The Gay Bowel Syndrome

Our experience in the management of 260 male homosexuals with coloreetal problems is described. The increased incidence of amebiasis, shigellosis and hepatitis, specific and nonspecific protocolitides, venereal disease and anal warts, is emphasized. It is important to recognize homosexual patients and the conditions to which they are predisposed.     

Unilateral groin surgery in children: will the addition of an ultrasound‐guided ilioinguinal nerve block enhance the duration of analgesia of a single‐shot caudal block?

Background: Inguinal hernia repair, hydrocelectomy, and orchidopexy are commonly performed surgical procedures in children. Postoperative pain control is usually provided with a single‐shot caudal block. Blockade of the ilioinguinal nerve may lead to additional analgesia. The aim of this double‐blind, randomized controlled trial was to evaluate the efficacy of an adjuvant blockade of the ilioinguinal nerve using ultrasound (US) guidance at the end of the procedure with local anesthetic vs normal saline and to explore the potential for prolongation of analgesia with decreased need for postoperative pain medication. Methods: Fifty children ages 1–6 years scheduled for unilateral inguinal hernia repair, hydrocelectomy, orchidopexy, or orchiectomy were prospectively randomized into one of two groups: Group S that received an US‐guided ilioinguinal nerve block with 0.1 ml·kg^?1 of preservative‐free normal saline and Group B that received an US‐guided nerve block with 0.1 ml·kg^?1 of 0.25% bupivacaine with 1 : 200 000 epinephrine at the conclusion of the surgery. After induction of anesthesia but prior to surgical incision, all patients received caudal anesthesia with 0.7 ml·kg^?1 of 0.125% bupivacaine with 1 : 200 000 epinephrine. Patients were observed by a blinded observer for (i) pain scores using the Children and Infants Postoperative Pain Scale, (ii) need for rescue medication in the PACU, (iii) need for oral pain medications given by the parents at home. Results: Forty‐eight patients, consisting of 46 males and two females, with a mean age of 3.98 (sd ± 1.88) were enrolled in the study. Two patients were excluded from the study because of study protocol violation and/or alteration in surgical procedure. The average pain scores reported for the entire duration spent in the recovery room for the caudal and caudal/ilioinguinal block groups were 1.92 (sd ± 1.59) and 1.18 (sd ± 1.31), respectively. The average pain score difference was 0.72 (sd ± 0.58) and was statistically significant (P < 0.05). In addition, when examined by procedure type, it was found that the difference in the average pain scores between the caudal and caudal/ilioinguinal block groups was statistically significant for the inguinal hernia repair patients (P < 0.05) but not for the other groin surgery patients (P = 0.13). For all groin surgery patients, six of the 23 patients in the caudal group and eight of the 25 patients in the caudal/ilioinguinal block group required pain rescue medications throughout their entire hospital stay or at home (P = 0.76). Overall, the caudal group received an average of 0.54 (sd ± 1.14) pain rescue medication doses, while the caudal/ilioinguinal block group received an average of 0.77 (sd ± 1.70) pain rescue medication doses; this was, however, not statistically significant (P = 0.58). Conclusions: The addition of an US‐guided ilioinguinal nerve block to a single‐shot caudal block decreases the severity of pain experienced by pediatric groin surgery patients. The decrease in pain scores were particularly pronounced in inguinal hernia repair patients.     

An Epstein-Barr virus-associated lymphoproliferative lesion of the skin presenting as recurrent necrotic papulovesicles of the face

Summary We describe lour patients with lymphoproliferative lesions confined to the skin for several years. They presented with recurrent necrotic papulovesicles of the face. Latent Epstein-Barr virus (EBV) infection was detected in the lymphoid cells from the skin lesions by in situ hybridization. The disease in three patients progressed to T-cell lymphoma. We believe that these patients represent a subset of peripheral T-eely lymphoma with a tendency to localize in the skin.     

Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults

Background and Aim: Differences in the prevalence of non‐alcoholic fatty liver disease (NAFLD) between Eastern and Western populations are primarily attributable to differences in definitions and biased population selection. Thus, the aim of the present study was to accurately determine the actual prevalence of NAFLD by sonography and to characterize the risk factors for NAFLD. Methods: The present cross‐sectional study was performed with data obtained from 6648 subjects, all of whom were older than 20 years of age (3530 men and 3118 women). The term ‘non‐drinker’ was applied to men who consumed less than 30 g alcohol/day and to women who consumed less than 20 g alcohol/day. Non‐alcoholic fatty liver disease was defined as a sonographically detected fatty liver in the absence of viral hepatitis in a non‐drinker. Results: Of the 1613 subjects who were diagnosed with sonographic fatty liver, 1240 were non‐drinkers and had no viral hepatitis. Overall, the unadjusted and age‐adjusted prevalences of NAFLD were 18.7% (23% in men, 13.7% in women) and 16.1% (21.6% in men, 11.2% in women), respectively. Multivariate analysis revealed that several risk factors were profoundly associated with the prevalence of NAFLD, including obesity, insulin resistance, hyperlipidemia and hyperglycemia in both genders, as well as age, menopausal status and estrogen medication in women only. Conclusions: These results demonstrate that the prevalence of NAFLD in Korean adults, according to sonographic surveys, is comparable to that seen in more developed countries. From the perspective of increasing obesity, the high prevalence rates noted in the study may herald an increased burden of chronic liver disease in the Korean population.     

