bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass anatomy: expert vs. novice experience
Authors: Kashani Amir , Abboud Gebran , Lo Simon , Jamil Laith 
Published: July 2018

Abstract
Background and study aims Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DBE-ERCP) in post-Roux-en-Y gastric bypass (RYGB) patients is a technically challenging procedure. We aimed to determine the success rate of DBE-ERCP performed by a novice to the procedure in post-RYGB after training with an expert.
Patients and methods Medical records for 103 consecutive post-RYGB patients who underwent DBE-ERCP in a tertiary center were retrospectively reviewed. The procedures were performed by Operator A (18 years of high-volume ERCP practice before acquiring DBE skill in 2004), and operator B ( < 2 years’ experience in DBE and ERCP). ERCP success rate and time in patients with an intact papilla were compared between Operator A’s first and last sets of cases in equal number to the cases performed by Operator B.
Results A total of 129 DBE-ERCPs were performed (Operator A: 109; Operator B: 20) over an 80-month time span. Among patients with an intact papilla, DBE-ERCP success rates for Operator A’s first (87.5 %) and last (92.9 %) 20 cases were similar to that of Operator B (92.9 %) (P = 1.00 for both). Mean of DBE-ERCP time for the last 20 cases of Operator A was (100 minutes; 95 % confidence interval: 81,123) less than that for operator B (176 minutes; 95 % confidence interval: 138,224) (P = 0.01). Overall adverse events rates were 11 % and 5 % for Operators A and B, respectively (P = 0.69): pancreatitis (n = 10), cholangitis (n = 1), and perforation (n = 2); all were mild and treated conservatively.
Conclusions Despite the intrinsic technical difficulty, DBE-ERCP can be successfully and safely performed in post-RYGB patients by an endoscopist proficient in both conventional DBE and ERCP. Ideally, this endoscopist should observe several cases of DBE-ERCP performed by an expert to learn the techniques.
Heads or tails: confusion about “proximal” and “distal” terminology for pancreaticobiliary anatomy
Authors: Khara Harshit , Kothari Truptesh , Johal Amitpal , Kothari Shivangi , Ahuja Nina , Bhanushali Ashok , Kotru Anil , Berger Andrea , Kaul Vivek , Gross Seth , DiMaio Christopher , Hale William , Abbass Rami , Ryou Marvin , Sethi Amrita , Turner Brian , Fockens Paul , Diehl David 
Published: July 2018

Abstract
Background and study aims The anatomical meaning of the terms “proximal” and “distal” in relation to the pancreaticobiliary anatomy can be confusing. We aimed to investigate practice patterns of use of the terms “proximal” and “distal” for pancreaticobiliary anatomy amongst various medical specialties.
Materials and methods An online survey link to a normal pancreaticobiliary diagram was emailed to a multispecialty physician pool. Respondents were asked to label various parts of the common bile duct (CBD) and pancreatic duct (PD) using the terms “proximal,” “distal,” “not sure,” or “other.” Variability in use of these terms between specialties was assessed.
Results We received 370 completed surveys from 182 gastroenterologists (49.2 %), 97 surgeons (26.2 %), 68 radiologists (18.4 %), and 23 other physicians (6.2 %). There was overall consensus in describing the upper/sub-hepatic CBD as “proximal CBD” (73.8 %, P = 0.1499) and the lower/pre-ampullary portion as “distal CBD” (84.6 %, P = 0.1821).However, there was marked variability when describing the PD. The PD in the head of the pancreas was labeled as “proximal PD” by 42.4 % and “distal PD” also by 42.4 % (P < 0.0001); and in the tail as “proximal PD” by 41.4 % and “distal PD” by 43.2 % (P < 0.0001). Only 13.8 % of respondents used descriptive terminology (“PD in the head” or “PD in the tail”) for the PD. Radiologists most often used descriptive terminology for both the CBD and PD. Surgeons most consistently called “proximal PD” in the head, and “distal PD” in the tail of the pancreas.
Conclusions Although use of the terms “proximal” and “distal” is still very common to describe pancreaticobiliary anatomy, there is a discordance about its meaning, particularly for the PD. Use of descriptive terminology may be a more accurate alternative to prior ambiguous terminologies such as “proximal” or “distal” and can serve to improve communication and decrease the possibility of medical errors.
Endoscopic ultrasound-guided coil and glue for treatment of splenic artery pseudo-aneurysm: new kid on the block!
Authors: Rai Praveer , KC Harish , Goel Amit , Aggarwal Rakesh , Sharma Malay 
Published: July 2018

