bluuebunny/crossref_metadata_2025 huggingface dataset:
Family, peer and individual factors related to methylenedioxymethamphetamine use in Taiwanese adolescents
Authors: YEN CHENG‐FANG , CHENG CHUNG‐PING , TSAI JIN‐LIAN , HSU SEN‐YEN
Published: September 2007

Abstract  Examination of the correlates of methylenedioxymethamphetamine (MDMA) use is crucial for the development and implementation of effective prevention programs for adolescents. The aim of the present study was therefore to identify the family, peer and individual factors that were related to MDMA use in Taiwanese adolescents. Two hundred adolescents who used MDMA and 200 who did not use MDMA were recruited into the study. The family, peer and individual factors related to MDMA use were examined using χ2 automatic interaction detection (CHAID) analysis. The results indicated that the adolescents who had more friends involved with substance use, disruptive family and attitude favoring MDMA use were more likely to use MDMA. Multiple factors of family, peer and individuals were related to MDMA use among Taiwanese adolescents. This knowledge may be helpful when designing and implementing preventive intervention programs.
Effective electroconvulsive therapy in a 92‐year‐old dementia patient with psychotic feature
Authors: KATAGAI HIROSHI , YASUI‐FURUKORI NORIO , KIKUCHI ATSUHIRO , KANEKO SUNAO
Published: September 2007

Abstract  A 92‐year‐old woman who suffered from dementia with psychotic feature was admitted to a psychiatric ward. She refused to eat or take any medications. After 0.5 mg i.v. injection haloperidol, prolongation of QTc interval occurred in the electrocardiogram. Therefore two sessions of electroconvulsive therapy (ECT) were performed carefully after informed consent was obtained by her family. Almost no psychotic symptoms were observed after the first ECT. No cognitive side‐effects were observed during and after the two ECT sessions. This demonstrates that ECT can be used as an alternative treatment when elderly dementia patients with psychotic feature cannot tolerate medication.
Serum brain‐derived neurotrophic factor levels in conversion disorder: Comparative study with depression
Authors: DEVECI ARTUNER , AYDEMIR OMER , TASKIN ORYAL , TANELI FATMA , ESEN‐DANACI AYSEN
Published: September 2007

Abstract  The aim of the present study was to compare serum brain‐derived neurotrophic factor (BDNF) levels of patients with major depressive disorder (MDD) and conversion disorder (CD). Serum BDNF levels were measured in the following three groups: 15 CD patients without any comorbid diagnosis of psychiatric disorder, 24 patients with MDD, and 26 healthy subjects without any psychiatric diagnosis or psychiatric treatment. The serum BDNF level of the healthy control group (31.4 ± 8.8 ng/mL) was statistically higher than the level of the MDD group (21.2 ± 11.3 ng/mL) and the CD group (24.3 ± 9.0 ng/mL; P = 0.008). This suggests that BDNF level may play a similar role in the pathophysiology of MDD and CD.
Incorporated home‐made long endotracheal tube: A useful option for treating mucus plugging following silicone stenting
Authors: CHAO Yin‐Kai , LIU Yun‐Hen , HSIEH Ming‐Ju , KO Po‐Jen , LIU Hui‐Ping
Published: September 2007

Stenting is an effective method of treating airway stenosis. However, airway obstruction due to mucus plugging is problematic. Treatment of this has mainly been conservative. This report describes a patient with complicated tracheal stenosis treated with silicone hood stent, who experienced repeated episodes of airway obstruction due to sputum accumulation. A novel method of sputum clearance and self‐care, using a long endotracheal tube within the silicone stent, is described. This procedure resulted in a stable and patent airway, and the patient was discharged smoothly after the procedure. No further respiratory symptom occurred during the follow‐up period.
Cyclophosphamide‐induced acute respiratory distress syndrome
Authors: BRIEVA Jorge
Published: September 2007

Abstract:  Cyclophosphamide is widely used in neoplastic and inflammatory diseases. Although several adverse events have been described with its use, acute and subacute interstitial pneumonitis leading to pulmonary fibrosis is rare and potentially fatal. This case report describes a 64‐year‐old man who, after the fifth chemotherapy cycle, developed a severe ARDS leading to pulmonary fibrosis in just 30 days.
Use of emergency rigid bronchoscopy to reduce tumour mass prior to surgical resection
Authors: TAKAGI Keigo , TAKAHASHI Shoji , HATA Yoshinobu , TAMAKI Kazuyoshi , KATO Nobuhide , SASAMOTO Shuichi
Published: September 2007

Abstract:  Two patients with lung adenocarcinoma developed acute respiratory failure as a result of unilateral lung collapse. They were successfully treated by tumour de‐bulking using a rigid brochoscope and subsequent radical sleeve lobectomy. Case 1 was a 46‐year‐old man whose carcinoma was pathological stage IIIb (P‐T4N2M0), and he remains tumour‐free 39 months after the surgery. Case 2 was a 79‐year‐old man whose carcinoma was pathological stage IIb (P‐T3N0M0). Following treatment, he was able to resume his daily activities, however, his tumour recurred and he died 5 months after the surgery. Debulking of tumours with a rigid bronchoscope was useful for improving patients' quality of life and for the subsequent multidisciplinary treatment of lung carcinoma.
Transforming growth factor β‐1 as a predictor of fibrosis in tuberculous pleurisy
Authors: SEISCENTO Márcia , VARGAS Francisco S. , ANTONANGELO Leila , ACENCIO Milena M.P. , BOMBARDA Sidney , CAPELOZZI Vera L. , TEIXEIRA Lisete R.
Published: September 2007

Background and objective:  To clarify the influence of transforming growth factor β‐1 (TGF‐β1) in the development of pleural thickening in tuberculosis (TB), the levels of TGF‐β1 in pleural fluid and in serum of patients with pleural TB and transudative effusions were determined.

