bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional Cerebral Glucose Metabolism in Monozygotic Twins Discordant for Alzheimer’s Disease
Authors: Järvenpää Tarja , Räihä Ismo , Kaprio Jaakko , Koskenvuo Markku , Laine Matti , Kurki Timo , Vahlberg Tero , Viljanen Tapio , Ahonen Kirsi , Rinne Juha O.
Published: September 2003

We investigated regional cerebral glucose metabolic rates (rCMRgluc) with positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose (FDG) in 7 monozygotic twin pairs discordant for Alzheimer’s disease (AD). Ten healthy volunteers with comparable mean age and educational level served as controls. In the hippocampus, the mean ± SD rCMRgluc were 0.20 ± 0.03 µmol/ml/min for the demented twins, 0.21 ± 0.03 µmol/ml/min for their non-demented co-twins, and 0.23 ± 0.02 µmol/ml/min for the controls. The mean hippocampal rCMRgluc was reduced in the demented twins (p = 0.006), compared with the controls. In the lateral temporal cortex, the mean ± SD rCMRgluc were 0.27 ± 0.05, 0.28 ± 0.04, and 0.32 ± 0.02 µmol/ml/min, respectively. These mean rates were reduced both in the demented (p = 0.02) and the non-demented (p = 0.01) twins, compared with the controls. In conclusion, in the demented twins, the reduction of rCMRgluc was detected in the hippocampus and lateral temporal cortex, i.e. the 2 brain areas which show early changes in pathological and imaging studies in AD. Their non-demented co-twins showed milder reductions, which may be an indication of genetic susceptibility for dementia, and an early sign of a dementing illness in them.
Hospital Admission Circumstances and Prevalence of Frontotemporal Lobar Degeneration: A Multicenter Psychiatric State Hospital Study in Germany
Authors: Ibach B. , Koch H. , Koller M. , Wolfersdorf M.
Published: September 2003

Frontotemporal lobar degeneration (FTLD) is a heterogenous, non-Alzheimer’s disease, dementia complex with variable clinical presentation. We carried out a prospective nationwide hospital-based clinico-epidemiologic study in geriatric psychiatry to estimate the prevalence and admission circumstances of patients with FTLD. During a 4-week period 33 patients with clinical FTLD were prospectively ascertained in 36 psychiatric state hospitals in Germany with a total catchment area of >20,000,000 people. The relative portion of FTLD patients within the primary dementia population accounted for 1.9%. The estimated prevalence of FTLD in Germany was 47.9/100,000 population aged between 45 and 79 years. The admission circumstances were mainly behavioral disturbances (54.5%), unclear syndromes of dementia (18.1%) and further remarkably heterogeneous psychiatric syndromes. FTLD is a common cause of dementia in geriatric psychiatry with a variable clinical presentation that could mimic most of the major psychiatric diseases. Patients with FTLD may be older than previously assumed (mean age at admission 63.9 years) and show their maximum age-related prevalence between 60 and 70 years (78.7/100,000).
Lack of Association of the Interleukin-1β Gene Polymorphism with Alzheimer’s Disease in a Chinese Population
Authors: Ma Suk Ling , Tang Nelson Leung Sang , Lam Linda Chiu Wa , Chiu Helen Fung Kum
Published: September 2003

Over the past few years, a number of genetic risk factors for Alzheimer’s disease (AD) have been proposed. IL-1β gene polymorphism such as IL-1β-511 and IL-1β+3953 have been reported to be associated with the risk of AD in a number of studies in a Caucasian population. However, conflicting results have been reported recently which showed that IL-1β was not universally associated with the risk of AD in other populations. In order to validate these associations, we investigated the IL-1β polymorphisms (IL-1β-31, IL-1β-511 and IL-1β+3953) in a Chinese population, which has not been studied before. In our study, the allelic frequencies of IL-1β-31C, IL-1β-511T and IL-1β+3953T for the AD group were 0.49, 0.57 and 0.03, respectively. The allelic frequencies of IL-1β-31C, IL-1β-511T and IL-1β+3953T for the control group were 0.53, 0.61 and 0.03, respectively. No significant difference was detected in the genotypic or allelic frequencies (p > 0.25). We conclude that IL-1β polymorphism is unlikely to be a significant risk factor for AD in the Chinese Population.
Cobalamin, Folate, Methylmalonic Acid, Homocysteine, and Gastritis Markers in Dementia
Authors: Nägga K. , Rajani R. , Mårdh E. , Borch K. , Mårdh S. , Marcusson J.
Published: September 2003

The prevalence of dementia disorders, cobalamin and/or folate deficiency as well as gastritis increases with age. To investigate whether there is an association between these conditions, plasma homocysteine (Hcy), serum methylmalonic acid, serum cobalamin and blood folate concentrations were measured. Gastritis was indirectly diagnosed by measuring serum antibodies against H,K-ATPase, Helicobacter pylori and intrinsic factor, using enzyme-linked immunosorbent assays. The studied groups consisted of 47 patients with Alzheimer’s disease (AD), 9 with AD pathology in combination with additive vascular lesions, 59 with vascular dementia, 8 who were cognitively impaired, and 101 control cases. Plasma Hcy concentrations were significantly elevated in the dementia groups, with the highest levels in patients with vascular pathology. We conclude that hyperhomocysteinemia is a common finding in patients with dementia disorders of different etiologies. The markers for gastritis did not contribute to an elucidation of a possible connection between this condition, dementia disorders, or cobalamin/folate deficiency.
Prediction of the Rate of Decline in Cognitive Function in Alzheimer’s Disease: A Model Based on Simple Demographic Data and Widely Used Rating Scales
Authors: Johnsen Sigurd , Hughes Steve , Bullock Roger , Hindmarch Ian
Published: September 2003

