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International Archives of Allergy and Immunology : Last 20 articles

Front & Back Matter
Wed, 01 Feb 2012 00:00:00 +0100
Int Arch Allergy Immunol 2012;157:X (DOI:10.1159/000336950)
The Loss of Smell in Persistent Allergic Rhinitis Is Improved by Levocetirizine due to Reduction of Nasal Inflammation but Not Nasal Congestion (the CIRANO Study)
Thu, 26 Jan 2012 00:00:00 +0100
Int Arch Allergy Immunol 2012;158:184–190 (DOI:10.1159/000331329)
Multiorgan Infiltration by CD8+ T Cells and 1p;16p Translocation in a Patient with Hypogammaglobulinemia and a Reduced Number of B Cells
Thu, 26 Jan 2012 00:00:00 +0100
Int Arch Allergy Immunol 2012;158:206–210 (DOI:10.1159/000331117)

Surgical Endoscopy (Online First™)

Comparison of long-term prognosis of laparoscopy-assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection
Mon, 06 Feb 2012 19:35:50 -0000
Abstract Background  Laparoscopy-assisted gastrectomy (LAG) is becoming widely used for early gastric cancer. However, how the curability and long-term prognosis of LAG and open gastrectomy (OG) for early and advanced gastric cancer compare remains unclear. This study assessed short- and long-term outcomes after LAG with lymph node dissection in early and advanced gastric cancer. Methods  A total of 332 patients who underwent LAG or OG for early and advanced gastric cancer from January 2001 through December 2010 were reviewed retrospectively. The mean operating time, estimated mean blood loss, number of dissected lymph nodes, and survival rates were compared between LAG and OG for early and advanced gastric cancer. Results  Overall, 47.6% (158/332) of patients underwent LAG; D1, D1+ lymph node dissection was carried out in 77.2%, with D2 dissection in 22.8%. Only one patient required conversion to OG. Comparing LAG and OG with D1, D1+ lymph node dissection for early gastric cancer (EGC), mean operating time was significantly longer, estimated mean blood loss was significantly smaller, and the average number of retrieved lymph nodes was significantly greater with LAG. The rate of specific postoperative morbidity was 17.2% for LAG patients and 25.0% for OG patients, with no postoperative mortality. Survival and recurrence rates were not significantly different. Comparing LAG and OG with D2 lymph node dissection for advanced gastric cancer (AGC), mean operating time was significantly longer and estimated mean blood loss was significantly smaller with LAG, while the average number of retrieved lymph nodes, specific postoperative morbidity and mortality, and survival and recurrence rates were not significantly different. Conclusions  LAG with D1, D1+ lymph node dissection for EGC is safe and equivalent to open gastrectomy in curability. Moreover, LAG with D2 lymph node dissection for AGC is comparable to OG with D2 lymph node dissection with regard to short- and long-term results. Content Type Journal ArticlePages 1-7DOI 10.1007/s00464-012-2167-xAuthors Hirohiko Sato, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanMitsuo Shimada, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanNobuhiro Kurita, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanTakashi Iwata, Department of Digestive and Transplantation Surgery, Institute of Health Biosciences, The University of Tokushima, Tokushima, JapanMasanori Nishioka, Department of Digestive and Transplantation Surgery, Institute of Health Biosciences, The University of Tokushima, Tokushima, JapanShinya Morimoto, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanKozo Yoshikawa, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanTomohiko Miyatani, Department of Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, JapanMasakazu Goto, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanHideya Kashihara, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 JapanChie Takasu, Department of Surgery, Institute of Health Biosciences, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Robotic liver resection: technique and results of 30 consecutive procedures
Mon, 06 Feb 2012 19:35:49 -0000
Abstract Background  Robotic surgery can enhance a surgeon’s laparoscopic skills through a magnified three-dimensional view and instruments with seven degrees of freedom compared to conventional laparoscopy. Methods  This study reviewed a single surgeon’s experience of robotic liver resections in 30 consecutive patients, focusing on major hepatectomy. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Results  The mean age of the patients was 52.4 years and 14 were male. There were 21 malignant tumors and 9 benign lesions. There were 6 right hepatectomies, 14 left hepatectomies, 4 left lateral sectionectomies, 2 segmentectomies, and 4 wedge resections. The average operating time for the right and left hepatectomies was 724 min (range 648–812) and 518 min (range 315–763), respectively. The average estimated blood loss in the right and left hepatectomies was 629 ml (range 100–1500) and 328 ml (range 150–900), respectively. Four patients (14.8%) received perioperative transfusion. There were two conversions to open surgery (one right hepatectomy and one left hepatectomy). The overall complication rate was 43.3% (grade I, 5; grade II, 2; grade III, 6; grade IV, 0) and 40% in 20 patients who underwent major hepatectomy. Among the