bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Filtration Coefficients and Circulating Plasma Volume by Continuously Monitoring Hematocrit during Hemodialysis
Authors: Yashiro M. , Hamada Y. , Matsushima H. , Muso E.
Published: April 2003

Background/Aims: Filtration coefficients (Lp) and plasma volume were estimated in order to investigate whether suppressed Lp associates with intradialytic hypotension and/or diabetic nephropathy. Methods: Twenty-one patients were evaluated. Nine patients were diabetic (DM) and 12 were nondiabetic (non-DM). Three of DM and 4 of non-DM were prone to dialysis-induced hypotension (hypo(+)) and others (hypo(–)) were not. Changes in hematocrit (Ht) were measured for 60 min after the start of ultrafiltration. Lp and plasma volume at the start of ultrafiltration (Vp0) were estimated to fit calculating values of Ht based on Schneditz’s open two compartment model to actual value. Results: There was no significant difference in the mean values of Lp/Vp0 either between hypo(+) and hypo(–) (0.87 ± 0.37 vs. 1.24 ± 0.48 ml/mm Hg·min·liter; n.s.) or between DM and non-DM (1.04 ± 0.32 vs. 1.17 ± 0.56 ml/mm Hg·min· liter; n.s.). However, the comparisons of Lp/Vp0 among the four groups (hypo(+)/DM, hypo(–)/DM, hypo(+)/non-DM and hypo(–)/non-DM) showed significant differences between hypo(+)/non-DM and hypo(–)/non-DM (1.08 ± 0.40, 1.02 ± 0.32, 0.71 ± 0.29*, 1.40 ± 0.53* ml/mm Hg·min·liter; *p < 0.05). Differences in the percentage of Vp0 to body weight (Vp0/BW) among four groups and correlation between Lp/Vp0 and Vp0/BW were not significant. Conclusion: These data indicated that reduction of Lp/Vp0 was not simply caused by decreased circulating plasma volume (Vp0/BW) and that the suppressed filtration coefficients may have substantial association with dialysis-induced hypotension in non-DM. The estimation of Lp using in-line measurement of Ht was a useful method for analyzing intradialytic hypotension.
Vascular Access for Dialysis in the Elderly
Authors: Ridao-Cano Natalia , Polo José R. , Polo Jorge , Pérez-García Rafael , Sanchez Mercedes , Gómez-Campderá Francisco J.
Published: April 2003

Aims: The aim of this study was to analyze early and late outcome of the first vascular accesses performed in the HGUGM of Madrid between 1992 and 1997, comparing the results in patients older and younger than 65 years. Methods: Retrospective study. All the vascular accesses performed in patients without previous permanent angioaccess between January 1992 and March 1997 were studied. Early failure, complication rate (patient-year of follow-up), and cumulative patency rates were analyzed. Results: The difference between grafts required in young (25%) and old patients (34%) was significant (p < 0.01). Complication rate in autologous fistulas was 0.07 per patient-year in the younger group and 0.12 per patient-year in the older (p < 0.01). Complication rate in grafts was 0.5 per patient-year in the younger group and 0.8 per patient-year in the older group (p < 0.05). There were no significant differences in patency rates for both autologous and graft accesses between patients younger or older than 65 years. Better primary patency (log-rank comparison between curves, p < 0.001), and lower complication rates (0.09 patient-year for autologous and 0.58 for grafts, p < 0.001), were observed in autologous fistulas in both groups. Conclusions: Autologous access is the best angioaccess for dialysis also in older patients and can be performed in most patients without a previous permanent access. Yet, we observed in our experience that more grafts were needed in patients older than 65 years.
8-Iso-Prostaglandin F2α as a Useful Clinical Biomarker of Oxidative Stress in ESRD Patients
Authors: Lim Paik-Seong , Chang Yei-Mei , Thien Lee-Moi , Wang Nai-Phong , Yang Chiu-Ching , Chen Tsen-Tsai , Hsu Wei-Min
Published: April 2003

Background/Aims: Chronic renal failure is associated with elevated indices of oxidative stress. We tested the hypothesis that the in vivo formation of the F2-isoprostane (8-iso-prostaglandin PGF2α), a bioactive product of arachidonic acid peroxidation, is enhanced in end-stage renal disease (ESRD) patients receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: Plasma samples were obtained from 35 HD patients, 30 CAPD patients and 30 age- and sex-matched healthy subjects for measurement of immunoreactive 8-iso-PGF2α. Results: Plasma 8-iso-PGF2α levels were significantly higher (p < 0.001) in HD and CAPD patients (346.3 ± 132.4 pg/ml; range 49.8–870) than in age-matched control subjects (150.9 ± 61.6 pg/ml; range 33.5–235). In addition, we also found that 8-iso-PGF2α concentration was significantly (p = 0.007) higher in HD patients (389.8 ± 148.3 pg/ml) than in CAPD patients (254.3 ± 76.6 pg/ml). Plasma 8-iso-PGF2α concentration was linearly correlated with serum haptoglobin, C-reactive protein (CRP) and plasma MDA (r = 0.58, p = 0.003; r = 0.29, p < 0.05 and r = 0.38, p < 0.05 respectively). On the other hand, plasma 8-iso-PGF2α levels were inversely associated with serum albumin and total cholesterol (r = –0.31 and r = –0.28, respectively; p < 0.05). Conclusions: We conclude that ESRD on both HD and CAPD is associated with increased formation of F2-isoprostanes, a correlate of enhanced lipid peroxidation. We also found that plasma 8-iso-PGF2α was casually related to some acute phase reactant proteins such as serum CRP, albumin and haptoglobin. This may provide an important biochemical link between lipid peroxidation, inflammation and accelerated atherosclerosis in the uremic milieu.
Epidemiological Data of Multiple Sclerosis in the Province ofEvros, Greece
Authors: Piperidou Haritomeni N. , Heliopoulos Ioannis N. , Maltezos Efstratios S. , Milonas Ioannis A.
Published: April 2003