Dementia represents a significant burden on the resources of both the National Health Service and Social Services as well as a great strain on the caregivers. The ability to predict, at diagnosis, those dementia patients that will deteriorate rapidly would allow a more effective allocation of resources as well as enabling the families and caregivers to make appropriate preparations. We performed discriminant analysis on a placebo data set of over 5,000 patients with Alzheimer’s disease in order to create a model that predicts the rate of cognitive decline in Alzheimer’s disease from simple demographic data and the baseline score on the cognitive subscale of the Alzheimer’s Disease Assessment Scale or the Mini Mental State Examination. This model has 96–97% sensitivity and 92–93% specificity. The potential benefits of this model argue for its validation in a prospective study.
Dexamethasone Inhibits TNF-α Synthesis More Effectively in Alzheimer’s Disease Patients than in Healthy Individuals
Authors: Dziedzic Tomasz , Wybranska Iwona , Dembinska-Kiec Aldona , Klimkowicz Aleksandra , Slowik Agnieszka , Pankiewicz Joanna , Zdzienicka Anna , Szczudlik Andrzej
Published: September 2003

Inflammatory mechanisms are involved in the pathogenesis of Alzheimer’s disease (AD). It is postulated that cytokine synthesis is altered in AD patients compared with nondemented subjects. Glucocorticoids play an important role in cytokine synthesis. We assessed the release of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10) and interleukin-12 (IL-12) and its regulation by dexamethasone in AD patients in vitro. Cytokine levels were measured using the ELISA method in unstimulated, LPS-stimulated or whole-blood samples incubated with LPS and dexamethasone from 18 AD patients and 12 controls. The cytokine levels spontaneously produced by blood cells after incubation with LPS or LPS and dexamethasone did not differ significantly between groups. Dexamathasone inhibited TNF-α synthesis by LPS-stimulated blood cells more effectively in AD patients than in controls. These results suggest that cytokine synthesis in AD patients could be regulated by glucocorticoids in a different way than in nondemented subjects.
Impairment of Verb Processing in Frontal Variant-Frontotemporal Dementia: A Dysexecutive Symptom
Authors: Silveri M.C. , Salvigni B.L. , Cappa A. , Della Vedova C. , Puopolo M.
Published: September 2003

Object and action naming and comprehension were tested in frontotemporal dementia (frontal variant, FTD), in Alzheimer’s disease (AD) and in controls. Although lower scores were obtained by all groups, we can confirm that actions were proportionally more impaired in FTD. The correlation between action naming deficit and severity of dementia was stronger in this group than in AD. The correlation analysis also suggested that the naming disorder was different in nature in FTD (mostly a dysexecutive deficit) and in AD (mostly a linguistic disorder). Our explanation is that since verbs are supposed to be more demanding of executive resources than nouns, a higher sensitivity to verbs should be expected in any brain pathology, but mostly in FTD in which executive resources are typically reduced.
The Immunohistochemical Profile of the Tethered Filum terminale
Authors: George Timothy M. , Bulsara Ketan R. , Cummings Thomas J.
Published: September 2003

The embryopathy underlying tethering of the filum terminale is poorly understood. Knowledge of normal filum development is the foundation upon which to compare normal fila to fila from patients with tethered cord syndrome. Thirty-four fila from patients with tethered cord syndrome were immunostained with caudal neural tube developmental markers H4C4 (CD44), VIN-IS-53, AC4, FP3 and NOT1, and a panel of mature neuroglial, neural crest, epithelial and mesenchymal markers. H4C4 (CD44) and NOT1 exhibited significant alterations in immunoexpression in tethered fila compared to controls. The change in expression may be indicative of altered cell identity in the filum and constitute the predisposition to tethering.
The Immunohistochemical Profile of the Myelomeningocele Placode: Is the Placode Normal?
Authors: George Timothy M. , Cummings Thomas J.
Published: September 2003

One key to predicting optimal outcome of novel treatments, such as fetal surgery, for myelomeningocele is understanding the structure of the placode. We hypothesize that if the placode retains normal patterning and is simply unneurulated, then repair may be effective in preventing secondary injury. Serial sections of human myelomeningocele placodes were characterized using novel immunohistochemical caudal spinal cord markers (H4C4, AC4, NOT, VIN-IS-53, and FP3) and established structural markers (e.g. neurofilament, glial fibrillary acidic protein, or synaptophysin). The myelomeningocele placodes studied exhibited abnormal patterning along the dorsoventral and rostrocaudal axes indicative of a change in pattern determination and a paucity of maturing neurons. In addition, there was significant inflammatory infiltrate, gliosis and fibrosis consistent with secondary injury. Additionally, injury to the placode was also demonstrated. The combination of effects may be contributory to abnormal spinal cord function in myelomeningocele patients.
The Natural History of Ventriculomegaly and Tonsillar Herniation in Children with Posterior Fossa Tumours – An MRI Study
Authors: Gnanalingham Kanna K. , Lafuente Jesus , Thompson Dominic , Harkness William , Hayward Richard
Published: September 2003

