bluuebunny/crossref_metadata_2025 huggingface dataset:
Controversial Issues of OSA Syndrome Care: The Role of Uvulopalatopharyngoplasty in Improveme nt of Upper Airway Aerodynamics
Authors: Finkelstein Yehuda
Published: April 2003

Objectives: Uvulopalatopharyngoplasty (UPPP) has been performed worldwide for nearly two decades. Despite the relatively large accumulated experience, the indications for its performance, the optimal surgical technique and its success rate are all still unclear. Patients with sleep-related breathing disorders have an abnormal velolinguopharyngeal structure. Indeed, some of them are also symptomatic when they are awake, breathy oral respiration and nasal obstruction being their most common manifestations. The compromised upper airway configuration in wakefulness predisposes them toward development of sleep-related breathing abnormalities. The objective of this article is to clarify the role of UPPP in improving upper airway aerodynamics. Methods: Clinical evidence, intraoral photographs and lateral radiographs are presented to illustrate the role of UPPP in the improvement of upper airway aerodynamics. The anatomic characteristics of patients having disordered upper airway dynamics, indications of performing UPPP and its optimal technique for improving upper airway dynamics during sleep and wakefulness will be presented and discussed along with the relevant literature. Conclusions: UPPP should be considered a method of improvement of upper airway dynamics in selected patients suffering from breathing difficulties including nasal and oral obstruction. Candidates for UPPP should be selected relying on otolaryngologic examination including flexible nasopharyngoscopy, on cephalometry and on polysomnography. UPPP effectiveness depends on rational selection of candidates. Adverse effects and complications can be diminished by a good operative technique.
Secretory Immunity in HIV Infection
Authors: Schneider Thomas , Zippel Thomas , Schmidt Wolfgang , Zeitz Martin , Ullrich Reiner
Published: April 2003

Secretory IgA plays a crucial role in the defense of pathogens at mucosal surfaces. As CD4+ T cells are lost early in the mucosa of human immunodeficiency virus (HIV)-infected patients and as CD4+ T cells play an essential role in the regulation of specific IgA responses to pathogenic agents at mucosal sides, it could be expected that this first line of defense is impaired in HIV-infected patients. Therefore, several studies were undertaken to characterize the humoral immune response at mucosal surfaces. However, the results obtained so far are in part contradictory. For intestinal IgA, reduced, increased and no changes compared to controls were described. The different results may be due to different methods applied. In most studies an abnormal predominance of HIV-specific IgG over IgA response was found in the intestine of HIV-infected patients. Studies on cytomegalovirus-specific intestinal antibodies indicate a complete lack of a specific intestinal IgA response. However, in cryptosporidiosis of HIV-infected patients, diarrhea persists despite a secretory IgA response indicating that other factors are also important for the clearance of this pathogen.
Three-Dimensional Spheroid Model in Tumor Biology
Authors: Santini Maria Teresa , Rainaldi Gabriella
Published: April 2003

It is becoming more and more apparent that monolayer cultures of tumor cells cannot completely represent the characteristics of three-dimensional solid tumors. Consequently, the multicellular tumor spheroid model, which is of intermediate complexity between in vivo tumors and monolayer cultures, was developed. In this review, the major similarities between spheroids and solid tumors are discussed. After a brief survey of the different spheroid culturing techniques, the general morphological and growth characteristics of these systems are examined and compared to solid tumors. Finally, selected studies regarding the use of tumor spheroids to examine cell response to antineoplastic agents and radiation, cell death including both necrosis and apoptosis and cell adhesion in spheroids are reviewed.
Effects of Magnesium on Human Umbilical Arteries: Role of Intracellular Calcium Stores
Authors: Tiritilli Alberto
Published: April 2003

The purpose of this investigation on human umbilical arteries was: (1) to analyze the effects of magnesium (Mg2+) in the prevention of contractions induced by 5-hydroxytryptamine (5-HT), KCl, Bay K 8644 and BaCl2; (2) to determine whether the presence of Mg2+ could modulate the response to caffeine in Ca2+-free medium at 25 and 37°C, and (3) to examine the influence of Mg2+ and temperature in the release of intracellular calcium induced by 5-HT in Ca2+-free medium. Human umbilical arteries were dissected and mounted in organ baths for isometric measurement of force. Our results showed: (1) Mg2+ is a potent inhibitor of smooth muscle contraction of human umbilical arteries caused by 5-HT, KCl, Bay K 8644 and BaCl2, and that this effect might be due to the inhibition of the transmembrane calcium influx. (2) The relaxant effect of Mg2+ did not seem to be mediated by a blockade of the release of calcium from an intracellular store. (3) Moreover, our results suggest an effect of temperature independent from the action of Mg2+ on 5-HT-induced contraction.
Comparative Pharmacology of Zinc Mesoporphyrin and Tin Mesoporphyrin: Toxic Actions of Zinc Mesoporphyrin on Hematopoiesis and Progenitor Cell Mobilization
Authors: Lutton J.D. , Jiang S. , Drummond G.S. , Abraham N.G. , Kappas A.
Published: April 2003

