bluuebunny/crossref_metadata_2025 huggingface dataset:
Litigants’ Epicondylitis
Authors: KAY N. R. M.
Published: September 2003

The speculated pathological causes of tennis elbow and the part work might play in its causation are briefly reviewed. The excellent surgical results, whatever operative technique was employed in those surgical series reported prior to the wave of work-related upper limb disorders is noted. One hundred and eight consecutive patients with tennis elbow who were also litigants (seeking compensation) were reviewed and the result of treatment and specifically surgery, analysed. Disappointing results of surgery were found in litigants and recommendations are made as to the management of litigants epicondylitis.
Scopolamine into the anterior cingulate cortex diminishes nociception in a neuropathic pain model in the rat: an interruption of ‘nociception‐related memory acquisition’?
Authors: Ortega‐Legaspi J. Manuel , López‐Avila Alberto , Coffeen Ulises , del Angel Rosendo , Pellicer Francisco
Published: September 2003

The cingulate cortex plays a key role in the affective component related to pain perception. This structure receives cholinergic projections and also plays a role in memory processing. Therefore, we propose that the cholinergic system in the anterior cingulate cortex is involved in the nociceptive memory process. We used scopolamine ( in ) microinjected into the anterior cingulate cortex, either before thermonociception followed by a sciatic denervation, between thermonociception and denervation or after both procedures (n=10 each). The vehicle group (saline solution 0.9%, n=14) was microinjected before thermonociception. Chronic nociception was measured by the autotomy score, which onset and incidence were also determined. Group scopolamine—thermonociception–denervation (STD) presented the lowest autotomy score as compared to vehicle and group thermonociception—denervation–scopolamine (TDS) (vehicle vs. STD, p=0.002, STD vs. TDS, p=0.001). Group thermonociception‐scopolamine‐denervation (TSD) showed a diminished autotomy score when compared to TDS (p=0.053). STD group showed a delay in the onset of AB as compared to the rest of the groups. Group TSD presented a significative delay (p=0.048) in AB onset when compared to group TDS. There were no differences in the incidence between groups. The results show that nociception‐related memory processed in the anterior cingulate cortex is susceptible of being modified by the cholinergic transmission blockade. When scopolamine is microinjected prior to the nociceptive stimuli, nociception‐related memory acquisition is prevented. The evidence obtained in this study shows the role of the anterior cingulate cortex in the acquisition of nociception‐related memory.
Determinants of health‐related quality of life in patients with persistent somatoform pain disorder
Authors: Petrak Frank , Hardt Jochen , Kappis Bernd , Nickel Ralf , Egle Ulrich Tiber
Published: September 2003

Background. Health‐related quality of life (HRQOL) has been investigated widely in patients with chronic pain, but no study has focused particularly on the situation of patients with persistent somatoform pain disorder.

Aims. To survey the impairments of patients with somatoform pain disorder (ICD‐10: F45.4) and to predict pain‐related impairments and HRQOL on the basis of coping styles.

Method. A consecutively recruited sample of 100 patients (65% female) was examined in a cross‐sectional study. Questionnaires were administered to assess pain intensity (visual analogue scale), pain‐related disabilities (Pain Disability Index), quality of life (Short‐Form Health Survey‐36), and ways of coping with pain (Coping Strategies Questionnaire). To predict pain‐related impairments and HRQOL, a multiple linear regression analysis was carried out.

Results. HRQOL of patients with somatoform pain is strongly and significantly reduced compared with the general population. Among the coping measures, Increasing Pain Behaviors and Catastrophizing have a negative influence on patients' pain‐related impairments and the physical components of HRQOL. The mental component of HRQOL was predicted solely by Catastrophizing. No positive effect of active coping styles on health‐related outcome variables could be observed.

Conclusion. Patients with persistent somatoform pain disorder feel severely impaired. A clear pattern emerges for negative effects of the coping styles Increasing Pain Behaviors and Catastrophizing, while the identification of beneficial coping failed.
Identifying a long‐term/chronic, non‐cancer pain population using a one‐dimensional verbal pain rating scale: an epidemiological study
Authors: Jensen Marianne Kjettrup , Sjøgren Per , Ekholm Ola , Rasmussen Niels Kristian , Eriksen Jørgen
Published: September 2003

The usefulness of the verbal pain rating scale (VRS) included in the Short Form 36 (SF‐36) in identifying characteristics of long‐term pain conditions, was analyzed using data from the 1994 Danish Health and Morbidity Survey. Based on the rating of pain intensity during a 4‐week recall period the respondents were categorized into three groups: a high pain group (HPG) consisting of persons reporting moderate to severe pain (VRS 4–6), a low pain group (LPG) who rated their pain as very mild or mild (VRS 2–3), and a control group (CG) with no pain (VRS 1). The investigated sample comprised 3992 persons (HPG=563 persons, LPG=1714, and CG=1715 persons). Older age, educational level (<10 years of schooling), cohabitation status (divorce/separation), and moderate to severe physical job strain were found to be significant risk factors for reporting high pain intensity (HPG). Only minor differences were observed between the LPG and CG. The proportion of respondents with good perceived health was significantly lower in the HPG compared with LPG and CG. The dominant complaints in the HPG were related to the musculoskeletal system. During a 14‐day period prior to the interview persons in the HPG had a mean of 1.19 working days lost due to illness compared with a mean of 0.2 for the LPG and CG. Analyzing the use of medical services during the year before the interview, persons belonging to the HPG had an average number of nine contacts to general practitioners and specialized doctors in the primary sector as compared to six for the LPG and four for the CG. Mean numbers of hospital admissions were 0.29 for the HPG, 0.15 for the LPG and 0.10 for the CG. Mean numbers of in‐hospital days were 1.60, 0.80, and 0.43 for the HPG, LPG, and CG, respectively. Our study suggest that one‐dimensional pain intensity scoring using a simple VRS‐scoring is useful as a screening instrument for identifying persons suffering from pain of a more complex nature. High intensity scores on a pain intensity scale should indicate to the investigator that she/he might be facing a person whose pain complaints and behavior are not only based on a pure biological background, but in whom also severe psychological and social problems might be present.
Enhanced levels of CD154 (CD40 ligand) on platelets in patients with chronic heart failure
Authors: Stumpf Christian , Lehner Christoph , Eskafi Saeed , Raaz Dorette , Yilmaz Atilla , Ropers Susanne , Schmeisser Alexander , Ludwig Joseph , Daniel Werner G. , Garlichs Christoph D.
Published: September 2003