The new air-QTM intubating laryngeal airway for tracheal intubation in children with anticipated difficult airway: a case series

The air-Q intubating laryngeal airway (ILA) is a new supraglottic airway device which may overcome some limitations inherent to the classic laryngeal mask airway for tracheal intubation. We present a case series of patients with anticipated difficult airway in whom the air-Q ILA was successfully used as a conduit for fiberoptic intubation.     

Effect of tea on the formation of DNA adducts by azoxymethane

1. The effect of black tea on the conversion of azoxymethane (AOM) to DNA reactive metabolites was studied in four groups of the male F344 rat. Each received 1·25% solutions of tea for 2 or 6 weeks, and simultaneous controls drank water. All rats were injected s.c. twice with 15?mg/kg AOM after the first or fifth week respectively, on tea or water, and again 1 week later. Groups were killed 6 h after the last dose, or 18 h later. The liver and colon were rapidly removed and rinsed with buffer solution, pH 7·0. DNA was isolated from these issues,and DNA methylation was examined by the typical fluorescence of O⁶-methylated and N-7-methylated products, separated by HPLC. 2. Two or 6 weeks of tea intake failed to affect significantly the formation of alkylated DNA from liver and colon compared with controls drinking water. Only in the group of rats on tea for 6 weeks, and killed 6 h after the last dose of AOM, was the O⁶-methyldG and 7-methyldG decreased in DNA obtained from colon. 3. Thus, solutions of tea affected the formation of alkylated products in DNA of the colon of rats given AOM only at one time point, but did not do so under most other experimental conditions. The underlying mechanism is based on our previous finding that tea does not affect cytochrome P4502E1 that our group established to be the enzyme metabolizing AOM.     

Erythrocyte thiopurine methyltransferase activity in a Korean population

Thiopurine methyltransferase (TPMT) is the enzyme responsible for the S-methylation of thiopurine drugs. The enzyme, present in human red blood cells (RBC), is known to exhibit genetic polymorphism and interethnic differences in its activity have been demonstrated. We have studied the role of TPMT polymorphism in Koreans and compared enzyme activity between this and other ethnic groups. In a population of 360 unrelated healthy Korean subjects TPMT activity showed a large interindividual variation ranging from 3.2 to 22.9 nmol ml^-1 packed RBC h^-1 with a median value of 12.0 and mode of 11.0 nmol ml^-1 packed RBC h^-1. The enzyme activity was higher in male subjects than that in female (median values; 12.2 vs 11.2, 95% confidence interval of the difference; –2.1, 4.0 nmol ml^-1 packed RBC h^-1). All subjects had detectable TPMT activity, but contrary to previous reports in other ethnic groups, this was distributed unimodally. The median RBC TPMT activity was very similar to values found in Caucasian populations, higher than in Floridian blacks and lower than that of a Norwegian Saami population.     

Prothrombotic effects of diclofenac on arteriolar platelet activation and thrombosis in vivo

Summary. Background: Diclofenac, like selective cyclooxygenase‐2 inhibitors, which alter vascular levels of platelet active prostaglandins, has been reported to increase rates of acute myocardial infarction. Objective: The study was performed to investigate, in an animal model of arterial thrombosis in vivo, whether diclofenac differentially influences platelet activation and thrombosis in vessels under non‐stimulated conditions or during acute systemic inflammation, such as induced by tumor necrosis factor‐α (TNF‐α). Methods: Platelet–vessel wall interaction (PVWI), firm platelet adhesion and arterial thrombosis following vessel injury were analyzed by intravital microscopy in arterioles of hamsters in the dorsal skinfold chamber model. Prostacyclin [prostaglandin I₂ (PGI₂)] and thromboxane A₂ (TxA₂) metabolites were measured. In vitro, endothelial adhesion molecule expression in cultured human microvascular endothelial cells was analyzed. Results: Under non‐stimulated conditions, diclofenac (1 mg kg^?1) enhanced PVWI, which was not mediated by increased adhesion molecule expression, but by decreased systemic PGI₂ levels. Following ferric chloride‐induced endothelial injury, diclofenac accelerated thrombotic vessel occlusion time, an effect that was reversed by the stable PGI₂ analog iloprost. TNF‐α, through induction of endothelial adhesion molecule expression, also enhanced PVWI, firm adhesion, and arterial thrombosis, but simultaneous treatment with TNF‐α and diclofenac did not have an additive effect. Conclusions: By decreasing levels of PGI₂ without, at the same time, altering prothrombotic TxA₂ levels, diclofenac can exert prothrombotic effects. However, this is not the case when an inflammatory situation is created by TNF‐α treatment. These data may explain the enhanced risk of acute myocardial infarction observed in patients taking diclofenac.