bluuebunny/crossref_metadata_2025 huggingface dataset:
A One-Year Trial of In-Center Daily Hemodialysis with an Emphasis on Quality of Life
Authors: Reynolds Jeffrey T. , Homel Peter , Cantey Lisa , Evans Ellen , Harding Pamela , Gotch Frank , Wuerth Diane , Finkelstein Susan , Levin Nathan , Kliger Alan , Simon David B. , Finkelstein Fredric O.
Published: June 2004

Background/Aims: Hemodialysis is associated with acute changes in several physiologic factors. Previous studies have suggested significant clinical and quality of life (QOL) benefits of daily hemodialysis (DHD) compared with 3 times weekly hemodialysis (CHD). We conducted a prospective trial to evaluate the effects of switching chronic hemodialysis patients to in-center DHD for a 12-month period. Methods: There were no exclusion criteria. Patients received hemodialysis 6 times per week. The study set a standardized weekly Kt/V (stdKt/V) goal of 3.0. A broad array of clinical parameters was determined. QOL was assessed with multiple instruments. Results: Eleven subjects completed 12 months and 12 completed 6 months on DHD. Significant changes relative to baseline at 12 months of DHD included decreased BP and improvements in QOL parameters by multiple techniques. 100% of patients at 12 months wished to continue DHD. Conclusions: DHD offers advantages over CHD with respect to improved QOL and BP control.
Cardiac Troponin I and Creatine Kinase Isoenzyme MB in Patients with Intradialytic Hypotension
Authors: Hung Shih-Yuan , Hung Yao-Min , Fang Hua-Chang , Yeh Jeng-Hsien , Hung Gin-Chuan , Wu Cheng-Ju , Chou Kang-Ju , Chung Hsiao-Min
Published: June 2004

Background: Intradialytic hypotension (IH) has been long recognized as a common complication during hemodialysis (HD) therapy, but few studies have discussed IH-related myocardial injuries and the long-term prognosis of patients prone to IH (HP). Methods: We conducted a prospective study on 70 chronic HD patients who had no recent occurrences of acute coronary artery syndrome. The patients were divided into two groups: HP (n = 29) and IH resistant (n = 41). While they underwent HD therapy, we monitored and evaluated their baseline data and their patterns of cardiac troponin I (cTnI), creatine kinase, and creatine kinase isoenzyme MB. Results: The HP and IH-resistant patients had similar baseline cardiac marker levels that did not seem to be influenced by uneventful HD therapy. However, if during HD therapy the patients experienced an episode of symptomatic IH, they were found to have significant increases in the creatine kinase MB activity at the end of HD therapy and in the cTnI levels 44 h following HD. After 12 months, the HP patients with baseline cTnI levels ≧0.20 ng/ml were more likely to experience cardiovascular events or death (adjusted odds ratio 15.0, p = 0.012). Conclusions: Our study showed that, after symptomatic IH episodes, the HP patients were more likely to suffer occult myocardial injuries. HP patients who have high cTnI levels should be closely monitored for cardiovascular diseases.
Defective Spatial Imagery with Pure Gerstmann’s Syndrome
Authors: Carota Antonio , Di Pietro Marie , Ptak Radek , Poglia Davide , Schnider Armin
Published: June 2004

Gerstmann’s syndrome comprises finger agnosia, peripheral agraphia, anarithmetia, and right-left confusion. We here report a single-case study of an 85-year-old ambidextrous man who exhibited pure Gerstmann’s syndrome (i.e., without aphasia) 10 weeks after a stroke involving the angular gyrus in the left parietal lobe. We hypothesize that, in this case, the main cognitive denominator of Gerstmann’s tetrad was a severe dysfunction in mental rotation and translation. This report provides further evidence for the spatial nature of Gerstmann’s syndrome.
Long-Term Prognosis, by Stroke Subtypes, after a First-Ever Stroke: A Hospital-Based Study over a 20-Year Period
Authors: Yokota Chiaki , Minematsu Kazuo , Hasegawa Yasuhiro , Yamaguchi Takenori
Published: June 2004

Background and Purpose: The influence of stroke subtype on recurrence, and determinants of recurrence-free survival after a first-ever stroke are not fully understood. We aimed to clarify the long-term prognosis by stroke subtypes and to identify determinants for recurrence and death after a first-ever stroke. Methods: We enrolled 1,732 consecutive patients (men/women = 1,134/598, mean age of 65 years) with a first-ever acute stroke who were admitted to our Stroke Care Unit during a period of 20 years. Stroke subtypes were classified as atherothrombotic brain infarction, lacunar infarction, cardioembolic infarction, other type of infarction, and brain hemorrhage. The prognosis was assessed by stroke subtypes. Results: During the hospital stay (mean 61 days), 99 patients died: 73 died directly from stroke. A total of 198 patients had recurrent strokes, and 286 died within 3 years after the index stroke. The overall recurrence rate within the first year was 6.5%, which was different among stroke subtypes. Patients with cardioembolic infarction (9.0%) as well as other type of infarction (9.1%) had more recurrent strokes within the initial year compared with the other subtypes. A history of transient ischemic attack (relative risk = 1.38), atrial fibrillation (1.52), ischemic heart disease (1.40), and disability at discharge (2.64) were independent predictors for the recurrence and death within 3 years after the first-ever stroke. Conclusions: The recurrence rate was different among stroke subtypes within 1 year after the index stroke. Atrial fibrillation, ischemic heart disease, history of transient ischemic attack, and disability at discharge were important determinants for stroke recurrence and death.
Reproducibility of Histological Assessment of Carotid Plaque: Implications for Studies of Carotid Imaging
Authors: Lovett J.K. , Gallagher P.J. , Rothwell P.M.
Published: June 2004

