bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Pediatric Congenital Atlantoaxial Dislocation: A Report of 23 Cases from Northern India
Authors: Kumar Raj , Nayak Suresh Radhakrishna
Published: April 2003

From July 1996 to August 2001, we operated on 23 children (age 4–12 years) with congenital atlantoaxial dislocation (AAD). Sixteen had reducible AAD and 6 had the fixed type, while a single patient had basilar invagination. Preoperatively, these children were divided into four functional grades depending on the level of neurological deficits and dependence on others for activities of daily living (Di Lorenzo grades I–IV). There were only 2 patients with no deficits (grade I), while 15 of the 23 children presented with severe neurological deficits and were completely dependent for all activities of daily living (grade IV). Stigmata suggestive of congenital AAD were documented in 6 children and radiological osseous anomalies in 18 children. Transoral decompression and posterior stabilization was performed in 7 children, while 16 patients underwent the posterior stabilization procedure only. All patients were immobilized with a hard cervical collar postoperatively. Six children developed one or other treatable complications, of whom reoperation was indicated in 3, but could only be undertaken in 2 children. Retightening of the wire was done in 1 and further decompression of the odontoid process was carried out in the other. There was no postoperative deterioration in patients with no preoperative deficits (grade I). Ten out of the 15 children who were completely dependent for all activities in the preoperative period (grade IV) improved, and 6 children achieved normalcy or near normalcy (grade I or II). Three children deteriorated in the postoperative period, of whom 2 subsequently improved at follow-up. There were 2 deaths in the series; both these patients belonged to the severely compromised group (grade IV) and in addition had respiratory compromise. Bony fusion at the posterior stabilization site could be seen in 14 out of 16 patients screened. The various problems faced by the authors in managing these very fragile and severely compromised children with cervicomedullary compression due to congenital atlantoaxial dislocation in a setting with limited resources are discussed.
Intracranial Infantile Myofibromatosis with Intraparenchymal Involvement
Authors: Kaplan Stuart S. , Ojemann Jeffrey G. , Grange Dorothy K. , Fuller Christine , Park T.S.
Published: April 2003

Infantile myofibromatosis is the most common fibrous disorder of infancy and early childhood. Intracranial involvement is rare, with the majority of lesions being localized to the skull or dura with variable intracranial extension. We present the case of a 19-month-old girl with infantile myofibromatosis and an incidentally discovered, enlarging, calcified, posterior fossa mass. The patient underwent suboccipital craniotomy and resection of the lesion. This is the first report of the surgical removal of an intraparenchymal infantile myofibroma.
No Effect of Phenobarbital Pretreatment of Rats on Methotrexate Pharmacokinetics in the Isolated Liver Perfused in a Single-Pass Way
Authors: Chládek Jaroslav , Martínková Jiřina , Šišpera Luděk , Chládková Jiřina , Cermanová Jolana
Published: April 2003

Pretreatment of the rat with phenobarbital (PB) is known to increase gene expression of the canalicular multispecific organic anion transporter (cMOAT) and hepatobiliary transport of its substrates (glutathione, sulfobromophthalein). To determine the effect of PB on the hepatobiliary transport of methotrexate (MTX, another substrate of cMOAT) and its metabolism to 7-hydroxymethotrexate (7-OHMTX) in the rat, we compared the steady-state pharmacokinetics of MTX in the isolated liver of either PB-pretreated (80 mg/day/kg bw for 4 days, i.p.) or nonpretreated rats. The livers were perfused in a single-pass way at a flow rate of 15 ml/min using a perfusate which consisted of Krebs-Henseleit buffer containing glucose, taurocholate, bovine albumin and erythrocytes. During the perfusion with 50 µmol/l MTX, the steady-state biliary clearance (1.26 ± 0.24 ml/min) in 7 nonpretreated rats accounted for a major proportion of the hepatic clearance (1.30 ± 0.33 ml/min), metabolism of MTX to 7- OHMTX was minor (partial metabolic clearance = 0.041 ± 0.023 ml/min). MTX concentrations in bile surpassed those in the input perfusate by approximately 100-fold. Pretreatment of rats (n = 7) with PB did not change significantly the steady-state hepatic, biliary and partial metabolic clearances of 50 µmol/l MTX. An interesting result is a 38% increase in the hepatic vascular resistance of non-pretreated livers caused by MTX. The results suggest that in rats, pretreatment with PB has no effect on the hepatobiliary transport and hydroxylation of MTX.
TAS-301, a New Synthetic Inhibitor of Neointimal Thickening after Balloon Injury, Inhibits Calcium-Dependent Signal Transduction and Cytoskeletal Reorganization
Authors: Sasaki Eiji , Miyoshi Kazuhisa , Nozawa Yoshihisa , Kanda Atsuhiro , Nakano Kohshi , Yamasaki Yasundo , Miyake Hidekazu , Matsuura Naosuke
Published: April 2003

