Effectiveness of surgical root coverage on dentin hypersensitivity: A systematic review and meta-analysis

AIM

To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession.

MATERIALS AND METHODS

Two independent reviewers conducted electronic literature searches in MEDLINE (PubMed), EMBASE, Cochrane Library, Web Of Science, Dentistry & Oral Sciences Source, ScienceDirect, and ClinicalTrials.gov databases as well as a manual search to identify eligible clinical studies from January 2000 to March 2022. Randomized controlled trials (RCTs) comparing two surgical RC techniques or a surgical RC technique with or without adjuvant were included. Meta-analyses were performed on data provided by RCTs.

RESULTS

Thirteen RCTs with a total of 701 patients (1086 recessions) were included. The percentage of DH suppression was 70.8% (95% confidence interval [CI] [64.4-76.6]; I²  = 39.2% [3.5-61.8], Q-test = 0.02) after surgical RC. Recession reduction and percentage of RC were both statistically significantly associated with DH suppression (estimate = 0.66 [0.10-1.23], p = .022, R²  = 14.45% and estimate = 0.04 [0.01-0.08], p = .012, R²  = 29.54%, respectively). Coronally advanced flap (CAF) + connective tissue graft showed results statistically more effective than CAF + xenogeneic collagen matrix in DH suppression (73.3% [65.6-79.8] and 61.4% [51.7-70.3], respectively; p = .048).

CONCLUSIONS

Success of surgical RC is associated with DH suppression.

Cigarette smoke inhibits lung fibroblast proliferation by translational mechanisms

Cigarette smoke is a major cause of chronic obstructive pulmonary disease (COPD) and emphysema. Although cigarette smoke represses cellular proliferation, the molecular mechanisms underlying this phenomenon are unknown. CCAAT/enhancer-binding proteins (C/EBPs) are key regulators of cell cycle progression, differentiation and pro-inflammatory gene expression, are regulated predominantly at the translational level and may be involved in the pathogenesis of COPD. The aim of this study was to assess the effect of cigarette smoke on proliferation and the expression and translational regulation of C/EBPα and C/EBPβ in nondiseased primary human lung fibroblasts. Fibroblasts were exposed to cigarette smoke-conditioned medium (10% and 20% for 24 h). Proliferation was determined by [(3)H]thymidine incorporation. Protein expression levels were determined by immunoblotting and translation was monitored using a translation control reporter system. Cigarette smoke significantly reduced fibroblast proliferation and significantly upregulated full-length C/EBPα and C/EBPβ proteins due to a shift in the translational control of CEBPA and CEBPB mRNAs. This shift involved the re-initiation of mRNA translation via the regulatory upstream open reading frame, which coincided with increased interleukin-8 release and a decrease in functional elastin level. These findings provide a novel mechanism to understanding the tissue remodelling observed in the lungs of COPD patients.

Relationship between occurrence of Phytophthora cambivora on plants in hardy ornamental nursery stocks and detection of the pathogen from water ponds

Phytophthora cambivora was isolated from rooted bases and roots of Castanea sativa, Chamaecyparis lawsoniana and Cotoneaster spp. as well as from water ponds Located in HNS. In the laboratory trials the species colonised leaf blades and stem parts of 3 tested plant species. Differentiated reaction of tested plant species on P. cambivora was observed.

Effect of particle size and spectral sub-range within the UV-VIS-NIR range using diffuse reflectance spectra on multivariate models in evaluating the severity of fusariosis in ground wheat

