bluuebunny/crossref_metadata_2025 huggingface dataset:
HITS in Internal Carotid Dissections
Authors: Oliveira V. , Batista P. , Soares F. , Ferro J.M.
Published: April 2003

Carotid dissections can cause neurological deficits either by hemodynamic or embolic mechanisms. Anticoagulants are often used in this setting to prevent neurological deterioration and stroke recurrence. High-intensity transient signals (HITS) detected by transcranial Doppler may be due to microembolism. We investigated the presence and number of HITS in a series of 27 patients with carotid dissection. HITS were detected in 14 (52%) patients and only in cases with a less than 7-day evolution. No association was found between HITS and clinical or imagiological features of the dissection nor with neurological aggravation or treatment type. We failed to demonstrate any relevant clinical significance of HITS in carotid dissection.
Accuracy of Color-Doppler in the Quantification of Proximal Vertebral Artery Stenoses
Authors: de Bray J.M. , Pasco A. , Tranquart F. , Papon X. , Alecu C. , Giraudeau B. , Dubas F. , Emile J.
Published: April 2003

Background: Vertebrobasilar (VB) strokes appear to have the same causes as carotid strokes. Obstructive lesions of proximal vertebral arteries probably occur in about 30% of stroke patients. Purpose: Our aim was to assess the validity of color Doppler sonography compared to selective intra-arterial angiography in the quantification of proximal vertebral artery stenoses. Materials and Methods: A prospective blind study of 316 vertebral arteries was undertaken between 1996 and 1998. One hundred and fifty-eight patients with cerebrovascular disorders without cerebral hemorrhage were studied consecutively by frequency or amplitude color Doppler flow imaging and intra-arterial angiography. The lesions were quantified by morphological and hemodynamic criteria and classified into 6 groups: 0% 207 arteries; 1–29% 32 arteries; 30–49% 29 arteries; 50–69% 13 arteries; 70–99% 23 arteries; 100% 12 arteries. Results: Ten of the 12 occlusions were identified, the 2 false-negatives were due to 2 revascularized vessels. Moderate stenoses (<50%) were differentiated from tight stenoses (>50%) using hemodynamic criteria. The majority of false-negative stenoses (38) in the different groups were related to intrathoracic or very deep origin of the artery, anechogenic stenosis or a tortuous vessel. Stenoses greater than 70% were diagnosed in 71% of cases with a specificity of 99%. The ĸ value was 0.80. Conclusion: Duplex sonography should be proposed first in VB attacks or stroke to detect and quantify vertebral artery stenoses for surgery and angioplasty.
Suicidal Ideas in Stroke Patients 3 and 15 Months after Stroke
Authors: Pohjasvaara T. , Vataja R. , Leppävuori A. , Kaste M. , Erkinjuntti T.
Published: April 2003

Patients with stroke may have an increased risk of suicide. We sought to examine the frequency and clinical correlates of suicidal ideas 3 and 15 months after stroke. The study group comprised 286 of 486 consecutive patients aged 55–85 years who at 3 and 15 months after ischemic stroke completed a detailed medical, neurological and radiological stroke evaluation, structured measures of cognition (Mini Mental State Examination), emotion (Beck Depression Inventory, BDI), disability (Rankin scale), and assessment of dependent living. Suicidal ideas were present in 9.8% (n = 28) at 3 months’ follow-up and in 14.0% (n = 40) at 15 months’ follow-up. The patients with suicidal ideas were more depressed measured by BDI both at 3 (17.0 vs. 7.9, p < 0.001) and 15 months (20.5 vs. 8.5, p < 0.001) after stroke compared to the patients without suicidal ideas. Patients with suicidal ideas had more often a history of a stroke already before the index stroke (35 vs. 18.3%, p = 0.0154), right-sided stroke (60.0 vs. 41.9%, p = 0.0323), they were more disabled according to the Rankin scale (2.4 vs. 1.9; p = 0.0035) and more dependent in living (45.0 vs. 27.2%, p = 0.023) 15 months after stroke. An independent correlate of suicidal ideas 15 months after stroke was history of prior stroke (OR 2.4; 95% CI 1.14–4.97) in logistic regression analysis. The frequency of suicidal ideas increased with the time elapsed from stroke. Recurrent strokes, depressive symptoms, more disabling stroke and right-sided stroke correlated to suicidal ideas at 15 months after stroke. Early identification of these risk factors may lead to effective therapeutic intervention.
Survival and Recurrent Strokes in Patients with Different Subtypes of Stroke: A Fourteen-Year Follow-Up Study
Authors: Eriksson Sven-Erik , Olsson Jan-Edvin
Published: April 2003

