bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth Hormone (GH) Secretion in Patients with Childhood-Onset GH Deficiency: Retesting after One Year of Therapy and at Final Height
Authors: Thomas M. , Massa G. , Maes M. , Beckers D. , Craen M. , François I. , Heinrichs C. , Bourguignon J.-P.
Published: April 2003

Background: Recent studies have shown that many patients treated with growth hormone (GH) during childhood because of idiopathic GH deficiency (GHD) are no longer GH deficient when retested after cessation of GH therapy when final height is achieved. These patients are labelled as transient GHD. We hypothesized that normalization of GH secretion in transient GHD could occur earlier during the course of GH treatment, which could allow earlier cessation of GH treatment. Methods: In a retrospective study, GH secretion was re-evaluated after cessation of GH treatment at final height in 43 patients diagnosed during childhood as idiopathic GHD (10 with multiple pituitary hormonal deficiencies (MPHD) and 33 with isolated GHD (IsGHD)). In a prospective study, GH secretion was re-assessed after interruption of GH treatment given for 1 year in 18 children with idiopathic GHD (2 MPHD, 16 IsGHD). GH secretion was evaluated by glucagon or insulin stimulation tests. Results: In the retrospective study, all the 10 patients with MPHD and 64% of the 33 patients with IsGHD were still deficient at re-evaluation using the paediatric criteria to define GHD (GH peak <10 ng/ml at provocative test). The proportion of persisting deficiency was greater in patients with complete IsGHD (86%, 12/14 patients) than in patients with partial IsGHD (47%, 9/19 patients). With the criteria proposed in adulthood (GH peak <3 ng/ml), all the 10 patients with MPHD were still considered to be deficient. In contrast, only 15% (5/33 patients) with IsGHD had a maximal GH value <3 ng/ml (36% of the 14 patients with complete IsGHD and none of the 19 patients with partial IsGHD). In the prospective study, after interruption of GH therapy given for 1 year, the 2 patients with MPHD were still GHD at re-evaluation and they resumed GH treatment. Among the 16 patients with IsGHD, 13 (81%) were still deficient (peak response <10 ng/ml) after 1 year. Two of the 3 patients in whom GHD was not confirmed at retesting after 1 year GH showed again a deficient response at second retesting. Conclusions: Although many patients diagnosed with IsGHD during childhood have a normalized GH secretory capacity when retested during adulthood, early retesting after interruption of GH treatment given for 1 year during childhood does not enable to determine if GH therapy has to be discontinued before cessation of growth.
The Stanley Foundation Bipolar Network: Results of the Naturalistic Follow-Up Study after 2.5 Years of Follow-Up in the German Centres
Authors: Dittmann S. , Biedermann N.C. , Grunze H. , Hummel B. , Schärer L.O. , Kleindienst N. , Forsthoff A. , Matzner N. , Walser S. , Walden J.
Published: April 2003

The Stanley Foundation Bipolar Network (SFBN) is an international, multisite network investigating the characteristics and course of bipolar disorder. Methods (history, ratings and longitudinal follow-up) are standardized and equally applied in all 7 centres. This article describes demographics and illness characteristics of the first 152 German patients enrolled in the SFBN as well as the results of 2.5 years of follow-up. Patients in Germany were usually enrolled after hospitalisation. More than 72% of the study population suffered from bipolar I disorder and 25% from bipolar II disorder. The mean ± SD age of the study participants was 42.08 ± 13.5 years, and the mean ± SD age of onset 24.44 ± 10.9 years. More than 40% of the sample reported a rapid-cycling course in history, and even more a cycle acceleration over time. 37% attempted suicide at least once. 36% had an additional Axis I disorder, with alcohol abuse being the most common one, followed by anxiety disorders. During the follow-up period, only 27% remained stable, 56% had a recurrence, 12.8% perceived subsyndromal symptoms despite treatment and regular visits. 27% suffered from a rapid-cycling course during the follow-up period. Recurrences were significantly associated with bipolar I disorder, an additional comorbid Axis I disorder, rapid cycling in history, a higher number of mood stabilizers and the long-term use of typical antipsychotics. Rapid cycling during follow-up was only associated with a rapid-cycling course in history, a higher number of mood stabilizers and at least one suicide attempt in history.
Polymorphic Genes for Kinin Receptors, Nephropathy and Blood Pressure in Type 2 Diabetic Patients
Authors: Zychma Marcin J. , Gumprecht Janusz , Trautsolt Wanda , Szydlowska Ilona , Grzeszczak Wladyslaw
Published: April 2003

Background/Aims: There is evidence that hereditary predisposition contributes to the development of diabetic nephropathy and hypertension. Polymorphisms in the genes for bradykinin receptors (B1R and B2R) were found to be associated with decreased risk of the development of end-stage renal disease. This study examines whether B1R G–699C and B2R C181T polymorphisms are associated with microalbuminuria or overt nephropathy, or blood pressure variation in type 2 diabetic subjects. Methods: B1R and B2R polymorphisms were determined in 153 type 2 diabetic patients with microalbuminuria, 132 with overt nephropathy (macroalbuminuria or chronic renal failure), and 161 patients with normoalbuminuria despite diabetes duration longer than 10 years. Results: Distributions of the examined polymorphisms did not differ between patients with microalbuminuria or overt nephropathy, compared to normoalbuminuric control subjects. Patients carrying the B2R T allele had lower DBP, compared with non-carriers: 83.6 ± 12.0 vs. 87.4 ± 12.1 mm Hg, p < 0.05. Among patients not receiving ACEI, both SBP and DBP was significantly lower in B2R T allele carriers, compared to non-carriers (137.2 ± 20.3 vs. 146.5 ± 21.7 mm Hg, and 80.3 ± 11.9 vs. 85.8 ± 11.6 mm Hg, p < 0.05). Conclusions: Examined polymorphisms are not associated with the increased risk of incipient or overt nephropathy in type 2 diabetic patients. B2R C181T polymorphism may contribute to blood pressure variation in these subjects.
Effects of an Acute Dose of L-Arginine during Coronary Angiography in Patients with Chronic Renal Failure
Authors: Miller Hylton I. , Dascalu Avi , Rassin Tovy A. , Wollman Y. , Chernichowsky T. , Iaina A.
Published: April 2003