The frequency of multiple sclerosis (MS) in Greece is still debated. Our previous epidemiological field survey with a cross-check study of MS on March 31, 1984, in the province of Evros in north-eastern Greece showed a prevalence rate of 10.1/100,000. In 1990, Milonas et al. recorded a prevalence rate of 29.5/100,000 in northern Greece. So Greece is classified in the medium-frequency zone according to Kurtzke. This study was performed to estimate the prevalence of MS in the province of Evros and the annual incidence rates from 1974 to 1999. Patients were identified from several sources. A clinical follow-up was performed in 95% of the cases, and, if clinically indicated, new paraclinical examinations were performed and cases classified by Poser’s criteria. The prevalence rate of the definite MS cases on December 31, 1999, was 38.9/100,000 and places the area in the high-risk zone. The mean annual incidence measured in 5-year intervals increased from 0.66/100,000 in 1974–1978 to 2.36/100,000 in 1994–1999 (p < 0.01). The increase in prevalence can be attributed to other causes than etiological changes, but the increase in the annual incidence rate indicates the possibility of a variation in risk factors of the disease.
Influence of the Platelet-Activating Factor Receptor Antagonist BB-882 on Intra-Abdominal Adhesion Formation in Rats
Authors: Otcu S. , Ozturk H. , Aldemir M. , Kilinc N. , Dokucu A.I.
Published: April 2003

Postoperative intra-abdominal adhesion formation is a major clinical problem. We aimed to examine the preventive effect of treatment with the platelet-activating factor (PAF) antagonist (lexipafant, BB-882) on experimentally induced intra-abdominal adhesion formation in rats. Twenty male Sprague-Dawley rats weighing 250 and 290 g were studied. Generation of adhesions in rats by brushing a 1-cm2 area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intra-abdominal administration of saline and 5 mg/kg in a volume of 0.2 ml PAF receptor antagonist BB-882. After 45 days, formation of adhesions was graded and histological evaluation was processed. The severity of adhesions was significantly less in the BB-882 group than in the control group (p < 0.001, p < 0.05). The average adhesion scores in the control and BB-882 groups were 3.2 ± 0.6 and 0.6 ± 0.6, respectively, and the difference between both groups was found to be significant (p < 0.0001). The number of polymorphonuclear leukocytes and fibrotic areas was significantly decreased in the BB-882 group when compared to the control group (p < 0.001, p < 0.002). In conclusion, this study confirms the efficacy of BB-882 in the prevention of postoperative intra-abdominal adhesions in a rat model.
Identification of Inwardly Rectifying Potassium Channels in Bovine Retinal and Choroidal Endothelial Cells
Authors: Eschke Dagmar , Richter Maik , Brylla Elke , Lewerenz Anne , Spanel-Borowski Katharina , Nieber Karen
Published: April 2003

Ion channels were studied using the whole-cell patch clamp technique in bovine retinal and choroidal microvascular endothelial cells (MVEC) cultured under the same conditions. The two types of MVEC expressed inward currents at hyperpolarizing voltage steps and showed small outward currents at depolarizing steps. The extrapolated reversal potentials of the inward currents were near to the potassium equilibrium potential. Cs+ and the K+ channel blocker TEA reduced the amplitudes of the currents indicating the selectivity and permeability for potassium. This was confirmed by changes of outside K+ concentration shifting the I-V curves to the right. RT-PCR studies revealed the presence of mRNA of Kir2.1, an inwardly rectifying K+ channel, in retinal and choroidal MVEC. The profile of the small outward currents is related to the Kv family but not identical with the Kv1.4 subtype.
Projection of Creutzfeldt-Jakob Disease Frequency Based on Cadaveric Dura Transplantation in Japan
Authors: Hamada Chikuma , Sadaike Tetsuji , Fukushima Masanori
Published: April 2003

Background: Projections of the size of the Creutzfeldt-Jakob disease (CJD) epidemic are of great importance for future health care and understanding of the natural history of this disease. Objective: We have estimated the incubation period and have projected the number of patients with iatrogenic CJD in Japan, using 75 patients who were transplanted with cadaveric dura mater grafts between 1979 and 1991 and developed CJD by the end of 2000. Methods: Several plausible scenarios, combinations of incubation period distribution forms, competing risks and exposure distributions were evaluated for the projections using data from the Japanese Ministry of Health, Labor and Welfare. Results: The range of median incubation periods from the time of dura mater transplantation to the onset of the disease was 10.8–34.3 years, and the range of the number of new CJD patients between 2001 and 2020 was 21–84. Conclusions: Since the potential incubation period was estimated to be considerably long, as few as 21 and as many as 84 new patients may develop CJD by 2020.
Ambient Air Quality and Occurrence of Multiple Sclerosis Relapse
Authors: Oikonen M. , Laaksonen M. , Laippala P. , Oksaranta O. , Lilius E.-M. , Lindgren S. , Rantio-Lehtimäki A. , Anttinen A. , Koski K. , Erälinna J.-P.
Published: April 2003

