregated in the mucosa of the ante‐mesenteric side of the developing colon. These cells also expressed interleukin‐7 receptor (IL‐7R), and some were positive for CD4 and Mar‐1 markers.

Conclusion:  The region of RALN undergoes rapid and dynamic changes in adhesion molecule expression during gestation, which may regulate interactions with intestine‐associated immune cells shortly after birth.
Interleukin‐18 overproduction exacerbates the development of colitis with markedly infiltrated macrophages in interleukin‐18 transgenic mice
Authors: ISHIKURA TAKAHIRO , KANAI TAKANORI , URAUSHIHARA KOJI , IIYAMA RYOICHI , MAKITA SHIN , TOTSUKA TERUJI , YAMAZAKI MOTOMI , SAWADA TAISUKE , NAKAMURA TETSUYA , MIYATA TATSUYA , KITAHORA TETSUJI , HIBI TOSHIFUMI , HOSHINO TOMOAKI , WATANABE MAMORU
Published: July 2003

Background and Aim:  The authors have previously shown that production of interleukin (IL)‐18 was increased in the inflamed mucosa of patients with Crohn's disease (CD) and blockade of IL‐18 ameliorated the murine model of CD. This demonstrated that IL‐18 plays a significant role during intestinal inflammation. However, the initial role of IL‐18 during intestinal inflammation was unclear; therefore the susceptibility of IL‐18 transgenic (Tg) mice to acute dextran sulfate sodium (DSS)‐induced colitis was examined.

Methods:  Interleukin‐18 Tg and wild‐type (WT) mice were fed 2.0% of DSS for 8 days. The total clinical scores (bodyweight loss, stool consistency, and rectal bleeding), colon length and histological scores were assessed. The expressions of surface markers and IL‐18 on infiltrating lamina propria mononuclear cells were analyzed immunohistochemistrically. Mesenteric lymph node (MLN) cells were isolated and the expressions of CD4+ T‐cell activation markers (CD69, CD25 and IL18R) were analyzed by flow cytometry.

Results:  The IL‐18 Tg mice exhibited an increased susceptibility to DSS‐induced colitis, as shown by significantly increased clinical, histological scores, and more severe colonic shortening compared with WT mice. Immunohistochemical analysis revealed a significant increase of IL‐18 production and CD11b+ macrophages but not CD4+ T cells in the inflamed mucosa in DSS‐fed IL‐18 Tg compared with DSS‐fed WT mice. Furthermore, MLN cells revealed no evidence of increased CD4+ T‐cell activation in DSS‐fed IL‐18 Tg.

Conclusions:  These findings suggest that IL‐18 overproduction in the mucosa plays an important role in the marked infiltration of macrophages and exacerbates colitis in IL‐18 Tg mice.
Lactoferrin sequestration and its contribution to iron‐deficiency anemia in Helicobacter pylori‐infected gastric mucosa
Authors: CHOE YON HO , OH YOO JOUNG , LEE NA GYONG , IMOTO ICHIRO , ADACHI YUKIHIKO , TOYODA NAGAHITO , GABAZZA ESTEBAN C
Published: July 2003

Background and Aim:  It is known that lactoferrin serves as a source of iron for Helicobacter pylori in gastric mucosa. The present study was undertaken to investigate the relationship between lactoferrin and H. pylori infection coexistent with iron‐deficiency anemia by determining the lactoferrin levels in gastric biopsy specimens, and by locating the major sites of lactoferrin expression, according to the presence or absence of iron‐deficiency anemia.

Methods:  One hundred and one adolescents who underwent gastroduodenoscopy were divided into four groups: controls without H. pylori infection (NL; n =43); patients with H. pylori infection (HP; n = 26); patients with iron‐deficiency anemia (IDA; n = 6); and patients with H. pylori gastritis and coexisting iron‐deficiency anemia (HPIDA; n = 26). The gastric mucosal levels of lactoferrin were measured by immunoassay. Immunohistochemical technique was used to allow identification of the location and quantification of the lactoferrin expression.

