bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of Abdominal Hydatid Cyst Disease: The Role of Ultrasound and Ultrasound-Guided Fine Needle Aspiration Cytology
Authors: Sinan Tareq , Sheikh Mehraj , Chisti Fayaz A. , Al Saeed Osama , Sheikh Zafar , Hira P.R. , Behbehani Abdullah
Published: April 2003

Objective: To retrospectively analyze the role of ultrasound (US) imaging and US-guided fine needle aspiration cytology in the diagnosis and management of abdominal hydatid cyst disease (HCD). Subjects and Methods: The medical records of 55 diagnosed cases of HCD seen between January 1986 and December 2000 at Mubarak Al-Kabeer Hospital and Al-Amiri Hospital in Kuwait were reviewed for demographic and clinical data, including radiology and serology. The US findings of the patients were classified into four types as follows: type I: single or multiple well-defined cysts, with or without detached or collapsed wall and with or without echogenic contents; type II: single or multiple cysts with peripheral cysts, with or without echogenic contents; type III: solid or semisolid lesions, and type IV: cysts with calcified walls. Results: The overall accuracy of US in the diagnosis of HCD was 80% (44/55 cases). US examination was suggestive of HCD type I, 16/19 (84%), type II, 21/23 (91%), type III, 3/8 (38%), and type IV, 4/5 (80%). For the 11 remaining undiagnosed cases, US was useful for localizing the lesions for US-guided fine needle aspiration cytology. It established the diagnosis in all the 11 cases, without precipitating complications. Conclusion: US alone was valuable for diagnosing and localizing HCD in the abdomen except for solid-type lesions. US-guided fine needle aspiration cytology was useful in localizing and establishing the diagnosis of HCD in the cases where US alone was ineffective.
Laparoscopic Cholecystectomy in 2,750 Cases in a Teaching Hospital in Kuwait
Authors: Hasaniah Wael Fathi , Ghada Ibrahim , Sabah Al-Hadeedi , Sulaiman Al-Hader , Jamal Mohamed Jamal , Derar Sultan Al-Shehab
Published: April 2003

Objective: To retrospectively analyse all laparoscopic cholecystectomies performed between April 1992 and May 1999. Methods: Medical records of 2,750 patients, clinically diagnosed with gall bladder disease, were reviewed. We analysed the operative time, length of postoperative hospital stay, conversion rate, intra- and postoperative complications as well as management outcome. Results: The mean operative time was 59.2 min, and the mean postoperative hospital stay was 1.46 days. However, the majority of our patients (66.8%) were discharged after 1 day. The conversion rate was 3.8%, which was mainly due to acute gall bladder pathology. The postoperative complication rate was 4.6%; all cases were managed successfully with no mortality or delayed morbidity. Conclusion: Our findings indicate that laparoscopic cholecystectomy appears to be a safe and effective procedure with low morbidity and no mortality. Therefore, it should be considered as the procedure of choice for patients with gall bladder disease.
Relationship of Gastroesophageal Reflux Disease with Adenocarcinoma of the Distal Esophagus and Cardia
Authors: Velanovich Vic , Hollingsworth John , Suresh Preethem , Ben-Menachem Tamir
Published: April 2003

Background: Recent studies have suggested that gastroesophageal reflux disease (GERD) increases the risk of developing adenocarcinoma of the distal esophagus and cardia. In order to further define this risk, we studied the relationship of GERD in patients with or without gastroesophageal junction adenocarcinomas. Methods: The records of all patients with adenocarcinoma of the distal esophagus and cardia treated between 1991 and 1999 were reviewed for the following data: gender, age of diagnosis, presence of GERD, presence of GERD for >4 years, and GERD treatment. A control group of patients without gastroesophageal junction adenocarcinoma were matched for age and gender. Data obtained from the control group included presence of GERD and treatment for GERD. Results: 60 patients with adenocarcinoma of the distal esophagus and cardia were identified. 40% of cancer patients had GERD at the time of diagnosis, (odds ratio 39, p < 0.0001). 27% of cancer patients had GERD for >4 years (odds ratio 21, p < 0.0001). 50% of cancer patients with GERD were being treated with either H2-blockers or proton pump inhibitors at the time of cancer diagnosis, with an average duration of treatment of 17 months, compared to none of the patients without GERD (p = 0.006). Conclusions: Patients with gastroesophageal junction adenocarcinoma had a higher prevalence of GERD-like symptoms compared to age- and gender-matched controls. This supports an association between GERD and gastroesophageal junction cancers. In addition, cancer patients with GERD may be treated for prolonged periods of time with acid-suppression medication prior to the diagnosis of cancer, masking the symptoms of cancer. Patients with long-standing GERD or older patients with new onset GERD may need endoscopy or imaging studies to evaluate for cancer of the distal esophagus or cardia.
Topical Treatment of Pyoderma gangraenosum
Authors: Wenzel Joerg , Gerdsen Rainer , Phillipp-Dormston Wolfgang , Bieber Thomas , Uerlich Manfred
Published: April 2003

