bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrasting effects of intrauterine growth retardation and premature delivery on adult cortisol secretion and metabolism in man
Authors: Walker Brian R. , Irving R. John , Andrew Ruth , Belton Neville R.
Published: March 2003

objective Among babies born at term, intrauterine growth retardation (IUGR) predicts adult hypertension and hyperglycaemia. This might be due to elevated circulating glucocorticoids in adulthood, as described in animal models and in several cohorts of men who were low birthweight at term. Recently, we found that premature low birthweight babies also have adult cardiovascular risk factors, irrespective of IUGR. We have now investigated cortisol secretion in this group.

design patients and measurements We studied 29 women and 23 men aged 22–25 years who had been recruited at birth as either normal term (mean birthweight 3·1 kg, gestation 39 weeks), premature appropriate for gestational age (AGA; 1·7 kg, 32 weeks), or premature IUGR (1·7 kg, 35 weeks) babies. Body composition was measured by dual‐energy X‐ray absorptiometry (DEXA); plasma was obtained at 0900 h after overnight fast; and cortisol metabolites were measured in a 24‐h urine sample by gas chromatography/mass spectrometry (GCMS).

results Cortisol metabolites were different in men and women, so results were analysed separately. Among women, adult body composition did not differ between groups. Plasma cortisol was not different, but total urinary cortisol metabolite excretion was lower in AGA (3·29 ± 1·91 mg/day, n = 7, P < 0·02) than in either normals (6·77 ± 4·10, n = 14) or IUGR (9·47 ± 8·84, n = 8). Relative excretion of cortisol and cortisone metabolites was not different. Statistically significant differences in cortisol parameters between groups were not seen in men.

conclusions Premature AGA baby girls have lower cortisol secretion in adulthood but normal plasma cortisol, suggesting impaired metabolic clearance of cortisol. By contrast, premature IUGR babies maintain normal cortisol secretion as adults, suggesting that IUGR, rather than premature delivery, is responsible for programmed activation of the hypothalamic–pituitary–adrenal (HPA) axis. The ability to detect such dramatic differences in a small study suggests that programming has a potent influence on adult cortisol secretion.
Preliminary evidence that an endogenous retroviral long‐terminal repeat (LTR13) at the HLA‐DQB1 gene locus confers susceptibility to Addison's disease
Authors: Pani Michael A. , Seidl Christian , Bieda Katrin , Seissler Jochen , Krause Maren , Seifried Erhard , Usadel Klaus‐H. , Badenhoop Klaus
Published: March 2003

OBJECTIVE Addison's disease is associated with particular haplotypes of the human leucocyte antigen (HLA) region [DQA1*0501‐DQB1*0201 (DQ2) and DQA1*0301‐DQB1*0302 (DQ8)]. This locus harbours several human endogenous retroviral (HERV) long‐terminal repeats (LTR). LTRs within the HLA region have been shown to confer additional susceptibility to type 1 diabetes and rheumatoid arthritis.

DESIGN We investigated the role of LTR3 and LTR13, both of which are located adjacent to the DQB1 gene, in Addison's disease.

PATIENTS Eighty‐seven patients and 160 controls were genotyped for HLA‐DQA, ‐DQB, and the presence or absence of LTR3 and LTR13.

RESULTS Significantly more patients’ HLA alleles than those of controls carried the LTR13 insertion (19·0% vs. 10·6%, P = 0·0143), whereas there was only a trend for LTR3 (allele‐wise chi‐squared test: P = 0·0941). Both, LTR3 and LTR13 are in strong linkage disequilibrium with DQ8, which itself was significantly more frequent in patients than in controls (29·9% vs. 15·0%, P = 0·0089). However, significantly more alleles of DQ8+ patients than of DQ8+ controls carried the LTR13 insertion (44·2% vs. 18·8%, P = 0·0119), whereas we did not observe any difference for LTR3 in the DQ8+ subset (30·5 vs. 23·1%, P = 0·9416).

CONCLUSIONS We have found preliminary evidence that the endogenous retroviral element DQ‐LTR13, but not LTR3, is associated with Addison's disease. LTR13 appears to enhance HLA‐DQ8 mediated disease risk. This retroviral insertion therefore might represent a novel susceptibility factor in Addison's disease, but these findings need to be confirmed in a larger data set.
Promoter mutations are no major cause of PTTG overexpression in pituitary adenomas
Authors: Kanakis D. , Kirches E. , Mawrin C. , Dietzmann K.
Published: March 2003

objective The pituitary tumour transforming gene (PTTG) was proven to cause transformation of NIH3T3 fibroblasts, which produce tumours when transplanted into immunodeficient mice. PTTG is overexpressed in about 90% of pituitary adenomas. The reason for its overexpression is still unclear.

design Because promoter mutations may play a role for an altered regulation of PTTG transcription in the pituitary adenomas, we analysed two promoter regions which were characterized previously as functionally important.

patients Twenty‐five patients of both sexes with pituitary adenomas, mainly null‐cell adenomas, were included in this study.

measurements Both DNA regions were amplified from paraffin sections by PCR and analysed for small deletions or insertions on polyacrylamide gels in all patients. In 16 cases both DNA regions were sequenced to detect base substitutions.

results No deletions/insertions and no tumour‐specific substitutions were found. In three homopolymeric regions a polymorphism was detected, which also occurred in control sequences. In addition, these tracts showed some degree of length instability.

