bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of complications of simultaneous kidney–pancreas transplantation with temporary venting jejunostomy
Authors: Boykin Kevin N , Zibari Gazi B 
Published: June 2003

Abstract: Background/Aims: The majority of simultaneous kidney–pancreas (SPK) transplants are being performed with portal‐enteric drainage, which does not allow easy access to the donor pancreas. By adding a temporary venting jejunostomy (TVJ) we have been able to closely monitor patients for bleeding, anastomotic leak and rejection.Methods: Retrospective chart review of 29 patients undergoing SPK with PE drainage from December 1996 to December 2001.Results: Median follow‐up was 32 months. Patient, kidney and pancreas graft survival were 93%, 90% and 93%, respectively. The most common early complications were wound infections and bleeding. No patient suffered vessel thrombosis. The most common late (greater than 3 months post‐transplant) complication was gastro‐intestinal bleeding. Adequate tissue was obtained for biopsy in 100% of patients with suspected pancreatic rejection. The TVJ allowed one patient to undergo donor pancreas ERCP that demonstrated the site of a pancreatic duct leak. Duodenal stump leak and anastomotic bleeding were diagnosed in one patient each via the TVJ. The median time to takedown of the TVJ was 14 months.Conclusion: TVJ allows patients an easy method of graft surveillance, is well tolerated, and has an acceptable complication rate. The TVJ allows access to diagnose anastomotic leak, cauterize bleeding mucosa, perform ERCP and biopsy the pancreas allograft.
Long‐term experience with simultaneous kidney–pancreas transplantation with portal‐enteric drainage and tacrolimus/mycophenolate mofetil‐based immunosuppression
Authors: Stratta Robert J , Shokouh‐Amiri M H , Egidi M Francesca , Grewal Hani P , Lo Agnes , Kizilisik A Tarik , Nezakatgoo Nosratollah , Gaber Lillian W , Gaber A. Osama 
Published: June 2003

Abstract: Background/Aims: Refinements in surgical techniques and advances in clinical immunosuppression have led to steadily improving results in pancreas transplantation (PTX). Although there is renewed interest in enteric exocrine drainage, most PTXs are performed with systemic venous delivery of insulin. To improve the physiology of PTX, we developed a novel technique of portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal‐enteric [P‐E]). The purpose of the study was to analyse outcomes in patients undergoing PTX with P‐E drainage and contemporary immunosuppression.Materials and methods: From January 1997 through September 2002, we performed 67 primary simultaneous kidney–PTXs (SKPT) with P‐E drainage. Maintenance immunosuppression consisted of tacrolimus (TAC), mycophenolate mofetil (MMF) and steroids. No antibody induction therapy occurred in 33 patients (49%) with the remainder receiving daclizumab (n = 15), basiliximab (n = 2), or thymoglobulin (n = 14) induction therapy. The patient group included 38 males and 29 females with a mean age of 39.7 year (range 23–58) and a mean duration of pretransplant diabetes of 24.5 year (9–46). Fourteen patients (21%) were African‐American.Results:The mean waiting time for SKPT was 3.3 months (range 0.1–10). Mean kidney and pancreas cold ischaemia times were 15.1 and 15.4 h, respectively. Patient, kidney and pancreas graft survival rates were 97%, 92.5% and 82%, respectively, with a mean follow‐up of 20 months (range 1–56). Two deaths (one sepsis, one cardiac event) occurred at 1 month after SKPT; both patients died with functioning grafts (DWFG). Three patients (4.5%) had delayed renal allograft function and received temporary dialysis after SKPT. Five kidney graft losses occurred (two DWFG, one thrombosis, two chronic rejection). All but four patients (6%) had immediate PTX function. A total of 12 pancreas graft losses occurred (two DWFG, five thrombosis, five chronic rejection). The incidence of acute rejection was 28%, but no grafts were lost due to isolated acute rejection. The incidence of major infection was 51%, but only five patients (7.5%) developed cytomegalovirus infection. A total of 19 patients (28%) underwent early relaparotomy within 3 months of SKPT. The composite endpoint of no rejection, graft loss, or mortality was attained by 63% of patients. At present, 58 patients (87%) are both dialysis and insulin‐independent (including four retransplants).Conclusion:These findings suggest that SKPT with P‐E drainage and contemporary immunosuppression may result in excellent intermediate‐term outcomes.
Intragraft cytokine mRNA expression in rejecting and non‐rejecting vascularized xenografts
Authors: Lorant Tomas , Krook Henrik , Wilton Jacob , Olausson Michael , Tufveson Gunnar , Korsgren Olle , Johnsson Cecilia 
Published: June 2003

