bluuebunny/crossref_metadata_2025 huggingface dataset:
Primärer Hyperparathyreoidismus mit persistierender Hyperkalziämie in der Schwangerschaft
Authors: von Poblotzki M. , Strauss A. , Schulze A. , Hepp H.
Published: April 2003

Als Therapie eines primären Hyperparathyreoidismus (pHPT) in der Schwangerschaft wird die Parathyreoidektomie im 2. Schwangerschaftstrimenon empfohlen, da in 90% der Fälle ein Adenom der Nebenschilddrüse Ursache dieser Erkrankung ist. In dem hier beschriebenen Fall wird der Verlauf eines schweren pHPT in der Schwangerschaft dargestellt, bei dem eine operative Therapie nicht möglich war, da die Ursache des pHPT nicht geklärt werden konnte. Eine 29-jährige Primigravida stellte sich in der 11. Schwangerschaftswoche mit pHPT unklarer Genese vor. Trotz Hyperkalziämie mit Werten >3,05 mmol/l (Normalbereich: 2,05–2,65) während der gesamten Schwangerschaft wurde die Patientin in der 35. Schwangerschaftswoche von einem eutrophen Mädchen entbunden. Bei dem Kind konnte mit frühzeitiger Kalzium- und Vitamin-D3-Substitution sowie phosphatarmer Ernährung durch Muttermilch eine Hypokalziämie vermieden werden. Im weiteren Verlauf entwickelte sich das Kind altersentsprechend. Fazit: Schwerer Hyperparathyreoidismus während der gesamten Schwangerschaft führt nicht notwendigerweise zu einer gravierenden fetalen bzw. neonatalen Morbidität.
A Longitudinal Study of Hormonal Reactions Accompanying Life Events in Recently Resettled Refugees
Authors: Söndergaard Hans Peter , Theorell Töres
Published: April 2003

Background: Refugees constitute a growing section of the general population in many countries. It is therefore important to study which factors in everyday life are important to recently resettled refugees after they have been granted residence. Methods: Life events from a checklist, as well as categories derived from written responses to open-ended questions were analysed (repeated-measures ANOVA). Changes over time in mean serum/plasma concentrations of cortisol, thyroxine, prolactin, and dehydroepiandrosterone sulphate (DHEA-S) were compared in subjects with and without the reported events. Results: Distress in significant others (close friends or first-degree relatives) and a perception of excessive demands in everyday life were associated with increases in serum cortisol. Events associated with decreased levels of prolactin were typically situations of strain in relation to authorities or individuals to which the subjects were in a position of dependency. DHEA-S changed in opposite directions in post-traumatic stress disorder (PTSD) and non-PTSD subjects. DHEA-S also changed with positive events. Conclusions: Distress in significant others and a too demanding everyday life lead to significant changes in the stress-responsive hormones cortisol, prolactin and DHEA-S. Since DHEA-S behaves differently in PTSD, this condition is a potential confounder in studies of DHEA-S with an unknown proportion of PTSD among participants.
The Distribution and Morphological Characteristics of Catecholaminergic Cells in the Brain of Monotremes as Revealed by Tyrosine Hydroxylase Immunohistochemistry
Authors: Manger Paul R. , Fahringer Heidi M. , Pettigrew John D. , Siegel Jerome M.
Published: April 2003

The present study describes the distribution and cellular morphology of catecholaminergic neurons in the CNS of two species of monotreme, the platypus (Ornithorhynchus anatinus) and the short-beaked echidna (Tachyglossus aculeatus). Tyrosine hydroxylase immunohistochemistry was used to visualize these neurons. The standard A1–A17, C1–C3 nomenclature was used for expediency, but the neuroanatomical names of the various nuclei have also been given. Monotremes exhibit catecholaminergic neurons in the diencephalon (A11, A12, A13, A14, A15), midbrain (A8, A9, A10), rostral rhombencephalon (A5, A6, A7), and medulla (A1, A2, C1, C2). The subdivisions of these neurons are in general agreement with those of other mammals, and indeed other amniotes. Apart from minor differences, those being a lack of A4, A3, and C3 groups, the catecholaminergic system of monotremes is very similar to that of other mammals. Catecholaminergic neurons outside these nuclei, such as those reported for other mammals, were not numerous with occasional cells observed in the striatum. It seems unlikely that differences in the sleep phenomenology of monotremes, as compared to other mammals, can be explained by these differences. The similarity of this system across mammalian and amniote species underlines the evolutionary conservatism of the catecholaminergic system.
PGE2 Action in Human Coronary Artery Smooth Muscle: Role of Potassium Channels and Signaling Cross-Talk
Authors: Zhu Shu , Han Guichun , White Richard E.
Published: April 2003

Cyclic AMP-stimulating agents are powerful vasodilators, but our knowledge of the signal transduction mechanisms of these agents, particularly in human arteries, is limited. We now report direct molecular effects of prostaglandin E2 (PGE2) on cultured human coronary artery smooth muscle cells (HCASMC). Patch-clamp studies revealed that 10 µM PGE2 opens a high-conductance (∼200 pS), calcium-stimulated potassium (BKCa) channel in intact HCASMC. In contrast, PGE2 had no direct effect on channels in cell-free patches, indicating involvement of a soluble second messenger. Enzyme immunoassay demonstrated that PGE2 enhances production of cAMP in HCASMC, but does not increase [cGMP]. Furthermore, forskolin, CPT-cAMP, or CPT-cGMP mimicked the stimulatory effect of PGE2 on BKCa channel activity. Interestingly, the response to PGE2 was unaffected by inhibiting the cAMP-dependent protein kinase, but was antagonized by inhibitors of the cGMP-dependent protein kinase (PKG). Furthermore, cAMP-stimulated PKG activity mimicked the effect of PGE2. These studies suggest a novel PGE2 action in human arteries: opening of BKCa channels via cAMP cross-activation of PKG in HCASMC. It is proposed that this signaling mechanism may mediate the vasodilatory response to cAMP-dependent agents in the human coronary and other vascular beds.
Early Detection of Lung Disease and Its Association with the Nutritional Status, Genetic Background and Life Events in Patients with Cystic Fibrosis
Authors: Kraemer Richard , Aebi Christoph , Casaulta Aebischer Carmen , Gallati Sabina
Published: April 2003

