Local allergic rhinitis in children: identification and characterization in a specialty outpatient clinic.

Summary: Background. Local Allergic Rhinitis (LAR) is a phenotype defined by rhinitis symptoms with negative responses to systemic sensitization tests but with an exclusively nasal allergic inflammatory response. Data on the pediatric age group is scarce, and no Latin American data has been published so far. Methods. Nasal Allergen Challenge (NAC) was performed with Dermatophagoides pteronyssinus and Blomia tropicalis in six- to 18-year-old patients diagnosed with rhinitis and no systemic sensitization. NAC was monitored using subjective parameters and acoustic rhinometry. The study aimed to identify LAR in child and adolescent subjects previously diagnosed with non-allergic rhinitis (NAR) in a Brazilian specialty outpatient clinic (Allergy and Immunology). Results. During the study period, we analyzed 758 skin prick tests (SPT). Of those, 517 (68.2%) were diagnosed with rhinitis. Among those, 18.4% (95/517) had a negative SPT, meeting the criteria for inclusion in the study. Twenty-five patients underwent NAC, and 40% (10/25) of them, previously considered to have NAR, had a positive test and were reclassified as having LAR. Based on the analyzed characteristics, clinically differentiating LAR from NAR was impossible. Conclusions. This study represents the first investigation of LAR in child and adolescent subjects in Latin America, contributing significantly to the understanding of its prevalence and characteristics in this geographic area. Among a subgroup of patients lacking systemic sensitization submitted to NAC, 40% (10/25) demonstrated a positive NAC with Dermatophagoides pteronyssinus and Blomia tropicalis, warranting their reclassification to LAR. NAC with multiple allergens has been proven safe and viable in pediatric populations, affirming its critical role in the accurate diagnosis of LAR.

Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease.

INTRODUCTION: Torsion of an undescended testis (UDT) associated with cerebral palsy (CP) and neuromuscular disease (NMD) is an uncommon condition that is not well recognized by primary care physicians or healthcare providers. OBJECTIVE: The objective of this study was to highlight the clinical importance of torsion of a UDT in children with CP and NMD. MATERIALS AND METHODS: Eleven children with testicular torsion of a UDT operated on at the study institute between 1991 and 2015 were identified. The records of seven children (63.6%) associated with CP or NMD were retrospectively reviewed. Clinical findings of testicular torsion were assessed along with the treatment outcome and testicular salvageability. RESULTS: All seven children were not identified with a UDT by public health checkup for infant and young children. No children with CP or NMD had torsion of a descended testis during the present study period. Median age at surgery was 15 years (range, 1-20 years). The testis location was at the external inguinal ring in five patients, in the inguinal canal in one, and in the superficial inguinal pouch in one. Of the contralateral testes, four were a UDT, one was a retractile testis, and two were descended testes. Orchiectomy was performed in six patients (85.7%). In the remaining patients, the testis was preserved but became atrophic. DISCUSSION: This study demonstrated that children with CP or NMD may be affected with torsion of a UDT with peak at around puberty with the poor salvage rate, even if the testes appear descended in infancy and young children. Shortcomings of this study were the retrospective design and a small series of children undergoing surgery for torsion of a UDT. CONCLUSION: Pediatric urologists need to educate primary care physicians and healthcare providers in the recognition of acquired UDTs and possibly associated testicular torsion in children with CP and NMD. Genital examination should be continued regularly until adolescence in these children to detect acquired UDT. These children should be referred to pediatric urologists to promote surgery as soon as the diagnosis of acquired UDT is carried out. It is believed that it is perhaps the best approach to prevent loss of the testis in children with CP and NMD.

Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents.

