bluuebunny/crossref_metadata_2025 huggingface dataset:
Open Eye Injuries in the Pediatric Population in Kuwait
Authors: Behbehani Abdul M. , Lotfy Nashaat , Ezzdean Hania , Albader Salem , Kamel Mostafa , Abul Nadia
Published: April 2003

Objective: To report the epidemiological characteristics of pediatric open globe injuries and to discuss treatment, management and outcomes of such injuries. Materials and Method: The hospital records and operative notes of 95 patients 16 years old and younger who were treated for open eye injury at Ibn Sina Hospital, Kuwait between September 1995 and January 1999 were reviewed. The average age of patients was 6.6 years. Patients were divided into three groups according to their final visual acuity (FVA): group 1, FVA of 20/40 or better; group 2, 20/40–20/200, and group 3, 20/400 or worse. The FVA of each group was compared to initial visual acuity (IVA), wound entry site, injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries and medical treatment. Results: Injury was most common in children 3–6 years old. Most injuries occurred during play at home (46%), between the months of July and November (58%), and evening time (42%). The most common causes were glass, pencil, stick, soft drink bottle, metal bar, and stone. The cornea was the most common entry site (59 cases). Seventy-three patients presented on the day of injury, and 38 of them had surgical repair that same day. The follow-up period ranged from 2 weeks to 58 months. Thirty-eight patients (40%) had an FVA of 20/40 or better (group 1), 23 (24%) between 20/40 and 20/200 (group 2), 12 (13%) 20/400 or worse (group 3), and 22 (23%) had no record of FVA. The difference between IVA and FVA of wound entry site was statistically significant (p < 0.005). Differences due to injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries, and the use of systemic antibiotics were found not to be statistically significant (p > 0.2). Conclusion: The prevalence of open globe injury among the pediatric population in Kuwait was high. Most injuries were due to household objects and occurred at home in the evening during the summer and autumn. IVA and anatomical location of the wound impacted on final outcome.
An Updated Survey on Skin Conditions in Down Syndrome
Authors: Schepis Carmelo , Barone Concetta , Siragusa Maddalena , Pettinato Rosa , Romano Corrado
Published: April 2003

Background: Only three not concordant surveys have been published on skin conditions associated with Down syndrome. Objective: A sample ranging from infancy to adulthood, using acknowledged criteria for diagnosis, may highlight the skin involvement in Down syndrome. Methods: We report the skin conditions observed in 203 people with Down syndrome, separated according to five different age ranges. We have set up two main groups of skin features: the phenotype and the dermatological diseases. Results: The single palmar crease and xerosis are strongly represented within the phenotype. Among the dermatological diseases, folliculitis and syringomas have been observed mainly in adolescence and adulthood. Atopic dermatitis has been recognized in 10 subjects. Alopecia areata and milia-like idiopathic calcinosis cutis appeared in 6 subjects. Conclusion: People with Down syndrome suffer from peculiar dermatoses (syringomas, milia-like calcinosis, elastosis perforans serpiginosa). Other conditions (folliculitis, alopecia areata) are frequently observed.
Production of Monospecific Antibody to Immunodominant Epitopes of the Caprine Arthritis Encephalitis Virus Transmembrane Glycoprotein and Analysis of Their Activity in vitro
Authors: Dufour Sophie , Zahno Marie-Luise , Vogt Hans-Rudolf , Peterhans Ernst , Bertoni Giuseppe
Published: April 2003

Caprine arthritis encephalitis virus (CAEV)-infected goats develop high titers of nonneutralizing antibody to several immunodominant epitopes of the viral envelope glycoprotein. Antibodies directed to these structures, and especially the principal immunodominant domain (PID) of the transmembrane portion of the envelope glycoprotein, have been implicated in the immunopathological mechanisms leading to the development of arthritis. We previously mapped the PID and additional epitopes of CAEV gp38 and showed an association between the development of clinical arthritis in infected animals and the antibody response to these epitopes. The development of clinical arthritis is associated with a higher rate of viral expression, especially in the affected tissue, indicating that antibody may favorably modulate virus replication. To test this hypothesis, we immunized goats with synthetic peptides corresponding to the mapped epitopes. The immunized animals developed high titers of nonneutralizing antibody to the immunizing peptides. In radioimmunoprecipitation experiments these antibodies were shown to react to the envelope glycoproteins in extracts obtained under nondenaturing conditions. Finally, these sera were tested in cultures of primary macrophages infected at low multiplicity without showing any (either positive or negative) modulatory activity.
Determining the Ventilatory Volumes Required to Ventilate Low Birth Weight Infants with Respiratory Distress Syndrome
Authors: Davies Mark William , Kecskes Zsuzsoka Bettina , Berrington Janet
Published: April 2003

