bluuebunny/crossref_metadata_2025 huggingface dataset:
Lysine-Acetylsalicylic Acid in Acute Migraine Attacks
Authors: Limmroth Volker , May Arne , Diener Hans-Christoph
Published: April 2003

Vasoconstrictive agents have been widely used in the treatment of migraine. These types of drugs have various side effects and are not suitable for many patients. Due to nausea or vomiting, nonoral treatment is often required, but only a few nonvasoconstrictive drugs exist in a parenteral form and are suitable for the treatment of acute migraine in the emergency setting. In a randomized, double-blind, crossover trial we evaluated the efficacy of 1,000 mg lysine-acetylsalicylic acid i.v. (LAS) compared to 0.5 mg ergotamine s.c. in 56 patients (112 attacks) with acute migraine. To gain further insight into the possible role of vasoconstriction, blood flow velocities (BFV) were measured in intra- and extracranial arteries using duplex sonography and transcranial Doppler sonography. Both agents were equally potent in relieving headache. Intravenous LAS resulted in a significantly faster relief and had fewer side effects. LAS had no effect on BFV. Ergotamine increased BFV in the middle cerebral artery only. No correlation was found between changes in BFV and the relief of headache. This is the first trial to compare the intravenous formulation of LAS in the treatment of migraine with another antimigraine medication and suggests that it is an effective and safe drug for the parenteral treatment of acute migraine attacks.
Sporadic Choreas: Analysis of a General Hospital Series
Authors: Piccolo Immacolata , Sterzi Roberto , Thiella Giuseppe , Minazzi Mario Stefano , Caraceni Tommaso
Published: April 2003

The incidence of sporadic chorea among general hospital admissions is unknown, and the relation of clinical manifestations and etiological factors to neuroimaging findings has been little investigated in this condition. We reviewed the 7,829 cases admitted to the neurology departments of two general hospitals over 3.25 years and identified 23 (8 male and 15 female) cases of apparently sporadic chorea. Analysis of the records of these patients permitted etiological classification as follows: drug-induced chorea (5 patients), vascular chorea (6 patients), chorea-vasculitis (1 patient), Sydenham’s chorea (1 patient), AIDS-related chorea (5 patients) and in 4 patients neither etiological factors nor neuroradiological alterations were found. Finally in 1 patient, the genetic test for Huntington’s disease was positive. Thirteen patients had pathological neuroimaging findings; however, in only 3 were basal ganglia lesions considered to be the cause of the chorea. We conclude that sporadic chorea is not rare among neurological department admissions (we found 2.94 cases per 1,000 admissions) and only in a minority of cases is the symptomatology attributable to gross basal ganglia lesions; HIV infection is an emerging cause of chorea.
Familial Hemiplegic Migraine with Cerebellar Ataxia and Paroxysmal Psychosis
Authors: Spranger M. , Spranger S. , Schwab S. , Benninger C. , Dichgans M.
Published: April 2003

Familial hemiplegic migraine is a rare autosomal dominant disorder associated with stereotypic neurologic aura phenomena including hemiparesis. So far two chromosomal loci have been identified. Families linked to the chromosome 19 locus display missense mutations within the CACNL1A4 gene. Here we report on a family with familial hemiplegic migraine and cerebellar ataxia with recurrent episodes of acute paranoid psychosis with anxiety and visual hallucinations associated with migraine attacks. Based on the clinical and haplotype evidence indicating linkage to chromosome 19 in this family, we hypothesize that a dysfunction of the mutated calcium channel may be involved not only in the development of hemiplegic migraine but also in the acute psychotic episodes observed in these patients.
Reproducibility of Brain MRI Lesion Volume Measurements in Multiple Sclerosis Using a Local Thresholding Technique: Effects of Formal Operator Training
Authors: Rovaris Marco , Rocca Maria A. , Sormani Maria Pia , Comi Giancarlo , Filippi Massimo
Published: April 2003

The assessment of lesion load (LL) on brain magnetic resonance imaging (MRI) scans from patients with multiple sclerosis (MS) is widely used to monitor disease evolution, natural or modified by treatments. In this study, we evaluated the effect of formal operator training on the intra- and inter-observer reproducibility of LL measurements obtained by several operators in a setting similar to that of clinical trials. Proton-density (PD)-weighted, unenhanced and enhanced T1-weighted brain MRI scans were obtained from 10 MS patients. Five naive technicians assessed LL on these images, using a semiautomated local thresholding technique for lesion segmentation and marked hardcopies as a reference. Measurements were performed twice before and twice after a 20-hour operator training. Mean intra-observer measurement coefficient of variations (COV) before and after the training were 3.1 and 1.6% for PD-weighted LL, 4.3 and 1.8% for unenhanced T1-weighted LL (p < 0.001), 4.9 and 2.0% for enhanced T1-weighted LL (p = 0.002). Mean inter-observer COV were significantly reduced after training (from 10.0 to 5.6% for PD-weighted, from 11.0 to 7.3% for unenhanced T1-weighted and from 16.0 to 6.8% for enhanced T1-weighted LL). Our data indicate that LL assessment on serial MRI scans from MS patients performed by technicians, using a local thresholding technique for lesion segmentation, is characterized by low measurement variability which may be significantly improved by a short and cost-effective training.
Decreased Regional Cerebral Metabolic Rate for Glucose in Systemic Lupus erythematosus Patients with Psychiatric Symptoms
Authors: Komatsu Naoya , Kodama Kazuhiro , Yamanouchi Naoto , Okada Shin-ichi , Noda Shingo , Nawata Yasushi , Takabayashi Katsuhiko , Iwamoto Itsuo , Saito Yasushi , Uchida Yoshitaka , Ito Hisashi , Yoshikawa Kyosan , Sato Toshio
Published: April 2003