Progression of lung disease is the most prominent cause of morbidity and death in patients with cystic fibrosis (CF), but the severity of lung disease and the rate of lung function decline are highly variable. An attempt was made to define accurate estimates of disease progression in these patients early diagnosed and prospectively evaluated until 10 years of age. The primary question to ask was whether functional abnormalities detected already in infancy are associated with functional derangements later on in life, and may be useful as parameters of prognostic value. Early diagnosis of CF can best be achieved by screening of mutation by new techniques (buccal cell brushing) in infants, even when the sweat test or accurate blood sampling is not available. Moreover, in infants lung function can be assessed by infant whole-body plethysmography enabling the study of the interrelationship with delayed weight gain and growth retardation, as well as the associations with the most common disease-causing mutations. Out of a cohort of 80 infants (39 males, 41 females) with CF a follow-up study was started with 50 CF infants diagnosed during infancy (mean age 4.6 ± 4.0 months; range 0.1–12.7 months) and prospectively evaluated at 6-month intervals during the first 2 years of life. Moreover, in 32 CF children out of this cohort, follow-up was continued until 10 years of age. Differences were encountered with respect to the different events occurring during the first years of life, especially the onset of chronic colonization with Pseudomonas aeruginosa. The association between infant lung function and specific mutations (ΔF508 homozygotes, frameshift ΔF508/3905insT compound heterozygotes and nonsense ΔF508/R553X compound heterozygotes) furthermore revealed that differences in lung function within the genetic groups are mainly related to the degree of pulmonary hyperinflation. Pulmonary hyperinflation was also associated with the degree of impaired nutritional status. An association between impaired gas exchange characteristics at 10 years of age and the degree of pulmonary hyperinflation during infancy finally demonstrates that by early mutation screening, lung function testing and assessment of the nutritional status predictors of disease progression later on in life can be defined. Therefore, preventive therapeutic measures should primarily be based on such prognostic factors.
Evidence of the Rapid Protective Effect of Formoterol Dry-Powder Inhalation against Exercise-Induced Bronchospasm in Athletes with Asthma
Authors: Ferrari M. , Balestreri F. , Baratieri S. , Biasin C. , Oldani V. , Lo Cascio V.
Published: April 2003

Background: Although formoterol, a new long-acting β2-adrenergic agonist, has a rapid bronchodilating action, no studies have previously examined whether it can provide equally rapid protection against exercise-induced bronchospasm (EIB). Aim: The aim of the study was to assess the effect of inhaled formoterol against EIB 15 min and 4 h after administration in asthmatic athletes. Methods: The protective effect of a formoterol (12 µg) dry-powder inhalation was evaluated in 14 EIB-positive asthmatic athletes (13 males, mean age 16.8 years), in a double-blind, placebo-controlled, two-period cross-over study. On each treatment day, the subjects underwent two cycloergometric exercise tests 15 min and 4 h after receiving formoterol or placebo. Results: Formoterol induced significant bronchodilation in comparison with placebo both 15 min and 4 h after administration (p = 0.007 and p = 0.004); placebo treatment had no effect on EIB, the maximum percent fall in FEV1 after exercise being 29.3 ± 14.3% and 22.9 ± 13.7% at 15 min and 4 h, respectively. Formoterol offered good protection against EIB in 12 athletes (86%) who experienced a decrease in FEV1 after exercise <10% both 15 min and 4 h after administration. The mean maximum percent fall in FEV1 after formoterol was 5.9±7.2% at 15 min (p < 0.0001), and 5.8 ± 6.9% at 4 h (p < 0.0001). There was no statistically significant difference in resting heart rate before and after medication with placebo or formoterol, nor was the heart rate at the end of exercise significantly different on the 2 treatment days. No side effect was observed in either group. Conclusions: This study demonstrates that formoterol dry powder inhalation is effective in protecting asthmatic athletes as early as 15 min after dosing. Furthermore, the data confirm the long duration of its protective effect and the absence of any significant adverse effects after acute administration.
Platelet Dynamics following Allergen Challenge in Allergic Asthmatics
Authors: Sullivan P.J. , Jafar Z.H. , Harbinson P.L. , Restrick L.J. , Costello J.F. , Page C.P.
Published: April 2003

