bluuebunny/crossref_metadata_2025 huggingface dataset:
Shuttle Walking Test and 6-Minute Walking Test Induce a Similar Cardiorespiratory Performance in Patients Recovering from an Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Vagaggini B. , Taccola M. , Severino S. , Marcello M. , Antonelli S. , Brogi S. , De Simone C. , Giardina A. , Paggiaro P.L.
Published: January 2004

Background: The incremental shuttle walking test (SWT) has recently been proposed as a more valid and reproducible alternative to the conventional 6-min walking test (6MWT) in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Objective: To compare the cardiorespiratory performance obtained during two sessions of SWT with that obtained during two sessions of 6MWT. Methods: We examined 18 patients (forced expiratory volume in 1 s: 48 ± 14%) recovering from an acute exacerbation of COPD that had required hospitalization. In the same afternoon, each patient performed two SWT and two 6MWT, with an interval of at least 30 min between each test; the sequence of the tests was randomized. Results: Mean walking distance was greater in the second SWT test than in the first SWT. The changes from baseline in systolic blood pressure, heart rate, respiratory rate, oxygen saturation and dyspnea Borg index at the end of the test were similar between the two 6MWT and the two SWT. There was a highly significant correlation between walking distances measured during SWT and during 6MWT (ρ: 0.85, p < 0.0005). Neither SWT nor 6MWT correlated with functional data of COPD. Conclusions: SWT, though being considered to be closer to a submaximal exercise test than 6MWT, does not induce a greater cardiorespiratory performance than 6MWT in patients recovering from acute exacerbation of COPD.
Plasma and Bronchoalveolar Lavage Fluid Levels of Endothelin-1 in Patients with Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension
Authors: Bacakoğlu Feza , Atasever Alev , Ozhan Mustafa H. , Gurgun Cemil , Ozkilic Hayal , Guzelant Asuman
Published: January 2004

Background: Secondary pulmonary hypertension (PH) and cor pulmonale are the major clinical cardiovascular complications affecting prognosis in patients with chronic obstructive pulmonary disease (COPD). It is also known that endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by the pulmonary vascular endothelium, and ET-1 may be implicated in the pathogenesis of PH. Objectives: The purpose of this study was to investigate the presence of ET-1 in patients with COPD and to assess the correlation of ET-1 levels in the plasma and bronchoalveolar lavage (BAL) fluid (BALF) in COPD patients with or without PH. Methods: Twenty-two patients with COPD and 15 healthy controls were enrolled in the study. Peripheral venous blood samples were collected in all patients and controls. BAL was obtained in COPD patients, and ET-1 levels were measured by radioimmunoassay in all plasma and BALF samples. Results: Plasma ET-1 levels were 2.46 ± 0.55 and 1.70 ± 0.42 pmol/dl in patients with COPD and controls, respectively (p < 0.0001). Sixteen of the 22 patients with COPD (73%) had PH established by echocardiography. The ET-1 level in these patients amounted to 2.59 ± 0.50 pmol/dl, and it was 2.10 ± 0.54 pmol/dl in 6 patients with COPD without PH. In COPD patients with and without PH, BALF ET-1 levels were 0.19 ± 0.08 and 0.24 ± 0.01 pmol/dl, respectively (p > 0.05). Conclusions: These results suggest that ET-1 is detectable in both the peripheral blood and BALF of COPD patients, but the levels do not statistically differ between patients with and without PH.
Evaluation of Arterial Endothelin-1 Levels, before and during a Sleep Study, in Patients with Bronchial Asthma and Chronic Obstructive Pulmonary Disease
Authors: Nikolaou E. , Trakada G. , Prodromakis E. , Efremidis G. , Pouli A. , Koniavitou A. , Spiropoulos K.
Published: January 2004

Background: Endothelin (ET)-1 has been implicated in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). The ET-1 levels are elevated during exacerbations of asthma and COPD in bronchoalveolar lavage, serum, and sputum, falling with treatment of the exacerbations. Objective: The aim of this study was to examine the ET-1 blood levels in stable asthmatic patients and stable COPD patients during alertness and sleep. Materials and Methods: We examined 48 COPD and 20 asthmatic patients. All underwent forced spirometry, measurement of SaO2 and of arterial ET-1 levels and nocturnal polysomnography. ET-1 levels were also determined during nocturnal oxyhaemoglobin desaturation. Results: The daytime SaO2 level of our asthmatic patients was higher than that of our COPD patients (p < 0.001). Daytime SaO2 level of our non-desaturator COPD patients was higher than that measured in desaturator COPD patients. Nightime SaO2 level in our asthmatic patients was higher than that in our desaturator COPD patients (p < 0.001). Daytime ET-1 levels in desaturator COPD patients were higher than those observed in normal individuals, in non-desaturator COPD patients and in asthmatic patients. The COPD desaturator patients had higher levels of ET-1 during nighttime than during daytime (p < 0.001). Conclusion: Asthmatic patients did not exhibit desaturation of haemoglobin during the night. ET-1 levels are significantly higher in desaturator COPD patients compared with non-desaturator COPD patients, both during the day and during the night. ET-1 levels in stable COPD patients are significantly higher than in patients with stable asthma. These findings are consistent with the hypothesis that ET-1 is implicated in the pathogenesis of COPD and asthma.
Newly Diagnosed Tuberculosis in Inner-City Chicago: The Pulmonary Fellow Perspective
Authors: Ramirez Allan , Fry Mary B. , Rubinstein Israel
Published: January 2004