In this study, 339 patients (154 men, 185 women) with a median age of 74 years (range 23–97) admitted to the Stroke Unit, Department of Neurology in 1986, have been followed up for 14 years. The diagnoses were intracerebral hemorrhage (ICH; 30, 8.8%), cardioembolic cerebral infarction (CE, 71, 20.9%), lacunar infarction (LI; 47, 13.9%) and atherosclerotic cerebral infarction (ACI; 191, 56.3%). The cumulative probabilities of recurrent stroke rates at 1-, 5- and 10-year follow-ups were 13.5% (95% confidence interval, CI, 9.6–17.4), 38.7% (95% CI 32.6–44.8) and 53.9% (95% CI 46.7–61.1). According to Cox proportional hazard regression analysis, age, severity of stroke, previous stroke and systolic blood pressure are each of importance in predicting recurrent stroke. During the observation period, 290 patients (85.5%) died. The mortality rate of 24.5% during the first year was 4.5 times higher compared to the normal population of the same age and gender. Patients with LI had lower mortality rates compared to ICH by the log rank test (p = 0.0275); to CE (p = 0.000) and to ACI (p = 0.049). Thirty-nine percent of all vascular deaths after the first year were caused by recurrent strokes. Fatal index/recurrent stroke occurred statistically more frequently in the CE group versus the non-CE one (p = 0.005). Cox proportional hazard regression analysis indicated that age, severity of stroke, previous stroke, heart failure and fasting blood glucose exceeding 6 mmol/l or history of diabetes were each predictors of mortality. In conclusion, this study has shown the worse outcomes for all subtypes of stroke compared to the normal population and also clearly pointed out independent predictors of recurrent stroke or death at the time of diagnosis.
Quantitative Regional Cerebral Blood Flow Measurement Techniques Improve Noninvasive Detection of Cerebrovascular Vasospasm after Aneurysmal Subarachnoid Hemorrhage
Authors: Horn P. , Vajkoczy P. , Bauhuf C. , Münch E. , Poeckler-Schoeniger C. , Schmiedek P.
Published: April 2003

Adequate therapy of vasospasm (VS) in patients suffering from aneurysmal subarachnoid hemorrhage critically depends upon early and reliable diagnosis of cerebral hypoperfusion. The objective of the present study was to evaluate the usefulness of quantitative regional blood flow (rCBF) analysis as an adjunct in noninvasive prediction of VS. Therefore, 33 transcranial Doppler sonography (TCD) studies assuming cerebrovascular VS (TCD flow velocity >120 cm/s) were followed by sXe/CT and cerebral panangiography (PA). TCD plus sXe/CT significantly increased the predictability of VS from 34 to 91%, proving that a combination of TCD and rCBF studies improves the noninvasive detection of VS and might help to prevent unnecessary angiographic examinations.
Carotid Artery Stenosis in Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation
Authors: Chang Yeu-Jhy , Ryu Shan-Jin , Lin Shinn-Kuang
Published: April 2003

Purpose: To study the prevalence, severity and clinical relevance of carotid atherosclerosis in ischemic stroke patients with nonvalvular atrial fibrillation (NVAF). Material and Methods: We reviewed carotid duplex sonography, computed tomography (CT) and clinical features in 103 consecutive ischemic stroke patients with NVAF. Both sonography and CT were performed within 3–7 days after stroke. There were 64 men and 39 women with a mean age at stroke onset of 69 years. Results: High-grade (≧50%) stenosis of the extracranial carotid artery was detected in 25 patients (24.3%), including 11 patients (10.6%) with internal carotid artery (ICA) occlusion. In 15 (66.7%) of the patients who had high-grade carotid stenosis, the lesion was ipsilateral to the infarct, including 8 ICA occlusions. Patients with high-grade stenosis smoked more cigarettes (p < 0.05) and had more peripheral vascular diseases (p < 0.05). Besides NVAF, all patients had more than one vascular risk factor. The clinical presentations (transient ischemic attacks, minor or major strokes) showed no significant difference between the groups of <50% and ≧50% stenosis. Clinical outcome was worse (dead and totally dependent in daily activities) in the group of high-grade stenosis (p < 0.05). Patients with high-grade carotid stenosis showed more cortical infarcts on cerebral CT (p < 0.01). Six out of 7 patients with a hemorrhagic transformation on the initial cerebral CT were in the low-grade carotid stenosis group, though this was statistically insignificant. Conclusions: Ischemic stroke with NVAF is not always cardiogenic. High-grade stenosis of the extracranial carotid artery is found in one fourth of ischemic stroke patients with NVAF and is related to more cortical infarction and worse clinical outcome. We speculate that ischemic stroke patients with NVAF who have high-grade carotid stenosis are less likely to develop hemorrhagic infarct. The pathogenesis of cerebral infarction and the therapeutic strategy in this clinical condition are complicated by the coexistence of carotid arterial lesions and cardiac disease.
Angioplasty and Stenting for Total Symptomatic Atherosclerotic Occlusion of the Subclavian or Innominate Arteries
Authors: González A. , Gil-Peralta A. , González-Marcos J.R. , Mayol A.
Published: April 2003

Bypass grafting is considered the treatment of choice for occlusions of supraaortic vessels. Percutaneous transluminal angioplasty (PTA) is a well-established treatment for patients with subclavian stenosis, but its efficacy in total subclavian or innominate occlusions is so far not well established. Since 1995, we have carried out 9 PTA revascularizations in 9 patients with total symptomatic atherosclerotic occlusion of supraaortic vessels. The technical success rate was 100%, without any major (death or stroke) or minor complications. In the follow-up period (mean 37.4 months), 1 patient had a symptomatic left internal carotid artery occlusion and an asymptomatic occlusion of the treated subclavian artery. In expert hands, stenting-PTA should be considered as the primary therapeutic option.
Thrombolytic Therapy in Acute Ischaemic Stroke
Authors: Thomassen Lars , Waje-Andreassen Ulrike , Morsund Åse Hagen , Hordnes Julie , Maintz Corinna , Smievoll Alf I. , Russell David
Published: April 2003