Infectious viruses and bacteria can trigger multiple sclerosis (MS) exacerbations. Seasonally changing concentrations of ambient air pollutants are known to predispose to transmissible infections, to induce systemic immune responses and to enhance existing peripheral inflammation. Ambient air quality and monthly MS relapse occurrence in south-western Finland were compared by multivariate logistic regression. The odds ratio of the risk of a relapse onset was over fourfold (4.143, p < 0.001) when the concentration of inhalable particulate matter (PM10) was at the highest quartile. Inhalable airborne particulate matter concentrations were connected to relapse occurrence. Poor air quality may enhance the seasonal changes in MS relapse occurrence by an increased susceptibility to transmissible infections.
The Role of Chronic Alcohol Intake in Patients with Spontaneous Intracranial Hemorrhage: A Carbohydrate-Deficient Transferrin Study
Authors: Herzig Roman , Urbánek Karel , Vlachová Ivanka , Křupka Bohdan , Gabryš Martin , Mareš Jan , Schneiderka Petr
Published: April 2003

Background and Purpose: Chronic alcohol intake is considered to be a risk factor for spontaneous intracranial hemorrhage (SICH). However, there is a lack of objective data in this field. The aim was to assess its role in hemorrhagic stroke objectively and to evaluate its correlation with the elevation of γ-glutamyltransferase (GGT) plasma levels. The reliability of patients’ anamnestic data concerning alcohol intake was also assessed. Methods: Laboratory assessment of the plasma carbohydrate-deficient transferrin (CDT) level was performed in 105 SICH patients and in a control group of 105 patients with dorsalgia. All patients were treated at the Clinic of Neurology, Faculty Hospital, Olomouc, Czech Republic. GGT plasma level values and anamnestic data concerning alcohol consumption were also analyzed. χ2 tests were applied when assessing statistical significance. Results: The CDT test was positive in 25.7% of SICH patients versus 7.6% of control group subjects (p = 0.0008). GGT plasma levels were elevated in 44.4% of SICH patients with a positive CDT test versus 25.6% of patients with a negative one. The GGT test is not reliable in the detection of alcohol intake when compared with the CDT test (p = 0.71). Only 13.0% of SICH patients with a positive CDT test (subgroup 1) stated regular and high consumption of all types of alcoholic beverages. Another 26.1% of these patients stated regular daily consumption of more than 1 liter, and 47.8% of them stated less than 1 liter of beer, with uncertain data concerning wine and spirits intake. Thirteen percent of subgroup 1 patients denied alcohol consumption altogether. Conclusions: Chronic alcohol consumption is at least one of several risk factors in one fourth of SICH patients in the Olomouc region of the Czech Republic. The CDT test is the most sensitive method to diagnose chronic alcohol consumption, and it is superior to the examination of GGT and the evaluation of patients’ anamnestic data.
Stroke in HIV-Infected Patients: A Clinical Perspective
Authors: Rabinstein Alejandro A.
Published: April 2003

The occurrence of stroke in patients with human immunodeficiency virus (HIV) infection has been traditionally associated with opportunistic infections and tumors, and advanced stages of immunosuppression. However, this reality is undergoing major changes. Effective antiretroviral regimens are now able to forestall the progression of HIV infection and avoid early mortality. As HIV-infected patients are growing older, clinicians are facing new challenges, including an increasing incidence of vascular complications. The use of protease inhibitors is associated with a variety of metabolic derangements that could produce accelerated atherosclerosis. Cerebrovascular hemodynamic function is impaired in HIV-infected patients with evidence of abnormal vasoreactivity even in otherwise healthy individuals. The potential contribution from these novel mechanisms should be added to the high incidence of classic vascular risk factors in the HIV-infected population and the cardiac abnormalities frequently observed in these patients. Large-scale epidemiological studies should be carried out to define the true incidence of stroke in HIV-infected patients and the factors associated with its occurrence.
Polymorphisms of Platelet Adhesive Receptors: Do They Play a Role in Primary Intracerebral Hemorrhage?
Authors: Iniesta Juan A. , Corral Javier , González-Conejero Rocio , Piqueras Claudio , Vicente Vicente
Published: April 2003

Background: Several reports suggested that polymorphisms affecting the structure or level of the main adhesive platelet glycoproteins (GPs) could behave as genetic risk factors for arterial thrombotic disorders. However, very few reports analyzed the significance of these polymorphisms in bleeding disorders. Interestingly, one study suggested a role of the 807 C/T polymorphism of the collagen receptor GP Ia in the severity of the bleeding manifestations in von Willebrand disease. The aim of this study was to evaluate the role of frequent polymorphisms affecting platelet GPs in primary intracerebral hemorrhage (PIH), the third most frequent cause of cerebrovascular disorder. Methods: We evaluated the role of four putative prothrombotic polymorphisms: GP Ia [807 C/T, and human platelet alloantigen system 5 (HPA-5)], GP Ibα (variable number of tandem repeats), and GP IIIa (HPA-1) in 141 Caucasian patients diagnosed of PIH, 141 race-, age-, sex- and risk factor-matched controls, and 446 subjects from the general population. Results: The frequency of genotypes and alleles were similar between patients and controls. Conclusions: Our results suggest that these polymorphisms play a minor role in PIH.
Diffuse Capillary Telangiectasia of the Brain Manifested as a Slowly Progressive Course
Authors: Tang Sung-Chun , Jeng Jiann-Shing , Liu Hon-Man , Yip Ping-Keung
Published: April 2003

