bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel micronutrient supplement in skin aging: a randomized placebo‐controlled double‐blind study
Authors: Béguin Alain
Published: December 2005

Background  Skin aging, a combination of intrinsic and environmentally induced processes, predominantly ultraviolet (UV) light from the sun, results in characteristic tissue alterations, such as the degradation of collagen and the formation of visible fine lines and wrinkles.

Objective  To test the efficacy and safety of a novel micronutrient supplement (Estime®) in skin aging.

Methods  A 4‐month randomized double‐blind controlled study including 40 subjects where the supplement was tested against placebo for 3 months followed by a 1‐month supplement‐free period for both groups to assess lasting effects. Efficacy measurements included skin surface evaluation, ultrasound measurement of sun‐exposed and protected areas of the skin (back of the hand and ventral forearms, respectively), and photographic assessment.

Results  All investigated parameters showed a continuous and significant improvement in the active group during the 3 months of supplementation as compared to placebo. Photographs showed visible improvement of the overall skin appearance and reduction of fine lines. Ultrasound measurements showed an increase in dermis density of up to 78% in the active group (P < 0.0001). The final assessment after 1 month without supplementation showed no further improvements, but a slight decrease was observed in most improved parameters. No treatment‐related side effects were reported.

Conclusion  The study demonstrated that the supplement appears to be effective and safe as an oral supplement to protect the skin and support its repair process. Recommendations are made for further evaluations.
Phosphatidylcholine treatment to induce lipolysis
Authors: Hasengschwandtner Franz
Published: December 2005

The medicine Lipostabil N® has been in widespread use in Europe since 2002 by doctors working in the field of esthetics to achieve a reduction in the volume of smaller fat deposits by means of injections into the subcutaneous fatty tissue.

The lipases released from the adipocytes by means of phosphatidylcholine produce a local breakdown of fat that is then discharged over the liver and metabolized via beta‐oxidation. The medicine has been authorized for intravenous use in the prophylaxis and therapy of fat embolisms and liver diseases.
Validity of HoNOS in identifying frequently hospitalized patients with ICD‐10 mental disorders
Authors: Bech P. , Bille J. , Waarst S. , Wiese M. , Borberg L. , Treufeldt P. , Kessing L.
Published: December 2005

Objective:  To identify frequently hospitalized patients by using the outcome and severity measure Health of the Nation Outcome Scales (HoNOS) in combination with the International Classification of Diseases (ICD)‐10 in patients consecutively admitted to a psychiatric hospital.

Method:  All full‐time in‐patients and all day‐hospital patients were considered. Frequently hospitalized patients were defined as those with 10 or more hospitalizations.

Results:  The total HoNOS score at admission was found valid to discriminate between frequently and non‐frequently hospitalized patients as well as in ranking the ICD‐10 diagnosis by severity of symptoms and social problems. Frequently hospitalized patients were predominantly found within the diagnoses of schizophrenia and bipolar affective disorders. In these groups, high HoNOS scores were significantly associated with a longer stay in hospital. Improvement during hospitalization as measured by the HoNOS was significantly better for bipolar than for schizophrenic patients.

Conclusion:  HoNOS was found to be a clinically relevant supplement to ICD‐10 in identifying frequently hospitalized patients.
Public beliefs about and attitudes towards people with mental illness: a review of population studies
Authors: Angermeyer M. C. , Dietrich S.
Published: December 2005

Objective:  To provide a review of population‐based attitude research in psychiatry during the past 15 years.

Method:  An electronic search using PubMed, Medline, and Academic Search Premier plus a hand search of the literature was carried out for studies on public beliefs about mental illness and attitudes towards the mentally ill published between 1990 and 2004.

Results:  Thirty‐three national studies and 29 local and regional studies were identified, mostly from Europe. Although the majority are of descriptive nature, more recent publications include studies testing theory‐based models of the stigmatization of mentally ill people, analyses of time trends and cross‐cultural comparisons, and evaluations of antistigma interventions.

Conclusion:  Attitude research in psychiatry made considerable progress over the past 15 years. However, there is still much to be done to provide an empirical basis for evidence‐based interventions to reduce misconceptions about mental illness and improve attitudes towards persons with mental illness.
Lower TSH and higher T4 levels are associated with current depressive syndrome in young adults
Authors: Forman‐Hoffman V. , Philibert R. A.
Published: December 2005

Objective:  The relationship of individual thyroid function indices to depression in those without a history of prior thyroid dysfunction is uncertain.

Method:  We examined the relationship between thyroid‐stimulating hormone (TSH) and thyroxine (T4) levels and current or lifetime history of depressive symptoms using information from 6869 participants, aged 17–39 years, in the Third National Health and Nutrition Examination Survey without history of thyroid‐related illness.

Results:  We found that lower TSH and higher T4 levels were associated with current depressive syndrome in men, but only higher T4 levels correlated with current depressive syndrome in women. Lifetime depressive syndrome was associated with neither TSH level nor T4 levels in men or women.