We previously demonstrated that a recently synthesized drug, TAS-301 [3-bis(4-methoxyphenyl)methylene-2-indolinone], inhibited neointimal thickening after single-balloon injury to the rat common carotid artery by inhibiting both the migration and proliferation processes of vascular smooth muscle cells (VSMCs). The purpose of this current study was to elucidate the possible mechanism of action for its inhibition of the migration process of VSMCs. We also determined the efficacy of TAS-301 on second neointimal formation 14 days after a double-balloon injury to the rat common carotid artery. Neointimal thickening, 14 days after second balloon injury, was reduced by the oral administration of TAS-301 in a dose-dependent manner. In in vitro assays using rat VSMCs, Western blot analysis showed that TAS-301 inhibited platelet-derived growth factor (PDGF)-induced tyrosine phosphorylation of both focal adhesion kinase and paxillin. Tyrosine phosphorylation of these proteins depended on the increment of intracellular calcium concentration ([Ca2+]i). The PDGF-induced elevation of [Ca2+]i and activation of Ca2+/calmodulin-dependent protein kinase II (CaM kinase II) were also inhibited by TAS-301. Additionally, TAS-301 at 10 µmol/l reduced the extent of F-actin stress fiber depolymerization observed in response to PDGF. These results indicate that TAS-301 reduced the intimal thickening after denudation to a pre-existing lesion to the same extent as it reduced that after a single-balloon injury to the normal artery. Furthermore, the results of our in vitro experiments suggest that antimigratory mechanisms of TAS-301 that contribute to preventing the intimal thickening might be mediated by drug inhibition of Ca2+-dependent signal molecules and the following cytoskeletal depolymerization.
Effect of Cyclooxygenase-2 Inhibitor (Celecoxib) on the Infarcted Heart in situ
Authors: Yamamoto Tadahiko , Kakar N. Rani , Vina Ernest R. , Johnson Paul E. , Bing Richard J.
Published: April 2003

Several attempts have been made to replace aspirin with compounds without gastric toxicity; a cyclooxygenase-2 (COX-2) inhibitor, celecoxib, and a nitric oxide-aspirin, NCX-4016, have been developed for this purpose. This paper compares effects of celecoxib, NCX-4016 and aspirin on production of prostacyclin (PGI2) and thromboxane A2 (TXA2) and activation of the inducible form of nitric oxide synthase (iNOS) in infarcted heart in situ. Aspirin was most effective in reducing myocardial PGI2 synthesis and formation of TXA2. Myocardial effects of celecoxib resemble those of NCX-4016, although the two compounds have different modes of action.
Inhibitory Effect of a TP-Receptor Antagonist, S-1452, on Antigen-Induced Nasal Plasma Exudation in Guinea Pig Model for Allergic Rhinitis
Authors: Yasui Kiyoshi , Asanuma Fujio , Arimura Akinori
Published: April 2003

S-1452, a selective thromboxane (Tx) A2 receptor (TP-receptor) antagonist, was evaluated in antigen- and U-46619 (a TxA2 mimetic)-induced guinea pig nasal plasma exudation models. Exposure of the nasal cavity of actively sensitized guinea pigs to aerosolized ovalbumin (OA) caused marked exudation of dye into both the nasal mucosa and nasal airway lumen. These responses were significantly inhibited by S-1452 (30 mg/kg, p.o.) as well as an H1-antihistamine, diphenhydramine (5 mg/kg, i.v.). In addition, exposure of the nasal cavity of nonsensitized guinea pigs to aerosolized U-46619 or histamine also resulted in nasal plasma exudation, and S-1452 (1 mg/kg, p.o.) almost completely suppressed the U-46619-induced response but did not affect the histamine-induced one, even at a high dose of 30 mg/kg. These results indicate that TxA2 as well as histamine may play an important role in antigen-induced nasal plasma exudation in guinea pigs, and S-1452 can be expected to be useful for the treatment of allergic rhinitis.
Alteration of Drug Kinetics in Rats following Exposure to Trichloroethylene
Authors: Kukongviriyapan Veerapol , Simajareuk Suthanee , Kukongviriyapan Upa , Cha-on Ubon , Airarat Wanchai
Published: April 2003

The effect of trichloroethylene (TCY) was investigated to determine whether repeated exposure alters the pharmacokinetics of some drugs. Sprague-Dawley rats were given intraperitoneal injections of TCY (5 mmol/kg) in corn oil once daily for 3 days, while the control group received only corn oil. Four hours after the last dose, theophylline, quinidine, or pentobarbital were administered. Blood samples were collected at appropriate intervals for drug analyses. There was a small decrease in plasma clearance of theophylline, with no change in volume of distribution (Vd) as compared with controls. For quinidine, the elimination half-life was unchanged, and the Vd was decreased by 40%. The clearance of pentobarbital was decreased by 40% in male rats, but not in the females. Nonetheless, the duration of the sleeping time for both sexes was remarkably prolonged as compared with the control group. There was a decrease in the cytochrome P-450 content only in male rats. In conclusion, exposure to TCY causes changes in some drug kinetics, probably resulting from differential effects on the drug-metabolizing enzymes.
Activation of the Metallothionein IIA Promoter and Other Key Stress Response Elements by Ursodeoxycholate in HepG2 Cells: Relevance to the Cytoprotective Function of Ursodeoxycholate
Authors: Bernstein Carol , Payne Claire M. , Bernstein Harris , Garewal Harinder
Published: April 2003

Ursodeoxycholate, used to treat a variety of pathologies, has the ability to reverse cytotoxic and hepatotoxic conditions. We examined HepG2, a hepatic cell line, treated with increasing levels of ursodeoxycholate, for responses of a range of promoters/response elements responsive to DNA damage, heavy metal ions, protein denaturants, aromatic hydrocarbons, retinoids, changes in intracellular AMP levels, end endoplasmic reticulum stress. The metallothionein IIA promoter was the most highly activated by ursodeoxycholate. Since ursodeoxycholate protects against the cytotoxic effects of deoxycholate, our data, combined with observations made by others, implicate metallothionein IIA as being important in this protective pathway.
Binding and Functional Affinity of Sarpogrelate, Its Metabolite M-1 and Ketanserin for Human Recombinant Alpha-1-Adrenoceptor Subtypes
Authors: Israilova Malika , Suzuki Fumiko , Tanaka Takashi , Nagatomo Takafumi , Taniguchi Takanobu , Muramatsu Ikunobu
Published: April 2003

