Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn's disease: a prospective study.

AIM: To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years, 1997 to January 2007. METHODS: A total of 25 patients (20 female and five male: aged 18-75 years), with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract, were included in the study. The main symptom was abdominal pain. The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control. RESULTS: Eleven strictures were located in the colon, 13 at the anastomosis after ileocecal resection, three at the Bauhin valve and four in the ileum. Four patients had two strictures and one patient had three strictures. Of the 31 strictures, in 30 was balloon dilatation successful in a single endoscopic session, so that eventually the strictures could be passed easily with the standard colonoscope. In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart, sufficient dilatation was not possible. This patient therefore required surgery. Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation, although in one case perforation occurred after dilatation of a recurrent stricture. Available follow-up was in the range of 54-118 mo (mean of 81 mo). The relapse rate over this period was 46%, but 64% of relapsing strictures could be successfully dilated again. Only in four patients was surgery required during this follow-up period. CONCLUSION: We conclude from these initial results that endoscopic balloon dilatation, especially for short strictures in Crohn's disease, can be performed with reliable success. Perforation is a rare complication. It is our opinion that in the long-term, the relapse rate is probably higher than after surgery, but usually a second endoscopic treatment can be performed successfully, leading to a considerable success rate of the endoscopic procedure.

[Double balloon enteroscopy. First surgical experience]. / Doppelballonenteroskopie in der Chirurgie. Ein erster Erfahrungsbericht.

INTRODUCTION: In Germany double balloon enteroscopy (DBE) has been used for about 4 years in diagnostics of the small intestine. Testing for the first time its value in daily surgical practice, we analyzed retrospectively the results of all DBE examinations from December 2004 to September 2006. MATERIAL AND METHODS: During the study period 106 enteroscopies were performed on 75 patients (42 males, 33 females, age 16-84 years). The approach was oral in 75 cases and anal in 31. Most indications were recurrent middle gastrointestinal bleeding. RESULTS: Complete small intestine inspection could be performed completely orally in seven of 106 examinations; and in most cases a combined oral/anal approach was required. Total endoscopy was completed in 21.3% of the patients studied. Pathologies were detected in 41 examinations (54.7%). These included 11 patients with angiodysplasias (14.7%) successfully treated with argon plasma coagulation (APC) and seven patients with small intestinal polyps (9.3%) that could be removed endoscopically. Further findings included diverticulum (6.7%), changes related to Crohn's disease (4.0%), small intestinal tumors (4.0%), extraluminar disorders (2.6%), stenoses (1.3%), and others (8.0%). Secondary diagnoses included colonic/rectal lesions in 5.3% of cases and pathologies of the stomach or esophagus in 4.0%. One patient had severe complications from a perforation following polypectomy. Therapies followed in 40.0% of all patients examined. Surgical interventions were indicated in six of 75 patients (8.0%), specifically five small intestinal resections and one bypass operation due to an infiltrating pancreas carcinoma. Endoscopic interventions were used in 25.3% of patients and medical treatment in 10.7%. CONCLUSION: With adequate indication, DBE shows very high diagnostic value. Immediate endoscopic therapy is possible in most cases, a considerable advantage over previous methods. Surgery was indicated for 8.0% of those examined in our study group, whereas the literature until now describes surgical indication rates of up to 22%.

Mass fluxes and spatial trends of xenobiotics in the waters of the city of Halle, Germany.

The behaviour and the effects of xenobiotics including pharmaceuticals and fragrances in the environment are widely unknown. In order to improve our knowledge, field investigations and modelling approaches for the entire area of the city of Halle/Saale, Germany, were performed. The distribution of the concentration values and mass fluxes are exemplified using indicators such as Bisphenol A, t-Nonylphenol, Carbamacepine, Galaxolide, Tonalide, Gadolinium and isotopes. Concentrations at a magnitude of ng/L to microg/L were found ubiquitously in the ground and surface waters. Using the concentration values, the impact of the city concerning the indicators was not always evident. Only the assessment of the mass fluxes shows significant urban impacts along the city passage. The calculation of the mass fluxes shows increasing values for all investigated xenobiotics during the city passage; only Bisphenol A stagnates. A balance model of water and indicator mass fluxes was built up for the entire city area.

