bluuebunny/crossref_metadata_2025 huggingface dataset:
Is the Sampling Site along the Umbilical Artery Significant?
Authors: Perlman Sharon , Goldman Ran D. , Maatuk Hila , Ron Einat , Shinwell Eric , Blickstein Isaac
Published: April 2003

The purpose of umbilical blood sampling is to obtain accurate reflection of fetal acid-base status at birth. The site along the umbilical artery from which blood should be sampled postpartum was not specified. We evaluated if blood gases and pH values from three sampling sites along the umbilical artery are different. After defining the range of intraobserver (method) variability, blood pO2, pCO2, and pH were directly determined. The data showed consistent and significant increases in arterial pH and pCO2 values and decreases in pO2 values from near the fetal cord insertion to the placenta. The largest difference was noted between the fetal site and the placental plate and the smallest between the site near the placental cord insertion and the placental plate. We conclude that the site of cord blood sampling should be standardized and the umbilical artery should be sampled at a site nearest to the neonate.
Relationships between Human Auditory Cortical Structure and Function
Authors: Hall Deborah A. , Hart Heledd C. , Johnsrude Ingrid S.
Published: April 2003

The human auditory cortex comprises multiple areas, largely distributed across the supratemporal plane, but the precise number and configuration of auditory areas and their functional significance have not yet been clearly established. In this paper, we discuss recent research concerning architectonic and functional organisation within the human auditory cortex, as well as architectonic and neurophysiological studies in non-human species, which can provide a broad conceptual framework for interpreting functional specialisation in humans. We review the pattern in human auditory cortex of the functional responses to various acoustic cues, such as frequency, pitch, sound level, temporal variation, motion and spatial location, and we discuss their correspondence to what is known about the organisation of the auditory cortex in other primates. There is some neuroimaging evidence of multiple tonotopically organised fields in humans and of functional specialisations of the fields in the processing of different sound features. It is thought that the primary area, on Heschl’s gyrus, may have a larger involvement in processing basic sound features, such as frequency and level, and that posterior non-primary areas on the planum temporale may play a larger role in processing more spectrotemporally complex sounds. Ways in which current knowledge of auditory cortical organisation and different data analysis approaches may benefit future functional neuroimaging studies which seek to link auditory cortical structure and function are discussed.
Overview of the Needs and Realities for Developing New and Improved Vaccines in the 21st Century
Authors: Hilleman Maurice R.
Published: April 2003

The science of present day vaccinology is based on the pioneering discoveries of the late 18th and late 19th centuries and the technologic breakthroughs of the past 60 years. The driving force for the development of new vaccines resides in technologic feasibility, public need and economic incentive for translating the basic knowledge into a product. Past efforts by government to define which particular vaccines to develop were mostly irrelevant to the realistic choices which were made. There is a vast array of viral, bacterial, parasitic and fungal disease agents against which preventative vaccines may be developed, and to this may be added cancer and certain amyloidoses such as Alzheimer’s and ‘mad cow’ diseases. The proven past for vaccines has relied on live, killed, protein and polysaccharide antigens plus the single example of recombinant-expressed hepatitis B vaccine. The validity of redirection of vaccinology to exploration of simplified vaccines such as recombinant vectored and DNA preparations and reductionist vaccines based on peptides of contrived epitope composition remains to be proved. Reductionism imposes vastly increased complexity and difficulty on vaccine development and might not be capable of achievement. The challenge in the 21st century will involve new and uncertain pathways toward worthwhile accomplishments.
Emerging Viruses: The Case ‘Hantavirus’
Authors: Ulrich Rainer , Hjelle Brian , Pitra Christian , Krüger Detlev H.
Published: April 2003

This review briefly summarises the recent knowledge about hantavirus infections and raises particular problems in hantavirus research that need further investigation. The following questions are addressed: (i) are hantaviruses distributed worldwide and what leads to new outbreaks, (ii) what is known about hantavirus evolution, (iii) how can hantavirus species be defined, (iv) what are the determinants of hantavirus pathogenesis in humans, and (v) what problems are associated with the development of new vaccines and antiviral therapeutics.
Concomitant Association of Thyroid Sarcoidosis and Graves’ Disease
Authors: Yarman S. , Kahraman H. , Tanakol R. , Kapran Y.
Published: April 2003

Objective: Graves’ disease (GD) with sarcoid involvement of the thyroid gland has rarely been reported. Method: We report a case of GD with thyroid sarcoidosis in a 28-year-old woman. Thyroid function was assessed by triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH) and TSH receptor antibodies (TSH-R Ab). Thyroid scintigraphy, ultrasound and fine-needle aspiration biopsy were performed. The patient underwent surgery. Result: The patient had a nodular goiter. Serum T3, T4 and TSH-R Ab levels were elevated with suppressed TSH level. Scintigraphy showed diffuse activity as seen in GD, and ultrasound revealed that parenchyma was heterogenous. Sarcoidosis was discovered on routine chest X-ray. Although no sarcoid involvement was found on specimen, the thyroid gland showed non-caseating granulomas on histology. Conclusion: Since sarcoid involvement of the thyroid gland can cause hypofunction, we report the uncommon infiltration of sarcoidosis with hyperthyroidism.
Chorioamnionitis: A Risk Factor for Fetal and Neonatal Morbidity
Authors: Bracci Rodolfo , Buonocore Giuseppe
Published: April 2003