Background:

Inflammation plays a significant contributory role in the pathogenesis of chronic heart failure (CHF). Previous data have shown enhanced plasma levels of proinflammatory cytokines, i.e. TNF‐α and IL‐6, as well as a persistent immune activation in patients with CHF. Furthermore, the immune modulator CD154 has been receiving increased attention, since it plays a key role in the pathophysiology of multicellular vascular events such as thrombosis, inflammation and atherosclerosis. Since CD154 intitiates and maintains the release of proinflammatory cytokines from endothelial cells, its potential role for the development and progression of CHF is of interest.

Methods:

Fifty patients with CHF (aged 66.9±12.6 years, mean ejection fraction 22.1±9.2%, NYHA II–IV, 39 of ischemic origin, 11 with idiopathic dilated cardiomyopathy) and 15 healthy controls (aged 62.5±9.8 years) were examined. Thirty‐two patients were taking aspirin (100 mg/day). Blood was drawn from a peripheral vein and immediately fixed with 1% paraformaldehyde, incubated with anti‐CD154, anti‐P‐selectin, and anti‐CD61 and thereafter analyzed by flow cytometry.

Results:

Patients with CHF showed significantly enhanced expression of platelet‐bound CD154 and P‐selectin as compared to controls (CD154: median 35.6 25th percentile: 26.3; 75th percentile: 44.6 vs. 12.8; 25th: 6.8; 75th: 15.6 mean fluorescence intensity [MFI], P<0.001; P‐selectin: median 3.2 25th percentile: 1.9; 75th percentile: 5.9 vs. 1.4; 25th: 1.2; 75th: 1.9, MFI, P<0.001). CD154 expression on platelets positively correlated with increasing NYHA‐class. In contrast, no significant differences in serum levels of soluble CD154 or CD40 expression on monocytes were detected in the study groups. Antiplatelet‐therapy with aspirin did not influence CD154 or P‐selectin expression on platelets.

Conclusion:

Our pilot study demonstrates significantly enhanced levels of CD154 on platelets in patients with CHF. This suggests that the CD40–CD154 axis may contribute to the proinflammatory milieu, which exists in CHF and thus may play a pathogenic role in the development and progression of CHF.
Methodological nationalism and the study of migration
Authors: WIMMER ANDREAS , SCHILLER NINA GLICK
Published: August 2003

The study purports to show how a bias, known as methodological nationalism, has weighed down research and investigation on migration until recently. Relying on the contribution of work on transnational communities, the authors propose a programmatic conclusion.
Contesting ethnic immigration: Germany and Israel compared
Authors: JOPPKE CHRISTIAN , ROSENHEK ZEEV
Published: August 2003

After World War II, Israel and Germany adopted curiously similar policies of ethnic immigration, accepting as immigrants only putative co-ethnics. The objective of this article is to account for the main variation between the two cases, the resilience of Jewish immigration in Israel, and the demise of ethnic-German immigration in Germany. The very fact of divergent outcomes casts doubt on conventional accounts of ethnic immigration, which see the latter as deriving from an ethnic (as against civic) definition of nationhood. We point instead to the possibility of ‘liberal’ and ‘restrictive’ contention surrounding ethnic immigration, and argue that for historical and geopolitical reasons the political space for such contention has been more constricted in Israel than in Germany.
Is friendship a sociological topic?
Authors: EVE MICHAEL
Published: August 2003

Sociologists have shown little interest in friendship. The rather fragmentary empirical work which does exist on friendship in modern society paradoxically tends to confirm the impression that the subject is of marginal importance; for friendship emerges from much research as a relationship which provides emotional support and small services but little else. Admittedly, there is also evidence indicating links with more classical sociological themes—such as access to jobs. But this evidence is often seen as representing ‘exceptional’ circumstances. Thus, among an immigrant group, friendship ties may be seen as particular to the culture from which immigrants come; among an elite group, the importance of friendship ties may be seen as peculiar to that elite circle. We can talk of a genuine ‘paradigm’ of modern society as being based on relatively impersonal relations. The paper maintains that if friendship is approached differently, it emerges as of more central and ‘structural’ interest. What is required is a shift on both theoretical and methodological levels. Sociology needs to shift its theoretical perspective and recognize that people articulate their values, enact their strategies, develop their language in face-to-face groups, not as isolated individuals. In terms of empirical research, what is needed are methods capable of tracing these groupings. This is difficult at present because most sociological methods rely heavily on data collected on individuals and their attributes.
Towards a more significant sociology of friendship
Authors: PAHL RAY
Published: August 2003