Background: Contrast media (CM) are nephrotoxic and might further worsen renal function in patients with chronic renal failure. L-Arginine, the substrate of nitric oxide, protects kidney function and may improve endothelial function in patients with coronary artery disease. Hypothesis: Acute administration of L-arginine in a subset of patients with combined coronary artery disease and impaired kidney function during coronary angiography might prevent superimposed acute renal failure. Methods: A double-blind study of patients with mild/moderate chronic renal failure (Cr >1.7 mg/dl) undergoing coronary angiography (meglumine ioxaglate) was conducted. Patients received either L-arginine (300 mg/kg) or placebo and were followed for 48 h. Cardiac hemodynamic parameters, renal function and nitric oxide production were sequentially recorded. Results – Primary and Secondary: Both groups experienced a decrease of creatinine clearance 48 h following the procedure (p < 0.05). Creatinine levels slightly increased following the administration of L-arginine (p < 0.05) but not in the placebo treated group. No changes of systemic and cardiac pressures, total peripheral resistance or cardiac output were recorded within and between the treatment and placebo groups. Conclusion: CM injection causes an impairment of renal function. Addition of intravenous L-arginine during cardiac catheterizations in patients with chronic renal failure does not prevent CM-induced nephrotoxicity and does not affect endothelial dysfunction in the particular population studied by the authors, i.e. patients with coronary artery disease (CAD) of various degrees, or suspicion of CAD and chronic mild renal failure.
Profile of Interdialytic Blood Pressure in Hemodialysis Patients
Authors: Santos Sergio F.F. , Mendes Roger B. , Santos Carlos A. , Dorigo David , Peixoto Aldo J.
Published: April 2003

Background and Methods: Hypertension is a common problem in hemodialysis (HD). However, its behavior during the interdialytic period is not completely known and is infrequently monitored in clinical practice. Thus, for better understanding of interdialytic blood pressure (BP), we analyzed the interdialytic blood pressure profile using 44-hour ambulatory blood pressure monitoring (ABPM) data in 71 unselected, stable HD patients. Results: There was an increase in BP during the interdialytic period (awake day 1: 135/84 ± 23/14 mm Hg; awake day 2: 140/86 ± 22/15 mm Hg, p < 0.05; sleep day 1: 130/77 ± 24/15 mm Hg; sleep day 2: 136/80 ± 24/15 mm Hg, p < 0.05). The correlation between the average 44-hour BP and interdialytic weight gain (IDWG) was not significant (r = –0.07 for systolic BP and r = –0.09 for diastolic BP). The number of non-dipper patients was high, 77% on interdialytic day 1 and 83% on interdialytic day 2 for systolic BP. Uncontrolled hypertension (average 44 h BP ≧135/85 mm Hg) was diagnosed in 58 (55%) patients. Patients with uncontrolled hypertension had higher pre- and posthemodialysis BP, higher BP on each interdialytic day and night, and higher night/day diastolic BP ratio on the second interdialytic day. These patients were also taking a greater number of vasoactive medications (1.5 vs. 0.6 in those with controlled BP, p = 0.001). There were no significant differences related to kt/V, hematocrit, or weekly erythropoietin dose between patients with controlled or uncontrolled BP. Hemodialysis shift assignment (morning or afternoon) did not impact on BP levels or diurnal profile. Conclusion: In HD patients, interdialytic BP is often poorly controlled, there is a progressive rise in BP, and a trend toward loss of nocturnal decline in BP as the interdialytic period progresses. Further research is needed to determine whether treatment directed to interdialytic BP changes can alter outcomes in HD patients.
Differential Modes of Alaryngeal Communication and Long-Term Voice Outcomes following Pharyngolaryngectomy and Laryngectomy
Authors: Ward E.C. , Koh S.K. , Frisby J. , Hodge R.
Published: April 2003

Patterns of vocal rehabilitation for 37 pharyngolaryngectomy patients and 55 total laryngectomy patients over a 5-year period were compared. An electrolarynx (EL) was introduced as the initial communication mode immediately after surgery for 98% of patients, with 30% of pharyngolaryngectomy and 74% of laryngectomy patients subsequently developing tracheoesophageal speech (TES) as their primary mode of communication. Follow-up with 14 of 37 pharyngolaryngectomy patients and 36 of 55 laryngectomy patients was conducted 1–6 years following surgery and revealed that 90% of the pharyngolaryngectomy patients maintained the use of TES in the long term compared to 69% of the laryngectomy group. Long-term outcomes relating to communication disability and handicap did not differ significantly between the two surgical groups, however the laryngectomy patients had significantly higher levels of wellbeing. Across the whole group of patients, statistical comparison revealed that patients using TES had significantly lower levels of disability, handicap and distress than EL users. Considering that lower levels of disability, handicap and distress are associated with TES, and the data supports that suitably selected patients can maintain functional TES in the long term, increased application of this form of communication rehabilitation should be encouraged where viable for the pharyngolaryngectomy population.
Hepatitis B Virus DNA in Anti-HBe-Positive Asymptomatic Carriers
Authors: Seo Yasushi , Yoon Seitetsu , Nakaji Miyuki , Yano Yoshihiko , Nagano Hidenobu , Ninomiya Toshiaki , Hayashi Yoshitake , Kasuga Masato
Published: April 2003

