bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Study of the Effect of Long-Term Topical Application of Retinaldehyde (0.05%) on the Development of Actinic Keratosis
Authors: Campanelli Alexandre , Naldi Luigi
Published: April 2003

Background: The role of topical retinoids on photocarcinogenesis is still unclear. Retinaldehyde is a natural metabolite of vitamin A used as a cosmetic product. Its effect on actinic keratoses has not been studied to date. Objective: To study the incidence of actinic keratoses during long-term application of retinaldehyde in order to evaluate a possible chemoprophylactic effect. Methods: We conducted a retrospective study on 61 patients who had applied retinaldehyde on photoexposed body areas for a period ranging from 6 to 142 months. We counted the total number of actinic keratoses and cutaneous tumors that appeared over the time of exposure to retinaldehyde. Results: The epidemiological characteristics of actinic keratoses were not modified by the application of retinaldehyde. Irregular application as compared to regular application of retinaldehyde was not associated with a change in the risk of actinic keratoses, suggesting that continuous use is not associated per se with a higher risk of actinic keratoses. Conclusion: With the statistical power limitation of this study, retinaldehyde applied alone does not appear to have prophylactic effects on the development of actinic keratoses. The design adopted is feasible to study the safety of cosmetic products applied for a long period of time.
Monoclonal Rearrangement of the T Cell Receptor Gamma-Chain in Lichenoid Pigmented Purpuric Dermatitis of Gougerot-Blum Responding to Topical Corticosteroid Therapy
Authors: Lor P. , Krueger U. , Kempf W. , Burg G. , Nestle F.O.
Published: April 2003

Lichenoid pigmented purpuric dermatitis of Gougerot-Blum belongs to a group of closely related disorders which are termed pigmented purpuric dermatoses. It clinically manifests itself with grouped lichenoid papules in association with purpuric lesions. We report a case of lichenoid pigmented purpuric dermatitis of Gougerot-Blum with a heavy band-like CD4-positive lymphocytic infiltrate and clonal rearrangements of the γ-chain of the T cell receptors as detected by polymerase chain reaction/denaturing gradient gel electrophoresis. Monoclonal expansion of T cells in combination with certain histological features of mycosis fungoides (MF) might support a biological relationship between lichenoid pigmented purpuric dermatitis of Gougerot-Blum and MF. However, prompt clinical response to topical steroid therapy supports the benign clinical nature of our case.
Cutaneous Larva migrans Associated with Löffler’s Syndrome
Authors: Schaub Nathalie A. , Perruchoud André P. , Buechner Stanislaw A.
Published: April 2003

We describe a patient who was admitted to hospital after returning from a holiday in Thailand with coronary artery disease and ventricular tachycardia. As an incidental finding, the routine chest radiography showed migratory pulmonary infiltrates. A peripheral blood smear showed eosinophilia. Physical examination revealed multiple, slightly raised, erythematous, serpentine tracks on the buttocks. A clinical diagnosis of larva migrans was made, and the patient was treated with oral albendazole 400 mg on 5 consecutive days and a single dose of oral praziquantel 3,600 mg. By the end of treatment, most of the cutaneous lesions, the pulmonary infiltrates and the peripheral eosinophilia had resolved. The final diagnosis was larva migrans associated with Löffler’s syndrome.
Intra- and Interexaminer Variability and Validity of Laser Fluorescence and Electrical Resistance Readings on Root Surface Lesions
Authors: Wicht Michael J. , Haak Rainer , Stützer Hartmut , Strohe Daniel , Noack Michael J.
Published: April 2003

The purpose of this study was to investigate the validity and reproducibility of laser fluorescence and electrical resistance readings on root carious lesions. One hundred and three freshly extracted human teeth with various forms of natural root caries were investigated by 6 operators using the laser fluorescence device DIAGNOdent (DD) and the Electronic Caries Monitor (ECM III). As a reference, a caries-free root area of each tooth was also examined. Specimens were classified as to colour, surface texture and cavitation depth. Teeth were sectioned through the centre of the lesion and prepared for polarising light microscopy. Histological depth of the lesions was defined as the distance between the surface and zone of translucency. Depths ranged from 0.1 to 3.1 mm. Statistical analysis of the interexaminer reproducibility revealed a significant correlation (Kendall’s W) for DD measurements of 0.85 and 0.76 for ECM readings. Moderate correlation between the histological depth and DD (rs = 0.45) or ECM scores (rs = –0.48) could be demonstrated. Electrical resistance readings revealed a positive correlation (rs = 0.43) with the thickness of the remaining dentine, whereas this was negative for laser fluorescence readings (rs = –0.43). However, scatter plots suggested that most lesions had very low resistance. This investigation suggests that laser fluorescence and electrical conductance measurements can be obtained reproducibly by different operators and correlate moderately with histological lesion depth and remaining thickness of the dentine bridge.
Primary Adenocarcinoma Arising from a Paraurethral Cyst in a Female Patient
Authors: Nagano Masafumi , Hasui Yoshihiro , Ide Hisamitsu , Itoi Tatsunori , Takehara Toshiyuki , Osada Yukio
Published: April 2003

A very rare case of primary adenocarcinoma arising from a paraurethral cyst in a 63-year-old woman is reported. Initially she was diagnosed as having a simple paraurethral cyst because of absent communication with the urethra. The resected paraurethral cyst was histologically associated with adenocarcinoma. We also performed chemotherapy composed of methotrexate, vinblastine, Adriamycin and cisplatin because of lymph node metastasis. Our treatment, however, was not effective and the patient died of systemic metastases.
Expression of p16 and Cyclin D1 in Bladder Cancer and Correlation in Cancer Progression
Authors: Yang Ching-Chiang , Chu Kang-Chu , Chen Huey-Yi , Chen Wen-Chi
Published: April 2003