Eve's polemic on the relatively insignificant contribution of sociological studies of friendship to the central concerns of the discipline has some force. However, he weakens his case in three main ways. Firstly, his over-reliance on Giddens to demonstrate the contrast in the importance of personalistic relations between ‘traditional’ and ‘late-modern’ societies. See for example Allan Silver. Secondly, Eve's contention that there is an over-reliance on dyadic relationships in the study of friendship is becoming outdated, as demonstrated in the major ESRC project ‘Rethinking Friendship’. Thirdly, Eve underestimates the importance of analyses of friendship in contemporary sociological studies of stratification and power. For example, the so-called velvet revolution of 1989 in Eastern Europe were fuelled by the friend-based organisation of radically dissident intellectuals.
L'intellectuel, le pouvoir et l'idée de démocratie en Chine
Authors: LUN ZHANG
Published: August 2003

New political legitimacy is the sticking point of Chinese modernity, which has puzzled Chinese intellectuals for centuries. Since Mao's death in 1976, the debate about the necessity, conditions, and strategy of democratization in China has taken place among scholars of all factions and tendencies. However, only the process of reform provides the possibility discuss of such sensitive questioning; however only eventual democratization could help us carry this process through.
Roquefort vs Big Mac: Globalization and Its Others
Authors: BODNÁR JUDIT
Published: August 2003

Being an ‘antiglobalizationist’ comes easy as a political label but as a theoretical endeavor, it is more difficult. Globalization encompasses a bundle of meanings. The paper disentangles some of the multiple implications of globalization and its purported enemies through the Big Mac-Roquefort opposition; it examines the taste differential of the two products, their symbolism and their stakes in the construction of ethnic, cultural and class identities. The simplistic opposition between globalization and its enemies is reinterpreted in the context of commercialization, Americanization, democratization, high-and massculture and-consumption, only to be cast in the age-old tensions of modernity.
NATALITY AND THE CHANGING PATTERN OF SEASONALITY OF BIRTHS IN THE PROVINCE OF TERAMO (ABRUZZO, ITALY: 1500–1871)
Authors: DANUBIO MARIA ENRICA , DI DONATO LEANDRO , VECCHI FRANCESCO , COPPA ALFREDO
Published: August 2003

Reconstruction of human ecosystems and their stability over time provides knowledge of the processes of adaptability developed by isolated communities. Seasonality of vital events is a good indicator of the effects of different ‘traditional’ lifestyles, which in turn depend on the ecological context in which a population developed specific subsistence models. Seasonality of births reflects the cultural attitude towards the best time to conceive, in relation to work activities and loads; the latter may also affect physiological functions related to fertility. The present research concerns gross birth rates and seasonality of births and conceptions during four centuries in south-central Italy. Birth rates were between 33·0 and 36·5 per 1000. The pattern of seasonality of births and, by extension, of conceptions defines a southern-type agricultural area for the earlier periods. However, it also shows a progressive shift towards an increasing concentration of conceptions in spring–summer – namely from April to August – with a large increase in summer in the 19th century with respect to the previous periods. The new 19th century pattern is reported by Crisafulli, Dalla Zuanna & Solero (2000) as being representative of the central Adriatic region, a geographical classification to which Abruzzo can also be attributed.
Home ranges in adult Scandinavian brown bears (Ursus arctos): effect of mass, sex, reproductive category, population density and habitat type
Authors: Dahle Bjørn , Swenson Jon E.
Published: August 2003

Annual home‐range size indices for 36 male and 52 female adult brown bearsUrsus arctosin two study areas in central and northern Scandinavia were estimated to evaluate factors believed to influence home‐range size. Male home ranges were larger than home ranges of lone females after controlling for the sexual size dimorphism acting on metabolic needs. Further, home ranges of females with cubs were smaller than home ranges of lone females and females with yearlings. Thus, differences in metabolic need were not able to explain the variation in range size among females of different reproductive categories or between males and females, suggesting roaming behaviour of males in this promiscuous species. Home‐range size in both males and females was inversely related to population density along a density gradient that was not linked to food availability. This contradicts the hypothesis that females use the minimum areas that sustain their energy requirements. However, on a large geographical scale a negative relationship between range size and food availability was evident. The annual home ranges in inland boreal environments in Scandinavia are the largest reported for brown bears in Eurasia, and similar to those in inland boreal and montane environments in North America.
Morphology of the middle ear of golden moles (Chrysochloridae)
Authors: Mason Matthew J.
Published: August 2003

The middle ear structures of nine species of golden moles (family Chrysochloridae) were examined under the light microscope. Auditory structures of several of these species are described here for the first time in detail, the emphasis being on the ossicular apparatus. Confirming previous observations, some golden moles (e.g. Amblysomus species) have ossicles of a morphology typical of mammals, whereas others (Chrysospalax, Chrysochloris, Cryptochloris and Eremitalpa species) have enormously hypertrophied mallei. Golden moles differ in the nature and extent of the interbullar connection, the shape of the tympanic membrane and that of the manubrium. The stapes has an unusual orientation, projecting dorsomedially from the incus. It has been proposed that hypertrophied ossicles in golden moles are adapted towards the detection of seismic vibrations. The functional morphology of the middle ear apparatus is reconsidered in this light, and it is proposed that adaptations towards low‐frequency airborne hearing might have predisposed golden moles towards the evolution of seismic sensitivity through inertial bone conduction. The morphology of the middle ear apparatus sheds little light on the disputed ordinal position of the Chrysochloridae.
Comment on Woolf
Authors: VINEN RICHARD
Published: August 2003