Results:  The mucosal level of lactoferrin was highest (3.93 ± 2.73 ng/µg protein) in HPIDA, followed by 2.67 ± 1.79 ng/µg protein in HP, 0.59 ± 0.57 ng/µg protein in NL and 0.14 ± 0.10 ng/µg protein in IDA. Their multiple comparisons were statistically significant at the 0.05 level. After the eradication of H. pylori in 12 HPIDA patients who underwent follow‐up endoscopy, the mean mucosal level of lactoferrin decreased significantly, while the blood hemoglobin level correspondingly increased. The major sites of lactoferrin expression by immunohistochemistry were in glands and neutrophils within epithelium. Lactoferrin was stained weakly in NL and IDA, and strongly in HP and HPIDA.

Conclusion:  The lactoferrin sequestration in the gastric mucosa of HPIDA was remarkable, and this finding seems to give a clue that leads to the clarification of the mechanism by which H. pylori infection contributes to iron‐deficiency anemia.
Lactobacillus gasseri OLL2716 as a probiotic in clarithromycin‐resistant Helicobacter pylori infection
Authors: USHIYAMA ATSUSHI , TANAKA KAZUO , AIBA YUJI , SHIBA TADAHIKO , TAKAGI ATSUSHI , MINE TETSUYA , KOGA YASUHIRO
Published: July 2003

Backgrounds and Aim:  Clarithromycin (CAM)‐resistant Helicobacter pylori sometimes offers serious problems with eradication by antibiotics. The aim of this study was to determine whether a probiotic can be an alternative therapy in CAM‐resistant Hp infection.

Methods:  The effects of Lactobacillus gasseri (strain OLL2716) on the growth of CAM‐susceptible and CAM‐resistant H. pylori and interleukin (IL)‐8 production provoked by these strains were examined by in vitro experiments. Moreover, mice were infected with these CAM‐susceptible or CAM‐resistant H. pylori, and were treated with CAM or L. gasseri.

Results:  In vitro experiments demonstrated that L. gasseri inhibited the growth of H. pylori and suppressed H. pylori‐associated IL‐8 production. Such effects were noted in CAM‐resistant and CAM‐susceptible H. pylori. Similarly, in an in vivo model of H. pylori infection, H. pylori colonization was significantly decreased by L. gasseri.

Conclusion:  Therefore, L. gasseri was found to act as a probiotic in CAM‐resistant H. pylori infection.
“Hands‐Free” Continuous Transthoracic Monitoring of Pericardiocentesis Using a Novel Ultrasound Transducer
Authors: Chandraratna P.A.N. , Vijayasekaran Sridhar , Brar Prabhjoyt , Tzeng John
Published: July 2003

Background: Pericardiocentesis can be monitored with a hand‐held transducer. The purpose of this study was to assess the feasibility of monitoring pericardiocentesis using a novel ultrasound transducer, which can be attached to the chest wall, developed in our laboratory (CONTISON). Methods: We studied nine patients with large pericardial effusions. The 2.5‐MHz transducer is spherical in its distal part and mounted in an external housing to permit steering in 360 degrees. The external housing is attached to the chest wall using an adhesive patch. The CONTISON transducer was placed at the cardiac apex and an apical four‐chamber view obtained. Pericardiocentesis was performed from the subcostal position. The pericardial effusion was continuously imaged. Mitral inflow velocity signals were recorded before and after pericardiocentesis. When fluid was first obtained, 50 mL of fluid were discarded after which 5 mL of agitated saline was injected through the needle. Results: In the first patient the pericardiocentesis needle was seen in the left ventricular cavity. Saline injection produced a contrast effect in the left ventricle. The needle was gradually withdrawn until contrast was seen in the pericardial sac. A total of 1100 mL was removed without further complications. The second patient had clear fluid followed by blood stained aspirate. The echocardiogram revealed gradual appearance of granular echoes within the pericardial sac, suggestive of intrapericardial clot that was subsequently surgically evacuated. In the remaining seven patients, agitated saline produced a contrast effect in the pericardial sac indicative of proper needle position. Mitral flow velocity paradoxus was noted in five patients, and it resolved after pericardiocentesis in four patients. No adjustment of the transducer was required. Conclusion: The CONTISON transducer permitted continuous monitoring of pericardiocentesis. This technique could potentially facilitate pericardiocentesis. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Novel Approach to Measure Myocardial Performance Index: Pulsed‐Wave Tissue Doppler Echocardiography
Authors: Tekten Tarkan , Onbasili Alper O. , Ceyhan Ceyhun , Ünal Selim , Discigil Berent
Published: July 2003