Objectives: We examined the level of hepatitis B virus (HBV) DNA and the mutations in the precore, core and polymerase regions of HBV in sera from anti-HBe-positive asymptomatic carriers (ASC). Methods: The amount of HBV DNA was determined semiquantitatively by mutation site-specific assay in sera from 19 anti-HBe-positive ASC and 31 HBeAg-positive patients with chronic liver disease (CLD). The mutations in the precore, core and polymerase (terminal protein) regions, spanning 1,037 nucleotides, of HBV in sera from three cases each of anti-HBe-positive ASC, HBeAg-positive ASC and HBeAg-positive CLD were examined by directly sequencing the amplified HBV DNA. Results: The level of HBV viremia in anti-HBe-positive ASC was significantly lower than that in HBeAg-positive CLD patients (p < 0.01). By sequence analysis, there were a few missense mutations detected in HBeAg-positive ASC and HBeAg-positive CLD patients. In contrast, many mutations, especially in the central or N-terminal half of the core region and N-terminal part of the polymerase region, were detected in anti-HBe-positive ASC. Conclusion: Mutations not only in the precore/core region, but also in the polymerase region of HBV might cause damage to some important functions for efficient replication of HBV and be involved in the reduced amount of HBV in anti-HBe-positive ASC.
Penile Revascularization Surgery in Erectile Dysfunction
Authors: Hauri D.
Published: April 2003

Anastomoses between the dorsal artery of penis and the deep penile artery are necessary for revascularization of penile arteries. Radiologic and anatomic proof is provided. Arterio-arterial anastomosis represents a risk factor for thrombosis. For its exclusion the necessary operative course of action is showed. By building an additional arteriovenous shunt close to the arterio-arterial anastomosis the risk of thrombosis is markedly decreased. Our technique produces good results in patients with diagnosed erectile dysfunction of vascular origin with a spontaneous erection when the occasion arises.
Contemporary Aspects of Penile Prosthesis Implantation
Authors: Montague Drogo K. , Angermeier Kenneth W.
Published: April 2003

Purpose: Erectile dysfunction today has a number of effective treatment options. This review was undertaken to examine the contemporary role of penile prosthesis implantation in the treatment of this disorder. Materials and Methods: A MEDLINE search was performed on the topic of penile prostheses and implants. Current literature was reviewed with regard to types of penile implants, issues related to prosthesis implantation, results, and patient/partner satisfaction. Results: Mechanical failure rates for early penile prostheses, especially the inflatable type, were unacceptably high. Advances in both prosthesis design and implantation techniques have resulted in increased device survival with 5-year actuarial survival rates free of mechanical failure ranging from 86.2 to 93.6%. Recent reviews of implant recipients show 83 and 85% satisfaction and for partners 70 and 76% satisfaction. Conclusions: When systemic therapy for erectile dysfunction fails, men have a variety of other options to choose from. Penile prosthesis implantation is an option that is feasible for nearly every man with this disorder. Current device survival rates and patient and partner satisfaction rates are high.
Identification of a Vimentin-Reactive Peptide Associated with Ocular Lens Membranes as Cytokeratin
Authors: Brooks Joseph , Fleschner C.R.
Published: April 2003

We wished to identify a 44-kD peptide isolated from lens membrane fractions which has apparent immunoreactivity to antivimentin and to antiphakinin. Urea-soluble proteins from rat lens membrane fractions were separated by two-dimensional electrophoresis, transferred to polyvinylidene fluoride membranes and probed with monoclonal antibodies to vimentin or cytokeratins, or a polyclonal antibody to phakinin. The monoclonal antibody to vimentin recognized the expected protein (Mr = 56 kD, pI = 5.1) and several smaller and more acidic peptides including a 44-kD spot with a pI of 4.9. A similar pattern of immunoreactivity was found with commercially available purified vimentin. The polyclonal antibody to phakinin recognized the expected protein (Mr = 52 kD, pI = 5.0) and several smaller and more acidic peptides, including a 44-kD spot with a pI of 4.9. Matrix-assisted laser desorption ionization mass spectroscopy analysis of the tryptic digest of the spot corresponding to 44 kD and pI of 4.9 identified neither vimentin nor phakinin but did identify peptides derived from ovalbumin (added to samples as an internal standard) and cytokeratin 1. Antibodies which recognize cytokeratin 1 reacted weakly with a 44-kD peptide which comigrated with the 44-kD vimentin-immunoreactive peptide in adjacent lanes of single-dimension SDS polyacrylamide gels. The 44-kD acidic (pI = 4.9) peptide which reacts with a monoclonal antibody to vimentin may be derived from cytokeratin 1.
Acute Stroke Units in Austria Are Being Set Up on a National Level Following Evidence-Based Recommendations and Structural Quality Criteria
Authors: Brainin Michael , Steiner Michaela
Published: April 2003

A system of acute stroke units is being set up in Austria, which will care for 70% of all acute strokes by 2005. This nationwide project has been planned according to evidence-based principles and contains pre-specified structural components for acute stroke care. With some exceptions in remote mountain regions, all stroke units can be reached within 90 min from any community. All units are within neurological departments. An ongoing documentation of quality performance shows that these units are being well accepted by the general population and the medical community alike.
Necrotizing External Otitis and Chromobacterium violaceum
Authors: Lawrence H.S. , Tucker A.G.
Published: April 2003

