bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience and Perspectives on the Classification of Organic Mental Disorders
Authors: Kopelman Michael D. , Fleminger Simon
Published: April 2003

The official diagnostic classification systems have been increasingly employed in the last few years, and this is true of both ICD-10 and DSM-IV. We will propose a few principles which should be considered when revisions are attempted. Our existing classifications should be simplified, but new syndromes incorporated where they have pathological justification. Links to other specialist diagnostic classifications should be made (e.g. in epilepsy, sleep disorders, dementias) wherever possible. A broader range of ‘Neuropsychiatric Disorders’ should be incorporated, including alcohol-related organic disorders, head injury, sleep disorders, if possible including the ‘psychogenic syndromes’. Progressive, degenerative disorders need to be clearly distinguished from non-progressive syndromes, and some gradation of severity needs to be built into the classificatory system. Finally, the definitions need to be concise and accurate.
The Classification of Anxiety Disorders in ICD-10 and DSM-IV: A Concordance Analysis
Authors: Andrews Gavin , Slade Tim
Published: April 2003

On the surface, the classifications of anxiety disorders in DSM-IV and ICD-10 appear quite similar. However, differences exist and are evident in four aspects of the diagnostic criteria: typology, identifying criteria, inclusion and exclusion criteria. The current study uses data from the Australian National Mental Health Survey to model the impact of these differences on the diagnosis of generalized anxiety disorder. The results show that the concordance between the current classifications would be improved with the removal of the criterion for uncontrollability from DSM-IV, a closer focus on the symptoms of hypervigilance and scanning as in DSM-IV and the removal of the clinical significance criterion from DSM-IV. Equivalency of the exclusion criteria between the two classification systems reduces the concordance, demonstrating that each classification systems is a set of interdependent diagnoses, and to ultimately achieve concordance, all diagnoses must be considered together.
The Classification of Stress-Related Disorders in ICD-10 and DSM-IV
Authors: López-Ibor Juan J.
Published: April 2003

This paper reviews the psychopathology, the nosology and classification principles of stress-related disorders, with focus on how they are characterized in ICD-10 and DSM-IV. The presence of a stressor and the reexperience of the event are the two criteria present in the three diagnostic systems: ICD-10 Research Diagnostic Criteria (RDC), ICD-10 Diagnostic Guidelines (DG), and DSM-IV. ICD-10 RDC and DSM-IV, being more strict, add two more criteria: avoidance and increased physiological arousal. ICD-10 RDC allows this to be substituted by ‘inability to recall’, while ICD-10 DG add a few more symptoms which are not necessary for the diagnosis but may be typical (numbness), common (anxiety and depression) or rare (acute bursts of fear or aggression). DSM-IV is the only system which mentions symptoms specific for children.
The Classification of Personality Disorders: Critical Review and Need for Rethinking
Authors: Jablensky Assen
Published: April 2003

An overview is presented of the historical background to the current classification of personality disorders in ICD-10 and DSM-IV. Although the precursors of the present diagnostic concepts were originally developed as dimensional or prototype typologies, both ICD-10 and DSM-IV have adopted a quasi-nosological, categorical model of personality disorders on Axis II. It is argued that the model is fundamentally flawed and restricts the capacity to collect and communicate relevant data on the impact of personality characteristics on the manifestations, course and outcome of Axis I disorders. Dimensional models originating in recent psychological research offer an alternative, but considerable theoretical and field research work will be required before a meaningful and generally acceptable restructuring of Axis II becomes feasible.
The APA Classification of Mental Disorders: Future Perspectives
Authors: Regier Darrel A. , Narrow William E. , First Michael B. , Marshall Tina
Published: April 2003

After 8–10 years of experience with the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) and the tenth edition of the International Classification of Diseases (ICD-10), it is an ideal time to begin looking at the clinical and research consequences of these diagnostic systems. The American Psychiatric Association, in conjunction with the National Institutes of Health, has initiated a research development process intended to accelerate an evaluation of existing criteria while developing and testing hypotheses that would improve the validity of our diagnostic concepts. Over the past year, a multidisciplinary, international panel has developed a series of six white papers which define research opportunities in the following broad areas: Nomenclature, Disability and Impairment, Personality Disorders, Relational Disorders, Developmental Psychopathology, Neuroscience, and Cross-Cultural aspects of Psychopathology. Recommendations for future national and international research in each of these areas will be discussed.
French Classification for Child and Adolescent Mental Disorders
Authors: Mises R. , Quemada N. , Botbol M. , Burzsteijn C. , Garrabe J. , Golse B. , Jeammet P. , Plantade A. , Portelli C. , Thevenot J.P.
Published: April 2003

This report presents the French Classification of Child and Adolescent Mental Disorders (CFTMEA), operational since 1983 and validated through a broad multicentric study. CFTMEA is now the classification of reference for French child psychiatrists, who appear to be comfortable with it because it fits their diagnostic and therapeutic work. It bases its clinical categories on a psychopathological approach which includes an appraisal of potentials and prognosis. CFTMEA is deliberately built on two quite distinct axes: Axis I: basic clinical categories, and Axis II: associated and possibly etiological factors. The CFTMEA favors a broad appraisal of the disorders that it classifies, seeking whenever possible to establish a structural diagnosis based on psychodynamic psychopathology. The CFTMEA does not claim to be atheoretical, but does not impose a theoretical allegiance, because it is compatible with any etiological concepts. The CFTMEA’s last revision (R 2000) is in an advanced phase of validation.
Classification Systems for Psychiatric Diseases Currently Used in Japan
Authors: Nakane Yoshibumi , Nakane Hideyuki
Published: April 2003

