bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Surgeons’ Specialty on the Selection of Vascular Access for Hemodialysis Treatment
Authors: Lazarides M.K. , Iatrou C. , Tzilalis V.D. , Ekonomou C.S. , Afentakis N. , Fragedaki E.J. , Simopoulos C.E.
Published: April 2003

Background/Aim: Various patient-related factors could not explain the variability of access types across facilities in the published literature. The aim of this study was to investigate the influence of surgeons’ specialty on access type selection for hemodialysis treatment. Methods: The directors (nephrologists) of all renal units in Greece (n = 92) were surveyed by a closed questionnaire. Results: The response rate was 75%. There was no statistically significant difference in the percentage of patients predominantly with autologous arteriovenous fistulae between units where only vascular surgeons were performing access surgery and those where either general surgeons or transplant surgeons were operating (mean value in all renal units 80.8% , range 43–97%). However, the difference between the three groups of renal units regarding their surgeons’ ability to create complex access procedures and to correct complications (as an index of surgeons’ skill) was statistically significant (p < 0.001). Conclusion: The general surgeons of the new generation are not often using vascular surgical techniques and may have less opportunities to develop expertise in vascular access creation.
Pilot Studies on the Use of 3,5-Diiodothyropropionic Acid, a Thyroid Hormone Analog, in the Treatment of Congestive Heart Failure
Authors: Morkin Eugene , Pennock Gregory , Spooner Peter H. , Bahl Joseph J. , Underhill Fox Katherine , Goldman Steven
Published: April 2003

After an initial safety study in 7 normal volunteers, a randomized double-blind comparison was made between 3,5-diiodothyropropionic acid (DITPA) and placebo in 19 patients with moderately severe congestive failure. In heart failure patients receiving the drug for 4 weeks, cardiac index was increased (p = 0.04) and systemic vascular resistance index was decreased (p = 0.02). Systolic cardiac function was unchanged but isovolumetric relaxation time was decreased significantly, suggesting improvement in diastolic function. Total serum cholesterol (p = 0.005) and triglycerides (p = 0.01) also were decreased significantly. DITPA could represent a useful new agent for treatment of congestive heart failure.
ECG Changes during Septic Shock
Authors: Rich Mark M. , McGarvey Mike L. , Teener James W. , Frame Lawrence H.
Published: April 2003

We have previously found that skeletal muscle becomes electrically inexcitable in septic patients. Work in an animal model suggests that a decrease in the available sodium current underlies the loss of electrical excitability. We examined ECGs from patients during periods of septic shock to determine whether there were any ECG abnormalities that might suggest a similar loss of excitability in cardiac tissue during sepsis. Fourteen out of 17 patients had low or significantly decreased QRS amplitudes during septic shock; 8 of 17 had long or increased QRS duration with or without bundle branch block. The mean decrease in QRS amplitude in septic patients was 41%, significantly higher than in controls where no consistent decrease in QRS amplitude was found (p < 0.01). In patients who recovered from septic shock, the QRS amplitude and the increased QRS duration both returned to normal. We conclude that there is a loss of QRS amplitude during septic shock that may be due to altered cardiac excitability.
The Coronary Slow Flow Phenomenon – A New Coronary Microvascular Disorder
Authors: Beltrame John F. , Limaye Sananand B. , Horowitz John D.
Published: April 2003

The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Case-control and observational studies of patients with this phenomenon were conducted to determine the associated clinical features and prognosis. Patients with coronary slow flow (n = 47) differed from controls (n = 47), more often being current smokers (32 vs. 9%; p < 0.01) and presenting with rest pain requiring urgent admission (74 vs. 21%; p < 0.001), usually to the coronary care unit (66 vs. 17%; p < 0.01). During a median 21-month follow-up of 64 slow flow patients, 84% had recurrent chest pain. Based upon these findings and those of previous investigators, it is speculated that coronary slow flow is a new disease entity characterized by acute but recurrent perturbations of microvascular function.
Eyelid Swelling: Think of Metastasis of Histiocytoid Breast Carcinoma
Authors: Tomasini Carlo , Soro Elisabetta , Pippione Mario
Published: April 2003

Metastatic breast carcinoma may assume many clinicopathological patterns. We here describe a case of histiocytoid breast carcinoma metastasis in the eyelids of a 73-year-old woman. Clinically, the patient presented painless swelling and nodular infiltration of the lateral and medial portions of the eyelids recalling a xanthomatous process or cystic lesions. Physical examination revealed similar lesions on the neck and right thigh. Medical history had revealed breast carcinoma 5 years previously. A biopsy specimen taken from a nodule on the eyelids revealed a relatively symmetric dermal tumor composed mainly of large, uniform, round-to-oval cells embedded in a fibrous stroma with moderate mucin deposits. The cells had abundant, coarsely granular eosinophilic cytoplasm and scant or absent nuclear atypia. No lobular arrangement of the cells or overt ductal formation were seen. Only occasional intracytoplasmic lumina were observed. Most cells demonstrated a positive immunoreaction for carcinoembryonic antigen. It is important to recognize histiocytoid breast carcinoma metastasis in the eyelids, because it may easily be overlooked clinically and histopathologically. This tumor should not be confused histopathologically with other benign and malignant skin tumors containing similar granular cells, but which have a different significance or a different prognosis. The immunohistochemical study, in conjunction with the medical history of the patient, facilitated the diagnosis.
Polymerase Chain Reaction for Diagnosis of Cutaneous Leishmaniasis in Histologically Positive, Suspicious and Negative Skin Biopsies
Authors: Safaei Akbar , Motazedian Mohammad Hossein , Vasei Mohammad
Published: April 2003