Abstract: Background: The aim of the present study was to further investigate the characteristics of both graft‐infiltrating cells and splenocytes during acute vascular rejection (AVR), cell‐mediated rejection and non‐rejection of vascularized concordant xenografts, by analysing both proinflammatory [interleukin‐1β (IL‐1β) and tumour necrosis factor (TNF‐α)] and more specific [(IL‐2, IL‐4, IL‐10, IL‐12p40 and interferon‐γ (IFN‐γ)] cytokines. A parallel investigation was made of the antibody response of IgM and IgG to the xenografts.Methods: Mouse hearts were heterotopically transplanted to the neck vessels of recipient rats. Grafts, spleens and sera were collected from untreated (AVR) and cyclosporin A (CyA) treated animals on day 2 after transplantation. Organs from rats treated with 15‐deoxyspergualin (DSG) or CyA and DSG in combination were harvested on both day 2 and day 8. Grafts from DSG‐treated rats undergo cell‐mediated rejection and stop beating on day 9 and forth, while CyA + DSG treatment results in long‐term graft survival. Real‐time quantitative reverse transcriptase polymerase chain reaction (RT‐PCR) was applied for analysis of intragraft and splenic cytokine messenger RNA (mRNA) expression. The phenotypes of the graft infiltrating cells were characterized by immunohistochemistry. The antibody response was investigated by means of immunofluorescence, haemagglutination and flow cytometry.Results: All the studied cytokines (IL‐1β, IL‐2, IL‐4, IL‐10, IL‐12p40, IFN‐γ and TNF‐α) were up‐regulated in the grafts from rejecting untreated (day 2) and DSG‐treated animals (day 8) in comparison with grafts from CyA + DSG treated animals (day 8). On day 2 under immunosuppression with CyA, DSG or CyA + DSG no or low cytokine mRNA levels were found. The mRNA levels of IL‐2, IL‐4 and IFN‐γ in the spleens were suppressed under both DSG‐ and CyA + DSG treatment on day 8. Immunofluorescence showed deposits of both IgM and IgG in grafts from untreated, CyA‐treated (day 2) and DSG‐treated (day 8) animals, while CyA + DSG treatment diminished these deposits on both day 2 and day 8. No circulating antibodies were identified in either group.Conclusion: We hereby conclude that both AVR on day 2 and cell‐mediated rejection on day 8 (under DSG treatment) in a concordant cardiac mouse‐to‐rat xenotransplantation model are associated with an increase of proinflammatory cytokines, T helper 1 (Th1)‐associated cytokines as well as IL‐10, while immunosuppression with CyA + DSG diminishes the levels of all examined cytokines. Grafts undergoing AVR or cellular rejection are subjected to deposits of both IgM and IgG, although circulating donor specific antibodies are undetectable in serum.
Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study
Authors: Wachtel Hannes , Schenk Günther , Böhm Sonja , Weng Dietmar , Zuhr Otto , Hürzeler Markus B. 
Published: June 2003