Despite widespread use of drugs to arrest preterm labor, there has been no decrease in the numbers of low-birth-weight or preterm infants in the last 20 years. Evidence from many sources links preterm birth to symptomatic and subclinical infections. Recently, an increasing body of evidence has suggested that not only is subclinical infection responsible for preterm birth but also for many serious neonatal sequelae, including periventricular leukomalacia, cerebral palsy, respiratory distress and even bronchopulmonary dysplasia and necrotizing enterocolitis. Proxies of intrauterine infection include clinical chorioamnionitis, histological chorioamnionitis and intraamniotic increase in cytokines, which have been found to be associated with acute neonatal morbidity and mortality and, at least to some degree, with neurological impairment, chronic lung disease and thymus involution in the preterm infant. The infectious/inflammatory mechanisms involved are not fully understood, and the types of microbes and genetic features of host adaptive and innate immune responses need to be better characterized.
Can Breast-Feeding Protect against Schizophrenia?
Authors: Amore M. , Balista C. , McCreadie R.G. , Cimmino C. , Pisani F. , Bevilacqua G. , Ferrari G.
Published: April 2003

Background: Human milk, unlike formula feeds, contains long-chain polyunsatured fatty acids, such as docosahexaenoic acid and arachidonic acid which are essential in the development of the central nervous system. If human milk is the optimal food for brain development, and if schizophrenia is a neurodevelopment disorder, might people who become schizophrenic in adult life be less likely to have been breast-fed? Aims: To compare the incidence and length of breast-feeding in patients, siblings and normal controls and to examine the relationship between the duration of breast-feeding and age at onset of schizophrenia. Method: 113 schizophrenic patients were recruited, as were 140 siblings of the patients and 113 nonschizophrenic controls. The breast-feeding history of the patients, their siblings and controls was obtained through interviews with the mothers of the patients and controls. Results: There were no significant differences between groups in the incidence of breast- feeding. The duration of breast-feeding was positively correlated with the age at onset of illness (r = +0.25, p < 0.02). Conclusion: Breast-feeding is no less common in those who develop schizophrenia in later life. However, breast milk might postpone the onset of the illness in schizophrenic patients.
Galantamine Provides Sustained Benefits in Patients with ‘Advanced Moderate’ Alzheimer’s Disease for at Least 12 Months
Authors: Blesa Rafael , Davidson Michael , Kurz Alexander , Reichman William , van Baelen Bart , Schwalen Susanne
Published: April 2003

Galantamine (Reminyl®), a novel agent with a dual mode of action, modulates nicotinic acetylcholine receptors and inhibits acetylcholinesterase. Galantamine has consistently demonstrated a broad range of beneficial effects and has shown sustained benefits in cognitive and functional abilities for at least 12 months in patients with mild-to-moderate Alzheimer’s disease (AD). As pivotal studies demonstrating the efficacy of cholinergic drugs were designed to exclude patients with severer AD, many patients with the advanced stage of this condition are currently not treated due to the lack of demonstrated efficacy in clinical trials. We aimed to investigate whether there was any evidence for the benefits of galantamine in patients with severer disease, by performing a post hoc analysis using data extracted from the population of the two long-term galantamine studies. We evaluated the efficacy of galantamine in patients with ‘advanced moderate’ AD. ‘Advanced moderate’ patients were those with baseline Mini Mental State Examination (MMSE) scores ≤14 or Alzheimer’s Disease Assessment Scale – cognitive subscale (ADAS-cog) scores >30. These patients were compared with matched controls who received placebo in a different historical study. Cognitive abilities (assessed using the ADAS-cog scale) of ‘advanced moderate’ AD patients receiving galantamine for 12 months were maintained at baseline levels after 12 months, and significantly improved over those of placebo patients (p < 0.001). Of the ‘advanced moderate’ patients receiving galantamine, 51% with baseline ADAS-cog of >30 maintained or improved their ADAS-cog scores over baseline values, compared with 13% receiving placebo (p < 0.001). In the subgroup of ‘advanced moderate’ patients with baseline MMSE ≤14, 48% of those receiving galantamine and 4% of those receiving placebo maintained or improved their ADAS-cog scores at 12 months (p = 0.001). In both subgroups, the treatment difference (galantamine vs. historical placebo) amounted to approximately 10 points on the ADAS-cog scale. Functional abilities, as assessed using the Disability Assessment for Dementia scale, remained significantly superior in galantamine-treated patients compared with historical placebo-treated patients at 12 months (p < 0.001). In conclusion, galantamine offered sustained efficacy to patients with ‘advanced moderate’ AD, confirming the benefits seen in published studies of patients with mild-to-moderate AD. This drug has potential for broader use in clinical practice.
Irving S. Cooper and His Role in Intracranial Stimulation for Movement Disorders and Epilepsy
Authors: Rosenow Joshua , Das Kaushik , Rovit Richard L. , Couldwell William T.
Published: April 2003

Dr. Irving Cooper (1922–1985) was a pioneer in the field of functional neurosurgery. After years of treating patients with tremor by creating deep lesions with either anterior choroidal artery ligation or cryogenic thalamotomy, he began to utilize methods of electrical cerebral stimulation as treatment for a variety of disorders. Chronic cerebellar stimulation was employed for patients with epilepsy, cerebral palsy, and dystonia. While Dr. Cooper believed his results to be significant, there still remain many challenges to his claims. Later in his career, he placed deep brain electrodes in the internal capsule and thalamus for epilepsy and dystonia. His encouraging results from this small series were often overlooked. This paper reviews the science behind Dr. Cooper’s work, his case series, and the controversies surrounding his results.
Impact of Posterior GPi Pallidotomy on Leg Tremor in Parkinson’s Disease
Authors: Goto Satoshi , Nishikawa Shigeyuki , Mita Shuji , Ushio Yukitaka
Published: April 2003