conclusions Promoter mutations do not play a major role for the enhanced PTTG transcription in pituitary adenomas. Therefore, DNA‐binding proteins, hypomethylation or other epigenetic factors may be responsible for PTTG overexpression.
Endocrine profiles and semen quality in spinal cord injured men
Authors: Naderi A. R. , Safarinejad M. R.
Published: March 2003

purpose To evaluate the hypothalamic–pituitary–testis (HPT) axis, endocrine profiles and semen quality in men with spinal cord injury (SCI).

materials and methods Fifty‐five men with SCI were studied. Serum levels of FSH, LH, testosterone, oestradiol and prolactin (PRL) were determined; the LH‐releasing hormone (LHRH) stimulation test and a semen analysis were performed, and testicular volumes were measured. Thirty‐six age‐matched healthy male volunteers and 34 noninjured infertile men served as controls.

results Eight SCI subjects had low basal LH, four had low basal FSH, and 16 had decreased basal serum levels of LH and FSH. Of subjects with lower serum levels of gonadotrophins (LH and/or FSH), nine had low serum testosterone and seven had hyperprolactinaemia. Serum levels of oestradiol were similar for all groups. There were increased LH and FSH responses to LHRH in SCI subjects compared to normal controls, but this difference was only statistically significant in SCI subjects with lower than normal serum levels of LH and/or FSH. There was no significant difference in testis volume between SCI subjects and controls. The mean semen volume in SCI subjects was lower than from controls, but the difference was not statistically significant. Sperm motility and percent normal sperm morphology were lower in SCI compared to normal controls but not to infertile control subjects. In total, 51% and 86% of SCI subjects had at least one hormonal or axis abnormality, respectively.

conclusion We conclude that hypogonadotropism in SCI subjects is likely to be secondary to altered neural or hormonal pathways between the hypothalamus and the pituitary gland, and that these endocrine abnormalities may be the mechanisms contributing to impairment of semen quality.
Facial disfigurement: is it in the eye of the beholder? A study in patients with Graves’ ophthalmopathy
Authors: Terwee Caroline B. , Dekker Friedo W. , Bonsel Gouke J. , Heisterkamp Siem H. , Prummel Mark F. , Baldeschi Lelio , Wiersinga Wilmar M.
Published: March 2003

objectives The importance of facial disfigurement in many diseases necessitates a reliable and valid measure of disfigurement severity for clinical studies. The hypothesis is that a universal concept of disfigurement exists and can be measured in a reliable way. The objectives of this study were to investigate if persons, in particular patients and physicians, can agree on facial disfigurement severity; and to determine the relative contribution of predefined clinical characteristics of patients with Graves’ ophthalmopathy (GO) to the overall rating of facial disfigurement severity.

design A panel study was carried out in four different panels, each consisting of four members.

patients We randomly selected 100 slide pairs of GO patients from four available study populations, involving mild, moderate and severe GO patients (mean age 49 years, 76% female) who were treated with either radiotherapy, sham‐irradiation, prednisone or orbital decompression.

measurements All panel members individually scored the disfigurement severity of 100 GO patients shown on standardized slides on a Visual Analog Scale. In total, 1600 ratings were collected. We calculated within‐ and between‐panel agreement of disfigurement severity and identified determinants of disfigurement.

results Agreement within a panel varied from 0·65 to 0·79 and was highest within the panel of ophthalmologists. Between‐panel agreement was 0·67 and was highest between ophthalmologists and laypersons. Compared with the global average, patients overrated and endocrinologists underrated disfigurement severity. Female panellists rated the patients, on average, more disfigured than male panellists. Important determinants of disfigurement were eyelid retraction, severe eyelid swelling and proptosis. Their relative importance was consistent across panels and in contrast to current measures of GO severity.

conclusion Facial disfigurement severity can be measured in a reliable way using panels of panellists. Except for some systematic differences between panellists, facial disfigurement does not seem to be in the eye of the beholder.
Effect of 2 years of cortisol normalization on the impaired bone mass and turnover in adolescent and adult patients with Cushing's disease: a prospective study
Authors: Di Somma Carolina , Pivonello Rosario , Loche Sandro , Faggiano Antongiulio , Klain Michele , Salvatore Marco , Lombardi Gaetano , Colao Annamaria
Published: March 2003

background Osteoporosis is a frequent, severe and often underestimated consequence of long‐term hypercortisolism, often presenting as bone fracture.

objective This prospective study was designed to evaluate whether the abnormalities of bone mass and turnover can be similarly reversed in adolescent and adult patients with Cushing's disease, after correction of hypercortisolism.

patients and methods Bone mineral density (BMD) at lumbar spine, serum osteocalcin (OC) and urinary cross‐linked N‐telopeptides of type I collagen (Ntx) levels were measured at diagnosis and 2 years after cure of Cushing's disease (CD) in six patients with childhood‐onset and nine with adulthood‐onset disease. Fifteen age‐, sex‐ and body mass index (BMI)‐matched healthy subjects served as controls.

results At diagnosis, BMD Z scores at lumbar spine and OC levels were lower (2·3 ± 0·1 vs.−0·2 ± 0·01; P < 0·01 and 1·6 ± 0·1 vs. 9·6 ± 1·2; P < 0·01 respectively) while urinary Ntx levels were significantly higher (139·9 ± 6·1 vs. 82·0 ± 1·6; P < 0·01) in CD patients than in controls. Among CD patients, similar values of Z scores (−2·4 ± 0·3 vs.−2·2 ± 0·1, P = 0·4) and OC levels (1·7 ± 0·2 vs. 1·6 ± 0·2, P = 0·6) were observed in adolescent and adults patients, whereas urinary Ntx levels were significantly higher (159·7 ± 7·9 vs. 125·9 ± 3·3, P < 0·001) in the former than in the latter group.

