bluuebunny/crossref_metadata_2025 huggingface dataset:
Searching for searchers
Authors: Mallows Colin L. , Meloche Jean
Published: September 2006

We describe a search problem that has arisen in the context of network monitoring. Abstractly, a known (very large) region may contain one or more ‘agents’. Starting with just one agent, we search until another agent is found; this new agent can assist in the remaining search, and so on recursively.
Cadherin is required for dendritic morphogenesis and synaptic terminal organization of retinal horizontal cells
Authors: Tanabe Koji , Takahashi Yoshiko , Sato Yuki , Kawakami Koichi , Takeichi Masatoshi , Nakagawa Shinichi
Published: September 2006

Dendrite morphology of neurons provides a structural basis for their physiological characteristics, and is precisely regulated in a cell type-dependent manner. Using a unique transposon-mediated gene transfer system that enables conditional and cell-type specific expression of exogenous genes,we investigated the role of cadherin on dendritic morphogenesis of horizontal cells in the developing chicken retina. We first visualized single horizontal cells by overexpressing membrane-targeted EGFP, and confirmed that there were three subtypes of horizontal cells, the dendritic terminals of which projected to distinct synaptic sites in the outer plexiform layer. Expression of a dominant-negative cadherin decreased the dendritic field size, and perturbed the termination of dendritic processes onto the photoreceptor cells. The cadherin blockade also impaired the accumulation of GluR4, a postsynaptic marker, at the cone pedicles. We thus provide in vivo evidence that cadherin is required for dendrite morphogenesis of horizontal cells and subsequent synapse formation with photoreceptor cells in the vertebrate retina.
Cardioblast-intrinsic Tinman activity controls proper diversification and differentiation of myocardial cells inDrosophila
Authors: Zaffran Stéphane , Reim Ingolf , Qian Li , Lo Patrick C. , Bodmer Rolf , Frasch Manfred
Published: September 2006

The NK homeobox gene tinman (tin) is required for the specification of the cardiac, visceral muscle and somatic muscle progenitors in the early dorsal mesoderm of Drosophila. Like its vertebrate counterpart Nkx2.5, the expression of tin is maintained in cardiac cells during cardiac maturation and differentiation; however, owing to the complete lack of a dorsal vessel in tin mutant embryos, the function of tin in these cells has not been defined. Here we show that myocardial cells and dorsal vessels can form even though they lack Tin,and that viable adults can develop, as long as Tin is provided in the embryonic precardiac mesoderm. However, embryos in which tinexpression is specifically missing from cardial cells show severe disruptions in the normal diversification of the myocardial cells, and adults exhibit severe defects in cardiac remodeling and function. Our study reveals that the normal expression and activity of Tin in four of the six bilateral cardioblasts within each hemisegment of the heart allows these cells to adopt a cell fate as `working' myocardium, as opposed to a fate as inflow tract(ostial) cells. This function of tin involves the repression of Dorsocross (Doc) T-box genes and, hence, the restriction of Doc to the Tin-negative cells that will form ostia. We conclude that tin has a crucial role within myocardial cells that is required for the proper diversification, differentiation, and post-embryonic maturation of cardiomyocytes, and we present a pathway involving regulatory interactions among seven-up, midline, tinman and Dorsocross that establishes these developmental events upon myocardial cell specification.
Interval breast cancers: prognostic features and survival by subtype and time since screening
Authors: Porter Gareth J R , Evans A J , Burrell H C , Lee A H S , Ellis I O , Chakrabarti J
Published: September 2006

Objectives: To investigate the hypothesis that interval cancers arising soon after the previous screen and true interval cancers are biologically aggressive and have a relatively poor prognosis compared with other interval cancers, and to assess which prognostic features are relevant to interval cancers.

Methods: Analysis of prognostic pathological features (grade, lymph node stage, size, vascular invasion, oestrogen receptor [ER] status and histological type), radiological features (comedo/non-comedo calcification and spiculation) and survival for 538 invasive interval breast cancer cases by type and time since previous screen.

Results: Late interval cancers were less likely to be lymph node positive (13 versus 43%, P = 0.003). Type 1 interval cancers were more likely to be histological grade 3 than type 2 (minimal signs) and type 3 (false-negative) intervals (52 versus 35%, P = 0.05). Type 3 interval cancers were more likely to have lobular features than other intervals (47 versus 20%, P < 0.0001). There was no significant survival difference by interval cancer type ( P = 0.64) or interval year ( P = 0.83). At univariate analysis of all interval cancers, tumour size, grade, nodal stage, ER status, vascular invasion and comedo calcification were associated with survival. On multivariate analysis of prognostic features significant at univariate analysis, nodal stage ( P value = 0.009), tumour size ( P = 0.001), ER status ( P < 0.0001) and vascular invasion ( P < 0.0001) maintained independent significance.

Conclusions: Our study shows that true intervals and interval cancers arising quickly after screening do not have a worse prognosis than other interval cancers, and that interval cancers have a unique set of prognostic features.
Women's information needs about ductal carcinoma in situ before mammographic screening and after diagnosis: a qualitative study
Authors: Prinjha Suman , Evans Julie , McPherson Ann
Published: September 2006

Objectives: To explore the attitudes of women with screen-detected ductal carcinoma in situ (DCIS) towards information provision for mammographic screening.

Setting: Respondents recruited throughout the UK during 2003–2004.

Methods: Qualitative study using semi-structured interviews.

Participants: Ten women diagnosed with DCIS as a result of mammographic screening.

Results: None of the women with DCIS had heard of it before their diagnosis. Most would have liked more information about DCIS when invited for routine screening. Comprehensive information about the benefits and risks of mammographic screening, including the possibility of a DCIS diagnosis, would have enabled them to make a fully informed choice about attending for screening.