Although stereotactic thalamotomy is the mainstay in the surgical treatment of tremor in patients with Parkinson’s disease (PD), this surgery is not favored and is even a matter of potential concern in the treatment of leg tremor since it carries a significant risk of injury to the internal capsule. In this study we have carried out a quantitative assessment of leg tremor alleviation in 12 patients with PD after MRI-/microelectrode-guided stereotactic ablation of the posterior part of the globus pallidus internus (GPi). The results showed that posterior GPi pallidotomy combined with drug therapy is a satisfactorily effective therapeutic strategy to treat parkinsonian leg tremor.
Impact of Birth Weight on Familial Aggregation of End-Stage Renal Disease
Authors: Fan Z. Joyce , Lackland Daniel T. , Kenderes Barbara , Krisher Jenna , Freedman Barry I.
Published: April 2003

Background: Birth weight (BW) and family history (FH) of end-stage renal disease (ESRD) have been shown to have an independent association with development of subsequent ESRD. This study was undertaken to determine the effects of BW (low BW suggesting a congenital reduction in functional nephron number) on the observed familial aggregation of ESRD. Methods: Cases were identified from the ESRD Network 6 ‘Family History of ESRD’ Study and BW was determined from birth certificate records maintained at the Office of Vital Records, South Carolina Department of Health and Environmental Control. BW and FH of ESRD data were available in 387 patients who initiated dialysis therapy between 1993 and 1997. Multiple logistic regression analysis was performed to assess the risk of low BW (<2,500 g) and high BW (≧4,000 g) on FH of ESRD. Results: A FH of ESRD in first or second-degree relatives was present in 24% of cases. No significant differences were observed in the frequency of a positive FH of ESRD in those with low BW compared to those with normal BW. There was a significant reduction in the prevalence of a FH of ESRD in those with high BW, compared to those with a normal BW (risk ratio 0.32, CI 0.11–0.94). Conclusion: The clustering of either high BW or low BW within multiply affected ESRD families does not account for the observed familial aggregation of ESRD. In addition, high BW was associated with a reduced familial aggregation of ESRD.
A Systematic Review of Brachial Plexus Surgery for Birth-Related Brachial Plexus Injury
Authors: McNeely P. Daniel , Drake James M.
Published: April 2003

Objective: Brachial plexus injury complicates 0.6–2.6 per 1,000 live births. Surgery is sometimes advocated for patients who fail to improve with conservative management. We reviewed the available literature on birth-related brachial plexus palsy in order to provide recommendations for surgical management, using evidence-based criteria. Methods: Studies were identified by searc hing Medline (1966–2002) and the Cochrane Library using the terms brachial plexus, neonate or infant, surgery and natural history. The reference lists of relevant articles were also reviewed. The search was restricted to articles published in English. Each article was classified according to its methodology. Management recommendations were suggested based on the results of the studies identified and the degree of certainty of the available literature. Results: Twenty-three papers were selected for detailed analysis. There are no randomized controlled trials that have investigated the role of brachial plexus surgery in the management of birth-related brachial plexus palsy. Two prospective studies of relevance were found, one describing the natural history of birth-related brachial plexus injury and one evaluating surgery for these patients. The remainder consisted of retrospective case series. Outcomes from surgical series are generally favorable (level III and V evidence). Direct comparison with the natural history could not be inferred from the series reviewed given the lack of controls. Conclusion: There is no conclusive evidence showing a benefit of surgery over conservative management approaches in the treatment of patients with birth-related brachial plexus injuries. Surgery remains a valid practice option given the level III and V evidence suggesting a possible benefit of surgery.
Intraoperative Low-Field Magnetic Resonance Imaging in Pediatric Neurosurgery
Authors: Nimsky Christopher , Ganslandt Oliver , Gralla Jan , Buchfelder Michael , Fahlbusch Rudolf
Published: April 2003

Background: Since the mid-1990s, the feasibility and indications of intraoperative magnetic resonance (MR) imaging have been investigated by different groups. The majority of examinations were carried out in adults. The aim of this study was to summarize our experience of over 5 years of intraoperative MR imaging in pediatric neurosurgery. Methods: For scanning, we used a 0.2-Tesla Magnetom Open, which was placed in a radiofrequency-shielded twin operating theater, allowing surgery with standard instruments and additional neuronavigational guidance either in an adjacent operating room or directly in the radiofrequency cabin on the extended MR table, at the 5-G line. Results: In total, 330 patients were investigated, among them 33 children who were younger than 17 years. We found four main indications for intraoperative MR imaging: the evaluation of cyst drainage (n = 9), of the extent of resection in epilepsy surgery (n = 6) and of the removal of pituitary tumors (n = 6) and gliomas and other brain tumors (n = 12). Intraoperative MR imaging allowed us to evaluate the extent of the resection or to monitor catheter placements and consecutive cyst alterations in all cases. In 2 tumor cases and 3 catheter placements, intraoperative imaging resulted in a modification of the surgical strategy. Conclusions: Intraoperative low-field MR imaging is a safe procedure; we did not encounter an increased morbidity in the children investigated. It serves as intraoperative quality control documenting the effects of surgery, e.g. the extent of a resection, which can then be compared to the treatment plan. Besides its most essential application in brain tumors, it also proved to be particularly helpful in children undergoing complicated catheter placements for cyst drainage, as well as in pituitary and epilepsy surgery.
Tethered Cord Associated with Anorectal Malformation
Authors: Morimoto Kazuyoshi , Takemoto Osamu , Wakayama Akatsuki
Published: April 2003

