bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical value of electrogastrography and the gastric emptying test
Authors: Luo Jinyan , Zhu Youling , Wang Xueqin , Qi Huibin 
Published: March 2003

OBJECTIVE: To: (i) assess the clinical value of electrogastrography (EGG) and the gastric emptying test; and (ii) investigate the relationship between gastric myoelectrical activity and gastric emptying (GE). METHODS: One hundred and forty patients with functional dyspepsia (FD), 30 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and 20 healthy volunteers were studied. Gastric myoelectrical activity was recorded by using cutaneous EGG. The gastric emptying time was measured by using isotopic, radiopaque marker (Rom’s) and ultrasound methods. RESULTS: The dysrhythmia rates in patients with NIDDM were 70.0% (21/30) before meals and 66.7% (20/30) after meals, and the tachygastria rates of these patients were 36.7% before meals and 33.3% after meals. In NIDDM patients, the dominant frequency (DF) after meals (2.60 ± 0.30 cycles per minute; c.p.m.), the fed DF/fasting DF ratio (1.01 ± 0.11), the dominant power (DP) after meals (121.45 ± 67.00 V2 c.p.m.) and the fed DP and fasting DP ratios (0.81 ± 0.07) were significantly lower than those in normal controls (P < 0.05 or P < 0.01). The DP after meals in patients with FD (210.60 ± 68.40 V2 c.p.m.) was significantly lower than that in normal controls (P < 0.01). Delayed gastric emptying was more common in patients with FD and NIDDM. The rate of delayed gastric emptying in 121 cases with normal myoelectrical rhythm was 39.7% (48/121). In 69 cases with dysrhythmia, 45.9% (17/37) with bradygastria and 78.1% (25/32) with tachygastria had delayed gastric emptying. CONCLUSIONS: Electrogastrography and the gastric emptying test are feasible methods for evaluating gastric myoelectrical activity and gastric motility. The precise relationship between gastric myoelectrical activity and gastric motility has not been proven, but there is a close relationship between tachygastria and delayed gastric emptying.
Clinicopathological analysis of non‐alcoholic steatohepatitis
Authors: Ni Yanjun , Liu Houyu , Hu Dechang , Zhe Weirong , Li Mingsheng 
Published: March 2003

OBJECTIVE: Based on liver biopsy samples collected during the past 10 years, the present study aimed to investigate the incidence of fatty liver, the relationship between fatty liver and other underlying liver diseases, and the clinical and pathological characteristics, and the risk factors of fatty liver.METHODS: From a total of 658 liver biopsy specimens collected from 1988 to 1997, there were 71 cases of fatty liver and 68 cases of non‐alcoholic fatty liver. Matched by sex and age, 155 specimens of non‐fatty liver were used as controls. All patients from which the biopsies were taken were tested for liver function, blood lipid profile, blood glucose and hepatitis virus markers. The liver biopsy samples were all investigated by the same pathologist.RESULTS: The prevalence of fatty liver among all the liver biopsies was 10.8%. The alanine aminotransferase, aspartate aminotransferase, total bilirubin and con‐jugated bilirubin levels in the fatty liver group were significantly lower than those in the non‐fatty liver group, whereas the triglyceride levels were higher. Pathologically, steatosis in patients with fatty liver was mainly located around the hepatic lobules, and macrovesicular steatosis was common. Of the 68 cases of non‐alcoholic fatty liver, hepatic cell necrosis was found in 35 cases (51.5%), inflammatory cell infiltration in 46 cases (67.6%) and fibrosis to various degrees in 19 cases (27.9%).CONCLUSION: Non‐alcoholic fatty liver is closely related to hyperlipidemia. In asymptomatic subjects with abnormal liver function, a liver biopsy is the only way to establish the type and severity of liver lesions.
Construction of an attenuated Salmonella typhimurium vaccine carrying the Helicobacter pylori hpaA gene
Authors: ZHU Sen Lin , CHEN Min Hu , LIAO Wen Jun , CHEN Jie , HU Pin Jin 
Published: March 2003

