The feasibility and efficacy of treatment with a Willis covered stent in recurrent intracranial aneurysms after coiling

BACKGROUND AND PURPOSE

Aneurysm recurrence is an innate problem after coiling, and the recurrence rate is higher in complicated aneurysms. We evaluated the feasibility and efficacy of using the Willis covered stent in treating recurrent aneurysms after coil embolization.

MATERIALS AND METHODS

Eight aneurysms in 8 patients treated with detachable coils had confirmed recurrent aneurysms: 3 giant, 1 large, 1 dissecting, and 3 small wide-necked. The recurrent aneurysms involved C3 in 1 patient, C4 in 1, C7 in 5, and V4 in 1. A total of 11 covered stents were implanted into 8 target arteries. Follow-up angiography was performed 1-16 months after the procedure. Clinical follow-up data were collected and retrospectively analyzed, grading as fully recovered, improved, unchanged, or aggravated.

RESULTS

Willis covered stent placement succeeded technically in all of the aneurysms. No technique-related adverse event occurred. Total occlusion was achieved immediately in 6 aneurysms, and a small endoleak was observed in 2 aneurysms. No mortality or morbidity occurred during or after the procedures, including during the follow-up period. Follow-up angiograms revealed that all 8 of the recurrent aneurysms were completely isolated, and 8 parent vessels kept patency, except 1 with mild stenosis. Clinical neurologic symptoms fully resolved in 5 patients, improved in 1, and were unchanged in 2 at the end of the follow-up period.

CONCLUSIONS

In this small study with a middle-term follow-up, the Willis covered stent was used safely and effectively to occlude recurred aneurysms after coiling. Longer-term follow-up and additional clinical experience are needed to fully determine the safety and efficacy of the device.

A new covered stent designed for intracranial vasculature: application in the management of pseudoaneurysms of the cranial internal carotid artery

BACKGROUND AND PURPOSE

The management of intracranial pseudoaneurysms is controversial. The purpose of this study was to provide a preliminary evaluation of the clinical efficacy of a Willis covered stent specially designed for the intracranial vasculature in the management of a pseudoaneurysm of the cranial internal carotid artery (CICA).

MATERIALS AND METHODS

Eight patients with pseudoaneurysms of the CICA were treated with use of the Willis covered stent. The flexibility of the entire stent system was gauged from the resistance met when reaching the target lesion and was categorized as no resistance, no apparent resistance, or resistance that could be overcome. The apposition of the Willis stent after deployment was scored as excellent with no endoleak, good with a small endoleak, or bad with an apparent endoleak. Follow-up angiography was performed 3 to 12 months after placement of the stent, and angiographic assessments were categorized as endoleak, stenosis of the covered segment of vessel, or occlusion of parent arteries. Follow-up clinical evaluations were also performed, and outcomes were graded as full recovery, improvement, unchanged, and aggravation.

RESULTS

Endovascular treatment was technically successful in all aneurysms without procedural-related complications, and all of the stents were easily navigated to the targeted lesions in the CICA. Complete resolution of the pseudoaneurysm was observed in 6 patients immediately after the procedure, and a minimal endoleak into the aneurysm persisted in 2 patients. No morbidity or mortality and no technical adverse event occurred. A follow-up angiogram confirmed complete reconstruction of the internal carotid artery, with no recurrent aneurysmal filling and no occurrence of stenosis in the area of the stent. By the final follow-up visit, 4 patients had fully recovered, 3 had improved, and 1 patient's condition was unchanged.

CONCLUSION

On the basis of our preliminary experience, the Willis covered stent specially designed for the intracranial vasculature can manage a CICA pseudoaneurysm safely and effectively, but longer follow-up and expanded clinical trials are needed.

