bluuebunny/crossref_metadata_2025 huggingface dataset:
Distance Learning in Undergraduate Education: Methods, Opportunities, and Challenges for Institutions and Educators
Authors: Maclean J. Ross , McShane Pat , Etchason Jeff
Published: April 2003

The term ‘distance learning’ represents a variety of educational models that have in common the physical separation of the educator and some or all of the students. Students can be reached through any combination of media: closed-circuit television, video and audio conferencing via telephone lines, and multimedia interaction via the internet. In the past decade, the expansion of distance learning has mirrored the rapid technological advances in the late 20th century that have resulted in a proliferation of educational programs available from an ever-growing number of institutions. This paper reviews the origins and current status of distance learning as an educational medium (including examples of excellent distance learning programs), describes the educational models underpinning distance learning, and discusses the opportunities and challenges for institutions and educators in developing distance learning-based curricula. The research method used was that of a modified systematic literature review. The findings of the literature review show an overwhelming number of distance learning programs now available through a multitude of delivery mechanisms, especially the internet. With regard to the educational models for distance learning, three considerations influence the eventual choice: structure, process, and outcome. To ensure excellence in distance learning, six issues must be addressed: administration, financial resources, human resources, marketing, consumer issues, and the method of assessing distance learning programs. Changing social, professional, and lifestyle dynamics, as well as the rapid evolution of the educational principles of distance learning and the technology available, ensure that demand for lifelong learning will be significant. To respond to this demand, universities and other centers of higher education must recognize and meet the needs of learners who are quite different from the traditional student of the past. This paper presents an overview of the main issues facing institutions and educators who are considering distance learning as a part of their educational programs.
Present Status of Antimicrobial Susceptibility of Haemophilus influenzae Isolates in Kuwait as Determined by E-Test
Authors: Dhar Rita , Wilson Sunita , Ghafoor Mahboob , Rotimi Vincent O. , Chugh Tulsi D.
Published: April 2003

Objective: To study antimicrobial susceptibility pattern of clinical isolates of Haemophilus influenzae using E-test and compare the results with those of a study done in 1983. Methods: The antimicrobial susceptibility of 196 isolates of H. influenzae against nine antimicrobial agents (amoxicillin-clavulanic acid, ampicillin, cefaclor, cefotaxime, ceftriaxone, chloramphenicol, ciprofloxacin, clarithromycin, and trimethoprim-sulfamethoxazole) was performed by E-test on Haemophilus test medium. The results obtained were compared with those from an earlier study conducted here on 108 strains collected between October and December 1983. Results: Except for cefotaxime, which consistently showed an excellent in vitro activity (MIC90 = 0.047 mg/l), other antimicrobial agents presented a decline in their effectiveness. Among the newer antibiotics tested, all the strains were found to be sensitive to ciprofloxacin (MIC range = 0.004–0.0094 mg/l) whereas clarithromycin showed high MIC of 12 mg/l for 90% of the strains. There was a marked increase in the number of beta-lactamase-producing isolates from 4.6% in 1983 to 31.6% in the present study. Amongst 62 beta-lactamase-producing strains 14.5% exhibited resistance to amoxicillin-clavulanic acid (MIC >8 mg/l). Only 3.1% isolates were found to be of capsular type b in 1998 compared to 9.2% in 1983. No beta-lactamase-negative ampicillin-resistant (BLNAR) strain was isolated during the present study whereas only one strain (0.9%) was isolated in 1983. Conclusion: This study shows that despite a decrease in the number of type b and BLNAR H. influenzae isolates, there is an apparent increase in the trend to acquire resistance to several antimicrobial agents.
Genetic Polymorphism at Codon 463 in the katG Gene in Isoniazid-Sensitive and -Resistant Isolates of Mycobacterium tuberculosis from the Middle East
Authors: Ahmad S. , Mokaddas E. , Abal A.T. , Araj G.F. , Fares E. , Mustafa A.S.
Published: April 2003

Objective: To determine whether substitution R463L within the katG gene is associated with resistance to isoniazid in clinical isolates of Mycobacterium tuberculosis recovered from tuberculosis (TB) patients from the Middle East. Methods: A total of 113 clinical isolates of M. tuberculosis obtained from TB patients residing in Kuwait, UAE and Lebanon were used. The isolates were characterized as isoniazid-susceptible (n = 25) or -resistant (n = 88) based on drug susceptibility testing by BACTEC 460 TB system. The presence of R463L mutation within the katG gene of each isolate was detected by amplification of the DNA region around codon 463 by polymerase chain reaction (PCR) followed by digestion with restriction endonuclease NciI to generate PCR-restriction fragment length polymorphism. The results with selected isolates were further confirmed by DNA sequencing. Results: The mutation R463L was detected in 46 of 59 isoniazid-resistant clinical M. tuberculosis isolates from Kuwait, 9 of 12 from UAE and 3 of 17 from Lebanon. The prevalence of this substitution was much higher in isolates recovered from patients of South Asian/Southeast Asian origin (41/49, 84%) than from patients of Middle Eastern origin (17/39, 44%). Although all the 7 isoniazid-susceptible isolates of M. tuberculosis from Lebanon (recovered exclusively from Middle Eastern patients) contained arginine at codon 463, 3/7 and 10/11 isoniazid-susceptible strains from Kuwait, recovered from Middle Eastern and South Asian patients, respectively, contained leucine at codon 463. Conclusion: The results show that genetic polymorphism exists at codon 463 in the katG gene of M. tuberculosis recovered from patients of different ethnic backgrounds. The data also show that substitution R463L within the katG gene does not contribute to isoniazid resistance.
Bronchial Hyperresponsiveness and Exhaled Nitric Oxide in Patients with Cardiac Disease
Authors: Nishimura Yoshihiro , Yu Yoko , Kotani Yoshikazu , Nishiuma Teruaki , Lin Shan , Maeda Hitoshi , Yokoyama Mitsuhiro
Published: April 2003