The effects of two synthetic heme analogues, zinc mesoporphyrin (ZnMP) and tin mesoporphyrin (SnMP), on in vivo hematopoietic progenitor cell mobilization and in vitro hematopoiesis were examined in rabbit bone marrow. Rabbits received granulocyte colony-stimulating factor (rhG-CSF) for 7 days in order to mobilize increased numbers of erythroid (BFU-E) and myeloid (CFU-GM) progenitors in peripheral blood. Concurrent treatment of rhG-CSF-treated rabbits with ZnMP reduced mobilization of the numbers of BFU-E (76% inhibition, p < 0.0001) and CFU-GM (70% inhibition, p < 0.005) in peripheral blood. In contrast, SnMP administered at the same concentration had no significant suppressive effect on BFU-E and CFU-GM recruitment. Both metalloporphyrins inhibited bone marrow heme oxygenase activity equally in vivo, thus indicating that both compounds enter bone marrow cells. Direct in vitro addition of ZnMP to normal rabbit bone marrow cultures suppressed BFU-E and CFU-GM growth, whereas SnMP had no such effect. These results confirm, in an in vivo system, our earlier in vitro studies and demonstrate that, at the concentrations studied, ZnMP, in contrast to SnMP, displays toxicity for hematopoietic growth and progenitor cell production.
Effect on Growth of Two Different Dexamethasone Courses for Preterm Infants at Risk of Chronic Lung Disease
Authors: Romagnoli Costantino , Zecca Enrico , Vento Giovanni , Maggio Luca , Papacci Patrizia , Tortorolo Giuseppe
Published: April 2003

A randomized study was designed to evaluate the effects of two different dexamethasone courses on the growth of preterm infants. The first phase included 30 preterm infants at high risk for chronic lung disease (CLD). 15 babies (moderately early dexamethasone group) were treated with dexamethasone for 14 days, from the 10th day of life, and received a total dose of 4.75 mg/kg; 15 babies were assigned to the control group. The second phase included 30 preterm infants at high risk for CLD. 15 babies (early dexamethasone group) were treated with dexamethasone for 7 days, from the 4th day of life, and received a total dose of 2.38 mg/kg; 15 babies were assigned to the control group. All the main clinical baseline characteristics were similar between the groups both in the first and in the second phase. Infants given the two dexamethasone courses showed significantly reduced weight gain during the period of treatment when compared to the respective control group, but they had a weight catch-up soon after the end of treatment. At 30 days of life the weight and length gain of each treated group were similar to those of control infants, but the moderately early dexamethasone group showed a significantly poorer head growth. No differences between the groups were observed at discharge. Dexamethasone treatment induces a slower weight gain which is time-limited to the period of treatment and is followed by a body weight catch-up. However, the poorer head growth detected at 30 days of life in the infants who received a higher dose of dexamethasone could indicate important adverse effects, possibly dose-related, on postnatal brain growth and development.
Pharmacogenetics of the Human Arylamine N-Acetyltransferases
Authors: Grant Denis M. , Goodfellow Geoffrey H. , Sugamori Kim S. , Durette Kristi
Published: April 2003

This review briefly describes current understanding of one of the earliest discovered pharmacogenetic polymorphisms of drug biotransformation affecting acetylation of certain homo- and heterocyclic aromatic amines and hydrazines. This so-called acetylation polymorphism arises from allelic variation in one of the two known human arylamine N-acetyltransferase genes, namely NAT2, which results in production of NAT2 proteins with variable enzyme activity or stability. The NAT1 gene locus encodes a structurally related enzyme, NAT1, with catalytic specificity for arylamine acceptor substrates distinct from that exhibited by NAT2. NAT1 function is also genetically variable in human populations. Clinical and toxicological consequences of genetic variation in NAT1 and NAT2 activity are discussed.
The Role of Perception in the Sound Change of Velar Palatalization
Authors: Guignard Guion Susan
Published: April 2003

Voiceless velar stops may become palatoalveolar affricates before front vowels. This sound change is not only one of the most common types of palatalization, but is a very common sound change in the world’s languages. Nevertheless, we do not have an adequate understanding of how this sound change takes place. Three experiments reported here test the hypothesis that velar palatalization is the result of listeners’ on-line perceptual reanalysis of fast rate speech. It is shown that velars before front vowels are both acoustically and perceptually similar to palatoalveolars. This supports the proposal that velar palatalization is perceptually conditioned.
Effects of Speaking Rate on Thai Tones
Authors: Gandour Jack , Tumtavitikul Apiluck , Satthamnuwong Nakarin
Published: April 2003

Effects of speaking rate on the production of lexical tones (mid, low, falling, high, rising) were investigated in Thai. Stimuli consisted of bisyllabic adverbials (first syllable unstressed, last syllable stressed) elicited in a fixed syntactic and prosodic environment. For unstressed and stressed syllables separately, F₀- and time-normalized, fitted, third-order polynomial curves were used to compare height and slope characteristics of the tonal contours at each of 11 measurement locations between fast and slow speaking rates. Results indicated that speaking rate effects on F₀ contours of unstressed syllables are more extensive, both in terms of height and slope, than those of stressed syllables. In particular, the height of F₀ contours in unstressed syllables was generally higher in the fast speaking rate when compared to the slow. Analysis of the preceding carrier syllable revealed that changes in height of F₀ contours of unstressed syllables may be due primarily to perseverative effects of tonal coarticulation rather than to stress itself. The slope of F₀ contours in unstressed syllables varied depending on range of F₀ movement. Thai tones with substantial F₀ movement (falling, high, rising) exhibited overall flatter slopes at the fast speaking rate; those tones with lesser F₀ movement (mild, low) displayed steeper slopes. Despite extensive changes in height and shape, the five-way tonal contrast appears to be maintained in unstressed syllables at a fast speaking rate albeit in a different tonal space.
Effects of Speaking Rate on the Singleton/Geminate Consonant Contrast in Italian
Authors: Pickett Emily R. , Blumstein Sheila E. , Burton Martha W.
Published: April 2003

