bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex Differences in Rabbit Masseter Muscle Function
Authors: English Arthur W. , Widmer Charles G.
Published: June 2003

The proportions of fibers of different phenotypes in the rabbit masseter muscle differ strikingly in adult males and females. Muscles from females contain similar proportions of small fibers that express both the slow/β and cardiac α myosin heavy chain (MyHC) isoforms and larger fibers containing the IIa MyHC isoform. In muscles from males, nearly 80% of fibers are of the IIa phenotype. To evaluate the functional significance of these sex differences, we used finely graded intramuscular microstimulation to study the contractile properties of masseter motor units in >6-month-old male and female rabbits. Twitch forces and torques in males were significantly greater in magnitude than those of females. Greater proportions of units that produced larger forces/torques were encountered in the males. The same motor units produced force or torque more rapidly in males than in females, principally because units in which twitch rise times were >22 ms were found only in females. The forces applied to the mandible and the torques generated about the right mandibular condyle were studied during cortically evoked rhythmic activation of the masticatory muscles. The overall range of torque rise times and the magnitudes of the peak torques did not differ between sexes. The mean rise time was significantly shorter and the mean peak torque was significantly greater in males. We conclude that sex differences in fiber phenotype proportions are reflected in sex differences in motor unit properties and in the function of these motor units during rhythmic activation.
The Prognostic Significance of Changes in X-Ray Attenuation on CT in Established Cerebral Infarcts
Authors: De Reuck J. , van de Velde E. , van Maele G. , Wissaert W.
Published: June 2003

Background: X-ray hypoattenuation on computed tomography (CT) reflects the severity of ischaemic damage after stroke. However, the clinical syndrome and the effect of time influence the visibility of infarcts. This prospective study analyses whether the degree of hypoattenuation on CT at two time intervals after stroke has a predictive value for the clinical outcome. Methods: 220 consecutive stroke patients were admitted within 24 h after onset with symptoms lasting more than 24 h. The study was restricted to 150 patients displaying an anterior circulation infarct or syndrome. All patients had CT scans without contrast enhancement on day 3 (±8 h) and day 10 (±8 h) after stroke onset. The degree of X-ray attenuation expressed in Hounsfield units was determined in the centre of the infarct area and compared to that in the corresponding zone of the contralateral hemisphere. The patients were divided into four groups according to their degree of disability at 3 months on the modified Rankin scale as follows: R 0–1, R 2–3, R 4–5 and R 6. Results: Patients in groups R 4–5 and R 6 had the most severe impairment on admission. The average decrease of X-ray attenuation on CT on day 3 was less in patients in group R 0–1, but was not different between the three other groups, while it was significantly correlated with the severity of the disability on day 10. CT X-ray attenuation increased between days 3 and 10 in group R 0–1, was unchanged in group R 2–3 and further decreased in groups R 4–5 and R 6. Conclusion: The degree of X-ray attenuation on CT on day 3 allows us to distinguish those patients who will recover more or less completely from those with definite disability, while the CT findings on day 10 allow a more precise prediction of outcome. Increase of X-ray attenuation on day 10 is known as the fogging effect and appears to be a favourable prognostic factor. Fogging is generally considered to be due to macrophage invasion and proliferation of capillaries within the infarct area, but probably also represents partial restoration of some viable tissue.
Cerebral Magnetic Resonance Imaging within 6 Hours of Stroke Onset: Inter- and Intra-Observer Reproducibility
Authors: Girot Marie , Leclerc Xavier , Gauvrit Jean-Yves , Verdelho Ana , Pruvo Jean-Pierre , Leys Didier
Published: June 2003

Background: Magnetic resonance imaging (MRI) provides valuable pathophysiological information during the very first hours of cerebral ischemia. However, the reliability of prime-time MRI in the setting of emergency care remains unknown. Aim: To evaluate the reproducibility between and within observers of the assessment of MRI scans in stroke patients. Method: We performed a MRI scan within 6 h of stroke onset, with time-of-flight (TOF), T2* gradient echo, FLAIR, diffusion- (DWI) and perfusion- (PWI) weighted images, in 17 consecutive patients. Four observers, blinded to the clinical history, separately performed a visual assessment of all scans, and repeated the assessment 2–8 days later. Two neuroradiologists made volumetric measures of diffusion and perfusion abnormalities using a semi-automatic technique 2 weeks after the 2nd visual assessment. We evaluated: (i) in the whole set of MRI scans, the quality of scans and their ability to identify primary hemorrhages on T2* gradient echo sequences; (ii) in patients with acute cerebral ischemia only, the inter- and intra-observer agreement for the presence of arterial occlusion and cerebral abnormalities on TOF sequences, and (iii) on DWI and PWI sequences, the relationship between visual and automatic assessments for the presence of a mismatch (defined as the difference between the perfusion and diffusion abnormalities) of >20%. Statistics used the kappa (ĸ) method. Results: The median delay between clinical onset and MRI was 285 min. Two patients had primary cerebral hemorrhages, 1 a post-ictal deficit, and 14 cerebral ischemia. The quality of the scans was judged as appropriate for all scans in all sequences except for FLAIR. All observers identified the 2 patients with hemorrhages. The inter- and intra-observer reliability was substantial to excellent (ĸ values ranging from 0.63 to 1.00) for all sequences. The agreement between visual and automatic assessments for the presence of a mismatch of >20% was excellent in all observers. Conclusion: The visual assessment of T2* gradient echo, TOF, diffusion and perfusion sequences at the acute stage of stroke is reproducible between and within observers. The visual assessment is as good as the volumetric assessment to detect a mismatch of >20%.
Stroke on Awakening: Looking for a More Rational Management
Authors: Serena Joaquín , Dávalos Antoni , Segura Tomás , Mostacero Enrique , Castillo José
Published: June 2003