Chromobacterium violaceum, a gram-negative rod, has been recognized as a pathogen which can cause life-threatening disease. It is the only Chromobacterium species known to be pathogenic to humans. The first human infection with C. violaceum was recorded in 1927. Due to its unfamiliarity it may largely be dismissed as a contaminant when isolated in sterile cultures, however its consistent appearance in an environment of malnourishment, immunocompromise and immune deficiency states makes it possible that we will see more of this condition in the future. Thus far, fatal or potentially fatal infections with C. violaceum involving the lungs, liver and eyes have been reported. However, to our knowledge involvement of the ear presenting as necrotizing external otitis has not been previously reported. We present a case of necrotizing external otitis secondary to infection with C. violaceum.
Neuropeptide-Induced Inhibition of IL-16 Release from Eosinophils
Authors: Dunzendorfer Stefan , Feistritzer Clemens , Enrich Barbara , Wiedermann Christian J.
Published: April 2003

Objectives: Eosinophils are prominent inflammatory cells that respond to peripheral neuropeptides in vitro and in vivo. At inflammatory sites, cytokines activate distinct cellular and biochemical pathways that act in a coordinated fashion. We investigated whether peripheral neuropeptides can act as immunomodulators by influencing cytokine release from eosinophils. Methods: Human eosinophils were enriched using magnetic cell sorting, and IL-16 levels in supernatants from maintained eosinophils were measured by ELISA. Biological activity of IL-16 was confirmed in lymphocyte chemotaxis assays. Results: Substance P, vasoactive intestinal polypeptide, calcitonin gene-related peptide and secretoneurin reduced the IL-16 release from eosinophils; this effect was additive to that observed with GM-CSF or IL-5. Decreased IL-16 levels in supernatants resulted in reduced lymphocyte chemotaxis, whereas supernatants derived from SP-treated eosinophils stimulated lymphocyte chemotaxis, even though IL-16 was decreased. Conclusions: Results suggest that distinct neuropeptides are able to reduce the number of lymphocytes at inflammatory sites during existing eosinophilia by inhibiting eosinophil IL-16 release, thus attenuating the pro-inflammatory action of lymphocytes and monocytes.
Immunologic Interaction between Infiltrating Eosinophils and T Lymphocytes in Murine Spontaneous Eosinophilic Myocarditis
Authors: Hirasawa Masao , Deguchi Hirofumi , Ukimura Akira , Kitaura Yasushi
Published: April 2003

Background: Eosinophilic myocarditis often occurs spontaneously in DBA/2 mice. Relationships between infiltrating eosinophils (Eos), T lymphocytes and interleukin-5 (IL-5) in this disorder were investigated microscopically and immunohistochemically. Methods: Hearts from male DBA/2 mice were studied from 5 to 10 weeks of age. Anti-CD4 and anti-CD8 antibodies were used. Infiltrating Eos, white blood cells (WBC), and CD4+ and CD8+ T cells were counted. Interactions were assessed with multiple regression and forward stepwise regression tests. Additionally, IL-5 distribution in heart tissue was histologically observed with special reference to immunological findings. Results: Beginning at 5 weeks, several necrotic foci containing many damaged cardiocytes were seen in the epicardium of the right ventricle. Eos and lymphocytes were numerous within and around the necrotic foci. Eos were occasionally seen adjacent to degenerating cardiocytes. Three quarters of the mice exhibited such Eo-related myocardial damage. CD4+ lymphocytes were often seen infiltrating actively inflamed foci where Eos could also be observed. The lesional CD4+-to-CD8+ ratio (CD4/CD8) was 5.2 ± 3.3 at 6 weeks, 6.8 ± 3.7 at 7 weeks, and 1.5 ± 0.8 at 10 weeks of age. The lesional Eo/WBC ratio was directly proportional to the CD4/CD8 ratio (p < 0.05), and was also significantly related to lesional CD4+ T cell count (p < 0.05). IL-5 was also expressed in Eo-rich areas. Conclusions: In this mouse strain with susceptibility to eosinophilic myocarditis, Eo infiltration was related to increased lesional CD4+ cell count. We suspect that CD4+ T cells induce local eosinotaxis, mediated by IL-5, and participate in myocardiocyte injury via Eo induction.
Lupus miliaris disseminatus faciei: A Distinctive Rosacea-Like Syndrome and Not a Granulomatous Form of Rosacea
Authors: van de Scheur Martijn R. , van der Waal Rutger I.F. , Starink Theo M.
Published: April 2003

Background: Lupus miliaris disseminatus faciei is an eruption of discrete red-brown, dome-shaped papules, histologically characterized by epithelioid cell granulomas. The pathogenesis of the disorder remains controversial. Objective: The authors discuss the place of lupus miliaris disseminatus faciei among granulomatous disorders. Methods: This report reviews the available literature and presents 3 patients with lupus miliaris disseminatus faciei. Results: The histopathologic characteristics of lupus miliaris disseminatus faciei – an epithelioid cell granuloma with central necrosis – may be found in granulomatous rosacea, whilst the clinical features and course of lupus miliaris disseminatus faciei are often similar to cutaneous sarcoidosis. Conclusions: We put forward lupus miliaris disseminatus faciei as a distinctive rosacea-like syndrome and not as a granulomatous form of rosacea.
The Role of Innate Immunity in the Pathogenesis of Acne
Authors: Koreck A. , Pivarcsi A. , Dobozy A. , Kemény L.
Published: April 2003