Serotonin (5-HT2) antagonists show high affinity for the α1-adrenoceptor (α1-AR) in addition to the 5-HT2 receptor. In the present study we compared the pharmacological characteristics of a new 5-HT2 antagonist sarpogrelate and its active metabolite M-1 with those of ketanserin on human recombinant α1-AR subtypes. In the binding study, sarpogrelate, M-1 and ketanserin produced concentration-dependent inhibition of 3H-prazosin binding to α1-ARs. Among the three drugs, ketanserin showed the highest affinity for α1a-, α1b- and α1d-ARs (pKi 8.0, 8.3 and 7.6, respectively). Sarpogrelate had a relatively low affinity for the three subtypes (6.3 , 6.4 and 6.3, respectively) and M-1 showed medium affinity (7.1, 7.1 and 6.1, respectively). Chinese hamster ovary (CHO) cells expressing each α1-AR subtype showed concentration-dependent inositol phosphate (IP) accumulation in response to phenylephrine. The concentration response curves were shifted to the right by three drugs, and the pKb values were close to the pKi values in the binding study. In addition to these effects, sarpogrelate and M-1, but not ketanserin produced an increase in the basal IP level of α1d-expressed CHO cells, although the increase was less than that of phenylephrine. The present results indicate that sarpogrelate and M-1 have antagonistic activity to the three α1-AR subtypes, but their affinities are significantly lower than those of ketanserin.
In vitro and in vivo Activities of Three Acridine Thioethers against Leishmania donovani
Authors: Mesa Concepción , Rodriguez-Cabezas Nieves , Castilla Juan J. , Moraleda-Lindez Valentín , Barbe Jacques , Sanchez-Moreno Manuel , Osuna Antonio
Published: April 2003

The lack of definitive chemotherapeutic agents to fight against visceral leishmaniasis has lead to the testing of numerous compounds. In the present work, we carry out an in-depth study of the activity against Leishmania donovani of three acridine derivatives both in vitro and in vivo. These compounds have proven to be highly effective at medium and high concentrations of 10 µg/ml, against both flagellate and nonflagellate forms of the parasite, which, though obtained in vitro, closely resemble natural intracellular amastigotes. The in vivo assays showed a significant reduction in the percentage of parasitation versus control, for all the compounds tested. In addition, we have studied the possible mechanism by which these acridine derivatives act: they displayed a greater inhibitory effect against macromolecule synthesis in treated flagellates, yet alterations are also caused in the production of end metabolites and in the activity of different enzymes. The data obtained indicate that the acridine derivatives had several targets, one of them is the synthesis of nucleic acids and proteins, while the second one might be interaction with the carbohydrate and energy-production processes in the parasite. This conclusion is consistent with our observations concerning the ultrastructural changes induced in the parasite by these compounds principally at the mitochondrial level.
Body Image and Psychopathology in Male Bodybuilders
Authors: Mangweth B. , Pope Jr. H.G. , Kemmler G. , Ebenbichler C. , Hausmann A. , De Col C. , Kreutner B. , Kinzl J. , Biebl W.
Published: April 2003

Background: To compare male bodybuilders to men with eating disorders and control men regarding body image, psychopathology and sexual history. Method: We compared 28 male bodybuilders, 30 men with eating disorders (anorexia nervosa, bulimia or binge eating disorder defined by DSM-IV), and 30 controls, using a battery of questionnaires covering weight history, eating behavior, body image, lifetime history of psychiatric disorders, and sexuality. Eating-disordered and control men were recruited from a college student population and studied during the course of an earlier investigation. Results: Bodybuilders exhibited a pattern of eating and exercising as obsessive as that of subjects with eating disorders, but with a ‘reverse’ focus of gaining muscle as opposed to losing fat. Bodybuilders displayed rates of psychiatric disorders intermediate between men with eating disorders and control men. In measures of body image, the bodybuilders closely resembled the men with eating disorders, but significantly differed from the control men, with the former two groups consistently displaying greater dissatisfaction than the latter. Sexual functioning did not distinguish the three groups except for the item ‘lack of sexual desire’ which was reported significantly more often by both bodybuilders and men with eating disorders. Conclusion: On measures of body image and eating behavior, bodybuilders share many features of individuals with eating disorders.
Childhood Abuse and Later Medical Disorders in Women
Authors: Romans Sarah , Belaise Carlotta , Martin Judy , Morris Eleanor , Raffi Annarita
Published: April 2003

