bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Infected and Sterile Pancreatic Necrosis by Programmed Endoscopic Necrosectomy
Authors: Coelho D. , Ardengh J.C. , Eulálio J.M.R. , Manso J.E.F. , Mönkemüller K. , Coelho J.F.
Published: January 2009

Introduction: Necrosectomy is the gold standard treatment for infected pancreatic necrosis (IPN). A percutaneous and endoscopic approach has been accepted in selected cases. Endoscopic drainage (ED) of IPN can be performed by using transpapillary or transmural procedures, or a combination of both with or without endoscopic ultrasound. Aims: The aim of this study was to determine the indications, complications, success rate, and the importance of assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography (ERP) in patients with IPN. Methods: Records of all patients who underwent endoscopic necrosectomy from January 2002 to December 2007 at Rio de Janeiro Federal University Hospital were reviewed. A total of 56 patients were included. ED was performed using daily transmural and transpapillary drainage. A diagnostic pancreatogram (ERP) to search for communications between the pancreatic duct and the collection were performed in all cases and in cases where communication existed. A pre-cut needle knife was used to puncture the cyst wall, aspirate the content and then enter at the cyst cavity (contrast was injected to ensure opacification of the cyst and subsequent drainage). Sphincterotomy catheter or balloons were used to enlarge and ensure a wide cystoenterostomy. All patients were followed with computerized tomography scans or ultrasound to ensure clinical resolution. Mean follow-up was 21 months. Results: 49/56 patients could be successfully treated. ED was successful in 49 patients (87%) and in 3 (13%) it failed. Mean follow-up was 21 months. During this period, there were 2 (10.5%) pseudocyst recurrences and only 1 (5.2%) recurrence of new episodes of pancreatic necrosis, and all were managed clinically and/or endoscopically. No mortality was related to the procedure. Conclusion: ED with daily necrosectomy is a useful method to remove infected and sterile pancreatic necrosis.
Role of Repeated Endoscopic Ultrasound-Guided Fine Needle Aspiration in Small Solid Pancreatic Masses with Previous Indeterminate and Negative Cytological Findings
Authors: Tadic M. , Kujundzic M. , Stoos-Veic T. , Kaic G. , Vukelic-Markovic M.
Published: January 2009

Introduction: Despite advances in imaging techniques, the differentiation between pancreatic cancer and benign lesions remains difficult. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an effective method for providing tissue diagnosis, but problems occur when lesions are small or the cytological diagnosis is indeterminate. Aim: To prospectively evaluate the utility of EUS-FNA in patients with small solid pancreatic lesions and those with initial indeterminate or negative cytological diagnosis. Methods: During the study period we performed a total of 119 EUS-FNA procedures on 46 patients (mean age 56.3 years) for 47 small solid pancreatic lesions (range 7–30 mm, mean 17.2 mm in diameter). FNAs were performed in the presence of a cytopathologist. If cytological diagnoses were indeterminate, EUS-FNA was repeated within 3 weeks. Diagnoses were confirmed histologically or by follow-up (clinical and imaging: EUS +/– FNA and CT). Results: Localization of the lesions: head 28 (60%), uncinate process 4 (9%), body 11 (23%) and tail 4 (9%). On average, 3.7 passes were performed. We observed no complications. Initial cytological findings were: malignant 17 (36%), benign 21 (45%), and indeterminate 9 (19%). 8 (78%) of the indeterminate findings were confirmed to be malignant on repeated procedures. A diagnosis of pancreatic cancer was subsequently confirmed in 1 patient who had a benign cytological finding. 19 patients underwent surgery. Histology confirmed a neoplasm in all cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 68, 100, 100, 73 and 83%, respectively. After repeated EUS-FNAs of indeterminate findings sensitivity, negative predictive value and diagnostic accuracy rose to 92, 77 and 96%, respectively. Conclusion: EUS-FNA is a highly effective method for providing tissue diagnosis in patients with small solid pancreatic masses. Repeated procedures enhanced diagnostic accuracy in indeterminate findings, among which was high percentage of malignancies. EUS-FNA reduced the number of operations in patients with pancreatic solid masses.
A ‘Double-Balloon Enteroscopy Worth the Money’: Endoscopic Removal of a Coin Lodged in the Small Bowel
Authors: Neumann Helmut , Fry Lucía C. , Rickes Steffen , Jurczok Christian , Malfertheiner Peter , Mönkemüller Klaus
Published: January 2009

Double-balloon enteroscopy (DBE) has become the standard endoscopic method to diagnose and treat disorders of the small bowel. The most common therapeutic applications of DBE are hemostasis, polypectomy and stricture dilation. DBE has also been used to place stents in the small bowel and to retrieve foreign bodies such as retained capsule endoscopes. In this report, we describe the removal of a coin that had remained lodged in the jejunum for 8 days.
Waist-to-Height Ratio Is the Best Anthropometric Index in Association with Adverse Cardiorenal Outcomes in Type 2 Diabetes Mellitus Patients
Authors: Lamacchia O. , Pinnelli S. , Camarchio D. , Fariello S. , Gesualdo L. , Stallone G. , Cignarelli M.
Published: January 2009