Background: There is evidence that platelet activation occurs in allergic inflammation and asthma, but little is known about the role platelets play in airway inflammation associated with asthma. Objectives: In the present study, we have investigated the kinetics of platelet activation following allergen provocation of allergic asthmatics to determine the dynamics of platelet activation relative to changes in lung function and changes in airway inflammation. Methods: Changes in platelet count and haematocrit from baseline were measured during the early asthmatic response (EAR), late asthmatic response (LAR; or at corresponding time points) and at 24 h were compared between allergen- and saline-challenged groups. A subgroup of allergen-challenged asthmatics, a group of 7 challenged asthmatics and 7 controls were bronchoscoped, and BAL fluid was collected and analysed for levels of histamine and eosinophil cationic protein. Results: There was a fall in circulating platelet count, but not haematocrit after allergen challenge when compared with saline during the LAR or at 24 h. At 24 h FEV1 had returned to within 20% of baseline in all subjects, although the thrombocytopaenia and airway inflammation persisted. Conclusions: Our results suggest that persistent thrombocytopaenia accompanies allergen exposure and persists beyond changes in airway obstruction at a time when airway inflammation is present. Our results provide further evidence that platelets may be involved in allergic disease.
Superoxide Dismutase in Alveolar Macrophages from Patients with Diffuse Panbronchiolitis
Authors: Morikawa Toru , Kadota Jun-ichi , Kohno Shigeru , Kondo Takahito
Published: April 2003

Background: Diffuse panbronchiolitis (DPB) is characterized by chronic neutrophil-mediated inflammation of the airway mediated by oxygen radical production. DPB can be controlled with low-dose and long-term erythromycin therapy based on its anti-inflammatory effect. Objective: In this study, the antioxidant levels were analyzed as an anti-inflammatory effect of erythromycin in the patients. Methods: We investigated the activity and protein level of an antioxidant enzyme, Cu, Zn-superoxide dismutase (SOD) in alveolar macrophages (AMs) of patients with DPB before and after erythromycin therapy. AMs were obtained from bronchoalveolar lavage fluid. Results: There was no significant difference in the activity of Cu, Zn-SOD between normal subjects and untreated patients. Erythromycin therapy (600 mg/day) significantly increased the activity of the enzyme relative to that before therapy and normal subjects [18.2 units/106 cells (9.2–26.2) vs. 4.4 units/106 cells (1.1–9.3), p < 0.01 and 10.4 units/106 cells (2.4–20.6), p < 0.05, respectively]. Furthermore, the protein level of Cu, Zn-SOD in AMs in treated patients was significantly higher than in the other two groups [69.4 ng/106 cells (34.2–147.1) vs. 20.1 ng/ 106 cells (16.9–39.8) for untreated patients, p < 0.01 and 43.2 ng/106 cells (32.6–68.2) for normal subjects, p < 0.01], but the levels in the latter groups were not different. Conclusion: Our results suggest that one of the anti-inflammatory effects of erythromycin in DPB may be, in part, mediated by enhancement of antioxidant activity in AMs.
Four Cases of Bronchiolitis obliterans Organizing Pneumonia Associated with Thyroid Disease
Authors: Watanabe Kentaro , Senju Shoji , Maeda Fumihiko , Yshida Minoru
Published: April 2003

We present 4 cases of bronchiolitis obliterans organizing pneumonia (BOOP) associated with thyroid diseases. Case 1 had previously undergone surgery for thyroid cancer, and had a secondary hypothyroidism at the onset of BOOP. Case 2 developed Basedow’s disease 3 months after the onset of BOOP and BOOP relapsed 21 months after the onset of Basedow’s disease. Case 3 developed subacute thyroiditis 33 months after the onset of BOOP, and has had no relapse of BOOP for 7 years. Case 4 had hypothyroidism at the time of diagnosis of BOOP, and her BOOP relapsed 3 months after the initial onset of BOOP. Two of these 4 cases of BOOP with thyroid diseases relapsed, and thyroid dysfunction could modify the pathophysiology of BOOP.
Stenting in Esophageal Strictures
Authors: Petruzziello L. , Costamagna G.
Published: April 2003

The interventional management of esophageal strictures remains, to date, an important clinical challenge. Stenting is probably the best palliation modality in patients with incurable esophagogastric carcinoma. Conversely, the use of esophageal stents is still relatively uncommon for the treatment of refractory benign strictures. In the last few years, several new stents have become available as a result of significant advances that have been made in terms of design and materials. This review focuses on the endoscopic use of esophageal stents in malignant and benign esophageal strictures, revisiting the different types of expandable stents presently available, the techniques, the results, and the complications of stent insertion and giving some practical advices. Future developments in the field of esophageal stenting are also discussed.
Self-Administered Symptom Questionnaires in Patients with Dyspepsia and Their Yield in Discriminating between Endoscopic Diagnoses
Authors: Bolling-Sternevald E. , Carlsson R. , Aalykke C. , Wilson B.V.L. , Junghard O. , Glise H. , Lauritsen K.
Published: April 2003

Background/Aims: Symptoms are generally considered to be poor predictors of organic findings in patients with dyspepsia. We aimed at evaluating whether specific gastrointestinal symptoms, identified by self-administered questionnaires, correlate with specific endoscopic diagnoses and discriminate organic from functional dyspepsia. Methods: Adult patients with pain or discomfort centred in the upper abdominal region were consecutively enrolled. Patients with heartburn, acid regurgitation, or defaecation and bowel habit problems as their predominant symptoms were excluded. Three self-administered questionnaires were applied before an oesophagogastroduodenoscopy was performed. Results: Among the 799 patients, 50.6% had a normal endoscopy. Endoscopic diagnoses comprised: non-erosive oesophagitis (7.5%), erosive oesophagitis (11.1%), Barrett’s oesophagus (1.1%), gastritis/duodenitis (8.4%), gastric ulcer (4.5%), duodenal ulcer (8.3%), and cancer (1.3%). Non-dominant heartburn and acid regurgitation were significantly more common in patients with organic dyspepsia, whereas hunger pains and rumbling occurred more often in those with functional dyspepsia. Multivariate analyses demonstrated that younger age, female gender, high scores for hunger pain, rumbling, hard stools, low scores for heartburn, and acid regurgitation predicted functional dyspepsia. Conclusions: Self-administered questionnaires revealed differences in the symptom patterns between patients with functional and organic dyspepsia. Furthermore, the health-related well-being in patients with functional and organic dyspepsia centred was impaired to the same extent.
Vertebrobasilar Thrombosis in Children: Report of Two Cases and Recommendations for Treatment
Authors: Sungarian Arno , Duncan III John A.
Published: April 2003