Background and Purpose: Stroke on awakening (SOA) is denied the benefits of thrombolytic therapy and is typically excluded from acute clinical trials on the grounds that the time of onset is unknown. In this study we compared the clinical characteristics of SOA and of stroke while awake (SWA), particularly in the subgroup of patients seen within a time frame of 6 h after stroke awareness. Material and Methods: Patients were included consecutively in the Stroke Data Bank of the Spanish Neurological Society (BADISEN) that records 365 different items, including vascular risk factors, neurological findings, stroke severity, aetiopathogenic diagnosis and neuroimaging data. Results: A total of 1,248 patients with acute cerebral infarction were included in the study, 301 (24.1%) with SOA and 947 (75.9%) with SWA. The peak time for stroke occurrence was between 6:01 a.m. and 12 noon, both in the whole stroke group and in each aetiopathogenic stroke subtype. Age, sex, stroke risk factors, stroke severity at admission, vital signs and stroke subtypes were not significantly different between SOA and SWA, neither in the group as a whole nor in the group of patients seen within 6 h of stroke recognition. Six hundred and fifty-four patients were seen within the potential 6-hour therapeutic window. In this group, the CT scan on admission was normal in 39.4% of SOA but the ultimate CT/MRI scan showed that 46.2% of these had a territorial infarction (in SWA these same figures were 60.8 and 67.7%, respectively). Conclusion: There are no relevant differences in the clinical, neuroimaging and aetiopathogenic characteristics of SOA and SWA. We should rely on new techniques such as DWI/PWI to indicate the most appropriate treatment in a more rational manner as nearly half of the patients with SOA seen early may benefit from them.
Stroke: Awareness of the Signs, Symptoms and Risk Factors – A Population-Based Survey
Authors: Parahoo Kader , Thompson Kate , Cooper Marian , Stringer Maurice , Ennis Edel , McCollam Paddy
Published: June 2003

Background: This article reports the findings from a population-based survey conducted to determine baseline knowledge regarding the signs, symptoms and risk factors of stroke. Methods: Data were collected in Northern Ireland from 892 adults using a self-completed questionnaire. Results: In general, the results indicate that respondents appeared knowledgeable about the risk factors of stroke but their recognition of the warning signs was poor. In addition, approximately half of those surveyed would not contact the ambulance service in the case of a suspected stroke but instead would make initial contact with their general practitioner (41.5%) or family/relatives (2.3%). Conclusions: Given the importance of early hospital presentation for effective stroke rehabilitation, these findings are of particular concern in a community where the death rate from stroke is one of the highest in Europe. Future health education campaigns should provide accurate and appropriate information regarding the warning signs of stroke and highlight the importance of early hospital presentation.
Stroke in an Elderly Population: Incidence and Impact on Survival and Daily Function
Authors: Di Carlo Antonio , Baldereschi Marzia , Gandolfo Carlo , Candelise Livia , Ghetti Augusto , Maggi Stefania , Scafato Emanuele , Carbonin Pierugo , Amaducci Luigi , Inzitari Domenico
Published: June 2003

Background: Epidemiological data are essential to estimate the burden of stroke.We evaluated stroke incidence in older Italians and the effect of first-ever stroke on survival and activities of daily living (ADL). Methods: The analysis was performed in the Italian Longitudinal Study on Aging (ILSA) sample, consisting of 5,632 individuals aged 65–84. The ILSA aims at major cardiovascular and neurological age-associated diseases. The baseline survey was performed in 1992 to detect prevalent diseases. The longitudinal examination started on September 1995 aiming at incidence, function and survival. Results: Complete follow-up data were achieved for 77% of the baseline stroke-free cohort (4,164 persons; 50.9% males; mean age 74.5 ± 5.7 years). Incidence for first-ever stroke was 9.51 (95% CI: 7.75–11.27) per 1,000 person years and 12.99 (95% CI: 10.99–14.98) including recurrent stroke (total incidence). Crude mortality was 49.2% among first stroke patients and 15% among persons without stroke. The first-ever stroke mortality risk ratio, adjusted for demographics and comorbidity, was 2.40 (95% CI: 1.62–3.54). In survivors, impairment of at least one ADL was present in 67.6% of first-ever stroke patients vs. 31.6% of individuals without stroke. The comorbidity-adjusted OR was 2.63 (95% CI: 1.20–5.78) in the total cohort, and 4.00 (95% CI: 1.39–11.46) in individuals without disability at baseline. Conclusions: The ILSA provides the first data on stroke incidence in Italy on a national basis. Overall, 153,000 new cases can be expected annually in the Italian elderly population. First-ever stroke still has a strong effect on survival and function of older persons.
Determination of Cerebrovascular Reactivity by Means of fMRI Signal Changes in Cerebral Microangiopathy: A Correlation with Morphological Abnormalities
Authors: Hund-Georgiadis Margret , Zysset Stefan , Naganawa Shinji , Norris David G. , von Cramon D. Yves
Published: June 2003