The treatment of pyoderma gangraenosum (PG) is still a therapeutic challenge. Although several drugs such as corticosteroids, dapsone, clofazimine, azathioprine, tacrolimus and cyclosporine A have been shown to be effective in this disease, side-effects of these agents limit their systemic use in seriously ill patients. In recent years, topical treatment of the disease has gained attention. Several reports show an improvement of cutaneous lesions of PG following topical treatment. These earlier reports as well as our own observations suggest that topical therapeutic regimens can be a useful and safe alternative to systemic immunosuppressive therapy in the treatment of PG. We give a review about these topically used drugs and the mechanisms probably involved.
CO2 Laser Surgery for Extensive, Cauliflower-Like Anogenital Condylomata acuminata: Retrospective Long-Term Study on 19 HIV-Positive and 45 HIV-Negative Men
Authors: Carrozza Patrizia M. , Merlani Giorgio M. , Burg Günter , Hafner Jürg
Published: April 2003

Background: Extensive ‘cauliflower-like’ condyloma acuminatum (CA) in males is commonly treated with CO2 laser surgery or with electrosurgery. Studies on the long-term outcome in this specific situation are scarce. Objectives: To determine the cure and recurrence rate in relation to the HIV status and endoanal location of lesions. To determine the complication rate and patient satisfaction. Methods: Questionnaire-based retrospective long-term study on 64 consecutive men (answer rate 60% or 64/107 addressed persons). The mean follow-up was 25 months (range 7–75). Results: The overall cure rate after 1 intervention was 67%. The cure rate in HIV-positive versus HIV-negative patients was 58 versus 71% (odds ratio = 1.79; p = 0.38). Endoanal versus perianal location was associated with a cure rate of 56 versus 84% (odds ratio = 4.06; p = 0.03). After a second treatment session, the cure rate increased to 79% or higher in all subgroups. Painful defecation for an average of 4–5 weeks was the main postoperative complaint. Severe complications were not seen or reported. Conclusions: The CO2 laser is a valuable and safe treatment to debulk extensive ‘cauliflower- like’ anogenital CA in males. The healing rate in HIV-positive patients is not significantly lower than in HIV-negative patients. Endoanal location of lesions is a risk factor for recurrence.
Diagnostic Odyssey of a Cutaneous Mycobacteriosis Rare in Central Europe
Authors: Fischer Tobias W. , Assefa Sentayehu , Bauer Heike I. , Graefe Tim , Scholz Matthias , Pfister Wolfgang , Barta Ute , Wollina Uwe , Elsner Peter
Published: April 2003

Cutaneous infection with Mycobacterium chelonae is an uncommon disease, although this atypical mycobacterium is an acid-fast bacillus ubiquitous in the environment. It is often misdiagnosed and treated as a fungal or common bacterial infection. We report a case of disseminated atypical mycobacterial skin infection of a 72-year-old woman who was treated with different topical and systemic antimycotic and antibiotic drugs over a period of 5 months without remarkable improvement. Eventually, repeated tissue cultures on special medium and performance of PCR led to the diagnosis of M. chelonae infection. The patient was treated successfully with oral clarithromycin within 8 weeks. In case of abscessing cutaneous infection, M. chelonae should be considered in the differential diagnosis of prolonged disease when common antibiotics are not effective after 2–4 weeks of treatment.
Treatment of Genito-Anal Lesions in Inflammatory Skin Diseases with PUVA Cream Photochemotherapy: An Open Pilot Study in 12 Patients
Authors: Reichrath Jörg , Reinhold Uwe , Tilgen Wolfgang
Published: April 2003

Background: Localized skin lesions of the genito-anal region such as in lichen sclerosus et atrophicus or in lichen planus are a burden for many patients, and therapeutic efforts, including therapies with potentially hazardous side-effects, are often unsatisfactory. Recently, PUVA bath photochemotherapy has been proven highly effective in the treatment of various inflammatory skin diseases, including localized scleroderma. Another form of topical PUVA therapy, 8-methoxypsoralen-containing cream or gel preparations, has been proven to be as effective as PUVA bath therapy for palmoplantar dermatoses. Objective: We evaluated the clinical effects of PUVA cream photochemotherapy in patients with genital lesions of inflammatory skin diseases. Methods: Twelve patients with lichen sclerosus et atrophicus, lichen planus, vulvar eczema and pruritus vulvae were included in the study. PUVA cream therapy was performed up to 4 times a week. Results: PUVA cream photochemotherapy induced a significant clinical improvement of genital lesions in most patients, as revealed by clinical examination. Clinical improvement (reduction in size of lesions of erythema, and/or of pruritus) was achieved in most patients after 10–20 treatments and was reduced in patients that had only received 5–15 treatments. Cumulative doses ranged between 4.5 and 180 J/cm2; all patients tolerated PUVA cream phototherapy well without any side-effects. Conclusion: PUVA cream phototherapy represents a highly effective therapy that should be further investigated as an alternative treatment for patients with genital lesions of inflammatory skin diseases.
The Diagnosis of Lichen-planus-Like Contact Dermatitis to Chlorpheniramine Maleate
Authors: Kuroda Kei , Hisanaga Yuko
Published: April 2003