Ten children with a tethered cord and also an anorectal malformation are reported in this document. The anorectal malformations comprised 5 vesicointestinal fissures, 2 cloacal exstrophies, 2 rectovesical fistulas and 1 rectobulbar fistula. All of the patients underwent colostomy in advance of surgery for untethering of the spinal cord. Although their neurologic deficits had previously been considered static, they were subjected to radiographic examination of the caudal spine and found to have a tethered cord. These 10 children were among 55 children with a tethered cord surgically treated at the Division of Neurosurgery of the Osaka Medical Center and Research Institute for Maternal and Child Health during the last 11 years. Data were obtained for these 10 children (6 boys and 4 girls, mean age 1.7 years) who underwent surgical untethering. Several hypotheses are offered to explain this association. Anorectal malformations are related to underlying spinal cord anomalies, which may be amenable to neurosurgical correction. Eight of our patients had no skin stigma of the lumbosacral region, in contrast to an ordinary tethered cord. Spinal cord imaging is necessary to closely scrutinize these children.
Increased Levels of Interleukin-6 in Cervical Secretions and Assessment of the Uterine Cervix by Transvaginal Ultrasonography Predict Preterm Premature Rupture of the Membranes
Authors: Kishida Tatsuro , Yamada Hideto , Furuta Itsuko , Kobayashi Noriko , Hirayama Emi K. , Ebina Yasuhiko , Sakuragi Noriaki , Fujimoto Seiichiro
Published: April 2003

Objective: The objective of this study was to investigate the predictive factors of premature rupture of the membranes (preterm PROM). Methods: The study was undertaken with cervical secretions collected from 72 consenting singleton pregnant women between 20 and 33 weeks of gestation. The levels of interleukin (IL) 1α, IL-1β, IL-6, IL-8, matrix metalloproteinase (MMP) 1, MMP-2, MMP-9, tissue inhibitors of matrix metalloproteinase (TIMP) 1, TIMP-2, granulocyte elastase, and fetal fibronectin in cervical diluted specimens were measured by immunoassay, and the uterine cervix was assessed by transvaginal ultrasonography. Demographic, obstetric, clinical, neonatal, and laboratory data were analyzed by univariate analysis, multiple logistic regression, and receiver operator characteristic curve analysis. Results: Preterm PROM occurred in 6 women, and 63 women delivered at term. Multiple logistic regression analysis indicated a significant independent association with preterm PROM for the cervical IL-6 levels and cervical length. The receiver operator characteristic curve analysis revealed that an IL-6 level of ≧240 pg/ml in cervical secretions and a cervical length of ≤28 mm had higher diagnostic performance in predicting preterm PROM. Conclusion: It is suggested that preterm PROM is associated with increased cervical IL-6 levels and a short cervix.
Elevated Second-Trimester Maternal Serum Inhibin A Levels in Asian Pregnancies with Fetal Down Syndrome and Other Chromosomal Abnormalities
Authors: Hsu Jenn-J. , Chiang Chi-H. , Hsieh Ching-C. , Hsieh T’sang-T.
Published: April 2003

Subjects: To evaluate second-trimester maternal serum inhibin A levels in Asian pregnancies with fetal Down syndrome and other chromosomal abnormalities. Methods: Inhibin A level was measured from the serum samples of 25 chromosomally abnormal pregnancies, including 15 cases of Down syndrome, 4 cases of trisomy 18, 1 case of trisomy 13, and 5 cases of sex chromosome aneuploidies (4 cases of 47,XXY and 1 case of 45,X) and in a cohort of 150 controls during the second trimester of pregnancy. Results: The multiple of median levels of Down syndrome (1.74) and other chromosomally abnormal pregnancies (2.03) are significantly higher than that of normal pregnancies (p = 0.002 and p = 0.024, respectively). Only 3 of 15 (20%) Down syndrome cases had inhibin A levels at or above the 95th centile of the control values. Conclusions: Inhibin A levels are raised in Asian women affected with fetal Down syndrome and sex chromosome abnormality. In spite of the poor discrepancy of inhibin A, it might be a potential marker for Down syndrome screening in Asians.
Transcription at Early Stages of Herpes Simplex Virus 1 Infection and during Reactivation
Authors: Režuchová Ingeborg , Kúdelová Marcela , Ďurmanová Vladimíra , Vojvodová Andrea , Košovský Ján , Rajčáni Július
Published: April 2003