Conclusion: DCIS is an inescapable outcome of mammographic screening and, until it is better understood, the screening industry needs to inform women about its existence and the lack of understanding of its natural history and management. Being alerted before screening to the possibility of a DCIS diagnosis and the uncertainty associated with it would better enable women to make fully informed decisions about whether to attend and could help to alleviate some of the distress women currently feel when diagnosed with DCIS.
Red blood cell disorders in Rwandese neonates: screening for sickle cell disease and glucose-6-phosphate dehydrogenase deficiency
Authors: Munyanganizi Rosine , Cotton Frédéric , Vertongen Fanchon , Gulbis Béatrice
Published: September 2006

Objectives: To determine the prevalence of haemoglobin (Hb) variants and glucose-6-phosphate dehydrogenase (G6PD) deficiency in Rwanda.

Methods: During a two-month period in 2005, 987 cord blood samples were obtained in two hospitals in Kigali and Butare, Rwanda. Screening for sickle cell disorders, other Hb disorders, G6PD deficiency and other rare erythroenzymopathy deficiencies was done using isoelectric focusing techniques and quantitative kinetic assays, respectively.

Results: The prevalence of Hb S trait was 2.7% and that of G6PD deficiency was 3.8%. No neonate suffered from a sickle cell disease (homozygous for Hb S or compound heterozygous for Hb S), from another clinically significant haemoglobinopathy, or from pyruvate kinase or glucose phosphate isomerase deficiency.

Conclusions: Sickle cell disorders should be considered a public health problem in Kigali and Butare. A systematic neonatal screening programme for those disorders, and to diagnose G6PD deficiency, seems reasonable, but local health priorities must be considered. Adapted management of hereditary sickle cell and G6PD disorders should be available.
Self-reported prostate cancer screening in Austria
Authors: Vutuc Christian , Waldhoer Thomas , Sevelda Paul , Micksche Michael , Haidinger Gerald
Published: September 2006

Objectives: The prevalence of self-reported participation and frequency of prostate cancer screening (digital rectal examination (DRE), prostate-specific antigen (PSA)) in Austrian men aged 40–79 years in the year 2005 is reported.

Methods: In a population-based cross-sectional study, a representative sample of 500 men was asked whether they ever had heard of early detection of prostate cancer by DRE or PSA test and, if so, whether they had ever had a prostate cancer screening test during their life, and if so the number of tests and the type of physician.

Results: Overall, the prevalence of self-reported prostate cancer screening was 55.8% (23.7% DRE only). The highest prevalence was observed in the age group of 60–69 years with 68.8% (28.1% DRE only). The highest prevalence of PSA tests was observed in the age group 70–79 years (40.9%). About 75% of the screening tests were performed by urologists.

Conclusions: More than half of the target population (men aged 40–79 years) have had at least one prostate cancer screening test. Nearly one-third of men have already had one or more PSA tests. One-fifth of the PSA tests were requested by general practitioners or internists.
vertical linear acceleration (otolithic‐ocular responses).
Authors: Kohut Robert I.
Published: September 2006

A 60‐foot vertical linear acceleration device was used to present linear acceleration forces to test animals within a light sealed capsule. Two types of stimuli were used: !1. constant direction of force with rectilinear alterations of the acceleration rate (0 G and 2 G); and 2. constant direction with curvilinear alterations of the acceleration rates (0 to 2 G). Multiple cycles of alternating G forces were presented during a test run.

Cats were used as the experimental animal. Eye movement recordings (vertical and horizontal) were made electronystagmographically. All linear acceleration tests were done in darkness. Analysis of data was done by evaluation of the direct recordings and by algebraic summation of consecutive acceleration cycles.

The responses of normal and labyrinth altered cats were similar. Conjugate eye deviation was the most prominent response. Nystagmus rarely occurred. The direction of the conjugate deviation in unilaterally labyrinthectomized – contralaterally semicircular canal plugged preparations (unilateral otolithic animals), was of greatest magnitude when the acceleration force was parallel to the utricular plane from a medial to lateral direction. Reversal of position by 180d̀ generally caused reversal of the direction of conjugate eye deviation.

The maximum eye deviation and/or production or alteration of nystagmus was related to the magnitude of jerk or, in other words, the rate of change of acceleration and not to the magnitude of acceleration (rate of change of velocity). The rate of change of acceleration at which these changes occurred was near 1.66G/sec (53 ft/sec3). Correlation with predicted planes from mathematical models is cited.

The lack of nystagmus production in this study was contrasted to previous reports of nystagmus production by linear acceleration. It was suggested that nystagmus production by otolithic stimulation may be regularly present when the values of linear acceleration are closer to physiologic levels and/or when the otolithic surface is serially stimulated as when the axis of the resultant force changes direction.

