bluuebunny/crossref_metadata_2025 huggingface dataset:
An Epidemiological Study of Migraine with Aura in the San Severo General Population: A Pilot Research Project of Cooperation between Neurologists and General Practitioners
Authors: Cologno Daniela , Manzoni Gian Camillo , Drion Medical Association D
Published: December 2003

Objectives: (A) To define the lifetime prevalence of migraine with aura (MA) in patients recruited in general practices for an epidemiologic study by the University of Parma Headache Centre from the general population of San Severo, Italy, and (B) to assess the recognition of MA in general practice. Methods: The study was conducted over a period of 5 consecutive months (January to May 2001) on patients aged 18–65, taken from the following general practice populations: (a) from the patient population of 4 general practitioners (GPs; 3,616 patients) and (b) from the patient population of 12 GPs (12,996 patients). The clinical diagnosis of MA was subsequently confirmed by a headache specialist. Results: For objective A, 648 patients (420 women and 228 men) were interviewed; MA diagnosis was confirmed in 10 patients (7 women and 3 men), lifetime MA prevalence being 1.5%. For objective B, 150 ‘suspected’ MA cases (96 women and 54 men) were reported by the 12 GPs; however, the diagnosis of MA was confirmed in only 3 cases (2 women and 1 man). Conclusion: The prevalence of MA observed in our small sample of the general practice patient population was comparable with that observed in the general population of San Severo, Italy. The results also suggest that GPs may be overestimating the number of cases of MA in their patient population.
Induction of Apoptosis of CD4+ T Cells by Immunomodulatory Therapy of Multiple Sclerosis with Glatiramer Acetate
Authors: Rieks Maike , Hoffmann Volker , Aktas Orhan , Juschka Miriam , Spitzer Iris , Brune Nils , Schimrigk Sebastian , Przuntek Horst , Pöhlau Dieter
Published: December 2003

Glatiramer acetate (GA), a mixture of synthetic polypeptides, has beneficial effects on the clinical course and the MRI-defined disease activity of patients with multiple sclerosis (MS). In MS, evidence has been provided that the apoptosis of disease-relevant T cells is dysregulated. In this study, we investigated the effect of GA on T cell apoptosis, T cell activation, and cytokine profile of lymphocytes derived from 19 relapsing-remitting MS patients during the first year of GA therapy. Analysis of blood samples obtained every 6 weeks showed an increase in apoptotic T helper cells after 30 weeks of therapy. This effect remained until the end of the study and was accompanied by an increase in activated T cells and interleukin-4-producing lymphocytes. Thus, in addition to the established effect of GA on the cytokine network, GA-mediated immunomodulation might involve the apoptotic elimination of T helper cells.
Impact of Emergency Room Neurologists on Patient Management and Outcome
Authors: Moulin Thierry , Sablot Denis , Vidry Elisabeth , Belahsen Faouzi , Berger Eric , Lemounaud Patrick , Tatu Laurent , Vuillier Fabrice , Cosson Anne , Revenco Eugeniu , Capellier Gilles , Rumbach Lucien
Published: December 2003

The frequency and impact of in-patient assessment by a neurologist in the emergency room (ER) setting remain largely underestimated. The objective of our study was to analyse the impact of neurologist in-patient management. Methods: Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the ER, the ER team’s tentative neurological diagnosis, the neurology team’s final diagnosis and patient outcomes. The time interval between admission, call for a neurologist and the assessment by the neurologist were recorded. Results: Assessments by neurologists were performed in 14.7% (1,679/11,421) of all patients admitted to the ER. The mean time between admission and examination was 32 (± 36) min, irrespective of the day of the week, and dependent on the tentative diagnosis: shorter for stroke and status epilepticus (p < 0.05) and longer for confusion and vertigo (p < 0.05). The initial causes for examination were: stroke (33.1%), epilepsy (20%), loss of consciousness (9%), headaches (9%), confusion (5.4%), peripheral nervous system disorders (4.4%), vertigo (4.2%), cognitive dysfunctions (4%), gait disorders (3.2%) and miscellaneous (7.1%). Overall, false positive or negative diagnoses were produced by the ER in 37.3 and 36.6% of ER admissions, respectively. A complete change of diagnosis by the neurologist was found in 52.5% of patients. Of the patients undergoing a neurological examination, 18.4% were able to go home, 31.8% were admitted to the stroke unit, 32.4% to the general neurology unit and 17.4% to other departments. Conclusion: Our study stresses the need for a neurologist in the ER, both in quantitative terms and for the benefit of patient management.
Alpha-Tocopherol and NADPH in the Erythrocytes and Plasma of Multiple Sclerosis Patients
Authors: Karg Eszter , Klivenyi Peter , Bencsik Krisztina , Turi Sandor , Vecsei Laszlo
Published: December 2003

Objectives: To investigate the influence of interferon-β-1b (INF-β-1b) therapy on blood antioxidants (α-tocopherol and NADPH) in multiple sclerosis (MS). Patients and Methods: Patients with relapsing-remitting MS (n = 14) have been studied during 6 months of INF-β-1b therapy. α-Tocopherol was determined by HPLC and UV or electrochemical detection; NADPH was quantified spectrophotometrically. Results: The erythrocyte α-tocopherol level was reduced (p < 0.001) before treatment, but had regained the control level by 6 months of therapy. The plasma α-tocopherol/lipid ratios were constant during therapy. Plasma triglyceride levels were transiently increased (p = 0.0270) after 1 month of treatment. INF-β-1b had also induced a transient decrease in NADPH after 1 month, but thereafter the level returned to approximately the initial value (p = 0.0248). Conclusion: INF-β-1b seems to exert a sparing effect toward the erythrocyte α-tocopherol content. The fall in NADPH in parallel to the rise in plasma triglycerides suggests stimulation of fatty acid synthesis by INF-β-1b.
Diffuse White Matter Lesions in Carbon Disulfide Intoxication: Microangiopathy or Demyelination
Authors: Ku Mei-Chuan , Huang Chin-Chang , Kuo Hung-Chou , Yen Tzu-Chen , Chen Chi-Jen , Shih Tung-Sheng , Chang Ho-Yuan
Published: December 2003