There are limited data on the volumes used to ventilate infants with respiratory distress syndrome (RDS). There are no data on the volumes to aim for to avoid hypocapnia or unacceptable levels of hypercapnia. In this pilot study we measured minute volumes (MV) in ventilated infants to determine whether MV can predict arterial carbon dioxide (PaCO2) within acceptable parameters. Low birth weight infants (n = 14) mechanically ventilated for RDS had lung function recorded (n = 53) as an arterial blood gas was taken. MVs were plotted against PaCO2 giving the regression equation for prediction of PaCO2 (mm Hg) with MV (ml/kg/min): PaCO2 = 58.3 – 0.075 × MV, r = 0.62, r2 = 0.38, p < 0.001, residual variance (s2) of 52.7 (s = 7.26). 95% CI give a predicted PaCO2 ± 15 mm Hg for a given MV. A MV of 200 ml/kg/min predicts a PaCO2 of 43 mm Hg (95% Cl 29–58). PaCO2 correlates reasonably well with MV. Setting appropriate MVs may allow closer targeting of PaCO2, and prevent over- or under-ventilation.
Reactivity of Secretory IgA Antibodies in Breast Milk from 107 Japanese Mothers to 20 Environmental Antigens
Authors: Takahashi Takeshi , Yoshida Yumi , Hatano Seiko , Sugita-Konishi Yoshiko , Igimi Shizunobu , Yajima Masako , Kojima Tadashi , Kanno Takahiro , Yonekubo Akie , Yajima Takaji , Kuwata Tamotsu
Published: April 2003

The secretory IgA (sIgA) antibody response to 20 environmental antigens, including microorganisms, toxins, food, and inhaled allergens, was evaluated in the breast milk from 107 Japanese mothers 1–10 days after delivery. Specific sIgA antibody responses were detected in most milk samples against almost all of the antigens tested, although there was a wide variation in the specific sIgA antibody profiles of each individual’s milk. With regard to twelve bacterial antigens, highly specific sIgA antibody responses were detected against Escherichia coli, Yersiniaenterocolitica, and Pseudomonasaeruginosa. With regard to eight nonbacterial antigens, highly specific sIgA antibody responses were detected against rotavirus, cholera, and pertussis toxins. Similar sIgA antibody profiles were obtained when the 107 milk specimens were divided into colostrum (milk 1–5 days after delivery, n = 36) and transitional milk (milk 6–10 days after delivery, n = 71). This study provides information on the possible protective role of human milk sIgA antibodies and will serve as a baseline for future studies.
Relationship among Dental Plaque Composition, Daily Sugar Exposure and Caries in the Primary Dentition
Authors: Nobre dos Santos M. , Melo dos Santos L. , Francisco S.B. , Cury J.A.
Published: April 2003

The relationship among daily sugar exposure, dental plaque composition and caries patterns in the primary dentition is not known. Three groups of 20 children (18–48 months old) were studied: (1) caries-free (CF), (2) presenting pit and fissure caries (PFC), and (3) with nursing caries (NC). Dental caries index (dmfs) was assessed and the frequency of daily sugar exposure (TS) and its forms were estimated by questionnaires. Fluoride (F), calcium (Ca), inorganic phosphorus (Pi), insoluble polysaccharide (IP) and mutans streptococci were quantified in dental plaque. The three groups of children were statistically different regarding daily sugar exposure. Concentrations of F, Ca and Pi were lower and the IP and mutans streptococci statistically higher in dental plaque from NC children than those from CF children. PFC children also showed statistically lower F and P levels in their plaque than CF children. Statistically significant correlations were found between IP, TS and dmfs from NC and PFC children. A statistically significant correlation between mutans streptococci in plaque from anterior teeth and dmfs for NC children was also observed. These results suggest that the dietary sugar experience changes the biochemical and microbiological composition of dental plaque, which could partly explain the different caries patterns observed in primary dentition.
Predictors of Course and Outcome in Hypochondriasis after Cognitive-Behavioral Treatment
Authors: Hiller Wolfgang , Leibbrand Rolf , Rief Winfried , Fichter Manfred M.
Published: April 2003

Background: Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. Methods: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Results: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R2 = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). Conclusions: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis.
Expression of CD34 in Pulmonary Endothelial Cells in vivo1
Authors: Müller Annette M. , Nesslinger Maya , Skipka Guido , Müller Klaus-Michael
Published: April 2003

Objectives: The morphological phenotype of endothelial cells (EC) is specific for individual types of vessels. There are, however, no studies on the phenotypical diversity of EC in human lung tissue. The influences exerted by physiological factors (e.g. age, sex) or pathological factors (e.g. pulmonary hypertension) on EC have not been ascertained up to now. Methods: In order to determine the influence of pulmonary hypertension (PH), age and sex on EC, we localized the expression of the endothelial marker CD34 immunohistologically by light microscopy and laser scanning microscopy in lung tissue specimens from children and adults. Results: Capillary EC showed a stronger staining reaction than EC in arteries, veins, arterioles or venules. The staining intensity increased with age in veins and arteries and decreased with age in venules, arterioles and capillaries. Sex exerted no statistically significant influence. CD34 was generally more strongly expressed in specimens with PH than in those without. Conclusion: The study demonstrates for the first time that (1) CD34 is heterogeneously expressed by human pulmonary EC, and (2) the physiological/pathophysiological factors age/PH influence CD34 expression. Hence a correlation between CD34 expression and its role as adhesion molecule and a link between CD34 expression and maturation are subject of discussion.
Identification of Germline Mutation of PTEN Gene and Analysis of Apoptosis Resistance of the Lymphocytes in a Patient with Cowden Disease
Authors: Kanaseki Takayuki , Torigoe Toshihiko , Hirohashi Yoshihiko , Hirai Itaru , Himi Tetsuo , Sato Noriyuki
Published: April 2003