Background: Thromboembolism from carotid plaque is an important cause of stroke. Identification of unstable plaque would therefore be clinically useful. Unfortunately, studies of carotid plaque imaging have shown poor agreement with histology. However, this may be due to inconsistent methods and the variability of assessments of carotid plaque histology, rather than inadequate imaging. Methods: We assessed the reproducibility of histological assessment in 60 plaques, and section-to-section variability along the length of 26 plaques. Results: Kappa values ranged from 0.35 to 0.89 and from 0.44 to 0.68, respectively, for intra- and inter-observer reproducibility. There was considerable section-to-section variability within plaques. Conclusions: The accuracy of imaging of carotid plaque morphology will be underestimated unless variability in the histology assessment is taken into account.
Measuring Outcomes as a Function of Baseline Severity of Ischemic Stroke
Authors: Adams Jr. Harold P. , Leclerc Jacques R. , Bluhmki Eric , Clarke William , Hansen Michael D. , Hacke Werner
Published: June 2004

Background: The spectrum of neurological impairments following acute ischemic stroke is broad. The initial stroke severity predicts responses to treatment and outcomes after ischemic stroke. While clinical trials are using baseline severity as an enrollment criterion or a stratified variable, adjustment of outcome measures as a function of initial impairments has not been done. Methods: We developed a responder analysis that defines favorable outcomes at 90 days as influenced by the baseline National Institutes of Health Stroke Scale (NIHSS). Favorable outcome was defined as a modified Rankin Scale (mRS) score of 0 if the baseline NIHSS score was <8, mRS score of 0–1 if the NIHSS score was 8–14, and mRS score of 0–2 if the NIHSS score was >14. The concept stemmed from the data of two European rtPA trials. The analysis is a predefined secondary endpoint in a trial testing abciximab. We also used the analysis to reexamine the Trial of Org 10172 in Acute Stroke Treatment data. Results: The responder analysis did not change the overall results of any of the 3 previous trials, but it did give information about differences in responses among subgroups of patients. Evidence about the potential utility of tPA for treatment of patients with mild stroke appeared from the analysis of the second European trial of rtPA. The analysis also provided a hint of efficacy of abciximab. Conclusions: The responder analysis appears to be a potentially useful way to evaluate outcomes of patients enrolled in clinical trials in stroke. The results of the analysis have clinical relevance and can further explain differences in responses to therapies. In addition, the analysis allows for improved comparisons of results among clinical trials.
A Regulatory Role for Complement in Innate Immunity and Autoimmunity
Authors: Nauta Alma J. , Roos Anja , Daha Mohamed R.
Published: June 2004

The complement system comprises a strong defense against various pathogens and is a major component of our innate immune system. While earlier studies have established a crucial role of complement in recognition, opsonization and enhanced phagocytosis of microorganisms by professional phagocytes such as polymorphonuclear leukocytes and macrophages, recent studies delineate an additional role of complement in initiation and maintenance of the acquired immune response. In addition, it seems that opsonization of apoptotic cells by complement may lead to polarization of the response of professional antigen-presenting cells to a more inflammatory or tolerogenic response. The present review summarizes these different contributions of complement to the shaping of the immune balance.
17β-Estradiol Promotes Striatal Medium Size Spiny Neuronal Maturation in vitro
Authors: Stroppolo Antonella , Tian Chai , Guinea Barbara , Olm Vicki , Sheffield Roxanne , Sommer John , Ehrlich Michelle E.
Published: June 2004

Gender differences exist in the development of the nigrostriatal dopamine system, and in the incidence and course of pediatric and adult neuropsychiatric diseases in which this system is implicated. The medium size spiny neuron (MSN) is the major output neuron of the caudate nucleus. It receives a large dopaminergic input from the substantia nigra, and 96% of the MSNs express DARPP-32, a dopamine and cyclic AMP-regulated phosphoprotein and key mediator of dopamine function. There are few examples, however, of direct effects of sex hormones, including 17β-estradiol (E2), on the MSN. We report that in vitro, E2 (10–50 nM) promotes MSN phenotypic maturation, as determined by increased soma size, neurite length, and DARPP-32 protein levels. Treatment with the ‘anti-estrogen’ ICI 182,780 or the partial-agonist tamoxifen also increases DARPP-32 levels, but when added to E2, ICI 182,780 only prevents the increase in DARPP-32 levels and increase in soma size and neurite length. Surprisingly, maturation effects are more robust in cells derived exclusively from female embryos. Western blot analysis of protein lysates and immunocytochemistry of cultured MSNs reveals the presence of the estrogen receptor β (ERβ). These data suggest that ERβ may mediate the differentiating effect of E2 on embryonic MSNs, and provide new avenues of investigation for the role of sex hormones in the development of the striatum and in diseases affecting the basal ganglia.
Alpha-Melanocyte-Stimulating Hormone through Melanocortin-4 Receptor Inhibits Nitric Oxide Synthase and Cyclooxygenase Expression in the Hypothalamus of Male Rats
Authors: Caruso Carla , Mohn Claudia , Karara Armando L. , Rettori Valeria , Watanobe Hajime , Schiöth Helgi B. , Seilicovich Adriana , Lasaga Mercedes
Published: June 2004

