New method of remnant closure during distal pancreatectomy.

PURPOSE: Pancreatic fistula following distal pancreatectomies still remains a relevant problem. The present study describes our first series with a new method of pancreatic remnant closure. METHODS: A free fascia-peritoneum graft - harvested from the internal rectus sheet - was fixed onto the pancreatic stump by one circular stitch. The method was applied in 18 cases. RESULTS: The postoperative hospital stay was 8 days in average. No clinically relevant postoperative pancreatic fistula (CR-POPF) developed. The morbidity rate was 39%, mostly Clavien-Dindo Grade II types. There was no reoperation or mortality. CONCLUSION: The first series showed advantageous results with our method. Certainly, further studies are needed for the evaluation of this new and promising technique.

Innovations in pancreatic anastomosis technique during pancreatoduodenectomies.

PURPOSE: Pancreatic fistula following pancreatic resections is still a relevant complication. The present work shows the efforts of a single institute to decrease this problem. METHODS: A total of 130 patients (63 men, 67 women) with a mean age of 60 (range: 23-81) years were operated on between January 2013 and March 2020. The most frequent type of pancreatic resection was a Whipple procedure with partial antrectomy. During all operations, an innovative method was used, namely a modification of the purse-string suture pancreatojejunostomy. Moreover, an early drain removal policy was applied, based on the drain amylase level on the first and subsequent postoperative days. RESULTS: Mean postoperative hospital stay was 13 days (range: 7-75). The overall morbidity rate was 43.8%; the clinically relevant (grade B/C) pancreatic fistula (CR-POPF) rate was 6.9%. Delayed gastric emptying (DGE) was observed in 4% of the patients. The ratio of operative mortality was 0.7%; the reoperation rate was 5.3%. Based on the drain amylase level on the first postoperative day, two groups could be established. In the first one, the drain was removed early, on the fourth day in average (range: 2-6). In the other group, the drain was left in situ protractedly or reinserted later on. CONCLUSION: A single center's experience proves that the refinement of the technique can improve the results of pancreatic surgery.

Radiocarbon signal of a low and intermediate level radioactive waste disposal facility in nearby trees.

Tree ring series were collected from the vicinity of a Hungarian radioactive waste treatment and disposal facility and from a distant control background site, which is not influenced by the radiocarbon discharge of the disposal facility but it represents the natural regional (14)C level. The (14)C concentration of the cellulose content of tree rings was measured by AMS. Data of the tree ring series from the disposal facility was compared to the control site for each year. The results were also compared to the (14)C data of the atmospheric (14)C monitoring stations at the disposal facility and to international background measurements. On the basis of the results, the excess radiocarbon of the disposal facility can unambiguously be detected in the tree from the repository site.

Celiac disease screening among healthy blood donors in Hungary.

BACKGROUND: Celiac disease (CD) is a common chronic systemic autoimmune disease in Europe. The prevalence of CD in Hungarian children is estimated at 1.2 - 1.4 %. To date, however, no data on adult CD prevalence has been published. AIMS: Analysis of the serological evidence for CD among Hungarian adults in order to estimate its prevalence. METHODS: Plasma samples from 4155 healthy blood donors were anonymously screened for circulating IgA autoantibodies by a highly sensitive tissue transglutaminase ELISA. Positive results were subsequently confirmed by endomysial antibody test. RESULTS: Endomysial antibody test confirmed positivity in 25 samples suggesting a prevalence of CD of at least 0.6 % (1:166). Since no identification on the samples was provided, no further examinations could be done on endomysial antibody positive individuals. CONCLUSIONS: The first serological screening study among healthy Hungarian adult blood donors showed a prevalence of CD similar to other central European countries and lower than that in Hungarian children. Among countries worldwide, the Hungarian prevalence of CD appears to be in the mid-range, although pediatric data suggest a higher prevalence.

P2 purinoceptor antagonists inhibit the non-adrenergic, non-cholinergic relaxation of the human colon in vitro.