Mutations of the tumor suppressor gene PTEN have been reported in patients with Cowden disease (CD) and in several malignant tumors. We analyzed a germline mutation of the PTEN gene in a patient with CD and identified a 4-bp deletion in exon 8 of the PTEN gene. The same germline mutation was detected in 3 members of her family. The mutated gene was predicted to encode a C-terminal truncated PTEN protein. Immunoblotting analysis revealed that the expression level of the wild-type PTEN protein in the patient’s lymphocytes was reduced to almost half the level of the control lymphocytes, and the predicted truncated mutant PTEN could not be detected. Since PTEN is known to function as a negative regulator of the phosphatidylinositol-3-kinase signal pathway that promotes cell survival, the patient’s lymphocytes were tested for the resistance against the apoptotic stimulus. It was shown that the patient’s lymphocytes were more resistant to apoptosis induced by calcium ionophore than the healthy control lymphocytes. These results indicate that the germline mutation of the PTEN gene and the consequent loss of heterozygous expression may lead to an increase in the survival potential of cells, thereby elucidating a role of PTEN in the pathogenesis of tumor generation and hyperplasia of lymphoid tissue in CD.
Behavioural Pathology in Alzheimer’s Disease with Special Reference to Apolipoprotein E Genotype
Authors: Gabryelewicz T. , Religa D. , Styczynska M. , Peplonska B. , Pfeffer A. , Wasiak B. , Luczywek E. , Golebiowski M. , Androsiuk W. , Czyzewski K. , Przekop I. , Barcikowska M.
Published: April 2003

The aim of this study was to define the co-occurrence of behavioural symptoms and Alzheimer’s disease (AD) in relation to apolipoprotein E (APOE) genotype. Probable AD patients from the Alzheimer’s Day Clinic (n = 139) were assessed with the ‘Behavioural Pathology in Alzheimer’s Disease’ rating scale, and their APOE genotype was determined. This study demonstrated no relationship between presence of the APOE Ε4 allele and any of the behavioural symptoms assessed, including delusions, hallucinations, depression, activity disturbances, aggressiveness and anxiety. Activity disturbances, delusions, hallucinations and aggressiveness paralleled the severity of AD, increasing in frequency with the severity of the dementia. The prevalence of delusions, hallucinations, aggressiveness and depression were found to be associated with lower levels of education.
Comparative Diagnostic Utility of Different MR Modalities in Mild Cognitive Impairment and Alzheimer’s Disease
Authors: Kantarci Kejal , Xu YueCheng , Shiung Maria M. , O’Brien Peter C. , Cha Ruth H. , Smith Glenn E. , Ivnik Robert J. , Boeve Bradley F. , Edland Steven D. , Kokmen Emre , Tangalos Eric G. , Petersen Ronald C. , Jack Jr. Clifford R.
Published: April 2003

This study compares the diagnostic accuracy of magnetic resonance (MR)-based hippocampal volumetry, single voxel 1H MR spectroscopy (1H MRS) and MR diffusion-weighted imaging (DWI) measurements in discriminating patients with amnestic mild cognitive impairment (MCI), Alzheimer’s disease (AD) and normally aging elderly. Sixty-one normally aging elderly, 24 MCI and 22 AD patients underwent MR-based hippocampal volumetry, 1H MRS and DWI. 1H MRS voxels were placed over both of the posterior cingulate gyri, and N-acetyl aspartate (NAA)/creatine (Cr), myoinositol (MI)/Cr and NAA/MI ratios were obtained. Apparent diffusion coefficient (ADC) maps were derived from DWI, and hippocampal borders were traced to measure hippocampal ADC. At 80% specificity, the most sensitive single measurement to discriminate MCI (79%) and AD (86%) from controls was hippocampal volumes. The most sensitive single measurement to discriminate AD from MCI was posterior cingulate gyrus NAA/Cr (67%). At high specificity (>85–90%), combinations of MR measures had superior diagnostic sensitivity compared with any single MR measurement for the AD vs. control and control vs. MCI comparisons. The MR measures that best discriminate more from less affected individuals along the cognitive continuum from normal to AD vary with disease severity. Selection of imaging measures used for clinical assessment or monitoring efficiency of therapeutic intervention should be tailored to the clinical stage of the disease.
Principal Components Representation of the Two-Dimensional Coronal Tongue Surface
Authors: Slud Eric , Stone Maureen , Smith Paul J. , Goldstein Jr. Moise
Published: April 2003

This paper uses principal components (PC) analysis to represent coronal tongue contours for the 11 vowels of English in two consonant contexts (/s/, /l/), based upon five replicated measurements in three sessions for each of 6 subjects. Curves from multiple sessions and speakers were overlaid before analysis onto a common (x, y) coordinate system by extensive preprocessing of the curves including: extension (padding) or truncation within session, translation, and truncation to a common x range. Four PCs plus a mean level allow accurate representation of coronal tongue curves, but PC shapes depend strongly on the degree of padding or truncation. The PCs successfully reduced the dimensionality of the curves and reflected vowel height, consonant context, and physiological features.
Manometric Abnormality in Dysphagic Patients after Medullary Cerebrovascular Accidents
Authors: Higo Ryuzaburo , Tayama Niro , Watanabe Takeshi
Published: April 2003