The variations in reproducibility of response patterns suggested a limited response range to linear acceleration of the (otolithic) vestibular‐ocular reflex.
Aerobic metabolism of the inner ear: Results of a critical evaluation.
Authors: Spector Gershon J. , Lucente Frank E.
Published: September 2006

Anatomic, pathologic, electrophysiologic and biochemical studies have indicated the dependence of the cochlear hair cell on aerobic metabolism; however, the precise mechanism for proper oxygenation is not well understood.
Remarks on the 50th anniversary of the american board of otolaryngology
Authors: Mccabe Brian F.
Published: September 2006

This year marks the 50th year of the existence of the American Board of Otolaryngology. It was the second certifying Board in American medicine, founded and incorporated in 1924 by 10 representatives from 5 of our largest specialty societies. The objectives of the Board were delineated. These were, and still are, to establish standards of qualification for otolaryngologists who desire and request Board certification; to determine which candidates fulfill these standards of qualification; to examine such candidates and issue certificates upon satisfactory completion of the requirements, and finally to encourage development and maintenance of the highest standards in the teaching and training of otolaryngologists.
Principles of treatment of different types of parotid tumors.
Authors: Eneroth C.‐M. , Hamberger C.‐A.
Published: September 2006

The prerequisite for an adequate treatment of a parotid tumor is a correct diagnosis — a diagnosis based on well delimited histological types of tumor. A classification with a clear delimitation between benign and malignant types of tumor is presented. The prognosis, relation to the facial nerve and the radiosensitivity of the different types of tumor in this classification have been studied in a series of about 2,000 parotid tumors. The extent of the surgical intervention — subtotal or total parotidectomy, radical neck dissection, sacrificing of the facial nerve — and the decision to perform preoperative irradiation are determined by the type of tumor; therefore, a correct diagnosis of the tumor before treatment is important as the primary diagnostic method aspiration biopsy has been routinely employed during the last decade.
Basal cell adenoma of the salivary glands.
Authors: Thawley Stanley E. , Ward Samuel P. , Ogura Joseph H.
Published: September 2006

Basal cell adenoma is an unusual type of salivary gland tumor which has only recently been classified as a separate entity. Four cases are presented. Three were discovered by reviewing a series of adenoid cystic carcinomas and mixed tumors, and one was diagnosed originally. Three cases involved the parotid; one, the submaxillary gland. There was no facial nerve involvement in any case. Treatment was local excision. Follow‐up from two to nine years revealed no recurrence. The lesions typically are slow growing, firm, non‐tender, asymptomatic masses present for several years before treatment. The average age of the patients is generally older than those with mixed tumors. They are most often found in the parotid gland, but have been reported from the submaxillary and minor salivary glands of the upper lip, cheek, and palate. Microscopically the tumor consists of monomorphic basaloid cells with an absence of myoepithelial cells. Myoepithelial cells play an important role in salivary gland tumors. Their range of activity and products determine to a certain degree the morphology of adenoid‐cystic and mixed tumors. They resemble muscle cells as demonstrated by electron microscopy studies and also by functioning as contractile elements. The cell of origin is unknown. The tumors may closely resemble adenoid cystic carcinoma and mixed tumors; therefore, diagnostic and therapeutic questions may arise. The tumors are benign. No malignancy has been reported. The lesions can be unencapsulated; therefore, the best treatment is adequate local excision rather than enucleation, tumor may contribute more knowledge concerning the histogenesis of certain salivary gland tumors.

With increased awareness and acceptance of this lesion as a separate entity by pathologists, we perhaps can expect an increase in its diagnosis.

As otolaryngologists we should have a thorough knowledge of its clinicopathology in terms of clinical presentation, pathology, treatment, and prognosis.
Direct visualization of living organ of corti and studies of its extracellular fluids.
Authors: Lawrence Merle
Published: September 2006

Occlusion of all or parts of any of the three separate capillary systems supplying the organ of Corti and its related tissues could result in different audiometric symptoms; however, little is known about the functional relationship between these capillaries and the tissues, so a series of experiments has been carried out to provide some data.

Sometime ago we reported an experiment that demonstrated a different role for the capillaries of the stria vascularis than for those underlying the osseous spiral lamina and basilar membrane. These latter capillaries care for the immediate demands of the organ of Corti.

Probably the greatest handicap to more complete research has been the inability to observe the cells, spaces, and capillaries of the organ of Corti in the living state. This paper describes an approach to the inner ear of the guinea pig that provides a view of the sensory area without injuring essential capillaries.

By means of a surgical approach to the round window a bit of bony promontory is removed to expose the basilar membrane. Removal of the stapes allows light from a cool fiber optics source to reflect from the walls of the vestibule to reveal the cells and spaces of the organ of Corti. Under this direct visualization, electrodes to monitor dc resting potentials or to measure oxygen concentrations are placed in the extracellular spaces. A motion picture shows the technique.

Experiments that determined the boundaries of the organ of Corti fluids and capillaries that provide oxygen to these spaces and subsequently to the sensory cells are reviewed. The tectorial membrane seals the fluids of the organ of Corti spaces including the inner sulcus from endolymph, and the spiral vessels provide oxygen to these fluids.

Occlusion of the spiral capillaries causes a relatively rapid degeneration of the organ of Corti in that region, whereas occlusion to capillaries of the spiral ligament and its structures may produce altered function of the organ of Corti and perhaps its degeneration over a longer period of time.
Occupational hearing loss — an otologist's view of a long‐term study.
Authors: Alberti P. W. , Morgan P. P. , Leblanc J. C.
Published: September 2006

Seven hundred nineteen consecutive patients referred by The Workmen's Compensation Board for adjudication of hearing loss of presumed occupational etiology, have had an otological and audiological evaluation. Significant ear disease was found in 7 percent of ears, and in >3 percent it was considered the major cause of hearing loss.

Routinely evoked response audiometry was undertaken in a consecutive sub‐series of 258 patients and the results compared with conventional tests. Approximately one in five showed an exaggerated hearing loss, which was well predicted by the audiologist on the basis of the patient's attitude during conventional tests.