AFLP fingerprinting for paternity testing in ducks

1. The accuracy and reproducibility of AFLP fingerprinting was investigated in the duck (Anas Platyrhynchos), using a multicolour fluorescent labeling technique. The fluorescent labelling fragments were separated on a capillary electrophoresis-base ABI PRISM 3100 Genetic Analyzer. 2. A total of 337 AFLP peaks with 103 of them being polymorphic markers were generated by 16 sets consisting of EcoRI/TaqI primer pair combinations. The number and size range of AFLP polymorphisms detected per primer pair varied from 3 to 11 and 58 to 290 bp, respectively. About 30.6% (103/337) of AFLP peaks were detected polymorphisms, with an average of 6.4 polymorphic markers per primer pair. 3. The clear polymorphic peaks were amplified with EcoR+AC/Taq+AC primer combinations. The AFLP peaks showed high reproducibility. From the family testing, we found that the fingerprints of all the offspring were derived from one or other parent. Therefore, we conclude that AFLP fingerprinting might be a suitable method for duck paternity testing.

Selection responses in duration of fertility and its consequences on hatchability in the intergeneric crossbreeding of ducks

1. From 1992 to 2003, selected (S) and control lines (C) of the laying Brown Tsaiya duck (Anas platyrhynchos) were simultaneously maintained under the same standardised conditions of feeding and management. 2. The selection objective was to increase the number of fertile eggs after a single artificial insemination (AI) with pooled Muscovy semen. From generations G1 to G11, 2452 and 2022 female ducks, in S and C lines, respectively, were measured and recorded. In the S line, the percentage selected varied between 20.2 and 34.3% in females and between 7.2 and 20.8% in males. 3. Selection for number of fertile eggs had a correlated effect of increasing the parameter tau of the logistic curves which fitted the daily variations (d 2 to 15) in fertility or hatchability on the basis of eggs set. The differences S-C for the estimates of the times of half maximal fertility and hatchability increased by 0.41 and 0.37 d per generation between G1 and G11, respectively. 4. The highest increases of fertility per day rates after a single AI were observed between d 5 and 11. Moreover, in the selected line, fertility rate was higher than, or equal to, 90% in d 2 from G8. The same tendencies were observed for the changes in the evolution of hatchability on the basis of eggs set. 5. Selection increased fertility and hatchability according to the egg set rates, especially for d 2 to 8 after AI. Hatchability of fertile eggs was not impaired, confirming that selection for one AI per week was possible in this strain of laying ducks.

Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils: an analysis of 162 cases with 173 aneurysms

BACKGROUND AND PURPOSE

The endovascular approach, with the use of Guglielmi detachable coils (GDC), has been increasingly used to treat ruptured and unruptured cerebral aneurysms in recent years. Our objective was to assess the mid- to long-term radiologic outcome of cerebral aneurysms treated with GDC embolization.

METHODS

One hundred and sixty-two patients with a total of 173 aneurysms embolized with GDCs underwent angiographic follow-up 1 to 54 months after the procedure and were reviewed retrospectively. Each angiogram was reviewed by 2 neuroradiologists and 1 neurosurgeon, each of whom made a comparison between the initial and follow-up angiograms. Morphologic outcomes were scored as follows: unchanged, progressive thrombosis, and reopening or regrowth.

RESULTS

Of the 173 aneurysms with GDC embolization, 142 had total or nearly total occlusion, 23 subtotal occlusion, and 8 partial occlusion on the initial angiograms. The incidence of reopening was 17.1% (13/76) in less than 3 months and 6.2% (6/97) between 3 and 6 months after the procedure. Four aneurysms (2.3%) were found to be recurrent in the second follow-up angiography within 1 year after the procedure. The 1-year cumulative recurrent rate was 13.3%. Among 56 aneurysms with a third follow-up angiography in the period of 12 to 54 months after the procedure, 4 (7.1%) displayed a slight enlargement; the long-term cumulative recurrent rate was 20.4%.

CONCLUSION

The direct and primary causes for aneurysmal recurrence are incomplete and loose packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier for incompletely occluded aneurysms and at 6 months for totally or nearly totally occluded aneurysms. In case of total or nearly total occlusion that remains stable at follow-up, the interval for monitoring should be prolonged appropriately. Retreatment with balloon- or stent-assisted coil embolization is recommended for reopened aneurysms.

