Allergist RSS : Gourt

Pediatric AI, University of New Mexico, #1 Place for Business and Careers by Forbes, #5278 :: New Mexico :: Timeline Recruiting

Nestled against the Sandia Mountains, Albuquerque is a dream destination. Impossible to avoid our incredible scenery, we offer four beautiful seasons with that Southwestern backdrop we are famous

Allergy opportunity in North Carolina close to the Atlantic Ocean :: North Carolina :: CompHealth Inc

Job 9110905 Assume a waiting Allergy patient base in North Carolina Stable multi specialty group seeks a Board Certified / Eligible Allergy Doctor Assume a waiting patient base. Be busy from day one!

Excellent Allergy/Immunology Opportunity in Washington State :: Washington :: CompHealth Inc

Job 514776 Join a highly respected organization located in this beautiful part of Washington Receive excellent competitive base income Earning potential is huge and exciting Wonderful, desirable and

Allergist Job Opportunity for Locum Tenens in Tennessee! :: North Carolina :: CompHealth Inc

Job 1166857-0001 We have an immediate opening for a Board Certified Allergist. This could easily work in to a permanent job opportunity. Please contact our Physician Recruiter for full details. Thank

Excellent opportunity for Allergist in Pennsylvania :: Pennsylvania :: Weatherby Locums

Job 9612060-0001 Group practice seeks locums Allergy physician to provide on-going coverage beginning as soon as possible. Ideal candidate will be eligible for licensure. Great, family oriented opportunity

Oklahoma College town needs an Allergy and Immunol :: Oklahoma :: Enterprise Medical Service

Multi-specialty group in Muskogee, Oklahoma looking to add a BC/BE Allergist and Immunologist-Job #16506 due to growth and retirement. This clinic offers the highest quality medical care to the citizens

Allergy/Immunology opportunity in New Mexico :: New Mexico :: CompHealth Inc

Job 9110391 Employed Allergy/Immunology opportunity in New Mexico Be the first in Allergy/Immunology the group Large referral base Nice size city and location Visa's welcomed Well established group

Wonderful Allergy/Immunology job in Missouri :: Missouri :: CompHealth Inc

Job 9110126 A terrific Allergy-Immunology opportunity with fast track to partnership Very lavished base salary or income guarantee Truly exciting earning potential with huge referral base Reside in

Allergy Opportunity in North Dakota :: North Dakota :: CompHealth Inc

Job 918660 Large Midwestern MSG is seeking an Allergy Doctor to join their practice High volume practice Be busy from day one Large service area Enjoy crystal blue lakes Low cost of living Family friendly

Group seeks Allergist :: New York :: CompHealth Inc

Job 9111009 Join dept. of 1 who retires in 2010 B/C or B/E Allergy Multispecialty group provides referrals Join 1 established who will retire Support of Allergy trained RN Great schools, safe friendly

Call for information :: South Carolina :: Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

South Central :: Kansas :: Rural Health Education & Services

KRC.1009.0813.04 BC/BE certified Allergy and Immunologist needed for a 65 physician multispecialty group. This well-established group is located conveniently near the admitting 200-bed hospital. This

Not Disclosed :: North Carolina :: Locum Medical Group

A facility along the North Carolina coast is looking for permanent physician in the specialty of Allergy and Immunology. This position can start ASAP. Ideal candidates will complete a residency in IM,

Derry :: New Hampshire :: New England Physician Recruitment Center

Southern NH -40 minutes to Boston Established Medical Facility in Southern New Hampshire seeking Allergy Specialist. Providing exceptional Primary Care services for over 10 years, this group offers multiple

Erratum

Int Arch Allergy Immunol 2009;150:342 (DOI:10.1159/000255392)

The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick Tests

Int Arch Allergy Immunol 2010;151:343-345 (DOI:10.1159/000250443)

Prevalence of Food Allergy among Children in Al-Ain City, United Arab Emirates

Int Arch Allergy Immunol 2010;151:336-342 (DOI:10.1159/000250442)

Oral Challenge with Pasteurized Egg White from Gallus domesticus

Int Arch Allergy Immunol 2010;151:331-335 (DOI:10.1159/000250441)

Antiapoptotic Seminal Vesicle Protein IV Induces Histamine Release from Human FceRI+ Cells

Int Arch Allergy Immunol 2010;151:318-330 (DOI:10.1159/000250440)

Galectin-9 in Allergic Airway Inflammation and Hyper-Responsiveness in Mice

Int Arch Allergy Immunol 2010;151:308-317 (DOI:10.1159/000250439)

Toll-Like Receptor-9 Agonist Inhibits Airway Inflammation, Remodeling and Hyperreactivity in Mice Exposed to Chronic Environmental Tobacco Smoke and Allergen

Int Arch Allergy Immunol 2010;151:285-296 (DOI:10.1159/000250437)

Reduced FceRI-Mediated Release of Asthma-Promoting Cytokines and Chemokines from Human Basophils during Omalizumab Therapy

Int Arch Allergy Immunol 2010;151:275-284 (DOI:10.1159/000250436)

The Major Cat Allergen, Fel d 1, in Diagnosis and Therapy

Int Arch Allergy Immunol 2010;151:265-274 (DOI:10.1159/000250435)

Th17 Immunity in Patients with Allergic Asthma

Int Arch Allergy Immunol 2010;151:297-307 (DOI:10.1159/000250438)

Measurement of Nasal Airway Resistance and Response in Mice

Int Arch Allergy Immunol 2010;151:262-264 (DOI:10.1159/000242364)

Prevalence of Allergic Rhinitis and Sensitization to Common Aeroallergens in a Japanese Population

Int Arch Allergy Immunol 2010;151:255-261 (DOI:10.1159/000242363)

Effects of Inhaled Corticosteroids on Metalloproteinase-8 and Tissue Inhibitor of Metalloproteinase-1 in the Airways of Asthmatic Children

Int Arch Allergy Immunol 2010;151:247-254 (DOI:10.1159/000242362)

The C-509T Promoter Polymorphism of the Transforming Growth Factor Beta-1 Gene Is Associated with Levels of Total and Specific IgE in a Colombian Population

Int Arch Allergy Immunol 2010;151:237-246 (DOI:10.1159/000242361)