OBJECTIVES: To standardize acoustic rhinometry (AR) in nasal provocation tests (NPTs) with histamine in children and adolescents. PATIENTS AND METHODS: We performed a cross-sectional validation to compare AR with anterior active rhinomanometry (AAR) during histamine NPT in 20 children and adolescents with persistent allergic rhinitis and 20 controls. Changes in total nasal resistance (AAR) were compared with changes in nasal volume in the first 5 cm (V5). RESULTS: Compared with controls, patients with rhinitis had significantly higher mean total nasal resistance (0.34 Pa/cm3/s vs 0.21 Pa/cm3/s; P=.01) and lower mean V5 values (8.20 cm3 vs 9.24 cm3; P=.04) at baseline. The mean histamine concentration necessary to increase total nasal resistance by at least 100% was significantly lower in the rhinitis group than in the control group (0.72 mg/mL vs 2.4 mg/mL; P<.001). At the end of the NPT a mean increase of 126% in total nasal resistance and a mean decrease of 24.3% in V5 were observed in the rhinitis group. When compared with the AAR criteria, the highest sensitivity and specificity values were observed for a cutoff represented by a 19%-21% drop in V5. CONCLUSIONS: We found AR to be a feasible and sensitive tool for monitoring nasal response in children and adolescents undergoing histamine NPT. The best AR cutoff for ending the NPT was a 19%-21% drop in V5.

Acoustic rhinometry in nasal provocation tests in children and adolescents

Objectives: To standardize acoustic rhinometry (AR) in nasal provocation tests (NPTs) with histamine in children and adolescents. Patients and Methods: We performed a cross-sectional validation to compare AR with anterior active rhinomanometry (AAR) during histamine NPT in 20 children and adolescents with persistent allergic rhinitis and 20 controls. Changes in total nasal resistance (AAR) were compared with changes in nasal volume in the first 5 cm (V5). Results: Compared with controls, patients with rhinitis had significantly higher mean total nasal resistance (0.34 Pa/cm3/s vs 0.21 Pa/cm3/s; P=.01) and lower mean V5 values (8.20 cm3 vs 9.24 cm3; P=.04) at baseline. The mean histamine concentration necessary to increase total nasal resistance by at least 100% was significantly lower in the rhinitis group than in the control group (0.72 mg/mL vs 2.4 mg/mL; P<.001). At the end of the NPT a mean increase of 126% in total nasal resistance and a mean decrease of 24.3% in V5 were observed in the rhinitis group. When compared with the AAR criteria, the highest sensitivity and specificity values were observed for a cutoff represented by a 19%-21% drop in V5. Conclusions: We found AR to be a feasible and sensitive tool for monitoring nasal response in children and adolescents undergoing histamine NPT. The best AR cutoff for ending the NPT was a 19%-21% drop in V5 (AU)

Objetivos: Estandarizar la rinometría acústica (RA) como medida de la respuesta a la prueba de provocación nasal con histamina (PPN) en niños y adolescentes. Pacientes y métodos: Se realizó un estudio de validación transversal comparando la RA frente a la rinomanometría anterior (RAA) activa en la evaluación de la respuesta frente a la PPN con histamina, realizado en 20 niños o adolescentes, diagnosticados de rinitis alérgica persistente y 20 controles sanos. Las variables estudiadas fueron los cambios en la resistencia nasal total, medida mediante RAA y los cambios en el volumen nasal de los primeros 5 cm (V5) evaluados mediante RA. Resultados: En relación con los sujetos control, los pacientes con rinitis alérgica presentaban niveles basales de resistencia nasal total significativamente más elevados (medias respectivas 0,34 Pa/cm3/s versus 0,21 Pa/cm3/s; p= 0,01) y valores de V5 significativamente inferiores (medias respectivas 8,20 cm3 versus 9,24 cm3; p= 0,04). La concentración media de histamina necesaria para incrementar el 100% la resistencia total nasal fue significativamente más baja en los pacientes con rinitis que en los controles (medias respectivas 0,72 mg/ml versus 2,4 mg/ml; p< 0,001). Al final de la PPN el incremento medio de la resistencia nasal total fue del 126%, en los sujetos con rinitis alérgica. En ese momento también se observó en este grupo un decremento medio del V5 del 24,3%. Utilizando como patrón oro de respuesta positiva un incremento en la resistencia nasal total del 100% mediante RAA, los puntos de corte con mayor sensibilidad y especificidad para el descenso de V5 se encontraban en un descenso de entre el 19 y 21%. Conclusiones: Nuestros resultados demuestran que la RA es una herramienta realizable y sensible para cuantificar la respuesta a la PPN en niños y adolescentes e identifican un punto de corte de descenso en el V5 de entre el 19 y el 21% como el de mayor sensibilidad y especificidad (AU)