There is evidence that α-melanocyte-stimulating hormone (α-MSH) has immunomodulatory and anti-inflammatory actions within the brain. In this study, we tested whether these actions are due to inhibition of the synthesis of nitric oxide (NO) and prostaglandins induced by lipopolysaccharide (LPS). Since melanocortin subtype MC4 receptor has been detected in the hypothalamus, we investigated the effect of central administration of α-MSH and HS024 (a selective MC4 receptor antagonist) on the gene expression of inducible, neuronal and endothelial NO synthase (iNOS, nNOS and eNOS) and on cyclooxygenase (COX-1 and COX-2) expression in the mediobasal hypothalamus (MBH) of LPS-treated male Wistar rats. Peripheral administration of LPS (250 µg/rat, 3 h) induced iNOS and COX-2 gene expression in the MBH. This stimulatory effect was reduced by α-MSH (3 nmol/rat) injected 30 min before LPS. α-MSH and HS024 (1 nmol/rat) alone had no effect on iNOS and COX-2 expression. The action of α-MSH on LPS-induced iNOS and COX-2 mRNA levels was not observed in the presence of HS024, suggesting that MC4-R may be involved in the modulatory effect of α-MSH. None of these treatments produced any modifications in nNOS, eNOS and COX-1 expression in MBH. The increase in serum corticosterone levels induced by LPS was attenuated by α-MSH. Both LPS and α-MSH decreased serum LH and prolactin levels. HS024 failed to modify the inhibitory effects of LPS and α-MSH on prolactin release but reverted the effect of LPS on LH secretion, indicating that MC4-R activation may be involved in the effects of α-MSH on LH secretion in male rats. When we examined the in vitro effect of LPS (10 µg/ml) and LPS plus interferon-γ (IFN-γ, 100 ng/ml) on iNOS expression in MBH, an increase in iNOS mRNA levels was observed only in the presence of LPS + IFN-γ. This stimulatory effect was attenuated in the presence of α-MSH (5 µM), which by itself had no effect. No changes were found in nNOS, eNOS, COX-1 or COX-2 expression. These results indicate that α-MSH reduces the induction of iNOS and COX-2 gene expression at the hypothalamic level during endotoxemia and suggest that endogenous α-MSH may exert an inhibitory tone on iNOS and COX-2 transcription via MC4 receptors acting as a local anti-inflammatory agent within the hypothalamus.
Co-Secretion of Aldosterone and Cortisol by an Adrenocortical Carcinoma
Authors: Kurtulmus Neslihan , Yarman Sema , Azizlerli Halil , Kapran Yersu
Published: June 2004

We report a rare case of adrenocortical carcinoma. A 26-year-old woman presented with hypokalemia and hypertension due to hyperaldosteronism. She had no signs of Cushing’s syndrome. Endocrinological data showed excess of aldosterone production and nonsupressible cortisol production on 2 mg of dexamethasone. Magnetic resonance imaging showed left adrenal tumor. Transabdominal left adrenalectomy was performed and histopathological diagnosis was adrenocortical carcinoma. Her blood pressure and hypokalemia returned to normal after adrenalectomy. There is no recurrence after 36 months. We want to emphasis the importance of adrenal tests before the operation even if there are no signs of excess cortisol production.
Impact of Meal Timing and Frequency on the Twenty-Four-Hour Leptin Rhythm
Authors: Fogteloo A.J. , Pijl H. , Roelfsema F. , Frölich M. , Meinders A.E.
Published: June 2004

Objective: To study the influence of changes in meal timing and frequency on the diurnal rhythm of leptin and on the 24-hour profile of insulin and glucose. Patients and Methods: Five obese women were studied twice during a weight-maintaining diet in either 3 daily or 8 day and night equal portions. Blood was sampled for 24-hour profiles of leptin and insulin. Results: During the 8-meal intervention, the 24-hour rhythm of leptin changed significantly: the amplitude decreased (p = 0.0089) and the acrophase was delayed by 168 min (p = 0.021). Also, 8 small insulin secretion peaks occurred instead of the 3 postprandial high insulin peaks. Conclusion: The dispersion of food intake over 24 h affects the diurnal leptin rhythm. These changes could not be attributed to changes in circadian timing or energy balance. Instead, changes in daily insulin secretion profiles might play a role.
Resection of the Angle of Treitz and Distal Diverticulization of the Duodenum in Penetrating Abdominal Injuries
Authors: Ruso Luis , Taruselli Roberto , Metcalfe Matthew , Maddern Guy
Published: June 2004

Background: Access to the 4th part of the duodenum in the region of the ligament of Treitz can be very difficult. Primary repair or traditional duodenal diverticulization is often technically challenging for managing trauma at this location. Due to the frequent concomitant injuries and hemorrhage, a quick, simple and safe repair technique is highly desirable. Methods: 3 patients with penetrating injuries to the 4th part of the duodenum were managed by a technique affording good exposure, and involving linear stapling across the bowel proximal and distal to the site of injury, with a jejuno-duodenal anastomosis to the 2nd part of the duodenum, the proximal jejunum having been delivered through a window fashioned in the transverse mesocolon. Results: All patients survived and suffered no complications of their duodenal repair. Conclusions: The technique described offers a relatively simple, apparently safe and effective approach to a difficult problem in trauma surgery.
Relaparotomy following Complications of Feeding Jejunostomy in Esophageal Surgery
Authors: Han-Geurts Ingrid J. M. , Verhoef Cornelis , Tilanus Hugo W.
Published: June 2004