Long-term exposure to carbon disulfide (CS2) may induce diffuse encephalopathy with parkinsonism, pyramidal signs, cerebellar ataxia, and cognitive impairments, as well as axonal polyneuropathy. The pathogenic mechanisms of diffuse encephalopathy are unclear, although vasculopathy and toxic demyelination have been proposed. Recently, we have encountered a patient who developed headache, limb tremors, gait disturbance, dysarthria, memory impairment, and emotional lability after long-term exposure to CS2. The brain magnetic resonance images (MRI) showed diffuse hyperintensity lesions in T2-weighted images in the subcortical white matter, basal ganglia, and brain stem. The brain computed tomography perfusion study revealed a diffusely decreased regional cerebral blood flow and prolonged regional mean transit time in the subcortical white matter and basal ganglion. To our knowledge, there have been few reports demonstrating diffuse white matter lesions in chronic CS2 encephalopathy using brain MRI. In addition, the 99mTc-TRODAT-1 single photon emission computed tomography showed a normal uptake of the dopamine transporter, indicating a normal presynaptic dopaminergic pathway. We conclude that diffuse white matter lesions may develop after chronic exposure to CS2, possibly through microangiopathy. In addition, CS2 poisoning can be considered as one of the causes of chronic leukoencephalopathy.
Beneficial Effect of Steroid Pulse Therapy on Acute Viral Encephalitis
Authors: Nakano Ayako , Yamasaki Ryuichi , Miyazaki Shuichi , Horiuchi Nobuaki , Kunishige Makoto , Mitsui Takao
Published: December 2003

Corticosteroids are often used in the treatment of acute viral encephalitis, although the efficacy of corticosteroid therapy has not been proven. We examined the effects of high-dose corticosteroid therapy on acute viral encephalitis in 5 patients with progressive disturbances of consciousness. In 3 patients who were treated within 5 days after the onset of illness, pulse therapy dramatically reduced the degree of consciousness disturbance. They became alert within 24 h, and then neurological symptoms gradually improved. Corticosteroid therapy in the other 2 patients, in whom treatment was started more than 3 weeks after the onset of illness, was not as effective, but repeated therapy at 2-week intervals resulted in complete recovery. These findings suggest that high-dose corticosteroid therapy is effective, particularly for disturbances of consciousness, an important prognostic factor in acute viral encephalitis.
Evaluation of Baroreflex Sensitivity by the Sequence Method Using Blood Pressure Oscillations and R–R Interval Changes during Deep Respiration
Authors: Oka Hisayoshi , Mochio Soichiro , Yoshioka Masayuki , Morita Masayo , Inoue Kiyoharu
Published: December 2003

Background: Baroreflex sensitivity assessments have been considered to be important to evaluate cardiac autonomic neuropathy. The phenylephrine method, Valsalva maneuver or sequence method at rest caused several problems. We evaluated the usefulness of the sequence method during deep respiration. Method: Baroreflex sensitivity was evaluated in 20 normal volunteers and 50 patients with Parkinson’s disease. R–R intervals and systolic blood pressures were obtained by electrocardiogram and tonometry using a continuous blood pressure monitoring system. The sequence method is an evaluation of baroreflex sensitivity using sequences of 3 or more consecutive beats for 4 min. Baroreflex sensitivity was also assessed by the Valsalva maneuver at 5 beats before the peak systolic blood pressure of phase IV. The slope of the linear interrelationship between systolic blood pressure and the following R–R interval, i.e. baroreflex sensitivity (ms/mm Hg), was calculated with a correlation coefficient greater than 0.8. Result: The mean value of baroreflex sensitivity obtained by the Valsalva maneuver was 7.91 in normal volunteers and 5.35 in patients with Parkinson’s disease; the one obtained by the sequence method at rest was 9.10 in normal volunteers and 8.42 in patients with Parkinson’s disease, and the one obtained by the sequence method during deep respiration was 10.23 in normal volunteers and 6.73 in patients with Parkinson’s disease. In some cases with Parkinson’s disease, baroreflex sensitivities could not be found, whereas in all patients with Parkinson’s disease, the sequence method during deep respiration could be used for evaluations. Significant correlations were found among the baroreflex sensitivities obtained by the Valsalva maneuver, and the sequence method at rest or during deep respiration in normal volunteers and patients with Parkinson’s disease. Conclusions: The baroreflex sensitivity obtained by the sequence method during deep respiration could be investigated noninvasively in all cases with PD, being thus a useful method for clinical evaluation of baroreflex sensitivity.
Molecular Genetic Studies in Atrial Fibrillation
Authors: Lai Ling-Ping , Lin Jiunn-Lee , Huang Shoei K. Stephen
Published: December 2003