Control (crops grown in natural conditions) and Fusarium head blight (FHB) damaged (crops inoculated with Fusarium culmorum conidia) grain of four wheat cultivars was ground and sieved into three fractions of different particle size. A series of blended samples differing in content of damaged material were prepared within fractions and cultivars, and diffuse reflectance spectra recorded within the 200-2500 nm wavelength range. Partial least-squares (PLS) models for the percentage of damaged material in blended samples were built for each of twelve series within different spectral ranges, and the root-mean-squared error of cross-validation (RMSECV) was used for the assessment of model performance. Errors using the models were lowest for the finest fraction independent of spectral range; however, their values depended on the cultivar. RMSECV for the finest fraction averaged over cultivars ranged from a little below 3.0 (when the ultraviolet light sub-range was used or participated with another one) to 8.1% (when only the near infrared (NIR) sub-range was used). For the medium and coarse fractions, averaged errors showed the same tendency of dependence on the sub-range(s); however, with higher values that increased with an increase in particle size. In conclusion, within the different fractions of particle size and spectral ranges, the most sensitive to the presence of damaged material were models developed for the finest fraction and when the ultraviolet light sub-range was used in modelling.

Effect of gabapentin on cognitive processes in rats not exposed and exposed to tobacco smoke during fetal life

Cognitive deficits, including memory deficiencies, are currently deemed one of key symptoms of psychopathologic mental disorders or epilepsy. The impairment of neurocognitive processes could be due to the administered therapy, in particular combined therapy or therapy using antiepileptics of older type. Gabapentin (GBP) is one of new antiepileptics with normothymic properties. It is known that epileptic patients run a significant risk of developing depression and mood changes. Smoking may also have a negative effect on memory processes and efficacy of administered drugs. Note that smoking in pregnant women also leads to neurobehavioral changes in their children. The objective of our research was to evaluate the effect of GBP on memory functions and antidepressant effect in rats not exposed and exposed to tobacco smoke in fetal life. We were also intent on finding whether GBP has an anticonvulsant effect in contact and without contact with tobacco smoke, and whether it affects motor coordination in animals if administered in the dose of 25 mg/kg. Spatial memory of the animals was assessed in the Morris test and the antidepressant effect in the Porsolt test. The ED(50) value was determined in the Swinyard maximum electric shock test, and the effect on motor coordination was assessed in the chimney test. GBP administered in the dose of 25 mg/kg intraperitoneal (i.p.) significantly reduced the immobility time on days 1 and 7 of the test in animals exposed to tobacco smoke, and on days 7 and 14 of the test in rats not exposed to tobacco smoke. Upon single and multiple administration of GBP to animals not exposed to tobacco smoke, the spatial memory improved, whereas in animals exposed to tobacco smoke in fetal life tolerance for procognitive effect was observed on day 21 of the test. It has been found that in rats not exposed to tobacco smoke, ED(50) of GBP was 28.73 mg/kg, whereas in animals exposed to tobacco smoke in fetal life, ED(50) was 46.2 mg/kg. Upon 14 and 21 days of drug administration, motor coordination was impaired in both GBP receiving animal groups. In conclusion, GBP beside its anticonvulsant efficacy also improves memory processes and has antidepressant effect. We also proved that GBP may reverse cognitive deficits concerning working memory induced by prenatal exposure to tobacco smoke and may have antidepressant effect in rats exposed to tobacco smoke.

First Report on the Occurrence of Fusarium langsethiae Isolated from Wheat Kernels in Poland

