bluuebunny/crossref_metadata_2025_split huggingface dataset:
Irritable bowel syndrome – an evidence‐based approach to diagnosis
Authors: Cash B. D. , Chey W. D. 
Published: June 2004

SummaryIrritable bowel syndrome (IBS) represents one of the most common reasons for primary care visits and consultation with a gastroenterologist. It is characterized by abdominal discomfort, bloating and disturbed defecation in the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic gastrointestinal disease. IBS is a costly disorder, responsible for significant direct and indirect costs to patients and society. Much of the cost attributed to IBS arises from the time and resources used to establish the diagnosis. Historically IBS has been viewed by many as a diagnosis of exclusion rather than as a primary diagnosis, and many patients with typical symptoms will undergo an extensive array of diagnostic tests and procedures prior to the eventual diagnosis of IBS.Recent reviews addressing the management of such patients have cast doubt on the necessity for this degree of testing. Current best evidence does not support the routine use of blood tests, stool studies, breath tests, abdominal imaging or lower endoscopy in order to exclude organic gastrointestinal disease in patients with typical IBS symptoms without alarm features. Serological testing for celiac sprue in this population may eventually prove useful but validation of studies indicating an increased prevalence of this disease in patients with suspected IBS is needed.The development and refinement of symptom‐based criteria defining the clinical syndrome of IBS has greatly facilitated the diagnosis of this condition, which can be confidently diagnosed through the identification of typical symptoms, normal physical examination and the exclusion of alarm features. The presence of alarm features or persistent non‐response to symptom‐directed therapies should prompt a more detailed diagnostic evaluation dictated by the patient's predominant symptoms.
Influence of a lipase inhibitor on gastric sensitivity and accommodation to an orally ingested meal
Authors: Demarchi B. , Vos R. , Deprez P. , Janssens J. , Tack J. 
Published: June 2004

SummaryBackground : Intraduodenal administration of lipids, through lipid digestion and release of cholecystokinin (CCK), induces viscero‐visceral reflexes that affect gastric tone and sensitivity. It is unclear whether the same mechanisms control gastric function after an orally ingested meal.Aim : To evaluate the effect of orlistat, a selective lipase inhibitor, on gastric response to an orally administered meal.Methods : Eighteen healthy volunteers participated in this study. They were treated for 5 days with orlistat (120 mg) or placebo t.d.s. in a double‐blind randomized crossover design. During treatment, all subjects underwent a gastric barostat study, measurement of plasma CCK levels and a satiety drinking test.Results : Although CCK plasma levels were significantly decreased, pre‐treatment with orlistat failed to affect gastric compliance (72 ± 6 mL/mm Hg and 64 ± 6 mL/mm Hg, NS), gastric sensitivity (discomfort threshold 12.2 ± 0.6 mm Hg vs. 10.9 ± 0.6 mm Hg above minimal distending pressure, NS) or gastric accommodation (172 ± 41 mL vs. 206 ± 49 mL, NS) to an orally ingested meal. Furthermore, orlistat pre‐treatment had no significant effect on the amount of calories ingested during a satiety drinking test (1329 ± 88 kcal vs. 1217 ± 115 kcal, NS).Conclusion : Administration of a lipase inhibitor does not affect gastric compliance, sensitivity to distension and accommodation to an orally ingested meal, and does not influence meal‐induced satiety.
Patient–physician discordance about benefits and risks in gastroenterology decision‐making
Authors: Sonnenberg A. 
Published: June 2004

SummaryAims : To illustrate the characteristics of situations in gastroenterology when patients and physicians harbour different perspectives of medical costs and benefits, and how such different perspectives affect the outcome of medical decision‐making.Methods : Two exemplary scenarios are presented, in which threshold analysis yields different results depending on the varying values assigned to identical medical events. The occurrence of varying values is subsequently phrased in economical terms of varying utility functions that characterize patient vs. physician behaviour.Results : Safety and therapy are the two major preferences that determine patient and physician utility functions. Patients and physicians make medical decisions based on two different utility functions. In comparison with their patients, gastroenterologists are more concerned with safety and inclined to spend more health care resources on safety than therapy because safety and the occurrence of medical complications affect their own professional status. In trying to maximize their own utility, gastroenterologists tend to spend more resources on safety than the patient him/herself might have spent given a free choice of management options.Conclusions : In instances of potential complications associated with risky medical interventions, patients may receive less medical therapy in exchange for more procedural safety.
The evolution to stool DNA testing for colorectal cancer
Authors: Tagore K. S. , Levin T. R. , Lawson M. J. 
Published: June 2004