Background: The aim of this study was to assess the feasibility, clinical effect and safety of intravenous thrombolysis with tissue plasminogen activator in patients with acute ischaemic stroke treated in an acute stroke unit. Methods: All patients admitted within 3 h after an acute ischaemic stroke were considered for thrombolysis. Twenty-four patients were treated. Results: Ten patients demonstrated early clinical improvement compatible with a positive effect of thrombolysis. Five patients demonstrated a substantial but slow clinical improvement with an uncertain relationship to thrombolysis. Nine patients did not improve. One patient developed an intracerebral haematoma and 2 developed a haemorrhagic infarction without clinical deterioration. Five patients (21%) died within the first 3 months. At follow-up after 6 months, 10 patients (42%) had achieved independence [modified Rankin Scale (mRS) 0–2], 9 (33%) had an unfavourable outcome (mRS 3–5) and 5 patients (21%) had died. None of these 5 patients died due to a treatment complication. Conclusions: This study in a small patient population suggests that thrombolysis may be administered relatively safely in an acute stroke unit without intensive care facilities. The clinical effect and safety were similar to those which have been found in large randomised studies and clinical series.
Neurological Outcome and Quality of Life after Stroke due to Vertebral Artery Dissection
Authors: Czechowsky Diana , Hill Michael D.
Published: April 2003

Background: Vertebral artery dissection is a well-recognized cause of posterior circulation stroke for which there is relatively little information on long-term outcomes. Quality of life (QOL) is an important patient-centred outcome measure. Methods: Stroke due to vertebral artery dissection was conservatively defined by neuroimaging documentation. Thirty sequential cases were identified based on a retrospective database and chart review with prospective follow-up. Surviving patients completed the Short Form-36 (SF-36) and the Stroke-Specific Quality of Life (SSQOL) scales and were subsequently examined neurologically and scored on the National Institutes of Health Stroke Scale (NIHSS). Comparisons were made between outcome on the stroke scale and QOL scales and between outcome on the SF-36 and the Canadian population. Results: There was discordance between outcomes recorded on a standard stroke scale and QOL measures with more patients scoring poorly on QOL measures. QOL was low in one third of the survivors. Overall QOL was significantly lower than the general population. Conclusions: Stroke due to vertebral artery dissection results in poorer outcomes on patient-centred QOL measures than on a standard stroke scale.
Inflammatory Leukocyte Infiltration in Focal Cerebral Ischemia: Unrelated to Infarct Size
Authors: Fassbender Klaus , Ragoschke Andreas , Kühl Sandra , Szabo Kristina , Fatar Marc , Back Walter , Bertsch Thomas , Kreisel Stefan , Hennerici Michael
Published: April 2003

Objective: An inflammatory host response in the ischemically injured brain is well documented. However, its pathophysiological relevance is uncertain. We investigated whether inflammatory leukocyte response in the ischemic brain alters infarct size. Methods: The cellular inflammatory response to cerebral ischemia in Wistar-derived rats induced by the transient occlusion of the middle cerebral artery with a thread was pharmacologically upmodulated by lipopolysaccharide (LPS) or downmodulated by continuous infusion of carboxylated sialyl Lewisx (sLex). The effects of such experimental modulation of focal cerebral leukocyte recruitment on the extent of the resulting infarction were assessed. Results:Compared to control treatments, LPS strongly enhanced (540.5 ± 504.8 vs. 94.6 ± 60.6, p < 0.01) and sLex decreased (32.8 ± 29.1vs. 97.0 ± 49.7, p < 0.05) the numbers of neutrophils at the investigated sites in cerebral ischemia. Unexpectedly, despite such marked experimental modulation of leukocyte infiltration in the ischemic brain, the extent of the resulting cerebral infarction (percent of total hemisphere) remained unchanged under these different conditions (54.5 ± 10.8vs. 53.0 ± 19.1, n.s. and 50.3 ± 18.0 vs. 57.2 ± 10.0, n.s., respectively). Conclusions: The striking dissociation between the massively altered inflammatory leukocyte infiltration in the ischemic brain and the unchanged infarct outcome indicates that intracerebral inflammatory leukocyte recruitment is not a major pathogenic factor in the development of ischemic tissue damage.
Stereological Study of Normal and Apoptotic Cell Populations in the Adrenal Gland in Calves
Authors: Blanco A. , Monterde J.G. , Méndez A. , Artacho-Pérula E.
Published: April 2003

Morphometrical features of the adrenal gland in calves were assessed using stereological methods for normal and apoptotic cells. Adrenal glands were obtained from calves (n = 16) after they were slaughtered in a commercial abattoir. Quantitative data of nuclear size showed the highest values in the noradrenaline-storing region for all parameters, whereas the nuclei of the zona fasciculata were significantly larger than those of the other cortical regions. Data of nuclear size and shape of apoptotic cells reflected their morphometrical features; as expected, a notable decrease in the nuclear size and a more irregular shape were found in apoptosis with respect to the normal nuclei in all adrenal regions. The volume fraction data supplied the percentage of the adrenal gland occupied by each histological zone, highlighting the zona fasciculata as being the most extensive one. A significant increase in VV(nucl/tis), SV(nucl/tis), and Nv(nucl/tis) was observed in cortical regions with respect to the medullar regions. A comparison between normal and apoptotic nuclei indicated a highly significant decrease in VV(nucl/tis), SV(nucl/tis), and Nv(nucl/tis) for the apoptotic nuclei in all the adrenal zones. The apoptotic nuclei figures found in all the adrenal regions suggest that a process of cell renovation occurred in all the zones, although the higher number of apoptosis in zona reticularis is in agreement with previous results that have pointed out this zone as being a cell senescence region. The results of discriminant analyses gave the parameter required and the percentage of correct classifications for discriminating between normal nuclei, between apoptotic nuclei and between normal and apoptotic nuclei.
Expression of Midkine in Regenerating Skeletal Muscle Fibers and Cultured Myoblasts of Human Skeletal Muscle
Authors: Hu Jing , Higuchi Itsuro , Yoshida Yoshihiro , Shiraishi Tadafumi , Osame Mitsuhiro
Published: April 2003