Two consecutive cases of children with vertebrobasilar thrombosis (VBT) were treated with high-dose intra-arterial urokinase within 4 h of presenting to the emergency room, after full evaluation by CT scan, MRI and MR angiography. Complete resolution of neurologic symptoms was achieved in both cases. Based on our limited pediatric experience, previous treatment of VBT at our institution and a review of the relevant literature, the authors suggest that VBT be specifically ruled out at initial diagnosis, and if present, full consideration be given to immediate treatment with intra-arterial thrombolytic therapy. This may lead to a significant reduction in the morbidity and mortality associated with VBT in children. A large prospective multi-institution study is needed to further evaluate the efficacy of this approach to childhood stroke.
Efficacy of Sequential Chemotherapy Including Methotrexate and Doxorubicin in an Infant with Partially Resected Choroid Plexus Carcinoma
Authors: Fiorillo Amedeo , Maggi Giuseppe , Cirillo Sossio , Migliorati Roberta , Buffardi Floriana , Alfieri Elvira , Sabbatino M. Simona , D’Amico Alessandra , DelBasso DeCaro M. Laura
Published: April 2003

This report refers to a 3-month-old male, with a residual choroid plexus carcinoma following partial resection, who was successfully treated with sequential chemotherapy without any postoperative radiation therapy. Along with carboplatin, we also used doxorubicin and methotrexate, hypothesizing that, given the patient’s age, the blood-brain barrier should not hamper drug delivery to the tumor. According to this hypothesis, the treatment achieved complete remission of the disease, which lasts 27 months after the diagnosis. This result deserves further studies to assess the possible curative role of chemotherapy in very young patients suffering from choroid plexus carcinoma.
Lipoadenoma: Is It Arising from Thyroid or Parathyroid? A Diagnostic Dilemma
Authors: Sheikh Salwa S. , Massloom Hasan S.
Published: April 2003

Fat-containing lesions of endocrine organs are rare. Distinguishing lipoadenomas of the thyroid gland from lipoadenomas of parathyroid glands can be challenging during intraoperative consultation. Our patient had a well-circumscribed tan-pink nodule present on the surface of the thyroid gland, exhibiting abundant fat interspersed between the cells, with ample eosinophilic cytoplasm arranged in trabeculae and solid sheets. Immunohistochemistry showed strong positivity for thyroglobulin confirming the origin of the nodule to be thyroid. Only few cases of lipoadenomas of the thyroid and parathyroid have been reported in the literature. There is considerable histologic overlap between the two, making it difficult to determine the site of origin. We briefly discuss the features that may be helpful in this distinction.
Allergenic Relevance of Cupressus arizonica Pollen Extract and Biological Characterization of the Allergoid
Authors: Mistrello G. , Roncarolo D. , Zanoni D. , Zanotta S. , Amato S. , Falagiani P. , Ariano R.
Published: April 2003

Background: Cupressaceae (cypress) pollens can cause pollinosis in winter. However, the lack of specific commercial extracts combined with the early pollination period of cypress trees make a precise diagnosis difficult. The need for a reliable and effective cypress extract for diagnostic and therapeutic purposes is increasingly felt. Methods: Mixed or single Cupressus arizonica, lusitanica and sempervirens pollen extracts precipitated with ammonium sulfate (PPT) were compared by direct RAST, RAST inhibition and SDS-PAGE techniques. The major allergen of C. arizonica (Cup a 1), purified by anion exchange chromatography, was checked by immunoblotting experiments before chemical modification, in parallel with a C. arizonica extract, with potassium cyanate (KCNO) to obtain a monomeric allergoid. The allergoid extract was characterized for its biological, chemico-physical and immunological features by RAST inhibition, SDS-PAGE and ELISA assays. Results: Direct RAST, RAST inhibition, and SDS-PAGE data indicated that the PPT C. arizonica pollen extract showed the most allergenic potential, and it can be considered representative of the Cupressus spp. Immunoblotting data confirmed Cup a 1 as a major allergen. RAST inhibition and ELISA showed that modified PPT C. arizonica extract had less IgE reactivity than the native, non-modified extract, while preserving the immunogenic capacity typical for an allergoid. Finally, the SDS-PAGE profile of Cup a 1 allergoid was similar to native Cup a 1 allergen, suggesting the modified C. arizonica extract shows the characteristics of a monomeric allergoid. Conclusions: The PPT C. arizonica pollen extract shows good in vitro diagnostic potential and its chemically modified form offers the features of a monomeric allergoid. It might therefore lend itself to the development of a product to be administered by the sublingual or oromucosal route for immunotherapy of individuals with cypress pollinosis.
IgE to Cross-Reactive Carbohydrate Determinants: Analysis of the Distribution and Appraisal of the in vivo and in vitro Reactivity
Authors: Mari Adriano
Published: April 2003