SummaryDespite a variety of screening strategies and recent trends showing death rate stabilization, colorectal cancer still remains the second leading cause of overall cancer death. Current screening tools suffer from performance limitations, low patient acceptability, and marginal reliable access within the health care system. Noninvasive strategies present the lowest risk with the highest potential for patient satisfaction. However, serious implementation barriers exist requiring consistent programmatic screening, strict patient adherence, and poor sensitivity for adenomas. Colonoscopy remains an invasive screening test with the best sensitivity and specificity, but faces large financial costs, manpower requirements, patient access and adherence. Development of advanced molecular techniques identifying altered DNA markers in exfoliated colonocytes signify early or precancerous growth. Stool‐based DNA testing provides an entirely noninvasive population‐based screening strategy which patients can perform easier than faecal occult blood testing (FOBT). Large‐scale prospective randomized control trials currently pending should help characterize accurate test performance, screening intervals, cost‐effectiveness, direct comparison to FOBT and analysis of patient adherence. As tumour development pathways and potential target genes are further elucidated, refinements in multi‐assay stool‐based DNA testing portend enhanced test characteristics to detect and treat this genetically heterogeneous disease.
The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy
Authors: El‐Serag H. B. , Aguirre T. , Kuebeler M. , Sampliner R. E. 
Published: June 2004

SummaryBackground : The length of Barrett's oesophagus seems to correlate well with indicators of severe gastro‐oesophageal reflux disease. However, it remains unknown whether prior acid suppressive therapy affects the length of newly diagnosed Barrett's oesophagus.Methods : A retrospective analysis of a well‐characterized large cohort of patients with Barrett's oesophagus diagnosed between 1981 and 2000.Aim : To compare the length of Barrett's oesophagus between patients who received acid suppressive therapy prior to their diagnosis to those who did not receive such therapy. Pharmacy records were obtained from Department of the Veterans Affairs computerized records and prospectively collected research records. We further examined the association between prior use of acid suppressive therapy and the length of Barrett's oesophagus in correlation analyses, as well as multivariate linear regression analyses while adjusting for differences in year of diagnosis, age, gender, ethnicity, and the presence of intestinal metaplasia of the gastric cardia.Results : There were 340 patients with Barrett's oesophagus first diagnosed between 1981 and 2000. The average length of Barrett's oesophagus at the time of first diagnosis was 4.4 cm (range: 0.5–16). Of all patients, 139 (41%) had prior use of histamine‐2 receptor antagonists, or proton‐pump inhibitors (41 used both), and 201 (59%) used neither prior to the diagnosis of Barrett's oesophagus. The mean length of Barrett's oesophagus was significantly shorter in patients with prior use of proton‐pump inhibitors (3.4 cm) or proton‐pump inhibitors and histamine‐2 receptor antagonists (3.1 cm) when compared to those with none of these medications (4.8 cm). In the multivariate linear regression model, the prior use of proton‐pump inhibitors or either proton‐pump inhibitors or histamine‐2 receptor antagonists was an independent predictor of shorter length of Barrett's oesophagus (P = 0.0396).Conclusions : The use of acid suppressive therapy among patients is associated with a reduction in the eventual length of newly diagnosed Barrett's oesophagus with gastro‐oesophageal reflux disease. This finding is independent of the year of diagnosis or demographic features of patients. Further studies are required to confirm this finding.
The needs of physically disabled young people during transition to adult services
Authors: Ko B. , McEnery G. 
Published: June 2004

AbstractObjectives  The needs and provisions for health service and housing adaptation of a cohort of school leavers with physical disabilities in two inner city London health districts are described in this cross‐sectional study.Methods  Fourteen young people were assessed by two consultant community paediatricians during their last year at school, using a structured proforma that includes the British Association of Community Child Health standards of functional levels.Results  Great difficulty was encountered in identifying the subjects, partly because of inadequate information systems. Only 16 were identified out of over 12 000 school leavers. Important discrepancies were found between the needs assessed and the services provided. For the total sample, the need for 49 potential referrals to adult specialist services was identified, but 17 were not made as such services did not exist, in contrast to what had been available within paediatric services. Adult physiotherapy and occupational therapy services were particularly under‐provided for young people with physical disabilities. Only a minority were eligible for housing adaptations.Conclusions  Suggestions are made for improvements in information systems, the transition process, revised provision of services and closer involvement of general practitioners.
Implications for the development of children in over 11 hours of centre‐based care
Authors: Anme T. , Segal U. A. 
Published: June 2004