Background/Aims: Visceral obesity is a potent risk factor for both chronic kidney disease (CKD) and myocardial infarction (MI) in type 2 diabetes mellitus patients (T2DM). Short stature is also associated with higher risk for either coronary or kidney diseases. Thus, the aim of our study was to investigate the association of the frequency of cardiorenal complications with waist-to-height index (W/Ht) in T2DM. Methods: This was a cross-sectional study where 958 T2DM patients were studied. Subjects with cardiorenal disease (CRD) were defined as those with both kidney dysfunction (KD) and MI. Results: We found a significant excess of MI in patients with KD as compared to those without KD (28 vs. 14%, p < 0.0001). Interestingly, among the commonly used indices of obesity, only W/Ht and BMI were significantly associated with CRD risk. Moreover, only the W/Ht index (but neither BMI nor WC) was significantly associated with the risks for every component of CRD. Lastly, in the multivariate logistic regression analysis, W/Ht proved superior to the other traditional factors associated with risk for CRD. Conclusions: Our study in a large cohort of subjects demonstrated that a higher W/Ht index is the best anthropometric measure associated with adverse CRD outcomes of T2DM patients.
Increased Cardiovascular Risk Associated with Reduced Kidney Function
Authors: Ryan Timothy P. , Fisher Susan G. , Elder Jessica L. , Winters Paul C. , Beckett William , Tacci James , Sloand James A.
Published: January 2009

Background: Individuals with chronic kidney disease (CKD) are at substantial risk for cardiovascular mortality, but the risk associated with specific glomerular filtration rates (GFRs) is unknown. The objective of this study was to investigate the relationship between level of kidney function and the risk of cardiovascular mortality in a diverse population. Methods and Results: This was a nonconcurrent cohort study of 34,982 ambulatory patients. Kidney function was entered into the model as a time-dependent variable to minimize misclassification and allow for improved estimate of the effect of decreasing GFR on cardiovascular mortality. The adjusted hazard ratio for cardiovascular mortality was 1.00 (95% CI 0.93–1.06) with an estimated GFR (eGFR) of 45–59; 1.77 (95% CI 1.65–1.89) with an eGFR 30–44; 3.75 (95% CI 3.47–4.06) with an eGFR 15–29, and 3.83 (95% CI 3.40–4.33) with an eGFR <15. Conclusion: We demonstrate a graded risk of cardiovascular mortality with decreasing GFR, with a marked increase with an eGFR <45 ml/min/1.73 m2. These data also suggest that the availability of eGFR to physicians has had little impact on reducing the cardiovascular risk facing individuals with CKD. Our findings further highlight the public health significance of CKD and the importance of its early identification and management to reduce cardiovascular mortality.
Methylation of p16INK4A and Mitotic Arrest Defective Protein 2 (MAD2) Genes in Gastric Marginal-Zone B-Cell Lymphomas
Authors: Park Sanghui , Kim Kyoung-Mee , Kim Jae J. , Lee Jun-Haeng , Rhee Jong-Chul , Ko Young-Hyeh
Published: January 2009

Background: Products of cyclin-dependent kinase inhibitor p16INK4Aand mitotic arrest defective protein 2 (MAD2) genesare key regulator proteins at the G1 restriction point and mitotic checkpoint of the cell cycle. The objective of this study was to investigate the role of promoter methylation of p16INK4A and MAD2 genes in gastric marginal-zone B-cell lymphoma (MZBCL). Materials and Methods: Gastric biopsies from 40 patients were analyzed by methylation-specific polymerase chain reaction, and the methylation status was compared with the results of BCL10 expression and t(11;18)(q21;q21) translocation. Results and Conclusion:p16INK4A was methylated in 30 of 40 MZBCLs (75%). The lymphomas with p16INK4A methylation tended to be negative for t(11;18)(q21;q21) (p = 0.011). MAD2 gene was methylated in 23 of 38 MZBCLs (61%). Lymphomas with MAD2 gene methylation more frequently expressed BCL10 (p = 0.037). These methylation profiles suggest that p16INK4A and MAD2 gene may play a role in the pathogenesis of MZBCL via different pathways; MAD2 gene is Helicobacter pylori independent with a close association with BCL10 while p16INK4A is H. pylori dependent with an inverse correlation with the t(11;18)(q21;q21) translocation.
Induction of Bradykinesia with Pallidal Deep Brain Stimulation in Patients with Cranial-Cervical Dystonia
Authors: Berman Brian D. , Starr Philip A. , Marks, Jr. William J. , Ostrem Jill L.
Published: January 2009

Background: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective and well-tolerated treatment for idiopathic generalized dystonia. More recently, it has been applied as a treatment for focal and segmental dystonias. This patient population offers an opportunity to study the effects of alteration of pallidal outflow on previously normal limb function. Methods: We sought to retrospectively characterize the extent of novel GPi DBS-induced adverse motor effects in patients with adult-onset cervical and cranial-cervical dystonia using a questionnaire, and compared the findings to dystonia improvement as measured by standard scales. Results: Despite significant improvement in dystonia (65% in mean Burke-Fahn-MarsdenDystonia Rating Scale motor score, p < 0.005, and 59% in mean Toronto Western Spasmodic Torticollis Rating Scale score, p < 0.008), slowing and difficulty with normal motor function was reported in previously nondystonic extremities in 10 of 11 patients. Symptoms were common in both upper and lower extremities and included new difficulties with handwriting (82%), getting up from a chair or in/out of a car (73%), and walking (45%), and were not associated with aberrant lead placement near the internal capsule. Conclusion: Although GPi DBS was shown to be effective in these patients, the influence of GPi DBS on nondystonic body regions deserves further investigation.
Subthalamic Nucleus Stimulation Does Not Cause Deterioration of Preexisting Hallucinations in Parkinson’s Disease Patients
Authors: Yoshida Fumiaki , Miyagi Yasushi , Kishimoto Junji , Morioka Takato , Murakami Nobuya , Hashiguchi Kimiaki , Samura Kazuhiro , Sakae Nobutaka , Yamasaki Ryo , Kawaguchi Minako , Sasaki Tomio
Published: January 2009