Conclusion:  These findings suggest that transient or ‘state dependent’ changes are associated with depression in those without a history of thyroid illness. Further studies to discern whether these depression‐associated changes represent distinct endophenotypes of depression should be encouraged.
Slow growth of a translocated beaver population partly due to a climatic shift in food quality
Authors: Nolet Bart A. , Broftová Lucie , Heitkönig Ignas M. A. , Vorel Aleš , Kostkan Vlastimil
Published: December 2005

In temperate regions climate change has led to advances in plant phenology which may disrupt the synchrony between food availability and reproductive requirements of higher trophic levels. Because leaf quality generally drops with leaf maturation, for herbivorous animals a stoichiometric effect of climate change may be of greater importance than a shift in food quantity. We hypothesized that such a climate‐related stoichiometric effect caused the low reproductive success of a beaver Castor fiber population that was translocated westward in Europe at the time of a rapid increase in spring temperatures. The staple food of these beavers was willow Salix spp. In 2003 willow bud burst occurred approximately one month earlier at the release site than at the site of origin. After bud burst, leaf quality, measured as nitrogen and phosphorus concentration, decreased in the course of spring in a predictable manner with accumulated degree‐days. Nitrogen and phosphorus concentrations calculated from accumulated degree‐days were, at a given date, around 20% lower at the release site during the 15 years after the translocation than at the site of origin during the 15 years prior to the translocation. Previous work had identified phosphorus as a likely limiting resource for beaver reproduction, and in most post‐translocation years phosphorus concentrations at the release site were below the required level towards the end of gestation. In addition to an increase over time, annual reproductive rate of the translocated beavers was highest in cold springs. We conclude that it was initially low due to a combination of low food quality and factors not related to climate.
Endogenous melatonin protects L‐DOPA from autoxidation in the striatal extracellular compartment of the freely moving rat: potential implication for long‐term L‐DOPA therapy in Parkinson's disease
Authors: Rocchitta Gaia , Migheli Rossana , Esposito Giovanni , Marchetti Bianca , Desole Maria S. , Miele Egidio , Serra Pier Andrea
Published: December 2005

Abstract:  We previously showed, using microdialysis, that autoxidation of exogenous L‐dihydroxyphenylalanine (l‐DOPA) occurs in vivo in the extracellular compartment of the freely moving rat, with a consequent formation of l‐DOPA semiquinone (l‐DOPA‐SQ). In the present study, intrastriatal infusion of l‐DOPA (1.0 μm for 200 min) increased dialysate l‐DOPA concentrations (maximum increases up to 116‐fold baseline values); moreover, l‐DOPA‐SQ was detected in dialysates. Individual dialysate concentrations of l‐DOPA were negatively correlated with those of l‐DOPA‐SQ. Co‐infusion of N‐acetylcysteine (100 μm) or melatonin (50 μm) increased l‐DOPA (up to 151‐ and 246‐fold, respectively) and decreased l‐DOPA‐SQ (by about 53% and 87%, respectively) dialysate concentrations. Systemic l‐DOPA [25 mg/kg intraperitoneally (i.p.) twice in a 12‐h interval] significantly increased striatal baseline dialysate concentrations of l‐DOPA and decreased dopamine (DA) and ascorbic acid (AsAc) concentrations, when compared with controls. Following systemic l‐DOPA, l‐DOPA‐SQ was detected in dialysates. Endogenous melatonin was depleted in rats maintained on a 24‐h light cycle for 1 wk. In melatonin‐depleted rats, systemic l‐DOPA induced a smaller increase in dialysate l‐DOPA, a greater increase in l‐DOPA‐SQ formation, and a greater reduction in DA and AsAc dialysate concentrations. Co‐administration of melatonin (5.0 mg/kg, i.p., twice in a 12‐h interval) with l‐DOPA, in control as well as in light‐exposed rats, significantly increased dialysate l‐DOPA concentrations, greatly inhibited l‐DOPA‐SQ formation, and restored up to the control values dialysate DA and AsAc concentrations. These findings demonstrate that endogenous melatonin protects exogenous l‐DOPA from autoxidation in the extracellular compartment of the striatum of freely moving rats; moreover, systemic co‐administration of melatonin with l‐DOPA markedly increases striatal l‐DOPA bioavailability in control as well as in melatonin‐depleted rats. These results may be of relevance to the long‐term l‐DOPA therapy of Parkinson's disease.
>VIMOS-VLT and Spitzer observations of a radio galaxy at z = 2.5
Authors: Villar-Martín M. , Sánchez S. F. , De Breuck C. , Peletier R. , Vernet J. , Rettura A. , Seymour N. , Humphrey A. , Stern D. , Di Serego Alighieri S. , Fosbury R.
Published: December 2005

We present: (i) a kinematic and morphological study of the giant Lyα nebula associated with the radio galaxy MRC 2104−242 (z= 2.49) based on integral field spectroscopic Visible Multiobject Spectrograph (VIMOS) data from the Very Large Telescope (VLT), and (ii) a photometric study of the host (proto?) galaxy based on Spitzer Space Telescope data. The galaxy appears to be embedded in a giant (≳120 kpc) gas reservoir that surrounds it completely. The kinematic properties of the nebula suggest that it is a rotating structure, which would imply a lower limit to the dynamical mass of ∼3 × 1011 M⊙. An alternate scenario is that the gas is infalling. Such a process would be able to initiate and sustain significant central starburst activity, although it is likely to contribute with less than 10 per cent of the total stellar mass.