Two years after remission from hypercortisolism, OC levels (P < 0·001) and lumbar BMD Z scores (−2·2 ± 0·3, P < 0·05; and −1·9 ± 0·2; P < 0·01, respectively) increased significantly, while urinary Ntx levels reduced significantly (P < 0·001) in both adolescent and adult patients. However, biochemical markers and Z scores of BMD remained significantly suppressed compared to controls.

conclusions Bone impairment in childhood‐ and adulthood‐onset Cushing's disease patients can be partly, but not completely, reversed 2 years after normalization of cortisol levels. Longer recovery times or additive therapeutic approaches are necessary to maximize peak bone mass in children and restore bone mass in adults with Cushing's disease.
Intelligent computer reporting `lack of experience': a confidence measure for decision support systems
Authors: Holst  , Ohlsson  , Peterson  , Edenbrandt
Published: March 2003

The purpose of this study was to explore the feasibility of developing artificial neural networks that are able to provide confidence measures for their diagnostic advice.

Computer‐aided decision making can improve physician performance, but many physicians hesitate to use these `black boxes'. If we are to rely upon decision support systems for such tasks as medical diagnosis it is essential that the computers indicate when the advice given is based on experience, i.e. give a confidence measure.

An artificial neural network was trained to diagnose healed anterior myocardial infarction and to indicate `lack of experience' when test electrocardiograms were different from the electrocardiograms of the training set. A database of 1249 electrocardiograms from patients who had undergone cardiac catheterization was used to train and test the neural network. Thereafter, the ability of the network to indicate `lack of experience' was assessed using 100 left bundle branch block electrocardiograms, an electrocardiographic pattern that was excluded from the training set.

The network indicated that 83% of the left bundle branch block electrocardiograms and 1% of the test electrocardiograms from catheterized patients were different from the electrocardiograms of the training set. All but one of the left bundle branch block electrocardiograms would otherwise be falsely classified as anterior myocardial infarction by the network.

Artificial neural networks can be trained to indicate `lack of experience', and this ability increases the possibility for neural networks to be accepted as reliable decision support systems in clinical practice.
Breathing efficiency during inspiratory threshold loading in patients with chronic obstructive pulmonary disease
Authors: Baarends  , Schols  , Nusmeier  , Grinten  , Wouters
Published: March 2003

Patients with chronic obstructive pulmonary disease (COPD) demonstrate an increased oxygen cost of breathing. It is as yet unclear whether this is related to a decreased breathing efficiency. The aim of the present study was to compare breathing efficiency in 16 patients with COPD (11 men, five women) and 16 healthy elderly subjects (seven men, nine women), and to investigate a possible relationship between breathing efficiency and resting energy expenditure (REE). REE was measured using a ventilated hood system. Breathing efficiency was assessed by measuring oxygen consumption (V ′O2), mean inspiratory mouth pressure (MIP) and flow during breathing at rest and subsequently during breathing against an inspiratory threshold (40% of maximal inspiratory pressure). During loaded breathing there was a significant increase in V ′O2, MIP, and external work of breathing compared with unloaded breathing in both groups. As intended, ventilation did not increase significantly during the breathing efficiency test in the patients with COPD. The breathing efficiency (median, range) of the patients with COPD was similar (3·7%, 1·4–8·7%) to that of the healthy elderly subjects (3·2%, 1·7–8·3%). Breathing efficiency was not correlated with REE in either group. In the present study, in which dynamic hyperinflation was probably prevented, no difference in breathing efficiency was found between healthy elderly subjects and COPD patients when breathing against an external inspiratory threshold. Furthermore, breathing efficiency was not related to REE in both groups.
Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) variability in asymptomatic never‐smoking men
Authors: Humerfelt S. , Eide G. E. , Kvåle G. , Gulsvik A.
Published: March 2003

We examined the effects from subjects, technicians and spirometers on within‐session variability in successful recordings of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in 4989 asymptomatic never‐smoking men. All eligible men aged 30–46 years living in western Norway (n = 45 380) were invited to a cross‐sectional community survey. Information on respiratory symptoms, smoking habits and occupational exposures was obtained from a self‐administered questionnaire. Three successful FEV1 and FVC recordings were obtained in 26 368 attendants using three dry‐wedge bellow spirometers operated by 10 different technicians. Within‐subject standard deviation (SD) from three recordings of FEV1 and FVC was on average 102 and 106 ml, respectively, and increased with height (14 and 17 ml, respectively, per 10 cm) and body mass index (BMI) (11 and 14 ml, respectively, per 5 kg m−2). Between‐subject SD of the mean of three FEV1 and FVC recordings was 591 and 754 ml, respectively, and increased in groups of increasing height (43 and 40 ml, respectively, per 10 cm). Small, but significant, differences were observed between technicians in within‐subject SD and in levels of FEV1 and FVC. Homogeneity of between‐subject variability, necessary for linear regression analysis, was obtained using FEV1 and FVC divided by height squared. In conclusion, within‐subject variability in three successful spirometric recordings was small, but dependent on height and BMI of the subjects as well as technician performance. The observed heterogeneity in between‐subject variation in FEV1 and FVC levels disappeared when each variable was divided by height squared. Novel multiple linear regression equations for FEV1/height2 and FVC/height2 were developed to be used in evaluating the effects from occupational airborne exposures in Nordic men aged 30–46 years.
Reproducibility of surface EMG during dynamic shoulder forward flexions: a study of clinically healthy subjects
Authors: Larsson Barbro , Karlberg Christian , Elert Jessica , Gerdle Björn
Published: March 2003