Background: After recognition of the importance of early postoperative enteral feeding, placement of a feeding jejunostomy as an adjunct to gastrointestinal surgery has become widely accepted. However, little attention has been paid to surgical complications and their consequences. Feeding jejunostomy as an adjunct to esophageal resection and reconstruction can lead to serious surgical complications. Methods: Between 1978 and 2000, 1,387 patients underwent esophageal resection and reconstruction. Of these, 1,166 patients received a needle catheter feeding jejunostomy at the end of the operation. All postoperative complications were prospectively evaluated in a database including surgical complications related to the feeding jejunostomy. Results: Overall, surgical complications occurred in 36%. There were 13 (1.1%) feeding jejunostomy related complications leading to relaparotomy. Of these, intraperitoneal leakage was the most common complication (n = 5). Other jejunostomy-related complications included dislodgement (n = 4), herniation (n = 3) and torsion (n = 1). Five patients (0.4%) died despite relaparotomy. Conclusions: Feeding jejunostomy as an adjunct to esophageal resection and reconstruction can lead to serious surgical complications. Preventive measures have not resulted in a decrease in complication rate. Complications of leakage necessitating relaparotomy are associated with a high mortality rate. Therefore, other means of enteral access should be considered.
Incidence and Therapeutic Outcome of Pouchitis for Ulcerative Colitis in Japanese Patients
Authors: Ikeuchi Hiroki , Nakano Hiroki , Uchino Motoi , Nakamura Mitsuhiro , Yanagi Hidenori , Noda Masafumi , Yamamura Takehira
Published: June 2004

Aim: The aim of this study was to examine the cumulative risk of pouchitis following restorative proctocolectomy for UC and FAP in Japanese patients, and to assess the response to medical treatment and its outcome. Patients and Methods: 521 patients with UC and 117 FAP patients underwent proctocolectomy and received a J-shaped IPAA at our department of surgery. We investigated these patients using PDAI for the diagnostic criteria of pouchitis. Results: Pouchitis occurred in only 32 UC patients (6.1%). The cumulative risk of developing pouchitis for a UC patient was 7% at 5 years after and 12% at 10 years after surgery. The medical treatment of acute pouchitis was usually oral metronidazole (250 mg twice daily) for 2 weeks or oral ciprofloxacin (200 mg thrice daily) in patients who could not tolerate metronidazole. Single episodes of pouchitis occurred in 21 patients (65.6%) and chronic or frequent relapses of pouchitis in 11 patients (34.4%). Three patients (9.4%) required re-ileostomy. Two patients (6.3%) required pouch excision. There were no patients with complicated dysplasia. Conclusion: The cumulative risk of pouchitis in Japanese UC patients is lower than that of western countries.
Nitric Oxide Levels in Preterm and Term Infants and in Premature Infants with Bacteremia
Authors: Marom D. , Yuhas Y. , Sirota L. , Livni G. , Ashkenazi S.
Published: June 2004

Objective: To determine the serum nitric oxide levels in healthy neonates and in infants with bacteremia. Methods: We performed a prospective study in a tertiary neonatal intensive care unit. The serum nitric oxide levels were measured in all infants at birth (basal) and in the infected neonates also on the first 2 days of bacteremia. Results: Thirty-three neonates (10 term, 23 preterm) were included. Eleven preterm infants (mean gestational age 27 weeks) had bacteremia. The main blood culture isolates included coagulase-negative staphylococci (n = 4), Klebsiella pneumoniae (n = 3), and Escherichia coli (n = 3). The serum nitric oxide levels increased during infection in 10 infants (p < 0.008). The mean nitric oxide level before infection was 44 µM and during infection 96 µM (p = 0.008). In the healthy babies, the mean nitric oxide level was 26 µM in those with a gestational age <27 weeks, 44 µM in those born between 28 and 36 weeks of gestation, and 63 µM in term infants. Conclusions: Bacteremic preterm infants produce significantly higher amounts of nitric oxide. The basal nitric oxide levels at birth may be correlated with gestational age.
Late Calcineurin Inhibitor Withdrawal as a Strategy to Prevent Graft Loss in Patients with Suboptimal Kidney Transplant Function
Authors: Weir Matthew R. , Blahut Steven , Drachenburg Cinthia , Young Cindi , Papademitriou John , Klassen David K. , Cangro Charles B. , Bartlett Stephen T. , Fink Jeffrey C.
Published: June 2004

