bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio–economic and Behavioural Factors Related to Caries in Twelve–Year–Old Sardinian Children
Authors: Campus G. , Lumbau A. , Lai S. , Solinas G. , Castiglia P.
Published: April 2003

Our aim was to describe socio–economic and behavioural factors related to caries experience in school children in Sassari, Sardinia (Italy). Four hundred and three 12–year–old schoolchildren were randomly selected and their teeth clinically examined after air drying, under standard light using a plain mirror and WHO community periodontal index for treatment needs (CPITN) ballpoint probe. The clinical DMFS index was recorded following a diagnostic threshold, CPITN following the WHO indications. A questionnaire concerning oral hygiene habits (OHH), the onset of toothbrushing habits (OTH), frequency of dental check–ups (DCU), sweet food and soft drink consumption and socio–economic background factors, i.e. parents'' occupational status (SOCFAM) and parents'' age, was filled in by children and parent(s)/guardian(s). The caries prevalence was 61.6%. A positive skewness of DMFS was observed. Regarding caries, a significant linear trend (p<0.05) was found among odds ratios at each exposure level in SOCFAM, OHH, OTH and CPITN. A logistic regression model for caries was constructed using related factors. CPITN (gingival conditions) gave a significant contribution in the predictive model (p = 0.01). Gender acted as an effect modifier on CPITN, so logistic regression models were constructed for males and females separately. CPITN was the only statistically significant covariate in males and OHH the only one in females. Our results confirm a high caries prevalence and also a need for preventive and educational programmes for caries in Sardinia.
Prediction of the Final Infarct Volume within 6 h of Stroke Using Single Photon Emission Computed Tomography with Technetium-99m Hexamethylpropylene Amine Oxime
Authors: Hirano T. , Read S.J. , Abbott D.F. , Baird A.E. , Yasaka M. , Infeld B. , Barber P.A. , Davis S.M. , McKay W.J. , Donnan G.A.
Published: April 2003

Background: A simple method to predict the final infarct volume within 6 h of onset of hemispheric ischemic stroke based on the measurement of cerebral blood flow (CBF) using single photon emission computed tomography (SPECT) with techneticum-99m hexamethylpropylene amine oxime (99mTc-HMPAO) was investigated in a clinical model involving patients without definite early reperfusion or clinical recovery. Methods: A group of 16 patients (group 1) was used to establish the methodology, which was then validated in a second group of 14 patients (group 2). The final infarct volume was defined using computed tomography (CT) performed at least 7 days after stroke. The relative CBF threshold value, expressed as a percentage of the mean contralateral hemispheric value, which most closely estimated the final infarct size on coregistered CT was established for each patient. Results: The mean threshold CBF value for group 1 was 63.7%. When this value was used to predict infarct size in group 2, a close correlation was observed between the actual and the estimated sizes (r = 0.973, p < 0.0001). This value was not time dependent. Conclusions: If no significant early reperfusion or clinical recovery occurs, a CBF threshold value of 63.7% on 99mTc-HMPAO SPECT performed within 6 h of stroke onset will reliably predict the final infarct size.
Potentially Reversible Factors during the Very Acute Phase of Stroke and Their Impact on the Prognosis: Is There a Large Therapeutic Potential to Be Explored?
Authors: Jørgensen Henrik Stig , Reith Jakob , Nakayama Hirofumi , Kammersgaard Lars Peter , Houth Jakob Gynthelberg , Raaschou Hans Otto , Olsen Tom Skyhøj
Published: April 2003

In the Copenhagen Stroke Study, we evaluated the combined impact on stroke outcome of potentially treatable factors such as acute body temperature, blood glucose, and stroke in progression. The patients were stratified into two groups: (1) patients with ‘good’ prognostic parameters (body temperature on admission ≤37.0°C and plasma glucose on admission ≤6.5 mmol/l and who did not develop stroke in progression) and (2) patients with correspondingly ‘poor’ prognostic parameters. A poor outcome was observed in 4% of the patients with good prognostic parameters versus in 49% of the patients with poor prognostic parameters (p < 0.01). In the multivariate analysis which also included stroke severity, blood glucose contributed significantly to poor outcome with an odds ratio (OR) of 1.2/1.0 mmol/l increase, body temperature with an OR of 2.2/1°C increase, and stroke in progression with an OR of 2.9. However, the combined effect of all three factors was more than additive with an OR of 10.0 (95% CI 1.5–56; p < 0.01). We have shown that in human stroke a strong and more than additive association exists between potentially reversible parameters and outcome. Intervention trials can prove whether these marked relations are causal.
Impact of Stroke Type on Survival and Functional Health
Authors: van Straten A. , Reitsma J.B. , Limburg M. , van den Bos G.A.M. , de Haan R.J.
Published: April 2003

In a cohort 760 consecutive stroke patients (23 hospitals in the Netherlands), we studied prognosis in relation to stroke type and focused on (a) short-term and long-term mortality, and (b) long-term functional health. Based on clinical and CT data, we distinguished infratentorial strokes from supratentorial strokes (lacunar infarctions, (sub)cortical infarctions and intracerebral hemorrhages). Cumulative mortality for all stroke patients was 34% at 6 months, 51% at 3 years, and 62% at 5 years. Short-term mortality could be explained by stroke type, whereas long-term mortality could not. Of all survivors, 55% were in poor functional health at 6 months, 49% at 3 years and 42% at 5 years. Long-term functional health outcomes were associated with stroke type. We conclude that the impact of stroke type on mortality is limited to the first 6 months, whereas the type of stroke influences the long-term functional health.
Yonsei Stroke Registry
Authors: Lee Byung In , Nam Hyo Suk , Heo Ji Hoe , Kim Dong Ik
Published: April 2003

