Long-Term Clinical Course after Successful Initial Treatment in Patients with Mild Erosive Esophagitis: A Prospective Follow-Up Study

INTRODUCTION

This study aimed to investigate the clinical course of patients with healed mild erosive esophagitis and clarify the predictive factors for continuous treatment.

METHOD

Fifty-one patients with mild erosive esophagitis who confirmed mucosal healing by endoscopy after initial treatment with vonoprazan (VPZ) were enrolled. The patients continued subsequent treatment of their choice: maintenance therapy with VPZ 10 mg (n = 15), on-demand therapy with VPZ 20 mg (n = 19), or no medication (n = 17). Each patient was prospectively followed up for over 2 years, and the treatment was switched to other options appropriately according to their symptoms.

RESULTS

During the mean follow-up period of 3.1 years (range: 2.0-3.9 years), 2 patients who chose maintenance therapy switched to on-demand therapy. One patient who chose on-demand therapy switched to maintenance therapy, while 3 patients switched to no medication. Recurrence of symptoms occurred in 9 patients who chose no medication. They were administered maintenance therapy and five of them were subsequently switched to on-demand therapy. Ultimately, the proportion of patients receiving each treatment was 35.3% (18/51) for maintenance therapy, 43.1% (22/51) for on-demand therapy, and 21.6% (11/51) for no medication. A predictive factor for the need for continuous treatment was the presence of esophageal hiatal hernia (odds ratio: 6.03, 95% confidence interval: 1.43-25.3, p = 0.014).

CONCLUSION

Among patients with healed mild erosive esophagitis, 78.4% required continuous treatment with VPZ, while 21.6% remained symptom free with no medication. On-demand therapy was the most common treatment, and continuous treatment may be recommended for patients with esophageal hiatal hernia.

[A case of retrograde intussusception due to transverse colon cancer detected by abdominal ultrasonography]

A 78-year-old female patient presented to our hospital with abdominal pain and melena. Abdominal ultrasonography detected a multiple concentric ring sign and retrograde invagination mass near the hepatic flexure. Colonoscopy revealed a 40-mm diameter type 1 tumor in the transverse colon near the splenic flexure, and the biopsy specimen demonstrated a well-differentiated adenocarcinoma. Retrograde intussusception due to transverse colon cancer was diagnosed, and laparoscopic transverse colon resection with lymph node dissection was performed. The resected specimen revealed a 48×40mm diameter type 1 tumor in the transverse colon and was diagnosed as pT2N0M0 pStage I. Contrast-enhanced computed tomography was unavailable, but real-time assessment of the invaginated mass and bowel blood flow was possible by abdominal ultrasonography, which was useful in determining the diagnosis and treatment strategy.

Predictive factors for the progression of primary localized stage small-bowel follicular lymphoma

BACKGROUND

Primary small-bowel follicular lymphoma (FL) is mainly diagnosed as a duodenal lesion during esophagogastroduodenoscopy. Recently, with the widespread use of small-bowel endoscopy, FL in the jejunum and ileum has been detected. Most patients with small-bowel FL are diagnosed at the localized stage, and a watch-and-wait policy is used. However, the predictive factors for the progression of small-bowel FL have not been clarified. This study retrospectively examined the predictive factors for the progression of primary localized stage small-bowel FL based on clinicopathological and endoscopic findings.

METHODS

We enrolled 60 consecutive patients with primary small-bowel FL diagnosed at two tertiary hospitals between January 2005 and December 2020, with localized stage, low grade, and low tumor burden with the watch-and-wait policy. We examined the predictive factors for progression according to the clinicopathological and endoscopic findings. Endoscopic findings were focused on the color tone, circumferential location of follicular lesions (circumference ≥ 1/2 or < 1/2), fusion of follicular lesions (fusion [ +] or [ -]), and protruded lesions (≥ 6 mm or < 6 mm).

RESULTS

Progressive disease was observed in 12 (20%) patients (mean observation period, 76.4 ± 55.4 months). In the multivariate analysis, "circumference ≥ 1/2" and "fusion (+)" were significant predictive factors for progression. According to the Kaplan-Meier analysis, progression-free survival was significantly shorter in the "circumference ≥ 1/2" and/or "fusion (+)" group than in the "circumference < 1/2" and "fusion ( -)" group.

CONCLUSIONS

Endoscopic findings of "circumference ≥ 1/2" and "fusion (+)" were significant predictive factors for the progression of primary localized stage small-bowel FL.

Long-Term Outcomes after Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Dysplasia

INTRODUCTION

The Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations guidelines recommend surveillance colonoscopy instead of colectomy after the complete removal of "endoscopically resectable" dysplastic lesions in ulcerative colitis (UC). There are no studies on long-term outcomes of endoscopic submucosal dissection (ESD) for UC-associated neoplasia (UCAN). We aimed to evaluate the clinical outcomes of ESD for UC-associated dysplasia (UCAD) during long-term follow-up.

METHODS

We retrospectively enrolled 17 consecutive UC patients with 22 UCADs, who underwent initial ESD or total proctocolectomy at the Hiroshima University Hospital. The clinicopathological features of the patients and neoplasias and clinical outcomes of ESD were evaluated and compared with those of total proctocolectomy.

RESULTS

UCAD in the ESD and total proctocolectomy groups was mostly noted on the left side of the colon, and most lesions were superficial macroscopic lesions. In the ESD group, en bloc resection and histological complete resection rates were 83 and 67%, respectively. One patient died of malignant melanoma; however, none of the patients died of UC-associated carcinoma in both groups. Metachronous neoplasias developed in 5 of the 7 patients in the ESD group. Among the 5 patients with metachronous UCAN, 4 finally underwent total proctocolectomy and 1 underwent additional ESD.

CONCLUSIONS

ESD for UCAD is a useful method for total excisional biopsy. UC patients with UCAD resected by ESD have a high risk of developing metachronous UCAN during the follow-up period.

Clinical usefulness of the S-O clip during colorectal endoscopic submucosal dissection in difficult-to-access submucosal layer

Background and study aims  In colorectal endoscopic submucosal dissection (ESD), the S-O clip improves the accessibility to the submucosal layer of the colon. However, its safety and usefulness in difficult colorectal ESDs are unclear. Thus, in this study, we aimed to assess the effectiveness of the S-O clip in colorectal ESD in the difficult-to-access submucosal layer. Patients and methods  From January 2016 to December 2016, 189 consecutive cases of colorectal ESD were performed at Hiroshima University Hospital before the S-O clip was introduced. Between January 2017 and June 2018, among 271 consecutive colorectal ESD cases, 41 cases were performed colorectal ESD using the S-O clip. We compared outcomes between the two groups (41 cases with S-O clip [use group] and 189 cases without S-O clip [non-use group]) using propensity score matching. Results  Prior to propensity score matching, 41 cases with the S-O clip (use group) and 189 cases without the S-O clip (non-use group) were extracted. The degree of submucosal fibrosis was more severe and the procedure time was longer in the use group than in the non-use group. In the use and non-use groups, en bloc resection (100 % vs. 94.7 %) and complete en bloc resection (100 % vs. 92.6 %) rates were satisfactory. After propensity score matching, 33 cases in each group were extracted. As a result, complete en bloc resection rate was significantly higher in the use group than in the non-use group (100 % vs. 84.9 %). Conclusion  The S-O clip is effective and can be used safely in colorectal ESD in the difficult-to-access submucosal layer.