AbstractObjectives: Application of the guided tissue regeneration (GTR) principle and utilization of enamel matrix derivative (EMD) have both been shown to result in periodontal regeneration. While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation, no such information is available for EMD‐treated periodontal defects. It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing.Material and Methods: Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of ≥3 mm participated in the study. At baseline and at 6 and 12 months after surgery, the following clinical parameters were assessed by a blinded examiner: oral hygiene status (API), gingival inflammation (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR). Defects were randomly assigned to test or control treatment, which both consisted of a microsurgical access flap procedure designed for maximum tissue preservation. The exposed root surfaces of the test sites were conditioned with a 24% EDTA gel followed by EMD (Emdogain®) application. Primary flap closure was achieved by a 2‐layered suturing technique. Postoperative healing was evaluated by a newly introduced early wound‐healing index (EHI) at 1 and 2 weeks after surgery.Results: Both test and control treatment resulted in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months, and 3.6 and 1.7 mm at 12 months, respectively (p<0.05). Differences in CAL gain between the two treatment modalities were statistically significant at both time points (p<0.05). Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites, respectively, and did not reach statistical significance (p≥0.05). Two weeks after surgery, primary closure was maintained in 89% of the test sites and in 96% of the control sites.Conclusion: Both treatment modalities using the microsurgical flap procedure resulted in a high percentage of primary flap closure and maximum tissue preservation. In terms of PPD reduction and CAL gain, the combination with EMD application appeared to be superior to the microsurgical access flap alone.
Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study
Authors: Stavropoulos A. , Karring E.S. , Kostopoulos L. , Karring T. 
Published: June 2003

AbstractObjectives: To evaluate whether Bio‐Oss® used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1‐ or 2‐wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio‐Oss® with gentamicin may have an added effect.Material and methods: Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) 7 mm and radiographic evidence of an intrabony component (IC) 4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio‐Oss® impregnated with saline (DBB−), a resorbable membrane in combination with Bio‐Oss® impregnated with gentamicin (DBB+), or with flap surgery (RBF).Results: All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio‐Oss® did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio‐Oss® with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups.Conclusion: The results failed to demonstrate an added effect of Bio‐Oss® implantation in combination with GTR on the healing of deep interproximal 1‐ or 2‐wall, or combined 1‐ and 2‐wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant.
Treatment of peri‐implant infections: a literature review
Authors: Roos‐Jansåker Ann‐Marie , Renvert Stefan , Egelberg Jan 
Published: June 2003

AbstractObjectives: The purpose of the present paper is to review available information on the treatment of peri‐implant mucositis and peri‐implantitis.Materials and Methods: The results of animal research and human studies are presented. Proposed strategies for the treatment of peri‐implantitis presented in the literature are also included.Results: Most of the information accessible at this time derives from case reports. The reports provide evidence that efforts to reduce the submucosal infection may result in short‐term improvements of the peri‐implant lesion. They also indicate that regenerative procedures in intrabony peri‐implant defects can result in the formation of new bone.Conclusions: Several uncertainties remain regarding the treatment of peri‐implantitis. Properly conducted long‐term follow‐ups of consecutively treated cases would seem to be a realistic avenue for accumulation of more information. This may assist in establishing the predictability, magnitude and stability of improvements that can be achieved.
Efficacy of a 0.5% chlorhexidine gel on the control of gingivitis in Brazilian mentally handicapped patients
Authors: Pannuti C. M. , Saraiva M. C. , Ferraro A. , Falsi D. , Cai S. , Lotufo R. F. M. 
Published: June 2003

AbstractObjective: To evaluate the effectiveness of a 0.5% chlorhexidine gel on the reduction of interdental gingival bleeding.Material and Methods: Forty‐three mentally handicapped subjects, living in an institution (Casas André Luiz, Brazil), were enrolled in a double‐blind randomised clinical trial. The subjects were randomly divided into two groups: test (chlorhexidine gel) and control (placebo gel). The gel was applied with trays, twice a day, over a period of 8 weeks. The interdental bleeding index (IBI) was recorded before and after the period in which the gel was used.Results: Statistical analysis showed that baseline IBI scores were similar (p=0.82) for test and control groups (55.6% and 54.5%, respectively). After 8 weeks, a statistically significant (p<0.001) decrease in IBI means took place in the test group (33.2%). The control group presented a small increase (60.6%) in IBI scores. The difference between groups was significant at the end of the study (p<0.001).Conclusion: The results indicated that the use of a 0.5% chlorhexidine gel was effective in reducing interdental gingival bleeding in special patients.
Modulation of androgen metabolism by phenytoin, oestradiol and tamoxifen in human gingival fibroblasts
Authors: Soory M. , Tilakaratne A. 
Published: June 2003

