bluuebunny/crossref_metadata_2025 huggingface dataset:
Failed paediatric laryngotracheoplasty
Authors: Berkowitz Robert G.
Published: March 2003

Introduction: Clinical experience with the surgical treatment of paediatric laryngeal stenosis is decreasing, and therefore it is important to highlight the factors that may contribute to failure.

Method: Retrospective study of 28 children undergoing laryngotracheoplasty (LTP) for laryngeal stenosis was carried out over an 11‐year period.

Results: Twenty‐one patients were decannulated after their initial surgery. One child died prior to stent removal, and the initial surgery was unsuccessful in six patients. Four of these underwent a second LTP. Three additional patients were decannulated, including one patient following endoscopic surgery only. One child is waiting decannulation, one child has not undergone further surgery, and another has undergone multiple failed LTP and remains dependent on the tracheostomy.

Conclusions: Factors identified as contributing to surgical failure in this series included severity of stenosis, cause of stenosis, presence of gastro‐oesophageal reflux, other airway abnormalities, timing of surgery, type of surgery employed, and factors related to postoperative management.
Human bites of the hand: The Tasmanian experience
Authors: Tonta Katherine , Kimble Frank W.
Published: March 2003

Introduction: The purpose of the present paper is to provide geographically representative information on the presentation, treatment and complications of human bites of the hand in Australia.

Methods: A 5‐year retrospective study was undertaken of patients treated at Royal Hobart Hospital for human bites of the hand. The variables evaluated included age, sex, hand involvement, anatomical distribution, presentation, operative findings, bacteriology, antibiotic use, X‐ray findings, complications and compliance.

Results: Thirty‐five patients had human bites to the hand. All were male with a median age of 24 years. Most were clenched fist injuries with the middle metacarpophalyngeal joint being the most prone to injury. Patients presenting early had a high incidence of open joints and fractures but spent less time in hospital than late presenters, almost all who had infection complications. Compliance with treatment was found to be a major problem. Serious hand infections were not observed.

Conclusion: The treatment of human bites must be early, correct and comprehensive. The appropriate treatment is surgical exploration with debridement and lavage, appropriate antibiotic administration, hand elevation and initial immobilization. Poor compliance of patients in the present study was demonstrated by a high incidence of late presentation, self‐discharge from hospital and loss to follow up, making assessment of outcomes difficult. Despite this there is an absence of serious hand infections reported in the literature and this may be due to the administration of antibiotics prior to referral.
Enabling occupation in the 21st Century: Making good intentions a reality
Authors: Townsend Elizabeth
Published: March 2003

Occupational therapists intend to collaborate with individuals, groups, agencies, and organizations in their search for meaningful occupations to promote health and justice. Since the 1997 publication of Enabling Occupation: An Occupational Therapy Perspective, Canada’s latest guidelines on client‐centred practice, the author has interwoven her ethnographic research in mental health services and client‐centred practice to raise awareness of disjunctures between intentions and actual practice. Her 1999 Keynote Presentation at OT Australia’s 20th National Conference in Canberra offers stories of George and Martha as allegories of the potential for enabling occupation in the 21st century. George presents a story of enabling occupation directly with people in need; Martha’s story is about organizing services for enabling occupation. Through these stories, Dr Townsend calls occupational therapists to develop the language, organization and practice needed to make the profession’s good intentions a reality in the 21st century.
Music therapy in physical medicine and rehabilitation
Authors: Paul Stanley , Ramsey David
Published: March 2003

The therapeutic effects of music are being recognized increasingly in the field of rehabilitation medicine. More music therapists are being employed in physical medicine and rehabilitation centres, with the goal of using music therapy services to assist in the physical recovery and health maintenance of clients. In spite of the benefits of physical rehabilitation programs, client participation to their full potential is often not observed. Music encourages participation in exercises and activities. Music can ease the discomfort and difficulty associated with exercise and therapy activities, and help ensure consistent participation. One of the goals of the music therapist is to provide a means for the client to express him/herself in a musical activity. Music therapy and rehabilitation medicine are starting to find a common niche in working together with clients who have various neurological, orthopaedic, and paediatric conditions. Therapeutic application of music in rehabilitation contributes to the quality of life of individuals with disabilities. Combined goals could include improving strength, range of motion, balance, communication, and cognition. Continued efforts in clinical practice and research will build on the information already available to further define possible applications of music therapy in rehabilitation, and its outcome and benefits. Occupational therapists can use the therapeutic medium of music, and the services of the music therapy discipline, in assisting clients to maximize their functional independence in their daily occupational roles.
Briefing and debriefing of student fieldwork experiences: Exploring concerns and reflecting on practice
Authors: Mackenzie Lynette
Published: March 2003

This paper describes a briefing and debriefing process used with occupational therapy students. Without a briefing and debriefing component of fieldwork experiences, there is a potential for fieldwork not to be fully integrated into the curriculum. An example of one briefing activity and one debriefing activity are presented. The briefing activity was designed to explore the perceptions and concerns of students at each stage of the course about imminent fieldwork placements. The debriefing activity investigated second‐year student perspectives about valued characteristics of supervisors and students. Written data generated during each activity were analysed using qualitative strategies. Specific concerns for students related to each year of the occupational therapy course were identified. Positive and negative student reflections about their fieldwork supervision were expressed. The value of the fieldwork briefing and debriefing process to enhance student learning is discussed.
Gastric irradiation for MALT lymphoma: Reducing the target volume, fast!
Authors: Wirth Andrew , Teo Aimee , Wittwer Helen , MacManus Michael , Ryan Gail
Published: March 2003