AbstractBackground  With increasing numbers of women joining the evening/night‐time and extended‐hour workforce, there is a need for quality childcare during these hours. This project, conducted in Japan, sought to compare the effects of expanded childcare on the development and adaptation of 648 young children after 2 years in care.Method  All parents in 41 governmentally licensed child care facilities in Japan completed a survey on the child‐rearing environment at home, their feelings of self‐efficacy, and the presence of support for childcare to provide a baseline of information. Two years later, 648 of these parents were surveyed again. Childcare professionals evaluated the development of children at both times.Results and discussion  The results of multiple regression analysis indicate that factors in the home environment, not length of centre‐based care, explained developmental risks 2 years later.
Childhood injury prevention advice: a survey of health professionals responses to common scenarios
Authors: Tomlinson R. , Sainsbury C. 
Published: June 2004

AbstractAim  To determine the responses of health professionals when asked at what age a child could safely engage in a number of common activities and scenarios.Methods  Eleven scenarios reflecting everyday activities were adapted from the BBC book Play it Safe. Questionnaires were completed by a convenience sample of health professionals. Respondents were asked to give the minimum age they felt a child could safely engage in each of the activities. The literature was searched for an evidential basis for answers to the activities and scenarios posed.Results  A total of 215 questionnaires were completed. For all questions there was a spread in responses of at least 9 years. Recommended answers were found in the literature for six of the scenarios, however, in only four of these was this confirmed to have an evidential basis. Fifty‐four per cent of responses were at least 2 or more years from these recommended answers.Discussion  Injury prevention advice needs to be consistent and, where possible, evidentially based. Health professionals often need to rely on their own opinions to provide advice. This survey shows opinions vary and highlights the need for evidence‐based guidelines for parents and professionals.
Histopathological evaluation of 0‐h biopsy specimens of donor kidney procured by laparoscopic donor nephrectomy
Authors: Shimizu T , Tanabe K , Ishida H , Toma H , Yamaguchi Y 
Published: June 2004

Abstract:  We evaluated the histopathology of donor kidneys procured by laparoscopic donor nephrectomy (LDN), by examining allograft biopsy specimens obtained immediately after donor nephrectomy (0‐h biopsies).Materials and methods:  LDN was performed on 65 donors between December 1999 and November 2002, in our institution. Their mean age was 56 years, and there were 19 males and 46 females. Hand‐assisted LDN (HALDN) was used in 10 cases and retroperitoneal LDN (RPLDN) in 55 cases. Allograft biopsy of all 65 kidneys was performed immediately after LDN (0‐h biopsy), and the biopsy specimens were used in this study. All specimens were routinely examined by light and immunofluorescence microscopy. The 43 donors who underwent traditional open donor nephrectomy (ODN) between January 2001 and June 2001 served as controls.Results:  There was no significant difference in the rate of glomerular sclerosis and moderate interstitial fibrosis with tubular atrophy, the severity of arteriosclerosis, and the severity of arteriolar hyalinosis among the specimens from kidneys removed by the three different methods: HALDN, RPLDN, and ODN. Prominent and characteristic histopathological changes which are not usually seen in 0‐h biopsy specimens of kidneys obtained by traditional ODN were ‘subcapsular cortical damage (SCCD) with capsular lesions (CL)’. The SCCD with CL changes included a subcapsular degeneration and necrosis of tubular cells and a congestion of glomerular and peritubular capillaries (SCCD) associated with haemorrhage and fibrin deposits in the renal capsule (CL). In this study, such characteristic ‘SCCD with CL’ findings were observed in 35 specimens (54%). The damage was much milder in donor kidneys procured by RPLDN than by HALDN.Conclusion:  SCCD with CL occurred in donor kidneys procured by LDN, which may be due to a compression of the renal parenchyma and veins. RPLDN may be better method for donor nephrectomy.
Central nervous system infection due to Penicillium chrysogenum
Authors: Kantarcıoğlu A. S. , Apaydın H. , Yücel A. , De Hoog G. S. , Samson R. A. , Vural M. , Özekmekçi S. 
Published: June 2004