six (20.0%) grade III complications, a liver resection–related complication (bile leakage) occurred in two patients. The mean length of hospital stay was 11.7 days (range 5–46). There was no recurrence in the 13 patients with hepatocellular carcinoma during the median follow-up of 11 months (range 5–29). Conclusions  From our experience, robotic liver resection seems to be a feasible and safe procedure, even for major hepatectomy. Robotic surgery can be considered a new advanced option for minimally invasive liver surgery. Content Type Journal ArticlePages 1-12DOI 10.1007/s00464-012-2168-9Authors Gi Hong Choi, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 KoreaSung Hoon Choi, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 KoreaSung Hoon Kim, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 KoreaHo Kyoung Hwang, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 KoreaChang Moo Kang, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 KoreaJin Sub Choi, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 KoreaWoo Jung Lee, Department of Surgery, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752 Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation
Thu, 02 Feb 2012 18:07:54 -0000
Abstract Background  Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that proves burdensome to patients. Nevertheless, very little data are available on patient tolerance of this procedure that may improve practice guidelines and could aid in decreasing the burden of ERCP. This study therefore investigated the burden of ERCP performed with the patient under conscious sedation. Methods  Consecutive patients receiving ERCP under conscious sedation between November 2007 and December 2008 at the University Medical Center Utrecht and Erasmus MC Rotterdam (The Netherlands) were asked to participate in this study. The patients completed questionnaires on demographics, medical history, burden of ERCP (mental health, discomfort, and pain), symptoms and the EuroQol-5D (EQ-5D), including the EQ-VAS (lower EQ-5D scores and higher EQ-VAS scores represent a better quality of life). The paired t-test, the Kruskal–Wallis test, Pearson correlation, and logistic regression were used to evaluate the results. Results  The questionnaire was returned by 149 (54%) of 276 eligible patients, 139 of whom completed the entire questionnaire (54% males; mean age, 60 ± 14 years). Throat ache (p < 0.001) was the only symptom higher than baseline value 1 day after the ERCP. On day 1, about one-tenth of the patients experienced moderate to severe mental health problems, which were associated with a higher EQ-5D score before ERCP (p = 0.01). Slightly fewer than half of the patients experienced pain and discomfort during and immediately after ERCP. More discomfort was experienced by patients who underwent therapeutic ERCP (p < 0.05) and those with a higher EQ-5D score (p < 0.001) or lower VAS (p < 0.01). Pain was associated with younger age (p < 0.01), higher EQ-5D score (p < 0.001), and lower VAS (p < 0.01). Conclusion  One-third to one-half of patients experience pain and discomfort during and immediately after ERCP when it is performed with conscious sedation for the patient. Other sedation strategies, such as the use of general anesthesia or propofol, may well reduce the burden of ERCP, particularly for patients with a higher EQ-5D score, younger age, or therapeutic ERCP treatment. However, randomized trials are warranted. Content Type Journal ArticlePages 1-7DOI 10.1007/s00464-012-2162-2Authors S. M. Jeurnink, Department of Gastroenterology and Hepatology, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The NetherlandsE. W. Steyerberg, Department of Public Health, Erasmus MC/University Medical Center, Rotterdam, The NetherlandsE. J. Kuipers, Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center, Rotterdam, The NetherlandsP. D. Siersema, Department of Gastroenterology and Hepatology, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
The use of novel hemostatic sealant (Tisseel®) in laparoscopic myomectomy: a case–control study
Thu, 02 Feb 2012 18:07:53 -0000
Abstract Background  This is the first case–control study on the use of a fibrin sealant (Tisseel®) on uterine suture during laparoscopic myomectomy (LM), with the primary endpoint to evaluate the intraoperative bleeding and postoperative blood loss. In addition, we evaluated the time required to achieve hemostasis using Tisseel® and how much it can influence operative time. Methods  From December 2009 to January 2011, consecutive patients older than 18 years with symptomatic isolate intramural myoma with maximal diameter ≤6 cm and ≥4 cm and with a sonographically diagnosed free myometrium margin ≥0.5 cm were included in the study. We selected from our institute’s database a group of consecutive patients with homogeneous features of the study group, who underwent laparoscopic myomectomy without Tisseel® application. Results  Fifteen women with symptomatic myoma were enrolled in the study (group A). Regarding the control group (group B), we selected a homogenous group of 15 patients with the same preoperative characteristics of the study group. Mean operative time was 47.7 min and 62.1 min, for groups A and B respectively (p < 0.05). Mean time required to achieve complete haemostasis was 195.5 s in group A and 