bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrapartum Surveillance of IUGR Fetuses with Cardiotocography and Fetal Pulse Oximetry
Authors: Siristatidis Charalambos , Salamalekis Emmanuel , Vitoratos Nikolaos , Loghis Constantinos , Salloum John , Kassanos Demetrios , Panayotopoulos Nikolaos , Creatsas George
Published: April 2003

Objective: To investigate the efficacy and safety of intrapartum fetal pulse oximetry, as a predictor of metabolic acidosis at birth of fetuses with intrauterine growth retardation (IUGR). Study Design: We studied 18 IUGR fetuses (group I) and a control group of 30 appropriate for gestational age (AGA) fetuses (group II) during labor. Both groups had abnormal fetal heart rate tracings and were monitored simultaneously throughout labor with cardiotocography and fetal pulse oximetry. Apgar scores, pH and base excess of fetal blood obtained from the umbilical artery after delivery were compared in both groups. Setting: The Fetal Surveillance Unit of the 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, Athens University. Results: In IUGR fetuses, when their oxygen saturation value (FSPO2) was less than 34%, cord artery pH was 7.10 ± 0.04, base excess –13 ± –1 mmol/l and Apgar scores ≤5 at the 5th min, and when FSPO2 was over 35%, artery pH was 7.29 ± 0.08, base excess –8 ± –2 mmol/l and Apgar scores ≧7 at the 5th minute. In cases of drops of FSPO2 below 30% for more than 2 min, labor was completed operatively and cord pH was 7.00 ± 0.04, base excess –15 ± –2 mmol/l and Apgar scores ≤5 at the 5th minute. In AGA fetuses, when FSPO2 was over 30%, artery pH was over 7.20, base excess <–11 mmol/l and Apgar scores ≧9 at the 5th minute; in contrast, when FSPO2 was <30% for 2 min, a cesarean section was performed and cord pH was ≤7.02, base excess ≧–13 mmol/l and Apgar scores ≤4 at the 5th minute. Conclusions: In IUGR fetuses, FSPO2 values less than 34% represent an acidotic status, while values of ≧35% are well tolerated. Fetal pulse oximetry proved reliable, according to umbilical cord blood measurements and Apgar scores, reducing cesarean deliveries in cases of nonreassuring cardiotocographic patterns in IUGR fetuses.
Age-Related Modulation of Dopamine D1 Receptor mRNA Level by Hypoxia in Rabbit Adrenal Gland
Authors: Labaune Jean-Marc , Boutroy Marie-Jeanne , Bairam Aida
Published: April 2003

In the perinatal period, the fetus and the neonate may be exposed to hypoxic conditions. The adrenal gland responds to systemic hypoxia by releasing catecholamines. Dopamine and dopamine D1 receptor are present in the adrenal medulla and are liable to be affected by exposure to hypoxia. We used a rabbit model to determine whether hypoxia modulates the dopamine D1 receptor (DA D1-R) mRNA expression in adrenal glands during development. Rabbits were investigated according to four different hypoxic conditions: 15% O2 for 6 h, 15% O2 for 24 h, 8% O2 for 6 h, and 8% O2 for 24 h. Control groups were maintained in normoxic conditions (21% O2). For each O2 condition, animals were studied at three different ages: 1-day old newborns, 25-day-old pups, and 6-month-old adults. We compared the hypoxic groups to their respective age normoxic group. We have shown that hypoxia decreases DA D1-R mRNA expression level, evaluated using Northern blot analysis, in newborn rabbits, whatever the duration and severity of hypoxia. This downmodulation was not observed in 25-day-old and in adult rabbits. This age-related modulation of adrenal DA D1-R mRNA could be linked to the age-related transition from the non-neurogenic to the neurogenic regulation of the adrenal function.
Early Arterial Lactate and Prediction of Outcome in Preterm Neonates Admitted to a Neonatal Intensive Care Unit
Authors: Groenendaal Floris , Lindemans Caroline , Uiterwaal Cuno S.P.M. , de Vries Linda S.
Published: April 2003

Aim: In the present study early arterial lactate samples were examined to predict adverse outcome in preterm neonates. Subjects and Methods: 88 preterm neonates (mean gestational age 29.8 weeks, mean birth weight 1,225 g) had arterial lactate levels measured from indwelling arterial catheters within the first 3 h of life. An adverse outcome was defined as death or abnormal neurodevelopment. The positive (PPV) and negative predictive value (NPV) of early arterial lactate levels for an adverse outcome (death or neurodevelopmental abnormalities) were calculated using receiver operating characteristic analysis. Results: PPV and NPV of arterial lactate within 3 h after birth were 0.47 and 0.92, respectively, with a cutoff value of 5.7 mmol/l. Umbilical blood gas values and 1 and 5 min Apgar scores had much lower PPVs. Conclusion: Arterial lactate levels within 3 h of life can be used to select preterm neonates who are at risk of an adverse outcome.
Digoxin-Like Immunoreactive Substance in Nonoliguric Hyperkalemia of the Premature Infant
Authors: Mildenberger Eva , Oels Kathrin , Bauer Karl , Paul Martin , Versmold Hans T.
Published: April 2003