Atrial fibrillation is a complex disease. Its etiologies are diverse and genetic factors may also contribute to this disease. With the advent of modern molecular biology technology, it is now possible to explore the genetic components in the pathogenesis of atrial fibrillation. Past molecular genetic studies on atrial fibrillation in the literature can be divided into linkage analysis studies and association studies. The subjects for linkage analysis studies are pedigrees of probands with Mendelian hereditary atrial fibrillation. The first locus identified for autosomal dominant atrial fibrillation locates at 10q22–q24. However, the exact gene is still unknown. Another linkage analysis study in Chinese revealed that LQT1 gene (IKs α-subunit) was the responsible gene. A missense mutation in the IKs α-subunit results in a gain of function, which is important in causing atrial fibrillation. The third known locus for familial atrial fibrillation locates at 6q14–16. The responsible gene remains still unknown. The other type of studies takes the case-control design (association studies) and the subjects have multigenic atrial fibrillation. In a study in a Japanese population, it was reported that the angiotensin-converting enzyme insertion/deletion polymorphism was not associated with atrial fibrillation. On the other hand, researchers in Taiwan reported that a nonsynonymous single nucleotide polymorphism of the LQT5 gene (IKs β-subunit) is associated with atrial fibrillation. In summary, there is growing evidence showing that genetic factors are important in the pathogenesis of atrial fibrillation. We expect that more genes responsible for or contributing to atrial fibrillation will be identified in the future and these will elucidate the molecular mechanisms of atrial fibrillation.
Association between Altered Circadian Blood Pressure Profile and Cardiac End-Organ Damage in Patients with Renovascular Hypertension
Authors: Iantorno Micaela , Pola Roberto , Schinzari Francesca , Filice Gianluca , Mettimano Marco , Cardillo Carmine , Melina Domenico
Published: December 2003

Background: Patients with renovascular hypertension (RVH) have a higher degree of cardiovascular end-organ damage compared to patients with essential hypertension (EH). The precise mechanisms underlying this phenomenon, however, have not been fully elucidated. This study investigated the relationship between circadian blood pressure (BP) profile and cardiac involvement in patients with RVH and EH. Methods: Twenty patients with RVH and 20 with EH, matched for demographic characteristics, underwent simultaneous 24-hour ambulatory BP recording and Holter ECG monitoring. Also, each participant underwent echocardiographic assessment of left ventricular mass. Cardiac damage was defined as the presence of left ventricular hypertrophy, myocardial ischemia or arrhythmias. Results: Casual BP was similar in both groups, whereas 24-hour ambulatory BP values were higher in RVH than in EH patients; moreover, RVH patients had higher blood pressure variability and blunted nocturnal BP fall compared to those with EH. Left ventricular mass, as well as the prevalence of myocardial ischemia and the presence and severity of cardiac arrhythmias, were higher in RVH than in EH patients. Conclusions: Patients with RVH have altered circadian BP profile compared to those with EH. This abnormality might contribute to their increased prevalence of cardiac damage and might adversely affect the prognosis of these patients.
Diminished Coronary Reserve in Patients with Biopsy-Proven Inflammatory Infiltrates
Authors: Klein Rolf Michael , Schwartzkopff Bodo , Gabbert Helmut Erich , Strauer Bodo Eckehard
Published: December 2003

Objective: We tested the hypothesis that patients with biopsy-proven inflammatory infiltrates have an impaired vasodilator capacity of the coronary microvasculation. Methods: In 80 patients with clinically suspected inflammatory heart disease, coronary regulation was assessed with the argon method (1) at rest and maximal coronary flow (Vcor/Vmax) and (2) at rest and minimal coronary resistance (Rcor/Rmin) both before and after dipyridamole (0.5 mg/kg body weight) treatment. Results: Compared to patients without evidence of myocardial inflammation in endomyocardial biopsy (n = 51) but similar demographic characteristics, patients with biopsy-proven inflammatory infiltrates (n = 29) showed significantly reduced maximal coronary flow (286 ± 122 vs. 189 ± 78 ml/min × 100 g; p = 0.001) and minimal coronary resistance was increased (0.40 ± 0.17 vs. 0.60 ± 0.27 mm Hg × min × 100 g/ml–1, p = 0.001). The coronary reserve in patients with inflammatory infiltrates was markedly reduced (3.5 ± 1.1 to 2.4 ± 0.81, p = 0.001). Conclusion: Patients with biopsy-proven inflammatory infiltrates have a diminished coronary reserve due to reduced coronary vasodilator capacity. This may be due to the involvement of the intramural coronary vasculature in inflammatory heart disease.
Antibacterial Activity of Polyphenol Components in Oolong Tea Extract against Streptococcus mutans
Authors: Sasaki H. , Matsumoto M. , Tanaka T. , Maeda M. , Nakai M. , Hamada S. , Ooshima T.
Published: December 2003

The purpose of the present study was to determine the antibacterial activity of oolong tea extract on oral streptococci, including Streptococcus mutans and Streptococcus sobrinus, and to identify the response to its components. Antibacterial activity was found when the extract was added to S. mutans cells in chemically defined medium but not in complex broth media. Further, pretreatment with bovine serum albumin reduced the antibacterial activity. The extract showed antibacterial activity against all of the oral streptococci examined, with the highest activity against S. mutans MT8148R. This activity was found to originate from a monomeric polyphenol-rich fraction, and it was stronger than that of pure polyphenols. Moreover, some combinations of monomeric polyphenols showed the highest level of antibacterial activity. These results suggest that the antibacterial activity of oolong tea extract is caused by a synergistic effect of monomeric polyphenols, which can easily bind to proteins.
Prevalence and Determinants of Enamel Fluorosis in Flemish Schoolchildren
Authors: Bottenberg P. , Declerck D. , Ghidey W. , Bogaerts K. , Vanobbergen J. , Martens L.
Published: December 2003