Objective: Posterior fossa tumours in children predispose to hydrocephalus, although the natural history is unclear and the need for drainage of the ventricles is controversial. We report on the natural history of ventriculomegaly and tonsillar herniation, as seen on serial MRI scans in children with posterior fossa tumours. Results: Eighty-nine children with posterior fossa tumours were reviewed retrospectively. Overall, 18 (20%) patients required permanent cerebrospinal fluid (CSF) drainage in the form of a ventriculoperitoneal shunt (n = 15) or third ventriculostomy (n = 3). On pre-operative MRI scan, the ventricular size was assessed by measurement of the ventricular index (VI) and 59 patients (66%) had a VI greater than 0.4. There was a progressive decrease in the mean VI from pre-operative to post-operative MRI scans and beyond 3–9 months after surgery, the mean VI was less than 0.4 (p = 0.0001). Patients requiring permanent CSF drainage had a greater VI pre-operatively and at 3–9 months post-operatively (p < 0.05). On pre-operative MRI scan, 75 patients (84%) had greater than 5 mm herniation of the cerebellar tonsils below the level of the foramen magnum. There was a progressive decrease in the mean tonsillar herniation from pre-operative to post-operative MRI scans, with time (p = 0.0001), although this did not relate to the need for CSF drainage. On multivariate analysis, the need for permanent CSF drainage was associated with pre- and intra-operative CSF drainage (odds ratio = 23.3; p = 0.0001) and incomplete surgical excision of tumour (odds ratio = 7.7; p = 0.006). Conclusions: Hydrocephalus and tonsillar herniation are common in children with posterior fossa tumours, although post-operatively there is a natural tendency for it to resolve and only a fifth of the patients needed permanent CSF drainage. We recommend selective drainage of CSF in children with posterior fossa tumours. Patients at risk are those with severe symptoms at presentation, needing peri-operative CSF drainage and those with subtotal resection of tumour.
Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Central Nervous System Infection or Intraventricular Hemorrhage in Children
Authors: Smyth Matthew D. , Tubbs R. Shane , Wellons, III John C. , Oakes W. Jerry , Blount Jeffrey P. , Grabb Paul A.
Published: September 2003

Objective: We review our experience of endoscopic third ventriculocisternostomy (ETV) in children with hydrocephalus from central nervous system (CNS) infection or intraventricular hemorrhage to better elucidate success rates and predictors of success in these children. Methods: We performed a retrospective review of 12 children less than 21 years of age with ETV treated from 1999 to 2002 with a minimum follow-up of 12 months. Children selected for surgery had been diagnosed with hydrocephalus from perinatal germinal matrix hemorrhage or CNS infection and had neuroimaging consistent with obstruction of the aqueduct, fourth ventricular outlets or both at the time of ETV. Charts and imaging studies were reviewed to determine clinical outcomes and predictors of successful ETV. An ETV was deemed successful if the child did not require placement or replacement of a ventriculoperitoneal shunt. Results: Thirteen ETV were performed in 12 patients (7 boys and 5 girls; mean age 9.2 years, range 3.8–21 years), with an overall success rate of 60% for those with CNS infections and 71% for those with perinatal intraventricular hemorrhage at initial presentation. There were no significant complications from the procedure. Conclusions: ETV is a safe procedure, which in carefully selected children with etiologies of hydrocephalus thought to be ‘communicating’ in nature carries a satisfyingly high success rate. Further application and study of this modality in larger groups of patients with these causes of hydrocephalus is warranted.
Moyamoya Syndrome after Prophylactic Cranial Irradiation for Acute Lymphocytic Leukemia
Authors: Kondoh Takeshi , Morishita Akitsugu , Kamei Masahito , Okamura Yusuke , Tamaki Masahiro , Kohmura Eiji
Published: September 2003

A 9-year-old boy presented with an episode of syncope, and MR imaging revealed bilateral internal carotid artery stenosis with moyamoya vessel formation. He had had prophylactic cranial irradiation at a total dose of 24 Gy for the treatment of acute lymphocytic leukemia at the age of 4. Following this, he was in a complete state of remission for 6 years. During an observation period of a year after the onset of syncope, MR imaging showed development of multiple ischemic lesions in both hemispheres. He developed a transient ischemic attack of mild motor weakness in his arm and an indirect anastomosis was performed on the severely affected side at the age of 10. Radiation-induced vasculopathies are known to be associated with primary diseases of intracranial tumors, but the frequency is unclear. Ours is the third case in whom prophylactic cranial irradiation for a hematological disorder might have induced cerebral vasculopathies.
A Large Planum sphenoidale Meningioma with Sinonasal Extension in a Child
Authors: Mohit Alex , Grant Gerald , Stevenson Kevin , Girotto John , Gruss Joseph , Manning Scott , Ellenbogen Richard G.
Published: September 2003

Anterior cranial base meningiomas are rare tumors in children. Due to the extensive involvement of orbit, paranasal sinuses, midface, and anterior skull base, a multidisciplinary approach is warranted. We present a case of a child with a large planum sphenoidale meningioma extending into subfrontal region, ethmoid and maxillary sinuses inferiorly, and orbits laterally. The patient, a 4-year-old girl, presented with long-standing nasal stuffiness and swelling of the midface. An extended frontobasal approach through a bifrontal craniotomy was used to resect the intracranial portion of this mass. The tumor had eroded through nasal septum, medial orbital walls, and left maxilla, structures which were not readily accessible from a cranial approach alone. A modified Weber-Ferguson incision was used for a transfacial approach to resect the residual mass below the skull base. The advantages of combining the bifrontal craniotomy with a transfacial split provided the added exposure to maximize the extent of resection.
Suprasellar Lymphoid Hyperplasia Presenting with Diabetes insipidus and Hypogonadism
Authors: Tubbs R. Shane , Kelly David R. , Hammers Yuki A. , Palmer Cheryl Ann , Wellons, III John C. , Blount Jeffrey P. , Oakes W. Jerry
Published: September 2003