AbstractObjectives: The aim of this investigation is to study androgen metabolism in gingival fibroblasts in response to phenytoin, oestradiol and the antioestrogen tamoxifen, in order to establish the possible role of hormones in the aetiopathogenesis of phenytoin‐induced gingival overgrowth.Materials and Methods: Six cell lines of human gingival fibroblasts were established in monolayer culture in Eagle's minimum essential medium. Duplicate incubations were performed independently with radiolabelled testosterone and 4‐androstenedione, respectively (14C‐T/14C‐4‐A), with optimal concentrations of phenytoin, oestradiol and tamoxifen alone and in combination. At the end of a 24‐h incubation period, the medium was solvent extracted for steroid metabolites, which were separated by thin layer chromatography and quantified using a radioisotope scanner.Results: The substrates were metabolised mainly to the diols, 5α‐dihydrotestosterone (DHT) and 4‐androstenedione or testosterone, with the two substrates used. The trends were that phenytoin and oestradiol significantly elevated the yields of the androgens DHT, diols and 4‐A/testosterone from both substrates while tamoxifen inhibited the stimulatory effects of oestradiol and phenytoin alone and in combination (n=6; p<0.01, one‐way anova).Conclusion: Specific hormone‐mediated activity in response to phenytoin could contribute to the pathogenesis of gingival overgrowth, which can be decreased by the anti oestrogen tamoxifen.
Short‐term epidemic dynamics in the Cakile maritima–Alternaria brassicicola host–pathogen association
Authors: Thrall Peter H. , Burdon J. J. , Bock Clive H. 
Published: June 2003

Summary

Studies combining within‐ and among‐population processes are crucial for understanding ecological and co‐evolutionary dynamics in host–pathogen interactions. We report on work over an 18‐month period involving multiple beach populations of the plant Cakile maritima and its fungal pathogen Alternaria brassicicola along the south‐east coast of Australia.
Results from permanent transects replicated on several beaches show that disease incidence and prevalence vary significantly with plant age, class and distance from the sea, as well as time during the season. Plant density is also positively related to disease levels.
Results from three subregions indicate that disease persistence depends on survival of infected plants behind the foredunes of protected beaches. Population extinction was more likely on beaches with greater wind exposure and sea access, with the latter also related to colonization consistent with the dispersal of Cakile seeds via ocean currents.
Although disease dynamics during the epidemic were similar across subregions, the severity of the epidemic varied significantly among these areas, suggesting that large‐scale environmental factors may influence the timing and development of the epidemic.
Estimates of synchrony in disease dynamics indicated that populations within a subregion were significantly correlated with respect to epidemic development. There was, however, no evidence for spatial synchrony in disease dynamics based on among‐population covariances in disease prevalence and interbeach distances. Populations within a subregion were thus often at quite different phases of the epidemic at any given time.
Absence of association between delayed type hypersensitivity to tuberculin and atopy in children in The Gambia
Authors: Ota M. O. C. , Van Der Sande M. A. B. , Walraven G. E. L. , Jeffries D. , Nyan O. A. , Marchant A. , McAdam K. P. W. J. 
Published: June 2003

SummaryBackground An inverse association between delayed type hypersensitivity to tuberculin and atopy has been observed in children, suggesting that exposure to mycobacteria may influence the immune response to allergens.Objective To investigate the relationship between tuberculin responses and atopy in children living in three different environments in The Gambia.Methods In this cross‐sectional study a total of 507 school‐aged children were recruited from rural, urban poor or urban affluent communities. They were assessed for skin responses to five common allergens and tuberculin, presence of bacille Calmette–Guérin (BCG) scar, presence of intestinal parasites, and total serum IgE. Atopy was defined as the presence of a skin prick test response ≥ 3 × 3 mm to at least one allergen.Results The overall prevalence of atopy was 33% but there was a significant variation among the three study groups. The prevalence of atopy was 22% in urban poor, 36% in urban affluent, and 43% in rural children. Controlling for potential confounding factors, children in the rural community had a significantly higher odds ratio, 3.3 (95% onfidence interval 1.8–6.0) of being atopic than children from the urban poor community. No association between atopy and tuberculin response or BCG scar was observed in any of the three groups. Serum IgE levels were higher among children of the urban poor group but were not associated with tuberculin response or BCG scar in any of the groups.Conclusion Environmental factors have an important influence on the development of atopy in children in The Gambia but delayed type hypersensitivity to tuberculin is not a protective factor.
Pranlukast, a cysteinyl leukotriene receptor 1 antagonist, attenuates allergen‐specific tumour necrosis factor alpha production and nuclear factor kappa B nuclear translocation in peripheral blood monocytes from atopic asthmatics
Authors: Tomari S. , Matsuse H. , Machida I. , Kondo Y. , Kawano T. , Obase Y. , Fukushima C. , Shimoda T. , Kohno S. 
Published: June 2003

