Familial obesity as a proxy for omitted variables in the obesity-mortality relationship.

In a conventional survival analysis of a sample of the U.S. population in 1971-1974, the association between mortality and obesity is compared with the analogous risk from the presence of an obese person in a household. The two factors have similar risk profiles, with a hazard ratio of 1.44 for nonmorbid obesity and 1.48 for nonmorbid familial obesity in one sample. If "familial obesity" cannot directly affect personal longevity, and if shared factors determine both personal and familial obesity, the mortality risk of family and actual personal obesity is similarly overstated. This false positive in the estimated risk arises from correlations among obesity and unobserved environmental, behavioral, or genetic factors.

A conserved transcription motif suggesting functional parallels between Caenorhabditis elegans SKN-1 and Cap'n'Collar-related basic leucine zipper proteins.

In Caenorhabditis elegans, the predicted transcription factor SKN-1 is required for embryonic endodermal and mesodermal specification and for maintaining differentiated intestinal cells post-embryonically. The SKN-1 DNA-binding region is related to the Cap'n'Collar (CNC) family of basic leucine zipper proteins, but uniquely, SKN-1 binds DNA as a monomer. CNC proteins are absent in C. elegans, however; and their involvement in the endoderm and mesoderm suggests some functional parallels to SKN-1. Using a cell culture assay, we show that SKN-1 induces transcription and contains three potent activation domains. The functional core of one domain is a short motif, the DIDLID element, which is highly conserved in a subgroup of vertebrate CNC proteins. The DIDLID element is important for SKN-1-driven transcription, suggesting a likely significance in other CNC proteins. SKN-1 binds to and activates transcription through the p300/cAMP-responsive element-binding protein-binding protein (CBP) coactivator, supporting the genetic prediction that SKN-1 recruits the C. elegans p300/CBP ortholog, CBP-1. The DIDLID element appears to act independently of p300/CBP, however, suggesting a distinct conserved target. The evolutionarily preservation of the DIDLID transcriptional element supports the model that SKN-1 and some CNC proteins interact with analogous cofactors and may have preserved some similar functions despite having divergent DNA-binding domains.

[Leiomyomatosis of the esophagus]. / Leiomyomatose des Osophagus.

A rare case of dysphagia caused by leiomyomatosis of the esophagus is presented. Esophageal leiomyomatosis is triggered by diffuse proliferation of smooth muscle cells in the wall of the entire esophagus. Only 1.0% of all tumors of the esophagus are benign lesions; 0.4% of all esophageal neoplasms are leiomyomas. Only a few cases of leiomyomatosis-a special form of diffuse leiomyomas-have been described so far in the literature. Modern diagnostic imaging techniques such as CT and MR are described in esophageal leiomyomatosis.

An abdominal aortic aneurysm (AAA) in combination with duplication of the inferior vena cava (IVC), the right renal artery (RRA) and the right renal vein (RRV).

Intra-abdominal abnormality of vessels may sometimes lead to complications. A case of the rare combination of an abdominal aortic aneurysm (AAA) at the origin of the inferior mesenteric a. with duplications of the inferior vena cava (IVC), the right renal a. (RRA) and the right renal v. (RRV) as well as absence of the left common iliac v. is reported.

[Local fibrinolytic therapy of vascular occlusions in the pelvic-leg area and the upper extremity]. / Lokale Fibrinolysetherapie von Gefässverschlüssen im Becken-Bein-Bereich und der oberen Extremität.

Seventy-three patients with vascular occlusions in the pelvis or lower limbs and three patients with upper limb lesions were treated by local low dose fibrinolysin, with strict control of any possible bleeding tendencies. Adequate recanalisation was obtained in 56 patients (73.6%). In ten patients, the occlusion recurred while the patient was still in hospital. After four to six months, 37 of the 56 (67%) of the vessels were still patent. In 18 patients, peripheral emboli resulted in some deterioration, but in 15 of these cases this could be treated successfully by operation. The methods and indications of local fibrinolysis therapy and the problems associated with it are discussed.

[Postoperative follow-up after thromboendarterectomy of the carotid artery using duplex sonography]. / Postoperative Verlaufskontrolle nach Thrombendarteriektomie der A. carotis mit der Duplex-Sonographie.