Effects of Industrial Processing on the Immunogenicity of Commonly Ingested Fish Species

Int Arch Allergy Immunol 2010;151:223-236 (DOI:10.1159/000242360)

Mast Cells Induce Migration of Dendritic Cells in a Murine Model of Acute Allergic Airway Disease

Int Arch Allergy Immunol 2010;151:214-222 (DOI:10.1159/000242359)

Allergenicity of Recombinant Troponin C from Tyrophagus putrescentiae

Int Arch Allergy Immunol 2010;151:207-213 (DOI:10.1159/000242358)

Allergenic Differences among Pollens of Three Salsola Species

Int Arch Allergy Immunol 2010;151:199-206 (DOI:10.1159/000242357)

Structural and IgE Binding Analyses of Recombinant Der p 2 Expressed from the Hosts Escherichia coli and Pichia pastoris

Int Arch Allergy Immunol 2010;151:190-198 (DOI:10.1159/000242356)

The Role of Costimulatory Molecules in Allergic Disease and Asthma

Int Arch Allergy Immunol 2010;151:179-189 (DOI:10.1159/000242355)

On the Cover

Smoking cessation toolbox for allergists

The atopic march: what's the evidence?

Sleep actigraphy evidence of improved sleep after treatment of allergic rhinitis

Decrease in airway mucous gene expression caused by treatment with anti-tumor necrosis factor in a murine model of allergic asthma

Differences in physicians self-reported knowledge of, attitudes toward, and responses to the black box warning on long-acting -agonists

Factors associated with severity and exacerbation of asthma: a baseline analysis of the COhort for Reality and Evolution of adult Asthma in Korea (COREA)

Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma

Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma

High sensitization rate to food allergens in breastfed infants with atopic dermatitis

Influence of dose and frequency of antigen injection on IgE development in young children: a comparison of fire ant stings and tetanus immunizations

Differences in total and allergen specific IgE during pregnancy compared with 1 month and 1 year post partum

Bromotyrosines in sputum proteins and treatment effects of terbutaline and budesonide in asthma

UNUSUAL COMPLICATION WITH USE OF AN INSTANT COLD PACK

USE OF EPINEPHRINE AUTOINJECTORS FOR TREATMENT OF ANAPHYLAXIS: WHICH COMMERCIALLY AVAILABLE AUTOINJECTOR DO PATIENTS PREFER?

REGULATION OF MONOCYTE CHEMOATTRACTANT PROTEIN 1 BY CYSTEINYL LEUKOTRIENE D4 IN HUMAN LUNG EPITHELIAL A549 CELLS

SEVERE ANAPHYLACTOID SHOCK SECONDARY TO GADOLINIUM CONTRAST MEDIA

News and notices

News and notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0731-9 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Upper gastrointestinal investigations before gastric banding

Abstract Background Long-term complications after laparoscopic gastric banding (LAGB) are frequent, leading to reoperations for a substantial number of patients. It is not known whether esophageal motility or the lower esophageal sphincter (LES) play a role in the development of complications. The results of preoperative upper gastrointestinal (GI) testing were compared with outcome after LAGB. Methods Before LAGB, 68 bariatric patients had esophageal manometry, endoscopy, and pH monitoring. For 61 of these patients (90% follow-up rate), the differences in weight loss, complications, and reoperation rate were retrospectively compared. Results Of these patients, 8.2% had a nonspecific motility disorder of the esophagus, 44.3% had an incompetent sphincter shown by manometry, and 17.5% had acid reflux shown by pH monitoring. Endoscopic evaluation showed esophagitis in 10.3% and hiatal hernia in 33.8% of the patients. Abnormal pH monitoring and endoscopic findings were not predictive for the long-term outcome or complications. The presence of an incompetent LES led to reoperation for a greater number of patients (44.4 vs. 14.7%; p = 0.01), especially if the band was placed using the pars flaccida technique. Conclusions Endoscopy and pH monitoring do not predict outcome for gastric banding and therefore have no relevance in the selection of patients for gastric banding. Patients with an incompetent LES shown by manometry had a higher reoperation rate. If this finding can be confirmed, patients with LES incompetence may need another intervention. Content Type Journal ArticleDOI 10.1007/s00464-009-0720-zAuthors Marco Bueter, University of Würzburg Department of Surgery Würzburg GermanyAndreas Thalheimer, University of Würzburg Department of Surgery Würzburg GermanyCarel W. le Roux, Hammersmith Hospital, Imperial College London Department of Metabolic Medicine Du Cane Road London W12 0NN UKAlexander Wierlemann, University of Würzburg Department of Surgery Würzburg GermanyFlorian Seyfried, University of Würzburg Department of Surgery Würzburg GermanyMartin Fein, University of Würzburg Department of Surgery Würzburg Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Ergonomics of disposable handles for minimally invasive surgery

Abstract Background The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. Methods In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. Results Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (~20%) and during precise maneuvering and targeting (~20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. Conclusions None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more efficiently using the prototype handle without any remarkable pressure areas, cramps, or pain. Content Type Journal ArticleDOI 10.1007/s00464-009-0714-xAuthors D. Büchel, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyR. Mårvik, St. Olavs Hospital, Trondheim, Norwegian University of Science and Technology (NTNU) National Center for Advanced Laparoscopic Surgery Trondheim NorwayB. Hallabrin, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyU. Matern, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes

Abstract Background This study aimed to compare the efficacy of laparoscopic sleeve gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment and to elucidate the role of weight loss in the T2DM resolution after SG. Methods For this study, 60 morbidly obese T2DM patients (44 females and 16 males) who underwent AGB (24 patients), GBP (16 patients), or SG (20 patients) between 1996 and 2008 were retrospectively analyzed. Age, sex, body mass index (BMI), estimated weight loss (EWL), fasting glycemia, HbA1c, euglycemic hyperinsulinemic clamp, discontinuation of diabetes treatment, and time until interruption of therapy were evaluated. Results In the study, 54 patients received oral hypoglycemic agents for at least 12 months before surgery, and 6 patients received insulin. The mean follow-up period was 36 months. The resolution rate was 60.8% for the AGB patients, 81.2% for the GBP patients, and 80.9% for the SG patients. The postoperative time until interruption of therapy was 12.6 months for the AGB patients, 3.2 months for the GBP patients, and 3.3 months for the SG patients. The hyperinsulinemic euglycemic clamp test was performed 12 months after surgery for the cured patients. Insulin resistance was restored to normal values in all the patients. The greatest improvement from preoperative values occurred in the SG group. For the not-cured GBP and SG patients, an improvement of 120 mg/dl in fasting plasma glucose was observed 3 months after the surgery, suggesting an enhancement in insulin sensitivity, which determines better medical control. The resolution rate remained constant at the 36-month follow-up evaluation in both the GBP and SG groups. Conclusions All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss. Content Type Journal ArticleDOI 10.1007/s00464-009-0715-9Authors F. Abbatini, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyM. Rizzello, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Casella, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Alessandri, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyD. Capoccia, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyF. Leonetti, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyN. Basso, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians

Abstract Background Endoscopic procedures using electrohydraulic lithotripsy (EHL) or intraductal laser lithotripsy (ILL) are the methods of choice for managing difficult common bile duct (CBD) stones. This retrospective study examined 10 years of Swedish experience using a mother-baby endoscopic system to assist in the fragmentation of CBD stones by EHL and ILL. Methods Between 1995 and 2006, 44 patients with a median age of 80 years underwent EHL or ILL at two Swedish centers after conventional endoscopic fragmentation of CBD stones had failed. Long-term follow-up assessment was conducted for 9 to 126 months (median, 53 months). Results Final stone clearance after EHL or ILL treatment with or without additional conventional endoscopic retrograde cholangiopancreatography (ERCP) was achieved for 34 (77%) of 44 patients. The results for 10 patients (23%) were defined as failures. Complete or partial stone fragmentation and definitive duct clearance were achieved in one session for 23 patients (52%). A second EHL or ILL attempt made in five cases of primary failure led to definitive stone clearance in three cases. Two patients experienced perioperative complications (stone basket impaction). Mild post-ERCP pancreatitis occurred for one patient and cholangitis for two patients. During long-term follow-up evaluation, recurrent CBD stones were found in one patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0716-8Authors Fredrik Swahn, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenGunnar Edlund, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenLars Enochsson, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenConny Svensson, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenBo Lindberg, Intervention and Technology (CLINTEC), Karolinska Institutet Department of Clinical Science Stockholm SwedenUrban Arnelo, Karolinska University Hospital Huddinge Department of Surgery Stockholm Sweden Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy

Abstract Objective To investigate the feasibility of laparoscopic total mesorectal excision (TME) in mid and lower rectal cancers following neoadjuvant chemoradiation (nCRT). Background The laparoscopic approach for colon cancer has been widely accepted. A few studies have shown that there are advantages of laparoscopic over open TME surgery for rectal cancer. However, the role of laparoscopy has not been clearly defined specifically in cases following nCRT. Methods All patients with rectal cancer who underwent nCRT were identified; no operations for rectal carcinoma were performed laparoscopically between 1997 and 2005. The laparoscopic cases were matched to open cases based on gender, procedure, age, and body mass index (BMI). The medical records were reviewed and short-term outcome was compared between these two groups. Statistical analysis was performed using SPSS© 15 software. Results Between 2002 and 2008, 64 patients were identified, including 32 patients who underwent laparoscopic surgery and 32 who had a laparotomy. There was no difference between the two groups based on gender, procedure, age, BMI or American Society of Anesthesiologists (ASA) classification. The procedures performed within each group included 8 abdominoperineal resections and 24 anterior resections, which included 20 colonic J-pouch-anal anastomoses and 4 straight coloanal anastomoses. In the laparoscopic group, 12 patients underwent totally laparoscopic operations, 12 were either laparoscopic-assisted or hand-assisted procedures, and 8 were converted to laparotomy. The reasons for conversion included bleeding, splenic injury, and difficult anatomy. There were no differences in comorbidities, tumor location, tumor size, tumor stage or radiation dose between the two groups. Operative time was longer in the laparoscopic group (267 ± 76 versus 205 ± 49 min, p < 0.001). Operative blood loss, complication rate, and mortality rate were all similar between the two groups. However, the laparoscopic group benefited from shorter length of stay (6.1 ± 2.4 versus 7.6 ± 2.3 days, p = 0.012), earlier first bowel movement (1.9 ± 1 versus 3.3 ± 2.4 days, p = 0.006), and shorter time to regular diet (3.9 ± 2.1 versus 5.8 ± 2.5 days, p = 0.003). There was no difference in lymph node harvest (both positive node harvest and total lymph node harvest), distal margin or radial margin. Conclusions In our experience, laparoscopic TME for mid and lower rectal cancer is feasible and safe. Patients benefit from the short-term advantages of laparoscopy, including shorter length of hospital stay, time to tolerating a regular diet, and time to first bowel movement or stoma function. Although there were no short-term differences in oncologic parameters, the long-term oncologic outcome requires further investigation. Content Type Journal ArticleDOI 10.1007/s00464-009-0702-1Authors P. Denoya, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAH. Wang, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAD. Sands, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAJ. Nogueras, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAE. Weiss, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USASteven D. Wexner, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Mixed reality for robotic treatment of a splenic artery aneurysm

Abstract Background Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy. Methods A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient’s anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling. Results The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery. Conclusions The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future. Content Type Journal ArticleCategory VideoDOI 10.1007/s00464-009-0703-0Authors Andrea Pietrabissa, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyLuca Morelli, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyMauro Ferrari, Università di Pisa Divisione di Chirurgia Vascolare, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Pisa ItalyAndrea Peri, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyVincenzo Ferrari, Università di Pisa Center for Computer Assisted Surgery ENDOCAS Pisa ItalyAndrea Moglia, Università di Pisa Center for Computer Assisted Surgery ENDOCAS Pisa ItalyLuigi Pugliese, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyFabio Guarracino, Azienda Ospedaliero-Universitaria Pisana Divisione di Anestesiologia Pisana ItalyFranco Mosca, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Favorable outcomes with laparoscopic surgery for rectal cancer

Favorable outcomes with laparoscopic surgery for rectal cancer Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0713-yAuthors T. Liakakos, University of Athens 3rd Surgical Department Athens GreeceK. Kopanakis, University of Athens 3rd Surgical Department Athens GreeceD. Schizas, University of Athens 3rd Surgical Department Athens Greece Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

The esophageal hiatus: what is the normal size?

