bluuebunny/crossref_metadata_2025 huggingface dataset:
Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study
Authors: Musolino Rossella , La Spina Paolino , Granata Antonio , Gallitto Giuseppe , Leggiadro Nestore , Carerj Scipione , Manganaro Agatino , Tripodi Fortunata , Epifanio Antonio , Gangemi Santo , Di Perri Raoul
Published: April 2003

Background: A few studies have comprehensively assessed the epidemiology, aetiology, prognosis, and secondary prevention of ischaemic stroke in young adults. To gain further information on this field, we have prospectively studied a hospital-based series of young adults with a first-ever episode of cerebral ischaemia (CI). Methods: Sixty consecutive patients aged 17–45 with ischaemic stroke (55 patients) or transient ischaemic attack within 24 h before hospital admission were recruited and investigated by a standardized rigorous protocol. The patients were followed up for ≧1 year after hospital discharge. Arbitrary doses of aspirin 100 mg/d or ticlopidine 250 mg b.i.d. in case of intolerance to aspirin were given for the secondary prevention. Adjusted-dose oral anticoagulation (INR target 2.5) was used in the presence of cardioembolism or hypercoagulable states. Endpoints included the residual disability, rated by modified Rankin Scale (RS) and Barthel Index (BI), and poststroke recurrence. Results: CI was associated with two or more risk factors in 61.6% of patients. Cigarette smoking was more frequently associated with male gender (p < 0.05) and migraine history with female sex (p < 0.05). The atherothrombotic diagnostic subtype and the subtype from ‘other cause’ predominated significantly among patients ≧35 years old (p < 0.05) and <35 years (p < 0.025), respectively. The ‘other cause’ subset was more frequent in female gender (p < 0.05). Transoesophageal echocardiography (TEE) detected potential cardiac sources of emboli (PCSE) at an extent 3 times higher (p < 0.0001) than transthoracic echocardiography. Congenital heart defects were nearly threefold more frequent than acquired ones, with a prevalence of patent foramen ovale. At a mean of 6.1 ± 2.6 years (confidence interval 5.4 to 6.8), follow-up data were available for only 54 patients, since five patients were lost and one died in the acute phase. Poststroke recurrence rate was low (7.4%) and no event was fatal. General handicap was severe to moderately severe (RS>3) in 11% of the patients, slight to moderate (1≧RS≤3) in 59% and absent in 30% (RS = 0). Functional disability was relatively low with 50% of the patients independent (BI ≧95), 38.9% partially dependent (BI 60 to 86), and 11.1% fully dependent (BI <60). Thirty-seven (68.5%) patients returned to work, although adjustments (other job or part-time employment) were necessary for 10 out of them (27%). Conclusions: The present study, though limited by the relatively small number of subjects, suggests that the overall prognosis of ischaemic stroke in young adults is good. We strongly recommend TEE in all patients with ischaemic stroke as an essential tool to increase the detection of PCSE and make the therapeutic approach more efficient.
New Chemotherapeutic Agents: Update of Major Chemoradiation Trials in Solid Tumors
Authors: Curran Walter J.
Published: April 2003

The institution of combined modality therapy for unresected solid tumors has resulted in significant improvements in tumor control and survival benefit compared with radiotherapy (RT) alone. A number of chemotherapy agents that can enhance the effectiveness of RT, such as cisplatin and 5-fluorouracil, are now considered standard treatment for patients with a number of cancer types. There is growing interest in a number of additional agents that have also been found to have radiosensitizing ability. These include paclitaxel, docetaxel, irinotecan, gemcitabine, and vinorelbine, as well as biologic agents. Other agents may be of value because they act to counter dose-limiting toxicities associated with RT. This article provides an update of some important, recently completed and ongoing clinical trials evaluating novel chemoradiation protocols, with examples taken primarily from studies conducted by the Radiation Therapy Oncology Group (RTOG). Theoretical approaches to the development of new agents and combined modality regimens are also discussed.
Wissenschaft und Recht der Reproduktionsmedizin – zwei Seiten einer Medaille
Authors: Hepp H. , Haller U. , Winter R.
Published: April 2003

In der Reproduktionsmedizin wird die Janusköpfigkeit jeden medizinischen Fortschritts besonders sichtbar. Es gibt nicht nur eine Verantwortung für die Forschung sondern auch zur Forschung. Im Zentrum der aktuellen Diskussion steht die bedeutende Frage, ob bei zu enger Interpretation des Embryonenschutzgesetzes und der darauf beruhenden ärztlichen Richtlinien mit standesrechtlicher Bindung eine dem internationalen Standard entsprechende Reproduktionsmedizin blockiert wird. In der aktuellen Diskussion, insbesondere im Hinblick auf ein zu erwartendes Fortpflanzungsmedizingesetz, stehen die offenen Fragen der heterologen Ei- und Samenspende mit möglicher «gespaltener» Elternschaft, die Bindung der Reproduktionsmedizin an den Verheiratetenstatus der Partner sowie das klinisch ernste Problem der höhergradigen Mehrlingsschwangerschaft. Das Machbare reicht oft über das berufsethische und rechtliche Dürfen und Sollen hinaus.
Pituitary Adenylate-Cyclase-Activating Polypeptide Expression in the Immune System
Authors: Abad Catalina , Martinez Carmen , Leceta Javier , Juarranz Maria G. , Delgado Mario , Gomariz Rosa P.
Published: April 2003