To determine brain functional abnormality in systemic lupus erythematosus (SLE) patients with psychiatric symptoms, we evaluated 12 active SLE patients with or without psychiatric symptoms by means of [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (PET), magnetic resonance imaging and neuropsychological testing. Patients with psychiatric symptoms showed significantly poorer performance in tests which subserved attentional function. The PET study revealed that the psychiatric patients had significantly decreased regional cerebral metabolic rates for glucose in the prefrontal, inferior parietal and anterior cingulate regions. Prefrontal, inferior parietal and anterior cingulate dysfunction may be related to attentional deficits that are involved in various psychiatric symptoms in SLE. PET is an invaluable tool to reveal such brain functional abnormality seen in SLE patients with psychiatric symptoms.
Clinical Characteristics of Aged Becker Muscular Dystrophy Patients with Onset after 30 Years
Authors: Yazaki Masahide , Yoshida Kunihiro , Nakamura Akinori , Koyama Jun , Nanba Takashi , Ohori Nobuhira , Ikeda Shu-ichi
Published: April 2003

To elucidate the clinical characteristics of aged patients with Becker muscular dystrophy (BMD), 4 patients with this disease who were over 50 years were examined. The ages at onset in all patients were later than 30 years. All were proven to have a deletion around exons 45–55 of the Duchenne muscular dystrophy (DMD) gene. Two patients became wheelchair bound in their 40s or beyond, while the other 2 (aged 73 and 69, respectively) were still able to walk at the time of examination. Three of 4 patients had no obvious hypertrophy in their calves, which is known to be one of the characteristic clinical features in the juvenile BMD patients. Serum creatine kinase levels were elevated in all patients, but not markedly (mean 444.8 ± 230.3 U/l; normal value < 180 U/l). Dilated cardiomyopathy was clinically apparent in 2 patients. We emphasize that some BMD patients are free of muscular symptoms until their 50s and are still self-supporting in their 60s or 70s.
Relationship between Brain Structure Sizes and Performing Rapid Limb Movements
Authors: Bekkelund Svein I. , Pierre-Jerome Claude , Winther John , Mellgren Svein I.
Published: April 2003

In this study, we aimed to determine the relationship between the size of cerebral structures evaluated by quantitative magnetic resonance technique and the ability of performing rapid-velocity limb movements. Forty-seven healthy women with a mean age of 43.4 years (range 22–68) were included. Exclusion criteria were systemic diseases including alcoholism. Finger and ankle tapping were quantitatively recorded for both right and left extremities. A mean value for the right and left side was calculated. To determine atrophy, we measured the area of the corpus callosum, the cerebrum and the cerebellum on midline sagittal sections. On transverse images, the ventricle-to-brain ratio, the bifrontal ratio and the bicaudate ratio were selected as atrophy parameters. Also, the prevalence of white matter hyperintensities was assessed. Fifteen (32%) had hyperintense white matter lesions. Using simple regression analysis, the frequencies of both finger (r = 0.37, β = –0.002, p = 0.022) and ankle (r = 0.35, β = –0.001, p = 0.032) tapping were associated with reduced cerebellar size. No association was found for other atrophy parameters or the number of hyperintense white matter lesions. This study indicates that impaired ability to perform fast limb movements may be related to a relative cerebellar atrophy.
Prolongation of the Frequency-Corrected QT Dispersion following Cerebral Strokes with Involvement of the Insula of Reil
Authors: Eckardt M. , Gerlach L. , Welter F.L.
Published: April 2003

Prolonged QT dispersion is a risk factor for cardiac arrhythmias and sudden death in patients with cardiac and peripheral artery diseases, but there is no study about prolonged QT dispersion in patients with ischaemic strokes. The insular cortex may play an important role in the genesis of cardiac arrhythmias and sudden death. In our study with 40 patients suffering from unilateral hemispheric ischaemic stroke, the QT dispersion was analysed and correlated to the location of the cerebral lesion. We found that in patients with involvement of the insular cortex, the QT dispersin is significantly longer than in those without insular involvement.
Aggravation of Poststroke Sensory Symptoms after a Second Stroke on the Opposite Side
Authors: Kim Jong S.
Published: April 2003

The role of the ipsilateral hemisphere in sensory functions remains unknown. The author describes 5 patients who presented with hemisensory symptoms due to unilateral strokes occurring in the left putamen, left thalamus, right putamen, right lateral medulla and left thalamic-internal capsular area, respectively. Sensory symptoms had gradually improved or remained stable after the initial events. However, when another stroke occurred on the contralateral thalamic-occipital, frontoparietal, lateral medulla, temporoparietal and pontine areas, respectively, previous sensory symptoms significantly worsened and became painful. These observations suggest that ipsilateral sensory pathways play a role in the modulation of sensory functions.
Continuous Facial Myokymia in Multiple Sclerosis: Treatment with Botulinum Toxin
Authors: Sedano Maria José , Trejo Jose Maria , Macarrón Jesus L. , Polo J. Miguel , Berciano Jose , Calleja Jesus
Published: April 2003

Continuous facial myokymia (CFM) is an involuntary undulating, vermicular movement that spreads across facial muscles and is associated with a characteristic electromyographic pattern. It is an infrequent clinical sign that almost always occurs in intrinsic brainstem lesions, particularly in multiple sclerosis (MS). It is usually present for only a few weeks, but it may persist for long periods of time being very troublesome for patients. We report 2 cases with MS and continuous hemifacial myokymia persisting for up to 1 month which disappeared after injection of botulinum toxin. Botulinum toxin A (BTX-A) has been used successfully to treat a variety of focal dystonias and occasionally in orbicularis myokymia, but its use has not been reported in continuous hemifacial myokymia. BTX-A appears to be effective and safe for treating persistent facial myokymia in MS patients.
Nerve Conduction Studies in Multiple System Atrophy
Authors: Abele Michael , Schulz Jörg B. , Bürk Katrin , Topka Helge , Dichgans Johannes , Klockgether Thomas
Published: April 2003