361.8 in control group B (p < 0.0001). Mean estimated blood loss was 111.3 mL and 230 mL in groups A and B, respectively (p < 0.05). Mean hemoglobin decrease was 1.36 g/dL and 2.04 g/dL in groups A and B, respectively (p < 0.05). Conclusions  The use of Tisseel® during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulation and traumatisms. Content Type Journal ArticlePages 1-8DOI 10.1007/s00464-012-2154-2Authors Roberto Angioli, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyFrancesco Plotti, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyRoberto Ricciardi, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyCorrado Terranova, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyMarzio Angelo Zullo, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyPatrizio Damiani, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyRoberto Montera, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyFederica Guzzo, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyGiuseppe Scaletta, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, ItalyLudovico Muzii, Department of Obstetrics and Gynecology, “Campus Bio Medico” University of Rome, Via Álvaro del Portillo, 200-00128 Rome, Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Randomized controlled trial of laparoscopic gastric ischemic conditioning prior to minimally invasive esophagectomy, the LOGIC trial
Thu, 02 Feb 2012 18:07:53 -0000
Abstract Introduction  Minimally invasive esophagectomy (MIE) is a viable alternative to open resection for the management of esophagogastric cancer. However, the technique may relate to a higher incidence of ischemia-related gastric conduit complications. Laparoscopic ischemic conditioning (LIC) by ligating the left gastric vessels 2 weeks before MIE may have a protective role, possibly through an improvement of conduit perfusion. This project was designed to evaluate whether LIC influenced ultimate conduit perfusion. Methods  A randomized controlled trial was designed to compare MIE with LIC (L) against MIE without (N). The project began in May 2009 and was offered to consecutive patients with the objective of recruiting 22 in each arm. Sample size calculations were based on data from previous clinical series. The main outcome measure was perfusion recorded by validated laser Doppler fluximetry, at the fundus (F) and greater curve (G); performed at routine staging laparoscopy and every stage of an MIE. A perfusion coefficient measured as ratio at stage of MIE over baseline was used for statistical analysis. Results  Sixteen patients were recruited before an interim analysis of the trial data. At staging laparoscopy perfusion at F was higher than at G (p = 0.016). In the L cohort, an apparent rise in perfusion at G is observed post intervention (p = 0.176). At MIE, baseline perfusion is comparable for both arms; however, a significant drop is observed at both locations once the stomach is mobilized and exteriorized (p = 0.001). Once delivered at the neck, perfusion coefficient is approximately 38% of baseline levels. However, there was no discernible difference between the L (38.3 ± 12) and N (37.7 ± 16.8) cohorts (p = 0.798). Conclusions  LIC does not translate into an improved perfusion of the gastric conduit tip. The benefits reported from published clinical series suggest that the resistance of the conduit to ischemia occurs through alternative possibly microcellular mechanisms. Content Type Journal ArticlePages 1-8DOI 10.1007/s00464-011-2123-1Authors Darmarajah Veeramootoo, Department of Upper Gastro-Intestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW UKAngela C. Shore, Institute of Biomedical and Clinical Science, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UKShahjehan A. Wajed, Department of Upper Gastro-Intestinal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Endoscopic laser fragmentation and removal of a nonremovable metal esophageal stent for persistent dysphagia: a technical note
Thu, 02 Feb 2012 18:07:53 -0000
Abstract Background  Self-expanding metal stents are widely used in the palliation of esophageal diseases (Todd, N Engl J Med 344(22):1681–1687, 2001). The majority are inserted for end-stage malignancy and are not designed to be removed. Methods  We report the first recorded successful endoscopic removal of an “irremovable” stent by laser fragmentation after its placement became redundant. A 72-year-old man who had persistent dysphagia after esophageal stent insertion for Boerhaave’s syndrome had his stent removed by Nd-YAG laser fragmentation at staged endoscopies. Results  The stent was removed in its entirety and the patients’ symptoms resolved. Conclusions  We describe a successful technique for the removal of a nonretrievable stent using laser fracture and endoscopic retrieval. This method of stent removal has not been previously reported. Content Type Journal ArticleCategory TechniquePages 1-3DOI 10.1007/s00464-011-2111-5Authors Ross S. Coomber, Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0HB UKPranav H. Patel, Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0HB UKAnubhav Dhir, Department of Healths Clinical Advisor Scheme, Bupa Health Dialog, London, UKJeremy I. Livingstone, Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford, WD18 0HB UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