Although pituitary adenylate-cyclase-activating polypeptide (PACAP) is a multifunctional and pleiotropic neuropeptide with many different immunomodulatory properties, investigations of its source in lymphoid organs are scarce. The present report contributes to the knowledge on the origin and synthesis of this peptide in immune cells of the lymphoid organs and peritoneum using immunohistochemistry, immunocytochemical staining, Western blot and RT-PCR methods. Our study reveals PACAP immunoreactivity in the thymus, spleen and lymph nodes. Cytochemical results show that PACAP is present in thymocytes, lymphocytes and plasma cells from the spleen and lymph nodes. Western blot analysis showed a band corresponding to PACAP for all lymphoid organs studied. mRNA appears in both double (CD4+CD8+)- and single-positive (CD4+CD8–, CD4–CD8+) thymocytes and in T subsets and B cells from the spleen and lymph nodes. In addition, PACAP mRNA is expressed in lymphocytes, but not in macrophages from peritoneal suspensions. Our findings show that PACAP produced by lymphocytes could be added to the growing list of mediators shared by nervous, endocrine and immune systems. Moreover, PACAP could be considered as a lymphocyte-derived cytokine in the central and peripheral lymphoid organs acting on lymphocytes and stromal cells.
Peptic Ulcer Disease and Neuroticism in the United States Adult Population
Authors: Goodwin Renee D. , Stein Murray B.
Published: April 2003

Background: The goal of the current study was to determine the association between personality factors and peptic ulcer disease (PUD) among adults in the general population. Method: Data were drawn from the Midlife Development in the United States Survey (MIDUS), a representative household survey of the adult population (ages 25–74; n = 3,032) of the United States. Multiple logistic regression analyses were used to determine the association between the big five personality factors and PUD, adjusting for differences in sociodemographic characteristics, psychiatric and physical comorbidity. Results: Neuroticism was associated with significantly increased odds of PUD [OR = 1.5 (95% CI: 1.03, 2.4)], which persisted after controlling for differences in sociodemographic characteristics, cigarette smoking, perception of poor health, comorbid mental disorders and physical illnesses. This relationship was specific to neuroticism. Conclusions: These findings are consistent with and extend previous clinical and epidemiologic data by providing evidence of an independent association between neuroticism and PUD among adults in the general population. Future work investigating the relationship between neuroticism and the development of PUD in prospective data, including objective measures of physical and mental health status, may contribute to our understanding of this association.
Asymmetry and Symmetry in Brain Waves from Dolphin Left and Right Hemispheres: Some Observations after Anesthesia, during Quiescent Hanging Behavior, and during Visual Obstruction
Authors: Ridgway Sam H.
Published: April 2003

Studies of sleep in cetaceans (whales, dolphins, and porpoises), substantiated by electrophysiological data, are rare with the great majority of observations having been made by one group from Russia. This group employed hard-wired recording with low-noise cables for their EEG observations, whereas our report describes behavioral and EEG observations of dolphin sleep using telemetry. Marked asymmetry of the EEG was observed during behavioral sleep posture. At different times synchronized slow waves appeared in both left and right brain hemispheres concurrently with lower voltage, faster, desynchronized EEG activity in the opposite hemisphere. On the other hand, during one brief period of sleep behavior, sleep-like EEG activity appeared on leads from both hemispheres. When the animal was exposed to a loud sound, it woke with lower voltage, faster, relatively symmetrical, desynchronized EEG activity appearing from both hemispheres. Additionally, the EEG appeared relatively desynchronized and symmetrical between the two hemispheres when the animal was awake during recovery from pentothal-halothane anesthesia as well as during waking periods when one or both of the animal’s eyes were covered by an opaque rubber suction cup.
Changes in the Epithelium of the Vaginal Complex during the Estrous Cycle of the Marsupial Monodelphis domestica
Authors: Regli Christian , Kress Annetrudi
Published: April 2003

The vaginal complex of marsupials differs from that of eutherians. Cervices open separately in a sinus vaginalis or cul-de-sac. Two lateral vaginae adjoin the sinus vaginalis and fuse at the level of the urethra opening and form the sinus urogenitalis. During the estrous cycle the vaginal epithelium undergoes a number of specified morphological changes. This paper is the first to describe these changes on an ultrastructural level in a marsupial. Investigations in Monodelphis vagina reveal that a cyclic switch exists between a keratinized and a stratified nonkeratinized epithelium. Keratinization starts during proestrus and reaches its maximum during estrus. In the postestrus, desquamation of the stratum corneum takes place, mostly in two steps. In metestrus one to two additional layers of the now nonkeratinized surface cells are shed into the vaginal lumen. Typical cell structures, such as keratin filaments, keratohyalin and membrane-coating granules, are involved in the keratinization process. Keratohyalin is found in the cytoplasm as well as in the nucleus of stratum granulosum cells, a phenomenon which is known from other parakeratinized epithelia of rapid turnover. Membrane-coating granules, responsible for the permeability barrier between the epithelial cells, are of the nonlamellated type in the nonkeratinized epithelium and produce an amorphous material in the intercellular spaces after extrusion. At periods, however, when the epithelium is keratinized, membrane-coating granules are of the lamellated type and form a lamellated barrier structure after extrusion in the intercellular space. The loss of the protective keratinized layers asks for an additional defense mechanism for the epithelium. The migration of leukocytes through the epithelium predominantly during post- and metestrus and their presence in the vaginal lumen may play a protective role together with the bacterial content.
Expression of 60-kD Heat Shock Protein Increases during Carcinogenesis in the Uterine Exocervix
Authors: Cappello Francesco , Bellafiore Marianna , Palma Antonio , Marciano Vito , Martorana Giuseppe , Belfiore Pina , Martorana Antonio , Farina Felicia , Zummo Giovanni , Bucchieri Fabio
Published: April 2003