As part of an epidemiological study on the oral health of Flemish schoolchildren, fluoride use was studied together with risk factors (medical history, tap water fluoride concentration, use of fluoride supplements, toothpaste and brushing habits). Fluorosis was scored according to the Thylstrup-Fejerskov index (TFI) in children aged 11 years (4,128 children examined). Explanatory variables were recorded yearly, starting at the age of 7. Earliest toothpaste use was reported at the age of 1. By age 7, 99.7% of the children reported the use of toothpaste (90% fluoride-containing), but only 13.9% reported using a pea-sized amount. At age 7, 66% of the children had received systemic fluoride supplements during at least part of their childhood. At 11 years, 92% of the children used a fluoride-containing toothpaste and 6% still received systemic fluoride supplements. Fluorosis was present in about 10% of all the children examined, mainly TFI score 1 (7.3% in upper central incisors). Logistic regression established tooth brushing frequency and fluoride supplement use, in addition to tap water fluoride concentrations above 0.7 mg/l, as significant risk factors when the presence of fluorosis on at least one tooth was used as outcome variable. Children having fluorosis had a lower risk of caries, both in the primary (median dmft 1, range 0–10 vs. 2, range 0–12) and permanent dentition (median DMFT 0, range 0–5 vs. 0, range 0–11).
Relationship between Histological and Radiographic Caries Lesion Depth Measured in Images from Four Digital Radiography Systems
Authors: Jacobsen Jette H. , Hansen Britt , Wenzel Ann , Hintze Hanne
Published: December 2003

The aim of this study was to compare the accuracy of approximal caries lesion depth measurements in radiographs from four digital systems. Two CCD-based sensors, Dixi (Planmeca) and Sidexis (Sirona), and two phosphor plate systems, Digora (Soredex) and DenOptix (Gendex), were used to record radiographs of 177 extracted human teeth. Sixty-four radiographically visible lesions were selected and measured by 4 observers in the digital radiographs and in digital photographs of histological sections of the teeth. The gold standard (true measure) was defined as the mean of the 4 observers’ measurements on the histological sections. Two untrained observers underestimated general lesion depth in all the radiographic systems while each of 2 trained observers underestimated the depth in one of the systems. Analysis of variance revealed that Digora images resulted overall in the smallest underestimation, followed by Dixi, DenOptix and Sidexis. The differences between Digora and Sidexis and between Dixi and Sidexis were statistically significant (p < 0.05). Analysis of variance using the regression coefficient as the test variable demonstrated that the coefficients differed between DenOptix and the remaining systems (p < 0.05) while there were no significant differences between these (p > 0.05). It can be concluded that radiographs obtained with the Dixi and Digora systems were more accurate than Sidexis and DenOptix images for measurement of caries lesion depth. Still, a high probability exists that the individual lesion measurement is either overestimated or underestimated compared to the true lesion depth.
Effect of Imaging Geometry on Evaluating Natural White-Spot Lesions Using Quantitative Light-Induced Fluorescence
Authors: Ando Masatoshi , Eckert George J. , Stookey George K. , Zero Domenick T.
Published: December 2003

The objective of this study was to determine the effect of imaging geometry on evaluating natural white-spot lesions with quantitative light-induced fluorescence (QLF). A total of 34 specimens were prepared from extracted human premolars and permanent molars with white spots on the interproximal surface. The specimens were each adjusted to a final thickness of 3.0 mm. Images were acquired with the QLF system perpendicular to the white spots and at 5° intervals up to 30° above and below the perpendicular. The specimens were rotated around the buccolingual axis of the tooth (pitch angle) and around the long axis of the tooth (roll angle). The averages of fluorescence loss (ΔF, %) and lesion size (mm2) were determined with QLF. Another variable, ΔQ, which was defined as the fluorescence loss integrated over the lesion size (% × mm2), was also calculated. ΔF was smaller when lesions were viewed from the cervical direction (angles less than 90°), and became bigger when viewed from the coronal direction. Roll angle did not significantly affect ΔF. Apparent lesion size diminished with deviations from 90° in both directions for pitch and roll angles. ΔQ was affected by pitch and roll angles with the largest value at 90° and values decreasing in both directions from 90°. In general, there were significant differences for angles larger than 20° from the perpendicular for all three QLF variables. This study suggests that angle is an important factor to control when performing QLF studies; however, small changes (deviations within 20°) have a minimal effect on QLF variables.
In vitro Assessment of Methods of Applying the Electrical Caries Monitor for the Detection of Occlusal Caries
Authors: Ellwood R.P. , Côrtes D.F.
Published: December 2003

The aim of this in vitro study was to assess the diagnostic performance of five methods of using the Electrical Caries Monitor (ECM) to detect caries lesions at enamel and dentine thresholds in occlusal molar surfaces with and without stain. Histological validation was performed in 152 occlusal sites in permanent molar teeth. For the sites without stain the areas under the ROC curve (AUC) for the five methods ranged from 0.69 to 0.93 (enamel) and 0.74 to 0.92 (dentine). For stained sites the AUC ranged from 0.59 to 0.65 (enamel) and 0.66 to 0.77 (dentine). The performance of the ECM was reduced in the presence of stain. The measurements using toothpaste as a conducting medium were generally worse than when direct measurements were taken. The profiles of the resistance curves generated as the tooth was dried for 5 s were used to derive additional summary variables. The AUC for all sites using an outcome variable generated from these data were 0.89 (enamel) and 0.91 (dentine), respectively, for all teeth. It is concluded that the performance of the ECM might be improved by either considering a combination of variables or using different resistance cut-offs in the presence or absence of stain.
Scanning Electron Microscopy of Softened Enamel
Authors: Eisenburger M. , Shellis R.P. , Addy M.
Published: December 2003