We investigated the pharyngeal swallowing function using videomanofluorometry (VMF) in patients after medullary cerebrovascular accidents. Upper esophageal sphincter pressure, which should drop when a bolus arrives at the hypopharynx, increased at the same time as the elevation of oropharyngeal and hypopharyngeal pressures. A reduction of oropharyngeal and hypopharyngeal swallowing pressures was also observed. Our results suggest that a misprogrammed excitatory output from the central pattern generators of the brain stem would cause an abnormal pressure-traveling pattern of pharyngeal swallowing. VMF was useful to assess the pharyngeal swallowing function and to determine the indications for cricopharyngeal myotomy for patients after medullary cerebrovascular accidents.
Inner Ear Dysplasia in Sporadic Lacrimo-Auriculo-Dento-Digital Syndrome
Authors: Meuschel-Wehner Stephanie , Klingebiel Randolf , Werbs Mechthild
Published: April 2003

The lacrimo-auriculo-dento-digital (LADD) syndrome is a rare inherited disorder affecting the lacrimal, auricular, salivary, and osseous system. Only very limited data on LADD associated petrous bone lesions are available up to now. We describe a young girl suffering from the LADD syndrome with sensorineural hearing loss and inner ear dysplasia. This case suggests, that inner ear dysplasia might be a more common feature of the LADD syndrome than has been assumed so far.
Immediate Facial Nerve Palsy following Stapedectomy
Authors: Rinaldo Alessandra , Mondin Vanni , Ferlito Alfio
Published: April 2003

Iatrogenic facial nerve palsy following stapedectomy is a rare but devastating complication. The authors describe a case of a 20-year-old man who presented for legal advice concerning an immediate facial nerve palsy following a left stapedectomy. The incidence, management and prognosis of such injuries are discussed.
Neuronal Nitric Oxide Synthase-Immunoreactivity
Authors: Rohrbach Saskia , Olthoff Arno , Laskawi Rainer , Götz Werner
Published: April 2003

The influence of botulinum toxin type A (BTA) on cellular mechanisms has not been studied in much detail. Since nitric oxide (NO) is of increasing interest as a neuromodulator in the innervation of the nose, its localization was examined in the nasal mucosa of guinea pigs treated with BTA or saline. Neuronal nitric oxide synthase-immunoreactivity (nNOS-IR) was found around vessels and nasal glands. Immunoreactivity was seen in the respiratory epithelium, in the periost and the osteocytes of the turbinate bone. A distinct interindividual difference in the strength of nNOS-IR was obvious among the animals, but there was no difference in the strength of immunoreactivity between the animals treated with BTA or saline. NO might therefore contribute to the regulation of vascular tone, glandular function, respiratory epithelial cell function and bone metabolism. BTA does not seem to influence the processes regulated and modulated by NO. This may represent a benefit for the application of BTA.
Blinded Speech Evaluation following Pharyngeal Flap Surgery by Speech Pathologists and Lay People in Children with Cleft Palate
Authors: Tönz Martin , Schmid Iris , Graf Maja , Mischler-Heeb Regula , Weissen Josef , Kaiser Georges
Published: April 2003

Methods: In order to assess intermediate-term speech outcome after pharyngeal flap surgery for velopharyngeal dysfunction in children with cleft palate between 1980 and 1998, their pre- and postoperative speech performance was analyzed in a blinded fashion by speech pathologists and adult lay people. Speech was evaluated on the basis of tape recordings with regard to resonance, intelligibility, articulation, voice and secondary speech disorders. Results: Twenty-three patients could be evaluated. Both lay assessors and speech pathologists noted a significant improvement in speech performance after pharyngeal flap surgery. The percentage of children who improved was 83% (19/23, 95% confidence interval: 0.68–0.98, p = 0.002) when rated by lay people, and 87% (20/23, CI 0.73–1.01, p < 0.0001) when rated by professionals. Rated on a 5-point scale, the mean improvement per speech characteristic was 0.52 ± 0.32 scale points when judged by lay people, and 0.75 ± 0.8 points when judged by experts. Experts considered none of the children to have normal speech after surgery. Agreement with regard to outcome between lay people and speech pathologists occurred in 87% of the patients. Conclusion: The cranially based pharyngeal flap can improve speech performance in cleft palate children with chronic velopharyngeal insufficiency. However, it cannot be expected that this type of surgery will result in normal speech.
Fibrinogen and the Amount of Leukoaraiosis in Patients with Symptomatic Small-Vessel Disease
Authors: Martí-Fàbregas Joan , Valencia Carlos , Pujol Jesús , García-Sánchez Carmen , Martí-Vilalta Josep-Lluis
Published: April 2003

