bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Behavior Therapy in Panic Disorder and Comorbid Major Depression
Authors: Rief Winfried , Trenkamp Susanne , Auer Claudia , Fichter Manfred M.
Published: April 2003

Background: There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. Methods: We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. Results: Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone. Conclusions: The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression.
Polysymptomatic Conversion Disorder in Childhood and Adolescence in Japan
Authors: Murase Satomi , Sugiyama Toshiro , Ishii Takashi , Wakako Rie , Ohta Tatsuro
Published: April 2003

Background: In conversion disorder in childhood and adolescence, polysymptomatic (PS) presentations are reportedly commoner than monosymptomatic (MS) ones. Somatization disorder is also associated with pseudoneurological symptoms, but is extremely rare in childhood. This occurs despite the age of onset peaking in the teens among adult somatization disorder patients. Method: We reviewed the records of 44 children and adolescents with pseudoneurological symptoms. They were categorized as MS cases (19) or PS cases (25), and their psychological backgrounds and clinical courses were compared. Results: PS patients had a poorer prognosis and more past psychiatric and family problems. While none met the DSM-IV criteria for somatization disorder, 2 PS patients met all but the sexual symptoms criteria. Conclusion: PS conversion disorder in childhood and adolescence may constitute a different entity from MS conversion disorder and may be an early manifestation or incomplete form of somatization disorder.
Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients
Authors: Meyer Thomas , Klemme Heike , Herrmann Christoph
Published: April 2003

Background: In a cross-sectional study we investigated associations between self-ratings of anxiety and depression, physical factors and physicians’ assessments of patients’ medical status. Methods: Hospital inpatients (n = 574) consecutively admitted to internal medical wards were evaluated for the presence of anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Physicians were asked for their perception of psychiatric problems in their patients and for their assessments of patients’ severity of illness, functional impairment and 1-year prognosis on 3-point ranking scales. Detailed somatic data including comorbidity and accepted risk factors were taken from the patients’ records. Results: Almost two thirds of all patients with abnormal HADS scores (65.2%) were not identified by their attending physicians as suffering from psychiatric problems. Using multiple-regression models, HADS scores for depression, but not for anxiety, proved to be an independent predictor for the clinicians’ judgements of disease severity [exp(β) = 1.08; 95% confidence interval (CI) 1.03–1.13; p < 0.01] and functional impairment [exp(β) = 1.11; 95% CI 1.05–1.17; p < 0.01]. The estimation of prognosis, however, was only related to physical predictors and showed no association with depressive symptoms or other psychosocial factors. Conclusions: Our data demonstrate that internists’ ratings of severity of illness and functional impairment, but not prognosis, are associated with HADS depression scores, whereas there is no such association with self-rated anxiety.
Teaching and Training in the Psychiatric-Psychosomatic Consultation-Liaison Setting
Authors: Rigatelli M. , Ferrari S. , Uguzzoni U. , Natali A.
Published: April 2003

Background: The consultation-liaison (C-L) psychiatrist is in an opportune position to undertake the tasks of education, training and assessment of performance as regards future physicians, psychiatrists, specialists in other branches and nurses. This paper describes the education and training programme in the Psychiatric-Psychosomatic C-L Service of Modena University Hospital. Description of the Programme: This programme consists of the following main activities: (1) daily group-case supervision, performed by the full-time psychiatrist together with the psychiatry residents of the C-L staff; (2) a bimonthly quality management meeting, which is part of a European project of measurement and improvement of quality of service; (3) weekly lectures on selected topics; (4) monthly tutorials in research techniques; (5) bimonthly presentations of literature reviews; (6) weekly clinical case conferences, which are the nucleus of the curriculum and which focus on the following main topics: ‘the patients’, ‘the intervention’ and ‘the group’, and (7) liaison meetings requested by non-psychiatric departments. Conclusions: A common denominator seen throughout the teaching and training activities of such a programme is the attitude of openness and effort toward integration which should be the C-L psychiatrist’s distinguishing mark, in the context of the general hospital.
Cognitive Therapy by Allocation versus Cognitive Therapy by Preference in the Treatment of Panic Disorder
Authors: Bakker Abraham , Spinhoven Philip , van Balkom Anton J.L.M. , Vleugel Liesbeth , van Dyck Richard
Published: April 2003

Background: Little is known about the influence of preference for a given therapy or preference against a modality of treatment on the outcome of that treatment. Results so far have been conflicting. The primary aim of this study was to investigate possible differences in outcome between panic disorder patients treated with preferred cognitive therapy and patients treated by randomization with the same intervention. Methods: A 12-week study comparing 35 patients treated by allocation with 31 patients treated by preference. Results: There were no differences at pretest between the two conditions on demographic or outcome measures. Outcome was assessed with measurements rating the panic frequency and severity of agoraphobia, general anxiety and depression. Both conditions improved significantly on nearly all ratings. There were no significant differences demonstrable between the two conditions on any of the outcome measures. Conclusion: Preference for a given therapy is not a powerful moderator of effect in the psychological treatment of panic disorder.
Comorbidity, Smoking Behavior and Treatment Outcome
Authors: Keuthen Nancy J. , Niaura Ray S. , Borrelli Belinda , Goldstein Michael , DePue Judith , Murphy Chris , Gastfriend David , Reiter Stewart R. , Abrams David
Published: April 2003