Background and Purpose: A reduced cerebrovascular reactivity (CR) is a risk factor of cerebrovascular disease. In this study, we implemented a protocol to assess CR by means of functional MRI (fMRI) using hyperventilation. Subjects and Methods: In 5 patients with cerebral microangiopathy (CM/lacunar infarction and white matter degeneration), 6 healthy elderly subjects (age-matched control), and 6 young healthy subjects, the CR in response to hyperventilation was evaluated by fMRI using gradient echo-planar Imaging. The percentage signal change normalized by end-tidal CO2 value was measured in various brain regions. Results: All subjects performed hyperventilation well without adverse reaction and significant gross motion. Patients with CM showed significant qualitative and quantitative differences (p < 0.05) as compared to controls. The volume of gray matter showing significant CR was significantly reduced in patients: by 40% in comparison to the age-matched elderly control group and by 60% when compared with the young controls. The CR impairment was most pronounced in the frontal cortices with a drastically reduced magnitude of the magnetic resonance (MR) signal change in the patients (–0.62 ± 0.2% in patients versus –2.0 ± 0.36% in age-matched controls, p < 0.0001). A strong relation was evident between the fMRI-based CR reduction in patients with CM and the individual severity of structural MR abnormalities (p = 0.002). Conclusion: This study demonstrates that fMRI-based signal changes in response to hyperventilation reliably reflect cerebral vasoreactivity. The protocol is feasible in healthy young and elderly controls and patients with CM. Quantitative and qualitative assessment of the signal decrease in the T2-weighted MR sequence and coregistration with individual anatomical data allow the generation of an individual cerebral vasoreactivity map. Future research will address the effect of CR reduction on neuropsychological parameters in patients with CM.
Prospective Study of Chlamydia pneumoniae IgG and IgA Seropositivity and Risk of Incident Ischemic Stroke
Authors: Tanne David , Haim Moti , Boyko Valentina , Goldbourt Uri , Reshef Tamar , Adler Yehuda , Brunner Daniel , Mekori Yoseph A. , Behar Solomon
Published: June 2003

Background and Purpose:Chlamydia pneumoniae infection or exposure to C. pneumoniae was implicated as a risk factor for ischemic stroke. Our aim was to evaluate prospectively the association between the presence of antibodies to C. pneumoniae (IgG and IgA) and the risk of incident ischemic stroke among patients with pre-existing vascular disease. Methods: Sera were collected from 3,090 coronary heart disease patients enrolled in a secondary prevention trial. We measured baseline antibodies (IgG and IgA) in the sera of patients who developed subsequent ischemic strokes (cases, n = 134) during follow-up (mean 8.2 years), and in 134 age- and gender-matched pairs without subsequent stroke or myocardial infarction. Results: The crude relative odds (95%CI) of incident ischemic strokes in seropositive patients at baseline (>1.1 relative value units) were 1.29 (95%CI, 0.69–2.47) for IgG and 1.31 (95% CI, 0.69–2.55) for IgA by matched-pair analyses, and 1.42 (95%CI, 0.69–2.98) for IgG and 1.57 (95%CI, 0.76–3.35) for IgA after adjustments for conventional risk factors and the inflammatory marker, soluble intercellular adhesion molecule-1. We explored the possibility that the risk of ischemic stroke may increase in parallel to increasing antibody titers, but did not demonstrate any significant association. Conclusions: Serological evidence for prior infection with C. pneumoniae did not emerge as an independent risk factor for incident ischemic stroke among patients at high risk due to pre-existing vascular disease.
Identification of Differentially Expressed Genes Associated with Colorectal Cancer Liver Metastasis
Authors: Li S.-R. , Dorudi Sina , Bustin S. A.
Published: June 2003

The molecular mechanisms underlying successful metastasis of primary colorectal tumour to the liver remain unknown. We have used suppression subtractive hybridisation (SSH) and reverse Northern dot blot analysis to profile the mRNA expression patterns of a primary colorectal cancer and its liver metastasis. After SSH and reverse Northern dot blot analysis, differential expression was confirmed in 17 clones from the forward, and 13 clones from the reverse subtracted cDNA library. Four clones showed no significant sequence identities with any known sequences in the GenBank data base and likely to represent novel genes whose up- or down-regulation is associated with colorectal liver metastasis. Interestingly, one of the 13 down-regulated clones displayed 99% sequence identity with the BRCA1 tumour suppressor gene. Since promoter methylation is a direct cause of transcription silencing of the BRCA1 gene in approximately 10–20% of human breast cancer we further investigated its promoter methylation status in ten primary colorectal tumour samples, but revealed no evidence of promoter methylation.
Determination of Regional Bone Blood Flow by Means of Fluorescent Microspheres Using an Automated Sample-Processing Procedure
Authors: Anetzberger H. , Thein E. , Walli A.K. , Messmer K.
Published: June 2003