OBJECTIVE: Helicobacter pylori is documented to have infected more
than half of the world’s population. It colonizes the human stomach and is
associated with the development of chronic active gastritis, peptic ulcer disease,
gastric adenocarcinoma and gastric mucosa‐associated lymphoid tissue (MALT) lymphoma.
Immunization against this bacterium represents a cost‐effective strategy to reduce
global gastric cancer rates and would have a major impact on H. pylori‐related
peptic ulcer disease. HpaA, a subunit protein of H. pylori adhesin, is known
to be the pathogenic factor and attenuated Salmonella typhimurium is a live
vaccine vector. The present study aimed at constructing and identifying a live attenuated
S. typhimurium vaccine carrying the hpaA gene of H. pylori. METHODS: The hpaA gene was amplified from H. pylori genomic
DNA by polymerase chain reaction (PCR) and cloned into the NcoI‐SalI
site of the prokaryotic expression plasmid pTrc99A. After sequence analysis of the
hpaA gene, the identified recombinant plasmid was then used to transform a
live attenuated S. typhimurium, namely SL3261, and positive clones were screened by PCR and restriction enzyme digestion. RESULTS: Confirmed by PCR, restriction enzyme digestion and sequence analysis,
a recombinant prokaryotic expression plasmid, namely pTrc99A‐hpaA, harboring approximately
560 bp hpaA was constructed and the recombinant plasmid was then successfully
introduced into a live attenuated S. typhimurium SL3261. CONCLUSION: A recombinant live attenuated S. typhimurium vaccine
harboring the H. pylori hpaA gene was constructed and identified. This work
will help develop an oral recombinant live vaccine against H. pylori infection.
Risk factors for postoperative pancreatitis associated with diagnostic and therapeutic endoscopic retrograde cholangiopancreatography
Authors: YE Li Ping , XU Guo Ming , SUN Zhen Xing , LI Zhao Shen 
Published: March 2003

OBJECTIVE: To investigate the risk factors for postoperative pancreatitis following endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting. METHODS: Four hundred and twelve patients referred to the endoscopy unit were divided into seven groups: (i) double ducts (pancreatic duct and biliary duct) contrast media filling group (ERCP group); (ii) biliary duct contrast media filling group (ERC group); (iii) pancreatic duct contrast media filling group (ERP group); (iv) ERCP plus biliary stenting group (ERCP + stent group); (v) ERC plus stenting group (ERC + stent group); (vi) ERCP plus EST and stone extraction (SE) group (ERCP + EST + SE group); and (vii) ERC plus EST and SE group (ERC + EST + SE group). Differences in postoperative serum amylase at 4 and 24 h, as well as clinical symptoms, were compared among the different groups. RESULTS: The incidence of postoperative hyperamylasemia at 4 and 24 h was 17.7 and 4.4%, respectively. The overall incidence of postoperative acute pancreatitis was 3.9% and the ERP group had the highest incidence of postoperative acute pancreatitis among the seven groups. CONCLUSIONS: Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis and therapeutic ERCP, such as EST, stenting and SE, does not increase the incidence of postoperative pancreatitis.
Diagnosis of gastric cancer by using autofluorescence spectroscopy
Authors: XIAO Shu Dong , GE Zhi Zheng , ZHONG Liang , LUO Hong Yu 
Published: March 2003

AIMS: To evaluate the clinical use of laser‐induced fluorescence (LIF) spectra for diagnosing gastric cancer during gastroscopy.METHODS: A helium−cadmium laser system (excitation wavelength = 442 nm) was used to detect autofluorescence in 38 patients with endoscopically and histologically diagnosed gastric cancer and chronic gastritis.RESULTS: The LIF spectra produced by the helium− cadmium laser from gastric cancer tissue had one major peak (510 nm) and three minor peaks (590, 670, 710 nm). The intensity and shape of the LIF spectra in gastric cancer and normal gastric tissue were significantly different. Using the integral fluorescence intensities (FI) at 662−677 and 701−716 nm and the FI ratio of 510 nm/710 nm as the diagnostic parameters, it was possible to diagnose gastric cancer with a sensitivity of 83%, a specificity of 91%, a positive predictive value of 88% and a negative predictive value of 88%. The diagnostic accuracy was 88%.CONCLUSIONS: Using autofluorescence spectro­scopy to detect gastric cancer allows real‐time detection of gastric cancerous lesions and it serves as a guide for taking biopsy specimens. The technique may become a useful tool in the diagnosis of early gastric cancer.
Esophageal pH and bile monitoring for detecting duodenogastroesophageal reflux and evaluating the effectiveness of treatment
Authors: LIN Jin Kun , HU Pin Jin , LI Chu Jun , DENG Hui Fen , CHEN Wei 
Published: March 2003