Background: A sizeable sector of the population continues to smoke cigarettes despite our efforts to prevent and treat this addiction. We explored the relationships between lifetime comorbidity, psychiatric symptomatology, smoking behavior and treatment outcome to better understand vulnerability to smoking and treatment response. Methods: One hundred and twenty smokers at two sites were enrolled in a multicenter, double-blind, randomized, 10-week smoking cessation trial with fluoxetine and behavioral treatment. The Structured Clinical Interview for DSM-III-R and Hamilton Depression Rating Scale were administered prior to treatment initiation. Self-report measures were used to assess psychiatric symptoms throughout treatment and during a 6-month follow-up period. Results: Overall 62.3% of our sample were diagnosed with a lifetime mood, anxiety or substance use disorder despite stringent study exclusion criteria. Lifetime comorbidity was shown to be related to higher smoking rates and nicotine dependence, depressed mood and greater self-report of anxiety and stress. Lifetime comorbidity, however, alone or in combination with treatment condition, failed to predict treatment outcome (at posttreatment or follow-up). Baseline depression scores (Beck Depression Inventory, BDI) were related to treatment outcome only for smokers without a positive history of any psychiatric disorder or depression, with lower BDI scores more frequent in those who were abstinent. Conclusions: High prevalence rates of lifetime psychiatric illness and substance use disorders are reported for chronic smokers. Subsyndromal psychiatric symptoms may play a role in smoking behavior in combination with diagnosable disorders. Clinicians need to carefully assess both psychiatric diagnoses and symptoms in chronic smokers to optimize patient-treatment matching.
Effects of Low Phosphate Intake on Bone and Mineral Metabolism in Rats: Evaluation by Biochemical Markers and Pyridinium Cross-Link Formation in Bone
Authors: Hoshino H. , Kushida K. , Takahashi M. , Koyama S. , Yamauchi H. , Inoue T.
Published: April 2003

We have investigated the changes in biochemical markers and in pyridinium cross-links in bone in hypophosphatemic rats. Six-week-old female Wistar rats were divided into two groups (normal diet and a phosphate-deficient diet) and fed for 8 weeks. A low phosphate intake caused a significant difference in the concentrations of osteocalcin and alkaline phosphatase with advancing rachitis as well as an increase in bone resorption marker concentrations in urine. Femur biochemical analysis revealed a significant (p < 0.005) increase in deoxypyridinoline per mole collagen in the phosphate-deficient group which suggested that urinary excretions of pyridinium cross-links might reflect not only bone resorption but also increased pyridinium cross-links in bone matrix collagen. Our results demonstrate that a low phosphate intake causes an increase of pyridinium cross-link formation as well as a discrepancy between the circulation levels of alkaline phosphatase and osteocalcin with advancing rachitis. These alterations induced by low phosphate intake should be considered when interpreting the values of biochemical markers.
Production of Interleukin-6 in Cultures of Peripheral Blood Mononuclear Cells from Children with Primary Protein-Calorie Malnutrition and from Eutrophic Controls
Authors: Malavé Inés , Vethencourt María A. , Chacón Rita , Quiñones Damelis , Rebrij Carlos , Bolívar Gonzalo
Published: April 2003

The spontaneous as well as mitogen-induced in vitro production of interleukin-6 (IL-6) was studied in cultures of peripheral blood mononuclear cells (PBMC) from 14 children with marginal protein-energy malnutrition, 43 children with definite protein-energy malnutrition and 38 eutrophic controls of similar age, sex, race and socioeconomical condition. PBMC were cultured without added mitogen or stimulated with either lipopolysaccharide (LPS) or phytohemagglutinin (PHA). After 48 h incubation, cell-free culture supernatants were collected and stored at –70°C. The amount of IL-6 in the supernatants was determined by a specific bioassay based on the proliferation of B9 hybridoma cells using human rIL-6 as standard. The mean level of IL-6 was significantly increased in supernatants from nonstimulated PBMC cultures from definitely malnourished children as compared with that observed in those of the controls. Stimulation with either LPS or PHA induced a rise in cytokine bioactivity in the supernatants of PBMC cultures from the different nutritional groups tested. Interestingly, IL-6 was significantly increased in the supernatants of PHA-stimulated cultures from malnourished children as compared with those of the controls.
Thymosin Alpha-1: Evidence for an Antiatherogenic Effect
Authors: Ademoglu Evin , Gökkuşu Cahide , Öz Büge
Published: April 2003

In the present study, the effects of thymosin α1 on lipid peroxidation were studied in an in vivo model of experimental hypercholesterolemia. In groups II–IV, rabbits were fed a high-cholesterol diet 2% (w/w) for 10 weeks. Thereafter, rabbits in group III were fed a normal diet for another 14 days and those in group IV were given a normal diet plus 25 µg/kg thymosin α1 intraperitoneally every other day for the same period. At the end of this period, plasma and erythrocyte lipid levels and susceptibility of erythrocytes to lipid peroxidation were determined in all groups. Hypercholesterolemic rabbits had high plasma and erythrocyte lipid peroxide (TBARS) levels compared to control animals fed a normal diet. Plasma and erythrocyte TBARS levels significantly decreased in the thymosin-α1-injected rabbits. In thymosin-α1-treated animals (group IV), most of the lipid plaques were replaced by fibrous tissue. These findings suggest that thymosin α1 may have some beneficial effects on the treatment of atherosclerosis by normalizing blood lipid levels and by substantially protecting endothelial cells against free radical injury.
Does Prolonged Exercise Alter Diet-Induced Thermogenesis?
Authors: Ohnaka Masaharu , Iwamoto Masako , Sakamoto Sadaichi , Niwa Yasuharu , Matoba Hideki , Nakayasu Kimiko , Nakaya Yutaka
Published: April 2003