Brain capillary telangiectasia (BCT) are usually small, solitary, benign in clinical manifestation, or found incidentally at autopsy. However, diffuse BCT are rarely reported. A 39-year-old woman had the first generalized seizure 10 years previously. Thereafter, she had sustained progressive spastic paraparesis and blurred vision. Computed tomography (CT) showed diffuse brain atrophy with numerous calcified spots. Contrast T1-weighted magnetic resonance images showed diffuse faintly enhancing lesions with stippled appearance in the whole brain. Cerebral angiography revealed multiple small nets of dilated capillaries and Xenon CT showed diffuse low cerebral blood flow in the resting and good cerebral reserve capacity in the acetazolamide challenge test. Therefore, diffuse BCT was diagnosed clinically. Although BCT are not rare, diffuse BCT with slowly progressive neurological symptoms had never been reported before. It causes global cerebral ischemia that lead to brain atrophy and a degenerative course.
Measurement of Global Cerebral Circulation Time Using Power Duplex Echo-Contrast Bolus Tracking
Authors: Schreiber Stephan Joachim , Kauert Andreas , Doepp Florian , Valdueza José Manuel
Published: April 2003

Ultrasound assessment of global cerebral circulation time (CCT) using echo-contrast bolus tracking is a new approach to characterise the perfusion status of the human brain. We present the analysis of global CCT in 36 healthy volunteers and one patient with a cerebral arteriovenous malformation (AVM), measured by extracranial power duplex. CCT was defined as the time interval between bolus arrival in the internal carotid artery and internal jugular vein. CCT in the volunteer group was 7.5 ± 1.1 s (mean ± SD). Values did not correlate with age, gender, blood pressure or blood flow velocity. Measurement in the AVM patient revealed a CCT of 1.5 s. Ultrasonographic CCT analysis is a promising new tool for the evaluation of cerebral hemodynamics.
Combined Cerebellar and Bilateral Cervical Posterior Spinal Artery Stroke Demonstrated on MRI
Authors: Reich P. , Müller-Schunk S. , Liebetrau M. , Scheuerer W. , Brückmann H. , Hamann G.F.
Published: April 2003

Combined cerebellar and spinal ischemic stroke is a rare, critical condition. We report a patient with combined cerebellar and bilateral posterolateral cervical spinal cord infarction due to bilateral stenosis of the vertebral arteries. MRI is the method of choice for imaging this condition; diffusion-weighted imaging of the spinal cord gives reliable results.
Adnexal Torsion during Pregnancy – Management and Literature Overview
Authors: Haenggi D. , Uehlinger U. , Heinzl S.
Published: April 2003

We present a patient in the 30th week of gestation with adnexal torsion, which was treated by laparotomy with oophorectomy. After 2 days, we had to perform a cesarean section because of bowel obstruction. We discuss the diagnosis and treatment of adnexal torsion in pregnancy and compare laparoscopic management with laparotomy. By reviewing the literature, we evaluate the conservative therapy by detorsion employing Doppler sonography.
Ist die Tubensterilisation noch eine zeitgemässe Verhütungsmethode?
Authors: von Mering Ruth , Merki Gabriele S. , Keller Paul J.
Published: April 2003

Die Sterilisation wird von etwa 30% der Frauen mit abgeschlossener Familienplanung als Verhütungsmethode gewählt. Die kontrazeptive Sicherheit der Sterilisation ist mit einem Pearl-Index von 0,18 mit der Sicherheit hormoneller ovulationshemmender Methoden und moderner Intrauterinpessare vergleichbar. Schwangerschaften, die trotz Sterilisation eintreten, liegen häufig extrauterin. Extrauteringravidität kommt vermehrt bei jungen Frauen vor. Es gibt derzeit keine Hinweise auf einen negativen Einfluss der Sterilisation auf das Menstruationsmuster, dennoch wird in einigen Studien für Frauen mit Status nach Sterilisation eine erhöhte Hysterektomierate gefunden. Das Risiko, an einem Karzinom von Uterus oder Mamma zu erkranken, ist für Frauen mit Status nach Sterilisation nicht erhöht. Frauen mit Status nach Sterilisation erkranken seltener an einem Ovarialkarzinom. Das Risiko, den Entscheid für eine definitive Antikonzeption zu bedauern, ist bei jungen Frauen (Alter <30 Jahre), die bereits Kinder geboren haben, deutlich höher als bei Frauen mittleren Alters (>30 Jahre). Die Antikonzeption mittels Sterilisation eignet sich daher vor allem für Frauen ab Mitte Dreissig mit abgeschlossener Familienplanung, insbesondere wenn Kontraindikationen für reversible Verhütungsmethoden bestehen. Generell sollte auch die Möglichkeit einer Vasektomie diskutiert werden.
Stellungnahme des Zürcher Gesprächskreises zum Gentest
Authors: Birkhäuser M. , Braendle W. , Breckwoldt M. , Keller P.J. , Kiesel L. , Kuhl H.
Published: April 2003

Leider besteht für diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfügung. Seit einiger Zeit wird ein Gentest angeboten, mit dem sich angeblich das individuelle Risiko für z.B. Herz-/Kreislauferkrankungen, Thrombosen, Osteoporose, Mammakarzinom oder Schwangerschaftskomplikationen durch die Analyse von 18 genetischen Parametern bzw. deren Polymorphismen erkennen lässt. Anhand der Ergebnisse dieses Tests soll es dann möglich sein, für jede Frau die optimale Hormonsubstitution festzulegen und die individuellen Krankheitsrisiken durch geeignete Massnahmen zu minimieren. Nach der Veröffentlichung einer kurzen Stellungnahme zu diesem Gentest im Addendum der jüngsten Empfehlungen des Zürcher Gesprächskreises zur Hormonsubstitution in ‘Frauenarzt’ 2/2002 gingen verschiedene Kommentare ein. Der Zürcher Gesprächskreis sieht sich deshalb veranlasst, zum Thema Polymorphismen eine ausführliche Stellungnahme abzugeben.
Für und gegen die Wassergeburt
Authors: Zanetti Dällenbach R. , Maertens A. , Hösli I.
Published: April 2003