I read Professor Woolf's erudite and ambitious article with great interest. The central argument of the piece – that writing a history of Europe is an impossibly complicated, but still worthwhile, enterprise that would involve the interrelation of many different kinds of history – is one that we would probably all accept. I am more more sceptical about three subplots in Woolf's essay.
Intellectual Trajectories in the Twentieth Century: Circles, Lines and Detours
Authors: LOYER EMMANUELLE
Published: August 2003

The history of intellectuals, as developed in France, is now venerable enough to have a history of its own. From the early 1980s its development signalled the end of the heroic age of the French intellectual and the beginning of a critical review of French intellectual practice, hitherto overshadowed by a ‘history of ideas’ stigmatised as inclining towards abstraction and idealism. Debray, Bourdieu, Hamon, Rotman and others have variously rhapsodised over the beauty of the intellectual ‘corpse’. At the beginning of the decade the tragic fading of the revolutionary adventure, the bitter retreat into a recrudescent professionalism and the surrender to the perceived invasion of mass culture were together bringing about fundamental changes in intellectual attitudes and created a new set of circumstances which the optimistic could interpret as a redefinition, and the pessimists as a laying to rest, of the function and figure of the intellectual.
Two urban districts in early modern Istanbul: Edirnekapı and Yedikule
Authors: ÖZKOÇAK SELMA AKYAZICI
Published: August 2003

This paper explores how the system of meat supply influenced the topographical
development of two marginal districts of sixteenth-century Istanbul. Through the combination of
information contained in various historical sources, the paper reconstructs the economic links between some of their ‘dependent’ establishments such as slaughterhouses, tanning workshops, candle- and soapmakers. Throughout, it is argued that decisions about the location of these establishments were closely related to social, economic and probably technological factors of the era.
‘Brothers by day’: colonial policing in Dar es Salaam under British rule, 1919–61
Authors: BURTON ANDREW
Published: August 2003

The creation of a colonial police force in Tanganyika after the First World War and its elaboration over the next four decades is described, as are its role in the attempted assertion of urban order and its relations with the Dar es Salaam public. The force was a central component in the colonial state's efforts to assert control over the urban arena. Lacking both resources and legitimacy it was only partially effective in this regard, with intermittent enforcement of colonial legislation being the norm. More concerted efforts to supervise the urban African population at a time of rapid urban growth in the post-Second World War period led to a deterioration in – already poor – police-public relations, which served further to undermine colonial authority.
Mammal invaders on islands: impact, control and control impact
Authors: COURCHAMP FRANCK , CHAPUIS JEAN‐LOUIS , PASCAL MICHEL
Published: August 2003

The invasion of ecosystems by exotic species is currently viewed as one of the most important sources of biodiversity loss. The largest part of this loss occurs on islands, where indigenous species have often evolved in the absence of strong competition, herbivory, parasitism or predation. As a result, introduced species thrive in those optimal insular ecosystems affecting their plant food, competitors or animal prey. As islands are characterised by a high rate of endemism, the impacted populations often correspond to local subspecies or even unique species. One of the most important taxa concerning biological invasions on islands is mammals. A small number of mammal species is responsible for most of the damage to invaded insular ecosystems: rats, cats, goats, rabbits, pigs and a few others. The effect of alien invasive species may be simple or very complex, especially since a large array of invasive species, mammals and others, can be present simultaneously and interact among themselves as well as with the indigenous species. In most cases, introduced species generally have a strong impact and they often are responsible for the impoverishment of the local flora and fauna. The best response to these effects is almost always to control the alien population, either by regularly reducing their numbers, or better still, by eradicating the population as a whole from the island. Several types of methods are currently used: physical (trapping, shooting), chemical (poisoning) and biological (e.g. directed use of diseases). Each has its own set of advantages and disadvantages, depending on the mammal species targeted. The best strategy is almost always to combine several methods. Whatever the strategy used, its long‐term success is critically dependent on solid support from several different areas, including financial support, staff commitment, and public support, to name only a few. In many cases, the elimination of the alien invasive species is followed by a rapid and often spectacular recovery of the impacted local populations. However, in other cases, the removal of the alien is not sufficient for the damaged ecosystem to revert to its former state, and complementary actions, such as species re‐introduction, are required. A third situation may be widespread: the sudden removal of the alien species may generate a further disequilibrium, resulting in further or greater damage to the ecosystem. Given the numerous and complex population interactions among island species, it is difficult to predict the outcome of the removal of key species, such as a top predator. This justifies careful pre‐control study and preparation prior to initiating the eradication of an alien species, in order to avoid an ecological catastrophe. In addition, long‐term monitoring of the post‐eradication ecosystem is crucial to assess success and prevent reinvasion.
Review of the ultrastructure of the nematode body cuticle and its phylogenetic interpretation
Authors: DECRAEMER WILFRIDA , KARANASTASI EIRINI , BROWN DEREK , BACKELJAU THIERRY
Published: August 2003