It is argued that compensation awards based upon pure‐tone averages ignore a major aspect of the patient's handicap — the loss of ability to discriminate sound in background noise. Comparison between speech discrimination results and pure‐tone threshold responses showed a statistically significant inverse relationship with the low frequency response and a positive relationship with high frequency response, which is contrary to the present method of evaluating handicap awards. It is suggested that 500 Hz should be eliminated from the frequencies used in handicap evaluation of sensori‐neural hearing loss and/or that at least one extra higher frequency (3,000 or 4,000 Hz) be included.
Are Multiaxial Fatigue Criteria Appropriate When Steels with Surface Defects are Subjected to Rolling Contact Fatigue
Authors: Desimone H , Bernasconi A , Beretta S
Published: September 2006

The fatigue strength assessment of parts subjected to rolling and sliding contacts is a multiaxial fatigue problem because of the cyclic variation of the six components of the stress tensor, which generate non proportional stress paths. In real steels, the difficulty of the problem is increased by the presence of defects, which has to be considered in order to achieve an accurate assessment of their multiaxial fatigue strength. In this context, this paper analyzes the behavior and accuracy of some multiaxial fatigue criteria when dealing with a quenched and tempered steel with and without defects. Several fatigue tests on smooth and micronotched specimens were carried out, for different stress ratio conditions. The results are confronted with the most popular multiaxial fatigue criteria of the critical plane class (e.g., Dang Van, Findley) and implementing an integral approach (e.g., Liu-Zenner). Even if some of these criteria fit the results when smooth specimens are considered, noticeable contradictions arise when they are applied to steels containing defects. From this point of view, it seems that new criteria should be considered for rolling contact fatigue in presence of defects.
Decrement of postprandial insulin secretion determines the progressive nature of type-2 diabetes
Authors: Shim Wan Sub , Kim Soo Kyung , Kim Hae Jin , Kang Eun Seok , Ahn Chul Woo , Lim Sung Kil , Lee Hyun Chul , Cha Bong Soo
Published: September 2006

Objective: Type-2 diabetes is a progressive disease. However, little is known about whether decreased fasting or postprandial pancreatic β-cell responsiveness is more prominent with increased duration of diabetes. The aim of this study was to evaluate the relationship between insulin secretion both during fasting and 2 h postprandial, and the duration of diabetes in type-2 diabetic patients.

Design: Cross-sectional clinical investigation.

Methods: We conducted a meal tolerance test in 1466 type-2 diabetic patients and calculated fasting (M0) and postprandial (M1) β-cell responsiveness.

Results: The fasting C-peptide, postprandial C-peptide, M0, and M1 values were lower, but HbA1c values were higher, in patients with diabetes duration > 10 years than those in other groups. There was no difference in the HbA1c levels according to the tertiles of their fasting C-peptide level. However, in a group of patients with highest postprandial C-peptide tertile, the HbA1c values were significantly lower than those in other groups. After adjustment of age, sex, and body mass index (BMI), the duration of diabetes was found to be negatively correlated with fasting C-peptide (γ = −0.102), postprandial C-peptide (γ = −0.356), M0 (γ = −0.263), and M1 (γ = −0.315; P < 0.01 respectively). After adjustment of age, sex, and BMI, HbA1c was found to be negatively correlated with postprandial C-peptide (γ = −0.264), M0 (γ = −0.379), and M1 (γ = −0.522), however, positively correlated with fasting C-peptide (γ = 0.105; P < 0.01 respectively). In stepwise multiple regression analysis, M0, M1, and homeostasis model assessment for insulin resistance (HOMA-IR) emerged as predictors of HbAlc after adjustment for age, sex, and BMI (R2 = 0.272, 0.080, and 0.056 respectively).

Conclusions: With increasing duration of diabetes, the decrease of postprandial insulin secretion is becoming more prominent, and postprandial β-cell responsiveness may be a more important determinant for glycemic control than fasting β-cell responsiveness.
Identification of factors differentially associated with isolated impaired fasting glucose and isolated post-load impaired glucose tolerance: the Hong Kong Cardiovascular Risk Factor Study
Authors: Thomas G Neil , Schooling C Mary , McGhee Sarah M , Ho Sai-Yin , Cheung Bernard M Y , Wat Nelson M , Janus Edward D , Lam Tai Hing , _ _
Published: September 2006

Background: The use of fasting and post-prandial glucose levels in the classification of hyperglycaemic states often identifies distinct subjects, but the factors determining these intermediate-isolated glucose intolerant states are yet to be clearly elucidated in Chinese subjects.

Methods: Representative subjects (n = 2769) were randomly recruited from the Hong Kong Chinese population and glycaemic status was determined using both fasting and 2h 75 g oral glucose tolerance test glucose levels. The relationship between the groups with isolated glucose intolerance and vascular risk factors was investigated using ANOVA and logistic regression analyses.

Results: Using either criterion, diabetes was identified in 265 (9.6%) subjects and glucose intolerance in 568 (20.5%) subjects. Of those 568, isolated impaired glucose tolerance (IGT) using the post-load criterion was identified in 49.5% and isolated impaired fasting glucose (IFG) in 30.5%. Ageing and hyperinsulinaemia were common determinants of IGT and IFG; with small hip circumference a marker of poorer early life development and being born in China rather than Hong Kong, a possible low birth weight marker was also associated with IFG. Hypertension, hypertriglyceridaemia and poor education were also associated with IGT. When we looked for factors differentially associated with these glucose intolerant states, female sex, greater hip circumference, high triglyceride levels, low fasting insulin levels, and not being born in China were independently associated with isolated IGT compared with isolated IFG.