Background: IgE to cross-reacting carbohydrate determinants has already been described by several authors, but their function and distribution are still a matter of debate. In previous studies we showed how the presence of IgE to bromelain could be a useful and simple marker of the presence of IgE to carbohydrate epitopes. Methods: A survey of 1,831 subjects with a suspected allergic respiratory disease has been carried out by detecting IgE to bromelain. Data were analysed on the basis of demographical and allergological parameters. To find out whether a glycoprotein is capable of triggering an allergic reaction, 1,076 subjects were also skin tested with several purified molecules bearing carbohydrate side chains differing in number, composition and complexity. Results: An overall prevalence of 23% of positive IgE to cross-reacting carbohydrate determinants was recorded. Prevalence varied when subsets of non-allergic (5%), non-pollen-allergic (10%), and pollen-allergic (31%) subjects were considered. Prevalence further increased in subsets with multiple pollen sensitization (71%), and with a previous pollen immunotherapy course (46%), whereas minor differences were found in gender and age distribution. Almost all the allergenic extracts recorded negative in the skin test gave a positive IgE test in vitro. A higher correlation was found mainly with plant-derived allergenic extracts, whereas a lower one was recorded with mites and fungi. Horseradish peroxidase was the only glycoprotein capable of exerting a positive skin test in 21% of the subjects with IgE to cross-reacting carbohydrate determinants, 80% of them having IgE to the HRP molecule. Conclusions: IgE to cross-reacting carbohydrate determinants are common among the allergic population and the binding to skin test negative allergenic extracts further confirms their poor biological activity. Further studies on horseradish peroxidase should be carried out to define the role of the glycan side chains in its allergenic activity.
Staging Laparoscopy and Its Indications in Pancreatic Cancer Patients
Authors: Hennig René , Tempia-Caliera Adrien A. , Hartel Marc , Büchler Markus W. , Friess Helmut
Published: April 2003

Background: Laparoscopy has become a popular and widespread surgical technique. An important goal in the treatment of patients with pancreatic cancer is to avoid any unnecessary procedure. Laparoscopy has been suggested as a routine tool for staging in order to prevent unnecessary laparotomies in these patients. Methods: In this article we present our experience regarding the value of laparoscopic staging and review the literature on this topic. Results and Conclusion: A direct and conclusive comparison of the controversial literature is difficult because of different study designs. Inconsistent use of high-quality CT scans significantly affects the results. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a state-of-the-art CT scan has been performed previously. Therefore, we conclude that routine diagnostic laparoscopy is not justified in all patients with pancreatic cancer. Rather, selective use is appropriate, especially in patients in whom ascites is an indirect sign of peritoneal metastases, or if liver metastases cannot be surely excluded preoperatively. This approach is cost-effective and limits diagnostic laparoscopy to a subgroup of patients in whom a laparotomy can be avoided.
Role of Laparoscopy in Hepatic Cyst Surgery
Authors: Gloor B. , Ly Q. , Candinas D.
Published: April 2003

Background: Hepatic cysts are detected incidentally in 2.5–5% of the population. Only about 15% of such cysts are symptomatic. Since laparoscopic deroofing for liver cysts was first described in 1991 there have been a number of reports of successful laparoscopic management of hepatic cysts, including the laparoscopic management of complex and parasitic cysts. Methods: A systematic review of English-language articles on the subject appearing in journals through May 2002 was conducted using the Medline database. Results: Only a minority of cystic liver lesions need treatment, and the therapeutic approach is guided by the type of cyst. Laparoscopic deroofing (combined with omentoplasty and/or oversewing) of uncomplicated liver cysts is associated with a recurrence rate of 10–25%, with less morbidity and mortality as compared to open surgery. On the other hand, treatment of complex liver cysts and hydatid cysts by laparoscopy is not considered a standard approach. Conclusion: The laparoscopic approach in uncomplicated but symptomatic liver cysts is effective, with low morbidity and mortality. Additional omentoplasty or oversewing appears to reduce the recurrence rate.
Laparoscopic versus Open Appendectomy: Between Evidence and Common Sense
Authors: Eypasch Ernst , Sauerland Stefan , Lefering Rolf , Neugebauer Edmund A.M.
Published: April 2003

Background: Laparoscopic surgery has been proposed to have diagnostic and therapeutic advantages over conventional surgery. The purpose of this article is to present a recently completed Cochrane review on laparoscopic surgery for suspected appendicitis on the background of daily surgical practice and the developments in the last decade. Methods: Within the Cochrane review, various medical databases (Medline, Embase, Cochrane, SciSearch) were searched electronically until October 2001. Congress proceedings were searched by hand. Randomized controlled trials were included that assessed the therapeutic effects of laparoscopic appendectomy (LA) versus open appendectomy (OA) in adults and children, the diagnostic effects of laparoscopy followed by LA or OA if necessary versus immediate OA, and the therapeutic effects of diagnostic laparoscopy followed by OA if necessary versus immediate OA. Results: Based on 45 studies, wound infection was half as likely while intra-abdominal abscesses were three times more frequent after LA. Return to normal activity showed a uniform tendency in favor of LA. Pain was also reduced, but data vary and most primary studies were not blinded. Obvious diagnostic advantages concerned the negative appendectomy rate and the rate of patients without established diagnosis, both being reduced to 0.2–0.3 (RR). Conclusion: The review finds that laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery – a fact which is in full agreement with the daily practice of surgeons interested in endoscopic surgery.
Appropriateness of Diagnostic Digestive Endoscopy
Authors: Lambert René , Rey Jean François
Published: April 2003