Die Wassergeburt erfreut sich heute zunehmender Beliebtheit, und für viele Schwangere ist es heute eine Selbstverständlichkeit, dass diese Gebärmethode an der Klinik angeboten wird. Betrachtet man die heutige Datenlage der Literatur kritisch, darf der Schluss gezogen werden, dass diese Gebärmethode jeder Frau, welche zu einem Low-risk-Kollektiv gehört, angeboten werden darf. Dabei muss angeführt werden, dass zum Thema Wassergeburt bisher keine prospektiv randomisierten Studien publiziert worden sind. Dem Wunsch der Frau, im Wasser zu gebären, darf also nachgekommen werden. Dabei müssen Richtlinien und der allgemein übliche Sicherheitsstandard der jeweiligen Klinik aber kompromisslos eingehalten werden, um keine unnötigen Risiken einzugehen.
Serum Soluble Interleukin-2 Receptor in Eosinophilia
Authors: Kaito Ken , Otsubo Hiroko , Ogasawara Yoji , Kimura Hiroko , Kurihara Etsuko , Koike Masaru , Aiso Masayoshi , Kobayashi Masayuki
Published: April 2003

The relationship between soluble interleukin-2 receptor (sIL-2R) levels and clinical characteristics was evaluated in patients with eosinophilia. Thirty-eight out of 60 patients showed sIL-2R levels of more than 800 U/ml. In these patients, sIL-2R was closely related to the eosinophil count, but not the IgE level. Their underlying diseases were heterogeneous, including neoplasms and collagen diseases. In patients with lower sIL-2R levels, there was no relationship to the eosinophil count, but sIL-2R was correlated with the IgE level. These findings indicate that patients with eosinophilia and higher sIL-2R levels tend to have underlying diseases other than allergy, and might be more severely ill than patients with lower sIL-2R levels. sIL-2R may be a good marker for evaluating patients with eosinophilia, as an indicator of the probable etiology and severity of their diseases.
A Test for the Determination of Sustained Attention in Patients with Obstructive Sleep Apnea Syndrome
Authors: Randerath Winfried J. , Gerdesmeyer Carsten , Siller Karsten , Gil Galina , Sanner Bernd , Rühle Karl-Heinz
Published: April 2003

Background and Objectives: To investigate the parameter daytime sleepiness in patients with the sleep apnea syndrome (SAS), a test for measurement of sustained attention was developed. The present studies were performed on volunteers undergoing preemployment medical examinations and SAS patients to determine the extent to which test results are in agreement with the symptoms of SAS and traffic accident reports, and also with daytime sleepiness, and whether learning or therapeutic effects can be seen with repeated tests prior to and following treatment with nasal continuous positive airway pressure (nCPAP). Methods: Participants: 125 healthy volunteers, and two groups of 28 SAS patients each. Design: Study A: The volunteers underwent a single attention test and completed a questionnaire concerned with traffic accidents and symptoms of sleep-related breathing disorders. Study B: SAS patients underwent two attention tests before treatment. Study C: SAS patients underwent one attention test before and one after nCPAP therapy. Results: Study A: The error rate in volunteers without symptoms of sleep-related breathing disorders (51 persons) was 4.7 ± 4.3% (number of errors 14.1 ± 12.9), 95% CI: 1.2 (number of errors 3.6). No dependence of the error rate on age, BMI or sex was found. In persons with a history of apneic events (n = 10), the error rate was 10.6 ± 10.0% (number of errors 31.8 ± 30), in those with more than two accidents during the last 5 years (n = 4), it was increased to 15.3 ± 9.7% (number of errors 45.9 ± 29.1). Study B: Among SAS patients, no significant learning effect was seen, and prolongation of the test duration beyond 30 min had no effect on the test results. Study C: The error rate improved significantly with nCPAP [10.6 ± 13.5 vs. 6.4 ± 8.9% (number of errors 31.8 ± 40.5 vs. 19.2 ± 26.7), p < 0.001]. Conclusions: The attention test can be helpful for the measurement of daytime sleepiness, and CPAP therapy can improve test performance.
Technique and Value of Staging Laparoscopy
Authors: Giger U. , Schäfer M. , Krähenbühl L.
Published: April 2003

Despite significant improvements in preoperative tumor staging due to sophisticated new imaging and interventional techniques, peritoneal tumor spread and occult liver and lymph node metastases are only detected during surgery in some patients. Newer treatment modalities using neoadjuvant regimens are only given if occult tumor spread is excluded. Diagnostic laparoscopy has therefore been introduced to prevent patients with advanced tumor disease from unnecessary laparotomy and as a diagnostic tool in neoadjuvant treatment protocols. Laparoscopic ultrasound represents an important technical improvement in diagnostic laparoscopy. The main indication for diagnostic laparoscopy is therefore exact tumor staging, especially in terms of peritoneal, liver, and lymphatic tumor spread, whereas determination of local tumor resectability is not the main issue. The aim of the current review is to summarize the technique of staging laparoscopy and to discuss its clinical value for a variety of gastrointestinal malignancies.
Intraoperative Suspicion of Gallbladder Carcinoma in Laparoscopic Surgery: What to Do?
Authors: Kraas E. , Frauenschuh D. , Farke S.
Published: April 2003