A simple, reproducible, noninvasive myocardial performance index (MPI) for the assessment of overall cardiac function has been described previously. The purpose of this study was to compare the MPI obtained by pulse Doppler method with the MPI obtained by tissue Doppler echocardiography (TDE) in normal subjects and patients with dilated cardiomyopathy (DCMP). Fifteen patients with DCMP and 15 healthy subjects were included. In order to calculate MPI by TDE, isovolumetric contraction (IVCT), relaxation time (IVRT), and ejection time (ET) were measured at two different sites of mitral annulus: septum and lateral. MPI was calculated by dividing the sum of IVCT and IVRT by ET at each site of measurement. The mean MPI value was found by dividing the sum of these MPI values into two. The same parameters were measured using the mitral inflow and left ventricular outflow velocity time intervals in pulsed Doppler method. At all sites measured, MPI by TDE correlated well with conventional MPI both in healthy subjects and patients with DCMP. The highest correlation was observed in mean values of MPI by TDE:

r = 0.94, P < 0.0001

in healthy subjects; and

r = 0.95, P < 0.0001

in patients with DCMP. In conclusion, this study clearly demonstrated that MPI could be measured by TDE and it correlated well with conventional MPI in normal and diseased heart. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Detection of Resting Myocardial Perfusion Defects by SonoVue® Myocardial Contrast Echocardiography
Authors: Nahar Tamanna , Li Peng , Kuersten Bettina , Batra Sanjay , Vannan Mani A.
Published: July 2003

Background: SonoVue® is a new microbubble contrast agent containing sulfur hexafluoride. We assessed the efficacy of SonoVue® myocardial contrast echocardiography (MCE) to detect resting perfusion abnormalities. Methods: Nineteen adult patients with a wall motion abnormality in a screening echocardiogram were studied. Each patient received up to four bolus injections of 2.0 mL SonoVue® (Bracco Diagnostics, Inc.) during echocardiographic examination using either B‐mode

(n = 12)

or power Doppler

(n = 7)

imaging. Each patient also had SPECT nuclear perfusion imaging performed. Segmental assessment of myocardial perfusion from SonoVue® MCE images were compared with corresponding SPECT nuclear images. Results: Using B‐mode imaging, the mean number of views obtained with a single SonoVue® injection ranged from 1.4 to 1.9, with 2 or 3 injections required for a complete examination. Ninety‐four percent of segments were scored as diagnostic. Agreement between B‐mode and SPECT images was 72% for segments with a perfusion defect, 86% for normal perfusion, and 80% for segments with either perfusion defect or normal perfusion (all views combined). Using power Doppler imaging, the mean number of views obtained with a single SonoVue® injection ranged from 1.0 to 1.3, with 2 to 4 injections required for a complete examination. Sixty‐eight percent of segments were scored as diagnostic. Agreement between power Doppler and SPECT images was 67% for perfusion defects, 53% for segments with normal perfusion, and 59% for segments with either perfusion defect or normal perfusion (all views combined). Conclusions: SonoVue® MCE has the potential to assess myocardial perfusion at rest. B‐mode imaging was more accurate than power Doppler imaging when compared with SPECT nuclear imaging. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Physiologic Assessment of Left Anterior Descending Coronary Artery Stenosis by Quantitative Intravenous Myocardial Contrast Echocardiography in Humans: Comparison With Exercise Single‐Photon Emission Computed Tomography
Authors: Fukuda Shota , Muro Takashi , Hozumi Takeshi , Watanabe Hiroyuki , Yamagishi Hiroyuki , Yoshiyama Minoru , Takeuchi Kazuhide , Yoshikawa Junichi
Published: July 2003