The near- to mid-infrared spectral energy distribution of the radio galaxy suggests the existence of a reddened, E(B−V) = 0.4 ± 0.1, evolved stellar population of age ≳1.8 Gyr and mass (5 ± 2) × 1011 M⊙. The implied formation redshift is zf≳ 6. This stellar mass is similar to the stellar masses found for massive early-type galaxies at z∼ 2 in deep, near-infrared surveys.
Aquifer Sensitivity to Pesticide Leaching: Testing a Soils and Hydrogeologic Index Method
Authors: Mehnert Edward , Keefer Donald A. , Dey William S. , Wehrmann H. Allen , Wilson Steven D. , Ray Chittaranjan
Published: December 2005

For years, researchers have sought index and other methods to predict aquifer sensitivity and vulnerability to nonpoint pesticide contamination. In 1995, an index method and map were developed to define aquifer sensitivity to pesticide leaching based on a combination of soil and hydrogeologic factors. The soil factor incorporated three soil properties: hydraulic conductivity, amount of organic matter within individual soil layers, and drainage class. These properties were obtained from a digital soil association map. The hydrogeologic factor was depth to uppermost aquifer material. To test this index method, a shallow ground water monitoring well network was designed, installed, and sampled in Illinois. The monitoring wells had a median depth of 7.6 m and were located adjacent to corn and soybean fields where the only known sources of pesticides were those used in normal agricultural production. From September 1998 through February 2001, 159 monitoring wells were sampled for 14 pesticides but no pesticide metabolites. Samples were collected and analyzed to assess the distribution of pesticide occurrence across three units of aquifer sensitivity. Pesticides were detected in 18% of all samples and nearly uniformly from samples from the three units of aquifer sensitivity. The new index method did not predict pesticide occurrence because occurrence was not dependent on the combined soil and hydrogeologic factors. However, pesticide occurrence was dependent on the tested hydrogeologic factor and was three times higher in areas where the depth to the uppermost aquifer was <6 m than in areas where the depth to the uppermost aquifer was 6 to <15 m.
A GIS‐Based Ground Water Contamination Risk Assessment Tool for Pesticides
Authors: Sinkevich Michael G. , Walter M. Todd , Lembo Arthur J. , Richards Brian K. , Peranginangin Natalia , Aburime Sunnie A. , Steenhuis Tammo S.
Published: December 2005

A process‐based preferential flow transport model was implemented in a geographic information system to locate areas in the landscape with high risk of contamination by agrochemicals, especially pesticides. Protecting ground water resources necessitates a reliable ground water quality monitoring strategy. It is valuable to be able to focus monitoring on areas with the highest risk of contamination because monitoring ground water is an expensive activity, especially at the landscape scale. The objective of this project was to develop a tool that quantifiably estimates distributed ground water contamination risk in order to develop reliable, cost‐effective ground water observation networks. The tool is based on a mechanistic model of chemical movement via preferential flow and uses land cover data, information about chemical properties, and modeled recharge to estimate the concentration of chemical reaching the ground water at each point in the landscape. The distributed risk assessment tool was tested by comparing the model‐predicted risk with observed concentrations from 40 sampling wells in Cortland County, New York, for atrazine (pesticide) and nitrate, the latter assumed to be an indicator of agricultural pollution. The tool predictions agreed well with observed nitrate concentrations and pesticide detections. An Internet‐based version of this tool is currently being developed for ready application to New York State.
Stable Isotope Analysis of MTBE to Evaluate the Source of TBA in Ground Water
Authors: Wilson John T. , Kolhatkar Ravi , Kuder Tomasz , Philp Paul , Daugherty Seth J.
Published: December 2005

Although tert‐butyl alcohol (TBA) has not been used as a fuel oxygenate in Orange County, California, the concentrations of TBA in ground water at gasoline spill sites are high compared those of the conventional fuel oxygenate methyl tert‐butyl ether (MTBE). In the year 2002, the geometric mean concentration of TBA was 839 μg/L compared to 627 μg/L for MTBE. There are two plausible sources of TBA, the TBA originally present in the gasoline and biodegradation of MTBE to TBA. Thirteen sites where the concentration of TBA was >10 mg/L were selected for study. Biodegradation was evaluated by determining the stable carbon isotope ratio (δ13C) of MTBE in the ground water. If MTBE was biodegraded, the residual MTBE should be enriched in the heavier carbon isotope 13C. The historical highest concentration of MTBE in each monitoring well and the δ13C of MTBE in the ground water were used to estimate the concentration of TBA produced from biodegradation of MTBE. Then, the estimated concentration of TBA was compared to the measured concentration. At each site, comparisons were made for the well in the source area, and the well in the plume outside the source area, that had the highest concentration of TBA. In the wells in the source areas, the estimate of TBA production accounted for the majority of TBA at 4 of the 13 sites. In the wells in the plume outside of the source area, the estimate accounted for the majority of TBA at six sites.
Constructions of self: ethical overtones in surprising locations
Authors: Kinsella E A
Published: December 2005