The frequency of gallbladder cancer in Europe is less than 1% of all gallstone operations. With the introduction of laparoscopic surgery and the higher acceptance of this technique, patients with gallstones have gallbladder removal much earlier in their gallstone history. So the percentage of gallbladder carcinomas will decrease in the future. We report on our surgical procedures in patients with suspicious gallbladders having laparoscopic gallbladder removal, and how to proceed after the diagnosis of gallbladder carcinoma. From June 1990 to December 2001, we have performed 7,130 cholecystectomies in a single department. 47 of these patients (0.66%) were identified as having carcinoma. There were 40 females and 7 males, with a mean age of 70.6 years. In 17 cases (36%) there was a preoperative suspicion of malignancy. Most commonly, in 30 cases (64%), malignancy was suspected intraoperatively or diagnosed postoperatively after pathological examination of the resected gallbladder. We recommend removal with a bag for all gallbladders with a suspected wall or scleroatrophic calcified gallbladder area. In stage Tis or T1 laparoscopy + cholecystectomy is sufficient. For T2 and T3 we perform reoperation with liver bed resection and lymphadenectomy.
Specimen Retrieval in Laparoscopic Colon Surgery
Authors: Hackert T. , Uhl W. , Büchler M.W.
Published: April 2003

In the past decade, for benign as well as malignant colon diseases, minimally invasive surgery has gained more and more importance in colon surgery. Specimen retrieval after colonic resections is difficult due to the large size of the specimen usually resected. To date there is no standardized retrieval technique for the different procedures. Four incision sites are common for transabdominal specimen retrieval: left or right lower quadrant transrectal portside incision; periumbilical midline incision, and transverse suprapubic incision. Perineal incisions are used for retrieval following low anterior resection or abdomino-perineal extirpation. Three major complications are described in the literature: wound infection (0–9%); hernias (0–2%), and incision site recurrence (0–1.3%). There are no significant differences between the different incision sites with regard to the occurrence of complications. In laparoscopic surgery for malignant diseases retrieval is usually performed using a plastic bag, whereas retrieval can be performed hand-assisted without a bag during surgery for benign diseases. Wound edge protectors are recommended by several authors, yet there is no standard system which is accepted broadly. In conclusion, specimen retrieval in laparoscopic colon surgery is not standardized. The morbidity rate for specific retrieval complications ranges between 0 and 9%, yet there are no randomized controlled studies or evidence-based data regarding different retrieval approaches and systems.
Stage pT1 Renal Cell Carcinoma: Review of the Prognostic Significance of Size
Authors: Zucchi Alessandro , Mearini Luigi , Mearini Ettore , Costantini Elisabetta
Published: April 2003

Introduction: The last TNM classification (before 1997) defined T1 kidney tumour as a tumour <2.5 cm, limited to the kidney: this cut-off point was changed in 1997 and T1 neoplasm was defined as <7 cm. This new cut-off now includes past T1 and T2 diseases, without any differences in terms of prognoses. We performed a retrospective analysis of our cases and specifically investigated if there were any differences in terms of prognosis in a group of patients, currently identifiable as pT1, if they were divided into two subgroups based on tumour pathological sizes. Materials and Methods: Our analysis involved 128 patients (mean age 57.6 years) who underwent radical nephrectomy or nephron-sparing surgery in the period between 1990 and 2000. All these patients were pT1 according to the new TNM classification and were divided into two groups according to different cut-off point sizes (from 2.5 to 5 cm). We analysed the surgical approach, overall survival and cancer-specific mortality in the two subgroups, renamed as pT1a and pT1b, and performed a statistical analysis of the results using the Kaplan-Meier method to prove if this substaging identified changes in survival outcome. Results: We obtained more interesting results for a 5-cm cut-off: the two groups showed a similar follow-up and overall survival rate but different cancer-specific mortality rate (6 vs. 12.1%). The statistical analysis showed that the two survival curves (pT1a vs. pT1b disease) had a similar trend up to about 60 months; after this period the two curves diversify with a drop in survival rate among patients with larger tumours (pT1b patients). Conclusions: It would seem reasonable to reassess the TNM classification of stage pT1 in order to better define prognosis in this group of patients.
Effects of Castration on Nitric Oxide- Mediated Relaxations in Male Rat Corpus cavernosum Smooth Muscle
Authors: Wada Yoshihiro , Kuwahara Tomohiro , Takahashi Wataru , Yoshida Masaki , Iwashita Hitoshi , Ueda Shoichi
Published: April 2003