We investigated whether there is a direct correlation between plasma fibrinogen levels and the amount of leukoaraiosis (LA) in patients with symptomatic small-vessel disease. The study included 28 patients: 12 with a first-ever lacunar infarction (LI) and 16 with Binswanger’s disease (BD). The mean age was 71 years (SD 8.6), and 21 were men. For each patient, we recorded demographic data, vascular risk factors and the results of blood chemistry analysis including fibrinogen (g/l), hematocrit (decimal fraction) and total serum proteins (g/l). A cerebral MR scan was performed in each patient and an LA score was obtained by an investigator blind to clinical data, using a semiquantified scale in six areas of each cerebral hemisphere (0–4 points in each area, total scoring range 0–48 points). Results: The mean (SD) for the LA score was 18.9 (10.7) and for plasma fibrinogen 3.97 (1.1). Pearson’s and Spearman’s correlation coefficients between fibrinogen and LA score were 0.43 (p = 0.02) and 0.49 (p = 0.007), respectively. Multiple-regression analysis between groups (LI or BD) and fibrinogen versus LA score showed the strongest association for the BD group (p = 0.014) and a direct relation with fibrinogen (p = 0.018). No statistically significant association was found between LA score and age, sex, any vascular risk factor, hematocrit or total serum protein. Conclusion: There is a significant correlation between plasma fibrinogen levels and the amount of LA in patients with symptomatic cerebral small-vessel disease. This result suggests that fibrinogen may be involved in the pathophysiology of LA in these patients.
Peripheral Neuropathy of Machado-Joseph Disease in Taiwan: A Morphometric and Genetic Study
Authors: Lin Kon-Ping , Soong Bing-Wen
Published: April 2003

Machado-Joseph disease (MJD) is a dominantly inherited cerebellar ataxia associated with spasticity, ophthalmoplegia, dystonia and peripheral neuropathy. Presented here are 5 MJD cases. A morphometric analysis of the histopathology of their sural nerves was carried out to know the relationship between axon size and myelin thickness. MJD cases were identified by polymerase chain reaction. On the basis of the clinical symptoms, there was 1 type I, 2 type II and 2 type III patients. The sural nerves were biopsied for single-fiber, ultrastructural and morphometric analysis. Morphometric parameters such as fiber and axon sizes, myelin thickness and g ratio (axon diameter:fiber diameter) were estimated. The pathological features of the sural nerves in the 2 type III and 1 of the type II patients revealed a loss of myelinated and unmyelinated fibers, and the morphometry studies showed a decreased fiber density, the loss of large myelinated fibers, a smaller size of the axons with thinner myelin sheaths and an increased percentage of myelinated fibers with a g ratio (axon diameter:fiber diameter) above 0.7. However, only subtle pathological changes were noted in the type I patient and the remaining type II patient. Our findings suggested that there is a loss of large myelinated fibers and distal axonopathy with relative hypomyelination in the neuropathy of patients with MJD.
Indocyanine Green Angiography in the Diagnosis of Small Choroidal Tumours
Authors: Kubicka-Trzaska Agnieszka , Starzycka Maria , Romanowska-Dixon Bożena
Published: April 2003

Objective: To evaluate indocyanine green (ICG) angiography in the diagnosis of small choroidal tumours. Methods: We studied 40 patients with small choroidal tumours, 22 males and 18 females. The tumour thickness on ultrasonography ranged from 2.2 to 4.3 mm. Results: Nineteen pigmented tumours showed early and late diffuse hypofluorescence, consistent with naevi. Eight non-pigmented tumours showed normal choroidal vessels in calibre, configuration, and branching, typical of non-pigmented naevi. The early frame of ICG angiography showed in 13 cases pathological, intrinsic vascularization, suggestive of melanomas. Conclusion: This preliminary study suggests that ICG angiography may be helpful in differentiating choroidal naevi from small melanomas.
Anesthesia with EMLA® Cream for Botulinum A Toxin Injection into Eyelids
Authors: Söylev Meltem F. , Koçak Nilüfer , Kuvaki Bahar , Özkan Seyhan B. , Kir Erkin
Published: April 2003

We investigated the efficacy of an eutectic mixture of local anesthetics (EMLA®) in reducing the pain of a botulinum toxin injection into eyelids. 17 patients with facial dyskinesia (9 blepharospasm and 8 hemifacial spasm) who had been treated regularly with botulinum toxin injections received EMLA cream and placebo. The pain was assessed by the ophthalmologist and the patient. Injection with EMLA cream showed lower pain scores (mean 1.82 ± 2.13, median 1) than injection with placebo (8.76 ± 2.17; p = 0.0001). Percutaneous anesthesia induced by EMLA cream is an effective and safe method which improves the comfort in patients who need repeated botulinum toxin injections for their facial dyskinesia.
Emerging Technologies for HER2 Testing
Authors: van de Vijver Marc
Published: April 2003

HER2-positive status is the sole criterion for identifying patients with breast cancer for Herceptin® therapy, which has known efficacy in women with metastatic breast cancer (MBC). Immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH), which measure the HER2 protein and gene, respectively, are currently the most widely used HER2 tests in the clinical setting. However, results from these assays are influenced by many variables including choice of antibody or probe, methodology, level of user experience and interlaboratory variability. Although there is no widespread standard testing algorithm, the importance of HER2 in clinical practice demands accurate and reproducible tests. Polymerase chain reaction (PCR) and chromogenic in-situ hybridization (CISH) represent upcoming methods for assessing HER2 gene amplification. Enzyme-linked immunosorption assay (ELISA), a semi-automated technique that can be used to measure the level of the HER2 extracellular domain (ECD) in serum, may also prove useful. While such technologies show great promise, they will at least have to be validated against IHC or FISH before being accepted into routine clinical practice.
Prenatal Sonographic Diagnosis of Lateral Ventricle Choroid Plexus Papilloma in an in vitro Fertilization-Induced Pregnancy
Authors: Cohen Zvi R. , Achiron Reuven , Feldman Zeev
Published: April 2003