In spite of the common use of the diagnostic category of lichen-planus-like contact dermatitis, we were unable to find established criteria for such a condition. An atypical distribution of otherwise typical lichen planus lesions is usually considered as a feature of a lichenoid eruption. When facing unusual or unexpected clinical features, it is always advisable to consider an adverse reaction to a medical intervention as a potential option. We report a lichen-planus-like eruption occurring after contact with a topical agent containing chlorpheniramine maleate. To our knowledge, this is the first reported case of lichen-planus-like contact dermatitis associated with chlorpheniramine maleate.
Temperature-Sensitive Viral Infection: Inhibition of Hemagglutinating Virus of Japan (Sendai Virus) Infection at 41°
Authors: Ishida Yo-ichi , Hiraki Akihiro , Hirayama Etsuko , Koga Yuji , Kim Jeman
Published: April 2003

While investigating myoblast fusion using enveloped viruses, we unexpectedly found that the production of hemagglutinating virus of Japan (HVJ; Sendai virus) was suppressed temperature dependently in quail myoblasts transformed with a temperature-sensitive Rous sarcoma virus, which proliferate at 35.5° but differentiate at 41°; viral production was normal at 35.5° but suppressed at 41° irrespective of the species of host cells. The production of some viruses, i.e. measles virus, influenza virus, herpes simplex virus type 1 and poliovirus, was also markedly suppressed at 41°, suggesting that a temperature of 41° affects viral infection generally. To clarify the mechanism of the suppression, the infectious pattern of HVJ was examined both at 37° and at 41° in LLC-MK2 cells. The synthesis of HVJ-specific proteins was inhibited at the transcriptional level at 41°, although viral penetration by envelope fusion was not affected. The transcriptional inhibition was also seen in quail fibroblasts, which do not express a 70-kD heat shock protein (HSP70), suggesting that HSP70 is dispensable for the inhibition of viral gene transcription at 41°. Further, when the infected cells were incubated at 41° after the viral proteins had been synthesized at 37°, viral production was also inhibited. Immunofluorescent staining of the cells exposed to 41° showed that HVJ envelope proteins formed large aggregates on the cell surface, into which both M and NP proteins were assembled. Under the electron microscope, HVJ virions appeared normal even at 41°, but were detected in clusters on the cell surface, unlike at 37°. These observations suggested that the release of HVJ virions from the cell surface was inhibited for some reason at 41°. Consequently, it was indicated that two steps, viral gene transcription and the release of virions, were inhibited at 41°.
Large Hepatitis Delta Antigen Is Phosphorylated at Multiple Sites and Phosphorylation Is Associated with Protein Conformational Change
Authors: Choi Soo-Ho , Park Kyu-Jin , Hwang Soon B.
Published: April 2003

Hepatitis delta antigen (HDAg) consists of two species, small HDAg (SHDAg) and large HDAg (LHDAg), which are identical in sequence with the exception that the large form contains an additional 19 amino acids at the C-terminus. Both HDAgs are nuclear phosphoproteins. However, LHDAg is hyperphosphorylated, i.e. it is at least 10 times more phosphorylated than SHDAg. To determine the phosphorylation site(s) of the LHDAg, we mutated all the conserved serine residues and expressed these mutant proteins using a recombinant baculovirus expression system. By labeling insect cells in vivo with 32P-orthophosphate and immunoprecipitation, we showed that LHDAg is phosphorylated at multiple serine residues. Although LHDAg contains two additional serines at its 19-amino acid extension, mutations of these two amino acids did not affect the overall phosphorylation level. Most importantly, the phosphorylation level of middle domain-deleted LHDAg (M75del) was significantly higher than that of wild-type LHDAg. We conclude that phosphorylation of the LHDAg occurs at multiple sites and that hyperphosphorylation is associated with alteration of protein conformation.
Rationale and Design of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) Study
Authors: Gheorghiade Mihai , Gattis Wendy A. , Lukas Mary Ann , O’Connor Christopher M.
Published: April 2003

β-Blockers for the treatment of heart failure are underprescribed in the United States despite the availability of extensive data and the current guidelines that support their use. The ongoing Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) study was designed to determine if initiation of beta blockade prior to hospital discharge is safe and improves the long-term use of β-blockers. IMPACT-HF is a multicenter, randomized, open-label trial of carvedilol initiated before hospital discharge or to usual care in 363 patients hospitalized for worsening heart failure. The primary end point of the study is the number of patients treated with any β-blocker at 60 days. Secondary endpoints include β-blocker dose achieved and a composite clinical endpoint. The data from the IMPACT-HF trial will provide evidence to evaluate whether in-hospital initiation of β-blocker therapy is effective in improving the long-term use of β-blockers in this population.
The Current View on Hypercholesterolemia after the ‘Heart Protection Study’ – Do We Need New Strategies?
Authors: Riesen Walter F.
Published: April 2003