The determination of regional blood flow utilizing fluorescent microspheres (FMs) is an established method for numerous organs. Recent progress, in particular the automation of sample processing, has further improved this method. However, the FM method (reference sample technique), which allows repetitive measurement of regional organ blood flow, has so far not been used for the determination of blood flow in bone. The aim of the present study was to establish FM for the quantification of regional bone blood flow (RBBF). Female, anesthetized New Zealand rabbits (n = 6) received left ventricular injections of different amounts of FM at six subsequent time points. In order to examine the precision of RBBF determination, two different FM species were injected simultaneously at the sixth injection. At the end of the experiments the femoral and tibial condyles of each hind limb were removed and the fluorescence intensity in the tissue samples was measured by an automated procedure. In an in vitro study we have shown that acid digestion of the crystalline matrix has no effect on the fluorescence characteristics of FM. The determination of the number of spheres per tissue sample revealed that depending on the tissue sample size up to 3 × 106 spheres/injection were necessary to obtain about 400 microspheres in the individual bone samples. RBBF values of the tibial and femoral condyles did not differ at various injection intervals. The tibial blood flow values varied between 6.6 ± 1.1 and 8.5 ± 1.4 ml/min/100 g and were significantly higher than those of the femur (4.3 ± 1.1 to 6.0 ± 1.8 ml/min/100 g). The bone blood flow values obtained by simultaneous injection of two FM species correlated significantly (r = 0.96, slope = 1.06, intercept = 0.05), the mean difference was 0.39 ± 1.11 ml/min/100 g. Our data demonstrate that the measurement of RBBF by means of FM allows a valid determination of RBBF.
Evaluation of a Preclinical Model of Bone Metastasis for the Study of Adoptive Immunotherapy
Authors: Rüttinger D. , Li Rui , Urba W.J. , Fox B.A. , Hu H.-M.
Published: June 2003

The development of new therapeutic strategies for the treatment of bone metastases strongly depends on the availability of valid animal models. In this paper, we evaluate a preclinical model of bone metastases using a technique of tumor cell injection into the left heart ventricle of mice to study the efficacy of adoptive immunotherapy. Using flow cytometric analysis and histopathological and radiological examination, we investigated whether this experimental model of bony metastases using two murine cell lines of melanoma and breast cancer would be suitable for the study of adoptive immunotherapy for these diseases. We further report that anti-CD3-activated and IL-2-expanded tumor vaccine draining lymph node cells cause regression of tumor metastases, including bone metastases, following adoptive transfer to mice bearing 3-day metastases from the D5 melanoma cell line. These promising early results lead us to conclude the following: (1) this model of experimental bone metastases is suitable for the study of immunotherapy, and (2) further studies are warranted to extend these promising early findings of the therapeutic effects of adoptive immunotherapy in this animal model.
Benefits of Intraluminal Injection of Glutamine for Intestinal Mucosa during Ischemia-Reperfusion
Authors: de Aguilar-Nascimento J.E. , Gurgel Marques Cláudia , Carvalho Mariano Alessandra , Bicudo Salomão A. , de Souza Neves J.
Published: June 2003

Background: We investigated the effect of intraluminal glutamine on the intestinal mucosa in the presence of ischemia-reperfusion injury (IRI). Methods: Six blind sacs were created in the small bowel (3 at the jejunum and 3 at the ileum) in 10 Wistar rats. The lateral sacs of both bowel regions were submitted to IRI (30/30 min), while the medial sacs were left free to receive blood supply. In the lateral sacs, a solution containing either saline plus 4% glutamine or pure saline was injected at the bowel lumen. No fluid was injected in the medial sacs. Results: Both at the jejunum and at the ileum, the score of the mucosal injury was higher in saline-injected sacs than in either glutamine-injected or control sacs. There was a significantly greater number of neutrophils in the sacs treated with saline than in the other two groups of sacs. Conclusion: Glutamine protects the mucosa and diminishes the accumulation of neutrophils at the lamina propria of the small bowel in IRI.
Role of Granulocyte-Macrophage Colony-Stimulating Factor on Apoptosis Induced by Ischemia-Reperfusion in the Intestinal Epithelium
Authors: Bedirli A. , Soyuer I. , Muhtaroglu S. , Guler I.
Published: June 2003

Background: To evaluate the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on ischemia-reperfusion-induced apoptosis in the intestinal epithelium. Methods: In this study, 50 male Wistar albino rats were used. After midline laparotomy superior mesenteric artery (SMA) was identified only in the sham group, while 60 min of ischemia and 2 h of reperfusion were performed in the control group. In the treatment groups, after 15, 30 and 60 min of ischemia, respectively, 1 µg/kg GM-CSF was administered subcutaneously, followed by 2 h of reperfusion. Malondialdehyde (MDA), campothecin (CAM), an indicator of DNA fragmentation, and histopathology were evaluated in the intestinal mucosa. Results: Tissue MDA levels were found significantly high in all groups at various times of ischemia and 2 h of reperfusion compared with the sham group (p < 0.001). Administration of GM-CSF following 60 min of ischemia caused a significant increase in the MDA levels compared with the control group (6,430 ± 725 vs. 4,174 ± 565 nmol/g protein for jejunum. 7,576 ± 618 vs. 4,938 ± 809 nmol/g protein for ileum, p < 0.05). Intestinal ischemia and reperfusion resulted in a significant increase in tissue CAM levels (p < 0.05). The highest CAM value was found in the group in which 60 min of ischemia and 2 h of reperfusion were performed (50 ± 3.2 ng/ml for jejunum, 52.8 ± 2.7 ng/mg for ileum). Compared with the control group, GM-CSF administration following 1 h of ischemia aggravated the tissue injury. Conclusions: Apoptosis was induced in the small intestine by ischemia-reperfusion. GM-CSF increased the apoptosis of intestinal epithelial cells and exacerbated mucosal injury due to ischemia-reperfusion.
Is Intraluminal Clip Application an Appropriate Treatment for Iatrogenic Gastric Perforation?
Authors: Karahasanoglu T. , Altinli E. , Hamzaoglu I. , Aydogan F. , Dobrucali A.
Published: June 2003

Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. Method: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. Results: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). Conclusions: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.
Androgen Therapy in Constitutional Delay of Growth
Authors: Lampit Meir , Hochberg Ze’ev
Published: June 2003

Background/Aims: Two modalities of androgen therapy prevail in the treatment of constitutional delay of growth (CDG): monthly injections of testosterone or daily tablets of the non-aromatizable oxandrolone. The present study was undertaken to prospectively compare both compounds and dose. Methods: Thirty patients with CDG were the subjects of this study. The protocol required that they all be at age 12–14 years with a bone age delay of more than 2 ‘years’, height less than –2 SDS and growth velocity less than –0.5 SDS. The subjects were at a Tanner stage 1 or 2 and testicular volume were no larger than 4 ml. They were randomly assigned into 3 treatment groups: group 1 patients received monthly injections of 25 mg testosterone propionate-enanthate; group 2 patients received monthly injections of 50 mg testosterone propionate-enanthate; group 3 patients received oral oxandrolone at a weekly dose of 0.7 mg/kg. Treatment was given for a period of 6 months and follow-up commenced 6 months later and yearly thereafter for 2 years. Results: Height velocity and height increased significantly only in groups 2 and 3. Bone age advanced most in group 2. Puberty progressed faster in that group as compared with group 3. The predicted adult height before and 2 years after completion of treatment remained unchanged in the two testosterone groups. It increased significantly in the oxandrolone group from a mean 169.8 cm before therapy to a mean 177.5 cm 2 years after completion of therapy. Peak GH levels were significantly higher on both testosterone 50 mg and oxandrolone, as compared to pretreatment levels. The increment was significantly greater in group 2 as was the increment in serum IGF-1 and IGFBP3. Conclusions: These results imply that 6 months of testosterone injections at a dose of 50 mg, but not 25 mg, is an effective and safe treatment for patients with CDG, with no considerable impact on final height prediction. On the other hand, daily oxandrolone treatment, starting at age 12–14 years, may increase the predicted final adult height.
Insulin-Like Growth Factor-1 Receptor Regulation in Activated Human T Lymphocytes
Authors: Segretin María Eugenia , Galeano Adriana , Roldán Alicia , Schillaci Roxana
Published: June 2003

Objective: To investigate the kinetics of insulin-like growth factor-1 receptor (IGF-1R) expression in PHA-stimulated T lymphocytes. Methods: IGF-1R protein and mRNA were detected by flow cytometry and RT-PCR respectively, between 0 and 48 h after cell activation. Results: Few minutes after T lymphocytes were activated, internalization of the IGF-1R from the cell membrane was observed, achieving the lower level between 1 and 6 h and was accompanied by a reduction in its mRNA. This was followed by re-expression of IGF-1R on the cell surface and an increase in IGF-1R mRNA levels in the cytoplasm, reaching levels higher than those recorded initially after 48 h activation. Conclusion: This down- and up-regulation suggests that restoration of IGF-1R would be the result of receptor recycling and de novo synthesis and highlights its importance for T lymphocyte proliferation.
Testosterone Is Significantly Reduced in Endurance Athletes without Impact on Bone Mineral Density
Authors: Maïmoun L. , Lumbroso S. , Manetta J. , Paris F. , Leroux J.L. , Sultan C.
Published: June 2003

Aims: To compare the basal plasma reproductive hormonal profile in three groups of athletes involved in different training programs, and to define the relationship between androgen level and bone mineral density (BMD) in male athletes. Methods: Basal serum total testosterone (TT), free androgen index (FAI), sex hormone-binding globulin (SHBG), cortisol, cortisol to TT ratio, luteinizing hormone (LH), estrogen and BMD were evaluated in cyclists (CY; n = 11), triathletes (TR; n = 14) and swimmers (SW; n = 13) and compared with less active controls (n = 10). Results: TT and FAI levels were lower (p < 0.05) in CY and TR, whereas the ratio of cortisol to TT was increased in CY only (p < 0.05). No alteration in serum LH, SHBG, estrogen or cortisol concentration was observed. BMD was higher in the proximal femur in TR (p < 0.05). No BMD or hormonal differences were found in SW. Conclusion: Only the endurance training of CY and TR induced androgen deficiency without apparent alteration of BMD.
Successful Treatment of Partial Nephrogenic Diabetes insipidus with Thiazide and Desmopressin
Authors: Mizuno Haruo , Fujimoto Shinji , Sugiyama Yukari , Kobayashi Masanori , Ohro Yoichiro , Uchida Shinichi , Sasaki Sei , Togari Hajime
Published: June 2003

Objective: To clarify whether combination treatment with desmopressin (DDAVP) and thiazide was clinically effective in a patient with congenital nephrogenic diabetes insipidus (CNDI), we evaluated the treatment in a 7-year-old boy with CNDI who had demonstrated a partial response to DDAVP. Method: Both volume of urine and the presence of nocturia were determined during treatment. Result: Neither the usual therapy of a low-salt diet and a thiazide nor intranasal therapy with a large dose of DDAVP was effective. However, combination treatment resulted in a decrease in urinary volume and the disappearance of nocturia. Conclusion: DDAVP coupled with thiazide may be useful for CNDI in patients who have shown a partial response to DDAVP.
Manifestation of Thyrotoxic Periodic Paralysis in Two Patients with Adrenal Adenomas and Hyperandrogenaemia
Authors: Biering Henrik , Bauditz Jürgen , Pirlich Matthias , Lochs Herbert , Gerl Helga
Published: June 2003