A case of low‐grade gastric mucosa‐associated lymphoid tissue (MALT) lymphoma treated with radiotherapy alone is reported here. This case highlights treatment issues related to the variability in size and position of the stomach, and the substantial reduction in the size of the irradiated volume achieved by treating the patient in a fasting state.
Primary spinal epidural extraosseous Ewing’s sarcoma: Report of five cases and literature review
Authors: Mukhopadhyay P , Gairola M , Sharma MC , Thulkar S , Julka PK , Rath GK
Published: March 2003

Ewing’s sarcoma is the most common malignant bone tumour occurring in children and adolescents and exists in two different clinicopathological entities: osseous Ewing’s sarcoma (OES) and extraosseous Ewing’s sarcoma (EES). Five cases of primary epidural EES are described, which presented with non‐specific symptoms leading to a long diagnostic delay. The median age at diagnosis was 22 years (range 13–36 years). The median diagnostic delay was 3 months. All patients had one or more neurological deficits. All underwent surgical exploration with a laminectomy and partial resection followed by adjuvant radiotherapy to a dose of 46–50 Gy and chemotherapy with VAC (vincristine, adriamycin and cyclophosphamide) alternating with ICE (ifosphamide, cisplatin and etoposide) for at least six cycles. The mean follow‐up period is 21.2 months (range 11–32 months). Four of the five patients achieved a complete remission and are disease free at the time of writing this report. Two patients have a residual neurological deficit – both having presented with long history of neurological deficit. Primary spinal epidural EES should be suspected whenever young patients present with back pain and/or radicular pain, have abnormal neurology and an extradural mass is demonstrated on MRI. Surgical excision followed by adjuvant radiotherapy (50 Gy) and combination chemotherapy (VAC alternating with ICE) achieved local and systemic control in these patients. A greater number of patients and longer follow up are required to evolve a generally accepted treatment policy for this aggressive but potentially curable malignancy.
Efficacy of daily bedside chest radiography as visualized by digital luminescence radiography
Authors: Kirchner Johannes , Stueckle Christoph A , Schilling Esther M , Peters Jutta
Published: March 2003

To determine the diagnostic impact of daily bedside chest radiography in comparison with digital luminescence technique (DLR; storage phosphor radiography) and conventional film screen radiography, a prospective randomized study was completed in 210 mechanically ventilated patients with a total of 420 analysed radiographs. The patients were allocated to two groups: 150 patients underwent DLR, and 60 patients underwent conventional film screen radiography. Radiological analysis was performed consensually and therapeutic efficacy was assessed by the clinicians. There was no statistical significant difference between the frequency of abnormal findings seen on DLR and conventional film screen radiography. In total, 448 abnormal findings were present in 249 of 300 DLR and 97 of 120 conventional film screen radiographs. The most common findings were signs of overhydration (41%), pleural effusion (31%), partial collapse of the lung (11%) and pneumothorax (2%). One hundred and twenty‐three of 448 (27%) of these abnormal findings were thought to have a considerable impact on patient management. The high rate of abnormal findings with significant impact on patient management suggests that the use of daily bedside chest radiography may be reasonable.
Diagnosis and management of astrocytomas, oligodendrogliomas and mixed gliomas: A review
Authors: Walker David G , Kaye Andrew H
Published: March 2003

Low‐grade gliomas are a diverse group of neoplasms which, as the name implies, are thought to arise from glial cells. Common among this group are astrocytomas (low‐grade astrocytoma; LGA), oligodendrogliomas and mixed gliomas. Among these, LGA is the commonest low‐grade glioma and, occasionally, although incorrectly, the terms are used interchangeably. Advances in imaging technology have improved the accuracy of preoperative diagnosis. The management of low‐grade gliomas is controversial. Recent evidence suggests that previously considered standard therapy (i.e. surgery plus radiotherapy) may not be in the patient’s best interests. A review of the available published research concerning low‐grade gliomas is therefore timely.
Magnetic resonance imaging features of an infected right atrial myxoma
Authors: Puvaneswary M , Thomson D
Published: March 2003

Myxomas are the most common primary intracardiac tumours, most commonly occurring in the left atrium, and rarely become infected. A search of the published research located only six case reports of infected right atrial myxoma. In this seventh reported case, the MRI findings are presented for the first time.
Embolization of proper hepatic artery pseudoaneurysm complicating choledochoscopic laser therapy
Authors: Auyeung KAI M , Chan YL
Published: March 2003

Biliary papillomatosis is a rare disease characterized by multiple papillary proliferation of the epithelial cell of the bile duct. Because it has a tendency to be recurrent, the treatment strategy is choledochoscopic laser therapy. A patient with biliary papillomatosis treated by choledochoscopic laser therapy, which was complicated by massive haemobilia and shock, is presented. An intrahepatic artery pseudoaneurysm was diagnosed on angiography. A coexisting occlusion necessitated a superselective embolization of the pseudoaneurysm in order to avoid devascularization of the left lobe of the liver.
Multiple bilateral giant fibroadenomas associated with cyclosporine A therapy in a renal transplant recipient
Authors: Muttarak Malai , Peh Wilfred CG , Chaiwun Benjaporn , Lumlertgul Dusit
Published: March 2003