Numerous Fusarium species have been associated with Fusarium head blight of wheat. In Poland, Fusarium poae was reported as the dominant species isolated from wheat grain during seasons with low amounts of rainfall during anthesis (1). F. langsethiae was described as a new toxigenic Fusarium species (3) and causal agent of Fusarium head blight (2), which has been isolated from infected oats, wheat, and barley in northern and central Europe (Norway, Austria, Germany, Czech Republic, Denmark, and England) (2). On the basis of morphological similarities, F. langsethiae has long been identified as a "powdery" form of F. poae. However, F. langsethiae produces type A trichothecene toxins such as T-2, whereas F. poae produces nivalenol and other 8-keto trichothecenes, scirpentriol, and 15-acetoxyscirpenol. In 2006, we obtained several isolates of F. langsethiae from kernels collected from winter wheat ears with head blight symptoms. Isolates were collected in the central (Sobiejuchy 52°54'N, 17°43'E; Minikowo 53°29'N, 17°56'E) and northern (Radostowo 53°59'N, 18°45'E) regions of Poland. Strains were isolated on potato dextrose agar (PDA) medium (pH 5.5). Further analyses were conducted on single-spore isolates. Initial species identification of all isolates was conducted on the basis of morphological features. The strains were grown in darkness at 25°C on PDA in plastic petri dishes to diagnose colony color, odor, and growth rate. The cultures also were incubated on saltwater nutrient agar (SNA) at 25°C for 7 days in near-UV light (Philips TLD 36W/08) and darkness in a 12/12-h cycle to promote conidia formation. The calculated average mycelial growth rate per day was based on the difference in millimeters between the colony diameters after 4 and 7 days of incubation. Growth rates ranged from 5.4 to 10.3 mm/day for nine strains. Mycelium was whitish or pinkish white, sparse, and 1 to 3 mm high with no odor. All colonies showed a powdery mycelium surface. Microconidia was napiform or globose, nonseptate, sporadically 1-septate, with an average length of 6.4 μm (range 3.9 to 13.7 μm) and width of 5.6 μm (range 2.9 to 8.8 μm). Microconidia were formed in heads, borne on unbranched or branched monophialides that were 8.5 to 16.3 μm long. All strains had slim, bent monophialides, typical for F. langsethiae, and always a few, short, thick, and squat ones resembling F. poae. In young cultures, monophialides may be formed directly on hyphae. Formation of macroconidia, sclerotia, and chlamydospores were not observed after 3 weeks of incubation. Species identification was confirmed by PCR assay with the use of SCAR (sequence characterized amplified region) primers producing a 310-bp DNA fragment (4), which was deposited in GenBank (Accession No. EU088404). To our knowledge, this is the first report of F. langsethiae in Poland. References: (1) C. Sadowski et al. J. Appl. Genet. 43A:69, 2002. (2) M. Torp and A. Adler. Int. J. Food Microbiol. 95:241, 2004. (3) M. Torp and H. I. Nirenberg. Int. J. Food Microbiol. 95:247, 2004. (4) A. Wilson et al. FEMS Microbiol. Lett. 233:69, 2004.

Comparison of the usability of different spectral ranges within the near ultraviolet, visible and near infrared ranges (UV-VIS-NIR) region for the determination of the content of scab-damaged component in blended samples of ground wheat

Soft wheat grain samples of the same variety were obtained from a plot where the crop grew under natural conditions (control material) and from a plot where the crop was inoculated with Fusarium culmorum. The grain was ground and sieved with the finest fraction (a particle size less than 0.18 mm) of both materials being used for the preparation of samples in which the content of damaged constituent varied from zero to approximately 84%. Diffuse reflectance spectra of the absorbance from the blended samples were recorded in the 200-2500 nm spectral range and multivariate calibration PLS (Partial Least Squares) models were built within three spectral ranges: 200-2500, 200-1400 and 1400-2500 nm. Before modelling, several variants for spectra pre-processing were tried: multiple scatter correction, single and double differentiation, in all cases with and without centring. Single differentiation followed by centring was found to be the best method for spectra pre-processing in all spectral ranges. Very good calibration models were obtained for the whole and shorter wavelengths spectral ranges, allowing the detection of 1.50 and 0.76% of the content of scab-damaged constituent, respectively. Two-dimensional correlation spectroscopy applied to the set of spectra enabled the assignment of spectral bands and an analysis of changes in the chemical composition caused by scab damage. It was found that the content of protein and lipids increased with an increase of the scab-damaged constituent, whereas the content of moisture and starch decreased.

Pylorus-preserving total pancreatectomy. Early and late results

BACKGROUND/AIMS

Preservation of the pylorus is an accepted alternative procedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse.

METHODS

A prospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99.