Objectives: The aim of the present study was to determine the presence and expression of the 60-kD heat shock protein (HSP60) in the dysplasia-carcinoma sequence in the uterine exocervix and to evaluate its diagnostic and prognostic significance. Methods and Results: We performed Western blot and immunohistochemical analyses on biopsies from 40 cases, consisting of 10 normal exocervical biopsies, 10 low-grade squamous intraepithelial lesions (L-SIL), 10 high-grade squamous intraepithelial lesions (H-SIL) and 10 cancerous exocervices (G2 grade). The immunohistochemical results were quantified by computer-assisted image analysis. Western blot analysis showed that HSP60 was undetectable in normal tissues and that there was a gradual increase of protein expression from L-SIL to carcinoma. Immunostaining for HSP60 was negative in normal tissue and positive in basal and parabasal layers of L-SIL epithelium; H-SIL were markedly stained in all layers of epithelium, and carcinomas showed an even stronger positivity. The increasing expression correlated with the malignancy grade. Finally, koilocytes were mostly negative in L-SIL and positive in H-SIL. Conclusions: The increasing degree of expression of HSP60 from L-SIL to carcinoma and the different intraepithelial distribution between L-SIL and H-SIL could be used as a new diagnostic tool. Moreover, HSP60 could have a role in cervical carcinogenesis.
Treatment with High Doses of Terbutaline Induces β-Adrenergic Desensitization of Guinea Pig Trachea Not Prevented by the Addition of Dexamethasone
Authors: Seco A.J. , Salgueiro M.E. , Villanueva M.A. , Manso G.
Published: April 2003

Background: The combination of β2-adrenergic agonists and glucocorticosteroids is frequently used to control bronchial asthma. It is believed that the co-administration of glucocorticosteroids will reduce the tachyphylaxis to β2-adrenergic agonists. Objective: To analyse the effects of glucocorticosteroids on the response to high concentrations of β2-adrenergic agonists. Methods: We have compared the effects of high doses of terbutaline, alone or in combination with dexamethasone, on the relaxation induced by in vitro β2-adrenergic agonists in guinea pig trachea. Results: Terbutaline (100 mg/kg/day), for 7 days, induced a marked homologous desensitization. The addition of dexamethasone (0.2 or 2 mg/kg/day) to the treatment did not prevent the development of desensitization, which was even more marked in the group treated with terbutaline and the higher doses of dexamethasone, compared with the group treated with terbutaline alone. Conclusion: Our results suggest a negative interaction between high doses of β2-adrenergic agonists and glucocorticosteroids in the airway smooth muscle of guinea pigs.
Variance between Program Versions in Measuring Optic Nerve Fiber Layer Thickness Using Optical Coherence Tomography
Authors: Furuichi Mieko , Kashiwagi Kenji , Tsukahara Shigeo
Published: April 2003

Purpose: To compare nerve fiber layer thickness (NFLT) in patients with glaucoma measured by two versions of an analysis program utilizing optical coherence tomography (OCT) with reference to the cup-to-disk (C/D) ratio and the mean deviation (MD) score of a static visual field test. Methods: Twenty-four eyes from 24 glaucoma patients were enrolled. The NFLT was measured by OCT along a circle around the disk with the circle diameter being 1.5 times that of the disk itself. The NFLTs evaluated by the two versions A4.01 and A6.01 were compared with respect to the C/D ratio and MD score. Results: The mean NFLTs evaluated by version A6.01 were 61.2% greater than those evaluated by version A4.01 (p < 0.001). The NFLTs in all quadrants evaluated by A6.01 were also greater than those evaluated by A4.01. Both A6.01 and A4.01 showed a significant correlation with the C/D ratio and MD score. Although A6.01 showed a better correlation with the C/D ratio than A4.01, both A4.01 and A6.01 showed similarly good correlations with MD. Conclusion: The NFLTs evaluated by the two versions differed significantly with regard to some parameters. These results should be taken into account in evaluating NFLTs when utilizing OCT.
Applications of the Neodymium:YAG Laser in Plastic Surgery of the Face and Lacrimal Surgery. Wound Repair
Authors: Fankhauser Franz , Kwasniewska Sylwia
Published: April 2003

The physical and clinical features of a number of laser energy sources presently being used in plastic and endonasal surgery, such as the Nd:YAG, KTP, Ho:YAG, Er:YAG and CO2 lasers, are emphasized. Particular attention is paid to the Nd:YAG laser and to an Nd:YAG laser-powered quartz laser scalpel.
Subclinical Experimental Optic Neuropathy after Accelerated Proton Beam Irradiation
Authors: Wolfensberger Thomas J. , Zwingli Martin , Egger Emmanuel , Schnyder Pierre , Zografos Leonidas
Published: April 2003