Abstract Background A hiatal hernia is defined as the protrusion of intra-abdominal organs through a dilated esophageal hiatus. The esophageal hiatus and its function have been described extensively, but an exact anatomical determination of its normal size is lacking. It seems important to define the normal size, as crural closure is an important part of surgical treatment of gastroesophageal reflux disease (GERD) and hiatal or paraesophageal hernias. The aim of this study was to determine normal values for the size of the esophageal hiatus. Methods In a prospective study 50 consecutive cadaver autopsies were performed between February and May 2008. The subjects had died from several diseases not related to GERD. Size of the esophageal hiatus was measured after opening the abdominal cavity before extirpation of any organs. Distance of the cardia and gastroesophageal junction and position of the angle of His were further measured. A formula was used to calculate the hiatal surface area (HSA). Results were analyzed regarding subject height, weight, body mass index (BMI), and chest circumference. Results In all 50 cadavers (24 male/26 female) the autopsy was performed and all measurements were obtained. Mean age was 74 years (40–90 years), mean height was 1.68 m (1.39–1.83 m), mean weight was 71 kg (40–120 kg), and mean body mass index (BMI) was 25 kg/m2 (14–40 kg/m2). Mean chest circumference was 101 cm (75–178 range). Mean HSA was 5.84 cm2 (3.62–9.56 cm2). In all cadavers the gastroesophageal junction was intraabdominal, the mean distance to the angle of His was 3.6 cm (2.7–4.6 cm), the mean length of the right and left crura was similar at 3.6 cm (2.7–4.6 cm), and the opening segment had a mean length of 2.4 cm (1.7–4.0 cm). Conclusion The mean HSA was determined in these normal subjects to be 5.84 cm2. It was directly proportional to chest circumference and independent of height, weight, BMI, and gender. Content Type Journal ArticleDOI 10.1007/s00464-009-0711-0Authors A. Shamiyeh, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz AustriaK. Szabo, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz AustriaF. A. Granderath, Neuwerk Hospital Department of General and Visceral Surgery Mönchengladbach GermanyG. Syré, Academic Teaching Hospital AKH Linz Department of Pathology Linz AustriaW. Wayand, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz AustriaJ. Zehetner, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz Austria Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Appropriateness of splenectomy for advanced cancer located in the upper third of the stomach

Appropriateness of splenectomy for advanced cancer located in the upper third of the stomach Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0710-1Authors Shinichi Sakuramoto, Kitasato University School of Medicine Department of Surgery 2-1-1 Asamizodai Sagamihara, Kanagawa 228-8520 JapanKeishi Yamashita, Kitasato University School of Medicine Department of Surgery 2-1-1 Asamizodai Sagamihara, Kanagawa 228-8520 JapanMasahiko Watanabe, Kitasato University School of Medicine Department of Surgery 2-1-1 Asamizodai Sagamihara, Kanagawa 228-8520 Japan Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

News and Notices

News and Notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0709-7 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

The frontal cortex is activated during learning of endoscopic procedures (Ohuchida et al., Surgical Endoscopy, January 2009)

The frontal cortex is activated during learning of endoscopic procedures (Ohuchida et al., Surgical Endoscopy, January 2009) Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0704-zAuthors Daniel R. Leff, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UKDavid R. C. James, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UKFelipe Orihuela-Espina, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UKGuang-Zhong Yang, Imperial College of Science, Technology, and Medicine Royal Society/Wolfson MIC Laboratory, 305/306 Huxley Building, Department of Computing, 180 Queens Gate London SW7 2BZ UKAra W. Darzi, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Esophageal dilation after gastric banding: to test or not to test before surgery?

Esophageal dilation after gastric banding: to test or not to test before surgery? Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0706-xAuthors François Mion, Hospices Civils de Lyon Digestive Physiology Pavillon H, Hôpital E. Herriot 69437 Lyon Cedex 03 FranceSabine Roman, Hospices Civils de Lyon Digestive Physiology Pavillon H, Hôpital E. Herriot 69437 Lyon Cedex 03 FranceValérie Lindecker, Haute Autorité de Santé St. Denis France Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Re: Surg Endosc (2009) 23:1142–1145, DOI:10.1007/s00464-009-0382-x (published online 5 March 2009). Erica P. Podolsky, Steven J. Rottman, Paul G. Curcillo II. Single Port Access (SPA™) gastrostomy tube in patients unable to receive percutaneous endoscopic gastrostomy placement

Re: Surg Endosc (2009) 23:1142–1145, DOI:10.1007/s00464-009-0382-x (published online 5 March 2009). Erica P. Podolsky, Steven J. Rottman, Paul G. Curcillo II. Single Port Access (SPA™) gastrostomy tube in patients unable to receive percutaneous endoscopic gastrostomy placement Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0705-yAuthors Philip Cheng Hin Ng, University Hospital Lewisham London SE13 6LH UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Treatment of primary spontaneous pneumothorax by videothoracoscopic talc pleurodesis under local anesthesia: a review of 133 procedures

Abstract Aim To review our experience of treatment of primary spontaneous pneumothorax by videothoracoscopic talc pleurodesis. Methods From 2000 to 2008, 124 consecutive patients with primary spontaneous pneumothorax were operated; 105 were men (84.7%) and 19 were women (15.3%) with a mean age of 26.6 years (range 17–46 years). Results No mortality was recorded. Staging according to Vanderschueren’s classification was as follows: stage I, 61 patients (45.9%); stage II, 39 patients (29.3%); stage III, 31 patients (23.3%); stage IV, two patients (1.5%). The overall rate of complications was 9% (12/133), corresponding to prolonged air leak in 9(6.7%) patients and hemothorax in 3(2.2%) patients. Four patients (3%) had recurrence requiring reoperation. There were no episodes of acute respiratory failure, pneumonia or subcutaneous emphysema following talc pleurodesis. Conclusions Thoracoscopic pleural talc pleurodesis as a treatment for recurrent pneumothorax is easy, safe, and rapid, and causes minimal morbidity and mortality. Content Type Journal ArticleDOI 10.1007/s00464-009-0707-9Authors R. Ramos-Izquierdo, Hospital Universitari de Bellvitge, School of Medicine, University of Barcelona Department of Thoracic Surgery and Unit of Human Anatomy and Embryology, Servei de Cirurgia Toràcica Feixa Llarga s/n 08907 L’Hospitalet de Llobregat SpainJ. Moya, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainI. Macia, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainF. Rivas, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainA. Ureña, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainG. Rosado, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainI. Escobar, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainJ. Saumench, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainA. Cabrera, Hospital Universitari de Bellvitge Department of Anesthesiology L’Hospitalet de Llobregat SpainM. A. Delgado, Hospital Universitari de Bellvitge Department of Anesthesiology L’Hospitalet de Llobregat SpainR. Villalonga, Hospital Universitari de Bellvitge Department of Anesthesiology L’Hospitalet de Llobregat Spain Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions

Abstract Background The endoscopic submucosal dissection (ESD) technique has been gaining popularity, with continued advances in this treatment approach. However, ESD still is associated with potential complications such as severe bleeding and perforation. Methods This study was performed to compare the clinical outcomes for macro- and microperforations with ESD procedures and to determine the short-term prognosis after ESD. A macroperforation was defined as a gross perforation that occurred during an ESD procedure, and a microperforation was defined by free air observed on simple radiography after the procedure. Immediate closure of macroperforations was performed using endoclips. From July 2003 through May 2008, 1,711 patients underwent ESD for gastric lesions such as dysplasia, early cancer, and subepithelial lesions. Results Among 39 perforation cases (2.3%), macroperforations occurred for 26 patients (67%) and microperforations for 13 patients (33%). All the patients except one who underwent emergency surgery because of severe bleeding and perforation during ESD were managed successfully by intravenous antibiotics and no oral intake. The clinical prognosis and endoscopic characteristics of the patients with macroperforations did not differ from those of the patients with microperforations. Conclusions Perforations associated with ESD could be managed safely and successfully by nonsurgical methods. The clinical prognoses for macro- and microperforations were favorable and comparable. Content Type Journal ArticleDOI 10.1007/s00464-009-0693-yAuthors Seong Woo Jeon, Kyungpook National University School of Medicine Department of Internal Medicine Daegu South KoreaMin Kyu Jung, Kyungpook National University School of Medicine Department of Internal Medicine Daegu South KoreaSung Kook Kim, Kyungpook National University School of Medicine Department of Internal Medicine Daegu South KoreaKwang Bum Cho, Keimyung University College of Medicine Department of Internal Medicine Daegu South KoreaKyung Sik Park, Keimyung University College of Medicine Department of Internal Medicine Daegu South KoreaChang Keun Park, Fatima Hospital Department of Internal Medicine Daegu South KoreaJoong Goo Kwon, Daegu Catholic University School of Medicine Department of Internal Medicine Daegu South KoreaJin Tae Jung, Daegu Catholic University School of Medicine Department of Internal Medicine Daegu South KoreaEun Young Kim, Daegu Catholic University School of Medicine Department of Internal Medicine Daegu South KoreaTae Nyeun Kim, Youngnam University School of Medicine Department of Internal Medicine Daegu South KoreaByung Ik Jang, Youngnam University School of Medicine Department of Internal Medicine Daegu South KoreaChang Hun Yang, Dongguk University School of Medicine Department of Internal Medicine 707, Seokjang-dong Gyeongju Gyeongsangbuk-do 780-714 South Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial

Abstract Background A prospective, randomized trial was performed to evaluate the long-term outcome and patient satisfaction of laparoscopic complete 360° fundoplication compared with partial posterior 270° fundoplication. Partial fundoplication is purported to have fewer side effects with a higher failure rate in controlling gastroesophageal reflux disease (GERD), while complete fundoplication is thought to result in more dysphagia and gas-related symptoms. Methods Patients were randomized to either laparoscopic Nissen (LN) or laparoscopic Toupet (LT) fundoplication. Esophageal manometry, 24-h pH studies, a detailed questionnaire, and a visual analog symptom (VAS) score were completed before and after surgery. A final global outcome questionnaire was performed. Failure was defined as recurrent GERD requiring revision surgery, maintenance proton pump inhibitor (PPI) therapy, or surgery for postoperative dysphagia. Results One hundred patients were randomized to LN (50) or LT (50). There were no differences between LN and LT with respect to postoperative symptoms and physiological variables except a higher wrap pressure in the LN group (15.2 vs. 12.0 mmHg). Dysmotility improved in 8/14 (57%) and 6/11 (54%) patients in the LN group and the LT group, respectively, after surgery. There was no correlation between dysmotility and dysphagia both pre- and post surgery in the two groups. Recurrent symptoms of GERD occurred in 8/47 (17.0%) and 8/48 (16.6%) in the LN group and the LT group, respectively. Outcome of patients with dysmotility was similar to those with normal motility in both groups. At final follow-up (59.76 ± 24.23 months), in the LN group, 33/37 (89.1%) would recommend surgery to others, 32/37 (86.4%) would have repeat surgery, and 34/37 (91.8%) felt they were better off than before surgery. The corresponding numbers for the LT group (follow-up = 55.18 ± 25.97 months) were 35/36 (97.2%), 30/36 (83.3%), and 33/36 (91.6%). Conclusion LN and LT are equally effective in restoring the lower esophageal sphincter function and provide similar long-term control of GERD with no difference in dysphagia. Esophageal dysmotility had no influence on the outcome of either operation. Content Type Journal ArticleDOI 10.1007/s00464-009-0700-3Authors John M. Shaw, University of Cape Town Department of Surgery, J45 OMB, Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South AfricaPhilippus C. Bornman, University of Cape Town Department of Surgery, J45 OMB, Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South AfricaMarie D. Callanan, Groote Schuur Hospital Surgical Gastroenterology Unit Observatory 7925 Cape Town South AfricaIan J. Beckingham, Nottingham University Hospitals NHS Trust Nottingham NG7 2UH UKDavid C. Metz, University of Pennsylvania School of Medicine Division of Gastroenterology Philadelphia PA 92103 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Do absorption and realistic distraction influence performance of component task surgical procedure?