Methods:  TGF‐β1 was quantified in 58 pleural fluid and serum samples of patients with TB (n = 50) or transudative effusions (n = 8). Pleural thickening evaluated by high‐resolution CT was scored as 0 (<3 mm); 1 (≥3 and <10 mm) or 2 (≥10 mm).

Results:  The highest pleural fluid TGF‐β1 levels before treatment for TB were observed in patients with a pleural thickness score of 2. Of the 14 patients with score 1, five regressed to 0, five progressed to 2, and four maintained 1. All 17 patients with score 2 maintained this evaluation. Patients who presented score 1 and progressed to 2 had higher TGF‐β1 levels than those who maintained the same score or regressed (score 1 or 0). Patients with score 2 (before or after treatment) had higher TGF‐β1 levels than those with score 0 or 1.

Conclusion:  Pleural fluid and serum TGF‐β1 levels were higher in patients with TB, with a correlation between pleural fluid TGF‐β1 levels before treatment and the degree of pleural thickening. This finding suggests that TGF‐β1 might be considered as a predictor of pleural thickening in pleural tuberculosis.
Cardiovascular risk in chronic obstructive pulmonary disease
Authors: MACLAY John D. , McALLISTER David A. , MacNEE William
Published: September 2007

Abstract:  Cardiovascular disease (CVD) contributes significantly to morbidity and mortality in COPD. There is a high prevalence of traditional risk factors in this patient group including smoking, sedentary behaviour and low socio‐economic class. However, large studies have shown that airflow limitation is an independent risk factor for CVD. Therefore there may be a 'COPD effect' that contributes to CVD in this condition, adding to the body of evidence that COPD has important systemic consequences, as well as being a lung disease. In this article, we review the evidence for CVD in COPD. Next, we examine systemic factors present in COPD, and link these to the pathogenesis of atherosclerosis, including inflammation, oxidative stress and hypoxia. Finally, we review those studies that have investigated therapeutic interventions in COPD that may modify cardiovascular risk.
Causes of childhood epilepsy in Vietnam: cases in Bach Mai Hospital
Authors: SHIRASAKA YUKIYOSHI , HINH LE DUC , MINH PHAN HONG , SATO WAKIRO
Published: September 2007

Background: Little is known about childhood epilepsy in Vietnam, and because the causes of symptomatic epilepsy could be the result of both rapid economic development and traditional Vietnamese lifestyle, the purpose of the present paper was to clarify the nature of childhood epilepsy in Vietnam.

Method: A classification of epilepsy using International League Against Epilepsy classification was made and an investigation of causes was carried out.

Results: Of those 162 new patients diagnosed as having epilepsy in Bach Mai Hospital, Hanoi, Vietnam, from February 2002 to February 2004 (male 84, female 78), there were 58 cases of generalized epilepsy: 22 symptomatic and 36 idiopathic or cryptogenic. A total of 90 patients were diagnosed as having localization‐related epilepsy: 53 as symptomatic and 37 as idiopathic or cryptogenic. A total of 14 cases were also considered as not epileptic after strict review of both the history and the examination data.

Conclusion: Concerning the causes, the following were noted: (i) the rate of infectious diseases and trauma as causes of epilepsy was considerably higher in Vietnam than in developed countries; (ii) certain infectious diseases could be prevented if vaccinations and public health knowledge were improved; and (iii) the number of trauma cases, mainly due to traffic accidents, would likely be reduced if the traffic system was improved.
Management of meconium‐related ileus in very low‐birthweight infants
Authors: SHINOHARA TSUYOSHI , TSUDA MINEYUKI , KOYAMA NORIHISA
Published: September 2007

Background: Although administration of a water‐soluble contrast enema has been recognized to be effective for meconium‐related ileus, there have been no definitive management guidelines for very low‐birthweight infants.

Methods: Between 1998 and 2004, 10 infants without cystic fibrosis were treated for meconium‐related ileus at Toyohashi Municipal Hospital. Their treatment and clinical course were reviewed retrospectively.

Results: The average gestational age and birthweight of the 10 infants was 27 weeks and 788 g, respectively. The average age at initiation of treatment with a water‐soluble contrast enema was 6.8 days. Intestinal obstruction was relieved by the enema in eight of 10 patients, while one underwent laparotomy and one died without any improvement of obstruction. In both neonates for whom the enema failed, rectal examination and rectal irrigation had been performed for several days before the enema was administered at the age of 14 and 15 days, respectively. In contrast, the enema was administered at the age of 1–11 days in neonates for whom this treatment was successful. Obstruction was relieved if the contrast medium reached the distal ileum, but enemas without reflux into the distal ileum failed to improve the obstruction. Contrast medium passed through the ileocecal valve to reach the distal ileum in all procedures done under fluoroscopy, but the medium failed to reach the ileum in most of the procedures done without fluoroscopy.

Conclusion: Although administration of water‐soluble contrast enemas can be effective for meconium‐related ileus, reflux into the terminal ileum is essential for bowel obstruction to improve, so it is desirable to perform the procedure under fluoroscopic guidance.
Bone mineral density in children and adolescent girls with anorexia nervosa in Japan
Authors: TANAKA KYOKO , HISADA KEN , UNNO KIYOE , IIJIMA MEGUMI , UNNO ATSUSHI , TOKITA AKIFUMI , SHIMIZU TOSHIAKI , YAMASHIRO YUICHIRO
Published: September 2007

Background: The correlation between reduced bone mineral density (BMD) and the disease anorexia nervosa (AN) has long been established. The aim of the present study was to examine the relationship in more detail, particularly focusing on the increasing incidence of the disease occurring in adolescent patients.