Background: The extent to which pulmonary fellows encounter patients with newly diagnosed tuberculosis during their 3-year training program in large metropolitan areas in the USA where active tuberculosis is still relatively common is uncertain. Objectives: To characterize clinical encounters of pulmonary fellows with patients with newly diagnosed tuberculosis at a large university-based training program in inner-city Chicago over a 3-year period. Methods: A retrospective review of medical records of patients with newly diagnosed tuberculosis at the University of Illinois Medical Center at Chicago outpatient clinics (UMC) and the City of Chicago Department of Public Health Uptown Neighborhood Health Center Tuberculosis Clinic (CDPH) between 1999 and 2001 was conducted. A pulmonary fellow encounter rate (PFER) was derived as the average number of patients with newly diagnosed tuberculosis seen by a pulmonary fellow per month over the 3-year study period in each institution. Results: We found that 9 pulmonary fellows diagnosed, treated and followed all 80 patients with newly diagnosed tuberculosis seen at CDPH over the 3-year study period. By contrast, they evaluated only 14 patients with newly diagnosed tuberculosis and followed 2 of them regularly at UMC (p < 0.05). PFER was 2.96 at CDPH and 0.52 at UMC (p < 0.05). Adverse events ascribed to anti-tuberculosis drugs were observed more frequently in patients seen by pulmonary fellows at CDPH than at UMC (p < 0.05). Conclusions: Pulmonary fellows are more likely to encounter patients with newly diagnosed tuberculosis at a designated tuberculosis clinic than at a university hospital in inner-city Chicago during their 3-year training.
Acute Phase Reactants and Cytokine Levels in Unilateral Community-Acquired Pneumonia
Authors: Kolsuz Mustafa , Erginel Sinan , Alataş Ozkan , Alataş Füsun , Metintaş Muzaffer , Uçgun Irfan , Harmanci Emel , Çolak Omer
Published: January 2004

Background: Bacterial infection of the lower respiratory tract initiates an acute inflammatory response. Regulation of the inflammatory response in bacterial pneumonia depends on a complex interaction between immune cells and inflammatory cytokines. Objectives: We investigated the initial levels of proinflammatory cytokines and acute phase reactants (APR), e.g. C-reactive protein (CRP), upon presentation of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Methods: We prospectively studied 28 consecutive patients with unilateral CAP. Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and IL-8 concentrations were measured by ELISA in both bronchoalveolar lavage (BAL) fluid and serum. Results: The concentrations of IL1-β and IL-6 in BAL fluid were found to be significantly higher in the involved lung than those in either the noninvolved lung (p = 0.008 and p = 0.012, respectively) or serum (p = 0.002 and p = 0.025, respectively). Serum CRP concentrations were increased compared to those in the involved and noninvolved lung in BAL fluid (p = 0.000 and p = 0.000, respectively). In serum and BAL from involved lung, IL-6 concentrations were higher in the systemic inflammatory response syndrome (SIRS) group than in the non-SIRS group (p < 0.05), whereas CRP, TNF-α , IL-1β and IL-8 concentrations showed no difference between SIRS and non-SIRS. There was no significant correlation between the acute physiology and chronic health evaluation II score and the cytokines. Conclusions: Our results indicate that the CRP level is higher in the serum than in the BAL fluid in the lung, and that IL-6 is the most important cytokine for the determination of the severity of the disease.
Cavernous Hemangiomas of Lungs and Liver in an Asymptomatic Girl
Authors: Kobayashi Akira , Ohno Shoji , Bando Masashi , Oshikawa Katsuhisa , Sugiyama Yukihiko
Published: January 2004

We describe a 15-year-old asymptomatic girl with multiple pulmonary nodules which turned out to be cavernous hemangiomas. The radiological findings of other organs revealed no abnormalities, excluding the liver, where multiple low-density areas were located. Thoracoscopy and laparoscopy revealed cavernous hemangiomas of the lung and liver. While liver cavernous hemangiomas are common, pulmonary hemangiomas are fairly rare. Although cavernous hemangiomas are classified as malformations, some of these lesions have been reported to grow. In pulmonary hemangiomas, some cases have an inexorable clinical course with hemoptysis, respiratory distress, and heart failure. In our case, the lesions have not remarkably progressed under observation for more than 2 years.
Methodological Aspects of Bronchoscopic Lung Volume Reduction with a Proprietary System
Authors: Toma Tudor P. , Polkey Michael I. , Goldstraw Peter G. , Morgan Clifford , Geddes Duncan M.
Published: January 2004

Bronchoscopic lung volume reduction (BLVR) is emerging as a new technique to palliate symptoms in patients with severe emphysema. Several devices and techniques are being developed to occlude airways resulting in collapse and reduced lung volume. Here we present in detail the methodological aspects of one such interventional bronchoscopic approach.
Inflammation and Obstructive Sleep Apnea Syndrome Pathogenesis: A Working Hypothesis
Authors: Hatipoğlu Umur , Rubinstein Israel
Published: January 2004