Acne is a multifactorial disease of the pilosebaceous follicle. The most significant pathogenetic factors of acne are: abnormal ductal keratinization, increased sebum secretion, abnormalities of the microbial flora and inflammation. The pilosebaceous unit is an immunocompetent organ. Keratinocytes and sebocytes may act as immune cells capable of pathogen recognition and abnormal lipid presentation, and they might have an important role in initiating and perpetuating the activation of both innate and adaptive immune responses. The elements of the skin immune system are involved in the development of both noninflammatory and inflammatory acne lesions.
The Importance of Associated Extra-Renal Vascular Disease on the Outcome of Patients with Atherosclerotic Renovascular Disease
Authors: Shurrab A.E. , MacDowall P. , Wright J. , Mamtora H. , Kalra P.A.
Published: April 2003

Atherosclerotic renovascular disease (ARVD) is a disease of ageing. It is usually a manifestation of widespread vascular disease and although it may be symptomless, many patients with ARVD present with the effects of extra-renal vascular disease, such as peripheral vascular (PVD), coronary heart (CHD) and cerebrovascular disease. ARVD is a common cause of hypertension and chronic renal failure (CRF), and it is one of the most common renal diagnoses in elderly patients accepted on to dialysis programmes with end-stage renal failure (ESRF). The cause of renal impairment in these patients is still a matter of debate. Patients with ARVD have a high mortality, especially those with renal failure. In this review we examine the relationships between ARVD and co-morbid extra-renal vascular disease, and the impact of these associated vascular pathologies upon renal functional and mortality outcomes is considered. The latest evidence concerning the likely pathogenesis of renal dysfunction in patients with ARVD is also reviewed.
Prednisolone and Azathioprine in IgA Nephropathy
Authors: Goumenos Dimitrios S. , Davlouros Periklis , El Nahas A. Meguid , Ahuja Manohar , Shortland John R. , Vlachojannis John G. , Brown Colin B.
Published: April 2003

Background: Immunoglobulin A nephropathy (IgAN) is one of the most common primary glomerular diseases. Although its clinical course is usually benign, some patients develop end-stage renal failure (ESRF). The role of immunosuppressive drugs in the treatment of IgAN remains controversial. The effect of treatment with prednisolone and azathioprine and the clinical and histological parameters related to a poor outcome are examined retrospectively in this analysis. Methods: Seventy-four patients with IgAN and a follow-up period of 10 years were included in this study. Forty-one were treated with prednisolone (initially 60 mg/day) and azathioprine (initially 2 mg/kg BW/day) in gradually reduced doses for 24 ± 9 months, whereas 33 patients received no immunosuppressive drugs. The clinical course was estimated using the end-points of doubling of baseline serum creatinine and/or ESRF. The contribution of clinical and histological parameters in the clinical outcome was estimated by univariate and multivariate analyses. Results: The overall clinical courses of both groups of patients showed a rather similar pattern. Doubling of serum baseline creatinine was observed in 9 of 41 treated (22%) and in 10 of 33 untreated (30%), whereas ESRF developed in 6 treated (15%) and 6 untreated patients (18%) (p = NS). However, treated patients with heavy proteinuria (>3 g/24 h) had a significantly better outcome compared to untreated (doubling of serum creatinine in 29 vs. 78% and ESRF in 17 vs. 55%, p < 0.05). Proteinuria (p < 0.01), mean blood pressure (p < 0.02), baseline serum creatinine (p = 0.02) and severity of interstitial myofibroblast expression (p = 0.02) were identified as independent risk factors related to a poor outcome by multivariate analysis. Side effects of treatment were not uncommomn and observed in 10 (24%) patients. Conclusion: Treatment with prednisolone and azathioprine is beneficial in ameliorating the clinical course of a subset of IgAN patients with heavy proteinuria or impaired renal function. Patients with advanced renal failure and severe chronic histological lesions should not be treated by this regimen as no benefit is expected and there is a risk of side effects.
A Nitric Oxide-Generating Beta-Blocking Agent Prevents Renal Injury in the Rat Remnant Kidney Model
Authors: Takamitsu Yoshihiro , Nakanishi Takeshi , Nishihara Futoshi , Hasuike Yukiko , Izumi Masaaki , Inoue Toru , Hiraoka Keisuke , Itahana Reiko , Miyagawa Koji
Published: April 2003

Background: The L-arginine-nitric oxide (NO) pathway plays an important role in the modulation of glomerular disease. We investigated whether β-blocking agents, with and without an NO-generating function, had renoprotective effects in the 5/6 nephrectomized rats (Nx), an animal model of glomerulosclerosis. Methods: Nipradilol, a β-blocker with an ONO2 group (5, 10 or 15 mg/kg/day) and propranolol, a β-blocker without this group (50 mg/kg/day) were administered for 12 weeks to Nx together with and without nitro-L-arginine methyl ester (L-NAME). We evaluated the effects of both drugs on proteinuria, hypertension, renal function, glomerulosclerosis and urinary excretion of NO metabolites (UNOx) and cyclic GMP (UcGMP). Results: Both drugs similarly attenuated the elevated blood pressure in Nx. However, nipradilol, at doses of 10 and 15 mg/kg/day, significantly decreased proteinuria and glomerulosclerosis, while propranolol did not. Nx showed reduced UNOx in comparison with the sham-operated rats. Nipradilol increased UNOx and UcGMP significantly and in a dose- dependent manner, whereas propranolol reduced them to levels lower than those in Nx. Nx receiving L-NAME reduced UNOx. The addition of nipradilol increased UNOx and decreased urinary protein excretion and glomerulosclerosis, suggesting that the NO released from the drug contributed to its renoprotective effect. Conclusion: These findings indicate that nipradilol exerts its renoprotective effect through NO generation, and not by lowering blood pressure. The β-adrenergic blocking action per se does not seem to be related to the renoprotective effect of these agents.
Hoffman’s Syndrome: Muscle Stiffness, Pseudohypertrophy and Hypothyroidism
Authors: Mastropasqua Maria , Spagna Gaetano , Baldini Valentina , Tedesco Ilaria , Paggi Anna
Published: April 2003