Background and Purpose: The hospital-based stroke registry is a well-established method useful for understanding diverse clinical characteristics of stroke related to geographical, racial or environmental differences. We analyzed the data from 1,000 patients with acute cerebral infarctions registered with the Yonsei Stroke Registry (YSR) which is the first prospective hospital-based observational study in Korea. Methods: All patients had cerebral infarctions and presented within 7 days of onset. CT or MRI was performed in all patients and a vascular imaging study (digital subtraction or magnetic resonance angiography) was conducted in 53.9% of the patients. Subtype classification was made through a consensus approach based on the strict application of TOAST criteria. Results: The mean age of patients was 62 ± 12 years, and 60.8% were males. Undetermined cause (UD) was the most frequent subtype (40.6%), which was followed by lacunar stroke (LS 21.5%), cardiac embolism (CE 18.3%), large-artery atherosclerosis (LAA 16.5%) and other determined causes (3.1%). Hypertension was found in 64.3%, smoking in 35.2%, diabetes mellitus in 26.9%, hypercholesterolemia in 24.1%, high hematocrit (≧50%) in 21.8%, clinically identified potential cardiac sources of embolism in 18.3%, a history of previous stroke in 22.0% and a history of previous transient ischemic attack in 4.7%. Recurrent stroke was associated with a higher number of risk factors (p < 0.001) and a higher incidence of LAA (p = 0.003) than the first stroke. Vertebrobasilar artery territorial infarction was found in 39.8%, which was associated with higher incidences of LAA and LS and a lower incidence of CE than carotid artery territorial lesions (p = 0.001). The 30-day mortality rate was 5.3% and cerebral herniation caused early death in 52%. Conclusion: The distribution of stroke subtypes in the YSR was largely comparable with that of western registries. The highest incidence of UD might be related to the strict application of TOAST criteria.
Natural Coagulation Inhibitor Proteins in Young Patients with Cerebral Ischemia
Authors: Oláh László , Misz Mária , Kappelmayer János , Ajzner Éva , Csépány Tünde , Fekete István , Bereczki Dániel , Blaskó György , Csiba László
Published: April 2003

Disturbances of coagulation and fibrinolytic pathways were studied in 53 young patients with cerebral ischemia. Upon admission 26 of 53 patients had abnormality in at least one of the antithrombin-III, protein C, protein S activities or in activated protein C (APC) ratios. Three months after the first examination the majority of the previously detected abnormalities returned to normal values and the most frequent alterations were decrease in protein S activity (3 patients) and APC resistance (3 patients). Conditions resulting in impaired fibrinolysis were frequently detected upon admission. Elevation of plasminogen activator inhibitor-1, lipoprotein (a), and alpha-2-antiplasmin was present in 23, 10, and 4 cases, respectively. It is concluded that abnormalities of coagulation as well as of the fibrinolytic systems are prevalent in the acute phase of cerebral ischemia, however, the results may be significantly influenced by the disease process or the acute phase effect.
Thrombolysis for Acute Ischemic Stroke: The Patient’s Point of View
Authors: Ciccone Alfonso , Sterzi Roberto , Crespi Vittorio , Defanti Carlo Alberto , Pasetti Carlo
Published: April 2003

Background: The use of thrombolytic therapy for acute ischemic stroke is still controversial. A major problem is balancing the improvement in functional ability against the risk of early death from cerebral hemorrhage. Our aim was to assess whether patients who have had a stroke, and their proxies, would give consent to thrombolysis if this therapy were introduced into clinical practice for acute ischemic stroke in Italy. Methods: A 10-item questionnaire was administered by personnel not directly involved in the care of patients in 12 Italian hospitals. Interviews were carried out with at least 10 consecutive stroke inpatients per center in the postacute phase and to their proxies. Results: There were 685 responders (377 female), median age 58 years (range 18–98); 332 were patients and 353 proxies. Responders were representative of the Italian population as a whole as regards mean age and sex, education and marital status; 59% of responders (95% confidence interval 55–62%) would agree to thrombolysis in the case of stroke. There was more uncertainty among proxies than patients, especially when the decision had to be taken for a relative (41 vs. 17% could not decide, p < 0.001). The preference for thrombolysis was higher among more educated people (p = 0.001) and was not influenced by sex, age and marital status. Overall, 81% of responders would prefer to risk dying rather than remain severely disabled. Conclusion: Thrombolytic therapy is feasible in Italy as there is ample willingness to trade off a better functional outcome with a higher risk of death. Education is the main sociodemographic determinant of independent decision-making, as only those with an adequate cultural level are able to discriminate between one treatment option and another. The proxy’s uncertainty about how to interpret a patient’s preference regarding consent to thrombolytic therapy should be tackled, since proxies play a key role in making patients’ preferences known in case of incompetence after an acute stroke.
Intracranial Dural Arteriovenous Fistulas: Analysis of 60 Patients
Authors: Chung Sun J. , Kim Jong S. , Kim Jong C. , Lee Soon K. , Kwon Sun U. , Lee Myoung C. , Suh Dae C.
Published: April 2003

