bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of the Vitreous in Retinal Detachment Surgery with External Buckling
Authors: Mester Ulrich , Anterist Nicola , Kroll Peter , Brieden-Azvedo Silvia
Published: April 2003

Purpose: To prove the role of the vitreous in retinal detachment surgery with scleral buckling procedures, we retrospectively investigated the charts of patients who were operated on for retinal detachment by scleral buckling between January 1995 and June 1997. Methods: Out of a total of 718 cases, 41 retinal detachments occurred in previously vitrectomized eyes. The buckling procedure consisted of silicone sponge explants in 513 cases (254 radial, 259 circumferential) and of encircling elements in 202 cases. Three eyes received a temporary balloon. The minimal follow-up was 3 months. Results: After primary surgery in the 677 nonvitrectomized eyes, the retina was attached in 482 eyes (71.2%), after reoperation in 627 eyes (92.6%). With up to 3 reoperations (including vitrectomy with gas or silicone oil tamponade in 79 eyes), the final success rate was 98.7%. The corresponding reattachment rates in the 41 vitrectomized eyes were 82.9% after primary surgery and 97.6% after reoperation. Repeated surgery in 6 eyes consisted of successful internal tamponade by silicone oil. The reattachment rates after primary buckle procedure are of most interest to the role of the vitreous: the highest success rate (82.9%) was achieved in the vitrectomized eyes versus 71.2% in the nonvitrectomized eyes. The difference is statistically not significant. Conclusions: We therefore conclude that the absence of the vitreous has no adverse effect on the results of buckling procedures for retinal detachment. The choice of the surgical technique in treating retinal detachments in vitrectomized eyes should only determined by retinal findings such as the number and extent of breaks or the presence and stage of proliferative vitreoretinopathy.
Consecutive Exotropia following Strabismus Surgery
Authors: Oğuz Velittin , Arvas Sema , Yolar Murat , Kizilkaya Melda , Tolun Hayati
Published: April 2003

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.
Colour Doppler Assessment of Blood Flow in Eyes with Central Retinal Vein Occlusion
Authors: Ozbek Z. , Saatci A.O. , Durak I. , Kaynak S. , Ergin M.H. , Öner B. , Çıngıl G.
Published: April 2003

Purpose: To assess the blood flow changes in eyes with central retinal vein occlusion (CRVO) and compare these values with values of fellow eyes and eyes of normal subjects. Methods: 25 eyes of 25 consecutive newly diagnosed patients with CRVO comprised the study group. Their fellow eyes and those of 25 healthy subjects were the control group. All patients underwent a complete ophthalmological examination. Eyes with CRVO were classified into two groups as non-ischaemic and ischaemic by fundus fluorescein angiography. Colour Doppler imaging was performed with a Toshiba Sonolayer SSH-140A and 7.5-MHz linear array probe. Maximum systolic velocity (Vmax), end-diastolic velocity (Vmin) and resistive index (Ri) values were noted for each of the central retinal artery (CRA), central retinal vein (CRV) and ophthalmic artery (OA). These parameters were compared with those of the fellow eyes and both eyes of the control group. Results: Mean ages were 63.55 and 61.45 years in the CRVO and control groups, respectively. Age and sex distributions were statistically identical in both groups. When we compared the eyes with CRVO to the control group, no statistically significant difference existed between the two groups with regard to the Vmin and Ri values of the CRA and CRV. However, Vmax  values of the CRA and CRV were significantly lower in CRVO eyes when compared to the control group. The CRVO group and control group had similar Vmax, Vmin  and Ri values for the OA. Only the Vmax was significantly lower in the CRV in eyes with CRVO when compared to the unaffected fellow eyes. No statistically significant difference could be detected between any of the parameters of CRA, CRV and OA of the ischaemic and non-ischaemic CRVO groups. Conlusions: More data on broader series need to be obtained in order to decide on the practical use of colour Doppler imaging in the differentiation of ischaemic eyes from non-ischaemic eyes in CRVO.
Self-Enucleation in Drug-Related Psychosis
Authors: Bergua Antonio , Sperling Wolfgang , Küchle Michael
Published: April 2003

Objective: To report on a patient who committed self-enucleation with his own fingers. Methods: Case report of a 28-year-old man who self-enucleated his right eye. After ophthalmological treatment, he was referred to the psychiatric department for further evaluation and treatment. Results: Reconstruction of the orbit was performed, and neither ophthalmological nor neurological complications were noted. The psychiatric history revealed continuous drug abuse (cannabis and amphetamines). The diagnosis of a drug-induced psychosis was established. Conclusions: Self-enucleation or ‘oedipism’ is a rare entity which requires, besides an operative reconstruction of the orbit, neurological monitoring to prevent possible intracranial complications. Long-term psychiatric therapy should be attempted to prevent further self-injurious behaviour.
Monoclonal Antibodies against the CεmX Domain of Human Membrane-Bound IgE and Their Potential Use for Targeting IgE-Expressing B Cells
Authors: Chen Huan Yuan , Liu Fu-Tong , Hou Charlie M.H. , Huang Janice S.W. , Sharma Bhavya Bhavna , Chang Tse Wen
Published: April 2003