Conclusion: Despite common antecedents to the glucose intolerant states, isolated IFG appeared to be particularly associated with early life development, and isolated IGT was more strongly associated with obesity-related determinants such as hypertriglyceridaemia.
The association between hypoechogenicity or irregular echo pattern at thyroid ultrasonography and thyroid function in the general population
Authors: Vejbjerg Pernille , Knudsen Nils , Perrild Hans , Laurberg Peter , Pedersen Inge Bülow , Rasmussen Lone B , Ovesen Lars , Jørgensen Torben
Published: September 2006

Objective: Patients with overt hypothyroidism show decreased echogenicity of the thyroid at ultrasonography (US). The aim of this study was to investigate the association between echogenicity of the thyroid/irregular echo pattern, and thyroid function in the general population, i.e. subjects without overt thyroid disease.

Design: A cross-sectional investigation of 4649 randomly selected adult subjects.

Methods: Blood samples were analysed for serum TSH, thyroid hormones and thyroid autoantibodies. US of the thyroid was performed.

Results: Participants with decreased echogenicity (n=379) had a higher mean TSH (1.65 mU/l) compared with subjects with normal echogenicity (1.21 mU/l, P<0.0001). The association was stronger in subjects with markedly decreased echogenicity (4.20 mU/l, P<0.0001). A similar association was seen when the subjects were divided into subgroups according to the level of TSH; more subjects with high levels of TSH had decreased echogenicity (P<0.0001). Likewise, more subjects with high levels of TSH had an irregular echo pattern (P<0.0001). Subjects with decreased echogenicity had a higher risk of having thyroid autoantibodies than subjects without decreased echogenicity (P<0.0001). This association was stronger when echogenicity was markedly decreased.

Conclusions: We demonstrated an association between hypoechogenicity at thyroid US and higher levels of serum TSH even in subjects without overt thyroid disease, suggesting decreased echogenicity as an early sign of thyroid dysfunction. Irregular echo pattern, whether accompanied by hypoechogenicity or not, was another possible marker of thyroid failure. This indicates a possible use of thyroid US in detecting early and subclinical thyroid dysfunction.
A perspective view of sodium iodide symporter research and its clinical implications
Authors: Riesco-Eizaguirre Garcilaso , Santisteban Pilar
Published: September 2006

The sodium iodide symporter (NIS) is an intrinsic plasma membrane protein that mediates active iodide transport into the thyroid gland and into several extrathyroidal tissues, in particular the lactating mammary gland. Cloning and molecular characterization of the NIS have allowed the investigation of its key role in thyroid physiology as well as its potential pathophysiological and therapeutic implications in benign and malignant thyroid diseases. Similarly, elucidating the mechanisms underlying the regulation of NIS in lactating mammary gland and breast cancer, in which more than 80% of cases express endogenous NIS, may lead to findings that have novel implications for pathophysiology and therapy. Two approaches may, in the future, pave the way to extend the use of radioiodide treatment to nonthyroidal cancer. One is based on the reinduction of endogenous NIS expression in thyroid and breast cancer by targeting the main mechanisms involving tumoral transformation and dedifferentiation. The other is based on the application of NIS as a novel cytoreductive gene therapy strategy. NIS offers the unique advantage that it can be used both as a reporter and as a therapeutic gene, so that it is possible to image, monitor, and treat the tumor with radioiodide, just as in differentiated thyroid cancer. This review summarizes the main recent findings in NIS research that have a direct impact on diagnosis and therapeutic management.
Birth weight and risk of type 2 diabetes, abdominal obesity and hypertension among Chinese adults
Authors: Tian Jing-Yan , Cheng Qi , Song Xiao-Min , Li Guo , Jiang Guo-Xin , Gu Yan-Yun , Luo Min
Published: September 2006

Objective: To investigate the association between birth weight and risk of type 2 diabetes, abdominal obesity and hypertension among Chinese adults.

Research methods and procedures: Nine hundred and seventy-three individuals from a population-based cross-sectional survey for the prevalence of type 2 diabetes conducted in Shanghai in 2002 were enrolled and followed up to 2004 with yearly examination. Birth weight was classified into four categories: <2500, 2500–2999, 3000–3499 and ≥3500 g.

Results: In this study, there were 373 males and 600 females, with a mean age of 46.2±9.9 years. Fasting plasma glucose was higher in subjects with the lowest birth weight (<2500 g) compared with those with the highest birth weight. Waist circumference and systolic blood pressure showed U-shaped relationships with birth weight. Birth weight was found to be an independent risk factor for type 2 diabetes, abdominal obesity and hypertension. For type 2 diabetes, the crude odds ratio (95% confidence interval) was 3.17 (1.48–6.78) in the lowest birth weight category when compared with that in the highest birth weight category (≥3500 g) and the ratio increased to 3.97 (1.71–9.22) after adjustment for related variables. The highest prevalence of type 2 diabetes (34.5%) was observed among those with the lowest birth weight and abdominal obesity.

Conclusions: Birth weight is inversely associated with the risk of type 2 diabetes. Subjects with the lowest or the highest birth weight were associated with a high risk of developing abdominal obesity and hypertension. Low birth weight coupled with abdominal obesity is a strong predictor of type 2 diabetes.
Endocrine dysfunction in patients operated on for non-pituitary intracranial tumors
Authors: Schneider H J , Rovere S , Corneli G , Croce C G , Gasco V , Rudà R , Grottoli S , Stalla G K , Soffietti R , Ghigo E , Aimaretti G
Published: September 2006

Objective: Hypopituitarism frequently follows pituitary neurosurgery (NS) and/or irradiation. However, the frequency of hypothalamic–pituitary dysfunction after NS of non-pituitary intracranial tumors is unclear. The aim of this study was to assess the presence of endocrine alterations in patients operated on for intracranial tumors.

Design: This is a retrospective study.

