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At least 55 records · Page 3Linked to original sources
PubMed2000

Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication.

Toupet (270 degrees) fundoplication is commonly recommended for patients with gastroesophageal reflux (GER) and esophageal dysmotility. However, Toupet fundoplication may be less effective at protecting against reflux than Nissen (360 degrees) fundoplication. We therefore compared the effectiveness and durability of both types of fundoplication as a function of preoperative esophageal motility. From January 1992 through January 1998, 669 patients with GER underwent laparoscopic fundoplication (78 Toupet, 591 Nissen). Patients scored heartburn, regurgitation, and dysphagia preoperatively, and at 6 weeks and 1 year postoperatively, using a 0 ("none") to 3 ("severe") scale. We compared symptom scores (Wilcoxon rank sum test) and redo fundoplication rates (Fisher exact test) in Toupet and Nissen patients. We also performed subgroup analyses on 81 patients with impaired esophageal motility (mean peristaltic amplitude, <30 mm Hg or peristalsis <70% of wet swallows) and 588 patients with normal esophageal motility. Toupet and Nissen patients reported similar preoperative heartburn, regurgitation, and dysphagia. At 6 weeks after operation, heartburn and regurgitation were similarly improved in both groups, but dysphagia was more prevalent among Nissen patients. After 1 year, heartburn and regurgitation were re-emerging in Toupet patients, and dysphagia was again similar between groups. Patients with impaired motility who have Nissen fundoplication are no more likely to suffer persistent dysphagia than their counterparts who have Toupet fundoplication. In addition, patients with normal motility are more likely to develop symptom recurrence after Toupet fundoplication than Nissen fundoplication, with no distinction in dysphagia rates. We conclude that since Toupet patients suffer more heartburn recurrence than Nissen patients, with similar dysphagia, selective use of Toupet fundoplication requires further study.

Deglutition Disorders↗
PubMed1998

Fatal pleomorphic xanthoastrocytoma with meningeal gliomatosis.

AIMS: To report the previously undescribed phenomenon of extensive meningeal gliomatosis in a pleomorphic xanthoastrocytoma (PXA) and to examine possible prognostic features. CASE DETAILS: An 11-year-old girl underwent excision of a left temporoparietal pleomorphic xanthoastrocytoma and 8 months later underwent re-excision of a local tumour recurrence. Although mitoses were not present in any of the resection specimens, the development of necrosis and increased immunoreactivity for proliferating cell nuclear antigen (PCNA) indicated anaplastic transformation in the recurrent tumour. Three months later extensive meningeal gliomatosis with minimal local recurrence resulted in death. CONCLUSIONS: Subarachnoid dissemination of a locally recurrent PXA in the absence of mitotic activity is an extremely unusual occurrence. PCNA expression in the initial excision specimens did not predict subsequent anaplastic transformation.

Astrocytoma↗
PubMed1998

Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results.

Primarily because of the lack of highly accurate preoperative localizing studies, the standard operation for primary hyperparathyroidism (HPTH) has consisted of bilateral neck exploration with examination of all four parathyroid glands. Recent experience with the technetium-99m-Sestamibi scan at our hospital has suggested that this single test was now accurate enough to allow unilateral neck exploration. This study was designed to examine the efficacy and safety of minimally invasive parathyroid-ectomy in select patients with a single adenoma demonstrated on a preoperative sestamibi. Eighteen consecutive patients with primary HPTH in whom a sestamibi scan suggested a single adenoma underwent unilateral neck exploration through a 2.5-cm incision, which was extended as necessary. Results were compared to the preceding 25 parathyroid explorations for primary HPTH due to a single adenoma, which were nondirected and included bilateral neck exploration. All patients undergoing minimal exploration were found to have a single adenoma and demonstrated a normal serum calcium within 24 hours of surgery. Standard bilateral exploration failed to locate the adenoma in one patient requiring subsequent re-exploration. Operative time, incision length, and length of hospital stay were all significantly less for those undergoing minimal exploration (all P < 0.01). There were no complications in either group. Minimally invasive neck exploration is a safe and effective treatment for primary HPTH, is easily accomplished under local anesthesia, and is associated with significant reductions in operative time and hospital stay. Limited exploration provides a better cosmetic result while decreasing the potential complications of bilateral exploration, but is dependent upon a high-quality sestamibi scan.