Diet-induced thermogenesis (DIT) is mainly an insulin-mediated response and the result of fat and glycogen synthesis. We investigated DIT at rest and after exercise to clarify the mechanism of exercise-induced changes in DIT in 6 healthy men (mean age 36 ± 16 years). Subjects exercised for 1 h at 58% of maximal O2 consumption on a bicycle ergometer and then rested for 8 h sitting in a comfortable chair (exercise experiment). On a different day, subjects rested for 8 h without preceding exercising (non-exercise experiment). At 12.30 h, the subjects were given their second meal. DIT to individual meal did not differ significantly between the exercise and non-exercise days. Increased insulin sensitivity and increased free fatty acid oxidation by exercise may facilitate the conversion of glucose to glycogen in muscle. On the other hand, insulin secretion expressed as the ratio of plasma levels of insulin to glucose after the meal was significantly decreased in the exercise experiment (p < 0.05). Study of heart rate variability showed that sympathetic tone, a primary hormonal determinant of glucose metabolism during exercise, was increased and parasympathetic tone was decreased during the recovery period in the exercise experiment (p < 0.05). These findings suggest that changes in DIT are affected by many factors and may be related to the balance between these counteracting factors.
Recruitment Procedures of EPIC-Germany
Authors: Boeing H. , Korfmann A. , Bergmann M.M.
Published: April 2003

EPIC is among the largest cohort studies, with approximately 475,000 study participants, on the etiological influence of diet and chronic diseases. During a 4-year recruitment period, two German EPIC centers, located in Heidelberg and Potsdam, aimed to recruit a total of 60,000 study participants from the local populations. The recruitment process was based on addresses from general population registries and started 4–5 weeks in advance with an initial invitation by mail to the basic examination for this study. Subjects not responding within 2 weeks were reminded. In Potsdam, this was done by mail and telephone, and in Heidelberg by telephone. During the recruitment phase, from 1994 to 1998, 53,162 subjects in total were examined for the cohort studies in Heidelberg (n = 25,546) and Potsdam (n = 27,616). The participation rate, compared to the invited number of subjects, was 22.7% in Potsdam and 38.3% in Heidelberg, with a considerable variation by municipality and gender. A comparison with data from the National Health Survey 1991/1992 revealed that the cohort populations were of higher socio-economic status and were healthier than the source population. We concluded that the selective participation would help to ensure high maintenance of the cohort during active follow-up. Selective participation does not harm etiological conclusions because disease associations are derived internally as relative risk. The relative risk estimates can be used to calculate population-attributable risk and preventable proportion, based on exposure prevalence derived by surveys and other studies.
Effect of Body Build on the Validity of Predicted Body Fat from Body Mass Index and Bioelectrical Impedance
Authors: Snijder Marieke B. , Kuyf Brenda E.M. , Deurenberg Paul
Published: April 2003

The objective of this study was to test whether differences between body fat percent (BF%) measured by densitometry and BF% predicted from body mass index (BMI) or bioimpedance (BIA) can be explained by differences in body build. Weight, height, sitting height (leg length), arm length, skeletal widths, BIA, bone mineral content from dual-energy X-ray absorptiometry, and BF% from densitometry were measured in 90 apparently healthy, young adult subjects (age range 18–31 years). The BMI was calculated and BF% predicted from BMI, age, and sex. BF% was also predicted from BIA. BF% measured by densitometry was 29.3 ± 5.0% for women and 14.6 ± 5.1% for men. BF% predicted from BIA (27.1 ± 6.7% in women, 19.0 ± 6.0% in men) was significantly different from measured values in both sexes. BF% predicted from BMI (25.9 ± 2.2% for women, 15.6 ± 2.4% for men) was only significantly different from BF% from densitometry in women, not in men. In both sexes skeletal widths, especially elbow width, were related to the prediction error of BF% from BMI, confirming the hypothesis that BF% predicted from BMI underestimates BF% in persons with a relatively slender body build or frame. The prediction error of BF% from BIA was found to be related to the length of the arms and legs, confirming the hypothesis that BIA overestimates BF% in persons with relatively long limbs.
Protective Function of Alpha-Tocopherol against the Process of Cataractogenesis in Humans
Authors: Seth R.K. , Kharb Simmi
Published: April 2003