RESULTS

11 patients underwent total pancreatectomy with preservation of the pylorus. Histopathological examination revealed pancreatic adenocarcinoma in 16 cases and duodenal adenocarcinoma in 1 patient, 5 patients had other types of pancreatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidity was 59% and reoperations were performed in 9.1% of cases (n = 2). Median follow-up was 37 months (range 5-66). 62% of patients (n = 13) developed tumor recurrence and 13 patients died during the follow-up period with 10 deaths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-preserving total pancreatectomy or pancreatectomy with gastrectomy. However, postoperative body weight was increased 3, 6, 9 and 12 months following preservation of the pylorus.

CONCLUSION

Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term survival but improved nutritional recovery compared with standard total pancreatectomy.

[Pylorus preserving or classical Whipple operation in tumors. Initial clinical results of a prospective randomized study]

During the last decades, the classical Whipple resection (cWhipple) and pylorus-preserving Whipple (ppWhipple) operation have been evolved for the resection of cancer of the pancreatic head. However no definitive answer exists whether the more conservative ppWhipple indeed equalizes the short and long term results of the cWhipple procedure.

METHODS

Therefore we conducted a randomized prospective trial in a non-selected, consecutive patient series. All relevant data concerning patient's demographics, intraoperative and histological findings as well as postoperative mortality morbidity and follow-up after discharge were analyzed.

RESULTS

From 6/96 to 10/99 139 patients with suspicion of pancreatic or periampullary tumor were prospectively randomized to undergo either a cWhipple or a ppWhipple (intention to treat). Based on the inclusion and exclusion criteria, 93 of these patients were finally analyzed in the study. There were 51 cWhipple and 42 ppWhipple resections. There were no differences concerning age, sex, ASA classification, tumor type and stage, length of ICU- and in-hospital stay. However, the ppWhipple group had a significant shorter operation time. There was no difference in mortality and morbidity. The incidence of delayed gastric emptying was identical in both groups. For long-term follow-up, a total of 76 patients with histological proven pancreatic or periampullary carcinoma were analyzed. There was no difference in tumor recurrence and in long-term survival after a median follow-up of 1.5 years (0.1-3.5).

CONCLUSION

Our intermediate results demonstrate that cWhipple and ppWhipple are equally radical. However, ppWhipple may be the procedure of choice for the treatment of pancreatic and periampullary cancer.

Randomized prospective trial of pylorus-preserving vs. Classic duodenopancreatectomy (Whipple procedure): initial clinical results

During the past decades, the classic Whipple resection (cWhipple) and the pylorus-preserving Whipple (ppWhipple) operation have been advanced for the resection of cancer of the pancreatic head. However, no definitive answer exists as to whether the more conservative ppWhipple operation indeed equalizes the short- and long-term results of the cWhipple procedure. Therefore we conducted a randomized prospective trial in a nonselected series of consecutive patients. Demographics, diagnostic, intraoperative, and histologic findings (tumor type and tumor stage of these patients) as well as postoperative mortality, morbidity, and follow-up after discharge were analyzed. For statistical evaluation Kruskal-Wallis and chi-square tests were used where appropriate. Survival was analyzed according to Kaplan-Meier curves, and differences were examined using the log-rank test. From June 1996 to April 1999, a total of 114 patients with suspected pancreatic or periampullary tumors were prospectively randomized to undergo either a cWhipple or a ppWhipple (intention to treat) operation. Based on the inclusion and exclusion criteria, 77 of these patients were included in the final analysis. Forty had a cWhipple and 37 had a ppWhipple resection. There were no differences with regard to age, sex distribution, ASA classification, histologic classification, UICC stage, length of stay in the intensive care unit, and length of hospital stay. The ppWhipple group had a significantly shorter operative time, reduced blood loss, and fewer blood transfusions. There was no difference in mortality, but the cWhipple group showed a significantly higher total morbidity. The incidence of delayed gastric emptying was identical in both groups. For long-term follow-up, a total of 61 patients with histologically proven pancreatic or periampullary carcinoma were analyzed. There were no differences in tumor recurrence or in long-term survival at a median follow-up of 1.1 years (range 0.1 to 2.9 years). Our initial results demonstrate that the cWhipple and ppWhipple operation are equally radical. However, ppWhipple may be the procedure of choice for the treatment of pancreatic and periampullary cancer.