SummaryBackground The cysteinyl leukotriene receptor 1 (cysLTR1) antagonists are useful for oral treatment of bronchial asthma. The underlying mechanism of cysLTR1 antagonists on inhibition of inflammatory cytokine production is yet to be determined.Objective The present study was designed to determine the effect of pranlukast, a cysLTR1 antagonist, on production of inflammatory cytokines by allergen‐stimulated peripheral blood monocytes (PBM) from atopic asthmatics.Methods PBM were obtained from normal control (n = 10) and Dermatophagoides farinae (Der f) allergen‐sensitized atopic asthmatics (n = 12), and were cultured in the presence of Der f allergen. The production of TNF‐α and nuclear‐translocation of nuclear factor kappa B (NF‐κB) was determined. In atopic asthmatics, pranlukast, tacrolimus or dexamethasone was added before stimulation by Der f. The additive effect of pranlukast and dexamethasone was also determined.Results PBM from atopic asthmatics cultured with Der f exhibited a significant increase in TNF‐α production and nuclear translocation of NF‐κB compared with normal control (P < 0.01). Pranlukast, tacrolimus and dexamethasone significantly inhibited production of TNF‐α and nuclear‐translocation of NF‐κB in PBM of atopic asthmatics (P < 0.01). An additive effect of pranlukast on low‐dose dexamethasone was also demonstrated. However, LTD4 did not induce TNF‐α production or NF‐κB nuclear translocation.Conclusion Our results suggest that pranlukast may inhibit TNF‐α production via suppression of NF‐κB activation through pathways distinct from cysLTR1 antagonism.
Lipoteichoic acid from Staphylococcus aureus enhances allergen‐specific immunoglobulin E production in mice
Authors: Matsui K. , Nishikawa A. 
Published: June 2003

SummaryBackground Our previous study demonstrated that lipoteichoic acid (LTA) from Staphylococcus aureus induced T helper type 2 (Th2)‐prone dermatitis resembling that seen in atopic dermatitis (AD) patients in mice sensitized percutaneously with an allergen. However, the effects of LTA on allergen‐specific IgE production in such sensitized mice have not been elucidated.Objective The purpose of this study was to determine the effects of LTA from S. aureus on allergen‐specific IgE production in mice sensitized percutaneously with a house dust mite antigen (MA).Methods Mice were sensitized with a single topical application of MA and/or LTA to barrier‐disrupted abdominal skin. One to 5 weeks later, MA‐specific IgE antibodies in sera from sensitized mice were detected by an enzyme‐linked immunosorbent assay (ELISA). Expression of B7.1 (CD80), B7.2 (CD86) and CD40L molecules by CD40‐positive (CD40+) and CD4‐positive (CD4+) cells in the lymph nodes of sensitized mice were analysed by flow‐cytometry (FACS).Results Simultaneous sensitization with MA and LTA increased IgE production 3 weeks later, significantly more than sensitization with MA alone. FACS analysis of CD40+ cells in the lymph nodes from sensitized mice showed that simultaneous sensitization with MA and LTA did not enhance CD80‐ or CD86‐expression by antigen‐presenting cells such as B lymphocytes and dendritic cells more than sensitization with MA alone. However, analysis of CD4+ cells in the lymph nodes showed that simultaneous sensitization with MA and LTA increased the number of CD40L‐expressing Th cells more than sensitization with MA alone.Conclusion These results suggest that LTA enhances allergen‐specific IgE production by a mechanism associated with up‐regulation of CD40L‐expressing Th cells and this might explain the role of skin colonization with S. aureus in AD patients.