Objective: To clarify the potential of quantitative intravenous myocardial contrast echocardiography (MCE) for physiologic assessment of the left anterior descending artery (LAD) stenosis. Methods: We studied 38 patients with suspected coronary artery disease. MCE was performed by continuous infusion of Levovist and intermittent ultrasonic exposure. Images were obtained from the apical four‐chamber view at rest and after dipyridamole infusion. The background‐subtracted intensity versus pulsing interval plots were fitted to an exponential function,

Y=A(1 e−ß)
, to obtain the plateau level (A) and rate of rise (ß) of background‐subtracted intensity both at rest and after dipyridamole infusion. We compared the results with those of exercise thallium‐201 single‐photon emission computed tomography (SPECT). Results: Of the 38 patients, 18 patients exhibited redistribution in the LAD territories with SPECT (group A), although 20 did not (group B). The ß reserve (DIP/rest) in group A was significantly lower than those in group B (

0.8 ± 0.5

versus

2.0 ± 1.1, P < 0.001

), while the A reserve did not differ between the two groups (

1.2 ± 0.6

versus

1.0 ± 0.5, P = NS

). The ß reserve <1.1, which was the optimal cutoff value, provided sensitivity of 79% and specificity of 84% for the presence of redistribution in SPECT. Conclusions: Quantitative intravenous MCE allows us to estimate physiologic severity of the LAD stenosis in the clinical setting. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Intravenous Myocardial Contrast Echocardiography During Angioplasty
Authors: Hagendorff A. , Goeckritz A. , Neugebauer A. , Rother T. , Pfeiffer D. , Becher H.
Published: July 2003

Myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI) has been reported to document regional myocardial perfusion. Two case reports demonstrate the potential of intravenous myocardial contrast echocardiography during angioplasty. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Avoiding the Left Internal Mammary Artery During Anterior Pericardiocentesis
Authors: Kronzon Itzhak , Glassman Lawrence R. , Tunick Paul A.
Published: July 2003

In patients with pericardial effusions who require anterior pericardiocentesis, it is important to avoid trauma to the left internal mammary artery. Such trauma could result in severe bleeding or tamponade. This article describes how the left internal mammary artery may be identified by duplex ultrasound, and therefore avoided. It is also important to ensure that the needle stick is just lateral to the artery, to avoid hitting the left lung. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Large Thrombus at the Site of Primary Sutured Atrial Septal Defect Associated With Pulmonary Embolism and Treatment by Thrombolysis
Authors: Dinckal M. Hakan , Davutoglu Vedat , Soydinc Serdar , Akdemir Ilyas , Aksoy Mehmet
Published: July 2003

A 53‐year‐old man with a history of repair of atrial septal defect 3‐months ago by primary suture was admitted to an emergency department with sudden onset chest pain and dyspnea. Transthoracic echocardiography revealed a large and mobile thrombus attached to the right side of the interatrial septum. The chest X ray and perfusion lung scan established the diagnosis of the multiple pulmonary emboli. Doppler examination of the venous system for a possible source of thrombus was unremarkable. The postoperative early appearance of thrombus and multiple pulmonary emboli defects at lung scan supported that thrombus was originated from the primary suture site. Thrombolytic treatment achieved complete resolution of the thrombus both in the pulmonary artery and at the repaired septal defect site. The patient was placed on warfarin and thrombus was not detected by transesophageal echocardiography at the 9‐month follow‐up. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Real‐Time Perfusion Imaging: A New Echocardiographic Technique for Simultaneous Evaluation of Myocardial Perfusion and Contraction
Authors: Sieswerda Gertjan T. , Yang Li , Boo Mirjam Bakker‐de , Kamp Otto
Published: July 2003