Nonoliguric hyperkalemia of premature infants probably results from a transient inhibition of membrane-bound Na+/K+-ATPase during the first 24 h after birth. We hypothesized that the endogenous digitalis-like activity of the serum of premature infants, which inhibits the Na+/K+-ATPase, triggered hyperkalemia. Serum concentrations of potassium ([K+]) and of the digoxin-like immunoreactive substance ([DLIS]) were measured during the first 24 h after birth in 60 infants including 30 infants <30 gestational weeks. Contrary to our hypothesis, there was a negative linear correlation between [DLIS] at birth and [K+] 24 h after birth (r2 = 0.24, p < 0.002). 24 h after birth there was no correlation between [DLIS] and [K+]. Thus, a major role of DLIS in nonoliguric hyperkalemia could not be established.
Messenger RNA Expression of Granulocyte Colony-Stimulating Factor Receptor Isoforms in the Fetus
Authors: Gersting Jason A. , Du Yan , Christensen Robert D. , Calhoun Darlene A.
Published: April 2003

Granulocyte colony-stimulating factor (G-CSF) is a growth factor known to support the proliferation, differentiation, and survival of cells of the neutrophil lineage. G-CSF affects these cells after binding to its specific receptor, G-CSF-R, which exists in seven isoforms. While information exists about the distribution of these isoforms in hematopoietic cells and placenta, G-CSF-R isoforms on non-hematopoietic fetal tissues have not been described. Using RT-PCR, we analyzed a variety of human fetal tissues ranging from 6 to 18 weeks gestation. Isoforms I and III were present in all tissues, and the expression of isoform III varied with gestational age. The remaining isoforms were variably expressed in relation to tissue type and gestational age. Thus in the human fetus, G-CSF-R isoform I is the predominant form expressed on non-hematopoietic and hematopoietic tissues.
Blunted Coronary Vasoreactivity to Insulin Is an Early Alteration in Hypertension
Authors: Sundell Jan , Laine Hanna , Luotolahti Matti , Nuutila Pirjo , Kalliokoski Kari , Raitakari Olli , Knuuti Juhani
Published: April 2003

Insulin resistance in the heart is not localized to the myocardium, but may also occur in blood vessels. We studied the effects of insulin on coronary vasodilation in hypertension. Coronary vascular resistance was quantitated in 11 nonsmoking men with untreated mild essential hypertension and 9 healthy normotensive men using positron emission tomography and 15O-labeled water. The measurements were performed at baseline and during adenosine infusion (140 µg·kg–1·min–1) with or without simultaneous euglycemic physiological (serum insulin approximately 70 mU/l) and supraphysiological (serum insulin approximately 460 mU/l) hyperinsulinemia. Coronary resistance was significantly higher in hypertensive than normotensive subjects at baseline and during adenosine infusion. Physiological hyperinsulinemia decreased hyperemic coronary resistance significantly in both groups. Supraphysiological hyperinsulinemia further decreased the hyperemic coronary resistance in normotensive but not in hypertensive subjects, leading to higher hyperemic coronary resistance in hypertensive than normotensive subjects (27.2 ± 8.7 vs. 19.2 ± 4.9 mm Hg·min·g·ml–1, p < 0.05). However, insulin-stimulated whole body glucose uptake values were similar between the groups during both insulin infusions. In conclusion, insulin-induced coronary vasodilation is blunted in young subjects with mild essential hypertension who are otherwise healthy. Coronary vascular resistance to insulin occurs although no change in peripheral glucose uptake can be detected. While we do not know whether the same results can be extrapolated to female or older subjects, these results indicate a novel defect in the regulation of coronary arteries in the early phase of hypertension.
A Histological Investigation of the Lymphoid and Immunohaematopoietic Tissues of the Adult Stripe-Faced Dunnart (Sminthopsis macroura)
Authors: Old J.M. , Selwood L. , Deane E.M.
Published: April 2003

This is the first published description of the lymphoid and immunohaematopoietic tissues of an Australian polyprotodont, the stripe-faced dunnart, Sminthopsis macroura and the first account of bronchus-associated lymphoid tissue (BALT) in a metatherian. Histologically, the tissue beds are similar in appearance to those reported in other adult eutherian and metatherian mammals. The liver and bone marrow were mature and virtually no haematopoietic activity was observed. The thymus had undergone involution but retained some lymphocytes. The spleen was similar to that observed in other metatherians containing areas of red and white pulp separated by a marginal zone. Lymph nodes, except for a pair in the posterior abdomen, were difficult to locate but were similar to those observed previously in other adult metatherians. Peyer’s patches were present; however, they lacked dome regions and sometimes had villi above them. BALT appeared to be both compartmentalised and non-compartmentalised in the adult stripe-faced dunnart.
Voiding Symptoms in Pregnancy: An Assessment with International Prostate Symptom Score
Authors: Aslan Dilek , Aslan Güven , Yamazhan Mustafa , İspahi Çiğdem , Tinar Şivekar
Published: April 2003

Objective: The aim of the study was to evaluate the voiding symptoms of pregnant women and to compare the symptoms amongst trimesters and controls by means of the International Prostate Symptom Score (IPSS). Materials and Methods: Voiding symptoms of 256 pregnant and 230 non-pregnant healthy women hospitalized for other reasons were evaluated. Subjects who had a history of urological and neurological problems or previous pelvic surgery associated with urinary symptoms and those who had urinary tract infection were excluded from the study. The pregnant group was then subdivided into subgroups as to the trimesters of pregnancy. The IPSS assesses seven symptoms on a scale of 0 (no symptoms) to 5 (symptom always present) and was administered as a self-administered questionnaire with the assistance of a trained nurse. Symptom scores of each group and subgroup and the distribution of scores were assessed. Results: The mean scores for all questions in the pregnant group were significantly higher than controls. The comparison of mean scores according to trimesters showed a significant difference for the questions of frequency, intermittency, urgency, weak stream, nocturia, quality of life and for the total scores. The distribution of the scores for each question showed that frequency and nocturia were the most prominent symptoms in pregnancy. The percentage of the respondents with an IPSS score of >7 was 47.6% and the percentage of a quality of life score of ≧4 (mostly dissatisfied) was 48.4%. Conclusions: Voiding symptoms during pregnancy are highly prevalent. These symptoms worsen as the pregnancy progresses.
MRI-Directed Subthalamic Nucleus Surgery for Parkinson’s Disease
Authors: Patel Nikunj K. , Heywood Peter , O’Sullivan Karen , Love Seth , Gill Steven S.
Published: April 2003