Background: Among the neuropsychiatric symptoms in Parkinson’s disease (PD) patients, hallucination can result from the disease itself or medical treatment. Hallucination associated with subthalamic nucleus stimulation (STN-DBS) has been reported; however, it is still unclear whether PD patients with a history of hallucination are appropriate candidates for STN-DBS or not. Aims: We investigated the effect of STN-DBS on preexisting hallucination associated with advanced PD. Methods: Eighteen STN-DBS patients were investigated retrospectively. The severity of hallucination was assessed by the thought disorder score on the Unified Parkinson’s Disease Rating Scale (UPDRS, part 1-item 2) in the patients’ interviews; the score 6 months after the initiation of STN-DBS was compared with the highest score throughout the preoperative history and the score 2 weeks before surgery. Results: Hoehn-Yahr stage and motor score (UPDRS part 3) were significantly improved following STN-DBS. Six months after the initiation of STN-DBS, the severity of hallucination, assessed by thought disorder score, did not increase, but rather decreased compared with the preoperative level (p < 0.05 by McNemar’s test). The daily levodopa equivalent dose was increased in 2 patients without the development of hallucination. On the other hand, anti-parkinsonian drugs were totally withdrawn in 1 patient, but without improvement of hallucination. Conclusions: Our findings indicate that STN-DBS surgery does not always lead to deterioration of preexisting hallucination in PD. In advanced PD, hallucination involves a multifactorial pathogenesis and a history of hallucination is not a contraindication to STN-DBS surgery.
Isosurface-Based Generation of Hulls Encompassing Neuronal Pathways
Authors: Merhof Dorit , Meister Martin , Bingöl Ezgi , Nimsky Christopher , Greiner Günther
Published: January 2009

Background: Diffusion tensor imaging provides information about the location of white matter tracts within the human brain. For neurosurgery, this imaging technique is of major interest in order to minimize the risk of postoperative neurological deficits. In preoperative planning, fiber tracking algorithms based on streamline propagation are used in order to reconstruct major fiber tracts. The resulting streamline bundles approximate the course of the underlying white matter structures and indicate their shape and location in 3 dimensions as well as the spatial relation with respect to surrounding anatomy. However, for intraoperative application in combination with the neuronavigation system, these streamline representations are not adequate. Hulls encompassing the streamline bundles are necessary, since the boundary curves of hulls can be superimposed on the operating room (OR) microscope view for guidance in neurosurgery. Methods: In this work, we present a novel hull approach which is based on rasterization and isosurface extraction, combined with surface filtering techniques. The advantages of this approach are its robustness and the possibility to control the tightness of wrapping. Results: The approach makes it possible to generate precise hulls for different tract systems, which can be used as a basis for intraoperative visualization in the OR microscope. Distance measurements further confirm the accuracy of the hulls.
Prevalence of Single and Multiple Human Papillomavirus Types in Cervical Cancer and Precursor Lesions in Hubei, China
Authors: Cai Hong Bing , Ding Xiao Hua , Chen Chang Chun
Published: January 2009

Objective: The objective of this study was to establish the prevalence and type distribution of human papillomavirus (HPV) in cervical cancer and cervical intraepithelial neoplasia (CIN) in Hubei, China. Methods: A total of 112 patients with cervical cancer and 60 CIN II–III samples were obtained from women undergoing biopsy or surgery. HPV and typing were examined by the polymerase chain reaction (PCR) and sequencing. Results: HPV DNA was detected in 105 patients with cervical cancer (93.75%), HPV 16 being detected in 91 (81.25%) cases, and HPV 58 in 7 (6.25%) cases. HPV DNA was detected in 50 patients with CIN II–III (83.33%), HPV 16 being detected in 37 (61.67%) cases, HPV 58 in 5 cases (8.33%). HPV 18 was not common in this study. About 11% cervical cancer and 8.33% CIN II–III specimens exhibited multiple infections (p = 0.79). Conclusion: The high prevalence of HPV 16 in Hubei, China, deserves attention as it has important implications for the usefulness of vaccine and the choice of diagnostic methods.
Hyperbaric Oxygen Reduces Inflammatory Response in Acute Pancreatitis by Inhibiting NF-κB Activation
Authors: Yu X. , Li Y.G. , He X.W. , Li X.R. , Din B.N. , Gan Y. , Xu M.
Published: January 2009

Aim: The mechanism of hyperbaric oxygen (HBO) therapy for acute pancreatitis has not been fully clarified yet. The main purpose of this study was to investigate the effect of HBO on nuclear factor κB (NF-κB) activation and the inflammatory response in rats with acute necrotizing pancreatitis (ANP). Methods: A total of 120 male Sprague-Dawley rats were randomly divided into 3 groups (40 in each): control, ANP and ANP + HBO. ANP rat models were established by a retrograde injection of 5% sodium taurocholate into the pancreatic duct. HBO treatment was performed at 2.5-fold absolute atmospheric pressure in 90% oxygen for 1, 3, 5, and 7 h. The activation of NF-κB and its inhibitor IκBα in peripheral blood neutrophilic granulocytes was measured by electrophoretic mobility shift assay and Western blot, respectively. The inflammatory cytokines [interleukin (IL)-2, IL-6, tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule 1] in the blood were measured by enzyme-linked immunosorbent assay. Results: The blood levels of inflammatory cytokines and NF-κB activation were significantly increased in ANP rats compared to control rats, but IκBα activation was suppressed. The levels of the elevated inflammatory cytokines were positively correlated with the changes in NF-κB activation. After HBO treatment, the blood levels of inflammatory cytokines and NF-κB activation were significantly decreased in the ANP + HBO group in a time-dependent manner, but IκBα activation was increased. Conclusion: Our findings suggest that acute pancreatitis is associated with the upregulation of cytokines in blood as well as upregulation of NF-κB levels and downregulation of IκBα activation in peripheral blood neutrophilic granulocytes. In contrast, HBO plays a role in acute pancreatitis treatment by normalizing these changes.
In vitro Evaluation of Dentifrice with Low Fluoride Content Supplemented with Trimetaphosphate
Authors: Takeshita E.M. , Castro L.P. , Sassaki K.T. , Delbem A.C.B.
Published: January 2009