The indications of diagnostic endoscopy – upper gastrointestinal endoscopy or colonoscopy – in the exploration of the digestive tract are classified as appropriate or inappropriate with regard to criteria established in guidelines supported by national scientific societies and by insurance companies. This applies to the exploration of symptomatic patients and to screening protocols for malignant lesions. Functional or nonstructural diseases being more frequent than structural diseases, negative findings in endoscopy are common. However this reassures the patient and should not be considered as overuse. On the other hand excess in the repetition of negative endoscopic procedures during surveillance raises ethical problems, increased costs, and may be considered as unethical.
Ethical, Legal and Economic Issues Raised by the Use of Human Tissue in Postgenomic Research
Authors: Reymond M.A. , Steinert R. , Escourrou J. , Fourtanier G.
Published: April 2003

Ethical, legal and economic framework issues concerning human samples, genetic data and bioresources are rapidly evolving. In most cases, international standards have not been defined. National legislations on the use and exploitation of human sample collections differ widely. Legislations relating to intellectual property rights, access to database information for public or private bodies, of national or foreign origin, are similarly diverse. Importation and exportation rules, concerning in particular data protection, biosafety and protection of individual rights, have not always been defined. This article makes a short assessment of the legal, ethical and economic framework in selected EC countries (Germany, France and UK), and compares them with the conditions in the USA. On the basis of the information collected, it is obvious that the use of human cells, tissues and organs in medical research has to be considered as a global, worldwide question. Such use has profound ethical, cultural and economic consequences not only in the country of origin, but also globally. Biotechnology and pharmaceutical companies conducting research with human samples are facing different framework conditions in the area of data protection, policy measures, economic support, exportation, etc., that already influence trade activities and investments of such firms at the international level. Over the 3 last years, a trend towards harmonization can be recognized: the World Health Organization has recognized the problems of postgenomic medical research as a priority. The OECD has created a taskforce on centers for biological resources. Biobanks are a common theme of the French and the German National Ethic Councils. A lack of international harmonization and consistency might not only present a challenge to biotechnology and pharmaceutical companies, but can also endanger the goals the laws and regulations seek to achieve.
Endovascular Repair of Abdominal Aortic Aneurysm in Renal Transplantation
Authors: Malagari K. , Brountzos E. , Gougoulakis A. , Kelekis A. , Drakopoulos S. , Sehas M. , Kelekis D.A.
Published: April 2003

Successful endovascular correction of a 12-cm abdominal aortic aneurysm (AAA) is described in a 76-year-old man with a functional pelvic renal transplant and 18-month follow-up. Endovascular treatment is a safe alternative to surgery for AAA correction in the elderly post-transplantation patient since it does not require flow interruption during the procedure.
Can Conventional Examinations Contribute to the Diagnostic Power of Unenhanced Helical Computed Tomography in Urolithiasis?
Authors: Unal Dogan , Yeni Ercan , Karaoglanoglu Mustafa , Verit Ayhan , Karatas Omer Faruk
Published: April 2003

Introduction: To investigate whether ordinary tests used in urolithiasis can increase the diagnostic value of unenhanced helical computed tomography (HCT). Materials and Methods: Of all patients admitted with acute flank pain, 137 without radiocontrast allergy, pregnancy and renal insufficiency were included in the study. After urinalysis (Ur) and ultrasonography (USG), HCT without a contrast agent was taken by 5-mm collimation, thereafter excretory urography (EU) was obtained. Confirmation of a stone was done by various tests and/or treatment methods. Statistically, the predictive values of HCT, USG, EU and Ur and their combinations were evaluated using the area under the receiver operating characteristic curve (AROC). Results: The patients’ mean age was 38 (range 4–72) years. Sensitivity values of HCT, USG, EU and Ur were 97, 69, 71 and 81%, respectively. Their specificity values were 96, 87, 91 and 65%, respectively. The widest AROC was found for HCT (97%). The best test combination was [HCT or USG] according to the AROC value (93%), but none of the AROC values of the test combinations was higher than that of HCT. However, 95% confidence intervals of the AROC values of these tests and their combinations overlapped. Conclusions: Because the HCT combinations with other tests improved the diagnostic value of HCT, they should be preferred in some individuals suspected of having urolithiasis. However, the most feasible single test meeting the all usage purposes was HCT in terms of the AROC value, and the combination was [HCT or USG] in which either HCT or USG was positive.
Pyruvate Kinase Type Tumor M2 in Urological Malignancies
Authors: Hegele A. , Varga Z. , Kosche B. , Stief T. , Heidenreich A. , Hofmann R.
Published: April 2003

Introduction: The dimeric form of pyruvate kinase type M2 is overexpressed in tumor cells (TuM2-PK). The aim of the present study was to evaluate the clinical value of TuM2-PK as a tumor marker for renal cell carcinoma (RCC), transitional cell carcinoma of the bladder (TCC) and prostate cancer (PCA) by using a commercially available enzyme-linked immunosorbent assay for detection of TuM2-PK in plasma. Material and Methods: The TuM2-PK concentration in EDTA plasma was determined quantitatively and immunologically using an ELISA (ScheBo®Tech, Germany). We measured the TuM2-PK plasma levels of 83 patients with RCC, 30 patients with TCC and 30 patients with PCA before any therapy. 100 patients with various non-malignant urological disorders were recruited as the control group. Results: Only patients with RCC showed significantly elevated plasma levels of TuM2-PK compared to the control group (p < 0.01). We found a sensitivity of 42.6% and a specificity of 80.4% using a cut-off value of 15 U/ml (manufacturer’s recommendation). During follow-up, only 50% showed increasing plasma levels of TuM2-PK in case of metastases. Significant differences could not be detected in either TCC or PCA. Conclusions: Our data suggest that TuM2-PK is not a useful marker for TCC and PCA. Due to low sensitivity and specificity, TuM2-PK is not suitable for the diagnosis of RCC. Whether TuM2-PK may be useful in advanced RCC to control success of palliative treatment regimens is still unclear.
Role of Protein Kinases on Acid-Induced Duodenal Bicarbonate Secretion in Rats
Authors: Furukawa Osamu , Hirokawa Masahiko , Guth Paul H. , Engel Eli , Kaunitz Jonathan D.
Published: April 2003