The phylogenetic interpretation of the nematode cuticle ultrastructure is reviewed within the framework of recent DNA‐sequence data. In particular, the structure of the median and basal zones is discussed. Several structural elements of the cuticle seem to have arisen independently several times within the Nematoda and thus are highly homoplasious (e.g. the cortical or basal radial striae, spiral fibre layers and a fluid matrix with struts). Moreover, identifying the homology of the nematode cuticle ultrastructures is often very difficult at deep taxonomic levels. Hence, the cuticle appears to be unreliable regarding resolution of deep‐level relationships in the Nematoda. However, at less inclusive taxonomic levels (e.g. families, genera, …) the cuticle seems to be a more reliable phylogenetic marker.
Quantitative steps in symbiogenesis and the evolution of homeostasis
Authors: KOOIJMAN S. A. L. M. , AUGER P. , POGGIALE J. C. , KOOI B. W.
Published: August 2003

The merging of two independent populations of heterotrophs and autotrophs into a single population of mixotrophs has occurred frequently in evolutionary history. It is an example of a wide class of related phenomena, known as symbiogenesis. The physiological basis is almost always (reciprocal) syntrophy, where each species uses the products of the other species. Symbiogenesis can repeat itself after specialization on particular assimilatory substrates. We discuss quantitative aspects and delineate eight steps from two free‐living interacting populations to a single fully integrated endosymbiotic one. The whole process of gradual interlocking of the two populations could be mimicked by incremental changes of particular parameter values. The role of products gradually changes from an ecological to a physiological one. We found conditions where the free‐living, epibiotic and endobiotic populations of symbionts can co‐exist, as well as conditions where the endobiotic symbionts outcompete other symbionts. Our population dynamical analyses give new insights into the evolution of cellular homeostasis. We show how structural biomass with a constant chemical composition can evolve in a chemically varying environment if the parameters for the formation of products satisfy simple constraints. No additional regulation mechanisms are required for homeostasis within the context of the dynamic energy budget (DEB) theory for the uptake and use of substrates by organisms. The DEB model appears to be closed under endosymbiosis. This means that when each free‐living partner follows DEB rules for substrate uptake and use, and they become engaged in an endosymbiotic relationship, a gradual transition to a single fully integrated system is possible that again follows DEB rules for substrate uptake and use.
Ophthalmic follow‐up of patients with tyrosinaemia type I on NTBC
Authors: Gissen P. , Preece M. A. , Willshaw H. A. , McKiernan P. J.
Published: September 2003

Summary: NTBC has revolutionized the management of tyrosinaemia type I, although animal experiments have shown that long‐term administration may produce corneal opacities analogous to those in tyrosinaemia type II. We have assessed the prevalence of ocular side‐effects in 11 tyrosinaemia type I patients on NTBC attending the Birmingham Children's Hospital. Despite high plasma tyrosine concentrations in some patients, they did not experience symptoms or signs of ocular toxicity.
Evaluation of 3‐methylcrotonyl‐CoA carboxylase deficiency detected by tandem mass spectrometry newborn screening
Authors: Koeberl D. D. , Millington D. S. , Smith W. E. , Weavil S. D. , Muenzer J. , McCandless S. E. , Kishnani P. S. , McDonald M. T. , Chaing S. , Boney A. , Moore E. , Frazier D. M.
Published: September 2003

Summary: Since the addition of tandem mass spectrometry (MS/MS) to the North Carolina Newborn Screening Program, 20 infants with two consecutive elevated 3‐hydroxyisovalerylcarnitine (C5OH) levels have been evaluated for evidence of inborn errors of metabolism associated with this metabolite. Ten of these 20 infants had significant concentrations of both 3‐hydroxyisovaleric acid and 3‐methylcrotonylglycine in their urine, suggestive of 3‐methylcrotonyl‐CoA carboxylase (3‐MCC) deficiency. Four of these 10 were infants whose abnormal metabolites were found to be of maternal origin. Of 8 patients with probable 3‐MCC deficiency, 7 have been tested and found to have the enzyme deficiency confirmed in lymphoblasts or cultured fibroblasts; one of these 7 infants had only marginally decreased 3‐MCC activity in lymphocytes but deficient 3‐MCC in fibroblasts. We estimate the incidence of 3‐MCC deficiency at 1:64000 live births in North Carolina. We conclude that MS/MS newborn screening will detect additional inborn errors of metabolism, such as 3‐MCC deficiency, not traditionally associated with newborn screening. The evaluation of newborns with two abnormally elevated C5OH levels on MS/MS newborn screening should include, at least, urine organic acid analysis by capillary GC‐MS and a plasma acylcarnitine profile by MS/MS. Long‐term follow‐up is needed to determine the outcome of presymptomatically diagnosed patients with 3‐MCC deficiency by MS/MS newborn screening.
Molecular analyses of the HGO gene mutations in Turkish alkaptonuria patients suggest that the R58fs mutation originated from Central Asia and was spread throughout Europe and Anatolia by human migrations
Authors: Uyguner O. , de Jorge E. Goicoechea , Cefle A. , Baykal T. , Kayserili H. , Cefle K. , Demirkol M. , Yuksel‐Apak M. , de Córdoba S. Rodríguez , Wollnik B.
Published: September 2003