Objective: To analyze and update the clinical symptomatology, CT and MRI findings, angiographic features, and therapeutic outcomes of patients with dural arteriovenous fistulas (DAVFs). Background: Studies of DAVFs in a large number of patients have seldom appeared in neurology literature. Methods: The authors investigated 60 consecutive patients with DAVFs who were admitted between January 1991 and January 2001. The DAVFs were graded into five types according to the classification of Cognard et al. [Radiology 1995;194:671–680]. Presumable etiologies, clinical features, imaging findings and therapeutic outcomes were evaluated on the basis of the location and type of DAVFs. Results: Sinus thrombosis, previous trauma, craniotomy, cerebral infarction and acupuncture were detected as possible etiologic factors of DAVFs. The cavernous sinus (57%) was the most common location of DAVFs. Although the neurological symptoms were closely related to the location of the DAVFs, in some patients, there were also symptoms that did not reflect the location. Although the women outnumbered the men, the men presented with aggressive neurological manifestations more often (p < 0.05). Ten out of 12 patients (83%) with DAVFs involving locations other than the large sinuses presented with aggressive neurological manifestations. 70% of brain CTs and 81% of brain MRIs showed abnormal findings suggestive of DAVFs. Of 33 patients who underwent only endovascular embolization, 29 patients (88%) were cured or improved. Radiosurgery and surgical excision done in some patients provided fair results. Patients with DAVFs involving large sinuses showed a better therapeutic outcome than those in whom locations other than the large sinuses were involved, while patients without venous ectasia had more a favorable outcome than those with it (each, p < 0.01). Conclusions: DAVFs result from various etiologic factors, show diverse manifestations usually reflecting the location and can be treated successfully in most patients. Factors related to poor clinical outcome include male sex, the presence of venous ectasia and involved locations other than the large sinuses.
Validity of the Aphasia Item from the Scandinavian Stroke Scale
Authors: Thommessen Bente , Thoresen Gerd Eva , Bautz-Holter Erik , Laake Knut
Published: April 2003

We studied the validity of the aphasia item of a widely used stroke scale – the Scandinavian Stroke Scale (SSS) – in discriminating between aphasia and normal language function in 33 stroke patients of an acute stroke unit. They were assessed by a nurse using the aphasia item from the SSS and by a speech and language therapist carrying out a full evaluation of the language function. The latter served as the ‘gold standard’. The agreement between the nurses’ and the speech and language therapist’s scoring was good (weighted kappa = 0.74, 95% CI 0.51–0.97), and the sensitivity and specificity of the SSS aphasia item were also satisfactory. However, the predictive value of a positive test was as low as 0.55 (95% CI 0.23–0.83), indicating nearly every second of the positives being false positive. Using the aphasia score of the SSS as a diagnostic aid for aphasia after stroke results in a high rate of false positives and inflates the prevalence figures for aphasia in epidemiological studies of stroke.
The Dynamic in vivo Distribution of Bone Marrow-Derived Mesenchymal Stem Cells after Infusion
Authors: Gao Jizong , Dennis James E. , Muzic Raymond F. , Lundberg Magnus , Caplan Arnold I.
Published: April 2003

Bone marrow-derived mesenchymal stem cells (MSCs) have the potential to differentiate along different mesenchymal lineages including those forming bone, cartilage, tendon, fat, muscle and marrow stroma that supports hematopoiesis. This differentiation potential makes MSCs candidates for cell-based therapeutic strategies for mesenchymal tissue injuries and for hematopoietic disorders by both local and systemic application. In the present study, rat marrow-derived MSCs were ex vivo culture-expanded, labeled with 111In-oxine, and infused into syngeneic rats via intra-artery (i.a.), intravenous (i.v.) and intraperitoneal cavity (i.p.) infusions. In addition, for i.a. and i.v. infusions, a vasodilator, sodium nitroprusside, was administered prior to the cell infusion and examined for its effect on MSC circulation. The dynamic distribution of infused MSCs was monitored by real-time imaging using a gamma camera immediately after infusion and at 48 h postinfusion. After 48 h, radioactivity in excised organs, including liver, lungs, kidneys, spleen and long bones, was measured in a gamma well counter and expressed as a percentage of injected doses. After both i.a. and i.v. infusion, radioactivity associated with MSCs was detected primarily in the lungs and then secondarily in the liver and other organs. When sodium nitroprusside was used, more labeled MSCs cleared the lungs resulting in a larger proportion detected in the liver. Most importantly, the homing of labeled MSCs to the marrow of long bones was significantly increased by the pretreatment with vasodilator. These results indicate multiple homing sites for injected MSCs and that the distribution of MSCs can be influenced by administration of vasodilator.
Image-Based Biomimetic Approach to Reconstruction of the Temporomandibular Joint
Authors: Feinberg Stephen E. , Hollister Scott J. , Halloran John W. , Chu T.M. Gabe , Krebsbach Paul H.
Published: April 2003

This article will present an image-based approach to the designing and manufacturing of biomimetic tissue engineered temporomandibular (TMJ) condylar prosthesis. Our vision of a tissue-engineered TMJ prosthesis utilizes a 3-D designed and manufactured biodegradable scaffold shaped similar to a condylar head and neck, i.e. a condylar-ramus unit (CRU). The fabricated CRU scaffold can be constructed with a specific intra-architectural design such that it will enhance the formation of tissue from implanted cells placed within its interstices. These biologic cues could influence scaffold-implanted mesenchymal stem cells (MSC) or bone marrow stromal cells (BMSC) to form a fibrocartilaginous joint surface, or cap, on top of a bony strut, similar to a costochondral rib graft (CCRG), which could be fixed to the mandibular ramus. This new approach to tissue engineering a TMJ would be advantageous because of its patient site-specific anatomical configuration as well as its potential ability to adapt to the loading forces placed on it during function.
Migration, Matrix Production and Lamellar Bone Formation of Human Osteoblast-Like Cells in Porous Titanium Implants
Authors: Frosch K.-H. , Barvencik F. , Lohmann C.H. , Viereck V. , Siggelkow H. , Breme J. , Dresing K. , Stürmer K.M.
Published: April 2003