Primary hypothyroidism is a chronic and insidious disease caused by failure of thyroid hormone production. We observed a 38-year-old woman admitted to our hospital due to progressive proximal weakness, muscle pain and fatigue during mild exercise. Laboratory tests showed features of rhabdomyolysis and hypothyroidism. After examination of the thyroid, we reached a diagnosis of Hashimoto’s thyroiditis and hypothyroid myopathy. Hypothyroidism should be considered as a differential diagnosis of creatine kinase elevation; actually, neuromuscular symptoms and signs occur in most newly diagnosed patients with thyroid diseases. Hypothyroidism presenting as muscle stiffness and pseudohypertrophy is called ‘Hoffman’s syndrome’.
Dynamic Change in Plasma Leptin Level during the Perioperative Period
Authors: Cho Young Min , Kim Min Seon , Shin Chan Soo , Park Do Joon , Park Kyong Soo , Yang Han-Kwang , Lee Kuhn Uk , Cho Bo Youn , Lee Hong Kyu , Kim Seong-Yeon
Published: April 2003

Objective: To examine the association of plasma leptin level with insulin, which is known as a metabolic regulator of leptin, and various stress-related factors during the perioperative period. Methods: Thirty-one patients undergoing gastrectomy were enrolled and blood samples were obtained preoperatively, intraoperatively, immediately after operation, and on the first and second postoperative days. Results: The plasma leptin level showed a triphasic response. Immediately after operation, the leptin level was the lowest, while the serum cortisol and interleukin-6 (IL-6) levels had their peak (phase 1). On the first postoperative day, the leptin level had its peak with the serum cortisol and IL-6 level remaining elevated (phase 2). On the second postoperative day, while the serum cortisol and IL-6 levels still remained elevated, the plasma leptin level fell to the preoperative value (phase 3). The plasma leptin level correlated well with the insulin level at all time points during the study period. Conclusion: Our results suggest a possible role of leptin in harmonizing neuroendocrine and immune responses with energy balance.
Adolescents and Their Parents: A Review of Intergenerational Family Relations for Immigrant and Non-Immigrant Families
Authors: Kwak Kyunghwa
Published: April 2003

The present review seeks to ascertain how intergenerational relations between adolescents and their parents are experienced through their socialization when cultural values are shared and practised by two generations in a family context. Within the framework of three culture-related developmental issues, (1) the influence of culture on family socialization, (2) the continuity of cultural transmission across generations, and (3) the impact of sociocultural context on enculturation, this review examines an initial hypothesis that there will be more intergenerational disagreement and difficulty in immigrant families than non-immigrant families. The cultural distance between the culture of origin and that of the new society can threaten the harmony of immigrant family relations, but when the core cultural values of family embeddedness are supported by their own culture as well as their own ethnocultural social network, immigrant families are able to maintain healthy intergenerational relations. Immigrant adolescents from collectivistic societies sustain these positive family relations in part by delaying their pursuit of autonomy. As with non-immigrant families, socioeconomic hardship in immigrant families necessitates collaboration by family members; yet, unlike the former, collaboration and participation by family members in the latter are encouraged by their own ethnic culture as well. Consequently, experiences of hardship do not result in overly adverse effects on intergenerational relations within the immigrant family. It is important to point out, however, that studies currently available in the literature are limited to immigrant groups which have settled in a small number of Western individualistic countries. Considering that migration movements are increasing under globalization, more effort needs to be put into examining the characteristics of the many other migrating groups and their receiving societies.
Ontogeny and Tissue-Specific Regulation of Ghrelin mRNA Expression Suggest that Ghrelin Is Primarily Involved in the Control of Extraendocrine Functions in the Rat
Authors: Torsello Antonio , Scibona Barbara , Leo Giuseppina , Bresciani Elena , Avallone Roberta , Bulgarelli Ilaria , Luoni Marina , Zoli Michele , Rindi Guido , Cocchi Daniela , Locatelli Vittorio
Published: April 2003

Ghrelin is a 28-amino-acid gastric peptide that potently stimulates growth hormone (GH) secretion in vivo and in vitro. Ghrelin-expressing cells have been found in the oxyntic region of the stomach and in the arcuate nucleus of the hypothalamus. The aim of this work was to investigate the regional distribution and developmental changes in ghrelin mRNA levels in the pituitary, hypothalamus and gastrointestinal (GI) tract of the rat using a semiquantitative RT-PCR assay. We also describe the effects of ghrelin immunoneutralization in late gestation and those resulting from induction of an isolated GH deficiency in adult rats. Ghrelin mRNA was already expressed in the fetus by embryonic day 12 (E12), by E17 most of ghrelin mRNA was in the trunk. At E17, in situ hybridization did not reveal a clear expression of ghrelin mRNA in fetal stomach but showed high ghrelin mRNA levels in the placenta. In the pituitary gland, levels of ghrelin mRNA were high after birth but declined significantly with puberty, whereas in the hypothalamus they were barely detectable at birth and remained very low at all subsequent time points tested. In the GI tract, ghrelin mRNA levels were high from birth to 270 days of life. Immunoneutralization of ghrelin at E16 had no effect on survival or development. Rats showed normal somatotropic function, ghrelin expression and onset of puberty. In young adult rats, passive immunization against GHRH did not affect ghrelin mRNA levels in the pituitary, hypothalamus and stomach. Only a 72-hour fasting period induced a significant increase in ghrelin mRNA levels in the stomach, but not in the pituitary and hypothalamus. These results strongly indicate that ghrelin is an important GI hormone expressed early in life and primarily sensitive to nutritional status.
Bilateral Emphysematous Pyelonephritis Combined with Subcapsular Hematoma and Disseminated Necrotizing Fasciitis
Authors: Lin Dennis C.S. , Shieh Gia-Shing , Tong Yat-Ching
Published: April 2003

