Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones.

BACKGROUND: Endoscopic balloon dilation was introduced as an alternative to endoscopic sphincterotomy to preserve the sphincter of Oddi and avoid undesirable effects due to an incompetent sphincter. Endoscopic balloon dilation has been largely abandoned by USA endoscopists due to increased risks of pancreatitis noted in one multicentre trial, but is still practiced in parts of Asia and Europe. OBJECTIVES: To assess the beneficial and harmful effects of endoscopic balloon dilation versus endoscopic sphincterotomy in the management of common bile duct stones. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, and EMBASE until January 2004. We hand searched Gastrointestinal Endoscopy (1983-2002), read through bibliographies of all included randomised clinical trials, and contacted all primary authors regarding missed randomised trials. SELECTION CRITERIA: Randomised clinical trials comparing endoscopic balloon dilation versus endoscopic sphincterotomy in removal of common bile duct stones irrespective of publication status, language, or blinding. DATA COLLECTION AND ANALYSIS: Data collection was done by two independent authors for decisions on study inclusion, data abstraction, and quality assessment. When there was a non-resolvable discrepancy, the third author made the final decision. Analysis was run with RevMan Analysis. MAIN RESULTS: Fifteen randomised trials met our inclusion criteria (1768 participants). Less than half of the trials reported adequate methods of randomisation and only two trials used blinded outcome assessment. Endoscopic balloon dilation is statistically less successful for stone removal (relative risk (RR) 0.90, 95% confidence interval (CI) 0.84 to 0.97), requires higher rates of mechanical lithotripsy (RR 1.34, 95% CI 1.08 to 1.66), and carries a higher risk of pancreatitis (RR 1.96, 95% CI 1.34 to 2.89). Conversely, endoscopic balloon dilation has statistically significant lower rates of bleeding. When a fixed-effect model is applied endoscopic balloon dilation leads to significantly less short-term infection and long-term infection. There was no statistically significant difference with regards to mortality, perforation, or total short-term complications. AUTHORS' CONCLUSIONS: Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky regarding pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have coagulopathy, who are at risk for infection, and possibly in those who are older.

Reversible deficit in haptic delay tasks from cooling prefrontal cortex.

The main purpose of this study was to explore the role of dorsolateral prefrontal cortex in skilled and sequential haptic performance. Monkeys were trained to perform a delayed matching-to-sample task that required the memorization of three-dimensional objects perceived either by palpation (haptically) or by sight. At the start of a trial the animal was allowed to touch or view an object, the sample; after a period of delay, during which the object remained out of touch and out of sight, the animal was presented with two side-by-side objects--one of them the sample--for either tactile or visual recognition, and the choice of the sample (correct match) was rewarded. Three variants of the task were used: (1) visual sample, haptic match; (2) haptic sample, visual match; and (3) haptic sample, haptic match. The temporary bilateral cooling of dorsolateral prefrontal cortex to 15 degrees C induced a reversible deficit in performance of all three tasks. Cooling to the same degree a portion of posterior parietal cortex of equivalent size did not significantly alter either performance or reaction time. These findings indicate that the functional integrity of the dorsolateral prefrontal cortex is important for performance of sequential behavior dependent on haptic skill. Further, the results suggest that the role of this cortex in active memory, already well documented for spatially and nonspatially defined visual information, extends also to tactile information and associated motor acts.

Identification of plant hormones from cotton ovules.

An extract from 8-day-old cotton ovules (Gossypium hirsutum L.) was partitioned into three fractions and each fraction was derivatized and analyzed separately. Gas-liquid chromatography and computer-controlled gas-liquid chromatography-mass spectrometry were used to separate, measure, and identify the naturally occurring plant hormones. A single extract contained abscisic acid, indoleacetic acid, and gibberellins A(1), A(3), A(4), A(7), A(9), and A(13) in the first fraction; ethyl indole-3-acetate and indole-3-aldehyde in the second fraction; and the cytokinins 6-(3-methyl-4-hydroxybutylamino)purine (dihydrozeatin), 6-(4-hydroxy-3-methyl-2-trans-butenylamino) purine (zeatin), 6-(3-methyl-2-butenylamino)purine(2iP), 6-(3-methyl-2-butenylamino)-9-beta-d-ribofuranosylpurine(2iPA), and 6-(4-hydroxy-3-methyl-2-trans-butenylamino)-9-beta-d- ribofuranosylpurine (zeatin riboside) in the third fraction.