A 31‐year‐old woman developed a right breast mass following cyclosporine A therapy after a renal transplant. Several large breast masses continued to grow bilaterally. Mammography and ultrasonography showed features of giant fibroadenomas. The diagnosis was confirmed by biopsy of one of the masses. Awareness of the association between cyclosporine A therapy and fibroadenoma development in renal transplant recipients is highlighted.
Direct B‐mode NASCET‐style stenosis measurement and Doppler ultrasound as parameters for assessment of internal carotid artery stenosis
Authors: Rotstein Andrew H , Gibson Robert N , King Paula M
Published: March 2003

Doppler ultrasound grading of internal carotid artery (ICA) stenosis using the two parameters of spectral analysis and internal carotid to common carotid artery peak systolic velocity (ICA/CCA PSV) ratio is well established. The improvements in B‐Mode ultrasound image quality now make direct ultrasound NASCET‐style stenosis measurement possible. We demonstrate that longitudinal B‐mode imaging can produce accurate North American Symptomatic Carotid Endarterectomy Trial (NASCET) style measurements which have good correlation with angiographic images. Ultrasound B‐mode stenosis measurement provides a third parameter which can be used in conjunction with the two Doppler parameters for the assessment of ICA stenosis. Taking the highest grade of stenosis of the three parameters produces a sensitivity of 100% for the detection of greater than 50% and greater than 80% stenosis with specificity of 66 and 90%, respectively. The performance of satisfactory B‐mode imaging against digital subtraction angiography (DSA) was very encouraging. When the B‐mode stenosis measurement showed a normal ICA, the positive predictive value (PPV) of the DSA being normal was 94%. When the B‐mode stenosis measurement was 35% or less, the PPV of the DSA stenosis being 35% or less was 93%. These excellent results support the use of good quality B‐Mode NASCET style stenosis measurement as the initial ultrasound measurement, with Doppler ultrasound only being performed when the B‐mode stenosis measurement is greater than 35% or if the B‐mode image is unsatisfactory. This approach would save considerable time enabling better utilization of ultrasound resources.
Systemic to portal shunting following vena cava obstruction: Computed tomography and venographic appearances
Authors: Teh LG , Schie G van , Cameron D , Sieunarine K
Published: March 2003

Obstruction of the inferior or superior vena cava normally leads to the formation of a well‐described and consistent pattern of collateral venous pathways. We present the angiographic and CT features of the unusual development of systemic to portal venous shunting in two cases with central vein obstruction.
Guide to the radiology report
Authors: Ridley Lloyd J
Published: March 2003

The radiology report is an important, but often neglected, aspect of radiology. Suggestions on style and content are discussed. These include: (i) concise reporting; (ii) correct English; (iii) present tense for current reporting; (iv) reading the request with care; (v) recognizing the recipients; (vi) being aware of unintended readers; (vii) stating the most important findings; (viii) where possible, quantifying findings; (ix) reporting some incidental findings; (x) avoiding a tale of woe; (xi) summarizing a longer report; (xii) using inductive logic; (xiii) using non‐radiological input (such as probability) if pertinent; (xiv) discussing minor findings in the body of the report; (xv) taking care in suggesting further investigations; (xvi) ensuring the conclusion and recommendations are clear; (xvii) considering alternate diagnoses; and (xviii) considering if a dictated report is sufficient.
Acute pulmonary schistosomiasis
Authors: Salanitri John , Stanley Peter , Hennessy Oliver
Published: March 2003

Acute pulmonary schistosomiasis occurs in non‐immune hosts, particularly visitors to regions where Schistosoma species are endemic. While radiological findings of acute pulmonary schistosomiasis might resemble neoplastic or granulomatous disease, an appropriate travel history might suggest the diagnosis. With rising popularity of travel to Africa and South‐East Asia, the incidence of acute pulmonary schistosomiasis can be expected to increase. We describe a case of acute pulmonary schistosomiasis occurring in an Australian returning from Lake Malawi, Sub‐Saharan Africa.
ACTIVATION OF VASCULAR SMOOTH MUSCLE K+ CHANNELS BY ENDOTHELIUM‐DERIVED RELAXING FACTORS
Authors: Waldron GJ , Cole WC
Published: March 2003

1. Endothelium‐derived relaxing factors (EDRF), including nitric oxide (NO), prostacyclin (PGI2) and an as yet uncharacterized endothelium‐derived hyperpolarizing factor (EDHF), are now recognized to induce relaxation of vascular smooth muscle, in part via the activation of K+ channels.

2. Experiments using selective K+ channel blockers, including iberiotoxin (IbTX), glibenclamide, apamin and 4‐aminopyridine (4‐AP) to inhibit endothelium‐induced relaxation suggest that more than one type of K+ channel may be involved, depending on the species and tissue, including: (i) large conductance Ca2+‐activated (BKCa) channels; (ii) ATP‐sensitive (KATP) channels; (iii) small conductance Ca2+‐activated (SKCa) channels; and (iv) voltage‐gated (Kv) K+ channels.

3. Recent observations suggest a role for Kv channels in some vessels based on a sensitivity of NO‐ and PGI2‐mediated relaxations to 4‐AP, as well as a complete suppression of EDHF‐ dependent relaxation by a combination of charybdotoxin (ChTX) and apamin but not IbTX and apamin.