Myocardial contrast echocardiography (MCE) with high acoustic energy and triggered harmonic imaging is the best established ultrasound technique to date for the assessment of myocardial perfusion. With this technique, however, the ultimate goal of MCE (noninvasive real‐time simultaneous assessment of myocardial perfusion and function after an intravenous injection of microbubbles) is not met. Recently, technologic advances have enabled myocardial opacification to be visualized during low‐energy real‐time imaging. During real‐time perfusion imaging, wall motion and myocardial perfusion may be assessed simultaneously, obviating the need of the presently time‐consuming combination of different imaging modalities. When high‐energy ultrasound bursts are periodically transmitted to produce bubble destruction during low‐power imaging, the consecutive frames after destruction delineate the restoration of contrast intensity. Microbubble replenishment rate and peak intensity may be determined subsequently, and provide reliable quantitative parameters of regional microcirculatory flow. This review will introduce the modalities used for real‐time perfusion imaging with focus on power pulse inversion imaging and quantitative analysis. Furthermore, we will describe the clinical role the technique may have in the identification of coronary artery disease, quantification of coronary stenosis severity, assessment of myocardial viability, determination of infarction size, and evaluation of reflow and no‐ or low‐reflow after acute myocardial infarction. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Evaluation and Management of Left Atrial Lymphoma Guided by Transesophageal Echocardiography
Authors: Willens Howard J. , Ahn Yeon S. , Gallagher Anthony J.
Published: July 2003

A highly mobile left atrial mass was detected by transesophageal echocardiography in a patient with mediastinal lymphoma. Transesophageal echocardiography also demonstrated resolution of the mass following chemotherapy. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Selective Contrast Echocardiography in Percutaneous Transluminal Septal Myocardial Ablation in an Elderly Patient With Left Ventricular Concentric Hypertrophy
Authors: Vieira Marcelo L.C. , Filho Roderick M. Silva , Filho Fábio S. Brito , Leal Samira B. , Filho Edgar B. Lira , Fischer Cláudio H. , Souza José A. de , Perin Marcos A.
Published: July 2003

We report an elderly patient, with hypertension and left ventricular concentric hypertrophy with sigmoid shape of the septum, who presented an unsatisfactory response to medical treatment and who was successfully submitted to myocardial contrast echocardiography‐guided percutaneous transluminal septal myocardial ablation. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Three‐Dimensional Transesophageal Echocardiographic Demonstration of Innominate Artery Dissection
Authors: Nekkanti Rajasekhar , Nanda Navin C. , Ahmed Sujood , Chen Jian Guo , McGiffin David C.
Published: July 2003

We describe an adult patient with type I aortic dissection in whom it was feasible to demonstrate the extension of the dissection into the innominate artery using color Doppler three‐dimensional transesophageal echocardiography. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Live Three‐Dimensional Transthoracic Echocardiographic Assessment of Aortic Dissection
Authors: Htay Thein , Nanda Navin C. , Agrawal Gopal , Ravi Barugur S. , Dod Harvinder S. , McGiffin David
Published: July 2003

In the present study, we report our experience of using live three‐dimensional transthoracic echocardiography in the assessment of aortic dissection in ten adult patients. To our knowledge, this has not been reported previously. (ECHOCARDIOGRAPHY, Volume 20, August 2003)
Prognostische Faktoren und operative Strategien bei Melanomen des Gesichts
Authors: Möhrle M. , Schippert W. , Garbe C. , Rassner G. , Röcken M. , Breuninger H.
Published: July 2003

Hintergrund: Bei Melanomen, die im Gesicht lokalisiert sind, lassen sich die am Körper üblichen Sicherheitsabstände aus funktionellen und ästhetischen Gründen nicht realisieren. In der Literatur fehlen kontrollierte Studien zu Sicherheitsabständen bei Gesichtmelanomen. Bei den Melanompatienten der Universitäts‐Hautklinik Tübingen (1980 – 1999) wurde retrospektiv analysiert, welche klinische Parameter und operativen Strategien die Prognose bei Gesichtsmelanomen beeinflussen. Die Bedeutung der lückenlosen histologischen Kontrolle der Exzisatschnittränder (3D‐Histologie) sollte validiert werden.

Patienten und Methodik: Die untersuchten 368 Melanome des Gesichts machten 9,3 % aller 3 960 Primärmelanome im klinischen Stadium I/II und 63 % der Melanome des Kopf/Hals‐Bereichs aus.