Midkine is a member of a family of developmentally regulated neurotrophic and heparin-binding growth factors. The expression of midkine was examined immunohistochemically in biopsied muscle specimens from patients with various myopathies. The intense immunoreactivity of midkine was observed in the sarcoplasm at an early stage regenerating fibers of small diameter. Midkine immunoreactivity was also detected in cultured human skeletal muscle myoblasts from the proliferation stage to the differentiation stage. These results suggest that midkine may be an important skeletal muscle growth-promoting factor that participates in the growth process during skeletal muscle development, proliferation, and differentiation, and in the skeletal muscle regeneration in various neuromuscular disorders. This is the first report demonstrating the presence of midkine in skeletal muscle cells.
Does Down’s Syndrome Protect against Multiple Sclerosis?
Authors: Weilbach Franz X. , Toyka Klaus V.
Published: April 2003

Background: A higher incidence of certain autoimmune disorders has been reported in Down’s syndrome (DS) but only 1 case of DS associated with multiple sclerosis (MS) has been published to date. Methods: We performed a calculation based on population and prevalence data of each condition to estimate the expected coprevalence of both diseases. As no published data on DS prevalence are available, a rough estimate was calculated from live birth rates and published life tables. Results: In a total of 116,939 assumed cases of patients with DS in Western Europe 102 patients with concordant MS would be expected at any time point according to the incidence of MS, but only 1 case was reported. Conclusion and Hypothesis: We propose the hypothesis that despite a propensity in DS for certain autoimmune diseases there is a negative association of DS and MS. Genes located on chromosome 21 may thus confer protection against MS. Candidate genes for protective immunomodulation might include interferon receptor I and II and S100b. Substantiated by further epidemiologic data, the identification of these and other chromosome 21 gene products may provide new hints for the understanding of modulatory genes in the pathogenesis of MS. In more general terms, this negative association also may allow to study basic principles of how certain candidate genes might act on autoimmune disease expression.
Antibody-Induced Botulinum Toxin Therapy Failure: Can It Be Overcome by Increased Botulinum Toxin Doses?
Authors: Dressler Dirk , Münchau Alexander , Bhatia Kailash P. , Quinn Niall P. , Bigalke Hans
Published: April 2003

In some patients treated with botulinum toxin type A (BT) therapy failure occurs due to the formation of antibodies against BT (BT-AB). We investigated whether increased BT doses can overcome this form of therapy failure. Eight patients with cervical dystonia, secondary BT therapy failure and evidence of BT-AB formation in the mouse diaphragm bioassay received BT test doses (Dysport®, Ipsen Ltd., Maidenhead, Berks, UK) into one of their sternocleidomastoid muscles. Test doses were increased in three steps at 3-month intervals and their effect on the amplitude of the electromyographic activity of the sternocleidomastoid muscle under maximal isometric activation (M-EMG) was measured and compared to a control group. In step 1 (200 or 300 MU) the M-EMG reduction was 12 ± 13% compared to 85 ± 10% (200 MU) and 83 ± 9% (300 MU) in the control group. In step 2 (400, 600 or 800 MU) the M-EMG reduction was 25 ± 21% compared to 78 ± 7% (400 MU) in the control group. In step 3 (1,600 or 1,800 MU) the M-EMG reduction was 24 ± 10%. Side effects were not observed in any of the patients studied. In 1 patient with partial secondary BT therapy failure, with a low BT-AB titre (0.0015 U/ml) and with a moderately pathological M-EMG reduction of 40% with 200 MU a normal M-EMG reduction of 71% could be regained with 800 MU. In three subsequent therapeutic injection series with quadrupled BT doses in all target muscles the original therapy outcome could be regained and maintained. Side effects or increasing BT-AB titres were not observed. Even massively increased BT doses cannot overcome BT-AB-induced complete secondary therapy failure. However, in patients with partial secondary therapy failure, low BT-AB titres and a moderately pathological M-EMG reduction, increased BT doses might regain and maintain normal BT efficacy without induction of side effects or increasing BT-AB titres.
Detection of Microembolic Signals in Patients with Neuropsychiatric Lupus erythematosus
Authors: Kumral Emre , Evyapan Dilek , Keser Gökhan , Kabasakal Yasemin , Oksel Fahrettin , Aksu Kenan , Balkir Kaan
Published: April 2003

The pathogenesis of central nervous system involvement in systemic lupus erythematosus (SLE) is not completely understood. In this study, we investigated the association of microembolic signals (MES) with a variety of neuropsychiatric SLE manifestations and compared our results with those from SLE patients without neuropsychiatric lupus and normal controls. Fifty-three patients with SLE (45 females and 8 males), all fulfilling the revised classification criteria for SLE, and 50 control subjects (44 females and 6 males) were enrolled in this study. All SLE patients were assessed by neuropsychological examination, including various neuropsychiatric tests. Twenty-five patients with SLE were found to have at least one of the neuropsychiatric syndromes defined by The American College of Rheumatology. The mean MES count in patients with neuropsychiatric lupus was significantly higher than those without (5.4 ± 1.1 vs. 0.3 ± 0.8/h; p < 0.005). We found a positive correlation between higher mean MES counts and the presence of neuropsychiatric syndromes in SLE. The mean MES count in the whole group of SLE patients was also significantly higher than that in healthy controls. The mean MES count of SLE patients with antiphospholipid (aPL) antibody positivity was significantly higher than those without aPL antibodies (3.6 ± 1.6 vs. 0.8 ± 0.1/h; p < 0.005). In conclusion, the association of MES with neuropsychiatric lupus may support the possible contribution of MES to the complex pathophysiology of this syndrome. More importantly, detection of MES on transcranial Doppler monitoring might suggest a high risk of involvement of the central nervous system in SLE, and could be used as a diagnostic tool.
First Case of Trisomy 13 plus Mosaic Trisomy 1q
Authors: Liehr Thomas , Schmidt Matthias , Starke Heike , Ziegler Monika , Kittner Gabriele , Heller Anita , Rubtsov Nikolai , Trifonov Vladimir , Claussen Uwe
Published: April 2003