Abstract
Background and study aims Pseudoaneurysm most commonly involves the splenic artery and is conventionally treated with angioembolization or surgery. Herein we describe six patients with splenic artery pseudoaneurysm who were treated using a new technique of endoscopic ultrasound (EUS)-guided glue and coil injection.
Patients and methods Six patients (median age 36.7, range: 19 – 60, M: F = 5:1) with splenic artery pseudoaneurysm who had failed angiographic embolization underwent EUS-guided transgastric injection of coil and glue injection between July 2016 and September 2017.
Results The diameter of the splenic artery pseudoaneurysms varied from 2.5 cm to 6.5 cm. The size (8, 14 and 16 mm) and number (1 to 5) of coils and amount of glue (1 – 2 mL) injected all were greater in larger aneurysm. All six patients had complete occlusion of the pseudoaneurysm as determined by using computed tomography at 4 weeks and EUS at 12 weeks. No complication was encountered.
Conclusion EUS-guided coil and glue injection for obliteration of splenic artery pseudoaneurysm is a feasible, highly effective and safe technique.
Bilateral Proximal Humerus Fracture – a Rare Combination with a High Complication Rate after Surgery
Authors: Königshausen Matthias , Rausch Valentin , Mempel Eileen , von Glinski Alexander , Ull Christopher , Bernstorff Maria , Schildhauer Thomas , Seybold Dominik , Gessmann Jan 
Published: July 2018

Abstract
Introduction Bilateral acute proximal humerus fractures are rare. There are no data available about these bilateral injuries. The aim of the study was to analyse bilateral proximal humerus fractures retrospectively in terms of incidence, complications and revisions.
Methods All bilateral proximal humerus fractures were evaluated retrospectively using the institutionʼs database, with the focus on cause of the injury, fracture severity and the clinical course compared to published information on monolateral proximal humerus fractures. Bilateral posterior dislocation fractures were excluded, because these fractures are a separate entity.
Results Between 2005 and 2016, n = 17 patients were primarily treated within our hospital for an acute proximal humerus fracture on both sides (n = 12 female, n = 5 male, average age: 68 years; overall 34 proximal humerus fractures). The general trauma mechanism was a fall on both arms (82% [18% polytrauma]). There were 65% displaced 3-/4-part proximal humerus fractures. Angle-stable plate osteosynthesis was performed predominantly (64%), followed by fracture prosthesis (18%; tension wiring: 3%; non-operatively: 15%). Overall, n = 10 patients (59%) or n = 18 (53%) proximal humerus fractures developed a complication, primarily with loss of reduction or implant loosening (44%). In n = 14 (78%) of the complications further operations were necessary. Alcohol abuse was increasingly found in 29% of the cases within the bilateral patient cohort compared to patients with monolateral fractures.
Conclusion Bilateral proximal humerus fractures are mainly associated with comminuted displaced fractures and a higher complication rate in comparison to monolateral fractures after surgical treatment.
Coagulation Activation Following Estrogen Administration to Postmenopausal Women
Authors: Caine Yehezkel G , Bauer Kenneth A , Barzegar Samad , ten Cate Hugo , Sacks Frank M , Walsh Brian W , Schiff Isaac , Rosenberg Robert D 
Published: July 2018