Ergebnisse: Operationen, die mehrzeitig durchgeführt wurden, eine Exzisonsbiopsie zur Diagnosesicherung gefolgt von einer späteren Nachexzision mit definitivem Sicherheitsabstand oder eine Nachexzision bei histologisch unvollständiger Primärexzision, waren mit einer höheren Wahrscheinlichkeit für das rezidivfreie Überleben verbunden (p = 0,0007), jedoch ohne prognostische Bedeutung für das Gesamtüberleben. In der multivariaten Analyse waren Invasionslevel (p = 0,0049), Ulzeration (p = 0,011), 3D‐Histologie (p = 0,027) und die Einhaltung definierter Sicherheitsabstände (Tumordicke ≤ 1,00 mm: 10 mm; > 1,00 mm 20 mm; LMM 5 mm unter Einsatz der 3D‐Histologie) (p = 0,033) unabhängige signifikante Risikofaktoren für das rezidivfreie Überleben. Für das Gesamtüberleben konnten Invasionslevel (p = 0,032), Ulzeration (p = 0,029), 3D‐Histologie (p = 0,0047) als unabhängige signifikante Risikofaktoren identifiziert werden. In der multivariaten Analyse konnte für den histologischen Tumortyp keine prognostische Bedeutung nachgewiesen werden.

Schlußfolgerung: Aufgrund dieser Ergebnisse können auch reduzierte Sicherheitsabstände im Gesicht als ausreichend sicher eingeschätzt werden. Die 3D‐Histologie ermöglicht eine weitere Reduzierung der Sicherheitsabstände, kann subklinische Tumorausläufer erkennen und ist mit einer besseren Prognose bei Patienten mit Gesichtsmelanomen assoziiert.
The role of dendritic cells during infection
Authors: Kolb‐Mäurer Annette , Bröcker Eva‐B.
Published: July 2003

The skin and the mucosa of the respiratory and gastrointestinal tracts are continuously exposed to microorganisms, but only a limited number of these enter the body and cause disease. To resist microbial infection, the host has developed a multitude of defense mechanisms involving the innate and adaptive immune systems. Dendritic cells (DCs) provide the link between these arms of the immune system. The initiation of an immune response is critically dependent on the activation of DCs, which can discriminate between different classes of microorganisms and elicit tailored antimicrobial immune responses. They have an extraordinary capacity to stimulate naive T cells and initiate primary immune responses. In turn, some pathogens interfere with DC function to block or delay their elimination by the host. Progress in understanding the role of DCs in the host response to microbes is reviewed.
Effect of dietary phospholipid level and phospholipid:neutral lipid value on the development of sea bass (Dicentrarchus labrax) larvae fed a compound diet
Authors: Cahu Chantal L. , Infante José L. Zambonino , Barbosa Valérie
Published: July 2003

The aim of the study was to determine the influence of dietary phospholipid concentration on survival and development in sea bass (Dicentrarchus labrax) larvae. Larvae were fed from day 9 to day 40 post-hatch with an isoproteic and isolipidic formulated diet with graded phospholipid levels from 27 to 116 g/kg DM and different phospholipid:neutral lipid values. The best growth (32 mg at the end of the experiment) survival (73 %) and larval quality (only 2% of malformed larvae) were obtained in the larvae fed the diet containing 116 g phospholipid/kg DM (P< 0·05). These results were related to the amount of phosphatidylcholine and phosphatidylinositol included in this diet (35 and 16 g/kg respectively). Amylase, alkaline phosphatase and aminopeptidase N activities revealed a proper maturation of the digestive tract in the two groups fed the highest phospholipid levels. Regulation of lipase and phospholipase A2 by the relative amount of their substrate in the diet occurred mainly at the transcriptional level. The response of pancreatic lipase to dietary neutral lipid was not linear. As in mammals 200 g triacylglycerol/kg diet seems to represent a threshold level above which the response of pancreatic lipase is maximal. The response of phospholipase A2 to dietary phospholipid content was gradual and showed a great modulation range in expression. Sea bass larvae have more efficient capacity to utilize dietary phospholipid than neutral lipids. For the first time a compound diet sustaining good growth, survival and skeletal development has been formulated and can be used in total replacement of live prey in the feeding sequence of marine fish larvae.
βcap73-ARF6 Interactions Modulate Cell Shape and Motility after Injury In Vitro
Authors: Riley Kathleen N. , Maldonado Angel E. , Tellier Patrice , D'Souza-Schorey Crislyn , Herman Ira M.
Published: July 2003