A research survey was conducted to find out which diagnostic classification systems were commonly used in university hospitals in Japan. By using a questionnaire, we collected data to determine which diagnostic classification systems and diagnostic criteria were being used to identify schizophrenia, affective (mood) disorders, and neurosis. The results indicated that most university hospitals used either the International Classification of Diseases (ICD) of the WHO or the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. For research of academic presentations, more than 60% of the surveyed institutions used DSM. In clinical settings, however, ICD and DSM were used with similar frequencies (42–43%). It was also noted that 15% of institutions still use a traditional psychiatric diagnosis for schizophrenia and mood disorders. This paper addresses historical aspects of the diagnosis and classification of mental illness in Japan.
Die Wertigkeit der Second-Look-Operation bei Patientinnen mit einem Ovarialkarzinom oder Tubenkarzinom mittels einer retrospektiven Vergleichsstudie
Authors: Ott H.W. , Illmensee K. , Zeimet A. , Mueller-Holzner E. , Windbichler G. , Eibl G. , Marth C.
Published: April 2003

Fragestellung: Eine retrospektive Analyse der Wertigkeit einer sogenannten Second-look-Operation bezogen auf das krankheitsfreie und Gesamtüberleben bei Patientinnen mit einem Ovarialkarzinom oder Tubenkarzinom. Methode: Bei einem Gesamtkollektiv von 469 Patientinnen wurden bei 208 Patientinnen mit und ohne Second- look-Operation eine gepaarte Analyse durchgeführt und im Rahmen einer Multivariatanalyse ein Cox-Regressionsmodell erstellt. Ergebnisse: Es konnte bezüglich krankheitsfreiem Intervall und Gesamtüberleben kein signifikanter Unterschied zwischen Patientinnen mit und ohne Second-look-Operation festgestellt werden. Die 10-Jahres-Überlebensrate war bei beiden verglichenen Gruppen praktisch identisch. Schlussfolgerungen: Die Second-look-Operation ist aufgrund der Aussagefähigkeit von klinisch nichtinvasiven Methoden wie Bildgebung in Kombination mit dem Tumormarker CA-125 und der mangelnden Effizienz einer Second-line-Therapie nicht als Routineeingriff gerechtfertigt und soll nur ausgewählten klinischen Studien, zur Evaluierung neuer Behandlungsmethoden, vorbehalten sein.
Role of Adverse Reactions to Food in Urticaria and Exercise-Induced Anaphylaxis
Authors: Chong Sie-Uen , Worm Margitta , Zuberbier Torsten
Published: April 2003

In urticaria, adverse reactions to food are only a frequent finding in the subset of patients with chronic continuous urticaria. Mostly these reactions are of pseudoallergic nature, directed against artificial additives as well as naturally occurring aromatic components. IgE-mediated allergic reactions are a rare cause in acute urticaria as well as in recurrent chronic urticaria. In other types of urticaria, e.g. physical urticaria, food plays hardly any role as an eliciting agent with the exception of ice-cold drinks in cold urticaria. By contrast, exercise-induced anaphylaxis is frequently food-dependent. Two subtypes are distinguished: unspecific food-dependent exercise-induced anaphylaxis (FDEIA), where the filling of the stomach independently of the kind of food ingested prior to exercise is responsible for the symptoms. In specific FDEIA, an IgE-mediated food allergy causes symptoms only in combination with exercise. In the latter group, wheat is an important allergen.
Treatment with Vitamin K Antagonists: Frequency of Indications and Appropriateness of Continuation
Authors: van der Heijden J.F. , Remkes M.G.H. , Büller H.R. , Vermeulen M.
Published: April 2003

To prevent venous and arterial thrombosis vitamin K antagonists (VKA) are the treatment of choice for many indications. It is important to balance the benefits and the potential hazards of this treatment. An effective way to prevent unnecessary bleeding during VKA treatment is to stop treatment when the indication is no longer present. In this study, we analyze the distribution of indications in a randomly selected group of 250 patients starting VKA treatment at the Amsterdam Thrombosis Service. The proportion of patients still treated after one year of follow-up was also investigated. The distribution of the indications among patients starting VKA therapy was approximately 50% for venous thromboembolism treatment and prophylaxis, and approximately 50% for prophylaxis of arterial thrombosis. After one year of follow-up, 164 (65.6%) of the 250 patients had stopped VKA therapy. Reasons for stopping included: no indication for continuing VKA treatment, e.g. end of treatment, prophylaxis or restoration of sinus rhythm (137 patients); death (17) and other reasons (10). Six (2.4%; 95% CI: 0.9–5.1%) patients had a questionable indication for long-term treatment, and 9 (3.6%, 95% CI: 1.6–6.7%) patients had no clear indication for continued VKA treatment. We conclude that in the setting of the Amsterdam Thrombosis Service, only a small proportion of patients is treated with long-term VKA therapy without a valid indication after 1 year.
Effect of an Ionic Compared to a Non-Ionic X-Ray Contrast Agent on Platelets and Coagulation during Diagnostic Cardiac Catheterisation
Authors: Jung F. , Spitzer S.G. , Pindur G.
Published: April 2003