Background: Accelerated proton beam irradiation has been used for several years to treat intraocular tumors. The pathophysiology of proton-beam-induced retinopathy and neuropathy has not been characterized to date. The present study investigates the early effects of irradiation with an accelerated proton beam on the optic nerve of the rabbit. Materials and Methods: The optic nerve head of Albino New Zealand rabbits (n = 14) was irradiated with a narrow beam of accelerated protons using the total dose of 60 and 43 Gy, respectively. This dose was split up into 4 equal sessions taking place on 4 consecutive days. Ophthalmoscopic examination was performed regularly, and the rabbits were sacrificed at 1, 3 and 8 months after irradiation. The eyes were enucleated and processed for light and electron microscopy. Results: Despite the absence of ophthalmoscopically detectable optic neuropathy in all 14 rabbits irrespective of the dose of irradiation, light and electron microscopy of the optic nerve showed a glial and fibrotic perivascular scar made up predominantly of altered astrocytes. This scar formation was seen as early as 1 month after irradiation and was at times accompanied by infiltration with inflammatory cells perivascularly both outside and within the optic nerve. In contrast to the astrocytes, oligodendrocytes did not show degenerative cellular alterations. During the 8-month follow-up, no signs of vascular occlusion were found. Conclusions: The observed lesions in the glial tissues with consecutive fibrosis appear to stem from a direct effect of irradiation. This may represent the initial mechanism of early subclinical irradiation-induced damage to the optic nerve before vascular occlusions may occur at a later stage, which may lead to more severe damage.
Endothelin-A Receptor Antagonist BQ-485 Protects against Intraocular Pressure Spike Induced by Laser Trabeculoplasty in the Rabbit
Authors: Holló Gábor , Kóthy Péter , Lakatos Péter , Vargha Péter
Published: April 2003

Purpose: We have previously shown in rabbits that the intraocular pressure (IOP) spike caused by argon laser trabeculoplasty (ALT) is associated with an acute endothelin-1 (ET-1) release from the uveal tissue into the aqueous humour. In this study we investigated whether pretreatment with an ETA receptor antagonist (BQ-485) protects against the pressure spike induced by ALT, in the rabbit model. Methods: Under general anaesthesia, 10 µl of 10–5M BQ-485 was injected into the anterior chamber of the right eye, and 10 µl of balanced salt solution (BSS) into the contralateral anterior chamber, for 12 pigmented rabbits. Five minutes later ALT (1,000 mW, 0.1 s, 100 spots over 360° focused on the iris pillars) was performed on both eyes of each animal. IOP was measured before the injections (baseline value), and also 30 min afterwards using a Tono-Pen XL tonometer. Immediately after the second IOP measurement aqueous humour was aspirated for measurement of ET-1 concentration. Results: The baseline IOP (mean ± SD) was 8.08 ± 1.73 mm Hg and 7.92 ± 1.78 mm Hg for the right and left eyes, respectively (Duncan test, p > 0.05). At 25 min after ALT the IOP of the BQ-485-pretreated right eyes remained unchanged (7.83 ± 2.44 mm Hg, p > 0.05) but the IOP of the BSS-pretreated left eyes at 30 min increased significantly to 10.67 ± 4.70 mm Hg (p < 0.05 for comparisons both with the corresponding baseline value for the same eye, and with the IOP of the contralateral eye at 30 min). There was no difference in aqueous humour ET-1 concentration between the corresponding right and left eyes (paired t test, p > 0.05). Conclusion: Intracameral BQ-485 pretreatment protected against the ALT-induced acute IOP elevation, but did not influence the laser-induced ET-1 release. This suggests that ETA receptor antagonists may potentially have a therapeutic role in the prevention of laser-induced IOP spikes.
Timolol 0.1% Gel (Nyogel 0.1%®) Once Daily versus Conventional Timolol 0.5% Solution Twice Daily: A Comparison of Efficacy and Safety
Authors: Rouland Jean-François , Morel-Mandrino Patricia , Elena Pierre-Paul , Polzer Heinz , Sunder Raj Palaniswamy
Published: April 2003

In a prospective, randomised, double-masked, parallel-group, multi-centre study, 210 patients with primary open angle glaucoma or ocular hypertension were enrolled of whom 167 (timolol 0.1% gel 82, timolol 0.5% 85) completed the study as per protocol. The change in intraocular pressure between baseline and week 12 in the worse eye (‘at trough’) was 6.3 (SD 3.3) mm Hg on timolol 0.1% gel and 7.0 (2.9) mm Hg on timolol 0.5%; this difference was not statistically significant (p = 0.19). The difference between the two study groups in the change of intraocular pressure from baseline was 0.62 mm Hg; the 90% CI of –0.09 to +1.33 mm Hg was within the pre-specified limits of –1.5 to +1.5 mm Hg demonstrating equivalence between timolol 0.1% gel and timolol 0.5%. The plasma levels of timolol (ng/ml) at 12 weeks in the timolol 0.1% gel group were significantly less than that with timolol 0.5% both before instillation (mean 0.057, SD 0.131 and mean 0.470, SD 0.519 respectively, p = 0.025) and after instillation (mean 0.552, SD 0.992 and mean 2.473, SD 1.780 respectively, p = 0.008). Both treatments were well tolerated with no statistically significant difference between the groups in the occurrence of ocular or systemic adverse events.
Effects of Amniotic Membrane Transplantation and Mitomycin C on Wound Healing in Experimental Glaucoma Surgery
Authors: Demir Tamer , Turgut Burak , Akyol Nuray , Ozercan Ibrahim , Ulaş Fatih , Celiker Ulkü
Published: April 2003