The goal of this study was to characterize growth, mineralization and bone formation of osteoblast-like cells in titanium pore channels of defined diameter. Titanium implants with continuous drill channels of diameters of 300, 400, 500, 600 and 1,000 µm were inserted into human osteoblast-like cell cultures. The ingrowth of the cells into the drill channels was investigated by transmitted-light microscopy and scanning electron microscopy. Immunofluorescence and histological analysis of 15-channel sections of each diameter were used to investigate the growth behavior and the matrix protein patterns. Mineralization was evidenced by Alizarin red staining and high-resolution microradiography. The ingrowth of human osteoblast-like cells in the drill channels occurred in a sequence of four characteristic stages. In stage 1, osteoblast precursor cells adhered to the wall of the channel and migrated three-dimensionally into the channel by forming foot-like protoplasmic processes. For all 15 sample drill channels that were investigated, the cell ingrowth over 20 days amounted on average to 793 µm (± 179) into 600-µm-diameter channels, where they migrated significantly faster than in all the other channels. In stage 2, approximately on day 5–7, the osteoblast-like cells began to anchor on the substrate wall by matrix proteins and to build up a dense network of matrix proteins in the drill channel. The mineralization of the extracellular matrix, while depending on cell stimulation, was initiated in stage 3, on average after 4 weeks. In drill channels of a diameter of 1,000 µm the cell growth was incomplete and no mineralization was found by radiological assessment. Starting in week 6, in the drill channels of diameters ranging from 300 to 600 µm, the network of extracellular matrix proteins and osteoblast-like cells began to form an osteon-like structure. Neither the highly developed migration behavior of osteoblastic cells nor the reorganization from a fiber-like matrix to a lamellar structure have so far been described for cell cultures.
Pathological Sleep Apnoea Frequency Remains Permanent in Ischaemic Stroke and It Is Transient in Haemorrhagic Stroke
Authors: Szücs Anna , Vitrai József , Janszky József , Migléczi György , Bódizs Róbert , Halász Péter , Nagy Zoltán
Published: April 2003

Frequency and severity of sleep apnoeas, snoring history, standard clinical stroke scale were assessed in 106 acute (73 ischaemic, 33 haemorrhagic) stroke patients. Thirty-seven patients with ischaemic stroke and 14 patients with cerebral bleeding, each having pathological oxygen desaturation index during sleep, were re-tested in 3 months for sleep apnoeas and clinical stroke scale. In haemorrhagic strokes, the apnoea frequency decreased parallel with clinical improvement; but it remained as frequent as in the acute phase in the ischaemic stroke group (p = 0.0002). Apnoea frequency decreased mostly during the course of posterior stroke (p = 0.0001). It is concluded that pathological sleep apnoea frequency remains stable after ischaemic stroke indicating a concomitant obstructive sleep apnoea syndrome and sleep apnoea is a transitory symptom of haemorrhagic strokes.
Serum Tau Protein Level as a Marker of Axonal Damage in Acute Ischemic Stroke
Authors: Bitsch Andreas , Horn Claudia , Kemmling Yvonne , Seipelt Maria , Hellenbrand Uwe , Stiefel Michael , Ciesielczyk Barbara , Cepek Lukas , Bahn Erik , Ratzka Peter , Prange Hilmar , Otto Markus
Published: April 2003

Biochemical markers of brain damage, e.g. ischemic stroke, should reflect the volume of irreversibly damaged brain parenchyma and the clinical outcome in a single patient in order to allow estimation of prognosis at an early stage. Tau protein, which derives predominantly from neurons and axons, is elevated in the cerebrospinal fluid of patients with neurodegenerative disease. This makes tau protein a potential marker of neuronal/axonal injury. In order to test this hypothesis, the current study aimed at showing that tau protein is measurable in the blood after acute ischemic stroke and that it correlates with clinical disability and stroke volume. In a longitudinal prospective study we measured tau protein serum levels with an ELISA in 30 patients longitudinally after ischemic stroke. Tau protein was detectable within 5 days after ischemia in the sera of 7/20 patients with MRI-proven infarction and in 2/10 patients with transitory ischemic attack; both of them had a small infarction visible on the MRI scan. Tau protein was measurable within 6 h after symptom onset, peaked after 3–5 days and correlated with infarct volume and disability after 3 months. In conclusion, serum tau protein is a candidate marker of axonal injury. In stroke, its clinical use is limited, because it is detectable only in a proportion of patients.
Advances in the Treatment of Alzheimer’s Disease: Benefits of Dual Cholinesterase Inhibition
Authors: Ballard C.G.
Published: April 2003