Emphysematous pyelonephritis (EPN) is a rapidly progressive and potentially life-threatening necrotizing infection of the renal parenchyma characterized by the presence of gas. Bilateral EPN is a rare disease process with a high mortality rate. Bleeding associated with EPN is an extremely rare complication. Necrotizing fasciitis is a rare but serous condition with a poor prognosis. Herein we present a rare case of bilateral EPN combined with subcapsular hematomas which progressed to the development of disseminated necrotizing fasciitis.
Cadaveric Renal Transplantation from a Non-Heart-Beating Pediatric Donor into Adult Recipients
Authors: Nakatani Tatsuya , Uchida Junji , Yamazaki Takeshi , Iwai Tomoaki , Naganuma Toshihide , Kim Taku , Sugimura Kazunobu
Published: April 2003

Introduction: The use of cadaveric pediatric kidneys has been suggested as a means to overcome organ shortage, but is debated because of technical complications and an increased incidence of functional allograft impairment. Methods: We experienced 2 cases of cadaveric renal transplantation from a non-heart-beating pediatric donor. Results: In our cases, transplanted kidneys achieved good graft function and proteinuria due to glomerulosclerosis was not recognized. Conclusion: Previous reports indicate that in transplantation from pediatric donors into adults recipients, glomerular sclerosis occurs as the reason for impairment of grafts. Further, cadaveric renal transplantation from a non-heart-beating donor has a warm ischemia time and an increased risk of hyperfiltrated injury and graft failure. If transplantation of pediatric kidneys into adults from a non-heart-beating donor is performed, BMI and BSA must be carefully considered in the selection of recipients in order to avoid imbalance between nephron supply and metabolic demands and to insure successful, healthy grafts.
Construct Validity of the Abbreviated Mental Test in Older Medical Inpatients
Authors: Antonelli Incalzi R. , Cesari M. , Pedone C. , Carosella L. , Carbonin P.U.
Published: April 2003

Objectives: To evaluate validity and internal structure of the Abbreviated Mental Test (AMT), and to assess the dependence of the internal structure upon the characteristics of the patients examined. Design: Cross-sectional examination using data from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA) database. Setting: Twenty-four acute care wards of Geriatrics or General Medicine. Participants: Two thousand eight hundred and eight patients consecutively admitted over a 4-month period. Measurements: Demographic characteristics, functional status, medical conditions and performance on AMT were collected at discharge. Sensitivity, specificity and predictive values of the AMT <7 versus a diagnosis of dementia made according to DSM-III-R criteria were computed. The internal structure of AMT was assessed by principal component analysis. The analysis was performed on the whole population and stratified for age (<65, 65–80 and >80 years), gender, education (<6 or >5 years) and presence of congestive heart failure (CHF). Results: AMT achieved high sensitivity (81%), specificity (84%) and negative predictive value (99%), but a low positive predictive value of 25%. The principal component analysis isolated two components: the former component represents the orientation to time and space and explains 45% of AMT variance; the latter is linked to memory and attention and explains 13% of variance. Comparable results were obtained after stratification by age, gender or education. In patients with CHF, only 48.3% of the cumulative variance was explained; the factor accounting for most (34.6%) of the variance explained was mainly related to the three items assessing memory. Conclusion: AMT >6 rules out dementia very reliably, whereas AMT <7 requires a second level cognitive assessment to confirm dementia. AMT is bidimensional and maintains the same internal structure across classes defined by selected social and demographic characteristics, but not in CHF patients. It is likely that its internal structure depends on the type of patients. The use of a sum-score could conceal some part of the information provided by the AMT.
Psychoanalyse und Spiritualität
Authors: Stein Murray
Published: April 2003

Anhand einer Kurzgeschichte, «Die Schrift Gottes» des argentinischen Schriftstellers Borges, wird dargestellt, wie durch unablässige und intensive Konzentration auf die Lebensumstände, in denen man gefangen ist, sich unerwartet und unvermutet Möglichkeiten auftun, sinnvolle Muster, die «Schrift Gottes», darin zu erkennen. Das sind Momente höchster spiritueller Erfahrung, die die tiefe Überzeugung vermitteln, eine kleine Faser in einem komplexen universellen Gewebe zu sein. Es wird aufgezeigt, dass Freud mit der Psychoanalyse ungewollt einen Weg für diese moderne Form von Spiritualität eröffnet hat, die Jung in vielen seiner Schriften dann weiterentwickelt hat: eine Spiritualität, die – inhaltlos und offen gegenüber dem Unbekannten, dem Unbewussten – im psychoanalytischen Setting sehr oft erfahrbar wird. Anhand von Träumen und Synchronizitätserlebnissen von Patienten wird diese Spiritualität ausführlich beschrieben.
Zur Geschlechtsspezifität des Animus-Konzeptes
Authors: Heinke Ellen , Läge Damian
Published: April 2003