To study the frequency and severity of peripheral neuropathy in multiple system atrophy (MSA), we performed nerve conduction studies in 42 MSA patients suffering from either cerebellar MSA (MSA-C) or parkinsonian MSA (MSA-P). Abnormal nerve conduction was present in 24% of the patients. Abnormalities were significantly more frequent in MSA-P (43%) compared to MSA-C (14%). Motor nerve conduction velocities were reduced in 4% of the MSA-C and in 7% of the MSA-P patients. Abnormal compound muscle action potentials were more frequent in MSA-P (29% versus 7% in MSA-C) pointing to a more pronounced loss of motor axons in this subgroup. Sensory nerve conduction velocities were abnormal in 4% of the MSA-C and 14% of the MSA-P patients, and mean sensory nerve action potentials were normal in all MSA-C and reduced in 7% of the MSA-P patients. The data provide evidence that the peripheral nervous system is differentially affected in MSA-C and MSA-P.
Blood Pressure Elevations in Riluzole-Treated Patients with Amyotrophic Lateral Sclerosis
Authors: Scelsa Stephen N. , Khan Intazam
Published: April 2003

Objective: To determine whether riluzole is associated with blood pressure elevations in patients with amyotrophic lateral sclerosis (ALS). Background: Though previously reported, hypertension is not considered a frequent adverse effect of riluzole. Methods: We reviewed data from 35 consecutive ALS patients on riluzole, and 88 randomly selected controls without and 20 patients with ALS who were not on riluzole. Results: A significantly greater number of ALS patients on riluzole had blood pressure elevations (28 of 35 patients) compared to controls (26 of 88, p < 0.001; 8 of 20, p = 0.007). Median systolic and diastolic blood pressures were both significantly higher in riluzole-treated (140/86 mm Hg) than in control patients without ALS (120/70 mm Hg, p < 0.001). Systolic, but not diastolic, blood pressures were significantly higher in riluzole-treated patients than in controls with ALS (126 mm Hg, p = 0.002). Conclusions: Riluzole treatment may be associated with mild blood pressure elevations. Future prospective trials of riluzole should closely assess hypertension.
Changes in Cerebral Hemodynamics during Simple Partial Motor Seizures
Authors: Niehaus L. , Wieshmann U.C. , Meyer B.-U.
Published: April 2003

Changes in cerebral perfusion were studied during nine short-lasting simple partial motor seizures (SPS) in an 11-year-old girl. Blood flow velocity changes in both middle cerebral arteries (MCAs) were assessed by transcranial Doppler sonography during simultaneous EEG monitoring. Within 7.4 ± 1.4 s after electroencephalographic seizure onset, flow velocity in the MCA ipsilateral to the electrical discharges started to increase and then gradually rose up to 70% above baseline values. Spread of the epileptic activity to the other hemisphere in the late stage of seizure was associated with a slight increase in blood flow velocity (<30%) in the contralateral MCA. After the end of the seizure, flow velocities returned to baseline within 47 ± 7 s. Our findings indicate that focal epileptic seizures evoke asymmetric perfusion increases which are closely related to the onset and cessation of the electroencephalographic seizure activity.
Five-Year Follow-Up of Early Lisuride and Levodopa Combination Therapy versus Levodopa Monotherapy in de novo Parkinson’s Disease
Authors: Allain H. , Destée A. , Petit H. , Patay M. , Schück S. , Bentué-Ferrer D. , Le Cavorzin P.
Published: April 2003

The value of an early initial coadministration of levodopa (L-dopa) and lisuride in Parkinson’s disease was the main goal of the present study. Eighty-two patients with recently diagnosed idiopathic Parkinson’s disease were randomized into two groups for treatment with L-dopa alone or L-dopa + lisuride. The trial was double-blinded for the first year and open for the following 4 years. Selegiline (10 mg/day b.i.d.) was added in both groups at the end of the first year. Outcome measures were evolution of L-dopa dosage and Unified Parkinson’s Disease Rating Scale scores and subscores, and incidence of motor complications. The dropout rate was higher in the L-dopa group (63.4%) than in the combination group. Motor improvement was better (p < 0.01) in the L-dopa + lisuride group. Expected motor complications were rare, moderate and equivalent in the two groups despite a difference in L-dopa dosage (446.7 vs. 387.5 mg/day). Long-term follow-up demonstrated the L-dopa-sparing effect of lisuride (average 1 mg/day), the beneficial effect of early combination therapy on motor status and the paucity of motor complications in both groups.
Complex Mitochondriopathy Associated with 4 mtDNA Transitions
Authors: Finsterer J. , Bittner R. , Bodingbauer M. , Eichberger H. , Stöllberger C. , Blazek G.
Published: April 2003

In a 33-year-old man, mitochondriopathy was diagnosed upon short stature, auditory impairment, gynaecomastia, hypogonadism, vertical ophthalmoplegia, cerebral atrophy, leucencephalopathy, cataract, hypertrabeculated left ventricle, hypothyroidism, diabetes mellitus, glomerulonephritis necessitating kidney transplantation, general wasting, polyneuropathy, abnormally high lactate levels on exercise, partially reduced cytochrome-c oxidase staining and abnormally structured mitochondria on muscle biopsy. Mitochondrial DNA (mtDNA) analysis revealed 1 novel (A15662G) and 3 known mtDNA transition(s) (T3398C, T4216C, G15812A) affecting the cytb and ND1 gene, respectively. Three of the patient’s transitions were also detected in blood leukocytes of the patient’s maternal grandmother, mother and brother. Mutant mtDNA was heteroplasmic at >75% in the patient’s skeletal muscle.
Transient Ischemic Attack in Heavy Cannabis Smokers – How ‘Safe’ Is It?
Authors: Mouzak A. , Agathos P. , Kerezoudi E. , Mantas A. , Vourdeli-Yiannakoura E.
Published: April 2003