We report a pediatric patient who presented with hypogonadism and diabetes insipidus. Further evaluation revealed hypothyroidism. MRI of the brain revealed a suprasellar mass. Following frontal craniotomy for mass biopsy, histological analysis of the mass revealed benign lymphoid hyperplasia. The patient has had no progression of his mass or symptoms at most recent follow-up (10 months). We review this unusual case and other similar conditions. We believe this to be the first reported case of lymphoid hyperplasia without malignant cells of the suprasellar region.
Corticosterone and Testosterone Levels after Chronic Stress in an Animal Model of Depression
Authors: Bonilla-Jaime H. , Retana-Marquez S. , Vazquez-Palacios G. , Velázquez-Moctezuma J.
Published: September 2003

Neonatal administration of clomipramine (CMI) in rats induces behavioral changes during adulthood, such as impairments of pleasure-seeking behaviors. However, the endocrine changes induced by this treatment are controversial. In the present study, we analyzed the levels of corticosterone and testosterone in rats neonatally treated with CMI in response to chronic stress by repeated immersion in cold water. Results obtained in the forced swim test corroborated the effect of neonatal CMI administration, showing a significant increase in immobility time. The testosterone response to stress was similar in both control and CMI-treated rats. Concerning corticosterone, there was a significantly lower response to stress in CMI-treated rats. The data suggest that CMI induces permanent changes in the reactivity of the hypothalamic-pituitary-adrenal axis, without affecting the hypothalamic-pituitary-gonadal axis.
Allelic Variants of the Tryptophan Hydroxylase (A218C) and Serotonin 1B Receptor (A-161T) and Personality Traits
Authors: Tsai Shih-Jen , Wang Ying-Chieh , Chen Jen-Yeu , Hong Chen-Jee
Published: September 2003

Human personality traits have a considerable hereditary component, and central serotonergic activity is implicated in the personality factors of the Tridimensional Personality Questionnaire (TPQ). Our population-based association study tested the hypothesis that the tryptophan hydroxylase (TPH) A218C and serotonin 1B receptor (HTR1B) A-161T polymorphisms were associated with TPQ personality trait scores in a sample population of 209 young healthy Chinese. No significant differences were demonstrated comparing scores of subjects bearing different TPH or HTR1B genotypes; however, a trend for difference in the novelty seeking score comparing TPH genotype groups was determined for the male population. Our negative findings suggest that the TPH A218C and HTR1B polymorphisms do not play major roles in the determination of TPQ personality traits.
Association of Muscarinic M1 Receptor Genetic Polymorphisms with Psychiatric Symptoms and Cognitive Function in Schizophrenic Patients
Authors: Liao Ding-Lieh , Hong Chen-Jee , Chen Hong-Mei , Chen Yueh-Er , Lee Shin-Min , Chang Chun-Yi , Chen Hong , Tsai Shih-Jen
Published: September 2003

Objective: The cholinergic system is important in the search for the pathophysiology of schizophrenia due to its role in cognitive function, interaction with the dopamine system in brain regions relevant to schizophrenia, side effects of antipsychotic medication and potential antipsychotic effect of muscarinic receptor antagonists. This study investigated the association of type I muscarinic receptor (CHRM1) genetic polymorphisms with the clinical characteristics of chronic schizophrenic inpatients. Methods: We determined the genotype of CHRM1 genetic polymorphisms in 243 schizophrenic patients hospitalized in chronic care wards. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and cognitive function was assessed using the Folstein Mini-Mental Status Examination (MMSE) test. Sixty of the 243 subjects also completed the Wisconsin Card Sorting Test (WCST). Results: There was a significant difference in the number of correct responses and the percentage of perseverative errors in the WCST in the CHRM1 C267A genotype group of schizophrenia patients. There was no significant association between age at onset, chlorpromazine equivalents, BPRS scores, MMSE or schizophrenia per se in patients with the CHRM1 C267A genotype. The full exon of the CHRM1 gene was screened out with single-strand conformation polymorphism, and 2 single nucleotide polymorphisms (C267A and C1353T) were identified in our patients and control subjects. These 2 single nucleotide polymorphisms were linked together without exception. Conclusion: This study demonstrated that in schizophrenic patients, the heterozygote group of CHRM1 C267A polymorphism (267C/A) had more correct responses and less perseverative errors on the WCST performance than the 267C/C homozygote group, implicating that this polymorphism may be related to prefrontal cortical function. Our results also suggested that the C267A polymorphism plays no major role in the susceptibility to and clinical manifestations of schizophrenia.
Event-Related Potentials to Emotional and Neutral Stimuli in Alcoholism
Authors: Hansenne Michel , Olin Cécile , Pinto Emmanuel , Pitchot William , Ansseau Marc
Published: September 2003

Several studies have demonstrated that the emotional value of stimuli affects P300 amplitude. In the present study, the influence of alcohol-related stimuli in alcoholic patients was investigated. Subjects were 10 alcoholic inpatients (3 female) and 10 age- and sex-matched controls. Eight alcohol-related and 8 neutral words served as stimuli in a visual oddball paradigm. Acohol-related words were targets (48 stimuli, 33%) and neutral words were standard stimuli (96 stimuli, 66%). Results showed that P300 amplitude for targets did not differ significantly between the two groups. However, P300 latency for targets as well as reaction time were significantly shorter in male alcoholic patients. In contrast, P300 latency was increased in female alcoholic patients but reaction time did not differ. These results suggest that male alcoholics process information linked to alcohol cues more rapidly than neutral cues, probably because a specific semantic network is activated in these patients. The decreased reaction time confirms the impulsive behavior frequently found in male alcoholism, as it has been described in type II alcoholism. Besides, the results imply that information processing was delayed in female alcoholic patients. Therefore this study demonstrates a gender-dependent impact of alcohol-related stimuli on information processing.
Gabapentin versus Ropinirole in the Treatment of Idiopathic Restless Legs Syndrome
Authors: Happe Svenja , Sauter Cornelia , Klösch Gerhard , Saletu Bernd , Zeitlhofer Josef
Published: September 2003