The aim of the present study was to evaluate the effects of ionic (ioxaglate) and non-ionic (iopromide) contrast media on haemostatic parameters ex vivo. In 40 patients undergoing coronary angiography, platelet function (platelet reactivity and serotonin concentration) and coagulation markers [thrombin-antithrombin III complexes, prothrombin fragments (F1+2) and the D-dimers] were measured. The use of an ionic X-ray contrast agent (XCA) (ioxaglate) in diagnostic cardiac catheterisation angiography is associated with lower thrombin generation and lower activation of the platelet system than when a non-ionic XCA is employed (iopromide). The results thus confirm the results of various in vitro studies and animal investigations.
Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis: A Suitable Monitoring in Elderly Patients?
Authors: Mahé Isabelle , Drouet Ludovic , Chassany Olivier , Grenard Anne-Sophie , Caulin Charles , Bergmann Jean-François
Published: April 2003

Monitoring of anti-Xa activity (aXa) levels is not routinely required in patients receiving enoxaparine at prophylactic dosages, since aXa is supposed to stay below the manufacturer’s recommended range in patients treated for venous thrombosis (0.5–1 IU/ml). In order to aXa in elderly subjects receiving prophylactic enoxaparin, 68 consecutive patients (mean age 82.5 ± 10.7 years) hospitalized in a medical department receiving 4,000 IU enoxaparin daily subcutaneously for the prevention of venous thromboembolic disease were studied. After the first injection of enoxaparin, the aXa of 57.4% patients was superior to 0.5 IU/ml while 69.4% had an aXa higher than 0.5 after 8.4 ± 1.2 days. A negative relationship between aXa and body weight and a trend towards a positive correlation between aXa and age but not with creatinine clearance were noted. Our findings question the opportunity to monitor aXa in elderly patients receiving 4,000 IU enoxaparin as antithrombotic prophylaxis.
Focal Segmental Glomerular Sclerosis in Two Patients with Addison’s Disease: Any More than Fortuitous Development of Glomerular Disease?
Authors: Arrizabalaga P. , Bergadá E. , Solé M. , Halperin I. , Botey A.
Published: April 2003

Adjustment of the mineralocorticoid activity under substitution therapy is of primary importance in Addison’s disease. We report the clinical and biological conditions of 2 patients with Addison’s disease who developed nephrotic proteinuria during their deficient mineralocorticoid state. Renal biopsy was performed and the specimens processed using conventional histochemistry, Congo red staining, and indirect immunofluorescence. The renal biopsy specimens showed focal segmental glomerular sclerosis and nodular deposits of IgM and C3. Negative for Congo red staining. Serum complement, circulating immune complexes, and anti-DNA and hepatitis B and C and human immunodeficiency virus antibodies were all normal or negative. Absence of vesicoureteral reflux was assessed by X-ray studies. Our observations suggest that deficiency in mineralocorticoid substitution therapy inducing a status of hyperreninemia could play a role in the development of focal segmental glomerulosclerosis in patients with Addison’s disease.
Helicobacter pylori in Patients Receiving Long-Term Dialysis
Authors: Nakajima Fumitaka , Sakaguchi Masahiro , Amemoto Kanji , Oka Hiroshi , Kubo Mitsuru , Shibahara Nobuhisa , Ueda Haruhiko , Katsuoka Yoji
Published: April 2003

Background:Helicobacter pylori (H. pylori) is considered to cause gastritis and gastric ulcer. In dialysis patients, digestive tract hemorrhage is sometimes fatal. However, in regard to H. pylori infection in patients with end-stage renal disease (ESRD), many issues remain to be clarified. Methods: This study included 76 symptom-free patients with ESRD. The subjects consisted of 25 patients with chronic renal failure who had not received dialysis and 51 patients receiving dialysis. On upper digestive tract endoscopy, specimens were taken for analysis of H. pylori. Urease test, culture, and microscopy were performed. Results: In non-dialysed patients, the prevalence of H. pylori-positive patients was 56.0%. In dialysed patients, the percentage was significantly lower (27.5%). In dialysed patients, the mean duration of dialysis was 8.1 ± 7.5 months (mean ± SD) in H. pylori-positive patients and 56.2 ± 60.9 months (mean ± SD) in H. pylori-negative patients (p < 0.001). 11 of 13 non-dialysed patients with chronic gastritis were positive for H. pylori. However, only 5 of 24 dialysed patients were positive for H. pylori infection. Conclusions: Long-term dialysis decreased the prevalence of H. pylori. The reduction of gastric acid secretion related to chronic gastritis may be involved.
A 12-Year-Old Girl with Hemolytic Uremic Syndrome as Initial Symptom of Systemic Lupus erythematosus and a Literature Review
Authors: Kawasaki Yokihiko , Suzuki Junzo , Nozawa Ruriko , Suzuki Shigeo , Suzuki Hitoshi
Published: April 2003

We describe a 12-year-old girl with systemic lupus erythematosus (SLE) who first presented with an atypical hemolytic uremic syndrome (HUS) associated with hypocomplementemia, and compare the clinical manifestations and prognosis between SLE patients with HUS and thrombotic thrombocytopenic purpura in the reported literature. Diagnoses were based on renal failure, hemolytic anemia, and thrombocytonemia, including the observation of fragmented red blood cells, hypocomplementemia and on the American College of Rheumatology criteria for SLE. Cocktail therapy may have been effective against the pathological condition of SLE. In 4 patients with SLE and HUS, prednisolone and immunosuppressive drugs were administered, and none of the patients suffered from chronic renal insufficiency. The prognosis for SLE patients with HUS is good. These findings suggest that SLE should be suspected in any HUS patient presenting with hemolytic anemia, thrombocytopenia, acute renal failure and hypocomplementemia, and the therapeutic response and prognosis for SLE with HUS are good.
Shunt Dependency in Shunted Arachnoid Cyst: A Reason to Avoid Shunting
Authors: Kim Seung-Ki , Cho Byung-Kyu , Chung You-Nam , Kim Hee-Soo , Wang Kyu-Chang
Published: April 2003