Can surveillance colonoscopy be discontinued in an elderly population with diminutive polyps?

OBJECTIVES

Surveillance colonoscopy after endoscopic resection (ER) for adenomatous polyps reduces the incidence and mortality of colorectal cancer (CRC). However, its significance in the elderly population is uncertain. The study aimed to determine whether surveillance colonoscopy should be discontinued in the elderly population.

METHODS

We enrolled 105 patients who underwent baseline colonoscopy between January 2004 and December 2009 and were subsequently followed-up over 5 years in our institution. All had diminutive colorectal polyps and were aged <80 years at baseline colonoscopy and ≥80 years at follow-up in May 2018. Patients who had undergone colectomy or who had inflammatory bowel disease, familial adenomatous polyposis, Lynch syndrome, and no diminutive polyps were excluded. The cumulative incidence of the target lesion was evaluated. Histopathological diagnoses included low-grade dysplasia (LGD), high-grade dysplasia (HGD), and carcinoma.

RESULTS

The target lesion was detected in 15% (16/105) of the patients. There was no invasive carcinoma; however, two HGDs were detected. There were three lesions that had increased from previously detected diminutive lesions, all of which were LGDs. There were no target lesions detected after 84 years of age, and the cumulative incidence was 0.20. The cumulative incidence was significantly higher in the group with HGD than in the group with no target lesions at baseline colonoscopy. There was no HGD after age 79 years, and the cumulative incidence was 0.019.

CONCLUSION

Surveillance colonoscopy for patients with diminutive polyps may be discontinued after age 79 years.

The utility of a novel colonoscope with retroflexion for colorectal endoscopic submucosal dissection

Background and study aims  The PCF-H290TI/L produced by Olympus is a novel colonoscope equipped with some advantageous features for endoscopic treatment. It is expected to improve the potential for retroflexion and overall endoscope operability, which can reduce the difficulty of performing colorectal ESD. The aim of this study was to evaluate the utility of the novel colonoscope in colorectal ESD. Methods  Three hundred and forty-eight consecutive colorectal lesions resected via ESD between June 2014 and January 2017 at Hiroshima University Hospital were included in the retroflexion ability analysis. We compared the retroflexion potential of PCF-H290TI to that of a conventional endoscope. Two hundred and twenty-seven colorectal lesions located in the left-sided colon and resected with ESD between April 2009 and February 2018 were enrolled in the treatment outcome analysis. Treatment outcomes using PCF-H290TI compared to those of the conventional colonoscope, and outcomes of the PCF-H290TI with retroflexion compared to those of the conventional colonoscope without retroflexion were evaluated by propensity score matching. Results  The retroflexion rate with the PCF-H290TI was 76 %, which was significantly higher than the 44 % rate with the conventional scope. Endoscope operability was better and dissection speed was faster when using the PCF-H290TI with retroflexion compared to the conventional colonoscope without retroflexion. There were no significant differences between the groups in en bloc resection rate and adverse events. Conclusion  Compared to the conventional colonoscope, the PCF-H290TI/L made it easier to perform ESD via a retrograde approach regardless of tumor location, and thus may be useful for performing colorectal ESD.

Dual Red Imaging Maintains Clear Visibility During Colorectal Endoscopic Submucosal Dissection

BACKGROUND

The endoscopic lens becomes clouded and its visibility reduces during colorectal endoscopic submucosal dissection (ESD), especially in cases with submucosal fatty tissue. Dual red imaging (DRI) is a novel image-enhanced endoscopic technique that improves endoscopic visibility.

AIMS

This study aimed to evaluate the predictive factors of submucosal fatty tissue and the clinical usefulness of DRI in maintaining clear visibility during colorectal ESD.

METHODS

The study participants included 586 consecutive patients with 645 colorectal tumors who underwent ESD between January 2014 and July 2017. First, the degree of submucosal fatty tissue was evaluated by reviewing recorded images, and the clinical characteristics of the patients and tumors related to severe submucosal fatty tissue were evaluated. Second, 34 tumors resected using DRI were propensity score-matched in a 1:1 ratio to other resected tumors using white light imaging (WLI), and the degree of endoscope lens cloudiness and clinical outcomes were evaluated.

RESULTS

The proportion of tumors located in the right side of the colon, body mass index (≥ 25, BMI), and hemoglobin A1c (≥ 6.5%, HbA1c) were significantly higher in patients with severe submucosal fatty tissue. The visibility in the DRI group was significantly better than in the WLI group. Treatment outcomes in the DRI group were as good as those in the WLI group.

CONCLUSIONS

Tumor location in the right side of the colon, BMI (≥ 25), and HbA1c (≥ 6.5%) are the predictive factors of severe submucosal fatty tissue. DRI is useful in maintaining clear visibility during colorectal ESD, especially with submucosal fatty tissue.

Use of anticoagulants increases risk of bleeding after colorectal endoscopic submucosal dissection

BACKGROUND AND STUDY AIMS

Japanese guidelines for gastroenterological endoscopy have recommended temporary withdrawal of anticoagulants (warfarin, direct oral anticoagulants [DOAC], or heparin) to prevent hemorrhagic complications during endoscopic submucosal dissection (ESD) for colorectal neoplasias (CRNs). However, serious thrombosis might occur during temporary withdrawal of anticoagulants. The current study aimed to evaluate outcomes with anticoagulants in patients undergoing ESD for CRNs.

PATIENTS AND METHODS

 This study was a single-institution retrospective cohort study based on clinical records. We assessed 650 consecutive patients with 698 CRNs who underwent ESD at Hiroshima University Hospital between December 2010 and June 2016. The patients were divided into three groups: the warfarin group (19 patients with 19 CRNs), DOAC group (7 patients with 9 CRNs), and no-antithrombotics group (624 patients with 670 CRNs). We replaced warfarin with heparin 3 to 5 days before endoscopy. Although DOAC was suspended on the morning of endoscopy, we did not replace heparin.

RESULTS

 Bleeding after the procedure occurred in 26.3 % (5/19), 22.0 % (2/9), and 2.7 % (18/670) of patients in the warfarin, DOAC, and no-antithrombotics groups, respectively. In the warfarin group, four patients who bled after the procedure took not only warfarin but also other antiplatelets. En bloc resection rates were 94.7 % (18/19), 100 % (9/9), and 96.6 % (647/670) in the warfarin, DOAC, and no-antithrombotics groups, respectively. No patients experienced ischemic events in the perioperative period.

CONCLUSIONS

Among patients undergoing ESD for CRNs, risk of bleeding was higher among patients who took anticoagulants than among those who did not. In particular, careful attention to patients who took antiplatelets in addition to warfarin before ESD for CRNs is warranted.

Short-term outcomes of endoscopic submucosal dissection for superficial cecal tumors: a comparison between extension and nonextension into the appendiceal orifice

BACKGROUND

Few studies have investigated the use of endoscopic submucosal dissection (ESD) for cecal tumors extending into the appendiceal orifice. Herein, we assessed the feasibility and safety of ESD for cecal tumors extending into the appendiceal orifice.