Chronic allograft nephropathy is a major cause of progressive renal failure in renal transplant recipients. Its etiology is multifactorial and may include both immunologic and nonimmunologic causes. In this observational cohort study we set out to see if calcineurin inhibitor withdrawal would reduce the likelihood of graft loss. Methods: One hundred and five renal transplant recipients with impaired kidney function (mean serum creatinine 3.0 ± 0.1 mg/dl) and biopsy-proven chronic allograft nephropathy had the dose of their calcineurin inhibitors, cyclosporine (CSA), or tacrolimus (FK), reduced or discontinued with either the addition of, or continuation of mycophenolate mofetil and low-dose corticosteroids. This intervention occurred at a mean of 29.0 ± 2.7 months after transplantation. Follow-up after intervention was 54.3 ± 4.1 months in the reduced CSA group (n = 64), 41.6 ± 3.2 months in the reduced FK group (n = 28), and 75.5 ± 6.7 months in the calcineurin inhibitor withdrawal group (n = 13). Results: There were 24 graft failures in the reduced CSA group, 9 graft failures in the reduced FK group, and 1 graft lost in the calcineurin inhibitor withdrawal group. The unadjusted relative risk for graft failure in the CSA and FK groups combined (confidence interval 1.05–31.6), was 4.07 using the calcineurin inhibitor withdrawal group as the reference, p = 0.05. A Cox proportional hazards model adjusting for baseline covariates including age, gender, race, type of transplant, delayed graft function, baseline blood pressure and random serum glucose and cholesterol demonstrated that only calcineurin inhibitor dose reduction but not withdrawal, older age, delayed graft function, higher serum creatinine at the time of intervention , and higher diastolic blood pressure and serum glucose, correlated with graft loss. Only 6 of the 105 patients developed Banff grade acute rejection. All responded to steroid therapy. We conclude that although this observational cohort study may have a selection bias, late calcineurin inhibitor withdrawal in patients with chronic allograft nephropathy and impaired kidney function appears safe and durable as a treatment strategy to reduce the likelihood of graft failure.
Prevalence of Congenital Hypothyroidism in Isfahan, Iran: Results of a Survey on 20,000 Neonates
Authors: Hashemipour Mahin , Amini Massoud , Iranpour Ramin , Sadri Gholam Hossein , Javaheri Narges , Haghighi Sassan , Hovsepian Silva , Javadi Abbas Ali , Nematbakhsh Mahdi , Sattari Goshtasb
Published: June 2004

Aims: To evaluate the prevalence of congenital hypothyroidism (CH) in a screening program performed for the first time in Isfahan, Iran. Methods: From May 2002 to December 2002, T4 and TSH serum concentrations of 20,000 3- to 7-day-old newborns, born in all 17 hospitals of the city, were measured by radioimmunoassay and immunoradiometric assay, respectively. The newborns with abnormal screening results (TSH >20 mIU/l, T4 <6.5 µg/dl and based on the weight) were re-examined. Results: Of 531 recalled subjects (recall rate 2.6%), 54 were confirmed to be hypothyroid, showing a prevalence of 1:370 for CH. Conclusion: Considering the high frequency of CH, the necessity of implementing a routine screening program in the healthcare system of Isfahan Province is emphasized.
Hand-Assisted Laparoscopic Splenectomy for Splenic Tumors
Authors: Yano Hiroshi , Nakano Yoshiaki , Tono Takeshi , Ohnishi Tadashi , Iwazawa Takashi , Kimura Yutaka , Kanoh Toshiyuki , Monden Takushi
Published: June 2004

Background: The feasibility of hand-assisted laparoscopic splenectomy (HALS) for splenic tumors including benign or malignant neoplasms and the associated clinical outcome of the patients remain unclear. Methods: A total of 10 patients with splenic tumors undergoing HALS were retrospectively analyzed in this study. The intraoperative course, postoperative course, and postoperative recovery were evaluated. Results: Ten patients with splenic tumors consisted of 5 with benign tumors and 5 with malignant tumors. HALS was not converted to an open splenectomy in any of the patients. Mean operative time was 170 min (range 100–310 min). Mean estimated blood loss was 105 g (range 10–900 g). Mean splenic size and splenic weight was 13 cm and 478 g, respectively. Splenomegaly based on size or weight occurred in 50% of the patients. There were no intra- or postoperative complications. Postoperative chemotherapy was given to 4 patients with malignant tumors including metastatic carcinomas and malignant lymphomas. All the patients were alive at a mean follow-up of 26 months, ranging from 15 to 43 months after surgery. There was no port-site recurrence after surgery in our study. Mean time to first flatus, mean time to first walking, mean time to resumption of oral intake, mean length of hospital stay, and mean duration of epidural analgesia were 1.8, 1, 1.5, 10.8 and 3.1 days, respectively. The results were equal in terms of intra- and postoperative course to those seen with a standard laparoscopic splenectomy for 13 patients with idiopathic thrombocytopenic purpura. Conclusion: HALS may be a good indication for malignant tumors as well as benign tumors of the spleen.
Leakage Testing at the Time of Surgical Oesophageal Myotomy
Authors: Kostic Srdjan , Lönroth Hans , Lundell Lars
Published: June 2004

Background: Surgical myotomy is a well-established and validated method to treat severe gastro-oesophageal motor disorders such as achalasia. The benign character of these diseases further substantiates the importance of operating with greatest possible safety margins. We presently report our experiences with the use of perioperative leakage testing. Materials and Methods: Thirty-seven consecutive patients are reported of whom 30 had a laparoscopic, 3 a thoracoscopic and 4 an open operation. The indications for an operation were in 3 patients oesophageal spasm, in 30 patients newly diagnosed achalasia and 4 patients had an open reoperation due to a previous incomplete myotomy plus epiphrenic diverticulum. Thirty patients had a perioperative endoscopy with gas insufflation and a leakage test, whereas the others did not. Results: A previously unrecognised oesophageal mucosal tear was discovered during the test and repaired in 4 of the 30 tested cases whereafter everyone had an uneventful postoperative recovery. Among the remaining 7 untested patients, 3 developed clinical signs of leakage of whom 1 had an immediate reoperation. The postoperative courses were in all those prolonged and complicated. Conclusion: Perioperative use of endoscopy at the time of completion of the surgical myotomy is a useful tool to document leakage. Thereby the safety profile of the operation can be further enhanced.
Cardiovascular Complications of Cancer Therapy
Authors: Yeh Edward T.H. , Tong Ann T. , Lenihan Daniel J. , Yusuf S. Wamique , Swafford Joseph , Champion Christopher , Durand Jean-Bernard , Gibbs Harry , Zafarmand Alireza Atef , Ewer Michael S.
Published: June 2004