[Mason vertical gastroplasty in treatment of morbid obesity. Results of a prospective clinical study]

Morbid obesity (body mass index > 40 kg/m2) is a risk factor for cardiovascular, pulmonary, metabolic, neoplastic, and psychologic sequelae. In the present prospective clinical study 65 patients (11 men, 54 women) underwent vertical banded gastroplasty (Mason procedure) from June 1994 to October 1997. The median age was 41 +/- 5.3 years (range 18-69; n = 65). Preoperative body weight was 135 +/- 23 kg (96-229; n = 65), excess body weight in kg was 75 +/- 6.9 (44-155; n = 65) or in % 126 +/- 10 (78-223; n = 65) and BMI was 49 +/- 7.4 kg/m2 (39-69; n = 65). Mean hospital stay was 9.7 +/- 2.4 days (6-18; n = 65). Hospital mortality was 0% (0/65). Early complications were vomiting (30%) and problems in wound healing (15%; n = 65). Late complications (> 30 days) were incisional hernias (13.8%) and staple-line disruptions (12.3%; n = 65) with a reoperation rate of 23% (15/65). Median follow-up was 15.0 +/- 5.2 months (2-42) with a follow up rate of 100%. Mean weight loss after 12 months was 38.5 +/- 17 kg (30-98; n = 34) (P < 0.0001) and loss of excessive body weight 65 +/- 10% (57-86; n = 34), respectively (P < 0.0001). Cardiovascular risk factors (hypertension, diabetes, hyperlipidemia) were significantly improved within 12 months (n = 34). Vertical banded gastroplasty (Mason procedure)--well established for 20 years--is a good, safe therapy for morbid obesity if strict indications for operation are observed and if there is multidisciplinary long-term follow-up. Comorbid risk factors are considerably reduced and a long-term weight loss of more than 50% can be achieved without the risk of pathological metabolic changes.

[Acute acromioclavicular dislocations]

Acromioclavicular dislocations represent over 10% of acute traumatic injuries to the shoulder girdle. The mechanism is usually a direct impact on the shoulder with the arm in adduction, producing rupture of the acromioclavicular (AC) ligaments, then of the coracoclavicular (CC) ligament, with displacement of the lateral end of the clavicle. Rockwood described 6 grades of injury. Physical examination usually provides the diagnosis, which is confirmed by radiological examination. X-rays centered on the AC joint, if necessary with forceful adduction of both shoulders or under traction, are useful to evaluate the severity of the lesion. Grade I and II lesions are usually treated conservatively by simply immobilizing the arm for 3 to 4 weeks. Surgical treatment is usually advocated for grade IV, V and VI lesions: AC or CC fixation, sometimes associated with ligament repair, depending on the surgeons. AC pinning or C-C screw fixation are the techniques most often used. Management of grade III lesions remains controversial. Some authors advocate immediate surgical treatment in young, active patients, in heavy laborers and even in slender individuals. The choice of the operative technique is controversial, as no single technique has clearly proved to be superior to others. Other authors advocate conservative treatment, which gives functional results which patients consider quite acceptable, with faster recovery; patients should be informed that results are essentially similar, whatever the treatment. The possibility of performing secondary operations with good results in cases with failure of conservative management is a further argument in favor of applying conservative therapy first in acute injuries.