METHODS

We retrospectively examined the outcomes of ESD for 78 patients with 78 cecal tumors (male/female ratio, 40/38; mean [standard deviation, SD] age, 67 [9] years; mean [SD] tumor size, 32 [15] mm), who underwent ESD at the Hiroshima University Hospital between October 2008 and March 2016. The indication for ESD in cecal tumors extending into the appendiceal orifice was recognition of the distal edge of the lesion in the appendix. They were classified into two groups: patients with cecal tumors extending (Group A: 29 patients, 29 tumors) and not extending (Group B: 49 patients, 49 tumors) into the appendiceal orifice. We compared the outcomes of ESD between both groups.

RESULTS

No significant differences in clinicopathological characteristics were observed between both groups. The rate of severe submucosal fibrosis in Group A (48%) was significantly higher than that in Group B (24%) (p < 0.05). The mean (SD) procedure speed in Group A (14 [10] mm²/min) was significantly slower than that in Group B (23 [16] mm²/min) (p < 0.01). The en bloc resection rates in Groups A and B were 90% and 96%, respectively. There were no significant differences in adverse events reported between both groups.

CONCLUSIONS

ESD for cecal tumors with extension into the appendiceal orifice is effective and safe.

Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group

BACKGROUND AND AIMS

Although advanced high-volume centers have reported good outcomes of colorectal endoscopic submucosal dissection (ESD), a limited number of highly skilled experts in specialized institutions performed these procedures. We undertook a retrospective multicenter survey, which included nonspecialized hospitals, to investigate the clinical outcomes of colorectal ESD.

METHODS

We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions. We evaluated the en bloc resection rate, histologic complete resection rate, curative (R0) resection rate, adverse events, and the long-term prognoses, including local recurrence, metachronous tumor development, and survival rate.

RESULTS

The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and .4%, respectively. The long-term outcomes analysis included 1091 patients (88.4%). Local recurrences occurred in 1.7%, and metachronous tumors (>5 mm) developed in 11.0% of the patients. The 3- and 5-year overall survival rates were 95.1% and 92.3%, respectively. The number of colonic tumors, severe submucosal fibrosis, and en bloc resection rates were significantly higher in the high-volume centers (Group H) than those in the low-volume centers (Group L). The average tumor size in Group H was significantly larger than that in Group L.

CONCLUSIONS

Colorectal ESDs are feasible, have acceptable adverse event risks, and favorable long-term prognoses. (Clinical trial registration number: UMIN000016197.).

Clinical impact of surveillance colonoscopy using magnification without diminutive polyp removal

BACKGROUND AND AIM

In Western countries, endoscopic removal of all adenomas during colonoscopy is recommended. The present study evaluates the usefulness of magnifying colonoscopy without removal of diminutive (≤5 mm) colorectal polyps.

METHODS

Patients with diminutive polyps who were observed for over 5 years using magnification at Hiroshima University Hospital were selected retrospectively. Lesions ≥6 mm in size, depressed lesions, and lesions with type V pit pattern were indications for endoscopic resection. We investigated the characteristics of lesions indicated for endoscopic resection detected on surveillance colonoscopy and the risk factors for the incidence of lesions indicated for endoscopic resection.

RESULTS

A total of 706 consecutive patients were enrolled. Sixty-eight lesions indicated for endoscopic resection were detected, averaging 9.0 ± 4.8 mm, and 33 (49%) lesions were located in the right colon. Pathological diagnoses were adenoma, Tis carcinoma, and T1 carcinoma in 58 (85%), eight (12%), and two (3%) lesions, respectively. Five lesions were considered to grow from previously detected diminutive polyps. Relative risks for the incidence of a lesion indicated for endoscopic resection were 1.76 (95% confidence interval [CI], 1.004-3.23) for males compared with females, 3.76 (95% CI, 2.03-7.50) for more than three polyps at initial colonoscopy compared with one polyp, and 2.84 (95% CI, 1.43-5.24) for patients with carcinoma at initial colonoscopy compared with patients with no lesion indicated for endoscopic resection. Nine carcinomas were resected endoscopically.

CONCLUSION

Diminutive low-grade adenomas detected by using magnifying colonoscopy may not necessarily require removal.

Abstract P1-10-11: Prone vs. supine positioning for optimizing radiation heart exposure during left breast radiotherapy: A simple clinical tool for prediction*

The benefit of reduced radiation heart exposure in the prone vs. supine position, individually differs according to the anatomical features of the patient (Varga Z, Int J Radiat Oncol Biol Phys. 2009;75:94-110). Preferable positioning may be predicted by a statistical model. This validated calculator using the patient's body mass index (BMI), the median distance of the anterior surface of the left coronary artery (LAD) from the chest wall (Dmed) and the heart area (Aheart) included in the radiation field in a single CT scan at the middle of the heart (median plane, Pmed) provides quantitative estimates of the dose differences to the LAD or heart in the two positions (Varga Z, Acta Oncol. 2014;53:58-64).

In this prospective cohort study, the goal was to develop a reliable method to collect data for the calculator without acquiring a full series of CT scans in both positions. The study was approved by the Institutional Review Board of the University of Szeged, and all the enrolled patients gave their written informed consent to participation. Eligible patients needed postoperative left breast radiotherapy. In 100 patients, a single CT slice image representing the middle of the heart (reference plane, Pref) was acquired by using the AP scout view in the supine position for the selection of the transversal plane appropriate for the measurements of Dmed and Aheart. Thereafter, CT series were acquired in both positions, and analyses were performed on 1. the conformance of the Pref with Pmed , 2. the effect of plane miss on the choice of preferable position. 3. Finally the sensitivity and specificity of this simple clinical method was reevaluated based on the dosimetry data (mean LAD dose, V25Gy heart) obtained using the topogram for selecting the position.

In 55 cases, Pref was the same as Pmed, while in 27 and 18 cases, Pref and Pmed differed by 2 or more planes, respectively. No difference was found between the values of Dmed or Aheart asmeasured in Pref vs. Pmed, independently whether Pref was identified correctly or not.The suggestion on treatment position per Pref measurements, was correct in 85 cases, was ambiguous in 8 cases and incorrect in 7 cases. Sensitivity of the calculator based on Pref measurements was 90% (both mean LAD dose and V25Gy heart), while specificity was 72% (mean LAD dose) and 68% (V25Gy heart). The simple clinical method was tested in additional 60 left breast radiotherapy cases, by taking a topogram and a CT series in the suggested position only. Mean LAD dose (mean [CI95%] prone vs. supine: 6.5 [5.7-7.3] Gy vs. 7.5 [5.6-9.5] Gy) and V25Gy heart (mean [CI95%] prone vs. supine: 0.87 [0.67-1.11] % vs. 1.13 [0.55-1.71]%) well corresponded to the institutional dose constraints based on dosimetry data achieved with individual positioning in &gt;300 patients with left-sided breast cancer.

We consider this simple clinical tool appropriate for assisting individual positioning aiming at maximum heart protection during left breast irradiation.

*Supported by the VKSZ 12-1-2013-0012 project.

Citation Format: Kahán Z, Gaál S, Cserháti A, Rárosi F, Boda K, Varga Z. Prone vs. supine positioning for optimizing radiation heart exposure during left breast radiotherapy: A simple clinical tool for prediction* [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-11.

