bluuebunny/crossref_metadata_2025 huggingface dataset:
A Phase II Study of Irinotecan Alternated with a Weekly Schedule of Oxaliplatin, High-Dose Leucovorin and 48-Hour Infusion 5-Fluorouracil in Patients with Advanced Colorectal Cancer
Authors: Rosati Gerardo , Tucci Aniello , Rinaldi Antonio , Colarusso Diodoro , Pizza Carmine , Reggiardo Giorgio , Manzione Luigi
Published: August 2004

Objectives: To evaluate the safety and efficacy of irinotecan (CPT-11) alternated with a weekly treatment for 4 weeks of oxaliplatin (L-OHP), high-dose leucovorin (LV) and a 48-hour 5-fluorouracil infusion (5-FU48h) as first-line chemotherapy for patients with advanced colorectal cancer (ACC). Patients and Methods: Previously untreated patients with ACC received chemotherapy consisting of a weekly treatment for 4 weeks of L-OHP (65 mg/m2), high-dose LV (150 mg/m2) followed by a 5-FU48h infusion (2,300 or 1,800 mg/m2) alternated with CPT-11 (350 mg/m2). A cycle was to be performed every 8 weeks. Treatment was continued up to tolerance, disease progression or patient refusal. Forty consecutive patients with measurable ACC, aged 26–70, performance status ≤2, entered our study. Results: Six complete and 17 partial responses were observed (overall response rate, 57.5%; 95% confidence interval, CI: 38.8–71.1%); an additional 35% of the patients had stable disease. The median duration of response was 10.9 months (range, 6.5–30+ months). The median time to progression and the median overall survival time were 11.4 (95% CI: 10.4–12.3) and 20.3 (95% CI: 16.4–23.7) months, respectively. At the median follow-up period of 24 months, 17 patients (42.5%) are still alive. After a median number of 4 cycles, one toxic death occurred. The incidence of grade 3–4 toxicity per patient in any cycle was: stomatitis 7.5%, nausea/vomiting 2.5% and diarrhea 45% for the infusional part, neutropenia 37.5%, anemia 2.5%, thrombocytopenia 5%, alopecia 5% and diarrhea 10% for the CPT-11 part of the regimen. Gastrointestinal toxicity was different according to the dose of 5-FU. Serious adverse events occurred most frequently when 5-FU was given at a dose of 2,300 mg/m2 with a high incidence of grade 3–4 diarrhea (72.2%) and stomatitis (16.6%), and led to dose reduction of 5-FU in 13 of 18 patients (72.2%). For 22 patients who started 5-FU at a dose of 1,800 mg/m2, a dose reduction of 5-FU was necessary only 5 times (22.7%). No patient discontinued treatment because of severe neurotoxicity. Conclusions: The activity of our alternating regimen of L-OHP/LV/5-FU48h and CPT-11 for not previously treated ACC patients is counterbalanced by a high toxicity and a inconvenient schedule.
B-raf Exon 15 Mutations Are Common in Primary Melanoma Resection Specimens but Not Associated with Clinical Outcome
Authors: Deichmann Martin , Thome Marianne , Benner Axel , Näher Helmut
Published: August 2004

Downstream of Ras, the serine/threonine kinase B-raf has recently been reported to be mutated, among other carcinomas, in a majority of melanoma cell lines with a preponderance of mutations within the kinase domain including the activating V599E transition. We therefore investigated a representative number of 50 primary melanoma resection specimens for the presence of mutations within the activation segment (exon 15) of the B-raf kinase domain. Applying polymerase chain reaction and single-strand conformation polymorphism gel electrophoresis, followed by DNA cloning and sequencing, we found 19 cases (38%) to harbor somatic B-raf exon 15 mutations. With respect to the B-raf protein sequence, the V599E mutation was predicted in 63% of these positive melanomas, followed in frequency by the V599K transition (31%). Detection of B-raf exon 15 mutations or prediction of the activating mutation V599E were not statistically associated with the risk for subsequent metastasis in the follow-up of patients. Altogether, the B-raf oncogene is affected in a substantial subset of melanoma resection specimens. As B-raf alterations possibly affect melanocyte-specific pathways controlling proliferation and differentiation, activation of this oncogene may contribute to the development of melanoma.
Clinical Implications of Expression of ETS-1 Related to Angiogenesis in Metastatic Lesions of Ovarian Cancers
Authors: Fujimoto Jiro , Aoki Ikumi , Toyoki Hiroshi , Khatun Sufia , Sato Eriko , Sakaguchi Hideki , Tamaya Teruhiko
Published: August 2004

Objective: ETS-1 has been identified as a proto-oncogene and a transcription factor for tumor angiogenesis, which is essential for the growth, invasion and metastasis of solid tumors. The aim is to investigate the clinical implications of ETS-1 expression in peritoneal metastatic lesions of ovarian cancers. Methods: In primary tumors and peritoneal metastatic lesions from 30 patients with stage III ovarian cancers, ETS-1 histoscores and ets-1 mRNA levels were determined by immunohistochemistry and competitive RT-PCR-Southern blot analysis using recombinant RNA, respectively. Results: Immunohistochemical staining revealed that ETS-1 was expressed in the cancer cells and vascular endothelial cells. ETS-1 histoscores in the endothelial cells and ets-1 mRNA levels were significantly (p < 0.05) increased in 20 of 30 peritoneal metastatic lesions of ovarian cancers. There was a significant correlation between microvessel counts (MVCs) and ETS-1 histoscores in the endothelial cells (p < 0.001) and between MVCs and ets-1 mRNA levels in the primary tumor and the peritoneal metastatic lesion of ovarian cancers (p < 0.001). Furthermore, the 24-month survival rate of patients with significantly increased ets-1 mRNA level (2/20, 10%) was significantly (p < 0.01) lower than that of patients with no change in the level (6/10, 60%) from the primary tumor to the peritoneal metastatic lesion. Conclusions: ETS-1 might be associated with peritoneal metastasis dominantly as an angiogenic mediator and additionally as an oncogene product to activate tumor invasion in ovarian cancers.
Testicular Torsion: A Perspective from the Middle East
Authors: Al-Hunayan A.A. , Hanafy A.M. , Kehinde E.O. , Al-Awadi K.A. , Ali Y.M. , Al-Twheed A.R. , Abdulhalim H.
Published: August 2004