Obstructive sleep apnea syndrome (OSAS) afflicts about 5% of adults in Western countries and is thought to play an important role in the pathogenesis of cardiovascular disorders and diabetes mellitus. Although the etiology of OSAS is uncertain, intense local and systemic inflammation are present in these patients. In the upper airway, this process may promote oropharyngeal inspiratory muscle dysfunction and amplify upper airway narrowing and collapsibility thereby worsening the frequency and duration of apneas during sleep. The presence of systemic inflammation, characterized by elevated levels of certain potent pro-inflammatory mediators, such as C-reactive protein, leptin, TNF-α, IL-1β, IL-6, reactive oxygen species and adhesion molecules, may predispose to the development of cardiovascular complications observed in patients with OSAS. Treatment with nasal CPAP abrogates, in part, local and systemic inflammation in these patients. Whether therapeutic interventions aimed at abating inflammation could be a useful adjunct in the treatment of OSAS merits further investigation.
Lactoferrin Inhibits Growth of Malignant Tumors of the Head and Neck
Authors: Wolf Jeffrey S. , Li Daqing , Taylor Rodney J. , O’Malley Jr. Bert W.
Published: January 2004

Lactoferrin, a naturally occurring glycoprotein found in breast milk, has previously been shown to have antimicrobial properties and recently has been demonstrated to inhibit malignant tumor growth, presumably through immunomodulation. We hypothesized that intratumoral injection of human and murine recombinant lactoferrin would decrease the growth of malignant tumors in vivo. Using an orthotopic murine model for both squamous cell carcinoma and fibrosarcoma of the floor of the mouth, we administered lactoferrin directly into the tumors using variable dosing strategies. Additionally, we performed in vitro experiments to assess whether the effects of lactoferrin are due to direct cytotoxicity. Our results revealed growth inhibition of 50% (p = 0.03)and 54% (p = 0.01) as compared with controls for both human and murine tumor cells in immunodeficient and immunocompetent mice, respectively. There was a more dramatic effect in immunocompetent models which may identify immunomodulation as an important mechanism of action for lactoferrin. Support for immunomodulation as a possible mechanism was the lack of any difference between controls and the experimental groups in vitro. Lactoferrin proved effective in reducing malignant tumor growth in a murine model. These properties offer hope for its use as a primary or adjuvant chemotherapeutic agent. Further investigation focused on mechanism and delivery is needed.
The Effect of Different ‘Pass-Fail’ Criteria on the Results of a Newborn Hearing Screening Program
Authors: Korres Stavros , Balatsouras Dimitrios , Ferekidis Eleftherios , Gkoritsa Eleni , Georgiou Anastasia , Nikolopoulos Thomas
Published: January 2004

‘Pass’ criteria in newborn hearing screening programs are important, since they affect the operating characteristics of the programs. In the present study, we intended to compare the results of two screening procedures, using different ‘pass’ criteria, in two samples from the same pool of screened newborns. The subjects were divided into two study groups, screened consecutively during 6 months. Testing and all procedures were exactly the same in both groups, differing only in the ‘pass’ criteria. In the first group a signal-to-noise ratio of at least 3 dB in the frequency bands of 1–2, 2–3 and 3–4 kHz was considered necessary for a ‘pass’, whereas a signal-to-noise ratio ≧6 dB was used in the second group, at the same frequency bands. During the period of the study, no other minor or major modification of the protocol was applied. The comparison of the screening predischarge results between the two groups showed no statistically significant differences in the ‘pass-refer’ results. Thus, it appears that the 3-dB signal-to-noise ratio is as valid as the 6-dB criterion, and it may be confidently used, especially in settings where rescreening is not available.
Magnetic Resonance Imaging of Endolymphatic Sac in Acute Low-Tone Sensorineural Hearing Loss without Vertigo
Authors: Sugiura Makoto , Naganawa Shinji , Nakashima Tsutomu , Misawa Hayato , Nakamura Tatsuya
Published: January 2004

The etiology of acute low-tone sensorineural hearing loss (ALHL) may be associated with deteriorated function of the endolymphatic sac. Using magnetic resonance (MR) imaging on a 1.5-tesla MR system, we evaluated the frequency of visualization and contrast enhancement of the endolymphatic sac in 25 patients (9 men and 16 women; age range 11–64 years) with ALHL and 21 control subjects. The present study demonstrated that the frequency of visualization and enhancement of the endolymphatic sac in patients with ALHL was not significantly higher than in control subjects.
Management Pathways and the Surgical Diagnosis of Tuberculous Lymphadenitis: Can They Be Improved? The Bradford Experience
Authors: Tsikoudas A.
Published: January 2004

Objective: To study the diagnostic pathway for tuberculous lymphadenitis from initial referral to the commencement of antituberculous therapy with the object of identifying potentially avoidable delays. Design: Retrospective case series study. Setting: District General Hospital, England, UK. Subjects: Thirty-four patients with head and neck tuberculous lymphadenitis diagnosed by a positive histological specimen over the 3-year period 1998–2000. Results: There were no clear pathways for referral and management. There were substantial variations in the management between different specialties and even sometimes within the same specialty. There was evidence of poor communication between various teams. Conclusions: The study shows that for the management of head and neck tuberculous lymphadenitis, there is a need for a ‘hospital’ or ‘trust’ approach. It also reinforces the arguments for a dedicated ‘neck lump clinic’ with easy access both from the general practitioners and from other specialties within the hospital and for a protocol for handling biopsy specimens from nodes.
Changes of Hair Cell Stereocilia and Threshold Shift after Acoustic Trauma in Guinea Pigs: Comparison between Inner and Outer Hair Cells
Authors: Chen Yuh-Shyang , Liu Tien-Chen , Cheng Chiung-Hsiang , Yeh Te-Huei , Lee Shiann-Yann , Hsu Chuan-Jen
Published: January 2004