The subthalamic nucleus (STN) is now regarded as the optimal surgical target for the treatment of medically refractory idiopathic Parkinson’s disease. In our center, a predominantly MRI-directed method has been developed for targeting the STN. The STN is localized on T2-weighted images from a 1.5-T MRI scanner. Long acquisition, high-resolution images are acquired in both the axial and coronal planes under strict stereotactic conditions with the patient under general anesthesia. The boundary of STN is co-registered in both planes to give optimal 3-dimensional target definition. Stereotactic coordinates of the dorsolateral STN are recorded and the trajectory is planned down the axis of the nucleus in the coronal plane. Initially, per-operative macrostimulation was used for adjustment at the target prior to unilateral subthalamotomy in 26 patients. Five patients were lost to follow-up. Assessments of the lesions in post-operative images confirmed successful localisation of the lesions within the dorsolateral STN in all of the remaining 21 cases. In a subsequent series of 19 patients treated by deep brain stimulation (DBS), unilateral in 1 patient and bilateral in 18, the STN was targeted using the same MRI-directed method, guide tubes and radio-opaque stylettes were implanted, and target verification was entirely MRI-based. Following implantation of the guide tubes and stylettes, assessments of the per-operative MRI images for the 37 STN targetings confirmed a mean target error, between the stylette and the desired target in the axial plane, of 0.3 mm mediolaterally (SD = 0.4) and 0.4 mm anteroposteriorly (SD = 0.4), with median errors of 0.5 mm. This study demonstrates that MRI-directed targeting of the STN through guide tubes is accurate, and allows direct verification and corrections as necessary. Cumulative frequencies predict that the majority of DBS electrodes placed in this manner will be within 0.5 mm of the planned target. Because physiological methods are not required, the whole procedure can be performed under general anesthesia. We feel that planning with reference to a standard atlas is unreliable and not significantly helped by the addition of microelectrode recording, the accuracy of which in the axial plane is dependent upon the distance between the recording trajectories, which is typically 2 mm.
A Glucocorticoid Reduces Adverse Effects of Adenovirus Vectors in the Cochlea
Authors: Ishimoto Shin-ichi , Kawamoto Kohei , Stöver Timo , Kanzaki Sho , Yamasoba Tatsuya , Raphael Yehoash
Published: April 2003

Gene transfer using a recombinant adenovirus is a powerful tool for research and clinical applications, but its cytotoxicity and immune response limit its use, especially when repeated application of the vector is necessary. This study investigated the effects of dexamethasone (DEX)-induced immunosuppression on the outcome of adenovirus gene transfer in guinea pig inner ears. Animals received DEX for 29 days. Their inner ear was inoculated with 5 µl of adenovirus vector twice, on days 5 and 26. Auditory brainstem response was measured on days 1, 8 and 29. The animals were sacrificed on day 29, and reporter gene expression was evaluated. In control animals that received no DEX, postinoculation threshold shifts and lesions in the organ of Corti were observed and reporter gene expression was absent. In contrast, DEX-treated ears were largely protected, and transduction of inner ear cells was readily apparent. These data demonstrate that immunosuppressive treatment can reduce the negative consequences of repeated adenovirus-mediated gene therapy.
Micro-Lesions in Reissner’s Membrane Evoked by Acute Hydrops
Authors: Flock Åke , Flock Britta
Published: April 2003

In some pathological conditions excessive amounts of endolymph can accumulate and cause swelling, hydrops, of the membranous labyrinth. Reissner’s membrane in the cochlea will distend and may even rupture. We have studied the effects of acute hydrops, followed for up to 5–6 h, in a preparation that allows continuous monitoring of structural alterations in individual cells in Reissner’s membrane. This is accomplished by using laser confocal microscopy on the membrane visualized by labeling its cells with fluorescent dyes. In specimens subjected to hydrops it was observed that discrete structural defects developed in Reissner’s membrane. These were seen as lesions in single cells or in groups of cells in the epithelial layer. It is suggested that through these micro-lesions the electro-chemical environment of the organ of Corti can be altered causing hearing loss and tinnitus during hydrops.
Pseudomonas aeruginosa Keratitis in IL-6-Deficient Mice
Authors: Cole Nerida , Bao Shisan , Stapleton Fiona , Thakur Archana , Husband Alan J. , Beagley Kenneth W. , Willcox Mark D.P.
Published: April 2003

Background:Pseudomonas aeruginosa infection is one of the most destructive diseases of the eye. The host response to this infection is critical to the outcome. Interleukin-6 (IL-6) is implicated in this response; however, the mechanisms by which IL-6 contributes to the host defences in corneal infection remain unclear. Using IL-6–/– mice, we have explored the role of IL-6 in P. aeruginosa keratitis. Methods: The eyes of IL-6 gene knockout and wild-type mice were challenged topically with P. aeruginosa and examined on days 1–7. Keratitis was examined clinically and histologically. Cytokine, chemokine and complement 3 levels were determined by ELISA and ICAM-1 by immunohistochemistry. Results: Clinically, the IL-6–/– mice showed more severe disease than wild-type mice and this was supported by the histological findings. More than 2-fold higher bacterial load was detected in the eyes of the IL-6–/– mice than in those of the wild-type mice. Neutrophil infiltration to the central cornea of the IL-6–/– mice failed to occur in response to infection, although a greater number of neutrophils were present in the whole eye. This may in part be due to the reduced expression of the adhesion molecule ICAM-1 in the cornea, but does not appear to stem from insufficient production of chemokines or complement 3. Conclusions: Our findings indicate that IL-6 is critical to the host defence of the cornea during P. aeruginosa infection. Pharmacological manipulation of the IL-6 response may represent a rational strategy for new interventions.
Serum Cytokine Levels, Cigarette Smoking and Airway Responsiveness among Pregnant Women
Authors: Tsunoda Masashi , Litonjua Augusto A. , Kuniak Michael P. , Weiss Scott T. , Satoh Toshihiko , Guevarra Lucille , Tollerud David J.
Published: April 2003