A retrospective screening and epidemiological study of oncological and other diseases in the oral and maxillofacial region at the University of Szeged, Department of Oral Medicine (1960-2014)

The Department of Oral Medicine at the University of Szeged was responsible for the stomato-oncological care of the population of three counties (with a population of 1,7 M at an average) in the period 1960-201 4. The present report summarizes the incidence of oral medicine diseases during this period. The overall number of new out-patients at the Department of Oral Surgery between 1960 and 2014 was 338,200. These patients were dental and oral surgical patients who presented spontaneously or were referred from the general practice, or stomato-oncological patients referred from general dental practices in-the three counties. Of the 338,200 new cases, 9,482 (2.8%) were benign tumors, 5438 (1.6%) premalignancies and 5,145 (1.5%) malignant tumors. This means a total of 20,065 tumor cases (5.9%) in the examined period, of which 10,579 (3.1 %) were premalignancies and malignancies. 14,446 patients presented with other diseases of the oral mucous membrane (5.8%, data available from 1974). Data on the number of stomato-oncological control patients in any given year are available from 1970 on. In the period 1970-2014, the total number of check-up patients was 117,268, this is the 76,97% of the departments overall number of patients. As for the tendencies, in the representative period of 1960-2004, the number of new benign tumors 15-fold, premalignancies 30-fold, and malignant tumors exhibited an 25-fold increase, while the number of other conditions affecting the oral mucosa showed a 14-fold increase.

International comparison of blood pressure and BMI values in schoolchildren aged 11-16 years

AIMS

This study comprised part of a larger cross-sectional survey performed in Hungary in the period 2005-2006, which was designed first to reveal the representative age-, gender- and height-specific percentile values for the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) in Hungarian children aged 11-16 years. The second aim was to determine the prevalence of overweight and obesity.

METHODS

Analyses were performed on 14,290 Hungarian children aged 11-16 years. All blood pressure (BP) measurements were made with a validated, automated, digital device. The criteria recommended by international guidelines were used.

RESULTS

The prevalence of overweight and obesity among the Hungarian children was found to be 23.4% (3347 adolescents; International Obesity Task Force criteria). Previous studies have reported that the strongest correlation is observed between the BP values and weight, and our results are in accordance with this.

CONCLUSIONS

Regional differences in morphometry (different prevalences of overweight and obesity) and the genetic background, disparate eating habits and other cultural factors may account for the differences in BP levels during childhood. As the prevalence of overweight and obesity is increasing worldwide, it is important that countries carefully monitor the weight and BP status of their children and adolescents.

Plasma concentrations of high-mobility group box protein 1, soluble receptor for advanced glycation end-products and circulating DNA in patients with acute pancreatitis

AIMS

High-mobility group box protein 1 (HMGB1), a late-acting proinflammatory cytokine, is secreted actively by inflammatory cells, and released passively from necrotic cells. From the aspect that both inflammation and necrosis are involved in the pathogenesis in acute pancreatitis, the aim of the study was a joint investigation of the plasma concentrations of HMGB1, its soluble receptor for advanced glycation end-products (sRAGE), and the circulating DNA as a marker of cell death.

METHODS

62 patients with acute pancreatitis (30 mild, 32 severe), 20 patients with sepsis, and 20 healthy controls were enrolled in the study. HMGB1 and sRAGE plasma levels were measured by means of ELISA. Plasma DNA concentrations were estimated by real-time quantitative PCR for the beta-globin gene.

RESULTS

The circulating HMGB1 level was significantly higher in patients with severe acute pancreatitis (13.33 +/- 2.11 ng/ml) than in healthy controls (0.161 +/- 0.03 ng/ml) or than in patients with mild pancreatitis (2.64 +/- 0.185 ng/ml). The plasma concentration of sRAGE was highest in patients with sepsis (2,210 +/- 252 pg/ml), while the levels of sRAGE correlated inversely with that of HMGB1 in patients with acute pancreatitis. The plasma DNA level was significantly elevated in patients with severe acute pancreatitis (2,206 +/- 452 ng/ml).

CONCLUSION

A complex study of the plasma levels of HMGB1, sRAGE and circulating DNA can be informative in evaluations of acute pancreatitis with different levels of severity.

Optical platelet aggregometry does not appear useful as a means of assessing the risk of recurrent vascular events in aspirin-treated patients

OBJECTIVES

To investigate whether the results of optical platelet aggregometry indicate the risk of recurrent ischemic events.

MATERIALS AND METHODS

Cerebro- and cardiovascular patients taking aspirin for at least 30 days were studied retrospectively. Ischemic vascular events occurring prior to testing and the presence of vascular risk factors were recorded.

RESULTS

241 subjects were included. Among the 78 patients (32.4%) who displayed recurrent vascular episodes, the age (62.5 +/- 10.6 vs. 58.4 +/- 11.6, P = 0.009) and the proportion of hypertensives (80.8% vs. 68.1%, P = 0.040) were significantly higher when compared with the participants who exhibited single events. The degree of platelet aggregation did not differ significantly between the patients with and those without recurrent episodes. Logistic regression analysis identified only age (OR 1.033, 95% CI 1.008-1.058, P = 0.010), and not aggregation values, as a risk condition for recurrent vascular episodes.

CONCLUSIONS

Results of optical platelet aggregometry were not indicative of the risk of recurrent vascular events. The role of conventional risk factors appeared to be more important.

Manual lymph drainage efficiently reduces postoperative facial swelling and discomfort after removal of impacted third molars

The removal of wisdom teeth is often associated with severe postoperative edema and pain, and operation on the third molar can cause local inflammation that impairs lymph transport. The objective of the study was to assess the efficacy of manual lymph drainage (MLD) in reducing swelling following bilateral wisdom tooth removal. Ten consecutive patients with bilateral impacted wisdom teeth that required surgical removal were enrolled in the study. Each patient was postoperatively treated with MLD (after Vodder's method) on one side of the neck region with the untreated contralateral side as a control. Swelling was evaluated using a tape-measure placed in contact with the skin. The six landmarks of measurement included tragus-lip junction, tragus-pogonion, mandibular angle-external corner of eye, mandibular angle-ala nasi, mandibular angle-lip junction, and mandibular angle-median point of chin. Subjective assessment of MLD was conducted with self-evaluation using a visual analogue bar scale (VAS, range 0-100 mm). Of the 6 linear measurements, 4 lines (2, 4, 5, 6) showed a significant reduction of swelling on the side of MLD compared to the untreated side. Mean score of VAS of pretreatment condition was 35.5 +/- 20.60 mm that decreased to 22 +/- 19.32 mm measured after MLD (p=0.0295). This initial study demonstrates that MLD may promote an improvement of lymph circulation and work in an adjunctive role for reduction of postoperative swelling and pain following removal of impacted third molars.