Little discussion has occurred in the health profession literature with respect to how the “self” is constructed, despite the imagination and attention it has garnered from philosophers and theorists in various other disciplines. Yet this subject has surprisingly ethical overtones for health professional education and practice. In this paper notions of the self are briefly considered and it is suggested that a narrativeanddialogic view of self can contribute to insights about ethical practice in the health professions. Subtle issues with respect to how relationship and language may be used to wield power are revealed and discussed; and awareness about how such power is used in practice is highlighted as a crucial issue. The assumptions practitioners make with respect to constructions of self are ethically important and this topic warrants consideration in the medical humanities.
Becoming a nurse: “it’s just who I am”
Authors: Flaming D
Published: December 2005

In any research study, researchers situate themselves, either explicitly or implicitly, within a variety of frameworks when studying phenomena. From a research perspective, the study will be more robust if these frameworks and the accompanying assumptions are compatible with each other; otherwise, the project may lack coherence. Ricoeur offers a methodological perspective—that is, an interpretive theory as reflected inmimesis, which is congruent with his ontological theory of self identity (ipse- andidem-identity). To illustrate Ricoeur’s frameworks when researching the self identities, I use examples from a research study in which I asked senior nursing students to explore their experience of becoming a nurse. I do not intend for this article to be a comprehensive research report, but I present it as an exemplar of how Ricoeur’s ideas can guide other researchers studying self identity. I labelled my study a narrative research project and assumed that becoming a nurse means developing a self identity as a nurse. While self identity is often framed in psychological terms, Ricoeur uses a philosophical perspective when exploring this concept. I conclude the paper by suggesting (a) that Ricoeur can guide any project in which researchers ask participants to describe “becoming” a person with illness, sickness or disease, and (b) that educators of healthcare professional students can improve the educative experience by purposefully considering how a student’s ontological self affects that student’s practice.
Effects of chronic portal hypertension on agonist-induced actin polymerization in small mesenteric arteries
Authors: Chen Xuesong , Pavlish Kristin , Zhang Hai-Ying , Benoit Joseph N.
Published: December 2005

The ability of arterial smooth muscle to respond to vasoconstrictor stimuli is reduced in chronic portal hypertension (PHT). Additional evidence supports the existence of a postreceptor defect in vascular smooth muscle excitation contraction coupling. However, the nature of this defect is unclear. Recent studies have shown that vasoconstrictor stimuli induce actin polymerization in smooth muscle and that the associated increase in F-actin is necessary for force development. In the present study we have tested the hypothesis that impaired actin polymerization contributes to reduced vasoconstrictor function in small mesenteric arteries derived from rats with chronic prehepatic PHT. In vitro studies were conducted on small mesenteric artery vessel rings isolated from normal and PHT rats. Isometric tension responses to incremental concentrations of phenylephrine were significantly reduced in PHT arteries. The ability to polymerize actin in portal hypertensive mesenteric arteries stimulated by phenylephrine was attenuated compared with control. Inhibition of cAMP-dependent protein kinase (PKA) restored agonist-induced actin polymerization of arteries from PHT rats to normal levels. Depolymerization of actin in arteries from normal rats reduced maximal contractile force but not myosin phosphorylation, suggesting a key role for the dynamic regulation of actin polymerization in the maintenance of vascular smooth muscle contraction. We conclude that reductions in agonist-induced maximal force development of PHT vascular smooth muscle is due, in part, to impaired actin polymerization, and prolonged PKA activation may underlie these changes.
Ambiguous Genitalia and Intersex
Authors: Frimberger Dominic , Gearhart John P.
Published: December 2005

Intersex disorders are rare congenital malformations with over 80% being diagnosed with congenital adrenal hyperplasia (CAH). It can be challenging to determine the correct gender at birth and a detailed understanding of the embryology and anatomy is crucial. The birth of a child with intersex is a true emergency situation and an immediate transfer to a medical center familiar with the diagnosis and management of intersex conditions should occur. In children with palpable gonads the presence of a Y chromosome is almost certain, since ovotestes or ovaries usually do not descend. Almost all those patients with male pseudohermaphroditism lack Mullerian structures due to MIS production from the Sertoli cells, but the insufficient testosterone stimulation leads to an inadequate male phenotype. The clinical manifestation of all CAH forms is characterized by the virilization of the outer genitalia. Surgical correction techniques have been developed and can provide satisfactory cosmetic and functional results. The discussion of the management of patients with intersex disorders continues. Current data challenge the past practice of sex reassignment. Further data are necessary to formulate guidelines and recommendations fitting for the individual situation of each patient. Until then the parents have to be supplied with the current data and outcome studies to make the correct choice for their child.
Maintenance of Pneumoperitoneum in Retroperitoneoscopy: Point of Technique
Authors: Goel Rajiv , Modi Pranjal , Dodia Sharad
Published: December 2005

Background: Retroperitoneoscopic surgery has become an established armamentarium in the hands of urologist. We present a simple and cost-effective technique that aids in the maintenance of pneumoretroperitoneum. Methods: Between June 2003 and December 2004, 150 retroperitoneal nephrectomies were performed with maintenance of the pneumoretroperitoneum using our technique. Results: The retroperitoneal space was maintained in all patients with minimal or no leakage of carbon dioxide from the port site. Conclusion: Our simple, cost-effective technique is highly reliable for the maintenance of pneumoretroperitoneum.
A Magnificent Circumcision Carnival in the Early 18th Century Ottoman Period
Authors: Verit Ayhan , Cengiz Mustafa , Yeni Ercan , Unal Dogan
Published: December 2005