One way to reduce dental fluorosis is by reducing the fluoride (F) concentration in dentifrice, but low-F dentifrice should be as effective as a standard dentifrice. This study evaluated in vitro whether the supplementation with sodium trimetaphosphate (TMP) of a dentifrice with low F content (500 μg/g) would provide a similar effect to that of a standard dentifrice. Bovine enamel blocks were submitted to a pH cycling regime incorporating daily exposures to a slurry of dentifrice: a low-F dentifrice with or without 0.1–3.0% TMP; an F-free, phosphate-free dentifrice (negative control), or a dentifrice with 1,100 μg/g F (positive control). The addition of TMP to dentifrice with or without F was associated with higher surface hardness and decreased loss of integrated subsurface hardness after pH cycling. The combination of 1% TMP and 500 μg F/g had a greater effect than the positive control dentifrice. It is concluded that the addition of TMP to the 500-μg F/g dentifrice allowed a similar or larger effect as compared with a standard dentifrice in this in vitro model.
Haloperidol versus Haloperidol plus Ondansetron for the Prophylaxis of Postoperative Nausea and Vomiting after Ophthalmologic Surgery
Authors: Dagtekin Oguzhan , Wiese Philip , Wolter Karsten , Hermann Manuel M. , Pietruck Christian , Kampe Sandra
Published: January 2009

Introduction: In this prospective, randomized, and double-blinded study we investigated the efficacy of haloperidol (10 μg/kg) and the combination of haloperidol (10 μg/kg) with ondansetron (0.1 mg/kg) for the prophylaxis of postoperative nausea and vomiting (PONV) after ophthalmologic surgery. Methods: 60 patients (ASA status 1–3) with risk factors for PONV (female, non-smoker, motion sickness or PONV in history, opioids for postoperative analgesia) undergoing retinal or strabismus surgery were included into the study and randomised to the haloperidol group (H-Group) or the haloperidol-ondansetron group (H/O-Group). 20 min before the end of anaesthesia the study medication was given. Nausea, vomiting, pain scores, and adverse events were assessed postoperatively over 24 h. Results: The incidence of PONV was lower for the H/O-Group (23 vs. 57% for the H-Group). Especially the incidence of vomiting was reduced for the H/O-Group (7 vs. 27% in the H-Group). No significant differences could be detected regarding adverse events. Conclusion: The single use of haloperidol for the prophylaxis of PONV is doubtful. Better results were obtained with the combination therapy of haloperidol with ondansetron, especially for vomiting.
Evaluation of the Antidiabetic Effects of Dipeptidyl Peptidase-IV Inhibitor ASP8497 in Streptozotocin-Nicotinamide-Induced Mildly Diabetic Mice
Authors: Tahara Atsuo , Matsuyama-Yokono Akiko , Nakano Ryosuke , Someya Yuka , Hayakawa Masahiko , Shibasaki Masayuki
Published: January 2009

Gastrointestinal hormone glucagon-like peptide-1 (GLP-1) has a potent glucose-dependent insulinotropic effect and is rapidly degraded by dipeptidyl peptidase (DPP)-IV. Therefore, the use of DPP-IV inhibitors is being actively explored as a novel approach to the treatment of type 2 diabetes. The present study investigated the antidiabetic effects of the DPP-IV inhibitor ASP8497 in streptozotocin-nicotinamide-induced mildly diabetic mice which possess aggravation of glucose tolerance due to loss of early-phase insulin secretion. ASP8497 exhibited good oral bioavailability with potent inhibition of plasma DPP-IV activity. This inhibitory activity lasted up to 24 h when administered at 5 mg/kg twice a day or 10 mg/kg once a day. A single oral administration of ASP8497 (0.3–3 mg/kg) significantly improved glucose tolerance by increasing plasma insulin and GLP-1 levels during the oral glucose or liquid meal tolerance tests. These effects were seen not only immediately, but also 8 h after administration. In contrast, ASP8497 (0.3–10 mg/kg) had no significant effect on blood glucose and plasma insulin levels under fasting conditions. Furthermore, repeated administration of ASP8497 (5 mg/kg twice a day or 10 mg/kg once a day) for 25 days significantly decreased nonfasting blood glucose and HbA1c levels. These results suggest that ASP8497 is a potent and long-acting DPP-IV inhibitor that improves glucose tolerance through glucose-dependent insulinotropic action via the elevation of the GLP-1 level in streptozotocin-nicotinamide-induced mildly diabetic mice. It is expected to be useful as a therapeutic agent for impaired glucose tolerance and type 2 diabetes.
Prenatal Diagnosis of Fetal Cardiac Right Ventricular Diverticulum Disappearing at Three Months of Age
Authors: Perlitz Yuri , Mukary Maggie , Lorber Abraham , Ben-Ami Moshe
Published: January 2009