This is a report of a prenatal sonographic diagnosis of a lateral ventricle choroid plexus papilloma in an in vitro fertilization (IVF)-induced pregnancy of a 40-year-old woman. The baby was delivered at 35 weeks of gestation and surgery was performed 5 days later with a good outcome. Several cases of malignancies associated with IVF are reported in the literature. To the best of the authors’ knowledge, this is the first report of a prenatal diagnosis of choroid plexus papilloma in an IVF-induced pregnancy. The authors also review other cases of choroid plexus papilloma diagnosed prenatally by ultrasound. The theoretical association between IVF and neoplasia is also considered.
Infantile Subdural Hematomas due to Traffic Accidents
Authors: Vinchon Matthieu , Noizet Odile , Defoort-Dhellemmes Sabine , Soto-Ares Gustavo , Dhellemmes Patrick
Published: April 2003

The most common cause of subdural hematomas (SDH) in infants is shaken-baby syndrome (SBS). The pathogenesis and natural history of infantile SDH (ISDH) are poorly documented, because in SBS, the date of shaking is usually imprecise and the assault is often repeated. Victims of traffic accidents (TA) form a study group close to experimental conditions, because the trauma is unique, witnessed and dated. We reviewed 18 cases of SDH due to TA in infants under the age of 24 months. Our goal was to investigate the clinical and radiological data and natural history of SDH. A subdural collection was found on the day of trauma in 7 cases. In 3 of these, the collection was already hypodense. The perifalcine region was the most frequent site of intracranial bleeding. Blood hyperdensity was always found on CT scans performed during the first week, and turned hypodense on about the 9th day. Three patients had retinal hemorrhage, of a type distinct from that found in SBS. Drainage of the SDH was required in 14 cases after a mean delay of 13.5 ± 5.8 days after trauma. Four patients also required a ventriculoperitoneal shunt because of associated hydrocephalus. Our data suggest that impaired CSF drainage plays a large role in the pathogenesis of ISDH. The fact that a single and recent trauma can result in mixed-density ISDH can be of great importance in forensic medicine.
Combined Evaluation of Expressions of p53 and p21 Proteins as Prognostic Factors for Patients with Gastric Carcinoma
Authors: Okuyama Toshiro , Maehara Yoshihiko , Kabashima Akira , Takahashi Ikuo , Kakeji Yoshihiro , Sugimachi Keizo
Published: April 2003

Background: The tumor suppressor gene p53 is a nuclear protein which plays a key role in tumor progression by regulating DNA repair, cell division and apoptosis. One major function of wild-type p53 is to control the onset of DNA replication at the G1-S boundary by inducing p21 protein, which promotes cell cycle arrest by inhibiting the phosphorylation of the cyclin-dependent kinases’ complexes and blocking cell cycle progression to the S-phase. Methods: 195 human gastric cancer specimens were prepared for immunohistochemical staining, using antibodies against p53 and p21. Clinicopathological factors and the clinical prognosis were examined for each indicator. Results: Of those 195, positive rates of p53 and p21 were 37.9% (74/195) and 42.6% (83/195), respectively. p53-negative patients had a better 5-year survival rate compared with positive ones (p < 0.05), and p21-positive cases had better 5-year survival rate compared with negative ones (p < 0.05). Four separate groups were prepared, based on expressions of p53 and p21, and the prognoses were compared. The incidence of the p53(–)/p21(+) group was 27.2% (53/195 cases) and that of the p53(–)/p21(–), p53(+)/p21(–) and p53(+)/p21(+) groups was totally 72.8% (142/195 cases). The 5-year survival time of the former group was 67.5% and was significantly longer than the combined 5-year survival time of the latter groups of 45.9% (p < 0.05). Conclusions: The incidence in cases where functions of either or both of p53 and p21 proteins were diminished exceeded 70% of all the cases. The survival time for the p53(–)/p21(+) group with proper functions of both proteins and the signal pathway was significantly longer. The combined evaluation of expressions of p53 and p21 proteins in gastric cancer tissues aids in predicting the clinical prognosis for surgically treated gastric cancer patients.
Pathological Features of Betel Quid-Related Oral Epithelial Lesions in Taiwan with Special Emphasis on the Tumor Progression and Human Papillomavirus Association
Authors: Chang Kong-Chao , Su Ih-Jen , Tsai Sen-Tien , Shieh Dar-Bin , Jin Ying-Tai
Published: April 2003