Purpose: To evaluate the effects of mitomycin C and amniotic membrane transplantation on the modulation of wound healing after glaucoma filtration surgery. Methods: Trabeculectomy was performed in 3 groups of 10 rabbit eyes each. Sponges soaked in mitomycin C were applied to the first group, and amniotic membranes were transplanted around the scleral flap in the second group; the third group was the control. The arithmetic means of fibroblast and macrophage numbers per square centimetre were calculated. Results: The mean numbers of fibroblasts and macrophages were decreased significantly in the mitomycin C group, compared with the controls (p < 0.0001). Cell counts in the amniotic membrane group were also lower than the ones in the control group for fibroblasts and macrophages (p < 0.0001, p < 0.01, respectively). The difference between the two treatment groups was statistically significant for fibroblasts (p < 0.0001), but not significant for macrophages (p > 0.05). Conclusion: In spite of the fact that amniotic membrane transplantation is less effective than mitomycin C for depressing wound healing after trabeculectomy, it might be a safer alternative in selected cases when considering severe adverse effects of antimetabolites.
Normal Isopter Position in the Peripheral Visual Field in Goldmann Kinetic Perimetry
Authors: Niederhauser Susanne , Mojon Daniel S.
Published: April 2003

Purpose: Often in young patients the question arises if a disease state has contracted their peripheral boundary of the visual field. Since the ‘hill of vision’ is steeper in the periphery, kinetic perimetry is more sensitive in detecting peripheral visual field abnormalities than static perimetry. In order to be able with kinetic perimetry to detect mild peripheral visual field constrictions, we determined the normal position of 4 isopters in the peripheral visual field. Subjects and Methods: Intraindividual sensitivity variations of the isopters in the peripheral visual field were determined in 3 normal subjects by one perimetrist. Then, in 22 subjects (19–42 years old) the position of the isopters V4e, III4e, I4e and I3e has been determined by one perimetrist. Visual fields were registered using a Goldmann kinetic perimeter. Results: The intraindividual sensitivity variations (measured as 1 standard deviation) for the isopter V4e was 0.98° and for the isopter I4e 1.13°. To visualize the normal isopter positions in the peripheral visual field, the average positions ± 2 standard deviations were plotted for the isopters V4e, III4e, I4e and I3e. Conclusion: In this study, we determined the normal position of 4 isopters frequently used to plot the peripheral visual field. The plots have been printed in a scale of 1:4 in order to facilitate its use. Photocopying the figures on transparencies by scaling them with a factor 4 will allow to superpose the transparencies on individual Goldmann kinetic visual fields in order to easily determine whether the individual isopters are inside or outside the normal range.
Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy
Authors: Simon Scott L. , Telfeian Albert , Duhaime Ann-Christine
Published: April 2003

Invasive monitoring for intractable epilepsy is useful when the epileptogenic focus is in question even after an extensive noninvasive presurgical evaluation, or when the epileptogenic focus is located in or near eloquent cortex. From June 1989 to June 2001 at the Children’s Hospital of Philadelphia, 64 children with intractable epilepsy underwent 67 invasive monitoring procedures as part of their presurgical evaluation. The average age at implantation was 10 years. In all but two cases, subdural strips and grids were used. Depth electrodes, when used, were placed stereotactically or under direct vision. The average duration of the monitoring period was 5.87 days. Every patient had intradural cultures sent during removal of the electrodes, and lumbar punctures were performed in 15 patients. Twenty-one patients had at least one episode of a CSF leak. Of the 67 patients, 10 had positive intradural cultures, only 1 of whom had a positive lumbar puncture and none of whom developed clinically significant meningitis. No clinically relevant hemorrhages occurred as a result of the invasive monitoring. One patient did have a transient visual field loss after placement of an occipital grid. While CSF leaks are common after invasive monitoring despite precautions, clinically significant CSF infections are uncommon and appear to be unrelated to the duration of monitoring, the occurrence of a CSF leak or the length of time the patient is on perioperative antibiotics. We conclude that invasive monitoring for intractable epilepsy is generally safe.
Vestibular Evoked Myogenic Potentials in Ipsilateral Delayed Endolymphatic Hydrops
Authors: Ohki Masafumi , Matsuzaki Masaki , Sugasawa Keiko , Murofushi Toshihisa
Published: April 2003

We recorded vestibular evoked myogenic potentials (VEMPs) in 12 patients diagnosed as having ipsilateral delayed endolymphatic hydrops (DEH). Seventy-five percent (9/12) of the patients showed decreased or absent VEMPs in the affected ears. Almost all patients had normal VEMPs in the unaffected ears. In addition, in 4 patients, VEMPs were recorded before and 3 h after oral glycerol administration (1.3 g/kg body weight). VEMPs improved after glycerol administration in 2 of the 3 patients whose VEMPs had been abnormal in the affected ears before glycerol administration. None of the 4 patients presented significant changes in VEMPs in the unaffected ears after glycerol administration. Improvement of VEMPs after glycerol administration confirmed the existence of endolymphatic hydrops in patients with ipsilateral DEH. In conclusion, VEMPs are useful to evaluate the function of otolith organs in patients with ipsilateral DEH, and the glycerol test using VEMPs may be useful to detect endolymphatic hydrops in ipsilateral DEH.
Three-Dimensional Eye Rotation Axis Analysis of Benign Paroxysmal Positioning Nystagmus
Authors: Imai Takao , Takeda Noriaki , Uno Atsuhiko , Morita Masahiro , Koizuka Izumi , Kubo Takeshi
Published: April 2003