Cystoperitoneal (CP) shunting is minimally invasive and achieves a high rate of resolution on neuroimaging. However, in the absence of definite symptoms, shunting should be reconsidered, because some patients can experience shunt dependency after CP shunting. In this study, the risk of shunt dependency in patients with arachnoid cysts treated with CP shunting and the management of these patients are described. Eight patients (7 boys and 1 girl) were diagnosed as shunt dependent following CP shunting. At the time of the first operation (mean age at first shunting 6.1 years, range 1–11 years), a causal relationship between symptoms and the arachnoid cyst was evident in only 2 cases. Clinical manifestations, neuroimaging (computed tomography and/or magnetic resonance imaging) and intracranial pressure (ICP) data were reviewed retrospectively. The mean age of the patients at the time of shunt dependency was 9.8 years (range 6–13 years), and the mean time between the first shunt operation and shunt dependency was 41 months (range 17–80 months). Although neuroimaging demonstrated a collapsed cyst and small ventricles in most patients, ICP monitoring revealed significant intracranial hypertension. The release of shunt ligation, revision or additional shunting, such as ventriculoperitoneal shunting or lumboperitoneal shunting, resulted in the complete resolution of symptoms except in one patient who lost vision. This study shows that shunt dependency after CP shunting is a real problem and requires more attention. ICP monitoring can demonstrate the presence of intracranial hypertension when clinical and radiological analyses do not.
The Effects of Protein, Red Blood Cells and Whole Blood on PS Valve Function
Authors: Baird Clint , Farner Staci , Mohr Clinton , Pittman Thomas
Published: April 2003

We tested the performance of low- and medium-pressure PS flow control valves as they were perfused with (1) solutions with varying concentrations of protein, (2) solutions with varying numbers of red blood cells (RBC) or (3) solutions with varying concentrations of whole blood. Perfusion was performed with a peristaltic pump at a constant rate and each trial lasted 2 weeks or until valve failure. Mean valve pressures were measured and recorded electronically, and opening and closing pressures were obtained at baseline and at the end of the perfusion period or upon valve failure. Any buildup of material within the valve was noted and recorded. Our findings were as follows: (1) protein levels have little practical effect on valve function; (2) moderate numbers of RBC cause increased variability in valve function while large numbers of RBC uniformly lead to valve failure; (3) prolonged perfusion with solutions of dilute whole blood is poorly tolerated, and (4) valve failure is preceded by a period of increased variability in perfusion pressure.
L-Asparaginase-Induced Reversible Posterior Leukoencephalopathy Syndrome in a Child with Acute Lymphoblastic Leukemia
Authors: Rathi Bharti , Azad Rajeev K. , Vasudha N. , Hissaria Praveen , Sawlani Vijay , Gupta Rakesh K.
Published: April 2003

Reversible posterior leukoencephalopathy syndrome (RPLS) is being increasingly described with various etiologies even in the absence of hypertension. We present an 11-year-old patient with acute lymphoblastic leukemia who presented with seizures while on treatment with L-asparaginase. MRI showed bilaterally symmetrical nonenhancing occipital lesions characteristic of RPLS. L-Asparaginase-induced RPLS is a rare cause of neurological symptoms in patients on induction chemotherapy.
Dolichoodontoid in a Pediatric Patient
Authors: Tubbs R. Shane , Wellons III John C. , Oakes W. Jerry
Published: April 2003

Dolichoodontoid is defined as hypertrophy of the apical portion of the odontoid process of the axis. We report the first case of a dolichoodontoid process in a pediatric patient with other congenital anomalies. This rare entity has had three previous citations in the literature. Our patient presented with scoliosis in which subsequent MRI demonstrated a Chiari I malformation, a small thoracic syrinx and a dolichoodontoid process. The diagnosis of this malformation should be entertained in cases of craniocervical anomalies.
Weight Gain and Serum Leptin Levels in Patients on Lithium Treatment
Authors: Atmaca Murad , Kuloglu Murat , Tezcan Ertan , Ustundag Bilal
Published: April 2003

Weight gain is a frequent adverse effect associated with lithium use. Leptin is an adipocyte hormone, regulating food intake and energy balance providing the hypothalamus with information on the amount of body fat. Therefore, we planned to evaluate whether lithium administration was associated with weight gain, and leptin levels. The study consisted of 15 consecutive inpatients with bipolar I disorder according to DSM-III-R. The fasting serum leptin levels were measured. The patients were evaluted at baseline and at the eighth week according to the body mass index, weight, Young Mania Rating (YMRS) and Hamilton Depression Rating (HAM-D) scales, and serum leptin levels. With respect to the leptin levels, a significant difference was observed after lithium treatment. There was a significant positive correlation between the changes in leptin levels and the duration of illness. The change in total YMRS scores correlated with change in leptin levels and that in weight. In conclusion, our result suggest that leptin may be associated with lithium-induced weight gain.
Age-Dependent Phosphate Homeostasis Is Regulated by a Circulating Factor
Authors: Matsumoto Naoko , Komatsu Yasuhiro , Hattori Motoshi , Shiraga Hiroshi , Ito Katsumi
Published: April 2003

To evaluate the age-dependent phosphate homeostasis, we studied the serum inorganic phosphate (Pi) concentration in 78 recipients, aged 5–25 years, a year after renal transplantation (RT). The significant age-dependent decline of the serum Pi concentration was observed in recipients (p < 0.0001) as well as in normal children. Our study revealed that a circulating factor may play a central role in the age-dependent change of phosphate regulation in human.
Which Kt/V Is the Most Valid for Assessment of Both Long Mild and Short Intensive Hemodialyses?
Authors: Miwa Toshihiko , Nakai Shigeru , Miwa Masamiki , Shinzato Toru , Segawa Kosei , Maeda Kenji
Published: April 2003