Cholinesterase inhibitors have produced the best evidence of clinical efficacy for treating patients with Alzheimer’s disease (AD). Many of these drugs selectively inhibit acetylcholinesterase (AChE), but agents that also target butyrylcholinesterase (BuChE) may provide added benefits. As AD progresses, ACh regulation may become increasingly dependent on BuChE and dual inhibitors may provide more sustained efficacy than AChE-selective agents. Dual inhibition may also help to slow the formation of amyloidogenic compounds, providing an important disease-modifying mechanism. Rivastigmine is a dual inhibitor that has demonstrated benefits across the spectrum of AD severity and across the cognitive, functional and behavioural domains of AD. It is a priority for future clinical trials to determine whether agents with dual inhibition properties have greater clinical efficacy.
Menopause and Menarche in Patients with Primary Blepharospasm: An Exploratory Case-Control Study
Authors: Martino Davide , Livrea Paolo , Giorelli Maurizio , Masi Gianluca , Aniello Maria Stella , Defazio Giovanni
Published: April 2003

We studied the relationships between blepharospasm (BSP) and menopause/menarche in female patients with primary BSP (n = 83) and age-matched healthy (n = 83) and disease controls (n = 83). BSP patients and matched controls had comparable age at menopause, and there was no correlation between age at menopause and age at BSP onset. Thus, menopause probably exerts no significant influence on the age-dependent development of BSP. BSP cases tended to have a later menarche than either group of controls. The association was independent of age, disease duration and education level. Because the higher the age at menarche, the higher the age at BSP onset, later menarche was unlikely to be a risk factor for BSP. Rather, the two conditions may share pathophysiologic mechanisms, for example minor abnormality of neurotransmitter systems controlling both the motor system and the maturation of the hypothalamic-pituitary-gonadal axis responsible for the onset of puberty.
Allergic Contact Dermatitis in Dentists and Dental Nurses
Authors: Kiec-Swierczyńska Marta , Krecisz Beata
Published: April 2003

The incidence of allergic contact dermatitis was analysed in 79 dentists and 46 dental nurses referred during 1990–2000 for consultation to our institute. Allergic contact dermatitis was diagnosed from the positive results of patch tests and type I allergy to latex and common environmental allergens from the positive results of prick tests. We have found that the dental personnel was hypersensitive primarily to components of disinfectants, metals, rubber and fragrances. Acrylates caused allergy only in the dentists (20–25% of all examined patients). Among 20 acrylate-sensitive dentists, 20 reacted to ethyleneglycol dimethacrylate. There was also a high incidence of allergy to nickel (25.3%), cobalt (20.2%), fragrances (17.2%), formaldehyde (15.2%), potassium dichromate (13.9%), thimerosal (12.6%), thiurams and Peru balsam (11.4%) as well as glutaraldehyde (10.1%). As much as 12 of 46 dental nurses developed allergy to glutaraldehyde, 6 were allergic to formaldehyde and 3 to glyoxal. Nickel produced a positive reaction in 10 patients, fragrances, thimerosal, potassium dichromate in 5 each, thiurams and eugenol in 4 each. In our opinion, acrylates in the dentists and disinfecant aldehydes in the dental nurses constitute the major sources of allergy among dental personnel. Type I allergy to natural latex was diagnosed in 6.3% dentists and 8.7% dental nurses.
Prenatal Ultrasound May Predict Fetal Response to Therapy in Non-Hydropic Fetuses with Supraventricular Tachycardia
Authors: Jouannic J.M. , Le Bidois J. , Fermont L. , Villain E. , Mahieu-Caputo D. , Dumez Y. , Dommergues M.
Published: April 2003

Objective: To study the fetal response to prenatal therapy in non-hydropic fetuses with supraventricular tachycardia (SVT) as a function of fetal haemodynamic status at presentation. Study Design: Retrospective study. Material and Methods: Between 1990 and 2000, 40 non-hydropic fetuses presented with SVT. Twenty-eight had reciprocating SVT and 12 had atrial flutter. Ten fetuses had significant tricuspid valve regurgitation. All fetuses were treated prenatally. The main outcome measurement was fetal response to therapy as assessed by the rate of prenatal SVT reduction and by the mean time interval to sinus rhythm restoration. Results: The mean gestational age at presentation was 29 ± 4.9 weeks. Overall, there were 39 liveborns and 1 intrauterine death. Reduction of SVT was achieved prenatally in 32 cases (80%). Among the 30 cases without tricuspid regurgitation, prenatal conversion to sinus rhythm was achieved in 27 cases (90%) with a mean time interval of 7 days. Among the 10 fetuses presenting with tricuspid regurgitation, the rate of prenatal conversion was significantly lower (5/10) and the mean time interval to conversion was significantly longer (24 days; p = 0.04, Mann-Whitney test). In the subgroup treated by digoxin as first-line therapy (n = 32), the interval to sinus rhythm restoration was also significantly higher in the presence of tricuspid regurgitation, with a slightly but not significantly lower reduction rate. Conclusion: The response to prenatal therapy may be poorer in cases presenting with tricuspid regurgitation.
Alagille Syndrome: Prenatal Diagnosis and Pregnancy Outcome
Authors: Albayram Ferah , Stone Kristyne , Nagey David , Schwarz Kathleen B. , Blakemore Karin
Published: April 2003

The Alagille syndrome (AGS) is a multisystem autosomal dominant condition. In this case report, we describe a pregnant woman with this unusual disorder, in whom serial fetal sonography revealed severe pulmonary stenosis and progressively severe intrauterine growth retardation, suggesting that the fetus also had AGS, a diagnosis which was confirmed postnatally. In this report, the potential complications for pregnancy, labor and delivery when both mother and fetus are affected with AGS are described.
Hypothalamic Hamartoma: Comparison of Clinical Presentation and Magnetic Resonance Images
Authors: Debeneix C. , Bourgeois M. , Trivin C. , Sainte-Rose C. , Brauner R.
Published: April 2003