Drugs are lately considered high-risk factors for cerebrovascular disease. Three male patients (mean age 24.6 years) who were heavy cannabis smokers presented with transient ischemic attacks (TIA) shortly after cannabis abuse. The complete examination of all 3 consisted of: EEG, brain CT scan, brain MRI, cerebral vessel angiography (digital subtraction and magnetic resonance angiography); also a full cerebrospinal fluid, urine and blood analysis (immunological, biochemical and hormonal tests were included). Urine was further examined for drug metabolites. An extensive cardiological investigation was carried out. Small vessel leukoencephalopathy was revealed by the brain CT and MRI. EEG recordings of the first patient showed paroxysmal sharp waves with left hemispheric dominance. The other 2 patients had diffuse delta and theta activity in their EEG tracings. The urine analysis was positive for cannabis metabolites. There were no other abnormal findings in the rest of the meticulous and thorough study of all 3 patients, which leads to the conclusion that cannabis was the only risk factor responsible for the observed TIA, contradictory to other studies, which support that cannabis is a ‘safe’ drug. More research is required in order for this issue to be completely elucidated.
Low-Dose Gabapentin Combined with either Lamotrigine or Carbamazepine Can Be Useful Therapies for Trigeminal Neuralgia in Multiple Sclerosis
Authors: Solaro C. , Messmer Uccelli M. , Uccelli A. , Leandri M. , Mancardi G.L.
Published: April 2003

Paroxysmal symptoms occur frequently in multiple sclerosis (MS). Usually they are treated with carbamazepine (CBZ) and phenytoin, although these medications are often interrupted due to adverse effects. We report 11 MS patients with trigeminal neuralgia (TN): 6 intolerant to a therapeutic dosage of CBZ, showing serious adverse effects and subsequently treated with a combination of low-dose CBZ and gabapentin (GBP) (group 1); 5 treated with lamotrigine (LMT), showing adverse effects and subsequently treated with GBP (group 2). Subjective pain level and impairment in performing daily activities were rated utilizing a 3-point scale at time 0 and at optimal dosage time (T1). GBP was initiated at 300 mg daily and titrated, until pain control was achieved without new adverse effects, to a maximum dose of 1,200 mg daily. CBZ or LMT were reduced to a level which no longer produced adverse effects, although resulting in a lack of efficacy in relieving pain. Pain control was obtained in all patients but 1, with no side effects. The plasma level analysis, performed in 5 patients, resulted in normal values. The mean dosages at T1 were: group 1 CBZ 400 mg and GBP 850 mg daily; group 2 LMT 150 mg and GBP 780 mg daily. Combining drugs with complementary modes of action may provide a rational pharmacological approach to the management of TN in MS.
Slowed Reaction Time in HIV-1-Seropositive Intravenous Drug Users without AIDS
Authors: Ayuso-Mateos J.L. , Pereda M. , Gómez del Barrio A. , Echevarria S. , Fariñas M.C. , García-Palomo D.
Published: April 2003

One hundred and fourteen subjects with a history of intravenous drug abuse (65 subjects infected with the human immunodeficiency virus, HIV, and 49 seronegative controls) were evaluated with a reaction time (RT) test which included one measure of simple RT and three measures of complex RT. All seropositive patients were in HIV stages A or B. The multivariate analysis of covariance controlled for age, educational level and Montgomery-Asberg Depression Rating Scale score, showed differences between seropositive subjects and controls: the seropositive group scored slower than the control group on two RT tasks, simple RT and a more complex RT measure. Our results suggest that computerized RT measures may be more sensitive than conventional neuropsychological tests in detecting subtle cognitive and motor retardation in the early stages of HIV infection, thus extending the findings of other studies to the intravenous drug-user population.
Polymorphisms of the Parkin Gene in Sporadic Parkinson’s Disease among Chinese in Taiwan
Authors: Hu Chaur-Jong , Sung Shing-Ming , Liu Hsing-Cheng , Lee Cheng-Chun , Tsai Chang-Hai , Chang Jan-Gowth
Published: April 2003

The role of genetics in Parkinson’s disease (PD), previously controversial, is now documented by several studies. A major breakthrough has been the discovery of two single-gene defects in familial PD. A single base pair change at position 209 from G to A (G209A) in the fourth exon of the α-synuclein gene has been identified in cases of autosomal dominant familial PD. Mutations in the Parkin gene can induce autosomal recessive juvenile parkinsonism. A polymorphism of R/W366 in the Parkin gene was found to be associated with a protective factor for sporadic PD. We surveyed the polymorphisms of the Parkin gene, including S/N167, R/W366 and V/L380, in 92 cases of sporadic PD and 98 nonaffected individuals in Taiwanese Chinese. The allele frequencies of these polymorphisms are not significantly different between PD and nonaffected controls. We conclude that polymorphisms of the Parkin gene, S/N167, R/W366, V/L380, are not genetic factors for sporadic PD among Chinese in Taiwan.
Periodic Arm Movements in Patients with the Restless Legs Syndrome
Authors: Chabli Allal , Michaud Martin , Montplaisir Jacques
Published: April 2003