Abstract Background Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance. Methods Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design. Results Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns. Conclusion The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0689-7Authors Jon R. Pluyter, Tilburg University Department of Information Systems and Management Warandelaan 2 5037 AB Tilburg The NetherlandsSonja N. Buzink, Catharina Hospital Eindhoven Department of Surgery Michelangelolaan 2 P.O. Box 1350 5602 ZA Eindhoven The NetherlandsAnne-F. Rutkowski, Tilburg University Department of Information Systems and Management Warandelaan 2 5037 AB Tilburg The NetherlandsJack J. Jakimowicz, Catharina Hospital Eindhoven Department of Surgery Michelangelolaan 2 P.O. Box 1350 5602 ZA Eindhoven The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

SAGES guideline for laparoscopic appendectomy

SAGES guideline for laparoscopic appendectomy Content Type Journal ArticleCategory GuidelinesDOI 10.1007/s00464-009-0632-yAuthors James R. Korndorffer, Tulane University School of Medicine Department of Surgery New Orleans LA USAErika Fellinger, Cambridge Health Alliance Department of Surgery Cambridge MA USAWilliam Reed, Winthrop University Hospital Department of Surgery Mineola NY USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Reply to 464-009-531: Re: ‘New horizons in colorectal cancer surgery’ ((2009)23:1–3)

Reply to 464-009-531: Re: ‘New horizons in colorectal cancer surgery’ ((2009)23:1–3) Content Type Journal ArticleCategory Letter--ReplyDOI 10.1007/s00464-009-0530-3Authors M. H. G. M. van der Pas, VU University Medical Center Department of Surgery Amsterdam The NetherlandsW. J. H. J. Meijerink, VU University Medical Center Department of Surgery Amsterdam The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Solar urticaria.

Solar urticaria. Allergy Asthma Proc. 2009 Sep-Oct;30(5):563-5 Authors: Webb LM, Mikita CP A case of solar urticaria is presented, followed by a discussion of the clinical characteristics, pathophysiology, diagnosis, and management of this disease. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. Solar urticaria is a physical urticaria that can be difficult to diagnose and distinguish from other photodermatoses. There are some characteristic features that are important to remember when evaluating a patient with suspected solar urticaria. Testing can be difficult without the assistance of an experienced dermatologist because there are several different wavelengths of light that can lead to a patient's symptoms. Solar urticaria tends to be a chronic disease with a low 5-year resolution rate but can usually be effectively managed with multiple antihistamines. PMID: 19843410 [PubMed - in process]

Twenty-one year old woman with severe eosinophilia and left bundle branch block.

Twenty-one year old woman with severe eosinophilia and left bundle branch block. Allergy Asthma Proc. 2009 Sep-Oct;30(5):558-62 Authors: Padi A, Silverman B, Schneider A Peripheral and tissue eosinophilia can occur in a wide variety of disease processes that include infectious, allergic, and primary hematologic disorders, and other more rare diseases such as hypereosinophilic syndromes (HES). We describe a case of a patient with severe eosinophilia and left bundle branch block. A 21-year-old woman with asthma and allergic rhinitis presented with neck pain and cough for >6 months with no other complaints. Physical exam was normal except for fever and minimal expiratory wheezes. Chest CT revealed diffuse airway inflammation with bronchiectasis. Admission electrocardiogram (EKG) was normal. Initial laboratory tests showed an absolute eosinophil count of 30,000 cells/mL. A thorough workup for eosinophilia was initiated, but the patient subsequently left against medical advice. The next day, in the outpatient pulmonary clinic, she was found to be tachycardic and an EKG showed sinus tachycardia with a new left bundle branch block. Laboratory tests revealed an eosinophil count of 33,200 cells/mL and elevated troponins. She was started on i.v. Solu-Medrol (Pfizer, Inc.). The next day, her EKG returned to normal. Three days later her absolute eosinophil count normalized. Identifying the cause of marked, persistent eosinophilia is a challenging problem. Excluding the more common causes of severe eosinophilia is required before making a diagnosis of HES and early therapeutic intervention can prevent morbidity from the disease. PMID: 19843409 [PubMed - in process]

Serum levels of protein oxidation products in patients with nickel allergy.

Serum levels of protein oxidation products in patients with nickel allergy. Allergy Asthma Proc. 2009 Sep-Oct;30(5):552-7 Authors: Gangemi S, Ricciardi L, Minciullo PL, Cristani M, Saitta S, Chirafisi J, Spatari G, Santoro G, Saija A Nickel sensitization can not only induce allergic contact dermatitis (ACD), but also can induce an overlapping disease referred to as "systemic nickel allergy syndrome" (SNAS), characterized by urticaria/angioedema and gastrointestinal symptoms correlated to the ingestion of nickel-containing foods. This study was designed to determine if oxidative stress occurs in patients with nickel allergy. Thirty-one female patients (mean age 31.26 + 13.04 years, range 16-64 years) with confirmed nickel CD underwent oral nickel challenge because of clinically suspected SNAS; serum concentrations of protein carbonyl groups (PCGs) and nitrosylated proteins (NPs; biomarkers of oxidative stress) were measured before and after oral nickel challenge as well as in healthy female controls. Twenty-three of these 31 patients were diagnosed with SNAS because they had a positive reaction to the oral nickel challenge, and 8 patients had no reaction and therefore were classified as patients with contact nickel allergy only. Although both nickel-allergic patients and controls presented similar serum levels of PCGs, NP values in nickel-allergic patients appeared higher than in controls and tended to decrease after the challenge; furthermore, serum levels of NPs in patients affected by SNAS were higher (although not significantly) than in patients with nickel ACD only. The involvement of specific biomarkers of oxidative stress such as NPs and the lack of involvement of other biomarkers such as PCGs may help to better understand the alteration of the redox homeostasis occurring in nickel ACD and particularly in SNAS. PMID: 19843408 [PubMed - in process]

Debilitating beliefs and emotional distress in patients given immunotherapy for insect sting allergy: A prospective study.