Shutting down operating theater ventilation when the theater is not in use: infection control and environmental aspects.

OBJECTIVE: In hospital operating rooms (ORs), specially conditioned air is supplied to protect patients from airborne agents that may cause infections. This study investigated whether it is hygienically safe to shut down the air supply at night if measures are taken to ensure a timely restart before surgery is performed. DESIGN: Experimental study. SETTING: Neurosurgical OR of a German university hospital. METHODS: The ventilation system was switched off and restarted after 10 hours. Particles suspended in the air near the operating table were counted, OR temperature was measured, and settle plates were exposed and incubated. RESULTS: In 13 investigations, a median of 1.3 x 10(4) particles 0.5 microm/m3 or greater (range, 5.8 x 10(3) to 1.1 x 10(5)) were documented immediately after restart in the morning. After 10 minutes and subsequently, no test showed a particle count exceeding the threshold limit of 1.0 x 10(4) particles 0.5 microm/m3 or greater recommended by the German Society of Hygiene and Microbiology. Only a few colony-forming units (CFU) were detected per settle plate (median, 0 CFU/60 cm2; range, 0 to 8) and OR temperatures quickly reached normal levels. CONCLUSIONS: Shutting down OR ventilation during off-duty periods does not appear to result in an unacceptably high particle count or microbial contamination of the OR air shortly after the system is restarted. Because substantial energy and cost savings are likely, this should be considered in hygienically safe heating, ventilation, and air conditioning systems. However, normal ventilation should be established at least 30 minutes before surgical activity.

Apparent nonergodic behavior of supercooled liquids above the glass transition temperature.

A speckle pattern can be observed in the polarized component of light scattered from glass forming liquids far above their glass transition temperature. This speckle pattern fluctuates with characteristic time that corresponds to the relaxation time of the additional ultraslow component in the correlation function and is about seven orders of magnitude longer than the relaxation time of the alpha-process. This slow process is out of the experimental time window when the alpha-process is measured by means of the photon correlation spectroscopy and results in an apparent nonergodicity which can be seen as a baseline offset in the ensemble-averaged correlation function. In contrast, the time-averaged field correlation functions which have been measured in practically all light scattering studies always decay to zero. The slow process contributes a q-dependent excess intensity to the polarized component of scattered light. The values of the nonergodicity parameters obtained from the static and dynamic light scattering experiments are equal. Both the slow component and the excess intensity result from denser regions of fractal character which develop in glass-forming liquids on approaching the glass transition.

Unusual features of long-range density fluctuations in glass-forming organic liquids: a Rayleigh and Rayleigh-Brillouin light scattering study.

A new feature of glass-forming liquids, i.e., long-range density fluctuations of the order of 100 nm, has been extensively characterized by means of static light scattering, photon correlation spectroscopy and Rayleigh-Brillouin spectroscopy in orthoterphenyl (OTP) and 1,1-di(4(')-methoxy-5(')methyl-phenyl)-cyclohexane (BMMPC). These long-range density fluctuations result in the following unusual features observed in a light scattering experiment, which are not described by the existing theories: (i) strong q-dependent isotropic excess Rayleigh intensity, (ii) additional slow component in the polarized photon correlation function, and (iii) high Landau-Placzek ratio. These unusual features are equilibrium properties of the glass-forming liquids and depend only on temperature, provided that the sample has been equilibrated long enough. The temperature-dependent equilibration times were measured for BMMPC and are about 11 orders of magnitude longer than the alpha process. It was found that the glass-forming liquid OTP may occur in two states: with and without long-range density fluctuations ("clusters"). We have characterized the two states by static and dynamic light scattering in the temperature range from T(g) to T(g)+200 K. The relaxation times of the alpha process as well as the parameters of the Brillouin line are identical in both OTP with and without clusters. The alpha process (density fluctuations) in OTP was characterized by measuring either the polarized (VV) or depolarized (VH) correlation function, which are practically identical and q-independent. This feature, which is commonly observed in glass-forming liquids, is not fully explained by the existing theories.

Discrepancies in the use of medications: their extent and predictors in an outpatient practice.