The cardiotoxicity of anticancer agents can lead to significant complications that can affect patients being treated for various malignancies. The severity of such toxicity depends on many factors such as the molecular site of action, the immediate and cumulative dose, the method of administration, the presence of any underlying cardiac condition, and the demographics of the patient. Moreover, toxicity can be affected by current or previous treatment with other antineoplastic agents. Cardiotoxic effects can occur immediately during administration of the drug, or they may not manifest themselves until months or years after the patient has been treated. In this article we review commonly used chemotherapy agents, including several recently approved medications, for their propensity to cause cardiotoxicity. Further research will be required to more accurately predict which patients are at risk for developing cardiotoxicity. In addition, management plans, as well as strategies to reduce cardiotoxicity, need to be developed.
Flávio de Carvalho: Media Artist Avant la Lettre
Authors: Leite Rui Moreira
Published: June 2004

This paper examines the work of Brazilian artist Flávio de Carvalho (1899-1973) from the perspective of contemporary media art, highlighting his practical and theoretical legacy. Initially associated with the Anthropophagy art movement, Carvalho used mass media creatively and incorporated insights from psychology, sociology and anthropology into his art. He realized events that went beyond “performance art,” including a pioneering presentation on television in 1957. This article offers a brief overview of Carvalho's trajectory.
Artistic Practice as Construction and Cultivation of Knowledge Space
Authors: Strauss Wolfgang , Fleischmann Monika
Published: June 2004

This article presents the netzspannung.org Internet platform, a media laboratory on the Internet that not only collects high-quality information on digital culture and media production but also interlinks this information, contextualizes it and makes it available on-line as a constantly expanding knowledge space that, like a library, can be explored by the public as an interactive installation and an educational space. In the broadest sense, the aim of this project is to visualize and semantically network information to create “knowledge spaces” that can be explored interactively and in real time and that are accessible to the user through play. Technologies, online tools and intuitive interfaces are being developed that support communication between the digital and physical spaces and investigate new forms of knowledge acquisition as “knowledge-based arts.”
The SMSMS Project: Collective Intelligence Machines in the Digital City
Authors: Bolognini Maurizio
Published: June 2004

The SMSMS project is a computer-based interactive installation that derives from the author's previous work, Computer sigillati, in which 200 machines have been programmed to produce an endless flow of random images and left to work indefinitely without being connected to a monitor. In SMSMS, one of the Computer sigillati programs is employed to create images that are visible and can be modified by the public using cell phones. SMSMS could be considered as either an exercise in collective intelligence or, in contrast, as a disturbance to the unpredictable working of the machine. Some implications concerning art and new technologies are discussed.
Intellectual Property: A Chronological Compendium of Intersections between Contemporary Art and Utility Patents
Authors: Thill Robert
Published: June 2004

The author presents a group of projects in which the roles of inventor, artist, amateur and institution variously overlap, merge and blur, offering new perspectives on the relationship between contemporary art and utility patents. Addressing issues of originality, aesthetics, labor, ownership and value, these projects demonstrate a continuous link between art and patents and encourage thoughtful speculation about shared concerns, guiding ideologies and forms.
The Privatization of Protection: Extortion and The State in the Circassian Mamluk Period
Authors: Meloy John
Published: June 2004

This article examines privatized forms of protection (himāyah ), and especially extortion, during the Circassian Mamluk period as reported in contemporary chronicles and a tract calling for administrative reform. Protection rackets were characterized by a symbiotic relationship between "protectors" and state officials. The article concludes with a discussion of the implications of extortion for our understanding of the effective power of the Mamluk Sultanate during its last century of rule. Cet article examine les formes privées de protection pratiquées durant le règne des Mamelouks circassiens, en particulier l'extorsion. Ces pratiques sont rapportées par les chroniques de l'époque et par un manifeste appelant à des réformes administratives. Cette forme de "racket" se caractérisait par la relation symbiotique liant les "protecteurs" aux fonctionnaires. En conclusion, cette étude nous amène à nous interroger sur la manière dont ces pratiques d'extorsion permettent de mieux cerner le pouvoir réel au sein du sultanat mamelouk pendant le dernier siècle de son existence.
Economic Boundaries? Late Antiquity and Early Islam
Authors: Morony Michael
Published: June 2004

The Mediterranean economy was retracting from the mid-sixth century while the Sasanian economy was expanding. Six trends are identified during Late Antiquity that extended into the Islamic period: (1) the development and spread of large estates with tenant labor, (2) the monetization of the economy, (3) the development and spread of irrigated agriculture, (4) the revival of mining, (5) the emergence of merchant diasporas, and (6) the domination of Indian Ocean commerce by Persian shipping. It is argued that these trends were strongest in Sasanian territory where the economic system identified as "Islamic" originated. À partir du milieu du sixième siècle l'économie méditerranéenne connaissait une régression alors que celle de l'Empire sasanide était en plein essor. Durant l'époque de l'Antiquité tardive et au cours de la période islamique, six tendances peuvent être relevées: 1) le développement et la diffusion des grands domaines avec fermiers à bail; (2) la monétarisation de l'économie; (3) l'extension de l'agriculture irriguée; (4) la revivi fication du secteur minier; (5) l'émergence des diasporas commerciales; et (6) la domination commerciale de la marine perse dans l'Océan indien. Selon notre analyse, ces tendances étaient plus fortement ressenties en territoire sasanide où le système économique dit "islamique" connut le jour.
Local and International Trade and Traders in The Straits of Melaka Region: 600-1500
Authors: Hall Kenneth
Published: June 2004