Background: Increased concentrations of exhaled nitric oxide (NO) correlate with increased airway inflammation and measurement of exhaled NO is a noninvasive method for the management of bronchial asthma. In various cardiac diseases, bronchial hyperresponsiveness is observed, as is bronchial asthma. However, there have been few studies on the relationship between exhaled NO and bronchial responsiveness in cardiac diseases. Objective: The aim of this study was to clarify the association between exhaled NO and bronchial hyperresponsiveness in patients with cardiac disease. Methods: We measured expired NO and bronchial responsiveness to inhaled methacholine in 19 patients with cardiac diseases and 17 with bronchial asthma. We divided the cardiac disease patients into two groups according to their bronchial responsiveness to inhaled methacholine: BHR(+) group consisted of 12 patients with bronchial hyperresponsiveness and BHR(–) group consisted of 7 patients without bronchial hyperresponsiveness. Results: The concentration of exhaled NO in the asthmatic patients was significantly higher than that in the BHR(+) and BHR(–) groups (142.0 ± 17.0, 33.6 ± 6.4 and 42.3 ± 10.3 ppb, respectively, p < 0.01). There was no significant difference in exhaled NO between BHR(+) and BHR(–) groups. There were also no significant differences in the parameters of bronchial hyperresponsiveness between the cardiac BHR(+) and bronchial asthma groups. These results indicate that bronchial hyperresponsiveness in patients with cardiac diseases is not a consequence of eosinophilic inflammation or of exhaled NO. Conclusion: We conclude that bronchial hyperresponsiveness in patients with cardiac diseases can occur independently of NO production.
Prevalence of Emphysema in Individuals Who Underwent Screening CT for Lung Cancer in Nagano Prefecture of Japan
Authors: Wang Qian , Takashima Shodayu , Wang Ji-Chen , Zheng Li-Ming , Sone Shusuke
Published: April 2003

Background: Screening for lung cancer with low-dose spiral computed tomography (CT) was carried out in Nagano prefecture in Japan. Objective: To study the prevalence of emphysema in 7,847 individuals based on the Nagano spiral CT screening and to correlate the prevalence and severity of emphysema with various factors. Methods: Spiral CT images with scan parameters of 120 kV, 50 mA, 10-mm collimation and a pitch of 2 obtained at full inspiration were retrospectively evaluated in 7,847 individuals. Emphysema was defined as the presence of low-attenuation areas in the lung parenchyma. Extent of emphysema was graded on a four-level scale and correlated with gender, age and smoking habits. Results: There were 4,288 males and 3,559 females. Mean age of the subjects was 61 years; 45.8% of the participants were smokers. Overall prevalence of emphysema was 2.9%; the prevalence was significantly higher in males (5.0%) than in females (0.5%); it was also significantly higher in smokers, and increased with age. Emphysema was positively correlated with age, but there was no correlation with smoking indices. Emphysema was mostly mild and localized in the upper lung. The logistic model revealed that gender, age and smoking indices were significant factors for developing emphysema. Conclusions: Overall prevalence of emphysema was 2.9%. The prevalence was higher in males and in older people. Smoking was also related to a higher prevalence of emphysema but not to its severity.
Continuous Positive Airway Pressure and Lung Inflation in Sleep Apnea Patients
Authors: Verbraecken J. , Willemen M. , de Cock W. , Van de Heyning P. , de Backer W.A.
Published: April 2003

Background: It was shown in normals that an important decrease in upper airway resistance can be obtained with continuous positive airway pressure (CPAP). It was suggested that lung inflation in patients with sleep apnea syndrome (SAS) could also be a mechanism of action of CPAP. Objective: In the present study we wanted to evaluate the effects of nocturnal CPAP on the daytime lung function pattern in patients with SAS. Methods: We measured arterial blood gases and possible changes in static lung volumes in 57 SAS patients (37 with normal lung function, 10 with COPD and 10 with restrictive lung disease) after at least one month of CPAP therapy. Results: A significant increase in PaO2 (from 79 to 84 mm Hg, p = 0.01) and a decrease in AaDO2 (from 23 ± 1 to 16 ± 1, p < 0.01) was only observed in SAS patients with normal lung function. This improved gas exchange was parallelled by a small but non significant change in the FRC (from 96.5 ± 3.2 to 105.4 ± 3.7%pred, p = 0.07) and TLC (from 101.3 ± 1.7 to 104.1 ± 1.4%pred, p = 0.15). Similar changes in TLC and FRC were also observed in SAS patients with obstructive and restrictive lung disease. Conclusions: Chronic nocturnal CPAP therapy can improve daytime gas exchange and may influence lung inflation during the daytime. The small changes seem to be a functional effect but of no clinical relevance.
High-Dose-Rate Endobronchial Brachytherapy in Endobronchial Metastatic Malignant Chondroid Syringoma
Authors: Solomonov Anna , Rosenblatt Edward , Ben-Izhak Ofer , Goralnik Luda , Yigla Mordechai
Published: April 2003