Background: Cutaneous leishmaniasis (CL) is a major problem in many tropical and subtropical countries. The clinical diagnosis should be confirmed by identification of the parasite in biopsy or smear or by tissue culture. The sensitivity of direct microscopy is not high, and tissue culture is not uniformly available and successful. Polymerase chain reaction (PCR) is a sensitive test for the detection of low amounts of DNA in tissues. Objective: We applied PCR on paraffin-embedded skin biopsies to assess the validity of this method in the diagnosis of cutaneous leishmaniasis. Methods: DNA extraction from paraffin blocks was performed by the heat method, and PCR was carried out using the primers for the Leishmania-specific 120-base-pair fragment of kinetoplast DNA minicircles. Paraffin blocks of gelatin-embedded formalin-fixed Leishmania tropica, taken from culture, served as positive controls. Negative controls were the skin biopsies of patients whose clinicopathologic diagnoses were not cutaneous leishmaniasis. Results: PCR showed the parasite in all 33 cases whose skin biopsies had shown the Leishmania parasite by light microscopy. PCR results were also positive in 24 cases out of 29 where microscopic examination of skin biopsies had failed to detect the amastigote but their clinical diagnosis was CL. The sensitivity of PCR in the diagnosis of CL was 92%. None of the nonleishmaniasis cases showed positive results (specificity 100%). PCR results were positive in 52 out of 54 cases whose skin biopsies showed granulomatous inflammation. Evaluation of the histopathologic findings showed that the presence of vaguely formed immature granuloma was directly and the detection of mature well-formed granuloma was inversely correlated with the detection of the parasite in biopsies (p < 0.01). Conclusion: PCR on paraffin-embedded tissue is a highly sensitive and specific test for the diagnosis of CL, and detection of granulomatus inflammation is a highly reliable histopathologic finding in suspected cases.
The Epidemiology of Fragrance Allergy: Questions and Needs
Authors: Naldi Luigi
Published: April 2003

Background: There are still open questions about the safety of fragrances. Objectives: To evaluate the evidence concerning the frequency of contact dermatitis to fragrances in the general population and selected subgroups and the risk factors for sensitization and clinical manifestations. Methods: Review of published data. Results: No criteria for a reliable diagnosis of ‘contact dermatitis’ are available. International recommendations and standardization for patch test methods exist; however, the question whether agents that are positive are causally linked to contact dermatitis remain fraught with uncertainties concerning false-positive rates and clinical relevance. Most of the discussion concerning prevalence or incidence variations of allergic contact dermatitis to fragrances concentrate on the frequency of positive patch tests in clinical series, i.e. ‘floating numerators’. Conclusions: Risk assessment requires that data from different sources are integrated and compared. Both a ‘sentinel surveillance’ system and more refined epidemiological studies in well-defined populations are needed to reliably assess the risks associated with fragrance exposure.
Anale Inkontinenz
Authors: Frudinger A.
Published: April 2003

Das Spektrum der analen Inkontinenz, das heisst der Verlust der willkürlichen Kontrolle von Darminhalt, reicht von geringen Stuhlspuren in der Unterwäsche über den Verlust von Winden bis hin zu massiven Episoden des unkontrollierbaren Abganges von weichem oder festem Stuhl. Es handelt sich dabei um beschämende Symptome, deren Ursachen vielschichtig und komplex sein können. Der häufigste ätiologische Faktor bei Frauen ist die geburtstraumatische Schädigung des Beckenbodens. Fachärzte/innen und Allgemeinmediziner/innen sind sich häufig nicht bewusst, dass es sich bei der analen Inkontinenz um ein behandelbares Leiden handelt, das mit geeigneten diagnostischen Tests und anschliessender, individueller Therapie die Lebensqualität der Betroffenen signifikant verbessern kann.
Die Tension-free-vaginal-tape-Operation zur Behandlung der Stressinkontinenz
Authors: Bader Arnim A. , Zivkovic Franjo , Moser Franz , Tamussino Karl
Published: April 2003

Die neueste Entwicklung in der chirurgischen Therapie der weiblichen Stressinkontinenz ist die Tension-free-vaginal-tape (TVT)-Operation und analoge Verfahren. Im Unterschied zur Kolposuspension nach Burch und abdominovaginalen Schlingenoperationen ist das Ziel des TVTs eine Stabilisierung der mittleren Urethra, nicht eine Reposition des Blasenhalses. In der einzigen Studie, die das neue Verfahren gegen den bisherigen Standard, der Kolposuspension nach Burch, randomisiert hat, sind die 2-Jahres-Kontinenzraten der TVT-Operation durchaus mit denen der Kolposuspension nach Burch vergleichbar. Die TVT-Operation dürfte sich aufgrund der technisch einfachen Durchführung, der niedrigen Rate an intra- und postoperativen Komplikationen sowie der guten Kontinenzraten als Standardverfahren in der Behandlung der primären und Rezidivstressinkontinenz etablieren.
Improvement of Water-Soluble Cephalosporin Derivatives Having Antibacterial Activity against Methicillin-Resistant Staphylococcus aureus
Authors: Hanaki Hideaki , Nomura Shuichi , Akagi Hiroshi , Hiramatsu Keiichi
Published: April 2003