OBJECTIVE: To study methods of diagnosing duo­denogastroesophageal reflux (DGER) and to evaluate the role of bile reflux in gastroesophageal reflux disease (GERD).METHODS: Simultaneous 24‐h esophageal mucosal bilirubin level and pH monitoring were performed in 20 healthy subjects and 52 patients with symptoms suggesting gastroesophageal reflux. Data were gathered by using an ambulatory duodenogastric reflux monitoring system (Bilitec 2000) and an ambulatory pH recorder (Digitrapper MKIII). An absorbance value of ≥0.14 was designated as the threshold value for the presence of bile reflux. Patients suffering from mixed pathological reflux of acid and bile were treated with hydrotalcite and cisapride for 4 weeks, then the monitoring was repeated.RESULTS: No pathological acid reflux was found in the 20 healthy subjects. Based on findings from 24‐h esophageal pH monitoring, 47 of 52 patients (including 12 with esophagitis) were found to have patho­logical reflux. The total fraction of time with bile reflux was greater in the patients (n
= 52) than in the healthy subjects (n
= 20; 2.67 ± 3.23%vs 0.47 ± 0.71%; P < 0.05) and was greater in the patients with esophagitis (n
= 12) than in the patients without esophagitis (n
= 35; 5.41 ± 4.93%vs 1.68 ± 1.76%; P < 0.05). Of the 47 patients with GERD, 15 (32%) had abnormal mixed acid and bile reflux. Eight of the 15 patients with esophagitis were found to have mixed reflux and only four of 32 had acid reflux only (P < 0.05). After treatment with hydrotalcite and cisapride, the total fraction of time with acid and bile reflux in the 15 patients with mixed reflux decreased significantly (P < 0.05). Esophagitis was cured in seven of eight patients.CONCLUSION: The ambulatory duodenogastric reflux monitoring system is a useful tool for detecting DGER and evaluating the efficacy of treatment. Approximately 32% (15/47 cases) of patients with GERD were found to have DGER. Bile reflux may play a significant role in causing esophageal mucosal damage in patients suffering from GERD.
Risk factors for pressure ulcers in bedridden elderly subjects: Importance of turning over in bed and serum albumin level
Authors: Mino Yoshio , Morimoto Shigeto , Okaishi Kohya , Sakurai Shoroku , Onishi Miyuki , Okuro Masashi , Matsuo Akiko , Ogihara Toshio 
Published: March 2003

Background:The purpose of the present paper was to determine clinical risk factors for the development of pressure ulcers in bedridden elderly inpatients.Methods:A case‐control study was performed for 117 subjects with pressure ulcers (mean age: 80.6 ± 7.2 years) with a 1‐year observation period, and 351 age‐ and sex‐matched controls. Factors examined were subitems of the Braden scale; convenient clinical assessment (continence, sitting, turning, oral intake, and sitting up); underlying chronic conditions (stroke and diabetes mellitus); and circulating levels of albumin, total cholesterol, total lymphocyte count, and hemoglobin.Results:Compared to the controls, test cases showed lower scores of the Braden scale and lower levels of circulating factors, and higher incidences of incapability of the subitems of convenient clinical assessment, and of diabetes mellitus (P < 0.20). Three models of multiple logistic regression analysis revealed that decreased serum level of albumin and impaired self‐positioning in bed were significant independent risk factors. The relative risk for the development of pressure ulcers after full adjustment in the group with both hypoalbuminemia (< 35 g/L) and incapability of turning over in bed, the group with the former risk alone, and the group with the latter risk alone, was 14.0 (95% confidence interval (CI): 4.2–46.6), 4.9 (1.6–14.9), and 5.9 (1.8–19.0), respectively, compared to subjects without the two risk factors. Moreover, decreased circulating levels of albumin and hemoglobin were associated with aggravation of pressure ulcers.Conclusion:A combined measure of albumin and incapability of self‐positioning may serve as a simple but useful index for the risk of pressure ulcers in bedridden elderly inpatients.
Neurochemical regulation of swallowing reflex in guinea pigs
Authors: Jia Yu X , Li Jian Q , Matsui Toshifumi , Yamaya Mutsuo , Ohrui Takashi , Sekizawa Kiyohisa , Sasaki Hidetada 
Published: March 2003