Background/Aims: Hypothalamic hamartoma (HH) is one of the most frequent causes of organic central precocious puberty (CPP). We compared the clinical presentation and the magnetic resonance images (MRI) of 19 patients with HH aged 5.7 ± 4.1 (SD) years at the first endocrine evaluation. They had isolated CPP (group 1, n = 9), CPP plus gelastic seizures (group 2, n = 5), isolated seizures (group 3, n = 4), and 1 patient was asymptomatic. Methods/Results: All patients without neurological symptoms (group 1 and the asymptomatic patient) had pedunculated lesion (diameter 6.4 ± 3.6 (3–15) mm), suspended from the floor of the third ventricle. All patients with neurological symptoms (groups 2 and 3) had sessile lesion (diameter 18.3 ± 9.6 (10–38) mm, p = 0.0005 compared to the others), located in the interpeduncular cistern with extension to the hypothalamus. Seven patients were overweight. The growth hormone peak, free thyroxine, cortisol and prolactin concentrations, and the concomitant plasma and urinary osmolalities were normal in all the cases evaluated. The mean predicted or adult heights of 10 patients treated 5.2 ± 3.3 years for CPP with gonadotropin hormone releasing hormone (GnRH) analog were –0.3 ± 1.7 SD, similar to their target height –0.1 ± 0.9 SD. Conclusion: The clinical presentation of HH depends on its anatomy: small and pedunculated HH are associated with CPP, while large and sessile HH are associated with seizures. The hypothalamic-pituitary function in these cases is normal, which suggests that the absence of CPP is not due to gonadotropin deficiency. GnRH analog treatment preserves the growth potential in those with CPP.
Effect of Near Physiologic Insulin Therapy on Hypoglycemia Counterregulation in Type-1 Diabetes
Authors: Bischof Martin G. , Bernroider Elisabeth , Ludwig Claudia , Kurzemann Susanne , Kletter Kurt , Waldhäusl Werner , Roden Michael
Published: April 2003

Objectives: The aim of this study was to examine hormonal counterregulation during insulin-induced hypoglycemia in type-1 diabetic patients during long-term near normoglycemic insulin therapy and intensive clinical care. Methods: Type-1 diabetic patients (age 35.3 ± 2 years, body mass index 22.8 ± 1 kg·m–2, mean diabetes duration 13.6 (11–17 years), mean HbA1c during the last year 6.6 ± 0.1%) and nondiabetic subjects were studied during (0–120 min) and after (120–240 min) hypoglycemic (3.05 mmol/l) hyperinsulinemic (∼330 pmol/l) clamp tests. Results: During hypoglycemia peak plasma concentrations of glucagon (199 ± 16 vs. 155 ± 11 ng/l, p < 0.05), epinephrine (4,514 ± 644 vs. 1,676 ± 513 pmol/l, p < 0.001), norepinephrine (2.21 ± 0.14 vs. 1.35 ± 0.19 nmol/l, p < 0.01) and cortisol (532 ± 44 vs. 334 ± 61 nmol/l) were reduced in the diabetic patients. Plasma lactate did not change from baseline values (0.51 ± 0.06 mmol/l) in diabetic but doubled in healthy subjects (1.13 ± 0.111 mmol/l, p < 0.001 vs. control). During the posthypoglycemic recovery period plasma concentrations of free fatty acids were higher in diabetic patients at 240 min (1.34 ± 0.12 vs. 2.01 ± 0.23 mmol/l, p < 0.05). Conclusion: Despite long-term near physiologic insulin substitution and the low incidence of hypoglycemia, hormonal hypoglycemia counterregulation was impaired in type-1 diabetic patients after a diabetes duration of more than 10 years.
Multiple Endocrine Neoplasia
Authors: Thakker R.V.
Published: April 2003

Multiple endocrine neoplasia (MEN) is characterized by the occurrence of tumours involving two or more endocrine glands; two major forms, referred to as MEN1 and MEN2, are recognized. MEN1 is characterized by parathyroid, pancreatic islet and anterior pituitary tumours, whilst MEN2 is characterized by medullary thyroid carcinoma (MTC) in association with phaeochromocytoma. There are three clinical variants, referred to as MEN2A, MEN2B and MTC-only. All these forms of MEN may be inherited as autosomal dominant syndromes. The MEN1 gene is on chromosome 11q13 and about 300 MEN1 mutations have been identified. These are of diverse types and are scattered throughout the coding region. There is also a lack of genotype-phenotype correlation. All these findings make it difficult to implement MEN1 mutational analysis in the clinical setting. The situation in MEN2 is more straightforward. The gene causing all three MEN2 variants is located on chromosome 10cen-10q11.2, and is the c-ret proto-oncogene which encodes a tyrosine kinase receptor with cadherin-like and cysteine-rich extracellular domains, and a tyrosine kinase intracellular domain. Specific mutations of c-ret have been identified for each of the three MEN2 variants and mutational analysis has been used in the diagnosis and management of patients and families with the MEN2 variants.
Long-Term Outcomes of Pediatric Moyamoya Disease Treated by Encephalo-Duro-Arterio-Synangiosis
Authors: Isono Mitsuo , Ishii Keisuke , Kamida Tohru , Inoue Ryo , Fujiki Minoru , Kobayashi Hidenori
Published: April 2003