We evaluated a series of novel cephem antibiotics, N-alkylpyridinium (alkyl group), N-carboxyethylpyridinium (carboxylic group), N-sulfoethylpyridinium (sulfonic group) and N-alkylquaternary ammonium salts (ammonioethyl group), N-alkyl-aromatic-quaternary ammonium salts and N-alkyl-heterocyclic quaternary ammonium salts (cyclic group) as vinylthio pyridinium derivatives at the C-3 position and hydroxyiminoaminothiazol at the C-7 position, for their activity against methicillin-resistant Staphylococcus aureus (MRSA) and their solubility, by measuring the minimum inhibitory concentrations (MICs) and the dissolving test in phosphate buffer. All tested compounds, except for the alkyl group, showed good solubility (>10%) in 1/15 M phosphate buffer (pH 7.2). The concentrations required to inhibit 80% of the bacterial strains (MIC80s) of the alkyl group, carboxylic group, sulfonic group, ammonioethyl group and cyclic group against MRSA were 1.56, 12.5–25, 6.25, 1.56 and 1.56 µg/ml, respectively. These results indicated that the ammonioethyl and cyclic groups yield the maximum anti-MRSA and anti-Enterococcusfaecalis activity, and also good water solubility.
Prospective Evaluation of the Impact of Amoxicillin, Clarithromycin and Their Combination on Human Gastrointestinal Colonization by Candida Species
Authors: Maraki S. , Mouzas I.A. , Kontoyiannis D.P. , Chatzinikolaou I. , Tselentis Y. , Samonis G.
Published: April 2003

Background: Amoxicillin and clarithromycin have been used extensively for the eradication of Helicobacter pylori. However, no study has examined the impact of their combination on the Candida albicans concentration of the gastrointestinal (GI) tract. This is the first study examining and comparing directly the effect of amoxicillin, clarithromycin and their combination on the C. albicans concentration of the human GI tract. Methods: Thirty-three adult patients (11 in each antibiotic group) were studied prospectively. Quantitative stool cultures for Candida were conducted at the beginning, the end and 1 week after the discontinuation of antibiotic treatment. Results: All three regimens increased the GI colonization in patients by Candida. The combination of amoxicillin with clarithromycin caused the highest increase; however, this was not statistically significant. Conclusion: Amoxicillin and clarithromycin used either alone or in combination cause a small to moderate increase in GI colonization by Candida. Hence, these drugs could be safely used in patients at risk for candidiasis originating from the GI tract.
Genotyping of Hepatitis E Virus from Vietnam
Authors: Hijikata Minako , Hayashi Shigeki , Trinh Ngoc Thi , Ha Le Dang , Ohara Hiroshi , Shimizu Yohko K. , Keicho Naoto , Yoshikura Hiroshi
Published: April 2003

To identify the genotype of Vietnamese isolates of human hepatitis E virus (HEV), phylogenetic analysis was performed for the open reading frame (ORF) 1 and ORF2 nucleotide sequences of the viral genome. HEV was detected by RT-PCR in 9 out of 141 sera collected from patients with a diagnosis of acute sporadic hepatitis in Hanoi, Vietnam. All of them had sequences related most closely to genotype 4. In addition, the Vietnamese isolate had a single nucleotide insertion in the ORF 3 region, a characteristic reported for genotype 4 with the possible change of initiation of ORF 3 and ORF 2.
Leiomyosarcoma Complicating Chronic Inflammation of the Testis
Authors: Ali Y. , Kehinde E.O. , Makar R. , Al-Awadi K.A. , Anim J.T.
Published: April 2003

Objective: To report on a case of leiomyosarcoma of the testis that appeared to have arisen from a background of chronic testicular inflammation. Clinical Presentation: A 65-year-old man with a 15-year history of diabetes mellitus and low-grade discomfort and swelling in the right testis presented as an emergency with exacerbation of the pain and swelling of the testis. Repeated ultrasound examination of the testis in the past 5 years had suggested a chronic testicular inflammatory disorder. Ultrasound during the current emergency case admission revealed a normal left testis, but a large heterogeneous solid mass with a moderate intratesticular calcification in the right testis and the presence of a moderate hydrocele. Serum α-fetoprotein and β-human chorionic gonadotropin were normal. A right radical orchidectomy was performed. Histopathology and immunohistochemistry revealed primary leiomyosarcoma of the right testis. There was no spermatic cord or venous involvement. One year after orchidectomy there was no sign of metastasis. Conclusion: Radical orchidectomy followed by surveillance appears to be the treatment of choice for this testicular leiomyosarcoma, which seemed to have run an indolent course compared to other testicular tumours.
Bilateral Vocal Cord Dysfunction Complicating Short-Term Intubation and the Utility of Heliox
Authors: Christopher Kenneth , Arbelaez Christian , Yodice Paul C.
Published: April 2003

Bilateral vocal cord paralysis is an extremely rare complication of short-term endotracheal intubation. Its etiology following intubation is likely due to recurrent laryngeal nerve injury on intubation. The anterior ramus of the recurrent laryngeal nerve is especially susceptible to pressure injury in intubated patients. Heliox is reported as a successful means of decreasing the work of breathing in upper airway obstruction via decreases in airway resistance. Two cases of bilateral vocal cord dysfunction following short-term intubation are reported. The first case of bilateral vocal cord paresis treated with Heliox is described.
Cyclosporin A Upmodulates Bleomycin-Induced Pulmonary Fibrosis in BALB/c Mice
Authors: Lossos Izidore S. , Or Reuven , Ginzburg Vallery , Christensen Thomas G. , Mashriki Yaffa , Breuer Raphael
Published: April 2003