Interferon-beta affects the tryptophan metabolism in multiple sclerosis patients

Tryptophan and its metabolites are of great interest in understanding the pathogenesis of multiple sclerosis (MS). The total levels of tryptophan and its metabolites, kynurenine and kynurenic acid were determined in plasma by capillary liquid chromatography electrospray ionisation tandem mass spectrometry. This is the first report of the plasma levels of these analytes in healthy controls and relapsing-remitting MS patients receiving long-term and acute interferon-beta (IFN-beta) treatment. Twenty-four hours post-administration increased kynurenine levels (first IFN MS versus healthy, P = 0.042) and kynurenine/tryptophan ratio (K/T; first IFN MS versus healthy, P =0.027; first IFN MS versus long-term IFN MS, P = 0.036) were found. The long-term IFN MS group had higher K/T ratios at 4 and 12 h post-administration (P = 0.015 and 0.009, respectively). The increase of K/T ratio in the first IFN MS group indicate an induction of the enzyme indolamine-2,3-dioxygenase (IDO), as reported earlier in experimental allergic encephalomyelitis. As IDO is participating in both inflammatory and neurodegenerative processes, further knowledge of its involvement in the pathogenesis of MS is of great importance.

Relationship between stimulus complexity and neuronal activity in the inferotemporal cortex of the macaque monkey

The single-unit activity of 217 cells was recorded from the inferotemporal cortex (IT) of two awake macaque monkeys while they performed a fixation task. The stimuli were coloured geometrical shapes or coloured representations of natural or artificial objects. To determine whether the stimuli could be separated into groups on the basis on neuronal population behaviour, the responses to the images were analysed by factor analysis and cluster analysis. It was a common result of each analysis that, on the basis of neuronal responses, the stimulus set could be separated into two groups, despite the lack of difference in mean response rate to them. Similar groups were formed when only the first half of the responses was analysed. The results suggest a differential coding of the images of simple geometrical shapes and of the images of complex, real (photographic) objects. We found significant differences between the two stimulus groups in physical features, other than size or luminance. Our results suggest that the same neurone population might respond differently to simple and complex images in the first 150 ms of their responses. The differences might be attributed to "non-obvious" physical features of the stimuli, such as the amount of internal lines in the images, colourfulness and the length of perimeter of the stimuli.

The effect of endometrial thickness on IVF/ICSI outcome

BACKGROUND

During the menstrual cycle the endometrium undergoes cyclic proliferative and secretory changes in preparation for implantation. If this preparation is not sufficient, then implantation will fail. The impact of endometrial thickness on the day of embryo transfer on IVF outcome was investigated in the present study.

METHODS

A retrospective analysis was conducted of 1228 IVF/ICSI cycles. Stimulation was with clomiphene citrate (CC) + hMG in one-third of the cycles, and ultrashort GnRH agonist stimulation in two-thirds. Cycle parameters were compared between pregnant and non-pregnant patients. A similar comparison was made between ongoing pregnancies and those that resulted in a loss.

RESULTS

There were more follicles, oocytes and embryos, the endometrium was thicker and the embryo quality was higher among women who became pregnant when compared with non-pregnant women after assisted reproduction. The pregnancy rate improved as endometrial thickness increased. No difference in cycle parameters and endometrial thickness was found between ongoing pregnancies and pregnancies that resulted in a first-trimester loss. CC had no measurable adverse endometrial effect, but the pregnancy rate was lower in CC+hMG cycles.

CONCLUSIONS

Increased endometrial thickness is associated with higher pregnancy rates. However, neither attainment of pregnancy nor pregnancy outcome was predicted by endometrial thickness alone.

Codon 311 (Cys --> Ser) polymorphism of paraoxonase-2 gene is associated with apolipoprotein E4 allele in both Alzheimer's and vascular dementias

The gene of an esterase enzyme, called paraoxonase (PON, EC.3.1.8.1.) is a member of a multigene family that comprises three related genes PON1, PON2, and PON3 with structural homology clustering on the chromosome 7.(1,2) The PON1 activity and the polymorphism of the PON1 and PON2 genes have been found to be associated with risk of cardiovascular diseases such as hypercholesterolaemia, non-insulin-dependent diabetes, coronary heart disease (CHD) and myocardial infaction.(3-8) The importance of cardiovascular risk factors in the pathomechanism of Alzheimer's disease (AD) and vascular dementia (VD)(9-13) prompted us to examine the genetic effect of PON2 gene codon 311 (Cys-->Ser; PON2*S) polymorphism and the relationship between the PON2*S allele and the other dementia risk factor, the apoE polymorphism in these dementias. The PON2*C and PON2*S allele frequencies were similar in both AD (25% and 75%) and VD groups (23% and 77%), respectively, compared with the controls (27% and 73%). The ratio of the PON2*S carriers was significantly higher among the apoE4 allele carrier AD (27%) and VD (25%) groups than in the control (12%). Our results indicate that the PON2*S and apoE4 alleles have interactive effect on the development of the two most common forms of dementias AD and VD, and further support the hypothesis that cardiovascular factors contribute to the development of AD.

Evaluation of pancreatic exocrine function by secretin-enhanced magnetic resonance cholangiopancreatography

AIM

To assess the feasibility and usefulness of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) for evaluation of pancreatic exocrine function.

METHODOLOGY

S-MRCP was performed in 20 patients with mild (n = 8) or severe (n = 12) chronic pancreatitis (according to the grade of exocrine pancreatic insufficiency indicated by the Lundh test) and in 10 volunteers without pancreatic disease. MRCP images were evaluated before and 10 minutes after the intravenous administration of 0.5 IU/kg secretin. The changes in pancreatic tissue T2 signal intensity and duodenal filling after the injection of secretin were determined by means of S-MRCP. The S-MRCP findings were then compared with those of the Lundh test.

RESULTS

The pancreatic T2 signal intensity showed a significant elevation after secretin administration in the volunteers and in the patients with mild or severe chronic pancreatitis. This elevation was significantly lower in patients with mild and severe chronic pancreatitis than in the volunteers (66.85+/-15.77 and 24.45+/-5.85 vs. 200.0+/-45.07, respectively). After administration of secretin. the diameter of the duodenum was significantly increased in all three groups. This duodenal filling was significantly reduced in patients with mild or severe exocrine pancreatic insufficiency as compared with the volunteers (4.12+/-1.33 and 1.70+/-0.77 vs. 15.38+/-1.73, respectively). There was no significant difference in pancreatic T2 signal intensity changes or in duodenal filling in patients with mild or severe exocrine pancreatic insufficiency. There were significant correlations between the pancreatic T2 signal intensity changes and the duodenal filling and the results of the Lundh test (r = -0.616 and -0.78).

CONCLUSION

These results demonstrate that the administration of secretin increases the T2 signal intensity of the pancreatic tissue and the diameter of the duodenum to different extents in normal subjects and in patients with chronic pancreatitis. This suggests that S-MRCP can provide information of value in the assessment of an exocrine pancreatic insufficiency.