Introduction: Gene p16 encodes a cyclin-dependent kinase inhibitor which functions to regulate cyclin D1, cell cycle progression and malignancies. The relationship between p16 and cyclin D1 is thought to alter bladder cancer formation and tumor progression. We aimed to investigate the expression of p16 and cyclin D1 genes in order to evaluate their clinical significance in bladder cancer. Materials and Methods: Tissue samples from 67 patients with transitional cell carcinoma were examined with an immunohistochemical stain for the expression of p16 and cyclin D1 genes. The expression rate was compared to 12 normal urinary bladder mucosa samples obtained from transurethral surgery from noncancer patients. Results: The results revealed significant differences between normal bladder mucosa (100%) and cancer tissue (40.3%) for the positive staining of p16 protein (p < 0.001), while positive staining for the cyclin D1 protein in the patient group (67.2%) was significantly higher (p = 0.003) than that in the control group (16.7%). With the progression of tumor grade and clinical staging the positive rate of p16 gene expression increased, whereas, that of cyclin D1 decreased. Expression of the p16 gene in the non-invasive group was greater than that in the invasive group and a lower expression rate of the cyclin D1 gene in the non-invasive group compared to the invasive group. Conclusions: The results revealed that expression of the p16 gene is inversely proportional to the expression of the cyclin D1 gene. Therefore, abnormal expression of the p16 and cyclin D1 genes play important roles in tumorigenesis and tumor progression.
p21 and p53 Immunostaining and Survival following Systemic Chemotherapy for Urothelial Cancer
Authors: Jankevicius Feliksas , Goebell Peter , Kushima Mayumi , Schulz Wolfgang A. , Ackermann Rolf , Schmitz-Dräger Bernd J.
Published: April 2003

Introduction: Induction of apoptosis and regulation of cell cycle checkpoints are important mechanisms of chemotherapy-induced cell death. The intact p53 tumor suppressor gene is required for efficient activation of apoptosis. The WAF1/p21 gene is transcriptionally activated by p53 and mediates p53-dependent G1 arrest following DNA damage. Therefore, p53 and p21 expression might be related to urothelial tumor response to cytotoxic therapy. Methods: In a retrospective study, archival tumor specimens from 60 patients treated with cisplatinum-based systemic chemotherapy for locally advanced and/or metastatic urothelial cancer were immunohistochemically stained for p53 and p21. Response to chemotherapy and overall survival were correlated with the results of immunohistochemistry. Results: Thirty-five tumors (58%) of the 60 specimens showed p53 accumulation, and 25 (42%) expressed detectable p21. No association between p53 accumulation and expression of p21 was observed. Correlation with complete and partial remissions following inductive chemotherapy (n = 39) demonstrated that patients with intact p53 responded significantly better (70 vs. 31%, p < 0.05). However, no difference in overall survival was observed with regard to p53 immunostaining (median 12 and 17 months for p53-positive and p53-negative tumors, respectively). The p21 expression was related neither to response nor to overall survival following inductive chemotherapy. In patients receiving adjuvant chemotherapy after cystectomy (n = 21), the outcome was correlated with the immunohistochemistry results. While the survival times for p53-negative patients (60 months) and p53-positive patients (23 months) did not translate into a significant difference, the median overall survival for patients with p21-positive or p21-negative tumors (60 vs. 21 months) was significantly different (p < 0.005). Conclusions: The short survival of patients with metastatic bladder cancer may conceal putative differences between different prognostic groups in smaller trials. In contrast, p21 immunohistochemistry appears to be of prognostic value in patients receiving systemic adjuvant chemotherapy for locally advanced bladder cancer. The observations made in this retrospective study in a limited number of patients warrant further investigation on the correlation between G1/S checkpoint regulatory genes and adjuvant chemotherapy in larger prospective studies.
Genioglossal Advancement – A Simple Surgical Procedure for Sleep Apnea
Authors: Nagler R.M. , Laufer D.
Published: April 2003

Although the use of a standard nasal continuous positive airway pressure device to combat obstructive sleep apnea is often effective, it is neither curative nor universally well tolerated. Thus, surgical intervention is often inevitable. We describe a simple, conservative surgical procedure performed on a patient with profound mandibular retrognathia (dolichofacial type), accompanied by sleep apnea. The procedure resulted in a significant pharyngeal airway enlargement of 53 and 87% at the mandible angle and hyoid bone levels, respectively, increased oxygen saturation, reduction in the respiratory disturbance index by 50%, and improved sleep quality. We present a procedure for patients whose sleep apnea is due to extensive mandibular retrognathism with concomitant retrolingual narrowing and collapse.
Preconditioning Hyperthermia Inhibits Restitution of Isolated Guinea Pig Gastric Mucosa
Authors: Oksala N.K.J. , Paimela H. , Alhava E.
Published: April 2003