Background: Intratracheal instillation of bleomycin (Bleo) into rodents serves as a model for human lung fibrosis. Various mouse strains respond differently to Bleo, and BALB/c mice are relatively resistant. Objective: Since T lymphocytes have been shown to play a major role in this model, the effect of the immunomodulator cyclosporin A (CyA) on lung fibrosis was studied in Bleo-‘resistant’ BALB/c mice. Methods: Pulmonary fibrosis was induced by a single intratracheal (IT) instillation of Bleo. One of the four following treatments was given to one of four groups of female BALB/c mice: (1) Bleo-CyA: IT Bleo and daily intraperitoneal (IP) injections of CyA 100 mg/day starting 1 day before IT instillation of Bleo; (2) Bleo-Sal: IT Bleo and IP injections of saline; (3) Sal-CyA: IT saline and IP CyA 100 mg/kg; (4) Sal-Sal: IT and IP saline. The animals were killed on day 14. Fibrosis was evaluated by analysis of hydroxyproline and by quantitative image analysis of the fibrosis fraction. Ex vivo IFN-γ, IL-4, IL-13 and IL-5 secretion by peribronchial lymphatic tissue lymphocytes was measured. Results: Pretreatment with CyA upmodulated Bleo-induced lung fibrosis in the Bleo-‘resistant’ BALB/c mice; hydroxyproline was higher in Bleo-CyA compared to Bleo-Sal animals and both hydroxyproline and fibrosis fraction measurements were higher in Bleo-CyA compared to Sal-Sal. Cytokine secretion by lymphocytes demonstrated increased IFN-γ/IL-4 and IFN-γ/IL-13 mean secretion ratios in the Bleo-CyA animals compared to the Bleo-Sal animals. Conclusions: These results indicate that CyA upmodulates Bleo-induced lung fibrosis in Bleo-‘resistant’ BALB/c mice by allowing the emergence of a Th1 inflammatory response.
Moving from CFC Aerosol to HFA Aerosol or Dry Powder Inhalers: What Do Patients Think?
Authors: Hartung Thomas K. , Allbutt Helen , Dewar Maria , Innes J. Alastair , Crompton Graham K.
Published: April 2003

Background/Objectives: Environmentally friendly hydrofluoroalkane (HFA) pressurised metered-dose inhalers are currently being marketed to replace chlorofluorocarbon (CFC)-driven devices. It is uncertain whether these new formulations with different properties are acceptable to patients. Similarly, switching a patient to a dry powder inhaler (DPI) carries the risk of non-acceptance. Methods: One hundred patients with obstructive airway disease on regular CFC aerosol inhaler medication underwent a standardised, structured interview. During the interview patients were asked to use a new HFA aerosol inhaler and three DPIs in random order. Patients’ notions were recorded. Results: Most patients (96) agreed to change from their CFC to the HFA inhaler, of those, only 12 did so with some reservation. Properties (taste, user-friendliness, design) of the HFA inhaler were rated favourably. DPIs represented an acceptable alternative to aerosol inhalers. In fact, 57 patients preferred a DPI over the HFA inhaler. Not all powder devices were equally acceptable. Replacing the CFC inhaler with patients’ preferred alternative devices resulted in a more than 3-fold increase in costs. Conclusion: Concerns about the acceptability of reformulated CFC-free aerosol inhalers are ill founded. However, if given the choice, many patients prefer a DPI over the HFA inhaler. The transition offers an opportunity to review patients’ current treatment and the proficiency of their inhaling technique. Moving to CFC-free inhalers will have revenue implications.
D-Glucose and NaCl Enhance the Expression of Aquaporin-1: Inhibition of Both by Cholera Toxin
Authors: Jenq Wheamei , Ramirez German , Peguero Alfredo , Cooper Denise R. , Vesely David L.
Published: April 2003

Aim: To determine whether glucose, NaCl and/or cholera toxin modify the expression of aquaporin-1 (AQP-1) water channel. Methods: Aquaporin-1 gene expression was studied using primary cultures of human renal proximal tubule epithelial (HRPTE) cells. Results:D-Glucose and NaCl (500 mosm/kg·H2O each) enhanced AQP-1 expression 2.4-fold (p < 0.05) and 4.0-fold (p < 0.01), respectively, which could be blocked 73 and 70% (p < 0.01), respectively, by cholera enterotoxin (10–7M). Angiotensin II (10–6M and 10–8M), vasopressin (10–8M) and/or atrial natriuretic peptide (10–8M) did not affect AQP-1 expression. Hyperosmolar Reno-60 and Hypaque-76 contrast agents at 500 mosm/kg·H2O and isomolar Visipaque at 25% (v/v) concentration(s) also increased AQP-1 expression 3.8- to 5.0-fold (p < 0.01) in HRPTE cells which also were inhibited by cholera toxin from 41% (p < 0.05) to 71% (p < 0.01). AQP-1 was translocated from the cytosol to the membrane of HRPTE cells and hyperosmolarity enhanced this translocation 2.5-fold (p < 0.01). Conclusions: The increased urinary concentrating ability in proximal segment of the diabetic kidney associated with increased plasma glucose may be mediated via glucose’s ability to enhance AQP-1 expression, which leads to a more concentrated urine. The decrease in urinary flow secondary to cholera toxin exposure, on the other hand, may be mediated indirectly by cholera toxin’s inhibition of aquaoporin-1 gene expression.
Methylenetetrahydrofolate Reductase Polymorphism in Childhood Primary Focal Segmental Glomerulosclerosis
Authors: Zou Chaochun , Tsukahara Hirokazu , Hiraoka Masahiro , Mizu Jiang , Todoroki Yukiko , Ohshima Yusei , Kimura Hideki , Tsuzuki Kazuo , Mayumi Mitsufumi
Published: April 2003

Aim: The purpose of this study was to evaluate the association between the methylenetetrahydrofolate reductase (MTHFR) C/T polymorphism and the prevalence and course of focal segmental glomerulosclerosis (FSGS) in our pediatric population. Methods: Genotypes for MTHFR were determined in 15 primary FSGS patients (male/female, 6/9) and 238 control subjects (male/female, 110/128) by the polymerase chain reaction and restriction fragment length polymorphism method. Results: For the whole group, the genotype frequencies (CC/CT/TT) of MTHFR in FSGS and control subjects were almost comparable. The TT genotype was associated with early onset of the disease as compared with the CC genotype. Furthermore, all the patients with the TT genotype had steroid-resistant FSGS and developed into end-stage renal failure, while those carrying either CC or CT genotype did not. Conclusion: We speculate that the TT genotype may be associated with early development and progression of childhood FSGS. Confirmatory studies using larger and ethnically distinct populations are needed to reveal the role of homocysteine in FSGS with consideration of medical interventions.
Experience with the Use of an Iron Polymaltose (Dextrin) Complex Given by Single Total Dose Infusion to Stable Chronic Haemodialysis Patients
Authors: van Zyl-Smit Roal , Halkett Janet A.
Published: April 2003