Background: IgE mediates immediate-type hypersensitivity reactions responsible for various allergic symptoms. It is secreted by IgE-producing plasma cells, which differentiate from B cells expressing membrane-bound IgE (mIgE) on their surface. The Ε-chain of human mIgE contains a membrane-anchoring peptide and an extra 52-amino-acid (a.a.)-long domain (referred to as CΕmX) between the membrane anchor and the CH4 domain. Objective: The study was designed to evaluate the effects of CΕmX-specific monoclonal antibodies (mAbs) to target IgE-expressing B cells and decrease IgE production. Methods: A CΕmX-containing IgG1.Fc fusion protein was produced in CHO cells and used to immunize mice; five hybridoma clones secreting CΕmX-specific mAbs were obtained. Results: Characterization of the mAbs using ELISA, immunoprecipitation, and immunoblotting methods showed that they could bind to both native and denatured forms of CΕmX. The mAbs exhibited mutual inhibition of binding to mIgE. Epitope mapping using synthetic peptides revealed that all five mAbs recognize the same epitope, RADWPGPP, located near the C-terminus of CΕmX . Binding of one of the mAbs to mIgE on SKO-007 cells induced the cross-linking of mIgE molecules on the cell surface, resulting in their patching and capping. In vitro functional analysis revealed that mAbs are able to cause complement-mediated cytotoxicity on transfectants expressing the Fc portion of mIgE. Conclusion: We have prepared several human mIgE-specific mAbs. The potential of the mAbs on targeting mIgE+ B cells was demonstrated by CDC analysis.
Immunological and Structural Analysis of IgE-Mediated Cross-Reactivity between Manganese Superoxide Dismutases
Authors: Flückiger Sabine , Scapozza Leonardo , Mayer Christina , Blaser Kurt , Folkers Gerd , Crameri Reto
Published: April 2003

Background: Allergy results from inappropriate immune responses to normally innocuous proteins. More than 300 IgE-binding proteins have been cloned and shown to cover structurally and functionally heterogeneous protein families including enzymes, backbone and storage proteins as well as proteins with unknown function. Structurally related cross-reactive allergens are involved in the pathogenesis of important clinical syndromes. We found that phylogenetically highly conserved proteins, including human manganese superoxide dismutase (MnSOD), are involved in IgE-mediated autoreactivity. Methods: MnSOD cloned from different phylogenetically distant species were produced as recombinant proteins in Escherichia coli and used to study IgE-mediated cross-reactivity and proliferative responses in peripheral blood mononuclear cells (PBMC) of individuals sensitised to Aspergillus fumigatus MnSOD. Homology models of the three-dimensional structures of MnSOD from A. fumigatus, Drosophila melanogaster and Saccharomyces cerevisiae using the human MnSOD structure refined at 2.2 Å as template were constructed to identify conserved amino acid residues exposed to the solvent. Results: Cross-reactivity between the MnSOD at B and T cell level was demonstrated by inhibition experiments showing shared B cell epitopes and by the capability of the different MnSODs to induce proliferative responses in PBMCs of sensitised individuals. Structural modelling allowed to identify conserved residues exposed to the solvent. The identified residues are scattered over the sequence of the enzyme indicating putative conformational IgE-binding epitopes. Conclusions: The results obtained corroborate molecular mimicry as a plausible mechanism to explain autoreactivity to human MnSOD. Moreover, homology modelling provides a rational tool to identify conserved residues involved in defining cross-reactive B cell epitopes.
Bcl-xL Antisense Oligonucleotides Chemosensitize Human Glioblastoma Cells
Authors: Guensberg Patrick , Wacheck Volker , Lucas Trevor , Monia Brett , Pehamberger Hubert , Eichler Hans-Georg , Jansen Burkhard
Published: April 2003

Background: Resistance to chemotherapy in glioblastoma has been linked to the expression of antiapoptotic Bcl-2 family members including Bcl-xL. Methods: Bcl-xL expression was specifically reduced in M059K glioblastoma cells with antisense oligonucleotides (ISIS 16009, ISIS 16967) as assessed by Western blotting. Induction of apoptosis by treatment with antisense oligonucleotides in combination with paclitaxel in cell culture was monitored by WST-1 assays and flow cytometric analysis. Results: Antisense oligonucleotide-mediated reduction of Bcl-xL levels led to enhanced cytotoxicity in M059K cells when compared to the use of a mismatch control oligonucleotide (p < 0.001). A decreased threshold for the induction of apoptosis led to significantly enhanced cytotoxic responses to paclitaxel treatment in WST-1 assays (p < 0.001) and flow cytometric analyses. Conclusion: Combination treatment using Bcl-xL antisense oligonucleotides and paclitaxel may qualify as a promising strategy to ultimately improve the clinical outcome of glioblastoma.
Eosinophilic Fasciitis (Shulman Syndrome)
Authors: Mosconi Sandro , Streit Markus , Brönimann Marcel , Braathen Lasse R.
Published: April 2003

We report a case of a 30-year-old Caucasian patient with progressive sclerosis of the skin mainly on the upper limbs which was diagnosed as eosinophilic fasciitis (Shulman syndrome). Circulating antibodies against Borrelia burgdorferi were detected. The association of B. burgdorferi infection with eosinophilic fasciitis is discussed.
Weaning from Mechanical Ventilation by Long-Term Nasal Positive Pressure Ventilation in Two Patients with Acute Respiratory Distress Syndrome Associated with Pneumococcal Sepsis
Authors: Windisch Wolfram , Storre Jan Hendrik , Matthys Heinrich , Sorichter Stephan , Virchow Jr. Johann Christian
Published: April 2003