To understand the role that ARF6 plays in regulating isoactin dynamics and cell motility, we transfected endothelial cells (EC) with HA-tagged ARF6: the wild-type form (WT), a constitutively-active form unable to hydrolyze GTP (Q67L), and two dominant-negative forms, which are either unable to release GDP (T27N) or fail to bind nucleotide (N122I). Motility was assessed by digital imaging microscopy before Western blot analysis, coimmunoprecipitation, or colocalization studies using ARF6, β-actin, or β-actin-binding protein-specific antibodies. EC expressing ARF6-Q67L spread and close in vitro wounds at twice the control rates. EC expressing dominant-negative ARF6 fail to develop a leading edge, are unable to ruffle their membranes (N122I), and possess arborized processes. Colocalization studies reveal that the Q67L and WT ARF6-HA are enriched at the leading edge with β-actin; but T27N and N122I ARF6-HA are localized on endosomes together with the β-actin capping protein, βcap73. Coimmunoprecipitation and Western blot analyses reveal the direct association of ARF6-HA with βcap73, defining a role for ARF6 in signaling cytoskeletal remodeling during motility. Knowledge of the role that ARF6 plays in orchestrating membrane and β-actin dynamics will help to reveal molecular mechanisms regulating actin-based motility during development and disease.
Spy1 Interacts with p27Kip1 to Allow G1/S Progression
Authors: Porter Lisa A. , Kong-Beltran Monica , Donoghue Daniel J.
Published: July 2003

Progression through the G1/S transition commits cells to synthesize DNA. Cyclin dependent kinase 2 (CDK2) is the major kinase that allows progression through G1/S phase and subsequent replication events. p27 is a CDK inhibitor (CKI) that binds to CDK2 to prevent premature activation of this kinase. Speedy (Spy1), a novel cell cycle regulatory protein, has been found to prematurely activate CDK2 when microinjected into Xenopus oocytes and when expressed in mammalian cells. To determine the mechanism underlying Spy1-induced proliferation in mammalian cell cycle regulation, we used human Spy1 as bait in a yeast two-hybrid screen to identify interacting proteins. One of the proteins isolated was p27; this novel interaction was confirmed both in vitro, using bacterially expressed and in vitro translated proteins, and in vivo, through the examination of endogenous and transfected proteins in mammalian cells. We demonstrate that Spy1 expression can overcome a p27-induced cell cycle arrest to allow for DNA synthesis and CDK2 histone H1 kinase activity. In addition, we utilized p27-null cells to demonstrate that the proliferative effect of Spy1 depends on the presence of endogenous p27. Our data suggest that Spy1 associates with p27 to promote cell cycle progression through the G1/S transition.
Energy Status and Its Control on Embryogenesis of Legumes. Embryo Photosynthesis Contributes to Oxygen Supply and Is Coupled to Biosynthetic Fluxes
Authors: Rolletschek Hardy , Weber Hans , Borisjuk Ljudmilla
Published: July 2003

Legume seeds are heterotrophic and dependent on mitochondrial respiration. Due to the limited diffusional gas exchange, embryos grow in an environment of low oxygen. O2 levels within embryo tissues were measured using microsensors and are lowest in early stages and during night, up to 0.4% of atmospheric O2 concentration (1.1 μm). Embryo respiration was more strongly inhibited by low O2 during earlier than later stages. ATP content and adenylate energy charge were lowest in young embryos, whereas ethanol emission and alcohol dehydrogenase activity were high, indicating restricted ATP synthesis and fermentative metabolism. In vitro and in vivo experiments further revealed that embryo metabolism is O2 limited. During maturation, ATP levels increased and fermentative metabolism disappeared. This indicates that embryos become adapted to the low O2 and can adjust its energy state on a higher level. Embryos become green and photosynthetically active during differentiation. Photosynthetic O2 production elevated the internal level up to approximately 50% of atmospheric O2 concentration (135 μm). Upon light conditions, embryos partitioned approximately 3-fold more [14C]sucrose into starch. The light-dependent increase of starch synthesis was developmentally regulated. However, steady-state levels of nucleotides, free amino acids, sugars, and glycolytic intermediates did not change upon light or dark conditions. Maturing embryos responded to low O2 supply by adjusting metabolic fluxes rather than the steady-state levels of metabolites. We conclude that embryogenic photosynthesis increases biosynthetic fluxes probably by providing O2 and energy that is readily used for biosynthesis and respiration.
Genetic Modification of Alternative Respiration Has Differential Effects on Antimycin A-Induced versus Salicylic Acid-Induced Resistance to Tobacco mosaic virus
Authors: Gilliland Androulla , Singh Davinder P. , Hayward Jennifer M. , Moore Catherine A. , Murphy Alex M. , York Caroline J. , Slator Jo , Carr John P.
Published: July 2003