After exposing enamel specimens to 0.3% citric acid at pH 3.2 for various times, the acid was titrated to pH 7 before rinsing the specimens in water. After freeze-drying the specimens were examined by scanning electron microscopy. This procedure eliminates artefacts due to drying and mineral precipitation. The results showed that the outer region of softened enamel is much more delicate than previously thought, even after short (5- to 20-min) etching times. Mineral was lost from both prism boundaries and the prism bodies, resulting in a surface presenting thin, separate crystal bundles. In further studies, replicas of subsurface pores, created by resin impregnation, showed the softening depth to be several times greater than is suggested by techniques based on removing the softened enamel by physical forces. The results point to a need for improved methods of measuring softening depth. More importantly, it appears that the outer region of the softened layer remaining after an erosive challenge might be too fragile to resist frictional forces in vivo.
Risk Stratification of In-Hospital Mortality in Patients Hospitalized for Chronic Congestive Heart Failure Secondary to Non-Ischemic Cardiomyopathy
Authors: Chen Mien-Cheng , Chang Hsueh-Wen , Cheng Cheng-I. , Chen Yen-Hsun , Chai Han-Tan
Published: December 2003

The study population consisted of 234 consecutive patients hospitalized for acute exacerbation of congestive heart failure secondary to non-ischemic cardiomyopathy. Of the 234 patients, there were 55 in-hospital deaths. Their medical records were deliberatively reviewed and the association of 38 clinical, hemodynamic and biochemical variables with in-hospital mortality was evaluated by multiple stepwise logistic regression analysis. The following variables were statistically associated with in-hospital mortality: profound cardiogenic shock, severe hyponatremia, the presence of ventricular arrhythmias, history of stroke, the presence of acute renal failure, and requirement of dobutamine therapy. In stratified analyses, the rates of in-hospital mortality rose rapidly as the number of risk factors increased: 0 risk factors, 2.5%; 1 risk factor, 5.1%; 2 risk factors, 36.4%; 3 risk factors, 75%, and no less than 4 risk factors, 100%. In conclusion, our study identified 6 variables that correlated with in-hospital death in patients with heart failure secondary to non-ischemic cardiomyopathy. The identification of these variables may allow more accurate risk stratification of individuals at risk of in-hospital mortality in this clinical setting.
Shocks from Pacemaker Cardioverter Defibrillators Increase with Amiodarone in Patients at High Risk for Sudden Cardiac Death
Authors: Shinde Abhijit A. , Juneman Elizabeth B. , Mitchell Brian , Pierce Mary K. , Gaballa Mohamed A. , Goldman Steven , Thai Hoang
Published: December 2003

The efficacy of amiodarone used in combination with a pacemaker cardioverter defibrillator (PCD) to decrease episodes of ventricular tachycardia and subsequent PCD shocks is not clear. We examined a retrospective registry of 82 patients with PCD implantation to define the efficacy of amiodarone treatment. We compared patients treated with amiodarone (for 24 consecutive months without interruption) versus no amiodarone. In patients treated with amiodarone there was a 3-fold increase (p = 0.02) in PCD shocks; in patients not on beta-blockers, amiodarone resulted in a 6-fold increase (p < 0.05) in PCD shocks. Patients with a left ventricular ejection fraction >30% on amiodarone and patients <72 years old had increases (p < 0.05) in PCD shocks. In conclusion, patients treated with amiodarone had more PCD shocks than those not treated. These findings are unexpected and merit a prospective study.
A Single Intravenous Dose of Ivabradine, a Novel If Inhibitor, Lowers Heart Rate but Does Not Depress Left Ventricular Function in Patients with Left Ventricular Dysfunction
Authors: Manz Matthias , Reuter Marcus , Lauck Gerhard , Omran Hegder , Jung Werner
Published: December 2003

This randomized, single-blind, placebo-controlled study investigated the effect of ivabradine, a novel heart rate-lowering agent, on echocardiographic indices of left ventricular (LV) systolic function in patients with regional (coronary artery disease) or global (cardiomyopathy) LV dysfunction. Patients were randomized on an unequal basis to receive ivabradine 0.25 mg/kg (n = 31) or placebo (n = 13) by intravenous infusion. Resting heart rate was reduced by a mean of 17.6 ± 4.7% with ivabradine and 1.5 ± 5.8% with placebo. The mean maximum decrease in LV ejection fraction was 0.2% with ivabradine and 1.7% with placebo. Fractional shortening and stroke volume were also fully preserved after ivabradine administration. Thus, a single intravenous dose of ivabradine produced a substantial reduction in resting heart rate without affecting LV function in patients with regional or global LV dysfunction.
Streptococcus agalactiae (Group B Streptococci) Carriage in Late Pregnancy in Kuwait
Authors: Al-Sweih Noora , Maiyegun Sitrat , Diejomaoh Michal , Rotimi Vincent , Khodakhast Fatma , Hassan Nahida , George Susan , Baig Saba
Published: December 2003