It is unclear at present which mathematical modeling Kt/Vurea is valid for assessment of both long mild hemodialysis (HD) and short intensive HD, the single-pool modeling Kt/V (Kt/Vsp) based on the pre- and postdialysis serum urea concentrations, double-pool modeling Kt/V (Kt/Vdp) based on the predialysis concentration and the estimated postdialysis equilibrated concentration, or Kt/V calculated on the basis of dialyzer urea clearance, HD session duration and urea distribution volume (Kt/Vdl). Thus, the respective Kt/V during a short intensive HD was compared with its counterpart Kt/V during a long mild HD, where the same amount of urea is removed during both HD treatments. It was found that the Kt/Vsp and Kt/Vdl during short intensive HD were significantly greater than the respective Kt/V during the long mild HD. On the other hand, there was no significant difference in the Kt/Vdp between the long mild and short intensive HDs. In conclusion, Kt/Vdp may be more valid for assessment of both long mild and short intensive HDs.
Impaired Urinary Concentrating Ability in Genetically Polyuric Mice
Authors: Homma Sumiko , Takeda Sigeyuki , Kusano Eiji , Matsuo Yoshiyuki , Shimizu Toshikatsu , Nakamura Masuhisa , Oohara Tadao , Makino Susumu , Asano Yasushi
Published: April 2003

Newly recognized strain of mice with hereditary polyuria (PUS mice) was characterized. Polyuria was inherited as a single autosomal-recessive trait. At 15 weeks, PUS mice excreted hypotonic (urine osmolality: PUS;270.8 ± 15.5 vs. cont.; 3,228.6 ± 163.6 mosm/kg) polyuria (urine volume: PUS; 25.0 ± 1.5 vs. cont.; 1.1 ± 0.1 ml/day). In PUS mice, plasma osmolality was slightly elevated as well as urinary excretion of vasopressin (AVP). Although PUS mice could concentrate urine after 24 h water deprivation, urine osmolality remained low. Blunted response to continuous infusion of dDAVP, a synthetic V2 agonist, was also observed. These in vivo studies indicated renal resistance to AVP contributed to the polyuria in this strain of mice. Microanalysis of isolated tubular segments revealed that AVP-induced cAMP accumulation in cortical collecting ducts (CCD) of PUS mice was significantly lower (60%) with or without a phosphodiesterase inhibitor, IBMX. Vasopressin induced similar cAMP accumulation in medullary ascending limbs of Henle (MAL), and medullary collecting ducts (MCD) between PUS and control mice. In CCDs, PUS mice had low basal adenylate cyclase (AdC) activity and responded less to AVP and forskolin stimulation than control mice. No difference in cyclic AMP phosphodiesterase activity was detected between control and PUS mice. These results indicate that impaired cAMP accumulation due to low AdC activity may be related to the impaired renal concentrating ability observed in this new strain of mice.
Late-Life Depression: Rationalizing Pharmacological Treatment Options
Authors: Montgomery Stuart A.
Published: April 2003

Background: Depressive symptoms in late life are a major concern as they increase disability and aggravate existing medical conditions. Depression is underrecognised and undertreated in the elderly, be it due to somatic symptoms, comorbid physical illness or anxiety, or because it is accepted as a normal feature of ageing. There is little doubt that effective and well-tolerated antidepressant therapy is required. Objective: This paper reviews the antidepressant treatment options for late-life depression (selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mixed noradrenergic and serotonergic agents), in terms of their efficacy, safety and pharmacokinetics in elderly patients. Results: In addition to proven efficacy, selection of an antidepressant agent for late-life depression must be based on an understanding of safety and pharmacokinetic issues associated with each agent. Comorbid conditions and lifestyle characteristics of the elderly that are different to those encountered in the younger adult population should also be considered. Conclusion: To date, published clinical evidence in the elderly suggests that the first-choice agents for treating late-life depression are the SSRIs.
Female Preponderance of Parkinson’s Disease in Japan
Authors: Kimura H. , Kurimura M. , Wada M. , Kawanami T. , Kurita K. , Suzuki Y. , Katagiri T. , Daimon M. , Kayama T. , Kato T.
Published: April 2003

A male preponderance of Parkinson’s disease (PD) has been reported in European countries and the USA. To verify this issue in Japanese patients with PD, we examined the age- and gender-specific prevalence of PD in Yamagata Prefecture (population 1,244,040), Japan. The prevalence of PD was 61.3/100,000 men and 91.0/100,000 women, showing that women were significantly more affected by PD than men (p < 0.001). Contrary to the findings in Europe and the USA, the results indicate a female preponderance of PD among the Japanese population.
p38 Mitogen-Activated Protein Kinase Activation Is Required for Thromboxane- Induced Contraction in Perfused and Pressurized Rat Mesenteric Resistance Arteries
Authors: Bolla Manlio , Matrougui Khalid , Loufrani Laurent , Maclouf Jacques , Levy Bernard I. , Levy-Toledano Sylviane , Habib Aïda , Henrion Daniel
Published: April 2003