The vulnerability of inner hair cells (IHCs) and outer hair cells (OHCs) to acoustic overstimulation is still controversially discussed. The present study was undertaken to investigate the vulnerability of IHCs and OHCs and the relation between chronological changes of auditory threshold shifts and stereocilia damages on IHCs and OHCs in guinea pigs after moderate acoustic trauma, caused by a single continuous exposure to pink noise (20 Hz to 20 kHz) of around 106 ± 2 dB SPL for 44 h. Stereocilia changes and threshold shifts of auditory brainstem responses (ABR) were assessed at regular intervals after noise exposure for 9 weeks. Scanning electron microscopy demonstrated the morphological changes of steriocilia as early as 1 day after noise exposure. The morphological changes included fused, bent, collapsed, and even missing stereocilia. These damages were more prominent on IHCs than on OHCs. The shift of ABR threshold was not parallel to the chronological change of the stereocilia on IHCs as well as OHCs. The elevation of the ABR threshold (40–60 dB SPL) was greatest on the 1st day after noise exposure, whereas the stereocilia showed the most damage 7 days after noise exposure. Combined with the results from previous studies, we conclude that moderate-level (around 105–110 dB) noise tends to induce more damage to the stereocilia of IHCs than of OHCs. Other damage (e.g., metabolic disturbance) than morphological damage of hair cell stereocilia may contribute partially to the hearing threshold shift induced by moderate acoustic overstimulation.
Optimal Specimen Site for Diagnosis of Nasal T/NK Cell Lymphoma and Treatment Including Bone Marrow Transplantation
Authors: Sakamoto Masayuki , Miyairi Yasuo , Ishizawa Mitsugu
Published: January 2004

Nasal T/NK cell lymphoma is characterized by unrelenting progressive ulceration and necrosis of the nasal cavity and midline facial tissues. Computer tomography scans and biopsy specimens from 4 cases were studied in order to determine the optimal sampling site. Specimens should be from the lateral plate of the nasal cavity and the inferior turbinate. Bone marrow transplantation was performed in 2 cases following chemotherapy and radiotherapy. The combination of chemotherapy, radiotherapy, and bone marrow transplantation has some ability to control the disease.
Decreased Measles Virus-Neutralizing Activity in Sera from Otosclerotic Patients
Authors: Lolov Stephan , Zarzalanova Petya , Edrev George , Kyurkchiev Stanimir
Published: January 2004

Hypothesis: Any kind of depressed systemic anti-measles reaction can lead to the induction of a local immune response in the inner ear and possibly to reactivation of bone turnover in this region. Methods: Different dilutions of sera were tested for neutralizing activity against a constant viral concentration. The ability of measles virus to infect and replicate in the cell monolayer was detected by enumeration of living and growing cells with a colored reaction. Results: Virus-neutralizing activity in the sera of patients with confirmed otosclerosis was significantly weaker than in that of healthy controls. When age- and sex-matched pairs were compared, the neutralizing activity in the healthy counterpart was higher in 5 cases. Nearly complete viral neutralization was achieved with samples containing inactivated complement and in IgG-containing fractions, but not in immunoglobulin-depleted samples. Conclusion: The present study is consistent with measles virus participation at least in the initiation of some cases of otosclerosis.
Benign Mixed Tumor of the Lacrimal Gland
Authors: Sadick Haneen , Riedel Frank , Naim Ramin , Gössler Ulrich , Hörmann Karl , Bergler Wolfgang F.
Published: January 2004

The accurate clinical diagnosis of benign mixed tumors of the lacrimal gland is important for the proper therapeutic management. We present an adult case with a benign mixed tumor of the orbital lobe of the lacrimal gland, 8 years after periorbital blunt injury. The tumor lesion was diagnosed later in the persisting traumatic tumefaction region. Clinical examination, ultrasonography and MRI revealed a soft-tissue mass with high density and peripheral enhancement over the superior lateral portion of the right eye with expansion to and invasion of the orbital roof and lateral wall. Lateral orbitotomy was performed to resect the tumor. Histopathology disclosed a pleomorphic adenoma of the orbital lobe of the lacrimal gland. Pleomorphic adenomas of the lacrimal gland are seen rarely. The awareness of the clinical and diagnostic features of benign mixed tumors of the orbital lobe should help to avoid complications arising from an incisional biopsy or incomplete tumor resection.
Benign Paroxysmal Positioning Vertigo: Diagnosis and Therapy Using Video-Oculographic Control
Authors: Yakinthou A. , Maurer J. , Mann W.
Published: January 2004

In this prospective study, 82 patients (40 males, 42 females, aged between 15 and 80 years) with benign paroxysmal positioning vertigo (BPPV) were treated with different positioning manoeuvres using video-oculographic control. The maximum age for females and males was 31 and 40 years respectively. After an interview about the special history related to vertigo imbalance symptoms and using video-oculographic control, we diagnosed 79 patients with BPPV of the posterior semicircular canal and 3 of the horizontal semicircular canal. The Dix-Hallpike and Cawthorne manoeuvres were used for the diagnosis of BPPV of the posterior semicircular canal and the McClure manoeuvre for the diagnosis of BPPV of the horizontal semicircular canal. 72% of the patients had an idiopathic BPPV and 12.2% were post-traumatic. 3.7% had BPPV after ear surgery and 2.4% were pregnant. 39 patients with posterior BPPV were treated with Semont’s manoeuvre and 40 with Epley’s. The 3 patients with horizontal BPPV were treated with Baloh’s manoeuvre. More than half of the patients (52.5%) were free of symptoms after one session of Epley’s manoeuvre and all of them after four sessions. 51.3% had no further symptoms after one session of Semont’s manoeuvre and all of them after four sessions. These results, in agreement with the literature, show that the success rate of Semont’s and Epley’s manoeuvres is approximately the same. Video-oculographic control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres.
Recurrent Ceruminous Adenocarcinoma of the External Auditory Canal
Authors: Tzagaroulakis Antonios , Pasxalidis John , Papadimitriou Nikolaos , Boussiotou Aggeliki , Nikolopoulos Thomas , Korres Stauros , Ferekidis Eleutherios
Published: January 2004