Congenital cardiac diverticula are transmural localized protrusions within the free wall of the ventricles. Right ventricular diverticula are rarely diagnosed during the fetal period, and due to their rarity, their natural history remains unclear. We present a case of prenatal diagnosis of right ventricular diverticulum at 22 weeks’ gestation. No other pathological findings were detected, the pregnancy and delivery were uneventful, and the diverticulum disappeared before the age of 3 months. Echocardiography of the infant at 1 year of age revealed no cardiac diverticulum or any cardiac anomaly and showed normal heart function. Literature review of all cases published to date reveal good outcome of right ventricular diverticula. We suggest reassuring our patients about the good prognosis of this cardiac anomaly.
Classification of Minor Stroke: Intra- and Inter-Observer Reliability
Authors: Selvarajah Johann R. , Glaves Matthew , Wainwright Jane , Jha Animesh , Vail Andy , Tyrrell Pippa J.
Published: January 2009

Background: The Oxfordshire Community Stroke Project (OCSP) and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classifications are widely used for the assessment of major ischaemic stroke. We explored their intra- and inter-observer reliability in the classification of outpatient minor stroke. Methods: Four physicians of differing seniority and training backgrounds classified minor stroke using clinical data from 90 patients. Results: For both the OCSP and TOAST classifications, the intra-observer reliability varied from moderate to excellent (κ = 0.48–0.83). The inter-observer reliability was good (κ = 0.64) for the OCSP and moderate (κ = 0.42) for the TOAST. Thus, neither classification was consistently reliable. Conclusions: Our results may reflect the limited validity of these classifications in a typical minor stroke outpatient population and variable observer expertise.
Paracentral Strip Infarcts of the Middle Cerebral Artery: Borderzone Ischaemia or Cortical Artery Occlusion?
Authors: Iwanaga Takeshi , Arakawa Shuji , Siritho Sasitorn , Fitt Greg , Dewey Helen M. , Chambers Brian R. , Donnan Geoffrey A.
Published: January 2009

Background and Purpose: We have noted the presence of small strip-like infarcts involving the cortex within the interdivisional territory of the middle cerebral artery (MCA) and sometimes extending to the periventricular region. The incidence in a stroke unit population, mechanisms, clinical expression and prognosis of patients with these cortical infarcts are unknown. To clarify these issues we retrospectively and prospectively identified these patients in our own stroke unit population. Methods: Patients were identified retrospectively and prospectively from the Austin Hospital Stroke Unit from March 2001 to May 2007. All were selected on the basis of the recent onset of an acute neurological deficit with imaging showing strip infarction within the MCA territory. Clinical features were recorded and the mechanism of infarction was classified based on the TOAST criteria from standard investigations. Results: From 4,274 acute stroke admissions, there were 24 patients (0.6%), 12 males and 12 females (mean age 75 years; range 44–92 years) with CT or MRI showing characteristic linear infarction in the middle cerebral territory. In most cases, infarction was adjacent to the central sulcus. Common clinical features included mild-to-moderate hemiparesis with cortical signs. The most common TOAST criterion mechanism categories were artery-to-artery or cardiac embolism. It is postulated that this resulted in either isolated small cortical artery branch occlusion or borderzone infarction between superior and inferior divisions of the MCA due to more proximal large-artery vessel occlusion. Prognosis was good. Conclusions: We describe the phenotypic expression, postulated mechanisms and prognosis of strip-like infarcts between the superior and inferior MCA divisions. The likely artery-artery or cardio-embolic mechanisms should prompt clinicians to search for an embolic source. While the prognosis of the syndrome is generally good, its recognition may allow specific therapies to be developed to improve clinical outcomes further.
Increased Prevalence of Hyperhomocysteinemia in Cervical Artery Dissection Causing Stroke
Authors: Benninger David H. , Herrmann François R. , Georgiadis Dimitri , Kretschmer Robert , Sarikaya Hakan , Schiller Andreas , Baumgartner Ralf W.
Published: January 2009

Background: Spontaneous cervical artery dissection (sCAD) is a nonatherosclerotic vascular disease of unknown etiology. Mild elevation of total plasma homocysteine (tHcy) levels may be a risk factor for sCAD, but the precise mechanism remains unknown. On the other hand, mild hyperhomocysteinemia is also associated with ischemic stroke related to atherothrombotic or small artery disease. We undertook a case-control study to compare the prevalence of mild hyperhomocysteinemia and tHcy levels between patients with a first ischemic stroke due to sCAD and healthy volunteers, as well as patients with a first ischemic stroke due to atherothrombotic or small artery disease. Methods: Fasting tHcy levels were determined in 346 consecutive patients with a first ischemic stroke due to sCAD (n = 86) and atherothrombotic or small artery disease (n = 260) within 24 h after the onset of symptoms, and in 100 healthy volunteers. Results: Mild hyperhomocysteinemia was more prevalent in patients with sCAD causing ischemic stroke (n = 33, 38%) than in healthy volunteers (n = 23, 23%; p = 0.034), and less prevalent than in patients with ischemic stroke due to atherothrombotic or small artery disease (n = 149, 57%; p = 0.001). Mean fasting tHcy levels of patients with ischemic stroke caused by sCAD showed a trend to be higher (11.4 ± 3.8 μmol/l) than those of healthy volunteers (10.2 ± 3.0 μmol/l, p = 0.61), but were lower than those of patients with stroke due to atherothrombotic or small artery disease (13.6 ± 6.6 μmol/l, p = 0.002). Conclusion: Our results suggest that mild hyperhomocysteinemia may be a risk factor for sCAD causing ischemic stroke, but further studies are needed to identify a possible mechanism. This study confirms the association of hyperhomocysteinemia with ischemic stroke due to atherothrombotic or small artery disease.
Treatment of Early Parkinson’s Disease
Authors: Simuni Tanya , Lyons Kelly E. , Pahwa Rajesh , Hauser Robert A. , Comella Cynthia , Elmer Lawrence , Weintraub Daniel
Published: January 2009