Objective: The kinetics of immediate early (IE) and early (E) herpes simplex virus 1 (HSV-1) mRNA transcription was followed in explanted trigeminal ganglia from rabbits with established latency. Methods: The expression of IE and E mRNAs was first assessed in infected Vero cells by RT-PCR and then in explanted trigeminal ganglia by nested RT-PCR. Results: In infected Vero cells, IE mRNAs [for infected cell protein (ICP) 0, ICP4 and ICP27] were first detected 1–2 h post-inoculation (p.i.), peaking at 3 h p.i. The transcription of E mRNAs [for thymidine kinase (TK), RR1 and UL9], which were first detected from 3 h p.i., peaked between 5 and 10 h p.i. In explanted ganglia, the ICP0, ICP4 and ICP27 mRNAs were first detected after 4 h in culture. This was followed by the appearance of TK mRNA at 8 h and then by the UL9 mRNA, detected from 12 h post-explantation. A further E mRNA (RR1), as well as the late gC mRNA, were first observed after 24 h in culture. Moreover, ICP4 mRNA could be found in non-cultured ganglia. Conclusions: During reactivation of latent HSV-1 in explanted ganglia, the onset of ICP0 and ICP27 transcription at 4 h in culture was followed by TK transcription (at 8 h). Thus, in the rabbit reactivation model, ICP0 gene transcription rather than ICP4 transcription represents the relevant indicator of latency reactivation.
Neutrophil Migration across the Intestinal Epithelial Barrier – Summary of in vitro Data and Description of a New Transgenic Mouse Model with Doxycycline-Inducible Interleukin-8 Expression in Intestinal Epithelial Cells
Authors: Kucharzik Torsten , Williams Ifor R.
Published: April 2003

The intestinal epithelium serves as a protective barrier between the gut lumen and the underlying mucosa. During intestinal inflammation in inflammatory bowel disease (IBD) there is increased paracellular permeability and strong migration of the neutrophils into the mucosa as well as transepithelial neutrophil migration with the formation of crypt abscesses. From in vitro data we know that neutrophil migration is triggered by epithelial-derived interleukin-8 (IL-8). A pathogen-elicited epithelial chemoattractant activity, which is released by intestinal epithelial cells from the apical surface, seems to be responsible for the final step in transepithelial migration. To mimic the pathophysiological situation with influx of neutrophils during IBD, a double transgenic mouse model with doxycycline-inducible IL-8 expression in intestinal epithelial cells was established. This model will allow to study the role of neutrophil influx during chronic intestinal inflammation. It will also provide insights into the mechanisms of neutrophil transepithelial migration.
Early Events in the Pathogenesis of a Murine Transfer Colitis
Authors: Leithäuser Frank , Krajina Tamara , Trobonjaca Zlatko , Reimann Jörg
Published: April 2003

Inflammatory bowel disease (IBD) is a chronic, disabling disease. A dysregulated immune response seems to play a pivotal role in the pathogenesis of this disorder. Here we will review current concepts of the adoptive transfer model of IBD with particular emphasis on early events in disease development. In the adoptive transfer model, the reconstitution of immunoincompetent mice with CD4+ T cells from congenic donor animals leads to severe colitis. We will address the question as to which CD4+ T cell subsets might be involved in the induction, suppression, or regulation of disease, and review data concerning the specificity of their T cell receptor and its putative MHC restriction elements. We will also discuss whether and at what anatomical sites donor T cells could be primed in the recipient.
Anti-Interleukin-18 Therapy in Murine Models of Inflammatory Bowel Disease
Authors: Lochner Matthias , Förster Irmgard
Published: April 2003

Interleukin (IL)-18 is a cytokine with a broad array of effector functions, the most prominent of which is to act synergistically with IL-12 in interferon-γ production and the induction of a strong T-helper-1-mediated immune response. In addition, IL-18 also upregulates the production of proinflammatory cytokines such as IL-1 and tumor necrosis factor-α. Analysis of IL-18-deficient mice revealed an important role of IL-18 in the activation of macrophages and natural killer cells in the context of infection with intracellular bacteria or parasites. In humans, it was reported that IL-18 is elevated at sites of inflammation in inflammatory bowel disease (IBD), particularly in Crohn’s disease, suggesting a possible role for IL-18 in the development and persistence of IBD. In this review we summarize recent findings on the functional role of IL-18 in the pathogenesis of colitis with a special focus on murine models of IBD. The neutralizing mouse anti-mouse IL-18 antibodies generated in our group should facilitate the evaluation of the efficiency of therapeutic blockade of endogenous IL-18 in chronic mouse models of colitis besides the use of recombinant forms of the inhibitory IL-18-binding protein.
Primary Ankle Fusion Using Blair Technique for Severely Comminuted Fracture of the Talus
Authors: Hantira Hazem , Al Sayed Hassan , Barghash Ibrahim
Published: April 2003

Objective: We report a case of a severely comminuted fracture of the body of the talus treated by primary Blair tibiotalar fusion. Clinical Presentation and Intervention: A very severely comminuted open fracture of the body of the talus was treated on the same day of injury by debridement and tibiotalar fusion using the Blair fusion technique. Conclusion: Blair fusion may be indicated in cases of severely comminuted fractures of the talar body. It has the advantage of giving a near-normal appearance to the foot, producing less shortening and allowing motion to remain at the talonavicular and anterior subtalar joints.
Stroke Units in Hungary – The Debrecen Experience
Authors: Bereczki Dániel , Csiba László , Fülesdi Béla , Fekete István
Published: April 2003

The Debrecen Stroke Unit covers a catchment area of 210,000 inhabitants in eastern Hungary. The unit was established at the Department of Neurology of the University Hospital in 1974 and has 23 beds, 7 of which have monitoring facilities. The unit treats about 600 patients with acute cerebrovascular diseases annually – about 60% of all hospitalised stroke cases in the region. Overall, 18 registered nurses and 4 nurse helpers work for the unit. Computer tomography is performed in over 90% of cases. Carotid duplex ultrasound and echocardiography are part of the routine examinations in ischaemic strokes. Delay from onset of stroke to hospital arrival is the main barrier against the use of rt-PA. Average length of stay is 12 days; a lack of rehabilitation and nursing capacities sometimes delays discharge of dependent patients. The hospital is reimbursed the costs of stroke care based on DRG.
Stroke Units – The Norwegian Experience
Authors: Indredavik Bent
Published: April 2003