There is a shortage of studies concerning the reproducibility of surface electromyography (EMG) during dynamic contractions. The movement per se introduces factors that could have the potential to affect the characteristics of the electromyogram. The aim of this study was to investigate the during‐the‐day reproducibility (using intra‐class coefficient, ICC) of the peak torque (PT) and the EMG variables (without removing electrodes) of dynamic shoulder forward flexions. Eleven healthy women performed three sets of 10 dynamic maximum right‐shoulder flexions at 1 h intervals using an isokinetic dynamometer. The PT of each flexion was determined. EMG signals were recorded from four muscles (trapezius, deltoid, infraspinatus and biceps brachii) using surface electrodes, and the mean frequency of the power spectrum (MNF [Hz]) and the signal amplitude (RMS [μV]), were computed. The ability to relax between maximum flexions was calculated as a ratio between the RMS during the passive extension phase and the RMS during the active flexion phase of each contraction cycle. This ratio is the signal amplitude ratio (SAR). The present study showed good reproducibility for PT, MNF and RMS, while the reproducibility of SAR was generally acceptable (fair) according to the criteria used.
Transperitoneal transport in diabetic and non‐diabetic patients on peritoneal dialysis
Authors: Graff Jesper , Fugleberg Steen , Nielsen Steen Levin , Feldt‐Rasmussen Bo
Published: March 2003

To investigate differences in the transport characteristics of the peritoneal membrane between diabetic and non‐diabetic patients on chronic peritoneal dialysis, a study was conducted in 21 non‐diabetic and 18 diabetic patients. Transperitoneal transport of small solutes was evaluated in terms of the mass transfer area coefficients (urea, creatinine and glucose), ultra‐filtration sieving coefficients (urea and creatinine) and by peritoneal equilibration test results. The capacity of the peritoneal membrane to transport macromolecules was evaluated by albumin mass transfer rates and clearances of albumin. Transperitoneal water transport was evaluated by the ultra‐filtration properties and the lymphatic flow rates. Finally, the whole‐body capillary permeability was estimated by measuring the unidirectional flux of albumin across the capillary wall, i.e. the transcapillary escape rate of 125I‐labelled human albumin. Despite a significantly increased transcapillary escape rate of albumin in the diabetic patients, no differences in peritoneal membrane characteristics could be demonstrated between diabetic and non‐diabetic patients on peritoneal dialysis.
The effect of interferential therapy upon cutaneous blood flow in humans
Authors: Noble J. Gareth , Henderson Gail , Cramp A. Fiona L. , Walsh Deirdre M. , Lowe Andrea S.
Published: March 2003

The aim of the current controlled and blinded study was to investigate the effect of various interferential current frequencies upon cutaneous blood flow in humans using laser Doppler flowmetry, in an attempt to define the physiological mechanisms involved. Following approval from the university’s ethical committee, 50 healthy volunteers (25 male, 25 female; age 18–34 years) were randomly allocated into one of five experimental groups: (i) control; neither suction nor interferential current was applied, (ii) placebo; suction only was applied, (iii) IFT 1; 10–100 Hz beat frequency applied, (iv) IFT 2; 80–100 Hz beat frequency applied, and (v) IFT 3; 10–20 Hz beat frequency applied. In the IFT groups, interferential currents were applied through four suction electrodes positioned to target the quadriceps femoris muscle. The following parameters were used in all IFT groups: 125 μs pulse duration, 4 kHz carrier frequency and a 6/6 sweep. In IFT groups 1 and 2 only, the rotating vector system was made active. Ambient and skin temperatures were measured concomitantly. Repeated‐measures ANOVA showed a significant difference between groups (P=0·0361) and over time (P=0·0001) for blood flow data; one‐factor ANOVA showed a significant increase in blood flow in the IFT 3 group (10–20 Hz) when compared to all experimental groups at 12 min (P=0·0156). In addition, at 21 min, there were significant differences between the IFT 3 group and all other groups except control (P=0·0213). Statistical analysis of skin temperature data demonstrated significant differences over time (P=0·0001) and a significant interactive effect (P=0·0022), with no significant differences observed between groups. These findings provide some evidence of a putative vasodilatory effect caused by interferential current therapy when applied through suction electrodes at a modulated frequency of 10–20 Hz.
Circulatory response to single circuit weight and walking training sessions of similar energy cost in middle‐aged overweight females
Authors: Jürimäe  , Jürimäe  , Pihl
Published: March 2003