The management of early Parkinson’s disease (PD) involves the treatment of motor symptoms, and, increasingly, non-motor symptoms. Given the fast pace of clinical research in PD, clinicians are faced with the challenge of integrating the latest findings into the ongoing care of individual PD patients. Part 1 of this 2-part article reviews efficacy and safety data for the newest PD treatment options, as well as for established therapies. Part 2 of the article, presented here, reviews key data relevant to the assessment of potential neuroprotective therapies and the treatment of non-motor symptoms.
Deficit of Episodic Memory: Anatomy and Related Patterns in Stroke Patients
Authors: Godefroy O. , Roussel M. , Leclerc X. , Leys D.
Published: January 2009

Background/Aims: Despite numerous studies performed in selected populations, major uncertainties regarding the anatomy and patterns of episodic memory deficit still persist. Such objectives require the analysis of consecutive unselected patients with well-delimitated lesions and the use of specific methodology. Methods: Nonaphasic stroke patients (n = 73) referred for cognitive complaints or deficits were examined using a standardized neuropsychological battery. Verbal episodic memory was assessed by the Grober and Buschke test. Results: Episodic memory deficit was related to lesions of medial temporal, thalamic, frontal, lenticular, and centrum semiovale regions, with a left hemisphere predominance. Although not specific, an immediate recall deficit was frequently observed in thalamic lesions (OR: 5.2, 95% CI: 1.09–24.9). False recognitions (OR: 25.7, 95% CI: 2.7–249) and efficiency of cued recall (OR: 8.6, 95% CI: 1.3–57) were highly specific of frontal damage. When combined with the usual ‘frontal lobe’ tests, this pattern of memory disorder was an independent predictor (OR: 36, 95% CI: 4.3–302) and increased the sensitivity of diagnosis of frontal damage (sensitivity: 0.92, specificity: 0.89). Conclusions: This study extends the classical anatomy of episodic verbal memory. In addition, the ‘frontal memory pattern’ was found to be relatively specific and to be an independent predictor of frontal damage.
Short-Term Effects of Prolonged Fasting on Multiple Sclerosis
Authors: Saadatnia Mohammad , Etemadifar Masoud , Fatehi Farzad , Ashtari Fereshteh , Shaygannejad Vahid , Chitsaz Ahmad , Maghzi Amir Hadi
Published: January 2009

Fasting during Ramadan is mandatory for all healthy Muslim adults. During the fasting month, many physiological and biochemical changes occur that may be due to alterations in eating and sleeping patterns. A concern for Muslim multiple sclerosis (MS) patients is whether prolonged fasting might have an unfavorable impact on the course of their disease. The aim of this prospective study was to determine the effects of prolonged intermittent fasting on the course of MS in a cohort of patients who reside in Isfahan, Iran. The cohort consisted of 40 adult MS patients who fasted during Ramadan and 40 MS patients who did not fast. Only patients with mild disability (expanded disability status scale (EDSS) score ≤3) were included. All patients were followed for 6 months after Ramadan to assess their EDSS score changes and to record the number of clinical relapses. At the end of the study, no significant changes in EDSS or the frequency of clinical relapses were detected between the 2 groups (p > 0.05). Fasting had no short-term unfavorable effects on the disease course in MS patients with mild disability. However, larger multi-center prospective studies of longer duration are needed to validate the results of this study.
Er:YAG Laser Osteotomy: Preliminary Clinical and Histological Results of a New Technique for Contact-Free Bone Surgery
Authors: Stübinger S. , Ghanaati S. , Saldamli B. , Kirkpatrick C.J. , Sader R.
Published: January 2009

Background: The purpose of this retrospective study was to evaluate the surgical performance, clinical usability and outcome of a new variable square pulsed (VSP) Er:YAG laser for bone cutting in oral and maxillofacial surgery. Materials and Methods: In 40 patients an Er:YAG laser with pulse energy of 1,000 mJ, pulse duration of 300 μs and a frequency of 12 Hz was used for different intraoral osteotomies. The spot size was 0.9 mm, and the handpiece was kept at a distance of 10 mm from the bone surface. Additionally, histological analyses of the fresh osteotomy rims of lasered bone were performed. Results: Er:YAG laser osteotomy revealed a remarkable cutting efficiency without any visible, negative, thermal side effects. There was no damage of adjacent soft tissue structures. However, depth control was limited to visual inspection. Histologically, a 5- to 10-μm-wide zone of a characteristic laser fingerprint appeared on the cut edges. However, there was no sign of thermal tissue damage to the underlying bone structures. Conclusions: VSP Er:YAG laser osteotomy is clinically practicable without any signs of charred tissue and wound healing disturbances. However, the lack of depth control and the necessity for careful handling are still technical limitations to be overcome.
Lower Extremity Neuromotor Function and Short-Term Ambulatory Potential following in utero Myelomeningocele Surgery
Authors: Danzer Enrico , Gerdes Marsha , Bebbington Michael W. , Sutton Leslie N. , Melchionni Jeanne , Adzick N. Scott , Wilson R. Douglas , Johnson Mark P.
Published: January 2009