Method: Twenty‐four girls diagnosed with AN were enrolled in the study. All subjects ranged in age from 11.1 to 15.5 years, with an average age of 13.5 years. The BMD of lumbar spines and femoral necks were measured. All the values for BMD at admission were expressed as means ± SD and patients with and without menarche were separately investigated.

Results: The average BMD of lumbar spines at the time of admission was −0.51 SD in total. However, the average BMD of patients without menarche was −1.28 SD, which was significantly lower than the −0.16 SD on average in patients with menarche. As a whole the BMD of femoral necks at admission tended to be lower than that of lumbar spines. Similarly, it was lower in patients without menarche (−1.7 SD on average) than in those with menarche (−0.77 SD on average).

Conclusions: BMD was lower in children and adolescent AN patients without menarche, and such a tendency was more significant at the femoral neck region. In child AN cases without menarche, the BMD, especially at the femoral neck, needs to be measured, and later recovery should be monitored closely over a long period.
Co‐prescribing of topical and systemic beta‐blockers in patients with glaucoma: a quality use of medicine issue in Australian practice
Authors: Goldberg Ivan , Adena Michael A
Published: September 2007

Abstract

Purpose: Prescribing topical beta‐blockers for patients with glaucoma, who are also being treated with systemic beta‐blockers, raises efficacy and safety concerns. This potentially inappropriate co‐prescribing practice is a Quality Use of Medicine issue. This study aimed to quantify the extent of co‐prescribing of topical and systemic beta‐blockers in Australian clinical practice.

Methods: This is a retrospective analysis of de‐identified billing data for supply (surrogate marker for prescribing) of topical and systemic beta‐blockers from the Pharmaceutical Benefits Scheme (1999–2004) to concessional patients supplied either topical or systemic beta‐blockers. The primary outcome was the percentage of patients supplied systemic beta‐blockers within the patient population supplied topical beta‐blockers. This percentage was calculated for each financial year (July 1999–June 2004), age group (<65 years; 65–74 years; 75–84 years; ≥85 years) and sex.

Results: Approximately 20% of patients supplied topical beta‐blockers (representing Australian glaucoma patients) were also supplied systemic beta‐blockers, equating to more than 20 000 patients per year. This percentage varied with age, but not with year or sex. The percentage of patients co‐supplied topical and systemic beta‐blockers was the lowest (13%) for patients <65 years and the highest (23%) for patients 75–84 years.

Conclusions: Pharmaceutical Benefits Scheme supply data shows that the potentially inappropriate practice of co‐prescribing topical and systemic beta‐blockers affects more than 20 000 concessional patients in Australia each year, particularly the elderly. This Quality Use of Medicine issue has now been quantified; doctors, pharmacists and patients must be made aware of the reduced efficacy and potential for more side‐effects from this co‐prescribing practice.
Functional specificity of human premotor–motor cortical interactions during action selection
Authors: O'Shea Jacinta , Sebastian Catherine , Boorman Erie D. , Johansen‐Berg Heidi , Rushworth Matthew F. S.
Published: September 2007

Functional connections between dorsal premotor cortex (PMd) and primary motor cortex (M1) have been revealed by paired‐pulse transcranial magnetic stimulation (TMS). We tested if such connections would be modulated during a cognitive process (response selection) known to rely on those circuits. PMd–M1 TMS applied 75 ms after a cue to select a manual response facilitated motor‐evoked potentials (MEPs). MEPs were facilitated at 50 ms in a control task of response execution, suggesting that PMd–M1 interactions at 75 ms are functionally specific to the process of response selection. At 100 ms, PMd–M1 TMS delayed choice reaction time (RT). Importantly, the MEP (at 75 ms) and the RT (at 100 ms) effects were correlated in a way that was hand‐specific. When the response was made with the M1‐contralateral hand, MEPs correlated with slower RTs. When the response was made with the M1‐ipsilateral hand, MEPs correlated with faster RTs. Paired‐pulse TMS confined to M1 did not produce these effects, confirming the causal influence of PMd inputs. This study shows that a response selection signal evolves in PMd early during the reaction period (75–100 ms), impacts on M1 and affects behaviour. Such interactions are temporally, anatomically and functionally specific, and have a causal role in choosing which movement to make.
Interleukin‐1 inhibits firing of serotonergic neurons in the dorsal raphe nucleus and enhances GABAergic inhibitory post‐synaptic potentials
Authors: Brambilla D. , Franciosi S. , Opp M. R. , Imeri L.
Published: September 2007

In vitro electrophysiological data suggest that interleukin‐1 may promote non‐rapid eye movement sleep by inhibiting spontaneous firing of wake‐active serotonergic neurons in the dorsal raphe nucleus (DRN). Interleukin‐1 enhances GABA inhibitory effects. DRN neurons are under an inhibitory GABAergic control. This study aimed to test the hypothesis that interleukin‐1 inhibits DRN serotonergic neurons by potentiating GABAergic inhibitory effects. In vitro intracellular recordings were performed to assess the responses of physiologically and pharmacologically identified DRN serotonergic neurons to rat recombinant interleukin‐1β. Coronal slices containing DRN were obtained from male Sprague–Dawley rats. The impact of interleukin‐1 on firing rate and on evoked post‐synaptic potentials was determined. Evoked post‐synaptic potentials were induced by stimulation with a bipolar electrode placed on the surface of the slice ventrolateral to DRN. Addition of interleukin‐1 (25 ng/mL) to the bath perfusate significantly decreased firing rates of DRN serotonergic neurons from 1.3 ± 0.2 Hz (before administration) to 0.7 ± 0.2 Hz. Electrical stimulation induced depolarizing evoked post‐synaptic potentials in DRN serotonergic neurons. The application of glutamatergic and GABAergic antagonists unmasked two different post‐synaptic potential components: a GABAergic evoked inhibitory post‐synaptic potentials and a glutamatergic evoked excitatory post‐synaptic potentials, respectively. Interleukin‐1 increased GABAergic evoked inhibitory post‐synaptic potentials amplitudes by 30.3 ± 3.8% (n = 6) without affecting glutamatergic evoked excitatory post‐synaptic potentials. These results support the hypothesis that interleukin‐1 inhibitory effects on DRN serotonergic neurons are mediated by an interleukin‐1‐induced potentiation of evoked GABAergic inhibitory responses.
Evidence for RPE65‐independent vision in the cone‐dominated zebrafish retina
Authors: Schonthaler Helia B. , Lampert Johanna M. , Isken Andrea , Rinner Oliver , Mader Andreas , Gesemann Matthias , Oberhauser Vitus , Golczak Marcin , Biehlmaier Oliver , Palczewski Krzysztof , Neuhauss Stephan C. F. , Von Lintig Johannes
Published: September 2007