Dopaminergic agents such as ropinirole are the drugs of first choice in treating restless legs syndrome (RLS). Recently, gabapentin, a structural analogue of γ-aminobutyric acid, has also been shown to improve sensorimotor symptoms in RLS. Therefore, the tolerability and efficacy of randomized treatment with either gabapentin or ropinirole in patients with idiopathic RLS was evaluated in this 4-week open clinical trial. Patients with idiopathic RLS were treated with either 300 mg of gabapentin (n = 8) or 0.5 mg of ropinirole (n = 8) as the initial dose, and the dose was up-titrated until relief of symptoms was achieved (gabapentin mean dosage 800 ± 397 mg, range 300–1,200 mg; ropinirole mean dosage 0.78 ± 0.47 mg, range 0.25–1.50 mg). In both groups, International Restless Legs Syndrome Study Group questionnaire scores improved significantly (p ≤ 0.018), whereas the scores of the Epworth sleepiness scale remained unchanged within normal limits. Polysomnographic data showed a reduction of periodic leg movements during sleep (PLMS; p < 0.03) and PLMS index (p < 0.02) in both groups. Side effects were only mild and mostly transient. After 6–10 months of follow-up, in most patients, RLS symptoms were still improved. We conclude that gabapentin and ropinirole provide a similarly well-tolerated and effective treatment of PLMS and sensorimotor symptoms in patients with idiopathic RLS.
Effects of Scopolamine on Matching to Sample Paradigm and Related Tests in Human Subjects
Authors: Koller G. , Satzger W. , Adam M. , Wagner M. , Kathmann N. , Soyka M. , Engel R.
Published: September 2003

This was a double-blind placebo-controlled study with a cross-over design to examine the effects of scopolamine on cognitive functions in young healthy subjects. Scopolamine hydrobromide was administered subcutaneously to 12 subjects (mean ± SD age 23.8 ± 2.2 years) at doses of 0.3 and 0.6 mg in comparison with two placebo conditions. Scopolamine at both doses produced marked sedation as rated by subjects and an observer. In the continuous performance test, vigilance was impaired by both doses of scopolamine. The span of apprehension test showed differing results (only the high dose of scopolamine showed a performance decrement only in the three-character version of the span of apprehension test). Significant impairment by both doses of scopolamine was seen in immediate and delayed free recall, continuous visual recognition, running word recognition and running picture recognition. While scopolamine caused a significant slowing in average reaction times for simultaneous matching as well as for delayed matching, subjects made more errors under scopolamine compared to placebo only in delayed matching, not in simultaneous matching. Also, the main outcome of matching to sample showed significant effects only in delayed matching, not in simultaneous matching. Notable in this study is the incongruity between the simultaneous matching test and the span of apprehension test on the one hand and the other cognitive tests used on the other. These results demonstrated that scopolamine has a greater effect on memory than on attention. Thus, the scopolamine-induced effects in the present study seem to be more relevant to Alzheimer’s disease in an advanced phase than to normal aging.
V/Q-Scanning/SPECT for the Diagnosis of Pulmonary Embolism
Authors: Schümichen C.
Published: September 2003

Pulmonary embolism (PE) is visualized indirectly by perfusion (Q) scanning as a parenchymal defect related to the embolized artery, and is confirmed by combined ventilation (V) scanning, showing a normal regional ventilation. Based on its principle of detection, V/Q scanning is able to show even small emboli and this ability is enhanced by SPECT. Compared to angiography, V/Q scanning seems to be burdened with low specificity, whereas its sensitivity is sufficiently high. Correlation of V/Q scanning with single-slice CT is comparable with that with angiography. The positive predictive value of V/Q scanning cannot be assessed by the reference standard angiography or by single-slice CT because both have turned out to be inadequate. Correlation of V/Q scanning with high-resolution CT is very promising, revealing high sensitivity as well as specificity of V/Q scanning, but this needs further evaluation in larger studies. Nevertheless, the use of V/Q scanning as a one-step diagnostic approach to PE is unrestricted in patients with normal chest radiograph, whereas V/Q scanning in combination with spiral CT is recommended in patients with abnormal chest radiograph. The negative predictive value of V/Q scanning for recurrent PE is unsurpassed high and by this, V/Q scanning tends to be used primarily to exclude rather than confirm PE.
Polysomnography in Chronic Neuromuscular Disease
Authors: Weinberg J. , Klefbeck B. , Borg J. , Svanborg E.
Published: September 2003

Background: Sleep is a risk factor for respiratory failure in patients with chronic neuromuscular diseases (NMD). Objective: To explore the diagnostic value of monitoring sleep parameters in addition to nocturnal respiratory parameters. Methods: Thirty-one patients with chronic NMD underwent whole-night polysomnograms including EMG from accessory respiratory muscles. Results: Sleep macrostructure was normal on average. The number of respiratory arousals per hour of sleep was above the upper limit observed in a control group (>2.1) in 71% of the patients, but was moderate in most cases. Nadir oxygen saturation <85% was the most common finding indicating respiratory dysfunction and was present in 80% of the patients. Noninvasive blood gas monitoring identified all but 2 patients with respiratory-induced sleep abnormalities. The respiratory arousal rate was correlated with the oxygen desaturation index, but otherwise there were no significant correlations between sleep and nocturnal respiratory parameters. Vital capacity was significantly positively correlated with obstructive apnea index and daytime base excess to nadir oxygen saturation. Inspiratory activity in accessory respiratory muscles was present during REM sleep and/or slow wave sleep in 70% of the patients. Conclusion: The severity of nocturnal respiratory dysfunction is not reflected in the extent of sleep impairment in patients with chronic neuromuscular diseases.
Effect of Different Levels of Pressure Support and Proportional Assist Ventilation on Breathing Pattern, Work of Breathing and Gas Exchange in Mechanically Ventilated Hypercapnic COPD Patients with Acute Respiratory Failure
Authors: Passam F. , Hoing S. , Prinianakis G. , Siafakas N. , Milic-Emili J. , Georgopoulos D.
Published: September 2003