Only few data concerning weaning by nasal positive pressure ventilation (NPPV) are available, and successful weaning by using NPPV in patients with acute respiratory distress syndrome (ARDS) and severe complications has not yet been described. Two cases with ARDS and both preexisting thoracopulmonary disease (infundibulum abnormality and suspected COPD) and associated complications (recurrent sepsis, acute renal failure, need for lobectomy, severe malnutrition) could not be weaned by invasive ventilatory techniques. Both patients presented with rapid shallow breathing and PaCO2 values >60 mm Hg during intermittent trials of spontaneous breathing, although the primary pathology and associated complications had been resolved. Patients were successfully adapted on NPPV in a stepwise approach after 93 days and 67 days of invasive ventilation. In one patient withdrawal from NPPV was possible after 2 months. In the other patient the duration of daily ventilation could be significantly reduced from 18 to 6 h/day after 9 months on NPPV. Therefore, patients with ARDS who cannot be weaned by invasive ventilatory strategies might be removed successfully from invasive mechanical ventilation by using NPPV even when there are preexisting thoracopulmonary disease and major complications during invasive ventilation.
Necrotizing Sarcoid Granulomatosis Presenting with Elevated Serum Soluble Interleukin-2 Receptor Levels
Authors: Harada Toshiyuki , Amano Toraji , Takahashi Ayumu , Furuya Jungo , Yamaguchi Etsuro , Kaji Mitsuhito , Morikawa Toshiaki , Itoh Tomoo , Shimizu Michio , Nishimura Masaharu
Published: April 2003

A 52-year-old woman presented with a one-week history of low-grade fever and dyspnea. A CT scan showed multiple pulmonary nodules with cavitation, as well as bilateral pleural thickenings with effusions. A specimen resected by video-assisted thoracoscopic surgery showed multiple confluent granulomas with central necrosis and granulomatous vasculitis. These findings were consistent with necrotizing sarcoid granulomatosis. An elevated serum soluble interleukin-2 receptor level became normal following clinical and radiological improvement. This indicates that the serum soluble interleukin-2 receptor can be a useful marker for the clinical management of necrotizing sarcoid granulomatosis.
Tidal Volume Forced Expiration in Asthmatic Infants: Reproducibility and Reversibility Tests
Authors: Lagerstrand Lars , Ingemansson Maria , Bergström Sten Erik , Lidberg Karin , Hedlin Gunilla
Published: April 2003

Background: The tidal volume forced expiration technique used in infants is considered as the first practical noninvasive method of assessing airway physiology in infants. However, its role has been discussed mainly due to the high variability of the derived parameters. Objectives: The aim of the study was to assess the reproducibility of a complete measurement with the tidal volume forced expiration technique in infants as measured by the maximal flow at FRC (v̇maxFRC). A second aim was to evaluate the bronchial reversibility test in infant asthma. Methods: Thirty infants with asthma were investigated with the tidal volume forced expiration technique twice with 10 min in between and a third time 10 min after inhalation of terbutalin 0.5 mg. Results: The mean v̇maxFRC in the first investigation was 285 ml·s–1 (coefficient of variation 57%), unchanged in the second investigation and significantly lower than the mean predicted value of 404 ml·s–1. The relative difference between the 2 investigations of v̇maxFRC was mean 10.5% (SD 8.4) of the absolute v̇maxFRC value and independent of the size of this v̇maxFRC value. The 95% confidence interval for individual changes would then be up to 27% (mean + 2 SD). The infants with the lowest v̇maxFRC percent predicted decreased further in v̇maxFRC after inhalation of the bronchodilator (p < 0.05). Conclusions: The tidal volume forced expiration technique was able to measure flow at late expiration with the same reproducibility as seen with spirometry in adults, even if the flow was low. We found the technique acceptable for clinical practice and research, but the results from reversibility tests are difficult to interpret. A significant change of v̇maxFRC would, however, be 27% or more.
Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants
Authors: Wildhaber Johannes H. , Dore Nigel D. , Devadason Sunalene G. , Hall Graham L. , Hamacher Jürg , Arheden Lars , LeSouëf Peter N.
Published: April 2003

Objectives: The aim of this study was to compare subjective measures (overall health assessment both by the study physician and the child’s mother) with objective measurements of forced expiratory volumes (FEVt) and maximal flow at functional residual capacity v̇maxFRC) in recurrently wheezy infants. Methods: Sixteen wheezy infants (12 boys) aged 8–26 months were studied. A clinical assessment at visit 1 was followed by the run-in period during which day- and nighttime asthma symptom scores were obtained. The actual study period consisted of 2 visits when patient’s lung function was assessed. The first of which was during an acute exacerbation (visit 2), while the second was when the infant was asymptomatic (visit 3). FEVt were obtained by the raised volume rapid thoracic compression technique (RVRTC) and v̇maxFRC by the tidal volume rapid thoracic compression technique (TVRTC). Results: Mean FEVt but not mean v̇maxFRC were significantly lower at visit 2 compared to visit 3 (FEV0.5: p = 0.005, and FEV0.75: p = 0.002; v̇maxFRC: p = 0.15) and correlated well with overall health assessment by the study physician (FEV0.5: r = 0.82, and FEV0.75: r = 0.84), but not with the overall health assessment by the mother. Conclusions: We have shown in the present study that objective measurements of FEVt from a raised lung volume correlate well with the overall health assessment by the study physician; this was in contrast to measurements of v̇maxFRC in the tidal volume range. We therefore conclude that the RVRTC technique is a feasible method to assess and monitor obstructive lung disease in infancy.
Chromosome banding in Amphibia
Authors: Schmid M. , Feichtinger W. , Steinlein C. , Rupprecht A. , Haaf T. , Kaiser H.
Published: April 2003