Circumcision has always been regarded as both an important social event and a milestone of a young man’s life in Turkish culture, especially in the Ottoman period. Herein we study an exceptional circumcision festivity which lasted 15 days in the early autumn of the year 1720, for the 4 princes of Sultan III Ahmed, some sons of two high-ranking Ottoman officials and thousands of male children of poor citizens of Istanbul as representing the beneficent of the Sultan. All the organizations of the Empire participated in this huge event, including many shows and a feast, and the preparations were initiated months before. Traditionally, this kind of important social event of Ottoman culture had been described in a literary manner, and Surname-i Vehbi was the special name for the book of this circumcision festivity with 137 colored paintings and a total of 175 pages. The original of this work, which is in the library of Topkapi Palace Museum in Istanbul, was written by Vehbi and illustrated by Levni. The importance of this antique book is that it is the last important example of the illustrated festivity books of Ottoman literature.
Management of Pelvic Stones Larger than 20 mm: Laparoscopic Transperitoneal Pyelolithotomy or Percutaneous Nephrolithotomy?
Authors: Meria Paul , Milcent Stéphane , Desgrandchamps François , Mongiat-Artus Pierre , Duclos Jean Marc , Teillac Pierre
Published: December 2005

Large pelvic stones are frequently managed with percutaneous nephrolithotomy (PCNL) but laparoscopic transperitoneal pyelolithotomy (LTP) can be an alternative. We compared PCNL and LTP for the treatment of pelvic stones >20 mm in diameter. Patients and Methods: Between November 1999 and November 2004, 16 consecutive patients, mean age 42, with a single pelvic stone >20 × 10 mm (group I), underwent LTP as first-line treatment or after shockwave lithotripsy failure. They were compared with a similar population of 16 consecutive patients, mean age 45 (group II), who underwent PCNL for the same indication and were assessed retrospectively. We evaluated operative characteristics, complications, and results for each technique. Results: There was no difference between the two groups regarding the characteristics of patients and stones. Operative time duration was significantly longer in group I (129 vs. 75 min; p = 0.001) and conversion was required in 2 patients (12%). The main postoperative complications were urinary leakage (2 patients, 12%) in group I and bleeding (3 patients, 18%) in group II, but only 1 required blood transfusion. Mean hospital stay was respectively 6.5 and 5.6 days in groups I and II (p = 0.17). Stone-free rates were assessed at 3 months and were not different between group I and group II (88 vs. 82%). Conclusions: The operative time of LTP is longer and the results of both techniques are comparable but postoperative morbidity is different. Specific indications of each technique must be determined although PCNL remains the gold standard for most large pelvic stones.
Ureteroscopic Laser Endopyelotomy in Secondary UPJ Obstruction after Pyeloplasty Failure
Authors: Di Grazia Eugenio , Nicolosi Dario
Published: December 2005

Objectives: Secondary ureteropelvic junction (UPJ) obstruction after failure of open and laparoscopic repair may be challenging to resolve due to possible extensive fibrosis and the increased invasiveness of this procedure. Alternatively, ureteroscopic laser endopyelotomy may be a more acceptable procedure for patients and surgeons. We report our preliminary experience with ureteroscopic holmium laser endopyelotomy after open pyeloplasty failure and define the complications that arose and the results. Materials and Methods: We performed 6 retrograde endopyelotomies with a holmium laser for failed UPJ repairs following the Anderson-Hynes procedures. Patient follow-up was carried out every 3 months using sonography and renal scan, and again after 1 year using renal scan and urography. Results: Mean hospitalization was 2.1 days. Ureteroscopic laser endopyelotomy was successful in 4 cases (66.6%). In 2 patients, failure occurred at the third month of follow-up. Complications included 1 case of slight bleeding, which was resolved conservatively without the need for blood transfusion, and 2 cases of guidewire rupture. Conclusions: Secondary UPJ obstruction is more challenging to resolve by open or laparoscopic approach. Retrograde endopyelotomy gives a valid alternative thanks to its success rate and its better acceptance by patients. We consider retrograde laser endopyelotomy the approach to choose when faced with secondary UPJ obstruction after open or laparoscopic failures.
Laparoscopic Management of the Adult Nonpalpable Testicle
Authors: Corvin Stefan , Sturm Wolfgang , Anastasiadis Aristotelis , Kuczyk Markus , Stenzl Arnulf
Published: December 2005