pubmed: 1088-5412

Recurrent diarrhea in a 26-year-old man.
Baker TW, Stokes S, Clawson J, Garrett T, Sacha JJ, Gonzalez-Reyes E Recurrent diarrhea in a 26-year-old man. Allergy Asthma Proc. 2011 Nov;32(6):482-5 Authors: Baker TW, Stokes S, Clawson J, Garrett T, Sacha JJ, Gonzalez-Reyes E Abstract This is a case report of a 26-year-old healthy man with chronic diarrhea for 2 years. He was initially believed to have irritable bowel syndrome by his primary care physician after all stool studies yielded negative results. His symptoms persisted, which prompted a referral to a gastroenterology specialist. The patient's esophagogastroduodenoscopy revealed variable villous blunting and a paucity of CD 138 plasma cells, which helped reveal the final diagnosis. This cases illustrates a unique presentation of a common primary immunodeficiency that allergy/immunology specialists, along with primary care specialists, will likely encounter. PMID: 22221444 [PubMed - in process]
Characterization of patients with suspected seminal plasma hypersensitivity.
Sublett JW, Bernstein JA Characterization of patients with suspected seminal plasma hypersensitivity. Allergy Asthma Proc. 2011 Nov;32(6):467-71 Authors: Sublett JW, Bernstein JA Abstract The epidemiology of seminal plasma hypersensitivity (SPH) is unknown. Case reports and a previous survey have identified two distinct phenotypes: localized and systemic reactors. The objective of this study was to use an Internet-based questionnaire to characterize and examine the differences among a population of women with suspected SPH. A questionnaire designed to distinguish women with probable SPH was made available via the Internet. Systemic symptoms included generalized pruritus, urticaria, angioedema, wheezing, chest tightness, shortness of breath, dizziness, and loss of consciousness whereas localized symptoms included vaginal burning, pain, swelling, erythema, or blister formation. Respondents with localized or systemic symptoms and whose symptoms were prevented with the use of a condom were included in the analysis. Frequency and means were calculated and further analyzed using chi-square and t-test analyses. A total of 165 women with probable SPH, 79 with systemic symptoms and 86 with only localized symptoms, were included in the analysis. Systemic compared with localized respondents were significantly older (mean age, 29.2 years versus 26.4 years; p = 0.01), had longer duration of symptoms (mean, 58 months versus 40.8 months; p = 0.03), and more frequently reported a family history of atopy (65.8% versus 50%; p < 0.05). Interestingly, significantly more systemic compared with localized respondents reported dog sensitization (11.4% versus 2.3%; p = 0.02). Localized and systemic SPH are more common than previously realized and should be considered in the differential diagnosis of anaphylaxis, vulvovaginitis, and dyspareunia. Additional research investigating the epidemiology, immunopathogenesis, and treatment of this disorder is warranted. PMID: 22221443 [PubMed - in process]
Ultrashort-specific immunotherapy successfully treats seasonal allergic rhinoconjunctivitis to grass pollen.
Dubuske LM, Frew AJ, Horak F, Keith PK, Corrigan CJ, Aberer W, Holdich T, von Weikersthal-Drachenberg KJ Ultrashort-specific immunotherapy successfully treats seasonal allergic rhinoconjunctivitis to grass pollen. Allergy Asthma Proc. 2011 Nov;32(6):466 Authors: Dubuske LM, Frew AJ, Horak F, Keith PK, Corrigan CJ, Aberer W, Holdich T, von Weikersthal-Drachenberg KJ PMID: 22221442 [PubMed - in process]

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Southwest coastal Oregon community in need of first Allergy/Immunology specialist due to patient demand in draw area covering over 13,000 population. This hospital employed position will require including
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Pittsburgh group adding another Allergist We are scheduling interviews with a busy Allergy Asthma & Immunology group adding another Allergist. This is primarily a clinical position with some teaching

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