This article notes that the recent mainstream scholarship on the pre-1500 Indian Ocean trade by non-Southeast Asia specialists has limited itself to Middle Eastern, South Asian, and Chinese evidence—and that these scholars' exclusion of Southeast Asian documentation has led to erroneous statements and conclusions. Based on selected examples of the omitted Southeast Asia evidence, this study highlights the changes taking place in the maritime trade network from the eleventh through the fifteenth centuries, and the increasing complexity of the Asian trade system. It demonstrates that scholars need to reconsider their characterizations of Asian trade "centers" ("emporia"), and that by the fifteenth century an Asia trade "center" is a convenient and commonly agreed upon marketplace that is networked with and shared by merchant sojourners who are based in other significant regional "centers." It also contends that assertions that there was a late fourteenth- through fifteenth-century Asian trade decline are incorrect, and that Asian commerce was robust when the Portuguese appeared on the scene at the beginning of the sixteenth century—and seized Melaka in their failed attempt to dominate the Asia maritime trade network. Cet article relève que le courant principal récent de la recherche sur le commerce dans l'Océan indien avant le XVe siècle par des non-spécialistes du Sud-Est asiatique a concentré ses études sur l'Asie moyenne orientale, méridionale et la Chine; en ignorant la documentation provenant de l'Asie du Sud-Est, ces chercheurs ont été conduits à avancer des conclusions erronées. Fondée sur des exemples choisis dans cette dernière région, cette étude met en évidence les changements intervenus dans le réseau du commerce maritime entre le XIe et XVe siècles et la complexité accrue du système commercial asiatique. Elle souligne également que les chercheurs doivent reconsidérer les caractéristiques qu'ils accordent aux "centres" ("emporia") de commerce asiatique et qu'au XVe siècle un "centre" est une place commerciale pratique intégrée dans un réseau partagé par des négociants installés dans d'autres "centres" notoires de la région. Elle s'élève en fin contre les affirmations avançant que le commerce était en déclin à la fin du XIVe et au XVe siècle; au contraire, il était encore fl orissant quand les Portugais apparaissent dans la région au début du XVIe siècle et s'emparent de Malacca dans leur tentative avortée de dominer le commerce maritime asiatique.
Assimilation and Revolt in the Territory of Isauria, From the 1st Century BC to the 6th Century AD
Authors: Lenski Noel
Published: June 2004

This article investigates shifts in the scale and organization of violence in the region of Isauria during the period of Roman rule. In contrast with the fundamental paper of B. Shaw in JESHO, volume 33 (1990), which argues that Isaurian violence was a constant in all periods of history, this study attempts to show that major Isaurian uprisings were brought under control from the mid-first century to the mid-third century AD. In these centuries the Isaurians became increasingly sedentarized, adopted Hellenistic social and political structures, and cooperated with the Roman state actively, particularly as soldiers. Only after the midthird century did Isauria again turn against Rome, this time with increased strength built on the economic and social development it had experienced under Roman rule.
The Turkish Officers of Samarra: Revenue and the Exercise of Authority
Authors: Gordon Matthew
Published: June 2004

The present article concerns the access to revenue on the part of the Turkish officers of Abbāsid Samarra. It is argued that the revenue in question explains their considerable influence. It is also argued that among the arrangements made for the Turkish officers were specific forms of land tenure which represented a decisive step toward the system of the new style iqtā so widely used after the third/ninth century in the Islamic Near East.
TROPICAL CYCLONE WINDS AT LANDFALL: The ASOS–C-MAN Wind Exposure Documentation Project
Authors: Powell Mark , Bowman David , Gilhousen David , Murillo Shirley , Carrasco Nick , Fleur Russell St.
Published: June 2004

Photographs describing the wind exposure at automatic weather stations susceptible to tropical cyclones are now available on Web pages at the National Climatic Data Center and the National Data Buoy Center. Given the exposure for one of eight wind direction sectors, a user may estimate the aerodynamic roughness and correct mean wind measurements to an open-terrain exposure. The open-terrain exposure is consistent with the tropical cyclone advisories and forecasts issued by the National Weather Service, as well as building design wind load standards published by the American Society of Civil Engineers.
Targeted deletion of T-cell clones using alpha-emitting suicide MHC tetramers
Authors: Yuan Rui Rong , Wong Phillip , McDevitt Michael R. , Doubrovina Ekaterina , Leiner Ingrid , Bornmann William , O'Reilly Richard , Pamer Eric G. , Scheinberg David A.
Published: June 2004

Immunosuppressive agents in current use are nonspecific. The capacity to delete specific CD8 T-cell clones of unique specificity could prove to be a powerful tool for dissecting the precise role of CD8+ T cells in human disease and could form the basis for a safe, highly selective therapy of autoimmune disorders. Major histocompatibility complex (MHC) tetramers (multimeric complexes capable of binding to specific CD8 T-cell clones) were conjugated to 225Ac (an alpha-emitting atomic nanogenerator, capable of single-hit killing from the cell surface) to create an agent for CD8 T-cell clonal deletion. The “suicide” tetramers specifically bound to, killed, and reduced the function of their cognate CD8 T cells (either human anti–Epstein-Barr virus (EBV) or mouse anti-Listeria in 2 model systems) while leaving the nonspecific control CD8 T-cell populations unharmed. Such an approach may allow a pathway to selective ablation of pathogenic T-cell clones ex vivo or in vivo without disturbing general immune function.
Intercellular adhesion molecule-1 (ICAM-1) is upregulated on alveolar macrophages from AIDS patients
Authors: Bohnet S , Braun J , Dalhoff K
Published: June 2004