Methods: We studied 68 consecutive adult patients (28 female, 40 male, age 45.0 ± 1.8 years; body mass index (BMI): 26.5 ± 0.6) with intracranial tumors who underwent NS only (n = 17) or in combination with radiotherapy (RT) and/or chemotherapy (CT) (n = 51). In all subjects, basal endocrine parameters and the GH response to GHRH + arginine test (using BMI-dependent cut offs) were evaluated.

Results: In 20.6% of the patients, peripheral endocrinopathy related to CT and/or RT was present. Hypopituitarism was found in 38.2% of the patients. Total pituitary hormone, multiple pituitary hormone, and isolated pituitary hormone deficits were present in 16.2, 5.8, and 16.2% respectively. The most common pituitary deficits were, in decreasing order: LH/FSH 29.4%, GH 27.9%, ACTH 19.1%, TSH 17.7%, and diabetes insipidus 4.4%. Hyperprolactinemia was present in 13.2%. The prevalence of hypopituitarism was higher in patients who underwent NS only and with tumors located closely to the sella turcica, but a substantial proportion of patients with tumors not directly neighboring the sella also showed hypopituitarism.

Conclusions: Hypopituitarism frequently occurs after NS for intracranial tumors. Also, exposure of these patients to CT and/or RT is frequently associated with peripheral endocrinopathies. Thus, endocrine evaluation and follow-up of patients treated for intracranial tumors should be performed on a regular basis.
Prevalência ambulatorial em um hospital geral de marcadores para hepatites B e C em pacientes com infecção pelo vírus da imunodeficiência humana
Authors: Tovo Cristiane Valle , Santos Diogo Edele dos , Mattos Ângelo Zambam de , Almeida Paulo Roberto Lerias de , Mattos Angelo Alves de , Santos Breno Riegel
Published: September 2006

RACIONAL: Os vírus das hepatites B (VHB) e C (VHC) e da imunodeficiência humana (HIV) utilizam a mesma rota de transmissão, sendo a prevalência de VHB e VHC em pacientes infectados pelo HIV maior do que aquela encontrada na população em geral. OBJETIVO: Determinar a prevalência de marcadores para hepatites B e C em uma população de pacientes com HIV, bem como os fatores de risco envolvidos. PACIENTES E MÉTODOS: Dentre os 5 870 prontuários de pacientes com HIV em acompanhamento no Serviço de Infectologia do Hospital Nossa Senhora da Conceição, Porto Alegre, RS, foram aleatoriamente selecionados 587 prontuários. Destes, foram considerados para análise retrospectiva aqueles em que havia sido pesquisado algum marcador para hepatites B (HBsAg, anti-HBc ou anti-HBs) ou C (anti-VHC), perfazendo o total de 343 pacientes. RESULTADOS: O HBsAg foi positivo em 14 de 306 (4,6%) pacientes, anticorpo anti-HBs, em 40 de 154 (26,0%) pacientes, e anti-HBc em 79 de 205 (38,5%) pacientes. Dentre aqueles que realizaram anti-VHC, 126 de 330 (38,2%) tinham-no positivo. Co-infecção por vírus B e C foi observada em 7 dentre os 296 pacientes que realizaram tanto o HBsAg, quanto o anti-VHC (2,4%). Dentre aqueles HBsAg positivos, a principal categoria de exposição foi o relacionamento homossexual masculino (50,0%). Dentre aqueles anti-VHC positivos, a principal categoria de exposição foi o uso de drogas ilícitas injetáveis (75,3%). Naqueles monoinfectados com HIV (185 pacientes), o fator de risco mais prevalente foi relacionamento heterossexual promíscuo ou com cônjuge infectado por HIV em 83 pacientes (44,9%). CONCLUSÃO: Em nosso meio, as co-infecções VHB-HIV e VHC-HIV são freqüentes, sendo observado maior impacto na associação do VHC com o HIV.
Prevalência de infecção pelo vírus da hepatite C em pacientes com diabetes melito tipo 2
Authors: Parolin Mônica Beatriz , Réa Rosângela , Vargas Rosa Maria , Almeida Ana Cristina Ravazzani de , Baldanzi Giorgio Roberto , Lopes Reginaldo Werneck
Published: September 2006

RACIONAL: Estudos recentes têm sugerido possível associação entre infecção pelo vírus da hepatite C (VHC) e diabetes melito tipo 2, relatando prevalência elevada de infecção pelo vírus C nessa população. OBJETIVO: Verificar a prevalência de infecção pelo VHC em adultos portadores de diabetes melito em nosso meio. MÉTODOS: Foram avaliados consecutivamente 145 adultos com diabetes melito tipo 2 e 104 com diabetes melito tipo 1, em acompanhamento no ambulatório de diabetes de um hospital universitário, quanto à presença de anticorpos contra VHC (anti-VHC) por método ELISA de quarta geração, utilizando como grupo controle 16 720 doadores de sangue da cidade de Curitiba, PR, no período em que foi realizada a pesquisa. Os pacientes diabéticos foram também avaliados quanto a dados demográficos, clínicos, bioquímicos (níveis séricos de aminotransferases) e exposição prévia a fatores de risco para infecção pelo VHC. RESULTADOS: Maior prevalência de positividade do anti-VHC foi observada em pacientes com diabetes melito tipo 2, em comparação aos doadores de sangue. A prevalência de anti-VHC naqueles com diabete melito tipo 2 foi superior à encontrada no tipo 1, embora não tenha alcançado significância estatística. Nos dois grupos de diabéticos houve predomínio do sexo feminino, sendo que os do tipo 2 apresentavam idade média superior aos do tipo 1. A distribuição de cor, tempo de diagnóstico do diabetes e a freqüência de exposição a fatores de risco foram semelhantes nos dois grupos. A mediana da taxa de alanina aminotransferase dos pacientes com diabetes tipo 2 foi superior à observada nos do tipo 1. CONCLUSÕES: Encontrou-se maior prevalência de infecção pelo VHC em diabéticos tipo 2 se comparado à população saudável de Curitiba, corroborando publicações prévias em outras populações.
Prevalence of hepatitis C virus in alcoholic patients: role of parenteral risk factors
Authors: Galperim Bruno , Cheinquer Hugo , Stein Airton , Fonseca André , Lunge Vagner , Ikuta Nilo
Published: September 2006