SummaryWe investigated coagulation system activation following estrogen treatment in 29 healthy postmenopausal women. Study participants received conjugated estrogens at 0.625 and 1.25 mg per day, and placebo for 3-month periods in a randomized crossover protocol. Blood samples were obtained on two consecutive days at the end of each treatment period for immunoassays of F1+2 and fibrinopeptide A (FPA), markers of factor Xa action on prothrombin and thrombin action on fibrinogen in vivo, respectively. Treatment with estrogens at a dose of 0.625 or 1.25 mg resulted in significant increases in mean F1+2 levels of 40 and 98%, respectively, and in mean FPA levels of 37 and 71%, respectively. The measurements of F1+2 were significantly higher in women receiving 1.25 mg of estrogen than 0.625 mg. We also observed significant declines in the levels of antithrombin III and total protein S antigen. Immunologic levels of protein C increased modestly at only the 1.25 mg estrogen dose level. These data indicate that low doses of oral estrogens (≤1.25 mg per day) frequently increase the amount of thrombin generated in vivo. Our observations may help to explain the increased thrombotic risk that has been observed with higher doses of this medication (≥2.5 mg).
Reduction in Factor VII, Fibrinogen and Plasminogen Activator Inhibitor-1 Activity after Surgical Treatment of Morbid Obesity
Authors: Primrose J N , Davies J A , Prentice C R M , Hughes R , Johnston D 
Published: July 2018

SummaryThe aim of this study was to determine the effects of the surgical treatment of morbid obesity on some aspects of haemostatic and fibrinolytic function. Measurement of haemostatic and fibrinolytic factors was performed before and again 6 and 12 months after operation in 19 patients suffering from morbid obesity. Surgical treatment resulted in a mean decrease in body weight of 50 kg at 6 months and 64 kg at 12 months. Weight loss was accompanied at 12 months by significant reductions in median (interquartile range) concentrations of serum cholesterol from 5.3 (4.5–6.2) mmol/1 to 3.6 (2.9–4.6) mmol/1; factor VII from 113 (92–145)% of normal to 99 (85–107)%; of fibrinogen from 3.5 (3–9.3) g/1 to 2.8 (2.4–3.8) g/1; and of plasminogen activator inhibitor-1 (PAI-1) activity from 21 (11–30) IU/ml to 6.3 (5–10) IU/ml. The decrease in PAI-1 activity probably accounted for a significant reduction in euglobulin clot lysis time. Tissue plasminogen activator activity was undetectable in most patients pre-operatively but increased slightly after 1 year to 110 (100–204) mIU/ml. There were no significant changes in plasma levels of KCCT, factor VIII, von Willebrand factor antigen, alpha-2-antiplasmin, antithrombin III, protein C antigen, beta thromboglobulin, platelet factor 4, fibrinopeptide A or platelet count. These findings provide support for the hypothesis that the surgical treatment of morbid obesity may have a long-term beneficial effect on mortality from cardiovascular and thromboembolic disease.
The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia
Authors: Sharrock Nigel E , Go George , Mineo Robert , Harpel Peter C 
Published: July 2018

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.
Prolonged Bleeding Time in Patients with Lupus Anticoagulant
Authors: Orlando E , Cortelazzo S , Marchetti M , Sanfratello R , Barbui T 
Published: July 2018

SummaryPlatelet adhesion to collagen under flow conditions was studied in 18 patients with lupus anticoagulant, seven of which showed a prolonged bleeding time in the presence of a normal platelet count. The effect of patient plasma, IgG and purified anticardiolipin antibodies on platelet adhesion was also examined. We found a significant reduction of platelet adhesion in patients with lupus anticoagulant, which was more evident in patients with prolonged bleeding time. This platelet adhesion defect could be attributed to a plasma factor. In fact, patients' platelets regained normal adhesion when mixed with normal plasma, whereas controls' platelets showed abnormal adhesion in the presence of patient plasma. A causative role of antiphospholipid antibodies was demonstrated in experiments using purified immunoglobulins and anticardiolipin antibodies.
Plasminogen Levels in Healthy Volunteers -Influence of Age, Sex, Smoking and Oral Contraceptives
Authors: Tait R C , Walker Isobel D , Conkie J A , Islam S I A M , McCall Frances , Mitchell R , Davidson J F 
Published: July 2018