Fifty-one patients, on whom a total of 64 carotid thromboendarterectomies had been performed, were followed up by duplex sonography. Five asymptomatic occlusions of the internal carotid artery (8%) and one occlusion of the common carotid artery were found. Two patients (3%) developed a restenosis of more than 50% and another two patients a restenosis of less than 50%. Changes in the vessel wall not producing significant luminal change were observed in another 18 cases (28%). Thirty-six of the operated vessels (56%) showed no change.

[Segmental arteriosclerotic occlusion of the infrarenal aorta]. / Segmentaler arteriosklerotischer Verschluss der infrarenalen Aorta.

Atherosclerosis involving the terminal aorta usually is a diffuse process that commonly includes the iliac and femoral arteries. Less frequently, the lesions are limited to the infrarenal aortic segment with normal distal vessels. Patients with isolated occlusion or stenosis of the infrarenal aorta tend to be younger, more often female and have slower progression of atherosclerotic lesions. There is a causative relationship of this well-localized form of atherosclerosis to the use of oral contraceptives and heavy smoking. In 90% of the cases, surgery of these lesions is limited to endarterectomy. End results are satisfactory in a majority of the patients. Percutaneous transluminal angioplasty produces satisfactory early results for concentric stenosis, although long-term results have not yet been established.

[Reconstruction of the gastroesophageal sphincter in reflux disease]. / Wiederherstellung des gastrooesophagealen Verschlusses bei Refluxkrankheit.

Valvuloplasties of which, for example, the Nissen fundoplication is perhaps the most effective operation, have been devised to correct gastroesophageal reflux. Fundopexia, a more anatomical antireflux procedure has been performed in 326 patients with 80% good (Visick I + II) clinical results. Postoperative complications and side effects are more frequent after fundoplication. In grade IV patients fundopexia is less successful. Since the introduction of H2-receptor antagonists the number of operations, especially fundopexia, has been considerably reduced.

Prehepatic and hepatic first-pass metabolism of lorcainide in rats.

The systemic availability of 3H-lorcainide in rats was investigated following oral doses of 1.5 to 100 mg/kg. Systemic availability increased from 14 to about 40% following the lowest and highest dose, respectively. Doses higher than 60 mg/kg produced a less marked increase of the systemic availability. In rats with portacaval shunt following an oral dose of 1.5 or 7.5 mg/kg lorcainide a systemic availability of 47% was found, indicating substantial prehepatic first-pass metabolism of lorcainide. Systemic availability of total radioactivity was 53% in control rats and 90% in rats with portacaval shunt. Since the maximal systemic availability obtained by increasing the dose was found to be identical with that obtained in rats with portacaval shunt, it is suggested that increasing doses will saturate the presystemic metabolism in the liver but will not affect the fraction of the dose which is metabolized in the gut.

[Transabdominal CT-guided sympathectomy]. / Transabdominelle CT-gesteuerte Sympathektomie.

A new technique for lumbar sympathectomy is described. It consists of CT-guided trans-abdominal fine needle puncture and injection of alcohol. The technique is simple and well tolerated by the patient, and it permits accurate application of the alcohol. Complications have so far not been observed.

[Postvagotomy complications: stomach bezoars - case report and review of the literature]. / Postvagotomiekomplikation: Magenbezoare - Fallbericht und Literaturübersicht.

A 59 year old female with multiple gastric surgical procedures (Billroth I and Billroth II) for recurring ulcer disease developed a gastric phytobezoar following an additional truncular vagotomy within 2 months. Already 1 month after complete endoscopic removal the phytobezoar recurred in spite of dietary restrictions. The phytobezoar was successfully dissolved by oral Cellulase-therapy. The truncular vagotomy and its influence on gastric motility has to be considered as the cause of the repeated bezoar formation.

[Secretin versus somatostatin in acute hemorrhage of gastroduodenal ulcers and erosions: a randomized trial]. / Sekretin versus Somatostatin bei akuter Blutung aus gastroduodenalen Ulcera und Erosionen, eine randomisierte Studie.