Objectives: This study investigated the vaginal colonization rate of Streptococcus agalactiae (group B streptococci, GBS) in an antenatal population in a maternity hospital. Subjects and Methods: Anal, vaginal and combined anal and vaginal specimens were obtained from 110 pregnant women (mean age 30.7 ± 5.5 years) at 35–37 weeks of gestation, using a commercially prepared culturette, and transported in 0.5 ml of Stuart’s transport medium. The specimens were then cultured in standard selective Todd-Hewitt broth medium, supplemented with gentamicin and nalidixic acid. After 36 h of incubation, the broth culture was subcultured onto sheep blood agar and incubated in 5% carbon dioxide for 18–24 h. Representative colonies morphologically resembling GBS were tested with latex agglutination kit. Each culture-positive woman was given ampicillin or piperacillin prophylactically and followed up through labour and postpartum. Detailed records of biodata, antecedent antenatal events and pregnancy outcome were reviewed. Results: The combined vaginal and anal specimens were positive for GBS in 18 (16.4%) women. Gestational age at delivery was 39.01 ± 1.79 weeks. The deliveries were uneventful and no neonate developed sepsis. Diabetes mellitus and pregnancy-induced hypertension/hypertension were detected antenatally in 16.6 and 11.5%, respectively. GBS carriage was not associated with adverse outcome of pregnancy. Conclusion: The colonization rate of GBS in pregnant women in Kuwait is high, and on the basis of the documented benefits of antenatal screening in Western countries, we recommend routine screening especially for our at-risk patients.
Effect of Treadmill Exercise on Circulating Thyroid Hormone Measurements
Authors: Huang Wen-Sheng , Yu Ming-Der , Lee Meei-Shyuan , Cheng Cheng-Yi , Yang Shih-Ping , Chin Hei-Min Linda , Wu Sing-Yung
Published: December 2003

Objectives: Effects of exercise on circulating thyroid hormone (TH) values remain controversial. We sought to observe the effect of treadmill exercise on serum TH values in highly selected subjects. Methods: Twenty-six healthy male military recruits aged 23–27 (mean, 25) years were studied. All had maintained identical diet and physical activity for a week before the test. Serum samples were drawn before (baseline) and immediately, 1, 4, 24, 24 and 48 h after maximal exercise (on a treadmill, Bruce protocol). All subjects completed the protocol with normal ECG results. Specimens were analyzed to measure 3,3′,5-triiodothyronine (T3), thyroxine (T4), free T4 (FT4), free T3 and thyroid-stimulating hormone (TSH) in the same assays. To determine the possible effect of hemodynamic changes, hematocrit (Hct)-adjusted data were also compared. Results: Hemoconcentration, as reflected by increased Hct, was found immediately after exercise. No significant changes of serum mean TH values before and after exercise were found except for TSH, which increased significantly immediately after exercise (1.72 vs. baseline 1.42 IU/l, p < 0.01). Values for T3, T4, and TSH increased significantly immediately after exercise, as compared to other postexercise values. However, the changes became insignificant after Hct adjustment. The FT4 values showed a reciprocal increase after exercise that became significant after Hct correction. Significantly negative correlation was found between FT4 and TSH values, but these values were still well within the normal range. Conclusions: Maximal treadmill exercise does not greatly affect the determination of concentrations of circulating THs.
Prevalence and Severity of Symptoms of Asthma, Allergic Rhinoconjunctivitis, and Atopic Eczema in 6- to 7-Year-Old Nigerian Primary School Children: The International Study of Asthma and Allergies in Childhood
Authors: Falade A.G. , Olawuyi J.F. , Osinusi K. , Onadeko B.O.
Published: December 2003

Objective: To determine the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and eczema in Nigerian children aged 6–7 years. Subjects and Methods: A cross-sectional study of selected children in primary schools in Ibadan, Nigeria was conducted using phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) format. Standardized questionnaires were distributed to parents and guardians of 2,325 children aged 6–7 years in 31 primary schools randomly selected among 272 in Ibadan. Results: Data was collected from 1,704 children (797 boys and 907 girls; M:F ratio 1:1.14), giving a participation rate of 73.3%. Both recent rhinoconjunctivitis and wheeze were reported by 5.1%, and itchy flexural rash in the past 12 months was reported by 8.5%. The cumulative prevalences of reported symptoms of wheezing, rhinitis and eczema were 7.2, 11.3 and 10.1%, respectively. These symptoms were basically the same among the boys and girls (rhinitis 11.4 vs. 11.2%; eczema 10.7 vs. 9.5%), except for wheezing, which was higher in boys (9.0%) than girls (5.6%), p = 0.015. Current symptoms of rhinitis and atopic eczema were associated with current wheeze and severe wheezing, whereas current symptoms of allergic rhinoconjunctivitis were only associated with severe wheezing attacks. One or more current symptoms occurred in 13.2% of the children, and all three symptoms were reported by 0.5%. Conclusion: The study demonstrates a high prevalence of atopic conditions among children 6–7 years old in Ibadan, Nigeria, with more than three fifths of the children who had current wheezing also showing symptoms of other atopic diseases. Children with allergic rhinoconjunctivitis were more likely to have severe wheezing attacks if they had developed atopic eczema before 2 years of age.
Interleukin-1 and Nitric Oxide Increase NADPH Oxidase Activity in Human Coronary Artery Smooth Muscle Cells
Authors: Kaur Jaspal , Dhaunsi Gursev S. , Turner Ronald B.
Published: December 2003

Objective: Cytokines, nitric oxide (NO) and reactive oxygen species (ROS) are well known for their pathogenic effects in development of cardiovascular diseases. Interleukin-1β (IL-1β) is known to induce NO generation, however it is not well established if IL-1β or NO regulate production of ROS, such as superoxide anion. Therefore, the main objective of this study was to evaluate the effect of IL-1β or NO on enzyme activity of NADPH oxidase (NOX), a superoxide-generating system recently documented to participate in a variety of vascular functions. Methods: Human coronary artery smooth muscle cells (SMC) obtained from Clonetics were treated with IL-1β and NO donor, sodium nitroprusside (SNP), in culture. Nitrites accumulated in supernatants of SMC cultures were measured as an index of NO released following treatment with IL-1β. NOX enzyme activity was assayed using cytochrome c as the electron acceptor. Results: Treatment with IL-1β resulted in a 3-fold increase in the production of NO by SMC. Both IL-1β and SNP enhanced NOX activity, by 67 and 45%, respectively, following 24 h of treatment. Conclusion: This study suggests that NO or NO- generating cytokines might regulate the production of ROS in the cardiovascular system through modulation of superoxide-generating systems such as NOX.
Prevalence of Endometrial Proliferation in Pipelle Biopsies in Tamoxifen-Treated Postmenopausal Women with Breast Cancer in Kuwait
Authors: Al-Azemi M. , Labib N.S. , Motawy M.M.M. , Temmim L. , Moussa M.A.A. , Omu A.E.
Published: December 2003