SummaryThere is considerable doubt as to the importance of reduced plasminogen (PLG) activity as a risk factor for venous thrombosis. In the present study we have identified a wide range of PLG activities (25–200%) in a cohort of 9,611 blood donors. Males and females not taking hormonal contraceptives show a similar distribution of PLG, however, variation related to age appears to follow a different pattern in males and females. These differences are of doubtful clinical importance as are differences related to smoking. In contrast, females taking hormonal contraceptives or hormone replacement therapy (HRT) have up to 25% higher mean PLG levels in younger females but a less marked elevation (10%) is seen in 40–50 year olds. A PLG activity <65% was recorded in 61 donors, none of whom appeared to have a history of thrombosis. These findings do not support the notion that reduced PLG is an important thrombophilic risk factor, however, further investigation of the donors with low PLG is required.
Congenital Deficiency of All Vitamin K-Dependent Blood Coagulation Factors Due to a Defective Vitamin K-Dependent Carboxylase in Devon Rex Cats
Authors: Soute Berry A M , Ulrich Magda M W , Watson A David J , Maddison Jill E , Ebberink Rob H M , Vermeer Cees 
Published: July 2018

SummaryTwo Devon Rex cats from the same litter, which had no evidence of liver disease, malabsorption of vitamin K or chronic ingestion of coumarin derivatives, were found to have plasma deficiencies of factors II, VII, IX and X. Oral treatment with vitamin K1 resulted in the normalization of these coagulation factors. After taking liver biopsies it was demonstrated that the coagulation abnormality was accompanied by a defective γ-glutamyl-carboxylase, which had a decreased affinity for both vitamin K hydroquinone and propeptide. This observation prompted us to study in a well-defined in vitro system the possible allosteric interaction between the propeptide binding site and the vitamin K hydroquinone binding site on carboxylase. It was shown that by the binding of a propeptide-containing substrate to γ-glutamylcarboxylase the apparent K
M for vitamin K hydroquinone is decreased about 20-fold. On the basis of these in vitro data the observed defect in the Devon Rex cats can be fully explained.
Influence of Heparin and a Low Molecular Weight Heparinoid on Specific Endogenous and Exogenous Fibrinolytic Factors during Rest and Exercise
Authors: de Boer A , Kluft C , Dooijewaard G , Kasper F J , Kroon J M , Breimer D D , Stiekema J C J , Cohen A F 
Published: July 2018

SummaryThe effects of heparin (5,000 IU i.v.) and the low molecular weight heparinoid Org 10172 (Orgaran®) (3,250 anti-Xa units i. v.) on components of the fibrinolytic system were studied in two double-blind, randomised, placebo-controlled, cross-over trials using healthy subjects. In study A (n = 6) the effects were studied during rest and standardized exercise and in study B (n = 6) during a low dose infusion of recombinant tissue-type plasminogen activator (rt-PA; 80 µg over 16 min). At rest, heparin and Org 10172 did not influence the plasma concentrations of endogenous t-PA antigen, and activity, urokinase-type PA (u-PA) antigen, plasmin activatable pro-urokinase (scu-PA), active urokinase (tcu-PA) and plasminogen activator inhibitor-1 (PAI-1) antigen. Recombinant t-PA antigen and activity during rt-PA infusion were also not affected. During exercise, neither heparin nor Org 10172 influenced the area under the curve (AUC) of t-PA and u-PA antigen and t-PA activity when compared with placebo. Unexpectedly, after heparin the AUC of t-PA activity was 49% larger (range +19 to +245%) than after Org 10172 (p <0.05). The last difference was considered spurious. scu-PA, tcu-PA and PAI-1 antigen levels at 2 min after termination of exercise were unaffected by both compounds (p >0.05). Sulphated polysaccharides do not increase fibrinolytic activity of the plasma by changing the concentrations of the components of the fibrinolytic system.
Influence of Selected Heparins on Human Neutrophil Functions In Vitro
Authors: Labrouche S , Freyburger G , Belloc F , Boisseau M R 
Published: July 2018