Objective: To evaluate lower extremity neuromotor function (LENF) and short-term ambulatory potential following fetal myelomeningocele (fMMC) closure. Methods: Retrospective chart review of 54 children that underwent fMMC closure at our institution prior to the NIHCD-MOMS trial. Neonatal LENF was compared to predicted function based on spinal lesion level assigned by prenatal ultrasound. Ambulatory status was classified as independent walkers (walks without assistive appliances), assisted walker (requires walking aid), and non-ambulatory (wheelchair bound). Results: Thoracic, lumbar, and sacral level lesions were present in 4, 44 and 6 fMMC infants, respectively. 31/54 of fMMC children (57.4%; median: 2 levels, range: 1–5) had better than predicted, 13/54 (24.1%) same as predicted and 10/54 (18.5%; median: 1 level, range: 1–2) worse than predicted LENF at birth. At a median follow-up age of 66 months (36–113), 37/54 (69%) walk independently, 13/54 (24%) are assisted walkers, and 4/54 (7%) are wheelchair dependent. The strongest factors predicting a lower likelihood to walk independently were higher-level lesion (>L4, p = 0.001) and the development of clubfoot deformity after fetal intervention (p = 0.026). Despite the observed improved ambulatory status, structured evaluation of coordinative skills revealed that the majority of independent ambulators and all children that require assistive devices to walk experience significant deficits in lower extremity coordination. Conclusions: We observed that fMMC surgery in this highly selective population results in better than predicted LENF at birth and short-term ambulatory status. However, fMMC toddlers continue to demonstrate deficits in movement coordination that are characteristic for children with spina bifida.
Adjustment for Selection Bias in Observational Studies with Application to the Analysis of Autopsy Data
Authors: Haneuse S. , Schildcrout J. , Crane P. , Sonnen J. , Breitner J. , Larson E.
Published: January 2009

Background: The interpretation of neuropathological studies of dementia and Alzheimer’s disease is complicated by potential selection mechanisms that can drive whether or not a study participant is observed to undergo autopsy. Notwithstanding this, there appears to have been little emphasis placed on potential selection bias in published reports from population-based neuropathological studies of dementia. Methods: We provide an overview of methodological issues relating to the identification of and adjustment for selection bias. When information is available on factors that govern selection, inverse-probability weighting provides an analytic approach to adjust for selection bias. The weights help alleviate bias by serving to bridge differences between the population from which the observed data may be viewed as a representative sample and the target population, identified as being of scientific interest. Results: We illustrate the methods with data obtained from the Adult Changes in Thought study. Adjustment for potential selection bias yields substantially strengthened association between neuropathological measurements and risk of dementia. Conclusions: Armed with analytic techniques to adjust for selection bias and to ensure generalizability of results from population-based neuropathological studies, researchers should consider incorporating information related to selection into their data collection schemes.
Successful Prevention of Cuffed Hemodialysis Catheter-Related Infection Using an Antibiotic Lock Technique by Strictly Catheter-Restricted Antibiotic Lock Solution Method
Authors: Zhang Ping , Yuan Jing , Tan Huizhen , Lv Rong , Chen Jianghua
Published: January 2009

Background: Catheter-related infection (CRI) is associated with increased all-cause mortality and morbidity in hemodialysis patients and may be reduced by using antimicrobial lock solutions. But the safety of long-term use of antimicrobial lock still needs to be defined. Methods: Patients with a new inserted permanent tunneled cuffed hemodialysis catheter were randomly assigned to an antibiotic lock solution of gentamicin (4 mg/ml) heparin (G group) or heparin alone (H group). Results: A total of 140 patients were enrolled in this study. CRI rates were 0.06/1,000 catheter-days for the G group versus 0.67 in the H group (p = 0.014). The risk of CRI was 10.54 higher in patients with a heparin-alone locked catheter (p = 0.025) than that with gentamicin. The serum-measured gentamicin levels were very low. Conclusions: Gentamicin lock solution reduces CRI and improves catheter survival rates in hemodialysis patients. It is relatively safe in strictly catheter-restricted antibiotic lock solution therapy.
Access Blood Flow and the Risk of Complications in Mature Forearm and Upper Arm Arteriovenous Fistulas
Authors: Huijbregts Henricus J.T.A.M. , Bots Michiel L. , Wittens Cees H.A. , Schrama Yvonne C. , Blankestijn Peter J.
Published: January 2009

Background/Aims: Optimization of vascular access use in the ‘fistula first’ era requires comprehension of its clinical behavior. Little is known about mature arteriovenous fistula (AVF) performance and the role of fistula location. Widely used access flow (Qa) was used to analyze complication risks and functionality after first hemodialysis use. Methods: 178 Mature AVFs were analyzed. Complication was defined as permanent failure or ≥1 intervention. Factors associated with complications and mean Qa were determined using Cox proportional-hazards and linear regression models. Results: Baseline Qa was significantly lower in complicated versus uncomplicated forearm and upper arm AVFs. In complicated forearm AVFs, preoperative arterial diameter was smaller while the risk of complications was graded per 100 ml/min baseline Qa increase. Diabetics had an increased risk of upper arm AVF complications. In uncomplicated forearm AVFs, diabetes was related to lower mean Qa, and BMI to higher Qa. Conclusions: In mature AVFs, baseline Qa depends on fistula location and is related to the risk of complications in a graded manner.
Bipolar Radiofrequency Uvulopalatoplasty Combined with Injection Snoreplasty: A Reasonable Option for the Problem of Snoring
Authors: O’Connor-Reina Carlos , Garcia-Iriarte Maria Teresa , Gomez Angel Diego , Rodríguez-Diaz Alfonso
Published: January 2009