Thromboxane A2 (TxA2) is a potent proaggregating, vasoconstrictor agent produced in many physiological and pathological situations. Although mitogen-activated protein (MAP) kinases [MAPK (ERK1/2 and p38)] have been shown to be activated after endoperoxide/thromboxane receptor (TP) stimulation, no study has investigated their potential role in resistance arteries, especially in physiological conditions of pressure and flow in which the arteries can contract. Thus, responses to TP stimulation by the stable agonist U46619 were studied in isolated rat mesenteric resistance arteries (inner diameter 262 ± 5 µm) mounted in an arteriograph. Changes in diameter were recorded under physiological levels of flow (90 µl/min) and pressure (50 mm Hg). TP stimulation induced a concentration-dependent contraction (EC50 value of 1.94 ± 0.22 × 10–7M), without desensitization. U46619-induced contraction was inhibited by calcium entry blockade (nifedipine) and protein kinase C inhibition (GF109203X), but it was not affected by tyrosine kinase inhibition (tyrphostin A25). MAPKK (MEK) inhibition (PD98059) did not alter U46619-dependent contraction, although ERK1/2 MAPK were activated. By contrast, p38 MAPK inhibition (SB203580) dose-dependently inhibited the contraction, and Western blot analysis showed activation of p38 MAPK in arteries contracted with U46619. Activation of p38 MAPK by U46619 was inhibited by nifedipine and in the absence of extracellular calcium. This study brings new insights in the transduction pathway involved in the contractile response of resistance arteries to TxA2/endoperoxide receptor stimulation. This contraction requires p38 MAPK activation, but did not involve ERK1/2 MAPK activation although both were activated.
Less Calcium in Cremaster Muscles of Boys with Undescended Testis Supports a Deficiency in Sympathetic Innervation
Authors: Tanyel F. Cahit , Ulusu N. Nuray , Tezcan E. Ferhan , Büyükpamukçu Nebil
Published: April 2003

In addition to an increase in contractility, contracted fibers and small and electron-dense mitochondria have suggested an increase of cytosolic Ca2+ within the cremaster muscles (CM) associated with undescended testis. Therefore, the Ca2+ content of CM associated with an undescended testis was determined and compared with the Ca2+ content associated with inguinal hernia and hydrocele and in internal oblique muscles. CM samples from boys with undescended testis (n = 9), inguinal hernia (n = 15), and hydrocele (n = 7) and from girls with inguinal hernia (n = 8) were obtained. The calcium contents of these samples and of samples from internal oblique muscle (n = 6) were determined by atomic absorption spectrophotometry. While the Ca2+ contents of CM from boys with undescended testis and from girls with inguinal hernia were similar (p > 0.05), the internal oblique muscle and the CM from boys with inguinal hernia and hydrocele contained more Ca2+ than CM from boys with undescended testis (p < 0.05). Despite evidence of an increase in cytosolic calcium, the decrease in total calcium content suggests a decrease in the adenylyl cyclase activity, thus inhibition of influx of Ca2+, but an increase in phospholipase C activity, and generation of more inositol 1,4,5-trisphosphate and mobilization of calcium from internal stores. Since the sympathetic system acts through adenylyl cyclase in striated muscles and is sexually dimorphic, similar Ca2+ contents as encountered in girls suggest an alteration in the balance of autonomic innervation against the sympathetic system in boys with undescended testis.
Malignant Peripheral Nerve Sheath Tumor of the Urinary Bladder in von Recklinghausen Disease
Authors: Kalafatis Panagiotis , Kavantzas Nikolaos , Pavlopoulos Petros M. , Agapitos Emmanuel , Politou Mary , Kranides Aggelos
Published: April 2003

A case of malignant peripheral nerve sheath tumor of the bladder in a 57-year-old man with multiple neurofibromatosis type 1 is presented. The patient had a recent history of a transurethrally resected bladder ganglioneuroma. A probable histogenetic association between these two extremely rare neoplasms is proposed.
Torsion of Spermatocele:A Rare M anifestation
Authors: Takimoto Keita , Okamoto Keisei , Wakabayashi Yoshihiko , Okada Yusaku
Published: April 2003

Torsion of a spermatocele on its pedicle is an extremely rare clinical condition that mimics acute testicular torsion. This rare condition has not been well characterized. Here, we report a case of torsion of a spermatocele. The present case is the 5th case of torsion of a spermatocele and the first report in a patient with a history of scrotal trauma. A tender cystic mass adjacent to the normally appearing testicle in the scrotum is highly significant for the differentiation from other types of acute scrotum. Torsion of a spermatocele should be considered a differential diagnosis of acute scrotum in adolescents and adults.
Effect of Helicobacter pylori Eradication or of Ranitidine plus Metoclopramide on Helicobacter pylori-Positive Functional Dyspepsia
Authors: Alizadeh-Naeeni M. , Saberi-Firoozi M. , Pourkhajeh A. , Taheri H. , Malekzadeh R. , Derakhshan M.H. , Massarrat S.
Published: April 2003