4. The molecular identity of the K+ channels affected by EDRF is not well characterized. Recently, findings indicate that the pore‐forming α‐subunit tetramers of vascular smooth muscle BKCa channels are due to the expression of the so‐called Slo channel gene. The identities of the KATP, SKCa and Kv channels involved in endothelium‐dependent vasodilation are not known.

5. The component of whole‐cell Kv current affected by PGI2 may be due to slowly inactivating, 4‐AP‐sensitive, 15 pS delayed‐rectifier K+ channels (KDR); the activity of these channels in vascular myocytes is increased by forskolin and protein kinase A (PKA) and rabbit portal vein Kv1.5 pore‐forming α‐subunits, which appear to be a component of native KDR current and possess consensus phosphorylation sequences for PKA.
ENDOTHELIN RECEPTOR DISTRIBUTION AND FUNCTION IN THE AIRWAYS
Authors: Henry PJ
Published: March 2003

1. Within the lung, endothelin (ET)‐1 is synthesized and released by airway epithelial and vascular endothelial cells, as well as by inflammatory cells, such as macrophages. Following release, ET‐1 can modulate the activities of a wide range of different cell types within the lung through the stimulation of specific endothelin ETA and ETB receptors. The present review focuses on recent advances in our understanding of the distribution and function of endothelin receptors within the airway wall and peripheral lung and, where possible, particular attention is given to studies using human cells, tissues and subjects.

2. The highest densities of endothelin receptors within the lung appear to be associated with airway smooth muscle and the alveolar septae. The relative proportions of ETA and ETB receptors present within these tissues display marked interspecies differences, although ETB receptors predominate at both sites in human lung.

3. The effects induced by ET‐1 within the lung include contraction and proliferation of airway smooth muscle, facilitation of cholinergic neurotransmission, mucous gland hypersecretion, microvascular leakage and inflammatory cell influx and activation. There is also evidence that a proportion of ETB receptors in the pulmonary microvasculature act as clearance receptors for endothelin‐1.

4. Evidence to date suggests that changes in the endothelin content within the airway wall, conceivably associated with lung pathology, are likely to have profound effects on the function of many cells within the lung.
PARTITIONING LUNG AND PLASMA PROTEINS: CIRCULATING SURFACTANT PROTEINS AS BIOMARKERS OF ALVEOLOCAPILLARY PERMEABILITY‡
Authors: Doyle Ian R , Nicholas Terence E , Bersten Andrew D
Published: March 2003

1. The alveolocapillary membrane faces an extraordinary task in partitioning the plasma and lung hypophase proteins, with a surface area approximately 50‐fold that of the body and only 0.1–0.2 μm thick.

2. Lung permeability is compromised under a variety of circumstances and the delineation between physiological and pathological changes in permeability is not always clear. Although the tight junctions of the epithelium, rather than the endothelium, are regarded as the major barrier to fluid and protein flux, it is becoming apparent that the permeability of both are dynamically regulated.

3. Whereas increased permeability and the flux of plasma proteins into the alveolar compartment has dire consequences, fortuitously the flux of surfactant proteins from the airspaces into the circulation may provide a sensitive means of non‐ invasively monitoring the lung, with important implications for treatment modalities.

4. Surfactant proteins are unique in that they are present in the alveolar hypophase in high concentrations. They diffuse down their vast concentration gradients (approximately 1:1500–7000) into the circulation in a manner that reflects lung function and injury score. Surfactant proteins vary markedly in size (approximately 20–650 kDa) and changes in the relative amounts appear particularly diagnostic with regard to disease severity. Alveolar levels of surfactant proteins remain remarkably constant despite respiratory disease and, unlike the flux of plasma proteins into the alveolus, which may reach equilibrium in acute lung injury, the flux of surfactant proteins is unidirectional because of the concentration gradient and because they are rapidly cleared from the circulation.

5. Ultimately, the diagnostic usefulness of surfactant proteins as markers of alveolocapillary permeability will demand a sound understanding of their kinetics through the vascular compartment.
NITRIC OXIDE, ENDOTHELIN AND NEPHRON TRANSPORT: POTENTIAL INTERACTIONS
Authors: Plato Craig F , Garvin Jeffrey L
Published: March 2003

1. Nitric oxide (NO) is produced and/or regulates transport in many segments of the nephron, including the proximal convoluted tubule, proximal straight tubule, thick ascending limb, cortical collecting duct and inner medullary collecting duct.

2. Endothelin (ET) is produced and/or regulates nephron transport in many of the segments that produce NO or in which transport is regulated by NO.

3. Four potential interactions between NO and ET are: (i) NO and ET may be antagonistic; (ii) NO and ET may be complementary; (iii) the effects of ET may be mediated via NO; and (iv) the effects of NO may be mediated by ET.

4. In conclusion, direct studies examining the interactions between NO and ET are few. However, circumstantial evidence suggests there may be many interactions between NO and ET in the regulation of nephron transport. In particular, recent data obtained from the collecting duct and thick ascending limb indicate that the effects of ET may be mediated by the production of NO and stimulation of its second messenger cascade.
EFFECTS OF VOLUNTARY EXERCISE AND L‐ARGININE ON THROMBOGENESIS AND MICROCIRCULATION IN STROKE‐PRONE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Noguchi Takanori , Sasaki Yasuto , Seki Junji , Giddings John C , Yamamoto Junichiro
Published: March 2003

1. The preventive effects of exercise and L‐arginine intake on hypertension and thrombosis in stroke‐prone spontaneously hypertensive rats (SHRSP) were studied.