A production and a perception experiment were conducted to investigate the effect of speaking rate on the singleton/geminate consonant contrast in Italian. Acoustic analyses were performed of labial and dental singleton and geminate consonants produced in words spoken in isolation and in a sentential context at both a slow and a fast rate of speech. Closure duration was found to discriminate between the two categories of consonants within a given speaking rate. For one speaker, at a fast speaking rate the distribution of closure duration of geminate consonants was identical to the distribution of closure duration of singleton consonants produced in isolation. However, a measure reflecting the relation between two durations, the ratio between consonant duration and preceding vowel duration, discriminated between singletons and geminates both within and across speaking rates. The perception experiment tested whether manipulation of the consonant to vowel ratio would result in perceptual shifts. Results indicated that changing the ratio did affect perception of the geminate/singleton distinction. However, these effects varied greatly across listeners. Taken together, these findings provide support for the view that there are stable acoustic properties corresponding to phonetic features in that even though one type of temporal information, closure duration, is greatly affected by changes in speaking rate, a higher-order relational measure remains constant.
The Identification of English Consonants by Native Speakers of Italian
Authors: MacKay Ian R.A. , Meador Diane , Flege James Emil
Published: April 2003

This study examined the identification of English consonants in noise by native speakers of Italian. The effect of age of first exposure to English was evaluated by comparing three groups of subjects who continued to use Italian relatively often but differed according to their age of arrival (AOA) in Canada from Italy (early: 7, mid: 14, late: 19 years). The subjects in the late group made more errors identifying word-initial consonants than subjects in the early group did; however, the effect of AOA was nonsignificant for word-final stops. The effect of amount of native language (L1) use was evaluated by comparing two groups of early bilinguals who were matched for AOA (mean = 7 years) but differed according to self-reported percentage use of Italian (early: 32%, early-low: 8%). The early bilinguals who used Italian often (early) made significantly more errors identifying word-initial and word-final consonants than native English (NE) subjects did, whereas the early bilinguals who used Italian seldom (early-low) did not differ from the NE subjects. The subjects’ phonological short-term memory was estimated by having them repeat Italian non-words. This was done in an attempt to identify the source of individual differences. The nonword repetition scores were in fact found to independently account for 15% of the variance in subjects’ errors identifying word-final English consonants and 8% of the variance for word-initial consonants.
Treatment of Villous Hypertrophy of the Choroid Plexus by Endoscopic Contact Coagulation
Authors: Philips Matthew F. , Shanno George , Duhaime Ann-Christine
Published: April 2003

Villous hypertrophy of the choroid plexus (VHCP) is a condition characterized by overproduction of cerebrospinal fluid by bilaterally symmetric and enlarged, yet histologically normal, choroid plexi. Medical and surgical therapy have been met with variable success. Traditional shunting procedures often result in failure to correct the underlying problem as well as failure to absorb the large volume of fluid produced. Craniotomy for open surgical resection of the choroid is associated with considerable morbidity. The authors describe a technique of endoscopic contact coagulation as an effective and safe treatment of VHCP. A 14-month-old hydrocephalic girl with VHCP who failed ventriculoperitoneal shunting as the sole treatment of her hydrocephalus presented with increasing ascites. She was successfully treated with ventriculoperitoneal shunting and endoscopic Bugby wire-directed monopolar contact coagulation of the hyperplastic choroid plexus. Postoperatively her head circumference and cognitive development is normal for her age, and her ascites has resolved. Endoscopic contact coagulation of the hyperplastic choroid plexus is a minimally invasive surgical method which treats the cause of the CSF production while avoiding the operative complications of open choroid plexus resection.
Potential Prognostic Factors of Relapse-Free Survival in Childhood Optic Pathway Glioma: A Multivariate Analysis
Authors: Chan Mei-Yoke , Foong Annie P. , Heisey Dennis M. , Harkness William , Hayward Richard , Michalski Antony
Published: April 2003

There is still no consensus on the natural history and optimal management of optic pathway gliomas (OPG) in children. In order to tackle optimal management issues, we need to clearly understand the prognostic and confounding factors affecting relapse of OPG. We propose the use of the Cox proportional hazards (PH) model in a retrospective study of childhood OPG of 69 children seen from 1977 to 1994. We have developed a comprehensive model capable of multivariate analyses and handling time-dependencies. Our studies showed that relapse-free survival improves with increasing age, the presence of neurofibromatosis 1 (NF1), and chemotherapy and radiotherapy (p < 0.0005). Sex, tumor position and surgery do not significantly affect survival. Older children with NF1 have extremely good prognosis. We noted behavior that departs from the strictly proportional hazards model, but results were inconclusive.
Neuroendoscopic Third Ventriculostomy in Patients Less than 1 Year Old
Authors: Buxton N. , Macarthur D. , Mallucci C. , Punt J. , Vloeberghs M.
Published: April 2003