Launch conditions might affect the formation of blood vessels in the quail chorioallantoic membrane

As a part of the first joint USA-Russian MIR/Shuttle program, fertilized quail eggs were flown on the MIR 18 mission. Post-flight examination indicated impaired survival of both the embryos in space and also of control embryo exposed to vibrational and g-forces simulating the condition experienced during the launch of Progress 227. We hypothesized that excess mechanical forces and/or other conditions during the launch might cause abnormal development or the blood supply in the chorioallantoic membrane (CAM) leading to the impaired survival of the embryos. The CAM, a highly vascularized extraembryonic organ, provides for the oxygen exchange across the egg shell and is thus pivotal for proper embryonic development. To test our hypothesis, we compared angiogenesis in CAMs of eggs which were either exposed to the vibration and g-force profile simulating the conditions at launch of Progress 227 (synchronous controls), or kept under routine conditions in a laboratory incubator (laboratory controls). At various time points during incubation, the eggs were fixed in paraformaldehyde for subsequent dissection. At the time of dissection, the CAM was carefully lifted from the egg shell and examined as whole mounts by bright-field and fluorescent microscopy. The development of the vasculature (angiogenesis) was assessed from the density of blood vessels per viewing field and evaluated by computer aided image analysis. We observed a significant decrease in blood-vessel density in the synchronous controls versus "normal" laboratory controls beginning from day 10 of incubation. The decrease in vascular density was restricted to the smallest vessels only, suggesting that conditions during the launch and/or during the subsequent incubation of the eggs may affect the normal progress of angiogenesis in the CAM. Abnormal angiogensis in the CAM might contribute to the impaired survival of the embryos observed in synchronous controls as well as in space.

Determinants of abortion among women undergoing artificial termination of pregnancy

OBJECTIVES

In order to determine factors involved in the contraceptive practice of women undergoing artificial abortion, a prospective questionnaire survey was carried out.

METHODS

Women (n = 800) requesting artificial abortion were compared with women (n = 1000) admitted to or visiting the department for reasons other than abortion. The SPSS program was used for statistical analysis between 1998 and 1999. Multiple logistic regression analysis was applied to evaluate the factors influencing the contraceptive practice of the aborters.

RESULTS

Reliable contraceptive methods were used significantly less frequently by the aborters than by the control group (19.1% vs. 55%, p < 0.001, adjusted odds ratio (AOR), 0.46; 95% confidence interval (CI), 0.3-0.7). The contraceptive choice of the aborters depended significantly on their low income (AOR, 1.87; 95% CI, 1.5-2.4). The likelihood of abortion was significantly lower among those informed by a health-care provider (AOR, 0.56; 95% CI, 0.4-0.8) or the media (AOR, 0.51; 95% CI, 0.4-0.7). Awareness of reliable methods was also an important factor (AOR, 0.25; 95% CI, 0.1-0.5).

CONCLUSIONS

It appears that a further decrease of the abortion ratio could be attained through an intensive media campaign and improved education.

Functional development of small intestine of Japanese quail hatched on MIR orbital station

The effect of microgravity on functional development of the small intestine of Japanese quails incubated for 2-3 d and hatched on the orbital station MIR was examined. After 5 d of space flight duodenal and jejunal alkaline phosphatase (AP) activity of the experimental group was compared with the AP activity in quails of the same age hatched on the Earth (laboratory controls). Short-term microgravity leading to decreased food intake resulted in significant increase of AP activity in both duodenal and jejunal enterocytes (P<0.001) of the experimental quails. The results suggest that increased AP activity probably reflects the delayed functional development of the small intestine as a consequence of inappropriate food intake during non-physiological conditions of space flight.

Independent and joint effects of antibodies to human heat-shock protein 60 and Chlamydia pneumoniae infection in the development of coronary atherosclerosis

BACKGROUND

Studies have suggested that the prevalence of antibodies against heat-shock proteins (HSPs), Chlamydia pneumoniae (CPN), and cytomegalovirus (CMV) is associated with coronary artery disease (CAD), but the independent or joint effects of human (h) HSP60 antibodies and these pathogens in patients have not been fully elucidated.

METHODS AND RESULTS

A total of 405 subjects (276 patients with CAD and 129 control individuals) were tested for serum antibodies to hHSP60, CPN, and CMV immediate-early-1 (IE1) antigens. Patients were also assessed for serum cholesterol, triglyceride levels, and smoking habit. Significantly elevated levels of antibodies to hHSP60 and CPN but not to CMV-IE1 antigens were documented in CAD patients. Multiple logistic regression analysis and subanalyses of selected subjects showed that these associations were independent of age, sex, smoking, and serum lipid levels. Antibodies to hHSP60 and CPN did not correlate quantitatively; however, the relative risk of disease development was substantially increased in subjects with high antibody levels to both hHSP60 and CPN:, reaching an odds ratio of 82.0 (95% CI 10.6 to 625.0).

CONCLUSIONS

High levels of antibodies to hHSP60 and CPN: are independent risk factors for coronary atherosclerosis, but their simultaneous presence substantially increases the risk for disease development.

Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis

BACKGROUND

Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM 1.

PATIENTS AND METHODS

A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R&D). PCT was determined in cell lysates by ECL Western blot.

RESULTS

PCT was found in relatively high concentrations (8.5 +/- 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin ( 15 +/- 5.4 ng/mL). Positive values (> 1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p < 0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines.

CONCLUSION

Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis

BACKGROUND

Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM 1.

PATIENTS AND METHODS

A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R&D). PCT was determined in cell lysates by ECL Western blot.

RESULTS

PCT was found in relatively high concentrations (8.5 +/- 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin ( 15 +/- 5.4 ng/mL). Positive values (> 1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p < 0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines.

CONCLUSION

Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

Stereotaxic injection of IgG from patients with Alzheimer disease initiates injury of cholinergic neurons of the basal forebrain

CONTEXT

The participation of an immune/inflammatory process in the pathomechanism of sporadic Alzheimer disease (AD) has been suggested by evidence for activated microglia and the potential therapeutic benefit of anti-inflammatory medication.

OBJECTIVE

To define a possible role for IgG in the immune/inflammatory process of AD in humans, we assayed the ability of IgG samples from patients with AD to target the injury to cholinergic neurons in rat basal forebrain in vivo.

DESIGN

IgG purified from the serum or plasma from patients with AD and patients with other neurological disease who were used as control (DC) patients was injected stereotaxically into the medial septum of adult rats. Four weeks later coronal sections of the whole medial septum-diagonal bands of Broca region were immunostained for choline acetyltransferase (ChAT) to identify cholinergic neuronal cells.

SETTING

University medical centers.

PATIENTS

Blood samples were collected from 8 patients with probable and definite AD and from 6 age-matched DC patients.

MAIN OUTCOME MEASURE

Detection of changes in the number of ChAT immunopositive cell profiles in sections and statistical evaluation.

RESULTS

Four weeks after the injections, IgG samples from patients with AD significantly reduced the number of ChAT-immunostained cell profiles in the whole medial septum-diagonal bands of Broca region compared with IgGs from DC patients. Neither DC IgGs nor saline solution significantly decreased the number of ChAT-immunopositive neuronal cell profiles.

CONCLUSION

Data document that IgG from patients with AD can target a stereotaxically induced immune/inflammatory injury to cholinergic neurons in the rat basal forebrain in vivo.