The aim of this study was to compare circulatory responses to circuit weight (CWT) and aerobic walking training sessions of similar energy cost in middle‐aged overweight females. Thirty‐three middle‐aged pre‐menopausal females participated in the experiment. They were divided into overweight (n=18, 36·2 ± 6·3 years, 166·3 ± 8·0 cm, 83·5 ± 9·7 kg, BMI 30·2 ± 3·1 kg m–2) and non‐overweight control (n=15, 34·1 ± 6·3 years, 165·0 ± 5·6 cm, 61·6 ± 5·0 kg, BMI 22·7 ± 1·5 kg m–2) groups. Individual physical working capacity (PWC) was measured using the cycle ergometer test (calculated at the level of predicted HRmax (205 – ½ age). A CWT session consisted of leg extension, bench press, sit‐ups and leg press exercises. The subjects performed four circuits at the maximal possible speed, using a work‐to‐rest ratio of 60 s. Blood pressure (BP) was measured during every rest period between the exercises, and the heart rate (HR) was recorded continuously during the whole CWT programme. During the walking training session, the subjects walked as fast as possible on the indoor track. The total energy cost of the walking training session was the same as during the CWT session, approximately 270 kcal, and was controlled by a CALTRAC accelerometer. HR and BP were measured every 5 min during the walking training session. The PWC index was significantly (P<0·05) higher in the overweight group in comparison with the control females (215·4 ± 76·1 and 187·9 ± 42·4 W, respectively). The resting BP was normal in both groups (<140/90 mmHg). HR was between 120 and 140 beats min–1 during CWT and walking sessions. There were no differences in BP during both training sessions in overweight and control subjects. It was concluded that both CWT and walking training sessions were acceptable forms of physical activity to increase cardiovascular fitness in middle‐aged overweight and normal body weight females.
Distribution of interstitial fluid pressure and fluid volumes in hind‐limb skin of rats: relation to meridians?
Authors: Zhang  , Aukland  , Lund  , Wiig
Published: March 2003

To determine the distribution of interstitial fluid pressure (Pi) and volume (Vi), and to relate the distribution of these parameters to the distribution of potential meridians located by measurement of electrical impedance, we measured Pi, extracellular fluid (Ve) and plasma volumes (Vp) in 14 pre‐defined skin areas, 2 × 2 mm, and in concave and convex regions on the hind‐limb and groin of rats in control conditions. Pi was measured with sharpened glass capillaries connected to a servo‐controlled counter‐pressure system, while Ve and Vp were determined as the extravascular distribution spaces of 51Cr‐EDTA and 125I‐human serum albumin, respectively. Vi was calculated as Ve – Vp, and Vw as the difference between skin wet and dry weight. Grand mean Pi averaged –0·81 mmHg (SD 0·83, n=95). Pi in skin was significantly higher in lateral and medial parts of the medial aspect of hind‐limb compared to pressures in the intermediate area (P<0·05). Pressures in the concave groin and the convex knee area were more negative and positive, respectively, than in the flat intermediate central hind‐limb area. There was a significantly higher Vi (P<0·05) and Vw (P<0·05) in the lateral side than that in the medial side. Vp was higher medially and laterally than in the intermediate area (P<0·05 for both comparisons), and correlated positively and significantly with Pi (r=0·66, P<0·05). No correlation was found between Pi and electrical impedance. The study suggests that the distribution of Pi, Vi, Vp and Vw is heterogeneous in hind‐limb skin at a macroscopic level without obvious relations to potential meridians.
Regional cerebral blood flow during hyperventilation in patients with acute bacterial meningitis
Authors: Møller K. , Høgh P. , Larsen F. S. , Strauss G. I. , Skinhøj P. , Sperling B. K. , Knudsen G. M.
Published: March 2003

Mechanical hyperventilation is often instituted in patients with acute bacterial meningitis when increased intracranial pressure is suspected. However, the effect on regional cerebral blood flow (CBF) is unknown. In this study, we measured regional CBF (rCBF) in patients with acute bacterial meningitis before and during short‐term hyperventilation. In 17 patients with acute bacterial meningitis, absolute rCBF (in ml/100 g min−1) was measured during baseline ventilation and hyperventilation by single‐photon emission computed tomography (SPECT) using intravenous 133Xe bolus injection. Intravenous 99mTc‐HMPAO (hexamethylpropyleneamine oxime) was subsequently given during hyperventilation. In 12 healthy volunteers, rCBF was measured by SPECT and 99mTc‐HMPAO during spontaneous ventilation. Using standard templates to identify regions of interest (ROIs), we calculated rCBF in percentage of cerebellar (99mTc‐HMPAO images) or mean hemispheric (133Xe images) flow for each ROI, the degree of side‐to‐side asymmetry for each ROI, and the anterior‐to‐posterior flow ratio. On 133Xe images, absolute rCBF decreased significantly during hyperventilation compared to baseline ventilation in all regions, but the relative rCBF did not change significantly from baseline ventilation (n=14) to hyperventilation (n=12), indicating that the perfusion distribution was unchanged. On 99mTc‐HMPAO images (n=12), relative rCBF and the anterior‐to‐posterior flow ratio were significantly lower in patients than in controls in the frontal and parietal cortex as well as in the basal ganglia. Focal perfusion abnormalities were present in 10 of 12 patients. Regional cerebral blood flow abnormalities are frequent in patients with acute bacterial meningitis. Short‐term hyperventilation does not enhance these abnormalities.
The changes in leg blood flow during and after mild or severe acute hypoxaemia in healthy humans
Authors: Barthèlemy Pierre , Bregeon Fabienne , Zattara‐Hartmann Marie Caroline , Humbert‐Tena Christine , Jammes Yves
Published: March 2003