Characterization of yolk sac proteins of Bos indicus cattle embryos.

The yolk sac is an embryonic membrane that is essential for the embryo's initial survival in many mammals. It also plays an important role in the production of proteins necessary for development. We studied proteins of the yolk sac in bovine embryos at up to 40 days of gestation. We examined the yolk sac of 17 bovine embryos at different gestational periods, measuring α-fetoprotein, α-1-antitrypsin, and transferrin. This experiment was carried out by Western blot technique, associated with electrophoresis on a 6% sodium dodecyl sulfate polyacrylamide gel. Mouse monoclonal antibody anti-human-α-fetoprotein, mouse antibody anti-human-transferrin and rabbit polyclonal anti-human-α-1-antitrypsin were used as primary antibodies, and conjugated peroxidase as a secondary antibody. We detected the three proteins in some of the yolk sac samples; however, the bands in some specimens (samples) were weak, maybe a result of poor antigen-antibody reaction, since the antibodies used in this study were not specific to bovine proteins. The fact that weak bands appeared might be due to a weak cross-reaction.

Characterization of 5-hydroxytryptamine-induced contraction and acetylcholine-induced relaxation in isolated chicken basilar artery.

The aim of the present study was to clarify the responsiveness of the chicken basilar artery to 5-hydroxytryptamine (5-HT) and acetylcholine (ACh) and to characterize the related receptor subtypes in vitro. Basilar arteries were obtained from freshly slaughtered broiler chickens. The 5-HT induced concentration-dependent contraction of the arteries. The concentration-response curves for 5-HT were shifted 30-fold to the right by methiothepin (a 5-HT(1) and 5-HT(2) receptor antagonist) and 3-fold to the right by ketanserin (a 5-HT(2) receptor antagonist). In the presence of ketanserin, the concentration-response curve for 5-HT was shifted 10-fold to the right by methiothepin. The pA(2) value for methiothepin was 8.26. The ACh induced concentration-dependent relaxation under conditions of precontraction by 5-HT. The concentration-response curve for ACh was shifted to the right by atropine [a nonselective muscarinic (M) receptor antagonist] and hexahydro-sila-difenidol hydrochloride, a p-fluoroanalog (pFHHSiD, an M(3) receptor antagonist), but not by pirenzepine (an M(1) receptor antagonist) or methoctramine (an M(2) receptor antagonist). The pA(2) value for pFHHSiD was 7.55. Nω-Nitro-l-arginine (a nitric oxide synthase inhibitor) inhibited ACh-induced relaxation by approximately 50%. These results suggest that 5-HT induces contraction via activation of 5-HT(1) and 5-HT(2) receptors and that ACh induces relaxation via activation of the M(3) receptor. The 5-HT(1) receptor might play a dominant role in 5-HT-induced contraction. One of the factors involved in ACh-induced relaxation is probably nitric oxide released from endothelial cells.

Clinical significance of intramedullary Gd-DTPA enhancement in cervical myelopathy.