A 65-year-old man with malignant chondroid syringoma (MCS) was found to have pulmonary metastases in the form of multiple pulmonary nodules 4 years after wide excision and adjuvant radiotherapy of a primary abdominal wall tumor. Atelectasis of the lingula due to obstructive endobronchial metastasis, resistant to combination chemotherapy, led us to perform high-dose rate (HDR) endobronchial brachytherapy for the first time in this rare tumor with a favorable response. This case emphasizes the role of HDR brachytherapy as a palliative procedure in endobronchial tumors not responding to other treatment modalities, even those considered to be radioresistant.
Comparison of the Bronchodilating Effect of Salmeterol and Zafirlukast in Combination with That of Their Use as Single Treatments in Asthma and Chronic Obstructive Pulmonary Disease
Authors: Cazzola M. , Centanni S. , Boveri B. , Di Marco F. , Santus P. , Matera M.G. , Allegra L.
Published: April 2003

Background: It has been suggested that the effect of a β2-agonist is additive with that of a cysteinyl leukotriene 1 receptor antagonist. Objectives: The present study was designed to answer the question of whether combined administration of inhaled salmeterol and oral zafirlukast at the standard doses would result in greater bronchodilation in patients with chronic airway obstruction than the use of either drug alone. Methods: The study was performed using a double-blind, double-dummy, crossover, randomised design, and was conducted on 4 non-consecutive days. Sixteen patients with moderate to severe chronic obstructive pulmonary disease (COPD) and 10 non-smoker asthmatic patients received 40 mg of oral zafirlukast, 50 µg of inhaled salmeterol, 50 µg of inhaled salmeterol plus 40 mg of oral zafirlukast of placebo. Lung function was assessed before drug administration and 30, 60, 120, 180 and 240 min thereafter. At the end of the 4-hour period, each patient received 400 µg of inhaled salbutamol and spirometric testing was performed 30 min later. Results: In both asthmatic and COPD patients, the overall effect of salmeterol and zafirlukast on the forced expiratory volume in 1 s (FEV1) was considered extremely significant (p < 0.0001), with a maximum bronchodilation above baseline after 180 min (20.7 and 11.0%, respectively) in asthmatics and after 2 h (21.7 and 11.2%, respectively) in COPD subjects. Zafirlukast did not produce any further significant acute bronchodilation in addition to that achieved with salmeterol alone in either asthmatic or COPD patients. Nevertheless, 7 out of 16 COPD patients and 7 out of 10 asthmatic patients had a further improvement after the combination of salmeterol and zafirlukast. The mean difference in pre- and post-salbutamol FEV1 values in both asthmatic and COPD patients after zafirlukast was significant (p < 0.05), but that after salmeterol and the combination of the two drugs was not significant (p > 0.05). The difference between placebo and zafirlukast was not significant following inhaled salbutamol given 4 h after each treatment. Conclusions: Both salmeterol and zafirlukast induced a significant increase in FEV1, although salmeterol elicited a greater improvement in both asthmatic and COPD patients. Apparently, zafirlukast at the clinically recommended dose did not produce any further significant acute bronchodilation in addition to that achieved with salmeterol alone, either in asthma or COPD. In any case, evaluation of the effect of the combination over a 12-hour period is mandatory.
Airway Hyperresponsiveness and Pulmonary Function in Adult Asthma
Authors: Mitsuta Kazuko , Shimoda Terufumi , Kawano Tetsuya , Obase Yasushi , Fukushima Chizu , Matsuse Hiroto , Kohno Shigeru
Published: April 2003

Background: Airway hyperresponsiveness (AHR) is a very important factor in the pathogenesis of bronchial asthma. Objectives: To examine the relationship between airway obstruction and AHR in adult asthma. Methods: This study was a retrospective study in 161 adult asthmatic patients. Nonspecific AHR to methacholine was measured. We examined the correlations between AHR and pulmonary function, severity of asthma, type of asthma and age. Results: In the moderate and severe groups, peripheral airway obstruction was more aggravated compared to the mild group, and AHR was significantly more severe. Analysis of AHR by age showed that the degree of airway obstruction increased with aging, but age did not clearly correlate with airway sensitivity. Airway reactivity decreased with aging. Aspirin-induced asthma tended to be severe. In fatal asthma, central airway obstruction was significantly more severe. Although AHR in fatal asthma did not significantly differ from that in the severe group, airway sensitivity and airway reactivity tended to be increased. Conclusions: AHR is an important factor determining the severity of asthma, and airway obstruction is an important index for the prediction of death from asthma. An evaluation of the degree of AHR and airway obstruction is considered to be the first step in controlling asthma.
Epidemiological Trends in Pancreatic Neoplasias
Authors: Simon Babette , Printz Hartmut
Published: April 2003

Primary prevention is the most effective approach to reduce the incidence of pancreatic cancer. Epidemiological studies have contributed to the identification of risk factors for pancreatic cancer, suggesting an association with age, various medical conditions, environmental and lifestyle risk factors, and occupational and genetic conditions. Age is the strongest risk factor. The most consistently identified environmental risk factor is smoking, but there is less certainty concerning dietary factors. Studies have suggested a positive association with high energy intake, cholesterol and meat, while vegetable and fruit intakes are probably protective. Patients with chronic pancreatitis and new onset of diabetes mellitus have a low but increasing risk of having or developing pancreatic cancer. There is strong evidence for the association of hereditary pancreatitis or cystic diseases of the pancreas and pancreatic cancer. A family history of pancreatic cancer is an important risk factor, but only a small proportion can be linked with known familial cancer syndromes. Thus, additional yet unidentified predisposing risk factors have to be assumed
Experimental Animal Models in Pancreatic Carcinogenesis: Lessons for Human Pancreatic Cancer
Authors: Standop Jens , Schneider Matthias B. , Ulrich Alexis , Pour Parviz M.
Published: April 2003