Evaluation of Nebulizer Performance under Various Humidity Conditions

Jet nebulizers are a drug delivery tool commonly used for treating respiratory diseases. When a nebulizer generates aerosols, the rate at which droplets evaporate depends on humidity conditions around the nebulizer outlet. Because the relative humidity (RH) of the air affects the evaporation rate, the aerosol distribution and drug delivery dose is also affected by RH. Four nebulizers were chosen for comparison in this study: PARI LC Plus (PARI Respiratory Equipment, Inc., Midlothian, VA), SideStream (Medic-Aid Ltd., UK), VixOne (Westmed, Inc., Tucson, AZ), and Micromist (Hudson Respiratory Care Inc., Temecula, CA). Two different formulations were used: albuterol (liquid solution) and budesonide (suspension). Particle distribution (mass median aerodynamic diameter [MMAD] and geometric standard deviation [GSD]), nebulizer efficiency (total efficiency and respirable fraction [RF] efficiency for particles less than 4.7 microm), and dead volume (the amount of solution remaining after nebulization) were compared at the RH of 5%, 50%, and 80%. Our results showed that the MMAD increased (p value varied from <0.001 to 0.016) with the increase in RH, except for with the VixOne unit with albuterol (p = 0.24). The MMAD from the budesonide always appeared higher than from the albuterol. The RF (and thus, the inhalation dose) was lower with a higher RH. Except for the PARI LC Plus with budesonide, the RF decreased approximately 15-27% when the RH rose from 5% to 50%. For the PARI LC Plus nebulizer, the lower dead volume (0.22 mL) with higher residual drugs (62.3% of total drug) was obtained at an RH of 5% comparing the RH of 50% and 80% because of the unit's unique design.

Intraosseous oral leiomyoma: systematic review and report of one case

OBJECTIVES

The objectives of this study were to report one case of intraosseous oral leiomyoma and to systematically review the English literature.

METHODS

The clinical and radiographic findings of a patient who presented with intraosseous oral leiomyoma were recorded. In addition, 11 references from the English literature that reported 12 patients were reviewed.

RESULTS

Thirteen patients (age range 8 months to 71 years; mean 36 years, median 25 years) were reported to present with intraosseous oral leiomyoma. After excluding one patient whose sex was not reported, there were five female patients (42%) and seven males (58%). The majority of patients presented with either no symptoms or with an asymptomatic swelling. Eleven of 13 lesions occurred in the mandible; the most common site was the posterior of the jaw. Radiographically, intraosseous oral leiomyoma was found to present as either a unilocular or multilocular radiolucency with either well defined or ill defined borders and frequent cortical involvement.

CONCLUSIONS

Intraosseous oral leiomyoma was found to occur in the mandibular posterior region of relatively young patients, with cortical involvement and a slight male gender preference. Surgical excision was the treatment of choice and no recurrence has been encountered.

Dosimetry of metal tritide particles as evaluated by the ICRP 66 model and a biokinetic model from laboratory rats

Internal radiation from inhalation of metal tritide aerosols may present a significant radiation protection problem for nuclear facility workers. Dose was evaluated for three metal tritides: hafnium, titanium, and zirconium. The study included in vitro and in vivo exposures. The inhalation doses for the three materials were calculated by using the ICRP 66 lung model. The doses also were evaluated by a biokinetic model, which was developed according to the results of animal studies. Results showed that the hafnium tritide particles were the most dense but they had a lower dissolution rate and a higher retention rate. Among these three tritides, hafnium was classified as a Type S material according to the ICRP 66 publication, whereas titanium and zirconium ranked between Type M and F materials. The dissolution rate of hafnium tritide appeared to agree well with the in vitro and in vivo studies. The dissolution rates of the other two materials in the in vitro studies were a little higher than those of the in vivo studies. The doses calculated by the ICRP 66 model for all materials were approximately two orders smaller than the doses obtained by the animal studies. This bias was caused by the different intake methods of the ICRP 66 model (inhalation) and in the animal study (instillation). The doses were on the same order while correcting for deposition fractions. The effective doses for hafnium, titanium, and zirconium tritides were 5.43 x 10(-10), 9.05 x 10(-11), and 6.5 x 10(-10) Sv Bq(-1), respectively, according to the animal studies.