BACKGROUND: The prevalence of hepatitis C virus (HCV) infection is elevated in alcoholic patients, but the risk factors are unclear. The role of parenteral risk factors are indeterminated in this population. AIMS: To determine the prevalence of hepatitis C virus infection in alcoholic patients admitted to a detoxification unit and to evaluate the presence of underlying parenteral risk factors. METHODS: A total of 114 consecutive unselected alcoholic patients admitted to a single chemical dependency unit during 14 month were included. Epidemiological data and history of parenteral risk factors for hepatitis C virus infection were obtained with a standardized questionnaire. Blood was collected for determination of aminotransferases and anti-hepatitis C virus antibodies (ELISA-3). Positive samples were confirmed by polymerase chain reaction and tested for genotype. RESULTS: Among the 114 alcoholics, 17 (15%) were anti-hepatitis C virus positive. Of these, 12 (71%) had detectable serum HCV-RNA by PCR. Genotype 1 was found in six cases and genotype 3 in five (one patient was undetermined). Forty-nine (43%) patients had elevated serum ALT and/or AST at baseline. The comparison between the 17 positive and the 97 negative patients showed significant differences in mean serum ALT levels (42 ± 41 IU/L vs. 22 ± 20 IU/L), rate of elevated ALT (65% vs. 34%), and presence of parenteral risk factors (94% vs. 10%). Comparison between alcoholic patients with and without elevated aminotransferases showed significant difference only in the rate of positive anti-hepatitis C virus antibodies (24% vs. 7%). Furthermore, among the 17 anti-hepatitis C virus positive patients, the rate of detectable HCV-RNA was significantly higher in the 12 with elevated aminotransferases versus the 5 with normal aminotransferases (92% vs. 20%). CONCLUSIONS: There was a high prevalence of anti-hepatitis C virus antibodies in alcoholics and the majority was confirmed by the presence of detectable HCV-RNA. Intravenous drug use was the main risk factor for hepatitis C virus infection in this population.
Relação entre idade e motilidade do esôfago em pacientes com doença do refluxo gastroesofágico
Authors: Dantas Roberto Oliveira , Aprile Lilian Rose Otoboni
Published: September 2006

RACIONAL: O comprometimento das contrações esofágicas pode agravar as lesões em esôfago conseqüentes ao refluxo gastroesofágico. A hipótese do presente estudo é de que alterações das contrações são limitadas ao esôfago distal e pioram com o processo de envelhecimento. OBJETIVO: Avaliar as contrações esofágicas em parte proximal e distal do esôfago em pacientes com sintomas de refluxo gastroesofágico, com e sem lesões no esôfago. CASUÍSTICA E MÉTODOS: Estudaram-se pelo método manométrico as contrações esofágicas a 2, 7, 12 e 17 cm do esfíncter superior do esôfago, após cinco deglutições de 5 mL de água, em 104 pacientes com pirose e regurgitação ácida, 42 com endoscopia do esôfago normal, 47 com esofagite moderada e 15 com esofagite grave. RESULTADOS: Nas medidas realizadas a 12 e 17 cm do esfíncter superior do esôfago, a amplitude e área sob a curva das contrações esofágicas foram menores nos pacientes com esofagite grave, quando comparadas com os pacientes sem esofagite ou com esofagite moderada. A 2 e 7 cm do esfíncter superior do esôfago não houve diferenças na amplitude e área sob a curva das contrações. Não houve diferenças entre os grupos, em todo o esôfago, em relação à duração das contrações, velocidade de propagação do peristaltismo e nas proporções de contrações falhas, simultâneas, não propagadas e peristálticas. Não houve diferenças entre os pacientes com mais de 50 anos e aqueles com menos de 50 anos. CONCLUSÕES: Esofagite grave esteve associada com diminuição da amplitude das contrações esofágicas, alteração limitada à parte distal do esôfago. Não foi observado efeito do envelhecimento nas contrações.
Eletromanometria esofágica e pHmetria de 24 horas na avaliação pós-operatória da hiatoplastia e válvula anti-refluxo total laparoscópica
Authors: Pastore Ricardo , Crema Eduardo , Silveira Mariana de Carvalho , Presoto Adriana Ferreira , Herbella Fernando Augusto Mardiros , Del Grande José Carlos
Published: September 2006