Objective: To determine the prevalence of pathologic changes in the endometrium of tamoxifen-treated asymptomatic postmenopausal patients with breast cancer. Subjects and Methods: Fifty postmenopausal asymptomatic breast cancer patients with positive estrogen receptor status were treated with 20 mg of tamoxifen daily for a period of 5–60 months. The control group consisted of 30 asymptomatic postmenopausal breast cancer patients who were negative for estrogen receptor and therefore did not receive tamoxifen. Endometrial biopsies were performed using Pipelle endometrial suction curette at least 5 months after the study began. The endometrium was classified as atrophic (negative finding) and proliferative or hyperplastic (positive findings). The study and control groups were compared for demographic characteristics, risk factors for endometrial cancer, histological findings and the duration of tamoxifen treatment. Results: A significantly greater prevalence of endometrial abnormalities existed among the tamoxifen-treated than control patients (76 vs. 33%, p < 0.001). The abnormal endometrial changes were further demarcated in both groups into proliferative (54 vs. 26.7%, p = 0.02) and hyperplastic (22 vs. 6.6%, p = NS). In the study group, 63.6% of hyperplastic endometrium was simple hyperplasia and 36.4% was complex/no atypia hyperplasia, while in the control group all the cases were simple hyperplasia. No endometrial cancer was detected in either group. In addition, there was a positive association between the duration of tamoxifen exposure (<1 year vs. ≧1 year) and the endometrial abnormalities (46.6 vs. 88.6%, p = 0.003; proliferative 57.1 vs. 74.1%, p = 0.015; hyperplastic 42.8 vs. 25.8%, p = NS). Conclusion: The adjuvant use of tamoxifen is associated with significant time-dependent abnormal endometrial changes among patients with cancer of the breast.
Effect of Plasma from Patients with Behçet’s Disease on the Production of Nitric Oxide in Cultured Human Umbilical Vein Endothelial Cells
Authors: Örem Asım , Ertürk Murat , Çimşit Gülseren , Kural Birgül Vanizor
Published: December 2003

Objective: To determine the effect of plasma from patients with Behçet’s disease (BD) on the production of nitric oxide (NO) in cultured human umbilical vein endothelial cells (HUVECs). Subjects and Methods: NO levels were measured in cell culture media after 24-hour incubation of the cells with plasma obtained from 22 BD patients and 16 age/sex-matched healthy control subjects. After treatment of the patients with colchicine and/or nonsteroidal anti-inflammatory drugs, 12 of the patients were considered to be in the inactive phase of the disease. Levels of NO production were also measured in these 12 patients. In addition to the in vitro experiments, erythrocyte sedimentation rate, α1-antitrypsin, α2-macroglobulin and neutrophil counts were measured in the patients and controls. Results: Levels of NO in active state BD patients (15.9 µmol/106 cells) were significantly lower than values obtained from both patients in the inactive period (19.2 µmol/106 cells) and the control group (19.7 µmol/106 cells). No significant differences were observed in induced NO products between the patients in the inactive stage and control subjects. Conclusion: Plasma from BD patients decreased the level of NO production in the HUVECs, and therefore may cause dysfunction in the endothelial NO synthase activity.
The Expression of Rheumatoid Arthritis in Kuwaiti Patients in an Outpatient Hospital-Based Practice
Authors: Al-Salem I.H. , Al-Awadhi A.M.
Published: December 2003

Objective: To describe the characteristic clinical, serologic and radiological features of rheumatoid arthritis (RA) in Kuwaiti patients in a tertiary outpatient hospital-based practice. Subjects and Methods: An outpatient hospital-based study on 100 consecutive consenting Kuwaiti patients with RA was done at the Rheumatology Unit, Al-Amiri Hospital, one of the main teaching hospitals in Kuwait. The study group included 11 men and 89 women. The duration of their disease ranged from 2 to 30 years with a mean duration of 10.7 (SD 7.5) years. The age at disease onset ranged from 21 to 71 years with a mean age of 39.1 (SD 11.2) years. Results: Joints most commonly involved in RA were metacarpophalangeal, wrist, knee, and proximal interphalangeal joints. Extra-articular manifestations were present in 24 patients; the most common was the sicca complex in 14 individuals. Rheumatoid factor seropositivity was found in 60 patients and erosive arthropathy in 42 patients. Conclusion: The findings indicate a low incidence of radiological erosive arthropathy in Kuwaiti patients. The sicca complex was the most common extra-articular manifestation of RA in these patients.
Successful Management of a Widespread Osteosarcoma
Authors: Grohn Pentti , Uttamchandani Ashok , Al-Haider Zuhair , Adams Bruce
Published: December 2003