Betel quid (BQ) chewing has been a well-documented cause of oral epithelial lesions (OEL). Evolution from early hyperplastic lesions to the late or carcinomatous stage has been recognized. The pathobiological and molecular mechanism, however, remains to be elucidated. In this study, a total of 232 samples obtained from 153 cases of BQ-related OEL were retrospectively evaluated for the expression of p53 and bcl-2 in comparison with 26 cases of BQ-unrelated lesions (n = 29). The possible role of human papillomavirus (HPV) was also investigated. These BQ-related OELs included verrucous hyperplasia (VIH, n = 57, 24.6%), epithelial dysplasia (n = 23, 9.9%), verrucous carcinoma (VC, n = 5, 2.1%) and squamous cell carcinoma (SCC, n = 106, 45.7%). Fifty-four cases (35.3%) had multiple lesions. In comparison with the BQ-unrelated OELs, the characteristics of BQ-related OELs were a younger age, male predilection and multicentricity. In contrast to the tongue in BQ-unrelated OELs, the most common site for all types of BQ-related lesions was the buccal mucosa. Immunohistochemical studies of BQ-related lesions showed p53 staining in 30% of dysplasia and 38% of SCC, but a consistent absence in VH and VC. The cases with p53-positive SCC had a higher recurrence rate than p53-negative ones. Bcl-2 expression was negligible for all types of lesions. HPV-6/11 was detectable in 10% of dysplasia and 13% of SCC, but in neither VH nor VC. HPV-16/18, however, was consistently negative for all types of lesions. Our data suggest that p53, but not bcl-2, may play a role in tumor progression of BQ-related OELs, and that VH and VC are distinct and closely related histological lesions. The consistent absence of the malignant-type HPV in all BQ-related lesions suggests that HPV plays an insignificant role in the tumorigenesis of BQ-related oral cancers, although a cooperative role may exist between the benign-type HPV and BQ chewing.
The Role of the IGF System in Cancer: From Basic to Clinical Studies and Clinical Applications
Authors: Moschos Stergios J. , Mantzoros Christos S.
Published: April 2003

Insulin-like growth factors (IGFs) are important mediators of growth, development, and survival, are synthesized by almost any tissue in the body, and their action is modulated by a complex network of molecules, including binding proteins, proteases and receptors, which all comprise the IGF system. Evidence from in vitro and animal studies suggests that overexpression of IGFs by cancer cells and/or the nearby stroma as well as the type IGF-I receptor by the cancer cells may play a significant role in establishing a transformed phenotype in an increasing number of malignancies. More specifically, IGFs may promote cell cycle progression and inhibition of apoptosis either by directly associating with other growth factors or indirectly by interacting with other molecular systems which have an established role in carcinogenesis and cancer promotion, such as the steroid hormones and integrins. In addition, a growing number of epidemiologic studies suggest that increased serum levels of IGFs and/or altered levels of their binding proteins are associated with increased risk for developing several malignancies. These data indicate that IGF dysregulation should now be considered as an important independent factor for cancer risk, and a potential target for novel antineoplastic therapies and/or preventative strategies in high-risk groups.
Schizophrenia-Specific Basic Symptoms
Authors: Mass Reinhard , Weigel Susanne , Schneider Silke , Klepsch Rüdiger
Published: April 2003

Several investigations showed that the Frankfurt Complaint Questionnaire (FCQ) has no diagnostic specificity. However, in a preceding study two new FCQ subscales were developed: FCQ-S, sensitive to schizophrenia, and FCQ-A, sensitive to alcoholism. The aim of the present study was to replicate the diagnostic sensitivity of those subscales. Four groups were considered: schizophrenics with marked negative symptoms (n = 25); schizophrenics with no or mild negative symptoms (n = 25); alcoholics (n = 25); patients with obsessive-compulsive disorder (n = 15). FCQ original subscales and total score did not differ between groups. As expected, in FCQ-S both schizophrenic groups had significantly higher scores than the other groups; FCQ-A failed to show group differences but was significantly related to alcoholism markers.
Disturbance of Consciousness Due to Methamphetamine Abuse
Authors: Nakatani Yoji , Hara Takashi
Published: April 2003

The present paper reports 2 cases of methamphetamine abuse. Following consecutive methamphetamine administration, the patients developed acute intoxication, during which time they showed a unique type of disturbance of consciousness: delirium and twilight state. In both cases, mental status changed, passing through three distinct stages: restlessness and insomnia, hallucinatory paranoid state, and disturbance of consciousness. A review of the literature suggests that disturbance of consciousness may occur occasionally during the course of amphetamine and methamphetamine intoxication, although these symptoms can be overlooked easily due to confounding symptomatology.
Psychopathological Assessment and Diagnosis
Authors: Ahrens B. , Stieglitz R.-D.
Published: April 2003

The importance of single symptoms in the diagnostic process has not been adequately studied, mainly because of the complexity of the information involved. The aim of the present study is to investigate the interconnection between psychopathological assessment and diagnostic classification, with the aid of a nonparametric, inductive pattern recognition method. Using the concept of inductive logic and a theory of inductive knowledge acquisition, a model has been developed to describe psychopathological assessment and diagnostic classification. Based on a comprehensive psychopathological assessment in 837 patients with 14 different diagnoses, classification values were calculated for specific symptoms in different diagnostic groups. Furthermore, nonparametric statistical procedures have advantages over discriminant analytic approaches: more information is utilized in differentiating the groups and differentiations can be made between more groups, whereby the rate of correctly classified cases is comparable with discriminant analytic approaches. The pattern recognition method appears to illustrate the multidimensional, medical decision-making in a comprehensible way.
Delayed Apoptosis Post-Cadmium Injury in Renal Proximal Tubule Epithelial Cells
Authors: Stinson Lindsay J. , Darmon Alison J. , Dagnino Lina , D’Souza S.J.A.
Published: April 2003