A high proportion of patients with restless legs syndrome (RLS) also complain of arm paresthesia but the presence of periodic arm movements (PAM) has never been documented in a sleep laboratory in these patients. We investigated the prevalence of PAM during nocturnal sleep and awakenings in 22 RLS patients. Fifteen patients had a PAM index >5 movements per hour during wakefulness and among them only 3 had a PAM index >5 during sleep. Twenty patients had a periodic leg movement (PLM) index >5 during wakefulness and 17 had a PLM index >5 during sleep. In 42.8% of cases, PAM showed temporal relationship with PLM during wakefulness. These results show that PAM is frequent in RLS and suggest that the basic neurological dysfunction responsible for RLS is probably not located exclusively at the level of the lumbar spinal cord but involves neuronal systems located at upper levels.
EMG Needle Causes Severer Pain in the End-Plate Region Compared to the Silent Site of the Muscle
Authors: Şener H. Özden , Gökdemir Özlem , Mutluer Nermin
Published: April 2003

We investigated the severity and the quality of pain in the end-plate and the electrically silent site during electromyography by self-assessment. In 42 muscles of 30 patients, the mean pain score was 52.0 ± 5.3 of 100 for the end-plate region, and it was 27.7 ± 4.8 for the silent site. The commonest type of pain was pricking both in the end-plate region and the silent site (19 and 31%, respectively). We suggest two hypotheses for the difference. The pain fibers may be more densely situated in the end-plate, or muscle fiber contraction precipitated by needle irritation may also cause irritation of pain fibers.
Sex Hormone Changes in Morbidly Obese Patients after Vertical Banded Gastroplasty
Authors: Bastounis E.A. , Karayiannakis A.J. , Syrigos K. , Zbar A. , Makri G.G. , Alexiou D.
Published: April 2003

Serum sex hormone levels were measured preoperatively in 57 morbidly obese patients (19 men and 38 premenopausal women) and 12 months after vertical banded gastroplasty. In the male group, there was a significant decrease in estradiol and an increase in follicle-stimulating hormone (FSH), total testosterone and sex-hormone-binding globulin (SHBG). Among female patients, a significant decrease in estradiol, total and free testosterone and an increase in FSH and SHBG was found. Irregular menses present preoperatively in 5 women were corrected after successful weight loss. In conclusion, altered sex hormonal levels and gynecologic abnormalities associated with morbid obesity are corrected with adequate weight loss following vertical banded gastroplasty.
Application of a Novel Method for Subsequent Evaluation of Sinusoids and Postsinusoidal Venules after Ischemia-Reperfusion Injury of Rat Liver
Authors: Kondo T. , Okamoto S. , Todoroki T. , Hirano T. , Schildberg F.W. , Messmer K.
Published: April 2003

Although several intravital fluorescence microscopic studies demonstrated that microcirculatory derangement is induced during liver ischemia-reperfusion, these data were obtained from randomly selected microvascular areas and microvessels. Repeated observation of the identical microvessels has not been performed yet. Using a specially designed cover glass, it is now possible to relocate desired sites of observation repeatedly over the whole reperfusion time. The aim of this study was to determine the impact of reperfusion time on hepatic microvascular perfusion state. Twenty minutes of ischemia induced a significant decrease in sinusoidal perfusion rate (29.1 ± 10.2%) as compared with baseline values (98.0 ± 0.3%). At 30, 60, and 120 min of reperfusion, the percentage of perfused sinusoids recovered to 62.8 ± 6.6, 67.5 ± 5.7, and 77.2 ± 5.4%. The number of stagnant leukocytes in the same sinusoids was 6.2 ± 1.9/lobule at baseline and increased to 22.3 ± 3.6/lobule at 120 min of reperfusion. The number of leukocytes adhering within postsinusoidal venules was 53.5 ± 12.5/mm2 before ischemia and increased to 414.2 ± 62.5/mm2 at 120 min of reperfusion. We have demonstrated that during 120 min of reperfusion, there was a steady increase in both sinusoidal and venular leukocyte adhesion along with an attenuation of the initially severely depressed sinusoidal perfusion. A no-reflow phenomenon at an early phase of reperfusion and subsequent reflow were proven.
Comparison of Euro-Collins Solution, Low-Potassium Dextran Solution Containing Glucose, and ET-Kyoto Solution for Lung Preservation in an Extracorporeal Rat Lung Perfusion Model
Authors: Bando T. , Albes J.M. , Nüsse T. , Wada H. , Hitomi S. , Wahlers T. , Schäfers H.-J.
Published: April 2003

We have recently developed a modified ET-Kyoto solution by adding N-acetylcysteine, nitroglycerin, and dibutyryl cyclic adenosine monophosphate to the previously reported ET-Kyoto solution. The purpose of this study was to compare the new ET-Kyoto solution with the regular Euro-Collins solution and a low-potassium dextran solution containing glucose (Perfadex®) in an isolated rat lung perfusion model. Rat lung blocks were preserved with ET-Kyoto solution, with Euro-Collins solution, or with Perfadex for 4 h. Arterial oxygen tension, shunt fraction, peak inspiratory pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance were assessed up to 50 min after reperfusion. ET-Kyoto solution provided a significantly better lung function after reperfusion than Euro-Collins solution and Perfadex, while Perfadex was also superior to the Euro-Collins solution. We conclude that lung preservation with ET-Kyoto solution is significantly superior to Euro-Collins solution and to Perfadex in an isolated rat lung perfusion model.
Effects of Growth Hormone and Insulin-Like Growth Factor-I on Radiation Enteritis
Authors: Alexandrides T. , Spiliotis J. , Mylonas P. , Melachrinou Maria , Kardamakis D. , Spiliopoulou Iris , Panagopoulos C. , Kalfarentzos F.
Published: April 2003