In a random trial 50 patients with unilateral/bilateral idiopathic immature senile cataract (cortical n = 25, nuclear n = 25) requiring surgery at least in one eye were included in the present study. Reduced glutathione (GSH), vitamin E, malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) were studied in these patients receiving either vitamin E (n = 12 in each subgroup) or placebo (n = 13 in each group) for 30 days. A comparable increase of vitamin E in both types of lens homogenates of cataractous patients was observed in the study group. The level of GSH in cortical cataractous lenses in the study group was significantly raised (p < 0.001) whereas it was not increased significantly in nuclear cataractous lenses (p > 0.05) as compared to the placebo group. The percentage decrease in MDA levels was greater in cortical cataracts (38.07%) than in the nuclear type (27.94%). The activity of GSH-Px in cortical lenses was higher than that in the nuclear cataractous lens. The change in the size of lens opacity in cortical cataractous patients receiving vitamin E therapy was significantly decreased as compared to the placebo group. There may be a direct modulating effect of vitamin E on some GSH-related enzymes and the cortex of the lens might be protected more than the nucleus.
Amelioration of Alloxan Induced Diabetes mellitus and Oxidative Stress in Rats by Oil of Eruca sativa Seeds
Authors: El-Missiry M.A. , El Gindy A.M.
Published: April 2003

Clinical research has confirmed the efficacy of several plant extracts in the modulation of oxidative stress associated with diabetes mellitus (DM). Oil of Eruca sativa seeds (ESS) is tried for prevention and treatment of DM induced experimentally by alloxan injection. A single dose of alloxan (100 mg/kg) produced a decrease in insulin level, hyperglycemia, elevated total lipids, triglycerides and cholesterol, decreased high-density lipoprotein and hepatic glycogen contents and elevated hepatic glucose-6-phosphatase activity. Concurrent with these changes, there was an increase in the concentration of malondialdehyde and 4-hydroxynonenal in the liver. This oxidative stress was related to a decreased glutathione (GSH) content and superoxide dismutase activity in the liver of alloxan-diabetic rats. ESS oil (0.06 ml/kg) on its own increased significantly hepatic GSH. Daily oral administration of ESS oil 2 weeks before or after diabetes induction ameliorated hyperglycemia, improved lipid profile, blunted the increase in malondialdehyde and 4-hydroxynonenal and stimulated the GSH production in the liver of alloxan-treated rats. We suggested that ESS oil could be used as antidiabetic complement in case of DM. This may be related to its antioxidative properties and to the increase in hepatic GSH.
Abdominal Aortic Thrombosis in a Patient with Nephrotic Syndrome
Authors: Nakamura Mamoo , Ohnishi Takahiro , Okamoto Shinya , Yamakado Tetsu , Isaka Naoki , Nakano Takeshi
Published: April 2003

We report a patient who presented with severe nephrotic syndrome complicated with infrarenal aortic and right renal arterial thrombosis. The nephrotic syndrome frequently causes thromboembolic complications in veins, but arterial thrombosis is relatively rare, especially in the aorta. Various predisposing factors leading to thromboembolic complications are discussed. In this case, the thromboembolic complication may have some clinical association with the hypercoagulable state in nephrotic syndrome.
Renal Oncocytoma of the Native Kidney after Renal Transplantation
Authors: Riehl Jochen , Schmitt Hans , Fritz Achim , Füzesi Laszlo , Sieberth Heinz-Günter
Published: April 2003

Patients with acquired cystic kidney disease (ACKD) are at an increased risk of renal neoplasms. Frequent tumors are adenomas and renal cell carcinomas. However, renal oncocytomas may occur in patients with ACKD. Little is known about oncocytomas of the native kidney following renal transplantation. By means of B scan ultrasonography, a solid and echo-inhomogeneous renal mass was incidentically observed in the right native kidney of a 28-year-old female patient with ACKD 4 years following renal transplantation. A nephrectomy was performed. The histological examination revealed a renal oncocytoma. The increased prevalence of neoplasms in the case of ACKD and following renal transplantation requires careful monitoring of the patients concerned. In very rare cases a renal oncocytoma may develop in the native kidney after renal transplantation.
Tissue-Type Plasminogen Activator (tPA) and Its Inhibitor (PAI-1) in Patients Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Opatrný Jr. Karel , Opatrná Sylvie , Vít Ladislav , Opatrný Karel
Published: April 2003

Aim: To establish whether the values of two key enzymes of fibrinolysis, tissue-type plasminogen activator (tPA) and its inhibitor (PAI-1), differ between patients treated with continuous ambulatory peritoneal dialysis (CAPD) and healthy volunteers and whether plasma and dialysate tPA and PAI-1 values vary during one exchange of dialysis solution. Methods: A total of 11 patients with chronic renal failure, treated with CAPD during the peritoneal equilibration test (in addition with blood sampling at time 0), and a control group of 11 healthy volunteers were examined. To identify the factors involved in the changes in tPA and PAI-1, 9 CAPD patients were subsequently monitored, in a crossover manner, during dialysis with solutions of 1.36 and 3.86% dextrose and off dialysis. Results: Compared with healthy individuals, CAPD-treated patients showed a significantly lower tPA activity (0.39 vs. 0.81 IU/ml, p < 0.05). Changes in plasma fibrinolysis during one exchange of dialysis solution were characterized mainly by a decrease in PAI-1 concentrations and activities caused by the circadian rhythm of fibrinolysis. To explain, in the crossover part of the study, the values of plasma PAI-1 antigen at time 0 (07.00 h) and at time 2 (09.00 h) were 9.4 versus 6.5 ng/ml with the 1.36% solution (p < 0.05), 8.2 versus 4.9 with the 3.86% solution (p < 0.05), and 14.1 versus 9.1 ng/ml off dialysis (p < 0.01). Compared to baseline (0 ng/ml with 1.36 as well as 3.86% solutions), the levels of PAI-1 antigen in dialysis solution rose, apparently due to local production in the peritoneal cavity, to 0.5 ng/ml (p < 0.05) with the 1.36% solution, to 0.7 (p < 0.05) with the 3.86% solution after a 2-hour dwell time, and to 1.6 (p < 0.05) and 1.3 ng/ml (p < 0.05) after a 4-hour dwell time, respectively. Hence, the different dextrose levels in the dialysis solutions had no effect on the monitored parameters of fibrinolysis. Conclusion: The lower activity of plasma tPA, and the increase in PAI-1 levels in dialysis solutions may contribute to the development of thromboses in CAPD patients and to fibrin formation on the peritoneal surface with consequences such as peritoneal fibrosis.
Atrial Natriuretic Peptide Increases Urodilatin in the Circulation
Authors: Vesely David L. , Overton Rose M. , Blankenship Mary , McCormick Michael T. , Schocken Douglas D.
Published: April 2003