Hypokalaemic periodic paralysis is a fairly common complication of hyperthyroidism in Asian populations, but a rare event in Caucasians. In the present work we describe 2 male Caucasian patients with thyrotoxic periodic paralysis (TPP) as initial clinical manifestation of Graves’ disease. Further diagnostic procedures demonstrated unilateral adrenal adenoma and hyperandrogenaemia in both patients. To date, only few data are available concerning the hormonal status of Caucasian patients with TPP. The constellation of TPP and adrenal adenomas with increased levels of androgens has not been described previously. Since androgens are capable of inducing sodium-potassium ATPase, which is thought to be centrally involved in the pathogenesis of TPP, hyperandrogenaemia may have triggered the manifestation of paralytic attacks in our patients. It may be of interest to focus not only on thyroid dysbalances in patients with TTP but also to investigate other hormonal disturbances.
Management of Giant Cell Arteritis
Authors: Hayreh Sohan Singh , Zimmerman Bridget
Published: June 2003

Giant cell arteritis (GCA) is the prime medical emergency in ophthalmology because of its dreaded complication of visual loss in one or both eyes, which is preventable if these patients are diagnosed early and treated immediately and aggressively with systemic corticosteroids. However, there is much controversy on diagnostic criteria and various aspects of steroid therapy to prevent visual loss. We discuss in detail the reasons for the controversy, clinical criteria to establish a definite early diagnosis of GCA, and its management. To provide new information on corticosteroid therapy in GCA, we also present our 27-year planned study on steroid therapy in GCA in 145 temporal artery biopsy-confirmed GCA patients (96 with and 49 without visual loss) seen and followed for 6 weeks or more in our clinic. The median follow-up time was 2.43 years, with interquartile range of 1–6 years (range 6 weeks to 20.2 years). Intravenous megadose steroid therapy was initially given to 33% followed by oral steroids, while the rest had only the oral therapy. The median starting oral prednisone dose was 80 mg/day, with 40% on ≧100 mg/day. We found that the most reliable and sensitive parameters to regulate and taper down steroid therapy were the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and not systemic symptoms. All patients were maintained at the high-dose prednisone till both the ESR and CRP had stabilized at low levels (that usually took 2–3 weeks), after which very gradual tapering of prednisone was started, guided by the ESR and CRP levels only. The median time to reach the lowest maintenance dose of prednisone at which the ESR and CRP stayed low and stable was 48.7 months (95% CI: 34.6, 71.4 months), and the median lowest prednisone dose achieved was 7 mg/day (interquartile range of 1–16 mg/day). A comparison of patients with and without visual loss showed no significant difference in the time to attain the lowest dose (p = 0.359). Our study showed that no generalization is possible for tapering down of prednisone and there is no set formula because of the infinite variation between individuals. Only 10 (7 without visual loss, 3 with visual loss) of 145 patients were able to stop the therapy and maintain stable ESR and CRP levels. We found that only 4% of GCA patients with visual loss showed any visual improvement with high-dose steroid therapy, and 4% developed further visual loss during the first 5 days of high-dose steroid therapy but none after that. Our studies found no evidence that intravenous megadose steroid therapy was more effective than oral therapy in improving vision or preventing visual deterioration due to GCA.
Normal Values of Short-Wavelength Automated Perimetry
Authors: Mojon Daniel S. , Zulauf Mario
Published: June 2003

Background: The purpose of this study was to evaluate short-wavelength automated perimetry (SWAP, i.e., blue-yellow) in normal volunteers and to review the current normal values provided by the manufacturer. Methods: 28 eyes of 28 normal subjects (age range 21–48 years, mean age 36.5 years) had SWAP (Octopus 101, two phases of program G2, Interzeag AG, Schlieren, Switzerland). All subjects had normal eye examinations, refractive errors with spherical equivalents <5 diopters and astigmatism <2 diopters, normal intraocular pressures, no history of diseases affecting the visual field or nerve fiber layer, and normal white-white automated perimetry (Octopus 101, program G2). Results: 21% of the subjects (6/28) had to be excluded since visual field testing was not reliable (reliability factor >5%). With the normal values provided by the manufacturer, only 45% of the remaining subjects (10/22) had all other indices within normal limits. With the appropriate normal values based on the multicenter SWAP Octopus 101 study, 11% (3/28) were beyond the normal range: all had abnormal high sensitivities – 2 due to false-positive response. The normal value range for the index Mean Defect is remarkably wide (5.-, median, 95.- percentile: –4.4, –0.5, +5.3 dB, respectively). The normal value range for the index Loss Variance is surprisingly low and similar to standard perimetry (5.-, median, 95.- percentile: –1.7, 6.8, +21.2 dB2, respectively). Conclusion: SWAP with the Octopus G2 program reaches appropriate specificity but only if the correct normal values of the multicenter SWAP Octopus 101 study are used. The variability between subjects is remarkably large. The variability within a visual field is similar for SWAP and standard perimetry as reflected by similar values for the visual field index Loss Variance. Further studies have to establish the sensitivity to detect a disease for SWAP on the Octopus 101.
Comparison of Three Techniques for Repair of Involutional Lower Lid Entropion: A Three-Year Follow-Up Study
Authors: Altieri Michele , Iester Michele , Harman Francesca , Bertagno Roberta , Capris Paolo , Venzano Davide , Baldi Franco , Altieri Gianguido
Published: June 2003