Summary Penicillium chrysogenum was isolated from three subsequent cerebrospinal fluid (CSF) specimens of a 73‐year‐old male patient without immunological compromise. The isolated was tested against five antifungal agents according to the NCCLS M38‐P macrodilution method. MICs were determined as follows: amphotericin B (AMB), 2 μg ml−1; fluconazole (FLZ), 8 μg ml−1; itraconazole (ITZ), 1 μg ml−1; flucytosine (5FC), 0.125 μg ml−1; and terbinafine (TRB), 0.06 μg ml−1. The patient has been cured with FLZ.
Agar sublimation test for the in vitro determination of the antifungal activity of morpholine derivatives
Authors: Polak A. , Jäckel A. , Noack A. , Kappe R. 
Published: June 2004

SummaryWe studied the in vitro antifungal activities of a wide range of antimycotic agents, including amorolfine, terbinafine, naftifine, five morpholine derivatives, ciclopiroxolamine, bifonazole, clotrimazole, ketoconazole, itraconazole, fluconazole, voriconazole, flucytosine, amphotericin B, nystatin, and caspofungin, against Candida albicans and Trichophyton rubrum by conventional agar diffusion tests and by a novel sublimation method. For the sublimation method, 6 mm filter paper disks were soaked with defined amounts of antimycotic drugs, air dried, placed in the center of the lids of 9 cm Petri dishes, and incubated upside down with inoculated agar plates 10 mm above the disks. The conventional disk diffusion tests produced inhibition zones as previously described. The disk sublimation tests produced large inhibition zones with amorolfine, five amorolfine derivatives, and terbinafine, but with none of the other antifungal agents. Possible therapeutic advantages of agents, which are able to overcome air cavities in mycotic lesions, e.g. in onychomycosis, are discussed.
Candida albicans‐induced inflammatory response in human keratinocytes
Authors: Wollina U. , Künkel W. , Bulling L. , Fünfstück C. , Knöll B. , Vennewald I. , Hipler U.‐C. 
Published: June 2004

Summary Candida albicans strains 3153a, ATCC 48867, CBS 2730, DSM 70014, and Vir 13 were cultivated and sterile C. albicans filtrates were produced. The interaction of soluble Candida factors of these infiltrates with human HaCaT keratinocytes was assayed in vitro. The following parameters were analyzed: cell proliferation, protein synthesis, nuclear matrix protein (NMP) 41 release, cytokine release (IL‐1β, soluble IL‐2 receptor, IL‐6, and IL‐8), and reactive oxygen species (ROS). Cell counts at 1, 12, and 24 h were significantly lower for C. albicans strains CBS 2730 and VIR 13 (P < 0.05). There was no significant change for the remaining strains. Neither the protein synthesis nor the NMP‐41 release was significantly affected. IL‐6 and IL‐8 were stimulated by C. albicans filtrates to different amounts with higher levels in strains of low virulence. There was no effect on the other cytokines. The production of ROS by HaCaT keratinocytes was suppressed. The induction of an inflammatory keratinocyte response by soluble C. albicans factors may play a role among the host–yeast interactions.
Fungal peritonitis at a tertiary care community teaching hospital: epidemiology, treatments, and outcome over a 3 year timespan*
Authors: Almoujahed M. O. , Riederer K. , Baran J. 
Published: June 2004

SummaryFungal species isolated from the peritoneal cavity over a 3‐year period were equally divided among dialysis and intra‐abdominal sources and demonstrated that triazole antifungal susceptible species predominated. The evolution toward triazole‐resistant species/strains noted in bloodstream infections has not yet developed in fungal peritonitis. A trend toward non‐albicans species in continuous ambulatory peritoneal dialysis (CAPD) cases, however, requires careful monitoring.
Etiology of tinea capitis in Athens, Greece – a 6‐year (1996–2001) retrospective study
Authors: Frangoulis E. , Athanasopoulou B. , Katsambas A. 
Published: June 2004