An enzyme‐based cyclic pathway for trans to cis isomerization of the chromophore of visual pigments (11‐cis‐retinal) is intrinsic to vertebrate cone and rod vision. This process, called the visual cycle, is mostly characterized in rod‐dominated retinas and essentially depends on RPE65, an all‐trans to 11‐cis‐retinoid isomerase. Here we analysed the role of RPE65 in zebrafish, a species with a cone‐dominated retina. We cloned zebrafish RPE65 and showed that its expression coincided with photoreceptor development. Targeted gene knockdown of RPE65 resulted in morphologically altered rod outer segments and overall reduced 11‐cis‐retinal levels. Cone vision of RPE65‐deficient larvae remained functional as demonstrated by behavioural tests and by metabolite profiling for retinoids. Furthermore, all‐trans retinylamine, a potent inhibitor of the rod visual cycle, reduced 11‐cis‐retinal levels of control larvae to a similar extent but showed no additive effects in RPE65‐deficient larvae. Thus, our study of zebrafish provides in vivo evidence for the existence of an RPE65‐independent pathway for the regeneration of 11‐cis‐retinal for cone vision.
Substance P excites globus pallidus neuronsin vivo
Authors: Cui Qiao‐Ling , Yung Wing‐Ho , Xue Yan , Chen Lei
Published: September 2007

Substance P is a member of the neurokinin family. Previous studies have reported the existence of substance P and its high‐affinity receptor, neurokinin‐1 receptor, in globus pallidus. Employingin vivoextracellular recording combined with behavioural tests, the effects of substance P in globus pallidus of rats were studied. Micropressure ejection of the selective neurokinin‐1 receptor agonist [Sar9,Met(O2)11] substance P increased the spontaneous firing rate of pallidal neurons in a concentration‐dependent manner, with increases of 27.3% at 0.01, 33.4% at 0.03, 45.5% at 0.1, 38.4% at 0.3 and 36.4% at 1.0 mm. The selective neurokinin‐1 receptor antagonist SR140333B prevented the excitatory effects induced by [Sar9,Met(O2)11] substance P. In behaving rats, we observed the postural effects of neurokinin‐1 receptor activation in the globus pallidus. Consistent with electrophysiological results, unilateral microinjection of [Sar9,Met(O2)11] substance P (0.1 mm) led to a SR140333B‐sensitive contralateral deflection in the presence of systemic haloperidol administration. Combining electrophysiological and behavioural findings, we concluded that substance P produces excitatory effects on globus pallidus neurons via neurokinin‐1 receptors.
Schwann cells revert to non‐myelinating phenotypes in the deafened rat cochlea
Authors: Hurley Patricia A. , Crook Jeremy M. , Shepherd Robert K.
Published: September 2007

Loss of sensory hair cells within the cochlea results in a permanent sensorineural hearing loss and initiates the gradual degeneration of spiral ganglion neurons (SGNs) − the primary afferent neurons of the cochlea. While these neurons are normally myelinated via Schwann cells, loss of myelin occurs as a precursor to neural degeneration. However, the relationship between demyelination and the status of Schwann cells in deafness is not well understood. We used a marker of peripheral myelin (myelin protein zero; P0) and a marker of Schwann cells (S100) to determine the temporal sequence of myelin and Schwann cell loss as a function of duration of deafness. Rat pups were systemically deafened for periods ranging from 2 weeks to greater than 6 months by co‐administration of frusemide and gentamicin. Cochleae were cryosectioned and quantitative immunohistochemistry used to determine the extent of P0 and S100 labelling within the peripheral processes, SGN soma and their central processes within the modiolus. SGN density was also determined for each cochlear turn. P0 labelling decreased throughout the cochlea with increasing duration of deafness. The reduction in P0 labelling occurred at a faster rate than the SGN loss. In contrast, S100 labelling was not significantly reduced compared with age‐matched controls in any cochlear region until 6 months post‐deafening. These results suggest that Schwann cells may revert to non‐myelinating phenotypes in response to deafness and exhibit greater survival traits than SGNs. The potential clinical significance of these findings for cochlear implants is discussed.
Long‐term depression of cortico‐striatal synaptic transmission by DHPG depends on endocannabinoid release and nitric oxide synthesis
Authors: Sergeeva O. A. , Doreulee N. , Chepkova A. N. , Kazmierczak T. , Haas H. L.
Published: September 2007