Neurotransmitters released by myenteric neurons regulate movements of intestinal smooth muscles. There has been little pharmacological evidence for a role of purinergic mechanisms in the non-adrenergic, non-cholinergic (NANC) relaxation of the human large intestine. We used P(2) purinoceptor antagonists to assess whether such receptors are involved in the NANC relaxation of the circular muscle of the human sigmoid colon. It was also investigated whether the guanylate cyclase enzyme mediates the NANC response. Human colonic circular strips were tested in organ bath experiments with isotonic recording. NANC, non-nitrergic relaxations induced by electrical field stimulation (1 and 10 Hz, in the presence of atropine, guanethidine, and 100 microM N(G)-nitro-L-arginine [L-NOARG]) were strongly inhibited by a combination of the P(2) purinoceptor antagonists pyridoxal-phosphate-6-azophenyl-2',4'-sulfonic acid (PPADS) (50 microM) and suramin (100 microM). PPADS plus suramin was ineffective in the absence of L-NOARG. L-NOARG alone significantly reduced the NANC relaxation to electrical stimulation. PPADS plus suramin strongly inhibited the relaxation in response to exogenous alpha,beta-methylene ATP. The guanylate cyclase inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) (3 microM) inhibited the NANC relaxation, but did not add to its reduction by L-NOARG. L-NOARG was still slightly effective in the presence of ODQ. Vasoactive intestinal polypeptide tachyphylaxis failed to influence the non-nitrergic NANC relaxation. It is concluded that nitric oxide (NO) and ATP co-mediate, in a non-additive manner, the NANC relaxation. NO probably acts through the guanylate cyclase, though a small fraction of its effect might be mediated by other mechanisms. Activators of the guanylate cyclase other than NO do not seem to participate in the NANC relaxation.

Experiences with single-layer biliodigestive anastomosis.

BACKGROUND/AIMS: The right technique for biliodigestive anastomosis is still being researched. The present study investigated the single-layer method. METHODOLOGY: The authors performed single-layer biliodigestive anastomosis in 153 patients between 1995 January and 2000 August. Among the operative procedures there were pancreatoduodenectomy, pancreatic head resection, pancreatic drainage operation, GEA and in a small percentage of the cases other procedures. 88.2% of the anastomoses were done with a continuous suture technique, mainly with 4/0 PDS. RESULTS: In 96 cases the diagnosis was tumor, while the others were benign diseases. Hepatico- or choledochojejunostomy was twice as much as cholecystojejunostomy. There were complications in 29.4% of the cases, from which the rate of biliary fistula was 3.9%. All fistulas healed for conservative therapy. Reoperation was in 7.1%, the operative mortality was 9.8%. Preoperatively 77.1% of the patients had cholestasis, which improved in all cases postoperatively. CONCLUSIONS: In summary the authors offer the single-layer technique for biliodigestive anastomosis.

Clinical experience with different techniques of pancreatic head resection for chronic pancreatitis.

BACKGROUND/AIMS: Recently organ-saving procedures have become popular in the treatment of chronic pancreatitis with head enlargement. The purpose of this study is to compare the results of three different procedures. METHODS: Between 1991 and 1998, 32 Beger operations, 13 Frey procedures and 21 pylorus-preserving pancreatoduodenectomies (PPPDs) were performed. The pre-, intra- and postoperative data were detailed. During the follow-up examination the quality of life, body weight, consumption of alcohol and enzymes, as well as the carbohydrate metabolism were checked. RESULTS: Considering the operative and late mortality and reoperation rate, there was no difference between the procedures. The postoperative hospitalization time was the shortest after the duodenum-preserving pancreatic head resections (Beger and Frey). While the rate of early morbidity was higher after PPPDs, there was no difference in late morbidity between the groups. The condition of the patients was better and the development rate of diabetes was lower after the Beger procedure than after PPPDs. CONCLUSION: Consequently duodenum-preserving pancreatic head resections seem to be more advantageous than PPPD. Nevertheless the latter operation is the only possibility in some situations.

Home testing of fructosamine improves glycemic control in patients with diabetes.