The MRC/BHF Heart Protection Study (HPS) is so far the largest lipid-lowering trial ever completed. It included more than 20,000 adults aged 40 to 80 years with coronary heart disease (CHD) or a high cardiovascular risk (other occlusive arterial diseases or diabetes). They were randomly allocated to receive 40 mg simvastatin daily or a matching placebo. Further, half of each group received antioxidants (600 mg vitamin E, 250 mg vitamin C, and 20 mg β-carotene daily). HPS included patients on whom little experience on the advantages of a lipid-lowering therapy existed. Among these were 5,082 women or 25% of all patients. More than half of the participants were older than 65 years, 5,805 patients over 70 years, and 5,963 were diabetics. Individuals with no previous vascular events were also included. Another subgroup included those with known cerebrovascular or peripheral artery disease. Patients at risk with medium and low cholesterol concentration also participated in the study. The mean follow-up period is 5½ years, the study was conducted at 69 hospitals in the UK. The HPS confirms the findings of other previous large studies and extends them onto special subgroups as e.g. women, elderly patients, diabetics, other atherosclerotic diseases. These subgroups are larger than in any other study due to the great number of patients included (more than 20,000). The major findings are that 40 mg/d simvastatin is of benefit in patients with LDL-cholesterol below 3.0 mmol/l; that the benefit of patients above 75 years is as good as in younger patients; that women derive the same benefit from statin treatment as men; and that the treatment reduced ischemic strokes without significantly increasing hemorrhagic strokes. The HPS will lead to significant changes in the routine treatment of certain patients and will imply some changes of the current strategies. The general target values for LDL-cholesterol remains unchanged; but in patients with symptomatic atherosclerotic disease and normal cholesterol or LDL-cholesterol (i.e. 5.0 and 3.0 mmol/l, respectively), statin therapy should still be applied. Laboratory assessment of lipid levels and monitoring of therapy are still recommended. A major change is that vitamin supplementation with pharmacological doses has no effect on the incidence of cardiovascular disease and may be omitted.
Statins: Monotherapy or Combination Strategy for the Treatment of Dyslipidemia
Authors: Carmena Rafael
Published: April 2003

Statins are the drug of first choice for the treatment of most dyslipidemias. They have excellent efficacy in reducing the concentration of low-density lipoprotein cholesterol (LDL-C) and have been proven to reduce the incidence of cardiovascular events, although differences exist in the lipid-modifying properties of these agents. Combination therapy may be considered for patients who do not achieve their lipid goal despite optimization of statin treatment. In severely hypercholesterolemic patients, combinations of statins with bile acid sequestrants, plant sterols or specific cholesterol absorption inhibitors may provide additional reductions in LDL-C and extend the therapeutic options in these difficult-to-treat patients. In patients with mixed dyslipidemias, combination of a statin with niacin or a fibrate may be necessary to fully correct lipid abnormalities. Although these combinations may be associated with an increased incidence of adverse effects, particularly myopathy and hepatotoxicity, recent clinical trials suggest that the benefit of enhanced efficacy across the lipid profile out weighs the risk of toxicity. Nevertheless, statin-niacin or statin-fibrate combinations should only be considered after careful risk-benefit assessment, and patients should be well informed of potential side effects. Doses of each drug should be kept to a minimum in order to reduce the risk of adverse effects. Combination treatment with statins and fish oil has shown promising improvements in several lipid parameters without an increase in systemic toxicity, and this combination may be a useful addition to the options available for treatment of refractory patients who cannot tolerate statin-niacin or statin-fibrate combinations.
Optimal Camera and Illumination Angulations for Detection of Interproximal Caries Using Quantitative Light-Induced Fluorescence
Authors: Buchalla W. , Lennon Á.M. , van der Veen M.H. , Stookey G.K.
Published: April 2003

The aim of the study was to find the optimal illumination and camera angulations for interproximal use of quantitative light-induced fluorescence (QLF). A multiaxis optical bench was developed and interproximal tooth assemblies were investigated using a modified version of QLF. Extracted human premolars without caries (n = 8) and with interproximal D1, D2 and D3 caries (n = 20) were selected. Tooth-pair models without caries and with interproximal caries of matching size, location, and shape were imaged with varying camera and illumination directions from buccal (0°) to occlusal (90°) to lingual (180°) in steps of 30° using a PC and framegrabber and examined for observed presence. Interproximal lesions could be detected in all teeth, but observed presence was dependent on camera angulation (p < 0.05), rather than on illumination angulation (p = 0.32). No caries could be detected with the camera in the 90° position.
Caries Occurrence in a Fluoridated and a Nonfluoridated Town in Finland: A Retrospective Study Using Longitudinal Data from Public Dental Records
Authors: Seppä L. , Hausen H. , Kärkkäinen S. , Larmas M.
Published: April 2003

The tap water of Kuopio, Finland, was fluoridated from 1959 to1992. In the first decade of fluoridation, children in Kuopio had lower DMF values than children in Jyväskylä, a nearby low-fluoride town, but later differences between the towns have been small and inconsistent. The present study aimed to gain further insight into caries occurrence in Kuopio and Jyväskylä using longitudinal tooth-specific data from public health records on cohorts born in 1970/71 and 1980/81 (total n = 1,503). Survival analyses were used to summarize the tooth-specific times elapsed between eruption and the first filling (used as a proxy for dental caries). Generally, the first filling was placed sooner after eruption in the 1970/71 cohort than in the 1980/81 cohort. The curves for the two towns were virtually identical except for the first molars of the 1970/71 cohort, for which the percentage of filled first molars was consistently lower in Jyväskylä than in Kuopio. This study indicates that, among children and adolescents whose permanent teeth erupted in the mid-1970s or thereafter, even a longitudinal approach did not reveal a lower caries occurrence in the fluoridated than in the low-fluoride reference community. The main reason for the modest effect of water fluoridation in Finnish circumstances is probably the widespread use of other measures for caries prevention. The children have been exposed to such intense efforts to increase tooth resistance that the effect of water fluoridation does not show up any more. The results must not be extrapolated to countries with less intensive preventive dental care.
Preliminary Validation of PRISM (Pictorial Representation of Illness and Self Measure) – A Brief Method to Assess Suffering
Authors: Büchi Stefan , Buddeberg Claus , Klaghofer Richard , Russi Erich W. , Brändli Otto , Schlösser Corinne , Stoll Thomas , Villiger Peter M. , Sensky Tom
Published: April 2003