2. Stroke‐prone spontaneously hypertensive rats were divided into three groups: (i) the control, sedentary group; (ii) the exercise group, which was allowed to run voluntarily on running wheels; and (iii) the L‐arginine intake group, which was given 2.25%L‐arginine solution for 8 weeks from 4 to 12 weeks of age. In the control group, one rat died from stroke and symptoms of stroke were observed in the remaining animals. Similar symptoms were recorded in one rat of the exercise group, but not in the L‐arginine group.

3. Blood pressure increased in the control group and this increase was suppressed significantly in the exercise and L‐arginine groups. Thrombotic potential in cerebral vessels was the lowest at 4 weeks in all groups and was increased significantly at 12 weeks in the control group, but not in the exercise and L‐arginine groups. Plasma concentrations of NO2/NO3 were lower in all animals at 12 weeks compared with those at 4 weeks. This reduction was significantly less marked in the L‐arginine group. Cerebral arterioles in control rats at 12 weeks of age were significantly smaller in diameter than those at 4 weeks and these changes were less pronounced in the exercise and L‐arginine groups.

4. The results provide clear evidence for the beneficial effects of L‐arginine intake and voluntary exercise in mechanisms related to hypertension, thrombosis and stroke.
COMPARISON OF OSCILLOMETRIC BLOOD PRESSURE MEASUREMENTS AT THE WRIST WITH AN UPPER‐ARM AUSCULTATORY MERCURY SPHYGMOMANOMETER
Authors: Rogers Penny , Burke Valerie , Stroud Pat , Puddey Ian B
Published: March 2003

1. Oscillometric devices for blood pressure (BP) measurement at the wrist are becoming more widely used in clinical practice. However, systematic comparisons with standard auscultatory BP measurement at the brachial artery are scarce. Therefore, we compared two such devices, the Boso‐Mediwatch (Bosch & Sohn GmbH U. Co., Jungingen, Germany) and the Omron R3 (Omron Corp., Tokyo, Japan), with upper‐arm auscultatory mercury sphygmomanometry.

2. In 20 normotensive subjects and 20 treated hypertensive subjects, the Boso‐Mediwatch was applied to the left wrist by observer 1 and was compared with mercury sphygmomanometry of the right upper arm by observer 2. Each observer swapped sides and the procedure was repeated. The Boso‐Mediwatch was then applied to the right wrist by observer 1 and was compared with mercury sphygmomanometry of the left upper arm by observer 2. Each observer once again swapped sides and the procedure was repeated. An identical protocol was followed for the Omron R3 in a further 20 treated hypertensive subjects and 20 normotensive subjects.

3. There were no significant differences between observers or left versus right arm for either oscillometric device or when measurements were performed by mercury sphygmomanometry. In normotensive subjects, the Boso‐Mediwatch readings were higher than mercury sphygmomanometer readings, with mean differences (95% confidence intervals) of 3.9 (0.1, 7.6; P = 0.045) and 7.0 mmHg (4.7, 9.2; P < 0.001) for systolic and diastolic BP, respectively. In hypertensive subjects, the Boso‐Mediwatch readings were lower for systolic BP (mean difference – 6.0 mmHg (– 11.6, – 0.3; P = 0.04) but were higher for diastolic BP (mean difference 3.8 mmHg (1.4, 6.3; P < 0.01).

4. In normotensive subjects, the Omron R3 readings were higher, with mean differences of 3.2 (0.6, 5.8; P = 0.018) and 4.2 mmHg (1.6, 6.7; P = 0.003) for systolic and diastolic BP, respectively. In hypertensive subjects, the Omron R3 readings were lower for both systolic and diastolic BP (mean differences: – 5.8 (– 8.8, – 2.8; P = 0.001) and – 5.5 (– 9.3, – 1.6; P = 0.008), respectively).

5. For the Boso‐Mediwatch, weighted least products analysis confirmed the presence of both fixed and proportional error for systolic BP but not for diastolic BP. For the Omron R3, fixed or proportional error was not detected for either systolic or diastolic BP.

6. These wrist oscillometric devices, although offering portability and convenience, give BP measurements that frequently differ substantially (by at least 5 mmHg) from readings simultaneously measured at the upper arm by a mercury sphygmomanometer. The magnitude and direction of differences detected are dependent on both the device used and the underlying level of BP.
LIPOCORTIN‐1 PRESERVES MYOCARDIAL RESPONSIVENESS TO β‐ADRENERGIC STIMULATION IN RAT PAPILLARY MUSCLE
Authors: Ritchie Rebecca H , Sun Xiaolu , Dusting Gregory J
Published: March 2003

1. During septic shock, myocardial contractile dysfunction is accompanied by the release of cytokines and enhanced production of nitric oxide, and the contractile dysfunction is prevented by glucocorticoids.

2. Myocardial dysfunction was induced in vitro by incubation of rat papillary muscle for 15 h with endotoxin (lipopolysaccharide, LPS) and interferon‐γ (IFN‐γ).