The silent course of pancreatic cancer and its explosive fatal outcome have hindered studies of tumor histogenesis and the identification of early biochemical and genetic alterations that could help to diagnose the disease at a curable stage and develop therapeutic strategies. Experimental animal models provide important tools to assess risk factors, as well as preventive and therapeutic possibilities. Although several pancreatic cancer models presently exist, only models that closely resemble human tumors in morphological, clinical, and biological aspects present useful media for preclinical studies. Because an estimated 70% of human tumors are induced by carcinogens and because a significant association has been found between cigarette smoking and pancreatic cancer, chemically induced models are of particular value. Moreover, in such models the etiology, modifying factors, effects of diets, and naturally occurring products can be studied and early diagnostic, preventive, and therapeutic possibilities sought out. Many of the existing models are described in this review, and the advantages and shortcomings of each model and their clinical implications are discussed.
Differentiation of Chronic Pancreatitis from Pancreatic Cancer: Recent Advances in Molecular Diagnosis
Authors: Ebert Matthias , Schandl Laslo , Schmid Roland M.
Published: April 2003

Chronic pancreatitis is an inflammatory disease of the pancreas, characterized by a progressive destruction of the exocrine and endocrine pancreas, leading both to exocrine and endocrine insufficiency. In recent years, our knowledge of this disease has improved, an epidemiological link between chronic pancreatitis and pancreatic cancer has been established, and the molecular alterations underlying their pathogenesis have been partly revealed. Nevertheless, the differentiation of chronic inflammation of the pancreas from cancer of the pancreas remains a great challenge. This overview will point out the present knowledge of the molecular pathogenesis of chronic pancreatitis and pancreatic cancer and will focus on the role of molecular markers for differentiating chronic pancreatitis from pancreatic cancer.
Epidemiological Trends of Functional Gastrointestinal Disorders
Authors: Gschossmann J.M. , Haag S. , Holtmann G.
Published: April 2003

Functional gastrointestinal disorders are highly prevalent in the population and in primary and secondary care centers. Most likely they have been highly prevalent for centuries but in the past the lack of appropriate diagnostic measures did not enable the precise exclusion of structural causes of symptoms. In recent decades the prevalence rates of Helicobacter pylori has clearly decreased. As a result the incidence of H. pylori-related structural diseases in the upper gut decreased. Thus the relative proportion of functional gastrointestinal disorders has increased and may result in the overall impression that the prevalence of functional gastrointestinal disorders has increased. Thus, the available data do not provide evidence that the prevalence of these disorders has changed in recent decades.
Update in the Therapeutic Management of Irritable Bowel Syndrome
Authors: Villanueva Augusto , Domínguez-Muñoz J. Enrique , Mearin Fermín
Published: April 2003

Irritable bowel syndrome (IBS) is a remarkably frequent disorder that leads to relevant impairment in patients’ quality of life. Four mechanisms are involved in the pathogenesis of IBS: altered intestinal motility; increased visceral sensitivity; disturbed intestinal reflexes (intrinsic and extrinsic), and psychological disorders. The close relationship between the central nervous system and the enteric nervous system (the brain-gut axis) is the basis of the actual research on IBS therapy. It is conceivable that in the near future a better understanding of IBS pathophysiology will help us to tailor treatment for different IBS patients. At the moment, the subclassification of the diverse patterns of symptomatology allows the adjustment of treatments for IBS according to the clinical predominance of each patient. Dietary modifications like fiber supplementation, antidiarrheal agents and antispasmodic drugs are the basis of the current treatment of IBS and depend on the predominant symptom (constipation, diarrhea or pain, respectively). If severe pain is present, antidepressant agents are an appropriate alternative. However, the scientific evidence supporting this current therapeutic approach is limited. Visceral analgesics and serotonin agonists and antagonists may play an important therapeutic role in the near future. However, it is not likely that one single treatment will help every IBS patient and many of them will need a more complex approach with multidisciplinary therapy (diet, psychotherapy, medications).
Hepatocellular Carcinoma: An Asian Perspective
Authors: Teo E.K. , Fock K.M.
Published: April 2003

Hepatocellular carcinoma (HCC) is one of the most frequently occurring malignancies in Asia. The incidence exceeds 30 cases/100,000/year in the east Asian region. Worldwide, it accounts for almost 1 million deaths/year. The high incidence in Asia is due to the high prevalence of chronic viral hepatitis, mainly chronic hepatitis B. With the introduction of universal vaccination for hepatitis B in some Asian countries in the mid 1980s, some of these countries are experiencing a decline in the incidence of HCC. This probably underscores the point that HCC caused by hepatitis B is a malignancy preventable by vaccine. Due to the relative paucity of symptoms in the early stages and the rapid doubling time of the tumor, most HCCs are discovered late in advanced stages at presentation. Most Asian countries have adopted a screening program for patients at risk. Earlier and smaller HCCs are detected through such programs but these programs have yet to demonstrate improved patient survival. Physicians managing patients with HCC are faced with two main challenges, the malignancy itself and the underlying liver disease. The extent of the tumor and the existing liver function limits the therapeutic choices available. Hepatic resection remains the treatment of choice. However, the majority of patients present with nonresectable tumors. Transarterial chemoembolization, percutaneous ethanol injection and radiofrequency ablation are the other treatment modalities. In patients with small tumors (<5 cm) and poor liver function, liver transplant offers a viable treatment alternative. In summary, the risk factor for HCC in Asia is predominantly chronic hepatitis B. Universal vaccination against hepatitis B is likely to reduce the incidence. The prognosis and outcome of treatment remains poor with a 5-year survival of 35% for patients treated surgically and less than 10% for nonresectable tumors. Current management is aimed at earlier detection and more effective treatment of early HCC. In future, the challenge will be managing HCC in the premalignant stage.
Systemic Treatment of Hepatocellular Carcinoma
Authors: Treiber G.
Published: April 2003