Background: Alleviation of suffering is widely acknowledged as one of the main goals of medicine. However, no measure to assess this crucial aspect of illness has been developed to date. Aims: To validate PRISM (Pictorial Representation of Illness and Self-Measure) as a simple quantitative method of assessing the perceived burden of suffering due to illness. Methods: Validity and reliability studies to date have involved over 700 patients with a variety of chronic physical illnesses. Results: Reliability of PRISM is good (test-retest reliability r = 0.95; p ≤ 0.001, interrater reliability r = 0.79; p ≤ 0.001). Qualitative data indicate that the interpretation of the PRISM task is not only consistent among patients, but also consistent with that expected from existing literature on suffering. As expected, PRISM shows strong correlations with psychological variables (notably depression and coping resilience) and also correlates with SF-36 subscale scores. Prospective longitudinal data demonstrate that PRISM is sensitive to therapeutic change. It is very acceptable to patients and takes less than 5 min to administer. Conclusion: In the absence of a ‘gold standard’ measure of suffering, our validation data must be interpreted with caution. However, the performance of PRISM is entirely consistent with what would be expected of a measure of suffering, based on current published work.
Clinical and Neuropathological Correlates of Apolipoprotein E Genotype in Dementia with Lewy Bodies
Authors: Singleton Andrew B. , Wharton Anna , O’Brien Kirsty K. , Walker Matthew P. , McKeith Ian G. , Ballard Clive G. , O’Brien John , Perry Robert H. , Ince Paul G. , Edwardson James A. , Morris Christopher M.
Published: April 2003

Dementia with Lewy bodies (DLB) represents the second commonest cause of dementia in the elderly following Alzheimer’s disease (AD). Whilst the presence of Lewy bodies is essential, DLB shares with AD the presence of senile plaques (SP), but neurofibrillary tangles (NFT) are not a necessary feature. The apolipoprotein E (APO E) Ε4 allele is the most consistently associated genetic risk factor for AD and has also been shown to associate with DLB. We have therefore analysed the APO E Ε4 allele in a large series of DLB cases coming to autopsy to: (1) determine if the Ε4 allele describes a similar risk in DLB development as in AD and (2) determine how APO E Ε4 allele status correlates with clinical and neuropathological findings in DLB, and in AD, as an indication of the role of APO E in underlying disease biology. Both DLB and AD share an increased Ε4 allele frequency, though in DLB the Ε2 allele frequency is not reduced and there is a relative lack of Ε4 homozygotes. In contrast to previous studies, no association of the Ε4 allele with age at onset or duration of disease was found in either disorders. In DLB cases, overall a significantly shorter duration of illness was observed when compared with AD cases, though no significant effect of the Ε4 allele on disease onset or duration was seen. The survival rate was reduced by the presence of the Ε4 allele in DLB, as with AD. No effect on SP or NFT counts was seen with the Ε4 allele, though DLB cases showed a lower SP burden in addition to the expected lower NFT counts. This study demonstrates that DLB shares the APO Ε4 allele with AD as a common risk factor, but that there are differences in the way the Ε4 allele affects the phenotypic expression of disease.
Acquisition of Serial Complexity in Speech Production: A Comparison of Phonetic and Phonological Approaches to First Word Production
Authors: Davis Barbara L. , MacNeilage Peter F. , Matyear Christine L.
Published: April 2003

Comparison was made between performance-based and competence-based approaches to the understanding of first word production. The performance-related frame/content approach is representative of the biological/functional perspective of phonetics in seeking explanations based on motor, perceptual and cognitive aspects of speech actions. From this perspective, intrasyllabic consonant-vowel (CV) co-occurrence patterns and intersyllabic sequence patterns are viewed as reflective of biomechanical constraints emerging from mandibular oscillation cycles. A labial-coronal sequence effect involved, in addition, the problem of interfacing the lexicon with the motor system, as well as the additional problem of initiation of movement complexes. Competence-based approaches to acquisition are within the generative phonological tradition; involving an initial assumption of innate, speech-specific mental structures. While various current phonological approaches to acquisition involve consideration of sequence effects and intrasyllabic patterns, they do not adequately establish the proposed mental entities in infants of this age, and are nonexplanatory in the sense of not considering the causes of the structures and constraints that they posit.
Articulation of Extreme Formant Patterns for Emphasized Vowels
Authors: Erickson Donna
Published: April 2003