Ceruminous adenocarcinoma is a rare malignant neoplasm of the glandular structures of the external auditory canal. The true incidence and behavior of these rare tumors are still unclear due to confusing terminology, classification and histological definitions. Therefore, the ENT surgeon faces major difficulties in choosing the method of management – conservative or more radical surgery – with the addition or not of radiotherapy. We report a 57-year-old male patient with a recurrence of a previously excised (maybe partially) and irradiated ceruminous adenocarcinoma of the right external auditory canal. Aggressive surgery was considered as the treatment of choice. However, the patient refused this approach and, as a consequence, a conservative excision was performed but with histologically confirmed healthy margins. To our surprise, the patient showed an excellent response and he is disease free 3 years following the last operation. Although recurrences usually occur within months after inadequate management, some may happen even 7 years post treatment. Therefore, routine long-term follow-up was advised.
Refractory Rhinosinusitis Complicating Immunosuppression: Application of N-Chlorotaurine, a Novel Endogenous Antiseptic Agent
Authors: Gstöttner Michaela , Nagl Markus , Pototschnig Claus , Neher Andreas
Published: January 2004

Severe infections are a frequent complication in immunosuppression following transplantations. In the case reported here, a heart-transplanted patient was treated for refractory rhinosinusitis with a combination of sinus surgery and rinsing with N-chlorotaurine (NCT). The daily rinse was well tolerated and effective. The combination of functional endonasal sinus surgery and topical treatment with NCT appeared effective and well tolerated in antibiotic-resistant sinusitis under immunosuppression.
A Case Report of Unilateral Hypoglossal Neuroparalysis Resulting from Horizontal Subluxation in the Atlanto-Occipital Joint due to Rheumatoid Arthritis
Authors: Konishi Aki , Higo Ryuzaburo , Nito Takaharu , Masumoto Tomohiko , Seichi Atsushi
Published: January 2004

We experienced a case of unilateral hypoglossal neuroparalysis, in which the right hypoglossal nerve was compressed by horizontal subluxation in the atlanto-occipital joint, due to rheumatoid arthritis. This report represents a very rare case of unilateral hypoglossal neuroparalysis, in which diagnostic imaging of CT with multiple cross-sectional images (three-dimensional CT) was quite useful for the identification of compression by horizontal subluxation.
Reflections on Shunt Infection
Authors: Kanev Paul. M. , Sheehan Jonas M.
Published: January 2004

The placement and revision of ventriculoperitoneal (VP) shunts remains a mainstay in the surgical treatment of hydrocephalus. While the North American infection rate averages nearly 8–10%, published infection rates for VP shunt infection below 1% have been reported. We retrospectively reviewed shunt operations by a single surgeon over 62 months to analyze the infection rate. In 62 months, we performed 526 shunt placements or revisions in patients up to 18 years of age. There were 7 shunt infections (1.33%). In 5 cases, the organism was Staphylococcus epidermidis, and a single shunt each was infected with Haemophilus influenzae and Staphylococcus aureus. Each infection was treated with external ventriculostomy drainage and intravenous antibiotics. The new shunt was placed at a new incision site after at least 5 days of sterile spinal fluid cultures. The mean follow-up among these patients after shunt insertion was 25 months. VP shunting remains the most common operation for hydrocephalus. Infections are linked with seizures, higher future risks of shunt infection and malfunction, and reduced IQ and school performance. Our infection rate during 62 months was limited to 1.33%. Uniform surgical technique, limited hardware and skin edge manipulation and double gloving may be important factors in limiting shunt infections.
Lumbar Split Cord Malformation and Klippel-Feil Syndrome
Authors: Tubbs R. Shane , Wellons, III John C. , Oakes W. Jerry
Published: January 2004

The authors report a patient with type II split cord malformation (SCM) and Klippel-Feil syndrome (KFS). Considering our review of the medical literature and present case report, we believe lumbar SCM and KFS in the same patient not to be coincidental findings but rather embryologically related entities. We propose that KFS in at least one of its phenotypes represents a forme fruste of occult spinal dysraphism.
Tacrolimus and Cyclosporine A Are of No Benefit to Young Rats with Kaolin-Induced Hydrocephalus
Authors: Khan Osaama H. , Enno Terry , Del Bigio Marc R.
Published: January 2004