In acquired immune deficiency syndrome (AIDS) patients, alveolar macrophages (AMs) have an increased ability to serve as accessory cells during the generation of an immune response. In addition to soluble mediators, like cytokines, molecules of the major histocompatibility complex (MHC) class II and adhesion molecules, like intercellular adhesion molecule-1 (ICAM-1), play a major role in the regulation of these cellular interactions. Using an enzyme-linked immunosorbent assay (ELISA) technique and immunocytochemical staining, we investigated ICAM-1 and human leucocyte antigen-DR (HLA-DR) expression on AMs from 20 AIDS (HIV+) patients in context with other parameters of macrophage activation, such as tumour necrosis factor-alpha (TNF-alpha) secretion and the release of superoxide anion, comparing the results to a group of healthy volunteers. In addition, we quantified soluble ICAM-1 in the bronchoalveolar lavage fluid (BALF) using a commercially available kit. We found a nearly twofold increase in ICAM-1 expression (0.81 +/- 0.30 (SD) versus 0.42 +/- 0.12 ELISA units (EU) (mean +/- SD)), whilst the number of HLA-DR+ AMs was slightly decreased in AIDS-patients (80 +/- 5 versus 89 +/- 3%). Furthermore, soluble ICAM-1 in the BALF of these patients was significantly increased (41.9 +/- 26.1 versus 19.1 +/- 5.1 ng.ml-1). ICAM-1 levels on AMs in the patient group correlated strongly with the sodium fluoride triggered release of superoxide anion (O2-) but not with the spontaneous secretion of TNF-alpha by AMs.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacterial pneumonia in HIV-infected patients: a prospective study of 68 episodes
Authors: Falco V , Fernandez de Sevilla T , Alegre J , Barbe J , Ferrer A , Ocana I , Ribera E , Martinez-Vazquez JM
Published: June 2004

We collected clinical and microbiological observations, as well as follow-up on human immunodeficiency virus (HIV)-infected patients with bacterial pneumonia, and compared pneumococcal pneumonia in patients with and without HIV infection. Fifty five HIV-infected patients, who had had 68 episodes of bacterial pneumonia, were studied prospectively. Twenty one HIV-infected patients with pneumococcal pneumonia were compared to 69 non-HIV-infected patients with pneumococcal pneumonia. Aetiological diagnosis was established in 48 cases (71%). The most common causative agents were S. pneumoniae and H. influenzae. Sixty percent of episodes took place in asymptomatic carriers of HIV infection and 37% in acquired immune deficiency syndrome (AIDS) patients. Overall mortality was 10%. Fifty five percent of patients with follow-up had recurrent episodes. Bacteraemic pneumococcal pneumonia was more frequent in HIV- than in non-HIV-infected patients, and the mortality of pneumococcal pneumonia was also higher in HIV- (19%) than in non-HIV-infected (4.3%) patients. We conclude that bacterial pneumonia is a frequent problem in HIV-infected patients and that recurrent episodes are common. The clinical presentation of pneumococcal pneumonia is generally indistinguishable from that occurring in normal hosts, but bacteraemia is more common and the mortality is higher in HIV-infected patients.
Clinical evaluation of a serological assay using a monoclonal antibody (TB72) to the 38 kDa antigen of Mycobacterium tuberculosis
Authors: Bothamley GH , Rudd RM
Published: June 2004

We examined an enzyme-linked immunosorbent assay (ELISA) modification of a radioimmunoassay, using the TB72 monoclonal antibody, as a serological test for tuberculosis in a clinical setting. Sera were obtained from 238 patients with suspected pulmonary tuberculosis, 30 patients treated for tuberculosis, 28 contacts, and 480 random samples from inpatients. Antibody levels were measured as the dilution of serum causing 50% inhibition of binding of the TB72 monoclonal antibody, which binds to an epitope of the 38 kDa antigen specific to the Mycobacterium tuberculosis complex, a positive titre being > 3. Positive antibody titres were present in 21 out of 25 (84%) patients with smear-positive and 22 out of 27 (82%) patients with smear-negative, culture-positive tuberculosis, and 37 out of 41 (90%) patients successfully treated for tuberculosis but without bacteriological confirmation of disease. Three out of 82 (4%) patients with a firm alternative diagnosis to tuberculosis gave a positive result. Serological tests were negative within 2.5 yrs of successful treatment. Patients without a definite diagnosis one year after tuberculosis had been suspected, and those who had received inadequate treatment for tuberculosis, were frequently positive (21 out of 31 and 21 out of 32, respectively). Positive tests concurred with tuberculin reactivity in 8 out of 11 contacts given chemoprophylaxis. Screening of 480 random serum samples gave 22 positive titres, 16 of which were not associated with tuberculosis; none of these 16 had an antibody titre > 10. We conclude that the TB72 test provides additional information in the diagnosis and treatment of tuberculosis. Antibody titres > 10 suggests active tuberculosis; titres of 3-10 merit observation.