We have developed a new technique for analyzing the rotation vector of eye movement with an infrared CCD camera [Imai et al.: Acta Otolaryngol 1999;119:24–28]. We used this technique to analyze the eye rotation axis of benign paroxysmal positioning nystagmus (BPPN) that was induced by the Dix-Hallpike maneuver in 14 patients with benign paroxysmal positioning vertigo (BPPV). Eye rotation axes of BPPN in 8 patients were closely perpendicular to the posterior canal of the undermost ear in the provocative head position. Under the hypothesis that BPPN is due to a mechanical stimulation of the posterior canal by canalolithiasis, this finding suggested that the posterior canal of the undermost ear is the lesion. On the other hand, eye rotation axes of BPPN in the other 6 patients were closely aligned with the naso-occipital axis. It is suggested that canalolithiasis induces endolymphatic flow in both posterior and anterior canals via the common crus and the summation of the eye movements induced by stimulation of both the posterior and anterior canals rotates the eye along the naso-occipital axis.
Meningitis following Cochlear Implantation: Pathomechanisms, Clinical Symptoms, Conservative and Surgical Treatments
Authors: Arnold W. , Bredberg G. , Gstöttner W. , Helms J. , Hildmann H. , Kiratzidis T. , Müller J. , Ramsden R.T. , Roland P. , Walterspiel J.N.
Published: April 2003

Pneumococcal otogenic meningitis is a rare postsurgical complication that can develop following stapedectomy or after cochlear implantation. The bacterial infection can be fatal in some instances. A recent increase in the incidence of otogenic meningitis among cochlear implant wearers is of concern. The majority of meningitis cases are associated with a 2-component electrode manufactured by one cochlear implant company. The device with the added ‘positioner’ component has been withdrawn from the market (FDA Public Health Web Notification: Cochlear Implant Recipients may be at Greater Risk for Meningitis, Updated: August 29, 2002, www.fda.gov/cdrh/safety/cochlear.html). Not all cases have been subsequent to otitis media and symptoms have developed from less than 24 h up to a few years after implantation. The purpose of this paper is to review and discuss the pathogenesis, pathology/bacteriology and to elaborate on some clinical features of otogenic meningitis in implanted children and adults. Essential aspects of surgery, electrode design, and cochleostomy seal are discussed. Conclusions are drawn from the available data and recommendations are made for good practice in cochlear implantation and follow-up.
Identification of Highly Expressed Genes in Peripheral Blood T Cells from Patients with Atopic Dermatitis
Authors: Matsumoto Yoshiko , Oshida Tadahilo , Obayashi Izumi , Imai Yukiho , Matsui Keiko , Yoshida Ning Lu , Nagata Naoko , Ogawa Kaoru , Obayashi Masaya , Kashiwabara Tomoko , Gunji Shigemichi , Nagasu Takeshi , Sugita Yuji , Tanaka Toshio , Tsujimoto Gozoh , Katsunuma Toshio , Akasawa Akira , Saito Hirohisa
Published: April 2003

Background: Analysis of genes that are differentially expressed in patients with atopic dermatitis (AD) and normal individuals will provide important information on the underlying molecular pathogenetic mechanisms of AD. Methods: Transcript of freshly isolated peripheral blood T cells from 59 individuals were analyzed with a fluorescent differential display (FDD) method. Ninety-two differentially expressed genes were identified in this manner. Additionally, real-time quantitative RT-PCR was employed to investigate the expression of the FDD-selected genes and also genes related to T cell function. Results: A number of genes, including CC chemokine receptor 4, T cell-specific tyrosine kinase (Emt/Itk), integrin β1, integrin α6, IQGAP1 and MAR/SAR DNA-binding protein (SATB1), were shown to be more highly expressed in patients with moderate and/or severe AD than in controls or patients with mild AD. Because the products of these upregulated genes influence chemotaxis, adhesion, migration and Th2 polarization, it is suggested that in more severe AD, circulating T cells may function differently in this regard. Several other genes, the role of which in T cell function is currently unknown, were also found to be differentially expressed in AD. These included the heat shock protein 40 and vasopressin-activated calcium-mobilizing receptor 1. Conclusion: The upregulated genes identified in this work may serve as useful markers for moderate to severe AD as opposed to normal or mild AD and also as markers indicating progression to more severe AD. Further functional characterization will provide a better understanding of the pathophysiology of circulating T cells in AD.
Relationship between Nasal and Bronchial Responsiveness in Perennial Allergic Rhinitic Patients with Asthma
Authors: Koh Youngil I. , Choi Inseon S.
Published: April 2003