OBJECTIVE: To determine whether weekly fructosamine testing at home by patients with type 2 diabetes, combined with therapeutic intervention when necessary on the basis of the results, would lead to improved glycemic control in comparison with usual care during a 3-month period. METHODS: In a prospective study, 25 patients with glycosylated hemoglobin (HbA1c) values above 8.0% were randomized into 2 groups. Both groups, a glucose-only testing group (14 patients with an initial mean HbA1c of 9.4 +/- 0.9%) and a combined glucose plus fructosamine testing group (11 patients with an initial mean HbA1c of 9.2 +/- 0.7%), received therapeutic intervention at the time of randomization. Both groups were instructed to perform blood glucose testing up to four times per day. The combined glucose plus fructosamine testing group was also instructed to perform weekly fructosamine testing in addition to the glucose testing and to telephone the investigator if their home-testing fructosamine value exceeded 350 mmol/L (approximately equivalent to HbA1c of 7.8%), whereupon the investigator implemented further interventions. Both groups returned in 3 months, at which time HbA1c testing was repeated in order to determine whether glycemic control had changed. RESULTS: The study results after 3 months showed that the HbA1c values in the combined glucose plus fructosamine testing group decreased from 9.2 +/- 0.7% to 8.0 +/- 0.5% (P<0.0001). In contrast, the HbA1c values in the glucose-only testing group declined from 9.4 +/- 0.9% to 9.1 +/- 1.3%, a difference that was not significant. CONCLUSION: In the 3 months after a change in therapy for type 2 diabetes, weekly home testing of fructosamine, combined with therapeutic interventions based on the results, led to a more rapid and significant improvement in glycemic control than did the usual regimen of glucose-only testing.

Why are rocks pointy? Children's preference for teleological explanations of the natural world.

Teleological explanations are based on the assumption that an object or behavior exists for a purpose. Two studies explored the tendency of adults and first-, second-, and fourth-grade elementary-school children to explain the properties of living and nonliving natural kinds in teleological terms. Consistent with the hypothesis that young children possess a promiscuous teleological tendency, Study 1 found that children were more likely than adults to broadly explain the properties of both living and nonliving natural kinds in teleological terms, although the kinds of functions that they endorsed varied with age. Study 2 was an attempt to reduce children's broad teleological bias by introducing a pretrial that described, in nonteleological terms, the physical process by which nonliving natural kinds form. In spite of this attempt, Study 2 replicated the effects of Study 1, with only fourth graders showing any shift in preference for teleological explanation.

Function, goals and intention: children's teleological reasoning about objects.

A fundamental aspect of adult thought is the 'teleological' tendency to assume that objects exist for a purpose. When seeing an unfamiliar artifact or strange anatomical part on an animal, the first question an adult will usually ask is 'what's that for?' - a query that assumes that the object can be teleologically explained in terms of its function. Current debate focuses on the origin and scope of teleological thought, and its role in children's emerging theories of the biological world. The bias to view objects as 'designed for a purpose' probably derives from children's privileged understanding of intentional behavior and artifacts. This makes children prone to a 'promiscuous teleology' in which artifacts and natural objects of all types are viewed as existing for a function. Because of this, I argue that we should be cautious about taking the existence of an early teleological bias as evidence that there is biological understanding that exists independently of a psychological construal of living things.

[Comparative study of pancreatic head resection in chronic pancreatitis]. / Pancreasfej-reszekciók összehasonlító vizsgálata chronicus pancreatitisben.

Between 1991 and 1998 the authors performed 21 pylorus-preserving pancreatoduodenectomies (PPPD), 32 Beger and 13 Frey procedures in chronic pancreatitis with inflammatory head enlargement. The pre- and intraoperative data, as well as the postoperative early and late results were also compared. The preoperative clinical features and the intraoperative morphology were similar in the three groups. Considering the operative and late mortality and the reoperation there was no statistical difference between the procedures. The postoperative hospitalization time was the shortest after the duodenum-preserving pancreatic head resections (Beger and Frey). While the rate of early complications was significantly higher after PPPD, there was no difference in the rate of late complications between the groups. Although each operation gave similarly good late results (freedom from pain, weight gain, exocrine function, quality of life), the condition of the patients was better and the development rate of diabetes was lower (1/27), after Beger procedure, that after PPPD (6/14). Consequently the duodenum-preserving pancreatic head resections seem to be more advantageous, than the PPPD. Nevertheless the latter procedure is the only possibility in some cases.