Background: Urodilatin is a 32-amino-acid (AA) peptide formed in the kidney. Methods: High-performance gel permeation chromatography and high-pressure liquid chromatography evaluation of plasma followed by sensitive urodilatin and atrial natriuretic peptide (ANP) assays revealed that urodilatin does circulate distinctly from ANP. Results: Urodilatin circulates at very low levels (i.e 9–12 pg/ml). Infusion of ANP increased the circulating concentration of urodilatin 135-fold (p < 0.001), suggesting that some of the effects of ANP may be mediated by urodilatin while long-acting natriuretic peptide, vessel dilator, and kaliuretic peptide did not affect urodilatin in healthy humans (n = 30). Only ANP decreased the renal clearance of urodilatin (60–75%, p < 0.01). Urodilatin was metabolized into peptides smaller than 5 AAs as well as excreted intact into urine. Conclusion: Urodilatin circulates and is increased by ANP in humans.
Uremic Optic Neuropathy
Authors: Korzets Ze’ev , Zeltzer Ella , Rathaus Mauro , Manor Riri , Bernheim Jacques
Published: April 2003

A 41-year-old male patient in end-stage renal failure presented on two occasions, over an 18-month period, with painless unilateral visual deterioration and optic disc edema. Clinical findings were compatible with a diagnosis of uremic optic neuropathy. On his initial presentation, the patient refused the onset of dialysis, resulting in a permanent visual deficit of the left eye. On his subsequent admission with a similar clinical picture, this time of the right eye, dialysis combined with corticosteroid therapy was promptly instituted. This led to a rapid improvement of the visual acuity and visual field defects of the right eye concomitant with subsidence of the edema of the optic nerve head.
Effects of Epoetin Alfa on Hemostasis in Chronic Renal Failure
Authors: Tang Winson W. , Stead Richard A. , Goodkin David A.
Published: April 2003

Epoetin alfa is the cornerstone of anemia therapy in patients with end-stage renal disease. In addition to stimulating erythropoiesis, Epoetin alfa has been demonstrated to affect hemostasis. Such effects may be important because patients with chronic renal failure have a bleeding diathesis that is multifactorial in origin. Therefore, a computer literature search on the relationship between Epoetin alfa therapy for anemia in patients with end-stage renal disease and platelets, coagulation, coagulation inhibitors, and fibrinolysis was performed. All articles and abstracts reporting original data in the English language on Epoetin alfa and its effect on hemostasis were reviewed. The literature suggests that the effects of Epoetin alfa on the coagulation cascade are of minimal clinical importance. However, Epoetin alfa transiently increases the number of circulating platelets and improves platelet function, and these effects are associated with a return of the bleeding time towards normal.
Low Molecular Weight Heparin Reduces Triglyceride, VLDL and Cholesterol/HDL Levels in Hyperlipidemic Diabetic Patients on Hemodialysis
Authors: Yang Chih-Wei , Wu Tsung-Han , Huang Chiu-Ching
Published: April 2003

Background: Low molecular weight heparin (LMWH) provides a safe and effective alternative for hemodialysis anticoagulation. While unfractionated (UF) heparin has been implicated in hyperlipidemia, the effect of LMWH on the lipid profile in nondiabetic patients is controversial in chronic hemodialysis. The effect of LMWH in diabetic patients, a high risk group of hyperlipidemia, has not been studied. Method: LMWH was tested for its safety and efficacy in 10 nondiabetic Taiwanese patients. To evaluate influence of lipid profile, a crossover study was carried out in 10 type II diabetic patients with poor blood sugar control associated with high triglyceride (430.4 ± 101.1 mg/dl) and total cholesterol levels (219.2 ± 12.7 mg/dl) using UF heparin for more than 1 year. These patients were subjected to Fraxiparine, an LMWH, for 6 months and then switched back to UF heparin for another 6 months. Lipid profiles were measured every 2 months without prescribing lipid-lowering agents and the blood sugar was maintained at stationary levels. Results: LMWH is safe and effective in Taiwanese patients as a single bolus injection and maintains a 9.4% higher platelet count immediate postdialysis compared to UF heparin. With high HbA1c levels (9.6 ± 0.6%), mean triglyceride and VLDL levels started to decrease at the 4th month after LMWH treatment and reached a 34% reduction in triglyceride, a 26.2% reduction in VLDL, and a 19% reduction of total cholesterol/HDL ratio at the 6th month. Increments of triglyceride levels were found at the 6th month after a switch back to UF heparin. The levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein A-1 and B remained unchanged. Conclusion: LMWH may be beneficial to lipid control in hyperlipidemic diabetic patients on hemodialysis.
Effect of Intravenous Calcitriol on Cardiac Systolic and Diastolic Function in Patients on Hemodialysis
Authors: Lemmilä Satu , Saha Heikki , Virtanen Vesa , Ala-Houhala Ilpo , Pasternack Amos
Published: April 2003