Objective: To report our experience in the management of testicular torsion with emphasis on seasonal variation, salvage rate and the status of the torted testis 3–6 months after orchidopexy. Subjects and Methods: Seventy-five patients with a presumptive diagnosis of testicular torsion, who presented to our hospital between January 1999 and December 2002, were included in the study. Following scrotal exploration, 63 patients were found to have testicular torsion. Of these, 11 with nonviable testes had orchiectomy while 52 with viable testes had orchidopexy. Both groups of patients had simultaneous contralateral orchidopexy. Patients who had orchidopexy were followed up 3-monthly by testicular ultrasound to assess the volume of the affected testis. Results: Sixty-three patients were confirmed to have testicular torsion. The average number of new cases in the winter was 6.7 compared to 4 in the summer. Fifty-two patients underwent orchidopexy to give an operative salvage rate of 82.5%. Of 51 patients in whom the duration of torsion was less than 24 h, 1 (2.0%) had a nonviable testis, whereas of 12 patients in whom the duration of torsion was more than 24 h, 10 (83.3%) had a nonviable testis. After a minimum follow-up of 3 months for patients who had orchidopexy, 7 (13.5%) developed testicular atrophy. The incidence rate was estimated to be 7.9 cases per 100,000 population. Conclusion: The highest incidence was during the cold season. The outcome of surgical management of testicular torsion was dependent on the duration of torsion.
Vitamin D Receptor Alleles, Bone Mineral Density and Turnover in Postmenopausal Osteoporotic and Healthy Women
Authors: Duman Belgin Süsleyici , Tanakol Refik , Erensoy Nevin , Öztürk Melek , Yilmazer Selma
Published: August 2004

Objective: Vitamin D receptor (VDR) gene polymorphisms and bone metabolic markers were investigated as potential genetic markers for osteoporosis in postmenopausal Turkish women. The relationship between their VDR gene polymorphisms and bone states was determined. Materials and Methods: Restriction fragment length polymorphisms at the VDR gene locus (i.e., for BsmI, ApaI, and TaqI) was investigated in 75 postmenopausal osteoporotic (53.16 ± 1.31 years) and 66 healthy (52.62 ± 1.69 years) Turkish women and the genotypes were related to bone mineral density (BMD) at femoral neck (FN), lumbar spine (L1–4), trochanter, Ward’s triangle (Ward’s) and metabolic parameters of bone turnover. Results: In osteoporotic women, TaqI genotype-related differences of the VDR gene were found to be significant at all BMD sites; TT genotype had higher L1–4 BMD values than Tt and tt (p < 0.05); tt genotype had significantly lower BMD at FN (p < 0.05), trochanter (p < 0.01), and Ward’s (p < 0.05) compared to TT genotype. The tt genotype was found to be associated with higher (p < 0.05) serum osteocalcin levels compared to Tt and TT genotypes in the osteoporotic women, whereas no such association was found for the healthy women. Conclusion: Our data showed an association between VDR TaqI genotype and BMD at the FN, L1–4, trochanter and Ward’s triangle in nonobese postmenopausal osteoporotic women. Thus the VDR gene Taql polymorphism modulates differences in BMD in the postmenopausal osteoporotic women.
Effects of Intravenous and Intracerebroventricular Theophylline on Hypoxic Ventilatory Depression in Anesthetized Cats
Authors: Yelmen N.K. , Turgut G. , Şahin G. , Oruç T.
Published: August 2004

Objective: The present study was undertaken to investigate the ventilatory response due to sustained isocapnic moderate hypoxia and the possible role of adenosine in hypoxic depression in anesthetized cats. Materials and Methods: Cats anesthetized with pentothal sodium (30 mg kg–1 i.p.) were divided into two groups: treated (n = 11) and control (n = 15). Respiratory frequency (f), tidal volume (VT), minute volume (v̇E) and systemic arterial blood pressure were recorded during air and 20 min of breathing hypoxic gas mixture (14% O2-86% N2). Isocapnia was maintained by adding fractions of 1% CO2 to the inspired hypoxic gas mixture. The PaO2 and PaCO2 were determined. Results: On hypoxic gas mixture breathing, VT and v̇E values of the control animals increased significantly, at 5 min to 50 ± 6 and 53 ± 6%, respectively, above the prehypoxic air phase value (p < 0.001). After that, the magnitude of increase in VT and v̇E declined gradually. At 20 min of hypoxia, VT and v̇E were less than those in prehypoxic air phase (17 ± 7, 16 ± 7%, respectively). In cats injected with an adenosine antagonist (theophylline 13.6 mg kg–1 i.v.), f, VT and v̇E increased significantly at 5 min of hypoxia (p < 0.001). At 20 min of hypoxia, f, VT and v̇E were 8 ± 2, 30 ± 8, and 39 ± 8%, respectively, higher than corresponding values of the prehypoxic stage. In cats injected with theophylline (0.5 mg kg–1) by cisternal puncture VT and v̇E increased significantly at 5 min of hypoxia. At 20 min of hypoxia, VT and v̇E were 27 ± 7 and 31 ± 8% higher than those in the prehypoxic air phase. Conclusion: The results of this study show that accumulation of adenosine in the brain during hypoxia seems to reduce the response of the central mechanisms to chemoreceptor impulses.
Growth Inhibition of Enteric Pathogens by Zinc Sulfate: An in vitro Study
Authors: Surjawidjaja Julius E. , Hidayat Adi , Lesmana Murad
Published: August 2004