Effect of inhaled residual oil fly ash on the electrocardiogram of dogs

Epidemiology studies have found associations between increases in air pollutants and increases in morbidity and mortality from cardiovascular disease. The 1995 finding by Godleski et al. at Harvard that inhalation exposures of dogs to high concentrations of residual oil fly ash (ROFA) caused changes in the ST segment and T waves in the electrocardiogram (ECG) suggested a potential mechanism, and also suggested that inhaled metals might contribute to the effect. We conducted the present study to establish a baseline correspondence to the Godleski et al. findings in preparation for studies of the cardiac effects of specific particle-borne metals. The ROFA used in this study consisted of 45% carbon and 15.5% transition metals by mass. In vitro assays using cultured A549 cells and rat alveolar macrophages demonstrated that the ROFA was biologically active but was not highly cytotoxic. Four 10.5-yr-old beagles were exposed by oral inhalation to 3 mg/m3 of aerosolized ROFA for 3 h/day on 3 consecutive days. During the exposures, ECGs were continuously recorded from leads I, II, III, and V4. ECG data were also collected during three control exposures to clean air, during one of which changes were induced using drugs as a positive control. The ROFA exposures caused no consistent changes in the amplitude of the ST segment, the form or amplitude of the T wave, or arrhythmias. The data suggested a slight slowing of heart rate during exposure. Whether the difference between the present and previous findings resulted from differences in the composition of the two batches of ROFA or differences in methodology could not be determined by the study. This study did not address the cardiac effects of ROFA in subjects having preexisting cardiac susceptibility factors, nor was it a rigorous evaluation of effects on the frequency distribution of heart rate. Our results indicate that healthy dogs can inhale high concentrations of ROFA without changes in cardiac electrophysiology, which are detectable by clinical evaluations.

Particle characteristics and lung deposition patterns in a human airway replica of a dry powder formulation of polylactic acid produced using supercritical fluid technology

Polylactic acid (PLA) powders have been used as vector particles to carry pharmaceutical material. Drugs incorporated in the PLA powder can be retained in the lung for a longer period and may be more effective than free-form drugs. A new formulation of L-PLA dry powder, which was easy to disperse in the air, was produced by using a supercritical technology. The L-PLA powder was characterized in terms of physical particle size and aerodynamic size as generated with a Turbuhaler dry powder inhaler (DPI). Electron microscopy analysis of the particles indicated that they were individual particles in bulk form and became aggregate particles after generation by the Turbuhaler. Aerodynamic particle size analysis using both an Aerodynamic Particle Sizer (APS) aerosol spectrometer and Andersen impactor showed that the aerodynamic size decreased as the flow rate in the Turbuhaler increased from 28.3 to 90 L min(-1). Deposition patterns in the human respiratory tract were estimated using a realistic physical replica of human airways. Deposition of the L-PLA was high (80.8%) in the oral airway at 28.3 L min(-1) and an average of 73.4% at flow rates of 60 and 90 L min(-1). In the lung region, the deposition totaled 7.2% at 28.3 L min(-1), 18.3% at 60 L min(-1), and 17.6% at 90 L min(-1). These deposition patterns were consistent with aerodynamic size measurement, which showed 76 to 86% deposition in the USP/EP (US Pharmacopoeia/European Pharmacopoeia) induction port. As the flow rate increased, fewer aggregates were formed resulting in the smaller aerodynamic particles. As a result, more particles penetrated the oral airways and were available for deposition in the lung. Our results showed that L-PLA particles as manufactured by the supercritical technology could be used in a DPI that does not require the use of carrier particles to facilitate aerosol delivery.