Debilitating beliefs and emotional distress in patients given immunotherapy for insect sting allergy: A prospective study. Allergy Asthma Proc. 2009 Sep-Oct;30(5):546-51 Authors: Confino-Cohen R, Melamed S, Goldberg A Patients who receive venom immunotherapy (VIT) for systemic reactions (SRs) to insect stings are advised that once they reach the maintenance dose they are almost 100% protected against future SRs. However, initial evidence indicates that some patients continue to perceive themselves as highly debilitated by the allergy and are preoccupied with the allergic event. These factors have significant impact on their emotional well-being and allergy-related quality of life (ARQOL). We aimed to explore prospectively whether patients would experience these adverse psychological outcomes after receiving VIT coupled with professional explanation and reassurance of protection. Thirty-four patients who received VIT for systemic insect allergy and were under close medical surveillance were included. Before and 1 year after initiation of treatment, patients completed a questionnaire that measured debilitating beliefs, preoccupation with the SR event, emotional distress ARQOL, and QOL in general. Physician-graded severity of the reaction was recorded as well. VIT had a beneficial effect on all allergy-related variables. Self-imposed debilitating beliefs, preoccupation with the anaphylactic event, and ARQOL significantly but modestly improved over time. No association was found between ARQOL and QOL in general. The later variable as well as emotional distress remained unchanged after the VIT. This study shows that patients with sting allergy guided by trained personnel and treated with VIT show a reduction in dysfunctional beliefs and an improvement in ARQOL. Disputing medically unfounded beliefs that persist in some patients might improve their ARQOL. PMID: 19843407 [PubMed - in process]

Patients' and primary care physicians' beliefs about asthma control and risk.

Patients' and primary care physicians' beliefs about asthma control and risk. Allergy Asthma Proc. 2009 Sep-Oct;30(5):519-28 Authors: Panettieri RA, Spector SL, Tringale M, Mintz ML Patients' and physicians' knowledge of asthma control and risks can affect long-term outcomes. The Asthma General Awareness and Perceptions II (Asthma GAP II) survey sought to assess the beliefs and behaviors of asthma patients and their physicians. In the United States, a telephone survey was conducted among 1885 adults with asthma (representative population sample [n = 1001] plus additional black [n = 436] and Hispanic samples [n = 448]) who took asthma medication in the previous year. An online survey included 300 primary care physicians. Most patients (66, 84, and 78% of national, black, and Hispanic samples, respectively) and physicians (80%) considered asthma a very or extremely serious condition. In contrast to current guidelines, most patients (69, 72, and 70%) believed that quick-relief medications could be taken daily. Many patients (42, 52, and 60%) and some physicians (22%) stated controller medications could be taken less regularly when symptoms decrease, although most patients (92, 92, and 89%) and physicians (95%) indicated that controller medications are most effective when taken daily. Of patients who discontinued controller medications (21%), 71% discontinued when symptoms abated. Most physicians (87%) believed that patients discontinued controller medications without their advice. After controller medication cessation, more black (22%) and Hispanic patients (22%) than patients in the national sample (15%) experienced serious health consequences after an asthma attack. Gaps exist between patients' understanding of asthma control and their use of controller and quick-relief medications. Many patients and physicians fail to recognize that, even with symptom abatement, serious asthma risks remain. PMID: 19843406 [PubMed - in process]

Frequency, timing, and type of prodromal symptoms associated with hereditary angioedema attacks.

Frequency, timing, and type of prodromal symptoms associated with hereditary angioedema attacks. Allergy Asthma Proc. 2009 Sep-Oct;30(5):506-11 Authors: Prematta MJ, Kemp JG, Gibbs JG, Mende C, Rhoads C, Craig TJ Hereditary angioedema (HAE) types I and II are autosomal dominant conditions characterized by recurrent attacks of edema formation in the subcutaneous tissue of the body or walls of the upper respiratory or gastrointestinal tract. Frequently, prodromal symptoms occur before an HAE attack. If certain prodromal symptoms were determined to be both sensitive and specific in predicting an acute HAE attack, treatment at the time of the prodrome could prevent development of an attack and decrease morbidity and mortality associated with HAE. The goal is to determine the frequency and timing of prodromal symptoms occurring before HAE attacks. After Institutional Review Board approval, a four-page survey was produced, using a focus group of patients with HAE and was assessed by HAE patients and physicians with expertise in HAE for cognitive reliability. Once devised, the questionnaire was sent to 158 HAE patients. The survey focused on questions related to prodromal symptoms that patients developed before their last HAE attack. Forty-six patients returned the survey and 40 (87.0%) reported the presence of prodromal symptoms before their last HAE attack. Forty-four of 46 (95.7%) reported having had prodromal symptoms before HAE attacks in the past. The most commonly reported prodromal symptoms included unusual fatigue, rash, and muscle aches. Prodromes occur frequently before HAE attacks. This high frequency suggests that prodromal symptoms could be a reliable indication to begin treatment to prevent an acute HAE attack, thus decreasing the anxiety associated with having an HAE attack. PMID: 19843405 [PubMed - in process]

Update on therapeutic developments for hereditary angioedema.

Update on therapeutic developments for hereditary angioedema. Allergy Asthma Proc. 2009 Sep-Oct;30(5):500-5 Authors: Christiansen SC, Zuraw BL Remarkable progress has been made in understanding the molecular mechanisms underlying attacks of swelling in hereditary angioedema (HAE). Treatment options in the United States for this potentially life-threatening disease had remained essentially static, however, over the past 40 years. Prophylactic therapy had relied on attenuated androgens or antifibrinolytic agents. Although demonstrably effective, these drugs have been fraught with side effects. Acute therapy has been largely relegated to supportive care. In this article we discuss emerging treatments that have evolved from the recognition that kinin generation is the fundamental abnormality leading to attacks of angioedema. We will review the newly approved replacement therapy for prophylaxis of HAE attacks with C1 inhibitor (C1INH). Potential options for the acute treatment of HAE will be discussed including purified C1INH, recombinant C1INH, an inhibitor of plasma kallikrein, and a B2-receptor antagonist. The arrival of these novel therapies promises to transform the future management of HAE. PMID: 19843404 [PubMed - in process]

Variability of prodromal signs and symptoms associated with hereditary angioedema attacks: A literature review.