STUDY DESIGN: Prospective multicenter study. OBJECTIVE: To clarify the significance of intramedullary Gd-DTPA enhancement in cervical myelopathy, the prevalence, morphologic features, clinical relevance and postoperative change were investigated. SETTING: Four hospitals in Japan. METHODS: A total of 683 patients with cervical myelopathy who underwent decompressive surgery were consecutively examined. T1, 2 and Gd-DTPA-enhanced MRI were taken before surgery. Fifty consecutive cases without intramedullary enhancement were allocated in the non-enhancement group. The following variables were investigated: prevalence of the enhancement, the morphologic feature, the relationship between the enhancement and T2 high-intensity areas, the change of the Japanese Orthopedic Association (JOA) score for cervical myelopathy and the change of the enhancement after surgery. RESULTS: Intramedullary enhancement was observed in 50 cases (7.3%). The enhancements were observed between the most severely compressed disc and the cranial half of the lower vertebral body. On axial images, they were observed at the posterior or posterolateral periphery of the spinal cord. Enhancement areas were observed within T2 high-intensity areas and smaller than them. The preoperative JOA score was 9.8+/-2.8 points in the enhancement group and 9.8+/-3.3 points in the non-enhancement group (NS). The postoperative JOA score was 12.7+/-2.9 points in the enhancement group and 14.2+/-2.4 in the non-enhancement group (P=0.006). Intramedullary enhancement disappeared in 60% of the patients 1 year after surgery. CONCLUSION: Intramedullary enhancement indicated not the severity of preoperative symptoms, but a sign of a worse prognosis.

One-stage lateral rhachotomy and posterior spinal fusion with compression hooks for Pott's paralysis in the elderly.

PURPOSE: To evaluate the safety and effectiveness of one-stage lateral rhachotomy and posterior fusion with compression hooks, for the treatment of Pott's paralysis in the elderly. METHODS: 11 elderly patients underwent lateral rhachotomy (costotransversectomy and pediculectomy) to debride the tuberculosis focus extending into the epidural space and to decompress the spinal cord. After debridement, the interbody cavity was packed with autologous iliac bone chips. For stabilisation, posterior fusion was performed using a compression lamina hook system. Patients were followed up for at least 2 years for complications. Neurological status was assessed using the Frankel score. The kyphotic deformity was measured on lateral radiographs taken before surgery and at follow-up. RESULTS: During separation of the adhesion around the abscess, a dural tear occurred in one patient and a pleural tear in another. Both tears were successfully repaired. One patient had mild pneumonia after surgery. The Frankel scores of the 11 patients improved from C or D before surgery to D or E after surgery. No relapse of spinal tuberculosis was encountered. The mean deformity angle was 25.5 degrees before surgery and 23.2 degrees at the final follow-up. Spinal fusion was achieved in all patients. CONCLUSION: Without the need of thoracotomy, one-stage lateral rhachotomy with posterior spinal fusion using compression hooks was an effective option for treating Pott's paralysis in the elderly.

Split renal function does not change after successful treatment in children with primary vesico-ureteric reflux.

OBJECTIVE: To evaluate the renal growth pattern in patients with primary vesico-ureteric reflux (VUR) using long-term measurements of split renal function with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. PATIENTS AND METHODS: In all, 712 children aged < 16 years (466 boys and 246 girls) with primary VUR were referred to our hospital from July 1991 to December 2000. VUR was diagnosed by voiding cysto-urethrography. The patients were treated either surgically (group 1) or conservatively (group 2) and followed with serial 99mTc-DMSA scintigraphy for up to 10 years. There were 942 examinations in 367 of 712 patients who had repeat scintigraphy. Patients with secondary VUR, VUR to a solitary or fused kidney, or upper urinary tract obstruction, were excluded. Five of 298 patients (1.7%) who had ureteric reimplantation had a febrile urinary tract infection (UTI) soon after surgery but none recurred (recurrence is an indication for surgery in children with VUR); there was no febrile UTI in the 69 patients in group 2. Planar scintigraphy with 99mTc-DMSA was used to assess the absolute uptake (AU) of each kidney, measured as a percentage of the injected dose, and the relative uptake (RU = AU of each kidney/AU of both kidneys) calculated. The initial examination was at least 4 weeks after any febrile UTI in most patients. Serial studies were conducted 1 year after surgery and then biannually in group 1. In group 2 the DMSA scan was repeated every 2-3 years. The change in split renal function was compared with the RU of the right kidney. RESULTS: The RU of the right kidney at the initial scan correlated closely with those on repeated scans in both groups. The correlation coefficients were 0.99 in group 1 and 0.94-0.97 in group 2 at every study. The change of RU remained within 0.05 in all patients after treatment. CONCLUSIONS: Under strict control of UTI, split renal function in children with primary VUR does not change. There may be no possibility of accelerated or compensatory growth of the kidney with reflux nephropathy, but no concern about deterioration and atrophy either.