The effect of growth hormone (GH) and insulin-like growth factor-I (IGF-I) on intestinal mucosal integrity and bacterial translocation after abdominal radiation was studied in rats. Animals were divided into the following groups: I (control), II (radiation), III (radiation plus GH) and IV (radiation plus IGF-I). Radiation (1,100 cGy) was administered on the 1st day to groups II, III and IV. GH [0.25 mg/kg body weight (BW) s.c. once daily] was administered on days 1, 2 and 3 to group III, and IGF-I (0.1 mg/kg BW s.c. twice daily) was given on days 1, 2 and 3 to group IV. On day 4, animals were sacrificed. Cultures of the mesenteric lymph nodes (MLN) and blood cultures from aorta and portal vein were performed. The number of villi per centimeter (V/cm), the villus height (Vh), mitoses per crypt (M/C) and protein and DNA contents of the mucosa were evaluated in samples from the terminal ileum. Radiation increased the number of positive MLN cultures, while treatment with GH and IGF-I reduced them significantly. V/cm, Vh, M/C, protein and DNA contents were significantly increased in all irradiated animals treated with GH and IGF-I. In conclusion both GH and IGF-I are not only capable of improving the mucosal integrity but also to reduce the bacterial translocation that follows intestinal radiation. In small doses IGF-I could reproduce the effects of GH and in some parameters the effects were more pronounced, although not statistically significant. This suggests that the effects of GH on intestine could be mediated through the local and systemic generation of IGF-I.
Inhibition of Myointimal Proliferation by Octreotide in Canine Vein Interposition Grafts
Authors: Ulus A. Tulga , Işcan Zafer , Saritaş Zülfikar , Can Cevat , Yamak Birol , Katircioglu S. Fehmi , Bayazit Murat
Published: April 2003

Purpose: The aim of this study was to evaluate the efficacy of octreotide in modulating the progression of intimal hyperplasia in autogenous vein bypass grafts in a canine model. The effect of the drug on the progression of intimal hyperplasia was measured with the Gilman parameter, a measure used extensively as a wound-healing descriptor. Methods: 12 mongrel dogs were randomly and equally divided into two groups. The first group (octreotide group) was administered octreotide 20 µg/kg/day. The control group (group II) received saline solution by subcutaneous injection. Each dog had 8- to 10-cm segments of autogenous jugular vein bypassed to the femoral arteries. Quantitative data on luminel narrowing over time from intimal hyperplasia were compared from calculated Gilman parameters after image analysis of retrieved, histologically processed graft sections. Each vein graft was analyzed by computerized morphometric analysis. Results: The mean Gilman parameter for distal graft segments was 0.47 ± 0.17 mm in the control group and 0.25 ± 0.07 mm in the octreotide group 6 weeks after operation (p < 0.05). Distal graft segments between the control and octreotide groups were statistically significant. In proximal, medial and distal graft segments, the mean Gilman parameters were 0.51 ± 0.16 mm in the control group and 0.37 ± 0.18 mm in the octreotide group, the difference being statistically significant (p < 0.01). Conclusion: Octreotide significantly inhibits myointimal thickening, and these data support the efficacy of octreotide in reducing intimal hyperplasia in arterialized vein grafts during the short postoperative period. Further investigations are required to as certain whether this beneficial effect of octretide persists in the long term.
An ex vivo Perfusion Model to Evaluate Hyperacute Rejection in a Discordant Pig-to-Human Combination
Authors: Fiane A.E. , Videm V. , Foerster A. , Scholz T. , Perdersen T.H. , Karlsen H. , Svennevig J.L. , Geiran O.R. , Aasen A.O. , Mollnes T.E.
Published: April 2003

Inadequate supplies of human organs for transplantation have evoked an escalating interest in human xenotransplantation. Hyperacute rejection precludes use of discordant organs. We have developed an ex vivo perfusion model in order to evaluate hyperacute rejection in a pig-to-human combination. Pig kidneys (n = 6) perfused with human blood deteriorated rapidly and rejection was seen after 70 (60–87) min (median, 95% confidence interval). Kidneys perfused with pig blood survived 300 (216–360) min, corresponding to the upper time limit of the model. Increases in prostaglandin E2 and 6-keto-prostaglandin F1α indicated endothelial activation. Sequential blood samples revealed a strong progressive inflammatory response with reduced leukocyte and platelet counts, granulocyte activation indicated by increased myeloperoxidase, and complement activation, shown by an increase in C3 activation products and the terminal SC5b-9 complement complex. A significant role for classical pathway activation was indicated by formation of C1rs-C1 inhibitor complexes and activation of C4, whereas factor B was not significantly activated. Biopsies at rejection demonstrated hyperacute rejection with inflammatory changes involving the vessels as well as the nephrons. Where the inflammatory markers could be studied in pig blood, activation was less than in human blood. The present discordant xenotransplant model is a valuable adjunct for evaluation of changes occurring in the human blood perfusate as well as in the pig kidney during hyperacute rejection.
Recognition of a Gastroesophageal Reflex in Dogs and Its Role in Lower Esophageal Sphincter Competence
Authors: Shafik A.
Published: April 2003