Background: Many studies of anaemia in patients on chronic haemodialysis have noted a high prevalence of iron deficiency despite oral iron supplementation. Our study examined the effect of intravenous iron given as bolus replacement. As the majority of these patients were not receiving concurrent recombinant human erythropoietin (rhEPO) it allowed an analysis of the safety and efficacy of intravenous iron as a single agent. Methods: All patients with a haemoglobin level of less than 10 g/dl and considered iron deficient by the finding of a percentage transferrin saturation of less than 20% were given intravenous iron in the form of iron polymaltose (dextrin) by total dose infusion (TDI). The dose was calculated from tables supplied by the manufacturers. Patients with serum ferritin levels in excess of 225 ng/ml were excluded. Results: In our unit, 62 out of 80 (77%) patients were considered iron deficient and received IV iron. Ten (10%) were considered to be in iron balance and 8 (10%) had biochemistry suggesting iron overload. None of the patients receiving iron experienced any adverse reactions. At three months a rise in haemoglobin level of at least 1 g/dl was noted in 53% of patients. The response was less in the remainder, but only 2 showed no response. Conclusions: Low levels of iron deficiency are often unrecognized in chronic haemodialysis patients on conventional therapy including oral iron supplementation. In such patients, the use of total dose infusion of iron polymaltose (dextrin) is a safe and effective method of raising haemoglobin levels. Substantial improvements may be achieved without the concurrent use of rhEPO.
Altered Expression of Na+/H+ Exchanger Isoforms 1 and 3 in Clipped and Unclipped Kidneys of a 2-Kidney-1-Clip Goldblatt Model of Hypertension
Authors: Khan Islam , Al-Qattan Khaled K. , Alnaqeeb Majed A. , Ali Muslim
Published: April 2003

Background: Functional differences between the clipped and unclipped kidneys in a 2-kidney-1-clip (2K-1C) hypertension model have been reported. However, the molecular basis of these changes is poorly understood. Objectives: Expression of NHE-1 and NHE-3 isoforms and sodium pump activity (PNP), and their modulation by blood pressure (BP), PGE2 and TXB2 were examined in the kidneys of 2K-1C rats treated with cilazapril for short- (4 and 24 h) and long-term (7 days) periods. Methods: 2K-1C rats were divided into two groups. Group 1 (short-term) animals were treated with a single dose of cilazapril for 4 or 24 h. Group 2 (long-term) animals received a daily dose of cilazapril for 7 days. 2K-1C animals receiving water served as clipped controls, and sham-operated animals were normal controls. Western blot analysis was used to estimate the protein levels and ELISA for PGE2 and TXB2. Results: Levels of NHE-1 and NHE-3 protein in the unclipped kidneys of both treatment groups were increased, whereas levels of α-actin, PNP activity and crude microsomes remained unchanged. These changes were significantly reduced by long-term, and not by short-term treatment with cilazapril. In group 1 clipped kidneys, NHE-3 and α-actin proteins were increased, and crude microsomes and PNP activity were decreased. In group 2 clipped kidneys, both NHE-1 and 3 isoforms were induced, whereas PNP activity was decreased. Cilazapril did not reverse the changes in the clipped kidneys in both groups, but reduced the crude microsomes. Group 2 unclipped kidneys showed hypertrophy, which remained unaffected by cilazapril treatment. Induced levels of BP, PGE2 and TXB2 in both groups were reduced significantly except for the 24-hour post-cilazapril treatment. Conclusions: These findings demonstrate a differential expression of NHE-1 and NHE-3 isoforms which is dependent on the rise in BP, PGE2 or TXB2 in the long-term treatment group, but not in the short-term treatment group. Thus, the changes in NHE isoforms and sodium pump activity, together, contribute to functional differences that exist in the 2K-1C kidneys.
Effect of Balloon Mitral Valvoplasty during Pregnancy on Childhood Development
Authors: Kinsara Abdulhalim Jamal , Ismail O. , Fawzi M.E.
Published: April 2003

In order to study the long-term effects of balloon mitral valvoplasty (BMV) on childhood development, we followed up closely 20 mothers with severe mitral stenosis who were treated with BMV during pregnancy. Their offspring aged 63 ± 39 (range 6–98) months were also regularly assessed using standard developmental charts and relevant laboratory tests. They were all found to have maintained normal growth, development, and speech for their appropriate ages. Developmental milestones were normal for their ages and comparable with those of their siblings. The laboratory tests revealed no abnormalities. Two losses occurred during the early course of follow-up, at the ages of 4 and 37 weeks, respectively. One of the pregnant patients suffered a stillbirth.
Genotype Association of C(-735)T Polymorphism in Matrix Metalloproteinase 2 Gene with G(8002)A Endothelin 1 Gene with Plaque Psoriasis
Authors: Vašků V. , Vašků A. , Tschöplová S. , Izakovičová Hollá L. , Semrádová V. , Vácha J.
Published: April 2003