Background: Five to twenty percent of healthy, nonasthmatic individuals exhibit airway hyperreactivity. Because cytokines are important intermediates in airway responses, we investigated the relationship between serum cytokines and airway responsiveness in a well-characterized population of pregnant women. Methods: We analyzed serum levels of interleukin-4 (IL-4), IL-5, IL-6, interferon-γ (IFN-γ), and granulocyte-macrophage colony-stimulating factor (GM-CSF) in frozen sera from 240 pregnant nonasthmatic subjects from a previous study of airway responsiveness and preterm labor for their relationship to methacholine challenge test results. Results: Serum IFN-γ and GM-CSF levels were significantly related to levels of methacholine airway responsiveness among nonasthmatics in this population. Nonasthmatics with PD20 <8 µmol (the highest level of airway responsiveness) had the highest mean serum levels of IFN-γ and GM-CSF, those with 8 ≤ PD20 ≤ 50 µmol had intermediate levels, and those with PD20 >50 µmol had the lowest levels. Both serum IFN-γ and GM-CSF levels were also significantly related to the log dose-response slope for methacholine responsiveness. These relationships were confirmed in a multiple linear regression analysis controlling for age, ethnic background, and cigarette smoking. Current smoking was uniformly associated with decreased cytokine levels. Conclusion: IFN-γ, GM-CSF, and other cytokines may be useful serum markers in population studies of airway responsiveness.
Extraocular Blood Flow and Endothelin-1 Plasma Levels in Patients with Multiple Sclerosis
Authors: Pache Mona , Kaiser Hedwig J. , Akhalbedashvili Nino , Lienert Carmen , Dubler Barbara , Kappos Ludwig , Flammer Josef
Published: April 2003

In order to evaluate whether plasma levels of the potent vasoconstrictor endothelin-1 (ET-1) are increased in patients with multiple sclerosis (MS) and whether these patients exhibit an ET-1-mediated vascular dysregulation, ET-1 plasma levels were measured in 30 patients with MS. Blood flow velocities in the ophthalmic artery, central retinal artery, central retinal vein, short lateral posterior ciliary artery, and short medial posterior ciliary artery were assessed in parallel. ET-1 plasma levels were significantly increased in MS patients when compared to sex- and age-matched healthy controls (2.0 ± 0.4 pg/ml, range 1.1–2.8 vs. 1.5 ± 0.2 pg/ml, range 0.9–2.0; p < 0.001). Moreover, the patients exhibited significant alterations of extraocular blood flow. The role of ET-1 in the inflammatory process remains to be clarified.
Recurrence of Symptoms after Chiari Decompression and Duraplasty with Nonautologous Graft Material
Authors: Rosen David S. , Wollman Robert , Frim David M.
Published: April 2003

Nonautologous material is commonly used for dural grafting. Although good results have been reported with the use of some of these materials in cranial surgery, there is a paucity of information regarding their use in craniocervical decompressive surgery. We report three cases of patients with Chiari malformation type I who experienced recurrent or new-onset Chiari symptoms after surgical decompression and duraplasty with bovine pericardium, Gore-Tex or cadaveric dura. We review the use of these materials and propose possible mechanisms by which a reaction to a nonautologous graft could cause recurrent Chiari symptoms. The preferential use of autologous material for dural grafts during posterior fossa decompressive surgery should prevent this cause of symptom recurrence.
Television Tipovers as a Significant Source of Pediatric Head Injury
Authors: Jea Andrew , Ragheb John , Morrison Glenn
Published: April 2003

Objective: To highlight the rising number and nature of pediatric head injuries secondary to falling television sets and correlate this with the increasing number of home TVs sold per year. Methods: National statistics for the past 10 years for the number of head traumas from falling television sets in children less than the age of 18 were obtained from the US Consumer Product Safety Commission. Statistics for the number of TV sales were obtained from the Consumer Electronic US Sales Report for the same time period. A retrospective chart review overlapping the same period of time was performed at our local institution. Results: National statistics show a steady rise in the number of pediatric head injuries, from 31 in 1992 to 117 in 2001. The number of TVs sold by year increased from 20,384,000 to 23,776,000 in a 10-year period from 1990 to 2000. Six of the 7 patients in our series (average age 22 months, range 18–36 months) suffered a skull fracture; 2 of those 6 were basilar skull fractures. The average length of hospital stay was 5 days (range 1–13 days). Conclusion: The number of pediatric head injuries from falling televisions has been steadily increasing. A similar, yet more modest rise in the number of televisions manufactured and sold per year has also been noted. From our series, the most common type of pediatric head injury sustained from falling television sets was skull fracture, seen mostly in children less than 2 years of age.
Polyostotic Monosystemic Calvarial and Spinal Langerhans’ Cell Histiocytosis Treated by Surgery and Chemotherapy
Authors: Karagoz Guzey Feyza , Bas N. Serdar , Emel Erhan , Alatas Ibrahim , Kebudi Rejin
Published: April 2003