In models of early stage Parkinson's disease (PD), motor deficits are accompanied by excessive activation of striatal glutamate receptors. Metabotropic glutamate group I receptors (mGluR I) play an important but not well‐understood role in PD progression. In mouse brain slices, bath application of the mGluR I agonist (RS)‐DHPG (3,5‐dihydroxyphenylglycine, 100 µm for 20 min) caused a long‐term depression of corticostriatal transmission (LTDDHPG), which was reversed by three mGluR I antagonists: LY 367385, CPCCOEt and MPEP. LTDDHPG required nitric oxide (NO) synthesis as it was blocked by the broad‐spectrum NO synthase (NOS) inhibitor Nω‐nitro‐l‐arginine (NL‐Arg) and impaired under blockade of neuronal NOS and in endothelial NOS‐deficient mice. Release of endocannabinoids (eCB) was critically involved in this form of striatal plasticity givem that the CB1 receptor antagonist AM251 prevented LTDDHPG, while the CB1 agonist ACEA elicited LTD. The NO synthesis necessary for LTDDHPG induction occurred downstream of CB1 activation as ACEA‐evoked LTD was also abolished by NL‐Arg. These findings are relevant for the pathophysiology of PD, as they link the overactivation of group I mGluRs and striatal NO production.
Spatio‐temporal dynamics of oscillatory network activity in the neonatal mouse cerebral cortex
Authors: Sun Jyh‐Jang , Luhmann Heiko J.
Published: September 2007

We used a 60‐channel microelectrode array to study in thick (600–1000 µm) somatosensory cortical slices from postnatal day (P)0–P3 mice the spatio‐temporal properties of early network oscillations. We recorded local non‐propagating as well as large‐scale propagating spontaneous oscillatory activity. Both types of activity patterns could never be observed in neocortical slices of conventional thickness (400 µm). Local non‐propagating spontaneous oscillations with an average peak frequency of 15.6 Hz, duration of 1.7 s and maximal amplitude of 66.8 µV were highly synchronized in a network of ∼200 µm in diameter. Spontaneous oscillations of lower frequency (10.4 Hz), longer duration (23.8 s) and larger amplitude (142.9 µV) propagated with 0.11 mm/s in the horizontal direction over at least 1 mm. These propagating oscillations were also synchronized in a columnar manner, but these waves synchronized the activity in a larger neuronal network of 300–400 µm in diameter. Both types of spontaneous network activity could be blocked by the gap junction antagonist carbenoxolone. Electrical stimulation of the subplate (SP) or bath application of the cholinergic agonist carbachol also elicited propagating network oscillations, emphasizing the role of the SP and the cholinergic system in the generation of early cortical network oscillations. Our data demonstrate that a sufficiently large network in thick neocortical slice preparations is capable of generating spontaneous and evoked network oscillations, which are highly synchronized via gap junctions in 200–400‐µm‐wide columns. These via synchronized oscillations coupled networks may represent a self‐organized functional template for the activity‐dependent formation of neocortical modules during the earliest stages of development.
Vacuolization correlates with spin–spin relaxation time in motor brainstem nuclei and behavioural tests in the transgenic G93A‐SOD1 mouse model of ALS
Authors: Bucher Selina , Braunstein Kerstin E. , Niessen Heiko G. , Kaulisch Thomas , Neumaier Michael , Boeckers Tobias M. , Stiller Detlef , Ludolph Albert C.
Published: September 2007

In recent years, magnetic resonance imaging (MRI) has emerged as a preferred tool for the diagnosis of amyotrophic lateral sclerosis (ALS) in humans. A widely used animal model for human ALS is the G93A‐superoxide dismutase 1 (G93A‐SOD1) transgenic mouse model. However, the mechanisms for the selective degeneration of motor neurons in the brainstem and spinal cord are still uncertain. In our study, we applied MRI at 4.7 Tesla to non‐invasively evaluate pathological alterations in the brainstem of this animal model and to follow the progression of the disease. Extending previous investigation, we used the relaxation parameter T2 as a suitable measure for the progression of ALS, and evaluated the potential agreement with histological evaluation and behavioural data of open‐field tests. In the brainstem of G93A‐SOD1 mice, T2 values were significantly increased in the motor nuclei Nc. V, Nc. VII and Nc. XII, as early as Day 80, i.e. before the average disease onset at about Day 90. Moreover, this increase is associated with a progressive development of vacuoles in the brainstem motor nuclei and a significantly decreased performance in behavioural tests. Overall, MRI is a very sensitive tool to obtain correlates for neuronal degeneration in vivo. Furthermore, MRI enables us to investigate a follow up at different time points of the disease. These advantages are especially useful for therapeutic studies with respect to survival rates of motor neurons using mouse models. Finally, our data suggest that MRI does not only resemble the findings of behavioural tests, but is potentially superior to behavioural studies.
Intra‐abdominal and gastrointestinal tuberculosis
Authors: Rasheed S. , Zinicola R. , Watson D. , Bajwa A. , McDonald P. J.
Published: September 2007

Objective  Reports suggest that the rates of tuberculosis (TB) continue to rise in the UK and throughout the world. The spread of the disease is aided by poverty, overcrowding, co‐infection with human immunodeficiency virus and drug resistance. Consistent with the overall trend, intra‐abdominal and gastrointestinal (GI) TB rates are rising. Tuberculosis is a treatable disease, whether occurring in the lungs or at extra‐pulmonary sites but the nonspecific features of the disease result in difficulty in establishing a diagnosis. In this report, we have concentrated on the benefits and potential pitfalls of diagnostic methods.

Method  A literature review was performed using the National Library of Medicine's Pubmed Database using the keywords diagnosis, management, abdominal and GI TB.

Results  Abdominal TB presents a particular challenge, as the diverse features of the disease do not readily suggest a particular diagnosis and diagnostic delays lead to significant morbidity and mortality. A number of investigative methods have been used to aid in the diagnosis of abdominal and GI TB.