We examined the effect of several protein kinase inhibitors, such as staurosporine for protein kinase C (PKC), H-89 for protein kinase A (PKA) and genistein for tyrosine kinase (TK) on acid-induced duodenal bicarbonate secretion (DBS) in rats. HCO–3 secretion was measured using the pH-stat method. Mucosal acidification was performed by perfusing the duodenal loop for 10 min with pH 2.2 HCl. Indomethacin, staurosporine and genistein were added to acidified saline and then perfused, respectively. In some cases, genistein and phorbol 12-myristate 13-acetate (PMA) were added to the luminal solution to examine the effect on basal duodenal HCO–3 secretion. PGE2 (PKA pathway) and PMA (PKC pathway) stimulate basal DBS. Indomethacin, H-89, staurosporine and genistein inhibit acid-induced DBS, indicating involvement of the cyclooxygenase, PKA, PKC and TK pathways.
Alterations of Renal Vasopressin V1A and V2 Receptors in Spontaneously Hypertensive Rats
Authors: Tahara Atsuo , Tsukada Junko , Tomura Yuichi , Wada Koh-ichi , Kusayama Toshiyuki , Ishii Noe , Yatsu Takeyuki , Uchida Wataru , Taniguchi Nobuaki , Tanaka Akihiro
Published: April 2003

To elucidate the role of arginine vasopressin (AVP) in a hypertensive state, the characteristics of renal cortex V1A and medulla V2 receptors in young spontaneously hypertensive rats (SHR) during the developmental phase of hypertension were compared with those of age-matched Wistar-Kyoto (WKY) rats using the radioligand receptor assay technique. The systolic blood pressure of 8-week-old SHR was statistically significantly higher than that of WKY rats (142 ± 1 vs. 125 ± 2 mm Hg). The plasma AVP levels were also significantly higher in SHR than in WKY rats (3.20 ± 0.41 vs. 1.96 ± 0.34 pg/ml). In SHR, the maximum capacity of 3H-d(CH2)5Tyr(Me)AVP binding to cortical V1A receptors (Bmax) was statistically significantly higher than that of WKY rats (39.7 ± 2.7 vs. 22.4 ± 0.9 fmol/mg protein). Furthermore, the Bmax values of 3H-AVP binding to medullary V2 receptors in SHR were also significantly higher than in WKY rats (40.2 ± 1.9 vs. 28.3 ± 1.3 fmol/mg protein). However, the apparent dissociation constant (Kd) values of renal cortex V1A and medulla V2 receptors in SHR and WKY rats were not significantly different. These results indicate that increased amounts of renal cortex V1A and medulla V2 receptors in SHR play an important role in the pathophysiology of hypertension.
Meta-Analysis of Five Studies on Tegafur plus Uracil (UFT) as Post-Operative Adjuvant Chemotherapy for Breast Cancer
Authors: Kasumi Fujio , Yoshimoto Masataka , Uchino Junichi , Abe Rikiya , Nomura Yasuo , Sugimachi Keizo , Nakazato Hiroaki , Abe Osahiko
Published: April 2003

Meta-analysis of 5 studies on postoperative breast cancer cases (2 studies on surgery alone vs. tegafur plus uracil (UFT) and 3 studies on tamoxifen (TAM) alone vs. TAM + UFT) were carried out to evaluate the anticancer drug UFT in oral postoperative adjuvant chemotherapy. Of the 1973 patients enrolled, 1898 were eligible and 75 were excluded (exclusion rate 3.8%). There was no bias in major background factors in either the UFT-treated (965) or non-UFT-treated (933) groups. The reduction in the odds of death and the odds of recurrence were 17 ± 17% (p = 0.33) and 21 ± 11% (p = 0.060), respectively. Multivariate analysis using Cox’s proportional hazards model emphasized the effectiveness of UFT treatment for suppression of recurrence compared with non-treatment with UFT (p = 0.038). Suppression of recurrence was remarkable in the group treated with UFT for 2 years. (the reduction in the odds of recurrence: 23 ± 11%, p = 0.048) Stratified analysis was applied concerning recurrence, and improved results were obtained in premenopausal cases (the reduction in the odds of recurrence: 33 ± 11%, p = 0.019). These results suggested that UFT treatment for 2 years was effective as postoperative adjuvant chemotherapy for stage I – IIIA breast cancer for the prolongation of the reccurence-free survival period.
A Comparative Study of Antioxidants S-Allyl Cysteine Sulfoxide and Vitamin E on the Damages Induced by Nicotine in Rats
Authors: Helen A. , Krishnakumar K. , Vijayammal P.L. , Augusti K.T.
Published: April 2003

The dietary consumption of antioxidant-rich fruits and vegetables is inversely correlated with the incidence of various diseases like cardiovascular diseases and lung cancer. We have tried to find out how far the S-allyl cysteine sulfoxide (SACS) isolated from garlic (Allium sativum L.) can combat the nicotine-induced peroxidative damage in rats. The effects have been compared with the standard antioxidant vitamin E. Administration of SACS or vitamin E (100 mg/kg) to nicotine (0.6 mg/kg) treated rats for 21 days showed decreased concentrations of thiobarbituric acid reactive substances, hydroperoxides, and conjugated dienes in liver, lungs, and heart as compared with the values found in rats treated with nicotine alone. The activities of catalase and superoxide dismutase increased. The levels of the antioxidants like vitamins A, C, and E in the liver and glutathione in all tissues increased significantly in SACS-treated or vitamin E fed rats. However, the antioxidant status was higher when vitamin E was administered as compared with SACS administered to nicotine-treated rats.
Further Results on the Association between Morningness-Eveningness Preference and the Season of Birth in Human Adults
Authors: Natale Vincenzo , Adan Ana , Chotai Jayanti
Published: April 2003