[Modern diagnostic strategy in ileus]

During the last 4 years (11/93-11/97) 330 patients with acute bowel obstruction were treated and analysed retrospectively. 80% of the obstructions (n = 265) were in the small bowel and 20% (n = 65) in the large bowel localized. Adhesions were the main cause in 65.7% (n = 174) of all small bowel obstructions, and one third (35.1%, n = 61) of these patients were treated conservatively. In the large bowel, however, 37% were caused by obstructing colon carcinoma mainly localized in the rectosigmoid region. Mechanical bowel obstruction remains to be one of the most common emergencies in general surgery. A successful treatment is based on a rapid and correct diagnosis followed by an immediate surgical intervention if indicated. There are no reliable clinical, laboratory or radiological signs of bowel strangulation available. Preoperative diagnostic examinations should confirm bowel obstruction, determine its localization and origin and exclude other pathologies. Furthermore, it should help in selecting a patient subgroup with small bowel obstruction due to adhesions, which might be treated conservatively. Preoperative diagnostic procedures include case history, clinical examination, basic laboratory tests and a plain abdominal x-ray. In patients with suspected small bowel obstruction due to adhesions without any signs of strangulation a contrast medium follow-through study may be indicated. If the contrast medium fails to pass into the colon within 5 hours, a surgical exploration is recommended. In large bowel obstruction a contrast medium enema, a computed tomography or a colonoscopy are valuable diagnostic tools.

[Surgical therapy of ileus of the small intestine]

BACKGROUND AND AIMS

Small bowel obstruction is a disease the surgeon frequently is confronted with. In the present study the records of the patients (n = 202) with mechanical obstruction of the small intestine from the last four years were analysed and the results are critically compared with the literature.

METHODS

In the reported retrospective study the length of patient's history, the cause of bowel obstruction, the preoperative examinations performed, the kind of surgical intervention and the postoperative management and outcome were investigated.

RESULTS

The average patient's age was 62 years, the mean preoperative duration of symptoms was 6.5 days. 77% of the patients had underwent abdominal surgery prior to the obstruction. Conventional x-ray was performed in 92%, gastrographin passage in 46% and CT-scan in 23% of the cases. The average length of hospitalisation was 12 days. The overall postoperative morbidity was 21%, the mortality 2.5%.

CONCLUSION

It could be shown that patient's history, clinical symptoms and conventional x-rays of the abdomen are sufficient for the indication of surgical intervention. In uncertain cases the examination of the passage with contrast medium is recommended. The surgical results of small bowel obstruction management have significantly improved over the past decades, today's mortality is lower than 5%.

The role of diagnostic laparoscopy in pancreatic and periampullary malignancies

BACKGROUND

The role of diagnostic laparoscopy before laparotomy in patients with pancreatic or periampullary malignancies remains controversial. We analyzed the value of using diagnostic laparoscopy to avoid laparotomy in these patients.

STUDY DESIGN

Between November 1993 and December 1996, 254 patients with pancreatic or periampullary malignancies were treated. In 74 patients, multiple distant metastases precluded further surgical treatment. In all, 180 patients underwent laparotomy for pancreatic cancer (119 patients) or periampullary cancer (61 patients). Preoperatively, all patients underwent computed tomography for staging and to assess resectability of the tumor. Based on the results of the imaging procedure, the patients were scheduled for either tumor resection or a palliative operation.

RESULTS

Twenty-one of 180 patients (12%) with pancreatic or periampullary malignancies were scheduled preoperatively for nonresectional operations because of distant metastasis or retroperitoneal tumor infiltration. In none of these patients was the operative strategy changed. In 159 of 180 patients (88%), a pancreatic resection was planned preoperatively; 119 patients underwent pancreatic resection. In the remaining 40 patients preoperatively scheduled for tumor resection, removal of the tumor was not possible. In 24, this resulted from tumor infiltration into the retropancreatic vessels, and in 16 it resulted from liver or peritoneal metastasis detected for the first time intraoperatively. These 16 patients (10%) could have benefited from diagnostic laparoscopy. Similar results were found in the subgroup of 119 patients with pancreatic cancer, of whom 102 were planned for tumor resection and 17 for palliative operation. Of the 102 patients planned preoperatively for tumor resection, 71 patients (70%) underwent pancreatic resection. In the remaining 31 patients scheduled for tumor resection, removal of the tumor was not possible: in 17 because of tumor infiltration into the retropancreatic vessels and in 14 because of liver or peritoneal metastasis detected for the first time intraoperatively. These 14 patients (14%) also would have benefited from laparoscopy.