Vasopressin deficiency decreases the frequency of gastroduodenal ulceration in humans

Vasopressin is a stress hormone released from the posterior pituitary. In humans suffering from central diabetes insipidus, this release of vasopressin is diminished. It was shown previously that the congenitally vasopressin-deficient Brattleboro homozygous rat is less sensitive to various ulcerogenic stimuli. In this study, we investigated the incidence of gastroduodenal ulceration in vasopressin deficient patients. Data on patients aged 20-70, hospitalized in Hungary between 1992 and 1995 were compared with those on the total population in this age group (6,681,020 in 1994). Subjects with central diabetes insipidus were selected separately (815 cases). Gastroduodenal ulceration was compared in subjects with an intact vasopressin release and vasopressin-deficient patients. The frequencies of gastroduodenal ulceration were also examined separately in male and female subjects. In the total population, the frequency of gastroduodenal ulceration was lower in vasopressin-deficient cases (2.22% versus 0.61%; P < 0.005). Among normal-vasopressin subjects, males have a higher risk of gastroduodenal ulceration than females (3.04% versus 1.46%, respectively; P < 0.001). Among vasopressin-deficient subjects, a similar male:female ratio was observed, but it was not significant (P = 0.36). In comparison to the normal-vasopressin population, the incidence of gastroduodenal ulceration was reduced among vasopressin-deficient males and females by 77% (P < 0.01) and by 82% (P < 0.05), respectively. In conclusion, endogenous vasopressin has a significant harmful action towards the human gastroduodenal mucosa. Peptide and non-peptide vasopressin receptor antagonists might have a potential therapeutic benefit in the treatment (as an adjuvant) and prevention of gastroduodenal ulceration.

[Marginal adaptation of different esthetic filling materials under the effect of heat treatment]

The aim of the study was to examine the marginal adaptation of six tooth coloured restoratives to the tooth hard tissues before and after heat treatment considering the filling method and the placement of the cavity margin. The study showed that 1) the composite marginal adaptation was better with enamel bonding technique than with total bonding technique; 2) the microleakage was less before heat treatment; 3) the best fit was at the occlusal surface and the worst at the gingival tooth-filling junction with the composites; 4) non-composites showed the best adaptation at the approximal enamel-filling junction and the worst at the occlusal surface; 5) the best marginal adaptation could be achieved with Charisma and SpectrumTPH among the composites, and Dyract among the non-composites.

[Diagnostic value of fecal elastase test in pancreatic exocrine deficiency]

The diagnostic value of the estimation of faecal elastase-1, the new noninvasive direct pancreatic function test was evaluated in a total of 35 patients. Twenty one patients were diagnosed with chronic pancreatitis and categorized according to grades of exocrine pancreatic insufficiency based on the Lundh test, 14 patients in the control group had gastrointestinal disorders. Faecal elastase 1 was measured by ELISA method. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of elastase determination was 71.4%, 92.8%, 88.2%, 81.2% and 83.7%, respectively in chronic pancreatitis. In the severe exocrine pancreas insufficiency group (n = 14), the sensitivity was 85.7%, while in the group with mild insufficiency (n = 7) the sensitivity was only 42.8%. The determination of faecal elastase is useful in the diagnosis of severe exocrine pancreas insufficiency, but it is not sensitive enough in the mild form of the disease.

The effect of mesoporphyrin on the production of cytokines by inflammatory cells in vitro

This study was conducted to investigate a mechanism of the anti-inflammatory action of mesoporphyrin, especially the effect on the production of cytokines by some cultured inflammatory cells. Mesoporphyrin had no effect on lipopolysaccharide-induced tumor necrosis factor-alpha production by RAW 264.7 cells (murine macrophage-like cells). Mesoporphyrin inhibited interferon-gamma production by 1E10.H2 cells (murine T helper-1 cells), but not interleukin-4 production by D10.G4.1 cells (murine T helper-2 cells). Mesoporphyrin inhibited interleukin-6 production by human osteoblast-like MG-63 cells. This inhibition of interleukin-6 production is closely related to the suppression of prostaglandin E2 generation by interfering cyclooxygenase 1 and 2 enzyme activities. These data suggest that the inhibition of cytokine production is one of the anti-inflammatory mechanisms of mesoporphyrin.

[In vitro comparison of marginal adaptation of different filling materials. II. Effect of the site and method of preparation on the marginal adaptation]

In a two-month in vitro experiment we examined the marginal adaptation of ten dental materials. Fifty Class II restorations were prepared extending to the cemento-enamel junction. The cavities of the composite restorations were bevelled at the vestibulo-occlusal and -approximal enamel margins, on the other side enamel and gingival margins were prepared conventionally. The specimens were thermocycled and examined with SEM. The microleakage was measured at the vestibulo-occlusal and -approximal tooth-filling junction, where adhesive technique was used, and at the gingival, oroocclusal and -approximal margins, which were not bevelled before. The obviously most important conclusion of the study is, that in the case of deep Class II cavities the amalgam has a better adaptation at the gingival margin than the examined composite resins.

Immunopharmacological studies on experimental allergic encephalomyelitis in DA rats

The immunopharmacological profile of experimental allergic encephalomyelitis (EAE) in DA rats was compared to that in Lewis rats, which are commonly used for the study of EAE. DA rats showed higher susceptibility to EAE than Lewis rats. The immunological studies indicate that DA rats showed higher humoral and cellular immune response to myelin basic protein (MBP) than Lewis rats. This is probably due to the susceptible T cells to mitogen and autoreactive T cells to MBP in DA rats. In pharmacological studies, cyclosporin A, FK-506 and prednisolone suppressed the development of EAE in both strains in a similar manner. These results suggest the existence of two different types of T cells with respect to the onset of EAE in DA rats: one is highly reactive to mitogen and MBP; the other is regulated by cyclosporin A and FK-506.

[Cardiovascular complications of pancreatis diseases]

Under physiological conditions, the pancreas scarcely influences the function of the cardiovascular system, although the hormones produced in the healthy pancreas (insulin, glucagon and somatostatin) affect the myocardial contractility in pharmacological doses. Among the diseases of the pancreas, the pancreatic tumours (insulinoma, glucagonoma and vipoma), furthermore the acute and chronic pancreatitis involve cardiovascular complications, which influence the outcome of the disease. Although the clinical picture is dominated by the metabolic changes of the excessively produced hormones in pancreatic tumours, the cardiac and vascular effects of the hormones may be considerable. In acute necrotizing pancreatitis, enzymes released from the pancreas and inflammatory mediators transform acute necrotizing pancreatitis into "multiple organ disease"; one of the important forms of this disease is the cardiovascular shock syndrome. One of the best-known complications of chronic pancreatitis is the pancreoprive diabetes mellitus, and beside that other, nonspecific cardiac alterations (e.g. ECG-changes) may occur.

[Gallbladder hypomotility in diabetic polyneuropathy]

A study was made of the pathogenic role of gallbladder hypomotility, which is presumably responsible for the high incidence of gallstone disease in long-standing diabetes mellitus. The gallbladder motility of diabetic patients (n = 10) was measured by means of quantitative hepatobiliary scintigraphy, and the severity of concomitant autonomic and sensory polyneuropathy was determined. The presence of marked gallbladder hypomotility was proven, and a positive correlation was observed between the severity of autonomic neuropathy and the contractile disorder. In this group of diabetic patients, a hypaesthetic sensory polyneuropathy too was recognized, the degree of which exhibited a positive correlation with the autonomic neuropathy score. This study underlines the important role of the autonomic neural dysfunction in the development of gallbladder hypomotility accompanying long-term diabetes mellitus.