Systemic treatment for hepatocellular carcinoma is indicated in locally advanced or metastatic disease. Monochemotherapies have yielded unsatisfactory results with response rates of around 20% but survival is often not improved. Polychemotherapies may induce complete responses but have substantial toxicity and are limited to selected patients with preserved liver function. Hormonal treatment with tamoxifen is ineffective while megestrol has shown an improvement in quality of life. Octreotide can be given even in cases of impaired liver function, has also a favorable side effect profile and can lead to disease stabilization. Adjuvant therapy with interferon is indicated after successful liver resection or transplantation in patients with chronic viral hepatitis, the role of interferon in other indications or in combination with chemotherapy remains to be determined.
Relation between Average Alcohol Consumption and Disease: An Overview
Authors: Gutjahr Elisabeth , Gmel Gerhard , Rehm Jürgen
Published: April 2003

Objective: To conduct an overview of alcohol-related health consequences and to estimate relative risk for chronic consequences and attributable fractions for acute consequences. Methods: Identification of alcohol-related consequences was performed by means of reviewing and evaluating large-scale epidemiological studies and reviews on alcohol and health, including epidemiological contributions to major social cost studies. Relative risks and alcohol-attributable fractions were drawn from the international literature and risk estimates were updated, whenever possible, by means of meta-analytical techniques. Results: More than 60 health consequences were identified for which a causal link between alcohol consumption and outcome can be assumed. Conclusions: Future research on alcohol-related health consequences should focus on standardization of exposure measures and take into consideration both average volume of consumption and patterns of drinking.
Quality Control by Cocaine Users: Underdeveloped Harm Reduction Strategies
Authors: Decorte Tom
Published: April 2003

The use of any drug involves both values and rules of conduct (social sanctions) and patterns of behavior (social rituals). Based on an ethnographic study (1996–1999) among 111 cocaine users from the metropolitan area of Antwerp (Belgium), the self-regulatory mechanisms surrounding the methods of controlling the quality of a drug are described. Users’ perceptions of reliable and unreliable sources of cocaine, quality and adulteration of cocaine and quality control techniques are confronted with objective information. It is argued that these informal control mechanisms may be crucial factors in the controlled use of any intoxicant, but myths are an important ingredient of the observed rituals, which indicates that knowledge about certain drugs and the best ways to use them in a safe way is still underdeveloped. Users are left to their own folk-experimental devices for testing tools or techniques, and many aspects of the natural processes of social learning are generally not based on objective information. Future harm reduction interventions should therefore also stimulate the development and dissemination of effective informal control mechanisms among illicit drug users.
Comparison of Alcohol-Dependent Patients with and without Physiological Dependence
Authors: Lejoyeux Michel , Claudon Micheline , McLoughlin Mary , Adès Jean
Published: April 2003

Sociodemographic and clinical characteristics of alcohol-dependent patients with or without physiological dependence (e.g. tolerance to alcohol or withdrawal) were compared. 186 consecutive alcohol-dependent patients hospitalized for alcohol detoxification were assessed. Diagnosis of alcohol dependence, tolerance and withdrawal was determined according to DSM-IV criteria. Assessment also included modalities of alcohol consumption and the Michigan Alcohol Screening Test (MAST). All patients presented alcohol dependence, 124 presented tolerance, 116 alcohol withdrawal and 146 (78.5%) tolerance and/or withdrawal. Patients with physiological dependence were older (51.4 vs. 46.9 years), drank more alcohol each day (20.3 vs. 11.3 drinks/day) and began alcohol consumption more often in the morning (67 vs. 37.5%). MAST scores were significantly higher in patients with physiological dependence (28.8 vs. 24.5), as was the mean corpuscular volume of erythrocytes (108 vs. 83 fl). No difference was found in terms of age, marital status, rate of unemployment, level of education and psychiatric comorbidity between the patients with and without physiological dependence.
Symptomatic Characteristics of Parkinsonism and the Width of Substantia nigra pars compacta on MRI According to Ischemic Changes in the Putamen and Cerebral White Matter: Implications for the Diagnosis of Vascular Parkinsonism
Authors: Tohgi Hideo , Takahashi Satoshi , Abe Takashi , Utsugisawa Kimiaki
Published: April 2003