A series of neuroendoscopic third ventriculostomies in children less than 1 year old is reported. Twenty-seven patients underwent the procedure with 21 (77%) failing within a mean of 1.36 months of the procedure. Nineteen were subsequently shunted. The presence or absence of flow through the ventriculostomy and the size of the lateral ventricles on post-operative imaging were not an indicator of success or failure. Only 4 (15%) had a complication of the procedure. Although the majority fail, approximately 1/3 are spared the added morbidity and mortality of having a shunt. With such a low morbidity and zero mortality the procedure has many benefits over shunting. Consequently, neuroendoscopic third ventriculostomy is used in this institution, where possible, rather than a shunt.
Recurrent Tethering: A Common Long-Term Problem after Lipomyelomeningocele Repair
Authors: Colak Ahmet , Pollack Ian F. , Albright A. Leland
Published: April 2003

The authors reviewed the records of 94 patients who underwent initial repair of a lipomyelomeningocele between 1982 and July 1996 at the Children’s Hospital of Pittsburgh to determine the incidence and time course of symptomatic retethering. In each of these patients, the initial operative goals were to microsurgically debulk as much of the lipoma as possible to allow the conus to move freely within the spinal canal, to divide any tethering arachnoidal adhesions, to close the pia if possible and to reconstitute a capacious thecal sac, using a dural graft if necessary. With a median follow-up of 58 months, 19 of these patients (20.2%) required 28 subsequent operations for symptomatic retethering. Median time between the initial procedure and reoperation for retethering was 52 months. The primary complaint of 12 patients was intractable low-back or leg pain. Other common symptoms were progressive bowel and/or bladder dysfunction, deterioration of motor function and foot deformities. The decision to reoperate was based predominantly on the clinical situation of the patient; magnetic resonance imaging was used to confirm the location and extent of tethering. Patients with transitional lipomas had a significantly higher frequency of symptomatic retethering than those with caudal or dorsal lesions (p < 0.05). No other clinical or technical feature correlated with an increased frequency of retethering. In particular, none of a variety of types of dural graft materials appeared to entirely prevent symptomatic retethering. Following reoperation, pain complaints resolved and many of the other symptoms improved partially or resolved completely. Although the long-term results were also favorable in the majority of patients, a small subgroup (n = 6) exhibited repetitive symptomatic tethering that proved increasingly difficult to treat. We concluded that symptomatic retethering is a common problem in children with lipomyelomeningoceles, even after an adequate initial operation. To date, no type of graft material has been shown to entirely prevent this problem. Close long-term surveillance of such patients is required to allow detection and treatment of symptomatic retethering.
Reduced Hindbrain Herniation after Intrauterine Myelomeningocele Repair: A Report of Four Cases
Authors: Tulipan Noel , Hernanz-Schulman Marta , Bruner Joseph P.
Published: April 2003

Background: It has been theorized that fetal myelomeningocele repair may reduce ongoing intrauterine injury and perhaps allow healing and regeneration of dysplastic neural tissue. We report on the postnatal imaging studies of the first 4 patients to have undergone intrauterine myelomeningocele repair at our institution. Methods: Each of the 4 patients underwent postnatal sonographic and MRI. In addition, the postnatal ultrasounds of these 4 were compared to a group of retrospective controls. Results: MRI scans of the 4 experimental subjects revealed no evidence of hindbrain herniation while other stigmata of the Chiari-II malformation persisted. In comparison to the retrospective controls this absence of herniation was distinctly unusual. Conclusion: Intrauterine myelomeningocele repair may reduce the degree of hindbrain herniation normally seen in patients with myelomeningocele. This raises the possibility that intrauterine repair may decrease the morbidity associated with the Chiari type-II malformation including brainstem dysfunction, hydrocephalus and syringomyelia.
A Piglet Model for Evaluation of Cerebral Blood Flow and Brain Oxidative Metabolism during Gradual Cerebral Perfusion Pressure Decrease
Authors: Bauer Reinhard , Walter Bernd , Torossian Alexander , Fritz Harald , Schlonski Olaf , Jochum Thomas , Hoyer Dirk , Reinhart Konrad , Zwiener Ulrich
Published: April 2003

A piglet model was developed to study the effect of epidural volume expansion on cerebral perfusion pressure (CPP) by stepwise elevating intracranial pressure (ICP). Mean arterial blood pressure (ABP) was strictly maintained using an extracorporeal ABP controller. Two-week-old piglets (n = 10) were studied by surgically placing an epidural balloon over the right parietal region and gradually increasing the inflation to increase ICP to 25, 35 and 45 mm Hg, maintaining each pressure level for 30 min. Regional cerebral blood flow was measured using the colored microsphere technique, and cerebral oxygen delivery and cerebral metabolic rate of oxygen were calculated at baseline conditions and after reaching ICP levels of 25, 35 and 45 mm Hg. The results showed that this model of epidural volume expansion reproducibly reduces CPP to 70, 50 and 33% of baseline CPP values with elevation of ICP, and that the physiological variables remained stable throughout each increase in ICP. We conclude that the model simulates the effects of an acute intracranial focal mass expansion and is well suited for the evaluation of different therapeutical strategies for increased ICP in newborns and infants.
Pediatric Blunt Carotid Injury: A Review of the National Pediatric Trauma Registry
Authors: Lew Sean M. , Frumiento Carmine , Wald Steven L.
Published: April 2003