Background:Most peripheral afferent fibers involved in swallowing travel through the glossopharyngeal and vagus nerves and terminate in the nucleus of the tractus solitarius (NTS) and nodose ganglion (NG). Sensory neurons within the NTS and NG contain several neurotransmitters, including acetylcholine, histamine, serotonin and dopamine. The roles of these four neurotransmitters were investigated.Methods:The effects of atropine (muscarinic cholinergic receptor antagonist); pyrilamine maleate (PM, histamine H1 receptor antagonist); cimetidine (histamine H2 receptor antagonist); 8‐hydroxy‐2‐(di‐n‐propylamino)‐tetralin (8‐OH‐DPAT, specific 5‐HT1A receptor agonist); and selective dopamine D1 receptor antagonist (Sch‐23390) on the number of swallows elicited by distilled water in anesthetized guinea pigs were investigated.Results:Atropine (0.2 mg/kg) inhibited swallowing by approximately 70%; PM (30 mg/kg) inhibited swallowing by approximately 60%; cimetidine (30 mg/kg) inhibited swallowing by approximately 52.9% and Sch‐23390 (chronic treatment) inhibited swallowing by approximately 40%. In contrast, 8‐OH‐DPAT did not alter the number of swallows. Chronic pretreatment of Sch‐23390 markedly decreased the substance P (SP) content in the pharyngeal mucosa and the esophagus.Conclusion:These findings indicate that acetylcholine, histamine and dopamine are involved in the regulation of the swallowing reflex, whereas it is unlikely that serotonin is involved.
Preoperative assessment scale for elderly Japanese patients (part I): basic study design and clinical trial
Authors: Tatematsu Mitsuyoshi , Kawamoto Takahiro , Hayashida Kazutaka , Yoshioka Hideyuki , Wada Taizo , Ueyama Kazuhisa , Nakajima Yasuyo , Nagano Yutaka , Takechi Hajime , Tanaka Makoto , Horiuchi Hisanori , Ishii Kenji , Arai Hidenori , Kume Noriaki , Wakatsuki Yoshio , Murakami Motonobu , Matsubayashi Kozo , Kita Toru , Yokode Masayuki 
Published: March 2003

Background:The aim of the present paper was to propose a general assessment system for elderly patients undergoing surgical operations.Methods:A protocol was designed to compare preoperative comorbidities and post‐operative complications.Results:When the data from 51 consecutive elderly patients (≥ 65 years) were applied to the protocol and analyzed by chi‐squared test and Cox proportional hazards regression models, left ventricular hypertrophy and myocardial ischemia on electrocardiogram (ECG) were revealed to be significantly associated with development of postoperative complications (P< 0.05).Conclusion:The current results serve as a basic data to design an assessment system to predict the prognosis of surgical patients.
Clostridium septicum and malignancy
Authors: Chew Simon S. B. , Lubowski David Z. 
Published: March 2003

Background:  Clostridium septicum is known to be associated with malignancy or immunosuppression. It has a variable clinical presentation and is associated with a high mortality. The aim of the present study was to review the experience at St George Hospital, Sydney, over a 10‐year period, with particular reference to the association of this condition with colorectal cancer.Methods:  The records of five patients with blood culture‐proven Clostridium septicum infection, among a larger group of 31 patients with clostridial infections, presenting to St George Hospital between 1990 and 2000 were reviewed.Results:  Associated malignancy was found in four (80%) of the patients with Clostridium septicum infection. Two infections were related to colorectal cancer, two to haematological malignancies and one to radiation‐induced recto‐urethral fistula. Those patients who had colorectal cancer presented with septicaemia and vague abdominal symptoms.Conclusions:  Clostridium septicum infections have a strong association with malignancy. When this infection occurs without an obvious underlying aetiology there should be a high index of suspicion about associated malignancy. In the absence of haematol­ogical malignancy a colonoscopy is warranted. Early diagnosis and aggressive treatment is essential in order to improve prognosis.
Treatment of the axilla in early breast cancer: past, present and future
Authors: Chua Boon , Ung Owen , Boyages John 
Published: March 2003