Background: Superficial epithelial injury is followed by restitution which is based on the migration of the surviving mucosal cells to restore the disturbed epithelial continuity. There is previous data that heat-shock (HS) preconditioning may be utilized to enhance the tissue tolerance to injury. Yet, there is little data about the effect of preconditioning on restitution. Methods: Guinea pig gastric mucosae were mounted and perfused in Ussing chambers. After stabilization, a HS (42°C, 30 min) and concomitant heat-shock protein (Hsp) production was induced. After stabilization and reaching the normothermia, a superficial injury (1.25 mol/l NaCl) was induced. Subsequently, the tissue was allowed to restitute for 3 h. In some sets of experiments, protein synthesis was inhibited either with quercetin or with cycloheximide. During the experiment, transmucosal electrophysiological resistance (R) of the tissue was recorded. After the experiment, the mucosa was prepared for morphologic analysis and for Western blot. Results: HS did not affect mucosal tolerance to hyperosmolar injury, but inhibited significantly restitution after injury and upregulated Hsp70 as well. The levels of Hsp70 correlated inversely with recovery of R and histology. Quercetin and cycloheximide abolished this effect of HS, while quercetin did not completely abolish Hsp70 upregulation. Conclusion: Hyperthermic preconditioning inhibits the restitution of gastrointestinal mucosa in correlation with Hsp70 levels. The inhibition of restitution is sensitive to blockades of de novo protein synthesis and of Hsp70 production.
Two Cases of ‘Asthma’ Revealing a Diverticulum of Kommerell
Authors: Morel V. , Corbineau H. , Lecoz A. , Verhoye J.-P. , Heautot J.-F. , Bassen R. , Delaval P. , Desrues B.
Published: April 2003

Among embryonic aortic vascular malformations, persistence of a right aortic arch and aberrant left subclavian artery associated with a diverticulum of Kommerell is rare, and is estimated to occur in 0.1% of the general population. We report two cases of diverticulum of Kommerell in which tracheal compression due to the vascular ring induced respiratory symptoms such as asthmatic dyspnoea. This reminds us that at least a chest X-ray should be performed in newly diagnosed asthmatic patients, focusing on the trachea and upper mediastinum. In case of vascular abnormality, angiography and magnetic resonance are the best investigations to define the abnormal anatomy and guide surgery.
Right-to-Left Atrial Shunt without Pulmonary Artery Hypertension
Authors: Gouitaa Marion , Vaillant Alain , Leude Elisabeth , Badier Monique , Malaterre Henri , Barbier Dominique , Charpin Denis
Published: April 2003

A 70-year-old woman without any history of pulmonary or cardiac disease developed breathlessness with severe arterial hypoxemia. Cardiac ultrasound examination and spirometry were normal. Cardiac catheterization and intravenous microbubble injection demonstrated an interatrial right-to-left shunt. The defect was closed surgically, and the patient recovered immediately. On surgery, the aorta was elongated, inducing an angulation of the interatrial septum and leading to the atrial septal defect just above the inferior vena cava.
High-Resolution Computed Tomography Findings Are Correlated with Disease Severity in Asthma
Authors: Harmanci Emel , Kebapci Mahmut , Metintas Muzaffer , Ozkan Ragip
Published: April 2003

Background: The structural changes in the airways of asthmatics are also referred to as remodeling and can be identified using high-resolution computerized tomography (HRCT).Objectives: To find out whether there are any abnormal HRCT features which can be attributed to asthma and their clinical correlates, and any differences of abnormal HRCT features between asthmatics and patients with chronic obstructive pulmonary disease (COPD). Methods: We performed (HRCT) scans to assess airway remodeling in 160 nonsmoker asthmatics compared with 27 patients with COPD. Results: Bronchial wall thickening, hyperlucency, centrilobular prominence, bronchiectasis, thick linear opacities and mucoid impaction were all correlated with disease severity in asthma. FEV1 values were inversely correlated with bronchial wall thickening, hyperlucency, mucoid impaction, linear shadows, centrilobular prominence and bronchiectasis. In adddition, thick linear opacities, mucoid impaction and bronchiectasis were more prominent in those patients with a long duration of asthma. Bronchial wall thickening, thick linear opacities, mucoid impaction, bronchiectasis and emphysema were more prominent in COPD patients compared with asthmatics. There was no difference with regard to age, mean values of FEV1 and the duration of asthma between allergic and nonallergic asthmatics as well as abnormal HRCT findings. Conclusions: COPD patients have more prominent HRCT findings as compared with asthmatics. In the asthmatics, abnormal HRCT findings are more prominent with increased severity, decreased FEV1 values and the duration of asthma. The remodelling of airways in allergic asthmatics did not differ from that in their nonallergic counterparts as determined by HRCT.
The complement factor 5a receptor gene maps to murine chromosome 7
Authors: Shubitowski D.M. , Wills-Karp M. , Ewart S.L.
Published: April 2003

Complement factor 5a (C5a) promotes local inflammation and is a potent chemoattractant for neutrophils and macrophages. We had an interest in C5a and its receptor, C5r1, because we previously identified C5a as a positional candidate gene for the quantitative trait locus Abhr2, which determines allergen-induced bronchial hyperresponsiveness in our murine model of asthma. To study the significance of C5r1 in our asthma model we first had to determine its genomic map location in mice. Genomic sequence surrounding murine C5r1 was analyzed for polymorphisms and two variable microsatellites were identified. These microsatellites were genotyped in A/J × (C3H/HeJ × A/J)F1 backcross mice (n = 355) and mapped in a panel of 164 markers spaced at approximately 10 cM intervals throughout the genome. Multipoint linkage analysis placed C5r1 on murine chromosome 7, 3.9 cM from the top of the linkage group. This map location has been previously identified as containing an additional quantitative trait locus for allergen-induced airway hyperresponsiveness, Abhr3, in this population of mice.
A Rare Combination of Sites of Involvement by Mycobacterium intracellulare in a Hemodialysis Patient: Multifocal Synovitis, Spondylitis, and Multiple Skin Lesions
Authors: Otaki Yoshinaga , Nakanishi Takeshi , Nanami Masayoshi , Aizawa Masayo , Yanase Kimihiko , Hiraoka Keisuke , Izumi Masaaki , Inoue Toru , Takamitu Yoshihiro , Arakawa Akira , Adachi Masaru , Maruo Souji
Published: April 2003