Objectives: In a case with severe sonographic abnormalities followed by missed abortion in week 14 + 5 days, cytogenetic analysis was performed on placental tissue. A mosaic karyotype 47,XY,+13,add(1)(q44)[3]/47,XY, +13[9]/46,XY[36] was detected. The purpose of the present study was to characterize the additional material on chromosome 1q. Methods: According to GTG banding, the additional material on chromosome 1 was most probably chromosome 1 material. Thus, multicolor banding analysis using a chromosome 1 specific probe set was done to precisely describe the rearranged chromosome 1. Results: Molecular cytogenetic approaches revealed that the derivative chromosome 1 was der(1)(1p36.3→1q44::1q12→1q44). Conclusions: This is the first description of a case with a trisomy 13 plus a partial trisomy 1q presenting with clinical signs of both aberrations. Moreover, the multicolor banding technique is suited to resolve complex karyotypes in the prenatal diagnosis, i.e., chromosome preparations of fibroblasts.
Influence of Volume Preloading on Uteroplacental and Fetal Circulation during Spinal Anaesthesia for Caesarean Section in Uncomplicated Singleton Pregnancies
Authors: Tercanli Sevgi , Schneider Markus , Visca Eva , Hösli Irene , Troeger Carolyn , Peukert Regina , Holzgreve Wolfgang
Published: April 2003

Objective: Effects of volume preloading during spinal anaesthesia for elective caesarean section on maternal blood pressure, feto-maternal circulation and fetal outcome. Patients and Methods: In a pilot study a randomised trial was performed in 22 healthy women with uncomplicated, singleton pregnancies at 36–40 weeks of gestation undergoing elective caesarean section under spinal anaesthesia. In the low volume group (group A) patients received 150 ml of crystalloid solution for preloading, in the high volume group (group B) they were given 15 ml/kg of crystalloid solution for preloading before the initiation of spinal anaesthesia. Maternal blood pressure was monitored intermittently. Hypotension was defined as a decrease in systolic pressure to less than 80% of the baseline value. The Doppler flow evaluation consisted of measurements from the uterine artery at the placental site, fetal umbilical artery and fetal middle cerebral artery. Pulsatility indices were derived before and after fluid preloading, and when spinal anaesthesia was established. The neonatal outcome was assessed by Apgar scores, arterial acid base status and neurologic and adaptive capacity scores (NACS). Results: The incidence of maternal hypotension in both groups was 45.5% (n = 10); 3 cases occurred in group A compared to 7 cases in group B (n.s.). There was no evidence that the high dose volume is useful in preventing maternal hypotension. The pulsatility indices of uterine arteries, umbilical arteries and middle cerebral arteries were not altered. Statistical analysis showed no changes in neonatal outcome concerning umbilical arterial pH, Apgar score and NACS (n.s.) between groups A and B. Conclusions: Our preliminary results suggest that high dose crystalloid volume preloading has no preventive function in the avoidance of maternal hypotension in healthy parturients undergoing elective caesarean section under spinal anaesthesia, and shows no harmful effects on neonatal outcome as long as maternal hypotension is corrected immediately. However, the statistical significance may reflect the small sample size, and larger series are needed before changing the current management.
Intervillous and Spiral Artery Flows in Normal Pregnancies between 5 and 10 Weeks of Amenorrhea Using Color Doppler Ultrasonography
Authors: Alouini S. , Carbillon L. , Perrot N. , Uzan S. , Uzan M.
Published: April 2003

Objective: The aim of our study was to investigate early placental circulation development and spiral and uterine artery flows in normal 1st-trimester pregnancies. Methods: A prospective study of intervillous and spiral artery flows in 49 normal pregnancies (5–10 weeks of amenorrhea) was performed. Transvaginal color and pulsed-wave Doppler techniques (6-MHz probe) were used as routine ultrasound scanning modalities before pregnancy termination for psychosocial reasons. Results: In all pregnancies, between 5 and 10 weeks, continuous nonpulsatile intervillous flow (mean Vmax 3.55 cm/s) and spiral artery flow (mean peak systolic velocity 16.2 cm/s, mean diastolic index D/S 0.49 ± 0.089) were detected. In the 47 women in whom the uterine artery flow was measured, the mean peak systolic velocity was 67.5 cm/s, the mean diastolic index was 0.12, and bilateral notching was observed. Conclusions: In all cases, between 5 and 10 weeks, slow and continuous nonpulsatile intrachorionic flow could be detected, whereas pulsatile flow was detected in spiral arteries. The true nature of this early intervillous circulation remains to be determined.
Prenatal Diagnosis of Fetal Complete Atrioventricular Block with QT Prolongation and Alternating Ventricular Pacemakers Using Multi-Channel Magnetocardiography and Current-Arrow Maps
Authors: Hosono Takayoshi , Shinto Mika , Chiba Yoshihide , Kandori Akihiko , Tsukada Keiji
Published: April 2003