The systolic and diastolic function of the heart of hemodialysis (HD) patients and the effect of intravenous vitamin D therapy on cardiac function was studied by Doppler and digitized M-mode echocardiography in 10 HD patients before and after 3–4.5 months of calcitriol therapy. Calcitriol was administered intravenously 1–3 times a week at a dose of 1–2 µg after the dialysis sessions. Ten age- and sex-matched healthy controls were also examined echocardiographically. Before calcitriol therapy cardiac wall thicknesses (interventricular septum, posterior wall) and left ventricle (LV) dimensions (end diastolic, end systolic) were greater, and LV diastolic (peak late diastolic velocity, peak early diastolic velocity/peak late diastolic velocity ratio, isovolumic relaxation time) and systolic (fractional shortening) function was impaired in HD patients as compared to controls. The LV posterior wall thickness was related to plasma parathyroid hormone (PTH; r = 0.70, p = 0.01) in the patients. Calcitriol therapy raised serum ionized Ca from 1.23±0.04 to 1.33 ± 0.04 mmol/l and reduced PTH from 41.1±10.7 to 34.2±11.7 pmol/l (29±11%). Calcitriol therapy did not cause any significant changes in cardiac function in the whole patient group. However, in a subgroup of 5 patients with severe but controllable hyperparathyroidism (PTH >3 times upper normal margin) the LV dimensions and systolic function improved (LV end systolic dimension from 39.0 ± 4.0 to 31.3 ± 2.9 mm, p = 0.03; LV end diastolic dimension from 57.7 ± 3.1 to 53.4 ± 3.0 mm, p = 0.06; fractional shortening from 33 ± 4 to 42 ± 3%, p = 0.03). The diastolic indices improved also, but not significantly. In conclusion, left ventricle hypertrophy and systolic and diastolic dysfunction was observed in HD patients. Intravenous calcitriol therapy improved cardiac function in patients with severe secondary hyperparathyroidism.
Plasma Concentration of Brain Natriuretic Peptide as an Indicator of Cardiac Ventricular Function in Patients on Hemodialysis
Authors: Nitta Kosaku , Kawashima Akira , Yumura Wako , Naruse Mitsuhide , Oba Takashi , Kabaya Takashi , Nihei Hiroshi
Published: April 2003

The plasma concentration of human brain natriuretic peptide (BNP) was measured by immunoradiometric assay in patients on maintenance hemodialysis (HD) to assess the possible relationship between the plasma levels of this peptide and cardiac ventricular function, as judged by M-mode echocardiography. The plasma BNP levels in the pre-HD state were significantly higher (688.5 ± 154.5 pg/ml) than those of healthy subjects (<40 pg/ml). In addition, the plasma BNP levels were slightly decreased during HD (post-HD, 617.3 ± 157.1 pg/ml). There was no correlation between the plasma levels of BNP and body weight changes during HD. The mean plasma BNP level was significantly higher in the group of patients with a low left ventricular ejection fraction (EF < 60%) than in the group with a normal EF. In the patients as a whole, there was an inverse correlation between plasma BNP levels and EF. Moreover, a positive correlation was found between plasma BNP levels and left ventricular mass index (r = 0.57, p < 0.05). These results suggest that plasma BNP levels increase in response to chronic stimulation in accordance with increased cardiac load, and that they may be a possible indicator of reduced ventricular function in HD patients.
Isoniazid-Induced Crescentic Glomerulonephritis in a Child with a Positive Tuberculin Skin Test
Authors: Brik Riva , Magen Daniella , Ben-Yzhak Ofer , Grin Jacob
Published: April 2003

Acute nonoliguric renal failure developed in a 13-year-old girl, 1 month after the institution of isoniazid therapy because of a positive tuberculin test at school screening. A renal biopsy demonstrated severe crescentic glomerulonephritis with focal interstitial changes. Discontinuation of isoniazid and a short course of steroids and cyclophosphamide therapy were followed by complete recovery. Whereas isoniazid has been shown to induce a lupus-like syndrome and antihistone antinuclear antibodies, our patient displayed none of the clinical or immunological features that are characteristic of drug-induced lupus. Furthermore, none of the identifiable causes for crescentic glomerulonephritis was evident in this girl. To the best of our knowledge this is the first report suggesting a possible association of crescentic glomerulonephritis to isoniazid treatment.
Role of the Calices in Urine Flow with Characterization of a Caliceopelvic Sphincter and Reflex
Authors: Shafik Ahmed
Published: April 2003