Purpose: Atypical mycobacterial infection is a rare but serious hazard in immunocompromised patients including those undergoing maintenance hemodialysis and immunosuppressive therapy. Recognition of unusual involvement patterns is important. Methods: We describe an extremely rare combination of complications caused by such an organism in a patient with end-stage renal disease: spinal osteolysis and multiple skin lesions associated with synovitis. Results: The patient had received a renal allograft 18 years previously but developed infection with Mycobacterium avium-M. intracellulare complex including dermatologic manifestations, spondylitis, and synovitis involving the wrist and lateral malleolus after initiation of hemodialysis when the transplanted kidney failed. An empirical antibiotic regimen failed to alleviate skin lesions or fevers, or to lower an elevated C-reactive protein concentration, until the patient’s dose of methylprednisolone was increased to treat mild adrenal insufficiency. The increase resulted in rapid resolution of skin lesions. A compression fracture 6 months later was attributed to spondylitis caused by the same organism. Conclusion: We suspect that spondylitis represented the primary focus of M. intracellulare infection.
Tranilast Slows the Progression of Advanced Diabetic Nephropathy
Authors: Soma Jun , Sugawara Takashi , Huang Yee-Der , Nakajima Jun , Kawamura Minoru
Published: April 2003

Background: Tranilast, N-(3,4-dimethoxycinnamoyl) anthranilic acid, suppresses collagen synthesis by various cells, including macrophages and fibroblasts, by interfering with the actions of transforming growth factor-beta 1. We investigated the effect of tranilast on progression of diabetic nephropathy (DN), since this process is associated with accumulation of collagens in the glomerulus and interstitium. Methods: Tranilast (100 mg, 3 times daily) was administered to 9 outpatients with advanced DN who were receiving an angiotensin-converting enzyme inhibitor or an angiotensin II receptor antagonist and who exhibited a progressive decline in renal function. The decline in renal function before and during tranilast treatment was evaluated for each patient on the basis of the slope in reciprocal serum creatinine (1/SCr) over time. Urinary type IV collagen (U-IV·C) and protein (U-P) excretions were measured just before commencement of tranilast treatment and every 2 months during the treatment. Results: One male patient dropped out soon after commencement of tranilast treatment due to development of lung cancer, and hemodialysis was introduced in one female patient 6 months after the start of treatment. In the 8 patients who did not drop out, 1/SCr was significantly less steep during tranilast treatment than before treatment (–0.00748 ± 0.00700 vs. –0.01348 ± 0.00636 dl/mg/month, respectively; p = 0.0374). U-IV·C and U-P tended to decrease with time, although the decrease was statistically insignificant. Conclusions: Our data suggest that tranilast treatment may suppress accumulation of collagens in renal tissue and may be therapeutically useful for reducing the progression of advanced DN.
Can Immunosuppressive Therapy Be Useful in IgA Nephropathy when the ‘Point of No Return’ Has Already Been Exceeded?
Authors: Pozzi Claudio , Del Vecchio Lucia , Locatelli Francesco
Published: April 2003

Immunosuppressive treatment of IgA nephropathy (IgAN) has been a controversial issue since many years, mainly because of skepticism on awaited results and fear of possible side effects. Some authors proposed the existence of a ‘point of no return’, after which the worsening in renal function becomes inexorable and treatment ineffective. Indeed, the decision to treat these patients is easily followed by disappointment due to lack of favorable results. We report the case of a 24-year-old woman with a diagnosis of IgAN with advanced sclerosis and chronic renal failure. After treatment with a 6-month steroid course, she experienced a long-lasting stabilization of renal function (serum creatinine) and decrease in proteinuria (from 2.9 to 0.46 g/24 h) that still persisted at the end of follow-up (48 months). Analysis of this case and review of the literature suggest that immunosuppressive treatment could delay the beginning of renal replacement therapy in the advanced phase of IgAN. However, the results of long-term, randomized, controlled, adequately sized trials are awaited.
Fenofibrate Increases Creatininemia by Increasing Metabolic Production of Creatinine
Authors: Hottelart Carine , El Esper Najeh , Rose Françoise , Achard Jean-Michel , Fournier Albert
Published: April 2003

Fenofibrate is a potent hypolipemic agent, widely used in patients with renal insufficiency in whom dyslipidemia is frequent. A moderate reversible increase in creatinine plasma levels is an established side effect of fenofibrate therapy, which mechanism remains unknown. We have previously reported that in 13 patients with normal renal function or moderate renal insufficiency, two weeks of fenofibrate therapy increased creatininemia without any changes in renal plasma flow and glomerular filtration rate [1]. In 13 additional patients, muscular enzymes (AST, GPT, CPK, LDH) and myoglobin were measured before and after 2 weeks on fenofibrate, and the values of creatininemia obtained by the Jaffé technique and HPLC were compared. CPK and AST activity and plasma myoglobin increased in 2 patients with fenofibrate, but muscular enzymes remained unchanged in the population as a whole, and were not correlated to the changes in creatininemia. The changes in creatininemia induced by fenofibrate measured by the Jaffé technique were strongly correlated to those measured by HPLC (r2 = 0.675, p = 0.0006). Analysis of the pooled data of the two arms of the study showed in 26 patients that two weeks of fenofibrate therapy efficiently reduced total cholesterol and triglycerides plasma levels, and raised creatininemia from 139 ± 8 to 160 ± 10 µmol/l (p < 0.0001), but confirmed that creatininuria also increased to the extent that creatinine clearance remained unchanged (68 ± 6 vs. 67 ± 6 ml/min, n.s.). It is concluded that the increase in creatininemia induced by fenofibrate in renal patients does not reflect an impairment of renal function, nor an alteration of tubular creatinine secretion, and is not falsely increased by a dosage interference. Fenofibrate-induced increase of daily creatinine production is neither readily explained by accelerated muscular cell lysis. It is proposed that fenofibrate increases the metabolic production rate of creatinine.
Gene Expression Analysis in Microdissected Renal Tissue
Authors: Cohen Clemens D. , Kretzler Matthias
Published: April 2003