Blunt carotid injury (BCI) is an uncommon yet potentially devastating entity which has received little attention in the pediatric literature. In an attempt to better characterize pediatric BCI, a review of the National Pediatric Trauma Registry was performed. Records were obtained from all children diagnosed with internal or common carotid injury associated with blunt trauma. The incidence of BCI was 0.03% (15 of 57,659 blunt trauma patients). Variables examined included: age, gender, mechanism of injury, associated injuries, various injury severity scores, and outcome. Various injuries were associated with an increase in BCI incidence including chest trauma (4-fold), combined head and chest trauma (6-fold), basilar skull fractures (4-fold), intracranial hemorrhage (6-fold), and clavicle fractures (8-fold). Thirty-three percent of the patients diagnosed with BCI suffered neurological complications directly attributable to their carotid injuries. Current practices regarding screening, diagnosis, and treatment are reviewed.
The Bifrontal Olfactory Nerve-Sparing Approach to Lesions of the Suprasellar Region in Children
Authors: Srinivasan Jayashree , Dailey Andrew T. , Berger Mitchel S.
Published: April 2003

Suprasellar masses in children include lesions such as craniopharyngiomas and germ cell neoplasms. The difficult location of these lesions and their proximity to important neural and vascular structures pose challenges to resection. We operated on 14 patients using a bifrontal craniotomy with removal of both orbital rims to provide access to suprasellar masses, even those with significant extension into the third ventricle. A complete resection was possible in 8/14 patients and 8/10 craniopharyngiomas. In 13 patients, the optic nerves were identified and preserved, and vision was stable or improved postoperatively. Postoperatively, 1 patient with hydrocephalus developed a CSF leak which was successfully treated with a ventriculoperitoneal shunt. No patient had a cosmetic defect related to orbital rim removal. The bifrontal approach used here enhanced the exposure of the suprasellar region and minimized manipulation of the optic apparatus and the carotid arteries. It may be used alone, or in conjunction with other approaches, to resect lesions in the suprasellar region.
The Shunt Design Trial: Variation in Surgical Experience Did Not Influence Shunt Survival
Authors: Kestle J. , Milner R. , Drake J.
Published: April 2003

Introduction: An international multicenter randomized trial comparing standard pressure differential valves, Orbis Sigma valves and PS Medical Delta valves for children with newly diagnosed hydrocephalus failed to show a difference in the time to first shunt failure. Surgeons’ prior experience with the three valves varied. This analysis was performed to assess whether lack of surgical experience with any of the valves could explain the overall negative result. Methods: (1) Shunt survival was compared at high- and low-volume centers. (2) The 1-year shunt survival rates (±95% confidence interval) for patients entered in the first quarter and the last quarter of the 25-month accrual period were compared (for all patients, and for each shunt). Results: Survival curves for high- and low-volume centers were similar. Ninety of the 344 randomized patients were accrued in the first quarter and 93 in the last quarter. The 1-year shunt survival for all patients entered in the first quarter was 72% (±11%) compared to 64% (±10%) for patients entered in the last quarter. The shunt-specific results were 66% (±20%) compared to 54% (±20%) for Delta valve patients, 75% (±20%) compared to 70% (±17%) for standard valve patients and 76% (±18%) compared to 66% (±16%) for Orbis Sigma patients. Discussion: Shunt survival did not improve as surgeons accumulated experience over the course of the study. Although participating surgeons had varying levels of experience with the different shunts at the start of the trial, this does not appear to explain the overall negative trial result.
Spontaneous Thrombosis of Vein of Galen Aneurysmal Malformation
Authors: Nikas Demetrios C. , Proctor Mark R. , Scott R. Michael
Published: April 2003

Two cases of aneurysmal malformations of the vein of Galen (AVG) with spontaneous thrombosis are reported. Angiogram and MRI before thrombosis demonstrated AVGs with slow arteriovenous shunts and associated stagnation of contrast in the venous sac secondary to severe outflow restriction. Based on these findings, one patient was managed conservatively, and the other underwent placement of a ventriculoperitoneal shunt. Surveillance of the lesions with subsequent MRIs revealed spontaneous thrombosis of the AVGs with excellent clinical outcomes. Proposed mechanisms of spontaneous thrombosis include slow flow shunts, obstruction of the venous outflow or obstruction of the feeding artery. Similar cases in the literature are reviewed with special emphasis on diagnostic tests, symptomatology, mechanisms of thrombosis and therapeutic options.
Abdominal Pseudocysts Complicating CSF Shunting in Infants and Children
Authors: Salomão J. Francisco , Leibinger René D.
Published: April 2003

Abdominal pseudocysts (APC) are rare complications of ventriculoperitoneal shunting for hydrocephalus. The authors studied retrospectively a series of 18 pediatric patients with APC. Signs and symptoms of shunt dysfunction were observed in 15 (83.3%), abdominal complaints in 10 (55.5%) and fever in 6 (33.3%). Prior to the diagnosis of APC, 2 patients suffered exploratory laparotomies due to important abdominal signs and symptoms. Ultrasonography was diagnostic in all cases and proved to be the method of choice in the evaluation of APC. Our series suggest that APC are strongly related to hardware infection and in some cases can result from a previous shunt infection not completely cured. The bacteriological examination of the tip of the peritoneal catheter was a reliable indicator of infection. According to our data, the best treatment seems to be the removal of the shunt system and the insertion of an external ventricular drainage. In our experience, almost half of the patients had a ventriculoatrial shunt replacing the peritoneal shunt at the end of the treatment.
Tectal Gliomas: Natural History of an Indolent Lesion in Pediatric Patients
Authors: Bowers Daniel C. , Georgiades Christos , Aronson Leslie J. , Carson Benjamin S. , Weingart Jon D. , Wharam Moody D. , Melhem Elias R. , Burger Peter C. , Cohen Kenneth J.
Published: April 2003