Highly differentiated, heteromorphic ZZ♀/ZW♂ sex chromosomes were found in the karyotypes of the neotropical leptodactylid frogs Eleutherodactylus euphronides and E. shrevei. The W chromosomes are the largest heterochromatic, female-specific chromosomes so far discovered in the class Amphibia. The analyses of the banding patterns with AT- and GC base-pair specific fluorochromes show that the constitutive heterochromatin in the giant W chromosomes consists of various categories of repetitive DNA sequences. The W chromosomes of both species are similar in size, morphology and banding patterns, whereas their Z chromosomes exhibit conspicuous differences. In the cell nuclei of female animals, the W chromosomes form very prominent chromatin bodies (W chromatin). DNA flow cytometric measurements demonstrate clear differences in the DNA content of male and female erythrocytes caused by the giant W chromosome, and also shows that these Eleutherodactylus genomes are among the smallest of all amphibian genomes. The importance of the heteromorphic ZW sex chromosomes for the study of Z-linked genes, the similarities and differences of the two karyotypes, and the significance of the exceptionally small genomes are discussed.
Leptin Correlates with Some Hemostatic Parameters in CAPD Patients
Authors: Małyszko Jolanta , Wołczyński Sławomir , Małyszko Jacek , Myśliwiec Michał
Published: April 2003

Hyperleptinemia is also common in chronic renal failure, particularly in CAPD. On the other hand, cardiovascular events related to thrombosis are a predominant cause of death and account also for an important morbidity in uremic patients. Treatment with recombinant human erythropoietin (rHuEPO) may shift the precarious hemostatic balance towards thrombosis. Therefore, the aim of the study was to assess the relationships between leptin and platelet aggregation and some hemostatic parameters in CAPD patients treated with rHuEPO. The study was performed on 15 patients maintained on CAPD given rHuEPO and 13 subjects without rHuEPO therapy served as a control group. Platelet aggregation was studied in both platelet-rich plasma (PRP) and in the whole blood. Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) (antigens and activities), von Willebrand factor, trombomodulin, protein C, thrombin activatable fibrinolysis inhibitor (TAFI) and leptin (serum and dialysate) were assayed by using commercially available kits. Patients in both groups studied did not differ significantly with respect to age, BMI, duration of renal replacement therapy, and other hematological and hemostatic parameters studied as well as leptin serum and dialysate leptin. In CAPD patients treated with rHuEPO serum and dialysate leptin significantly correlated with tissue factor pathway inhibitor, protein C, thrombomodulin, ristocetin-induced platelet aggregation in the whole blood and PRP. In CAPD patients not treated with rHuEPO the significant correlations were observed between serum and dialysate leptin and protein C. Positive correlations between platelet aggregation and leptinemia in CAPD patients might indicate that hyperleptinemia could be associated with the cardiovascular disease in dialyzed patients. Leptin might contribute at least in part to the thrombotic complications observed in CAPD patients.
Maintenance Hemodialysis and Circulating Ionized Magnesium
Authors: Truttmann Anita C. , Faraone Rita , von Vigier Rodo O. , Nuoffer Jean Marc , Pfister Roger , Bianchetti Mario G.
Published: April 2003

Background: Circulating magnesium exists in the bound and in the free ionized form, that is biologically active. In kidney disease the relationship between ionized and total circulating magnesium is often altered. Little information is available on the influence of hemodialysis on the relationship between ionized and total circulating magnesium in end-stage kidney disease. Methods: Plasma total and ionized magnesium and the plasma ionized magnesium fraction were assessed before and after hemodialysis (dialysate magnesium content 0.75 mmol/l) in 46 patients with end-stage kidney disease and in a control group of 25 healthy subjects. Results: In patients plasma total (from 1.19 [1.05–1.33] to 1.10 [1.02–1.16] mmol/l; median and interquartile range) and ionized (from 0.71 [0.66–0.78] to 0.65 [0.63–0.69] mmol/l) magnesium significantly decreased during dialysis (control subjects: 0.82 [0.80–0.92], respectively, 0.57 [0.54–0.59] mmol/l). The plasma ionized magnesium fraction was significantly lower in patients both before (0.61 [0.58–0.64)] and after (0.60 [0.56–0.62]) hemodialysis than in controls (0.68 [0.65–0.70]). Conclusion: The study demonstrates a tendency towards a reduced circulating ionized magnesium fraction in end-stage kidney disease that is not corrected by hemodialysis.
Preservation of Residual Hearing in Children and Post-Lingually Deafened Adults after Cochlear Implantation: An Initial Study
Authors: Skarżyński Henryk , Lorens Artur , D’Haese Patrick , Walkowiak Adam , Piotrowska Anna , Śliwa Lech , Anderson Ilona
Published: April 2003