BACKGROUND: Misuse of medications is a major cause of morbidity and mortality. Few studies have examined the frequency of, and factors associated with, discrepancies between what doctors prescribe and what patients take in actual practice. PATIENTS AND METHODS: Patients' medication bottles and their reported use of medications were compared with physicians' records of outpatients seen between November 1997 and February 1998 in a private practice affiliated with an academic medical center in Boston, Mass. Three hundred twelve patients from the practices of 5 cardiologists and 2 internists who were returning for their routine follow-up visits were included. MAIN OUTCOME MEASURE: The presence of discrepancies based on comparing medication bottles with medical records. RESULTS: Discrepancies were present in 239 patients (76%). The 545 discrepancies in these patients were the result of patients taking medications that were not recorded (n = 278 [51%]); patients not taking a recorded medication (n = 158 [29%]); and differences in dosage (n = 109 [20%]). Overall, discrepancies were randomly distributed among different drugs and discrepancy types with no discernible pattern. On multivariate analysis, patient age and number of recorded medications were the 2 most significant predictors of medication discrepancy. CONCLUSIONS: Discrepancies among recorded and reported medications were common and involved all classes of medications, including cardiac and prescription drugs. Older age and polypharmacy were the most significant correlates of discrepancy. The pervasiveness of discrepancies can have significant health care implications, and action is urgently needed to address their causes. Such action would likely have a positive impact on patient care.

Recognition of prominent viral epitopes induced by immunization with human immunodeficiency virus type 1 regulatory genes.

Mice immunized with the regulatory genes nef, rev, and tat from human immunodeficiency virus type 1 developed both humoral and cellular immune responses to the gene products Nef, Rev, and Tat. This study demonstrates that it is feasible to induce immune reactions to all of these regulatory gene products. Humoral responses were seen after DNA boosts, while potent T-cell proliferative responses were noted already after a single immunization. A Th1-directed immune response was demonstrated early after immunization. A 3- to 75-fold-stronger T-cell response was seen in animals receiving DNA epidermally compared to that in animals receiving intramuscular injections. Nef, Rev, and Tat putative B- and T-cell epitopes were clearly mapped by using peptides derived from the regulatory proteins and were similar to those which are detected in human immunodeficiency virus infection. Although immunization by the Nef, Rev, and Tat proteins raised high immunoglobulin G titers in serum, the epitope spreading appeared broader after DNA immunization. The combination of all of these regulatory genes together with two genes for structural proteins, the envelope and gag genes, demonstrated that a combined approach is feasible in that reactivities to all antigens persisted or were even augmented. No interference between plasmids was noted.

[Etiological accident types and recommendations for prevention in basketball]. / Unfallhergangstypen und Vorschläge zu ihrer Prävention im Basketball.

The study is based on 128 basketball accidents. The following accident types were discovered: ankle sprains 54.7%, handling the ball (saving and catching) 15.6%, knee-joint-distorsions 10.2%, collisions, blows and kicks 11.7%, falls 3.9%, spontaneous damage of muscles and tendons 1.6% and getting hurt because of the equipment in the gym 2.3%. Prophylactic precautions might be physiological or synthetic taping, proprioceptor training and preventive sports medical checkups.

Salt tolerance and methionine biosynthesis in Saccharomyces cerevisiae involve a putative phosphatase gene.

The progressive salinization of irrigated land poses a threat to the future of agriculture in arid regions. The identification of crucial metabolic steps in salt tolerance is important for the understanding of stress physiology and may provide the tools for its genetic engineering. In the yeast Saccharomyces cerevisiae we have isolated a gene, HAL2, which upon increase in gene dosage improves growth under NaCl and LiCl stresses. The HAL2 protein is homologous to inositol phosphatases, enzymes known to be inhibited by lithium salts. Complementation analysis demonstrated that HAL2 is identical to MET22, a gene involved in methionine biosynthesis. Accordingly, methionine supplementation improves the tolerance of yeast to NaCl and LiCl. These results demonstrate an unsuspected interplay between methionine biosynthesis and salt tolerance.

Characterization of a plasma membrane H(+)-ATPase from the extremely acidophilic alga Dunaliella acidophila.