Objectives: This report describes own experiences with laparoscopic management of adult men with cryptorchidism. Patients and Methods: 8 men with nonpalpable testes were referred to our department. Laparoscopy was used to assess the presence and location of the gonad and perform an orchiectomy or orchidopexy, respectively. Results: A uni-/bilateral atrophic testicle was palpable in 2 patients under general anesthesia and removed after inguinal exploration. In 4 individuals the testicular vessels and vas deferens were found laparoscopically entering the internal inguinal ring. Two vanishing testicles and 2 atrophic gonads were removed during subsequent inguinal exploration. In 1 patient with a solitary testis, a morphologically intact abdominal testicle was presented. In this patient, endocrine function was lost completely after stage 1 of a Fowler-Stephens orchidopexy. In 1 patient an atrophic abdominal testicle was removed laparoscopically. Conclusions: These results demonstrate the suitability of laparoscopy for the treatment of cryptorchidism in the adult population. In most cases, atrophic inguinal gonads or vanishing testicles are found and should be removed. Our results suggest that in cases of intact abdominal testicles, Fowler-Stephens orchidopexy with transection of the spermatic vessels should be avoided to preserve endocrine function of the gonad.
Lumbar Plexus Blockade with Ropivacaine for Postoperative Pain Management in Elderly Patients Undergoing Urologic Surgeries
Authors: Akin Sule , Aribogan Anis , Turunc Tahsin , Aridogan Atilla
Published: December 2005

Background/Aims: We evaluated the effectiveness and safety of lumbar plexus blockade with ropivacaine for postoperative pain relief in elderly patients undergoing flank incision for urological surgery. Methods: 60 urological patients (>65 years old) were chosen randomly for paravertebral lumbar blockade. Postoperatively ropivacaine was used in group I (n = 30) and bupivacaine was administered in group II (n = 30) for lumbar plexus blockade. Heart rates, systolic and diastolic blood pressures, peripheral oxygen saturations, analgesia levels with visual analogue scales (VAS) were measured postoperatively at 5 and 30 min and 1, 3, 6, 8,and 12 h. Patient satisfaction scores and complications were recorded. Results: The hemodynamic parameters of the groups were in the normal ranges (p > 0.05). VAS were significantly decreased at 60 min in both groups (p < 0.05) and no important increase was observed during the first 8 h (p > 0.05). After the 8-hour measurement, analgesic was given to 7 patients in group I and 6 patients in group II (p < 0.05). There were no complications (p > 0.05). Patient satisfaction scores were found to be higher for all patients (p > 0.05). Conclusion: In elderly patients, lumbar plexus blockade with ropivacaine can be a simple, safe and effective analgesic technique especially in the early postoperative period after urologic surgeries with flank incision.
An Appendicular Mass Mimicking a Bladder Tumour
Authors: Johal N.S. , Kouriefs C. , Apthorp L. , Plail R.O.
Published: December 2005

We present a case of an appendicular mass mimicking symptoms of a bladder tumour in a 27-year-old female. The patient initially presented with a 5-month history of intermittent lower abdominal pain associated with dysuria, anorexia and weight loss. Cystoscopy revealed an erythematous urothelium with the appearance of a solid mass bulging into the bladder posteriorly. Urothelial biopsies were negative and computerised tomography showed a soft tissue mass extending from the right superior aspect of the bladder and abutting the distal ileum. At laparoscopy an appendiceal mass adherent to the bladder was found. The symptoms later resolved and she is well at follow-up.
Evidence of a Genetic Basis of Morgagni-Stewart-Morel Syndrome
Authors: Koller Michael F. , Papassotiropoulos Andreas , Henke Katharina , Behrends Britta , Noda Shigeru , Kratzer Adelgunde , Hock Christoph , Hofmann Marc
Published: December 2005

We report two 71-year-old female monozygotic twins presenting with advanced hyperostosis frontalis interna, obesity, shortness and cognitive impairment. They both have suffered from generalized seizures since their early adulthood. Moreover, the patients showed some additional conditions only occurring in one individual or the other such as migraine, marked recurrent depressive disorder or polyarthrosis. The symptoms common to both twins appear to correspond to the Morgagni-Stewart-Morel syndrome and indicate a genetic basis of this disorder as these features occur in genetically identical patients.
Vascular Diagnosis and Acute Stroke: What, When and Why Not?
Authors: Szabo Kristina , Lanczik Oliver , Hennerici Michael G.
Published: December 2005

Even within the 3-hour time window, the less the delay to thrombolysis, the more likely it is to be effective. Delays caused by unnecessary examinations based on physicians’ uncertainty about the relevance of vascular diagnostics must be overcome if acute therapy is to be administered efficiently. Only defined information concerning inclusion and exclusion criteria, a CT or preferably an MRI of the brain and limited additional data should be achieved prior to treatment and as quickly as possible, preferably within 1 h. All other information is to be gathered after the start of treatment, to assess the possible etiology of stroke, to classify the prognosis, and to recognize the possible need for early intervention such as in carotid stenosis. A primary diagnostic approach with MRI-guided treatment decision should be limited to cases with uncertain or 3- to 9-hour time window to improve selection of patients potentially at benefit from specific treatment and stroke unit/ICU care.
Platelets, Inflammation, and Atherothrombotic Neurovascular Disease: The Role of Endothelial Dysfunction
Authors: Blanco Miguel , Rodríguez-Yáñez Manuel , Sobrino Tomás , Leira Rogelio , Castillo José
Published: December 2005