Background:  The optimal treatment of the axilla in early breast cancer is controversial. The present study reviews the pattern and predictors of regional recurrence (RR) and prognosis after RR in patients with early breast cancer treated by conservative surgery and radiotherapy (CS + RT). Implications of the results on current practice and future directions are explored.Methods:   Between 1979 and 1994, 1158 patients with stage I or II breast cancer were treated with CS + RT at Westmead Hospital. Two groups of patients were compared: 782 patients who underwent axillary dissection (axillary surgery group) and 229 patients who received radiotherapy (axillary RT group) as the only axillary treatment. At least 10 lymph nodes were dissected in 82% of the axillary surgery group. Of the women in the RT group, 90% received RT to the axilla and supraclavicular fossa (SCF) only and 10% also received RT to the internal mammary chain (IMC).Results:  With a median follow‐up period of 79 months for the axillary surgery group and 111 months for the axillary RT group, 27 patients developed a RR (2.8% and 2.2%, respectively). Seven patients (0.9%) in the axillary surgery group and three patients (1.3%) in the axillary RT group developed a RR in the axilla (P, not significant). Of the patients with SCF recurrences, 14 (1.8%) were in the axillary surgery group and one (0.4%) in the axillary RT group (P, not significant). One patient in the axillary surgery group developed concurrent axillary and SCF recurrences, while a patient in the axillary RT group developed an IMC recurrence. Twenty (74%) of the 27 patients with a RR developed a concurrent or subsequent distant relapse (30% and 44%, respectively). In the pathologically node‐positive patients, the axillary recurrence rate was higher in those who had less than five nodes removed (17%) than those who had 10 or more nodes removed (0%; P = 0.01). The SCF recurrence rate was higher in patients with four or more positive axillary nodes (9.5%) than in those with 0–3 positive nodes (1.5%; P = 0.003).Conclusion:  Adequate treatment of the axilla by surgery or RT alone is associated with a low rate of RR. The incidence of distant relapse was substantial in patients who developed a RR, which gives emphasis to the importance of optimizing local–regional control.
Computer‐based logbook for surgical registrars
Authors: Brouwer Richard , Kiroff George 
Published: March 2003

Background: The documentation and monitoring of operative experience is an important component of advanced surgical training. The Royal Australasian College of Surgeons (RACS) monitors the adequacy of training by use of the surgical logbook. The logbook has been a paper‐based record that does not permit longitudinal evaluation of the progress of an individual trainee or comparison of different surgical units. Methods: An electronic logbook has been developed in FileMaker Pro version 5.03 (FileMaker, Santa Clara, California, USA). Results: The electronic logbook has been employed for 1 year and has been used on both Windows and Macintosh platforms without difficulty. Appropriate summaries of the training experience were provided for the RACS at the conclusion of each rotation. Conclusions: The use of a relational database for logbook purposes provides trainees with a convenient and versatile record of their experience while meeting RACS requirements for documentation of surgical experience.
Iatrogenic bile duct injury: The scourge of laparoscopic cholecystectomy
Authors: Slater K. , Strong R. W. , Wall D. R. , Lynch S. V. 
Published: March 2003

Background: Laparoscopic cholecystectomy (LC) has become the first‐line surgical treatment of calculous gall‐bladder disease and the benefits over open cholecystectomy are well known. In the early years of LC, the higher rate of bile duct injuries compared with open cholecystectomy was believed to be due to the ‘learning curve’ and would dissipate with increased experience. The purpose of the present paper was to review a tertiary referral unit’s experience of bile duct injuries induced by LC. Methods: A retrospective analysis was performed on all patients referred for management of an iatrogenic bile duct injury from 1981 to 2000. For injuries sustained at LC, details of time between LC and recognition of the injury, time from injury to definitive repair, type of injury, use of intraoperative cholangiography (IOC), definitive repair and postoperative outcome were recorded. The type of injury sustained at open cholecystectomy was similarly classified to allow the severity of injury to be compared. Results: There were 131 patients referred for management of an iatrogenic bile duct injury that occurred at open cholecystectomy (n = 62), liver resection (n = 5) and at LC (n = 64). Only 39% of bile duct injuries were recognized at the time of LC. Following conversion to open operation, half the subsequent procedures were considered inappropriate. When the injury was not recognized during LC, 70% of patients developed bile leak/peritonitis, almost half of whom were referred, whereas the rest underwent a variety of operative procedures by the referring surgeon. The remainder developed jaundice or abnormal liver function tests and cholangitis. An IOC was performed in 43% of cases, but failed to identify an injury in two‐thirds of patients. The bile duct injuries that occurred at LC were of greater severity than with open cholecystectomy. Following definitive repair, there was one death (1.6%). Ninety‐two per cent of patients had an uncomplicated recovery and there was one late stricture requiring surgical revision. Conclusions: The early prediction that the rate of injury during LC would decline substantially with increased experience has not been fulfilled. Bile duct injury that occurs at LC is of greater severity than with open cholecystectomy. Bile duct injury is recognized during LC in less than half the cases. Evidence is accruing that the use of cholangiography reduces the risk and severity of injury and, when correctly interpreted, increases the chance of recognition of bile duct injury during the procedure. Prevention is the key but, should an injury occur, referral to a specialist in biliary reconstructive surgery is indicated.