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Background: Current data indicate that infliximab-given immediately after surgery-may be very effective in preventing postsurgical recurrence of Crohn's disease. However, it is unknown whether a similar benefit would result from early diagnosis and treatment, rather than prevention of endoscopic recurrence.Aims: The primary outcome of this study was to clarify whether infliximab, given after diagnosis of postoperative endoscopic recurrence of Crohn's diseases (Rutgeerts score ≥ 2) can induce endoscopic remission (score <2) at 54 weeks. The secondary outcomes were improvement in the endoscopic score and clinical recurrence at 54 weeks.Methods: In this prospective open label multicenter pilot study 43 patients with ileocolonic Crohn's disease subjected to curative surgery underwent colonoscopy 6 months after surgery. Patients with endoscopic recurrence (Rutgeerts score ≥2) were treated with either mesalamine 800 mg tid or infliximab 5 mg/kg bw on a maintenance basis. Colonoscopy was performed after 54 weeks of therapy.Results: A total of 24/43 patients were diagnosed with endoscopic recurrence at 6 months. Thirteen were treated with infliximab and 11 with mesalamine. None of the 11 mesalamine-treated patients had endoscopic remission at 54 weeks. Two had clinical recurrence at 8 and 9 months. Fifty-four percent of patients treated with infliximab had endoscopic remission at 54 weeks (P = 0.01) while 69% had an improvement in the endoscopic score. None had clinical recurrence.Conclusions: Treatment of postsurgical endoscopic lesions by infliximab appears superior to mesalamine. However, a sizeable proportion of patients did not fully benefit from this strategy. [ABSTRACT FROM AUTHOR]

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OBJECTIVE: Our aim was the assessment of frequency and evolution of osteopenia in patients with inflammatory bowel disease and identification of related factors. METHODS: Bone mineral density (BMD) of the lumbar spine was measured in 54 patients with Crohn's disease (CD) and in 49 patients with ulcerative colitis (UC) and was repeated after a mean observation period of 21 (range, 8-50) months in 30 CD and 14 UC patients. Eighteen age-matched healthy subjects served as controls. Serum biochemistry (parathyroid hormone, osteocalcin, alkaline phosphatase, insulin-like growth factor 1, minerals, and markers of inflammation) was assessed at the time of the second BMD measurement. RESULTS: Reduced BMD values were found in 48% of CD, and in 38% of UC patients. Compared with control subjects, the mean BMD was significantly lower in CD (p < 0.003) and UC (p < 0.0001) patients. BMD was positively correlated with the body mass index (p < 0.05) and inversely correlated with the lifetime steroid dose (p < 0.03). After 21 months the BMD of CD patients was virtually unchanged, with an annual variation (%ΔBMD/yr) of -0.31 ± 0.49, whether treated with steroids or not, whereas in UC patients the BMD decreased significantly (p < 0.02) with a %ΔBMD/yr of -2.47 ± 0.82 (p < 0.02 vs CD). This decrease can be attributed to steroid treatment. No biochemical alterations were detected in patients with rapid bone loss, compared with those with stable BMD. CONCLUSIONS: Low bone density is frequent in both CD and UC, but apparently stable in CD. The evolution of BMD suggests that low bone density is associated with the pathogenesis of CD, whereas in UC it seems to be correlated with the side effects of corticosteroid treatment. [ABSTRACT FROM AUTHOR]

Neuronal plasticity in the mammalian visual system has been studied with a variety of experimental methods like induction of artificial squint and eye rotation. To investigate neuronal plasticity in the human visual system, we examined a patient with a congenital convergent squint of his left eye, who later suffered a vascular lesion in his left occipital lobe that led to an incomplete hemianopia in his right visual field. The examination revealed that the visual field representation in the striate cortex is rigidly prewired with reference to the anatomical fovea. In contrast, plasticity in the oculomotor system enables the patient to use a functional visual axis that does not correspond to the anatomical fovea. Local alterations of sensitivity within the visual field that indicate interactions among non-corresponding retinal points provide additional evidence of functional plasticity. [ABSTRACT FROM AUTHOR]

Layer VI of macaque striate cortex contains a number of large solitary neurones called Meynert cells. It has been shown earlier that these Meynert cells project to the posterior bank of the superior temporal sulcus (area V5), but it has also been shown that they project to the superior colliculus. In retrograde fluorescent double-labelling experiments, it was found that Meynert cells represent a class of neurones which distribute divergent axon collaterals to the posterior bank of the superior temporal sulcus and to the superior colliculus, i.e. to a distant cortical and a subcortical structure. This feature appears to be unique among projecting neurones in monkey visual cortex. [ABSTRACT FROM AUTHOR]