Background: There have been many studies documenting adverse psychiatric consequences for people who have experienced childhood and adult sexual and physical abuse. These include posttraumatic stress disorder, anxiety, depression, substance abuse, eating disorders and probably some personality disorders or trait abnormalities. Much less is known about the links between abuse and physical/psychosomatic conditions in adult life. Hints of causal links are evident in the literature discussing headache, lower back pain, pelvic pain and irritable bowel syndrome. These studies are not definitive as they use clinic-based samples. Methods: This study used interview data with a random community sample of New Zealand women, half of whom reported childhood sexual abuse and half who did not. Details about childhood physical abuse and adult abuse were also collected in a two-phase study. Results: Complex relationships were found, as abuses tended to co-occur. Seven of 18 potentially relevant medical conditions emerged as significantly increased in women with one or more types of abuse. These were chronic fatigue, bladder problems, headache including migraine, asthma, diabetes and heart problems. Several of these associations with abuse are previously unreported. Conclusions: In this random community sample, a number of chronic physical conditions were found more often in women who reported different types of sexual and physical abuse, both in childhood and in adult life. The causal relationships cannot be studied in a cross-sectional retrospective design, but immature coping strategies and increased rates of dissociation appeared important only in chronic fatigue and headache, suggesting that these are not part of the causal pathway between abuse experiences and the other later physical health problems. This finding and the low co-occurrence of the identified physical conditions suggest relative specificity rather than a general vulnerability to psychosomatic conditions in women who have suffered abuses. Each condition may require separate further study.
Dithranol and Dimethylfumarate Suppress the Interferon-γ-Induced Up-Regulation of Cytokeratin 17 as a Putative Psoriasis Autoantigen in vitro
Authors: Bonnekoh B. , Böckelmann R. , Ambach A. , Gollnick H.
Published: April 2003

In psoriasis an etiopathogenetic vicious circle has been hypothesized in which disease manifestation is triggered by skin-specific autoantigen structures. Autoreactive T cells are supposed to mediate inflammation and hyperproliferation in the epidermopapillary compartment, positively feeding back the expression and accessibility of decisive antigen structures. Recently an epitope within cytokeratin 17 (K17) has been described as such a putative psoriasis autoantigen, which is moreover known to be up-regulated under the influence of proinflammatory interferon-γ (IFN-γ), which is abundantly detected in psoriatic plaques. The present study proposes an in vitro model for this presumptive IFN-γ/K17 autoimmune loop, i.e. the incubation of hyperproliferative human HaCaT keratinocytes with 25 U IFN-γ/ml for 72 h. This treatment led to a significant up-regulation of K17 protein expression (≧300%) measured by flow immunocytometry as compared to the untreated control (100%, p ≤ 0.05). Preincubation with a subcytotoxic and antiproliferative dithranol concentration as low as 0.3 µM for 2 h prior to the IFN-γ exposure resulted in a K17 expression that was significantly lower than the IFN-γ-induced K17 expression reference level. The IFN-γ-induced K17 expression was also significantly lowered by coincubation with a subcytotoxic and nonantiproliferative concentration of 3 µM dimethylfumarate. The data indicate for dithranol and dimethylfumarate that a part of their antipsoriatic mode of action may be related to a direct down-regulation of putative psoriasis autoantigen structures.
Perforin Granule Release from Cytotoxic Lymphocytes ex vivo Is Inhibited by Ciclosporin but Not by Methotrexate
Authors: Ambach A. , Bonnekoh B. , Gollnick H.
Published: April 2003

The 70-kD plasma membrane pore-forming protein perforin is a key component of lymphocyte cytotoxicity mediated by lytic granules. It represents a major player in the regulation of various immune reactions like immunoglobulin synthesis, T-cell activation and homeostasis, and in the elimination of virus-infected and tumor cells. Dysregulation of the perforin-granule system, i.e. an increase of perforin-containing lymphocytes, was recently demonstrated in exacerbated psoriasis and generalized drug reactions. In contrast, in patients with exacerbated atopic dermatitis or unsymptomatic rhinitis allergica, a severe perforin depletion in cytotoxic T cells was demonstrated. In addition, these cells displayed a remarkable transport defect of lytic granules, i.e. a perforin hyperreleasability. Thus, the process of perforin-granule release may represent an attractive target for therapeutic immune modulation in various dermatological diseases. Ficoll isolated peripheral blood mononuclear cells (PBMCs) of healthy volunteers were preincubated with different concentrations of ciclosporin or methotrexate (MTX) for 1 h. A newly developed flow cytometry based perforin release assay was used to quantify the velocity of ionomycin/phorbol 12-myristate 13-acetate stimulated perforin-granule release in the presence or absence of pharmacological agents. The immunosuppressant MTX did not influence perforin-granule release. Ciclosporin, in contrast, was found to inhibit perforin-granule release significantly and dose dependently: whereas release from CD8+ lymphocytes was almost maximal for the untreated control after 60 min (41% of CD8+ perforin+ cells at time zero), ciclosporin at 20, 4 and 2 µg/ml elevated the aforementioned parameter up to 73, 65 and 53%, respectively. Our data demonstrate that (i) perforin-granule release can be targeted efficiently by pharmacological agents which can be monitored directly in a newly developed perforin-granule release assay, and (ii) suppression of perforin-granule based cytotoxicity by ciclosporin might contribute to the beneficial therapeutic effects of this drug as an immunomodulating and immunosuppressant target.
Relevance of Oral Supplementation with Antioxidants for Prevention and Treatment of Skin Disorders
Authors: Tebbe Beate
Published: April 2003

Reactive oxygen species can cause harmful effects in keratinocytes and fibroblasts if antioxidative defence mechanisms are exhausted. Therefore, it seems to be reasonable to prove if oral supplementation with various nutrient antioxidants is useful in prevention or treatment of skin disorders especially in those mediated by UV irradiation. Betacarotene, ascorbic acid and tocopherol have been tested alone or in combination for prevention of sunburn, photodermatoses and photocarcinogenesis with divergent results. Other candidates for oral antioxidative supplementation in humans are selenium and polyphenols. However, clinical data are limited or missing up to date.
Current Progress in Phlebosurgery
Authors: Stadler Rudolf
Published: April 2003