To investigate the efficacy of encephalo-duro-arterio-synangiosis (EDAS) for the treatment of pediatric moyamoya disease, we analyzed 11 patients who were followed up for more than 100 months. Among 22 sides in 11 patients, we performed EDAS on 16 sides in 10 pa- tients, encephalo-duro-arterio-myo-synangiosis (EDAMS) on 5 sides in 4 patients and encephalo-myo-synangiosis (EMS) on 1 side. Of the 11 patients, 8 patients showed normal development and had no neurological deficit. The remaining 3 patients showed mild to moderate neurological deficits, but in these cases, pre- and perioperative insults were considered to be attributable to the morbidities. Of 13 sides treated by EDAS, well-developed neovascularization was observed in 12. However, well-developed neovascularization was observed in only 3 out of 6 sides treated by EMS or EDAMS. These data might indicate that EDAS is a therapeutic alternative for the surgical treatment of pediatric moyamoya disease.
Chronological Changes on Magnetic Resonance Images in a Case of Desmoplastic Infantile Ganglioglioma
Authors: Tseng Jen-Ho , Tseng Ming-Yuan , Kuo Meng-Fai , Tseng Chao-Lin , Chang Yih-Leong
Published: April 2003

Desmoplastic infantile gangliogliomas (DIGs) are rare tumors during infancy. They often occur as huge cystic tumors in the frontal and parietal lobes, with their solid component being adjacent to the leptomeningeal membrane. This report presents a patient with DIG and intractable epilepsy. Due to hesitation by the patient’s family in allowing surgery, this is the first time that the chronological changes in DIG have been observed on imaging studies. During the follow-up, the tumor changed from a pure solid tumor to a cystic one, which is a typical picture of DIG. Surgical pathology confirmed the diagnosis of DIG. However, for a patient with epilepsy, it is recommended that this condition should be treated immediately with surgery.
Pediatric Craniopharyngiomas: Clinicomorphological Study of 189 Cases
Authors: Zhang Yu-Qi , Wang Chung-Cheng , Ma Zhen-Yu
Published: April 2003

Objective: To understand the pathological changes in pediatric craniopharyngiomas in order to determine the diagnosis and operative strategy and to prevent damage to the hypothalamus. Methods: A total of 189 cases of pediatric craniopharyngiomas from 1990 to 1998 were reviewed and analyzed based on computerized tomography scans, magnetic resonance imaging and operations. Results: Of the 189 cases, 187 (98.9%) were cystic tumors and calcification could be seen in 176 cases (93.1%). Two cases were solid tumors (1.1%), and calcification occurred in only 1 of these. There was a gliosis layer between the wall of the tumor and the hypothalamus. Conclusion: Cystic changes and calcification are the pathological features of pediatric craniopharyngiomas. There are some special relationships between the tumors and stalk. This is the basis for the total removal of pediatric craniopharyngiomas.
Rotating Gamma System Radiosurgery for Cerebral Arteriovenous Malformations
Authors: Zhou Dongxue , Liu Zonghui , Yu Xin , Qi Shubin , Du Jixiang
Published: April 2003

One hundred and thirty-two patients with cerebral arteriovenous malformations (AVMs) were treated using the Rotating Gamma System, a new radiosurgical system between November 1996 and May 2000. The average size of the AVMs was 23 mm in diameter (range 6 to 69 mm). The mean dose delivered to the AVM margin was 19.2 Gy (range 13 to 25 Gy), and that delivered to the center of the AVMs was 37.6 Gy (range 32.5 to 50 Gy). One hundred and six patients were followed up for an average of 18.4 months (range 5 to 44 months). Five patients (4.7%) experienced rebleeding which took place between 5 and 13 months after treatment, but none of them died from hemorrhage. No bleeding took place after complete angiographic obliteration. Neuroimaging studies showed radiation-induced edema in 19 (22%) of the 87 patients, none of whom had severe permanent neurological deficits. Of the 68 patients followed up for more than one year, 57 underwent angiography at 1 year after treatment. The complete obliteration was demonstrated in 24 patients (42%) at 1 year. Of the 27 patients followed for more than 2 years, 23 patients underwent angiography 2 years after treatment, and complete obliteration was demonstrated in 18 patients (78%). These results are comparable to the results of treatment with other radiosurgical systems.
Gamma Knife Radiosurgery as a Primary Surgical Treatment for Hypersecreting Pituitary Adenomas
Authors: Zhang Nan , Pan Li , Dai Jiazhong , Wang Binjiang , Wang Enmin , Zhang Weijun , Cai Peiwu
Published: April 2003

Object: To estimate the efficacy of Gamma Knife radiosurgery (GKR) especially as a primary surgical treatment for hypersecreting pituitary adenomas. Methods: 274 patients were treated with GKR. The mean tumor volume was 1.86 cm3. The mean peripheral dose was 28.7 Gy. Results: 223 patients were followed up for an average of 31.6 months. The dose related to the tumor growth control and endocrinological normalization was detailed and statistical analysis of the data was performed. Conclusion: GKR as a primary surgical treatment for hypersecreting pituitary adenomas may be safe and effective.
Continuous Intrathecal Clonidine Administration for the Treatment of Neuropathic Pain
Authors: Uhle E.-I. , Becker R. , Gatscher S. , Bertalanffy H.
Published: April 2003