Objective: To determine the inhibition effect of zinc sulfate on isolates of enteric bacteria. Materials and Methods: Mueller-Hinton agar containing different concentrations of zinc sulfate was prepared. Isolates used in this study were obtained from local clinics. They were Salmonella typhi, Salmonella groups A, B, C, D and E, Escherichia coli, Enterobacter, Shigella and Vibrio cholerae. Overnight cultures of test organisms in brain-heart infusion broth were adjusted to 0.5 McFarland standard turbidity by adding normal saline with 1 µl of each adjusted broth culture inoculated onto zinc sulfate agar plates. The plates were incubated for 18–20 h at 37°C. The inhibition concentration was recorded as the lowest concentration of zinc sulfate that completely inhibited growth. Results: All enteric pathogens tested were inhibited by zinc sulfate. Of the isolates, S. typhi was most sensitive since 20% of the strains were inhibited by zinc sulfate of 0.8 mg/ml. Salmonella paratyphi A was inhibited at 1.2 mg/ml. Other Salmonella spp. were inhibited at concentrations between 1.4 and 2.0 mg/ml. V. cholerae O1 and Shigella flexneri demonstrated a similar pattern of inhibition as S. paratyphi A. A higher concentration of zinc sulfate (1.6 mg/ml) was required to completely inhibit Shigella sonnei. Conclusion: The findings indicate that zinc sulfate has an antimicrobial effect on enteric pathogens and may contribute to the treatment of diarrhea.
Repair of Common Carotid Artery Injury with an External Carotid Artery Flap
Authors: Asfar Sami , Al-Ali Jasem , Ben-Nakhi Moneera
Published: August 2004

Objectives: To describe a new technique to repair injuries of the common carotid artery. Clinical Presentation and Intervention: A 30-year-old man sustained an iatrogenic injury to the left common carotid artery during surgical dissection of a left branchial cyst. The artery was repaired as follows: the left external carotid artery was ligated distally, its stump was longitudinally opened to create an arterial flap, which was then used to repair the defect in the common carotid artery. The patient remained free of any symptoms throughout 1 year of follow-up. Conclusion: Use of an external carotid flap provides an alternative method of repairing an injured carotid artery.
Exflagellation of Microgametocytes in Plasmodium vivax Malaria: A Diagnostic Conundrum
Authors: Enger Asle , Strand Øystein Anders , Ranheim Trond , Hellum Kjell Block
Published: August 2004

Objective: To present a clinical diagnostic conundrum of unidentified structures in a blood smear from a patient with Plasmodium vivax malaria. Clinical Presentation and Intervention: A 37-year-old Ethiopian male presented with a 4-month history of chills, chronic diarrhea and weight loss. He was diagnosed with P. vivax malaria, advanced HIV infection and Isospora belli enteritis. Unidentified structures initially confusing to the diagnosticians were seen in blood smears taken on admission. The structures were initially considered to represent atypical spirochetes, but were later identified as microgametes and other exflagellation forms of P. vivax. The patient recovered after receiving adequate treatment for his infections. Conclusion: This case illustrates that exflagellation may be observed in blood smears from patients with P. vivax malaria. Size and morphological characteristics differentiate malaria microgametes and other exflagellation forms from microfilaria, spirochetes and trypanosomes.
High Frequency of Detection of Herpes simplex Virus DNA in the Oral Cavity of Patients with Eczema herpeticum
Authors: Yoshida Masami , Amatsu Akinori
Published: August 2004

Background: It has been reported that herpes simplex virus (HSV) DNA was detected in the oral cavity of patients with herpes labialis under various conditions such as during oral surgery. Objective: The frequency of detection of oral HSV DNA was compared between first or recurrent episodes of eczema herpeticum and recurrent type herpes labialis. Patients and Methods: Oral swabs were collected from 7 patients with eczema herpeticum and 9 with herpes labialis. The detection of oral HSV DNA was performed by the polymerase chain reaction method. Results: Oral HSV DNA was detected in 6 out of 7 patients (86%) with eczema herpeticum and 3 of 9 (33%) with herpes labialis. Conclusions: The high frequency of oral HSV DNA detection in eczema herpeticum suggests that subclinical herpetic lesions may develop in the oral cavity of patients with a first episode of eczema herpeticum or may occur during asymptomatic oral HSV shedding in people with recurrent eczema herpeticum.
Early Cutaneous Alterations in Experimental Sepsis by Pseudomonas aeruginosa
Authors: Petropoulou Haritini , Giamarellos-Bourboulis Evangelos J. , Kavatzas Nicolaos , Stratigos Alexandros , Mouktaroudi Maria , Adamis Theodoros , Baziaka Fotini , Katsambas Andreas D. , Stavrianeas Nicolaos G.
Published: August 2004