Adenoma↗
PubMed2001

Gut blood flow in fish during exercise and severe hypercapnia.

This paper reviews the effects of exercise and hypercapnia on blood flow to the splanchnic circulation. Brief struggling behaviours are known to decrease blood flow to the gut (GBF). Likewise, prolonged swimming in unfed fish has been shown to reduce GBF in proportion to the increased oxygen uptake. Therefore, the normal postprandial increase in GBF theoretically should be impaired whenever fish are active. However, indirect evidence suggests that GBF is spared to some degree when fed fish swim continuously but at a cost (10-15%) to their critical swimming speed. Severe respiratory acidosis can be created by the new intensive aquaculture settings that use oxygen injection into re-circulated water. The only study so far to examine the effects of severe hypercapnia on GBF and its regulation showed that routine GBF and alpha-adrenergic control of GBF remained normal in unfed white sturgeon (Acipenser transmontanus). However, severe hypercapnia produced a hyperactive state and increased sensitivity of GBF to struggling. As a result, routine GBF was maintained for a short period of time. Thus, environmental changes such as severe hypercapnia can indirectly impact GBF through altered struggling behaviour, but the implications of the overall reduction in GBF to food assimilation have yet to be established.

Animals↗
PubMed1982

Duration of pulmonary function adaptation to ozone in humans.

The duration of pulmonary function adaptation subsequent to cessation of a 5-day repeated ozone (O3) exposure was studied in 24 nonsmoking human subjects. A three-week, 3 hr/day study was conducted. The subjects received filtered air on Week 1 and 0.4 ppm O3 on Week 2. During Week 3, 13 subjects were re-exposed to O3 on Friday and 11 were re-exposed to O3 on Tuesday. Spirometric measurements (FVC and FEV1) and bronchial reactivity to methacholine showed adaptation within 2-3 days of the repeated daily exposures (Week 2). Although the duration of adaptation seen with bronchial reactivity appears longer than 7-days, the FVC and FEV1 clearly demonstrated complete loss of adaptation by 7 days, with a trend toward significance by 4 days. We conclude, therefore, the loss of ozone adaptation in pulmonary function is a gradual phenomenon lasting less than 7 days following cessation of repeated daily exposures.

Adaptation, Physiological↗
PubMed1981

Availability to pigs of amino acids in cereal grains. 2. Apparent and true ileal availability.

1. Pigs prepared with re-entrant ileal cannulas were used to determine the ileal availability of amino acids in nine cereal grains including five wheats, sorghum (Sorghum vulgare Pers.), maize, barley and Triticale. 2. The average true availability of amino acids in these grains was 0.88 but there were consistent differences in availability among amino acids. Generally, lysine and threonine were among the least available amino acids while glutamic acid and arginine were among the most available amino acids in cereal protein. 3. There was much variation in amino acid availability within a grain species (wheat) as among the other grains.

Amino Acids↗
PubMed1989

Workers' perceptions of discrepancies between chronological age and personal age: you're only as old as you feel.

A large manufacturing organization was surveyed to determine whether workers perceive discrepancies between their chronological ages and the ages they "feel" themselves to be. A substantial proportion (61.5%) of the sample did report such discrepancies. Feeling "younger than one's years" was reported significantly more frequently than feeling "older than one's years"; the mean magnitude of discrepancies was 5.6 years. However, age of respondent affected both the magnitude and the direction of perceived discrepancies. Younger respondents were more likely to perceive themselves as older than their chronological ages, and older respondents were more likely to report that they felt themselves to be younger than their chronological ages. The implications of these observations for the understanding and measurement of subjective age and other age-related variables is discussed.

Adolescent↗
PubMed1992

Early-life food restriction of broiler chickens. I. Methods of application, amino acid supplementation and the age at which restrictions should commence.

1. Three experiments were performed to examine practical methods of early-life food restrictions and to examine the influence of increased dietary lysine or methionine on bodyweight recovery during re-alimentation in broiler chickens. 2. Food intake of broiler chicks was restricted quantitatively or by dietary dilution at 3 ages and the birds slaughtered at 49 d of age. The success of each food restriction was measured in terms of bodyweight recovery and body fat content. 3. Discontinuous food restriction and restriction by dietary dilution produced similar effects to a previously established food restriction regime. Bodyweight recovery was complete and fat contents depressed. FCR was inconsistently affected. 4. Supplementation of the finisher diet with lysine and/or methionine produced no conclusive results when this diet was fed to broilers previously subjected to early-life food restriction.