The present communication describes a reflex which we call ‘gastroesophageal reflex’ and discusses its significance. Fourteen dogs were anesthetized, and two balloon-tipped catheters were introduced: one in the stomach and the other one in the lower esophageal sphincter (LES). The LES pressure response to gastric distension with a balloon filled with H2O in increments of 10 ml up to 100 ml and to the increase of the intra-abdominal pressure (IAP) was recorded. The gastric pressure response to LES distension with water in increments of 2, 4, and 6 ml was also registered. Gastric distension led to LES pressure increase; the greater the gastric distension, the higher the LES pressure increase. An increase of the IAP, too, effected the LES pressure increase. In contrast, LES distension caused insignificant gastric pressure changes. The results were reproducible. The constant response of the LES to gastric distension as well as the reproducibility postulate a reflex relationship between the two actions. We call this relationship ‘gastroesophageal reflex’. This reflex is suggested to play an important role in prevention of gastroesophageal reflux. It tightens the LES upon increase of gastric or IAP pressure. This is important in cases of full stomach or during coughing, sneezing, or straining at defecation or micturition. The ‘reflex theory’ is advanced to explain the mechanism of gastroesophageal competence. It seems that the gastroesophageal reflex, rather than the pressure of a controversial anatomical LES, is responsible for gastroesophageal competence. The reflex may prove to be of diagnostic significance in gastroesophageal competence disorders.
Tetraploidization Is a Physiological Enhancer of Wound Healing
Authors: Ermis A. , Oberringer M. , Wirbel R. , Koschnick M. , Mutschler W. , Hanselmann R.G.
Published: April 2003

To investigate the role of chromosomal alterations in the process of wound healing on the cellular level, we analyzed biopsies from well-healing (10) and chronic defect (8) wounds. Classical chromosome preparation and fluorescence in situ hybridization were performed with cultured cells and smear preparations. Results from both techniques showed an unusual high rate of tetraploid cells (4 n) in granulation tissue of well-healing wounds (6.5–60%), whereas we found only a low amount of tetraploid cells (from 0 to 5.5%) in chronic wounds. In fibroblast control cultures, there was a percentage of 2–5.5%. In chromosome preparations, we noticed an increased number of nonclonal structural and numerical chromosome aberrations in both well-healing and chronic wounds. Our data show clearly that especially tetraploidization is a typical phenomenon in the well-healing wound, where it apparently supports the healing process.
Connective Tissue Formation in Subcutaneous Cellulose Sponge Implants in the Rat
Authors: Märtson M. , Viljanto J. , Laippala P. , Saukko P.
Published: April 2003

Granulation tissue formation was studied in viscose cellulose sponges with different cellulose contents and sizes after subcutaneous implantation in rats. Samples were removed and studied histologically and histomorphometrically 1–16 weeks after implantation. The implants with lower cellulose content and smaller size were invaded by more cells and filled with connective tissue more rapidly than those with the higher content and larger size. In larger sponge implants the beneficial effect of the lower cellulose content was more conspicuous.
Portal Blood Flow and Liver Regeneration in Auxiliary Partial Orthotopic Liver Transplantation in a Canine Model
Authors: Yabe S. , Nishizawa H. , Egawa H. , Nakayama H. , Okamoto S. , Kiuchi T. , Uemoto S. , Asonuma K. , Shapiro A.M.J. , Inomata Y. , Yamaoka Y. , Tanaka K.
Published: April 2003

Functional competition has been shown to lead to a detrimental outcome in auxiliary liver transplantation. We evaluated the interaction in auxiliary partial orthotopic liver transplantation between the native liver and the graft in terms of portal flow and regeneration. The need for diversion of the portal flow to the graft was also assessed. Reduced-size liver grafts were transplanted orthotopically after partial hepatectomy in beagles. There were two groups: the preserved group, where portal inflow to the native liver was preserved, and the ligated group, where it was interrupted. Portal flow was measured serially and liver regeneration was evaluated on postoperative day 5. Functional competition was not observed in the preserved group. On the other hand, ligation of the native liver portal vein had no obviously detrimental effects on the remnant native liver. This leads to the conclusion that the portal vein to the native liver can be safely ligated to prevent functional competition.
Modified Technique of Isolated Left Lung Perfusion in the Rat
Authors: Hendriks J.M.H. , van Schil P.E.Y. , Eyskens E.J.M.
Published: April 2003

Isolated lung perfusion is a novel therapy for the treatment of pulmonary metastases to increase current low survival rates. Due to tumor heterogeneity, perfusion has to be evaluated in different rat species for efficacy and ideal drug regimens. The revised technique of isolated left lung perfusion as described by Wang and originally performed in the Fisher rat resulted in a high morbiditity in the Wag/Rij rat in our laboratory. Therefore, we modified techniques for intubation and anesthesia, and developed a new approach of catheterization with improved results.
Xenogeneic, Extracorporeal Liver Perfusion in Primates Improves the Ratio of Branched-Chain Amino Acids to Aromatic Amino Acids (Fischer’s Ratio)
Authors: Schön M.R. , Heil W. , Lemmens H.-P. , Padval D. , Matthes M. , Puhl G. , Neuhaus P. , Hammer C.
Published: April 2003

In fulminant hepatic failure (FHF), the development of hepatic encephalopathy is associated with grossly abnormal concentrations of plasma amino acids (PAA). Normalization of the ratio of branched-chain amino acids to aromatic amino acids (Fischer’s ratio) correlates with clinical improvement. This study evaluated changes in PAA metabolism during 4 h of isolated, normothermic extracorporeal liver perfusion using a newly designed system containing human blood and a rhesus monkey liver. Bile and urea production were within the physiological range. Release of the transaminases AST, ALT and LDH were minimal. The ratio of branched (valine, leucine, isoleucine) to aromatic (tyrosine, phenylalanine) amino acids increased significantly. These results indicate that a xenogeneic extracorporeal liver perfusion system is capable of significantly increasing Fischer’s ratio and may play a role in treating and bridging patients in FHF in the future.
A Rabbit Model of Abdominal Aortic Aneurysm Associated with Intimal Thickening
Authors: Matsushita M. , Kobayashi H. , Oda K. , Nishikimi N. , Sakurai T. , Nimura Y.
Published: April 2003