Background: Proportional assist ventilation (PAV) has been shown to maintain better patient-ventilator synchrony than pressure support ventilation (PSV); however, its clinical advantage regarding invasive ventilation of COPD patients has not been clarified. Objectives: To compare the effect of PAV and PSV on respiratory parameters of hypercapnic COPD patients with acute respiratory failure (ARF). Methods: Nine intubated hypercapnic COPD patients were placed on the PAV or PSV mode in random sequence. For each mode, four levels (L1–L4) of support were applied. At each level, blood gases, flow, tidal volume (VT), airway pressure (Paw), esophageal pressure (Pes) (n = 7), patient respiratory rate (fp), ventilator rate (fv), missing efforts (ME = fp – fv) were measured. Results: We found increases in ME with increasing levels of PSV but not with PAV. PO2 and VT increased whereas PCO2 decreased significantly with increasing levels of PSV (p < 0.05). With PAV, PCO2 decreased and VT increased significantly only at L4 whereas PO2 increased from L1 to L4. Runaways were observed at L3 and L4 of PAV. The pressure-time product (PTP) was determined for effective and missing breaths. The mean total PTP per minute (of effective plus missing breaths) was 160 ± 57 cm H2O/s·min in PSV and 194 ± 60 cm H2O/s·min in PAV. Conclusion: We conclude that in COPD patients with hypercapnic ARF, with increasing support, PSV causes the appearance of ME whereas PAV develops runaway phenomena, due to the different patient-ventilator interaction; however, these do not limit the improvement of blood gases with the application of both methods.
Chronic Eosinophilic Pneumonia: Treatment with Inhaled Corticosteroids
Authors: Minakuchi Masayoshi , Niimi Akio , Matsumoto Hisako , Amitani Ryoichi , Mishima Michiaki
Published: September 2003

Background: Chronic eosinophilic pneumonia (CEP) is highly sensitive to systemic corticosteroids, but frequently relapses if the dose is tapered or treatment discontinued. Long-term usage of systemic corticosteroids may cause side effects. Alternative treatments are therefore desired. Objectives: We evaluated the response of CEP to monotherapy with inhaled corticosteroids (ICS). Methods: Four patients who had CEP without spontaneous resolution were studied. Patients received inhaled beclomethasone dipropionate (BDP) at a dose of 0.8 mg/day in 1 patient and 1.6 mg/day in 3 patients for 2 weeks. Treatment was continued if a patient showed improvement in at least 1 of the following indices: radiological findings, symptoms, and blood eosinophilia. Results: After the initial 2 weeks of treatment with BDP, the blood eosinophil count increased in 2 patients and decreased in 2. Symptoms worsened in 2 and improved in 2. Infiltrates on chest radiography increased in 3 and showed little change in 1. In the 2 patients with worsening of all 3 outcome indices, oral prednisolone was started; the indices improved. In the remaining 2 patients, BDP alone was continued. One patient had worsening of CEP after 2 months of treatment, and another had relapse of CEP at 3.5 years while receiving 1.6 mg/day of BDP. All patients thus finally had worsening or relapse of CEP during treatment with BDP. Conclusions: ICS may not be effective when given as monotherapy in patients with CEP.
State-of-the-Art Imaging of the Central Airways
Authors: Boiselle Phillip M. , Ernst Armin
Published: September 2003

Recent technological advances in CT imaging have revolutionized non-invasive imaging of the central airways. It is now possible to image the entire central airways in a few seconds and to create elegant three-dimensional reconstructions of the airways in a few minutes. The fast speed of CT scanning now allows for a dynamic assessment of the central airways, expanding the ability to non-invasively detect functional abnormalities such as tracheobronchomalacia. The purpose of this article is to familiarize clinicians with recent advances in airway imaging. A special emphasis is placed upon advanced CT reconstruction methods and their potential contributions to the evaluation of a variety of airway disorders.
Autofluorescence Bronchoscopy – A Comparison of Two Systems (LIFE and D-Light)
Authors: Herth F.J.F. , Ernst A. , Becker H.D.
Published: September 2003

Background: Autofluorescense (AF) bronchoscopy is an established method to detect dysplasia and carcinoma in situ (CIS). Several different systems are currently available. Objectives: This study aimed to directly compare the LIFE system (Xillix Technologies, Vancouver, Canada) and the D-light system (Storz, Tuttlingen, Germany). Methods: In a prospective study performed between May 1999 and October 2000, we examined patients with risk factors for lung cancer that underwent bronchoscopy with both (LIFE and D-light) systems in a crossover design. The findings were classified into normal, abnormal and suspicious lesions by independent investigators and then compared. Results: This study comprised 332 patients (220 males, 112 females, mean age 62.7 years, range 40–85); 1,117 biopsies were studied (mean biopsy rate 3.4/patient). In 817 biopsies, mucosal areas were classified as normal with respect to control biopsy specimens, 113 as abnormal and 187 as suspicious using AF bronchoscopy. The histological examination showed normal tissue in 850 cases, in 55 cases scarring or inflammation, in 62 meta- or dysplasias, in 11 carcinomas in situ and in 127 invasive tumors. In only 5 cases, classifications were found to be different between the two systems (2 normal, 2 dysplasias, 1 invasive tumor). The mean time for the LIFE system examination amounted to 11.7 min (range 6.2–19.5) and for the D-light system to 7.4 min (range 4.3–11.9). This difference was statistically significant (p < 0.001). Conclusion: Both systems yielded comparable results. The examination time was significantly shorter with the D-light system, which may be explained by the more comfortable handling and the direct switch between white light and AF imaging. Different trials using either methodology could be compared directly.
Efficacy, Safety, and Acceptance of Beclomethasone Dipropionate Administered via a New Dry Powder Inhaler or a Standard CFC Metered-Dose Inhaler in Asthma Patients
Authors: Kunkel G. , Schäper C. , Noga O. , Schläfke S. , Lemmnitz G. , Köhler S.
Published: September 2003