Summary: Alkaptonuria (AKU) is a rare metabolic disorder of phenylalanine catabolism that is inherited as an autosomal recessive trait. AKU is caused by loss‐of‐function mutations in the homogentisate 1,2‐dioxygenase (HGO) gene. The deficiency of homogentisate 1,2‐dioxygenase activity causes homogentisic aciduria, ochronosis and arthritis. We present the first molecular study of the HGO gene in Turkish AKU patients. Seven unrelated AKU families from different regions in Turkey were analysed. Patients in three families were homozygous for the R58fs mutation; another three families were homozygous for the R225H mutation; and one family was homozygous for the G270R mutation. Analysis of nine intragenic HGO polymorphisms showed that the R58fs, R225H and G270R Turkish AKU mutations are associated with specific HGO haplotypes. The comparison with previously reported haplotypes associated with these mutations from other populations revealed that the R225H is a recurrent mutation in Turkey, whereas G270R most likely has a Slovak origin. Most interestingly, these analyses showed that the Turkish R58fs mutation shares an HGO haplotype with the R58fs mutation found in Finland, Slovakia and India, suggesting that R58fs is an old AKU mutation that probably originated in central Asia and spread throughout Europe and Anatolia during human migrations.
3‐Hydroxy‐2‐methylbutyryl‐CoA dehydrogenase deficiency
Authors: Sutton V. R. , O'Brien W. E. , Clark G. D. , Kim J. , Wanders R. J. A.
Published: September 2003

Summary: A boy now 8 years old presented at 21 months of age with developmental arrest, followed by regression, cortical blindness and myoclonic seizures. Urine organic acid analysis revealed 3‐hydroxy‐2‐methylbutyric acid and tiglyglycine; 3‐ketothiolase enzyme activity was normal and he was subsequently found to have 3‐hydroxy‐2‐methylbutyryl‐CoA dehydrogenase deficiency.
Patient‐controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression†
Authors: Axelsson K. , Nordenson U. , Johanzon E. , Rawal N. , Ekbäck G. , Lidegran G. , Gupta A.
Published: August 2003

Background:  The aim of the study was to evaluate postoperative analgesia and safety of wound instillation of ropivacaine either by a single dose or a patient‐controlled regional anaesthesia (PCRA) technique.

Methods:  In 40 patients undergoing arthroscopic subacromial decompression the surgeon placed a catheter into the subacromial space at the end of the operation. In Phase I (10 patients), ropivacaine 250 mg was injected twice within 1 h. In Phase II, 30 patients were randomised into three groups: group prilocaine‐ropivacaine (PR) = 20 ml of 1% prilocaine‐epinephrine injected preoperatively into the subacromial bursa + 20 ml of 0.5% ropivacaine infused in the catheter postoperatively; group saline‐ropivacaine (SR) = saline‐epinephrine (20 ml) preoperatively + 0.5% ropivacaine as in group PR; group saline‐saline (SS) = saline‐epinephrine (20 ml) preoperatively + saline postoperatively. The PCRA pump was filled with local anaesthetic or saline to allow boluses of 10‐ml each, maximum one bolus/h, via the catheter. Pain relief, side‐effects and venous plasma concentration of ropivacaine were evaluated during a 24‐h‐test period.

Results:  The free plasma concentration of ropivacaine was 0.12 + 0.041 mg l−1 in Phase I. No adverse effects were seen. In Phase II pain at rest and on movement was lower in group PR than in group SS during the first 30 min postoperatively (P < 0.05). Group PR had the lowest morphine consumption (P < 0.05). Five to seven boluses were administered via the PCRA‐pump, and 20 min after administration of the study solution, pain was lower in groups PR and SR compared with group SS (P < 0.001).

Conclusions:  Preoperative intrabursal prilocaine with epinephrine + postoperative subacromial administration of ropivacaine by PCRA‐technique provided the most effective analgesia with no major side‐effects. The free plasma concentrations of ropivacaine were far below toxic concentrations.
Differences in cerebral reperfusion and oxidative injury after cardiac arrest in pigs
Authors: Liu X. L. , Wiklund L. , Nozari A. , Rubertsson S. , Basu S.
Published: August 2003

Background:  An investigation of the free radical scavenger sodium 2‐sulfophenyl‐N‐tert‐butyl nitrone (S‐PBN) and the weak vasodilatator Tris buffer mixture (TBM) on cerebral cortical blood flow (CCBF) and the jugular bulb concentration of two eicosanoids, indicators of oxidative stress and inflammation, was undertaken in 30 anaesthetized piglets during cardiopulmonary resuscitation (CPR) and after restoration of spontaneous circulation (ROSC).

Methods:  Thirty animals were subjected to 8 min of untreated circulatory arrest followed by 8 min of closed‐chest CPR. During CPR, the animals were randomized to receive 60 mg/kg S‐PBN, 1 mmol/kg TBM or 2 ml/kg normal saline (n = 10 in each group). Systemic haemodynamic variables, CCBF and jugular bulb plasma concentrations of 8‐iso‐PGF2α and 15‐keto‐dihydro‐PGF2α were measured.

Results:  The CCBF during reperfusion after ROSC was greater in the TBM group than in the S‐PBN group, the regression coefficient between CCBF and mean arterial blood pressure being lower in the S‐PBN group than in the TBM group. The jugular bulb plasma concentration of 8‐iso‐PGF2α during the first 30 min after ROSC was greater in the TBM group than in the S‐PBN group. Administration of TBM after vasopressin did not attenuate the pressor effect of vasopressin.