There are several treatment modalities for Langerhans’ cell histiocytosis (LCH) of bone, formerly usually referred to as eosinophilic granuloma, including surgery, radiotherapy and chemotherapy. In spinal lesions, surgery is not recommended generally, because of the potential for reconstitution of vertebral height. We report a case of multifocal monosystemic LCH treated by surgery and chemotherapy for calvarial and spinal lesions. A 7-year-old boy was initially operated for an occipital monostotic LCH of bone. Then, he was treated by surgery for cervical and thoracic lesions, and by chemotherapy with vinblastine. The patient had no complaints at the 24-month follow-up. Although surgery is not recommended for spinal lesions in children with LCH of bone, short segmental fusion and internal fixation may be a suitable choice for selected cases, especially in children who are not likely to comply with activity restrictions and in those who it is difficult to follow up. The treatment must be planned according to the characteristics of the patient.
Surgical Treatment of Thoracic and Lumbar Tuberculosis by Anterior Interbody Fusion and Posterior Instrumentation
Authors: Mukhtar Ahmed M. , Farghaly Medhat M. , Ahmed Shaban H.
Published: April 2003

Objective: To evaluate the efficacy and clinical outcome of simultaneous or sequential anterior and posterior surgical approaches in the management of spinal tuberculosis in the form of anterior extirpation of the tuberculous lesion, strut bone grafting of the defect produced and posterior instrumentation for spinal fixation. Subjects and Methods: Twenty-two patients who had tuberculosis of the thoracic and lumbar spine with moderate to severe localized kyphosis and variable degrees of neurological deficits were treated at Al Razi Hospital (Kuwait) in the period from 1998 to 2000 by anterior debridement and autogenous strut bone grafting with simultaneous or staged posterior spinal fixation using either USS or SOCON spinal instrumentation. Appropriate antituberculosis treatment was given to all patients for 9–12 months. The postoperative follow-up period was 18 months. Results: Of the 22 cases the average of preoperative kyphosis was 42°. The average of immediate postoperative correction was 27°. At the last follow-up the average correction was 24° and the loss of correction did not exceed 3°. Average fusion times were 5 months for one-segment fusions and 8 months for two-segment fusions. There was no recurrence of the disease in any of the cases. Conclusion: Posterior instrumental stabilization and anterior interbody fusion were found to be effective in arresting the disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.
Female Genital Cutting: Types, Motives and Perineal Damage in Laboring Egyptian Women
Authors: Al-Hussaini Tarek K.
Published: April 2003

Objectives: To study the prevalence of female genital cutting (FGC) in a nulliparous population admitted for childbirth. In addition, the type of FGC, the motives supporting FGC and perineal damage associated with this practice were evaluated. Subjects and Methods: A prospective cross-sectional study was conducted in the labor ward, Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut, Egypt. Two hundred and fifty-four primigravid women in active labor were recruited over a period of 20 months. The subjects responded to a questionnaire and obstetric and pelvic examinations were carried out. The type of cut (circumcision) and extent of tissue removal were recorded. Data was gathered concerning possible motives for FGC, rates of episiotomy and incidence of perineal tears. Results: All women recruited had been circumcised; 51% had type I cut and 49% had type II. Adherence to tradition was the most common motive for the operation (46.5%). Ninety-five percent of the study population had an episiotomy. The incidence of perineal tears was 1.6%. Conclusions: Female genital cutting (only types I and II) was confirmed in all patients in the study. There was a low incidence of perineal tears and a high episiotomy rate (95%). Episiotomy should be performed in all cases where FGC has made the vulva/vagina inelastic.
Further Genetic Heterogeneity for Autosomal Dominant Human Sutural Cataracts
Authors: Klopp Norman , Héon Elise , Billingsley Gail , Illig Thomas , Wjst Matthias , Rudolph Günther , Graw Jochen
Published: April 2003

A unique sutural cataract was observed in a 4-generation German family to be transmitted as an isolated autosomal, dominant trait. Since mutations in the γ-crystallin encoding CRYG genes have previously been demonstrated to be the most frequent reason for isolated congenital cataracts, all 4 active CRYG genes have been sequenced. A single base-pair change in the CRYGA gene has been shown, leading to a premature stop codon. This was not observed in 170 control individuals. However, it did not segregate with the disease phenotype. This is the first truncating mutation in an active CRYG gene without a dominant phenotype. As the CRYGA mutation did not explain the cataract, several other candidate loci (CCV, GJA8, CRYBB2, BFSP2, MIP, GJA8, central pouch-like, CRYBA1) were investigated by microsatellite markers and linkage analysis, but they were excluded based on the combination of haplotype analysis and two-point linkage analysis. The phenotype in this family is due to a mutation in another sutural cataract gene yet to be identified.
End-Stage Renal Failure Patients Requiring Renal Replacement Therapy in the Intensive Care Unit: Incidence, Clinical Features, and Outcome
Authors: Uchino Shigehiko , Morimatsu Hiroshi , Bellomo Rinaldo , Silvester William , Cole Louise
Published: April 2003