A possible paracrine hedgehog signalling pathway in neurofibromas from patients with neurofibromatosis type 1.

BACKGROUND: Hedgehogs (Hhs) and their receptors are involved in organ development as well as in tumorigenesis observed in basal cell carcinoma. Among Hhs, Desert hedgehog secreted from Schwann cells mediates the formation of peripheral nerve sheaths. However, there has been no study on the role of Hhs and their receptors in tumorigenesis of neurofibromas in neurofibromatosis type 1 (NF1). OBJECTIVES: To clarify the expression and localization of Hhs and their receptors in neurofibromas of NF1 patients. METHODS: Expression of Hhs and their receptors was studied by immunohistochemistry using neurofibromas from NF1 patients and control normal skin samples. RESULTS: In neurofibromas, CD57-positive tumour cells with delicate elongated processes were positive for the receptor PTCH2. Perineurial cells of involved nerves within neurofibromas as well as those of normal cutaneous nerves expressed Indian hedgehog and Sonic hedgehog. Schwann cells of normal cutaneous nerves were positive for PTCH2. CONCLUSIONS: Our study suggests that a paracrine Hh signalling pathway may be involved in tumorigenesis of neurofibromas in NF1.

Effects of nutrition on the cell survival and gene expression of transplanted fat tissues in mice.

Fat tissue transplantation is a useful and common clinical technique in the plastic and reconstructive surgeries. To know the nutritional effects on the survival and maintenance of fat grafts, the weights of tissues and cell sizes, and the gene expressions in the fat tissues were analyzed 14 days after transplantation. The body weight and the plasma insulin level in high nutritional group (HNG) were significantly higher (p<0.05) than those in low nutritional group (LNG), respectively. The measurements of cell size showed that there were 32.5% distributed in the diameter less than 2 microm in LNG, significantly higher than 28.5% in HNG. There were 7.5% distributed in the diameter more than 6 microm in LNG, significantly lower than 10.0% in HNG. The mRNA levels of leptin, lipoprotein lipase, and beta(3)-adrenergic receptor were 2.0-, 1.5-, and 1.7-fold higher in HNG than those in LNG, respectively. The levels of hormone sensitive lipase and hexokinase 2 transcripts were not significantly different in both groups. These results show that the systemic nutritional status in host causes the changes of cell size and tissue weight as well as gene expression in the transplanted fat using mice model. The nutritional condition is probably important for the fat graft clinically both as lipid-storage and functional cells.

Yeasts isolated from blood and catheter in children from a public hospital of São Paulo, Brazil.

The great majority of nosocomial fungal infections, especially fungemias, are caused by yeasts, mostly of the genus Candida. In addition, such infections may be associated with intravascular catheters. In this study, 80 yeast strains were isolated from hospitalized children, being 59 from blood cultures and 21 from vascular catheter cultures. The prevalent species in both blood and catheter was C. parapsilosis (32.2% and 48.9%, respectively), followed by C. albicans (16.9% and 28.6%, respectively). Concerning enzyme production, 78.8% of the 80 isolates presented strong proteolytic activity but 78.8% showed no phospholipase activity. We also detected two prevalent "killer" biotypes: 511 and 888. Additionally, in five patients, it was possible to observe that the yeast species, "killer" biotype and proteolytic and phospholipase activity of blood and catheter were similar. In view of this, we suggest a transmission of nosocomial yeast infection from catheter to blood.