In der Arbeit wird der Frage nachgegangen, ob das von C.G. Jung formulierte Animus-Konzept nur auf Frauen anzuwenden sei oder auch für Männer Gültigkeit besitze. Zur Beantwortung dieses Forschungsproblems wurde ein halbstandardisiertes Interview entwickelt, das mit 28 Sachverständigen der Analytischen Psychologie durchgeführt wurde. Durch die Befragung ergab sich, dass die Geschlechtsspezifität des Animus-Konzepts von einer überraschend grossen Anzahl der Experten und Expertinnen (24 von 28) abgelehnt wird. Geschlechtsspezifische Unterschiede traten hingegen auf, wenn es um die Frage ging, wie der Animus in Erscheinung tritt. Ferner liessen sich aus dem erhobenen Datenmaterial durch Ähnlichkeitswerte Antwortkategorien bilden, die als Ausgangspunkt für die Berechnung einer NMDS dienten. Mit Hilfe dieses Verfahrens konnten dann die individuellen Abweichungen aller Befragten zu den gemeinsamen Auffassungen hinsichtlich des Animus-Konzepts einerseits und zu Jungs ursprünglichem Standpunkt andererseits ermittelt werden. Die detaillierte Datenerhebung und die neuartige Auswertung ermöglichten somit eine empirische Überprüfung des kontrovers diskutierten Animus-Konzeptes.
Interaction of Clothing and Thermoregulation
Authors: Havenith George
Published: April 2003

Human temperature regulation is based upon a physiological system ‘designed’ for a naked person. Hence, the statement ‘man is a tropical animal’. Human thermoregulation can be described as a feedback system with sensors in the body core and the skin, and effectors in the form of skin blood flow (vasoconstriction and dilation), metabolic activity (shivering), pilo-erection and sweating. This system on its own would provide some adjustment capabilities to various environments, but would nevertheless limit man to life in warm environments. It is the behavioural response that is the most powerful additional thermoregulatory effector in humans. People wear clothing, live in houses and have active heating and cooling systems to expand their habitat beyond the original physiological limits. Clothing is an important interface between the human and the environment. Apart from the cultural meaning of clothing it provides insulation against cold, protection against the sun, wind or rain as well as protection from other environmental hazards (chemicals, mechanical). The effect of clothing on thermoregulation depends in the first place on the textile materials used. These provide thermal insulation as well as resistance against vapour (sweat) transfer. However, a garment is more than just the textile layer. Air layers included in the clothing provide additional insulation and the total thermal protection provided by a garment is for a large part based on these enclosed air layers and strongly influenced by the clothing design and fit. Clothing comfort is determined by a number of clothing properties that affect the thermal conditions at the skin. Skin temperatures and the tactile sensation of the skin (e.g. sticky moist clothing) are the main signals that are fed to the brain and lead to an overall sensation of comfort or discomfort.
Flupenthixol in Relapse Prevention in Schizophrenics with Comorbid Alcoholism: Results from an Open Clinical Study
Authors: Soyka Michael , Aichmüller Claus , v Bardeleben Ulrich , Beneke Manfred , Glaser Thomas , Hornung-Knobel Sybille , Wegner Ulrike
Published: April 2003

Substance use, especially alcoholism, has been recognized as a significant problem in schizophrenic patients, though only a few studies on the effects of pharmacotherapy in these patients have been conducted so far. The thioxanthene neuroleptic flupenthixol, which can be given intramuscularly (i.m.) for improving compliance, has been studied as a possible anti-craving drug both in animal models of alcoholism and some clinical studies. Pilot studies suggest that comorbid schizophrenics with substance use may benefit from treatment with flupenthixol. Efficacy of flupenthixol (10–60 mg i.m.) in reducing alcohol consumption of dual diagnosis patients was studied in an open 6-month clinical trial in 27 schizophrenics with comorbid alcoholism. Twenty-one patients entered the intention-to-treat analysis. Fourteen subjects were completers, 13 dropped out. Six patients completely abstained from alcohol during treatment. Alcohol consumption was significantly reduced compared to baseline (4 weeks before treatment as measured by timeline follow-back interview). In general, while patients showed a marked improvement concerning alcohol consumption, only a slight improvement in psychopathology was recorded. Overall tolerability was good. These data indicate a probable beneficial effect of flupenthixol in schizophrenic patients with comorbid alcoholism. Although the efficacy of flupenthixol as an anti-craving drug in dual diagnosis patients has to be explored in further studies, the drug may be considered a promising medication for these patients.
Cost-Effectiveness of Adjuvant Treatment with Acamprosate in Maintaining Abstinence in Alcohol Dependent Patients
Authors: Rychlik R. , Siedentop H. , Pfeil T. , Daniel D.
Published: April 2003

An open prospective cohort study was performed in Germany in order to evaluate the costs of treating alcohol dependence under real-world conditions. Eight hundred and fourteen recently detoxified alcohol-dependent patients were provided with psychosocial rehabilitation support. In addition, 540 alcohol-dependent patients treated with adjuvant acamprosate therapy were compared with 274 patients without pharmacotherapy. Real costs were assessed over a period of one year. Of the patients who were treated with acamprosate, 33.6% remained abstinent compared to only 21.1% in the standard cohort. The mean total costs per patient treated with acamprosate were EUR 1,631.49 per year. In the standard cohort, total costs were EUR 2,068.83. This difference is highly significant (p = 0.012). Direct costs amounted to 76.9% of the total costs, with a 27% difference between the cohorts (p < 0.001). There was no difference in indirect costs between the two groups (p = 0.324). This real-cost study confirms the favourable cost-effectiveness of acamprosate previously suggested by pharmaco-economic modelling studies.