Dose assessment for inhaling hafnium particles based on laboratory rats study

Internal radiation from inhalation of hafnium tritide aerosols may be a significant radiation protection problem encountered by nuclear facility workers. Based on experimental results of the rat intratracheally instilled with hafnium tritide particles and on a self-absorption factor of beta particles determined by a numerical method, a biokinetic model was developed for inhaled particles of hafnium tritide. Results show that lung burdens of the tritide are well represented by a two-component exponential equation; biological half-lives derived for the retention of 3H in lung were 4.9 d and 1,257 d for the short- and long-term clearance, respectively. The tritium clearance rate via urine or feces was described by bi-phase exponential components. At the end of the experiment (180 d after instillation), only approximately 30% of the initial lung burden of 3H had been eliminated, of which approximately 98% was excreted via feces and 2% in urine, but none through exhaled air. Results also showed that a large percentage (70%) of the hafnium tritide initially present in lung still remained in the organ 6 mo after the exposure. The calculation of the radiation dose indicates that the cumulative dose to the lung directly from the tritide particles was approximately 10(6) times the lung dose from the dissolved tritium in the lung region. The committed effective dose to the lung was estimated to be 5.41 x 10(-10) Sv Bq(-1), which is over 99% of that to the whole body. The dose to the liver was 6.00 x 10(-15) Sv Bq(-1). This information will be useful in developing new guidelines for radiation protection purposes.

Fracture toughness and microhardness of a composite: do they correlate?

OBJECTIVES

Chipping and bulk fracture are major contributors in clinical failures of composite restorations. Fracture toughness (K(Ic)) quantifies susceptibility for fracture, but experimental determination is complicated. It would be beneficial for the dental community if a relatively simple experiment, such as microhardness (HK), could be used to screen composites for fracture resistance. This study explores a possible correlation between K(Ic) and HK.

METHODS

Composite cylinders (4mm diameter and approximately 7 mm long) were cured for five combinations of light intensity (I, microm W/cm(2)) and curing time (T, s) to achieve a range of different total light energy densities (I x T=100 x 10, 100 x 20, 300 x 20, 300 x 40, and 700 x 60 microm W s/cm(2)). A chevron-notch was cut in the median plane of the cylinders for the fracture toughness test, which was executed in a displacement control mode at 6 micro m/s cross-head speed (sample size 4). Knoop hardness was determined at the median plane of the cylinders (sample size 6). The tests were performed 15 min and 24h after curing.

RESULTS

Both the K(Ic) and HK increased with increased light energy density and storage time. Linear regression analysis indicated a strong correlation between HK and K(Ic) tested at the same time period (R(2)=0.97 and 0.90 for 15 min and 24h, respectively). The correlation became weaker between the different storage times (R(2)=0.71), indicating a change in fracture toughness and/or microhardness mechanisms.

CONCLUSION

Fracture toughness of a composite cannot be simply extrapolated from microhardness.

Effects of buyang huanwu decoction on peripheral nerve regeneration using silicone rubber chambers

This study investigated the effect of buyang huanwu decoction on the regeneration of a 10-mm gap of rat sciatic nerve created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes. Empty silicone rubber tubes with no further treatment were used as controls. Six weeks after implantation, 89% of the animals orally administered the buyang huanwu decoction exhibited regeneration across the nerve gaps, whereas only 70% had regenerated in the control group. Both qualitative and quantitative histology of the regenerated nerves revealed a more mature ultrastructural organization with significantly higher numbers of myelinated axons, larger endoneurial areas, higher axon densities and a larger percentage of axon area per total nerve area in the buyang huanwu group than in the controls. These results showed that the buyang huanwu decoction had a growth-promoting effect on the regenerated nerves.

Respiratory deposition patterns of salbutamol pMDI with CFC and HFA-134a formulations in a human airway replica