Objective: The aim of this study was to quantify the efficacy of three different surgical techniques for entropion repair in a 3-year follow-up study: (1) the Fox procedure, (2) everting sutures and (3) a modified technique of lower lid retractor plication. Methods: We included in our study 32 eyelids of 32 consecutive patients with involutional lower lid entropion; 10 lids underwent the Fox procedure, 13 the everting sutures and 9 the modified retractor plication. We evaluated the pre- and postoperative horizontal lid laxity (HLL), the pre- and postoperative lower lid excursion (LLE) and the number of recurrences in each patient group. Statistical analysis was performed with the non-parametric Mann-Whitney test and the exact Fisher’s test where appropriate. Results: Only the modified retractor plication technique showed statistically significant differences in HLL and LLE (p < 0.05). In the group treated with this technique, there was a lower incidence of entropion recurrence (p < 0.05). The everting suture technique showed a statistically significant improvement of the LLE only (p < 0.05). The Fox procedure did not show any statistically significant improvement of the studied parameters. Conclusions: The modified retractor plication technique gave the best results in terms of improvement of HLL and LLE and a lower incidence of entropion recurrence compared to the two other techniques studied.
Evaluation of the Effect of Aging on Retinal Nerve Fiber Layer Thickness Measured by Optical Coherence Tomography
Authors: Kanamori Akiyasu , Escano Michael F.T. , Eno Ayako , Nakamura Makoto , Maeda Hidetaka , Seya Ryu , Ishibashi Kazuki , Negi Akira
Published: June 2003

Purpose: To evaluate the relationship between age and retinal nerve fiber layer (RNFL) thickness in normal subjects, as measured by optical coherence tomography (OCT). Methods: One hundred and forty-four normal subjects (144 eyes), ranging from 16 to 84 years of age, were enrolled in this cross-sectional study. The RNFL thickness was determined using OCT with three circle scans 3.4 mm in diameter. Results: The average RNFL thickness was inversely correlated with age (r = –0.348, p < 0.001). Analyzing the quadrants as a parameter, RNFL thickness in the superior, temporal and inferior quadrants also decreased with age. Using 30-degree segments, there were significant correlations between age and the RNFL thickness of temporal segments (7–11 o’clock). The average RNFL thickness had the highest correlation among all parameters (r = –0.348, p < 0.001). Regarding nasal quadrant thickness, RNFL ratios (average, superior, temporal and inferior RNFL thickness relative to the nasal quadrant thickness) were not significantly correlated with age. The refractive error did not affect RNFL thickness (r = 0.091, p = 0.276). Conclusion: Our study revealed that RNFL thickness, in particular in the temporal quadrant, measured by OCT significantly decreased with age. Age has to be taken into consideration when we compare RNFL thickness between normal and glaucomatous eyes.
Long-Term Follow-Up after Transscleral Diode Laser Photocoagulation in Refractory Glaucoma
Authors: Pucci Vincenzo , Tappainer Federica , Borin Stefano , Bellucci Roberto
Published: June 2003

Background and Objective: Patients affected by glaucoma refractory to medical or surgical treatment are difficult to treat. The aim of this study was to evaluate the long-term effect of contact transscleral diode laser cyclophotocoagulation (DLPC) on intraocular pressure (IOP) and on visual acuity of these patients. Patients and Methods: One hundred and twenty eyes of 107 patients suffering from refractory glaucoma and treated with DLPC were followed at the Eye Clinic of Verona University for an average of 26 ± 8 months. Mean age was 57 ± 26 years. IOP, visual acuity, and ocular complications were analyzed. Results: A total of 207 treatments were given. More than one treatment was given in 55 eyes (45.8%). Mean pretreatment IOP was 30.4 ± 3.1 mm Hg. At the last follow-up, mean IOP was 20.3 ± 1.8 mm Hg. Mean total medications were reduced from 4.5 ± 0.5 to 2.3 ± 0.3. No serious complications occurred in the 207 treatments. Visual acuity remained stable in 66 eyes (55%), improved in 25 eyes (20.8%), and decreased in 29 eyes (24.2%). Conclusions: DLPC was effective in lowering IOP in eyes with refractory glaucoma. It also served to reduce the number of antiglaucoma medications, thus improving both the quality of life of the patients and their compliance to therapy. This procedure is relatively safe, very fast and easy to learn. However, careful attention is required to determine the exact position of the ciliary body in malformative glaucoma. Multiple treatments may be required to control IOP.
Effect of Hospitalization on Intraocular Pressure in Patients with Normal-Tension Glaucoma
Authors: Kashiwagi Kenji , Kohno Kyoko , Tsukahara Shigeo
Published: June 2003