Aims: To study incidence, clinical features, and outcome of critically ill patients with end-stage renal failure (ESRF) requiring renal replacement therapy (RRT) in the intensive care unit (ICU) and to test the validity of severity scoring systems for these patients. Methods: Data for ESRF patients treated with RRT were collected from 81 Australian adult ICUs providing RRT. They were compared with matched controls with acute renal failure. Results: Thirty-eight ESRF patients received RRT in the ICU over 3 months. The mean APACHE II score was 21.8 (predicted mortality: 37%) and the SAPS II score 44.7 (predicted mortality: 37%). The hospital mortality was 34%. Receiver operating characteristic curves showed good discrimination ability for hospital mortality for these two scores (AUC: 0.81 for APACHE II and 0.84 for SAPS II). Using admission diagnosis and SAPS II scores, 32 ESRF patients treated with continuous RRT (CRRT) were matched to 32 acute renal failure patients also treated with CRRT. ICU mortality (22 vs. 38%) and hospital mortality (38 vs. 38%) were comparable between the two groups. Conclusions: ESRF patients requiring RRT in the ICU were relatively frequent. Severity scores could be used to predict the hospital outcome for these patients. Their mortality, when treated with CRRT, was similar to that of diagnosis- and severity-score-matched patients with acute renal failure.
Comparison of the Effects of Cellulose Triacetate and Polysulfone Membrane on GPIIb/IIIa and Platelet Activation
Authors: Kuragano Takahiro , Kuno Tsutomu , Takahashi Yoshiko , Yamamoto Chii , Nagura Yuji , Takahashi Susumu , Kanmatsuse Katsuo
Published: April 2003

Background: During hemodialysis session, several adverse reactions can occur on platelets, which are attributable to bioincompatibility of the dialysis membrane. Glycoprotein IIb/IIIa (GPIIb/IIIa) is the receptor for fibrinogen, which mediates platelet aggregation and adhesion. Accordingly, we compared the influence of a cellulose triacetate (CTA) and polysulfone (PS) membrane on GPIIb/IIIa and platelet activation. Methods: Blood samples from 5 patients on hemodialysis were taken at 0 time, 15 min, 30 min, 60 min and 240 min, during a single hemodialysis session, by a crossover design using CTA or PS. Platelet count and plasma concentration of GPIIb/IIIa, β-thromboglobulin (β-TG) and platelet factor 4 (PF-4) were measured. GPIIb/IIIa was measured by flow cytometry. β-TG and PF-4 were measured by ELISA. Results: There was no significant change in the total amount of GPIIb/IIIa during dialysis session between the CTA and PS. However, the level of bound GPIIb/IIIa was significantly (p < 0.0002) increased from 1,426 ± 435 to 40,446 ± 2,777 mol/PLT with PS. In contrast, there was no significant change with CTA (3,258 ± 1,469 to 4,301 ± 1,422 mol/PLT). The platelet counts and β-TG and PF-4 behavior during the dialysis session did not show significant change between the PS and CTA. Conclusion: The characterization of changes in platelet membrane receptor (GPIIb/IIIa) may be a useful marker for studying the biocompatibility of dialysis membranes. On platelet aggregation, CTA might be more biocompatible membrane than PS.
Acute Stroke Predisposes to Oral Gram-Negative Bacilli – a Cause of Aspiration Pneumonia?
Authors: Millns B. , Gosney M. , Jack C.I.A. , Martin M.V. , Wright A.E.
Published: April 2003

Objectives: To assess any change in the oral flora in the mouths of stroke patients during the acute and rehabilitation phases and to determine whether this is related to episodes of aspiration pneumonia and clinical outcome. Materials and Methods: This observational study was carried out in hospital wards in a University teaching hospital. The subjects were patients immediately post-stroke and during the rehabilitation period, acute admissions and a group of healthy volunteers. An assessment of dentition and swallow in the presence or absence of oral aerobic gram-negative bacilli (AGNB) was correlated. Results: Of the acute stroke patients 52% had an unsafe swallow. AGNB carriage was documented in 34% of the acute stroke group. Of the 11 patients who died 55% had AGNB, 73% had an unsafe swallow and 36% had a combination of both. Conclusion: AGNB is a common finding in acute stroke patients. It is not a consequence of age or acute hospitalisation and is associated with an unsafe swallow and a higher mortality.
Obesity and Type-2 Diabetes in the Elderly
Authors: Dewan Shivani , Wilding John P.H.
Published: April 2003

Type-2 diabetes is common in the elderly and when compounded by obesity presents a major challenge for the physician. Obesity plays a central role in the aetiology and pathogenesis of type-2 diabetes. Body weight is determined by an interaction between genetic, environmental and psychosocial factors acting through the physiological mediators of energy intake and expenditure. Obesity is thought to predispose to type-2 diabetes primarily by causing insulin resistance. Education and changes in lifestyle remain the key issues in obesity management. Anti-obesity drugs may delay the onset of diabetes but there is limited experience of their use in elderly patients. Obesity should not be viewed as a cosmetic problem that affects a few individuals, but a major health hazard that is both preventable and amenable to treatment.
Nutritional and Clinical Evaluation of a Modified Soy Protein with Covalently Bound Branched-Chain Amino Acids in Cirrhotic Sprague-Dawley Rats
Authors: Rodríguez M.F. , Wall A. , Kondrup J. , López-Cervantes G. , Calderón de la Barca A.M.
Published: April 2003