Conclusion  The nonspecific presentation of abdominal and GI TB present challenges in the diagnosis of this increasingly common disease. A high index of suspicion is an important factor in early diagnosis. After a diagnosis has been established, prompt initiation of treatment helps prevent morbidity and mortality.
Palliative surgery for rectal cancer in a national cohort
Authors: Sigurdsson H. K. , Kørner H. , Dahl O. , Skarstein A. , Søreide J. A. ,   On behalf of The Norwegian Rectal Cancer Group
Published: September 2007

Objective  Whether resection of the primary tumour is of benefit to patients with incurable rectal cancer (RC) remains a matter of debate. In this study we analyse prospectively recorded data from a national cohort.

Method  Among 4831 patients diagnosed with RC between 1997 and 2001, 838 (17%) patients were treated with palliative surgery. Patients were stratified according to disease stage, age and type of surgery.

Results  A significantly longer median survival, 12 (range 10–13) months, was observed in patients treated with resection of the primary tumour compared with 5 (range 4–6) months in patients treated with nonresective procedures (P < 0.001). Median survival in months was significantly (P < 0.001) related to age (13; < 60 years of age, 10; 60 to 69 years, 7; 70 to 79 years, 6; ≥ 80 years of age). In patients over 80 years, survival was similar regardless of the treatment. Thirty‐day mortality varied from 2.5% to 20%, according to age groups.

Conclusion  The longer survival observed in patients with resection of the primary tumour may partly be explained by patient selection. Elderly patients (≥ 80 years) had a similar survival, irrespective of resection of the primary tumour or not. Careful consideration of the individual patient, extent of disease and treatment‐related factors are important in decision‐taking for palliative treatment for patients with advanced RC.
Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass
Authors: Tekin A. , Kurtoğlu H. C. , Can I. , Öztan S.
Published: September 2007

Objective  The traditional management of appendiceal mass is initial conservative treatment followed by interval appendicectomy. Recently interval appendicectomy has been questioned by a growing amount of evidence. The purpose of this study was to clarify the role of interval appendicectomy after successful initial conservative treatment.

Method  The study included 98 patients with a mass in the right iliac fossa. Four (4%) patients were excluded wing to another diagnosis of appendiceal mass including caecal cancer (two), diverticulitis (one), and Crohn’s disease (one). The remaining 94 patients were treated conservatively. Routine interval appendicectomy was not performed after successful conservative treatment.

Results  Ultrasound (US)‐guided drainage was performed in seven (7.4%) patients. Two were drained surgically because of a persistent abscess despite a previous US‐guided drainage. In five (5.3%) patients, a delayed operation was necessary because of complications. One patient developed small bowel obstruction, and in three patients, conservative treatment was unsuccessful with the abscess remaining unresolved. Within 3 months, seven out of the 89 patients were readmitted to hospital with a recurrent mass in two patients and acute appendicitis without a mass in five patients. Six (6.7%) patients were readmitted with recurrent appendicitis after 3 months. The recurrence rate after successful conservative treatment was 14.6%. The majority (nine patients; 10.1%) of the recurrences occurred within the first 6 months, and after 1 year the recurrence rate was very low (two patients; 2.2%).

Conclusion  Routine interval appendicectomy after initial successful conservative treatment is not justified and should be abandoned. At present, there is no consensus for the management of appendiceal mass. There is, therefore, a need to develop a protocol for the management of this common problem.
The diagnostic value of digital rectal examination in primary care for palpable rectal tumour
Authors: Ang C. W. , Dawson R. , Hall C. , Farmer M.
Published: September 2007

Background  Accurate digital rectal examination (DRE) enables the early diagnosis of palpable rectal tumour. We aimed at evaluating the diagnostic value of DRE performed by general practitioners (GPs), with respect to detecting the presence of a palpable rectal tumour.

Method  All patients diagnosed to have a palpable rectal tumour via a 14‐day cancer referral system between May and December 2006 were identified from the colorectal database. Patients referred by GPs during the same period as having a palpable rectal tumour were also identified by reviewing the 14‐day cancer referrals. Sensitivity, specificity, positive and negative predictive value of a DRE in primary care were calculated by using these data.

Results  Between May and December 2006, 1069 patients were referred to the University Hospital of North Staffordshire to the 14‐day urgent colorectal cancer referral service. Of these, 108 patients were referred as having a ‘palpable rectal tumour’. Only 32 of the 108 were found to have a rectal lesion on examination in the hospital. Ten tumours were missed by GPs’ DREs.

Conclusion  Digital rectal examination in primary care for palpable rectal tumour has a sensitivity of 0.762, specificity of 0.917, positive predictive value of 0.296 and negative predictive value of 0.988. It is an inaccurate procedure and a poor predictor for palpable rectal tumour.
Botulinum toxin vs glyceryltrinitrate for the medical management of chronic anal fissure: a meta‐analysis
Authors: Sajid M. S. , Vijaynagar B. , Desai M. , Cheek E. , Baig M. K.
Published: September 2007

Objective  The objective of this review was to analyse systematically the prospective randomized controlled trials on the effectiveness of botulinum toxin (BTX) and glyceryltrinitrate (GTN) for the pharmacological management of chronic anal fissure (CAF).

Method  A systematic review of the literature was undertaken. Prospective randomized controlled trials on the effectiveness of BTX and GTN for the management of CAF were selected according to specific criteria and analysed to generate summative data.