Background: Thenasal and bronchial mucosa present similarities and mostpatients with asthma also have rhinitis, suggesting the concept of ‘one airway one disease’. Although many studies may suggest the relationship between nasal and bronchial responsiveness in patients with allergic rhinitis and asthma, few studies have been published which address this question directly. The aim of this study is to investigate whether the relationship between nonspecific nasal and bronchial responsiveness exists in perennial allergic rhinitic patients with asthma. Methods: Fifty-one perennial allergic rhinitic patients with the definitive or suspected asthma underwent methacholine bronchial provocation tests and nasal histamine challenge tests. A slope of the absolute changes in nasal symptoms score/log concentrations of histamine was calculated by linear regression analysis. A ratio of the final absolute change in nasal symptoms score to the sum of all the doses of histamine given to the subject was also calculated. The degree of bronchial responsiveness to methacholine was categorized as positive bronchial hyperresponsiveness (BHR) if PC20 (provocative concentration of methacholine resulting in 20% fall in FEV1) was <4 mg/ml, borderline BHR if PC20 was ≧4 but ≤16 mg/ml, and negative BHR if PC20 was >16 mg/ml. Another index of bronchial responsiveness (BRindex) was calculated as the log [(% decline in FEV1/log final methacholine concentration as mg/dl) + 10]. Results: The geometric means of the slope (4.47 vs. 2.95, p < 0.05) and the ratio (1.68 vs. 0.54, p < 0.01) were higher in patients with positive BHR (n = 23) than in patients with negative BHR (n = 19), respectively. The geometric means of the slope (3.50) and the ratio (1.13) in patients with borderline BHR (n = 9) were between the two groups, respectively. In all patients, the log-slope (r = 0.48, p < 0.001) and the log-ratio (r = 0.51, p < 0.001) were correlated well with the BRindex, respectively. Even in allergic rhinitic patients with definitive asthma, the log-slope was correlated with the BRindex (r = 0.39, p < 0.05) or log-PC20 (r = –0.36, p < 0.05). Conclusions: The nonspecific nasal responsiveness may be related to the nonspecific bronchial responsiveness in patients with allergic rhinitis and asthma, which may support the viewpoint that allergic rhinitis and asthma represent a continuum of inflammation involving one common airway.
Endoscopic Inguinal Hernia Repair in Comparison with Shouldice and Lichtenstein Repair
Authors: Schmedt C.-G. , Leibl B.J. , Bittner R.
Published: April 2003

Aims: This article provides an overview of randomized studies which compare endoscopic hernia repair techniques (TAPP/TEP) with the Shouldice and Lichtenstein repair. Methods: Systematic analysis of 33 published studies which meet the criteria of a randomized controlled trial with a high evidence level. Results: The majority of the studies document statistically significant advantages of the endoscopic repair techniques in relation to wound pain (15/22), need for analgesics (16/21), return-to-work time (16/22) and physical activity (18/25), although only one study showed significant advantages of the Lichtenstein method. Six of 28 studies showed a lower morbidity in comparison to open approaches, although 22 of 28 studies documented no significant difference. The first long-term studies with follow-up periods between 5 and 6 years also show advantages of the endoscopic techniques. Conclusion: Even with cautious interpretation of the data, it is clear that endoscopic techniques are more comfortable for patients and that morbidity is no higher than for open procedures. Due to the short follow-up periods final evaluation regarding long-term complications and recurrence is not yet possible.
Modeling of Protein Interaction Networks
Authors: Vázquez Alexei , Flammini Alessandro , Maritan Amos , Vespignani Alessandro
Published: April 2003

We introduce a graph-generating model aimed at representing the evolution of protein interaction networks. The model is based on the hypothesis of evolution by duplication and divergence of the genes which produce proteins. The obtained graphs have multifractal properties recovering the absence of a characteristic connectivity as found in real data of protein interaction networks. The error tolerance of the model to random or targeted damage is in very good agreement with the behavior obtained in real protein network analyses. The proposed model is a first step in the identification of the evolutionary dynamics leading to the development of protein functions and interactions.
Two New Recursive Likelihood Calculation Methods for Genetic Analysis
Authors: Yuan Ao , Bonney George E.
Published: April 2003

Recursive likelihood calculations for genetic analysis with ungenotyped pedigree data employ variations of the Elston-Stewart (ES) or the Lander-Green (LG) algorithms. With the ES algorithm, the number of loci may be limited but not the pedigree size. With the LG algorithm, the reverse is the case. We introduce two new algorithms for the computation of regressive likelihoods for pedigrees with multivariate traits. The first is an alternative formulation of our existing model, which leads to a simpler form in the binary trait, polygenic and mixed model cases. The second is an approximation model, which is computationally efficient. These methods apply to both continuous and binary traits, in the oligogenic and polygenic cases. Both methods coincide in the binary case. We considered these methods for cases in which all the traits are controlled by a single locus, with each trait controlled by one locus independent to the others. Simulation studies and analysis of a real data are presented for segregation analysis as illustrations. These methods can also be used in other model-based analyses. These methods are implemented in G.E.M.S., the genetic epidemiology models software.
Enhanced Pedigree Error Detection
Authors: Sun Lei , Wilder Kenneth , McPeek Mary Sara
Published: April 2003

Accurate information on the relationships among individuals in a study is critical for valid linkage analysis. We extend the MLLR, EIBD, AIBS and IBS tests for detection of misspecified relationships to a broader range of relative pairs, and we improve the two-stage screening procedure for analyzing large data sets. We have developed software, PREST, which calculates the test statistics and performs the corresponding hypothesis tests for relationship misclassification in general outbred pedigrees. When a potential pedigree error is detected, our companion program, ALTERTEST, can be used to determine which relationships are compatible with the genotype data. Both programs are now freely available on the web.
Prognostic Significance of p53 Nuclear Overexpression in Patients of Muscle Invasive Urinary Bladder Carcinoma Treated with Cystectomy
Authors: Hemal Ashok K. , Khaitan Anurag , Dinda Amit K. , Gupta Narmada P. , Seth Amlesh , Dogra P.N. , Nabi Gulam
Published: April 2003