The architecture and compartmentalization of the kidney has stimulated the development of an array of microtechniques to study the functional differences between the distinct nephron segments. With the vast amounts of genomic sequence data now available, the groundwork has been laid for a comprehensive characterization of the molecular pathways defining the differences in nephron function. With the development of sensitive gene expression techniques the tools for a comprehensive molecular analysis of specific renal microenvironments have been provided: Quantitative RT-PCR technologies now allow the analysis of specific mRNAs from as little as single microdissected renal cells. A more global view of gene expression regulation is a logical development from the application of large scale profiling techniques. In this review, we will discuss the power and pitfalls of these approaches, including their potential for the functional characterization of nephron heterogeneity and diagnostic application in renal disease.
Acute Hydrothorax in CAPD
Authors: Halstead J.C. , Lim E. , Ritchie A.J.
Published: April 2003

Background/Aims: Hydrothorax is a complication of continuous ambulatory peritoneal dialysis (CAPD) occurring due to pleuroperitoneal fistulae. Several treatments exist with no consensus as to best management. We report on the largest series of video-assisted thoracoscopic surgery (VATS) treated pleuroperitoneal fistulae yet available. Methods: Between 1995 and 2000, we treated 6 CAPD patients for acute right hydrothoraces using VATS. Data pertaining to size and sterility of hydrothoraces, presence of diaphragmatic defects, surgical procedures performed, morbidity and return to CAPD were obtained. Results: Hydrothoraces were drained in all patients and there were no significant growths on subsequent culture. Fistulae were directly identified and closed in three patients. In the remaining patients, endoclips were placed across the base of small diaphragmatic blebs (the presumed site of communication). Parietal pleurectomy was performed uneventfully in all patients. There was no morbidity, all patients returned to haemodialysis and there have been no recurrences. Conclusion: Pleuroperitoneal fistulae produce symptomatic hydrothoraces in CAPD patients. A variety of approaches to the problem have been described. This is the largest series of VATS available and shows the usefulness of this approach in both closing the defect and producing an effective pleurectomy to prevent recurrence.
Intracellular Recording and Staining of Neurons in the Pigeon Nucleus lentiformis mesencephali
Authors: Tang Zong-Xiang , Wang Shu-Rong
Published: April 2003

The pretectal nucleus lentiformis mesencephali in pigeons is involved in optokinetic nystagmus and consists of lateral (nLMl) and medial (nLMm) subnuclei. The present study using intracellular recordings and brain slices shows that pretectal cells respond to depolarizing current injection in different ways. Type I cells (32%) fire spontaneously and have regular spikes. Type II cells (20%) discharge regular spikes, whose frequency increases as current intensity increases. Type III cells (8%) produce a series of bursts, each of which consists of 2–5 spikes depending on current intensities. Type IV cells (39%) fire several spikes in a cluster at the onset of current injection and are then rapidly adapted. One cell of type V (1%) shows spontaneous firing and is inactivated by depolarizing currents. Cells of types III and V are only found in nLMm, and other types of cells exist in both subnuclei. This physiological difference might be a bias due to the small sampling of cells. Twenty-six cells are labeled with dye and they could be categorized into fusiform (23.1%), piriform (7.7%), or multipolar (69.2%) cells. Some correlation seems to exist between the physiological and morphological properties of pretectal neurons. Statistically, the somatic size of nLMm cells is significantly larger than that of nLMl cells, indicating that the nucleus could be divided cytoarchitecturally into magnocellular and parvocellular components as suggested previously.
Connectional Evidence for Dorsal and Ventral V3, and Other Extrastriate Areas in the Prosimian Primate, Galago garnetti
Authors: Lyon David C. , Kaas Jon H.
Published: April 2003

Previously we described patterns of connections that support the concept of V3 in small New World marmoset monkeys, three species of larger New World monkeys, and two species of Old World macaque monkeys. Here we describe a pattern of V1 connections with extrastriate visual cortex in Galago garnetti (also known as Otolemur garnetti) that demonstrates the existence of a V3 in a strepsirhine (prosimian) primate. Injections of fluorochromes or cholera toxin subunit-B (CTB) in V1 labeled cells and terminals in retinotopically matched regions in V2, V3, DL (V4), and MT. Labeled axon terminations were more focused primarily in middle layers of cortex, likely representing ‘feedforward’ input from V1, whereas labeled cells were more widespread and found in both superficial and deeper cortical layers, indicative of feedback projections. Averaged across injections, V3 had the third largest percentage of labeled cells (11%), following only V2 (47%) and the middle temporal area (MT; 19%). The dorsolateral area (DL, or V4; 9%) also contained a relatively large number of retrogradely labeled cells. These results indicate that V2, V3, DL (V4), and MT are retinotopically connected with V1, and provide major sources of feedback. Other extrastriate areas were less densely connected to V1, and there was no clear indication of labeled terminals. Inferotemporal cortex (IT) provided nearly 7% of feedback connections, whereas the dorsomedial area (DM) contributed about 3%. The remaining areas that have been proposed for galago extrastriate cortex, MTc, MST, FST, LPP and VPP, each accounted for about 1% or less of the total number of labeled cells. Thus, six extrastriate areas, V2, MT, V3, DL (V4), IT, and DM provide over 96% of visual cortex projections to V1. These areas also provide most of the projections to V1 in New and Old World monkeys.
Life and Health Insurance Behaviour of Individuals Having Undergone a Predictive Genetic Testing Programme for Hereditary Non-Polyposis Colorectal Cancer
Authors: Aktan-Collan Katja , Haukkala Ari , Kääriäinen Helena
Published: April 2003