Absorption and distribution of high specific radioactivity 2-C-abscisic Acid in cotton seedlings.

High specific radioactivity (26.3 mc/mmole) racemic 2-(14)C-abscisic acid was synthesized. An aliquot of abscisic acid, 1.2 x 10(-4)m in aqueous methanolic solution, was applied to the surface of either a cotyledon or the first true leaf of 8- to 32-day-old cotton seedlings (Gossypium hirsutum L.). After various intervals (6-192 hours), the seedlings were processed for autoradiography, counting, and identification of the radioactivity. After 6 hours, radioactivity was observed moving basipetally out of the treated leaf toward the roots. Four days later, radioactivity could be detected throughout the whole seedling. After 8 days, 10% of the recovered radioactivity was found in the roots, and 80% remained in the treated leaf blade. Neither leaf type nor age had any effect on the abscisic acid movement or pattern of distribution. Isolated radioactivity from the roots was identified as abscisic acid, based on comparison with an authentic standard by thin layer chromatography, gas-liquid chromatography, or gas-liquid chromatography-mass spectrometry.

Benzyladenine-induced Movement of C-Labeled Photosynthate into Roots of Vitis vinifera.

Roots of Vitis vinifera L., were treated with benzyladenine when the plant shoots were 38 cm long. Seventy-two hours after benzyladenine treatment, apical or basal leaves on separate shoots were exposed to (14)CO(2). Control shoots received (14)CO(2) but no benzyladenine. Application of benzyladenine directed (14)C-photosynthate to roots, but a small amount of radioactivity was detected in the shoot tip when (14)CO(2) was administered to an apical leaf. Distribution of radioactivity among the sugar, organic acid, and amino acid fractions was altered by benzyladenine treatment. In all parts of plants with roots treated with benzyladenine and apical leaf fed (14)CO(2), the percentage of the total label in the sugar fraction comprised of fructose was generally more than twice that in control plants.

Growth regulator induced movement of photosynthetic products into fruits of ;black corinth' grapes.

The effect of exogenous growth regulators on movement of assimilates into flowers and young fruits of ;Black Corinth' grapes was studied. Clusters were treated with growth regulator and after 0.5 hr to 5 days the leaves above the clusters were exposed to (14)CO(2). Control shoots received (14)CO(2) but no growth regulator. At harvest, counting and radioautographic techniques were used to ascertain amount and distribution of activity in clusters. Clusters were dipped in 4-CPA (4-chlorophenoxyacetic acid), GA(3) (gibberellic acid), or BA (benzyladenine). All berries were heavier than controls within 3 days. Total counts in the fruits were increased by 4-CPA, and the distribution of radioactivity among the sugar, organic acid, and amino acid fractions was usually altered by all treatments. In a time series experiment, within 6 hr after treatment of fruits with GA(3) there was almost an 8-fold increase in total counts relative to the control. After 12 hr there was about a 9-fold and 6-fold increase in counts in tartaric and malic acids, respectively, and in gamma-aminobutyric acid, pipecolic acid, and valine increases of 56, 150, and 330%. Radioactivity in fructose was increased 70% in gibberellin-treated clusters over the controls. After 96 hr there were only about 1000 cmp per g fr wt in controls, but there were about 31,000 cpm counts in treated clusters. Treatment of clusters with gibberellin attracted less assimilates into the fruits when shoots had also been sprayed with gibberellin. Dipping portions of clusters in gibberellin increased the movement of (14)C assimilates into the treated portions. Hormonal control of mobilization is discussed.