We report a case of fetal complete atrioventricular block (CAVB) with QT prolongation and alternating ventricular pacemakers diagnosed by magentocardiography (MCG). Fetal bradyarrhythmia of around 60 bpm was detected at 30 weeks of gestation. Ultrasonography revealed fetal CAVB without structural cardiac anomalies. MCG was recorded at 30 weeks of gestation using a 64-channel superconducting quantum interference device (MC-6400, Hitachi, Japan). The averaged MCG revealed QT prolongation, and the current-arrow maps generated by MCG revealed alternating ventricular pacemakers. The diagnosis was confirmed by electrocardiogram after birth. A permanent pacemaker was implanted during the early neonatal period, and the infant was healthy at 6 months of follow-up. MCG may be a useful diagnostic tool for fetal CAVB with QT prolongation and alternating ventricular pacemakers.
Congenital Micropenis: Long-Term Medical, Surgical and Psychosexual Follow-Up of Individuals Raised Male or Female
Authors: Wisniewski Amy B. , Migeon Claude J. , Gearhart John P. , Rock John A. , Berkovitz Gary D. , Plotnick Leslie P. , Meyer-Bahlburg Heino F.L. , Money John
Published: April 2003

Objectives: to document long-term medical, surgical and psychosexual outcome of individuals with congenital micropenis (13 males, 5 females). Methods: Physical measurements from childhood were collected retrospectively from medical records and at adulthood by physical examination. An adult psychosexual assessment was conducted with a written questionnaire and oral discussion. Results: Adult penile length was below the normal mean in all men. Three women had vaginoplasty resulting in normal length. All men reported good or fair erections but 50% were dissatisfied with their genitalia. Dissatisfaction with body image resulted from having a small penis (66%), inadequate body hair (50%), gynecomastia (33%) and youthful appearance (33%). Ten men were heterosexual, 1 homosexual and 2 bisexual. Among women, 4 (80%) were dissatisfied with their genitalia. Three women reported average libido with orgasm and were also heterosexual. Two women had no sexual interest or experience. Finally, males were masculine and females feminine in their gender-role identity, and both groups were satisfied with their sex of rearing. Conclusions: Regarding choice of gender, male sex of rearing can result in satisfactory genito-sexual function. Female gender can also result in success, however it requires extensive feminizing surgery.
Computer-Guided, Population-Based Screening System for Growth Disorders (CrescNet®) and On-Line Generation of Normative Data for Growth and Development
Authors: Kiess W. , Gausche R. , Keller A. , Burmeister J. , Willgerodt H. , Keller E.
Published: April 2003

The mean age at which the diagnosis of growth disorders such as Turner’s syndrome, growth hormone (GH) deficiency or true GH-dependent gigantism is established is still rather late in many countries around the world. In addition, the question of secular trends in a given population and the rate at which childhood obesity is increasing in industrialized countries make it mandatory to establish a time-adapted system to develop percentiles for body height, weight and body mass index (BMI) and also to develop a screening system for growth disorders. In 1998 we established a network, now involving more than 160 paediatric practices in Germany and seven paediatric endocrinology departments. Paediatricians record heights, weights and growth velocities of all children in their care and systematically feed the data into the database at our centre usually by mailing formatted, structured data tickets. Data are then continuously analysed at the centre and the paediatricians in the network are informed immediately about their individual patients’ growth situations via phone or E-mail (feedback system). Regular annual conferences including structured reports, scientific presentations and discussion groups are organized for all participants at our centre. By May 2001, the data of 83,721 children and adolescents had been analysed. The mean values for height were 1–1.5 cm higher than the mean values in the German Synthetic Growth Curve, which serves as an internal standard. However, and most importantly, in comparison with the internal standard and historical normative data from Germany and Switzerland, there is a continuous increase in the 97th percentile for weight and BMI, while the third percentile remains unchanged. In addition, many children with short stature and tall stature due to a variety of endocrine disorders and genetic diseases which had not been diagnosed previously are now being identified. In conclusion, the databank allows for a continuous adaptation of normative curves based on a large number of children in a given population, i.e. eastern Germany. Secondly, the system allows for detection of pathological growth curves and is already serving to diagnose growth disorders in a defined population in a systematic way.
Identification and Characterization of Che a 1 Allergen from Chenopodium album Pollen
Authors: Barderas Rodrigo , Villalba Mayte , Lombardero Manuel , Rodríguez Rosalía
Published: April 2003

Background: Pollinosis to Chenopodium album has been reported, but no data are available on its allergenic proteins. Methods: An allergen from C. album pollen has been isolated by means of gel permeation and reverse-phase high-performance liquid chromatography. Molecular characterization was achieved by concanavalin A reaction, mass spectrometry, Edman degradation and cDNA sequence. Antigenic analyses were performed by immunoblotting, ELISA, and ELISA inhibition, using sera from allergic patients, two Ole e 1-specific monoclonal antibodies and an Ole e 1-specific polyclonal antiserum. Results: The isolated allergen, Che a 1, is a glycoprotein of molecular mass 17.088 kD and 143 amino acid residues, whose sequence exhibits 27–45% identity with known members of the Ole e 1-like protein family. 77% of sera from patients allergic to chenopod pollen were reactive to Che a 1. No correlation was found between the IgE reactivities to Che a 1 and Ole e 1, the major allergens from olive pollen, and both allergens display low, although detectable, IgE and IgG cross-reactivities. Conclusions: Che a 1, a relevant allergen from chenopod pollen, is structurally related to the Ole e 1-like protein family, but exhibits significant differences on its polypeptide sequence that could explain its different antigenic behavior and limited cross-reactivity.
Cutaneous Mastocytosis – Clinical Heterogeneity
Authors: Hartmann Karin , Henz Beate M.
Published: April 2003