Background: Excessive angiogenesis is one of the characteristic features of psoriasis. Objective: To determine the possible genetic background of neo-angiogenesis in plaque psoriasis, frequent polymorphisms in matrix metalloproteinase 2 (MMP-2) and endothelin 1 (ET-1) genes were studied. Methods: The case group (n = 119) included patients with plaque psoriasis, aged 44 ± 15 years. The age of onset of psoriasis was 27 ± 11 years. The control group (n = 184) consisted of healthy subjects without any individual history of psoriasis, aged 37 ± 15 years. C(-735)T MMP-2 and G(8002)A ET-1 polymorphisms were determined by PCR reaction with subsequent restriction analyses. Results: A significant difference in genotype distribution of C(-735)T MMP-2 between psoriatic and control patients was found (pcorr = 0.008). Two associated genotypes (CCGG and CTGG) of the two polymorphisms were significantly less frequent in psoriatic patients (pcorr = 0.03 and pcorr = 0.008, respectively). Conclusion: The results seem to reflect a different susceptibility of MMP-2 as well as of some associated MMP-2 and ET-1 genotypes to psoriasis.
Effects of Roxithromycin on the Production of Lipase and Neutrophil Chemotactic Factor by Propionibacterium acnes
Authors: Akamatsu H. , Tomita T. , Horio T.
Published: April 2003

Background: The macrolide antibiotic roxithromycin is effective against acne associated with inflammation, but the mechanism by which this is achieved has not been clarified. Objective: We studied the effects of roxithromycin on the production of lipase and neutrophil chemotactic factor by Propionibacterium acnes in vitro. Results: Roxithromycin significantly inhibited the production of lipase and neutrophil chemotactic factor by P. acnes at a concentration one eighth of the MIC, at which the growth curve of P. acnes is not affected. Conclusion: One mechanism of the effectiveness of roxithromycin in acne therapy is thought to be the inhibition of bacterial lipase and neutrophil chemotactic factor production by P. acnes.
Assessment of Topical Hypopigmenting Agents on Solar Lentigines of Asian Women
Authors: Hermanns J.F. , Petit L. , Piérard-Franchimont C. , Paquet P. , Piérard G.E.
Published: April 2003

Background: So-called darkened age spots encompass distinct pathological processes. The efficacy of topical depigmenting agents is difficult to objectivate. Objective: To assess the hypopigmenting effect of three cosmetic formulations using objective biometrological methods. Methods: 50 women of South-East Asian ancestry were enrolled in this pilot study. They had solar lentigines according to dermoscopic criteria. The lesions were treated by topical hypopigmenting formulations. Products were applied twice daily for 2 or 3 months. Assessments at 1-month intervals were made using narrow-band reflectance spectrophotometry, image analysis of video-recorded ultraviolet light reflection and photodensitometry- and image-analysis-assisted corneomelametry. Results: A 20% azelaic acid formulation and another one containing 5% ascorbyl glucosamine, 1% kojic acid and α-hydroxyacid esters appeared inefficacious on solar lentigines. A stabilized soy extract showed a better although modest lightening effect when assessed by corneomelametry. The subclinical or faint mottled skin revealed by ultraviolet light examination better responded (p < 0.05) to treatments. Conclusion: Focal epidermal hyperpigmentation is better controlled by topical whitening agents when the increase in melanin content reflects a modest functional hyperactivity of melanocytes.
Thalidomide-Induced Morbilliform Rash: Diagnosis and Continuation of Therapy, Premedicated with Methylprednisolone
Authors: Nijsten T. , Meuleman L. , Schroyens W. , Lambert J.
Published: April 2003

In the past few years, thalidomide is experiencing a revival in many different fields as a last therapeutic option, because of the potential severe adverse drug reactions (ADR) induced by this drug (teratogenicity, peripheral neuropathy and sedation). Taking into consideration the increased use, we should focus on the prevalence of these and other ADR as well on their management. We describe a patient with multiple myeloma who presented with a morbilliform rash induced by thalidomide. Reintroduction of the drug confirmed the diagnosis. Nevertheless we continued the thalidomide treatment, although combined with methylprednisolone 64 mg. There was no recurrence of the cutaneous drug reaction (CDR). To the best of our knowledge, this is the first case showing that systemic steroids can help to ‘treat through’ a thalidomide CDR.
Comparison of Regional Blood Flow Values Measured by Radioactive and Fluorescent Microspheres
Authors: Thein E. , Raab S. , Harris A.G. , Kleen M. , Habler O. , Meisner F. , Messmer K.
Published: April 2003

Fluorescent microspheres (FM) have become an attractive alternative to radioactive microspheres (RM) for the measurement of regional blood flow (RBF). The aim of the present study was to investigate the comparability of both methods by measuring RBF with FM and RM. Eight anaesthetised pigs received simultaneous, left atrial injections of FM and RM with a diameter of 15 µm at six different time points. Blood reference samples were collected from the descending aorta. RBF was determined in tissue samples of the myocardium, spleen and kidneys of all 8 animals. After radioactivity of the tissue samples was determined, the samples were processed automatically for measuring fluorescence using a recently developed filter device (SPU). RBF was calculated with both the isotope and spectrometric data of both methods for each sample resulting in a total of 10,512 blood flow values. The comparison of the RBF values yielded high linear correlation (mean r2 = 0.95 ± 0.03 to 0.97 ± 0.02) and excellent agreement (bias 5.4–6.7%, precision 9.9– 16.5%) of both methods. Our results indicate the validity of MS and of the automated tissue processing technique by means of the SPU.
Connective Tissue Growth Factor in Indomethacin-Induced Rat Gastric Ulcer
Authors: Lempinen M. , Inkinen K. , Wolff H. , Ahonen J.
Published: April 2003