Noninvasive monitoring of hemodynamic changes in acute pancreatitis in rabbits

Hemodynamic parameters of experimental acute necrotizing pancreatitis (AP) were monitored by means of echocardiography in rabbits. Left ventricular (LV) systolic and diastolic parameters were determined before and 1, 3, 6, 12, 18, and 24 hr after injection of taurocholic acid in the pancreatic duct in AP animals. Temporary LV dilatation was observed 6 hr after the AP induction [LV end-diastolic (ED) diameter from 1.16 +/- 0.04 to 1.22 +/- 0.04 cm, P < 0.05, ED volume from 2.98 +/- 0.34 to 3.57 +/- 0.75 ml, P < 0.05] without decrease in systolic function. Cardiac output (CO) and stroke volume (StV) was increased in both groups 3 hr after the operation (from 0.53 +/- 0.15 to 0.71 +/- 0.06 L/min, P < 0.05 in AP), but in the AP animals it remained high. However, 24 hr after AP induction, both the CO and the StV were decreased significantly. The LV diastolic function was impaired 1 hr after AP induction, but had recovered after 12 hr. In conclusion, an early diastolic impairment followed by LV enlargement could be noninvasively observed in experimental AP in rabbits.

Clinical and gait analysis of 171 unilateral calcaneal fractures

INTRODUCTION:: Reviewing the management of calcaneus fractures, conservative and operative treatment are known without a generally accepted, well proven therapeutical strategy or tactics compared to other types of fractures. The purpose of this study is to define the parameters of the differences between the fractured calcaneus and the intact one, as well as the two types of treatments using the gait analysis method. MATERIALS AND METHODS:: Retrospective clinical investigation and gait analysis have been performed on 217 patients with calcaneus fractures. An analysis of the X-rays was also included. The Novel 101 B pedobarography analyser with platform 102H (4 sensor/cm(2)) was used for pressure distribution analysis. The region of the foot was divided into four masks, Mask 1 (M1) the area of the heel, Mask 2 (M2), the mid-foot, Mask 3 (M3), metatarsal region, and Mask 4 (M4) the region of the toes. The total area of the foot (TOT) included all four masks. Eighteen bilateral fractured calcanei have been omitted from the evaluation, owing to the lack of control foot, and 28 patients were excluded for the other complications of the fractures foot, complications of the control foot or complications extending to both feet. The data on the 171 fractures (68 patients treated conservatively and 103 patients treated operatively) of the calcaneus were compared with their control feet. The average age was 52.0 years (+/- 2.7) and the average follow up time was 49.9 months (+/- 17.5). The statistical analysis was performed using SPSS for Windows. Examination of correlation, repeated measurement analysis of variance, ANOVA, and multiple comparisons were performed by Bonferoni. Linear discriminating analysis was also performed. Significance level was defined as p<0.05 in each case. RESULTS:: All investigated parameters (area, max.F, max.P, absolute and relative contact time, FTI, PTI.) of M2 were significantly higher on the fractured side than on the intact one. The investigation of the whole foot showed significant increase concerning the area, and significant decrease in the max. force, FTI and PTI values. The differences between the conservatively treated and the intact foot values, as well as the differences between operatively treated foot and the intact one, demonstrated a significant decrease in the FTI TOT and the PTI TOT in both groups. A significantly higher difference was also demonstrated when the difference in the value of PTI TOT in the operative group was compared to the conservative one. Therefore, the values of the fractured side of the operative group were significantly lower than the values of the intact one, but significantly higher than the values of the conservative group. CONCLUSIONS:: The gait analysis parameters for the calcaneus fractured and the intact sides allowed for separation of the data according to significant differences. The results of the gait analysis comparing the conservative and operative method of the treatment showed that the surgical method was the better choice.

[Increase of the QT interval dispersion in diabetes mellitus]

The QT dispersion, measured as the interlead variability of QT interval (QTd = QTmax-QTmin), reflects the spatial inhomogeneity of ventricular repolarization times. The authors studied QTd and heart rate-corrected QTd (QTc-d) in 81 patients with diabetes mellitus (IDDM: 39, NIDDM: 42) using Bazett's formula; 20 non-diabetic subjects acted as controls (means +/- SD). QTd (43 +/- 17 ms) and QT c-d (52 +/- 20 ms) were increased (p < 0.05) as compared to the control values (QTd = 32 +/- 17 and, QTc-d = 35 +/- 17 ms, respectively). A significant difference was also observed in QTc-d if the two diabetic groups were compared to the control separately (p < 0.05). Moreover, comparison of the diabetic groups (IDDM vs NIDDM) revealed that type I diabetes mellitus is accompanied by a more pronounced spatial dispersion of ventricular reporlarization (QTd = 49 +/- 16, and QTc-d = 59 +/- 19 ms) as compared to NIDDM (QTd = 38 +/- 16, QTc-d = 46 +/- 20 ms [p < 0.01]). The hypothesis that increased QTd/QTc-d is truly a predictive marker of sudden arrhythmic cardiac death in patients with diabetes mellitus needs further clinical investigation.

Measurement of surface tension in biological fluids by a pulsating capillary technique

Ever since the discovery of the antiatelectatic function of the pulmonary surfactant, the measurement of surface tension (ST) has been of increasing importance in respiration physiology and clinical research. For the determination of ST, the elevation of the level of a fluid artificially pulsated in a capillary glass tube was monitored, and ST was calculated with the digitalized video-computerized picture analysis program Surftens. The biological relevance of the method is given by the Gibbs-Thomson principle, according to which surface-active lipids stream towards the surface by an adsorptive process; on pulsation of the fluid in a capillary glass tube, therefore, ST is gradually decreased to a minimal value. ST values of 60 amniotic fluid samples collected from pregnancies with different gestation times were determined. A multiple regression analysis of the results, including other parameters (total protein content, total lipid content, phospholipid content and microviscosity), indicated that this method may enhance the precision of the determination of gestation time. Precision analysis of various samples proved that this technique gives well-reproducible results under the given standardized conditions. The main field of application of the method may be in clinical practice and in studies on as yet inadequately known factors affecting the ST of biological fluids.

[Effect of preventive fluoride treatment in childhood on dental conditions in adults]

The purpose of the study was to compare the dental health status of three groups of adults aged 18-47. In the first group belonged the population, that consumed in their childhood salt containing 250-350 mg fluoride per kg. The second group consisted of those who drank water with an optimal fluoride concentration (1 mg/kg). The individuals without fluoride prevention formed the third group. The results showed, that the consumption of fluoridated drinking water or salt in childhood has a life-long beneficial effect on the dental health of the adult population.

[Epidemiology of psychosomatic symptoms and its effect on the self-evaluation of general health in university students]

This paper reports on the prevalence of some common psychosomatic symptoms as a part of a larger study of health state and health risk behaviour of a medical student population in Szeged. The prevalence of psychosomatic symptoms was considered as a health-related variable. In the study 691 students participated, the investigation was carried out by survey method, using self-completed questionnaire. In both sexes, backache and sleeping disorders were the most frequent symptoms. Furthermore, men reported stomach ache and palpitation in higher occurrence, while in women stress-related headache and chronic fatigue were the most common among the self-reported symptoms. The index of symptoms were significantly higher among women than men (p < 0.0001). Prevalence of psychosomatic symptoms proved an important variable affecting self-perceived health. The literature reviewed by the authors suggests that health state of medical students are significantly better than students of other colleges. Unfortunately, the morbidity and mortality data of physicians show inverse results among other intellectual populations. The authors suggestion is applying standardised method and cooperation among epidemiological teams working on this question.