Modern operative varicosurgery is based on sophisticated diagnosis and surgical techniques protecting tissue to achieve optimized functional results combined with the best possible cosmetic success.
Cutaneous Vitamins A and E in the Context of Ultraviolet- or Chemically-Induced Oxidative Stress
Authors: Sorg Olivier , Tran Christian , Saurat Jean-Hilaire
Published: April 2003

Vitamins A and E are present in mammalian skin. Although the main circulating form of vitamin A in the blood is retinol, the epidermis stores it as retinyl esters. The epidermis can be easily loaded with high amounts of vitamin A by topical application of either retinol or retinaldehyde, two well-tolerated precursors of the biologically active retinoic acid, while topical α-tocopherol loads the epidermis with vitamin E. The probable physiological function of epidermal vitamin E is to contribute to the antioxidant defense of the skin, whereas that of epidermal vitamin A (retinol and retinyl esters) is not yet well understood. Besides being a precursor for retinoic acid, vitamin A also has a free radical scavenging potential. Due to their physical properties, vitamins A and E absorb ultraviolet (UV) light in the region of solar spectrum that is responsible for most of the deleterious biological effects of the sun. In the mouse, topical vitamin A has been shown to prevent the UV-induced epidermal hypovitaminosis A, while topical vitamin E prevents oxidative stress and cutaneous and systemic immunosuppression elicited by UV. Thus constitutive epidermal vitamins A and E appear complementary in preventing UV-induced deleterious cutaneous and systemic effects, and these properties can be reinforced by topical application of retinol or retinaldehyde and topical α-tocopherol.
Barrier Function in Reconstructed Epidermis and Its Resemblance to Native Human Skin
Authors: Ponec M. , Gibbs S. , Pilgram G. , Boelsma E. , Koerten H. , Bouwstra J. , Mommaas M.
Published: April 2003

One of the prerequisites for the use of human skin equivalents for scientific and screening purposes is that their barrier function is similar to that of native skin. Using human epidermis reconstructed on de-epidermized dermis we demonstrated that the formation of the stratum corneum (SC) barrier in vitro proceeds similarly as in vivo as judged from the extensive production of lamellar bodies, their complete extrusion at the stratum granulosum/SC interface, and the formation of multiple broad lamellar structures in the intercorneocyte space. The presence of well-ordered lipid lamellar phases was confirmed by small-angle X-ray diffraction. Although the long periodicity lamellar phase was present in both the native and the reconstructed epidermis, the short periodicity lamellar phase was present only in native tissue. In addition, the SC lipids predominantly formed the hexagonal sublattice. Analysis of lipid composition revealed that all SC lipids are synthesized in vitro. Differences in SC lipid organization in reconstructed epidermis may be ascribed to the differences in fatty acid content and profile indicating that further improvement in culture conditions is required for generation of in vitro reconstructed epidermis with stratum barrier properties of the native tissue.
Correlation of the Local Distribution of Topically Applied Substances Inside the Stratum corneum Determined by Tape-Stripping to Differences in Bioavailability
Authors: Weigmann H.-J. , Lademann J. , Schanzer S. , Lindemann U. , von Pelchrzim R. , Schaefer H. , Sterry W. , Shah V.
Published: April 2003

Tape-stripping and optical spectroscopy are used as a suitable combined method to determine the horny layer profile. Firstly, typical ultraviolet filter substances are used as active substances which are fixed inside the horny layer. Secondly, clobetasol propionate was applied topically in two formulations, Temovate® Cream and Temovate Ε Emollient®. The measured changes in the local distribution of the drug inside stratum corneum reflect the observed differences in the biological response visualized as blanching. The concentration of the drug in deeper parts of the horny layer proposes the existence of a small channel available for the percutaneous absorption. The observed low intensity blanching is correlated to the follicle orifices of the skin. After application of Temovate Ε Emollient®, a lateral spreading of the drug must be taken into account.
Haematuria: A Long-Term Problem after Prostatectomy
Authors: Nargund Vinod H. , Noble Jeremy G. , Cranston David , Fellows Griff J.
Published: April 2003

Objective: The causes of ‘late’ haematuria (2 years or more) following endoscopic and open prostatectomy were studied. Methods: Between 1994 and 1996, more than 400 patients were evaluated for haematuria. Ninety patients with post-prostatectomy haematuria were investigated with upper tract imaging and cystoscopic examination. Amongst these 90 patients, 30 presented with haematuria within 2 years of surgery. These patients were excluded from the study as they had normal investigations. Results: Of these 60 patients, 24 (43%) had demonstrable causes of haematuria in their urinary tract. Six of them had urinary tract malignancy. Conclusions: There is a substantial likelihood of finding a cause for haematuria in patients who had prostatectomy even though they had full-scale urological investigations before. There is a need, therefore, to carry out necessary screening investigations in such patients.
Long-Term Results of Surgical Treatment for Female Stress Urinary Incontinence
Authors: Kuo Hann-Chorng
Published: April 2003