Objectives: The aim of this study was to assess the effectiveness and morbidity of the combined use of bipolar radiofrequency uvulopalatoplasty and a sclerosing agent applied to the soft palate in patients with snoring and apnea during a 1-year follow-up period. Methods: This was a prospective, nonrandomized study. Twenty-eight patients with primary snoring due to palatal flutter who fulfilled the inclusion criteria were enrolled. Under local anesthesia, a single procedure uvulopalatoplasty using bipolar radiofrequency applied with sterilized forceps was undertaken in combination with a sclerosing agent. Results: Four patients required a repeat procedure 6 weeks after the initial operation. The postoperative Epworth Sleepiness Scale score improved significantly 360 days after surgery. Snoring, measured on the Visual Analogue Scale, decreased from 8.9 ± 0.7 to 4.1 ± 1.4 (p < 0.005). No complications were reported. The average reduction on the apnea-hypopnea index was from 24.2 ± 7.1 to 12.8 ± 4.4 (p < 0.005). Conclusion: Bipolar radiofrequency uvulopalatoplasty combined with injection snoreplasty is an ambulatory, cost-effective, simple, and safe method to reduce the occurrence and effects of snoring and apnea.
Incidence of Traumatic Peripheral Nerve Injuries and Amputations in Sweden between 1998 and 2006
Authors: Asplund Maria , Nilsson Mats , Jacobsson Anders , von Holst Hans
Published: January 2009

Background: To define the epidemiological pattern of nerve injuries and traumatic amputations in Sweden, 1998–2006, and investigate possible targets for emerging neural engineering and neuroprosthetic technologies. Methods: The Swedish Hospital Discharge Register was used as the information base, including data from all public inpatient care, excluding outpatient data. ICD-10 codes were used to classify nerve injuries and traumatic amputations of high incidence levels or inpatient care time. Selected codes, causative factors, age and gender distribution were discussed in detail, and potential targets for tailored solutions were identified. Results: Incidence rate was determined as 13.9 for nerve injuries and 5.21 for amputations per 100,000 person-years. The majority of injuries occurred at the wrist and hand levels, although it could be concluded that these are often minor injuries requiring less than a week of hospitalization. The single most care-consuming nerve injury was brachial plexus injury, constituting on average 68 injuries and 960 hospital days annually. When minor amputations of fingers and toes were disregarded, the most frequent site of amputation was between the knee and ankle (24 patients/year). Conclusions: Based on an analysis of incidence and care time, we find that brachial plexus injuries and lower leg amputations should be the primary targets of new technologies.
Inhibition of Hemoxygenase-1 Improves Survival after Liver Resection in Jaundiced Rats
Authors: Scheingraber S. , Bauer M. , Bauer I. , Bardens D. , Abel K. , Horn A.-K. , Schilling M.K. , Wolff M.
Published: January 2009

Background: The role of hemoxygenase (HO)-1 after partial liver resection (PLR) in jaundiced animals has yet to be defined. We therefore investigated: (1) the acute effects of bile duct ligation (BDL) on bilirubin accumulation and hepatocellular integrity after PLR; (2) how BDL and PLR affect HO-1 protein expression; (3) how functional HO-1 blockade affects survival and liver regeneration after BDL and PLR. Methods: Male Sprague-Dawley rats were subjected to BDL or a sham operation. After 3 days, a 70% hepatectomy was performed. In a second set of experiments, BDL animals received either Sn(IV) mesoporphyrin IX dichloride (SnMP) for HO-1 blockade or a vehicle. Three days later, PLR was performed and survival of the animals was observed for 7 days. Results: PLR, BDL and both together cause a hepatocellular injury and HO-1 expression. Inhibition of HO-1 with SnMP in jaundiced rats that underwent PLR was associated with improved survival, attenuated postoperative weight loss and better liver synthesis. Conclusion: The present findings add further evidence that the protective properties of increased HO-1 expression largely depend on the model used, and that HO-1 overexpression in the model of liver resection during acute cholestasis may also be detrimental.
Three-Dimensional Ultrasound of Ophthalmic Pathologies
Authors: Forte Raimondo , Cennamo Gilda , Breve Maria Angelica
Published: January 2009

Purpose: To assess three-dimensional echography image quality and multiplanar imaging for the visualization of vitreoretinal and choroidal diseases. Methods: In an observational cross-sectional study, 20 eyes of 20 patients presenting different vitreoretinal and choroidal pathologies have been evaluated with three-dimensional ultrasonography (3DUS). Results: Of the 20 eyes, an epiretinal membrane was present in 2 eyes, diabetic macular edema in 6, a macular hole in 2, a myopic posterior detachment in 2, myopic peripapillary detachment of the pigment epithelium in 1, choroidal melanoma in 4, optic nerve glioma in 1 case, carotidocavernous fistula in 1 and an intravitreal dislocation of an intraocular lens in 1 eye. 3DUS was effective in wide-field representation of the vitreoretinal interface during macular edema, in good-quality visualization of the dislocated intraocular lens and in calculating the volume of choroidal melanoma. No advantages were found in other evaluated cases if compared with the already existing imaging techniques. Conclusions: One of the main advantages of 3DUS was the possibility to obtain a wide-field representation of spatial relationships between the lesions and the surrounding ocular structures.