This study examined formant, jaw and tongue dorsum measurements from X-ray microbeam recordings of American English speakers producing emphasized vs. unemphasized words containing high-front, mid-front and low vowels. For emphasized vowels, the jaw position, regardless of vowel height, was lower, while the tongue dorsum had a more extreme articulation in the direction of the phonological specification of the vowel. For emphasized low vowels, the tongue dorsum position was lower with the acoustic consequence of F1 and F2 bunched closer together. For emphasized high and mid-front vowels, the tongue was more forward with the acoustic consequence of F1 and F2 spread more apart. These findings are interpreted within acoustic models of speech production. They also provide empirical data which have application to the C/D model hypothesis that both increased lowering of jaw and enhanced tongue gesture are consequences of a magnitude increase in the syllable pulse due to emphasis.
Spontaneous Bladder Rupture due to Chronic Cystitis 20 Years after Cystolithotomy
Authors: Gogus Çaǧatay , Türkölmez Kadir , Savaş Berna , Sertçelik Ayşe , Baltaci Sümer
Published: April 2003

Spontaneous bladder rupture is a very rare condition. The majority of the cases are due to long-term indwelling catheters, radiation, or acute infravesical obstruction. Spontaneous rupture of the bladder due to inflammation is extremely rare. A case of intraperitoneal bladder rupture due to chronic cystitis is reported. Exploratory laparotomy and partial cystectomy were performed. Diagnosis and treatment are discussed.
Diagnosis of Pediatric Varicoceles by Physical Examination and Ultrasonography and Measurement of the Testicular Volume
Authors: Çayan Selahittin , Akbay Erdem , Bozlu Murat , Doruk Erdal , Yildiz Altan , Acar Deniz , Kanık E. Arzu , Ulusoy Ercüment
Published: April 2003

Introduction: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. Patients and Methods: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. Results: The mean age of the boys was 13.5 ± 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). Conclusions: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.
The Role of Skin Moisturizers in the Prevention of Irritant Contact Dermatitis – A Review
Authors: Goh C.L.
Published: April 2003

This review studies the efficacy of moisturizers in preventing contact dermatitis. Moisturizers have been in use for many decades to prevent contact dermatitis. In wet-work occupations, workers apply moisturizers daily for the prevention and treatment of skin irritation. Several in vitro and in vivo skin studies and field studies on the effects of moisturizers on irritant contact dermatitis have indicated their efficacy. It is an important preventive measure where wearing of gloves is not possible or inappropriate. Moisturizers can be seen to reinforce the natural barrier function of the skin by increasing the water content of the stratum corneum directly or indirectly. Studies have shown that eczematous skin heals faster when treated for several days with a moisturizer compared to untreated, symmetrical, control skin. There have been several studies on the efficacy of moisturizers in preventing contact dermatitis. Unfortunately, most of these studies are based on experimental models where the effects of specific moisturizers in preventing the irritant effects of specific irritants are measured. We have to be aware that different irritants have different effects on different individuals and that different moisturizers may have different protective effects on different skin characteristics. More field studies on the effects of moisturizers in the work environment need to be done to ascertain whether moisturizers do indeed help prevent contact dermatitis. Nevertheless, there has been sufficient evidence to suggest that moisturizers can prevent irritant contact dermatitis and should be recommended to workers who are constantly exposed to contact irritants.
Immunological Contact Urticaria and Anaphylaxis to Chlorhexidine: Overview
Authors: Heinemann C. , Sinaiko R. , Maibach H.I.
Published: April 2003

For more than 50 years chlorhexidine has been widely used as a medical disinfectant, as an additive for wound dressings or as a preservative in many cosmetic products, personal care products and drugs. In the last two decades, reports of immediate-type reactions to chlorhexidine reaching from localized urticaria to anaphylactic shock began to appear more frequently. However, the prevalence of contact urticaria and anaphylaxis due to chlorhexidine remains unknown. In this article, we reviewed the literature using PubMed, entering queries for ‘chlorhexidine anaphylaxis’, ‘chlorhexidine contact urticaria’ and ‘chlorhexidine allergy’. In total we reviewed 66 case reports. Twenty reactions occurred when chlorhexidine was applied to damaged skin surfaces, 27 patients showed an immediate-type reaction when chlorhexidine was applied to mucous membranes. Sixteen reports, all but one of them from Japan, concerned anaphylactic reactions after introduction of a chlorhexidine-coated central venous catheter. Slight damage to the epidermal barrier or application to mucous membranes seems to enhance the immediate reaction to chlorhexidine. Life-threatening shocks may be provoked even by application of chlorhexidine at its lowest bactericidal concentration. The diagnosis was confirmed by prick testing, intradermal testing or scratch testing. In 16 case reports, more than one severe immediate-type reaction occurred, because chlorhexidine had not been identified as the cause of one or more earlier episodes, suggesting that severe anaphylactic reactions to chlorhexidine are still not well recognized.
Psychoacoustic Characterization of the Tinnitus Spectrum: Implications for the Underlying Mechanisms of Tinnitus
Authors: Norena Arnaud , Micheyl Christophe , Chéry-Croze Sylviane , Collet Lionel
Published: April 2003