Background: To evaluate whether histopathologic findings of skin in sepsis by Pseudomonas aeruginosa correlate with the clinical course. Methods: Histological alterations after bacterial challenge by one susceptible (A) and two multidrug-resistant isolates (B and C) of P. aeruginosa were studied in 18 rabbits. Sepsis was induced by the intravenous infusion of 1 × 108 CFU by a catheter in the right jugular vein; blood was sampled for the estimation of tumor necrosis factor α (TNF-α) and malondialdehyde (MDA). Skin biopsies were collected along with a subcutaneous fat specimen for culture. Results: The mean survival was 0.85, 1.75 and 11.00 days after challenge by isolates A, B and C, respectively. The main histologic findings of skin were: inflammation and swelling of the dermis; thickening of the endothelium and infiltration of vessel wall and lumen by polymorphonuclear leukocytes; extravasation of red blood cells, and necrobiotic changes of the hair follicles. Serum TNF-α was elevated in animals challenged by isolate A compared to challenge by isolates B and C. Concentrations of MDA were similar for all isolates. Mean log10 of viable cells isolated from subcutaneous fat were 5.74, 2.74 and 1.40 after challenge by isolates A, B and C, respectively. Conclusions: Prolongation of survival was accompanied by lower serum TNF-α, decreased viable cells from subcutaneous fat and intensified inflammatory response in the dermis and subcutaneous tissue. These findings might be of importance for immunomodulatory intervention.
Pseudosclerodermatous Panniculitis after Irradiation and Bronchiolitis obliterans Organizing Pneumonia: Simultaneous Onset Suggesting a Common Origin
Authors: Dalle Stéphane , Skowron François , Ronger-Savlè Sandra , Balme Brigitte , Thomas Luc
Published: August 2004

Due to the technical evolution of radiation therapy of breast carcinoma, new manifestations occur as side effects. Newly described unexpected cutaneous events are morphea of the breast and pseudosclerodermatous panniculitis after irradiation (PPAI). They appear as specific consequences of megavoltage radiation. Radiotherapy-induced bronchiolitis obliterans organizing pneumonia (R-BOOP) is one of the pulmonary manifestations due to recent advances in radiotherapy of breast carcinoma. We report a case of PPAI and R-BOOP of simultaneous onset in a 60-year-old woman 6 months after megavoltage radiation therapy for breast carcinoma. We also noted an improvement of both unexpected reactions with systemic corticosteroid therapy and a common relapse when tapering the treatment. Only eight cases of PPAI have previously been reported. We believe that this entity is often underdiagnosed. The symmetrical onset and parallel evolution suggest a common origin for PPAI and BOOP in our case: the megavoltage radiation therapy. The pathogeny of R-BOOP is not direct toxicity of irradiation because untreated areas can also be affected. Pathogenesis of PPAI remains unknown, but a simultaneous onset with R-BOOP suggests a similar mechanism. While a cumulative dose of irradiation does not seem to be determinant an immune reaction to neoantigens induced by radiation could be an hypothesis.
Caries-Inhibiting Effect of Preventive Measures during Orthodontic Treatment with Fixed Appliances
Authors: Derks A. , Katsaros C. , Frencken J.E. , van ’t Hof M.A. , Kuijpers-Jagtman A.M.
Published: August 2004

A systematic review was performed of published data on the caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. The purpose was to develop evidence-based recommendations about the most effective means of preventing white spot lesions in orthodontic patients. The 15 studies included were divided into four groups based on comparable preventive measures: fluoride, chlorhexidine, sealants and bonding materials. The caries-inhibiting effect of the preventive measures was expressed by the prevented fraction (PF). The overall PF of the fluoride-releasing bonding materials was 20% (SEM 0.09). This effect was, however, not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect has been described. The use of toothpaste and gel with a high fluoride concentration of 1,500–5,000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect. Many publications had to be excluded from this systematic review because of improper research designs. Future clinical trials are needed to give evidence- based advice on the optimal caries-prevention strategy.
Individual Vitality Pattern of in situ Dental Biofilms at Different Locations in the Oral Cavity
Authors: Arweiler N.B. , Hellwig E. , Sculean A. , Hein N. , Auschill T.M.
Published: August 2004

The aim of the study was to examine the three-dimensional vitality structure of dental biofilms grown simultaneously at different locations in the oral cavity over a 48-hour period. Eight healthy volunteers wore special acrylic appliances. On each buccal side of the upper and the lower jaw three glass slabs were inserted, allowing for growth of a biofilm mimicking approximal plaque. After 48 h, the specimens were removed and biofilms were stained using two fluorescent dyes which selectively stain vital bacteria green and dead bacteria red. Under the confocal laser scanning microscope optical sections of 1 µm throughout the biofilm were made. To assess the vitality values (proportion of vital bacteria) of the whole biofilm as well as the vitality distribution in the different plaque sections an image analysis program was used. Plaque from the different locations revealed mean vitality values between 64.4 and 75.7% in the upper jaw and between 64.3 and 76.8% in the lower jaw, which were not statistically different. However, a great variation of the vitality values for the different layers and among the 8 subjects was found. Nevertheless, the analysis of the data of each single volunteer revealed a very similar vitality pattern in all twelve locations.
A Method for Mapping the Distribution Pattern of Cariogenic Streptococci within Dental Plaque in vivo
Authors: Kato K. , Sato T. , Takahashi N. , Fukui K. , Yamamoto K. , Nakagaki H.
Published: August 2004