Hydrocephalus causes damage to periventricular axons. Tacrolimus, cyclosporine A (CsA) and calpain inhibitors have been shown to protect axons in rat models of acute traumatic brain injury. We hypothesized that these agents would ameliorate the axon damage and behavioral effects in experimental hydrocephalus. Hydrocephalus was induced in 3-week-old rats by injection of kaolin into the cisterna magna. Tests of cognitive and motor function were performed on a weekly basis. In a blinded and randomized manner, tacrolimus (FK506; 3.6 mg/kg body weight) or CsA (10 mg/kg) was administered once daily by subcutaneous injection for 2 weeks, beginning 2 weeks after induction of hydrocephalus. In a separate experiment, calpain inhibitor I (10 mg/kg/day) was administered by continuous subcutaneous infusion. The brains were subjected to histopathological and biochemical analyses after 2 weeks of treatment. There was no statistically significant protection in regard to behavior, brain structure or brain composition in any of the experiments. However, there was biochemical and histological evidence of renal injury following chronic tacrolimus and CsA administration. Calcineurin inhibition does not offer significant protection in this rat model of hydrocephalus.
Surgical Outcome following Resection of Contrast-Enhanced Pediatric Brainstem Gliomas
Authors: Lesniak Maciej S. , Klem Jack M. , Weingart Jon , Carson, Sr. Benjamin S.
Published: January 2004

Background: The role of surgery in the management of gadolinium-enhancing pediatric brainstem lesions on magnetic resonance imaging (MRI) has been a matter of open debate. This clinical series correlates radiological and pathological findings to assess the role of contrast enhancement as an indication for surgery with respect to clinical outcome. Methods: We retrospectively reviewed the charts of all pediatric patients admitted to the Johns Hopkins Hospital with a diagnosis of a brainstem tumor between January 1985 and December 2000. Results: There were a total of 89 patients who met the inclusion criteria. Fifty-seven patients (64.0%) underwent surgical resection while 32 (36%) were treated with radiation and/or chemotherapy. Of the surgical candidates, 57 (100%) had an accompanying MRI scan significant for an enhancing lesion in the midbrain, pons or the medulla. The pathology was consistent with juvenile pilocytic astrocytoma in 30 patients (52.6%) and glioblastoma multiforme in 12 patients (21.1%). The remaining cases consisted of 10 patients (17.5%) with fibrillary astrocytomas, 3 (5.3%) with gangliogliomas, 1 (1.8%) with an oligodendroglioma and 1 (1.8%) with a primitive neuroectodermal tumor. A total of 29 patients had a total surgical resection, 8 a near total resection (>90%), 15 a subtotal resection (50–90%) and 5 a partial resection (<50%). The progression-free survival of all patients was 71.9% at 3 years and 45.6% at 5 years. Conclusions: This case series illustrates that contrast-enhanced MRI has positive prognostic value in the management of pediatric brainstem gliomas. In our study, the majority of enhancing tumors were low grade and amenable to surgical intervention. Consequently, we recommend surgical resection and pathological diagnosis of all enhancing brainstem tumors with adjuvant therapy reserved for recurrent or unresectable cases.
Cystoventricular Shunting of Intracranial Arachnoid Cysts
Authors: McBride Lori A. , Winston Ken R. , Freeman Jane E.
Published: January 2004

Ten patients with intracranial arachnoid cysts were treated with direct shunting of the cyst to a lateral ventricle. The strategic goal of cystoventricular shunting is to establish physiologically normal intracranial pressure relationships, rather than cyst obliteration. Cystoventricular shunts were successful in treating single and multiple intracranial cysts in supratentorial and infratentorial locations and in patients with normal and enlarged lateral ventricles. Cystoventricular shunting is conceptually simple as well as effective and reliable.
Distances from the Atlantal Segment of the Vertebral Artery to the Midline in Children
Authors: Tubbs R. Shane , Smyth Matthew D. , Wellons, III John C. , Oakes W. Jerry
Published: January 2004

There are scant data in the literature regarding distances from the midline to the suboccipital segment of the vertebral artery, and to our knowledge, none addressing this measurement in the pediatric population. This study seeks to establish age-related distances (Y) from the laterally placed vertebral artery to the midline at the level of the posterior arch of the atlas in children. Measurements from the midline to the most medial portion of the vertebral artery at the level of the posterior arch of the atlas were made in 50 children who underwent CT imaging of the cervical spine. For all left sides, Y = 12–23 mm (mean 17 mm). For all right sides, Y = 10–25 mm (mean 17.5 mm). For girls, Y = 12–16 mm (mean 12.7 mm) for left sides and Y = 12–25 mm (mean 18.5 mm) for right sides. For boys, Y = 12–20 mm (mean 16 mm) for left sides and Y = 10–21 mm (mean 16.7 mm) for right sides. We have found that the most medial portion of the vertebral artery from the midpoint of the posterior arch of the atlas for all ages was approximately 17 and 17.5 mm for left and right sides, respectively. This distance was generally less for left sides, except in the 16–19 years age group. However, as a group, this distance did not vary more than 2.8 mm between left and right sides. These data should assist the neurosurgeon who operates in the suboccipital region in children.
Estimated Blood Loss Underestimates Calculated Blood Loss during Radical Retropubic Prostatectomy
Authors: McCullough T. Casey , Roth Jonathan V. , Ginsberg Phillip C. , Harkaway Richard C.
Published: January 2004