Adipose Tissue↗
PubMed2003

Eosinophilic-lymphocytic myocarditis after smallpox vaccination.

Smallpox is an eradicated viral disease that has re-emerged as a potential bioterrorism threat. Smallpox vaccination was historically the most effective defence measure against wild smallpox virus. The risk of myopericarditis after vaccination might limit this option. We report a case of biopsy-proven eosinophilic-lymphocytic myocarditis diagnosed in vivo with histological evidence for eosinophil-mediated cardiac myocyte necrosis shortly after smallpox vaccination. Furthermore, we report a beneficial haemodynamic response to high-dose corticosteroids. A better understanding of the aberrant immune mechanism of myocyte injury after smallpox vaccination might improve the risk/benefit assessment for people considering smallpox vaccination and better smallpox vaccines in the future.

Adult↗
PubMed2001

Acute humoral rejection in renal allograft recipients: I. Incidence, serology and clinical characteristics.

BACKGROUND: Acute rejection (AR) associated with de novo production of donor-specific antibodies (DSA) is a clinicopathological entity that carries a poor prognosis (acute humoral rejection, AHR). The aim of this study was to determine the incidence and clinical characteristics of AHR in renal allograft recipients, and to further analyze the antibodies involved. METHODS: During a 4-year period, 232 renal transplants (Tx) were performed at our institution. Assays for DSA included T and B cell cytotoxic and/or flow cytometric cross-matches and cytotoxic antibody screens (PRA). C4d complement staining was performed on frozen biopsy tissue. RESULTS: A total of 81 patients (35%) suffered at least one episode of AR within the first 3 months: 51 had steroid-insensitive AR whereas the remaining 30 had steroid-sensitive AR. No DSA were found in patients with steroid-sensitive AR. In contrast, circulating DSA were found in 19/51 patients (37%) with steroid-insensitive AR, and widespread C4d deposits in peritubular capillaries were present in 18 of these 19 (95%). In at least three cases, antibodies were against donor HLA class II antigens. DSA were not found in the remaining 32 patients but C4d staining was positive in 2 of 32. The DSA/C4d positive (n=18) and DSA/C4d negative (n=30) groups differed in pre-Tx PRA levels, percentage of re-Tx patients, refractoriness to antilymphocyte therapy, and outcome. Plasmapheresis and tacrolimus-mycophenolate mofetil rescue reversed rejection in 9 of 10 recipients with refractory AHR. CONCLUSION: More than one-third of the patients with steroid-insensitive AR had evidence of AHR, often resistant to antilymphocyte therapy. Most cases (95%) with DSA at the time of rejection had widespread C4d deposits in peritubular capillaries, suggesting a pathogenic role of the circulating alloantibody. Combined DSA testing and C4d staining provides a useful approach for the early diagnosis of AHR, a condition that often necessitates a more intensive therapeutic rescue regimen.

Acute Disease↗
PubMed1985

Regulation of gene expression in Tetrahymena pyriformis under heat-shock and during recovery.

Proteins extracted from Tetrahymena pyriformis cells, which were shifted from 28 degrees C to 34 degrees C (heat-shocked) and then labelled with [35S]-methionine, were analysed by two-dimensional gel electrophoresis according to the method of O'Farrell. In the fluorogram obtained after 2.5 min heat-shock new polypeptide spots already appear in the region of 70-75 kDa and 25-29 kDa, indicating that the induction response is very rapidly triggered. Other newly induced proteins become more intense after 15 min and 30 min of heat-shock. After a 60-min treatment, the electrophoretic analysis shows the normal pattern of proteins resembling that of exponentially growing cells. Our experiments in vivo and in vitro also show that the messengers coding for stress proteins have a short lifetime, suggesting that modulation of the translation efficiency of heat-shock protein mRNAs is accompanied by an alteration in their biological stability. Studies using the inhibitor actinomycin D suggest that control of this response is exercise mainly at the transcriptional level for the 70-75-kDa and at the translational level for the 25-29-kDa heat-shock proteins. When T. pyriformis cells are allowed to recover at 28 degrees C the heat-shock proteins disappear completely and normal protein synthesis is completely re-established. Although the level of normal protein synthesis attained is lower, cells are able to recover completely from heat-shock when new mRNA synthesis is blocked by actinomycin D, indicating a conservation of normal pre-existing mRNAs during heat-shock.