SummaryThe effects of four heparin derivatives [unfractionated heparin (UFH) at 5–50 IU/ml, low molecular weight heparin (LMWH) at 2–20 IU/ml, pentasaccharide (Penta) at 5 IU/ml and a synthetic heparinoid (PPS) at 10–6–10–5 M] on various polymorphonuclear (PMN) leukocyte end-functions (aggregation, chemotaxis, phagocytosis and burst) were examined. CR3 expression, actin polymerization and membrane surface charge were also studied to gain more insight on the mechanisms of the action of heparins on PMN. The different heparins were found to have rather different actions. PMN were found to be hyperreactive to PPS. Pentasaccharide hat no effect on PMN functions, while UFH and LMWH had intermediate reactivity, modulating responses in an adenosine-like manner. Interactions of heparins with PMN were attributed to biophysical properties of the molecules rather than to the presence of a specific sequence such as a pentasaccharide.Our results show that certain heparin derivatives, apart their well-known anticoagulant action, modulate polymorphonuclear leukocyte functions that may be involved in vascular injury.
Neutrophil Elastase Potentiates Cathepsin G-lnduced Platelet Activation
Authors: Selak Mary A 
Published: July 2018

SummaryWe have previously demonstrated that human neutrophil cathepsin G is a strong platelet agonist that binds to a specific receptor. This work describes the effect of neutrophil elastase on cathepsin G-induced platelet responses. While platelets were not activated by high concentrations of neutrophil elastase by itself, elastase enhanced aggregation, secretion and calcium mobilization induced by low concentrations of cathepsin G. Platelet aggregation and secretion were potentiated in a concentration-dependent manner by neutrophil elastase with maximal responses observable at 200 nM. Enhancement was observed when elastase was preincubated with platelets for time intervals of 10–60 s prior to addition of a low concentration of cathepsin G and required catalytically-active elastase since phenylmethanesulphonyl fluoride-inhibited enzyme failed to potentiate cell activation. Neutrophil elastase potentiation of platelet responses induced by low concentrations of cathepsin G was markedly inhibited by creatine phosphate/creatine phosphokinase and/or indomethacin, indicating that the synergism between elastase and cathepsin G required the participation of ADP and thromboxane A2. On the other hand, platelet responses were not attenuated by the PAF antagonist BN 52021, signifying that PAF-acether did not play a role in elastase potentiation. At higher concentrations porcine pancreatic elastase exhibits similar effects to neutrophil elastase, demonstrating that the effect of elastase was not unique to the neutrophil protease. While neutrophil elastase failed to alter the ability of cathepsin G to hydrolyze a synthetic chromogenic substrate, preincubation of platelets with elastase increased the apparent affinity of cathepsin G binding to platelets. In contrast to their effect on cathepsin G-induced platelet responses, neither neutrophil nor pancreatic elasatse potentiated aggregation or dense granule release initiated by ADP, PAF-acether, arachidonic acid or U46619, a thromboxane A2 mimetic. Moreover, unlike its effect on cathepsin G, neutrophil elastase inhibited thrombin-induced responses. The current observations demonstrate that elastase can potentiate platelet responses mediated by low concentrations of cathepsin G, suggesting that both enzymes may function synergistically to activate platelets under conditions where neutrophil degranulation occurs.