Objective: To compare the calculated blood loss for radical retropubic prostatectomy (RRP) with the anesthesiologist’s and operating surgeon’s estimates of operative blood loss. Methods: A retrospective review of 52 consecutive patients undergoing RRP between January 1999 and February 2000 was performed. Patient charts were reviewed for preoperative hemoglobin (Hgbi), preoperative hematocrit (Hcti), body weight (Wt), anesthesiologist’s and surgeon’s estimated blood loss (EBLA and EBLS), and postoperative day one morning hemoglobin (Hgbf) and hematocrit (Hctf). For each patient, the actual blood loss (ABL), i.e., the amount of blood that left the patient’s body, was calculated as the average ABLn resulting from two computations of the following formula: ABLn = (EBV × (Hi – Hf)) / ((Hi + Hf)/2) + (500 × Tu) where: (1) estimated blood volume (EBV) is assumed to be 70 cm3/kg; (2) Hi and Hf represent Hgbi and Hgbf for one computation and Hcti and Hctf for the second computation, and (3) Tu is the sum of autologous whole blood (AWB), packed red blood cells (PRBC), and cell saver (CS) units transfused. For each patient, ABL was compared with EBLA and EBLS. Descriptive statistics of the pooled data were calculated. Results: The mean (± SD) age was 60 ± 7.1 years. The mean ABL was 2,774 ± 1,014 cm3. Patients received an average of 1.96 U CS, 0.14 U PRBC, and 0.42 U AWB. Five patients (9.6%) were exposed to homologous blood. The average ABLnet (i.e. ABL reduced by the amount of CS returned) was 1,794 ± 806 cm3. EBLA and EBLS were 1,337 ± 676 and 1,300 ± 658 cm3, respectively. Conclusion: During radical retropubic prostatectomy, anesthesiologists and urologists both appear to underestimate blood loss as determined by standard calculation.
Radiotherapy in cT3 Prostatic Carcinoma: Retrospective Comparison between Neoadjuvant and Adjuvant Hormonotherapy
Authors: Cellini Numa , Luzi Stefano , Morganti Alessio Giuseppe , Valentini Vincenzo , Mantini Giovanna , Racioppi Marco , Smaniotto Daniela , Leone Mariavittoria , Mattiucci Gian Carlo , Digesù Cinzia , Giustacchini Mario , Destito Antonio , Alcini Eugenio
Published: January 2004

Introduction: The aim of this study was to retrospectively compare the clinical outcomes achieved in 2 groups of patients with cT3 prostatic carcinoma undergoing neoadjuvant hormonotherapy and neoadjuvant hormonotherapy plus adjuvant hormonotherapy with external beam radiotherapy. Patients and Methods: One hundred patients with cT3N0M0 prostatic carcinoma underwent radiotherapy to pelvic lymph nodes (45 Gy, 1.8 Gy/fraction) with a booster dose (65–70 Gy) to the prostatic cavity. Forty-four patients received neoadjuvant hormonotherapy (goserelin, starting 2 months before radiotherapy and continuing until the end of irradiation); 56 patients received neoadjuvant hormonotherapy plus adjuvant goserelin until disease progression, if present. Results: Patients undergoing adjuvant hormonotherapy as compared to those who received exclusive neoadjuvant therapy showed a higher reduction in PSA level below 1.0 ng/ml (p = 0.0211), a lower incidence of biochemical failures (p = 0.0170), a lower incidence of hematogenous metastases (p = 0.0320) and a trend suggestive of a better disease-free survival (p = 0.0660). At univariate analysis (logrank), Gleason score did not show a significant correlation with any of the end points analyzed. To the contrary, patients with tumor <15 mm showed a better local control (p = 0.0347) and biochemical failure-free survival (p = 0.0102). Furthermore, a trend between initial PSA level and incidence of hematogenous metastases was observed (p = 0.0519). Patients with a posttreatment PSA level <1.0 ng/ml had a lower incidence of metastases (p = 0.0237) and a better survival (p = 0.0178); patients with complete clinical response showed a lower incidence of biochemical failures (p = 0.0469). Radiotherapy doses >70 Gy showed a trend with biochemical failure-free survival (p = 0.0554). At multivariate analysis, a correlation between Gleason score and incidence of metastases (p = 0.0232), and between tumor diameter and local control (p = 0.0178) and biochemical failure-free survival (p = 0.0290) was recorded. Conclusions: In patients with cT3N0M0 prostate carcinoma, prolonged hormonotherapy was shown to be significantly correlated with biochemical failure-free survival and distant metastasis-free survival. Furthermore, tumor size had a significant impact on biochemical failure-free survival as well as on local control.
Squamous Cell Carcinoma of the Prostate
Authors: Kanthan R. , Torkian B.
Published: January 2004

Squamous cell carcinoma of the prostate is uncommon. In an attempt to assess the incidence of squamous cell carcinoma of the prostate, we searched the records of the Saskatchewan Cancer Agency over the past 30 years. Using strict diagnostic criteria a total of 6 cases of pure squamous cell carcinoma among 13,497 cases of prostatic carcinoma were identified. The ages of these patients ranged from 42 to 85 years. The survival rates of these cases ranged from 1 to 13 months.
Treatment of Benign Prostatic Hyperplasia through Transurethral Needle Ablation (TUNATM)
Authors: Braun M. , Mathers M. , Bondarenko B. , Engelmann U.
Published: January 2004

Following FDA clearance and the establishment of Medicare coverage, transurethral needle ablation (TUNA) has become an established and widely-adopted treatment method for BPH in the USA. Germany is lagging behind at present, though a change can also be recognized there. The lack of long-term data has often been criticized. This review presents an overview of clinical outcomes of TUNA, long-term results and patient selection criteria.
Urodynamic Parameters for the Diagnosis of Bladder Outlet Obstruction in Women
Authors: Kuo Hann-Chorng
Published: January 2004