Objective and Methods: We describe the insurance behaviour of subjects (n = 271) who had previously taken a predictive genetic test for hereditary non-polyposis colorectal cancer (HNPCC); 31% of them were mutation positive, indicating a high risk of cancer. One year after testing, the subjects were sent a questionnaire including questions about their present life and health insurance before participation in the study, and their actual and planned purchase of the insurance policies during the testing programme which comprised a pre-test counselling session, a period for reflection, the testing, and a test disclosure session. Results: Thirty percent reported that they already had a life insurance and 14% a health insurance before participating in the study. The mutation-positive subjects possessed a health insurance significantly more often than the mutation-negative individuals (21 vs. 11%, p = 0.02) and a similar trend was observed for life insurance (36 vs. 28%, p = 0.12). Life and health insurance policies purchased just before testing was reported by 3 and 2% of the subjects, respectively. Life and health insurance policies purchased after testing were reported by 3 and <1%, respectively, and planned purchase by 3 and 2%, respectively. No statistically significant differences were found between the groups defined by mutation status in reports of life or health insurance behaviour during or after the programme. Conclusion: According to self-reported data, the mutation-positive subjects did not differ from the others in the purchase of life or health insurance policies. However, the mutation-positive individuals reported that they possessed health insurance policies before entering the study more often than their counterparts.
The Implications of Subspecialisation on the Management and Outcome of Surgery for Rectal Carcinoma
Authors: Warsi A.A. , Woodward A. , Stock D. , Williams R.J.Ll. , Lewis M.H. , Foster M.E.
Published: April 2003

Background: The management of rectal carcinoma has changed significantly over the last decade. We studied the changing trends in the management of rectal carcinoma over a 7-year period in a district general hospital. Methods: A retrospective analysis of all patients with histologically proven rectal adenocarcinoma who underwent operative treatment between January 1991 and December 1997 was performed. The type of operative procedure, local recurrence rate and completeness of pathology reporting was documented. Results: There were 200 operative procedures: 102 anterior resections (AR), and 98 abdominoperineal resections (APR). This included 17 palliative resections because of metastatic disease (n = 8) or extensive local invasion (n = 7) or both (n = 2). The APR rate steadily declined from 72% in 1991 to 19% in 1997 (p < 0.005). Subspecialist ‘colorectal’ surgeons performed only 24% of the operations in 1991 but the figure for 1997 was 85% (p < 0.01). No circumferential resection margin was reported in 1991 but was reported in 85% of the cases in 1997 (p < 0.001). There was a steady increase in stapled anastomoses from 43% in 1991 to 93% in 1997 (p < 0.03). There were 15 local recurrences following ‘curative’ resection; 7 following APR and 8 following AR (n.s.). Conclusion: There was a significant increase in the rate of restorative resection of rectal cancer with a concomitant reduction in permanent stoma formation; this may be attributed to an increase in subspecialisation. Despite this, a low rate of local recurrence was maintained throughout the study period.
The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned
Authors: Willemsen Paul J. , Hoorntje Lidewij E. , Eddes Eric-Hans , Ploeg Rutger J.
Published: April 2003

Background: Our current treatment of an appendiceal mass is initially conservative, followed by an interval appendectomy. The necessity of this routine interval appendectomy is debatable. A study was conducted to evaluate whether surgical factors and pathological features of the excised appendices support interval appendectomy. Methods: We performed a retrospective study at the University Hospital Groningen and the Deventer Ziekenhuis. All patients diagnosed with an appendiceal mass in the period January 1991 to January 1997 were identified using the hospital database. The medical records of all these patients (n = 233, 108 M, 125 F) were reviewed. The clinical course of the appendiceal mass patients was split up into three distinct episodes: initial diagnosis and treatment of the appendiceal mass, the interval period and the interval appendectomy. Presenting symptoms, findings at clinical examination and additional imaging (ultrasound) were registered, as well as the course of the primary hospitalisation, the interval period, and the interval appendectomy. Results of histological examination of all resected specimens were reviewed. Results: It was found that clinical findings alone were not specific enough to diagnose an appendiceal mass; 47% had a palpable abdominal mass and the median temperature was 38.2°C ranging from 36 to 40.5°C. Ultrasound examination was done in 69% of patients and showed an appendiceal mass in 72%. During the interval period, 4 patients presented with an appendiceal mass needing drainage, and 3 with acute appendicitis requiring emergency appendectomy. At interval appendectomy, histological examination of resection specimen showed a normal appendix without signs of previous inflammation in 30% of cases. In addition, complications due to interval appendectomy were seen in 18% of patients, including sepsis, bowel perforation, small bowel ileus, and various wound abscesses. Conclusions: We conclude that when causes for the appendiceal mass other than appendicitis are excluded, interval appendectomy seems unnecessary in patients who respond well to initial conservative treatment.
Therapeutic Fistuloscopy: An Alternative Approach in the Management of Postoperative Fistulas
Authors: Eleftheriadis Efthimios , Kotzampassi Katerina
Published: April 2003

