The natural history of pancreatic pseudocysts documented by computed tomography

The clinical courses of 75 patients with pancreatic pseudocysts documented by computed tomography (CT) were retrospectively reviewed. History, physical examination, laboratory findings and CT scan data were analyzed. The treatment regimen followed during the period spanning the review dictated nonoperative management for those patients with asymptomatic pseudocysts who were able to tolerate oral intake. Operative management was used only for patients with persistent abdominal pain or enlargement or complications of pseudocyst. Approximately one-half of the patients (n = 36, 48 per cent) were managed nonoperatively, and the remainder (n = 39, 52 per cent) were treated operatively. In the group managed nonoperatively, with a mean follow-up period of one year, 60 per cent had complete resolution of the pseudocyst documented roentgenographically, and 40 per cent had pseudocysts that remained stable or decreased in size. Only one pseudocyst-related complication developed in the nonoperative group. No pseudocyst-related mortality occurred in either group. The size of the pseudocyst was a significant predictor of the need for operative drainage. Pseudocysts greater than 6 centimeters in diameter required surgical treatment in 67 per cent, significantly more frequently (p less than 0.05) than the 40 per cent of patients who required operative treatment for pseudocysts less than 6 centimeters in diameter. We conclude that a large proportion of patients with pancreatic pseudocysts, without specific indications for operative treatment, can be safely managed nonoperatively, with careful clinical and roentgenographic follow-up study.     

Influence of meal composition on canine jejunal water and electrolyte absorption.

The absorption of water and electrolytes from the proximal jejunal lumen increases immediately after a meal. This meal-induced jejunal absorption occurs in jejunal segments out of normal gastrointestinal continuity. This study was designed to characterize the jejunal absorptive response to a series of isovolumetric gavage-delivered stimuli. Twenty-five-centimeter canine proximal jejunal Thiry-Vella fistulas were constructed, and jejunal absorption studies (n = 66) were performed by luminal perfusion of the jejunal segments with an isotonic buffer containing 14C-labeled polyethylene glycol. Each study consisted of a 1-hour basal period, followed by a 3-hour experimental period. Nine groups were studied, each receiving one of the following isovolumetric stimuli delivered via the gavage route: water, 0.9% saline, mixed meal, protein, lipid, carbohydrate, and mannitol (150 mmol/L, 300 mmol/L, and 600 mmol/L). The water and 0.9% saline gavage groups showed no significant changes in integrated postprandial water and electrolyte absorption above basal. The isocaloric mixed meal, protein, lipid, carbohydrate, and mannitol groups all had significantly increased integrated postprandial jejunal water and electrolyte absorption above basal (P less than 0.05). These results indicate that a proabsorptive signal for meal-induced jejunal absorption originates from or distal to the stomach. Meal-induced jejunal absorption occurs in response to nutrients of diverse composition and is also responsive to nonnutritive solutes such as mannitol. These findings support a new role for gastric or intestinal chemo- or osmo-receptors in stimulating the neurohumoral mechanisms that mediate meal-induced jejunal absorption.     

Signaling cascades as drug targets in model and pathogenic fungi

Microbes evolved to produce natural products that inhibit growth of competing soil microorganisms. In many cases these compounds act on fungi, which are eukaryotes with conserved gene sequences closely related to metazoans, including humans. The calcineurin inhibitors cyclosporin A and FK-506, the Tor inhibitor rapamycin, and the Hsp90 inhibitor geldanamycin, all act via targets conserved from yeast to humans. This allows the use of genetically tractable fungi as models to elucidate how these drugs and their targets function in yeast and human cells. These inhibitors also enable studies aimed at harnessing their intrinsic antimicrobial activities to develop novel antifungal therapies.Extensive studies have revealed a globally conserved role for the Tor protein in regulating growth and proliferation in response to nutrients, and targeting its essential functions results in robust antifungal action. Similarly, a conserved and essential role for calcineurin in fungal virulence has been established and could be targeted by inhibitors for therapeutic uses in a variety of clinical settings. Finally, the discovery that inhibitors of calcineurin or Hsp90 result in dramatic synergism with either azoles or glucan synthase inhibitors (candins) provides another therapeutic vantage point. Taken together, these fungal targets and their inhibitors provide a robust platform from which to develop novel antimicrobial therapies.     

Lead exposure in day care centres in the Caracas Valley--Venezuela

Lead has been used as an additive to improve the anti-knock quality of gasoline. However, the combustion of lead gasoline produces particles rich in this element. These kinds of particles impact the alveoli and move into the bloodstream, causing serious health problems. The objective of this study is to determine the granulometric distribution, mineralogy, and lead levels in samples such as settled dust and soil, as well as lead concentration in drinking water, in different day care centers located in the metropolitan area of Caracas, which have been previously studied and classified, according to the Total Suspended Particles (TSP) levels by the national environmental office, as high (80 microg m(-3)) and low (50 microg m(-3)) polluted areas. The chemical analysis was performed by atomic absorption spectroscopy and atomic emission spectroscopy-inductively coupled plasma. The mineralogy was determined using X-ray differentiation. Results show that all samples are enriched by small particles (<44 microm). Lead concentrations in day care centres located in areas of high vehicular density were higher than those in areas of low vehicular traffic. Lead concentration for drinking water samples was below the standard value reported by the Environmental Protection Agency (EPA) (15 microg Pb/l).     

Adjuvant radiotherapy and concomitant 5-fluorouracil by protracted venous infusion for resected pancreatic cancer

Purpose: To assess the toxicity and clinical benefit from adjuvant chemoradiotherapy consisting of protracted venous infusion 5-fluorouracil (5-FU) and concomitant radiotherapy in patients with resected pancreatic cancer.

Methods and Materials: Between 1994 and 1999, 52 patients who underwent pancreaticoduodenectomy received adjuvant chemoradiotherapy. The tumor bed and regional nodes received a dose of 45 Gy in fractions of 1.8 Gy followed by boost to the tumor bed if the surgical margins were involved (total dose, 54 Gy). The patients also received concomitant 5-FU by protracted venous infusion (200–250 mg/m²/day, 7 days/week) during the entire radiotherapy course.

Results: Fifty-two patients (30 men, 22 women) were enrolled and treated on this protocol. The median age was 63 years (range, 38–78 years), and the median Karnofsky Performance Status was 80 (range, 70–100). Thirty-five percent had involved surgical margins and 59% had involved lymph nodes. All patients completed therapy, and there were no Grade IV/V toxicities observed. With median follow-up of 24 months (range, 3–52 months) for surviving patients, the median survival is 32 months, and 2-year and 3-year survivals are 62%, and 39%, respectively.

Conclusion: Radiotherapy with concomitant 5-FU by protracted venous infusion as adjuvant treatment for resected pancreatic cancer is well tolerated. This approach allows for greater dose intensity with reduced toxicity. The median survival of this cohort of patients compares favorably with our earlier experience and other published series.     

HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity

Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study’s objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen’s Behavioral Model of Health Services Use was used as the study’s theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants’ level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study’s results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.