3. Both baseline contractile function and inotropic responsiveness to isoprenaline were markedly reduced by the combination of LPS plus IFN‐γ.

4. Lipocortin‐1 (LC‐1) is induced by glucocorticoids, and LC‐12–26, its N‐terminal fragment, protected the papillary muscle inotropic responsiveness to isoprenaline, but did not affect the decline in baseline contractile function induced by LPS plus IFN‐γ.

5. The mechanisms of this protective action need to be explored further, but LC‐1 may prove to be a novel cardioprotective agent for the management of septic shock.
FROM ANIMAL MODELS TO HUMANS
Authors: Nabika Toru
Published: March 2003

1. Essential hypertension is a mixture of several ‘hypertensions’ with different aetiologies. Analyses of inbred rat models of hypertension have so far provided several candidate loci and genes that may be responsible for hypertension. Among them, SA and α‐adducin were evaluated in humans both by linkage and association analyses. However, the results are still controversial. Two major reasons may account for these discrepancies.

2. Heterogeneity of human essential hypertension still keeps us from comprehensive conclusions. Comparative analysis of more than one homogeneous population may be necessary to overcome this problem.

3. As in the case of SA, a lack of information on the physiological or pathophysiological roles of candidate genes makes it difficult to evaluate them in human hypertension. Efforts to find good intermediate phenotypes regulated directly by putative hypertension genes are essential to dissect a heterogeneous mixture of ‘hypertensions’. In this context, physiological studies on congenic strains as well as conventional rat models will become important.
BAD GENES, GOOD PEOPLE, ASSOCIATION, LINKAGE, LONGEVITY AND THE PREVENTION OF CARDIOVASCULAR DISEASE
Authors: Luft Friedrich C
Published: March 2003

1. Cardiovascular disease, the most common cause of death, is the product of risk factors such as hypertension, lipid disturbances, diabetes mellitus, left ventricular hypertrophy and nicotine smoking, all of which are influenced by genetic variance. Thus, genes that influence these factors have a considerable bearing on longevity.

2. Although mortality rates increase exponentially with increasing age, an interesting tendency towards a plateau occurs, suggesting that old individuals are somewhat protected from the propensity to die. This phenomenon is difficult to explain.

3. One possibility is a model of repair, in which certain alleles exert a beneficial influence at an advanced age.

4. An alternative explanation might be a mutation that exerts both negative and positive effects.

5. The insertion/deletion (I/D) polymorphism in the angiotensin‐converting enzyme (ACE) gene exerts was observed to have an effect on heart size. The D allele was linked to a greater heart size, compared with the I allele in a modified sib‐pair model. This potentially deleterious effect was counterbalanced by linkage of the D allele to increased heart rate variability, which is potentially a beneficial attribute. Furthermore, in a cohort of the German population over age 80 years, it was observed that the D allele occurred at a frequency higher than would be expected.

6. The present study discusses the hypothesis that the ACE gene I/D polymorphism may be a genetic variant with both negative and positive effects.
PHYSICAL AND BIOCHEMICAL PREDICTORS OF DEATH IN AN AUSTRALIAN ABORIGINAL COHORT
Authors: McDonald Stephen P , Wang Zhiqiang , Hoy Wendy E
Published: March 2003

1. Predictors of natural and cardiovascular death were examined in a cohort from a remote Australian Aboriginal community with high mortality rates. The cohort was marked by high prevalences of diabetes (17%), hypertension (19% diastolic blood pressure (BP) > 90 mmHg), obesity (16% body mass index (BMI) > 30), albuminuria (26% albumin/creatinine ratio (ACR) ≥ 34 g/mol) and renal failure (26% calculated glomerular filtration rate < 80 mL/min).

2. Relationships between baseline characteristics and subsequent mortality were examined using multivariate techniques.

3. Albuminuria, diabetes and hypertension (but not smoking dyslipidaemia or obesity) were all markers for increased risk of natural and especially of cardiovascular death. Age‐ and sex‐adjusted relative risk [95% CI] of natural deaths were 4.3 [1.9–9.5] for overt albuminuria (ACR ≥ 34, 3.2 (range 1.6–6.5) for diastolic BP ≥ 100 and 3.7 (range 1.5–8.9) for diabetes.

4. The relative risk associated with albuminuria was independent of diabetes and hypertension. Albuminuria was more common than either diabetes or hypertension and represents a target for intervention to reduce not only progression to renal disease, but also overall mortality.
Gender‐Specific Inhibition of Ca2+ Entry Mechanisms of Arterial Vasoconstriction by Sex Hormones
Authors: Crews Janice K , Khalil Raouf A
Published: March 2003

1. The clinical observation that hypertension is more common in males and postmenopausal women than in premenopausal women suggests vascular protective effects of female sex hormones, including hormone‐mediated inhibition of vascular tone. The purpose of the present study was to investigate whether the Ca2+ mobilization mechanisms of vascular smooth muscle contraction are modified by gender and sex hormones.