The main aims of acute stroke care should be to reduce death and disability. Treatment in stroke units is the only treatment option proven to reduce death in acute stroke patients. Stroke unit care is also the only treatment which has shown a marked reduction in disability for general stroke patients, and also the only treatment with beneficial long-term effects on survival, disability and quality of life. Most acute hospitals in Norway have established stroke units. The recommended stroke unit model is a non-intensive combined unit able to focus simultaneously both on acute care and rehabilitation. This model has been very well evaluated in randomised trials and has achieved some of the best results regarding acute stroke care. Hence one can probably conclude that stroke unit care in Norway is evidence based.
The Prechordal Plate, the Rostral End of the Notochord and Nearby Median Features in Staged Human Embryos
Authors: Müller F. , O'Rahilly R.
Published: April 2003

The enigmatic structure known as the prechordal plate and also the precursors of the notochord were reassessed in 101 human embryos of stages 8–14; 36 were controlled by precise graphic reconstructions. Various measurements were made and the appearance of median structures was tabulated. The prechordal plate, which has been unequivocally found first at stage 7, is usually detectable at stage 8 as a highly developed mesendodermal mass in contact with the floor of the neural groove. At stages 9 and 10 the plate is related to neuromere D1. Cellular migration laterad at stages 9–11 gives rise to the bilateral premandibular condensations, which are lateral to the adenohypophysial primordium, and at stages 13 and 14 these condensations are closely related to the future tentorium cerebelli. The notochordal process is first visible at stage 7, and its dorsal part constitutes the notochordal plate at stage 8. At stages 8–10 the notochordal and prechordal plates appear continuous, but they are distinguishable histologically. The notochordal plate becomes intercalated in the endoderm of the foregut and begins to give rise to the notochord at stages 10 and 11. Bifurcation occurs rostrally at stage 12: the dorsal limb disappears, whereas the ventral limb is the definitive continuation. The topographical relationships of the prechordal and notochordal plates, the notochord, the adenohypophysis, and the oropharyngeal membrane are documented. Definitions and pertinent remarks on terminology are included, comparative data are considered, and the origin and derivatives of the prechordal plate are discussed. In addition to giving rise to external ocular muscles, the possibility of contributions to the heart and the tentorium cerebelli is raised. The importance of the plate in the development of the forebrain, as well as in the production of median anomalies such as holoprosencephaly and cyclopia, is stressed.
Different Analytical Approaches in an Experimental Cohort Study on Preventive Measures for Caries in Adolescents
Authors: Källestål C. , Stenlund H.
Published: April 2003

Aim: To use different analytical approaches to data from a longitudinal, quasi-experimental study evaluating caries-preventive measures in order to estimate the differences in results due to the analytical tool used. Methods: 1,165 patients at high risk for caries underwent yearly examinations in 1996, 1997 and 1998 and randomly received one out of four tested preventive measures. Two analytical methods were used: (1) increment was calculated using the indices DMFSa and DeMFSa, (2) incidence density was calculated for each individual using new approximal dentin lesions or dentin and enamel lesions in the numerator and the risk time for the surfaces in the denumerator. The Poisson regression with overdispersion was used for multivariate modelling of the outcomes. Results: In all analyses of approximal dentine as well as dentine and enamel caries bad oral health at baseline increased the risk of new approximal dentine caries. In the incidence analysis poor oral health behaviour also increased the risk. Conclusion: Since the difference between the two analytical methods are small for young individuals the method of preference would be increment analysis.
Clinical Study of the Use of the Laser Fluorescence Device DIAGNOdent for Detection of Occlusal Caries in Children
Authors: Anttonen V. , Seppä L. , Hausen H.
Published: April 2003

Diagnosis of non-cavitated occlusal caries is generally considered problematic. The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent as part of routine dental check-ups in children. A total of 613 occlusal surfaces on permanent molars and 436 surfaces on primary molars in children aged 7–8 (n = 55) and 13–14 years (n = 54) were examined visually, using DIAGNOdent and for most 13- to 14-year-olds also using radiographs. The teeth were not cleaned professionally before examination. To provide a gold standard for carious teeth, the depth of the caries lesion was determined in those lesions that were judged visually to need opening by drilling (51 teeth). The higher the visual score, the higher were the mean DIAGNOdent values, but in each visual category the variation among values was large. The presence of a clear sealant did not affect DIAGNOdent measurements. The values for permanent and primary molars differed slightly. For permanent teeth, Youden’s index value was highest (60%) at a cut-off value of 30, which indicates that the overall performance for DIAGNOdent in detecting dentinal caries was best at this point. Using this cut-off, sensitivity was 92% and specificity 69% with visual examination for validation, while sensitivity was 92% and specificity 82% with validation by fissure opening. Of the three methods, radiographic examination was the least accurate. In routine dental check-ups of children, DIAGNOdent appears to be useful as an adjunct to visual examination.
Influence of Enamel Thickness on Quantification of Mineral Loss in Enamel Using Laser-Induced Fluorescence
Authors: Ando M. , Schemehorn B.R. , Eckert G.J. , Zero D.T. , Stookey G.K.
Published: April 2003