Cutaneous mastocytosis (CM) encompasses several distinct patterns of disease which can be distinguished by the type of skin lesions, age of onset, familial occurrence, noncutaneous involvement, associated c-kit mutations, and prognosis. A clear distinction of the type of CM in individual patients has important implications regarding patient management and prognosis.
Up-Regulation of Vasopressin and Angiotensin II Receptors in the Thalamus and Brainstem of Inbred Polydipsic Mice
Authors: Tribollet Eliane , Ueta Yoichi , Heitz Freddy , Marguerat Anouk , Koizumi Kiyomi , Yamashita Hiroshi
Published: April 2003

Vasopressin (AVP), angiotensin II (Ang II) and oxytocin (OT) receptors were mapped in the brain of inbred polydipsic mice of the STR/N strain by quantitative in vitro autoradiography and receptor binding levels, compared with those found in control non-polydipsic mice of the ICR strain. A remarkable difference was evidenced in the thalamic paraventricular nucleus where AVP receptor binding was 7- to 10-fold higher in polydipsic mice than in control mice. Another disparity was observed in the hypothalamic paraventricular nucleus, which contained AVP binding sites in the control mice, but was unlabelled in the polydipsic animals. Ang II receptor binding was reduced in the hypothalamic paraventricular nucleus of the polydipsic mice, whereas it was abundant in the brainstem region, encompassing area postrema and the nucleus of the solitary tract. The distribution and amount of OT receptor binding were similar in the polydipsic and control mice. Strain-related differences of AVP and Ang II receptor binding were observed both in male and female animals. A sex-related difference was seen only for OT receptor binding in the hypothalamic ventromedial nucleus, where labelling was less intense in males than in females of both strains. Altogether, our results support the view that central AVP and Ang II systems are involved in the mechanisms responsible for polydipsia in STR/N mice.
Significance of Genetic Variation at the Glutathione S-Transferase M1 and NAD(P)H:Quinone Oxidoreductase 1 Detoxification Genes in Breast Cancer Development
Authors: Siegelmann-Danieli Nava , Buetow Kenneth H.
Published: April 2003

This work examined the role of constitutional genetic variation at the glutathione S-transferase M1 (GSTM1) and NAD(P)H:quinone oxidoreductase 1 (NQO1) detoxification loci in breast cancer development. Methods included contrasting patterns of genetic variations at these loci between cases with breast cancer and healthy controls and assessing the association of genotypes with tumor characteristics. Participants were Caucasian women living in the Greater Philadelphia region, recruited from 1988 to 1994, with recently diagnosed women attending breast cancer clinics at Fox Chase Cancer Center (FCCC) and network affiliated hospitals as cases, and FCCC employees or women attending noncancer clinics as controls. The GSTM1 locus was determined for 402 cases and 238 controls, NQO1 for 346 cases and 235 controls. Results show that neither locus was associated with breast cancer occurrence, with the GSTM1 null genotype occurring at frequencies of 0.560 and 0.563 in cases and controls, respectively [odds ratio (OR) 0.98, 0.95 confidence interval (CI) 0.70–1.38] and the NQO1 wild-type allele at frequencies of 0.808 and 0.845, respectively (OR 0.77, 0.95 CI 0.55–1.06). The GSTM1 null genotype, however, was significantly overrepresented among larger (T3 and T4) primary tumors (OR 7.61, 0.95 CI 1.05–333) and with the occurrence of axillary lymph node metastases (OR 1.62, 0.95 CI 0.98–2.69). NQO1 results revealed that homozygotes for the wild type allele were more likely to have ductal carcinoma and poor histologic grade when compared with individuals carrying one or two mutated alleles (OR 3.50, 0.95 CI 1.41–9.0, and OR 2.26, 0.95 CI 1.18–4.35 for histology type and grade, respectively). We conclude that while these loci are not associated with breast cancer occurrence, the GSTM1 locus is likely associated with tumor progression. NQO1 results suggest that different quinones (possibly estrogenic quinone metabolites) might affect the histological development of breast tumors.
Laser Vitreolysis
Authors: Fankhauser Franz , Kwasniewska Sylwia
Published: April 2003

Strands and vitreous adhesion bands can either be dissected noninvasively, transpupillarily by photodisruptive pulses of a Nd:YAG laser, operated in the photodisruptive mode, or invasively using an Er:YAG laser and specialized fibers. The previously used CO2, Ho:YAG, and ultraviolet lasers have become less popular in the recent past. When using the transpupillary method, specialized contact lenses are required. Noninvasive methods avoid the risks incurred with invasive methods, but they require specialized knowledge, which is not available usually in vitreoretinal services. The invasive laser method provides a number of advantages typical of laser-tissue interaction. Advances in electrosurgical methods have opened the door to a new class of miniaturized electrosurgical equipment with which tissue dissection is made possible by plasma due to dielectrical breakdown which allows the pulse energy to be reduced to a very low level, resulting in a highly localized tissue effect. None of these methods has yet been considered for clinical use, mainly because the presently used mechanical methods are thought to be optimal by the majority of vitreoretinal surgeons.
Choroidal Vasculature Changes in Spontaneously Hypertensive Rats – Transmission Electron Microscopy and Scanning Electron Microscopy with Casts
Authors: Bhutto Imran Ahmed , Amemiya Tsugio
Published: April 2003