In this study, an original psychometric procedure was used in order to characterize in more detail than in previous studies the different perceptual components of tinnitus, i.e. auditory sensations which are perceived in the absence of a corresponding external acoustic stimulus. Ten subjects with chronic tinnitus were asked to rate on a numeric scale the contribution of elementary pitch sensations evoked by isolated frequency components to their overall tinnitus sensation. The resulting ‘internal tinnitus spectra’, which represented the estimated perceptual contribution to the tinnitus sensation as a function of frequency over a large range of frequencies, were found to occupy a wide frequency range corresponding largely to that at which hearing thresholds were abnormally elevated. In most cases, they exhibited a broad peak falling within the hearing loss range. This pattern of result suggests that in subjects with high-frequency hearing loss, tinnitus sensations, when present, resemble those evoked by high-frequency noise bands with, in some cases, a superimposed tonal-like pitch. These results confirm and extend earlier results in the literature and agree with the patients’ reports; their practical implications for the design of future studies on tinnitus and theoretical implications for the understanding of the neurophysiological mechanisms underlying tinnitus are discussed. The results of an additional experiment showed that the internal tinnitus spectrum could be altered by perceptual training in a fine frequency discrimination task with tones in the frequency range of the main peak of the tinnitus spectrum.
Cortical Representation of Hering’s Nerve: A Possible Anatomical Pathway for Seizure Cessation following Electrical Stimulation
Authors: Tubbs R. Shane , Patwardhan Ravish V. , Wellons III John C. , Oakes W. Jerry
Published: April 2003

Objective: We recently found that Hering’s nerve stimulation (HNS) effectively blunts seizure activity. This study characterizes the cortical areas that are activated by HNS. Methods: Hering’s nerve (HN) was stimulated in 3 dogs and 6 pigs, and then the brains of the animals were removed. The insular and mesial temporal cortices were removed and evaluated for increased neuronal activity by examining Fos-like activity. Results: In both the dogs and pigs, Fos activity was elevated in the anterior insular and mesial temporal cortices. Increased cortical activity was not noted in adjacent areas such as the frontal cortex. Conclusion: This study demonstrates that the mesial temporal and anterior insular cortices are selectively activated by stimulation of HN, thus suggesting cortical loci at which HNS might blunt seizure activity.
Movements of Energy Substrates in the Mammalian Brain, with Special Emphasis on Transporters during Normal and Pathological Development
Authors: Baud Olivier , Fayol Laurence , Evrard Philippe , Verney Catherine
Published: April 2003

Glucose is the main energy source for the mammalian brain and glycogen the largest energy reserve available in the developing nervous system. In addition to glucose, monocarboxylates including lactate, pyruvate and ketone bodies are a major source of energy of the brain under several conditions including development, excitotoxic stress or energy deprivation. Delivery of energy substrates from the blood to the brain requires specific glucose and monocarboxylate transporters across the endothelial cells involved in blood-brain barrier and cellular membranes of the neurons and glia. As the energy metabolism of the brain is based on coupling between neuronal activity, blood flow and energy supply, it could play a crucial role in the genesis of lesions associated with hypoxic and/or inflammatory insults. This review summarizes recent advances on the use and transport of carbohydrate substrates in adult and developing mammals. Characterization of the cellular sites of glucose and monocarboxylate transporter expression in the different cell populations of brain telencephalon during development is a relevant question for the understanding of cerebral metabolisms in the normal neonate and in clinical disorders occurring during hypoxia-ischemia insults or energy deprivation.
Nephrotic-Like Proteinuria in Experimental Diabetes
Authors: Greive Kerryn A. , Osicka Tanya M. , Russo Leileata M. , Comper Wayne D.
Published: April 2003

Aims/Hypothesis: Streptozotocin (STZ) diabetic rats are characterized by the development of albuminuria. It is not known, however, whether the excess excretion of protein is primarily due to intact protein or protein fragments or whether it is specific for albumin or occurs for all high-molecular-weight plasma proteins. To test this we have measured the excretion rates and fractional clearances of [14C]albumin, [3H]immunoglobulin G and [3H]transferrin in diabetic rats. Methods: The radiolabeled proteins were delivered to the circulation of conscious diabetic (STZ induced for 6 weeks) and control rats by ALZET osmotic pumps. The plasma level of the radiolabeled proteins reached steady-state levels by day 7. Urine and plasma samples from day 7 were used to determine the excretion rates of the proteins by radioactivity and radioimmunoassay. Results: When excretion rates were determined by radioactivity it was apparent that only the albumin excretion rate increased significantly with STZ diabetes to a value of 354 ± 166 µg/min which agrees with proteinuria determined by Biuret assay of 299.9 ± 52.4 µg/min. The major proportion of protein being excreted was in the form of protein fragments which are not detected by conventional immmunochemical assays. Conclusion: The previously unrecognized nephrotic-like levels of proteinuria in experimental diabetes appears to be associated with an albumin-specific mechanism responsible for the increase in albumin peptides in urine. There was significant lowering of plasma albumin concentration but plasma concentrations of transferrin and immunoglobulin G remained unchanged. There was also no significant appearance of intact protein in urine that is normally found in nephrotic states.
Protective Effect of HMG-CoA Reductase Inhibitor on Experimental Renal Ischemia-Reperfusion Injury
Authors: Yokota Naoko , O’Donnell Michael , Daniels Frank , Burne-Taney Melissa , Keane William , Kasiske Bertram , Rabb Hamid
Published: April 2003