In many cases, the treatment of neuropathic pain by intrathecal opioids fails to meet expectations. In a trial involving 10 patients, the intrathecal administration of clonidine combined with opioids in the treatment of chronic pain was introduced in our department for the first time. Eight patients with neuropathic pain syndromes were subjected to a continuous intrathecal clonidine application in addition to intrathecal morphine. At an average dose of 44 µg clonidine/day, a 70–100% reduction in pain was achieved. Residual non-neuropathic pain in 4 of 8 patients was successfully treated with clonidine and low doses of opioids. On the basis of the results achieved so far, we recommend that clonidine should be routinely tested for intrathecal drug administration, especially in patients with a prominent neuropathic pain component.
Factors Influencing the Application Accuracy of Neuronavigation Systems
Authors: Steinmeier Ralf , Rachinger Jens , Kaus Michael , Ganslandt Oliver , Huk Walter , Fahlbusch Rudolf
Published: April 2003

Objective: The overall accuracy of neuronavigation systems may be influenced by (1) the technical accuracy, (2) the registration process, (3) voxel size and/or distortion of image data and (4) intraoperative events. The aim of this study was to test the influence of the registration and imaging modality on the accuracy. Methods: A plexiglas phantom with 32 rods was taken for navigation targeting. Sixteen fiducials were attached to the surface of the phantom forming two different attachment patterns (clustered vs. diffusely scattered). This model was scanned by MRI and CT (1-mm slices). Registration was performed using different numbers and attachment patterns of the fiducials. Using CT or MRI, the localization error was measured in image space as the Euclidean distance between targets defined in image space and those detected in the physical space. Accuracy was measured with two commercial systems, the Zeiss MKM and the StealthStation. Results: The mean localization error varied between 1.59 ± 0.29 mm (MKM, 8 scattered fiducials, CT scanning) and 3.86 ± 2.19 mm (MKM, 4 clustered fiducials, MRI). The worst localization error was 9.5 mm (MKM). In case of an optimal registration, the 95th percentile for the localization error was 2.2 (MKM) and 2.75 mm (StealthStation). The imaging modality has only minor influence on the localization error, with CT increasing accuracy minimally. Both the fiducial number and the attachment pattern critically influence the localization error: 8 fiducials and a generalized attachment pattern increase the accuracy significantly. No correlation between the calculated registration accuracy and the measured localization accuracy was found. Conclusion: The application accuracy of different neuronavigation systems critically depends on the registration. The calculated registration accuracy provided by the system does not correspond to the localization error found in reality. The accuracy of frameless neuronavigation systems is comparable to that of classical frame-based stereotactic devices.
Prostate-Specific Antigen Levels and Prognosis in Patients with Hormone-Refractory Prostate Cancer Treated with Low-Dose Dexamethasone
Authors: Morioka Masaaki , Kobayashi Tatsuya , Furukawa Yoji , Jo Yoshimasa , Shinkai Masanori , Matsuki Takakazu , Yamamoto Tokunori , Tanaka Hiroyoshi
Published: April 2003

Objective: The efficacy of low-dose dexamethasone (DXM) therapy in patients with hormone-refractory prostate cancer (HRPC) was evaluated. Patients and Methods: Prostate-specific antigen (PSA) response and survival following DXM therapy were analyzed in 27 Japanese patients exhibiting HRPC. Concurrent therapies and antiandrogen withdrawal syndrome, which may affect PSA levels and palliative effects, were excluded from the study. A dose of 1.5 mg of DXM was administered, and androgen deprivation therapy was maintained during DXM therapy. A decline in PSA levels of at least 50% from baseline was considered a significant PSA response. Prognostic factors for PSA response and survival were examined by univariate and multivariate analyses. Results: A significant PSA response was observed in 16 of the 27 cases (59.3%). Median survival period of patients exhibiting significant PSA response was 15.9 months and was significantly longer than that of patients demonstrating a decline in PSA of less than 50% (median 7.7 months, p < 0.0001). Effect on pain control also correlated with the significant PSA response. No meaningful prognostic factors for PSA response were detected; however, a PSA decline of greater than 50% was the prognostic factor for survival. Conclusion: DXM therapy remains one of the most beneficial treatment modalities in patients with HRPC.
Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm
Authors: Koyanagi Tomohiko , Nonomura Katsuya , Takeuchi Ichiro , Watarai Yoshihiko , Seki Toshimori , Kakizaki Hidehiro
Published: April 2003

Objective: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). Patients and Methods: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9–69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced 99mTc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. Results: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. Conclusions: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.
Complications of Stamey Needle Suspension for Female Stress Urinary Incontinence
Authors: Takahashi Satoshi , Miyao Noriomi , Hisataki Toshihiro , Matsukawa Masanori , Takagi Seiji , Sasao Takumi , Adachi Hideki , Miyake Masafumi , Tsukamoto Taiji
Published: April 2003

Introduction: The Stamey bladder neck suspension for stress urinary incontinence in females is thought to be an excellent procedure. However, recent studies revealed that complications of this procedure have not been negligible. In this retrospective study, complications of the Stamey needle bladder neck suspension were examined. Materials and Methods: The Stamey procedure was performed either alone or in combination with anterior colporrhaphy for 86 female patients with stress urinary incontinence between 1989 and 1999. The mean follow-up period was 37.6 months and the mean age was 59.1 years. We studied the complications postoperatively pointed out by patients’ complaint and image examination. Results: The overall incidence of complications was 37.2%. Voiding difficulties and lower abdominal pain were present in 15 cases, respectively. We experienced 2 unusual cases in whom suspensory stitches had to be removed due to abdominal pain. Conclusions: Although the Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence, surgeons should beware of possible complications and be alert of the symptoms, such as abdominal pain and bladder irritation.