RACIONAL: A operação de "short floppy Nissen" tem como objetivo tratar o refluxo gastroesofágico. Avaliações clínicas e endoscópicas de sua eficiência têm sido demonstradas por diferentes autores, porém estudos comparando pHmetria ácida de 24 horas com exames realizados no pré e pós-operatório têm sido pouco freqüentes. OBJETIVOS: Avaliar os resultados da hiatoplastia e válvula anti-refluxo total laparoscópica no tratamento da doença do refluxo gastroesofágico não complicada através de estudo comparativo pré e pós-operatório de aspectos manométricos e pHmétricos. MÉTODOS: Cinqüenta e nove indivíduos com sintomas típicos de refluxo gastroesofágico submetidos a cirurgia de "short floppy Nissen" por laparoscopia foram estudados prospectiva e consecutivamente no período de março de 2002 a agosto de 2003. Realizou-se no período pré e pós-operatório, em um tempo mínimo de 3 meses, endoscopia digestiva alta, manometria esofágica e pHmetria ácida de 24 horas. RESULTADOS: Dezoito (30,5%) doentes eram do sexo masculino e 41 (69,5%) do feminino, com idade média de 43,8 anos. Houve diferença nos seguintes achados manométricos, quando comparados no período pré e pós-operatório: localização do esfíncter inferior do esôfago em relação à borda nasal; extensão do esfíncter inferior do esôfago; pressão de repouso do esfíncter inferior do esôfago; pressão do corpo esofágico. Houve diferença nos seguintes achados pHmétricos quando comparados no período pré e pós-operatório: redução do número de refluxo ácidos totais; número de refluxos ácidos prolongados; número de refluxos ácidos prolongados em decúbito dorsal; número de refluxos ácidos prolongados em posição ereta; fração de tempo de acidificação em minutos; índice de DeMeester. CONCLUSÕES: A eletromanometria e a pHmetria esofágicas mostraram melhora em cada um dos seus parâmetros com significância estatística entre os pacientes no período pré e pós-operatório de hiatoplastia e válvula anti-refluxo, demonstrando a eficiência do procedimento operatório quando avaliado por esses exames.
Estudo de válvulas artificiais no cólon esquerdo após amputação abdominoperineal parcial do reto mais colostomia perineal, em cães
Authors: Siqueira Sávio Lana , Lázaro-da-Silva Alcino , Reis Otávio Augusto Fonseca , Fantauzzi Rodrigo Santana , Silva Jr. Otávio de Melo , Sales Paulo Guilherme de Oliveira
Published: September 2006

RACIONAL: Ao longo do tempo, estudou-se a escolha da colostomia perineal como a forma de se evitar a colostomia abdominal após cirurgia de amputação abdominoperineal. A colostomia perineal associada a um mecanismo frenador das fezes vem sendo estudada há vários anos com resultados satisfatórios. OBJETIVO: Investigação, em cães, da valvuloplastia cólica aplicada à amputação abdominoperineal do reto mais colostomia perineal e a discussão dos resultados obtidos na avaliação clínica e histopatológica. MATERIAL E MÉTODOS: O modelo experimental desta pesquisa foi desenvolvido no cólon de cães. Foram operados 65 animais, dos quais 10 constituíram o grupo-piloto, 15 o grupo-controle e os 40 demais foram separados em três grupos. O grupo 1 para observação de 10 dias; o grupo 2 em pós-operatório de 20 dias; e o grupo 3 de 30 dias. Os cães foram submetidos a amputação abdominoperineal parcial do reto com colostomia perineal associada à seromiotomia circunferencial, extramucosa em cólon esquerdo (exceto nos dos grupos-controle). RESULTADOS: Através de acompanhamento e estudo post-mortem, foi possível verificar fezes sólidas a montante das válvulas, evidenciando-se o eficiente mecanismo frenador das mesmas. A análise histológica das válvulas mostrou neoproliferação conjuntiva com fibrose em toda a área seccionada da serosa e das camadas musculares, separando-as. Evidenciou-se um anel fibroso com diminuição do lúmen intestinal, em resposta à cicatrização da serosa e muscular invertidas pela sutura, levando à formação da "válvula artificial". O processo inflamatório fibrosante reparativo ocorreu em todas as válvulas, associado a reações do tipo corpo estranho e à estenose parcial do lúmen intestinal. CONCLUSÃO: Conclui-se que a seromiotomia circunferencial produz um anel fibroso que facilita a estase fecal em colo esquerdo.
Tratamento endoscópico do câncer epidermóide do esôfago
Authors: Maluf-Filho Fauze , Spencer Cheng , Luz Gustavo de Oliveira
Published: September 2006

OBJETIVOS: Procurou-se avaliar o papel atual dos procedimentos terapêuticos endoscópicos no manejo do pacientes com carcinoma epidermóide do esôfago. LEVANTAMENTO DE DADOS: Utilizando o banco de dados do PubMed (U.S. National Library of Medicine), analisaram-se as publicações sobre o tema nos últimos 10 anos, cotejando-as com a experiência desenvolvida no Serviço de Endoscopia Gastrointestinal do Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo. SÍNTESE DOS DADOS: Neste campo, destacam-se a ressecção endoscópica do câncer esofágico precoce e a tunelização do tumor avançado daquele órgão. A ressecção endoscópica da mucosa do câncer epidermóide precoce do esôfago é indicada quando a lesão é confinada ao epitélio (m1) ou à lamina própria (m2). A taxa de sobrevida conhecida de 5 anos após a ressecção endoscópica da mucosa do tumor epidermóide intramucoso do esôfago aproxima-se de 95%. CONCLUSÕES: Baseado nas evidências disponíveis, parece razoável indicar a ressecção endoscópica da mucosa como tratamento de primeira escolha para pacientes com carcinoma esofágico epidermóide intramucoso. Existem vários métodos endoscópicos paliativos para o alívio da disfagia em câncer esofágico avançado. A escolha variará de acordo com as características anatômicas e a localização do tumor, as preferências do paciente, a disponibilidade e a capacitação do centro assistencial. A taxa de sucesso técnico da colocação de próteses metálicas auto-expansíveis em estenose maligna praticamente atinge 100%. A taxa de efeito paliativo em longo prazo da disfagia aproxima-se de 80%, o que faz com que esta opção seja, até o momento, o tratamento paliativo de escolha para os sintomas de obstrução causados pelo câncer esofágico de células escamosas.