Background: The effects of castration on nitric oxide- mediated relaxations and nitric oxide synthase activity in male rat corpus cavernosum smooth muscles. Methods: Eight-week-old male rats were assigned to two groups: control (sham operated) and castrated animals. After 8 weeks, corpus cavernosum smooth muscle strips were mounted in an organ bath for isometric tension recordings. Electrical field stimulation (EFS) was applied to the strips precontracted with 30 µM phenylephrine. The microdialysis probe was inserted into the strip, and Krebs-Henseleit solution was perfused into the probe. The dialysate during EFS and cholinergic stimulation was collected, and the amount of NO–2/NO–3 (NOx) released in the dialysate was measured by the Greiss method. Sodium nitroprusside and carbachol were cumulatively added to the strips precontracted with 30 µM phenylephrine. Results: EFS caused frequency-dependent relaxations and NOx releases in the strips. Pretreatment with Nω-nitro-L-arginine (100 µM) and tetrodotoxin (1 µM) completely inhibited relaxations and NOx releases. The maximum relaxation in the castration group was significantly greater than that in the control group. The release of NOx was significantly greater in the castration group than in the control group. Sodium nitroprusside relaxed the tissues in both groups similarly. Carbachol failed either to relax the tissue or to increase the amount of NOx production in the tissue. Conclusion: The present data suggest that castration enhances nitric oxide synthase activity and nitric oxide-mediated relaxations in the male rat corpus cavernosum.
Use of Percent Free Prostate-Specific Antigen Density to Improve the Specificity for Detecting Prostate Cancer in Patients with Normal Rectal Examinations and Intermediate Prostate-Specific Antigen Levels
Authors: Baltaci Sümer , Aksoy Hakan , Türkölmez Kadir , Elhan Atilla H. , Özden Eriz , Gogus Orhan
Published: April 2003

Introduction: As prostatic volume influences percent free prostate-specific antigen (PSA) in patients with prostate cancer, we evaluated whether percent free PSA density, which relates the serum percent free PSA to the volume of the prostate determined by transrectal ultrasound, could increase the specificity of cancer detection in men with normal digital rectal examinations and intermediate PSA levels. Materials and Methods: We prospectively evaluated 105 consecutive men with normal digital rectal examinations and serum PSA levels of 4.1–10.0 ng/ml. All patients underwent at least sextant prostate biopsies to establish the diagnosis. For detection of total and free PSA we used an Immulite free and total PSA assay. We compared PSA density, percent free PSA and percent free PSA density for their utility in cancer detection. Results: Overall, 20 of 105 patients (19%) had prostate cancer. The area under the curve (AUC) for percent free PSA density was 0.771, not significantly higher than the AUC of 0.75 for PSA density (p = 0.778), but significantly higher than the AUC of 0.604 for percent free PSA (p = 0.021). Of these three parameters, percent free PSA density yielded the highest specificity percentage (54.1%) at 95% sensitivity. Conclusions: Percent free PSA density is more specific than percent free PSA in distinguishing benign from malignant disease in men with a normal digital rectal examination and an intermediate PSA level. Further study is necessary to discover whether percent free PSA density is superior to percent free PSA or PSA density.
Behaviour of Cytokine Levels in Serum and Peritoneal Fluid of Women with Endometriosis
Authors: Pizzo Alfonsa , Salmeri Francesca M. , Ardita Francesca V. , Sofo Vincenza , Tripepi Maria , Marsico Silvano
Published: April 2003

Endometriosis is a disorder characterised by presence and growth of endometrial tissue outside the uterus, primarily into the peritoneum. The peritoneal fluid (PF) of women with endometriosis undergoes a number of biological changes, including local inflammatory-reparative phenomena and peripheral blood mononuclear cells (PBMC) involvement. These activated cells as well as the endometriotic cells secrete various cytokines with pleiotropic biological activities. Dynamic interplay among cytokines may contribute to realise a favourable microenvironment for the implantation of endometrial cells and the progression of the disease. In the present study, we evaluated the levels of cytokines, such as the tumour necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) in PF and in serum (S) of women with endometriosis to compare their behaviour in both biological fluids. The patients (n = 26) were women of reproductive age attending our observation centre for infertility, diagnosed endometriosis at laparoscopy. Control group (n = 5) consisted of women affected by non-immunologic infertility, diagnosed by explorative laparoscopy. S samples were obtained from peripheral blood before anaesthesia and laparoscopy. PF samples were collected at the time of laparoscopy. Both biological fluids were examined for cytokine by ELISA assays. Our results showed that S and PF levels of TNF-α, not dosable in controls, were very high at the early stage and decreased significantly with the severity of the disease (p < 0.001). TGF-β levels were significantly (p < 0.001) higher than in controls and increased with the severity of the disease (p < 0.001), particularly in the PF. S and PF IL-8 as well as MCP-1 concentrations at all stages were higher than in controls (p < 0.001), yet showed an opposite behaviour in both biological fluids. In fact, S levels of IL-8 and MCP-1 were significantly (p < 0.001) higher at early stages and decreased with the severity of the disease, whereas we observed a significant (p < 0.001) enhancement of these chemokine levels in PF from stage I to stage II and stage III. These observations showed that TNF-α and TGF-β levels were overlapping in S and PF of women with endometriosis. On the contrary, MCP-1 and IL-8 S concentrations decreased with the severity of the disease, whereas PF levels showed markedly increased at severe stages. Taken together the observed changes may be due both to the increased peritoneal macrophage activity and to the larger recruitment of PBMC and autocrine release by endometriotic cells.
Acute Coronary Syndrome and Early Statin Therapy: What Is the Evidence?
Authors: Okkels Jensen Lisette , Steen Hansen Henrik
Published: April 2003

In patients with stable ischemic heart disease, lipid-lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) markedly reduces long-term morbidity and mortality. In trials where statin therapy has been initiated as secondary prevention after an acute coronary syndrome (ACS), treatment has been initiated 3–6 months after the event. In the unstable clinical state after an ACS, patients experience a high rate of serious complications including death and myocardial infarction. The incidence of serious complications declines after 1 month and then gradually diminishes. It has not been determined whether initiation of statin therapy soon after an ACS can reduce the occurrence of early coronary events. Statins have effects on the vessel wall beyond a lipid-lowering effect, which may partly account for the benefit of statin therapy. It is not yet clarified if these mechanisms are associated with a prognostic effect soon after an ACS.
Left Ventricular Hypertrophy in Hypertension
Authors: Liebson Philip R.
Published: April 2003