The healing of gastric ulcers requires not only the complete epithelial covering but also the restitution of connective tissue. Transforming growth factor-β (TGF-β) and its downstream mediator, connective tissue growth factor (CTGF), are potent stimulators for connective tissue formation during wound healing. The expression of TGF-β, CTGF and type III collagen mRNA in indomethacin-induced gastric ulcers in rat, was investigated by Northern blot analysis. We also examined the localization of CTGF producing cells by in situ hybridization. Northern blot analysis showed expression of TGF-β mRNA on days 1 and 3 after indomethacin administration, expression of CTGF mRNA on days 1, 3 and 7 and type III collagen mRNA expression on days 1, 3, 7 and 12, respectively. Control animals showed no expression of TGF-β, CTGF or type III collagen mRNA. In situ hybridization showed CTGF mRNA positive cells on days 1, 3 and 7 after ulcer induction in fibroblast-like cells and in some of the blood vessels. Thus our findings indicate that growth factor CTGF, together with TGF-β, participates in gastric ulcer healing by regulating connective tissue formation and angiogenesis. These results are compatible with the role of CTGF as a downstream mediator of TGF-β effects.
Prevention of Intraabdominal Adhesions Produced by Polypropylene Mesh
Authors: Besim H. , Yalçın Y. , Hamamcı O. , Arslan K. , Sonışık M. , Korkmaz A. , Erdoğan S.
Published: April 2003

Polypropylene mesh (PPM) is widely used in ventral hernia repair, however is also associated with visceral adhesions when the mesh is exposed to intraabdominal organs. In this study, a composite mesh [ePTFE (expanded polytetrafluoroehylene) + PPM] and sodium hyaluronate/carboxymethyl cellulose (NaHA/CMC) membrane laid under PPM are evaluated in terms of adhesion formation in a rat model of ventral hernia repair. In this experimental study, a 2 × 1 cm of peritoneum and underlying muscle defect was created at the right side of the anterior abdominal wall of 37 male Wistar albino rats. These defects were repaired with 2.5 × 2 cm PPM in group 1 (n = 13), with composite mesh in group 2 (n = 12) and with PPM+NaHA/CMC in group 3 (n = 12). Rats were sacrificed after 14 days and the prosthetic materials were examined for the calculation of surface area percentage covered by adhesions, for organ involvement in the adhesions and for histological evaluation. There was a reduction in the adhesion-covered area in group 2 and group 3. Organ involvement was predominantly seen in group 1. Neoperitoneum was perfect in group 2. Fibrosis and inflammation were higher in group 1. All groups showed adhesiogenic potential to some extent. This potential was maximum with PPM. Both ePTFE and NaHA/CMC displayed similar effects in preventing adhesion formation.
Na+/H+ Exchanger Inhibitor HOE642 Offers Myoprotection in Senescent Myocardium Independent of Ischemic Preconditioning Mechanisms
Authors: Nakai Y. , Horimoto H. , Mieno S. , Sasaki S.
Published: April 2003

Background: Inhibition of Na+/H+ exchange has been shown to provide functional protection during ischemia and reperfusion in mature heart. This study was undertaken to elucidate the effect of Na+/H+ exchange inhibitor HOE642 in the aged rabbit heart. Methods: Isolated rabbit hearts were subjected to 1 h of left descending coronary artery (LAD) ischemia and 1 h of reperfusion. To determine the effects of HOE642 on ischemia/reperfusion injury, seven aged or mature hearts received the Na+/H+ exchange inhibitor HOE642 (1 µM) for 15 min before the ischemia and for 30 min after reperfusion. Seven aged (more than 135 weeks) or mature (15–20 weeks) rabbit hearts served as a control (untreated) with no interventions. Left ventricular pressures, monophasic action potentials and coronary flows were measured throughout the experiment and infarct size was detected at the end of experiment. Results: (1) In the mature hearts, HOE642 improved postischemic functional recovery (63.1 ± 5.0% vs. 84.4 ± 5.4%, mature untreated vs. mature HOE, p < 0.05) and reduced infarct size as compared to untreated hearts (42.0 ± 2.5% vs. 24.8 ± 2.3%, mature untreated vs. mature HOE, p < 0.05). (2) Although infarct size in aged untreated hearts was significantly decreased as compared to mature untreated hearts (42.0 ± 2.5% vs. 19.3 ± 1.6%, mature untreated vs. aged untreated, p < 0.05), there are no significant differences regarding postischemic functional recovery between mature and aged untreated hearts (63.1 ± 5.0% vs. 59.5 ± 5.9%, mature untreated vs. aged untreated, p = n.s.). (3) In the aged hearts, HOE642 improved postischemic functional recovery as compared to untreated hearts (59.5 ± 5.9% vs. 85.9 ± 8.1%, aged untreated vs. aged HOE, p < 0.05). Conclusion: Na+/H+ exchange inhibitor HOE642 is effective against ischemia-reperfusion injury in senescent as well as mature hearts.
Prolonged Suppression of Humoral Immune Response after Organ Transplantation
Authors: Gu Y.L. , Dahmen U. , Li J. , Dirsch O. , Polywka S. , Broelsch C.E.
Published: April 2003

Rats receiving either kidney or liver grafts were vaccinated with recombinant hepatitis B virus (HBV) vaccine either 1 or 10 weeks post-transplantation to explore the nonspecific immunosuppressive effect of transplantation surgery on antibody development. Response rate and geometric mean titer of the anti-HBs antibody were significantly lower in organ-transplanted animals undergoing early vaccination compared to unoperated control animals. Both parameters were affected when vaccination was performed early after kidney transplantation, but also in case of late vaccination in liver graft recipients. The nonspecific suppressive effect of transplantation surgery on the humoral immune response was related to the time point of vaccination after surgery and the extent of the surgical intervention and lasted longer than previously reported.
Reimplanted Ureter as an Alternative to the Catheterizable Mitrofanoff Tube
Authors: Özgök Y. , Kıbar Y. , Kilciler M. , Ide T. , Harmankaya Ç.
Published: April 2003