Introduction: Bladder outlet obstruction (BOO) is often overlooked in the diagnosis of women with lower urinary tract symptoms. Although the incidence of BOO is not high in the female population with lower urinary tract symptoms, a correct diagnosis for BOO is important. This study was designed to compare the urodynamic parameters in women with bladder outlet obstruction (BOO), stress urinary incontinence (SUI) and asymptomatic volunteers. Materials and Methods: Videourodynamic study was performed in 76 patients who were clinically diagnosed as BOO, 265 with stress urinary incontinence (SUI). In addition, 30 asymptomatic female volunteers were recruited and served as controls. Voiding pressure (Pdet.Qmax), maximum flow rate (Qmax), and urodynamic parameters were compared among the BOO, SUI and control groups and the criteria values for BOO in women were estimated. Results: BOO was identified in 30 women with bladder outlet stricture, 40 women with dysfunctional voiding, and 6 women with high-grade cystocele. The mean Pdet.Qmax was significantly higher and the mean Qmax was significantly lower in the obstructed groups. When a Pdet.Qmax ≧35 cm H2O was set as the criteria for BOO, the sensitivity was 96.1% and specificity was 89.0%, whereas a Pdet.Qmax of ≧30 cm H2O had a sensitivity of 100% but the specificity was only 65.5%. If the criteria of BOO was set as Pdet.Qmax ≧35 cm H2O combined with Qmax ≤15 ml/s, the sensitivity for BOO was 81.6% and specificity was 93.9%. Conclusions: Our results demonstrate a Pdet.Qmax of ≧30 cm H2O is a good index value for screening of female BOO. When a Pdet.Qmax of ≧35 cm H2O combined with a Qmax ≤15 ml/s was found, a high suspicion of BOO should be raised, for which a specificity of 93.9% and sensitivity of 81.6% for BOO was obtained.
The Prevalence of Female Sexual Dysfunction and Potential Risk Factors That May Impair Sexual Function in Turkish Women
Authors: Çayan Selahittin , Akbay Erdem , Bozlu Murat , Canpolat Bülent , Acar Deniz , Ulusoy Ercüment
Published: January 2004

Objectives: To detect the prevalence of sexual dysfunction, and also to investigate possible risk factors that may cause sexual dysfunction in the Turkish women. Materials and Methods: The study consisted of 179 women between the ages of 18 and 66 years living in households from different sociocultural areas. The women were divided into 5 groups according to their ages: 18–27 years (n = 23), 28–37 years (n = 55), 38–47 years (n = 43), 48–57 years (n = 44) and 58–67 years (n = 14). Female sexual function was evaluated with a detailed 19-item questionnaire to assess desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was calculated for each domain and compared among the groups. In addition, demographic characteristics and medical risk factors were assessed in all women, and the findings were compared between the women with and without sexual dysfunction. Results: Based on total sexual function score, 84 (46.9%) out of 179 women had sexual dysfunction. The prevalence of female sexual dysfunction was 21.7% in the ages of 18–27 years, 25.5% in the ages of 28–37 years, 53.5% in the ages of 38–47 years, 65.9% in the ages of 48–57 years and 92.9% in the ages of 58–67 years. The prevalence of sexual dysfunction for each domain also increased with age. To investigate various factors that may cause female sexual dysfunction, no significant differences were detected in smoking history (p = 0.14), marriage age (p = 0.7), the presence of previous pelvic surgery (p = 0.09), and contraception methods used (p = 0.31). However, sexual dysfunction was observed as significantly higher in the presence of older age (p = 0.001), lower educational level (p = 0.012), unemployment status (p = 0.017), chronic disease (p = 0.032), multiparity (p = 0.0027) and menopause status (p = 0.0001). Conclusions: The prevalence of female sexual dysfunction including desire, arousal, lubrication, orgasm, satisfaction and pain problems increases with age. In addition, the presence of a lower educational level, unemployment status, chronic diseases, multiparity and menopause status are important risk factors that may cause sexual dysfunction.
A New Tension-Adjustment Technique for Sling Operation: An Animal Model
Authors: Kafali Hasan , Verit Ayhan , Iriadam Mehmet , Unal Doğan , Demir Nurettin
Published: January 2004

Objective: To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding difficulties encountered after sling operations. Method: To test our new method, urethral obstruction was developed in 5 female dogs by modifying the sling operation by exerting more tension on a specially prepared polypropylene strip in which a gap had been developed. After filling the bladder with isotonic solution, detrusor contractions were induced by pelvic nerve stimulations, and urodynamic studies were performed to document the urethral obstruction. In each case Foley catheters were inserted into the bladder and left in place until the time of tension adjustment. Tension adjustment was performed in the 1st, 2nd, 3rd, 4th and 5th weeks postoperatively for dogs 1, 2, 3, 4, and 5, respectively. Results: On the day of tension adjustment, after filling the bladder with isotonic solution and removing the Foley catheter, none of the dogs, except dog 3, was able to produce a free flow of urine either spontaneously or provoked by detrusor contractions. The release of the prolene sutures was readily achieved in all cases except dog 5. In this case, sling takedown was achieved after surgical exploration in which the sling location was confirmed by following the prolene sutures and Hegar’s dilator. After identifying the sling, the gap was opened by cutting the prolene sutures, instead of a sling incision. Release of the prolene sutures resulted in a distinct drop in the urethra with decreased resistance of Hegar’s dilator. The improvement in voiding was confirmed by postoperative urodynamic studies and was immediate in all cases. Conclusion: Our new technique for postoperative voiding difficulties encountered after sling operation is simple, effective and avoids re-operation in the early postoperative period.