Because of the importance of left ventricular (LV) hypertrophy (LVH) as a strong independent risk factor for adverse cardiovascular events, clinical trials of the treatment of hypertension have recently focused on the efficacy of antihypertensive agents to decrease LV mass. Although a decrease in LV mass appears in general to correlate with reduction of blood pressure, considerable variation is found. Clinical trials have found, for example, that decreases in LV mass tend to correlate with duration of treatment, class of antihypertensive agent and initial LV mass. Although there has been concern about possible adverse effects on LV function if antihypertensive agents are stopped abruptly after regression of LVH and blood pressure increases to previous levels, no evidence has been found for decreased LV function after 1 month. Regression of LVH has been found to produce such beneficial effects as a decrease in dysrhythmias and normalization of diastolic function. Most importantly, recent clinical trials have been designed to assess the independent effects of decreased LV mass on cardiovascular events. Preliminary studies suggest a decrease in cardiovascular morbidity.
Alcohol Consumption in Heroin Users, Methadone-Substituted and Codeine-Substituted Patients – Frequency and Correlates of Use
Authors: Backmund Markus , Schütz Christian G. , Meyer Kirsten , Eichenlaub Dieter , Soyka Michael
Published: April 2003

This retrospective study aims to determine whether there is a difference in the additional consumption of alcohol between addicts treated with methadone or dihydrocodeine (DHC) and untreated addicts injecting heroin.1,685 patients admitted for opioid withdrawal between 1991 and 1997 were reviewed. Cross-reference tables and multiple logistic regression analyses were carried out. 28% of patients take more than 40 g of alcohol daily (on average 176 g). We found that patients who are treated with methadone or DHC drink alcohol significantly more often daily than the heroin-dependent patients (p < 0.01). Using multiple regression analyses, the results were confirmed. Additionally, we found that co-abuse of alcohol was predicted by male gender, longer duration of drug use, additional daily consumption of tetrahydrocannabinol and daily consumption of benzodiazepines. Alcohol consumption by opioid-addicted patients treated with methadone or DHC presents a serious medical problem. Co-abuse of alcohol will receive more attention.
Entering a Community of Minds: An Experiential Approach to ‘Theory of Mind’
Authors: Nelson Katherine , Plesa Skwerer Daniela , Goldman Sylvie , Henseler Sarah , Presler Nechama , Fried Walkenfeld Faye
Published: April 2003

Entering a community of minds is conceptualized as a theoretical framework for understanding social cognitive development during the preschool years. This framework incorporates an experiential and social-pragmatic view of cognitive development. How language functions to advance the development of children’s understanding of the social world is a central issue within this framework. Two studies of 3- and 4-year-old children solving theory-of-mind-like problems and engaging in discourse about their responses are discussed in terms of the community of minds proposal, in particular that changes in their understanding of mental states reflect participation in discourse about social interactions within pragmatic contexts.
Neopterin and Macrophage Inflammatory Protein-1α in the Cerebrospinal Fluid of Schizophrenic Patients: No Evidence of Intrathecal Inflammation
Authors: Nikkilä Heikki V. , Ahokas Antti , Wahlbeck Kristian , Rimón Ranan , Andersson Leif C.
Published: April 2003

Background: Numerous reports support the idea that inflammatory and/or immunological processes contribute to the etiopathogenesis of schizophrenia. Most of the data are, however, based on findings from body compartments outside the central nervous system (CNS). We measured the concentrations of the inflammatory marker neopterin and the chemokine macrophage inflammatory protein-α (MIP-1α) in the cerebrospinal fluid (CSF) of acutely psychotic schizophrenic patients and of healthy controls. Methods: The concentration of neopterin was measured in the CSF of 11 schizophrenic patients by radioimmunoassay, and of MIP-1α in the CSF from 8 patients using ELISA. Control CSF was collected from 10 and 8 healthy individuals. Results: No statistically significant differences in CSF neopterin or MIP-1α were detected between patients and controls or between the patient samples obtained on hospital admission and after the treatment period associated with clinical improvement. Conclusions: These findings argue against the hypothesis that active inflammatory processes are part of the pathophysiology of acute psychotic episodes in schizophrenia. The possible mechanisms explaining the previously reported aberrations of mononuclear cells and cytokines in schizophrenia are discussed.
Effects of Mirtazapine on Sleep Polygraphic Variables in Major Depression
Authors: Schittecatte Michel , Dumont Françoise , Machowski Robert , Cornil Catherine , Lavergne Francis , Wilmotte Jean
Published: April 2003

Mirtazapine, a noradrenergic and specific serotonergic antidepressant(NaSSA), was administered on a flexible schedule in a sample of 17 drug-free patients meeting DSM-IV criteria for a major depressive episode. Sleep polygraphic recordings were performed before and during acute and chronic treatment. Severity of depression and subjective assessment of changes within different aspects of sleep were also evaluated. During the acute administration (first 2 days), mirtazapine significantly increased total sleep time, sleep efficiency, stage II, stage rapid eye movement and slow-wave sleep percentages, and decreased sleep latency and stage awake percentage. These effects persisted after 5 weeks of treatment. Subjectively, mirtazapine induced an improvement of sleep. This open, noncontrolled study suggests that mirtazapine ameliorates the sleep disturbances encountered in depressed patients both objectively and subjectively.