Aim: To study the role of the caliceal system in urine flow. Methods: Eight patients (6 men, 2 women; mean age 42.6 ± 7.6 years) with an upper polar renal mass (6 renal cysts; 2 hypernephromas) which did not encroach on the pelvicaliceal system were studied. After mass removal, a manometric catheter was introduced into one of the intact calices. Another catheter was introduced through the same calix, and the calix was filled with saline in increments of 0.1 ml, and the caliceal, caliceopelvic junction (CPJ), and renal pelvis pressures were recorded. The catheter was moved to the renal pelvis, and the pressure response of the aforementioned sites to renal pelvic filling with saline in increments of 1 ml was registered. The effect of filling of the locally anesthetized calix on the pelvicaliceal pressure was also determined. Results: Caliceal filling resulted in a rise of the caliceal (p < 0.01) and a drop of the CPJ (p < 0.01) pressures with no pressure response in the renal pelvis. Renal pelvic filling produced a rise of renal pelvic (p < 0.01) and CPJ (p < 0.05) pressures; the caliceal pressure showed no change (p > 0.05). Filling of the anesthetized calix or renal pelvis produced no significant pressure changes in calix, CPJ, or renal pelvis (p > 0.05). Conclusions: The CPJ dilatation upon caliceal contraction suggests a reflex relationship which we named ‘caliceopelvic inhibitory reflex’. The reflex is suggested to effect caliceal evacuation. On the other hand, CPJ closure upon renal pelvic contraction postulates another reflex relationship which we designated ‘pelvicaliceal excitatory reflex’. This reflex seems to prevent pelvicaliceal reflux. It is suggested that a ‘functional’ sphincter exists at the CPJ.
Prevalence of Hepatitis C Virus Antibodies in Primary Glomerulonephritis in Brazil
Authors: Lopes Lucila M.V. , Lopes Edmundo P.A. , Silva Eduardo , Kirsztajn Gianna M. , Pereira Aparecido B. , Sesso Ricardo C. , Ferraz M. Lucia
Published: April 2003

The association between hepatitis B virus and membranous glomerulonephritis and membranoproliferative glomerulonephritis (MPGN) was first described in 1971. Recently, a similar association between hepatitis C virus (HCV) and glomerulonephritis (GN) has been reported. We investigated the prevalence of hepatitis C serum antibodies (anti-HCV) in patients with primary GN followed up at our Nephrology Outpatient Clinic between March 1993 and November 1995. The diagnosis of primary GN was established after excluding the presence of connective tissue disease, diabetes, infectious disease, and malignancy. Anti-HCV antibodies were detected by a second-generation enzyme immunosorbent assay and HCV RNA by polymerase chain reaction. Of 81 patients with primary GN, 24 had membranous glomerulonephritis, 17 MPGN, 15 minimal-change disease, 12 focal-segmental glomerulosclerosis, 9 diffuse proliferative GN, and 4 IgA nephropathy. Anti-HCV were detected in 2 cases (2.5%), both were HCV RNA positive and had a polyclonal mixed cryoglobulinemia (IgM-IgG). These 2 cases both came from the group of 17 patients with MPGN. Biochemical investigation in these patients revealed persistent elevation of serum aminotransferase activity, and a liver biopsy specimen in 1 of them showed evidence of chronic active hepatitis. We conclude that in our setting the prevalence of anti-HCV among patients with primary GN is low, being higher (11.8%) only if we consider the patients with MPGN as the reference group. Further studies are necessary to clarify this association and to determine appropriate therapy for these patients.
Delivered Dialysis Dose Is Suboptimal in Hospitalized Patients
Authors: Obialo Chamberlain I. , Hernandez Beverly , Carter Dianne
Published: April 2003

Underdialyzed patients have high hospitalization and mortality rates. It is unclear if such patients receive adequate dialysis during hospitalization. In this cross-sectional study, we evaluated single treatment delivered dialysis dose during hospitalization and compared this to the dosage received at the free-standing outpatient clinics in the same patients. Eighty-four patients (54% male) aged 23–63 years (means ± SD 55.5 ± 14.6) who have been on dialysis for at least 3 months were evaluated. Hypertension and diabetes were the most common diagnoses, while thrombosed graft or fistula accounted for 40% of admissions. The mean dialysis treatment time (Td) was 30 min longer in the outpatient (OP) setting than the hospital (H): 3.6 ± 0.3 vs. 3.1 ± 0.2 h (p < 0.0001). Attained blood flow (QB) was 15% greater in the OP than H: 394 ± 40 vs. 331 ± 54 ml/min (p < 0.0001). The Kt/V was analyzed in 49 of 84 patients; the OP Kt/V was 20% greater than the H Kt/V: 1.38 ± 0.2 vs. 1.11 ± 0.1 (p < 0.0001). A further breakdown of H Kt/V according to access and membrane types showed that patients with functional grafts/fistula had a higher Kt/V than those with temporary accesses 1.14 ± 0.1 vs. 1.07 ± 0.1 (p = 0.01). We conclude that hospitalized patients receive suboptimal dialysis dose, this could have a negative impact on survival if hospitalization is recurrent and prolonged. Kinetic modeling should be routinely performed in such patients and Td should be increased in patients with temporary accesses.
Increased Excretion of Urinary Transforming Growth Factor Beta 1 in Patients with Diabetic Nephropathy
Authors: Sato Hiroaki , Iwano Masayuki , Akai Yasuhiro , Kurioka Hideyuki , Kubo Atsushi , Yamaguchi Toru , Hirata Eiji , Kanauchi Masao , Dohi Kazuhiro
Published: April 2003