Several studies suggested that branched-chain amino acids (BCAA) improve plasma amino acid imbalance as well as protein metabolism in patients with cirrhosis. However, commercial formulas supplemented with free BCAA have their limitations. We evaluated a modified soy protein diet with covalently bound BCAA (diet M) by comparing it with diets based on casein (diet C) or Hepatic Aid II (diet H; commercial formula) as protein sources. After 3 weeks of bile duct obstruction, 24 Sprague-Dawley rats divided into three groups received diets with 9% (w/w) protein/amino acids for 7 days. Nutritional and clinical parameters were determined. Nitrogen balance and weight gain (g)/protein intake (g) with diet M (0.19 ± 0.31 and 1.33 ± 1.43 g, respectively) were significantly higher (p < 0.05) than with diet H (–0.34 ± 0.20 and –0.34 ± 1.11 g), but comparable to those with diet C (0.04 ± 0.38 and 0.20 ± 0.93 g). Animals on diet M had a significantly (p < 0.05) increased plasma BCAA:aromatic amino acid ratio (1.8 ± 0.3) as compared with those on diets H (1.3 ± 0.1) and C (0.8 ± 0.0). There were no significant differences in organ weight or liver function among the groups. We conclude that the BCAA-modified protein is an attractive option in the nutritional support of patients having cirrhosis.
Resection of Hepatocellular Carcinoma in a Patient with Congenital Anomaly of the Portal System
Authors: Tashiro Hirotaka , Itamoto Toshiyuki , Nakahara Hideki , Ohdan Hideki , Kobayashi Takeshi , Asahara Toshimasa
Published: April 2003

Hepatic resection in a patient with an anomalous portal vein system is presented. A 53-year-old man was referred to our hospital for hepatic resection. Preoperative computed tomography (CT) and angiography demonstrated that the umbilical portion of the portal vein gave off major branches to the right anterior segment, and the hepatic tumor was located on the dorsal side of one of the right anterior portal branches near the umbilical portion. Partial hepatic resection was performed using the indocyanine green staining technique under operative echo guidance. Limited hepatic resection was indicated due to the patient’s poor hepatic reserve function. His postoperative course was uneventful. This case emphasizes the importance of delineating the hepatic vascular anatomy before and during operation, especially in the case of an anomalous portal vein system.
Surgical Management of Synchronous Hepatocellular Carcinoma and Gastric Cancer
Authors: Uenishi Takahiro , Kubo Shoji , Hirohashi Kazuhiro , Osugi Harushi , Shuto Taichi , Tanaka Hiromu , Yamamoto Takatsugu , Ogawa Masao , Kinoshita Hiroaki
Published: April 2003

Background/Aims: The improvement of diagnostic modalities and operative techniques has resulted in prolonged survival for cancer patients, but has also led to the diagnosis of an increasing number of patients with synchronous hepatocellular carcinoma (HCC) and extrahepatic primary cancer. It is necessary to determine the optimal surgical strategies for synchronous HCC and gastric cancer. Methods: In this retrospective study, clinicopathologic findings, diagnostic methods, treatment and outcome were reviewed in 13 patients who underwent curative surgery for synchronous HCC and gastric cancer. Results: Twelve of the 13 patients were men older than 60 years. All patients had chronic hepatic disease, and hepatitis viral infection was detected in 9 patients. Examinations of the esophagus to search for esophageal varices before liver resection for HCC, and imaging studies to rule out liver metastasis before gastrectomy for gastric cancer can lead to the incidental finding of a synchronous carcinoma. The most frequent postoperative complication was massive ascites, which occurred in 4 patients who underwent lymph node dissection, 1 of whom died of perioperative hepatic failure. HCC recurred in 7 patients, 4 of whom died of their disease; only 1 patient died of recurrence of gastric cancer. Conclusion: Careful follow-up for recurrence of HCC is necessary because the most common cause of death in patients with synchronous carcinoma is recurrence of HCC.
Prognostic Significance of the Number of Metastatic Lymph Nodes in Early Gastric Cancer
Authors: Gunji Yoshio , Suzuki Takao , Hori Seiji , Hayashi Hideki , Matsubara Hisahiro , Shimada Hideaki , Ochiai Takenori
Published: April 2003

Background: The prognostic value of the number of metastatic lymph nodes in early gastric cancer has not been evaluated much, although the significance of metastatic lymph nodes is defined by the location of positive nodes, according to the JRSGC for gastric cancer. Methods: The postoperative courses of 305 early gastric cancer patients who had undergone D2-extended lymphadenectomy were followed up for a median of 108 months to evaluate the significance of the number of metastatic lymph nodes on recurrence of the disease. Results: Recurrence of gastric cancer was more frequently observed in submucosal cancer than in mucosal cancer. All patients but one who revealed recurrence had nodal metastasis at the time of surgery. In cases with 1–3 metastatic lymph nodes, no patient had revealed any sign of recurrence; however, in cases with 4 or more metastatic lymph nodes, 6 of 7 patients died of recurrent disease. There were 3 cases of bone metastases, 2 of peritoneal dissemination, and 1 each of both recurrent diseases. Conclusions: These data suggest that in n-positive cases, in which there are 4 or more metastatic lymph nodes, there is a high probability of recurrence of early gastric cancer, and especially of hematogenic metastasis.
Risks and Causes of Death in a Community-Based Stroke Population: 1 Month and 3 Years after Stroke
Authors: Loor Henriëtte I. , Groenier Klaas H. , Limburg Martien , Schuling Jan , Meyboom-de Jong Betty
Published: April 2003

We performed a community-based study on a cohort of 221 stroke patients followed for 3 years. In this paper, we tried to answer the following questions: Is the risk of dying increased throughout the first 3 years after stroke? What are the causes of death after the 1st month? What factors at stroke onset are independent predictors of early and late mortality? The relative risk of death was estimated using age- and sex-specific mortality rates for the Netherlands. Causes of death were registered by the attending physicians, mostly general practitioners. During the 1st month 26% of the patients died. At 1, 2 and 3 years, the cumulative mortality rates were 37, 46 and 54%, respectively. Stroke patients had an increased risk of dying, approximately twice that of the general population, during the 3 years of follow-up. In women, this increased risk was more pronounced than in men. After 1 month, cardiovascular pathology, stroke and diseases resulting from stroke were the causes of death in 70% of the patients, i.e. substantially higher than in the general population, matched for age and sex. Factors predicting mortality after stroke varied over time. Severity of the stroke, preexisting atrial fibrillation and congestive heart failure were associated with early mortality (within 30 days). For 1-month survivors, incontinence and preexisting atrial fibrillation were associated with mortality in the 1st year after stroke. After 1 year, only age was associated with mortality.
Migraine History and Migraine-Induced Stroke in the Dijon Stroke Registry
Authors: Sochurkova D. , Moreau T. , Lemesle M. , Menassa M. , Giroud M. , Dumas R.
Published: April 2003