To investigate the significance of vascular lesions as a cause of secondary parkinsonism, we analyzed the symptomatic characteristics, the width of the substantia nigra pars compacta (SNpc) on MRI and the responsiveness to L-dopa in 227 parkinsonian cases, excluding those with drug-induced parkinsonism and neurodegenerative diseases other than idiopathic Parkinson’s disease (IPD). They were classified into those without a significant infarct in the basal ganglia (n = 144), those with status lacunaris in the putamen (SLP; n = 66) and those with confluent white matter hyperintensity signals (CWMH; n = 17). The 4- to 6-Hz tremor and cogwheel rigidity were significantly more frequent in cases without significant infarct (69%) than those with SLP (50%) and those with CWMH (12%; p < 0.05). Among cases with 4- to 6-Hz tremor and cogwheel rigidity, the frequency of patients with a reduced SNpc width and L-dopa responders did not significantly differ between those with SLP (73 and 83%, respectively) and those without significant infarct (83 and 86%, respectively), suggesting that the diagnosis for most of these cases would be probable IPD. In contrast, among cases without 4- to 6-Hz tremor and cogwheel rigidity, those with a reduced SNpc width or L-dopa responders were significantly less frequent among cases with SLP (25 and 38%, respectively) than among those without significant infarct (75 and 71%, respectively; p < 0.05). Patients with neither 4- to 6-Hz tremor and cogwheel rigidity nor reduction in the SNpc width, for whom the probable diagnosis was vascular parkinsonism (VP), were significantly more frequent in cases with SLP (26%) and with CWMH (40%) than those without significant infarct (8%), accounting for 10.6% of the total parkinsonian cases. These findings suggest that parkinsonian cases with SLP or CWMH consist of not only cases with vascular-lesion-related VP but also IPD in which vascular lesions are not directly related to parkinsonism. Absence of 4- to 6-Hz tremor, cogwheel rigidity and the reduction in the SNpc width could be indicators for differentiating VP from IPD.
Corticospinal Tract Involvement in a Variant of Guillain-Barré Syndrome
Authors: Oshima Yasushi , Mitsui Takao , Endo Itsuro , Umaki Yoshifumi , Matsumoto Toshio
Published: April 2003

To determine the involvement of the corticospinal tract in Guillain-Barré syndrome (GBS), we examined central motor conduction in patients with GBS-like symptoms and hyperreflexia using a magnetic stimulation technique. The subjects were 3 patients who exhibited ascending muscle weakness 2–4 weeks after preceding infections. Deep tendon reflexes were exaggerated in all four limbs of the 3 patients. The results of cerebrospinal fluid examinations revealed protein elevation without pleocytosis. The serum anti-GM1 antibody titer was elevated in 2 patients. The results of nerve conduction study revealed axonal motor neuropathy and normal F-wave conduction. Central motor conduction time (CMCT) in patients with hyperreflexia was significantly delayed compared to that in patients with GBS and areflexia (p < 0.001), and the delayed CMCTs were significantly improved in the recovery periods (p < 0.001). Although hyperreflexia is a controversial symptom in patients with GBS, these findings indicate that there is functional corticospinal tract involvement in patients with a GBS variant.
The Role of Carotid Stenosis in Vascular Cognitive Impairment
Authors: Rao Rahul
Published: April 2003

The role of carotid stenosis in vascular cognitive impairment was reviewed using Medline, EMBASE, PsychLit and PsychInfo databases using the words ‘carotid stenosis’, ‘neuropsychological tests’ and ‘endarterectomy’. Limited evidence exists for frontal lobe dysfunction associated with carotid stenosis, but there is a lack of systematic and prospective studies carried out in consecutive patients, including appropriate neuropsychological and MRI assessment. Possible pathophysiological processes suggested for cognitive impairment associated with carotid stenosis are suggested; these include chronic ischaemia and lacunar infarction; such mechanisms and resultant pathologies may co-exist in the presence of large-artery atheroma.
An Atypical Neuropsychological Profile of a Korsakoff Syndrome Patient throughout the Follow-Up
Authors: Noël Xavier , Schmidt Nicolas , van der Linden Martial , Sferrazza Rita , Hanak Catherine , de Mol Jacques , Kornreich Charles , Pelc Isy , Verbanck Paul
Published: April 2003

The basis of amnesia in alcoholic Wernicke-Korsakoff syndrome (WKS) has been generally associated with diencephalic lesions and more specifically with lesions of the anterior thalamic nuclei. These brain structures are considered to be involved in encoding/consolidation processes of episodic memory. However, frontal lobe damage responsible for executive function deficits has also been documented. The present report details the nature and extent of amnesia in an alcoholic patients with WKS and which appears to be mainly due to frontal lobe (executive) deficits.
The Prevalence of Multiple Sclerosis, Distribution of Clinical Forms of the Disease and Functional Status of Patients in Csongrád County, Hungary
Authors: Bencsik Krisztina , Rajda Cecília , Füvesi Judit , Klivényi Péter , Járdánházy Tamás , Török Margit , Vécsei László
Published: April 2003

Objective: The aim of this study was to determine the prevalence of multiple sclerosis (MS) in the population of Csongrád County, Hungary (400,128 inhabitants) and to determine the functional status (based on the Expanded Disability Status Scale; EDSS) of the patients according to the clinical forms of the disease. Methods: The diagnosis was established with the aid of the Poser diagnostic criteria, and the degree of physical disability was determined using the Kurtzke EDSS. Results: In Csongrád County, the prevalence of MS is 62/100,000. The distribution of patients according to the clinical forms of MS was as follows: 15% had the benign form, 54% had relapsing-remitting MS, 20% had secondary chronic progressive MS and 11% had the primary chronic progressive form of MS. Sixty percent of relapsing-remitting MS patients had an EDSS score of 0–4 points and 33% had an EDSS score of 4.5–6.5 points. Conclusion: The distribution of patients according to the clinical forms of the disease in this representative population is comparable to results in other regions of the world.
Color Doppler Imaging of the Orbital Vessels in Behçet’s Disease
Authors: Duranoglu Yaşar , Apaydin Cemil , Karaali Kamil , Yücel İclal , Apaydin Ali
Published: April 2003