Salicylic acid (SA), a natural defensive signal chemical, and antimycin A, a cytochrome pathway inhibitor, induce resistance to Tobacco mosaic virus (TMV). Pharmacological evidence suggested signaling during resistance induction by both chemicals involved alternative oxidase (AOX), sole component of the alternative respiratory pathway (AP). Roles of the AP include regulation of intramitochondrial reactive oxygen species and maintenance of metabolic homeostasis. Transgenic tobacco (Nicotiana tabacum) with modified AP capacities (2- to 3-fold increased or decreased) showed no alteration in phenotype with respect to basal susceptibility to TMV or the ability to display SA-induced resistance to systemic viral disease. However, in directly inoculated tissue, antimycin A-induced TMV resistance was inhibited in plants with increased AP capacities, whereas SA and antimycin A-induced resistance was transiently enhanced in plant lines with decreased AP capacities. We conclude that SA-induced TMV resistance results from activation of multiple mechanisms, a subset of which are inducible by antimycin A and influenced by AOX. Other antiviral factors, potentially including the SA-inducible RNA-dependent RNA polymerase, are regulated by AOX-independent mechanisms.
The Eukaryotic Translation Initiation Factor 4E Controls Lettuce Susceptibility to the PotyvirusLettuce mosaic virus
Authors: Nicaise Valérie , German-Retana Sylvie , Sanjuán Raquel , Dubrana Marie-Pierre , Mazier Marianne , Maisonneuve Brigitte , Candresse Thierry , Caranta Carole , LeGall Olivier
Published: July 2003

The eIF4E and eIF(iso)4E cDNAs from several genotypes of lettuce (Lactuca sativa) that are susceptible, tolerant, or resistant to infection by Lettuce mosaic virus (LMV; genus Potyvirus) were cloned and sequenced. Although Ls-eIF(iso)4E was monomorphic in sequence, three types of Ls-eIF4E differed by point sequence variations, and a short in-frame deletion in one of them. The amino acid variations specific to Ls-eIF4E  1 and Ls-eIF4E  2 were predicted to be located near the cap recognition pocket in a homology-based tridimensional protein model. In 19 lettuce genotypes, including two near-isogenic pairs, there was a strict correlation between these three allelic types and the presence or absence of the recessive LMV resistance genes mo1  1 and mo1  2. Ls-eIF4E  1 and mo1  1 cosegregated in the progeny of two separate crosses between susceptible genotypes and an mo1  1 genotype. Finally, transient ectopic expression of Ls-eIF4E restored systemic accumulation of a green fluorescent protein-tagged LMV in LMV-resistant mo1  2 plants and a recombinant LMV expressing Ls-eIF4E° from its genome, but not Ls-eIF4E1 or Ls-eIF(iso)4E, accumulated and produced symptoms in mo1  1 or mo1  2 genotypes. Therefore, sequence correlation, tight genetic linkage, and functional complementation strongly suggest that eIF4E plays a role in the LMV cycle in lettuce and that mo1  1 and mo1  2 are alleles coding for forms of eIF4E unable or less effective to fulfill this role. More generally, the isoforms of eIF4E appear to be host factors involved in the cycle of potyviruses in plants, probably through a general mechanism yet to be clarified.