Objective: To investigate whether the residual hearing of severely hearing-impaired children and adults could be preserved using the soft surgery approach. Patients and Methods: This project employed a prospective study design. All testing and surgery took place in the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. Twenty-six patients (7 children and 19 post-lingually deafened adults) with residual hearing were assessed. Subjects were assessed using conventional pure-tone audiometry at least 1 month prior to surgery. Cochlear implant surgery with a Med-El Combi 40/40+ standard electrode array was conducted, using the soft surgery approach. Pure-tone audiometry thresholds were re-assessed at least 1 month after surgery. The researchers assessed change in auditory thresholds using pure-tone audiometry to determine preservation of residual hearing. Results: Sixteen of 26 patients (62%) retained their residual hearing within 5 dB HL of pre-operative scores. Only 5 of 26 patients (19%) lost all measurable residual hearing after cochlear implantation. This suggests that surgeons are often able to preserve residual hearing during cochlear implant surgery using the soft surgery technique. Conclusions: Preservation of residual hearing is an important consideration in cochlear implantation in the light of changing selection criteria for cochlear implant candidates, and as younger children are receiving implants. This is important, as we do not know yet the long-term effects of inner ear damage due to traumatic insertions of electrodes. This finding suggests a good prognosis for future possibilities of re-implantation.
The Glycocalyx and Stereociliary Interconnections of the Vestibular Sensory Epithelia of the Guinea Pig
Authors: Valk W.L. , Oei M.L.Y.M. , Segenhout J.M. , Dijk F. , Stokroos I. , Albers F.W.J.
Published: April 2003

In this study freeze fracture, low-voltage cryo-SEM, SEM and TEM were used to characterise the glycocalyx and stereociliary interconnections in the hair cell bundle of the vestibular sensory epithelia of the guinea pig. The glycocalyx resembles a shell-like structure separately surrounding each stereocilium and kinocilium over its entire length. The lateral interciliary connections emerge from the glycocalyx layer, forming an extensive extracellular network maintaining the stereocilia as a bundle. These connections are morphologically similar to the glycocalyx, and grossly oriented in the same direction, indicative of a role in the mechanical transduction system. The matrix material around the glycocalyx also appears to be morphologically similar to the glycocalyx, suggesting the glycocalyx to be even more important in the mechanical transduction system. The tip-links are covered with a layer, which is a continuation of the glycocalyx covering the stereocilia.
Diagnosis, Management and Surgical Treatment of Non-Tuberculous Mycobacterial Head and Neck Infection in Children
Authors: Danielides Vasilis , Patrikakos George , Moerman Mieke , Bonte Katrien , Dhooge Catharina , Vermeersch Hubert
Published: April 2003

The aim of this study was to present our experience with the clinical characteristics of non-tuberculous mycobacterial (NTM) head and neck lymph node infections, the use of modern diagnostic tools and the appropriate therapeutic measures. We have reviewed the cases of 14 Caucasian children with NTM head and neck lymphadenitis who were treated in our clinic in the last 5 years. Three of the patients were male and 11 were female. Their age ranged from 15 to 98 months (mean age 45.7 ± 21.76 months). Cervical lymph nodes were involved in all of our cases, while the submandibular region was found to be the area mostly affected. Overlying skin was involved in 7 cases. Diagnosis was based on intradermal skin testing with specific antigens for atypical mycobacteria, histological examination and specimen culture. Skin tests were positive for NTM in all of the patients with a predilection for Mycobacteriumavium complex. The diagnosis was confirmed by histological examination in 13 cases. Specimen culture was positive in 9 cases, most of them growing M. avium-intracellulare complex. Treatment included complete surgical excision of the affected lymph nodes and the overlying skin, as well as functional neck dissection when required. A second procedure was performed in 2 patients. Successful evaluation of NTM infections of the head and neck lymph nodes should include a detailed history, thorough physical examination and specific laboratory investigations. The treatment of choice is complete surgical excision of all affected tissue.
Rhinomanometry: An Update
Authors: Hirschberg Andor
Published: April 2003

Rhinomanometry has been widely accepted and used as an objective method to assess nasal patency for more than two decades. Much knowledge was obtained with its application in nasal pathophysiology and measuring techniques are still an issue for continuous improvement. Background, concept and current techniques, past, present and future, reliability, indications and contraindications are discussed in details. Special attention is paid to problems of definition, correlation between rhinomanometric data and subjective sensation of nasal patency and calibration. It is concluded that rhinomanometry applied together with acoustic rhinometry gives the most reliable objective information on nasal patency in an authentic rhinologic laboratory.
Effect of Glucose and Fatty Acid Availability on Neonatal and Adult Heart Contractility
Authors: Guarner Verónica , Contreras Karina , Carbó Roxana
Published: April 2003

Changes in contractility of newborn and adult hearts with different substrates were studied under oxygenation and hypoxia. Under oxygenation, insulin (50 mU/l) and low doses of fatty acids (sodium palmitate 0.12 mM) increased the differential ventricular pressure (DVP), while higher doses of fatty acids (from 0.3 to 1.5 mM) decreased it. However, when both low doses of fatty acids and insulin were added simultaneously, tension development decreased. Hypoxia reduced DVP, and low doses of fatty acids restored cardiac force. The contractile response to extracellular glucose concentrations changed during development, and sensitivity to high doses of fatty acids increased with age. In adult cardiomyocytes, glucose uptake was also inhibited by sodium palmitate under oxygenation when cardiac metabolism is fatty acid dependent, but not under hypoxia, when it consumes carbohydrates. Newborn cardiomyocytes consumed more glucose than adult cells, they did not respond to insulin, and palmitate did not completely inhibit glucose uptake neither under oxygenation nor under hypoxia. Substrate availability modified glucose uptake and contractility by independent mechanisms.
NMDA Receptor Modification during Graded Hypoxia in the Cerebral Cortex of Newborn Piglets
Authors: Fritz Karen I. , Zubrow Alan B. , Mishra Om P. , Delivoria-Papadopoulos Maria
Published: April 2003