Objective: To compare the long-term success rates of bladder neck suspension (BNS) and pubovaginal sling procedure in different types of female stress urinary incontinence (SUI) in order to identify appropriate treatment strategies for SUI. Methods: A total of 157 women who received anti-incontinence surgery were followed-up for a mean period of 58.1 ± 33.9 months. The surgical outcome was analyzed and was compared among the different types of SUI and among BNS and pubovaginal sling procedures. Results: SUI was classified as type I in 16 patients, type II in 111 patients, and type III in 34 patients. Surgical procedures included Gittes BNS (n = 62), Raz BNS (n = 53), and pubovaginal sling procedure (n = 42). The total success rate was 77.1%, including a 38.2% cure rate and a 38.9% significantly improved rate. Analysis of the results revealed that type III SUI had the lowest success rate (67.6%), while the pubovaginal sling procedure had the best success (93.9%) and cure rates (54.8%). The success rates of BNS were significantly lower than that of pubovaginal sling in type III SUI, less favorable in type II SUI, but remained high in type I SUI. 75% of patients with treatment failure had recurrence within the fist postoperative year. Conclusions: In this series of patients, the long-term cure rates of anti-incontinence surgeries are not satisfactory. BNS procedures had satisfactory results only in type I SUI while the pubovaginal sling procedure had better results in both types II and III SUI. The pubovaginal sling procedure might have better long-term results in the treatment of all types of SUI.
Missed Stab Wound of the Ureter Treated by Antegrade Stenting Alone
Authors: Khan H.N. , Surenthiran S. , Sarangi N.B. , Cetti N.E.
Published: April 2003

Ureteric injury complicates 1% of penetrating abdominal trauma. Detection and management of this rare complication is difficult. We present the case of a 32-year-old man who presented with a penetrating ureteric trauma that was treated by antegrade stenting.
Diagnosis of Retrovesical Ectopic and Hyperplastic Prostate Tissue by Transrectal Needle Biopsy
Authors: Hamasaki Takashi , Akasaka Soichiro , Yamaguchi Raizo , Inatomi Hisato , Takahashi Koichi , Matsumoto Tetsuro , Okamoto Sumika
Published: April 2003

We report on an ectopic prostate in a 50-year-old man. Transabdominal ultrasonography, pelvic computed tomography, and pelvic magnetic resonance imaging revealed a heterogeneous tumor 8 cm in diameter in contact with the posterior wall of the urinary bladder. The tumor was histologically confirmed to be a benign prostatic hyperplasia. This is the 3rd case of retrovesical ectopic prostatic tissue which was diagnosed by transrectal needle biopsy.
NMP 22, BTA stat Test and Cytology in the Diagnosis of Bladder Cancer: A Comparative Study
Authors: Gutiérrez Baños J.L. , Rebollo Rodrigo M.H. , Antolín Juárez F.M. , Martín García B.
Published: April 2003

Objective: To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routine diagnostic methods. Methods: 150 patients followed up for bladder cancer or symptoms suggestive of bladder cancer underwent cystoscopy after cytology, NMP 22 and BTA stat test using a recently voided urine sample. In suspect cases, TUR and histopathological analysis were performed. Results: Bladder cancer was proven in 76 patients and excluded in 74. For NMP 22 we have used the cutoff value recommended by the manufacturer (10 U/ml) and that obtained by our receiver-operating characteristic curve (6 U/ml). Sensitivity was 84.21% for NMP 22 at the cutoff value of 6 U/ml and 76.32% with 10 U/ml; 72.37% for BTA stat test; 69.74% for cytology, and 100% for cystoscopy. Specificity was 86.49% for NMP 22 at a cutoff value of 6 U/ml and 90.54% at 10 U/ml; 89.19% for the BTA stat test; 93.24% for cytology and 89.19% for cystoscopy. NMP 22 sensitivity for grades 1, 2, and 3 was 68.75, 75.86 and 100%, respectively, at a cutoff value of 6 U/ml, and 50, 68.97 and 96.77%, respectively, at a cutoff level of 10 U/ml; for BTA stat the sensitivity was 56.25% in G1, 62.07% in G2 and 90.32% in G3, and for cytology the sensitivity was 43.75, 62.07 and 90.32%, respectively. The sensitivity of NMP 22 was 68.75% in stage Ta, 84.78% in T1 and 100% in T2–T4 at a cutoff level of 6 U/ml and 50, 80.43 and 92.86%, respectively, at a cutoff level of 10 U/ml; BTA stat sensitivity was 50% in Ta, 73.91% in T1 and 92.86% in T2–T4; and in cytology the results were 37.50, 73.91 and 85.71%, respectively. Using the McNemar test, there was only a significant difference between the sensitivity of NMP 22 at a cutoff level of 6 U/ml and cytology in the overall sample. Conclusions: The high sensitivity of the NMP 22 and BTA stat test in combination with the data obtained from the parameters used for the evaluation of the test demonstrate their usefulness in the diagnosis and follow-up of bladder cancer. NMP 22 at a cutoff value of 6 U/ml is significantly more sensitive than cytology and consequently a thoroughly valid diagnostic tool in the diagnosis of bladder cancer which may substitute voided urine cytology.
Transvesical Placement of One Limb of an Aortobifemoral Bypass Graft as a Complication of Aortic Bypass Surgery
Authors: Farkas P. , Lüdecke G. , Akintürk H. , Weidner W.
Published: April 2003

We report about a rare complication after aortobifemoral bypass surgery. In the present case the left limb of an aortobifemoral bypass graft was placed straight through the cavity of the urinary bladder. The diagnosis was found and ascertained by colour duplex ultrasound examination, cystoskopy and angiography. In consequence, we successfully performed open bladder surgery to replace the misplaced graft.
Process Structure of Semiotic Mediation in Human Development
Authors: Valsiner Jaan
Published: April 2003