The accumulation of extracellular matrix in the glomeruli of human and experimental models of diabetic nephropathy is associated with disease progression. Transforming growth factor beta 1 (TGF-β1), which is a multifunctional peptide growth factor, plays a key role in the synthesis of extracellular matrix protein in vitro, and the expression of TGF-β1 is elevated in human and rat diabetic nephropathy. In this study, we measured the urinary TGF-β1 excretion in 57 patients with non-insulin-dependent diabetes mellitus and in 20 healthy volunteers to examine whether the determination of urinary TGF-β1 excretion would facilitate the evaluation of the degree of mesangial expansion in patients with diabetic nephropathy. Both active and total TGF-β1 levels in 24-hour urine samples collected from patients with diabetes mellitus and normal controls were measured using an enzyme-linked immunosorbent assay. We observed a higher excretion of urinary TGF-β1 in patients with diabetes mellitus than in normal controls. In addition, the urinary TGF-β1 excretion was elevated in patients with severe mesangial expansion. These results suggest that urinary TGF-β1 may represent one parameter that can be used to evaluate the progression of diabetic nephropathy.
Saint Marina: The Protectress of Nephrology
Authors: Eftychiadis A.C. , Marketos S.G.
Published: April 2003

Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255–270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology.
The Medicinal Use of Urine
Authors: Hörl Walter H.
Published: April 2003

Oral intake of freshly voided morning urine has been recommended for many diseases such as viral or bacterial infections. Symptoms reported during the first days of oral intake of urine include nausea, vomiting, headache, palpitations, diarrhea or fever. Several substances in the urine are believed to be important for oral intake such as urea, uric acid, cytokines, hormones or urokinase. Local urine therapies include embrocations, compresses for local tumors, whole body bath or foot bath in the urine, use of urine as eye drops, ear drops or nose drops and the use of urine for wound cleaning.
Uroporphyria: Some Notes on Its Ancient Historical Background
Authors: Gazzaniga Valentina
Published: April 2003

Black urine is recorded in all ancient urology as a negative prognostic sign, often linked with the presence of blood; its presence can also be considered as a sign of massive hemolytic crisis, especially if associated with specific nosological patterns. The Hippocratic case of Epidemics III, 11 has recently been diagnosed as an intermittent acute porphyria. Despite the difficult ‘retrospective’ diagnosis of an ancient case, it seems likely that the Hippocratic physicians empirically knew clinical associations of symptoms that modern medicine could consider as the first descriptions of porphyria.
Water and Its Effects when Drunk Cold
Authors: Bonfante Luciana , Calò Lorenzo , D’Angelo Angela , Favaro Silvana , Abaterusso Cataldo , Mennella Giuseppe , Normanno Marcella , Spinello Michela , Antonello Augusto
Published: April 2003

Starting with Baldassare Pisanelli’s book Trattato della natura de’ cibi et del bere, published in Venice in 1586, the controversies that have kept physicians busy over the centuries regarding the relative importance of water in human health are traced. These controversies were of considerable importance as the Latin word for water ‘aqua’ is derived from the phrase ‘a qua vinimus’ (from whence we come). However, until the studies of Nicolas Lemery, one of the most important pharmacologists of the 18th century, the controversies were debated using more theoretical, philosophical arguments. Lemery’s studies shifted the debates from those based on philosophical arguments to more physiologically and scientifically based arguments.
Jewish Medicine and the University of Padua: Contribution of the Padua Graduate Toviah Cohen to Nephrology
Authors: Massry Shaul G. , Smogorzewski Miroslaw , Hazani Elizur , Shasha Shaul M.
Published: April 2003

During the period of the 11th to 17th century, the access of Jews to European universities was restricted and even those who were fortunate enough to be admitted to a university were not awarded a degree at the end of their studies. An exception to this situation was the University of Padua that allowed Jewish students to study and awarded them degrees; indeed 229 physicians graduated from this university between 1409 and 1721. Among these physicians there were many luminaries such as Joseph Del Medigo, Salmon Congeliano and Toviah Cohen. The latter made many contributions to the field of nephrology. In this treatise Maaseh Toviah he discussed uroscopy, kidney function, body fluid homeostasis and obstructive uropathy.
Giovan Battista Morgagni, a Pioneer of Clinical Nephrology
Authors: Antonello Augusto , Calò Lorenzo , Bonfante Luciana , Mennella Giuseppe , Abaterusso Cataldo , Spinello Michela , Favaro Silvana , D’Angelo Angela
Published: April 2003

In the 18th century, Giovanni Battista Morgagni was the first to propose that specific signs and symptoms are linked to particular anatomical changes at autopsy and that these changes were the cause of the disease. This paper describes the report by Morgagni wherein he linked the anatomic findings at autopsy, specifically atrophied kidneys, with the signs and symptoms of a disease now known as uremia. From these findings, Morgagni felt that he had identified the factors responsible for the disease as well as its clinical course.