Dunaliella acidophila is an unicellular green alga which grows optimally at pH 0-1 while maintaining neutral internal pH. A plasma membrane preparation of this algae has been purified on sucrose density gradients. The preparation exhibits vanadate-sensitive ATPase activity of 2 mumol Pi/mg protein/min, an activity 15 to 30-fold higher than that in the related neutrophilic species D. salina. The following properties suggest that the ATPase is an electrogenic plasma membrane H+ pump. (i) ATP induces proton uptake and generates a positive-inside membrane potential as demonstrated with optical probes. (ii) ATP hydrolysis and proton uptake are inhibited by vanadate, diethylstilbestrol, dicyclohexylcarbodiimide and erythrosine but not by molybdate, azide or nitrate. (iii) ATP hydrolysis and proton uptake are stimulated by fussicoccin in a pH-dependent manner as found for plants plasma membrane H(+)-ATPase. Unusual properties of this enzyme are: (i) the Km for ATP is around 60 microM, considerably lower than in other plasma membrane H(+)-ATPases, and (ii) the ATPase activity and proton uptake are stimulated three to fourfold by K+ and to a smaller extent by other monovalent cations. These results suggest that D. acidophila possesses a vanadate-sensitive H(+)-ATPase with unusual features enabling it to maintain the large transmembrane pH gradient.

[Physician's clinical responsibility in managing suicidal patients from the forensic psychiatry viewpoint]. / Arztliche Sorgfaltspflichten im Umgang mit suizidalen Patienten aus forensisch-psychiatrischer Sicht.

The discussion concerning the involvement of another person in suicidal behaviour is focussed on the responsibility of the therapeutic staff towards a potentially suicidal patient. Consequences regarding the psychiatric treatment of overtly or latently suicidal patients are pointed out.

Development of gastrin-and somatostatin-containing cells in the pyloric gland region of the bovine abomasum.

The ontogeny of gastrin- and somatostatin-containing cells in the pyloric gland region of the abomasum was studied in bovine fetuses, newborns and adults, using immunohistochemical techniques. A clear-cut developmental increase in the two kinds of endocrine cells could not be observed. The region of the lesser curvature displays more D and G cells than the greater curvature. Cells of both open and closed types are found from the earliest stages examined and continue to be present throughout the complete differentiation of the pyloric mucosa.

Ion-dependent generation of the electrochemical proton gradient delta muH+ in reconstituted plasma membrane vesicles from the yeast Metschnikowia reukaufii.

Plasma membrane vesicles were reconstituted by freezing and thawing of purified plasma membrane fraction from the yeast Metschnikowia reukaufii and phosphatidylcholine (type II-S from Sigma). The reconstituted plasma membrane vesicles generated a proton gradient (acidic inside) upon addition of ATP in presence of alkali cations. delta pH generation was most efficient when K+ was present both outside and inside the plasma membrane vesicles. Both ATPase activity and proton translocation in plasma membrane vesicles were inhibited by orthovanadate (50% inhibition at 100 microM). Plasma membrane vesicles reconstituted without added phosphatidylcholine generated in addition to delta pH, also an electrical potential difference delta psi (inside positive). Delta psi generation exhibited no K+ specificity. 50 microM dicyclohexylcarbodiimide inhibited completely delta psi generation whereas the K+-channel blocker quinine (5 microM) caused an 8-fold increase of delta psi. The proton gradient was much less affected by the agents. Taking into account the K+-dependent stimulation of the plasma membrane ATPase of M. reukaufii, these results further support the conclusion that the ATPase operates as a partially electrogenic H+/K+ exchanger, as was also suggested for other yeast plasma membrane ATPases.

[Multiple metastases of a benign leiomyoma. Apropos of a case. Review of the literature. Pathogenic concepts and therapeutic stance]. / Métastases multiples d'un léiomyome bénin. A propos d'un cas. Revue de la littérature. Conception pathogénique et attitude thérapeutique.

The authors report a rare unusual case of fibroleiomyoma of the uterus which which recurred and which had metastases in the peritoneum, the abdominal wall and in the lungs. They review the international literature and the various hypotheses that have been mentioned in it to try to explain how fibroleiomyomata can metastasise. They suggest that aggressive therapy should be used in spite of the benign character of the fibroma and of the matastases.