The mesencephalic tectal glioma is a distinctive form of brain stem glioma with an unusually benign clinical course. Periaqueductal location, lack of contrast enhancement, and long periods of stability are classic features. The clinical management of these lesions, especially at the time of radiographic enlargement varies widely in the published literature. It is unclear whether these progressive lesions need to be treated. Accordingly, clinical and radiologic features of 7 patients were reviewed, with attention to the clinical course of the disease after radiologic enlargement. The age at diagnosis ranged from 3.3 to 16.6 years. Six of 7 had MRI tumor enlargement beginning 0.3–5.7 years after initial diagnosis. One of these 6 patients had radiographic progression coupled with a new clinical symptom which was treated with stereotactic radiation therapy. The remaining 5 patients with MRI progression and normal neurological exams were not treated and remain free of new neurologic deficits 1.8–6.9 years after the first radiographic tumor enlargement. The results suggest that pediatric tectal gliomas are a very low-grade lesion. Conservative management in the absence of new clinical symptoms could be argued, reserving radiotherapy or chemotherapy for clinical progression.
Pediatric Peri-Insular Hemispherotomy
Authors: Kestle J. , Connolly M. , Cochrane D.
Published: April 2003

A number of surgical procedures are available for patients with epilepsy associated with diffuse hemispheric disorders. In this report, 16 pediatric patients had hemispherectomy: 5 underwent hemidecortication and 11 had peri-insular hemispherotomy. The clinical records were retrospectively reviewed, and the results and complications of the procedures were documented. The procedure was feasible in very young children and in the absence of ventriculomegaly.
Fibromyxoma of the Petrous Apex
Authors: Srinivasan U.S.
Published: April 2003

The common petroclival bony tumors are chordoma and chondrosarcoma. Myxoma of the bone occurs only in the facial bones, and it has not been reported in skull bones. The computed tomographic scanning, magnetic resonance imaging and intraoperative characteristics of a case of fibromyxoma of the petrous bone in a 14-year-old girl are described.
Postural Changes in Intracranial Pressure in Chronically Shunted Patients
Authors: Barami Kaveh , Sood Sandeep , Ham Steven D. , Canady Alexa I.
Published: April 2003

A subset of hydrocephalic patients with indwelling shunts become symptomatic when they are upright and active. Intracranial pressure (ICP) measurements in these patients have shown a significant drop in pressure when the patient is upright with return to normal levels when the patient is supine. In 20 chronically shunted hydrocephalic patients who previously had no siphon protection devices, ICP changes in supine and upright position were studied at the time when the patient had external ventriculostomy for treatment of shunt infection. Our hypothesis was that these patients might display rapid changes in ICP from fluid shifts occurring in non-CSF compartments. To minimize the effects of hysteresis, drift and zero-point error, measurements were made using a fluid manometer rather than a strain gauge pressure transducer. The pressure-volume index was estimated using the standard technique of bolus injection. Intracranial CSF volume was estimated on CT scans. The fluid shift was calculated using a mathematical model of the CSF compartment that incorporates negative pressure and volume components that permits simulation of siphoning. Sixteen patients had small, slit ventricles; 3 patients had moderate-sized ventricles and in 1 patient the ventricular size was normal. The average intracranial CSF volume estimated on CT scan was 12 cm3. There was a mean drop in ICP in the upright position of 159 mm H2O. The mean PVI of 42 ml suggested a volume displacement out of proportion to the available intracranial CSF volume. Based on these findings, we conclude that even in the absence of drainage through the shunt, chronically shunted patients still display a fall in ICP when assuming the upright position. This raises the possibility of fluid shifts other than of CSF through nonshunt pathways. Possible mechanisms involving altered CSF-venous system interaction are discussed.
Clinical Correlates of Major Depression in Cushing’s Disease
Authors: Sonino Nicoletta , Fava Giovanni A. , Raffi Anna Rita , Boscaro Marco , Fallo Francesco
Published: April 2003

Major depression is a common, life-threatening complication of Cushing’s syndrome, with no significant differences between pituitary-dependent and -independent forms. Little is known about the clinical correlates of depression; in particular, whether patients with Cushing’s disease and major depression show some clinical features that are distinctive compared to those who are not depressed. The occurrence of major depression according to DSM-IV criteria was ascertained in 162 patients with pituitary-dependent Cushing disease. Major depression occurred in 88 of the patients (54%). It was significantly associated with older age, female sex, higher pretreatment urinary cortisol levels, relatively more severe clinical condition, and absence of pituitary adenoma. Patients with Cushing’s disease and depression appeared to suffer from a more severe form of illness, both in terms of cortisol production and clinical presentation, compared to those who were not depressed. Because of these connections, the presence of depression is an important clinical feature that should not be neglected. The findings in this study may have implications for a better understanding of the pathophysiological role of depression associated with medical illness.
Atypical Bipolar II Depression Compared with Atypical Unipolar Depression and Nonatypical Bipolar II Depression
Authors: Benazzi Franco
Published: April 2003