Introduction: The objective of the study was to determine the pattern of p53 expression in patients with muscle invasive bladder cancer treated with cystectomy and to assess the prognostic value of p53 expression in this group of patients. Materials and Methods: We retrospectively analyzed data of 100 patients who underwent cystectomy for invasive transitional cell carcinoma of the urinary bladder. These patients were seen at 3-monthly intervals during the first 2 years, 6-monthly in the third year, and yearly thereafter. Immunohistochemical analysis for p53 was done on paraffin-fixed tissues with DO-7 antibodies. The tumours with >30% cells staining for p53 proteins were considered p53 positive. Results: There were 95 males and 5 females with a mean age of 54 years. Two patients died in the perioperative period and were excluded from analysis. Over a median follow-up period of 2 years (range 3 months to 10 years) 62 patients are alive without disease while 36 had relapse and of these, 31 have died. The p53 expression was significantly related to stage and grade of the tumour. p53-negative tumours were more likely to be organ confined and of lower grade as compared to p53-positive tumours. The stage of tumour was significantly related to outcome but grade and p53 immunohistochemistry did not provide any prognostic information. Conclusions: p53 immunostaining was positive in 57% of muscle invasive urinary bladder tumours. The p53 positivity correlated well with the stage and grade of the disease, whereas it has no additional prognostic value.
Analysis of Premature Ejaculation in Hemodialysis Patients Using the International Index of Erectile Function
Authors: Aslan Güven , Arslan Deniz , Çavdar Caner , Sifil Aykut , Esen A. Adil , Çamsarı Taner
Published: April 2003

Objective: We have conducted the following study to determine the prevalence of premature ejaculation in male hemodialysis patients and its impact on sexual quality of life. Methods: This study was performed in hemodialysis facilities. Patients were asked to complete the International Index of Erectile Function (IIEF) questionnaire and also to report their ejaculation status. 98 male hemodialysis patients with normal potency were included in the study. The IIEF domain scores were determined, and the overall and relationship satisfaction rates were calculated for the patients with and without premature ejaculation separately. Results: The mean age was 45.9 (range 30–69) years and the duration of hemodialysis was 37.8 (range 7–84) months. Premature ejaculation was determined in 31 (31.6%) patients. Patients with premature ejaculation experienced significantly lower overall satisfaction scores. Items of satisfaction with overall sexual life and sexual relationship with partner were responded to with a score of ‘moderately satisfied’ or ‘very satisfied’ in 47 and 53% of patients with premature ejaculation and 84 and 86% of patients without premature ejaculation, respectively. Conclusions: Premature ejaculation is a prevalent disorder in hemodialysis patients and seems to affect the satisfaction rate and sexual quality of life of these patients.
Circulating Inhibin Forms in Patients with Hydatidiform Mole
Authors: Kato Takako , Seki Katsuyoshi , Matsui Hideo , Sekiya Souei
Published: April 2003

Circulating inhibin forms have not been evaluated in patients with hydatidiform mole (HM) before evacuation of the mole. Serum inhibin A, inhibin B, pro-αC and hCG levels were determined by enzyme-linked immunosorbent assay in HM before and after evacuation of the mole (inhibin B only before evacuation). Before evacuation, inhibin B levels in HM were undetectable, and inhibin A levels were similar to those in normal women at the corresponding weeks of pregnancy. Pro-αC and hCG levels were higher in molar pregnancy than in normal pregnancy. After evacuation, pro-αC levels significantly fell in the patients with spontaneous resolution, but not in those who developed persistent trophoblastic disease (PTD). Both pro-αC and hCG levels were higher in the patients with PTD than in those with spontaneous resolution after evacuation, reflecting continued stimulation of the corpus luteum by lower, but still effective hCG levels, persistent trophoblastic tissues secreting pro-αC or both.
Comparison of the Clinical Efficacy and Safety of Flutamide versus Flutamide plus an Oral Contraceptive in the Treatment of Hirsutism
Authors: Taner Cüneyt , İnal Murat , Basoglu Ömer , Onoglu Ahmet , Karanfil Cemal , Tınar Şivekar , İspahi Çiǧdem
Published: April 2003

Objective: To compare the clinical, hormonal, biochemical and hemotological effects of flutamide versus flutamide plus an oral contraceptive (OC) in the treatment of hirsutism. Patients: Eighty-four women with hirsutism were equally randomized to receive either flutamide or flutamide plus OC. Design: Eighty-four women with hirsutism were recruited from patients presenting to our hospital. Each patient underwent a complete medical and gynecological examination as well as blood cell counts, biochemical and endocrine profiles. Hirsutism scores and laboratory tests were done during the 1st, 3rd and 6th months of therapy. Thirty-seven women in the flutamide group (taking 250 mg flutamide per day) and 32 women in the flutamide plus OC group (taking 250 mg flutamide plus 35 µg ethinyl estradiol and 2 mg cyproterone acetate per day) regularly followed the therapy regimens. Results: There were no significant differences in Ferriman-Gallway scores at the beginning and at the end of the therapies between the two groups (p > 0.05). At the 6th month, the decreases in Ferriman-Gallway scores were significant in both flutamide (from 18.95 ± 4.44 to 14.46 ± 5.02; p < 0.05) and flutamide plus OC groups (from 19.94 ± 4.31 to 15.58 ± 4.28; p < 0.05). In the first group, 2 of 6 oligomenorrheic women had regular cycles at the end of the therapy. Oligomenorrhea in 8 women was all changed to regular cycles in the flutamide plus OC group. Regarding the hormonal profile, only in the second group were prolactin, free testosterone and dehydroepiandrosterone sulfate levels significantly decreased (p < 0.05). Hepatic function tests were significantly increased in both groups, but they were all within normal ranges. Conclusion: These data suggest that both therapies were similarly effective and safe in the treatment of hirsutism. In women with oligomenorrhea and/or needing contraception, adding an OC shows better results than flutamide treatment alone in providing regular cycles.