Background: A definitive treatment for functional dyspepsia (FD), and the role of Helicobacter pylori eradication on the course of this disease are controversial. Aim: To investigate the effect of a combination of acid-suppressing and prokinetic drugs or eradication therapy on the course of H. pylori-positive FD. Method: A total of 157 patients with endoscopically-proven H. pylori-positive FD and no response to 4 weeks of antacid therapy were randomly divided into 2 groups. 84 were placed on bismuth subnitrate plus metronidazole and amoxicillin (group A) and 73 received ranitidine and metoclopramide for 4 weeks (group B). The severity of symptoms (7 items) were assessed on a 6-point categorical scale. Group B patients who failed to respond to their medication underwent eradication therapy after 3 months. All patients were followed and assessed for 9 months after the end of therapy by the same clinicians who initiated the therapy. Results: At the end of the medication period, symptom’s score decreased significantly, and to the same extent. At 3-month follow-up moderate or complete response was achieved in 27.4% (group A) and 19.2% (group B) by intention-to-treat analysis. 34 patients of group B, not responding to treatment, underwent eradication therapy and followed as group A. Eradication of H. pylori was successful in 60 of 110 controlled patients (54%). After 9-month follow-up, complete or moderate response was observed in only 30% of 60 patients in whom H. pylori had been eradicated (intention-to-treat analysis), compared to 38% in 50 noneradicated cases (p > 0.05, 95% CI: 19–43 vs. 24–52). Conclusion: Eradication therapy with bismuth compound is effective as ranitidine plus metoclopramide in a subgroup of patients with FD not responding to antacid therapy. There is no difference in improvement between patients cured or not cured from H. pylori infection. This suggests that bismuth compounds were effective in FD when used in the eradication regimen. Combination therapy with acid-suppressing drugs plus prokinetic and bismuth seems to hold promise for FD.
Efficacy of Vascular Endothelial Growth Factor in the Treatment of Experimental Gastric Injury
Authors: Matsui Yutaka , Mitsuyama Keiichi , Tomiyasu Nobuo , Toyonaga Atsushi , Sata Michio
Published: April 2003

Background/Aims: Studies indicate that angiogenesis is important in tissue healing. However, the role of vascular endothelial growth factor (VEGF) in tissue healing has not been established. The aim of the study is to determine whether VEGF has a gastroprotective role in experimental gastric injury. Methods: Acute gastric injury was induced in Sprague-Dawley rats by intragastric administration of 100% ethanol. Expression of gastric VEGF was determined in tissue homogenates by enzyme-linked immunosorbent assay and in paraffin-embedded sections by immunohistochemistry. The effect of systemic administration of anti-VEGF antibodies and recombinant VEGF on injury severity was assessed macroscopically and microscopically. Results: Gastric VEGF concentrations peaked at 6 h and again 3 days after acute injury. The presence of VEGF was demonstrated in epithelial cells and in mononuclear cells. Blocking endogenous VEGF effects with anti-VEGF antibodies exacerbated mucosal injury. Administration of recombinant VEGF after the onset of injury reduced the severity of mucosal injury, irrespective of the timing of initial treatment with VEGF. Immunohistochemical detection of vascular endothelial cells revealed that the VEGF-induced mucosal repair is closely related to the degree of angiogenesis. Conclusion: The results provide strong evidence for the role of VEGF in the repair of tissue damage induced by ethanol. The results also show how VEGF may be used in a clinical setting to treat some acute gastric lesions.
The Role of the Autonomic Nervous System in Liver Regeneration and Apoptosis – Recent Developments
Authors: Kiba Takayoshi
Published: April 2003

Hepatocytes have a great replicative capacity and are capable of repopulating the liver. Previous studies have suggested that the autonomic nervous system regulates liver regeneration and apoptosis. Moreover, the central nervous system modulates them through the autonomic nervous system. The lateral hypothalamus (LH) area and the ventromedial hypothalamus (VMH) nucleus have been studied for their role in the integration of neurohumoral information. The LH is part of the parasympathetic system, while the VMH belongs to the sympathetic system. Lesions of the LH reportedly induced an increase in sympathetic nerve activity, while those in the VMH produced facilitation of vagus nerve activity. Moreover, VMH or LH lesions facilitate hepatic regeneration after partial hepatectomy. Furthermore, the hypothalamus mediates hepatic apoptosis through the autonomic nervous system. Although further studies are needed to define the role clearly, the autonomic nervous system is one of the important factors that regulate liver regeneration and apoptosis.
Age-Related Light Scattering in Rat Lenses Observed in a 2-Year Inhalation Toxicity Study
Authors: Wegener A. , Kaegler M. , Stinn W.
Published: April 2003

Normal light scattering in the eye is determined primarily by the size of α-crystalline molecules. Ageing effects appear as an increase in normal lens light scattering in distinct layers. Subliminal effects of toxins on lens transparency can also cause an increase in light scattering due to protein molecule aggregation before visible opacities appear. Scheimpflug photography of the anterior eye segment with subsequent densitometric image analysis is the method of choice to evaluate such effects. To gain more insight into normal ageing and the potential effects of complex aerosols, a subset of Wistar rats (both sexes) belonging to a larger chronic inhalation toxicity study was documented at baseline and after 2 years with a Topcon SL-45 Scheimpflug camera on Kodak Tmax 400 ISO film. The recording procedure, film development, and microdensitometric image analysis were all performed according to standard protocol. A second group from the same study was documented at the start and after 5 months of a 6-month posttreatment period immediately following the inhalation period. Rats were nose-only exposed for 6 h/day, 7 days/week, for 2 years to low (3 µg/l) or high (10 µg/l) concentrations of room-aged cigarette sidestream smoke or diesel engine exhaust. Control animals were exposed to filtered fresh air. At the baseline examination, there were no relevant differences between groups with respect to corneal density or density of defined layers in the lens capsule (1), epithelium and superficial cortex (2), deep cortex (3), supranuclear layer (4) and nucleus (5). At the 2-year examination, mean corneal density was significantly lower in females than in males. This same trend, although not significant, was also found in most layers of the lens. The most prominent differences in density over time were measured in lens layers 3 and 4, but neither corneal density nor lenticular density showed any consistent treatment-related effects in any of the layers. The data from the posttreatment period confirmed the results of the 2-year study. The depth of the anterior chamber increased constantly over the 2.5-year period, but again, treatment did not affect this. This study provided completely new data on age-related light scattering in the cornea and in defined layers of the lens in long-term toxicity studies in Wistar rats.
Apoptotic Genes in Cancer Therapy
Authors: Opalka Bertram , Dickopp Alexandra , Kirch Hans-Christoph
Published: April 2003