The objective of this study was to evaluate the effect of enamel thickness on the quantification of white-spot lesions with laser fluorescence. One hundred and twenty 3-mm-diameter human ground and polished enamel specimens were used. Specimens were illuminated by a 488-nm argon laser, images were acquired through a 540-nm high-pass filter and stored on the Quantitative Light-Induced Fluorescence (QLF) program. Specimens were divided into two groups and demineralized for 48 or 96 h and QLF images were again acquired. Fluorescence radiance (FR) of both sound (FRs) and demineralized (FRd) enamel was determined using the QLF program. Change in fluorescence radiance (ΔFR, %) was determined as follows: ΔFR = FRd/FRs × 100. One thin section was obtained for transverse microradiography analysis. Enamel and dentin thickness of the thin sections were measured. There was a good correlation between QLF parameters and enamel thickness. It can be concluded that the FR observed for similar lesions depends on the actual enamel thickness.
Biomolecular Markers of Malignancy in Human Uveal Melanoma: The Role of the Cadherin-Catenin Complex and Gene Expression Profiling
Authors: Conway R.M. , Cursiefen C. , Behrens J. , Naumann G.O.H. , Holbach L.M.
Published: April 2003

In recent years there has been a trend towards conservative management of uveal melanoma (UM), aimed at preserving the eye and vision. Despite improvements with this approach, recurrent tumour and metastatic disease still occur, and the management remains problematic. As a result of these limitations, there is interest in gaining a greater understanding of molecular changes associated with aggressive disease patterns in UM. This might result in new, more effective and less toxic therapies as well as provide prognostic information for defining subgroups of patients with a less favourable prognosis as potential candidates for adjuvant therapies. Accumulating evidence over the past decade suggests that disturbance in the cadherin-catenin adhesion complex is critical in the process leading to invasion and metastasis of many cancers. The recent advent of DNA micro-array technology now offers an unprecedented ability to study these molecules and others associated with malignant transformation. In this mini-review, the aspects of tumour progression in which cadherin-catenin may be involved are dealt with along with the potential application of DNA micro-array technology to the problem in UM.
Low Specificity of Scanning Laser Polarimetry
Authors: Mojon Daniel S.
Published: April 2003

Purpose: Scanning laser polarimetry is used to assess the peripapillary retinal nerve fiber layer. This study evaluates scanning laser polarimetry in normal subjects. Subjects and Methods: 28 eyes of 28 normal subjects (age range 21–48 years, mean age 36.5 years) had scanning laser polarimetry (NFA-GDx, Laser Diagnostic Technologies, San Diego, Calif., USA). All subjects had normal eye examinations, refractive errors with spherical equivalents <5 D and astigmatism <2 D, normal intraocular pressures, no history of diseases affecting the visual field or nerve fiber layer, and normal white-on-white automated perimetry (Octopus 101, program G2). The mean image of three good-quality measurements with the scanning laser polarimeter was included. Results: 36% of the normal subjects (10/28) had at least one NFA parameter outside normal (p < 0.05). The parameters most frequently found to be outside normal were symmetry (21%, 6/28) and superior ratio (17%, 5/28). Conclusions: Scanning laser polarimetry is often used for early detection of glaucomatous damage in glaucoma suspects. This study found a specificity of only 64% and indicates that the actual selection of parameters is not adequate. Especially the parameters symmetry and superior ratio should be reevaluated in order to achieve a higher specificity.
Elevated Adrenomedullin in the Vitreous of Patients with Diabetic Retinopathy
Authors: Ito Shinji , Fujisawa Kimihiko , Sakamoto Taiji , Ishibashi Tatsuro
Published: April 2003

Adrenomedullin (AM) is a multifunctional peptide with various physiological actions, including vasodilatation, a defense mechanism against microorganisms, the regulation of growth and the regulation of insulin and glucose. In this study, we measured the vitreous AM levels in patients with diabetes mellitus to determine its potential involvement in the pathogenesis of diabetic retinopathy (DR). We used an immunoradiometric assay to measure the vitreous AM concentrations in a total of 28 eyes: 13 with DR and 15 with macular holes (15 men and 13 women, 62.9 ± 10.4 years old). The AM levels in the vitreous fluid of patients with DR (22.9 ± 7.9 fmol/ml) were found to be significantly higher than the corresponding AM levels in patients with macular holes (4.7 ± 1.1 fmol/ml) (p < 0.05). These results indicate that the increase in the vitreous AM is related to DR.
Aqueous Flare and Macular Edema in Eyes with Diabetic Retinopathy
Authors: Jandrasits Kerstin , Krepler Katharina , Wedrich Andreas
Published: April 2003

Background: The breakdown of the blood-retina barrier in diabetic patients is correlated with a dysfunction of the blood-aqueous barrier. In our study, we wanted to investigate the effect of grid photocoagulation in diabetic macular edema on the aqueous flare. Methods: Modified grid pattern photocoagulation was performed on 20 patients with diabetic macular edema. The aqueous flare intensity was measured by the laser flare cell meter before and 4 months after laser treatment. Results: The mean flare value was 9.8 ± 4.7 photons/ms before laser treatment. After grid photocoagulation, the flare value was 7.1 ± 3.6 photons/ms. Flare values were significantly decreased after laser treatment. Conclusion: Our results suggest a correlation between the effect of grid photocoagulation on the blood-retina barrier and the permeability of the blood-aqueous barrier. The laser flare intensity seems to be a quantitative indicator for the diabetic dysfunction of the blood-retina barrier.
Comparison of Efficacy and Tolerability between Two Gel-Forming Timolol Maleate Ophthalmic Solutions in Patients with Glaucoma or Ocular Hypertension
Authors: Shibuya Takashi , Kashiwagi Kenji , Tsukahara Shigeo
Published: April 2003