Background/Aim: Since the treatment of postoperative fistulas remains a difficult problem, we applied endoscopic treatment in such 14 persistent fistulas. Methods: Fourteen patients presented with postoperative fistulas: 7 patients (low-output group) due to residual cavity after liver hydatid disease surgery and 7 patients (high-output group) after small-bowel resection (n = 3), diverted duodenostomy (n = 1), vertical gastroplasty (n = 1), external pancreatic cyst drainage (n = 1), and transduodenal sphincteroplasty (n = 1). The therapeutic procedures included mechanical removal of silk sutures, necrotic material, and hydatid membranes in the low-output group and fibrin sealing in the high-output group. Results: Fistuloscopy was performed 170–278 days (mean ± SD 198.7 ± 36.7 days) and 18–51 days (mean ± SD 34.0 ± 11.3 days) postoperatively in low- and high-output fistula patients, respectively, when the average daily output was 20–50 (32.8 ± 12.5) ml and 200–1,000 (563.1 ± 319.4) ml, respectively. The low-output group needed only one fistuloscopy session, while the other group required a median number of three sessions plus fibrin sealing, the total amount of fibrin glue used per patient being 2–14 (6.5 ± 4.4) ml. No procedure-related complication occurred. All fistulas except one healed within 10–33 (21.8 ± 7.9) days and 2–17 (9.2 ± 5.1) days in low- and high-output groups, respectively. Conclusions: We believe fistuloscopy to be a useful tool in the management of gastrointestinal fistulas, but more experience should be gained in using this technique.
Two Unusual Cases of Adult Intussusception
Authors: Bellows Charles F. , Haque Salima , Jaffe Bernard M.
Published: April 2003

Adult intussusception is very rare. We report 2 unusual cases, a 58-year-old man with a transverse colo-colonic intussusception caused by a malignant sessile polyp that also had an asymptomatic synchronous neoplasm of the kidney, and an 18-year-old female with an ileocecolic intussusception caused by acute appendicitis. This report stresses the point that intussusception in adults may represent an underlying malignancy. The age of the patient and the anatomic location of the intussusception provide significant input as to the etiology and hence the most appropriate surgical procedure.
Chymase Inhibitor Ameliorates Eosinophilia in Mice Infected with Nippostrongylus brasiliensis
Authors: Watanabe Naohiro , Miura Kenju , Fukuda Yoshiaki
Published: April 2003

Background: Chymase is a chymotrypsin-like serine protease primarily stored in mast cells. Infection with helminth parasites is known to increase the level of mast cell chymase in the jejunum and serum in mice. The aim of the present study is to elucidate the role of chymase in helminth infection. Methods: Chymase inhibitor SUN-C8257 was administered to mice infected with the nematode Nippostrongylus brasiliensis, and the number of eosinophils in the blood, serum IgE levels and fecal egg counts were determined. Results: Administration of SUN-C8257 significantly inhibited blood eosinophilia in BALB/c mice infected with N. brasiliensis. The effect of SUN-C8257 was specific for eosinophils, in that it affected neither the number of total leukocytes nor serum IgE levels. SUN-C8257 did not alter the fecal egg counts in this model, showing that SUN-C8257 has no effect on infectivity and expulsion of the nematode. N. brasiliensis infection induced eosinophilia in mast cell-deficient mice (W/Wv) as well as their littermates (+/+), and SUN-C8257 inhibited the eosinophilia in +/+ mice but not in W/Wv mice. These results suggest that the eosinophil number may be regulated by different mechanisms in W/Wv and +/+ mice, and that the effect of SUN-C8257 on nematode-induced eosinophilia is probably due to chymase inhibition. Conclusions: Chymase released by activated mast cells may play a role in helminth-induced eosinophilia.
Platelet Activation Markers in Patients with Nephrotic Syndrome
Authors: Sirolli Vittorio , Ballone Enzo , Garofalo Donato , Merciaro Gabriele , Settefrati Nicola , Di Mascio Rocco , Di Gregorio Patrizia , Bonomini Mario
Published: April 2003

Background/Aim: Enhanced platelet reactivity may play a significant role in the genesis of the hypercoagulable state of nephrotic syndrome. However, the role of platelet function testing in nephrosis is controversial, partly because the methods used to assess platelet function (platelet aggregation and immunoassays of plasma β-thromboglobulin and platelet factor 4) have such marked methodological problems. In the present study, we evaluated several tests assessing platelet function in 18 adult patients with idiopathic nephrotic syndrome and normal renal function. Methods: Platelet function was assessed by measurement of plasma β-thromboglobulin (enzyme-linked immunosorbent assay, ELISA), plasma P-selectin (ELISA), circulating platelets exposing the activation-dependent antigens P-selectin (CD62P) and lysosomal GP53 (CD63) (flow cytometry), and by aggregation response to agonists such as ADP and collagen. Results were compared to those obtained in a group of 16 age- and gender-matched healthy subjects. Results: Levels of plasma β-thromboglobulin (p = 0.001), plasma P-selectin (p < 0.001), and CD62P/CD63-positive platelets (p < 0.001 for both) were increased in nephrotic patients as compared to healthy controls. Platelet hyperaggregability in vitro was found in 13/18 patients. The reproducibility of platelet activation markers, as assessed by blood sample collection a week later from all patients, was found to be higher for plasma P-selectin (Spearman correlation coefficient, R = 0.99) and circulating activated platelets (CD62P: R = 0.97; CD63: R = 0.96) than for plasma β-thromboglobulin (R = 0.78). Conclusions: Pronounced platelet activation takes place in nephrotic syndrome and may contribute to the hypercoagulability of nephrosis. Whole blood flow cytometry assay of platelet activation and plasma P-selectin assay may represent useful tests to assess the hypercoagulable state in nephrotic patients.
Effects of L-Arginine and L-NAME on the Renal Function in Hypertensive and Normotensive Subjects
Authors: van den Meiracker Anton H. , van der Linde Nicole A.J. , Broere Annemieke , Derkx Frans H.M. , Boomsma Frans
Published: April 2003