Previous studies have shown that the cerebral N-methyl-D-aspartate (NMDA) receptor is altered during hypoxia in newborn piglets. The present study tests whether modification of the glutamate and ion channel sites of the NMDA receptor correlates with the progressive decrease in cerebral energy metabolism induced by hypoxia. Degrees of cerebral hypoxia were attained by exposure of ventilated piglets to decreased oxygen at different concentrations and confirmed by tissue phosphocreatine levels. During graded hypoxia, the number of glutamate sites decreased, the affinity of the ion channel site increased, the inhibition by Zn2+ increased, the activation by glutamate increased, and the activation by glycine decreased. Therefore, modification of the NMDA receptor correlates with the energy state of the tissue. Alterations in receptor phosphorylation may gradually modify the NMDA receptor and may be initiated by subtle decreases in tissue oxygenation in the newborn brain.
Partial Liquid VentilationTM with Low Dose of Perflubron and a Low Stretch Ventilation Strategy Improves Oxygenation in a Rabbit Model of Surfactant Depletion
Authors: Nakamura Tomohiko , Tamura Masanori
Published: April 2003

To demonstrate the efficacy of partial liquid ventilation (PLV) with a low dose of perflubron (PFB), severe lung injury model followed surfactant-depleted rabbits underwent PLV with either moderate tidal volume (VT) and high positive end-expiratory pressure (PEEP) or high VT and low PEEP. PLV with low-dose PFB was effective in alleviating hypoxia in a severe lung injury model if adequate PEEP was applied. We concluded that the addition of a low dose of PFB might be beneficial to a low stretch ventilation strategy, which allows a less aggressive approach to achieve adequate oxygenation with a possible reduction in further lung injury.
ACE Gene Polymorphism and Disease Progression of IgA Nephropathy in Asians in Singapore
Authors: Lau Y.K. , Woo K.T. , Choong H.L. , Zhao Y. , Tan H.B. , Cheung W. , Yap H.K.
Published: April 2003

The deletion polymorphism of the angiotensin-converting enzyme (ACE) gene has been considered as a risk factor for IgA nephropathy and for its progression to end-stage renal failure. However, results from various studies are conflicting. We had genotyped the ACE gene in 100 patients with IgA nephropathy, 32 of whom were in end-stage renal failure and in 90 normal adult subjects. All DD cases were subjected to confirmation with a second PCR, performed with the insert-specific forward primer. Similar genotype frequencies were obtained for the 90 normal control subjects (II: 47%, ID: 44%, DD: 9%); for the 68 patients not in end-stage renal failure (ESRF) (II: 47%, ID: 46%, DD: 7%) and for the 32 patients with ESRF (II: 53%, ID: 38%, DD: 9%). The genotype frequencies in all 3 series are in Hardy-Weinberg equilibrium. These results suggest that ACE gene polymorphism is not a risk factor for IgA nephropathy and is not a predictor for its progression. Definitive proof of association between ACE gene polymorphism and progression in IgA nephropathy will require a prospective study, controlled for important risk factors, with adequate patient numbers and facility for confirming DD genotypes.
Sensitivity of Transplantable Melanoma Cells to Cytokines with Regard to Their Spontaneous Apoptosis
Authors: Kozłowska Krystyna , Zarzeczna Małgorzata , Cichorek Mirosława
Published: April 2003

Objectives: Changes in the sensitivity of two lines of transplantable melanoma cells to the antiproliferative activity of interleukin 6 (IL-6), oncostatin M (OSM), tumor necrosis factor-α (TNF-α) during melanoma progression were the subject of this study. We were looking for a correlation between these changes and the ability of melanoma cells to undergo spontaneous apoptosis. Methods: The influence of exogenous cytokines on the proliferation of melanoma cells was measured by colorimetric methods with MTT and apoptosis of these cells was estimated by staining with annexin V/propidium iodide, measurement of DNA degradation and cell cycle analysis. Results: It was observed that during melanoma progression the sensitivity of those two melanoma line cells to the antiproliferative effect of IL-6 and OSM did not change, while a spontaneous alteration of the melanotic line into an amelanotic one seemed to be accompanied by resistance of the amelanotic melanoma cells to the antiproliferative activity of TNF-α. Simultaneously, we observed a decreased ability of amelanotic melanoma cells (in comparison with the native line) to undergo spontaneous apoptosis. Conclusions: The observed resistance to the TNF-α antiproliferative effect which appears during melanoma progression seems to be correlated with a lower ability of the amelanotic melanoma cells to undergo spontaneous apoptosis.
Activation of Peroxisome Proliferator-Activated Receptor Gamma Inhibits the Growth of Human Pancreatic Cancer
Authors: Sasaki Tamito , Fujimoto Yoshifumi , Tsuchida Akira , Kawasaki Yousuke , Kuwada Yukio , Chayama Kazuaki
Published: April 2003