The present study examines the leg blood flow changes in resting healthy humans during and after a 10‐min period of mild (PaO2=5·60 kPa) or severe hypoxaemia (PaO2=4·53 kPa) induced by breathing hypoxic gas mixtures. A Colour Duplex Scan system allowed to measure the cross‐sectional area (CSA) and mean blood flow (Qdot;) in a femoral artery (FA) and a femoral vein (FV) and also in an artery supplying leg muscles (medial gastrocnemius artery, MGA). During the mild as well as the severe hypoxaemia and their recovery periods, no significant variations of Qdot; and CSA occurred in FA and FV. During the mild hypoxaemia and the first 10 min of the recovery period, Qdot; and CSA of MGA increased (maximal changes: +84 and +20%, respectively). By contrast, a marked Qdot; decrease and a reduced CSA were measured in MGA during the severe hypoxaemia (−67 and −60%, respectively). This reduced muscle blood flow was followed by a vasodilatation (CSA increase = +30%), which began 10 min after the hypoxaemia ended and persisted for a further 10‐min period. This study shows that the time course of muscle blood flow changes in response to acute hypoxaemia depends on the PaO2 level. Reverse effects were measured during the mild or the severe hypoxaemia, whereas a post‐hypoxaemic vasodilatation occurred in all circumstances.
Alveolar albumin leakage during large tidal volume ventilation and surfactant dysfunction
Authors: Liu Jin‐Ming , Evander Eva , Zhao Jiang , Wollmer Per , Jonson Björn
Published: March 2003

Detergent given as an aerosol and large tidal volume ventilation (LTVV) have been observed, by us, to promote lung injury by an additive effect on alveolocapillary barrier function. The surfactant system may be further damaged if protein leakage occurs into the alveoli. The aim was to study the effect of detergent and LTVV on the alveolar leakage of albumin and also the effect of detergent on surface activity of lung washings and lung tissue extracts. Technetium‐99m‐labelled human serum albumin was given intravenously. The alveolar leakage of albumin was measured after perturbing the surfactant system with the detergent dioctyl sodium sulfosuccinate either singly or in combination with LTVV. Four groups of rabbits were studied after 3 h of experimental ventilation. Surface tension measurements of tissue extracts, lung mechanics and gas exchange did not show any differences between groups. Wet lung weight and albumin leakage were significantly increased in the two groups subjected to LTVV compared with groups given normal tidal volume ventilation. Low doses of detergent did not affect surface activity of lung tissue extracts or alveolar leakage of albumin. LTVV increased alveolar leakage of albumin and produced oedema. No additive effect was seen when detergent and LTVV were combined.
Bone mineral density of visually handicapped women
Authors: Uusi‐Rasi Kirsti , Sievänen Harri , Rinne Marjo , Oja Pekka , Vuori Ilkka
Published: March 2003

While physical activity is an essential factor for muscle performance and development and also for the maintenance of bone mass in the loaded bones, apparently low intensity of physical activity of blind persons may compromise the muscle performance and bone mineral density (BMD). Therefore, the aim was to study whether there are differences in BMD of the weight‐bearing or non‐weight‐bearing bones between visually handicapped persons and those with normal sight. Nineteen visually handicapped premenopausal women and their matched pairs were recruited to the study. The mean age of the visually handicapped women was 39·9 years (SD 8·1) and that of the women with normal vision 39·7 years (6·5). BMD of the distal radius, femoral neck and trochanter was measured with dual energy X‐ray absorptiometry (DXA), and isometric muscle strength of the extremities and trunk with a dynamometer. Between‐group differences were compared with paired Student’s t‐test. The BMD at the femur was 8% higher in favour of the group with normal sight, whereas radial BMD was similar in the two groups. The t‐score was −1·0 (95% confidence interval −1·5 to −0·5) for the femoral neck BMD and −0·7 (−1·1 to −0·2) for the trochanter BMD in the group with impaired vision. The respective t‐scores for the group with normal sight were −0·3 (−0·9 to 0·3) for the femoral neck and 0 (−0·7 to 0·7) for the trochanter. Visual handicap seems to be a risk for lower BMD of the weight‐bearing proximal femur, but not for lower BMD of the non‐weight‐bearing distal radius.
Ventilation–perfusion inequality and carbon dioxide sensitivity in hypoxaemic chronic obstructive pulmonary disease (COPD) and effects of 6 months of long‐term oxygen treatment (LTOT)
Authors: Sandek K. , Bratel T. , Hellström G. , Lagerstrand L.
Published: March 2003

The aim of our study was to find out how blood gas disturbances in stable, eucapnic, severe chronic obstructive pulmonary disease (COPD) patients with an arterial oxygen tension (PaO2) value of 7·7 (6·1–8·4) kPa are affected by ventilation–perfusion (VA/Q) relationships and carbon dioxide (CO2) sensitivity and how these parameters are influenced by 6 months of long‐term oxygen treatment (LTOT). VA/Q ratios were measured using the multiple inert gas elimination technique (MIGET). Mouth occlusion pressure 0·1 s after onset of inspiration (Pi0·1) and minute ventilation (VE) were measured to assess respiratory drive response (ΔPi0·1/ΔPCO2) and hypercapnic ventilatory response (HCVR) to CO2 rebreathing. At the start of LTOT, a normal median respiratory drive response level of 1·2 (0·2–2·3) cm H2O/kPa and a low median HCVR as compared with healthy individuals (P<0·001) were found. However, 7·9 (0–29·8)% of the VE, was directed towards hypoperfused lung areas. The dispersion of ventilation (log SDV; 0·47–1·76), and the dispersion of perfusion (log SDQ; 0·66–1·07) were wider than normal. The PaO2 level correlated inversely with mean VA/Q ratio for ventilation (V mean) and shunt. The PaCO2 level correlated inversely with HCVR and vital capacity. After 6 months of LTOT, no significant changes in daytime blood gas levels, CO2‐sensitivity or VA/Q ratios were found. VE tended to be reduced by 1·0 l min–1. Conclusions: An elevated V mean and probably shunting are important contributing factors for the reduced PaO2 and hypercapnic ventilatory response is a major determinant of PaCO2 in eucapnic stable hypoxaemic COPD. Six months of LTOT does not affect blood gases, CO2 sensitivity or ventilation–perfusion relationships.
Can blood pressure responses to tests unmask future blood pressure trends and the need for antihypertensive medication? Ten years of follow‐up
Authors: Jokiniitty J. , Majahalme S. , Kähönen M. , Tuomisto M.T. , Turjanmaa V.
Published: March 2003