Results  Six studies encompassing 355 patients with CAF were retrieved from electronic databases. Only three randomized controlled trials on 180 patients qualified for the meta‐analysis according to inclusion criteria. There were 90 patients in BTX and 90 in the GTN group. BTX and GTN were equally effective in healing/improving the CAF. There was no statistically significant difference between the two pharmacotherapies [RR 1.29 (0.98–1.70) 95% CI, z = −1.83, P = 1.93, Fig. 1]. However, there was statistically significant heterogeneity among the trials (Q = 4.03, df = 1, P = 0.042). On fixed effect model, GTN was associated with higher incidence of total side effects [fixed effect model RR 0.14 (0.05–0.40) 95% CI, z = −3.71, P = 0.0002] and headache [RR 0.07 (0.02–0.20) 95% CI, z = −5.05, P = 0.0007] among patients of CAF.

 Healing.

image

Conclusion  Botulinum toxin is as effective as GTN for the management of CAF but it is associated with a lower complication rate. BTX can be recommended as a first‐line therapy for chemical sphincterotomy in patients of CAF. However, a major and multi‐centre randomized controlled trial is required to support this treatment approach in order to establish stronger evidence.
Comparison of surgical vs chemical sphincterotomy using botulinum toxin for the treatment of chronic anal fissure: a meta‐analysis
Authors: Sajid M. S. , Hunte S. , Hippolyte S. , Kiri V. A. , Maringe C. , Baig M. K.
Published: September 2007

Objective  To analyse systematically prospective randomized controlled trials dealing with the effectiveness of surgical sphincterotomy (SS) vs chemical sphincterotomy (CS) using botulinum toxin for the management of chronic anal fissure (CAF).

Method  A systematic review of the literature was undertaken. Prospective randomized controlled trials on the effectiveness of SS vs CS using botulinum toxin were selected and analysed to generate the summative outcome.

Results  Four prospective randomized controlled trials dealing with SS vs CS using botulinum injection, which included 279 CAF patients, were analysed. Based on the random effects model, there was a higher complication rate [Risk ratio (RR) 14.54 (−9.84, −38.9) 95% CI, df = 2, P < 0.0163] and a higher risk of transient faecal incontinence [RR 6.39 (−2.37, −15.1) 95% CI, df = 3, P < 0.0001] in the SS group than in the CS group. However, there was significant heterogeneity among the trials (Q = 8 408 891, P < 0.0001), indicating a wide confidence interval range; thus, the inferiority of SS could not be shown. SS had a significantly higher healing rate [RR 1.63, (1.34–1.91) 95% CI, df = 3, P < 0.0110] and a significantly lower recurrence rate [RR 0.35 (0.33–0.38) 95% CI, df = 3, P < 0.0221] than CS.

Conclusion  Both CS and SS are comparable in the management of CAF. There are no differences in the complication rates and incontinence rates between the two procedures. SS has a higher healing rate and a lower recurrence rate than CS. As long as the patient is willing to accept a negligible risk of transient faecal incontinence, SS should be the first‐line treatment for CAF.
Laparoscopic reconstructive options for obstruction in children with duplex renal anomalies
Authors: Lowe Gregory J. , Canon Stephen J. , Jayanthi Venkata R.
Published: September 2007

OBJECTIVE

To present our initial experience of laparoscopic reconstructive surgery in children with upper urinary tract obstruction associated with duplex anomalies, as although there is much information on ablative procedures such as laparoscopic heminephrectomy, there is little available about minimally invasive reconstructive options for duplex renal anomalies in children.

PATIENTS AND METHODS

We retrospectively reviewed four consecutive patients (aged 6–11 years) with duplex anomalies and laparoscopic reconstruction for obstructed, dilated segments treated at our institution. The port placement and surgical exposure were analogous to that for transperitoneal laparoscopic pyeloplasty. A JJ stent was placed retrogradely into the ureter immediately before each procedure. The procedures performed were pyelo‐ureterostomy for incomplete duplication and lower pole pelvi‐ureteric junction (PUJ) obstruction, lower pole pyeloplasty for lower pole PUJ obstruction and complete duplication, and ipsilateral uretero‐ureterostomy and distal ureterectomy for an obstructed, ectopic upper pole. Foley catheters were left indwelling for 36–48 h and stents were removed at 4–6 weeks. Postoperative imaging included either ultrasonography or intravenous urography.

RESULTS

Three children presented with intermittent flank pain due to lower pole PUJ obstruction. The other child presented with pyonephrosis and purulent drainage from her vagina due to an ectopic ureter associated with a functioning upper pole segment. All procedures were successfully completed. The only complication was in the first patient (pyelo‐ureterostomy) who had transient urinary extravasation that resolved with bladder decompression for 10 days. With a follow‐up of 6–18 months, all had resolution of symptoms with improvement in radiographic variables.

CONCLUSIONS

This series shows that children with duplex anomalies and obstruction can undergo successful reconstruction using techniques learned with laparoscopic pyeloplasty.
The associations amongeNOSG894T gene polymorphism, erectile dysfunction and related risk factors
Authors: Lee Yung‐Chin , Huang Chun‐Hsiung , Wang Chii‐Jye , Liu Chia‐Chu , Wu Wen‐Jeng , Chang Lin‐Li , Lin Hui‐Hui
Published: September 2007

OBJECTIVE

To investigate the possible correlations amongeNOSG894T polymorphism, erectile dysfunction (ED) and related risk factors in a Taiwanese population.

MATERIALS AND METHODS

In all, 151 patients with ED and 77 healthy controls were enrolled. All the men had a complete clinical history taken and laboratory data was collected. To assess erectile conditions the five‐item version of the International Index of Erectile Function (IIEF‐5) was used. TheeNOSG894T polymorphisms were determined using the polymerase chain reaction‐restriction fragment length polymorphism method.