Objective: In the present study, we examined the expression of peroxisome proliferator-activated receptor gamma (PPARγ) in human pancreatic cancer and the possible effects of its ligand engagement on cell growth. Methods: Seven human pancreatic cancer cell lines and 7 surgically resected human pancreatic cancer tissues were used as samples. The expression of PPARγ was analyzed with reverse transcription-polymerase chain reaction and immunoblotting. The interaction between PPARγ and PPAR-responsive element (PPRE) was examined by gel shift assay. Growth inhibition by thiazolidinediones was confirmed with anchorage-dependent and anchorage-independent growth assays. Results: PPARγ was detected in all cell lines tested and in 5 out of 7 cancer tissues (71%), but was not found in adjacent normal pancreatic tissues. Gel shift analysis revealed that the proteins in nuclear extracts of the pancreatic cancer cell line PANC-1 specifically bind to the PPRE. Cell growth was significantly inhibited by treatment with troglitazone and rosiglitazone in a dose- and time-dependent manner (p < 0.01). In contrast, a nonfunctional metabolic analog of troglitazone did not affect cell growth. Conclusion: These observations suggest that PPARγ plays an important role in human pancreatic cancer growth and that ligand-induced activation of PPARγ would be a useful strategy for treatment of human pancreatic cancer.
Downregulation of the Retinoblastoma Gene Expression in the Progression of Malignant Melanoma
Authors: Korabiowska Monika , Ruschenburg Ilka , Betke Herbert , Stachura Jerzy , Schlott Thilo , Cardo Carlos Cordon , Brinck Ulrich
Published: April 2003

The retinoblastoma gene is a cell cycle regulator preventing cells from entering into S-phase. An altered expression of the retinoblastoma gene has been reported in the majority of human malignancies. The main aim of this study was to investigate retinoblastoma gene expression in the full spectrum of melanoma progression from naevus to melanoma metastases by applying immunohistochemistry and RT-PCR. All naevi with and without dysplasia showed high expression of the retinoblastoma gene. In primary melanomas, Rb-positive cells were found in 82 out of 106. Loss of expression correlated with an increase in Clark level and shorter survival rates. An independent prognostic role of the retinoblastoma gene was confirmed by Cox multivariate analyses (p < 0.01). In melanoma metastases, retinoblastoma gene expression (at the RNA level) was found in 18 out of 26 melanoma lymphatic metastases, and in 2 out of 5 liver metastases. Our results indicate a downregulation of the retinoblastoma gene in the progression of melanocytic tumours.
Inhibition of Angiotensin-Converting Enzyme by Quercetin Alters the Vascular Response to Bradykinin and Angiotensin I
Authors: Häckl L.P.N. , Cuttle G. , Sanches Dovichi S. , Lima-Landman M.T. , Nicolau M.
Published: April 2003

Quercetin, one of the most widely distributed flavonoids in the plant kingdom, inhibits various enzymes. This study examined its inhibitory effect on the angiotensin-converting enzyme activity through the cardiovascular response to bradykinin and angiotensin I. Quercetin pretreatment (88.7 µmol/kg p.o., 45 min; 14.7 µmol/kg i.v., 5 min) significantly potentiated the hypotensive effect of bradykinin (10 nmol/kg i.v.). This association was significantly attenuated by an antagonist of the B2 receptor. In addition, the hypertensive response to angiotensin I (0.1 nmol/kg i.v.) was significantly reduced by quercetin pretreatment using the same parameters as before. These results suggest an inhibitory effect of quercetin on the angiotensin-converting enzyme activity, similar to that of captopril. Quercetin was equally effective when given orally or intravenously.
Neurofibromatosis Type 1 and the Pediatric Neurosurgeon: A 20-Year Institutional Review
Authors: Farmer Jean-Pierre , Khan Saad , Khan Asad , Ortenberg June , Freeman Carolyn , O’Gorman Augustin M. , Montes Jose
Published: April 2003

Children with neurofibromatosis type 1 (NF1) undergo costly surveillance scanning for a variety of asymptomatic central nervous system lesions whose natural history is poorly understood. We performed a 20-year retrospective chart review of 25 patients with clinically proven NF1 who required surgery (group A) and contrasted this cohort with 150 NF1 patients who did not require surgery (group B). In group A, 52% of patients underwent multiple procedures for more than one lesion (p = 0.043). Group A patients were further distinguished from those in group B by exhibiting a greater number of optic gliomas (p = 0.015), nonoptic intracranial tumors (p = 0.006), cranial nerve (p = 0.000), paraspinal (p = 0.0062), craniofacial (p = 0.001) and visceral (p = 0.03) neurofibromas and moyamoya disease (p = 0.00), as well as a higher frequency of seizure disorder, sphenoid wing dysplasia and poor academic performance. Gadolinium enhancement occurred in 43% of optic gliomas, 50% of parenchymal gliomas, 100% of cranial nerve, 100% of plexus, 67% of paraspinal, 50% of craniofacial and 50% of visceral neurofibromas in group A, while only 1 group B tumor enhanced. In group A, radiological progression occurred after a median of 4 years from initial diagnosis for optic gliomas as well as cranial nerve, plexus and visceral neurofibromas, 2 years for paraspinal neurofibromas and brainstem gliomas and 2.7 years for craniofacial neurofibromas. Only 1 tumor progressed in group B. Therefore, a small subgroup of NF1 patients (12.5%) who require treatment are at risk of subsequently needing further surgical attention, whereas a larger group of NF1 patients (87.5%) carry an indolent form of the disease. We recommend imaging for asymptomatic, gadolinium-enhancing lesions every 2 years for optic pathway and parenchymal gliomas and cranial nerve and visceral neurofibromas, and every year for brainstem gliomas and paraspinal as well as craniofacial neurofibromas. Nonenhancing optic pathway lesions could be followed up radiographically much less often since they do not show progression.
Cervical and Thoracic Dermal Sinus Tracts
Authors: Ackerman Laurie L. , Menezes Arnold H. , Follett Kenneth A.
Published: April 2003