Background/Objectives: The mechanical aerosol generator, MAGhaler®, is a new chlorofluorocarbon-free inhalation device. The objective of this trial was to show equivalent efficacy and safety of beclomethasone dipropionate (BDP) delivered via the MAGhaler® and the metered-dose inhaler (MDI) in patients with mild to moderate bronchial asthma. Moreover, user-friendliness and acceptance of the two devices were compared. Methods: This was a double-blind, reference-controlled, 12-week trial in 171 patients with asthma receiving BDP (1,000 µg/day) delivered via either the MAGhaler® or the conventional MDI. Respiratory function parameters, clinical symptoms, concomitant intake of salbutamol or fenoterol, adverse events (AEs), laboratory values, and concomitant medications and diseases were recorded. The primary efficacy parameter was mean forced expiratory volume in 1 s (FEV1), measured after 4, 8, and 12 weeks of therapy. Results: The equivalence of the two devices was confirmed (p = 0.003) on the basis of the ratios of the mean FEV1 in weeks 4 to 12. Mean (± SD) FEV1 (MAGhaler®) was 2.24 ± 0.60 l (baseline), 2.61 ± 0.90 litres (week 4), and 2.62 ± 0.87 litres (weeks 4–12). Mean FEV1 (MDI) was 2.28 ± 0.59 litres (baseline), 2.53 ± 0.82 litres (week 4), and 2.56 ± 0.77 litres (weeks 4–12). In total, 33 AEs occurred in 26 (30.2%) patients (MAGhaler®) and 51 AEs in 36 (42.4%) patients (MDI). Most of the AEs were of mild or moderate intensity. The relationship to treatment could not be excluded for 11 AEs in 11 patients (MAGhaler®) and 23 AEs in 18 patients (MDI). Three serious AEs, all unrelated to treatment, occurred in 3 patients (MAGhaler®: 2, MDI: 1). There were no clinically relevant changes in other safety parameters. Most patients either preferred the MAGhaler® or rated the two devices as equally acceptable. Conclusion: The new MAGhaler® was equivalent to the standard MDI in terms of the safety and efficacy of BDP. The improved user-friendliness and acceptance of the MAGhaler® over the conventional MDI represent an important advance in the clinical management of bronchial asthma.
Fluorodeoxyglucose PET Scan in Pulmonary Sarcoidosis during Treatment with Inhaled and Oral Corticosteroids
Authors: Milman Nils , Mortensen Jann , Sloth Carsten
Published: September 2003

The objective was to investigate longitudinal changes in fluorodeoxyglucose PET scan (FDG-PET) in a patient with pulmonary sarcoidosis prior to and during treatment with inhaled corticosteroids followed by systemic corticosteroids. The patient was a 41-year-old man presenting with stage I pulmonary sarcoidosis (hilar adenopathy), which had progressed to stage II (pulmonary infiltrates) 19 months later. FDG-PET was performed at 19, 29 and 33 months after presentation. No treatment was given prior to the 1st PET. Subsequently, before the 2nd PET, the patient was treated with inhaled beclomethasone (QVAR Autohaler®) 0.8 mg/day for 8 months. Finally, prior to the 3rd PET, the patient was treated with oral prednisolone 30 mg/day for 3 months. The 1st PET showed a high FDG uptake in the hilar and mediastinal lymph nodes and a high focal uptake in the peripheral parts of the lungs. The 2nd PET showed a slight uptake in a few mediastinal lymph nodes and an unchanged high focal uptake in the peripheral parts of the lungs and the pleura. The 3rd PET showed no abnormal uptake at all. In conclusion, as assessed by FDG-PET, inhaled beclomethasone had no recognizable influence on sarcoid inflammatory activity. Treatment with oral prednisolone depressed the inflammatory activity to such a degree that it was undetectable by PET. The results are in accordance with clinical studies on pulmonary sarcoidosis, showing a marginal effect of inhaled corticosteroids and a marked effect of systemic corticosteroids.
A Case of Pulmonary Intravascular Lymphomatosis Diagnosed by Thoracoscopic Lung Biopsy
Authors: Yamagata Toshiyuki , Okamoto Yukiharu , Ota Kiichiro , Katayama Norifumi , Tsuda Tadaaki , Yukawa Susumu
Published: September 2003

Intravascular lymphomatosis with primary pulmonary lesion is an extremely rare disease. Although the major clinical symptoms include fever, cough, dyspnea and loss of body weight, these are not diagnostic. Chest radiograph findings are also nonspecific and include bilateral reticular shadow, reticulonodular shadow, ground-glass opacity or wedge-shaped subpleural opacities. Therefore, the antemortem diagnosis is relatively difficult. It is considered that intravascular lymphomatosis is a high-grade malignant lymphoma. However, it has been shown recently that a good response and long-term survival may possibly be obtained through systemic combination chemotherapy. We report a case of intravascular lymphomatosis with primary pulmonary lesion where an early diagnosis was obtained through thoracoscopic lung biopsy and subsequent systemic chemotherapy proved to be quite effective. Because the clinical symptoms or chest radiograph findings are usually nonspecific, it was thought that thoracoscopic lung biopsy could be a useful procedure for early and reliable diagnosis of primary pulmonary intravascular lymphomatosis and that it might contribute to an improved prognosis.
Acute Respiratory Failure and Cerebral Hemorrhage due to Primary Epstein-Barr Virus Infection
Authors: Gautschi O. , Berger C. , Gubler J. , Laube I.
Published: September 2003