Objective: We performed this study in dogs to investigate whether a ureter can be used as an alternative to the appendix without disrupting the uniformity of the gastrointestinal system. Materials and Methods: This study comprised 10 adult healthy female mongrel dogs. The procedure was done in 2 stages: in the first stage, we performed a left-end cutaneous ureterostomy at the lower left quadrant just above the inguinal ligament. A second operation was performed 6 weeks later. The left ureter was divided and using Paquin’s technique, the proximal end of the distal third of the left ureter was reimplanted in the anterolateral surface near the dome of the bladder. A high transureteroureterostomy with the remaining left proximal ureter to the opposite ureter completed the reconstruction. The bladder neck was ligated in order to create an experimental bladder outlet obstruction. At the time of creating the distal ureteral stoma, a feeding tube was left in the bladder, passing through the ureterostomy stoma and sutured to the skin. This catheter remained in place for 20 days, preventing the bladder form distending. Then in the following 6 months, intermittent catheterization was applied through the stoma at 3- to 4-hour intervals. Exploration was performed at the end of the 6th month. Results: No animal died. The dogs were still continent. Intravenous urography, urea and creatinin values were normal. The ureteral stoma was viable in all 10 cases. Stenosis of the ureteral stoma developed in 1 dog and required surgical revision. Possible traumatic effects were investigated by histological sections, but no harmful effects were found at the ureteral endothelium. Conclusions: This method may be an alternative to the Mitrofanoff method, which uses the appendix.
Effect of Endovascular Treatment on Nitric Oxide and Renal Function in Takayasu’s Arteritis with Renovascular Hypertension
Authors: Parildar Zuhal , Gulter Ceyda , Parildar Mustafa , Oran Ismail , Erdener Dilek , Memis Ahmet
Published: April 2003

Background: Renal involvement in Takayasu’s arteritis (TA) effects the disease outcome and endovascular treatment is an effective treatment of choice. We investigated nitric oxide (NO) levels and the effect of endovascular treatment in renovascular hypertensive TA patients. Methods: In five hypertensive patients with renal artery stenosis due to TA, serum creatinine, nitrite, nitrate; urinary microalbumin, nitrite, nitrate measurements and blood pressures were recorded at entry and after 24 h and 6 weeks of endovascular treatment. Results: Serum NO levels were higher in patients than controls (p = 0.008). Serum and urine NO levels increased 24 h after the treatment and decreased after 6 weeks (p = 0.015; p = 0.01, respectively). After the treatment blood pressures decreased. Urinary microalbumin excretions increased after the intervention (p = 0.02) and returned to normal in patients 1 and 4, and decreased in the others. There were no significant differences in estimated glomerular filtration rate (EGFR), serum creatinine, urinary sodium and potassium levels. Conclusion: Increased NO secretion in these patients may contribute to improve the prognosis of renal function through its vasodilator and antiproliferative activities possibly by counterbalancing the excessive vasoconstrictor actions. Endovascular treatment causes a dilatation-induced shear stress that may be responsible for the increased NO release, which in turn leads to the rapid hypotensive response.
Regulatory Factors and Functions of Microglia during Development
Authors: Dheen S.T. , Hao A.J. , Ng Y.K. , Ling E.A.
Published: April 2003

This article reviews current knowledge on the origin and development of microglia as well as on regulatory factors that influence microglial development within the neural tube during embryogenesis. Ameboid microglia found in the developing neural tube originate from mesodermal precursors derived from the yolk sac. These microglial cells, which exhibit characteristic features of reactive microglia, undergo mitosis in situ in the nervous parenchyma and function as the full-blown phagocytes involved in the removal of cellular debris resulting from neural tube defect or normal cellular turnover. During embryogenesis, the microglia express various cytokines, growth factors and chemokines. Some of those factors together with other local factors may influence the proliferation and activation of microglia in the developing neural tube.
Differences in Quantitative Characteristics of Intracranial Pressure in Hydrocephalic Children Treated Surgically or Conservatively
Authors: Eide Per Kristian , Due-Tønnessen Bernt , Helseth Eirik , Lundar Tryggve
Published: April 2003

This study reports the results of quantitative analysis of continuous intracranial pressure (ICP) recordings in 33 hydrocephalic children. The aim of the study was to compare the exact numbers of increases in ICP during sleep or the awake state in hydrocephalic children who were treated either surgically or conservatively. At the time of ICP monitoring, the ICP curves were assessed by the calculation of mean ICP and visual inspection for the detection of plateau waves. Quantitative analysis was performed with the software SensometricsTM Pressure Analyser, which presented the ICP curve as a matrix of numbers of ICP elevations of different levels (20–40 mm Hg) and durations (0.5–20 min). In each case, the numbers of ICP elevations were standardized to 10 h of recording time, providing the opportunity for comparisons of ICP curves between individuals. Compared to the surgery group, there was a rather high number of ICP elevations of 20 mm Hg of various durations in the nonsurgery group, e.g. ICP elevations of 20 mm Hg lasting 10 min occurred in 13 of 19 children (68%) in the nonsurgery group. There was no apparent relationship between ICP and age or between the size of the cerebral ventricles and ICP. In children with hydrocephalus, the presentation of the ICP data as a matrix of ICP elevations of different levels and durations may enhance the informative value of continuous ICP monitoring, as compared to the calculation of mean ICP and visual detection of plateau waves.
Cardiovascular Changes in Renal Failure
Authors: Tyralla Karin , Amann Kerstin
Published: April 2003

In patients with renal failure cardiovascular complications are an important clinical problem and cardiac death is the main cause of death in these patients. It is well documented that cardiac risk is increased by a factor of 20 in uremic patients compared with age- and sex-matched segments of the general population. This finding in patients with renal failure can be at least partially explained by the well-described structural and metabolic abnormalities of the myocardium. The present article focuses on the structural changes in the heart and the vasculature and their potential repercussions for cardiovascular function, in particular their contribution to the high cardiovascular morbidity and mortality in patients with renal failure.