The scope of teleological thinking in preschool children.

These studies explore the scope of young children's teleological tendency to view entities as 'designed for purposes'. One view ('Selective Teleology') argues that teleology is an innate, basic mode of thinking that, throughout development, is selectively applied by children and adults to artifacts and biological properties. An alternative proposal ('Promiscuous Teleology') argues that teleological reasoning derives from children's knowledge of intentionality and is not restricted to any particular category of phenomena until later in development. Two studies explored the predictions of these two hypotheses regarding the scope of children's functional intuitions. Using different methods, both studies found that, unlike adults, pre-schoolers tend to attribute functions to all kinds of objects--clocks, tigers, clouds and their parts. A third study then explored this finding further by examining whether the developmental effect was due to differences in children's and adults' concept of function. It found that both children and adults predominantly view an object's function as the activity it was designed to perform. Possible explanations for the developmental differences found in the first two studies, and implications for notions of a teleological stance are discussed.

Syntactic cues in the acquisition of collective nouns.

One basic finding in the study of word learning is that children tend to construe a word describing an object as referring to the kind of whole object, rather than to a part of the object, one of its properties, or the substance it is made of. This has been taken as evidence that there exist certain special constraints on word meaning that guide children to favor the kind-of-object interpretation when exposed to a new word. There are descriptive problems with this proposal, however, as it cannot explain how children learn other kinds of words, such as names for specific people, substances, parts, events, collections, and periods of time. These problems motivate an alternative theory in which young children possess several distinct conceptual categories--including "individual", which is more abstract than "whole object"--and can use syntactic cues to determine the conceptual category that a new word belongs to. This theory is explored in two experiments in which we attempt to use syntactic cues to teach children and adults novel collective nouns--words that refer to groups of objects. The results indicate that children can use such cues to learn names for kinds of individuals that are not whole objects, although they are less able to do so than adults. Candidate explanations for why this developmental difference exists are discussed and implications are drawn for theories of word learning and conceptual representation.

Nucleotide sequence and expression of kerA, the gene encoding a keratinolytic protease of Bacillus licheniformis PWD-1.

Bacillus licheniformis PWD-1 (ATCC 53757) secretes keratinase, a proteolytic enzyme which is active on whole feathers. By amino acid sequence similarity and phenylmethylsulfonyl fluoride inhibition, the keratinase was demonstrated to be a serine protease. The entire nucleotide sequence of the coding and flanking regions of the keratinase structure gene, kerA, was determined. A fixed oligonucleotide primer derived from the N-terminal sequence of the purified enzyme and a second random oligonucleotide primer were used in a procedure called PCR walking, which was developed to amplify and sequence the upstream and downstream regions of kerA. Another method, PCR screening, was conducted with a lambda phage vector with inserted PWD-1 genomic DNA fragments as templates and with the known sequences of the vector arms and the N-terminal sequence of the enzyme as primers. PCR amplification and sequence analysis of the lambda library completed the entire kerA sequence and established a set of gene deletions. The kerA gene shares a 97% sequence identity with the gene encoding subtilisin Carlsberg from B. licheniformis NCIMB 6816. The putative promoters, ribosome binding sites, and transcriptional terminators are also similar in these two bacteria. The deduced amino acid sequences indicate only three amino acid differences between the two mature proteases. Northern (RNA) analysis demonstrates that transcriptional regulation controls kerA expression on different growth media.

Possible role of viruses in atherosclerosis.

Relative to the role of viruses in the pathogenesis of atherosclerosis a number of questions remain to be answered. Being ubiquitous, are the herpesvirus infections the norm or a diseased state in humans and animals? In all cases studied, including MDV induced atherosclerosis, direct isolation of viruses from arterial tissues has not been successful. Are herpesviruses always latent or dormant in vascular tissues? What is the relationship between provirus and disease development? Are they setting the stage for the pathogenic process triggered by certain environmental factors? Is hypercholesterolemia to trigger the development of atherosclerosis in the presence of proviruses? Is the reactivated and infectious virus the injuring agent that initiates atherogenesis? Or, are the proviral genes activated to transform arterial cells? In the latter case, are these proviral genes equivalent to "proto-atherogenes"? Hopefully, further study on Japanese quail will help clarify many of these questions.