Background/Aim: Renal vasodilation in response to L-arginine has been reported to be diminished in hypertensive (HT) subjects. If this diminished renal vasodilator response indicates disturbance of the renal NO pathway, a diminished renal vasoconstrictor response to NO synthase inhibition may be present in HT subjects as well. The present study was conducted to compare the effects of L-arginine and NG-nitro-L-arginine methyl ester (L-NAME) on renal and systemic hemodynamics between HT and normotensive (NT) subjects. Methods: The responses of renal and systemic vascular resistances (RVR and SVR) and plasma noradrenaline and renin (NOR and PRA) to systemic NO stimulation and inhibition were studied in patients with grade 1 essential HT and age- and sex-matched NT subjects. On separate occasions, after baseline values were obtained, 40-min randomly administered intravenous infusions of L-arginine (12.5 mg·kg–1·min–1) or L-NAME (0.0125 mg·kg–1·min–1) were given. Results: Baseline values of RVR (129 ± 21 and 162 ± 10 resistance units) and SVR (15.1 ± 4.3 and 21.6 ± 5.1 resistance units) were higher (p < 0.01) in HT than in NT subjects, whereas the baseline values of NOR and PRA were similar. Infusion of L-arginine caused similar decrements in SVR (29 ± 10 and 31 ± 11%), but the decrease in RVR was smaller (22 ± 8 and 35 ± 12%, respectively; p < 0.05) in HT than in NT subjects. In response to L-NAME, the increments in RVR (66 ± 10 and 61 ± 25%) and SVR (36 ± 21 and 34 ± 18%) were similar in HT and NT subjects. In both groups, infusion of L-arginine was associated with similar increments, whereas infusion of L-NAME was associated with similar decrements in NOR and PRA. Conclusions: This study confirms the smaller renal vasodilator response to L-arginine in HT than in NT subjects. Whether this is caused by a disturbance of the renal NO pathway remains doubtful considering the observed similar L-NAME-induced increments in RVR and SVR in the two groups of subjects
Calcium and Phosphate Plasma Levels in Dialysis Patients after Dietary Ca-P Overload
Authors: Graziani Giorgio , Badalamenti Salvatore , Como Giovanna , Gallieni Maurizio , Finazzi Silvia , Angelini Claudio , Brancaccio Diego , Ponticelli Claudio
Published: April 2003

In normal subjects, the gastric ionisation of calcium and phosphate seems to be a prerequisite for their intestinal absorption. We investigated the behavior of the plasma calcium and phosphate profile in 30 patients on regular dialysis treatment in the 6 h following a meal containing 1 g of calcium and 2 g of phosphate. Moreover, to assess the role of gastric acidity, the study was repeated after 3 days on omeprazole administration, to nearly abolish gastric acid secretion. Both total plasma calcium and ionized calcium peaked after the meal (at 30 and 120 min, respectively) only in basal study, while no peak was observed after the administration of omeprazole. Surprisingly, both in basal and in the omeprazole study the levels of plasma phosphate did not increase after the test meal. In conclusion, as in normal subjects, the gastric ionization of dietary calcium promotes the intestinal absorption of calcium in uremic patients on dialysis treatment, while the acute gastric acid inhibition by omeprazole reduced the intestinal calcium transport. In contrast, with the ‘trade off’ hypothesis we did not observe any postprandial phosphate peak after the dietary load, and, in contrast with normal subjects, omeprazole administration did not influence the phosphate profile.
Cast Nephropathy in a Case of Waldenström’s Macroglobulinemia
Authors: Isaac Jorge , Herrera Guillermo A.
Published: April 2003

Waldenström’s macroglobulinemia is a low-grade lymphoplasmacytic lymphoma characterized by a circulating monoclonal IgM. The clinical manifestations are due to deposition of IgM in liver, spleen, and/or lymph nodes. Related symptoms include anemia and complications of the hyperviscosity syndrome. Renal involvement in classical cases of Waldenström’s macroglobulinemia is rare, and the pathological hallmark finding in the renal biopsy specimen is a thrombotic microangiopathy. We report the case of a 73-year-old female with the diagnosis of pernicious anemia for 2 years before she presented with acute renal failure. A renal biopsy performed suggested the diagnosis of myeloma cast nephropathy. However, bone marrow biopsy specimens and hematological studies did not support this diagnosis. Serum and urinary protein electrophoresis revealed a monoclonal lambda subtype IgM. Ultrasound imaging showed an enlarged spleen. The diagnosis of cast nephropathy in a patient with Waldenström’s macroglobulinemia was made. She underwent treatment with fludarabine and plasmapheresis/hemodyalisis with dramatic improvement of her renal function.