This study was carried out to develop a method for mapping the distribution of cariogenic oral streptococci, Streptococcus mutans and Streptococcus sobrinus, from the outermost to the innermost plaque. Ten consenting subjects were asked to form plaque by abstaining from tooth brushing over 3 days within in situ plaque-generating devices, which were placed on the upper molars. The plaque formed in the devices was separated into 8–10 layered fractions (100 µm thick). Genomic DNA was extracted from each plaque fraction by a commercial DNA purification kit and used for the amplification of the 16S ribosomal RNA gene sequences by polymerase chain reaction (PCR) with universal primers. The products were then amplified by PCR with S. mutans- or S. sobrinus-specific nested primers. The final products were separated on agarose gels, stained and photographed to confirm the existence of S. mutans and S. sobrinus. The results showed that S. mutans was detected in the plaque obtained from all of the 10 subjects and S. sobrinus in the plaque of 7 subjects. However, the distribution patterns of fractions positive for S. mutans and S. sobrinus varied among the subjects, with a tendency for frequent detection of both species in the outer to middle layers of dental plaque. There were no plaque fractions in which only S. sobrinus was found. This method could be useful to map the distribution of cariogenic microorganisms and to estimate the bacterial ecology for oral biofilm.
Streptococcus mutans Genotypes Isolated from Root and Coronal Caries
Authors: Nascimento M.M. , Höfling J.F. , Gonçalves R.B.
Published: August 2004

The aim of the present study was to evaluate the colonization profile and clonal distribution of Streptococcus mutans isolated from oral cavities that presented coronal and root caries lesions. The isolation and biochemical identification of mutans streptococci were carried out by using saliva samples, dental plaque, and tissue from the caries lesions. In order to confirm their molecular identity, S. mutans and Streptococcus sobrinus were submitted to the PCR method, using specific primers for portions of the glucosyltransferase genes (gtfB and gtfI, respectively). The AP-PCR method was used to detect the genetic polymorphism of S. mutans strains. Among the isolated and identified species, S. mutans showed a significantly greater frequency of isolation (59.2%) than the other mutans streptococci. Each of the subjects harbored two to ten genotypes of S. mutans, randomly distributed in different sites. S. mutans genotypes showed no evidence of variability in colonizing noncarious and carious surfaces within the same individual, nor evidence of etiologic differences between coronal and root caries. This study showed that no particular genotype of S. mutans is uniquely associated with the initiation and progression of caries, and that root and coronal caries can emerge in the presence of a broad spectrum of S. mutans clones.
An in situ Investigation into the Abrasion of Eroded Dental Hard Tissues by a Whitening Dentifrice
Authors: Turssi C.P. , Faraoni J.J. , Rodrigues Jr. A.L. , Serra M.C.
Published: August 2004

This crossover study aimed to investigate abrasion of previously eroded hard dental tissues by a whitening dentifrice compared to a regular dentifrice. After a 3-day lead-in period, 14 volunteers were randomly assigned to use one of the toothpastes while wearing a removable appliance, containing 3 enamel and 3 root dentine slabs on each side. On the first day salivary pellicle was allowed to form. Twice daily for the following 3 days, one side of each appliance was immersed in an acidic carbonated drink ex vivo while the other side remained unexposed. Specimens were then brushed with the allocated dentifrice. After a 3-day washout period, new sets of enamel and dentine slabs were mounted in the appliances and the participants commenced period 2 using the alternative toothpaste. Acid-treated specimens always showed more wear than untreated specimens. The whitening dentifrice did not significantly increase the wear of softened enamel compared with the regular dentifrice. Brushing with the whitening toothpaste led to significantly greater wear of sound enamel and of both eroded and sound dentine than the regular dentifrice. The results suggest that whitening dentifrices may not increase the wear of acid-softened enamel but may have a more deleterious effect on dentine than regular toothpastes.
Correlations between Exhaled Nitric Oxide Levels and pH-Metry Data in Asthmatics with Gastro-Oesophageal Reflux
Authors: Silvestri M. , Mattioli G. , Defilippi A.-C. , Fregonese B. , Battistini E. , Jasonni V. , Rossi G.A.
Published: August 2004

Background: In gastro-oesophageal reflux (GER), micro-aspirations of gastric fluid may damage the epithelial surface of the airways, an important source of endogenous nitric oxide (NO). Objectives: The aim of the study was to evaluate the possible influence of GER on fractional exhaled nitric oxide (FENO) release. Methods: FENO levels were compared in two age-matched groups of allergic children: (1) 20 with mild asthma, responding to standard anti-asthma pharmacologic therapy (asthmatic children) and (2) 12 with mild ‘asthma-like symptoms’ and GER. Results: No differences in pulmonary functions parameters (FEV1, FVC and FEF25–75%) were found between the two groups of children (p > 0.1); FENO levels were higher in asthmatic children compared with GER children (p = 0.0001). GER children underwent 24-hour oesophageal pH-metry, and possible correlations between pH-metry data, pulmonary functions and FENO levels were evaluated. No correlations were found between pulmonary functions and pH-metry data (p > 0.05, each correlation). In contrast, correlations were observed between FENO levels and pH-metry data, including (1) percentage of study time with pH < 4 (r = –0.80, p = 0.008), (2) number of episodes with pH < 4 (r = –0.76, p = 0.012), and (3) number of episodes >5 min with pH < 4 (r = –0.69, p = 0.02). Conclusions: Thus, FENO levels are lower in allergic children with ‘asthma-like symptoms’ and GER as compared to asthmatic children. The correlations between FENO levels and pH-metry data suggest that inhalation of acid gastric content may interfere with NO production in the airways.
Long-Term Oxygen Therapy Stops the Natural Decline of Endurance in COPD Patients with Reversible Hypercapnia
Authors: Haidl P. , Clement C. , Wiese C. , Dellweg D. , Köhler D.
Published: August 2004