Induction of apoptosis in malignant cells is a major goal of cancer therapy in general and of certain cancer gene therapy strategies in particular. Numerous apoptosis-regulating genes have been evaluated for this purpose. Besides the most prominent p53 gene others include p16, p21, p27, E2F genes, FHIT, PTEN and CASPASE genes. Recently, the potential for therapy of an adenoviral gene, E1A, known for a long time for its apoptosis-inducing activity, has been discovered. In experimental settings, these genes have proven their tumor-suppressive and apoptosis-inducing activity. Clinical trials are currently being performed with selected genes. By far the most studies transfer the p53 gene using retro- or adenoviral vectors. Disease stabilization or other benefits were observed in a limited number of patients when p53 was applied alone or in combination with cytotoxic drugs. A second proapoptotic gene that has entered clinical trials is adenovirus E1A. Here, too, disease stabilization as well as/or local regression in one case have been demonstrated in selected patients. In all cases, side effects were tolerable. To further improve E1A as a therapeutic transgene, we have deleted transforming domains from the adenovirus 5 and 12 13S cDNAs. Mutants were derived which had completely lost their transforming activity in combination with the E1B oncogene but retained a pronounced tumor-suppressive activity. Cells transduced with these constructs showed a highly reduced ability to grow in soft agar, and tumor growth in nude mice could be substantially suppressed. Outgrowing tumors had lost E1A expression when analyzed in Western blots. These E1A constructs may represent valuable tools for cancer gene therapy in the future.
Gene Expression and Biological Significance of Hexokinase in Erythroid Cells
Authors: Murakami Koko , Kanno Hitoshi , Tancabelic Jakica , Fujii Hisaichi
Published: April 2003

Red blood cells (RBCs) express two hexokinase (HK) isoforms, HK-I and HK-R. Both isozymes are generated from the HK-I gene by use of an alternate promoter. Gene structure and exon-intron organization of the HK-I gene have been elucidated from a sequence of three contiguous genomic clones localized at human chromosome 10. The sequence spans about 131 kb, and consists of 25 exons, which include 6 testis- and 1 erythroid-specific exons. HK-R has been shown as an erythroid-specific isozyme whose expression is turned on in the early erythroid-progenitors and is significantly induced during their differentiation. HK-R unfolds major HK activity in immature RBCs and is rapidly degraded during the maturation process. HK-I has a porin-binding domain in its N-terminus. Recent studies have shown that HK isozymes with a porin-binding domain play a role in mitochondrial integrity, suggesting that HK-I-deficient erythroid cells might be eliminated by apoptosis. It is most likely that RBCs are most labile as a result of HK-I/R deficiency since the HK-I gene but not the other isozyme genes are expressed in fetal and adult RBCs.
Effects of Dipyridamole and Aspirin on Shear-Induced Platelet Aggregation in Whole Blood and Platelet-Rich Plasma
Authors: Nakamura T. , Uchiyama S. , Yamazaki M. , Iwata M.
Published: April 2003

Background: Shear-induced platelet aggregation (SIPA) is an important mechanism of thrombosis at arterial bifurcations or stenotic lesions. Methods: We investigated the in vitro effects of dipyridamole (DP) and acetylsalicyclic acid (ASA) on SIPA in whole blood and platelet-rich plasma (PRP). Results: In whole blood, DP 20 µM significantly inhibited SIPA, while DP 5 µM or ASA 5 or 20 µM did not. SIPA in whole blood was, however, significantly inhibited by the combination of 5 or 20 µM of DP and ASA. SIPA in PRP was not inhibited by any concentration of DP or ASA, alone or in combination. Conclusions: These results suggest that DP has an effect on red blood cells and that ASA enhances the inhibitory effect of DP on SIPA in whole blood. These effects may be related to the additive effect of combination therapy with DP and ASA on stroke prevention.
Hemodynamic Flow Patterns Evaluated by Transcranial Color-Coded Duplex Sonography after STA-MCA Bypass for Internal Carotid Artery Occlusion
Authors: Umemura Atsushi , Yamada Kazuo , Masago Atsuo , Kanda Yoshie , Matsumoto Takashi , Shimazu Naoki
Published: April 2003

Extracranial-intracranial (EC-IC) bypass surgery had been widely performed for the treatment of internal carotid artery occlusion. However, it is presently difficult to predict how the bypass flow will contribute to intracranial circulation. We examined intracranial hemodynamics by transcranial color-coded duplex sonography (TCCD) after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and retrospectively studied the relationship between the postoperative contribution of the bypass flow and the preoperative collateral circulation and cerebrovascular perfusion status in 10 patients. Hemodynamics in the MCA detected by TCCD were classified into three patterns. In pattern A, perfusion of the whole MCA area is completely dependent on the bypass flow. In pattern B, perfusion of the M2 segment is dependent on the bypass flow, but perfusion of the M1 segment is independent of the bypass flow. In pattern C, perfusion of the whole MCA area is supplied by collateral flow and the bypass does not function efficiently. Preoperative absence of collateral flow via anterior communicating artery and cerebral perfusion status type 3 (reduced regional cerebral blood flow and regional cerebral vasoreactivity) seems to predict hemodynamic usefulness of the bypass flow after surgery. TCCD is an easy and noninvasive method for evaluating intracranial cerebral circulation after EC-IC bypass surgery.