The vascular endothelium is an indispensable organ in the regulation of tonicity and vascular homeostasis. Endothelial dysfunction is a marker of atherosclerosis and contributes to the atherogenic process and the development of atherothrombotic complications. Endothelial dysfunction is the common meeting point among factors for vascular risk and launches complex cellular and biochemical interactions that are characterized by oxidative stress and an intense inflammatory response. The strategic importance of the concept of endothelial dysfunction arises from the following facts: its diagnosis is simple, it allows the identification of asymptomatic arteriosclerotic subjects with a high risk of developing atherothrombotic complications, it is reversible, and it responds to various therapeutic strategies.
Blood Pressure as a Risk Factor for Stroke and the Impact of Antihypertensive Treatment
Authors: Gil-Núñez Antonio C. , Vivancos-Mora José
Published: December 2005

We review hypertension and blood pressure levels as risk factors for stroke and the impact of antihypertensive treatment on the prevention of first stroke event and of recurrent stroke, not only with respect to the prevention of vascular events but also the prevention of cognitive deterioration, dementia, and physical disability. We review whether pharmacological blockage of the renin-angiotensin system has additional long-term effects over that of control of blood pressure levels alone, and the benefit of treatment with antihypertensive drugs in normotensive patients. Therapeutic objectives for blood pressure levels after stroke are defined together with recommendations of drugs and doses which have been demonstrated to have the greatest benefit in the prevention of stroke.
Lipids and Stroke: The Opportunity of Lipid-Lowering Treatment
Authors: Vivancos-Mora José , Gil-Núñez Antonio C.
Published: December 2005

Dyslipemia is a clear risk factor (RF) for ischemic heart disease and peripheral artery disease, but its relation with ischemic stroke (IS) is not so clear. HMG-CoA reductase inhibitor drugs or statins (simvastatin, atorvastatin, pravastatin) reduce the relative risk of IS by between 18 and 51% in patients with IHD, in patients with high vascular disease risk and in hypertensive patients with other RFs, acute coronary syndrome, and type 2 diabetes mellitus. According to the guidelines for use, statins are indicated in the majority of patients with IS since the risk is equivalent to that of IHD or high vascular disease risk. In view of the existing clinical evidence of benefit, it would not seem unreasonable to proceed with treatment of patients using statins while awaiting specific studies justifying their use. The non-lipid-lowering mechanisms of the statins and results of studies, such as the Heart Protection Study, provide evidence for widening the indications of statins beyond the prevention of dyslipemia, as a new therapeutic approach in the prevention of IS in patients with plasma levels of total cholesterol or low density lipoproteins currently considered within the normal distribution. The neuroprotective role, which these drugs may play in the acute phase of cerebral ischemia, remains to be clarified, but very recent evidence suggests that such patients may also benefit.
Anticoagulation in Ischemic Stroke: Opportunities in Arterial Disease
Authors: van Gijn J. , Algra A.
Published: December 2005

In the acute phase of ischemic stroke, there is no evidence that anticoagulants provide any benefit in terms of death or dependency. A small reduction in the incidence of recurrent stroke is offset by an equally small increase in intracranial hemorrhage (ICH). In the secondary prevention of stroke, in patients with transient ischemic attacks (TIAs) and moderately disabling ischemic stroke, the relative risk reduction of major vascular events by aspirin is rather modest: 13% (or 19% in a systematic review of arterial disease in general). Anticoagulants might well offer stronger protection, since they provide a 35–50% risk reduction after myocardial infarction or in patients with TIAs or nondisabling ischemic stroke in the presence of atrial fibrillation. Meanwhile, it has become clear that anticoagulation with high intensity (INR 3.0 – 4.5) is associated with a high risk of ICH in patients with cerebral ischemia who are in sinus rhythm, while INR values around 1.9 do not offer protection against major vascular events. An international clinical trial of anticoagulation with INR values between 2.0 and 3.0 (ESPRIT) is still in progress. In cerebral venous sinus thrombosis, anticoagulant treatment is associated with a nonsignificant reduction of the risk of death or dependence, but the treatment has nevertheless become widely adopted because it seems safe: no increase in the proportion of patients with hemorrhagic transformation of infarction has so far been demonstrated.
Antiplatelets in Stroke Prevention: The MATCH Trial
Authors: Bezerra Daniel C. , Bogousslavsky Julien
Published: December 2005

Antiplatelet drugs have an established efficacy in the secondary prevention of ischemic stroke. The recent results of the CAPRIE, CURE, and CREDO studies formed the rationale for the MATCH, designed to test whether the association of clopidogrel and aspirin was better than clopidogrel alone for the prevention of vascular events among high-risk ischemic cerebrovascular patients. Although the benefits were outweighed for a higher bleeding risk in the combination group, this study will provide important insight for upcoming trials in other to determine what populations might mostly benefit from these drugs for the secondary prevention of stroke in the future.
Proteinuria and Fusion of Podocyte Foot Processes in Rats after Infusion of Cytokine from Patients with Idiopathic Minimal Lesion Nephrotic Syndrome
Authors: Garin Eduardo H. , Laflam Paul F. , Muffly Karl
Published: December 2005