Purpose: The purpose of the present study was to elucidate the specific morphological changes of the choroidal vasculature in long-term hypertension. Methods: The choroidal vessels of spontaneously hypertensive (SHR) rats were examined with corrosion casts/scanning electron microscope (SEM) and the transmission electron microscope (TEM). Results: In 18-month-old SHRs, corrosion casts and SEM showed tortuosity, caliber irregularity and generalized narrowing of the choroidal arteries. The draining venules were prominently decreased in number. The ampullae of the vortex veins were narrow, but arteriovenous anastomoses, crossing defects and obstruction were not seen. The choriocapillaris was elongated and engorged. TEM of the choroidal vessels showed hypertrophy of smooth muscle cells and irregular thickening of the basement membrane and narrow lumen of the choriocapillaris. The RPE and Bruch’s membrane were intact. Conclusion: The choroidal vascular bed showed extensive morphological changes. This study revealed that hypertensive choroidopathy has specific features such as tortuosity, caliber irregularity, generalized narrowing of arteries, decreased number of draining venules and elongated and engorged choriocapillaris. These findings indicate that hypertensive choroidopathy is as important as retinopathy.
Further Characterization of Human Mucin-Like Glycoprotein Associated with Photoreceptor Cells by Its Introduction into Y79 Retinoblastoma Cells
Authors: Yamashita Takehiro , Uehara Fumiyuki , Ozawa Masayuki , Ohba Norio
Published: April 2003

Purpose: To understand the function of a mucin- like glycoprotein associated with photoreceptor cells (MLGAPC), MLGAPC-transfected Y79 retinoblastoma cells were analyzed biochemically and morphologically. Methods: The cDNA for the core protein of human MLGAPC was isolated, cloned into a mammalian expression vector, pCAGGSneo, and then transfected into Y79 retinoblastoma cells. The cells and the medium were analyzed by means of Western blotting, and the morphology of the transfectants and parental cells was compared. Results: Western blot analysis of the culture medium revealed that the transfectants secreted MLGAPC into the medium. Lectin blot analysis of MLGAPC in the medium showed that it had a binding site for Maackia amurensis lectin II. No morphological difference was detected between the transfectants and parental cells. Conclusions: As expected from the deduced amino acid sequence of MLGAPC, it was secreted into the medium. The secreted MLGAPC was found to carry sialoglycans (rod type). The expression of MLGAPC had no effect on the adhesion or morphology of the cultured cells, which suggests that its interaction with other components may be required for these effects.
The Impact of Benign Prostatic Hyperplasia Surgery on Patients’ Quality of Life
Authors: Salinas Sánchez A.S. , Hernández Millán I.R. , Segura Martín M. , Lorenzo Romero J.G. , Virseda Rodríguez J.A.
Published: April 2003

Objective: To assess the impact of surgical treatment of benign hyperplasia of the prostate on patients’ quality of life (QoL). Material and Methods: The QoL of 181 patients was assessed by the health questionnaire SF-36. The measurement was carried out before and 6 months after surgery. Results: After surgery, SF-36 scales improved their scores, fundamentally General Health (57.4%) and Physical Functioning (57.1%). 70.3% improved their physical component summary (PCS) and 49.1% their mental component summary (MCS). The improved PCS and MCS were not associated with the improved I-PSS or urine flow. The improved PCS was 2.2 times higher in patients who had previously scored under 44 in the PCS, 2.2 in patients who had scored over 25 in the I-PSS, and 2.9 times higher in patients without chronic diseases. With regard to MCS improvement, this was 17.1 times higher in patients who scored under 50 previously on the MCS, 3.1 in patients who scored over 4 on the IQL, 5.7 in patients without postoperative incontinence, and 3.3 times higher in patients who lived in urban areas. Conclusions: Improvement in QoL after surgery is noted more in physical than in psychological aspects. Although a reduction in the intensity of prostatic symptoms and an increase in urine flow values were noted postoperatively, the improvement QoL was not associated with improved symptoms or urinary flow.
Quantification of Proteins Extracted from Calcium Oxalate and Calcium Phosphate Crystals Induced in vitro in the Urine of Healthy Controls and Stone-Forming Patients
Authors: Atmani Fouad , Khan Saeed R.
Published: April 2003

We have previously identified proteins extracted from calcium oxalate (CaOx) and calcium phosphate (CaP) crystals generated experimentally in vitro in whole urine of healthy controls and stone formers. No significant differences were detected between protein components in matrices of crystals obtained from both groups. The aim of the present study was to estimate the amounts of six proteins identified earlier in order to investigate the differences, if any, between healthy controls and lithiasis patients. CaOx and CaP crystals were generated in the urine samples by adding an oxalate and phosphate load, respectively. Crystals were harvested, washed, dried, and analyzed. Crystal matrix protein was extracted by demineralizing crystals with EDTA solution, analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis, and identified immunochemically using Western blot analysis. The quantity of each protein was estimated by densitometric analysis. The predominant proteins found in organic matrices of CaOx crystals induced in the urine of healthy controls were prothrombin-related proteins followed by albumin and osteopontin. In matrices of CaP crystals, the principal proteins were Tamm-Horsfall protein followed by albumin, prothrombin-related proteins and osteopontin. However, when crystals were induced in the urine of stone formers, albumin was the major component of the organic matrix of both CaOx and CaP crystals. We concluded that a subset of urinary proteins is present in crystal matrix. Among them, albumin seems to play a crucial role in kidney stone formation.