Background: Respiratory muscle weakness is one of the most important causes of hypercapnia in patients with COPD. There is evidence that stable hypercapnic patients will benefit from long-term oxygen therapy (LTOT). Objectives: The prognostic role of reversible hypercapnia in COPD is still unclear. Early implementation of LTOT in these patients may influence endurance time and mortality. Methods: In this pilot study, we investigated 28 patients (26 males, 49–74 years) with COPD, advanced airflow limitation [forced expiratory volume in 1 s (percentage of predicted value) 40.8 ± 10.2] and mild hypoxaemia (pO2 66.5 ± 6.3 mm Hg). All patients had developed a moderate reversible hypercapnia during an acute exacerbation or during exercise testing (peak pCO2 48.0 ± 2.5 mm Hg). Patients were allocated randomly to a control group (n = 14) or an LTOT group (n = 14). The two groups were well matched in terms of physiological data. Lung function, endurance time (cycle ergometer), dyspnoea score, blood gases and LTOT compliance were measured at baseline and every 6 months over a period of 3 years. Results: Endurance time increased from 6.4 ± 2.7 min at baseline to 7.1 ± 2.7 min after 1 year in the LTOT group and decreased from 6.1 ± 3.0 to 4.9 ± 3.8 min in the controls (p < 0.05). After 1 year, the end-exercise dyspnoea score was significantly lower in the LTOT group (4.5 ± 1.5) than in the controls (5.7 ± 1.9). Conclusion: COPD patients with reversible hypercapnia and mild hypoxaemia benefit from LTOT in terms of endurance time and a reduction of exertional dyspnoea after 1 year.
A Normal FEV1/VC Ratio Does Not Exclude Airway Obstruction
Authors: Stănescu Dan , Veriter Claude
Published: August 2004

Background: A decreased forced expiratory volume in 1 s/vital capacity (FEV1/VC) ratio is the hallmark of the definition of airway obstruction. We recently suggested that a lung function pattern, we called small airways syndrome (SAOS), has a normal FEV1/VC and total lung capacity (TLC) and reflects obstruction of small airways. Objectives: To substantiate our hypothesis we measured and compared lung function tests including maximal expiratory flow rates (MEFR), sensitive indicators of airway obstruction, in SAOS subjects and in matched controls. Methods: We selected 12 subjects with the pattern of SAOS, but without chronic lung or heart disease (average age: 40.7 ± 7.8 years) and 36 age-matched subjects with normal lung function (42.8 ± 6.3 years). We measured static and dynamic lung volumes, MEFR and lung diffusing capacity (DLCO). Results: SAOS subjects were heavier smokers (p < 0.05) and body mass index was less than in control subjects (p < 0.01). Both FEV1/VC ratio and TLC were comparable in the two groups. However, FEV1, VC, DLCO, and MEFR were lower and residual volume (RV) and RV/TLC ratio were higher (p < 0.05) in the SAOS group than in the control one. Furthermore, the MEFR curve of the SAOS group was displaced to the left without any change in slope, suggesting premature airway closure. Conclusion: Our results suggest that a normal FEV1/VC ratio does not exclude airway obstruction. A decrease of FEV1, provided TLC is normal, reflects small airway obstruction.
Comparison of Nasal Prong Pressure and Thermistor Measurements for Detecting Respiratory Events during Sleep
Authors: BaHammam Ahmed
Published: August 2004

Introduction and Objectives: Thermistor (TH) measurements have been traditionally used to determine airflow during polysomnographic studies (PSG). However, low accuracy in detecting hypopneas is a major drawback. Nasal prong pressure (NPP) measurements are becoming increasingly popular for quantifying respiratory events during sleep. We prospectively compared NPP and TH measurements with respect to their ability to detect respiratory events during routine PSG. Methods: Forty consecutive patients (26 male, 14 female) with clinically suspected sleep-disordered breathing (SDB) underwent routine diagnostic PSG. Airflow was measured using NPP and TH devices simultaneously. PSG was scored manually according to R and K criteria. Respiratory events were scored in two passes. During the first pass, the TH signal was disabled and the NPP signal was scored. During the second pass, the NPP signal was disabled and the TH signal was scored. Scorers for one method were blinded from the results of the other method. To assess respiratory events, we used the respiratory arousal index (RAI), which was defined as the number of apneas and/or hypopneas followed by an arousal per hour of sleep, as detected by TH (RAI-TH) or NPP (RAI- NPP). Agreement analysis of the results obtained using the two different techniques was performed using the methodology of Bland-Altman. Results: Twenty-six patients had obstructive sleep apnea, 10 had respiratory effort-related arousals and 4 had habitual snoring. The failure time of the flow signal on the raw data was not different between the two methods (NPP: 6 ± 13 min, TH: 4 ± 7 min). The Bland-Altman analysis of RAIs demonstrated that more events were nearly always detected using NPP compared to TH devices (44.4 ± 37 vs. 35.4 ± 31, p < 0.001). No difference in the index of central apneas between the two methods could be detected. Sleep position had no effect on either measurement method. Conclusions: NPP measurements are superior to TH measurements for detecting obstructive respiratory events during sleep. Measurement of NPP is a simple, practical, sensitive and reliable method for detecting the whole spectrum of SDB. We recommend incorporating nasal prongs in routine polysomnographic monitoring.
Hemodynamic Effects of Endobronchial Application of Ornipressin versus Terlipressin
Authors: Tüller Claudia , Tüller David , Tamm Michael , Brutsche Martin H.
Published: August 2004