Conclusion:  Administration of S‐PBN during CPR results in less cerebral oxidative stress, possibly by promoting normal distribution of cerebral blood flow.
Effects of adding epinephrine plus fentanyl to low‐dose lidocaine for spinal anesthesia in outpatient knee arthroscopy
Authors: Türker G. , UÇkunkaya N. , Yilmazlar A. , Demirag B. , Tokat O.
Published: August 2003

Background:  This study investigated whether addition of 15 µg epinephrine plus 25 µg fentanyl to lidocaine spinal anesthesia for outpatient knee arthroscopy makes it possible to use a subanesthetic lidocaine dose. The aim was to assess the quality of anesthesia and the suitability of this protocol for outpatient knee arthroscopy.

Methods:  Seventy‐five outpatients scheduled for knee arthroscopy were randomly assigned to one of three spinal anesthetic protocols: Group L10F25 received 10 mg of lidocaine plus 25 µg fentanyl; Group L10F25E15 received 10 mg of lidocaine plus 25 µg fentanyl plus 15 µg epinephrine; and Group L20F25 received 20 µg lidocaine plus 25 µg fentanyl. Tourniquet pain and surgical pain were assessed using a visual analog scale. If spinal anesthesia was inadequate despite supplementary intravenous analgesia and sedation, the patient was converted to general anesthesia. Recovery times and side‐effects in the early postoperative period were recorded.

Results:  The highest level of sensory block was above the T12 dermatome in all patients. Compared with the other groups, significantly more patients in Group L10F25 converted to general anesthesia. Group L10F25 had a significantly higher mean surgical pain score than the other groups. The mean tourniquet pain score was significantly higher in Group L20F25 than Group L10F25E15. Group L10F25E15 had a significantly shorter time to discharge than the other groups. Post‐operative nausea and vomiting and drowsiness were more frequent in Group L10F25 than in the other groups.

Conclusion:  The combination of 10 mg lidocaine and 25 µg fentanyl plus 15 µg epinephrine provides adequate spinal anesthesia and has favorable recovery characteristics for outpatient knee arthroscopy.
Prospect for vaginal delivery of growth restricted fetuses with abnormal umbilical artery blood flow
Authors: Li Hui , Gudmundsson Saemundur , Olofsson Per
Published: August 2003

Background.  The best mode of delivery in cases of intrauterine growth restriction (IUGR) with umbilical artery blood flow changes is not well elucidated.

Objective.  To evaluate outcome in IUGR with umbilical artery blood flow changes planned for vaginal delivery after a negative oxytocin challenge test (OCT).

Methods.  In 84 term singleton pregnancies with suspected IUGR and no unanimous indication for abdominal delivery, Doppler velocimetry and OCT were performed. Positive OCT cases were delivered by cesarean section, negative OCT cases planned for vaginal delivery.

Results.  Umbilical artery Doppler velocimetry was normal in 51 cases (normal group) and abnormal in 33 cases (increased pulsatility index with maintained forward diastolic flow). Gestational age at delivery was shorter (p = 0.008), positive OCT more common (33% vs. 16%; p = 0.06), and vaginal delivery less common (40% vs. 63%; p = 0.04) in the abnormal blood flow group compared with the normal flow group. When in labor, 68% in the abnormal flow group and 76% in the normal flow group delivered vaginally (p = 0.6). One baby had a lethal malformation and another suffered meconium aspiration and pneumothorax, but was discharged home healthy.

Conclusions.  The vaginal delivery rate was significantly lower in the abnormal flow group compared with the normal flow group, but in cases finally destined for a trial of labor the vaginal delivery rates were similar. There was no indication that any fetus was exposed to detrimental hypoxia or distress.
Homocysteine‐induced enhancement of spontaneous contractions of myometrium isolated from pregnant women
Authors: Ayar Ahmet , Celik Husnu , Ozcelik Oguz , Kelestimur Haluk
Published: August 2003

Background.  Although many associations have been demonstrated between hyperhomocysteinemia and pregnancy complications, such as spontaneous abortion, preterm labor, preeclampsia and low birthweight, it is still not clear whether hyperhomocysteinemia is the cause or the consequence of these pregnancy complications. The aim of this study was to investigate the effects of homocysteine on the spontaneous contractility of isolated pregnant human myometrium.

Methods.  Myometrium samples obtained from women undergoing elective caesarean section were suspended in a jacketed organ bath containing Krebs' solution at 37°C (pH 7.4), continuously gassed with 95% O2 and 5% CO2. After manifestation of spontaneous contractions under 2 g of resting tension, homocysteine was applied to the organ bath, and amplitude and frequency of contractions were evaluated at 20‐min intervals. Statistical analysis of amplitude and frequency of the contractions was performed using the Kruskal–Wallis analysis of variance test.

Results.  Application of 0.1 mm homocysteine had no significant effect on either frequency (4.63 ± 0.42 vs. 4.01 ± 0.53 for the control period; p > 0.05) or amplitude (3.20 ± 0.07 g vs. 3.15 ± 0.07 g; p > 0.05) of spontaneous contractions, while 1 and 2 mm homocysteine significantly increased the frequency (8.54 ± 0.62 vs. 3.9 ± 0.44, p < 0.02, and 12.32 ± 0.72 vs. 3.96 ± 0.51, p < 0.001, respectively) of spontaneous contractions but caused only a modest change in amplitude (2.92 ± 0.04 g vs. 2.87 ± 0.05 g, p > 0.05, and 3.02 ± 0.06 g vs. 2.93 ± 0.05 g, p > 0.05, respectively).