CONCLUSIONS

Preoperative computed tomography is a reliable technique to detect tumor metastasis in patients with pancreatic or periampullary cancer. Unlike other investigators, we found that only 10% of patients with periampullary or pancreatic cancer and 14% of patients with pancreatic cancer might profit from laparoscopy. Because of this low number, laparoscopy cannot generally be recommended for patients with pancreatic or periampullary cancer before laparotomy.

[Efficacy and economic aspects of preoperative diagnosis: laparoscopy is useful in only 13% of patients with pancreatic carcinoma]

The value of diagnostic laparoscopy to improve tumor staging in patients with pancreatic and periampullary cancer is still a matter of controversial discussion, especially with regard to whether diagnostic laparoscopy can identify patients in whom a laparotomy can be avoided due to metastases. To answer this question, all patients who underwent operations for pancreatic cancer (n = 97) or periampullary cancer (n = 30) between 11/1993 and 12/1995 were evaluated. Only 10% of the patients with periampullary/pancreatic cancer and 13% with pancreatic cancer could avoid laparotomy through diagnostic laparoscopy. Due to these low numbers, a diagnostic laparotomy cannot be recommended in general in patients with pancreatic and/or periampullary cancer on economic grounds and because of the risk of trocar metastases.

[Duodenum preserving resection of the head of the pancreas: a standard procedure in chronic pancreatitis]

Duodenum-preserving resection of the head of the pancreas was developed 25 years ago by Beger. This procedure is indicated in patients suffering from chronic pain in combination with inflammation of the head of the pancreas, common bile duct obstruction, pancreatic duct obstruction and/or obstruction of the retropancreatic vessels. At the Inselspital in Berne, 74 patients underwent this operation between 1993 and 1996. The median length of the operation was 380 min, with the need for transfusion in a median of 0 units (0-6). There was no postoperative mortality. Total postoperative morbidity was 13%. One patient needed relaparotomy on day 17 for small bowel obstruction. Median length of hospital stay was 11 days. Postoperatively, two patients developed diabetes. Duodenum-preserving resection of the head of the pancreas represents an organ-preserving principle of surgery. This procedure treats the complications of chronic pancreatitis and provides long-term pain relief in more than 80% of patients.

[Pancreatic carcinoma: surgical therapy]

The incidence of pancreatic diseases has increased over the last years. Low morbidity and mortality rates after pancreatic resection procedures and an increasing 5-years survival rate allow more liberal indications for operation. These better results are due to careful preoperative investigations, perfect surgical techniques and the use of Octreotide perioperatively to reduce morbidity and leakage rate. Therefore resections for cancer of the pancreas should be carried out whenever possible, as well in curative as in palliative attempt. We discuss the indications and contraindications of pancreatic resection. At last, the decision to perform a resection depends of the tumor extension found at the operation and of the surgeon's skill. Infiltration of the wall of portal or superior mesenteric vein and retroperitoneum are not always definitive criteria of non-resectability, as there is still the possibility of vessel resection or partial excision of the retroperitoneum followed by locoregional chemotherapy. Today encouraging results of pancreatic resections allow the surgeon to carry out pancreatic resections whenever possible in patients fit for the operation. These resections should be carried out by experienced surgeons who carry out more than 10 pancreas resections per year and achieve a mortality rate below 5%.