Objective: To investigate blood flow velocity changes, pulsatility and resistivity index values of orbital vessels in Behçet’s disease with or without ocular involvement (groups I and II) and healthy volunteers (group III). Methods: Twenty-five eyes in the first group, 24 eyes in the second group and 24 eyes in the third group were examined by using color Doppler imaging. Peak systolic and end-diastolic blood flow velocity measurements, pulsatility and resistivity index values were measured in ophthalmic, central retinal, nasal and temporal ciliary arteries and the central retinal vein. Results: The end-diastolic blood flow velocity measurements in all arteries were significantly higher in groups II and III than in group I, but resistivity and pulsatility indexes of all arteries were higher in group I than the other two groups. There was no significant difference in blood flow velocity of the central retinal vein in the three groups. Conclusion: Detection of increased vascular resistance of orbital vessels may predict the diagnosis of ocular involvement in Behçet’s disease.
Early Ultrastructural Findings and Superoxide Dismutase Levels in Experimental Ischemic Optic Neuropathy: Effect of Hypertension and Hypotension on Ischemic Changes
Authors: Hacıyakupoğlu Gülhanım , İşigüzel İsmail , Zorludemir Suzan , Zeren Handan , Bağdatoğlu Hüseyin , Menziletlioğlu Şule , Hacıyakupoğlu Sebahattin , Aksoy Kıymet , Dağlıoğlu Kenan
Published: April 2003

We induced ischemia, hypertension and hypotension in 15 rabbits in order to evaluate the ischemic changes in the optic nerve and the effect of hypertension and hypotension on ischemia. We cauterized the right internal and external carotid arteries of 15 rabbits and applied dopamine hydrochloride and glycerol trinitrate to 5 each of these rabbits. Two rabbits were used as controls. We enucleated both eyes of all animals at the 24th hour. All of the optic nerves underwent biochemical, histopathological and ultrastructural examination. Histopathological and transmission electron-microscopic changes were found to be more prominent in the hypotensive group. We observed decreased superoxide dismutase levels in all groups, but it was more evident in the third group. In comparison to hypertension, hypotension is found to be a more important factor in the development of early degenerative changes.
Disappearance of Desmosomal Components in Rat Corneal Epithelium during Wound Healing
Authors: Okada Yuka , Saika Shizuya , Shirai Kumi , Hashizume Natsuko , Yamanaka Osamu , Ohnishi Yoshitaka , Senba Emiko
Published: April 2003

Purpose: Epithelial migration is essential for healing of the ablated corneal epithelium. To reveal the mechanism which enables the corneal epithelial cells to dissociate during migration, we investigated the immunolocalization of the components of the desmosome, which is the main constituent of the intercellular junction attaching the intermediate filaments to the cell surface, desmoplakin 1, desmoglein and plakoglobin, in the corneal epithelium during wound healing in rats. Methods: Under general anesthesia with ether inhalation, Wistar rats (n = 48) underwent removal of the central corneal epithelium of one eye with a small trephine and a scalpel. After various intervals of healing (5 min; 1, 3, 6, 9, 12, 24, 48 h; 1 and 2 weeks), the animals were killed and the affected eye was excised. Cryosections of each anterior segment of the eye were fixed with cold acetone and treated with primary antibodies against desmoplakin 1, desmoglein and plakoglobin. Immunolocalization of these substances was visualized by the peroxidase-diaminobenzidine reaction. Results: A marked immunoreactivity for these desomosome components was detected at the intercellular junction in the normal corneal and conjunctival epithelium. At 6–24 h after epithelial ablation, a weak immunoreactivity for desmoplakin 1 and plakoglobin was observed in the migrating epithelium. At 48 h after epithelial ablation, a marked immunoreactivity for these desmosome components was seen again. At 6–48 h after epithelial ablation, a weak immunoreactivity for desmoglein was observed in the migrating epithelium. At 1 week after epithelial ablation, a marked immunoreactivity for this desmosome component reappeared. The regenerated epithelium gradually exhibited normal immunolocalization of the proteins. Conclusions: The desmosome components were considered to be degraded or destroyed prior to epithelial migration and reconstructed during healing of the squamous epithelium.
Combined Phaco-Emulsification Cataract Extraction and Pars plana Vitrectomy without Intra-Ocular Lens Implantation
Authors: Jackson Timothy L. , Larsson Jorgen , Tanner Vaughan , Williamson Tom H.
Published: April 2003

Purpose: To report the indications, surgical technique and visual outcome of combined phaco-emulsification cataract surgery and three-port pars plana vitrectomy (CPPV) in patients unsuitable for primary intra-ocular lens (IOL) implantation. Method: A 4-year review in a tertiary referral hospital. Results: Thirty patients (30 eyes) had CPPV without primary IOL insertion. The patients had a mean pre-operative logMAR acuity of 1.81 (SD 0.49) which improved to 1.50 (SD 0.72) postoperatively (p = 0.036). Conclusion: CPPV with primary IOL insertion is now an established surgical technique. This series suggests that patients with contra-indications to primary IOL insertion may also benefit from CPPV.
Penetration of Amikacin into Aqueous Humor of Rabbits
Authors: Erkin Esin F. , Günenç Üzeyir , Öner Ferit H. , Gelal Ayşe , Erkin Yüksel , Güven Hülya
Published: April 2003