Two thousand three hundred and eighty-nine patients with first-ever stroke were registered in the population-based Dijon Stroke Registry over an 11-year period. There was a history of migraine in 49 cases (2%), with a majority of women (2.8% versus 1.1% men) with the following distribution: 27 cases among 1,380 large-artery cerebral infarctions (1.9%), 6 cases among 358 small-artery cerebral infarctions (1.6%), 6 cases among 412 cerebral infarctions due to cardiac embolism (1.4%), 7 cases among 191 cerebral hemorrhages (3.6%) and 3 cases among 47 subarachnoid hemorrhages (6.3%). The male/female ratio was 0.58 for the 49 strokes with a history of migraine versus 1.27 for the 2,340 strokes with no history of migraine. Twelve migraine-induced ischemic strokes occurred with an infarction of the posterior area of the brain in young patients. The annual incidence was 0.80/100,000/year (confidence interval, CI = 0.37–1.57) with a predominance of women (1.02/100,000/year, CI = 0.52–1.25; men: 0.57/100,000/year; CI = 0.28–1.04). We conclude that a history of migraine is more frequent in women, in particular in those with hemorrhagic strokes, and that the incidence of migraine-induced stroke in our population-based study is higher in women, although it remains low.
Indirect Discharges as an Early Nerve Conduction Abnormality in the Guillain-Barré Syndrome
Authors: Roth Gérard , Magistris Michel R.
Published: April 2003

Abnormal electrophysiological findings may be delayed in the Guillain-Barré syndrome (GBS). In this study, conducted in 29 GBS patients, 23 patients (group 1) fulfilled the electrodiagnostic criteria for GBS [1]at the time of initial investigation, performed on average 22.3 days after onset of symptoms; whereas the 6 patients (group 2) who did not fulfil the criteria were first seen earlier, on average after 9.7 days. During the initial nerve conduction studies, numerous late responses, distinct from F waves, were observed in 26 of the 29 patients (90%), that is in 20 patients of group 1, and in all patients of group 2. Most of these responses, if not all, were indirect discharges (iDs) caused by proximal re-excitation on motor axons. If the iDs had been included in the electrodiagnostic criteria of GBS, all the patients of this series would have been diagnosed at the initial electrophysiological examination. We conclude that iDs occur frequently in GBS and are observed early in the disease. We recommend adding the presence of multiple iDs to the classical electrodiagnostic criteria of GBS.
Practice Variability in Management of Transient Ischemic Attacks
Authors: Johnston S. Claiborne , Smith Wade S.
Published: April 2003

To define practice patterns in the management of transient ischemic attacks (TIAs), we surveyed practicing neurologists attending an educational conference in San Francisco, evaluating management decisions in 2 TIA case vignettes. In a vignette describing a hemispheric TIA 1 day prior with ipsilateral bruit, 53% chose admission, 47% elected an outpatient work-up, 28% treated with intravenous heparin and 70% chose aspirin, reflecting the disagreement about medical management of carotid stenosis in the literature. There was more agreement in the second case, a posterior circulation TIA 1 day prior with atrial fibrillation, in which 84% chose hospital admission, 74% chose intravenous heparin and 90% treated with some form of anticoagulation. There are areas of important practice variability in the management of TIAs. Further research is justified to guide patient care decisions in TIA patients.
Dural Cell Culture
Authors: Schick Bernhard , Wolf Gregor , Romeike Bernd F.M. , Mestres Pedro , Praetorius Mark , Plinkert Peter K.
Published: April 2003

Fistulas of the cerebrospinal fluid are often repaired by insertion of grafts of various kinds. However, current knowledge of wound healing after graft insertion is limited, and only a few animal studies are available. The objective of this study is to test whether an in vitro model is suited to analyze cellular healing aspects after duraplasty and to assess dura substitutes in such conditions in regard to their surface attractiveness for cellular migration from the dura margins. Harvested dura pieces from minipigs were perforated to mimic central dura lesions, placed on various coated surfaces (collagen, laminin, poly-L-lysine) or grafts, and investigated in a cell culture for cellular closure of the perforation. Cellular migration from the dura into the central perforation was noted on collagen-coated surfaces and when defects were filled with collagen gels, but there was no cell growth on surfaces with poly-L-lysine or laminin coating. Immunocytochemistry identified the migrating cells mainly as fibroblasts with some intermingled epithelial cells. Scanning electron microscopy proved cellular closure of defects after dura placement on allogenic non-crosslinked collagen transplants. Less cellular migration was observed on poly-p-dioxanon sheets, while no cells migrated into the central dura perforation after placement on a cartilage substitute. Cell counting indicated enhanced cellular closure of the dura opening after introduction of insulin or fibroblast growth factor (sign test for both: 0.031). Our study succeeded in establishing a cell culture model for duraplasty and indicated cellular migration from the dura borders at the site of the defect during the wound healing process. The cell culture model presented in this report shows that collagen grafts are best suited for duraplasty. In accordance with the immunocytological finding of fibroblast migration from the dura borders additional application of fibroblast-stimulating growth factors accelerated cellular defect closure.