A model of abdominal aortic aneurysm with intimal thickening was developed in the rabbit. A segment of the abdominal aorta just proximal to the bifurcation (1 or 2 cm in length) was dissected and isolated with clamps. This segment was perfused by injecting physiologic saline or 100 U/ml of hog pancreatic elastase from the lumen. Perfusion was performed manually for 5 min and the peak pressure in the segment was between 300 and 400 mm Hg in order to cause aortic wall injury. After 4 weeks, animals that had received perfusion with elastase had aneurysms in the perfused segment on arteriography. None of the other animals developed aortic aneurysms. Histologically, the segments of aorta perfused with saline exhibited intimal hyperplasia. In addition to the intimal hyperplasia, the segments of aorta perfused with elastase solution showed lysis of the elastic lamellae in the media that resulted in aneurysm formation.
Appropriate Blood Flow for Arterio-Portal Shunt in Acute Hypoxic Liver Failure
Authors: Suzuki O. , Takahashi T. , Kitagami H. , Manase H. , Watanabe S. , Kondo S. , Kato H.
Published: April 2003

Hepatic arterial interruption inevitably leads to fatal liver hypoxia when all the collateral arteries to the liver have been eradicated. To prevent such hypoxia, we aimed to determine the appropriate flow of arterial blood in the arterio-portal shunt (APS). After division of all the arteries to the liver, we created three types of APSs between the common hepatic artery (CHA) and the portal vein in dogs, using catheters which were adjusted to pass blood flows of approximately half (group I), equal to (group II) and twice (group III) the CHA blood flow before shunting, except in the control (no-shunt) group. Postoperatively, at 1 and 48 h, we examined the hemodynamics of the liver biochemically and pathologically. After shunting, portal blood flow and oxygen saturation markedly increased, whereas portal venous pressure did not rise significantly. The serum alanine aminotransferase level was significantly higher in the no-shunt group and group I than in group II. Only in group II was the preoperative energy charge maintained, and light- and electron-microscopic examinations revealed no degeneration of the hepatocytes. APS blood flow similar to the original CHA (as in group II) is most appropriate for preventing liver hypoxia.
Donor Lung Pretreatment with Prostaglandin E1 Does Not Improve Lung Graft Preservation
Authors: Vainikka Tiina , Heikkilä L. , Kukkonen Sinikka , Toivonen H. , Verkkala K. , Mattila S.
Published: April 2003

Prostaglandin E1 (PGE1) is widely used to improve early graft function after lung transplantation, but some studies have questioned its benefits. Therefore we evaluated the effect of donor pretreatment with PGE1 in our porcine model of single lung transplantation. Donors received PGE1 or placebo intravenously before flushing the pulmonary artery with modified Euro-Collins solution. After cold storage, the excised left lung was transplanted. Ischemic time was 4 h. We used our right side heart bypass model to measure standardized pulmonary vascular resistance and to study blood flow distribution between recipient’s native and transplanted lung. Systemic and pulmonary hemodynamics and gas exchange were also measured. After transplantation, pulmonary vascular resistance was significantly higher in the transplanted lung, which received only one fourth of the total pulmonary blood flow. PGE1 pretreatment did not improve pulmonary hemodynamic parameters, or gas exchange.
A Trial of Reducing Adhesion Formation in a Uterine Horn Model
Authors: Vural Birol , Mercan Ramazan , Çorakçı Aydın , Özeren Semih , Keskin Nadi , Vural Sevil , Yücesoy İzzet , Erk Ahmet
Published: April 2003

For the prevention of postoperative adhesion formation, one of the most common causes of infertility, none of the adjuvants had been proven uniformly effective. In this study we evaluated the effectiveness of sodium carboxymethylcellulose (SCMC) and disodium cromoglycate (DSCG) in postoperative adhesion prevention in a rat uterine horn model. Thirty female Sprague-Dawley rats were used. After uterine horn abrasion, in 10 rats 10 ml 0.9% saline, in 10 rats 10 ml of 2% SCMC, and in 10 rats 10 ml DSCG were administered intraperitoneally. Two weeks later, all animals were sacrificed and adhesion formation was assessed. All the pieces of the peritoneum biopsies were stained with Luna’s mast cell stain to assess the mast cell degranulation. The mean adhesion scores were 2.1, 2.0 and 1.5 for saline, SCMC and DSCG groups respectively. There were no significant differences among all groups. In the pathologic examination, mast cell degranulation was less in the DSCG group than the other groups.
Adenosine-Stimulated Intracellular Calcium Increase in Cultured Human Uterine Myocyte
Authors: Tsai E.M. , Chiang P.H. , Lee J.N.
Published: April 2003

The effect of adenosine on intracellular free calcium concentration ([Ca2+]i) was studied in human uterine myocyte. Adenosine 10–6 M elicited a rapid followed by a maintained increase in [Ca2+]i in Fluo-3-loaded myocytes. Compared with basal [Ca2+]i level, adenosine induced a 2.6-fold increase in the absence of extracellular calcium, and a 2.4-fold increase in the presence of extracellular calcium. There was no significant difference between the two groups in the initial response. After depletion of intracellular calcium stores by repetitive caffeine (10 mM) applications, adenosine could not induce increase in [Ca2+]i. The initial rise could be induced in the absence of extracellular calcium, whereas the maintained phase after 120 s of adenosine application was dependent on the presence of extracellular calcium. The maintained phase response was 1.39- and 0.90-fold compared with basal [Ca2+]i level in the presence and absence of extracellular calcium respectively. There was significant (p < 0.01) maintenance of [Ca2+]i in the presence of extracellular calcium, which appeared to be associated with calcium influx. The data suggest that in human uterine myocytes, adenosine stimulates release of Ca2+ from intracellular stores and influx of extracellular Ca2+ through Ca2+ entry pathway.