Allergenic evaluation of Malassezia furfur crude extracts.

Crude extracts of the lipophilic yeast Malassezia furfur were obtained from 2, 6, 10 and 28 day old cultures. The in vitro cultivation periods corresponded, respectively, to the lag phase, middle of the log phase, end of log phase and the decline phase of the growth curve, which was based on viable cell counts obtained with a fluorescent viability test. Biochemical analyses showed that the protein and carbohydrate contents were greater in day 10 extracts. Seventy patients with different allergic manifestations and 30 healthy volunteers were skin prick tested using the extracts. Of these, thirteen (18.57%) patients gave positive responses. SDS PAGE gradient electrophoretic profiles of the preparations indicated that the 28 day extracts contained the greatest number of protein bands with molecular weights ranging mostly between 30 and 94 kDa. Immunoblots incubated with individual patient sera showed that four IgE binding M. furfur allergens of approximately 88, 61, 52 and 39 kDa were present in the 28 day extracts. The components identified could be used for detecting IgE mediated responses to M. furfur among individuals affected with different allergic conditions.

[Expression of urokinase-type plasminogen activator (uPA) and uPA receptor (uPAR) plays a role in destruction of joint tissue in rapidly destructive coxarthropathy (RDC)].

OBJECTIVE: Proliferation of small vessels including capillaries in joint tissues is one of the significant histopathological features of rapidly destructive coxarthropathy (RDC). To examine the relationship between the angiogenesis and bone destruction, expression of urokinase-type plasminogen activator (uPA) and uPA receptor (uPAR), which are necessary for angiogenesis was histochemically investigated. MATERIALS AND METHODS: Synovia and cartilage-bone tissues of femoral head were obtained from RDC patients at total hip replacement (THR). These joint tissues were fixed with 4% paraformaldehyde, and cartilage-bone tissues were decalcified, additionally. Immunohistochemical staining was performed on paraffin sections, using monoclonal antibodies against human uPA and uPAR. RESULT: There was a difference between expression of uPA and that of uPAR. Expression of uPA was observed in many types of cells such as osteoclasts, giant cells, fibroblast-like cells and macrophages, of which osteoclasts and giant cells were most prominent. On the other hand, expression of uPAR was detected mainly in fibroblast-like cells and macrophages and rarely seen in osteoclasts and giant cells. CONCLUSION: These results indicate that uPA-plasmin system contributes to bone destruction in RDC, and furthermore, that fibroblast-like cells and macrophages play an important role in activation of uPA-plasmin system.

Effects of the quantity of water and milk ingested concomitantly with AS-924, a novel ester-type cephem antibiotic, on its pharmacokinetics.

The effect of the quantity of water ingested concomitantly with drugs, on the absorption of AS-924, a novel prodrug-type cephem antibiotic, was studied in five healthy adult volunteers by a cross-over method, using cefteram-pivoxil (CTER-PI) as the control drug. In addition, the effect of milk on the absorption of AS-924 was also investigated. The absorption of CTER-PI was significantly reduced when administered together with 30 ml of water compared with its absorption when administered together with 150 ml of water, whereas no such reduction was found in the case of AS-924. Ingestion of milk did not significantly affect the absorption of AS-924. These results confirm that absorption of AS-924 after oral administration is not likely to be affected by the quantity of water taken concomitantly with the drug, nor by milk.

[Outcome of neonates born with unilateral multicystic dysplastic kidneys].