This paper describes a technique that uses a well-defined human airway replica and gamma counting as a standard method for evaluating and comparing the performance of medical inhalers and spacers. High-fidelity replicas reproduced as needed from master casts made from human cadavers include the oropharyngeal cavity, larynx, trachea, and five to nine generations of bronchi. Deposition in the small airways and alveoli region of the cast is simulated by material that passes through the upstream airways and is collected on foam filters. Deposition patterns in the respiratory tract replica were obtained by using radiolabel in the medical inhaler and by gamma scintigraphy. This technique was used to determine respiratory deposition patterns of salbutamol in a pressurized metered dose inhaler (pMDI) with chlorofluorocarbon (CFC, in-house formulation) and HFA-134 formulations (Proventil hydrofluoroalkane [HFA]). At an inspiration flow of 30 L/min, patterns in the salbutamol/CFC formula showed a high deposition in the oropharyngeal airway (78%) and a 16% deposition in the lung, similar to in vivo measurements reported in the literature. However, the salbutamol/HFA formula showed lower oral deposition (56%) but higher lung deposition (24%). The difference in the oral deposition patterns may be attributed to lower initial spray velocity, initial droplet evaporation rate, and possibly initial droplet sizes of Proventil HFA. The small orifice diameter (0.25 mm) of the Proventil HFA actuator produced a softer plume with a smaller impact force, resulting in lower oropharyngeal deposition. Cascade impactor measurements showed similar aerodynamic particle size distribution of the CFC and HFA formulations. We also showed that using spacers in the Proventil HFA resulted in a lower oropharyngeal deposition and higher lung deposition, indicating beneficial effects. Comparison of oropharyngeal deposition and those predicted by artificial throats used in the impactor measurements showed that, in general, the artificial throat predicted a lower deposition.

Characterization of nasal spray pumps and deposition pattern in a replica of the human nasal airway

Deposition patterns are described of a nasal spray formulation for a novel rhinovirus protease inhibitor. These patterns, which were generated from different nasal spray pumps, were characterized using a multisectional nasal airway model. A human nasal replica was made from an in vivo magnetic resonance imaging (MRI) scan of an adult male human. The nasal replica consisted of 77 acrylic plastic sections, 1.5-mm thick. Our data showed that the aerosols were deposited mainly in the anterior and turbinate regions with little passing beyond the nasopharyngeal region. Detailed deposition information from the turbinate region indicated that deposition was high toward the anterior portion where most deposition was concentrated on the inferior meatus. Spray droplets were also deposited in spots of the middle and posterior portions of the turbinate region, and this nonuniform deposition pattern may be correlated with the flow pattern. The spray angle and droplet size of the nasal spray were found to be important in influencing the deposition pattern in the nasal airway. The droplet size was determined by a laser-diffraction technique and the spray angle by high-speed photography. Larger droplets and a wider spray angle increased deposition in the anterior region of the nasal airway, which prevented more material from depositing in the turbinate region.

Automated construction of high-density comparative maps between rat, human, and mouse

Animal models have been used primarily as surrogates for humans, having similar disease-based phenotypes. Genomic organization also tends to be conserved between species, leading to the generation of comparative genome maps. The emergence of radiation hybrid (RH) maps, coupled with the large numbers of available Expressed Sequence Tags (ESTs), has revolutionized the way comparative maps can be built. We used publicly available rat, mouse, and human data to identify genes and ESTs with interspecies sequence identity (homology), identified their UniGene relationships, and incorporated their RH map positions to build integrated comparative maps with >2100 homologous UniGenes mapped in more than one species (approximately 6% of all mammalian genes). The generation of these maps is iterative and labor intensive; therefore, we developed a series of computer tools (not described here) based on our algorithm that identifies anchors between species and produces printable and on-line clickable comparative maps that link to a wide variety of useful tools and databases. The maps were constructed using sequence-based comparisons, thus creating "hooks" for further sequence-based annotation of human, mouse, and rat sequences. Currently, this map enables investigators to link the physiology of the rat with the genetics of the mouse and the clinical significance of the human.

Projection-invariant pattern recognition with logarithmic harmonic function and wavelet transform

A logarithmic harmonic filter can detect objects at different projection angles. The Mexican-hat wavelet function can extract edges of equal width for objects, regardless of their sizes. Hence incorporating wavelet filtering in the logarithmic harmonic filter can improve its performance. The theory is presented together with computer simulation. Finally, an experiment using a joint transform correlator is presented to verify the capability of the proposed filter.