Aim of the study was to find out whether atypical bipolar II depression was distinct from both atypical unipolar depression and nonatypical bipolar II depression. Seventy-nine consecutive atypical bipolar II depressed outpatients were compared with 42 consecutive atypical unipolar depressed outpatients and with 53 consecutive nonatypical bipolar II depressed outpatients. Among the variables studied (age at intake, age at onset, female gender, duration of illness, psychosis, comorbidity, chronicity, recurrences, severity), age at intake and onset were significantly lower in the atypical bipolar II group than in the other groups. The other variables, apart from psychosis, were not significantly different. Findings suggest that atypical bipolar II depression may have an age at onset different from that of atypical unipolar depression and nonatypical bipolar II depression. As different ages at onset may identify distinct subtypes of depression, this finding might suggest that atypical bipolar II depression may be distinct from both atypical unipolar depression and nonatypical bipolar II depression.
Clinical Models of Schizophrenia: A Critical Approach to Competing Conceptions1
Authors: Peralta Victor , Cuesta Manuel J.
Published: April 2003

Clinical and etiopathological heterogeneity in schizophrenia has been recognized long ago. The main hypothesis held in this report is that as long as we are not able to disentangle the heterogeneity question at the clinical level, it is not likely that heterogeneity at the etiological and pathophysiological levels may be solved. While the description of symptoms and signs of schizophrenia has remained mainly unchanged over the years, the way in which authors have articulated the varied phenomenological manifestations has been very unequal, thus rendering different views of schizophrenia across periods and countries. We still lack a global and comprehensive model to understand clinical heterogeneity in schizophrenia. In absence of compelling evidence for supporting either a categorical or a dimensional view, it is necessary to integrate and empirically compare competing approaches. The use of a polydiagnostic approach on the one hand, and a multidimensional approach on the other (the polydiagnostic-multidimensional paradigm), seems to be a promising strategy to better understand the heterogeneity of schizophrenia.
Relapsing Polychondritis
Authors: Özbay Bülent , Dilek Fatma Hüsniye , Yalçınkaya İrfan , Gencer Mehmet
Published: April 2003

In this article, we report on a 40-year-old man with relapsing polychondritis (RP) of the tracheobronchial tree without clinical manifestations of other systems including nasal septum and earlobe cartilage involvement. The illness was diagnosed histologically, and treatment with procaine penicillin was successful. RP is an unusual systemic disorder characterized by widespread inflammation and destruction of cartilage tissues. The main cause is usually autoimmune. In RP various clinical manifestations including nasal chondritis, arthritis, scleritis, damage to tracheal and bronchial cartilage, and aortic, cardiac, and renal involvement may occur. Isolated tracheobronchial involvement is very rare. The diagnosis must be based on a combination of clinical and pathologic features. If diagnosed early, appropriate treatment may prevent life-threatening airway obstruction.
A Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with Pleuritis Caused by OK-432
Authors: Hanagiri Takeshi , Muranaka Hiroyuki , Hashimoto Mitunori , Nagashima Akira
Published: April 2003

We here report a case presenting with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after having been treated for pleurodesis with OK-432, which is a lyophilized preparation of an attenuated strain of Streptococcus pyogenes. The patient, who had undergone a subtotal esophagectomy 4 years previously, was referred to our department after the diagnosis of a metastatic lung tumor. A right lower lobectomy of the lung was performed, and prolonged air leakage from a pulmonary fistula thereafter developed because of the dissection of severe pleural adhesion. OK-432 (5 klinische einheiten) was administered to the pleural cavity 3 times. On the 13th postoperative day, the patient began to complain of general fatigue and nausea. SIADH was diagnosed based on laboratory findings such as hyponatremia, serum hypo-osmolality and a high excretion of sodium in the urine. A restriction of the fluid intake with a sodium supplement resulted in the return to a normal serum level within 2 weeks. We therefore concluded that the intrapleural instillation of OK-432 had apparently caused SIADH in this case, because no other causes could be found.
Prolonged Prophylaxis with Unfractioned Heparin Is Effective to Reduce Delayed Deep Vein Thrombosis in Total Hip Replacement
Authors: Manganelli Daniela , Pazzagli Marcello , Mazzantini David , Punzi Giovanni , Manca Mario , Vignali Claudio , Palla Alessandro , Troiani Riccardo , Rossi Giuseppe , Palla Antonio
Published: April 2003

The aim of this study was to assess the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) until 45 days after elective total hip replacement (THR) and the efficacy of prolonged unfractioned heparin (UH) prophylaxis up to postoperative day 30. To this end 79 of 96 patients admitted consecutively to the University Hospital of Pisa for THR were randomly assigned to short- or long-term UH prophylaxis. Sixty-one patients completed the study: 28 of them received short-term prophylaxis (subcutaneous UH 15,000 IU/24 h for 15 days) and 33 prolonged prophylaxis (subcutaneous UH 15,000 IU/24 h for 30 days). Lower limb phlebography was performed in all patients on day 45 after THR. DVT was demonstrated in 10 (16.3%) cases after hospital discharge. Among them, 2 patients also had symptomatic PE. The incidence of DVT was 21.4% in short- and 12.1% in long-term UH-treated patients. The incidence of only proximal DVT was 17.8% in short- and 3.0% in long-term UH-treated patients; although the difference was only close to significance (p = 0.085), the relative risk of developing proximal DVT was about six times greater in the former group of patients. We concluded that the risk for thromboembolism persists at least until 45 days after surgery in patients subjected to THR. Prophylaxis with UH given up to postoperative day 30 appears more effective and safer in reducing the delayed thromboembolic risk compared to prophylaxis with UH given up to discharge only.
Acute Effects of Nebulized Salbutamol on Resting Energy Expenditure in Patients with Chronic Obstructive Pulmonary Disease and in Healthy Subjects
Authors: Creutzberg E.C. , Schols A.M.W.J. , Bothmer-Quaedvlieg F.C.M. , Wesseling G. , Wouters E.F.M.
Published: April 2003