Mutational analysis of cysteine residues within the hormone-binding domain of the human estrogen receptor identifies mutants that are defective in both DNA-binding and subcellular distribution

To further our understanding of the role played by cysteine residues in ligand recognition by the human estrogen receptor (hER), we have individually mutated residues 381, 417, 447, and 530 within the hormone-binding domain from cysteine to serine. We have also examined 10 additional nonconservative amino acid changes at C530. Four mutants were identified with defects in their ability to stimulate transcription in response to hormone: C447S, C530P, C530W, and C530G. Accumulation of the mutant proteins to comparable steady state levels after transient expression in COS-7 cells leads us to conclude that none of these substitutions results in increased turnover of receptor protein. None of these mutations had a reduced affinity for estradiol when compared with wild-type hER [dissociation constant (Kd) = 0.29 nM]. Although C447 and C530 reside outside of motifs previously defined as being necessary for DNA binding or receptor dimerization, all four of these mutants unexpectedly displayed altered DNA-binding properties when analyzed using a gel mobility shift assay. Their loss of DNA binding could be overcome, at least in part, by hormone treatment or by the addition of antibody. Additionally, mutations C447S, C530S, and C530P displayed patterns of subcellular localization in the absence of hormone that differed from wild-type hER. These results argue that cysteine residues 447 and 530 within the hormone-binding domain play no direct role in the ability of this receptor to bind estradiol. These mutations, however, can effect DNA-binding activity and the distribution of hER within cells.

Psychometric properties of the Social Problem Solving Inventory (SPSI) with normal and emotionally disturbed adolescents

The factor structure of the Social Problem Solving Inventory (SPSI; D'Zurilla & Nezu, 1990) was evaluated with a sample of 708 normal adolescents. Confirmatory factor analysis supported the empirically derived five-factor model reported by D'Zurilla and Maydeu-Olivares (1994) using an adult sample, but not the theoretically derived seven-factor structure of the original SPSI. The psychometric properties of the original and revised inventories are reported for normal adolescents and psychiatrically hospitalized adolescents (n = 63). Internal consistency and reliability estimates were adequate. Support for the validity of the revised SPSI was demonstrated by examining the relationship between social skills, depression, and social problem solving; in addition, differences between normal and inpatient adolescent samples were examined. The findings are discussed in terms of the utility of the inventories with adolescents.

Empirical study of mental health professionals' knowledge and attitudes towards the concept of age appropriateness

Questionnaires on age appropriateness were completed by 100 mental health professionals from 10 states. In general, the respondents were familiar with the concept and had learned about age appropriateness from a variety of sources. Age appropriateness was defined in terms of chronological age rather than mental age or the two concepts combined. Respondents viewed it as a particularly important component in treatment success, especially in working with people who have developmental disabilities, adolescents, and young adults. Implications of these findings and suggestions for future research were provided.

Practical applications of a monoclonal antibody (NDOG2) against placental alkaline phosphatase in ovarian cancer

A monoclonal antibody (NDOG2) against placental alkaline phosphatase (PLAP) in ovarian cancer has been used in three ways by the Bristol University Department of Obstetrics & Gynaecology. First, in an indirect immunoperoxidase technique, NDOG2 demonstrated positive standing in 64% of 56 ovarian carcinomas as well as in 25% of 44 benign tumours. The majority of these positive tumours were serous cystadenocarcinomas or serous cystadenomas and there was considerable variation in the expression of this antigen from tumour to tumour. NDOG2 was also used as the basis of two serum assays and, when labelled with 123-iodine (123I), in radioimmunoscintigraphy (RIS) to monitor patients' response to therapy. The first serum assay measures the enzymic activity of PLAP and the second recognizes the antigenicity of the molecules. Assay 2 proved more useful in that it predicted the course of the disease in 45% of patients followed up, whereas Assay 1 was only of use in 25% of cases. RIS proved to be a useful imaging technique and was at least as sensitive as conventional imaging techniques. The common causes of false-positive and false-negative results are described.