Early colonic carcinoma with extensive lymph node metastases: case report and review of literature

An 81-year-old woman had an early carcinoma invading focally into the upper submucosa of the middle-transverse colon, which was accompanied by extensive lymph node metastases and resulted in a poor prognosis. Although her tumor was small and flat, a rim of pale yellow-speckled mucosa adjacent to the tumor enabled its earlier detection. To further study the exceptional lymph node metastases we studied the expression of intestinal trefoil factor and sialyl Tn antigen immunohistochemically on the resected specimen. Their simultaneous expression in lymph node metastasis further supports the aggressive nature of this tumor.

Investigation of the extent of gastric metaplasia in the duodenal bulb by using methylene blue staining

BACKGROUND AND AIMS

The existence of gastric metaplasia (GM) of the duodenal mucosa has been considered to be highly related to the recurrence of duodenal ulcers (DU). The aims of this study are to evaluate the usefulness of methylene blue staining in the detection of GM, and to clarify the relationship between GM and the deformity of the duodenal bulb.

METHODS

Fifteen patients with healed DU and four patients with symptoms of dyspepsia without evidence of ulcers were enrolled into this endoscopic study. During each endoscopy, methylene blue was sprayed evenly on the duodenal bulb, and biopsies were taken from blue-stained and unstained areas. The existence and extent of GM were assessed histologically and grossly. The correlation between duodenal bulb deformity and the extent of GM was also studied.

RESULTS

The mean score of methylene blue non-staining (MBNS) was 0, 1.30 +/- 0.15, and 3.00 +/- 0.00 in group A (non-ulcer patients), group B (patients with healed DU and with normal-shaped bulb) and C (patients with healed DU and with deformed duodenal bulb), respectively; showing significant differences among the groups (P < 0.05 in each). Both the existence and the grading of GM were higher in unstained specimens than in blue-stained specimens (100 vs 16.6%, P < 0.0001 and 3.62 +/- 0.09 vs 0.19 +/- 0.06, P < 0.001, respectively).

CONCLUSIONS

Methylene blue non-staining can be applied to investigate the existence and extent of GM in the duodenal bulb accurately. The incidence of GM in the duodenal bulb was higher in patients with healed ulcers than in non-ulcer patients. Patients with deformed duodenal bulbs have a higher extent of GM than those without deformed duodenal bulbs.

Childhood oral pemphigoid: a case report and review of the literature

Oral pemphigoid, defined as cicatricial pemphigoid limited to the oral cavity, is a clinical subset of cicatricial pemphigoid. Like cicatricial pemphigoid, it occurs mostly in middle-aged women and it is uncommon in children under 20 years of age. There are 11 cases of childhood cicatricial pemphigoid published previously in the English language literature, and four of them are oral pemphigoid patients. We present a case of the youngest oral pemphigoid patient reported yet. Because of the rareness of cicatricial pemphigoid in children, delayed diagnosis and treatment have been shown in many cases reported earlier. Clinical awareness and early recognition are, therefore, emphasized.

Genetic parameters of reproductive traits in Brown Tsaiya ducks artificially inseminated with semen from Muscovy drakes

A selection experiment on maximum duration of fertility of Brown Tsaiya ducks after artificial insemination (AI) with pooled Muscovy semen has been conducted since 1992. The Brown Tsaiya ducks were divided into two lines: a control line (T) with no selection and a selected line (S). The traits measured were the number of eggs set that were laid from Days 2 to 15 after one AI (NES), the number of fertile eggs at candling (NEF), the total number of dead embryos (NED), the maximum duration of fertility (MD), and the number of hatched mule ducklings (NEH). The selected trait was NEF. Six generations with a total of 2,127 females were measured. The variance components were estimated for each line in a multiple-trait animal model, using the restricted maximum likelihood (REML) methodology, which yields estimates free of bias caused by selection and inbreeding. Estimates of the heritability and genetic correlation from the two lines were very similar. Heritabilities in the S and T lines, respectively, were 0.14 and 0.10 for NES, 0.30 and 0.26 for NEF, 0.06 and 0.09 for NED, 0.28 and 0.21 for MD, and 0.18 and 0.19 for NEH. High and favorable genetic correlations existed between NEF and MD (0.96 and 0.92), between NEF and NEH (0.86 and 0.91), and between MD and NEH (0.90 and 0.82). The results suggested that selection for NEF could improve the maximum duration of fertility, but it could be useful to check the estimates of genetic parameters in a meat-type female duck.