Morningness-eveningness preference by the self-rated Morningness-Eveningness Questionnaire (MEQ) has earlier been shown to be associated with the subjects’ season of birth. Here, we obtain this result for a new sample of 2,125 university students and for the sample obtained by pooling the data with the earlier study, yielding totally 3,709 Italian and Spanish subjects. An nonlinear regression of MEQ as a cosine curve according to the month of birth, adjusting for age and gender, gave a maximum (morningness) around the transition between the birth months December and January, and a minimum (eveningness) around the transition between the birth months June and July. Multiple logistic regressions showed that for females as well as for males, the group born during the half-year April to September containing summer had a significantly lower proportion of morning types as compared with the group born during the half-year October to March containing winter. This was more pronounced for males. Moreover, a significantly higher proportion of morning types among females compared with males was found only in the group born during April to September, but not in the group born during October to March. There was a weak but statistically significant positive correlation between MEQ and age in the sample’s limited age range of 17–30 years. We discuss the results in terms of the mutually inhibitory systems of melatonin and dopamine, and find further support for a hypothesis that it is the variation in the length of photoperiod during the gestational or perinatal period that contributes significantly to the season of birth variation found in the morningness-eveningness preference among adults.
Association Study of the Estrogen Receptor Polymorphisms with Tardive Dyskinesia in Schizophrenia
Authors: Lai I-Ching , Liao Ding-Lieh , Bai Ya-Mei , Lin Chao-Cheng , Yu Shun-Chieh , Chen Jen-Yeu , Wang Ying-Chieh
Published: April 2003

Tardive dyskinesia (TD) is an involuntary movement disorder induced by long-term antipsychotic treatments. Estrogen is suggested to modulate dopamine receptors in the central nervous system and may decrease the incidence and/or relieve the symptoms of TD. In this study, 118 schizophrenia patients with antipsychotic-induced TD and 128 sex- and age-matched non-TD schizophrenia patients were recruited. All patients were assessed by the Abnormal Involuntary Movement Scale and genotyped for the polymorphisms of estrogen receptor-α gene (ESR 1). There was a marginal association of the genotypes determined by Pvu II between TD and non-TD patients (p = 0.057), but not of the genotypes determined by Xba I (p = 0.896). However, further studies on other polymorphisms of ESR 1 or other estrogen receptors are necessary to clarify the role of estrogen in the pathogenesis of TD.
Comedogenesis: Some Aetiological, Clinical and Therapeutic Strategies
Authors: Cunliffe W.J. , Holland D.B. , Clark S.M. , Stables G.I.
Published: April 2003

Hypercornification is an early feature of acne and usually precedes inflammation. It is associated with ductal hyperproliferation, and there are many controlling factors such as androgens, retinoids, sebum composition and cytokines. Cycling of normal follicles and of comedones may explain the natural resolution of comedones and, in the longer term, resolution of the disease itself. There is a need to tailor treatment according to comedonal type. Suboptimal therapy can often result from inappropriate assessments of comedones, especially microcomedones, sandpaper comedones, submarine comedones and macrocomedones. Macrocomedones can produce devastating acne flares, particularly if patients are inappropriately prescribed oral isotretinoin. Gentle cautery under topical local anaesthesia is a useful therapy in the treatment of such lesions. The newer retinoids and new formulations of all-trans-retinoic acid show a better benefit/risk ratio.
Improving Vascular Access Outcomes: A Systems Approach to Eliminating Structural Barriers
Authors: Sands Jeffrey J. , Perry Michael A.
Published: April 2003

Maximizing AV fistula creation, regular access monitoring, prompt outpatient interventions and minimizing catheter use are well-accepted approaches for vascular access management. Systemic barriers impede the application of these strategies. A misaligned reimbursement system coupled with educational deficits and a lack of accountability has contributed to the institutionalization of substandard vascular access care. The hallmark of performance management is to create systems in which incentives are aligned to produce desired behaviors. Realigning reimbursement through a combination of pre-ESRD funding, enhancements to the composite rate to reward outcomes and cover vascular access monitoring and updated reimbursement for outpatient vascular access procedures would improve care and decrease unnecessary hospitalizations. This should be coupled with clearly defined outcome standards and accountability incorporated into hospital accreditation and credentialing. Capitation may provide alternative solutions. A two-phased approach including reimbursement reform while exploring capitation represents a prudent course with the best likelihood of success.
ADEMEX and HEMO Trials: Where Are We Going?
Authors: Prichard Sarah
Published: April 2003

Doubt has remained as to whether or not the K/DOQI recommended targets for adequacy of dialysis for peritoneal dialysis patients is appropriate (weekly Kt/V 2 + creatinine clearance 50–60 l/1.73 m2). The ADEMEX trial can be interpreted as indicating that lower targets might be acceptable. The HEMO trial, not yet published but presented in April 2002, casts doubts on the advantages of achieving higher than recommended small solute clearance targets. Taken together, these trials require that we broaden our concept of adequacy. There is also a risk of complacency with respect to dialysis adequacy because of these trials and this would be unwise.