Background: Ornipressin and terlipressin, two ADH-derivates, are instilled endobronchially for bronchoscopy- related bleeding without sufficient evidence of efficacy, nor safety. Objectives: To compare the immediate hemodynamic effects of ornipressin and terlipressin used for procedure-related bleeding during flexible bronchoscopy. Methods: This retrospective study included patients referred for flexible bronchoscopy who needed administration of ornipressin (15 patients) or terlipressin (15 patients) for procedure-related bleeding. Endobronchial ornipressin (5 IU) or terlipressin (0.5 mg) was administered through the bronchoscope when bleeding persisted for 2 min of continuous suction, or when bleeding was considered increasing in time or major. Hemodynamic data were collected before, during and after administration of either drug. Results: Biopsy-associated hemoptysis requiring medical treatment occurred in 110 (4.2%) of 2,592 bronchoscopies. After administration of ornipressin, no significant change in heart rate or blood pressure was observed. Following terlipressin instillation, heart rate increased from 93 ± 17 to 101 ± 22 b.p.m. (p = 0.03), and blood pressure decreased from 107 ± 14 to 101 ± 17 mm Hg (p = 0.04). Oxygen saturation under supplemental nasal oxygen was not different in both groups. None of the 110 patients died from bronchoscopy-related hemoptysis or needed further intervention to stop bleeding or prolonged monitoring because of hemodynamic instability. Conclusions: In contrast to ornipressin, administration of terlipressin is associated with significant changes in heart rate and blood pressure. However, these changes are of minor clinical importance, and terlipressin can be safely given for bronchoscopy-associated bleeding.
Exposure of Differentiated Airway Epithelial Cells to Volatile Smoke in vitro
Authors: Beisswenger Christoph , Platz Juliane , Seifart Carola , Vogelmeier Claus , Bals Robert
Published: August 2004

Background: Cigarette smoke (CS) is the predominant pathogenetic factor in the development of chronic bronchitis and chronic obstructive pulmonary disease. The knowledge about the cellular and molecular mechanisms underlying the smoke-induced inflammation in epithelial cells is limited. Objectives: The aim of this study was to develop an in vitro model to monitor the effects of volatile CS on differentiated airway epithelial cells. Methods: The airway epithelial cell line MM-39 and primary human bronchial epithelial cells were cultivated as air-liquid interface cultures and exposed directly to volatile CS. We used two types of exposure models, one using ambient air, the other using humidified and warm air. Cytokine levels were measured by quantitative PCR and ELISA. Phosphorylation of p38 MAP kinase was assessed by Western blot analysis. To reduce the smoke-induced inflammation, antisense oligonucleotides directed against the p65 subunit of NF-ĸB were applied. Results: Exposure of epithelia to cold and dry air resulted in a significant inflammatory response. In contrast, exposure to humidified warm air did not elicit a cellular response. Stimulation with CS resulted in upregulation of mRNA for IL-6 and IL-8 and protein release. Exposure to CS combined with heat-inactivated bacteria synergistically increased levels of the cytokines. Reactions of differentiated epithelial cells to smoke are mediated by the MAP kinase p38 and the transcription factor NF-ĸB. Conclusions: We developed an exposure model to examine the consequences of direct exposure of differentiated airway epithelial cells to volatile CS. The model enables to measure the cellular reactions to smoke exposure and to determine the outcome of therapeutic interventions.
Single-Agent Chemotherapy with Docetaxel Significantly Reduces PSA Levels in Patients with High-Grade Localized Prostate Cancers
Authors: Berger Andreas P. , Niescher Mathias , Fischer-Colbrie Reiner , Pelzer Alexandre , Bartsch Georg , Horninger Wolfgang
Published: August 2004

Objective: Chemotherapy has been shown to be effective in the management of prostate cancer in patients with androgen-independent metastatic disease, however, a survival benefit has not been demonstrated yet. Docetaxel alone or in combination with estramustine has been shown to exhibit a high level of activity in the treatment of hormone-refractory prostate cancer. To date there are only few reports on chemotherapy for localized prostate cancer. Methods: The efficacy and safety of neoadjuvant chemotherapy with docetaxel as a single agent given prior to radical retropubic prostatectomy (RRP) has been evaluated in 5 patients presenting with Gleason score 8 prostate cancers at biopsy. Results: The mean reduction in prostate-specific antigen levels in the 5 patients was 66.5% (range 47.6–94.0%). Histology after RRP yielded pT2N0MxR0 prostate cancers in all subjects. Testosterone and secretoneurin levels were not significantly affected by docetaxel monotherapy. Conclusions: Although the use of neoadjuvant chemotherapy prior to RRP is still experimental, the dramatic prostate-specific antigen decrease during chemotherapy and the pathologic findings after radical prostatectomy are encouraging. Studies including larger number of patients will have to confirm the present results.
Increasing Resistance against Antibiotics in Bacteria Isolated from the Lower Urinary Tract of an Outpatient Population of Spinal Cord Injury Patients
Authors: Hinkel A. , Finke W. , Bötel U. , Gatermann S.G. , Pannek J.
Published: August 2004

Objective: To investigate changes of the bacterial spectrum and susceptibility in bacteria isolated from urine samples of spinal cord injury patients followed in a strict outpatient setting. Subjects and Methods: Due to neurogenic dysfunction, urinary tract infections are common in spinal cord injury patients. Nosocomial urinary tract infections and resistance against antibiotics are increasing problems in hospitalized spinal cord injury patients. Urine samples were obtained by aseptic catheterization during 1,293 outpatient appointments at our institution over a period of 6 years. The urine samples were analyzed for bacterial colonization and microbiologically evaluated. Results: We demonstrate significant changes in both bacterial spectrum and bacterial resistance in an outpatient population as well. Even multiresistant staphylococcus species were detected, in spite of excluding nosocomial infections. Conclusions: Antibiotic treatment should be limited to symptomatic urinary tract infections and be initiated after sensitivity testing only. Empiric use of antibiotics must be limited to highly symptomatic infections until the results of sensitivity testing are available.
Urinary Basic Fibroblast Growth Factor in Bladder Cancer Patients
Authors: Gravas S. , Bosinakou I. , Kehayas P. , Giannopoulos A.
Published: August 2004