Animals↗
PubMed2000

Focal upper limb neuropathy in a child.

A 9-year-old girl presented with a 4-week history of right upper limb weakness. Clinical assessment and neurophysiological studies suggested an atypical brachial plexitis. She re-presented 3 1/2 years later with progressive muscle weakness involving both legs and left arm and hand. There had been no interval improvement in her right upper limb. Clinical, neurophysiological and pathological findings were consistent with chronic inflammatory demyelinating polyneuropathy. She responded to a single course of intravenous immunoglobulin--and review more than 6 years after treatment confirms that she remains functionally normal. Focal upper limb neuropathy preceding a diffuse demyelinating process by several years has not been previously described in a child. Long-term follow-up of this patient allows us to comment on the natural history of her condition and the apparent long-term efficacy of intravenous immunoglobulin in this case.

Arm↗
PubMed2006

Oxidant enhancement in martian dust devils and storms: implications for life and habitability.

We investigate a new mechanism for producing oxidants, especially hydrogen peroxide (H2O2), on Mars. Large-scale electrostatic fields generated by charged sand and dust in the martian dust devils and storms, as well as during normal saltation, can induce chemical changes near and above the surface of Mars. The most dramatic effect is found in the production of H2O2 whose atmospheric abundance in the "vapor" phase can exceed 200 times that produced by photochemistry alone. With large electric fields, H2O2 abundance gets large enough for condensation to occur, followed by precipitation out of the atmosphere. Large quantities of H2O2 would then be adsorbed into the regolith, either as solid H2O2 "dust" or as re-evaporated vapor if the solid does not survive as it diffuses from its production region close to the surface. We suggest that this H2O2, or another superoxide processed from it in the surface, may be responsible for scavenging organic material from Mars. The presence of H2O2 in the surface could also accelerate the loss of methane from the atmosphere, thus requiring a larger source for maintaining a steady-state abundance of methane on Mars. The surface oxidants, together with storm electric fields and the harmful ultraviolet radiation that readily passes through the thin martian atmosphere, are likely to render the surface of Mars inhospitable to life as we know it.

Exobiology↗
PubMed1999

An infective aetiology for vulval lichen sclerosus re-addressed.

Although there is evidence to support an autoimmune basis for lichen sclerosus, there have also been some studies which suggest an infective aetiology. These include reports of the presence of spirochaetal forms with Steiner silver stains and purplish coccoid forms with Fite stains. We have repeated these studies on vulval biopsies obtained from 16 patients with vulval lichen sclerosus. Using the Steiner silver method we found no evidence of spirochaetal forms in any of the specimens. With the Fite stain we observed purple-staining coccoid forms within the dermis of 13 of the 16 lichen sclerosus specimens. However, these coccoid forms also stained strongly positive with toluidine blue, suggesting they were mast cell granules rather than micro-organisms. We were therefore unable to demonstrate evidence for an infective aetiology in vulval lichen sclerosus, although this cannot yet be excluded. Further work is also needed to understand the significance of mast cells in lichen sclerosus.

Adult↗
PubMed2000

Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited.

There is debate on the role of male circumcision in HIV transmission. Most case-control and cohort studies from Africa have shown an association between a lack of circumcision and an increased risk of HIV infection in men. The evidence is conflicting, however, with cross-sectional surveys from Tanzania and Rwanda either showing no relationship or an association in the opposite direction. A recent review and meta-analysis of the literature concluded that the risk of HIV infection was lower in uncircumcised men (combined odds ratio 0.94, 95% confidence interval 0.89 to 0.99). However, the analysis was performed by simply pooling the data from 33 diverse studies, which is an inappropriate method for combining studies. We re-analysed the data, stratifying by study, and found that an intact foreskin was associated with an increased risk of HIV infection: combined odds ratio 1.43 (1.32 to 1.54) with a fixed effect model and 1.67 (1.25 to 2.24) with a random effect model. There was significant between-study heterogeneity (P<0.0001) which was partly explained by stronger associations in studies in high-risk groups. The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.