Development of semiotic mediation of psychological functions entails construction and use of signs to regulate both interpersonal and intrapersonal psychological processes. The latter can be viewed as regulated through a hierarchy of semiotic mechanisms. It is demonstrated that semiotic mediation leads to the creation of psychological problems as well as to their solutions. Semiotic mediation guarantees both flexibility and inflexibility of the human psychological system, through the processes of abstracting generalization and contextualizing specification, which operate through the layers of the semiotic regulation hierarchy. Context specificity of psychological phenomena is an indication of general mechanisms that generate variability. Much has been written about the role of signs – semiotic mediators – in psychology over recent decades. Usually more or less elaborate claims in favor of the importance of signs – semiotic mediators, words, ‘voices’, meanings – in human psychological worlds have been made [Cole, 1996; Shweder, 1995; Wertsch, 1991, 1998]. That importance is here taken for granted, and the question addressed moves beyond the discourse about the social nature of the human individual psyche [Valsiner & Van der Veer, 2000]. In which ways could one conceptualize the functioning of signs in the regulation of psychological processes? The present elaboration is based on previous work along similar lines [Valsiner, 1996, 1997a, 1998a, 1999]. By a focus on regulation, a systemic perspective is immediately evoked. The system that is being regulated entails psychological processes of intra- and interpsychological communication. These processes are mutually related in a hierarchical organizational order – some of them (higher psychological functions, based on the operation of signs) controlling others (lower, nonintentional psychological functions, or flow of personal experience). The hierarchy can be viewed as open to changes [including reversals, or formation of intransitive order – see Valsiner, 1997d]. The person is viewed as inclusively separated from its environment [Valsiner, 1997a, 1998c]. The intrapsychological system is cultural through the inclusion of semiotic regulators into the hierarchy of psychological processes [Valsiner, 1998a]. How that system works in its immediate relatedness with the environment is the target of the present theoretical construction.
Effects of the Magenstrasse and Mill Operation for Obesity on Plasma Plasminogen Activator Inhibitor Type 1, Tissue Plasminogen Activator, Fibrinogen and Insulin
Authors: Carmichael A.R. , Tate G. , King R.F.G.J. , Sue-Ling H.M. , Johnston D.
Published: April 2003

Plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA), fibrinogen and insulin were measured in 43 patients 3 years after they had undergone the Magenstrasse and Mill (MM) procedure and in 43 morbidly obese (MO) patients. Mean plasma PAI-1 was 61 ng/ml in the MO group compared to 30 ng/ml in the MM group (p < 0.0001); mean plasma t-PA was 10 ng/ml in the MO group compared to 7 ng/ml in the MM group (p < 0.001). Mean fibrinogen was 3.6 g/l in the MO group compared to 3.2 g/l in the MM group (p < 0.05). Mean plasma insulin levels were 32 U/ml in the MO group compared to 15 U/ml in the MM group. These changes suggest that use of the MM procedure may reduce mortality and morbidity from coronary heart disease in these high-risk obese patients.
A Neuroactive Steroid, Pregnenolone, Alters the Striatal Dopaminergic Tone before and after Puberty
Authors: Muneoka Katsumasa T. , Takigawa Morikuni
Published: April 2003

Neuroactive steroids are known to modulate excitability in neurons. Neuronal activity during early development is critical to normal development of the brain. A neuroactive steroid, pregnenolone, was administered (10 µg/g) to rats from postnatal day 3 (PD 3) through PD 7. Dopamine (DA), serotonin (5-HT) and their metabolites were measured in the striatum. The results showed that neonatal treatment with pregnenolone increases DA and 5-HT turnover in the striatum at 3 weeks of age. The increased 5-HT turnover in the pregnenolone-treated animals was normalized at 14 weeks of age whereas the DA turnover in the pregnenolone-treated group was lower than in the control group. The present study indicated that pregnenolone treatment during the neonatal period induced abnormal development of the striatal dopaminergic function in adulthood.
Derangements in Protein Metabolism Induced by Type I Diabetes mellitus
Authors: Castellino Pietro , Giordano Mauro , de Pascale Emanuela , Solini Anna
Published: April 2003

In poorly controlled diabetics, the whole-body protein flux is increased by 20–30% in comparison to well-controlled type I diabetes (IDDM) and normal subjects. Intensive insulin administration completely reverses these abnormalities. In poorly controlled IDDM, the primary effect of insulin administration is to reduce the increased protein catabolic rate by suppressing the accelerated rate of protein breakdown. Studies in humans have demonstrated that the increased rate of protein synthesis observed in these patients is the consequence of elevated plasma amino acid levels. When IDDM subjects develop renal complications, a protein-restricted diet may be recommended to preserve the remnant kidney function. However, it has been demonstrated that in IDDM patients, metabolic adaptation to protein restriction is incomplete because suppression of endogenous proteolysis is impaired. Since this component of protein metabolism is very sensitive to insulin action, maintaining strict metabolic control during the protein restriction regimen has been suggested. The major studies on the effects of amino acid and insulin on protein metabolism in patients with diabetes mellitus are reviewed.
Strategies for Nutritional Intervention in Patients with Renal Failure
Authors: Goldstein D. Jordi , Callahan Claire
Published: April 2003

This review article discusses the evidence documenting the interrelationship between nutritional status and clinical outcome of the renal patient population. The limitations of accurately assessing the nutritional status of this patient group with commonly used indices are detailed. An overview of the history of nutrition supplementation as an intervention for the malnourished renal patient reveals that the efficacy of both enteral and parenteral methods has not been adequately explored to draw any firm conclusions. Based on available data, recommendations for providing nutrition care for the malnourished patient are provided. Therapeutics that are currently under investigation as future interventions for malnutrition are identified.
Role of TGF-β in Vascular Development and Vascular Reactivity
Authors: Perrella Mark A. , Jain Mukesh K. , Lee Mu-En
Published: April 2003