AIMS: To review our experience of neonates with unilateral multicystic dysplastic kidneys (MCDKs) and to plan how to manage this anomaly. PATIENTS AND METHODS: Forty-eight neonates (30 boys, 18 girls) with unilateral MCDK were referred to our institute between August 1991 and February 1999. Urological evaluation was performed by USG, VCUG and radionuclide study. Follow-up period was 15 month to 106 months (Ave. 54 months). RESULTS: Forty-five of 48 (93.8%) MCDKs were found prenatally. No surgical procedure was performed in utero. Seven (14.6%) had low grade vesicoureteral reflux (ipsilateral 5, contralateral 2). Dilation of contralateral upper urinaly tract was detected in 16 (33.3%) neonates and diuretic renography revealed 4PUJ obstruction and 2 mid-ureteral stenosis. Although 29 of 48 (60.4%) MCDKs were large, no neonate showed mass effect which caused vomiting or dyspnea. All MCDKs except two, which removed because of ipsilateral ureterocele or ectopic ureter, were followed conservatively. Two boys had nephrectomy when they became 5-year-old on their parent's request. Surgical correction of contralateral urinary tract anomaly, 3 pyeloplasty and 2 end-to-end ureteral anastomosis, was performed. All neonates but one with contralateral hypodysplastic kidney had good renal function. Neither hypertension nor malignant tumor had occurred. CONCLUSION: These findings suggest that neonates with unilateral MCDKs can be treated conservatively only if they have no contralateral serious anomaly. Surgical intervention is not necessary for unilateral MCDKs before and after birth but socially and/or economically it depends on patients' request.

Analysis of urinary prostacyclin and thromboxane/prostacyclin ratio in patients with rheumatoid arthritis using gas chromatography/selected ion monitoring.

We investigated production of prostacyclin and the urinary ratio of thromboxane and prostacyclin in patients with rheumatoid arthritis. The prostacyclin production level was assessed according to the level of urinary 2,3-dinor-6-keto-prostaglandin F(1 alpha)measuring by gas chromatography/selected ion monitoring. In patients receiving medication, the prostacyclin level was lower and the thromboxane/prostacyclin ratio was greater compare with that of healthy volunteers. The prostacyclin level in patients without medication was approximately 4-fold higher than that of healthy volunteers and 8-fold higher than those of medicated groups. Although the ratio of the group without medication was similar to that of healthy volunteers, the urinary levels of each prostanoid were higher than those of other groups. Then, the ratios of groups receiving steroids were higher than that of other groups owing to high TX level. The present findings demonstrated that endogenous prostacyclin and thromboxane production increased in patients without medication, and prostacyclin production decreased with medication.

Comparison of ultrasonically activated scalpel versus conventional division for the pancreas in distal pancreatectomy.

PURPOSE: The goal of this study was to compare the benefits and complications of using an ultrasonically activated scalpel and conventional division of the pancreas in patients undergoing a distal pancreatectomy. METHODS: A retrospective review was performed of all patients who underwent distal pancreatectomy at the Department of Surgery, Koshigaya Municipal Hospital. In the ultrasonically activated scalpel (US) group (n = 11), the pancreas was divided using coagulation shears. The stump of the pancreas was left open without parenchymal suturing. In the conventional surgical division (CV) group (n = 20), the pancreas was cut with a knife and the stump was oversewn with interrupted mattress sutures. The main pancreatic duct was ligated in all patients in both groups. The postoperative courses in the two groups were then compared in terms of postoperative serum amylase levels and the incidence of pancreatic fistulas. RESULTS: The postoperative serum amylase levels were significantly lower in the US group than in the CV group (P < 0.01 on the day of operation). The incidence of pancreatic fistulas was also significantly lower in the US group (0%) than in the CV group (30%) (P = 0.04). CONCLUSIONS: The use of the ultrasonically activated scalpel was found to reduce the incidence of pancreatic fistula in distal pancreatectomy. Furthermore, the use of this device without any clamping or parenchymal suturing may reduce the damage to the remnant pancreas.