RESULTS

In all, 228 men were enrolled with a mean (sd) age of 58.6 (9.7) years. In a univariate analysis, age, serum testosterone level, and the prevalence of diabetes mellitus (DM) and hypertension were significantly different between patients with ED and the healthy controls (P < 0.01). In the multiple logistic regression analysis, DM, age and hypogonadism were three independent risk factors for ED (P = 0.018,P = 0.046 andP = 0.016, respectively). The prevalence of ED in T allele carriers (GT/TT) was significantly greater than in G allele carriers (GG; 80.0% vs 63.3%,P = 0.04). Also theeNOS894T allele carriers had significantly lower IIEF‐5 scores than theeNOS894G allele carriers, at 13.2 (5.3) vs 15.7 (6.1) (P = 0.01) and it was associated with increment of T allele number (11.0 (5.6) vs 13.6 (5.2) vs 15.7 (6.1);P = 0.03).

CONCLUSION

Our results indicate that DM, age and hypoganadism are three significant independent risk factors for ED. Also, in the Taiwanese population, theeNOS894T allele carriers are at greater risk of ED, both in prevalence and severity, and this might be a factor of genetic susceptibility.
Transobturator surgery for female stress incontinence: a comparative anatomical study of outside‐in vs inside‐out techniques
Authors: Spinosa Jean‐Pierre , Dubuis Pierre Yves , Riederer Beat M.
Published: September 2007

OBJECTIVE

To assess the specific risks of injury to neural and vascular structures inherent in two approaches to transobturator surgery for inserting a suburethral sling, i.e. the outside‐in (standard technique) and inside‐out approaches.

MATERIALS AND METHODS

The study comprised seven cadavers, providing 14 obturator regions. Five specimens had a tape inserted outside‐in on one side, and inside‐out on the other; of the remaining two cadavers, one had an inside‐out tape and one an outside‐in tape, bilaterally. After tape insertion, the cadavers were dissected. Particular attention was paid to the distances between the tape and the deep external pudendal vessels, and between the tape and the posterior branch of the obturator nerve.

RESULTS

With the inside‐out technique, the safety margins were reduced, and the external pudendal vessels and the posterior branch of the obturator nerve were at greater risk of injury.

CONCLUSION

The two techniques are not equivalent, with a lower risk of injury to vascular and nerve structures with the outside‐in technique.
Influence of the glycosaminoglycan layer on the permeation of hypericin in rat bladders in vivo
Authors: Huygens Ann , Crnolatac Ivo , Maes Jan , Van Cleynenbreugel Ben , Van Poppel Hendrik , Roskams Tania , De Witte Peter A.M.
Published: September 2007

OBJECTIVE

To investigate the influence of a glycosaminoglycan (GAG) layer on the specific location of hypericin in superficial urothelial carcinoma lesions of the bladder after intravesical instillation.

MATERIALS AND METHODS

Fisher rat bladders were incubated with 15 or 30 µm hypericin for 2 h. To examine the influence of the GAG layer on the permeation of hypericin, bladders were pre‐treated with chondroitinase ABC, n‐dodecyl‐β‐d‐maltoside (DDM) or sodium dodecyl sulphate (SDS) to disrupt, or protamine to neutralise the GAG layer before incubating with hypericin. After incubation, the photosensitizer permeation was examined quantitatively in cryostat sections of the bladders, using fluorescence microscopy and image analysis.

RESULTS

Disrupting or neutralising the GAG layer in the bladder had no influence on the permeation of hypericin. Pre‐treatment of the bladder with chondroitinase, DDM or SDS resulted in a significantly lower accumulation of hypericin, whereas neutralising the GAG layer in rats with protamine had no significant effect on the biodistribution of hypericin.

CONCLUSION

The GAG matrix causes no obstacle to the permeation of hypericin in the urothelium of the bladder, and modification of this GAG layer cannot explain the enhanced accumulation of hypericin in superficial bladder tumours.
Non‐genomic effects of androgens on isolated human vascular and nonvascular penile erectile tissue
Authors: Waldkirch Eginhard , Ückert Stefan , Schultheiss Dirk , Geismar Ulrike , Bruns Carola , Scheller Friedemann , Jonas Udo , Becker Armin J. , Stief Christian G. , Hedlund Petter
Published: September 2007

OBJECTIVES

To evaluate non‐genomic effects of testosterone and dihydrotestosterone (DHT) on isolated human cavernosal arteries (HCA) and corpus cavernosum (HCC) using organ‐bath studies and radio‐immunoassays (RIA), as non‐genomic effects of androgens are reported for vascular smooth musculature and there is evidence that the relaxant response involves a modulation of cyclic nucleotide tissue levels.

MATERIALS AND METHODS

The relaxation induced by the cumulative addition of testosterone and DHT (0.01–10 µm) was studied using circular segments of HCA and strip preparations of HCC. To evaluate the effects of testosterone and DHT on tissue levels of cAMP and cGMP, specimens were exposed to increasing concentrations of the hormones. Forskolin and sodium nitroprusside (SNP) served as reference compounds.

RESULTS

Testosterone and DHT dose‐dependently reversed the noradrenaline‐induced tension of vascular segments and HCC strips. At the maximum concentration, testosterone and DHT reduced the mean (sd) tension to 79.8 (4.43)% and 83.9 (10.94)%, respectively. SNP and forskolin significantly stimulated the production of cGMP and cAMP. No effects of testosterone and DHT on cGMP and cAMP levels were detected.

CONCLUSION

Rapid androgen‐induced relaxation of HCA and HCC occurs via non‐genomic mechanisms. In penile erectile tissue, non‐genomic relaxant effects of testosterone and DHT are not mediated via modulation of cyclic nucleotide tissue levels. Additional studies are required to establish if non‐genomic relaxant effects are important in ensuring a basal level of perfusion to maintain overall penile function.