2. Active stress and [45Ca2+] influx were measured in de‐endothelialized aortic strips isolated from intact and gonadectomized male and female Sprague‐Dawley rats. In normal Krebs’ (2.5 mmol/L Ca2+), both phenylephrine (Phe; 10–5 mol/L) and membrane depolarization by 96 mmol/L KCl increased active stress to 15.5±1.3 × 10
3 and 14.8±1.2 × 10
3 N/m
2, respectively, and Ca2+ influx to 28.4±1.4 and 32.3±1.5 μmol/kg per min, respectively, in intact males. The Phe‐ and KCl‐induced stress and Ca2+ influx were significantly reduced in intact females. Gonadectomy was associated with no significant changes in the Phe‐ and KCl‐induced stress and Ca2+ influx in males, but was associated with significant enhancement in females. In Ca2+‐free (2 mmol/L EGTA) Krebs’, stimulation of intracellular Ca2+ release by Phe or caffeine (25 mmol/L) caused a transient contraction that was not significantly different in all groups of rats.

3. Exogenous application of 17β‐oestradiol, progesterone or testosterone to aortic strips caused concentration‐dependent inhibition of Phe‐ and KCl‐stimulated contractions and Ca2+ influx. 17β‐Oestradiol was the most effective hormone and its relative potency was intact males, castrated males and ovariectomized females > intact females.

4. Thus, vascular reactivity and Ca2+ entry in aortic smooth muscle are reduced in the presence and enhanced in the absence of female gonads. Both male and female sex hormones cause vascular relaxation, mainly by inhibiting Ca2+ entry, with oestrogen being the most effective, particularly in the absence of female gonads. The results suggest that a cellular mech‐ anism of oestrogen‐induced vascular relaxation involving inhibition of Ca2+ entry into vascular smooth muscle is gender dependent.
Changes In Cell Volume Induced By Ion Channel Flux In Guinea‐Pig Cardiac Myocytes
Authors: Sasaki N , Takano M , Mitsuiye T , Noma A
Published: March 2003

1. The cell width of guinea‐pig ventricular myocytes was measured using an optic device during patch‐clamp experiments and the relationship between the ion channel flux and changes in cell volume was examined.

2. On superfusing myocytes with 50, 70, 150 and 200% osmotic solutions, the relative cell width changed to 121.1 (n = 4), 110.8 (n = 27), 87.1 (n = 6) and 82.6% (n = 6) of control, respectively. Changes in cell length were less than 2% in these test solutions.

3. The application of 300 nmol/L isoprenaline to myocytes swollen in the 70% hypotonic solution induced a decrease in cell width from 111.2 to 106.2% (n = 13). The application of isoprenaline in the isotonic solution also induced a decrease in cell width to 96.5% in eight of 13 cells. A membrane depolarization of 2–4 mV accompanied the isoprenaline‐induced decrease in volume. In the remaining five cells, neither an obvious isoprenaline‐induced decrease in volume nor membrane depolarization was observed. Under ruptured whole‐cell voltage clamp conditions, the activation of inward isoprenaline‐induced Cl− current decreased cell width.

4. Cell width was seen to either decrease or increase when a large outward or inward K+ current, respectively, was induced by shifting the holding potential or by applying 200 μmol/L pinacidil. Under gramicidin‐perforated whole‐cell clamp conditions, the cell width did not change, even when a large inward K+ current was induced.

5. When the test solution was applied to half of an elongated myocyte by using a micropipette, the cell width increased or decreased in the part exposed to the hypotonic or hypertonic test solutions, respectively. In contrast, in the other half of the elongated myocyte, the cell width responded in the opposite direction.

6. It is concluded that a continuous ionic flux through ion channels is capable of inducing changes in cell volume by generating a localized osmotic gradient across the cardiac sarcolemma.
NBPA: A CEREBRAL ISCHAEMIC PROTECTIVE AGENT
Authors: Zhang JUNTIAN , Peng XINQI , Wei GUO , Su DAN
Published: March 2003

1. NBPA is a derivative of 3‐n‐butylpathalide isolated from Apium granolens Linn.

2. At concentrations ranging from 6 × 10–6 to 10–6 mol/L, NBPA inhibited the L‐type calcium current in guinea‐pig myocardial cells and cultured human neuroblastoma cells.

3. At 10–6 mol/L, NBPA markedly inhibited calcium‐ dependent and ‐independent release of glutamate from synaptosomes.

4. The [31P] nuclear magnetic resonance spectrum has shown that pretreatment with NBPA at 15 mg/kg, i.p., improved energy metabolism.

5. In situ hybridization has shown that 10 and 20 mg/kg, i.p., NBPA prior to cerebral artery occlusion can accelerate the expression of heat shock protein 70 mRNA and inhibit c‐fos mRNA expression.

6. It has been shown that NBPA decreases the nitric oxide content and bc nitric oxide synthase (NOS) activity in the global cerebral ischaemia–reperfusion model in rats. In addition, it has been shown that NBPA significantly inhibits the expression of inducible NOS protein.
ENDOTHELIN AND THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS: A DECADE OF ENDOTHELIN RESEARCH
Authors: Mortensen Luke H
Published: March 2003

1. During the past decade, extensive investigation of the endothelin (ET) system, primarily characterized by its potent vasoactive peptide element ET‐1, has suggested a prominent role for this humoral agent and its isopeptides in cardiovascular and neural regulation.

2. Major elements of this system, including its peptide isoforms, converting enzymes involved in their formation and metabolism, as well as multiple receptor subtypes, have been localized within various components of the cardiovascular system and the central and peripheral nervous systems.

3. An understanding of the possible roles for the ET system in neural regulation and development has progressed over the past several years; most notable is the influence of ET on the central control of cardiovascular function and sympathetic tone.