This study investigated the contribution of a single dose of salbutamol by nebulizer to the increased resting energy expenditure (REE) frequently found in patients with chronic obstructive pulmonary disease (COPD) (n = 22), in comparison with a younger (n = 15) and an older healthy (n = 10) control group. The rise in REE after nebulization of 5 mg salbutamol was significantly higher in younger (11.4%) compared to older healthy subjects (5.7%; p < 0.05) and patients with COPD (4.2%; p < 0.001), which also accounted for the increase in heart rate and the drop in the respiratory quotient. No differences in metabolic effects were found between older control subjects and patients with COPD. In conclusion, despite significant improvements in FEV1 and airway resistance, a significant rise in REE was observed in patients with COPD after nebulization of salbutamol. The metabolic effects of salbutamol were however not sufficient to explain totally the elevated REE seen in these patients.
Casual Recognition of an Azygous Continuation of the Inferior Vena cava in a Patient with Lung Cancer
Authors: Martínez García M.A. , Pastor A. , Ferrando D. , Nieto M.L.
Published: April 2003

Anomalous continuation of the inferior vena cava with an azygous vein is a rare vacular anomaly. The enlarged venous system may simulate adenopathies or mediastinal and retroperitoneal masses on the radiographs. We describe the case of a patient with lung cancer – a pathological condition which may cause adenopathies at these sites – and a dilated azygous-hemiazygous system resulting from failure of formation of the hepatic segment of the inferior vena cava.
The Lung in the Immunocompromised Patient
Authors: Baughman RobertP.
Published: April 2003

Pulmonary infections are a major cause of morbidity and mortality in the immunosuppressed patient. Among the infections encountered are Pneumocystis carinii, mycobacterial, fungal, and bacterial infection. In this review, we will discuss these various possible infections, their frequency of occurrence, and their clinical presentation in the various immunosuppressed groups.
Contribution of Lung Function to Exercise Capacity in Patients with Chronic Heart Failure
Authors: Dimopoulou Ioanna , Tsintzas Orestis K. , Daganou Maria , Cokkinos Dennis V. , Tzelepis George E.
Published: April 2003

Background: The importance of exercise capacity as an indicator of prognosis in patients with heart disease is well recognized. However, factors contributing to exercise limitation in such patients have not been fully characterized and in particular, the role of lung function in determining exercise capacity has not been extensively investigated. Objective: To examine the extent to which pulmonary function and respiratory muscle strength indices predict exercise performance in patients with moderate to severe heart failure. Methods: Fifty stable heart failure patients underwent a maximal symptom-limited cardiopulmonary exercise test on a treadmill to determine maximum oxygen consumption (VO2max), pulmonary function tests and maximum inspiratory (PImax) and expiratory (PEmax) pressure measurement. Results: In univariate analysis, VO2max correlated with forced vital capacity (r = 0.35, p = 0.01), forced expiratory volume in 1 s (r = 0.45, p = 0.001), FEV1/FVC ratio (r = 0.37, p = 0.009), maximal midexpiratory flow rate (FEF25–75, r = 0.47, p < 0.001), and PImax (r = 0.46, p = 0.001), but not with total lung capacity, diffusion capacity or PEmax. In stepwise linear regression analysis, FEF25–75 and PImax were shown to be independently related to VO2max, with a combined r and r2 value of 0.56 and 0.32, respectively. Conclusions: Lung function indices overall accounted for only approximately 30% of the variance in maximum exercise capacity observed in heart failure patients. The mechanism(s) by which these variables could set exercise limitation in heart failure awaits further investigation.
Crohn’s Disease Mimicking Sarcoidosis in Bronchoalveolar Lavage
Authors: Bewig Burkhard , Manske Ingrid , Böttcher Heidi , Bastian Andreas , Nitsche Rolf , Fölsch Ulrich R.
Published: April 2003

Granulomatous disorders like sarcoidosis or Crohn’s disease are commonly associated with extrapulmonary or extraintestinal manifestations which occasionally may represent the only symptoms. We describe a 28-year-old female patient suffering from atypical erythema nodosum and arthritis. Although the chest x-ray was unremarkable bronchoalveolar lavage revealed lymphocytic alveolitis with an elevated CD4/CD8 ratio of 8 and 11.4 at repeated examinations suggesting a diagnosis of sarcoidosis. Further diagnostic workup included endoscopy of the bowel. The macroscopic aspect and histology of the terminal small bowel and colon ascendens indicated Crohn’s disease. The patient recovered on steroids and sulfasalazine. Six months later she developed a perianal abscess for which she needed surgery supporting the diagnosis of Crohn’s disease. This is the first case of a significantly (>6) elevated CD4/CD8 ratio in Crohn’s disease previously regarded as highly specific for sarcoidosis.