Conclusion.  Results from this study indicate for the first time that homocysteine causes enhancement of spontaneous contractions of myometrium derived from pregnant women.
Interleukin‐2 Production in Whole Blood Cell Cultures of Women Undergoing Controlled Ovarian Hyperstimulation for Assisted Reproduction Technology Cycles
Authors: Orvieto Raoul , Leites Tatiana , Abir Ronit , Bar Jacob , Yoeli Rakefet , Feldberg Dov , Fisch Benjamin
Published: August 2003

Problem:  To determine whether human chorionic gonadotropin (hCG) modulates the in vitro release of interleukin (IL‐2) from human peripheral lymphocytes and monocytes derived from patients undergoing controlled ovarian hyperstimulation (COH).

Method of Study:  A large university‐based IVF unit was used for the study. Blood was drawn thrice from 12 women undergoing our routine IVF long gonadotropin‐releasing‐hormone‐analog protocol during the COH cycle: (1) day on which adequate suppression was obtained (Day‐S); (2) day of or prior to hCG administration (Day‐hCG); and (3) day of ovum pick‐up (Day‐OPU). At each point of time, blood was tested for sex‐steroid levels and then cultured for 72 hr either without (control‐culture) or with hCG (hCG‐culture) or with mitogenic stimulation by phytohemagglutinin (PHA‐culture). The culture‐medium supernatants were tested for IL‐2 levels with a commercial sandwich enzyme‐linked immunoassay.

Results:  Whole blood culture IL‐2 levels increased significantly during COH until peak E2, and then decreased significantly after hCG administration. IL‐2 levels were decreased in the control‐ and PHA‐culture media on Day‐OPU compared with Day‐hCG. There were no significant correlations between IL‐2 levels in the culture media and serum estradiol, progesterone or human chorionic gonadotropin levels.

Conclusion:  Apparently, hCG attenuates IL‐2 production by mononuclear cells with and without mitogenic stimulation, irrespective of the estradiol level. This suggests that hCG may indirectly modulate the inflammatory response, resulting in the ovarian hyperstimulation syndrome.
Breath malodor in an asthmatic patient caused by side‐effects of medication: a case report and review of the literature
Authors: Murata T , Fujiyama Y , Yamaga T , Miyazaki H
Published: August 2003

Objective:  The purpose of this report is to document the presence of dimethyl sulfide in mouth air as the predominant volatile sulfur compound (VSC) in an asthmatic patient who was regularly taking suplatast tosilate.

Study design: The patient was a 33‐year‐old woman who complained of bad breath. She had been diagnosed as having asthma and was receiving periodical medical examinations once a month. VSC in her mouth air were measured with a gas chromatograph. Oral physiotherapy was also carried out to remove any oral malodor of which the source was intraoral.

Results: With the improvement in oral hygiene and periodontal conditions, the level of VSC was reduced but dimethyl sulfide still remained as the predominant VSC.

Conclusions: Dimethyl sulfide metabolized from suplatast tosilate may be a potential cause of halitosis.
Oral involvement in a case of AA amyloidosis
Authors: Koloktronis A , Chatzigiannis I , Paloukidou N
Published: August 2003

A case of oral involvement of amyloid associated (AA) amyloidosis (secondary systemic amyloidosis) in a patient who is suffering from psoriatic arthritis and ankylosing spondylitis, is described. The patient was complaining of pain in the oral cavity (burning mouth), especially on the tongue, and difficulty in chewing and swallowing foods. Oral examination revealed a few papules on the dorsum of the tongue associated with xerostomia. In addition, two slightly painful, small ulcers, localized on the vestibule of the mouth were observed. Biopsy of the tongue demonstrated amyloid deposits.
Gideon Mantell's inaugural publication
Authors: Brook Anthony
Published: August 2003

The Sussex‐born scientific genius, Gideon Mantell (1790–1852), who died 150 years ago, gained fame as the discoverer of Iguanodon and other dinosaurian fossils, but it is a little‐known fact that his very first appearance in print related to archaeology rather than geology.
Direct comparative trials of the efficacy of proton pump inhibitors in the management of gastro‐oesophageal reflux disease and peptic ulcer disease
Authors: Vakil N. , Fennerty M. B.
Published: September 2003

Background : Five proton pump inhibitors are now available for use in North America. Claims of differences in the clinical efficacy of different strengths and/or agents have been made.

Aim : To identify any consistent evidence of differences in outcomes between agents or doses within this class of drugs.

Methods : A search of the medical literature was performed in two electronic databases, and randomized controlled trials of higher quality were included in the assessment.

Results and conclusions : Thirty‐two trials met our criteria. No convincing data were found to indicate that low doses of proton pump inhibitors are as effective as standard doses of proton pump inhibitors in the healing of erosive oesophagitis or in the relief of symptoms of gastro‐oesophageal reflux disease; however, they may be as effective as maintenance therapy for gastro‐oesophageal reflux disease and peptic ulcer disease. Differences were found between the standard doses of proton pump inhibitors with regard to the onset of symptom relief in gastro‐oesophageal reflux disease (lansoprazole was faster than omeprazole, and esomeprazole was faster than both lansoprazole and omeprazole) and the healing of oesophagitis (esomeprazole was superior to both omeprazole and lansoprazole). Despite these differences, there are as yet insufficient data to establish the superiority of any one agent over all others across all disease states treated with these agents.