Cortical projections from the contralateral hemisphere to the superior colliculus (SC) were studied in macaque monkey using retrograde transport of the enzyme horseradish peroxidase (HRP). After single or multiple injections of HRP into SC, labelled cells were found contralaterally in layer V of the anterior bank of the arcuate sulcus, the origin of this contralateral projection being confined to the anterior part of Brodmann's area 6. Only a few labelled cells appeared in adjacent area 8. Labelled cells occured in patches, forming bands which were found to run in a ventromedial direction. A similar pattern was seen homotopically in ipsilateral area 6. Thus, this anterior part of area 6 gives rise to a bilateral projection to the SC. The findings emphasize structural differences in a region of the frontal lobe which has been considered functionally uniform as frontal eye field. [ABSTRACT FROM AUTHOR]

In humans, gastric surgery results in in osteopenia via mechanisms that are insufficiently understood; surgery-induced changes in the hormonal axes involving the stomach, thyroid, and the parathyroids may play a role. To study this in more detail, we evaluated calcium (Ca), magnesium (Mg), and phosphorus (P) metabolism as well as physical, chemical, and histomorphometric bone parameters in rats rendered hypergastrinemic by fundectomy (FX). In independent experiments, the response to an oral Ca challenge was investigated in intact rats versus FX, and in thyroidectomized versus thyroid-intact FX rats. Sixteen weeks following FX, body weight was approximately 80% that of sham-operated controls. In urine, P excretion was elevated fivefold, the pH was significantly decreased, and cAMP excretion was elevated as compared with controls; serum parathyroid hormone (PTH), calcitonin, 25OHD, Ca, Mg, and P were normal; gastrin and 1,25(OH)2D were elevated. On the basis of bone ash mineral content, FX rats developed significant osteopenia, and histomorphometry indicated only slightly elevated bone turnover and mineralization. Following oral Ca, thyroid-intact FX rats developed hypercalcemia, serum gastrin decreased, and calcitonin increased significantly; in thyroidectomized FX rats, calcitonin remained at baseline levels although there was a similar degree of hypercalcemia; PTH decreased during the hypercalcemic period in both groups. Serum gastrin did not correlate with calcitonin or PTH, and in multivariate regression analysis the only predictor of serum 1,25(OH)2D was urinary phosphorus. It was concluded that in the FX rat (1) osteopenia is not caused by intestinal Ca malabsorption, vitamin D, Ca deficiency, or secondary hyperparathyroidism; (2) osteopenia may be related to PTH-independent urinary hyperexcretion of P, followed by a rise of serum 1,25(OH)2D; (3) the existence of endocrine axes among gastrin, calcitonin, and PTH cannot be substantiated. FX osteopenia appears to be related to gastric acid abolition, and the reactive hypergastrinemia probably stabilizes the mass and turnover of bone. [ABSTRACT FROM AUTHOR]

Eleven healthy male subjects aged 23 to 38 years (including 2 smokers) were exposed to purified air (= control experiment), to NO, O, and SO alone, to mixtures of NO + SO, and NO + O in MAK concentration, and to a mixture of NO + SO + O in MAK and MIK concentrations for 2 h. Nine of these subjects underwent a bronchial challenge by inhaling in a standardized procedure, an aerosol containing 1%, 2%, and 3% acetylcholine after a 2-h exposure to clean air and to a mixture of NO + SO + O in MAK and MIK concentrations, respectively. The following results were obtained: From the results of this study and previous data there is a special need for re-evaluation of the present NO MAK concentration (5 ppm; 9 mg/m). [ABSTRACT FROM AUTHOR]

Objective: Impaired quality of life (QOL) in patients with ulcerative colitis (UC) may be a prominent feature of the disease, and in some cases, may become an indication for surgical treatment. The objective of this study was to assess QOL in patients who underwent proctocolectomy with ileo-anal anastomosis with a J pouch for severe UC and to compare it with patients with UC of different severity who were under medical treatment. Methods: We used a validated, disease-specific research instrument (a 29 item, self-administered questionnaire) that examines the following four functions: intestinal (score 0-24) and systemic symptoms (0-21), and emotional (0-27) and Social Function (0-15). High scores indicate an impairment of the function examined and the sum of the four scores (maximal total score = 87) reflects the patient's QOL. We studied 29 operated patients (22 men, mean age 35 yr, mean time after intervention 3.8 yr) and compared their scores with those of 57 UC patients (39 men, mean age 36 yr) with different degrees of disease activity, and with those of 72 healthy controls (38 men, mean age 31 yr). Results: In UC, scores were significantly higher than in controls, increasing with the severity of the disease. Even patients in remission bad higher scores than controls in the "systemic" (4.6 vs. 2.0) and emotional (5.6 vs. 2.5) functions. Patients who underwent surgical treatment bad much better scores than patients with severe disease (total score 20.1 vs. 38.2), with values comparable to those of patients in remission or with mild disease activity. There was no significant gender difference, either for UC and ileo-anal anastomosis patients, or In healthy controls. Conclusion: In patients with UC, even in remission, there is a measurable impairment of QOL, which increases with the severity of disease. Operated patients have a QOL that is comparable to that of patients in remission or with mild disease, and proctocolectomy with ileo-anal anastomosis may... [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "How to prevent varices from bleeding: Shades of grey: The case for nonselective beta blockers," by U. Thalheimer and colleagues in the previous issue.