An exaggerated blood pressure (BP) response to test may unmask the subjects who have a high risk of developing hypertension. In this prospective 10 years of follow‐up, we examined whether the predictive value of casual BP measurements on future BP level and need for antihypertensive medication could be improved by using BP responses to different physical tests. At baseline, BP was recorded by casual measurements and intra‐arterial monitoring. During the intra‐arterial BP recording, standardized postural and exercise tests were performed on 97 healthy, untreated men (34 normotensive, 29 borderline hypertensive, and 34 mild hypertensive). After 10 years of follow‐up, 87 of them (90%) returned for casual and non‐invasive 24‐h BP measurements. At follow‐up, 20 (23%) of the men had antihypertensive medication. The prediction of casual systolic blood pressure (SBP) was best improved by SBP at 10 min after the dynamic exercise test (adj. R2=0·448; adj. R2=0·356 for casual SBP alone). The prediction of casual diastolic blood pressure (DBP) was most improved by DBP at 10 min after the dynamic exercise test (adj. R2=0·282; adj. R2=0·259 for casual BP alone). SBP in the supine test best improved the prediction of 24‐h SBP (adj. R2=0·448; adj. R2=0·275 for casual SBP alone). DBP in the standing test best improved the prediction of 24‐h DBP (adj. R2=0·252; adj. R2=0·214 for casual DBP alone). Pre‐exercise DBP and casual SBP were the best predictors of the need for antihypertensive medication (Cox–Snell R2=0·256; Cox–Snell R2=0·164 for casual SBP alone). In conclusion the prediction of future BP and need for antihypertensive medication can be improved by using BP measurements during postural and exercise tests. Future SBP is more predictable than DBP.
Evaluation of 40 × 22 mm coverslip area in cervical cancer screening
Authors: OOMMEN  , CURLING  , ADAMS  , BARRETT  , TITMUSS  , WIDDOWSON
Published: March 2003

oommen r., curling m., adams c., barrett e., titmuss e. and widdowson a. (1998) Cytopathology 9, 46–49

Evaluation of 40 ×3 20 mm coverslip area in cervical cancer screening

Nine hundred and twenty‐three smears covered by 40 × 22 mm size coverslips were examined inside and outside the coverslip area to determine whether this coverslip size could be responsible for missed dyskaryotic cells in conventional cervical cancer screening. There was no instance when abnormal cells seen outside the coverslip were not also present within the coverslipped area.
Guidelines for anal cytology—to make cytological diagnosis and follow up much more reliable
Authors: SCHOLEFIELD  , JOHNSON  , HITCHCOCK  , KOCJAN  , SMITH  , SMITH  , FERRYMAN  , BYASS
Published: March 2003

scholefield j. h., johnson j., hitchcock a., kocjan g., smith j. h. f., smith p. a., ferryman s. and byass p. (1998) Cytopathology9, 15–22

Guidelines for anal cytology—to make cytological diagnosis and follow up much more reliable
Heat shock protein (HSP)27: a further refinement in the diagnosis of suspicious fine needle aspirates of breast
Authors: KEELING J. , MCKEE G. T.
Published: March 2003

Heat shock protein (HSP)27: a further refinement in the diagnosis of suspicious fine needle aspirates of breast

The technique of fine needle aspiration (FNA) is increasingly used in the investigation of breast abnormalities both palpable and impalpable. However, up to 20% of aspirates fall into two categories which require further investigation, because they either show cytological atypia or exhibit features which are suspicious of malignancy (reporting categories C3 and C4). The usefulness of the 27‐kD heat shock protein (HSP27) expression in refining these categories of suspicion, and possibly in predicting malignancy, was investigated using an established immunocytochemical staining procedure. Positive HSP27 staining was shown by 73.1% of C4 and 33.3% of C3 FNAs. Statistical analysis showed a significant difference between the results obtained for the C3 and C4 FNAs.
Columnar and metaplastic cells in vault smears: cytologic and colposcopic study
Authors: Sodhani P. , Gupta S. , Prakash S. , Singh V.
Published: March 2003

Columnar and metaplastic cells in vault smears: cytologic and colposcopic study

Vault smears (n= 250) were examined as routine follow up of hysterectomized individuals. Although the majority of these smears were normal, 14 of them revealed the presence of columnar cells or metaplastic cells. None of these patients had any known cause which could account for the presence of these cells in a post‐hysterectomy smear. The possible explanations could be (i) the common mullerian origin of the upper vaginal mucosal cells, (ii) exfoliated reparative squamous parabasal and basal cells mimicking columnar cells, (iii) goblet cell metaplasia in atrophic vaginal epithelium.
Cytological and immunocytochemical evaluation of thyroid and breast masses in patients with a previous neoplasm: case reports
Authors: Pisani T. , Antonaci A. , Sinopoli N. T. , Mottolese† M. , Vecchione A. , Giovagnoli M. R.
Published: March 2003

Cytological and immunocytochemical evaluation of thyroid and breast masses in patients with a previous neoplasm: case reports