4. The present concentrated review of ET and the central and peripheral nervous systems is presented to introduce the other papers within this symposium by briefly describing the presence and influence of components of this unique peptide system within pertinent physiological structures involved in cardiovascular, adrenal, sympathetic and enteric developmental function.
ENDOTHELIN AND THE DEVELOPMENT OF THE ENTERIC NERVOUS SYSTEM
Authors: Gershon Michael D
Published: March 2003

1. The enteric nervous system (ENS) is derived from cells that migrate to the bowel from the neural crest. These émigrés must find the gut, reach their correct locations within its wall and finally differentiate as neurons or glia.

2. Because the crest‐derived precursor population is multipotent when it colonizes the bowel, the enteric micro‐environment plays a prominent role in ENS development.

3. A number of molecules of the enteric micro‐environment have been found to promote the development of neurons.

4. However, endothelin (ET)‐3 appears to be different from any of these in that its role appears to be to prevent premature neuronal differentiation.

5. By activating ETB receptors, ET‐3 inhibits the differentiation of crest‐derived cells into neurons and promotes the development of smooth muscle.

6. The effect of ET‐3 on smooth muscle down‐regulates the secretion of laminin‐1, which is a promoter of the formation of neurons.

7. In the absence of ET‐3/ETB, crest‐derived cells develop as neurons and, thus, cease migrating before they complete the colonization of the bowel. This premature development leaves the terminal colon aganglionic.
Anti‐remodelling drugs for the treatment of asthma: requirement for animal models of airway wall remodelling
Authors: Fernandes Darren J , Xu Kai‐Feng , Stewart Alastair G
Published: March 2003

1. Airway wall remodelling (AWR), the structural change induced by acute and chronic inflammation in the airways, may be one of the most significant and difficult to reverse components of progressive asthma.

2. The mechanisms underlying the development of AWR are not known. Studies of only the most superficial wall structures of large airways can be conducted in living humans because of the degree of invasiveness required to measure airway structural changes. These studies reveal that currently available agents do not fully prevent or reverse AWR. Thus, animal models of asthma pathology may be used to assess the contribution of particular mediators and cells to the development of remodelling and may also prove to be useful in the initial screening of potential anti‐remodelling agents.

3. Airway hyperresponsiveness and AWR stimulated by chronic antigen challenge in previously disease‐free animals is the most popular of the currently used models of remodelling. Other animal models include the use of specially bred strains with intrinsic airway hyperresponsiveness or animals that have a naturally occurring asthma‐like disease, such as cats with feline asthma or horses with heaves. The further development of animal models of AWR will facilitate the development of novel anti‐asthma therapies.
Sodium Sensitivity And Sympathetic Nervous System In Hypertension Induced By Long‐Term Nitric Oxide Blockade In Rats
Authors: Yuasa Shigekazu , Li Xiuping , Hitomi Hirofumi , Hashimoto Mayuko , Fujioka Hiroshi , Kiyomoto Hideyasu , Uchida Kouichi , Shoji Tetsuo , Takahashi Norihiro , Miki Shigehiro , Miyatake Akira , Mizushige Katsufumi , Matsuo Hirohide
Published: March 2003

1. Pharmacological inhibition of nitric oxide (NO) synthesis is known to produce acute and chronic hypertension in many animal species, but the underlying mechanisms mediating the hypertension are not completely understood. In particular, the pathogenetic roles of sodium sensitivity and the sympathetic nervous system in this model of hypertension are controversial. The present study was designed to test the hypothesis that long‐term administration of the NO synthesis inhibitor NG‐nitro‐L‐arginine methyl ester (L‐NAME) to male Sprague‐Dawley rats would produce a sodium‐sensitive hypertension and that the enhanced activity of the sympathetic nervous system in this type of hypertension contributes to the sodium sensitivity.

2. NG‐Nitro‐L‐arginine methyl ester was added to drinking fluid for 8 weeks at a concentration of 16 mg/dL. Rats received tap water for the first 4 weeks of the study and were then divided into two groups and placed on either a normal or high sodium intake (ingestion of either tap water or 0.9% NaCl, respectively). Awake systolic blood pressure was measured by the tail‐cuff method every week. Urinary excretion rates of the stable NO metabolites and catecholamines during NO synthesis inhibition were examined.

3. Long‐term administration of L‐NAME produced a marked and sustained elevation in arterial pressure without altering urine flow, or sodium excretion rate. NG‐Nitro‐L‐arginine methyl ester‐induced hypertension was accompanied by a decreased urinary excretion of the stable NO metabolites NO2– and NO3– and was aggravated when rats drank 0.9% NaCl in place of tap water. Urinary excretion of adrenaline and noradrenaline, but not dopamine, in L‐NAME‐treated rats increased significantly within the first week of the study compared with control rats. L‐Arginine (2 g/dL in drinking fluid) completely reversed the elevation of arterial pressure as well as the decrease in urinary NO2– and NO3– excretion and the increased urinary excretion of catecholamines associated with L‐NAME treatment by 3 weeks of concomitant administration.

4. These results suggest that long‐term inhibition of NO synthesis produces a sodium‐sensitive hypertension and that changes in sympathetic nerve activity may, at least in part, contribute to the sodium sensitivity in this type of hypertension.