Epstein-Barr virus (EBV) is a ubiquitous human herpesvirus with worldwide distribution. Primary infection with EBV occurs early in life and typically presents as infectious mononucleosis. The usual course of the disease is benign and most patients recover uneventfully. Severe infections are reported particularly in immunocompromised patients. Mild, asymptomatic pneumonitis is reported in about 5–10% of cases of infectious mononucleosis, but severe pneumonitis with hypoxemia is very rare in immunocompetent individuals. We report a young female adolescent in whom an acute EBV infection led to severe bilateral pneumonitis, a systemic inflammatory response and intracerebral bleeding. The clinical course and results of quantitative viral DNA determinations in plasma are presented.
Duro-Pleural Fistula Diagnosed by β2-Transferrin
Authors: Huggins John T. , Sahn Steven A.
Published: September 2003

An 81-year-old man was referred for evaluation of a chronic transudative pleural effusion that required 8 therapeutic thoracenteses over 11 months for relief of dyspnea. Extensive lumbar disk surgery had been performed 2 years prior to his onset of dyspnea. The diagnosis of duro-pleural fistula was confirmed by finding the presence of β2-transferrin in the pleural fluid. The ‘water-like’ pleural fluid had a total protein of <1 gm/dl, an LDH of 92 IU/l, a glucose of 101 mg/dl, and pH of 7.55. β2-Transferrin has a sensitivity approaching 100% and a specificity of 95% in identifying CSF leaks from head trauma. To our knowledge, this is the first report of β2-transferrin in pleural fluid from a duro-pleural fistula.
Pathogenesis and Treatment of Primary Spontaneous Pneumothorax: An Overview
Authors: Noppen Marc , Baumann Michael H.
Published: September 2003

The exact pathogenesis of primary spontaneous pneumothorax (PSP) remains unknown. Furthermore, various specialists including pulmonologists, surgeons, emergency care physicians, radiologists and others are known to treat this disorder in clinical practice. As a consequence, guidelines on the management of PSP are scarce, and differences in treatment approaches persist. In this paper, evidence on the pathogenesis and on various treatment techniques and strategies is reviewed. An algorithmic treatment approach is proposed.
The Th1 and Th2 Paradigm in ANCA-Associated Vasculitis
Authors: Sanders J.S.F. , Stegeman C.A. , Kallenberg C.G.M.
Published: September 2003

In the pathogenesis of anti-neutrophil cytoplasm antibodies (ANCA)-associated vasculitis, T cell contribution is indicated by T cell-dependent ANCA production combined with the presence of T cells in inflammatory infiltrates. However, the exact pathogenic role of T cells in ANCA-associated vasculitis remains to be determined. The Th1/Th2 concept is useful for understanding T cell involvement in pathological processes. This review focuses on T cells and particularly the Th1/Th2 paradigm in ANCA-associated vasculitis. Most research has been done in Wegener’s granulomatosis, where a shift in T cell response, from a Th1 pattern in localized disease towards a Th0/Th2 pattern in generalized disease, appears to occur. Although less thoroughly studied, data in Churg-Strauss syndrome and microscopic polyangiitis indicate that these diseases are predominantly associated with Th2 patterns. Further studies elucidating the true nature of the polarization towards Th1 or Th2 in ANCA-associated vasculitis are clearly needed.
Preoperative Administration of Rebamipide Significantly Lowers Body Temperature and Circulating Interleukin-6 in Gastric Cancer Patients after Gastrectomy
Authors: Shimada S. , Inoue K. , Kuramoto M. , Suzuki S. , Yamamoto K. , Ogawa M.
Published: September 2003

Background/Aims: It has recently been reported that rebamipide (OPC-12759) inhibits inflammatory cytokines and activation of neutrophils. The aim of the present study was to investigate the effects of preoperative administration of rebamipide on parameters of systemic inflammatory response syndrome (SIRS) and serum levels of inflammatory cytokines in gastric cancer patients after gastrectomy. Patients and Methods: We measured the parameters of SIRS, circulating cytokines and acute phase reactants in patients after (i) distal gastrectomy with D2 lymph node dissection (group 1, n = 10); (ii) distal gastrectomy with D2 lymph node dissection following administration of rebamipide (group 2, n = 10), and (iii) laparoscopy-assisted distal gastrectomy (LADG) with D1 lymph node dissection (group 3, n = 10). Group 2 was administered 100 mg of rebamipide 3 times/day after meals for 7 days before surgery. Results: Among the parameters of SIRS, a difference was observed in body temperature on day 3. The mean body temperature of group 2 was significantly lower than group 1 (p = 0.006), and was similar to group 3. In proinflammatory cytokines, a significant difference was observed in the serum levels of interleukin (IL)-6. On day 1 the IL-6 levels of group 2 were significantly lower than those of group 1 (p < 0.001). The changes in the IL-6 level of group 2 were similar to group 3, except in the very early postoperative phase. However, other proinflammatory cytokines, such as IL-8 and IL-10, were not detected, and there was no difference in C-reactive protein between the 3 groups. Conclusion: Preoperative administration of rebamipide significantly decreased postoperative body temperatures and circulating IL-6 in gastric cancer patients after gastrectomy to levels similar to those of patients with LADG.