Transforming growth factor-β (TGF-β) is the prototypic member of a large family of structurally related proteins. Three vertebrate TGF-β isoforms have been identified and termed TGF-β1, TGF-β2, and TGF-β3, respectively. In addition, two receptors of the serine/threonine kinase family termed type I and II have also been identified. In this review, we focused our attention on the effects of TGF-β on vascular development and vascular reactivity. The critical role of the TGF-β1 and the TGF-β type II receptor in blood vessel formation in the yolk sac has been demonstrated by gene deletion experiments. Recent investigations have also shown that isoforms of TGF-β play a critical role in smooth muscle cell differentiation. And, finally, a role for TGF-β1 in the regulation of vascular tone and reactivity has been suggested by studies demonstrating that TGF-β1 can inhibit the production of potent vasodilators (such as nitric oxide) and stimulate the production of potent vasoconstrictors (such as endothelin). Taken together, these studies suggest that TGF-β plays a critical role in blood vessel development and vascular function.
Corticomedullary Procollagen α1(IV) mRNA Levels and Localization after Subtotal Nephrectomy
Authors: Adler Sharon G. , Lee Grace S. , Cohen Arthur H. , Nast Cynthia C.
Published: April 2003

The relationships between tubular hypertrophy/hyperplasia, procollagen α1(IV) mRNA levels, and the development of tubular basement membrane thickening were studied in male Sprague-Dawley rats subjected to subtotal renal ablation and sacrificed 2 or 15 days later. Tubular hypertrophy and hyperplasia were demonstrable at 2 days, however no increment in procollagen α1(IV) mRNA levels was discerned at that time, demonstrating a dissociation between mRNA levels for classical type IV collagen and tubular enlargement. At 15 days, tubular procollagen α1(IV) mRNA levels did increase approximately 2-fold (p < 0.002), localizing predominantly in proximal tubules in the deep cortex and outer medullary stripe. At this time point, there was still no significant correlation to tubular enlargement, but there was a significant correlation to tubular basement membrane thickening (r = 0.89, p < 0.01). These studies demonstrated that an increase in mRNA for classical type IV collagen is not required for the development of hypertrophy, and that the increment is a better marker for matrix expansion than it is for hypertrophy.
Effects of Thyroid Hormones on Heart and Kidney Functions
Authors: Capasso Giovambattista , De Tommaso Giannantonio , Pica Angelo , Anastasio Pietro , Capasso Joseph , Kinne Rolf , De Santo Natale
Published: April 2003

Thyroid hormones affect the functions of several organs including the heart and kidney. Using isolated left papillary muscles we have investigated the action of thyroid hormones on the mechanical and electrical properties of the heart. We found that pure hypothyroidism causes a depression in contractile and electrical parameters, but we noticed that superimposed hypoparathyroidism accounts for the marked prolongation in contractile kinetics and action potential duration. At kidney level we have shown that thyroid hormones affect proximal tubular sodium transport and this effect is only partially mediated by the action of thyroid hormones on Na-K-ATPase activity. Using the micropuncture technique, we hypothesized that the early effect of thyroid hormone action is on the potassium permeabilty of proximal tubular cell membrane. This latter effect would explain the increase in isotonic fluid reabsorption through an increase in the driving force for sodium. Finally, hypothyroid patients have a decrease in glomerular filtration rate and renal plasma flow that are completely reversed by thyroxine administration. On the other hand, hyperthyroid subjects exhibit a significant increase in both parameters.
Blood Pressure in Nuns in a Secluded Order: A 30-Year Follow-Up
Authors: Timio M. , Saronio P. , Venanzi S. , Gentili S. , Verdura C. , Timio F.
Published: April 2003

The powerful effect of psychosocial and acculturating influences on population blood pressure trends seems to be confirmed, through longitudinal observations, in the nuns in a secluded order. After initial observations had been made on culture, body form, blood pressure, diet, and other variables in 144 nuns and 138 lay women, included as a control group, a 30-year follow-up study was undertaken. Most striking were opposite trends noted between the two groups in blood pressure trend. During the follow-up period, blood pressure remained remarkably stable among the nuns. None showed an increase in diastolic blood pressure over 90 mm Hg. By contrast, the control women showed the expected increase in blood pressure with age. This resulted in a gradually greater difference (δ>30/15 mm Hg) in systolic and diastolic blood pressure between the two groups, which was statistically significant. In addition, cardiovascular morbidity and mortality, expressed as the outcome of fatal and nonfatal events, were different in the two groups. They were significantly more common in the lay women than in the nuns. Comparisons between survivalcurves were statistically significant (p = 0.0043 for fatal events; p = 0.0056 for nonfatal events) between the two groups. In conclusion, it seems reasonable to attribute much of the difference in blood pressure and cardiovascular events, to the different burden in psychosocial factor and to the preserved peaceful lifestyle of the nuns.
The Management of Hypotension in Dialyzed Patients
Authors: Zucchelli Pietro , Santoro Antonio
Published: April 2003

Acute hypotension is a frequent hemodialysis complication. This intra-treatment vascular instability is a multifactorial process in which procedure-related and patient-related factors may influence the decrease in plasma volume and the impairment of cardiovascular regulatory mechanisms. Identification of the most susceptible patients and of the various risk factors may contribute to significantly improving cardiovascular stability during dialysis. In some high-risk patients, continuous monitoring of the various parameters can predict the appearance of symptomatic hypotension and help to prevent its onset.