Amikacin is an aminoglycoside antibiotic that has poor corneal penetration due to its hydrophilic properties. The purpose of this study was to compare and evaluate the penetration of amikacin sulfate into aqueous humor of the rabbit eye when applied by different routes and concentrations, namely 100 or 250 mg/ml topical fortified amikacin eye drops, 100 or 250 mg/ml amikacin-embedded soft contact lenses and 25 mg subconjunctival amikacin injection. One hour after application, amikacin was not detectable in any of the 100 mg/ml concentration groups. High levels of amikacin above the minimum inhibitory concentration for susceptible bacteria were detected when applied subconjunctivally and by 250 mg/ml topical fortified routes. Topical fortified amikacin 250 mg/ml reached the highest value in the aqueous (p < 0.05). Our results point out the poor corneal penetration of amikacin in standard concentrations from the intact rabbit cornea and that subconjunctival injections might provide satisfactory penetration.
Effect of Trimetazidine on Retinal Ischemia/Reperfusion Injury in Rats
Authors: Özden Serap , Kildaci Bahriye , Muftuoglu Sevda , Cakar Nur , Yildirim Cem
Published: April 2003

Purpose: To investigate the effect of trimetazidine (TMZ), an antioxidant agent, on the ischemia/reperfusion (I/R) injury in rat retina histopathologically. Methods: The retinal I/R model was carried out by the 4-vessel occlusion method on Wistar albino rats. Twenty-one rats were divided into 7 groups, each comprising 3 rats. The animals in groups 1, 2 and 3 underwent 30 min of ischemia + 4 h of reperfusion and were treated by the administration of saline, TMZ before reperfusion and TMZ before ischemia, respectively. The animals in groups 4, 5 and 6 underwent 90 min of ischemia + 4 h of reperfusion and were treated in the same way as those in groups 1, 2 and 3, respectively. The 7th group was sham operated. Results: Thirty and 90 min of ischemia followed by 4 h of reperfusion induced retinal injury in the rat retina. Histopathologically, the inner plexiform and inner nuclear layers were the most affected parts. TMZ was able to reduce almost all retinal I/R damage when administered before ischemia. A cytoprotective effect of TMZ was partly observed in those animals which were treated before reperfusion. Conclusion: TMZ seemed to have a protective effect against retinal I/R injury in rats.
Analysis of the Antibody Repertoire in Tears of Dry-Eye Patients
Authors: Grus F.H. , Dick B. , Augustin A.J. , Pfeiffer N.
Published: April 2003

Purpose: It has recently been suggested that dry-eye disease has an underlying autoimmune mechanism. This hypothesis is further supported by the successful treatment of the disease with immunomodulatory drugs such as cyclosporin A. Although it is known that tears contain antibodies, very little is known about the antibody repertoires in tears. It was the aim of this study to analyze the IgA antibody repertoire against ocular antigens in the tears of patients suffering from dry-eye disease and compare it to those of healthy volunteers. Methods: Two groups were examined: 20 healthy volunteers (controls) and 28 patients suffering from dry-eye disease. The patients were grouped according to the results of the basic secretory test. Patients with values ≤10 and subjective symptoms were classified as dry-eye patients. All tears were tested against Western blots of ocular antigens. For each Western blot, a densitograph was built by digital image analysis, and subsequently a multivariate discriminate analysis was performed. Results: A complex staining pattern was found in the tears of both dry-eye patients and healthy controls. However, the number of peaks was statistically significantly increased (p < 0.05) in the tears of dry-eye patients. The discriminant analysis found a statistically significant difference between the antibody repertoires of both groups (Wilks’ λ = 0.11; p < 0.001). Conclusions: In this study, it could be shown that the complex antibody repertoires in the tears of patients suffering from dry-eye disease are different from those found in the tears of healthy volunteers. Thus, our findings support the hypothesis that the dry eye disease has an autoimmune mechanism.
Comparison of Gleason Scores from Sextant Prostate Biopsies and Radical Prostatectomy Specimens
Authors: Altay Barış , Kefi Aykut , Nazlı Oktay , Killi Refik , Semerci Bülent , Akar İlker
Published: April 2003

Objectives: We compared the Gleason scores obtained from sextant prostate biopsy and radical prostatectomy (RP) specimens in patients with localized prostate cancer. Patients and Methods: Sixty-one patients having a clinical diagnosis of localized prostate cancer underwent needle biopsy under transrectal ultrasonography (TRUS) and RP. Grading and staging were assigned based on Gleason scores and the TNM system, respectively. Results: Mean patient age was 65.5 ± 13.43 years and mean PSA level was 14.69 ± 3.95. Mean Gleason score for prostate biopsy and RP specimen were 5.85 ± 0.7 and 6.34 ± 1.44, respectively. With respect to clinical stage, there were 20 patients in stage 1 and 41 patients in stage 2 prostate cancer. Comparing the Gleason scores, the biopsy score was lower in 26 (42.26%) and higher than RP specimens in 7 (11.84%) cases, and there was agreement between the biopsy and RP specimens in 28 (45.9%) patients. The difference between the two Gleason scores was ± 1 for 18 patients (29.5%) and ± 2 or more for 17 patients (27.86%). Conclusion: In our study, high Gleason score biopsies with elevated PSA level (>10 ng/ml) were risk factors for extraprostatic extension, and we demonstrated that Gleason scores were significantly correlated with seminal vesicle and lymph node invasion (p < 0.05). The Gleason scores of biopsy and RP specimens agreed with 45.9% of TRUS-guided sextant prostate biopsies, and this ratio was 91.1% in moderately differentiated tumors