Objective: To investigate the effect of hospitalization on intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG). Methods: The study was conducted in 52 patients with a definite diagnosis of NTG. The correlation between IOP measured from 9.00 a.m. to 12.00 p.m. on an outpatient basis within 3 months each prior to and after hospitalization (ambulatory IOP) and IOP measured during the same time period after admission (inpatient IOP) was investigated in NTG patients. Results: Inpatient IOP (13.9 ± 2.4 mm Hg) was significantly lower than ambulatory IOP (15.2 ± 2.1 mm Hg), with a difference of 1.3 ± 2.0 mm Hg (p < 0.01). The difference between inpatient IOP and ambulatory IOP was negatively correlated with inpatient IOP (r = 0.58, p < 0.01). Conclusions: These results revealed that hospitalization decreased IOP in NTG patients, with the decrease being particularly pronounced in cases of low ambulatory IOP. Interpretation of inpatient IOP should be carefully included in glaucoma treatment.
Elevated Nitric Oxide Level in Aqueous Humor of AIDS Patients with Cytomegalovirus Retinitis
Authors: Hsu Wen-Ming , Chen Steve S.-L. , Peng Chi-Hsien , Chen Chieh-Fu , Ko Yu-Chieh , Tsai Der-Chong , Chou Ching-Kuang , Ho Larry L.-T. , Chiou Shih-Hwa , Liu Jorn-Hon
Published: June 2003

Human cytomegalovirus (HCMV) retinitis is the most common ocular opportunistic infection in AIDS. It often leads to blindness if left untreated. The questions as to how HCMV infection causes retinal immunopathogenesis and visual destruction in AIDS patients have not been completely established. Here we reported that the nitric oxide (NO) levels in aqueous humor samples in 10 AIDS patients with CMV retinitis (104.3 ± 27.1 µM) were higher than the levels in 7 AIDS patients without CMV retinitis (36.1 ± 10.4 µM; p < 0.001). After ganciclovir treatment, the NO level in the vitreous body of 5 patients declined dramatically (53.4 ± 11.8 µM). By using immunohistochemistry assay, we found that the aggregates of macrophages infiltrated in the CMV-infected retina of 4 AIDS patients. Moreover, the expression of inducible-form NO synthase was detected in the infected retina of these patients. These results suggest that NO production in the eye may play a fundamental role in the immunopathogenesis of AIDS patients with CMV retinitis.
Dietary Sugar and Salt Represent Real Risk Factors for Cataract Development
Authors: Veromann S. , Sünter A. , Tasa G. , Juronen E. , Panov A. , Pastak M. , Kaljurand K.
Published: June 2003

Dietary sugar and salt represent etiological risk factors of human cataract. To verify etiological data on the basis of histological findings, 9 pigs with a body weight of 40 kg, 3 months of age, in groups of 3 were continuously fed with 5% of refined dietary sugar (sucrose – C12H22O11), 0.5% of salt (NaCl) and a sugar-salt mixture (2.5 + 0.25% accordingly) in their crude (unboiled) meal food during 3 months, which resulted in minor cataractous changes in the lens. In the second experiment, 10 weight- and age-matched animals were fed a chronic sugar and intermittent salt diet during 6 months; the other 10 animals served as controls. During the second experiment, crystallin leakage into the aqueous humor of the lens was detected, and a marked swelling of the lens fibers and fiber tips was noticed, indicating that excessive amounts of dietary sugar and salt are risk factors for the development of cataract in normal (nondiabetic) animals.
Conservative Treatment of Vertical Diplopia in a Patient with Silent Sinus Syndrome
Authors: Iseli Hans Peter , Hafezi Farhad , Mojon Daniel S.
Published: June 2003

Silent sinus syndrome is a rare disease of the maxillary sinus characterized by bony absorption processes leading to progressive sinus wall thinning with consecutive enophthalmos and hypoglobus. It represents a benign cause of acquired enophthalmos and is often accompanied by painless vertical diplopia, the latter treated surgically in all cases published to date. We report a 56-year-old patient with silent sinus syndrome in whom vertical diplopia was treated with prisms showing that conservative treatment alone may, in mild cases, be an effective alternative to reconstructive surgery.
MRI Study of Caudate Nucleus Volume in Parkinson’s Disease with and without Dementia with Lewy Bodies and Alzheimer’s Disease
Authors: Almeida Osvaldo P. , Burton Emma J. , McKeith Ian , Gholkar Anil , Burn David , O’Brien John T.
Published: June 2003

Objective: To compare whole brain and caudate volume on MRI in subjects with Parkinson’s disease without cognitive impairment (PD), Parkinson’s disease with dementia with Lewy bodies (PD + DLB), Alzheimer’s disease (AD) and normal control subjects. To examine the relationship between caudate volume and cognitive impairment, depression and movement disorder. Method: Whole brain and caudate volumes were segmented from volumetric 1.5-tesla magnetic resonance imaging (MRI) scans of older subjects with PD (n = 28; mean age 75.5 years), PD + DLB (n = 20; 73.0 years), AD (n = 27; 77.5 years) and normal controls (n = 35; 74.9 years). Results: Subjects with AD had significantly reduced whole brain and caudate volume compared to controls and those with PD. Caudate atrophy in AD was proportionate to whole brain atrophy. There were no significant differences in whole brain or caudate volume between controls, PD and PD + DLB. There were no significant correlations between caudate volume and either global cognitive function, executive performance or processing speed. Conclusions: Caudate atrophy occurs in AD but not PD without dementia. Caudate atrophy is not regionally specific but part of generalised brain volume loss. Structural changes in the caudate, as assessed by in vivo MRI, do not appear to contribute to the cognitive impairment observed amongst patients with PD, PD + DLB or AD. Results indicate that the executive and attentional dysfunctions associated with PD and DLB are unlikely to be a direct and specific consequence of caudate atrophy as assessed on MRI.