Objective and Importance: To report the case of a 23-year-old woman with widespread osteosarcoma including skeletal, pulmonary and pleural metastases, who had a remarkable response to combined chemo- and radiotherapy. Clinical Presentation and Intervention: A 23-year-old Indonesian woman presented in October 1999 with a swelling of the right thigh, severe generalized pain and progressive left hemiparesis. Radiological examination revealed osteolytic lesions in the cervical spine. CT scan of the chest showed multiple pulmonary metastases and a huge left pleural effusion. Bone scan with technetium-99m hydroxymethylene diphosphonate showed intense uptake of the radiopharmaceutical in the distal right femur, generalized deposits throughout the skeleton and in the right hemithorax corresponding to the lung findings. Bone marrow and kidney function tests as well as serum calcium level were normal. Alkaline phosphatase was markedly elevated, 8,000 IU/l (normal <250 IU/l). Histopathology from the femoral tumor showed osteosarcoma. Treatment was started with radiotherapy to the cervical spine followed immediately by a combination chemotherapy with ifosfamide, cisplatin, etoposide and mesna rescue. In addition, the patient received bisphosphonates regularly. Eleven cycles of chemotherapy were given with a remarkable response. Conclusion: The patient was successfully treated with a combination of radio- and chemotherapy. She recovered fully and is in almost complete remission. The disease remained stable 24 months after the discontinuation of the treatment.
Lateral Spreading of Topically Applied UV Filter Substances Investigated by Tape Stripping
Authors: Jacobi U. , Weigmann H.-J. , Baumann M. , Reiche A.-I. , Sterry W. , Lademann J.
Published: December 2003

The lateral spreading of topically applied substances is a competitive process to the penetration into the stratum corneum (SC). The penetration of topically applied UV filter substances into the human SC and the lateral spreading were investigated in vivo. Tape stripping in combination with spectroscopic measurements was used to study both processes of two UV filter substances. The concentration of both UV filters was determined inside and outside the application area by varying the application and tape stripping protocol. A spreading of the topically applied substances from the treated to the untreated areas was observed, which caused a concentration gradient. This lateral spreading depends on the time between application and tape stripping and the size of the treated skin area. Significant amounts of topically applied substances were found adjoining the application area, due to the lateral spreading which takes place on the skin surface. In general, the lateral spreading must be considered to be a competitive process when studying penetration processes of topically applied substances. It has to be considered during drug treatment of small limited skin areas and for the interpretation of recovery rates obtained in penetration studies.
Toxicity and Antimicrobial Activity of a Hydrocolloid Dressing Containing Silver Particles in an ex vivo Model of Cutaneous Infection
Authors: Schaller M. , Laude J. , Bodewaldt H. , Hamm G. , Korting H.C.
Published: December 2003

In the present study we examined the effects of two hydrocolloid wound dressings (conventional silver-free Comfeel®, silver-incorporating Contreet-H®) on uninfected and Candida albicans- ormethicillin-resistant Staphylococcus aureus-infected reconstituted human epithelium (RHE). The morphological alterations of the keratinocytes caused by infection and by treatment were analysed with light and electron microscopy. As a measure of epithelial cell damage the release of lactate dehydrogenase from epithelial cells into the surrounding medium was monitored. Application of Contreet-H or Comfeel to uninfected RHE induced no major morphological effects on epithelial cells. Both wound dressings reduced the growth of micro-organisms. Specific alterations of the infected epithelium (vacuoles, spongiosis, oedema, detachment of keratinocytes) and invasion of the epithelium were significantly reduced only by treatment with Contreet-H. At the ultrastructural level release of silver by Contreet-H and superior antimicrobial efficacy could be verified. In summary, treatment with both wound dressings reduced the number of pathogens, with the silver-based wound dressing providing a more effective antimicrobial activity. This resulted in a strong decrease of pathogen-specific alterations of the infected epithelium. We present evidence that delivering silver to infected keratinocytes in a moist healing environment improves the benefit/risk ratio as compared to silver-free wound dressings.
Detection of Monohydroxyeicosatetraenoic Acids and F2-Isoprostanes in Microdialysis Samples of Human UV-Irradiated Skin byGas Chromatography-Mass Spectrometry
Authors: Grundmann J.-U. , Wiswedel I. , Hirsch D. , Gollnick H.P.M.
Published: December 2003

UV irradiation of the human skin leads to induction of oxidative stress and inflammation mediated by reactive oxygen radicals, lipid peroxidation, liberation of arachidonic acid from membrane phospholipids and formation of prostaglandins and leucotrienes. We investigated ‘lipid mediators’, such as F2-isoprostanes (8-iso-PGF2α, 9α,11α-PGF2α) and monohydroxyeicosatetraenoic acids (HETEs)in the dermal interstitial fluid obtained by a cutaneous microdialysis technique. Defined areas on the volar forearm of 10 healthy volunteers were exposed to UVB irradiation (20–60 mJ/cm2). Microdialysis membranes were cutaneously inserted beneath the irradiated area. The probes were perfused with isotonic saline solution, and microdialysate samples were collected at 20-min intervals up to 4–5 h. Oxidized arachidonic acid derivatives (2-, 3-, 5-, 8–12- and 15-HETEs, 8-iso-PGF2α and 9α,11α-PGF2α) could be detected and quantified in microdialysates of normal skin in the picomole (HETEs) and femtomole (isoprostanes) range and after UVB irradiation using sensitive gas chromatography-mass spectrometry/negative ion chemical ionization. UVB irradiation enhanced the levels of 8-iso-PGF2α after 24 h significantly, whereas the HETE levels were slightly increased within shorter time intervals (3 h after UVB irradiation). Further investigations have to show whether these new findings are relevant to validate therapeutic strategies for topical and systemic UV prevention agents or for monitoring of specific therapeutic strategies in inflammatory skin disorders.