The diagnosis of secondary tumours represents one of the most important fields in the application of fine needle aspiration cytology (FNAC). We studied two patients, one with a history of breast cancer and one with a previous tumour of the thyroid, who showed a second mass, in the thyroid and in the breast, respectively, during follow up. The aim of our study was to evaluate if cytology, performed on FNAC smears, may distinguish a metastatic lesion from a second primary tumour, or if further immunocytochemistry should be performed. Our data demonstrate that, while cytology may be indicative of a second primary tumour, the histotype should be confirmed by immunocytochemical staining.
Fine needle aspiration (FNA) cytology of mammary fibromatosis: a case report and review of literature
Authors: Chhieng D. C. , Cohen J.‐M.
Published: March 2003

Introduction
Fine needle aspiration (FNA) cytology of pilomatrixoma: report of 14 cases and review of the literature
Authors: Viero R. M. , Tani E. , Skoog L.
Published: March 2003

Fine needle aspiration (FNA) cytology of pilomatrixoma: report of 14 cases and review of the literature

We describe 14 cases of pilomatrixoma which were diagnosed preoperatively on FNA cytology. In contrast to the literature, our series showed male preponderance and some of the tumours in unusual locations such as thigh and breast. In three patients the tumours were larger than 5 cm. The clinical diagnosis varied from tumour not otherwise defined to sarcoma. The cytologic presentation had features which allowed a correct diagnosis in all cases and included basaloid cells surrounded by delicate pink fibres, shadow cells, giant cells, naked nuclei and calcium deposits. It is concluded that the FNA cytology of pilomatrixoma is characteristic and will allow a conclusive diagnosis even in cases with an aberrant clinical presentation.
Inflammatory pseudotumour of the subcutis: a report on the fine needle aspiration findings in a case misdiagnosed cytologically as malignant
Authors: MacSweeney F. , Desai S. A.
Published: March 2003

Introduction
The interaction of Trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: light microscopic observation
Authors: Demirezen S. , Safi Z. , Beksaç S.
Published: March 2003

The interaction of Trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: light microscopic observation

In this study, vaginal smears taken from 400 patients were examined cytologically using the Papanicolaou technique. Twenty of the 400 patients were detected as harbouring Trichomonas vaginalis.

The interactions of T. vaginalis with epithelial cells, polymorphonuclear leucocytes (PMNLs) and erythrocytes were determined at light microscopic level. It was observed that T. vaginalis were juxtaposed to the epithelial cells and changed shape according to the contours of the epithelial cell revealing the cytopathic effect of trichomonads on epithelial cells.

Trichomonads attached to PMNLs produced pseudopodia to phagocytose the cells. Occasionally an amoeboid shaped T. vaginalis organism was seen trailed by a row of PMNLs. This light microscopic study supports the production by trichomonads of a chemotactic factor for PMNLs.

Phagocytosed erythrocytes were also seen in the cytoplasm of T. vaginalis, suggesting the need for the patient to be tested for anaemia.
Continuing education for cytotechnologists: the Australian experience
Authors: Stevens M. W. , Whitaker D.
Published: March 2003

Continuing education for cytotechnologists: the Australian experience

The development of a continuing education scheme for cytotechonologists in Australia is described. The process involved the establishment of a working party with Terms of Reference to review current practice in Australia and existing schemes in other parts of the world. The scheme developed takes the form of a continuing education diary that provides guidelines on the various forms of continuing education activity and corresponding credit points. The diary also provides for a record of activity to be kept. The scheme requires bi‐annual submission of personal activity which is logged into a national database. A peer profile is provided and successful achievement is marked by the issue of a certificate of participation. The programme has achieved a 57% compliance in its first year of operation.
Evaluation of thin‐layer methods in urine cytology
Authors: Wright R. G. , Halford J. A.
Published: March 2003

Evaluation of thin‐layer methods in urine cytology

Conventional cytospin smears prepared from urinary tract specimens were compared with two new thin layer techniques, i.e. ThinPrep® and AutoCyte PREP™. Cellularity, cell preservation, background features, detection rate, screening time and ease of preparation were evaluated. Thin‐layer techniques when applied to urine cytology were found to improve cell yield and cell preservation, and reduce background artefact. The reporting rate for abnormal urothelial cells was comparable to conventional cytospin smears, as was screening time. Laboratory staff found the methodologies to be practicable and easily incorporated into a large routine diagnostic service. We conclude that a one‐slide thin‐layer urine preparation is comparable to four cytospin slides in the detection of urothelial abnormalities, and that both ThinPrep® and AutoCyte PREP™ have comparable features.
Costs and benefits of cervical screening IV: valuation by women of the cervical screening programme
Authors: WORDSWORTH SARAH , RYAN MANDY , WAUGH NORMAN
Published: March 2003

Costs and benefits of cervical screening IV: valuation by women of the cervical screening programme

Objectives: To assess the value of the cervical smear test to women, taking account of the positive and negative aspects of the cervical screening service.

Design: A postal survey.

Setting: Tayside Health Board region of Scotland.

Participants: A sample of 2000 women aged 20–59.

Main outcome measures: Maximum willingness to pay (WTP) for a cervical smear test.

Results: Women were prepared to pay £50.20 per smear on a 3‐yearly basis. Willingness to pay was positively related to income, but unrelated to age and whether or not the respondent had previously had a smear.

Conclusions: Previous studies have estimated the cost per screen or cost per life year saved by cervical screening. This study used the economic instrument of WTP to take account of other potential (dis)benefits to women. The value women place on having a smear was more than the cost to the National Health Service (NHS) of providing the service. The output of a WTP study is potentially useful at the policy level. Future work should explore both the value of alternative approaches to cervical screening, and the value of competing health care interventions.