Variability of prodromal signs and symptoms associated with hereditary angioedema attacks: A literature review. Allergy Asthma Proc. 2009 Sep-Oct;30(5):493-9 Authors: Kemp JG, Craig TJ Hereditary angioedema (HAE) is a rare disease caused by deficiency in the production or function of C1 inhibitor. It predisposes individuals to paroxysmal acute attacks causing painful, debilitating, disfiguring, and life-threatening angioedema. Prodromes occurring hours to days before attacks have been described in the literature; however, their significance as predictive signals of impending attacks is uncertain. Given the morbidity and mortality associated with HAE attacks and the increasing availability of therapeutic products for their treatment, identifying prodromes that accurately predict the onset of attacks could provide the basis for the development of a validated instrument to identify the onset of such attacks requiring abortive therapeutic intervention before the development of clinically significant angioedema. The aim of this study was to review the literature to identify the prodromes reported to occur with HAE attacks. A literature review of English language journal articles was performed using search terms hereditary angioedema, HAE, angioneurotic edema, prodrome, signs, and symptoms. Nineteen original English language articles that included both case reports and studies describing prodromes associated with HAE attacks were obtained. Our review indicates that there is significant variability in the expression, manifestation, prevalence, timing, and predictive reliability of the prodromes that have been described. There is considerable variability of the prodromal manifestations that may occur before or during HAE attacks. We have not found any evidence that their sensitivity and specificity for accurately predicting such attacks has been studied. PMID: 19843403 [PubMed - in process]

Pathogenesis and laboratory diagnosis of hereditary angioedema.

Pathogenesis and laboratory diagnosis of hereditary angioedema. Allergy Asthma Proc. 2009 Sep-Oct;30(5):487-92 Authors: Zuraw BL, Christiansen SC Hereditary angioedema (HAE) was first described in the 19th century. Over the past 50 years, many details of the pathophysiology and molecular biology of HAE have been elucidated. Two types of HAE, type I and type II, result from mutations in the gene for the broad-spectrum protease inhibitor C1 inhibitor (C1INH). Type I HAE is characterized by low antigenic and functional C1INH levels and type II HAE has normal antigenic but low functional C1INH levels. Type III HAE, by contrast, has normal antigenic and functional C1INH levels. In some families, type III HAE has been linked to mutations in Hageman factor. C1INH is the primary inhibitor of the complement proteases C1r and C1s as well as the contact system proteases activated Hageman factor (coagulation factor XIIa and XIIf) and plasma kallikrein. It is also an inhibitor of plasmin and coagulation factor XIa. The primary mediator of swelling in HAE has now been unequivocally shown to be bradykinin, generated from activation of the plasma contact system. The knowledge gained concerning the underlying mechanisms of the different types of HAE allow the clinician to approach the laboratory diagnosis with confidence and provides opportunities for novel therapeutic strategies. PMID: 19843402 [PubMed - in process]

Histamine, antihistamines, and the central nervous system.

Histamine, antihistamines, and the central nervous system. Allergy Asthma Proc. 2009 Sep-Oct;30(5):482-6 Authors: Lieberman P Histamine is a central nervous system (CNS) neurotransmitter. It acts in the brain via three receptors, H(1), H(2), and H(3). It is a mediator of "wakefulness" and its activity is necessary to maintain wakefulness, alertness, and reaction time. These activities can be impaired by H(1)-antagonists (reverse agonists) capable of penetrating the blood-brain barrier. By blocking the homeostatic effects of histamine in the CNS, drowsiness and functional impairment with or without drowsiness can occur. Several tests have been designed to assess the effects of antihistamines on the CNS. These include subjective measurements of drowsiness and more objective measurements of impairment. Second-generation antihistamines have been designed to minimize blood-brain barrier penetration by reducing lipophilicity and increasing the affinity for P-aminnoglycoprotein. PMID: 19843401 [PubMed - in process]

Allergic rhinitis, histamine, and otitis media.

Allergic rhinitis, histamine, and otitis media. Allergy Asthma Proc. 2009 Sep-Oct;30(5):470-81 Authors: Skoner AR, Skoner KR, Skoner DP Otitis media (OM) is a common and costly medical condition, especially in children. Most episodes of OM are associated with an upper respiratory viral infection and are short-lived and self-limiting with or without medical treatment. However, chronic OM with effusion (OME) has significant sequelae, is refractory to most medical treatments, and frequently requires surgical intervention. The pathophysiology of OME is complex and involves both eustachian tube (ET) dysfunction and middle ear pressure dysregulation. OM likely results from an increase in blood flow to and, thus, gas loss from the middle ear, in combination with a dysfunctional ET that can not resupply that gas. These processes could be induced by viral and/or allergen-driven inflammation. A large body of epidemiologic and mechanistic evidence supports a role for allergic rhinitis as a risk for OM. Indeed, evidence also supports a role for histamine in both conditions. However, not all such evidence is supportive of this relationship and a causal relationship between the two conditions has not been definitively proven. Moreover, therapeutic trials using common allergy therapies have either not been conducted or showed no benefit in OM. This prompted the 2004 clinical practice guidelines on OM to conclude that no recommendations could be made for "... allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME." Nonetheless, given the strong likelihood of allergy as a risk factor for OM, allergic rhinitis patients should be evaluated for OM and patients with OME should be considered for an allergy evaluation. If significant allergic rhinitis is diagnosed in a patient with OME, it should be treated aggressively (as in any case of moderate to severe allergic rhinitis) until further studies are conducted. No definitive conclusions about a role for food allergy in causing or treating OM can be made. Clearly, more studies are needed to examine the relationship between these two important conditions. PMID: 19843400 [PubMed - in process]

Allergic rhinitis with negative skin tests: Does it exist?

Allergic rhinitis with negative skin tests: Does it exist? Allergy Asthma Proc. 2009 Sep-Oct;30(5):465-9 Authors: Khan DA Nonallergic rhinitis (NAR) is a common disorder encountered by the practicing allergist/immunologist. The immunopathology of allergic rhinitis (AR) and NAR share several characteristics. Patients with AR have allergen-specific IgE demonstrable both systemically (e.g., positive skin tests) as well as local IgE produced in the nasal mucosa. A few studies have evaluated patients with NAR using nasal provocation with allergen. Some, but not all, studies have revealed positive allergen challenge in these nonallergic subjects with negative skin tests. This article reviews these studies and highlights the differences in methodology. Further refinements and standardization of nasal provocation techniques may be required before proving that localized IgE-mediated allergy occurs in patients with negative skin tests. PMID: 19843399 [PubMed - in process]