Introduction: Angiogenesis plays a significant role in the growth and progress of cancer, thus we evaluated the levels of urinary basic fibroblast growth factor (bFGF) in bladder cancer (Ca) patients and investigated any possible correlation between this angiogenic factor with tumor stage and grade. Materials and Methods: Urine samples from 41 patients with bladder Ca, 11 patients with history of bladder Ca but negative follow-up cystoscopy, 18 patients with benign prostate hyperplasia (BPH) and 15 normal healthy volunteers were assayed using an enzyme-linked immunosorbent assay for bFGF. Resulting values were normalized against urine creatinine and expressed as pg/g. Results: The median urinary bFGF level of patients with active disease, history of bladder carcinoma and negative follow-up cystoscopy, BPH, and healthy volunteers were 2,717, 1,009, 1,414 and 1,100 pg/g, respectively. There was a statistically significant difference between median bFGF levels of patients with active bladder Ca and those of the other groups (p = 0.000). Eleven patients with invasive bladder Ca had a median bFGF value of 6,880 pg/g that was significantly increased (p = 0.002) compared to the median of 2,312 pg/g of those with superficial tumors (Ta 14, T1 16). Grades 1, 2 and 3 carcinoma were found in 5, 19 and 17 patients which had a median bFGF of 2,717, 1,762 and 3,617 pg/g, respectively, but the difference was not statistically significant (p = 0.13). Conclusions: Our results confirm the implication of bFGF in the biology of bladder cancer, and demonstrate that urinary bFGF concentration seems to be significantly related to the stage but not to the grade of the disease supporting the proposed mechanisms of release of bFGF. Further studies are required in order to validate the potential clinical applications of bFGF for specific groups of bladder cancer patients.
Renal Hydatid Cyst Presenting as Perinephric and Iliopsoas Abscess
Authors: Gupta Rajshekhar , Kapoor Rakesh , Mandhani Anil , Dubey Deepak
Published: August 2004

Hydatid disease is an infestation caused in humans by the larval forms of Taenia echinococcus. Isolated renal hydatid cyst is rare with a frequency of 2–4% of hydatid disease. Infection of hydatid cyst is a very rare condition. We describe a rare case of isolated renal hydatid cyst presenting as perinephric and ilopsoas abscess and discuss the dilemma in diagnosis and its managment.
Intrinsic Form of Ureteral Endometriosis Causing Ureteral Obstruction and Partial Loss of Kidney Function
Authors: Horn L.-C. , Do Minh M. , Stolzenburg J.-U.
Published: August 2004

Introduction: Urinary tract endometriosis is rare and occurs in about 1% of all endometriotic lesions. About 30% of patients suffer from reduced kidney function at the time of diagnosis. Case Report: A 49-year-old woman presented with a history of abdominal hysterectomy without adnexae because of uterus myomatosus without any signs of endometriosis 6 years before. Now she complained of dysuria and intermittent left loin pain. Sonography and retrograde pyelography demonstrated incomplete ureteric obstruction and scintigraphy revealed a partial loss of kidney function. Intraoperatively frozen section histology and final histologic examination demonstrated a tumorlike intrinsic form of ureteral endometriosis engulfing the left ureter. The patient was treated with uretero-ureterostomy and danazole for preventing recurrence. She is well 28 months postoperatively. Conclusions: In the extrinsic form (about 75% of all cases), ureteral endometriosis is localised to the adventitia or surrounding connective tissue of the ureter, whereas the intrinsic form of ureteral endometriosis is very rare and more often needs aggressive surgery.
Paranephric Abscess during Pregnancy: A Case for a Low-Dose Interventional CT
Authors: Athanasopoulos A. , Petsas T. , Fokaefs E. , Skouras T. , Galazidou E. , Perimenis P. , Barbalias G.
Published: August 2004

A young pregnant woman hospitalized in our department with sepsis due to a paranephric abscess, and treated successfully with a nephrostomy under the guidance of low-dose CT, is presented. Based on this successful and safe treatment for the fetus, it is proposed that low-dose CT can be applied without any risk to pregnant women with special urological problems such as paranephric and splenic abscesses, dysmorphic and extopic or horseshoe kidneys.
Clinical Applications of Levofloxacin for Severe Infections
Authors: Graninger Wolfgang , Zeitlinger Markus
Published: August 2004

New fluoroquinolones, as exemplified by levofloxacin, possess broad spectrum activity against many common pathogens, including the majority responsible for respiratory tract infections (RTIs), atypical pathogens and those resistant to other therapeutic regimens. Following administration, levofloxacin attains high intracellular and tissue levels. This, coupled with an exceptional pharmacodynamic profile, allows levofloxacin to be administered once daily. However, in certain circumstances, such as seriously ill patients or those with difficult-to-treat pathogens, higher doses may be required. Since the bactericidal effect of levofloxacin is concentration-dependent, it is possible to increase peak concentration by increasing the dose, resulting in even better tissue concentration (and a possible reduction in the development of resistance). High-dose levofloxacin is able to exploit these pharmacokinetic features to provide an effective treatment for severe infections. Data is now available confirming the efficacy of high-dose levofloxacin in a wide range of infections, including nosocomial pneumonia, meningitis and complicated skin and skin structure infections (CSSSIs). Not only is this regimen effective, it is also well tolerated and provides the physician with an additional therapeutic option to manage critically ill patients.