Background: Increasing evidence supports an important role for inflammation in the pathogenesis of renal ischemia-reperfusion injury (IRI). Recently, HMG-CoA reductase inhibitors, ‘statins’, have demonstrated anti-inflammatory effects independent of cholesterol-lowering. Hypothesis: We tested the hypothesis that a statin would improve outcome in a murine model of renal IRI. Upon finding a protective effect, we tested the hypothesis that the mechanisms by which statins protected in renal IRI was by reducing neutrophil and macrophage infiltration and upregulating the anti-inflammatory cytokine IL-6. Methods: Cerivastatin at various dosing regimens was administered to NIH Swiss mice to evaluate the effects on renal IRI. Analysis of renal structure, function, neutrophil and macrophage infiltration, cytokine production, as well as mortality was performed in cerivastatin- and saline-treated groups. Results:Primary: Cerivastatin pretreatment for 3 days led to a significant improvement in renal function, tubular injury as well as survival after IRI compared to saline-treated mice. Secondary: Neutrophil and macrophage infiltration into kidney tissue was similar in both groups. IL-6 was markedly upregulated early in the kidneys of statin-treated compared to saline-treated mice. Conclusion: These data demonstrate that a statin compound can improve the course of ischemic acute renal failure. Induction of protective molecules such as IL-6 may underlie this effect.
Reversible Holocord Edema Associated with Intramedullary Spinal Abscess Secondary to an Infected Dermoid Cyst
Authors: Tsurubuchi Takao , Matsumura Akira , Nakai Kei , Fujita Keishi , Enomoto Takao , Iwasaki Nobuaki , Nose Tadao
Published: April 2003

We report a case of a holocord high-intensity lesion extending from L1 up to the medulla oblongata on T2-weighted spinal magnetic resonance imaging (MRI) associated with an intramedullary spinal abscess secondary to an infected dermoid cyst. The intraoperative findings revealed that the high-intensity lesion on the T2-weighted image was edematous tissue. The MRI change in the spinal cord gradually improved in response to the use of postoperative antibiotics. The change was considered to represent reversible inflammatory changes, as there was no neurological deficit found at the cervical level and it resolved after surgery and medical treatment. The pathomechanism is discussed herein.
Hematological Risk Factors for Coronary Heart Disease
Authors: El-Hazmi Mohsen A.F.
Published: April 2003

Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the developed and developing countries. Several underlying genetic and environmental factors have been implicated in its etiology. Some of the hematological risk factors implicated in the development of coronary heart disease include antithrombin III deficiency, protein C and protein S deficiency, factor V Leiden mutation, prothrombin gene (20210A) mutation hyperhomocystinaemia, elevated factor VIII levels, plasminogen activator inhibitor type 1 and dysfibrinogenaemia. In general, these factors result in thrombosis, thus having a negative effect on the heart and blood vessels. This paper presents an overview of some of the hematological risk factors involved in the development of CHD.
Nitrogen Oxides Reduce Albuterol-Induced Bronchodilation in Patients with Bronchial Asthma
Authors: Kanazawa Hiroshi , Hirata Kazuto , Yoshikawa Junichi
Published: April 2003

Background: We have previously found that asthmatics exhibit higher levels of nitrogen oxides (NOs) in exhaled air and in induced sputum than normal controls, and that NOs altered β2-adrenoceptor (β2-AR) function in an experimental animal model. Objectives: To determine whether NOs influence the bronchodilator activity of albuterol in asthmatic patients. Methods: We simultaneously measured the levels of NOs in exhaled air and in induced sputum in 20 asthmatic patients. The bronchodilator activity of albuterol was expressed as spontaneous recovery (before methacholine) and recovery from the lowest value in FEV1 evoked by the methacholine challenge (after methacholine). After the first study, 400 µg of beclomethasone dipropionate (BDP) was administered twice daily for 1 week to all patients, and the above-mentioned protocols were repeated. Results: The recovery of FEV1 (before methacholine) after albuterol was not significantly correlated with either baseline FEV1 or PC20 methacholine. Nor was the recovery of FEV1 (after methacholine) after albuterol significantly correlated with the maximal fall in FEV1 after the methacholine challenge and PC20 methacholine. However, the recovery of FEV1 after albuterol was inversely correlated with the nitric oxide levels in exhaled air (before methacholine: r = –0.556, p = 0.0151; after methacholine: r = –0.684, p = 0.0028), and the concentration of nitrite and nitrate in induced sputum (before methacholine: r = –0.459, p = 0.0448; after methacholine: r = –0.830, p = 0.0003). After treatment with inhaled BDP for 1 week, there was no significant change in baseline FEV1. However, there was a significant decrease in the concentration of nitrite and nitrate in induced sputum (p < 0.0001). The changes in nitrite and nitrate levels in induced sputum after 1 week of BDP therapy were significantly correlated with the changes in bronchodilator activity of albuterol before and after BDP therapy (before methacholine: r = 0.704, p = 0.0022; after methacholine: r = 0.727, p = 0.0015). Conclusions: We demonstrated that NOs in the airways reduced albuterol-induced brochodilation in asthmatics.