Cervical and thoracic dermal sinus tracts (DSTs) account for 1 and 10%, respectively, of all DSTs. Few case reports describe this diagnosis. To characterize this entity, a 30-year retrospective audit was utilized to identify cases. Nine cases were identified, five of which were cervical and four thoracic. Four cases less than 1 year old presented with skin findings and no neurologic deficit. All five cases greater than 1 year old presented with neurologic findings. Initial examination revealed changes in motor function (n = 5), sensation (n = 4), reflexes (n = 5), gait (n = 4) and altered bowel/bladder function (n = 2). Eight patients had cutaneous findings and 7 had bifid spinous processes overlying tract entry into the dura. Operative findings included 6 buckled tethered cords, opacified arachnoid or frank arachnoiditis in 4 patients, 2 tract CSF leaks, 2 split cord malformations and 2 intradural tumors. Mean follow-up was 36 months. All infants remained neurologically intact. Four of the 5 patients greater than 1 year old demonstrated improvement; 1 continued with a stable deficit. This series of cervical and thoracic DSTs highlights the need for close attention to skin lesions in infants and consideration of retethering or tumor in patients with previous resections who deteriorate. Definitive operation including intradural exploration should be performed with the initial operation in an attempt to obviate future complications.
Presence of Bile in the Oesophagus Is Associated with Less Effective Oesophageal Motility
Authors: Freedman Jacob , Lindqvist Madeleine , Hellström Per M. , Granström Lars , Näslund Erik
Published: April 2003

Background/Aims: Reflux of bile to the oesophagus has been shown to be of importance in the development of gastro-oesophageal reflux disease. This study aims to assess oesophageal motility patterns in relation to acid and bile reflux to the oesophagus. Methods: Forty-nine subjects with and without reflux disease underwent 24-hour ambulatory recordings of oesophageal pH, bile and 3-channel manometry. Gastroscopy was performed to assess severity of oesophagitis. The percentage of effective peristaltic contractions (oesophageal contractions with a peristaltic pattern and a pressure >30 mm Hg) were correlated to the degree of acid and bile reflux. Ten subjects were re-evaluated within 2 years post-fundoplication. Results: Acid and bile reflux were associated with fewer effective contractions (R2 = 0.07, p = 0.06 and R2 = 0.21, p = 0.008, respectively). However, in a multivariate model including acid, bile, age and gender dependency, only bile could show a systematic effect on the variation in percentage of effective peristaltic contractions (R2 = 0.22, p = 0.001). One year after laparoscopic fundoplication, 24-hour oesophageal motility was unchanged. Conclusion: Reflux of duodenal juice to the oesophagus is associated with less effective oesophageal motility, which in turn can perpetuate the disease by less effective oesophageal clearance of bile and acid. The reduced oesophageal motility is not reversed by fundoplication.
Twenty-Four-Hour Ambulatory versus Stationary Esophageal Manometry in the Evaluation of Esophageal Motility in Patients with Gastroesophageal Reflux Disease
Authors: Chrysos Emmanuel , Athanasakis Elias H. , Zoras Odysseus John , Tsiaoussis John , Xynos Evaghelos
Published: April 2003

Background: Although stationary manometry commonly reveals esophageal body motility disorders in patients with gastroesophageal reflux disease (GERD), esophageal function cannot be fully and precisely assessed during normal daily activities by this investigatory modality. Aim: To compare the results of 24-hour ambulatory manometry with those of stationary manometry and to determine the specificity and accuracy of the former to detect motility disorders in patients with GERD. Patients and Methods: 15 patients with documented GERD were included in the study. Clinical assessment, upper alimentary endoscopy and stationary manometry as well as 24-hour ambulatory manometry with concomitant 24-hour monitoring of the esophageal pH were performed in each patient. Results: 24-hour ambulatory manometry revealed a significant number of dropped or interrupted esophageal contractions in patients who were found to have only complete peristalsis on stationary manometry. Furthermore, in certain patients, ambulatory manometry detected an increased incidence of dropped or interrupted contractions as compared to those recorded during stationary manometry. Ineffective contractions, suggestive of poor esophageal motility, although absent on stationary manometry, were detected in a large number of patients during a 24-hour period of recording. Also, the amplitude of esophageal contractions was clearly overestimated when evaluated by stationary manometry. Conclusions: 24-hour ambulatory esophageal manometry reveals esophageal motor abnormalities to a greater extent than those demonstrated at stationary manometry, in patients with GERD. This might be of significance in designing the treatment and predicting possible outcome.