In a randomized trial the efficiency of synthetic secretin (0,25 clinical units/kg bw/h; 15 patients) was compared with that of synthetic somatostatin (250 micrograms/h, 15 patients) in treatment of severe acute non arterial bleeding from peptic ulcers or stress lesions in the upper digestive tract. In all patients the presence of hemorrhage at beginning of the therapy was established by endoscopic examination. Both test preparations were given as continuous infusions over 48 h and had identical effects on the hemorrhage: in 12 patients (80%) out of each group bleeding stopped during the infusion of secretin or somatostatin, 6 patients (20%) had to be operated on for persistant bleeding or severe recurrence.

Influence of cis-platinum on healing of enterostomies in the rat.

The influence of cis-platinum on the wound healing of bowel anastomoses was studied in 104 male Sprague-Dawley rats. After a single preoperative doses of 5 mg/kg body weight, the wound-breaking strength (WBS) was tested with a material tester on the 4th, 7th, 14th and 28th day postoperatively. The WBS was significantly lower in treated animals as compared to the untreated controls. The reasons for this are discussed in comparison with other cytotoxic agents. Before cis-platinum can be used as adjuvant chemotherapy to cystectomy, which is frequently combined with an ileum or colon conduit procedure, further investigations on the operative side effects of cis-platinum on bowel anastomoses are necessary.

[Treatment of jejunal peptic ulcer with cimetidine or an antacid? Results of a long-term study]. / Behandlung von Ulcera peptica jujuni mit cimetidin oder einem Antacidum? Ergebnisse einer Langzeitstudie.

The effectiveness of cimetidine or antacid in healing recurrent jejunal peptic ulcers after Billroth II gastric resection without vagotomy was tested in a randomized study of 18 in-patients. Mean stimulated acid secretion of the cimetidine group was 11.2 +/- 4.3 mmol/h, in the antacid group 12.6 +/- 5.6 mmol/h. Serum gastrin levels were within the normal range in all patients. Within four weeks the ulcers had healed completely in eight of the nine patients on cimetidine (1,000 mg/d), but in only three of the nine patients on antacids (magnesium-aluminiumhydroxide, neutralization capacity 564 mmol/d). The difference is statistically significant (P less than 0.025). All 11 patients with healed ulcers were given prophylactically either 800 mg cimetidine daily or magnesium-aluminiumhydroxide (neutralization capacity 564 mmol/d). During a follow-up period of one year recurrences occurred in two of the five patients on antacids, but in none of the six treated with cimetidine. The results indicate that cimetidine also accelerates the healing of recurrent jejunal peptic ulcers. But further studies are required to elucidate whether long-term treatment with histamine-H2-receptor antagonists is as good as surgery in the long-term prevention of ulcer recurrences.

[Chronic intestinal ischemia after migration of larvae in ascaridiasis (author's transl)]. / Chronische Durchblutungsstörung des Dünndarms nach Larvenmigration bei Askaridiasis.

A case report is given of a 25 year old turkish patient, who had ascaridiasis and multiple stenoses of the small intestine. This syndrome was caused by extensive obliterating phlebitis of the small mesenterial veins and sclerosing lymphadenitis of the mesenterial lymph nodes. Granuloma containing epitheloid cells and giant cells could be found in the venous walls and in the lymph nodes, some of the granuloma being grouped around atrophic ascarides larvae; this demonstrates, that the intestinal stenoses represent an unusual complication of larvae migration in this worm disease. Perforation of the intestinal wall in one these stenotic areas possibly was caused by ascarides worms actively.

[Focal nodular hyperplasia (author's transl)]. / Fokal noduläre Hyperplasie.

Focal nodular hyperplasia was diagnosed angiographically in 14 patients and confirmed histologically. Differentiation of this benign lesion from other space-occupying diseases of the liver can be very difficult, since focal nodular hyperplasia produces a variable angiographic appearance. The typical angiogram showing radial vessels in the arterial phase and sharply demarcated foci in the parenchyma phase is found in only one third of patients. Angiographic differential diagnosis includes adenomas and carcinomas of the liver. Resection of the tumours in case of malignant tumours is not indicated. Foci at the margin of the liver, or if they are pedunculated, should be removed in case of spontaneous perforation. Tumours in the centre of the liver should be observed (computer tomography). Oral contraceptives stimulate the growth of these foci. They may diminish in size after stopping these drugs. 70% of cases of focal nodular hyperplasia remain clinically silent and were discovered accidentally or at autopsy.