Background/Aims: We report on the isolation of a factor secreted by peripheral blood mononuclear cells from patients with idiopathic minimal lesion nephrotic syndrome (IMLNS) in relapse and its effect on proteinuria and podocyte morphology in the rat. Methods: Peripheral blood mononuclear cells from patients with IMLNS (in relapse and in remission) and patients with focal segmental glomerulosclerosis were cultured for 72 h. Supernatants from 20 × 106 cultured cells were separated by liquid chromatography into three fractions according to markers (bovine serum albumin, β-amylase, and apoferritin). Each supernatant fraction was infused into rats for 5 days using an osmotic pump. Proteinuria, 24-hour albumin excretion or albumin/creatinine ratio in a 24-hour urine collection, was measured daily starting 3 days prior to fraction infusion. Renal tissue was obtained for electron microscopy studies. The β-amylase fraction underwent electrophoresis using isoelectric focusing gel. Results: When protein excretion was compared prior to and during supernatant fraction infusion, a significant increase in proteinuria was observed only when β-amylase fraction from IMLNS patients in relapse was infused (p < 0.05). Protein electrophoresis of the β-amylase fraction showed a single band at pH 6.0 only in samples from IMLNS patients in relapse. The band was composed of two proteins, β-amylase and a 100-kDa glycoprotein. Fusion of foot processes was observed only when the β-amylase fraction from IMLNS patients in relapse was infused. Conclusions: The infusion of the β-amylase fraction containing a 100-kDa glycoprotein from IMLNS patients in relapse induced proteinuria and effacement of foot processes in the rat. This protein may play a role in the pathogenesis of IMLNS.
Percutaneous Embolization for Cervicofacial Neoplasms and Hemorrhages
Authors: Zähringer Markus , Guntinas-Lichius Orlando , Gossmann Axel , Wustrow Jochen , Krüger Karsten , Lackner Klaus
Published: December 2005

Objective: To retrospectively assess the effectiveness of percutaneous embolization for curative, preoperative or palliative management of hypervascular neoplasms, vascular malformations and bleedings of the head and neck area. Methods: A retrospective 8-year analysis of outcomes in 85 patients undergoing preoperative embolization for tumors or vascular lesions of the head and neck or embolization for refractory tumor bleeding and epistaxis at our hospitals was performed by reviewing case records. Outcome of the preoperatively embolized patients was defined as successful if intraoperative bleeding was <500 ml and/or postinterventional angiogram showed complete occlusion of all tumor-feeding or bleeding vessels. Results: Complete preoperative tumor embolization was achieved in 83.5% of the patients. Partial embolization was possible in 10.5%. All tumor bleedings refractory to conservative therapy and bleedings from epistaxis showed a successful outcome. Conclusions: In vascular lesions and tumors of the head and neck, preoperative percutaneous embolization improved the surgical outcome, reduced intraoperative blood loss significantly and facilitated tumor resectability. Cervicofacial bleeding resulting from a tumor, vascular malformation or epistaxis can be managed effectively by endovascular techniques.
Effect of Bacterial Vaginosis on Premature Rupture of Membranes and Related Complications in Pregnant Women with a Gestational Age of 37–42 Weeks
Authors: Ziaei Saeideh , Sadrkhanlu Mitra , Moeini Ashraf , Faghihzadeh Soghrate
Published: December 2005

Background: The most serious outcome of term, premature rupture of membrane and chorioamnionitis is often associated with adverse maternal and infant outcomes related to infection. This study was undertaken to determine the prevalence of bacterial vaginosis (BV) at 37–42 gestational weeks and its relationship to premature rupture of membranes. Method: During an analytical descriptive prospective study, 425 pregnant women with a gestational age of 37–42 weeks were studied for prevalence of BV. Then, 304 women on the basis of having BV or not were followed up until 48 h after delivery for premature rupture of membranes. Result: The rate of BV in this population was 30.5%. No significant association was found between BV and premature rupture of membranes (odds ratio 1.6, 95% CI 0.9–2.8).Conclusion: BV is a common vaginitis in term pregnancy, but we could not find any relationship between BV and premature rupture of membranes at term.
Growth Hormone Deficiency and Memory Functioning in Adults Visualized by Functional Magnetic Resonance Imaging
Authors: Arwert Lucia I. , Veltman Dick J. , Deijen Jan Berend , van Dam P. Sytze , Delemarre-van deWaal Henriette A. , Drent Madeleine L.
Published: December 2005

Cognitive functioning, especially memory performance, is known to be impaired in patients with childhood-onset growth hormone deficiency (CO-GHD), and growth hormone substitution has been found to counteract this memory impairment. Neuropsychological and functional magnetic resonance imagining (fMRI) data acquired during a working memory task in 13 childhood-onset GH-deficient patients were compared with 13 age, sex and education level matched healthy controls. Results demonstrated that there is no difference in the quality of the performance in the working memory task between GH-deficient patients and control subjects. However, memory speed was found to be subnormal in patients. Concerning mood, patients reported more complaints of fatigue, and less vigor. Imaging data showed that patients had increased activity in dorsolateral/ventrolateral prefrontal cortex, anterior cingulate cortex, parietal cortex, supplementary motor and motor cortex, as well as in the thalamus and precuneus area. Increasing task load was also associated with an increase in brain activity in similar areas in patients compared to control subjects. In conclusion, this fMRI study shows that GH-deficient patients have a subnormal memory speed, but no impaired quality of memory performance, which may be due to compensatory recruitment of dorsal prefrontal brain regions. These findings indicate that the GH-IGF-1 axis contributes to prefrontal functioning in patients with CO-GHD.