Background: Accumulation of the widespread environmental toxin cadmium (Cd) in the kidney results initially in proximal tubule dysfunction. Exposure to Cd has been previously shown to induce apoptosis in LLC-PK (Lily Laboratory Culture, Porcine Kidney) cells, which are a model of proximal tubule epithelium. Hypothesis: We postulated that modulation of the components of the apoptotic pathway triggered by Cd is amenable to therapeutic intervention. Methods: We subjected confluent LLC-PK cells grown on two-compartment filters and on plastic to Cd (1–50 µM). Apoptosis and changes in components of the apoptotic pathway were measured by immunocytochemical and immunoblot analysis during the period of exposure and following Cd withdrawal. Results: Insignificant apoptosis was seen during exposure to Cd and immediately after removal of this metal. Two waves of apoptosis were noted 6 and 48 h after the Cd was removed from the apical compartment. The apoptosis 48 h post-Cd exposure was accompanied by a decrease in cellular ATP levels and transepithelial resistance and preceded by an increase in p38 phosphorylation. Inhibition of p38 mitogen-activated protein kinase activity decreased the delayed apoptotic peak, without affecting the rate of recovery of the integrity of the renal epithelium. IGF-1 neither altered the delayed apoptosis nor facilitated the rate of recovery of the integrity of the renal epithelium. Conclusion: We demonstrate that following exposure to Cd, renal epithelial cells undergo significant apoptosis, which appears to involve p38 and is not amenable to IGF therapy.
Neuroendoscopic Treatment of Paediatric Cerebrospinal Fluid Rhinorrhoea
Authors: Husain Mazhar , Jha Deepak , Husain Nuzhat , Gupta Rakesh K.
Published: April 2003

Endoscopic management of CSF rhinorrhoea in children is usually associated with a higher incidence of mucosal abrasion and post-operative synechiae formation due to surgical manoeuvres in narrower nasal passages. We have used the Gaab universal neuroendoscope for the treatment of CSF rhinorrhoea in children. Three patients were treated in the last 2 years with this technique. All patients became completely asymptomatic after the initial procedure without any significant complications. We conclude that the treatment of CSF rhinorrhoea in children by means of a neuroendoscope with a working sheath may be effective and less traumatic to the nasal passage.
Outcome of Myocardial Infarction in Patients Treated with Aspirin Is Enhanced by Pre-Hospital Administration
Authors: Barbash Israel M. , Freimark Dov , Gottlieb Shmuel , Hod Hanoch , Hasin Yonathan , Battler Alexander , Crystal Eugene , Matetzky Shlomi , Boyko Valentina , Mandelzweig Lori , Behar Solomon , Leor Jonathan
Published: April 2003

Objective: Reducing time to reperfusion therapy is one of the goals in the management of acute myocardial infarction (AMI). We assessed the association between timing of aspirin administration and outcome of patients with AMI. Patients: We studied 922 consecutive AMI patients with ST-segment elevation in Killip class I–III on admission. Patients were divided into two groups based upon the timing of emergency aspirin administration: before (early aspirin users) or after (late aspirin users) hospital admission. Results: Early aspirin users (n = 338; 37%) were younger, less likely to be women, and more likely to smoke (p < 0.006) than late users (n = 584; 63%). Other baseline and clinical characteristics were similar. Early aspirin users were more likely to be treated with thrombolysis or primary percutaneous transluminal coronary angioplasty. Compared with late users, early aspirin users had significantly lower in-hospital complications and lower mortality rates at 7 (2.4 vs. 7.3%, p = 0.002) and 30 days (4.9 vs. 11.1%, p = 0.001). By multivariate adjustment, pre-hospital aspirin was an independent determinant of survival at 7 (odds ratio 0.43; 95% confidence interval 0.18–0.92) and at 30 days (odds ratio, 0.60; 95% confidence interval 0.32–1.08). Survival benefit associated with aspirin persisted for subgroups treated or not with reperfusion therapy. Conclusions: Outcome of AMI patients treated with aspirin is improved by pre-hospital administration.Our findings suggest that emergency pre-hospital aspirin might facilitate early reperfusion.
The Burden of Genetic Disorders in India and a Framework for Community Control
Authors: Verma I.C. , Bijarnia S.
Published: April 2003

With a very large population and high birth rate, and consanguineous marriage favoured in many communities, there is a high prevalence of genetic disorders in India. An estimated 495,000 infants with congenital malformations, 390,000 with G6PD deficiency, 21,400 with Down syndrome, 9,000 with β-thalassaemia, 5,200 with sickle cell disease, and 9,760 with amino acid disorders are born each year. The prevalence of late-onset multi-factorial disorders (including coronary artery disease, hypertension and psychiatric disorders) is also large. Due to inadequate diagnostic, management and rehabilitation facilities, the burden of these disorders is greater than in Western countries. Although genetic diseases receive little attention from the health services, research funding by the government has been liberal. Community control of common disorders like thalassaemia, Down syndrome, neural tube defects, and muscular dystrophies deserves high priority, and genetic services should be integrated into the existing primary health care and medical services. Most genetic counselling would have to be provided through training physicians who staff the district and medical school hospitals. To ensure future progress, there is a need to establish additional departments of medical genetics in medical schools.