Adjuvant sclerotherapy after ligation for the treatment of esophageal varices: a prospective, randomized long-term study

BACKGROUND

To assess the efficacy of adjuvant sclerotherapy after banding for the treatment of esophageal varices, a randomized trial was carried out of endoscopic variceal ligation (EVL) alone with sequential sclerotherapy versus sequential ligation-sclerotherapy (SLS) after banding with respect to variceal eradication, associated complications, and recurrence of varices.

METHODS

One hundred patients qualified for this study. Fourteen patients were not included for the following reasons: 6 chose not to participate, 4 had fundal varices, and 4 had some form of cancer. Of the remaining 86 patients in the study, 42 underwent EVL alone and the other 44 SLS. Variceal ligation was begun in the region of the gastroesophageal junction, with subsequent ligatures applied cephalad 3 to 5 cm; ligation was repeated every 2 weeks until variceal obliteration. For SLS, ligation was also begun in the region of the gastroesophageal junction and repeated until varices were reduced to F1 size. Subsequently, these patients underwent sclerotherapy with between 6 and 8 mL of sodium tetradecyl sulfate (free hand technique).

RESULTS

No significant differences were found between EVL alone and SLS with regard to variceal eradication, development of associated complications, and recurrent bleeding during a follow-up of 2 years. The probability of variceal recurrence requiring further treatment after 1 year was 14% for the SLS group and 26% for EVL group patients. Another year later, the probability of variceal recurrence was 24% and 45%, respectively, for the SLS and EVL groups.

CONCLUSIONS

Because a significantly lower rate of variceal recurrence was found for SLS patients, sequential sclerotherapy followed by ligation to eradicate those varices too small to easily band may be a better procedure.

Relationship of duodenal ulcer recurrence to gastric metaplasia of the duodenal mucosa and duodenal bulb deformity

BACKGROUND AND PURPOSE

This study investigated changes in the severity of gastric metaplasia (GM) of the duodenal mucosa before and after ulcer healing and Helicobacter pylori eradication. It also investigated whether deformity of the duodenal bulb affects the severity of GM and the likelihood of ulcer recurrence.

METHODS

Eleven patients were consecutively enrolled in this study. They all had duodenal ulcer(s) and H. pylori infection, for which they had received anti-H. pylori triple therapy during the active ulcer stage, and had all undergone serial endoscopic examinations during both the active ulcer and scarring ulcer stages, and at 1 year after ulcer healing. Duodenal biopsies were obtained at each endoscopy to identify the severity of GM. Duodenal ulcers were divided into three types by bulbar shape and GM was classified into four grades of severity.

RESULTS

All 11 patients had increased GM severity just after ulcer healing. The 1-year follow-up study revealed that the GM was unchanged in six of eight patients with grade 3 GM severity at the scarring stage, while in the other two it regressed to grade 1 or 2; these two patients suffered ulcer recurrence. A markedly deformed bulb (type III) was found in three patients, of whom two had ulcer recurrence.

CONCLUSION

Two characteristic conditions were found in patients with duodenal ulcer recurrence after H. pylori eradication: a markedly deformed bulb with grade 3 GM at the scarring stage, and a change in GM from high to low grade at or around the previous ulcer site after ulcer healing.

Diterpenoids from the leaves of Juniperus chinensis var. kaizuka

Two diterpenoids based on novel carbon skeletons, namely, 8,19-dioxo-8,14-seco-chinan-14,11-olide (1) and 8-oxo-8,14-seco-abiet-12-en-14,19-dial (2), have been isolated, together with two new abietane diterpenoids, 13 beta,14 beta-epoxyabiet-7-en-19,6 beta-olide (3) and 7 beta-hydroxyabieta-8,11,13-trien-19-al (4), from the leaves of Juniperus chinensis. Their structures were determined by spectroscopic methods, including 2D NMR, and, in the case of 1, X-ray crystallographic analysis.