Culture characterization and viral infection of aortic smooth muscle cells from Japanese quail susceptible to atherosclerosis.

Proliferation of aortic smooth muscle cells (SMCs), an important feature of atherosclerosis, occurs in the early stage of the disease in Japanese quail when fed an atherogenic diet. Quail aortic SMCs were isolated from a total of 32 quail and cultured in Eagle's minimum essential medium supplemented with 10% bovine fetal serum. Studies were carried out to characterize the cells in vitro. They grew actively in the early passages, but began to develop cytopathic changes after 3-4 passages and eventually cell death. The pathobiology had similarities to virus infected cells. Whole-mount electron microscopic examination detected virus-like particles in the cultured cells. All cell lines tested were positive for viral infection as screened by DNA dot blot hybridization using a genomic library of Marek's disease herpesvirus as a probe. However, the attempt to isolate the virus was unsuccessful. In summary, these cell lines are believed to be infected by a putative quail herpesvirus. Results of this in vitro cellular study support previous findings that the atherosclerosis susceptible quail are latently infected in vivo. Future studies will be needed to determine whether the virus plays a role in the pathogenesis of atherosclerosis in this animal model.

Domain-specific knowledge in simple categorization tasks.

Many contemporary theories of learning and memory adopt the empiricist premise that concepts are structured according to perceptual similarity. Developmental differences in categorization tasks are thereby interpreted as the result of qualitative shifts in the capacity to attend to specific perceptual dimensions. An alternative theory is that domain-specific knowledge underlies categorization, and that even performance on simple categorization tasks is influenced by such knowledge. To test this hypothesis, adults were asked to categorize colored circles, which were described as either natural kinds or artifacts. In Study 1, the subjects were shown the actual circles; in Study 2, they were given descriptions. Adults categorized the circles differently as a function of how they were described and were influenced on subsequent choices by the demand to create "cohesive" categories. These results suggest that the developmental shifts may be due to differences in domain-specific knowledge about the nature of categorization tasks, not due to global cognitive changes. This proposal is supported by evidence from previous studies of adult categorization and children's acquisition of word meaning.

A new computerized polarization--microscopic method for the demonstration of collagen fibers.

A new computerized polarization microscopic method was developed for objective, quick quantitative analysis of anisotropic structures. The paper presents the technology on collagen fibers of kidney and liver preparations. According to the observations the birefringence of one fiber can be characterized not by a single number as it is accepted generally but by a series of data. It suggests that the process of compensation is gradual. One of the explanations of this fact might be that the collagen fibers are inhomogeneous at submicroscopic level. With regard to this assumption, first several birefringent capillary basement membranes of a whole glomerulum were measured simultaneously. In this case, the individual capillaries showed nearly the same retardation. Second, portal zones of normal and cirrhotic livers as functional units were analyzed simultaneously. In the latter case the individual fibers show different birefringence. Comparing the results obtained by their technique with the data of the classic measuring method authors found similarity that proved its validity. Data suggest that the new method seems to be useful in experimental and diagnostic pathology.

Pancreatogastrostomy in experimental acute necrotizing pancreatitis.

Experimental acute necrotizing pancreatitis was induced retrogradely in dogs with sunflower oil injected intraductally. Then, a zipper was sutured into the abdominal wound. From the first postoperative day, three different treatments were started: first group: only conservative therapy was used; second group: removal of necrotized tissue and single peritoneal lavage were applied; and third group: the necrotic part of the pancreas was marsupialized into the stomach. Through the systematic opening of the zipper, the abdominal cavity could easily be explored and the temporal course of disease could be observed in all animals. During this regular procedure, the amylase concentration and the amount of peritoneal exudate were determined. The blood amylase and glucose levels were also measured. On the first postoperative day, the amylase level and the amount of peritoneal exudate were high in all groups. The dogs of the pancreatogastrostomized group showed a dramatic decrease of the exudate and the most advantageous temporal course of the blood amylase level. The survival rate similarly was advantageous in the pancreatogastrostomized group.