SummaryA total of 577 patients with tinea capitis have been diagnosed at the Mycology laboratory of ‘A. Sygros’ Hospital of Skin and Venereal Diseases, Athens, Greece between 1996 and 2001. From these patients, 100 were immigrants from Balkan, Near East and African countries. The vast majority of the patients (95%) were children, mainly at preschool and school age and only 5% were adults. Zoophilic dermatophytes accounted for 86.5% followed by anthropophilic (12.4%) and geophilic (1.2%) dermatophytes. The majority of anthropophilic infections (59.5%) were recorded in the sub‐population of immigrants. Microsporum canis (84.5%) was the main etiologic agent.
Keratinophilic fungi on feathers of pigeon in Maharashtra, India
Authors: Deshmukh S. K. 
Published: June 2004

SummaryResults of a preliminary survey of keratinophilic fungi associated with feathers of pigeon on high rise buildings in Thane district of Maharashtra (India) are reported. A total of 100 samples were examined, of which 67 samples were positive for keratinophilic fungi. Altogether 67 fungal strains belonging to 10 species of seven genera were isolated viz. Chrysosporium indicum (24%), Chrysosporium sp. (2%), Chr. tropicum (8%), Chrysosporium state of Arthroderma tuberculatum (3%), Chrysosporium state of Ctenomyces serratus (15%), Malbranchea pulchella (3%), Malbranchea sp. (1%), Microsporum gypseum (5%), Myriodontium keratinophilum (2%) and Trichophyton terrestre (4%).
Goodness Beyond Speech
Authors: Segal Alex 
Published: June 2004

AbstractThe article addresses Raimond Gaita's attempt to construe the ethical in terms of a notion of speech that is tied to presence (each of us, he holds, is called to become someone ‘authentically present in speech and deed’ (Gaita 1991, p. 145)), a notion through which he articulates a sense both of human uniqueness – speech demands that one find one's own words – and of human fellowship: to find one's words is to achieve the depth that enables one to be taken seriously by others. The article argues, however, that the notion of speech is caught in a double bind; for it requires a spontaneity that is incompatible with the self‐presence that it also requires. In a way that Gaita cannot acknowledge, goodness is beyond speech.
The End(s) of Philosophy: Rhetoric, Therapy and Wittgenstein's Pyrrhonism
Authors: Plant Bob 
Published: June 2004

AbstractIn Culture and Value Wittgenstein remarks: ‘Thoughts that are at peace. That's what someone who philosophizes yearns for’. The desire for such conceptual tranquillity is a recurrent theme in Wittgenstein's work, and especially in his later ‘grammatical‐therapeutic’ philosophy. Some commentators (notably Rush Rhees and C. G. Luckhardt) have cautioned that emphasising this facet of Wittgenstein's work ‘trivialises’ philosophy – something which is at odds with Wittgenstein's own philosophical ‘seriousness’ (in particular his insistence that philosophy demands that one ‘Go the bloody hard way’). Drawing on a number of correlations between Wittgenstein's conception of philosophy and that of the Pyrrhonian Sceptics, in this paper I defend a strong ‘therapeutic’ reading of Wittgenstein, and show how this can be maintained without ‘trivialising’ philosophy.
Progenitor cell activation in chronic viralhepatitis
Authors: Fotiadu Anastasia , Tzioufa Valentini , Vrettou Eleni , Koufogiannis Dimitrios , Papadimitriou Constantine S. , Hytiroglou Prodromos 
Published: June 2004

Abstract: Background/Aim: Oval cell proliferation is known to occur in experimental models of hepatic regeneration and carcinogenesis. Recent studies have suggested that activation of progenitor cells, representing the human counterpart of oval cells, may play a role in hepatic diseases. Therefore, we evaluated putative progenitor cells in chronic viral hepatitis.Methods: Forty‐one needle liver biopsy specimens from patients with chronic hepatitis B and 43 specimens from patients with chronic hepatitis C were examined histologically. The grade (histological activity index (HAI)) and stage (degree of fibrosis) were determined on routinely stained sections. The number of progenitor cells was assessed semiquantitatively on cytokeratin 7‐ (CK 7‐) stained sections.Results: In both aetiological categories of chronic viral hepatitis, progenitor cell numbers were found to increase in parallel to the HAI, as well as to the stage of disease. Features suggestive of hepatocytic differentiation of progenitor cells were also noted on immunohistochemical stains for CK 7 and ‘hepatocyte‐specific’ antigen.Conclusions: In chronic hepatitis B and chronic hepatitis C, progenitor cell activation is correlated with the grade and stage of disease. Proliferating progenitor cells may play a role in hepatic regeneration occurring in this setting.