Purpose: To compare two gel-forming timolol maleate ophthalmic solutions, Timoptol XE® and Lizmon TG®, in regard to efficacy and tolerability in patients with glaucoma or ocular hypertension by means of a patient-masked prospective randomized crossover study. Subjects and Methods: A total of 37 patients with glaucoma or ocular hypertension under treatment with antiglaucoma ophthalmic solutions including 0.5% twice-daily timolol maleate participated in this study. Only timolol maleate was withdrawn and either Timoptol XE or Lizmon TG was randomly allocated. After instillation for 1 month, the other ophthalmic solution was subsequently instilled for another month. Routine ophthalmic examination including slit-lamp examination and intraocular pressure (IOP) monitoring was conducted before instillation of gel-forming ophthalmic solutions and just after completing the instillation of each ophthalmic solution. Patient questionnaire surveys were also performed just after completing the instillation of each ophthalmic solution. Results: Mean IOP, just before the withdrawal of timolol ophthalmic solution, was 16.4 ± 2.9 mm Hg. At the end of Timoptol XE or Lizmon TG instillation, mean IOPs were 16.3 ± 2.5 or 16.3 ± 3.0 mm Hg, respectively. The results of the questionnaire survey showed no significant difference between Timoptol XE and Lizmon TG in regard to all survey items. Twenty-nine patients (78.4%) preferred to use gel-forming timolol solutions rather than twice-daily timolol ophthalmic solution. The presence of concurrently used ophthalmic solutions did not effect the incidences of subjective symptoms. The incidences of objective adverse effects were not significantly different between two gel-forming timolol ophthalmic solutions. Conclusion: Both gel-forming timolol ophthalmic solutions could be good choices for glaucoma treatment.
Orbital Involvement in Multiple Myeloma: First Sign of Insufficient Chemotherapy
Authors: Kottler Ulrike B. , Cursiefen Claus , Holbach Leonard M.
Published: April 2003

Orbital involvement in multiple myeloma is unusual. We describe the case of a 60-year-old male who presented with left proptosis, reduced visual acuity, diplopia and progressing signs of globe indentation 2 months after chemotherapy for multiple myeloma. MRI showed a well-defined tumor filling the mediobasal part of the left orbit. Incisional biopsy and reduction of tumor mass were performed using an anterior transconjunctival orbitotomy. Histopathologic findings and further systemic examination confirmed the reactivation of the multiple myeloma. Proptosis, intraocular pressure and visual acuity improved following external beam radiation therapy of the left orbit and repeated systemic chemotherapy. Orbital involvement in multiple myeloma was the only sign of insufficient chemotherapy.
Peripheral Sensory Neuropathy Associated with Short-Term Oral Acitretin Therapy
Authors: Tsambaos D. , Sakkis T. , Chroni E. , Koniavitou K. , Monastirli A. , Pasmatzi E. , Paschalis C.
Published: April 2003

A 57-year-old female patient with widespread chronic plaque psoriasis and a 32-year-old male patient with severe oral lichen planus are reported, who developed sensory symptoms in the extremities 3 and 4 months after the onset of oral acitretin therapy, respectively. Both patients showed clinical and electrophysiological evidence of a sensory peripheral neuropathy, which completely resolved 2 and 2.5 years after discontinuation of oral acitretin administration, respectively.
Alteration of the Expression of Bcl-2, Bcl-x, Bax, Fas, and Fas Ligand in the Involved Skin of Psoriasis vulgaris following Topical Anthralin Therapy
Authors: Yamamoto T. , Nishioka K.
Published: April 2003

Anthralin (dithranol) is frequently used for the treatment of psoriasis. However, the mode of action of anthralin has not been completely elucidated as yet. Recent findings suggest that psoriatic keratinocytes are resistant to the apoptotic process. In this study, we examined the immunohistochemical expression of apoptosis-regulated protein in the involved psoriatic skin following topical anthralin therapy. Biopsy specimens were obtained from back skins treated with topical anthralin or white petrolatum (control) in 4 patients with psoriasis vulgaris. Immunohistochemical examination revealed that psoriatic keratinocytes expressed high levels of Bcl-x, which was significantly reduced after anthralin treatment. Bax was not detected in the epidermal keratinocytes in the petrolatum-treated skin, while it was present in the upper keratinocytes after anthralin therapy. Bcl-2 was detected only in basal layers of psoriatic epidermis following both petrolatum and anthralin application. Psoriatic keratinocytes expressed higher levels of Fas in the lower epidermis, while only weak expression was detected in anthralin-treated plaques. On the other hand, hyperproliferative keratinocytes strongly expressed Fas ligand (FasL) on their plasma membranes as well as infiltrating lymphocytes in the upper dermis. Furthermore, anthralin-treated psoriatic epidermis did not express FasL. In normal skin, keratinocytes expressed low to absent levels of Bcl-x and Bax, while Bcl-2 was detected only in melanocytes in basal layers. Neither Fas nor FasL were detected in the epidermis of normal skin. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) staining revealed positive labeling on the majority of psoriatic keratinocytes through the epidermis in petrolatum-treated skin, whereas anthralin treatment markedly reduced TUNEL-positive keratinocytes. These in vivo results may reflect improvement of the psoriatic skin following effective anthralin therapy.