Africa↗
PubMed2002

Controlling air pollution from passenger ferries: cost-effectiveness of seven technological options.

Continued interest in improving air quality in the United States along with renewed interest in the expansion of urban passenger ferry service has created concern about air pollution from ferry vessels. This paper presents a methodology for estimating the air pollution emissions from passenger ferries and the costs of emissions control strategies. The methodology is used to estimate the emissions and costs of retrofitting or re-powering ferries with seven technological options (combinations of propulsion and emission control systems) onto three vessels currently in service in San Francisco Bay. The technologies include improved engine design, cleaner fuels (including natural gas), and exhaust gas cleanup devices. The three vessels span a range of ages and technologies, from a 25-year-old monohull to a modern, high-speed catamaran built only four years ago. By looking at a range of technologies, vessel designs, and service conditions, a sense of the broader implications of controlling emissions from passenger ferries across a range of vessels and service profiles is provided. Tier 2-certified engines are the most cost-effective choice, but all options are cost-effective relative to other emission control strategies already in place in the transportation system.

Air Pollution↗
PubMed2003

New technology for endoscopic retrograde cholangiopancreatography: improving safety, success, and efficiency.

Known and documented factors attributable to ERCP-related complications include the experience and technique of the endoscopist as well as anatomic and pathologic factors pertaining to the papilla. In an effort to minimize trauma, facilitate deep entry to the biliary system, and improve the efficiency of therapeutic ERCP, new cannulation, sphincterotomy, and guide wire devices have been developed, based on principles of safe and successful therapeutic ERCP learned over the years. By totally re-engineering familiar accessories into smaller, more flexible, and more versatile devices, the 0.025-inch guide wire-based DASH system attempts to minimize the trauma at deep CBD cannulation and thereby increase the safety and success of achieving deep cannulation and sphincterotomy. Limited clinical experience to date suggests that the DASH system can provide full-function ERCP while reducing risks and costs. Attention to cannulation has led to the development of the RX Biliary System which provides the endoscopist and the assistant with increased control of the guide wire and exchange compared with traditional devices, resulting in less stress, less hand and wrist force used for contrast injection, and easier guide wire management, all of which have been shown in clinical trials to improve the speed and efficiency of ERCP while reducing complications.

Catheterization↗
PubMed1996

Carcinoma of the ampulla of Vater: a tumour with a poor prognosis?

OBJECTIVE: To assess the overall prognosis of patients with ampullary carcinomas and evaluate the presentation, diagnosis, pathology and management of these potentially highly curable tumours, attempting to relate these factors to overall survival. PATIENTS AND METHODS: Forty patients with ampullary carcinoma were reviewed. Age, Sex, nature and duration of history, laboratory information at admission, results of diagnostic radiology, endoscopic retrograde cholangiopancreatograms and pathological findings were considered. Both curative and palliative management strategies were reviewed. RESULTS: The overall median survival was 19 months. The median duration of history was 5.9 +/- 5.4. weeks, with no significant difference in survival between patients with short and those with long histories (P = 0.46). Twenty nine (73%) patients were potentially resectable, but only 15 (37%) underwent potentially curative surgery. The difference in survival between the Whipple's (13) and the endoscopically stented (20 ) groups was not significant (p = 0.08). The Whipple's group were significantly younger than the stented group (P = 0.001) and had a significant operative morbidity, re-operation rate (38%) and post-operative mortality (15%). Only five of 13 patients were alive following Whipple's treatment after a mean follow-up of 18.9 months. Sphincterotomy before Whipple's treatment improved survival significantly (P = 0.04); absence of jaundice, exophytic macroscopic appearance, well-differentiated tumours and early stage were also associated with good survival. Endoscopic retrograde cholangiopancreatography has a high diagnostic yield and a low associated morbidity and mortality, with endoscopic papillectomy aiding cannulation while effective palliation was provided through stenting, endoscopic papillectomy and laser debulking of obstructing tumours. Little benefit was obtained from chemoradiotherapy. CONCLUSION: Despite the potential for curative resection in patients with ampullary carcinoma, the majority of such patients are unsuitable for curative surgery on grounds of age, general health status or advanced disease; since only 37% of patients undergo potentially curative surgery the condition has a poor prognosis.

Aged↗